exam 3 Flashcards
(181 cards)
1
Q
What reflex is tested by using the pointed side of the reflex hammer in the bend of the elbow?
A
Biceps reflex
This reflex assesses the biceps muscle’s response to stimulation.
2
Q
How is the triceps reflex tested?
A
By using the pointed side of the reflex hammer just above the elbow
This reflex evaluates the triceps muscle’s reactivity.
3
Q
Which side of the reflex hammer is used to test the brachioradialis reflex?
A
Flat side halfway between elbow and wrist (anterior side)
This reflex helps assess the function of the radial nerve.
4
Q
Where should the flat side of the reflex hammer be applied to test the patellar reflex?
A
Just below the knee with the patient sitting and leg hanging freely
This reflex evaluates the knee-jerk response.
5
Q
How is the Achilles reflex tested?
A
By using the flat side of the hammer against the Achilles tendon while holding the patient’s foot
This reflex assesses the function of the gastrocnemius and soleus muscles.
6
Q
What is the technique for testing the plantar reflex (Babinski reflex)?
A
Scrape lateral edge of the bottom of the foot starting at the bottom and coming up and then medially
This reflex indicates neurological function, particularly in infants.
7
Q
What object is used to scrape the abdominal quadrants during the abdominal reflex test?
A
A dull object (tongue blade)
This reflex assesses the integrity of the abdominal muscles and spinal nerves.
8
Q
What are the signs of increased intracranial pressure (ICP)?
A
- Level of consciousness (LOC)
- Motor function
- Pupillary response
- Vital signs
These assessments help in identifying potential brain injury or swelling.
9
Q
What is the normal range for ICP?
A
15-20 mmHg
Elevated ICP can indicate serious medical conditions.
10
Q
Which cranial nerve controls pupil size?
A
Cranial nerve 3
This nerve is crucial for constriction and dilation of the pupils.
11
Q
What is considered a normal pupil size?
A
3-5 mm
Pupils should also be round in shape.
12
Q
What does a fixed dilated pupil indicate?
A
Increased ICP, prolonged diffuse hypoxia, atropine
This condition suggests serious neurological issues.
13
Q
What does a pinpoint pupil indicate?
A
Narcotics
This response is often associated with opioid overdose.
14
Q
How many pairs of spinal nerves are there?
A
31 pairs
These nerves are categorized into cervical, thoracic, lumbar, sacral, and coccygeal.
15
Q
List the number of spinal nerves in each category.
A
- 8 cervical
- 12 thoracic
- 5 lumbar
- 5 sacral
- 1 coccygeal
Each category corresponds to different regions of the spine.
16
Q
What is the Glasgow Coma Scale (GCS)?
A
A scale used to assess the consciousness level of a person based on their responses in three areas: eye opening, verbal response, and motor response.
17
Q
What are the three components of the Glasgow Coma Scale?
A
Eye opening, verbal response, and motor response.
18
Q
What is the maximum score on the Glasgow Coma Scale?
A
15
19
Q
What is the minimum score on the Glasgow Coma Scale?
A
3
20
Q
True or False: A GCS score of 8 or less indicates a coma.
A
True
21
Q
What score range on the GCS indicates mild brain injury?
A
13-15
22
Q
What score range on the GCS indicates moderate brain injury?
A
9-12
23
Q
What score range on the GCS indicates severe brain injury?
A
8 or less
24
Q
Fill in the blank: The eye opening response is scored from ___ to ___ on the GCS.
A
1 to 4
25
What is the highest score for eye opening response?
4
26
What does a score of '1' in the verbal response indicate?
No verbal response
27
What does a score of '5' in the verbal response indicate?
Oriented and converses normally
28
What is the highest score for motor response?
6
29
What does a score of '2' in the motor response indicate?
Abnormal extension (decerebrate response)
30
True or False: The GCS can be used for both adults and children.
True
31
What is the scoring for eye opening in response to speech?
3
32
Fill in the blank: The GCS is primarily used in ___ settings.
Emergency and critical care
33
What does a GCS score of 10 indicate?
Moderate brain injury
34
What is the significance of a GCS score that decreases over time?
It may indicate worsening neurological status.
35
What does 'localizing to pain' score in the motor response?
5
36
What is the score for 'inappropriate words' in the verbal response?
3
37
What type of response is scored '4' in eye opening?
Spontaneous eye opening
38
Fill in the blank: A GCS score of ___ indicates a fully conscious person.
15
39
What does a score of '3' in eye opening indicate?
Eye opening in response to speech
40
True or False: The Glasgow Coma Scale is a subjective measure.
False
41
What does a score of '1' in the motor response indicate?
No motor response
42
What is the purpose of the Glasgow Coma Scale?
To provide a reliable and objective way to assess the level of consciousness.
43
What are the vertebral levels in humans?
7 cervical, 12 thoracic, 5 lumbar, 5 sacral, 3 to 4 coccygeal
44
What are the prominent surface landmarks of the spine?
C7 and T1 at base of neck, interspace between T7 & T8, L4 at iliac crest, and sacrum at posterior superior iliac spines
45
What is the shape of the vertebral column in a lateral view?
Double-S shape with four curves: cervical and lumbar curves are concave; thoracic and sacrococcygeal curves are convex
46
What is the first step in the order of a musculoskeletal exam?
Inspection
47
What should be noted during the inspection of joints?
Size and contour of joint, skin color, swelling, masses, or deformity
48
What is a key aspect of palpation in a musculoskeletal exam?
Palpate each joint for temperature, tenderness, swelling, or masses
49
What is the range of motion (ROM) assessment?
Ask for active voluntary ROM while stabilizing the proximal area
50
What should muscle strength tests reveal?
Strength should be equal bilaterally and fully resist opposing force
51
What does the shoulder shrug test assess?
Integrity of cranial nerve XI (spinal accessory nerve)
52
What is checked during the elbow examination?
Size, contour, deformity, redness, swelling, and olecranon bursa
53
What tests are used to determine Carpal Tunnel Syndrome?
Phalen test and Tinel sign test
54
What is the common motion dysfunction found in hip disease?
Limitation of abduction of hip while supine
55
What is the purpose of McMurray’s test?
To assess for meniscal tears in the knee
56
What should be inspected in the ankle and foot exam?
Contour of joints, alignment with lower leg, and weight-bearing distribution
57
What should be noted during the spine inspection?
Spine straightness, thoracic curve, and lumbar curve
58
What does kyphosis refer to?
Enhanced thoracic curve typically seen in aging people
59
What does lordosis refer to?
Pronounced lumbar curve seen in obese people
60
What is the significance of the straight leg raising or Lasègue’s test?
It may confirm presence of herniated nucleus pulposus if it reproduces sciatic pain
61
How is true leg length measured?
From anterior iliac spine to medial malleolus, crossing medial side of knee
62
What should be the normal outcome of leg length measurements?
Equal or within 1 cm, indicating no true bone discrepancy
63
Fill in the blank: The lumbar curve should disappear with _______.
flexion
64
True or False: Joints are normally tender to palpation.
False
65
What indicates a positive Phalen test?
Numbness and burning during acute flexion of wrist
66
What should be assessed when testing the hip joint?
Symmetric levels of iliac crests, gluteal folds, and equally sized buttocks
67
What does the assessment of the wrist and hand include?
Inspection, palpation, ROM, and muscle strength testing
68
What are the expected postural changes in pregnancy?
* Progressive lordosis
* Anterior cervical flexion toward third trimester
* Kyphosis and slumped shoulders
* Protuberant abdomen and relaxed mobility in joints create characteristic 'waddling' gait
## Footnote
These changes are due to the body's adaptation to accommodate the growing fetus and maintain balance.
69
What does an Ortolani’s sign indicate?
It is used for detecting hip dislocation in infants.
## Footnote
Ortolani’s sign should be checked at every visit until the infant is 1 year old.
70
What does a positive Phalen test indicate?
Numbness and burning in the wrist due to median nerve compression.
## Footnote
This is often associated with carpal tunnel syndrome.
71
What does the Tinel sign test assess?
It assesses for median nerve irritation.
## Footnote
Percussion of the median nerve produces burning and tingling if positive.
72
What does McMurray's Test assess?
Meniscal tear in the knee.
## Footnote
This test involves flexing and rotating the knee while applying a varus or valgus stress.
73
What does the Thessaly test (twist and shout) assess?
Meniscal tear in the knee.
## Footnote
The patient rotates on one leg while the knee is flexed.
74
What does the Anterior Drawer Test evaluate?
Anterior cruciate ligament integrity.
## Footnote
This test involves pulling the tibia forward while stabilizing the femur.
75
What does the Posterior Drawer Test evaluate?
Posterior cruciate ligament integrity.
## Footnote
This test involves pushing the tibia backward while stabilizing the femur.
76
What is the purpose of the Straight Leg Raising or Lasègue’s Test?
To reproduce back and leg pain to confirm the presence of herniated nucleus pulposus.
## Footnote
A positive test reproduces sciatic pain.
77
What is the Nucleus pulposus?
The disk center composed of soft, semifluid, mucoid material.
## Footnote
It plays a critical role in the flexibility and shock absorption of the vertebral column.
78
What motions of the vertebral column are involved in the function of the nucleus pulposus?
* Flexion
* Extension
* Abduction
* Rotation
## Footnote
These motions are essential for overall spinal mobility.
79
What should be inspected and palpated during a TMJ examination?
* Audible and palpable snap or click
* Contracted temporalis and masseter muscles
* Size, firmness, and strength of right and left sides
* Swelling, limitation of motion, and/or reported pain
## Footnote
This examination assesses the integrity of the temporomandibular joint.
80
What does the Trendelenburg sign assess?
Progressive subluxation of the hip.
## Footnote
This test involves observing the pelvis when the patient stands on one leg.
81
What is the procedure for checking for tibial torsion?
Note the relationship of forefoot to hindfoot and assess for any twisting of the tibia.
## Footnote
This can be a residual effect of fetal positioning.
82
What is the recommended position for examining an infant?
Fully undressed and lying on their back while maintaining temperature.
## Footnote
This approach allows for a thorough examination of the infant's musculoskeletal system.
83
What is the treatment for bleeding related to clotting factors?
FFP, platelets if less than 100,000/uL, ddavp (desmopressin)
## Footnote
FFP stands for Fresh Frozen Plasma, which is used to treat bleeding disorders.
84
What is the largest internal organ and gland in the human body?
Liver
## Footnote
The liver performs various vital functions in the body.
85
What is the approximate weight of the liver in males and females?
4lbs in males, 3lbs in females
86
What percentage of adult mass does the liver comprise?
2%
87
Where is the liver located?
Right upper quadrant of the chest area
88
What ribs does the liver span in the mid axillary line?
7th to 11th ribs
89
What covers the liver except for the gallbladder and IVC?
Peritoneum (Gibson's Capsule)
90
How many lobes does the liver have?
4: Right, Left, Caudate, Quadrate
91
How many segments is the liver divided into and what is unique about them?
8 segments, each with independent blood supply & venous & biliary drainage system
92
What are the major functions of the liver?
* Breaking down or converting substances from food like fats & proteins
* Extracting energy, vitamins, & minerals
* Making toxins less harmful and removing them from bloodstream
93
What is the liver's capacity after injury or damage?
Regeneration
94
How much bile does the liver manufacture daily?
800 to 1,000 mLs
95
What does the liver release as a toxic by-product of protein breakdown?
Ammonia, converted to urea in urine
96
What are the types of liver regulation?
* Autoregulation
* Metabolic control
* Buffer response (acids and base)
* Extrinsic control (hormones, neural control, anesthesia & medications)
97
Which anesthetics preserve hepatic blood flow?
Isoflurane & Sevoflurane
98
What is the effect of upper abdominal surgery on hepatic blood flow?
Decreases by 60%
99
What is the effect of a spinal block of T4 on hepatic blood flow?
Reduces by 20%
100
What major protein is produced by the liver?
Albumin
101
Which coagulation factor is not produced by the liver?
Factor VIII
102
What are the functions of the liver important to anesthesia?
* Bilirubin conjugation and secretion
* Bile formation
* Clears fibrin degradation products
* Hormonal function
* T4-T3 conversion
* Inactivation of aldosterone, estrogen, androgen, ADH
* Immunological support
* Drug biotransformation (Cytochrome p450 system)
103
Which drugs with high extraction ratios can be affected by hepatic blood flow?
* Propranolol
* Lidocaine
* Demerol
104
What are poorly extracted drugs sensitive to?
Liver function
105
What is the unique metabolism characteristic of Ketamine?
Induces its own metabolism, can result in rapid tolerance
106
What is the liver acinus?
Microvascular unit of the liver
107
What are the three zones of the liver acinus?
* Zone 1: oxygen rich, oxidative metabolism, synthesis of glycogen
* Zone 2: transition zone
* Zone 3: lowest in oxygen, anaerobic metabolism, responsible for biotransformation of drugs, chemicals & toxins
108
What is cirrhosis?
Condition where scar tissue replaces healthy liver tissue
109
What can cause cirrhosis?
* Long-term excessive alcohol use
* Chronic hepatitis
* Rare genetic disorders (e.g., Wilson’s disease)
* Taking too much acetaminophen
* Insufficient blood supply to the liver
* Drug overdose
* Certain herbal or dietary supplements
110
What complications can arise from cirrhosis?
* High pressure in the liver’s portal vein (portal hypertension)
* Ascites
* Swollen & painful abdomen
* Edema
* Spontaneous bacterial peritonitis (if ascites become infected)
111
True or False: Cirrhosis should be treated immediately.
True
112
What are the responsibilities of the kidneys represented by the acronym A.W.E.T.B.E.V?
A = Acid/base, W = Water, E = Electrolytes, T = Toxin Removal, B = Blood Pressure Regulation, E = Erythropoietin, V = Vitamin D Activation
## Footnote
These functions are critical for maintaining homeostasis in the body.
113
What are the three substances the kidneys excrete?
* Hydrogen Ions
* Urea
* Creatinine
## Footnote
These substances are crucial for assessing kidney function and metabolic status.
114
What is the normal range for Blood Urea Nitrogen (BUN)?
7 – 20 mg/dl
## Footnote
BUN levels help assess kidney function and hydration status.
115
What is the normal range for creatinine in men?
0.7 to 1.3 mg/dL (61.9 to 114.9 μmol/L)
## Footnote
Creatinine levels differ based on sex and muscle mass.
116
What does a specific gravity of 1.03 in urine indicate?
Very concentrated urine
## Footnote
This measurement reflects hydration status and kidney concentrating ability.
117
What is the relationship between GFR and creatinine levels?
GFR is roughly 3 times that of creatinine
## Footnote
Both elevated levels indicate potential kidney problems.
118
What is the definition of Chronic Kidney Disease (CKD)?
Decrease in GFR < 60 for greater than 3 months
## Footnote
This represents at least ½ loss of adult kidney function.
119
What are the first-line therapies for hypertension in patients with CKD?
ACEI & ARB
## Footnote
These medications provide renal protective effects.
120
What is the goal hemoglobin level for patients with anemia and CKD?
11 - 12 g/dl, but not to exceed 13 g/dl
## Footnote
Maintaining this level helps manage anemia effectively.
121
What medications should be avoided in CKD?
* Non Steroidals
* IV Contrast Dye
* Metformin
* Lithium
* Digoxin
## Footnote
These can exacerbate kidney injury or impair function.
122
What is the leading cause of Acute Kidney Injury (AKI) in hospitalized patients?
Surgery
## Footnote
This is due to factors like hypoperfusion and inflammation.
123
What is the pre-renal ratio of BUN to creatinine in AKI?
20 to 1
## Footnote
This ratio indicates prerenal azotemia.
124
What is the treatment of choice for end-stage renal disease (ESRD)?
Renal transplant
## Footnote
This procedure is essential for improving quality of life and survival.
125
What are some contraindications for renal transplant?
* Active acute infection or malignancy
* Uncontrolled systemic disease
* Uncontrolled psychiatric disorder or substance abuse
* Evidence of treatment nonadherence
* Limited life expectancy d/t advanced lung disease or heart failure
## Footnote
These factors can complicate transplant outcomes.
126
How often should low-risk patients be reevaluated for transplant risk?
Every 3 years
## Footnote
This applies to patients aged 18-45 with no major comorbidities.
127
What are recommendations to prevent Contrast-Induced Acute Kidney Injury (CI-AKI)?
* Obtain baseline Cr level & eGFR
* Limit CM volume
* Use preheated (37°C) iso-osmolar CM
* Avoid dehydration
* Administer isotonic saline hydration
## Footnote
These steps are critical to safeguarding kidney function during imaging procedures.
128
What is Addison's disease?
Adrenocortical insufficiency resulting from autoimmune or idiopathic atrophy.
129
What can cause Addison's disease?
Inadequate ACTH from the pituitary or therapeutic use of steroids.
130
List some manifestations of Addison's disease.
* Muscle weakness
* Anorexia
* Dark pigmentation
* Hypotension
* Hypoglycemia
* Low sodium levels
* High potassium levels
131
What is an Addisonian crisis?
A severe condition characterized by circulatory shock and symptoms like pallor, apprehension, and low blood pressure.
132
What are some triggers for an Addisonian crisis?
* Overexertion
* Exposure to cold
* Acute infection
* Decrease in salt intake
133
What diagnostic tests are performed for Addison's disease?
Early morning serum cortisol and plasma ACTH tests to distinguish between primary and secondary adrenal insufficiency.
134
What is the management approach for Addison's disease?
* Restore circulatory status with fluids and steroids
* May need antibiotics if infection precipitated crisis
* Lifelong steroid therapy and mineralocorticoid therapy
135
What causes Cushing’s syndrome?
Excessive adrenocortical activity, often due to corticosteroid medications or pituitary tumors.
136
Name some manifestations of Cushing’s syndrome.
* Cataracts
* Hypertension
* Truncal obesity
* Moon face
* Buffalo hump
* Sodium retention
* Hypokalemia
* Hyperglycemia
137
What diagnostic test is frequently used for Cushing’s syndrome?
Overnight dexamethasone suppression test.
138
What is the significance of a cortisol level less than 5mg/dL in the dexamethasone suppression test?
Indicates normal functioning of the adrenal glands.
139
What is the primary treatment for pituitary source Cushing’s syndrome?
Transsphenoidal hypophysectomy.
140
What are common symptoms of carcinoid syndrome?
* Cutaneous flushing
* Labile blood pressure
* Diarrhea
* Bronchospasm
* Cardiac failure
141
List treatments for carcinoid syndrome.
* Fluid resuscitation
* H1 and H2 antagonists
* Serotonin antagonists
* Bronchodilators
* Vasoactive drugs
* Octreotide
142
What hormones are produced by the thyroid gland?
T3 and T4.
143
What is the Wolf-Chaikoff mechanism?
An adaptive decline in utilization of iodine due to excess iodine.
144
What is calcitonin's role in the body?
Secreted in response to high serum calcium levels, increasing deposition in the bone.
145
What is the most common cause of hypothyroidism?
Hashimoto’s thyroiditis.
146
What are some clinical manifestations of hypothyroidism?
* Fatigue
* Hair loss
* Dry skin
* Brittle nails
* Weight gain
* Cognitive changes
147
What is the preferred pharmacologic treatment for hypothyroidism?
Levothyroxine.
148
What are the signs and symptoms of hyperthyroidism?
* Nervousness
* Irritability
* Palpitations
* Heat intolerance
* Tremors
149
What is thyroid storm?
A life-threatening condition characterized by high fever, tachycardia, and delirium.
150
What medications are used to manage hyperthyroidism?
* PTU (propylthiouracil)
* Tapazole (methimazole)
* Sodium Iodide
* Dexamethasone
151
What is the main function of parathormone?
Maintains sufficient serum calcium levels.
152
What are the manifestations of hyperparathyroidism?
* Apathy
* Fatigue
* Muscle weakness
* Nausea
* Vomiting
* Constipation
153
What is the primary treatment for hyperparathyroidism?
Surgical removal of the parathyroid glands.
154
What are the clinical manifestations of hypoparathyroidism?
* Tetany
* Numbness
* Tingling
* Cramps in extremities
* Laryngeal spasm
155
How is hypoparathyroidism managed?
* Restore calcium levels to 9-10 mg/dL
* May need IV calcium gluconate
* Monitor calcium levels and provide cardiac monitoring
156
What are the two main types of diabetes mellitus?
IDDM (Insulin-Dependent Diabetes Mellitus) and NIDDM (Non-Insulin Dependent Diabetes Mellitus)
## Footnote
IDDM is also known as juvenile diabetes, while NIDDM typically occurs in adults.
157
What is the typical age of onset for IDDM?
16 years old
## Footnote
Onset is usually abrupt.
158
What is the typical age of onset for NIDDM?
Greater than 35 years old
## Footnote
Onset is usually gradual.
159
List three common manifestations of diabetes mellitus.
* Polyphagia
* Polydipsia
* Polyuria
160
True or False: Ketoacidosis is common in NIDDM.
False
## Footnote
Ketoacidosis is common in IDDM.
161
Does NIDDM always require insulin?
No
## Footnote
NIDDM does not always require insulin.
162
What is a common preoperative insulin approach for diabetics?
Give 1/4 to 1/2 the daily dose of intermediate-acting insulin subcutaneously
## Footnote
Additionally, adjust for prescribed insulin and start IV glucose.
163
What is diabetes insipidus characterized by?
Deficiency of ADH (Antidiuretic Hormone)
## Footnote
Leads to excessive thirst and large volumes of dilute urine.
164
What are the typical manifestations of diabetes insipidus?
* Excessive thirst
* Urinary specific gravity of 1.001-1.005
165
What diagnostic test is used for diabetes insipidus?
Fluid deprivation test
## Footnote
This test assesses the ability to concentrate urine.
166
What is a common management medication for diabetes insipidus?
DDAVP (Desmopressin)
## Footnote
Can be given intranasally or IM.
167
What is a pheochromocytoma?
A usually benign tumor originating from the chromaffin cells of the adrenal medulla
## Footnote
Can be malignant in 10% of cases.
168
List three clinical manifestations of pheochromocytoma.
* Headache
* Diaphoresis
* Palpitations
169
What are the 5 H's associated with pheochromocytoma?
* Hypertension
* Headache
* Hyperhidrosis
* Hypermetabolism
* Hyperglycemia
170
What is the primary treatment for pheochromocytoma?
Surgical management
## Footnote
Manipulation of the tumor can cause excessive release of catecholamines.
171
What are corticosteroids used to treat?
* RA
* Asthma
* MS
* COPD exacerbations
* Lupus
* Other autoimmune disorders
* Dermatologic disorders
172
What is a key side effect of corticosteroid therapy?
Hypertension
## Footnote
Other side effects include increased infection risk and osteoporosis.
173
What hormone does the hypothalamus release that stimulates the pituitary?
Corticotropin-releasing hormone
## Footnote
This hormone is involved in the stress response.
174
What is the function of insulin?
Stimulates glucose uptake in cells
## Footnote
It plays a crucial role in regulating blood sugar levels.
175
What does the adrenal cortex produce?
* Mineralocorticoids (e.g., aldosterone)
* Glucocorticoids (e.g., cortisol)
* Adrenal androgens
176
What is the role of parathyroid hormone?
Regulates serum calcium levels
## Footnote
It increases calcium levels in the blood.
177
Fill in the blank: The _______ releases thymosin, affecting T lymphocyte maturation.
Thymus
178
List two hormones produced by the ovaries.
* Estrogen
* Progesterone
179
What is the role of melatonin?
Affects sleep, fertility, and aging
## Footnote
It is produced by the pineal gland.
180
What are prostaglandins?
Local hormones released by plasma cells
## Footnote
They affect various physiological functions.
181
What is the best time to administer corticosteroids?
Early morning between 7-8 AM
## Footnote
This timing helps mimic the body's natural rhythm.
