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;
276 Cards in this Set
- Front
- Back
|
What are the following landmarks used for?
2nd ICS 4th ICS T4 T7-8 |
Needle insertion for tension pneumothorax
Chest tube Insertion Lower margin of endotracheal tube on chest xray Thoracocentesis |
|
|
Pain/ Discomfort in the myocardium is caused by
|
Angina pectoris, MI
|
|
|
Pain/ Discomfort in the pericardium is caused by
|
Pericarditis
|
|
|
Pain/ Discomfort in the aorta is caused by
|
Dissecting aortic aneurysm
|
|
|
Pain/ Discomfort in the trachea and large bronchi is caused by
|
Bronchitis
|
|
|
Pain/ Discomfort in the parietal pleura is caused by
|
Pericarditis, pneumonia
|
|
|
Pain/ Discomfort in the chest wall: musculoskeletal system & skin is caused by
|
Costochondritis, herpes zoster
|
|
|
Pain/ Discomfort in the esophagus is caused by
|
Reflux esophagitis, esophageal spasm
|
|
|
Pain/ Discomfort in the extrathoracic structures such as the neck, gall bladder, and stomach is caused by
|
Cervical arthritis, biliary colic gastritis
|
|
|
A clenched fist over the sternum suggests
|
angina pectoris
|
|
|
A finger pointing to a tender area on the chest wall suggests
|
musculoskeletal pain
|
|
|
A hand moving from the neck to epigastrum suggests
|
heartburn
|
|
|
What is the most frequent cause of chest pain in children? Second most?
|
Anxiety, costochondritis
|
|
|
Anxious patients may have these symptoms
|
Episodic dyspnea during both rest and exercise, hyperventilation, and they may sigh frequently
|
|
|
Wheezing suggests...
|
partial airway obstruction from secretions, tissue inflammation, or a foreign body
|
|
|
A cough can be a symptom of what type of heart failure?
|
Left sided heart failure
|
|
|
Acute cough is most commonly caused by?
|
Viral upper respiratory infections
|
|
|
What are other causes of an acute cough?
|
acute bronchitis, pneumonia, L ventricular heart failure, asthma, and foreign bodies.
|
|
|
What are common causes of subacute coughs?
|
Postinfectious cough, bacterial sinusitis, and asthma
|
|
|
What are the causes of a chronic cough?
|
postnasal drip, asthma, GERD, chronic bronchitis, and bronchiectasis
|
|
|
What are the characteristics of mucoid sputum?
|
Translucent, white, or gray
|
|
|
What are the characteristics of purulent sputum?
|
Yellowish or greenish
|
|
|
Anaerobic lung abscesses produce what kind of sputum?
|
Foul smelling sputum
|
|
|
Cystic Fibrosis produces what kind of sputum?
|
Tenacious sputum
|
|
|
What are some diagnostically helpful symptoms when diagnosing the cause of a cough?
|
Fever, chest pain, dyspnea, orthopnea, and wheezing
|
|
|
Blood originating in the stomach is usually _____ than blood from the tract and may be mixed with ____
|
Darker, food particles
|
|
|
Cyanosis signals what?
|
Hypoxia
|
|
|
Clubbing of the nails is seen in...
|
lung abscesses, malignancy, and congenital heart failure
|
|
|
Audible stridor, a high-pitched wheeze, is an ominous sign of what?
|
An airway obstruction in the larynx or trachea
|
|
|
Inspiratory contraction of the sternomastoids and scalenes at rest signal what?
|
Difficulty breathing
|
|
|
Lateral displacement of the trachea is found in what?
|
Pneumothorax, pleural effusion, and atelectasis
|
|
|
The anteriorposterior diameter may increase with what disease?
|
COPD
|
|
|
Retraction of the interspaces during inspiration is seen in?
|
Severe asthma, COPD, or upper airway obstruction
|
|
|
Unilateral impairment or lagging of respiratory movement suggests?
|
Disease of the underlying lung or pleura
|
|
|
Although rare, sinus tracts usually indicate what?
|
Infection of the underlying pleura and lung (as in TB and actinomycosis)
|
|
|
Causes of unilateral decrease or delay in chest expansion include...
|
Cystic Fibrosis of the underlying lung or pleura, pleural effusion, lobar pneumonia, pleural pain with associated splinting, and unilateral bronchial obstruction
|
|
|
What are some causes of decreased fremitus?
|
Very thick chest wall, obstructed bronchus, COPD, pleural effusion, pleural thickening (fibrosis), pneumothorax, or an infiltrating tumor
|
|
|
Look for asymmetric decreased fremitus in what?
|
Unilateral pleural effusion, pneumothorax, and neoplasm from decreased transmission of low frequency sounds
|
|
|
Look for asymmetric infreased fremitus in what?
|
unilateral pneumonia from increased transmission
|
|
|
Dullness replaces resonance when...
|
fluid or solid tissue replaces air-containing lung or occupies the pleural space beneath your percussing fingers
|
|
|
Causes of dullness on percussion are
|
lobar pneumonia, pleural effusion, hemothorax, empyema, fibrous tissue, or tumors
|
|
|
Generalized hyperresonance may be heard over the hyperinflated lungs of what diseases?
|
COPD or asthma, but it isn't a reliable sign
|
|
|
Unilateral hyperresonance suggests
|
A large pneumothorax or possibly a large air-filled bulla in the lung
|
|
|
What sounds may cause confusion when auscultating?
|
Bedclothes, paper gowns, the chest itself, hair on chest, muscle contraction when the patient is tense. You may eliminate these by changing a patient's position or pressing down harder
|
|
|
Breath sounds may be decreased when...
|
Air flow is decreased or when transmission of sound is poor
|
|
|
If bronchovesicular or bronchial breath sounds are heard in locations distant from normal then suspect...
|
That air filled lung has been replaced by fluid filled or solid lung tissue
|
|
|
A silent gap between inspiratory and expiratory breath sounds suggests
|
Bronchial breath sounds
|
|
|
Crackles may be from abnormalities of the lungs/ airways such as
|
pneumonia, fibrosis, early CHF, bronchitis, and bronchiectasis
|
|
|
Wheezes suggest narrowed airways as in
|
asthma, COPD, or bronchitis
|
|
|
Rhonchi suggest what?
|
Secretions in large airways
|
|
|
Clearing of crackles, wheezes, or rhonchi after coughing or position change suggest...
|
inspissated secretions as in bronchitis or atelectasis
|
|
|
Findings predictive of COPD are:
|
wheezing, history of smoking, age, and decreased breath sounds. Dx on spirometry
|
|
|
Increased transmission of voice sounds suggests...
|
air filled lung has become airless
|
|
|
Louder clearer voice sounds are called...
|
bronchophony
|
|
|
An E to A change (egophony) is found in
|
Lobar consolidation from pneumonia, the quality sounds nasal
|
|
|
Louder, clearer whispered sounds are called...
|
whispered pectoriloquy
|
|
|
Persons with ____ prefer to sit leaning forward, with lips pursed during exhalation and arms supported on their knees or a table
|
COPD
|
|
|
Tender pectoral muscles or costal cartilages corroborate but do not prove that chest pain has a _____ origin
|
Musculoskeletal
|
|
|
Why can only a very large effusion be detected anteriorly on a person's chest?
|
Because pleural fluid usually sinks to the lowest part of a pleural space
|
|
|
The hyperresonance of COPD may totally replace ____ dullness
|
cardiac
|
|
|
Where does the dullness of right middle lobe pneumonia usually occur?
|
Behind the right breast, unless you displace the breast you may miss the abnormal percussion note.
|
|
|
A lung affected by COPD often displaces what organs?
|
displaces the upper border of the liver downward and lowers the level of the diaphragmatic dullness posteriorly
|
|
|
Non-disabled older adults taking 5.6 seconds or longer to walk 8ft are______ than those taking 3.1sec or fewer
|
More likely to be disabled.
(Early intervention may prevent onset of subsequent disability) |
|
|
Patients older than 60yrs with a forced expiratory time of 6-8sec are ____ as likely to have_____
|
Twice
COPD |
|
|
An increase in the local pain distant from your hands suggests ____ rather than just_____
|
rib fracture, soft tissue injury
|
|
|
Articular disease typically involves...
|
swelling and tenderness of the entire jt and limits both active and passive range of motion
|
|
|
Extra-articular disease typically involves
|
Selected regions of the jt and types of movements
|
|
|
Approximately___% of patients have idiopathic lower back pain
|
85
|
|
|
For midline pain you should asses this potential causes
|
musculoligamentous injury, disc herniation, vertebral collapse, spinal cord metastases, or rarely epidural abscess
|
|
|
For pain off of the midline assess for these potential causes
|
sacroiliitis, trochanteric bursitis, sciatica, or hip arthritis
|
|
|
Symptoms of sciatica include
|
Radicular gluteal and posterior leg pain in the S1 distribution that increases with cough or valsalva
|
|
|
Symptoms of spinal stenosis include
|
Leg pain that resolves with rest and or lumbar forward flexion
|
|
|
Consider cauda equina syndrome from S2-4 midline disc or tumor if...
|
bowel or bladder dysfunction is present
|
|
|
In cases of low back pain plus a red flag, there is a ___% probability of serious _____ disease
|
10, systemic
|
|
|
Radicular pain from spinal nerve compression is commonly....
|
C7 followed by C6, usually it is from foraminal impingement from degenerative jt changes rather than disc herniation
|
|
|
Pain in one jt suggests....
|
trauma, monoarticular arthritis, possible tendinitis or bursitis
|
|
|
Lateral hip pain near the greater trochanter suggests
|
Trochanteric bursitis
|
|
|
Migratory pattern of spread is seen in what diseases?
|
Rheumatic fever or gonococcal arthritis
|
|
|
Progressive additive pattern with symmetric involvement is seen in?
|
Rheumatoid arthritis
|
|
|
Extra-articular pain is seen in...
|
bursitis, tendinitis, tenosynovitis, and sprains from stretching or tearing of ligs
|
|
|
Severe pain of rapid onset in a red swollen joint is seen in what?
|
Acute septic arthritis or gout, in children consider osteomyelitis in a bone contiguous to a jt
|
|
|
Fever, chills, warmth, and redness are symptoms of...
|
septic arthritis, also consider gout or rheumatic fever
|
|
|
Pain, swelling, loss of active and passive motion, locking, and deformity are seen in what?
|
articular jt pain
|
|
|
Loss of active but not passive motion, tenderness outside the jt, absence of deformity are all seen in?
|
nonarticular pain
|
|
|
Stiffness and limited motion after inacivity (gelling) lasting only a few minutes is seen in?
|
degenerative jt disease
|
|
|
Stiffness lasting 30 min or more is indicative of...
|
Rheumatoid arthritis and other inflammatory arthritides. Stiffness is also seen in fibromyalgia and PMR
|
|
|
Generalized symptoms are common in...
|
Rheumatoid arthritis, SLE, PMR, and other inflammatory arthritides
|
|
|
Butterfly rash seen in
|
SLE
|
|
|
A scaly rash and pitted nails are seen in
|
psoriatic arthritis
|
|
|
A few papules, pustules, or vesicles on reddened bases, located on the distal extremities are seen in
|
Gonococcal arthritis
|
|
|
An expanding erythematous patch early in an illness is seen in
|
Lyme disease
|
|
|
Hives indicate
|
a drug reaction or serum sickness
|
|
|
Erosions or scale on the penis and cruste, scaling papules on the soles and palms are seen in
|
Reiter's syndrome, which also includes arthritis, urethritis, and uveitis
|
|
|
Maculopapular rash is characteristic of
|
rubella
|
|
|
Clubbing of the fingernails is seen in
|
hypertrophic osteoarthropathy
|
|
|
Red, burning, and itchy eyes are seen in
|
Reiter's syndrome, Behcet's syndrome
|
|
|
A preceding sore throat is seen in
|
Acute rheumatic fever or gonococcal arthritis
|
|
|
Diarrhea, abdominal pain, cramping are seen in
|
arthritis with ulcerative colitis, regional enteritis, scleroderma
|
|
|
Symptoms of urethritis seen in
|
Reiters syndrome or possibly gonococcal arthritis
|
|
|
Mental status change, facial or other weakness, stiff neck are all seen in
|
Lyme disease with CNS involvement
|
|
|
Acute involvement of only 1 jt suggests...
|
trauma, septic arthitis, gout
|
|
|
What typically involves several jts and is symmetrically distributed?
|
Rheumatoid arthritis
|
|
|
Bowlegs or knock knees are seen in?
|
Dupuytren's contracture
|
|
|
Subcutaneous nodules are found in...
|
rheumatic fever and rheumatoid arthritis
|
|
|
Crepitus over inflamed jts is found in...
|
osteoarthritis, inflamed tendon sheaths
|
|
|
Ligamentous laxity of the ACL is seen in
|
Knee trauma
|
|
|
Inflammation of tissues around a jt, fibrosis in or around a jt or bony fixation as well as decreased ROM are symptoms of
|
Arthritis
|
|
|
Muscle atrophy or weakness is characteristic of
|
Rheumatoid arthritis
|
|
|
Palpable bogginess or doughiness of the synovial membrane indicates what?
|
Synovitis, which is often accompanied by effusion
|
|
|
Palpable jt fluid in effusion, tenderness over tendon sheaths are both seen in
|
Tendinitis
|
|
|
Tenderness and warmth over a thickened synovium suggest what?
|
Arthritis or infection
|
|
|
Redness over a tender jt suggests?
|
Septic or gouty arthritis, or possibly rheumatoid arthritis
|
|
|
What are some symptoms associated with TMJ syndrome?
|
Facial asymmetry, unilateral chronic pain with chewing, jaw clenching, or teeth grinding, often associated with stress, may also present as a headache
|
|
|
Pain with chewing is seen in what diseases other than TMJ?
|
Trigeminal neuralgia, temporal arteritis
|
|
|
What could cause dislocation of the TMJ jt?
|
Trauma which leads to palpable crepitus or clicking in poor occlusion, meniscus injury, or synovial swelling
|
|
|
Elevation of one shoulder is characteristic of what?
|
Scoliosis
|
|
|
The round lateral aspect of the shoulder appears flattened in what?
|
Anterior dislocation of the shoulder
|
|
|
Atrophy of supraspinatus and infraspinatus over posterior scapula with increased prominence of scapular spine occurs within 2-3 weeks of what injury?
|
Rotator cuff tear
|
|
|
What must occur before the jt capsule appears distended?
|
A significant amount of synovial fluid must accumulate
|
|
|
Subacromial or subdeltoid bursitis, degenerative changes, or calcific deposits in the rotator cuff cause what symptom?
|
Localized tenderness
|
|
|
What suggests a bursal tear that communicates with the articular cavity?
|
Swelling
|
|
|
Tenderness over the SITS muscle insertions and inability to lift the arm above shoulder level are seen in what?
|
sprains, tears, and tendon rupture of the rotator cuff, most commonly the supraspinatus
|
|
|
Tenderness and effusion of the shoulder suggest____? What suggests a moderate to large effusion?
|
Synovitis of the glenohumeral jt; if the margins of the capsule and synovial membrane are palpable
|
|
|
Restricted ROM of the shoulder is seen in?
|
bursitis, capsulitis, rotator cuff tears, or sprains, and tendinitis
|
|
|
Age 60yrs or older and a positive drop arm test is most likely to identify what?
|
Rotator cuff tear with likelihood ratios of 3.2 and 5.0; Supraspinatus & infraspinatus weakness and a positive impingement sign increase this likelihood to 48.0
|
|
|
Localized tenderness or pain with adduction of the shoulder suggests what?
|
Inflammation or arthritis of the acromioclavicular jt
|
|
|
Difficulty with both internal and external rotation of the shoulder suggest?
|
Rotator cuff disorder
|
|
|
Pain during Neer's and Hawkin's impingement sign test (positive result) of the shoulder, a positive drop arm test, as well as weakness during supraspinatus strength test indicates?
|
A possible rotator cuff tear
|
|
|
Weakness during an infraspinatus strength test indicates?
|
Rotator cuff tear or bicipital tendinitis
|
|
|
Pain during forearm supination indicates?
|
Inflammation of the long head of the biceps tendon and possible rotator cuff tear
|
|
|
Swelling over the olecranon indicates?
|
Olecranon bursitis
|
|
|
Tenderness distal to the epicondyle of the elbow indicates?
|
Lateral epicondylitis and less commonly in medial epicondylitis
|
|
|
The olecranon is displaced posteriorly in what?
|
Posterior dislocation of the elbow and supracondylar fracture
|
|
|
Full elbow extension would not be possible in what conditions?
|
intra-articular effusion or hemarthrosis
|
|
|
Guarded movement suggests what?
|
Injury
|
|
|
Poor finger alignment is seen in what?
|
Flexor tendon damage
|
|
|
Diffuse swelling of the hands is seen in?
|
Arthritis or infection
|
|
|
Local swelling of the hands is seen in?
|
Cystic Ganglion
|
|
|
Heberden's nodes at the DIPs and Bouchard's nodes that the PIPs are seen in?
|
Osteoarthritis
|
|
|
Symmetric deformity in the PIP, MCP, and wrist jts as well as ulnar deviation is seen in
|
Rheumatoid arthritis
|
|
|
Thenar atrophy in median nerve compression is from?
|
Carpal Tunnel Syndrome
|
|
|
Hypothenar atrophy is seen in?
|
Ulnar nerve compression
|
|
|
Flexion contractures in the ring, 5th, and 3rd, fingers (Dupuytren's contractures) arise from?
|
Thickening of the palmar fascia
|
|
|
Tenderness over the distal radius is seen in what? Any tenderness or bony step offs are also suspicious for this.
|
Colles' Fracture
|
|
|
Bilateral swelling/ tenderness of several weeks duration suggests?
|
Rheumatoid arthritis
|
|
|
Tenderness over the extensor and abductor tendons of the thumb at the radial styloid is seen in?
|
de Quervain's tenosynovitis and gonococcal tenosynovitis
|
|
|
Tenderness over the snuffbox is seen in what? This is also the most common injury of the carpal bones.
|
Scaphoid fracture
|
|
|
Poor blood supply puts the scaphoid bone at risk for what?
|
Avascular necrosis
|
|
|
Pressure of the MCPs is painful in this...remember this when shaking hands.
|
Synovitis of the MCPs and possibly posttraumatic arthritis
|
|
|
The MCPs are often boggy or tender in what?
|
Rheumatoid arthritis
|
|
|
Pain at the base of the thumb indicates?
|
Carpometacarpal arthritis
|
|
|
Psoriatic arthritis involves what jt?
|
DIP jt
|
|
|
Conditions that impair wrist ROM include...
|
arthritis, tenosynovitis, Dupuytren's contracture
|
|
|
Onset of carpal tunnel syndrome is often related to...
|
Repetitive motion with the wrists flexed, pregnancy, rheumatoid arthritis, diabetes, and hypothyroidism. Thenar atrophy may also be present
|
|
|
Decreased grip strength is a positive test for?
|
Weakness of the finger flexors and or intrinsic muscles of the hand as in: arthritis, carpal tunnel syndrome, epicondylitis, and cervical radiculopathy
|
|
|
Wrist pain and grip weakness as well as pain during the finkelstein's test is seen in?
|
deQuervain's tenosynovitis from inflammation of the abductor pollicis longus and extensor pollicis brevis tendons and tendon sheaths
|
|
|
Weak thumb abduction, hand symptom diagrams, and decreased sensation double the likelihood of what disease?
|
Carpal tunnel disease
|
|
|
The abductor pollicis longus is innervated only by what nerve?
|
Median nerve
|
|
|
What is a positive Tinel's Sign nest?
|
Aching and numbness in the median nerve distribution
|
|
|
What is a positive Phalen's Sign test?
|
Numbness and tingling in the median nerve distribution within 60sec.
|
|
|
Tinels and Phalen's signs do not reliably predict positive electrodiagnosis of what disease?
|
Carpal tunnel disease
|
|
|
Impaired hand movement is seen in?
|
Arthritis, trigger finger, and Dupuytren's contracture
|
|
|
Neck stiffness signals what?
|
Arthritis, muscle strain, or other underlying pathology
|
|
|
Lateral deviation and rotation of the head suggest...
|
Torticollis from contraction of the sternocleidomastoid muscle
|
|
|
Tenderness at the facet jts between C5 and C6 suggest?
|
Arthritis
|
|
|
Step-offs, or forward slippage of one vertebra which may compress the spinal cord is seen in?
|
Spondylolisthesis
|
|
|
Vertebral tenderness is suspicious for...
|
fracture or infection
|
|
|
Tenderness over the sacroiliac joint is seen in?
|
Sacroiliitis and ankylosing spondylitis
|
|
|
Pain on percussion of the spine is seen in?
|
Osteoporosis, infection, or malignancy
|
|
|
What spine deformity increases with age?
|
Thoracic kyphosis
|
|
|
Winging of the scapula is caused by?
|
Loss of innervation of the serratus anterior muscle by the long thoracic nerve
|
|
|
Lateral and rotatory curvature of the spine to bring the head back to the midline is seen in what disease that becomes evident in adolescence?
|
Scoliosis
|
|
|
Unequal shoulder heights are seen in what disease?
|
Scoliosis, Sprengel's deformity of the scapula, winging of the scapula, and contralateral weakness of the trapezius
|
|
|
Unequal height of the iliac crests or pelvic tilt suggest...
|
Unequal lengths of the legs, scoliosis, and hip abduction/adduction.
|
|
|
Listing of the trunk to one side is seen in what?
|
herniated lumbar disk
|
|
|
Birthmarks, port-wine stains, hairy patches, and lipomas overlie bony defects such as...
|
spina bifida
|
|
|
Cafe-au-lait spots, skin tags, and fibrous tumors are seen in?
|
Neurofibromatosis
|
|
|
Degenerative and inflammatory processes of muscles, prolonged contraction from abnormal posture and anxiety all cause what?
|
Spasms
|
|
|
Sciatic nerve tenderness suggests what?
|
A herniated disc or mass lesion impinging on contributing nerve roots
|
|
|
Herniated intervertebral discs most common at____ or ____ may produce what symptoms?
|
L5-S1 or L4-L5; tenderness of the spinous processes, the intervertebral jts, paravertebral muscles, sacrosciatic notch, and the sciatic nerve
|
|
|
Tenderness in the costovertebral angles may signify what?
|
Kidney infection
|
|
|
Why is it important to assess any complaints or findings of neck, shoulder, arm pain, or numbness?
|
There might be possible cervical cord or nerve root compression
|
|
|
Tenderness at C1-C2 in rheumatoid arthritis may suggest possible risk for what?
|
Subluxation and high cervical cord compression
|
|
|
How do you measure flexion of the spine?
|
Mark the spine at the lumbosacral junction, then 10cm above and 5cm below this point. A 4-cm increase between the 2 upper marks is normal, the lower two marks should be unchanged
|
|
|
Deformity of the thorax on forward bending is in?
|
Scoliosis
|
|
|
Presence of lumbar lordosis suggests what?
|
muscle spasm or ankylosing spondylitis
|
|
|
Decreased spinal mobility is seen in?
|
Osteoarthritis and ankylosing spondylitis
|
|
|
Arthritis or infection in the hip, rectum, or pelvis may cause symptoms in what part of the spine?
|
lumbar
|
|
|
A wide base gait suggests what?
|
Cerebellar disease or foot problems
|
|
|
What can cause the pelvis to drop on one side producing a waddling gait?
|
Hip dislocation, arthritis, or abductor weakness
|
|
|
Most foot problems appear during what phase of gait?
|
Weight-bearing stance phase
|
|
|
Lack of ____ flexion interrupts the smooth pattern of gait
|
knee
|
|
|
Loss of lordosis may reflect
|
paravertebral spasm
|
|
|
Excess lordosis suggests...
|
flexion deformity of the hip
|
|
|
Changes in leg length are seen in what? Leg shortening and external rotation suggest what?
|
abduction or adduction deformities and scoliosis
hip fracture |
|
|
Bulges along the inguinal lig may suggest?
|
inguinal hernia or aneurysm
|
|
|
Enlarged inguinal lymph nodes suggest?
|
Infection of the lower extremity or pelvis
|
|
|
Tenderness in the groin area may be from what?
|
Synovitis of the hip jt, bursitis, or psoas abscess
|
|
|
Focal tenderness of the trochanter indicates?
|
Trochanteric bursitis
|
|
|
Tenderness over the posterolateral surface of the greater trochanter in?
|
tendinitis or muscle spasm from referred hip pain
|
|
|
Tenderness in ischiogluteal bursitis or "weaver's bottom" is due to?
|
The adjacent sciatic nerve, this may mimic sciatica
|
|
|
What occurs in flexion deformity of the hip?
|
As the opposite hip is flexed, the affected hip does not allow full leg extension and the affected thigh appears flexed; it may be masked by an increase in lumbar lordosis and an anterior pelvic tilt
|
|
|
Restricted abduction is common in?
|
Hip osteoarthritis
|
|
|
Restrictions of internal and external rotation are sensitive indicators of?
|
Hip disease such as arthritis
|
|
|
Stumbling or pushing the knee into extension with the hand during heel strike suggests?
|
quadriceps weakness
|
|
|
Bow legs (genu varum) and knock knees (genu valgum) are ____ abnormalities
|
Common
|
|
|
Flexion contracture (inability to extend fully) is seen in
|
Limb paralysis
|
|
|
Swelling over the patella suggests
|
prepatellar bursitis
|
|
|
Swelling over the tibial tubercle suggests? And if more medial suggests?
|
infrapatellar bursitis
anserine bursitis |
|
|
Tender bony ridges along the knee jt margins, genuvarum deformity, and stiffness for 30min or less and possible crepitus indicate.
|
Osteoarthritis
|
|
|
Meniscus tear with tenderness after trauma is more common in which meniscus?
|
medial
|
|
|
MCL tenderness after injury is suspicious for?
|
MCL tear; LCL injuries are less frequent
|
|
|
Tenderness over the patellar tendon or inability to extend the leg suggests?
|
Partial or complete tear of the patellar tendon
|
|
|
Pain and crepitus suggest roughining of the patellar undersurface that articulates with the femur. When can this pain occur?
|
When climbing stairs or getting up from a chair
|
|
|
Pain with compression and with patellar movement during quadriceps contraction suggests what?
|
Chondromalacia or degenerative patella
|
|
|
Swelling above and adjacent to the patella suggests?
|
Synovial thickening or effusion in the knee jt
|
|
|
Thickening, bogginess, or warmth in the areas adjacent or above the patella suggest?
|
Synovitis or non tender effusions from osteoarthritis
|
|
|
Prepateller bursitis can be caused by?
|
excessive kneeling
|
|
|
Anserine bursitis is caused by
|
running, valgus knee deformity, fibromyalgias, osteoarthritis
|
|
|
Popliteal or "bakers" cyst from?
|
Distension of the gastrocnemius semimebranosus bursa
|
|
|
A fluid wave or bulge on the medial side between the patella and femur is considered a positive bulge sign consistent with?
|
Effusion
|
|
|
Suprapatellar compression ejects fluid into the spaces adjacent to the patella when the knee joint contains?
|
A large effusion
|
|
|
A palpable fluid wave signifies a positive?
|
Balloon sign. A returning fluid wave in the suprapatellar pouch confirms an effusion
|
|
|
Tenderness and thickening of the tendon above the calcaneus, sometimes with a protuberant bony process of the calcaneus is seen in? A defect in these muscles with tenderness and swelling is seen in?
|
Achilles tendinitis
Ruptured Achilles tendon |
|
|
Absence of plantar flexion, 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" all may be present in?
|
Rupture of the Achilles tendon
|
|
|
Knee crepitus with flexion and extension is seen in?
|
osteoarthritis
|
|
|
A click or pop along the medial jt with valgus stress, external rotation, and leg extension suggests?
|
tear of the posterior portion of the medial meniscus; this tear may displace meniscal tissue causing locking on full knee extension
|
|
|
A McMurray sign and locking make ____ 8.2 and 3.2 times more likely
|
medial meniscus tear
|
|
|
Pain or gap in the medial jt line points to?
|
ligamentous laxity and partial tear of the medial collateral lig
|
|
|
Pain or gap in the lateral jt line points to?
|
ligamentous laxity and partial tear of the lateral collateral lig
|
|
|
A forward jerk showing the contours of the upper tibia is a what positive sign? And what becomes 11.5 times more likely as the cause.
|
A positive anterior drawer sign
ACL tear |
|
|
Significant forward excursion indicates?
|
ACL tear; PCL tears are rare
|
|
|
Bone spurs may be present on the calcaneus. Focal heel pain on palpation of the plantar fascia suggests?
|
Plantar fascitis seen in prolonged standing or heel-strike exercise, it is also in rheumatoid arthritis and gout
|
|
|
After trauma, inability to bear weight after 4 steps and tenderness over the posterior aspects of either malleolus (esp medial) is suspicious for what?
|
ankle fracture
|
|
|
Tenderness on compression of the metatarsophalangeal jts is an early sign of what?
|
Rheumatoid arthritis
|
|
|
Acute inflammation of the first metatarsophalangeal jt is seen in?
|
gout
|
|
|
Pain and tenderness (metatarsalgia) is seen in?
|
trauma, arthritis, and vascular comprise
|
|
|
Tenderness over the 3rd and 4th metatarsal heads on the plantar surface is seen in?
|
Morton's neuroma
|
|
|
Pain during movement of the ankle and foot help to localize what?
|
Arthritis
|
|
|
What kind of jt is frequently painful when moved in any direction?
|
Arthritis jt
|
|
|
What type of sprain produces maximal pain when a ligament is stretched?
|
Ligamentous sprain
|
|
|
Normal air-filled lung breath sounds sound?
|
Predominantly vesicular
|
|
|
Airless lung, as in lobar pneumonia breath sounds sound?
|
Brochial or bronchovesicular over the involved area
|
|
|
Normal air-filled lung transmitted voice sounds sound?
|
Spoken words muffled and indistinct; spoken "ee" heard as "ee" whispered words are faint and indistinct if heard at all.
|
|
|
Airless lung, as in lobar pneumonia transmitted voice sounds sound?
|
Spoken words are louder, clearer (bronchophony); spoken "ee" heard as "ay" (egophony); whispered words louder, clearer (whispered pectoriloquy)
|
|
|
Normal Air-filled lung tactile fremitus is?
|
Normal
|
|
|
Airless lung, as in lobar pneumonia tactile fremitus is?
|
Increased
|
|
|
Describe the thorax of a normal adult.
|
The thorax in the normal adult is wider than it is deep; its lateral diameter is larger than its anteroposterior diameter
|
|
|
Depression in the lower portion of the sternum, compression of the heart and great vessels causing murmers is indicative of?
|
Funnel chest (pectus excavatum)
|
|
|
Increased anteroposterior diameter of the chest is indicative of?
|
Barrel chest, common in COPD and normal during infancy
|
|
|
Displaced sternum anteriorly, increasesing the anteroposterior diameter as well as the costal cartilages adjacent to the protruding sternum being depressed are indicative of?
|
Pigeon Chest (pectus carinatum)
|
|
|
Multiple rib fractures causing paradoxical movement of the thorax as well as while the descent of the diaphragm decreases intrathoracic pressure on inspiration the injured are caves inward and on expiration it moves outward indicate?
|
Traumatic Flail Chest
|
|
|
Abnormal spinal curvatures and vertebral rotation deform the chest; distortion of the underlying lungs may make interpretation of lung findings difficult. This indicates?
|
Thoracic Kyphoscoliosis
|
|
|
A resonant lung on percussion, midline trachea, vesicular or bronchovesicular/ bronchial sounds over large bronchi & trachea, no adventitious sounds except a few transient inspiratory crackles at the bases of the lungs, and normal tactile fremitus and normla transmitted voice sounds indicate?
|
Normal Lungs
|
|
|
A resonant lung on percussion, midline trachea, vesicular breath sounds (normal), no adventitious sounds except crackles in early inspiration and perhaps expiration or wheezes or rhonchi, and normal tactile fremitus and normal transmitted voice sounds indicate?
|
Chronic Bronchitis
|
|
|
A resonant lung on percussion, midline trachea, vesicular breath sounds, late inspiratory crackles in the dependent portion of the lungs, possible wheezes, and normal tactile fremitus and normal transmitted voice sounds indicate?
|
Left-sided heart failure
|
|
|
A dull lung to percussion over airless area, midline trachea, bronchial breath sounds over involved area, late inspiratory crackles over the involved area, and increased tactile fremitus/ transmitted voice sounds with bronchophony, egophony, and whispered pectoriloquy indicates?
|
Consolidation (alveoli filled with fluid or blood cells)
|
|
|
A dull lung on percussion, a shifted trachea towards the affected side, absent breath sounds except when right upper lobe is affected, no adventitious sounds, and absent tactile fremitus and transmitted voice sounds indicate?
|
Atelectasis (plug in the mainstem bronchus obstructing airflow, and affected lung tissue collapses
|
|
|
A dull/ flat lung on percussion, shifted trachea to opposite side that is not affected, decreased or absent breath sounds, no adventitious sounds except for a pleural rub, and decreased to absent tactile fremitus and transmitted voice sounds indicate?
|
Pleural effusion
|
|
|
Hyperresonant or tympanic lung to percussion, shifted trachea to opposite side that isn't affected, decreased to absent breath sounds, no adventitious sounds except pleural rub, and decreased or absent tactile fremitus/ transmitted voice sounds indicates?
|
Pneumothorax
|
|
|
Diffusely hyperresonant lung to percussion, midline trachea, decreased to absent breath sounds, none or crackles, wheezes, and rhonchi of chronic bronchitis, and decreased tactile fremitus/ transmitted voice sounds indicate?
|
COPD
|
|
|
Resonant to diffusely hyperresonant lung to percussion, midline trachea, obscured breath sounds by wheezes, wheezes and crackles, and decreased tactile fremitus/ transmitted voice sounds indicate?
|
Asthma
|
|
|
Describe the swelling and cause of olecranon bursitis?
|
Swelling and inflammation of the olecranon bursa may result from trauma or may be associated with rheumatoid or gouty arthritis. The swelling is superficial to the olecranon process.
|
|
|
Where is arthritis of the elbow felt?
|
Synovial inflammation or fluid is felt best in the grooves between the olecranon process and the epicondyles on either side. Palpate for boggy, soft or fluctuant swelling and for tenderness.
|
|
|
Describe Rheumatoid Nodules.
|
Subcutaneous nodules may develop at pressure points along the extensor surface of the ulna in rheumatoid arthritis/ rheumatic fever pts. They are firm, nontender, and are not attached to overlying skin. They may or may not be attached to underlying periosteum, They develop in olecranon bursa and more distally.
|
|
|
What does Lateral epicondylitis result from?
|
it follows repetetive extension of the wrist or pronation/supination of the forearm. Pain and tenderness develop 1cm distal to the lateral epicondyle and in the extensor muscles close to it. Pain increases whith extension of wrist against resistance
|
|
|
What does medial epicondylitis result from?
|
it follows repetitive wrist flexion as in throwing, tenderness is maximal lateral and distal to medial epicondyle, wrist flexion against resistance increases pain
|
|
|
tender, painful, stiff jts, symmetric involvement on both sides, PIPs, MCPs, and wrist jts are frequently affected and fusiform/ spindle shaped swelling of the PIPs all occur in?
|
Acute Rheumatoid Arthritis
|
|
|
Swelling and thickening of MCPs and PIPs, limited ROM, ulnar deviation, atrophy of interosseous muscles, swan-neck fingers, boutonniere deformity, and nodules all occur in?
|
Chronic Rheumatoid Arthritis
|
|
|
Heberden's nodes on the dorsolateral aspect of DIPs that are hard and painless, flexion and deviation deformities, bouchard's nodes on PIPs, and bony overgrowth all occur in?
|
Osteoarthritis (degenerative jt disease)
|
|
|
Deformities mimicing rheumatoid arthritis and osteoarthritis, non-symmetrical jt involvement, acute inflammation, knobby swellings around the jts ulcerate and discharge white chalklike urates in?
|
Chronic Tophaceous Gout
|
|
|
Thickened plaque overlying the flexor tendon of the ring finger and little finger, puckering skin in this area, thickened fibrotic cord developing btwn palm and finer, and flexion contracture of the fingers all occur in?
|
Dupuytren's Contracture
|
|
|
A painless nodule in a flexor tendon in the palm that is too big to enter easily in the tendon sheath during extension of the fingers from a flexed position causing the finger to extend and flex with a "snap" as the nodule pops into the tendon sheath indicates?
|
Trigger Finger
|
|
|
Thenar atrophy suggests?
|
median nerve disorder such as carpal tunnel syndrome
|
|
|
Hypothenar atrophy suggests?
|
Ulnar nerve disorder
|
|
|
Cystic, round, non-tender swellings along the tendon sheaths or jt capsules frequently on the dorsal wrist, flexion making these more prominent and extension obscuring them are called?
|
Ganglion
|
