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Comprehensive Exam Material Flashcards

0
Q

What are the 4 heart sounds?

A 
S1 = "lub" = systole - closure of mitral & tricuspid valves; loudest sound at apex
S2 = "dub" = diastole - closure of aortic & pulmonary valves; loudest at base
S3 = early diastolic/ventricular filling; normal under 15 yrs, abnormal over 15 yrs
S4 = late diastolic/ventricular filling
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1
Q

What are the BMI ranges for underweight, normal, overweight, and obese?

A

Underweight: < 18.5
Normal: 18.5 - 24.9
Overweight: 25 - 29.9
Obese: 30 or greater

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2
Q

What is conductive hearing loss?

A

External (outer) or middle ear disorders caused by foreign body, cerumen (wax), or middle ear disorders. Often seen in kids.

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3
Q

What is sensorineural hearing loss?

A

Caused by inner ear disorders from cochlear nerve injury and impulse transmission to the brain via loud noise exposure, inner ear infections, acoustic neuroma. Often seen in elderly patients.

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4
Q

What is presbycusis?

A

Gradual hearing loss in both ears that commonly occurs as people age. Can be mild, moderate, or severe. Presbycusis that leads to permanent loss may be referred to as nerve deafness.

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5
Q

In what direction do maxillary sinus infections travel?

A

Uphill

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6
Q

What are the draping positions?

A

Standing
Seated
Supine
Prone
Dorsal recumbent (on back, knees bent)
Sim’s position (on side, top knee crossed over bottom to touch table)
Lithotomy (think gyno exam)
Knee-chest position (on hands & knees, butt up)
Fowler’s position (seated against wall/board, legs out straight)

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7
Q

What are the 8 factors of communication?

A 
Active listening
Nonverbal communication
Facilitation
Guided Questioning
Echoing
Validation
Reassurance
Empathy
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8
Q

What is active listening?

A

Be fully attentive to what the patient is communicating; be aware of patient’s emotional state, using verbal and nonverbal clues to encourage the patient to continue and expand on the topic. Use focused and open-ended rather than leading questions.

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9
Q

What is nonverbal communication?

A

Read the patient. Pay close attention to body language. Bring the nonverbal communication to the conscious level. Mirror the patient’s paralanguage or qualities of speech, such as pacing, tone, volume, etc. to increase rapport.

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10
Q

What is facilitation?

A

Posture, actions, or words that encourage the patient to say more, but do not specify the topic. Say “mhmm,” “go on,” or “I’m listening” to maintain flow of story.

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11
Q

What is guided questioning?

A

Directed questioning, from general to specific information, used to elicit a graded response. Ask a series of questions, one at a time, offering multiple choices for answers and clarifying what the patient means.

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12
Q

What is echoing?

A

Simple repetition of the patient’s words to encourage the patient to express both factual details and feelings.

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13
Q

What is validation?

A

Legitimization/validation of patient’s emotional experience. Use phrases like “I can understand how this must have upset you.”

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14
Q

When/how do you offer reassurance?

A

Identify and accept the patient’s feelings without offering reassurance at that moment - don’t give false security. Wait until after the history/physical, lab tests, etc. to reassure patient, then deal with him/her openly with real concerns.

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15
Q

What is empathy?

A

Establishment of strong rapport with patients by identifying with his/her feelings. Let patients know that you are interested in feelings as well as facts.

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16
Q

What is tactile fremitus?

A

Palpable vibrations during pulmonary exam (patient says “99” while physician places ulnar side of hands along back).

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17
Q

Who should get the pneumococcal vaccine?

A

Smokers - not healthy adults

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18
Q

What are the vital signs?

A 
Temperature
Respiratory Rate
Pulse
Blood Pressure
Pain
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19
Q

What is normal temperature?

A

98.6 (F)/37 (C)

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20
Q

What is the preferred method to take temperature and why?

A

Rectally - more accurate; higher than oral temp by about 1 degree (F).

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21
Q

What’s the 2nd most accurate method to take temperature?

A

Via tympanic membrane - higher than oral temp by about 1.4 (F).

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22
Q

What are the 3 BP cuff sizes?

A

Pediatric - for very thin arms; /= 41 cm

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23
Q

What are normal, pre-hypertension, stage 1 hypertension, and stage 2 hypertension measurements?

A

Normal: 120/80 mm Hg
Pre-HTN: 120-139/80-89 mm Hg
Stage 1 HTN: 140-149/90-99 mm Hg
Stage 2 HTN: >150/>100 mm Hg

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24
Q

How do you perform cardiac auscultation?

A

“Always Pay The Man”
Aortic valve - 2nd right intercostal space
Pulmonary valve - 2nd left intercostal space
Tricuspid valve - 4th left intercostal space
Mitral valve - 5th left intercostal space

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25
Q

What is the name for gallstones, and what symptoms would you look for?

A

Cholelithiasis - patient may experience intense pain in upper-right side of abdomen, often accompanied by nausea and vomiting. Patient may also have referred pain between shoulder blades or below the right shoulder

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26
Q

Who is your likely patient with gallstones?

A

Fat, female, and fertile

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27
Q

Inflamed posterior lymph nodes indicate presence of what?

A

Mononucleosis

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28
Q

Inflamed anterior lymph nodes indicate presence of what?

A

Strep throat

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29
Q

What is Cushing’s Syndrome caused by, and what are its indicators?

A

It’s caused by abnormally high levels of exposure to cortisol. Indicators are purple striae on the abdomen and central obesity.

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30
Q

What signs are indicative of pancreatitis?

A

Grey Turner’s (looks like grey bulls-eye) & Cullen’s (looks like a splotchy purple bruise)

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31
Q

What is a congenital umbilical hernia?

A

Protrusion of abdominal viscera through umbilicus, potentially resulting from an omphalocele.

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32
Q

Post-abdominal surgery, patient may present with what?

A

Large ventral hernia

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33
Q

Hepatic cirrhosis can result in what?

A

Dilated veins

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34
Q

What is McBurney’s Point?

A

Marker for appendicitis - 1/3 of distance from ASIS to umbilicus

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35
Q

What is Rovsing’s sign?

A

Pain in right lower quadrant with palpation of left lower quadrant - appendix.

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36
Q

What is Dunphy’s sign?

A

Increased pain with coughing - appendix.

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37
Q

What is Murphy’s sign?

A

Abrupt cessation of deep inspiration with palpation of the gallbladder.

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38
Q

What portion of the vagina gets cervical cancer?

A

Ectocervix

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39
Q

What is the age range for women who should get pap smears?

A

21-65

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40
Q

Which types of HPV can result in cervical cancer? What percentage of women who have this type are at risk?

A

HPV Type 16 & 18 - 75%

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41
Q

Which types of HPV are responsible for genital warts?

A

Types 6 & 11

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42
Q

What would you expect to find in a patient with Trichimonas?

A

Green/yellow discharge with “strawberry” cervix

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43
Q

What are non-changeable breast cancer risks?

A 
Age
Age at first menarche
Age at first pregnancy
Late menopause
Family history
Breast dentistry
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44
Q

What are changeable breast cancer risks?

A

Obesity
HRT
Alcohol
Sedentary lifestyle

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45
Q

What does Tanner Staging refer to, and how many stages are there?

A

Breast development - 5 stages

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46
Q

ACS recommends clinical breast exams every _____ years for women between the ages of _______.

A

2-3; 20-40

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47
Q

Consonant sounds are heard with what condition?

A

Presbycusis

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48
Q

What is the sternal angle?

A

Angle between the manubrium and the body of the sternum at the manubriosternal junction. Marks the level of the 2nd rib and denotes the level of the aortic arch, bifurcation of trachea, and T4/T5 IV disc.

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49
Q

What (loud) sounds last longer and are best heard over the manubrium?

A

Bronchial sounds

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50
Q

All diastolic murmurs are what until proven otherwise?

A

Bad

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51
Q

An increase in tactile fremitus indicates what?

A

Pneumonia

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52
Q

What is the foreskin also called?

A

Prepuce of penis

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53
Q

The epididymus is located at what part of the scrotum?

A

Posterolateral

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54
Q

What is a varicocele?

A

Enlargement of pampiniform venous plexus in the scrotum; looks like a bag of worms.

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55
Q

What is the Valsalva maneuver?

A

Ask patient to bear down in order to detect presence of hernia.

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56
Q

Describe a direct hernia.

A

Goes through the inguinal/Hesselbech’s triangle. Herniation is more superior.

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57
Q

Describe an indirect hernia.

A

Goes through the inguinal ring. Herniation is more inferior.

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58
Q

Describe a congenital indirect hernia.

A

Protrudes through the inguinal ring; internal inguinal ring fails to close after the testicle passes through.

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59
Q

Describe a femoral hernia.

A

Occurs just below the inguinal ligament (femoral ring). Noted when the abdominal contents pass through femoral canal. Uncommon; accounts for just 3% of hernias and is more common in women.

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60
Q

What is inflammation of the prostate called?

A

Prostatitis

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61
Q

What are causes of prostatitis?

A

Chlamydia & gonnorhea in sexually active males

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62
Q

An abnormal repeated (30 seconds - 2 minutes) pattern of breathing characterized by progressively deeper and sometimes faster breathing, followed by a gradual decrease that results in a temporary stop in breathing (apnea) is called what?

A

Cheyne-Stokes Sign

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63
Q

What nerve is responsible for Carpal Tunnel Syndrome?

A

Median nerve

64
Q

This test for carpal tunnel syndrome involves tapping the finger over the median nerve above the volar carpal ligament to produce radicular symptoms in the hand.

A

Tinel sign

65
Q

This test for carpal tunnel syndrome has the patient place hands in flexed position, pressing against each other, to reproduce radicular symptoms in median nerve distribution.

A

Phalen’s Test

66
Q

This test for DeQuervian’s Syndrome calls for passive ulnar deviation of the wrist with the hand in a fist position (thumb inside first) to check for pain.

A

Finkelstein Test

67
Q

What is Dequervain’s Syndrome?

A

Stenosing tenosynovitis of abductor pollicis and extensor pollicis brevis tendons

68
Q

This test, done prior to ABGs, test for patency of radial and ulnar arteries: patient opens and closes hand several times quickly. Compression is applied to arteries alternatively and releases to observe length of hand flushing.

A

Allen Test

69
Q

Golfer’s elbow, involving the ulnar nerve, is also known as?

A

Medial epicondylitis

70
Q

Tennis elbow is also known as?

A

Lateral epicondylitis

71
Q

The funny bone hurts because which nerve has been hit?

A

Ulnar nerve

72
Q

Patient presenting with what looks like a swollen ball at the back of his elbow most likely has?

A

Olecranon bursitis

73
Q

Which rotator cuff muscle is used for abduction?

A

Supraspinatus

74
Q

Which rotator cuff muscles are responsible for external rotation?

A

Infraspinatus and teres minor

75
Q

Which rotator cuff muscle is responsible for internal rotation?

A

Subscapularis

76
Q

Is teres major a rotator cuff muscle?

A

No

77
Q

How would you test for external rotation of the shoulder?

A

Raise arm up, bend at elbow to place hand at back of neck.

78
Q

How would you test internal rotation of the shoulder muscle?

A

Arm hangs down, bends at elbow in attempt to reach hand up middle of back.

79
Q

What muscle is responsible for 0-15 degrees of abduction?

A

Supraspinatus

81
Q

What muscle is responsible for 15-90 degrees of abduction?

A

Deltoid

81
Q

What does a unilateral incomplete cleft palate look like?

A

Cleft on one side of the top lip that goes up to but does not reach the nose.

82
Q

What muscle is responsible for 90-180 degrees of abduction?

A

Trap

83
Q

What does a bilateral complete cleft lip look like?

A

Cleft on both sides of the top lip that goes up to and reaches both sides of the nose.

84
Q

What does a unilateral complete cleft lip look like?

A

Cleft on one side of the top lip that goes up to and reaches the nose on the same side as the lip cleft.

85
Q

Define each part of the SOAP note.

A

S - subjective
O - objective
A - assessment
P - plan

86
Q

Pain on extension of the right thigh is positive for what test?

A

Psoas test

87
Q

Abduction/rotation of the right thigh is tested for what sign?

A

Obturator sign

88
Q

Patient presents with over-reactive or exaggerated body language for which sign?

A

Waddell’s sign

89
Q

This test is performed to detect whether or not a patient is malingering

A

Hoover test

90
Q

You would perform a neuroexam of the iliopsoas muscle to test which nerves?

A

T12, L1, L2, L3

91
Q

You would perform a neuroexam of the quadriceps muscle to test which nerves?

A

L2, L3, L4 (femoral nerve)

92
Q

You would perform a neuroexam of the adductor muscles to test which nerves?

A

L2, L3, L4 (obturator nerve)

93
Q

You would perform a neuroexam of the tibialis anterior muscle to test which nerves? What would a positive exam elicit?

A

L4 - resisted inversion

94
Q

You would perform a neuroexam of the extensor hallucis longus muscle to test which nerves? What would a positive exam elicit?

A

L5 - resisted dorsiflexion

95
Q

You would perform a neuroexam of the peroneus longus and brevis muscles to test which nerves? What would a positive exam elicit?

A

S1 - resisted eversion

96
Q

What nerve does the patellar reflex test? What would a positive test elicit?

A

L4 - restricted inversion

97
Q

What nerve does the achilles tendon reflex test? What would a positive test elicit?

A

S1 - restricted eversion

98
Q

Patient presents with a significant non-contact injury with foot planted on ground - foot planted then knee twisted or body changed direction, felt a pop, had immediate swelling, could not continue playing). What injury should you think of first?

A

ACL injury

99
Q

Suspect what injury with noncontact injury with a “pop”?

A

ACL tear

100
Q

Suspect what injury with fall onto flexed knee?

A

PCL tear

101
Q

Suspect what injury with valgus/lateral blow to knee?

A

MCL tear

102
Q

Suspect what injury with varum/medial blow to knee?

A

LCL

103
Q

Name all possible injuries that can result from a contact injury with a “pop.”

A

MCL tear
LCL tear
Meniscus tear
Fracture

104
Q

Patient presents with acute swelling of the knee; suspect what injuries?

A

ACL tear
PCL tear
Fracture
Patellar dislocation

105
Q

Patient’s knee “gave out” or “buckled”; suspect what injury?

A

ACL

Patellar dislocation

106
Q

What is the stabilizing role of the medial collateral ligament?

A

Prevents knee from buckling inwards (valgus injury).

107
Q

What is the stabilizing role of the lateral collateral ligament?

A

Prevents knee from buckling outwards (varus injury).

108
Q

What is the stabilizing role of the anterior cruciate ligament?

A

Prevents tibia from sliding forward under the femur.

109
Q

What is the stabilizing role of the posterior cruciate ligament?

A

Prevents the tibia from sliding backward under the femur.

110
Q

What is the name of the test for assessment of the ACL in which the patient is supine, knee is flexed 20-30 degrees, and the proximal tibia is moved forward on the femur?

A

Lachman’s Test - positive test if have excessive forward motion of tibia (>5mm) without firm endpoint, indicating ACL damage.

111
Q

What is the name of the test for assessment of the ACL in which the patient is supine, knee is flexed to 90 degrees, and foot is stabilized, and the physician, while sitting on dorsum of patient’s foot, places both hands behind the knee and tries to displace proximal leg anteriorly once hamstrings are relaxed?

A

Anterior drawer test; normal test will have

112
Q

What is the name of the test for assessment of the PCL in which the patient is supine, knee is flexed to 90 degrees, and foot is stabilized, and the physician, while sitting on dorsum of patient’s foot, places both hands behind the knee and tries to push the tibia posteriorly?

A

Posterior drawer test; normal test will have

113
Q

What is being tested in the following test: patient in supine position, with knee at 20-30 degrees of flexion. Physician’s proximal hand on lateral aspect of knee, holding and stabilizing thigh; distal hand directs ankle laterally in attempt to open knee joint on medial side. Estimate the medial joint space and evaluate the stiffness of motion. Positive test shows significant gap in medial aspect of knee with valgus stress.

A

MCL (valgus stress)

114
Q

What is being tested in the following test: patient in supine position, with knee at 20-30 degrees of flexion. Physician’s proximal hand on medial aspect of knee, holding and stabilizing thigh; distal hand directs ankle medially in attempt to open knee joint on lateral side. Estimate the lateral joint space and evaluate the stiffness of motion.

A

LCL (varus) stress - positive test is indicated by difference in degree of lateral knee tautness with varus stress. Compare affected knee to uninjured side.

115
Q

The US preventative services task force recommended that healthy women between ages ___ & ___ get breast exams __________.

A

50; 74; biennially

116
Q

What would happen if the radial nerve is damaged while doing an arterial blood gas?

A

Wrist extension would be impaired

117
Q

Patient presents with carpal tunnel syndrome. What symptoms would you expect to see?

A

Atrophy of the thenar eminence and weakness of the thumb & little finger opposition

118
Q

32 y/o man presents with inner aspect of right elbow pain. Climbs 3-5 days per week for rock climbing. Point tenderness on medial elbow.

A

Medial epicondylitis

119
Q

32 y/o man presents with outer aspect of right elbow pain. Climbs 3-5 days per week for rock climbing. Point tenderness on lateral elbow.

A

Lateral epicondylitis

120
Q

Coarction in left subclavian artery would result in what?

A

Decreased femoral pulses compared to radial pulses

121
Q

35 y/o male falls on outstretched hand. Pain in snuff box.

A

Displaced scaphoid fracture

122
Q

Pregnant woman. Numbness and tingling are markedly increased over the first 3 digits and alter palm when the wrist is held in flexion for 30 seconds.

A

Carpal tunnel syndrome - median nerve

123
Q

What is the length of a normal diaphragmatic excursion?

A

3-5 cm

124
Q

When listening to the lungs with a stethoscope, the patient is asked to pronounce the long “E” sound. This is called what?

A

Egophany

125
Q

What is a breast cancer risk factor?

A

Early menarche - early exposure to estrogen

126
Q

Lacrosse player sprains foot - inversion, supination, plantar flexion. What is torn?

A

Anterior talofibular ligament

127
Q

An eversion ankle sprain is also known as what?

A

Masoneuve fracture

128
Q

The achilles tendon rupture test, which will be positive if patient does not have plantar flexion, is called?

A

Thompson test

129
Q

Injury to right knee with force in varus direction indicates what kind of tear?

A

LCL

130
Q

Left knee pain, patient cannot walk, knee is swollen and does not feel stable. What kind of injury is this?

A

Meniscus

131
Q

MVA; patient’s right knee hit dash board. Positive for posterior drawer test and sag test. What is torn?

A

PCL

132
Q

What is injured if left foot is plantar flexed and inverted?

A

Anterior Talofibular ligament

133
Q

17 y/o with limitation of movement of right arm. Went drinking the previous night with friends and woke up unable to move arm - cannot extend elbow or wrist. Which nerve is affected and where?

A

Radial nerve at axilla

134
Q

The highest risk of cervical dysplasia is where?

A

Transformational zone

135
Q

Presence of a scrotal mass with accompanying bowel sounds indicates what?

A

Hernia

136
Q

What make up the terrible triad?

A

MCL tear, medial meniscus tear, ACL tear

137
Q

Patient with wheezing, uni-lateral rhonchi, right chest pain, fever most likely has what?

A

Pneumonia

138
Q

Patient with unilateral tactile fremitus most-likely has?

A

Pneumonia

139
Q

What does percussion sound like if patient has pneumonia?

A

Dull

140
Q

If light palpation of baby’s cheeks causes its mouth to open, this is known as what?

A

Rooting - primitive reflex; sign that baby is hungry

141
Q

If baby lifts one foot then the other as if walking when held upright with feet on a flat surface, this reflex is known as what?

A

Stepping

142
Q

Fat baby/40 weeks is known as what?

A

LGA or AGA

143
Q

Male with testicular volume of 0.6-1.6 mL, redness of scrotum, and no pubic hair is at what Tanner stage?

A

Tanner II

144
Q

Elongation of scrotum, but not of penis; scrotal skin this. Male is at what Tanner stage?

A

Tanner II

145
Q

78 y/o diabetic woman with JVD above 10, S3 heart sounds, crackles, and leg edema has what condition?

A

Congestive heart failure

146
Q

What changes during iron-deficiency anemia?

A

RDW (red blood cell distribution width)

147
Q

Megaloblastic anemia occurs when what happens?

A

Have MCV (mean corpuscular volume) over 100

148
Q

Where should you auscultate to hear bronchial sounds?

A

Manubrium

149
Q

If adolescent patient wants parents out of the room during the exam, is this possible?

A

Yes - patient has right to privacy.

150
Q

What does PO stand for?

A

per os

151
Q

What does BID stand for?

A

Twice a day

152
Q

What does PRN stand for?

A

When necessary

153
Q

Which drugs are most abused?

A

Schedule I

154
Q

Spontaneous bleeding is characterized by what?

A

< 20,000 platelet count

155
Q

Male patient with urinary continence is likely to have an issue with what gland?

A

Prostate

156
Q

What would you ask of a child, but not an adult?

A

Birth history

157
Q

What does the APGAR test assess?

A

Health of newborns immediately following birth. Test appearance, pulse, grimace, activity, and respiration.

158
Q

How is the APGAR test generally performed?

A

Done at 1 and 5 minutes after birth. Sores 7+ are normal; 4-6 are fairly low; 3 & below are critically low

PCS (3 decks)

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