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158 Cards in this Set
- Front
- Back
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Define Anorexia Nervosa. |
A serious psychosocial disorder that includes loss of appetite, voluntary starvation and grave weight loss. Person may purge or use laxatives. |
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Define Ascites. |
Free fluid in the peritoneal cavity. |
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Define Borborygmus. |
Creating bowel sounds. |
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What's a bruit? |
A pulsatile blowing sound that occurs with stenosis or occlusion of an artery. |
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What is the costovertebral angle? |
The acute angle formed on either side of the human back between the twelfth rib and the vertebral column |
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What is dysphagia? |
difficulty swallowing |
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What is the epigastric region? |
The area between the costal margins. |
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What is a fluid wave test? |
It is performed by having the patient push their hands down on the midline of the abdomen. The examiner then taps one flank, while feeling on the other flank for the tap. The pressure on the midline prevents vibrations through the abdominal wall while the fluid allows the tap to be felt on the other side. This is a test for free fluid, or ascites, in the abdomen. |
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What is hematemesis? |
Bloody vomit. |
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What is a hernia? |
A protrusion of abdominal viscera through an abnormal opening in the muscle wall. There are different kinds of hernias. |
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What is the hypogastric, or suprapubic, region? |
The area above the pubic bone. |
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What is the iliopsoas muscle test? |
With the person supine, lift the right leg straight up, flexing at the hip, then push down over the lower part of the right thigh as the person tries to hold the leg up. It is painful in the lower right quadrant if the test is positive for appendicitis. |
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What is inspiratory arrest (Murphy's sign)? |
It is a sharp pain on inspiration during palpation of the liver. It indicates cholecystitis. |
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What is cholecystitis? |
Inflammation of the gall bladder. |
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What is melena? |
Black tarry stools, indicating the passage of blood. |
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What is the obturator test? |
The patient lies on her/his back with the hip and knee both flexed at ninety degrees. The examiner holds the patient's ankle with one hand and knee with the other hand. The examiner rotates the hip by moving the patient's ankle away from the patient's body while allowing the knee to move only inward. This supposedly indicates appendicitis if there's pain, but is said to not be a reliable indicator. |
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What is pica? |
An abnormal appetite or craving for substances that are not fit to eat,as chalk or clay, common in malnutrition, pregnancy, etc. |
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What is purging? |
Self induced vomiting |
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What is pyrosis? |
Heartburn. |
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What is rebound tenderness, or Blumberg's sign? |
An indication of peritonitis in which pain is felt upon sudden release of steadily applied pressure on a suspected area of the abdomen. |
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What is referred pain? |
Pain that is felt at a particular site but originates from another location. |
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What is shifting dullness? |
If the patient is suspected of having ascites, or fluid in the abdomen, turning the patient to the side, will cause the fluid to move towards the bed. Dullness on palpation will have shifted. |
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Define Succession splash. |
A very loud splash auscultated over the upper abdomen when an infant is rocked side to side. It indicates increased air and fluid in the stomach as seen with pyloric obstruction or large hiatus hernia. |
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What is tympany? |
The predominate sound heard when percussing the abdomen because air in the intestines rises to the surface when supine. |
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What is the umbilical region? |
The area directly around the umbilicus or navel in the human anatomy. |
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What is viscera? |
Internal organs. |
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What happens to the abdomen with aging? |
- fat accumulates in the suprapubic region in females (decreased estrogen) - fat deposits in the abdomen for men as well - adipose tissue is redistributed away from the face and extremities to the abdomen and hips |
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What happens to the GI system with aging? |
- decreased saliva production - esophageal emptying is delayed (being fed in the supine position increases risk of aspiration) - Gastric acid secretion decreases with aging (may cause pernicious anemia iron deficiency because it interferes with vitamin B12 absorption) - incidence of gall stones increases with age - liver size decreases 25% between ages of 20 and 70. - drug metabolism is impaired because by age 65, blood flow through the liver is decreased by 33% (this causes an increase in drug side effects) - an increased incidence of constipation (slowed gastric emptying - slowed peristalsis) |
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What are the transcultural affects on the abdomen? |
- 70%-90% of black, native americans, asians and mediterranean groups are lactose intolerant - 15% northern and western europeans and americans are lactose intolerant |
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What organs are located in the upper right quadrant of the abdomen? |
- most of the liver - the gallbladder - some of the ascending colon and transverse colon - some small intestine - a small portion of the stomach |
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What organs are located in the upper left quadrant of the abdomen? |
- most of the stomach - some of the liver - the spleen - some of the transverse and descending colon - some small intestine |
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What organs are located in the lower left quadrant of the abdomen? |
- the descending colon - the sigmoid colon - small intestine |
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What organs are located in the lower right quadrant of the abdomen? |
- some of the ascending colon - cecum - appendix |
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What's the difference between solid and hollow viscera? |
- solid organs maintain a shape - hollow organs have a shape depending on it's contents |
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List the solid viscera. |
- liver - pancreas - spleen - kidneys - ovaries - uterus - adrenal glands |
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List the hollow viscera. |
- stomach - gall bladder - small intestine - colon - bladder |
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What are the topics that need to be addressed during an abdominal assessment? |
- appetite info & characteristics - dysphagia & characteristic - food intolerances - abdominal pain & info - nausea/ vomiting - bowel habits - past abdominal history - meds - diet |
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What additional topics need to be addressed during the abdominal assessment of an elderly patient? |
- how groceries are acquired - who prepares meals - are meals shared - what is done after eating - sensitivity to pain may diminish with aging, so elderly must be carefully assessed for acute abdominal conditions. |
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What measures will enhance abdominal wall relaxation? |
- breathing exercises - emotive imagery - a low soothing voice - engaging in conversation |
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What is the correct sequence of examining techniques for the abdomen? |
- inspection - auscultation - percussion - palpation (this is different than the thorax) |
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Why is the sequence of examination techniques for the abdomen different than that of the thorax? |
Percussion and palpation can increase peristalsis, which would give a false interpretation of bowel sounds. |
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What is the stomach inspected for? |
- shape (rounded, flat, scaphoid) - size - distended - symmetry (hernia will be a bulge) - shape of umbilicus (midline, inverted) - skin (color, moles, lesions, scars, petechia - red spots, turgor, striae - stretch marks) - pulsation or movement - demeanor of the patient (relaxed? in pain?)
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What is the stomach auscultated for? |
Bowel Sounds; If they are hypoactive or hyperactive |
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What does it mean for bowel sounds to be absent? |
Hypoactive bowel sounds signal - decreased motility as a result of peritonitis - from paralytic ileus as from surgery - from late bowel obstruction which can occur with pneumonia. |
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What is the stomach percussed for? |
- assess the density of the abdominal contents - locate the organs - check for abdominal fluid or masses |
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Where is dullness heard when palpating the abdomen? |
- over a distended bladder - over adipose tissue - over fluid - over a mass - over the liver (if enlarged) |
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When is hyperresonance heard when palpating the abdomen? |
- when there is gaseous distension |
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What is the normal size of the liver? |
- 10cm for men - 7cm for women |
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What does a dull note percussed forward of the midaxillary line indicate? |
An enlarged spleen most likely caused from mononucleosis, trauma or infection. |
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What do we percuss for in the costovertebral angle? How is it done? |
- assessing the kidney - place a hand over the 12th rib, thump that hand with the fist of your other hand. If it's normal, there's no pain. There's inflammation of the kidney if there's sharp pain. |
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What is palpated for in the abdomen? |
- judge size, location, consistency, and mobility of organs - screen for abnormal enlargement, mass or tenderness - muscle relaxation is necessary, use relaxation or talk to them about their history |
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What is the good palpation technique? |
- have the patient bend knees - keep the palpating hand low and parallel to the abdomen - have the patient breathe slowly (in nose and out mouth) - have the patient use relaxation techniques - use their hand or stethoscope if ticklish |
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When there is constant hardness in the abdomen that is not voluntary on the part of the patient, what does it indicate? |
Inflammation of the peritoneum |
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How does light palpation differ from deep palpation? |
Light palpation is depressed about 1 cm. Deep palpation is depressed 5-8cm (2-3") |
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What is the bimanual technique? |
- used for large or obese abdomens - 2 hands on top of each other (the top hand pushes, the bottom hand feels |
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What is abduction? |
The action of certain muscles in pulling a leg, arm, etc away from the median axis of the body. (A good way to remember is a child being abducted - taken away). |
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What is the acromion process? |
A bony extension of the scapula that connects to the clavicle. |
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What is adduction? |
The action of certain muscles in pulling a leg, arm, etc toward the median axis of the body. (A good way to remember is "adding" to the body). |
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What is the allis test? |
A test performed on babies to check for hip dislocation. Placing the baby's feet flat on the table and flexing the knees up. The tops of the knees should be at the same height. |
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What is a bulge sign? |
Firmly stroke up on the medial aspect of the knee two or three times to displace any fluid. Tap the lateral aspect and watch the medial side in the hollow for a distinct bulge from a fluid wave. The bulge sign occurs with very small amounts of effusion. |
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What is a bursa? |
An enclosed sac filled with viscous synovial fluid located at synovial joints. |
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What is crepitation? |
An audible and palpable crunching or grating that accompanies movement. |
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What is epiphyses? |
A growth plate in the bones of children or people still growing |
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What is "genu valgum"? |
"Knock knees", present when there is more than 2.5 cm between the medial mallioli when the knees are together. Occurs normally in small children between 2 and 3 1/2. Can also occur with rickets, poliomyelitis and syphilis. |
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What is "genu varum"? |
"bowlegged", present when there is more than 2.5 cm between the knees when the medial malleoli are together. Normal for 1 year after a child begins walking and resolves with growth. |
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What are intervertebral discs? |
Elastic fibrocartilaginous plates that constitute one fourth of the length of the spinal column. Help to cushion and move the vertebrae. |
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What is kyphosis? |
A forward curvature of the spine. Common in the elderly. |
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What is a lasegue test? |
A straight leg raise test helps determine if the patient has a herniated disk. The patient lies supine and the examiner lifts the patient's legs while straight. If the patient has sciatic pain anywhere between 30 and 70 degrees, then the test is positive. Typically the herniated disk would be located around L5. |
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What is a ligament? |
Fibrous connective tissue connecting bones or cartilage together. |
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What is lordosis? |
Commonly referred to as "swayback", it is a curvature of the lumbar spine caused by excessive visceral fat or pregnancy. |
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What is McMurray's test and how is it performed? |
It is to test to evaluate patients for tears in the meniscus of the knee. The patient lies supine while the examiner holds the patients heel, flexes the knee and rotates the foot then extends the leg in the direction it was rotated. If there is "click" or pain, then it is a positive test. |
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What is myalgia? |
Pain in the muscles |
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What is nucleus pulposis? |
The inner core of the intervertebral disc. |
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What is ortolani's maneuver? |
It is a test to see if an infants hips dislocate. With infant supine, flex the knees holding your thumbs on the inner mid-thighs and your fingers outside on the hips touching the greater trochanters. Adduct the legs until your thumbs touch. Then gently lift and abduct moving the knees apart and down so their lateral aspects touch the table. If it feels like a 'clunk' as the head of the femur pops back into place, this is a positive ortolani sign and warrants referral. |
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What is osteoporosis? |
Loss of bone density, or resorption, which occurs more rapidly than bone deposition. |
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What is a Phalen's test? |
Ask patient to hold both hands back to back while flexing the wrists 90 degrees. This held for 60 seconds produces no symptoms. A positive test produces numbness and burning in a patient with carpal tunnel syndrome. |
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What is a rotator cuff? |
Four powerful muscles and tendons that support the glenohumeral joint. |
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What is scoliosis? |
A lateral curvature of the spine. |
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What is a synovial joint? |
Joints that are freely movable with bones that are separated from each other and enclosed in a joint cavity. |
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What is a tendon? |
A dense, tough, inelastic, white, fibrous tissue connecting muscle to bone. |
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What is a sprain? |
a violent straining or wrenching of the parts around a joint, without dislocation. |
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What is a Tinel's sign? |
Direct percussion of the location of the median nerve at the wrist produces no symptoms in a normal hand. A positive sign is burning and tingling indicating carpal tunnel syndrome. |
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What is patellar ballotment? |
Using your left hand to compress the suprapatellar pouch to move any fluid into the knee joint. With your right hand, push the patella sharply against the femur. If no fluid is present, the patella is already snug against the femur. If fluid has collected, your tap on the patella moves it through the fluid and you will hear a tap as the patella bumps up against the femur. Positive sign of fluid in the joint. |
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What type of joint motion is inversion and eversion? |
An ankle moving sideways toward the median and eversion, away from the median. |
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What type of joint motion is rotation? |
Joint rotating on it's axis, like the head turning to look sideways. |
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What type of joint motion is protraction? Retraction? |
The neck joint pushing the face forward. Pushing the face backward. |
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What type of joint motion is elevation? Depression? |
The shoulder joint as if to shrug. Can also lower them in depression. |
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What type of joint motion is flexion? Extension? |
Flexion - Bending at the joint. Extension - straightening or extending the limb. |
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What type of joint motion is abduction? adduction? |
Abduction - Moving a limb away from the body. Adduction - moving a limb toward the body. |
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What type of joint motion is pronation? supination? |
Pronation is as turning the palm to face the floor. Supination is as turning the palm face up. (Supination - holding a bowl of soup. Pronation - P - pour the soup). |
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What type of joint motion is circumduction? |
Circular as if pitching a softball. (shoulder joint) |
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What makes up the 33 vertebrae in the spinal column? |
7 cervical vertebrae 12 thoracic vertebrae 5 lumbar vertebrae (breakfast at 7, lunch at 12 and dinner at 5) 5 sacral 4 coccygeal |
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What is the glenohumeral joint? |
The articulation of the humerus with the glenoid fossa of the scapula. It is a ball and socket joint. The shoulder joint. |
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What is the acromian process? |
The outward end of the spine of the scapula (or shoulder blade). The bump palpable at the top edge of the shoulder. |
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What is the grading system for muscle strength? |
0 - no contraction (zero) 1 - slight contraction (trace) 2 - Full ROM with gravity eliminated (poor) 3 - Full ROM with gravity (fair) 4 - Full ROM against gravity some resistance (good) 5 - Full ROM against gravity, full resistance (normal) |
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Describe rheumatoid arthritis? |
It is an autoimmune disease that attacks the joints symmetrically. Affects younger adults. The patient stiffens with inactivity and wakes stiff. After some movement, it improves somewhat. |
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Describe gouty arthritis. |
It is a reaction to the uric acid in the system. It improves as the uric acid is metabolized. Meds can help with that. It does not affect the joints symmetrically. |
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Describe osteoarthritis. |
A degenerative joint disease. Pain is worse with activity and improves with rest, so it is worse later in the day. |
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How is scoliosis screened for? |
A forward bend test. The spine should be in a straight vertical line. Posterior ribs should be symmetric with equal elevation of shoulders, scapulae and iliac crests. |
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What is tennis elbow? |
Tendonitis. In inflammation of the tendon that attaches forearm muscles to the humerus. |
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What is ganglion cyst? |
A tumor or swelling on top of a tendon at a joint. Is filled with fluid. |
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What is carpal tunnel syndrome? |
Tingling, numbness or weakness in the hands and wrists due to the nerve between the carpal bones being compressed by inflammation. Repetitive motions appear to be the culprit. |
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Name the two parts of the nervous system. |
Central Nervous System (CNS) Peripheral Nervous System (PNS) |
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What are the pathways of the CNS? |
Sensory Pathways Motor Pathways |
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What neurons are in the CNS? |
The upper and lower neurons |
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What is the cerebellum responsible for? |
- Motor coordination - equilibrium - balance |
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What is the Wernicke's area of the brain responsible for? |
Speech comprehension. When damaged, receptive aphasia results. Person hears the sound but cannot understand it. |
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What is the temporal lobe responsible for? |
- hearing - taste - smell |
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What is the parietal lobe responsible for? |
Sensation |
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What is the broca's area of the brain responsible for? |
Motor speech. When injured, expressive aphasia results and the person cannot talk. |
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What is the frontal lobe responsible for? |
- personality - behavior - emotion - intellectual functioning |
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What is the occipital lobe responsible for? |
Visual reception |
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What kind of area is the post central gyrus? |
The Primary sensory area |
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What kind of area is the precentral gyrus? |
The Primary Motor area - voluntary movement |
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If you went to a party and got drunk, what area of your brain would be most affected? |
The cerebellum |
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What does the brain stem include? |
- the pons - the midbrain - the medulla |
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What makes up the peripheral nervous system? |
- cranial nerves - spinal nerves - autonomic nervous system - reflex arc (SCAR) |
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What are the 12 Cranial Nerves and what do they control? |
I - Olfactory (smell) II - Optic (vision) III - Oculomotor (EOM, eyelids, pupils, lens shpe) IV - Trochlear (down, inward moving of eye) V - Trigeminal (muscles of mastication {chew}) VI - Abducens (lateral movement of the eye) VII - Facial (face muscles, taste) VIII - Acoustic (hearing and equilibrium) IX - Glossopharyngeal (pharynx, gag reflex) X - Vagus (talking and swallowing - viscera sens.) XI - Spinal (movement of neck muscles T, SCM) XII - Hypoglossal - Movement of the tongue
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What is a good mnemonic to remember the order of the cranial nerves? |
Oh, Oh, Oh, To Touch And Feel A Girl's Vagina (Guy's Virility), So Heaven! |
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Which cranial nerves are sensory nerves? |
I, II, and VIII |
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Which cranial nerves are motor nerves? |
IV, VI, XI and XII |
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Which cranial nerves are a mixture of both motor and sensory nerves? |
III, V, VII, IX and X |
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What are the types of neurologic exams? |
- Screening (for a seemingly well person with no significant findings) - Complete neurologic exam (would get in the ER after an accident) - Neurologic Recheck (such as a hospitalized patient is monitored closely for any improvement or deterioration in neurologic status and for sign of ICP) |
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What would a neurologic recheck include? |
- level of consciousness (Arousal, orientation) - motor function - pupillary response - VS |
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What is decorticate posturing and what does it mean? |
When patient is in a stiff abnormal position with legs out straight, arms curled in and clenched fists. Indication of ICP or brain damage. |
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What is decerebrate posturing and what does it mean? |
When patient is in a stiff abnormal position with legs out straight, toes being pointed down and head and neck being arched back. Indication of ICP or brain damage. |
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What is the function of the peripheral nervous system? |
Carries input to the CNS via their sensory afferent fibers and delivers output from the CNS via the efferent fibers. |
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What is a dermatome? |
It is a defined skin area that is supplied mainly from one spinal cord segment through a particular spinal nerve. |
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What are some useful landmarks to have a general idea of dermatomes for certain spinal nerves? |
Thumb, middle finger and pinky - C6, C7 and C8 Axilla - T1 Nipple - T4 Umbilicus - T10 Groin - L1 Knee - L4 |
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Describe the term "Reflex Arc" |
The nerve pathways followed by an impulse during a reflex, an involuntary defense mechanism of the nervous system. |
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What are the four types of reflexes? |
1. Deep tendon reflexes 2. Superficial 3. Visceral 4. Pathologic |
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Describe the autonomic nervous system. |
The autonomic fibers of the peripheral nervous system innervate smooth (involuntary) muscles such as cardiac muscle and glands. It mediates unconscious activity. Maintains homeostasis of the body. |
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What are the neurologic changes in the aging? |
There is a general atrophy with a steady loss of neuron structure in the brain and spinal cord. This causes - loss of muscle bulk - loss of muscle tone in the face, neck and spine - decreased muscle strength - impaired fine coordination and agility - loss of vibratory sense at the ankle - decreased or absent Achilles reflex - loss of position sense in the big toe - pupillary myosis (excess pupillary restriction) - irregular pupil shape - decreased pupillary reflexes - slower reaction time |
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What is dysmetria? |
The inability to control the distance, power and speed of a muscular action. |
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What is paresis? |
Partial or incomplete paralysis |
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What is paresthesia? |
An abnormal sensation like tingling or burning. |
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What is dysarthria ? |
Difficulty forming words. |
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What is aphasia (or dysphasia)? |
Difficulty with language comprehension or expression. |
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What is anosmia? |
Decrease or loss of smell. Occurs bilaterally with smoking, allergy rhinitis and cocaine use. (Tested with Cranial Nerve I) |
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What is unilateral loss of smell called? |
Neurogenic anosmia. (CNI) |
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What is nystagmus? |
A congenital or acquired persistent, rapid, involuntary and oscillatory movement of the eyeball, usually from side to side. Occurs with disease of the vestibular system, cerebellum or brain stem. |
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What is ptosis? |
Eye drooping. Can be caused by Myesthenia Gravis (autoimmune disorder), dysfunction of cranial nerve III or Horner Syndrome. |
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What would cause a unilateral, dilated and unresponsive pupil? |
ICP |
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What is strabismus? |
Cross eyes |
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What is the proper sequence for a complete neurological exam? |
1. Mental Status 2. Cranial nerves 3. Motor system 4. Sensory system 5. Reflexes |
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What causes papilledema |
ICP (CNII) |
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If there is visual field loss, which cranial nerve is being tested? |
CNII |
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Which cranial nerve is being tested with the whispered voice test? |
CNVIII |
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What is the Glasgow Coma Scale? |
A quantitative tool used to assess the conscious level of a patient. The three areas used are 'eye opening', 'verbal response' and 'motor response'. They are each given a score from 1 to 5 with a total score between 3 and 15, 3 indicating a coma and 15, a normal alert state. |
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What is the sequence for a neurological recheck? |
1. level of consciousness 2. motor function 3. pupillary response 4. VS |
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What is the earliest and most sensitive index of change in neurological status? |
A change in the level of consciousness. |
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What are some qualitative measures of a patient's level of consciousness? |
Asking the patient questions such as their name, where they are, what day, month or year it is. Testing their motor function by asking them to follow commands also tests their level of consciousness by noting their ability to do so. |
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If a person is not fully alert, in what order do you increase the amount of stimulus? |
1. Call their name 2. Lightly touch the person's arm 3. Vigorous shake of the shoulder 4. Apply pain (rub knuckles on sternum, pinch nail beds, pinch the trapezius muscle) |
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What is stereognosis? |
The ability to recognize an object placed in the hand with eyes closed by feel, weight, etc. |
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What is astereognosis? |
The inability to recognize an object placed in the hand with eyes closed. Occurs in stroke patients. |
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What is graphesthesia? |
The ability to read (with eyes closed) a number by having it traced on the skin. The inability to do this occurs with stroke patients. |
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What is kinesthesia? |
Passive movement of a body part to test a patient's sense of position. The patient has their eyes closed and the examiner moves a big toe up or down (holding it by the sides). |
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For the musculoskeletal assessment, reminder - what is the PQRST again? |
The question sequence mnemonic for an assessment of pain. P: Provocative or Palliative - what makes it worse, what makes it better? Q: Quality or quantity. How severe is it? R: Region or radiation. Where is it? Does it spread? S: Severity scale. How bad is it on a scale 1 to 10? Is it getting better or worse? T: Timing. Onset, duration frequency U: Understand Patient's Perception. What do you think it means? |
