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Clinical Applications Final Flashcards

1
Q

Which is higher in the seated position, diastolic or systolic? What about standing?

A

Diastolic is higher while seated, Systolic is higher when supine

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2
Q

What affect does raising vs lowering the arm at the level of the heart have on BP?

A

Raising the arm above the level of the heart causes low readings. Having the arm below the level of the heart causes high readings.

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3
Q

BP cuff should encircle _____% of the patient’s arm

A

80

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4
Q

Rapidly inflate the cuff ____mmHg above the estimated sytolic pressure when taking blood pressure

A

30

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5
Q

You should deflate the BP cuff at a rate of…

A

2-4mmHg/sec

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6
Q

Absolute Contraindications for NG tube

VS.

Relative Contraindications

A

severe midface trauma or recent nasal surgery

relative = coag issues, esop varices, strictures, alkaline ingestion

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7
Q

How do verify NG tube placement

A

ask the patient to talk (trachea vs esophagus)

CXR can verify

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8
Q

Are internal hemorrhoids painful?

A

not unless thrombosed

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9
Q

What is the Simm position

A

left lateral knee to chest position that can be used for anorectal exam

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10
Q

Would you do a DRE on a patient with anal fissures?

A
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11
Q

Do you prescribe abx for anorectal abscesses?

A

No, unless there is a surrounding cellulitis

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12
Q

Pilonidal Disease =

A
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13
Q

What is procidentia

A

Rectal prolapse (redundant sigmoid colon + loss of rectal support)

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14
Q

So a patient comes in with itchy butt and you do a “scotch tape test” that reveals PINWORMS! Oh no, what do you do?

A

These little egglets can be airborne….treat the entire family so that there’s no itchy butt outbreak!

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15
Q

Murphy’s Sign

A

Pain in RUQW during deep inspiration that indicated GB inflammation

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16
Q

What is cutaneous hyperesthesia?

A

sign of peritoneal inflammation…..everything hurts

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17
Q

Rebound Tenderness

A

pain when there you press down and quickly release fingers. Pain occurs with the withdrawl

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18
Q

Rovsing’s Sign

A

type of rebound pain. Press on LLQ and upon release, there is pain in the RLQ….indicates appendicitis with peritoneal signs

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19
Q

Obturator test

A

internally rotate, pain indicates peritoneal pain/appendicitis

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20
Q

H. Pylori Testing…what to do, what to do….

A

Breath Test - confirms they have the bugger. 2 weeks prior patient must stop PPI, Abx and pepto

Antigen test - detects in the stool and good for assessing treatment.

Biopsy - most expensive but also most accurate. Do this if endoscopy needed for other reasons

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21
Q

What does vitamin c do to a fecal occult blood test?

A

false negative

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22
Q

Colorectal Cancer Screening

A

start at the age of 50years.

Most risk of colorectal cancer is 50-75 years old.

Do colonscopy q10 year, FOBT q1 year

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23
Q

Viseral Pain VS parietal pain

A

Visceral = distention of the organs and is difficult to localize

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24
Q

Doubling over with crampy colicky pain + hematuria….

A

renal colic, kidney stones

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25
Sudden knifelike epigastric pain =
gallstone pancreatitis
26
RLQ pain can be d/t
appendicitis, ovary issues, ectopic preggo, kidney stones
27
LLQ
diverticulitis, SBO, LBO, ovary issues, ectopic preggo, kidney stones, UTI
28
Hematochezia VS Melena
Hematochezia = \>1000ml of blood usually from lower GI bleed Melana = \>100ml of blood usually from upper GI bleed
29
What's official absent BS?
when there is a lack of BS for more than 5 minutes. Flick the abdomen to try and induce BS....if not, think adynamic ileus or obstruction
30
Are the kidneys at the same level?
no the left kidney is higher
31
Spleen lies in the \_\_\_\_intercostal space
10th
32
Light palpation means that you are pressing with the pads of your fingers no more than \_\_\_\_cm in all 4 quads
1cm
33
Jugular Vein VS Carotid Artery
vein = has no pulse, but has 2 systolic pulsations that change with respirations artery = has a palpable pulse, but no pulsations and no changes with respiration
34
JVD
patient reclined at 45degrees; measure vertical distance from angle of louis and highest level of jugular vein pulsation. Add 5 cm to the measurement at the RA is 5cm from the sternal angle. USE INTERNAL VEIN PREFERRABLY rather than external is possible (may use external if internal not visible)
35
ABI is useful for determining....... But is unreliable in.....
Ankle/Brachial Index useful for PAD detection, but not useful in diabetes. 95% sensitive and 99% specific
36
Define orthostatic BP
symptomatic hypotension brought on by a sudden change in the body position
37
How do you test for orthostatic hypotension....you know this will be on there cuz Mol's loves talking about orthostatic hypotension....
take BP and PP supine have patient stand up wait 1 minute record BP and PP IF.......there is a drop in PP or BP by 20 in either or in both, this is + for orthostatic hypotension
38
Locations of the EKG leads
v1 =4ICS RSB v2 =4ICS LSB v3 =between 2 and 4 v4 = LMidclavicular 5ICS v5 = L anterior axillary 5ICS v6 = L midaxillary 5ICS
39
Holter VS Event monitor
holter takes readings continuously for 24-48 hours event monitor can be worn for weeks and is used for symptomatic heart conditions
40
How can you better hear a left sided S3 or S4? What about a suspected aortic or pulmonic murmur?
s3/s4, have patient in the LLD position for aortic/pulmonic - have patient sitting and lean forward
41
Grading of a murmur intensity
1-3 have NO THRILL 4-6 have THRILL PRESENT
42
Ausculation areas of the heart
Aortic = 2ICS RSB Pulmonic = 2ICS LSB Tricuspid = 4ICS LSB Mitral = 5 ICS midclavicular Erbs =
43
Tet Spells =
hypercyanotic events characteristic of TOF
44
Kerley B lines on CXR
CHF
45
Grading of Pulses
0 = absent 1+ = diminished 2+ = bounding, normal 3+ = more than expected
46
Trendelenburg Test
Special test used to assess venous valve compentency. Patient is supine asnd elevates leg 90 degrees. Then you compress the saphenous vein and ask the patient to stand. Watch for venous filling (norm = 35s)
47
Raynauds Disease VS Phenomon
disease = vasospastic and involves the small arterioles and includes fingers, toes and EARS AND NOSE. Phenomenon = idiopathic, bilateral cyanosis of the arterioles due to cold or emotion that are only in the fingers and toes
48
Indications for a central line
cannot get peripheral access, chemo, dialysis, etc
49
Average cost of ECHO
$1400
50
Diagnosing DM
fasting BG \>126 on two seperate occasions or a A1c\>6.5% on 2 seperate occasions
51
What is the HbA1c
glycosylated hemoglobin that measures the average glucose over the last 6-8 weeks
52
Patau Syndrome
trisomy 13
53
ichthyosis
dry, thickened, scaly or flaky skin
54
Fructosamine
can be used to measure glucose levels 2-3 weeks estimate. May be better is patient in preggo, have anemia, or if you want to evaluate the diabteic treatment 75micromol change = 60mg/dl in blood sugar or 2% a1c
55
LDL and HDL, where do each move lipids?
LDL moves cholesterol into the arteries, and HDL removes it from the aa
56
How long should a patient fast prior to getting lipid levels checked?
12-24 hours
57
Goal ranges for cholesterol, LDL and HDL?
\<200 cholesterol \<100 LDL \> 60 HDL
58
Normal RBC count
4.5-6 million
59
Normal Hct and Hgb
Hct = packed cell volume = 42-52% or 36-48% in females Hgb = 13.5-17.5% or 12.5-15.5% in females
60
MCV = (how do you calculate?) MCH?
MCV = hct x 10 / RBC Normal = 80-100 MCH = hgb x 10/ RBC normal = 33ish
61
Normal Sed Rate
0-10mm/hr in males, 0-20 in females
62
If MCHC is \> 36....suspect what?
spherocytosis
63
Normal Plt # Normal WBC #
Plt = 150,000-400,000 WBCs = 4,800-10,800
64
Most common leukemia in children
ALL
65
Most common acute leukemia in adults Most common leukemia in adults
Acute = AML Chronic = CLL
66
PNM%, Bands, Eosinophils, basophils, lymphocytes, monocytes
PNM = 54-62% Bands = 2-6% Eosinophils = 1-3% Basophils = 0-1% Lymphocytes = 20-40% Monocytes = 4-10%

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