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98 Cards in this Set
- Front
- Back
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Pregnancy: Neuro |
- Increased HA (due to vasodilation) |
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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 |
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Pregnancy: MSK |
- Wobbly gait - Lordosis - Slumping of the shoulders - Aches and pain |
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Pregnancy: Skin |
- Striae - Linea nigra (midline of abdominal skin is pigmented) - Melasma (mask of pregnancy) |
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Pregnancy: Respiratory |
- Some SOB - Elevated diaphragm - More O2 needed |
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Pregnancy: Breasts |
- Get bigger - Veins more visible - Produce Colostrum |
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Colostrum |
- Precursor to milk - Expressed from nipples - Yellow in color - Contain minerals and protein (less sugar and fat than milk) - Contain antibodies |
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Elderly: Neuro |
- Reflexes intact, but slow - Decreased taste sensation - Memory should be intact |
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Elderly: Eyes |
- Decreased accommodation (reading glasses) - Glaucoma is abnormal (cloudy vision and peripheral loss) |
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Elderly: MSK |
- Decreased muscle mass and tone - Arteriosclerosis - Peripheral and vascular resistance |
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Elderly: Skin |
- Decreased collagen, increase wrinkles - Potential breakdown on sacrum, hips, bony areas |
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Dementia |
- Insidious (gradual) - Alterations in word finding, naming objects - Good at hiding it! - Memorize certain things to mask - Long term memory still intact |
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Delirium |
- 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 |
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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 |
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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 |
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Always screen for depression in elderly! |
Can effect self-care behaviors |
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Min Mental Exam (MME) |
- 30 questions to measure cognitive impairment - Used to screen for dementia - 24 = normal - < 23 = cognitive impairment - Effective, because it quantifiable |
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Confusion Assessment Method (CAM) |
- Used to identify delirium from cognitive impairment |
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Glasgow Coma Scale (GCS) |
- Eye, verbal and motor response - Min score = 3 (comatose) - Max score = 15 (fully awake) |
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Mini Cog |
- 3 minute instrument to screen for cognitive impairment in older adults - Recall memory and simply scored clock drawing test |
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Functional Mobility in elderly |
- Ability to perform ADLs - Used to determine if compliant with medications |
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Functional status |
- NOT static - Older adults may move continuously through varying stages of independence and disability |
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Aphasia |
Inability to comprehend language |
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Aphagia |
Inability to swallow |
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Dysphasia |
Difficulty comprehending language |
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Dysphagia |
Difficulty swallowing |
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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 |
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Kyphosis |
- Forward rounding of the back - common in older adults |
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Lordosis |
- Inward curvature of the lumbar spin - Common in pregnancy |
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Scoliosis |
- Sideways curvature of the spine - Both thoracic and lumbar spine can be affected - Forward bend test |
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Knee: Anatomy |
- 3 bone: femur, tibia, patella - Hing joint - Flexion and extension |
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Knee: Joint stability |
ACL and PCL: anterior and posterior stability MCL and LCL: connect joint at both sides, provide medial and lateral stability |
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Knee: Mostly frequently injured |
Medial Collateral Ligament (MCL) *sprained knee = injury to MCL |
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Tenderness at joint line |
= Meniscus tear * tenderness above joint line = ligament damage |
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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" |
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ACL injury |
- Swelling and pain after sudden deceleration or jumping - Feels like something gave - Associated with twist and turns - hinge brace helpful |
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PCL Injury |
- Forceful hyperextension of knee - 70% occur in combo with other knee injuries |
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Ballotment Test |
- Testing for knee join effusion or excess fluid (+) = presence of effusion of a palpable tap |
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Bulge Sign |
- testing for excess fluid in knee (+) = bulge of returning fluid |
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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 |
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Lachman's test |
- Most sensitive for acute ACL injuries (+) = if tibia slides of femur it indicates ACL tear |
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Anterior Drawer Test |
- Assessment of ACL injury (+) = forward movement of tibia > 5-6 cm (suggest ACL tear or strain) |
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Posterior Drawer Test |
- Assessment of PCL injury (+) = tibia slides posteriorly against femoral condyles |
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McMurray Test |
- Test for meniscus injury - Hyperflex knee and internally and externally applying varus and valgus stress while extending the knee - Gold standard |
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Back |
Most commonly complained about MSK |
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Schober test |
Screening for fusion of lumbar spine |
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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 |
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Sitting Knee Extension Test |
- Sciatic nerve test (+) = pain reproduced as leg is extended |
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Herniated disc (HNP) |
- Radicular pain (shoot, electrical) - Extends below the knee |
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Straight Leg Raised Test |
- Testing for HNP - Leg is raise between 30-60 degrees (+) = pain |
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Crossed Leg Raised Test |
- Testing for HNP (+) = pain when leg is not raise |
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Pelvic Rock Test |
(+) = sacroiliac joint problems |
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Shoulder: Anatomy |
- Glenohumeral joint - Ball and socket joint |
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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 |
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Hawkins |
- Test for impingement of shoulder - Arm is elevated forward 90 degrees with slight adduction - Examiner internally rotates the arm (+) = pain, indicates impingement |
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Impingement Syndrome |
- Most common shoulder complaint - Issue with rotator cuff |
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Neer's Test |
- Testing for impingement - Flex shoulder, flex elbow, wave arm in front of face (single ladies) |
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Lateral Epicondylitis |
- Tennis elbow - Pain radiates down extensor surface of forearm - Exacerbated by movements such as opening the door or lifting a glass |
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Medial Epicondylitis |
- Golfers elbow - Palpation reveals tenderness - Pain is elicited by wrist flexion |
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Test for Golfer's/Tennis Elbow |
- Flex elbow, then extend while pronating (+) = pain over the lateral and medial epicondyle |
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Rheumatoid Arthritis |
- Inflammatory process - Autoimmune - Hand stiffness in the morning - Ulnar deviation of MCL (right hand) - Swelling of distal joints (both hands) |
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Osteoarthritis |
- Over use, cartilage worn down - Heberden's nodes = distal - Bouchard's nodes = proximal |
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Presumptive Signs of Pregnancy |
- What the woman experiences - Amenorrhea - Breast tenderness - Nausea - Fatigue - Increase urinary frequency |
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Probably Signs of Pregnancy |
- Detected by examiner - Enlarged uterus |
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Positive Signs of Pregnancy |
- Direct evidence of fetus - Auscultation of heart tone and cardiac activity on ultrasound |
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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 |
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Fundal Height |
Fetal outline palpable through abdominal wall at approximately 20 weeks |
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Paraphimosis |
- Medical Emergency! - Foreskin is only partially retractable - Blood restriction and glands swell - Use 27 gauge needle to get fluid out and retract foreskin |
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Phimosis |
- Non-retracable foreskin - Not a medical emergency - Biggest issue is cleanliness |
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Breast Exam |
Inspect first |
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Best time to discuss breast self exam |
During or right after so that they know how to do it themselves |
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Fibrotic tissue changes with cancer |
- Bands become contracted which produces dimpling of overlying skin |
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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 |
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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 |
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Break Cancer Risk |
- Family Hx - Pre unbound estrogen (never had children, early menses + late menopause) |
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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 |
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Vulvovaginal inflammations |
- Atrophic Vaginitis - Candidiasis - Trichomoniasis - Bacterial vaginosis - Chlamydia - Gonorrhea |
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Trichomoniasis |
- Strawberry cervix - Vaginal discharge is profuse, frothy and high pH |
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Bacterial Vaginosis |
- Fish odor with KOH test (Whiff Test) - Presence of clue cells (on wet mount) |
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Risk Factors for Cervical Cancer |
- HPV - Sexual activity - Increase # of partners = higher risk of contracting HPV - Advise patients to use protection |
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Nabothian Cyst |
- Mucus filled cysts of cervix |
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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 |
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Epispadias |
Displacement of meatus to dorsal side |
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Normal Scrotum |
Left testicle is lower than right |
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Transillumination |
- 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 |
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Hydrocele |
- Most common mass in scrotum - Can be transilluminated |
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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 |
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Inguinal Canal |
- Passageway for spermatic cord - 4-6 cm long - Lies above inguinal ligament between anterior iliac spine and pubis |
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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 |
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Indirect Hernia |
- Reducible - Most common among all ages - In the scrotum |
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Direct Hernia |
- Reducible when lying down - Less common, usually in older men - Abovethe inguinal ligament, near the external inguinal ring - Rarely in the scrotum |
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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 |
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Prehn's Sign |
Scrotum is gently lifted onto symphysis, pain caused by epididymitis is relieved |
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Epididymitis |
- Infection - Sudden pain - Scrotal redness and enlargement - Associated with prostatitis or STD |
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Testicular Self Exam |
- Importance self-maintenance - Can be done quickly during shower - Report and changes or pain (immediately) |
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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? |
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Overflow Incontinence |
- Chronically distended bladders - Large amounts of residual urine - Constant increase in bladder - Leakage may be steady or intermittent |
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Urge Incontinence |
- Overactive bladder - Sudden need to urinate - Urinate often |
