Final - Spring Flashcards
(294 cards)
1
Q
neonate =
A
bith - 28 days
2
Q
infant defined as
A
29 days - 1 year
3
Q
general schedule for well visits
A
48 hrs after discharge - wt & jaundice
2 weeks
1/2/4/6/9/12 months
4
Q
terminology:
preterm
late preterm
term
post-term
wt percentile: small, appropriate, large
A
<34
34-36
37-42
>42
<10th, 10th-90th, >90th
5
Q
A
6
Q
APGAR
A
A - appearance - usually lose a point for blue hands and feet
P - pulse
G- grimace
A - activity
R - respiration
done @ 1 (response for dilvery) & 5 min (response to resusc effects)
7
Q
APGAR INTERPRETATION
A
8
Q
dev milestones
domains?
A
set of fx skills/age-related tasks that most children do @ a certain age
- gross motor
- fine motor
- self-help/adative
- cog
- social/emo
- language
stand screedning recommended @ 9mo
9
Q
___ children have dev/behav disorder
A
15%
10
Q
early intervention
A
state run program that eval child for dev delays: futhur screening and potential tx
11
Q
dev milestones during infancy
A
12
Q
immunizations for neonates
A
most important roles of ped docs
- impt to vacc infant caregivers aga influenza and pertussis
should be reviewed @ each visit
gen starts with hep B
13
Q
phys exam of neoname
A
exam table/open crib
- start with inspection
- heart and lung
- head –> toe: ear and hips for last (b/c more irritating)
- eye when infants eyes are spont open
older infants >6mo can be started with parent holding infant on lap/arms
14
Q
temp should always be meas -_____ in children under age ____
A
rectal
2
15
Q
normal VS for infants: temp, HR, RR, BP
A
16
Q
periodic breathing
A
infants: RR may vary sig from min to min
17
Q
growth meas of infant include
usually plotted on:
A
length
wt
head circumceference (over more prominent portion of occiput to supraorbital ridge)
**when baby is supine
plotted on WHO
- b/c breast -fed babies usually grow faster in first 6mo than formula ones and then slow down and then they both should be similar
18
Q
macrocephaly usually due to
A
family
hydrocephalus
genetic conditions (sotos syndrome)
tumor/mass
19
Q
microcephaly
A
genetic
intrauterine infections (TORCH, zika)
materanal smoking/drug
family
20
Q
erythema toxicum
A
small/white papules/pustules on red base
- benign
- eosinophils
occur on day 2-3, face by 7-10
21
Q
transient pustular melanosis
A
small pustles on HYPERPIG base:
- neutrophils
- benign
mostly in af-am infants
resolves over 1st week but hyperpig can persist for a couple of weeks
22
Q
miliaria rubrum
A
“prinkly heat”: vesciles on red base = obstructed eccrine sweat glands
- 1st 1-2 weeks
- benign
23
Q
milia
A
pinpoint papules on face: typ nose
- present @ birth nd fades over weeks
- keratin
- benign
24
Q
how to dress infant approp?
A
see what you are wearing and then add 1 more layer
25
cafe au lait spot
hyperpig lesion:
* early infancy --\> enlg as child ages
* typ benign
* multiple --\> NF1
26
mongolian spot
discolored macules: blue-gray --\> green-blue
* large: \>10cm
* typ: butt/lower spine
* common in af-am and asians
delayed disappearnce of dermal melanoctyes --\> benign
27
acrocyanosis
blue hands and feet:
* vasomotor rxn to cool environ (disting from central by looking at mucous memb)
* mucous memb should be pink: not raspberry red or blue-ish
* benign
28
jaundice
common due to decr activity of UDPGT enz: peaks @ day 2-3
* glucuronidase conjugation enz
patho = high bili/direct hyperbili
tx: photothx
29
hemangioma
benign vasc tumor: typ involutes by age 5
can be tx with laser if in diaper or eye
30
nevus simplex
salmon patch: pink-red cap dilations
* fades over time --\> benign
31
nevus falmmeus
port-wine stain: dark purp/red cap malformation
* typ does NOT fade
* usually benign but larger lesions may interfere with N fx or lead to glaucoma
32
neonatal acne
erythematous comedones: 3-6 weeks
* thought to be from neonatal androgens
* usually more common in breast fed babies
* no tx
33
seborrheic dermatitis
greasy, yellow plaques/scales on scalp/forehead/ears
* "cradle cap"
* overactive sebaceous glands
* usually resolves within first 6mo
34
diaper dermatitis
irritant:
* localized irritation: urine, feces
* eryth with areas of scaling
* tx: freq diaper changes and emollients/barrier creams
candidal:
* 2nday infection of irritant diaper dermatitis
* BEEFY RED, worse in skin folds
* satellite lesion due to spread
* tx: topical antifungals
35
chovstek's sign
percuss just below zygo arch looking for facial twitching: tests facial nerve
* potentally sign of hypercalcemia
36
normal skull of newborn
37
sutures:
memb spaces that separate bones of skull
fontanelles:
* ant: close b/w 9-24 months
* post: by 2 months
* bulge = increased ICP
* sunken: dehydr/malnut
* early closure: craniosynotosis
* late closure: hypothyroidism
38
pos plagiocephaly due to prolonged time spent laying on back
tx: sometimes tx with helmet
39
scalp trauma on delivery
caput succedaneum: soft tiss swell above periosteum (cross suture lines)
* more extensive
cephalohematoma: injury of bridge bv in subperiosteal layer (does NOT cross suture lines)
* often assoc with vacuum delivery
* high risk for jaundice due to low UGPGT
40
visual milestones of infancy
41
subconjunctival hemorr
common after deliver --\> resolves within 1-2 weeks
if found AFTER perinatal period: concern for child abuse
42
lac duct obstruction
greenish-yellow discharge common in first sev months
* failure of memb @ end of tear duct to open around birth
* tx: tear duct message, dilation in more persistent cases
43
red reflex
3rd pic: retinoblastoma
44
cover/uncover test
pt focus on distant obj and cover one eye briefly
uncover eye and look for drifting --\> strabismus
* normal = eyes remain fixed when covered
45
esotropia
extropia
hypertropia
hypotropia
in
out
up
down
46
opacity --\> cataract, glaucoma
47
preauricular skin tag
preauricular pit
usually benign but can indicated renal anomalies
48
normal position of ears
line from inner canthi --\> occipital protruberance
* 1/3 of ear above line = normal
* low set --\> abnormal
49
signs baby can hear
50
infat ear canal directed
downwards
51
how do infants breath?
obligate nose breathers
52
choanal atresia
congen narrow of nasal passages: present @ birth with cyanosis and relieved by crying
* chonae = nasal "bumps"
* atresia = "narrow"
53
"tongue tie" - tight lingual frenulum
usually benign
54
tonsils visible @
6 mo
55
epstein pearls: epith remnants of palate fusion
midline hard palate
benign --\> resolves spontaneously
56
shrill, high pitched cry may indicate
increased ICP
opiate withdrawl
57
hoarse cry may indicate
hypocalcemic tetany
congenital hypothyroidism
58
con't stridor may indicate
underdev airway
upper airway lesion
59
absent cry may indicate
severe illness
vocal cord paralysis
profound neuro dmg
60
short neck with excessive skin seen in:
webbed neck often seen in:
down
turner
61
neck masses:
midline: thyroglossal duct cyst
lateral: cystic hygroma/brachial cleft cyst
torticollolis: "fibromatosis coli"
62
grunting
repeatitive short expiratory sound
63
wheezing
musical expiratory sound
64
stridor
high piched inspiratory sound
65
nasal flaring due to needing to get more air
66
bounding pulses may be seen in ...
PDA
67
tachypnea in absense of retractions --\>
congen heart disease
68
decr pulses may indicate
valve obstruction
69
decreased femoral pulses --\>
conactation of aorta
70
s2
split = normal
single = cyanotic congenital heart disease (hypoplastic left heart)
71
o2 sats
\<95% or difference \>3% b/w UE and LE --\> echocardiogram
prior to discharge
72
widely spaced nipples typ seen in
turners
73
hypertrophic breast tissue
common due to materal horm exposure
can expr witch's milk: thin, milky fluid
74
umb cord =
2 A, 1 V
75
scaphoid abdomen
congen diphramatic hernia
76
umb hernia due to weak fascia
77
diastasis rect: weak ab fascia -\> bulge when P increases
above naval
78
omphalocele: ab contents covered by peritoneal layer - midline
gastroschisis: no layer covered - R of midline
79
hypospadius: urethral oepning displaced from tip of glans
* CONTRAINDCATION to circumcision
80
hydrocele - fluid collection in scrotum
81
highly estrogenized hymen of newbord with thick/hypertrophic vag tissue
82
clitoromegaly: enlg clit with 21-OH deficiency
83
imperforate hymen: bulge of introitus due to vag secr
84
imperforate anus: isolated or VACTERL
85
sacral dimples
often benign
eval when:
1. \>0.5cm size
2. \>2.5 cm from anus
3. no visible base
4. hemangioma
5. tuft of hair
86
sacral dimple - benign
87
sacral skin tag
88
dysplasia of hip
pior to 3 mo: hip instab MOST sens finding
after 3mo: asymm of leg/skin folds or lim ROM: MORE sens for finding
89
test of hip instability
supine: unilat with clothing diaper removed: hips flex to 90
barlow: ADD hip --\> disloc of fem head
ortolani: AB hip (anterior mvmt of trochanter) --\> "clunk" = reduction of dislo hip
small amt of laxity "clicking" = normal
* more common in females due to relaxin
90
91
hip ____ lim in most cases of DDH
normal v in DDH
abduction
normal: \> 75 degrees
DDH: often \<45 degrees
92
asymm skin folds
problem is on side with mor PROX folds
93
transverse palmar crease
trisomy 21
94
polydactyly
syndactyly
95
primitive reflexes
help with survival
med @ BS/SC lvl
resolves with age and NS maturation
96
sucking refelx
30wk --\> 1.5/3 years
touch roof of mouth --\> suck
97
rooting
30wk --\> 2/3 mo
stroke perioral corners of mouth --\> open and turn mouth
98
moro
32wk --\> 3/4 mo
hold supine and drop --\> abduct/extend arms, open hands, flex legs
asymm response = birth injury
99
palmar grasp
32 wks --\> 3/4 months
press palm --\> grasp
persistance = pyramidal tract dysfx
100
plantar grasp
32wk --\> 8/9mo
touch soles --\> toe curl
persist = pyr tract dysfx
101
stepping reflex
32 wk --\> 3/4 mo
hold infant upright wth one sole on table --\> that sole = hip and knee flex and other food = step forward
absense: paralysis
102
trun incurvation
32wk --\> 1/2 mo
prone and stroke 1cm of midline from shoulder to butt --\> spine curves towards sti side
absense: SC lesion/injury
persist: delayed dev
103
assymetric tonic neck
35wk --\> 2/3 mo
supine: turn head to one side: ipsi arm/leg extend, contra flex
persist: asymm CNS dev
104
CN testing in newborns
CN II, III, IV, VI: light/track obj
CN V: sucking, rooting reflex
CN VII: facial mvmt/symm
CN VIII: acoustic blink refelx
CN IX, X, XII: suck & swallow when feeding ,gag refelx
CN XI: shoulder symm
105
age definitions
toddler: 1-3
preschool: 3-5
school: 5-10
adol: 11-21
106
anxiety changes during childhood
\<6 = little anxiety
6-36: HIGH (peak @ 15-18 mo)
3-teenage: comfy
* teenagers = unhappy since they want to be elsewere
107
VS for children
gen measured beginninng @ age 3
cuff covereing 2/3 of upper armm
108
screening for children
dev surveillance: 9, 18, 24 mo
M-CHAT for autism @ 18, 24 moths
vision/hearing @ age 3/4
dislipidemia screening @ 10 (sooner if risk factors)
109
height measured...
supine until age 2 and then upright
110
WHO v CDC chart
WHO until 2 years (due to discrepancies breastfed v not) and then CDC afterwards
111
while hild in on growth chart, esp with regards to height, it is often related to size of...
parents
112
BP is compared to standards based on..
age
sex
wt %tile
113
childhood obesity
CDC defines at BMI \> 95th %tile
114
lea symbol
used to check vision in younger children
115
normal
otitis media with effusion: translucent, air-fluid
acute otitis media: ertthema, opacity, bulge TM
116
normal
v
allergic rhinitis
superior turbinate NOT visible on exam
117
what is the #1 chronic disease in children?
dental caries
118
tonsilloliths (tonsil stones) due to crypts
119
"shotty" lymph nodes
small, under 1 cm
typical in young children
120
lymph nodes _____ may require further investigation
\>1.5cm
firm
fixed
non-tender
121
I:E ratio
inspiratory:expiratory ratio - usually 1:1
long inspire = upper airway obstruct - croup
long expire = lower airway obstruct - asthma
122
most important physical exam findings of pna in children =
hypoxia
increased work of breathing
123
asthma
chronic airflow obstruct due to inflamma --\> BHR (broch hyperresponsiveness)
common after vial upper respiratory infections in children
8% dx
usually dev before age 5
many = transient --\> only wheeze with upper respiratory infections
124
4 main listening areas for CV
125
innoent heart murmurs in children
1. still's
* LLSB: vib/musical with increase in supine pos
* early systolic
* infancy --\> adol: most common = 2-6 y/o
2. pulm flow
* LUSB: blow, cres-decrescendo
* early --\> mid systolic
3. venous um
* roaring, resolves when supine: con't
4. carotid bruit
* harsh, loud (3/6): long systolic
126
seven S's of innocent murmurs
systolic
sensitive (to pos changes/respiration)
short duration
single: no clicks, gallops
small: lim to small area/non-radiating
soft (low amp)
sweet (not harsh) - exception = carotid bruit
127
grading heart murmurs
128
murmurs that require further investigation
CHAD HAG
click: early, midsystolic
holosystolic
abnormal S2 (single, loud) S3
diastolic
harsh
assoc physical exam findings
grade 3 or higher
129
abdomen in todlers
often protuberant that becomes more scaphoi with age
130
scrotal masses in boys
131
bowleg is common until
age 2
132
scoliosis
lateral curve \>10 degrees (cobb angle)
rotatory cmpt (rib hump)
commonly _idiopathic_ *_-_* usulaly presents preteen/teen years but canbe as early as infancy (which is less likely to be idiopathy)
occurs eq in males and femaels but _10x more likely to progress in female_
133
when to screen for scoliosis
10-12 in females
13-14 in males
134
cobb angle
135
scoliosis screening
adam's forward flex test with scoliometer
136
\_\_\_\_\_ thoracic curve = high association with underlying neuro prob
left
137
scoliosis curves are naed according to the _____ side
convex
138
test _____ by assess finger to nose mvmts
cerebellum
139
adolescent hx mneumonic
140
tanner staging
141
preparticipation sprts visit
annual for competitive sports: 6 weeks prior to beginning of season
* detect conditions that predispose athlete to illness/injury
* risk factors for sudden cardiac death
* strategies to prevent injury
can detect 88% med conditions and 67% musc-skel problems
142
AHA screening recommendations that should promt referral to ped cardiologist for further eval
143
#1 cause of sudden cardiac death in young athletes
hypertrophic cardiomyopathy: 30-50% of cases
* auto-dom with variable penetrace (60%)
* sudden death due to vent arrhythmia
enlg vent septum --\> obstruct LV outflow --\> decrease CO/blood flow --\> syncope after exertion
exam findings:
* systolic murmur that decr in supine pos (increased preload lessens obstruction)
* \*\*\*\*contrast to MOST outflow murmurs that INCREASE in intensity when supine
144
dx HOCM
abnormal ECG in up to 90% of pts
* incr voltage
* prom Q
* deeply negative T
145
geriatric is age
65 or older
146
changes in elderly: vitals
HR: resting same but max & pacemaker cells declines
* incr risk for arrhythmias
systolic htn
widened pulse pressure
ortho hypotn --\> falls
RR unchanges
temp reg: increased risk for hypothermia
147
changes in elderly: skin, hair, nails
148
changes in elderly: eyes
most likely affect fx:
* eyes:
* acuity declines: cataract, glaucoma, macular degen
* presbyopia: age 40
149
changes in elderly: hearing
presbycusis: age 50 --\> social withdrawal, depression
150
changes in elderly: teeth
poor dentition --\> wt loss
* poor fitting dentures
* chronic gum/tooth infections
151
changes in elderly: thorax & lungs
chest wall stiffens
lungs:
* elastic recoil
* mass declines
* residual volume increases
skeletal may chnage shape of chest --\> hinder breathing/lung cap
152
changes in elderly:CV
kinking/buckling of carotid arteries: R \> L - common in women with htn
stiff artery walls --\> sys bruits
CO same: HR max can decrease but SV will increased to maint
* systolic aortic murmur: holosystolic
* diastolic dysfx due to loose heart, mitral regurg (S4)
153
PVD
peripheral arteries lengthen and tortuous = harder, less resilient
loss of arterial pulsations = abnormal
most concerning:
* AA
* male
* smoker
* coronary disease
* presents as back/ab pain
* temporal arteritis (giant cell arteritis)
* age \>50
* unilateral headaches
* tender over over temp A
* sends a branch to the retina --\> _blindness_
154
changes in elderly: men genitalia
decreased tesosterone:
* small penis
* low testicles
* thin pubic hair
* ED (usu more due to vasc issues)
155
BPH
prolif of prostate epith/stromal tissue
symptoms:
* urinary hestinancy
* dribbling
* incomplete empty of bladder
* nocturia --\> sleep depreivation
156
changes in elderly: woman genitalia
ovarian fx declines
* smaller repro organs
* prolapse of uterus due to laxity of suspensory lig of adnexa
menopause 45-52 years of age
157
incontinence
types:
1. stress
* relaxed pelvic floor --\> increased ab pressure
2. overflow
* blockage --\> bladder unable to empty properly --\> dribbling
3. urge
* oversensitive bladder from infection
* neuro disorders
158
urinary incontinence menumonic
DIAPERS
* delirium
* infection
* atrophy
* pills (diuretic)
* excess urine output
* restricted mobility
* stool impaction (dehydrated due to not wanting to drip)
159
sacropenia
loss of M mass, strength, performance
160
frailty
late-life weakness , illness, wt loss
core cmpt = sarcopenia
161
benign forgetfulness
difficulty recalling names of people/objects
low retrieval and processing
162
benign essential tremors
tremors with exertion, disappear with rest
163
balance problems in elderly due to:
decrease/loss of vib sens in feet/ankles BUT not in hands
* position sense may disappear
* gag reflex may decrease
* ankle/patella reflex difficult to elicit on exam
164
acute illness that may preset different in older adult
lack of feer with infection
thyroid dysfx
165
neumonic of addressing cultural dimensions of aging
ETHNICS
* explanation
* tx
* healers
* negotitate
* intervention
* collaborate
* spirituality
166
SLUMS: st. luis university mental status exam
167
what are the most common modifiable fisk factor associated with falls
medications - "brown bag" review
168
drinking
169
decreased in wt....
predictor of increased mortality --\> further investigation into medical/psychosocial causes
AAFP: 10% in 6mo or 5% in 1mo
Cecils: 4% in 1 yr
170
advanced directives
health care proxy
* agent to make decisions: online - no lawyer
living will
DNR
* MOLST/POLST (bright pink)
* doc & pt/pt's representative
171
goal of palliative care
relieve suffering
improved quality of life
172
preventative screening: vaccines
shingles: 1 time regardless of prior shingles
pna/pneumococcal: 1 time after age 65 unless high risk
influenza: yearly
tetanus: every 10 years after 1 dose Tdap
173
depression screening
in the last 2 weeks...
scores responses:
* 0 = not at all
* 1 = several days
* 2 = more than half of days
* 3 = nearly every day
174
mild cognitive impairment (MCI)
memory impairment without cognitive deficits/fx decline
175
mini-cog test
detects mild cog impairment (MCI): 3 minute recall + clock drawing test
1. name 3 obj
2. draw a clock
3. ask to repeat obj
scoring:
* 3: all words
* 0: no words - dementia
* 1-2 words & normal clock = normal
* 1-2 workds & abnorm CDT = "impaired cognition"
176
Folstein MMSE
admin 5-10 min
max score: 30pts
* \<24 = dementia
* 20-24 = mild dementia
* 13-20 = mod dementia
* \<12 = severe dementia
alzheimers lose 2-4 points/year
177
ADL v IADL v AADL
ADL: self-care tasks
IADL: maint indep lifestyle
AADL: employment, hobbies, social events
178
VS of elderly
1. BP
2. pulse
3. RR
4. temp
5. pain
6. fx assessment: only in geriatrics
179
orthostatic BP
drop in systolic \> 20
or
diastolic \>10 after 3 min of standing
180
10 min screening
PLUM DHEW
1. eyes: diff ADL due to eyes, snellen inab to read \>20/40
2. hearing: audioscope @ 40dB, test @ 1000,2000 Hz and whisper
3. get up and go test: unable to complete within 15s
4. urinary incontinence: lost urine/got wet in last year, leaked on 6 separate dates --\> DIAPER
5. nutrition: lose weight over last year or wt \< 100 lbs
6. memory: 3 item recall (unable to recall after 1 min)
7. depression: yes to "sad or depressed?"
8. physical disability: are you able to... (6 Q's)
1. do strenuous acitivity: fast walking, bicycling
2. heavy work around house: wash windows, walls, floors
3. go shopping for clothes/groceries
4. get to places out of walking distance
5. bathe?
6. dress yourself
181
balance and gait tests
timed get up a go (TUG): abnormal is \>15s
* rise from airchair
* walk 3 meters/10 feet
* turn
* walk down
* sit
gait speed: \>13 s for 10meters/35feet abnormal
test balance:
* feet side by side
* semi tandem
* heel-toe
* resistnace to nudge on 360 turn
182
non blanching redness =
P ulcers until proven otherwise
183
arcus senilis
benign white ring around limbus
184
ectropion v entropion
185
macula degen
186
JVP
what is the pulsatile mass seen on the right side of neck usually?
what vlave gets affected first?
supine with head of table @ 30 deg
pulsatile mass on R side: carotid on women
valve degen: aortic then mitral valve
* S4 common
187
AAA: no palpation
188
inguinal hernia
189
SDMM
siebens domain management model
org pt's health problems into 4 domains
* med-surg
* mental/emotions/coping
* physical fx
* living environment
190
mental disorder statistics
20% primary care outpts have mental disorders
50-75% undetected and untx
191
_SSD_
somatic symptom disorder: mental illness that causes one or more bodily symp (pain) that can invovle one or more different organs and body systems
192
hental health screening in primary care setting
2 tier approach:
* brief: yigh yield Q with high sensitivity and specificity
* detailed if indictated
193
suicide rates among pts with major depression ____ higher than general population
8x
194
high yeild questions for anxiety
1. over past 2 weeks: feel nervous, anxious, on edge
2. over past 2 weeks: unable to stop/control worrying
3. over past 4 weeks: anxiety attack suddenly or feeling fear/panic
195
CAGE scoring
total score of 2 or great = clinically significant
196
PRIME-MD is for...
5 more common disorders in primary care:
A SEED
* anxiety
* somatoform
* eating
* etoh
* depression
197
when is demential reversible?
drugs
alcohol
hormal
depression
vitamin b12 inbalance
198
delirum v dementia
delirium:
* acute confusion
* causes: metabolic inbalance, med SE, after sx
dementia:
* slow
* reversible and irreversible causes
199
what test is useful for screening for dementia
mini mental state exam
200
perceptions
sensory awareness of obj in environement
internal stim: dreams/hallucinations
201
thought processes v thought content
"how" people think v "who/what" people think about
202
insight
awareness that behaviors are normal/abnormal
distinguish b/w daydreams and hallucinations that seem real
203
LOC
alert: response to normal tone of voice
lethargy: "drowsy" - speak in loud voice
obtundation: shake to wake - opens eyes, responds slowly, somewhat confused
stupor: painful stim (sternal rub) - unresponsive without it
coma: unarousable
204
difference speech patterns of:
## Footnote
depression
mania
dysarthria
paraphasia
slow
accerelated, rapid, loud
defective articulation
words are malformed: I write with a "den"
205
circumstantiality
indirecton/delay in reaching the point: "non-linear thought pattern"
unneccessary detail but often comes back to point
found in pts with obsessions
206
derailment
loosenin of associations: shifting of one subject to unrelated or related only obliquely
found in:
* schizophrenia
* manic and psychotic episodes
207
illusions
misinterpretations of real external stimuli
seen in grief and delirium
208
hallucinations
subjective sensory perceptions in absence of relevent external stim
may not recognize experiences as false
occurs in: delirium, alcoholism
209
affect
external expression of inner emo state
210
feelings of unreality and depersonalization
unreality: things in ENVIRON strange/unreal
depersonalization: things about SELF strange/unreal - "detached from one's mind/body"
211
clanging
# choose word based on sound rather than meaning
rhyming and punning speech
212
perseveration v echolalia
perserveration: repetition of OWN words
echolalia: repetition of OTHERS words
213
blocking
sudden interruption mid-speech: "lost the thought"
214
incoherence
largely incomprehensible
* illogic
* ack of meaningful connections
* abrupt topic chnages
* disordered grammar/word use
215
neologisms
invented/distorted words wiht new nad high idosyncratic meanings
observed in:
* schizo
* psychotic disorders
* aphasia
216
flight of ideas
con't flow of acclerated speech that changes abruptly from topic to topic
changes based on:
* understanble associations
* plays on words
* distracting stim
observed in manic episodes
217
3 tests for attn
digital span
* recite set of digits (start 2 @ a time, clearly, 1 sec apart)
* stop after second failure of a single series
serial 7's
* starting from 100, subtract 7...subtract 7...
* normal: 1.5 min with less than 4 errors
* can try 3s if cannot do 7s
spelling backwards
* can substitue for serial 7s
* say 5 letter world to pt and have pt spell it bwds to you
218
testing new learning ability
say 4 words
con't with rest of exam
test after 3-5min
note accuracy
219
how to test capacity of pt to think abstractly?
similarities
* ask pt to tell you how 2 things are alike
proverbs
* ask pt what people mean when they use proverbs:
* a stitch in time saves 9
* don't count your chickens before they're hatched
220
high cog fx: tests constructional ability
copy figures of increasing complexity onto piece of blank/unlined paper
draw a clock with numbers and hands
221
vertigo v presyncope v disequilibrium
spinning
feeling of passing out/falling
unsteadiness/loss of balance
222
proximal v distal weakness
prox: comb hair, reach for shelf, geting up from chair, high stepping
distal: open jar, using scissors/screwdriver, tripping/falling while walking
223
dermatome map
224
faintin/syncope
sudeen temporary LOC and postural tone from transient global hypoperfusion to brain
225
seizure
tonic-clonic motor activity:
* tongue biting
* limb bruises
* urniary incontinence
* may/may not lose consciousness
226
tremors
rhytmic oscillary mvmt from contraction of opposing M groups that is worse @ rest or with intentional mvmt
* resting:
* parkinsons
* postural: appear when affect part actively maint a posture
* hyperthyroidism
* anxiety/fatigue
* intention: absent @ rest, and appear with mvmt (cerebellar)
* MS
parkinsons: low freq resting remor with rigidity and bradykinesia
essential tremor: high freq, bilateral UE during mvmt and sustained posture
227
testing CN I
present familiar smells but occluding one nose and then the other
228
tesing CN II
visual acuity: snellen- read smallest line at least half the letters
visual fields: wiggle fingers in peripheral 2 feet away in a fishbowl-like pattern
opthalmascopic:
* optic disk: physiological cup and penetrating retinal vessels
229
tesing CN II and III
inspect pupils
pupillary reflex
near rxn: pupil constriction on near object (10cm away)
230
tesing CN III, IV, VI
extraocular mvmts: big H
* asymmetry, nystagmus, lid lag
convergence: push pen towards pt
231
testing CN V
sensation: face, nasal, buccal mucosa, teeth
* V1: forehead
* V2: cheef
* V3: jaw
afferent corneal reflex
* have pt look up and away and approach on contra side --\> touch cornea --\> blink
motor: mastication
* temporalis
* masseter
232
anisocoria
difference \>0.4 mm
233
absent blinking AND sensorineural hearing loss seen in...
acoustic neuroma
234
testing CN VII
1. raise brows
2. frown
3. close eyes tightly
4. smile showing both upper and lower teeth
5. smile without teeth
6. puff out cheeks
235
test CN VIII
acoustic N: whispered voice test
* stand 1-2 feet behind pt, rub tragus
Weber and Rinne test: not applicable for bilateral hearing loss
236
testing CN IX, X
\*\* use light
motion of soft palate (X)
uvula (away lesion)
pharynx
gag reflex
237
testing CN XI
238
M atrophy
loss of M bulk - M wasting
eval:
* hands, shoulders, thighs
* thenar, hypothenar
* space b/w metacarpals, dorsal interosseous M
239
fasciculations
fine flickering irregular mvmts in small groups of M fibers
240
M tone
residual tension in relaxed M
241
a M is strongest when...
weakest when...
shortest
longest
242
M strength testing
243
testing of UE
_shoulder_
F, E, Ab, Ad, ext rotation, internal rotation
_elbow_
flex - bicep: c5, c6
extension: tricep - c6-8
pronation:
* pronator teres: median N - c6
supination:
* bicep: musculocutaneous N - C5, C6
_wrist_
extension:
* carpi radialis: radial N: c6-c8 - have pt make fist and resist you pulling down their wrist
flexion:
* flexor carpial radialis (median N - c7) & ulnaris (ulnar N - C8/T1) - have pt make fist and resis you pulling it up
_hand_
* hand grip
_finger_
* abduct & adduction: interosseous M (ulnar N - c8/t1)
* opposition: (median N - C8/T1)
* have pt try to touch tip of little finger with thumb aga resistance
244
M strength testing of LE
_hip_
* flex: iliopsoas - L2, L3, L4
* ext: g. max - S1
* adduction: adductors - L2, L3, L4
* abduction: g. medius & minimus - L4, L5, S1
_knee_
* extension: quads - L2-4
* flex: hamstrings - L4, L5, S1, S2
_ankle_
* dorsiflex: tib anterior - L4, L5 (pull up aga my hand)
* plantar flex: gastroc/soleus - S1 (push aga my hand)
_toe_
* dorsiflex 1st toe: deep peroneal - L4-S1
* plantar flex 1st toe: posterior tib - L5-S2
245
how to test sensory
start distally and move prox
246
seosry exam vib use what hz tuning fork?
128
247
posterior column disease common causes
teriary syph
b12 deficiency
248
peripheral neuropathy common causes
DM
etoh
249
common dorsal column disorders
tabes dorsalis
MS
b12 deificiency
250
sterognosis
pt IDs obj by touch
normal: within 5 sec
251
graphesthesia
discriminative sensation: draw number on hand
252
2 pt discrimination
use ends of paper clip
normal = 2 pt \<5mm on fingers (vary on other parts of body)
253
discriminative sensation
point localization: touch pt and have them touch where you touched
extinction:
* touch same parts bilateral
* sensory cotex lesions = only 1 stim recognizated
* extinguished stim on opposite side of dmged cortex
254
dysdiadochokinesia
unability to perform rapid, alternating mvmts
hand: palms up and down rapidly on thighs
foot: tap your hand and then ground
255
dysmetria
abnormal: lesion in vestibular sys or cerebellum
inability to judge distance/scale
* touch index finger to your finger and then their nose
* reposition hand after each touch
* touch your index finger with theirs up and down with eyes closed
* slide foot down shin
256
tesing gait
1. rise from sitting
2. walk down hall
3. heel to toe
4. walk on toes then heels
5. hop in place
6. shallow knee bend
257
gait: spastic hemiparesis
dmg: corticospinal tract
lean away while circumduction of foot, plantar-flex and inverted
258
steppage gait
dmg: foot drop - weak tib-anterior and toe extensors
drag feet or lift up high
cannot walk on heels
259
cerebellar ataxia gait
staggering, unsteady, _wide base_, exaggerated dif on turns
other cerebellar signs present:
* dysmetria
* mystag
* intention tremor
260
scissors gait
dmg: SC disease --\> bilateral LE spasticity, _common in cerebral palsy_
stiff, advance slowly with thighs crossing fwd each other on each step
"walking through water"
261
parkinsonian gait
dmg: basal ganglion
stooped posture with felx of head, arms, hips, knees
short, shuffling, involuntary hastening (festination)
262
sensory ataxia
dmg: polyneuropathy, posterior column
unsteady and wide based, throw feet fwd and outward and bring hem down from heel to toe in a _double tapping sound_
watch ground for guidance
263
hopping in place involves
prox M
distal M
position sense
normal cereballar fx
264
shallow knee bend tests
hip extensor (hamstring)
knee extensor (quad)
265
romberg test
pt stands with feet together, closes eyes, maint pos for 30-60s
inability --\> dorsal column disease
* loss of balance with eyes closed
266
pronator drift test
267
reflex arc cmpts
sensory N fibers
SC synapse
motor N fibers
NMJ
M fiber
268
scale for grading reflexes
269
hyperactive reflex can be due to:
CNS
corticospinal tract lesion
weakness/spasticity
(+) babinski
270
hypoactive/absent reflex
PNS
LMN lesion
weakness/atrophy
fasiculations
271
reinforcement
arm: clench teeth, squeeze one thigh
leg: locks fingers and pulls
272
bicep reflex: c5-6
273
tricep: C6-7
@ tricep insertion on olecranon process (2.5 - 5cm above olecranon process)
274
brachioradialis: C5/C6
2. 5-5 cm above wrist: forearm partly flexed and pronated
275
patellar reflex: L2-4
276
achilles: S1
sitting: dorsiflex --\> (+) = plantar flex
supine: flex hip & knee and ext-rot across opposite shin, dorsiflex --\> (+) plantar flex
277
ankle clonus --\> jerk into dorsiflexion
test rhythmic oscillations b/w dorsiflex and plantar flex
(+) = hyperactive reflexes: graded 4+
278
cut stim reflexes: abdominal
(+) = contraction of ab M and deviation of naval towards stim
can be MASKED in obesity: use finger to retract naval away from side to be stimulated and note contraction with retracting finger
above naval: T8-10
below naval: T10-12
279
babinski
testing plantar flex: L5, S1
* normal = plantar
* abnormal = dorsiflex
280
anal refelx
S2-S4
use cotton swab to stroke outward in 4 quads from anus
(+) = contraction
abnormal = cauda equina lesion
281
meningitis testing
common in acute bacterial meningitis, also in subarach hemorr
* test neck mobility/nuchal rigidity: pt supine and flex neck until chin touches chest
* (+) = neck stiffness
brudzinski
* (+) flexion of hips and knees with NECK FLEX
kernig
* (+) = pain with knee extension
282
lumbosacral radiculopathy
straight leg raise - stretches sciatic N & sens for disc herniation
* S1 commpression can also be associated with ipsi calf wasting and weak ankle dorsiflex
contralat straight-leg raise
* SPECIFIC for sciatica
(+) = pain
283
asterixis
* sudden brief clonus flexion of hands and fingers
* "stop traffic": hold for 1-2min
dmg: metabolic encephalopathy with impaired mental fx
* liver disease
* uremia
* hypercapnia
284
winged scapula - dmg to long thoracic N or muscular dystrophy
* weakness of serratus anterior
285
GCS
intubate pt @ 8
286
poor outcome signs in stuporous/coma pt
absent corneal
absent pupillary
absent withdrawal to pain
no motor response
287
what don't you do to a stuporous/comatose pt?
dilate pupils
flex neck: rule out fx before neck manipulation
288
oculocephalic reflex
doll's eye mvmts = intact brainstem
* hold open upper eyelids
* as head turns to one side, eyes move towards opposite side
absent: eyes move towards direction of head turning
289
vestibulo-ocular reflex
cold water: eyes deviate towards cold water
* eardrums intact and canals clear
* elev head to 30 degrees
abnormal: no response to cold water --\> brainstem injury
290
acute glaucoma headache
increased ICP around 1 eye
* steady/aching
* provoked by drops that dilate pupils
291
sinusitis headaches
mucosal inflammation
* usually frontal or maxillary sinus
* recurrent daily pattern
* local tenderness, nasal congestion/discharge/fever
can be relieved with nasal decongestants, antibiotics
292
subarachnoid hemorrhage
SUDDEN "worst pain of my entire life"
293
brain tumor headache
displacement/traction of pain-sensitive A/V or P on N
* brief --\> intermittant --\> progressive
* aggreated by: cough, sneeze, sudden head mvmts
294
postconcussion headache
acceleration-deceleration TBI
* 7days - 3mo after incident that diminishes over time
* poor concentration, memory problems, vertigo, irritabilty, restless/fatigue
