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PCM III AP > Random > Flashcards

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1
Q

Curanderismo

A

latino healing tradition in mexico and latin american

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2
Q

santeria

A

latino healing tradition in brazil and cuba

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3
Q

espiritismo

A

latino healing tradition in puerto rico

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4
Q

curandero

A

traditional latino healer

use incantations and herbs

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5
Q

sobadores

A

practice manipulation

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6
Q

parteras

A

midwives

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7
Q

what re the cold diagnoses of latinos

A 
Cancer
Colic
Empacho (indigestion)
Frio de la matriz (“frozen womb”)
Headache
Menstrual cramps
Pneumonia
Upper respiratory infections
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8
Q

what are the hot diagnoses of latinos

A 
Bilis (“bile,” rage)
Diabetes mellitus
Gastroesophageal reflux or peptic ulcer
Hypertension
Mal de ojo (“evil eye”)
Pregnancy
Sore throat or infection
Susto (“soul loss”)
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9
Q

white on a CXR

A

mass
fluid
space occupying lesion

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10
Q

how much should a person inspire with CXR

A

diaphragm gets to 9th or 10th rib

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11
Q

why is PA more accurate than AP CXR

A

On an AP CXR view the heart shadow will be falsely enlarged *bed bound pt’s because of the divergence if the x-ray beams.

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12
Q

how does PE show up on CXR

A

normal

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13
Q

5 things measured by ABG

A

pH of blood
Partial pressure of oxygen in the blood (PaO2)
Partial pressure of carbon dioxide (PaCO2)
Bicarbonate level (HCO3)
Oxygen saturation of hemoglobin (O2 sat.)

use:
Radial artery
Brachial artery
Femoral artery

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14
Q

carboxyhemoglobin and the pulse oximeter as well as the ABG machine

A

both cannot distinguish b/w oxyhemoglobin and carboxyhemoglobin so you must get CO-oximeter measurement to get the CO hemoglobin

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15
Q

why do you need ice for transport of ABG to lab?

A

Ice is used because it slows down the metabolism of red cells. if the sample is left for a long time (e.g. transferred to another hospital) then the use of oxygen by cells can lead to a falsely low O2 level in the sample. -

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16
Q

what angle do you insert the needle for ABG collection

A

45 degree angle to skin bevel up

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17
Q

what must you ensure prior to ET tube placement

A

IV placement for sedation!- risk is sudden drop in BP

and muscle relaxant (Succinylcholine, rocuronium)
-risk for arrhythmias and post-op myalgias

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18
Q

differences b/w curved blade and straight blade when intubating

A

Curved blade: tip is inserted into the vallecula

Straight blade
tip is just below epiglottis.***

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19
Q

correct placement measurements for men and women of the ET tube (intubation)

A

21 cm mark - women

23 cm mark- men

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20
Q

how do you verify the ET tube is in the right place

A

Look for: a symmetrical rise of the chest wall.
Listen for: equal breath sounds bilaterally and over the epigastrium. epigepigastrium.

Secure tube to skin with tape or strap
Do CXR to confirm placement is correct.
Monitor respiratory values to confirm proper function

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21
Q

where do you insert Chest tube

A

Prep and drape (sterile) 5th and 6th intercostal ***space in mid-axillary line (least amount of muscle in this area)

*Do not go below this area because of risk of injury to diaphragm or liver

use 1.5 inch needle

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22
Q

what do you use for pneumothorax and hemothorax/pleural effusion

A

Pneumothorax – number 22-24 French straight

Hemothorax or pleural effusion – 32-36 French straight or right angled

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23
Q

where do you direct the tube if inserting a CT for pneumothorax?

how about for fluid?

A

Pneumothorax: direct the tube posteriorly & toward apex

Fluid: direct tube posteriorly, keeping in a dependent position

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24
Q

simple spirometry graphs plot what

A

volume as a function of time

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25
Q

pulmonary function tests plot what

A

flow-volume loops

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26
Q

broad nasal bridge

A

fragile X syndrome

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27
Q

mild microcephaly, bullet shaped head

A

Fetal alcohol syndrome

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28
Q

Low nasal bridge

Frontal prominence

A

Hurler syndrome

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29
Q

Downward slanting of
the palpebral fissures
Low set ears
Micrognathia

A

treacher collins syndrome

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30
Q

cushings disease facial appearance

A

moon face

reddended cheeks

high cortisol

hirsuitism

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31
Q

Puffiness of the face

Thinning and coarsening of the eyebrows and hair

A

hypothyroidism

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32
Q

what is the cause of a preauricular pit

A

Developmental defect in the branchial arches

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33
Q

cone of light tells us what?

A

Cone of light:

  • can deduce if the person has increased pressure in their middle ear with this
  • if it is more diffuse and spread out there is increased pressure

Right ear- cone of light at 5 o clock.
Left ear- cone of light at 7 o clock

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34
Q

most common bacteria with otitis externa

A

pseudomonas

  • This is an infection of the external canal. The canal is painful ** when the auricle is pulled.
  • Otitis externa is often caused by the canal remaining moist. The bacteria responsible for the infection is most often Pseudomonas. ***
  • Oral antibiotics are usually not effective. Ear drops must be used and the canal must be opened and if possible cleaned.
  • A solution of 1 part white vingear (5% acetic acid) mixed with 3 parts water is often helpful in preventing this disorder.
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35
Q

why must diabetics worry about otitis externa

A

Not treated, acute otitis externa can be dangerous. This is especially true in diabetics where it can spread and cause an infection of the soft tissues of the base of the skull called Malignant Otitis Externa.

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36
Q

most common type of epistaxis

A

anterior- in the site of kesselbach’s plexus

Not treated, acute otitis externa can be dangerous. This is especially true in diabetics where it can spread and cause an infection of the soft tissues of the base of the skull called Malignant Otitis Externa.

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37
Q

etiology of posterior epistaxis

which artery is usually involved

A

In general, posterior epistaxis occurs in older patients, who have fragile vessels because of hypertension, atherosclerosis, coagulopathies, or weakened tissue. Bleeding is profuse because of the larger vessels in that location (usually, the sphenopalatine artery) and usually requires hospitalization and surgical treatment.

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38
Q

what causes nasal septal perforation

A

Etiologies include any condition where the blood supply to the septum is chronically compromised
Commonly caused by inhalation (Snorting) of vasoconstrictive substances, i.e. cocaine

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39
Q 
Most common skin cancer
Slow growing
Often found on sun exposed areas 
Fair skinned individuals
Over exposure to radiation; solar, x-rays , etc.
A

basal cell carcinoma

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40
Q

appears as a scaly , crusting patch

A

squamous cell carcinoma

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41
Q

An autosomal dominant disease
Melanin deposition of mucous membranes
Multiple intestinal polyps
15-fold increase in cancers of the gastrointestinal tract

A

Peutz-Jeghers syndrome

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42
Q

what is geographic tongue and what can it be associated with

A

Appearance is caused by loss of papillae
May be linked to Vitamin B deficiency
No treatment is necessary

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43
Q

what is hairy leukoplakia

activities?
diseases?

A

Usually an early sign of HIV infection
Associated with pipe smoking and chewing tobacco or snuff
May resemble thrush
Usually painless
Rarely undergoes malignant transformation

doesn’t scrape off

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44
Q

what type of cancer is tonsillar cancer usually and what disease is it linked to ?

A

squamous cell
usually linked to HPV

Often present late in the course of the disease since there are few early symptoms

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45
Q

what is a torus palatinus

A

A hard bony growth in the center of the roof of the mouth (hard palate). It is
Not a tumor but rather a benign bony growth called an exostosis.
Commonly occurs in females over the age of 30 and rarely needs treatment.
Occasionally it is removed for the proper fitting of dentures

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46
Q

what commonly causes tonsilitis

A

gram positive bacteria

strep pyrogenes can lead to rheumatic fever

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47
Q

what do hear on auscultation of pneumonia?
Percussion?
Special tests?

A

Decreased breath sounds over affected area
Sounds over affected area are bronchial rather than vesicular
Primarily rhonci but may have wheezing

Percussion
Dullness

Special Tests
Bronchophony-Increased- sounds moves better through fluid
Tactile fremitus-Increased

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48
Q

what is heard on auscultation, percussion and special tests of COPD

A

Auscultation
Decreased breath sounds throughout lung fields- b/c air has poor sound transmission
Primarily wheezing but may have rhonci

Percussion
Hyperresonance

Special Tests
Bronchophony-Decreased
Tactile fremitus-Decreased

CXR–> more air in the lungs (flattens diaphragm) and pt’s heart shifts right and more vertical orientation

decreased lung markings

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49
Q

what is heard on auscultation, percussion and special tests of congestive heart failure

A

Auscultation
Decreased breath sounds most prominent in dependent portions of the lung
Rales (crackles)

Percussion
May be unchanged or decreased over dependent portions of the lungs

Special Tests
Bronchophony-Usually unchanged
Tactile fremitus-Usually unchanged

CXR- diffuse whiteness b/c lungs are distended with fluid and big heart

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50
Q

what is heard on auscultation, percussion and special tests of pneumothorax

A

Auscultation
Breath sounds decreased or absent on affected side

Percussion
Marked hyperresonance

Special Tests
Bronchophony-Decreased
Tactile fremitus-Decreased

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51
Q

what is heard on auscultation, percussion and special tests of pleural effusion

A

Auscultation
Decreased or absent on affected side

Percussion
Dullness on affected side

Special Tests
Bronchophony-Unchanged
Tactile fremitus-Decreased*** b/c fluid is in b/w the lung tissue and the physicians hand

most commonly occurs b/w of lung cancer

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52
Q

3 reasons to be anemic

A

Blood loss
Increased destruction (hemolysis)
Decreased RBC production

53
Q

MCV

A

mean cell volume

usually 80-100

microcytic < 80
macrocytic >100

54
Q

causes of macrocytic anemia

A

ethanol
folate / vitamin B12 deficiency

myelodysplastic syndrome

AML

liver disease

55
Q

causes of microcytic anemia

A 
iron deficiency anemia
thalassemia 
anemia of chronic disease
sideroblastic anemia
copper deficiency 
lead intoxication
56
Q

reference range for MCHC

A

33-37

57
Q

hypochromic?

A

low hemoglobin (MCHC)

58
Q

reticulocyte staining pattern?

A

This remnant Ribosomal RNA reticulum stains blue with Methylene Blue

This ribosomal RNA is extruded during the first 24 to 36 hours of circulation

larger than mature RBC’s

Reticulocytes represent ~2% of the red cell population

59
Q

adult retic count

A

0.5-1.5%

60
Q

child retic count

A

3.0-7.0

61
Q

after an episode of acute hemorrhage, when do reticulocytes increase

A

3-4 days

should peak at 6-10 days=6 - 8%.

62
Q

causes of reticulocytosis

A

Acute blood loss or hemorrhage

Acute hemolysis

Hemolytic anemia

Response to therapy (Fe or other
nutritional correction of deficiency)

63
Q

ferritin
TIBC
serum iron
soluble transferrin receptor (sTfR)

in iron deficiency anemia

A

ferritin- low
TIBC- high
serum iron low
sTfR- high

64
Q 
ferritin
TIBC
serum iron 
soluble transferrin receptor (sTfR)
anemia of chronic disease
A

ferritin- high
TIBC- low
serum iron - low
soluble transferrin receptor (sTfR)- normal

65
Q

ferritin
TIBC
serum iron
soluble transferrin receptor (sTfR)

sideroblastic anemia

A

ferritin- high
TIBC- low
serum iron - high
soluble transferrin receptor (sTfR)- low

66
Q

causes of normocytic anemia

A

Acute Blood Loss

Autoimmune Hemolytic

Anemia of Chronic Disease
Infection
Inflammation
Malignancy

Anemia of Chronic Renal Failure

Bone Marrow Failure
Aplastic Anemia
Marrow Replacement
fibrosis/malignancy

Sickle Cell Anemia

67
Q

if you have macrocytic anemia, what lab studies should you obtain

A

reticulocytes
peripheral smear
B12/folate

68
Q

most common time when needle sticks occur

A

40% after use, but before disposal

69
Q

most common mode of transmission of pathogens is via what

A

hands

70
Q

what kind of handrub is best at killing bacteria

A

alcohol based handrub

71
Q

what are some rules in the OR concerning sterile field

A

Needles are never picked up by ones fingers
Fingers and hands are never used a retractors
A verbal warning always precedes the
movement of sharps from one member of
the team to another.
Double gloving may occur

Keep hands at waist level and in sight at all times
Keep hands away from face
Never fold hands under arms
Sit only if for entire procedure

72
Q

what is sterile in the OR

A

front of the gown from just below the neck to the waist, at the level of the sterile field, table level
Gloved hands and arms up to the shoulders.
Draped part of the patient down to the
table level, anything over the edge of the table is considered unsterile, such as a table drape or a suture.
Covered parts of the “Mayo” stand
and “back table”, instruments on the tables.
Sterile areas are created as close as possible to time of use. They are always kept in view.

73
Q

Variation in Red Cell Size

A

Anisocytosis

74
Q

when do you see schistocytes

A

TTP (Thrombotic thrombocytopenic purpura)
DIC (Disseminated intravascular coagulation )
HUS (Hemolytic uremic syndrome )
Defective heart valves**
Hemolytic anemias

75
Q

Stomatocyte

A

Folded RBC mimicking a mouth and lips (slit-like appearance). Seen in hemolytic anemias, either constitutive or acquired

76
Q

dacrocyte?

A

tear drop shaped

myeloproliferative disorders
myelofibrosis
pernicious anemia
thalassemias

77
Q

codocyte

A

target cell

seen in Sickle cell, HbC & the thalassemias.

78
Q

acanthocyte

A

burr cell

Red cells with irregularly spaced projections, variable in width with rounded ends. Seen in liver disorders.

79
Q

Poikilocytosis

A

abnormal shape

80
Q

what are some causes of decreased central pallor of RBC’s

A

hereditary spherocytosis

autoimmune hemolytic anemia

81
Q

rouleaux “stack of coins”

A

multiple myleoma

due to elevated plasma fibrinogen or globulins

82
Q

when do you see normoblast in the peripheral smear

A

Nucleated red cells in blood indicate a severely “stressed” bone marrow unable to meet increased red cell requirements. They are seen in patients undergoing hemolytic crises.

83
Q

when do you see basophilic stippling

A

round, dark-blue granules in reticulocytes on smears stained with supra vital stains (brilliant cresyl blue).

The granules are precipitated ribosomes and mitochondria. Classic finding in lead poisoning***

84
Q

howell - jolly bodies

A

: Spherical blue-black red cell inclusions seen on Wright-stained smears.

They are nuclear fragments of condensed DNA, 1-2 µm diameter, normally removed by the spleen. Seen in severe hemolytic anemias and in post-splenectomy*** patients

85
Q

Plasmodium vivax signet ring

A

seen on malaria blood smear

86
Q

neuts make up what percent of the wbc count

A

50-60%

Elevated in bacterial infections, stress, corticosteroid therapy (asthma!)

Immature forms
often present with
elevated count (bands, metamyelocytes, myelocytes)

87
Q

lymphocytes make up what percent of the wbc count

when are they elevated

when do you see fragile lymphocytes (smudge cells)

A

30-40%

Elevated in viral infections (Epstein-Barr, etc.)

“atypical” lymphocytes (mono)

Fragile lymphocytes (smudge or basket cells) are common in chronic lymphocytic leukemia (CLL)

88
Q

when are basophils elevated

A

<1% usually

elevated in CML (chronic myelogenous leukemia)

89
Q

Dohle bodies

A

Seen in systemic infectious or inflammatory disease
Often accompanied by a left shift, toxic granulation and cytoplasmic vacuoles

little blue things in cytoplasmic vacuoles

(sepsis!!)

90
Q

what defines hypersegemnted neuts

A

> 5 lobes

megaloblastic anemias

91
Q

when do you see reduced lobulation of white cells

A

myelodysplastic syndromes

92
Q

when do you see an increase in plasma cells

A

may indicate lymphoid neoplasia (e.g., multiple myeloma)

93
Q

when do you get spontaneous bleeding (platelet count?)

A

<25,000

94
Q

do you ever give 1 unit of platelets?

A

no , usually give at least 5

1 unit only equals 5,000

95
Q

giant platelets?

A

Suggest marrow response secondary to increased platelet destruction or consumption
Congenital disorders
Immune destruction
Disseminated intravascular coagulation (DIC)
Hemolytic uremic syndrome (HUS)
Thrombotic thrombocytopenic purpura (TTP)

96
Q

how does visceral pain present

A

Visceral Pain (colic pain): source is usually hollow organ caused by distension or stretching. Comes and goes, crescendo/decrescendo pattern. CrampingNot well localized.

97
Q

causes of unconjugated hyperbilirubinemia

A 
Hemolysis
Red cell defects – sickle cell
Ineffective erythropoiesis
Deficient hepatic uptake
Deficient hepatic conjugation – hepatitis
98
Q

Serum alkaline phosphatase is elevated out of proportion to the transaminases.

what is this a sign of

A

conjugated hyperbilirubinemia

causing jaundice

99
Q

4 signs of free fluid in the abdomen

A

Bulging flanks
Tympany at the top of the abdomen
Fluid wave
Shifting dullness

100
Q

borborygmi

A

Increased, hyperactive bowel sounds,
Low pitched rumbling
Hyperperistalsis

101
Q

what causes anal warts

A

HPV

syphilis

102
Q

most sensitive imaging test for appendicitis

A

CT

103
Q

what must you do in a suspected appendicits case in a female

A

pregnancy test

104
Q

RUQ pain, fever and leukocytosis.

A

acute cholecystitis

Do Ultrasound
HIDA scan
CT scan

105
Q

Low grade fever
Hypotension
Decreased or absent bowel sounds
Epigastric tenderness
Turner’s sign – discoloration around the flanks
Cullen’s sign – discoloration around the umbilicus
D/T Hemorrhagic pancreatitis

A

acute pancreatitis

106
Q

painless juandie is what until proven otherwise

A

pancreatic cancer

107
Q

situations where voided sample are not adequate

A
  • Vaginitis
  • Menses
  • Extremes in age
  • Morbid obesity
108
Q

why is urine blue/green

A

drugs or ingested dyes, pseudomonas

109
Q

why would you have nitrites in the urine

A
  • Nitrites-Urinary tract infection, nitrogen in the urine and the bacteria in the urine changes them from nitrates to nitrites
  • If leukocytes and nitrates are positive there is a 74% predictive value for UTI, and 97% predictive value if both are negative
110
Q

most common cause of UTI

A

e coli

111
Q

calcium oxalate crystals?

A

meaningless

112
Q

WBC casts

A

acute pyelo

113
Q

what is included in a 24 hr urine collection

A
  • Total protein
  • Calcium, sodium, potassium
  • Creatinine (Cr)and creatinine clearance (CrCl)
  • Clearance = Urine Cr (x) Total volume / Plasma Cr (x) Time
114
Q

contraindications for catheter of bladder

A
  • Known urinary tract obstruction (stricture)
  • Reconstructive surgery of urethra or bladder neck
  • Combative or uncooperative patient
  • Pelvic trauma – suspect urethra injury
  • Acute infection of the prostrate and/or urethra (relative)
115
Q

contraindications for suprapubic catheter

A
  • Uncooperative patient
  • Blood dyscrasia or anti coagulation treatment
  • Infection or cellulitis of the suprapubic area
116
Q

procedure for suprapubic catheter

A
  • 1 cm lateral incision 5 cm above pubic symphysis – midline
  • Obturator and catheter are inserted through the incision and directed inferiorly at 60⁰
  • Advance through rectus sheath and into the bladder dome
117
Q

contraindications for cystoscopy

A

• Relative -UTI or pyelonephritis-Can cause sepsis so patient is usually treated with antibiotics before procedure

118
Q

contraindications for circumcision

A
  • Hypospadius or epispadius- need foreskin as landmark
  • Atypical genitalia
  • Undetermined phenotype (ambiguous genitalia)
  • Less than 12 hours postpartum
  • Illness
  • Prematurity (Relative)
  • Familial bleeding disorder
  • Maternal thrombocytopenia
119
Q

contraindications for vasectomy

A
  • Infection
  • Coagulation disorder
  • Inability to palpate or elevate vas deferens
  • Stress – divorce, financial
  • Inappropriate reasons for wanting procedure
  • Concern about ability to perform sexually after the procedure
120
Q

Contraindications to NG tube

A 
Facial trauma 
Basilar skull fracture
Bilateral nasal obstruction  
Recent nasal, pharyngeal,  esophageal or gastric surgery 
Bleeding diathesis
121
Q

levin tube

A

The Levin tube is a one-lumen nasogastric tube. The Levin tube is usually made of PVC with several drainage holes near the gastric end of the tube. There are graduated markings on the lumen so that you can see how far you have inserted the tube into the patient.

122
Q

Salem Sump

A

The Salem-Sump tube is a two-lumen tube. It has a drainage lumen and a smaller secondary tube that is open to the atmosphere. The second lumen allows for continuous suction and prevents gastric mucosa from being aspirated into the tube.

123
Q

absolute contraindications for EGD

A

Known or suspected perforation
Medically unstable patients
Obstruction

124
Q

relative contraindications for EGD

A

Anticoagulation
Pharyngeal diverticulum
Recent head or neck surgery
Esophageal stricture

125
Q

The following increase the risk of what?

  • Alcohol use
  • Cigarette smoking
  • Surgery or radiation to the chest (for example, treatment for lung cancer)
  • Taking certain medications, i.e. tetracycline, doxycycline, vitamin C and aspirin
  • Prolonged vomiting
  • Persons with weakened immune systems due to HIV and certain medications (such as corticosteroids)
  • Fungi or viruses
A

esophagitis

126
Q

most common sites of esophageal mets

A

lungs, pleura, liver, stomach, peritoneum, kidneys and the adrenal gland.

127
Q

most common sites of gastric cancer

A

most common sites of gastric cancer are the proximal lesser curvature, cardia, and GE junction

128
Q

absolute contraindications for sigmoidoscopy

A 
Bowel perforation
Acute diverticulitis
Active peritonitis
Fulminant colitis
Cardiopulmonary instability

PCM III AP (1 decks)

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