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PCM II > exam I > Flashcards

exam I Flashcards

1
Q

ligamentum trite

A

bleeding above this will be melena, below will be red

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2
Q

visceral pain

A

aka colic
comes and goes, crescendo/decrecendo
not well localized

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3
Q

parietal pain

A

steady ache, well localized

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4
Q

kurrs sign

A

spleen referred pain to left shoulder

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5
Q

pancreas referred pain

A

right shoulder

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6
Q

expose abdomen

A

from xiphoid to pubic symphisis

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7
Q

bowel sounds

A

normal- high pitched ‘tinkle’ about every 3-5 seconds

no sounds for 2 minutes- report as absent

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8
Q

borborygmi

A

increased hyperactive bowel sounds
low pitched rumbling
hyperperistalisis

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9
Q

percussion of abdomen

A

tympany over intestines

dull over liver

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10
Q

liver

A

should be less then 10 cm along MCL

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11
Q

Fluid wave

A

place patients or assistants hand in midline

tap on one flank and palpate w/the other hand, easily detected impuse indicative of ascites

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12
Q

shifting dullness

A

percuss the patient on their back and then their side, where the sound changes from tympany to dull and the shift of the sound when patient on their side
shift indicative of ascites

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13
Q

rebound pain

A

peritoneal tenderness and inflammation

Rovsing sign- referred rebound tenderness test LLQ but get pain in RLQ

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14
Q

palpation of liver

A

under right 11th and 12th rib

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15
Q

palpation of spleen

A

under left 11th and 12th ribs

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16
Q

Llyods sign

A

CVA (costovertebral angle) tenderness during kideny percussion

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17
Q

obturator sign

A

place right lef in figure 4 press on right knee while holding down left iliac crest- appendicitis

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18
Q

appendicitis

A 
annorexia!!
nausea, vomiting 
pain
rovsing sign
psoas pain
obturator sign
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19
Q

lower abdominal pain

A

MUST DO RECTAL

PREGNANCY EXAM IN FEMALES

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20
Q

murphys sign

A

RUQ pain, sudden arrest of inspiration during palpation of liver and gallbladder -> acute cholecytitis

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21
Q

diagnostic tirad

A

RUQ pain, fever, and leukocytosis ->acute cholecystitis

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22
Q

five ‘f’s

A

female, fat, fertile, fair, flatulent -> acute cholecytitis

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23
Q

newborn

A

0-28 days

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24
Q

infancy

A

0-12

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25
Q

toddler/early childhood

A

1-4 yrs

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26
Q

school-aged/middle childhood

A

5-10

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27
Q

adolensence

A

11-20, subdivided into early, middle, late

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28
Q

APGAR

A 
A- appearance
P-pulse
G- grimace
A- activity
R-respiratory effort
assesses neuroglogic recovery
each rated on a 0-3, 3 the best
done at 1 and 5 minutes
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29
Q

shortly after delivery

A

erythromycin ointment in eyes, prevents infection
vitamin K injection to prevent bleeding
full bath

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30
Q

ballard scoring system

A

to determine gestational age
nueromuscular -1-5
physical maturity -1-5
add both categories and use scale to get age
this considered more accurate then mom n dads dates

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31
Q

normal birth weight

A

> 2,500 grams

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32
Q

weight

A

normal to loose up to 10% in first week

should be gained bak in 10-14 days of life

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33
Q

voiding

A

3-4 in first 1-2 days by day 5-5 should see 6-8 in 24 hours

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34
Q

stooling

A

initial stools are meconium, w/in first 24 hours of life, dark black, tarry
by day 4-5 stool changes depending on diet

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35
Q

jaundice

A

transcutaneous bilimeter or serum w/in 24 hours
elevated levels with in first 24 hours more concerning
photobathing

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36
Q

hospital discharge

A

vaginal 2-days
c-section 3 days
given hep B, hearing screen, neonate screening blood test, circumcision

37
Q

follow up

A

24-48 hours
weight?
bilirubin?

38
Q

well visits

A 
3-4 days of life
2wks (not in all states)
1mo
2mo
4mo
6mo
9mo (check hemoglobin)
12mo
39
Q

components used to assess development

A

physical (gross and fine motor)
language/cognative
personal/social

40
Q

language

A

2 months- cooing
6 months- babbling
1yr- 1-3 words

41
Q

palmar grasp

A

place finger in hand and press, fingers curl around your finer, disappear by 4 mo

42
Q

plantar grasp

A

touch sole at base of toes -> toes curl

gone by 9m

43
Q

rooting

A

stroke perioral skin at corner of mouth-> mouth opens and turn head towards stimulation
gone by 3-4 mo

44
Q

hip exam

A

use barlow and ortolani maneuvers to test for signs of dislocation
DHD- developmental hip dysplasia, need imaging to diagnose
tests are reliable up to 3mo, but then hip capsule tightens, other signs -> galeazzi

45
Q

ortolani test

A

posterior hip dislocation

externally rotate with fingers underacetabulum pushing anterior, will put it back in place

46
Q

barlow

A

`tests for ability to sublux intact, but unstable hip

internally rotate pushing acetabulum posterior, will dislocate

47
Q

stills murmur

A

grade II, musical, vibratory midsystole, worse when patient supine

48
Q

venous hum

A

sof continuous, louder in diastole

49
Q

carotid bruit

A

midsystolic, louder on left, eliminated by carotid compression

50
Q

tanner breast

A

1- preadolescent, elevation of nipple only
2-elevation breast, nipple small mound
3- further enlargement of breast/areola, no separation of contour
4- projection of areola/nipple to form secondary mound
5- mature, projection of nipple only

51
Q

tanner female pubic hair

A

1- preadolescent, no hair except for fine body hair
2- sparse growth of long slightly pigmented downy hair, straight or slightly curly, along labia
3-darker, curlier, spreading to pubic sympthysis
4- course and curly hair, not yet on thigh
5- spread out onto inner thigh

52
Q

tanner-male 1

A

1- preadolescent, no hair, penis/testes same size as childhood

53
Q

tanner- male 2

A

2-pubic hair sparse slightly pigmented, penis slight to no enlargement, testes/scrotum larger, slightly reddened

54
Q

tanner male 3

A

3- pubic hair darker, coarser, curlier, localized, penis larger in length, testes further enlargement

55
Q

tanner male 4

A

4-pubic hair coarser, curlier, not yet on thighs

further enlargement length, breadth w/developement of glands

56
Q

tanner male 5

A

5- pubic hair spread to thigh, penis/scrotum adult size and shape

57
Q

when do you start doing exam on parents lap

A

9 months, this is when they develop a sense of strangers

58
Q

head circumfrence

A

measured until 36 months

59
Q

vaccines by 6 months

A
  • Hepatitis B (Hep B)
  • Rotavirus (RV)
  • Diphtheria, tetanus, acellular pertussis (DTaP)
  • Haemophilus influenza type B (HIB)
  • Pneumococcal (PCV)
  • Inactivated poliovirus (IPV)
  • Influenza
60
Q

vaccines by 12 months

A
  • Measles, mumps, rubella (MMR)
  • Varicella
  • Hepatitis A (Hep A)
61
Q

puberty begins

A

8-13 females

9-13.5 males

62
Q

early adolescences

A 
10-14
puberty begins
concrete operational
focus on present 
'am I normal'
independence/ambivalence
63
Q

middle adolescence

A

15-16
physical- females more comfortable, males more awkward
transitional- many ideas
begin to develop insight, reflect on thoughts/feelings of others
‘who am i’ introspective
independence, rebellious, push boundaries

64
Q

late adolescence

A 
17-20
adult appearance
formal operative
identify self w/respect to others
independence from family
65
Q

adrenarche

A

Activation of adrenal medulla for production of adrenal androgens
Occurs before the onset of puberty

66
Q

Gonadarche

A

Earliest gonadal changes of puberty-GnRH released
Boys-LH stimulates testosterone production and FSH stimulates sperm maturation
Girls-FSH stimulates estrogen & follicle formation and LH stimulates corpus luteum after ovulation

67
Q

Thelarche

A

Beginning of breast development at puberty

68
Q

Pubarche

A

Beginning of pubic hair

69
Q

Ab pain thru 1yr

A
  • Colic
  • Gastroenteritis
  • Constipation
  • Urinary tract infection
  • Intussusception
  • Volvulus
  • Incarcerated hernia
  • Hirshsprung’s Disease
70
Q

Ab pain 2-5 yrs

A
  • Gastroenteritis
  • Trauma
  • Appendicitis
  • Pharyngitis
  • Constipation
  • Urinary tract infection
  • Intussusception
  • Sickle cell syndrome
  • Henoch-Schonlein purpura
  • Volvulus
  • Mesenteric lymphadenitis
71
Q

ab pain 6-11 yrs

A
  • Gastroenteritis
  • Trauma
  • Appendicitis
  • Pharyngitis
  • Constipation
  • Urinary tract infection
  • Pneumonia
  • Sickle cell syndrome
  • Henoch Schonlein purpura
  • Functional pain
  • Mesenteric lymphadenitis
72
Q

ab pain 12-18 yrs

A
  • Appendicitis
  • Gastroenteritis
  • Constipation
  • Dysmenorrhea
  • Mittelschmerz
  • Pelvic inflammatory disease
  • Threatened abortion
  • Ectopic pregnancy
  • Ovarian/testicular torsion
73
Q

things that cause mesenteric lymphadenitis

A 
Beta hemolytic streptococcus
Staphlococcus species
E. coli
Streptococcal viridans
Yersinia species (most cases currently)
Mycobacterium tuberculosis
Viruses
Coxsackievirus A & B
Rubeola virus
EBV
Adenovirus serotypes 1,2,3,5 & 7
74
Q

labs to run if jaudice w/in 24 hours

A 
Sepsis panel
CBC, CMP, DIC panel
Rubella abs
Toxo abs
Coombs test
ABO/Rh typing
CBC/Retic count
Periph smear
Fractionated bilirubin level
75
Q

labs to run if jaundice in a 24hours-2wks

A 
Fractionated bilirubin level
Includes direct and indirect
(conjugated &unconjugated)
CBC
Retic count
Peripheral smear
76
Q

labs to run if jaundice after 2 wks

A 
CBC/retic
Fractionated bilirubin level
Urine bili levels
Thyroid studies
Sepsis eval
Genetics for metabolic disorders
77
Q

phimosis

A

cannot retract foreskin back over penis

hygiene issues root cause

78
Q

Paraphimosis

A

cannot pull foreskin back around glans

79
Q

Cryptorchidism

A

undescended testicles

80
Q

syphillis

A

causative organism Treponema pallidum
Syphilitic Chancre – painless round or oval erosion or ulcer. Non-tender enlarged inguinal lymph nodes are common.
RPR and VDRL are positive, screening test, many false positives.
FTA- ABS is positive or Dark Field Microscopy, confirmatory test.

81
Q

Genital Herpes

A

cluster of small vesicles. Burning and painful. Progress to ulcers on a erthymic base.
Dx – viral culture of the fluid in the vesicle.
Herpes simplex virus 1 and 2 need serological testing to determine which one

82
Q

Venereal warts

A

(Condyloma acuminatum) - caused by HPV (human papillomavirus. Grow in clusters.
Difficult to treat – cryosurgery, laser surgery, electrosurgery, podophyllin, Aldara(imiquimod), surgery.

83
Q

Genital Scabies

A

Genital Scabies:

  • Contagious disease caused by a mite (Sarcoptes scabiei)
  • Direct skin contact.
  • Nocturnal pruritus is very characteristic progressing to intense pruritus.
  • Linear, curved or s-shaped burrows.
  • Diagnosis: clinical suspicion, slide mount preparation.
  • Treatment: Permethrin cream (Elimite), Lindane; oral steroids or antihistamines for pruritus.
84
Q

Gonococcal Urethritis

A

purulent discharge
Gram-negative intracellular diplococci of GC
WBC = neutrophils

85
Q

axillary tail drains to

A

subscapular grp of axillary nodes

86
Q

upper breast drains to

A

subclavicular nodes

87
Q

medial beast drains to

A

submammary plexus of the opposite
breast
lymph glands along the internal thoracic artery -> mediastinal nodes

88
Q

inferior breast drains to

A

lymp of ab wall and to extraperitoneal lymph

PCM II (2 decks)

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