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364 Cards in this Set
- Front
- Back
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2 muscles underlying the breast
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pectoralis major (2/3) and serratus anterior (1/3)
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ribs associated with the breast
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ribs 2-6
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region of breast extending superolaterally from the upper/outer quadrant
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axillary tail of spence
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what happens to the breast right before menses
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they become nodular, enlarge, tender, and sometimes painful
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supernumerary nipples have to be located along what anatomical line
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milk line
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hormones associated with breast formation
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estrogen and progesterone
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the most easily palpable nodes involved with drainage of the breasts
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central axillary nodes
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which nodes drain the anterior chest wall and majority of the breast
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pectoral nodes
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the central axillary nodes drain into what nodes
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supra/infraclavicular nodes
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which ligaments attach mammary glands to the overlying dermis
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suspensory ligaments (Cooper's)
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blood supply to the breast
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the anterior intercostals (branch from the internal thoracic artery)
the posterior intercostals (branch from the thoracic aorta) the mammary arteries (branches off the thoracic arteries) |
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venous drainage of the breast is via what vein
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axillary
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lymph from the medial breast drains where
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parasternal nodes
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lymph from the inferior breast drains where
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abdominal nodes
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creamy white/yellow fluid secreted from the nipples during the last trimester and during the initial episodes of breastfeeding
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colostrum
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prominent ("puffy") skin between dimpled pores giving the breast an orange peel appearance
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peau d'orange sign
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physical observations of the breast that suggest breast cancer
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dimpling of the skin, abnormal contours, peau d'orange sign, and nipple inversion
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difference between simple and radical mastectomy
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radical mastectomy includes removal of the fat, fascia, and lymph nodes, whereas simple mastectomy only removes the breast tissue
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innervation to the breasts
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intercostal nerves 4-6
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MOST common breast lesion in female teens
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fibroadenomas
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condition of the breast characterized as nodular/ropelike lesions; most common between the ages of 25-50
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fibrocystic disease
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race associated with breast cancer at earlier ages and more likely to die
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african americans
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treatment regimen in post-menopausal women that increases risk for breast cancer
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HRT (estrogen/progesterone combination)
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genes associated with breast cancer
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BRCA1 and BRCA2
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risk factors for breast cancer
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female, old age, BRCA1,2 gene mutations, family history of breast cancer, high breast tissue density, atypical hyperplasia of the breasts, radiation, high bone density in post-menopausal women, late age at first pregnancy (>30), early menarche (<12), late menopause (>55), nulliparity, failure to breastfeed, oral contraceptives, HRT, obesity, patient history of cancer, alcohol, tall height, Jewish
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when is the ideal time to do a breast exam
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5-7 days after menstruation
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which BRCA gene mutation is linked to MALE breast cancer
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BRCA2
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characterized by deeply pigmented and velvety axillary skin associated with internal malignancy
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acanthosis nigricans
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causes of milky discharge from the breast unrelated to cancer
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galactorrhea, hypothyroidism, prolactinoma, drug toxicity (eg. dopamine agonists and psychotropics)
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which type of breast lesion is poorly delineated
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cancer
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which type of breast lesion is fixed to underlying tissue
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cancer
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which type of breast lesion is usually tender
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cysts
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which type of breast lesion has an irregular shape
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cancer (stellate shape)
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which type of breast lesion has a very hard consistency
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cancer
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form of breast cancer characterized by scaly, eczema-like lesions on the nipple and or areola; almost always unilateral
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Paget's disease
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what are the columns of vascular erectile tissue that comprises the shaft of the penis
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corpus spongiosum (1) and corpus cavernosa (2)
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what is smegma
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secretions of the glans penis that collect under the foreskin
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where do sperm mature
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epididymis
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what 2 structures come together to form the ejaculatory duct
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vas deferens and seminal vesicle
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describe the 2nd messengers involved with erection
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parasympathetics activate adenyl cyclase which forms cGMP which increases nitric oxide to cause vasodilation
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what 2 structures does the inguinal ligament connect
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ASIS and pubic tubercle
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causes of decreased libido
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psychogenic, depression, endocrine dysfunction, drug toxicity
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causes of erectile dysfunction
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psychogenic, performance anxiety, decreased hormones, decreased blood flow, impaired neural innervation
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MOST common cause of orgasms that lack ejaculation
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psychogenic
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causes of premature ejaculation
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sexual inexperience in young men, drug toxicity, surgery, neurologic deficits, and decreased androgens
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difference in penile discharge in gonococcal vs. non-gonococcal urethritis
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gonococcal discharge is yellow
non-gonococcal discharge is clear/white |
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4 most common STDs that can be transferred from oral sex
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chlamydia, syphilis, herpes, gonorrhea
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according to the CDC, what is the MOST common STD in the US
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chlamydia
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which form of hepatitis is MOST commonly transferred via sexual contact
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hepatitis B
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condition characterized by a tight prepuce that can't be retracted over the glans
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phimosis
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condition characterized by a tight prepuce that can be retracted over the glans, but once retracted, it cant be returned to its original position, thus causing edema
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paraphimosis
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what is balanitis
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inflammation of the glans penis
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what is balanoposthitis
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inflammation of both the glans and prepuce
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condition suggested by the presence of genital excoriations
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crabs (pubic lice)
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2 conditions suggested by the presence of indurations along the ventral surface of the penis
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urethral stricture or carcinoma
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common causes (6) of scrotal swelling
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inguinal hernias, hydroceles, and scrotal edema, epididymitis, orchitis, and spermatic torsion
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condition suggested by a poorly developed scrotum
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cryptorchidism
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dome-shaped papules/nodules formed by occluded follicles containing keratin debris made of desquamated follicular epithelium
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epidermoid cysts
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Are nodules in the testes/scrotum related to testicular cancer painful or painless
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usually painless
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MOST common side of variocele
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Left
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feeling a "bag of worms" in the scrotum suggests this condition
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variocele
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condition suggested by a positive transillumination test or red glow test
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hydrocele
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what type of hernia is suggested by a bulge in the external inguinal ring, and which type is suggested by a bulge in the internal inguinal ring
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bulge in the external inguinal ring- DIRECT inguinal hernia
bulge in the internal inguinal ring- INDIRECT inguinal hernia |
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Can you hear bowel sounds over a hernia or hydrocele?
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hernia
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what's an incarcerated hernia
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contents can NOT be returned to the abdominal cavity
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what is a strangulated hernia
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blood supply to the entrapped contents is compromised by the hernia
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which type of hernia (strangulated or incarcerated) is suspected when symptoms include nausea/vomiting
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strangulated
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testicular cancer is the MOST common cancer in men of what age group
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ages 15-35
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risk factors of testicular cancer
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cryptorchidism, family history, mumps, orchitis, inguinal hernias, and hydrocele in childhood
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characterized by palpable, nontender, hard plaques found just beneath the skin on the shaft of the penis causing the crooked/painful erection
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peyronie's disease
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are scrotal hernias more commonly caused by indirect or direct inguinal hernias
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indirect
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is carcinoma of the penis seen in circumcised or uncircumcised men?
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uncircumcised
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within what layer do hydroceles form
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tunica vaginalis
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causative organism of genital warts
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HPV 6,11
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incubation period for HSV2 infection
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2-7 days
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incubation period for HPV
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weeks to months
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does primary syphilis or chancroid have a PAINFUL ulcer
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chancroid
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causative organism of syphilis
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treponema pallidum
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what type of bacteria is treponema
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spirochetes
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causative organism of chancroid
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haemophilus ducreyi
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conditions associate with small testes
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Klinefelter's syndrome, cirrhosis, myotonic dystrophy, estrogens, steroids, and hypopituitarism
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MOST common cause of orchitis
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mumps
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acute epididymitis usually coexists with what 2 other conditions
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UTI and prostatitis
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associated with an EXTREMELY painful, edematous, and swollen scrotum; this is an emergency
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testicular torsion (or torsion of the spermatic cord)
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which hernia is MORE common in women than men
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femoral hernia
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what are glands that lie on both sides of the urethral meatus in the female
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paraurethral (skene's)
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orientation/direction of the vagina
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superior and posteriorly
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the vagina lies at a right angle to what organ
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uterus
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the ectocervix is made of what epithelium
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squamous
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the endocervix is made of what epithelium
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columnar
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name of the boundary between the endo/ectocervix
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squamocolumnar junction (aka tranformation zone)
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the parietal peritoneum extends downward behind the uterus into a cul de sac called what
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rectouterine pouch (aka pouch of douglas)
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this classification system is used to asses the stages of sexual maturity in females
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Tanner's stages of sexual development
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why are women resistant to most infection during menstruation
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leukorrhea occurs during menstruation
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which nodes does lymph from the vulva and lower vagina drain to
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inguinal nodes
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which nodes does lymph from the internal genitalia and upper vagina drain to
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pelvic and abdominal nodes
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in order to classify someone as having menopause, how long must they go without menstruating
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1 year
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define postmenopausal bleeding
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bleeding occurring 6 months or more after cessation of menses
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in order to classify someone as having PMS, for how many consecutive cycles must they show the corresponding symptoms
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3 consecutive cycles
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after the onset of menarche, how long does it take for menstruation to normalize and become regular
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1 year
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average length of menstruation
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5 days
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cause of primary dysmenorrhea
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increased prostaglandin production during the luteal phase of the menstrual cycle
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causes of secondary dysmenorrhea
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endometriosis, adenomyosis, PID, and endometrial polyps
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condition characterized by depression, angry outburts, irritability, anxiety, confusion, crying spells, sleep disturbances, poor concentration, and social withdrawal seen in women
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PMS
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causes of secondary amenorrhea
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pregnancy, lactation, menopause, low body weight, malnutrition, eating disorders, stress, chronic illness, and hypothalamic-pituitary-ovarian dysfunction
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postcoidal bleeding can signify what conditions (3)
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cervical polyps, cancer, or atrophic vagintis
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postmenopausal bleeding can signify what conditions (3)
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endometrial cancer, HRT, cervical polyps
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definition of gravida
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total number of pregnancies
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if a woman was G5 P3114 what would this signify
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G5- she has been pregnant 5 times
P: 3- full term births 1- premature births 1- abortions 4- living children |
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condition characterized by involuntary spasms of the muscles surrounding the vaginal orifice that make any type of penetration painful and almost impossible
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vaginismus
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MOST common cause of sexual dysfunction in women
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psychological reasons
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test to check for cervical cancer
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Pap smear
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MOST common type of cervical cancer
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squamous cell carcinoma
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high-risk strains of HPV linked to cervical cancer
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16,18
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risk factors for cervical cancer
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sexual activity at a young age, multiple sexual partners, history of STDs, poor nutrition, smoking, immunodeficiency, genetics
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According to the cervical cancer screening guidelines, when should a woman first be screened
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3 years after first sexual intercourse or by age 21, whichever comes first
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According to the cervical cancer screening guidelines, how often should women get screened between the ages of 21-30
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annually
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According to the cervical cancer screening guidelines, how often should women get screened older than age 30
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every 2-3 years as long as tests remain negative
(should screen annually in high risk patients) |
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According to the cervical cancer screening guidelines, how often should women get screened if they've had a hysterectomy
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discontinue routine screening unless the patient has had a positive history
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According to the cervical cancer screening guidelines, how often should geriatric females get screened
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not necessary unless they've had a positive history
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what is gardisil
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the HPV vaccine
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what strains of HPV goes gardisil target
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6,11,16,18
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what circumstances confer the best results when taking Gardisil
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given before onset of sexual activity (younger the better) and in those who have never been exposed to HPV before
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gene mutation linked to ovarian cancer
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BRCA 1 and 2
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tumor marker for ovarian cancer
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CA-125
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what are the different types of birth control
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abstinence, withdrawal method, lactation method, condoms (males and females), diaphragms, cervical caps, IUDs, subdermal implants, spermicide, the pill, hormone injections, vaginal rings, tubal ligation (females), and vasectomy (males)
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risks and benefits of HRT in postmenopausal women
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benefits: slow down bone loss, maintain good cholesterol levels, prevent vaginal atrophy
risks: increase risk for strokes, pulmonary embolisms, dementia, and breast cancer |
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MOST commonly used speculum
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medium Pedersen speculum
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best speculum for virgins or elderly women
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small Pedersen speculum
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best speculum for multiparous women and those with vaginal prolapse
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medium or large Graves speculums
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what position are the legs in while in the lithotomy position
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thighs should be flexed, abducted, and externally rotated
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this type of hymen is associated with delaying the onset of menarche
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imperforate hymen
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what position should the speculum be in when first entering the vagina
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45 degree angle
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what position should the speculum be after entering the vagina
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rotate into a horizontal position
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what condition is suggested with pain on movement of the cervix combined with adnexal tenderness
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PID
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condyloma latum are associated with what condition
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secondary syphilis
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causes the entire vaginal wall, bladder, and urethra to bulge
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cystourethrocele
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causes the upper 2/3 of the anterior vaginal wall and bladder to bulge; caused by weakened supporting tissues
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cystocele
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MOST common location for a caruncle
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urethral meatus
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MOST common group of people to have a caruncle
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post-menopausal women
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when is the urethral meatus MOST likely to prolapse
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before menarche and after menopause
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with increasing estrogen stimulation during adolescence, the columnar epithelium undergoes metaplasia -> this blocks secretions of the columnar epithelium and leads to the formation of what?
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nabothian cysts (aka retention cysts)
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common causative agents (3) of mucopurulent cervicitis
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chlamydia, neisseria, and herpes
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clear cell adenocarcinoma is linked to exposure to what agent
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DES
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describe the discharge of candidal vaginitis
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cottage cheese like
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describe the discharge of trichomonal vaginitis
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yellow/green color and frothy
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describe the discharge of bacterial vaginosis (usually Gardnerella)
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gray/white color with a fishy odor; pH > 4.5
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what method is used to visualize trichomonal vaginitis
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saline wet mount
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what method is used to visualize candidal vaginitis
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10% KOH mount
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what method is used to visualize bacterial vaginosis (Gardnerella)
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saline wet mount and the "whiff test"
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morphologic feature of bacterial vaginosis (Gardnerella)
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clue cells
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MOST common position of the uterus
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antiverted and antiflexed
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in what conditions is the uterus fixed and immobile
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endometriosis and PID
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what are uterine fibroids
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common benign tumors on the outside of the uterus
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in first-degree uterine prolapse, where is the uterus
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within the vagina
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in second-degree uterine prolapse, where is the uterus
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introitus
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in third-degree uterine prolapse, where is the uterus
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outside the introitus
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prolapse of the uterus is commonly linked to what 2 conditions
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cystocele and rectocele
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disease characterized by absent/irregular menses, hirsutism, acne, alopecia, elevated testosterone, multiple cyst formation, obesity, and lactation
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polycystic ovary disease
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2 common causes of PID
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chlamydia and neisseria
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innervation to the external anal sphincter
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pudendal nerve (S2-S4)
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what separates the rectum from the anus
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pectinate line (aka the dentate line or anorectal junction)
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what are valves of Houston
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the rectal wall contains 3 inward foldings throughout the distal rectum aka the valves of Houston
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black stools (melena) suggest what
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upper GI bleed or possibly a benign SE of anti-diarrhea meds
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bright red stool (hematochezia) suggest what
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lower GI bleed, colon/colorectal cancer
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pencil-like stools suggest what
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colorectal cancer
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minor bleeding in the stool (red color) usually found as streaks on the toilet paper suggests what
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internal hemorrhoids
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which type of hemorrhoids are painful
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external
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helminth known to cause severe proctitis especially at night
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enterobius vermicularis (pinworms)
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anal fissures are associated with what 2 conditions
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proctitis and Crohn's disease
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this condition is characterized by difficulty starting/stopping the urine stream, a weak urine flow, and increased frequency especially at night
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BPH or prostate cancer
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condition characterized by a feeling of heaviness at the base of the penis associated with malaise, fever, chills, and the common urinary symptoms of BPH
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prostatitis
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MOST common cancer in men
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prostate
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screening for prostate cancer involves checking what levels
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PSA
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what value of the PSA is considered abnormal
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> 4 ng/mL
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what types of conditions can cause false positives in a PSA test
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BPH, prostatitis, recent ejaculation, urinary retention, and biopsy of the prostate
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since both BPH and prostate cancer elevate PSA levels, how can you differentiate the two?
|
increased "free" PSA suggests BPH, and increased "bound" PSA suggests cancer
(*bound PSA binds to alpha-1-antichymotrypsin*) |
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gene mutation associated with prostate cancer
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BRCA2
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which type of cancer MOST common in the prostate
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adenocarcinoma
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whats the grading system used for prostate cancer
|
the Gleason system
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patients at high risk for colorectal cancer should have a colonoscopy how often
|
every 3-5 years
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congenital abnormality located in the midline superficial to the coccyx or the lower sacrum; may show up as a tuft of hair surrounded by a halo of erythema; may open into a sinus tract
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pilonidal cyst/sinus
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characterized as a very painful, oval ulceration of the anal canal found midline; its axis lies longitudinally; causes a spastic sphincter
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anal fissure
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skin lesion associated with anal fissures
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sentinel tags
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whats the difference between pedunculated and sessile rectal polyps
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pedunculated polyps develop on a stalk
sessile polyps develop on the mucosa |
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what is a "rectal shelf"
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cancer can metastasize and compress the rectum cutting off access inside the rectum during examination
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common causative organisms (5) of acute bacterial prostatitis
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E.coli, enterococcus, proteus, neisseria, and chlamydia
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MOST common cause of chronic bacterial prostatitis
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E.coli
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where are the cell bodies located in the brain
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gray matter
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where are the neuronal axons located in the brain
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white matter
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what coats an axon to facilitate transmission of signals
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myelin
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what is term for signal transmission along a myelinated axon in which the signal appears to "jump" between breaks in the myelin (nodes of Ranvier)
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saltatory conduction
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this is a white matter structure in the brain where myelinated fibers converge from all parts of the cortices and then descend into the brainstem
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internal capsule
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what part of the brain is important in maintaining consciousness
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reticular formation (aka reticular activating system)
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when the spinal cord ends, it gives off continuation fibers that travel to S2-- what are these fibers called
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cauda equina
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what are the 2 IV disc locations where lumbar taps are performed
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L3-4 and L4-L5
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which cranial nerves arise directly from the brain rather than the brainstem
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CN I and II
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do ventral roots of the spinal cord give off motor or sensory fibers?
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motor
(dorsal roots give off sensory fibers) |
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where are UMNs located
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primary motor cortex and brainstem nuclei
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where are LMNs located
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spinal cord and peripheral nerves
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what tract synapses in the brainstem and gives off motor fibers for the cranial nerves
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corticobulbar
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3 main pathways involves in motor functioning are the corticospinal tracts, basal ganglia, and cerebellar system-- which one, if damaged, will cause paralysis
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corticospinal
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DTRs in the extremities are examples of which type of reflex
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monosynaptic
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what are MAJOR spinal levels associated with with the achilles, patellar, brachioradialis, biceps, and triceps reflexes
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achilles: S1
patellar: L4 brachioradialis: C6 biceps: C5 triceps: C7 |
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what are the spinal levels for the upper and lower abdominal reflexes
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upper: T8-10
lower: T10-12 |
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what are the spinal levels for the plantar reflex
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L5-S1
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what the spinal levels for the anal reflex
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S2-S4
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what typically presents as "the worst headache of my life"
|
subarachnoid hemorrhage
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if a patient complains of "the worst headache of my life" and a subarachnoid hemorrhage is ruled OUT, what is the likely cause
|
acute meningitis or cluster headache
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sudden onset of diplopia, ataxia, dysarthria, and headache would suggest what
|
stroke
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|
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difference between vasovagal and cardiac syncope
|
vasovagal: more common in young people who are stressed; warning signs include flushing, warmth, and nausea; onset is slow and it last for awhile
cardiac: more common in older people; caused by arrhythmias; onset is sudden and patient recovers quickly |
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what diseases increases the risk of strokes in YOUNG people
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collagen vascular disease, Takayasu's arteritis, arterial dissection, fibromuscular dysplasia, and drug use
|
|
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HIGHEST risk factor for stroke in the general population
|
HTN
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MOST common cause of peripheral neuropathy
|
diabetes
|
|
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how does the peripheral neuropathy in diabetics present
|
"stocking-glove" distribution (affects distal extremities first)
|
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what are the 3 D's you always have to assess during a neurologic exam
|
delirium, dementia, and depression
|
|
|
neurodegenerative condition associated with loss of smell
|
Parkinsons
|
|
|
a pallor disc on fundoscopic exam suggests what
|
optic atrophy
|
|
|
a bulging disc on fundoscopic exam suggests what
|
papilledema
|
|
|
MOST common cause of bitemporal hemianopia
|
compression of the optic chiasm by a pituitary tumor
|
|
|
what common visual field lesion is seen in strokes
|
quadrantanopsia (pie in the sky or pie on the floor)
|
|
|
definition of anisocoria
|
pupil size differs by > 0.4mm
|
|
|
what muscle controls accommodation and what innervates it
|
ciliary muscle; it's innervated by both parasympathetics from CNIII and sympathetics from the superior cervical ganlgion
|
|
|
3 common conditions that ptosis is seen in
|
CN III palsy, Horner's syndrome, and myasthenia gravis
|
|
|
how is nystagmus named
|
for the direction of the fast component
|
|
|
isolated facial sensory loss can be seen in what cranial nerve lesion
|
trigeminal neuralgia
|
|
|
the corneal reflex tests what cranial nerves
|
V and VII
|
|
|
absent blinking and sensorineural hearing loss are the 2 common symptoms of what brain tumor
|
schwanomma
|
|
|
what hearing test is used to assess air vs. bone conduction
|
Rinne test
|
|
|
what hearing test is used to assess lateralization
|
Weber test
|
|
|
this disease is characterized by vertigo, hearing loss, and nystagmus
|
Meniere's disease
|
|
|
with a unilateral lesion to CN X, which side does the uvula deviate to
|
away from the lesion
|
|
|
the gag reflex assesses what cranial nerves
|
CN IX and X
|
|
|
the tongue may atrophy and have fasciculations in what 2 neurodegenerative conditions
|
ALS and polio
|
|
|
increased muscle bulk with decreases strength (aka pseudohypertrophy) is characteristic of what muscular disease
|
Duchenne's
|
|
|
which muscles show the MOST pseudohypertrophy in Duchenne's
|
calf muscle (gastrocnemius)
|
|
|
Is spasticity an UMN or LMN sign?
|
UMN
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|
|
2 MAIN muscles that extend the wrist and what nerve innervates them
|
extensor carpi radialis longus and brevis
innervated by the radial nerve |
|
|
what conditions (5) are associated with having a weak hand grip
|
cervical radiculopathy, de Quervain's tenosynovitis, carpal tunnel syndrome, arthritis, and epicondylitis
|
|
|
weak finger abduction suggests lesion to what nerve
|
ulnar nerve
|
|
|
MAJOR flexor of the hip
|
iliopsoas
|
|
|
MAJOR extensor of the hip
|
gluteus maximus
|
|
|
MAJOR abductors of the hip
|
gluteus medius and minimus
|
|
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nerve root that innervates gluteus maximus
|
S1
|
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MAJOR extensor of the knee
|
quadriceps
|
|
|
MAJOR flexor of the knee
|
hamstrings
|
|
|
MAJOR dorsiflexor of the foot
|
tibialis anterior
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|
|
MAJOR plantarflexors (2) of the foot
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gastrocnemius and soleus
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|
wide-spaced gait suggests damage to what region of the brain
|
cerebellum
|
|
|
define dysdiadochokinesis
|
one movement can't be followed quickly by another movement; movements in general are slow, irregular, and clumsy; seen in cerebellar dysfunction
|
|
|
what are some tests to assess for cerebellar function
|
rapid alternating movement (thigh striking), rapid finger to thumb, rapid foot tap, finger to nose, heel to shin, tandem gait, walking on heels/toes, hop in place on one foot, shallow knee bend, Romberg
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|
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are cerebellar symptoms worse with eyes open or eye closed
|
eyes closed
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How would the Romberg test differ in someone with a lesion to the dorsal column versus cerebellar dysfunction
|
In a lesion to the posterior column, they will only have a positive Romberg sign with their eyes closed
In cerebellar dysfunction, they will have a positive Romberg sign with both their eyes open and closed |
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In the absence of a CNS lesion, what else could a positive Babinski suggest in an adult
|
unconscious states due to drugs or alcohol, as well as the post-ictal period following a seizure
|
|
|
What would signify a positive Babinski reflex
|
dorsiflexion of the big toe
|
|
|
what is Brudzinski's sign
|
while the patient is supine, you flex the neck- if the hips and knees begin to flex, this is a positive Brudzinski's sign
|
|
|
what is Kernig's sign
|
while the patient is supine, flex the patient's hip and knee- then try and straighten the knee- pain would be a positive Kernig's sign
|
|
|
define asterixis
|
sudden, brief, nonrhythmic flexion of the hands and fingers
|
|
|
what conditions is asterixis associated with
|
liver disease, uremia, and hypercapnia
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what type of patient would be described as drowsy, but can open their eyes and look at you, respond to your questions, but then fall asleep
|
lethargic
|
|
|
what type of patient would described as opening their eyes to look at you, but they respond slowly and are confused; they have decreased interest in the environment around them
|
obtunded
|
|
|
what type of patient would described as arising from sleep only after applying a painful stimuli; verbal responses are slow or absent; patient lapses into unresponsive state when the stimulus ceases
|
stuporous
|
|
|
what type of patient would described as remaining unarousable even with repeated pain and their eyes stay closed
|
comatose
|
|
|
what reflex is used to assess brainstem function in a comatose patient
|
oculocephalic reflex (aka doll's eyes movements)
|
|
|
how do you perform the oculocephalic reflex
|
hold open the eyelids so you can see the eyes and quickly turn head to one side; in a normal person the eyes will move to the contralateral side; if there is a lesion to brainstem, the eyes wont move
|
|
|
what is the oculovestibular reflex
|
elevate head 30 degrees and inject ice water into the ear canal; eyes should drift towards the ear with the water; no response suggests brainstem lesion; note that this reflex is almost NEVER done in a non-comatose patient
|
|
|
artery that when damaged causes locked-in syndrome
|
basilar
|
|
|
a stroke producing contralateral leg weakness suggests what artery was involved
|
ACA
|
|
|
a stroke producing contralateral arm weakness suggests what artery was involved
|
MCA
|
|
|
precipitating factor for vasovagal syncope
|
strong emotion such as fear or pain; being fatigued, hungry, or in a hot/humid environment increases risk
|
|
|
2 possible mechanisms for the cause of postural hypotension
|
inadequate vasoconstrictor reflexes and hypovolemia
|
|
|
when does postural hypotension usually occur
|
immediately after standing up; increased risk in patients taking anti-hypertensive meds
|
|
|
MOA for why cough syncope occurs
|
increases in intrathoracic pressure; increased risk in those with bronchitis
|
|
|
difference between simple partial and complex partial seizures
|
simple partial seizures maintain consciousness and complex partial ones do NOT
|
|
|
What are Jacksonian motor movements often seen in simple partial seizures
|
tonic and then clonic movements that start unilaterally in the hand, foot, or face, and spreads to other body parts on the same side
|
|
|
what are some of the automatisms seen in complex partial seizures
|
chewing, smacking lips, stumbling around, unbuttoning clothes
|
|
|
what are some toxic/metabolic causes of seizures
|
withdrawal, uremia, hypoglycemia, hyponatremia, and bacterial meningitis
|
|
|
petit mal seizures (absence seizures) last for how long
|
<10 sec
|
|
|
atypical absence seizures last for how long
|
>10 sec
|
|
|
in this type of seizures, the movements may have personally symbolic significance and often do not follow a neuroanatomic pattern
|
pseudoseizure
|
|
|
Parkinson's has which type of tremor
|
resting ("pill-rolling")
|
|
|
when do resting tremors disappear
|
upon movements
|
|
|
what type of tremor is seen in hyperthyroidism and fatigue
|
postural tremor
|
|
|
when do postural tremors go away
|
at rest
|
|
|
what type of tremor is seen in MS
|
intention tremor
|
|
|
tardive dyskinesia is an irreversible SE of what class of drugs
|
anti-psychotics and phenothiazines
|
|
|
what are brief, reptitive, stereotyped, coordinated movements occuring at irregular intervals called
|
tics
|
|
|
what disease is most commonly associated with tics
|
Tourette's
|
|
|
what is the term for twisting, writhing movements of the extremities and face
|
athetosis
|
|
|
what is the term for athetoid-like movements, but they affect large portions of the body including the trunk
|
dystonia
|
|
|
what is the term for brief, rapid, jerky, irregular, and unpredictable dance-like movements
|
chorea
|
|
|
what 2 diseases is chorea seen in
|
Huntingtons and rheumatic fever
|
|
|
this condition is characterized by fluent but meaningless speech often accompanied by neologisms
|
Wernicke's aphasia
|
|
|
this condition is characterized by non-fluent but meaningful speech; patient seems very frustrated when trying to speak
|
Broca's aphasia
|
|
|
bilateral lesions to the frontal lobes causes what type of muscle tone dysfunction
|
paratonia
|
|
|
this disorder of muscle tone is characterized by flexion/extension of the wrist/forearm with a superimposed rachetlike jerkiness
|
cogwheel rigidity
|
|
|
MOST common cause of spasticity
|
stroke
|
|
|
MOST common cause of rigidity
|
Parkinsons
|
|
|
MOST common causes (2) of flaccidity
|
Guillain-Barre and spinal cord injury
|
|
|
MOST common cause of paratonia
|
dementia
|
|
|
what is gegenhalten
|
sudden increase in tone makes motion more difficult
|
|
|
what is mitgehen
|
sudden loss of tone that increases the ease of motion
|
|
|
2 common diseases associated with anterior horn lesions
|
polio and ALS
|
|
|
which gait is characterized by extremely weak tibialis anterior and toe extensor muscles
|
steppage gait
|
|
|
which gait is characterized by patients who appear to be walking through water
|
scissor gait
|
|
|
what is the irregular respiratory pattern seen in comas
|
Cheyne-stokes
|
|
|
how do opioids affect the pupils
|
miosis (pinpoint pupils)
|
|
|
how does cocaine and LSD affect the pupils
|
mydriasis (blown pupils)
|
|
|
what is decorticate rigidity
|
abnormal flexor response-- upper arms are flexed and held against sides with the fingers and wrists flexed as well; the feet are plantar flexed; legs are internally rotated
|
|
|
what is decerebrate rigidity
|
abnormal extensor response-- arms are extended, pronated, and adducted; legs are extended and feet are plantar flexed
|
|
|
what is the postcentral gyrus
|
primary sensory cortex
|
|
|
hemineglect would suggest dysfunction to what lobe of the brain
|
parietal lobe
|
|
|
do cerebellar lesions produce ipsilateral or contralateral findings
|
ipsilateral
|
|
|
genetic mutation causing Freidrich's ataxia is located on what chromosome
|
9
|
|
|
the thalamus is located by what ventricle
|
3rd ventricle
|
|
|
the nuclei of which cranial nerves are located on the medulla
|
CN 9-12
|
|
|
describe characteristics of the post-ictal stage of a seizure
|
lethargic, confused, muscle pain, headache, amnesia
|
|
|
are migraines more common in men or women
|
women
|
|
|
difference between a prodroma and aura
|
prodroma: 1-2 days prior to migraine; characterized by euphoria, yawning, food craving, lethargy, depression
aura: 1-2 hours prior; charcterized by scintillating scotoma, paresthesias, weakness, speech disturbance, and dizziness |
|
|
are cluster headaches more common in men or women
|
men
|
|
|
PET scans during a cluster headache show increased arterial flow in which portion of the brain
|
ipsilateral inferior portion of the hypothalamus
|
|
|
what group of drugs aggravates cluster headaches
|
nitrates
|
|
|
are tension headaches more common in men or women
|
women
|
|
|
MOST common cause of seizures in adults
|
neoplasm
|
|
|
what is the mechanism behind the initial high pitched cry at the start of a grand mal seizure
|
air is forced across the glottis
|
|
|
MOST common cause of cerebrovascular hemorrhage
|
HTN
|
|
|
where does the spinothalamic pathway decussate
|
anterior white commisure
|
|
|
where does the lateral corticospinal tract decussate
|
pyramidal decussation
|
|
|
where does the dorsal column decussate
|
internal arcuate fibers
|
|
|
which stage of breast cancer is characterized by a tumor of 2cm or less, it hasn't spread or metastasized, and survival rate is 98%
|
stage I
|
|
|
which stage of breast cancer is characterized by a 2-5cm tumor, hasn't spread or metastasized, about an 80% survival rate
|
stage II
|
|
|
which stage of breast cancer is characterized by the spreading of cancer to local lymph nodes, the skin of the breast is usually affected, survival rate is about 50%
|
stage III
|
|
|
which stage of breast cancer is characterized by distant metastasis, treatment usually doesnt cure the cancer, survival rate is minimal
|
stage IV
|
|
|
what position is the patient in for a prostate exam
|
left lateral recumbent
|
|
|
what position is the patient in for a hernia exam
|
standing
|
|
|
What are the measurements of the testicles in Tanner Stage 1
|
2cm with a volume of 2mL
|
|
|
What are the measurements of the testicles in Tanner Stage 2
|
2.7cm with a volume of 5mL
|
|
|
What are the measurements of the testicles in Tanner Stage 3
|
3.4cm with a volume of 10mL
|
|
|
What are the measurements of the testicles in Tanner Stage 4
|
4.1cm with a volume of 20mL
|
|
|
What are the measurements of the testicles in Tanner Stage 5
|
5cm with a volume of 29mL
|
|
|
what are some risk factors for colorectal cancer
|
family history, high fat diet, obesity, smoking, physical inactivity, and ETOH
|
|
|
blood flecked mucous in the stool suggests what as the causative agent
|
amoeba
|
|
|
fatty stools are seen in conditions (2)
|
malabsorption syndromes and pancreatic disease
|
|
|
what will the stools look like in people with obstructive jaundice
|
clay colored
|
|
|
What is a unique feature of stage 4 of Tanner's stages of breast development
|
Areola project to form a secondary mound over the breast
|
|
|
At what stage in the Tanner's stages of testes/scrotum development does the scrotum darken
|
Stage 4
|
|
|
At what stage in Tanner's stages of penis development does the penis undergo the greastest increase in length
|
Stage 3
|
|
|
In females, according to the Tanner stages of pubic hair, what is the only major difference between stages 4 and 5
|
Pubic hair reaches the medial surface of the thighs in stage 5
|
|
|
What is the name of the special hair that is located around the genitalia according to stage 1 of Tanner's stages of pubic hair growth in males
|
Vellus
|
|
|
Lesions to which optic radiation and which artery cause contralateral superior quadrantanopia (pie in the sky)
|
Inferior optic radiations and the inferior division of the MCA
|
|
|
Once a woman is of age for possible breast cancer risk, how often should she have a mammogram
|
annually regardless of past history
|
|
|
what complications are associated with having a supernumerary nipple
|
congenital cardiac and renal anomalies
|
|
|
newborns may secrete milky fluid from their breasts up to what age
|
up to 3 months old
|
|
|
what are nonsuppurative bumps on the areola called
|
Montgomery's tubercles
|
|
|
which condition of the breast is most commonly associated with breast feeding
|
mastitis
|
|
|
condition in females characterized by pain, dysmenorrhea, and heavy prolonged menstrual flow; tender nodules are palpated along the uterosacral ligament
|
endometriosis
|
|
|
what can happen to the vas deferens in diabetics
|
become beaded and lumpy
|
|
|
how would you describe the state of the testes in a full term newborn male
|
pendulous
|
|
|
painful, prolonged erections are called what
|
priapism
|
|
|
rectal prolapse in young children is associated with what disease
|
cystic fibrosis
|
|
|
inability to pass the meconium stool in an infant suggests what
|
anorectal fistula
|
|
|
characterized by elevated, red, granular tissue, opening on the perianal skin with purulent drainage
|
anorectal fistula
|
|
|
chance of getting prostate cancer
|
1 in 6
|
|
|
at what age should screening for colon cancer (i.e. colonoscopy) be performed in patients with no significant history
|
50
|
