Final Exam Shit! Flashcards
1
Q
OPIM
A
other potentially infectious materials
-treat all human blood and OPIM as if known to be infectious with bloodborne disease
2
Q
when do needlesticks occur?
A
40% during use
40% after use
15% during disposal
5% recapping
break in skin from needle or other sharp**
3
Q
2 common problems in patients when doing needlestick?
A
fainting
allergic reaction
4
Q
major contraindications for injection?
A
hypersensitivity
inflamed/irritated skin
pregnant/breastfeeding
stopper latex - patient allergic
5
Q
intradermal injection?
A
10-15 degrees
small syringe and small gauge needle
-creates a wheal**
for diagnostic and local anesthetics
6
Q
subQ injection?
A
45-90 (45 degrees preferred)
slow-sustained absorption
abdomen, upper arm, anterior thigh, glutes
variety of needle and syringe sizes
7
Q
intramuscular injection
A
90 degree angle
rapid, systemic action of lage dose of medication
vaccine injection
syringe and needle size vary greatly
8
Q
injection site for IM injection?
A
deltoid gluteus medius vastus lateralis rectus femoris gluteus maximus
9
Q
size of needle?
A
anesthesia 30 gauge
injection 22-25 gauge
aspiration 18-20 gauge
10
Q
lidocaine versus bupivicaine?
A
lidocaine is short duration
bupivicaine is log duration (nerve block)
11
Q
epinephrine?
A
can be mixed with lido or bupiv for vasoconstriction
12
Q
post injection care?
A
dressing 8-12 hours
ice (15 minutes 1-2x per hour)
NSAIDs first 24-48 hours
13
Q
shoulder injection?
A
glenohumeral
acromioclavicular
14
Q
hand injection?
A
carpal tunnel
first carpometacarpal joint
trigger finger
de Quervains tenosynovitis
15
Q
finkelstein test
A
dequervains tenosynovitis
16
Q
elbow injection?
A
olecranon bursitis
epicondylitis
humerus, radius, ulna triangle
17
Q
trigger point injections?
A
3x
local anesthetic
advance until reach tenderpoint
18
Q
basis of most radiologic dyes?
A
iodine (shellfish allergy as well)
19
Q
fixed drug reaction?
A
allergic reaction that happens with drug
always occurs in the same location
20
Q
mcmurrays test
A
meniscus
21
Q
drawer sign
A
ACL PCL
22
Q
medial and lateral instability
A
medial/lateral collateral
23
Q
sarcoma
A
cancer of connective tissue
24
Q
ratio of BUN/Creatinine?
A
should be 10-20
25
liver function tests
bilirubin
albumin
prothrombin time
26
alkaline phosphatase level?
elevated for lots of problems
27
alkaline phosphatase
```
liver
bone
intestine
placenta
tumor
```
gotta fractionate it**
- will tell where it comes from
- majority bone and liver
28
sedimentation rate
indicates inflammatory process
-never diagnostic**
autoimmune
infection
neoplasm
29
osteosarcoma
malignant mesenchymal tumor
most common malignant tumor of bone
20% of all bone cancers
often in younger patients
association with retinoblastoma
30
anterior neck triangle?
superior - mandible
medial - midline of neck
lateral - sternocleidomastoid
31
posterior neck triangle?
inferior - clavicle
posterior - trapezius
anterior - sternocleidomastoid
32
throat cartilage?
thyroid - on top
| cricoid - below thyroid
33
cervical lymph drainage
most to deep system
- deep to sternocleidomastoid
- not palpable
34
virchows node
supraclavicular of deep chain
| sometimes palpable
35
thyroglossal duct cyst
of thyroglossal duct does not close before birth
| -may form cyst
36
spurlings maneuver?
cervical compression test
- sidebending and compression to affected side
- radicular symptoms
37
maximum cervical compression test?
extension and rotation to same side as head is bent in spurlings
38
distraction test?
elevate head
| -alleviate radicular symptoms
39
thoracic outlet syndrome
compression of vessels and nerves around clavicle
40
roos test
arms out abducted to 90 and flexed elbows
patient opens closes hands for 3 minutes
numbness or weakness - thoracic outlet syndrome
41
adsons test
palpate radial pulse with elbow and shoulder in extension
move arm into abduction and external rotation and have patient turn head AWAY from tested side
pulse diminished - thoracic outlet syndrome
42
rotator cuff muscles?
supraspinatus
infraspinatus
teres minor
subscapularis
43
apley scratch test
scratch back with both arms
upper - external rotation and abduction
lower - internal rotation and adduction
44
strength test scale?
0 no active movement
1 muscle contraction, no movement
2 full active ROM with no gravity
3 full active ROM against gravity
4 full active ROM against partial resistance
5 full active ROM against full resistance
45
supraspinatus test?
abducts against resistance
46
subscapularis test?
internal rotation against resistance
47
infraspinatus/teres minor test?
external rotation against resistance
48
thoracohumeral group test?
adducts forearm against resistance
49
empty can test?
indicates injury to supraspinatus
50
lift off test
subscapularis injury
patient hand behind back
-lifts hand off back
51
crossover test
compresses AC joint
adduct arm across chest
52
drop arm test
patient slowly abducts arm from 90 degrees
indicates rotator cuff problem
53
apprehension test
arm abducted and externally rotated
-pressure gently forward
pain indicates loose joint capsule
54
obriens test
flex arm and adduct across chest
internally rotate with thumb pointing down and push down on arm
pain positive for labral tear
SLAP - superior labrum anterior to posterior
55
speeds test
test biceps tendon
patient resists flexion of arm
56
hawkins impingement sign
grasp patients elbow and distal forearm
passive external rotation - subscapularis
passive internal rotation - supraspinatus, teres minor, infraspinatus
57
nursemaids elbow
radial head dislocation
58
cubital tunnel syndrome
ulnar nerve compression behind medial epicondyle
59
tennis elbow
lateral epicondylitis
| extensor tendonitis
60
golfers elbow
medial epicondylitis
| flexor tendonitis
61
varus test
lateral ligaments of elbow
62
valgus test
medial ligaments of elbow
63
heberdens node
distal interphalangeal
64
bouchards nodes
proximal interphalangeal
65
boutonnieres deformity
rheumatoid arthritis
66
tinels sign
tap over median nerve
carpal tunnel syndrome
-not specific, good for any compression neuropathy
67
phalens maneuver
flex wrists against one another
68
colles fracture?
distal radius fracture with fragment displaced dorsally
69
boxers fracture
distal 5th metacarpal
70
scaphoid fracture
snuffbox tenderness
poor blood supply**
71
dupuytrens contracture
4th and 5th digit palmar fascia thickening
72
trigger finger
inflammation of flexor digitorum tendon sheath
73
grind test
carpo-metacarpal osteoarthritis
rotate metacarpal and rotate back and forth
74
finkelsteins test
hold thumb - ulnar deviate wrist
positive - dequerveins disease
75
popliteal artery
posterior to knee
76
posterior tibial artery
posterior to medial malleolus
77
pulse ratings?
0 can't palpate
1 diminished
2 normal briskness (expected)
3 bounding
78
auscultation of artery?
with bell
79
ankle brachial index
less than 0.9 = abnormal
-peripheral arterial disease
comparison of systolic pressures of each
80
allen test
patient opens and closes hand and fist several times
pressure over radial and ulnar arteries
release - should return color to hand (pink)
81
postural color change test
chronic PAD
elevated extremity for 1 minute
-if becomes pale, lower to observe return of color
82
acute arterial occlusion
embolus - often thromboembolus
| sudden extreme pain
83
PAD
chronic inadequate aterial flow
muscle fatigue, weakness, cold feet
ankle-brachial index less than 0.9
84
venous valve competency test
patient supine, raise one leg to 90 degrees
-occlude great saphenous vein and lower leg
watch for slow filling with pressure
- release pressure
- if rapid distension, indicates rapid filling and incompetent valves
85
homans sign
flex knee and dorsiflex foot
| -pain indicates thromboemboli
86
saphenous vein
great - medial
| small - posterior
87
virchows triad
stasis
hypercoagubility
endothelial injury
results in DVT
88
thrombophlebitis
DVT in smaller leg vein
89
varicose vein
incompetent veins
90
mapping varicose veins
finger on vein
| -tap, should feel pressure wave
91
chronic venous insufficiency
because of damaged valves
92
lymphedema?
non-pitting**
93
malignant lymphadenopathy
```
greater than 1cm
non tender
rock hard
fixed
difficult to palpate
```
94
lymphangitis?
infection of lymphatics
95
pitting vs. non-pitting edema
pitting - fluid overload/cardiac problem
| non-pitting - lymph problem
96
grading edema?
1 - 2mm pit resolves quickly
2 - 4mm pit resolves less than 1 minute
3 - 6mm pit lasts 1-2 minutes
4 - 8mm pit 2-5 minutes
97
erythema nodosum
inflammation of skin of shins
gradual onset**
immune reaction/ systemic infection
98
cellulitis
inflammation of skin / subQ tissue
almost always bacterial infection
acute onset**
99
paroxysmal
episodic
100
claudication
pain in skeletal muscle
101
angina
pain in heart (cardiac myo)
102
heave
heart enlarged
103
thrill
murmur
104
mitral regurgitation
systolic murmur
105
mitral stenosis
diastolic murmur
106
holosystolic murmur?
through entire systole
107
mitral valve prolapse?
only portion of systolic murmur
108
MCV
cell size - higher is macrocytic
anemia
109
MCH
cell concentration
110
macrocytic anemia
secondary to alcoholism
111
beta hydroxybutyrate
ketone measure
112
diabetic ketoacidosis
high glucose
high ketone
acidic pH
113
DKA compensation?
respiratory - blow off CO2
114
anion gap
measures where acidosis comes from
DKA is increased gap
115
pre-renal?
greater than 20 BUN/Cr ration
116
where sodium goes?
water goes
117
liver function?
PT
bilirubin
albumin
118
liver inflammation
ALT
| AST
119
hypothyroid
high TSH
| low T4
120
BNP
b-type natriuretic peptide
-hormone secreted by myocytes due to pressure and stretch
LV dysfunction sensitive marker
-not Dx specific
121
cardiomegaly
greater than 2:1 ratio heart:lung size
122
types of cardiomyopathy?
dilated (alcoholics)
| hypertrophic
123
heart failure
decreased contractility
(starling curve analysis)
-lower slope
124
embolic stroke
embolus from atrium goes to brain
125
calcium channel blocker
decreased contractility
126
patient centered interviewing
from patients perspective
127
pitfalls of patient centered interview?
time constraint
| low access to bio information
128
nondirective dimension (patient centered)
1-2 minutes at beginning
| asks how are things - 30 second pause
129
directive dimension (patient centered)
increased participation by physician
as little as 3-4 minutes
directing conversation to primary concern of patient
130
directive dimension
develop personal story
131
transition phase
patient had opportunity to share
| patient IS AWARE that physician understands
132
physician-centered interviewing
open end medical questions
directive and nondirective
133
AV valves
tricuspid and mitral
134
semilunar valves
aortic and pulmonic
135
S1
closure of mitral and tricuspid
louder at apex
136
S2
aortic and pulmonic
louder at base
can be heard splitting
137
S2 splitting?
A2 before P2
138
S3
ventricular gallop
139
S4
atrial gallop
140
grading murmurs
1 very faint
2 quiet, immediately heard with stethoscope on chest
3 moderately
4 loud with palpable thrill
5 very loud with thrill may be heard with stethoscope partially off chest
6 very loud with thrill, heary with stethoscope entirely off chest
141
position to feel PMI?
left lateral decubitus
142
JVP
jugular venous pressure
-for right heart pressures
greater than 9cm above RA is abnormal
143
A wave
RA contraction
144
X descent
RA relaxation
145
V wave
RA filling
146
Y descent
RA emptying
147
hepatojugular reflex
should see distension 2-3 seconds
extended time is abnormal
148
diaphragm
high pitched S1 and S2
149
bell
low pitched S3 and S4
150
innocent murmur
venous hum
| stills (musical)
151
border of lung
MCL - 6th rib
midaxillary - 8th rib
posterior - 10th rib
152
horizontal fissure
in right lung only
153
fremitus
vibrations through to chest wall when patient speaks (normal)
154
dull sound
liver
155
resnonant sound
lung
156
flat sound
thigh
157
tympanic sound
gastric bubble or puffed cheeks
158
diaphragmatic excursion
normal 5-6cm
159
vesicular breath sounds
inspiration
| low pitch
160
bronchovesicular breath sounds
inspiration and expiration
| intermediate pitch
161
bronchial breath sounds
expiration
| high pitched
162
tracheal breath sounds
inspiration and expiration
| high pitched
163
sibilant rhonchi
wheeze
| high pitched
164
sonorous rhonchi
rhonchi
| low pitched
165
stridor
almost entirely inspiration
| louder in neck than chest wall
166
crackles/rales
discontinuous
| intermittent and nonmusical
167
bronchophony
say 99
168
egophony
say ee
169
whispered pectoriloquy
whisper 99
170
stance
60% walk cycle
171
swing
40% walk cycle
172
L4
iliac crest
173
reinforcement
engaging bilateral muscle groups in a region above spinal level of reflex being tested
174
L4 dermatome
lateral ankle to large toe
175
L5 dermatome
mid top of foot and plantar foot
176
S1 dermatome
lateral foot
177
T12-L2
colon and rectum
bladder
uterus
prostate
178
T10-T11
small intestine
| ovaries/testies
179
most common injury lumbar spine
L5-S1
180
reiters syndrome
uveitis
sacroilitis
urethritis
181
sciatic nerve
L4-S3
182
straight leg raise
sciatica
183
order of things under inguinal ligament?
```
NAVEL
nerve
artery
vein
empty
lymph node
```
184
trendelenburg test?
gluteus medius
| -keeps hip stable during gait
185
ober test
IT band
| abduct leg and let it down
186
thomas test
psoas flexion contractures
| flex at hip and knee (like a high knee)
187
fabere test?
aka patric test
hip joint
make a 4 with your legs and push down on knee
188
leg length
ASIS to medial malleolus
189
psoas test
seated, raise knee, resist down pressure
190
piriformis test
palpation
191
bulge sign
minor effusion
192
balloon sign
large effusion
193
balloting
large effusion
194
housemaids knee
prepatellar bursitis - anterior
195
anserine bursitis
medial
196
bakers cyst
posterior
197
apprehension test
patella
198
anterior drawer test
ACL
199
lachman test
only ACL
200
posterior drawer test
PCL
201
mcmurray test
meniscus
| patient supine
202
apley compression test
meniscus
| patient prone
203
thessaly test
dancing meniscus
204
thompson test
squeeze calf - plantar flex foot
positive - achilles rupture
205
talar tilt test
calcaneofibular ligaments
| ATF torn
206
ottowa rule
inability to bear wight after 4 steps or tenderness over posterior aspect of either malleolus
FRACTURE
207
kleiger test
high ankle sprain
208
anterior drawer test
anterior talofibular ligament
209
pes planus
flat foot
210
hallux valgus
abduction of great toe (bunion)
211
tinnitus
ringing ears
212
epistaxis
nose bleed
213
conjuctiva
protective membrane covering all anterior globe
214
ptosis
lid partially or fully closed
215
nystagmus
involuntary rapid, rhythmic movement of eye in any direction
216
strabismus
misalignment of eyes relative to eachother
217
bones of ear
malleus incus stapes
can see malleus**
kind of incus
218
nonmobile tympanic membrane
fluid, mass, sclerosis
219
hypermobile tympanic membrane
ossicle bone disruption
220
weber test
lateralization of sound
221
rinne test
air vs. bone conductance
222
PORT score
pneumonia severity index
-over 50 - yes
-neoplastic, CHF, cerebrovascular, renal disease, liver disease -yes
mental status, pulse >125, RR > 30, systolic < 90, temp 40 - yes
no? risk class rank
223
risk class ranks?
```
1 - based on algorithm
2 - less than 70
3 - 71-90
4 - 91-130
5 - greater than 130
```
224
PPV
pneumococcal polysaccharide vaccination
225
streptococcus pneumoniae
gram positive diplococcus
226
antibiotics to use?
cefotaxime
ceftriaxone
respiratory fluoroquinolone
