PCMII Midterm Flashcards
(85 cards)
1
Q
What goes in the S portion of the SOAP note?
A
CC OLDCAAARTS PMH, PSH Meds, Alls SH, FH
2
Q
What goes in the O portion of soap note?
A
VS
Heart, Lungs, OSE
3
Q
What is in O portion of a SOAP note?
A
CC: x3 diff diagnosis
4
Q
What goes in the P portion of the SOAP note?
A
Any OMT done or planned Any med recommendations Followup Immunizations Life style changes Screenings
5
Q
Who is given the influenza vaccine?
What type of vaccine do pregos get?
What type do >65 y/o get?
A
Give vaccine >6 months old
Pregos- inactivated influenza vaccine
>65 y/o- high does inactivated
6
Q
How many doses of Tdap do you give?
When do you give boosters?
What about pregos?
A
One dose of Tdap
Booster every 10 years of TD
Tdap for every pregnancy
7
Q
How many doses of varicella vaccine?
Who is contraindicated?
When do you give varicella zoster shot?
A
2 doses of varicella unless you have chickenpox
Don’t give to pregos or immunocompromised pt
Give varicella zoster at age 60
8
Q
When do you begin giving HPV vaccines?
How many doses?
When do you stop for males and females?
A
Begin at age 11
3 doses
Male-21
Female-26
9
Q
Who do you give the pneumococcal vaccine to?
When do you give the second dose?
A
Age 65, smokers, living in nursing home, or kidney problems
Second dose 5 years after vaccine
10
Q
Who do you give the Hep A vaccine to?
Who do you give the Hep B vaccine to?
A
Hep A- homosexual males or travel to area affected by hep A
Hep B- health care workers
11
Q
Who do you screen for abdominal aortic aneurysm?
A
Age 65-74 if they ever smoked
12
Q
Who do you screen for alcohol misuse?
What do you provide?
A
Screen >18 y/o
Provide behavioral counseling
13
Q
When do you begin mammograms?
How often?
A
Start at age 50, then every 2 years until 75 y/o
14
Q
When do you begin and stop doing pap smears?
A
Begin at age 21 and do every 3 years until 65
15
Q
At what ages do you screen for colorectal cancer?
A
Age 50-75
16
Q
Who do you screen for diabetes?
A
Age 40-70 if overweight
17
Q
What age do you screen for HIV?
A
Age 15-65
18
Q
What is the order of the physical exam for an abdominal exam?
A
Inspect
Auscultate
Percuss
Palpate
19
Q
What are the 4 quadrants of the abdomen?
What are the 9 regions?
A
Quadrants- R and L upper and lower
Regions-R and L hyochondriac and epigastric, R and L lumbar and umbilical, R and L iliac and hypogastric
20
Q
What is Grey Turners sign?
What is Cullen Sign?
A
Grey Turner- ecchymosis around the flank
Cullen sign- ecchymosis around the umbilicus
21
Q
What do striae possibly indicate?
A
Cushings syndrome
22
Q
What does caput medusae indicate?
A
Portal hypertension
23
Q
Auscultation of abdomen: How frequent are normal bowel sounds? What does absent sounds indicate? What do dec soudns indicate? What do inc sounds indicate? What do high pitched sounds indicate?
A
Normal- 5 to 34 clicks per minute Absent sounds- obstruction or ischemia Dec sounds- peritonitis Inc sounds- diarrhea High pitched- early obstruction
24
Q
When ascultating the abdomen what vasculature do you listen do?
A
Renal, abdominal aorta, common iliac, and femoral
25
Tympanic percussion =
Dullness percussion =
Resonant percussion =
Hyperresonant percussion =
Tympanic- air filled
Dull- solid
Resonant- hallow organ
Hyperresonant- pneumothorax
26
Explain percussion of liver?
| Explain percussion of the spleen?
Liver- 6-12 cm at R mid clavicular line
| Spleen- left ribs 6-12 at mid axillary line
27
What is rebound tenderness of palpation? What does it indicate?
Pain when releasing pressure
| Peritoneal inflammation
28
What is abdominal ridigity and what causes it?
Hard abdomen due to involuntary abdominal contraction
29
What is Rovsings sign? What does it indicate
RLQ pain when applying P on L side
| Indicates appendicitis
30
Where is mcburneys point?
1/3 of way from ASIS to umbilicus and indicates where appendix is usually located
31
What is murphys sign of the gallbladder?
When palpating R costal margin for gallbladder it is pain or cessation of inhalation and indicates acute cholecystitis
32
What is Courvosiers sign of the gallbladder?
Palpate large non tender gallbladder
| Indicates pancreatic cancer
33
What are shifting oulines for ascites?
Percuss from tympany to dullness supine then lateral recumbent and if borders change so tympany is on top then it may be ascites
34
What is fluid wave of ascites?
Assistant places ulnar aspects along midline at top and bottom
Then tap flank on one side and feel for impulse on other side
If other side impulse is felt then maybe ascites
35
What is the Psoas test for abdomen? What does a positive test indicate?
Flex hip against R
| If abdominal pain then appendicitis
36
What is the obturator test for abdomen? What does a positive test indicate?
Flex hip and knee over opposite knee
| Pain may indicate appendicitis
37
What is lloyds punch and what does it indicate?
Apply force on posterior aspect of kidney region
| Pain indicates kidney infeciton
38
What does a positive heel strike test indicate?
Appendicitis
39
What does chovsket sign indicate? What is it?
Tap facial nerve and it triggers facial muscle twitches
| Indicates hypocalcemia/hypoparathyroidism
40
What is trousseaus sign and what does it indicate?
Inflate BP cuffs leads to muscle spasm
| Indicates hypocalcemia/hypoparathyroidism
41
Bones, groans, and stones are complaints associated with?
Hypercalcemia/hyperparathyroidism
42
What are thyroid hormone levels associated with hypothryoidism vs hyperthryoidism
Hypo- elevated TSH and low T4 T3
| Hyper- low TSH and high T4 and T3
43
What are some signs and symptoms of cushings disease?
Moon face, buffalo hump, trunk obesity, striae
44
Explain mechanics of OA, AA, and typical C spine
OA- modified type 1 (main F/E)
AA- rotation only
Typical C spine- modified type II and I
45
What makes the anterior and posterior triangle of the neck
Ant triangle- SCM, mandible, midline
| Post triangle- SCM, traps, clavicle
46
When palpating the thryoid
Soft indicates
Firm indicates
Tender indicates
Soft- GD
Firm- hashimotos
Tender- thyroiditis
47
What is ROM of C spine
Flex- 45-90
Extend- 70-90
Rotate 70-90
SB- 20-45
48
```
Explain muscle strength testing of:
C1
C2-4
C5
C6
C7
C8
T1
```
```
C1- rotate head
C2-4- elevate scapula
C5- abduct shoulders
C6- flex elbow and extend wrist
C7- extend elbow and flex wrist
C8- flex finger
T1- abduct finger
```
49
Explain dermatomes from C1- T1
```
C1-4 from head to shoulder
C5- shoulder and upper arm
C6- lateral forearm and 6 shooter
C7- middle finger
C8- medial forearm
T1- medial upper arm
```
50
DTR spinal n.
Biceps
Brachioradialis
Triceps
Biceps- C5
Brachioradialis- C6
Triceps- C7
51
What is a compression neuropathy?
MSK or myofascial tissue is compressing a nerve leading to pain and paresthesia
52
What is the compression, distraction, and spurling test? What may it indicate?
Compression- axial load
Distraction- relieve pain
Spurlings- compress in neutral, extension, and SB/rotated
53
What are the boundaries of the thoracic outlet?
Manubrium, t1, and first rib
54
What is found within the thoracic outlet?
Brachial plexus, subclavian a/v
55
What are the zones of the thoracic oulet?
Scalene triangle
Costoclavicular space
Retropectoralis minor
56
What is the EAST test? What may it indicate
Abduct and externally rotate shoulders 90 and flex elbow 90
Then open and close fist for 3 min
Pain may indicate compressed subclavian a
57
What is adson test? What may it indicate?
Abduct, extend, and externally rotate arm while monitoring radial pulse
Have patient look at arm to evaluate rib
have patient look forward to evaluate scalene
Indicates one is compressing subclavian a
58
What is wrights hyperabduction test? What does it indicate
Abduct shoulder fully and apply some extension while monitoring radial pulse for any change
Indicates pec minor compression of thoracic outlet
59
What is the costoclavicular test and what does it indicate
Extend shoulder and apply caudad force on superior ascpect of shoulder while monitoring radial pulse
Change in pulse indicates compression by the clavicle and first rib
60
Explain nuchal ridigity
| Explain brudzinskis
Rigidity- supine then flex head to chest to evaluate any stiffness which may indicate subarachnoid inflammation
Brudzinkis- when doing ridigity it causes the patients hips and knees to flex which indicates subarachnoid inflammation
61
Posture evaluation
Slumped over-
Erect-
Slumped over- depression, muscle spasm, or to relieve pressure
Erect- relieve hernia or spinal stenosis
62
What is a spinal step off? What may it indicate
An abnormally prominent or recessed spinous process that may indicate spondylolisthesis
63
What is the ROM of lumbar spine
Flex- 40-90
Extend- 20-45
SB- 15-30
Rotate- 3-18
64
```
Explain muscle evaluation of:
L1-3
L4
L5
S1
```
L1-3- hip flexion
L4- knee extension
L5- Dorsiflex/heel walk
S1- plantarflex/ toe walk
65
DTR
Patellar
Achilles
Patellar- L4
| Achilles- S1
66
Explain straight leg raise and contralateral straight leg raise for lumbar spine and why you do both
Straight leg raise- flex hip and extended knee where pain usually appears between 30-60, greater than 70 is mechanical issue and indicates disc hernia
Contralateral leg raise- do straight leg raise of not affected leg to see if it recreates symptoms in affected leg
Straight leg is sensitive but contralateral is specific for disc herniation
67
What is hoovers sign?
Place hand under unaffected legs heel then have patient flex hip of affected leg against resistance
Should feel heel push
If it doesnt- function weakness or malingering
68
Explain thomas test and what it indicates
While supine hold one knee to chest and let other fall over table to evaluate if it extends fully
Indicates psoas contracture
69
What is gaenslens test and what does it indicate?
One hip off with leg extending down and other hip and knee pulled to chest
Evaluates SI joint problems
70
What is stork test and what does it indicate
Standing, have patient flip one hip and knee then have them extend back for pain
Indicates pars fracture
71
Whiplash is a combo of what two actions in what is refered as a what type of injury
Whiplash= hyperextend and hyperflex
| Inertia injury
72
Does hyperextension or hyperflexion in whiplash do more damage and why?
Hyperextension because the chin/chest limits hyperflexion
73
What is the most commonly affected muscle of whiplash?
SCM
74
What ligament does hyperextension/flexion in a whiplash injury affect in the vertebra?
Hyperextension- anterior longitidunal
| Hyperflexion- posterior longitudinal
75
Torticolis-
Laterocolis-
Anterocolis-
Retrocolis-
Torticolis- rotation
Laterocolis- SB
Anterocolis- flex
Retrocolis- extend
76
Is congenital or adult torticolis more common?
Adult
77
What is scoliosis and what plane does the injury occur in?
Abnormal lateral curvature of spine in coronal plane
78
How do you name a scoliosis?
The side of convexity (what side the curve points to)
79
What form of scoliosis is most common?
Double major curvature
80
Idiopathic scoliosis
Infantile- ages, gender, side, when to refer
Juvenile- age and when to refer
Adolescent- age, gender, progression
Infantile- age 0-3, M>F, L>R, angle over 35
Juvenile- age 4-9, angle over 20
Adolescent- age 10, most common, M=F, F progress more
81
What are some related symptoms of congenital scoliosis?
Urinary, cardiac, and spinal dysraphia (spine doesn't close along midline and leads to club feet)
82
What are conditions associated with neuromuscular scoliosis?
Polio, duchenes, cerebral palsy
83
What are conditions associated with syndromic scoliosis?
Marfans, elhlers danlos, and neurofibromatosis
84
When do you generally begin screening for scoliosis?
Age 10
85
How do you measure cobbs angle and what is the gold standard angle for scoliosis and when to refer
Superior aspect of most superior vert involved in curvature
Inferior aspect of most inferior vert involved in curvature
Make right angles from both lines to create angle
10 degrees for scoliosis and 20 to refer
