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PCM Review (Test 1) Flashcards

1
Q

Body Position and Patient Skills

A
  • Right Lateral Renumber: Patient lying on RIGHT SIDE (left side up)

ABDOMINAL EXAM:

1) INSPECTION:
- LOOK at your Patient

  • Are they Responsive? Are they Agitated? Do they look Sick?

2) AUSCULTATION (Use Stethoscope to Identify Sounds):
- Heart, Lungs, Abdomen (If Indicated), Vessels (Renal, Abdominal, Carotids, Etc [If Indicated])

  • Lungs: Deep Breath IN and OUT through Mouth at each Lung Lobe Location

3) PERCUSSION (Tap with 3rd Finer over Last Joint):
- DULL (Fluid) vs FLAT (Solid) vs TYMPANIC (Air)

4) PALPATATION

**RESPIRATION has the AUSCULTATION LAST!!!!!!!!

**ALWAYS CHECK BILATERALLY- You don’t want to miss something like a diminished Pulse Pressure on One side and find out later that was a CRUCIAL aspect of the DIFFERENTIAL!

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2
Q

Osteopathic Structural Exam

A

1) Body = UNIT
2) Body = Self- Regulatory Mechanisms
3) Structure and Function are RELATED
4) Using 1 through 3 —> RATIONAL THERAPY
5) OSE uses Musculoskeletal Exam even in NOT CHIEF COMPLAINT

***Use LAY TERMS so that you patient feel a part of the CONVERSATION because they are YOUR BEST TOOLS!!!!

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3
Q

Opthalmoscope

A

EYES

  • Hand on Patient: Use Your RIGHT eye to examine patients RIGHT Eye —–> Start LATERALLY —> Move MEDIALLY —–> RED REFLEX!!!!!!!!
  • DIRECT PUPIL LIGHT REFLEX: That pupil CONSTRICTS vs CONSENSUAL (Light in Eye 1 —> Constriction of Eye 2)
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4
Q

Otoscope

A

EARS

  • Adults: Up, Out, and AWAY
  • CONE of LIGHT and TYMPANIC MEMBRANE
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5
Q

Snellen Chart

A
  • Visual ACUITY TESTED: Hold at about 14 Inches from EYES
  • Normal 20/20
  • 20/40 means that the test subject sees at 20 feel what fNormal person sees at 40 Feet!
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6
Q

Oropharynx

A
  • Light + “AHHHHHH” —-> Examine Mucosa, Pharynx, Uvula, Tonsils, Etc
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7
Q

BP Cuff (Spygmomanometer)

A
  • Choose what fits the PATIENT —> Wrap Cuff over BRACHIAL ARTERY—-> Fill —> Listen
  • 1st Sound Heard: 1st Korotkoff Sound (Systole)
  • 2nd Sound: Last Korotkoff Sound (Diastole)
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8
Q

Tuning Fork

A

HEARING

  • Air Conduction > Bone Conduction
  • AC: In from of EAM
  • BC: Bone area BEHIND EAR

Vibratory Sense:
- On the KNEE CAP and Compare Bilaterally

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9
Q

Reflex Hammer

A

DEEP TENDON REFLEX

  • Make Sure the Patient is Relaxed
  • Graded from 0 to 4 (2/4 is NORMAL)
    • 3/4: HYPER and 0,1: HYPO

Upper Extremity:
- C5: Biceps, Strike THUMB

  • C6: Brachioradialis, Strike LIGAMENT
  • C7: Triceps, Strike LIGAMENT

Lower Extremity:
- L4: Patella, Strike TENDON

  • S1: Achilles, Strike TENDON
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10
Q

Stethoscope

A

1) Bell= Bruits (LOW Pitched)!!!!!!!!!!!
2) Diaphragm= Heart/ Lungs (HIGH Pitched)!!!!

***NEVER Listen OVER CLOTHES!!!!!

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11
Q

Standards (CDC)

A

CDC:
- Prevent SPREAD of Disease

  • CLEAN GLOVES
  • WASH hands before AND AFTER WEARING GLOVES!!!
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12
Q

Anatomic Position

A
  • When diagnosing, be able to determine where things are at (Medial, Lateral) you need to Know where it should be!!!!!
    - Ex: Is the Ulna MEDIAL or LATERAL to the Radius?
    * * Ulna is MEDIAL

Be familiar with TERMS, they will be Involved in EVERYTHING from here on out!!!
- Medial/ Lateral

  • Deep/ Superficial
  • Proximal/ Distal
  • Ipsilateral (Same Side)/ Contralateral (Opposite Side)
  • Anterior/ Posterior (Ventral/ Dorsal)
  • Superior/ Inferior (Cephalic/ Caudad)
  • Prone/ Supine
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13
Q

Coronal/ Frontal Plane

A
  • Divides the Body into ANTERIOR and POSTERIOR (Face or FRON versus Back of the Head)
  • Motion: SIDE BENDING!!!!
  • Anterior/ Posterior AXIS!!!!
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14
Q

Sagittal

A
  • Divides the Body into RIGHT and LEFT
  • Motion: Forward/ Backward Bending aka FLEXION/ EXTENSION (Touch Your Toes)
  • Right/ Left AXIS!!!!!
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15
Q

Transverse

A
  • Divides the Body into SUPERIOR and INFERIOR (Upper versus Lower)
  • Motion: ROTATION
  • LONGITUDINAL (Superior/ Inferior) AXIS!!!!!!
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16
Q

Axis

A
  • Imaginary Line around which Motion Occurs

- PERPENDICULAR to the PLANE!!!!

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17
Q

Gravitational Line

A

1) Head: External Auditory Canal
2) Arms: lateral Head of the Humerus
3) Spine: 3rd Lumbar Vertebrae
4) Sacrum: Anterior 1/3 of the Sacrum
5) Hip: Greater Trochanter
6) Knee: Lateral Condyle of the Knee
7) Ankle: Lateral Malleolus

  • ***Related to Posture:
  • Goal: The Body wants to MAINTAIN EYE LEVEL!!!!!!
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18
Q

Scoliosis

A
  • S SHAPED curve (Lateral Curve)
  • Side Bending
  • CORONAL PLANE
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19
Q

Rotated

A
  • Looking a a DIFFERENT DIRECTION
  • Rotated
  • TRANSVERSE PLANE
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20
Q

Kyphosis

A
  • HUNCHED OVER
  • Bent FORWARD/ Flexion
  • SAGITTAL PLANE!!!!!!!
  • Concave: ANTERIOR
  • Convex: POSTERIOR
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21
Q

Lordosis

A
  • Extremely ARCHED
  • Bench BACKWARD/ Extension
  • SAGITTAL PLANE!!!!!
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22
Q

Pectus Excavatum

A
  • Funnel Chest. Abnormal DEPRESSIOn

- “Excavate” —> “Dig a Hole”

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23
Q

Pectus Carinatum

A
  • PIGEON CHEST
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24
Q

Review the Osteopathic Approach

A
  • Landmarks
  • If one ASIS is HIGHER than the Other, what place is the DYSFUNCTION in???

CERVICAL and LUMBAR= Lordosis!!!!!!

THORACIC and SACRUM = Kyphosis!!!!!!!

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25
Q

Dubins Clinical Correlation

A
  • If a patient comes in with a headache, you would ask them about Vision Problems because the Optic Nerve can be involved with Cranial Problems
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26
Q

Interview Basics I

A

O- Onset
L- Location
D- Duration

C- Characteristics
A- Alleviating Factors
A- Aggravating Factors
A- Associated Symptoms
R- Radiation
T- Timing
S- Severity

***Be sure to ask OPEN ENDED QUESTIONS!!!!!!!

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27
Q

Soap Note

A

Subjective: Something you get from talking to them

  • CC
  • HPI
  • PMH
  • PSH
  • Meds
  • SH
  • Alls
  • FH

Objective: Something you get from the Physical Exam

  • Vital Signs
  • Heart
  • Lungs
  • OSE

Assessment: Relating it to a Diagnosis
- Restatement of the Chief Complaint followed by 3 Differential Diagnosis

Plan: What will you do for them

  • OMT
  • Meds
  • Diagnostic (EKG, Radiology)
  • Self-Care Instructions (Quit Smoking, No weight Bearing)
  • Follow up
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28
Q

Address Emotions with NURS

A

N: NAME the Patient’s Expressed EMOTION

U: Make an UNDERSTANDING Statement

R: RESPECT the Patient (Praise them, acknowledge Plight)

S: Offer SUPPORT

**Ask them why they’re agitated, DO NOT ASSUME!!!!!!!

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29
Q

Discuss the rationale behind and Demonstrate ability to obtain a Substance use History with attention to the CAGE Questions

A

ALCOHOL:
- DO they Consume it? What form?

  • A response of “LESS THAN 24 HOURS AGO” to this last question has a POSITIVE PREDICTIVE vale of 68% and a NEGATIVE PREDICTIVE Value of 98% for ALCOHOL ABUSE!!!!!!!!!

Consider “CAGE”ing them: Have you ever….
1) Felt the need to CUT BACK on your Drinking?

2) Felt ANNOYED by criticism of your Drinking?
3) Had GUILTY feeling about your Drinking?
4) Take a morning EYE OPENER?

*** If 2 OR MORE of these are YES—–> 90% SENSITIVITY and SPECIFICITY for ALCOHOL DEPENDENCE!!!!!!!!!!!

NIAA Safe Drinking Limits:
1) Men: 14 or fewer drinks per week, no more than 4 drinks per Day

2) Women and those above 65: 7 drinks per week, or more than 3 in a day!

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30
Q

Tobacco

A
  • What form

- Pack Years: (Years Smoking) x (Packs/day)

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31
Q

Street Drugs

A
  • What they use?
  • How much?
  • Share needles?

***Ask other questions like if they have ever had a problem using Addicting Substances (Divorce, Job Loss, Delirium, Tremers for Alcohol Withdrawal, Emphysema from Cigarettes)

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32
Q

Discuss the rationale behind and demonstrate ability to obtain a Sexual History with attention to the 5 Ps!!!!!

A

1) Partners:
- Men, Women, Both: How many, over how long

2) Prevention of Pregnancy:
- What Method

3) Protection from STDs:
- What do they do/ do they use Condoms

4) Practices:
- For understanding wish of STIs- Vaginal, Anal. Oral Sex

5) Past History of STDs:
- Have you or your partner had an STI ever?

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33
Q

Discuss the Rationale behind and demonstrate ability to screen for risk of Domestic Violence and other issues of Personal Safety

A
  • If you suspect DOMESTIC VIOLENCE a good opening question: “Have you ever been Hit, Slapped, Kicked, or Otherwise hurt physically by someone? Yes? ——> Ask the SAFE Questions!!!!!!

S: Safety/ Stress
- What stress do you experience in your relationship? Should I be concerned about your safety?

A: Afraid/ Abuse
- Are there situations in your relationships where you have felt afraid?

F: Friends/ Family
- Are your friends, parents, or siblings aware that you’ve been hurt?

E: Emergency Plan
- Do you have a safe place to go and resources you need in an Emergency?

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34
Q

Discuss the Rationale behind and Demonstrate ability to elicit a patient’s Spiritual Beliefs, Diet, Exercise, and Caffein Use

A

Diet:
- 24 hour recalls “tell me what you ate in the last 24 Hours”

  • Eating habits
  • Ex: Bulimia “Are you satisfied with your eating habits?”

Special Dietary area to consider asking about:

1) Na INTAKE:
- Hypertensive?

  • Heart Failure or Renal Patients?
  • Do they add Salt to the cooking, or eat a High Sodium Food (soups, restaurant meals)

2) FAT:
- Thinking about Cholesterol and Vascular disease

  • Ex: Dairy, Egg, Raw Meat, Organ Meats

3) CAFFEINE:
- Thinking about Nervousness, Tremors, Palpitations, Sleep Disturbances.

  • Note Caffeine can come in many forms (Soda, Coffee, Tea, Supplement, “pre-workout”
    4) FIBER: GI Problems
    5) DAIRY: GI Problems- maybe lactose Intolerant and they’d don’t know
    6) WHEAT: Gluten Enteropathy
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35
Q

CDC Exercise Recommendations

A
  • CDC recommendations get 150 Minutes per week of Moderate Activity (brisk walking) and strength Training 2 days of the week that focus on All Major Muscle Groups
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36
Q

Faith/ Spirituality

A

FICA:

FAITH and BELIEVE: Do you consider yourself a spiritual or religious person?

IMPORTANCE: What importance does faith have in your life

COMMUNITY: Are you a part of spiritual or religious community?

ADDRESS IN CARE: Asking them if they want you to Address these issues int heir care

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37
Q

When entering patient room

A
  • Handshake
  • Introduce yourself (Student Doctor First Name, Last Name)
  • Hand Sanitizer
  • Sit
  • Explain your role
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38
Q

Physical Exam

A
  • Heart
  • Lungs
  • OSE
  • 1 to 2 Specific Tests
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39
Q

What is Biomechanics

A
  • The Study and Function of Biological Systems by looking at the STATICS, DYNAMICS, and MECHANICS of MATERIALS (What they’re like when still, then in motion, how they work together)
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40
Q

We need Biomechanics to Understand Human Physical Performance

A
  • How motions are PERFORMED
  • How we CONTROL MOTION
  • How forces (Internal and External) affect the human body and tissues
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41
Q

Leonard Da Vinci

A
  • First to STUDY in the context of MECHANICS

- Analyze MUSCLE FORCES as acting along point son attachment and Joint Function

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42
Q

Galileo Galilei

A

STRENGTH of BONES:
- Increasing Body Mass Correlated with an INCREASE in BONE DIAMETER

  • LOAD Bearing Strength
  • Suggested that BONES are hollow to MAXIMIZE STRENGTH and MINIMIZE STRENGTH
43
Q

What is GAIT CYCLE

A
  • One GAIT is from a HEEL STRIKE to a HEEL STRIEK on the SAME FOOT!!!!
  • Two Phases:
    1) STANCE: When the foot is on the Ground
    2) SWING: Foot not on the Ground
  • There are Changes in the Average Step Length, Cadence, and Speed when considering Age, Pain, Disease, or Fatigue!!!!!
44
Q

Lets Start Walking

A

1) CONTACT
- LATERAL aspect of the CALCANEUS strikes the Ground
- TIBIA INTERNALLY ROTATES and the CALCANEUS to EVERT, thus the TALUS Drops and ADDUCTS (The Foot is currently a Shock Absorber)
- PRONATION!!!!!!!!!!!
- EXTENSOR DIGITORUM LONGUS and TIBIALIS ANTERIOR relax slowly to LOWER the FOOT to the GROUND
2) MID-STANCE
- Before we can HEEL-OFF, we must GET FLAT-FOOTED: the Rear foot as FULLY PRONATED. Metatarsals hit the Ground, and the BODY’S CENTER of GRAVITY MOVES SO THAT IT IS OVER THE FOOT!!!!!
- To get HEEL-OFF, the SUBTALAR JOINT RESUPINATES, which LOCKS the MIDTARSAL JOINT: The foot is now a RIGID LEVER!!!!!
- POSTERIOR TIBIALIS prevents OVERPRONATION and is an ACTIVE SUPINATOR!!!!!

45
Q

Take a Step

A

1) PROPULSION
- Heel- Lift becomes TOE-OFF
- The Center of Gravity Passes over the METATARSALS and begins to PULL THE HEEL UP!!!
- MTP JOINTS (Especially 1st MTP) EXTEND: WINDLASS Effect of Plantar Fascia (ELEVATING ARCH, ASSISTING SUPINATION)
- Supination means we have a RIGID LEVEL: We can now PROPEL the FOOT FORWARD via Maximal Contraction of GASTROCNEMIUS-SOLEUS and HAMSTRINGS!!!!
- Phase CONCLUDES with Body Weight moving OVER GREAT TOE before all Weight is TRANSFERRED to OTHER FOOT
2) SWING:
- FOOT DORSIFLEXES to Keep TOES from HITTING the GROUND
- FOOT SUPINATES (Gets it further away from the Ground, Stabilizes it in Preparation for the FIRST Jarring MOMENT of HEEL STRIKE)

46
Q

Review of Gait

A

1) STANCE:
- From Heel Strike (Initial Contact) to Toe Off (Pre-Swing)
- Approximately 60% of the CYCLE
- Foot is on the Ground and Bearing Weight
- This is when Most Problems Occur
2) SWING:
- From Toe Off to HEEL STRIKE
- Foot is Moving FORWARD and is NON WEIGHT BEARING

  • ***PRESWING PHASE is 50-60% of the STANCE PHASE!!!!!!!
  • About to Initialize Swing
47
Q

Requirements for Gait

A

1) STABILITY in STANCE
- Need a stable foot, Ankle, Knee, Hip, and Torso

2) FOOT CLEARANCE in SWING
- Coordination of Ankle Dorsiflexion, Knee Flexion, and Hip Flexion

3) Pre-POSITION for INITIAL CONTACT
- Ready to PLACE FOOT in the DESIRED LOCATION, Ready to ABSORB WEIGHT

4) Adequate STEP LENGTH
- Too SHORT, EXPENDS too much ENERGY for too Little Progress

  • Too LONG, will make BALANCE DIFFICULT and will Strain Ligaments and Muscle

5) ENERGY Conservation
- Center of GRAVITY barely moves Vertically
- HIP DROPS on the Side of the NON WEIGHT BEARING side to COMPENSATE

  • PELVIS rotates FORWARD on the SIDE Ready for HEEL STRIKE: “Lengthens” the FEMUR!!!!!!!
48
Q

Pathologic Gaits (Antalgic)

A
  • PAINFUL
49
Q

Pathologic Gaits (Anthrogenic)

A
  • Stiff
50
Q

Pathologic Gaits (Ataxic)

A
  • UNSTABLE (Imagine a Dizzy person Staggering)
51
Q

Pathologic Gaits (Parkinson or Festinating)

A
  • SHUFFLING, Slow
52
Q

Pathologic Gaits (Steppage)

A
  • HIGH KNEES to compensate for FOOT DROP
53
Q

Pathologic Gaits (Hemiplegic)

A
  • NO FLEXION of Knee or Ankle, SEMICIRCLE made with HIP!!!!
54
Q

Anatomical Relationship of Scapula

A

1) T3: Spine fo Sacpula

2) T7: Inferior Angle of Scapula

55
Q

GH joint and Muscles

A

1) FLEXION: Deltoid and Coracobrachialis
2) EXTENSION: Latissimus Dorsi and Teres Major
3) ABDUCTION: Supraspinatus and Mid Deltoid
4) ADDUCTION: Pec Major and Latissimus Dorsi
5) External Rotation: Infraspinatus and Teres Minor

56
Q

SC Joint

A

1) ABDUCTION: Pt Shrugs Shoulders
- Distal End of Clavicle: SUPERIOR

  • Proximal End of Clavicle: INFERIOR

2) ADDUCTION: Pt Lowers Shrugged Shoulder
- Distal End of Clavicle: INFERIOR

  • Proximal End of Clavicle: SUPERIOR

3) HORIZONTAL FLEXION: Pt Raises Hand in Air
- Distal End of Clavicle: ANTERIOR

  • Proximal End of Clavicle: POSTERIOR

4) HORIZONTAL EXTENSION: Pt Lowers Arms
- Distal End of Clavicle: POSTERIOR

  • Proximal End of Clavicle: ANTERIOR

***KNOW DERMATOME PATTERN OF ARM

57
Q

Muscle Weakness of Shoulder

A

1) APLEY SCRATCH TEST: Test Pt ROM!!!!

  • 2 Parts:
    1) ABDUCTION and EXTERNAL ROTATION2) ADDUCTION and INTERNAL ROTATION

2) LIFT OFF TEST: Subscapularis Weakness
- Arm INTERNAL ROTATION and ADDUCTION (Like being Handcuffed)

  • Pt TRY to LIFT OFF: If Cannot = Positive Sign!!!!
58
Q

GH Instability

A

1) APPREHENSION Test: Positive if Pt Apprehensive
- Shoulder Abducted to 90 Degrees and Elbow Flexed to 90 Degrees
- Bring into EXTERNAL ROTATION, look for APPREHENSION
2) SULCUS Sign: Positive if SULCUS Appears
- Grasp Elbow and apply INFERIOR Traction
- Look for SULCUS to DEVELOP in GH Joint!!!!!

59
Q

Long Head of Biceps

A

1) YERGASON TEST:
- Arm at 90 Degrees at Side, Doctor monitors at BICIPITAL GROOVE!!!!!

  • Have Pt EXTERNALLY ROTATE and SUPINATE ARM
  • If Pain or Popping, POSITIVE TEST

2) SPEEDS TEST:
- Pts Arm Extend out in FRONT

  • Have Pt Keeping Arm STRAIGHT try to FLEX SHOULDER against RESISTANCE
  • Pain or Tenderness, Positive Test
60
Q

Rotator Cuff Impingement

A

1) NEER IMPINGEMENT:
- Passively Flex a Pts Fully PRONATED Forearm

  • If Pain, SUBACROMIAL or ROTATOR CUDD IMPINGEMENT

2) HAWKINS TEST:
- Exact Same Setup as APPREHENSION TEST

  • Move arm in INTERNAL ROTATION (Like a Hawks Wing), Instead of external rotation
  • If Pain, SUBACROMIAL or ROTATOR CUFF IMPINGEMENT!!!
61
Q

Rotator Cuff

A

1) EMPTY CAN TEST
- Flex Pts Arms to 90 Degrees and ABDUCT to 45 Degrees and INTERNALLY ROTATE till Thumbs Point Down (Like EMPTYING out two cans)
- Press Down on Arm: Pain or Weakness = POSITIVE TEST, Supraspinatus Pathology!!!!!!
2) DROP ARM TEST:
- ABDUCTS arms to Between 90 to 180 Degrees
- Slowly lower arms, if drop or gentle Tap causes them to Drop = POSITIVE TEST
- FULL THICKNESS TEAR SUPRASPINATUS!!!!

62
Q

Muscle Reflexes

A

1) C5: Biceps Tendon
2) C6: Brachioradialis
3) C7: Triceps

63
Q

Valgus/ Varus Testing

A
  • Test Stability of MCL/ LCL in Elbow
  • Valgus Testing: Make a L around the ELBOW Joint
    • Pain or Laxicity = MCL Pathology
  • Varus Testing: Make a gap so a R can fit in it
    • Pain or Laxicity = LCL pathology
64
Q

Ulnar Nerve Entrapment

A
  • Tinels Sign
  • Tap between Olecranon and Medial Epicondyle
  • Positive Sign: Tingling Down Forearm
65
Q

Golfers and Tennis Elbow

A
  • Wrist Flexors Attach to Medial Epicondyle
  • Wrist Extensors to Lateral Epicondyle

GOLFERS Elbow: Test Flexion of Wrist Against Resistance

- Pain at Medial Epicondyle: Positive Test
- Epicondylitis

TENNIS Elbow: Test Extension of Wrist Against Resistance

- Pain at Lateral Epicondyle: Positive Test
- Epicondylitis
66
Q

Coupled Motion at Wrist

A

1) FLEXION: Dorsal Carpal Glide
2) EXTENSION: Ventral Carpal Glide
3) Ulnar Deviation: Ulnar ABDUCTION
4) Radial Deviation: Ulnar ADDUCTION

67
Q

Median Nerve Testing

A

1) OK SIGN: Pt Cannot make an OK sign with Thumb and Index
- Sign of Anterior Interosseous Pathology (Branch of Median Nerve)

2) TINELS SIGN: Tap over the Transverse Carpal Ligament
- Pain or Tingling = Positive CTS

3) PHALENS SIGN: DORSUM of hands put together, hold for 60 seconds
- Pain or Tingling = Positive Test CTS

68
Q

De Quervian’s Tensosynovitis

A
  • Possible Inflammation for Overuse/ repetitive use of a Muscle in:
    1) ABDUCTOR POLLICIS LONGUS

2) EXTENSOR POLLICIS BREVI

FINKELSTEINS TEST:

  • Have Pt make fist Entrapment Thumb
  • Then ULNAR DEVIATE TOWARDS WRIST (Perform a Hammering motion)
  • POSITIVE SIGN: Pain
69
Q

Hip Muscles

A

1) Flexors: Iliopsoas, Sartorius, Rectus Femoris, IT
2) Extensor: Glut Max, Hamstrings
3) Adduction: Adductor Longus
4) Abduction: Glut Med, Sartorius
5) External Rotation: Sartorias, Glut Med, Glut Min

***Tight Hamstrings —> Decrease Hip Flexion —-> EXTENSION DISFUNCTION!!!!!!

  • Be familiar with angles
  • Muscle strength 0/5
70
Q

Innervation and Sensation

A

INNERVATIONS:
1) Flexion: Femoral N (L2-L4)

2) Extension: Inferior Gluteal N (L5-S2)
3) Abduction: Superior Gluteal N (L5-S1)
4) Adduction: Obturator N (L2- L4)

SENSATIONS:
1) Dermatomes (L1-L3)

2) Anterior Femoral Cutaneous (L2-L4)
3) Lateral Femoral Cutaneous (L2-L3)
4) Posterior Femoral Cutaneous N (S2)

71
Q

Compartments

A

1) Central:
- Labrum, Ligamentum Teres, Articular Surfaces

  • Log Roll, C-Sing, Labral Loading/ Distraction, Scour, Apprehension: FABER

2) PERIPHERAL:
- Femoral Neck, Synovial Lining

  • Ely’s, Rectus Femoris

3) LATERAL:
- Gluteus Maximus, Gluteus Minimus, Piriformis, IT Band, Trochanteric Bursa

  • Jump Sign, Straight Leg Raise, Ober’s, Piriformis, Trendelenburg, Patricks: FABERS

4) ANTERIOR:
- Iliopsoas Insertion, Iliopsoas Bursae

  • Patricks: FABERS, Psoas Test, Thomas Test
72
Q

FABERS Three Tests

A

1) Central: Passive work by doc, patient not active
2) Lateral: Patient ABDUCTS against Resistance
3) Anterior: Patient ADDUCTS against Resistance

73
Q

OSE

A
  • Name dysfunctions for where they like to live
  • Check BILATERALLY
  • Be able to take these clinical tests and know what a positive fining is and what is meant for the patient Clinically
74
Q

Trendelenburg

A
  • Everything wants to be eye level, so if we stand on our Right leg, out Right Muscles will have to work harder to CONTRACT and maintain an EVEN BALANCE
  • If there is something wrong with OUR RIGHT Muscle Group, then it will not be able to COMPENSATE—> HIP DROP on the LEFT!!!
75
Q

Knee

A
  • Flexion: 145-150 (Hamstrings, Tibial Divison of Sciatic N)
  • Extension: 0 (Quads, Femoral N)

Q ANGLE:

  • About 15 Degrees
  • Females have a wider Q Angle

Sensation/ DTR/ Strength:
- Candycane Stripe/ Barbershop

  • L4: PATELLA and Medial Malleolus
  • S1: Achilles

Grade:

  • No Movement: 0
  • Gravity Only: 3
  • Resistance: 5
76
Q

Knee Orthopedic Testing

A

1) MCL: Valgus Stress Testing, Neutral and Slight Flexion
- Positive test: Increased Laxity, Pain, Elaborated Endpoint
- Indicated MCL disruption and/ or Joint Capsule Injury

2) LCL: Varus Stress Test
- Increased Laxity, Pain, Elaborated Endpoint
- Indicated LCL Disruption and/ or Joint Capsule Injury

3) ACL: Lachmans and Anterior Drawer
- Pos Test: Increased Laxity, Excessive Movement (Compare Bilaterally), Pain
- Indicated ACL Sprain/ Tear

4) PCL: Reverse Lachmans and Posterior Drawer
- Pos Test: Increased Laxity, Excessive Movement, Pain
- Indicates PCL Sprain/ Tear

5) Patella: Laxity/ Apprehension, Compression, Glide
- Push Medial and lateral
- Grade 1-4!!!!

- If Apprehensive, Previous dislocation or Instability
- Compression: Positive Pain or CREPITUS with Compression. Indicated Articular Surface abnormal/ Injury
- Glide: Pos Pain, Crepitus, Catching with Movement. Indicated Articular Surface Damage

6) Menisci: MCMURRAY and APLEY
A) Medial Meniscus: Internal Rotation and VARUS
- Positive with Pain, Clicking indicated Possible Meniscus Tear

B) Lateral Meniscus: External Rotation and VALGUS
- Positive with Pain, Clicking indicates possible Meniscus Tear

C) Apley Compression: Positive Pain with Compression/ Rotation ---> Nonspecific Meniscal or Collateral Ligament

 D) Apley Distraction: Positive Pain with Distraction/ Rotation ----> COLLATERAL LIGAMENT DAMAGE!!!!
77
Q

Other Knee Pathology

A

1) Unhappy Triad ACL, MCL, Lateral Meniscus!!!!
2) Chondromalacia: No CARTILAGE, Bone on Bone
3) Hamstring Strain: Quick, Explosive Motions
4) ITBS: Overuse
5) Patellar Tendonitis: “JUMPER’s KNEE” and Quadriceps Tendonitis
6) Osgood- Schlatter’s: Adolescents; Slight AVULSION of TIBIAL TUBEROSITY!!!!

78
Q

Ankle/ Foot

A

Anatomy and ROM:
1) Plantar Flexion: 50-65 (Post Compartment, Tibal N)

2) Dorsiflexion: 15-20 (Ant Compartment, Deep Fibular N)
3) Inversion: 20-30
4) Eversion: 10-20

Sensation/ DTR/ Strength:
1) Achilles Tendon: S1

2) L4, L5, S1—–> MEDIAL to LATERAL on FOOT
3) Strength same as other joints

79
Q

Ankle/ Foot Ligamentous Testing

A

1) Anterior Drawer Test:
- Pos Test= Pain or Gapping
- Indicates ATF Ligament Sprain or Tear

2) Talar Tilt Test:
- Pos Test = Pain or Gapping
- Indicates CALCANEOLFIBULAR (CF) Ligament Sprain or Tear

3) EVERSION TEST:
- Pos Test = Pain, Increased ROM, Laxity
- Indicates DELTOID Ligament Sprain or Tear

4) Squeeze/ Cross Leg Test:
- Pos Test = Pain
- Indicates HIGH ANKLE SPRAIN (Syndesmosis)

80
Q

Other Clinical Lower Leg/ Foot PAthology

A

1) Achilles Tendon Rupture: THOMPOSON TEST!!!!!

2) Venous THROMBOSIS:
A) HOMANS: Nonspecific

 B) MOSES: Anterior Compressive Force, Posterior Tibial Vein

3) Morton’s Neuroma: Walking on a MARBLE
4) Plantar Fasciitis: Plantar Aponeurosis —> MFR
5) Turf Toe: 1st Toe Hyperextension
6) Achilles Tendonitis: Pain, Inflammation at Base of Tendon

7) Calf Strains: Gastroc vs Soleus
- Knee Flexion removes GASTROC from Planter Flexion

- Plain/ Inability to Plantar Flex = SOLEUS MUSCLE!!!!!
81
Q

Upper Respiratory Clinical Considerations

A

1) ACUTE BACTERIAL RHINOSINUSITIS:
- 10 or more days without Improvement, High Fever (102), Purulent Discharge —> BACTERIAL

  • AMOXICILLIN (If Allergic to Resistant Bug, then DOXYCYCLINE)
  • FLUSH SINUSES

2) DIZZINESS:
- ENT, CV, RESP, NEURO Causes

  • Differentiate Lightheadedness vs Vertigo/ Spinning vs Imbalance if Possible:
    1) LIGHTHEADEDNESS: usually from HYPOTENSION/ CV Causes of HYPERVENTILATION
        2) VERTIGO: ENT dz (Meniere's, BPPV, Labyrinthitis)
             A) Meniere's: Vertigo + Tinnitus (Ringing) + Hearing Loss

              B) BPPV: Episodic Vertigo (Perform Dix Hallpike to Help Diagnose, Epley Maneuver to Treat)

              C) Labyrinthitis: Hearing Loss, Vertigo (Non episodic), often associated WITH INFECTION (Fever)!!!!!!
82
Q

Upper Respiratory Clinical Considerations Continued

A

1) STREPTOCOCCAL PHARYNGITIS: Group A beta-Hemolytic Strep (S. pyrogens)
- Red, Inflamed Throat, Fever, Inflamed Tonsils with Exudate (fluid)

  - Important to Completely Diagnose and Treat since sequel includes 

  - CENTOR SCORE:
      - 1 pt for each: Fever, Cervical Adenopathy, Tonsillar Exudate, No Cough, Age (1 pt for age  15 yrs)

2) EARACHES: AOM, OE, OM with Effusion:

A) AOM: Behind ear drum, Diagnosed with Infection (red, Swollen, Angry Looking)
- Kids have POOR drainage, EUSTACHIAN TUBE more HORIZONTAL!!!!!!!

B) Otitis Externa: In Ear Canal, Swimmers Ear!!!!

C) OM with Effusion: Fluid Buildup, not with a diagnosed Infection (Not red, just bulging with Fluid)

  - DO NOT GIVE antibiotics 
  - Treat with OMT
83
Q

Grading Tonsils

A

0: In Fossa

+1: Less than 25%

+2: Between 25% and 50%

+3: Between 50% and 75%

+4: Greater than 75%
- All closed up

84
Q

Physical in regards to Cardiac Function

A

1) Inspection
2) Palpation
3) Percussion
4) Auscultation
- Quiet Room
- Gown Patient
- Sitting, Supine, Left Lateral Decubitus

85
Q

Principles of Physical Exam

A

Auscultation:

1) S1:
- MITRAL and TRICUSPID Closure
- Beginning of Ventricular Systole

2) S2:
- AORTIC and PULMONIC Closure
- Marks end of Systole, and beginning of Diastole!!!

86
Q

Heart Sounds

A

1) Aortic Ventricle: 2nd ICS to the RIGHT of STERNUM
2) Pulmonic Valve: 2nd ICS to the LEFT of STERNUM
3) Tricuspid: 4th ICS at LSB
4) Mitral: APEX of Heart, 5th ICS to the LEFT at MIDCLAVICULAR LINE

87
Q

S1 and S2

A

S1:

  • LOUDEST at APEX!!!
  • Beginning of Systole

S2:

  • LOUDEST at BASE!!!
  • End of Systole
88
Q

Normal Expiration and Inspiration

A

Expiration:
- S1 S2 SINGLE SOUND

Inspiration
- Splitting of S2 because of INCREASED VENOUS return during INSPIRATION and MORE TIME for RV to DELIVER BLOOD to the LUNG (Delayed P2)

89
Q

Murmurs Grading System

A

Grade:
1: Barely audible, faint

2: Soft, but easily heard, quiet
3: Loud, without a Thrill
4: Loud with a Thrill
4: Loud with minimal contact between Stethoscope and Chest- THRILL
5: Loud, can be heard without a Stethoscope- THRILL

90
Q

Midsystolic Murmur

A
  • Begins after S1 and stops before S2
91
Q

Pansystolic Murmur

A
  • Starts with S1 and stops at S2 without gap between murmur and heart sounds
92
Q

Late Systolic Murmur

A
  • Usually starts in Mid or Late Systole and persists up to S2
93
Q

Early Diastolic Murmur

A
  • Starts immediately after S2, without a discernible gap, then usually fades into silence
94
Q

Mid diastolic Murmur

A
  • starts a short time after S2
95
Q

Preload

A
  • Stretching of Myocytes prior to CONTRACTION. Its the EDP at the beginning of Systole

**INCREASE in PRELOAD causes an INCREASE in Active Force development up to a LIMIT

96
Q

Afterload

A
  • Load on Heart during EJECTION of Blood from Ventricle
  • Ventricle pressure at end of Systole (ESP)

**INCREASE in Afterload causes a DECREASE in Volume of Blood ejected each Beat!

97
Q

Contractility

A
  • Capacity to produce Active Force at a specified PRELOAD
  • INCREASE in Contractility causes an INCREASE in ability to work
  • DECREASE in Contractility causes a DECREASE in ability to work
98
Q

Rate

A
  • Heart Rate number of Cardiac Cycles per Minute

- Increase output of blood/ minute, but DECREASE output/ beat; VERY HIGH Rate (> 150/ min)

99
Q

Stroke Volume (SV)

A
  • Blood ejected from Ventricle per beat (= EDV-ESV)
100
Q

End Diastolic Volume (EDV)

A
  • Volume of blood in Ventricle at end of DIASTOLE; the PRELOAD
101
Q

End Systolic Volume (ESV)

A
  • Volume of Blood remaining in Ventricle at end of Systole
102
Q

Cardiac Output (CO)

A
  • Volume of Blood per minute pumped out by the Heart (CO = SV x HR)
103
Q

Ejection Fraction (EF)

A
  • Measure Contractility (EF= SV/ EDV)
  • Normal: 50-60%
  • Mod Reduced: 30-39%
  • Mildy Reduced: 40-49%
  • Severely Reduced: 15-29%
104
Q

Kussmauls Sign

A
  • VENOUS COLUMN (JVP) rises during Inspiration, rather than Falls
  • Seen in Right Heart Failure, CONSTRUCTIVE PERICARDITIS or RV Infarction!!!!

PCM (6 decks)

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