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ABEM Flash cards

1
Q

Ehrlichiosis - organism and transmission?

A

Ehrlichia (gram neg, intracellular), lone star tick (Amblyomma)

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2
Q

Babesiosis - organism and transmission

A

protozoan parasite, Ixodes tick

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3
Q

tick borne relapsing fever - organism and transmission

A

spirochete Borrelia hermsii, Ornithodoros tick

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4
Q

tick borne relapsing fever - clinical syndrome

A

fever, HA, myalgias, arthralgias, jaundice x3-6 days; then afebrile, x several cycles.

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5
Q

colorado tick fever - organism and transmission?

A

RNA virus, wood tick Dermacentor

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6
Q

class I hemorrhage: EBL and VS?

A

<750 cc’s. normal HR/BP, normal to elevated pulse pressure

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7
Q

class II hemorrhage: EBL and VS?

A

750-1500 cc’s. HR 100-120, BP normal, decreased pulse pressure

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8
Q

class III hemorrhage: EBL and VS?

A

> 1500 c’s. elevated HR, low BP, decreased pulse pressure

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9
Q

MR murmur

A

apex, systolic murmur, radiates to axilla

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10
Q

most common traumatic valvular injury

A

aortic valve

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11
Q

diastolic murmurs

A

AR, MS, pulmonary regurg, PDA (continuous)

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12
Q

systolic murmurs

A

AS, MR/TR, VSD, MVP, PDA (continuous)

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13
Q

XR for toxic megacolon

A

dilated colon to 6 cm, loss of haustra, thumbprinting

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14
Q

black widow spider bite symptoms

A

mostly local (including diaphoresis near site), occasional systemic. Caused by release of ACh and NE.

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15
Q

bark scorpion (Centruroides) envenomation symptoms

A

localized pain, can cause severe neurologic sx in children (neuroexcitatory of sympathetic and parasympathetic nervous system causing ataxia, cranial nerve dysfunction, hypersalivation, muscle jerking, and unusual eye movements)

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16
Q

GIB after aortic aneurysm repair = what diagnosis

A

aortoenteric fistula

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17
Q

When is a patient’s risk for future stroke highest following a transient ischemic attack?

A

first 2 days

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18
Q

Montaggia

A

prox ulnar fx and prox radial (head) dislocation

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19
Q

smallpox vs chicken pox

A

smallpox = all the same age. chickenpox = lesions of varying ages

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20
Q

indication, and absolute contraindication to physostigmine

A

anticholinergic syndrome. C/I if QRS >100 or if Na channel blockade

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21
Q

dry socket syndrome and treatment

A

pain 2-3 days after dental extraction due to loss of protective clot. Irrigate with chlorhexidine 0.12% or warmed NS. If e/o infection, PCN (or clinda if PCN allergy)

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22
Q

Best test for giardia

A

stool antigen test

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23
Q

cyproheptadine is the treatment for?

A

serotonin syndrome

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24
Q

antibiotics assoc with non convulsive status

A

PCNs

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25
Q

odynophagia in HIV patient: organisms?

A

Candida or CMV

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26
Q

cancer and lethargy/AMS

A

Hypercalcemia

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27
Q

recurrent food impactions and GERD despite PPI/antacids

A

eosinophilic esophagitis (can develop strictures)

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28
Q

superficial vs partial thickness burns?

A

superficial is painful, red, and blanching.

partial is non-blanching, bright red, and may have blisters

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29
Q

how to treat amenorrhea 2/2 anorexia nervosa

A

weight gain - no OCPs!

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30
Q

red flag back symptoms

A

fever, weakness, weight loss/night sweats, hx of cancer, bowel/bladder, trauma

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31
Q

treatment for mild impetigo

A

Mupirocin ointment (or retapamulin)

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32
Q

predominant electrolyte abnormality in anorexia? treatment?

A

hypophos. treat promptly (PO vs IV depending on severity) to help prevent refeeding syndrome

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33
Q

Korsakoff syndrome

A

apathy, confabulation, anterograde and retrograde amnesia

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34
Q

abdominal pain, palpable purpura

A

HSP

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35
Q

diseases associated with HSP

A

meckel’s, lymphoma, celiac, IBD

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36
Q

treatment for contact lens related corneal abrasions

A

topical anti-pseudomonal (cipro, oflox, tobramycin)

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37
Q

diffuse vesicular lesions in various stages of development

A

varicella

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38
Q

hard signs of vascular neck injuries

A

pulsatile bleeds, expanding hematoma, thrills/bruits, neurologic deficits, shock

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39
Q

sx of scombroid poisoning

A

flushing, GI sx, conj injection 30 mins after eating. Fish may be peppery, bitter, metallic

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40
Q

sx of ciguatera poisoning

A

GI + neuro sx (GI precedes neuro sx). pathognomonic sx = cold allodynia and worsening/recurrence with alcohol.

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41
Q

3 topical cycloplegic drugs

A

cyclopentolate, scopolamine, homatropine

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42
Q

first line treatment for obstruction + coffee bean sign on abd XR

A

dx: sigmoid volvulus. first line tx = sigmoidoscopy (if no gangrene)

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43
Q

1 risk factor for IPV homocide

A

access to firearms

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44
Q

LVH

A

R (aVL) > 11 mm
S V1 + R V5/V6 > 35 mm
S deep + S V4 > 23 mm in M / 28 mm in F

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45
Q

dose of recomb factor VIII in life-threatening bleeds

A

50 units/kg (replaces 100% of factor levels)

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46
Q

chads2vasc: what ages give you points?

A

65-74 = 1 point. >75 = 2 points

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47
Q

chads2vasc: what sex give you points

A

female = 1, male = 0

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48
Q

chads2vasc: what conditions give you points

A

HTN, DM, stroke/TIA/VTE, vascular disease (MI, PAD, aortic plaque), CHF

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49
Q

xray findings suggestive of SBO

A

bowel dilation >3 cm, prominent plicae circulares, and multiple air-fluid levels.

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50
Q

first line abx for mastitis

A

keflex, dicloxacillin (against MSSA). If MRSA suspected, give Bactirim.

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51
Q

acute lung abscess: most likely organism?

A

oral anaerobes

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52
Q

what age for femur IO?

A

<1 year

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53
Q

Ehrlichiosis - clinical syndrome?

A

constitutional sx + hematologic abnormalities (thrombocytopenia/leukopenia). Usually no rash!

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54
Q

drugs that trigger gout

A

ASA, cyclosporine, diuretics

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55
Q

ketosis/ketonuria with normal AG = ?

A

isopropyl alcohol

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56
Q

electrolyte disturbances in tumor lysis

A

hyperuricemia, hyperK, hyperphosphatemia, hypoCa

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57
Q

Fluorescein pattern for UV keratitis

A

Multiple punctate erosions

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58
Q

hard signs of vascular injury

A

pulsatile bleed, diminished distal pulse, expanding hematoma, thrill/bruit

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59
Q

MOA of isoproterenol

A

beta-1 and beta-2 agonist (Increased heart rate. Increased heart contractility. Relaxation of bronchial, gastrointestinal, and uterine smooth muscle.)

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60
Q

normal CSF WBC, glucose, protein

A

WBC <5, glucose 60% of serum, <200 mg/dL

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61
Q

1 inherited bleeding disorder

A

vWD

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62
Q

1 inherited clotting (hypercoagulable) disorder

A

factor V leiden

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63
Q

EKG findings to look for in syncope

A

block, WPW, long QT, Brugada, HOCM, AVRD

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64
Q

pityriasis rosea description and treatment

A

herald patch followed by many scaly red plaques/patches. ?reactivation of HHV6/7, treat pruritis

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65
Q

distinguishing factors between bullous pemphigoid and pemphigus vulgaris

A

BP slightly older (>65), less mucosal involvement, neg Nikolsky.
PV involves mucosae and has +Nikolsky

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66
Q

neuro sx that worsen with fever, hot bath, warm environment

A

Uhthoff sign - think MS

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67
Q

1 organism causing osteomyelitis assoc with puncture wounds

A

Pseudomonas

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68
Q

treatment of pediatric lead poisoning

A

Treatment depends on sx and blood lead levels. If symptomatic, ADMIT. If asymptomatic and elevated blood lead levels, outpatient chelation

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69
Q

SIRS criteria

A

HR >90
RR >20
WBC >12, <4, or >10% bands
Temp >38 or <36

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70
Q

difference between labyrinthitis and vestibular neuritis

A

no tinnitus or hearing loss in vestibular neuritis

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71
Q

definition of delta pressure for acute compartment syndrome. What delta is concerning?

A

diastolic BP - compartment pressure. <30 is concerning!

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72
Q

CSF findings in MS

A

oligoclonal bands

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73
Q

what kind of bundle/fascicular blocks are an indication for pacemaker placement following acute anterior MI?

A

RBBB + LAFB (has potential to progress to CHB)

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74
Q

PT/INR measures what clotting factors?

A

I, II, V, VII, X

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75
Q

age for walking? (developmental milestones)

A

~13 months

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76
Q

when to suspect NAT in spiral fracture of tibia

A

less than walking age, fx is proximal rather than distal

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77
Q

opiates that require renal dosing

A

morphine, tramadol, codeine, meperidine

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78
Q

reversal agent for Xa inhibitors

A

andexanet alfa, 4 factor PCC

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79
Q

DDx for wide QRS

A

hyperK, Na channel blockade, BBB, PM, WPW, ventricular beats, nonspecific IVCD

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80
Q

Marcus Gunn vs Argyl Robertson pupil

A

Marcus Gunn = APD (think optic neuritis/MS)

Argyl Robertson = non reactive but accommodates (think neurosyphilis)

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81
Q

antibiotics which can trigger myasthenic crisis

A

fluoroquinolones, macrolides, aminoglycosides

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82
Q

what kind of parasite is Strongyloides stercoralis?

A

nematode (roundworm)

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83
Q

site of infection of Strongyloides stercoralis?

A

small intestine. Larvae migrate through skin

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84
Q

clinical syndrome of Strongyloides stercoralis?

A

typically asymptomatic, sometimes GI/dysentery. Larvae migrate through skin –> rash/pruritis.

Hyperinfestation in immune compromised or elderly can be deadly. (PNA, septicemia, meningitis, ileus)

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85
Q

who gets tetanus IVIG as prophylaxis?

A

<3 vaccines + complicated wound.

complicated wound = contaminated (dirt/feces/saliva), crush, burn, frostbite, puncture, missile

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86
Q

number 1 cause of arterial embolism?

A

AFib

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87
Q

What level is sensation over medial malleolus?

A

L4 nerve root

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88
Q

Weakness of great toe extension localizes to what nerve root?

A

L5

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89
Q

Bilateral subconjunctival hemorrhage in infants

A

raises concern for NAT

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90
Q

Facial swelling, cough, sob, HA

A

SVC syndrome

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91
Q

Earliest sign of HACE?

A

Ataxia (this is also the most specific finding)

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92
Q

Mainstay if PTSD pharmacotherapy

A

SSRI

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93
Q

Adjunct pharmacotherapy for specific sx of PTSD?

A

Prazosin for nightmares;

propranolol for anxiety/sympathetic activation symptoms

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94
Q

INTRACTIBLE seizures of neonate

A

Consider possible pyridoxine deficiency

95
Q

GI sx, then shock, acidosis, hepatotoxicity, AMS/seizure

A

Iron toxicity

96
Q

Specific Signs of orbital fracture in trauma

A

Enophthalmos, diplopia, infraorbital numbness, orbital step off

97
Q

First steps to work up possible PM lead displacement

98
Q

First line ppx after exposure to N. meningitidis

A

CTX, rifampin, ciprofloxacin

99
Q

erythema marginatum is due to what disease

A

acute rheumatic fever

100
Q

first medicine to give to treat pheo

A

alpha blockers before beta blockers

101
Q

first medicine to give when treating thyroid storm

A

BB, then methimazole or PTU, then KI

102
Q

risk factors for endometrial cancer

A

estrogen and more exposure to thickened endometrium

obesity, nulliparity, early menarche / late menopause, anovulatory cycles

103
Q

1 risk factor for developmet of hepatorenal syndrome

104
Q

what volume of contrast should be used for cystourethrogram in trauma?

105
Q

cave exploration + respiratory sx =

A

histo (flu like illness, CXR with hilar LAD)

106
Q

construction work + respiratory sx =

A

coccidiomycosis (fever/myalgias, CXR with LAD/focality/effusions)

107
Q

alpha blocker for use in acute treatment of pheo

A

phentolamine or phenoxybenzamine

108
Q

complications of therapeutic hypothermia

A

coagulopathy/bleeding, arrhythmias, hyperglycemia/insulin resistance, infection, “cold diuresis”

109
Q

uncomplicated withdrawal - how many hours after last drink?

110
Q

alcoholic hallucinosis occurs how many hours after last drink?

A

onset 12-24h after last drink, can last 1-2 days

111
Q

withdrawal seizures occur how many hours after last drink?

A

6-48 hours

112
Q

DTs occur how many hours after last drink?

A

onset 72-96 hours after last drink

113
Q

treatment for baclofen withdrawal seizures

114
Q

unstable pregnant patient with CP and widened mediastinum. What test to order next?

A

TEE for dx of possible AO dissection

115
Q

ETT for regular sized neonate

A

3.0 uncuffed

116
Q

what is a helminth

A

parasitic worm (types = roundworm/nematode, fluke/trematode, tapeworm/cestode)

117
Q

PERC vs Wells

A

PERC has age, hormone use

Wells has immobilization, hx cancer, PE #1 ddx

118
Q

calculated serum osms

A

2*Na + glucose/18 + BUN/2.8 + etoh/4.6

mg/dl

119
Q

toxin ketosis without acidosis

A

isopropyl alcohol

120
Q

effects of methylene glycol

A

CNS, CV, QT prolongation, RENAL effects (AKI, kidney stone)

121
Q

effects of methanol

A

CNS and VISUAL (“snowstorm”)

122
Q

where do you check sensation for L5 nerve root

A

first web space (between great/2nd toe)

123
Q

how to treat PJP pneumonia

A

Bactrim. If A-a grad >35 or PaO2 < 70, add steroids.

124
Q

treatment of tetanus disease

A

administer tetanus immune globulin, surgical wound debridement, abx, supportive care

125
Q

fentanyl affects mu receptors and has what additional activity?

A

serotonergic

126
Q

indication for HD in salicylate toxicity

A

pulmonary edema

127
Q

unstable TdP: cardiovert or defib?

A

unstable but +pulse: cardiovert

only defib if pulseless

128
Q

SCIWORA: risk factors, mechanism, location?

A 
young age
flex/extension mechanism
#1 c spine
129
Q

1 cause of cardiogenic shock

130
Q

mean incubation period for COVID-19

131
Q

secondary gain vs volitional

A

secondary gain means there is something other than resolution of the primary health concern at play. Can be malingering or non-volitional such as in conversion disorder, where what is to be gained is avoidance of psychological stressor

132
Q

mech of action of nitroprusside

A

venous/arteriolar smooth muscle relaxation –> afterload reduction

133
Q

BP goal in acute ischemic stroke prior to tPA

A

SBP <185 and DBP <110

134
Q

mech of action of tetanospasmin

A

inhibits release of glycine (CNS inhibitor neurotransmiter) producing involuntary muscle contractions

135
Q

strychnine poison mech of action

A

antagonizes glycine (CNS inhibitory neurotransitter) receptors, which produce involuntary muscle contractions

136
Q

child with exercise related syncope

A

think long QT, HOCM!

137
Q

turner syndrome is associated with what vascular pathology

A

aortic dissection

138
Q

how does esophageal web present

A

poor PO tolerance after introduction of solid foods

139
Q

neonate 1-2 days with feeding difficulties and excessive drooling (not infectious)

A

think TE fistula

140
Q

electrolyte disturbances in rhabdo

A

hyperK, hyperphos, hypOcalcemia

141
Q

treatment of PD-related peritonitis

A

intraperitoneal vanc or first gen cephalosporin

142
Q

toxic substance with natural gas + rotten egg smell

A

hydrogen sulfide

143
Q

severe hydrogen sulfide toxicity symptoms?

A

CN-like toxicity

severe lactic acidosis, AKI, CNS, cardiac sx.

144
Q

what to use against ESBL?

A

carbapenems
extended spectrum cephalosporin + betalactamase

ESBL has activity against beta lactams and aztreonam

145
Q

sensitivity of NCHCT for SAH decreases with…

A

time, anemia, atypical presentation (isolated neck pain)

146
Q

1 cause of large bowel obstruction

147
Q

oleander poisoning

A

rapid GI sx, hyperK, dysrhythia (like dig)

148
Q

pt presents with significant hyperthermia in setting of sympathomimetic use. What medication should be avoided?

A

antipsychotics: lower seizure threshold (can worsen hyperthermia)

149
Q

first line prevention for cluster headaches

150
Q

niacin (B3) deficiency

A

pellagra:

photosensitive dermatitis, diarrhea, dementia

151
Q

Westermark sign

A

decreased vascular markings (vascular cutoff sign)

sign of PE

152
Q

Hamman sign

A

crunching sound heard over the mediastinum in the presence of mediastinal air

153
Q

most sensitive Xray for free air

A

lateral CXR

154
Q

fever, RLQ abd pain, diarrhea, normal appendix

A

Yersinia enterocolitica (mimics appy)

155
Q

steps to acid-base

A
  1. acidosis vs alk
  2. AG = Na - Cl - bicarb (>20 = primary AG acidosis)
  3. EAG = AG + bicarb - 12 (>30 = metabolic alkalosis; <24 non-gap metabolic acidosis)
  4. compensation? PaCO2 should = decimals of pH
156
Q

When to suspect CN toxicity?

A

burn + AG acidosis + lactate > 8

bradycardia, hypotension

157
Q

best lab for epidural abscess

158
Q

Maltese cross sign in urine

A

pathognomonic for nephrotic syndrome

159
Q

UA with +blood but neg RBCs

A

myoglobinuria (think rhbado)

160
Q

what dysrhythmia is associated with dig toxicity?

A

ANY, but make assoc with bidirectional VT and AF without RVR

161
Q

preferred approach for knee arthrocentesis

A

anterolateral or superolateral

162
Q

what voltage is high voltage?

A

~600 V (household 120 - 240 volts)

163
Q

treatment for air embolism stroke

164
Q

1 complication of hyphema

A

elevated IOP

165
Q

most common life-threatening arrhythmia immediately following a lightning injury

166
Q

Test of choice for GIB if endoscopy neg

167
Q

treatmet for acute chest

A

O2, fluids, abx, pain control

168
Q

PIP and DIP nodes: RA or OA?

A

OA (absence of DIP points towards RA)

169
Q

HR for admission in anorexia

A

<50 awake / <45 asleep

+orthostatics (>20 bmp)

170
Q

Temp for admit in anorexia

171
Q

BP for admit in anorexia

A

SBP<90

+orthostatics (+10 mm Hg)

172
Q

weight for admit in anorexia

A

<75% IBW or losing weight despite therapy

173
Q

strongest indications for HBO

A

syncope, CO-Hb >25% (or >20% in pregnancy), severe acidosis pH < 7.10, evidence of end organ damage

174
Q

direct vs indirect inguinal hernia

A

indirect = in scrotum

175
Q

Hill-Sachs vs Bankart

A 
Hill-Sachs = on humeral head
Bankart = on glenoid
176
Q

how long does it take for molluscum contagiosum to resolve

177
Q

clothes of sexual assault victims -> how to dispose?

A

paper bag and give to police

178
Q

different drugs for thyroid storm

A

thionamide, iodine, BB, steroids

179
Q

features of inflammatory back pain

A

subacute, nighttime pain, improvement with activity, no improvement with rest

180
Q

staccato cough

A

chlamydia pnuemonia in children

181
Q

1 tendon injury in athletes

A

mallet finger

182
Q

how to splint mallet finger

A

in slight hyperextension at DIP, FROM at PIP

183
Q

congestion, facial pain –> fever, HA + lateral gaze palsy. Dx?

A

cavernous sinus thrombosis

184
Q

1 disease associated with anterior uveitis

A

ankylosing spondylitis

185
Q

ratio of powdered baby formula to water

A

1 scoop to 2 ounces

186
Q

how to tell difference between primary and secondary adrenal insufficiency

A

hyperK often seen in primary but never in secondary

187
Q

what is a normal ABI

188
Q

1 assoc injury with knee disloc

A

popliteal artery

189
Q

toxic dose of ibuprofen

190
Q

what is rubella?

A

mostly abroad due to vaccination, caused by togavirus, causes mild illness with rash, can cause congenital rubella

191
Q

congenital rubella

A

cataracts, hearing loss, blueberry muffin rash

192
Q

rash assoc with non-congenital rubella

A

pinpoint, erythematous, blanching macules that spread cephalocaudal
generalizes within 24 h and lasts for 3 d

193
Q

what respiratory fluoroquinolones do not have good Pseudomonas coverage?

A

moxi, levoflox

194
Q

intussusception = what belly exam?

A

sausage shaped mass in RUQ

195
Q

pyloric stenosis = what belly exam?

A

olive shaped mass in upper abdomen

196
Q

which maneuver is better for nursemaids?

A

hyperpronation > flexion/supination

197
Q

encapsulated organisms

A 
SHiNE SKiS
Strep pneumo
H. influenza
Neisseria meningitis
E coli
Salmonella typhi
Klebsiella pneuoniae
Strep group B
198
Q

1 most common lung cancer

A

adenocarcinoma

199
Q

lung cancers centrally located

A

small cell

squamous cell

200
Q

common contaminants in blood cultures

A

coag neg Staph, Bacillus, Propionibacterium

201
Q

systemic JIA clinical

A

quotian (once daily) fever, arthritis, rash

202
Q

why do nasal button batteries produce septal necrosis?

A

electrical current

203
Q

most sensitive physical exam finding to exclude torsion

A

cremasteric reflex

204
Q

dose of pediatric code epi

A

0.01 mg/kg 1:10,000

205
Q

Parkland formula

A

4 cc * % BSA * kg in first 24 hrs

50% in first 8 hours, remainder over 16 hours

206
Q

PPV/NPV vs LR+ / LR-

A

PPV/NPV are calculated based on disease prevalence and cannot be applied to populations outside the study population
LRs can be applied to pre-test probabilities to attain post test probabilities.

207
Q

formula for LR+

A

sens / (1 - spec)

208
Q

formula for LR-

A

(1 - sens) / spec

209
Q

etanercept is what kind of medication

A

anti TNF (for AS, JIA, psoriasis, RA)

210
Q

anti TNF produces what side effects

A

immune suppression

211
Q

best way to prevent pediatric drowning

A

fence and latch (swim lessons not effective enough)

212
Q

1 most common cause of death after resuscitation from hypothermia

A

pulmonary edema

213
Q

1 cause of SBO in pregnancy

214
Q

time frame and mechanism of acute rejection in renal transplantation.
What cells involved?

A

within weeks of transplant.
CD8 mediated, type IV hypersensitivity
leukocyte infiltration to graft vessels impairing perfusion

215
Q

Treatment of epididymitis

A

< 35 years OR high risk sexual behavior: CTX/doxy

> 35 years: levofloxacin (2nd line Bactrim)

216
Q

diagnostic test for suspected Boerhaave syndrome

A

contrast esophagram

217
Q

Reed sternberg cells have what appearance and are associated with what dx?

A

owl’s eye

Hodgkin lymphoma

218
Q

treatment for hypercalcemia of malignancy

A

fluids +/- bisphosphonates / calcitonin

219
Q

bilateral pedicle fracture of C2 is what fracture, and what is the mechanism of the fracture?

A

hangman fx, extension

220
Q

farm/animal + atypical pneumonia

A

Q fever (Coxiella burnetii)

221
Q

features of atopic dermatitis for clinical dx

A

flexor involvement, onset prior to age 2, hx atopy, intense itching

222
Q

treatment for Jefferson fracture

A

halo

C1 burst fx, often football player or diver

223
Q

phimosis vs paraphimosis

A 
phimosis = foreskin cannot be retracted
paraphimosis = foreskin cannot be extended

phimosis in Greek means “muzzle”

224
Q

typhoid fever clinical picture

A

travel, GI sx, rash, bradycardia relative to fever

225
Q

What anatomic structure delineates internal from external hemorrhoids?

A

dentate line

226
Q

treatment for hypothermic arrest

A

ECMO / CPB

227
Q

1 non-device related complication of LVAD pts

228
Q

what coagulation factors are NOT made in the liver?

A

factor VIII and vWF

229
Q

how do you dose rhogam?

A

50 mcg for <12 weeks gestation
300 mcg for hemorrhage up to 30 cc’s
Kleihauer-Betke test if >30 cc’s is suspected (e.g. abruption at full term)

230
Q

ddx of neonatal conjugated hyperbilirbinemia

A

sepsis, TORCH infection, biliary atresia, CF, inborn errors

231
Q

1 cause of neonatal seizures

232
Q

DDx for narrow complex PEA

A

tension, tamponade, PE, hypovolemia, ischemia

233
Q

risk factors for PRES

A

HTN, renal failure, immune suppression, autoimmune disorders, pregnancy

234
Q

clinical dx of carpal tunnel syndrome

A

Tinel and Phalen are neither sensitive nor specific.

Most sensitive is altered sensation at second finger pad

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