Midterm Flashcards
(89 cards)
1
Q
Circumstantiality:
A
indirect delayed speech, unnecessary detail
2
Q
Flight of ideas:
A
continuous rapid flow of speech
3
Q
Neologisms
A
invented or distorted words
4
Q
Incoherence
A
incomprehensible speech
5
Q
Blocking
A
sudden interruption in mid-sentence, loss of thought
6
Q
Confabulation
A
The spontaneous reporting of events that have never actually happened, usually as a result of neurological or psychological dysfunction. Patients with short term memory deficits from Wernicke- Korsakoff sydrome are prone to confabulation.
7
Q
Perseveration
A
persistent repetition of words and ideas
8
Q
Echolalia
A
repetition of words, phrases
9
Q
Clanging
A
choosing a word on the basis of sound rather than meaning; rhyming
10
Q
Obsessions
A
recurrent uncontrollable thoughts, ideas
11
Q
Compulsions
A
repetitive acts that a person feels compelled to perform
12
Q
Phobias
A
persistent irrational fears
13
Q
Anxieties
A
apprehensions, fears, tensions
14
Q
Feelings of unreality
A
strangeness in environment
15
Q
Depersonalization
A
loss of self-identity
16
Q
Delusions
A
fixed, false personal beliefs
17
Q
SAD PERSONS
assessment for suicide
A
Sex Age Depressed Previous attempt Ethanol Rational thinking loss Social support loss Organized plan No spouse Sickness
18
Q
normal ROM in TMJ is
A
3cm btwn upper and lower incisors
19
Q
other findings for TMJ
A
swelling, crepitus, decreased ROM or deviation.
20
Q
crepitus
A
a grating sound or friction between two bones
21
Q
Adson’s Test
A
Check the radial pulse as you abduct, extend, and externally rotate the arm
Have the patient Valsalva and turn her head toward the side being tested
22
Q
Adson’s test
- An absent or diminished pulse suggests
- Reproduction of peripheral neuropathy suggests
A
- compression of the subclavian artery.
- thoracic outlet syndrome.
23
Q
Heberden’s
A
nodules of DIP joints
24
Q
Bouchard’s
A
nodules of PIP joints
25
Finklestein's Test
Make a fist with the thumb grasped by the fingers and deviate fist to ulnar side
26
Finklestein's Test
| -Severe pain is indicative of
tenosynovitis
| -inflammation of a tendon often in the wrist
27
Carpal tunnel syndrom (CTS)
| what are the tests?
- Hand symptom diagram
- Hypoalgesia (diminished ability to perceive painful stimuli applied along the palmer aspect of the index finger compared to the ipsilateral little finger)
- Weak thumb abduction (patient elevates thumb against resistance)
- Tinel's sign (percuss lightly over the flexor retinaculum)
- Phalen's sign (allow wrists to fall freely into maximum flexion and maintain the position for 60 seconds)
A positive for both Tinel's and Phalen's is a tingling sensation along the distribution of the median nerve
28
What are the best exams for ruling in/out Carpal Tunnel syndrome?
RULE IN: Katz hand diagram and weak thumb abduction
| RULE OUT: Hypoalgesia
29
What are the findings in tennis elbow?
Olecranon bursitis
| Pain with lifting, twisting, etc
30
Know how to assess ROM in shoulder
Apley’s Scratch Test
External rotation and abduction
Internal rotation and adduction
31
Where is the subacromial bursa?
on top of the humerus
32
Where is the bicipital groove?
Head of humerus, anterior
33
What are the tests for non-organic back pain (i.e. malingering)?
Flip test - positive with leg extended while supine, but non painful extension of leg while sitting
Hoover's test - pt supine, one leg elevated, if this movement is difficult, the pt will push the contralateral leg toward the table for assistance in raising the leg. Therefore, lack of downward pressure from contralateral leg is a positive for malingering
34
Most reliable test to detect quadriceps weakness?
sit to stand test
35
When will pain be elicited in Kemp's test? (rotation, extension, and lateral bending of spine)
- facet disease
| - lumbar disc hernation
36
What is the term for gout on the great toe?
Podagra (toe, aggravated)
37
What part of the leg is affected in Osgoof-Schlatter disease?
Tibial tuberosity (inflmmatoion of patellar ligament)
38
What test most sensitive for ACL tear?
Lachman’s test: + when knee flex 20-30 degrees, >4mm displacement of tibia anterior to femur
39
How does one test the knee for effusion? Where would you expect to find tenderness to palpation in a meniscal tear?
Bulge sign: look and milk
Ballotement: downward pressure towards the foot with one hand, while pushing the patella backwards against the femur with one finger of the opposite hand.
40
Know the tests for ligamentous stability in the knee
Valgus/Varus stress:
valgus= pressing on lateral side, stressing medial side
varus= pressing on medial side, stressing lateral side
Apley’s compression/distraction: prone, practitioner presses down and grinds, pain will localize (tests the meniscus and collateral ligaments)
McMurray’s Test:
Apply valgus stress to flexed knee while externally rotating legs and slowly extend knee. Popping: + for tear of medial mensiscus
Apply varus stress to flexed knee while internally rotating legs and slowly extend knee. Popping: + for tear of lateral mensiscus.
Anterior Drawer Sign: tests anterior cruciate ligaments
Posterior Drawer Sign: tests posterior cruciate ligaments.
Patellar Entrapment: chondromalacia patella.
41
Thessaly test is for
meniscal injury
42
Patrick-Fabere Test
- Assesses flexion, abduction and external rotation of hip
| - Positive in hip or sacroiliac disease.
43
Gaenslen's Test
-Assesses hip extension, psoas tenderness, and sacroiliac disease
44
Straight Leg Raise (SLR)
- Assesses lumbar spine
| - most sensitive for detecting disc herniation
45
Bragard’s
- Assesses lumbar spine
| - Do SLR until painful, lower until pain stops, then dorsiflex the foot
46
What are the findings of DJD and RA in the hand?
Degenerative joint disease: swollen knuckles, phalanges deviated
Rheumatoid arthritis: boutonnière deformity of thumb, ulnar deviation of metacarpal phalangeal joints
47
What is hallux valgus?
Looks like a bunion. Medial deviation of the first metatarsal and lateral deviation and/or rotation of the hallux
48
What are the normal variants of the epidydimis?
7% men have epidydimi anterior
49
indirect inguinal hernia
most common, tissue herniates through internal ring often into scrotum
50
direct inguinal hernia
less common, M>F, >40yrs, tissue herniates behind external ring rarely into scrotum
51
femoral inguinal hernia
least common, F>M, never into scrotum
52
Are the testicles usually equal in position, or is one lower than the other?
Usu left is lower
53
Spermatocele
painless, movable cystic mass.
| Will transilluminate
54
Testicular CA
painless nodule
55
Hematocele
nontender
| opaque on transillumination
56
Hydrocele
nontender accumulation of serous fluid from infection or trauma
will transilluminate
57
where is a varicocele most often found?
| how is it dx?
- Left side
| - collapses when scrotum elevated in supine patient
58
Orchitis
entire testicle inflamed, usu seconday to mumps
59
Epididymitis
bacterial infection (usu Chlamydia)
60
What is the size of a normal prostate?
2.5 cm
61
BPH
smooth, enlarged lobes, elastic—rubbery, nontender
62
Prostate cancer
hard, nontender nodules, median sulcus may be obscured
63
Acute prostatitis
enlarged, tender prostate with asymmetrical edematous tissue, boggy
64
What is Peyronie’s disease? What are the findings on PE?
Scarring of the tunica albuginea in the corpora cavernosa ➔formation of plaques that can cause painful erection and dorsal curvature
65
```
How do we rate muscle strength?
How do we test muscle tone?
What is spasticity?
What is cogwheel rigidity?
What conditions cause them?
```
Strength: 0-5 scale, hold active resistance for 3-5 sec (5 is normal)
Tone: resistance even when patient passive
Spasticity: UMN/corticospinal tract system lesion, hypertonia that is rate dependent. “clasp-knife resistance”. Tone is greater when passive movement is rapid
Cogwheel rigidity: ratchet like jerkiness, parkinsonism
66
What tests check coordination?
Arms—Rapid alternating movements of arms on lap
Arms—finger-to-nose test, forearm rolling
Legs—heel to shin test
Gait—walk on toes, walk on heels, hop in place, shallow knee bend
Romberg-walk heel-to-toe,
Pronator drift- arm up held in place
67
Posterior column
vibration and proprioception
68
Lateral spinothalamic
sharp vs dull, hot versus cold
69
Anterior spinothalamic
light touch
70
How are deep tendon reflexes tested and rated?
| When are deep tendon reflexes abnormal?
0-4 scale (2=normal)
| 3 and 4 =hyper reflexive, suggest UMN disease
71
What is clonus?
alternate involuntary muscular contraction and relaxation in rapid succession
72
Describe a Babinski reflex. What does a positive Babinski sign indicate in a 21-year old patient versus an 18-month old child?
- Stroke lateral aspect of sole, curving medially across the ball
- Negative: toes flex
- Positive: toes abduct and extend (physiologic response in infants)
73
Know tests for meningeal irritation
| both tests are insensitive!
Brudzinski: flexion of supine patient’s neck causes patient to flex both hips and knees
Kernig: with patient’s hip and knees flexed, test is positive when patient resists extension oy the knee.
74
What does “glove and stocking distribution” mean in terms of sensory testing?
Affects distal extremities
75
Stereognosis
ability to recognize common objects 90% of time in 5 s
76
How are discriminative sensations tested?
2 point discrimination: sharp objects. Normal distance is 3cm for hand, 6mm for fingertips
77
never OMIT stands for what in the MSE?
orientation X3
memory
intelligence
talk
78
CN I
name?
sensory or motor?
test?
- Oflactory
- sensory
- non-irritating substance to check smell
79
CN II
name?
sensory or motor?
test?
- Optic
- sensory
- Snellen for far vision, Rosenbaum for near vision
- Test visual fields by confrontation
- Ophthalmoscopic exam
80
CN III
name?
sensory or motor?
test?
- Oculomotor
- motor, medial and upward mvmnt
- PERRLA
81
CN IV
name?
sensory or motor?
test?
- Trochlear
- motor, medial and down mvmnt
- test with X in space
82
CN VI
name?
sensory or motor?
test?
- Abducens
- motor, lateral mvmnt
- test with H ins space
83
CN V
name?
sensory or motor?
test?
- Trigeminal
- sensory to face, motor to mastication mm
- ask pt to clench jaw
- Be sure to check the three divisions: ophthalmic, maxillary and mandibular. Use a cotton ball to check light touch
- Followed by corneal reflex if there is a deficit on light touch
84
CN VII
name?
sensory or motor?
test?
- Facial
- Motor to the face, Taste on anterior 2/3 of the tongue
- ask pt to frown, smile, puff out cheeks, raise eyebrows
85
CN VIII
name?
sensory or motor?
test?
- Acoustic
- sensory
- Gross hearing test (whispered breath)
- If there's a deficit, perform Weber and Rinne tests
- Romberg (balance)
86
CN IX
name?
sensory or motor?
test?
- Glossopharyngeal
- sensory to pharynx, taste on post 1/3 tongue
- cotton swab to stimulate gag reflex
87
CN X
name?
sensory or motor?
test?
- Vagus
- motor to pharynx
- ask pt to swallow
- ask pt to phonate "say ahh"
88
CN XI
name?
sensory or motor?
test?
- Accessary
- motor to trapezius and SCM
- shrug against minimal resistance
- if deficit, test the SCM
89
CN XII
name?
sensory or motor?
test?
- Hypoglossal
- motor to tongue
- protrude their tongue
