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70 Cards in this Set
- Front
- Back
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What organs are in the RUQ?
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liver at the right costal margin
lower pole of right kidney when abdominals relaxed |
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What organs are in the LUQ?
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tip of spleen (MAYBE)
healthy pancreas NOT felt |
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What organs are in the LLQ?
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sigmoid colon (firm narrow tubular)
transverse and descending lower midline: distended bladder uterus and ovaries |
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What organs are in the RLQ?
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No palpable in healthy ppl
Bowel loops, appendix |
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Visceral Pain:
Def? Solid organs why? palpable where? |
forcefull contractions of hollow organs (intestines)
solid organs when capsules stretched midline |
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Parietal pain..
From? Aggravated by? |
steady aching pain more sever and localized
aggravted by movement and coughing |
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Epigastric pain.. from?
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stomach duodenum or pancreas
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RUQ or Epigastric Pain.. from?
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biliary tree and liver
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Periumbilical pain... form?
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sm intestine, apdx, prox colon
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suprapubic/sacral pain... from?
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rectum
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hypogastric pain... from?
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colon, bladder, uterus
colon pain is diffuse |
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What is dyspepsia?
how does it differ from discomfort? |
chronic or recurrent discomfort or pain centered in abdomen
subjective negative feeling that is non-painful |
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Risk factors for GERD (4)
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decreased salivation
delayed gastric emptying hiatal hernia meds (tetracyclin, bisphosphonates, NSAIDS, anticholinergics) |
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What are the alarm symptoms of GERD
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dysphgaia
odynophagia recurrent vomiting GI bleed weight loss |
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What are the signs of IBS?
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intermittent pain for 12 wks of preceding 12 months with relief from defecation
Bloating, gas, alternating diahrea and constipation |
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hematemesis is?
coffee ground appearance indicates? causes? |
vomit with blood
coffee suggests blood altered by gastric acid gastric varices, peptic ulcer |
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Pain from small bowel obstruction is whre?
symptoms? (4) Timing? |
periumbilical
vomiting (bile = high obstruction, fecal material = low obstruction) cramping fecal odor to vomit timing: paroxysmal: decrease as bowel mobility is impaired |
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Obstruction in large bowel..
from? location of pain? |
gas
lower abdominal or general cramping and constipation paroxysmal, milder |
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what do you use to localize oropharyngal or esophageal pain?
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sternoclavicular notch
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oropharyngeal pain..
above or below SCN? Causes? Symptoms? |
above SCN (sternoclav)
drooling, regurgitation, zenkers diverticulum - gurgling |
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what is the problem if both solids and liquids get stuck in the esophagus?
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motility disorder (neurological or muscular
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what is odynophagia?
causes? |
pain on swallowing
ulceration, infeciton with candida, CMV, pill induced |
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what times are associated with acute and chronic diarrhea?
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acute: <2 wks
infection chronic: >/= 4 wks crohns |
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what is/causes steatorrhea
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fatty stool, malabsorption of fat
sprue, celiacs, pancreatic insufficiency, small bowel bacterial overgrowth |
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what are the definition of constipation?
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12 weeks of previous 6 months with 2 of the following:
< 3 bowel movts/wk 25% of defecations require straining lumpy/hard stools manual facilitation |
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What is melina?
cause? |
blakc tarry stools
upper GI bleed |
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What is hematochezia?
cause? |
red/marroon stools
lower GI bleed |
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What is obstipation?
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intesting obstruction
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What can cause jaundice?
(5) |
increased bilirubin
decreased uptake of bilirubin decreased conjugation of bili decreased extretion of bili into the bile |
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what is intrahepatic jaundice?
AKA? |
cholestatic jaundice
damage to hepatocytes or bile ducts |
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extrahepatic jaundice is causes by?
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gall stones
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Acholic stools..
Def? seen with? |
gray stool
viral hepatitis, obstructive jaundice |
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Dark yellow/brown urine =?
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increased conjugated bilirubin
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pinkish or brownish urine?
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blood
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red urine
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beets, blood, meds
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What are the red flags for underlying disease?
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IV drugs
>50 history of cancer weight loss pain >1 month/at night infection |
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if bowel or bladder funciton is present with cauda equina what are two considerations?
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S2-4 midline disc or tumor
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most common cause of radicular pain from spinal nerves in cervical
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C7 then C6
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polyarticular pain with symmetrical involvement that progressivel increases is?
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rheumatoid arthritis
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polyarticular pain with migratory pattern of spread but not symmetricla is?
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rheumatic fever or gonococcal arthritis
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myalgia is?
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generalized aches and pains
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arthralgia is?
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pain with no evidence of arthritis
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waht is the pain and pattern of acute septc arthritis?
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severe pain of rapid onset in swollen join (can be gout or osteomyelitis in kids)
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if a patient has pain plus loss of active and passive motion it is?
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articular joint pain
locking deformitity in articular joint pain |
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what is non-articular joint pain?
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loss of active but NOT passsive motion, tenderness outside of joint, no deformity
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what is gelling? when do you become concerned about an inflammatory process as compared to degenerative
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gellling: stiffness and limitedmotion after use
In degenerative only lasts a few minutes In inflam, >30 mins Can also occur with fibromyalgia and polymyalgia rheumatoid arthritis |
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what are the systemic factors associated with joint complains?
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weight loss, fever, chills, anorexia, weakness
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Why is maintenance of a clutter free home important as you age?
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prevents falls
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what is the male female fracture incidence with osteoporosis
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1/2 women. 1/4 men > 50
1/3 of fractures occur in younger women |
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What are the 2 comps of bone strength?
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bone density: interaction of bone mass (highest in 2nd decade of life) new bone and loss of bone
Bone quality: architecture |
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Who gets osteoporosis?
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10 million americans, 34 mil at risk
42% of at risk are male women: 15% from 50-59, 70% >80 African American women: 12% >50 Mexican Women : 15% >50 |
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Risk factors of osteoporosis?
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menopause
age >50 weight <70 (single best predictr of low bone density) alcohol smokers low vit D corticosteroids |
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What are T scoreS? osteopenia/osteoporosis?
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T scores: bone density
osteopenia: 1-2.5 standard deviations below the meanfor a young adult white women osteoporosis: >2.5 std dev |
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What are Z scores? who do you use them on? how to measure them?
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age matched controls, more useful for younger people
bone density at hip, femoral neck, greater trochanter and total hip A 10% drop in density = 1 std dev means a 20% increase for risk of fracture |
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How many people with hip fractures are deficient in vit D?
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66%
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Anti-resorptive agents for calcium?
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SERMS, bisphosphonates, calcitonin
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Anabolic agents for osteoporosis?
who gets them? |
PTH
reserved for moderate to severe cases of osteoporosis |
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how do you exam the TMJ? why does it click?
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fingertips on tragus of ear and ask patient to open mouth, fingertips drop into joint space
clicks due to occlusion, meniscus injury or synovial swelling from trauma |
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What are the dynamic and static stabilizers of the shoulder?
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Dynamic: SITS rotator cuff (supraspinatus, infraspinatus, teres minor, subscapularis)
Static: bones of clavicle labrum (cartiledge of socket) articular capsule (tendors of rotator cuffs) glenohumeral ligaments |
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Muscle attachment of rotator cuff? which tears? which is anterior?
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Supraspin: runs above glenohumeral joint, inserts in greater tubercle
MOST TORN Infraspin and Teres: joint posteriorly, inset on greater tubercle Subscap: anterior surface of scapula, crosses joint anteriorly, lesser tubercle |
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how do you examine for subacromial bursitis?
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a bursa between acromion and head of humerus overlying supraspinatus tendon
*look for tenderness below tip of acromion, pain with ABduct and rotation, loss of smooth movement |
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atrophy occurs after a rotator cuff tear, which muscles? how soon?
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Supra and infraspinatus over posterior scapula, causes increased prominence of scapular spine
2-3 wks |
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6 motions of shoulder, give degrees
Flexion Extension ABduct ADduct Int. Rotation Ext. rotation |
F: 0-180 (arms in front of u over head)
Ext: 0-80 raise arms behind you AB: 0-90: palms down, pure glenohumeral motion 90-150: scapulothoracic motion ADD: 45 Inter. Rot: toouch shouldreblade behind ur back ext. rot: |
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HOw do you predict a rotator cuff teat? what is impingement on cuff?
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weakness on ABduction (supraspin) or ext rotation (infraspinatus)
Impingement: compression of the cuff muscles and tendons between head of humerus and acromion |
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Neer;'s manuever?
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Neers: press on scapula motion with one hand, and raise patents arm with other: pain=positve
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Apley test for shoulder?
scratch test |
scratch test
touch the other shoulderblade both over and under above: tests ABduction and ext. rotation below: ADD and INT rotation |
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Hawkins test:
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flex patients shoulder and elbow to 90 with palm down, rotate internally
PAIN=Pos |
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empty can test if for which muscle?
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supraspinatus strength
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drop arm test is used for?
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rotator cuff tear, cant hold arm fully ABducteed at shoulder lever = postiive
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Tennis and Golfers elbow?
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Tennis :Lateral (repetive wrist extension or pronation/supination
golfers: medialrepetive flexion |
