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Flashcards in Exam 3 Deck (204)
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1
Q

a glistening, taut appearance suggests

A

ascites

2
Q

a bluish periumbilical discoloration is known as ___ and suggests __

A

cullen’s sign

intraabdominal bleeding

3
Q

Recent origin color of straie

A

pink or blue

4
Q

color of straie over time

A

silvery white

5
Q

What can produce straies

A

abdominal tumors, ascites, pregnancy, or weight gain

6
Q

straie remains purplishs in what disease

A

cushing disease

7
Q

a pearl-like, enlarged and sometimes painful umbilical nodule is known as __

A

Sister Mary Joseph’s nodule

8
Q

Sister Mary Joseph’s nodule may be the first sign of waht

A

intraabdominal malignancy

9
Q

the abdominal profile fromt he rib margin to the pubis

A

contour

10
Q

Expected contour

A

flat, round, and scaphoid

11
Q

expected contour in children

A

rounded or convex

12
Q

Where should the maximum height of convexity be in an adult?

A

at the umbilicus

13
Q

distention from the umbilicus to they symphysis can be caused by

A

an ovarian tumor, pregnancy, uterine fibroids, or distened bladder

14
Q

distension of the upper half, avoce the umbilicus, can be due to

A

tumor, pancreatic cyst, or gastric dilation

15
Q

hernia cause by defect in abdominal muscularture that develops after a surgical incision

A

incisional hernia

16
Q

protrusion of the navel indicates

A

umbilical hernia

17
Q

typical adult herniation occurs during

A

pregnancy, longstanding ascites or when intrathoracic pressure is repeatedly increased, as in chronic respiratory disease

18
Q

Hernia that occurs in the midline of the epigastrum

A

hernia of the linea alba

19
Q

characteristics of a hernia of the linea alba

A

contains fat and is felts as a small tender nodule

20
Q

separation of the rectus abdominis muscle

A

diastasis recti

21
Q

common causes of diastasis recti

A

pregnancy and postpartum period

22
Q

males exhibit what type of movement with respiration

A

primarily abdominal movement

23
Q

females exhibit what type of movement with respiration

A

costal movement

24
Q

limited abdominal motion is associated with respiration may indicate

A

peritonitis

25
Q

surface motion from peristalsis is seen as ___ and may also indicate

A

rippling movement across the abdomen

intestinal obstruction

26
Q

loud prolonged gurgles (stomach growling)

A

borborygmi

27
Q

increased bowel sounds may occur with

A

gastroenteritis, early intestinal obstruction or hunger

28
Q

high pitched tinkling sounds in the abdomin suggest

A

intestinal fluid and air under pressure

29
Q

decreased bowel sounds occur with

A

peritonitis and paralytic ileus

30
Q

Where do you listen for friction rubs?

A

over liver and spleen

31
Q

high pitched rubs heard in associated with respiration

A

friction rubs

32
Q

friction rubs may indicate

A

inflammation of the peritoneal surface of the organ from tumor, infection or infarct

33
Q

Occurs with increased collateral circulation between the portal and systemic venous systems

A

venous hum

34
Q

the predominant sound in the abdomen because air is present in the stomach and intestines

A

tympany

35
Q

___ is heard over organs and solid masses

A

dullness

36
Q

a lower liver border that ismore than ________ below the costal margin may indicate organ enlargment or downard displacement of the diaphragm

A

2-3cm (3/4- 1 inch)

37
Q

begin percussion for the upper border of the liver around __

A

3rd intercostal space on right midclavicular line

38
Q

Upper border of the liver is usually around ___ intercostal space

A

5th

39
Q

The usual span of the liver is about

A

6-12cm or 2.5-4.5inches

40
Q

liver span is usually greater in

A

males and in tall individuals

41
Q

Usual span of the liver at the midsternal line is

A

4-8cm or 1.5- 3inches

42
Q

Where do you percuss the spleen

A

just posterior to the midaxillary line on the left

43
Q

what is the semilunar region defined by the 6th rib superiorly, midaxillary line laterally, and left costal margin inferiorly

A

Traube’s space

44
Q

What does Traube’s space overlie

A

the fundus of the stomach

45
Q

____ is known as the speen going forward and downward with inspiration

A

splenic percussion sign

46
Q

Tympany produced by gastric bubbles is ___ in pitch than that of tympany of the intestines

A

lower

47
Q

depress abdominal wall in ____ and in a __ motion for light palpation

A

no more than 1cm deep

circular motion

48
Q

___ palpation is useful in identifying muscular resistance and areas of tenderness

A

light palpation

49
Q

Boardline hardness of the abdominal wall overlying areas of peritoneal irritation

A

rigidity

50
Q

use side of the hand with ___ palpation

A

moderate

51
Q

as the patient inspires, the organ is displaced ____

A

downward

52
Q

how do you check for liver tenderness when the liver is not palpable

A

use indirect fist percussion

53
Q

palpable tender gallbladder indicates

A

cholecystitis

54
Q

palpable nontender gallbladder indicates

A

common bile duct obstruction

55
Q

what test do you perform if you suggest choleystitis

A

Murphy sign

56
Q

patients with splenomegaly from infectious mononucleosis have a small risk for

A

spontaneous splenic rupture

57
Q

liver edge tends to be ___ and the kidney edges tends to be ___

A

sharp

round

58
Q

where do you palpate for the aorta

A

left of midline

59
Q

a pathologic incrase in fluid in the peritoneal cavity

A

ascites

60
Q

signs of ascites

A

protuberant abdomen or bulging flank when supine
shifting dullness of percussion
easily detected fluid wave

61
Q

alvarado score is also known as

A

MANTRELS

62
Q

MANTRELS stands for

A
Migration of pain
Anorexia
Nausea/vomitting
Tenderness in RLQ
Rebound pain
Elevation of temp
Leukocytosis
Shift to the left
63
Q

Scoring tool that uses pain with cough, hopping or rebound tenderness with percusioon in place of RLQ

A

Pediatric Appendicitis Score

64
Q

Scoing tool that uses patient age, history, physical exam, and laboratory findings

A

Ohmann Score

65
Q

Ohmann score is used to assess risk of

A

appendicities

66
Q

Rebound tenderness is used to assess for

A

peritoneal inflammation

67
Q

a sharp stabbing pain at the site of peritoneal inflammation during the rebound tenderness test is a positive ____

A

Blumberg sign

68
Q

Rebound tenderness of McBurney’s point suggests

A

appendicities

69
Q

When is an iliopsoas muscle test performed

A

to assess for appendicities

70
Q

When do you perform an obturator muscle test

A

when you suspect a ruptured appendix or pelvic abscess due to irritation of the obturator muscle

71
Q

How to perform an obturator muscle test

A

have patient lay supine, flex right leg at the hip and knee 90 degrees, rotate the leg laterally and medially

72
Q

Where is pain felt during the obturator muscle test when there is irritation of the obturator muscle

A

right hypogastric region

73
Q

A palpation technique used to assess an organ or mass

A

ballottement

74
Q

extensive outward curvature of the spine

A

kyphosis

75
Q

extensive inward curvature of the spine

A

lordosis

76
Q

spine curved side to side

A

scoliosis

77
Q

muscle wasting occurs after injury as a result of

A

pain, disease of muscle, or damage to motor neurons

78
Q

synovial thickening can be felt synovium is ____ bc of inflammation

A

edematous or hypertrophied

79
Q

tenosynovitis can cause ___ with ____

A

crepitus with movement of a tendon inside the tendon sheath

80
Q

passive range of motion often excees active range of motion by ____ degrees

A

5

81
Q

what is used to precisely measure the angle of motion

A

goniometer

82
Q

disability is present when muscle strength is ___

A

grade 3 or less

83
Q

What grade is it when there is full range of motion against gravity but not against resistance

A

3

84
Q

rounded mound on palm under thumb

A

thenar eminence

85
Q

deviations of the fingers on the ulnar side and swan neck, or boutonniere deformities of fingers indicate

A

RA

86
Q

where/how do you palpate the radiocarpal groove

A

with thumbs on dorsal side of hand

87
Q

bony overgrowths in the distal interphalangeal joint, which are felt as hard, nontender nodules usually 2-3 mm in diamtere but sometimes encompassing entire joint are associated with __

A

osteoarthritis

88
Q

bony overgrowths that are located along distal interphalangeal joint are called

A

Heberden nodes

89
Q

bony overgrowths that are located on proximal interphalangeal joints are called

A

Bouchard nodes

90
Q

painful swelling of prox. interphalangeal joints that causes spindle-shaped fingers are associated with

A

acute stage of RA

91
Q

cystic, round, nontender swellings along tendon sheaths or joint capsules that are more prominent w/ flexion may indicate

A

ganglia

92
Q

Expected metacarpophalangeal flexion

A

90 degrees

93
Q

Expected metacarpophalngeal hyperextension

A

30 degrees

94
Q

Expected flexion of the wrist

A

90 degrees

95
Q

Expected hyperextension of the wrist

A

70 degrees

96
Q

Expected radial motion

A

20 degrees

97
Q

expected ulnar motion

A

55 degrees

98
Q

subcutaneous nodules along pressure points of the ulnar surface may indicate

A

RA or gouty tophi

99
Q

expected carrying angle between humerus and radius with passive extension

A

5-15 degrees laterally

100
Q

lateral angle exceeding 15 degrees

A

cubitus valgus

101
Q

a medial carrying angle

A

cubitus varus

102
Q

Palpate the extensor surface of the ulna, olecranon process, and medial and lateral epicondyles of the humerus when the patient’s elbow is at ___ degrees

A

70 degrees

103
Q
  • boggy, soft, or fluctuant swelling
  • point of tenderness at lateral epicondyle or along the grooves of olecranon process and epicondyles
  • increased pain w/ pronation and supination of the elbow

all indicate

A

epicondylitis or tendonitis

104
Q

expected flexion of the elbow

A

160 degrees

105
Q

expected extension of the elbow

A

180 degrees or back to 0

106
Q

Expected pronation and supination of elbow when flexed at 90 degrees

A

90 degrees for both

107
Q

asymmetric shoulder contour and when one shoulder has hollows in the rounding contour indicate

A

shoulder dislocation

108
Q

winged scapular, an outward prominence of scapula indicate

A

injury to serratus anterior muscle nerve

109
Q

Where do you palpate biceps groove

A

anterior aspect of humerus

110
Q

where do you palpate the insertion of supraspinatus, infraspinatus, and teres minor

A

near greater tuberosity of humerus

111
Q

Expected shoulder flexion

A

180 degrees

112
Q

Expected hyperextension of the shoulders

A

50 degrees

113
Q

Expected shoulder abduction

A

180 degrees

114
Q

Expected adduction of shoulder

A

50 degrees

115
Q

Expected internal rotation of shoulder

A

90 degrees

116
Q

Expect external rotation of shoulders

A

90 degrees

117
Q

What is assessed when the patient tries to resist opposing pressure during a shoulder shrug

A

shoulder strength

CN XI

118
Q

Where do you put your fingers when locating the temporomandibular joint

A

anterior to tragus of each ear

119
Q

Expected space between upper and lower teeth when the jaw is open

A

3-6cm

120
Q

Expected lateral movement of the jaw

A

1-2cm in each direction

121
Q

testing strength of temporalis and masseter muscles also tests

A

CN V

122
Q

Cervical spine should be ___

A

concave

123
Q

Expected flexion of the cervical spine

A

45 degrees

124
Q

Expected lateral bending of the cervical spine

A

40 degrees

125
Q

Expected rotation of of the cervical spine

A

70 degrees

126
Q

What is testing when the patient resists opposing forces of cervical spine movements

A
  • strength of sternocleidomastoid and trap muscles

- CN XI

127
Q

major landmarks of the back

A

C7, T1, scapulae, iliac crest, paravertebral muscles

128
Q

Head should be positioned directly over the

A

gluteal cleft and the vertebrae

129
Q

curve of thoracic spine should be

A

convex

130
Q

curve of lumbar spine should be

A

concave

131
Q

a form of structural kyphosis with a sharp angular deformity

A

gibbus

132
Q

a gibbus is associated with

A

a collapsed vertebrae from osteoporosis

133
Q

lateral curvature or rib hump when bending over indicates

A

scoliosis

134
Q

Expected flexion of the waist

A

75-90 degrees

135
Q

expected hyperextension of the waist

A

30 degrees

136
Q

Expected lateral bending of the waist

A

35 degrees bilaterally

137
Q

Expected rotation of the upper trunk is __ degrees forwards and backwards

A

30 degrees in both directions

138
Q

Expected flexion of the hip

A

90 degrees

139
Q

Expected hyperextension of the hip

A

30 degrees or less

140
Q

Expected hip flexion with knee flexed

A

120 degrees

141
Q

Expected abduction of hip

A

45 degrees

142
Q

Expected adduction of hip

A

30 degrees

143
Q

Expected internal rotation of the hip

A

40 degrees

144
Q

Expected external rotation of the hip

A

45 degrees

145
Q

what does FABER stand for

A

Flex
ABduct
Externally Rotate

146
Q

Major landmarks of knees and legs

A

tibial tuberosity, medial an lateral tibial condyles, medial and lateral epicondyles of the femur, adductor tubercle of the femur, patella

147
Q

loss of natural concavities of knees suggest

A

knee effusion

148
Q

expected angle between the femur and tibia

A

less than 15 degrees

149
Q

genu valgum

A

knock knees

150
Q

genu varum

A

bowlegs

151
Q

excessive hyperextension of the knee with weight bearing

A

genu recurvatum

152
Q

genu recurvatum indicates

A

weakness of the quadriceps muscles

153
Q

when the knee appears convex

A

knee effusion

154
Q

fullness in the popliteal space may indicate

A

popliteal cyst or baker cyst

155
Q

Expected knee flexion

A

130 degrees

156
Q

Expected extension/ hyperextension of knee

A

full extension and up to 15 degrees of hyperextension

157
Q

landmarks of the ankle

A

medial malleolus, lateral malleolus, achilles tendon

158
Q

pes varus

A

in-toeing

159
Q

pes valgus

A

out-toeing

160
Q

The foot should have a __ arch

A

longitudinal arch

161
Q

a foot that remains flat even when not bearing weight

A

pes planus

162
Q

a high instep

A

pes cavus

163
Q

pes cavus is associated with

A

claw toes

164
Q

hyperextension of the metatarsophalangeal joint with flexion of the toes proximal joint

A

hammertoe

165
Q

a flexion deformity at the distal interphalangeal joint

A

mallet toe

166
Q

hyperextension of the metatarsophalangeal joint with flexion of the toes proximal AND distal joints

A

claw toe

167
Q

lateral deviation of the great toe, which may cause overlapping with the second doe

A

hallux valgus

168
Q

an inflammed painful bursa at a pressure point

A

bunion

169
Q

inflamed metatarsophalangeal joint of great toe suggests

A

gouty arthritis

170
Q

spondyloarthritis or xanthelasma of hyperlipidemia can cause

A

tendonitis

171
Q

expected dorsiflexion

A

20 degrees

172
Q

expected plantar flexion

A

45 degrees

173
Q

expected inversion

A

30 degrees

174
Q

expected eversion

A

20 degrees

175
Q

Expected abduction of ankle

A

10 degrees

176
Q

expected adduction of ankle

A

20 degrees

177
Q

what innervates palm of hand, palmar surface of thumb, index and middle fingers and half of ring finger

A

median nerve

178
Q

thumb abduction test isolates what muscle

A

abductor pollicis brevis (innervated by median nerve)

179
Q

weakness with thumb abductor test indicates

A

carpal tunnel syndrome

180
Q

numbness and paresthesia in the distribution of the median nerve during the phalen test indicate

A

carpal tunnel syndrome

181
Q

Positive tinel sign indicates

A

carpal tunnel syndrome

182
Q

positive neer test indicates

A

rotator cuff inflammation or tear

183
Q

What test forward flexes the patient’s arm up to 150 degrees while depressing the scapula (presses greater truberosity and supraspinatus muscles against the anteroinferior acromion)

A

Neer test

184
Q

positive hawkins test indicates

A

rotator cuff inflammation or tear

185
Q

what test abducts the shoulder to 90 degrees, flexes elblow to 90 degrees then internally rotates arm to its limit

A

hawkins test

186
Q

what muscle is being assessed when you have the patien place the arm in 90 degrees of abduction, 30 degrees of forward flexion, and internally rotate (thumbs pointing down)

A

supraspinatus muscle

187
Q

what muscle is being assessed when you ahve the patient hold the arm at the side, elbow flexed 90 degrees, and rotate the forearm medially against resistance

A

subscapularis muslce

188
Q

what muscles are being assessed when the patient holds the arm at the side, elbow flexed 90 degrees, and rotate the armlatearlly against resistance

A

infraspinatus and teres minor

189
Q

straight leg raising test is used to test for

A

nerve root irritation of lumbar disk herniation at L4, 5, and S1 levels

190
Q

crossover pain with the straight leg test indicates

A

sciatic nerve impingements

191
Q

radicular pain below the knee with straight leg raising test indicates

A

disk herniation

192
Q

femoral stretch test or hip extension test is used to detect

A

inflammation of nerve root L1, 2, 3 and sometimes L4

193
Q

what test is used to detect flexion contractures of the hip that may be maksed by excessive lumbar lordosis

A

thomas test

194
Q

what test detects weak hip abductors muscles

A

trendelenburg test

195
Q

what is used to determine the presence of excess fluid or an effusion of the knee

A

ballottement or bulge sign

196
Q

what test is used to detect a torn medial or lateral meniscus

A

McMurray test

197
Q

rotating the foot and knee outward to lateral position applies __ stress

A

valgus stress

198
Q

rotating the foot and knee inward applies __ stress

A

varus stress

199
Q

what test is used to dectect torn ACL or PCL

A

anterior or posterior drawer test

200
Q

anterior or posterior movement of the knee of ___ during the drawer test is an unexpected finding

A

greater that 5mm

201
Q

what test is used to assess ACL integrity

A

Lachman test

202
Q

what tests are used to assess instability of LCL and MCL

A

varus (abduction) and valgus (adduction) stress tests

203
Q

varus force of knee is directed ___ and laxity indicates injury to what ligament

A

toward the midline (laxity indicated injury to MCL)

204
Q

valgus force of knee is directed ___ and laxity indicates injury to what ligament

A

away from the midline (laxity indicated injury to MCL)