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Physical Diagnosis (exam 2)
Terms in this set (17)
List the 3 kinds of arthritis
1) Rheumatoid arthritis: autoimmune inflammation
2) Osteoarthritis: trauma or overuse inflammation
3) Gout: inflammation due to uric acid deposits
List the 2 kinds of rheumatoid arthritis deformities and major distinguishing characteristics
Swan Neck Deformity - fixed DIP joint flexion, PIP joint hyperextension
Boutonniere Deformity - DIP joint hyperextension, fixed PIP joint flexion
List the 2 kinds of osteoarthritis deformities and major distinguishing characteristics
Herberden's Nodes: DIP joint, more common
Bouchard's Nodes: PIP joint, less common
Rheumatoid arthritis vs. Osteoarthritis:
clinical differential points
- symmetric deformities, since it's autoimmune
- most commonly affects PIP and MCP joints
- usually spares DIP joints (positional changes only, usually no nodules)
- not necessarily symmetric, since it's often related to trauma or overuse
- most commonly affects DIP joints
- less commonly affects PIP joints
- usually sapres MCP joints
Neuromotor Strength Test Grading Scale
against gravity vs. against resistance
5: full; full ("normal")
4: full; weak
3: full; none
2: none; none (contractility only)
1: none; none ("trace" contractility, no joint motion)
0: none; none (no contractility)
Deep Tendon Reflex Grading Scale
4+: hyperactive with clonus (rhythmic oscilation btwn flexion & extension)
3+: brisker than average
2+: average; normal
1+: somewhat diminished
0: no response
Vascular Exam (Pulse) Grading Scale
2+: normal; brisk
0: absent/unable to palpate
What is the most common type/cause of low back pain?
Idiopathic low back pain: musculoligamentous injuries and age-related degenerative processes of intervertebral discs and facet joints
Sciatica and spinal stenosis can both present as low back pain radiating to the leg. How do you distinguish these differential diagnoses?
Sciatic pain increases with cough or Valsalva
Spinal stenosis resolves with rest and/or lumbar forward flexion
In a patient presenting with low back pain:
A) What are some things from the patient's history that are red flags for serious systemic disease?
B) What are some symptomatic red flags for serious systemic disease?
- Age > 50
- Cancer history
- Unintentional weight loss
- Intravenous drug use history
- Pain > 1 month
- Pain not responsive to treatment
- Night pain, rest pain
Is the most common cause of back pain the same as the most common cause of neck pain?
- Back pain is usually caused by disc herniation.
- Neck pain is usually caused by formaminal impingement from degenerative joint changes.
What criterion is used to distinguish between articular joint pain and extra-articular joint pain?
Articular joint pain: both active and passive range of motion are lost and patient complains of joint "locking"
Extra-articular joint pain; only active range of motion is lost; passive range of motion is preserved
If you are unable to elicit a reflex on the first attempt, what technique do you use before trying again? Give an example of the technique for upper and for lower extremity reflexes.
Reinforcement: isometric contraction of other muscles for 10 seconds to increase reflex activity of the target muscles
- UE: clench teeth or squeeze one thigh with opposite hand
- LE: lock fingers and pull one hand against the other just before to reflex strike
What is the proper technique for taking pulse/HR?
Use PADS of index + middle fingers to detect maximal pulsation
What is the range of a normal vs. abnormal heart rate?
- 50-90bpm or 60-100bpm
- Tachcardia: >100bpm
- Bradycardia: <50bpm
What are the two things you are looking for when taking the heart rate?
1) Abnormal rate
2) Abnormal rhythm
If you detect an abnormal heart rhythm, what do you do next?
Listen @ cardiac apex w/ stethoscope and listen for abnormal patterns:
- Regular early beats
- Variations w/ respiration
- Irregularly irregular
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