Deontological imperatives

Fairness and justice

When the sensitivity of a symptom or sign is high, a ________ response rules ____ the targer disorder.

What is the acronym to help remember?

Negative

OUT

SnNout

When the specificity is high, a ______ test result rules ____ the target disorder. 

What is the acronym?

When does the history transition from pt driven to provider driven?

HEADS

Home

Education

Activities, affect, ambition, anger

Drugs

Sex

PACES

Parents, peers

Accidents, etoh

cigarettes

emotional issues

school, sexuality

Subarachnoid hemorrhage

or

Meningitis

Migraine and

Tension Headache

New and persisting, progressively severe headaches raise concerns of ____, ____. or_____?

60-70

Migraine

Abnormalities:  Ear canal is often swollen, narrowed, moist, pale, and tender. 

May be reddened.

Gold standard for assessing otitis media in peds?

What is normal?

pneumatic otoscopy

TM should look like a sail in the wind

Usually caused by viral URI or sudden changes in atmospheric pressure, flying or diving.

Amber fluid behind the eardrum.

Sometimes with bubbles

Nasal mucosa is reddened and swollen with ?

Sphenoid

Ethmoid

Frontal

Maxillary

Sinuses of infant, 1 yr old

Sphenoid

Ethmoid

Maxillary

Sphenoid

Frontal

Ethmoid

Maxillary

The following incr. likelihood..

1.  History of colored nasal discharge

2.  Poor response to decongestants

3.  Maxillary tooth pain

4.  Physical exam showing purulent nasal discharge and abnormal maxillary sinus transillumination.

Left CN IX lesion.  may be caused

by CN IX palsy.  deviates away from tumor or infection.

Tongue deviates ______ lesions.

What CN?

towards

hypoglossal CN XII

Early sign of measles(rubeola)

small white specks that resemble grains of salt on red background in throat.

Round face

Red Cheeks

Excessive hair growth

Edematous face

Pale

Swelling around eyes starts in AM

Eyes may become slitlike

Severe hypothyroidism

dull puffy face

edema around eyes

hair thin, dry

skin dry

Associated with obesity, diabetes, cirrhosis

Swelling anterior to the ear lobes and above angles of jaw.

increased growth hormone

produces enlargement of soft and bone tissues

head elongated

soft tissues of head also enlarged

Decreased facial mobility blunts expression

decreased blinking, stare

neck flexed foward

drooling may occur

anterior fontanel bulging

setting sun sign

In newborns

Usually appear within first 24 hours after birth

does not extend across a suture. 

Resolves in several weeks.

What eye mvmnt test CN IV?  Trochlear

Superior oblique

Down and towards nose

CN VI

Abducens

Draw visual field to expain defects

1.  Horizontal Defect

2.  Blind right eye

3.  Bitemporal Hemianopsia

4.  Left homonymous hemianopsia

5.  Homonymous left superior Quadratic defect

6.  Left homonymous hemianopsia

lesion of optic tract on either side

The common form of glaucoma

The normal spacial relationship between iris and cornea is preserved and the iris is fully lit.

Argyll Robertson

and

Tonic (adie's)pupils

Head injury and coma

Narrow angle glaucoma

Wide eye stare, eyeballs protrude foward.

Graves hyperthyroidism

Harmless yellow triangular nodule in the bulbar conjuntiva on either side of the iris. 

Appears frequently with aging.

A subacute nontender and usually painless nodule involving a meibomian gland. 

Usually points inside the lid unlike a sty

Slight raised, yellowish plaques that appear along the nasal portions of eyelids.

Accompany lipid disorders

Chron's disease

RA

Autoimmune d/o

An abnormal growth of conjunctiva from limbus to cornea.

Common in people with overexposure to light.

Diabetes

HTN

Yellowish round spots

undigested cellular debris

Age related macular degen

Cataract

Children:  retinoblastoma

Term for unilateral blindness

Occluded central retina artery or

Occluded internal carotid artery

Aids in integration of voluntary mvmnt

Processes sensory information

Uses sensory data for reflex control

-muscle tone

-equilibrium

-Posture

Medulla oblongota

midbrain

pons

diencephalon

Occularmotor-pupils

Facial-tears

Glossopharangeal-secretions

Vagus-Digestive enzymes and heart

Pupill constr.

Opening of eye lid

EOMs

Motor- jaw clenching

Sensory-facial sensation

Abducens

Lateral deviation of eye

CN7? function?

Motor-facial mvnts

sensory-taste

Hearing-cochlear

balance-vestibular

Glossopharyngeal

Motor-pharynx

Sensory-posterior tongue taste

Vagus

Motor-palate, pharynx, larynx

Sensory:  pharynx and larynx

Spinal Accessory

Motor-SCM, Trapezius

Hypoglossal

Motor-tongue

Common dermatomes?

C7

C6

L4

t4

L1

Middle finger

Thumb

Big toe

nipple

Inguinal ligament

Segment level of this DTR?

Ankle

Segment level of this DTR?

Knee

Segment level of this DTR?

Brachioradialis?

Segment level of this DTR?

Biceps?

Segment level of this DTR?

Triceps?

Segment level of this DTR?

Plantar?

Lumbar 5

Sacral 1

Sudden numbness of the face, arm or leg

Sudden confusion, trouble speaking, or understanding

Sundden trouble walking, dizziness, or loss of balance and coordinatin

Sudden trouble seeing n one or both eyes

Sudden severe headache

Bells palsy affects both the upper and lower face.  a central lesion affects mainly the lower face.

Grade muscle strength:

No muscular contraction noted

Grading muscle strength:

Barely detectable trace of contraction

Grading muscle strength:

Active movement of the body part with gravity eliminated

Grading muscle strength:

Avitve movement against gravity

3

Grading muscle strength:

Active movement against gravity with some resistance.

Grading muscle strength:

Active movement against full resistance without fatigue.  This is the normal finding.

The ability to identify an object by feeling it.

Inability could suggest lesion in sensory cortex.

Touch a point on pt skin.

ask pt to open eyes and point to where sensation was felt.

Tests used to check for meningeal inflammation?

Brudzinski

Kernig

Positive Brudzinki's sign?

sign of

Flex neck..

flexion of hips and knees occur with it.

meningeal inflammation

Compression of the spinal nerve root as it exits through the vertebral foramen

Painful

with associated muscle weakness

usually from herniated disc

95%

25%

liver disease

uremia

hypercapnia

Seen in spinal cord disease causing bilateral lower extremity spasticity.  Gait is stiff

Pts appear to be walking thru water.

Stooped

flexion of head arms hips and knees

shuffle

short steps

turns around "all in one piece"

Seen in corticospinal tract lesion in stroke

causing poor control of flexor muscles during swing phase

patients may drag toe, circe leg stiffly outward

seen in foot drop usually secondary to peripher motor unit disease. 

drag feet or lift them high.

cannot walk on heels

Musculoligamentous injury

disc herniation

vertebral collapse

spinal cord metastases

RARE epidural abcess

sacroilitis

trochanteric bursitis

sciatica

hip arthritis

Lateral deviation and rotation of the head upon inspection could suggest?

Caused by?

Torticollis

From contration of the SCM muscle.

Type of back pain:

Shooting pain below the knee

Type of back pain:

Commonly in lateral leg or posterior calf

Type of back pain:

Pt's report parasthesias and weakness

Type of back pain:

Bending, coughing, straining during BMs often worsen pain.

Type of back pain:

Psudoclaudication pain

Type of back pain:

Pain is improved with rest, lumbar flexion(why?)

Lumbar spinal stenosis

Decompresses spinal cord

Type of back pain:

Pain vague but usually bilat with parasthesias in one or both legs

Type of back pain:

More common after age 60

Type of back pain:

positive crossed straight leg raise(whats this?)

pain in afercted leg when healthy leg tested

sciatica

Type of back pain:

straight leg test usually negative

posture may be flexed foward

Type of back pain:

most common in men younger than 40.

chronic back stiffness

ankylosing spondylitis

Type of back pain:

acute less than 3 months

idiopathic

benign

self limiting

Rheumatoid arthritis

Process:

Common location:

Pattern of spread:

Onset:

Chronic inflammation of synovial membranes with secondary erosion of cartilage and bone.

Hands, feet, wrist ankels and knees

Symmetrically additive

Insidious onset

What joint disease?

Weakness fatigue, wt loss, low fever

Type of joint pain:

Joint stiffness prominent, often for an hour or more in am.  also after inactivity

What joint disease?

Stiffness frequent but brief(5-10min)

in am and after inactivity

Process of osteoarthritis?

common locations?

degeneration and progressive loss of cartilage within joints. 

Common locations for gouty arthritis?

onset?

Base of the big toe

sudden often at night after injury, surgery

A joint disease of unclear etiolgoy in ppl >50

especially women

may be associated with giant cell arteritis

Widespread musculoskeletal pain and tender points

Mechanisms unclear

Cerebellar disease

Foot problem

Hip dislocation

arthritis

abductor weakness

NAVEL

nerve

artery

vein

emptyspace

lymph node

inguinal hernia

aneuryism

SITS muscles

Suprasinatus

Infraspinatus and Teres minor

Sbuscapularis

palpate both joints for swelling and tenderness

crossover test(adduction accross chest)

Press on scapula

have pt raise arm

+ test =possible rotator cuff tear

Flex pt should and elbow to 90 degrees

rotate arm internally

pain =+ rotator cuff tear

Empty can test

arms to 90 degrees, internally rotate arms

possible rotator cuff tear

arms at side at 90 degrees

provide resistance

rotator cuff tear or

bicpital tendinitis

tests for rotator cuff tear and

bicep tendon inflammation

DIP

PIP

MCP

joints?

grasp thumb against palm then move wrist toward midline.

+ pain=de quervains tenosynovitis

Thumb abduction

Tinel's sign

Phalen's sign

How do you test for Tinel's sign?

What is positive?

Tap lightly over median nerve.

Aching or numbness in the median nerve

press backs of both hands together downward.

Hold for 60 secs.

numbness and tingling within 60 seconds is positive.

Bulge sign-milk fluid downward, apply medial pressure, tap and watch for fluid wave.

balloon sign-

Ballotting- push down on patella

Anterior drawer sign.

pull foward on tibia.