MT Flashcards
(157 cards)
1
Q
visceral abdominal pain vs somatic abdominal pain
A
stimulation of visceral pain fibers usually on organs, not localized
stimulation of somatic pain fibers usually in peritoneum, is localized
2
Q
important meds to ask about in abdominal exams
A
blood thinners, NSAIDs, narcotics, steroids
3
Q
order of abdominal physical exam
A
inspection
auscultation
percussion
palpation
4
Q
RUQ contents
A
liver, gb, stomach, si/li
5
Q
RLQ contents
A
appendix, ovary, si/li
6
Q
LLQ contents
A
sigmoid colon, ovary, si/li
7
Q
LUQ contents
A
spleen, stomach, si/li
8
Q
epigastric area contents
A
pancreas, liver, gb, stomach, si/li
9
Q
normal bowel sounds
A
5-34 clicks per minute
10
Q
high pitched bowel sounds suggest
A
obstruction
11
Q
bruits suggest
A
vascular obstruction
12
Q
friction rub sounds suggest
A
inflammation of peritoneal surface of an organ
13
Q
venous hum sound suggests
A
increased circulation b/w portal/systemic
14
Q
where to start w/ abdomen palpation
A
start farthest from tender area
15
Q
causes of splenomegaly
A
portal hypertension, blood malignancies, hematoma, mono
16
Q
ascites tests
A
shifting dullness - percuss borders of tympany/dullness and then have Pt lay on side and if it changes (+)
fluid wave - tapping one side of abdomen felt on other side w/ other hand monitoring
17
Q
mcburney’s point
A
2 inches medial to R ASIS towards umbilicus
(+) tenderness, appendicitis
18
Q
rosvings sign
A
deep palpation in LLQ
(+) tenderness in RLQ, appendicitis
19
Q
psoas sign
A
Pt raises R thigh against resistance then lays on left side and extends R leg at hip
+ pain w/ either maneuver, appendicitis
20
Q
obturator sign
A
flex Pts R hip w/ knee bent, then internally rotate hip
+ R hypogastric pain, appendicitis
21
Q
murphy’s sign
A
palpate under R costal margin then Pt breaths deep
+ sharp pain w/ stop in inspiration, biliary colic
22
Q
lloyd’s sign
A
deep percussion down back
+ pain, kidney pathology
23
Q
signs of peritoneal inflammation
A
guarding - contraction of abdominal wall w/ palpation
rigidity - reflex contraction of abdominal wall, Pt stiff
rebound tenderness - more pain when letting go after palpation than pushing in
24
Q
vindicate
A
vascular infectious/inflammatory drugs/degenerative iatrogenic/idiopathic cogenital AI/allergic/anatomic trauma endocrine/environment
25
expected sound on percussion of abdomen
tympanic mostly
26
GERD Sx
heartburn
regurgitation
dysphagia 30% of Pts
27
lifestyle modifications for GERD
```
lose weight (if overweight)
avoid triggers
avoid large meals
wait 3 hours to lay down after meal
elevate head of bed by 8 inches
```
28
rome 3 criteria for constipation
```
<3 bowel movements/week
straining
lumpy/hard stools
sensation of incomplete defecation
manual maneuvering required to defecate
```
must have 2+ over 3 months
29
bistol stool chart
```
1 - lumps
2 - sausage, lumpy
3 - sausage, cracks
4 - sausage, smooth
5 - soft blobs
6 - fluffy pieces, mushy
7 - watery
```
30
main cause of gastroenteritis
viral
31
viral gastroenteritis two "biggies"
norovirus - sudden onset, 12-48 hours after exposure, usually more vomiting; seen w/ ship/casino outbreaks
rotavirus - most immunized for this, kids either have it or immunized by age 5
32
bacterial gastroenteritis three "biggies"
salmonella - eating something contaminated
C. diff - most common hospital acquired illness, exposure to antibiotics
E. coli - most common w/ travel
33
parasitic gastroenteritis one "biggie"
giardia - causes greasy diarrhea (tends to float), bloating, cramping; most common from infected water w/ campers etc
34
parasitic gastroenteritis one "biggie"
giardia - causes greasy diarrhea (tends to float), bloating, cramping; most common from infected water w/ campers etc
35
cullen sign
ecchymosis around umbilicus secondary to hemorrhage
36
grey turner sign
flank ecchymosis secondary to hemorrhage
37
expected liver size
6-12 cm at mid-clavicular line on the right
38
expected spleen size
from ribs 6-10 at mid-axillary line on left
39
heel strike indicates
appendicits or peritonitis
40
chovstek sign
tap facial N when facial Ms relaxed
(+) spasm = hypocalcemia
41
hypoparathyroidism causes/Sx
causes: removal, DiGeorge, AI disorder
Sx: hypocalcemia (b/c low PTH) -> seizures, dementia, anxiety, paresthesia, stiffness/spasms, prolonged QT
42
adrenal insufficiency/addison's disease causes/Sx
causes: primary usually AI, secondary due to lack of ACTH production
Sx: underproduction of cortisol/ACTH -> low blood glucose/Na levels, skin pigment, salty food craving, hypotension, fatigue
43
adrenal overproduction/cushing's disease causes/Sx
causes: endogenous w/ tumors, etc; or exogenous due to meds
Sx: cortisol overproduction -> moon face, buffalo hump on shoulders, high blood/glucose, excess body hair growth in women, striae on skin
44
T4/T3 and relation to thyroid function
t4 = inactive / t3 = active
```
hypothyroid = TSH high b/c low T4/T3
hyperthyroid = TSH low b/c high T4/T3
```
45
T4/T3 and relation to thyroid function
t4 = inactive / t3 = active
```
hypothyroid = TSH high b/c low T4/T3
hyperthyroid = TSH low b/c high T4/T3
```
46
pituitary adenoma Sx
hypersecretion of hormone
deficiency of hormone (LH/FSH)
headaches, visual disturbances, loss of balance, seizures
47
where does thyroid lie
isthmus over 2-4 tracheal rings
48
soft thyroid seen in
Grave's
49
firm thyroid seen in
Hashiomoto's and malignancy
50
tender thyroid seen in
thyroiditis
51
DM Sx/Labs
Sx: polyurea, thirst, fatigue, cuts/bruises slow to heal, feeling hungry, weight loss
labs: FG > 126 mg/dL
A1C > 6.5%
random glucose > 200 mg/dL
52
Metabolic Syndrome
Sx: abdominal obesity, insulin resistance, elevated BP, lipid abnormalities
prevalence increases w/ age and body weight but cause unk
53
geriatric meds assessment
- brown bag check: bring in bag w/ all meds
- ask prescriptions, OTC, vitamins, herbs, supplements
- review meds every visit
- use Beer's criteria to avoid prescribing meds w/ adverse effects
- start low, go slow (dosage for elderly)
- close followup after starting new medication
54
assessment tools for functional ability and risk of falls
- ability to perform activities of daily living (ADL)
- -self care, housework, meal prep, taking meds, managing finances, using telephone
- useful scales: Katz, Lawton ADL scales
55
risks secondary to DM
retinopathy -> blindness
nephropathy -> kidney failure
neuropathy of hands/feet
vascular changes -> MI/strokes
56
DKA at risk in T1 or T2DM
T1
57
geriatric vision assessment
- Snellen eye chart
- ophthalmologist referral to monitor DM Pt
- ophthalmologist referral for Pt w/ glaucoma risk (FH)
- assess vision for driving safety
58
mini-mental status exam
```
mild = 21-29
moderate = 10-20
severe = 0-9
```
*not relaible if Pt cant read/write or not fluent
59
diabetic retinopathy Sx
black spots in visual field
60
geriatric hearing loss
age-related sensorineural hearing loss most common hearing condition in older Pts, loss of high frequency hearing
Sx: hearing loss w/ tinnitus/vertigo/poor balance (fall risk)
cause: CN8, review meds for ototoxicity
61
stress incontinence
involuntary leakage w/ sneezing, coughing, laughing, exertion, etc
62
urge incontinence
detrusor overactivity, leading to uninhibited detrusor contractions
63
overflow incontinence
continuous leakage due to incomplete emptying, detrusor inactivity or bladder outlet obstruction
64
risk factors for osteoporosis
white females
older white males
postemenopausal females
vitamin D deficient
65
osteoporosis screening
dual energy x-ray scan (DEXA) on women 65+
screening women <65 w/ high fracture risk
66
geriatric vax assessment
tetanus w/ pertussis
flu
pneumococcal pneumonia
herpes zoster
67
geriatric vax assessment
tetanus w/ pertussis
flu
pneumococcal pneumonia
herpes zoster
68
RA risk factors and Sx
Tx
often ages 30-50, women, smokers, w/ FH
Sx: joint pain/stiffness (wrists, IP/MP joints), morning stiffness lasting longer than an hour, swelling and synovial thickening of joints on examination
Tx: methotrexate
69
juvenile RA risk factors and Sx
children w/ painless joint inflammation, limp
Sx must last 6 weeks in at least 1 joint w/ other causes ruled out under age 16
70
SLE risk factors and Sx
risk factors: black, female
Sx: fatigue, weight loss, fever, arthralgia/myalgia
4 top Sx: coin shaped rash, malar rash, unexplained seizures/psychosis, photosensitivity
71
psoriasis risk factors and Sx
15-30 y/o, smoker, obese, alcoholic, FH
Sx: scaly skin lesions, erythematous
*consider joint exam when seeing rash/nail pitting
72
Graves' risk factors and Sx
Tx
female, FH, AI disorder
Sx: asymptomatic -> thyroid storm; heat intolerance, diaphoresis, tremor, bulged eyes, weight loss
Tx: beta blockers and anti-thyroid meds
73
Hashimoto's Sx
Tx
Sx: non-tender goiter, hypothyroidism, high TPO Ab level, weight gain, cold intolerance
Tx: levothyroxine
74
Ab disorder risk factors and (1ID) Sx
FH strongest predictor
Sx: infections w/ unusual organisms or severe recurrent infections w/ common organisms
75
agammaglobinemia Sx
absent of B cells
76
hypogammaglobinemia Sx
low/deficient Ig levels, abnormal Ig response to vaccinations
77
phagocytic disorder Sx
inability to kill catalase-positive organsism (Ex: staph aureus)
Sx: recurrent fungal infections
78
complement disorder Sx
infectinos w/ encapsulated organisms (pneumoniae, influenzae)
79
HIV Sx
Sx: mucocutaneous rash, myalgia/athralgias, anorexia, weight loss, fever, CNS manifestations, fatigue, pharyngitis, GI distress
80
type 1 hypersensitivity Sx
IgE mediated - allergy activity activating mast cells and increasing vascular permeability; usually targets eyes/nose/respiratory/GI
Sx: allergic conjunctivitis/rhinitis, dermatitis (eczema), diarrhea/cramping
81
type 2 hypersensitivity Sx
Ab toxicity involving C' activation; recruitment of inflammatory cells and Abs against receptors
ABO mismatch, rheumatic fever, hemolytic disease of newborns, myasthenia gravis, graves
82
type 3 hypersensitivity Sx
IgG/IgM and C' activation -> neuts/Mcs damaging tissue; takes 2 exposures b/c needs Ab deposition
Farmers Lung, Serum Sickness
83
type 4 hypersensitivity Sx
T cell mediated, no Abs required
allergic contact dermatitis (poison ivy), late phase of Farmer's lung, PPD skin test for TB
84
t cell disorder
usual present in early life
diarrhea, failure to thrive, opportunistic infections in a child younger than 3 months should raise suspicion for SCID
85
assessing sexual dev in physical exam
female puberty = 10-14 w/ menarche 2-3 years after beginning of puberty (secondary sex dev)
male puberty = 11-16
other considerations = hair growth, facial bone changes, thyroid size increase, acne
86
how to obtain ob/gyn history
menstrual Hx: age and cycle history, LMP
gyn Hx: breast Hx/disease, last mammogram, previous gyn surgery, fertility Hx, last pap smear
ob Hx: # of pregnancies/# of births, TPAL
87
how/when/why pap smear
mammograms
women 21-65 y/o
- yearly if abnormal
- every 3 years w/ normal
- every 5 years w/ normal and no HPV (reason for PS)
* sample take at ectocervix/endocervix/TZ
50+ years for mammogram
88
pelvic exam vs pap smear
both require insertion of speculum
```
pelvic = visual, bimanual exam, swab if needed
pap = obtains sample by scraping cervical cells
```
89
TPAL acronym
```
T = term deliveries (>37 wks)
P = preterm deliveries (20-37 wks)
A = abortion (<20 wks)
L = live delivery regardless of age
```
90
ectopic pregnancy Sx/Dx
abdominal/pelvic pain w/ vaginal bleeding and may have other pregnancy related Sx
do urine pregnancy test followed by ultrasound
91
UTI Sx/cause/Tx
Sx: dysuria, may have hematuria, test w/ Lloyd's punch and uinalysis
Cause: often E. Coli
Tx: antibiotic
92
when is prostate exam indicated
w/ FH of prostate cancer
93
when is male wellness exam indicated
not indicated unless having Sx
94
inguinal hernia Sx/Tx
pain w/ increased abdominal pressure, may have bulge; have Pt cough
Tx: mild = watchful waiting, moderate to severe = surgery
95
5Ps of sexual history
```
partners
practices
prevention
protection
past history of STI
```
96
gonorrhea Sx
Sx: men discharge/dysuria/asymptomatic, women pelvic pain/discharge
97
chlamydia Sx
Sx: many asymptomatic, can have discharge or dysuria
98
Syphilis Sx
Sx: chancre, joint pains/fatigue, can be asymptomatic in latent phase
99
genital herpes Sx/Tx
Sx: clusters of vesicles, burning, tingling
Tx: antiviral
100
trichomonasis Sx/Tx
Sx: men asymptomatic, women fould smelling discharge, dysuria, pruritis
Tx: antiprotozoal
101
HPV Sx/Tx
Sx: genital warts
Tx: vax, pap smears, wart removal
102
cervical myelopathy vs radiculopathy
myelopathy - spinal cord, emergent b/c more systemic Sx
radiculopathy - nerve root, urgen but not emergent
103
meningitis Dx/Sx
Dx - lumbar puncture
Sx - fever, malaise, headache, pain/stiffness, etc
104
lumbar puncture level
L4/L5
105
atraumatic Dx workup
if no red flags, dont require imaging
106
C4-C5 disc testing
C5 root, biceps
107
C5-C6 disc testing
C6 root, brachioradialis
108
C6-C7 disc testing
C7 root, triceps
109
C4 dermatome
lateral neck
110
C5 dermatome
lateral upper arm
111
C6 dermatome
lateral forearm, thumb
112
C7 dermatome
middle finger
113
C8 dermatome
medial wrist/forearm
114
T1 dermatome
medial elbow/upper arm
115
C1 strength testing
resisted rotation ROM
116
C2-4 strength testing
scapular elevation
117
C5 strength testing
deltoid, shoulder abduction
118
C6 strength testing
biceps, wrist extension
119
C7 strength testing
triceps, wrist flexion
120
C8 strength testing
finger flexion
121
T1 strength testing
finger abduction
122
T4/T10 dermatomes
T4 - nipple
| T10 - umbilicus
123
spurlings test
compress head down then do the same in extension, SB, and rotation
+ pain -> radiculopathy
*do not perform w/ RA, cervical malformations, or metastatic disease
124
manual distraction test
distract head
+ relief of pain -> central neuropathy
125
roos/east tests
Pt abducts shoulder to 90 and ER w/ flexed elbow to 90 (T formation), Pt opens and closes hands for 3 mins
+ reproduciton of Sx -> TOS, compression of SCA
126
nuchal rigidity
Pt supine, hands behind Pt's head and flex chin to chest
+ stiffness -> inflammation in subarachnoid space (meningitis or subarachnoid hemorrhage)
127
brudzinksi's sign
Pt supine, hands behind Pts head and flex chin to chest
+ flexion in hips and needs -> inflammation in subarachnoid space
128
kernig's sign
Pt supine, flex hip and knee to 90 and attempt to passively extend the leg at the knee
+ resistance, pain behind knee -> meningeal/dural irritation
129
lines in vertebrae
anterior vertebral line - anterior body
posterior vertebral line - posterior body
spinolaminar line - TP line
posterior spinous line - SP line
130
lines in vertebrae
anterior vertebral line - anterior body
posterior vertebral line - posterior body
spinolaminar line - TP line
posterior spinous line - SP line
131
scoliosis
usually idiopathic, lateral curve of spine
most common in females
132
screening recommendations for scoliosis
most cases detected through screening do not advance to significant scoliosis so no Tx needed
significant scoliosis detected w/o screening
133
red flag pathology w/ scoliosis
- onset before age 8
- severe pain
- rapid curve progression (>1 degree/mo)
- usual left thoracic curve (convex to the left)
- neuro deficits/findings
(ask for these in ROS)
134
management/Tx of scoliosis
>45 degree curve needs Tx
Tx w/ bracing, surgery if bad enough
135
adam's forward bend test
Pt bends forward, one side of back would be higher if + for scoliosis
136
acute low back pain characteristics
6-12 weeks of pain b/w costal angles and gluteal folds that may radiate down one or both legs
acute LBP is often nonspecific so it cannot be attributed to a definite cause
137
red flags of LBP
```
TUNA FISH
trauma
unexplained weight loss
neuro Sx
age (>50)
fever
IVDU
steroid use
history of cancer
```
138
management/tx of LBP
bed rest NOT helpful
NSAIDs and muscle relaxants, Pt education
139
back strain (lumbar SD) Sx
usually onset of mild trauma and described as an ache or spasm
exam = discrete tender points, no neuro deficits
140
psoas syndrome Sx
Sx: dull ache in low back, sometimes referring to groin
exam = tender point at iliacus (medial to ASIS), + Thomas test
141
herniated nucleus pulposus Sx
pain often originates from lumbar spine and radiates down leg into foot w/ sharp burning pain
exam = weakness in effected myotome, usually +SLR
treat w/ rest
142
LBP radiating pain patterns
spine (Ms/Ls/discs) -> thigh
SI joint -> thigh, sometimes knee
L1-3 -> high and/or thigh
L4-S1 -> knee
143
disc herniation at L4/L5 - what nerve root impinged
L5
144
cauda equina syndrome
large central disc herniation compressing the tail of the lumbar spine causing pain similar to herniated disc; impingment S2-S4 can cause bowel/bladder dysfunction
emergent - w/o surgery can cause paralysis
145
spinal stenosis
narrowing of space around SC
Sx: LBP radiating down the leg w/ pain, numbness, weakness; pain worsens w/ movement and laying supine
exam = diminished reflexes, weak myotome/dermatome
146
spondylosis
defect in pars interarticularis w/o anterior displacement, thinning discs and bone spurs - "scotty dog"
usually at L5/S1
147
spondylolisthesis
vertebral body slips in relation to one below
148
imaging w/ LBP
only image w/ 6+ weeks or if there are red flags (neuro deficits, or serious conditions)
149
history questions to ask w/ LBP
```
age
level of trauma
IVDU
steroid use
Hx of cancer
```
150
ROS questions w/ LBP
fever
weight loss
neuro Sx
incontinence
151
GXPXXXX meanings
G4P2112 = 4 pregnancies, 2 full term, 1 preterm, 1 abortion, 2 living kids
152
tanner stages pubic hair
1 - none
2 - some slightly pigmented hair
3 - darker, coarser hair
4 - adult type hair w/o spread to thighs
5 - adult type w/ horizontal upper border
153
nexus criteria
- no posterior midline cervical tenderness
- normal alertness
- no intoxication
- no neuro findings
- no painful distracting injuries
*all must be met for no imaging/collar
154
hoover sign
pt flexes weak leg against resistance, downward pressure should be felt on non-weak leg
+ no pressure = malingering
155
Gaenslen test
pt flexes one hip and other hip is extended
+ posterior pelvic pain = SI joint pathology
156
valsava test
bears down
+ sciatica
157
stork test
pt flexes hip and bends back
+ LBP = par defect/stress fracture, if bilatreal increased spondylolisthesis risk
