NBCE Part 3 Ty's Notes Flashcards
Study
1
Q
What does a general case history include? (8 things)
A
1) Identifying data
2) Chief Complaint (CC)
3) Present Illness
4) Past History
5) Family History
6) Occupational History
7) Social History
8) Review of Systems (ROS)
2
Q
In the case history what topics fall under identifying data?
A
Gender, Age, marital status
3
Q
What falls under the chief complaint? What is the chief complaint?
A
- Patients own words of the problem
- CC is the reason the person is in your office
4
Q
What falls under present illness?
A
LOPPQRST and MOI
5
Q
What does LOPPQRST stand for?
A
- Location
- Onset
- Palliative
- Provocative
- Quality
- Radiate
- Site/Setting/Severity
- Timing
6
Q
What do we have to ask when it comes to location in the case history?
A
We have to ask about the anatomic regions that are in 2’s. 1 area might have brought them in but have to ask about the other if it bothers them as well.
7
Q
What does bilateral location pain indicate?
A
Systemic issues
8
Q
What does MOI stand for?
A
Mechanism of injury, must have the patient describe it
9
Q
What falls under past history? What do we need to know about the patients past?
A
- Sugeries
- Trauma
- Previous illnesses
- Previous injuries
- Medications
- Hospitalizations
- Need to know if they have seen some else for this same issue and if they were diagnosed with something specific
10
Q
What falls under family history?
A
- Dwelling (where did they grow up?)(Exposure to things)
- Death
- Diseases
- Adoption
11
Q
What falls under occupational history?
A
- School
- Work
- Activities of daily living (no matter what age the patient is we need to find out if what is going on today is bothering them with the things they need/want to do)
12
Q
What falls under social history?
A
- Sleep
- Smoke
- Stress
- Sex
- Diet
- Drugs (medical/illegal)
- Alcohol
- Water intake
13
Q
Under alcohol is social history what is the questionnaire usually asked? What does it stand for? How many “YES” answers for male and female?
A
CAGE questionnaire
-Cut down (have you ever felt the need to cut down?)
-Annoyed (have you ever felt annoyed by criticism of how much you drink?)
-Guilty (have you ever felt guilty about your drinking?)
-Eye opener (have you ever felt the need for a morning eye-opener drink?)
Male = 2
Female = 1
14
Q
What is the review of systems?
A
Questions to find any other issues that might be going on with the patient
15
Q
What are the vital signs
A
- HR (heart rate/pulse)
- RR (respiratory rate)
- BP (blood pressure)
- Temperature
- Height
- Weight
16
Q
What does pyrexia mean?
A
Elevated temperature.
I have a Fever
Elevated = pyrexia = itis
17
Q
Where do we take temperatures?
A
Oral, otic, anal, axillary
18
Q
What happens to temperature in a bacterial infection?
A
- Sustained, “night sweats” Increased temp
- Increased neutrophils
- No change in lymphocytes
- Increased leukocytes (>10,000 WBCs aka leukocytes)
19
Q
What is the normal leukocyte count (aka WBC)?
A
5,000-10,000
20
Q
What is it called if our WBC (leukocyte) count is above 17,000?
A
Schilling Shift. This is an ER moment.
21
Q
What is neutrophilia?
A
Increased neutrophils
22
Q
What is leukocytosis?
A
The number of WBC (leukocytes) >10,000
23
Q
What is leukopenia?
A
The number of WBC (leukocytes) <10,000
24
Q
What happens to temp in a viral infection?
A
- Spikes then lowers
- Decreased neutrophils
- Increased lymphocytes
- Decreased leukocytes (<5,000)
25
Where is the most accurate place to take temperature?
Anal
26
What does apyrexia mean?
I do not have a fever
27
What is the apyrexia"itis" list?
```
DON'T HAVE A FEVER!!!
Osteoarthritis
Costochondritis
Cystitis and Urethritis
Tendonitis and Bursitis
Osteitis deformans (aka Paget's)
Osteochondritis dessicans (aka AVN- avascular necrosis)
Osteitis Condensans ilii (SI problem)
```
28
What are the normal values for pulse (heart rate) in adults, newborns and elderly?
```
Adult = 60-100 BPM
Newborn = 120-160
Elderly = 70-80
```
29
What is the normal respiration rate in adults and newborns?
```
Adult = 14-20
Newborn = 44
```
30
Basic Strep story
Mouth --> Kidney --> Heart
31
What is the Lab test for Strep? What is the definitive test for Strep?
Lab test = ASO titre
| Definitive = culture
32
Detailed Strep story
Dental work/Sore throat leads to strep throat turns into glomerulonephritis (back ache/ flank pain) a couple weeks later then turns into carditis a couple months later (sub-acute bacterial endocarditis SBE affects the Mitral/Aortic valves)
33
How do we confirm strep throat?
Culture
34
How do we confirm glomerulonephritis?
UA (urine analysis) will have RBC casts
35
How do we confirm carditis?
Blood culture
36
What special study is for the heart valves?
ECHO
37
What are Osler's nodes?
Painful, red, raised lesions on the hands and feet. Associated with infective endocarditis (sub-acute bacterial endocarditis)
38
With Osler's nodes what fingernail change is likely?
Splinter. Due to Valve infection in the heart
39
How do you diagnose hypertension?
Must have 3 consecutive visits with elevated blood pressure
40
What is primary hypertension?
aka Essential
| The heart and vessels have the disease
41
What is secondary hypertension?
Malignant hypertension due to the kidneys
42
What is subclavian steal syndrome?
When the subclavian artery steals blood from the vertebral artery
43
What is the cause of clubbing of the nails with dyspnea at night? What is the dyspnea due to?
CHF (left sided heart failure)(congestive heart failure)
| Dyspnea is due to the left side of the heart failing
44
What is clubbing of nails due to?
Hypoxia, you don't get enough blood to them
45
What is ADH (antidiuretic hormone)? What does it deal with? What does antidiuretic mean?
- Peptide made by the posterior pituitary aka vasopressin
- All about Diabetes Insipidus
- Antidiuretic = not to pee (so if your not to peer is broken then you pee a lot)
46
What happens due to decreased ADH?
Diabetes Insipidus
polydipsia (increased thirst)
polyuria (increased urinating)
47
What does a diuretic do?
Makes you pee
48
What does antidiuretic do?
Makes you stop peeing
49
What happens with decreased insulin? What must we get this patient to do?
```
Diabetes Mellitus
polydipsia
polyuria
polyphagia (increased eating)
Must get this patient moving/exercising (get them off the couch)
```
50
Where is insulin made?
Tail of the pancreas
51
What happens with decreased adrenocorticoids (hypoadrenocorticism)?
Addison's disease (weight loss, hypotension, bronze skin, Arroyo sign)
52
What happens with increased adrenocorticoids (hyperadrenocorticism)?
- Cushing's (weight gain, swollen, hypertension, moon face, Hirsutism, infertility, thin extremities.
- These people are swollen on the outside
53
AKA for Cushings
hypercorticism or hyperadrenocorticism
54
Where are T3, T4 and TSH made?
Anterior pituitary
55
What is decreased T3, T4 and TSH?
Secondary hypothyroidism aka Myxedema
56
What are the characteristics of Myxedema?
- Weight gain, swollen, hypotension, dry skin, constipation, ENophthalmosis, lateral third of eyebrows missing.
- These people are swollen on the inside
57
If we have a middle aged woman with swollen, burning peripheral nerve entrapment (hands and feet), what is the differential diagnosis?
Hypercorticism (hyperadrenocorticism) aka Cushing's
OR
Secondary Hypothyroidism aka Myxedema
58
What is increased T3, T4 and TSH?
Secondary Hyperthyroidism aka Grave's disease (sweaty, diarrhea, EXophthalmosis)
59
What is hypothyroid?
Hashimoto
60
What does Vitamin D control?
Calcium
61
What happens to adults and children with decreased Vitamin D?
```
Adult = osteomalacia
Children = Rickets
```
62
What is anasarca?
Person is swollen all over. Something major in the body is dying.
63
What is icterus? Found?
Jaundice
| Eyes
64
What is kernicterus?
Brain jaundice in newborns
65
What does intracranial pressure cause in the eye?
Papilledema, enlargement and blurring
66
What does intraocular pressure cause?
Glaucoma
67
What do we see with diabetic retinopathy?
Waxy exudates and microaneurysms
68
What does hypertension cause in the eye?
Flame hemorrhages, cotton wool exudates
69
What has an absent red light reflex?
Cataract, Retinal detachment
70
What is Addie's pupil?
Asymmetrical pupil size, ANS (autonomic nervous system) damage
Unilateral
Parasympathetic lesion of CN III
71
What is lost with glaucoma?
Peripheral vision loss
72
What is lose with macular degeneration?
Central vision loss
73
The optic disc is found on what side of the eye?
Medial
74
What does the iris help prevent?
Myopia (nearsightedness) and Presbyopia (farsightedness)
75
Which is more contagious? Conjunctivitis or Iritis?
Conjunctivitis (pink eye) is more contagious because it is superficial. Iritis is deeper and can affect pupillary responses. There is a red rim around the pupil and is an ER moment with iritis.
76
What is anisocoria?
Unequal pupil size
77
What is a bump inside the eye called?
Sty
78
What is a painless bump inside the eye called?
Chalazion
79
What is a painful bump inside the eye called?
Hordeolum (painful sty in the eye)
80
How do you treat a hordeolum?
Hot pad, moist pack, epsom salt, magnesium sulfate
81
What are the triangles in the eye called?
Pterygium and Pinguecula
82
What are the triangles that do not impede or invade vision in the eye?
Pinguecula
83
What do we need to get people with pterygium or pinguecula to do to help slow the process?
Wear sunglasses
84
What is Argyll Robertson?
Bilateral small and irregular pupils that accommodate (change lens shape) but do not react to light.
Seen with tertiary syphilis
aka prostitutes pupil
85
What is blepharitis?
Staph infection in the eye
86
What are cataracts?
Opacities seen in the lens
Common with diabetes and the elderly
Absent light reflex
87
Pink conjunctica is? Pale? Bright red?
Pink = Normal
Pale = Anemic
Bright red = Infection
88
What does diabetic retinopathy affect? Presents with?
Affects the Veins
| Presents with microaneurysms, hard exudates and neovascularization
89
When is EXophthalmosis bilateral? Unilateral?
```
Bilateral = Grave's
Unilateral = Tumor
```
90
What does glaucoma cause?
Cupping of the disc, blurring vision especially in the peripheral fields of view, rings around lights.
91
Eye problems that also have skin problems are caused by?
Staph
92
Staph is associated with what eye problems?
Argyll Robertson, Corneal Arcus, Diabetic retinopathy, EXophthalmosis, Hordoleum, Horner's syndrome, Macular degeneration, pterygium, retinal detachment, xanthelasma
93
What is Horner's syndrome?
- Ptosis, Miosis and Anhydrosis and ENophthalmosis
- Commonly associated with Pancoast tumor/syndrome
- Is an interruption to the sympathetics of the face
94
What is likely to be found with Horner's syndrome?
Lower Brachial plexus involvement
Ptosis, Miosis, Anhydrosis and ENophthalmosis
Flushing of the face
Arm pain
95
What is seen with hypertensive retinopathy?
Copper/Silver wire deformity
A-V nicking
Flame hemorrhages
Cotton wool soft exudates
96
What is associated with internal ophthalmoplegia?
Dilated pupil, ptosis, lateral deviation
| Multiple Sclerosis
97
What is the most common reason for blindness in the elderly?
Macular degeneration
98
What is involved with macular degeneration?
```
Central vision loss
Macular drusen (early sign, yellow deposits under the retina)
```
99
What is swelling of the optic disc?
Papilledema aka choked disc due to increased intracranial pressure
100
What causes periorbital edema?
Allergies
Myxedema (hypothyroid)
Nephrotic Syndrome (Severe kidney damage)(HEP = hypertension, edema, proteinuria)
101
What can cause Ptosis?
Horner's
CN 3 paralysis
Myasthenia Gravis
Multiple Sclerosis
102
What is retinal detachment?
Painless sudden onset of blindness
Closing curtains
Lightning flashes and Floaters
103
Colors of the sclera?
```
White = normal
Yellow = jaundice
Blue = osteogenesis imperfecta
```
104
What are fatty plaques on the nasal surface of the eyelids?
Xanthelasma.
| Can indicate hypercholesterolemia
105
SO4LR6AO3 stands for?
Superior Oblique = CN 4
Lateral Rectus = CN 6
All other eye muscles = CN 3
106
What do the sympathetics control?
Sudomotor, Pilomotor, Vasomotor
107
What is pancoast syndrome?
When a pancoast tumor eats its way out of the lung
108
When you see METS what do you think?
METS-->Spine-->Lytic
109
Prostate or Reproductive cancer you think?
METS-->Spine-->BLASTIC
110
Exophthalmosis bilateral?
Graves aka Hyperthyroid
111
Exophthalmosis unilateral?
Space Occupying Lesion (SOL)
112
Enophthalmosis bilateral?
Myxedema aka Hypothyroid
113
Enophthalmosis unilateral?
Horner's
114
Lateral third of eyebrow missing (usually bilateral)?
Hypothyroidism
115
Bilateral anhydrosis?
Sjogren's
116
Unilateral anhydrosis?
Horner's
117
Mydriasis mean?
Dilated
118
Argyll Robertson pupil is associated with?
Tertiary syphilis or Posterior column disease
119
What is the most common lesion of the mouth?
Fordyce spot
120
What are Koplik spots?
White spots from Rubeola
121
Thrush is from?
Candidiasis
| Thick white patches that CAN be scraped off
122
Leukoplakia?
White patches that CANNOT be scraped off
123
Basal cell is?
Cancer
| Due to exposure to the sun or smoker
124
What vitamin is a problem with gingivitis?
Vitamin C (ascorbic acid)
125
Red nose equals?
Acute rhinitis and coryza
126
Pale/Gray/Blue nose equals?
Chronic infections and allergies
127
Foul discharge from nose?
Foreign object
128
Clear discharge from nose?
```
Thin = CSF (ER moment) and allergies
Thick = infection
```
129
Associated with conduction loss?
Cerumen
Otosclerosis
Infection
130
Associated with sensorineural loss?
Presbycusis
| Meniere's
131
Bulging tympanic membrane?
Acute/Chronic otitis
| All inner ear infections
132
Retracted tympanic membrane?
Serous (bubbles)
Altitude
Clogged/Blocked eustachian tube
133
What are the tests for the ear?
Weber and Rinne
134
Which test is performed first for hearing?
Weber
135
Which way does Weber test migrate?
Weber goes to the ear that can hear
136
What does Rinne test?
Air conduction vs bone conduction
| Should be 2:1
137
If air conduction is longer than bone what is going on?
That side ear is fine but the other has a nerve dying which is sensorineural hearing loss
138
If Weber test doesn't lateralize what does that mean?
Everything is normal
139
If bone and air conduction are equal what does that mean?
There is a conduction deficit
140
AKAs for Meniere's disease?
Central vertigo
| Endolymphatic Hydrops
141
What is Meniere's disease?
Recurrent vertigo, sensory hearing loss, tinnitus and fullness in the ear
142
What is presbycussis?
Sensorineural hearing loss that occurs in people as they age
143
What are common lymphadenopathies in children? Young adults? Elderly?
Children = Leukemia
Young adults = Mono, Hodgkin's and AIDS
Elderly = Multiple Myeloma
144
What is a plasma cell cytoma?
- Multiple myeloma in one bone
| - Is a primary bone cancer even though it starts in the blood of bone
145
Where is the most metastatic disease found?
Left supraclavicular lymph nodes
146
Malignant lymph nodes will display?
```
No fever (except Hodgkins)
Non-mobile
Painless sensitivity/bleeding
Firm texture
Rubbery (Hodgkin's)
```
147
Wide mediastinum, irregular, asymmetrical, lumpy, bumpy is what type of case?
Hodgkin's case
| Lymphoma
148
Hypercalcemia equals?
Bone cancer
149
Multiple Myeloma is? (MM)
```
Primary Bone Malignant Bone Cancer
Hypercalcemia
Hyperproteinemia
Bence Jones Proteinuria
Spares the pedicle
Cold Bone Scan
Elevated IgG
Endosteal scalloping
Punched out lesions (same size)
Collapsed vertebra
```
150
Lytic Mets is?
```
Secondary Bone Malignant Bone Cancer
Hypercalcemia
Targets pedicle (winking pedicle)
Hot Bone Scan
Permeative pattern
Punched out lesions (different sizes)
Long zone of transition
Moth eaten
Collapsed vertebra
```
151
Endosteal scalloping and permeative pattern eat bone from?
Inside-->Out
152
How does Lytic Mets do to bone? How does it travel?
Eats the bone and uses the blood to travel
153
What does Multiple Myeloma (MM) eat and affect?
Eats and affects the blood products and blood of bone
| MM will eat the vertebra and leave the neural arch
154
Hot bone scan? Lytic Mets or MM?
Lytic Mets
155
Cold bone scan? Lytic Mets or MM?
MM
156
How do you confirm MM?
Electrophoresis
157
What is the aka for MM?
Plasma cell sarcoma
158
ESR (SED) rate >80 with patient over 50 years old?
MM
159
Signs and symptoms of MM?
Signs = unrelenting back pain, fatigue, joint pain and swelling
Sx =Cachexia, Weight loss, Anemia, Punched out lesions
160
What is the most common primary malignancy of bone?
MM
161
What is MM associated with in the skull?
Rain drop skull
162
What are the labs for MM?
M spike on immunoelectrophoresis
A/G reversal
Bence Jones proteinuria
Elevated ESR (sed) rate
163
What is the most common malignant tumor of bone?
Lytic Mets
164
What is the most common tumor in the spine?
Lytic Mets
165
What is the most common form of metastasis in ages 20-40?
Hodgkin's disease
166
What radiographic signs are seen with Hodgkin's?
Ivory white vertebra with anterior body scalloping
| Unilateral hilar lymphadenopathy
167
How do you confirm Hodgkin's?
Biopsy confirms
| Will see Reed Sternberg cells
168
What radiographic signs are seen with Blastic Mets?
Ivory white vertebra
| No cortical thickening or bone enlargement
169
What is the aka for Paget's?
Osteitis deformans
170
What radiographic signs are seen with Paget's?
```
Cortical thickening
Picture frame vertebra
Increased bone density
Coarsened trabeculae
Bone expansion
Bowing deformities
Brim sign (whitening of pelvic brim)
Shepards crook
```
171
What are the stages of Paget's?
1) Lytic or destructive
2) Combined
3) Sclerotic
4) Malignant (osteosarcoma)
172
What are the signs and symptoms of Paget's?
Older male, getting shorter, hat isn't fitting, can't hear and shoes don't fit well
173
Describe Paget's
Paget's aka osteitis deformans will not have a fever but will have localized warmth over the areas and body parts it affects.
Replaces calcium bone with phosphorus bone (which is very weak) which leads to deforming of the bone hence osteitis deformans
174
How do you find and confirm Paget's?
Bone scan
175
Is Paget's malignant or benign?
Non-malignant (benign) until 4th stage when it becomes an osteosarcoma
176
What is the most common malignancy found in children age 10-30?
Osteosarcoma
177
What are the radiographic signs of an osteosarcoma?
Periosteal reaction that is spiculated, radiating, sunburst in appearance
178
What malignant neoplasms have ivory white vertebra?
Hodgkin's
Paget's
Blastic Mets
179
What is the number one cause of chest pain?
Heart burn and GERD
180
What is achalasia? Cause?
Narrowing of the esophagus
| Cause = scleroderma
181
What causes varices?
Alcohol
| Bulimia
182
Where do we feel pain from the head of the pancreas?
Straight through like a knife at xiphoid (T10)
183
If we feel pain at T10 straight through the xiphoid what are the 2 possible reasons? How do we differentiate the 2?
Aorta or Head of pancreas
| Differentiate by forward flexion, if pain goes away with forward flexion = head of the pancreas
184
What is pancreatitis?
Infection with fever, painful, bleeding, Grey Turner's sign, increased amylase and lipase
185
What is Grey Turner's sign? Pain? AKA
Weeping of blood into the flanks.
There is no pain.
AKA = Echymosis
186
Where is the head of the pancreas located?
Midline
187
What is the tail of the pancreas involved with?
Diabetes Mellitus
188
What types of Diabetes Mellitus are there?
2 types
1) Juvenile onset (type 1) insulin dependent, under 30 years old, thin
2) Adult onset (type 2) non-insulin dependent, over 40 years old, obese
189
What are the labs for Diabetes Mellitus?
GTT (glucose tolerance test)
FBS (fasting blood sugar) FPG (fasting plasma glucose)
Post-Prandial
HBA1C (glycosylated hemoglobin)
190
Polydypsia, polyphagia, polyuria equals?
Diabetes Mellitus
191
What is Diabetes Mellitus associated with?
DISH aka Forestier's Disease in those older than 50
| AS (ankylosing spondylitis) in those 15-35, will have increased vaginal infections
192
What is the best test for diabetes mellitus?
HBA1C
193
What are gastric and duodenal ulcers considered?
Peptic ulcers
194
What is the most common peptic ulcer?
Duodenal
195
What causes peptic ulcers?
Infection
196
What is chronic gastritis?
Abuse, Alcoholism, B12 deficiency
| -Denaturing of lining of gut-->pernicious (megaloblastic) anemia--> PLS
197
What does B12 deficiency lead to?
RBC death --> Pernicious (megaloblastic) anemia --> Demyelination of posterior columns and lateral tracts --> loss of fine touch, vibration, 2-point discrimination, and proprioception --> stocking/glove paresthesia aka Posterolateral sclerosis (PLS)
198
What is secreted by Parietal cells in the gut? What does it do?
Intrinsic factor.
| Makes B12 absorbable
199
Vegans have what vitamin deficiency?
B12
200
What is B12 used for in the body?
- RBC maturation
| - Myelination of nerves
201
aka for demyelination
sclerosis
202
demyelination of posterior columns is?
Posterolateral sclerosis aka stocking/glove paresthesia
203
What are the tests for B12?
- B12 assay (checks levels of B12 not confirmation)
- Schilling's Test (Best test, if a lot of B12 is in the urine you are getting what you need)
- Achlorhydria (absence of HCl in gastric secretions)
204
Signs and symptoms of stomach cancer?
Unexplained weight loss (even with eating)
Painless bleeding
Chronic GI disorders
Left virchow/sentinel node
205
Crohn's and Ulcerative Colitis have diarrhea but what is the difference between the two?
Crohn's = epsiodes of diarrhea, skip lesions, explosive
| Ulcerative Colitis = bloody diarrhea, descending colon, megacolon
206
What is appendicitis?
Periumbilical pain--> Tender McBurney's point--> Fever--> Relief (burst)--> Rebound tenderness (peritonitis)(all 4 quadrants have pain)--> Death
207
Cholecystitis and cholelithiasis are connected to what organ?
Gallbladder
208
What is cholecystitis?
Severe RUQ pain with nausea, vomiting, precipitated by large fatty meals.
MC seen in Females, Forty years old, fat, fertile
Increased WBCs
209
What is the most common cause of cholecystitis?
Cholelithiasis (gallstones)
210
Where is McBurney's point?
1/3 the distance from the ASIS to the umbilicus
| Base of the appendix where is attaches to the cecum
211
What are cholelithiasis?
Gallstones
| Normal WBCs
212
Where is pain referral for the gallbladder?
Right shoulder or tip of the right scapula
213
When you hear liver what do you think of?
Liver = veins
214
Hepatitis A is?
Oral-fecal
215
Hepatitis B is?
Blood born, needles, transfusion, surgeries, sexual, carrier for life
216
Hepatitis C is?
Chronic, blood transfusions
217
Which Hepatitis is most common to become liver cancer?
Hep B
218
Labs associated with the liver?
Alk Phos, SGOT/AST, LDH, Aspartate transaminase, GGT, SGPT/ALT, CPK, BUN (blood urea nitrogen)
219
Describe BUN.
BUN is blood urea nitrogen. BUN is made in the liver and excreted through the kidneys
220
GGT is the test for?
Alcohol
221
What is the best test for the liver?
ALT (alanine transaminase)
222
What is the most common site for metastatic disease?
Liver
223
What is the most common cause of liver damage? What does it lead to?
Alcoholism
| Cirrhosis
224
What does cirrhosis cause?
Portal hypertension
Ascites
Esophageal varices
225
What is Mallory Weiss syndrome?
Coughing, tearing esophageal blood vessels and hematemeis with palmar rash due to bile salts
226
What do we evaluate with a Biliary duct obstruction? What does it lead to?
Liver, gallbladder and head of the pancreas
| Leads to yellow skin and pale poop (clay gray)
227
Orthopedic test for the kidney?
Murphys punch
228
What is nephritis?
```
Infection
Fever
Flank pain
Proteinuria
Single cast
```
229
What is nephrosis?
Death
Hypertension, Edema, Proteinuria (HEP)
All casts
230
What is toxemia of pregnancy?
HEP + pre-eclampsia
231
RBC casts equals?
Glomerulonephritis (STREP)
232
WBC and Waxy casts equals?
Pyelonephritis
233
All casts equals?
Nephrosis
234
Hyaline casts equals?
Normal/Nephrosis
235
Where is the referred pain for renal and ureters?
Flank
236
Where is the referred pain for bladder?
Suprapubic
237
Where is the referred pain for the urethra?
Groin
238
Referred pain for a stone?
Colicky
239
Upper Tract infection is due to? What direction?
Kidney
| Descending
240
Lower Tract infection is due to? What direction?
Bladder, sexual activity, female with poor hygiene, prostate
| Ascending
241
What are the tests for prostate cancer?
Acid phos, Alk phos
242
If acid phos is elevated?
Agressive prostate disease
243
If Alk phos elevated?
Blastic Mets
244
What does alk phos tell us?
We are making bone or the liver is in trouble
245
When will we see and increase in Alk Phos?
Puberty, Fracture, Paget's Blastic Mets
246
If we have increased acid phos and increased alk phos?
Prostate cancer with Blastic Mets
247
What is a fibroadenoma?
A painless, firm lesion, non-malignant lump
| Single nodule
248
What is fibrocystic disease?
Painful, multiple, mobile nodules that get worse
249
Who can get a fibroadenoma?
Both Men and Women
250
Who gets breast cancer?
Both men and women
251
What is breast cancer in men called?
Gynecomastia
252
What is the aka for Paget's Disease?
Nipple cancer
253
What is the most common are for metastasis of the breast?
Axilla
254
What are the first signs of pregnancy? What do we order if these symptoms are present?
LBP, breast tenderness, and nausea
| Order HCG test
255
What does a HCG test tell us?
Increased HCG = tumor or twins
| Decreased HCG = ectopic pregnancy
256
What is the second most common primary cancer in females?
Uterine/Cervical cancer
257
Describe Cheyne Stokes
Rhythmical apnea, brain lesion, ER moment
258
Describe Biot's
Irregular apnea, medulla damage, ER moment
259
Describe Kussmaul
Air hunger, associated with diabetic coma, deep breathing, ER moment
260
Describe Pink puffer
Balloon lungs, emphysema
261
Describe Blue bloater
Chronic bronchitis
262
What does fremitus feel?
Fremitus feels fluid
263
Dull percussion in the lungs associated with? Fremitus will be?
Bacterial pneumonia, pulmonary edema, CHF
| Fremitus will be increased
264
Air in the chest will percuss? Associated with what conditions? Fremitus will be?
Hyperresonant
Emphysema, pneumothorax, COPD
Fremitus decreased
265
Gastric air will percuss? Condition?
Tympanic
| Magenblase
266
Flat percussion is associated with what condition?
Atelectasis
267
Rales, wheezes and crackles with all have what type of percussion?
Dull percussion
| Fremitus will be increased
268
Friction rub equals?
Pleurisy
269
Prolonged expiration associated with?
COPD
270
Rusty sputum associated with?
Pneumococcal
271
Red currant jelly sputum?
Klebsiella (Friedlander's)
| Pneumonia, chronic depressed, alcoholics
272
Walking pneumonia in an adult?
Mycoplasma
273
Mucopurulent, productive sputum?
Viral
274
What is Reye's syndrome?
Children with a recent viral infection, can cause confusion, swelling the the brain and liver damage.
275
Who is most at risk to get Reye's syndrome?
Children recovering from a viral infection that have a metabolic disorder (ie: diabetes mellitus 1 or 2, PKU, maple syrup urine disease), that have been taking aspirin
276
Foul sputum?
Bronchiectasis, Chronic infections
277
Protozoan associated with AIDS?
Pneumocystic Carinii
278
Dry cough vs Productive cough
```
Dry = Marfan's, long standing hypertension, AAA (arch), Laryngitis
Productive = TB (red), CHF (pink, frothy, bubbly)
```
279
What are associated with bright red hemoptysis?
- Pulmonary infarct
- Caner
- TB
280
What will an xray look like with someone with COPD?
Air gets trapped in the lungs so they look more black,
| Narrowed mediastinum, flattened hemidiaphragm, ribs will look horizontal, increased intercostal space
281
AKA COPD
Emphysema
282
Radiographic signs of lung cancer?
Primary (snowball) one nodule
| Secondary (cannonballs) multiple nodules
283
Radiographic sign of lymphoma? Types of lymphoma?
Lumpy bumpy
| Types = Hodgkin's, Sarcoidosis
284
Hyperlucent radiographic finding? What does it cause the mediastinum to do?
Pneumothorax.
| Pushes the mediastinum away from side of involvement
285
Radiographic findings for atelectasis? What is atelectasis due to?
Collapsed area of the lungs, Mediastinum sucked towards side of involvement.
Due to bronchial obstruction, mucous plug
286
Associated with Schepelmanns ortho test?
Pleurisy and Intercostal neuritis
Pleurisy hurts opposite side leaning towards
Intercostal neuritis hurt same side leaning towards
287
AKA for Myocardial Infarct (MI)? Lab test? Makes it worse? Better?
```
aka = Coronary infarct
Lab = Troponin, CPK, SGOT, LDH
Worse = anything
Better = Nothing
```
288
AKA for Angina? Lab test? Makes it worse? Better?
```
aka = Coronary ischemia
Lab = Normal labs
Worse = activity
Better = Rest within 10 minutes
```
289
What is a normal EKG?
P wave, QRS complex, T wave
290
What is the P wave?
Atrial depolarization
291
What is the QRS complex?
Ventricular Depolarization
292
What is the T wave?
Ventricular repolarization
293
Anything that disrupts QRST?
Myocardial Infarct
294
What does an MI do to EKG?
Increases time between QRS and T wave
| Inverts T wave
295
Widened QRS complex?
Bundle of HIS lesion, ventricular hypertrophy
296
When are the heart sounds heard?
S1 heard end of QRS (AV shut)
| S2 heard end of T (Semilunar shut)
297
S1 is which valves?
AV valves (mitral and tricuspid)
298
S2 is which valves?
Semilunar (Aortic, Pulmonic)
299
What are the murmurs?
Stenosis, Regurgitation
300
What are the diastolic murmurs?
ARMS PRTS
Aortic Regurgitation Pulmonic Regurgitation
Mitral Stenosis Tricuspid Stenosis
301
What is APETM?
```
A= Aortic (2nd ICS on R sternal border)
P= Pulmonic (2nd ICS on L sternal border)
E= Erb's Point (3rd ICS L sternal border, all murmurs best heard here)
T= Tricuspid (4th/5th ICS L sternal border)
M= Mitral (5th ICS midclavicular line, best heard in lateral decubitis position)
```
302
What is the cause and result of heart failure?
```
Cause = hypertension
Result = edema
```
303
What is the 1st sign of heart failure? Last sign?
```
1st = fatigue
Last = pitting edema (anasarca)
```
304
What is Right sided heart failure?
aka Cor Pulmonale (lungs caused the problem)
Cause = pulmonary hypertension (smoking, COPD, emphysema)
R ventricle hypertrophy --> R ventricle failure
Result = body edema, jugular distention, "portal hypertension"
305
What caused Right sided heart failure?
The problem started in the lungs
306
Right sided heart failure is involved with veins or arteries?
Veins
307
What is Left sided heart failure?
```
aka CHF (congestive heart failure)
Cause = Systemic hypertension (diet, DM, drugs)(clogged blood from fats and sugars in the blood)
L ventricular hypertrophy --> L ventricular failure (fatigue)(failure to pump forward)
Result = pulmonary edema, nocturnal dyspnea, pink frothy sputum
```
308
Progression of heart failure starting from L side
L side heart failure --> pulmonary problems --> R side heart failure
309
Which way does the heart fail from?
Fails from L --> R
310
Arterial, Venous or Both?
| Atherosclerosis/Arteriosclerosis?
Arterial
311
Arterial, Venous or Both?
| Raynaud's
Arterial
312
Arterial, Venous or Both?
| Buerger's
Both
313
Arterial, Venous or Both?
| Diabetes Mellitus
Arterial
314
Arterial, Venous or Both?
| Aneurysm
Arterial
315
Arterial, Venous or Both?
| Leriche's
Arterial
316
Arterial, Venous or Both?
| Coarctation of the Aorta
Arterial
317
Arterial, Venous or Both?
| RSDS/CRPS
Arterial
318
Arterial, Venous or Both?
| Shoulder-Hand-Finger Syndrome
Venous
| Is venous lymphatic return
319
Arterial, Venous or Both?
| DVT
Venous
320
Arterial, Venous or Both?
| Liver disease
Venous
321
Arterial, Venous or Both?
| Intermittent claudication
Arterial
322
What is neurogenic claudication? Pattern? Relief? Cause? Treatment?
Pain during activity and relief of pain with change in position.
Pattern = Non-predictable, LBP, bilateral
Relief = Positional, stoop/supine, knees bent, bicycle
Cause = Central canal stenosis, DJD
Treatment = walk and primary cary
323
What is vascular claudication? Pattern? Relief? Cause? Treatment?
```
Pain during activity and relief of pain with rest
Pattern = Predictable
Relief = Always with rest
Cause = arteriosclerosis, buerger's
Treatment = walk and co-care
```
324
Normal RBC count?
4.5-6 Million
325
What is a reticulocyte?
Young (immature) RBC
326
What is polycythemia?
Increase RBC count 6-8 Million
327
What is polycythemia vera?
RBC count greater than 8 Million
328
Normal WBC count?
5-10,000
329
What is a Schillings shift?
WBC count 17-18,000
330
Arterial, Venous or Both?
| Scleroderma
Arterial
331
What is the difference between Raynaud's Phenomenon and Raynaud's Disease
Both have = Triphasic, cold sensitivity, hands/feet
Difference = If it's the only thing you have it is considered Raynaud's Disease. If it is accompanied by anything else (Scleroderma, Buerger's, other conditions) it is Raynaud's phenomenon and that makes it secondary
332
aka for Buerger's?
Thromboangitis obliterans. It obliterates the veins then the arteries, usually the veins first
333
What does RSDS/CRPS stand for?
```
RSDS = Reflex Sympathetic Dystrophy Syndrome
CRPS = Complex Regional Pain Syndrome
```
Is a lack of sympathetic supply after an injury on the extremity
334
A CBC is all about which cells?
RBCs
335
A differential is all about which cells?
WBCs
336
What 2 things will increase RBC count?
Altitude and smoking
| Increased RBC count = polycythemia
337
MCV, MCH, MCHC indicate what?
Anemias
338
What are the big 3 anemias?
1) Microcytic/Hypochromic = RBC shrunk down, no dark rusty color (lost its iron), tells us person is iron deficient
2) Macrocytic/Normochromic = Reticulocytes are dying, no maturation, this is a B vitamin problem (B9 or B12), B12 pernicious anemia --> PLS, or B9 folate, baby development
3) Normocytic/Normochromic = Pt is on chemo, radiation therapy. Have trouble manufacturing blood products
339
aka for WBC
Leukocyte
340
What is an increase in WBCs?
Leukocytosis
341
WBC types?
```
Neutrophils
Lymphocytes
Monocytes
Eosinophils
Basophils
```
342
When do Neutrophils increase?
Bacterial infection, Schilling shift, inflammation
343
When do Lymphocytes increase?
Viral infection, decreased neutrophils, mononucleosis
344
Monocytes deal with?
Chronic infection, lymphoma
345
Eosinophils deal with?
Allergies
346
Basophils deal with?
Heavy metal and polycythemia
347
What does a urinalysis look for?
Protein, Glucose, Ketones, Blood, Casts
348
Protein in the urine due to?
Nephron disease and Multiple Myeloma
349
Glucose in the urine due to?
Diabetes Mellitus, shock
350
Ketones in the urine due to?
Diabetes Mellitus, starvation
351
Blood in the urine due to?
Trauma, infection, stone, prostate and cancer
352
Casts in the urine due to?
Nephron disease
353
```
Urine colors:
Green equals
Yellow =
Orange =
Black =
Red =
Smoky =
```
```
Green = Bilirubin
Yellow = Concentrated
Orange = B vitamins
Black = Ochronosis (alkaptonuria- can't change phenylalanine into tyrosine)
Red = Lower tract RBCs
Smoky = Upper tract RBCs
```
354
Frank blood stool is?
Lower GI issue
355
Occult blood stool is?
Upper GI issue
| GUAIAC- study hidden bleeding
356
What are the immunoglobulins?
IgG, IgA, IgM, IgE, IgD
357
What is IgG for?
Fights bacterial, fungus and toxins. Second to fight, Increased in Multiple Myeloma
358
What is IgA for?
Mucosal linings of GI and Lung
359
What is IgM for?
First to fight
360
Acid phosphatase study used for?
Prostate disease
361
A/G reversal seen in?
Multiple Myeloma
362
Alkaline phosphatase seen in?
Blastic bone disease, liver disease
363
ANA (sero +)
```
Collagen diseases:
SLE (lupus)
Scleroderma
Polyarteritis nodosa
Sjogren's
RA (rheumatoid arthritis)
```
364
Increased BUN?
Kidney disease
365
Decreased BUN?
Liver disease
366
GTT study?
Diabetes Mellitus, hypoglycemia
367
HLA-B27 (sero -) study?
```
UCRAPE
Ulcerative Colitis
Crohn's
Reiters (reactive) arthritis
AS (ankylosing spondylitis)
Psoriatic arthritis
Enteropathic arthritis
```
368
Increased potassium?
Addison's, renal failure
369
Protein (CSF)
Viral meningitis, sclerosis
370
Protein (Blood)- Increased?
Hyperproteinemia (Multiple Myeloma)
| Proteinuria
371
Protein (Blood)- Decreased?
Hypoproteinemia (Kidney)
| Proteinuria
372
SGOT/AST
Heart and Liver disease
373
SGPT/ALT
Liver disease
374
T3/T4/TSH
Thyroid disease
375
ESR > 80 in a patient > 50 years old =
Giant Cell Arteritis
Temporal arteritis shows up with headaches
polymyalgia rheumatica = ache all over
Plasma Cell Cytoma = Primary bone cancer, Multiple Myeloma
376
Nocturnal, boring, deep, achy pain, what should you order? Result?
Order bone panel
| Result = possible bone cancer
377
What does RA not like?
I don't like my Synovium
378
What does scleroderma not like?
I don't like my smooth muscle
379
What does SLE (lupus) not like?
I don't like my body in general, don't put me in the sun (malar rash)
380
In the HLA-B27 club, which things are related or look alike?
UCRAPE-
UC&E = colon-joint club
EA = can look exactly alike in the spine, Bilateral, marginal syndesmophytes (calicification of the ligaments), fragile
PR = look alike in the spine, thick, bulky flowing syndesmophytes (calicification of the ligaments)
381
Enteropathic and AS like which joints?
Bilateral SI joints
382
Psoriatic and Reiters (reactive) like which joints?
Unilateral SI joints
383
Psoriatic likes?
Hands (only one to like the hands)
384
Reiters (reactive) likes?
Heel spur
385
Enteropathic all about?
diarrhea
386
AS likes getting into?
Costovertebral joints leads to trouble breathing, dyspnea
387
In HLA-B27, which parts are not arthritides and not seen on xray?
Ulcerative Colitis and Crohn's
388
Which 2 of HLA-B27 are spine only?
Enteropathic and AS
389
Bone panel, increased alkaline phosphatase is
Blastic
390
Bone panel, decreased alkaline phosphatase is
Lytic
391
Myelopathy: Definition? UMNL or LMNL? Region? Signs/Symptoms? Neurological exam? Ortho exam? Definitive?
- Definition = Spinal cord
- UMNL or LMNL = UMNL and CNS (only one to cause an UMNL)
- Region = Upper cervical (ADI, RA), Lower cervical (canal stenosis, OA) lower lordotic curve
- S/Sx = Cervical flexion
- Neuro exam = Complete, clonus and pathological reflexes
- Ortho exam = Lhermitte's (active test performed by the patient only)
- Definitive = MRI, EMG, SSEP, Xray (flex/ext views)
392
Radiculopathy: Definition? UMNL or LMNL? Region? Signs/Symptoms? Neurological exam? Ortho exam? Definitive?
- Definition = Root/number. C4, T6, L2.
- UMNL or LMNL = LMNL and PNS
- Region = IVF, Lateral recess. C5-T1 lower cervical spine, L4-S1 lower lumbar spine
- S/Sx = Spinal lateral flexion and extension, rotation towards side of lesion. Radiating pain.
- Neuro exam = Myotome, dermatome, DTRs
- Ortho exam = Cervical compression, shoulder depression, Kemps, SLR, WLR
- Definitive = EMG, Xray (IVF), Disc (MRI)
393
Neuropathy: Definition? UMNL or LMNL? Region? Signs/Symptoms? Neurological exam? Ortho exam? Definitive?
- Definition = Peripheral name (PNE-peripheral nerve entrapment) Sciatic neuropathy
- UMNL or LMNL = LMNL and PNS
- Region = Extremities, brachial plexus, sciatica
- S/Sx = Distal to site of entrapment (adjacent), burning (causalgia)
- Neuro exam = several muscles in compartment, pure patch
- Ortho exam = varies
- Definitive = NCV (nerve conduction velocity), EMG
394
Only one to cause an UMNL. Can be both UMNL and LMNL if really significant diseases. Would have to be CNS involvement, bilateral upper/lower extremities, coordination, increase/decrease in bone density. Mostly systemic problems, might consider co-care
myelopathy
395
Always present in an IVF. Always present after the cord ends. Is in the central canal of the lumbar spine but not the cervical or thoracic spine. Always a number. Is a peripheral nervous system lesion, or PNS disorder but not a peripheral nerve entrapment
Radiculopathy
396
PNE (peripheral nerve entrapment) is after the IVF when a nerve gets trapped. Gets trapped by spams. Named nerve.
Neuropathy
397
What is the traction test for the cervical spine nerve roots?
Shoulder depression
398
What is the traction test for the lumbar spine nerve roots?
SLR, WLR, Braggard's, Kemp's
399
What is the only compression test in the lumbar spine?
Kemp's test. aka Oblique extension test
400
What does NCV test for?
PNE (peripheral nerve entrapment), Neuropathy only
401
What does EMG stand for? Test for?
Electromyography
| PNE, CNS, radiculopathy
402
What does SSEP test for?
CNS and PNS
403
What does MRI test for?
Disc, Nerve, Brain, Stroke, Joint, Healing
404
What does CT (cat scan, spect) test for?
Stenosis, Fracture, Bleeding, Lung
405
What does absorptiometry/DEXA test for?
Bone density, osteopenia
406
What does a PET scan test for?
Metabolic activity in soft tissue, lymph, breast
407
What does a bone scan (scintigraphy) test for?
Lytic and blastic mets
408
Cancer referral
Oncologist
409
Arthritide, collagen diseases referral
Rheumatologist
410
KUB diseases, infection, stones, prostate referral
Urologist
411
Pancreas (DM), thyroid, adrenals, DISH referral
Endocrinologist
412
Systemic, alcoholism, DM, inflammatory arthritides, collagen referral
Internist
413
MS, ALS, myasthenia gravis, polio referral
Neurologist
414
Skin cancer (melanoma) referral
Dermatologist then oncologist
415
What type of skin cancer is waxy, indurated or hard and least likely to metastasize?
Basal Cell
416
What type of skin cancer is irregular, flaky, bleeding?
Squamous cell
417
What type of skin cancer is pigmented, multicolor, invasive skin cancer and the most dangerous?
Melanoma
418
What is involved with Psoriasis
Silver scales, pitted nails, occurs on extensors, brown patches
419
Associated with purple cancer and AIDS?
Kaposi's sarcoma
420
Associated with butterfly rash, malar rash, sun sensitive?
SLE (Lupus)
421
Associated with rash on the eyelids and knuckles, sun sensitive?
Dermatomyositis
422
What causes clubbing of the nails?
COPD, emphysema, arthritis, cancer, hypertrophic pulmonary osteoarthropathy, CHF, RA
Lack of oxygen (Hypoxia)
423
What causes transverse grooves and lines aka Beau's lines on the nails?
Systemic disease
| Must be in all fingers and toes
424
What causes vertical lines on the nails?
Valve problems, subacute bacterial endocarditis
| aka Splinter hemorrhages
425
What causes pitted nails?
Psoriasis
426
What causes spooning aka koilonychia of the nails?
Iron deficiency and fungus
427
What is the most common endocrine disease in the geriatric population?
Diabetes mellitus
428
What is the most common PNE (peripheral nerve entrapment) disease in the geriatric population?
Hypothyroid
429
Most common cause of blindness in the geriatric population?
Macular degeneration
430
Most common cause of hearing loss in the geriatric population? Every age group?
Cerumen
| Cerumen
431
Most common lung disease in the geriatric population?
Pneumonia (bacterial)
432
Most common cause of death in the geriatric population?
Heart, Cancer, Lung
433
Aka for old eyes?
Presbyopia
434
Aka for old ears?
Prebycusis (sensorineural deficit)
| Otosclerosis (conduction deficit)
435
Most common spontaneous fracture in the geriatric population?
Hip
436
Most common traumatic fracture in the geriatric population?
Wrist
437
Most common compression fracture in the geriatric population?
T4-T8
438
Most common cause of visual loss in the geriatric population?
Cataracts
439
Describe temporal arteritis
- Must be in a person 50 years old or older
- Localized headache (giant cell arteritis) associated with polymyalgia rheumatica (generalized achiness), hypertension, fever, increased ESR
440
How do you confirm temporal arteritis?
Aspiration biopsy
441
Most common cancer in the geriatric population both male and female?
Lung
442
Second most common cancer in the geriatric population for female? Male?
```
F = Breast
M = prostate
```
443
Key words for CHF?
Insidious, swollen, fatigue, nocturnal dyspnea
444
Key words for MI?
Sudden, painful
445
What is most commonly lost first in neuromuscular issues in the geriatric population?
Vibration
446
When evaluating the posterior columns, what test must you always perform?
2-point discrimination
Vibration sense
Position sense
447
What will we typically see in the geriatric population with parkinson's?
Shuffling gait, resting tremor, cog wheel rigidity, bradykinesia
448
Symmetrical or Asymmetrical?
| OA
Asymmetrical
| Except in the knee it's symmetrical
449
Symmetrical or Asymmetrical?
| RA
Symmetrical
| Except in the SI joint in both M/F over 40 years old
450
OA is considered ___ to the joints?
Abuse
451
RA is considered ___ to the joints?
Patterned
452
Which way does OA do damage?
Distal to proximal
453
Which way does RA do damage?
Proximal to distal
454
What is the first thing to show up with OA?
Geode cyst or small cracks due to trauma
455
What is the second thing to show up with OA?
Offset of alignment of the joint
456
What is the end stage of OA?
More bone made to help with stability, osteophytes in the spine called spondylophytes
Approximation and widening of the joint surface
457
Instability is associated with OA or RA? What is instability a sign of?
OA
| Instability is a sign of trauma or abuse
458
OA is a bone ___?
Bone maker
459
What is the 1st sign of RA?
Soft tissue swelling
460
What is the last sign of RA?
Joint fusion, deformity
461
How does RA affect the joints?
It goes all the way across the joints, MCPs, PIPs, DIPs, and we see juxta-articular osteoporosis
462
Describe whole process of RA
Soft tissue swelling --> Rinsing (hyperemia) loss of bone -->juxta-articular osteoporosis --> bone replaced, subchondral cysts --> Eating/erosion of bare spot (rat bite) --> Joint instability --> Joint migration --> Fusion, deformity
463
Early RA think? Late RA?
```
Early = Juxta-articular osteoporosis
Late = Instability
```
464
Does OA or RA fuse?
RA will fuse
465
aka spondylosis?
DDD (degenerative disc disease)
466
Spondylosis affects which part of the vertebra?
Anterior portion
467
Arthosis affects which part of the vertebra?
Posterior portion
468
Radiographic features with spondylosis?
Eburnation (whitening/thickening of the end plates), decreased disc space, schmorls node, spondylophyte or osteophyte growing from the bone, traction spurs
469
aka arthrosis?
DJD (degenerative joint disease)
470
What does AS (ankylosing spondylitis) and DISH preserve?
The Disc
471
What is the difference between AS and DISH?
AS affect both the anterior and posterior joints
| DISH affects anterior only
472
Which ligaments does AS affect?
ALL and PLL
473
Complications of AS?
Trouble breathing and getting a full breath of air
474
Which ligaments does DISH affect?
ALL only
475
DISH is associated with?
Diabetes mellitus
476
When will we see facet ankylosis?
In patients with AS
477
Describe lytic mets. What labs?
Osteoclasts break down bone and send out calcium in the urine. Replace calcium with phosphorus. bone is cheap bone so it gets thicker to help with strength
Hallmark of phosphorus is thickening the cortex and expanding bone
Labs = UA
478
What will Mixed and blastic mets have
Increased Alk Phos but normal calcium
479
Radiographic feature called picture frame associated with?
Mix of lytic and blastic mets
480
What happens to bone in blastic mets?
The body sends in more and more phosphorus, in the spine this is called ivory white vertebra, in the skull it's cotton wool.
481
What can blastic mets turn into?
Osteosarcoma
482
What lab values give away osteosarcoma?
Increased alk phos and increased calcium
483
What to think of with hypercalcemia?
Bone cancer
484
How do we tell what areas of the body are involved with bone cancer?
Order a bone scan
485
Describe Paget's
Cortex thickening, increased spider web trabeculae, brim sign (whitening of the pelvic brim), shepherds crook femur
486
aka for Paget's
Osteitis deformans
487
What happens with osteopetrosis?
Can't absorb cartilage, so it gets left and ossified, bone is not as strong.
488
Radiographic features with osteopetrosis
Sandwich vertebra
489
Radiographic features with Secondary Hyperparathyroidism
Rugger jersey spine, salt and pepper skill, radial erosions of the fingers, distal tuft resorption, vessel calcification
490
Describe secondary hyperparathyroidism
Life threatening. Refer this person out. Hypercalcemia
491
What is secondary hyperparathyroidism really?
It is a renal problem causing bone disturbances trying to maintain blood calcium.
492
What is the aka for secondary hyperparathyroidism
Renal osteodystrophy
493
Where is the most common place for a congenital block?
Cervical spine. Lower cervical spine due to most degeneration
494
What do we call a congenital block on xray
wasp waist
495
Radiographic features of congenital block
Was waist deformity, hypoplastic or rudimentary disc, posterior joint fusion. Can see IVF on lateral cervical film
496
How do you differnetiate Legg Calve Perthes (LCP) against Slipped Capital Femoral Epiphysis (SCFE)?
AGE of the patient!
4-8 year old = LCP
12-16 year old = SCFE
497
What is Legg Clave Perthes?
Affects 4-8 year olds, lack of blood supply to the bone. Bone degeneration of one side. If the joint is healthy on the opposite side of the degeneration then there is an asceptic problem.
498
What is an asceptic problem in a joint due to?
Lack of blood supply from trauma, idiopathic, growth spurt, anemia, crisis anemias (sickle cell)
499
What does an asceptic proble lead to?
Leads to AVN (avascular necrosis)
500
Describe SCFE (slipped capital femoral epiphysis)
Bone slips up. Shaft points coxa vara called juvenile coxa vara, is a Salter Harris type/grade 1 fracture
501
What is "SOC HOP"
SOC HOP = ways to think of bone problems for age group 12-16 year olds.
4 S's = Scoliosis (girls), Scheurmannns (boys), SCFE, osgood Schlotter's (knee)
502
Describe an Aneurysmal bone cyst (ABC).
ABC = fluid filled cyst, multiple cysts gathered together, soap bubble appearance, does not have to be symmetrical, causes pain.
503
Describe a Unicameral bone cyst (UBC).
aka Simple bone cyst or single bone cyst, symmetrical balloon shaped single cyst
504
How do we find benign bone tumors?
Incidentally
505
Which benign bone tumors have pain?
ABC (aneurysmal bone cyst) and Osteoid osteoma
506
What has ulnar deviation?
SLE (lupus) and RA (rheumatoid arthritis)
507
What has reducible ulnar deviation?
SLE, doesn't usually go into the fingers but can and can be reducible on a table (meaning they can be straightened)
508
Describe RA
Permanent joint deformity, causes destruction throughout the hand, affects all of the MCP's then PIP's the DIP's. Moves in unifrom pattern.
If you have it on the right you have it on the left
Destroys proximal to distal
509
Who destroys the distal tufts?
Scleroderma, Psoriatic, Secondary Hyperparathyroidism (renal osteodystrophy)
510
OA attacks the joint
Distal to proximal and usually only those being abused
511
Associated with sausage digit
Psoriatic, which attacks an entire MCP, PIP, DIP at the same time
512
Is psoriatic symmetrical or asymmetrical?
Very asymmetrical, can attack whatever it wants
513
Of scleroderma, psoriatic and secondary HPT, which one destroys joint?
Psoriatic only
514
What do scleroderma and secondary HPT have in common?
Distal tuft erosion, vessel calcification
515
How does scleroderma calcify?
Calcifies vessels through smooth muscle
516
How does secondary HPT calcify?
Calcifies vessels through the kidneys releasing calcium leading to hypercalcemia in blood products
517
Patient has distal tuft erosion, good looking joints, can't swallow, Diagnosis?
Scleroderma
518
See a hand film, skull film, spine film, diagnosis?
Secondary HPT, salt and pepper skull, rugger jersey spine
519
Primary bone cancer
Multiple Myeloma, Osteosarcoma, Chondrosarcoma, Ewings sarcoma
520
Secondary bone cancer
Lytic and Blastic Mets
521
Periosteal reaction
Osteosarcoma, chondrosarcoma, ewings sarcoma
522
No periosteal reaction
Multiple myeloma, lytic and blastic mets
523
Holes in the bone
Multiple myeloma, lyitc mets
524
Blastic mets radiographic features
build up of bone, ivory white vertebra, cotton balls
525
Multiple Myeloma (MM) is
```
Primary bone cancer
No periosteal reaction
Hole in the bone
Raindrop skull
Blood, bone, protein problem
Bence Jones Proteinuria
Increased ESR, A/G reversal, IgG
Cold Bone Scan
```
526
Winking pedicle
Lytic mets
527
Which primary/secondary bone cancers have +/hot bone scan?
Osteosarcoma, chondrosarcoma, ewing's sarcoma, lytic mets, blastic mets
528
What is the purpose of kVp? Low kVp will have? High kVp will have?
Controls contrast
low = High contrast
high = Low contrast
529
If there is more of someone, or something what needs to happen with kVp?
More of me = more kVp
530
With OA what will need to happen to kVp?
OA is a bone make, there will be more bone, so kVp will need to be increased
531
Developer will reduce?
Exposed silver bromide crystals
532
What does the fixer do?
Clears/removes unexposed silver bromide crystals
| Hardens the film by removing unexposed silver bromide crystals
533
What is normal aortic diameter?
```
Normal = 3.5 cm
>3.5 = aneurysm
6+ = medical emergency
```
534
Avulsion fracture aka
Clay shoveler's
535
Tansverse fracture aka
Pathological Disease
536
Fatigue fracture aka
Repetitive physical stress
537
Comminuted fracture aka
more than 2 pieces
538
Impacted fracture aka
One part driven into the other
539
Greenstick fracture aka
Children
540
Compound fracture aka
Protruding through the skin
541
Growth plate fracture aka
Salter Harris (children)
542
Silhouette sign aka
Bacterial pneumonia
543
Stair step gas aka
Paralytic ilii
544
Multiple blocked vertebra in the cervical spine?
Klippel Feil
545
Most common congenital anomaly of the spine?
Spina Bifida
546
aka for PSS (progressive systemic sclerosis)
Scleroderma
547
Where is the most common spondylolisthesis?
L5
548
L5 spondylolisthesis found in which types?
Type 1 = dysplastic - congenital defect in the pars
Type 2 = Isthmic - broken early in life, broken pars
Type 5 = Pathological - disease causes pars defect
549
Where is degenerative spondylolisthesis found?
L4
550
Can you adjust a spondylolisthesis?
Yes you can adjust 1-3 but have to rule out instability
551
What are the types of spondylolisthesis'?
```
1 = Dysplastic
2 = Isthmic
3 = Degenerative
4 = Traumatic
5 = Pathological
6 = Iatrogenic
7 = Pending
```
552
What is the most common spondylolisthesis?
Type 2 - Isthmic
| too early of weight bearing
553
Paget's is what type of disorder?
Bone disorder
554
What happens in Paget's?
Thickened cortex, increased trabeculae, increased Alk. Phos, normal calcium, bowing of legs, increased head size (hat doesn't fit), deafness
555
Is Paget's benign or malignant?
Non-malignant (benign)
556
Progression of Paget's?
Lytic --> Mixed --> Blastic/Sclerotic --> Malignant (Osteosarcoma)
557
aka for Paget's
Osteitis deformans
558
What is the screen for Paget's?
Bone scan
559
Is there going to be a fever with Paget's?
No, but there will be localized warmth over the areas with a lot of metabolic activity
560
What is happening in Paget's to the bone?
Replacing calcium with phosphorus
561
aka for osteochondrosis?
Ischemic necrosis, Aseptic necrosis, AVN (avascular necrosis)
562
What is the initial treatment for osteochondrosis?
Brace, support, rest and heat
563
Osteochondrosis (ischemic necrosis, aseptic necrosis, AVN) of the vertebral body is?
Kummel's
564
Osteochondrosis (ischemic necrosis, aseptic necrosis, AVN) of the vertebral end plates is?
Scheuermann's aka Juvenile Disc Disease, Juvenile Postural Syndrome
Is a lack of blood to the disc not bone
565
Osteochondrosis (ischemic necrosis, aseptic necrosis, AVN) of the carpal lunate is?
Kienbock's
566
Osteochondrosis (ischemic necrosis, aseptic necrosis, AVN) of the scaphoid is?
Prissier's
567
Osteochondrosis (ischemic necrosis, aseptic necrosis, AVN) of the hip is?
Legg Calve Perthes
568
Osteochondrosis (ischemic necrosis, aseptic necrosis, AVN) of the medial femoral condyle is?
Osteochondritis dissecans
569
Osteochondrosis (ischemic necrosis, aseptic necrosis, AVN) of the medial tibial condyle is?
Blount's
570
Osteochondrosis (ischemic necrosis, aseptic necrosis, AVN) of the anterior tibial tuberosity is?
Osgood Schlatter's
571
Osteochondrosis (ischemic necrosis, aseptic necrosis, AVN) of the tarsal navicular is?
Kohler's
572
Osteochondrosis (ischemic necrosis, aseptic necrosis, AVN) of the second metatarsal is?
Freiberg's
573
How does infection affect the joint?
Affects both sides of the joint
574
What is osteochondritis dissecans? S/Sx?
AVN of the medial femoral condyle
| S/Sx = pain and swelling, "catches" and "locks" during movement.
575
What happens in septic arthritis?
The joint gets widened and then destroyed
576
What is the STAPH story?
IV drug user (something that can get through the skin) --> discitis --> carditis (tricuspid valve).
skin -> disc (discitis)-> bone (osteomyelitis) -> heart (carditis) -> tricuspid valve
577
aka for joint infection?
septic arthritis
578
Marfan's affects?
Long bones, heart
| Ehlers Danlos = hyperflexible joints
579
What is cleidocranial dysplasia?
It's a clavicle/head problem in development.
Father to son problem.
The clavicle usually has 3 parts but these guys only have 2.
Rounded shoulders
Wormian bones in the skull
580
Xray findings of secondary hyperparathyroidism?
```
Radial finger erosion
Rugger jersey spine
Salt and pepper skull
calcification of vessels
acro-osteolysis in fingertips
```
581
What is the most aggressive of all primary bone cancers?
Osteosarcoma
582
Where will we see osteosarcoma in the young? Old?
```
Young = knee
Old = Paget's stage IV
```
583
Most common secondary cancer?
Lytic
584
Types of secondary cancers?
Lytic or Blastic
585
What is blastic (secondary) cancer?
Reproductive cancer
586
aka for secondary bone cancer?
metastases
587
How do we differentiate spinal METS?
```
Lytic = Moth eaten, permeative pattern, winking pedicle, vertebral collapse
Blastic = Ivory white vertebra, cotton balls
```
588
What are the epiphyseal tumors? aka for epiphyseal?
Chondroblastoma (<20 years old), Giant cell aka quasi-malignant (>20 years old)
aka for epiphyseal = subarticular, bone end tumor
589
What is a chondroblastoma?
Well encapsulated tumor in the epiphysis of a pre-puberty child (The growth plate will still be visible)
590
What is a giant cell tumor?
aka quasi-malignant bone end tumor seen in a person post-puberty (no growth plate visible). Not encapsulated
591
What are the diaphyseal tumors?
Ewing's sarcoma (children) and Multiple Myeloma (MM)(adults)
592
Most common complication of giant cell arteritis?
Blindness (temporal arteritis)
593
Most common benign bone tumor of the hand? multiple? Affects soft tissue as well?
Enchondroma
Multiple enchondroma's = Olliers
Soft tissue = Maffucci's
594
Most common benign bone tumor of the spine?
Hemangioma
595
Most common benign bone tumor of the body?
Osteochondroma
596
Name for many osteochondromas?
Hereditary multiple exostosis (HME) which can lead to chondrosarcoma
597
Most common malignancy of the body?
Lytic METS
598
Most common primary malignancy of bone?
Multiple Myeloma (MM)
599
Most common fracture?
Clavie
600
Most common malignancy of bone?
Lytic METS
601
Most common skin cancer?
Basal cell
602
Most common complication of giant cell tumor?
Cancer (quasi-malignant)
603
What are the non-inflammatory arthritides?
OA and DISH
604
Which arthritides make syndesmophytes?
AS, Enteropathic arthropaty, Psoriatic, Reiter's(reactive)
605
Which syndesmophyte maker likes the hands/feet?
Psoriatic
606
Which syndesmophyte maker likes the feet but not the joints?
Reiter's (Reactive Arthritis)
607
Which syndesmophyte makers like the spine?
AS and Enteropathic
608
Which syndesmophyte maker causes explosive diarrhea?
Enteropathic
609
Which syndesmophyte maker has trouble breathing?
AS
610
Which arthritides erode the distal tufts?
Psoriatic and Scleroderma
611
Which arthritides have trouble swallowing?
Scleroderma and DISH
612
Which arthritide has normal labs?
OA
613
What does OA attack?
weight bearing joints
614
What does RA attack?
wrist, symmetrical MCPs, DIPs, PIPs, cervical spine, ADI
615
What does gout attack?
big toe (podagra), elbow, hands and feet
616
What does CPPD attack?
knee
617
What does AS attack?
SI joints, spine, rib joints (costovertebral)
618
What does Enteropathic attack?
SI joints, spine
619
Which arthritides attack the SI joint?
Enteropathic, AS, Psoriatic, Reiter's(reactive)
620
What does scleroderma attack?
Hands
621
What can scleroderma turn into?
PSS (progressive systemic sclerosis)
622
What does psoriatic attack?
DIPs, hands, feet, SI, spine
623
What does SLE (lupus) attack?
hands and feet
624
What does Reiter's (reactive) attack?
Feet, SI, spine
| Heel spur
625
What does DISH attack?
Cervical and thoracic spine (works its way down)
626
What is associated with a thick flowing hyperostosis?
DISH
627
What is the enemy of scoliosis?
Cardio-Pulmonary compromise
628
Best way to measure scoliosis?
Cobb's angle
629
Most common scoliosis?
Right convexity
630
How is a scoliosis classified?
Lovett's classification
631
What is a positive Lovett's scoliosis?
Rotatory, is the least symptomatic
632
What is a negative Lovett's scoliosis?
Simple, usually has multifidi spasm, quite symptomatic
633
What is Lovett's failure?
List, very bad/mad disc at the bottom of the list, get a really bad disc lesion
634
How do we determine if a scoliosis is structural or functional?
Adam's test.
Any improvement = functional
No improvement = Structural
635
Protocol for scoliosis?
0-20 degrees = adjust
20-40 degrees = brace
> 40 degrees = surgery
> 50 degrees = Cardiopulmonary compromise
636
Which is worst? Left or Right thoraco scoliosis? Why? Who should they be referred to?
Left because it impedes on the heart
| Referred to cardiologist
637
What can cause a structural scoliosis?
Hemivertebrae
638
What causes a kyphoscoliosis? Can you adjust?
Neurofribromatosis. No do not adjust this is a very dangerous situation
639
Normal ADI in a child? Adult?
```
Child = < 5mm
Adult = < 3mm
```
640
What diseases affect the cerebellum?
Alcoholism and MS
641
What is the cerebellar tract in charge of?
motor, coordination, speech, gait
642
What is Charcot's triad?
SIN- Speech, Intention tremor, Nystagmus
643
What is the posterior column tract in charge of?
Sensory, 2-point discrimination, vibration, position sense
644
What part of the Posterior columns is in charge of the upper extremity? lower?
Upper extremity = Cuneatus
| Lower extremity = Gracilis
645
What diseases affect the posterior columns?
PLS, MS, Syphilis, DM
646
What is the Extra-Pyramidal tract in charge of?
Posture, flexor tone
647
What disease affects the Extra-pyramidal tract?
Parkinsons
648
What is the lateral-spinal thalamic tract in charge of? A lesion would cause?
Sensory, pain and temperature
| Lesion = Bilateral loss of pain and temp
649
What disease affects lateral-spinal thalamic tract?
Syringomyelia
650
What is the corticospinal tract in charge of?
Voluntary motor
651
What affects the corticospinal tract?
UMNL and LMNL
652
What is a UMNL?
```
Brain or cord lesions
Increased Motor responses:
Spastic paralysis
Increased DTR
Present pathological reflex
Clonus present
Hypertrophy
Absent fasciculations
Absent superficial reflex
```
653
Where do we see UMNL? Treatment?
CNS, bilateral
| Tx = Co-care
654
When can you test for UMNL?
Must have 3 or more features present to test
655
What is a LMNL?
```
Decreased Motor responses:
Flaccid Paralysis
Decreased DTR
Absent pathological reflex
Absent clonus
Atrophy present
Fasciculations present
Absent superficial reflex
```
656
Where do we see LMNL? Treatment?
PNS, Unilateral
| Tx= Primary care provider
657
What kind of gait will we see with posterior columns disturbance?
Wide gait base, bilateral foot slappage (CNS issue), have to look down to see where their feet are going
658
An UMNL is associated with?
Myelopathy
659
A LMNL is associated with?
Radiculopathy and Neuropathy
660
What neurological diseases are motor only?
5: Muscular dystrophy, Amyotrophic lateral sclerosis (ALS, Lou Gherig's Disease), Myasthenia Gravis, Cerebral Palsy, Parkinsonism (aka Paralysis Agitans)
661
What will we see in muscular dystrophy?
```
Young boys
muscle destruction
pseudohypertrophy of the calves
waddling gait
Gower's sign
albuminuria, creatinuria
```
662
Where does ALS start?
In the intrinsic muscles of the hands
663
When ALS affects the neck what happens?
Bulbar palsy, can't swallow or breathe
664
Symptoms of myasthenia gravis?
Diplopia, trouble swallowing, fatigue
665
What helps myasthenia gravis?
Naps
666
What does myasthenia mostly affect?
The CNs of the face
667
What is cerebral palsy?
Stroke at birth. lack of oxygen to the brain at birth. Non progressive (one time thing)
668
aka for parkinsonism?
paralysis agitans
669
S/Sx of parkinson's?
```
Resting tremor (pill rolling)
blank stare
festinating gait
no arm swing in gait
Hard to initiate movement, also hard to stop once started
```
670
What is Guillain Barre?
Rapidly ascending paralysis (post viral polyneuropathy)
671
Where does Guillain Barre start?
Feet
672
What is Brown Sequard's?
Hemisection of the spinal cord with ipsilateral loss of motor and paresthesia and contralateral loss of pain and temp
673
What is Charcot Marie Tooth? aka?
aka = Peroneal disease
| Calf weakness and sensory loss, steppage gait
674
Cauda equina causes?
Radiculopathy (S2-4)
| Bowel and bladder control (nerve root compression) LMNL
675
What does stroke spare that Bell's palsy does not?
The forehead
676
What is syringomyelia?
Lesion that puts pressure on the lateral spinothalamic tract causing bilateral loss of pain and temp in a shawl or cape like distribution
Will feel burning in hands
677
What is PLS?
PLS = posterolateral sclerosis aka combined systems disease
B12 problem
Gastritis leads to anemia (perncious anemia) which then leads to PLS.
678
S/Sx of PLS?
Paresthesia, weakness, pain and temperature loss, progressive neurological deficits
Schillings test
Reticulocytosis
679
What is multiple sclerosis?
MS = demyelination of the cord
680
S/Sx of MS? Diagnose?
diplopia, intention tremors, slurred speech, incontinence, exacerbations and remissions.
+ Lhermitte's Test
Charcot's triad
Dx = MRI, CSF eval, eye exam, EMG
681
What is subclavian steal?
TIA (transient ischemic attack)
Vertebral artery steals blood from subclavian
Stenosis of the subclavian artery
682
aka for Meniere's? S/Sx?
```
aka = endolymphatic hydrops
S/Sx = tinnitus, vertigo, transient deafness
```
683
What is Horner's?
Interruption of the sympathetics to the face.
| Ptosis, Miosis, Anhydrosis and Enophthalmosis
684
What cuases Horner's?
TOS, Pancoast tumor, Whiplash, birth
685
What is a pancoast tumor?
Bronchogenic carcinoma (tumor in the apex of the lung)
686
What is Pancoast syndrome?
Metastasis, TOS (neuropathy), Horner's syndrome
687
aka Festinating gait?
shuffling, mincing, propulsion
| Parkinson's
688
aka Motor ataxia?
staggering
| Cerebellum
689
aka Sensory ataxia?
slappage
| Posterior columns, neurological
690
aka steppage gait?
foot drop, toe drag, foot slap
Tibialis anterior
L4 nerve root
691
aka Glut medius lurch?
lateral sway over weight bearing leg
| L5 nerve root
692
aka Glut maximus lurch?
A-P sway (leans back during mid stance)
| S1 nerve root
693
aka circumduction?
CVA, weak quads (unilateral)
694
aka waddling?
muscular dystrophy
| clumsy and weak
695
aka scissors?
cerebral palsy
| adductor spasm
696
What is normal gait?
Heel strike, mid-stance, toe-off, accelerate, mid-swing, deaccelerate
697
In normal gait which parts happen at the same time?
Toe off and heel strike
698
Where are the most changes in gait seen?
Mid-stance, mid-swing
699
What does S1 cover?
Plantar foot, little toe, glut max, hip extension
700
C5 nerve root cover?
Arm abduction, biceps (myotome)
lateral arm (dermatome)
Biceps DTR
701
L4 nerve root cover?
Tibialis anterior (myotome), Heel walk (foot drop)
Medial leg, ankle (dermatome)
Patella DTR
702
L5 nerve root?
Glut medius, extensor hallicus longus (heel walk) (myotome)
Lateral leg, dorsum of foot (dermatome)
Posterior tibial, medial hamstring DTR
703
C6 nerve root?
Wrist extension (myotome)
Lateral forearm, 1st 2 digits (dermatome)
Brachioradialis DTR
704
What is the DTR scale?
```
0-5
0 - nothing
1 - hyporeflexia
2- normal
3 - Hyperreflexia
4 - transient clonus
5 - sustained clonus
```
705
What DTR describes an UMNL? LMNL?
```
UMNL = 3-5
LMNL = 0-1
```
706
Which headaches have a fever?
Sinusitis, Giant cell Temporal arteritis, meningitis
707
Which headaches occur in the morning?
hypertension, metabolic
708
which headache is post-prandial?
hypoglycemic (hyperinsulinemia)
709
What is Morton's neuroma?
Burning pain in the 2nd-4th metatarsals.
| pain refers to dorsal surface
710
What is the terrible triad?
Medial meniscus, ACL, MCL
711
Positive sag sign in the knee?
PCL problem
712
What orthos perfomred for S.O.L.?
Valsalva, Naffziger's, Milgram's
Valsalva- C/S
Milgram's- L/S
Naffziger's- occlude jugulars
713
Cervical spine orthos for IVF encroachment? Identify?
Compression, Jackson's, Maximal, Spurling's
| Identify radiculopathy
714
Cervical spine orthos for nerve root?
Bakod'ys, choulder depression, distraction
715
What does Lhermitte's of the cervical spine check for?
MS, cord degeneration
716
What is a general cervical spine ortho?
Soto Hall
717
What orthos are for TOS?
Adson's, Modified Adson's, Eden's, Wright's, Reverse Bakody's, Allen's maneuver, Roo's
718
Which TOS orthos are general tests?
Reverse Bakody's, Allen's maneuver, Roo's
719
What is TOS considered?
NVE (neurovascular entrapment)
720
What are the orthos for the shoulder?
```
CAADDYS
Codmans- rotator cuff
Apley'- ROM
Apprehension- Chronic dislocation
Dugas'- Anterior dislocation (Kocher's, Milch's)
Dawbarns- Bursitis
Yerguson's- bicipital tendon instability (Abbott-Saunders)
Speed's- tendonitis
```
721
Orthos for the elbow?
Lateral epicondylitis = Cozen's, Mill's
| Medial epicondylitis = Reverse Cozen's, reverse Mill's
722
aka lateral epicondylitis?
Tennis elbow
723
aka medial epicondylitis?
Golfer's elbow, little leaguers elbow
724
orthos for LBP?
SLR, Braggard's, Sicard's, Bowstring's, Kemps, Bonnet's
| SOTO, WLR, Fajersztajn's, Lindner's, Bechterew's
725
which orthos for LBP radiculopathy?
SLR, Braggard's, Sicard's, Bowstring's, Kemp's (only if it radiates below the knee)
726
which orthos for medial disc LBP?
WLR, Fajersztajn's
727
which orhtos for lateral disc LBP?
Lindner's
728
which orthos for piriformis syndrome?
Bonnet's, SOTO
729
Kemps has radiating pain to the knee but not below it what does this mean?
Localized, facet, sclerotogenous
730
What does Bechterew's test for?
Sciatica or hamstrings
731
Which tests are for tight hamstrings?
Tripod sign, Neri Bowing's, Beery's (aka chair test)
732
Which orhtos are for AS?
Forestier's bowstring, Lewin supine, Chest expansion
733
Which orthos are for the SI joint?
Belt, Iliac compression, Lewin-Gaenslen's, Gaenslen's, Goldthwait's, Mennell's, Hibb's, Yeoman's
734
In the belt test if SI pain gets better (decreases), then where is the issue?
SI joint
735
What is a general test for the lumbosacral region?
Ely's test
736
What are the orthos for the hip?
Anvil, FABERE (aka Patrick), Laguerre, Thomas, Hibbs, Ober's/Nobles, Trendelenburg's, Ortolani, Barlow
737
Which orthos for the knee?
Drawer, rotary instability, Lachman's, grinding, effusion, McMurray's, Apley's, Sag sign
738
Which orthos in the knee have the heel point to pathology?
Rotary instability, McMurray's (external rotation = medial meniscus, internal rotation = lateral meniscus), Apley's
739
Orthos for meningitis?
Brudzinski's, Kernig's
740
What are the malingering ortho exams?
Hoover's, Burn's bench, Magnusson's, Mannkopf's
741
What are the vascular orthos?
Stress test, MAigne (VBAI)(DeKlyn's, Hallpike), , Barre-Leiou's, Allen's test (upper extremity artery competency), Buerger's (lower extremity artery compentency), Homan's (DVT)
742
What is Rust's sign for?
ADI instability
743
What causes rust sign?
RA, trauma, Downs syndrome
744
Treatment for rust sign?
Hard collar, ER, orthopedist
745
When performing Schepelmann's and pain is on the same side as lateral flexion? Opposite side?
Same side = intercostal neuritis
| Opposite side = Pleurisy
746
What does DRCUMA stand for?
Drop wrist = Radial nerve
Claw hand = Ulnar nerve
Median nerve = Ape hand
747
aka for wrist drop or radial nerve entrapment?
crutch palsy
748
What does common peroneal nerve entrapment lead to?
foot drop
749
What is aka for meralgia paresthetica? Located?
Lateral femoral cutaneous nerve entrapment
| Located L2-L3
750
Long thoracic nerve entrapment? Muscle?
Winging of the scapula
| Serratus anterior
751
Dorsal scapula nerve entrapment? Muscle?
Flaring of the scapula
| Rhomboids
752
Is TOS a neuropathy? What structures are involved?
Yes TOS = neuropathy aka peripheral nerve entrapment
| Structures = Scalenes/Cervical rib, Pec minor, Costoclavicular
753
Disc pressure from least to most?
Supine, side posture, standing, sitting, sitting with leaning forward.
754
What are William's exercises?
Flexion exercises
755
What are McKenzie's exercises?
Extension exercises
756
What causes a hyperlordosis or the lumbar spine?
Weak abs weak hams, weak glut max
| Tight paraspinals, quads, psoas
757
What is the treatment for hyperolordosis?
Sole lifts
Strengthen abs, hams, and glut max
Stretch paraspinals, quads, psoas
758
What is Upper Cross syndrome? aka? Weak muscles? Tight muscles?
Anterior head carriage.
aka protraction
weak = suprahyoid, deep neck flexors, subscapularis, lower trapezius, serratus anterior, diaphragm
tight = pectorals, SCM, masseters, suboccipital, upper trapezius, levator scapulae
759
T5 is what landmark?
Sternal angle, 2nd intercostal space
760
T2 is what landmark?
Jugular notch
761
T6 is what landmark?
Inferior angle of the scapula while prone
762
T7 is what landmark?
Inferior angle of the scapula sitting or standing
763
T10 is what landmark?
Xiphoid, 7th rib, 7th dermatome
764
L3 disc is what landmark?
Umbilicus
765
L4 is what landmark?
Iliac crest
766
S2 is what landmark?
PSIS
767
What is the first spinous we feel?
C2
768
What does the pelvic listing IN mean?
Obturator foramen gets smaller, Ilium shadow gets bigger
| External foot flare, gluteal widening, long leg
769
What does PI pelvic listing mean?
obturator and ilium get taller
