Clinical Reflexes
Achilles reflex Patellar reflex Biceps and brachioradialis reflexes Triceps reflex Cremasteric reflex Anal wink reflex Jaw jerk reflex Nerve Palsies - Erb's Palsy (Waiter's tip)
C5-C6 Roots Superior (Upper) Trunk Lateral Traction on Neck during Delivery Trauma in Adults Deltoid Infraspinatus Biceps Brachii Waiter's Tip Deformity Actions of Hip Muscles
Gluteus medius, gluteus minimus Adductor magnus, adductor longus, adductor brevis Gluteus maximus, semitendinosus, semimembranosus, biceps femoris (long head) Iliopsoas, rectus femoris, tensor fascia lata, pectineus Gluteus medius, gluteus minimus, tensor fascia latae Iliopsoas, gluteus maximus, piriformis, obturator Branches of Brachial Plexus
Flexion Supination Abduction of shoulder Posterior circumflex artery Fracture of surgical neck Extensors of arm, wrist, fingers Supinator Sensory back of arm and hand Saturday night palsy Fracture of humerus shaft Ulnar claw Lumbricals Interosseus Muscles Wrist and finger flexion Pronation Hand of benediction Carpal tunnel Lumbricals Brachial Plexus
Long Thoracic nerve (C5-C7) Dorsal Scapular nerve (C5) Subclavian Nerve (C5-C6) Suprascapular Nerve (C5-C6) Suprascapular innervates supraspinatus and infraspinatus Lateral Pectoral Nerve Lateral pectoral innervates pec major Upper and lower subscapular nerves Upper and lower subscapular nerves innervate subscapularis muscle Thoracodorsal nerve (AKA middle subscapular n) Thoracodorsal innervates latissimus dorsi Medial Pectoral nerve Medial Brachial Cutaneous Nerve Median nerve (C5-C6) Axillary Nerve Axillary nerve innervates deltoid and teres minor Musculocutaneous nerve Radial nerve Ulnar Nerve Leg Nerves
Femoral Saphenous Posterior Femoral Cutaneous Sciatic Tibial Common Peroneal Superficial Peroneal Deep Peroneal Adhesive Capsulitis (Frozen Shoulder)
Pain, loss of shoulder motion, especially external rotation Diabetes Breast/lung surgery Thyroid disorders Extended use of sling NSAIDS Steroids Scoliosis
S Shaped Lateral Spinal Rotation Unequal Shoulder and Scapula Height Uneven Gait Impaired Oxygenation Hump when Bending Forward Body Braces Worn 23 Hours/Day Surgery Adolescent Screening Dermatomes - Cervical
C2 - Posterior Cap Distribution C3 - High Turtleneck C4 - Low Collar Shirt C5 - Anterolateral Shoulder C6 - Thumb C7 - Middle Finger C8 - Pinky Finger Rotator Cuff
External Rotation Teres Minor Infraspinatus Internal Rotation Subscapularis Abduction Supraspinatus Juvenile Idiopathic Arthritis (JIA)
Most common cause of Arthritis in Children. Onset before Age 10. More common in females Persistent joint swelling (synovial thickening, accumulation of synovial fluid) Severe symmetrical arthritis Dactylitis Typically involves large joints (shoulders, elbows, hips and knees) 20-25% have Uveitis. Increased risk of blindness in children. Also known as Still's disease Begins with systemic symptoms (fever, rash, elevated WBC, anemia, hepatosplenomegaly, lymphadenopathy). Described as "spikes of rash and fever." Arthritis begins later in the course of the disease Diabetes Insipidus
Excess urinary loss of water Deficiency/insensitivity to vasopressin Hypernatremia Low urinary sodium excretion Treat with desmopressin Patient should drink to thirst Paracentesis
Performed on patients with severe ascites For procedure patient should be sitting on side of the bed or in high fowlers position Provides only temporary relief Uses a syringe to extract fluid Patient must void immediately before procedure Look for signs of electrolyte imbalance and hypovolemia after procedure Angina Diagnostics
Resting EKG Normal in stable angina Q Wave= previous MI ST or T changes + chest pain= unstable angina Cardiac stress EKG Indicated if normal resting EKG ST Depression= positive test Patients with positive stress EKG or Echo should undergo catheterization Stress echocardiogram Autosomal Recessive Diseases
Albinism AR Polycystic Kidney Disease Cystic fibrosis Von Gierke's Disease Pompe Disease Cori Disease McArdles Disease Hemochromatosis Kartagener's Syndrome Hurlers Syndrome Phenylketonuria (PKU) Sickle Cell Disease Gauchers Disease Niemann-Pick Disease Tay-Sachs Disease Krabbe Disease Metachromatic Leukodystrophy Thalassemias Wilson's Disease Friedreich's Ataxia Fructose Intolerance Hartnup Disease Leukocyte Adhesion Deficiency Essential Fructosuria Galactokinase Deficiency Alkaptonuria Ataxia Telangiectasia 5 Alpha Reductase Deficiency Bernard-Soulier Syndrome Classic Galactosemia Orotic Aciduria Crigler-Najjar Syndrome Type 1 Pyruvate Kinase Deficiency Homocystinuria Glanzmann Thrombasthenia Cancer pain
Mild Acetaminophen NSAIDS Moderate Weak opioids ± nonopioids hydrocodone Codeine Tramadol Severe Strong short-acting opioids Morphine and Hydromorphone daily dose and convert to long-acting formulation Fentanyl patch Oxycodone PLUS Short-acting opioids for breakthrough pain increase should be done via titration (50% every 24 hours) prerenal acute kidney injury
no underlying kidney disease intravascular volume depletion Heart Failure Cirrhosis Sepsis Pancreatitis stenosis NSAID (afferent arteriole vasoconstriction) increased serum creatinine (eg 50% from baseline) Oliguria BUN/creatinine ratio >20:1 fractional excretion of Na < 1 % unremarkable urine sediment IV Fluids Metformin should be stopped Burns Assessment
Stage and Extent of Burn Dyspnea Singed Nasal Hairs Pain Initial Decrease Urinary Output Paralytic Ileus Signs of Inadequate Hydration Shock Hypothermia Hyperkalemia Diabetes Education
Self-Monitoring (Blood Glucose) SubQ Injection Technique Lifestyle Changes Symptoms of Hyperglycemia and Hypoglycemia Sick Day Care Foot Care Exercise Therapy Medication Acute Respiratory Distress Syndrome (ARDS) Interventions
Closely Monitor Patient ABG's (Arterial Blood Gases) Oxygen Assess for O2 Toxicity Mechanical Ventilation PEEP Assess for Pneumothorax Permissive Hypercapnia High Mortality Rate View More
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