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Flashcards in FCM III Final Deck (197)
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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
Q

BP target for HTN patients under 60

A

<140/90

26
Q

palmar erythema, asterixis (hands tremor or flapping), spider angioma, eye jaundice/sceral icterus

A

advanced liver disease

27
Q

abdominal pain radiating to the back (3)

A

pancreatitis, duodenal ulcer, aortic dissection

28
Q

palpating contralateral abdomen results in RLQ pain

A

Rovsing’s sign, appendicitis

29
Q

acuity defect (blindness)

A

II

30
Q

visual field defects (hemianopsia)

A

II

31
Q

optic disc defects (papilledema or optic atrophy)

A

II

32
Q

pupillary light response defects

A

II and III

33
Q

other maybe causes of pupillary light response defects 4

A

blindness, CN III paralysis, tonic pupils, horners

34
Q

extraocular movement defects (strabismus, nystagmus, etc)

A

III, IV, VI

35
Q

temporal/masseter weakness, facial numbness

A

V

36
Q

lateralization to affected ear

A

Weber, conduction loss (bone>air)

37
Q

lateralization to unaffected ear

A

Weber, sensoineural loss (air>bone)

38
Q

impaired swallowing, hoarseness, palatal paralysis, absent gag reflex

A

IX and X

39
Q

tongue atropy, fasciluations

A

XII (fasculations in ALS, polio)

40
Q

poor word articulation

A

XII (can be due to X as well)

41
Q

protruded tongue deviates which way

A

to weak side (contralateral CVA)

42
Q

atrophy, fasciluations, weakness in trapezius or SCM

A

XI

43
Q

facial muscle weakness

A

VII

44
Q

sudden onset, wax and wane, infections, metabolic emergencies, PE, MI etc

A

delirium

45
Q

tips of lateral and medial malleous, navicular bone and base of fifth metatarsal

A

ottawa ankle rules

46
Q

passively internally rotate shouulder and flex forward greater than 90 degreses

A

Neer’s: RTC impingement, subacromial bursitis

47
Q

Neer’s Sen/Spec for RTC

A

83/51

48
Q

Neer’s Sen/Spec for subacromial bursitis

A

75/48

49
Q

elbow and should flexed 90 degrees, examiner internally rotates shoulder

A

Hawkin’s: RTC impingement, subacromial bursitis

50
Q

Hawkin’s Sen/Spec for RTC

A

86/43

51
Q

Hawkin’s Sen/Spec for subacromial bursitis

A

92/44

52
Q

flex shoulder actively against resistance with the elbow extended and forearm supinated

A

Speed’s: bicipital tendonitis

53
Q

Speed’s sen/spec for bicipital tendonitis

A

90/13

54
Q

active supination against resistance with elbow flexed to 90 degrees and the forearm pronated

A

yergason’s: bicipital tendonitis

55
Q

Yergason’s Sen/spec for bicipital tendonopathy

A

43/79

56
Q

arm held in 90 degree abduction with full internal rotation maintained against downward resistance

A

Empty Can: supraspinatus pathology

57
Q

Empty Can Sens/Spec for supraspinatus pathology

A

89/50

58
Q

dorsum of hand lifted off lower back with and without resistance

A

lift-off: subscapularis tendon tear

59
Q

lift-off sens/spec for subscapularis tendon tear

A

partial tear 22/99, full tear 94/99

60
Q

unable to lower arm slowly, or only with extreme pain

A

drop-arm: RTC tear

61
Q

drop arm test sens/spc for RTC tear

A

partial tear 14/78, full tear 35/86

62
Q

bulging ear drum, purulent effusions, erythematous membrane

A

otitis media

63
Q

clear or purulent drainage, edema, pain on tug test, tip insertion

A

otits externa (swimmer’s ear)

64
Q

thyroid bruit can be heard in

A

hyperthyroid secondary to graves

65
Q

how close to examine a derm lesion

A

closer than 20cm (about 8 inches)

66
Q

ABCDE of melanoma

A

assymmetry, border irregularity, color variegation, diamter >6cm, evolutionin size, color or shape

67
Q

blanchable redness

A

erythema

68
Q

large area of redness, maybe also desquamation

A

erythroderma

69
Q

dilation of small superficial blood vessels

A

telengectasia

70
Q

non-blanchable, 1-2cm, flat

A

petechia

71
Q

bruise, can change color from blue to yellow

A

ecchymosis

72
Q

redness from vascular inflammation

A

palpable purpura

73
Q

small (<1cm) flat lesions, usually just epidermal or dermal color changes

A

macule

74
Q

primary lesion in tinea versicolor (tropical yeast infection)

A

macule

75
Q

a small flat lesion >1cm

A

patch (big macule)

76
Q

raised lesion, no fluid, <1cm

A

papule

77
Q

raised lesion, no fluid, >1cm

A

plaque

78
Q

primary lesion in psoriasis, in epidermis or superficial dermis

A

plaque

79
Q

large, hard, deep papule, down to midermis, overlying epidermis looks normal

A

nodule

80
Q

small blister (fluid filled vesicle), <1cm

A

vesicle

81
Q

blister >1cm

A

bulla

82
Q

vesicle filled with pus

A

pustule

83
Q

contains fluid/semi-solid material

A

cyst

84
Q

primary lesion in shingles

A

vesicle

85
Q

loss of epidermis (as in a post-weeping, crusted vesicle), usually heals with no scarring

A

erosion

86
Q

circumscribed loss of dermis, usually scarrs, can develop eschar

A

ulcer

87
Q

hard darkened plaque covering

A

eschar

88
Q

thinning of skin, as from topical steroid use

A

atrophy

89
Q

abrasion or stripping of skin due to repetitve motion

A

excoriation

90
Q

white/gray flakes/plates of compacted stratum corneum

A

scales

91
Q

drying of plasma, blood, or purulent exudate on skin, seen in impetigo

A

crust

92
Q

thickening of dermis due to repeated rubbing, as in pruritic scabies

A

lichenification

93
Q

head, hands and feet distribution

A

acral

94
Q

herpes zoster distribution

A

dermatomal

95
Q

extensor surface distribution

A

knees and elbows

96
Q

flexor surface distribution

A

backs of knees, fronts of elbows

97
Q

in axilla, perineum, under breasts and skin folds

A

intertriginous

98
Q

address in handoff so care-team understands patient

A

SBAR: situation/background/assessment/recommendation

99
Q

mediastinum and heart normally should be

A

less than 50% of transverse chest diameter

100
Q

HR from EKG

A

count the large boxes between 2 R waves and count off starting with 300, 150, 100, 75, 50

101
Q

QRS is upright in leads I and avF

A

normal axis on EKG

102
Q

Large diphasic P wave (V1) at initial upstroke

A

right atrial hypertrophy

103
Q

Large diphasic P wave (V1) in wide terminal component

A

left atrial hypertrophy

104
Q

S wave in V1 and R wave in V5 sum to greater than 35mm

A

left ventricular hypertrophy

105
Q

Q waves bigger than 1 mm in width or .04 seconds in duration

A

MI

106
Q

T wave depressions or inversions

A

ischemia

107
Q

ST elevation

A

acute MI

108
Q

evidence pyramid, worse to best

A

studies, synopses of studies, syntheses (cochrane library), summaries (evidence-based textbooks), CPE (computers)

109
Q

vertebra prominens

A

C7

110
Q

normal strength

A

5

111
Q

moves against gravity/light resistance

A

4

112
Q

gravity with no resistance

A

3

113
Q

gravity eliminated

A

2

114
Q

muscle movement w/o joint movement

A

1

115
Q

no muscle movement

A

0

116
Q

sustained clonus (always abnormal)

A

4

117
Q

brisk w/at most a few beats of clonus (may be normal)

A

3

118
Q

easily detectable (normal)

A

2

119
Q

detectable only with reinforcement (may be normal)

A

1

120
Q

no reflexes (always abnormal)

A

0

121
Q

Katz Basic Activities of Daily Living:

A

bathing, dressing, toiletting, tranferring, continence, feeding

122
Q

lawton-brody instrumental activites of daily living:

A

telephone, shopping, food prep, housekeeping, laundry, modes of transport, medications, finances

123
Q

should be able to see how many posterior ribs in x-ray

A

10

124
Q

adduct hip (bring thigh toward midline) and direct posterior force on the knee

A

barlow test for hip dysplasia

125
Q

flex hip to 90 degrees, place index fingers on greater trochaners, and gently abduct legs

A

ortolani test for hip dysplasia

126
Q

baby respiratory rate

A

40-60 bpm, may be irregular so count for 20-30 seconds

127
Q

length of typical admission presentation

A

7 minutes

128
Q

1 large box (five small boxes) on EKG

A

.2 seconds

129
Q

carotid upstroke corresponds to

A

systole

130
Q

extension fracture of the radius

A

Colles fracture

131
Q

flexion fracture of radius, pain localized to distal radius

A

Smith’s fracture

132
Q

aortic regurg murmur occurs in

A

diastole

133
Q

blurred lateral optic disk indicates

A

acute increase in ICP

134
Q

hypocalcemia presesnts on PE

A

Chvostek’s sign: neuromuscular irritability

135
Q

pulsus paradoxus

A

aortic dissection sign

136
Q

L3 lesion

A

quadriceps impaired, Can’t bend the knee

137
Q

squeeze gastrocnemius, see no foot movement

A

positive Thompson test (achilles tendon rupture)

138
Q

presents as unilateral, effects lower face on controlateral side

A

upper motor facial nerve lesion

139
Q

s1 lesion

A

can’t plantarflex the foot

140
Q

L5 Lesion

A

foot drop, diffulty with toe extension and heel walk

141
Q

flexing neck causes hips and knees to flex

A

brudinski’s sign: meningitis

142
Q

where is S1 louder than S2

A

at the apex

143
Q

lateral epicondyle tenderness

A

tennis elbow

144
Q

medial epicondyle tenderness

A

golf elbow

145
Q

first palpable midline spinous process

A

C2

146
Q

at the level of the spine of the scapular

A

T3

147
Q

at the inferior angle fo the scapula

A

T8

148
Q

at the lowest rib

A

T12

149
Q

at the level of the hyoid bone

A

C3

150
Q

at the level of the thyroid cartilage anteriorly

A

C4-5

151
Q

and the level of the first cricoid ring

A

C6

152
Q

at the iliac crests

A

L4

153
Q

at the lvel of the posterior superior iliac spine

A

S2

154
Q

ankle reflexes before 60

A

90% have both

155
Q

ankle reflexes after 60

A

60% have both, 30% have none

156
Q

flick the distal phalanx of the long finger

A

hoffman’s: thumb flexion means upper motor lesions

157
Q

relief with arm abduction (hand behind head)

A

arm abduction sign: cervical radiculopathy

158
Q

radiating pain in ipsilateral arm with passive extenstion, flexing and rotating of neck with gentle downward pressure

A

spurling maneuver: cervical radiculopathy

159
Q

pain down spin eiwth chin to chest

A

L’Hermitte’s: cervical myelopathy

160
Q

pain with leg raise beyond 30 degrees

A

straight leg raise: sciatica

161
Q

pain down ipsilateral leg below knee when head is forward flexed while foot is dorsiflexed with knee fully extended

A

seated slump test: lumbar radiculopathy

162
Q

pain in thigh with knee flexion then hip extension in supine position

A

femoral nerve stretch test: lumbar radiculopathy

163
Q

detect quadriceps weakness

A

single leg sit-to-stand test

164
Q

light reflecting asymmetrically off of corneas

A

hirschberg test: occular misalignment

165
Q

red free setting (green circle)

A

good for hemorrhages, nerve fiber layer

166
Q

hypermic optic disc

A

blood vessel hypertrophy

167
Q

pale optic disc

A

optic atrophy

168
Q

blurred optic disc

A

papilledema

169
Q

in a normal optic disc, diameter of cup

A

should not exceed 1/2 the diameter of the entire disc (otherwise glaucoma)

170
Q

loss of spontaneous venous pulsations in eye

A

maybe papilledema

171
Q

occurrence of undescended testicles

A

3-4% of term boys

172
Q

assymetric Moro reflex

A

fractures, brachial plexus lesions

173
Q

Derm stone fronton neck

A

C3

174
Q

Derm arms

A

C6/t1

175
Q

T4 and T10 dermatomes

A

Nipples, umbilicus

176
Q

L4/5 dermatomes

A

Front of legs

177
Q

S1/s2 dermatomes

A

Back of legs

178
Q

S5 dermatome

A

Personal

179
Q

Biceps level

A

C5/6

180
Q

Brachioradialis level

A

C6

181
Q

Triceps level

A

C7

182
Q

Patellar level

A

L4

183
Q

Ankle level

A

S1

184
Q

Plantar levels

A

L5/S1

185
Q

Weak baby femoral pulses

A

Only sign of aortic coarc before cardiogenic shock

186
Q

Normal baby HR

A

120-160 bpm. Less than 90 is abnormal

187
Q

Average baby head circumference

A

35 cm

188
Q

Babies with meningitis, hypothyroid, hydrocephalus, genetic disorders, bony dysplasia

A

Large fontanelles

189
Q

Wide nipples, lymphedema, excess nuchal skin

A

Turners

190
Q

Adducted internally rotated arm w/intact grasp

A

Erbs palsy, common, c5/6 traction

191
Q

Metatarsal adductus

A

C shaped lateral foot edge, associated with hip dysplasia

192
Q

Severe port wine stains

A

Surge-weber, involves brain and eye

193
Q

Sharp pain on poking liver: stops breath

A

Murphy’s: chile cystitis

194
Q

RUQ sans radiation

A

Acute or alcoholic hepatitis

195
Q

Epigastric pain

A

MI, GERD, gastritis

196
Q

RLQ pain

A

Appendicitis, PID, ectopic pregnancy

197
Q

LLQ pain

A

Diverticulitis