Miscellaneous Flashcards
What is the obturator sign?
test for acute appendicitis/ectopic rupture - PT supine rotates hip through full ROM => positive if pain with movement or flexion of the hip
What is the psoas sign?
test for acute appendicitis/ectopic rupture - pain with passive extension of the thigh while the patient is lying on his/her side with knees extended (90 degrees) or with active flexion of his/her thigh at the hip
What is the recommended care for women with mild preeclampsia?
bed rest with bathroom privileges; weight and BP monitoring; close tracking of protein, serum protein, creatinine, and platelet counts => Rx of methyldopa (Aldomet) PO is not a first line Tx
What are common signs of pregnancy induced HTN?
edema of face/upper extremities, weight gain, blurred vision, elevated BP, proteinuria, headaches
What are signs and symptoms of B12 deficiency?
tingling/numbness in fingers and toes, difficulty walking, mood changes/depression, memory loss, disorientation, dementia
What does the acronym TORCH stand for?
Toxoplasma gondii, other infections, rubella, cytomegalovirus, and herpes - conditions which can cause microcephaly, mental retardation, hepatosplenomegaly, and intrauterine growth retardation in the fetus
What is apraxia?
disorder of the nervous system in which the brain is affected and the patient is unable to move the arms/legs when asked to do so
What is Murphy’s sign?
test for cholecystitis - provider palpates RUQ while the PT takes a deep inspiration => positive if PT abruptly stops breathing during maneuver due to pain
What are clue cells?
squamous epithelial cells with blurred margins (cells with bacteria adherent giving a stippled, granular appearance) - indicative of bacterial vaginosis
What are the signs and symptoms of bacterial vaginosis?
copious off-white to grey discharge, foul odor, lack of vaginal erythema/irritation, clue cells, positive Whiff Test (strong fishy odor when vaginal discharge mixed with one drop of KOH)
What is lichen sclerosus?
disease of the skin - white spots appear on the skin and change over time, found mainly in genital/rectal areas, spots are shiny and smooth and eventually spreads into patches, skin is thin and crinkled and tears easily, bright red or purple bruises are common, skin can become scarred
What is a tonometer?
used to measure intraocular pressure of the eye to screen for glaucoma - normal = 10-22 mmHg
What are the signs and symptoms of CHF?
S1/S2/S3 heart sounds, fatigue, SOB with activity, edema of lower extremities
What is Rovsing’s sign?
identifies acute abdomen (e.g., appendicitis) - PT supine, provider palpates deep into LLQ of the abdomen, PT reports referred pain to RLQ (R for Rovsing and Referred)
What is Cullen’s sign?
superficial bleeding and bruising in the subcutaneous (sub-c for Cullen) fatty tissue around umbilicus causes yellowish-blue color - occurs in ruptured ectopic pregnancy and acute pancreatitis (due to pancreatic enzymes that run along the ligament and subcutaneous tissues around the umbilicus)
What is the difference between condyloma lata and condyloma acuminata?
condyloma acuminata (genital warts) are caused by human papilloma virus subtypes 6, 11, and others while condylomata lata are white lesions associated with secondary syphilis
What type of anemia is associated with lead poisoning?
microcytic anemia - lead mimicks healthful minerals and is absorbed by the bones, where is interferes with the production of RBCs
What is podagra?
pain in the joint of the great toe due to the accumulation of uric acid and salts in the joint
How is a pulse deficit calculated?
counting apical and radial pulses at the same time the subtracting the difference between the two
What is anergy?
when the immune system is unable to perform a healthy, normal immune response when the body is challenged with a particular antigen
How is anergy tested?
application of tetanus, Candida, or mumps antigen to the right forearm and PPD to the left forearm and read results in 48 to 72 hours => if control side is negative patient is immunocompromised and PPD testing is unreliable
Which tests are performed to assess kidney function?
BUN, creatinine, estimated GFR, urinalysis
What is the common name for enterobiasis?
pinworms - small worms that infect the intestines, causing itching around the anus (worse at night)
What is the screening test for pinworms?
Scotch tape test - application of scotch tape to the anus in the morning => worms come out at night and stick to the tape
What is myxedema?
rare, sometimes fatal, disease in which the thyroid is severely underactive and causes life-threatening symptoms (low BP, decreased breathing, decrease body temp, unresponsiveness, coma) - associated with severe atherosclerosis due to increased serum cholesterol (i.e., LDL) => also used to describe the dermatologic changes that occur in hypothyroidism and occasionally hyperthyroidism - deposition of mucopolysaccharides (mucin) in the dermis and other tissues, which results in a dry, waxy swelling of the affected area (when skin changes occur in hyperthyroidism, mostly Graves disease, it’s called pretibial myxedema)
What is Auspitz sign?
presence of pinpoint bleeding spots from psoriasis where the skin is scraped off
What is Kernig’s maneuver?
test for meningitis - patient flexes both hips and legs then straightens the legs against resistance => flexion of hip/knees is positive sign
What is Brudzinski’s maneuver?
place patients hands behind the head and tucking chin to chest - severe neck stiffness causes a patient’s hips and knees to flex when the neck is flexed
What is Homan’s sign?
flexion of foot causes pain in the calf - may be suggestive of DVT
What is the mechanism of action of RhoGAM?
given to mothers with Rh- blood when the fetus is Rh+ => protects the mother from developing antibodies by destroying the Rh+ fetal RBCs in the mother’s blood system
What are vesicular breath sounds?
soft and/or blowing, heard throughout inspiration and fade with expiration - best hear over the base of the lungs
What is pulsus paradoxous?
a fall of systolic blood pressure of >10 mmHg during the inspiratory phase (due to the increased pressure in the chest) - most commonly occurs in severe acute asthma, emphysema, and cardiac tamponade => apical pulse can still be heard even though radial pulse is no longer palpable
What is pes planus?
flat feet - fat pads on an infant’s feet can cause them to appear flat
Which class of antibiotics is recommended for the treatment of community-acquired pneumonia?
no comorbidity: macrolides (clarithromycin/Biaxin, azithromycin/Z-pack, erythromycin for 5-10 days) or tetracycline (doxy for 10 days); comorbidity: respiratory fluroquinolones (levaquin, gatifloxacin, moxifloxacin/Avelox for 5-10 days) or high dose amoxicillin PLUS a macrolide
What is Virchow’s node (sentinel node)?
lymph node in the left supraclavicular fossa (the area above the left clavicle) that takes its supply from lymph vessels in the abdominal cavity => the finding of an enlarged, hard node (also referred to as Troisier’s sign) is strongly indicative of the presence of cancer in the abdomen (i.e., gastric cancer) that has spread through the lymph vessels
How is cholesterol classified?
normal: < 200; borderline: 200-239; high: >= 240
What is balanitis?
candida albicans infection of the glans penis - more common in uncircumcised men, diabetics, and immunocompromised => Tx: topical OTC azole creams (treat partner if also infected)
What produces the S1 heart sound?
closure of the mitral and tricuspid (atrioventricular) valves
What produces the S2 heart sound?
closure of the aortic and pulmonic (semilunar) valves
What is the S3 heart sound?
occurs during early diastole (ventricular gallop/sounds like “Kentucky”) - always considered abnormal after age 35 => pathognomic for CHF - best hear with bell of stethoscope
What is the S4 heart sound?
caused by increased resistance due to stiff left ventricle - usually indicated LVH (normal in some elderly if no signs/symptoms of heart/valvular disease) => occurs in late diastole (sounds like “Tennessee”) - best heard at apex using the bell of the stethoscope
What is a split S2?
benign sound caused by splitting of the aortic and pulmonic components - normal if it appears during inspiration and disappears at expiration => best heard over the pulmonic area (second ICS left of the sternum)
Which heart sounds are best heard with the bell of the stethoscope?
low tones (bell-low): S3, S4 and mitral stenosis
What is the role of prostaglandins in dysmenorrhea?
prostaglandins are hormones the body produces prior to menses - they cause the uterus to contract to shed the endometrial lining, causing pain => the greater the amount of prostaglandins, the more pain - treat dysmenorrhea with NSAIDs due to their effects on prostaglandins
What is the plan for management of acne vulgaris?
(1) wash with medicated soap at bedtime, (2) benzoyl peroxide and salicylic acid, (3) topical retin A 0.25% gel, (4) oral agents (tetracycline), (5) Accutane
When are microaneurysms seen on fundoscopic exam?
with diabetic retinopathy
Which organism causes pneumonia in children and people with cystic fibrosis?
Pseudomonas aeruginosa (also the most common cause of otitis externa)
What is roseola infantum (exanthema subitum)?
common viral macupapular rash caused by the herpes virus that appears in infants (6 months to 2 years) a few days after a high fever breaks - first appear on trunk and spread to extremities
Which infection presents with three stages of rash?
erythema infectiosum/Fifth disease - 3 stages: (1) URI with low-grade fever, headache, chills, and malaise; (2) red rash on cheeks (slapped cheek rash) for 2-3 days; (3) rash moves to arms and legs and becomes lacy appearing (flat/purple appearance)
What is the treatment for post-herpetic neuralgia?
tricyclic antidepressants and anticonvulsants
What is the Somogyi effect?
nocturnal hypoglycemia (2-3 a.m.) stimulates the liver to produce glucagon to raise blood sugar - fasting blood glucose levels will be elevated
What is 1st line treatment for essential tremor?
propranolol (Inderal) - essential tremors are permanent and cannot be cured => order EKG beore prescribing to rule out heart block
What are the findings on the Weber and Rinne tests with conductive hearing loss?
Weber: lateralization to affected ear; Rinne: BC > AC in the affected ear
What is bacterial endocarditis (infective endocarditis)?
serious bacterial infection of the heart valves and endocardial surface - Dx with three blood cultures taken at separate sites 1 hour apart
What are the signs and symptoms of bacterial endocarditis?
Osler’s nodes (subcutaneous red painful nodules on the finger pads), subungal splinter hemorrhages on the nailbeds (caused by microemboli), Janeway’s lesions (painless red papules and macules caused by bleeding under the skin), conjunctival hemorrhages, petechaie, cardiac friction rubs, arrhythmias, murmurs
What are the findings on pulmonary function testing with COPD?
reduction in FEV1 (forced expiratory volume in 1 second) and FVC (forced vital capacity) - lungs lose recoil AND increase in TLC (total lung capacity) and RV (residual volume) - lungs are always full of air that is hard to squeeze out
What is Armour thyroid?
desiccated thyroid - a natural supplement composed of dried pork thyroid glands
What is the rule of 9s in burn assessment?
- torso = 36% (front and back of chest and abdomen each 9%)
- legs = 36% (each leg 18% - 9% each front and back)
- arms = 18% (each arm 9% - 4.5% front and back - 2% upper arm, 1.5% lower arm, 1% hand)
- head = 9% (front and back each 4.5%)
- groin = 1%
What is the 1st line Tx for C diff?
metronidazole (Flagyl) 500 mg PO TID x 10 days
What is the preferred antibiotic for strep throat in a patient with penicillin allergy?
azithromycin (Z-pack)
Which type of anti-hypertensive agent has a positive effect on the bones?
thiazide diuretics - decrease calcium excretion by the kidneys and stimulate osteoclast production
How is Colchicine used?
prescribed during a gouty attack - give only 10 pills and do not refill => have patient take 1 tablet every 1-2 hours until relief is obtained or adverse GI effects occur (max dose is 6 mg/day)
What test should be ordered prior to prescription of hydroxychloroquine (Plaquenil)?
comprehensive eye exam - Plaquenil can affect the retina
Which ethnic groups are most commonly affected by thalassemia?
alpha - Asian (Chinese or Filipino)
beta - Mediterraneans (Greeks or Italians)
What is Chvetock’s sign?
contraction of the facial muscles when the facial nerve is tapped briskly in front of the ear (anterior to the auditory canal) in the setting of hypocalcemia
What is polymyalgia rheumatica?
self-limited (few months to 3 years) rheumatic condition that involves the joints and arteries - high risk of giant cell arteritis (temporal arteritis) => treated with oral steroids - hallmark is rapid improvement in symptoms after starting steroids
What is the classic triad of symptoms with Meniere’s disease?
vertigo, tinnitus, hearing loss
How frequently should Kegel’s be performed to treat for stress incontinence?
10 exercises 3 times per day
How is the ankle-brachial index (ABI) test used?
to assess the severity of arterial blockage for patients with PAD - normal: 1.0-1.4, less than 1.0 is abnormal
What are the major criteria for diagnosis of PID?
tenderness of cervical motion, adnexa, or uterus
What are the features of the eyes that produce vision?
- fovea - center of the macula, responsible for sharpest (20/20) vision
- cones - receptors on the fovea that allow seeing in color and detail (cones and color both start with C)
- rods - receptors that allow for night vision
- macula - responsible for central vision
What is the mnemonic for remembering anticholinergic effects?
dry as a bone, red as a beet, mad as a hatter, blind as a bat
What is the Grey-Turner sign?
bluish discoloration located on the flank area - sign of severe pancreatitis (but can also indicate a ruptured ectopic pregnancy)
What is a Tzanck smear?
scraping of an ulcer base to look for Tzanck cells - used to test for chickenpox and herpes zoster
What is the cause for a positive obturator or psoas sign?
obturator and psoas are muscles (hip flexors) located in the retroperitoneal area that assist with hip movement - with acute appendicitis, blood and pus irritate these muscles causing pain with hip movement (can also be positive for ruptured ectopic pregnancy)
What is Ortolani’s maneuver?
part of the physical examination for developmental dysplasia of the hip - tests posterior dislocation of the hip => relocates the dislocation of the hip joint that has just been elicited by the Barlow maneuver
performed by an examiner first flexing the hips and knees of a supine infant to 90 degrees, then with the examiner’s index fingers placing anterior pressure on the greater trochanters, gently and smoothly abducting (O = out) the infant’s legs using the examiner’s thumbs - positive sign is a distinctive ‘clunk’ which can be heard and felt as the femoral head relocates anteriorly into the acetabulum
What is Barlow’s maneuver?
physical examination performed on infants to screen for developmental dysplasia of the hip (B = bad to dislocate hip)
performed by adducting the hip (bringing the thigh towards the midline) while applying light pressure on the knee, directing the force posteriorly - positive if the hip is dislocatable (hip can be popped out of socket with this maneuver) => Ortolani maneuver is then used, to confirm the positive finding (i.e., that the hip actually dislocated)
When is the Hep B vaccine given to children?
birth, 1-2 months, 6-18 months
Which 5 vaccines are given at 2, 4, and 6 months of age?
rotavirus, DTaP, Hib, PCV13, and IPV (6-18 months)
Which 5 vaccines are given at 12 months of age?
Hib, PCV13, MMR, VAR, Hep A (2-dose series separated 6-18 months)
When should influenza vaccine be started?
6 months
Which 5 vaccines should be given at 15 months of age?
influenza, DTaP (boosters of Hib, PCV13, IPV, if not given at 12 months) => MMR, VAR, and Hep A, if not started at 12 months