Exam 1 review Flashcards
(165 cards)
1
Q
Definition of “knot”
A
Fastening by looping length of suture material and tightening by hand or insturment
2
Q
2 typs of stable knots?
A
- Square knot
2. Surgeons knot
3
Q
2 types of unstable knot?
A
- Granny knot
2. Simple knot
4
Q
Where can one see an “External knot”
A
outside body
5
Q
Where is a “buried knot”?
A
Inside body
6
Q
Ideal surgical knot?
A
No slip, not too much or too little tension, minimal context between tissue and suture material
7
Q
What is “dishecense”?
A
Rupture along surgical incision
8
Q
Breast cancer #1 risk factor?
A
Being female
9
Q
Breast cancer #2 risk factor?
A
History of first-degree relatives with breast cancer
10
Q
What is a physiological nodularity?
A
Uneven texture of breast. Granular, nodular, or lumpy.
11
Q
Is physiological nodularity normal?
A
YES
12
Q
Where do breast lymphatics drain toward?
A
axilla
13
Q
Which node can malignant breast cells spready directly to?
A
Infraclavicular nodes
14
Q
Peau D’Orange?
A
One breast looks like orange peel. BAD!
15
Q
Paget’s dz and breast ca?
A
Eczema on one breast concerning for malignancy
16
Q
Is tenderness suggestive of breast malignancy?
A
Nope! Malignany masses most likely non-tender.
17
Q
Clinical Breast Exam how often? Position?
A
q3y, 20-39 y/o. supine.
18
Q
Breast Self Exam how often?
A
Every month after age 20. 5-7 days after menses begins.
19
Q
Female breast extends from ____ down to ___
A
clavicle/2nd rib down to 6th rib
20
Q
Muscles overlying breasts? Overlying inf margin?
A
Pectoralis major
Inferior margin=serratous anterior
21
Q
Tail of breast aka?
A
Tail of Spence
22
Q
Which breast nodes are most easily palpated?
A
Central nodes
23
Q
What is the loose, wrinkled pouch in men?
A
Scrotum
24
Q
How many compartments in scrotum?
A
2 compartments, one testis in each
25
Covering of scrotum?
Tunica vaginalis
26
Tunica vaginalis covers posterior scrotum?
Nope!
27
Name of tissue covering posterolateral scrotum?
Epididymis
28
Shape of Epididymis?
Comma shape
29
What does Epididymis feel like? (hint: what it feels like)
Noduar, soft, cordlike
30
What is Epididymis site for?
REservoir for storage, maturation, and transport of sperm
31
How to view Epididymis
Lift up
32
What sort of test done to any palpable mass of scrotum?
Transillumination
33
Which 4 scrotal masses do not transilluminate?
1. Inguinal hernia
2. Varicocele
3. Tumor
4. Hematoma
34
Mass while standing which disappears while laying?
Hernia
35
Mass while standing which stays while laying?
Listen to mass with stethoscope for bowel sounds (indirect inguinal hernia)
36
Red glow during scrotal transillumination is likely not what?
Not hernia
37
Two major types of hernias?
1. Inguinal
| 2. Femoral
38
Inguinal Hernia when loops of bowel do what?
Force way through weak spots of inguinal canal
39
2 types of Inguinal Hernia?
1. Indirect Inguinal Hernia
| 2. Direct inguinal hernia
40
Most common type of inguinal hernia?
Indirect
41
Origin of indirect inguinal hernia?
Above inguinal ligament
42
Course of indirect inguinal hernia?
Into scrotum
43
What hear in scrotum with indirect inguinal hernia?
bowel sounds
44
Which hernia responds to “cough and bear down”
indirect inguinal hernia
45
Direct inguinal hernia rare in who?
Rarely in women
46
Direct inguinal hernia above what age?
>40, men
47
Origin of Direct inguinal hernia?
Above inguinal ligament near public tubercle
48
What direction does Direct inguinal hernia bulge?
Anteriorally
49
Where does Direct inguinal hernia push side of finger?
Forward
50
Femoral hernia is when bowel pushes through where?
Trough femoral canal weak spots
51
Origin of femoral hernia?
Below inguinal ligament
52
Least common hernia?
Femoral hernia
53
Who gets Femoral hernia more often?
Womens
54
First thing to do in BLS?
Scene safe, shout for help, activate emergency response system, get AED
55
When to start CPR?
No pulse, gasping w/snoring noises
56
CPR for adults ratio and rate?
30:2, 100-120 compressions per minute
57
How often to rotate for adult CPR?
q2min
58
What to do with AED and pacemaker?
Don’t put pads over pacemaker
59
Rescue breathing for opioid overdose rate?
1 breath every 5 seconds
60
What to do for opioid no pulse and no breathing?
One person start CPR, one person get AED and naloxone
61
Wheezing between cought is what degree of choking obstruction?
Mild
62
Can’t talk, cyanosis, high-pitch during inhale is what degree of choking?
Severe
63
Who can and can’t do abdominal thrusts on?
Can=people of average size
| Can’t=preggers, obese, infants
64
Unstable defintion according to ACLS?
No pulse, no breathing, signs of shock, altered mental state, acute heart failure, VTach, VFib
65
Stable defintion according to ACLS?
Pulse, breathing, stable tachycardia, stable bradycardia
66
When to do synchronized cardioversion?
Persistent tachycardia with pulse and hypotension/AMS/Shock/Ischemic CP/Acute heart failure
67
Who to defibrillate? (Hint: only 2 rhythms)
1. VFib
| 2. Pulseless VTach
68
Which antiarrythmics for tachycardia with wide QRS but otherwise stable?
Adenosine, Procainamide, Amiodarine, Sotolol
69
Antiarrythmic for refractory VFib and Pulseless VTach?
Amiodarone
70
Can shock PEA and asystole?
Nope!
71
Pulse ox for post-arrest care?
Maintain at 94%
72
Define BRUE
Brief Resolved Unexplained Event
73
Age of BRUE?
<12 y/o
74
Is there a clear explanation of symptoms in BRUE?
Nope
75
BRUE consists of resolved episodes of....?
Cyanosis/Pallor, absent/irregular/decreased brathing, hypo/hypertonia, altered LOC
76
High risk BRUE?
<60 days old, born <32wk gestation w/>42wk corrected, requiring CPR, >1 min event, not first event
77
Low risk BRUE?
>60d old, >32wk gestation w/>42wk corrected, no CPR required, <1min event, first event
78
Tx for high risk BRUE?
Admit for observation, CBC, blood cx, LP, CMP, lytes, ABG, UA, urine CX, echo, ekg, eeg, etc etc
79
Tx for low risk BRUE?
No admit, pertussis testing, EKG, brief observation, educate family on CPR
80
Etiology of Nursemaid’s Elbow?
Radial head subluxation (partial dislocation)
81
Ages of Nursemaid’s Elbow?
15mo-3y
82
Area of true tenderness in Nursemaid’s Elbow?
No
83
DX tests needed in Nursemaid’s Elbow?
Nope
84
PE of Nursemaid’s Elbow?
Arm held at side w/slight 130-150º elbow flexion “self splint”
85
Tx of Nursemaid’s Elbow?
Simple reduction. Palm up, touch hand to shoulder, rotate thumb
86
How long no lift/twist after Nursemaid’s Elbow reduction?
2-3 days
87
Fever up to 12 weeks?
100.4
88
Fever over 3 months?
101.2
89
Fever w/source, well-appearing, <28d?
Full work up. CBC w/diff, blood cx, urine cx, UA, LP, CXR
90
Fever w/source, well-appearing, 1mo-90d?
All but LP if had 2 mo immunizations
| CBC w/diff, blood cx, urine cx, UA, CXR
91
Fever w/source, well-appearing, 3mo-1yr?
Tx source, consider CBC w/diff, blood cx, urine cx, UA.
| CXR only w/cough
92
Fever w/source, well-appearing, >3yr?
No further work up
93
Fever without source, well-appearing, <28d?
Full w/u
| CBC w/diff, blood cx, urine cx, UA, LP, CXR
94
Fever without source, well-appearing, 1-3 mo?
Full workup, +/-LP
| CBC w/diff, blood cx, urine cx, UA, CXR
95
Fever without source, well-appearing, >3 mo?
CBC w/diff, UA, urine cx
| Cough=Blood cx or CXR
96
Fever and ill appearing neonate?
Setic until proven otherwise
97
Worry for fever and ill appearing in 30-90d?
Yes, worry
98
WHat age are fontanelles fused by?
1. “Almost entire size”
99
When to perform neuro exam for LP?
Before and after LP
100
Where is LP done? (Hint: 2 sites)
L3-L4 or L4-L5
101
Why is LP done where it’s done?
Below spinal cord, in cauda equina
102
What to do if his bone with LP needle?
Move caudally (down)
103
What to do if his bone with LP needle and already moved caudally?
Move cephaled (toward head)
104
Neutrophils in CSF means?
Bacterial infx
105
Lymphocytes in CSF means?
Viral aseptic meningitis
106
Normal RBC in CSF?
<10
107
What causes increased RBC in CSF?
Traumatic tap, SAH
108
Xanthochromia is what?
Yellow/orange discoloration in CSF. Product of RBC lysis. Can mean SAH.
109
Normal glucose in CSF?
50-80
110
Low glucose in CSF means what? (hint: 4)
1. Bacterial meningitis
2. sarcoidosis
3. syphillis
4. SAH
111
Glucose levels in CSF when viral?
Variable
112
Serum glucose and CSF glucose?
Serum hyperglycemia may mask depressed CSF glucose to always check serum CSF
113
Normal protein range in CSF?
15-45
114
Elevated protein range in CSF?
>45
115
Percent of CSF gram stain being false negative?
20%
116
Gram negative dipococci in CSF which bacteria?
N. Meningites
117
Gram negative bascilli in CSF which bacteria?
H. Flu
118
Gram positive cocci in CSF which bacteria? (hint: 2)
Strep or staph
119
CSF cultures take how long?
24-48h
120
Normal opening pressure in lateral recumbant position?
18-20
121
CSF opening pressure >30 can mean? (hint: 2)
1. Bacterial infx
| 2. Pseudotumor cerebri
122
How many tubes of CSF collected in LP?
4
123
How many mL collected in LP?
4-8mL
124
Tubes and traumatic LP tap?
If RBC in #4 > than in #1=traumatic tap
125
Cobalt Blue Filter used with what to check for eye problems?
Flourescein
126
Flourescein can help find what sorts of eye problems?
Abrasions, ulcers, superficial punctate, leratitis
127
Herpes Zoser Opthalmicus effects which nerve?
V1 nerve (Trigeminal)
128
What are seen on the V1 dermatome in Herpes Zoster Opthalmicus?
Dendritic epithelial lesions
129
What is Hitchinson’s Sign (part of Herpes Zoster Opthalmicus)?
Tip of nose has rash
130
Acute onset, red, discharge, stuck eye lip is which problem?
Acute Bacterial Conjunctivitis
131
Pseudomembrane, subepithelial infiltrates is which eye condition?
Viral Keratoconjunctivitis
132
Excoriation and inflammation at base of penis is which condition?
Scabies of penis
133
Is Chancre painful of painless?
Painless!
134
Chancre is a lesion of what?
Primary Syphilis
135
Chancre is a lesion of Primary Syphilis and which bacteria?
T. Palladium
136
T. Palladium incubation period?
9-90d
137
Chanchroid painful or painless?
PAINFUL!!!!
138
Painful, deep ulcer?
Chanchroid
139
Chanchroid from which bacteria?
H Ducrey
140
H. Ducrey causes Chanchroid in what period post-exposure?
3-7 days
141
What is Hydrospadias?
Urethral opening in area other than tip of penis
142
Majority of breast masses detected by who?
Female herself
143
Quadrant where are a majority of breast masses found?
Upper outer quadrant
144
Where does the Tail of Spence point toward?
Axilla
145
Which pattern is the most validated for breast exams?
Vertical strip pattern
146
What mental health question to ask post-preggers?
About depression
147
EGBUS?
External genetalia, batrholinns gland, utrthra, skenes
148
What does the multiparous os look like?
Not around, more linear
149
Nulliparous os looks like?
Small and perfectly round
150
Speculum exam before or after bimanual exam?
BEFORE
151
Gyn exams in which position?
Lithotomy
152
What does a normal prostate feel like?
Rubbery, non-tender
153
What if prostate feels firm?
Concerning
154
Firm and bumpy prostate?
Think cancer
155
What sort of pain with hernia?
Referred pain (Esp in indirect hernia)
156
Descibe pain in indirect hernia? Swelling?
One-sided pain in testes, scrotal swelling
157
When to defer rectal exam in adults?
If Asx
158
Thunderclap, slap onset HA from what? “worst HA of life”
Subarrachnoid Hemorrhage
159
MA, nuchal rigifity, +kernig or brudzinski’s, petechial rash?
Meningitis
160
Kernig sign?
Pain with fip and knee flexion
161
Burdzinski’s sign?
Neck flexes and causes hips and knees to flex
162
What to use to guide LP in obese?
Fluorscopy
163
How to rule out headbleed before LP?
CT scan!
164
What sort of pain can occur to nerve root after LP?
Radicular pain
165
Name of intralaminar space where “pop” is heard in LP?
Ligamentum flavum
