Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
96 Cards in this Set
- Front
- Back
|
Where is the liver located? Where is the lower margin sometimes palpable?
|
In right upper quadrant . palpable at the right costal margin
|
|
|
Where is the spleen located?
|
left upper quadrant lateral to and behind the stomach, just above the left kidney in the left midaxillary line
|
|
|
Risk factors for Hepatitis A
|
-travel or meals in areas of poor sanitation
-ingestion of contaminated water |
|
|
Risk factors for Hepatitis B
|
-parenteral or mucous membrane exposure to infectious body fluids (blood, serum, semen,and saliva)
-sexual contact with an infected partner -sharing needles for IV drug use |
|
|
Risk factors for Hepatitis C
|
IV drug use
blood transfusion |
|
|
Where do you measure for liver dullness?
|
right midclavicular line
|
|
|
How do you determine the vertical span of liver dullness?
|
percuss up from the umbilicus to the lower border of dullness. Then percuss down from the nipple line to the upper border of liver dullness (both in the midclavicular line). Measure the distance between the two.
|
|
|
What is the normal liver span?
|
4-8 cm in the midsternal line
6-12 cm in the right midclavicular line |
|
|
Firmness or hardness of the liver, and bluntness or rounding of its edge indicates a normal liver. T/F
|
False. The normal liver edge is soft, sharp, and regular with a smooth surface. It may also be slightly tender.
|
|
|
On inspiration, where is the liver palpable?
|
3 cm below the right costal margin in the midclavicular line
|
|
|
What technique can be used to palpate the liver?
|
The hooking technique. Standing to the right of the chest with both hands, side by side, on the right abdomen below the border of liver dullness. press in with fingers and up toward the costal margin. have pt take a deep breath. should feel the liver edge on the tips of both fingers
|
|
|
When a spleen enlarges it ....
|
expands anteriorly, downward, and medially.
|
|
|
Name 2 techniques to detect splenomegaly.
|
1. percuss the left lower anterior chest wall in Traube's space (between the anterior and midaxillary line below the left costal margin)
2. Check for a splenic percussion sign. Percuss the lowest interspace in the left anterior axillary line (should be tympanic). have patient take a deep breath and percuss same place again. |
|
|
When checking for a splenic percussion sign, what does a change in percussion from tympany to dullness on inspiration suggest?
|
splenic enlargement. This is a positive splenic percussion sign.
|
|
|
Percussion of a stomach with ascites will sound...
|
dull in dependent areas of the abdomen. ascitic fluid sinks with gravity.
|
|
|
3 findings that make a diagnosis of ascites highly likely.
|
positive fluid wave, shifting dullness, and peripheral edema
|
|
|
Pain in the right lower quadrant during left sided pressure
|
Rovsing's sign (suggesting appendicitis)
|
|
|
Increased abdominal pain while either lifting right thigh while holding pressure to the right knee or flexion of the right hip while lying on the left side
|
Psoas sign (suggests irritation of the psoas muscle by an inflamed appendix)
|
|
|
right hypogastric pain with the right leg flexed at the hip, knee bent, and internally rotated
|
obturator sign (indicates irritation of the obturator muscle by an inflamed appendix)
|
|
|
right upper quadrant pain with a sharp increase in tenderness and a sudden stop in inspiratory effort
|
Murphys sign ( acute cholecystitis)
|
|
|
Bruits that have both systolic and diastolic components heard in the upper quadrants over the renal arteries suggest what?
|
renal artery stenosis (causing HTN)
|
|
|
Bruits with systolic and diastolic components heard over the aorta, the iliac arteries, and the femoral arteries suggest...
|
turbulent blood flow of partial arterial occlusion or arterial insufficiency
|
|
|
Typically _____ is heard with percussion in the abdomen because of gas in the GI tract.
|
tympany
|
|
|
When percussing the stomach you will find____ on the right, and on the left you will find _____.
|
dullness of the liver; tympany overlying the gastric bubble and splenic flexure of the colon.
|
|
|
What is the straight leg raise testing for? what is a positive finding?
|
Testing for lumbosacral radiculopathy. Pain radiating into the ipsilateral leg when the leg is straight and relaxed, and the foot is dorsiflexed.
|
|
|
Which ribs protect the spleen?
|
9th, 10th, and 11th ribs protect most of the spleen
|
|
|
Where might the tip of the spleen be palpable?
|
below the left costal margin
|
|
|
Symptoms of gnawing, burning, cramping, or aching indicate which type of pain? What is it associated with when it becomes severe?
|
Visceral pain; sweating, pallor, nausea, vomiting, and restlessness can be associated when becomes severe
|
|
|
Steady aching pain that is more precisely localized over the involved structure.
|
Parietal pain caused by inflammation in the parietal peritoneium
|
|
|
Referred pain develops as ...
|
the initial pain becomes more intense. It radiates or travels from the initial site.
|
|
|
A collateral pathway of recanalized umbilical veins radiating up the abdomen that decompresses portal vein hypertension
|
caput medusa
|
|
|
If a notch is palpated on the left medial border, the edge extends beyond the midline, percussion is dull, and your fingers can probe deep to the medial and lateral borders but not between the mass and the costal margin you should suspect what?
|
splenomegaly
|
|
|
A enlarged spleen is palpable...
|
about 2 cm below the left costal margin on deep inspiration.
|
|
|
What position should the pt be in to help palpate the spleen?
|
lying on the right side with legs somewhat flexed at hips and knees. Gravity may bring the spleen forward and to the right into a palpable location
|
|
|
Cranial Nerve I
|
Olfactory
Sense of smell |
|
|
Cranial Nerve II
|
Optic
Vision |
|
|
Cranial Nerve III
|
Oculomotor
Pupillary constriction Opening the eye (lid elevation) Most extraocular movements |
|
|
Cranial Nerve IV
|
Trochlear
Downward, internal rotation of the eye |
|
|
Cranial Nerve V
|
Trigeminal
Motor-temporal and masseter muscles (jaw clenching), lateral pteryoids (lateral jaw movements) Sensory-facial. Has 3 divisions: opthalmic, maxillary, and mandibular |
|
|
Cranial Nerve VI
|
Abducens
lateral deviation of the eye |
|
|
Cranial Nerve VII
|
Facial
Motor-facial movements, including those of facial expression, closing the eye, and closing the mouth Sensory-taste for salty, sweet, sour, and bitter substancs on the anterior two thirds of the tongue |
|
|
Cranial Nerve VIII
|
Acoustic
Hearing (cochlear division) and balance (vestibular division) |
|
|
Cranial Nerve IX
|
Glossopharyngeal
Motor-pharynx Sensory-posterior portions of the eardrum and ear canal, the pharynx, and the posterior tongue, including taste (salty, sweet, sour, bitter) |
|
|
Cranial Nerve X
|
Vagus
Motor-palate, pharynx, and larynx Sensory-pharynx and larynx |
|
|
Cranial Nerve XI
|
Spinal accessory
Motor-the sternomastoid and upper portion of the trapezius |
|
|
Cranial Nerve XII
|
Hypoglossal
Motor-tongue |
|
|
In ascites, ____ shifts to the more dependent side, whereas ____ shifts to the top.
|
dullness; tympany
Used when the patient moves on her side after mapping the area. A person without ascites will have no changes (no shifting). The borders between tympany and dullness stay relatively constant. |
|
|
A protuberant abdomen with bulging flanks suggests the possibility of ...
|
ascitic fluid.
|
|
|
How do you percuss the abdomen for ascites?
|
Percuss outward in several directions from the central area of tympany. Map the border between tympany and dullness.
|
|
|
How do you do the fluid wave test to determine ascites.?
|
Have someone place the ulnar surface of both hands on the mid portion of the abdomen. Tap one flank sharply with your fingers, and feel on the other flank for an impulse transmitted through the fluid.
|
|
|
A lesion in the sensory cortex may not impair the _____, but does impair ____.
|
perception of pain, touch, and position; finer discrimination
|
|
|
Loss of position and vibration sense with preservation of other sensations points to disease of ....
|
the posterior columns.
|
|
|
Loss of all sensations from the waist down, with paralysis and hyperactive reflexes in the legs, indicates what?
|
Transection of the spinal cord
|
|
|
The spinothalamic tract transmits sensations of ...
|
pain and temperature, and crude touch (a sensation perceived as light touch but without accurate localization)
|
|
|
The posterior columns conduct sensations of...
|
position and vibration, and fine touch (touch that is accurately localized and finely discriminating)
|
|
|
When the corticospinal tract is damaged or destroyed, what happens?
|
its motor functions are reduced or lost below the level of injury
|
|
|
When upper motor neuron systems are damaged above the crossover of its tracts in the medulla, where does motor impairment develop?
|
motor impairment develops on the opposite or contralateral side
|
|
|
When motor neurons are damaged below the crossover, where does motor impairment occur?
|
motor impairment occurs on the same or ipsilateral side of the body.
|
|
|
What do corticospinal (pyramidal) tracts do?
|
mediate voluntary movement and integrate skilled, complicated, or delicate movements by stimulating selected muscular actions and inhibiting others.
|
|
|
Where do corticospinal tracts orginate?
|
In the motor cortex of the brain.
|
|
|
the ability to identify an object by feeling it
|
Stereognosis
|
|
|
What is a normal finding when testing stereognosis?
|
Normally a patient will manipulate the familiar object skillfully and identify it correctly within 5 seconds.
|
|
|
Asking the patient to distinguish "heads" from "tails" on a coin is what typed of test?
|
a sensitive test of stereognosis
|
|
|
Stereognosis, number identification, and two-point discrimination are impaired in..
|
posterior column disease
|
|
|
ability to identify a letter or number written on the hand (with the eyes closed)
|
graphognosis
|
|
|
Inability to identify numbers or letters suggests a lesion in
|
the sensory cortex
|
|
|
test for median nerve compression by tapping lightly over the course of the median nerve in the carpal tunnel area
|
Tinel's sign
|
|
|
What is a positive Tinel's sign?
|
aching and numbness in the meidan nerve distribution
|
|
|
Test for median nerve compression by asking the patient to hold the writswt in flexion for 60 sec or ask the pt to press the bacfks of both hands together to form right angles
|
Phalen's sign
|
|
|
What is a positive Phalen's sign?
|
Numbness and tingling in the median nerve distribution within 60 sec
|
|
|
Do Tinel's and Phalen's signs reliably predict positive electrodiagnosis of carpal tunnel disease?
|
No
|
|
|
an involuntary stereotypical response that may involve as few as two neurons, one afferent (sensory) and one efferent (motor), across a single synapse
|
reflex
|
|
|
Ankle reflex
|
sacral 1 primarily
|
|
|
knee reflex
|
lumbar 2,3,4
|
|
|
bracioradialis reflex
|
Cervical 5,6
|
|
|
biceps reflex
|
cervical 5,6
|
|
|
triceps reflex
|
cervical 5,6
|
|
|
Testing CN I
|
sense of smell
|
|
|
Testing CN II
|
Test visual acuity and visual fields to confrontation
|
|
|
Testing CN III
|
Pupils, inspection and reaction to light; EOM
|
|
|
Testing CN IV, IV
|
EOM, convergence of the eyes
|
|
|
Testing CN V
|
motor-TMJ
sensory-facial sensation |
|
|
Testing CN VII
|
raise eyebrows, smile, puff out cheeks, close eyes tightly
|
|
|
Testing CN VIII
|
Weber and Rinne test
|
|
|
Testing CN IX and X
|
gag reflex, listen to voice
|
|
|
Testing CN XI
|
shrug shoulders and turn face against hand
|
|
|
Testing CN XII
|
stick out tongue
|
|
|
technique involving isometric contraction of other muscles for up to 10 sec that may increase reflex activity
|
reinforcement
|
|
|
What should you see when you test for the bicep reflex (C5,6)?
|
Observe flexion at the elbow, and watch for and feel the contraction of the biceps muscle.
|
|
|
The pointed end of the reflex hammer is useful for striking...
|
small areas, such as your finger as it overlies the biceps tendon
|
|
|
What should you see when you test the triceps reflex (C6,7)?
|
contraction of the triceps muscle and extension at the elbow
|
|
|
What should you see when you test the brachioradialis reflex (C5,6)?
|
Striking the radius with either the flat or point of the reflex hammer about 1-2 inches above the wrist should elicit flexion and supination of the forearm
|
|
|
What should you see when you test the knee reflex (L2,3,4)?
|
tapping the patellar tendon should elicit contraction of the quadriceps muscle with extension at the knee.
|
|
|
What should you see when you test for the ankle reflex (primarily S1)?
|
feel for plantar flexion at the ankle noting the speed of relaxation after muscle contraction (can indicate hypothyroidism if slow)
|
|
|
What is the mini mental exam used for?
|
screening for congnitive dysfunction or dementia and following their course over time
|
|
|
What is included in the mini mental exam?
|
Orientation to time
Registration (Repeating three words) Naming (show a pencil or pen and ask what is this?) Reading (have card that says close your eyes-tell pt to read and do what it says) |
