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PD Year 1 > Final - Spring > Flashcards

Final - Spring Flashcards

1
Q

neonate =

A

bith - 28 days

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2
Q

infant defined as

A

29 days - 1 year

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3
Q

general schedule for well visits

A

48 hrs after discharge - wt & jaundice

2 weeks

1/2/4/6/9/12 months

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4
Q

terminology:

preterm

late preterm

term

post-term

wt percentile: small, appropriate, large

A

<34

34-36

37-42

>42

<10th, 10th-90th, >90th

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5
Q
A
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6
Q

APGAR

A

A - appearance - usually lose a point for blue hands and feet

P - pulse

G- grimace

A - activity

R - respiration

done @ 1 (response for dilvery) & 5 min (response to resusc effects)

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7
Q

APGAR INTERPRETATION

A
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8
Q

dev milestones

domains?

A

set of fx skills/age-related tasks that most children do @ a certain age

  1. gross motor
  2. fine motor
  3. self-help/adative
  4. cog
  5. social/emo
  6. language

stand screedning recommended @ 9mo

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9
Q

___ children have dev/behav disorder

A

15%

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10
Q

early intervention

A

state run program that eval child for dev delays: futhur screening and potential tx

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11
Q

dev milestones during infancy

A
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12
Q

immunizations for neonates

A

most important roles of ped docs

  • impt to vacc infant caregivers aga influenza and pertussis

should be reviewed @ each visit

gen starts with hep B

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13
Q

phys exam of neoname

A

exam table/open crib

  • start with inspection
  • heart and lung
  • head –> toe: ear and hips for last (b/c more irritating)
  • eye when infants eyes are spont open

older infants >6mo can be started with parent holding infant on lap/arms

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14
Q

temp should always be meas -_____ in children under age ____

A

rectal

2

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15
Q

normal VS for infants: temp, HR, RR, BP

A
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16
Q

periodic breathing

A

infants: RR may vary sig from min to min

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17
Q

growth meas of infant include

usually plotted on:

A

length

wt

head circumceference (over more prominent portion of occiput to supraorbital ridge)

**when baby is supine

plotted on WHO

  • b/c breast -fed babies usually grow faster in first 6mo than formula ones and then slow down and then they both should be similar
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18
Q

macrocephaly usually due to

A

family

hydrocephalus

genetic conditions (sotos syndrome)

tumor/mass

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19
Q

microcephaly

A

genetic

intrauterine infections (TORCH, zika)

materanal smoking/drug

family

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20
Q

erythema toxicum

A

small/white papules/pustules on red base

  • benign
  • eosinophils

occur on day 2-3, face by 7-10

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21
Q

transient pustular melanosis

A

small pustles on HYPERPIG base:

  • neutrophils
  • benign

mostly in af-am infants

resolves over 1st week but hyperpig can persist for a couple of weeks

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22
Q

miliaria rubrum

A

“prinkly heat”: vesciles on red base = obstructed eccrine sweat glands

  • 1st 1-2 weeks
  • benign
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23
Q

milia

A

pinpoint papules on face: typ nose

  • present @ birth nd fades over weeks
  • keratin
  • benign
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24
Q

how to dress infant approp?

A

see what you are wearing and then add 1 more layer

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25
Q

cafe au lait spot

A

hyperpig lesion:

  • early infancy –> enlg as child ages
  • typ benign
  • multiple –> NF1
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26
Q

mongolian spot

A

discolored macules: blue-gray –> green-blue

  • large: >10cm
  • typ: butt/lower spine
  • common in af-am and asians

delayed disappearnce of dermal melanoctyes –> benign

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27
Q

acrocyanosis

A

blue hands and feet:

  • vasomotor rxn to cool environ (disting from central by looking at mucous memb)
    • mucous memb should be pink: not raspberry red or blue-ish
  • benign
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28
Q

jaundice

A

common due to decr activity of UDPGT enz: peaks @ day 2-3

  • glucuronidase conjugation enz

patho = high bili/direct hyperbili

tx: photothx

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29
Q

hemangioma

A

benign vasc tumor: typ involutes by age 5

can be tx with laser if in diaper or eye

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30
Q

nevus simplex

A

salmon patch: pink-red cap dilations

  • fades over time –> benign
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31
Q

nevus falmmeus

A

port-wine stain: dark purp/red cap malformation

  • typ does NOT fade
  • usually benign but larger lesions may interfere with N fx or lead to glaucoma
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32
Q

neonatal acne

A

erythematous comedones: 3-6 weeks

  • thought to be from neonatal androgens
  • usually more common in breast fed babies
  • no tx
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33
Q

seborrheic dermatitis

A

greasy, yellow plaques/scales on scalp/forehead/ears

  • “cradle cap”
  • overactive sebaceous glands
  • usually resolves within first 6mo
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34
Q

diaper dermatitis

A

irritant:

  • localized irritation: urine, feces
  • eryth with areas of scaling
  • tx: freq diaper changes and emollients/barrier creams

candidal:

  • 2nday infection of irritant diaper dermatitis
  • BEEFY RED, worse in skin folds
  • satellite lesion due to spread
  • tx: topical antifungals
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35
Q

chovstek’s sign

A

percuss just below zygo arch looking for facial twitching: tests facial nerve

  • potentally sign of hypercalcemia
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36
Q

normal skull of newborn

A
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37
Q

sutures:

A

memb spaces that separate bones of skull

fontanelles:

  • ant: close b/w 9-24 months
  • post: by 2 months
  • bulge = increased ICP
  • sunken: dehydr/malnut
  • early closure: craniosynotosis
  • late closure: hypothyroidism
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38
Q
A

pos plagiocephaly due to prolonged time spent laying on back

tx: sometimes tx with helmet

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39
Q

scalp trauma on delivery

A

caput succedaneum: soft tiss swell above periosteum (cross suture lines)

  • more extensive
    cephalohematoma: injury of bridge bv in subperiosteal layer (does NOT cross suture lines)
  • often assoc with vacuum delivery
  • high risk for jaundice due to low UGPGT
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40
Q

visual milestones of infancy

A
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41
Q

subconjunctival hemorr

A

common after deliver –> resolves within 1-2 weeks

if found AFTER perinatal period: concern for child abuse

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42
Q

lac duct obstruction

A

greenish-yellow discharge common in first sev months

  • failure of memb @ end of tear duct to open around birth
  • tx: tear duct message, dilation in more persistent cases
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43
Q

red reflex

A

3rd pic: retinoblastoma

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44
Q

cover/uncover test

A

pt focus on distant obj and cover one eye briefly

uncover eye and look for drifting –> strabismus

  • normal = eyes remain fixed when covered
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45
Q

esotropia

extropia

hypertropia

hypotropia

A

in

out

up

down

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46
Q
A

opacity –> cataract, glaucoma

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47
Q
A

preauricular skin tag

preauricular pit

usually benign but can indicated renal anomalies

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48
Q

normal position of ears

A

line from inner canthi –> occipital protruberance

  • 1/3 of ear above line = normal
  • low set –> abnormal
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49
Q

signs baby can hear

A
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50
Q

infat ear canal directed

A

downwards

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51
Q

how do infants breath?

A

obligate nose breathers

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52
Q

choanal atresia

A

congen narrow of nasal passages: present @ birth with cyanosis and relieved by crying

  • chonae = nasal “bumps”
  • atresia = “narrow”
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53
Q
A

“tongue tie” - tight lingual frenulum

usually benign

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54
Q

tonsils visible @

A

6 mo

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55
Q
A

epstein pearls: epith remnants of palate fusion

midline hard palate

benign –> resolves spontaneously

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56
Q

shrill, high pitched cry may indicate

A

increased ICP

opiate withdrawl

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57
Q

hoarse cry may indicate

A

hypocalcemic tetany

congenital hypothyroidism

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58
Q

con’t stridor may indicate

A

underdev airway

upper airway lesion

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59
Q

absent cry may indicate

A

severe illness

vocal cord paralysis

profound neuro dmg

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60
Q

short neck with excessive skin seen in:

webbed neck often seen in:

A

down

turner

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61
Q

neck masses:

A

midline: thyroglossal duct cyst
lateral: cystic hygroma/brachial cleft cyst
torticollolis: “fibromatosis coli”

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62
Q

grunting

A

repeatitive short expiratory sound

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63
Q

wheezing

A

musical expiratory sound

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64
Q

stridor

A

high piched inspiratory sound

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65
Q
A

nasal flaring due to needing to get more air

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66
Q

bounding pulses may be seen in …

A

PDA

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67
Q

tachypnea in absense of retractions –>

A

congen heart disease

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68
Q

decr pulses may indicate

A

valve obstruction

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69
Q

decreased femoral pulses –>

A

conactation of aorta

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70
Q

s2

A

split = normal

single = cyanotic congenital heart disease (hypoplastic left heart)

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71
Q

o2 sats

A

<95% or difference >3% b/w UE and LE –> echocardiogram

prior to discharge

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72
Q

widely spaced nipples typ seen in

A

turners

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73
Q

hypertrophic breast tissue

A

common due to materal horm exposure

can expr witch’s milk: thin, milky fluid

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74
Q

umb cord =

A

2 A, 1 V

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75
Q

scaphoid abdomen

A

congen diphramatic hernia

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76
Q
A

umb hernia due to weak fascia

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77
Q
A

diastasis rect: weak ab fascia -> bulge when P increases

above naval

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78
Q
A

omphalocele: ab contents covered by peritoneal layer - midline
gastroschisis: no layer covered - R of midline

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79
Q
A

hypospadius: urethral oepning displaced from tip of glans
* CONTRAINDCATION to circumcision

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80
Q
A

hydrocele - fluid collection in scrotum

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81
Q
A

highly estrogenized hymen of newbord with thick/hypertrophic vag tissue

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82
Q
A

clitoromegaly: enlg clit with 21-OH deficiency

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83
Q
A

imperforate hymen: bulge of introitus due to vag secr

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84
Q
A

imperforate anus: isolated or VACTERL

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85
Q

sacral dimples

A

often benign

eval when:

  1. >0.5cm size
  2. >2.5 cm from anus
  3. no visible base
  4. hemangioma
  5. tuft of hair
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86
Q
A

sacral dimple - benign

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87
Q
A

sacral skin tag

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88
Q

dysplasia of hip

A

pior to 3 mo: hip instab MOST sens finding

after 3mo: asymm of leg/skin folds or lim ROM: MORE sens for finding

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89
Q

test of hip instability

A

supine: unilat with clothing diaper removed: hips flex to 90
barlow: ADD hip –> disloc of fem head
ortolani: AB hip (anterior mvmt of trochanter) –> “clunk” = reduction of dislo hip

small amt of laxity “clicking” = normal

  • more common in females due to relaxin
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90
Q
A
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91
Q

hip ____ lim in most cases of DDH

normal v in DDH

A

abduction

normal: > 75 degrees

DDH: often <45 degrees

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92
Q

asymm skin folds

A

problem is on side with mor PROX folds

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93
Q

transverse palmar crease

A

trisomy 21

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94
Q
A

polydactyly

syndactyly

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95
Q

primitive reflexes

A

help with survival

med @ BS/SC lvl

resolves with age and NS maturation

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96
Q

sucking refelx

A

30wk –> 1.5/3 years

touch roof of mouth –> suck

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97
Q

rooting

A

30wk –> 2/3 mo

stroke perioral corners of mouth –> open and turn mouth

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98
Q

moro

A

32wk –> 3/4 mo

hold supine and drop –> abduct/extend arms, open hands, flex legs

asymm response = birth injury

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99
Q

palmar grasp

A

32 wks –> 3/4 months

press palm –> grasp

persistance = pyramidal tract dysfx

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100
Q

plantar grasp

A

32wk –> 8/9mo

touch soles –> toe curl

persist = pyr tract dysfx

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101
Q

stepping reflex

A

32 wk –> 3/4 mo

hold infant upright wth one sole on table –> that sole = hip and knee flex and other food = step forward

absense: paralysis

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102
Q

trun incurvation

A

32wk –> 1/2 mo

prone and stroke 1cm of midline from shoulder to butt –> spine curves towards sti side

absense: SC lesion/injury
persist: delayed dev

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103
Q

assymetric tonic neck

A

35wk –> 2/3 mo

supine: turn head to one side: ipsi arm/leg extend, contra flex
persist: asymm CNS dev

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104
Q

CN testing in newborns

A

CN II, III, IV, VI: light/track obj

CN V: sucking, rooting reflex

CN VII: facial mvmt/symm

CN VIII: acoustic blink refelx

CN IX, X, XII: suck & swallow when feeding ,gag refelx

CN XI: shoulder symm

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105
Q

age definitions

A

toddler: 1-3
preschool: 3-5
school: 5-10
adol: 11-21

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106
Q

anxiety changes during childhood

A

<6 = little anxiety

6-36: HIGH (peak @ 15-18 mo)

3-teenage: comfy

  • teenagers = unhappy since they want to be elsewere
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107
Q

VS for children

A

gen measured beginninng @ age 3

cuff covereing 2/3 of upper armm

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108
Q

screening for children

A

dev surveillance: 9, 18, 24 mo

M-CHAT for autism @ 18, 24 moths

vision/hearing @ age 3/4

dislipidemia screening @ 10 (sooner if risk factors)

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109
Q

height measured…

A

supine until age 2 and then upright

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110
Q

WHO v CDC chart

A

WHO until 2 years (due to discrepancies breastfed v not) and then CDC afterwards

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111
Q

while hild in on growth chart, esp with regards to height, it is often related to size of…

A

parents

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112
Q

BP is compared to standards based on..

A

age

sex

wt %tile

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113
Q

childhood obesity

A

CDC defines at BMI > 95th %tile

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114
Q

lea symbol

A

used to check vision in younger children

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115
Q
A

normal

otitis media with effusion: translucent, air-fluid

acute otitis media: ertthema, opacity, bulge TM

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116
Q
A

normal

v

allergic rhinitis

superior turbinate NOT visible on exam

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117
Q

what is the #1 chronic disease in children?

A

dental caries

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118
Q
A

tonsilloliths (tonsil stones) due to crypts

119
Q

“shotty” lymph nodes

A

small, under 1 cm

typical in young children

120
Q

lymph nodes _____ may require further investigation

A

>1.5cm

firm

fixed

non-tender

121
Q

I:E ratio

A

inspiratory:expiratory ratio - usually 1:1

long inspire = upper airway obstruct - croup

long expire = lower airway obstruct - asthma

122
Q

most important physical exam findings of pna in children =

A

hypoxia

increased work of breathing

123
Q

asthma

A

chronic airflow obstruct due to inflamma –> BHR (broch hyperresponsiveness)

common after vial upper respiratory infections in children

8% dx

usually dev before age 5

many = transient –> only wheeze with upper respiratory infections

124
Q

4 main listening areas for CV

A
125
Q

innoent heart murmurs in children

A
  1. still’s
    • LLSB: vib/musical with increase in supine pos
    • early systolic
    • infancy –> adol: most common = 2-6 y/o
  2. pulm flow
    • LUSB: blow, cres-decrescendo
    • early –> mid systolic
  3. venous um
    • roaring, resolves when supine: con’t
  4. carotid bruit
    • harsh, loud (3/6): long systolic
126
Q

seven S’s of innocent murmurs

A

systolic

sensitive (to pos changes/respiration)

short duration

single: no clicks, gallops
small: lim to small area/non-radiating

soft (low amp)

sweet (not harsh) - exception = carotid bruit

127
Q

grading heart murmurs

A
128
Q

murmurs that require further investigation

A

CHAD HAG

click: early, midsystolic

holosystolic

abnormal S2 (single, loud) S3

diastolic

harsh

assoc physical exam findings

grade 3 or higher

129
Q

abdomen in todlers

A

often protuberant that becomes more scaphoi with age

130
Q

scrotal masses in boys

A
131
Q

bowleg is common until

A

age 2

132
Q

scoliosis

A

lateral curve >10 degrees (cobb angle)

rotatory cmpt (rib hump)

commonly idiopathic - usulaly presents preteen/teen years but canbe as early as infancy (which is less likely to be idiopathy)

occurs eq in males and femaels but 10x more likely to progress in female

133
Q

when to screen for scoliosis

A

10-12 in females

13-14 in males

134
Q

cobb angle

A
135
Q

scoliosis screening

A

adam’s forward flex test with scoliometer

136
Q

_____ thoracic curve = high association with underlying neuro prob

A

left

137
Q

scoliosis curves are naed according to the _____ side

A

convex

138
Q

test _____ by assess finger to nose mvmts

A

cerebellum

139
Q

adolescent hx mneumonic

A
140
Q

tanner staging

A
141
Q

preparticipation sprts visit

A

annual for competitive sports: 6 weeks prior to beginning of season

  • detect conditions that predispose athlete to illness/injury
  • risk factors for sudden cardiac death
  • strategies to prevent injury

can detect 88% med conditions and 67% musc-skel problems

142
Q

AHA screening recommendations that should promt referral to ped cardiologist for further eval

A
143
Q

1 cause of sudden cardiac death in young athletes

A

hypertrophic cardiomyopathy: 30-50% of cases

  • auto-dom with variable penetrace (60%)
  • sudden death due to vent arrhythmia

enlg vent septum –> obstruct LV outflow –> decrease CO/blood flow –> syncope after exertion

exam findings:

  • systolic murmur that decr in supine pos (increased preload lessens obstruction)
  • ****contrast to MOST outflow murmurs that INCREASE in intensity when supine
144
Q

dx HOCM

A

abnormal ECG in up to 90% of pts

  • incr voltage
  • prom Q
  • deeply negative T
145
Q

geriatric is age

A

65 or older

146
Q

changes in elderly: vitals

A

HR: resting same but max & pacemaker cells declines

  • incr risk for arrhythmias

systolic htn

widened pulse pressure

ortho hypotn –> falls

RR unchanges

temp reg: increased risk for hypothermia

147
Q

changes in elderly: skin, hair, nails

A
148
Q

changes in elderly: eyes

A

most likely affect fx:

  • eyes:
    • acuity declines: cataract, glaucoma, macular degen
    • presbyopia: age 40
149
Q

changes in elderly: hearing

A

presbycusis: age 50 –> social withdrawal, depression

150
Q

changes in elderly: teeth

A

poor dentition –> wt loss

  • poor fitting dentures
  • chronic gum/tooth infections
151
Q

changes in elderly: thorax & lungs

A

chest wall stiffens

lungs:

  • elastic recoil
  • mass declines
  • residual volume increases

skeletal may chnage shape of chest –> hinder breathing/lung cap

152
Q

changes in elderly:CV

A

kinking/buckling of carotid arteries: R > L - common in women with htn

stiff artery walls –> sys bruits

CO same: HR max can decrease but SV will increased to maint

  • systolic aortic murmur: holosystolic
  • diastolic dysfx due to loose heart, mitral regurg (S4)
153
Q

PVD

A

peripheral arteries lengthen and tortuous = harder, less resilient

loss of arterial pulsations = abnormal

most concerning:

  • AA
    • male
    • smoker
    • coronary disease
    • presents as back/ab pain
  • temporal arteritis (giant cell arteritis)
    • age >50
    • unilateral headaches
    • tender over over temp A
    • sends a branch to the retina –> blindness
154
Q

changes in elderly: men genitalia

A

decreased tesosterone:

  • small penis
  • low testicles
  • thin pubic hair
  • ED (usu more due to vasc issues)
155
Q

BPH

A

prolif of prostate epith/stromal tissue

symptoms:

  • urinary hestinancy
  • dribbling
  • incomplete empty of bladder
  • nocturia –> sleep depreivation
156
Q

changes in elderly: woman genitalia

A

ovarian fx declines

  • smaller repro organs
  • prolapse of uterus due to laxity of suspensory lig of adnexa

menopause 45-52 years of age

157
Q

incontinence

A

types:

  1. stress
    • relaxed pelvic floor –> increased ab pressure
  2. overflow
    • blockage –> bladder unable to empty properly –> dribbling
  3. urge
    • oversensitive bladder from infection
    • neuro disorders
158
Q

urinary incontinence menumonic

A

DIAPERS

  • delirium
  • infection
  • atrophy
  • pills (diuretic)
  • excess urine output
  • restricted mobility
  • stool impaction (dehydrated due to not wanting to drip)
159
Q

sacropenia

A

loss of M mass, strength, performance

160
Q

frailty

A

late-life weakness , illness, wt loss

core cmpt = sarcopenia

161
Q

benign forgetfulness

A

difficulty recalling names of people/objects

low retrieval and processing

162
Q

benign essential tremors

A

tremors with exertion, disappear with rest

163
Q

balance problems in elderly due to:

A

decrease/loss of vib sens in feet/ankles BUT not in hands

  • position sense may disappear
  • gag reflex may decrease
  • ankle/patella reflex difficult to elicit on exam
164
Q

acute illness that may preset different in older adult

A

lack of feer with infection

thyroid dysfx

165
Q

neumonic of addressing cultural dimensions of aging

A

ETHNICS

  • explanation
  • tx
  • healers
  • negotitate
  • intervention
  • collaborate
  • spirituality
166
Q
A

SLUMS: st. luis university mental status exam

167
Q

what are the most common modifiable fisk factor associated with falls

A

medications - “brown bag” review

168
Q

drinking

A
169
Q

decreased in wt….

A

predictor of increased mortality –> further investigation into medical/psychosocial causes

AAFP: 10% in 6mo or 5% in 1mo

Cecils: 4% in 1 yr

170
Q

advanced directives

A

health care proxy

  • agent to make decisions: online - no lawyer

living will

DNR

  • MOLST/POLST (bright pink)
    • doc & pt/pt’s representative
171
Q

goal of palliative care

A

relieve suffering

improved quality of life

172
Q

preventative screening: vaccines

A

shingles: 1 time regardless of prior shingles

pna/pneumococcal: 1 time after age 65 unless high risk

influenza: yearly
tetanus: every 10 years after 1 dose Tdap

173
Q

depression screening

A

in the last 2 weeks…

scores responses:

  • 0 = not at all
  • 1 = several days
  • 2 = more than half of days
  • 3 = nearly every day
174
Q

mild cognitive impairment (MCI)

A

memory impairment without cognitive deficits/fx decline

175
Q

mini-cog test

A

detects mild cog impairment (MCI): 3 minute recall + clock drawing test

  1. name 3 obj
  2. draw a clock
  3. ask to repeat obj

scoring:

  • 3: all words
  • 0: no words - dementia
  • 1-2 words & normal clock = normal
  • 1-2 workds & abnorm CDT = “impaired cognition”
176
Q

Folstein MMSE

A

admin 5-10 min

max score: 30pts

  • <24 = dementia
  • 20-24 = mild dementia
  • 13-20 = mod dementia
  • <12 = severe dementia

alzheimers lose 2-4 points/year

177
Q

ADL v IADL v AADL

A

ADL: self-care tasks

IADL: maint indep lifestyle

AADL: employment, hobbies, social events

178
Q

VS of elderly

A
  1. BP
  2. pulse
  3. RR
  4. temp
  5. pain
  6. fx assessment: only in geriatrics
179
Q

orthostatic BP

A

drop in systolic > 20

or

diastolic >10 after 3 min of standing

180
Q

10 min screening

A

PLUM DHEW

  1. eyes: diff ADL due to eyes, snellen inab to read >20/40
  2. hearing: audioscope @ 40dB, test @ 1000,2000 Hz and whisper
  3. get up and go test: unable to complete within 15s
  4. urinary incontinence: lost urine/got wet in last year, leaked on 6 separate dates –> DIAPER
  5. nutrition: lose weight over last year or wt < 100 lbs
  6. memory: 3 item recall (unable to recall after 1 min)
  7. depression: yes to “sad or depressed?”
  8. physical disability: are you able to… (6 Q’s)
    1. do strenuous acitivity: fast walking, bicycling
    2. heavy work around house: wash windows, walls, floors
    3. go shopping for clothes/groceries
    4. get to places out of walking distance
    5. bathe?
    6. dress yourself
181
Q

balance and gait tests

A

timed get up a go (TUG): abnormal is >15s

  • rise from airchair
  • walk 3 meters/10 feet
  • turn
  • walk down
  • sit

gait speed: >13 s for 10meters/35feet abnormal

test balance:

  • feet side by side
  • semi tandem
  • heel-toe
  • resistnace to nudge on 360 turn
182
Q

non blanching redness =

A

P ulcers until proven otherwise

183
Q

arcus senilis

A

benign white ring around limbus

184
Q

ectropion v entropion

A
185
Q

macula degen

A
186
Q

JVP

what is the pulsatile mass seen on the right side of neck usually?

what vlave gets affected first?

A

supine with head of table @ 30 deg

pulsatile mass on R side: carotid on women

valve degen: aortic then mitral valve

  • S4 common
187
Q
A

AAA: no palpation

188
Q
A

inguinal hernia

189
Q

SDMM

A

siebens domain management model

org pt’s health problems into 4 domains

  • med-surg
  • mental/emotions/coping
  • physical fx
  • living environment
190
Q

mental disorder statistics

A

20% primary care outpts have mental disorders

50-75% undetected and untx

191
Q

SSD

A

somatic symptom disorder: mental illness that causes one or more bodily symp (pain) that can invovle one or more different organs and body systems

192
Q

hental health screening in primary care setting

A

2 tier approach:

  • brief: yigh yield Q with high sensitivity and specificity
  • detailed if indictated
193
Q

suicide rates among pts with major depression ____ higher than general population

A

8x

194
Q

high yeild questions for anxiety

A
  1. over past 2 weeks: feel nervous, anxious, on edge
  2. over past 2 weeks: unable to stop/control worrying
  3. over past 4 weeks: anxiety attack suddenly or feeling fear/panic
195
Q

CAGE scoring

A

total score of 2 or great = clinically significant

196
Q

PRIME-MD is for…

A

5 more common disorders in primary care:

A SEED

  • anxiety
  • somatoform
  • eating
  • etoh
  • depression
197
Q

when is demential reversible?

A

drugs

alcohol

hormal

depression

vitamin b12 inbalance

198
Q

delirum v dementia

A

delirium:

  • acute confusion
  • causes: metabolic inbalance, med SE, after sx

dementia:

  • slow
  • reversible and irreversible causes
199
Q

what test is useful for screening for dementia

A

mini mental state exam

200
Q

perceptions

A

sensory awareness of obj in environement

internal stim: dreams/hallucinations

201
Q

thought processes v thought content

A

“how” people think v “who/what” people think about

202
Q

insight

A

awareness that behaviors are normal/abnormal

distinguish b/w daydreams and hallucinations that seem real

203
Q

LOC

A

alert: response to normal tone of voice
lethargy: “drowsy” - speak in loud voice
obtundation: shake to wake - opens eyes, responds slowly, somewhat confused
stupor: painful stim (sternal rub) - unresponsive without it
coma: unarousable

204
Q

difference speech patterns of:

depression

mania

dysarthria

paraphasia

A

slow

accerelated, rapid, loud

defective articulation

words are malformed: I write with a “den”

205
Q

circumstantiality

A

indirecton/delay in reaching the point: “non-linear thought pattern”

unneccessary detail but often comes back to point

found in pts with obsessions

206
Q

derailment

A

loosenin of associations: shifting of one subject to unrelated or related only obliquely

found in:

  • schizophrenia
  • manic and psychotic episodes
207
Q

illusions

A

misinterpretations of real external stimuli

seen in grief and delirium

208
Q

hallucinations

A

subjective sensory perceptions in absence of relevent external stim

may not recognize experiences as false

occurs in: delirium, alcoholism

209
Q

affect

A

external expression of inner emo state

210
Q

feelings of unreality and depersonalization

A

unreality: things in ENVIRON strange/unreal
depersonalization: things about SELF strange/unreal - “detached from one’s mind/body”

211
Q

clanging

A

choose word based on sound rather than meaning

rhyming and punning speech

212
Q

perseveration v echolalia

A

perserveration: repetition of OWN words
echolalia: repetition of OTHERS words

213
Q

blocking

A

sudden interruption mid-speech: “lost the thought”

214
Q

incoherence

A

largely incomprehensible

  • illogic
  • ack of meaningful connections
  • abrupt topic chnages
  • disordered grammar/word use
215
Q

neologisms

A

invented/distorted words wiht new nad high idosyncratic meanings

observed in:

  • schizo
  • psychotic disorders
  • aphasia
216
Q

flight of ideas

A

con’t flow of acclerated speech that changes abruptly from topic to topic

changes based on:

  • understanble associations
  • plays on words
  • distracting stim

observed in manic episodes

217
Q

3 tests for attn

A

digital span

  • recite set of digits (start 2 @ a time, clearly, 1 sec apart)
  • stop after second failure of a single series

serial 7’s

  • starting from 100, subtract 7…subtract 7…
    • normal: 1.5 min with less than 4 errors
  • can try 3s if cannot do 7s

spelling backwards

  • can substitue for serial 7s
  • say 5 letter world to pt and have pt spell it bwds to you
218
Q

testing new learning ability

A

say 4 words

con’t with rest of exam

test after 3-5min

note accuracy

219
Q

how to test capacity of pt to think abstractly?

A

similarities

  • ask pt to tell you how 2 things are alike

proverbs

  • ask pt what people mean when they use proverbs:
    • a stitch in time saves 9
    • don’t count your chickens before they’re hatched
220
Q

high cog fx: tests constructional ability

A

copy figures of increasing complexity onto piece of blank/unlined paper

draw a clock with numbers and hands

221
Q

vertigo v presyncope v disequilibrium

A

spinning

feeling of passing out/falling

unsteadiness/loss of balance

222
Q

proximal v distal weakness

A

prox: comb hair, reach for shelf, geting up from chair, high stepping
distal: open jar, using scissors/screwdriver, tripping/falling while walking

223
Q

dermatome map

A
224
Q

faintin/syncope

A

sudeen temporary LOC and postural tone from transient global hypoperfusion to brain

225
Q

seizure

A

tonic-clonic motor activity:

  • tongue biting
  • limb bruises
  • urniary incontinence
  • may/may not lose consciousness
226
Q

tremors

A

rhytmic oscillary mvmt from contraction of opposing M groups that is worse @ rest or with intentional mvmt

  • resting:
    • parkinsons
  • postural: appear when affect part actively maint a posture
    • hyperthyroidism
    • anxiety/fatigue
  • intention: absent @ rest, and appear with mvmt (cerebellar)
    • MS

parkinsons: low freq resting remor with rigidity and bradykinesia

essential tremor: high freq, bilateral UE during mvmt and sustained posture

227
Q

testing CN I

A

present familiar smells but occluding one nose and then the other

228
Q

tesing CN II

A

visual acuity: snellen- read smallest line at least half the letters

visual fields: wiggle fingers in peripheral 2 feet away in a fishbowl-like pattern

opthalmascopic:

  • optic disk: physiological cup and penetrating retinal vessels
229
Q

tesing CN II and III

A

inspect pupils

pupillary reflex

near rxn: pupil constriction on near object (10cm away)

230
Q

tesing CN III, IV, VI

A

extraocular mvmts: big H

  • asymmetry, nystagmus, lid lag
    convergence: push pen towards pt
231
Q

testing CN V

A

sensation: face, nasal, buccal mucosa, teeth

  • V1: forehead
  • V2: cheef
  • V3: jaw

afferent corneal reflex

  • have pt look up and away and approach on contra side –> touch cornea –> blink
    motor: mastication
  • temporalis
  • masseter
232
Q

anisocoria

A

difference >0.4 mm

233
Q

absent blinking AND sensorineural hearing loss seen in…

A

acoustic neuroma

234
Q

testing CN VII

A
  1. raise brows
  2. frown
  3. close eyes tightly
  4. smile showing both upper and lower teeth
  5. smile without teeth
  6. puff out cheeks
235
Q

test CN VIII

A

acoustic N: whispered voice test

  • stand 1-2 feet behind pt, rub tragus

Weber and Rinne test: not applicable for bilateral hearing loss

236
Q

testing CN IX, X

A

** use light

motion of soft palate (X)

uvula (away lesion)

pharynx

gag reflex

237
Q

testing CN XI

A
238
Q

M atrophy

A

loss of M bulk - M wasting

eval:

  • hands, shoulders, thighs
  • thenar, hypothenar
  • space b/w metacarpals, dorsal interosseous M
239
Q

fasciculations

A

fine flickering irregular mvmts in small groups of M fibers

240
Q

M tone

A

residual tension in relaxed M

241
Q

a M is strongest when…

weakest when…

A

shortest

longest

242
Q

M strength testing

A
243
Q

testing of UE

A

shoulder

F, E, Ab, Ad, ext rotation, internal rotation

elbow

flex - bicep: c5, c6

extension: tricep - c6-8

pronation:

  • pronator teres: median N - c6

supination:

  • bicep: musculocutaneous N - C5, C6

wrist

extension:

  • carpi radialis: radial N: c6-c8 - have pt make fist and resist you pulling down their wrist

flexion:

  • flexor carpial radialis (median N - c7) & ulnaris (ulnar N - C8/T1) - have pt make fist and resis you pulling it up

hand

  • hand grip

finger

  • abduct & adduction: interosseous M (ulnar N - c8/t1)
  • opposition: (median N - C8/T1)
    • have pt try to touch tip of little finger with thumb aga resistance
244
Q

M strength testing of LE

A

hip

  • flex: iliopsoas - L2, L3, L4
  • ext: g. max - S1
  • adduction: adductors - L2, L3, L4
  • abduction: g. medius & minimus - L4, L5, S1

knee

  • extension: quads - L2-4
  • flex: hamstrings - L4, L5, S1, S2

ankle

  • dorsiflex: tib anterior - L4, L5 (pull up aga my hand)
  • plantar flex: gastroc/soleus - S1 (push aga my hand)

toe

  • dorsiflex 1st toe: deep peroneal - L4-S1
  • plantar flex 1st toe: posterior tib - L5-S2
245
Q

how to test sensory

A

start distally and move prox

246
Q

seosry exam vib use what hz tuning fork?

A

128

247
Q

posterior column disease common causes

A

teriary syph

b12 deficiency

248
Q

peripheral neuropathy common causes

A

DM

etoh

249
Q

common dorsal column disorders

A

tabes dorsalis

MS

b12 deificiency

250
Q

sterognosis

A

pt IDs obj by touch

normal: within 5 sec

251
Q

graphesthesia

A

discriminative sensation: draw number on hand

252
Q

2 pt discrimination

A

use ends of paper clip

normal = 2 pt <5mm on fingers (vary on other parts of body)

253
Q

discriminative sensation

A

point localization: touch pt and have them touch where you touched

extinction:

  • touch same parts bilateral
  • sensory cotex lesions = only 1 stim recognizated
    • extinguished stim on opposite side of dmged cortex
254
Q

dysdiadochokinesia

A

unability to perform rapid, alternating mvmts

hand: palms up and down rapidly on thighs
foot: tap your hand and then ground

255
Q

dysmetria

A

abnormal: lesion in vestibular sys or cerebellum

inability to judge distance/scale

  • touch index finger to your finger and then their nose
  • reposition hand after each touch
  • touch your index finger with theirs up and down with eyes closed
  • slide foot down shin
256
Q

tesing gait

A
  1. rise from sitting
  2. walk down hall
  3. heel to toe
  4. walk on toes then heels
  5. hop in place
  6. shallow knee bend
257
Q

gait: spastic hemiparesis

A

dmg: corticospinal tract

lean away while circumduction of foot, plantar-flex and inverted

258
Q

steppage gait

A

dmg: foot drop - weak tib-anterior and toe extensors

drag feet or lift up high

cannot walk on heels

259
Q

cerebellar ataxia gait

A

staggering, unsteady, wide base, exaggerated dif on turns

other cerebellar signs present:

  • dysmetria
  • mystag
  • intention tremor
260
Q

scissors gait

A

dmg: SC disease –> bilateral LE spasticity, common in cerebral palsy

stiff, advance slowly with thighs crossing fwd each other on each step

“walking through water”

261
Q

parkinsonian gait

A

dmg: basal ganglion

stooped posture with felx of head, arms, hips, knees

short, shuffling, involuntary hastening (festination)

262
Q

sensory ataxia

A

dmg: polyneuropathy, posterior column

unsteady and wide based, throw feet fwd and outward and bring hem down from heel to toe in a double tapping sound

watch ground for guidance

263
Q

hopping in place involves

A

prox M

distal M

position sense

normal cereballar fx

264
Q

shallow knee bend tests

A

hip extensor (hamstring)

knee extensor (quad)

265
Q

romberg test

A

pt stands with feet together, closes eyes, maint pos for 30-60s

inability –> dorsal column disease

  • loss of balance with eyes closed
266
Q

pronator drift test

A
267
Q

reflex arc cmpts

A

sensory N fibers

SC synapse

motor N fibers

NMJ

M fiber

268
Q

scale for grading reflexes

A
269
Q

hyperactive reflex can be due to:

A

CNS

corticospinal tract lesion

weakness/spasticity

(+) babinski

270
Q

hypoactive/absent reflex

A

PNS

LMN lesion

weakness/atrophy

fasiculations

271
Q

reinforcement

A

arm: clench teeth, squeeze one thigh
leg: locks fingers and pulls

272
Q
A

bicep reflex: c5-6

273
Q
A

tricep: C6-7

@ tricep insertion on olecranon process (2.5 - 5cm above olecranon process)

274
Q
A

brachioradialis: C5/C6
2. 5-5 cm above wrist: forearm partly flexed and pronated

275
Q
A

patellar reflex: L2-4

276
Q
A

achilles: S1
sitting: dorsiflex –> (+) = plantar flex
supine: flex hip & knee and ext-rot across opposite shin, dorsiflex –> (+) plantar flex

277
Q
A

ankle clonus –> jerk into dorsiflexion

test rhythmic oscillations b/w dorsiflex and plantar flex

(+) = hyperactive reflexes: graded 4+

278
Q

cut stim reflexes: abdominal

A

(+) = contraction of ab M and deviation of naval towards stim

can be MASKED in obesity: use finger to retract naval away from side to be stimulated and note contraction with retracting finger

above naval: T8-10

below naval: T10-12

279
Q

babinski

A

testing plantar flex: L5, S1

  • normal = plantar
  • abnormal = dorsiflex
280
Q

anal refelx

A

S2-S4

use cotton swab to stroke outward in 4 quads from anus

(+) = contraction

abnormal = cauda equina lesion

281
Q

meningitis testing

A

common in acute bacterial meningitis, also in subarach hemorr

  • test neck mobility/nuchal rigidity: pt supine and flex neck until chin touches chest
  • (+) = neck stiffness

brudzinski

  • (+) flexion of hips and knees with NECK FLEX

kernig

  • (+) = pain with knee extension
282
Q

lumbosacral radiculopathy

A

straight leg raise - stretches sciatic N & sens for disc herniation

  • S1 commpression can also be associated with ipsi calf wasting and weak ankle dorsiflex

contralat straight-leg raise

  • SPECIFIC for sciatica

(+) = pain

283
Q
A

asterixis

  • sudden brief clonus flexion of hands and fingers
  • “stop traffic”: hold for 1-2min

dmg: metabolic encephalopathy with impaired mental fx

  • liver disease
  • uremia
  • hypercapnia
284
Q
A

winged scapula - dmg to long thoracic N or muscular dystrophy

  • weakness of serratus anterior
285
Q

GCS

A

intubate pt @ 8

286
Q

poor outcome signs in stuporous/coma pt

A

absent corneal

absent pupillary

absent withdrawal to pain

no motor response

287
Q

what don’t you do to a stuporous/comatose pt?

A

dilate pupils

flex neck: rule out fx before neck manipulation

288
Q

oculocephalic reflex

A

doll’s eye mvmts = intact brainstem

  • hold open upper eyelids
  • as head turns to one side, eyes move towards opposite side

absent: eyes move towards direction of head turning

289
Q

vestibulo-ocular reflex

A

cold water: eyes deviate towards cold water

  • eardrums intact and canals clear
  • elev head to 30 degrees

abnormal: no response to cold water –> brainstem injury

290
Q

acute glaucoma headache

A

increased ICP around 1 eye

  • steady/aching
  • provoked by drops that dilate pupils
291
Q

sinusitis headaches

A

mucosal inflammation

  • usually frontal or maxillary sinus
  • recurrent daily pattern
  • local tenderness, nasal congestion/discharge/fever

can be relieved with nasal decongestants, antibiotics

292
Q

subarachnoid hemorrhage

A

SUDDEN “worst pain of my entire life”

293
Q

brain tumor headache

A

displacement/traction of pain-sensitive A/V or P on N

  • brief –> intermittant –> progressive
  • aggreated by: cough, sneeze, sudden head mvmts
294
Q

postconcussion headache

A

acceleration-deceleration TBI

  • 7days - 3mo after incident that diminishes over time
  • poor concentration, memory problems, vertigo, irritabilty, restless/fatigue

PD Year 1 (6 decks)

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