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PCM 2 > Semester 4 Final > Flashcards

Semester 4 Final Flashcards

1
Q

What is Mobitz type I heart block?

A

“Wenckebach”: Second degree heart block Each successive atrial impulse encounters a longer delay until it can’t get through; more common, less serious, may be transient, higher in AV node

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2
Q

Signs of pleural effusion on CXR

A
  • Fluid in the pleural space
  • Pleura can hold a lot of fluid
  • Need around 250 cc’s to see
  • Meniscus sign
  • Usually free-flowing, but can be loculated, sub-pulmonic, infected
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3
Q

What are burrows?

A

Elevated channels in the superficial epidermis produced by a parasite such as scabies or worms

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4
Q

What indicates ischemia during an EKG stress test or during angina?

A

ST depression T wave inversion

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5
Q

Patch

A

Large flat skin lesion

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6
Q

Which is the correct way to write the following dose?

1 microgram

1.0 mcg

1 μg

1 mcg

A

Do not use trailing zeros (1.0), and micrograms should be abbreviated mcg, not with a μ, which can be confused with an m

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7
Q

4 elements of a law suit

A

Duty

Breach of duty

Causation

Damages

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8
Q

Pygmalion Effect

A
  • Researcher’s belief in the efficacy of a treatment changes the outcome of the treatment
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9
Q

Treatment following HCV exposure

A
  • Test at baseline and at four to six months with anti HCV and ALT
  • Can perform HCV RNA test at four to six weeks
  • No therapy is effective in preventing HCV infection, but treat acute infection aggressively
  • No special sexual precautions advised
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10
Q

C-spine exam technique for patient with trapezius pain or retro-occipital “headache”, cervical nerve radicular pain

A

Technique: Lateral flexion of head (“touch your ear to your shoulder”) to both sides.

Pt should be able to move at least 30 degrees towards shoulder

decreased mobility without pain suggests DJD or inflammatory C spine disease especially ankylosing spondylitis. Ipsilateral decreased or normal flexion with pain suggests nerve impingement. Contralateral trapezius pain suggests paracervical muscle spasm secondary to Cspine DJD

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11
Q

Exam technique for penis

A

Look at penis, inspect all sides, open meatus

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12
Q

Common causes of protuberant abdomen

A
  • Fat
  • Gas
  • Tumor
  • Ascities
  • Pregnancy
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13
Q

Papule

A

Small raised, solid and rounded skin lesion

Smaller than 0.5 cm diameter

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14
Q

Primary vs Secondary vs Tertiary prevention

A

o Primary – prevent disease occurrence – vaccinations

o Secondary – early detection – pap smear

o Tertiary – reduce the consequences of disease - insulin

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15
Q

PPE for listening to lungs of ventilated patient

A

mask with face shield and gloves

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16
Q

Tips for dealing with patient with narcissistic PD

A
  • Self centered, criticize others, believe that no one is qualified to care for them
  • Issue: fearful, threatened, and vulnerable but they can’t admit this or are unaware of this.
  • Helpful: avoid confrontation, emphasize that they deserve the best the staff can give, be sure staff are on the same page
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17
Q

Tips for dealing with patient with dependent PD

A
  • Patients ask many questions, don’t want you to leave the room, call you frequently
  • Fear: afraid you won’t find them worth treating, fear you’ll abandon them
  • Helpful: regular, brief sessions – set tactful limits, say to them you’ll come back later – and briefly do.
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18
Q

Normal shoulder ROM findings

A

Pt can elevate the arm 180 degrees from the side and then touch the contralateral trapezius behind the head (external rotation) and then re-elevate and touch the ipsilateral paralumbar muscles internal rotation), it is extremely unlikely there is significant shoulder disease

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19
Q

Selection bias

A

Non-random assignment to study group

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20
Q

6 steps for delivering bad medical news

A
  1. Schedule the meeting - have enough time
  2. Determine if the patient understands seriousness of the illness
  3. Do they want to know more
  4. Deliver news, then listen
  5. Ask how the patient feels
  6. Move forward, what’s next?, offer hope
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21
Q

What is a RCT study?

A

Randomized Controlled Trial - In this type of study, participants are randomly assigned, using a computer or matrix, into the control group or the investigational group. The control group receives the typically used or approved treatment; the investigational group receives the treatment or intervention being studied. This study type is generally considered the most rigorous study design.

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22
Q

Exam technique for the prostate

A

Palpable by direct rectal exam, chestnut sized, consistency of the thenar eminence

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23
Q

Tips for dealing with patient with obsessive PD

A
  • Patients are insistent and detailed – they want all the information
  • Issue: angry when they are not in control of their illness, the staff, the schedule, or their lives
  • Helpful: give detailed explanations, provide choices when possible, try to use the patients input in a collaborative way
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24
Q

Criteria for a significant Q wave

A

Greater than 0.04 seconds in duration Depth at least 1/3 height of R in the same QRS complex

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25
Q

What hemiblock is more common?

A

Anterior hemiblock because, longer, thinner and single more tenuous blood supply

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26
Q

Exam technique for the testes

A

Gently examine the testicle by rolling it on your finger tips

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27
Q

Treatment following HBV exposure from an HBsAg+ source

A
  • Unvaccinated – Give HBIG + HB vaccine
  • Vaccinated
    • Known responder: (anti-HBs in blood has been measured) – No treatment
    • Known nonresponder: treat as unvaccinated patient with HBIG + HB vaccine
    • Response unknown: Test exposed for anti Hbs [Adequate response – No treatment; Inadequate response HGIG + HB vaccine (one dose)]
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28
Q

PPE for trauma team and mass casualty brought to ER

A

gown, facemask, gloves

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29
Q

Late-look bias

A
  • Information gathered at wrong (too late) time point
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30
Q

What is an advanced directive?

A

The expression of an individual regarding his or her wishes for care in the event of an illness which renders him or her incapable of participating in the decision making process.

Includes:

  • Living will
  • Durable power of attorney
  • Code status What measures to be taken if patient dies
  • DNR - Do not resuscitate orders
  • No intubation/ventilation/chest compressions/defibrillation

​

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31
Q

Ways to reduce risk of medical malpractice

A

Communication with patients or other staff

Documentation

Education - know clinical guidelines, know your patient

Attitude and concern

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32
Q

Types of exposure in order of increasing severity

A
  • Splash to intact skin (least dangerous)
  • Splash to non-intact skin
  • Percutaneous puncture of skin with needle (hollow bore needle higher risk than solid needle [solid needle = suture needle])
  • Deep tissue with hollow bore needle containing visible blood (highest risk)
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33
Q

What are the common causes of localized bulges in the abdominal wall?

A

Ventral hernias: umbilical, incisional, epigastric

Lipomas

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34
Q

EKG of LBBB

A

Prolongation of the QRS complex > 120 msec with typical pattern formation: prominent wide s waves in right leads, left leads have wide, sometimes notched R waves

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35
Q

PPE for drawing CBC and electrolytes on a GI patient

A

gloves

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36
Q

What are the ABCDEs of melanoma?

A

Asymmetry

Borders are irregular

Color varies

Diabeter greater than 6mm

Elevation

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37
Q

Grading of deep tendon reflexes

A
  • 0 = absent despite re-inforcement (Jendrassik maneuver)
  • 1 = present only with reinforcement
  • 2 = normal
  • 3 = increased, but normal
  • 4 = markedly hyperactive, with clonus
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38
Q

Tips for dealing with a patient with Schizoid PD

A
  • Very lonely, isolative, tend to avoid medical care
  • Issue: Really have a tough time around people, feel that their privacy or space is being invaded
  • Helpful: Engage patient in making medical decisions, don’t feel that you have a great rapport
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39
Q

Treatment following possible HIV exposure

A
  • Baseline HIV test
  • Repeat HIV testing at 6 weeks, 12 weeks, and 6 months: use of PCR testing not recommended
  • Begin ART ASAP
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40
Q

Inferior wall MI has ST elevation in leads:

A

II, III, aVF

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41
Q

Proper abbreviation for international units

A

Write out “international units”

IU can be mistaken for IV (or that horrible school in Indiana)

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42
Q

Lateral wall MI has ST elevation in leads:

A

aVL, I, V5, V6

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43
Q

PPE for Uncontrolled diarrhea (unknown if it is infectious or not)

A

put on mask, gloves, gown, and put pt in isolation

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44
Q

Sensitivity

A

Probability that a test produces a positive result when a patient is known to have the ailment

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45
Q

Tips for dealing with Suffering victim patient

A
  • Always symptoms, always wants attention, may not follow through with plans
  • Issue: suffering their role, possible secondary gain, views illness and its treatment as punishments but keeps coming back for more
  • Helpful: regular visits, no matter how variable the complaints are
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46
Q

Macule

A

small, flat lesion

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47
Q

What are excoriations?

A

Linear erosions of the skin induced by scratching

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48
Q

What are some of the kinds of measures that can be improved in health care?

A

Structure, process, and outcome measures

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49
Q

What are three strategies for dealing with seed resistances?

A
  1. Content discussion - directly confront
  2. Process discussion - ask about underlying emotion and empathize
  3. Side stepping - last resort
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50
Q

Normal heart rate and rhythm

A

Normal sinus: 60—100 bpm Sinus bradycardia: 100bpm

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51
Q

Exam technique for the bladder

A

Palpable above the pubis in the midline (150 cc to feel). Dull to percussion

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52
Q

Plaque

A

Raised, mesa-like skin lesion occupying a large surface area compared to its height

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53
Q

Do hemiblocks prolong the QRS complex?

A

No, not appreciably

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54
Q

What are seed resistances?

A

Anger, demands, rambling, anxiety, confusion, inquiries

These are how core pains often present

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55
Q

Vaginal delivery in patient with no prenatal care and high on cocaine. You puncture yourself. What do you do?

A

it’s a high risk needle stick. Pt is tested for HCV, HBV, HIV. Wash your hands, report exposure

56
Q

PPE for dealing with body fluid non-contaminated with blood

A

wash hands, no special precautions for cleaning up spill

57
Q

What is lichenification?

A

Focal areas of thickened skin produced by chronic scratching or rubbing

Skin lines are exaggerated or accentuated

58
Q

Anterior wall MI has ST elevation in leads:

A

V1, V2, V3, V4

59
Q

Susceptibility bias

A

Patients receive one intervention or another on basis of disease severity

60
Q

Tips for dealing with patient with paranoid PD

A
  • Do not trust doctors, refuses to participate in treatment plans, may leave AMA
  • Issue: always feels that others are taking advantage of them or purposefully neglecting or harming them
  • Helpful: stay calm, don’t argue, offer understanding of patient’s position, provide clear recommendations
61
Q

Types of masses seen on CXR

A
  • Can be round, spiculated, cavitated, ill- defined, multiple
  • Cancer – spiculated, cavitated, extend to adjacent structures
  • Vascular- rounded with linear extensions
  • Multiple – metastases
62
Q

Pustule

A

Small, raised, puss filled skin lesion

63
Q

What are the quality improvement tools generally used in health care?

A
  • PDSA: Plan, Do, Study, Act model
  • Six-Sigma: eliminating errors/defects
  • Lean: systematic process assessment
  • DMAIC: Define, Measure, Analyze, Improve, Control
64
Q

Vesicle

A

Small, raised, fluid filled skin lesion

65
Q

Recall bias

A

Knowledge of presence of disorder alters subject recall

66
Q

What is an observational study?

A

A description of one or more groups from a snapshot in time. Exposure and disease status determined at a single point in time, a cross-section of the population. Weakest epidemiologic study design

67
Q

Hemiblock effect on axis deviation

A

LAD of -30 to -90 for LAH; 90-180 RAD for left posterior hemiblock

68
Q

EKG of RBBB

A

RSR’ pattern or “rabbit ears” in the right leads with wide S waves in the lateral leads

69
Q

What are the major abnormal heart rhythms?

A

Sinus arrhythmia Atrial flutter Atrial fibrillation Ventricular tachycardia Ventricular fibrillation

70
Q

Tips for preventing sharps injuries

A
  • Concentrate on what you are doing
  • Limit contact of “other hand” with needle tip or blade
  • DO NOT RECAP NEEDLES
  • Dispose of sharps in puncture proof container
  • Use needle removing device only when instrument is needed
  • DO NOT LEAVE NEEDLES OR OTHER DISPOSABLE SHARPS IN LINENS OR ON TRAYS
  • DO NOT THROW NEEDLES, SYRINGES, OR SHARPS IN PLASTIC GARBAGE BAGS
  • Report all percutaneous, mucosal & significant cutaneous exposures to hospital occupational health services
71
Q

What does anechoic mean?

A

On ultrasound, no wave is bounced back off of a structure, appears black

72
Q

Exam technique for the ureter

A

Best examined radiologically as it is not palpable except when massively dilated in children

73
Q

What is Mobitz type II heart block?

A

A dropped beat without progressive lengthening of PR, below AV node, can progress to 3rd degree 2:1—can’t tell;

74
Q

Nodule

A

Large, raised, rounded skin lesion

Deeper than a papule

Greater than 5 cm diameter

75
Q

What are the secondary skin lesions?

A
  • Ulcers
  • Scars
  • Atrophy
  • Scale
  • Crust
  • Fissure
  • Erosion
  • Excoriation
  • Burrows
  • Lichenification
  • Telangiectasia
76
Q

Coufounding bias

A

o Effect of one factor influences the effect of another

77
Q

Proper abbreviations for dosing drugs in units

A

Write out “units”, do not abbreviate as U

Do not use QD, QOD. Instead, write daily, or every other day

78
Q

What are the components of quality in health care?

A

Safe, effective, patient centered, timely, efficient, equitable

79
Q

Signs of consolidation on CXR

A
  • Air bronchogram:
    • Bronchi - air filled
    • Alveoli - fluid-filled
  • Lobar anatomy
  • Silhouette sign
    • No contrast between fluid-filled structures
    • heart, diaphragm
80
Q

C-spine exam technique for patient with painful rotation of head, unilateral or bilateral trapezius pain, suboccipital pain or headache, radicular pain in distribution of C1-8

A

Anterior and posterior flexion and then anterior flexion against resistance. Rotate head “like in the Exorcist!”

Pt should be able to touch chin to the chest and extend >30 degrees. Rotate 75-90 degrees.

Possible abnormalities: degenerative joint disease, inflammatory arthritis, disc disease

81
Q

What is the difference between precision and accuracy?

A

Precision refers to the exactness of measurement. Repeated measures are very similar.

Accuracy refers to the truth of a measurement, absence of bias, validity of results

82
Q

Which blood born pathogen has the highest risk of transmission from needle stick?

A

HBV > HCV > HIV

83
Q

Abnormal findings of wrist exam

A
  • Synovial thickening and limited flexion/extension with pain but not in a median nerve distribution may be inflammation and/or median nerve impingement
  • Retrograde or antegrade pain or tingling suggestive of carpal tunnel syndrome
  • Non-tender dorsal localized effusions are likely to be ganglion cysts
  • Tender dorsal swelling and thickening likely to be synovitis. Tenderness on palpation of the “snuffbox” and/or lateral(ulnar) deviation) of the hand suggests extensor tendonitis
84
Q

Signs of CHF on chest X-ray

A
  • Thickening of the interlobular septa – Kerley B lines
  • Peribronchial cuffing- Wall is normally hairline thin
  • Thickening of the fissures - Fluid in the subpleural space in continuity with interlobular septa Pleural effusions
85
Q

Sampling/Referral bias

A

Subjects aren’t representative of the population

86
Q

What percentages of the time do patient actually receive the recommended care?

A

About 54%, and has similar percentage for preventative, acute, or chronic care

87
Q

Exam technique for the epididymis

A

Gently palpate the tender epididymis

88
Q

Detection bias

A

o More information is solicited from treatment than control group

89
Q

Common causes of abdominal pain

A

GERD, PUD, stomach cancer, acute appendicitis, acute cholecystitis, biliary colic, acute pancreatitis, chronic pancreatitis, pancreatic cancer, diverticulitis, bowel obstruction, mesenteric ischemia

90
Q

What is first degree heart block?

A

PR interval longer than 200 msec (5 small boxes) or 0.2 sec; each impulse makes it through

91
Q

Which side are varicoceles usually found on?

A

Left.

Feels like a soft bag of worms, separate from the testes

92
Q

Hawthorne Effect

A

Subject knows he or she is being observed or investigated, his behavior and response can change

93
Q

What is the difference between prevalence and incidence?

A

Prevalence is the proportion of persons who have a particular condition at a specified point in time whereas incidence refers to the occurence of new cases in a population over a certain period of time

94
Q

Good samaritan act of Illinois

A

grants good-faith immunity to individuals who provide emergency assistance without charging a fee

95
Q

PPE for routine exam of patient with AIDS post-appendectomy

A

gloves, but don’t have to because you’re not touching the wound

96
Q

What are the major organizations responsible for advancing quality in health care?

A

Center for Medicare and Medicaid Services (CMS), Leapfrog, and Joint Commission

97
Q

Abnormal findings of shoulder ROM test

A

if pain in the A-P passive movement, likely there is gleno-humeral arthritis. If pain with the abduction and resistance maneuvers, rotator cuff disease is likely. If there is pain on supination while elbow flexed, bicipital tendonitis likely

98
Q

Motor strength grading in neuro exam

A
  • 0 = no contraction
  • 1 = flicker or trace of contraction
  • 2 = active movement, when gravity is eliminated
  • 3 = active movement against gravity
  • 4 = active movement against gravity and resistance
  • 5 = normal power
99
Q

What steps are done when a patient dies?

A
  • Pronounce death
  • Determine if a medical examiner needs to be called
  • Notify family
  • Request autopsy
  • Death certificate completed
100
Q

Bulla

A

Large raised and fluid filled skin lesion

101
Q

PPE when you are asked to examine patient vomiting blood

A

put on everything

102
Q

Specificity

A

Probability that a test produces a negative result when a patient is known to be ailment free

103
Q

Wheal

A

Firm, edematous plaques, evanescent and pruritic

Also called: Hives

104
Q

Examination technique of the kidney

A

Palpable only in children and lean adults unless abnormal

Palpate in the CVA

105
Q

Signs of pneumothorax on CXR

A
  • Air enters between visceral and parietal pleura
  • Tension pneumothorax = shift of mediastinum, good lung compressed
  • Recognize white line of pneumothorax
  • Can be confused with skin fold
106
Q

What does hyperechoic or hypoechoic mean?

A

Highly reflective structures like calcifications are hyperechoic. Hypoechoic is less reflective than comparable surrounding structures but not black.

107
Q

Why use a process map or value stream map?

A

These tools allow a clear visualization of each step in a process to identify steps where interventions can occur (process map) or where to reduce waste (value stream map)

108
Q

Procedure bias

A

o Subjects not treated the same in both groups (one group gets more visits, more attention, etc.)

109
Q

What is HIPAA?

A

Health Insurance Portability and Accountability Act

federal protections for personal health information held by covered entities and gives patients an array of rights with respect to that information

assures the confidentiality, integrity, and availability of electronic protected health information

110
Q

Exam technique for seminal vesicle

A

Can at times be palpated, lie postero-lateral to prostate

111
Q

Who is called regarding organ donation following the death of a patient?

A

Gift of hope - Hospitals must refer all deaths to the Organ Procurement Organization, all imminent deaths of patients with brain dysfunction and all individuals who have died from cardiac death. They are all potential tissue donors

112
Q

What is the most common type of hernia?

A

Indirect inguinal hernia

113
Q

Ascertainment bias

A

o Patients with suspected outcome are more extensively probed about symptoms and histories than others

114
Q

What drug is the abbreviation for morphine, MS04, commonly confused with?

A

Magnesium sulfate

Write out “morphine” and “magnesium sulfate” to avoid confusion

115
Q

Female pelvic exam tips

A

Simple relaxation techniques helpful ( deep breathing/perineal relaxation)

A chaperone should always attend an examiner

Tell patient what you’re doing as you proceed

116
Q

Steps of the female pelvic exam

A

External: lymph nodes, pubic and perianal region, labia

Speculum: cervix, pap smear

Bimanual exam: cervix, uterus, adnexa

117
Q

Exam technique fore the vas deferens

A

Palpated above the testis, is a fibrous mobile cord

118
Q

Abscess

A

Large, raised, pus filled skin lesion

119
Q

Physical exam finding associated with PID

A

Cervical motion tenderness

120
Q

Abnormal findings of elbow exam

A
  • pain on flexion and extension indicates intra-articular disease
  • no pain on flexion/extension but large effusion with or without signs of inflammation is olecranon bursitis
  • pain on palpation of medial epicondyle is epicondylitis (golfer’s elbow)
  • pain on palpation of lateral epicondyle is epicondylitis (tennis elbow)
  • thickened ulnar groove, bilateral, systemic inflammatory arthritis
  • nodules on proximal posterior forearm indicates rheumatoid arthritis
121
Q

Proficiency bias

A

Intervention or treatment not applied equally to subjects. May be due to skill, training differences or differences in resources or procedures used at different sites

122
Q

What is the proper post-exposure care?

A
  • Wash wound and skin with soap and water, flush mucosal surfaces with water
  • Exposure report: Date/time, Details (where, how, sharp or not, amount of fluid), Severity – percutaneous, depth, hollow needle in artery or vein, injected or not, Mucus membrane/skin – volume of fluid, condition of skin
  • Testing of both exposure source and exposed person
123
Q

What is the difference between a direct and an indirect hernia?

A

Indirect hernias originate from above the inguinal ligament and pass through the inginal canal into the scrotum

Direct hernias originate from above the inguinal ligament and bulge anteriorly. Rarely passes into the scrotum.

124
Q

Indications for a Pap smear

A

Screen everyone between 21-65 every 3 years

125
Q

PPE for bloody 6 hour procedure

A

waterproof gown

126
Q

Nerves associated with each reflex

A

Biceps (C5-C6), triceps (C7-C8), brachioradialis (C5-C6), knee (L2-L4), and ankle (S1)

127
Q

What is EMTALA?

A

Emergency Medical Treatment and Active Labor Act

requires hospitals with emergency departments to provide a medical screening examination to any individual who comes to the emergency department

128
Q

When examining joints, what must always be done?

A

Always examine joints bilaterally to have a comparison

129
Q

PPE for routine daily bedside eval on 33 y/o woman with acute leukemia

A

gloves or nothing (no mucous membrane or bodily fluid exposure)

130
Q

What are some examples of when to call the medical examiner?

A
  • Suicide, accident, trauma, criminal violence
  • Deaths within 24 hours of hospital admission
  • Attending physician has no adequate or reasonable explanation for cause of death
  • Deaths during diagnostic/therapeutic procedures
  • Deaths occurring while patient is under influence of anesthesia or in recovery from anesthesia
  • DOA to the ED
  • EtOH or drugs implicated
  • Suspicious circumstances
131
Q

What are the four principles of bioethics

A

Autonomy

Beneficence

Non-maleficence

Justice

132
Q

What is informed consent?

A

Duty to disclose risks, benefits and alternatives to treatment

Patient must have capacity and not be coerced

133
Q

Can a parent refuse lifesaving medical treatment for their child?

A

while a competent adult has the right to refuse even lifesaving medical treatment for herself, she is generally not accorded the right to do so for her child

134
Q

Difference between capacity and competency?

A

Capacity is a patients ability to make decisions and is assessed by healthcare workers

Competency is a legal term established by the courts due to a long-standing global condition

135
Q

If a patient is determined to not have capacity, how are medical treatment decisions made?

A

First, see if they have an advanced directive

If no advanced directive, use a surrogate decision maker

136
Q

What are the exceptions to confidentiality?

A

Consent

Court order

Continued treatment

Comply with the law

Communicate a threat

PCM 2 (2 decks)

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