PT2/3 NB: Know This Shit (Part Dos)
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. What would you like to do?
______: fracture through the base/dens.
- Type II: fracture through the base/dens... MC & most severe.
- *DDX: non-union dens (Os Odontodium).
Which type of odontoid FX goes through the body?
- Type III.
Where does a teardrop FX occur?
- Teardrop: avulsion of the ANT INF aspect of the VB (MC @ C2).
- = Ant cervical cord syndrome.
- Salter Harris: fracture through growth plate.
- I: horizontal through growth plate... SCFE.
- II: growth plate & metaphysis... MC.
- III: growth plate & epiphysis.
- IV: growth plate, metaphysis, epiphysis.
- V: compression deformity... most severe.
Difference between spondylolysis & spondylolisthesis?
- Spondylolysis: pars FX w/o slippage.
- Spondylolisthesis: slippage of the VB w/ or w/o FX.
- I Dysplastic: congenital.
- II Isthmic: pars FX "spondylolytic spondylolisthesis" MC @ L5... D/T trauma or microtrauma.
- III Degenerative: facet DJD. MC @ L4. "non-spondylolitic spondylolisthesis"
- IV Traumatic: pedicle FX.
- V Pathological
What is the best way to DX a spondy?
When you broke your back, which type of spondy did you have?
- Type II: Isthmic, due to cheerleading accident (trauma).
- "Spondylolytic spondylolisthesis"
______: tibial apophysitis (avulsion).
- Osgood Schlatter's.
- *10-16 YO w/ pinpoint pain & swelling.
- *Quads too strong D/T sports (soccer, basketball)... hip flexion, knee extension.
- *Cho-Pat Brace.
______: avulsion of the ischial tuberosity.
- Rider's bone: avulsion of the ischial tuberosity.
- *Track, horse back, cheerleading.
abcdefghijKLmnop: Kleinback's = lunate.
Pie sign, MC dislocated carpal bone...
Terry Thomas Sign & Signet Ring Sign...
Scaphoid: 2nd MC displaced carpal bone (MC FX).
- Glenohumeral joint: chronic disolation may present w/ Bankhart (avulsion/inf aspect of glenoid rim) &/or Hill-Sacks/Hatchet Deformity (compression deformity of the sup aspect of the humeral head).
- *Dugas & Apprehension Test.
Which N & A are within the contents of a posterior ponticus?
- 1. Sub-occipital N.
- 2. VA.
20% are born without a transverse ligament with which condition?
Atlast hyperplasia, smooth/wide/lucent defect between the body of C2 & the dens.
Wasp waist & hypoplastic dens...
_______ syndrome: multiple congenital blocks.
- Klippel-Feil Syndrome: short webbed neck, low hair line, decrease ROM.
- *Possibly a Springle's Deformity & omo vertebral bone.
- *Rhomboid calcification.
An obviously more sclerotic pedicle than the bone below indicates...
- Pedicle agenesis.
- *DDX lytic mets.
Failure of the center of the VB to ossify properly..
Butterfly Vertebrae: does NOT create scoliosis.
Primary defect of the growth center, associated with scrambled spine & scoliosis...
- Hemivertebrae: lateral ossication center defect.
- *Gibbus deformity.
- *Non-progressive scoliosis.
- *Pedicle duplication.
Facet trophism is MC @ ?
- *Assymetric articular planes.
- *Best seen on AP projection.
Corticosteroids are associated with... (4)
- 1. AVN
- 2. Pathological FX
- 3. RA
- 4. Asthma
- Coxa Valga/Vara.
- Valga: >130*
- Vara: <120*
______: ulna is unusually shorter than the radius, seen with __________ dislocations.
- Negative Ulnar Variance: ulna is unusually shorter than the radius, seen with scapholunate dislocations.
- *Madelung's deformity: short distal radius, assymetirc ulnar styloid prominence, post sulux of distal ulna.
- Calcification of the MCL (knee).
- *Whispy smoke appearance.
2 MC locations of myositis ossificans?
___-____ = refer AAA to vascular specialist.
- 3.8 -5.0 cm = refer AAA to vascular specialist.
- *In front of L2-L4 VB's.
- *Aortic dilation, curvilinear calcification, fusiform appearance
- *Doppler, US.
- *Most specific test: MRA or angiogram.
What is the most specific test for DX AAA?
MRA or angiogram.
Gallstones are seen at which levels?
Alkaline phophate test for... (2)
What 2 diagnostic tests for prostate?
- 1. PSA
- 2. Acid phosphatase.
Fat pads indicate ?
Radial head FX, seen on lateral view.
Hair on end appearance (mohawk) on x-ray in the skull is associated with which condition?
- Sickle Cell Anemia.
- *H shaped vertebrae in spine D/T collapse of vasculature, involving every segment.
Erlenmeyer flask deformity is associated with...
- Thalassemia "Cooley's Anemia" "Medeterranean Anemia"
- Hereditary disorder of hemoglobin synthesis (microcytic hypochromic).
- Erlenmeyer flask = widened epiphysis.
- "Hair on end" appearance in skull.
Brown Tumors, Salt & Pepper Skull & Rugger Jersey Spine are associated with...
- HPT: females 30-50 YO.
- *Calcium build up, decreased phosphorus.
- *Brown tumors: central geographic osteopenia in bones.
- *Salt & pepper skull: DDX swiss cheese (lytic mets) & raindrop (MM).
- *Rugger-jersey spine: DDX vs sandwich vertebra (osteoporosis) vs picture frame (early Paget's).
- *Increased alk phos.
Swiss cheese skull is associated with which condition?
- Lytic mets.
- *Rain drop = MM
- *Salt & pepper = HPT
Which two conditions cause sandwich vertebrae?
- Osteoporosis & osteopetrosis.
- *Osteopetrosis: hereditary abscence of marrow.
- *Anemia, hepatosplenomegaly.
- *Bone within bone.
- *Erlenmeyer flask deformity = widened epiphysis.
*Osteoporosis = transverse FX.
Rickets: seen at the epiphysis, particularly in long bones.
- *Muscle tetany & weakness.
- *Bone deformity & lucency.
- *Paintbrush metaphysis: absent zone of provisional calcification.
Which is better for soft tissue, CT or MRI?
- *Anything in the lung.
- *Discitis, osteomyelitis, Brodie's abscess.
- *Measured in hounsfield units.
Least invasive diagnostic imagaing?
- MRI: no radiation dose.
- *Best for MS, AVN's.
- *T1: fatty pahologies (MD)
- *T2: H2O
- "Whatever is weighted is white." ...other densities appear gray.
- *Cortical bone is alway black (signal void).
Bone scan a/k/a's (2)
- 1. Scintigraphy.
- 2. Radionucleotide scan.
- *Inject technetium 99.
- *Measures body's ATTEMPT to lay down new bone.
- *Hot is positive = AVN's, Mets, Paget's, Hodgkin's, FX's.
- *Cold = MM.
Martin's Basilar Angle: platybasia.
McGregor's Line: most accurate line for basilar invagination.
What is the most accurate line for basilar invagination?
- Chamberlin's Line: basilar invagination.
- *Martin's Basilar, McGregor's & Chamberlin's = basilar invagination. GMC
WNL for ADI?
- Children: <5mm
- Adults: <3 mm
Which line is drawn at each SLJ & should form a smooth arc?
- Post cerv line.
- *Discontinous line = malposition (anterolisthesis or retrolisthesis).
Where should extension stress lines intersect?
- Extension: C4/5
- Flexion: C5/6
Paravertebral ST measurements...
- PLT sandwich 7, 14, 21
- retroPharyngeal: C2-4, <7mm
- retroLaryngeal: C5, <14mm
- retroTracheal: C6-7, <22mm
What is the best method for scoliosis evaluation?
What is the normal sacral inclination angle?
What is the average angle for Fergauson's Angle?
Meyerding's Grading is for _______.
- Grade I: <25%
- Grade 2: 26-50%
- Grade 3: 51-75%
- Grade 4: 76-100%
- *> Grade 3 = inverted Napoleon hat sign.
Garland Thomas line is for...
- Ullman's Line: spondy.
- *<15mm = spinal canal stenosis.
WNL for the lumbosacral disc angle?
Ferguson's Line is drawn...
- Through the center of the L3 VB.
- *Should intersect the base.
- *ant to sacrum = hyperlordosis.
- *post to sacrum = hypolordosis.
Ferguson's Line vs. Ferguson's Angle...
- Ferguson's Line: hyper/hypolordosis.
- Ferguson's Angle: sacral base angle.
McNab's Line & _______ are for....
Hadley's S curve & McNab's = facet imbrication.
- protrusio acetabuli.
- *Smooth curvilinear line.
Mikulicz's Angle a/k/a...
- Skinner's line.
- *Fracture or coxa vara.
Klein's line... best for SCFE.
Boehler's Angle: <28* = calcaneal FX.
Who was the first to use short levers (spinous & TP)?
Tone (nerves too tense or too slack) is associated with whom?
- DD Palmer
- *Foundation that chiropractic is based upon.
Chiropractic philosophy is based upon the principle of _______ to _______.
- Chiropractic philosophy is based upon the principle of structure (spinal column) to function (NS for healing).
- *Innate is similar to homeostasis.
Which theory states that the causes of subluxation are chemical, mechanical, & psychic?
Nerve Compression Theory (Garden Hose Theory).
______: pelvic distortion model.
Carver: pelvic distortion model.
________: fixation theory of joint hypomobility.
Father of homeopathy?
Who was the first to manipulate?
_______: joint HYPERmobility... disovered & tested SI ligaments.
Illi: joint HYPERmobility.
What are the 3 phases of the model of instability?
- 1. Dysfunction
- 2. Unstable
- 3. Stabilization
- Kirkaldy-Willis = Instability (Kwiiiii KY)
- *Breaking up spinal adhesions on an injured segment.
_______: Segmental facilitation theory... a subluxation can cause a hyperative nervous system.
- Korr: Muscle is central to this theory.
- Michael Kors
Who was the first to use heel lifts?
Logan: founder of Logan Basic (sacrum is keystone).
______: General adaptation syndrome.
- Selye: general adaptation syndrome.
- *Under optimum conditions the body can respond to stressors.
Founder of osteopathy?
- Andrew Taylor Still
- *Proper functioning of the circulatory system.
Who named chiropractic?
5 Components of the VSC (Faye)...
"Nutritious Kids Make Happy Poops"
*Names ALWAYS have 'pathophysiology' in them.
- 1. Neuropathophysiology: irritation, compression, decreased axoplasmic transport.
- 2. Kinesiopathophysiology: hypomobility.
- 3. Myopathology: Hilton's law.
- 4. Histopathology: inflammation.
- 5. Pathophysiology (Biochemical): end result of subluxation.
What are the 3 components of the first component of the VSC? (neuropathophysiology)
- 1. Irritation: sustained hyperactivity = facilitation.
- 2. Compression or mechanical insult: pressure in the IVF = degeneration = muscle atrophy, anesthesia & sympathetic atonia.
- 3. Decreased axoplasmic transport: alters development, growth & maintenance of cells & structures.
Neuropathophysiology (1st component/VSC)...
What does irritation of the anterior horn cause?
Hypertonicity or mm spasm.
Neuropathophysiology (1st component/VSC)...
What does irritation of the lat horn cause?
- cell irritation = vasomotor changes.
- *Hypersympatheticotonic vasoconstriction.
Neuropathophysiology (1st component/VSC)...
What does irritation of the post horn cause?
Which component of the VSC results in muscle atrophy, anesthesia & sympathetic atonia?
Neuropathophysiology... Compression (mechanical insult).
Which component of the VSC results in altered development & growth?
- Neuropathophysiology... Decreased axoplasmic transport.
- *Decreased food = does not grow.
Atrophy results from ....
- Chronic compression/inhibition of the anterior horn.
Diminished or absent joint play, or segmental hyper mobility due to compression is described as....
- Kinesiopathophysiology (hypomobility).
- *Lack of motion = nociception, proprioception & mechanoreceptive reflex functions affected.
- *Leads to shortening of ligaments D/T decreased ROM.
- *Cornerstone model of chiropractic... goal of adjustment is to restore motion.
Which component of the VSC is the cornerstone of chiropractic?
Kinesiopathophysiology... the goal of the adjustment is to restore motion.
Which component of the VSC is associated with Hilton's Law?
- Myopathology: includes hypertonicity D/T compensation, Hilton's Law, or any combination.
- *Hilton's Law: a nerve supplying a joint also supplies the mm's which move the joint, & the skin covering the insertion of those muscles.
- *Acute condition: spasm.
- *Chronic condition: atrophy.
Which component of the VSC is associated with inflammation?
- Histopathology: pain, heat & swelling D/T trauma, hypermobility, or the repair process,
- *5 signs of inflammation: reddness (rubor), heat (calor), swelling (tumor), pain (dolor) & loss of function (functio laesa).
Which component of the VSC is the end result of subluxation?
Pathophysiology (biochemical): stress syndrome, pro-inflammatory, dis-ease.
_________ reflex: bone, nerve, muscle, ligaments, tendons.
- Somatosomatic reflex: musculoskeletal stimulation produces a reflex in the NS which is exhibited elsewhere in the musculoskeletal system.
- *Knee jerk reflex.
- *Chiropractic adjustment to relieve mm spasm.
- *Somatic (muscle spasm) somatic (subluxation.
What term is interchangeable with autonomic?
- *Viscerovisceral: afferents & efferents are visceral sensory & autonomic.
- *Organs, blood, lymph.
- Somatoautonomic: N stimulus = reflexive response in visceral organs.
- *Adjustment relieves SX of dysmennorrhea (painful period).
Which reflex model is associated with chronic asthma causing muscle tenstion & joint subluxation?
What is the "gate" for the gate control theory of pain?
- Gate = substantia gelatinoa (lamina II) of the gray matter.
- *Controls what gets to the thalamus.
Which type of fibers depress (inhibit) pain transmission?
- Fast, type 1a (A alpha) inhibit pain transmission.
- *Pain travels on type C (IV) fibers.
Cerebral circulation is altered by an insufficiency of...
- The Vertebrobasilar Artery (VBAI) D/T subluxation.
- 5 D's, 3 N's.
Where is the MC location for compression of the VA?
- Over the post arch of C1.
- *Rotation & extension causes the most compression.
Which side are you testing with George's Test for VBAI?
- The side you rotate the head to is the side of the A you are checking.
- *Turn to L = closes R, so checking to see if L is working.
What is the end result of nerve compression?
Subluxations interfere with the normal transmission of ______.
Subluxations interfere with the normal transmission of nerve energy (never compression theory).
The nerve compression theory puts emphasis on the importance of...
- The IVF & its contents (spinal N, NR's, recurrent meningial N, blood vessels, lymphatics, CT).
- *Degeneration/IVF = predisposed compression of NR's.
- *Only 2-5% of subluxations exhibit all SX of nerve compression.
______ are more mechanically predisposed to irritation or compression.
- Nerve roots are more mechanically predisposed to irritation or compression.
- *NR's are placed in tension by traction.
What structures do not have strong connective sheath that support periphreal nerves?
The nerve roots (endoneurium) do not have epunuerium & perinuerium = NR fails before periphreal N's.
Which fails first; NR or preiphreal N's?
______ substances are associated with axonal aberration.
- Trophic substances are associated with axonal aberration.
- *Axoplasmic transport: the way in which substances are carried to & from the nerve cell body.
Cell body -> terminal
- Forward moving
- Cell body -> terminal
- Nerve growth (trophic)
- More common
The HIO technique is based on which theory?
- Cord compression (Compressive Myelopathy).
- *Affects any & all functions of the body.
- *Pressure from neoplasms, hematomas, congenital defects & extreme trauma.
The facilitation hypothesis is a/k/a
Fixation theory: segmental facilitation, gamma motor gain, proprioceptive insult, sympatheticotonia.
_______: lowered threshold for firing in a spinal cord segment.
- Segmental facilitation: lowered threshold for firing in a spinal cord segment.
- *Facilitation: continuous firing of nociception makes it easter to get to the brain.
_________: the constant bombardment of nociception lowering the threshold for firing in a segment.
Proprioceptive insult: the constant bombardment of nociception lowering the threshold for firing in a segment.
The immune system is associated with which hypothesis?
- Neurodystrophic Hypothesis (Neuroimmunomodulation): anything immune system!
- *Increase eosinophils.
- *Neural dysfunction is stressful to the viscera & other body structures, which may modify the immune responses & alter the trophic function of the involved nerves.
- *DD Palmer: lowered tissue resistance is the cause of disease.
______: based on the idea that under optimum conditions, the body can respond to various stressors by adapting to them.
- General Adaptation Syndrome (GAS): under optimum conditions the body can respond to various stressors by adapting to them.
- *Stages: alarm, resist, adapt, exhaust.
- *Neuroendocrine mechanism.
Ig production increases during which phase of GAS?
Which ligament holds the dens & is stressed via flexion views?
Which ligament limits rotation of C2?
Alar (Check) Ligament
Which ligament limits flexion/extension of C2?
Apical dental ligament.
Which ligament connects the pia to dura?
- Dentate ligaments.
- *21 ligaments.
- *Dural Torque Theory.
Which ligament limits extension?
- *Anterior atlanta-occipital ligament: continuation of ALL from C1-C0.
Which ligament is a continuation of the ALL from C1 - C0?
- Anterior atlanta-occipital ligament: continuation of ALL from C1-C0.
Which ligament protects facets?
- PLL: limits flexion.
- *Wider in cervicals.... thinnest @ L5.
- *Tectorial membrane: continuation of the PLL from C2-C0.
Which membrane is a continuation of the PLL?
- Tectorial membrane: continuation of the PLL from C2-C0.
- *Limits flexion of C1/2.
Which ligament is most important for limiting flexion?
- Ligamentum flavum.
- *Lamina -> lamina.
- *Hypertrophy = IVF encroachment.
- *Post atlanto-axial: C1-C2.
- *Post atlanto-occipital: C1-C0.
Which 2 ligaments are a continuation of the ligamentum flavum?
Post atlanto-axial & post atlanto-occipital.
_______: limits the amount of torsion allowed on the disc, & the amount of rotation of the vertebrae.
Annulus fibrosis: limits the amount of torsion allowed on the disc, & the amount of rotation of the vertebrae.
The outer portion of the annulus fibrosis is innervated by which nerves?
- Sinuvertebral nerves.
- *Provides nutrition to the disc via motion.
- *Gradually decreases w/ age = more herniations.
Where is the weakest part of the IVD?
Post lat (D/T narrowing of the PLL).
The endplates fail with....
- Increased axial loading.
- (Endplate gives way first in response to axial pressure).
________: found primarily in the thoracic region, anchors to the dura.
Most external meningie?
- Dura mater: continuous from cranial cavity -> sacrum.
- *Covers NR's, DRG.
Which meningial layer is avascular?
Which meningeal layer adheres directly to the surface of neural tissue?
The IVF _____ in flexion & _____ in extension.
The IVF opens in flexion & closes in extension.
Anterior border of the IVF?
- Bodies & IVD's.
- (Bodies = uncinates in the cervicals).
Superior & inferior border of the IVF?
pedicles (roof & floor).
Posterior border of the IVF?
Facets (z-joints): covered by hyaline cartilage.
- Order of compression in the IVF:
- Fat (adipose tissue)
What is most sensitive to compression in the IVF?
- *Also most affected by subluxation.
________: produce myelin in the CNS.
*Demylenation = _______.
- Oligodendrocytes produce myelin in the CNS.
- *Demyelenation = MS.
______: produce myelin in the PNS.
*Demyelenation = _______.
- Schwann cells produce myelin in the PNS.
- *Demyelenation = Guilliane-Barre.
What establishes a set point for mm tone?
Gamma motor neurons.
Which general adaptation phase results in cortisol production?
- Resistance phase.
- *Alarm = fight or flight.
- *Exhaustion = gives up (dis-ease).
______: innervate mm fibers.
- Alpha motor neurons.
- *Myoneural junction.
- *Large diameter = fast.
Which neurons innervate mm spindles?
- Gamma motor neurons = mm spindles.
- *Establishes set point for mm tone.
Which type of nerve fiber detects stretch/velocity?
Which type of nerve fiber is the largest & most sensitive?
Which type of nerve fiber is associated with the muscle spindle?
Which type of nerve fiber detects stretch/velocity?
1a = muscle spindle = stretch/velocity
Which type of nerve fiber is associated with the GTO?
- *JPS, vibration, 2 point decrimination
Tension is associated with which type of nerve fiver?
JPS, vibration & 2 point discrimination are associated with which type of nerve fiber?
Fast pain is associated with which type of nerve fiber?
Slow pain is associated with which type of nerve fiber?
C (IV): un-myelinated, small, slow.
What is the most important function of the ANS?
To regulate blood flow.
Pupil constriction & secretions are associated with which subcategory of the ANS?
What is the opposite of sympatheticotonia?
- Vagotonia: increased firing of parasympathetics.
- *Sympathetictonia: increased firing to sympathetics.
Which subcategory of the ANS is responsible for orgasm?
- *Erection = parasympathetic... keeps pee & poo off the floor.
Which tract is associated with the flexors of the upper extremity?
Which tract is associated with the extensor muscles of the back & arms?
Which tract is associated with the extensor muscles of the back & legs?
Which tract is associated with the flexors of the distal extremities?
Which tract is associated with crude touch & pressure?
Which tract is responsible for conscious proprioception?
- *Meissner's/Merkel's: touch
- *Pacinian: vibration
- *Ruffini: JPS
MSC - Muscle Spindle Cell - type 1a fibers - stretch
GTO - Golgi Tendon Organ - type 1b fibers - tension
What is the goal of the adjustment (in addition to restoring motion) ?
- Stimulate the 1b golgi tendons &
- Postsynaptic inhibition of the alpha motor neurons due to the fast stretch on the tendon.
- *Closes the pain gate.
- *Nociceptive inhibition by proprioception
- *Break up adhesions (K-Willis)
Meric chart... heart & lung...
Meric chart... gall bladder...
The ovary & colon are driven by which subdivision of the ANS?
- *Colon & utuerus = parasympathetic.
T10 increases which response?
Damage to the cells releases which substance?
Pulsed US is used for....
- Acute phase only.
- *Continuous = subacture & chronic.
Which exercise is best for increasing lumbar lordosis & rehabing a disc?
- *William's = reduce hyperlordosis.
Which exercise is used to rehab the knee?
Wobble board exercises are associated with...
What is an example of open chain exercises?
- Bicep curls, leg extensions.
- *Free to move.
What is an example of closed chain exercises?
- Pushups or squats.
What is an a/k/a for timing in OPQRST?
Timing = Temporal Factors.
Auscultory gap may be seen in....
- *Auscultory gap = the loss & reappearance of the pulse during cuff deflation.
_________: low pitched sounds produced by turbulent blood flow in arteries.
Korotkoff sounds: low pitched sounds produced by turbulent blood flow in arteries.
Korotkoff sounds are associated with which syndrome?
- Subclavian Steal Syndrome: steals blood from the VA = BP 20% higher in LE.
- *Working out @ gym lifting weights & passes out.
The Barre-Lieou VBAI test is done...
The DeKlyeyn's VBAI test is done...
The Hallpike VBAI test is done...
The Hautant's VBAI test is done...
The Underberg VBAI test is done...
How can you tell the difference between Horner's Ptosis & CN III Ptosis?
*MG can also cause ptosis...
- Horner's: also has meiosis (smaller/constricted pupil D/T sympathetics)... pancoast tumor, TOS, whiplash.
- CN III: dialates the pupil.
Is graves disease hypo or hyperthyroidism? What happens to the eyes?
- Graves = hyperthyroidism.
Periorbital edema is seen with which 3 conditions?
- 1. Allergies (MC)
- 2. Myxedema (HYPOthyroidism)
- 3. Nephrotic Syndrome: kidney damage = protein in urine.
What causes an absent red light reflex?
- Cataracts, D/T diabetes or old age.
- *Affects night vision.
- Tyerygium: triangular thickening of the bulbar conjunctiva that grows across the cornea.
- *Brought on by dry eyes.
A/k/a for hordoleum?
Sty: infection of the sebaceous glands causing a pimple or boil on the eyelid.
What is the name for a nodule inside of the eyelid?
______: a yellowish triangular nodule on the bulbar conjunctiva that is harmless & D/T aging (WNL).
Pinquecula: a yellowish triangular nodule on the bulbar conjunctiva that is harmless & D/T aging (WNL).
Fatty plaques on the nasal surface of the eyelids are known as?
Xanthelasma: normal, or associated with hypercholestremia.
Argyll Robertson pupil: accommodates but does not react to light.
Adie's Pupil is associated with...
Adie's Pupil: sluggish pupillary reaction D/T sympathetic lesion of CN III.
Addison's DX is associated with which eye sign?
Arroyo Sign: sluggish pupillary reaction D/T hypoadrealism (Addison's DX).
What is the MCC of Horner's Syndrome?
- Pancoast tumor... affects sympathetic chain ganglia.
- Ptosis: dropping of the upper eyelid.
- Miosis: constriction of the pupil.
- Anhydrosis: decreased sweating.
Cupping of the optic disc is associated with...
- Glaucoma: increased intraocular pressure.
- *Blurring of the vision in peripheral fields, w/ rings around lights.
- *Crescent sign w/ tangential lighting of the cornea.
- *May lead to blindness.
Swelling of the optic disc is due to...
Intracranial pressure... papilledema (choked disc).
Curtains closing over vision...
Retinal detachment... painless... needs surgery.
What is the MCC of blindness in the elderly?
- Macular degeneration = central vision loss.
- *Drusen sign: yellow deposits under the retina = early sign.
Loss of peripheral vision is associated with....
- *MD = central vision.
Copper wire deformity, A-V nicking, flame/splinter hemorrhages & cotton wool exudates are D/T...
Neovascularization of the eye is associated with...
- Diabetic retinopathy.
- *Affects veins more than arteries.
Iritis is seen with which condition?
Pic on the test...
- *The obliques do the opposite of their name.
- *Lateral rectus: CN VI.
- *Superior oblique: CN IV.
- *All others: CN III.
Term for old ears?
- Presbycussis: sensorinural hearing loss.
- *Presbyopia = old eyes.
Tugging of the pinna in painful with...
Acute otitis externa: infection of the outer ear (in front of the tympanic membrane).
Acute otitis media & hearing loss may be associated with...
A bulging, red tympanic membrane is associated with...
Purulent Otitis Media (Bacterial Otitis Media).
Fluid with amber bubbles is associated with...
Serous otitis media
Endolymphatic Hydrops is a/k/a...
Endolymphatic hydrops a/k/a Meniere's DX, Central Vertigo = recurrent vertigo, sensory hearing loss, tinnitus & fullness in the ear.
Appley's Maneuver is for...
BPPV: brief episodes of vertigo brought on by changes of head position.
A Schwannoma is a/k/a...
Schwannoma = acoustic neuroma: hearing loss, tinnitus, vertigo.
A retracted tympanic membrane is associated with...
- Eustachian tube block.
- *Bulging TM = purulent otitis media.
*Conduction -> bad ear.
*Sensorineural -> good ear.
(conduction = blocked)
- Rinne Test.
- *Normal: AC 2x as long as BC (AC>BC).
- *Conduction: AC = BC, AC<BC.
- *Sensorineural: AC & BC are reduced or absent.
Red & swollen nasal mucosa is associated with..
Pale or blue nasal mucousa is associated with...
Cheilosis is D/T a deficiency of which vitamin?
is associated with....
- *Candidiasis (thrush) is also common with aids... can be scraped off.
A smooth & glossy tongue is associated with a deficiency of which vitamin?
Atrophic glossitis: B vitamins or iron.
Fissured (scrotal) Tongue is associated with...
Which growth hormone condition results in a big jaw?
- Acromegaly: begins in middle age, affecting the hands, feet & facial bones.
- *Gigantism: before skeletal maturation.
What is the MCC of hyperthyroidism?
Grave's Disease: autoimmune = bilateral exopthalmos.
What is the MCC of myxedema?
- Hoshimoto's thyroiditis = hypothyroidism (myxedema).
- *Congenital hypothyroid = creatinism = mental & physical retardation.
Macroglossia & loss of the lateral 1/3 of the eyebrow is associated with...
- Hypothyroidism (myxedema):
- *Weight gain w/ decreased appetite.
- *Depression, weakness & fatigue.
- *Cold intolerance.
- *Coarse, dry hair & skin.
- *Periorbital edema.
- *Macroglossia (big tongue) & losss/lateral 1/3 eyebrow.
- *Increased TSH.
What type of HA is provoked by bright light, associated with hypoglycemia & tyromine?
- Migraines: adjust, massage, dietary log.
- *Common (sick, vascular) migraine: photophobia, worse behind one eye, nausea, familial.
- *Classic migraine: unilateral, aura (prodone).
What type of HA is gone by noon?
- Hypertension: throbbing, wakes up with suboccipital HA.
- *BP & lipid profile.
- *Lose weight & decrease NaCl.
What condition is associated with "Autonomic NS Disturbance?"
- Cluster HA (Vasomotor HA).
- *R/O intracranial pathology.
- *Cranial CT scan, CN exam & allergy testing.
Polymyalgia Rheumatica a/k/a...
- Temporal Arteritis (Giant Cell): >50 YO, unilateral, can go blind.
- *Increased pain with hair combing.
- *Jaw claudication.
- *Elevated ESR.
- Cervicogenic HA.
- *Can be D/T congenital anomalies = take F/E views.
- *Decreased ROM upper cervical = pain referred to head.
Which types of HA's are worse in the morning? (3)
- 1. Hypertension HA: gone by noon.
- 2. Sinus HA: worse in morning, affected by body position.
- 3. Brain tumor: morning & evening onset, progressive.
Which type of HA has an abrupt onset?
- Subarachnoid hemorrhage: basilar area.
- *Emergency room!
What type of HA needs to be referred to an endocrinologist?
Hypoglycemic: take FBS test.
What type of HA needs to be referred to a dentist?
For this test, never refer to...
PT, osteopath, or dietician.
Cystic fibrosis is associated with which chest deformity?
Barrel chest (COPD also).
What type of respiration is characterized by alternating periods of apnea & hperapnea in a regular pattern?
Cheyne Stokes Respiration: associated with respiratory acidosis.
DM & metabolic acidosis are associated with which respiration pattern?
- Kussmauls: as metabolic acidosis worsens, breathing goes from being rapid & shallow -> deep, slow & labored gasping.
- "Air hunger breathing"
Splinter Hemorrhage nails are associated with...
subacute baterial endocarditis.
Transverse ridging associated w/ severe DX.
Inflammation of the nail fold near the cuticle...
_______: nail base angle >180*.
- Clubbing: hypoxia / COPS.
- *Bronchogenic carcinoma, heart failure.
What type of nail is associated with iron deficient anemia?
Koilonuchia (spoon nail).
What is the only lung condition to increase tactile fremitus?
Pneumonia, D/T consolidation.
What conditions decrease tactile fremitus? (4)
- 1. Emphysema: decreased air.
- 2. Pneumothorax: decreased air.
- 3. Atelectasis: sound barrier.
- 4. Pleurisy: sound barrier.
What is the normal tone over lungs?
Emphysema & pneumothorax percuss...
- hyperresonant D/T increased air in the lungs.
- *Emphysema: can get air in, but not out.
A dull percussive tone is associated with which 2 conditions?
- Pneumonia & atelectasis, D/T increased density.
Diaphragmatic excursion is used to DX which 2 conditions?
- Pneumonia or pheumothorax.
- *Marks where resonant changes to dull.
Bronchial sounds are found over...
Vesicular sounds are heard particularly at the....
- Base of the lung.
- *Most of the lung field.
Bronchovesicular is normally heard where?
Ribs 1&2, between scapula, @ lung apex.
Rhonchi sound like snoring & are associated with which condition?
Wheezes are heard during...
- *Asthma & emphysema.
What is a wheeze-like sounds that is heard during inspiration?
Stridor "barking cough"
Vocal resonance rule..
- "Your lungs don't talk, so you should not hear '99' clearly."
- *For locating pneumonia.
Describe a positive consolidation finding for whispered pectoriloquy...
- Whispered words are heard clearly.
- *Bronchophony: spoken words heard clearly.
- *Egophony: eeee sounds like aaaa.
Breath sounds are absent with which condition?
Atelectasis (collapsed lung).
Crackles (friction rub) are associated with which condition?
Breath sounds are decreased with which condition?
Blunting of the lungs on x-ray is associated with which condition?
- Lobar pneumonia.
- *Consolidation of the lung.
- *Dull percussion, rales, increased tactile fremitus, productive cough, rusty brown sputum, silhouette sign.
Which condition is associated with rusty brown sputum & silhouette sign?
Gohn lesions are associated with which condition?
- *Factory workers, AIDS.
- *Low fever, night sweats, yellow/green sputum, crackles, Tine/Mantoux Test, radiopaque densities.
Which condition is associated with the Tine/Mantoux Test?
- *Best DX = sputum culture.
Which side does the mediastinum shift to with atelectasis?
Curshmann's Spirals & Charcot Laden Crystals are associated with which condition?
Flattening of the diaphragmatic domes is associated with which condition?
- *Narrowed compressed heart, horizontal ribs.
Tietze Syndrome a/k/a...
Costochondritis: what I get with running!
What is the MC CN associated with shingles?
- CN V.
- *Primarily involves the DRG.
Bilateral hilar lymphadenopathy is associated with which condition?
- Sarcoidosis: abnormal collections of granulomas in the lungs or lymph nodes.
- *African americans.
- *Bilateral lymph node swelling.
- *DDX Hogkin's.
Which condition is associated with unilateral hilar lymphadenopathy?
- Hodgkin's: cancer of the lymphatic system that spreads to the spleen.
- *Caucasian males.
- *Pain when they drink beer.
- *Reed Sternberg Cells... absent = NHL.
What is the first sign of cystic fibrosis?
- A mother kisses her baby & their skin tastes like salty tears.
- *Thick mucus in the intestines & lungs.
- *Barrel chest.
Jugular venous pulsations are associated with what condition?
Right sided heart failure... applies pressure to the liver.
______: when the ventricles contract.
- Systole: when the ventricles contract.
- *When the ventricles rest = diastole.
Closure of the AV valves =
- Saved By the Bell is #1!
- *Valves only make noise when they are closing.
A ventricular gallop is heard during....
- *Normal in children, young adults & athletes.
- * >40 = earliest sign of CHF.
What sound is related to stiffness of the ventricular myocardium to rapid filling?
S4 atrial gallop
The aortic valve is best heard with the patient....
seated, leaning forward & exhaling.
Where are all murmurs heard best?
The mitral valve is best heard...
In left lateral decubitus.
Murmurs have a _____ pitch & are best heard with the _______ of the stethoscope.
- Murmurs have a low pitch & are best heard with the bell of the stethoscope.
- *Regurgitation = high pitch, bell of stethoscope.
Blood exiting the right side of the heart goes to...
- The lungs.
- *Blood exiting the left side of the heart goes to the body.
- *Mitral regurgitation = pulmonic edema.
- Aortic Regurgitation
- Mitral Stenosis
- Pulmonic Regurgitation
- Tricuspid Stenosis
- *switches for systole.
- *Snap = stenosis
- *Clicks = regurgitation
- Tetrology of Fallot:
- Dextraposition of the aorta
- Right ventricular hypertrophy
- Interventricular septal defect
- Pulmonic stenosis
What heart condition is commonly associated with Marfan's Syndrome (tall & long... heart, lungs, eyes & spine affected).
Coarctation of the Aorta: constriction of the descending aorta (distal to the left subclavian) = higher BP in the UE.
Which side of the heart fails first?
- *MCC is HBP.
- *2nd MCC: aortic stenosis.
- *Exertional dyspnea & orthopnea.
- *Fluid collects @ the costophrenic angle.
What is the first sign of left sided heart failure?
What is the MCC of right sided heart failure?
Left heart failure.
_________: when the right side of the heart fails by itself.
- Cor Pulmondale: right side fails by itself D/T a primary lung condition.
- *Jugular venous distention & pulsations.
- *Pitting edema.
Aortic distention presents as which type of pain?
Tearing = medical emergency.
What is elevated with an MI?
- CK-MB (creatinine kinase), SGOT.
- *LDH is decreased.
No QRS segment indicates...
- complete heart block.
- *Primary heart block = increased PR interval.
An increased ST segment indicates...
The QRS complex indicates...
- Atrial repolarization & ventricular depolarization.
- *P wave = atrial depolarization.
Hemolysis is associated with which kind of bilirubin?
- Hemolysis = prehapatic = unconjugated bilirubin.
- *Post hepatic = biliary duct obstruction.
Yellow skin, but white eyes indicates...
What is the MCC of liver destruction?
- *Portal hypertension, ascities, esophageal varicies, Mallory Weiss Syndrome, & palmar rash.
Thiamin deficiency without alcoholism is...
- Beri Beri. (B1)
- *Wernike Kosakoff Syndrome: alcoholic dementia.
A soft, smooth & tender liver is associated with...
Dirty needles & sex hepatitis?
Blood transfusion hepatitis?
Where is the MC site for metastatic DX?
What is the tumor marker for hepatocellular carcinoma?
Coomb's Test is associated with...
- Hemolytic anemia.
- *Indirect/unconjugated bilirubin.
What is the proper order for abdomen palpation?
- Light palpation
- Deep palpation
What is the normal tone of the abdomen?
Murphy's Sign is associated with..
- *DX via US.
Grey Turner's Sign (bleeding into flank) is associated with...
- *Cullen's Sign: periumbical ecchymosis.
What is the MCC of Cullen's Sign?
Which type of diabetes does not present with polyphagia (increased eating)?
_______: protrusion of the stomach above the diaphragm.
- Hiatal hernia.
- *LUQ tenderness.
Sliding hiatal hernias are associated with...
Reflux esophagitis (GERD).
What type of ulcer causes pain immediately after eating?
What kind of ulcer causes pain 2 hours after eating?
- Duodenal ulcer.
- *MC type of peptic ulcer.
- *Guaiac test: occult blood in the stool.
Where is the MC location for stomach cancer?
- Lesser curvature.
- *Affects the left supraclavicular lymph nodes (Virchow's Nodes).
An enlarged right supraclavicular lypmh node is associated with which condition?
- Pancoast tumor.
- *Left = Virchow's Node.
The Paul Bunnell Test is associated with...
- *Monospot/Herterophile Agglutination.
- *Caused by the Epstein Barr Virus.
- *Downey Cells.
Which condition causes bone marrow to become sclerotic?
- Osteopetrosis: involves every bone... RBC's aren't made.
- *Liver & spleen make RBC's & become enlarged.
Inflammation & a cobblestone appearance are associated with which condition?
- Regional Ileitis (Chron's DX)
- *Right side/intestines.
- *Non-specific inflammatory DX affecting the distal ileum & colon.
- *Healthy tissue patches = cobblestone appearance (skip lesions).
- *Does not absorb B12.*RLQ pain & chronic diarrhea.
- *Associated with Non-Tropical Srupe (Gluten).
- Crones = skip lesions (cobblestone).
- *Distal ileum.
Bloody mucous diarrhea is associated with...
- Ulcerative Colitis: left side of the intestines.
- *MC @ colon & rectum.
- *Can lead to sacroilitis (enteropathic arthropathy).
_______: outpouching of the ileum.
- Meckle's Diverticulum.
- *Zenker's = out pouching/esophagus.
Gluten sensitivity is associated with...
Celiac DX: Non-tropical sprue.
Moon face & buffalo hump is associated with...
- Cushing's Disease: hyperadrenalism, hypercorticolism.
- *Moon face, pie face, buffalo hump, pendulous abdomen, purple striae, hirsutism (hair where it shouldn't be), weakness & hypertension.
What DX is known as the Bronze Diabetes?
- Addison's Disease.
- *Opposite of Cushing's.
- *Hypoadrenalism, Hypocortisolism. (Adrenal insufficiency).
What is a GCT of the adrenal medulla?
What is the MC type of nephrolithiasis?
- Calcium Oxalate.
- *Increased BUN, UA, Creatinine.
- *KUB study.
Nephritic Syndrome a/k/a...
- Acute Glomerulonephritis: caused by group A hemolytic strep.
- *RBC casts.
RBC casts are associated with...
Nephritis Syndrome (Acute Glomerulonephritis) & Pyelonephritis.
Is pre-eclampsia a type of nephrotic or nephritic syndrome?
- *Waxy, fatty casts in urine.
Waxy casts are associated with...
What is the MCC of urethritis in males?
- *Females = E Coli
What is the MC type of inguinal hernia?
- Indirect: children.
- *Lat & inf to the epigastric vessels.
What type of inguinal hernia is associated with heavy lifting & obesity?
- Direct inguinal hernia: felt when pt coughs or bears down.
- *Med & inf to epigastric vessels.
Which breast tissue disorder presents with a non-tender singular lump?
Fibroadenoma: MC benign breast tumor.
TV does not transilluminate.
- Does not transilluminate:
- Testicular cancer: 20-35 YO, painless nodule.
- Varicocele: bag of worms, infertility.
Which condition is relieved by rising the testicle?
- *Ghonorrhea or shyphillis
What is the only cancer that metastasizes & is blastic?
Prostatic carcinoma: mets to the lumbar spine via Baston's Plexus.
What causes pain that appears while walking which disappears after rest?
What are the 2 types of intermittent claudication?
- 1. Neurogenic: not predictable, positional related.
- 2. Vascular: reproducible, with rest.
Intermittent pain that goes away with leaning forward...
- *DX via Bicycle Test.
- *Claudication Time = vascular.
Intermittent claudication, non-healing ulcers & gangrene...
- Buerger's (Thromboangitis Obliterans)
- *DO NOT pick if the pt is >40 YO.
Treatment for DVT?
Elevate leg, anti-coagulants, compression stalking.
Reflex Sympathetic Dystrophy a/k/a...
- Complex Regional Pain Syndrome: chronic, continuous, intense pain.
- *Sympathetic overdrive.
- *TX: thermography, symp n block, US.
Thin, shiny skin is due to swelling of the...
BUN is increased with...
- Renal DX.
- *Decreased with hepatic DX.
Hatchet Deformity is associated with...
Hill Sack's, recurrent should dislocation.
Which ortho test is used to DX a SLAP lesion?
Hawkin's Kennedy ortho test for...
Shoulder impingement... pain between 70-30*.
Which pelvic listing correlates witha flexed ilium?
What would you like to do?
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