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Shoulder Exam - Provocative Testing Supraspinatus muscle injury: - Jobe’s Test - Hawkin’s Test - Drop Arm
injury: - Jobe’s Test ... - Hawkin’s Test ... - Drop Arm Test ... Rotator cuff subacromial ... - O’Brien Test
Bilateral LMN palsy with tongue weakness, wasting and fasciculations. → Bulbar motor Neuron disease Note
Bilateral LMN palsy ... differentiates this from an UMN ... fasciculations #LMN ... #CNXII #CN12 #clinical
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 Upper Motor Neuron (UMN) lesions are lesions occurring anywhere in the CNS from the brain up
Motor Neuron (UMN ... However, in UMN ... clinically characterized ... very different clinical ... UMN lesions are
Amyotrophic Lateral Sclerosis (ALS) Summary ALS: combination of the clinical examination finding of amyotrophy with the pathologic
combination of the clinical ... cellular function Clinical ... involving both UMN ... Exam: clinical evidence ... of both UMN and
Generalized Weakness - Differential Diagnosis Framework "l feel weak": • Infectious: Influenza, EBV, PNA, Bacteremia, Sepsis •
Rhabdomyolysis, Critical ... Infection • Neuro: UMN ... stroke, tumor), LMN
Liver Function Test (LFTs) Elevation AST - Cardiac and skeletal muscle, kidney, brain ALT - More specific for
Liver Function Test ... Phosphatase, ALT ≥ 3x ULN ... Transaminase, ALP ≥ 2x ULN ... Value = (ALT / ULN ... ALT) / (ALP / ULN
Shoulder Impingement Syndrome (SIS): Signs and Symptoms Repetitive Overhead Activity, Scapular Dyskinesis -> Scapulohumeral mechanics become altered
> Narrowing of subacromial ... Impingement of subacromial ... + Painful arc test ... pain + Hawkin's test
Abnormal Liver Function Tests - Differential Diagnosis Algorithm for Transaminitis Hepatocellular Pattern (ALT or AST > ALP):
Liver Function Tests ... Severe - ALT >15X ULN ... Moderate - ALT 5-15X ULN ... Mild - ALT < 5x ULN
Synovial Fluid Analysis: Findings (COLOR TRANSPARENCY VISCOSITY WBC COUNT (PER MM3) PMN CELL COUNT (%) GRAM STAIN CULTURE PCR TEST CRYSTALS) By Condition (Normal Noninflammatory Inflammatory:
COUNT (PER MM3) PMN ... STAIN CULTURE PCR TEST
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 Peritonitis - Spontaneous vs Secondary vs Peritoneal Dialysis Associated Peritonitis Spontaneous Bacterial Peritonitis • Cirrhosis (high SAAG)
) + ascites w/ PMN ... glucose < 50, LDH ULN ... at least 2): 1) Clinical
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