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Hannah- PCM > PCM Final Cumulative > Flashcards

PCM Final Cumulative Flashcards

1
Q

when does the frontal sinus develop ?

A

8-10 y/o

Born with maxillary and ethmoid sinus

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2
Q

what causes cobblestoning in the throat

A

post nasal dripping

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3
Q

what are the common viral causes of sinusitis

A 
FARP
Flu
adenovirus
rhinovirus
parainfluenza virus
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4
Q

what are the common bacterial causes of sinusitis

A

SMH
streppocal pneumonia
moraxella catarrhelis
haemophilis flu

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5
Q

what labs should be used for acute bacterial maxillary sinusitis

A

ESR or CRP ( but not needed)

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6
Q

what are key symptoms and clinical presentations of bacterial sinusitis

A
  • double sickening
  • purulent rhinorrhea
  • elevated ESR (eythroycyte sedimentation rate)
  • is acute bacterial rhinosinusitis if persists without evidence of improvement for at least 10 days beyond the onset of upper respiratory symptoms
  • first line antibiotics: amoxicillin, augmentin
  • second line: doxycycline, levaquin, clindamycin, and cefixime
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7
Q

what is Croup

A
  • AKA Laryngotracheitis
  • barking cough
  • swelling of larynx trachea, and bronchi, causing inspiratory stridor in children 6months-3 y.o
  • caused by the flu or respiratory syncytial virus
  • presents with fever, nasal flaring, respiratory retractions, stridor
  • tx: O2, dexamthosome, epinephrine
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8
Q

what is epiglottitis

A
  • emergent
  • inflammation of epiglottis and adjacent structures
  • caused by haempphilus type B flu, GABHS
  • rapid onset, sore throat, muffled voice, drooling
  • high grade fever, leaning forward
  • TX: protect airway, antibiotics
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9
Q

ENT Differential causes of vertigo

A
  1. eustachian tube dysfunction
  2. Benign paroxysmal positional vertigo (BPPV)
  3. vestibular neuritis
  4. labyrinthitis
  5. Menieres disease
    (BE a LVing Mother)
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10
Q

vestibular neuritis (neuronitis) vs. labyrinthitis

A

VN: inflammation of the nerve associated with balance causing vertigo but no change in hearing
(damage to sensory neurons of vestibular ganglion)

L: infection of inner ear; affects both branches of vestibule-cochlear nerve causing hearing changes and vertigo

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11
Q

Meniere’s disease

A

inner ear disorder causing vertigo, fluctuating hearing loss until complete loss, rising of ear (tinnitus), pressure in ear

  • usually one ear
  • any age (normal 20-50)
  • considered chronic
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12
Q

outer, middle, inner ear pathology

A

otis externa,
otis media
labyrinthitis

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13
Q

what is the most common cause of BPPV

A

canalthiasis

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14
Q

canalthiasis vs cupulothiasis

A
  1. canal stones
    - otoconial debris are floating freely in semicircular canals
    - posterior multiple canals SCC involved
  2. cupulo stones
    otoconial debris are adhered to the cupula of the crest ampullaris
    -not freely floating
    -not common
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15
Q

to moves to confirm or treat BPPV

A
  1. dix hall pike maneuver
    - seated, legs in front, rotate head 60 degree and extend 20 degrees, lay back quickly and observe nystagmus, or vertigo symptoms, hold 30 sec and repeat 3 times each side
  2. empley maneuver
    - rotate head 45 degrees and lay back to extend head 20-30 degrees, look for nystagmus, after 30 sec rotate 90 degrees to other side and hold 30 sec, rotate another 90 by turning onto side, then sit up. helps manipulate crystal to canal opening and help ease symptoms
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16
Q

atelectasis

A

collapse of lung tissue that affects the alveoli from normal O2 absorption

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17
Q

pleximeter finger and plexor finger

A
  1. hyperextended middle finger of non dominant hand in percussion
  2. tapping finger, dominant hand
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18
Q

what does atelectasis cause

A

decreased breath sounds, moved trachea, diaphragmatic excursion (unilateral ) , crackles during inspiration , fever.
use IS to treat

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19
Q

where is a needle thoracentesis placed

A

2 ICS, midclavicular line

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20
Q

where is a chest tube placed

A

4th or 5th ICS, anterior to midaxillary line

or 5th ICS inferior to nipple or inframammary fold
always over superior margin bc NV is at inferior margin

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21
Q

what is the 5th vital sign you need for lower respiratory assessment

A

Pulse oximetry

  • O2 hg absorbs infrared light and allows red light to pass. (non O2 hg is opposite). amount of light received by detector indicates SpO2 (peripheral arterial O2 saturation)
  • % saturation = red/ red + blue
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22
Q

what can cause improper waveforms of a pulse ox

A

improper placement, hypo perfusion , hypothermia, motion artifact, skin pigment

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23
Q

what is end tidal CO2

A

concentration of CO2 in exhaled air at the end of respiration
-PETCO2 = PaCO2 (35-45)

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24
Q

what is incentive spirometer

A

IS is a treatment used to practice inhalation and holding it. (used for atelectasis )

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25
Q

what is spirometery

A

lung fun measurement

  • amount and speed of air inhaled and exhaled
  • dx. b/t obstructive and restrictive
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26
Q

during inspection what can cause asymmetrical expansion

A

pleural effusion

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27
Q

during inspection what can cause retractions

A

severe asthma, COPD, upper airway obstructions

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28
Q

during inspection what can cause unilateral lagging

A

pleural disease (asbestosis, trauma, phrenic never damage)

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29
Q

what causes tracheal deviation

A

pneumothorax, pleural effusion, atelectasis, mass

PPAM

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30
Q

what causes nail clubbing

A

congenital heart disease, interstitial lung disease, bronchiectasis, pulmonary fibrosis, cystic fibrosis, lung abscess, malignancy, IBD [not COPD or asthma, smoking or anemia)
C- BLIMI

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31
Q

barrel chest and pursed lips

A

COPD

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32
Q

presentation of chronic bronchitis (COPD)

A

blue bloater

  • cough for 3+ months
  • overweight and cyanotic
  • elevated Hg
  • edema
  • ronchi and wheezing
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33
Q

clinical presentations of emphysema (COPD)

A

pink puffer

  • older/ thin
  • severe dyspnea (feeling SOB)
  • flattened diaphragms on Xray with hyperinflation
  • decreased breath sounds
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34
Q

what causes flail chest

A

trauma of rib fracture

  • unilateral change in respiration
  • in during inhale and out during exhale
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35
Q

during palpation and tactile fremitus, what causes decreased sounds ? increased sounds?

A

COPD, pleural effusion, fibrosis, tumor, pneumothorax

pneumonia

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36
Q

during percussion, what causes dullness, b/l hyper resonance, unilateral hyper resonance , tympanic

A

dull- fluid or solid replaces air in lungs [ pneumonia, effusion, hemothorax, fibrous tissue or tumor]

b/l : hyper inflated lungs [ COPD, asthma]

Uni: pneumothorax, large air filled bubble in lung

tympanic: abdominal percussion (gastric bubble)

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37
Q

what does a healthy lung sound like during percussion

A

resonant: loud intensity, low pitch, long duration

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38
Q

what can cause diaphragmatic excursion asymmetry

A

pleural effusion, atelectasis, phrenic nerve paralysis

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39
Q

what are the normal lung auscultation sounds

A

vestibular, (high pitched, breezy)
bronchovestibular ( coarse, loud)
broncial (coarse, loud)
tracheal

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40
Q

Lung sound: rhonchi

A

coarse low pitched, may clear with cough

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41
Q

Lung sound: wheeze

A
  • expiratory
  • whistling high pitched bronchus
  • rapid airflow thru narrow bronchial airway
  • RAD, asthma, COPD
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42
Q

Lung sound: crackles (rales)

A
  • inspiratory
  • fine crackling, high pitched. like velcro
  • intermittent
  • small airway closure due to exipiration and popping open during inspiration
  • pneumonia, CHF, atelectasis, pulmonary fibrosis, broncietasis, COPD asthma
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43
Q

Lung sound: stridor

A

inspiratory

-narrowing upper airway from Croup, epiglottitis , anaplaxis , upper airway obstruction

44
Q

primary and accessory muscles of breathing

A

primary - diaphragm

accessory- scale, sternomastoids, intercostal, subcostal

45
Q

describe normal vocal resonance during lung auscultation

A

words are muffled and indistinct
whispered words are faint and indistinct
pt says “ee” and you head a long muffled E

46
Q

bronchophony

A

spoken words get louder

47
Q

whispered pectoriloquy

A

whispered words are louder and clearer during auscultation

48
Q

egophony

A

pt says “ee” and you hear “A”

49
Q

CTAB on documentation means

A

clear to auscultation bilaterally

50
Q

ABC’s of X-rays

A

adequate, airway, bones, cardiac size, diaphragms, effusions, endotracheal tube, EKG leads, fields and fissures, foreign bodies, great vessels, gastric bubble, hilar masses, impression

51
Q

unilateral vs bilateral decrease in breath sounds

A

uni- pneumothorax, fluid in lungs on one side

b/l- asthma, COPD

52
Q

five finger method of normal CV exam

A

history, physical, ECG, labs, imaging

I HELP

53
Q

palpate heart for ___ and ____

A

PMI and thrills

54
Q

how to percuss the heart

A

start lateral to the left (resonant) and move medial (till dullness)

55
Q

where do you auscultate for the CV exam

A 
aortic - 2 ICS on RSB 
pulmonic - 2ICS at LSB 
tricuspid - 4th ICS on LSB 
mitral - 5th ICS at LMCL 
carotids with bell for bruits ( hold breath and do one at time)
56
Q

describe the S1 heart sound

A

closure of AV valves.
loudest at Apex
-beginning of ventricular systole
-mitral then tricuspid

57
Q

describe S2 heart sound

A

closure of semilunar valves

  • loudest at base
  • Av-> PV
  • end of ventricular systole
  • splits when preload increases and causes PV to close slower during inspiration
58
Q

S3 and S4 heart sound

A

S3- after S2 from blooding rushing into the ventricles from high pressure.

  • Kentucky
  • CHF in elderly

S4- before S1. atrial gallop from forceful contraction of atria against still ventricle

  • Tennessee
  • hypertrophy from CAD
  • normal in athletes
59
Q

murmur grading

A 
1- barely audible
2- soft but easily heard
3- loud w//o thrill 
4- loud with thrill 
5- loud with minimal contact with stethoscope and thrill
6- loud w/o stethoscope and thrill
60
Q

what does JVP and JVD measure

A

estimate of CVP and RA pressure
activity of right side of heart
if JVP visible gives indication of CV pathology or RA pathology
internal jugular is better than external jugular
*MCC of elevated JVP is elevated RV diastolic pressure

61
Q

causes of increased JVD/JVP

A

MCC- elevated RV diastolic pressure

  • SVC obstruction
  • severe heart failure
  • constrictive pericarditis, cardiac tamponade, RV infarction
  • restrictive Cardiomyopathy
62
Q

things that cause HJR (hepato-jugular reflex)

A

RV failure
constrictive pericarditis
Obstructuve RV filling by tricuspid or atrial tumor

63
Q

what makes murmurs louder or softer

A

RINSPIRATION (tricuspid and pulmonic louder on inspiration)

LEXSPIRATION (mitral and AV louder on expiration)

preload increases = louder (HOCM and MVP exception)
after load increases = louder (HOCM and MVP exception)

64
Q

what is HOCM

A

hypertrophic obstructive Cardiomyopathy

  • family history of sudden death at young age
  • murmur is softer with increased preload
65
Q

what is MVP

A

Mitral valve prolapse

  • leafest of MV prolapse into the left atria under normal pressure and blood flow (regurg happens)
  • increase in preload (EDV) improves the mid-systolic click and decreases murmur sound
  • common in women with mental disorders
  • seen with MVD ( myxomatosis valvular disease)
66
Q

Murmur presentation: Aortic stenosis

A

systolic murmur

  • crescendo- decrescendo murmur
  • Old SAD (syncope, angina, dyspnea)
  • calcifed aortic valve
  • radiates up to carotids
  • sound gets softer with decreased preload and increased inter thoracic pressure
67
Q

Murmur presentation: mitral regurgitation

A

systolic murmur

  • seen with rheumatic disease
  • radiates to axilla
  • best heard at APEX
  • holosystolic murmur
68
Q

Murmur presentation: tricuspid regurgitation

A

systolic murmur
history of IVDA
-holosystolic

69
Q

Murmur presentation: aortic regurgitation

A

diastolic murmur

  • blowing murmur
  • seen with Marfan’s, head bobbing, water hammer pulse, femoral bruits
70
Q

Murmur presentation: mitral stenosis

A

diastolic murmur

  • opening snap
  • rheumatic disease
71
Q

A wave of JVP curve

A

right atrial contraction, when the TV opens

  • with S1 sound
  • increased with RA/ RV obstruction, increased pressure in RV, pulmonary HTN, pulmonary emboli, AV dissociation
72
Q

C wave of JVP curve

A

backward push by closure of the TV during isovolumetric systole

73
Q

X wave of JVP

A

passive atrial filling and atrial relaxation

-steep X wave in cardiac tamponade and constrictive pericarditis

74
Q

V wave of JVP

A

atrial filling

  • increased with increased volume and pressure in RA
  • prominent with tricuspid regurg and and pulmonary HTN
75
Q

Y slope of JVP

A

open TV and rapid RV filling

  • deep wave in severe tricuspid regurg
  • slow Y = obstruction to RV filling
76
Q

pleural friction rub sound in lung auscultation

A
  • inflamed pleural surfaces rub and increase friction

- creaking sound during expiration

77
Q

cheilitis

A

red cracks on corner of mouth

-b12 or Fe deficiency

78
Q

torus palatinus

A

benign lump on hard palate

79
Q

sprain vs strain

A

sprain -ligament tearing. blood will cause bruise. hear ‘pop’ . immediate pain and swelling, bruising. more severe.

strain- muscle tear. ‘grabbing sensation’

80
Q

sensitivity vs specificity

A

sensitivity- true positive. proportion of pts with dx and physical signs

specificity - true negative. portion of its without the dx and lack of physical signs

SnNOUT ( sensitive test with a negative rules a disease out)
SpPIN ( specific test with a positive result rules IN a disease)

81
Q

VINDICATE - differential building

A 
vascular 
inflammatory 
neoplastic
degenerative/deficiency 
idiopathic/ intoxication 
congenital 
autoimmune/ allergic 
traumatic 
endocrine
82
Q

joint vs extremity exam

A

both : inspect, palpate, ROM, special test

extremity add: DTR, NV status

83
Q

shoulder is the only joint that ___

A

tendons (rotator cuff) pass between bones (acromion and humerus )

84
Q

what tests for acromioclavicular injury

A

cross arm test

85
Q

rotator cuff tendon injury or subacromial impingement tests

A 
painful arc
neer impingement sign 
hawkins impingment
empty can test
drop arm test

speeds and yeargesons (bicipital tendon)

86
Q

dislocated shoulder presentations

A

-usually anterior dislocation

posterior or inferior is also possible

87
Q

rotator cuff muscles

A

SITS

  • supraspinatus,
  • infraspinatus
  • teres minor
  • subscalpularis
88
Q

most rotator cuff tendon injures are what muscle

A

surpraspinatus tendon

89
Q

most common cause of chronic shoulder pain

A

rotator cuff disorder
adhesive capsulitis
shoulder instability
shoulder arthritis

90
Q

septic arthritis (life threatining)

A
  • common in elderly, RA, prothestics, IVDA
  • knee involved 50% of time
  • joint is red, swollen, warm, and tender
  • ROM limited
  • aspirations of synovial fluid, fever, tachycardia, and hypotension
  • treat with antibiotics, surgical washout
91
Q

most common cause of lateral hip pain

A

trochanteric bursitis

92
Q

legg calve perthes disease

A

idiopathic avascular necrosis (osteonecrosis) of hip

  • decreased perfusion to femoral head
  • kids 3-12
  • obesity is a risk factor
  • x rays show loose chondral bodies
93
Q

Slippeed capital femoral epiphysis ( SCFE)

A

-pain and limited ROM with femoral head slippage
-obesity 8-15 y.o.
-impaired internal rotation, hip pain , limping
-

94
Q

femoroacetabular impingement

A

pain with prolonged sitting, leaning forward and getting out of car

  • pain in groin area and buttocks
  • c sign, FADIR, FABER test

(labral tear has positive thomas test )

95
Q

pririformis syndrome

A
  • sciatic nerve pinch
  • wallet sign
  • log roll and PACE test (FAIR)
96
Q

clinical presentation of hip fracture

A

external rotation and abduction of leg, also leg looks shortened

97
Q

for nursemaids elbow what is the best treatment

A

hyperpronation

98
Q

median nerve entrapment test

A

Ok sign
or for carpal tunnel tingles test at wrist

(cubital test should use for ulnar nerve trapment and tinels at elbow)

99
Q

skiers thumb is a tear in what

A

ulnar collateral ligament of thumb (medial collateral ligament )

100
Q

difference b/t collet and smith fracture

A

both are fracture of distal radius

  • colles = posterior displacement
  • smtih = anterior displacement of wrist and hand
101
Q

monteggia fracture vs galeazzi vs nightstick fracture

A
  1. proximal ulnar fracture with radial head dislocation
  2. fracture of distal radius with dislocation of ulna
  3. fracture of mid shaft ulna
102
Q

what is a muddlers sign

A

clicking sensation when palpating the third intermetatrsal space

103
Q

what is tinea pedis

A

fungal infection of the foot

  • dry scaling itching
  • topical cream
104
Q

what is onchomycosis

A

fungal infection of the nail

  • thick discolored nails
  • oral meds
105
Q

thompson test

A

achilles tendon rupture

-squeeze calf and look for plantarflexion

106
Q

homens sign and moses sign

A
  1. dorsiflex foot and if plain then DVT

2. pain with anterior compression = DVT

Hannah- PCM (3 decks)

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