-
______: 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.
-
DIDTP
- 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?
SPECT test.
-
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...
abcdefghijKLmnop: Kleinback's = lunate.
-
Pie sign, MC dislocated carpal bone...
Lunate.
-
Terry Thomas Sign & Signet Ring Sign...
Scaphoid: 2nd MC displaced carpal bone (MC FX).
-
Hill-Sacks/Hatchet Deformity...
- 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?
Down's Syndrome.
-
Atlast hyperplasia, smooth/wide/lucent defect between the body of C2 & the dens.
Os Odontodium.
-
Wasp waist & hypoplastic dens...
Congenital block.
-
_______ 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 @ ?
- L5/S1.
- *Assymetric articular planes.
- *Best seen on AP projection.
-
Corticosteroids are associated with... (4)
- 1. AVN
- 2. Pathological FX
- 3. RA
- 4. Asthma
-
Mikulicz's Line...
- 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.
-
Pelligrini Steida...
- 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?
L1/2
-
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?
- CT.
- *Anything in the lung.
- *Discitis, osteomyelitis, Brodie's abscess.
- *AAA
- *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?
McGregor's
-
- 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?
Flexion?
- Extension: C4/5
- Flexion: C5/6
-
Paravertebral ST measurements...
PLT Sandwich...
- PLT sandwich 7, 14, 21
- retroPharyngeal: C2-4, <7mm
- retroLaryngeal: C5, <14mm
- retroTracheal: C6-7, <22mm
-
What is the best method for scoliosis evaluation?
Cobb's.
-
What is the normal sacral inclination angle?
-
What is the average angle for Fergauson's Angle?
- 41.

-
Meyerding's Grading is for _______.
- Spondylolisthesis.
- 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.

-
Eisenstein's measures...
- Canal.
- *<15mm = spinal canal stenosis.
-
WNL for the lumbosacral disc angle?
10-15*
-
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.
-
Kohler's Line...
- protrusio acetabuli.

-
What line?
- Shenton's.
- *Smooth curvilinear line.
-
What line?
-
Mikulicz's Angle a/k/a...
Femoral angle.
-
What line?
- 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)?
DD Palmer.
-
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.
Gillet/Faye.
-
Father of homeopathy?
Hahnemann.
-
Who was the first to manipulate?
Hippocrates.
-
_______: joint HYPERmobility... disovered & tested SI ligaments.
Illi: joint HYPERmobility.
-
What are the 3 phases of the model of instability?
KY
- 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?
Samuel Weed
-
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)
ICD 3
- 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?
Sensory changes.
-
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?
- Visceral.
- *Viscerovisceral: afferents & efferents are visceral sensory & autonomic.
- *Organs, blood, lymph.
-
Somatovisceral a/k/a...
- Somatoautonomic: N stimulus = reflexive response in visceral organs.
- *Adjustment relieves SX of dysmennorrhea (painful period).
- *Asthma.
-
Which reflex model is associated with chronic asthma causing muscle tenstion & joint subluxation?
Viscerosomatic.
-
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?
Wallerian Degeneration.
-
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?
NR.
-
______ 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.
-
Antegrade:
Forward moving
Cell body -> terminal
Nerve growth
______
_______
- Antegrade:
- Forward moving
- Cell body -> terminal
- Nerve growth (trophic)
- Faster
- 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.
- *Korr.
- *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?
Resistance phase.
-
Which ligament holds the dens & is stressed via flexion views?
Transverse ligament.
-
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?
- ALL.
- *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.
Dentate ligament.
-
Most external meningie?
- Dura mater: continuous from cranial cavity -> sacrum.
- *Covers NR's, DRG.
-
Which meningial layer is avascular?
Arachnoid mater.
-
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.
-
Fat VAN
- Order of compression in the IVF:
- Fat (adipose tissue)
- Veins
- Arteries
- Nerves
-
What is most sensitive to compression in the IVF?
- DRG.
- *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.
- *ACH.
-
Which neurons innervate mm spindles?
- Gamma motor neurons = mm spindles.
- *Establishes set point for mm tone.

-
Which type of nerve fiber detects stretch/velocity?
1A
-
Which type of nerve fiber is the largest & most sensitive?
A Alpha
-
Which type of nerve fiber is associated with the muscle spindle?
1a
-
Which type of nerve fiber detects stretch/velocity?
1a = muscle spindle = stretch/velocity
-
Which type of nerve fiber is associated with the GTO?
- 1b
- *tension
- *JPS, vibration, 2 point decrimination
-
Tension is associated with which type of nerve fiver?
1b
-
JPS, vibration & 2 point discrimination are associated with which type of nerve fiber?
1b
-
Fast pain is associated with which type of nerve fiber?
A delta
-
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?
Parasympathetics.
-
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?
- Sympathetic.
- *Erection = parasympathetic... keeps pee & poo off the floor.
-
Which tract is associated with the flexors of the upper extremity?
Rubrospinal
-
Which tract is associated with the extensor muscles of the back & arms?
reticulospinal
-
Which tract is associated with the extensor muscles of the back & legs?
Vestibulospinal
-
Which tract is associated with the flexors of the distal extremities?
Corticospinal (pyramidal).
-
Which tract is associated with crude touch & pressure?
Ventral spinothalamic.
-
Which tract is responsible for conscious proprioception?
- DCML
- *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...
T1-4
-
Meric chart... gall bladder...
T4, T6-10
-
The ovary & colon are driven by which subdivision of the ANS?
- Sympathetic.
- *Colon & utuerus = parasympathetic.
-
T10 increases which response?
sudomotor
-
Damage to the cells releases which substance?
histamine
-
Pulsed US is used for....
- Acute phase only.
- *Continuous = subacture & chronic.
-
Which exercise is best for increasing lumbar lordosis & rehabing a disc?
- McKenzie's.
- *William's = reduce hyperlordosis.
-
Which exercise is used to rehab the knee?
DeLorme
-
Wobble board exercises are associated with...
Frenkel's exercises.
-
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.
- *Fixed.
-
What is an a/k/a for timing in OPQRST?
Timing = Temporal Factors.
-
Auscultory gap may be seen in....
- Hypertensives.
- *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...
seated
-
The DeKlyeyn's VBAI test is done...
Supine
-
The Hallpike VBAI test is done...
Supine
-
The Hautant's VBAI test is done...
Seated
-
The Underberg VBAI test is done...
patient standing.
-
How can you tell the difference between Horner's Ptosis & CN III Ptosis?
- Horner's: also has meiosis (smaller/constricted pupil D/T sympathetics)... pancoast tumor, TOS, whiplash.
- CN III: dialates the pupil.
*MG can also cause ptosis...
-
Is graves disease hypo or hyperthyroidism? What happens to the eyes?
- Graves = hyperthyroidism.
- *Exopthalmosis.
-
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?
Chalazion.
-
______: 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....
- Glaucoma.
- *MD = central vision.
-
Copper wire deformity, A-V nicking, flame/splinter hemorrhages & cotton wool exudates are D/T...
Hypertensive retinopathy.
-
Neovascularization of the eye is associated with...
- Diabetic retinopathy.
- *Affects veins more than arteries.
-
Iritis is seen with which condition?
AS
-
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...
Acute mastoiditis.
-
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.
-
Weber's lateralizes.
*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..
Viral rhinitis
-
Pale or blue nasal mucousa is associated with...
Allegic rhinitis
-
Cheilosis is D/T a deficiency of which vitamin?
B2 (riboflavin).
-
Kaposis's Sarcoma is associated with....
- AIDS.
- *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...
Normal variant.
-
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.
-
Bandline pain..
Tension HA
-
Polymyalgia Rheumatica a/k/a...
- Temporal Arteritis (Giant Cell): >50 YO, unilateral, can go blind.
- *Increased pain with hair combing.
- *Jaw claudication.
- *Elevated ESR.
-
Vertebrogenic a/k/a...
- 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?
TMJ
-
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?
(vinegar strokes)
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.
-
Beau's lines...
Transverse ridging associated w/ severe DX.
-
Inflammation of the nail fold near the cuticle...
Paronychina.
-
_______: 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?
Resonante
-
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.
- *Consolidation.
-
Diaphragmatic excursion is used to DX which 2 conditions?
- Pneumonia or pheumothorax.
- *Marks where resonant changes to dull.
-
Bronchial sounds are found over...
The manibrium.
-
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?
Bronchiectasis.
-
Wheezes are heard during...
- Expiration.
- *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?
Pleurisy
-
Breath sounds are decreased with which condition?
Pneumothorax
-
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?
Lobar pneumonia.
-
Gohn lesions are associated with which condition?
- TB.
- *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?
- TB.
- *Best DX = sputum culture.
-
Which side does the mediastinum shift to with atelectasis?
Same side.
-
Curshmann's Spirals & Charcot Laden Crystals are associated with which condition?
-
Flattening of the diaphragmatic domes is associated with which condition?
- Emphysema.
- *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.
- *Genetic.
-
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 =
- S1
- Saved By the Bell is #1!
- *Valves only make noise when they are closing.
-
A ventricular gallop is heard during....
- S3.
- *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?
Erb's Point
-
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.
-
DIASTOLE
ARMS PRTS
- Aortic Regurgitation
- Mitral Stenosis
- Pulmonic Regurgitation
- Tricuspid Stenosis
- *switches for systole.
- *Snap = stenosis
- *Clicks = regurgitation
-
DRIP
- 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?
- Left.
- *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?
Exertional dyspnea.
-
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.
- *Ascities.
- *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...
MI
-
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...
Hypervitaminosis A.
-
What is the MCC of liver destruction?
- Alcoholism.
- *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...
Hepatitis.
-
-
Dirty needles & sex hepatitis?
-
Blood transfusion hepatitis?
C
-
Where is the MC site for metastatic DX?
Liver
-
What is the tumor marker for hepatocellular carcinoma?
AFP
-
Coomb's Test is associated with...
- Hemolytic anemia.
- *Indirect/unconjugated bilirubin.
- *Hemolysis.
-
What is the proper order for abdomen palpation?
I APLD
- Inspect
- Auscultate
- Percuss
- Light palpation
- Deep palpation
-
What is the normal tone of the abdomen?
Tympanic.
-
Murphy's Sign is associated with..
- Cholecystitis.
- *DX via US.
-
Grey Turner's Sign (bleeding into flank) is associated with...
- Pacreatitis.
- *Cullen's Sign: periumbical ecchymosis.
-
What is the MCC of Cullen's Sign?
Ectopic pregnancy.
-
Which type of diabetes does not present with polyphagia (increased eating)?
Diabetes insipidus.
-
_______: 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?
Gastric ulcer.
-
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...
- Mono.
- *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).
-
Skipping stones...
- Crones = skip lesions (cobblestone).
- *Distal ileum.
-
Bloody mucous diarrhea is associated with...
- Ulcerative Colitis: left side of the intestines.
- *MC @ colon & rectum.
- *Fever.
- *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?
Pheochrmocytoma.
-
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?
- Nephrotic.
- HEP
- *Waxy, fatty casts in urine.
-
Waxy casts are associated with...
Nephrotic Syndrome.
-
What is the MCC of urethritis in males?
- Gonorrhea.
- *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?
- Epididymitis
- *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?
Intermittent Caludication
-
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...
- Neurogenic.
- *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...
*Sudek's Atrophy
- 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...
Lower extremity.
-
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?
O'Brien's.
-
Hawkin's Kennedy ortho test for...
Shoulder impingement... pain between 70-30*.
-
Which pelvic listing correlates witha flexed ilium?
PI
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