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
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
3
Q
What are burrows?
A
Elevated channels in the superficial epidermis produced by a parasite such as scabies or worms
4
Q
What indicates ischemia during an EKG stress test or during angina?
A
ST depression T wave inversion
5
Q
Patch
A
Large flat skin lesion
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
7
Q
4 elements of a law suit
A
Duty
Breach of duty
Causation
Damages
8
Q
Pygmalion Effect
A
- Researcher’s belief in the efficacy of a treatment changes the outcome of the treatment
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
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
11
Q
Exam technique for penis
A
Look at penis, inspect all sides, open meatus
12
Q
Common causes of protuberant abdomen
A
- Fat
- Gas
- Tumor
- Ascities
- Pregnancy
13
Q
Papule
A
Small raised, solid and rounded skin lesion
Smaller than 0.5 cm diameter
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
15
Q
PPE for listening to lungs of ventilated patient
A
mask with face shield and gloves
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
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.
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
19
Q
Selection bias
A
Non-random assignment to study group
20
Q
6 steps for delivering bad medical news
A
- Schedule the meeting - have enough time
- Determine if the patient understands seriousness of the illness
- Do they want to know more
- Deliver news, then listen
- Ask how the patient feels
- Move forward, what’s next?, offer hope
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.
22
Q
Exam technique for the prostate
A
Palpable by direct rectal exam, chestnut sized, consistency of the thenar eminence
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
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
25
What hemiblock is more common?
Anterior hemiblock because, longer, thinner and single more tenuous blood supply
26
Exam technique for the testes
Gently examine the testicle by rolling it on your finger tips
27
Treatment following HBV exposure from an HBsAg+ source
* _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)]
28
PPE for trauma team and mass casualty brought to ER
gown, facemask, gloves
29
Late-look bias
* Information gathered at wrong (too late) time point
30
What is an advanced directive?
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
31
Ways to reduce risk of medical malpractice
Communication with patients or other staff
Documentation
Education - know clinical guidelines, know your patient
Attitude and concern
32
Types of exposure in order of increasing severity
* **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)**
33
What are the common causes of localized bulges in the abdominal wall?
Ventral hernias: umbilical, incisional, epigastric
Lipomas
34
EKG of LBBB
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
35
PPE for drawing CBC and electrolytes on a GI patient
gloves
36
What are the ABCDEs of melanoma?
Asymmetry
Borders are irregular
Color varies
Diabeter greater than 6mm
Elevation
37
Grading of deep tendon reflexes
* 0 = absent despite re-inforcement (Jendrassik maneuver)
* 1 = present only with reinforcement
* 2 = normal
* 3 = increased, but normal
* 4 = markedly hyperactive, with clonus
38
Tips for dealing with a patient with Schizoid PD
* 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
39
Treatment following possible HIV exposure
* Baseline HIV test
* Repeat HIV testing at 6 weeks, 12 weeks, and 6 months: use of PCR testing not recommended
* Begin ART ASAP
40
Inferior wall MI has ST elevation in leads:
II, III, aVF
41
Proper abbreviation for international units
Write out "international units"
IU can be mistaken for IV (or that horrible school in Indiana)
42
Lateral wall MI has ST elevation in leads:
aVL, I, V5, V6
43
PPE for Uncontrolled diarrhea (unknown if it is infectious or not)
put on mask, gloves, gown, and put pt in isolation
44
Sensitivity
Probability that a test produces a positive result when a patient is known to have the ailment
45
Tips for dealing with Suffering victim patient
* 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
46
Macule
small, flat lesion
47
What are excoriations?
Linear erosions of the skin induced by scratching
48
What are some of the kinds of measures that can be improved in health care?
Structure, process, and outcome measures
49
What are three strategies for dealing with seed resistances?
1. Content discussion - directly confront
2. Process discussion - ask about underlying emotion and empathize
3. Side stepping - last resort
50
Normal heart rate and rhythm
Normal sinus: 60—100 bpm Sinus bradycardia: 100bpm
51
Exam technique for the bladder
Palpable above the pubis in the midline (150 cc to feel). Dull to percussion
52
Plaque
Raised, mesa-like skin lesion occupying a large surface area compared to its height
53
Do hemiblocks prolong the QRS complex?
No, not appreciably
54
What are seed resistances?
Anger, demands, rambling, anxiety, confusion, inquiries
These are how core pains often present
55
Vaginal delivery in patient with no prenatal care and high on cocaine. You puncture yourself. What do you do?
it’s a high risk needle stick. Pt is tested for HCV, HBV, HIV. Wash your hands, report exposure
56
PPE for dealing with body fluid non-contaminated with blood
wash hands, no special precautions for cleaning up spill
57
What is lichenification?
Focal areas of thickened skin produced by chronic scratching or rubbing
Skin lines are exaggerated or accentuated
58
Anterior wall MI has ST elevation in leads:
V1, V2, V3, V4
59
Susceptibility bias
Patients receive one intervention or another on basis of disease severity
60
Tips for dealing with patient with paranoid PD
* 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
Types of masses seen on CXR
* Can be round, spiculated, cavitated, ill- defined, multiple
* Cancer – spiculated, cavitated, extend to adjacent structures
* Vascular- rounded with linear extensions
* Multiple – metastases
62
Pustule
Small, raised, puss filled skin lesion
63
What are the quality improvement tools generally used in health care?
* PDSA: Plan, Do, Study, Act model
* Six-Sigma: eliminating errors/defects
* Lean: systematic process assessment
* DMAIC: Define, Measure, Analyze, Improve, Control
64
Vesicle
Small, raised, fluid filled skin lesion
65
Recall bias
Knowledge of presence of disorder alters subject recall
66
What is an observational study?
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
Hemiblock effect on axis deviation
LAD of -30 to -90 for LAH; 90-180 RAD for left posterior hemiblock
68
EKG of RBBB
RSR’ pattern or “rabbit ears” in the right leads with wide S waves in the lateral leads
69
What are the major abnormal heart rhythms?
Sinus arrhythmia Atrial flutter Atrial fibrillation Ventricular tachycardia Ventricular fibrillation
70
Tips for preventing sharps injuries
* 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
What does anechoic mean?
On ultrasound, no wave is bounced back off of a structure, appears black
72
Exam technique for the ureter
Best examined radiologically as it is not palpable except when massively dilated in children
73
What is Mobitz type II heart block?
A dropped beat without progressive lengthening of PR, below AV node, can progress to 3rd degree 2:1—can’t tell;
74
Nodule
Large, raised, rounded skin lesion
Deeper than a papule
Greater than 5 cm diameter
75
What are the secondary skin lesions?
* Ulcers
* Scars
* Atrophy
* Scale
* Crust
* Fissure
* Erosion
* Excoriation
* Burrows
* Lichenification
* Telangiectasia
76
Coufounding bias
o Effect of one factor influences the effect of another
77
Proper abbreviations for dosing drugs in units
Write out "units", do not abbreviate as U
Do not use QD, QOD. Instead, write daily, or every other day
78
What are the components of quality in health care?
Safe, effective, patient centered, timely, efficient, equitable
79
Signs of consolidation on CXR
* Air bronchogram:
* Bronchi - air filled
* Alveoli - fluid-filled
* Lobar anatomy
* **Silhouette sign**
* No contrast between fluid-filled structures
* heart, diaphragm
80
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
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
What is the difference between precision and accuracy?
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
Which blood born pathogen has the highest risk of transmission from needle stick?
HBV \> HCV \> HIV
83
Abnormal findings of wrist exam
* 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
Signs of CHF on chest X-ray
* 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
Sampling/Referral bias
Subjects aren’t representative of the population
86
What percentages of the time do patient actually receive the recommended care?
About 54%, and has similar percentage for preventative, acute, or chronic care
87
Exam technique for the epididymis
Gently palpate the tender epididymis
88
Detection bias
o More information is solicited from treatment than control group
89
Common causes of abdominal pain
GERD, PUD, stomach cancer, acute appendicitis, acute cholecystitis, biliary colic, acute pancreatitis, chronic pancreatitis, pancreatic cancer, diverticulitis, bowel obstruction, mesenteric ischemia
90
What is first degree heart block?
PR interval longer than 200 msec (5 small boxes) or 0.2 sec; each impulse makes it through
91
Which side are varicoceles usually found on?
Left.
Feels like a soft bag of worms, separate from the testes
92
Hawthorne Effect
Subject knows he or she is being observed or investigated, his behavior and response can change
93
What is the difference between prevalence and incidence?
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
Good samaritan act of Illinois
grants good-faith immunity to individuals who provide emergency assistance without charging a fee
95
PPE for routine exam of patient with AIDS post-appendectomy
gloves, but don’t *have to* because you’re not touching the wound
96
What are the major organizations responsible for advancing quality in health care?
Center for Medicare and Medicaid Services (CMS), Leapfrog, and Joint Commission
97
Abnormal findings of shoulder ROM test
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
Motor strength grading in neuro exam
* 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
What steps are done when a patient dies?
* Pronounce death
* Determine if a medical examiner needs to be called
* Notify family
* Request autopsy
* Death certificate completed
100
Bulla
Large raised and fluid filled skin lesion
101
PPE when you are asked to examine patient vomiting blood
put on everything
102
Specificity
Probability that a test produces a negative result when a patient is known to be ailment free
103
Wheal
Firm, edematous plaques, evanescent and pruritic
Also called: Hives
104
Examination technique of the kidney
Palpable only in children and lean adults unless abnormal
Palpate in the CVA
105
Signs of pneumothorax on CXR
* 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
What does hyperechoic or hypoechoic mean?
Highly reflective structures like calcifications are hyperechoic. Hypoechoic is less reflective than comparable surrounding structures but not black.
107
Why use a process map or value stream map?
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
Procedure bias
o Subjects not treated the same in both groups (one group gets more visits, more attention, etc.)
109
What is HIPAA?
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
Exam technique for seminal vesicle
Can at times be palpated, lie postero-lateral to prostate
111
Who is called regarding organ donation following the death of a patient?
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
What is the most common type of hernia?
Indirect inguinal hernia
113
Ascertainment bias
o Patients with suspected outcome are more extensively probed about symptoms and histories than others
114
What drug is the abbreviation for morphine, MS04, commonly confused with?
Magnesium sulfate
Write out "morphine" and "magnesium sulfate" to avoid confusion
115
Female pelvic exam tips
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
Steps of the female pelvic exam
External: lymph nodes, pubic and perianal region, labia
Speculum: cervix, pap smear
Bimanual exam: cervix, uterus, adnexa
117
Exam technique fore the vas deferens
Palpated above the testis, is a fibrous mobile cord
118
Abscess
Large, raised, pus filled skin lesion
119
Physical exam finding associated with PID
Cervical motion tenderness
120
Abnormal findings of elbow exam
* 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
Proficiency bias
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
What is the proper post-exposure care?
* **_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
What is the difference between a direct and an indirect hernia?
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
Indications for a Pap smear
Screen everyone between 21-65 every 3 years
125
PPE for bloody 6 hour procedure
waterproof gown
126
Nerves associated with each reflex
Biceps (C5-C6), triceps (C7-C8), brachioradialis (C5-C6), knee (L2-L4), and ankle (S1)
127
What is EMTALA?
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
When examining joints, what must always be done?
Always examine joints bilaterally to have a comparison
129
PPE for routine daily bedside eval on 33 y/o woman with acute leukemia
gloves or nothing (no mucous membrane or bodily fluid exposure)
130
What are some examples of when to call the medical examiner?
* 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
What are the four principles of bioethics
Autonomy
Beneficence
Non-maleficence
Justice
132
What is informed consent?
Duty to disclose risks, benefits and alternatives to treatment
Patient must have capacity and not be coerced
133
Can a parent refuse lifesaving medical treatment for their child?
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
Difference between capacity and competency?
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
If a patient is determined to not have capacity, how are medical treatment decisions made?
First, see if they have an advanced directive
If no advanced directive, use a surrogate decision maker
136
What are the exceptions to confidentiality?
Consent
Court order
Continued treatment
Comply with the law
Communicate a threat
