COMSAE 115 Questions with Verified Correct
Answers
apprehension test
used to evaluate anterior glenohumeral shoulder instability
- abduct the shoulder 90 degrees, flex the elbow to 90, and slowly externally rotate the shoulder
while supporting the arm
Yergason test
determines whether head of biceps is stable in the bicipital groove- pt fully flexes elbow while
examiner grasps elbow and wrist- pt resists motion while examiner simultaneously extends
elbow and externally rotates the arm.
pain or snapping sensation in the bicipital groove
Speed test
forearm supinated, palm up. stresses the long head of the biceps.
alloimmunization causing fetal anemia
common causes of sinusoidal fetal heart tracing:
- Rh alloimmunization
- fetomaternal hemorrhage
- twin to twin transfusion
- severe fetal hypoxia (less common)
button battery ingestion = GI emergency
, Button battery
Mechanism of injury
Electrical current → hydroxide ions → alkali burn → liquefactive necrosis
Complications
Esophageal ulcer
Esophageal perforation
Tracheoesophageal fistula
Mediastinitis
Aortoesophageal fistula (can cause fatal hemorrhage)
Management
Battery in esophagus: Emergent endoscopic removal
Battery beyond the esophagus + asymptomatic: Observe with serial imaging and monitor for
passage (management depends on battery size, patient age, symptoms, and location).
massive transfusion can lead to coagulopathy
massive transfusion:
greater than 10 units PRBCs within 24 hours, or replacement of an entire blood volume
dilution coagulopathy (packed RBCs contain very few platelets, very little clotting factors)
platelets become diluted --> thrombocytopenia
clotting factors become diluted --> prolonged PT/PTT
increases risk of postoperative bleeding, so coagulation studies and platelet
,hr and rr
Newborn: 100-160 HR, 30-60 RR
Infant: 100-160 HR, 30-50 RR
Adult: 60-100 HR, 12-20 RR
upper lobe consolidation --> obstructing bronchogenic carcinoma causing post obstructive
pneumonia
Smoker + persistent upper lobe infiltrate → Bronchogenic carcinoma
Nonresolving pneumonia after antibiotics → CT chest
Post-obstructive pneumonia is a classic presentation of lung cancer.
coal workers' pneumoconiosis
Carbon dust, seen in coal miners. Massive exposure leads to diffuse fibrosis('black lung')
measure functional pulmonary impairment with spirometry
CI for lymphatic pump techniques
High-yield contraindications for lymphatic techniques (Pedal pump, Thoracic pump)
Think of anything where increasing lymphatic/venous return could be harmful:
Acute decompensated CHF
Pulmonary edema
Untreated DVT (risk of embolization)
Acute fracture
, Open wounds/burns over treatment area
Metastatic cancer involving the area (relative)
Ottawa ankle rules
Ottawa Ankle Rules:
Order an ankle X-ray if the patient has pain in the malleolar zone AND one of the following:
1. Bone tenderness over the posterior edge or tip of the lateral malleolus (distal 6 cm)
2. Bone tenderness over the posterior edge or tip of the medial malleolus
3. Unable to bear weight for 4 steps immediately after the injury AND in the ED/clinic
drugs for nausea
chemotherapy/postoperative: ondansetron
gastroparesis: metoclopramide, can cause dystonia and tarydive dyskinesia
motion sickness: scopolamine, antihistamine (promethazine - side effect of anticholinergic,
sedation)
pregnancy: pyridoxine + doxylamine
emphysema (pink puffer)
Barrel chest (due to lung hyperinflation), pursed lips
if papilledema or altered mental status , think CT first LP second
Suspected meningitis
Step 1: Obtain blood cultures (if they won't significantly delay therapy)
Step 2: Start empiric IV antibiotics immediately (± dexamethasone)
Step 3: Determine if CT is needed before LP.
Answers
apprehension test
used to evaluate anterior glenohumeral shoulder instability
- abduct the shoulder 90 degrees, flex the elbow to 90, and slowly externally rotate the shoulder
while supporting the arm
Yergason test
determines whether head of biceps is stable in the bicipital groove- pt fully flexes elbow while
examiner grasps elbow and wrist- pt resists motion while examiner simultaneously extends
elbow and externally rotates the arm.
pain or snapping sensation in the bicipital groove
Speed test
forearm supinated, palm up. stresses the long head of the biceps.
alloimmunization causing fetal anemia
common causes of sinusoidal fetal heart tracing:
- Rh alloimmunization
- fetomaternal hemorrhage
- twin to twin transfusion
- severe fetal hypoxia (less common)
button battery ingestion = GI emergency
, Button battery
Mechanism of injury
Electrical current → hydroxide ions → alkali burn → liquefactive necrosis
Complications
Esophageal ulcer
Esophageal perforation
Tracheoesophageal fistula
Mediastinitis
Aortoesophageal fistula (can cause fatal hemorrhage)
Management
Battery in esophagus: Emergent endoscopic removal
Battery beyond the esophagus + asymptomatic: Observe with serial imaging and monitor for
passage (management depends on battery size, patient age, symptoms, and location).
massive transfusion can lead to coagulopathy
massive transfusion:
greater than 10 units PRBCs within 24 hours, or replacement of an entire blood volume
dilution coagulopathy (packed RBCs contain very few platelets, very little clotting factors)
platelets become diluted --> thrombocytopenia
clotting factors become diluted --> prolonged PT/PTT
increases risk of postoperative bleeding, so coagulation studies and platelet
,hr and rr
Newborn: 100-160 HR, 30-60 RR
Infant: 100-160 HR, 30-50 RR
Adult: 60-100 HR, 12-20 RR
upper lobe consolidation --> obstructing bronchogenic carcinoma causing post obstructive
pneumonia
Smoker + persistent upper lobe infiltrate → Bronchogenic carcinoma
Nonresolving pneumonia after antibiotics → CT chest
Post-obstructive pneumonia is a classic presentation of lung cancer.
coal workers' pneumoconiosis
Carbon dust, seen in coal miners. Massive exposure leads to diffuse fibrosis('black lung')
measure functional pulmonary impairment with spirometry
CI for lymphatic pump techniques
High-yield contraindications for lymphatic techniques (Pedal pump, Thoracic pump)
Think of anything where increasing lymphatic/venous return could be harmful:
Acute decompensated CHF
Pulmonary edema
Untreated DVT (risk of embolization)
Acute fracture
, Open wounds/burns over treatment area
Metastatic cancer involving the area (relative)
Ottawa ankle rules
Ottawa Ankle Rules:
Order an ankle X-ray if the patient has pain in the malleolar zone AND one of the following:
1. Bone tenderness over the posterior edge or tip of the lateral malleolus (distal 6 cm)
2. Bone tenderness over the posterior edge or tip of the medial malleolus
3. Unable to bear weight for 4 steps immediately after the injury AND in the ED/clinic
drugs for nausea
chemotherapy/postoperative: ondansetron
gastroparesis: metoclopramide, can cause dystonia and tarydive dyskinesia
motion sickness: scopolamine, antihistamine (promethazine - side effect of anticholinergic,
sedation)
pregnancy: pyridoxine + doxylamine
emphysema (pink puffer)
Barrel chest (due to lung hyperinflation), pursed lips
if papilledema or altered mental status , think CT first LP second
Suspected meningitis
Step 1: Obtain blood cultures (if they won't significantly delay therapy)
Step 2: Start empiric IV antibiotics immediately (± dexamethasone)
Step 3: Determine if CT is needed before LP.
