APMLE Part II flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Ankle-brachial index interpretation

ABI 0.90–1.30 is normal; 0.70–0.89 mild-to-moderate PAD; 0.40–0.69 moderate-to-severe; below 0.40 severe; above 1.30 suggests non-compressible calcified vessels as in diabetes or CKD.

Ottawa ankle rules

Ankle radiography is indicated with malleolar pain plus bone tenderness at the posterior edge or tip of either malleolus, or inability to bear weight both immediately and in the emergency department.

Charcot neuroarthropathy presentation

Acute Charcot foot presents as a warm, swollen, erythematous foot without ulceration in a neuropathic patient, often after minor trauma; a skin temperature difference above 2°C versus the other foot is suggestive.

MRI in osteomyelitis

MRI is the modality of choice for osteomyelitis, showing low T1 marrow signal and high T2/STIR signal from marrow edema; it also identifies abscess and sinus tracts.

Synovial fluid in septic arthritis

Septic synovial fluid typically has more than 50,000 WBC/mm³ with more than 90% neutrophils; Gram stain and culture guide therapy, and empiric antibiotics should follow joint aspiration.

Gout crystal identification

Gout is confirmed by needle-shaped, negatively birefringent monosodium urate crystals in synovial fluid; pseudogout shows rhomboid, positively birefringent calcium pyrophosphate crystals.

Total contact cast

A total contact cast is the gold standard for offloading plantar neuropathic diabetic foot ulcers; removable cast walkers or healing sandals are alternatives when casting is contraindicated.

Wagner ulcer classification

Wagner grade 0 is intact skin; 1 superficial ulcer; 2 ulcer to tendon or bone; 3 deep ulcer with abscess or osteomyelitis; 4 localized gangrene; 5 extensive gangrene of the foot.

Acute compartment syndrome signs

Compartment syndrome presents with pain out of proportion, pain on passive stretch, paresthesia, pallor, and later paralysis and pulselessness; emergent fasciotomy is required and should not be delayed.

Thompson test

The Thompson (Simmonds) test squeezes the calf with the patient prone; absence of plantarflexion indicates Achilles tendon rupture. A palpable gap and weak push-off also support the diagnosis.

Windlass mechanism

Dorsiflexion of the metatarsophalangeal joints tightens the plantar fascia, raises the medial longitudinal arch, and stabilizes the midfoot during push-off in gait.

Hallux valgus angles

Hallux valgus is defined by a hallux valgus angle greater than 15° and an intermetatarsal angle greater than 9°; severity guides whether osteotomy with soft-tissue release is considered.

Gait cycle phases

The gait cycle comprises stance phase about 60% and swing phase about 40%; double support occurs about 10% of each cycle and decreases as walking speed increases.

Pressure injury staging

Stage 1 is nonblanchable erythema; 2 partial-thickness loss with dermis exposed; 3 full-thickness loss with fat visible; 4 full-thickness with fascia, muscle, tendon, or bone exposed; unstageable when eschar obscures depth.

TIME wound bed preparation

TIME stands for Tissue debridement, Infection or inflammation control, Moisture balance, and Edge advancement; it guides systematic wound assessment and dressing selection.

Moist wound healing

Moist wound healing outperforms dry healing; choose hydrocolloids for low exudate, foams and alginates for moderate to heavy exudate, and hydrogels for dry wounds.

Tinea pedis treatment

Interdigital tinea pedis is treated with topical azoles or terbinafine; coexisting onychomycosis may require oral terbinafine, and diagnosis is confirmed with KOH preparation or culture.

Probe-to-bone test

A sterile probe that contacts bone through a diabetic foot ulcer is a positive probe-to-bone test and is predictive of underlying osteomyelitis, prompting imaging and bone culture.

Diabetes diagnostic criteria

Diabetes is diagnosed by fasting glucose ≥126 mg/dL, 2-hour OGTT glucose ≥200 mg/dL, HbA1c ≥6.5%, or random glucose ≥200 mg/dL with symptoms; repeat testing confirms unless hyperglycemia is unequivocal.

Metabolic syndrome criteria

Metabolic syndrome requires three or more of central obesity, elevated triglycerides, low HDL, elevated blood pressure, and impaired fasting glucose; it increases cardiovascular and diabetes risk.

Hypothyroidism findings

Hypothyroidism causes fatigue, weight gain, cold intolerance, bradycardia, and delayed relaxation of deep tendon reflexes; screen with TSH and confirm with free T4.

NSAID mechanism and risks

NSAIDs inhibit cyclooxygenase and reduce prostaglandin synthesis; risks include GI ulceration, renal impairment, and cardiovascular events, so they are avoided in CKD and with anticoagulants when possible.

Allopurinol HLA-B*5801

Screen for HLA-B*5801 in high-risk populations such as Han Chinese, Korean, and Thai patients before starting allopurinol, because the allele predicts severe cutaneous adverse reactions.

Corticosteroid injection risks

Local corticosteroid injections relieve plantar fasciitis and tendinopathy short term but risk tendon rupture, skin atrophy, and infection; injections should be limited in frequency.

Informed consent elements

Valid informed consent requires diagnosis, nature and purpose of treatment, risks and benefits, alternatives, and consequences of refusal, given by a patient with decision-making capacity.

HIPAA confidentiality exceptions

HIPAA permits disclosure without authorization for mandated reporting, serious threats to identifiable persons, and certain public health or legal requirements; otherwise patient authorization is needed.

Upcoding and unbundling

Upcoding bills a higher service level than documented, and unbundling bills components of a single procedure separately; both are fraudulent and violate billing compliance rules.

Teach-back method

Teach-back asks the patient to restate the plan in their own words; it confirms comprehension, reveals gaps, and improves adherence, especially for patients with low health literacy.

SPIKES framework

SPIKES guides breaking bad news: Setting, Perception, Invitation, Knowledge, Empathy, and Strategy or summary; it structures the conversation and supports the patient.

Motivational interviewing OARS

OARS stands for Open questions, Affirmations, Reflections, and Summaries; these core skills explore ambivalence and support behavior change such as smoking cessation.

NURSE empathic statements

NURSE stands for Name, Understand, Respect, Support, and Explore; these empathic responses acknowledge emotion before further information is provided in difficult conversations.

Duplex ultrasound indications

Duplex ultrasound is first-line for suspected deep vein thrombosis and for evaluating lower-extremity arterial stenosis; it is noninvasive and avoids iodinated contrast and ionizing radiation.