Patient Assessment Test 2 Set 3

Front 1

Gout
a)classic case
b)bad one is...
c)usually follows

Back 1

a)big toe is hot/HURTS and woke up w/ it this morning and looks infected
b)TOPHI, sq deposits of uric acid crystals
c)injury, surgery, fasting or excess food/alcohol

Front 2

Gout tx (4)

Back 2

1)NSAIDs or steroids
2)colchicine reduces acute attack
3)allpurinol for prophylaxis (decr urate syn)
4)avoid anchovies, sardines, liver, high purine food

Front 3

Bunion (3)

Back 3

1)inflammation/thickening of bursa of the joint of big toe
2)marked enlargement of the joint and lateral displacement of toe
3)caused by arthritis, tight fitting shoes, high heels

Front 4

Hammer toe (2 and 2tx)

Back 4

1)Plantar flexion deformity of PIP joint
2)associated w/ hyperextension of the metatarsal joint w/ flexion of distal interphalangeal joint

1)proper shoe wear
2)surgery

Front 5

Plantar Wart (3 and 2tx)

Back 5

1)common wart in thickened skin of sole
2)pain w/ walking
3)dark spots in wart differentiate it from callus

1)cryotherapy
2)surgery

Front 6

Plantar Fasciitis
a)what is it (2)
b)tx (4)

Back 6

a1)most common cause of heel pain
a2)WORSE IN MORNING IN HEEL; gets better as they walk

b1)activity modification
b2)proper shoes (get new ones very 6mo)
b3)arch support
b4)NSAIDs/steroids

Front 7

Thoracic/Lumbar Spine STRAIGHT LEG RAISING TEST (3)

Back 7

1)test nerve L4,L5,S1
2)+ test is shooting pain down leg when at a 45degree angle
3)- test is tightness in hamstring as manuver is done

Front 8

Scoliosis (2)

Back 8

1)lateral/rotator curvature of spoine
2)once growth plate closes can't do much about it

Front 9

Kyphosis (excess of is...cause...)

Lordosis (abnormal one is...)

Back 9

K)humpback/hunch back of posterior curve caused by OSTEOPOROSIS****

L)abnormal anterior convexity of spine

Front 10

Ankylosing Spondylitis
a)disease desc
b)sx
c)tx

Back 10

a)rheumatic/AUTOIMMUNE disease that causes arthritis of spine, hips, sacroiliac joints
b)loss of kyphosis in cervical/lumbar spine w/ decr ROM (pt looks hunched over)
c)anti-inflam, surgery

Front 11

Herniated Disk, Lumbar Spine
a)what is it
b)sx (3)
c)most often affected... (4)

Back 11

a1)radicular (nerve root) pain

b1)sciatic pain is shooting and radiates down one/both legs
b2)can have dermatomal distribution
b3)pain worsened by spinal movement (bending)

c1)L4/L5
c2)L5/S1

Front 12

Other Herniated Disk, Lumbar Spine PE signs (4)

Back 12

1)pain on straight leg raising
2)tenderness on sciatic nerve
3)loss of sensation
4)decr to absent reflexes

Front 13

Osteoarthritis
a)also called...
b)inflammation vs. RA
c)most commmon...
d)chronic disease involving
e)characterized by...

Back 13

a)degenerative joint disease
b)a lot less than RA (see inflammation think RA)
c)form of arthritis
d)joints/wt bearing joints
e)destruction of articular cartilage, overgrowth of bone, and impaired fxn

Front 14

OA risk factors (4)

Back 14

1)age (over 75)
2)POST TRAUMATIC*****
3)Iatrogenic (after surgery)
4)no proof obesity and stress cause OA

Front 15

OA clinical symptoms (5)

Back 15

1)pain
2)stiffness but brief in morning and after activity
3)limitation of motion
4)crepitus
5)NOT RED/HOT

Front 16

OA
a)tx (3)
b)consequences (3)

Back 16

a1)SYMPTOMATIC
a2)anti-inflammatories (first line)
a3)narcotic analgesics (first line in elderly who can't take NSAIDs)

b1)lipping
b2)osteophytes
b3)diseased articular cartilage

Front 17

Heberden's Nodes*****
a)what is it
b)associated w/...
c)usually...

Back 17

a)hard nodules or bony swellings around DIP joints in hands
b)OA
c)painless

Front 18

Bouchard's Nodes***
a)what is it
b)associated w/...

Back 18

a)like herbenden's but in PIP joints
b)OA

Front 19

RA what is it? (4)

Back 19

1)chronic systemic inflammatory disease/arthritis****
2)bone formation inhibited
3)bone resorption is promoted
4)enzymes are produced that destory the cartilage/joint

Front 20

RA
a)clinical symptoms (4)
b)deformities (3)

Back 20

a1)morning stiffness lasting hours
a2)progression is symmetric
a3)deformities common
a4)sq nodules

b1)boutonniere of thumb
b2)ulnar deviation of metacarpal joints
b3)swan-neck deformity of fingers

Front 21

Boutonniere Deformity

Swan Neck deformity

Back 21

PIP joint flexion and DIP joint hyperextension

flexion of DIP joints and hyperextension of PIP joint

Front 22

Undisplaced fracture

Back 22

fracture in which the 2 bone fragments are aligned properly

Front 23

Displaced fracture

Back 23

fracture in which the 2 bone fragments are NOT aligned properly

Front 24

Incomplete fracture

Back 24

fracture in which line of fracture does NOT include the whole bone

Front 25

Complete fracture

Back 25

fracture in which bone is completely broken (neither fragment is connected to the other)

Front 26

Compound fracture

Back 26

fracture w/ bone displacement thru the skin (high risk of infexn)

Front 27

Hairline fracture

Back 27

minor fracture in which all portions of bone are in perfect alignment

Front 28

Spiral fracture

Back 28

an oblique fracture

Front 29

Segmental fracture

Back 29

an entire segment of bone is fractured

Front 30

Comminuted fracture

Back 30

fracture in which the bone is broken or splintered into pieces

Front 31

Scaphoid Fracture (3 and 2tx)

Back 31

1)tender over snuffbox suggests scaphoid fracture (b/w thumb and index finger)
2)occurs after fall w/ outreached hand
3)common to have avascular necrosis of scaphoid

1)cast immobilization for nondisplaced fractures
2)surgery for displaced fractures

Front 32

Osteomyelitis (2,2dx,2tx)

Back 32

1)infexn of bone (especially marrow)
2)can be spread thru blood stream or be associated w/ trauma/surgery

1)X-ray will see loss of bone or air filled cavities in the bone structure
2)will see real white finger bone

1)surgery
2)IV Abx for 6-8wks

Front 33

Generalized symmetric distension of abdomen caused by... (3)

Back 33

1)obesity
2)enlarged organs
3)fluid/gas

Front 34

Distension of abdomen from umbilicus to symphysis causes(4)

Back 34

1)ovarian tumor
2)pregnancy
3)uterine fibroids
4)distended bladder

Front 35

Asymetric distension or protrusion of abdomen causes (4)

Back 35

1)hernia
2)tumor
3)cyts
4)bowel obstruction
5)enlarged liver

Front 36

Over 35 bowel sounds per minute cause (3)

Back 36

1)gastroenteritis
2)early intestinal obstruction
3)hunger

Front 37

Fewer than 5 bowel sounds per minute cause (2)

Back 37

1)peritonitis
2)paralytic ileus

Front 38

A PROMINTENT lateral pulsation in abdomen suggests....

Back 38

aneurysm

Front 39

Cutaneous hyperesthesia
a)indicates...
b)how indicates...

Back 39

a)peritoneal irritation
b)hypersensitivity/pain in response to this manuver

Front 40

Guarding
a)indicates...

Back 40

peritoneal inflammation

Front 41

Appendicitis
a)findings (3)
b)(+) tests for it (5)

Back 41

a1)periumbilical or epigastric pain in RLQ (McBurney point*****)
a2)anorexia, n/v
a3)no BM since symptoms began

b1)positive guarding and rebound tenderness
b2)positive iliopsoas
b3)obturator signs
b4)Rovsing
b5)Heel jar test

Front 42

Heel Jar test (3)

Back 42

1)pt stand w/ straightened knees
2)then raise toes and allow heels to hit floor
3)(+) test is pain upon doing this

Front 43

Rebound tenderness?

Back 43

when pressing in at a point and it doesn't hurt when pressing in BUT it hurts when you let go

Front 44

Rovsings sign (2)

Back 44

1)RLQ pain intensified by LLQ abdominal pressure
2)Push on LLQ and get pain in RLQ

Front 45

Splenic Rupture
a)is....
b)complaints (4)

Back 45

a)most commonly injured organ in abdomen b/c of location

b1)LUQ pain w/ radiation to left shoulder (POSITIVE KEHR SIGN)
b2)hypovolemic
b3)peritoneal irritation
b4)pallor/lower temp/shock

Front 46

Pancreatitis
a)characterized by... (4)
b)#1 cause

Back 46

a1)sudden, severe LUQ pain
a2)n/v, fever, shock
a3)Positive Grey turner sign
a4)positive cullen sign

b)alcohol abuse

Front 47

Cullen sign

Back 47

1)bruising/ecchymosis around umbilicus

Front 48

Gray Turner sign

Back 48

1)brusing of flanks

Front 49

Distended Abdomen (big belly) causes....

Back 49

F's!!!
fat
fluid
fecec
fetus
flatus
fibroid
full bladder
false pregnancy
fatal tumor

Front 50

Ascites
a)what is it (2)
b)signs (2)

Back 50

a1)accumulation of fluid in peritoneal cavity
a2)caused by portal HTN due to chronic liver disease

b1)incr ab girth w/ ab pain
b2)if weight loss included THEN IT IS CANCER UNLESS PROVEN OTHERWISE

Front 51

Cholelithiasis
a)what is it
b)how known if pt has it

Back 51

a)stone formation in gallbladder
b)gall bladder is palpable and NONtender

Front 52

Cholecystitis
a)what is it
b)symptoms (4)

Back 52

a)inflammation of gallbladder due to duct blockage from stones

b1)pain in RUQ and radiates to mid-torso to right scapular area
b2)Murphy sign
b3)severe pain lasting 2-4h
b4)anorexia, n/v

Front 53

Murphy sign?

Back 53

abrupt cessation of inspiration of palpation of gallbladder

Front 54

Five F's of Cholecystitis

Back 54

1)forty
2)fat
3)female
4)fertile
5)flatulent

Front 55

Classic hepatitis symptoms and which do we have vaccines for...

Back 55

1)clay colored stools****
2)tea colored urine****

1)A and B, not C

Front 56

Which hepatitis causes liver disease

and common comlication of HepC

Back 56

1)HepB and Hep C

2)invades immune system making immunocompromised

Front 57

Trasmission of
a)HepA
b)HepB/C

Back 57

a)fecal oral, food/water borne outbreaks

b)bloodborne, sexual, perinatal

Front 58

Cirrhosis
a)what is it
b)symptoms (4)

Back 58

a)destruction of liver parenchyma (organ itself)

b1)firm enlarged liver
b2)ascites
b3)jaundice
b4)spider angiomas

Front 59

Aneurysm
a)what is it
b)causes (3)
c)characteristic findings (3)

Back 59

a)abnormal dilation of blood vessel

b1)arteriosclerosis
b2)HTN
b3)infexn/trauma

c1)steady throbbing midline over aneurysm
c2)pain radiates to back and to flank areas
c3)n/v & abdominal mass

Front 60

Pyloric Stenosis
a)what is it
b)findings (3)

Back 60

a)hypertrophy of circular muscle of the pylorus leads to obstruction of pyloric sphincter DURING 1ST MONTH AFTER BIRTH

b1)SEE VOMITING EVERYTIME THEY FEED THE KID
b2)small olive shaped structure
b3)failure to gain wt

Front 61

GERD
a)risk factors (3)
b)symptoms (3)

Back 61

a1)large meals b4 bedtime
a2)dietary fat
a3)chocolate, EtOH, caffeine

b1)retrosternal burning/pain
b2)regurgitation
b3)dysphagia

Front 62

GERD Tx (4 Steps)

Back 62

1)Nonpharma first- diet change, raise head of bead
2)OTC meds- antacids, tagamet
3)Decr acid production- full strength H2 antagonist, PPI
4)Long-term maintenance therapy- prokinetic agents & PPI

Front 63

Peptic Ulcer Disease
a)usually occurs from...
b)second most common cause
c)tx (2)

Back 63

a)H. pylori infexn
b)NSAIDs

c1)dc NSAIDs
c2)2abx plus bismuth and PPI if H.pylori infexn

Front 64

Peptic Ulcer Perforation
a)signs (4)

Back 64

a1)pt knows they have an ulcer but pain has gotten worse
a2)pain may awaken pt @ night
a3)pain relieved by food/antacids
a4)anorexia/wt loss

Front 65

Hernias
a)2 types
b)symptoms
c)tx

Back 65

a)umbilical or inguinal

b1)acute onset of pain @ site of hernia
b2)bowel sounds @ site of hernia

c)surgery

Front 66

Colon cancer
a)occurs where?
b)earliest sign

Back 66

a)rectum, sigmoid and lower descending colon
b)occult blood detectable w/ guaiac testing

Front 67

Constipation
a)cause
b)pharma tx (3)
c)nonpharma tx (2)

Back 67

a1)lack of exercise
a2)inadequate intake of fluid/fiber

b1)bulk forming agents
b2)stool softeners
b3)stimulants

c1)incr exercise/fluid
c2)bran/fruits/veggies

Front 68

Diarrhea
a)usually due to...(4)
b)classification (2)

Back 68

a1)infexn
a2)food contamination
a3)meds
a4)inflammatory bowel disease

b1)acute (less than 3wks)
b2)chronic (more than 3wks)

Front 69

Acute Diarrhea
a)presentation (3)
b)tx

Back 69

a1)ab cramping
a2)nausea
a3)watery stools

b)usually requires no therapy

Front 70

Chronic Diarrhea
a)can lead to... (2)
b)usually a...

Back 70

a1)skin breakdown/dehydration
a2)wt loss/malnutrition

b)symptom of underlying disease; must tx underlying disease

Front 71

Diarrhea tx (3)

Back 71

1)loperamide
2)fluids
3)diet (BRAT/avoid dairy)

Front 72

Fecal incontinence major causes (3)

Back 72

1)fecal impaction (most common)
2)underlying disease (cancer, diverticulitis, IBD)
3)neurogenic

Front 73

Inflammatory Bowel Disease
a)2 of em
b)cause
c)tx (4)

Back 73

a)Crohn's, UC
b)infexn, autoimmune

c1)anti-inflammatory
c2)F&E
c3)antidiarrheal
c4)immunosuppressive

Front 74

Crohn's Disease
a)common feature (2)

Back 74

a)SKIP LESIONS****
a)cobblestone appearnce of GI

Front 75

UC
a)features (3)

Back 75

a1)NO SKIP LESIONS
a2)blood, freq, watery diarrhea
a3)wt loss and fatigue

Front 76

Diverticulitis
a)what is it
b)findings (2)

Back 76

a)infexn of existing diverticula

b1)epigastric pain radiating down left side of abdomen after eating
b2)flatulence/diarrhea

Front 77

Intussusception
a)what is it
b)findings (2)

Back 77

a)prolapse of one segment of intestine into another causing obstruction

b1)CURRET JELLY STOOLS*****
b2)sausage shaped mass

Front 78

Characteristic findings of Intestinal Obstruction (5)

Back 78

1)abrupt, severe, spasmodic pain
2)distension
3)visible peristalsis
4)absent bowel sounds
5)IN PPL WHO JUST HAD SURGERY***

Front 79

Volvulus
a)what is it
b)findings (3)

Back 79

a)twisting of bowel upon itself causing obstruction

b1)pain in hypogastrium and umbilicus
b2)n/v/distention
b3)hyperactive bowel sounds

Front 80

Polyps
a)what is it
b)first sign

Back 80

a)cancerous or NONcancerous formation in colon
b)painless rectal bleeding

Front 81

Hemorrhoids
a)what is it
b)can cause...

Back 81

a)varicose veins that originate below the anorectal line and are covered by anal skin

b)itching/bleeding w/ defecation

Front 82

CVA Tenderness indicates...

Back 82

pyelonephritis (infexn of kidney/renal pelvis)

Front 83

Renal Calculi
a)findings (3)

Back 83

a1)COLICKY PAIN****
a2)fever
a3)hematuria

Front 84

FEMALE Tanner stage 1 (3)

Back 84

1)preadolescent
2)no pubic hair
3)except for peach fuzz body hair

Front 85

FEMALE Tanner stage 2 (3)

Back 85

1)sparse growth of long, slightly darkened downy hair
2)mostly along labia
3)usually straight or slightly curled

Front 86

FEMALE Tanner stage 3 (2)

Back 86

1)pubic hair gets darker, coarser, curlier
2)grows sparsely over mons veneris

Front 87

FEMALE Tanner stage 4 (2)

Back 87

1)hair grows in more densely
2)coarser and curly like in adult but not as much of it

Front 88

FEMALE Tanner stage 5 (2)

Back 88

1)classic coarse and curly pubic hair
2)extends onto inner thigh

Front 89

Bartholin gland abcess? (2)

Back 89

1)labial swelling, redness, tenderness
2)DUE TO STD/GONORRHEA/CHLAMYDIA*****

Front 90

_____ of Urethral orifice indicates UTI

Back 90

discharge/polyp/fistulas

Front 91

Word ulcerative in female genitalia exam =

Back 91

HERPES

Front 92

Cystocele/Rectocele

Back 92

collapse of vaginal/rectal tubing due to bladder falling on them

Front 93

Cystocele (2)

Back 93

1)large contributor to urinary stress incontinence
2)higher risk of UTI

Front 94

Rectocele

Back 94

pushes up to block off vaginal opening

Front 95

When NOT to use KY in female genitalia exam

Back 95

during papilloma test; KY screws it up

Front 96

_____ screens for cervical cancer

Back 96

SPECULUM

Front 97

Color of internal examination of female genitalia (2)

Back 97

1)if blue; indicates increased vasularity meaning pregnancy
2)red/friable (bleeds quickly/easily) may indicate infexn

Front 98

a)Nulliparous women?
b)Multiparous women?

Back 98

a)small round or oval OS = never had kids
b)horizontal slit or irregular and stellate = probably had kids

Front 99

____ are used to detect gonoccal and chlamydia in female genitalia internal exam (2)

Back 99

1)DNA probe
2)swab insterted into cervix and rotate for 10-30s

Front 100

Wet prep
a)when done
b)ID's what? (3)
c)other

Back 100

a)woman complains of discharge or recent unprotected sex
b)trichomoniasis, candidiasis and bacterial vaginosis
c)FISH ODOR using whiff tests or after adding KOH = bacterical vaginosis*****