Comprehensive Exam Material Flashcards
What are the 4 heart sounds?
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
What are the BMI ranges for underweight, normal, overweight, and obese?
Underweight: < 18.5
Normal: 18.5 - 24.9
Overweight: 25 - 29.9
Obese: 30 or greater
What is conductive hearing loss?
External (outer) or middle ear disorders caused by foreign body, cerumen (wax), or middle ear disorders. Often seen in kids.
What is sensorineural hearing loss?
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.
What is presbycusis?
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.
In what direction do maxillary sinus infections travel?
Uphill
What are the draping positions?
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)
What are the 8 factors of communication?
Active listening Nonverbal communication Facilitation Guided Questioning Echoing Validation Reassurance Empathy
What is active listening?
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.
What is nonverbal communication?
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.
What is facilitation?
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.
What is guided questioning?
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.
What is echoing?
Simple repetition of the patient’s words to encourage the patient to express both factual details and feelings.
What is validation?
Legitimization/validation of patient’s emotional experience. Use phrases like “I can understand how this must have upset you.”
When/how do you offer reassurance?
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.
What is empathy?
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.
What is tactile fremitus?
Palpable vibrations during pulmonary exam (patient says “99” while physician places ulnar side of hands along back).
Who should get the pneumococcal vaccine?
Smokers - not healthy adults
What are the vital signs?
Temperature Respiratory Rate Pulse Blood Pressure Pain
What is normal temperature?
98.6 (F)/37 (C)
What is the preferred method to take temperature and why?
Rectally - more accurate; higher than oral temp by about 1 degree (F).
What’s the 2nd most accurate method to take temperature?
Via tympanic membrane - higher than oral temp by about 1.4 (F).
What are the 3 BP cuff sizes?
Pediatric - for very thin arms; /= 41 cm
What are normal, pre-hypertension, stage 1 hypertension, and stage 2 hypertension measurements?
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
How do you perform cardiac auscultation?
“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
What is the name for gallstones, and what symptoms would you look for?
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
Who is your likely patient with gallstones?
Fat, female, and fertile
Inflamed posterior lymph nodes indicate presence of what?
Mononucleosis
Inflamed anterior lymph nodes indicate presence of what?
Strep throat
What is Cushing’s Syndrome caused by, and what are its indicators?
It’s caused by abnormally high levels of exposure to cortisol. Indicators are purple striae on the abdomen and central obesity.
What signs are indicative of pancreatitis?
Grey Turner’s (looks like grey bulls-eye) & Cullen’s (looks like a splotchy purple bruise)
What is a congenital umbilical hernia?
Protrusion of abdominal viscera through umbilicus, potentially resulting from an omphalocele.
Post-abdominal surgery, patient may present with what?
Large ventral hernia
Hepatic cirrhosis can result in what?
Dilated veins
What is McBurney’s Point?
Marker for appendicitis - 1/3 of distance from ASIS to umbilicus
What is Rovsing’s sign?
Pain in right lower quadrant with palpation of left lower quadrant - appendix.
What is Dunphy’s sign?
Increased pain with coughing - appendix.
What is Murphy’s sign?
Abrupt cessation of deep inspiration with palpation of the gallbladder.
What portion of the vagina gets cervical cancer?
Ectocervix
What is the age range for women who should get pap smears?
21-65
Which types of HPV can result in cervical cancer? What percentage of women who have this type are at risk?
HPV Type 16 & 18 - 75%
Which types of HPV are responsible for genital warts?
Types 6 & 11
What would you expect to find in a patient with Trichimonas?
Green/yellow discharge with “strawberry” cervix
What are non-changeable breast cancer risks?
Age Age at first menarche Age at first pregnancy Late menopause Family history Breast dentistry
What are changeable breast cancer risks?
Obesity
HRT
Alcohol
Sedentary lifestyle
What does Tanner Staging refer to, and how many stages are there?
Breast development - 5 stages
ACS recommends clinical breast exams every _____ years for women between the ages of _______.
2-3; 20-40
Consonant sounds are heard with what condition?
Presbycusis
What is the sternal angle?
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.
What (loud) sounds last longer and are best heard over the manubrium?
Bronchial sounds
All diastolic murmurs are what until proven otherwise?
Bad
An increase in tactile fremitus indicates what?
Pneumonia
What is the foreskin also called?
Prepuce of penis
The epididymus is located at what part of the scrotum?
Posterolateral
What is a varicocele?
Enlargement of pampiniform venous plexus in the scrotum; looks like a bag of worms.
What is the Valsalva maneuver?
Ask patient to bear down in order to detect presence of hernia.
Describe a direct hernia.
Goes through the inguinal/Hesselbech’s triangle. Herniation is more superior.
Describe an indirect hernia.
Goes through the inguinal ring. Herniation is more inferior.
Describe a congenital indirect hernia.
Protrudes through the inguinal ring; internal inguinal ring fails to close after the testicle passes through.
Describe a femoral hernia.
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.
What is inflammation of the prostate called?
Prostatitis
What are causes of prostatitis?
Chlamydia & gonnorhea in sexually active males
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?
Cheyne-Stokes Sign
What nerve is responsible for Carpal Tunnel Syndrome?
Median nerve
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.
Tinel sign
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.
Phalen’s Test
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.
Finkelstein Test
What is Dequervain’s Syndrome?
Stenosing tenosynovitis of abductor pollicis and extensor pollicis brevis tendons
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.
Allen Test
Golfer’s elbow, involving the ulnar nerve, is also known as?
Medial epicondylitis
Tennis elbow is also known as?
Lateral epicondylitis
The funny bone hurts because which nerve has been hit?
Ulnar nerve
Patient presenting with what looks like a swollen ball at the back of his elbow most likely has?
Olecranon bursitis
Which rotator cuff muscle is used for abduction?
Supraspinatus
Which rotator cuff muscles are responsible for external rotation?
Infraspinatus and teres minor
Which rotator cuff muscle is responsible for internal rotation?
Subscapularis
Is teres major a rotator cuff muscle?
No
How would you test for external rotation of the shoulder?
Raise arm up, bend at elbow to place hand at back of neck.
How would you test internal rotation of the shoulder muscle?
Arm hangs down, bends at elbow in attempt to reach hand up middle of back.
What muscle is responsible for 0-15 degrees of abduction?
Supraspinatus
What muscle is responsible for 15-90 degrees of abduction?
Deltoid
What does a unilateral incomplete cleft palate look like?
Cleft on one side of the top lip that goes up to but does not reach the nose.
What muscle is responsible for 90-180 degrees of abduction?
Trap
What does a bilateral complete cleft lip look like?
Cleft on both sides of the top lip that goes up to and reaches both sides of the nose.
What does a unilateral complete cleft lip look like?
Cleft on one side of the top lip that goes up to and reaches the nose on the same side as the lip cleft.
Define each part of the SOAP note.
S - subjective
O - objective
A - assessment
P - plan
Pain on extension of the right thigh is positive for what test?
Psoas test
Abduction/rotation of the right thigh is tested for what sign?
Obturator sign
Patient presents with over-reactive or exaggerated body language for which sign?
Waddell’s sign
This test is performed to detect whether or not a patient is malingering
Hoover test
You would perform a neuroexam of the iliopsoas muscle to test which nerves?
T12, L1, L2, L3
You would perform a neuroexam of the quadriceps muscle to test which nerves?
L2, L3, L4 (femoral nerve)
You would perform a neuroexam of the adductor muscles to test which nerves?
L2, L3, L4 (obturator nerve)
You would perform a neuroexam of the tibialis anterior muscle to test which nerves? What would a positive exam elicit?
L4 - resisted inversion
You would perform a neuroexam of the extensor hallucis longus muscle to test which nerves? What would a positive exam elicit?
L5 - resisted dorsiflexion
You would perform a neuroexam of the peroneus longus and brevis muscles to test which nerves? What would a positive exam elicit?
S1 - resisted eversion
What nerve does the patellar reflex test? What would a positive test elicit?
L4 - restricted inversion
What nerve does the achilles tendon reflex test? What would a positive test elicit?
S1 - restricted eversion
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?
ACL injury
Suspect what injury with noncontact injury with a “pop”?
ACL tear
Suspect what injury with fall onto flexed knee?
PCL tear
Suspect what injury with valgus/lateral blow to knee?
MCL tear
Suspect what injury with varum/medial blow to knee?
LCL
Name all possible injuries that can result from a contact injury with a “pop.”
MCL tear
LCL tear
Meniscus tear
Fracture
Patient presents with acute swelling of the knee; suspect what injuries?
ACL tear
PCL tear
Fracture
Patellar dislocation
Patient’s knee “gave out” or “buckled”; suspect what injury?
ACL
Patellar dislocation
What is the stabilizing role of the medial collateral ligament?
Prevents knee from buckling inwards (valgus injury).
What is the stabilizing role of the lateral collateral ligament?
Prevents knee from buckling outwards (varus injury).
What is the stabilizing role of the anterior cruciate ligament?
Prevents tibia from sliding forward under the femur.
What is the stabilizing role of the posterior cruciate ligament?
Prevents the tibia from sliding backward under the femur.
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?
Lachman’s Test - positive test if have excessive forward motion of tibia (>5mm) without firm endpoint, indicating ACL damage.
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?
Anterior drawer test; normal test will have
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?
Posterior drawer test; normal test will have
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.
MCL (valgus stress)
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.
LCL (varus) stress - positive test is indicated by difference in degree of lateral knee tautness with varus stress. Compare affected knee to uninjured side.
The US preventative services task force recommended that healthy women between ages ___ & ___ get breast exams __________.
50; 74; biennially
What would happen if the radial nerve is damaged while doing an arterial blood gas?
Wrist extension would be impaired
Patient presents with carpal tunnel syndrome. What symptoms would you expect to see?
Atrophy of the thenar eminence and weakness of the thumb & little finger opposition
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.
Medial epicondylitis
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.
Lateral epicondylitis
Coarction in left subclavian artery would result in what?
Decreased femoral pulses compared to radial pulses
35 y/o male falls on outstretched hand. Pain in snuff box.
Displaced scaphoid fracture
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.
Carpal tunnel syndrome - median nerve
What is the length of a normal diaphragmatic excursion?
3-5 cm
When listening to the lungs with a stethoscope, the patient is asked to pronounce the long “E” sound. This is called what?
Egophany
What is a breast cancer risk factor?
Early menarche - early exposure to estrogen
Lacrosse player sprains foot - inversion, supination, plantar flexion. What is torn?
Anterior talofibular ligament
An eversion ankle sprain is also known as what?
Masoneuve fracture
The achilles tendon rupture test, which will be positive if patient does not have plantar flexion, is called?
Thompson test
Injury to right knee with force in varus direction indicates what kind of tear?
LCL
Left knee pain, patient cannot walk, knee is swollen and does not feel stable. What kind of injury is this?
Meniscus
MVA; patient’s right knee hit dash board. Positive for posterior drawer test and sag test. What is torn?
PCL
What is injured if left foot is plantar flexed and inverted?
Anterior Talofibular ligament
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?
Radial nerve at axilla
The highest risk of cervical dysplasia is where?
Transformational zone
Presence of a scrotal mass with accompanying bowel sounds indicates what?
Hernia
What make up the terrible triad?
MCL tear, medial meniscus tear, ACL tear
Patient with wheezing, uni-lateral rhonchi, right chest pain, fever most likely has what?
Pneumonia
Patient with unilateral tactile fremitus most-likely has?
Pneumonia
What does percussion sound like if patient has pneumonia?
Dull
If light palpation of baby’s cheeks causes its mouth to open, this is known as what?
Rooting - primitive reflex; sign that baby is hungry
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?
Stepping
Fat baby/40 weeks is known as what?
LGA or AGA
Male with testicular volume of 0.6-1.6 mL, redness of scrotum, and no pubic hair is at what Tanner stage?
Tanner II
Elongation of scrotum, but not of penis; scrotal skin this. Male is at what Tanner stage?
Tanner II
78 y/o diabetic woman with JVD above 10, S3 heart sounds, crackles, and leg edema has what condition?
Congestive heart failure
What changes during iron-deficiency anemia?
RDW (red blood cell distribution width)
Megaloblastic anemia occurs when what happens?
Have MCV (mean corpuscular volume) over 100
Where should you auscultate to hear bronchial sounds?
Manubrium
If adolescent patient wants parents out of the room during the exam, is this possible?
Yes - patient has right to privacy.
What does PO stand for?
per os
What does BID stand for?
Twice a day
What does PRN stand for?
When necessary
Which drugs are most abused?
Schedule I
Spontaneous bleeding is characterized by what?
< 20,000 platelet count
Male patient with urinary continence is likely to have an issue with what gland?
Prostate
What would you ask of a child, but not an adult?
Birth history
What does the APGAR test assess?
Health of newborns immediately following birth. Test appearance, pulse, grimace, activity, and respiration.
How is the APGAR test generally performed?
Done at 1 and 5 minutes after birth. Sores 7+ are normal; 4-6 are fairly low; 3 & below are critically low
