Midterm Flashcards
Midterm sample questions
what is HIPAA and when was it started?
Health Insurance Portability and Accountability Act - 1996
Designed to provide privacy standards for patients.
Created by the dept. of health and human resources
What CANNOT be included in a case presentation?
any identifiers:
Names
Numbers of any sort (DOB, phone, MRN, SS, etc)
Identifying Photos
what happens if you do not safeguard the patients information?
you get kicked out
What is on the identification sheet (aka registration form)?
demographics
employment
insurance
emergency contact
what is included in the patient’s history?
Date & Time Identifying Data Chief Complaint History of Present Illness incl. medications, allergies, habits Past History: both medical and surgical Family History: narrative or diagram Personal/Social History: Review of Systems (ROS)
what is included in the physical exam?
Vital Signs: Blood Pressure, Heart rate, Respiration rate, Temp(C), O2 Saturation (SpO2)
Exam of all systems:
Skin, HEENT(incl. thyroid and lymph nodes), Thorax/lungs, breasts/axillae, musculoskeletal, cardiovascular, abdomen, peripheral vascular/nervous system & genital/rectal exam
what are the components of a consent form?
Patient Name & Date
Name and Description of Surgery
Indication for Surgery
Risks & Benefits of Procedure
Alternatives to Procedure
Patient’s Signature, printed name, date, and time/Surgeon’s signature
*Patient must be competent to make medical decisions
what is the SOAP format?
Subjective: what the patient tells you
Objective: found as part of your physical exam
Assessment: Problem list
Plan: Management
what are the normal ranges for vital signs for a patient at rest?
Blood Pressure: 90/60- 120/80
Heart Rate: 60-100 beats per minute (BPM)
Respiratory Rate: 12-20 breaths per minute
Temperature: 97.8-99.1 F (ave. 98.6)
Pulse Oximetry: 95-100%
what is the difference between systolic and diastolic pressure?
Systolic BP (SP): the pressure exerted on the walls of the arteries during heart contraction (systole) (top number) Diastolic BP (DP): the pressure exerted on the walls of the arteries during heart relaxation (diastole) (bottom number)
what is MAP and how does it effect perfusion?
Mean Arterial Pressure (MAP): aka perfusion pressure
MAP= DP+ 1/3 PP (pulse pressure= SP-DP)
MAP > 60 mmHg to perfuse organs
MAP > 70 mmHg to perfuse organs in hypertensive patient.
what are the classifications of HTN?
Normal: Systolic:119 or lower Diastolic: 79 or lower
Prehypertension: Systolic: 120-139 Diastolic 80-89
Stage 1 Hypertension: Systolic: 140-159 Diastolic: 90-99
Stage 2 Hypertension: Systolic: 160 or higher Diastolic: 100 or higher.
are body temperatures uniform wherever they are taken?
No,
Axillary temperatures - 1 C lower than oral
Rectal temperatures + 1 C higher than oral
what is pulse oximetry?
Non-invasive means of measuring the saturation of hemoglobin
What is the CAGE questionnaire and what is it used for?
CAGE Questionnaire
Have you ever felt the need to CUT DOWN on drinking?
Have you ever felt ANNOYED by criticism of your drinking?
Have you ever felt GUILTY about drinking?
Have you ever had an EYE-OPENER to steady your nerves or get rid of a hangover?
what are the stages of the kubler-ross response?
Kubler-Ross: 5 stages in a person’s response to death.
Denial & Isolation Anger Bargaining Depression or Sadness Acceptance
what is the difference between subjective and objective data?
Subjective Data: What the patient tells you.
Objective Data: What you detect during the exam.
what is the chief complaint?
The reason the patient is here to see you.
Make every attempt to use the patient’s own words.
If the patient has NO complaints, report their GOALS instead.
what are the seven attributes of a symptom?
Seven Attributes of a Symptoms (Chloride)
Character or Quality Location Onset Radiation Intensity Duration Exacerbating or Alleviating factors
what is included in the past medical history?
General health and strength of the patient Adult illnesses Childhood illnesses Past surgeries or hospitalizations Recent tests Immunizations
what is the review of systems?
Series of questions from “head to toe” in a system based approach
(General, skin, HEENT, Neck, Breasts, Resp. Cardio, GI, Urinary, Genitals, Perif. Vasc., MS, Neuro, Hematologic, Endocrine, Psych)
what are the cardinal techniques of examination?
Inspection, Palpation, Percussion, Ascultation
what are the BMI ranges and how is it calculated?
Weight (kg)/height (meters squared)
25 overweight
>30 is obese
what are the 5 segments when doing a neuro exam?
mental status cranial nerves motor function sensory system reflexes
what are some normal hematology lab values?
White Blood Cell Count (WBC)(cells/ml): 4,500-10,000
Red Blood Cell Count (RBC)(x 10 6): 4.0-5.5
Hemoglobin (Hgb)(g/dl): 12.0-16.5
Hematocrit (Hct)(%): 36-50
Mean Corpuscular Volume (MCV): 80-100
Platelet Count (plt): 100,000-450,000
what are some normal values for a complete metabolic panel?
Sodium (Na)( mEq/L): 135-147 Potassium (K)(mEq/L): 3.5-5.2 Chloride (Cl)(mEq/L): 95-107 Bicarbonate (HCO3) (mEq/L) 23-29 BUN (Blood Urea Nitrogen)(mg/dl): 7-20 Creatinine (Cr)(mg/dl): 0.5-1.4 Glucose (Glu) (mg/dl): 60-110
what are normal bilirubin and alkaline phospatase values and what do they indicate?
Total Bilirubin (TB) (mg/dl): 0.1-1.2
Alkaline Phosphatase (Alk phos)(IU/L:) 33-153 liver function: bile duct or gallbladder issue
what are some normal values for coagulation studies?
Protime (PT)(Extrinsic pathway): 10-14 seconds
Partial Prothrombin Time (PTT)(Intrinsic pathway): 25-39 sec
International Normalized Ratio (INR): 0.8-1.2
INR= PT test/PT normal
whatis the purpose of the lacrimal gland?
produces tears. Tears protect the cornea from drying out, inhibits microbial growth, and gives a smooth optical surface to the cornea
what is the fundus of the eye?
Fundus (posterior part of the eye) contains the retina, choroid, fovea, macula, optic disc, and retinal vessels
what are the two phases of hearing?
Conductive Phase
From external ear through the middle ear
Sensorineural Phase
Involves the cochlea and vestibulocochlear nerve (CN VIII)
what is the function of the nasal turbinates and meatuses?
Principal functions: cleansing, humidification, and temperature control of inspired air.
which sinuses are accessible to exam?
Only the frontal and maxillary sinuses are accessible to exam.
what is the snellen eye chart used for?
visual acuity NOT peripheral vision
what is Nystagmus?
Nystagmus (fine rhythmic oscillation of the eyes)
what is the difference between the Weber and Rinne tests?
hearing tests
Weber test: lateralization
Rinne test: compares air conduction and bone conduction
where are some of the places where lymph nodes can be identified?
Preauricular: front of ear
Posterior auricular: superficial to mastoid process
Occipital: at base of skull posteriorly
Tonsillar: at angle of mandible
Submandibular: midway btwn the angle and tip of the mandible
Submental: few centimeters behind tip of mandible
Superficial cervical: superficial to sternomastoid
Posterior cervical: along anterior edge of the trapezius
Deep cervical chain: deep to sternomastoid (often inaccessible to exam)
Supraclavicular: deep in the angle formed by the clavicle and the sternomastoid
The parts of the history and ROS that will be especially pertinent to the airway exam include:
Previous surgeries
Previous prolonged intubations
Previous tracheostomy
Previous laryngectomy
Previous traumas to the airway, neck, etc.
Social history including smoking, drug and alcohol dependence
what are some clues to a difficult intubation?
Dry cough -Possible tracheobronchial compression Easy bleeding -Epistaxis risk Gastroesophageal reflux -Aspiration risk Longstanding diabetes mellitus -Limited cervical mobility Loud snoring -Prone to soft-tissue obstruction Major trauma -unstable neck Radiation to the neck -Fibrosis, immobility of larynx Recent temporal craniotomy -Limited mandibular mobility Smoking -Salivation, cough, laryngospasm Undigested food returning to the mouth -Aspiration risk from the pharyngeal pouch
what are the mallampati scores?
Grade 1: Most of glottis visible
Grade 2: Only posterior portion of glottis visible
Grade 3: Epiglottis, but none of glottis visible
Grade 4: No airway structures visualized
trace blood flow to and from the heart
VCs -> RA -> (tricuspid) RV -> (pulmonary) PAs-> Lungs-> PVs-> LA-> (mitral) LV-> (aortic) Aorta-> Body
when do systole and diastole occur?
Diastole:
Pressure in Left Atrium (LA) > pressure in the Left Ventricle (LV) and blood flows from the LA through the open mitral valve and into the LV
Systole:
When the LV starts to contract, and LV pressure > LA pressure the mitral valves shut
LV pressure > aorta and forces the aortic valve open (maximal LV pressure=systolic pressure)
After the LV ejects most of its blood, LV pressure < aorta and the aortic valve shuts
what are the heart sounds and when do they occur?
mitral valves shut (which produces the 1st heart sound S1)
aortic valve shuts (which produces the 2nd heart sound S2)
S3 (a 3rd heart sound): in children and young adults, arises from a rapid deceleration of the column of blood against the ventricular wall. In older adults, an “S3 gallop” usually indicates a pathologic change in ventricular compliance.
S4 (a 4th heart sound) marks atrial contraction and usually happens just before S1. Reflects a pathologic change in ventricular compliance.
what can cause heart murmurs?
Attributed to turbulent blood flow
Stenotic valve: abnormally narrowed valvular orifice that obstructs blood flow and has a very “harsh” characteristic sound Ex. Aortic stenosis
Regurgitant valve: fails to close fully and allows blood to leak backward in a retrograde direction. Ex. Aortic regurgitation/insufficiency.
where do you listen for valve sounds?
Mitral Valve: heard best at the cardiac apex.
Tricuspid Valve: heard best at the lower left sternal border.
Pulmonic Valve: heard best in the 2nd and 3rd left interspaces close to the sternum.
Aortic Valve: heard anywhere from the right 2nd interspace to the apex.
what is the path of conduction in the heart?
SA -> AV -> His -> R and L bundle branches
why is there a delay at the AV node?
allow ventricles to fill
what is a P wave, QRS complex and T wave?
atrial depol.
ventricular depol.
ventricular repol.
define cardiac output and stroke volume
Cardiac Output (CO): the volume of blood ejected from each ventricle in 1 min (product of heart rate (HR) & stroke volume (SV). CO= HR X SV
Stroke Volume: the volume of blood ejected with each heartbeat (depends on: preload, myocardial contraction, and afterload)
what are preload and afterload?
Preload: the load that stretches the cardiac muscle before contraction. The volume of blood in the RV at the end of diastole=preload for the next beat.
Increases: inspiration, increased volume (exercise), CHF
Decreases: exhalation, decreased LV output, and pooling of blood in capillary bed/venous system.
Afterload: refers to the degree of vascular resistance to ventricular contraction (from tone in walls of arterial system).
what is myocardial contractility and how is it affected?
Myocardial Contractility: refers to the ability of the cardiac muscle, when given a load, to shorten.
Increases: when stimulation occurs from the sympathetic ns
Decreases: when blood flow or oxygen delivery to the myocardium is impaired.
what is jugular venous pressure and where is it measured?
Jugular Venous Pressure (JVP): height in the venous column of blood in the internal jugular veins.
Reflects right atrial pressure; important clinical indicator of cardiac function and right heart hemodynamics.
Estimated from the RIGHT internal jugular vein (IJV) b/c right side has a more direct path to the right atrium.
what do the jugular venous pulsations represent?
A wave: reflects the slight rise in atrial pressure that accompanies atrial contraction (just before S1)
C wave: RV contraction causing tricuspid valve to bulge toward RA.
X descent: starts with atrial relaxation, rapid atrial filling due to low pressure.
V wave: tricuspid valve closes & RA fills with blood (after S2)
Y descent: tricuspid valve opens and blood flows from RA passively into RV and right atrial pressure falls.
what is Paroxysmal nocturnal dyspnea (PND)?
Paroxysmal nocturnal dyspnea (PND): episodes of sudden dyspnea or orthopnea that awakens patient from sleep prompting need to go to window for air.