Ppal99 Dissecting The Usmle 1,2,3 Step 2 Cs

Front 1

Adult normal Vital Signs: Resp rate

Back 1

= 14-20 bpm

Front 2

Adult normal Vital Signs:Temp

Back 2

= 98.6F (37 C)

Front 3

Adult normal Vital Signs: Pulse

Back 3

= 60-100 bpm

Front 4

Adult normal Vital Signs:BP, how much does it increase to go to the next level? how many readings to diagnose?

Back 4

= 120/ 80 (+20/+10 increases stage, need 3 readings to diagnose)

Front 5

what are the grades of Heart murmur? which one has a thrill?

Back 5

1-6 (Grade IV has thrill)

Front 6

levels of Muscle strength, what is normal?

Back 6

0-5 (normal = 5)

Front 7

levels of Reflexes, what is normal?

Back 7

0 to 4+ (normal= 2+)

Front 8

JVD

Back 8

normal = 3-8 cm

Front 9

what is normal levels for Edema?

Back 9

1 + to 4+ (2-8mm)

Front 10

what are the level of Pulses? what is normal

Back 10

0 to 4+ (normal= 2+)

Front 11

normal size of PMI?

Back 11

normal= "dime size" (2cm)

Front 12

Radiating Pain to the Jaw:

Back 12

MI

Front 13

Radiating Pain:to Left Shoulder:

Back 13

MI or Spleen rupture

Front 14

Radiating Pain to Scapula:

Back 14

Gall bladder problems

Front 15

Radiating Pain to Trapezius:

Back 15

Pericarditis

Front 16

Blumberg's sign

Back 16

rebound tenderness => peritonitis

Front 17

Brudzinski's sign:

Back 17

bend neck, see knee flexion=> meningitis

Front 18

Chadwick's sign:

Back 18

purple vagina=> pregnancy

Front 19

Chandelier sign:

Back 19

cervical motion tenderness => PID

Front 20

Chovstek's sign:

Back 20

tap facial nerve=> muscle spasm

Front 21

Courvoisier's sign:

Back 21

palpable gall bladder=> cancer (pancreatic)

Front 22

Cozen's sign:

Back 22

dorsiflex wrist causes pain => lateral epicondylitis "tennis elbow"

Front 23

Cullen's sign:

Back 23

bleeding around umbilicus =>hemorrhagic pancreatitis

Front 24

Gottran's sign:

Back 24

scaly patches on MCP, PIP joints => dermatomyositis

Front 25

Hamman's sign:

Back 25

crunching sound on auscultation=> subcutaneous emphysema

Front 26

Homan's sign:

Back 26

pain in calf w/ dorsiflexion => DVT

Front 27

Kehr's sign:

Back 27

left shoulder pain => spleen rupture

Front 28

Kenig's sign:

Back 28

flexing knee causes resistance or pain = > meningitis

Front 29

Kussmaul's sign:

Back 29

big neck veins w/ inspiration=> pericardial tamponade

Front 30

Levine sign:

Back 30

hold clenched fist over sternum => angina

Front 31

Murphy's sign

Back 31

pressed gallbladder causes pt to stop breathing=> cholecystitis

Front 32

Obturator sign

Back 32

inward rotation of hip causes pain => appendicitis

Front 33

Phalen's test:

Back 33

flexing wrists for 60s causes paresthesia => carpal tunnel

Front 34

Psoas sign:

Back 34

extending hip causes pain => appendicitis

Front 35

Rovsing's sign:

Back 35

palpating LLQ causes RLQ pain => appendicitis

Front 36

Tinel's test:

Back 36

percussing median nerve causes 1st-3rd finger pain => carpal tunnel

Front 37

Trousseau's sign:

Back 37

BP check causes carpal spasm=> hypocalcemia

Front 38

Turner's sign:

Back 38

bleeding into flank=> hemorrhagic pancreatitis

Front 39

Neural Hearing Loss etiology (3)

Back 39

• Infection
• Trauma
• Tumor

Front 40

Conductive Hearing Loss etiology (4)

Back 40

• Cerumen, foreign body
• Otitis externa
• Tympanic membrane perforation

Front 41

rinne and weber test

Back 41

Rinne test: tuning fork on mastoid, then near ear
weber test: tuning fork on top of head, then near ear
Normal: AC > BC in both ears

Front 42

abnormal rinne test

Back 42

Abnormal:
• Right bone conduction problem => BC > AC on right (lateralization to right side)
• Left neural problem => AC > BC on both sides (lateralize to right side)

Front 43

eat pain worse w / chewing

Back 43

TMJ

Front 44

genetic hearing loss in 30's

Back 44

Otosclerosis:

Front 45

excess endolymph=>

Back 45

Meniere's:

Front 46

S1
define
Patho:

Back 46

M/T closed

Front 47

S2
define
Patho:

Back 47

A/P closed, S2 > S1
normal patho

Front 48

Physiologically split S2
define
Patho:

Back 48

Inspiration only
normal patho

Front 49

Paradoxically split S2
define
Patho:

Back 49

Expiration only
LBBB

Front 50

Fixed split S2
Patho:

Back 50

ASD

Front 51

Widely split S2
Patho: (2)

Back 51

RBBB, PS

Front 52

S3
define
Patho:

Back 52

"SLOSH(S1)-ing(S2)in(S3)"
CHF, "ventricular gallop"

Front 53

S4
define
Patho: (3)

Back 53

"a(S4) STIFF(S1) wall(S2)
AS,VH, HTN

Front 54

Ejection murmur
define
Patho:

Back 54

hear S1, S2
AS,HCM

Front 55

Holosystolic
define
Patho:

Back 55

sounds blowing
MR,VSD

Front 56

Blowing
define
Patho:

Back 56

S3 time, high pitch blowing
AR

Front 57

Rumble
define
Patho:

Back 57

S4 time, rumble with OS
MS

Front 58

Friction rub (hold breath)
define
Patho:

Back 58

Inspiration and Expiration
Pericarditis

Front 59

Friction rub (breathing)
define
Patho:

Back 59

Inspiration and Expiration
Pleuritis

Front 60

Continuous
define
Patho:

Back 60

Machine-like
PDA, OWR, VHL

Front 61

Pulse: QRS complex
• Irregularly irregular = >
• Regularly irregular=>

Back 61

Pulse: QRS complex
• Irregularly irregular = > A Fib
• Regularly irregular=> PVC

Front 62

Increased JVP

Back 62

=> RV failure (add 5cm to sternum)

Front 63

Large a wave

Back 63

=> atrial conctraction (TS, RVH, Pulm HTN)

Front 64

Large c wave

Back 64

=> RV contraction (after carotid pulse)

Front 65

Large v wave

Back 65

=> atrial filling (TR)

Front 66

Kussmaul's sign (⇧JVP w/ inspiration)

Back 66

constrictive pericarditis

Front 67

what happens to PMI in mitral stenosis?

Back 67

no PMI

Front 68

Sustained PMl:

Back 68

• AS (parvus et tardus)
• HTN

Front 69

Increased PMI:

Back 69

• DCM (pulsus alterans)
• HCM (trifid PMI w/ bifid carotid pulse)
• AR (Waterhammer bounding pulse)
• MR

Front 70

Hyper-resonance Percuss:

Back 70

=> air (pneumothorax, emphysema, asthma)

Front 71

Flat, dull percussion

Back 71

=> fluid, solid (pleural effusion, consolidation)

Front 72

Tactile Fremitus: what happens in consolidation? what happens in Pleural effusion?

Back 72

increased in consolidation
decreased in consolidation

Front 73

Lung sounds: Bronchial
define
Pathology:

Back 73

Lung sounds: Bronchial
define: Exp > Insp (loud)
Pathology: Normal

Front 74

Lung sounds: Vesicular
define
Pathology:

Back 74

define: Insp > Exp (soft)
Pathology: Normal

Front 75

Lung sounds: Bronchovesicular
define
Pathology:

Back 75

define: Insp = Exp
Pathology:Normal

Front 76

Lung sounds: Tracheal
define
Pathology:

Back 76

define: Insp = Exp (loud, high pitch)
Pathology:Normal

Front 77

Lung sounds: Wheeze
define
Pathology:

Back 77

define: whistle
Pathology: Asthma

Front 78

Lung sounds: Rhonchi
define
Pathology:

Back 78

define: snore Bronchitis
Pathology: pulm. edema

Front 79

Lung sounds:
define
Pathology:

Back 79

define
Pathology:

Front 80

Lung sounds: Stridor
define
Pathology:

Back 80

define: Vocal cord obstruction
Pathology:

Front 81

Lung sounds: Egophony
define:
Pathology:

Back 81

Lung sounds
define: e -> a change
Pathology: Consolidation

Front 82

Lung sounds: Fine crackles
define:
Pathology:

Back 82

define: late inpiration
Pathology: Pulnonary fibrosis

Front 83

Lung sounds: Coarse crackles
define:
Pathology:

Back 83

define: Early insp "horse races"
Pathology: Pulmonary edema

Front 84

Lung sounds: Pleural friction rub
define:
Pathology:

Back 84

define: Insp and Exp
Pathology: Pleuritis

Front 85

Nerve Reflexes:
L4:
LS:
Sl:
S2-4:

Back 85

L4: knee jerk, foot dorsiflex
LS: big toe dorsiflex
Sl: ankle jerk, foot eversion
S2-4: anal wink

Front 86

Criteria for Hospitalization:

Back 86

• Pain > 20 min or at rest
• Age> 65
• EKG: Q wave, TWI, ⇩ST

Front 87

Killer Chest Pain:

Back 87

• MI
• AAA
• PE
• SpontPTX

Front 88

Criteria for Hospitalization:

Back 88

''ADMIT NOW"
• Age> 65
• Decreased immunity
• Mental status changes
• Increased A-a gradient
• Two or more lobes involved
• No home
• Organ failure
• WBC < 4,000 or > 30,000

Front 89

''BRAT" Diet:

Back 89

• Bananas
• Rice
• Applesauce
• Toast

Front 90

Fatigue DDx:

Back 90

• Depression
• Anemia
• Hypothyroid
• Mononucleosis

Front 91

Upper GI Bleed DDx

Back 91

"Mallory's Vices Gave An Ulcer"
• Mallory-Weiss tear
• Variceal bleeding
• Gastritis
• AV malformation
• Ulcer (peptic)

Front 92

Lower GI Bleed:

Back 92

"Can U Cure Aunt Di's Hemorrhoids?"
• Ulcerative Colitis
• Upper GI bleed
• Cancer
• Angiodysplasia
• Diverticulosis
• Hemorrhoids

Front 93

cold and exercise make it worse

Back 93

Asthma

Front 94

face pain

Back 94

Sinusitis

Front 95

blood, mucoputulent sputum

Back 95

Bronchiectasis

Front 96

DOE, rales, cor pulmonale

Back 96

Pulmonary fibrosis

Front 97

morning cough

Back 97

Bronchitis

Front 98

hemoptysis, night sweats

Back 98

TB

Front 99

hemoptysis, weight loss

Back 99

Cancer

Front 100

night cough, "heartburn

Back 100

GERD

Front 101

Osteoarthritis:

Back 101

PIP /DIP joints, pain worse with activity

Front 102

Rheumatoid Arthritis:

Back 102

MCP /PIP joints, pain worse in the morning

Front 103

Medial epicondylitis

Back 103

= ''golfer's/ pitcher's elbow": flex wrist

Front 104

Tendonitis

Back 104

Thompson test- squeeze back of calf, no foot plantarflex

Front 105

Lateral epicondylitis

Back 105

= "tennis elbow": Cozen's sign (dorsiflex wrist)

Front 106

Polio: gait, nerve affected and muscle

Back 106

Trendelenburg gait (superior gluteal nerve => gluteus mm.)

Front 107

Cubital tunnel syndrome

Back 107

percuss ulnar nerve => 4th, 5th finger pain

Front 108

Carpal tunnel syndrome: and tx

Back 108

o Tests: Phalen's, Tinel's => 1st- 3rd finger pain
o Tx: wrist splint, steroid injection, cut flexor retinaculum