CS Exam 2

1. What is acute low back pain defined as?

2. Define:

   1. Mechanical low back pain

   2. Chronic Mechanical

   3. Acute

   4. Subacute

   5. Chronic

3. Radiation consider “__?

4. Typical First Episode?

List out the causes of Acute Mechanical Low Back Pain

WHat are non mechanical causes?

1. What is the difference between Simple and Complicated MSK Low Back pain?

Simple = no red flags

• Systemic disease and referred pain ruled out

• Conservative therapy x 6 weeks (Home Exercise Program?)

List out the red flags for complicated Low BAck Pain

For Acute Low Back pain w/ Radicular Symptoms past knee (4%), Describe the difference criteria for conservative management vs urgent evalulation

How would you know if the acute low back pain is due to lumbar stenosis?

What are the six steps to a MSK exam for acute low back pain

Describe the Imaging used for acute low back pain

• Describe how you could diagnose Acute Mechanical Low Back Pain;

  • Differentials?

List out some treatments for acute mechanical low back pain;

Describe Management of low back pain

Describe the aftermath/resolution of Low back pain

Describe the classification of Dermatological Disorders

What are the seven functions of the skin

List the Diseases Associated w/ irregularity in each of the 7 functions of skin

• Barrier function: ATOPIC DERMATITIS , (ECZEMA)

• Immunologic function: MYCOSIS FUNGOIDES

  • a type of skin lymphoma. Dysfunction of cutaneous lymphocytes increases risk for bacterial and fungal skin colonization and subsequent infection.

• Temperature regulation: ERYTHRODERMA (Exfoliative dermatitis)

  • >90% of the skin is erythematous (red) and/or inflamed. Extensive cutaneous vasodilation can cause hypothermia and high-output cardiac failure leading to organ failure.

• Protection from radiation: ALBINISM: Higher risk of MELANOMA

• Sensation: chronic stasis ulcer on the lower extremity of a patient with peripheral neuropathy related to diabetic neuropathy.

• Injury repair: POST –RADIATION TREATMENT FOR SQUAMOUS CELL CARCINOMA

• Appearance: Quality of life:

  • vitiligo

  • HIV-associated lipoatrophy, characterized by loss of fat throughout the face.

Describe the three layers of the skin; function/structure

What is the function of the epidermis

Describe the five layers of the Epidermis; Structure/Function

1. Stratum corneum

   • Corneal layer Made of desquamating keratinocytes.

   • Thick outer layers of flattened keratinized non-nucleated cells provide a barrier against trauma and infection

2. Stratum lucidum

   • Lucid or Clear layer: Present only in the palms of the hands and soles of the feet.

   • The keratinocytes that compose the stratum lucidum are dead and flattened.

   • These cells are densely packed with eleiden, a clear protein rich in lipids, derived from keratohyalin, which gives these cells their transparent (i.e., lucid) appearance and provides a barrier to water.

3. Stratum granulosum

   • Granular layer: The keratinocytes produce lipids
     (the mortar) in the granular cell layer and secretes it into the extracellular space between the keratinocyte forms a water barrier that Keeps water in the skin

4. Spinous layer

   • Center of epidermis.

   • Has a “spiny” appearance due to desmosomal junctions which hold the keratinocytes together.

5. Stratum basale

   • Basal layer

   • The basal layer is the source of epidermal stem cells.

   • Cell division occurs here.

   • Keratinocytes start in the basal layer and move upwards.

   • Melanocytes are located here

What are the four Diseases associated w/ the epidermis

Describe Bullous pemphigoid:

Describe Pemphigus Vulgaris

Describe Psoriasis

Describe Ehlers-Danlos Syndrome and Solar elastosis

Describe keratosis pilaris

What are Fordyce spots?

Describe Acne Vulgaris

Describe Morphea

Describe Erythema nodosum

Erythema NODOSUM mneumonic

List out Lymph node terminology and description

Describe the Upper Extremety Lymphatic System

What is the difference between Lymphangitis and Lymphedema

Lymphangitis is an active infection; Lymphedema is a fluid retention problem, often a long-term consequence of other issues, including past infections or cancer treatment

What are the Differential DIagnosis of:

• Infraclavicular nodes

• epitrochlear Nodes

• Axillary nodes

Describe Evaluation of Epitrochlear nodes (and
Brachial artery)

Describe Axillary Nodes:

• Size

• Firmness

• Quantity

• Pain

• Relation

• Changes over time

Describe the Lymphatics of the Lower Extremeties

What are the two chains of superficial Inguinal Lymph Nodes?

Describe the Venous System of the upper extremity

Describe the Venous System Lower Extremity

What is Virchow’s Triad

What is Homan’s sign for DVT
(Deep vein thrombosis

Describe Pitting Edema Assessment

Describe difference between varicose and healthy veins

Describe the function of the layers of blood vessels

Describe the progression of Artheroslerosis and PAD

What is the Dicrotic Notch?

Describe these Pathologic Pulses:

• Pulsus parvus et tardus

• Pulsus Alternans

• Pulsus paradoxus

• Water hammer pulse

Describe how to do Assessment of peripheral pulses

List the Peripheral Arterial System Upper Extremity

List the Peripheral Arterial System Lower Extremity

How would you Palpation of the Popliteal artery

Describe how to determine Ankle-Brachial index

Describe Normal Peripheral Vascular Exam Documentation

Describe how a patient-provider relationship is terminated?

Describe the “duty to treat”

Describe Fiduciary Duty

Describe Confidentiality: Duty to Patient

Describe Limitations on Confidentiality: Duty to Third Parties

Describe Autonomy

Describe Autonomy: Informed Consent

Describe Justice

Describe Beneficence and Non-Maleficence

Describe how you would examine the Head

What sort of things are you looking for when inspecting the face

Describe the Anatomic Locations of the Sinuses

SINUS REVIEW
• Maxillary Sinus
• Ethmoid Sinus
• Frontal Sinus
• Sphenoid sinus
• Superior Turbinate
• Middle Turbinate
• Inferior Turbinate

Describe how to do Sinus Palpation

Describe What goes through the:

• Infraobital foramen

• Supraorbital foramen

• Mental Foramen

What are the Turbinates

Describe what you are looking for when inspecting/Palpating the Ear

Describe the External Ear Landmarks

What is a Darwin’s Tubercle

Describe how you would examine the ear

Explain how you would use the otoscope

Describe the modification to using the otoscope for Kids (younger/older then 3)

What are Pneumatic otoscopes used for?

Describe what a Normal Tympanic Membrane Looks like?

What does tympanosclerosis look like?

Describe the weber test

Describe the Rinne Test

Describe the difference between Air/Bone conduction

How do you interpret the results of the Rinne/Weber Test

Describe the Documentation: Normal exam of Head, Ears, and Nose

How would you inspect the throat?

Describe the normal range of findings for throat exam

Describe Tonsilar Grading

Describe how you would inspect the mouth

Inspect the Mouth:

• Begin with the anterior structures and move posteriorly
  

• Use a tongue blade to retract structures and a bright light for optimal
  visualization

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Inspect the Lips:

• Notice color, moisture, cracking or lesions
  

• Retract the lips and note the inner surface as wel

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Normally the gums look pink with a stippled surface. The gum margins should be tight and well defined.

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With a gloved hand, hold the tongue with a cotton gauze pad for retraction and inspect both sides of the tongue. Look for
any white patches or lesions and if present, palpate checking for induration.

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Inspect carefully the entire U-shaped area under the
tongue behind the teeth. Oral malignancies are likely to develop here. Note any white patches, nodules or ulcerations. If lesions are present or for any person older than 50 or with a positive history of smoking or alcohol use, use your gloved hand to palpate the area. Place your other hand under the jaw to stabilize the tissue and the ‘capture’ and abnormalities.

How would you examine the Tonque

How would you examine the Palate

Describe Documentation: Normal exam of Head, Ears, Nose and Throat

Describe how you would test for Visual Acuity (VA)

How would you document Visual Acuity (eye exam)

What happens if the patient is unable to read ANY of the chart (illiterate)

CF: Count Fingers @ ?? feet
HW: Hand Wave @ ?? feet
LP: Light Perception
NLP: No Light Perception

How would you test for color blindness