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heme > Clinical Applications Final > Flashcards

Clinical Applications Final Flashcards

1
Q

Which is higher in the seated position, diastolic or systolic? What about standing?

A

Diastolic is higher while seated, Systolic is higher when supine

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2
Q

What affect does raising vs lowering the arm at the level of the heart have on BP?

A

Raising the arm above the level of the heart causes low readings. Having the arm below the level of the heart causes high readings.

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3
Q

BP cuff should encircle _____% of the patient’s arm

A

80

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4
Q

Rapidly inflate the cuff ____mmHg above the estimated sytolic pressure when taking blood pressure

A

30

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5
Q

You should deflate the BP cuff at a rate of…

A

2-4mmHg/sec

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6
Q

Absolute Contraindications for NG tube

VS.

Relative Contraindications

A

severe midface trauma or recent nasal surgery

relative = coag issues, esop varices, strictures, alkaline ingestion

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7
Q

How do verify NG tube placement

A

ask the patient to talk (trachea vs esophagus)

CXR can verify

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8
Q

Are internal hemorrhoids painful?

A

not unless thrombosed

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9
Q

What is the Simm position

A

left lateral knee to chest position that can be used for anorectal exam

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10
Q

Would you do a DRE on a patient with anal fissures?

A
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11
Q

Do you prescribe abx for anorectal abscesses?

A

No, unless there is a surrounding cellulitis

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12
Q

Pilonidal Disease =

A
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13
Q

What is procidentia

A

Rectal prolapse (redundant sigmoid colon + loss of rectal support)

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14
Q

So a patient comes in with itchy butt and you do a “scotch tape test” that reveals PINWORMS! Oh no, what do you do?

A

These little egglets can be airborne….treat the entire family so that there’s no itchy butt outbreak!

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15
Q

Murphy’s Sign

A

Pain in RUQW during deep inspiration that indicated GB inflammation

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16
Q

What is cutaneous hyperesthesia?

A

sign of peritoneal inflammation…..everything hurts

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17
Q

Rebound Tenderness

A

pain when there you press down and quickly release fingers. Pain occurs with the withdrawl

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18
Q

Rovsing’s Sign

A

type of rebound pain. Press on LLQ and upon release, there is pain in the RLQ….indicates appendicitis with peritoneal signs

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19
Q

Obturator test

A

internally rotate, pain indicates peritoneal pain/appendicitis

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20
Q

H. Pylori Testing…what to do, what to do….

A

Breath Test - confirms they have the bugger. 2 weeks prior patient must stop PPI, Abx and pepto

Antigen test - detects in the stool and good for assessing treatment.

Biopsy - most expensive but also most accurate. Do this if endoscopy needed for other reasons

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21
Q

What does vitamin c do to a fecal occult blood test?

A

false negative

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22
Q

Colorectal Cancer Screening

A

start at the age of 50years.

Most risk of colorectal cancer is 50-75 years old.

Do colonscopy q10 year, FOBT q1 year

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23
Q

Viseral Pain VS parietal pain

A

Visceral = distention of the organs and is difficult to localize

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24
Q

Doubling over with crampy colicky pain + hematuria….

A

renal colic, kidney stones

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25
Q

Sudden knifelike epigastric pain =

A

gallstone pancreatitis

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26
Q

RLQ pain can be d/t

A

appendicitis, ovary issues, ectopic preggo, kidney stones

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27
Q

LLQ

A

diverticulitis, SBO, LBO, ovary issues, ectopic preggo, kidney stones, UTI

28
Q

Hematochezia VS Melena

A

Hematochezia = >1000ml of blood usually from lower GI bleed

Melana = >100ml of blood usually from upper GI bleed

29
Q

What’s official absent BS?

A

when there is a lack of BS for more than 5 minutes. Flick the abdomen to try and induce BS….if not, think adynamic ileus or obstruction

30
Q

Are the kidneys at the same level?

A

no the left kidney is higher

31
Q

Spleen lies in the ____intercostal space

A

10th

32
Q

Light palpation means that you are pressing with the pads of your fingers no more than ____cm in all 4 quads

A

1cm

33
Q

Jugular Vein VS Carotid Artery

A

vein = has no pulse, but has 2 systolic pulsations that change with respirations

artery = has a palpable pulse, but no pulsations and no changes with respiration

34
Q

JVD

A

patient reclined at 45degrees; measure vertical distance from angle of louis and highest level of jugular vein pulsation. Add 5 cm to the measurement at the RA is 5cm from the sternal angle.

USE INTERNAL VEIN PREFERRABLY rather than external is possible (may use external if internal not visible)

35
Q

ABI is useful for determining…….

But is unreliable in…..

A

Ankle/Brachial Index useful for PAD detection, but not useful in diabetes.

95% sensitive and 99% specific

36
Q

Define orthostatic BP

A

symptomatic hypotension brought on by a sudden change in the body position

37
Q

How do you test for orthostatic hypotension….you know this will be on there cuz Mol’s loves talking about orthostatic hypotension….

A

take BP and PP supine

have patient stand up

wait 1 minute

record BP and PP

IF…….there is a drop in PP or BP by 20 in either or in both, this is + for orthostatic hypotension

38
Q

Locations of the EKG leads

A

v1 =4ICS RSB

v2 =4ICS LSB

v3 =between 2 and 4

v4 = LMidclavicular 5ICS

v5 = L anterior axillary 5ICS

v6 = L midaxillary 5ICS

39
Q

Holter VS Event monitor

A

holter takes readings continuously for 24-48 hours

event monitor can be worn for weeks and is used for symptomatic heart conditions

40
Q

How can you better hear a left sided S3 or S4? What about a suspected aortic or pulmonic murmur?

A

s3/s4, have patient in the LLD position

for aortic/pulmonic - have patient sitting and lean forward

41
Q

Grading of a murmur intensity

A

1-3 have NO THRILL

4-6 have THRILL PRESENT

42
Q

Ausculation areas of the heart

A

Aortic = 2ICS RSB

Pulmonic = 2ICS LSB

Tricuspid = 4ICS LSB

Mitral = 5 ICS midclavicular

Erbs =

43
Q

Tet Spells =

A

hypercyanotic events characteristic of TOF

44
Q

Kerley B lines on CXR

A

CHF

45
Q

Grading of Pulses

A

0 = absent

1+ = diminished

2+ = bounding, normal

3+ = more than expected

46
Q

Trendelenburg Test

A

Special test used to assess venous valve compentency. Patient is supine asnd elevates leg 90 degrees. Then you compress the saphenous vein and ask the patient to stand. Watch for venous filling (norm = 35s)

47
Q

Raynauds Disease VS Phenomon

A

disease = vasospastic and involves the small arterioles and includes fingers, toes and EARS AND NOSE.

Phenomenon = idiopathic, bilateral cyanosis of the arterioles due to cold or emotion that are only in the fingers and toes

48
Q

Indications for a central line

A

cannot get peripheral access, chemo, dialysis, etc

49
Q

Average cost of ECHO

A

$1400

50
Q

Diagnosing DM

A

fasting BG >126 on two seperate occasions or a A1c>6.5% on 2 seperate occasions

51
Q

What is the HbA1c

A

glycosylated hemoglobin that measures the average glucose over the last 6-8 weeks

52
Q

Patau Syndrome

A

trisomy 13

53
Q

ichthyosis

A

dry, thickened, scaly or flaky skin

54
Q

Fructosamine

A

can be used to measure glucose levels 2-3 weeks estimate.

May be better is patient in preggo, have anemia, or if you want to evaluate the diabteic treatment

75micromol change = 60mg/dl in blood sugar or 2% a1c

55
Q

LDL and HDL, where do each move lipids?

A

LDL moves cholesterol into the arteries, and HDL removes it from the aa

56
Q

How long should a patient fast prior to getting lipid levels checked?

A

12-24 hours

57
Q

Goal ranges for cholesterol, LDL and HDL?

A

<200 cholesterol

<100 LDL

> 60 HDL

58
Q

Normal RBC count

A

4.5-6 million

59
Q

Normal Hct and Hgb

A

Hct = packed cell volume = 42-52% or 36-48% in females

Hgb = 13.5-17.5% or 12.5-15.5% in females

60
Q

MCV = (how do you calculate?)

MCH?

A

MCV = hct x 10 / RBC

Normal = 80-100

MCH = hgb x 10/ RBC

normal = 33ish

61
Q

Normal Sed Rate

A

0-10mm/hr in males, 0-20 in females

62
Q

If MCHC is > 36….suspect what?

A

spherocytosis

63
Q

Normal Plt #

Normal WBC #

A

Plt = 150,000-400,000

WBCs = 4,800-10,800

64
Q

Most common leukemia in children

A

ALL

65
Q

Most common acute leukemia in adults

Most common leukemia in adults

A

Acute = AML

Chronic = CLL

66
Q

PNM%, Bands, Eosinophils, basophils, lymphocytes, monocytes

A

PNM = 54-62%

Bands = 2-6%

Eosinophils = 1-3%

Basophils = 0-1%

Lymphocytes = 20-40%

Monocytes = 4-10%

heme (2 decks)

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