Lab study guide for the last test Flashcards
1
Q
What is Lymphangitis?
A
red streaks in the skin
2
Q
What is lymphedema?
A
edematous swelling due to excess accumulation of lymph fluid in the tissues
3
Q
Where are the tonsillar lymph nodes?
A
= Parotid lymph nodes, at the angle of the mandible
4
Q
Where are the submandibular lymphs nodes?
A
halfway between the angle of the mandible and the chin, on the inferior
boarder of the jaw line
5
Q
What are the submental lymph nodes
A
midline behind the tip of the mandible
6
Q
Where are the anterior cervical lymph nodes?
A
In front of the SCM
7
Q
Where are the posterior cervical lymph nodes?
A
located on the anterior border of the trapezius and deep to the
sternocleidomastoid
8
Q
What are Virchow’s nodes?
A
Subclavicular nodes
9
Q
Where are the epitrochlear lymph nodes?
A
proximal and posterior to the medial condyle of the humerus
10
Q
Where are the superior superficial inguinal lymph nodes? Inferior superficial inguinal lymph nodes?
A
Superior = just over inguinal canal
Inferior = – deeper in the groin compared to the superior superficial
inguina
11
Q
True or false: you need to have the knee flexed to assess the popliteal lymph nodes
A
true
12
Q
What hand should you hold the pts arm with while inspecting their right axillary lymph nodes?
A
Right hand holds their arm,
Left hand inspects
13
Q
What are the five surfaces that should be evaluated with inspecting the axillary lymph nodes?
A
- Apex
- Medial aspect along the rib cage
- Lateral aspect along the upper surface of the medial humerus
- Anterior wall along the pectoralis major and minor
- Posterior wall along the border of the scapula
14
Q
What is the technique for palpating the epitrochlear nodes?
A
Hold their hand up 90 degrees with your non-dominant hand
Circular motion between the tris and bis
15
Q
What is the mnemonic for documenting lymph node findings?
A
PALS (P=primary site. A=All associated.
L=Liver. S=Spleen)
16
Q
Lymph nodes that are Hard and discrete = ?
A
Malignancy
17
Q
Lymph nodes that are Rapid enlargement and no signs of inflammation = ?
A
Malignancy
18
Q
Lymph nodes that are Slow enlargement over weeks or months = ?
A
Benign tumor
19
Q
Lymph nodes that are Tender =
A
inflammatory
20
Q
Lymph nodes that are Pulsatile = ?
A
probably an artery, dumb-dumb
21
Q
Enlarge left sided supraclavicular node = ?
A
Thoracic or abdominal malignancy
22
Q
What are the three areas that should be checked for pitting edema?
A
a. Dorsum of each foot
b. Behind each medial malleolus
c. Over the shins
23
Q
What is the scale for pitting edema (range)?
A
1-4
24
Q
Rate this edema: Slight, no visible distortion, disappears rapidly
A
1+
25
Rate this edema: A little deeper pit, no real detectible distortion, disappears in 10 to 15 seconds
2+
26
Rate this edema: Noticeable deep pit, lasts more than a minute, noticeable dependent swelling or fullness
3+
27
Rate this edema: A very deep pit, lasts 2 to 5 minutes, dependent gross distortion
4+
28
How long should you hold your finger in place to assess for pitting edema?
5 seconds
29
What part of the stethoscope do you use to listen for a bruit?
Bell
30
What does venous flow sound like on a doppler?
"rushing wind"
31
How should the probe of a doppler be held to auscultate a DP or PT pulse?
Hold the Doppler tip at an angle along the axis of blood flow to gain the best signal
32
True or false: Absence of dorsalis pedis pulse in the expected location may not be pathological
in all cases
True -- may branch elsewhere in the lower limb
33
When is Allen's test utilized?
specifically to test for patency of the ulnar artery prior to a radial artery puncture (in
arterial blood gas sampling) or the insertion of a radial arterial catheter.
34
When performing the Allen's test prior to obtaining an ABG, how long should a pt make a fist for prior to you occluding the ulnar and radial arteries? What is the normal result time?
30 seconds
Normal = 3-5 seconds
35
Jugular venous pulses are assessed as a clinical measure of what?
central venous pressure
36
The height of the pulsating column of blood in the left jugular vein measures what, specifically (think what part of the heart this corresponds to)?
```
The amount of blood
draining into the right atrium and is useful in measuring over hydration (hypervolemia) or
under hydration (hypovolemia)
```
37
In almost all cases, elevated jugular venous pressure is
| indicative of what?
-An increased left ventricular end diastolic pressure
-Low left ventricular
ejection fraction
38
What does the "a" wave of the jugular venous pulses correspond to?
rebound from right atrial systole
39
What does the "c" wave of the jugular venous pulses correspond to?
expansion of the underlying carotid artery
40
What does the "y" wave of the jugular venous pulses correspond to?
filling of the right atrium from the systemic veins while the tricuspid valve
closes.
41
What is the order of the jugular venous pulse waves?
a, c, y
42
What does a prominent jugular "a" wave represent?
increased resistance to right atrial contraction. This
| is seen in tricuspid stenosis
43
What does an absent jugular "a" wave represent?
A-fib
44
What do large jugular "v" waves represent?
tricuspid regurgitation and constrictive pericarditis
45
What angle should patients be at when assessing for JVD?
45 degrees
46
What conditions result in edema of the LE?
Venous Insufficiency, Thrombosis,
Deep Vein Thrombosis,
Lymphedema
47
What conditions result in local swelling of the LE?
Superficial Thrombophlebitis
48
What conditions result in pallor of the LE?
Arterial Occlusion
49
What conditions result in redness of the LE?
Thrombosis, Superficial
| Thrombophlebitis
50
What conditions result in varicosities of the LE?
Venous Insufficiency
51
What conditions result in thrombosis of the LE?
Venous Insufficiency
52
What conditions result in thickened skin of the LE?
Thrombosis, Lymphedema
53
What conditions result in Brownish discoloration of the LE?
Chronic Venous Insufficiency
54
What conditions result in warmth of the LE?
Superficial Thrombophlebitis
55
What conditions result in coldness of the LE?
Arterial Occlusion, Arterial
| Insufficiency
56
What is homan's test used for?
Tests for DVTs (but is neither specific nor sensitive)
57
What are the steps of checking for Homan's sign? What indicates a positive sign?
Flex knee slightly, and dorsiflex the foot. Positive if pain.
58
What is the pathogenesis of varicose veins?
Varicose veins result from incompetent vessel walls, incompetent valves, or
an obstruction of a proximal vein
59
What is a way to test for varicose veins that are not present right away?
have pt stand on toes 10 times in succession
60
What is the trendelenburg test used to assess?
assess for venous incompetence and can
| be used to locate incompetent valves in the saphenous vein and communicating veins.
61
What are the steps of the trendelenburg test?
pt is supine. Raise their leg above their heart to allow for blood to drain. Occlude superficial thigh veins with hand, and have pt stand.
62
What is an abnormal finding for the Trendelenburg test?
a. Incompetent valve is present in the communicating veins when sudden refilling is
noted (color quickly returns to leg) before removal of pressure.
b. Incompetent valve is present in the saphenous vein when sudden additional refilling
takes place following the removal of pressure.
63
What is the order of examination for the upper limb and hip? (5)
1. Inspection
2. Palpation
3. ROM
4. Strength testing
5. Special testing
64
True or false: Normally, passive ROM exceeds active ROM by 5 degrees
True
65
How is muscle tone assessed?
by feeling resistance to stretch
66
Grade this muscle strength: No movement
0/5
67
Grade this muscle strength: Trace movement
1/5
68
Grade this muscle strength: Full motion, but not against gravity
2/5
69
Grade this muscle strength: Full motion against gravity but not resistance
3/5
70
Grade this muscle strength: Full motion against gravity and some resistance, but weak
4/5
71
Grade this muscle strength: Full motion against gravity and resistance
5/5
72
Weakness with pain suggests what type of issue?
MS
73
Weakness without pain suggests what type of issue?
Neuro
74
What are the four muscles of the rotator cuff?
1. Supraspinatus
2. Infraspinatus
3. Subscapularis
4. Teres minor
75
How do you test for internal rotation of the arm?
hand behind the back
76
How do you test for external rotation of the arm?
place hand on the back of the neck
77
What is the subscapularis lift off test or Gerber’s test?
Assess subscapularis--
Have pt place hand on their back, then lift off away from the back. if cannot, then subscapularis prob
78
What is the empty can or Jobe's test?
Test for the supraspinatus muscle
Steps:
i. Clinician stands in front of the patient and passively raises the arms to 90˚ in the
plane of the scapula (midway between forward flexion and sideways abduction).
ii. Arms are internally rotated with thumbs pointing down.
iii. Ask the patient to hold this position and resist attempts to push the arms downward.
79
What is the arm drop test, and what is it used for?
Used to evaluate for a large rotator cuff tear.
Steps:
i. Ask patient to lift arm to abduct it up to shoulder level at 90⁰.
ii. Have the patient slowly lower the arm to his/her side
80
What is Neer's test, and what does it evaluate?
evaluates for shoulder rotator cuff impingement or tear
i. Examiner prevents scapular motion with one hand by pressing on the scapula.
ii. Using the other hand, raise the patient’s arm in forward flexion (up to 150⁰) while
depressing the scapula. This presses the greater tuberosity of the humerus against the
acromion.
81
What is Yergason's test, and what is it used to assess for?
Evaluates forearm supination, and rotator cuff
i. Examiner stands in front of the patient and flexes his/her forearm to 90˚ at the elbow.
ii. Pronate the patient’s wrist.
iii. Ask the patient to supinate against resistance.
82
What is the carrying angle?
Angle between the humerus and the radius/ulna
83
What is tennis elbow?
Lateral epicondylitis
84
What is golfer's/pitchers elbow?
Medial epicondylitis
85
What is the flexor digitorum superficialis test?
Hold other fingers down, have pt flex the finger in question at the PIP
86
What is the flexor digitorum profundus test?
Hold other fingers down, have pt flex the finger in question at the DIP
87
Phalen's test = ?
Place dorsum of the hands together (causing flexion of the wrist)
88
Tinels' sign?
Tapping in any area, but classically over the median nerve, checking for carpal tunnel
89
What is the thomas test? What is it used for?
evaluation for hip flexion contracture
-The uninvolved flexed leg is held against the chest of the supine patient to flatten the
lumbar lordosis.
-The contralateral leg should stay extended.
90
What is the trendelenburg sign?
Asymmetry of the iliac crests when standing/walking may indicate gluteus minimus problem
91
What is the SLR used to test for?
Tests for sciatica. If pain down ipsilateral leg, positive. If pain in back, negative
92
What is the "opposite" of a swan neck deformity?
Boutonniere deformity
93
What is De Quervain's tendonitis?
TTP over the snuffbox d/t inflammation of retinaculum of the wrist
94
What is the Finkelstein test?
Place thumb in fist. Ulnar deviate wrist.
Tests for De Quervain's tendonitis
95
What is the term that describes when a person is disoriented x3, but has normal consciousness?
Confused
96
What is obtunded?
Pt will look at you when talking, but fall back asleep. No responses
97
What is stupor?
slow responses, simple motor or moaning to stimuli, arousable for short
periods of times
98
What is the AVPU mnemonic for alertness?
Alert
Verbal responsiveness
Pain responsiveness
unresponsive
99
What is the range of scores for the glasgow coma scale?
3-15
100
What are the three areas that are tested in the glasgow coma scale?
Eye opening
Verbal response
Motor response
101
What are the four levels of eye opening in the glasgow coma scale?
4= spontaneous
3= to voice
2=to pain
1= none
102
What are the five levels of verbal response in the glasgow coma scale?
```
5 = normal
4 = disoriented
3 = inappropriate
2 = incomprehensible
1= None
```
103
What are the six levels of motor response in the glasgow coma scale?
```
6 = normal
5= localized to pain
4= withdraws to pain
3 = flexes to pain
2 = extends to pain
1 = none
```
104
What are the three components of a mini-cognition test?
Three words
Clock draw
Three words again
105
The mini-mental status exam is useful for helping to diagnose what?
Dementia
106
How do you test immediate memory?
Say numbers, ask pt to repeat
107
How do you test recent memory?
Test recall of 4-5 objects after 10 minutes
108
SIGE-CAPS = ?
```
Sleep
Interest
Guilt
Energy
Concentration
Appetite
Psychomotor
Suicidal
```
109
How do you test CN I?
Occlude nostril, identify smells
110
Which chart is used for far distances: snellen or rosenbaum?
Snellen
111
What type of patient may have a problem with accommodation?
DM
112
Which is more likely to suggest a CN V problem: a unilateral or bilateral lesion?
unilateral
113
How do you test for innervation to the face?
have pt close eyes and tell difference between sharp and soft end of a q-tip
114
What are the usual five steps to test CN VII motor function?
(a) . Wrinkle forehead by raising eyebrows.
(b) . Squeeze eyes shut.
(c) . Puff cheeks.
(d) . Smile and show teeth.
(e) . Purse lips and blow out
115
What are the three tests that can be used to assess CN VIII?
Rinne
Weber
Whisper
116
Which two nerves are needed for swallowing to be intact?
CN IX, X
117
Which taste is utilized for testing CN IX?
Bitter
118
Weakness of the SCM and trapezius on opposite sides may indicate an upper motor neuron lesion on which side?
The side of the SCM weakness
119
How do you test CN XII strength?
Have pt push tongue against cheek. You resist
120
What are the two tests for rapid alternating movements?
Finger to thumb
| Palm up/down
121
What are the three tests of LE (point to point) movements?
Finger to nose
FNF
Heel to shin
122
What are the three tests of balance?
Romberg
Balance
Hop test
123
What are the four tests of gait and stance?
a. Walking without shoes
b. Tandem walk
c. Walking on heels and toes
d. Pronator drift
124
Ability to perform rapid alternating movements evaluates what?
cerebellar function of
| ipsilateral side
125
Ability to perform the finger-thumb test evaluates what?
cerebellar function of the
| ipsilateral side
126
Normal rapid alternating movements is called what?
diadochokinesia.
127
Ability to perform the palm up/palm down test evaluates what?
Cerebellar function of the ipsilateral side
128
True or false: it is okay to test the palm up/down test together
False, according to the manual
129
What is the term that this class wants you to use for FNF?
Finger-to-nose test
130
What does dysmetria (found through the FNF) suggest?
Cerebellar disease
131
What is the FNF test according to this manual?
The field sobriety test one
132
Ability to perform the heel-to-shin test evaluates what?
Cerebellar function of the ipsilateral side
133
Patients with vestibular dysfunction are likely to fall
| toward or away the side of the lesion with a Romberg test
Toward (remember, cerebellar tracts are ipsilateral)
134
What does pronator drift test for (which tract, which side)?
Tests for contralateral lesions of the corticospinal tract and position sense.
135
What does graphesthesia,
| Stereognosis, and two-point discrimination test?
Dorsal columns / medial lemniscus pathways
136
How do you assess the spinothalamic (and DCs) pathways?
Sharp end of a Q-tip alternating with soft end
137
Where should a tuning fork be placed when assessing for vibration?
Over bony prominences
138
How do you test proprioception?
Have them close their eyes, and move a joint (starting from fingers/toes, going upward)
139
Graphesthesia is carried by which spinal pathway?
Dorsal columns
140
What is the grading for DTRs? What is normal?
0-4, with 2 being normal
141
What is are the spinal levels that innervate the biceps reflex?
C5-C6
142
What is are the spinal levels that innervate the brachioradialis reflex?
C5-C6
143
What is are the spinal levels that innervate the triceps reflex?
C6-C7
144
Where should the arm be placed with the brachioradialis reflex?
resting on pts leg
145
Where should the arm be placed with the biceps reflex?
Palm down, on your forearm
146
What are the spinal levels that are tested for the calcaneal tendon reflex?
S1 S2
147
When should you check for clonus?
When DTRs are hyperactive
148
What is the test for clonus?
Briskly dorsiflex the foot with your hand while maintaining foot in flexion.
149
What is the scale used for superficial reflexes?
positive or negative
150
Spinal levels for the babinski sign?
L5 and S1
151
What is the correct stroke for the Babinski test?
Heel, move laterally, then medially to the ball of the foot (like an "S")
152
Spinal levels for the cremasteric reflex?
L1 and L2
153
How do you test for the abdominal reflexes?
Lightly stroke the abdomen from the top of each quadrant diagonally toward the
umbilicus.
154
What is Brudzinski's sign?
Flexion of the neck elicits flexion of the hips
155
What is Kernig's sign?
While the patient is supine, passively flex the hip to 90 degrees while the knee is flexed to 90 degrees.
b. Gently extend the knee past 90 degrees while keeping the hip flexed.
156
Bilateral leg pain with Kernig's sign suggests what? Unilateral?
```
Bilateral = meningeal irritation
Unilateral = nerve compression
```
157
What are the 10 sites tested in the Monofilament test?
```
Great toe
Third toe
Fifth toe
Just below each of the above
Heel
Dorsum of the foot
```
158
For Mcmurrays testing, how do you test the medial meniscus?
External rotation
| Valgus stress
159
For Mcmurrays testing, how do you test the lateral meniscus?
Internal rotation
| Varus stress
