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MT Flashcards

1
Q

visceral abdominal pain vs somatic abdominal pain

A

stimulation of visceral pain fibers usually on organs, not localized

stimulation of somatic pain fibers usually in peritoneum, is localized

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2
Q

important meds to ask about in abdominal exams

A

blood thinners, NSAIDs, narcotics, steroids

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3
Q

order of abdominal physical exam

A

inspection
auscultation
percussion
palpation

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4
Q

RUQ contents

A

liver, gb, stomach, si/li

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5
Q

RLQ contents

A

appendix, ovary, si/li

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6
Q

LLQ contents

A

sigmoid colon, ovary, si/li

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7
Q

LUQ contents

A

spleen, stomach, si/li

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8
Q

epigastric area contents

A

pancreas, liver, gb, stomach, si/li

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9
Q

normal bowel sounds

A

5-34 clicks per minute

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10
Q

high pitched bowel sounds suggest

A

obstruction

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11
Q

bruits suggest

A

vascular obstruction

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12
Q

friction rub sounds suggest

A

inflammation of peritoneal surface of an organ

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13
Q

venous hum sound suggests

A

increased circulation b/w portal/systemic

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14
Q

where to start w/ abdomen palpation

A

start farthest from tender area

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15
Q

causes of splenomegaly

A

portal hypertension, blood malignancies, hematoma, mono

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16
Q

ascites tests

A

shifting dullness - percuss borders of tympany/dullness and then have Pt lay on side and if it changes (+)

fluid wave - tapping one side of abdomen felt on other side w/ other hand monitoring

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17
Q

mcburney’s point

A

2 inches medial to R ASIS towards umbilicus

(+) tenderness, appendicitis

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18
Q

rosvings sign

A

deep palpation in LLQ

(+) tenderness in RLQ, appendicitis

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19
Q

psoas sign

A

Pt raises R thigh against resistance then lays on left side and extends R leg at hip

+ pain w/ either maneuver, appendicitis

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20
Q

obturator sign

A

flex Pts R hip w/ knee bent, then internally rotate hip

+ R hypogastric pain, appendicitis

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21
Q

murphy’s sign

A

palpate under R costal margin then Pt breaths deep

+ sharp pain w/ stop in inspiration, biliary colic

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22
Q

lloyd’s sign

A

deep percussion down back

+ pain, kidney pathology

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23
Q

signs of peritoneal inflammation

A

guarding - contraction of abdominal wall w/ palpation

rigidity - reflex contraction of abdominal wall, Pt stiff

rebound tenderness - more pain when letting go after palpation than pushing in

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24
Q

vindicate

A 
vascular
infectious/inflammatory
drugs/degenerative
iatrogenic/idiopathic 
cogenital
AI/allergic/anatomic
trauma
endocrine/environment
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25
Q

expected sound on percussion of abdomen

A

tympanic mostly

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26
Q

GERD Sx

A

heartburn
regurgitation
dysphagia 30% of Pts

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27
Q

lifestyle modifications for GERD

A 
lose weight (if overweight)
avoid triggers
avoid large meals
wait 3 hours to lay down after meal
elevate head of bed by 8 inches
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28
Q

rome 3 criteria for constipation

A 
<3 bowel movements/week
straining
lumpy/hard stools 
sensation of incomplete defecation 
manual maneuvering required to defecate

must have 2+ over 3 months

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29
Q

bistol stool chart

A 
1 - lumps
2 - sausage, lumpy
3 - sausage, cracks
4 - sausage, smooth
5 - soft blobs
6 - fluffy pieces, mushy
7 - watery
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30
Q

main cause of gastroenteritis

A

viral

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31
Q

viral gastroenteritis two “biggies”

A

norovirus - sudden onset, 12-48 hours after exposure, usually more vomiting; seen w/ ship/casino outbreaks

rotavirus - most immunized for this, kids either have it or immunized by age 5

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32
Q

bacterial gastroenteritis three “biggies”

A

salmonella - eating something contaminated

C. diff - most common hospital acquired illness, exposure to antibiotics

E. coli - most common w/ travel

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33
Q

parasitic gastroenteritis one “biggie”

A

giardia - causes greasy diarrhea (tends to float), bloating, cramping; most common from infected water w/ campers etc

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34
Q

parasitic gastroenteritis one “biggie”

A

giardia - causes greasy diarrhea (tends to float), bloating, cramping; most common from infected water w/ campers etc

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35
Q

cullen sign

A

ecchymosis around umbilicus secondary to hemorrhage

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36
Q

grey turner sign

A

flank ecchymosis secondary to hemorrhage

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37
Q

expected liver size

A

6-12 cm at mid-clavicular line on the right

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38
Q

expected spleen size

A

from ribs 6-10 at mid-axillary line on left

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39
Q

heel strike indicates

A

appendicits or peritonitis

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40
Q

chovstek sign

A

tap facial N when facial Ms relaxed

(+) spasm = hypocalcemia

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41
Q

hypoparathyroidism causes/Sx

A

causes: removal, DiGeorge, AI disorder

Sx: hypocalcemia (b/c low PTH) -> seizures, dementia, anxiety, paresthesia, stiffness/spasms, prolonged QT

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42
Q

adrenal insufficiency/addison’s disease causes/Sx

A

causes: primary usually AI, secondary due to lack of ACTH production

Sx: underproduction of cortisol/ACTH -> low blood glucose/Na levels, skin pigment, salty food craving, hypotension, fatigue

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43
Q

adrenal overproduction/cushing’s disease causes/Sx

A

causes: endogenous w/ tumors, etc; or exogenous due to meds

Sx: cortisol overproduction -> moon face, buffalo hump on shoulders, high blood/glucose, excess body hair growth in women, striae on skin

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44
Q

T4/T3 and relation to thyroid function

A

t4 = inactive / t3 = active

hypothyroid = TSH high b/c low T4/T3
hyperthyroid = TSH low b/c high T4/T3
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45
Q

T4/T3 and relation to thyroid function

A

t4 = inactive / t3 = active

hypothyroid = TSH high b/c low T4/T3
hyperthyroid = TSH low b/c high T4/T3
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46
Q

pituitary adenoma Sx

A

hypersecretion of hormone

deficiency of hormone (LH/FSH)

headaches, visual disturbances, loss of balance, seizures

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47
Q

where does thyroid lie

A

isthmus over 2-4 tracheal rings

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48
Q

soft thyroid seen in

A

Grave’s

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49
Q

firm thyroid seen in

A

Hashiomoto’s and malignancy

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50
Q

tender thyroid seen in

A

thyroiditis

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51
Q

DM Sx/Labs

A

Sx: polyurea, thirst, fatigue, cuts/bruises slow to heal, feeling hungry, weight loss

labs: FG > 126 mg/dL
A1C > 6.5%
random glucose > 200 mg/dL

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52
Q

Metabolic Syndrome

A

Sx: abdominal obesity, insulin resistance, elevated BP, lipid abnormalities

prevalence increases w/ age and body weight but cause unk

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53
Q

geriatric meds assessment

A
  • brown bag check: bring in bag w/ all meds
  • ask prescriptions, OTC, vitamins, herbs, supplements
  • review meds every visit
  • use Beer’s criteria to avoid prescribing meds w/ adverse effects
  • start low, go slow (dosage for elderly)
  • close followup after starting new medication
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54
Q

assessment tools for functional ability and risk of falls

A
  • ability to perform activities of daily living (ADL)
  • -self care, housework, meal prep, taking meds, managing finances, using telephone
  • useful scales: Katz, Lawton ADL scales
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55
Q

risks secondary to DM

A

retinopathy -> blindness
nephropathy -> kidney failure
neuropathy of hands/feet
vascular changes -> MI/strokes

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56
Q

DKA at risk in T1 or T2DM

A

T1

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57
Q

geriatric vision assessment

A
  • Snellen eye chart
  • ophthalmologist referral to monitor DM Pt
  • ophthalmologist referral for Pt w/ glaucoma risk (FH)
  • assess vision for driving safety
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58
Q

mini-mental status exam

A 
mild = 21-29
moderate = 10-20
severe = 0-9

*not relaible if Pt cant read/write or not fluent

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59
Q

diabetic retinopathy Sx

A

black spots in visual field

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60
Q

geriatric hearing loss

A

age-related sensorineural hearing loss most common hearing condition in older Pts, loss of high frequency hearing

Sx: hearing loss w/ tinnitus/vertigo/poor balance (fall risk)
cause: CN8, review meds for ototoxicity

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61
Q

stress incontinence

A

involuntary leakage w/ sneezing, coughing, laughing, exertion, etc

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62
Q

urge incontinence

A

detrusor overactivity, leading to uninhibited detrusor contractions

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63
Q

overflow incontinence

A

continuous leakage due to incomplete emptying, detrusor inactivity or bladder outlet obstruction

64
Q

risk factors for osteoporosis

A

white females
older white males
postemenopausal females
vitamin D deficient

65
Q

osteoporosis screening

A

dual energy x-ray scan (DEXA) on women 65+

screening women <65 w/ high fracture risk

66
Q

geriatric vax assessment

A

tetanus w/ pertussis
flu
pneumococcal pneumonia
herpes zoster

67
Q

geriatric vax assessment

A

tetanus w/ pertussis
flu
pneumococcal pneumonia
herpes zoster

68
Q

RA risk factors and Sx

Tx

A

often ages 30-50, women, smokers, w/ FH
Sx: joint pain/stiffness (wrists, IP/MP joints), morning stiffness lasting longer than an hour, swelling and synovial thickening of joints on examination

Tx: methotrexate

69
Q

juvenile RA risk factors and Sx

A

children w/ painless joint inflammation, limp

Sx must last 6 weeks in at least 1 joint w/ other causes ruled out under age 16

70
Q

SLE risk factors and Sx

A

risk factors: black, female

Sx: fatigue, weight loss, fever, arthralgia/myalgia
4 top Sx: coin shaped rash, malar rash, unexplained seizures/psychosis, photosensitivity

71
Q

psoriasis risk factors and Sx

A

15-30 y/o, smoker, obese, alcoholic, FH

Sx: scaly skin lesions, erythematous

*consider joint exam when seeing rash/nail pitting

72
Q

Graves’ risk factors and Sx

Tx

A

female, FH, AI disorder

Sx: asymptomatic -> thyroid storm; heat intolerance, diaphoresis, tremor, bulged eyes, weight loss

Tx: beta blockers and anti-thyroid meds

73
Q

Hashimoto’s Sx

Tx

A

Sx: non-tender goiter, hypothyroidism, high TPO Ab level, weight gain, cold intolerance

Tx: levothyroxine

74
Q

Ab disorder risk factors and (1ID) Sx

A

FH strongest predictor

Sx: infections w/ unusual organisms or severe recurrent infections w/ common organisms

75
Q

agammaglobinemia Sx

A

absent of B cells

76
Q

hypogammaglobinemia Sx

A

low/deficient Ig levels, abnormal Ig response to vaccinations

77
Q

phagocytic disorder Sx

A

inability to kill catalase-positive organsism (Ex: staph aureus)

Sx: recurrent fungal infections

78
Q

complement disorder Sx

A

infectinos w/ encapsulated organisms (pneumoniae, influenzae)

79
Q

HIV Sx

A

Sx: mucocutaneous rash, myalgia/athralgias, anorexia, weight loss, fever, CNS manifestations, fatigue, pharyngitis, GI distress

80
Q

type 1 hypersensitivity Sx

A

IgE mediated - allergy activity activating mast cells and increasing vascular permeability; usually targets eyes/nose/respiratory/GI

Sx: allergic conjunctivitis/rhinitis, dermatitis (eczema), diarrhea/cramping

81
Q

type 2 hypersensitivity Sx

A

Ab toxicity involving C’ activation; recruitment of inflammatory cells and Abs against receptors

ABO mismatch, rheumatic fever, hemolytic disease of newborns, myasthenia gravis, graves

82
Q

type 3 hypersensitivity Sx

A

IgG/IgM and C’ activation -> neuts/Mcs damaging tissue; takes 2 exposures b/c needs Ab deposition

Farmers Lung, Serum Sickness

83
Q

type 4 hypersensitivity Sx

A

T cell mediated, no Abs required

allergic contact dermatitis (poison ivy), late phase of Farmer’s lung, PPD skin test for TB

84
Q

t cell disorder

A

usual present in early life

diarrhea, failure to thrive, opportunistic infections in a child younger than 3 months should raise suspicion for SCID

85
Q

assessing sexual dev in physical exam

A

female puberty = 10-14 w/ menarche 2-3 years after beginning of puberty (secondary sex dev)
male puberty = 11-16

other considerations = hair growth, facial bone changes, thyroid size increase, acne

86
Q

how to obtain ob/gyn history

A

menstrual Hx: age and cycle history, LMP

gyn Hx: breast Hx/disease, last mammogram, previous gyn surgery, fertility Hx, last pap smear

ob Hx: # of pregnancies/# of births, TPAL

87
Q

how/when/why pap smear

mammograms

A

women 21-65 y/o

  • yearly if abnormal
  • every 3 years w/ normal
  • every 5 years w/ normal and no HPV (reason for PS)
  • sample take at ectocervix/endocervix/TZ

50+ years for mammogram

88
Q

pelvic exam vs pap smear

A

both require insertion of speculum

pelvic = visual, bimanual exam, swab if needed
pap = obtains sample by scraping cervical cells
89
Q

TPAL acronym

A 
T = term deliveries (>37 wks)
P = preterm deliveries (20-37 wks)
A = abortion (<20 wks) 
L = live delivery regardless of age
90
Q

ectopic pregnancy Sx/Dx

A

abdominal/pelvic pain w/ vaginal bleeding and may have other pregnancy related Sx

do urine pregnancy test followed by ultrasound

91
Q

UTI Sx/cause/Tx

A

Sx: dysuria, may have hematuria, test w/ Lloyd’s punch and uinalysis

Cause: often E. Coli

Tx: antibiotic

92
Q

when is prostate exam indicated

A

w/ FH of prostate cancer

93
Q

when is male wellness exam indicated

A

not indicated unless having Sx

94
Q

inguinal hernia Sx/Tx

A

pain w/ increased abdominal pressure, may have bulge; have Pt cough

Tx: mild = watchful waiting, moderate to severe = surgery

95
Q

5Ps of sexual history

A 
partners
practices 
prevention 
protection 
past history of STI
96
Q

gonorrhea Sx

A

Sx: men discharge/dysuria/asymptomatic, women pelvic pain/discharge

97
Q

chlamydia Sx

A

Sx: many asymptomatic, can have discharge or dysuria

98
Q

Syphilis Sx

A

Sx: chancre, joint pains/fatigue, can be asymptomatic in latent phase

99
Q

genital herpes Sx/Tx

A

Sx: clusters of vesicles, burning, tingling

Tx: antiviral

100
Q

trichomonasis Sx/Tx

A

Sx: men asymptomatic, women fould smelling discharge, dysuria, pruritis

Tx: antiprotozoal

101
Q

HPV Sx/Tx

A

Sx: genital warts

Tx: vax, pap smears, wart removal

102
Q

cervical myelopathy vs radiculopathy

A

myelopathy - spinal cord, emergent b/c more systemic Sx

radiculopathy - nerve root, urgen but not emergent

103
Q

meningitis Dx/Sx

A

Dx - lumbar puncture

Sx - fever, malaise, headache, pain/stiffness, etc

104
Q

lumbar puncture level

A

L4/L5

105
Q

atraumatic Dx workup

A

if no red flags, dont require imaging

106
Q

C4-C5 disc testing

A

C5 root, biceps

107
Q

C5-C6 disc testing

A

C6 root, brachioradialis

108
Q

C6-C7 disc testing

A

C7 root, triceps

109
Q

C4 dermatome

A

lateral neck

110
Q

C5 dermatome

A

lateral upper arm

111
Q

C6 dermatome

A

lateral forearm, thumb

112
Q

C7 dermatome

A

middle finger

113
Q

C8 dermatome

A

medial wrist/forearm

114
Q

T1 dermatome

A

medial elbow/upper arm

115
Q

C1 strength testing

A

resisted rotation ROM

116
Q

C2-4 strength testing

A

scapular elevation

117
Q

C5 strength testing

A

deltoid, shoulder abduction

118
Q

C6 strength testing

A

biceps, wrist extension

119
Q

C7 strength testing

A

triceps, wrist flexion

120
Q

C8 strength testing

A

finger flexion

121
Q

T1 strength testing

A

finger abduction

122
Q

T4/T10 dermatomes

A

T4 - nipple

T10 - umbilicus

123
Q

spurlings test

A

compress head down then do the same in extension, SB, and rotation

+ pain -> radiculopathy

*do not perform w/ RA, cervical malformations, or metastatic disease

124
Q

manual distraction test

A

distract head

+ relief of pain -> central neuropathy

125
Q

roos/east tests

A

Pt abducts shoulder to 90 and ER w/ flexed elbow to 90 (T formation), Pt opens and closes hands for 3 mins

+ reproduciton of Sx -> TOS, compression of SCA

126
Q

nuchal rigidity

A

Pt supine, hands behind Pt’s head and flex chin to chest

+ stiffness -> inflammation in subarachnoid space (meningitis or subarachnoid hemorrhage)

127
Q

brudzinksi’s sign

A

Pt supine, hands behind Pts head and flex chin to chest

+ flexion in hips and needs -> inflammation in subarachnoid space

128
Q

kernig’s sign

A

Pt supine, flex hip and knee to 90 and attempt to passively extend the leg at the knee

+ resistance, pain behind knee -> meningeal/dural irritation

129
Q

lines in vertebrae

A

anterior vertebral line - anterior body
posterior vertebral line - posterior body
spinolaminar line - TP line
posterior spinous line - SP line

130
Q

lines in vertebrae

A

anterior vertebral line - anterior body
posterior vertebral line - posterior body
spinolaminar line - TP line
posterior spinous line - SP line

131
Q

scoliosis

A

usually idiopathic, lateral curve of spine

most common in females

132
Q

screening recommendations for scoliosis

A

most cases detected through screening do not advance to significant scoliosis so no Tx needed

significant scoliosis detected w/o screening

133
Q

red flag pathology w/ scoliosis

A
  • onset before age 8
  • severe pain
  • rapid curve progression (>1 degree/mo)
  • usual left thoracic curve (convex to the left)
  • neuro deficits/findings

(ask for these in ROS)

134
Q

management/Tx of scoliosis

A

> 45 degree curve needs Tx

Tx w/ bracing, surgery if bad enough

135
Q

adam’s forward bend test

A

Pt bends forward, one side of back would be higher if + for scoliosis

136
Q

acute low back pain characteristics

A

6-12 weeks of pain b/w costal angles and gluteal folds that may radiate down one or both legs

acute LBP is often nonspecific so it cannot be attributed to a definite cause

137
Q

red flags of LBP

A 
TUNA FISH
trauma 
unexplained weight loss
neuro Sx
age (>50)
fever
IVDU
steroid use
history of cancer
138
Q

management/tx of LBP

A

bed rest NOT helpful

NSAIDs and muscle relaxants, Pt education

139
Q

back strain (lumbar SD) Sx

A

usually onset of mild trauma and described as an ache or spasm

exam = discrete tender points, no neuro deficits

140
Q

psoas syndrome Sx

A

Sx: dull ache in low back, sometimes referring to groin

exam = tender point at iliacus (medial to ASIS), + Thomas test

141
Q

herniated nucleus pulposus Sx

A

pain often originates from lumbar spine and radiates down leg into foot w/ sharp burning pain

exam = weakness in effected myotome, usually +SLR

treat w/ rest

142
Q

LBP radiating pain patterns

A

spine (Ms/Ls/discs) -> thigh

SI joint -> thigh, sometimes knee

L1-3 -> high and/or thigh
L4-S1 -> knee

143
Q

disc herniation at L4/L5 - what nerve root impinged

A

L5

144
Q

cauda equina syndrome

A

large central disc herniation compressing the tail of the lumbar spine causing pain similar to herniated disc; impingment S2-S4 can cause bowel/bladder dysfunction

emergent - w/o surgery can cause paralysis

145
Q

spinal stenosis

A

narrowing of space around SC

Sx: LBP radiating down the leg w/ pain, numbness, weakness; pain worsens w/ movement and laying supine

exam = diminished reflexes, weak myotome/dermatome

146
Q

spondylosis

A

defect in pars interarticularis w/o anterior displacement, thinning discs and bone spurs - “scotty dog”

usually at L5/S1

147
Q

spondylolisthesis

A

vertebral body slips in relation to one below

148
Q

imaging w/ LBP

A

only image w/ 6+ weeks or if there are red flags (neuro deficits, or serious conditions)

149
Q

history questions to ask w/ LBP

A 
age
level of trauma
IVDU
steroid use
Hx of cancer
150
Q

ROS questions w/ LBP

A

fever
weight loss
neuro Sx
incontinence

151
Q

GXPXXXX meanings

A

G4P2112 = 4 pregnancies, 2 full term, 1 preterm, 1 abortion, 2 living kids

152
Q

tanner stages pubic hair

A

1 - none
2 - some slightly pigmented hair
3 - darker, coarser hair
4 - adult type hair w/o spread to thighs
5 - adult type w/ horizontal upper border

153
Q

nexus criteria

A
  • no posterior midline cervical tenderness
  • normal alertness
  • no intoxication
  • no neuro findings
  • no painful distracting injuries

*all must be met for no imaging/collar

154
Q

hoover sign

A

pt flexes weak leg against resistance, downward pressure should be felt on non-weak leg

+ no pressure = malingering

155
Q

Gaenslen test

A

pt flexes one hip and other hip is extended

+ posterior pelvic pain = SI joint pathology

156
Q

valsava test

A

bears down

+ sciatica

157
Q

stork test

A

pt flexes hip and bends back

+ LBP = par defect/stress fracture, if bilatreal increased spondylolisthesis risk

PCM2 (1 decks)

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