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Physical Exam 2 COPY COPY > Exam 1 review > Flashcards

Exam 1 review Flashcards

1
Q

Definition of “knot”

A

Fastening by looping length of suture material and tightening by hand or insturment

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2
Q

2 typs of stable knots?

A
  1. Square knot

2. Surgeons knot

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3
Q

2 types of unstable knot?

A
  1. Granny knot

2. Simple knot

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4
Q

Where can one see an “External knot”

A

outside body

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5
Q

Where is a “buried knot”?

A

Inside body

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6
Q

Ideal surgical knot?

A

No slip, not too much or too little tension, minimal context between tissue and suture material

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7
Q

What is “dishecense”?

A

Rupture along surgical incision

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8
Q

Breast cancer #1 risk factor?

A

Being female

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9
Q

Breast cancer #2 risk factor?

A

History of first-degree relatives with breast cancer

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10
Q

What is a physiological nodularity?

A

Uneven texture of breast. Granular, nodular, or lumpy.

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11
Q

Is physiological nodularity normal?

A

YES

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12
Q

Where do breast lymphatics drain toward?

A

axilla

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13
Q

Which node can malignant breast cells spready directly to?

A

Infraclavicular nodes

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14
Q

Peau D’Orange?

A

One breast looks like orange peel. BAD!

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15
Q

Paget’s dz and breast ca?

A

Eczema on one breast concerning for malignancy

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16
Q

Is tenderness suggestive of breast malignancy?

A

Nope! Malignany masses most likely non-tender.

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17
Q

Clinical Breast Exam how often? Position?

A

q3y, 20-39 y/o. supine.

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18
Q

Breast Self Exam how often?

A

Every month after age 20. 5-7 days after menses begins.

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19
Q

Female breast extends from ____ down to ___

A

clavicle/2nd rib down to 6th rib

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20
Q

Muscles overlying breasts? Overlying inf margin?

A

Pectoralis major

Inferior margin=serratous anterior

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21
Q

Tail of breast aka?

A

Tail of Spence

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22
Q

Which breast nodes are most easily palpated?

A

Central nodes

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23
Q

What is the loose, wrinkled pouch in men?

A

Scrotum

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24
Q

How many compartments in scrotum?

A

2 compartments, one testis in each

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25
Q

Covering of scrotum?

A

Tunica vaginalis

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26
Q

Tunica vaginalis covers posterior scrotum?

A

Nope!

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27
Q

Name of tissue covering posterolateral scrotum?

A

Epididymis

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28
Q

Shape of Epididymis?

A

Comma shape

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29
Q

What does Epididymis feel like? (hint: what it feels like)

A

Noduar, soft, cordlike

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30
Q

What is Epididymis site for?

A

REservoir for storage, maturation, and transport of sperm

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31
Q

How to view Epididymis

A

Lift up

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32
Q

What sort of test done to any palpable mass of scrotum?

A

Transillumination

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33
Q

Which 4 scrotal masses do not transilluminate?

A
  1. Inguinal hernia
  2. Varicocele
  3. Tumor
  4. Hematoma
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34
Q

Mass while standing which disappears while laying?

A

Hernia

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35
Q

Mass while standing which stays while laying?

A

Listen to mass with stethoscope for bowel sounds (indirect inguinal hernia)

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36
Q

Red glow during scrotal transillumination is likely not what?

A

Not hernia

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37
Q

Two major types of hernias?

A
  1. Inguinal

2. Femoral

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38
Q

Inguinal Hernia when loops of bowel do what?

A

Force way through weak spots of inguinal canal

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39
Q

2 types of Inguinal Hernia?

A
  1. Indirect Inguinal Hernia

2. Direct inguinal hernia

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40
Q

Most common type of inguinal hernia?

A

Indirect

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41
Q

Origin of indirect inguinal hernia?

A

Above inguinal ligament

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42
Q

Course of indirect inguinal hernia?

A

Into scrotum

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43
Q

What hear in scrotum with indirect inguinal hernia?

A

bowel sounds

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44
Q

Which hernia responds to “cough and bear down”

A

indirect inguinal hernia

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45
Q

Direct inguinal hernia rare in who?

A

Rarely in women

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46
Q

Direct inguinal hernia above what age?

A

> 40, men

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47
Q

Origin of Direct inguinal hernia?

A

Above inguinal ligament near public tubercle

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48
Q

What direction does Direct inguinal hernia bulge?

A

Anteriorally

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49
Q

Where does Direct inguinal hernia push side of finger?

A

Forward

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50
Q

Femoral hernia is when bowel pushes through where?

A

Trough femoral canal weak spots

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51
Q

Origin of femoral hernia?

A

Below inguinal ligament

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52
Q

Least common hernia?

A

Femoral hernia

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53
Q

Who gets Femoral hernia more often?

A

Womens

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54
Q

First thing to do in BLS?

A

Scene safe, shout for help, activate emergency response system, get AED

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55
Q

When to start CPR?

A

No pulse, gasping w/snoring noises

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56
Q

CPR for adults ratio and rate?

A

30:2, 100-120 compressions per minute

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57
Q

How often to rotate for adult CPR?

A

q2min

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58
Q

What to do with AED and pacemaker?

A

Don’t put pads over pacemaker

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59
Q

Rescue breathing for opioid overdose rate?

A

1 breath every 5 seconds

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60
Q

What to do for opioid no pulse and no breathing?

A

One person start CPR, one person get AED and naloxone

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61
Q

Wheezing between cought is what degree of choking obstruction?

A

Mild

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62
Q

Can’t talk, cyanosis, high-pitch during inhale is what degree of choking?

A

Severe

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63
Q

Who can and can’t do abdominal thrusts on?

A

Can=people of average size

Can’t=preggers, obese, infants

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64
Q

Unstable defintion according to ACLS?

A

No pulse, no breathing, signs of shock, altered mental state, acute heart failure, VTach, VFib

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65
Q

Stable defintion according to ACLS?

A

Pulse, breathing, stable tachycardia, stable bradycardia

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66
Q

When to do synchronized cardioversion?

A

Persistent tachycardia with pulse and hypotension/AMS/Shock/Ischemic CP/Acute heart failure

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67
Q

Who to defibrillate? (Hint: only 2 rhythms)

A
  1. VFib

2. Pulseless VTach

68
Q

Which antiarrythmics for tachycardia with wide QRS but otherwise stable?

A

Adenosine, Procainamide, Amiodarine, Sotolol

69
Q

Antiarrythmic for refractory VFib and Pulseless VTach?

A

Amiodarone

70
Q

Can shock PEA and asystole?

A

Nope!

71
Q

Pulse ox for post-arrest care?

A

Maintain at 94%

72
Q

Define BRUE

A

Brief Resolved Unexplained Event

73
Q

Age of BRUE?

A

<12 y/o

74
Q

Is there a clear explanation of symptoms in BRUE?

A

Nope

75
Q

BRUE consists of resolved episodes of….?

A

Cyanosis/Pallor, absent/irregular/decreased brathing, hypo/hypertonia, altered LOC

76
Q

High risk BRUE?

A

<60 days old, born <32wk gestation w/>42wk corrected, requiring CPR, >1 min event, not first event

77
Q

Low risk BRUE?

A

> 60d old, >32wk gestation w/>42wk corrected, no CPR required, <1min event, first event

78
Q

Tx for high risk BRUE?

A

Admit for observation, CBC, blood cx, LP, CMP, lytes, ABG, UA, urine CX, echo, ekg, eeg, etc etc

79
Q

Tx for low risk BRUE?

A

No admit, pertussis testing, EKG, brief observation, educate family on CPR

80
Q

Etiology of Nursemaid’s Elbow?

A

Radial head subluxation (partial dislocation)

81
Q

Ages of Nursemaid’s Elbow?

A

15mo-3y

82
Q

Area of true tenderness in Nursemaid’s Elbow?

A

No

83
Q

DX tests needed in Nursemaid’s Elbow?

A

Nope

84
Q

PE of Nursemaid’s Elbow?

A

Arm held at side w/slight 130-150º elbow flexion “self splint”

85
Q

Tx of Nursemaid’s Elbow?

A

Simple reduction. Palm up, touch hand to shoulder, rotate thumb

86
Q

How long no lift/twist after Nursemaid’s Elbow reduction?

A

2-3 days

87
Q

Fever up to 12 weeks?

A

100.4

88
Q

Fever over 3 months?

A

101.2

89
Q

Fever w/source, well-appearing, <28d?

A

Full work up. CBC w/diff, blood cx, urine cx, UA, LP, CXR

90
Q

Fever w/source, well-appearing, 1mo-90d?

A

All but LP if had 2 mo immunizations

CBC w/diff, blood cx, urine cx, UA, CXR

91
Q

Fever w/source, well-appearing, 3mo-1yr?

A

Tx source, consider CBC w/diff, blood cx, urine cx, UA.

CXR only w/cough

92
Q

Fever w/source, well-appearing, >3yr?

A

No further work up

93
Q

Fever without source, well-appearing, <28d?

A

Full w/u

CBC w/diff, blood cx, urine cx, UA, LP, CXR

94
Q

Fever without source, well-appearing, 1-3 mo?

A

Full workup, +/-LP

CBC w/diff, blood cx, urine cx, UA, CXR

95
Q

Fever without source, well-appearing, >3 mo?

A

CBC w/diff, UA, urine cx

Cough=Blood cx or CXR

96
Q

Fever and ill appearing neonate?

A

Setic until proven otherwise

97
Q

Worry for fever and ill appearing in 30-90d?

A

Yes, worry

98
Q

WHat age are fontanelles fused by?

A
  1. “Almost entire size”
99
Q

When to perform neuro exam for LP?

A

Before and after LP

100
Q

Where is LP done? (Hint: 2 sites)

A

L3-L4 or L4-L5

101
Q

Why is LP done where it’s done?

A

Below spinal cord, in cauda equina

102
Q

What to do if his bone with LP needle?

A

Move caudally (down)

103
Q

What to do if his bone with LP needle and already moved caudally?

A

Move cephaled (toward head)

104
Q

Neutrophils in CSF means?

A

Bacterial infx

105
Q

Lymphocytes in CSF means?

A

Viral aseptic meningitis

106
Q

Normal RBC in CSF?

A

<10

107
Q

What causes increased RBC in CSF?

A

Traumatic tap, SAH

108
Q

Xanthochromia is what?

A

Yellow/orange discoloration in CSF. Product of RBC lysis. Can mean SAH.

109
Q

Normal glucose in CSF?

A

50-80

110
Q

Low glucose in CSF means what? (hint: 4)

A
  1. Bacterial meningitis
  2. sarcoidosis
  3. syphillis
  4. SAH
111
Q

Glucose levels in CSF when viral?

A

Variable

112
Q

Serum glucose and CSF glucose?

A

Serum hyperglycemia may mask depressed CSF glucose to always check serum CSF

113
Q

Normal protein range in CSF?

A

15-45

114
Q

Elevated protein range in CSF?

A

> 45

115
Q

Percent of CSF gram stain being false negative?

A

20%

116
Q

Gram negative dipococci in CSF which bacteria?

A

N. Meningites

117
Q

Gram negative bascilli in CSF which bacteria?

A

H. Flu

118
Q

Gram positive cocci in CSF which bacteria? (hint: 2)

A

Strep or staph

119
Q

CSF cultures take how long?

A

24-48h

120
Q

Normal opening pressure in lateral recumbant position?

A

18-20

121
Q

CSF opening pressure >30 can mean? (hint: 2)

A
  1. Bacterial infx

2. Pseudotumor cerebri

122
Q

How many tubes of CSF collected in LP?

A

4

123
Q

How many mL collected in LP?

A

4-8mL

124
Q

Tubes and traumatic LP tap?

A

If RBC in #4 > than in #1=traumatic tap

125
Q

Cobalt Blue Filter used with what to check for eye problems?

A

Flourescein

126
Q

Flourescein can help find what sorts of eye problems?

A

Abrasions, ulcers, superficial punctate, leratitis

127
Q

Herpes Zoser Opthalmicus effects which nerve?

A

V1 nerve (Trigeminal)

128
Q

What are seen on the V1 dermatome in Herpes Zoster Opthalmicus?

A

Dendritic epithelial lesions

129
Q

What is Hitchinson’s Sign (part of Herpes Zoster Opthalmicus)?

A

Tip of nose has rash

130
Q

Acute onset, red, discharge, stuck eye lip is which problem?

A

Acute Bacterial Conjunctivitis

131
Q

Pseudomembrane, subepithelial infiltrates is which eye condition?

A

Viral Keratoconjunctivitis

132
Q

Excoriation and inflammation at base of penis is which condition?

A

Scabies of penis

133
Q

Is Chancre painful of painless?

A

Painless!

134
Q

Chancre is a lesion of what?

A

Primary Syphilis

135
Q

Chancre is a lesion of Primary Syphilis and which bacteria?

A

T. Palladium

136
Q

T. Palladium incubation period?

A

9-90d

137
Q

Chanchroid painful or painless?

A

PAINFUL!!!!

138
Q

Painful, deep ulcer?

A

Chanchroid

139
Q

Chanchroid from which bacteria?

A

H Ducrey

140
Q

H. Ducrey causes Chanchroid in what period post-exposure?

A

3-7 days

141
Q

What is Hydrospadias?

A

Urethral opening in area other than tip of penis

142
Q

Majority of breast masses detected by who?

A

Female herself

143
Q

Quadrant where are a majority of breast masses found?

A

Upper outer quadrant

144
Q

Where does the Tail of Spence point toward?

A

Axilla

145
Q

Which pattern is the most validated for breast exams?

A

Vertical strip pattern

146
Q

What mental health question to ask post-preggers?

A

About depression

147
Q

EGBUS?

A

External genetalia, batrholinns gland, utrthra, skenes

148
Q

What does the multiparous os look like?

A

Not around, more linear

149
Q

Nulliparous os looks like?

A

Small and perfectly round

150
Q

Speculum exam before or after bimanual exam?

A

BEFORE

151
Q

Gyn exams in which position?

A

Lithotomy

152
Q

What does a normal prostate feel like?

A

Rubbery, non-tender

153
Q

What if prostate feels firm?

A

Concerning

154
Q

Firm and bumpy prostate?

A

Think cancer

155
Q

What sort of pain with hernia?

A

Referred pain (Esp in indirect hernia)

156
Q

Descibe pain in indirect hernia? Swelling?

A

One-sided pain in testes, scrotal swelling

157
Q

When to defer rectal exam in adults?

A

If Asx

158
Q

Thunderclap, slap onset HA from what? “worst HA of life”

A

Subarrachnoid Hemorrhage

159
Q

MA, nuchal rigifity, +kernig or brudzinski’s, petechial rash?

A

Meningitis

160
Q

Kernig sign?

A

Pain with fip and knee flexion

161
Q

Burdzinski’s sign?

A

Neck flexes and causes hips and knees to flex

162
Q

What to use to guide LP in obese?

A

Fluorscopy

163
Q

How to rule out headbleed before LP?

A

CT scan!

164
Q

What sort of pain can occur to nerve root after LP?

A

Radicular pain

165
Q

Name of intralaminar space where “pop” is heard in LP?

A

Ligamentum flavum

Physical Exam 2 COPY COPY (5 decks)

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