FCM III Final Flashcards
(197 cards)
1
Q
Increased fremitus, decreased percussion, egophany
A
solid (tumor)
2
Q
Decreased fremitus, decreased percussion, egophany
A
fluid (effusion)
3
Q
decreased fremitus, increased percussion, no egophany
A
gas (pneumothorax)
4
Q
in effusion, see tracheal deviation in what direction
A
away from disease
5
Q
clicking, bubbling or rattling on inhalation; when air opens closed air spaces
A
rales (can be moist, fine, dry or coarse)
6
Q
snoring sound from blocked air flow or turbulence in large airways
A
rhonchi
7
Q
wheeeze due to blockage of airflow in trachea or back of throat
A
stridor
8
Q
high-pitch sound on exhalation, caused by narrow airways
A
wheeze
9
Q
normal JVP
A
1-3 cm above sternal angle, 6-8cm above right atrium
10
Q
assessed in left lateral decubitus position
A
mitral stenosis murmurs/gallops
11
Q
sound in early diastole (filling); indicates enlarged ventricle
A
S3 gallop
12
Q
sound in later diastole, atrium straining to fill stiff ventricle
A
S4 gallop
13
Q
can be normal in children, YA
A
S3
14
Q
can be normal in adults, atheletes
A
S4
15
Q
a “thrill” is a palpable murmur, corresponds to grades
A
Grades 4-6
16
Q
6 dimensions of a murmur
A
LRQuITS: location, radiation, quality, intensity (1-6), timing, shape
17
Q
loud, with thrill
A
4
18
Q
loud, can hear with stethoscope partially off of chest
A
5
19
Q
can hear with stethoscope off of chest
A
6
20
Q
closing bicupid and tricuspid valves (begins systole)
A
S1
21
Q
which valve in S1 closes first?
A
biscuspid (mitral)
22
Q
closing aortic and pulmonic valves (begins diastole)
A
S2
23
Q
which valve in S2 closes first
A
Aortic (split S2 normal in inspiration)
24
Q
BP target for HTN patients over 60
A
<150/90
25
BP target for HTN patients under 60
<140/90
26
palmar erythema, asterixis (hands tremor or flapping), spider angioma, eye jaundice/sceral icterus
advanced liver disease
27
abdominal pain radiating to the back (3)
pancreatitis, duodenal ulcer, aortic dissection
28
palpating contralateral abdomen results in RLQ pain
Rovsing's sign, appendicitis
29
acuity defect (blindness)
II
30
visual field defects (hemianopsia)
II
31
optic disc defects (papilledema or optic atrophy)
II
32
pupillary light response defects
II and III
33
other maybe causes of pupillary light response defects 4
blindness, CN III paralysis, tonic pupils, horners
34
extraocular movement defects (strabismus, nystagmus, etc)
III, IV, VI
35
temporal/masseter weakness, facial numbness
V
36
lateralization to affected ear
Weber, conduction loss (bone>air)
37
lateralization to unaffected ear
Weber, sensoineural loss (air>bone)
38
impaired swallowing, hoarseness, palatal paralysis, absent gag reflex
IX and X
39
tongue atropy, fasciluations
XII (fasculations in ALS, polio)
40
poor word articulation
XII (can be due to X as well)
41
protruded tongue deviates which way
to weak side (contralateral CVA)
42
atrophy, fasciluations, weakness in trapezius or SCM
XI
43
facial muscle weakness
VII
44
sudden onset, wax and wane, infections, metabolic emergencies, PE, MI etc
delirium
45
tips of lateral and medial malleous, navicular bone and base of fifth metatarsal
ottawa ankle rules
46
passively internally rotate shouulder and flex forward greater than 90 degreses
Neer's: RTC impingement, subacromial bursitis
47
Neer's Sen/Spec for RTC
83/51
48
Neer's Sen/Spec for subacromial bursitis
75/48
49
elbow and should flexed 90 degrees, examiner internally rotates shoulder
Hawkin's: RTC impingement, subacromial bursitis
50
Hawkin's Sen/Spec for RTC
86/43
51
Hawkin's Sen/Spec for subacromial bursitis
92/44
52
flex shoulder actively against resistance with the elbow extended and forearm supinated
Speed's: bicipital tendonitis
53
Speed's sen/spec for bicipital tendonitis
90/13
54
active supination against resistance with elbow flexed to 90 degrees and the forearm pronated
yergason's: bicipital tendonitis
55
Yergason's Sen/spec for bicipital tendonopathy
43/79
56
arm held in 90 degree abduction with full internal rotation maintained against downward resistance
Empty Can: supraspinatus pathology
57
Empty Can Sens/Spec for supraspinatus pathology
89/50
58
dorsum of hand lifted off lower back with and without resistance
lift-off: subscapularis tendon tear
59
lift-off sens/spec for subscapularis tendon tear
partial tear 22/99, full tear 94/99
60
unable to lower arm slowly, or only with extreme pain
drop-arm: RTC tear
61
drop arm test sens/spc for RTC tear
partial tear 14/78, full tear 35/86
62
bulging ear drum, purulent effusions, erythematous membrane
otitis media
63
clear or purulent drainage, edema, pain on tug test, tip insertion
otits externa (swimmer's ear)
64
thyroid bruit can be heard in
hyperthyroid secondary to graves
65
how close to examine a derm lesion
closer than 20cm (about 8 inches)
66
ABCDE of melanoma
assymmetry, border irregularity, color variegation, diamter >6cm, evolutionin size, color or shape
67
blanchable redness
erythema
68
large area of redness, maybe also desquamation
erythroderma
69
dilation of small superficial blood vessels
telengectasia
70
non-blanchable, 1-2cm, flat
petechia
71
bruise, can change color from blue to yellow
ecchymosis
72
redness from vascular inflammation
palpable purpura
73
small (<1cm) flat lesions, usually just epidermal or dermal color changes
macule
74
primary lesion in tinea versicolor (tropical yeast infection)
macule
75
a small flat lesion >1cm
patch (big macule)
76
raised lesion, no fluid, <1cm
papule
77
raised lesion, no fluid, >1cm
plaque
78
primary lesion in psoriasis, in epidermis or superficial dermis
plaque
79
large, hard, deep papule, down to midermis, overlying epidermis looks normal
nodule
80
small blister (fluid filled vesicle), <1cm
vesicle
81
blister >1cm
bulla
82
vesicle filled with pus
pustule
83
contains fluid/semi-solid material
cyst
84
primary lesion in shingles
vesicle
85
loss of epidermis (as in a post-weeping, crusted vesicle), usually heals with no scarring
erosion
86
circumscribed loss of dermis, usually scarrs, can develop eschar
ulcer
87
hard darkened plaque covering
eschar
88
thinning of skin, as from topical steroid use
atrophy
89
abrasion or stripping of skin due to repetitve motion
excoriation
90
white/gray flakes/plates of compacted stratum corneum
scales
91
drying of plasma, blood, or purulent exudate on skin, seen in impetigo
crust
92
thickening of dermis due to repeated rubbing, as in pruritic scabies
lichenification
93
head, hands and feet distribution
acral
94
herpes zoster distribution
dermatomal
95
extensor surface distribution
knees and elbows
96
flexor surface distribution
backs of knees, fronts of elbows
97
in axilla, perineum, under breasts and skin folds
intertriginous
98
address in handoff so care-team understands patient
SBAR: situation/background/assessment/recommendation
99
mediastinum and heart normally should be
less than 50% of transverse chest diameter
100
HR from EKG
count the large boxes between 2 R waves and count off starting with 300, 150, 100, 75, 50
101
QRS is upright in leads I and avF
normal axis on EKG
102
Large diphasic P wave (V1) at initial upstroke
right atrial hypertrophy
103
Large diphasic P wave (V1) in wide terminal component
left atrial hypertrophy
104
S wave in V1 and R wave in V5 sum to greater than 35mm
left ventricular hypertrophy
105
Q waves bigger than 1 mm in width or .04 seconds in duration
MI
106
T wave depressions or inversions
ischemia
107
ST elevation
acute MI
108
evidence pyramid, worse to best
studies, synopses of studies, syntheses (cochrane library), summaries (evidence-based textbooks), CPE (computers)
109
vertebra prominens
C7
110
normal strength
5
111
moves against gravity/light resistance
4
112
gravity with no resistance
3
113
gravity eliminated
2
114
muscle movement w/o joint movement
1
115
no muscle movement
0
116
sustained clonus (always abnormal)
4
117
brisk w/at most a few beats of clonus (may be normal)
3
118
easily detectable (normal)
2
119
detectable only with reinforcement (may be normal)
1
120
no reflexes (always abnormal)
0
121
Katz Basic Activities of Daily Living:
bathing, dressing, toiletting, tranferring, continence, feeding
122
lawton-brody instrumental activites of daily living:
telephone, shopping, food prep, housekeeping, laundry, modes of transport, medications, finances
123
should be able to see how many posterior ribs in x-ray
10
124
adduct hip (bring thigh toward midline) and direct posterior force on the knee
barlow test for hip dysplasia
125
flex hip to 90 degrees, place index fingers on greater trochaners, and gently abduct legs
ortolani test for hip dysplasia
126
baby respiratory rate
40-60 bpm, may be irregular so count for 20-30 seconds
127
length of typical admission presentation
7 minutes
128
1 large box (five small boxes) on EKG
.2 seconds
129
carotid upstroke corresponds to
systole
130
extension fracture of the radius
Colles fracture
131
flexion fracture of radius, pain localized to distal radius
Smith's fracture
132
aortic regurg murmur occurs in
diastole
133
blurred lateral optic disk indicates
acute increase in ICP
134
hypocalcemia presesnts on PE
Chvostek's sign: neuromuscular irritability
135
pulsus paradoxus
aortic dissection sign
136
L3 lesion
quadriceps impaired, Can't bend the knee
137
squeeze gastrocnemius, see no foot movement
positive Thompson test (achilles tendon rupture)
138
presents as unilateral, effects lower face on controlateral side
upper motor facial nerve lesion
139
s1 lesion
can't plantarflex the foot
140
L5 Lesion
foot drop, diffulty with toe extension and heel walk
141
flexing neck causes hips and knees to flex
brudinski's sign: meningitis
142
where is S1 louder than S2
at the apex
143
lateral epicondyle tenderness
tennis elbow
144
medial epicondyle tenderness
golf elbow
145
first palpable midline spinous process
C2
146
at the level of the spine of the scapular
T3
147
at the inferior angle fo the scapula
T8
148
at the lowest rib
T12
149
at the level of the hyoid bone
C3
150
at the level of the thyroid cartilage anteriorly
C4-5
151
and the level of the first cricoid ring
C6
152
at the iliac crests
L4
153
at the lvel of the posterior superior iliac spine
S2
154
ankle reflexes before 60
90% have both
155
ankle reflexes after 60
60% have both, 30% have none
156
flick the distal phalanx of the long finger
hoffman's: thumb flexion means upper motor lesions
157
relief with arm abduction (hand behind head)
arm abduction sign: cervical radiculopathy
158
radiating pain in ipsilateral arm with passive extenstion, flexing and rotating of neck with gentle downward pressure
spurling maneuver: cervical radiculopathy
159
pain down spin eiwth chin to chest
L'Hermitte's: cervical myelopathy
160
pain with leg raise beyond 30 degrees
straight leg raise: sciatica
161
pain down ipsilateral leg below knee when head is forward flexed while foot is dorsiflexed with knee fully extended
seated slump test: lumbar radiculopathy
162
pain in thigh with knee flexion then hip extension in supine position
femoral nerve stretch test: lumbar radiculopathy
163
detect quadriceps weakness
single leg sit-to-stand test
164
light reflecting asymmetrically off of corneas
hirschberg test: occular misalignment
165
red free setting (green circle)
good for hemorrhages, nerve fiber layer
166
hypermic optic disc
blood vessel hypertrophy
167
pale optic disc
optic atrophy
168
blurred optic disc
papilledema
169
in a normal optic disc, diameter of cup
should not exceed 1/2 the diameter of the entire disc (otherwise glaucoma)
170
loss of spontaneous venous pulsations in eye
maybe papilledema
171
occurrence of undescended testicles
3-4% of term boys
172
assymetric Moro reflex
fractures, brachial plexus lesions
173
Derm stone fronton neck
C3
174
Derm arms
C6/t1
175
T4 and T10 dermatomes
Nipples, umbilicus
176
L4/5 dermatomes
Front of legs
177
S1/s2 dermatomes
Back of legs
178
S5 dermatome
Personal
179
Biceps level
C5/6
180
Brachioradialis level
C6
181
Triceps level
C7
182
Patellar level
L4
183
Ankle level
S1
184
Plantar levels
L5/S1
185
Weak baby femoral pulses
Only sign of aortic coarc before cardiogenic shock
186
Normal baby HR
120-160 bpm. Less than 90 is abnormal
187
Average baby head circumference
35 cm
188
Babies with meningitis, hypothyroid, hydrocephalus, genetic disorders, bony dysplasia
Large fontanelles
189
Wide nipples, lymphedema, excess nuchal skin
Turners
190
Adducted internally rotated arm w/intact grasp
Erbs palsy, common, c5/6 traction
191
Metatarsal adductus
C shaped lateral foot edge, associated with hip dysplasia
192
Severe port wine stains
Surge-weber, involves brain and eye
193
Sharp pain on poking liver: stops breath
Murphy's: chile cystitis
194
RUQ sans radiation
Acute or alcoholic hepatitis
195
Epigastric pain
MI, GERD, gastritis
196
RLQ pain
Appendicitis, PID, ectopic pregnancy
197
LLQ pain
Diverticulitis
