Tutorials Written I Flashcards
(135 cards)
1
Q
innervation: lateral rectus and superior oblique
A
CN VI
2
Q
innervation: superior medial and inferior rectus, inferior oblique
A
CN III
3
Q
innervation: pupillary constriction, consenual response
A
CN II
4
Q
how to find the optic disk
A
find and artery or vein branch point and follow the acute angle to the disk
5
Q
blurred optic disk margins
A
increased intercranial pressure/papilledema
6
Q
Rinne: air equal or worse than bone
A
conductive hearing loss
7
Q
Rinne: air better than bone
A
sensorineural hearing loss
8
Q
Weber: lateralizes to bad ear
A
conductive hearing loss
9
Q
Weber: lateralizes to good ear
A
sensorineural hearing loss
10
Q
Ddx ear pain
A
otitis externa or media, TMJ, temporal arteritis, zoster
11
Q
tug test: extreme pain
A
otitis externa, swimmer’s ear! Treat with abx
12
Q
cloudy, bulging or perforated ear drum
A
otitis media
13
Q
Ddx pain swallowing, sore throat, voice change
A
viral or strep pharyngitis, mono, GERD, allergic rhinitis
14
Q
Ddx slow explanding neck mass
A
thyroid nodule, goiter, malignany, lymphadenopathy, congetinal neck masses
15
Q
hear a thyroid bruit?
A
hyperthyroidism secondary to Graves
16
Q
tracheal deviation
A
in pneumothorax and lobar collapse (toward side of condition), or tumor or pleural effusion (away from conditions)
17
Q
RLQ rebound tenderness, pain on percussion, rigidity and guarding
A
appendicitis
18
Q
mildly enlarged, soft liver, enlarged spleen (5-15%)
A
hepatitis
19
Q
Epigastric tendernessRUQ tenderness (if biliary)
A
peptic ulcers
20
Q
abdominal tenderness, guarding (upper), distention. Diminished bowel sounds
A
pancreatitis
21
Q
abdominal distenion, hyperactive bowel sounds (early), absent bowel sounds (late)
A
small bowel obstruction
22
Q
localized tenderness, commonly LLQ (sigmoid colon)
A
diverticulitis
23
Q
chest pain when lying supine or bent over
A
GERD
24
Q
pain begins epigastric and then localizes RUQ
A
cholecystitis
25
normal bowel sounds
5-30 per minute
26
listen for renal bruits if
pt has history of hypertension
27
listen for iliac and femoral bruits if
pt has hx of peripheral arterial disease
28
causes of peritoneal inflammation
perforated stomach ulcer, perforated small or large intestine (ruptured appendix, perf from diverticulitis or obstructing cancer), ruptured gall bladder (from cholecystitis)
29
normal liver span
6-12 cm
30
conditions causing a small liver
advanced cirrhosis
31
conditions causing a large liver
hepatitis, hepatic congestion from R-side HF, liver cancer or metastatic liver disease
32
splenic percussion becomes dull on inspiration
enlarged spleen (you want tympanic throughout)
33
antalgic gait
when phase of gait is shortened on the injured side to alleviate pain
34
tenderness at the greater tubercle of the humerus, pain with abduction over 90 degrees
rotator cuff tendonitis
35
tenderness just lateral and inferior to the acromion
subacromial bursitis
36
pain and crepitus at the AC joint
acromioclavicular arthritis
37
tenderness at the insertion site or along the bicipital groove
tendonitis of the long head of the biceps
38
drop arm test
tear of supraspinatus (a rotator cuff muscle)
39
nodes at the PIP
bouchard's nodes, osteo or rhumatoid arthritis
40
nodes at the DIP
heberden's nodes, osteoarthritis
41
inguinal or groin pain that may radiate to knee, pain and limited internal rotation (15 degrees)
hip arthritis
42
lachman test (supine patient, knee bend thirty degrees, then move lower leg anteriorly)
ACL tear
43
tenderness when pressing patella to femur
patellofemoral syndrome
44
thompson test (squeeze grastocnemius)
check for ruptured achilles tendon
45
heel or foot pain in the morning, pain in plantar fascia when dorisflexed toes
plantar fascitis
46
straight leg raise
sciatica
47
assymetric chest wall movement
pneumothorax, atelectasis, lobar pneumonia, lung cancer
48
increased fremitus
consolidation
49
decreased fremitus
pleural effusion, pneumothorax
50
S1 is louder
apex (mitral area)
51
S2 is louder
base (AP area)
52
pt leans forward and exhales while you listen at the left sternal border
to appreciate aortic regurg murmur
53
normal JVD
1-3 cm above sternal angle, 6-8 cm above right atrium
54
listen to carotid with
diaphragm or bell
55
RV heave may mean
right ventricular hypertension
56
6 dimensions of a murmur
LRQITS location, radiation, quality, intensity (1-5), timing and shape
57
left lateral decubitus
use bell to hear mitral stenosis murmurs and gallops
58
upper motor neuron lesion
increased tone, increased reflexes, clonus, upgoing plantar reflexes,
59
lower motor neuron lesoin
atrophy, hypotonia, decreased reflexes, fasciculations (muscle twitching)
60
Power/strength 0
absent motor strenth
61
power/strength 1
trace: slight contraction detected
62
power/strength 2
weak: movement with gravity eliminated
63
power/strength 3
fair: movement against gravity
64
power/strength 4
good: movement against gravity with some resistance
65
power/strength 5
normal: movement against gravity with full resistance
66
normal tendon reflexes
2
67
biceps nerve levels
C5, C6
68
brachioradialis nerve levels
C6
69
tricep nerve levels
C7
70
patellar nerve levels
L4
71
ankle nerve levels
S1
72
plantar nerve levels
L5,S1
73
upgoing (extensor) plantar response
upper motor neuron lesion
74
how close should you be to evaluate a lesion
closer than 20 cm
75
arcal distribution
head, hands and feet
76
dermatomal distribution
along dermatomes: herpes zoster
77
intertriginous distribution
in axilla, perineum, under breasts, under skin folds
78
ABCDE of melanoma
asymmetry, border irregularity, color variegation, diameter > 6mm, evolution
79
clubbing is associated with 6
interstitial lung disease, lung cancer (esp large cell), mesthelioma, subacute bacterial endocarditis, Crohn's, primary biliary cirrhosis
80
phimosis
inability to retract prepuce, normal in kids under 4
81
peyronie's disease
fibrous plaque on corpus cavernosum gives penis a sharp curve
82
tender prostate
acute or chronic prostatitis
83
firm prostate
Normal or BPH: feels like thenar eminence of stretched hand
84
hard prostate
cancer or stones (scar), feels like a knuckle
85
soft prostate
hypogonadism, feels like an earlobe
86
boggy prostate
abscess, feels like blown out cheeks
87
discrete nodular prostate
BPH or cancer
88
3 of the 10 most common cancers in men are
GU: prostate, bladder, kidney
89
normal BMI
18.5-24.5
90
obese BMI
Over 30
91
fever in C and F
37.7 or 99.9
92
drinking hot beverages
increase oral temp by .9 C for fifteen minutes
93
drinking cold beverages
decrease oral temp by .3-1.2 C for 15 minutes
94
tachypnea and temperature
can lower temp by .5 C for every 10 breaths above normal
95
present with a weak thready pulse
hypervolemia, hypertension
96
present with a bounding pulse, wide pulse pressure
hyperthyroidism
97
normal HR
Between 50/60 and 100
98
Pressure difference in both arms should be less than
10-15 mmHg
99
proper cuff: length of bladder is
80% of arm circumference, width is 40%
100
BP asymmetry
coarctation of aorta, aortic dissection, external compression of arterial flow
101
prehypertension
120-139/80-89
102
stage I HTN
140-159/90-99
103
stage II HTN
>160/100
104
orthostasis definition
drop of 20 systolic or 10 diastolic within three minutes of standing
105
conductive hearing defects
cerumen impaction, typmanic membrane diseases, middle ear disorders
106
visual acuity, top and bottom number
top is where patient can read charge from, bottom is normal person
107
diminished light transillumination in mouth
indicates sinus congestion
108
expiration is prolonged in
obstructive ventilatory diseases such as asthma and emphysema
109
pt with inferior MI may complain of
nausea
110
acute ischemia or MI in elderly may present as
delirium, reduced cognition, waxing and waning levels of consciousness
111
pt with subacute bacterial endocarditis may appear
fatigued, with evidence of weight loss
112
apical impulse is typically found
midclavicular line at fifth intercostal space
113
aortic area
right second intercostal
114
pulmonic area
left second intercostal
115
mitral area
cardiac apex
116
tricupsid area
left lower sternal border
117
S1 marks
beginning of systole (closure of M and T)
118
S2 marks
onset of diastole (relaxation, AP close)
119
aortic regurg murmur occurs
left sternal border/apex in diastole
120
carotid v. IJV
IJV: not palpable, flutters, varies with respiration. Carotid: palpable, up and down, does not vary
121
hyperdynamic PMI
hyperthyroid, anemia, beriberi, infection states.
122
normally split on inspiration
S2
123
S3 represents
sound of passive filling into dilated venricle
124
S4 represents
active filling into stiff ventricle
125
involuntary guarding may indicate
peritoneal irritation
126
inspiration causing pain enough to halt it while pressing RUQ
murphy's sign: cholecystitis
127
tenderness at lateral epicondyle
tennis elbow
128
tenderness at medial epicondyle
golfer's elbow
129
pain at the base of the thumb commonly occurs in
osteoarthritis
130
atrophy of the thenar eminence
advanced carpal tunnel
131
Tinnel's sign
percussion over carpal tunnel makes pain/tingling over medial nerve distribution
132
Phalen's test
maximal wrist flexion for one minute causes pain or numbness
133
test of trapezius/SCM
CN XI
134
symmetrical uvula
CN IX
135
anatomical snuffbox pain
scaphoid fracture, osteoarthritis, tenosynovitis
