FCM III Final Flashcards
Increased fremitus, decreased percussion, egophany
solid (tumor)
Decreased fremitus, decreased percussion, egophany
fluid (effusion)
decreased fremitus, increased percussion, no egophany
gas (pneumothorax)
in effusion, see tracheal deviation in what direction
away from disease
clicking, bubbling or rattling on inhalation; when air opens closed air spaces
rales (can be moist, fine, dry or coarse)
snoring sound from blocked air flow or turbulence in large airways
rhonchi
wheeeze due to blockage of airflow in trachea or back of throat
stridor
high-pitch sound on exhalation, caused by narrow airways
wheeze
normal JVP
1-3 cm above sternal angle, 6-8cm above right atrium
assessed in left lateral decubitus position
mitral stenosis murmurs/gallops
sound in early diastole (filling); indicates enlarged ventricle
S3 gallop
sound in later diastole, atrium straining to fill stiff ventricle
S4 gallop
can be normal in children, YA
S3
can be normal in adults, atheletes
S4
a “thrill” is a palpable murmur, corresponds to grades
Grades 4-6
6 dimensions of a murmur
LRQuITS: location, radiation, quality, intensity (1-6), timing, shape
loud, with thrill
4
loud, can hear with stethoscope partially off of chest
5
can hear with stethoscope off of chest
6
closing bicupid and tricuspid valves (begins systole)
S1
which valve in S1 closes first?
biscuspid (mitral)
closing aortic and pulmonic valves (begins diastole)
S2
which valve in S2 closes first
Aortic (split S2 normal in inspiration)
BP target for HTN patients over 60
<150/90
BP target for HTN patients under 60
<140/90
palmar erythema, asterixis (hands tremor or flapping), spider angioma, eye jaundice/sceral icterus
advanced liver disease
abdominal pain radiating to the back (3)
pancreatitis, duodenal ulcer, aortic dissection
palpating contralateral abdomen results in RLQ pain
Rovsing’s sign, appendicitis
acuity defect (blindness)
II
visual field defects (hemianopsia)
II
optic disc defects (papilledema or optic atrophy)
II
pupillary light response defects
II and III
other maybe causes of pupillary light response defects 4
blindness, CN III paralysis, tonic pupils, horners
extraocular movement defects (strabismus, nystagmus, etc)
III, IV, VI
temporal/masseter weakness, facial numbness
V
lateralization to affected ear
Weber, conduction loss (bone>air)
lateralization to unaffected ear
Weber, sensoineural loss (air>bone)
impaired swallowing, hoarseness, palatal paralysis, absent gag reflex
IX and X
tongue atropy, fasciluations
XII (fasculations in ALS, polio)
poor word articulation
XII (can be due to X as well)
protruded tongue deviates which way
to weak side (contralateral CVA)
atrophy, fasciluations, weakness in trapezius or SCM
XI
facial muscle weakness
VII
sudden onset, wax and wane, infections, metabolic emergencies, PE, MI etc
delirium
tips of lateral and medial malleous, navicular bone and base of fifth metatarsal
ottawa ankle rules
passively internally rotate shouulder and flex forward greater than 90 degreses
Neer’s: RTC impingement, subacromial bursitis
Neer’s Sen/Spec for RTC
83/51
Neer’s Sen/Spec for subacromial bursitis
75/48
elbow and should flexed 90 degrees, examiner internally rotates shoulder
Hawkin’s: RTC impingement, subacromial bursitis
Hawkin’s Sen/Spec for RTC
86/43
Hawkin’s Sen/Spec for subacromial bursitis
92/44
flex shoulder actively against resistance with the elbow extended and forearm supinated
Speed’s: bicipital tendonitis
Speed’s sen/spec for bicipital tendonitis
90/13
active supination against resistance with elbow flexed to 90 degrees and the forearm pronated
yergason’s: bicipital tendonitis
Yergason’s Sen/spec for bicipital tendonopathy
43/79
arm held in 90 degree abduction with full internal rotation maintained against downward resistance
Empty Can: supraspinatus pathology
Empty Can Sens/Spec for supraspinatus pathology
89/50
dorsum of hand lifted off lower back with and without resistance
lift-off: subscapularis tendon tear
lift-off sens/spec for subscapularis tendon tear
partial tear 22/99, full tear 94/99
unable to lower arm slowly, or only with extreme pain
drop-arm: RTC tear
drop arm test sens/spc for RTC tear
partial tear 14/78, full tear 35/86
bulging ear drum, purulent effusions, erythematous membrane
otitis media
clear or purulent drainage, edema, pain on tug test, tip insertion
otits externa (swimmer’s ear)
thyroid bruit can be heard in
hyperthyroid secondary to graves
how close to examine a derm lesion
closer than 20cm (about 8 inches)
ABCDE of melanoma
assymmetry, border irregularity, color variegation, diamter >6cm, evolutionin size, color or shape
blanchable redness
erythema
large area of redness, maybe also desquamation
erythroderma
dilation of small superficial blood vessels
telengectasia
non-blanchable, 1-2cm, flat
petechia
bruise, can change color from blue to yellow
ecchymosis
redness from vascular inflammation
palpable purpura
small (<1cm) flat lesions, usually just epidermal or dermal color changes
macule
primary lesion in tinea versicolor (tropical yeast infection)
macule
a small flat lesion >1cm
patch (big macule)
raised lesion, no fluid, <1cm
papule
raised lesion, no fluid, >1cm
plaque
primary lesion in psoriasis, in epidermis or superficial dermis
plaque
large, hard, deep papule, down to midermis, overlying epidermis looks normal
nodule
small blister (fluid filled vesicle), <1cm
vesicle
blister >1cm
bulla
vesicle filled with pus
pustule
contains fluid/semi-solid material
cyst
primary lesion in shingles
vesicle
loss of epidermis (as in a post-weeping, crusted vesicle), usually heals with no scarring
erosion
circumscribed loss of dermis, usually scarrs, can develop eschar
ulcer
hard darkened plaque covering
eschar
thinning of skin, as from topical steroid use
atrophy
abrasion or stripping of skin due to repetitve motion
excoriation
white/gray flakes/plates of compacted stratum corneum
scales
drying of plasma, blood, or purulent exudate on skin, seen in impetigo
crust
thickening of dermis due to repeated rubbing, as in pruritic scabies
lichenification
head, hands and feet distribution
acral
herpes zoster distribution
dermatomal
extensor surface distribution
knees and elbows
flexor surface distribution
backs of knees, fronts of elbows
in axilla, perineum, under breasts and skin folds
intertriginous
address in handoff so care-team understands patient
SBAR: situation/background/assessment/recommendation
mediastinum and heart normally should be
less than 50% of transverse chest diameter
HR from EKG
count the large boxes between 2 R waves and count off starting with 300, 150, 100, 75, 50
QRS is upright in leads I and avF
normal axis on EKG
Large diphasic P wave (V1) at initial upstroke
right atrial hypertrophy
Large diphasic P wave (V1) in wide terminal component
left atrial hypertrophy
S wave in V1 and R wave in V5 sum to greater than 35mm
left ventricular hypertrophy
Q waves bigger than 1 mm in width or .04 seconds in duration
MI
T wave depressions or inversions
ischemia
ST elevation
acute MI
evidence pyramid, worse to best
studies, synopses of studies, syntheses (cochrane library), summaries (evidence-based textbooks), CPE (computers)
vertebra prominens
C7
normal strength
5
moves against gravity/light resistance
4
gravity with no resistance
3
gravity eliminated
2
muscle movement w/o joint movement
1
no muscle movement
0
sustained clonus (always abnormal)
4
brisk w/at most a few beats of clonus (may be normal)
3
easily detectable (normal)
2
detectable only with reinforcement (may be normal)
1
no reflexes (always abnormal)
0
Katz Basic Activities of Daily Living:
bathing, dressing, toiletting, tranferring, continence, feeding
lawton-brody instrumental activites of daily living:
telephone, shopping, food prep, housekeeping, laundry, modes of transport, medications, finances
should be able to see how many posterior ribs in x-ray
10
adduct hip (bring thigh toward midline) and direct posterior force on the knee
barlow test for hip dysplasia
flex hip to 90 degrees, place index fingers on greater trochaners, and gently abduct legs
ortolani test for hip dysplasia
baby respiratory rate
40-60 bpm, may be irregular so count for 20-30 seconds
length of typical admission presentation
7 minutes
1 large box (five small boxes) on EKG
.2 seconds
carotid upstroke corresponds to
systole
extension fracture of the radius
Colles fracture
flexion fracture of radius, pain localized to distal radius
Smith’s fracture
aortic regurg murmur occurs in
diastole
blurred lateral optic disk indicates
acute increase in ICP
hypocalcemia presesnts on PE
Chvostek’s sign: neuromuscular irritability
pulsus paradoxus
aortic dissection sign
L3 lesion
quadriceps impaired, Can’t bend the knee
squeeze gastrocnemius, see no foot movement
positive Thompson test (achilles tendon rupture)
presents as unilateral, effects lower face on controlateral side
upper motor facial nerve lesion
s1 lesion
can’t plantarflex the foot
L5 Lesion
foot drop, diffulty with toe extension and heel walk
flexing neck causes hips and knees to flex
brudinski’s sign: meningitis
where is S1 louder than S2
at the apex
lateral epicondyle tenderness
tennis elbow
medial epicondyle tenderness
golf elbow
first palpable midline spinous process
C2
at the level of the spine of the scapular
T3
at the inferior angle fo the scapula
T8
at the lowest rib
T12
at the level of the hyoid bone
C3
at the level of the thyroid cartilage anteriorly
C4-5
and the level of the first cricoid ring
C6
at the iliac crests
L4
at the lvel of the posterior superior iliac spine
S2
ankle reflexes before 60
90% have both
ankle reflexes after 60
60% have both, 30% have none
flick the distal phalanx of the long finger
hoffman’s: thumb flexion means upper motor lesions
relief with arm abduction (hand behind head)
arm abduction sign: cervical radiculopathy
radiating pain in ipsilateral arm with passive extenstion, flexing and rotating of neck with gentle downward pressure
spurling maneuver: cervical radiculopathy
pain down spin eiwth chin to chest
L’Hermitte’s: cervical myelopathy
pain with leg raise beyond 30 degrees
straight leg raise: sciatica
pain down ipsilateral leg below knee when head is forward flexed while foot is dorsiflexed with knee fully extended
seated slump test: lumbar radiculopathy
pain in thigh with knee flexion then hip extension in supine position
femoral nerve stretch test: lumbar radiculopathy
detect quadriceps weakness
single leg sit-to-stand test
light reflecting asymmetrically off of corneas
hirschberg test: occular misalignment
red free setting (green circle)
good for hemorrhages, nerve fiber layer
hypermic optic disc
blood vessel hypertrophy
pale optic disc
optic atrophy
blurred optic disc
papilledema
in a normal optic disc, diameter of cup
should not exceed 1/2 the diameter of the entire disc (otherwise glaucoma)
loss of spontaneous venous pulsations in eye
maybe papilledema
occurrence of undescended testicles
3-4% of term boys
assymetric Moro reflex
fractures, brachial plexus lesions
Derm stone fronton neck
C3
Derm arms
C6/t1
T4 and T10 dermatomes
Nipples, umbilicus
L4/5 dermatomes
Front of legs
S1/s2 dermatomes
Back of legs
S5 dermatome
Personal
Biceps level
C5/6
Brachioradialis level
C6
Triceps level
C7
Patellar level
L4
Ankle level
S1
Plantar levels
L5/S1
Weak baby femoral pulses
Only sign of aortic coarc before cardiogenic shock
Normal baby HR
120-160 bpm. Less than 90 is abnormal
Average baby head circumference
35 cm
Babies with meningitis, hypothyroid, hydrocephalus, genetic disorders, bony dysplasia
Large fontanelles
Wide nipples, lymphedema, excess nuchal skin
Turners
Adducted internally rotated arm w/intact grasp
Erbs palsy, common, c5/6 traction
Metatarsal adductus
C shaped lateral foot edge, associated with hip dysplasia
Severe port wine stains
Surge-weber, involves brain and eye
Sharp pain on poking liver: stops breath
Murphy’s: chile cystitis
RUQ sans radiation
Acute or alcoholic hepatitis
Epigastric pain
MI, GERD, gastritis
RLQ pain
Appendicitis, PID, ectopic pregnancy
LLQ pain
Diverticulitis
