Clinical Exam Test Iii

Front 1

Small volume incontinence with cough, sneezing, lauging, and running

Back 1

Stress incontinence

Front 2

Uncontrolled urge to void, large volume incontinence

Back 2

Urge incontinence

Front 3

Small volume incontinence dribbling, hesitancy

Back 3

Overflow incontinence

Front 4

Change in mental status, impaired mobility; new environment

Back 4

Functional Incontinence

Front 5

A positive hx of pelvic surgery

Back 5

Stress Incontinence

Front 6

Pelvic floor relaxation; cystocele, retrocele, lax sphicter

Back 6

Stress Incontinence

Front 7

A positive hx of CNS disorders; stroke, MS, parkinsonism

Back 7

Urge Incontinence

Front 8

Hx of neurogenic bladder, bowel problems, spinal cord injury

Back 8

Overflow incontinence

Front 9

A positive med hx for hypnotics, diuretics, anticholinergic agents, alpha-adrenergic agents, calcium channel blockers

Back 9

Functional Incontinence

Front 10

A physical exam with spinal cord disease or diabetic neuropathy; gait disturbance

Back 10

Overflow incontinence

Front 11

Inability to hold urine once the urge to void is encounter

Back 11

Urge Incontinence

Front 12

A mechanical dysfunction of resulting from an overdistended bladder

Back 12

Overflow incontinence

Front 13

Intact urinary tract but cognitive abilities, immobility, MS impairments,

Back 13

Functional Incontinence

Front 14

What are the reversible causes of incontinence?

Back 14

DRIP:
Delirium, dehydration
Retention, restricted mobility
Impaction, infection
Polyuria, pharmaceuticals, psychologic

Front 15

An unihibited bladder contractions and no urge to void

Back 15

Relfex incontinence; a type of urge incontinence

Front 16

The most common cause of fecal incontinence is

Back 16

immobilization and poor fluid and diet intake

Front 17

The three major causes of fecal incontinence:

Back 17

Neurological, fecal impaction, underlying disease

Front 18

Unable to recognize rectal fullness and inability to inhibit intrinsic rectal contraction.

Back 18

Cognitive neurogenic fecal incontinence

Front 19

What are the two types of neurogenic fecal incontinence:

Back 19

Cognitive and Local

Front 20

Any process that causes degeneration of mesenteric plexus and lower bowel resulting in a lax sphincter, diminished sacral reflex and decreased puborectal muscle tone.

Back 20

Local neurogenic fecal incontinence

Front 21

A reduced amount of amniotic fluid on ultrasound

Back 21

Oligohydraminos

Front 22

________ index of 1/5 percentile for gestational age is associated with premature rupture of membranes, intrauterine growth restrictions, renal anomalies

Back 22

Amniotic fluid index

Front 23

An excessive amount of amniotic fluid

Back 23

Hydraminos

Front 24

An AFI greater than 95% is associated with

Back 24

Gestational diabetes, CNS malformations, GI tract

Front 25

The most common cause of acute renal failure in children

Back 25

HUS, hemolytic uremic syndromw

Front 26

The most common cause of HUS

Back 26

E.coli O157:h7

Front 27

A 6 year old boy is brought by his mother b/c of diarrhea, cough and running nose. She states he has been being and running a fever.

Back 27

Possible HUS, E.coli O157:h7

Front 28

Absence of parasympathetic ganglion in segment of colon.

Back 28

Hirshspung disese

Front 29

The absence of perstalsis causes feces to accumulate ______ to the defect in Hirschsprung disease

Back 29

proximal

Front 30

A 24 hour baby does not pass their merconium that are at increased risk for

Back 30

Hirshsprung disease

Front 31

The most common intraabdominal tumor of childhood is______

Back 31

Wilm's tumor; nephroblastoma

Front 32

A two year old child is brought into your office by his father b/c of enlarged abdomen and low grade fever. A physical exam reveals hypertension

Back 32

Wilm's tumor

Front 33

A common solid malignancy in early childhood often appears as a mass in adrenal medulla or craniospinal axis.

Back 33

Neuroblastoma

Front 34

A firm fixed, nontender, irregular nodule in the abdomen that crosses the midline

Back 34

A neuroblastoma

Front 35

A two year old is brought into your office by his father b/c his baby is not eating, lost weight and eyes recently protruded.

Back 35

A neurobalstoma

Front 36

The prolapse of one segment of intestine into another that causes blockage.

Back 36

Intussusception

Front 37

Occurs between the age of 3-12 months with acute intermittent abdominal pain, vomiting, with mixed bloody stools, red current jelly

Back 37

Intussusception

Front 38

A 6 mo old projectile vomits and still continues to eat afterwards, is not gaining weight.

Back 38

Pyloric stenosis

Front 39

A 6 mo old projectile vomits and you notice a small rounded mass in the RUQ. You astutely recall from CE that this is a sign of

Back 39

Pyloric Stenosis

Front 40

A lower intestinal obstruction caused by thinckening and hardening of meconium in lower intestine.

Back 40

Meconium ileus

Front 41

Meconium ileus is associated with

Back 41

Cystic fibrosis

Front 42

A 3 week old child is brought into the ED b/c of a yellow looking skin, a large round abdomen, and itching skin.

Back 42

Biliary Atresia

Front 43

The most common congenital anomaly of the GI tract

Back 43

Meckel Diverticulum

Front 44

An outpouching of the ileum that varies in size ______

Back 44

Meckel Diverticulum

Front 45

Meconium ileus is associated with

Back 45

Cystic fibrosis

Front 46

A 3 week old child is brought into the ED b/c of a yellow looking skin, a large round abdomen, and itching skin.

Back 46

Biliary Atresia

Front 47

The most common congenital anomaly of the GI tract

Back 47

Meckel Diverticulum

Front 48

An outpouching of the ileum that varies in size ______

Back 48

Meckel Diverticulum

Front 49

PAin or distress occurs in the area of the patient's heart or stomach on palpation on Mcburney's point

Back 49

Aaron sign = appendicitis

Front 50

Fixed dullness to percussion in left flank, and dullness in right flank that disappears on change of position.

Back 50

Ballance sign = peritoneal irritation

Front 51

Rebound tenderness

Back 51

Blumberg sign = peritoneal irritation appendicitis

Front 52

Ecchymosis around umbilicus

Back 52

Cullen sign; hemoperitoneum; pancreatitis, ectopic pregnancy

Front 53

Absence of bowel sounds in right lower quandrant

Back 53

Dance sign; Intussusception

Front 54

Ecchymosis of flanks

Back 54

Grey Turner sign; hemoperitoneum;pancreatitis

Front 55

Abdominal pain radiating to left shoulder

Back 55

Kehr sign; spleen rupture; renal calculi; ectopic pregnancy

Front 56

Pt stands with straightened knees; then raises up on toes, relaxes, and allows heels to hit floor, thus jarring body. Action causes abdominal pain if positive.

Back 56

Markle Sign/ Heel Jar; peritoneal irritation, appendicitis

Front 57

Abrupt cessation of inspiration on palpation of gallbladder

Back 57

Murphy sign, cholecystiis

Front 58

Pain down the medial aspect of the thigh to the knees

Back 58

Romberg-Howship sign; strangulated obturator hernia

Front 59

Right lower quandrant pain intensified by lower left quadrant abdominal palpation

Back 59

Rovsing sign; peritoneal irritation; appendicitis

Front 60

A scaphoid abdomen of infant suggest

Back 60

Abdominal contents are displaced into thorax

Front 61

A distended abdomen in an infant can result fro

Back 61

Feces, a mass, or organ enlargement

Front 62

A intestinal structure protruding into the umbilical area and visible thru a thick transparent membrane is ________

Back 62

Omphalocele

Front 63

The maximum size of an abdominal hernia in an infant is reached by age _____ and spontaneously closes by ______

Back 63

1 month and closes by 1-2 years

Front 64

If you spot a perstalic wave in the abdomen of a newborn is this normal? What does indicate?

Back 64

Sometimes in thin babies but usually abnormal, Intestinal obstruction

Front 65

Bowel sounds first appear at ______ after birth

Back 65

1-2 hours

Front 66

The bruit of renal stenosis is heard as a ______ freq. and is ______

Back 66

high frequency and is soft

Front 67

The bruit of a renal atriovenous fistula is ______

Back 67

Continous

Front 68

What position should you try to listen to renal stenosis or AV fistula in infant?2nd position

Back 68

1st try held upright and listen in posterior flanks
2nd try pat in supine listen over abdomen

Front 69

The liver of a diabetic mother may be _______

Back 69

Enlarged

Front 70

The upper edge of the liver should be detected within _______ cm of the _____space

Back 70

1cm of 5th intercostal space at the RMCL

Front 71

The liver span for:
6 months =
12 months =
24 months =
3 years =
4 years =

Back 71

6mo = 2.4 - 2.8 cm
12 mo = 2.8-3.1
24 = 3.5-3.6
3 years= 4.0
4 years = 4.3-4.4

Front 72

The liver span for:
5 years =
6 years =
8 years =
10 years

Back 72

5 y = 4.5-4.8
6 y = 4.8-5.1
8 y = 5.1-5.6
10 y = 5.5-6.1

Front 73

The infant spleen is normally palpated ___ cm below the left costal margin during the first few weeks after birth.

Back 73

1-2

Front 74

Hepatomegaly is present in an infant when the liver is more than _____ cm below the right costal margin

Back 74

3cm

Front 75

Hepatomegaly in an infant suggest ________

Back 75

Infection, Cardiac Failure, liver disease

Front 76

A sausage-shaped mass in the left or right upper quadrant may indicate ______

Back 76

Intussusception

Front 77

A sausage shaped mass in the left lower quadrant may indicate ______

Back 77

feces b/c of constipation

Front 78

A distended bladder, felt as firm central dome shaped structure in the lower abdomen may indicate __________

Back 78

Urethral obstruction of CNS defects

Front 79

Mneumonic in infants who have Intussusception ABCDEF

Back 79

A = Abdominal or anal sausage
B= Blood from the rectum, Red Currant jelly
C= Colic babies; babies draw up their legs
D= Distention, dehydration, and shock
E=Emesis
F=Face pale

Front 80

What is the Naegele rule for pregnancy estimation?

Back 80

Add 7 days to the first day of the LMP and subtract three months

Front 81

The average duration of pregnancy is ______ days or _____ weeks

Back 81

280 days or 40 weeks

Front 82

The fundal height measurement is most accurate between _____ and _____ weeks gestation.

Back 82

20-30

Front 83

What is the expected increase in fundal height per week?

Back 83

1cm/week

Front 84

How do measure the Fundal Height using the Mcdonald rule?

Back 84

Divide the height of the fundus by 3.5, which is equal in the duration of pregnancy in lunar months

Front 85

How do you determine the fetal heart rate?

Back 85

Count FHR or impulse in 1 minute and compare to mother's pulse

Front 86

How do you chart the results of FHR?

Back 86

Using a two-line figure in which the umbilicus is the point of intersection and the 4 quadrants are the maternal abdomen

Front 87

_______ can be used as indicator for fetal well-being.

Back 87

Kick counts

Front 88

What is a simple technique used to asses fetal movement?

Back 88

Count 10 movements and note the length of time

Front 89

What is the standard ranges for FM,fetal movement, count criteria?

Back 89

10 time / hour to 10 / 12hours

Front 90

If there are increased risk factors when should monitoring of FM occur?

Back 90

28 weeks; normal is 34-36 weeks

Front 91

If your are not using the monitoring technique what other method could you tell your patient to evaluate fetal well-being?

Back 91

Less than three or fewer FM in 2 hours for 2 consecutive days

Front 92

What is the Leopold maneuvers?

Back 92

1. Place hands over the fundus and indentify the fetal part; the head feels round firm and freely movable; the buttocks feels soft and less mobie
2. With the palmar surface of your hand, locate the back of the fetus; the back feels smooth and convex whereas the small parts feel irregular
3.With Right or left hand, dominant, use your thumb and third finger and grasp the the part over the pubic symphsis. The head will feel firm, if not engaged wil be movable from side to side. Breach will feel softer and irregular.
4. Turn and face the woman's feet and use tow hands to outline the fetal head. If the head is presenting only a small part will be felt

Front 93

What is the optimal position of the a baby presenting when felt in the Leopold technique?

Back 93

THe head is flexed and the vertex is presenting

Front 94

If you palpate the cephalic prominence on the same side of the back suggest _________

Back 94

Extended presentation

Front 95

When recording the information from abdominal palpation record the presenting as______
the lie as ________
and attitude of head as _____

Back 95

Presenting =vertex if the head and breach if buttocks
LIE= longitudinal or vertical
Attitude = Flexed or Extended

Front 96

Relationship of long axis of fetus to long as axis of mother is ______

Back 96

Lie

Front 97

Uterine contractions begin as early as ______ month of gestation

Back 97

third month

Front 98

A women is experiencing regular contractions of 4-6/hour before 37 weeks. IS this normal?

Back 98

No,not until after 37 weeks

Front 99

In order to asses uterine contractions when equipment is not accessible the strength is classified as:
MILD =
MODERATE=
STRONG=

Back 99

Mild= slightly tense that can indent with two fingers
Moderate = firm fundus that is difficult to indent
Strong= rigid or hard, boardlike and does not indent with two fingers

Front 100

If the fetal heart rate is heard above the umbilicus the presentation is

Back 100

Breech

Front 101

If the fetal heart is heard below the umbilicus the presentation is

Back 101

Vertex

Front 102

In order to asses uterine contractions when equipment is not accessible the strength is classified as:
MILD =
MODERATE=
STRONG=

Back 102

Mild= slightly tense that can indent with two fingers
Moderate = firm fundus that is difficult to indent
Strong= rigid or hard, boardlike and does not indent with two fingers

Front 103

If the fetal heart rate is heard above the umbilicus the presentation is

Back 103

Breech

Front 104

If the fetal heart is heard below the umbilicus the presentation is

Back 104

Vertex

Front 105

In order to asses uterine contractions when equipment is not accessible the strength is classified as:
MILD =
MODERATE=
STRONG=

Back 105

Mild= slightly tense that can indent with two fingers
Moderate = firm fundus that is difficult to indent
Strong= rigid or hard, boardlike and does not indent with two fingers

Front 106

If the fetal heart rate is heard above the umbilicus the presentation is

Back 106

Breech

Front 107

If the fetal heart is heard below the umbilicus the presentation is

Back 107

Vertex