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165 Cards in this Set
- Front
- Back
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noting joint deformities or misalignment of bones |
use inspection/ palpation to assess surrounding tissue - noting any skin changes, nodules, muscle atrophy.
rest range of motion and maneuvers |
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an audible or palpable crunching during movement of tendons or ligaments over bone |
crepitus |
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joint instability from excess mobility of joint ligaments |
ligamentous laxity |
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least common sign of inflammation near the joints |
redness |
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swelling in joints may involve (3) |
synovial membrane - which can feel boggy or doughy effusion from excess synovial fluid within the joint space soft tissue structures such as bursae, tendons and sheaths |
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checking the warmth of joints - use ___ |
back of fingers |
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bony fixation of a joint |
ankylosis |
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palpable bogginess or doughiness of the synovial membrane indicates ____, often accompanied by effusion |
synovitis |
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palpable joint fluid in ____ |
effusion |
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tenderness over the tendon sheaths |
tendinitis |
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joint capsule and articular cartilage, the synovium and synovial fluid, intra-articular ligaments, and junta articular bone |
articular structures |
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periarticular ligaments, tendons, bursae, muscle, fascia, bone, nerve, and overlying skin |
extra-articular structures |
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involves swelling and tenderness of the entire joint and limits both active and passive range of motion |
articular disease |
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involves selected regions of the joint and types of movement |
extra-articular disease |
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rope like bundles of collagen fibrils that connect bone to bone |
ligaments |
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collagen fibers connecting muscle to bone |
tendons |
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collagen matrix that overlies bony surfaces |
cartilage |
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points of synovial fluid that cushion the movement of tendons and muscles over bone and other joint structures |
bursae |
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joint
freely movable
ie: knee and shoulder |
synovial |
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joint
slightly movable
vertebral bodies in spine |
cartilaginous |
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joint
immovable
skull sutures |
fibrous |
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chronic inflammation of synovial membranes with secondary erosion of adjacent cartilage and bone, damage to ligaments and tendons |
Rheumatoid Arthritis |
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degeneration and progressive loss of cartilage within the joints, damage to underlying bone, and formation of new bone at the margins of the cartilage |
Osteoarthritis (degenerative joint disease) |
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rheumatoid arthritis 1: location 2: pattern 3: progression 4: redness, warmth, tenderness 5: stiffness 6: generalized symptoms |
1: hands, feet, wrists, elbows, knees, ankles 2: symmetrically additive 3: often chronic, with remission/exacerbations 4: tender, often warm, seldom red 5: prominent, often for an hour or more 6: weakness, fatigue, weight loss, low fever |
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osteoarthritis 1: location 2: pattern 3: progression 4: redness, warmth, tenderness 5: stiffness |
1: knees, hips, hands, cervical, lumbar spine, wrists, previously injured joints 2: additive (may only be 1 joint) 3: slowly progressive 4: possibly tender, seldom warm or red 5: frequent but brief (5-10 min) |
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an inflammatory reaction to micro crystals of sodium urate
fever may be present |
gouty arthritis |
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gouty arthritis 1: location 2: pattern 3: progression 4: redness, warmth, tenderness 5: stiffness 6: onset |
1: big toe, feet, ankles, knees, elbows 2: usually one joint 3: lasts days - 2 weeks 4: exquisitely hott, tender, red 5: no stiffness 6: sudden, often at night, could be excessive food or alcohol intake |
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widespread musculoskeletal pain and tender points. may accompany other diseases. mechanism unclear
may disturb sleep |
fibromyalgia syndrome |
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most commonly affected joints of rheumatoid arthritis (3)
with chronic, joints swell and thicken, muscles atrophy, fingers deviate toward ______ and may show swan neck |
interphalangeal, metacarpophalangeal, wrist
ulnar side |
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______ on the doors lateral aspects of distal interphalangeal joints from bony overgrowth of osteoarthritis.
in proximal interphalangeal joints, they are called ____
usually painless |
Herberden Nodes
bouchard nodes |
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for elbow examination, the elbow should be ____
identify __3__ |
flexed to 70*
medial/ lateral epicondyles, olcarnon process of the ulna |
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swelling over the olecranon process |
olecranon bursitis |
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tenderness distal to the epicondyle
less common is |
lateral epicondylitis (tennis elbow)
medial epicondylitis (pitcher/golfers elbow) |
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the synovium of the elbow is most accessible to examination between ____&____
____ is felt between ole canon and medial epicondyle |
olecranon and epicondyles
ulnar nerve |
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partial seizures indicate ____
simple partial seizures _____ consciousness
complex partial seizures ____ consciousness
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structural lesion in the cerebral cortex such as scar, tumor, infarction
do not impair
impair |
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simple partial seizures may include ___4__ symptoms (include examples) |
motor: jacksonian (tonic/ clonic movements - start unilaterally then spread)
sensory: numbness, tingling, hallucinations (flashing lights)
autonomic: funny feeling in epigastric, nausea, pallor, light headed
psychiatric: anxiety, fear, deja vu, rage, etc |
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patient may have aura, but is amnesic for remainder of seizure.
person feels confused, automatic motor behaviors |
complex partial seizure |
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_____ seizure begins with bilateral movements, impairment of consciousness, or both
may be hereditary (beginning in childhood) or acquired (beginning after 30 - signifying metabolic or toxic disorder) |
generalized |
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describe tonic clonic convulsion (grand mal) |
the person loses consciousness suddenly, sometimes with a cry, and the body stiffens into tonic extensor rigidity. Breathing stops, and person becomes cyanotic. A clonic phase follows with rhythmic muscular contraction
breathing resumes and is often noisy
injury, tongue biting, urinary incontinence may occur
person has amnesia and recalls no aura |
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types of generalized seizures |
tonic clonic
absence
atonic seizure or drop attack
myoclonus
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Generalized Seizure a sudden brief lapse of consciousness with momentary blinking, staring, or movements of the lips and hands but no falling
no aura
may/ may not be followed w/ confusion |
absence |
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Generalized Seizure
sudden loss of consciousness with falling but no movements |
atonic seizure (drop attack) |
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Generalized Seizure
sudden brief, rapid jerks, involving trunk or limbs |
myclonus |
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mimic seizures but are due to a conversion reaction (psychological disorder) |
pseudoseizures |
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____ are relatively rhythmic oscillator movements, which are divided into 3 subgroups __3__ |
Tremors
resting (static), postural, intention |
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tremors most prominent at rest. may disappear w/ voluntary movement example is slow, fine, pill rolling tremor of Parkinsonism |
resting (static) tremors |
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tremors appear when the affected part is actively maintaining a posture.
ie: fine rapid tremor of hyperthyroidism, tremors of anxiety and fatigue, benign essential tremor |
postural (action tremor)
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tremors are absent at rest, and appear with activity and often get worse as the target is neared
causes include disorders of cerebellar pathways, as in MS |
intention tremors |
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rhythmic, repetitive, bizarre movements that chiefly involve the face, mouth, jaw, and tongue
include: grimacing, pursing of the lips, protrusions of the tongue, opening of mouth, deviations of jaw
may be a complication of psychotropic drugs, or from psychoses, or appear in edentulous individuals |
oral-facial dyskinesias |
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brief, repetitive, stereotyped, coordinated movements occurring at irregular intervals
ie: repetitive winking, grimacing, shoulder shrugging
causes are tourette syndrome and drugs |
tics |
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slow twisting and writhing movements that have a large amplitude.
most commonly involve the face and distal extremities.
causes are cerebral palsy and often associated with spasticity |
athetosis |
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grotesque, twisted posture. involves larger portions of the body like the trunk and head
causes include drugs and spasmodic torticollis |
dystonia
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brief, rapid, jerky, irregular, unpredictable movements.
occur at rest or interrupt normal coordinated movements.
seldom repeat themselves
face, head, lower arms, hands
causes are sydenham chorea and huntingtons |
chorea |
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two most common causes of comas
arounsal centers poisoned or critical substrates are depleted, ____
lesions destroy or compress brainstem arousal areas, ____ |
toxic metabolic
structural |
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toxic metabolic coma 1: respiratory pattern 2: pupillary size and reaction 3: level of consciousness 4: ie |
1: regular - normal or hypervent; irregular - cheyne stokes 2: Equal, reactive to light. or unreactive - fixed/ dilated 3: changes after pupils change 4: alcohol, drugs, liver failure, hyper/hypothermia hyperglycemia |
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structural coma 1: respiratory pattern 2: pupillary size and reaction 3: level of consciousness 4: ie |
1: irregular, cheyne stokes or other pattern 2: unqual, unreactive to light (fixed) midposition (midbrain compress) Dilated (compression of CN III from herniation) 3: changes before pupils change 4: tumor, abscess, hemorrhage, infact |
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drowsy patients but open their eyes and look look at you, respond to questions, then fall asleep |
lethargic |
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patients open their eyes and look at you but respond slowly and are somewhat confused |
obtunded |
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unaware of surroundings and are totally or almost totally immobile and unresponsive, even to painful stimuli |
stuporous |
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unconscious and do not respond to painful stimuli or voice and do not open their eyes |
comatose |
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if pt does not respond to questions, escalate the stimulus in steps (1) then (2) |
speak to pt by name , in a loud voice
shake pt gently as if awakening a sleeper |
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fainting or passing out |
syncope |
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syncope sudden peripheral vasodilation, without compensatory rise in cardiac output - blood pressure drops, usual slow onset/ offset precipitated by fear or pain (strong emotion) usually when standing return of consciousness when lying down
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vasodepressor or vasovagal syncope (the common faint) |
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syncope inadequate vasoconstrictor reflexes (low BP) or hypovolemia, caused usually by standing up
may have light headedness, palpitations |
POSTURAL (orthostatic) hypotension |
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syncope severe paroxysm of coughing (usually happens in muscular men w/ chronic bronchitis) |
cough syncope |
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syncope emptying of the bladder after getting out of bed to void. occurs frequently with nocturia |
micturition syncope |
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decreased cardiac output secondary to rhythms that are too fast (180+) or too slow (35-34 or less)
sudden change in rhythm usually with heart disease and/ or old age |
arrhythmias |
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vascular resistance falls with exercise but cardiac output cannot rise
aortic valve does not open all the way |
aortic stenosis or hypertrophic cardiomyopathy |
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sudden arrhythmia or decreased cardiac output usually because of coronary artery disease |
myocardial infarction |
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sudden hypoxia and decreased cardiac output usually because of DVT |
massive pulmonary embolism |
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constriction of cerebral blood vessels secondary to hypocapnia (hypocarbia) that is induced by _____
may be caused by anxiety and/or stressful situation |
hyperventilation |
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insufficient glucose to maintain cerebral metabolism, may be caused by fasting or insulin therapy
pt may experience tremor, palpitations, confusion, coma, etc |
hypoglycemia |
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symbolic expression of an unacceptable idea through body language - slipping to the floor
anxiety is "converted" into physical symptoms.
brought on by stressful situation in someone with hysterical personality traits |
hysterical fainting from conversion reactions |
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____ may resemble tonic - clonic seizures in infants and young children. usually benign but occasionally may be first manifestation of seizure disorder |
febrile convulsion |
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is a general term for infection of the uterus lining, fallopian tubes, or ovaries.
may or may not have * Pain in your lower abdomen; Fever; An unusual discharge with a bad odor from your vagina; Pain and/or bleeding when you have sex; Burning sensation when you urinate; or Bleeding between periods. |
Pelvic inflammatory disease |
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an infection of a woman’s reproductive organs. It is a complication often caused by some STDs, like chlamydia and gonorrhea. Other infections that are not sexually transmitted can also cause
may make it hard to get pregnant |
PID |
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* Have an STD and do not get treated;
* Have more than one sex partner; * Have a sex partner who has sex partners other than you; * Have had PID before; * Are sexually active and are age 25 or younger; * Douche; * Use an intrauterine device (IUD) for birth control. |
More likely to get PID |
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a sac filled with fluid that forms on or inside of an ovary.
may cause more frequent urination if pressing on bladder
usually non painful, but can be painful |
ovarian cyst |
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pain or discomfort during intercourse |
dyspareunia |
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involuntary spasm of the muscles surrounding the vaginal orifice that makes pentration during intercourse impossible or painful |
vaginismus |
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a pregnancy that occurs outside the womb (uterus), embryo implants outside the uterine cavity (can be in fallopian tubes). It is life-threatening to the mother because of hemorrhage risk. |
Ectopic pregnancy Tubal pregnancy |
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pain with menses reported with 50% of women |
dysmenorrhea |
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dysmenorrhea without an organic cause
results from increased prostaglandin production during the luteal phase of the menstrual cycle, when estrogen and progesterone levels decline |
primary dysmenorrhea |
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dysmenorrhea with an organic cause
caused by endometriosis, adenomyosis, PID, and endometrial polyps |
secondary dysmenorrhea |
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absence of periods |
amenorrhea |
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5 types of abnormal uterine bleeding
causes include pregnancy, infection, cancer, polyps |
polymenorrhea: intervals of few than 21 days between menses oligomenorrhea: infrequent bleeding menorrhagia: excessive flow metrorrhagia: intermenstrual bleeding postcoital bleeding |
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failure of periods to initiate |
primary amenorrhea |
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cessation of periods after they have been established |
secondary amenorrhea |
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menopause usually occurs between _____ years following a period of fluctuation in pituitary secretion of follicle - stimulating hormone (FSH) and luteinizing hormone (LH) and ovarian function |
48 and 55 |
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onset of variable cycle length ____ , also mean around menopause
symptoms may include |
perimenopausal
hot flashes, flushing, sweating, sleep disturbances |
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after menopause, there may be (3) |
vaginal dryness, pain during intercourse, hair loss |
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postmenopausal bleed occurs during |
cancer, uterine/ cervical polyps, and hormone replacement therapy |
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abnormal flexor response
upper arms are flexed tight to sides with elbows wrists and fingers flexed, legs are extended and internally rotated, feet are plantar flexed
this posture implies a destructive lesion of the corticospinal tracts within or near the cerebral hemispheres |
decorticate rigidity |
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one sided paralysis
can be caused by sudden unilateral brain damage involving the corticospinal tract
both may be turned away from paralyzed side |
hemiplegia |
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abnormal extensor response
the jaws are clenched and the neck is extended. arms are adducted and stiffly extended at the elbows, forearms pronated. legs are extended at the knees and plantar flexed
caused by lesion in the diencephalon, midbrain, or pons; or metabolic disorders |
decerebrate rigidity |
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meaning "one's own", "individual" and perception, is the sense of the relative position of neighbouring parts of the body and strength of effort being employed in movement |
proprioception |
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to test proprioception ____
caused by MS, dorsalis, B12 deficiency, posterior column disease, peripheral neuropathy from diabetes |
grasp pt big toe and move it up and down then have pt repeat himself with eyes closed |
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most common joint problem is in the |
TMJ |
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important areas of examination for the nervous system (5) |
mental status: alertness and orientation cranial nerves I through XII motor system: coordination, gait, stance sensory system: pain and temp, position and vibration, light touch, discrimination deep tendon, abdominal, and plantar reflexes |
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Cranial nerve V |
trigeminal - corneal reflexes, facial sensation, and jaw movements
includes both motor and sensory aspects |
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to test sensory aspect of CN V |
use sharp and dull for pain sensation on head cheeks and jaw
or hot and cold test tubes |
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to test corneal reflex
sensory is carried out by CNV and motor by CN VII |
have pt look up and away from you touch cornea with wisp of cotton
normal reflex is blinking
absent blinking in acoustic neuroma |
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Cranial Nerve VII |
facial
inspect face for symmetrical and observe for tics |
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to test facial nerve, ask pt to (6) |
raise eyebrows from close both eyes tightly show upper/ lower teeth smile puff out cheeks |
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facial droop is caused by a damaged |
CN VII - Facial |
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Cranial Nerve VIII |
Acoustic |
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test hearing close with |
whispered voice test |
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vertigo with hearing loss and nystagmus in ____ |
meniere disease |
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if hearing loss is present, deter if loss is ___ or ___ |
conductive
sensiorneural (dmg to CN VIII) |
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Cranial Nerves IX and X
controls ___3___ |
glossopharyngeal and vagus
swallowing, rise of palate and gag reflex |
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hoarseness in _____ paralysis
Nasal voice in ____ paralysis |
vocal cord
palate |
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sudden neurologic deficit caused by cerebrovascular ischemia (80-85%) or hemorrhage (15-20%) |
stroke |
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sudden focal neurologic deficit defined as lasting less than 1 hour, without underlying structural defects. Important harbinger of stroke
people are very at risk for stroke in first 30 days. but 15% of pt with have stroke within 3 months |
Transient Ischemic Attack (TIA) |
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3rd leading cause of US death after HD and Cancer Much greater mortality rate in blacks/mexicans 25% die of this w/in 1 year after TIA outcomes improve greatly if pt is admitted w/in 3 hours |
stroke |
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most common cause of ischemic symptoms in brain
causes visual field cuts and contralateral hemiparesis and sensory deficits |
occlusion of middle cerebral artery. |
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occlusion of middle cerebral artery results
left hemisphere _____
right hemisphere ____ |
aphasia
pt has decreased attention to what is happening on the opposite side of body |
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5 signs of stroke; aka stroke/ brain attack |
sudden numbness or weakness in face/arm/leg sudden confusion or trouble speaking or understanding sudden trouble walking, dizziness, or loss of balance/ coordination sudden trouble seeing in one or both eyes sudden severe headache |
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primary prevention for stroke |
modifiable risk factors for ischemic stroke - hypertension, hyperlipidemia, smoking, diabetes, excess weight, lack of exercise, alc use.
careful management of A Fib and carotid art dis |
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most common cause of hemorrhagic stroke |
rupture of saccular aneurysms in the circle of willis |
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once a pt has experience an ischemic stroke or TIA, focus on addressing addition risk factors. This is called |
secondary prevention |
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prepuce, aka _____, must be _____ for examination
essential step for detection of chancres and carcinomas |
foreskin
retracted |
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_____ can accumulate normally under the foreskin |
smegma, a cheesy, whitish material |
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tight prepuce that cannot be retracted over the glans |
phimosis |
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tight prepuce that once retracted, cannot be returned |
paraphimosis |
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if pt has erection, |
finish examination with an unruffled manner |
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a congenital, ventral displacement of the meatus on the penis to the inferior surface
a groove extends from the actual urethral meatus to its normal location on the tip of the glans |
hypospadias |
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the urethral meatus is located on the top of the glans (dorsal side) This is a congenital defect and is rare |
epispadias |
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testicular self exam is best performed after |
a warm bath or shower. the heat relaxes the scrotum and makes it easier to find anything unusual |
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tips for testicular self exam |
stand in front of mirror and note any swelling examine each testicle with both hands. roll the testy between 2 fingers & thumb one may be bigger (normal) pain or lump (abnormal) find epididymis and not lumps |
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the ability to identify an object by feeling it
test the ability of the sensory cortex to correlate, analyze and interpret sensations |
stereognosis |
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stereognosis technique |
place familiar object in pt hand (coin, paperclip, key) and have pt tell you what it is |
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inability to recognize objects place in the hand may suggest lesion in sensory cortex |
astereognosis |
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number identification on palm of hand |
graphesthesia |
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with lesions of the sensory cortex, only one stimulus may be recognized during a point localization test. Stimulus on the ______ as the damaged cortex is extinguished |
opposite side |
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the band of skin innervated by the sensory root of a single spinal nerve |
dermatome |
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2 phases of range of motion |
active (by the patient)
passive (by the examiner) |
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____ typically involves several joints, systemically distributed. |
Rheumatoid arthritis |
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tenderness and warmth over a thickened synovium suggests __2__ |
infection arthritis |
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occurring around a joint of the body. |
periarticular |
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hyperextension of the proximal interphalangeal joints with fixed flexion of the distal interphalangeal joints |
swan neck deformities of rheumatoid arthritis |
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persistent flexion of the proximal interphalangeal joint with hyperextension of the distal interphalangeal joint |
boutonnieres deformity of rheumatoid arthritis |
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radial deviation of distal phalanx is seen in |
osteoarthritis |
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another name for osteoarthritis |
degenerative joint disease |
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kobby swelling around the joints ulcerate and discharge white chalk like urates is seen in _____ |
chronic tophaceous gout |
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the olecranon is displaced posteriorly in ___2___ |
posterior dislocation of the elbow and supracondylar fracture |
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initial autonomic or psychic symptoms in a seizure |
aura |
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partial seizures can become |
generalized |
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suggest a widespread, bilateral cortical disturbance that may be hereditary or acquired |
generalized seizures |
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generalized seizures before age 30 ____
after age 30 _____ |
hereditary
from toxic or metabolic disorder |
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toxic and metabolic disorders that cause generalized seizures |
withdrawal from alcohol or other sedative drugs, uremia, hypo/ hyperglycemia, hyponatremia, bacterial meningitis |
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main difference between tics and chorea |
tics are repetitive and stereotyped chorea rarely repeat themselves |
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pin point pupils from |
opiates or cholinergics, may need magnifying glass to see pupil |
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_____ can press on bladder, increasing the need to urinate. |
ovarian cyst |
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individuals experience return to normal from syncope when |
lying down |
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is uterine bleeding at irregular intervals, particularly between the expected menstrual periods. |
metrorrhagia |
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excessive flow |
menorrhagia |
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abnormal flexor response - rigidity |
decorticate rigidity lesion in corticospinal tracts |
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abnormal extensor response - rigidity |
decerebrate rigidity lesion in brainstem |
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if abnormality is found during pain sensation test, check it with |
temp sensation |
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is the cumulative effect of aging on hearing. It is a progressive bilateral symmetrical age-related sensorineural hearing loss. |
presbycusis |
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impacted cerumen and otitis media causes |
conductive hearing loss |
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discriminative sensations tests |
stereognosis graphesthesia two point discrimination point localization extinction |
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using a paper clip, touch the finger pad in two places simultaneously. find the minimal distance the pt can differentiate between one and 2 points
lesions in the sensory cortex increase the distance of these 2 points |
two point discrimination |
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touch a point on pt skin, then ask pt to open eyes and touch that same place
lesion of sensory cortex impairs this ability |
point localization test |
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last card |
last card |
