-
Patient with popping on opening
Where is disc when closed?
Where is disc when opened?
- closed: anterior
- opening: back in place
anterior disk displacement WITH reduction
-
Clicking on opening and closing is
Reciprocal
-
Superior division of the facial nerve crosses the ___ ____ ____ mms from the anterior edge of the bony _____ _____
- zygomatic arch
- 8-35 mm
- auditory canal
-
If having spasms after pop in the back the patient most likely has
herination nucleus pulposus (HNP)
-
Innervation of the index finger is supplied by
median nerve
median covers index, thumb, middle and half of ring fingers
-
Innervation of the fifth finger is supplied by
ulnar nerve
-
Innervation of the dorsal webspace of thumb and index finger is supplied by
radial nerve
-
carpal tunnel syndrome is caused by
median nerve compression
-
A patient with a positive phalen's test experiences what and has what most likely?
Tingling and numbess with wrist in acute flexion
carpal tunnel syndrome
-
A patient with a positive tinel's test experiences what and has what most likely?
Electrical sensation when percussing over carpal tunnel
carpal tunnel syndrome
-
Hard, painless nodes in the DIP are called
herberden's nodes (osetoarthritis)
-
Hard, painless nodes called bouchard's nodes are located in the ____
PIP
-
RA over a long time can cause panes which is
Swelling of synovium and is a soft tissue mass of the joint the is attacking normal joint tissues
-
First gout attack will most likely be where and what is it called?
In the big toe (podagra)
tophaceous gout
-
infection of the enclosed fascial space of the finger pad that required emergency attention
Felon
-
What is usually harvested for the CABG
Great saphenous vein
-
intermittent claudication, pale, decreased pulses and ulcers at tips are characteristics of
Chronic arterial vascular insufficiency
-
aching or painless, brown discoloration on inside of lower calf and medial ulceration are characteristics of
Chronic venous vascular insufficiency
-
polynerupatjy
microvascular insufficiency
decreases phagocytic function are characteristic of what?
Diabetic neuropathy
-
diabetic neuropathy can cause what?
Foot ulcers
no good blood supply, can't feel it, and can't heal from it because shitty phagocytes
-
the noise heard when listing to the heart is what?
valves CLOSING
normally dont hear them opening
-
physiological murmur that you outgrew
Benign systolic ejection murmur
normal
-
flow across disease or stenotic valves
turbulent
-
back flow over insufficient valves
regurgitation
-
what is the S1 sound "lub"
closing of mitral and tricuspid valves
systole
-
what is the S2 sounds "dub"
closing of aortic and pulmonic valves
diastole
-
Characteristics of physiologic splitting (5)
- S2 sound
- A2 comes earlier
- P2 is delayed
- deep inspiration augments it
- normal variation
-
intercostal spaces are named
for the rib above it
-
what is the sternal angle
where the sternum meets the manubrieum at the second rib
-
If you hear a heart sound at the RIGHT 2nd interspace it is
aortic
-
If you hear a heart sound at the LEFT 2nd interspace it is
pulmonic
-
If you hear a heart sound at the lower left sternal border it is
Tricuspid
-
If you hear a heart sound at the apex/PMI/5th LEFT interspace it is
Mitral
-
Order of valve involvement with rheumatic fever
- Mitral alone (most)
- mitral and aortic
- Aortic alone (least)
-
What murmur is best heard at the right second intercostal space during systole?
Aortic stenosis
-
What murmur is best heard at the left second to fourth intercostal space (but actually BEST at the right second intercostal) during diastole?
Aortic Regurgitation
on the exam he will say right intercostal space for this because still heard BEST here
-
What murmur is best heard at the apex second during systole?
Mitral regurgitation
-
What murmur is best heard at the apex during diastole?
Mitral stenosis
-
Difference between diastolic and systolic pressure?
Pulse pressure
-
As you get hypertension and more regurgitation occurs the diastolic pressure goes up and what happens to pulse pressure?
Is it widened
**sign that the disease is progressing (more stress on the heart and worsening regurgitation)
-
Systemic congestion with jugular distention pedal and pitting edema and an enlarged liver is characteristic of
Right congestive heart failure
-
pulmonary congestion with dyspnea and orthopnea and mitral value insufficiency are characteristic of
left congestive heart failure
-
T/F: CABG require prophylaxis
FALSE
rapidly re-endotheliazes so no AB
dont need it for stenting either
-
Elevated Creatanine Phosphate Kinase in the blood can tell you want
that the person has had a heart attack and not just ischemia
increase in CPK and MB fraction in the blood indicate heart attack because cells die and enzymes leak out
-
Waterhammer pulse are caused by?
stenotic vessels
-
-
EKG parallel flow towards the positive end of the lead results in
strong deflection upwards
-
EKG parallel flow towards the negative end of the lead results in
strong downward deflection
-
EKG perpendicular flow of the lead results in
flat tracing (cancels out)
-
P wave indications what?
atrial depolarization
SA node impulse
-
where is atrial depolarization best seen?
Lead II
-
The T wave represents what
The depolarization of the ventricles
-
Why is atrial depolarization not on the EKG?
hidden pithing the larger QRS complex
-
ventral depolarization is shown with what?
QRS complex
-
a small block is how many seconds?
0.04 sec
-
a large block is how many seconds?
0.2 sec
-
Normal axis is positive in which leads (2)
-
a beat that came form a spot some where in ventricle that fired early-- looks wide (>0.2 sec) and bizarre
PVC
<6 is ok
-
ST depression on an EKG means what
ischemia
-
ST elevation on an EKG means what and in what leads?
-
A Q wave that is >0.08 sec or > small blocks tall or wide indicates
Old MI
is significant
-
leads for anterior (LAD) (4)
-
leads for anteriolateral (LAD) (4)
-
leads for inferior (RCA) (3)
-
No p waves
irregularly irregular (no pattern)
ventricular rate?
anticoagulation?
A fib
-
how many seconds (max) is the QRS interval
0.1 sec (2.5 blocks)
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