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1

Malar Rash

SLE

2

Heliotrope Rash

Dermatomyositis; Rash around eyes

3

Rashes over dorsal joints of hand, upper back, around eyes

Dermatomyositis

4

Rashes with Progressive muscle weakness

Dermatomyositis

5

Rash on left elbow and forearm with weakness of that arm that is getting worse

Dermatomyositis

6

Rash on extensors

Psoriasis

7

Silver Scale Rash

Psoriasis

8

Rash on Flexors

Eczema

9

Eczema

Severe Itching. SO Itchy that Pts will scratch till it bleeds; In areas of folded skin;

10

Psoriasis

Well-defined lesions; thick, silver scale; Feels less itchy (Mild) but more like a burn

11

Contact dermatitis can cause

Eczema

12

Skin Conditions to avoid Sun exposure

SLE; Dermatomyositis

13

Skin lesion with ulceration and crusting; signs of bleeding; Border irregular

Squamous Cell Carcinoma

14

Shiny Pearly Skin lesion with raised borders and flat center

Basal Cell

15

Basal Cell Slow or Fast growing

SLow

16

Hyperpigmented skin lesion that has been changing quickly

Melanoma

17

Icterus (AKA)

Jaundice

18

Enopthalmos

Sunken eye

19

Unilateral Miosis

Horner's; B/L = Drugs

20

Dry Eyes could indicate

Sjorgrens

21

Vertical Nystagmus

Brain Stem or MS; Vertical Nystagmus is not good. Horizontal can be normal or is much more likely to be benign

22

If asked to perform CN 2 and 3 perform which tests?

Direct; Indirect; Accommodation and convergence (Look for pupil constriction)

23

Mydriasis is?

Fully Dilated pupil

24

Anisocoria is?

Irregular pupil size compared B/L; Can be normal; affects 20% of the population??

25

Pupil that accommodates but does not react to light

Argyll-Robinson Pupil

26

Nerve responsible for "Opening of eyelid"

CN3

27

Nerve responsible for "Closing of eyelid"

CN7

28

Dilation of Pupil (Sympath or parasympathetic Nerve?)

Sympath

29

Why do chiros eval the eyes?

For early signs of getting MS, MG, DM

30

Silver Wire/Copper Wire Appearance; AV Nicking (sign of?)

Atherosclerosis

31

Absent Red light reflex (Sign of?)

Cataracts

32

DM signs in the EYE?

Hard Waxy Exudates, Microaneurysms

33

Disc:Cup ratio > 2:1 (Sign of?)

Glucoma or Increased intra-ocular pressure; Volcano disc appearence

34

Flame Hemorrhages (Sign of?)

HTN

35

Cotton Wool appearance (Sign of?)

HTN

36

Coryza (Def?)

Inflammation of Mucus membrane of nose

37

Red Mucus membrane of nose (Types of conditions?)

Acute Infection

38

Pale, Grey-Blue Membrane of nose (Types of conditions?)

Chronic Infection or allergies

39

Clear and Thin Nasal Drainage Indicates

Coryza/allergies

40

Clear and thin and sweet Nasal Drainage (Indicates?)

Possible Basal Skull Fracture; Ask about trauma. If Trauma ER visit.

41

Clear and thick Nasal Drainage (Viscous) (Indicates?)

Viral Infection

42

What should you ask the PT if they have nasal drainage?

Any memory loss, confusion, or recent Trauma? Any recent colds, fevers, headaches, or infections?

43

Pain with Palpation the Auricle or Tragus could indicate?

Otitis Externa

44

Pain with palpation of Mastoid Process Could indicate?

Otitis Media

45

To instrument (Look inside) the Ear pull the ear which direction for Adult and then for child?

Adult = Up and Back
Child = DOWN and back

46

Ear: AC>BC (Normal or abnormal?)

Normal

47

Perform Rinnes test in which ear after Weber's Test?

The ear the sound lateralizes to (Do it in the ear that hears the best); Weber's Lateralizes to the potential conductive deficit side

48

Examples of Conductive deficit in an Ear

Ear Infection, Wax, or Foreign object

49

Examples of Sensorineural deficit in an Ear

Presbycusis (Ear hair cell damage); Neuroma, Meniere's (MC on boards)(AKA CN8 damage).

50

What to Ask a Patient if Weber's lateralizes

Do you have any hearing loss?
Do you have Tinnitus or ringing in your ears?

51

Webers Lateralizes to which ear?

The ear that they hear better

52

Describe the 3 possibilities of Rinnes test.

Sensorineural = AC>BC (In lateralized ear)
Conductive Hearing loss = AC=/

53

Signs of Acute Otitis EXTERNA

Canal: Swollen Canal, Moist, Pale red

54

Signs of Perforated Ear

Black and Chronic Infections

55

Signs of Chronic Otitis EXTERNA

Canal: Thick, Red, itchy

56

Serous Otitis Media

A CHRONIC condition; Tympanic Membrane: Bubbles, yellow, retraction

57

Serous Otitis Media

A CHRONIC condition; Tympanic Membrane: BUBBLES, yellow, retraction

58

Describe Serous Fluid

Resemble serum; Pale yellow/Transparent; Benign; Fluid found between membranes and provides lubrication to joints or to the lungs between visceral and parietal plura

59

Describe Herpes Lesion

Vesicles near mouth

60

Myxedema (What is it?)

Severe Hypothyroidism; Can result in Coma

61

Hashimotos, Hypothyroidism, and Myxedema (Difference?)

Hashimotos and Myxedema are AI conditions; Hypothyroidism is not AI and could be the result of pituitary abnormality or a thyroid tumor.

62

Hashimotos, Hypothyroidism, and Myxedema (Difference?)

Hashimotos and Myxedema are AI conditions; Hypothyroidism is not AI and could be the result of pituitary abnormality or a thyroid tumor.

63

DIabetics Vs Myxedema Vs Cushings

All: Mostly Female and Fat and aging;
DM = Polys (Polyneuropathy, polydipsea, Polyphasia, Polyurea)
Myxedema = Everything in body is slowing down bec it controls BMR (Basal metabolic rate); Constipation, fatigue, cat naps, PERIORBITAL swelling (Anopthalmosis)
Cushings = Moon Face (puffy face), Buffalo hump; takes on male features (Hirutism: Face hair and chest hair, male aggression, short temper)

64

Anopthalmosis (What is it?)

Periorbital swelling

65

XRay in Hashimotos?, Graves?, Myxedema?, Cushings?, Addisons?

Addisons and Cushings BECAUSE Tx is Steroids -> Osteoporosis. !!XRAY before CMT!!

66

Chiro Tx for Addisons and Cushings?

Immune Boosters

67

Chiro Tx (Vit) for Peripheral Neuropathies?

B6

68

If you are considering diagnosing a PT with endocrine disease perform lateral skull XRay. (Why?)

Rule out Pituitary Tumor.

69

If you are considering diagnosing a PT with endocrine disease perform lateral skull XRay. (Why?)

Rule out Pituitary Tumor.
Not always done because a Pit tumor would also cause BiTemporal Hemianopia (Loss of lateral field of vision)

70

Bitemporal Hemianopia indicates?
Unilateral VIsion loss indicates?
Homonymous hemianopia indicates?

Pituitary Tumor
Optic Nerve Compression
Contralateral cerebrovascular event

71

There are 4 conditions to consider during male exam (Name them)

Acute Prostatitis; Chronic Prostatitis; Benign Hypertrophy; Cancer

72

Male Exam: PT has: Warm and tender prostate w/ Fever, Normal PSA (Diagnose)

Acute Prostatitis
Tender Prostate only in Acute Prostatitis

73

Male Exam: Normal Prostate Exam (DRE = Digital Rectal Exam) except prostate has general enlargement, PSA > 4

Chronic Prostatitis

74

Male Exam: DRE reveals Enlarged LATERAL lobe of prostate with LOSS of median sulcus, Boggy feel, Nocturia, PSA > 4

Benign Hypertrophy of prostate
PSA will be increased
Nocturia not seen in other prostate issues

75

Male Exam: Hard Walnut Nodule of Posterior Lobe, non-tender=, PSA > 4

Cancer of Prostate
Cancer of Prostate is Blastic; Most Cancers are lytic. Therefore Alk Phos test is useful.

76

Alk Phos Measures?

Bone growth and Blastic growths; Blastic Mets (Most Cancers are lytic)

77

PET is used to evalute?

All ST Cancers

78

Signs of Breast Cancer

Niiple retraction, Dimpling

79

MC location of Breast Cancer

Tail of Spence (Near Axilla) via lymphatic drainage channels

80

What is Mastitis?

Inflammed Breasts; Tender, enlarged, red streaks;
ER referal

81

Age and description of lesion in Fibroadenoma

<30yo; Benign Nodule(s) of Breast

82

What is Pagets disease of the breast?

Breast Cancer; Not Bone cancer also called Pagets

83

Where is the Adnexal region?

Ovaries, uterine ligaments, fallopian tubes, uterus.

84

HCG increased indicates?

Tumors

85

Back pain and Chiro (Tx?)

Adjust, Nutrition

86

HCG decreased during pregnancy indicates?

Ectopic

87

Endometriosis (What is it?)

Ectopic endometrium

88

Endometriosis (SS?)

Irregular period and trouble getting pregnant (IE Dysmenorrhea and infertility)

89

Cause OF PID

STD
Such as: Gonorrhea and Chlamydia

90

Virchow node (What is it?)

Mets; Located in supraclavicular lymph chain

91

Sentinal Node (What is it?)

Mets; Located in Axilla

92

Right Vs Left Supraclavicular Lymph node (What is)

Right: Drains Breast, Inside Chest, and Arm
Left: Perform ROS; Rare; Could be from anywhere

93

Inguinal lymph nodes drain?
Indicate?

Legs and genitals
Possible STD

94

What is observed with: Lymphangitis, Lymphadenopathy, Lymphoma

Lymphangitis: Red Streak -- ER referral
Lymphadenopathy: Swelling -- Monitor
Lymphoma: Tumor -- Biopsy

95

3 Conditions that produce Lymphadenopathy: Mono, Hodgkins, AIDs
Describe Chest XRay findings of Hodgkins?

Mono: Neg
Hodgkins: Mediastinal widening due to lymphadenopathy
AIDS: Variable

96

3 Conditions that produce Lymphadenopathy: Mono, Hodgkins, AIDs
Describe Chest XRay findings of Hodgkins?

Mono: Neg
Hodgkins: Mediastinal widening due to lymphadenopathy (Box Car look, Potato nodules)
AIDS: Variable

97

Lymphadenopathy with Weight loss, relapsing fever suggests?

Hodgkins

98

What do these have in common:
TB, Thrush, Herpes, Candida, Toxoplasmosis, Kaposi Sarcoma, Pneumocystic carinii

Opportunistic Infections
Note: Kaposi Sarcoma is caused by the Kaposi Sarcoma virus. Not everyone with the virus develops the ST masses.
Note: These infections occur in late stages of AIDs.

99

PVE (Stands for?)

Peripheral Vascular Exam

100

PVE Tx? (General)

Walking

101

PVE: Arterial Vs Venous disease. Name 3 differences?

A: Skin cool pale cyanotic, Vessel color is red and tortuous, Pulse weak, Raynauds MBS, Vit C def, Skin thinning.
No swelling.
V: Skin warm normal to red color, Pulse normal, Swelling MBS, Stasis dermatitis with Age.
No Vit C def as cause/excarbent, no Raynauds.

102

Where is the Brachial Artery Palpated?

Medial aspect of arm and press up under biceps

103

Where is the Subclavian Artery Palpated?

Medial Aspect of Supraclavicular Fossa just deep to Clavicle

104

Describe Artery Palpation Steps

1. Ask PT to remove any clothing that could interfere with Exam
2. Palpate Pulse
3. Look off into Space as if counting (For test) and count quietly to 5
4. Perform B/L
5. Always tell PT to relax after each full Exam question (For Test)

105

Describe the Capillary Refill Test

1. Raise Limb above heart level (If possible).
2. Pinch each Finger/Toes until blanched/White (Occurs quickly. SO just pinch and let go for test)
3. Observe for blood to return to Fingers/Toes
Pos when Remains Blanched >2sec.
Pos indicates dehydration, Shock, PVD, Hypothermia

106

Describe Allens Test for Arterial Refill

1. Pt seated resting hands palm up on legs.
2. Have PT make a tight fist.
3. Dr Occludes Radial and Ulnar Arteries
4. Have PT open hand. (Hand should be blanched/White).
5. Observe Hand while letting go of Ulnar A.
6. Repeat for Radial A.
7. Compare to opposite open hand.
8. Perform B/L
9. Ask Pt to relax.

107

Describe Buerger's Test

1. PT supine
2. Raise PTs legs to ~45deg
3. Pump PTs ankles for 5secs (Dorsiflex/Plantarflex)
4. Sit PT up and observe refill (5 Sec)
5. Ask PT to relax

108

Describe Homan's Test

*Do not perform in my clinic
EX: PT has pain in R calf
1. Raise PTs L leg ~45deg
2. Dorsiflex ankle. Ask if there is pain
3. Squeeze calf w/ Ankle dorsiflex. Ask if there is pain.
4. W PTs legs on table Dorsiflex R Leg. Ask PT if this reproduces pain.
IF there is pain ASK:
Have you recent been immobilized or have been seated for a long period of time? Are you on Blood thinners, birth control, or steroids?

109

Where is Carotid A. Auscultated?

At Bifurcation of Carotid (C4)

110

Describe Hepatojugular Reflux test and what is it for

1. PT supine. Observe Jugular Vein in Neck. (Should be seen)
2. Raise PT to 45 deg inclination. (Jugular V should Disappear)
3. Compress Abdomen over Inf. Vena Cava and continue to observe Jugular Vein
4. If Jugular V re-appears and stays visible then pos.
Pos indicates CHF.
Because Pressing on a major vein will increase Venous return to the heart and the heart has to work harder to pump this blood out. As the heart works harder the jugular vein will swell until the heart is able to compensate for the increased blood in the veins. If the JUgular vein does not disappear then this means that the heart is not able to pump this extra blood.

111

CHF

Coronary Heart Failure

112

Describe the Claudication Test?
What is positive for Vascular Claudication?

1. PT Stands and marches in place for 5sec
2. Ask if pain
3. IF PAIN PT repeats w forward hip flexion
Pain w Flex = Vascular Claudication
Pain reduced w flex = Neurogenic Claudication (Because flexion reduces Canal Stenosis)

113

Tx or refer? Neurogenic Claudication

Treat

114

Tx or refer? Vascular Claudication

Co-Manage

115

Buerger's disease AKA?
What is Buerger's Dx?

Thromboangiitis Obliterans
Caludication in LE (Artery of Vein) in younf male smokee

116

Thrombosis Vs Thrombophlebitis

Thrombosis is superficial. Deep Vein Thrombophlebitis

117

Describe Raynauds

Triphasic color changel Female; UE; No ice

118

Perform Serum Chemistry for PAD

Peripheral Arterial disease

119

What spinal level does the Carotid bifurcate?

C4

120

Describe the Pattern/TIming for Neurgogenic Claudication?

Unpredictable

121

Describe Episodes of relief with Vasc and neurogenic claudication

Vasc = No relief
Neuro = With rest (Only)

122

Describe the treatment for vasc and neurogenic claudication

WALK
Vasc = mid-late stage REFER, Early = Walk
Neuro = CMT and have PT walk

123

Describe the Pattern/TIming for Vasc Claudication?

Predictable with amount of acitivity

124

Causes of vasc and neurogenic claudication

Neuro = Central Stenosis, DJD, Facet, Disc.
Vasc = Arteriosclerosis, DM, PVD, Beurger's

125

Testing for vasc and neurogenic claudication?

Neuro= Claudication Test, bicycle test, stoop test.
Vasc = Claudication test, Serum Chemistry, BP.

126

Describe Capillary Refill test

Pinch each finger while limb is above heart and watch for refill. (Perform quickly for boards)

127

Describe Allen's Test

PT makes a fist and dr compresses Radial and ulnar arteries in hand. PT relaxes hand and dr release an artery

128

Describe Buerger's Test

PT Supine. Dr raises (Both) legs of PT to ~45. Dr/PT pumps ankles (Dorsi/Plantar flexion) several times (5sec) pt SITS UP and dr observes blood return to feet (5Sec).
Pos = Blood does not return in 2 min.

129

Describe Homans Test

PT has calf pain. PT supine. Dr raises unaffected limb to 45 and then dorsiflexes ankle. Then Squeezes the calf. Ask PT if this changes the pain. Perform on opposite limb but start small. Do not raise the limb right away. First try dorsiflex to see if pain increases. If no pain then raise the affected limb and dorsiflex.

130

Where do you palpate the heart?

AT the 4 listening points (A,P,T,M)

131

What and where are the 4 listening points for the heart?

A = 2nd R intercoastal (Para-sternal)
P = 2nd L intercoastal (Para-sternal)
T = 4th L intercoastal (Para-sternal)
M = 5th L intercoastal space (Mid-clavicular)
*When palpating press w/3 palpating fingers for 5sec at each location.
Point of maximum impulse?

132

How to percuss the heart

Percuss from mid-axillary line on left to left boarder of heart. Repeat 3 times starting at R4 then R5 then R6.

133

How to Auscultate the heart

A PeT Monkey; 5 Sec each pnt; Bell for low sounds = Bruit (Stenosis).
Diaphragm for higher sounds = (Regurgitation)
State: I am listening for murmurs of splitting and evaluating the rate, rythym, and syncopation (Disturbance of rythym).

134

How to Ausc and Palpate the Abdominal Aorta

Palpate lateral to medial for both sides (Dont press on the ab. Aorta. It can rupture if enlarged.)
Ausc with Bell.

135

Disease when R side heart fails

Cor Pulmonale (Rare)

136

Cause of Cor Pulmonale?

Pulmonary HTN -> R side heart failure

137

SS of Cor Pulmonale

Jugular distention; Portal HTN (Liver dx)

138

Tests/Monitor for Cor Pulmonale

Spirometry, Pulse Ox.

139

Tests/Monitor for CHF

BP; Labs; Stress test; Xray Cardiomegaly; Echo

140

Cause of CHF

Left sides heart failure

141

SS of CHF

Nocturnal Dyspnea, Pul edema (Fluid in lungs), Pul Effusion (Pink and frothy sputum)(Fluid around lungs)

142

Thirsty all the time = dx?

Diabetes insipidous

143

Pitting edema = dx?

CHF

144

Pitting edema how to perform

Depress tissue and count for recovery time

145

MI SS

Pain > 10m after rest

146

MI labs (Cardiac enzymes) explain

Troponin > CPK > SGOT (AST) > LDH
Troponin shows up first
Next is CPK

147

Angina Vs MI

Anginia = pain with activity and stops w rest

148

Aortic Aneurysm Vs Heart

Heart = pain everywhere in chest ("Its the big one")
Aortic Aneurysm = Localized pain (Knife like)(Straight through chest)

149

Pneumonia Vs Pleurisy

Pneumonia = Pain w fever, no position of relief.
Pleurisy = Positional Relief (Pt holds side of chest and leans towards that side)

150

How to Ausc the lungs?
Where is the R middle lobe?

*Be able to tell them which lobes you are ausc.
Right middle lobe is directly across from heart. Note that the R inferior lobe is more lateral and slightly inferior to middle lobe.

151

Flat Sound with Percussion indicates?

Tumor or Atelectasis (Collapse)

152

Dull Sound with Percussion indicates?

Fluid; Pneumonia

153

Resonant Sound with Percussion indicates?

Normal; But can occur with Bronchitis/laryngitis

154

Hyper-resonant Sound with Percussion indicates?

Air trapping; COPD

155

Respiratory Excursion performed where/how?

At T10 with both hands

156

Decreased B/L Respiratory excursion could indicate?

Emphysema, AS

157

Decreased U/L Respiratory excursion could indicate?

Pneumothorax

158

Rhonchi vs Rales/wheezing/Crackling

Rhonchi = Fluid in larger airways
Rales/wheezing/Crackling = Fluid in SMALLER airways

159

Whispered pecteriloquay looks for?

Fluid

160

What is Stridor and what is Tx?

Tx = ER
High pitched whistling sound (Crowing), often heard wo stethescope.
Indicates: Upper airway obstruction.

161

What does Rhonchi sound like?

Low pitched rattle that resembles snoring

162

What does Rales sound like?

Low pitched velcro sound; Crackly; Crackles and Rales are the same thing (Sort of). Rales are crackles occuring LATE in the inspiration cycle.

163

Prolonged inspiration indicates?

CHF

164

Prolonged expiration indicates?

COPD

165

Bacterial Vs Viral: Chills indicate?

Virus; Fever goes up and down often.

166

Bacterial Vs Viral: Night Sweats indicate?

Bacterial

167

Bacterial Vs Viral: What would auscultation reveal for each?

Viral = Clear/Normal
Bacterial = Rales, Wheezing, Voice changes

168

Bacterial Vs Viral: Neutrophils and lymphocytes. Which are elevated and which are decreased for each condition?

Viral = DEC Neutrophils; INC Lymphocytes; WBC 5000 - 10000.
Bacterial = INC Neutrophils; WBC 10k+, (Schilling shift)

169

Opportunistic infections causes:
Pneumocystic Carnii =caused by what AI dx?
Klebsella pneumonia =caused by what AI dx?

Pneumocystic Carnii = AIDs
Klebsella pneumonia = Alcohol

170

TB describe Xray finding progression

Ghon lesions develop from healing lymph tissue.

171

What is a Ranke Complex

From healing Primary TB.
Ghon lesion and Fingernail calcifications

172

Milliary TB. Primary or secondary TB?

Secondary

173

What diagnostic test is used to determine primary or secondary TB?

XRay

174

Name 2 Screening tests for TB and describe them?

Mantoux = More commonly used
Tine
Both Use Tuberculin injection; Size of resulting lesion measured

175

XRay: Widening of the Mediastinum indicates?

Hodgkin's Lymphoma

176

What is Cachexia?

Weakening and Wastin of the body due to illness; Occurs with Cancer and eating disorders.

177

Chronic un-productive cough could indicate?

Lung Cancer

178

Causes of Stridor?

Pertusses, Croup, Epiglotitis, Aspiration of an object.
Upper airway obstruction

179

Crackling heard in late inspiration indicates?

Rales

180

Crackling heard in late inspiration indicates?

Rales; Occurs in Bronchiectasis, Pul. Edema, Asthma, Bronchitis

181

Rales are best heard at what part of the lung

Base

182

Rales are sounds that cant be cleared by coughing

But posture and deep breaths may clear it

183

Name of normal breath sounds heard over small airways?

Vesicular

184

Crackles heard at start of inspiration is characteristic of what dx?

COPD or emphysema = air trapping. Air can get in (a bit) but cant get out easily.

185

Bronchiectasis: Chronic bronchiole thickening and fibrosis from chronic inflamm and infections
SS of Bronchiectasis?

Abnormal breath sounds, Chronic bad breath, Recurrent respiratory infections with green/yellow sputum, chronic coughing, SOB

186

What is Bronchiectasis?

Thickening of the bronchioles

187

Pleurisy/Pluritis of lung. Causes (Plural)?

Flu or pneumonia OR Pul. Embolism
Cause: Inflamm of the lung tissue.

188

Symptoms of Pleurisy?

Sudden onset. PT leans towards side of lesion to decrease pain. PT may hold their side. Fever MBS if cause is infection.

189

XRay findings of Pleurisy?

NONE

190

XRAY findings of COPD/Emphysema?

Barrel chest: Horizontal ribs w/ INC space BTW ribs.
Narrow mediastinum
Flattening of B/L diaphrams because increasing lung sizes.

191

Widdening of mediastinum indicates

Hodgkins

192

XRAY findings of Lobar pneumonia?

Silhouette sign

193

Describe Silhouette sign?

Blurring of the borders of the heart due to fluid buildup in bronchioles

194

Cause of Silhouette sign?

Pneumonia (Lobar)

195

Describe Meniscus sign? Indicates?

Occurs in late Plural effusion. Significant sign. Indicates plural effusion; Fluid accumulation (Outside the lungs)!!

196

Describe XRAY findings in both Plural effusion and Pul. edema?

Early findings appear the same: Fluid covering costophrenic angles.
Late Plural effusion = occurs w meniscus sign; fluid outside the lungs
Pul. Edema = occurs w/ CHF; Kerley B Lines

197

Characteristic XRAY finding of late Plural effusion?

Meniscus sign

198

Pul edema occurs in CHF. Is the fluid inside or outside the lungs? Name another characterisitc XRAY finding?

Inside the lungs; Kerely B lines

199

XRAY finding of Kerely B lines occur in what Dx?

CHF; Pul edema