maneuvers (to diagnose disorders) & some Peds general questions

Question 1

This maneuver is positive in De Quervain’s tenosynovitis

Answer 1

Finkelstein’s test

Question 2

These maneuvers are positive if ACL of knee is damaged. The knee may also be unstable.

Answer 2

anterior drawer maneuver and Lachman maneuver

Question 3

This maneuver is positive in meniscus injuries of the knee

Answer 3

McMurray’s sign

Question 4

Diagnosing bacterial meningitis:

_______ sign is for nuchal rigidity. Patient supine. Raise head and flex chin toward chest.

Answer 4

Brudzinski

Question 5

Brudzinski sign for bacterial meningitis:

Positive result if patient automatically _______ ______ ____

Answer 5

bends both hips

Question 6

Diagnosing bacterial meningitis:
_______ sign is for the hip. Patient supine. Flex patient’s hips and knees in a right angle, then slowly straighten/extend the leg. Positive result is when the patient complains of pain during extension or resisting.

Answer 6

Kernig’s

Question 7

Signs to diagnose appendicitis:
RLQ pain with passive leg extension:

RLQ pain with internal rotation of right hip:

Firm deep palpation of the LLQ will cause severe pain on the RLQ:

Pelvic/abdominal pain when patient drops heels to floor:

Answer 7

Psoas

Obturator

Rovsing’s

Markle (heel jar) test

Question 8

Abrupt cessation of inspiration caused by hooking fingers on the right costal margin and pressing down firmly - used to diagnose cholecystitis:

Answer 8

Murphy’s sign

Question 9

Periumbilical bruising/discoloration is called ________ sign and is an indication of acute _________.

Answer 9

Cullen’s

pancreatitis

Question 10

Bruising on the flank area is called _________’s sign and is an indication of acute pancreatitis.

Answer 10

Grey-Turner’s sign

Question 11

The test used to assess for meniscus injury of the knee by hearing a “CLICK”, either heard and/or palpated, is the _____ test.

Answer 11

McMurray

Question 12

*** The _____ tests look for knee instability

Answer 12

Drawer

Question 13

The ________ test is for the ACL only, and is a more sensitive test than the Drawer sign

Answer 13

Lachman

Question 14

This test is used to diagnose torn/laxity of the MCL of the knee: _________
Patient is supine with legs straight, and medial stress is applied to the knee.

Answer 14

Valgus stress test

THINK - “valGUM - knees stick together (medial) like with GUM”

Question 15

***The ______ test is used to diagnose DeQuervain’s Tenosynovitis/Tendonitis. Tell the patient to make a fist by holding the thumb against the palm, then cover it with the other 4 fingers. Applying ulnar deviation causes pain (positive).

Answer 15

Finkelstein

Question 16

Test for median nerve problem/carpal tunnel syndrome in which the wrist is in full flexion for 60 seconds:

Answer 16

Phalen test/maneuver

Question 17

***Test for median nerve problem/carpal tunnel syndrome in which the anterior wrist is briskly tapped:

Answer 17

Tinel’s test -

THINK “Tinel - Tap” - T and T

Question 18

Name the sign:
Patient is supine. Use one hand to press two metatarsal heads together while applying pressure on the area pf pain by using the other hand. A positive sign is where the pain is reproduced and you may hear a click.

Answer 18

Mulder’s sign (for Morton’s neuroma)

Question 19

Name this test:
Instruct patient to stand with feet together and arms on the side with eyes open. Then instruct patient to close eyes. Watch for swaying and loss of balance.

Answer 19

Romberg test

Question 20

Name this pediatric maneuver:
Flex both hips with thighs at 90 degrees together (adduction)
Push the hip posteriorly which will cause abnormal hip to dislocate.
Palpate as femoral head slips out of socket. Confirm with the other test.

Answer 20

Barlow’s test/maneuver
Perform Barlow’s test first, before doing the Ortolani test.
Remember, B comes before O.

Question 21

Name this pediatric maneuver:

1. Examine one hip at a time. Flex the infant’s hip and knees 90 degrees
2. Place your index and middle fingers along the greater trochanter of the femur (outer thigh) and place your thumb on top of the knees and the inner thigh.
3. Gently abduct hips while pulling it anteriorly. You may feel the unstable hip and or hear an ***AUDIBLE “CLUNK” SOUND as the unstable hip slips back into the acetabulum after being displaced.

Answer 21

Ortolani Test/maneuver

Remember - “O”rtolani - “O” - rotate the hip in an “O” (Circle)

Question 22

Acute diarrhea in kids:
Antibiotics should not be used routinely for well-appearing children with acute bloody diarrhea unless a ____ ______ has been isolated. Antibiotic therapy may be a risk factor for the development of hemolytic uremic syndrome.

Answer 22

specific pathogen

Question 23

Signs of dehydration in an infant/child:
\_\_\_\_\_\_ fontanelles (\_\_\_\_ spot)
Sunken eyes
Parched dry lip sand mouth
Fewer tears when crying
Tachycardia, tachypnea
Lethargy/sleepiness
Reduced skin turgor
Voiding less often (< \_\_\_ wet diapers/day)

Answer 23

Sunken; soft

6

Question 24

infant dehydration:

***____ ____ is an important indicator - > ___%.

Answer 24

weight loss; 10%

Question 25

Name this pediatric condition:
Transfer of eggs from fingers touching the perianal area and then fomites. Causes perianal itching, vaginitis, excoriations.

Answer 25

Enterobiasis (pinworms)

Question 26

Enterobiasis (pinworms):

**Labs to diagnose include the _____ _____ test in the **____ _______.

Answer 26

Scotch tape

EARLY MORNING

Question 27

Enterobiasis (pinworms):

Treatment is with ______ or _____. Treat the entire household.

Answer 27

Antiminth; Mebenzadole

Question 28

What is the most common genetic abnormality in African Americans (1 in 12)?
All newborns in US are screened.

Answer 28

sickle cell

Question 29

What is the “gold standard” test for sickle cell disease?

Answer 29

hemoglobin electrophoresis (Hgb S)

Question 30

Acute enlargement of the spleen in sickle cell disease:

called acute splenic _________.

Answer 30

Sequestration

Question 31

G6PD is a genetic defect in an enzyme that protects ______ from oxidative injury. It is an x-linked recessive trait that is more common among _________,
_________, and ______ descent.

Answer 31

RBCs
Mediterranean
African; Asian

Question 32

All of the following statements are true about G6PD anemia except:
1 An X-linked recessive trait that is more common among Mediterranean, African, and Asian descent
2 It is a type of hemolytic anemia
3 Sulfa drugs and fava beans can cause hemolysis
4 A genetic disorder that can cause sickling when RBCs are exposed to hypoxic conditions

Answer 32

4 A genetic disorder that can cause sickling when RBCs are exposed to hypoxic conditions

Question 33

Peds:
Child abuse:
Are health care workers required by law to report any suspicion of abuse/neglect?
Almost ___% are below age one and preschool

***What type of presentation should elicit suspicion of child abuse in the clinical setting?

Answer 33

YES
50%

*** A controlling type of adult who doesn’t want to be interviewed

Question 34

Risk factors for child abuse:
Financial problems/low income family
Parent was a victim of abuse, _____ age, ____ parent, divorced
Low level of education

Answer 34

young; single

Question 35

***Indicators of child abuse:
Retinal/conjuncitval hemorrhages
Burns w/location and pattern
Bruises
Spiral fractures
Rib and skull fractures
***NOT an indication of child abuse: \_\_\_\_ \_\_\_\_\_

Answer 35

vaginal infection

Question 36

Child abuse:

A delay in obtaining _______ _____ coupled with an inconsistent ______ is a RED FLAG

Answer 36

medical care

history

Question 37

ADHD: More common in _____
ADD: More common in _______.
Treatment is with ______ or ______.

Answer 37

boys
girls
Ritalin; Adderall

Question 38

Peds:
Take adderall (amphetamine) when?
Do not give when?

Answer 38

In the morning before school starts

At night b/c it can cause insomnia

Question 39

Non-amphetamine treatment for ADD/ADHD is: ________.

It has an increased risk of suicidal thoughts or actions in children and teenagers.

Answer 39

Strattera

Question 40

Strattera:

Avoid in ______ patients.

Answer 40

anorexic

Question 41

Lead toxicity starts at _____ mcg/dl, but no safe level or nontoxic blood lead levels exist.

Answer 41

5

Question 42

Lead poisoning affects _____ synthesis in the bone marrow, leading to microcytic anemia.
The source with the highest level of lead is _____ ___.

Answer 42

heme

paint chips

Question 43

Lead level ___ or higher - CDC recommends chelation.

Most serious complications are acute encephalopathy, seizures, coma

Answer 43

45