Clinical Medicine Vocab and Concepts Exam II

Question 1

Seven Attributes of a Symptom

Answer 1

Location, Quality, Quantity or Severity, Timing, Setting in which it Occurs, Remitting or Exacerbating factors, Associated manifestations

Question 2

Tinnitus

Answer 2

Ringing in the ears, typically associated with high frequency hearing loss

Question 3

Common or Concerning Symptoms

Answer 3

Headache, Change in vision, Double vision, Hearing loss, earache, tinnitus

Question 4

Head Trauma height for level 1 trauma

Answer 4

if they are at their height or higher

Question 5

Retrograde

Answer 5

After

Question 6

Anterograde

Answer 6

Before

Question 7

Concussion

Answer 7

Disturbance in brain function caused by a direct or indirect force to the head.

• You do not have to be “knocked out” to have a concussion
• symptoms: headache, unsteadiness, impaired brain function or confusion, abnormal behavior

Question 8

Classic Migraine

Answer 8

• Unilateral in 70%
• Pulsating or throbbing
• Hours to days
• Female
• Nausea/Vomiting: very common
• Missing meals, menses, BCP (Birth Control Pills) stress, certain foods: all these can serve as a trigger

Question 9

Cluster

Answer 9

rare but has classical characteristics; most misdiagnosed type of headache; specific treatment - dramatic improvement in symptoms
-adulthood, unilateral, 1/2 to 2 hours, Intense burning, searing, knife-like, several nights for several days then gone, males, increased tearing/nasal discharge (almost always unilateral)

Question 10

Tension

Answer 10

Adulthood, Unilateral or bilateral (if unilateral, do not automatically think classic migraine, hours to days, Anytime, bandlike or constricting
-No prodrome - “tip off” to the patient that they are going to get a headache (vision changes, smells, sensations, classic migraines typically have a prodrome

Question 11

Medication Rebound

Answer 11

Diffuse, hours, hours or days of last dose, dull or throbbing, daily analgesics, abrupt analgesic stop

Question 12

Hyperparathyroidism

Answer 12

“Speed up”; the following symptoms often do not begin at the same time
-nervousness, weight loss, excessive sweating, heat intolerance, Warm, smooth, moist skin, Graves’ disease, tachycardia

Question 13

Hypothyroidism

Answer 13

“Slow down”

• Fatigue, lethargy, Modest weight gain, Dry, coarse skin, cold intolerance, swelling in the face, hands, and legs; Bradycardia, Impaired memory
• Thyroid dysfunctions are the most common misdiagnosis; same symptoms that accompany other diseases as well.

Question 14

Head Circuference

Answer 14

measured from Birth to 24 months

measure more than once - double check values

Question 15

Infant head statistics

Answer 15

Head is 1/4 of body length at birth (1/8 for adult)

Head is 1/3 of body weight at birth (1/10 for adult)

Question 16

Sutures

Answer 16

membranous tissue spaces that separate bones

Question 17

Fontanelles

Answer 17

Areas where sutures intersect

Question 18

Anterior Fontanelle

Answer 18

closes around 18 months (range 9-24 months)

measures 4-6 cm at birth

Question 19

Posterior Fontanelle

Answer 19

closes around 2 months

Question 20

What do Fontanelles measure

Answer 20

ICP - increase ICP causes bulging (seen with coughing, crying, vomiting)
dehydration causes sunken fontanelle

Question 21

Microcephaly

Answer 21

“small head” - less than the 3rd percentile
measure and remeasure
Could be caused by infections, hemorrhages, alcohol use

Question 22

Microencephaly

Answer 22

Brain is not growing

Question 23

Hydrocephalus

Answer 23

Increased ICP from deficient spinal fluid circulation (or excess production)

• causes enlargement of the calvarium before the sutures are closed
• if the head has gotten bigger, worry about hydrocephalus

Question 24

Overlapping sutures

Answer 24

causes a ridge along the head, may decrease in size of the anterior fontanelle
-feel a ridge at birth; during vaginal deliver, the head gets squished together and sutures overlap; over a few days, the sutures move

Question 25

Molding

Answer 25

the re-positioning of the cranial bones to allow passage of the baby through the birth canal - Cone head - elongated head - Seen with vaginal delivery

Question 26

Caput Succedaneum

Answer 26

subcutaneous edema over the presenting part of the head at delivery - scalp edema, not worrisome - It usually occurs over the occipitoparietal area and crosses suture lines - transluminates

Question 27

Cephalhematoma

Answer 27

1. Subperiosteal collection of blood a. Not edema, it is blood! And it is stuck. b. Caused by “trauma” of vaginal delivery, shearing of blood vessels 2. Does not cross over suture lines 3. It is commonly found in the parietal region 4. Does not transluminate 5. May not be obvious at birth a. Because they may be overlapping caput succedaneum takes 10-14 days to resolve

Question 28

Plagiocephaly

Answer 28

1. Occurs when an infant lies on one side constantly a. Subsequent flattening b. Misshapen head, no ridging c. No change in head size, simply misshapen 2. May cause some facial asymmetry as well 3. Treated in most cases with parental education and different holding patterns, placing objects of interest opposite normal head rotation a. And tummy time 4. Self resolves with age and more upright, active babies

Question 29

Craniosynostosis

Answer 29

1. Premature closure of sutures, can cause asymmetry as well a. Asymmetry in the line of the suture b. Different than plagiocephaly 2. Early closure of fontanelles 3. Brachycephaly: premature closure of coronal suture a. Children typically need surgical procedure to fix this

Question 30

1. You are seeing a 4 week old for a cold and mother notes that the baby turns his head only to the right and seems to have a misshaped head. Exam: fontanelles are open and soft, the head has a flattening in the posterior right occipitoparietal area. Neck is rotated left, side bent right.

Answer 30

Congenital muscular torticollis 1. Injury and possible bleed into sternocleidomastoid muscle at birth (shortens the muscle) 2. Treatment with stretching exercises (physical therapy) 3. You are now equipped to diagnose this condition!

Question 31

Pulling ear for Adult

Answer 31

up and out

Question 32

Pulling ear for Child

Answer 32

Down and out