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Physical Exam 2 COPY COPY > Written comp review > Flashcards

Written comp review Flashcards

1
Q

What sort of exam does a first-time patient in office or hospital get?

A

Comprehensive assessment

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2
Q

Which exam includes all elements of health history and complete physical exam?

A

Comprehensive assessment

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3
Q

Which exam covers base-line for future assessments?

A

Comprehensive assessment

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4
Q

What type of exam for a PT who is known-well and coming in for routine care?

A

Focal/Problem-oriented assessment

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5
Q

What type of exam for specific “urgent care” like sore throat or knee pain?

A

Focal/Problem-oriented assessment

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6
Q

Which exam is addressed to symptoms and specific body system?

A

Focal/Problem-oriented assessment

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7
Q

What is the sequence of physical exam?

A

Head to toe

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8
Q

Which side to exam PT on?

A

PT’s right side, even if lefty

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9
Q

3 goals of exam sequence?

A
  1. Maximize PT comfort
  2. Avoid unnecessary changes in position
  3. Enhance clinical efficiency
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10
Q

Normal BP for age 18-60?

A

Systolic <120

Diastolic <80

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11
Q

Prehypertensive age 18-60?

A

Systolic=120-139

Diastolic=80-89

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12
Q

Stage 1 range HTN in 18-60?

A

Systolic=140-159

Diastolic 90-99

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13
Q

Stage 2 range HTN in 18-60?

A

Systolic ≥160

Diastolic ≥100

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14
Q

4 end-organs damaged by HTN?

A
  1. Eyes
  2. Brain
  3. Heart
  4. Kidneys
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15
Q

Is home/ambulatory or office BP measurment more predictive of CV disease and end-organ damage?

A

Home/ambulatory

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16
Q

What is home/ambulatory BP measurement for HTN with automated device?

A

≤135/85

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17
Q

HTN: Office manual or automated avg how many times? Occasions?

A

Average of two separate occasions

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18
Q

HTN: Office manual or automated avg for Stage 1 HTN? (actual numbers)

A

≥140/90 (aka Stage 1 HTN)

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19
Q

Asleep HTN measurment?

A

> 120/70

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20
Q

What is Masked HTN? What are the home and office measurments?

A

Office blood pressure <140/90, but an elevated daytime blood pressure of >135/85 on home or ambulatory testing

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21
Q

What does Masked HTN a risk for?

A

Increased risk for CV disease and end-organ damage

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22
Q

White Coat HTN measurment?

A

≥140/90

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23
Q

White Coat HTN is what type of response?

A

Anxiety response

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24
Q

White Coat HTN and risk for what?

A

Normal to slight increased CV risk

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25
Q

Does White Coat HTN require treatment?

A

No tx required

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26
Q

Cuff bladder width what % of upper arm?

A

40%

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27
Q

Cuff bladder length what % of upper arm?

A

80%. Almost long enough to encircle arm.

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28
Q

Standard cuff measurment? Good for what arm circumference?

A

12x23cm. Good for 28cm arm circumference.

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29
Q

Where should brachial artery be when assessing BP?

A

At level of heart

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30
Q

BP if brachial artery is below heart?

A

Elevated BP

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31
Q

BP if brachial artery is above heart?

A

Low BP

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32
Q

Systolic: when to stop inflating cuff and what to feel for?

A

Feel radial art until disappears. Note that number and add 30. Deflate, wait 15-30 sec, and reinflate to check systolic.

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33
Q

Systolic: What is avoided when inflating, adding 30, then reinflating?

A

Ausculatory gap

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34
Q

Which side of stethoscope over brachial artery for BP?

A

Bell

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35
Q

How many mmHg to deflate cuff in BP?

A

2-3mmHg

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36
Q

Systolic: What is heard?

A

2 consecutive beats

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37
Q

Diastolic: What is heard?

A

Disappearance point ater muffling sound

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38
Q

Diastolic: Which heart condition causes muffling to never disappear?

A

Aortic regurg

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39
Q

BP: Round to nearest what?

A

2 mmHg

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40
Q

How long to wait between taking BP?

A

2 or more minutes

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41
Q

If two BPs differ by more than ___mmHg take additional readings

A

5mmHg

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42
Q

BP: ≥10mmHg difference between arms which 3 conditions?

A
  1. Subclavian steel syndrome
  2. Supraclavicular Aortic Stenosis
  3. Aortic Dissection
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43
Q

What will Coarctation of Aorta and Occlusive Aortic Disease to do BP and pulses in extremities?

A

Upper ext=Higher systolic BP

Lower ext=Lower systolic BP, delayed/diminished femoral pulses

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44
Q

Which 3 CNs are sensory only?

A

1, 2, 8

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45
Q

Which 5 CNs are motor only?

A

3, 4, 6, 11, 12

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46
Q

Which 4 CNs are both motor and sensory?

A

5, 7, 9, 10

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47
Q

How to test CN 1 Olfactory?

A

Occlude each nostril for patency. Then PT closes eyes and smells through one nostril to identify scent.

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48
Q

How to test CN 2 Optic?

A

Test visual acuity with charts. Test visual fields by controntation. Fundoscopic exam.

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49
Q

How to test CN 3 Oculomotor?

A

Pupilary reaction to light and near response. Ptosis (levator palpebrae muscle) and medial rectus muscle (convergance).

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50
Q

How to test CN 4 Trochlear?

A

Superior oblique muscle. Vertical diplopia.

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51
Q

How to test CN 6 Abducens?

A

Lateral rectus muscle. Moves eye out/lateral.

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52
Q

CNs 3, 4, and 6 control what 3 things about the pupil?

A

Pupil size, shape, reaction to light

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53
Q

How to test CN 8 Vestibularchocolear?

A

Whisper in one each while closing off opposite ear.
Rinne Test=bone conduction
Webber test=lateralization

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54
Q

How to test CN 11 Spinal Accessory?

A

Head turn against resistance to test SCM. Inspect trap muscles for fasiculations or atrophy, shoulder droop, scapula downward drop.

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55
Q

How to test CN 12 Hypoglossal?

A

Observe tongue for atrophy or fisculations. Stick tongue out and it deviates to weak side. Also word articulation problems.

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56
Q

3 questions which frame neuro exam?

A
  1. Is mental status intact?
  2. Are findings symmetric?
  3. Where is lesion?
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57
Q

What is the most sensitive indicator of brain injury?

A

Change in PTs level of mentation

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58
Q

What seen in Upper Motor Neuron Lesion? (hint: 5)

A
  1. Hypertonia
  2. Hyperreflexia
  3. No fasciculations
  4. No atrophy
    • Babinski
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59
Q

What seen in Lower Motor Neuron Lesion?

A
  1. Hypotonia
  2. Hyporeflexia
  3. Has fasciculations
  4. Has atrophy
  5. Normal plantar reflex
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60
Q

Range of reflex grading?

A

0-4

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61
Q

Reflex grade 0?

A

No response

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62
Q

Reflex grade 1+?

A

Diminished response

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63
Q

Reflex grade 2+?

A

Normal

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64
Q

Reflex grade 3+?

A

Brisk, maybe normal.

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65
Q

Reflex grade 4+?

A

Hyperactive. Brisk with clonus.

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66
Q

Which reflex grade has clonus?

A

4+

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67
Q

Can plain films rule out C-spine fx?

A

No

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68
Q

Why measure infant head?

A

Reflects brain and cranium rate of growth

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69
Q

Define Proptosis

A

AKA exophthalmos.

Eye protrusion.

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70
Q

Proptosis/Exophalamos seen in which dz?

A

Graves

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71
Q

Define Hyperopia

A

Far sighted

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72
Q

Define Myopia

A

Near sighted

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73
Q

Define Presbyopia

A

Aging vision

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74
Q

Define Scomata

A

Specks in vision where can’t see

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75
Q

3 causes of diplopia?

A
  1. Brainstem
  2. Cerebellum
  3. CN problems
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76
Q

Horizontal Diplopia due to palsy of which 2 CNs?

A

3 or 6

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77
Q

Vertical Diplopia due to palsy of which 2 CNs?

A

3 or 4

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78
Q

Diplopia in one eye with other eye closed due to problem where? (hint: 2 possible places)

A
  1. Cornea

2. Lens

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79
Q

Define Coloboma

A

Defect/hole in iris

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80
Q

Define hyphema

A

Blood in anterior chamber of eye

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81
Q

Define hypopon

A

Pus in anterior chamber of eye

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82
Q

Describe near reaction

A

Pupils constrict (miosis) when look from far to near

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83
Q

Convergence due to which CN and muscle?

A

CN 3, medial rectus

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84
Q

Define miosis

A

Pupils constrict

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85
Q

Define mydriasis

A

Pupils dialate

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86
Q

Describe Marcus Gunn Pipil

A

Partial dilation of pupils when light shined into eye with optic nerve damage

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87
Q

Which condition: Partial dilation of pupils when light shined into eye with optic nerve damage

A

Marcus Gunn Pupil

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88
Q

Describe Tonic/Adie Pupil

A

Dilated large pupil. Slow to no reaction to light.

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89
Q

Which condition: Dilated large pupil. Slow to no reaction to light.

A

Tonic/Adie pupil

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90
Q

Horner Syndrome 3 signs?

A
  1. Ptosis
  2. Miosis
  3. Anhydrosis
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91
Q

Describe Argyll Robertson Pupils

A

Bilateral small and irregularly shaped pupils. Do not react to light.

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92
Q

Which condition: Bilateral small and irregularly shaped pupils. Do not react to light.

A

Argyll Robertson Pupils

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93
Q

Define Anisocoria

A

Unequal pupil size

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94
Q

Color, size, and light reflex arteries in eye?

A

Light red, small, bright light reflex

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95
Q

Color, size, and light reflex veins in eye?

A

Dark red, large, absent light reflex

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96
Q

Normal introcular pressure range?

A

10-22mmHg

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97
Q

Describe Style/hordeolum. 2 causes? Which way does it point?

A

Painful, tender, red eyelid. Points outside lid.

  1. S Aureus
  2. Blocked meibomian gland
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98
Q

Describe Chalazion. Which way does it point?

A

Painless nodules due to blocked meibomian gland. Points inside lid.

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99
Q

Describe Xanthelasma

A

Yellow cholesterol plaque on eye lid

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100
Q

Describe Corneal Arcus

A

Thin white/gray arc at edge of cornea

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101
Q

Describe Keyser Fleischer Ring. Cause?

A

Golden to red brown ring. Copper deposits.

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102
Q

Describe corneal scar

A

Opacity of lens

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103
Q

Color nuclear cataract? Need what to see?

A

Gray with flashlight

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104
Q

Describe peripheral cataract

A

Spokelike shadows

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105
Q

Which wall does the breast lay against?

A

Anterior thoracic wall

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106
Q

Breast goes from which rib to which rib?

A

(Clavicle ) 2nd rb to 6th rib

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107
Q

Breast horizontal borders?

A

Sternum to midaxillary line

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108
Q

What is the male loose, wrinkled pouch?

A

Scrotum

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109
Q

Scrotum how many compartments?

A

2

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110
Q

2 compartments of the Scrotum?

A
  1. Tunica vaginalis

2. Epididymis

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111
Q

Scrotum’s Tunica vaginalis covers what? Where doesn’t it cover?

A

Covers Testis, not posteriorally

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112
Q

Scrotum’s epididymis covers what and where?

A

Posterolateral surface of testis

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113
Q

Epididymis shape?

A

Comma-like

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114
Q

Job of epididymis

A

Reservoir for storage, maturaiton, and transport of sperm

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115
Q

2 types if inguinal hernia?

A
  1. Direct

2. Indirect

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116
Q

What pokes through in inguinal hernia?

A

Loops of bowel thorugh weak areas into inguinal canal

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117
Q

Which 2 hernias are above the inguinal ligament?

A
  1. Indirect

2. Direct

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118
Q

Which is the most common inguinal hernia?

A

Indirect hernia

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119
Q

Which hernia affects men over 40 and women rarely?

A

Direct hernia

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120
Q

Which hernia is more common in women?

A

Femoral

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121
Q

Indirect Inguinal Hernia goes into where?

A

Scrotum

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122
Q

What direction Direct Inguinal Hernia bulge?

A

Anteriorally

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123
Q

Which hernia is below the inguinal ligament?

A

Femoral

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124
Q

What is a herniation of the rectum into the posterior vaginal wall?

A

Rectocele

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Perfectly
125
Q

What is a bulge of the upper 2/3 of ant vaginal wall?

A

Cystocele

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126
Q

What is a tight prepuce (foreskin) which cannot retract over glans penis?

A

Phimosis

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127
Q

Describe Phimosis

A

Tight prepuce (foreskin) which cannot rectract over glans penis

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128
Q

What is a tight prepuce (foreskin) which is retracted and cannot be returned

A

Paraphimosis

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129
Q

Describe paraphimosis

A

A tight prepuce (foreskin) which is retracted and cannot be returned

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130
Q

What is an inflammation of the glans penis?

A

Valanitis

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131
Q

Describe Valanitis

A

Inflammation of the glans penis

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132
Q

What is a tender and painful scrotal swelling called?

A

Epididymitis

133
Q

Describe Epididymitis

A

Tender and painful scrotal swelling

134
Q

What is a twist of the sermatic cord causing acutely painful, tender, and swollen scrotum?

A

Testicular torsion

135
Q

Decribe testicular torsion

A

A twist of the sermatic cord causing acutely painful, tender, and swollen scrotum

136
Q

Which side of stethoscope to hear high-pitch sounds of S1 and S2?

A

Diaphragm

137
Q

Diaphragm for which pitch sounds?

A

High-pitch

138
Q

Which side of stethoscope for mitral regurg, aortic regurg, and preicardial friction rubs

A

Diaphragm

139
Q

Bell of stethoscope for which pitch sounds?

A

Low-pitch

140
Q

S3 and S4 hears with which side of stethoscope?

A

Bell of stethoscope

141
Q

S3 and S4 which pitch?

A

Low-pitch

142
Q

Pitch of mitral stenosis? Which side of stethoscope?

A

Bell of stethoscope

143
Q

What causes the S1 sound?

A

When mitral and tricuspid valves slam shut

144
Q

Where is S1 loudest?

A

Apex

145
Q

What immediately follows S1?

A

Carotid upstroke

S1->carotid upstoke->S2

146
Q

What causes the S2 sound

A

Aortic and pulmonic valves slam shut, and blood ejected out of left ventricle

147
Q

Where is S2 loudest?

A

At base

148
Q

S3 normal in who?

A

Children, preggers, well-trained athelets

149
Q

S4 represents what pathology?

A

LVH

150
Q

5 spots for cardiac auscultation?

A
  1. Apical
  2. Pulmonic
  3. Erb’s point
  4. Tricuspid area
  5. Mitral area
151
Q

Which side of stethoscope to use with cardiac auscultation

A

Diaphragm

152
Q

Which sides of stethoscope to use for Tricuspid and Mitral area?

A

Diaphragm and bell

153
Q

What does JVP measure/reflect?

A

Pressure in right atrium

154
Q

Which vein to use for JVP?

A

Right internal jugular vein

155
Q

Where to measure for JVP?

A

Meniscus (high point) of pulsations

156
Q

JVP measures height of colums in relation to which angle?

A

Sternal angle

157
Q

How much to add to column measurement in JVP?

A

5cm

158
Q

What is normal JVP measurement?

A

≤9cm

159
Q

High JVP measurement?

A

> 9cm

160
Q

Bed at which angle for JVP? Lighting?

A

30º. Tangential lighting.

161
Q

JVP: what to do to bed if PT is hypovolemic?

A

Lower head of bed

162
Q

JVP: what to do to bed if PT is hypervolemic?

A

Raise head of bed

163
Q

What is Kussmal’s Sign?

A

JVP rises with inspiration (normally goes down)

164
Q

What called when JVP rises with inspiration?

A

Kussmal’s Sign

165
Q

In normal heart what happens to JVP waveform when pressure put on liver?

A

Transient rise

166
Q

In heart with right sided failure what happens to JVP waveform when pressure put on liver?

A

Progressive rise in CVP then JVP waveform

167
Q

Describe Hepato Jugular Reflex

A

Normal heart= increased blood volume only causes transient increase of JVP
R-sided heart impaired=progressive rise in CVP and JVP waveform

168
Q

3 types of pain

A
  1. Patietal pain
  2. Visceral pain
  3. Referred pain
169
Q

Which pain is steady aching, localized over involved structure, and worse with movement like cough or ambulance ride?

A

Patietal Pain

170
Q

Which pain in due to stretching/distentin of hollow abdominal organs and difficult to localize?

A

Visceral Pain

171
Q

Renal Colic causes which type of pain?

A

Visceral pain

172
Q

Which pain is felt in distance sites due to dermatomal innervation at same spinal level?

A

Referred pain

173
Q

What causes Pleuritic Chest Pain?

A

Irritation of parietal pleura with deep inspiration. Viral pleurisy, pericarditis, pulmonary embolism, pneumomia.

174
Q

Which pain is worse with cough or movement?

A

Parietal Pain

175
Q

Describe Murphy’s Sign

A

Sharp increase in RUQ tenderness with inspiration

176
Q

Murphy’s Sign for which condition?

A

Acute cholecystitis

177
Q

3 appendix signs?

A
  1. Rovsing
  2. Psoas
  3. Obturator
178
Q

Rovsing Sign when…?

A

RLQ pain during LLQ pressure

179
Q

Which sign is RLQ pain during LLQ pressure?

A

Rovsing Sign for appendix

180
Q

How many Psoas Signs are there?

A

TWO!

181
Q

Which sign: Pain of psoas muscle with rise thigh against hand at knee or flex leg at hip

A

Psoas Sign

182
Q

Which sign: Flex right thigh at hip, bend knee, int rotate causes right hypogastric pain

A

Obtorator Sign

183
Q

Subluxation vs dislocation: which is temporary and partial?

A

Subluxation

184
Q

Shoulder subluxation can also be called what?

A

“Shoulder joint instability”

185
Q

Should joint instability (temporary and partial dislocation) is most consistent with what type of ortho problem?

A

Subluxation

186
Q

What happens with a true shoulder dislocation?

A

Humerus comes out of socket (the glenoid)

187
Q

ROM and pain with shoulder dislocation?

A

Poor ROM. LOTS OF PAIN!

188
Q

What 2 things are the main shoulder joint stabilizers?

A
  1. Ligaments

2. Capsule complex

189
Q

Arm position in anterior shoulder dislocation?

A

Slight abduction and external rotation

190
Q

Humeral head and void in anterior shoulder dislocation?

A

In patients who are thin, the prominent humeral head can be felt anteriorly and the void can be seen posteriorly (sulcus sign) in the shoulder.

191
Q

Arm position in posterior shoulder dislocation?

A

Arm in adduction and internal rotation

192
Q

Why are posterior shoulder dislocations easy to miss?

A

PT appears to be only guarding extremity

193
Q

Which 2 radiograph views for shoulder dislocation?

A
  1. AP

2. Axillary

194
Q

Shoulder dislocation: Which view to get if axillary view cannot be obtained?

A

Y-view

195
Q

Which view required for posterior shoulder dislocation or might be missed?

A

Orthogonal view

196
Q

What is the most important treatment of an acute shoulder dislocation?

A

Primpr reduction of the glenohumeral joint

197
Q

After determining the direction of the dislocation what is the most important next step in treatment?

A

Relaxation of the shoulder musculature

198
Q

How does one verify successful shoulder reduction?

A

Post-reduction films

199
Q

Which tx for common anterior shoulder dislocations?

A

Hippocratic Method. For common anterior dislocations, one of the oldest methods of reduction. The clinician places their foot in the patient’s axilla while gentle longitudinal traction is applied (may be utilized with or without int./ext. rotation of shoulder).

200
Q

Describe Stimson Technique technique

A

Stimson Technique—The clinician has the patient lie prone on an examining table, allowing the affected arm to hang off the bed. Again, longitudinal traction and int./ext. rotation are applied to the arm. Weights can also be added to the patient’s wrist to facilitate reduction.

201
Q

Which tx for shoulder dislocation has always worked for Orrahood?

A

Fried Maneuver—Taught to this PA by his then supervising physician, Dr. Fried, circa 2001.
Patient lies supine, and an assistant applies counter traction to the patient’s chest wall; the clinician begins maneuver with forced long axial traction of the affected extremity, followed by slow, gentle abduction to roughly 90 degrees (or until resistance encountered) and subsequent external rotation applied.

202
Q

How long to immobilize arm after post-reduction? With what?

A

Sling and swath for 1-3 weeks.

203
Q

What should be encourages while PT in sling for shoulder dislocation?

A

Elbow, wrist, and hand ROM should be encouraged.

204
Q

T or F
After diagnosing an anterior shoulder dislocation (with an associated axillary
nerve injury), the clinician should expect, and subsequently plan for,
prolonged sequelae from said nerve injury.

A

False

205
Q

Injury to the axillary nerve during shoulder dislocation has been reported to be as high as what?

A

40%

206
Q

When do perform a detailed neurovascular exam with a shoulder dislocation?

A

Before and after reduction

207
Q

When does Apprehension Sign occur?

A

Paltellar dislocation

208
Q

Which sign: Knee placed at 30 degrees flexion, and lateral pressure is applied. Medial instability results in apprehension by the patient.

A

Apprehension Sign

209
Q

4 phases of wound healing?

A
  1. Hemostasis/Coagulation phase
  2. Inflammation phase
  3. Proliferation/migratory phase
  4. Remodeling phase
210
Q

When does hemostasis/coagulation phase occur in wound healing?

A

Immediately after wound

211
Q

What is formed, constricted, and seals in Hemostasis/Coagulation Phase of wound healing?

A

Platelet plug forms. Vessels constrict. Thrombus seals wound.

212
Q

When does Inflammatory Phase occur in wound healing?

A

First 2-3 days after injury

213
Q

What do WBCs to in Inflammatory Phase of wound healing?

A

WBCs remove necrotic tissue and control infection.

214
Q

When does Proliferation/Migratory Phase occur in wound healing? How long does it last?

A

2-3 days after injury. Lasts 2-3 weeks.

215
Q

Which tissue migrates across top of wound in Proliferation Phase?

A

Granulation tissue. Forms capillaries and epithelial cells.

216
Q

What proliferate into wound during Proliferation/Migratory Phase of wound healing? What do they create?

A

Fibroblasts proliferate into wound. Create structure.

217
Q

When does Remodeling Phase occur in wound healing?

A

Days to weeks after injury

218
Q

What forms in Remodeling Phase of wound healing? What contractures?

A

Collagen forms, scar contracture.

219
Q

What is the strength of the scar in Remodeling Phase?

A

80% of original wound up to one year

220
Q

What to confirm before repairing wounds?

A

Neurovascular and sensori-motor condition

221
Q

When to update tetanus shot? (Hint: 2 cases)

A
  1. ≥10y since last

2. 5y plus wound is tetanus prone

222
Q

When is a wound considered tetanus prone? (Hint: 4)

A
  1. 6h+
  2. > 1cm deep
  3. Stellate lacerations
  4. Soiled with feces, saliva, gunshot, puncture, burn, or frostbit
223
Q

Which tetanus shot to use if between 6 weeks and 6 years old?

A

DTaP

224
Q

Which tetanus shot to use if 11 years or older?

A

Tdap

225
Q

Which animal causes most infections with bite?

A

Cats

226
Q

Motto when suturing?

A

“Approximate, don’t stangulate”

227
Q

Range of suture size?

A

00 to 10-0

228
Q

Which suture size is larger- 00 or 10-0?

A

00 is larger. 10-0 is smaller.

229
Q

Most commonly used suture dizes?

A

3-0 to 6-0

230
Q

2 non-absorbable monofilamented sutures?

A

Ethilon and Prolene

231
Q

Which suture material is absorbable for dermal and fascial closure?

A

Vicryl

232
Q

Which suture material is absorbable for mucosal and scrotal closure?

A

Vicryl

233
Q

Ways to do primary wound closure?

A

Suturing, stapling, taping, etc

234
Q

Primary wound closure and wound edges?

A

Wound edges approximated

235
Q

Timeframe for primary wound closure?

A

6-12h

236
Q

Primary wound closure and cosmetic outcome good or bad?

A

Good!

237
Q

Which wound closure not to use is cosmetic is a concern?

A

Staples

238
Q

When does delayed primary closure occur?

A

When primary closure inappropriate

239
Q

When is primary closure inappropriate and required delayed primary closure? (hint: 2)

A
  1. Infection

2. Severely contaminated

240
Q

Delayed primary closure is a period of time when what type of healing occurs?

A

Secondary healing prior to closure

241
Q

Timeframe for delayed primary closure?

A

48-96h

242
Q

When to avoid staples for wound closure?

A

Avoid in cosmetic areas

243
Q

Staples good for which areas?

A

Scalp, torso, genital areas

244
Q

Most common type of suture knot?

A

Square knot

245
Q

Most common type of suture technique?

A

Simply interrupted

246
Q

When it horizontal mattress used? (hint: wound edges)

A

To pull wounde edges together over distance

247
Q

When it vertical mattress used? (hint: wound edges)

A

Used when wound edges tend to invert or on concave surfaces

248
Q

When to remove sutures from eyelid?

A

3 days

249
Q

When to remove sutures from cheek?

A

3-5 days

250
Q

When to remove sutures from nose, forehead, or neck?

A

5 days

251
Q

When to remove sutures from ear or scalp?

A

5-7 days

252
Q

When to remove sutures from arm, leg, hand, foot, chest, back, and abdomen?

A

7-10 days

253
Q

1% Lidocaine blocks what? What intact?

A

Blocks painful stimulant. Pressure and touch intact.

254
Q

2% Lidocaine blocks what? What intact?

A

Block all stimuli including pressure and touch. Nothing intact.

255
Q

Max dose of Lidocaine?

A

4mg/kg

256
Q

How much volume for average finger numbing?

A

No more than 5mL

257
Q

Where to avoid epi? (hint: 4 places)

A
  1. Digits
  2. Nose
  3. Ear
  4. Penis
258
Q

Goal of splinting?

A

To stabilize/immobilize until seen by ortho

259
Q

When it PT seen by ortho after splint places?

A

2-3 days (another slide says follow up w/n 3-5d after injury)

260
Q

When to splint?

A

Immediately after injury

261
Q

What direction to wrap injury?

A

Distal to proximal

262
Q

When to evaluate circulation, sensory, and motor when splinting?

A

Before and after splint placed

263
Q

Plaster splint sets in how many minutes?

A

2-8 minutes

264
Q

Plaster splint max strength in how long?

A

24h

265
Q

DIP Joint Splint must not be removed for how many weeks?

A

8 weeks

266
Q

How long is a cast on for?

A

4-6 weeks

267
Q

When to put on a cast?

A

After post-traumatic swelling resolved, 5-7d

268
Q

2 most common spots to do LP?

A
  1. L3-L4

2. L4-L5

269
Q

PT position for LP if need opening pressure?

A

Lateral recumbant (on side with knees to chest)

270
Q

LP opening pressure normal range?

A

18-20mm H2O

271
Q

CSF volume to collect?

A

4-8ml

272
Q

How many tubes for CSF collection?

A

4

273
Q

Tube 1 CSF for what?

A

Cell count and diff

274
Q

Tube 2 CSF for what?

A

Glucose and protein

275
Q

Tube 3 CSF for what?

A

Culture and gram stain

276
Q

Tube 4 CSF for what?

A

Cell count and diff

277
Q

Normal CSF protein range?

A

15-45

278
Q

Elevated CSF protein can mean?

A

Infection

279
Q

CSF WBC above 5 means what?

A

Possible infection

280
Q

Increased CSF neutrophil means what type of infection?

A

Bacterial

281
Q

Increased CSF lymphocytes means what type of infection?

A

Viral (aseptic meningitis)

282
Q

Normal CSF RBC?

A

<10

283
Q

What is a yellow color in CSF called?

A

Xanthochromia

284
Q

Xanthochromia means what?

A

Possible SAH

285
Q

Xanthochromia vs traumatic tap?

A

Traumatic tap isn’t caused by SAH while Xanthochromia can be from SAH.

286
Q

Normal CSF glucose range?

A

50-80

287
Q

Low CSF glucose can mean what?

A

Bacterial meningitis, sarcoidosis, syphillis, SAH

288
Q

Variable CSF glucose can mean what?

A

Viral

289
Q

Serum hyperglycemia can do what to CSF glucose?

A

Mask CSF hypoglycemia

290
Q

Xanthochromia is produced from lysis of what?

A

RBCs

291
Q

Xanthochromia helps to differentiate from what complication?

A

Traumatic tap

292
Q

N. Menigitidis gram and shape?

A

Gram negative diplococci

293
Q

H. Flu gram and shape?

A

Gram negative bacilli

294
Q

Steph and Strep gram and shape?

A

Gram positive cocci

295
Q

Opening pressure above 30 can mean what? (hint: 2)

A
  1. Bacterial infection

2. Pseudotumor cerebri

296
Q

When to get help for: Sudden vision loss, flash of light/floaters, any chemical to eye, and diplopia?

A

Right now. Ocular emergency!

297
Q

When to get help for: Ocular pain, foreign body, corneal abrasion

A

Today. Ocular urgency.

298
Q

When to get help for: Itchty eyes, painful bump on eyelip

A

This week. Ocular priority.

299
Q

When to get help for: Vision change over last few months, bump on eye, non-painful bump on lid

A

Next available appointment. Ocular routine.

300
Q

Ascites and flanks?

A

Bulging and dullness

301
Q

Ascites and fluid?

A

Fluid shift

302
Q

What does cyanosis suggest?

A

Hypoxia

303
Q

What does diaphoresis and somnolence suggest?

A

Hypercapnia and respiratory acidosis

304
Q

Can does assisted ventilations do to ICP?

A

Decreases ICP

305
Q

Can does assisted ventilations do to hypercarbia and acidosis?

A

Corrects hypercarbia and acidosis

306
Q

Blind Nasotracheal Intubation and apnea?

A

CI’d due to increased risk of esophageal intubation

307
Q

Blind Nasotracheal Intubation and coagulopathy?

A

CI’d due to risk of epistaxis

308
Q

Cricothyotomy CI’d before what age?

A

8

309
Q

Airway of choice in children and PT with tracheal injury?

A

Tracheotomy

310
Q

Does a CXR rule out esophageal intubation?

A

Nope!

311
Q

Which airway used when gag reflex present?

A

Nasopharyngeal

312
Q

Which airway used when gag reflex absent?

A

Oropharyngeal

313
Q

Most common type of intubation?

A

Orotracheal

314
Q

When to ventilate prior to orotracheal intubation?

A

Hypoxic or apenic

315
Q

Orotracheal head position?

A

Sniffing position

316
Q

Miller Blade shape and where does it go?

A

Straight. Under epiglottis.

317
Q

McIntosh Blade shape and where does it go?

A

Curved blade. Anterior to epiglottis in vallexula.

318
Q

Best method to confirm placement of endotracheal tube?

A

See tube pass through cords

319
Q

When to do Rapid Sequence Intubation?

A

PT with full stomach

320
Q

RSI and preoxygenation aka?

A

Nitrogen washout

321
Q

What does preoxygenation before RSI do to O2?

A

Creates O2 reservoir. Sat 90% up to 8 minutes.

322
Q

How to do preoxygenation for RSI?

A

100% O2 with tight fitting mask. 8 deep breaths over 60 seconds.

323
Q

Preoxygenation in RSI CI’d in who?

A

PT with severe COPD or asthma

324
Q

accommodation of the lens is controlled by what muscle?

A

cilliary muscle

325
Q

what is anisocoria?

A

difference of >.4mm in the diameter of one pupil

326
Q

what is nystagmus?

A

involuntary jerking movement of the eye with quick and slow components (horizontal, vertical or rotary)

327
Q

in what diseases is nystagmus seen?

A

cerebellar disease, gait ataxia, dysarthria and vestibular disorders

328
Q

what diseases is ptosis seen in?

A

3rd nerve palsy, Horner syndrome, myasthenia gravis

Physical Exam 2 COPY COPY (5 decks)

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