Clinical Skills - Exam I

Front 1

Definition: SENSITIVITY

Back 1

proportion of people who test positive for a condition out of all those who actually have the condition

Front 2

What type of test is best for ruling OUT?

high sensitivity or high specificity?

Back 2

high SENSITIVITY

"SNOUT"

Front 3

Good tests have a sensitivity of over ____%

Back 3

90%

Front 4

Definition: SPECIFICITY

Back 4

proportion of people who test negative for a condition out of all those who do NOT have the condition

Front 5

Best type of test for reuling IN a condiiton?

high sensitivity or high specificity?

Back 5

high SPECIFICITY

"SPIN"

Front 6

Predictive Value Positive

Back 6

probability of person having a condition given that the test is positive

Front 7

Predictive Value Negative

Back 7

probability of person NOT having a condition given that the test is negative

Front 8

PRECISION

Back 8

the extent to which repeated measurements of a phenomenon tend to yeld the same results

regulardless of whether they are correct or not

(don't confuse with validity!)

Front 9

what are the vital signs

Back 9

pulse
resps
blood pressure
temperature

Front 10

what types of temperature are HIGHER than oral?

Back 10

rectal

tympanic

Front 11

what type of temperature is HIGHEST above oral?

Back 11

typanic

by 1.4F or 0.8C

Front 12

diurnal fluctuations in body temperature

early morning -->-->--> evening

Back 12

early morning: 35.8*C (96.4*F)

evening: 37.3*C (99.1*F)

Front 13

Normal pulse range

Back 13

60-100bpm

Front 14

normal blood pressure

Back 14

systolic < 120 mmHg

diastolic < 80 mmHg

Front 15

PreHTN

Back 15

systolic 120-139 mmHg
diastolic 80-89 mmHg

Front 16

stage 1 HTN

Back 16

systolic 140-159

Front 17

stage 2 HTN

Back 17

systolic 160 mmHg

Front 18

normal resp range

Back 18

12-20 breaths per minute

Front 19

Cheynes-Stokes respiration

Back 19

periods of deep breathing
alternating with periods of apnea

Front 20

Kussmaul respiration

Back 20

deep breathing, usually related to metabolic acidosis

Front 21

Biot's respiration

Back 21

Ataxic (irregular) breathing

Front 22

Korotkoff sounds

Back 22

low pitched sounds originating in the blood vessel (arm: brachial artery)

related to the turbulence (non-laminar flow) by partially occluded artery

Front 23

KS =

Back 23

Korotkoff sound

Front 24

KS 1

Back 24

first sound heard; faint tapping

Systolic blood pressure

Front 25

KS2

Back 25

sounds have swishing quality

Front 26

KS 3

Back 26

crisp, intense sounds

Front 27

KS 4

Back 27

abrupt muffling of sounds

Diastolic blood pressure
(in children and adults with hyperdynamic circulations, i.e.: hyperthyroidism, certain heart valve lesions)

Front 28

KS 5

Back 28

sounds disappear

Diastolic Blood PRessure (in normal adults)

Front 29

Pulse pressure =

Back 29

difference between systolic and diastolic blood pressure

Pp = Ps - Pd

Front 30

HTN in the arms +

low BP in legs is characteristic of...

Back 30

coarctation of the aorta and occlusive aortic disease

Front 31

what happens to systolic BP when pt moves from supine to standing position?

Back 31

systolic BP typically falls slightly or remains unchanged while diastolic pressure rises slightly

Front 32

orthostatic hypotention

Back 32

falling BP coincident with standing up

Front 33

correct cuff size

Back 33

bladder width >/= 40% of arm/leg circumference

Front 34

where should arm/leg be positioned for BP?

Back 34

heart level

Front 35

if limb is too high for BP, BP is ____

Back 35

falsely DEPRESSED

Front 36

if limb is too low for BP, BP is _____

Back 36

fasely ELEVATED

Front 37

auscultatory gap

Back 37

"break" in Korotkoff sounds

causes falsely low systolic BP

Front 38

most common BP error is

Back 38

OVERestimating BP

Front 39

4 sources of elevated blood pressure of normotensive individuals

Back 39

patient anxiety
wrong cuff size
loose cuff
brachial artery is below heart level

Front 40

2 types of pupillary light reactions

Back 40

direct

consensual (reaction in opposite eye)

Front 41

anterior chamber of the eye

Back 41

lies between the cornea and iris

filled with aqueous humor

Front 42

bulbar conjunctivae of eye

Back 42

covers most of anterior eyeball and meets the cornea at the lumbus

Front 43

conjunctiva

Back 43

clear mucous membrane with two components, the bulbar conjunctiva and the palpebral conjunctiva

Front 44

cornea

Back 44

transparent and avascular

covers the anterior chamber

Front 45

fundus

Back 45

posterior part of eye that is seen through an opthalmoscope

Front 46

iris

Back 46

pigmented diaphragm at anterior edge of ciliary body

central aperture is the pupil

Front 47

lens

Back 47

transparent biconcave cellular refractive structure iris and vitrous body

attached to ciliary body by suspensory ligaments

Front 48

lens diameter is controlled by which muscles?

Back 48

muscles in ciliary body

Front 49

palpebral conjunctiva

Back 49

lines the eyelids

Front 50

posterior chamber

Back 50

lies between iris, lens and suspensory ligaments

filled with aqueous humor produced by the ciliary humor

Front 51

vitreous humor

Back 51

transparent mass of gelatinous material that fills the eyeball behind the lens

Front 52

3 landmarks for fundoscopic exam

Back 52

fovea

optic disk

macula

Front 53

fovea

Back 53

located lateral and slightly inferior to the optic disc

darkened circular area that surrounds a small depression in the retinal surface that marks the point of central vision

Front 54

optic disk

Back 54

where the optic nerve and vessels enter the eyeball posteriorly

blind spot of vision

Front 55

macula

Back 55

microscopic yellow spot

surrounds the fovea but has not discernible margins

Front 56

arteries are ____ red

Back 56

light

Front 57

veins are ____ red

Back 57

dark

Front 58

which are bigger, ocular arteries or veins?

Back 58

veins are larger

Front 59

what has a brighter light reflex, arteries or veins?

Back 59

arteries

Front 60

anisocoria

Back 60

two pupils are NOT same diameter

normal in 5% of the population

Front 61

pars tensa

Back 61

lower 4/5 of tympanic membrane

Front 62

pars flaccida

Back 62

upper 1/5 of tympanic membrane

Front 63

where is malleus located?

Back 63

near center of pars tensa

Front 64

cone of light on tympanic membrane points from ____ to _____

Back 64

anteroinferiorly from umbo of malleus

Front 65

where may chorda tympani nerve be found in ear?

Back 65

upper posterior quadrant of TM

passing horizontally between incus and malleus

Front 66

may multiple white keratin patches on TM be normal?

Back 66

yes

Front 67

infection of one or more sinus cavities =

Back 67

sinusitis

Front 68

9 symptoms of sinusitis

Back 68

fever
malaise
cough
nasal congestion
maxillary toothache
purulent nasal discharge
little improvement with nasal decongestant
HA or facial pain when leaning forward
bad breath

Front 69

Symptoms with high sensitivity for sinusitis
(if DO NOT have, probably DO NOT have sinusitis)

Back 69

colored nasal discharge
cough
sneezing

Front 70

symptoms with highest SPECIFICITY for sinusitis

Back 70

maxillary toothache

Front 71

most useful findings wrt sinusitis

Back 71

history of maxillary toothache
poor response to nasal decongestants
history of colored nasal discharge
purulent secretions on exam
abnormal transillumination

Front 72

6 characteristics used to describe lymph nodes

Back 72

size
shape
motility
delimitation (discrete or matted)
consistency
tenderness

Front 73

Preauricular lymph nodes

location
drain what?

Back 73

in front of ear

drain lateral face and scalp including eyelids

Front 74

Posterior auricular lymph nodes

location
drain what?

Back 74

superficial to mastoid process

drain posterior half of ear and posterior half of lateral scalp/face

Front 75

occipital lymph nodes

location
drain what?

Back 75

at base of posterior skull

drain posterior scalp

Front 76

tonsillar lymph nodes

Back 76

at angle of mandible

drain tonsillar and posterior pharyngeal regions

Front 77

submandibular lymph nodes

Back 77

midway between angle and tip of mandible

drain nasal area, upper lip, lateral lower lip, floor of mouth

Front 78

submental lymph nodes

location
drains what?

Back 78

midline, behind mandible

drain chin, central part of lower lip, intra-oral cavity

Front 79

superficial cervical lymph nodes

Back 79

superficial to SCM

drain superficial cheeks and neck,
internal structures of the throat
part of posterior pharynx, tonsils, thyroid

Front 80

posterior cervical LNs

location
drains what?

Back 80

along the anterior edge of trapezius

drain skin on the back of head

Front 81

deep cervical chain LNs

Back 81

deep to SCM, often inaccessible for examination - hook fingers around either side of SCM to find them

drain all lymphatic vessels from head/neck
internal structures of the throat as well as part of posterior pharynx, tonsils, thyroid

Front 82

supraclavicular LNs

Back 82

deep in angle formed by clavicle and SCM

receives lymph from deep cervical nodes & part of thoracic cavity and abdomen

Front 83

apex of each lung is found where?

Back 83

2-4 cm above inner third of clavicle

Front 84

inferior border of anterior lung crosses 6th rib at _____

and 8th rib at ______

Back 84

6th rib at MCL

8th rib at midaxillary line

Front 85

posteriorly, lower border of lung is found at ______

descends to ______ upon inspiration

Back 85

T10 at rest

T12 upon inspiration

Front 86

oblique fissure location

Back 86

runs from T3 SP obliquely down and around chest wall to

6th rib at MCL

Front 87

horizontal fissure location (R only)

Back 87

anteriorly, runs close to 4th rib at MCL

meets oblique fissure at about 5th rib at midaxillary line

Front 88

lobes of RIGHT lung

Back 88

upper
middle
lower

Front 89

horizontal fissure separates which lobes?

Back 89

R. upper lobe from R. middle lobe

Front 90

Oblique fissure separates which lobes on R. lung?

Back 90

middle from lower lobe

Front 91

in left lung, oblique fissure separates which lobes?

Back 91

upper from lower lobes

Front 92

location of tracheal bifrucation

anteriorly at ____
posteriorly at ____

Back 92

anteriorly at sternal angle

posteriorly at T4 SP

Front 93

function of percussion

Back 93

sets chest wall and underlying tissues into motion, producing audible sound and palpable vibrations

Front 94

flat percussion sound

relative intensity
relative pitch
relative duration
example location

Back 94

relative intensity: SOFT
relative pitch: HIGH
relative duration: SHORT
example location: THIGH

Front 95

DULL percussion sound

relative intensity
relative pitch
relative duration
example location

Back 95

relative intensity: MEDIUM
relative pitch: MEDIUM
relative duration: MEDIUM
example location: LIVER

Front 96

RESONANT percussion sound

relative intensity
relative pitch
relative duration
example location

Back 96

relative intensity: LOUD
relative pitch: LOW
relative duration: LONG
example location: NORMAL LUNG

Front 97

HYPERRESONANT percussion sound

relative intensity
relative pitch
relative duration
example location

Back 97

relative intensity: VERY LOUD
relative pitch: LOWER
relative duration: LONGER
example location: EMPHYSEMA/HYPERINFLATION

Front 98

TYPANIC percussion sound

relative intensity
relative pitch
relative duration
example location

Back 98

relative intensity: LOUD
relative pitch: HIGH
relative duration
example location: GASTRIC AIR BUBBLE, AIR-FILLED COLON, PUFFED CHEEK

Front 99

TRACHEAL breath sound

duration
intensity of expiratory sound
pitch of expiratory sound
locations heard normally

Back 99

duration: INSPIRATION = EXPIRATION
intensity of expiratory sound: V. LOUD
pitch of expiratory sound: REL. HIGH
locations heard normally: OVER TRACHEA IN NECK

Front 100

VESICULAR breath sounds

duration
intensity of expiratory sound
pitch of expiratory sound
locations heard normally

Back 100

duration: INSPIRATORY > EXPIRATORY
intensity of expiratory sound: SOFT
pitch of expiratory sound: REL. LOW
locations heard normally: MOST OF BOTH LUNGS

Front 101

BRONCHOVESICULAR breath sounds

duration
intensity of expiratory sound
pitch of expiratory sound
locations heard normally

Back 101

duration: INSPIRATORY = EXPIRATORY
intensity of expiratory sound: INTERMEDIATE
pitch of expiratory sound: INTERMEDIATE
locations heard normally: 1ST & 2ND ICS ANTERIORLY, BTW SCAPULA POSTERIORLY

Front 102

BRONCHIAL breath sounds

duration
intensity of expiratory sound
pitch of expiratory sound
locations heard normally

Back 102

duration: INSPIRATORY < EXPIRATORY
intensity of expiratory sound: LOUD
pitch of expiratory sound: REL. HIGH
locations heard normally: OVER MANUBRIUM (ABNORMAL IF HEARD ELSEWHERE)

Front 103

adventitious sounds

Back 103

abnormal or added sounds heard during auscultation of the chest

Front 104

4 types of adventitious sounds

Back 104

crackles
wheezes
rhonchi
stridor

Front 105

sound corresponding to "alveolar problems"

Back 105

crackles

Front 106

sound corresponding to "narrowed airways problem"

Back 106

wheezes

Front 107

sound corresponding to "larger airways problem"

Back 107

rhonchi

Front 108

sounds corresponding to "obstruction of larynx/trachea"

Back 108

stridor

Front 109

crackles

describe
when heard most commonly

Back 109

crackles are discrete, discontinous, intermittent, nonmusical, brief

sounds like "pops"or Velcro being pulled apart

Front 110

If heard at late inspiration, crackles may be due to...

Back 110

abnormalities of the lungs such as PNA, fibrosis or early CHF

Front 111

If heard at early inspiration, crackles may be due to...

Back 111

abnormalities of airways such as bronchitis or asthma

Front 112

wheezes sound like

Back 112

continuous, musical, prolonged
much longer in duration than crackles
high pitched with hissing

Front 113

wheezes suggest...

Back 113

narrowed airways caused by asthma, COPD, bronchitis

Front 114

rhonchi sound like...

Back 114

continuous, musical, prolonged
longer duration
relatively low pitched w/ snoring quality

Front 115

rhonchi suggest...

Back 115

secretions w/in larger airways

Front 116

stridor sounds like..

Back 116

loud, harsh, musical
wheeze that is predominantly inspiratory
louder in neck than chest

Front 117

what adventitious sound demands immediate attention?

Back 117

stridor

Front 118

stridor suggests...

Back 118

obstruction of larynx/trachea

Front 119

tactile fremitus

Back 119

palpable vibrations transmitted through bronchopulmonary tree to chest wall when pt speaks

Front 120

how detect fremitus

Back 120

use either ball or ulnar surface of hand to optimize vibratory sensitivity of bones

ask pt to say "99" or "1-1-1"

Front 121

fremitus is decreased or absent when _____ or _____

Back 121

the voice is soft

when the transmission of vibrations from larynx to the surface of the chest is impeded

Front 122

7 causes for decreased fremitus

Back 122

obstructed bronchus
COPD
pleural effusion
fibrosis of pleura
pneumothorax
infiltrating tumor
v. thick chest wall

Front 123

fremitus is increased by...

Back 123

transmission of vibrations from the larynx to the surface of the chest

eg: consolidated lung of lobar PNA

Front 124

normal air-filled lung

breath sounds
transmitted voice sounds
tactile fremitus

Back 124

breath sounds: MOSTLY VESICULAR
transmitted voice sounds: SPOKEN WORDS INDISTINCT, SPOKEN "EE" HEARD AS "EE"

tactile fremitus: NORMAL

Front 125

airless lung, as in lobar PNA

breath sounds
transmitted voice sounds
tactile fremitus

Back 125

breath sounds: BRONCHIAL/BRONCHIALVESICULAR OVER INVOLVED AREA
transmitted voice sounds: SPOKEN WORDS LOUDER AND CLEARER; SPOKEN "EE" HEARD AS "AY"

tactile fremitus: INCREASED

Front 126

EGOPHONY

Back 126

spoken "ee" heard as "ay" when auscultating chest

Front 127

spoken words abnormally clear, loud when auscultating chest

Back 127

BRONCHOPHONY

Front 128

PNA

Back 128

acute inflammation of lung parenchyma from respiratory bronchioles to the alveoli

Front 129

two findings that rule against PNA

Back 129

rhinorrhea

sore throat

Front 130

physical findings that rule in favor of PNA

Back 130

RR > 25 breaths/min
temp > 37.8*C

night sweats
myalgias
sputum all day

Front 131

4 additional predictors of PNA

Back 131

absence of asthma
HR > 100 bpm
decreased breath sounds
unilateral crackles

Front 132

location of PMI

Back 132

5th ICS at MCL when pt supine

Front 133

PMI

Back 133

point of maximal impulse

Front 134

duration of PMI

Back 134

less than 2/3 of systole

does not continue to the 2nd heart sound

Front 135

apical impulse of PMI may be displaced upward and to the left by _____ or _____

Back 135

pregnancy

high left diaphragm

Front 136

lateral displacement of PMI can result from _______ due to ____ , ____ or _____

Back 136

cardiac enlargement due to CHF, cardiomyopathy or ischemic heart ds

Front 137

general displacement of PMI can result from _____

Back 137

deformities of thorax and mediastinal shift