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Davita Final Exam Summer 2022

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Final Exam Summer 2022 arrest (a catching of the breath) with deep palpation of the right upper quadrant along the costal margin indicates Cholecystitis. This is a positive _________________ sign. - ANS-Murphy's First line treatment for carpal tunnel syndrome along with splinting the wrist in neutral position while sleeping. - ANS-NSAIDs Local steroid injections, oral steroids, and carpal tunnel release surgery are what line treatment for carpal tunnel syndrome - ANS-second Tapping over the palmar surface of wrist proximal to the carpal tunnel produces an electric sensation along the distribution of the median nerve. This is a positive____________sign. ANS-Tinel Holding the wrist in fully flexed position for 60 seconds precipitates paresthesias. This is a positive____________ sign. - ANS-Phalen Patient has with pain when turning wrist, grasping anything or making a fist and has insidious onset of burning, aching pain over radial aspect of wrist and base of thumb. Patient is at increased risk for __________________ because they do repetitive activities with hands/wrists like working in the garden, sewing, or playing golf or racket sports. - ANS-De Quervain's tenosynovitis The test to evaluate for De Quervain's tenosynovitis is the ___________________ test. It involves placing thumb in closed fist and tilting hand down. ANS-Finkelstein A patient has a ______________ __________ on the dorsum of his wrist that fluctuates with activity. It is not painful unless it's compressed - ANS-ganglion cyst A ganglion cyst will usually go away on its own. If aspirated it has a high recurrence rate. True or False - ANS-True Patient's knee is maximally flexed, then internally rotated; as leg is passively extended, examiner simultaneously externally rotates leg while palpating tibial joint line. Repeat with leg externally rotated, internally rotating while extending. + test is palpable click or tibial joint pain. What test is this? - ANS-McMurray A positive McMurray test suggests injury to the medial ________________. - ANS-meniscus *Rapid onset of red, hot, swollen, very tender joint (1st metatarsophalangeal (MTP) joint most common) *Foot, ankle, knee, shoulder, wrist, elbow, fingers may also be affected *Fever, may be present *Tophi (ongoing or chronic ________________ ): soft tissue mass Pain with urination secondary to uric acid renal - ANS-gout First line treatment for acute gout flare: *NSAIDs (naproxen, indomethacin (Indocin), celecoxib (Celebrex), indomethacin (Indocin) at full antiinflammatory dose 1-3 days until symptoms subside then taper to cessation over 3-5 days to cessation * _______________________________________tapered over 10-14 days. Useful if cannot tolerate - ANS-corticosteroids Second-line treatment for acute gout flare: ____________________________ (urate lowering agent) as soon as symptoms appear. 1.2 mg PO at onset, then 0.6 mg PO 1 hour later, maintenance dose 0.6 mg PO QD or BID. Good for patients who cannot take NSAIDs. Drug has very narrow therapeutic index - ANS-Colchicine

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