COMBANK Incorrect Qs - Explanations

1. Location of Chapman Reflexes
1. Appendix - Anteriorly at the tip of the 12th rib. Posteriorly at the transverse process of T11.
2. Pancreas - Anteriorly the point is lateral to the costal cartilage between the 7th and 8th ribs on the right. Posteriorly between the transverse process of T7 and T8 on the right.
3. Lungs - (upper lung): 3rd ICS, just lateral to the sternum; (lower lung): 4th ICS, just lateral to the sternum
4. Adrenals - Anteriorly 2" superior and 1" lateral to the umbilicus. Posteriorly between the spinous and transverse processes of T11 and T12
5. Kidney - Anteriorly 1" superior and 1" lateral to the umbilicus. Posteriorly between the spinous and transverse processes of T12 and L1.
6. Bladder - Periumbilical region
7. Urethra - Anteriorly in the myofacial tissues along the superior margin of the pubis ramus about 2 cm lateral to the symphysis
8. Prostate - Anteriorly located in myofacial tissue along the posterior margin of the iliotibial band
9. Colon - On the lateral thigh within the iliotibial band from the greater trochanter to just above the knee.
10. Pasted from <http://en.wikipedia.org/wiki/Chapman_reflex_points>

1. In a healthy female patient, screening for osteoporosis should begin at 65 years of age.
2. Pancreatic cancer commonly presents with weight loss, obstructive jaundice and an enlarged painless gallbladder.
3. Intrahepatic cholestasis of pregnancy presents with pruritus and jaundice in the third trimester. Elevated bile salts confirm the diagnosis.
4. Susptect biliary atresia in newborns who develop jaundice, dark urine, and light colored stools several weeks following birth.
5. Inhaled asbestos fibers commonly get coated with protein and iron and are called ferruginous bodies. They stain positive with Prussian blue.
6. The most common cause of malignant mesothelioma is asbestos exposure but the most common type of lung cancer in people exposed to asbestos is bronchogenic. Remember this point!
7. Immediate surgery can be life-saving for cerebellar hematoma
8. Ulnar nerve entrapment at the wrist (Guyon’s canal) results in hypothenar atrophy and difficulty with finger adduction/abduction. If the entrapment occurs a the level of the elbow (cubital tunnel), there will also be impaired flexion of the 4th and 5th digits.
9. Imipramine is a TCA known to be associated with cases of orthostatic hypotension.
10. Educate all patients with prehypertension. Encourage them to be active and change their diet.
11. Suspect Meniere's disease in patients who present with waxing and waning hearing loss and tinnitus associated with vertigo. Patients may report an abnormal sensation of pressure or fullness in the ears, as in the case above.
12. Intrinsic renal failure in the setting of infection and shock is most likely caused by sepsis due to hematogenous spread of infection.
13. In addition to a complete history and physical, digital rectal examination should be the next step in the management of all patients who present with constipation, especially in those suspected of having fecal impaction.
14. Along with a high-fiber diet, bulking agents such as psyllium should be used first-line in the treatment of patients suffering from fecal impaction.
15. Untreated UTIs in pregnant patients can lead to an increased risk for the following sequelae: Preterm labor, second-trimester abortions, preeclampsia, maternal anemia and amnionitis.
16. Escherichia coli is the leading cause of UTIs in both pregnant and non-pregnant females.
17. Beta-blockers are contraindicated in acute chest pain due to unopposed alpha activation.
18. Psychotherapy can be helpful in addressing interpersonal issues that are not relieved with antidepressive medication.
19. Laparoscopy is the treatment of choice for a suspected non-ruptured ectopic pregnancy.
20. Myelofibrosis can present as an early sign of acute leukemia and should be susptected in patients suffering from Down syndrome who complain of symptoms such as fever, pallor, or fatigue.
21. Tear-drop cells:
1. 1. Myelofibrosis
2. 2. Leukoerythroblastic anemia
3. 3. Thalassemia major
4. 4. Severe iron deficiency
22. Spherocytes:
1. 1. Hereditary spherocytosis
2. 2. Autoimmune hemolysis
23. Helmet cell, schistocyte:
1. 1. DIC
2. 2. Traumatic hemolysis (ie - severe calcific aortic stenosis)
24. Target Cell:
1. 1. HbC disease
2. 2. Asplenia
3. 3. Liver disease
4. 4. Thalassemia
25. Burr cell:
1. 1. TTP/HUS
26. The combination of a positive seated flexion test on the right, an anterior sacral base on the right, and a posterior ILA on the left lead to the diagnosis of a left on left sacral torsion.
27. Abandonment - Medical abandonment results when the caregiver-patient relationship is terminated without making reasonable arrangements with an appropriate person so that care by others can be continued.
28. Battery - Medical battery can be defined as an intentional act on the part of the caregiver to fail to respect a patient's advance directive.
29. Breach of duty - a failure to maintain the duty that the physician owes to the patient, deviating from the “standard of care”.
30. Standard of care - the level at which a professional having the same training and experience in good standing in a same or similar community would practice under the same or similar circumstances.
31. Vicarious liability – Employers are liable for negligent acts or omissions by their employees in the course of employment.
32. romolyn sulfate is an effective prophylactic therapy for exercise-induced asthma and works through the stabilization of mast cells.
33. First line treatment for IgA nephropathy is the combination of ACE inhibitor and ARB. This combination is effective for both proteinuria and hypertension. If there is progressively active disease despite ACE inhibitor/ARB therapy, prednisone can be added to the regimen.
34. The most common compulsion associated with obsessive-compulsive disorder is excessive grooming, hand washing, tooth brushing, etc. This occurs in approximately 60% of patients.
35. In a multiple segment thoracic somatic dysfunction, rotation and sidebending are in opposite directions.
36. Magnesium replacement should be initiated in patients suffering from alcohol withdrawal.
37. Raloxifene is a SERM used in osteoporosis that may exacerbate hot flashes and vaginal dryness.
38. The initial treatment of choice for nasal polyps is oral corticosteroids.
39. Sinus bradycardia that fails to resolve with observation may require the administration of atropine or even transcutaneous pacing.
40. Coronary angiography demonstrating transient coronary spasm is the diagnostic hallmark of Prinzmetal variant angina. Treatment should include nitrates and calcium channel blockers.
41. Lead toxicity should be ruled out in a child presenting with altered mental status, seizure activity, and iron deficiency anemia.
42. Alkylating agents such as cyclophosphamide are contraindicated in pregnancy and breast-feeding.
43. Meningococcal meningitis typically presents with high fever and petechial rash in pediatric patients.
44. The stepwise approach to uterine atony includes: Uterine massage with oxytocin, Methylergonovine, prostin (PGF2), dilation and curettage, exploratory laparotomy, and hysterectomy.
45. Dilated intrahepatic ducts are the classic radiological finding for obstructive jaundice.
46. Pronouncing death, or any patient encounter, should begin with correctly identifying the patient.
47. Middle cerebral artery (MCA): In cases of MCA occlusion, symptoms are usually more profound in the face and arms. Patients usually present with symptoms of contralateral hemiparesis, contralateral hypesthesia, contralateral hemianopia (blindness in half of the visual field), and preference of gaze toward the side of the lesion. Agnosia is also a common symptom. Receptive or expressive aphasia may also result if the lesion is in the dominant hemisphere. Neglect and inattention are signs that the lesion is located in the nondominant hemisphere.
48. Anterior cerebral artery (ACA): Infarcts of the ACA commonly result in disinhibition with speech perseveration and the contralateral weakness is expected to be greater in the lower extremities. Patients may also demonstrate the production of primitive reflexes such as sucking and grasping from frontal lobe effects. Look for accompaning signs such as contralateral cortical sensory deficits, gait apraxia, and urinary incontinence.
49. Posterior cerebral artery (PCA): Occlusions of the PCA typically affect vision and thought, producing contralateral homonymous hemianopia, symptoms of cortical blindness and other vision disturbances. Signs of altered mental status and memory impairment are also likely to be present. Visual abnormalities are the key to diagnoses in most cases.
50. Vertebrobasilar artery: Infarcts affecting vertebrobasilar arteries produce a broad spectrum of findings and can be difficult to diagnose. Most commonly patients will demonstrate vertigo, nystagmus, syncopal episodes, ataxia, diplopia, and dysarthria. The key to differentiating these from anterior circulation strokes is the presence of ipsilateral cranial nerve affects with contralateral motor defecits. This differentiates them from anterior strokes, which are limited to symptoms on one half of the body.
51. Lenticulostriate arteries: Infarcts referred to as lacunar strokes (also known as lacunes) most commonly present with pure motor symptoms but may also be purely sensory or cause ataxic hemiparesis. Lacunar strokes account for up to 20% of all cerebral infarctions and are typically seen in patients with small vessel disease such as those suffering from diabetes and hypertension.
52. Methylgonovine should be avoided in hypertensive patients.
53. Oral contraception is a prevalent and often overlooked cause of hypertension in females of reproductive age.
54. The pedal pump can be a valuable tool for augmenting thoracoabdominal pressure gradients but is contraindicated in patients with DVT, fractures to the lower extremities, or those who have recently undergone surgery to the abdomen.
55. Placing infants in the supine position during sleep has been shown to be the most effective way to prevent SIDS.
56. Penicillin G is the preferred treatment for patients diagnosed with meningococcal meningitis. All contacts should undergo prophylactic treatment with either rifampin or ciprofloxacin.
57. Know how to use the Parkland formula and the rules of 9’s to determine fluid replacement and percent body surface affected in victims of 2nd and 3rd degree burns. The formula is: mL of fluid/24-hours = 4 X body mass (kg) X % body surface. This formula calculates the fluid needed in addition to maintenance over a 24-hour period. The rule of 9’s is used to determine % body surface affected where the head and both arms are 9% each and the anterior trunk, back, and both legs are 18% each.
58. Renal tubular acidosis type 1 is associated with hypokalemia and high urine pH with a predisposition for kidney stones.
59. Whipple disease is a systemic gram-positive bacterial infection that commonly manifests as malabsorption, joint pain and CNS symptoms. Oculomasticatory myorhythmia (OMM), which is pendular vergence oscillations of the eyes and synchronous contractions of the masticatory but not palatal muscles, is pathognomonic of Whipple disease.
60. Alcoholic dilated cardiomyopathy can cause a pre-excitation syndrome that may be observed as delta waves on the ECG.
61. Treat a black widow spider bite with calcium gluconate.
62. The patient is demonstrating radial nerve entrapment involving the C7 nerve root, which is responsible for her diminished triceps reflex. The biceps reflex is moderated at C5 (A), whereas C6 (B) is responsible for the brachioradialis reflex. L4 (D) is associated with the patellar reflex and S1 (E) is responsible for the Achilles reflex.
63. IV medications that can be used to hypertensive emergencies include: nitroprusside, nicardipine, clevidipine, labetalol, fenoldopam. The blood pressure should never be dropped by more than 25% of the initial presenting value.
64. Clinical criteria for brain death include the absence of spontaneous ventilations coupled with loss of brain stem activity and warrant removal of life-sustaining interventions such as mechanical ventilation if no documentation exists suggesting the patient (or family) wished otherwise.
65. The abductor pollicis longus and extensor pollicis brevis are the two tendons inflamed in DeQuervain’s tenosynovitis.
66. Cervical vertebrae (C2-C7) rotate and sidebend in the same direction.
67. Rectal examination is an important physical examination tool and should be performed before imaging studies in patients suspected of having acute appendicitis. computed tomography (CT) would be preferred over ultrasound, and should be used to confirm the diagnosis of acute appendicitis in a stable patient prior to surgical consultation
68. The appropriate treatment for subacute thyroiditis is supportive and NSAIDs.
69. the patient has an anomalous tract around the AV node it would be very unlikely for a patient with WPW to develop any type of AV block.
70. The most important first step in young patients with suspected cardiomyopathy is to take a thorough family history because it could be genetic.
71. The classic presentation of Rubella includes low-grade fever, malaise, and postauricular lymphadenopathy followed by a maculopapular rash that begins on the face.
72. Axis I: Psychiatric disorders
73. Axis II: Personality disorders, developmental disorders, mental retardation
74. Axis III: Medical conditions
75. Axis IV: Psychosocial stressors
76. Axis V: GAF (global assessment of function)
77. Indirect sacral treatments exaggerate the existing dysfunction and move away from the physiologic barrier, placing the structure in its position of ease.
78. These four rules are critical for memorization and must be followed when diagnosing sacral torsions:
79. 1) Sidebending of L5 and the sacral oblique axis must be engaged on the same side.
80. 2) The sacrum rotates in the opposite direction of L5.
81. 3) The seated flexion test must be positive for the diagnosis of sacral torsion.
82. 4) The seated flexion test will be positive on the side opposite of the oblique axis.
83. Hypsarrhythmia on EEG is associated with infantile spasms in tuberous sclerosis. A baby with developmental delay, infantile spasms and a hypopigmented macule (ash-leaf spots) should make you think of tuberous sclerosis. This is a neurocutaneous disease like neurofibromatous. The infantile spasms have a characteristic hyperarrhythmic pattern on EEG. The heart condition associated with tuberous sclerosis is rhabdomyoma.
84. Suspect carbon monoxide poisoning in all patients who present with lethargy and acute mental status changes, especially if they have a history of depression or prior suicide attempts. Both pulse oximetry and ABG analysis of PaO2 are generally normal.
85. A patient with a non-seminoma will have an elevated β-hCG approximately 65% of the time, as opposed to a seminoma which only has this marker about 10% of the time. PLAP is also likely to be elevated in patients with testicular cancer. While CEA may be elevated in patients with testicular cancer, CA-125 is a tumor marker for ovarian cancer. PSA is used as a marker of prostatic hyperplasia and prostate cancer. CA19-9 is a marker for pancreas, breast and lung cancer. CA15-3 and CA27.29 are specific markers for breast cancer.
86. A positive straight leg test and pain that radiates down the posterior thigh are consistent with an impinged sciatic nerve from a herniated nucleus pulposus. Nerve impingement can affect the reflexes of the lower extremity.
87. 21-hydroxylase deficiency leads to low mineralcorticoid production which stimulates the renin-angiotensin system.
88. Any patient with BPH and renal insufficiency needs to have radiographic evaluation of his renal system (kidneys, ureters, and bladder). This is best accomplished with a renal ultrasound which will evaluate for any bladder outlet obstruction or hydronephrosis. The ultrasound is first-line since it is safe, sensitive, specific, and cost-effective.
89. The uterus and cervix are innervated autonomically at the level of T10-L2.
90. Treatment of the piriformis muscle using counterstrain requires placement of the patient in a prone position with flexion of the right lower extremity. The patient’s leg should also be placed in a position of abduction and external rotation to place the muscle in a position of least resistance
91. Negligence, breach of duty, vicarious liability, nonmaleficence, and EMTALA are all topics you should know well.
92. It is appropriate for a 13 year old female to be in Tanner stage 4 with adult quality pubic hair that excludes growth on the thighs and breasts that have a secondary mound.
93. Dyspnea of pregnancy is a common occurrence most commonly due to decreased Paco2 levels, resulting from a 30 – 40% increase in tidal volume., and warrants reassurance as it can precipitate feelings anxiety, which can worsen the problem further.
94. Primary tumors that metastasize to brain: lung, breast, skin, kidney, GI; remember that 50% of brain tumors are from metastases.
95. Primary tumors that metastasize to liver: colon, stomach, pancreas, breast, lung
96. Primary tumors that metastasize to bone: prostate, thyroid, testes, breast, lung, kidney
97. Patients suffering from schizoid personality disorder are “loners” contented with being alone. They differ from avoidant and schizotypal personality-types in that they do not feel inadequate or insecure and have no signs of “weird” thoughts or behavior.
98. The sympathetic innervations for the appendix comes for the T12 nerve root and it will therefore be that segment which is facilitated in acute appendicitis. T5-T9 innervate the upper GI tract up to the ligament of treitz.T10-T11 innervated the middle GI tract, picking up where T5-T9 left off through the proximal 2/3rds of the transverse colon. T12-L2 are credited with the remaining portion of the GI tract, but it is know that T12 specifically innervates the appendix.
99. Psoas syndrome can be defined as a muscular imbalance, strain, spasm, tendonitis, or flexion contracture of the iliopsoas muscle. Ureteral stones can cause a viscerosomatic reflex causing psoas syndrome.
100. Eroded cartilage with thickened underlying bone is typical of OA.
101. Symmetrical joint involvement is characteristic of RA and primary OA.
102. Chronic hypertension causes left-sided congestive heart failure which can lead to transudative pleural effusions. Pleural fluid with a pH greater than 7.3 is consistent with a transudative effusion.
103. Always do an ultrasound before pelvic exam in third trimester bleeding to rule out placenta previa. Placenta previa is a contraindication for a pelvic exam.
104. Suspect Behcet’s syndrome in patients presenting with genital and oral ulcers in the presence of uveitis. Treat acute exacerbations of Behcet's syndrome with oral prednisone.
105. 1. The OA's rotation and sidebending are coupled in opposite directions. 2. Translation in one direction induces sidebending in the opposite direction.
106. The anterior Chapman’s point for the myocardium is located at the 2nd intercostal space, near the sternum.
107. Dihydropyridine calcium-channel blockers such as nifedipine are the preferred treatment for the relief of symptoms associated with Raynaud’s phenomenon.
108. Cryoglobulinemia presents with GN and decreased C3/C4 levels.
109. Acute tissue texture changes include the following: boggy texture, increased temperature with increased moisture, marked tenderness, and palpable edema.
110. Chronic tissue texture changes include the following: ropy texture, cool temperature with dry skin, minimal tenderness and no edema.
111. Atrial fibrillation with rapid ventricular response can be initially managed with diltiazem. rapid ventricular response (diltiazem) and Wolff-Parkinson-White (procainamide).
112. Patients exposed to radon gas are at an increased risk of developing cancer of the lung.
113. The Thomas test is a useful tool in the evaluation of psoas syndrome.
114. T2-5 corresponds to the respiratory system, esophagus, and upper GI tract.
115. T5-T9 corresponds to the upper GI tract such as stomach, liver, spleen, and gallbladder.
116. T10-T11 kidneys.
117. The most likely explanation for not being able to see the string of an IUD is that it has fallen out or it has moved into the uterine cavity. Because the next step is exploring the endocervix which could compromise a growing fetus you should always perform a pregnancy test first.
118. Asthma presents as attacks of dyspnea and wheezing. The pathogenesis involves airway inflammation and bronchoconstriction.
119. Bile acid resins such as cholestyramine and colestipol are known to have a very bad taste and are not tolerated well by patients
120. Friedreich’s ataxia is a progressive degenerative disease affecting the dorsal columns and spinocerebellar tracts. It is highly associated with cardiomyopathies.
121. Remember that when a patient is hypernatremic they are also hyperosmotic. This is a water problem. The patient does not have enough water, and they are either losing water or not taking enough water in. The cells in the brain adjust to this by also becoming Hyperosmolar. Therefore if the electrolyte disturbance is corrected too quickly then the brain will draw in water and the brain will swell.
122. The initial evaluation of patients presenting to the hospital for any reason should begin with focus history and physical examination.
123. Rib 1: Anterior and middle scalenes
124. Rib 2: Posterior scalene
125. Ribs 3-5: Pectoralis minor
126. Ribs 6-9: Serratus anterior
127. Ribs 10-11: Latissimus dorsi
128. Rib 12: Quatratus lumborum
129. Ewing sarcoma (neural) is the second most common bone cancer is childhood behind Osteosarcoma. Neural (mesoderm) differention seperates the two histologically.
130. Primary prevention avoids the development of a disease, i.e. starting an ad campaign that smoking is bad for your lungs!
131. Treat inhalation rib dysfunctions by targeting the most inferior rib. A good tool to remember this is "BITE". Treat the bottom rib with inhalation dysfunction and the top rib with exhalation dysfunction.
132. Vaginal delivery and zidovudine prophylaxis are recommended for HIV-positive women. Breast feeding is contraindicated.
133. Surgical resection of both the tonsils and adenoids is the most effective treatment for obstructive sleep apnea in the pediatric population.
134. Dilated ventricles, without cortical atrophy, are the most common finding for normal pressure hydrocephalus.
135. Chlordiazepoxide is the drug of choice to treat alcohol withdrawal syndrome.
136. The management for inevitable abortion is emergent dilation and curettage.
137. Colon biopsy is the definitive diagnostic test in Hirschsprung disease and is taken just distal to the expanded segment (megacolon).
138. The first step for a patient suspected of SBP is a paracentesis. The diagnosis is confirmed if the neutrophil count is greater than 250/mm3.
139. The cecum through the colon and prostate refer to the iliotibial band in a “fold down manner.” The cecum through the proximal colon refers to the right IT band in a proximal-to-distal manner. Following the prostate and sigmoid through the distal transverse colon refer proximal to distal down the left IT band. The posterior Chapman reflex point for the appendix lies at the transverse process of T11. The Chapman point located lateral to the costal cartilage between the 7th and 8th ribs on the right corresponds to the pancreas anteriorly. The point located between the spinous and transverse processes of T11 and T12 corresponds posteriorly to diseases involving the adrenals. Additionally, the posterior point between the spinous and transverse processes of T12 and L1 corresponds to the kidneys.
140. Use common sense when answering these questions and never fall into the trap of ordering unnecessary tests or advising alternative medical therapeutic regimens.
141. Craniosacral Flexion: midline bones flex, sacrum counternutates, paired bones externally rotate and the AP diameter decreases.
     Extension: midline bones extend, sacrum nutates, paired bones internally rotate, and the AP diameter increases.
142. Nephrotic syndrome is associated with a hypercoagulable state.
143. Erb-Duchenne palsy occurs secondary to the stretching of the brachial plexus and is more specifically due to the injury of the upper cervical (C5 and C6) nerve roots. Todd’s paralysis refers to focal weakness on one side of the body following a seizure and typically resolves within 24 hours. Klumpke's Palsy is one of the rarest of the brachial plexus injuries and results in weakness of the wrist and finger flexors due to injury of the lower cervical (C8-T1) nerve roots, resulting in a “claw hand.”
144. Atropine is the best initial therapy of symptomatic bradycardia secondary to organophosphate poisoning, Pralidoxime, however, remains the definitive treatment and should be given as soon as possible.
145. Oral corticosteroids are considered to be the most effective therapy for patients suffering from polymyalgia rheumatica.
146. Hyperosmolar coma is seen in type 2 diabetics with glucose levels greater than 600 mg/dL who present with polyuria, polydipsia, mental status changes and lethargy secondary to the effects of dehydration. Fluid resuscitation with isotonic saline is the first-line treatment for hyperosmolar coma.
147. Hypoglycemia is the most common side effect associated with sulfonylurea oral hypoglycemics, such as glyburide.
148. Adenocarcinoma is the most common non-small cell carcinoma of the lung in the United States and arises peripherally from mucin-producing glandular tissue. Adenocarcinoma of the lung is described histologically by glandular formation with mucin production identified on PAS staining.
149. Fiberoptic bronchoscopy is the preferred method to evaluate centrally-located lung lesions while CT-guided biopsy remains the preferred method for the evaluation of peripheral lesions.
150. Adenocarcinoma of the lung is described histologically by glandular formation with mucin production identified on PAS staining.
151. Telephone consent is just as valid as written consent and should be obtained when necessary, as in the above case.
152. Anterior Chapman’s points lying 1” superior and 1” lateral to the umbilicus correspond to diseases of the kidneys.
153. Rib raising has been shown to improve breathing in patients suffering from asthma and viral pneumonia. This is thought to occur through normalization of hypersympathetic activity.
154. The liver is the most common primary site for GI metastasis. Jaundice, elevated liver enzymes and hepatomegaly support this diagnosis.
155. CEA is a marker for colon cancer.
     Alpha fetoprotein is a marker for hepatocellular carcinoma which is a primary liver cancer. It is also a marker for germ cell tumors of the testes and ovary.
     LDH is elevated in hemolysis and lymphoma.
     CA 19-9 is a marker for pancreatic cancer.
     CA-125 is a marker for ovarian cancer.
156. Imperforate hymen presents in neonates as a bulging yellow-gray mass at the level of the vaginal introitus and can lead to urinary obstruction. Recall that imperforate hymen is also a cause of primary amenorrhea with cyclic pelvic pain. Pelvic ultrasonography is the study of choice in patients suffering from imperforate hymen.
157. Treat mild scoliosis with conservative measures including osteopathic manipulative therapy, Konstancin exercises, and physical therapy.
158. Respiratory compromise is an indication for surgery in patient suffering from scoliosis and has been associated with thoracic curvatures greater than 50 degrees.
159. When given fever and headache on board examinations, confusion implies encephalitis, nuchal rigidity implies meningitis, and focal findings imply brain abscess. Herpes encephalitis affects the temporal lobe. Encephalitis can be differentiated from meningitis and brain abscess by the symptom of confusion.
160. Assist-control ventilation, or ACV, the patient initiates a breath and the ventilator subsequently delivers a breath at a preset tidal volume, with a backup rate in place in the event that the patient fails to initiate a breath.
     Intermittent mandatory ventilation, or IMV, is similar, in that the patient can also initiate breaths, however, the machine does not support these breaths with a preset tidal volume. There is also a backup rate setting with IMV.
     Synchronized intermittent mandatory ventilation, or SIMV, also allows the patient to breathe spontaneously, and tries to coordinate a set amount of its own mechanical breaths with these spontaneous breaths, while also allowing spontaneous unsupported breaths in between.
     Controlled mechanical ventilation, or CMV, is used when the patient is making no respiratory effort – the machine does not allow spontaneous breaths, nor does it support them.
161. Lateral epicondylitis is an overuse injury primarily caused by microscopic tearing of the extensor carpi radialis brevis.
162. Shigellosis commonly presents with seizures, high-fever, and diarrhea consisting of blood and mucus.
163. The criteria for a diagnosis of anorexia nervosa includes a body weight of at least 15% below expected, amenorrhea for at least 3-months and a fear of becoming fat.
164. Posterolateral disc herniation at the L3-L4 level can cause L4 nerve root entrapment, tibialis anterior weakness and loss of sensation over the medial malleolus.
165. Domestic violence is a subject that should be approached very carefully and privately with the patient.
166. For physical exam testing, the palmar 5th fingertip correlates to ulnar, the palmar 2nd fingertip correlates to median, and the dorsal aspect near the thumb correlates to radial.
167. Charles Bonnet syndrome involves visual hallucinations in a mentally healthy elderly patient with poor vision.
168. Chronic hypertension is a strong risk factor for left-sided congestive heart failure.
169. Methyldopa and Labetalol are safe antihypertensives for use in pregnancy.
170. There are several situations that require Rhogam administration. These include: routine administration at 28 weeks, immediately following invasive procedures such as amniocentesis, chorionic villus sampling, as well as elective abortions, stillbirths, ectopic pregnancies and any other circumstance where transplacental bleeding is a possibility.
171. The sphenoid flexes during craniosacral flexion. Remember the four following facts for craniosacral flexion: 1. External rotation of the paired bones. 2. Flexion of the midline bones. 3. Decreased AP diameter of the cranium. 4. The sacral base moves posteriorly which is called counternutation.
172. Abdominal ultrasound is the best screening test for acute cholecystitis because of its high sensitivity, whereas, HIDA scanning is very specific, and therefore, an ideal test for establishing a definitive diagnosis of acute cholecystitis. Both endoscopic retrograde cholangiopancreatography (ERCP) and magnetic resonance cholangiopancreatography (MRCP) can be used to confirm the diagnosis of choledocholithiasis.
173. A low protein diet is recommended for all types of kidney stones.
174. Benign-appearing pulmonary nodules should be followed with chest radiography every 3-6 months.
175. A physician cannot force a teenager to take a drug test against their will.
176. End stage liver disease is a result of years of cirrhosis leading to portal hypertension, which manifests as ascites.
177. Neonatal respiratory distress syndrome presents with tachypnea, nasal flaring, intercostal retractions, cyanosis, and grunting within the first hour of delivery. Evidence shows that antenatal corticosteroid therapy reduces NRDS when given between 24-34 weeks gestation for high-risk patients.
178. The management for PPROM complicated by infection is vaginal delivery as soon as possible.
179. Teenagers have the same rights to privacy as that of adults. STD’s can be reported to the local health agency only for statistical purposes.
180. Anti-cholinergic drugs are a common cause of delirium in the elderly.
181. Elevated levels of acetylcholine result in prolonged REM and total sleep times.
182. Cauda equina syndrome (CES) is an emergent diagnosis requiring immediate surgical consultation.
183. The ovaries and testes are innervated by the vagus nerve. The ureters are split between the CN X and S2-S4. The testes and ovaries, which descend during development, are innervated by CN X. Organs innervated by the vagus nerve are: heart, bronchial tree, lower 2/3 esophagus, stomach, intestines, liver, gallbladder, pancreas, kidney, upper ureter, ovaries, testes, ascending colon, and transverse colon. (S2-S4). Organs innervated by pelvic splanchnics are: lower ureter, bladder, uterus, prostate, genitalia, descending colon, sigmoid, rectum.
184. Bloating, bbdominal cramping & flatulence after consuming dairy products is lactose intolerance. The hydrogen breath test is confirmatory although it can usually be diagnosed on clinical symptoms alone. after an overnight fast when the patient is given 50 grams of lactose. If the patient has a reduced or absent level of lactase, the lactose disaccharide cannot be broken down and absorbed in the bowel. Therefore, the enteric bacteria take on the responsibility of metabolizing lactose and in the process, form Hydrogen, Methane and Carbon Dioxide. Increased levels of these gases cause bowel distention with subsequent bloating, cramping, and flatulence and can be detected by gas chromatography in the breath of the patient.
185. Unless otherwise stated, a living will applies to terminal conditions only.