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ICE

  1. CERVICAL, THORACIC, LUMBAR ADJUSTING
    2 SETUPS EACH... DO EXACTLY WHAT THE INSTRUCTIONS SAY!! 
    • Cervical: Toggle, Diversified, Drop.
    • Thoracic: Diversified, Drop.
    • Lumbar: Diversified, Drop.
  2. EXTREMITY ADJUSTING
    + EXTREMITY COMPLAINT DX OR EXAM
    + MULTIPLE CHOICE STATION

    WATCH VIDEO!
    • 1. Ant. Shoulder
    • 2. Ant-Inf Shoulder *STABILIZE*
    • 3. Frozen Shoulder (glenohumeral adhesions)
    • 4. Internal Fixation/GH-Joint 
    • 5. Ext. Fixation/GH-joint
    • 6. Posterior Radius
    • 7. Superior (Proximal) Radius
    • 8. Post. Ulna (Post. Olecranon)
    • 9. Post. Lunate
    • 10. Post. Scaphoid
    • 11. Superior Femur
    • 12. General Mobilization/Patella
    • 13. Ant. Fibula
    • 14. And. Talus
    • 15. Inf. Cuneiform
  3. AB/THORAX HX OR EXAM
    + MULTIPLE CHOICE STATION
    *ABTHORAX - THORAX EXAM NOT WORKING IN NOTABILITY*
  4. Grey-Turner's Sign is associated with which condition?
    • Bruising in flanks = hemorrhagic pancreatitis.
    • *Cullen's sign = hemorrhagic pancreatitis. 
    • *Caput Medusa = portal hypertension.
    • *Sister Mary Joseph Nodules = gastric cancer. 
    • *Blue-grey skin = Wilson's DX. 
  5. Virchow's Nodes are associated with...
    Mets from abdominal cancer.
  6. Which side do you stand on for the abdominal exam?
    • The right.
    • *Except for kidney capture/entrapment. 
  7. Abdominal auscultation listening for bruits: (4)
    *Breath in & hold. 
    *LW uses the diaphragm for bruits. 
    *High pitch sounds. 
    • 1. Aorta: up 1" to the L.
    • 2. Renals: 2" up & 2" out.
    • 3. Common iliacs: 2" down, 2" out. 
    • 4. Femoral: 2" above ilioinguinal ligament.
    • *Liver: right side, 10th ICS @ bottom of rib cage (midclavicular).
    • *Spleen: left side, 10th ICS (ant. ax line).
  8. What do bruitis indicate?
    Stenosis or local obstruction.
  9. Abdominal auscultation for friction rubs: (2)
    *Breathe deeply though open mouth.
    • 1. Liver: right side below costal margin = hepatitis, hepatic carcinoma. 
    • 2. Spleen: left side ant ax line = splenomegaly.
  10. Abdominal friction rubs indicate... (2)
    • 1. Inflammation. 
    • 2. Peritonitis. 
    • *Cancer, infection, trauma. 
  11. Absent bowel sounds indicate...
    Paralytic ileus.
  12. What is the normal percussion tone of the liver?
    • Dull.
  13. What is the normal span for the liver (S-I)?
    • Superior & inferior margin: WNL 6-12cm.
    • *Midsternal (4th-8th ICS): WNL 4-8cm.
    • *Begin @ midclavicular line on the R over area of tympany... continue down until dullness. Mark upper border of liver (5th-7th ICS)... then percuss upward to the lower border (costal margin) & mark.
  14. What is the normal sound for the abdomen?
    • Tympanic.
    • *Enlarged spleen = dull.
  15. What are 4 causes of an enlarged spleen?
    • 1. Malaria.
    • 2. RBC hemolysis.
    • 3. Sickle cell anemia.
    • 4. Hemolytic anemia.
  16. What are the 3 tests for ascities?
    • 1. Fluid wave: pt's hand in center of abdomen & percuss opposite side & feel for fluid wave. 
    • 2. Shifting dullness: pt supine & water goes to side. Have them roll over to side & tap. Wait 2-3 min & flip sides.
    • 3. Puddle sign: pt on all 4's, percuss & auscultate.
  17. What are the 3 causes of ascities?
    • 1. Cirrhosis. 
    • 2. Portal HT.
    • 3. Bowel cancer.
  18. What are the 4 things you are feeling for with superficial palpation of the abdomen?
    • 1. Tenderness.
    • 2. Guarding.
    • 3. Masses. 
    • 4. Hernias.
  19. What 3 conditions are DX via rebound tenderness?
    • 1. Peritonitis.
    • 2. Diverticulitis/osis.
    • 3. Appendicitis.
  20. Direct liver palpation instructions:
    • 1. One hand on back of liver.
    • 2. Breath in & hold. 
    • 3. On inhale go in to palpate in circular motions.
  21. Hooking/Middleton's Maneuver liver palpation instructions:
    • 1. Face pt's left foot. 
    • 2. Pt's fist under back. 
    • 3. Breath in & hold. 
    • 4. On inhale, palpate upwards in circular motions.
  22. Murphy's Sign abdomen palpation instructions:
    • 1. Pt exhales & holds.
    • 2. On expiration go in to palpate. 
    • 3. Pain & reflex apnea = cholecystitis/hepatitis.
  23. Instructions for palpation of the spleen:
    • 1. Breath in & hold.
    • 3. Standing on the right, on inhale place left hand under pulling P-A, then right hand palpates under ribs. 
    • *Not normally felt... if felt = enlargement D/T infection. 
  24. What side do you stand on for left kidney capture?
    • The left.
    • *Breath in & hold... press in... pt exhales & kidney slips away = enlarged kidney D/T tumor or polycystic kidney DX. 
  25. Instructions for kidney entrapment:
    • 1. Pt exhales & holds.
    • 2. One hand on top, one hand on back... press hands together on exhale.
    • 3. Pt inhales. 
    • + = dr feels kidney push hands apart D/T tumor or polycystic kidney DX. 
  26. Pain with Murhpy's Punch indicates which condition?
    • Pyelonephritis.
    • *No pain = glomerulonephritis. 
  27. Respiratory excursion is diminished with which 4 conditions?
    • 1. Pleural effusion.
    • 2. Lobar pneumonia.
    • 3. Diaphragm pathology. 
    • 4. Lung failure.
  28. What causes an increase of tactile fremitus?
    Pneumonia.
  29. How far should the lungs move with diaphragmatic excursion?
    3-6cm
  30. What is the normal percussive tone for the lungs?
    • Resonant. 
    • *Flat = pleural effusion.
    • *Dull = lobar pneumonia. 
    • *Hyperresonant = emphysema. 
    • *Tympany = pneumothorax. 
  31. What is the normal sound for auscultation of the lungs?
    • Vesicular. 
    • *Bronchovesicular = lobar pneumonia.
    • *Bronchial = lobar pneumonia. 
  32. What are the 3 main conditions associated with rales?
    • 1. Bronchitis. 
    • 2. Asthma. 
    • 3. Tumor. 
    • *Pulmonary edema, TB, bronchiectasis, end-stage pneumonia. 
  33. Positive voice sound tests (bronchophony, whispered pectoriloquey & egophony) indicate...
    Lung consolidation.
  34. 3 findings for heart palpation?
    • 1. Pulsations: pads of fingers over APETME.
    • 2. Thrills: pads of fingers/ball of hand over APETME. 
    • 3. AA Thrills.
  35. Describe heart percussion procedure...
    • Right sternal border: 6th ICS.
    • Left sternal border: 3th ICS, 4th ICS, 5th ICS. 
    • *Enlarged = thickened blood D/T obesity, atherosclerosis, ventricular hypertrophy, etc. 
  36. What are the 5 things you are listening for while auscultating the heart?
    • 1. Splits. 
    • 2. Murmurs. 
    • 3. S3.
    • 4. S4.
    • 5. Arrhythmias (S2 ArMsPrTs <-diastole).
  37. Using the ____ at the _____ point, the patient is lying on their _____ side @ a 45 degree angle. They are breathing __________. This accentuates __________ (3).
    • Using the BELL at the MITRAL point, the patient is lying on their LEFT side @ a 45 degree angle. They are breathing QUIETLY THOUGH AN OPEN MOUTH.
    • This accentuates:
    • 1. S3.
    • 2. S4.
    • 3. MITRAL STENOSIS.
  38. What does the aortic maneuver accenuate?
    • Aortic regurgitation. 
    • *Diaphragm @ PETM, pt seated & leaning forward 25 degrees. Exhale & hold breath. 
    • *@ all parts except aortic. 
  39. 10 areas for peripheral pulses:
    • 1. Temporal. 
    • 2. Carotid. 
    • 3. Brachial. 
    • 4. Ulnar. 
    • 5. Radial. 
    • 6. Aorta. 
    • 7. Femoral. 
    • 8. Popliteal. 
    • 9. Post tib. 
    • 10. Dorsalis pedis.
  40. ORTHO/NEURO
    MUSCLE STRENGTH
    • -Normal muscle strength = bilaterally symmetrical & complete ROM against full resistance (5/5)... Weakness (0/5-4/5) = abnormal.
    • -Muscle strength: UML-LMN pathway, NMJ, muscle... Weakness may result from any of these... Weakness may be D/T pain during testing. 
    • -DDX from distribution, motor/reflex/sensory findings, HX & physical exam.
  41. ORTHO/NEURO
    DTR
    • -Reflects activity of reflex arc (muscle spindle receptor, Ia sensory fibers, LMB & muscle) as well as the UMN'S inhibitory activity. 
    • -Reflex Arc Lesion (radiculopathy, periphreal neuropathy) = decreased or absent DTR (hyporeflexia/areflexia).
    • -UMN Lesion (CNS) = hyperreflexia (4+). 
    • -Normal finding: bilaterally symmetrical/brisk reflexes in the absence of other neurologic SX's. 
    • -Correlate with other aspects of reflex arc (pathologic reflexes, motor & sensory exam findings).
  42. C5: Strong Man
    C5: “STRONG MAN”

    • -Disc: C4.
    • -Muscle:
    •     1) Shoulder Abduction: deltoid (axillary N).
    •     2) Forearm flexion: biceps (MCN).
    • -Reflex: biceps.
    • -Sensory: lateral arm.
  43. C6: "Biker Chicks"
    • -Disc: C5.
    • -Muscle:
    •     1) Wrist extension: ECRL & B, ECU (rad N).
    • -Reflex: brachioradialis.
    • -Sensory: ant. lat. FA, palm, thumb, & 2nd digit.
  44. C7: “ELBOW EXTENSION, WRIST FLEXION, FINGER EXTENSION”
    • -Disc: C6.
    • -Muscle:
    •     1) Elbow extension: triceps (radial N).
    •     2) Wrist flexion: FCR (median N), FCU (ulnar N)… Golfer’s elbow test.
    •     3) Finger ext: EDC, EIP, EDM (rad N).
    • -Reflex: triceps.
    • -Sensory: 3rd digit, middle/palm.
  45. C8: “FINGER FLEXION”
    • -Disc: C7.
    • -Muscle:
    •     1) Finger flexion: FDS, FDP, lumbricals (M&U N’s)... (test w/ fingers interlocked looking like an 8).
    • -Reflex: NONE.
    • -Sensory: 4th & 5th digits, antero-medial hand & FA.
  46. T1: “FINGER FUN”
    • -Disc: T1.
    • -Muscle:
    •     1) Finger ABduction: dorsal interossei (ulnar N).
    •     2) Finger adduction: palmer interossei (ulnar N).
    • -Reflex: NONE.
    • -Sensory: anteromedial arm.
  47. L4: “DORSIFLEXOR & INVERTOR MAKES A FOUR”
    • -Disc: L3.
    • -Muscle:
    •     1) Foot dorsiflexion & inversion (up & in): (test down & out)… TA, EHL, EDL (DPN).
    • -Reflex: Patellar.
    • -Sensory: Medial aspect/leg, medial foot,
    • medial big toe.
  48. L5: “TOE JIVE, HEEL JIVE, ABDUCT THE THIGH.”
    • -Disc: L4.
    • -Muscle:
    •     1) Foot dorsiflexion (up): TA, EHL, EDL (DPN). 
    •     2) Big toe dorsiflexion (up): EHL
    • (DPN).
    •     3) Toes 2, 3,4 dorsiflexion: EDL&B (DPN).
    •     4) Hip & pelvis ABduction: glute med & min (SGN).
    • -Reflex: NONE.
    • -Sensory: Lateral leg, dorsum/foot, middle 3 toes.
  49. S1
    • -Disc: L5.
    • -Muscle:
    •     1) Foot plantar flexion (down): gastroc & soleus (Tibial N).
    •     2) Foot plantar flexion & eversion (down & out): peroneus L&B (SuperficialPN).
    •     3) Hip extension: glute max (IGN).
    • -Reflex: Achilles (tested with foot in slight
    • flexion).
    • -Sensory: Post. leg, lat. foot, & lat little toe.
  50. S2
    • -Disc: S1.
    • -Sensory: Post thigh over popliteal fossa & posteromedial calf (L-M through popliteal fossa).
  51. Which NR is associated with the biceps reflex?
    C5 NR, C4 disc.
  52. Which nerve innervates the mm associated with testing forearm flexion for the ___ NR?
    • Forearm flexion: biceps = MCN.
    • C5 NR, C4 disc.
  53. The brachioradialis reflex is associated with which NR?
    C6 NR, C5 disc.
  54. Wrist extensors are innervated by which N?
    Radial: ECRL & B, ECU.
  55. The triceps reflex is associated with which NR?
    C7.
  56. Golfer's elbow test is associated with which NR?
    C7.
  57. Which NR do you test by pushing down & out?
    L4: testing foot dorsiflexion & inversion (up & in).
  58. What are the 4 muscle tests associated with the L5 NR?

    FBTH
    • 1. Foot dorsiflexion
    • 2. Big toe dorsiflexion
    • 3. Toes (2,3,4) dorsiflexion
    • 4. Hip ABduction
  59. Which NR is mm testing plantar flexion, eversion & hip extension?
    • S1.
    • Foot plantar flexion
    • Foot plantar flexion & eversion
    • Hip extension
  60. Which 4 mm are responsible for plantar flexion?
    What are their innervations?
    • Gastroc & soleus (Tibial N). 
    • Peroneous longus & brevis (SPN).
  61. EENT HX OR EXAM
    + MULTIPLE CHOICE STATION
    REVIEW EENT NOTES
  62. HEART/LUNGS SOUNDS 
    (LISTEN TO A CD & NAME SOUND) 
  63. CERVICAL, THORACIC, LUMBAR 
    +COMPLAINT HX
    +MULTIPLE CHOICE DX, DDX, CASE MANAGEMENT STATION
    +ORTHOR OR NEURO EXAM 
    (2 QUESTIONS EACH) 
  64. REVIEW CASE HX SETUP GET FROM PAUL!!

    OPQRST SHITMD GREENCRUMS
    • Onset
    • Pallative
    • Quantitive
    • Referral
    • Site
    • Timing

    • Social HX
    • Hospitalizations
    • Infection
    • Trauma
    • MD's
    • DC's

    • GI
    • Respiratory
    • Eyes
    • Ears
    • Nose
    • Cardiovascular
    • Repro
    • Urinary
    • Musculoskeletal
    • Sexual
Author
dcmommy13
ID
208401
Card Set
ICE
Description
Intern Competency Exam... Almost done ! ! !
Updated

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