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98 Cards in this Set

  • Front
  • Back

Pregnancy: Neuro

- Increased HA (due to vasodilation)

Pregnancy: CV

- Decreased BP at week 20 (1st trimester)

- Increased BP in 2nd trimester

- Varicose veins, hemorrhoids, edema (extra volume)

- Pathological = gestational dibetes, diastolic murmur

Pregnancy: MSK

- Wobbly gait

- Lordosis

- Slumping of the shoulders

- Aches and pain

Pregnancy: Skin

- Striae

- Linea nigra (midline of abdominal skin is pigmented)

- Melasma (mask of pregnancy)

Pregnancy: Respiratory

- Some SOB

- Elevated diaphragm

- More O2 needed

Pregnancy: Breasts

- Get bigger

- Veins more visible

- Produce Colostrum


- Precursor to milk

- Expressed from nipples

- Yellow in color

- Contain minerals and protein (less sugar and fat than milk)

- Contain antibodies

Elderly: Neuro

- Reflexes intact, but slow

- Decreased taste sensation

- Memory should be intact

Elderly: Eyes

- Decreased accommodation (reading glasses)

- Glaucoma is abnormal (cloudy vision and peripheral loss)

Elderly: MSK

- Decreased muscle mass and tone

- Arteriosclerosis

- Peripheral and vascular resistance

Elderly: Skin

- Decreased collagen, increase wrinkles

- Potential breakdown on sacrum, hips, bony areas


- Insidious (gradual)

- Alterations in word finding, naming objects

- Good at hiding it!

- Memorize certain things to mask

- Long term memory still intact


- Acute onset

- Can be caused by UIT or infectious source, or medications

- Worse in evenings

- Is reversible

- Ex. ask them to sit in chair, put a try on head

Screening for elderly abuse

- Talk to patient and caregiver together and separately

- Look for signs of abuse (malnutrition, inappropriate clothing, social isolation, bruising or restraint marks)

- Doctor shopping is a red flag

- Look for caregiver congruency

Caregiver burnout

- Increased stress, burden and impaired physical health of caregiver

- Can lead to sleep disturbances, depression, morbidity, increase mortality, anxiety, social isolation, general malaise

Always screen for depression in elderly!

Can effect self-care behaviors

Min Mental Exam (MME)

- 30 questions to measure cognitive impairment

- Used to screen for dementia

- 24 = normal

- < 23 = cognitive impairment

- Effective, because it quantifiable

Confusion Assessment Method (CAM)

- Used to identify delirium from cognitive impairment

Glasgow Coma Scale (GCS)

- Eye, verbal and motor response

- Min score = 3 (comatose)

- Max score = 15 (fully awake)

Mini Cog

- 3 minute instrument to screen for cognitive impairment in older adults

- Recall memory and simply scored clock drawing test

Functional Mobility in elderly

- Ability to perform ADLs

- Used to determine if compliant with medications

Functional status

- NOT static

- Older adults may move continuously through varying stages of independence and disability


Inability to comprehend language


Inability to swallow


Difficulty comprehending language


Difficulty swallowing

Muscle Strength Grading

0 = no movement

+1 = trace movement

+2 = full ROM, no gravity

+3 = full ROM, gravity no resistance

+4 = full ROM, gravity + some resistance

+5 = Full ROM, full resistance


- Forward rounding of the back

- common in older adults


- Inward curvature of the lumbar spin

- Common in pregnancy


- Sideways curvature of the spine

- Both thoracic and lumbar spine can be affected

- Forward bend test

Knee: Anatomy

- 3 bone: femur, tibia, patella

- Hing joint

- Flexion and extension

Knee: Joint stability

ACL and PCL: anterior and posterior stability

MCL and LCL: connect joint at both sides, provide medial and lateral stability

Knee: Mostly frequently injured

Medial Collateral Ligament (MCL)

*sprained knee = injury to MCL

Tenderness at joint line

= Meniscus tear

* tenderness above joint line = ligament damage

MCL injury

- direct blow lateral or medial portion of knee

- Common in football, basketball, soccer or wrestling

- High association with ACL injury

- "pop" or "snap"

ACL injury

- Swelling and pain after sudden deceleration or jumping

- Feels like something gave

- Associated with twist and turns

- hinge brace helpful

PCL Injury

- Forceful hyperextension of knee

- 70% occur in combo with other knee injuries

Ballotment Test

- Testing for knee join effusion or excess fluid

(+) = presence of effusion of a palpable tap

Bulge Sign

- testing for excess fluid in knee

(+) = bulge of returning fluid

Varus and Valgus Stress test

- Testing stability of medial and lateral ligaments of knee

- Flex knee at 30 degrees and apply force away from midline

Lachman's test

- Most sensitive for acute ACL injuries

(+) = if tibia slides of femur it indicates ACL tear

Anterior Drawer Test

- Assessment of ACL injury

(+) = forward movement of tibia > 5-6 cm (suggest ACL tear or strain)

Posterior Drawer Test

- Assessment of PCL injury

(+) = tibia slides posteriorly against femoral condyles

McMurray Test

- Test for meniscus injury

- Hyperflex knee and internally and externally applying varus and valgus stress while extending the knee

- Gold standard


Most commonly complained about MSK

Schober test

Screening for fusion of lumbar spine

Straight Leg Raise test or LeSegue's Test

- Screening for nerve compression (sciatic nerve)

- Extension of leg at hip with plantar and dorsiflexion of foot

- L5-S1

Sitting Knee Extension Test

- Sciatic nerve test

(+) = pain reproduced as leg is extended

Herniated disc (HNP)

- Radicular pain (shoot, electrical)

- Extends below the knee

Straight Leg Raised Test

- Testing for HNP

- Leg is raise between 30-60 degrees

(+) = pain

Crossed Leg Raised Test

- Testing for HNP

(+) = pain when leg is not raise

Pelvic Rock Test

(+) = sacroiliac joint problems

Shoulder: Anatomy

- Glenohumeral joint

- Ball and socket joint

Apprehension Test

- Testing should anterior shoulder instability

- Arm is abducted 90 degrees and externally rotated 90 degrees

- Examiner push forward

(+) = pain, motion and or click


- Test for impingement of shoulder

- Arm is elevated forward 90 degrees with slight adduction

- Examiner internally rotates the arm

(+) = pain, indicates impingement

Impingement Syndrome

- Most common shoulder complaint

- Issue with rotator cuff

Neer's Test

- Testing for impingement

- Flex shoulder, flex elbow, wave arm in front of face (single ladies)

Lateral Epicondylitis

- Tennis elbow

- Pain radiates down extensor surface of forearm

- Exacerbated by movements such as opening the door or lifting a glass

Medial Epicondylitis

- Golfers elbow

- Palpation reveals tenderness

- Pain is elicited by wrist flexion

Test for Golfer's/Tennis Elbow

- Flex elbow, then extend while pronating

(+) = pain over the lateral and medial epicondyle

Rheumatoid Arthritis

- Inflammatory process

- Autoimmune

- Hand stiffness in the morning

- Ulnar deviation of MCL (right hand)

- Swelling of distal joints (both hands)


- Over use, cartilage worn down

- Heberden's nodes = distal

- Bouchard's nodes = proximal

Presumptive Signs of Pregnancy

- What the woman experiences

- Amenorrhea

- Breast tenderness

- Nausea

- Fatigue

- Increase urinary frequency

Probably Signs of Pregnancy

- Detected by examiner

- Enlarged uterus

Positive Signs of Pregnancy

- Direct evidence of fetus

- Auscultation of heart tone and cardiac activity on ultrasound

Nagele's Rule

- Estimating gestational age by using first day of last menstrual period

- First day of LMP + 7 days - 3 months = Estimated Delivery Date

Fundal Height

Fetal outline palpable through abdominal wall at approximately 20 weeks


- Medical Emergency!

- Foreskin is only partially retractable

- Blood restriction and glands swell

- Use 27 gauge needle to get fluid out and retract foreskin


- Non-retracable foreskin

- Not a medical emergency

- Biggest issue is cleanliness

Breast Exam

Inspect first

Best time to discuss breast self exam

During or right after so that they know how to do it themselves

Fibrotic tissue changes with cancer

- Bands become contracted which produces dimpling of overlying skin

Tail of Spence

- Most common site for metastasis!!

- Located in the upper, outer quadrant of breast

- Cone shaped breast tissue that projects into axial close to pectoral group of axillary lymph nodes

Relationship between breast tenderness and menses

Premenopausal women: mid-cycle have tissue edema and pain making it hard to detect lesion

Adolescents: during first 3-4 days before menstruation breast feel tender

Break Cancer Risk

- Family Hx

- Pre unbound estrogen (never had children, early menses + late menopause)

Conducting Pelvic Exam

- Pt should refrain from douching, vaginal medication of sexual intercourse for 24 hrs

- Lithotomy position with examiner in stool

- Drape to cover stomach, legs -- expose on vulva

- Good eye contact, alleviate anxiety

Vulvovaginal inflammations

- Atrophic Vaginitis

- Candidiasis

- Trichomoniasis

- Bacterial vaginosis

- Chlamydia

- Gonorrhea


- Strawberry cervix

- Vaginal discharge is profuse, frothy and high pH

Bacterial Vaginosis

- Fish odor with KOH test (Whiff Test)

- Presence of clue cells (on wet mount)

Risk Factors for Cervical Cancer


- Sexual activity

- Increase # of partners = higher risk of contracting HPV

- Advise patients to use protection

Nabothian Cyst

- Mucus filled cysts of cervix

Ayre Spatula

- Cervical scrape

- Insert bifid end of spatula into vagina with pointed bump into cervix

- Rotate 360-720 degrees

- Specimen important for adolescents whose cervical cells have not yet migrated into endocervical canal


Displacement of meatus to dorsal side

Normal Scrotum

Left testicle is lower than right


- Performed is scrotum is swollen

- Dark room

- Shine flashlight from behind scrotal sac

- Normal: does NOT transilluminate

- Red glow: fluid, hydrocele or speratocele

- Solid tissue will not transilluminate


- Most common mass in scrotum

- Can be transilluminated

Risk for Prostate Cancer

*leading cause of death

- Men > 55

- African American men

- Hx

- Obstruction s/s

- Dysuria

- Slow stream

- Frequency

- Retention

- Digital Rectal Exam (DRE): single most important means of detection

Inguinal Canal

- Passageway for spermatic cord

- 4-6 cm long

- Lies above inguinal ligament between anterior iliac spine and pubis

Inguinal Hernia

Inspection: Instruction patient to bear down and look for bulges

Palpation: femoral areas

- Invaginate the scrotum and check inguinal canals

- Have pt shift weight to opposite leg

- Use index finger and follow cord through external ring

- As pt coughs, feel for mass

**If mass is present, get an ultrasound

Indirect Hernia

- Reducible

- Most common among all ages

- In the scrotum

Direct Hernia

- Reducible when lying down

- Less common, usually in older men

- Abovethe inguinal ligament, near the external inguinal ring

- Rarely in the scrotum

Testicular Torsion

- Medical emergency!

- Very painful

- Twisting of the spermatic cord, occluding blood flow

- Occurs to pubescent boys during athletic activity or spontaneously

- Abrupt, localized pain that radiates into groin or abdomen

- Scrotal redness or enlargement

- One testicle is higher than normal

- Positive prehn's sign = pain relief when lifting affected testicle

Prehn's Sign

Scrotum is gently lifted onto symphysis, pain caused by epididymitis is relieved


- Infection

- Sudden pain

- Scrotal redness and enlargement

- Associated with prostatitis or STD

Testicular Self Exam

- Importance self-maintenance

- Can be done quickly during shower

- Report and changes or pain (immediately)

Stress Incontinence

- Occurs with straining

- Primary defect is loss of muscular support

- More common in women as they age

- As pt: Do you urinate when sneezing, laughing, coughing or bearing down?

Overflow Incontinence

- Chronically distended bladders

- Large amounts of residual urine

- Constant increase in bladder

- Leakage may be steady or intermittent

Urge Incontinence

- Overactive bladder

- Sudden need to urinate

- Urinate often