PCM Final Cumulative Flashcards
(106 cards)
1
Q
when does the frontal sinus develop ?
A
8-10 y/o
Born with maxillary and ethmoid sinus
2
Q
what causes cobblestoning in the throat
A
post nasal dripping
3
Q
what are the common viral causes of sinusitis
A
FARP Flu adenovirus rhinovirus parainfluenza virus
4
Q
what are the common bacterial causes of sinusitis
A
SMH
streppocal pneumonia
moraxella catarrhelis
haemophilis flu
5
Q
what labs should be used for acute bacterial maxillary sinusitis
A
ESR or CRP ( but not needed)
6
Q
what are key symptoms and clinical presentations of bacterial sinusitis
A
- double sickening
- purulent rhinorrhea
- elevated ESR (eythroycyte sedimentation rate)
- is acute bacterial rhinosinusitis if persists without evidence of improvement for at least 10 days beyond the onset of upper respiratory symptoms
- first line antibiotics: amoxicillin, augmentin
- second line: doxycycline, levaquin, clindamycin, and cefixime
7
Q
what is Croup
A
- AKA Laryngotracheitis
- barking cough
- swelling of larynx trachea, and bronchi, causing inspiratory stridor in children 6months-3 y.o
- caused by the flu or respiratory syncytial virus
- presents with fever, nasal flaring, respiratory retractions, stridor
- tx: O2, dexamthosome, epinephrine
8
Q
what is epiglottitis
A
- emergent
- inflammation of epiglottis and adjacent structures
- caused by haempphilus type B flu, GABHS
- rapid onset, sore throat, muffled voice, drooling
- high grade fever, leaning forward
- TX: protect airway, antibiotics
9
Q
ENT Differential causes of vertigo
A
- eustachian tube dysfunction
- Benign paroxysmal positional vertigo (BPPV)
- vestibular neuritis
- labyrinthitis
- Menieres disease
(BE a LVing Mother)
10
Q
vestibular neuritis (neuronitis) vs. labyrinthitis
A
VN: inflammation of the nerve associated with balance causing vertigo but no change in hearing
(damage to sensory neurons of vestibular ganglion)
L: infection of inner ear; affects both branches of vestibule-cochlear nerve causing hearing changes and vertigo
11
Q
Meniere’s disease
A
inner ear disorder causing vertigo, fluctuating hearing loss until complete loss, rising of ear (tinnitus), pressure in ear
- usually one ear
- any age (normal 20-50)
- considered chronic
12
Q
outer, middle, inner ear pathology
A
otis externa,
otis media
labyrinthitis
13
Q
what is the most common cause of BPPV
A
canalthiasis
14
Q
canalthiasis vs cupulothiasis
A
- canal stones
- otoconial debris are floating freely in semicircular canals
- posterior multiple canals SCC involved - cupulo stones
otoconial debris are adhered to the cupula of the crest ampullaris
-not freely floating
-not common
15
Q
to moves to confirm or treat BPPV
A
- dix hall pike maneuver
- seated, legs in front, rotate head 60 degree and extend 20 degrees, lay back quickly and observe nystagmus, or vertigo symptoms, hold 30 sec and repeat 3 times each side - empley maneuver
- rotate head 45 degrees and lay back to extend head 20-30 degrees, look for nystagmus, after 30 sec rotate 90 degrees to other side and hold 30 sec, rotate another 90 by turning onto side, then sit up. helps manipulate crystal to canal opening and help ease symptoms
16
Q
atelectasis
A
collapse of lung tissue that affects the alveoli from normal O2 absorption
17
Q
pleximeter finger and plexor finger
A
- hyperextended middle finger of non dominant hand in percussion
- tapping finger, dominant hand
18
Q
what does atelectasis cause
A
decreased breath sounds, moved trachea, diaphragmatic excursion (unilateral ) , crackles during inspiration , fever.
use IS to treat
19
Q
where is a needle thoracentesis placed
A
2 ICS, midclavicular line
20
Q
where is a chest tube placed
A
4th or 5th ICS, anterior to midaxillary line
or 5th ICS inferior to nipple or inframammary fold
always over superior margin bc NV is at inferior margin
21
Q
what is the 5th vital sign you need for lower respiratory assessment
A
Pulse oximetry
- O2 hg absorbs infrared light and allows red light to pass. (non O2 hg is opposite). amount of light received by detector indicates SpO2 (peripheral arterial O2 saturation)
- % saturation = red/ red + blue
22
Q
what can cause improper waveforms of a pulse ox
A
improper placement, hypo perfusion , hypothermia, motion artifact, skin pigment
23
Q
what is end tidal CO2
A
concentration of CO2 in exhaled air at the end of respiration
-PETCO2 = PaCO2 (35-45)
24
Q
what is incentive spirometer
A
IS is a treatment used to practice inhalation and holding it. (used for atelectasis )
25
what is spirometery
lung fun measurement
- amount and speed of air inhaled and exhaled
- dx. b/t obstructive and restrictive
26
during inspection what can cause asymmetrical expansion
pleural effusion
27
during inspection what can cause retractions
severe asthma, COPD, upper airway obstructions
28
during inspection what can cause unilateral lagging
pleural disease (asbestosis, trauma, phrenic never damage)
29
what causes tracheal deviation
pneumothorax, pleural effusion, atelectasis, mass
| PPAM
30
what causes nail clubbing
congenital heart disease, interstitial lung disease, bronchiectasis, pulmonary fibrosis, cystic fibrosis, lung abscess, malignancy, IBD [not COPD or asthma, smoking or anemia)
C- BLIMI
31
barrel chest and pursed lips
COPD
32
presentation of chronic bronchitis (COPD)
blue bloater
- cough for 3+ months
- overweight and cyanotic
- elevated Hg
- edema
- ronchi and wheezing
33
clinical presentations of emphysema (COPD)
pink puffer
- older/ thin
- severe dyspnea (feeling SOB)
- flattened diaphragms on Xray with hyperinflation
- decreased breath sounds
34
what causes flail chest
trauma of rib fracture
- unilateral change in respiration
- in during inhale and out during exhale
35
during palpation and tactile fremitus, what causes decreased sounds ? increased sounds?
COPD, pleural effusion, fibrosis, tumor, pneumothorax
pneumonia
36
during percussion, what causes dullness, b/l hyper resonance, unilateral hyper resonance , tympanic
dull- fluid or solid replaces air in lungs [ pneumonia, effusion, hemothorax, fibrous tissue or tumor]
b/l : hyper inflated lungs [ COPD, asthma]
Uni: pneumothorax, large air filled bubble in lung
tympanic: abdominal percussion (gastric bubble)
37
what does a healthy lung sound like during percussion
resonant: loud intensity, low pitch, long duration
38
what can cause diaphragmatic excursion asymmetry
pleural effusion, atelectasis, phrenic nerve paralysis
39
what are the normal lung auscultation sounds
vestibular, (high pitched, breezy)
bronchovestibular ( coarse, loud)
broncial (coarse, loud)
tracheal
40
Lung sound: rhonchi
coarse low pitched, may clear with cough
41
Lung sound: wheeze
- expiratory
- whistling high pitched bronchus
- rapid airflow thru narrow bronchial airway
- RAD, asthma, COPD
42
Lung sound: crackles (rales)
- inspiratory
- fine crackling, high pitched. like velcro
- intermittent
- small airway closure due to exipiration and popping open during inspiration
- pneumonia, CHF, atelectasis, pulmonary fibrosis, broncietasis, COPD asthma
43
Lung sound: stridor
inspiratory
| -narrowing upper airway from Croup, epiglottitis , anaplaxis , upper airway obstruction
44
primary and accessory muscles of breathing
primary - diaphragm
accessory- scale, sternomastoids, intercostal, subcostal
45
describe normal vocal resonance during lung auscultation
words are muffled and indistinct
whispered words are faint and indistinct
pt says "ee" and you head a long muffled E
46
bronchophony
spoken words get louder
47
whispered pectoriloquy
whispered words are louder and clearer during auscultation
48
egophony
pt says "ee" and you hear "A"
49
CTAB on documentation means
clear to auscultation bilaterally
50
ABC's of X-rays
adequate, airway, bones, cardiac size, diaphragms, effusions, endotracheal tube, EKG leads, fields and fissures, foreign bodies, great vessels, gastric bubble, hilar masses, impression
51
unilateral vs bilateral decrease in breath sounds
uni- pneumothorax, fluid in lungs on one side
| b/l- asthma, COPD
52
five finger method of normal CV exam
history, physical, ECG, labs, imaging
| I HELP
53
palpate heart for ___ and ____
PMI and thrills
54
how to percuss the heart
start lateral to the left (resonant) and move medial (till dullness)
55
where do you auscultate for the CV exam
```
aortic - 2 ICS on RSB
pulmonic - 2ICS at LSB
tricuspid - 4th ICS on LSB
mitral - 5th ICS at LMCL
carotids with bell for bruits ( hold breath and do one at time)
```
56
describe the S1 heart sound
closure of AV valves.
loudest at Apex
-beginning of ventricular systole
-mitral then tricuspid
57
describe S2 heart sound
closure of semilunar valves
- loudest at base
- Av-> PV
- end of ventricular systole
- splits when preload increases and causes PV to close slower during inspiration
58
S3 and S4 heart sound
S3- after S2 from blooding rushing into the ventricles from high pressure.
- Kentucky
- CHF in elderly
S4- before S1. atrial gallop from forceful contraction of atria against still ventricle
- Tennessee
- hypertrophy from CAD
- normal in athletes
59
murmur grading
```
1- barely audible
2- soft but easily heard
3- loud w//o thrill
4- loud with thrill
5- loud with minimal contact with stethoscope and thrill
6- loud w/o stethoscope and thrill
```
60
what does JVP and JVD measure
estimate of CVP and RA pressure
activity of right side of heart
if JVP visible gives indication of CV pathology or RA pathology
internal jugular is better than external jugular
*MCC of elevated JVP is elevated RV diastolic pressure
61
causes of increased JVD/JVP
MCC- elevated RV diastolic pressure
- SVC obstruction
- severe heart failure
- constrictive pericarditis, cardiac tamponade, RV infarction
- restrictive Cardiomyopathy
62
things that cause HJR (hepato-jugular reflex)
RV failure
constrictive pericarditis
Obstructuve RV filling by tricuspid or atrial tumor
63
what makes murmurs louder or softer
RINSPIRATION (tricuspid and pulmonic louder on inspiration)
LEXSPIRATION (mitral and AV louder on expiration)
preload increases = louder (HOCM and MVP exception)
after load increases = louder (HOCM and MVP exception)
64
what is HOCM
hypertrophic obstructive Cardiomyopathy
- family history of sudden death at young age
- murmur is softer with increased preload
65
what is MVP
Mitral valve prolapse
- leafest of MV prolapse into the left atria under normal pressure and blood flow (regurg happens)
- increase in preload (EDV) improves the mid-systolic click and decreases murmur sound
- common in women with mental disorders
- seen with MVD ( myxomatosis valvular disease)
66
Murmur presentation: Aortic stenosis
systolic murmur
- crescendo- decrescendo murmur
- Old SAD (syncope, angina, dyspnea)
- calcifed aortic valve
- radiates up to carotids
- sound gets softer with decreased preload and increased inter thoracic pressure
67
Murmur presentation: mitral regurgitation
systolic murmur
- seen with rheumatic disease
- radiates to axilla
- best heard at APEX
- holosystolic murmur
68
Murmur presentation: tricuspid regurgitation
systolic murmur
history of IVDA
-holosystolic
69
Murmur presentation: aortic regurgitation
diastolic murmur
- blowing murmur
- seen with Marfan's, head bobbing, water hammer pulse, femoral bruits
70
Murmur presentation: mitral stenosis
diastolic murmur
- opening snap
- rheumatic disease
71
A wave of JVP curve
right atrial contraction, when the TV opens
- with S1 sound
- increased with RA/ RV obstruction, increased pressure in RV, pulmonary HTN, pulmonary emboli, AV dissociation
72
C wave of JVP curve
backward push by closure of the TV during isovolumetric systole
73
X wave of JVP
passive atrial filling and atrial relaxation
| -steep X wave in cardiac tamponade and constrictive pericarditis
74
V wave of JVP
atrial filling
- increased with increased volume and pressure in RA
- prominent with tricuspid regurg and and pulmonary HTN
75
Y slope of JVP
open TV and rapid RV filling
- deep wave in severe tricuspid regurg
- slow Y = obstruction to RV filling
76
pleural friction rub sound in lung auscultation
- inflamed pleural surfaces rub and increase friction
| - creaking sound during expiration
77
cheilitis
red cracks on corner of mouth
| -b12 or Fe deficiency
78
torus palatinus
benign lump on hard palate
79
sprain vs strain
sprain -ligament tearing. blood will cause bruise. hear 'pop' . immediate pain and swelling, bruising. more severe.
strain- muscle tear. 'grabbing sensation'
80
sensitivity vs specificity
sensitivity- true positive. proportion of pts with dx and physical signs
specificity - true negative. portion of its without the dx and lack of physical signs
SnNOUT ( sensitive test with a negative rules a disease out)
SpPIN ( specific test with a positive result rules IN a disease)
81
VINDICATE - differential building
```
vascular
inflammatory
neoplastic
degenerative/deficiency
idiopathic/ intoxication
congenital
autoimmune/ allergic
traumatic
endocrine
```
82
joint vs extremity exam
both : inspect, palpate, ROM, special test
| extremity add: DTR, NV status
83
shoulder is the only joint that ___
tendons (rotator cuff) pass between bones (acromion and humerus )
84
what tests for acromioclavicular injury
cross arm test
85
rotator cuff tendon injury or subacromial impingement tests
```
painful arc
neer impingement sign
hawkins impingment
empty can test
drop arm test
```
speeds and yeargesons (bicipital tendon)
86
dislocated shoulder presentations
-usually anterior dislocation
posterior or inferior is also possible
87
rotator cuff muscles
SITS
- supraspinatus,
- infraspinatus
- teres minor
- subscalpularis
88
most rotator cuff tendon injures are what muscle
surpraspinatus tendon
89
most common cause of chronic shoulder pain
rotator cuff disorder
adhesive capsulitis
shoulder instability
shoulder arthritis
90
septic arthritis (life threatining)
- common in elderly, RA, prothestics, IVDA
- knee involved 50% of time
- joint is red, swollen, warm, and tender
- ROM limited
- aspirations of synovial fluid, fever, tachycardia, and hypotension
- treat with antibiotics, surgical washout
91
most common cause of lateral hip pain
trochanteric bursitis
92
legg calve perthes disease
idiopathic avascular necrosis (osteonecrosis) of hip
- decreased perfusion to femoral head
- kids 3-12
- obesity is a risk factor
- x rays show loose chondral bodies
93
Slippeed capital femoral epiphysis ( SCFE)
-pain and limited ROM with femoral head slippage
-obesity 8-15 y.o.
-impaired internal rotation, hip pain , limping
-
94
femoroacetabular impingement
pain with prolonged sitting, leaning forward and getting out of car
- pain in groin area and buttocks
- c sign, FADIR, FABER test
(labral tear has positive thomas test )
95
pririformis syndrome
- sciatic nerve pinch
- wallet sign
- log roll and PACE test (FAIR)
96
clinical presentation of hip fracture
external rotation and abduction of leg, also leg looks shortened
97
for nursemaids elbow what is the best treatment
hyperpronation
98
median nerve entrapment test
Ok sign
or for carpal tunnel tingles test at wrist
(cubital test should use for ulnar nerve trapment and tinels at elbow)
99
skiers thumb is a tear in what
ulnar collateral ligament of thumb (medial collateral ligament )
100
difference b/t collet and smith fracture
both are fracture of distal radius
* colles = posterior displacement
* smtih = anterior displacement of wrist and hand
101
monteggia fracture vs galeazzi vs nightstick fracture
1. proximal ulnar fracture with radial head dislocation
2. fracture of distal radius with dislocation of ulna
3. fracture of mid shaft ulna
102
what is a muddlers sign
clicking sensation when palpating the third intermetatrsal space
103
what is tinea pedis
fungal infection of the foot
- dry scaling itching
* topical cream
104
what is onchomycosis
fungal infection of the nail
- thick discolored nails
* oral meds
105
thompson test
achilles tendon rupture
| -squeeze calf and look for plantarflexion
106
homens sign and moses sign
1. dorsiflex foot and if plain then DVT
| 2. pain with anterior compression = DVT
