What do the following techniques identify: - woods lamp - oil microscopy - Tzanck smear - KOH

- woods lamp: tinea capitis - oil microscopy: scabies - Tzanck smear: herpes - KOH: fungal

INDE Yr 2 Term 2 Flashcards by Bethany Woodrow

When to ideally do a breast exam

at the end of bleeding (first day of OCP)

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peau d’orange

edema, but the skin is tethered by sweat ducts

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what technique do we use for breast exam

vertical strip, 3 min per breast

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where would supernuemary breasts be found?

anywhere along the milk line…subject to the same diseases as regular breasts

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If you are doing a bimanual exam, which hand would feel an anteverted uterus and which hand would feel a retroverted uterus?

Anteverted: the abdominal hand
Retroverted: the internal hand, through the posterior vagina

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How much to rotate the spatula and the cytobrush when you are doing a pap?

spatula: 360
cytobrush: 180

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Should you do a pap on a menstruating woman?

technically no…

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When to start cervical cancer screening? How often to screen?

21 y.o or 3 yrs after first sexual contact (including, digital and oral contact).

q12/12 until 3 normal, then at 24/12 intervals

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What has a mocassin-like distribution?

tinea pedis

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What might the toenails of a patient with DM neuropathy look like?

thickened

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What do oncomychotic (is that a word?) nails look like? Occurs more often in…
What is the sequela we are trying to avoid?

In this condition, fungus is eating up the keratin in the nails. The toenails are thick, hyperkeratotic and friable (oncholysis)

adults

can develop into cellulitis

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Do we recommend that women do self-exams?

Yes, they should do everything but the axilla part.

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Drugs/exposures commonly associated with tinea effluvium?

antidepressants
OCP
sudden diet changes

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What do the following techniques identify:

woods lamp
oil microscopy
Tzanck smear
KOH

woods lamp: tinea capitis
oil microscopy: scabies
Tzanck smear: herpes
KOH: fungal

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Where is psoriasis normally found? Differentiate from eczema.

Psoriasis:

extensor surfaces, scalp, post-auricular, lumbar, shins
salmon red, papule, silver scale, sharp borders

Eczema:

flexor surfaces
intensely pruritic, moist, not well-circumscribed

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Differentiate features of basal cell, actinic keratosis (–>SCC), nevi, melanoma

Basal cell: raised, pearly, red, sun exposed areas.

Actinic keratosis (–>squamous cell): well defined, scaly, nodular

Melanoma: brown/black/blue/white

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What could cause hair coming out by the roots, vs. hair breaking off?

Coming out:

telogen effluvium
alopecia areata (T-cell mediated)
androgenetic alopecia

Breaking:

tinea capitis (infxn of follicle by Trichophyton tonsurans and microsporum canis
hair shaft abnormalities (?genetic)
traumatic hair practices
trichotillomania

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What is the DDx of cicatricial and non-cicatricial hair loss?

Cicatricial (scarring, loss of follicular ostia) :

discoid lupus
lichen planopilaris

Non-cicatricial- pretty much everything else

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How many hairs is a normal and abnormal

6-10 is normal, 60 is NOT

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What are the integuement signs of hypothyroid? Hyperthyroid?

HYPOTHYROID

brittle, slow growing nails
skin: swollen, waxy, cool, dry
hair: thin and brittle

HYPERTHYROID

fine, silky hair
pretibial myexedma (incl. papules, nodules, plaques in pretibial region)

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What are the components of the MSE?

ASEPTIC

Appearance
Speech
Emotion (mood and affect)
Perception (hallucinations, illusion)
Thought form and content (delusions)
Insight & Judgement
Cognition

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asking the meaning of a proverb assesses what?

asking patients to identify similarities between objects tests what?

abstract thinking

logical thinking

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Dominant and non-dominant parietal lesion may have the following symptoms…

Dominant:

dyscalculia
R-L confusion
body part agnosia
apraxia (?….not according to some textbooks)

non-dominant:

directional sense
construction
dressing

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Pronator drift is a sign of….

Study These Flashcards

cerebellar

upper limb weakness? And possibly inability to simultaneously activate both cerebral hemispheres.

How to decide if a droopy eyelid is "ptosis"

if it encroaches on the pupil

Tuning forks to use for: | vibration

128 Hz

Which test to do first: Rinne or Weber?

Rinne- decide first is BC>AC and then see if it lateralizes.

Where to touch to elicit the gag reflex?

The pillar in front of the tonsil

Which border of the optic cup is papilledema more easily visualized?

The temporal border is normally very crisp, so a blurred border is bad

Differential of ptosis

- Horner's (partial) - CN III palsy (complete , and eye will be down and out) - myasthenia gravis (affects muscles used more frequently first) - Autosomal dominant ptosis

differentiate bulbar and pseudobulbar palsy

Bulbar: LMN lesion of CN IX-XII (medulla=bulb)...seen in ALS Pseudobulbar: UMN of the corticobulbar nerves...could get with MS

When would you see chorea? When would you see athetosis?

Chorea: huntington's classically Athethosis: cerebral palsy (slow, convoluted, writhing movements)

Muscle power scale

``` 0- nothing 1- flicker 2- w/o gravity 3-with gravity 4- with gravity and some resistance 5- full strength ```

Reflex rating scale

``` 0- absent 1+ weak 2+ normal 3+ brisk 4+ clonus ```

An ataxic gait with titubation is characteristic of....

Limb ataxia vs. truncal ataxia signs

Trunk: wide gait, inability to do tandem Limb: impaired heel-shin tests, dysmetria, dysdiadochokinesia

triad for normal pressure hydrocephalus

gait disturbance, decline in cognition, urinary incontinence

A waddling gait with increased lumbar lordosis could be...

muscular distrophy....has proximal muscle weakness

When taking a vision history what is the possible significance of the following complaints: - halos around lights - floaters - flashes - curtain that obscures part of vision

Halos: ?cartaracts Floaters: normal vitreous condensations with age, retinal detachement, vitritis, tumours Flashes: retinal detachment, papilledema Curtain: amaurosis fugax (symptomatice carotid artery disease)

Is the cause of diplopia more likely to be supratentorial or infratentorial?

Infratententorial.

What might cause monocular diplopia vs. bionocular diplopia?

Monocular: an opthalmologic cause (e.g. corneal deformity) Binocular: a neurologic lesion

Diplopia made worse by looking down and in (e.g. walking down the stairs) is suggestive of...

CN IV palsy- these pts also tend to tilt their head away from the lesion.

Morning headaches are suggestive of:

space occupying intracranial lesions...or OSA.

What is bilateral proximal weakness vs. bilateral distal weakness suggestive of?

Proximal: myopathy Distal: neuropathy

Paresthesia around the mouth and hands, lasting for several minutes is most indicative of...

an anxiety disorder/panic attack

Ataxia that is significantly worse (or only present when) a person is navigating in the dark is likely...

sensory ataxia vs. cerebellar ataxia

Components of the Folstein (MMSE)

Orientation to Time and Place (-/10): - year - season - month - date - day - floor - building - city - province - country ``` Immediate recall (-/3) Attention (-/5) (WORLD-DLROW) Delayed recall (-/3) Naming (-/2) Repetition (-/1) 3-stage command (-/3) Reading (-/1) Writing (-/1) ```

What does ADMIT stand for?

``` Admit/Activity Diet Monitor (e.g. vitals) Investigations Therapy ```

How to do an APGAR?

Appearance (0=blue, 1=acrocyanosis. 2= pink all over) Pulse (0=absent, 1=100) Grimace (0=none, 1=grimace, 2= vigorous cry) Activity (0=flaccid, 1= some flexion, 2= active motion) Respiration (0= absent, 1= slow/irregular, 2= good, crying)

What newborn features can be used to assessed gestational age?

``` foot creases ear cartilage genitalia scalp hair breast buds ```

What are the following primitive reflexes: - Moro - Root - Babinski - Galant

Moro: "drop" baby, they splay arms out Root: a newborn will search for their mother's breast Babinski: upgoing plantar Galant: hold baby face down, stroke along the spine, the baby laterally flexes to the stroked side

Social and Cognitive Levels of Play

Social: - solitary - paralell - interactive/group Cognitive - functional - constructive - dramatic - games with rules

Significant delays in the toddler years

- not sitting by 9 months - not mobile by 1 year - not walking or speaking by 18 months - not forming sentences by 3 yrs

What is the age of sexual consent in BC?

- 16 if it is non-exploitive - 14-15 if 5 yr difference (or less) - 12-13 if 2 yr difference (or less)

What is the significance of the BC Infants Act and the BC Mental Health Act and the Child, Family and Community Services Act?

BC Infants Act: all patients from 0-19 yrs are legally able to consent to treatment as long as they are competent (e.g. understand risks and benefits) BC Mental Health Act: patients can only accept/reject treatment if they are over 16 y.o. Younger than that it is parents job. **there is no age limit to certify someone** Child, Family and Community Services Act: have to protect kids <19 y.o (e.g report abuse

What is the CRAFT screen?

For problem/risky substance use in teens. ``` Car (been driving high) Relax (use drugs to relax) Alone (use drugs alone) Family/Friends concerns Forget (use drugs to forget) Trouble ```

What is PBIND?

``` Things you should ask in a pediatric history Prenatal Birth Immunization Nutrition Development ```

When is jaundice in the neonate pathologic?

<10 days

INDE Yr 2 Term 2 Flashcards

(58 cards)