Mcphs Musculoskeletal, Neurological And Geriatric Exam

Front 1

Active range of motion is when?

Back 1

The patient performs the motion

Front 2

Passive range of motion is when?

Back 2

The examiner performs the motion

Front 3

Strength against resistance is measured how?

Back 3

On a numerical, zero to five, scale

Front 4

What is the Lovett's descriptive scale?

Back 4

A scale that measures muscle strength as Zero, Trace, Poor, Fair, Good, "Normal"

Front 5

What are two things to inspect the fingers for in the musculoskeletal exam?

Back 5

Haberden's Nodes

Bouchard Nodes

Front 6

Finkelstein's Test is used to diagnose what?

Back 6

DeQuervain's Syndrome - Tenosynovitis

Front 7

When this test is performed the knee is flexed at 15 degrees and externally rotated. The distal femur and proximal tibia are held, and the fingers are placed on the joint line simultaneously moving the tibia forward and the femur posteriorly.

Back 7

Lachman Test

Front 8

What in McMurray's Test is usually a sign of a torn meniscus?

Back 8

Locking of the knee

Front 9

This is when you instruct the patient to lie flat on the stomach and flex the knee to 90 degrees. Grasp the foot and apply downward pressure, internally and externally rotate foot, an audible click or pop is indicative of a loose body.

Back 9

Apley's Sign - Meniscus Problem

Front 10

This typically involves swelling and tenderness of the entire joint and limits both active and passive range of motion.

Back 10

Articular disease

Front 11

This typically involves selected regions of the joint and types of movement.

Back 11

Extra-articular disease.

Front 12

Approximately 85% of patients have _______________ without a precise underlying cause (this term is preferred to "sprain" or "strain").

Back 12

Idiopathic low back pain

Front 13

For this you need to assess for musculolgamentous injury, disc herniation, vertebral collapse, spinal cord metastases, or rarely epidural abscess.

Back 13

Midline back pain

Front 14

For pain __________, assess for sacroiliitis, trochanteric bursitis, sciatica, or hip arthritis.

Back 14

off the midline

Front 15

Radicular gluteal and posterior leg pain in the S1 distribution in ______ increases with cough or valsalva.

Back 15

Sciatica

Front 16

Leg pain that resolves with rest and/or lumbar forward flexion is seen in?

Back 16

Spinal stenosis

Front 17

Consider this from S2-4 midline disc or tumor if bowel or bladder dysfunction (usually urinary retention and overflow incontinence).

Back 17

Cauda equina syndrome

Front 18

If you see low back pain and a "red flag" - age older than 50 years, history of cancer, unexplained weight loss, pain lasting more than 1 month, or not responding to treatment, pain at night or increased by rest, history of IV drug use, or presence of infection - It could mean what?

Back 18

Serious Systemic Disease

Front 19

Radicular pain from ___________, most commonly C7 followed by C6.

Back 19

spinal nerve compression

Front 20

Usually from foraminal impingement from degenerative joint changes (70-75%) rather than disc herniation (20-25%)

Back 20

Low back pain

Front 21

Pain in _______ suggests trauma, monoarticular arthritis, possible tendinitis, or bursitis.

Back 21

Pain in one joint

Front 22

Lateral hip pain near the greater trochanter suggests?

Back 22

Trochanteric bursitis

Front 23

Extra articular pain in inflammation of the bursae.

Back 23

Bursitis

Front 24

Extra articular pain in inflammation of tendons and tendon sheaths.

Back 24

tendons - tendonitis

tendon sheaths - tenosynovitis

Front 25

Severe pain of rapid onset in a red, swollen joint is seen in?

Back 25

Acute septic arthritis or gout

Front 26

If a child has severe pain of rapid onset in a red, swollen joint, what should be considered?

Back 26

Osteomyelitis

Front 27

Pain, swelling, loss of active and passive motion, "locking", deformity can occur in?

Back 27

articular joint pain

Front 28

Loss of active but not passive motion, tenderness outside the joint, absence of deformity often in?

Back 28

Nonarticular pain

Front 29

Stiffness and limited motion after inactivity, sometimes called gelling, in degenerative joint disease but usually lasts only a few minutes; stiffness lasting 30 minutes or more in ?

Back 29

rheumatoid arthritis and other inflammatory arthrides.

Front 30

Some joint problems have systemic features such as fever, chills, rash, anorexia, weight loss and weakness. What are they?

Back 30

Rheumatoid arthritis, systemic lupus erythematosus, PMR, and other inflammatory arthritides. High fever and chills suggest an infectious cause.

Front 31

A butterfly rash on the cheeks could be a sign of what?

Back 31

SLE

Front 32

The scaly rash and pitted nails of psoriasis could be a sign of ?

Back 32

Psoriatic arthritis

Front 33

A few papules, pustules, or vesicles on reddened bases, located on the distal extremities could be a sign of what?

Back 33

Gonococcal arthritis

Front 34

An expanding erythematous patch early in an illness could be a sign of what?

Back 34

Lyme disease

Front 35

Hives associated with joint problems could be?

Back 35

Serum sickness, drug reaction

Front 36

Erosions or scale on the penis and crusted, sclaing papules on the soles and palms along with joint pain could mean?

Back 36

Reiter's syndrome, which also includes arthritis, urethritis, and uveitis

Front 37

The maculopapular rash of rubella along with joint pain could mean?

Back 37

arthritis of rubella

Front 38

What dermatologic symptom is associated with Reiter's syndrome, Behcet's syndrome?

Back 38

Red, burning and itchy eyes (conjunctivitis)

Front 39

If you have joint pain that happens before a sore throat it could mean?

Back 39

acute rheumatic fever or gonococcal arthritis

Front 40

If a patient has joint pain with diarrhea, abdominal pain and cramping it could mean?

Back 40

Arthritis with ulcerative colitis, regional enteritis, or scleroderma

Front 41

If there are symptoms of urethritis and joint pain it could be what two things?

Back 41

Reiter's Syndrome or possibly gonococcal arthritis.

Front 42

If a patient has mental status change, facial or other weakness, a stiff neck along with joint pain it could be?

Back 42

Lyme disease with central nervous system involvement.

Front 43

Acute involvement of only one joint suggests?

Back 43

Trauma, septic arthritis or gout

Front 44

This typically involves several joints, and is symmetrically distributed.

Back 44

Rheumatoid arthritis

Front 45

What are three types of joint deformity/malalignment of bones?

Back 45

Dupuytren's Contracture, bowlegs or are knock kneed.

Front 46

Subcutaneous nodules maybe seen in?

Back 46

Rheumatoid arthritis or rheumatic fever

Front 47

Effusions are seen in what?

Back 47

Trauma

Front 48

Crepitus can be observed over?

Back 48

inflamed joints, in osteoarthritis, or inflamed tendon sheaths

Front 49

Muscle atrophy or weakness can be seen in what musculoskeletal problem?

Back 49

rheumatoid arthritis

Front 50

Palpable bogginess or doughiness of the synovial membrane indicates what?

Back 50

synovitis - which is often accompanied by effusion

Front 51

Tenderness over the tendon sheaths is?

Back 51

tendonitis

Front 52

In what conditions can the joints be warm?

Back 52

Arthritis, tendinitis, bursitis, osteomyelitis

Front 53

Tenderness and warmth over a thickened synovium suggest ?

Back 53

Arthritis or infection

Front 54

Redness over a tender joint suggests?

Back 54

Septic or gouty arthritis, or possibly rheumatoid arthritis.

Front 55

Typical features of this are unilateral chronic pain with chewing, jaw clenching, or teeth grinding, often associated with stress (may also present as headache).

Back 55

TMJ syndrome

Front 56

Pain with chewing can also be seen in what disorders, other than TMJ?

Back 56

Trigeminal neuralgia, temporal arteritis

Front 57

This may cause elevation of one shoulder.

Back 57

Scoliosis

Front 58

With this the rounded lateral aspect of the shoulder appears to be flattened.

Back 58

Anterior dislocation of the shoulder

Front 59

Atrophy of supraspinatus and infraspinatus over posterior scapula with increased prominence of scapular spine within 2-3 weeks of ?

Back 59

Rotator cuff tear

Front 60

A significant amount of synovial fluid is needed before the ?

Back 60

Joint capsule appears distended

Front 61

Swelling over the shoulder suggests a ?

Back 61

Bursal tear that communicates with the articular cavity.

Front 62

Tenderness over the SITS muscle insertions and inability to lift the arm above shoulder level are seen in sprains, tears and tendon rupture of the?

Back 62

rotator cuff

Front 63

What is the most commonly injured muscle in the rotator cuff?

Back 63

supraspinatus

Front 64

Age 60 years or older and a positive dropped arm test are the individual findings most likely to identify a ?

Back 64

rotator cuff tear

Front 65

Localized tenderness or pain with adduction of the shoulder suggests ?

Back 65

Inflammation or arthritis of the acromioclavicular joint.

Front 66

With this you seen swelling over the olecranon process.

Back 66

Olecranon bursitis

Front 67

If there is inflammation or synovial fluid at the olecranon it is a sign of?

Back 67

Arthritis

Front 68

Tenderness distal to the epicondyle near the olecranon is a sign of tennis elbow, what is this called?

Back 68

Lateral epicondylitis

Front 69

Pitcher's or golfer's elbow is known as?

Back 69

medial epicondylitis

Front 70

The olecranon is displaced posteriorly in posterior dislocation of the elbow and?

Back 70

supracondylar fracture

Front 71

Guarded movement suggests injury to the hand. Poor finger alignment is seen in?

Back 71

Flexor tendon damage

Front 72

Palmar and dorsal surfaces of the wrists:

1. Diffuse swelling is seen in ?

2. Local swelling is seen with?

Back 72

1. Arthritis or infection.

2. Cystic ganglion

Front 73

Deformities of the hand, wrists or finger bones:

In osteoarthritis, what is seen at the

1. DIP joint?

2. PIP joint?

3. PIP, MCP and wrist joints with ulnar deviation?

Back 73

1. Heberden's nodes

2. Bouchard's nodes

3. Rheumatoid arthritis

Front 74

Contours of the plam, thenar and hypothenar eminences:

1. Thenar atrophy is seen in?

2. Hypothenar atrophy is seen in?

Back 74

1. Median nerve compression from carpal tunnel syndrome

2. Ulnar nerve compression

Front 75

Note any thickening of the flexor tendons or flexion contractures in fingers:

Flexion contractures in the ring, 5th, and 3rd fingers, or Dupuytren's contractures, arise from?

Back 75

Thickening of the palmar fascia

Front 76

Tenderness over the distal radius could be a sign of?

Back 76

Colles' fracture. Any tenderness or bony step-offs are suspicious for fracture.

Front 77

Swelling and or tenderness at the wrists suggests ________________ if bilateral and of several weeks' duration.

Back 77

rheumatoid arthritis

Front 78

Tenderness over the extensor and abductor tendons of the thumb at the radial styloid is seen in?

Back 78

de Quervain's tenosynovitis and gonococcal tenosynovitis.

Front 79

Tenderness over the "snuffbox" is seen in this, and it is the most common injury of the carpal bones.

Back 79

Scaphoid fracture

Front 80

What puts the scaphoid bone at high risk for avascular necrosis?

Back 80

It has a poor blood supply

Front 81

The metacarpophilangeal joints are often boggy or tendor in?

Back 81

rheumatoid arthritis

Front 82

Bouchard's nodes are usually seen in what kind of arthritis?

Back 82

osteoarthritis

Front 83

Hard dorsolateral nodules on the DIP joints that are common in osteoarthritis.

Back 83

Heberden's nodes

Front 84

This is often related to repetitive motion with wrists flexed (as in keyboard use, mail sorting), pregnancy, rheumatoid arthritis, diabetes, or hypothyroidism.

Back 84

Carpal tunnel syndrome

Front 85

Lateral deviation and rotation of the head suggest this, from contraction of the sternocleidomatoid muscle.

Back 85

Torticollis

Front 86

Tenderness in the spine suggests this, if it is preceded by trauma, underlying infection or arthritis.

Back 86

fracture or dislocation

Front 87

Tenderness in the cervical vert., especially at the facet joints between C5 and C6 suggests?

Back 87

arthritis

Front 88

tenderness over the sacroiliac joint could be from?

Back 88

Sacroiliitis or ankylosing spondylitis

Front 89

Pain on percussion of the spine may arise from what three things?

Back 89

Osteoporosis, Infection or malignancy

Front 90

Increased ________ _________ occurs with aging. In children a correctable structural deformity should be pursued.

Back 90

thoracic kyphosis

Front 91

In this, there is a lateral and rotary curvature of the spine to bring the head back to midline. This often becomes evident during adolescence, before symptoms appear.

Back 91

Scoliosis

Front 92

Unequal shoulder heights may be seen in what?

Back 92

scoliosis, Sprengel's deformity of the scapula (from the attachment of an extra bone or band between the upper scapula and C7).

Front 93

Winging of the scapula is caused by?

Back 93

Loss of innervation of the serratus anterior muscle by the long thoracic nerve and in contralateral weakness of the trapezius.

Front 94

Unequal heights of the iliac crests, or pelvic tilt, suggest?

Back 94

unequal lengths of the legs and disappear when a block is placed under the short leg and foot.

Front 95

"listing" of the trunk to one side is seen with?

Back 95

a herniated lumbar disc

Front 96

Birthmarks, port wine stains, hairy patches, and lipomas often overlie bony defects such as?

Back 96

spina bifida

Front 97

Cafe-au-lait spots (discolored patches of skin), skin tags, and fibrous tumors are seen in?

Back 97

neurofibromatosis

Front 98

This suggests a herniated disc or mass lesion impinging on the contributing nerve roots.

Back 98

Sciatic nerve tenderness

Front 99

Herniated intervertebral discs are most common at?

Back 99

L5-S1, or L4-L5

Front 100

It is important to assess any complaints or findings of neck, shoulder, or arm pain or numbness for possible ?

Back 100

cervical cord or nerve root compression

Front 101

Tenderness at C1-C2 in rheumatoid arthritis suggests possible risk for?

Back 101

subluxation and high cervical cord compression.

Front 102

Deformity of the thorax on forward bending is?

Back 102

scoliosis

Front 103

Persistence of lumbar lordosis suggests what two things?

Back 103

muscle spasm or ankylosing spondylitis

Front 104

Most problems in the gait appear at what phase?

Back 104

In the weight bearing stance phase

Front 105

A wide base in the gait suggests?

Back 105

Cerebellar disease or foot problems

Front 106

Hip dislocation, arthritis, or abductor weakness can cause the pelvis to drop on the opposite side, producing a ?

Back 106

Waddling gait

Front 107

Loss of lordosis may reflect?

Back 107

Paravertebral spasm

Front 108

Excess lordosis suggests a what of the hip?

Back 108

flexor deformity

Front 109

Changes in leg length are seen in?

Back 109

adbuction or adduction deformities and scoliosis.

Front 110

Leg shortening and external rotation suggests?

Back 110

hip fracture

Front 111

In this, as the opposite hip is flexed (with the thigh against the chest), the affected hip does not allow full leg extension and the affected thigh appears flexed.

Back 111

In flexion deformity of the hip

Front 112

Flexion deformity may be masked by an increase, rather than flattening, in ?

Back 112

lumbar lordosis and an anterior pelvic tilt.

Front 113

Restrictions of internal and external rotation are sensitive indicators of hip disease such as?

Back 113

arthritis

Front 114

Stumbling or pushing the knee into extension with the hand during heel strike suggests?

Back 114

quadriceps weakness

Front 115

Bowlegs is also known as?

Back 115

(genu varum)

Front 116

knock knees are known as?

Back 116

(genu valgum)

Front 117

Swelling over the patella suggests?

Back 117

prepatellar bursitis

Front 118

Swelling over the tibial tubercle suggests 1.? or if more medial 2.?

Back 118

1. Infrapatellar bursitis

2. Anserine bursitis

Front 119

If you have tender bony ridges along the joint margins, genu varum deformity, and stiffness 30 minutes or less, and crepitus may be present.

Back 119

Osteoarthritis of knee

Front 120

Tenderness over the tendon or inability to extend the leg suggests a partial or complete tear of the?

Back 120

patellar tendon

Front 121

Pain with compression and with patellar movement during quadriceps contraction suggests?

Back 121

Chondromalacia, or degenerative patella (the patellofemoral syndrome)

Front 122

This occurs from excessive kneeling?

Back 122

Pepattellar bursitis (housemaid's knee)

Front 123

This occurs from distention of the gastrocnemius semimembranosus bursa.

Back 123

A popliteal or "backer's cyst"

Front 124

Absence of plantar flexion is a positive test for this. Sudden severe pain "like a gunshot wound", an ecchymosis from the calf into the heel, and a flat footed gait with absence of "toe-off" may also be present with this.

Back 124

Ruptured achilles tendon

Front 125

After trauma, inability to bear weight after 4 steps and tenderness over the posterior aspects of either the malleolus, especially the medial malleolus is suspicious for?

Back 125

Ankle fracture (known as the Ottawa ankle rule)

Front 126

Pain and tenderness over the metatarsals of the foot seen in trauma, arthritis and vascular compromise is called?

Back 126

metatasrsalgia

Front 127

Tenderness over the 3rd and fourth metatarsal heads on the plantar surface is seen in?

Back 127

Morton's neuroma

Front 128

Aching pain in the lumbosacral area, may radiate into lower leg, especially along L5 (lateral leg) or S1 (positive leg) dermatomes. Refers to anatomic or functional abnormality in absence of neoplastic, infectious or inflammatory disease. Commonly work related and occurring in patients 30-50 years old, risk factors include heavy lifting, poor conditioning, obesity.

Back 128

Mechanical low back pain

Front 129

Shooting pain below the knee, commonly into the lateral leg (L5) or posterior calf (S1), typically accompanies low back pain, patients report associated parasthesias and weakness, bending, sneezing, coughing, straining during bowel movements often worsens pain.

Back 129

Sciatica (radicular low back pain)

Front 130

"Pseudoclaudication" pain in the back or legs with walking that improves with rest, lumbar flexion (which decompresses the spinal cord), or both. Pain is vague but usually bilateral with parasthesias in one or both legs.

Back 130

Lumbar spinal stenosis

Front 131

Aching pain in the cervical paraspinal muscles and ligaments with associated muscle spasm, with associated stiffness and tightness in the upper back and shoulder, lasting up to six weeks. No associated radiation, paresthesias, or weakness. Headache may be present.

Back 131

Mechanical neck pain

Front 132

Mechanical neck pain with aching paracervical pain and stiffness, often beginning the day after injury. Occipital headache, dizziness, malaise, and fatigue may be present.

Back 132

Mechanical neck pain "whiplash"

Front 133

Sharp, burning or tingling pain in the neck and one arm, with associated parathesias and weakness. Sensory symptoms often in myotomal pattern, deep in muscle, rather than dermatomal pattern.

Back 133

Cervical radiculopathy - from nerve root compression

Front 134

Neck pain with bilateral weakness and parathesias in both upper and lower extremities, often with urinary frequency. Hand clumsiness, palmar parathesias, and gait changes may be subtle. Neck flexion often exacerbates symptoms.

Back 134

Cervical myelopathy-from cervical cord compression.

Front 135

Chronic inflammation of synovial membranes with secondary erosion of adjacent cartilage and bone, and damge to ligaments and tendons.

Back 135

Rheumatoid arthritis

Front 136

Degeneration and progressive loss of cartilage within the joints, damage to underlying bone, and formation of new bone at the margins of the cartilage.

Back 136

Osteoarthritis

Front 137

An inflammatory reaction to microcrystals of sodium urate.

Back 137

Gouty arthritis

Front 138

Multiple local accumulations of sodium urate in the joints and other tissues, with or without inflammation.

Back 138

Chronic Tophaceous Gout

Front 139

A disease of unclear etiology in people over age 509, especially women, may be associated with giant cell arteritis.

Back 139

Polymalgia rheumatica

Front 140

Widespread musculoskeletal pain and tender points. May accompany other diseases. Mechanisms unclear.

Back 140

Fibromyalgia syndrome

Front 141

Repeated shoulder motion as in throwing or swimming can cause edema and hemorrhage followed by inflammation, most commonly involving the supraspinatus tendon. Acute, recurrent or chronic pain may result, often aggrevated by activity.

Back 141

Rotator cuff tendonitis

Front 142

When the arm is raised in forward flexion, the rotator cuff may impinge against the undersurface of the acromion and the coracoacromial ligament. Injury from a fall or repeated impingement may weaken the rotator cuff, causing a partial or complete tear usually after age 40.

Back 142

Rotator cuff tears

Front 143

This is a degenerative process in the tendon associated with the deposition of calcium salts. Usually involves the supraspinatus tendon.

Back 143

Calcific tendinitis

Front 144

Inflammation of the long head of the biceps tendon and tendon sheath causes anterior shoulder pain resembling and often coexisting with rotator cuff tendinitis.

Back 144

Bicipital tendinitis

Front 145

This refers to fibrosis of the glenohumeral joint capsule, manifested by diffuse, dull, aching pain in the shoulder and progressive restriction of active and passive range of motion, but usually no localized tenderness. The condition is usually unilateral and occurs in people aged 50-70.

Back 145

Adhesive capsulitis (frozen shoulder)

Front 146

This is uncommon, usually arising from direct injury to the shoulder girdle with resulting degenerative changes. Tenderness is localized over the acromioclavicular joint.

Back 146

Acromioclavicular arthritis

Front 147

Shoulder instability from this usually results from a fall or forceful throwing motion, then becomes recurrent. The shoulder seems to "slip out of joint" when the arm is abducted and externally rotated, causing a positive apprehension sign.

Back 147

Anterior dislocation of the humerus

Front 148

Swelling and inflammation of the olecranon bursa.

Back 148

Olecranon bursitis

Front 149

Synovial inflammation or fluid is felt best in the grooves between the olecranon process and the epicondyles on either side.

Back 149

Arthritis of the elbow

Front 150

Subcutaneous nodules may develop at pressure points along the extensor surface of the ulna in patients with rheumatoid arthritis or acute rheumatic fever.

Back 150

Rheumatoid nodules

Front 151

This follows repetitive extension of the wrist of pronation-supination of the forearm. Pain and tenderness develop 1cm distal to the lateral epicondyle and possibly in the extensor muscle close to it.

Back 151

Epicondylitis - Lateral Epicondylitis

Front 152

The first sign of this is a thickened plaque overlying the flexor tendon of the ring finger and possibly the little finger at the level of the distal palmar crease. Subsequently the skin in this area puckers and a thickened fibrotic cord develops between the palm and finger.

Back 152

Dupuytren's Contracture

Front 153

Caused by a painless nodule in a flexor tendon in the palm, near the metacarpal head. The nodule is too big to enter easily into the tendon sheath during extension of the fingers from a flexed position.

Back 153

Trigger finger

Front 154

This suggests a median never disorder such as carpal tunnel syndrome.

Back 154

Thenar Atrophy

Front 155

Cystic, round usually nontender swellings along tendon sheaths or joint capsules, frequently at the dorsum of the wrist.

Back 155

Ganglion

Front 156

Infection of the flexor tendon sheaths, may follow local injyry, even when trivial in nature. Unlike arthritis, tenderness and swelling develop not in the joint but along the course of the tendon sheath, from the distal phalanx to the level of the MCP joint.

Back 156

Acute tenosynovitis

Front 157

If the infection progresses it may extend from the tendon sheath into the adjacent fascial spaces within the palm. Early diagnosis and TX are important.

Back 157

Acute tenosynovitis and Thenar space involvement.

Front 158

Injury to the fingertip may result in infection in the enclosed fascial spaces of the finger pad.

Back 158

Felon

Front 159

The great toe is abnormally abducted in relationship to the first metatarsal.

Back 159

Hallux Valgus

Front 160

Tenderness over the plantar surface, third and fourth metatarsal heads, from probable entrapment of the medial and lateral plantar nerves.

Back 160

Morton's neuroma

Front 161

Most commonly involving the second toe, this is characterized by a hyperextension at the MCP joint with flexion at the proximal interphalangeal joint. A corn frequently develops at the pressure point over the proximal interphalangeal joint.

Back 161

Hammer Toe

Front 162

This is a painful conical thickening of skin that results from recurrent pressure on normally thin skin. The apex of the cone points inward and causes pain.

Back 162

Corn

Front 163

Like a corn, this is an area of greatly thickened skin that develops in a region of recurrent pressure. Unlike a corn, this involves skin that is normally thick.

Back 163

Callus

Front 164

This is a common wart, verruca vulgaris, located in the thickened skin of the sole It may look like a callus or even be covered by one.

Back 164

Plantar Wart

Front 165

When pain sensation is diminished or absent, as in diabetic neuropathy, these may develop at pressure points on the feet.

Back 165

Neuropathic ulcer

Front 166

This may present as "the worst headache of my life".

Back 166

Subarachnoid hemorrhage

Front 167

If there is a dull headache, and it is affected by coughing, sneezing or sudden movement of the head, especially in the same location it could be what?

Back 167

A mass lesion or an abscess

Front 168

Light headedness can be experienced with?

Back 168

Palpitations

Front 169

Vasovagal stimulation, low blood pressure, febrile illness etc. can cause?

Back 169

Near Syncope

Front 170

What symptom can inner ear conditions and brainstem tumors cause?

Back 170

vertigo

Front 171

Diplopia, dysarthria, ataxia can be seen in?

Back 171

in vertebrobasilar transient ischemic attack (TIA) or stroke

Front 172

Transient ischemic attack can result in ?

Back 172

weakness or paralysis

Front 173

This may arise from ischemic, vascular, or mass lesions in the central nervous system; also from peripheral nervous system disorders, neuromuscular disorders, or disease in the muscles themselves.

Back 173

Focal weakness

Front 174

This may happen in myopathy.

Back 174

Bilateral proximal weakness

Front 175

This may happen in polyneuropathy?

Back 175

Bilateral, predominately distal weakness

Front 176

Weakness made worse with repeated effort and improved with rest suggests?

Back 176

Myasthenia gravis

Front 177

These are a loss of sensation in central lesions in the brain and spinal cord, as well as disorders of peripheral sensory roots and nerves.

Back 177

parasthesias and dysthesias

Front 178

These occur in the hands and round the mouth in hyperventilation.

Back 178

parasthesias

Front 179

Burning pain occurs with?

Back 179

painful sensory neuropathy

Front 180

Young people with emotional stress and warning symptoms of flushing, warmth, or nausea may have?

Back 180

Vasodepressor (or vasovagal) syncope of slow onset, slow offset.

Front 181

This occurs from arrhythmias, more common in older patients, often with sudden onset, sudden offset.

Back 181

Cardiac syncope

Front 182

Tonic-clonic motor activity, bladder or bowel incontinence, and postictal state suggest a ?

Back 182

generalized seizure - Unlike syncope, injury such as tongue biting or bruising of the limbs may occur.

Front 183

Parkinson's disease presents with?

Back 183

Tremor, rigidity and bradykinesia

Front 184

True or False, Restless leg syndrome is a common but overlooked benign syndrome.

Back 184

True

Front 185

This can occur when there is a loss of smell, head trauma, smoking, aging, and the use of cocaine, as well as Parkinson disease.

Back 185

Loss of smell

Front 186

1. Disc pallor occurs in?

2. Disc bulging occurs in?

Back 186

1. Optic atrophy

2. Papilledema

Front 187

These visual field defects are seen in glaucoma, retinal emboli, optic neuritis.

Back 187

Prechiasmal or anterior defects

Front 188

This occurs with defects at the optic chiasm, usually from pituitary tumor.

Back 188

Bitemporal hemianopsias

Front 189

These defects may occur in postchiasmal lesions, usually in the parietal lobe, with associated findings of stroke.

Back 189

Homonymous hemianopsias or quadrantanopsia

Front 190

Minimal constriction in the larger pupil if abnormality of the pupillary constrictor muscle from what two things?

Back 190

Iris disorder

Front 191

With this you can see parasympathetic denervation, ptosis, and ophthalmoplegia (eyes not aligned).

Back 191

CN III palsy

Front 192

Pupils constrict to light, but due to sympathetic degeneration the affected pupil remains (miosis) due to abnormal pupillary dilator muscle. What causes this?

Back 192

Horner's Syndrome

Front 193

This can occur when there are problems with glasses or contact lenses, cataracts; astigmatism, ptosis.

Back 193

Disconjugate gaze, momocular diplopia

Front 194

This can occur when there is CN III, IV, VI neuropathy, eye muscled disease from myasthenia gravis, trauma, thyroid ophthalmopathy, internuclear ophthalmoplegia.

Back 194

Binocular diplopia

Front 195

This is seen in cerebellar disease, especially with gait ataxia and dysarthria (increases with retinal fixation) and vstibular disorders (decreases with retinal fixation. This is also seen in internuclear ophthalmoplegia.

Back 195

Nystagmus

Front 196

Ptosis (drooping of the upper eyelid) can be seen in?

Back 196

3rd nerve palsy (CN III)

Front 197

Ptosis, meiosis, anhidrosis, and myathenia gravis can be seen with?

Back 197

Horner's Syndrome

Front 198

Difficulty in clenching the jaw or moving it to the opposite side in?

Back 198

Masseter and lateral pterygoid weakness, respectively

Front 199

Isolated facial sensory loss in peripheral nerve disorders like?

Back 199

trigeminal neuralgia

Front 200

Absent blinking occurs when?

Back 200

There is a lesion in CN V or VII

Front 201

Absent blinking and sensorineural hearing loss occurs in?

Back 201

acoustic neuroma

Front 202

Flattening of the nasolabial fold and drooping of the lower eyelid suggest?

Back 202

facial weakness.

Front 203

A peripheral injury to this, as in Bell's palsy, affects both the upper and lower face, a central lesion affects mainly the lower face. Loss of taste, hypercusis, increased or decreased tearing also in bell's palsy.

Back 203

Injury to CN VII

Front 204

The mouth droops on the paralyzed side when the patient smiles or grimaces.

Back 204

In unilateral facial paralysis

Front 205

This is a loss of muscle bulk, or wasting. It results from diseases of the peripheral nervous system such as diabetic neuropathy, as well as diseases of the muscles themselves.

Back 205

Muscular atrophy

Front 206

Fasciculations with atrophy and muscle weakness suggest disease of the?

Back 206

peripheral motor unit

Front 207

This is increased resistance that worsens at the extremes of range.

Back 207

Spasticity

Front 208

This is increased resistance throughout the range of movement and in both directions.

Back 208

Rigidity

Front 209

Weakness of extension in the arm is seen in peripheral nerve disease such as?

Back 209

radial nerve damage and in central nervous system disease producing hemiplegia, as in stroke or multiple sclerosis

Front 210

This symptom can be seen with cervical radiculopathy, de Quervain's tenosynovitis, carpal tunnel syndrome, arthritis, epicondylitis.

Back 210

A weak grip

Front 211

Weak finger abduction occurs in?

Back 211

ulnar nerve disorders

Front 212

Weak opposition of the thumb occurs in?

Back 212

Median nerve disorders such as carpal tunnel syndrome

Front 213

This should be suspected if nystagmus, dysarthria, hypotonia, and ataxia are seen.

Back 213

Cerebellar disease

Front 214

With this, one movement cannot be followed quickly by its opposit and movements are slow, irregular, and clumsy. This abnormality is called dysdiadochokinesis. Upper motor neuron weakness and basal ganglia disease may also impair rapid alternating movements, but not in the same manner.

Back 214

Cerebellar disease

Front 215

Abnormalities of gait increase?

Back 215

The risk of falls

Front 216

A gait that lacks coordination, with reeling and instability is called?

Back 216

Ataxic

Front 217

Ataxia may be due to?

Back 217

cerebellar disease, loss of position sense, or intoxication

Front 218

Inability to heel walk is a sensitive test for?

Back 218

corticospinal tract damage

Front 219

Walking on toes and heels may reveal?

Back 219

distal muscular weakness in the legs

Front 220

This is a test that is sensitive and specific for a corticospinal tract lesion originating in the contralateral hemisphere.

Back 220

Pronator drift

Front 221

if you have a glove and stocking sensory loss of a polyneuropathy this is seen in what two things?

Back 221

Alcoholism and Diabetes

Front 222

This refers to the inability to recognize objects placed in the hand.

Back 222

Astereognosis

Front 223

The inability to recognize numbers, like astereognosis, suggests?

Back 223

A lesion in the sensory cortex

Front 224

There is an increase in the distance between two recognizable points with?

Back 224

A lesion in the sensory cortex

Front 225

This can be seen in CNS lesions along the descending corticospinal tract. Look for associated upper motor neuron findings of weakness, spasticity, or a positive babinski sign.

Back 225

Hyperactive reflexes

Front 226

This is seen in diseases of the spinal nerve roots, spinal nerves, plexuses, or peripheral nerves. Look for associated findings of lower motor unit disease, namely weakness, atrophy and fasciculations.

Back 226

Hypoactive or absent reflexes.

Front 227

The slowed relaxation phase of reflexes in this is often easily seen and felt in the ankle reflexes.

Back 227

Hypothyroidism

Front 228

This indicates central nervous system disease. The ankle plantar flexes and dorsiflexes repetitively and rhythmically.

Back 228

Sustained clonus

Front 229

Abdominal reflexes may be absent in both?

Back 229

central and peripheral nerve disorders.

Front 230

This can occur from a central nervous system lesion in the corticospinal tract; also seen in unconscious states from drug or alcohol intoxication or the postictal period following a seizure.

Back 230

Babinski response/reflex

Front 231

A marked babinski response is occasionally accompanied by ?

Back 231

reflex flexion at hip and knee

Front 232

Loss of this suggests a lesion in the S2, 3, 4 reflex arc, as in cauda equina lesion.

Back 232

Loss of the anal reflex

Front 233

Neck stiffness and resistance to flexion in 90% of patients occurs with?

Back 233

bacterial meningitis, and in 20%-85% of patients with subarachnoid hemorrhage.

Front 234

What do you never do when assessing a comatose patient?

Back 234

Don't dilate the pupils

Don't flex the neck if there is any chance of trauma there.

Front 235

Five clinical signs strongly predicting death or poor outcome with comatose patient.

Back 235

At 24 hours - absent corneal response, absent pupillary response, absent withdrawal response to pain, no motor response

At 72 hours - no motor response

Front 236

This patient appears drowsy but opens the eyes and looks at you, responds to questions and then falls asleep.

Back 236

Lethargic patient

Front 237

This patient opens the eyes and looks at you, but responds slowly and is somewhat confused. Alertness and interest in the environment are decreased.

Back 237

Obtunded patient

Front 238

This patient arouses from sleep only after painful stimuli, verbal responses are slow or even absent. The patient lapses into an unresponsive state when the stimulus ceases. There is minimal awareness of self or the environment.

Back 238

Stuporous patient

Front 239

This patient remains unarousable with eyes closed. There is no evident response to inner need or external stimuli.

Back 239

Comatose patient

Front 240

No response to stimulus suggests?

Back 240

Brainstem injury

Front 241

Two sterotypic responses predominate with comatose patients what are they?

Back 241

decorticate and decerebrate rigidity

Front 242

If there is no response on side of a comatose patient that suggests a?

Back 242

corticospinal tract lesion

Front 243

These are tremors most prominent at rest, and may decrease or disappear with voluntary movement.

Back 243

resting static tremors

Front 244

These tremors appear when the affected part is actively maintaining a posture. Examples include the fine rapid tremor of hypterthyroidism, the tremors of anxiety or fatigue, and benign essential tremor. Tremor may worsen somewhat with intention.

Back 244

Postural action tremors

Front 245

These are absent at rest, appear with activity and often get worse as the target is nered. Causes include disorders of cerebellar pathways, as in MS.

Back 245

Intention tremors

Front 246

These affect the face, and are rhythmic, repetitive, bizarre movements that chiefly involve the face, mouth, jaw, and tongue, grimacing pursing of the lips, protrusion of the tongue, opening and closing of the mouth, and deviations of the jaw.

Back 246

Oral-facial dyskinesias

Front 247

Brief, repetitive stereotyped coordinated movements occuring at irregular intervals.

Back 247

Tics

Front 248

Movements are similar to athetoid movements, but often involve larger portions of the body, including the trunk. Grotesque, twisted postures may result.

Back 248

Dystonia

Front 249

These movements are slower and more twisting and writhing that choreiform movements, and have a larger amplitude, they are seen most commonly in the face and distal extremities.

Back 249

Athetosis

Front 250

These movements are brief, rapid, jerky, irregular, and unpredictable. They occur at rest or interrupt normal coordinated movements.

Back 250

Chorea

Front 251

This is a speech disorder that results in speech that is fluent, often rapid, voluble, and effortless. Inflection and articulation are good, but sentences lack meaning and words are malformed (paraphasias) or invented (neologisms). Speech may be totally incomprehensible.

Back 251

Wernicke's Aphasia

Front 252

This speech disorder is nonfluent, slow, with few words and laborious effort, inflection and articulation are impaired but words are meaningful, with nouns transitive verbs and important adjectives, small grammatical words are often dropped.

Back 252

Broca's Aphasia

Front 253

Eyes do not close, but eyeballs roll up, flat nasolabial fold, forehead is not wrinkled, eyebrows are not raised, paralysis of lower face is witnessed.

Back 253

CN VII peripheral lesion

Front 254

Eye closes, perhaps with slight weakness, flat nasolabial fold, Forehead wrinkled, eyebrow raising, paralysis of lower face is witnessed.

Back 254

CN VII central lesion

Front 255

This can be seen in the elderly with depression, Parkinsons disease, or Alzheimers.

Back 255

Flag or impoverished affect

Front 256

Undernutrition, slowed motor performance, loss of muscle mass, or weakness suggests?

Back 256

Frailty

Front 257

Kyphosis or abnormal gait can impair balance and increase?

Back 257

The risk of falls

Front 258

This is SBP >140 occuring after age 50 which triples the risk for coronary heart disease in men and increases the risk of stroke.

Back 258

Isolated systolic hypertension

Front 259

Caution is advised when doing this in the oldest old - people over 80 years old because it can be a risk factor for cardiovascular, renal disease and stroke.

Back 259

Lowering blood pressure

Front 260

This occurs in 10%-20% of older adults and in up to 30% of frail nursing home residents, especially when they first arise in the morning.

Back 260

Orthostatic hypotension

Front 261

A respiratory rate in the elderly over 25 breaths per minute indicate?

Back 261

Lower respiratory infection, also CHF and COPD exacerbation

Front 262

This is more common in elderly patients in regards to temperature.

Back 262

Hypothermia

Front 263

This is a key indicator of poor nutrition.

Back 263

Low weight

Front 264

This is seen with depression, alcoholism, cognitive impairment, malignancy, chronic organ failure, medication use, social isolation, and poverty.

Back 264

Undernutrition

Front 265

These may develop from obliteration of arteriolar and capillary blood flow to the skin or from shear forces during movement across sheets or when lifted upright incorrectly.

Back 265

Pressure sores

Front 266

This is the world's leading cause of blindness. Risk factors include cigarette smoking, exposure to UV-B light, high alcohol intake, diabetes, medications (including steroids), and trauma.

Back 266

Cataracts

Front 267

This suggests open angle glaucoma, caused by irreversible optic neuropathy and leading to loss of peripheral and central vision and blindness.

Back 267

An increased cup to disc ratio

Front 268

This causes poor central vision and blindness. Types include dry atrophic (more common but less severe) and wet exudative, or neovascular.

Back 268

Macular degeneration

Front 269

This may occur with poor oral hygiene or periodontitis, caries.

Back 269

Malodor

Front 270

Increased anteroposterior diameter, purse-lipped breathing, and dyspnea with talking or minimal exertion suggest?

Back 270

Chronic obstructive pulmonary disease

Front 271

Isolated systolic hyptertension and a widened pulse pressure are cardiac risk factors, prompting a search for ?

Back 271

Left ventricular hypertrophy

Front 272

This can raise pressure in the left jugular veins by impairing drainage into the right atrium. It may also cause kinking of the carotid artery low in the neck on the right, chiefly in women with hypertension, which can be mistaken for a carotid aneurysm.

Back 272

A tortuous atherosclerotic aorta

Front 273

These in the elderly warrent further investigation for possible carotid stenosis due to risk for ipsilateral stroke.

Back 273

Carotid Bruit

Front 274

When do you see sustained PMI?

Back 274

Left ventricular hypertrophy

Front 275

Diffuse PMI occurs in?

Back 275

congestive heart failure

Front 276

In older adults an S3 suggests?

Back 276

Dilation of the left ventricle from congestive heart failure or cardiomyopathy.

Front 277

An S4 in the elderly usually accompanies?

Back 277

Hypertension

Front 278

A systolic crescendo decrescendo murmur in the second right intercostal space suggests ?

Back 278

Aortic sclerosis or aortic stenosis

Front 279

Delay during simultaneous palpation but not compression of the brachial and radial pulses denotes ?

Back 279

Aortic stenosis

Front 280

A harsh holosystolic murmur at the apex suggests?

Back 280

Mitral regurgitation

Front 281

Lumps or masses in older women, and rarely in older men, mandate?

Back 281

further investigation for possible malignancy

Front 282

Widened aorta and pulsatile mass are seen in?

Back 282

Abdominal aortic aneurysm

Front 283

Erythema with satellite lesions results from infection with?

Back 283

Candida

Front 284

Erythema with ulceration or necrotic center is associated with?

Back 284

Carcinoma

Front 285

Multifocal reddened lesions with white scaling plaques are consistent with?

Back 285

Paget's disease

Front 286

Clitoral enlargement may accompany?

Back 286

Androgen producing tumors or use of androgen creams.

Front 287

Estrogen stimulated cervical mucus with ferning is seen with use of?

Back 287

Hormone replacement therapy, endometrial hyperplasia and estrogen producing tumors.

Front 288

A uterus that is enlarged, fixed, or irregular may indicate?

Back 288

Adhesions, or possible malignancy

Front 289

Rectal masses are found in?

Back 289

Colon cancer

Front 290

What are three things that can be seen with the geriatric male genitalia?

Back 290

Smegma, penile cancer, scrotal hydroceles

Front 291

These symptoms are seen with?

Tremor, rigidity, bradykinesia, micrographia, shuffling gait, and difficulty turning in bed, opening jars, and rising from chair.

Back 291

Parkinson's Disease

Front 292

What are five things noticed in the skin with aging?

Back 292

–Wrinkles and becomes lax and loses turgor*
•
Decreased Vascularity of the dermis
–
Actinic Purpura*
–
Effects of Sun Exposure become evident*
–
Dryness (asteatosis) - Atrophy of sweat glands

Front 293

What are three benign lesions associated with aging skin?

Back 293

• actinic keratoses
• actinic lentigines - liver spots
• seborrheic keratosis

Front 294

What are five things associated with the aging eye?

Back 294

– Periorbital fat atrophies - Wrinkles around the eyes
•
Eyeball recedes into the orbit
–
Fewer lacrimal secretions - Dry Eyes
–
Senile ptosis
–
Entropium/ectropium

Front 295

What are four changes in the ear with aging?

Back 295

–1. Degenerative changes of ossicles
–2. Increased obstruction of the eustachian tubes
–3. Atrophy of cochlear hair cells
–4. Loss of auditory neurons

Front 296

What are six endocrine changes seen in the elderly?

Back 296

– Decreased triiodothyronine (T3)
– Decreased free (unbound) testosterone
– Increased insulin
– Increased norepinephrine
– Increased parathormone
– Increased vasopressin

Front 297

Your role as a Clinician with the elderly is to?

Back 297

enhance your patient’s coping mechanisms by identifying and treating their
remediable problems properly,
facilitating their environment and
obtaining needed services to
maximize their function and quality
of life.

Front 298

What are three important immunizations for the elderly patient?

Back 298

– Influenza
– Pneumococcal
– Tetanus