Assessment, Diagnostic Testing, Interpretation Flashcards
12% of exam, ~21 questions 1. Health History & Physical Exam 2. Diagnostic/Lab Studies 3. Imaging (168 cards)
1
Q
Define: chief concern
A
client’s own brief statement in their words for seeking care
2
Q
Define: HPI
A
chronological account of problems for which client is seeking care
3
Q
Pain dimension mnemonic
A
OLD-CARTS
onset, location duration, characteristics, aggravating/associated factors, relieving factors, temporal factors, severity
4
Q
Adolescent psychosocial mnemonic
A
HEADSS
home, education, activities, drugs, sex, suicide
5
Q
Define: gravidity
A
total # of pregnancies, regardless of outcome
6
Q
Define: parity
A
total # of pregnancies reaching 20 weeks or beyond
7
Q
OB history mnemonic
A
GTPAL
gravida, term, preterm, abortion, living children
8
Q
Patient risks can be related to (9)
A
age, gender, ethnic/racial background, family hx, environmental exposures, military service, lifestyle, geographic area, preventive healthcare adequacy
9
Q
Problem-oriented medical record mnemonic for notes
A
SOAP Subjective Objective Assessment Plan
10
Q
Subjective information
A
information obtained during history. Use ‘reports,’ ‘endorses,’ ‘describes,’ instead of ‘complains of.’
11
Q
Objective information
A
information obtained through physical exam and lab/diagnostic tests
12
Q
Assessment information
A
determination of diagnosis w/ rationale, or prioritized differential diagnosis, using subjective and objective info.
13
Q
Plan information
A
information about diagnostic tests, therapeutic treatment regimen, client education, referrals, and date of reevaluation.
14
Q
Order of exam techniques
abdomen alternative
A
inspection, palpation, percussion, auscultation
inspection, auscultation, percussion, palpation
15
Q
Diaphragm of stethascope is used to hear…
A
high pitched sounds (S1, S2 heart sounds)
16
Q
Bell of stethoscope is used to hear…
A
low pitched sounds (large blood vessels)
17
Q
percussion: Tympany
A
loud, high-pitched drum-like sound (gastic bubbles, gas-filled bowel)
18
Q
Hyperresonance
A
very loud, low-pitched, boom-like sound (lungs with emphysema)
19
Q
Resonance
A
loud, low-pitched, hollow sound (healthy lungs)
20
Q
percussion: dull
A
soft to moderate, moderate-pitched, thud-like sound (liver, heart)
21
Q
Flat
A
soft, high-pitched sound, very dull (muscle, bone)
22
Q
Depth of light palpation, and what you are looking for
A
1 cm
muscle resistance, tenderness, large masses, distention
23
Q
Depth of deep palpation, and what you are looking for
A
4 cm
delineate organs, ID less obvious masses
24
Q
BMI ranges
A
< 18.5: underweight 18.5 - 24.9: normal 25.0 - 29.9: overweight 30.0 - 39.9: obesity 40+ : extreme obesity
25
Waist circumference can serve as a risk predictor for which diseases in which BMI range?
DMT2, dyslipidemia, hypertension, CVD
| 25 - 39.9
26
Waist circumference of how much is an increased relative risk?
> 35 inches
27
Types of primary skin lesions (5)
macule, papule, pustule, vesicle, wheal
28
Types of secondary skin lesions (4)
ulcer, fissure, crust, scar
29
Malignant melanoma mnemonic
ABCDE
| asymmetry, borders irregular, color blue/black or variegated, diameter > 6mm, elevation
30
Normal findings of lymph nodes
< 1 cm, nontender, mobile, soft, discrete
31
Normal conjunctiva
clear
32
Normal sclera
white/buff colored
33
Normal pupil mnemonic
PERRLA
| pupils equal, round, reactive to light, and accommodate
34
Increased tactile fremitus could be...
lobar pneumonia, pulmonary edema
35
Decreased tactile fremitus could be...
emphysema, asthma pleural effusion
36
Normal sound of percussed lung fields
resonance
37
Normal sound of auscultated lungs
vesicular/bronchovesicular
38
Normal transmitted voice sounds
muffled/indistinct
39
What could bronchophony, egophony, whispered pectoriloquy indicate?
fluid or solid mass in lungs
40
Adventitious breath sound types (4)
crackles, ronchi, wheezes, pleural friction rub
41
What causes crackles?
air flowing by fluid (pneumonia, bronchitis, early HF)
42
What causes ronchi?
air passing over solid or thick secretions in large airways (pneumonia, bronchitis)
43
What causes wheezes?
air flowing through constrictions (asthma, chronic emphysema)
44
What causes pleural friction rub?
Inflamed pleural tissue (pleuritis, pericarditis)
45
What is S1? Where is it best heard?
occurs at start of systole
| apex
46
What is S2? Where is it best heard
occurs at start of diastole
| base
47
Fixed split S2 could indicate...
atrial septal defect, RVF (delayed closure of pulmonic valve)
48
Increased S3 could indicate...
also called ventricular gallop
normal in young adults and late pregnancy
decreased myocardial contractility, HF, volume overload (rapid ventricular filling)
49
Increased S4 could indicate...
also called atrial gallop
normal in well-trained athletes and older adults
aortic stenosis, hypertensive heart disease, cardiomyopathy (forceful arterial ejection into distended ventricle)
50
Physiologic murmur...
normal finding, common in pregnancy
51
Murmur of mitral stenosis caused by...
narrowed mitral valve that restricts forward flow, causes forceful ejection into ventricle
52
Systolic click could indicate...
mitral valve prolapse
53
Pericardial friction rub (heart sound) could indicate...
pericarditis
54
Palpating the liver...
should not extend more than 2 cm beyond right costal margin
55
Palpating spleen and kidneys...
normally should not be able to
56
Typical percussive sound of abdomen
tympany, dullness over organs/masses
57
Tenderness at McBurney's (RLQ) point could indicate...
appendicitis
58
Guarding, rigidity, rebound tenderness in abdomen could indicate...
peritonitis
59
What is Rovsig's sign?
pain in RLQ when left-sided pressure is applied and then quickly withdrawn
referred rebound tenderness
60
+ R psoas/obturator signs could indicate...
appendicitis
61
What is Murphy's sign? What can it indicate?
sharp increase in tenderness and sudden stop in inspiratory effort with upward pressure under the R costal margin while patient takes a deep breath
cholecystitis
62
CN I
olfactory (smell)
63
CN II
optic (vision)
64
CN III
ocularmotor (PERRLA)
65
CN IV
trochlear (PERRLA)
66
CN VI
abducens (PERRLA)
67
CN V
trigeminal (sharp/dull/light touch on face)
68
CN VII
facial (smile)
69
CN VIII
acoustic (auditory acuity)
70
CN IX
glossopharyngeal (swalow)
71
CN X
vagus ("Ah")
72
CN XI
spinal accessory (traps)
73
CN XII
hypoglossal (tongue)
74
Normal size of clitoris
no more than 2 cm by 0.5 cm
75
Normal size of cervix
2.5 cm diameter
76
Normal size of uterus
5.5 cm - 8 cm
| could be 2-3 cm larger in parous patient
77
Normal ovary size
3 cm by 2 cm by 1 cm
78
Components of CBC w/ diff
RBC, Hct/Hgb, RBC indices (MCV, MCH, MCHC), WBC, peripheral blood smear
79
Define w/ normal range: RBC
red blood cell (RBCs per cubic mm of blood)
| 4.2 - 5.4 million/cubic mm
80
Define w/ normal range: Hct
hematocrit (percentage of total blood volume that is made up of RBCs)
nonpregnant: 37 - 47%
pregnant:
1st & 3rd trimester: 33% or more; 31% or more for black patients
2nd trimester: 32% or more; 30% or more for black patients
81
Define w/ normal range: Hgb
hemoglobin (measurement of total hemoglobin [which carries oxygen] in the blood)
nonpregnant: 12 - 16 g/dL
1st & 3rd trimester: 11 g/dL or more; 10.2 g/dL or more for black patients
2nd trimester: 10.5 g/dL or more; 9.5 g/dL or more for black patients
82
Define w/ normal range: MCV
mean corpuscular volume (average volume/size of a single RBC)
80 - 95
83
Microcytic anemias
Fe-deficiency and thalassemia
84
Macrocytic anemias
Vit B-deficiency and folic acid-deficiency (megaloblastic)
85
Define w/ normal range: MCH
mean corpuscular hemoglobin (average amount/weight of Hgb within an RBC)
27 - 31 pg/cell
86
Define w/ normal range: MCHC
mean corpsucular hemoglobin concentration (average concentration/percentage of Hgb within a single RBC)
32 - 36 g/dL
87
decreased MCHC and associated anemias
hypochromic
| Fe-deficiency and thalassemia
88
Define w/ normal range: WBC
white blood cell count
| 5000 - 10000/cubic mm
89
components/breakdown/high value associations of WBC w/ diff (5)
neutrophils 30 - 70% (bacterial infx, inflammation, 'left shift')
basophils 0 - 3% (hypersensitivity rx)
eosinophils 0 - 5% (allergic rx)
lymphocytes 15 - 40% (viral infx, chronic bacterial infx/inflammation)
monocytes 2 - 8% (recovery phase of infx, chronic infx)
90
What does a peripheral blood smear look at?
microscopic examination of RBCs, platelets, leukocytes
91
Components of blood clotting studies (4)
platelet count
prothrombin time (PT)
partial thromboplastin time (PTT)
coagulation factors
92
Define w/ normal range: platelets
150000 - 400000/cubic mm
93
Components of CMP (13)
glucose, albumin, total protein, sodium, potassium, CO2, chloride, BUN, creatinine, ALP, ALT, AST, bilirubin
94
Define w/ normal range: fasting glucose
8 hours fasting
normal: < 100 mg/dL
impaired fasting: 100 - 125 mg/dL
diagnostic for DM: 126 mg/dL or greater
95
Define w/ normal range: OGTT (2 hr postload 75g glucose)
2 hours after 75 g glucose
normal: <140 mg/dL
impaired tolerance: 140 - 199 mg/dL
diagnostic for DM: 200mg/dL or greater
96
Define w/ normal range: HbA1c
```
measures glycemic control over 60 - 90 days
normal: <5.7%
prediabetes: 5.7 - 6.4%
diabetes: >6.5%
good control in a diabetic is <7%
```
97
components of lipid profile (4)
total, triglycerides, HDL, LDL
98
Define w/ normal range: total cholesterol
normal: 200 mg/dL
| can be elevated in pregnancy
99
Define w/ normal range: triglycerides
35 - 135 mg/dL
| can be elevated in pregnancy
100
Define w/ normal range: HDL
>40 mg/dL
101
Define w/ normal range: LDL
<130 mg/dL
102
Define w/ normal range: TSH
0.4 - 4.12 mU/mL
| upper limit during pregnancy: 2.5 - 3.5 mU/mL
103
Define w/ normal range: free T4
0.58 - 1.64 ng/dL
104
Define w/ normal range: total T4
4.5 - 12.0 micrograms/dL
| measurement can be affected by increased TBG (pregnancy)
105
What could a positive antithyroid peroxidase antibody test (anti-TPO) indicate?
Grave's, Hashimoto's
106
Define w/ normal range: bilirubin
0.3 - 1.0 mg/dL
direct/conjugated: 0.1 - 0.3 mg/dL
indirect/unconjugated: 0.2-0.8 mg/dL
107
What can a protein/creatinine ratio tell us? What is it?
kidney damage/disease, preeclampsia, diabetes
| random urine sample
108
Fecal occult blood testing: positive test can indicate
GI cx, polyps, PUD, IBD, trauma, GI bleed
109
How does blood type/Rh factor testing work?
Looking for antigens A, B, Rh on RBCs
0- is universal donor because ot has no antigens
AB+ is universal receiver because it will have no antiBODIES to react to transfused blood
110
What does screening for sickle cell look like?
+ test (presence of Hgb S indicates disease or trait)
| refer for Hgb electrophoresis to identify Hgb type and amount
111
Causes of increased estradiol (4)
adrenal tumor, estrogen-producing tumor, hepatic cirrhosis, hyperthyroidism
112
Causes of decreased estradiol (5)
postmenopausal, ovarian failure, hypogonadism, Turner's, anorexia nervosa
113
Causes of increased progesterone (5)
pregnancy, ovulation, progesterone-secreting tumor or cyst of ovary, congenital adrenal hyperplasia, hydatiform mole
114
Causes of decreased progesterone (5)
hypogonadism, threatened abortion, fetal demise, preeclampsia, short luteal phase syndrome
115
Causes of increased FSH (5)
postmenopause, gonadatropin-secreting pituitary tumor, ovarian failure, primary hypogonadism, Turner's
116
Causes of decreased FSH (4)
pregnancy, pituitary or hypothalamic dysfx, hyperprolactinemia, anorexia nervosa
117
Causes of increased LH (3)
postmenopause, primary hypogonadism, gonadal failure
118
Causes of decreased LH (2)
pituitary or hypothalamic dysfx, anorexia nervosa
119
Components of UA (14)
appearance, color, odor, pH, protein, specific gravity, leukocyte esterase, nitrites, ketones, crystals, casts, glucose, WBCs, RBCs
120
Define w/ normal range: UA pH
4.6 - 8
121
Define w/ normal range: UA protein
0 - 8 mg/dL
122
Define w/ normal range: UA SG
1.005 - 1.030
123
Define w/ normal range: UA WBCs
0 - 4 per HPF
124
Define w/ normal range: UA RBCs
2 or less
125
What should be negative on a UA? (6)
nitrites, ketones, crystals, casts, glucose, leukocyte esterase
126
Positive urine culture indicates
UTI
127
Positive urine culture is typically defined as
100000 CFU/mL of single type of bacteria
OR
1000 CFU/mL with symptoms of UTI
128
Normal vaginal pH
3.8 - 4.5
129
BV clinical/microscopy findings (5)
```
pH > 4.5
+ whiff test
> 20% of epithelial cells are clue cells
0 - 1 WBCs per epithelial cell
lactobacillus reduced or absent
```
130
Trich clinical/microscopy findings (5)
```
pH > 4.5
+/- whiff test
motile trichomonads
> 1 WBC per epithelial cell
lactobacillus reduced or absent
```
131
Yeast clinical/microscopy findings
```
PH = 4.5
- whiff test
hyphae/spores
> 1 WBC per epithelial cell
lactobacillus present
```
132
other test for trich
NAAT
133
other test for yeast
culture
134
1st screening for HIV
EIA
135
if EIA reactive for HIV, confirm with?
western blot or IFA
136
test for Gonorrhea
NAAT
137
test for Chlamydia
NAAT
138
test for syph
```
Nontreponemal tests (VDRL or RPR): reactive or nonreactive
Treponemal tests (FTA-ABS, TPI): positive or negative
```
139
test for HSV
PCR assay or tissue culture
| serologic tests differentiate between HSV-1 and HSV-2
140
IgM antibodies typically indicate
active infx
141
IgG antibodies typically indicate
previous infection and current protection from another primary infx
142
CMV test is
an antibody test
143
Toxo test is
an antibody test
144
Hep C test is
an antibody assay, followed if reactive with RNA test to determine if current infection or past resolved infection
145
Hep B test is
a lot of stuff that you can find on page 22 if you care
146
Rapid strep test tells us
if pharyngitis is caused by group a beta hemolytic streptococci (GABHS)
it's positive or negative (viral if negative)
147
When would we get a throat culture?
If you're considering other pathogens for pharyngitis
148
When would we get a skin culture?
wound that is tender, red, swollen, draining fluid/pus, slow to heal, fever
149
Types of breast biopsy
```
fine-needle aspiration
tissue biopsy (diagnostic)
```
150
Gene
basic unit of heredity passed from parents to offspring
| ~23000
151
Chromosome
live in nucleus
46
22 pairs are autosomes
1 pair is sex chromosomes
152
Karyotype
an individual's collection of chromosomes
153
Gene mutation
change in the DNA sequence
154
Types of gene mutations
somatic: acquired
| germ cell: inherited
155
Genetic marker
DNA sequence with a known physical location on a chromosome
156
Autosomal dominant and examples
only one copy of gene in each cell is needed
one affected parent
50% chance of inheriting
examples: Huntington, BRCA1/2, Lynch
157
Autosomal recessive and examples
2 copies of gene needed
parents usually unaffected (carriers only)
50% chance of carrying, 25% chance of having disease
examples: CF, SS anemia
158
X-linked dominant and example
```
genes on X-chromosome are mutated
females more frequently affected
fathers can't pass trait to sons
if mother is affected, 50% chance of inheriting disorder for both M and F offspring
fragile x syndrome
```
159
X-linked recessive and example
genes on X-chromosome are mutated
males more frequently affected
fathers can't pass trait to sons
F offspring need to inherit affected X from both parents
M offspring need to only inherit the affect X from mother
hemophilia
160
Pelvic US used to (7)
distinguish between solid and cystic pelvic masses
confirm viability/location of products of conception
determine endometrial thickness
evaluate size/location of uterine myomas
evaluate adnexal masses/fullness
evaluate fetal growth
detect fetal anomalies/abnormalities
161
Types of pelvic US
transabdominal (full bladder)
| transvaginal (empty bladder) better resolution
162
Mammography used to
detect cancerous, precancerous, benign lesions
| screening and diagnostic
163
Types of mammography
digital, conventional film, 3D/tomosynthesis
164
Mammography findings standardized by
BI-RADS (0-5)
165
Breast US is used to
diagnose in adjunct w/ mammogram
not a screening tool
differentiated between cystic and solid masses
can be a guide for localized procedures
166
Bone densitometry/bone density testing used for
screening, diagnosis, and monitoring treatment for osteopenia and osteoporosis
167
What is the T-score based on?
comparing bone density in post-menopausal women to young adult female reference population
168
T-scoring ranges
normal: > -1
osteopenia: -1 to -2.5
osteoporosis: @ or < -2.5
