COMLEX Level 3 flashcards

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

Somatic dysfunction definition

Impaired or altered function of related components of the somatic system (skeletal, arthrodial, myofascial) diagnosed by TART: tissue texture change, asymmetry, restriction of motion, and tenderness.

Direct versus indirect technique

Direct technique engages the restrictive barrier and moves toward it (HVLA, muscle energy). Indirect technique moves the region away from the barrier into ease (counterstrain, functional, balanced ligamentous tension).

HVLA contraindications

Avoid high-velocity low-amplitude thrust with osteomyelitis, metastatic bone disease, fracture, severe osteoporosis, and unstable cervical spine. Caution with anticoagulation and conditions causing atlantoaxial instability such as Down syndrome.

Counterstrain technique parameters

Position the tender point into a position of ease until tenderness decreases at least 70 percent, hold about 90 seconds, then slowly return to neutral and reassess the point.

Lymphatic pump contraindications

Avoid lymphatic pump techniques in acute infection with fever, deep vein thrombosis, and decompensated heart failure, because they increase venous and lymphatic return to the central circulation.

Cranial rhythmic impulse rate

The primary respiratory mechanism is described as having a normal cranial rhythmic impulse of approximately 10 to 14 cycles per minute in adults, assessed by trained palpation.

Suture removal timing

Typical removal: face 4 to 5 days, scalp and trunk 7 to 10 days, extremities 10 to 14 days, and over joints about 14 days. Prolong when healing is impaired.

Septic joint synovial fluid

Septic synovial fluid typically shows more than 50,000 white cells per microliter with more than 75 percent neutrophils, plus positive Gram stain or culture. Avoid aspiration through overlying cellulitis.

Anaphylaxis first-line treatment

Give intramuscular epinephrine 0.3 to 0.5 mg of 1:1000 solution into the anterolateral thigh, repeating every 5 to 15 minutes. Antihistamines and steroids are adjuncts, not first-line.

Traumatic lumbar puncture findings

A traumatic tap shows red blood cell counts that decrease from tube to tube and a supernatant that clears after centrifugation, unlike subarachnoid hemorrhage with uniform blood and xanthochromia.

Adult BLS compression parameters

Deliver compressions at 100 to 120 per minute with a depth of 5 to 6 cm, using a 30:2 compression-to-ventilation ratio for a single rescuer, and keep interruptions under 10 seconds.

DKA treatment sequence

Begin isotonic fluids, start an insulin infusion once potassium is at least 3.3 mEq/L, and add dextrose when glucose falls below roughly 200 to 250 mg/dL while continuing insulin until the gap closes.

Hyperkalemia with ECG changes

Give intravenous calcium gluconate first for membrane stabilization, then shift potassium intracellularly with insulin plus glucose and albuterol, and arrange definitive removal by dialysis if refractory.

CURB-65 components

Confusion, urea greater than 7 mmol/L, respiratory rate at least 30, low blood pressure, and age 65 or older. Higher scores predict pneumonia mortality and guide inpatient versus outpatient care.

Acute pancreatitis diagnosis

Diagnosis requires two of three: characteristic epigastric pain radiating to the back, lipase greater than three times the upper limit of normal, or imaging findings consistent with pancreatitis.

Thyroid storm treatment

Use a beta-blocker for symptoms, a thionamide such as propylthiouracil, iodine given at least one hour after the thionamide, and glucocorticoid, with supportive care for fever and volume depletion.

Stroke thrombolysis window

Intravenous alteplase may be given within 4.5 hours of last known well after noncontrast CT excludes hemorrhage. Thrombectomy is an option up to 24 hours in selected large-vessel occlusion.

Hardy-Weinberg carrier frequency

For an autosomal recessive condition, p plus q equals 1 and p squared plus 2pq plus q squared equals 1; the heterozygous carrier frequency is 2pq, where q is the disease allele frequency.

Renal clearance formula

Clearance equals urine concentration times urine flow rate divided by plasma concentration. Inulin clearance equals glomerular filtration rate, while para-aminohippurate clearance approximates renal plasma flow.

Oxygen content equation

Arterial oxygen content equals 1.34 times hemoglobin times arterial saturation plus 0.003 times arterial oxygen tension, so hemoglobin and saturation dominate delivery far more than dissolved oxygen.

Anion gap and delta-delta

Anion gap equals sodium minus chloride plus bicarbonate, normal 8 to 12 mEq/L. Delta-delta compares the rise in anion gap to the fall in bicarbonate to detect mixed metabolic disorders.

Virchow triad

The three contributors to thrombosis are venous stasis, endothelial injury, and hypercoagulability. The triad frames risk assessment for deep vein thrombosis and pulmonary embolism.

Antibiotic ribosomal targets

Aminoglycosides and tetracyclines bind the 30S subunit; macrolides, chloramphenicol, and clindamycin bind the 50S subunit. Beta-lactams inhibit cell wall transpeptidase and fluoroquinolones inhibit DNA gyrase.

Sensitivity and specificity use

Sensitivity is true positives divided by all diseased; specificity is true negatives divided by all healthy. Highly sensitive tests rule out disease (SnNout); highly specific tests rule in disease (SpPin).

Likelihood ratio calculation

Positive likelihood ratio equals sensitivity divided by one minus specificity. Negative likelihood ratio equals one minus sensitivity divided by specificity. Values above 10 or below 0.1 substantially change probability.

Number needed to treat

Number needed to treat equals one divided by the absolute risk reduction; number needed to harm equals one divided by the absolute risk increase. Lower values indicate a larger clinical effect.

SPIKES protocol

A six-step framework for breaking bad news: Setting up the conversation, assessing Perception, obtaining Invitation, giving Knowledge, addressing Emotions with empathy, and summarizing Strategy.

Teach-back method

The clinician asks the patient to restate the plan or instructions in their own words, then clarifies misunderstandings. A correct restatement confirms comprehension better than asking whether they understand.

Motivational interviewing OARS

Core skills are open-ended questions, affirmations, reflections, and summaries. The clinician rolls with resistance rather than arguing, supporting the patient's own reasons for change.

LEARN cross-cultural model

Listen to the patient's perspective, Explain your view, Acknowledge differences and similarities, Recommend a plan, and Negotiate agreement that incorporates the patient's cultural context.

HIPAA minimum necessary rule

When using or disclosing protected health information, share only the minimum needed for the purpose. Disclosures for treatment, payment, and operations generally do not require patient authorization.

Medicare Part A versus B

Part A covers inpatient hospital, skilled nursing facility, hospice, and some home health care. Part B covers outpatient services, physician visits, durable medical equipment, and preventive services.