Final Exam Flashcards

Question

Common errors when administering local anesthesia

Answer 1

* Inject only while withdrawing the needle. * Inadequate anesthesia may be the result of failure to wait for the agent to work effectively. Allow time for the drug to diffuse and achieve the desired effect (4 to 5 minutes). If the injection is intradermal (causing a wheal), it will have a more rapid onset. If deeper (subcutaneous), it will take longer to achieve its effect. * Injection directly into an area of infection will not achieve good anesthesia and may contribute to spread of the infection. Do not inject into an area of infection. Rather, inject around the area in a field block pattern (Fig. 5.3), and do not use epinephrine in areas near infection. * Although there is no proof that injection directly into a suspected cancer will spread the cancer along the needle track, injection into or through a suspected cancer should be avoided if possible. Injection of too much anesthetic may distort a lesion in a way that inhibits the accuracy and completeness of the excision or destruction. It may also mask a lesion and make it difficult to palpate and find if it is below the skin. Use a field block to avoid the lesion while achieving anesthesia.

Answer 2

Conventional radiographs, computed tomography (CT), and magnetic resonance imaging (MRI) are all used to evaluate the spine, but **MRI is the study of choice** for most diseases of the spine because of its superior ability to display soft tissues.

Answer 3

look at the QRS and T waves

Answer 4

fracture that has no communiation with the atmosphere

Answer 5

fracture line is diagonal in orientation relative to the long axis of the bone

Answer 6

* Streaky, linear appearance outlining extraperitoneal structures * Mottled, blotchy appearance (especially the anterior pararenal space) * Relatively fixed position, moving little if at all with changes in patient positioning

Answer 7

* Assessment of wound length and depth * mechanism of injury * location of injury * potential for infection * contamination or clean * amount of time since injury * tension * end result-is the end goal cosmetics or not?

Answer 8

Use a 2mm 3mm or 4mm elliptical shaped punch biopsy when possible. Make elliptical excision at least three times as long as wide. Incision length and width ratios should be greater than 3: 1, and the terminal angles should be less than 30 degrees to avoid dog-ears.

Answer 9

Waived testing can be delegated, PPM testing must be performed in the office at the time of visit by the patient’s own provider. This prevents practitioners from marketing themselves as a laboratory service provider.

Answer 10

_{In the cervical spine, three parallel arcuate lines should smoothly join:} _{(1) all of the spinolaminar white lines (the junction between the lamina and the spinous process)} _{(2) the posterior aspects of the vertebral bodies} _{(3) all of the anterior aspects of the vertebral bodies.} _{Alterations in the smooth parallel curvature of these three lines may indicate forward or backward displacement of all or part of vertebral body}

Answer 11

_{one or more loops of bowel lose their ability to propagate the peristaltic waves of the bowel, usually due to some local irritation or inflammation, and hence cause a functional type of “obstruction” proximal to the affected loop(s).} _{2 types:} 1. _{Localized ileus affects only one or two loops of (usually small) bowel (also called sentinel loops).} 2. _{Generalized adynamic ileus affects all loops of large and small bowel and frequently the stomach.}

Answer 12

Obstructive

Answer 13

* Air beneath the diaphragm * Visualization of both sides of the bowel wall * Visualization of the falciform ligament

Answer 14

1. _{Sinoatrial (SA) node which sits high in the right atrium, begins the electrical impulse which causes the atria to contract. The impulse spreads through the atria to the AV node.} 2. _{The AV node sits low in the right atrium. It briefly pauses the impulse, allowing the blood to enter the ventricles.} 3. _{Once the atria are empty of blood, the valves between the atria and the ventricles close & the electrical impulse proceeds rapidly down the His Bundle to the left and Right Bundle Branches.} 4. _{The fine purkinje fibers transmit the electrical stimulus directly to the myocardial cells of the ventricles making them contract.} 5. _{Then the system starts all over again.}

Answer 15

* _{Using an otoscope make sure that the canal is clear and you can visualize the tympanic membrane.} * _{The tympanometry probe should be inserted into the ear canal to create a light seal.} _{Indications for Tympanometry include} * _{Evaluation of hearing impairment} * _{Evaluation of unexplained vertigo or Eustachian tube dysfunction} * _{Assess for middle ear effusions} * _{Assess tympanic membrane compliance} _{Contraindications include} * _{Otorrhea or ear bleeding} * _{Otitis externa} * _{External auditory canal injury or obstruction} _{Complications include external auditory canal abrasions.}

Answer 16

1. Intraperitoneal (pneumoperitoneum) (frequently called free air) 2. Retroperitoneal air 3. Air in the bowel wall (pneumatosis intestinalis) 4. Air in the biliary system (pneumobilia)

Answer 17

Gas pattern Extraluminal air Calcifications Soft tissues

Answer 18

Free air Air fluid levels in the bowel

Answer 19

1. A rare primary form called **pneumatosis cystoides intestinalis**, which usually affects the left colon producing cystlike collections of air in the submucosa or serosa 2. Chronic obstructive pulmonary disease—presumably secondary to air from ruptured blebs dissecting through the mediastinum to the abdomen

Answer 20

used extensively as a diagnostic tool in the field of ophthalmology and optometry, where topical fluorescein is used in the diagnosis of corneal abrasions, corneal ulcers and herpetic cornealinfections.

Answer 21

located in the gluteal crease. The pilonidal sinus needs to be surgically removed after the abscess heals

Answer 22

Holdsworth fracture Jefferson fracture

Answer 23

* sprained wrist, triquetral fracture, 2^nd through 5^th metacarpal head fracture * extends along volar aspect of the forearm from carpal heads to just proximal of radial head, allows flexion of the elbow * Place forearm in a neutral position with thumb upward and wrist at a 20 degree of extension

Answer 24

In heart block, the heart beats irregularly and more slowly than usual, potentially stopping for up to 20 seconds at a time. This is due to a delay, obstruction, or disruption along the pathway that electrical impulses travel through to make the heart beat. It can result from injury or damage to the heart muscle or heart valves.

Answer 25

when performing procedures on digits due to risk of ischemia & tissue damage

Answer 26

the rupture of an atherosclerotic plaque on an artery supplying heart muscle. Plaques can become unstable, rupture, and additionally promote the formation of a blood clot that blocks the artery; this can occur in minutes.

Answer 27

a condition which affects repolarization of the heart after a heartbeat. This results in an increased risk of an irregular heartbeat which can result in palpitations, fainting, drowning, or sudden death. Long QT syndrome may be present at birth or develop later in life.

Answer 28

Infarction is characterized by pathological Q waves Injury is characterized by ST segment abnormalities Ischemia produces changes in T wave

Answer 29

It is contraindicated for small firm abscesses, facial abscesses or furuncles in the facial triangle (bridge of nose to corners of lips).

Answer 30

## Footnote a break of the **scaphoid** bone in the wrist. Symptoms generally includes pain at the base of the thumb which is worse with use of the hand. The anatomic snuffbox is generally tender and swelling may occur. Complications may include nonunion of the **fracture**, avascular necrosis, and arthritis.

Answer 31

Barton fracture Colles fracture Hutchinson fracture Smith fracture

Answer 32

when the patient and physician have discussed the reasons for treatment, the available alternatives, the risks and complications from treatment and also foregoing it, and the patient must consent.

Answer 33

You can tell if a frontal chest radiograph is underpenetrated (too light) ***if*** ***you are not able to see the thoracic spine through the heart.***

Answer 34

Yes. Magnification of the heart produced by projection, usually on an anteroposterior (AP), supine, portable chest examination, is the most common cause of apparent cardiomegaly.

Answer 35

The bone will look white and where the fracture is, there will be a gap which will be black. The bones can be going in one direction or overlapping depending on the type of fracture occurred.

Answer 36

Osgood-Schlatter disease Pelligrini-Stieda lesion Schatzker classification Segond fracture

Answer 37

Ø round or oval fibrous-walled, mucin (jelly like fluid) filled connected to a joint capsule or tendon sheath. Ø Most common tumor of the hand or wrist and more common in women. Ø Ganglion cysts may come and go over weeks to years due to rupture or reabsorption Ø Indication for aspiration or surgery include pain, paresthesias, limited range of motion, cosmetic reasons or concern for malignant tumor. Ø Referral to an orthopedic or podiatrist is preferred due to the possible neurovascular and tendon complications.

Answer 38

CLIA monitors the practice’s laboratory quarterly to ensure they are meeting competency standards, waived testing (ex: hcg, strep test, flu tests etc) and provider performed microscopy (PPM) are part of the quarterly testing criteria.

Answer 39

* a fracture of the posterior elements of C2. * result from a hyperextension-compression injury typically occurring in an unrestrained occupant in a motor vehicle accident who strikes his forehead on the windshield. * best evaluated on the lateral view of the cervical spine on conventional radiography and the sagittal view on CT.

Answer 40

* Used to immobilize the arm along the ulnar aspect of the hand including 4^th and 5^th phalanges * Extends from the fourth and fifth distal interphalangeal joint to proximal forearm * Leave thumb ,index finger and middle fingers freely mobile

Answer 41

* _{A piece of blotting paper containing the dye is touched to the surface of the eye. The patient is asked to blink. Blinking spreads the dye and coats the tear film covering the surface of the cornea. The tear film contains water, oil, and mucus to protect and lubricate the eye.} * _{A blue light is shined in the eye. Any problems on the surface of the cornea will be stained by the dye and appear green under the blue light.} * _{The provider can determine the location and likely cause of the cornea problem depending on the size, location, and shape of the staining.}

Answer 42

* _{Make it a practice to look in every child’s nose as well as their ears!} * _{Button or disk batteries are poisonous and can cause burns so should be removed ASAP} * _{Limit time and attempts to remove to decrease trauma to nasal mucosa and child.} * _{Use of aerosolized phenylephrine 2% or oxymetazoline 0.05% can be helpful to constrict mucosa (but do not use if button or disk battery).}

Answer 43

## Footnote implies that the applied part is easily visible in an x-ray machine so it can be manipulated via the x-ray viewer.

Answer 44

The most common tachycardia in children is supraventricular tachycardia (SVT).

Answer 45

* _{wrist and distal forearm fractures} * _{immobilizes wrist and forearm} * _{start at proximal palmar crease} * _{continue proximally along the volar forearm toward elbow} * _{bend the splint behind the elbow} * _{continue the splint distally toward the fingers} * _{complete the splint at the dorsal metacarpal joints} * _{maintains flexion of elbow and neutral position for forearm and wrist}

Answer 46

* _{can occur at any level but are most common in the cervical spine, thoracic spine and upper lumbar spine.} * _{They are high-energy axial loading injuries, typically secondary to motor vehicle accidents or falls in which the disk above is driven into the vertebral body below, and the vertebral body bursts. This in turn drives bony fragments posteriorly into the spinal canal (retropulsed fragments), and the anterior aspect of the vertebral body is displaced forward.} * _{Because these fractures involve incursion on the spinal canal, the majority of burst fractures are associated with a neurologic deficit.}

Answer 47

**Heart rate** is **controlled** by the two branches of the autonomic (involuntary) nervous system. The sympathetic nervous system (SNS) and the parasympathetic nervous system (PNS). The sympathetic nervous system (SNS) releases the hormones (catecholamines - epinephrine and norepinephrine) to accelerate the **heart rate**.

Answer 48

* When did the injury occur? * Is it greater than 12 hours old? * Is it a facial laceration greater than 24 hours old? * Where did the injury occur? * What was the mechanism of injury? * What are present symptoms and care prior to arrival? * Other information…HIV, diabetes, allergies, tetanus

Answer 49

The projection is called a right lateral **decubitus** if the patient is lying on the right side and a left lateral **decubitus** if the patient is lying on the left side. A lateral **decubitus** projection can be obtained in anteroposterior (AP) or posteroanterior (PA)**view**; however, the AP **view** is more commonly used.

Answer 50

occurs when two objects of the same radiographic density (such as water and soft tissue) touch each other so that the edge or margin between them disappears. It will be impossible to tell where one object begins and the other ends. The silhouette sign is valuable not only in the chest but also as an aid in the analysis of imaging studies throughout the body.

Answer 51

It appears the darkest (blackest).

Answer 52

a break between the base and middle part of the fifth metatarsal of the foot. It results in pain near the midportion of the foot on the outside. There may also be bruising and difficulty walking. Onset is generally sudden.

Answer 53

only if the biopsy site is 4 mm or larger

Answer 54

If the study is overpenetrated (too dark), the lung markings may seem decreased or absent. You could mistakenly think the patient has emphysema or a pneumothorax, or if the degree of overpenetration is marked, it could render findings such as a pulmonary nodule almost invisible.

Answer 55

## Footnote If the QRS complex is widened and downwardly deflected in lead V1, a left bundle branch block is present.

Answer 56

Cardiomegaly—defined on chest x‐ray as a “cardiothoracic ratio” (horizontal width of the [heart](https://www.sciencedirect.com/topics/medicine-and-dentistry/heart) divided by the widest internal diameter of the thorax) above 0.5 Cardiomegaly should be assessed on PA CXR. In AP view, the heart appears enlarged and may lead to misdiagnosis.

Answer 57

Implies that the applied part is only partially or not visible in the x-ray viewer.

Answer 58

Uncooperative patients who cannot follow directions

Answer 59

Their bones are softer & more flexible

Answer 60

also known as anterior wall MI, or AWMI, or anterior ST segment elevation MI, or anterior STEMI — occurs when anterior myocardial tissue usually supplied by the left anterior descending coronary artery suffers injury due to lack of blood supply.

Answer 61

_{Patients with a Corneal Abrasion commonly complain of “something in my eye” along with scratchy feeling, pain in eye, unable to open eye or excessive tearing.} * _{The History is vital in this situation: What was the patient doing before or at the time that the eye pain started? Was it windy outside? Bugs? Does the patient wear contacts?}

Answer 62

## Footnote the break of the 5th metacarpal bones of the hand near the knuckle. Occasionally it is used to refer to **fractures** of the 4th metacarpal as well. Symptoms include pain and a depressed knuckle. Classically, it occurs after a person **hits an object with a closed fist.**

Answer 63

_{The intervertebral disks have a central gelatinous nucleus pulposus surrounded by an outer annulus fibrosus, which is in turn made up of inner fibrocartilaginous fibers and outer cartilaginous fibers (Sharpey fibers). The nucleus pulposus is located near the posterior aspect of the disk.} _{The relative height of the disk space varies in each part of the spine.} * _{In the cervical spine, the disk spaces are about equal to each other in height.} * _{In the thoracic spine, they are usually slightly decreased in size from the cervical spine but equal in height to each other.} * _{In the lumbar spine, the disk spaces progressively increase in height with each successive interspace, except for L5 to S1, which can be equal to or slightly less than the height of L4 to L5 on conventional radiographs.}

Answer 64

an abscess formed by an infected hair follicle or sweat gland.

Answer 65

The size of the heart is usually less than half of the internal diameter of the thoracic rib cage. This is important so that you can recognize a normal sized heart.

Answer 66

also known as IWMI, or inferior MI, or inferior ST segment elevation MI, or inferior STEMI — occurs when inferior myocardial tissue supplied by the right coronary artery, or RCA, is injured due to thrombosis of that vessel.

Answer 67

* ^{If the complexes in the chest leads look very tall consider left ventricular hypertrophy. If the depth of the S waves inV1 added to the height of the R wave in V6 comes to more than 35 mm, left ventricular hypertrophy is present} * ^{The width pf the QRS complex with should be less than 0.12 seconds or 3 small squares. If the QRS is wider than this it suggests a ventricular conduction problem usually called a right or left bundle branch block}

Answer 68

Type I – fractures of the epiphyseal plate alone ## Footnote Type II – most common, involve the epiphyseal plate and metaphysis Type III – fracture of epiphyseal plate and the epiphysis Type IV – fracture of epiphyseal plate, epiphysis and metaphysis Type V – crush injury of the epiphyseal plate

Answer 69

* _{Immobilize proximal forearm and elbow fractures} * _{90 degree angle at elbow} * _{Can provide temporary stabilization for fx humerus while awaiting surgery} * _{Split at angle, wrap in final position, avoid excess padding at interior aspect can result in skin pressure points} * _{Limits flexion and extension of the elbow and supination and pronation of forearm} * _{Extends from wrist to proximal humerus along the posterior forearm}

Answer 70

collar bone fracture, located between your shoulder and the front of the neck, is the bone which is easily fractured by impacts to the shoulder, from the force of **falling on outstretched arms, or by a direct hit.**

Answer 71

Barium and Iodine

Answer 72

Air is normally not present in the peritoneal or extraperitoneal spaces, bowel wall, or biliary system. Air outside of the bowel

Answer 73

Most causes can be attributed to one of four main mechanisms. These include: 1. rightventricular hypertrophy 2. reduced muscle mass of leftventricle 3. altered conduction pathways 4. change in the position of the heart in the chest (COPD).

Answer 74

there is communication between the fracture and the outside (broken skin)

Answer 75

fracture produces more than two fragments

Answer 76

* Generally the T wave shouldn’t be taller than half the size of the preceding QRS. Causes of tall or peaked T-waves include: electrolyte imbalances such as hyperkalemia or acute myocardial infarction * T wave changes: If the T wave is flat it may indicate hypokalemia. If the T wave is inverted and it may indicate ischemia

Answer 77

* At the onset of pain the ECG would be normal but the ST segment would soon start to change - the T wave would begin to grow taller. * Within an hour the ST segment would be noticeably elevated, indicating the onset on myocardial necrosis. (tissue death). This is the point at which we would be aiming to administer the thrombolytic (clot-busting) drug. * If thrombolysis is administered, we would be looking for specific changes on the ECG. A 50% reduction in ST segment elevation is a good indicator of success. We would expect to see these changes within 90 minutes of administering thrombolysis. If the T wave invertion begins to show as much deeper, this is a good sign of reperfusion. (blood flow returning to the damaged area.) * 24 hours later, the ST segment may have returned to the iso-electric line. The T wave may stay inverted for days, weeks or months. **A "pathological" Q wave is not "time-specific". It may be there from a previous heart attack and therefore is not part of the criteria for evaluating an Acute Myocardial Infarction.**

Answer 78

After 10-14 days

Answer 79

fracture produces two fragments

Answer 80

twisting force or torque produces a fracture

Answer 81

* Laceration length and location, N/V distal to the injury * Laceration clean or contaminated * Anesthetic medication with local/digital Block * How the wound was cleaned * Suture size, number and layer * Skin, Dermis, Fascia * Discussion of potential for infection or impaired function

Answer 82

_{Stage 1 Pressure Injury: Non-blanchable erythema of intact skin} _{Stage 2 Pressure Injury: Partial-thickness skin loss with exposed dermis

Stage 3 Pressure Injury: Full-thickness skin loss

Stage 4 Pressure Injury: Full-thickness skin and tissue loss} _{Unstageable Pressure Injury: Full-thickness skin and tissue loss obscured by slough or eschar} _{Deep Tissue Pressure Injury: Persistent non-blanchable deep red, maroon or purple discoloration}

Answer 83

The P wave indicates atrial depolarization. The P wave occurs when the sinus node, also known as the sinoatrial node, creates an action potential that depolarizes the atria.

Answer 84

Yes - they are specialized cells of the electrical conduction system. Are sometimes called conducting cells or automatic cells. They are responsible for the spontaneous generation and conduction of electrical impulses

Answer 85

- Diabetic - Nutritional Status

Answer 86

There are normally: 7 cervical vertebrae 12 thoracic vertebrae—all of which normally bear ribs 5 lumbar vertebrae 5 fused sacral vertebrae

Answer 87

A consent form alone is not legally sufficient to protect a physician from litigation. It must be informed consent.

Answer 88

* CLIA allows the APRN to become a CLIA certified lab director for their practice so that certain tests can be ran in-house. * Provider performed microscopy must be performed on the provider’s own patient, during the office visit to the provider. * PPM cannot be delegated, waived testing can be delegated to MA, LVN etc.

Answer 89

Overall gas pattern Calcifications Masses

Answer 90

* Neurovascular compromise/Compartment syndrome * Increased swelling * Worsening pain * Discoloration * Difficulty in moving finger and toes * Change in sensation of finger or toes

Answer 91

an abscess on the edge of a nail

Answer 92

The R wave should be small in lead V1. Throughout the precordial leads (V1-V6), the R wave becomes larger — to the point that the R wave is larger than the S wave in lead V4. The S wave then becomes quite small in lead V6; this is called “normal R wave progression.” When the R wave remains small in leads V3 to V4 — that is, smaller than the S wave — the term “poor R wave progression” is used.

Answer 93

## Footnote Minor children are not typically able to consent to medical treatment. Consent must be obtained from a parent or legal guardian.

Answer 94

* _{Because pneumonia fills the involved airspaces or interstitial tissues with some form of fluid, or inflammatory exudate, pneumonias appear denser (whiter) than the surrounding, normally aerated lung.} * _{Pneumonia may contain air bronchograms if the bronchi themselves are not filled with inflammatory exudate or fluid} * _{Air bronchograms are much more likely to be visible when the pneumonia involves the central portion of the lung near the hilum. Near the periphery of the lung, the bronchi are usually too small to be visible}

Answer 95

Represents the interval between ventricular depolarization and repolarization.

Answer 96

fracture fragment is pulled from its parent bone by contraction of a tendon or ligament

Answer 97

RBBB can occur in children who had some type of cardiac surgery by cutting through the right ventricle

Answer 98

Free air PNA pleural effusions

Answer 99

The corneal abrasion exam should start with a visual acuity exam * Use topical ophthalmic anesthetic such as tetracaine or proparacaine 0.5%. Anesthesia usually lasts about an hour. * Then you need to evert both eyelids to search for foreign body. * After applying the moistened fluorescein strip, use the Wood’s lamp or blue light pen with room lights off. The abrasion will fluoresce as in the picture below. Note the position and size the irrigate then irrigate the eye with sterile normal saline.

Answer 100

_{The visibility of air in the bronchus because of surrounding airspace disease is called an air bronchogram and is a sign of airspace disease.} _{Bronchi are normally not visible because their walls are very thin, they contain air, and they are surrounded by air. When something like fluid or soft tissue replaces the air normally surrounding the bronchus, then the air inside of the bronchus becomes visible as a series of black, branching tubular structures—this is the air bronchogram}

Answer 101

* _{ST segments should sit on the isoelectric at the electrocardiogram. It is abnormal if there is planar of flat elevation or depression of the ST segment. Planar ST segment can represent myocardial infarction, or Prinzmetal’s (vasospastic) angina. Planar ST depression can represent ischemia.} * _{ST segment is elevated but slanted it may not be significant. If there are raised ST segments in most of the leads it may indicate pericarditis - especially if the ST segments are saddle shaped. There can also be PR segment depression.}

Answer 102

## Footnote occur as a result of a hyperflexion injury in which the inferior facets of one vertebral body slide over and in front of the superior facets of the body below. In this position, the slipped facets cannot return to their normal position without medical intervention; thus, the term locked. Locked facets occur with forward slippage of the affected vertebral body on the body below it by at least 50% of its AP diameter.

Answer 103

## Footnote _{Review location of dorsal digital nerve & palmar/plantar digital nerve to obtain successful block by injecting anesthetic into the web space about 1-2cm and inject 1-2ml of anesthetic while withdrawing the needle, never inject while advancing the needle (repeat on other side of digit). After the web space is infiltrated, insert the needle perpendicular to the base of the digit and insert until the needle touches bone, withdraw a few millimeters and inject 1mL of anesthetic. Digital blocks may take several minutes to take effect.}

Answer 104

As a result, most myocardial perfusion occurs duringheart relaxation (diastole) when the subendocardialcoronary vessels are open and under lower pressure. Flow never comes to zero in the right coronary artery, since the right ventricular pressure is less than the diastolic blood pressure.

Answer 105

an abnormally rapid heart rhythm having an electropathologic substrate emerging above the bundle of His (atrioventricular bundle), thus causing the heart to escalate to rates higher than 100 beats per minute.

Answer 106

Jones fracture Lisfranc fracture Shepherd fracture

Answer 107

Hill-Sachs fracture

Answer 108

also sometimes known as a reverse Colles' **fracture** or Goyrand-**Smith's**, is a **fracture** of the distal radius. It is caused by a direct blow to the dorsal forearm or falling onto **flexed wrists**

Answer 109

1. yeast 2. trichomonas 3. clue cells

Answer 110

Gas in the rectosigmoid colon

Answer 111

* _{P waves represent atrial depolarization; right atrial depolarization occurs first. Height of a P was over 2.5 mm should arouse suspicion. The length of the P-wave longer than .08 seconds or two small squares should be investigated} * _{A tall P-wave over 2.5 mm can be caused by right atrial hypertrophy. Causes a right atrial hypertrophy include attention pulmonary stenosis or tricuspid stenosis} * _{A P-wave was only greater than .08 seconds and a double are bifid shape P-wave is called left atrial hypertrophy and delayed left atrial depolarization, causes include mitral valve disease}

Answer 112

* Stabilize severe sprains, immobilize fx of ankle, dislocation, distal leg, and foot * Extends from metatarsal heads to just below fibular head * Fibular head free * Non-weight bearing * Patient needs to use crutches to walk safely

Answer 113

It is important to teach how to avoid ingrown toenails (square the nails when trimming, clean under nails regularly, and avoid tight shoes). Ø In the initial occurrence, remove only the affecting corner of the nail. Ø Refer to podiatrist for reoccurring problems. Ø Digital block with Marcaine is preferable but can be very painful when first administered.

Answer 114

* _{Inform and consent} * _{If tumor suspected x-ray prior} * _{Identify entry point and mark} * _{Prep area with alcohol or iodine} * _{Draw up proper amount of steroid and anesthetic in single syringe (Larger amount of lidocaine may be beneficial) Mix well} * _{Aspirate first then 2 options to inject} * _{Pull needle out and start with new needle and new syringe} * _{Untwist syringe from needle and replace with lidocaine/steroid syringe} * _{Injections may be two or three slightly different areas to help with pain}

Answer 115

* _{To minimize the risk for vasovagal reaction, do not draw up medication in front of the patient. Also, only administer local anesthesia when the patient is in the supine position.} * _{The local injection may be intradermal (creating a wheal) or subcutaneous (deep to the skin), depending on the intended procedure. While subcutaneous injections cause less discomfort, and should be preferred, they also require longer for the anesthetic to take effect. Advance the needle to the desired location and draw back on the plunger before injecting to avoid systemic effects associated with injecting directly into a vessel. If there is blood return on aspiration, reposition the needle, aspirate again, and inject if there was no blood return during aspiration.} * _{Attempt to minimize the number of punctures by redirecting the needle along a different path before entirely withdrawing it. When injecting for laceration repair, inject from the wound edge and advance the needle only in the subdermal layer. This avoids the need for skin puncture. Spread of infection from the wound margin has not been demonstrated clinically with this technique.}

Answer 116

fracture line is perpendicular to the long axis of the bone

Answer 117

Women – they are typically secondary to osteoporosis

Answer 118

_Lidocaine _{Use in contaminated wounds. Fingers, toes, penis, toes or earlobes} _{Comes in concentration of 0.5-2%, fast onset, lasts 30-120 minutes, max dose 300mg} _{Lidocaine with epinephrine} _{Use in highly vascular areas to improve visualization of field, use in clean wounds. Do NOT use on digits, nose, penis or earlobes due to ischemia risk.} _{Fast onset, lasts 60-400 minutes, 500mg max dose} _Bupivacaine _{Use for longer duration & for nerve blocks} _{0.25%, slow onset, lasts 120-240 minutes, 175mg max dose} _{Bupivacaine with Epinephrine} _{Avoid in digits due to} _{Slow onset, lasts 240-480 minutes, 225mg max dose}

Answer 119

Localized infection that is tender and not resolving with S/S of pain, swelling, redness, loss of function and fever.

Answer 120

* _{Evaluation of unexplained dyspnea} * _{Evaluation of chronic cough} * _{Evaluation of unexplained hypoxia} * _{Evaluation of unexplained hypercapnea} * _{Evaluation of polycythemia} * _{Evaluation of abnormal chest x-ray} * _{To assess pulmonary reserve in patients with neuromuscular disorder} * _{Preoperative pulmonary evaluation} * _{To follow-up patients with chronic lung disease}

Answer 121

* a condition in which there is an extra electrical pathway in the heart. The condition can lead to periods of rapid heart rate (tachycardia). * WPW syndrome is one of the most common causes of fast heart rate problems in infants and children.

Answer 122

Yes. There is almost always air in the stomach, unless: 1. The patient has recently vomited, or 2. There is a nasogastric tube in the stomach, and the tube is attached to a suction device.

Answer 123

_{The PA (posterioranterior) film is obtained with the patient facing the cassette and the x-ray tube 6 feet away. This distance diminishes the effect of beam divergence and magnification of structures closer to the x-ray tube.} _{On the AP film of the chest, a heart shadow is magnified because it is an anterior structure. The pulmonary vasculature is also altered when patients are examined in the supine position. On the AP supine film there is more equalization of the pulmonary vasculature when the size of the lower lobe vessels are compared to the upper.}

Answer 124

_{Bosworth fracture} _{Cotton fracture} _{Dupuytren fracture} _{Gosselin fracture} _{Lauge-Hansen classification} _{Le Fort ankle fractures} _{Maisonneuve fracture} _{Pott fracture} _{Tillaux fracture} _{Weber classification}

Answer 125

Common causes of LAD include: left anterior fascicular block (or hemiblock) and inferior myocardial infarction. Less commonly LAD may be a normal variant, particularly in obese or stocky individuals, or it may be associated with Wolff–Parkinson–White syndrome or an ostium primum atrial septal defect.

Answer 126

CT is the diagnostic modality of choice for most abdominal abnormalities including trauma.

Answer 127

* both to fuel their growth and make up for greater heat loss to the environment. * Little hearts maintain a higher metabolic rate, pound for pound, than big hearts.

Answer 128

* Fractures * Dislocations * Sprains

Answer 129

* _{^{Q-tips and hearing aids make cerumen impaction one of the most common otologic problems in the US}} * _{^{Risk of injury is very high, so you must be very careful.}} * _{^{Indication for removal include decreased hearing, tinnitus, vertigo, ear pain, or need to test hearing.}} * _{^{Contraindication in uncooperative patient (due to risk for injury), acute otitis media, known or suspected tympanic membrane perforation or distorted ear canal.}} * _{^{Irrigation is the safest method}} * _{^{Use body-temperature water (tap water) to decrease the stimulation of the vestibular reflex which can cause nystagmus and nausea.}} * _{^{Direct the water superiorly toward the occiput to flush the wax out of the canal while having patient hold ear basin under ear.}} * _{^{If pieces of wax are not coming out after several minutes of flushing, terminate the procedure and send patient home with instructions to use wax softener for several days before returning.}} * _{^{After successful removal of wax, inspect the canal with the otoscope. Dry canal with gauze when procedure is completed.}}

Answer 130

* Occur as the result of numerous microfractures * Many times the fracture may not be diagnosable until after periosteal new bone formation occurs or there is an appearance of a thin dense zone of sclerosis across the medullary cavity * Common locations of stress fractures are the shafts of long bones such as the proximal femur, proximal tibia and the 2^nd and 3^rd metatarsals

Answer 131

“green stick fracture” - because the fracture will look similar to what happens if you try and break a ‘green’ branch on a tree.

Answer 132

Gadolinium

Answer 133

Look like long branches on the scope **Tx: Oral (Fluconazole) or topical anti-fungals**

Answer 134

* _{From the level of C3 through the level of L5, the vertebral bodies are more or less rectangular in shape and of about equal height posteriorly as anteriorly.} * _{The end plates of contiguous vertebral bodies are roughly parallel to each other.} * _{The articular facets of the superior and inferior articular processes are lined with cartilage, and these facet joints are true synovial joints.} * _{In the frontal projection, each vertebral body displays two ovoid pedicles visible on each side of the vertebral body. The pedicles of L5 are frequently difficult to visualize, even in normal individuals, because of the lordosis of the lumbar spine}

Answer 135

an abscess on the tuft of a distal finger

Answer 136

MRI the costliest of all imaging modalities is used for problem solving for difficult diagnosis, extension of known disease into soft tissues and vascular anatomy.

Answer 137

_{bilateral, lateral offset of the lateral masses of C1 relative to C2 as seen on the open mouth view (atlantoaxial view) of the cervical spine.} _{The fracture is confirmed utilizing CT.} _{It is a “self-decompressing” fracture in that the spinal canal at the level of the fracture is wide enough to accommodate any swelling of the cord. There is usually no neurologic deficit associated with this type of fracture.} * _{this most frequently occurs when a person dives into shallow water, the head strikes an obstacle (or the bottom of the pool), and the force is transmitted to the cervical spine} * _{It may also occur from motor vehicle accidents in which the head is thrown forcefully against the windshield, frequently producing both hyperextension and compression} * _{Another mechanism is falling onto the head from a height}

Answer 138

* Examine injury extremity * Assess pulses, motor function and sensory function * Treat skin or soft tissue injuries first * May need meds * Place patient in comfortable position * Remove all jewelry

Answer 139

Feed on cervix and leave little strawberry marks on cervix. Very active on the slide but will be still when “full” or if they are cold. **Tx: Metronidazole**

Answer 140

Dextrogastria

Answer 141

* High velocity injury * Inflammation greater than 24 hours * Hyphema (collection of blood in anterior chamber of the eye) or other indications that damage to the globe has occurred. * Any chemical exposure * Uncooperative patient

Answer 142

* Stirrup adds strength and helps prevent inversion or eversion of the ankle * Greater mobilization for ankle fractures * Apply to medial and lateral leg extending from the tibial tuberosity and end just below fibular head

Answer 143

Dry nasal mucosa, nose picking

Answer 144

* Splinting and immobilization of the injured are to reduce pain and the risk of further damage to adjacent soft tissues * Decreases pain and bleeding * Allows injury to heal

Answer 145

Restrictive

Answer 146

This wave is much larger than the P wave, and it represents the depolarization of the ventricles. Represents ventricular systole.

Answer 147

* _{Do not irrigate the ear if expandable foreign objects are present such as seeds, beans, rice, or other organic materials} * _{If the object is close to the ear drum, refer to ENT for removal.} _{Do not attempt to remove PET tubes.} * _{Irrigation is the most common method used for ear foreign bodies in the ear.} * _{In a cooperative patient, acrylic glue or skin glue on the tip of a cotton swab can be used to adhere to objects then remove. Be careful not to push the object farther in the ear canal when using this method.} * _{Insects in the ear should first be drowned using lidocaine or benzocaine solution to relieve the patient of the painful and disturbing movements and noise. Then the provider can use alligator forceps or irrigation to remove the insect.}

Answer 148

* You should make a 1 cm incision even for large abscesses. Remember to make the incision along skin lines * Express pus then probe for loculations. Packing of an abscess with iodoform gauze is painful and not shown to increase healing. * A culture should be obtained from the abscess cavity.

Answer 149

They have particular importance because of the implications for associated spinal cord injury. The most commonly fractured vertebrae are L1, L2, and T12, accounting for more than half of all thoracolumbar spine fractures. In the thoracic spine, compression fractures are the most common type of spinal fracture.

Answer 150

good choice for complete removal of small lesions (\<5 mm) or whenever there is doubt as to the diagnosis or optimal treatment for a particular lesion.

Answer 151

## Footnote Stimulating the **vagus** nerve, sometimes results in **slowed** conduction of electrical impulses through the atrioventricular (AV) node of the **heart**.

Answer 152

(stye or sometimes called star) - an abscess of the eyelid.

Answer 153

To primarily screen for abdominal pain, a conventional abdominal film is used. To further screen for potential gallbladder and biliary tree disease, aortic aneurysm, vascular abnormalities and fluid, ultrasound is the next choice.

Answer 154

Transmission from SA node stimulates AV node to generate fresh impulse for ventricles. Therefore, AV node is also called pacesetter. Sinoatrial node is located insuperior lateral wall opening of superior vena cava. ... SA node transmits impulse directly to the two atria.