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978 Cards in this Set
- Front
- Back
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FPP 1
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late resupination with propulsion
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FPP 1
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absence of a nail
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FPP 1
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decrease hallux dorsiflexion at the first MPJ associated with first ray hypermobility and abducted gait
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FPP 1
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fungus or melanoma.
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FPP 1
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Tibial varum ...tibias are inverted distally
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FPP 1
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fungi that live off of skin cells
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FPP 1
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1. red feet without swelling 2.bilateral warm or hot feet 3. pain
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FPP 1
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1. mossy, pig skin with warts 2. foot gets larger with stimulated fibrous tissue 3. non pitting edema 4. blood flow slows down`
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FPP 1
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pain at the achilles tendon insertion due to and equinus functioning foot
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FPP 1
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the disease bursa is associated with the synovial sheath of the achilles tendon (anterior bursa). A posterior bursa will develop if the achilles tendon or its attachment is being rubbed or abuse hense the mechanical bursa for protection.
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FPP 1
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the presence of fibrous tumors on the plantar aspect of the foot
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FPP 1
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spur on the back of the heel, usually seen in a mechanically imbalanced foot with a lot of rocking back and forth. aka pump bumps
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FPP 1
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plantar flex and invert
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FPP 1
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non pitting edema
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FPP 1
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the buildup of extra wartlike tissue is burnt away with acid
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FPP 1
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three: dorsal, intermediate, ventral
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FPP 1
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area under the nail that is not attached to the bed
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FPP 1
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L4 slipped disc
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FPP 1
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inferior calcaneal bursitis.. it need a steriod injection in the bursa
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FPP 1
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arterial ulcer
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FPP 1
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30 sec, 3 times
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FPP 1
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HIV patients
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FPP 1
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intractable plantar keratosis, buildup of skin on the bottom of the foot due to pressure points. in diabetics, this may cause ulceration
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FPP 1
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genu valgum
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FPP 1
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accumulation of fat in the anterior aspect of the ankle in women after menopause
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FPP 1
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white patches on the surface of the nail that is a superficial fungal infection caused by candida
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FPP 1
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bigger or wider than normal nail
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FPP 1
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peeling away of lateral foot border
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FPP 1
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the red zone under the skin at the proximal end of the nail where nail growth originates.
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FPP 1
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trychophytan, hypersporum, epidermophytan, candida
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FPP 1
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painful nerve, usually do to tight shoes and is immediatly relieved when they are removed
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FPP 1
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thickening of a nerve
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FPP 1
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lack of sensation, as in a diabetic
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FPP 1
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uniform thickening of the nail
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FPP 1
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chronic inflammation of the nail matrix
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FPP 1
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ingrown toenail
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FPP 1
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the toe is abnormal
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FPP 1
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thick, grossly deformed and enlarged nails
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FPP 1
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separation of nail plate from the end of the toe (too proximally)
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FPP 1
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Separation from the proximal nail fold
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FPP 1
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the nail is soft
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FPP 1
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localized infection of the nail or nail bed caused by fungus
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FPP 1
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nail fungus (tinea ungum) characterized by thick, discolored nails
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FPP 1
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the nail is in layers
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FPP 1
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abnormal sensory signs
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FPP 1
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inflammation of veins
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FPP 1
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more than one nail on a digit
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FPP 1
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Grades 5 - 0 5 being normal 0 being no palpable contraction
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FPP 1
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contracture of the plantar and palmar fascia that is associated with insulin dependant diabetics...they cannot straighten their hands out....its called the prayer sign
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FPP 1
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in a child, the calcaneus grows faster than the soft tissues causing an equinus condition. it can be painful. casting and night splints help the soft tissue to catch up
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FPP 1
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distal phalanx bone tumor
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FPP 1
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tapping the nerve and getting a tingling sensation distally (electrical tingle)
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FPP 1
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loss of dermis and epidermis
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FPP 1
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tapping a nerve sends an electrical feeling proximally
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FPP 1
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results because of the vamp of improper shoes
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FPP 1
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1. Achilles tendonitis 2. Anterior Tendo-achilles bursitis (haglunds deformity) 3. Posterior achilles bursitis4. Posterior talar tubercle pain
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FPP 1
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1. Tarsal tunnel syndrome 2. Great saphenous vein (phlebitis) 3. Tibialis posterior tendonitis 4. Tibial nerve (entrapement or compression)
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FPP 1
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Keenan's fibromas or periomal fibromas
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FPP 1
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1. Rest portion 2. Stance portion 3. Gait portion 4. Footgear Survey 5. Radiographic Assessment
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FPP 1
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1. morphological exam (visual inspection) 2. comparative deviations (asymmetry) 3. palpation exam (determine tenderness) 4. Arthrometric exam (motion)~
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FPP 1
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calcaneal inversion = 20 deg. calcaneal eversion = 10 deg.
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FPP 1
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1. they are on the medial side of the ankle 2. they have a red granulating base 3. they have irregular borders 4. hard or indurated skin 5. Reactive bone formation 6. Usually not painful
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FPP 1
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1. lateral side of foot 2. cold, red foot 3. swelling 4. greyish centers 5. pain 6. smaller and punched out
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FPP 1
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CalcaneoNavicular coalition and Excessive ankle pronation
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FPP 1
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lamisil, sporanox
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FPP 1
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red is healthy, venous ulcer
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FPP 1
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non-glycosylation of connective tissue and collagen causing the deposition of mucopolysaccarides in the collagen.
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FPP 1
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soft tissue which is part of the posterior nail fold. Sometimes referred to as eponychium. plays a part in nail generation
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FPP 1
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white area you see on your fingernails. the most distal point of the nail matrix is the lunula. plays a role in nail generation
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FPP 1
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lateral ankle sprain
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FPP 1
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an epithelial layer with indentations and grooves so it can attatch to the nail.
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FPP 1
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keratohyalin
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FPP 1
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plantar flexion = 35 deg dorsiflexion = 65 deg
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FPP 1
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plantar flexion = 45 deg dorsiflexion = 15 deg (knee straight)
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FPP 1
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onych
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FPP 1
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ASIS to medial malleolus
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FPP 1
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Look at the shoes for clues and wear patterns
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FPP 1
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ROM, muscle strength tests and observe gait
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FPP 1
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look for obvious problems like fractures, variations and malalignments
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FPP 1
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Postural evaluation...foot alignment and balance
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FPP 1
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peroneus longus
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FPP 1
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intermediate dorsal cutaneous of superficial peroneal nerve.
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FPP 1
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S1 from an L5 slipped disc.....make the patient stretch his leg and if his heel hurts, it could be a slipped disc.
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FPP 1
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sickle cell disease
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FPP 1
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give a cortisone injection because it will tear the tendon further.
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FPP 1
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L5
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FPP 1
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liver disease or rheumatoid arthritis
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FPP 1
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English nail clipper, hemostats, freer elevator, pickups, small curette, 62 mini blade
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FPP 1
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the dorsal lateral part of the big toe....the saggital plane motion is gone in the MP joint so it is reflected in the IP joint
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FPP 1
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the matrix and soft tissues proximal and under the nail
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FPP 1
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the proximal end is the least attached because this is where the nail grows
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FPP 1
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sporanox
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FPP 1
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diabetics, alcoholics and patients suffering from epilepsy
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FPP 1
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diabetics
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FPP 1
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bump on the top of the foot, sometimes caused by osteoarthritis
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FPP 1
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bone spurs, can occur especially on heel, but can be seen in multiple places, also seen commonly with osteoarthritis
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FPP 1
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its C-shaped erosion of the bone
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FPP 1
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forms around wounds that won't heal
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FPP 1
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hard corn (possibly secondary to contracted or hammer toe)
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FPP 1
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Suppurative inflammation of the nail fold surrounding the nail plate; may be due to bacteria or fungi, most commonly staphylococci and streptococci. Origin [para- + G. onyx, nail]
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FPP 1
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inflammation of the nail fold surrounding the nail plate; may be due to bacteria or fungi, most commonly staphylococci and streptococci. Origin [para- + G. onyx, nail]
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FPP 1
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5th toe adducto varus
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FPP 1
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fungal infection of the scalp
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FPP 1
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athlete's foot
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FPP 1
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Interdigital infections, Moccasin distribution, and Vesiculobullos infection. ON BOARDS
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FPP 1
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Present in the webspaces, Scaling, Maceration, Fissuring, Erythema. Tx: Betadine, Powders, antifungal gel, Castallini's paint.
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FPP 1
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Scaling of the plantar surface, Hyperkeratosis plantar surface. Tx: Topical or oral antifungal, Loprox TS, Grispeg (pediatric safe) Lamisil.
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FPP 1
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Marked by vesicles in the arch of the foot. Tx: Topical Antifungal
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FPP 1
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aka. Verruca Plantaris caused by HPV, Warts display pinpoing bleeding on debridement. Pain upon lateral compression. Can occur singly or in groups. Tx: acids, electrotherapy, cryotherapy, excisional surgery, laser.
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FPP 1
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aka. Corns and calluses. Develps in response friction or pressure. Usually over prominent bony areas. Can be caused due to abnormal weight distribution, faulty biomechanics, improper shoe gear.
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FPP 1
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Dorsal hard corns usually centered over the proximal interphalangeal joint. PIPJ
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FPP 1
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soft corns usually interdigital corn.
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FPP 1
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Arterial ulcers are caused by ichemia (Local anemia due to mechanical obstruction (mainly arterial narrowing) of the blood supply); often marked by pain and by organ dysfunction) Presence of Peripheral Vascular Disease. VERY PAINFUL!
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FPP 1
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Inflammation of the nail fold. Red hot, swollen, and painful. Can yave a pyogenic granuloma Tx: remove the offending nail, betadine and H2O (epsom salt 15 min) soaks, topical or oral antibiotics.
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FPP 1
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Limited range of motion in the 1st metatarsal phalangeal joint (MTPJ)
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FPP 1
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Loss of motion metatarsal phalangeal joint (MTPJ)
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FPP 1
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dorsiflexed 1st ray, 1st ray hypermobility, long 1st ray, DJD of the MTPJ, prolonged 1st MTPH immobilization, Iatrogenic.
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FPP 1
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plantarflexed PIPJ, DIP Neutral or hyperectended, MTP dorsiflexed, can be flexible, semi-rigid, or rigid.
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FPP 1
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Plantar pain due to repeated microtrauma on the plantar aponeurosis causing strain of the posterior attachment to the medial tubercle. High association with cavus and planus feet. HALLMARK SYPMTOM: post-static dyskinesia; first step in the morning is extremely painful. Tx: NSAIDS, local steroid injection, strappings, orthotics, streching, PT, Sx.
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FPP 1
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Martel's sign on xray (On x-ray one may see soft tissue swelling, and joint effusions, rat-bite erosions, cyst-like or punched-out erosions. Many lesions are expansile with overhanging margins(Martel's sign) that are displaced away from the axis of the bone). Serum uric acid levels increased. Tx: aspiration, NSAIDS, colchicine injection.
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FPP 1
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area of skin on the sides of the nails: lateral, medial and proximal (posterior)
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FPP 1
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1. pointy heel spurs that are associated with plantar fasciaitis 2.fluffy heel spurs that are associated with systemic diseases like psoriatic arthitis, ankylosing spondylitis and Reiter's syndrome.
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FPP 1
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1. foot health# 2. protection# 3. wear# 4. comfort# 5. functional performance / support# 6. aesthtics
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FPP 1
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A Branick Device
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FPP 1
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A counter is the posterior portionof the shoe that stiffens the support around the heel. It contorls the heel at heelstrick and stabilizes the heels motion inside the shoe.
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FPP 1
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The box toe is the material that covers the toe box. Your toes fit into the toe box.
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FPP 1
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"PEDS#
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Shoe - how the correction is to be accomplished#"
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1
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FPP 1
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The cuticle
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FPP 1
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where the skin meets the nail at the distal edge
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FPP 1
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skin that is covering your nail matrix proximal to the eponychium
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FPP 1
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benign cartilaginous tumor that grows up from the distal phalanx and deforms the shape of the nail
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FPP 1
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the area that hurts with ingrown toe nails
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FPP 1
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(nail fungus) and also in nicotine use
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FPP 1
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lack oxygen
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FPP 1
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Tetracycline, if given to children, their teeth will be discolored and their nails will be a grey brown
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FPP 1
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liver cirrhosis, that is terry’s nails- a whitish tinge. Superficial white onychomycois occurs in AIDS patients which will also present as a white nail
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FPP 1
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Psuedomonas is a bacteria that likes to turn things green. Green alcohol is a phenomenon- rubbing alcohol that has a green food dye
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FPP 1
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jogger’s toenail…second toe will hit constantly against toe box of shoe and will get subungual hemmorage.# Subungual melanoma is a deadly skin cancer under your toe nail- you have less than 5 years to live. Bob Marley had subugnal melanoma
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FPP 1
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Onychoschizia- means nail is weak and brittle. It is peeling.
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FPP 1
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Onychomycosis- nail fungus disease
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FPP 1
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Onychomedesis- thickening of the nail over 1 mm.
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FPP 1
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Onycholysis- lifting up of the nail plate from the nail bed.
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FPP 1
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Paronychia- infection of the nail- ingrown toe nail.
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FPP 1
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Trachonychia- roughness of the nail plate (like with sandpaper).
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FPP 1
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Koilonychia- some children are born with spoon nails- nails curve in. Often times they grow out of it.
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FPP 1
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Anonychia- no nail.
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FPP 1
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Onychocryptosis- nail is ingrown but there is no infection- no pus.
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FPP 1
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Onychodystrophy- any disorder of the nail.
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FPP 1
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Anonychia- also seen in frostbite, trauma, amputation of distal toe (no distal aspect of toe= no nail!!).
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FPP 1
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Leukonychia-white nail- poisned with arsenic or with liver disease (Terry’s Nails).
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FPP 1
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Onychauxis-thickened nail plate- thickness is caused by onychomycosis and psoriasis.
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FPP 1
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Onychogryphosis- also known as a Ram’s horn nail- they are huge, curved, and brittle nails- caused by neglect. They are brittle nails- start at the distal aspect of nail when debriding. The curvature comes from the length.
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FPP 1
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Onycholysis- is detachment of the nail plate from the nail bed. if you ever picked under your finger nail and you see a bit of whiteness past the hyponychium, well, that’s where the nail plate has detached from nail bed…that can be a first sign of nail fungus when there is yellowish tinge with onycholysis.
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FPP 1
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Onychophagia- biting your nails.
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FPP 1
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Clubbing- think of pulmonary disorder. Lovibond’s angle is the angle that you see if you look at the side of your nail- it is a little less than 180…this is over 180 in clubbing disorders. Also seen in heart and liver disease, it may also be hereditary. You need to do a thorough history to figure this out. There is nothing we can do to change it when it is hereditary.
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FPP 1
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Oncyhocryptosis- ingrown nail plate at the proximal nail border but not infected. If infected paronychia. This is called proud flesh or granulation tissue when you see the red beefy tissue associated with an infected nail.
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FPP 1
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Onychomycosis is caused by a dermatophyte- same as causing athletes foot. It is caused by Trichophyum rubrum
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FPP 1
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hyperhydrosis. That is increased moisture of skin.
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FPP 1
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moccasin distribution#, the interdigital infection and the #vesicular infection
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FPP 1
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Warts display a pinpoint bleeding on debridement. Warts actually have pain upon lateral compression. So when you compress it side to side, you get a lot of pain. When you compress it directly on top of it, it doesn’t hurt
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FPP 1
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FALSE
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FPP 1
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heloma dura, which means that the corn is on the dorsal part of your digit.
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FPP 1
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Halloma mole is a soft corn, and it’s usually in the interspace; it’s an interdigital corn.
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FPP 1
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Absolutely nothing. You can’t cut somebody with poor circulation because they can’t heel at the incision site. Even if you’re debriding…with some people, you can’t even take out a nail, because they will get gangrene. This ulcer was really painful; he wanted to cut his own foot off. An arterial ulcer (might be on the test) is very, very painful. Because you don’t have enough blood flow to carry the oxygen that your tissues need to live. Never cut somebody who doesn’t have enough circulation.
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FPP 1
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to be taken before meals as with certain prescriptions [L. ante, before, in front of]
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FPP 1
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arteriosclerotic heart disease
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FPP 1
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twice a day
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FPP 1
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blood sugar
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FPP 1
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chief concern
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FPP 1
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congestive heart failure
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FPP 1
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Chronic obstructive pulmonary disease
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FPP 1
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Computerized tomography, as in a CT scan
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FPP 1
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cerebral vascular accident (stroke)
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FPP 1
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degenerative joint disease, or osteoarthritis
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FPP 1
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diabetes mellitus
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FPP 1
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deep vein thrombosis
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FPP 1
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diagnosis
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FPP 1
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electromyogram
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FPP 1
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family history
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FPP 1
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fracture
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FPP 1
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at bedtime [hour of sleep]
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FPP 1
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bunion
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FPP 1
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hepatitus B virus
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FPP 1
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heart disease
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FPP 1
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head, ears, eyes, nose, throat
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FPP 1
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hemoglobin
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FPP 1
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1. aviod incidental conversation and digressions 2. begin with short open ended questions to get the patient talking 3. control the questions and answers 4. clarify specific questions by asking focused or close-ended questions 5. limit the amount of direct questions to avoid an interrogation-like feeling. use indirect questions to soften the mood
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FPP 1
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only to confirm a diagnosis
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FPP 1
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history of present illness
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FPP 1
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hormone replacement therapy
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FPP 1
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hypertension (high blood pressure)
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FPP 1
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history
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FPP 1
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incision and drainage
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FPP 1
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intake and output
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FPP 1
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insulin dependent diabetes
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FPP 1
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internal fixation
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FPP 1
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intramuscular
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FPP 1
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last menstrual period
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FPP 1
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right in the center of the heel.
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FPP 1
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TB-multiple drug resistence tuberculosis
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FPP 1
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metastases (DPM's use this for met heads)
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FPP 1
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myocardial infarction
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FPP 1
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Magnetic resonance imaging
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FPP 1
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no food after midnight [L. non per os or nil per os, nothing by mouth.]
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FPP 1
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1. CC 2. HPI 3. PMH 4. PSH 5. FH 6. SH 7. Medications 8. Allergies 9. ROS”
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FPP 1
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non insulin dependent diabetes
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FPP 1
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non-steroidal anti-inflammatory drug
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FPP 1
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osteoarthritis
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FPP 1
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narrowing of joint space, not much cartilage, spurs cause dorsal bunions sometimes
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FPP 1
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destruction of bone, usually seen on x-ray, can occur in instances of gout
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FPP 1
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infection of bone
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FPP 1
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to be taken after meals, as with certain prescriptions
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FPP 1
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high arch foot type
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FPP 1
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low/no arch foot type
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FPP 1
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past medical history
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FPP 1
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pain on palpation
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FPP 1
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as needed (use for pain med Rx)
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FPP 1
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past surgical history
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FPP 1
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peptic ulcer disease
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FPP 1
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once daily
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FPP 1
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once an hour
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FPP 1
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four times daily
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FPP 1
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rule out
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FPP 1
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rheumatoid arthritis
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FPP 1
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range of motion
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FPP 1
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review of systems
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FPP 1
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regular rate and rhythem (of heart)
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FPP 1
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prescribe
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FPP 1
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status post
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FPP 1
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social or psychosocial history
|
|
|
FPP 1
|
shortness of breath
|
|
|
FPP 1
|
symptoms, surgery, depends on the clinician
|
|
|
FPP 1
|
three times daily
|
|
|
FPP 1
|
entrapment of tibial nerve in the lacunar ligament
|
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FPP 1
|
tenderness on palpation
|
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FPP 1
|
temperature, pulse, respiration
|
|
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FPP 1
|
treatment
|
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FPP 1
|
usual childhood diseases (measles, mumps, german measles)
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FPP 1
|
1. general appearance 2. state of nutrition 3. body habits 4. symmetry 5. posture and gait 6. speech
|
|
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FPP 1
|
1. introduce yourself as a student doctor with under the attending physician 2. keep eye contact, respect their space (3 ft.) 3. small talk, be able to maintain a conversation
|
|
|
FPP 1
|
1. CAGE test 2. MAST test 3. TWEAK test
|
|
|
FPP 1
|
1. inspection - visual acuity 2. palpation - feeling the abnormality 3. inspection and palpation 4. percussion 5. auscultation - use of stethoscope
|
|
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FPP 1
|
1. shock and denial 2. anger 3. bargaining 4. depression 5. acceptance
|
|
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FPP 1
|
1. Dolor (pain) 2. Edema (swelling) 3. Calor (heat) 4. Erythema (redness) 5. Exudate [pus (purulent) or transducent (clear)] if infected
|
|
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FPP 1
|
1. establish rapport with patient 2. elicit info: medical history, physical exam, diagnostic tests 3. consult with your preceptor 4. assessment and plan: a. could involve more tests b. think of treament approaches for short nd long term relief 5. Exposition phase: speek to patient about problem and plan 6. Recording: write up the information collected
|
|
|
FPP 1
|
1. Rx (prescription) 2. dispense (number you want them to have) 3. signa (let it be labeled)\
|
|
|
FPP 1
|
1. expose areas to be inspected in good light 2. palpate tender areas while maintaining eye contact
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FPP 1
|
1. use of tactile sensation 2. determines characteristics of organ system
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FPP 1
|
1. combines tactile sensation and sound 2. difference in sound from normal can indicate mass or fluid
|
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FPP 1
|
1. ask open ended questions (leaves things wide open) 2. ask close ended questions (yes or no answers) 3. direct/focused questions (when trying to determine) 4. indirect questions (statement like soften tone) 5. facilitation: head nodding, mhmm, mhmm; hand motions
|
|
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FPP 1
|
subjective
|
|
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FPP 1
|
past medical history contains all active and significant inactive (MI, pneumonia, syphilis, hepatitis) medical conditions
|
|
|
FPP 1
|
the past surgical history asks for the date and type of any kind of surgical procedure performed. also, be sure to ask about scarring or allergies or problems with anesthesia (local or general), blood clotting or scarring
|
|
|
FPP 1
|
a family history using goes three generations, from patient to parents to grandparents. always ask about their history with DM, HD, cancer, anemias and RA.
|
|
|
FPP 1
|
1. Age 2. Race 3. Gender 4. Chief Concern There may also be secondary and tertiary concerns
|
|
|
FPP 1
|
a hypertrophic scar is typically thick and wide but follows the line of incision (typically due to sloppy suturing)
|
|
|
FPP 1
|
a keloid scar appears almost tumorous and is typically consistent with the person.
|
|
|
FPP 1
|
Michigan Alcohol Screening Test~this is a 15 question test designed for social workers to asses alcholism
|
|
|
FPP 1
|
the number of packs of cigarettes smoked per day multiplied by the number of years of smoking
|
|
|
FPP 1
|
P -provocative/palliative (aggravating factors/better) Q -qualify and quantify pain on 1 -10 scale R -region/radiation (pinpoint pain, does it radiate) S –severity T-temporal characteristics/treatment (worse in the morning, evening, after periods of rest? what treament has been given? )
|
|
|
FPP 1
|
designed for women who drink while pregnant. 7 point scale T - tolerance. if a pregnant woman could hold 5 or more drinks without falling asleep or passing out - 2 points W - worry. if relatives are worried - 2 points E - eye openers - 1 point A - amnesia. have frequent blackouts K - do they feel the need to cut down. - 2 points
|
|
|
FPP 1
|
N-nature (sharp/dull pain) L-location D-duration (how long, acute/chronic) O-onset (how and when did the pain start C-course (has pain gotten worse) A-aggravating factors (what makes it hurt more or less) T-treatment (patient self treatment and previous doctors Rx)
|
|
|
FPP 1
|
assesses alcohol dependence. C - have you ever felt the need to cut down alcohol intake? A - have you been annoyed by others criticizing your alcohol intake? G - have you ever felt guilty about your alcohol intake? E - have you ever had an eye-opener (drink in the morning) 2 or more positive responses indicate clinical relevance"
|
|
|
FPP 1
|
you will be listening to sounds produced by internal organs, so 1. eliminate background noise 2. apply diaphragm firmly for high pitched sounds 3. apply bell lightly for low pitched sounds
|
|
|
FPP 1
|
1. NLDOCAT 2. PQRST
|
|
|
FPP 1
|
the social history is the personal history and psych evalution. It includes, job (sedentary, on feet all day), marrital status, home life, caffeine intake, alcohol intake, drugs etc.
|
|
|
FPP 1
|
within normal limits
|
|
|
FPP 1
|
years old
|
|
|
|
late resupination with propulsion
|
|
|
|
absence of a nail
|
|
|
|
decrease hallux dorsiflexion at the first MPJ associated with first ray hypermobility and abducted gait
|
|
|
|
fungus or melanoma.
|
|
|
|
Tibial varum ...tibias are inverted distally
|
|
|
|
fungi that live off of skin cells
|
|
|
|
1. red feet without swelling 2.bilateral warm or hot feet 3. pain
|
|
|
|
1. mossy, pig skin with warts 2. foot gets larger with stimulated fibrous tissue 3. non pitting edema 4. blood flow slows down`
|
|
|
|
pain at the achilles tendon insertion due to and equinus functioning foot
|
|
|
|
the disease bursa is associated with the synovial sheath of the achilles tendon (anterior bursa). A posterior bursa will develop if the achilles tendon or its attachment is being rubbed or abuse hense the mechanical bursa for protection.
|
|
|
|
the presence of fibrous tumors on the plantar aspect of the foot
|
|
|
|
spur on the back of the heel, usually seen in a mechanically imbalanced foot with a lot of rocking back and forth. aka pump bumps
|
|
|
|
plantar flex and invert
|
|
|
|
non pitting edema
|
|
|
|
the buildup of extra wartlike tissue is burnt away with acid
|
|
|
|
three: dorsal, intermediate, ventral
|
|
|
|
area under the nail that is not attached to the bed
|
|
|
|
L4 slipped disc
|
|
|
|
inferior calcaneal bursitis.. it need a steriod injection in the bursa
|
|
|
|
arterial ulcer
|
|
|
|
30 sec, 3 times
|
|
|
|
HIV patients
|
|
|
|
intractable plantar keratosis, buildup of skin on the bottom of the foot due to pressure points. in diabetics, this may cause ulceration
|
|
|
|
genu valgum
|
|
|
|
accumulation of fat in the anterior aspect of the ankle in women after menopause
|
|
|
|
white patches on the surface of the nail that is a superficial fungal infection caused by candida
|
|
|
|
bigger or wider than normal nail
|
|
|
|
peeling away of lateral foot border
|
|
|
|
the red zone under the skin at the proximal end of the nail where nail growth originates.
|
|
|
|
trychophytan, hypersporum, epidermophytan, candida
|
|
|
|
painful nerve, usually do to tight shoes and is immediatly relieved when they are removed
|
|
|
|
thickening of a nerve
|
|
|
|
lack of sensation, as in a diabetic
|
|
|
|
uniform thickening of the nail
|
|
|
|
chronic inflammation of the nail matrix
|
|
|
|
ingrown toenail
|
|
|
|
the toe is abnormal
|
|
|
|
thick, grossly deformed and enlarged nails
|
|
|
|
separation of nail plate from the end of the toe (too proximally)
|
|
|
|
Separation from the proximal nail fold
|
|
|
|
the nail is soft
|
|
|
|
localized infection of the nail or nail bed caused by fungus
|
|
|
|
nail fungus (tinea ungum) characterized by thick, discolored nails
|
|
|
|
the nail is in layers
|
|
|
|
abnormal sensory signs
|
|
|
|
inflammation of veins
|
|
|
|
more than one nail on a digit
|
|
|
|
Grades 5 - 0 5 being normal 0 being no palpable contraction
|
|
|
|
contracture of the plantar and palmar fascia that is associated with insulin dependant diabetics...they cannot straighten their hands out....its called the prayer sign
|
|
|
|
in a child, the calcaneus grows faster than the soft tissues causing an equinus condition. it can be painful. casting and night splints help the soft tissue to catch up
|
|
|
|
distal phalanx bone tumor
|
|
|
|
tapping the nerve and getting a tingling sensation distally (electrical tingle)
|
|
|
|
loss of dermis and epidermis
|
|
|
|
tapping a nerve sends an electrical feeling proximally
|
|
|
|
results because of the vamp of improper shoes
|
|
|
|
1. Achilles tendonitis 2. Anterior Tendo-achilles bursitis (haglunds deformity) 3. Posterior achilles bursitis4. Posterior talar tubercle pain
|
|
|
|
1. Tarsal tunnel syndrome 2. Great saphenous vein (phlebitis) 3. Tibialis posterior tendonitis 4. Tibial nerve (entrapement or compression)
|
|
|
|
Keenan's fibromas or periomal fibromas
|
|
|
|
1. Rest portion 2. Stance portion 3. Gait portion 4. Footgear Survey 5. Radiographic Assessment
|
|
|
|
1. morphological exam (visual inspection) 2. comparative deviations (asymmetry) 3. palpation exam (determine tenderness) 4. Arthrometric exam (motion)~
|
|
|
|
calcaneal inversion = 20 deg. calcaneal eversion = 10 deg.
|
|
|
|
1. they are on the medial side of the ankle 2. they have a red granulating base 3. they have irregular borders 4. hard or indurated skin 5. Reactive bone formation 6. Usually not painful
|
|
|
|
1. lateral side of foot 2. cold, red foot 3. swelling 4. greyish centers 5. pain 6. smaller and punched out
|
|
|
|
CalcaneoNavicular coalition and Excessive ankle pronation
|
|
|
|
lamisil, sporanox
|
|
|
|
red is healthy, venous ulcer
|
|
|
|
non-glycosylation of connective tissue and collagen causing the deposition of mucopolysaccarides in the collagen.
|
|
|
|
soft tissue which is part of the posterior nail fold. Sometimes referred to as eponychium. plays a part in nail generation
|
|
|
|
white area you see on your fingernails. the most distal point of the nail matrix is the lunula. plays a role in nail generation
|
|
|
|
lateral ankle sprain
|
|
|
|
an epithelial layer with indentations and grooves so it can attatch to the nail.
|
|
|
|
keratohyalin
|
|
|
|
plantar flexion = 35 deg dorsiflexion = 65 deg
|
|
|
|
plantar flexion = 45 deg dorsiflexion = 15 deg (knee straight)
|
|
|
|
onych
|
|
|
|
ASIS to medial malleolus
|
|
|
|
Look at the shoes for clues and wear patterns
|
|
|
|
ROM, muscle strength tests and observe gait
|
|
|
|
look for obvious problems like fractures, variations and malalignments
|
|
|
|
Postural evaluation...foot alignment and balance
|
|
|
|
peroneus longus
|
|
|
|
intermediate dorsal cutaneous of superficial peroneal nerve.
|
|
|
|
S1 from an L5 slipped disc.....make the patient stretch his leg and if his heel hurts, it could be a slipped disc.
|
|
|
|
sickle cell disease
|
|
|
|
give a cortisone injection because it will tear the tendon further.
|
|
|
|
L5
|
|
|
|
liver disease or rheumatoid arthritis
|
|
|
|
English nail clipper, hemostats, freer elevator, pickups, small curette, 62 mini blade
|
|
|
|
the dorsal lateral part of the big toe....the saggital plane motion is gone in the MP joint so it is reflected in the IP joint
|
|
|
|
the matrix and soft tissues proximal and under the nail
|
|
|
|
the proximal end is the least attached because this is where the nail grows
|
|
|
|
sporanox
|
|
|
|
diabetics, alcoholics and patients suffering from epilepsy
|
|
|
|
diabetics
|
|
|
|
bump on the top of the foot, sometimes caused by osteoarthritis
|
|
|
|
bone spurs, can occur especially on heel, but can be seen in multiple places, also seen commonly with osteoarthritis
|
|
|
|
its C-shaped erosion of the bone
|
|
|
|
forms around wounds that won't heal
|
|
|
|
hard corn (possibly secondary to contracted or hammer toe)
|
|
|
|
Suppurative inflammation of the nail fold surrounding the nail plate; may be due to bacteria or fungi, most commonly staphylococci and streptococci. Origin [para- + G. onyx, nail]
|
|
|
|
inflammation of the nail fold surrounding the nail plate; may be due to bacteria or fungi, most commonly staphylococci and streptococci. Origin [para- + G. onyx, nail]
|
|
|
|
5th toe adducto varus
|
|
|
|
fungal infection of the scalp
|
|
|
|
athlete's foot
|
|
|
|
Interdigital infections, Moccasin distribution, and Vesiculobullos infection. ON BOARDS
|
|
|
|
Present in the webspaces, Scaling, Maceration, Fissuring, Erythema. Tx: Betadine, Powders, antifungal gel, Castallini's paint.
|
|
|
|
Scaling of the plantar surface, Hyperkeratosis plantar surface. Tx: Topical or oral antifungal, Loprox TS, Grispeg (pediatric safe) Lamisil.
|
|
|
|
Marked by vesicles in the arch of the foot. Tx: Topical Antifungal
|
|
|
|
aka. Verruca Plantaris caused by HPV, Warts display pinpoing bleeding on debridement. Pain upon lateral compression. Can occur singly or in groups. Tx: acids, electrotherapy, cryotherapy, excisional surgery, laser.
|
|
|
|
aka. Corns and calluses. Develps in response friction or pressure. Usually over prominent bony areas. Can be caused due to abnormal weight distribution, faulty biomechanics, improper shoe gear.
|
|
|
|
Dorsal hard corns usually centered over the proximal interphalangeal joint. PIPJ
|
|
|
|
soft corns usually interdigital corn.
|
|
|
|
Arterial ulcers are caused by ichemia (Local anemia due to mechanical obstruction (mainly arterial narrowing) of the blood supply); often marked by pain and by organ dysfunction) Presence of Peripheral Vascular Disease. VERY PAINFUL!
|
|
|
|
Inflammation of the nail fold. Red hot, swollen, and painful. Can yave a pyogenic granuloma Tx: remove the offending nail, betadine and H2O (epsom salt 15 min) soaks, topical or oral antibiotics.
|
|
|
|
Limited range of motion in the 1st metatarsal phalangeal joint (MTPJ)
|
|
|
|
Loss of motion metatarsal phalangeal joint (MTPJ)
|
|
|
|
dorsiflexed 1st ray, 1st ray hypermobility, long 1st ray, DJD of the MTPJ, prolonged 1st MTPH immobilization, Iatrogenic.
|
|
|
|
plantarflexed PIPJ, DIP Neutral or hyperectended, MTP dorsiflexed, can be flexible, semi-rigid, or rigid.
|
|
|
|
Plantar pain due to repeated microtrauma on the plantar aponeurosis causing strain of the posterior attachment to the medial tubercle. High association with cavus and planus feet. HALLMARK SYPMTOM: post-static dyskinesia; first step in the morning is extremely painful. Tx: NSAIDS, local steroid injection, strappings, orthotics, streching, PT, Sx.
|
|
|
|
Martel's sign on xray (On x-ray one may see soft tissue swelling, and joint effusions, rat-bite erosions, cyst-like or punched-out erosions. Many lesions are expansile with overhanging margins(Martel's sign) that are displaced away from the axis of the bone). Serum uric acid levels increased. Tx: aspiration, NSAIDS, colchicine injection.
|
|
|
|
area of skin on the sides of the nails: lateral, medial and proximal (posterior)
|
|
|
|
1. pointy heel spurs that are associated with plantar fasciaitis 2.fluffy heel spurs that are associated with systemic diseases like psoriatic arthitis, ankylosing spondylitis and Reiter's syndrome.
|
|
|
|
1. foot health# 2. protection# 3. wear# 4. comfort# 5. functional performance / support# 6. aesthtics
|
|
|
|
A Branick Device
|
|
|
|
A counter is the posterior portionof the shoe that stiffens the support around the heel. It contorls the heel at heelstrick and stabilizes the heels motion inside the shoe.
|
|
|
|
The box toe is the material that covers the toe box. Your toes fit into the toe box.
|
|
|
|
"PEDS#
|
|
|
Shoe - how the correction is to be accomplished#"
|
|
|
|
|
The cuticle
|
|
|
|
where the skin meets the nail at the distal edge
|
|
|
|
skin that is covering your nail matrix proximal to the eponychium
|
|
|
|
benign cartilaginous tumor that grows up from the distal phalanx and deforms the shape of the nail
|
|
|
|
the area that hurts with ingrown toe nails
|
|
|
|
(nail fungus) and also in nicotine use
|
|
|
|
lack oxygen
|
|
|
|
Tetracycline, if given to children, their teeth will be discolored and their nails will be a grey brown
|
|
|
|
liver cirrhosis, that is terry’s nails- a whitish tinge. Superficial white onychomycois occurs in AIDS patients which will also present as a white nail
|
|
|
|
Psuedomonas is a bacteria that likes to turn things green. Green alcohol is a phenomenon- rubbing alcohol that has a green food dye
|
|
|
|
jogger’s toenail…second toe will hit constantly against toe box of shoe and will get subungual hemmorage.# Subungual melanoma is a deadly skin cancer under your toe nail- you have less than 5 years to live. Bob Marley had subugnal melanoma
|
|
|
|
Onychoschizia- means nail is weak and brittle. It is peeling.
|
|
|
|
Onychomycosis- nail fungus disease
|
|
|
|
Onychomedesis- thickening of the nail over 1 mm.
|
|
|
|
Onycholysis- lifting up of the nail plate from the nail bed.
|
|
|
|
Paronychia- infection of the nail- ingrown toe nail.
|
|
|
|
Trachonychia- roughness of the nail plate (like with sandpaper).
|
|
|
|
Koilonychia- some children are born with spoon nails- nails curve in. Often times they grow out of it.
|
|
|
|
Anonychia- no nail.
|
|
|
|
Onychocryptosis- nail is ingrown but there is no infection- no pus.
|
|
|
|
Onychodystrophy- any disorder of the nail.
|
|
|
|
Anonychia- also seen in frostbite, trauma, amputation of distal toe (no distal aspect of toe= no nail!!).
|
|
|
|
Leukonychia-white nail- poisned with arsenic or with liver disease (Terry’s Nails).
|
|
|
|
Onychauxis-thickened nail plate- thickness is caused by onychomycosis and psoriasis.
|
|
|
|
Onychogryphosis- also known as a Ram’s horn nail- they are huge, curved, and brittle nails- caused by neglect. They are brittle nails- start at the distal aspect of nail when debriding. The curvature comes from the length.
|
|
|
|
Onycholysis- is detachment of the nail plate from the nail bed. if you ever picked under your finger nail and you see a bit of whiteness past the hyponychium, well, that’s where the nail plate has detached from nail bed…that can be a first sign of nail fungus when there is yellowish tinge with onycholysis.
|
|
|
|
Onychophagia- biting your nails.
|
|
|
|
Clubbing- think of pulmonary disorder. Lovibond’s angle is the angle that you see if you look at the side of your nail- it is a little less than 180…this is over 180 in clubbing disorders. Also seen in heart and liver disease, it may also be hereditary. You need to do a thorough history to figure this out. There is nothing we can do to change it when it is hereditary.
|
|
|
|
Oncyhocryptosis- ingrown nail plate at the proximal nail border but not infected. If infected paronychia. This is called proud flesh or granulation tissue when you see the red beefy tissue associated with an infected nail.
|
|
|
|
Onychomycosis is caused by a dermatophyte- same as causing athletes foot. It is caused by Trichophyum rubrum
|
|
|
|
hyperhydrosis. That is increased moisture of skin.
|
|
|
|
moccasin distribution#, the interdigital infection and the #vesicular infection
|
|
|
|
Warts display a pinpoint bleeding on debridement. Warts actually have pain upon lateral compression. So when you compress it side to side, you get a lot of pain. When you compress it directly on top of it, it doesn’t hurt
|
|
|
|
FALSE
|
|
|
|
heloma dura, which means that the corn is on the dorsal part of your digit.
|
|
|
|
Halloma mole is a soft corn, and it’s usually in the interspace; it’s an interdigital corn.
|
|
|
|
Absolutely nothing. You can’t cut somebody with poor circulation because they can’t heel at the incision site. Even if you’re debriding…with some people, you can’t even take out a nail, because they will get gangrene. This ulcer was really painful; he wanted to cut his own foot off. An arterial ulcer (might be on the test) is very, very painful. Because you don’t have enough blood flow to carry the oxygen that your tissues need to live. Never cut somebody who doesn’t have enough circulation.
|
|
|
|
to be taken before meals as with certain prescriptions [L. ante, before, in front of]
|
|
|
|
arteriosclerotic heart disease
|
|
|
|
twice a day
|
|
|
|
blood sugar
|
|
|
|
chief concern
|
|
|
|
congestive heart failure
|
|
|
|
Chronic obstructive pulmonary disease
|
|
|
|
Computerized tomography, as in a CT scan
|
|
|
|
cerebral vascular accident (stroke)
|
|
|
|
degenerative joint disease, or osteoarthritis
|
|
|
|
diabetes mellitus
|
|
|
|
deep vein thrombosis
|
|
|
|
diagnosis
|
|
|
|
electromyogram
|
|
|
|
family history
|
|
|
|
fracture
|
|
|
|
at bedtime [hour of sleep]
|
|
|
|
bunion
|
|
|
|
hepatitus B virus
|
|
|
|
heart disease
|
|
|
|
head, ears, eyes, nose, throat
|
|
|
|
hemoglobin
|
|
|
|
1. aviod incidental conversation and digressions 2. begin with short open ended questions to get the patient talking 3. control the questions and answers 4. clarify specific questions by asking focused or close-ended questions 5. limit the amount of direct questions to avoid an interrogation-like feeling. use indirect questions to soften the mood
|
|
|
|
only to confirm a diagnosis
|
|
|
|
history of present illness
|
|
|
|
hormone replacement therapy
|
|
|
|
hypertension (high blood pressure)
|
|
|
|
history
|
|
|
|
incision and drainage
|
|
|
|
intake and output
|
|
|
|
insulin dependent diabetes
|
|
|
|
internal fixation
|
|
|
|
intramuscular
|
|
|
|
last menstrual period
|
|
|
|
right in the center of the heel.
|
|
|
|
TB-multiple drug resistence tuberculosis
|
|
|
|
metastases (DPM's use this for met heads)
|
|
|
|
myocardial infarction
|
|
|
|
Magnetic resonance imaging
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no food after midnight [L. non per os or nil per os, nothing by mouth.]
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1. CC 2. HPI 3. PMH 4. PSH 5. FH 6. SH 7. Medications 8. Allergies 9. ROS”
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non insulin dependent diabetes
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non-steroidal anti-inflammatory drug
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osteoarthritis
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narrowing of joint space, not much cartilage, spurs cause dorsal bunions sometimes
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destruction of bone, usually seen on x-ray, can occur in instances of gout
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infection of bone
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to be taken after meals, as with certain prescriptions
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high arch foot type
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low/no arch foot type
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past medical history
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pain on palpation
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as needed (use for pain med Rx)
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past surgical history
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peptic ulcer disease
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once daily
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once an hour
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four times daily
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rule out
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rheumatoid arthritis
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range of motion
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review of systems
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regular rate and rhythem (of heart)
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prescribe
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status post
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social or psychosocial history
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shortness of breath
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symptoms, surgery, depends on the clinician
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three times daily
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entrapment of tibial nerve in the lacunar ligament
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tenderness on palpation
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temperature, pulse, respiration
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treatment
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usual childhood diseases (measles, mumps, german measles)
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1. general appearance 2. state of nutrition 3. body habits 4. symmetry 5. posture and gait 6. speech
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1. introduce yourself as a student doctor with under the attending physician 2. keep eye contact, respect their space (3 ft.) 3. small talk, be able to maintain a conversation
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1. CAGE test 2. MAST test 3. TWEAK test
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1. inspection - visual acuity 2. palpation - feeling the abnormality 3. inspection and palpation 4. percussion 5. auscultation - use of stethoscope
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1. shock and denial 2. anger 3. bargaining 4. depression 5. acceptance
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1. Dolor (pain) 2. Edema (swelling) 3. Calor (heat) 4. Erythema (redness) 5. Exudate [pus (purulent) or transducent (clear)] if infected
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1. establish rapport with patient 2. elicit info: medical history, physical exam, diagnostic tests 3. consult with your preceptor 4. assessment and plan: a. could involve more tests b. think of treament approaches for short nd long term relief 5. Exposition phase: speek to patient about problem and plan 6. Recording: write up the information collected
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1. Rx (prescription) 2. dispense (number you want them to have) 3. signa (let it be labeled)\
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1. expose areas to be inspected in good light 2. palpate tender areas while maintaining eye contact
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1. use of tactile sensation 2. determines characteristics of organ system
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1. combines tactile sensation and sound 2. difference in sound from normal can indicate mass or fluid
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1. ask open ended questions (leaves things wide open) 2. ask close ended questions (yes or no answers) 3. direct/focused questions (when trying to determine) 4. indirect questions (statement like soften tone) 5. facilitation: head nodding, mhmm, mhmm; hand motions
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subjective
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past medical history contains all active and significant inactive (MI, pneumonia, syphilis, hepatitis) medical conditions
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the past surgical history asks for the date and type of any kind of surgical procedure performed. also, be sure to ask about scarring or allergies or problems with anesthesia (local or general), blood clotting or scarring
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a family history using goes three generations, from patient to parents to grandparents. always ask about their history with DM, HD, cancer, anemias and RA.
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1. Age 2. Race 3. Gender 4. Chief Concern There may also be secondary and tertiary concerns
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a hypertrophic scar is typically thick and wide but follows the line of incision (typically due to sloppy suturing)
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a keloid scar appears almost tumorous and is typically consistent with the person.
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Michigan Alcohol Screening Test~this is a 15 question test designed for social workers to asses alcholism
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the number of packs of cigarettes smoked per day multiplied by the number of years of smoking
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P -provocative/palliative (aggravating factors/better) Q -qualify and quantify pain on 1 -10 scale R -region/radiation (pinpoint pain, does it radiate) S –severity T-temporal characteristics/treatment (worse in the morning, evening, after periods of rest? what treament has been given? )
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designed for women who drink while pregnant. 7 point scale T - tolerance. if a pregnant woman could hold 5 or more drinks without falling asleep or passing out - 2 points W - worry. if relatives are worried - 2 points E - eye openers - 1 point A - amnesia. have frequent blackouts K - do they feel the need to cut down. - 2 points
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N-nature (sharp/dull pain) L-location D-duration (how long, acute/chronic) O-onset (how and when did the pain start C-course (has pain gotten worse) A-aggravating factors (what makes it hurt more or less) T-treatment (patient self treatment and previous doctors Rx)
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assesses alcohol dependence. C - have you ever felt the need to cut down alcohol intake? A - have you been annoyed by others criticizing your alcohol intake? G - have you ever felt guilty about your alcohol intake? E - have you ever had an eye-opener (drink in the morning) 2 or more positive responses indicate clinical relevance"
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you will be listening to sounds produced by internal organs, so 1. eliminate background noise 2. apply diaphragm firmly for high pitched sounds 3. apply bell lightly for low pitched sounds
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1. NLDOCAT 2. PQRST
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the social history is the personal history and psych evalution. It includes, job (sedentary, on feet all day), marrital status, home life, caffeine intake, alcohol intake, drugs etc.
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within normal limits
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years old
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late resupination with propulsion
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Abductory twist
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absence of a nail
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anonychia
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decrease hallux dorsiflexion at the first MPJ associated with first ray hypermobility and abducted gait
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Apropulsive gait
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fungus or melanoma.
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Blackish color under the nail can be due to?
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Tibial varum ...tibias are inverted distally
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Bow legged
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fungi that live off of skin cells
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dermatophytes
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1. red feet without swelling 2.bilateral warm or hot feet 3. pain
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Describe the symptoms for erythromyalgia.
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1. mossy, pig skin with warts 2. foot gets larger with stimulated fibrous tissue 3. non pitting edema 4. blood flow slows down`
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Describe the symptoms of Lymphedema.
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pain at the achilles tendon insertion due to and equinus functioning foot
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Enthesopathy
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the disease bursa is associated with the synovial sheath of the achilles tendon (anterior bursa). A posterior bursa will develop if the achilles tendon or its attachment is being rubbed or abuse hense the mechanical bursa for protection.
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Explain the concept of a disease bursa and a mechanical bursa.
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the presence of fibrous tumors on the plantar aspect of the foot
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Fibromatosis
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spur on the back of the heel, usually seen in a mechanically imbalanced foot with a lot of rocking back and forth. aka pump bumps
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Haglund's deformity
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plantar flex and invert
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How do you accentuate the intermediate dorsal cutaneous nerve?
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non pitting edema
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How do you diagnose lymphedema proaecox?
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the buildup of extra wartlike tissue is burnt away with acid
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How is lymphedema treated?
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three: dorsal, intermediate, ventral
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how many layers can the nail be divided into?
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area under the nail that is not attached to the bed
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hyponichium
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L4 slipped disc
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If a patient presents sensory symptoms (numbness or tingling) on the dorsal lateral aspect of their foot, what would you suspect?
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inferior calcaneal bursitis.. it need a steriod injection in the bursa
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If a patient presents with a painful plantar heel, with warmth, swelling and throbbing pain..what are the suspicions?
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arterial ulcer
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If you had a swollen red, cold foot, it would be a sign of?
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30 sec, 3 times
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In removing an ingrown toenail, how long should you apply phenol?
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HIV patients
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In what population would you see a lot of white fungal infection?
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intractable plantar keratosis, buildup of skin on the bottom of the foot due to pressure points. in diabetics, this may cause ulceration
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IPK is an abbreviation for….
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genu valgum
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Knock Knee
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accumulation of fat in the anterior aspect of the ankle in women after menopause
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Lipomas
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white patches on the surface of the nail that is a superficial fungal infection caused by candida
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luconychia
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bigger or wider than normal nail
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macronychia
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peeling away of lateral foot border
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Midtarsal break?
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the red zone under the skin at the proximal end of the nail where nail growth originates.
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Nail matrix
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trychophytan, hypersporum, epidermophytan, candida
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Name four common dermatophytes.
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painful nerve, usually do to tight shoes and is immediatly relieved when they are removed
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Neuralgia
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thickening of a nerve
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Neuroma
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lack of sensation, as in a diabetic
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Neuropathy
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uniform thickening of the nail
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Onychauxis
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chronic inflammation of the nail matrix
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Onychia
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ingrown toenail
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onychocryptosis
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the toe is abnormal
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Onychodystrophy
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thick, grossly deformed and enlarged nails
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Onychogryphosis
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separation of nail plate from the end of the toe (too proximally)
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Onycholysis
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Separation from the proximal nail fold
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Onychomadesis
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the nail is soft
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Onychomalacia
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localized infection of the nail or nail bed caused by fungus
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Onychomycosis
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nail fungus (tinea ungum) characterized by thick, discolored nails
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onychomycosis
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the nail is in layers
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Onychoschizia
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abnormal sensory signs
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Parasthesia
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inflammation of veins
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Phlebitis
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more than one nail on a digit
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polynychia
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Grades 5 - 0 5 being normal 0 being no palpable contraction
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Resistive muscle testing is graded how?
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contracture of the plantar and palmar fascia that is associated with insulin dependant diabetics...they cannot straighten their hands out....its called the prayer sign
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Rosenbloom syndrome
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in a child, the calcaneus grows faster than the soft tissues causing an equinus condition. it can be painful. casting and night splints help the soft tissue to catch up
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Sever's disease
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distal phalanx bone tumor
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Subungual osteochondroma
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tapping the nerve and getting a tingling sensation distally (electrical tingle)
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Tineal sign
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loss of dermis and epidermis
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Ulcer
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tapping a nerve sends an electrical feeling proximally
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Valleix phenomenon
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results because of the vamp of improper shoes
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Vamps disease
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1. Achilles tendonitis 2. Anterior Tendo-achilles bursitis (haglunds deformity) 3. Posterior achilles bursitis4. Posterior talar tubercle pain
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What are considerations for posterior ankle pain?
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1. Tarsal tunnel syndrome 2. Great saphenous vein (phlebitis) 3. Tibialis posterior tendonitis 4. Tibial nerve (entrapement or compression)
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What are some considerations for medial ankle pain?
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Keenan's fibromas or periomal fibromas
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What are some tumors in the toe region?
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1. Rest portion 2. Stance portion 3. Gait portion 4. Footgear Survey 5. Radiographic Assessment
|
What are the five phases of a biomechanical exam?
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1. morphological exam (visual inspection) 2. comparative deviations (asymmetry) 3. palpation exam (determine tenderness) 4. Arthrometric exam (motion)~
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What are the four points of the rest phase of a biomechanical exam?
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calcaneal inversion = 20 deg. calcaneal eversion = 10 deg.
|
What are the normal values for sub-taler joint ROM?
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1. they are on the medial side of the ankle 2. they have a red granulating base 3. they have irregular borders 4. hard or indurated skin 5. Reactive bone formation 6. Usually not painful
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What are the properties of a venous ulcer?
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1. lateral side of foot 2. cold, red foot 3. swelling 4. greyish centers 5. pain 6. smaller and punched out
|
What are the signs of arterial ulcers?
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CalcaneoNavicular coalition and Excessive ankle pronation
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What are the two main causes of sinus tarsi pain?
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lamisil, sporanox
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What are the two main medications for onychomycosis?
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red is healthy, venous ulcer
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What does it mean if you look at an ulcer and its base is red?
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non-glycosylation of connective tissue and collagen causing the deposition of mucopolysaccarides in the collagen.
|
What is the cause of Rosenbloom syndrome?
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soft tissue which is part of the posterior nail fold. Sometimes referred to as eponychium. plays a part in nail generation
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what is the cuticle?
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white area you see on your fingernails. the most distal point of the nail matrix is the lunula. plays a role in nail generation
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what is the lunula
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lateral ankle sprain
|
what is the most common way to injure the intermediate dorsal cutaneous nerve?
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an epithelial layer with indentations and grooves so it can attatch to the nail.
|
what is the nail bed?
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keratohyalin
|
what is the nail plate made up of?
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plantar flexion = 35 deg dorsiflexion = 65 deg
|
What is the normal ROM for the 1st MPJ?
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plantar flexion = 45 deg dorsiflexion = 15 deg (knee straight)
|
What is the normal ROM for the ankle joint?
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|
onych
|
what is the root word for nail?
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ASIS to medial malleolus
|
What is the true measure of limb length discrepancy?
|
|
|
Look at the shoes for clues and wear patterns
|
What mainly happens in the footwear part of a biomechanical exam?
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ROM, muscle strength tests and observe gait
|
What mainly happens in the gait part of a biomechanical exam?
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look for obvious problems like fractures, variations and malalignments
|
What mainly happens in the radiographic part of a biomechanical exam?
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Postural evaluation...foot alignment and balance
|
What mainly happens in the stance part of a biomechanical exam?
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|
peroneus longus
|
What muscle is responsible for plantarflexing the 1st ray?
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intermediate dorsal cutaneous of superficial peroneal nerve.
|
What nerve is at risk for compression when you have a lipoma?
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|
S1 from an L5 slipped disc.....make the patient stretch his leg and if his heel hurts, it could be a slipped disc.
|
What nerve root is capable of causing heel pain?
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|
sickle cell disease
|
What pathology seems to be more prone to arterial ulcers?
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|
|
give a cortisone injection because it will tear the tendon further.
|
What should you never do for post tibialis tendonitis?
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L5
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What spinal level innervates the dorsal lateral part of the foot?
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liver disease or rheumatoid arthritis
|
What systemic disease could you attribute red feet and no swelling?
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English nail clipper, hemostats, freer elevator, pickups, small curette, 62 mini blade
|
What utensils do you need for an ingrown toenail removal?
|
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the dorsal lateral part of the big toe....the saggital plane motion is gone in the MP joint so it is reflected in the IP joint
|
Where do you see the majority of the symptoms for hallux limitus?
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the matrix and soft tissues proximal and under the nail
|
which area is most important for permanently removing a nail?
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|
the proximal end is the least attached because this is where the nail grows
|
which is the least attached part of a nail?
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|
sporanox
|
Which medication is given in pulse therapy
|
|
|
diabetics, alcoholics and patients suffering from epilepsy
|
Who is at risk for fibromatosis?
|
|
|
diabetics
|
Blood in a corn is diagnostic of what group?
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|
bump on the top of the foot, sometimes caused by osteoarthritis
|
dorsal bunion
|
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bone spurs, can occur especially on heel, but can be seen in multiple places, also seen commonly with osteoarthritis
|
Exostoses
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its C-shaped erosion of the bone
|
Gout is characteristic by?
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forms around wounds that won't heal
|
Granulation tissue
|
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hard corn (possibly secondary to contracted or hammer toe)
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heloma durum
|
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Suppurative inflammation of the nail fold surrounding the nail plate; may be due to bacteria or fungi, most commonly staphylococci and streptococci. Origin [para- + G. onyx, nail]
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Paranychia
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inflammation of the nail fold surrounding the nail plate; may be due to bacteria or fungi, most commonly staphylococci and streptococci. Origin [para- + G. onyx, nail]
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Paronychia
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|
5th toe adducto varus
|
Tailor's bunion
|
|
|
fungal infection of the scalp
|
tinea capitis
|
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|
athlete's foot
|
tinea pedis
|
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|
Interdigital infections, Moccasin distribution, and Vesiculobullos infection. ON BOARDS
|
What are three types of tinea pedis?
|
|
|
Present in the webspaces, Scaling, Maceration, Fissuring, Erythema. Tx: Betadine, Powders, antifungal gel, Castallini's paint.
|
List the hallmarks and treatment of Interdigital Tinea Pedis.
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Scaling of the plantar surface, Hyperkeratosis plantar surface. Tx: Topical or oral antifungal, Loprox TS, Grispeg (pediatric safe) Lamisil.
|
List the hallmarks and treatment of Moccasin Tinea Pedis
|
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|
Marked by vesicles in the arch of the foot. Tx: Topical Antifungal
|
List the hallmarks and treatment of Vesicular Tinea Pedis.
|
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|
aka. Verruca Plantaris caused by HPV, Warts display pinpoing bleeding on debridement. Pain upon lateral compression. Can occur singly or in groups. Tx: acids, electrotherapy, cryotherapy, excisional surgery, laser.
|
List the hallmarks and treatment of Viral Warts
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|
aka. Corns and calluses. Develps in response friction or pressure. Usually over prominent bony areas. Can be caused due to abnormal weight distribution, faulty biomechanics, improper shoe gear.
|
List the hallmarks and treatment of Hyperkeratotic Lesions
|
|
|
Dorsal hard corns usually centered over the proximal interphalangeal joint. PIPJ
|
Define Heloma Dura
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|
soft corns usually interdigital corn.
|
Define Heloma Molle
|
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|
Arterial ulcers are caused by ichemia (Local anemia due to mechanical obstruction (mainly arterial narrowing) of the blood supply); often marked by pain and by organ dysfunction) Presence of Peripheral Vascular Disease. VERY PAINFUL!
|
List the hallmarks of Ulcers
|
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|
Inflammation of the nail fold. Red hot, swollen, and painful. Can yave a pyogenic granuloma Tx: remove the offending nail, betadine and H2O (epsom salt 15 min) soaks, topical or oral antibiotics.
|
List the hallmarks of paronychia
|
|
|
Limited range of motion in the 1st metatarsal phalangeal joint (MTPJ)
|
Define hallux limitus
|
|
|
Loss of motion metatarsal phalangeal joint (MTPJ)
|
Define hallux rigidus
|
|
|
dorsiflexed 1st ray, 1st ray hypermobility, long 1st ray, DJD of the MTPJ, prolonged 1st MTPH immobilization, Iatrogenic.
|
What are the causes of Hallux Rigidus / Limitus
|
|
|
plantarflexed PIPJ, DIP Neutral or hyperectended, MTP dorsiflexed, can be flexible, semi-rigid, or rigid.
|
List the hallmarks of hammertoes
|
|
|
Plantar pain due to repeated microtrauma on the plantar aponeurosis causing strain of the posterior attachment to the medial tubercle. High association with cavus and planus feet. HALLMARK SYPMTOM: post-static dyskinesia; first step in the morning is extremely painful. Tx: NSAIDS, local steroid injection, strappings, orthotics, streching, PT, Sx.
|
List the hallmarks of plantar fasciitis
|
|
|
Martel's sign on xray (On x-ray one may see soft tissue swelling, and joint effusions, rat-bite erosions, cyst-like or punched-out erosions. Many lesions are expansile with overhanging margins(Martel's sign) that are displaced away from the axis of the bone). Serum uric acid levels increased. Tx: aspiration, NSAIDS, colchicine injection.
|
List the hallmarks of gout
|
|
|
area of skin on the sides of the nails: lateral, medial and proximal (posterior)
|
what are nail folds?
|
|
|
1. pointy heel spurs that are associated with plantar fasciaitis 2.fluffy heel spurs that are associated with systemic diseases like psoriatic arthitis, ankylosing spondylitis and Reiter's syndrome.
|
What are the two kinds of heel spurs?
|
|
|
1. foot health# 2. protection# 3. wear# 4. comfort# 5. functional performance / support# 6. aesthtics
|
What are the 6 roles that shoes have?
|
|
|
A Branick Device
|
What do you use to measure the foot?
|
|
|
A counter is the posterior portionof the shoe that stiffens the support around the heel. It contorls the heel at heelstrick and stabilizes the heels motion inside the shoe.
|
Describe the counter in a shoe.
|
|
|
The box toe is the material that covers the toe box. Your toes fit into the toe box.
|
how does the box toe relate to the toe box.
|
|
|
Shoe - how the correction is to be accomplished#"
|
How do you write a shoe prescription?
|
|
|
The cuticle
|
eponychium
|
|
|
where the skin meets the nail at the distal edge
|
hyponichium
|
|
|
skin that is covering your nail matrix proximal to the eponychium
|
proximal nail fold
|
|
|
benign cartilaginous tumor that grows up from the distal phalanx and deforms the shape of the nail
|
exostosis
|
|
|
the area that hurts with ingrown toe nails
|
lateral nail fold
|
|
|
(nail fungus) and also in nicotine use
|
yellow nails
|
|
|
lack oxygen
|
blue nails
|
|
|
Tetracycline, if given to children, their teeth will be discolored and their nails will be a grey brown
|
grey brown nails
|
|
|
liver cirrhosis, that is terry’s nails- a whitish tinge. Superficial white onychomycois occurs in AIDS patients which will also present as a white nail
|
a whitish tinge nails
|
|
|
Psuedomonas is a bacteria that likes to turn things green. Green alcohol is a phenomenon- rubbing alcohol that has a green food dye
|
green nails
|
|
|
jogger’s toenail…second toe will hit constantly against toe box of shoe and will get subungual hemmorage.# Subungual melanoma is a deadly skin cancer under your toe nail- you have less than 5 years to live. Bob Marley had subugnal melanoma
|
Black nails
|
|
|
Onychoschizia- means nail is weak and brittle. It is peeling.
|
Onychoschizia
|
|
|
Onychomycosis- nail fungus disease
|
Onychomycosis
|
|
|
Onychomedesis- thickening of the nail over 1 mm.
|
Onychomedesis
|
|
|
Onycholysis- lifting up of the nail plate from the nail bed.
|
Onycholysis
|
|
|
Paronychia- infection of the nail- ingrown toe nail.
|
Paronychia
|
|
|
Trachonychia- roughness of the nail plate (like with sandpaper).
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Trachonychia
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Koilonychia- some children are born with spoon nails- nails curve in. Often times they grow out of it.
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Koilonychia
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Anonychia- no nail.
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Anonychia
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Onychocryptosis- nail is ingrown but there is no infection- no pus.
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Onychocryptosis
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Onychodystrophy- any disorder of the nail.
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Onychodystrophy
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Anonychia- also seen in frostbite, trauma, amputation of distal toe (no distal aspect of toe= no nail!!).
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Anonychia
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Leukonychia-white nail- poisned with arsenic or with liver disease (Terry’s Nails).
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Leukonychia
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Onychauxis-thickened nail plate- thickness is caused by onychomycosis and psoriasis.
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Onychauxis
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Onychogryphosis- also known as a Ram’s horn nail- they are huge, curved, and brittle nails- caused by neglect. They are brittle nails- start at the distal aspect of nail when debriding. The curvature comes from the length.
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Onychogryphosis
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Onycholysis- is detachment of the nail plate from the nail bed. if you ever picked under your finger nail and you see a bit of whiteness past the hyponychium, well, that’s where the nail plate has detached from nail bed…that can be a first sign of nail fungus when there is yellowish tinge with onycholysis.
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Onycholysis
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Onychophagia- biting your nails.
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Onychophagia
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Clubbing- think of pulmonary disorder. Lovibond’s angle is the angle that you see if you look at the side of your nail- it is a little less than 180…this is over 180 in clubbing disorders. Also seen in heart and liver disease, it may also be hereditary. You need to do a thorough history to figure this out. There is nothing we can do to change it when it is hereditary.
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Clubbing
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Oncyhocryptosis- ingrown nail plate at the proximal nail border but not infected. If infected paronychia. This is called proud flesh or granulation tissue when you see the red beefy tissue associated with an infected nail.
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Oncyhocryptosis
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Onychomycosis is caused by a dermatophyte- same as causing athletes foot. It is caused by Trichophyum rubrum
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What dermatophyte causes onychomychosis?
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hyperhydrosis. That is increased moisture of skin.
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hyperhydrosis. That is increased moisture of skin.
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moccasin distribution#, the interdigital infection and the #vesicular infection
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name the three types of tinea pedis infections.
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Warts display a pinpoint bleeding on debridement. Warts actually have pain upon lateral compression. So when you compress it side to side, you get a lot of pain. When you compress it directly on top of it, it doesn’t hurt
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What are the hallmarks of a wart?
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FALSE
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true or false: a halloma mole is usually found on the dorsum of the digit.
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heloma dura, which means that the corn is on the dorsal part of your digit.
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heloma dura
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Halloma mole is a soft corn, and it’s usually in the interspace; it’s an interdigital corn.
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Halloma mole
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Absolutely nothing. You can’t cut somebody with poor circulation because they can’t heel at the incision site. Even if you’re debriding…with some people, you can’t even take out a nail, because they will get gangrene. This ulcer was really painful; he wanted to cut his own foot off. An arterial ulcer (might be on the test) is very, very painful. Because you don’t have enough blood flow to carry the oxygen that your tissues need to live. Never cut somebody who doesn’t have enough circulation.
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What do you do with a patient with an arterial ulcer?
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to be taken before meals as with certain prescriptions [L. ante, before, in front of]
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a.c. (ante cibum) is an abbreviation for….
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arteriosclerotic heart disease
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ASHD is an abbreviation for….
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twice a day
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b.i.d. (bis in die) is an abbreviation for….
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blood sugar
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BS is an abbreviation for….
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chief concern
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CC is an abbreviation for….
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congestive heart failure
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CHF is an abbreviation for….
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Chronic obstructive pulmonary disease
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COPD is an abbreviation for….
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Computerized tomography, as in a CT scan
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CT is an abbreviation for….
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cerebral vascular accident (stroke)
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CVA is an abbreviation for….
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degenerative joint disease, or osteoarthritis
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DJD is an abbreviation for….
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diabetes mellitus
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DM is an abbreviation for….
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deep vein thrombosis
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DVT is an abbreviation for….
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diagnosis
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Dx is an abbreviation for….
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electromyogram
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EMG is an abbreviation for….
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family history
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FH is an abbreviation for….
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fracture
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Fx is an abbreviation for….
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at bedtime [hour of sleep]
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h.s. is an abbreviation for….
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bunion
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hallux abducto valgus
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hepatitus B virus
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HBV is an abbreviation for….
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heart disease
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HD is an abbreviation for….
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head, ears, eyes, nose, throat
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HEENT is an abbreviation for….
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hemoglobin
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HGB is an abbreviation for….
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1. aviod incidental conversation and digressions 2. begin with short open ended questions to get the patient talking 3. control the questions and answers 4. clarify specific questions by asking focused or close-ended questions 5. limit the amount of direct questions to avoid an interrogation-like feeling. use indirect questions to soften the mood
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how can a doctor maintain control of the interview?
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only to confirm a diagnosis
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How should lab values and x-rays be used?
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history of present illness
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HPI is an abbreviation for….
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hormone replacement therapy
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HRT is an abbreviation for….
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hypertension (high blood pressure)
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HTN (HBP) is an abbreviation for….
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history
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Hx is an abbreviation for….
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incision and drainage
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I & D is an abbreviation for….
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intake and output
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I & O is an abbreviation for….
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insulin dependent diabetes
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IDDM is an abbreviation for….
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internal fixation
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IF is an abbreviation for….
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intramuscular
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IM is an abbreviation for….
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last menstrual period
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LMP is an abbreviation for….
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right in the center of the heel.
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Looking at the plantar aspect of the foot, where is the medial tubercle?
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TB-multiple drug resistence tuberculosis
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MDR is an abbreviation for….
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metastases (DPM's use this for met heads)
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mets is an abbreviation for….
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myocardial infarction
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MI is an abbreviation for….
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Magnetic resonance imaging
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MRI is an abbreviation for….
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no food after midnight [L. non per os or nil per os, nothing by mouth.]
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n.p.o. is an abbreviation for….
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1. CC 2. HPI 3. PMH 4. PSH 5. FH 6. SH 7. Medications 8. Allergies 9. ROS”
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name the 9 steps of the medical history in the correct order
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non insulin dependent diabetes
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NIDDM is an abbreviation for….
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non-steroidal anti-inflammatory drug
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NSAID is an abbreviation for….
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osteoarthritis
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OA is an abbreviation for….
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narrowing of joint space, not much cartilage, spurs cause dorsal bunions sometimes
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osteoarthritis
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destruction of bone, usually seen on x-ray, can occur in instances of gout
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Osteolysis
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infection of bone
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osteomyelitis
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to be taken after meals, as with certain prescriptions
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p.c. (post cibum) is an abbreviation for….
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high arch foot type
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pes cavus
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low/no arch foot type
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pes planus
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past medical history
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PMH is an abbreviation for….
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pain on palpation
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POP is an abbreviation for….
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as needed (use for pain med Rx)
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prn is an abbreviation for….
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past surgical history
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PSH is an abbreviation for….
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peptic ulcer disease
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PUD is an abbreviation for….
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once daily
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q.d. is an abbreviation for….
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once an hour
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q.h. is an abbreviation for….
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four times daily
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q.i.d. is an abbreviation for….
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rule out
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R/O is an abbreviation for….
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rheumatoid arthritis
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RA is an abbreviation for….
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range of motion
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ROM is an abbreviation for….
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review of systems
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ROS is an abbreviation for….
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regular rate and rhythem (of heart)
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RRR is an abbreviation for….
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prescribe
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Rx is an abbreviation for….
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status post
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s/p is an abbreviation for….
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social or psychosocial history
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SH is an abbreviation for….
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shortness of breath
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SOB is an abbreviation for….
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symptoms, surgery, depends on the clinician
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Sx is an abbreviation for….
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three times daily
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t.i.d. is an abbreviation for….
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entrapment of tibial nerve in the lacunar ligament
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Tarsal tunnel syndrome?
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tenderness on palpation
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TOP is an abbreviation for….
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temperature, pulse, respiration
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TPR is an abbreviation for….
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treatment
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Tx is an abbreviation for….
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usual childhood diseases (measles, mumps, german measles)
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UCHD is an abbreviation for….
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1. general appearance 2. state of nutrition 3. body habits 4. symmetry 5. posture and gait 6. speech
|
what 6 criteria make up the inspection portion of the physical examination?
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1. introduce yourself as a student doctor with under the attending physician 2. keep eye contact, respect their space (3 ft.) 3. small talk, be able to maintain a conversation
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what are some helpful ways to establish rapport with a patient?
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1. CAGE test 2. MAST test 3. TWEAK test
|
what are some tests to assess alcohol problems?
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1. inspection - visual acuity 2. palpation - feeling the abnormality 3. inspection and palpation 4. percussion 5. auscultation - use of stethoscope
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what are the 5 cardinal principle of the physical examination?
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1. shock and denial 2. anger 3. bargaining 4. depression 5. acceptance
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what are the 5 stages of grief?
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1. Dolor (pain) 2. Edema (swelling) 3. Calor (heat) 4. Erythema (redness) 5. Exudate [pus (purulent) or transducent (clear)] if infected
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what are the cardinal signs of inflammation?
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1. establish rapport with patient 2. elicit info: medical history, physical exam, diagnostic tests 3. consult with your preceptor 4. assessment and plan: a. could involve more tests b. think of treament approaches for short nd long term relief 5. Exposition phase: speek to patient about problem and plan 6. Recording: write up the information collected
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what are the six tasks in the patient overview?
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1. Rx (prescription) 2. dispense (number you want them to have) 3. signa (let it be labeled)\
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what are the three segments of a prescription?
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1. expose areas to be inspected in good light 2. palpate tender areas while maintaining eye contact
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what are the two components of the inspection and palpation portion of the physical exam?
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1. use of tactile sensation 2. determines characteristics of organ system
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what are the two components of the palpation portion of the physical exam?
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1. combines tactile sensation and sound 2. difference in sound from normal can indicate mass or fluid
|
what are the two components of the percussion portion of the physical exam?
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1. ask open ended questions (leaves things wide open) 2. ask close ended questions (yes or no answers) 3. direct/focused questions (when trying to determine) 4. indirect questions (statement like soften tone) 5. facilitation: head nodding, mhmm, mhmm; hand motions
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what can a doctor do to elicit info?
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subjective
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what component of the patient interview is the medical history?
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past medical history contains all active and significant inactive (MI, pneumonia, syphilis, hepatitis) medical conditions
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what info is given in the PMH
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the past surgical history asks for the date and type of any kind of surgical procedure performed. also, be sure to ask about scarring or allergies or problems with anesthesia (local or general), blood clotting or scarring
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what info is given in the PSH
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a family history using goes three generations, from patient to parents to grandparents. always ask about their history with DM, HD, cancer, anemias and RA.
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what info is needed in the FH component of a medical history?
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1. Age 2. Race 3. Gender 4. Chief Concern There may also be secondary and tertiary concerns
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what info should be present in the CC?
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a hypertrophic scar is typically thick and wide but follows the line of incision (typically due to sloppy suturing)
|
what is a hypertrophic scar?
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a keloid scar appears almost tumorous and is typically consistent with the person.
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what is a keloid scar?
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Michigan Alcohol Screening Test~this is a 15 question test designed for social workers to asses alcholism
|
what is a MAST test?
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the number of packs of cigarettes smoked per day multiplied by the number of years of smoking
|
what is a pack year?
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P -provocative/palliative (aggravating factors/better) Q -qualify and quantify pain on 1 -10 scale R -region/radiation (pinpoint pain, does it radiate) S –severity T-temporal characteristics/treatment (worse in the morning, evening, after periods of rest? what treament has been given? )
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what is a PQRST?
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designed for women who drink while pregnant. 7 point scale T - tolerance. if a pregnant woman could hold 5 or more drinks without falling asleep or passing out - 2 points W - worry. if relatives are worried - 2 points E - eye openers - 1 point A - amnesia. have frequent blackouts K - do they feel the need to cut down. - 2 points
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what is a TWEAK test?
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N-nature (sharp/dull pain) L-location D-duration (how long, acute/chronic) O-onset (how and when did the pain start C-course (has pain gotten worse) A-aggravating factors (what makes it hurt more or less) T-treatment (patient self treatment and previous doctors Rx)
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what is an NLDOCAT
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assesses alcohol dependence. C - have you ever felt the need to cut down alcohol intake? A - have you been annoyed by others criticizing your alcohol intake? G - have you ever felt guilty about your alcohol intake? E - have you ever had an eye-opener (drink in the morning) 2 or more positive responses indicate clinical relevance"
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what is the CAGE test?
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you will be listening to sounds produced by internal organs, so 1. eliminate background noise 2. apply diaphragm firmly for high pitched sounds 3. apply bell lightly for low pitched sounds
|
what precautions must be taken while performing the auscultation portion of the physical exam?
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1. NLDOCAT 2. PQRST
|
what two mnemonic devices are used to list questions for the HPI?
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the social history is the personal history and psych evalution. It includes, job (sedentary, on feet all day), marrital status, home life, caffeine intake, alcohol intake, drugs etc.
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what type of info is found in the SH component of the medical history?
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within normal limits
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WNL is an abbreviation for….
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years old
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y/o is an abbreviation for….
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