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PCM II > exam 2 > Flashcards

exam 2 Flashcards

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1
Q

geriatric HEENT

A 
temporal arteritis
decreased lens accomadation
presbycusis
poor dentition/false teeth
decreased olfaction
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2
Q

geriatric chest and lung exam

A

kyphotic changes -> decreased lung capacity

increased risk of breast cancer

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3
Q

geriatric CV exam

A

thrills and bruis

murmurs much more prevalent after 80

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4
Q

geriatric abdominal exam

A

compression fractures -> altered contour
often present atypical/asymptomatic
perforation, ischemia, inflammation, bleeding

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5
Q

geriatric GU exam

A

prostatic hypertrophy
vaginal and labial atrophy
squamous cell cancer
vaginal bleeding

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6
Q

geriatric MSK exam

A

deformities related to arthritis

compression fractions and kyphosis

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7
Q

geriatric neuro exam

A

olfaction
cognition
gag/speech- aspiration
gait

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8
Q

focus of geriatric care

A

reduce nursing home placement
reduce hospitalization
quality vs quantity of life (what are the patients goals of care)
socio-econoic issues

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9
Q

falls H&P

A 
full Hx including meds
lower extremity weakness
gait and and balance
vision
arthritis
pain
neuro exam
CV exam
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10
Q

Falls- lab tests

A

CBC, blood chem, EKG, HbAC1, holter monitor, Vit D

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11
Q

falls- treatment

A

PT and OT
medication review (reduce)
pacemaker
treat underlying conditions

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12
Q

urinary incontinence

A 
more common in females
types:
-stress
-urge
-overflow
-functional
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13
Q

evaluation of urinary incontinence

A

fnx alertness, CHF, abdominal, genital exams
CBC, U/A, blood sugar, imagins, culture
post void residual

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14
Q

causes of urinary incontinence

A 
DIAPERS
drugs
infection
atrophic vaginitis
psychiatric
endocrine
restricted mobility
stool impaction
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15
Q

urge incontinence

A

bladder training/toilet schedule
medication- anticholinergic for detrusor stability
reduce/eliminate caffeine
treat underlying infection

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16
Q

stress incontinence

A

kegels
meds- estrogen? alpah adrenergic agonists
surgery- urethropexy or pubovaginal sligns
pessary- uteriine prolapse

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17
Q

overflow incontinece

A 
important to treat for preservation of renal fnx
post void residual volume elevated
fecal impaction
prostatic enlargement 
meds- finasteride, alpha adrenergic antagonists
treatment w/augments voiding maneuvers:
-suprapubic pressure
-valsalva maneuver
-intermittent catheterization
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18
Q

causes of constipation

A

meds- opiates, anticholinergics, antidopaminergics, CaCh blockers
mechanical obstruction- tumor, prolapse, adhesions
neuro- CVA, MS
systemic- hypothyroid, diabetes, inflammation, electrolyte disorders
dehydration and inactivity

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19
Q

constipation H&P

A 
meds, fluid intake, disease Hx
Abdominal distention and pain
rectal exam- tone, impacted stool, hemorrhoids, stricutes, or fissures
neuro exam (rectal tone)
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20
Q

constipation tests

A

electrolytes, BUN, creatinine, TSH, Ca
colonoscopy
ab Xray
CT

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21
Q

contipation treatment

A 
bulk laxatives (don't use w/opiate induced)
osmotic agents
enemas
stool softener
hydration
maintaing physical activity
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22
Q

pressure ulcers

A

ischemic soft tissue injury usually over a boney prominence
risk factors- immobility, poor nutrition, incontinence, vascular insufficiency, altered level of consciousness
braden scale to access risk

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23
Q

treatment of pressure ulcers

A

prevention- pressure relieving devices/mattresses, turning and barrier creams, reduce moisture
antibiotics, bandages

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24
Q

cognitive impairment

A

benign senescent forgetfulness

dementia

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25
deression
inadequate finances, loss of spouse/children, fnxal decline widely under recognized due to its non-specific presentation pseudo-dementia
26
sensory impairment
``` increased safety risks olfaction -> spoiled food vision loss hearing loss -> isolation, frustration decreased thirst perception ```
27
dementia
``` presents as slow progressive disease impaired memory and learning behavior and personality changes hallucinations safety -> wondering, high risk for injury ```
28
causes of dementia
``` B-12 deficiency normal pressure hydrocephalus neurosyphillis hypothyroidism seizure disorder ```
29
types of dementia
``` multi-infarct (vascular) lewy body alcoholic parkinsons disease alzheimers pseudo-dementia (depression) picks disease ```
30
dementia H&P
meds and substance Hx living and safety arrangements basic activities of daily living (ADLs) instrumental activities of daily living (IADLs) aka executive fnxs weight loss, missed appointment, inappropriate phone calls, repeatedly wearing same clothes, driving MMSE, GDS
31
management of dementia
``` rule out reversible cause cholinesterase inhibitors and/or NMDA receptor antagonists antidepressents structured day simple calm direct communication reorientation realistic goals attention to safety agitated or agreeive restraints ```
32
polypharmacy
greater than 5 meds drug interactions med errors altered pharmacodynamics and kinetics
33
components of mental status exam
``` appearance and behavior affect/mood language/speech thoughts/perceptions cognitive/executive ```
34
lethargic
awake, but tending to fall asleep w/out gentle stimulation
35
stuporous
falling asleep unless vigorously stimulated
36
comatose
a sleep like stance from which the patient cannot be awakened
37
anomia
cannot name common objects
38
dysphasia
impairment in use of speech
39
dysarthria
imperfect articulation due to lack of motor coordination
40
apraxia
inability to turn verbal command into motor performance
41
thoughts/perceptions
process content insight judgement
42
process
coherence
43
content
phobias, anxieties, obsessions, delusions
44
insight
ability to understand own problem
45
judgement
appropriate decisions/actions
46
cognative
orientation attention memory
47
executive
abstract thinking/insight calculation constructional ability
48
orientation
person, place, time
49
testing insight
proverbs situational questions similarities
50
mini mental exam status
23-30 normal 19-23 borderline <19 impaired
51
cerebellar testing
gait heel to knee and slide down shin rhomberg/pronator drift
52
rhomberg
stand with feet close and close eyes | PCML test
53
pronator drft
contralateral corticospinal tract
54
pupillary reflex
II and III
55
esotropia
medial deviation
56
exotropia
lateral deviation
57
IV
moves eye down and out
58
gag reflex
sensory- IX | motor- X
59
3 layers of skin
epidermis dermis sub Q
60
phases of hair
catagen phase- transitional 3% telogen phase- resting phase 10-15% anagen- growing phase- 85-90%
61
clubbing of nails
rounding, soft, spongy | congenital, chronic hypoxia, heart disease, lung cancer, hepatic cirrhosis
62
psoriasis of nails
small pits thick nail
63
mee's lines
change in color due to acute or chronic illness
64
beau's lines
actual depression in nail due to chronic or acute illness
65
brown skin
melanin
66
yellow skin
carotene, bilirubin
67
red skin
carboxyhemoglobin, polycythemia
68
blueish-red skin
deoxyhemoglobin
69
things to check on skin exam
moisture temp texture mobility and turgor
70
tinea
groin and feet
71
lues
aka syphilis | hands
72
macule
circumscribed change in color flush w/surrounding skin lesion <1 cm
73
examples of macule
solar lentigo | traumatic purpura
74
patch
circumcised change in skin color flush with w/surrounding skin lesion > 1cm
75
patch examples
cafe au lait spot | vitiligo
76
papule
solid or cystic elevation | < 1cm
77
examples of papule
acne | eruptive xanthoma
78
nodule
solid or cystic elevation | >1 cm < 2cm
79
examples of nodule
dermatofibroma
80
tumor
a solid or cystic elevation | >2 cm
81
tumor example
follicular cyst
82
plaque
an elevated lesion | >1cm
83
examples of plaque
psoriasis
84
scale
desiccated, thin plates of cornified epidermal cells that form flakes on skin surface
85
examples of scale
ichthyosis
86
wheal
circumscribed elevated lesion containing clear serous or hemorrhagic fluid red, blanche w/pressure < 1 cm
87
examples of wheal
contact dermatitis | herpes simplex
88
bulla
circumscribed elevated lesion containing clear serous or hemorrhagic fluid > 2cm
89
examples of bulla
bullous pemphigoid
90
atrophy
a depression from surface of skin w/loss of all or part of epidermis or dermal substance
91
atrophy example
lichen sclerosis et atrophic
92
erosion
a depression from the surface of skin w/loss of all or part of epidermis can be secondary lesion
93
ulcerations
a depression from the surface of the skin w/loss of entire epi and at least some of dermis can be secondary lesion
94
examples of erosion
burn | ruptured bulla
95
examples of ulceration
ecthyma | excoriation of acne papule
96
lichenifcation
seconday | dry leathery thick skin w/exaggerated skin markings
97
lichenification example
chronic eczema
98
scar
secondary | elevated or depressed area of fibrosis of dermis or sub Q tissue resulting from an antecedent destructive process
99
fissure
secondary | a deep linear split in skin extending thru epi
100
crust
dried exudates of serum, blood, sebrum, or purulent material on surface of skin
101
examples of fissure
traumatized eczema
102
examples of crust
acute and or secondarily infected eczema
103
ABCDE
``` A- asymmetry B- border irregular C- variation or change in color, especially blue or black D- diameter > 6mm E- elevation ```
104
basal cell carcinoma
pearl white | rodent ulcer
105
geographic
mycosis fungoides
106
serpiginous
tinea corporis
107
annular
tinea faciale
108
heliotrope
over and around eyelids
109
staph
linear
110
strep
clumping
111
herpes
multinucleated giant cells
112
hyperopia
farsightedness, can't see up close
113
myopia
nearsightedness, can't see far away
114
presbyopia
aging vision, progressive difficulty seeing near objects
115
heterophoria
failure of visual exes to remain parallel
116
esophoria
deviates medially
117
exophoria
deviates outward
118
blepharitis
inflamed lid margins
119
entropion
eyelids turn inward
120
ectropion
eyelids turn outward
121
osterogenesis imperfecta
blue sclera, hypocalcemic
122
anisocoria
unequal pupils greater then .5mm
123
pinguecula
small nodule on bulbar conjunctiva, does not cross over to cornea
124
pterygium
thickening of bulbar conjuctiva which grows across cornea
125
sty
infection at margin of eyelid
126
chlazion
painless nodule involving meiobomian gland
127
xantehlasma
flat yellow plaques found under eye | associated w/hyperlipidemias
128
subconjuctivial hemorrhage
leakage of blood under conjuctiva painless sharply demarcated resolves on own
129
ciliary injection
inflammation of radiating vessesl around limbus | emergency
130
hyphema
blood in ant chamber, trauma
131
galcomatous cupping
increased IOP causes increases disc cupping | physiologic cup more then half disc diameter
132
cotton wool patches
infarcted n fibers
133
brachioradialis
C5-6
134
biceps
C5-6
135
Triceps
C5-7
136
patellar
L2,3,4
137
Achilles
S1
138
PNS disorders
``` polio, amyotrophic lateral sclerosis (ALS) herniated disc carpel tunnel, bells palsy diabetes, alcoholic neuropathy myesthenia gravis muscular dystrophy ```
139
anterior horn cell
polio, ALS fasiculations and weakness in segemental pattern sensation intact weak DTR
140
spinal n roots
herniated dsic dermatomal sensory changes weakness -> atrophy weak DTR
141
peripherhal mononeuropathy
carpel tunnel, bells palsy weakness and sensor loss in peripheral n distribution weak DTR
142
peripheral mononeuropathy
diabetes, alcoholic neuropathy weakness and sensory loss in stocking glove distribution weak DTR
143
neuromuscular jnx
myasthenia gravis mm fatigability sensation intact DTR intact
144
muscle
muscular dystrophy weakness primarily in prox mm sensation intact DTR intact or possibly decreased
145
upper brachial plexus injury
waiters tip
146
median n
damage in C6-T1 ape hand resisting pronation reproducing symptoms
147
ulnar n
damage in C6-8 region | claw hand
148
radial n
wrist drop

PCM II (2 decks)

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