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MS1 Fall > ICM 1 - Exam 2 > Flashcards

ICM 1 - Exam 2 Flashcards

1
Q

Borborygmi

A

Hyperactive bowel sounds. Near continuous, very high-pitched tinkles (diarrhea) or rushes (early bowel obstruction)

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2
Q

Normal bowel sounds

A

Clicks and gurgles every 2 - 12 seconds

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3
Q

Normal abdominal aorta width?

A

2-2.5 cm

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4
Q

Signs of peritonitis?

A
  1. Rebound tenderness: sudden release of deeply palpating hand results in signs of pain like grimace or grasping of abdomen
  2. Rigidity/involuntary guarding: uncontrollable markedly increased abdominal wall muscular tone
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5
Q

What positive test result will indicate ascites?

A

Shifting dullness. Percuss with the patient in supine and side positions to determine if there is shifting dullness in the abdomen

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6
Q

Positive signs suggesting appendicitis?

A
  1. McBurney’s Point
  2. Psoas sign
  3. Obturator sign
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7
Q

McBurney’s Point

A

involuntary guarding and rebound tenderness just below the middle of a line joining the umbilicus and the anterior superior iliac spine

positive result indicates appendicitis

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8
Q

Psoas sign

A

Patient flexes his or her hip and pushes their thigh against the examiner’s hand. Pain indicates a positive sign for appendicitis

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9
Q

Obturator sign

A

Flex the patient’s hip and rotate the thigh internally. Pain indicates a positive sign for appendicitis

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10
Q

Murphy’s sign

A

Test for acute cholecystitis

On exhale place hand below the costal margin and at the mid-clavicular line on the right side. Upon inspiration see if patient winces or stops breathing in, indicating a positive test result

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11
Q

Visceral pain

A

gnawing, cramping or aching and is often difficult to localize

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12
Q

Parietal pain

A

Inflammation from the parietal peritoneum. More severe than visceral and easily localized (i.e. appendicitis)

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13
Q

Referred pain

A

Originates at different sites but shares innervation from the same spinal level (i.e. gallbladder -> shoulder; pancreas -> back)

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14
Q

Three superior openings into the abdominal cavity

A

IVC, Esophagus, Aorta

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15
Q

Four types of abdominal Xrays

A
  1. Supine view
  2. Upright and supine view - allows evaluation of free air and air fluid levels in bowel
  3. Acute abdominal series (includes CXR/PA chest view)
  4. Decubitus view - allows evaluation of air and air fluid levels if patient is unable to stand
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16
Q

What is the initial imaging modality used for abdominal pain, nausea, vomiting, etc?

A

Xray

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17
Q

What is often the most important feature of abdominal xrays?

A

The bowel gas pattern. Is it normal, ileus (dilated/not moving right), or obstructed?

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18
Q

Plicae circularis

A

Vavulae conniventes or circular folds seen in the small bowel; they cross the entire diameter of small bowel loop

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19
Q

Haustra

A

Folds seen in large bowl; do not cross entire diameter of the bowel

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20
Q

Outside of xrays, what other imaging modalities are used on the GI tract?

A

Contrast studies (fluoroscopy), CT, MRI, ultrasound

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21
Q

Rehab swallow

A

Used typically in stroke patients to see how the patient is swallowing/what kind of diet they can tolerate

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22
Q

Contrasts used?

A

Barium sulfate or iodine-based. Can be given orally, rectally or through a tube

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23
Q

What are we not able to typically view with an endoscope?

A

Jejunum and ileum

Alternatives: capsule endoscope, small bowel follow through (timed looks), enterography (CT, MRI)

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24
Q

What can you view with an endoscope?

A

Esophagus, stomach, and duodenum

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25
Q

Single Contrast Barium Enema (SCBE)

A

Used predominately to look for leaks or at anatomy

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26
Q

Air Contrast Barium Enema (ACBE)

A

Contrast studies performed using fluoroscopy. Allow for the assessment of contour and position. Superior for detecting small lumen abnormalities

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27
Q

Common indications for abdominal CT?

A

Suspected appendicitis, diverticulitis, small bowel obstruction, inflammatory bowel disease, colitis

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28
Q

CT colonoscopy

A

Substitute for colonoscopy as screen for polyps and cancer. Rapid examination using air

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29
Q

When would you use ultrasound to view the abdomen?

A

Viewing the appendix. Otherwise gas will obscure structures

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30
Q

What modality is best for evaluation of rectal cancer?

A

MR defacography

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31
Q

What modality is best for evaluation of Crohn’s disease?

A

MR enterography

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32
Q

What kind of imaging is frequently used in pregnant women?

A

Ultrasound and MRI because CT has high levels of radiation that may affect the fetus

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33
Q

What imaging modality is commonly used to evaluate solid organs?

A

CT

MRI is also commonly used but due to time constraints is not used first

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34
Q

Uses of MRI in abdominal imaging?

A

Mass evaluation, esp. of liver, kidneys and adrenal glands, ductal evaluation of biliary tree and pancreas

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35
Q

Uses of CT in abdominal imaging?

A

Renal stone evaluation, pancreatitis evaluation, trauma evaluation, gastrointestinal bleed, etc

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36
Q

What imaging modality is commonly used to evaluate the hepatobiliary system, kidneys, and blood vessels?

A

Ultrasound

Not as good for adrenal glands or pancreas

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37
Q

First imaging modality often used to screen in patients with elevated liver function tests?

A

Ultrasound. CT and MRI used with multiple phases and contrast after to evaluate US findings

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38
Q

Blood inflow to liver? Blood outflow?

A

Inflow: hepatic artery & portal vein

Outflow: hepatic veins

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39
Q

Imaging modality of choice for gallbladder and bile ducts?

A

Ultrasound

Can also use CT, MRI, MRCP and ERCP

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40
Q

Endoscopic Retrograde Cholangio-Pancreaticogram (ERCP)

A

used to inject fluoroscopy into biliary system

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41
Q

MRI Cholangio-Pancreatogram (MRCP)

A

Utilizes fluid-sensitive sequences to create an image. Slow moving fluid becomes white

We get the same image from ERCP without having to stick a scope down someone’s throat. Usually done before an ERCP so DRs have an idea of what’s going on

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42
Q

Best imaging modality for the pancreas?

A

CT or MRI

Hard to see on US because of bowel gas

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43
Q

Retroperitoneal organs?

A

Duodenum, pancreas, kidneys

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44
Q

Best imaging modality for spleen?

A

All three depending on clinical concern

Splenomegaly - US
Injury from trauma - CT
Splenic mass - CT or MRI

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45
Q

Best imaging modality for adrenal glands?

A

CT or MRI. Not well seen with US

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46
Q

Best imaging modality for kidneys?

A

All three depending on clinical concern

Acute kidney injury or Hydronephrosis - US
Flank Pain, Stone or Hematuria - CT
Renal mass - MRI

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47
Q

Urography

A

IVP = Intravenous Pyleogram

Iodine contrast excreted by kidneys in 5-10 minutes. Allows evaluation of collecting systems, ureters, and bladder

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48
Q

Phases of evaluation in CT IVP?

A

Arterial Phase (cortex white) - 30 sec

Venous phase - 70 sec

Delayed/pyelogram phase - 7 mins (looking for filling defects here)

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49
Q

Mood

A

sustained emotional state; in the patient’s own words

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50
Q

Affect

A

observed from emotional responses

ex: full, constricted, blunted, flat, labile

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51
Q

Suicide risk: “SAD PERSONS”

A

Sex - male
Age > 60
Depression

Previous attempt
Ethanol/drug use
Rational thinking loss
Suicide in family
Organized plan/access
No support
Sickness
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52
Q

What is a non-modifiable risk factor?

A

You are always going to have these risk factors, cannot change

Ex: Being white and male

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53
Q

Examples of modifiable risk factors?

A

Psychiatric disorder, co-morbid medical disorder, low self esteem, hopelessness, low self esteem, lack of social acceptance, firearms, access to pills, lack of support

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54
Q

What is the best predictor of future suicide attempts?

A

Past suicide attempts

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55
Q

SBIRT?

A

Screening, Brief Introduction, and Referral to Treatment

Used for substance use. Target high-risk drinkers and probable alcohol dependence

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56
Q

What are substance-related disorders?

A

Intoxication, withdrawal, substance/medication-induced mental disorders

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57
Q

Substance use disorder

A

Problematic pattern of substance use leading to clinically-significant impairment or distress

Diagnosis based on DSM-5 criteria; must name the substance (e.g. alcohol, cannabis)

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58
Q

What two substance use criteria are not considered to be met for Rx drugs taken exclusively under appropriate medical supervision?

A

Tolerance and withdrawal

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59
Q

Early remission

A

No symptoms (except craving) present for 3-12 months

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60
Q

Sustained remission

A

No symptoms (except craving) present for more than 12 months

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61
Q

Gambling disorder

A

Persistent and recurrent problematic gambling behavior leading to clinically significant impairment or distress

The gambling behavior is not better explained by a manic episode

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62
Q

Addiction

A

moderate/severe substance use disorder (4+ criteria met)

NOT just a physiological dependence

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63
Q

Four C’s of Addiction

A

Compulsive use, inability to control, continued use despite consequences, craving

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64
Q

Are dopamine D2 receptors lower or higher in addicts?

A

Lower in virtually all drugs of abuse

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65
Q

Relationship between perceived risk of taking drug and drug usage?

A

Inverse

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66
Q

Naloxone (narcan)

A

Reverses opioid overdose if administered in a timely manner

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67
Q

Addiction is a treatable ________ _______

A

brain disease

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68
Q

disruptive behavior

A

no accepted standard definition; creates a hostile work environment and negatively impacts patient safety

abusive conduct, including sexual or other forms of harassment; behaviors that undermine a culture of safety

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69
Q

spectrum of disruptive behavior

A

aggressive, passive-aggressive, passive

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70
Q

What does most bone imaging begin with?

A

plain film xray

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71
Q

Reasons for CT imaging (MSK related)?

A

Evaluation of complex fractures, fractures at joint, pathologic fracture, unclear finding on xray

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72
Q

Reasons for MRI (MSK related)?

A

Evaluation of tendon, muscle or ligament injury, tumor evaluation

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73
Q

Lytic tumor

A

Destroys bone

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74
Q

Sclerotic tumor

A

lays down bone

75
Q

Three joints that articulate at the shoulder?

A
  1. sternoclavicular joint
  2. Acromioclavicular joint
  3. Glenohumeral joint
76
Q

What is included in a shoulder series (xray)?

A

AP - internal rotation, AP - external rotation, axillary or trans-scapular Y view

77
Q

Which muscle(s) insert into the greater tubercle of the humerus?

A

Supraspinatus and infraspinatus

78
Q

Which muscle(s) insert into the lesser tubercle of the humerus?

A

Subscapularis

79
Q

Xray views needed for humerus evaluation?

A

Frontal and lateral

80
Q

Xray views needed for elbow evaluation?

A

AP and lateral

81
Q

What does it mean if there is a posterior fat pad in the elbow and an anterior “sail sign”?

A

There is a joint effusion (fluid in joint) at the elbow

82
Q

Xray views needed for hand and wrist?

A

Usually 3: frontal, oblique, and lateral

83
Q

What does the drop arm test examine?

A

Issues with the supraspinatus tendon

84
Q

What does the lift off test examine?

A

Issues with the subscapularis muscle

85
Q

What does the empty can test examine?

A

Supraspinatus impingement

86
Q

What does internal rotation with resistance examine?

A

Subscapularis and teres major

87
Q

What does external rotation with resistance examine?

A

Infraspinatus and teres minor

88
Q

What are the six cardinal signs of MSK disease?

A

Redness, Swelling, Pain, Deformity, Loss of Function, Warmth

RS(W)P DL

89
Q

Prevalence of mental health disorders in US adults?

A

57 million people (26%)

90
Q

_______ is the 10th leading cause of death in the US

A

suicide

91
Q

tangential thought process

A

gradual veering off topic

92
Q

circumstantial thought process

A

over inclusion of details (what your grandparents might do)

93
Q

flight of ideas

A

rapid disconnections of thoughts; ideas are hanging on by a thread

can overlap with disorganized thought process as well

94
Q

How can you test a patient’s attention and concentration?

A

Spell “world” backward and give the days of the week backwards

Serial 7s from 100 or serial 3s from 20

Digit span - series of numbers increasing in length. Ask patient to remember until you get to 7

95
Q

How can you test a patient’s cognition?

A

Abstraction (similarities, proverbs), math problems, orientation, memory, reading & writing

96
Q

What is key when assessing patients with suicidal behaviors?

A

DOCUMENTATION

97
Q

What things should you specifically inquire about during a suicide assessment?

A

suicidal thoughts, plans, and behaviors

98
Q

Who attempts suicide more: males or females?

A

Females

99
Q

Who dies from suicide more frequently: males or females?

A

Males

100
Q

Who has a higher rate of suicide: Caucasians or African Americans?

A

Caucasians

101
Q

List the non-modifiable risk factors for suicide

A

Race (white), sex (male), old age (over 65 esp), history of past attempts, family history of suicide, history or trauma or abuse, history of violent behaviors

102
Q

What is the strongest indicator of future suicide attempts?

A

Past attempts

103
Q

What should you ask about past suicide attempts?

A

How was it attempted? Did they leave a note? What were the circumstances?

104
Q

Are patients at an increased or decreased risk for suicide after discharge from psychiatric inpatient care?

A

increased

105
Q

What contributes to physician distress/disruption?

A

Substance use disorders, psychiatric symptoms/disorders, personality disorders, poor anger management/coping skills, physical illness, poor social skills, burnout or suppression of problems

106
Q

What is a physician CME course?

A

It is designed to address specific needs of professionals whose workplace conduct has become problematic but not risen to the point of formal referral

Typically 3 days with additional 1 day follow-ups at 1, 3, and 6 months

107
Q

Who is a good target for SBIRT?

A

Those that are high-risk or have a probable dependence

108
Q

What are substance-related disorders?

A

Intoxication, withdrawal, substance/medication-induced mental disorders, and unspecified substance-related disorders

109
Q

Define a substance use disorder

A

Problematic pattern of substance use leading to clinically significant impairment or distress, as manifested by at least 2 of 11 criteria in the last 12 months

110
Q

What two criteria of substance use are not considered for Rx drugs taken exclusively under supervised medical care?

A

Tolerance and withdrawal

111
Q

Addiction is a _____ disease

A

brain

112
Q

All drugs of abuse increase what?

A

Dopamine

113
Q

Some drugs of abuse can release how much dopamine compared to natural rewards?

A

2 to 10 times as much

114
Q

In what age group does most illicit drug use begin?

A

Teenage years

“disease of pediatric origin”

115
Q

What type of receptor is lower in addicts to virtually all drugs of abuse?

A

Dopamine D2 receptors

116
Q

Drug use is _______ related to perceived risk of taking the drug

A

inversely

117
Q

If a patient has an acute injury what exam should you perform first?

A

A neurovascular exam

118
Q

Range of motion of the hip?

A

Six axes

Flexion, extension, abduction, adduction, internal & external rotation

119
Q

Flexion _____ the joint angle

A

Decreases

120
Q

Extension _____ the joint angle

A

Increases

121
Q

Range of motion of the knee?

A

Four axes

Flexion, extension, internal rotation, external rotation

122
Q

Valgus stress tests which ligament?

A

MCL by applying valgus stress to the lateral side of the knee

123
Q

Varus stress tests which ligament?

A

LCL by applying varus stress to the medial side of the knee

124
Q

How much should the knee be bent in the valgus and varus stress tests?

A

About 20 degrees

125
Q

Name the three lateral ligaments of the ankle joint

A

Anterior and posterior talofibular ligaments + the calcaneofibular ligament

126
Q

Range of motion of the ankle?

A

4 axes

Dorsiflexion, plantarflexion, inversion, eversion

127
Q

What four questions do you ask your patient who has a lower extremity injury?

A
  1. What was the mechanism of injury?
  2. Where does the pain localize to?
  3. Was there any swelling?
  4. Could you bear weight?
128
Q

Nerves of the anterior abdominal wall?

A

Thoraco-abdominal nerves (T7-T11)
Subcostal (T12)
Iliohypogastric (L1)
Ilioinguinal (L1)

129
Q

Where does the inguinal ligament begin and end?

A

Anterior superior iliac spine and the pubic tubercule

130
Q

Indirect inguinal hernia

A

Pass through the deep inguinal ring lateral to the inferior epigastric vessels

Usually congenital, more common in males

131
Q

Direct inguinal hernia

A

Passes directly though the abdominal wall medial to the epigastric vessels

132
Q

Femoral hernia

A

Pass through the femoral canal

More common in women

133
Q

How many layers of peritoneum is a mesentery?

A

Two

Connects an organ to the posterior abdominal wall; contains blood and lymphatic vessels

134
Q

How many layers of peritoneum is a ligament?

A

Two

Connects an organ to another organ

135
Q

How many layers of peritoneum is the greater omentum?

A

four

136
Q

What ligament of the greater omentum creates the “omental apron”?

A

The gastrocolic

137
Q

What are the three ligaments of the greater omentum?

A
  1. Gatsrophrenic
  2. Gastrosplenic
  3. Gasrocolic
138
Q

What are the three ligaments of the lesser omentum?

A
  1. Hepatoduodenal
  2. Hepatogastric
  3. Hepatoesophageal
139
Q

Parasympathetic supply to the gut up until the left colic flexure?

A

Vagus nerve

140
Q

Parasympathetic supply to everything after the left colic flexure?

A

Pelvic Splanchnic nerves (S2,3,4)

141
Q

If you see varices (abnormally dilated veins) on a person, what should you suspect?

A

Portal hypertension

142
Q

Peritoneal formations?

A

Mesenteries, ligaments, greater and lesser omentums

143
Q

Duodenum: retroperitoneal or intraperitoneal?

A

Retro except the first part, which is intra

144
Q

Where does the foregut become the midgut?

A

The major duodenal papilla

145
Q

The common bile duct and the main pancreatic duct join to form what?

A

The hepatopancreatic ampulla (of Vater)

146
Q

The hepatopancreatic ampulla drains where?

A

Into the major duodenal papilla

147
Q

Pancreas: retroperitoneal or intraperitoneal?

A

Retro except for the tail

148
Q

Innervation of the kidneys?

A

Renal plexus

149
Q

Where does the superior suprarenal artery arise from?

A

Inferior phrenic artery

150
Q

Where does the middle suprarenal artery arise from?

A

aorta

151
Q

Where does the inferior suprarenal artery arise from?

A

renal artery

152
Q

Order of the structures in the renal hilum from anterior to posterior?

A

Vein, artery, pelvis

153
Q

Superior mesenteric artery syndrome

A

Compression of the 3rd part of the duodenum between the abdominal aorta and the superior mesenteric artery

154
Q

Nutcracker syndrome

A

Compression of the left renal vein between the abdominal aorta and the superior mesenteric artery

155
Q

What narrows to form the thoracic duct?

A

The cisterna chyli

156
Q

What type of xray does an acute abdominal series include?

A

A chest xray - PA

157
Q

What is often the most important feature of an abdominal film?

A

The bowel gas pattern

158
Q

What does it mean if the abdominal gas pattern is described as “ileus”?

A

The bowel isn’t moving right; its dilated. Common in post-op patients or those on narcotics

159
Q

What are the circular folds that cross the entire diameter of the small bowel?

A

plicae circularis or vavulae conniventes

160
Q

Two types of abdominal GI contrast?

A

Barium sulfate and iodine-based like Gastroview and Gastrograffin

Barium can cause fibrosis in abdomen or chest and iodine can cause edema in the lungs. have to be careful!

161
Q

Ligament of Trietz

A

Arises from the right crus of the diaphragm and attaches to the junction between the duodenum and jejunum

162
Q

Can we view the jejunum and ileum with an endoscope?

A

Nope!

Alternatives are: capsule endoscope, small bowel follow through or enterography (Ct, MRI)

163
Q

Small bowel enterography

A

Cross sectional study of small bowel with ingested oral contrast

164
Q

Single Contrast Barium Enema (SCBE)

A

used predominately to look for leaks or at the anatomy of the colon

165
Q

Air Contrast Barium Enema (ACBE)

A

superior for detecting small abnormalities of the lumen

166
Q

Common indications for an abdominal CT?

A

Evaluate pain when suspected appendicitis, diverticulitis, small bowel obstruction, IBD, colitis

167
Q

Which is more common: abdominal fluoroscopy or CT?

A

CT

168
Q

When is ultrasound for the abdomen okay?

A

For appendix evaluation and in pregnant women & children

169
Q

When is an abdominal MRI used?

A

Crohn’s patients (due to frequent imaging), evaluation of pain in pregnant patients, and in MR defacography/in rectal cancer evaluation

170
Q

Imaging modality commonly used to evaluate solid organs?

A

CT

171
Q

What is an MRI commonly used for in abdominal imaging?

A

Evaluating solid organs. Generally done after a CT or when people are allergic to the iodinated CT contrast/have renal problems.

Not typically done in an acute setting due to time constraints

172
Q

What is an ultrasound commonly used for in abdominal imaging?

A

Hepatobiliary evaluation, kidney evaluation, and assessment of vessels

can also assess spleen size

173
Q

ERCP

A

Endoscopic Retrograde Cholangio-Pancreaticogram

Goes through the major duodenal papilla to evaluate the biliary ducts

174
Q

MRCP

A

Magnetic resonance cholangiopancreatography (MRCP) is a special type of magnetic resonance imaging (MRI) exam that produces detailed images of the hepatobiliary and pancreatic systems, including the liver, gallbladder, bile ducts, pancreas and pancreatic duct.

175
Q

Imaging modality to evaluate splenomegaly?

Splenic injury or mass?

A

US

CT or MRI

176
Q

Best imaging for suprarenal glands?

A

CT or MRI, not US

177
Q

Best imaging for kidneys?

A

US

CT and MRI also work though!

178
Q

Urography

A

Common evaluation for hematuria. IV contrast excreted by the kidneys in 5-10 minutes to evaluate urinary system

179
Q

Types of IVC filters?

A

Nitinol, greenfield, bird nest

180
Q

Shoulder xray series includes?

A
  1. AP - internal rotation
  2. AP - external rotation
  3. Axillary or transcapular Y view
181
Q

How can we tell on an xray if there is a joint effusion in the elbow?

A

Posterior fat pad and anterior “sail sign”

182
Q

Difference between T1 and T2 weight on MRI

A

T1 - fluids weighted dark

T2 - fluids weighted bright

183
Q

Can you seen CSF and the spinal cord without contrast on MRI?

A

Yep!

MS1 Fall (23 decks)

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