Test 1 Flashcards
(632 cards)
1
Q
Diagnostic Process order
A
1) Identify the problem
2) Frame the differential diagnosis in a way that facilitates recall
3) Organize differential diagnosis
4) limit the differentials by using pivotal points to create a pt specific differential
5) Explore pt specific differentials - using history and physical exam findings
6) Rank the differentials using results of exploration
- select leading differential
- select must not miss
- select additional alternatives
7) Test
8) re-rank
9) Test
2
Q
What is the most precise way of estimating pretest probability.
A
CDRs ( clinical decision rule )
3
Q
which system reasoning is used based on memory
A
System 1
4
Q
Which system reasoning is a more analytical approach
A
System 2
5
Q
How should problem lists be organized?
A
Acute problems
chronic active problems
ending with inactive problems.
6
Q
What are the components used for assessing pretest probability
A
use a validated clinical decision rule (CDR)
use prevalence data regarding the causes/etiologies of a symptom
use your overall clinical impression
7
Q
probability above which the diagnosis is so likely you would treat the patient without further testing
A
treatment threshold
8
Q
the probability below which the diagnosis is so unlikely it is excluded without further testing
A
test threshold
9
Q
the probability of disease after the test is done
A
posttest probability
10
Q
How likely can we “rule this in”
A
Sensitivity
11
Q
the higher a sensitivity is (and the more symptoms/findings usually), the more likely we can
A
“rule in” a disease.
12
Q
“rule this out”
A
Specificity
13
Q
USPSTF levels of certainty regarding net benefit
A
net benefit = benefit – harm as implemented in a primary care population
14
Q
Consistent results from well-designed studies in representative primary care populations that assess the effects of the preventive service on health outcomes; it is unlikely that these conclusions will change based on future studies.
A
USPSTF levels of certainty - High
15
Q
Evidence sufficient to determine the effects of the preventive service on health outcomes, but methodologic issues such as limited generalizability, inconsistent findings, or inadequate size or number of studies exist; these conclusions could change based on future studies.
A
USPSTF levels of certainty - Moderate
16
Q
Insufficient evidence to assess effects on health outcomes, due to limited number or size of studies, flaws in study designs, inconsistency of findings, lack of generalizability.
A
USPSTF levels of certainty - Low
17
Q
The USPSTF recommends this service. There is high certainty that the net benefit is substantial.
A
Grades of recommendations - Grade A
18
Q
The USPSTF recommends this service. There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial
A
Grades of recommendations - Grade B
19
Q
The USPSTF recommends selectively offering or providing this service to individual patients based on professional judgment and patient preferences. There is at least moderate certainty that the net benefit is small.
A
Grades of recommendations - Grade C
20
Q
The USPSTF recommends against the service. There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.
A
Grades of recommendations - Grade D
21
Q
The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the service. Evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined.
A
Grades of recommendations - Grade I statement
22
Q
higher the specificity is, the more likely we can
A
“rule out” a disease
23
Q
OLDCARTS
A
onset location duration character aggravating or associated factors relieving factors temporal factors severity
24
Q
are the physiological links, predisposing factors, and complications for this disease present in the patient?
A
coherence
25
Does the suspected disease encompass all of the patients normal and abnormal findings?
Adequacy
26
Is it the simplest explanation of the patients findings?
| crucial step bc patients must find the treatment recommendations acceptable
Parsimony
27
is the diagnosis confirmed by a radiographic or lab tests?
Diagnostic probability
28
rules of thumb that guide the inductive or inferential process of diagnostic reasoning. Generally accurate and useful rules to make the task of information gathering more manageable.
Heuristics
29
“Are the physiological links, predisposing factors, and complications for this process present in the patient?”
(All the things present in the disease, does the patient have symptoms?)
Coherence
30
“Does the suspected disease encompass all of the patient’s normal and abnormal findings?”
(Symptoms patients have...does this match the disease?)
Adequacy
31
when the practitioner suspects a cause of symptoms based on previous clinical knowledge, practitioner gathers relevant information at a quicker speed
Diagnostic reasoning:
32
form of reasoning acknowledging that there are many variables (environmental & social) present in an actual clinical situation
Clinical reasoning
33
PICO
Problem
Intervention/exposure
Comparison
Outcome
34
ratio of risk in the experimental group compared with the risk in the control group
RElative Risk
35
Is the difference between groups large enough to be worth achieving
Clinical versus statistical significance
36
odds of previous exposure in a case divided by the odds of exposure in a control patient
Odds ratio
37
Measure of the precision of results
Confidence Intervals (CIs)
38
in Confidence intervals the wider the CIs indicate a ____ _____
lower precision
39
what source of evidence provides sound evidence of cause and effect and can control for bias
RCTS (Randomized controlled clinical trials)
40
what source of evidence examines a number of valid studies on a topic and mathematically combines the results to report them as if they were one large study
meta analysis
41
what source of evidence is based on clinical experience, collective experience and knowledge of professional organizations
Expert opinion
42
what level of prevention involves activities directed at improving general well-being while also providing specific protection for selected diseases.
Primary prevention
43
screening, counseling or preventive medicines such as vaccines or dental sealants is what level of prevention
primary
44
Common model used to guide behavioral counseling (5As)
Ask about the behavior
Advise about the health risks and benefits of change
Agree to set a goal
Assist with identifying and overcoming barriers
Arrange for a follow up
45
what level of prevention goal is to identify and detect disease in its earliest stages before symptoms appear
Secondary prevention
46
What level of prevention includes
| screening interventions to identify elevated BP or risk of DM with A1C measurement
secondary prevention
47
What level of prevention aims to improve the quality of life for people with various conditions by limiting complications and disabilities, reducing the severity and progression of disease and providing rehab therapy to maximize functionality and self-sufficiency.
Tertiary prevention
48
What level of prevention includes
| optimizing treatment for chronic conditions such as asthma, DM, physical or cognitive disability
Tertiary prevention
49
what type of screening includes all members of a population
Population screening
50
what type of screening is more selective and focuses on a population at risk
Targeted screening
ie) STI screening in sexually active adolescents and young adults in a specific age groups
51
Name that Bias
| Considering easily remembered diagnoses more likely irrespective of prevalence
Availability
52
Name that Bias
| Pursuing Zebras
Base Rate Neglect
53
Name that Bias
| Ignoring atypical features that are inconsistent with the favored diagnosis
Representativeness
54
Name that Bias
| Seeking data to confirm, rather than refute the initial hypothesis
Confirmation Bias
55
Name that Bias
| Stopping the diagnostic process too soon
Premature closure
56
What does the term Pursuing zebras mean
People ignore base rate (what is more likely) in favor of given individual information (the way someone appears)
57
Pt comes in with cough 1-3 weeks
myalgias
low grade fevers
what are you thinking?
Acute Bronchitis
| R/o flu, Covid, Pneumonia, RSV
58
Etiology for Acute bronchitis
Viral
Bacterial (<10%)
Noninfectious
59
Impaired mentation/swallowing
elderly
intoxicated (alcoholics)
poor dentition
think...
Aspiration pneumonia
60
```
Signs and symptoms
Fever
cough
chest pain
Putrid Sputum
Evolved over days not acute
Involves the basal segment of lower lobes
can also involve posterior segments of upper lobes
```
think aspiration pneumonia
61
```
productive cough
crackles
higher fevers
may have chest pain
SOB
Chills
could be viral or bacterial
```
Community acquired pneumonia
62
what views for chest x ray for pneumonia
PA and Lat better than AP
63
What are your differentials for Acute cough and congestion
```
Common cold
Sinusitis
bronchitis
influenza
Pertusis
Pneumonia
-CAP
-HAP
-AP
-TB
-PJP (fungal)
```
64
If Pneumonia develops more than 48 hours post hospital admission
Hospital acquired pneumonia
65
If pt develops pneumonia more than 48 hrs post intubation
Ventilator acquired pneumonia
66
```
abrupt onset
myalgia
diffuse pain
cough
rhinitis
pharyngitis
high fevers (peaks within 12 hours 40-41C)
Rigors
chills
headache
```
Influenza
67
when is flu season
December - march
68
time line of flu
1-5 days (3 typical)
69
If fever is increasing gradually over several days think
bacterial pneumonia
70
```
cough
rhinorrhea
sore throat
sneezing
but does not resolve after 3-7 days
may have posttussive emesis
```
pertussis
side note Whooping at end of cough is rare in adults
71
median duration of pertussis
42 days
72
```
immunocompromised
diagnosed/undiagnosed HIV
Progressive SOB
Dry cough 1-3 weeks
Often before diagnosed to aids
Chest x ray shows diffuse bilat pneumonia (diffuse symmetric bilat alveolar or interstitial infiltrates
cough
Progressive dyspnea
Lung sounds may be normal
CT scan shows patchy nodular ground glass appearance
```
PJP (Pneumocystis jirovecii pneumonia)
73
```
Mycobacteria in upper lobes
chronic cough, fever, weigh loss,
night sweats
economically disadvantaged
nursing homes
drug dependent
homeless
prison inmates
weeks to months
```
TB
74
People at high risk for TB
```
HIV
AIDS
Alcoholics
immunocompromised
Cancer
Diabetes
ESRD
Transplants
Malnutrition
TB previously on x ray
PPD+
```
75
```
Fever
Consolidation Xray
Lower middle lobes
PPD may be negative
may resolve on its own
```
Primary TB
76
Increased risk first 2 years
decline immune fx
typical tb symptoms
progresses unless pt is tx
Reactivated TB
77
Associated with at least 3 of the following:
- Easy fatigability
- Feeling restless or on edge
- Trouble concentrating
- Irritability
- Muscle tension
- Sleep disturbance
Daily functioning and performance is affected.
Symptoms cannot be explained by another psychiatric or medical condition.
Generalized anxiety disorder
78
Intense fear of social situations
Lifetime prevalence: 13%, 12-month prevalence: 7.4%
Social Anxiety disorder
79
Episodic attacks not brought on by a specific trigger
Characterized by an abrupt surge in fear or discomfort, peaking within a few minutes, accompanied by at least 4 of the following symptoms:
- Sweating
- Trembling or shaking
- Shortness of breath or feeling of smothering
- Chest pain or discomfort
- Feelings of choking
- Nausea or abdominal discomfort
- Feeling dizzy, lightheaded or faint
- Chills or heat sensations
- Paresthesias
- Feeling of feeling disconnected
- Fear of losing control
- Fear of dying
Lifetime prevalence: 6.8%, 12-month prevalence: 2.4%
Panic Disorder
80
Metabolic: Decreased metabolism that can lead to weight gain, cold intolerance, and increased total and low-density lipoprotein (LDL) cholesterol (due to decreased clearance)
Cardiac: Reduction in myocardial contractility and heart rate
Skin: Nonpitting edema, due to accumulation of glycosaminoglycans; dry skin; coarse, fragile hair
Central nervous system: fatigue, delayed relaxation phase of the deep tendon reflexes
Pulmonary: hypoventilation seen with severe hypothyroidism
Gastrointestinal: reduced intestinal motility causes constipation
Reproductive: menstrual abnormalities, reduced fertility, increased risk of miscarriage
Hypothyroidism
81
Labs for Hypothyroidism
TSH and free T4
82
screening questions for Insomnia
Difficulty initiating sleep, staying asleep, or both?
Early awakening?
Nonrestorative sleep?
Daytime consequences? (Lack of daytime fatigue or sleepiness suggests the insomnia is not clinically significant.)
Frequency and duration?
83
follow up questions for insomnia
Precipitating events, progression, ameliorating or exacerbating factors?
Sleep-wake schedule?
Cognitive attitude toward sleep?
Negative expectations regarding the ability to sleep and distortions about the effects of insomnia lead to perpetuation of the insomnia.
Attitudes toward previous treatments are also important.
Psychiatric disorder present?
Substance misuse or medication use?
Medical illness with nocturnal symptoms?
Symptoms of sleep apnea, restless legs? (See discussion below.)
84
complain of daytime sleepiness or fatigue. Bed partners often note snoring or actual apneic episodes. Most patients are obese.
obstructive sleep apnea
85
obstructive sleep apnea is more common in what gender?
men
86
Is obstructive sleep apnea more common pre or post menopausal
post menopausal
87
what questions would you ask about fatigue for a focused history and why
Can you tell me what you mean by fatigue?
How old are you?
Do you notice other symptoms with feelings of fatigue?
88
what are some other things that get confused with fatigue?
Weakness
| Frailty
89
frailty can be measured based on the presence of 5 symptoms
```
unintentional weight loss
slow mobility
weakness
decreased reduced activities
fatigue
```
90
Frailty increases the risk for
falls
91
5 key questions to tell if fatigue is physiologic?
```
Lifestyle habits? (exercise and diet)
Sleep pattern?
Do you require naps? how often?
Do you feel rested when you wake up in the morning?
Last menstrual period?
```
92
adequate amount of sleep for adults
6-8 hours
93
adequate amount of sleep for adolescents
8-9 hours
94
adequate amount of sleep for children
10 hours
95
sleep pattern related to depression
early-morning wakening and excessive sleeping during the day
96
Men over 50 with fatigue due to nocturia associated with
BPH
97
last normal menstrual period might tell us what about fatigue
early sign of pregnancy
symptom after childbirth
associated with menopause
perimenopausal adults as a r/o disrupted sleep due to hot flashes
98
what might finding out if someone practices safe sex tell us about fatigue
may be the initial and most prominent symptom of hepatitis, HIV, AIDS
99
What might finding out if someone takes medications have to do with fatigue
May be a side effect.
100
most common drugs that cause fatigue
```
antihypertensive drugs
cardiovascular meds
psychotropic meds
opiates
sedatives
antihistamines
```
101
What will asking about drinking alcohol tell us about fatigue
Alcohol abuse and use of recreational drugs may be overlooked as a cause of chronic fatigue in adolescents and school age children.
usually alcohol or marijuana
102
useful screening tool to assess for alcohol abuse
CAGE questionnaire
103
what does appetite tell us about fatigue
increased appetite may indicate hypoglycemia or hyperglycemia
increased thirst - hyperglycemia
decreased appetite - infectious process
104
What does weight loss tell us about fatigue
weight loss - malignancy, infection, poor nutrition r/t depression or lack of info on a healthy diet
105
weight loss of greater than 10lbs in the past year and may be associated with other signs and symptoms
unintentional weight loss
106
what will joint tenderness or pain tell us about fatigue
In children with Juvenile RA - severe fatigue
| young and middle aged patients - can involve multiple tender points on the body that are over joints
107
Increased urination and fatigue
Diabetes mellitus (esp type 2) often presents with fatigue along with Polydipsia, polyphagia and polyuria
108
Fatigue with specific symptoms that worsen over time such as dry skin, nails
Hypothyroid
109
Fatigue with shortness of breath with exertion or when laying flat
heart failure
110
what does fatigue have to do with where you work
occupational exposure - heavy metals and pesticides may cause fatigue and other neurologic symptoms
military returning from combat zones from unknown cause
111
what does fatigue have to do with if they have been camping
lyme disease is carried by the deer tick. They may present with weeks of malaise and chronic fatigue before any skin manifestations appear
112
fatigue that has a slow and progressive onset could be associated with ______
metabolic causes
113
What timeline is considered significant fatigue
greater than 2 weeks
114
what type of fatigue is usually worse in the morning
psychological fatigue
115
what will help relieve psychological fatigue
physical activity
116
what type of fatigue is not associated with intensity or duration of activity and is not relieved with rest or sleep
organic fatigue
117
why would you ask if they were a caregiver if they are having fatigue
Burnout
118
why would you ask if you or anyone in your family has a problem with anxiety or depression for someone with fatigue
children who have family members with depression are at a greater risk for depression.
119
Generally the first episode of major depression occurs between the ages of ----- and effects ____-
20 and 30 and effects women and transgender individuals more often then men
120
cc - fatigue
| fever
inflammation or infection
121
CC fatigue
| elevated HR
anxiety
anemia
dehydration
hyperthyroidism
122
CC fatigue
| abnormal BMI
poor nutritional status
| cardiovascular risk
123
cc fatigue
coarse, dry hair and skin
thickening of nails
hypothyroidism
124
cc fatigue
fine, limp hair
warm skin
hyperthyroidsim
125
cc fatigue
faint maculopapular rash
mononucleosis
126
CC fatigue
macular lesion with a clear center
lyme disease
127
cc fatigue
atrophic skin of the lower extremities
arterial insufficiency and underlying areriovascular disease
128
cc fatigue
swelling of ankles
varicose veins
skin ulcers
venous stasis
129
CC fatigue
evidence of nail biting
self inflicted excoriation lesions
Anxiety disorders
130
CC fatigue
petechiae on the palate
mononucleosis
131
CC fatigue
dry, cracked, ulcerated mucosa
nutritional deficiency or dehydration
132
CC fatigue
audible third or fourth heart sounds (S3, S4) in an adult
Heart failure
133
cc fatigue
increased AP diameter of the thorax
COPD
134
CC fatigue
Bilateral basilar rales
Congestive heart failure
135
Most pneumonia is on what sides
unilaterally
136
Barely audible breath sounds are associated with
COPD
137
CC fatigue
generalized symmetrical abdominal distension
obesity
enlarged organs
fluid (ascites)
gas
138
CC fatigue
concave contour of abdomen
dehydration or malnutrition
139
CC fatigue
a change in deep tendon reflexes may indicate
thyroid dysfunction
140
CC fatigue
diet history shows inadequate dietary intake of iron
Anemia
141
Pt reports cold intolerance, constipation, weight gain, hoarseness, depression, fatigue
physical exam shows bradycardia, dry skin, generalized edema, delayed recovery of deep tendon reflexes.
Hypothyroidism (myxedema)
142
Pt has increased sweating, heat intolerance, weight loss, irritability, disturbed sleep, menstrual irregularity.
Physical exam shows tachycardia, a-fib, tremor, warm moist skin, lid lag, exophthalmos
Hyperthyroidism (Graves disease)
143
What antihypertensive med is often associated with fatigue
B blockers
144
associated with dyspnea, orthopnea, paroxysmal nocturnal dyspnea, peripheral edema, weight gain, cough with forthy sputum, palpitations and fatigue
heart failure
145
```
gradual onset of low grade fever
sore throat
posterior cervical lymphadenopathy
fatigue
malaise
```
mononucleosis
146
```
malaise
fatigue
flulike symptoms
abd pain
arthralgia
aversion to smoking
```
hepatitis
147
occurs most often in women 20-50
chronic pain and stiffness of trunk and extremities esp in neck, shoulders, low back and hips
fatigue, headaches, sleep disturbance, bowel irritability
fibromyalgia
148
severe pain lasting longer than 6 mos and associated with impaired memory or concentration
sore throat, tender cervical or axillary lymph nodes
muscle pain
multiple joint pain
new onset headaches
nonrestorative sleep
postexertional malaise
chronic fatigue syndrome
149
Agitation and restlessness are common manifestations of
depression
anxiety
substance abuse
150
agitation, hypertension, and tachycardia occurring during the first 2 days after hospital admission
Alcohol withdrawal
Seizures may soon follow with delusions and delirium occurring during the first 3–5 days.
151
hallucinosis usually have a clear sensorium
Alcoholic hallucinosis (this is a distinguishing factor setting it apart from delirium)
152
Confusion, disorientation, and autonomic hyperactivity are hallmarks
delirium tremens (can be fatal)
153
Wernicke encephalopathy is not an alcohol withdrawal syndrome but is caused by
thiamine deficiency
154
Alcohol abuse is the most common cause of ___ deficeincy
Thiamine
155
Wernicke encephalopathy may occur when a patient, who is thiamine deficient, receives
intravenous glucose
156
Symptoms include the triad of confusion, disorders of ocular movement, and ataxia. The confusion commonly manifests as disorientation and indifference.
Wernicke encephalopathy
157
presents with memory problems and resulting confabulation
Korsakoff syndrome is the chronic form of Wernicke encephalopathy.
158
Adrenergic overactivity (hypertension, tachycardia, fever) is always present unless masked by medications.
delirium tremens
159
Alzheimer Disease most commonly occurs after the age of
65
160
Memory loss, behavioral or personality change, functional impairments, and social withdrawal
common early symptoms of AD.
161
most-evaluated instrument for diagnostic cognitive impairment
MMSE (mini mental status exam)
162
fluent aphasia, paraphasia, and word substitutions
language disturbances associated with AD
163
Highly educated patients are more likely or less likely to receive an early diagnosis for AD
less likely
164
3 tests for dementia
MMSE (mini mental status exam)
Mini-Cog
MoCA
IQCODE
165
which mental screening exam includes 3-item recall and clock drawing
mini-cog
166
which mental screening exam was Initially developed and validated as a screening test for MCI (mild cognitive impairment)
MoCA
167
which mental screening exam is a Short form is a 16-item questionnaire.
IQCODE
168
Considered the clinical gold standard for diagnosing dementia
Neuropsychiatric testing
169
Reasons to explore for reversible dementia
CNS infections
Hypothyroidism
Vitamin B12 deficiency
CNS masses
Neoplasms
Subdural hematomas
Normal-pressure hydrocephalus
Medications
170
tests for dementia
CBC
Thyroid-stimulating hormone (TSH)
Basic metabolic panel and liver biochemical tests
Vitamin B12 level
Tests to exclude neurosyphilis
Consider neuroimaging (MRI or CT)
Imaging is not required in most patients with dementia.
In practice, most patients will undergo imaging both to assess for diagnoses other than AD and to detect brain atrophy that may support the diagnosis of AD.
171
manifests as inattention and confusion
Delirium
172
Several conditions are more likely to cause delirium than others.
Severe illness
Drug toxicity
Fluid and electrolyte disturbances (hyponatremia and azotemia)
Infections
Hypothermia or hyperthermia
173
Delirium is very common in
sick, hospitalized patients over the age of 65
174
The prognosis of delirium is
poor
patients who experienced delirium had a higher risk of death, institutionalization, and dementia during follow-up.
175
the best-validated and most widely used tool for diagnosing delirium.
The Confusion Assessment Method (CAM)
176
typically seen in a patient with Parkinson disease who has dementia. In patients without a previous diagnosis of Parkinson disease, motor symptoms similar to those seen in Parkinson disease are often present.
Dementia with Lewy Bodies (DLB)
177
screening tool for Validated for use in older adults to assist in depression diagnosis
PHQ-9 (Personal Health Questionaire):
178
what type of dementia - Visual hallucinations are common
Dementia with Lewy Bodies (DLB)
179
Mild extrapyramidal motor symptoms (rigidity and bradykinesis) are often seen early in this type of dementia
Dementia with Lewy Bodies (DLB)
180
Repeated falls
Syncope
Transient loss of consciousness
Neuroleptic sensitivity
Systematized delusions and hallucinations
Dementia with Lewy Bodies (DLB)
181
what does SOAP note include
```
Chief Complaint (subjective)
History of Present Illness (subjective)
Family/medical/surgical histories (subjective)
Review of systems (subjective)
Physical exam (objective)
Assessment
Plan
```
182
most likely diagnosis based on prevalence, demographics, risk factors, signs & symptoms
Leading hypothesis
183
Hypothesis generating starts with
patient’s demographics
184
most significant factor of pt demographics
Age
185
problem specific framework for Frequently used for chest pain
anatomic
186
problem specific framework Used for problems with very broad differentials such as fatigue
Organ based /system based
187
PQRST
P(provocative, palliative) What brings it on, what makes it better
Quality - what does it feel like
Region/radiate where is it at and where does it radiate
Severity and setting - how bad is it? What were you doing at the time
Temporal - when did it start, how long does it last, have you had it before
188
what framework?
What could be happening pathologically(what diseases could) to make this symptom happen
organic
189
VINDICATE
```
Vascular,
Infection
Neoplastic
Degenerative,
Idiopathic/Inflammatory
Congenital
Autoimmune,
Traumatic
Endocrine
```
190
MEDICINE
```
Metabolic/Medication
Endocrine
Degenerative,
Infection/Ischemia/Infarction
Congenital
Neoplastic,
Electrical( Neuro/Psych)
```
191
VITAMINCDE
```
Vascular
Infection/Ischemic/Infarction
Trauma/Toxin
Autoimmune
Metabolic/Medications
Iatrogenic/Idiopathic,
Neoplastic
Congenital
Degenerative
Electrical (Neuro/psych)
```
192
What is the order problems should be listed in a problem list
begin with the acute problems, followed by chronic active problems, ending with inactive problems (past medical history)
193
Organic (chronic) causes of fatigue
sleep apnea, medications, HF, cancer, EBV, hepatitis, fibromyalgia, chronic fatigue syndrome
194
Organic (acute) causes of fatigue
infection, drugs/alcohol, anemia, hypothyroidism, hyperthyroidism
195
fatigue presentation in children
Withdrawn from social and recreational activities → mood disturbances
196
fatigue presentation in adolescents
Withdrawn from social/recreational activities → mood disturbances
Decreased academic performance and decreased productivity
Recreational drug and alcohol use, high caffeine intake
197
an older patient complaining of memory loss. Common complaints are difficulty remembering names and appointments or solving complex problems
mild cognitive impairment
198
people have memory loss and no other deficits
Single domain amnestic MCI
199
people have memory loss as well as other deficits
Multiple domain amnestic MCI
200
people have impairment in a single, non–memory-related, cognitive domain.
Single domain non-amnestic MCI
201
people have impairment in multiple, non–memory-related, cognitive domain.
Multiple domain non-amnestic MCI
202
may be abrupt or gradual. The patient usually has risk factors for, or has previously diagnosed, vascular disease. The patient may have gait disturbance during the neurologic exam.
Multi-infarct Dementia (Vascular Dementia, VaD)
203
the most common cause of dementia after AD.
Multi-infarct Dementia (Vascular Dementia, VaD)
204
Most common in patients with risk factors for vascular disease or an embolic stroke
Multi-infarct Dementia (Vascular Dementia, VaD)
205
Screening tool for Multi-infarct Dementia (Vascular Dementia, VaD)
DSM-5 criteria
206
Exaggeration of deep tendon reflexes
Extensor plantar response
Gait abnormalities (consider history of unsteadiness and frequent, unprovoked falls)
Pseudobulbar palsy (pathologic laughing, crying, grimacing; and weakness of the muscles associated with cranial nerves V, VII, IX, X, XI, and XII)
Focal neurologic signs
Multi-infarct Dementia (Vascular Dementia, VaD)
207
clinically useful test for determining whether ischemic disease is playing a role in a patient’s dementia.
Hachinski Ischemic Score
208
cc fever
| why is it important to ask about recent head trauma?
recent head trauma esp at base of skull may provide entrance for infectious organisms
209
cc fever
| why ask about recurrent ear infections
may have mastoiditis spreading to meninges
210
```
headache
fever
lethargy
confusion
vomiting
stiff neck
```
meningitis
211
why is fever younger than 2 mos significant
neonates and young infants are less able to mount a febrile response so when they do it is significant
212
fevers in a neonate may also be an indication of an
underlying anatomical defect
| URI and bacteremia is often the first indications of a structural abnormality of the urinary tract
213
genetic disorder that may present in the first weeks to 1 month of life with gram negative sepsis
galactosemia - rare genetic metabolic disorder (affects ability to metabolize the sugar (galactose) properly
214
all infants younger than 2 months with fever are considered to have ____ or ____ until proven otherwise
Sepsis or meningitis
215
in adults fevers from acute process usually resolves in
1-2 weeks
216
fevers that last > 3 weeks that exceed temp of 38.4 (101.1) and remain undiagnosed after 1 week of intensive diagnostic study are classified as
FUOS
217
fever in children with short duration, readily diagnosed and resolves within 1 week
short term fever
218
fever in children < 10 days that is not explained by findings on history or physical exam
fever without localizing signs
219
fever in children greater than 38.5 (101.2) that lasts longer than 2 weeks on more than 4 occasions
FUOs
220
Fever greater than 41.1C (106) are seen in
heat illness
CNS disease
infection
221
the higher the fever, the greater likelihood of
bacteremia
222
most common infection in girls younger than 2 years old who present with a high fever and in all infants younger than 90 days with a fever
UTI
223
fever
| increased amount of vaginal discharge and bleeding after intercourse
PID
224
```
chills
high fever
urinary frequency and urgency
perineal pain
low back pain
penile discharge
```
acute UTI in male
225
CC fever
joint pain
connective tissue disorder in adults and children older than 6.
osteomyelitis or septic arthritis
226
rash for hand foot mouth usually erupts on what day
3 days
227
rash for measles usually erupts on what day
4 days
228
Rash for roseola infantum usually erupts on what day
5 days
229
rash for scarlet fever usually erupts on what day
2 day
230
rash for varicella, rubella, erythema infectiosiosum usually erupts on what day
1
231
infections to r/o with history of travel outside the country
```
amebiasis
malaria
schistosomiasis
typhoid fever
hepatitis A or B
Dengue
```
232
the most common vector borne disease worldwide and is a diff diagnosis for pt who live or have recently traveled to the tropics or subtropical areas of the US
Dengue
233
recent camping or exposure to wooded areas may indicate
```
exposure to ticks
Q fever
tularemia
rocky mountain spotted fever
giardia
lyme disease
```
234
what overdose can cause fever
ASA
235
food poisoning fevers can occur up to ____ hours after ingestion of contaminated food
72
236
what plants can cause fever
plants containing the alkaloid atropine (deadly nightshade, jessamine, and thornapple)
cause dilated pupils, flushed skin and fever
237
bacterial infection transmitted by cats (changing kitty litter boxes. )
Cat-Scratch disease or toxoplasmosis (single node or regional adenopathy is the dominant clinical feature)
238
What is the etiologic agent of Cat Scratch disease
Gram neg bacillus
239
bacterial infection transmitted by dogs
brucellosis and leptospirosis
240
bacterial infection transmitted by rabbits
tularemia
241
bacterial infection transmitted by birds
ornithosis
histoplasmosis
psittacosis
242
bacterial infection transmitted by hamsters or cats
lymphocytic choriomeningitis
243
hyperthermia and change in LOC
classic heat stroke
244
causes of fever of unknown orgin in child
```
infectious disease (localized and systemic)
collagen/inflammatory diseases
neoplastic diseases
drug fever
factitious fever
kawasaki disease
inflammatory bowel disease
immunodeficiency
CNS dysfunction
```
245
CC fever
petechial eruptions on the hard and soft palate
mononucleosis
246
cc fever
splinter hemorrhages found in the nail beds and petechiae of the conjunctivae
endocarditis
247
cc fever
petechial skin rash
meningococcemia
rocky mountain spotted fever
anticoagulation treatment outside of therapeutic range
indicates a serious infection that requires immediate referral and hospitalization
248
inspecting the fontanel of an infant is best noted if the patient is in what position
sitting
249
cc fever
palpable anterior cervical lymph nodes
suspect viral or bacterial pharyngitis
250
cc fever
palpable preauricular or postauricular lymph nodes
suspect ear infection
251
cc fever
palpable submental and submandibular lymph nodes
suspect tooth abscess
252
cc fever
palpable posterior cervical lymph nodes
suspect mononucleosis
253
cc fever
palpable supraclavicular lymph nodes
suspect neoplasm
254
cc fever
palpable axillary lymph nodes
suspect breast inflammation, local infection or neoplasm
255
cc fever
palpable inguinal lymph nodes
Suspect a STI
256
cc fever
localized lymphadenopathy
suspect local infectious process
257
cc fever
generalized lymphadenopathy
suspect immunosuppression such as HIV positive or neoplasm
258
yellow green sputum
suspect bacterial infection
259
brown sputum
check smoking history
260
blood streaked sputum
Suspect URI or bronchitis
261
hemoptysis
suspect tumor, trauma, pneumonia, TB or PE
262
Clear sputum
COPD or emphysema without infection
263
cervical motion tenderness
discharge
adnexal tenderness
lower abd tenderness
PID
264
Penis with fever and discharge
STI
UTI
prostatitis
265
tenderness and discharge during a rectal exam
rectal abscess/infection
| retrocecal appendicitis
266
If you suspect prostatitis, do not
perform a vigorous exam or massage the prostate bc this can release bacteria and produce septicemia
267
Osteomyelitis may occur in young children most commonly between ages
3-10
268
Septic arthritis can occur in children
under the age of 3 and in young women who are sexually active
269
Brudzinski sign
with the patient supine, attempt to flex the neck cause the knees and hips to rise from the bed to reduce the pull on the meninges. test for meningitis
270
kernig sign
attempt to extend the knee joint when the hip joint is flexed are resisted and the other limb may flex at the hip . - meningitis
271
```
disturbances in mentation
irritability
lethargy
somnolence
coma
```
indicates increased intracranial pressure
272
a seizure in a febrile infant younger than 6 months old is suggestive of
meningitis rather than simple febrile seizures
273
fever, sinuses that are tender to percussion or do not transilluminate. Pt often report a frontal headache that worsens as they lean forward. sometimes an upper incisor toothache, sore throat, cough from postnasal discharge
Acute sinusitis
274
a vasculitic syndrome affects infants and young children younger than age 9. Acute mucocutaneous lymph node syndrome. fevers range 38C-40C (100.4-104) and persist despite antibiotics and antipyretics. Seizures may be present ...febrile phase lasting 5-25 days. Rash.
Kawasaki disease
275
fever lasting at least 5 days
and at least four of the following:
Bilat conjunctival hyperemia
mouth lesions: dry fissured lips, injected pharynx or strawberry tongue
changes in peripheral extremities (edema, erythema, desquamation of skin at 10-14 days)
Nonvesicular erythematous rash
cervical lymphadenopathy
Kawasaki disease
276
fever lasting at least 5 days
and at least four of the following:
Bilat conjunctival hyperemia
mouth lesions: dry fissured lips, injected pharynx or strawberry tongue
changes in peripheral extremities (edema, erythema, desquamation of skin at 10-14 days)
Non-vesicular erythematous rash
cervical lymphadenopathy
Kawasaki disease
277
the most common exanthema (skin rash) of children younger than 3 yrs old with irritability, high fever, rash that appears on day 3-4 and lasts 1-2 days
Roseola Infantum
278
mild nonspecific, febrile illness that lasts 2-5 days
herpangina
nonexudative pharyngitis with or without lymphadenopathy
enterovirus
279
fever in child older than 3 months who have pos blood cultures but do not have the usual clinical manifestations of sepsis.
occult bacteremia
| occult means hidden
280
peak ages for bacteremia are ages
6-24 months
281
what organism is most commonly responsible for bacteremia in peak age group
streptococcus pneumoniae
282
condition characterized by an abrupt fever that occurs in children ages 2-5 on a regularly recurring basis every 6 weeks. Lasts average of 4 days. other symptoms include malaise, sore throat, cervical adenopathy and aphthous stomatitis
Periodic fever in children
| no associated diseases or other physical exam or lab findings with normal growth and development
283
Weight loss after birth is normal, but expected to start to gain weight within the
first 2 weeks of life
284
In newborns Decrease in weight of more than ___ and necessitates _____
8% necessitates follow up within 48 hours and a bilirubin check
285
in newborns Loss of more than 10% of birth weight necessitates
careful assessment and potential hospital admission
286
Components of a Mental health history (
Acute (days to weeks) or chronic (weeks to months)
Alertness, orientation, attention, mood, judgement, affect, language, cognitive function, thought process/perception (unusual thoughts)
Use OLDCARTS/COLDSPA
Find out about developmental age (ex: prematurity, autism)
Academic history (ex: learning disabilities)
Difficulty with authority (ex: teachers, parents)
Pertinent past medical history (including mental health, medications)
Substance use (ex: drugs, alcohol, OTC, herbal, caffeine)
Culture/religion, coping/support systems
Sleep pattern (ex: hours/night, disrupted sleep)
287
somatic
Physical symptoms
288
Somatic symptoms are either very distressing or result in significant disruption of functioning, as well as excessive and disproportionate thoughts, feelings, and behaviors related to those symptoms. Symptoms should be specific if with predominant pain.
Somatic symptom disorder
289
Preoccupation with having or acquiring a serious illness where somatic symptoms, if present, are only mild in intensity.
Illness anxiety disorder
290
Syndrome of symptoms of deficits mimicking neurologic or medical illness in which psychological factors are judged to be of etiologic importance.
Conversion disorder
291
Presence of one or more clinically significant psychological or behavioral factors that adversely affect a medical condition by increasing the risk for suffering, death, or disability
Psychological factors affecting other medical conditions
292
Falsification of physical or psychological signs or symptoms, or induction of injury or disease, associated with identified deception. The individual presents himself or herself as ill, impaired, or injured even in the absence of external rewards.
Factitious disorder
293
Preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear only slight to others.
Body dysmorphic disorder
294
Disruption of and/or discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior.
Dissociative disorder
295
for the five most common disorders in primary care: depression, anxiety, alcohol, somatoform, and eating disorders
however, it contains 26 questions and takes up to 10 minutes to complete
what is the shorter version?
PRIME-MD (Primary Care Evaluation of Mental Disorders);
PRIME-MD Patient Health Questionnaire, available as patient health questionnaire for self-rating; takes approximately 3 minutes.
296
high yield questions for Depression
Over the past 2 weeks, have you felt down, depressed, or hopeless?22,28,29
Over the past 2 weeks, have you felt little interest or pleasure in doing things (anhedonia)?
297
High yield questions for anxiety
Over the past 2 weeks, have you been feeling nervous, anxious, or on edge?
Over the past 2 weeks, have you been unable to stop or control worrying?
Over the past 4 weeks, have you had an anxiety attack—suddenly feeling fear or panic?
298
screening tool for anxiety
Whiteley Index: 14-item self-rating scale
299
Distrust and suspiciousness
Detachment from social relations with a restricted emotional range
Eccentricities in behavior and cognitive distortions; acute discomfort in close relationships
Paranoid
Schizoid
Schizotypal
cluster personality type A for DSM 5
300
Disregard for, and violation of, the rights of others
Instability in interpersonal relationships, self-image and affective regulation; impulsivity
Excessive emotionality and attention seeking
Persisting grandiosity, need for admiration and lack of empathy
Antisocial
Borderline
Histrionic
Narcissistic
cluster personality type B for DSM 5
301
Social inhibition, feelings of inadequacy and hypersensitivity to negative evaluation
Submissive and clinging behavior related to an excessive need to be taken care of
Preoccupation with orderliness, perfectionism, and control
Avoidant
Dependent
Obsessive–compulsive
cluster personality type C for DSM 5
302
These patients show “a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity.”[12] They make “frantic efforts to avoid real or imagined abandonment” and show recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
Patients often report feeling depressed and empty, with mood swings that spiral out of control leading to feelings of rage, sadness, and anxiety. To clinicians, these patients may appear demanding, disruptive, or manipulative.
Borderline Personality Disorder
303
The ability to focus or concentrate over time on a particular stimulus or activity—an inattentive person is easily distractible and may have difficulty giving a history or responding to questions.
Attention
304
The process of registering or recording information, tested by asking for immediate repetition of material, followed by storage or retention of information. Recent or short-term memory covers minutes, hours, or days; remote or long-term memory refers to intervals of years.
Memory
305
Awareness of personal identity, place, and time; requires both memory and attention
Orientation
306
Sensory awareness of objects in the environment and their interrelationships (external stimuli); also refers to internal stimuli such as dreams or hallucinations.
Perceptions
307
The logic, coherence, and relevance of the patient's thought as it leads to selected goals; how people think
Thought processes
308
What the patient thinks about, including level of insight and judgment
Thought content
309
Awareness that symptoms or disturbed behaviors are normal or abnormal; for example, distinguishing between daydreams and hallucinations that seem real.
Insight
310
Process of comparing and evaluating alternatives when deciding on a course of action; reflects values that may or may not be based on reality and social conventions or norms
Judgment
311
A fluctuating pattern of observable behaviors that expresses subjective feelings or emotions through tone of voice, facial expression, and demeanor. Disturbed affect may be flat, blunted, labile, or inappropriate.
Affect
312
A more pervasive and sustained emotion that colors the person's perception of the world. (Affect is to mood as weather is to climate.) Mood may be euthymic (in the normal range), elevated, or dysphoric (unpleasant, possibly as sad, anxious, or irritable), for example.
Mood
313
A complex symbolic system for expressing, receiving, and comprehending words; as with consciousness, attention, and memory, language is essential for assessing other mental functions
Language
314
Assessed by vocabulary, fund of information, abstract thinking, calculations, construction of objects that have two or three dimensions
Higher cognitive functions
315
characterized by re-experiencing, avoidance,
posttraumatic stress disorder
316
with recurrent panic attacks followed by a period of anxiety about further attacks
panic disorder
317
depression is twice as common in what gender
women
318
loss of pleasure in daily activities
anhedonia
319
Mental Status Examination consists of five components
appearance and behavior; speech and language; mood; thoughts and perceptions; and cognitive function
320
Lethargic patients vs Obtunded
Lethargic patients are drowsy, but open their eyes and look at you, respond to questions, and then fall asleep.
Obtunded patients open their eyes and look at you, but respond slowly and are somewhat confused.
321
Grooming and personal hygiene may deteriorate in
depression, schizophrenia, and dementia.
322
One-sided neglect may result from
a lesion in the opposite parietal cortex, usually the nondominant side.
323
Watch for the anger, hostility, suspiciousness, or evasiveness of patients with
paranoia
324
flat affect and remoteness of
schizophrenia
325
the apathy (dulled affect with detachment and indifference) of
dementia
| and anxiety or depression
326
Hallucinations occur in
schizophrenia, alcohol withdrawal, and systemic toxicity.
327
refers to defective articulation
Dysarthria
328
is a disorder of language.
Aphasia
329
results from impaired volume, quality, or pitch of the voice
Dysphonia
330
reflects the rate, flow, and melody of speech and the content and use of words.
Fluency
331
which phrases or sentences are substituted for a word the person cannot think of, such as “what you write with” for “pen”
Circumlocutions
332
in which words are malformed (“I write with a den”), wrong (“I write with a bar”), or invented (“I write with a dar”).
Paraphasias
333
The mildest thought disorder, consisting of speech with unnecessary detail, indirection, and delay in reaching the point. Some topics may have a meaningful connection. Many people without mental disorders have circumstantial speech.
Circumstantiality
334
“Tangential” speech with shifting topics that are loosely connected or unrelated. The patient is unaware of the lack of association.
Derailment (loosening of associations)
335
An almost continuous flow of accelerated speech with abrupt changes from one topic to the next. Changes are based on understandable associations, plays on words, or distracting stimuli, but ideas are not well connected
Flight of Ideas
336
Invented or distorted words, or words with new and highly idiosyncratic meanings.
Neologisms
337
Speech that is incomprehensible and illogical, with lack of meaningful connections, abrupt changes in topic, or disordered grammar or word use. Flight of ideas, when severe, may produce incoherence.
Incoherence
338
Sudden interruption of speech in midsentence or before the idea is completed, attributed to “losing the thought.” Blocking occurs in normal people.
Blocking
339
Fabrication of facts or events in response to questions, to fill in the gaps from impaired memory.
Confabulation
340
Persistent repetition of words or ideas.
Perseveration
341
Repetition of the words and phrases of others.
Echolalia
342
Speech with choice of words based on sound, rather than meaning, as in rhyming and punning. For example, “Look at my eyes and nose, wise eyes and rosy nose. Two to one, the ayes have it!”
Clanging
343
Circumstantiality occurs in people with
obsessions.
344
Derailment is seen in
schizophrenia, manic episodes, and other psychotic disorders.
345
Flight of ideas is most frequently noted in
manic episodes.
346
Neologisms are observed in
schizophrenia, psychotic disorders, and aphasia.
347
Incoherence is seen in
severe psychotic disturbances (usually schizophrenia).
348
Blocking may be striking in
schizophrenia.
349
Confabulation is seen in
Korsakoff syndrome from alcoholism.
350
Perseveration occurs in
schizophrenia and other psychotic disorders.
351
Echolalia occurs in
manic episodes and schizophrenia.
352
Clanging occurs in
schizophrenia and manic episodes.
353
A sense that one's self or identity is different, changed, unreal; lost; or detached from one's mind or body
Depersonalization
354
Compulsions, obsessions, phobias, and anxieties often occur in
anxiety disorders.
355
Misinterpretations of real external stimuli, such as mistaking rustling leaves for the sound of voices.1
Illusions
356
Perception-like experiences that seem real but, unlike illusions, lack actual external stimulation. The person may or may not recognize the experiences as false. Hallucinations may be auditory, visual, olfactory, gustatory, tactile, or somatic. False perceptions associated with dreaming, falling asleep, and awakening are not classified as hallucinations.
Hallucinations
357
Illusions may occur in
grief reactions, delirium, acute and posttraumatic stress disorders, and schizophrenia.
358
Hallucinations may occur in
delirium, dementia (less commonly), posttraumatic stress disorder, schizophrenia, and alcoholism.
359
Remote memory may be impaired in
(Inquire about birthdays, anniversaries, social security number, names of schools attended, jobs held, or past historical events such as wars relevant to the patient's past. )
late stage of dementia.
360
Recent memory is impaired in
dementia and delirium
361
impair memory or new learning ability and reduce social or occupational functioning, but lack the global features of delirium or dementia
Amnestic disorders
362
delirium causes
acute onset
| Metabolic (temp, electrolytes, dehydration), medication, infectious, psychiatric, or cardiac causes
363
High risk of developing delirium
poor vision, severe illness, cognitive impairment, high BUN/Cr
364
delirium vs dementia
| Chronic over weeks to months, insidious in onset
dementia
365
delirium vs dementia
| acute onset
delirium
366
delirium vs dementia
Attention intact with impaired cognition and may have CNS symptoms or risk factors
dementia
367
reversible causes of dementia
hydrocephalus, HIV, B12 deficiency, hypothyroidism, subdural hematoma
368
irreversible causes of dementia
Alzheimer’s, vascular dementia, Lewy bodies, TBI, Parkinson’s
369
screening tool
Less sensitive for mild dementia, better at detecting moderate to severe dementia
High sensitivity and specificity
Influenced by age and education level (highly educated are less likely to receive early diagnosis)
MMSE (mini mental status exam): most-evaluated instrument for diagnostic cognitive impairment
370
Test for dementia, MCI
| Highly sensitive
MoCA (Montreal Cognitive Assessment):
371
screening tool
| Validated for use in older adults to assist in depression diagnosis
PHQ-9 (Personal Health Questionnaire):
372
2 Questions for Suicide Screening:
In the past week have you wished you were dead or wished that you could fall asleep and not wake up?
In the past week, have you had any actual thoughts of killing yourself?
373
CAGE (substance abuse screen) what does this stand for
Cutting down, Annoyance, Guilty feeling, Eye openers
374
T-ACE, CRAFT screen for what
alcohol screen
375
Adolescent screen for situational stress, substance abuse, relationship, safety screening:
HEEADSSS
376
Relationship screening (domestic violence):
“Have you been hit, kicked, punched, or otherwise hurt by someone within the past year?”
“Do you feel safe in your current relationship?”
“Is there a partner from a previous relationship who is making you feel unsafe now?”
377
BATHE model:
| is for what
situational stress
378
BATHE
Background: context of the visit
Affect: elicits the emotional response and allows the patient to label the feeling
Trouble: determines the symbolic meaning of the situation for the patient
Handling: helps to assess patient’s resources and responses to the situation
Empathy: reflects an understanding that the patient’s response is reasonable under the circumstances
379
Issues affecting sleep in women
Menopause: causes sleep disturbances, hot-flashes can awaken from sleep, reduce total sleep time, prolonged time to initiate sleep, and reduced REM sleep
380
Allow children to fall asleep on their own using self-comforting measures so that they can
fall back asleep during the night on their own
381
recommendations for a bedtime routine
no vigorous activity before bedtime, no caffeine, too-early bedtime can lead to problems falling asleep
382
Children may use resistance to bedtime as an issue of
control or pattern of oppositional behavior
383
nocturnal episodes of inconsolability, screaming, crying for up to 30 minutes (age 3-10 years)
Night terrors -
384
viral causes of sore throat
Rhinovirus (common cold)
Coronavirus (common cold)
Adenovirus (Acute respiratory disease)
Herpes simplex virus (HSV) 1 & 2 (stomatitis, pharyngitis)
Influenza A and B (Influenza)
Parainfluenza virus (common cold)
Epstein-Barr Virus (EBV) (Infectious mononucleosis)
Cytomegalovirus (CMV) (Infectious mononucleosis)
Human Herpesvirus (HHV) 6
HIV (primary HIV infection)
385
Group A B-hemolytic streptococcus (pharyngitis, tonsillitis)
Fusobacterium Necrophorum (pharyngitis, peritonsillar abscess, Lemierre syndrome (rare))
Group C beta-hemolytic streptococci (pharyngitis, tonsillitis)
Neisseria gonorrhoeae (pharyngitis)
Corynebacterium diphtheria (Diphtheria)
Mycoplasma pneumoniae (pneumonia, bronchitis)
Chlamydophila pneumoniae (pneumonia, bronchitis)
bacterial causes of sore throat
386
noninfectious reasons for sore throat
```
Persistent cough
Postnasal drip
Gastroesophageal reflux disease
Acute thyroiditis
Neoplasm
Allergies
Smoking
```
387
Fever, sore throat, muffled hot potato voice, drooling, and stridor presenting symptoms
Airway obstruction causing- wheezing, stridor, and drooling
Caused by H influenzae (swelling of epiglottis) and other viruses
Airway emergency
Epiglottitis
388
Diagnostic for Epiglottitis
Direct or indirect laryngoscopy
Be prepared to intubate patient or trach
Patient sitting in an erect position with stridor big sign
“Thumb sign” of swollen epiglottis on lateral neck films, negative film does not rule it out.
389
Rapid onset of severe throat pain
Moderate fever (39-40.5C)
Malaise
Headaches
Throat Examination
Edema, erythema of posterior pharynx and tonsils are often covered with grey/white exudates
Tender anterior cervical lymph nodes
GI symptoms: nausea, vomiting, abdominal pain (especially in children)
Untreated last 8-10 days
Postinfectious symptoms: acute rheumatic fever and post-streptococcal glomerulonephritis
Group A Beta- Hemolytic Streptococci pharyngitis
390
diagnosing Group A Beta- Hemolytic Streptococci pharyngitis
```
Throat culture-
high sensitivity, high specificity
24-72 delay in results
RADT (rapid antigen detection test)
Results a few minutes
Sensitivity 70-90%
Specificity 90-100%
```
391
S/S
Fever, malaise, chills, and sweats. The classic triad of severe sore throat, fever and lymphadenopathy
15-24 years of age
Usually caused by EBV, but can be caused by CMV or HHV 6
Shed via salivary secretions
90% of adults are EBV seropositive
Physical exam findings
Enlarged tonsils, pharyngeal erythema, thick coating, pharyngeal exudate, palatal petechiae, and tender anterior and/or posterior cervical adenopathy (very specific for EBV)
Infectious Mononucleosis
392
Diagnostic Testing
| Infectious Mononucleosis
Monospot test
-Specificity 99%
-Sensitivity
-False negatives 25% in first week
Serum IgM antibody
-Highly accurate test, takes longer
-Used when mono suspected but negative monospot
Elevated aminotransferases
Lymphocytosis and the presence of atypical lymphocytes
393
Severe fever, respiratory illness, begins abruptly (hit by a train), diffuse pain, respiratory symptoms (cough, rhinitis, pharyngitis), may have chills and headache, crackles in 25%
Usually have cough but may not in the elderly
Winter months
Usually no GI symptoms
Influenza
394
Diagnostic flu
History, physical exam, and vaccination status, also flu season vs. non flu season time.
RT- PCR (gold standard)
Rapid test
Patients with pneumonia should have additional testing for co-infection including a sputum gram stain, sputum and blood cultures, and urine for streptococcal and legionella antigen.
395
Septic thrombophlebitis of the internal jugular vein
Lemierre Syndrome
396
High fevers, rigors, respiratory distress, and neck/throat pain
Exam may reveal ulceration, pseudomembrane or erythema
Tenderness and swelling may be observed overlying the jugular vein
May have no abnormal physical findings
Rare but life threatening
Usually caused by 81% F necrophorum
Some symptoms sometimes seen but not seen in pharyngitis is dyspnea, pleuritic chest pain, abdominal pain, and trismus
Can see emboli from septic thrombophlebitis also cause bone and joint complications, liver abscess, CNS complications
Septic thrombophlebitis and septic emboli can mask the initial complications of oropharyngeal symptoms
Lemierre Syndrome
397
Diagnostic for Lemierre Syndrome
Anaerobic primary infection of the oropharynx
Subsequent septicemia (1 positive blood culture)
Metastatic infection of 1 or more distant site
Thrombophlebitis of the internal jugular vein
CT scan of neck with contrast is best diagnostic modality
398
S/S- severe unilateral sore throat, fever, muffled hot potato voice, malaise,
dysphagia, otalgia, pain when swallowing, drooling of saliva, trismus (difficulty opening mouth d/t pain)
Exam reveals- extremely swollen tonsil with the displacement of the uvula to the unaffected side, bulging soft palate on the affected side, tender cervical lymphadenitis on the affected side
Peritonsillar Abscess
399
nonspecific and resolve spontaneously without treatment
Fever, lymphadenopathy, sore throat, rash, myalgia/arthralgia, headache, and mucocutaneous ulcers
Highest in men who have sex with men, injection drug users, commercial sex workers, high number of sexual partners
Primary HIV Infection- Acute Retroviral Syndrome
400
testing for Primary HIV Infection- Acute Retroviral Syndrome
Fourth generation HIV immunoassay
| HIV viral load assay
401
Children and/or adults
Symptoms similar to epiglottitis but recent hx of upper respiratory infection or trauma from recent ingested material (bones) or procedures
Retropharyngeal Abscess
402
Epiglottitis vs retropharyngeal abscess
Sense lump in throat
| Comfortable supine with neck extended (opposite of epiglottitis
403
Diagnosis of Retropharyngeal Abscess
Thickening of the retropharyngeal tissues is seen on lateral neck radiographs
If xray normal CT scan should be done to verify the diagnosis
404
viral vs bacterial pharyngitis
Cough, coryza, rhinorrhea, and hoarseness, congestion, conjunctivitis, sometimes diarrhea
Usually rhino, adeno, corona
viral
405
Fevers, throat pain, but usually associated with cough and myalgias
Influenza (Viral)
406
-fever, sore throat, ages 15-24, and associated with malaise and marked adenopathy
EBV
407
Nonspecific symptoms of pharyngitis, fever, mucocutaneous ulcers, adenopathy, fatigue, and should be considered in people with high risk behaviors
HIV (Viral)
408
Fever, tender anterior cervical lymphadenopathy, tonsillar erythema with or without tonsillar swelling and exudates.
Bacterial
409
Early stage
Signs- microaneurysms and retinal hemorrhages
Lack of perfusion leads to ischemia due to cotton wool spots, venous bleeding, and intraretinal vascular abnormalities
nonproliferative retinopathy
410
Advanced
New blood vessels on the retina or optic disk d/t ischemia
Vision loss occurs due to vitreous hemorrhage, fibrosis, or retinal detachment
Proliferative diabetic retinopathy
411
Happens at any stage of retinopathy
Leading cause of vision loss in persons with diabetes
Increased vascular permeability causes plasma leaks from the macular vessels, leading to swelling and formation of hard exudates at the central retina
Diabetic macular edema
412
Eye changes are more likely to occur when
risk factors are present such as duration of DM, elevated HbA1C level, hypertension, dyslipidemia, pregnancy, and nephropathy
413
Type 1 and 2 DM common complications
```
Retinopathy
Peripheral neuropathy and foot ulcers
Nephropathy
Dyslipidemia
Hypertension
Smoking
Obesity
Coronary artery disease
Cerebrovascular disease
HHS
DKA
Peripheral arterial disease
Foot ulcers
Osteomyelitis
```
414
when do you screen for diabetic retinopathy in Type 1DM
within 5 years of dx onset and annual exams
415
when do you screen for diabetic retinopathy in Type 2DM
time of diagnosis and at least annual exams
416
Important physical examinations specific to individual with DM
Obesity, particularly central
Hypertension
Eye-hemorrhages, exudates, neovascularization
Skin-acanthosis nigricans (particularly in the dark skinned ethnic and racial groups) candida infections
Neurologic-decreased or absent light touch, temperature sensation and proprioception; loss of deep tendon reflexes in ankles
Feet-dry, muscle atrophy, claw toes, ulcers.
417
cc earache
| why would you ask if anyone around them smokes
secondhand cigarette smoke exposure has been associated with a 2-3fold increased risk of otitis media (leads to functional eustachian tube obstruction and decreases the protective ciliary action in the tube.)
418
what does recent trip in airplane or scuba diving have to do with earrache
barotrauma is a cause of acute serous otitis r/t pressure changes from flying or scuba diving.
419
diabetes and earrache
predisposes adults to malignant otitis externa (cellulitis involving ear and surrounding tissue)
also at increased r/o otitis media, mastoiditis, osteomyelitis
420
immunosuppression and earrache
increased risk for malignant otitis externa (cellulitis involving ear and surrounding tissue)
also at increased r/o otitis media, mastoiditis, osteomyelitis
421
history of seborrheic dermatitis or psoriasis and earrache
overproduction of sebum in external canal can cause otitis externa
422
history of cleft palate and earrache
anomalies that are not repaired anatomically predispose a child to otitis media because of functional obstruction of eustachian tubes
423
jaw pain described as severe lasting a few min and returning 3-4 times per day sometimes associated with headache. worse in morning.
TMJ
424
infant crying when sucking
pain with compression and increased pressure in ears
425
itching or drainage from ear
infection or inflammation of external canal
426
Itching, burning or tingling of ear can be a precursor to
herpes zoster of the trigeminal nerve (cranial nerve V) which can cause paroxysmal pain of face and jaw and hyperalgesia to minimal stimulation such as tooth brushing, cold air and grimacing
427
foul smelling discharge from ear
perforation of TM
428
Why do you ask about recent trauma to ear, head trauma and how do you clean your ears?
in cc of earrache
perforation of eardrum can be caused by blunt or penetrating trauma. Blunt trauma might include a slap to ear, barotrauma. Penetrating trauma to canal or TM may be self induced with cotton tipped swabs or other sharp objects when trying to remove cerumen
429
```
hearing loss
tinnitus
pressure sensation
vertigo
infection
```
cerumen impaction
self cleaning can produce trauma
cerumen softening solutions can cause chemical irritation to canal tissue
430
ear pain and inflammation
foreign bodies such as feathers, beads, and insects (cockroaches) can produce ear pain and inflammation
431
exposure to high pitched and loud noises for a prolonged period of time destroys ____
cochlear hair cells. increases risk of injury and eventually hearing loss.
432
the most frequent cause of hearing loss is conductive hearing loss caused by
blockage of the external canal, usually by cerumen
433
presbycusis
age related hearing loss - adults older than 65
434
chronic otitis media in children causes a _____ hearing loss
conductive
| negative middle ear pressure, presence of effusion in middle ear, or structural damage to the TM or ossicles
435
Hearing loss associated with dizziness, vertigo, tinnitus may indicate a
serious inner ear condition such as acoustic neuroma or Meniere disease
436
```
young infants
irritability
poor feeding
congestion
fever
```
otitis media
437
older infants and young toddlers
pull on the painful ear
bang their head on affected side
otitis media
438
battle sign
hemorrhage over mastoid bone - may occur with a basal skull fracture
439
appear as white or dark patches to ear
fungal or yeast infections
440
a hot swollen and erythemous ear and surrounding skin
cellulitis
441
redness and painful swelling over the mastoid process is a
sign of infection in the mastoid air cells
442
In mastoiditis the pinna is _______
displaced forward
443
pain on manipulation of the pinna and tragus
otitis externa
444
Postauricular swelling may indicate
extension of infection into the mastoid cavity
445
Vesicles on the external ear canal and auricle may indicate
herpes zoster (Ramsay hunt syndrome)
446
what kind of discharge can be seen with otitis externa
cheesy, green-blue or gray discharge
447
what does a normal TM look like
translucent and pearly gray in color
448
Mild diffuse redness of the tympanic membrane can occur from
cyring or coughing
449
scarring and effusion can cause what to the TM
whitening and opacification
450
the contour of the normal TM is somewhat
concave
451
fullness or bulging of the TM indicates
either
increased air pressure
increased hydrostatic pressure in the middle ear
452
Fullness of the eardrum is seen first around the
periphery of the TM. As pressure increases, central fullness becomes visible
453
what is associated with negative middle ear pressure or postinflammatory adhesions
concavity or retraction of the eardrum
454
As the eardrum retracts, the handle of the malleus short process becomes
more visible
455
red inflamed eardrum without effusion
myringitis
456
extremely painful condition of small blisters on the TM caused by bacterial otitis media
Bullous myringitis
457
chronic otitis media can lead to
cholesteatoma - a cyst like mass behind the eardrum
458
what cranial nerve is acoustic for hearing
CN VIII
459
which hearing test is performed with the tuning fork
Weber test
460
what type of hearing loss results when sound transmission is impaired through the external or middle ear
conductive hearing loss
461
what type of hearing loss results from a defect in the inner ear
sensorineural hearing loss
462
what tests help differentiate conductive hearing loss from sensorineural hearing loss
Webber and Rinne
463
how do you evaluate the trigeminal nerve (CNV)
observe jaw and facial muscle movement for symmetry and strength by palpating over the masseter muscles and ask the pt to bite and clench their teeth.
Assess intactness of sensation to pain and light touch using a sharp and dull stimulus over the 3 branches of CN V
464
how do you evaluate CN VII and CN IX
taste and sensation to tongue and sensation to external ear. Have pt protrude the tongue and apply sweet and salty substances separately to each half of the tongue to test CN VII and bitter and sour substances to test CN IX
465
most often occurs in children younger than 6 and associated with URIs
Acute otitis media
466
painless ear infection caused by a mechanical process or eustachian tube blockage that leads to inadequate ventilation of middle ear
otitis media with effusion
467
anterior cervical lymphadenitis is a common cause of
referred ear pain in children. may be seen with strep throat and mono
468
what cranial nerves are associated with referred ear pain
V, VII, IX and X
469
CN V
trigeminal
470
CN VII
facial
471
CN X
vagus
472
CN IX
glossopharyngeal
473
chronic laryngitis (longer than 2 weeks) needs to be evaluated for
neoplasm - most often squamous cell carcinoma. Chronic laryngitis rarely has an infectious cause
474
recurrent episodes of hoarseness may indicate
allergies
sinusitis with postnasal drip
laryngeal reflux
systemic disease
475
progressive hoarseness usually indicates
lesion such as laryngeal or hypopharyngeal cyst
476
hoarseness from birth may indicate
```
a congenital problem such as laryngeal web
cyst
palsy
angioma
congenital anomaly
papilloma
vocal cord paralysis
```
477
hoarseness or voice change is a sign of what cranial nerve
X (vagus nerve)
478
damage to CN X can be the result of
hormone imbalance
bacterial infection
tumor
voice surgery by transgender population can injure the tissues of the vocal fold
479
children with epiglottitis are not hoarse but as the epiglottis swells the voice becomes
muffled and drooling is observed
480
Chronic consumption of smoking and hard liquor is a direct irritant and associated with
laryngeal cancer
481
what should be considered in patients with hoarseness who have failed to update their diphtheria and acellular pertussis (Td/Tdap) vaccination
Laryngeal diphtheria
482
Td/Tdap vaccination is recommended once then Td boosters every
10 years, pregnant women are advised to get Tdap during each pregnancy
483
Hoarseness that is altered by a position change suggests
a mobile lesion such as a pedunculated polyp
484
pt who has normal voice in the morning with progressive hoarseness throughout the day
Myasthenia Gravis
485
the presence of cough , sob, weight loss, dysphagia, ear pain or throat pain should raise concerns about
neoplasm
486
Hoarseness and thyroid
associated with late sign of hypothyroidism
487
```
dysphagia
hoarseness
vomiting
chronic cough
in child
```
GERD
488
habit of frequent throat clearing and sensation of lump in the throat
chronic cough or throat clearing. hoarseness in morning and coughing at night
GERD
489
voice or whisper test assesses what cranial nerve
VIII
490
adults will report severe and rapidly progressing symptoms of sore throat, dyspnea and hoarseness. In children there is no cough or hoarseness but drooling with a forward leaning posture. Voice quality is froglike
Acute epiglottitis
491
croup is most often caused by
parainfluenza virus 1
492
croup is most common in children ages
3mos - 3 years
493
leukoplakia (white scaly appearance to vocal cords)
| do not usually report pain
laryngeal cancer
pain secondary to ulceration is late and often perceived as ear pain, esp when swallowing
494
associated with a low gravelly voice
hypothyroidism - the degree of hoarseness depends on the severity of thyroid deficiency
495
weak, breathy voice
vocal cord paralysis
usually unilateral caused by pressure on the vagus or recurrent laryngeal nerve by a mass of malignant glands in the superior mediastinum or carcinoma of thyroid or esophagus
496
low breathy voice with no found cause usually after a traumatic event
psychogenic hoarseness
497
most common laryngeal lesions in childhood between ages 2-7
laryngeal papilloma
can be seen in newborn caused by HPV
498
acute symptoms of rhinitis or sinus congestion usually lasts and caused by
48 - 72 hrs
| caused by edematous mucosa obstructing the sinus ostia
499
fever
myalgias
chills
acute infectious rhinitis are caused by
rhinoviruses
| Parainfluenza virus
500
adults with symptoms that last more than 3 weeks
upper molar pain or headache
postnasal drip
nausea
chronic rhinitis rarely infectious
| anatomical abnormalities that impair sinus drainage system
501
in children chronic sinusitis is defined as presence of symptoms for longer than
30 days
502
produces pain that worsens with bending or leaning forward. The postnasal produces a cough that worsens when laying down
Maxillary sinusitis
503
chronic sinusitis can be attributed to
infection
growths in the sinuses (polyps)
deviation in nasal septum
504
seropurulent nasal discharge is often present with
acute bacterial infection of the nasal and sinus mucosa
505
sneezing
nasal congestion
clear and profuse rhinorrhea
pruritis of nose, palate, pharynx, and middle ear
conjunctival irritation
feeling of fullness in ears
pressure or pain of cheeks, forehead or behind eyes
allergic rhinitis
506
unilateral rhinitis symptoms are more indicative of
anatomical cause or foreign body
507
the use of topical sympathomimetic sprays or drops for more than 1 week can lead to
rebound congestion or vasodilation after short periods of vasoconstriction
508
what medications may cause nasal congestion
oral contraceptives
phenothiazines
ACE inhibitors
B blockers
509
what rec drug can cause rebound nasal congestion
chronic or acute cocaine use
510
facial inspection for rhinitis/sinusitis
allergic salute - a crease on nose from continued wiping up of nasal drainage
allergic shiners - dark circles under eyes suggestive of venous congestion and stasis
511
halitosis can be a sign of
dental abscess or sinusitis
512
lymphoid hyperplasia or cobblestoning
may be seen on the posterior pharynx with chronic allergies
513
pale swollen and wet turbinates are seen with
allergic rhinitis
514
produces a violet colored mucous membrane
allergic rhinitis
515
foul smelling unilateral purlent discharge may indicate
a foreign body in the nasal cavity
516
how do you identify CSF leak
test nasal drainage for glucose and protein levels
517
foul smelling nasal discharge is characteristic of
sinusitis of dental orgin
518
light will pass through
air filled sinuses
519
normal transillumination of the frontal sinus r/o _____ in 90% of cases
frontal sinusitis
520
presence of yellow or green purulent discharge and red nasal mucosa
Infectious rhinitis
521
recurrent rhinorrhea with clear watery mucus, sneezing and pruritis
allergic rhinitis
522
associated with eosinophilia on a nasal smear
nonallergic rhinitis
523
drug induced rebound congestion that can follow the use of topical nasal decongestants
rhinitis medicamentosa
524
purulent nasal discharge, postnasal drip and localized facial pain over the sinus involved. often follows a URI
Acute sinusitis
525
the diagnosis of sinusitis in children requires
2/3 major criterion
- cough
- purulent nasal discharge
- purulent pharyngeal drainage
or 1 major and 2 minor
- sore throat
- wheezing
- foul breath
- facial pain
- periorbital edema
- headache
- earache
- fever
- toothache
526
persistent symptoms of low grade infection and intermittent acute exacerbations typical of acute sinusitis
chronic sinusitis
527
this syndrome has multiple causative factors including history of asthma and aspirin intolerance.
nasal polyposis
the polyps are translucent, grape like growths that are mobile, rarely bleed and prolapse into nasal cavity. any suspicious polyps should be biopsied
528
can occur as a complication of sinusitis. may also follow head trauma or scuba diving
osteomyelitis of frontal bone
529
pt appear severely ill and may have edema of upper eyelid and puffy swelling over the frontal bone
osteomyelitis of frontal bone
530
what type of chemical burn is worse to the eye
alkali more damage than acid burns because they penetrate ocular tissues more rapidly
531
what do you do for a chemical burn
immediate and profuse irrigation to eye with water or saline wash for at least 15 min
referral to ophthalmology
532
acute redness can be caused by infection of the conjunctiva or eyelids
conjunctivitis
533
unilateral eye redness is more likely to indicate
trauma or infection
534
bilateral eye redness is more likely to indicate
allergy or underlying systemic pprocess
535
inflammation of the eyelids
causes itching and crusting of the lash line
usually bilat
Blepharitis
536
produces redness at base of eyelashes and usually unilateral
Hordeolum (stye)
537
chronic granulomatous inflammation of the meibomian gland which is in the middle of the eyelid, often on the conjunctival side. Usually unilateral but may involve both eyes
chalazion
538
unilateral painful, inflamed eye with photophobia and often a foreign body sensation without a history of significant trauma may indicate
glaucoma
| keratitis with corneal ulceration
539
constant, boring, throbbing pain often severe enough to interfere with sleep can result from
ocular inflammation associated with iritis
acute glaucoma
scleritis
540
produce a gritty sensation in eye
viral causes of conjuncivitis
541
vision changes in conjunctivitis?
no
542
vision is mildly decreased in
iritis
543
vision is markedly decreased with
acute glaucoma, corneal abrasions or ulcers
544
sudden diminution in or loss of visual acuity is
an ocular emergency and may indicate corneal or uveal tract disorders
retinal tears or detachment
acute glaucoma
orbital cellulitis
545
true double vision becomes single vision when
one eye is covered
546
visual halos
corneal edema
| water drops in cornea or lens (seen in corneal edema or cataract)
547
visual floaters or flashing lights
may occur with vitreo-retinal traction. May progress to a retinal tear or detachment
548
patients will give a history of blurred or blackened vision over several hours that progresses to complete or partial monocular blindness often described as curtains dropping
retinal detachment
549
copious purulent discharge to eyes
N. gonorrhoeae infection
550
watery discharge that may affect only one eye
viral conjunctivitis
551
a neonate who is 24 hours old with mucoid or purlent ocular discharge indicates
chemical conjunctivitis from prophylactic instillation of erythromycin ophthalmic ointment
552
severe bilat purulent conjunctivitis 3-7 days after birth may indicate
gonococcal infection of the eye
553
discharge 5-30 days postpartum may indicate
chlamydial conjunctivitis
554
photophobia indicates
ocular inflamation or irritation
555
in infants and young children, photophobia signals
```
a serious condition
such as juvenile arthritis
intraocular tumors
congenital glaucoma
keratitis
trauma
```
556
Epiphora
excessive production of tears is common with viral conjunctivitis, corneal abrasions, infantile glaucoma, nasal lacrimal duct stenosis
557
itching and tearing disproportionate to findings are hallmark of
allergic conjunctivitis
558
low grade to moderate fever,
mucopurulent rhinorrhea
cough
crusting of eyelashes
otitis-conjunctivitis syndrome
559
what virus has emerged as an infection contracted in warmer climates and may appear as viral conjunctivitis and often accompanied by fever, rash and arthralgia
Zika Virus
560
for young children or adults not able to use the snellen or sloan chart, use
HOTV characters or LEA symbols
561
visual acuity chart for children older than 3 1/2 and adults
use snellen, tumbling E or Lippman chart
562
in children the referral standard for visual acuity is
20/40 or worse in both eyes or a 2 line difference between eyes
563
infection of the lacrimal sac that occurs secondary to obstruction
Dacryocystitis
564
scratchy sensation, no photophobia, purulent discharge and matted eyelids
bacterial conjunctivitis
565
scratchy sensation
watery discharge
eyelids may have follicular changes in the palpebral conjunctiva
viral conjunctivitis
566
chronic seasonal condition caused by hypersensitivity to a specific allergen
bilat
itchy
painless
ropy, mucoid discharge
palpebral conjunctiva has a cobblestone appearance
allergic conjunctivitis
567
blood in the anterior chamber of eye, usually produced by trauma to eye. Marked decrease in vision with RBCs present. pupil is irregular and poorly reactive
Hyphema
568
no discharge
lacrimation
photophobia
visual acuity unimpaired
episcleritis
569
inflammation of sclera can result in severe destructive disease. unilateral associated with RA, or other autoimmune
pain
Lacrimation is present
visual acuity is variable
Scleritis
570
```
bacterial, fungal and viral organisms can cause infection to the cornea, which leads to corneal ulceration and potential destruction of the cornea
moderate to severe eye pain
some discharge
visual acuity decreased
cornea appears cloudy
```
keratitis
571
moderate to severe pain with discharge present
| photophobia
corneal abrasion
fluorescein stain is taken into the ulcer and can be seen under a wood lamp
572
```
pain
photophobia
diffuse or ciliary injection
possibly discharge
visual acuity markely decreased
dendritic lesions seen with fluorescein staining
```
Herpetic infection cause by herpes simplex virus
573
severe or chronic outbreaks of herpes zoster may cause
glaucoma
cataract formation
double vision
scarring of cornea
574
unilateral eyelid swelling
redness
fever
Conjunctiva is clear,
periorbital cellulitis
575
```
unilateral eyelid swelling
fever
pain
proptosis
chemosis
conjunctivitis
```
orbital cellulitis
| life threatening and requires immediate attention
576
inflammation of iris and ciliary body
iritis
577
chronic glaucoma
open-angle glaucoma
578
acute glaucoma
angle -closure glaucoma
579
```
unilateral deep eye pain
photophobia
halos around visualized objects
decreased visual acuity
pupil is mid dilated and decreased reactivity to light
cornea is cloudy
```
angle closure glaucoma
emergency
580
doughnut lesions (red, raised hemorrhagic lesions with yellow center)
streptococcal pharyngitis
581
a bright red uvula and presence of petechiae on posterior pharynx and palate indicate
group A streptococcal pharyngitis
582
curdlike patches that bleed on scraping are characteristic of
oral candidiasis
583
in ____ ____ the anterior cervical lymph nodes are often enlarged and tender
streptococcal pharyngitis
584
in ____ _____ the posterior cervical nodes are often enlarged
viral infections
585
what type of pneumonia is associated with sore throat
mycoplasma pneumoniae
586
splenomegaly is found in about half the cases of
mononucleosis
587
```
history of resp symptoms
difficulty swallowing
otalgia
malaise
fever
toxic appearance
refusal to swallow - drooling, stridor
```
peritonsillar or retropharyngeal abscess
588
fever temp 38.5/101.5 or higher
tonsillar exudate
anterior cervical adenopathy
history of recent exposure
streptococcal pharyngitis
589
causative agent for mononucleosis is
EBV
590
```
low grade fever
mild sore throat
posterior cervical lymphadenopathy
weight loss
pronounced malaise and fatigue
```
Mononucleosis
591
Diagnosis for mononucleosis
monospot
CBC
splenomegaly
592
exudative pharyngitis
bilat cervical lymphadenopathy
history of orogenital sexual activity
may have no symptoms
gonococcal pharyngitis
gram staining or culture to confirm diagnosis
593
herpangina caused by
cox sackievirus
594
```
painful sore throat
fever
malaise
headache
anorexia
neck, abd and extremity pain may occur
small grayis papulovesicular lesions on solft palate, pharynce
```
cox sackievirus
595
caused by a fusospirochetal infection that results in necrotizing ulcerative gingivostomatitis
```
painful ulcers
foul breath
bleeding gums
usually no fever
gray necrotic ulcers without vesicles on the gingivae and interdental papillae
```
vincent angina
to confirm do gram staining to show spirochetes
596
discrete ulcers without preceding vesicles
located on inner lip, tongue and buccal mucosa
lasts 1-2 weeks
Aphthous stomatitis "canker sores"
597
fever
headache
sore throat
lymphadenitis
characteristic clusters of yellow vesicles appear on the palate, pharynx and gingiva that last 2-3 weeks
recurrent lesions have prodromal symptoms of burning, tingling, or itching
Herpes simplex virus type I
598
yeast infection that produces white plaques over tongue and oral mucosa with erythema . Bleeds when scraped
candidiasis
599
who do you see oral candidiasis in
infants in the first 5 weeks of life
immunocompromised people
diabetics
people taking abx or using inhaled steroids
600
device that measures intraocular pressure
tonometer
| IOP > 21 is high risk for glaucoma
601
the most common cause of vision loss in children is
amblyopia (lazy eye) and strabismus (2 eyes do not point in the same direction)
602
when the cornea and lens of the eye focus on the image in front of the retina
myopia (nearsightedness)
603
a refractive error where the focus of an image is behind the retina
hyperopia (farsightednes)
604
an irregularity in the refractive system of the eye that prevents light from being focused onto the retina
astigmatism
605
any opacity of the crystalline lens of the eye
cataracts
606
first sign of opacity
the inability to focus on near objects (presbyopia) and altered color vision
607
associated with MS, after viral infection and with granulomatous inflammatory conditions. Seen in adults 20-50.
vision loss occurs over a few hous to days. Pain precedes vision loss in most patients
optic neuritis
608
some have loss of peripheral vision and others lose central vision
affects optic nerve
optic nerve hypoplasia
609
most common intraocular tumor of childhood
retinoblastoma
610
common symptom is strabismus
| can spread to brain through optic nerve or into bone marrow
retinoblastoma
611
seen in premature infants
refers to changes of ischemia, blood vessel growth and fibrosis that occur bc of inadequate oxygen delivery to peripheral retina.
Retinopathy of prematurity
612
what infants are at greatest risk for retinopathy of prematurity
infants who weigh less than 1500g
613
sudden onset of severe vision loss in one eye. no associated pain. caused by plaque lodging at level of the lamina cribrosa
a few hours later the retina becomes edematous and white or opaque. There is a reddish-orange reflex from the intact choroidal vascular and foveola that creates a cherry red spot
central retinal artery occlusion
with time the retinal artery opens and the retinal edema clears.
614
loss of vision caused by increased pressure in the eye. characterized by defects in the visual field and optic nerve damage.
glaucoma
615
leading cause of blindness in the US
glaucoma
616
what type of glaucoma is associated with another ocular or nonocular event
secondary glaucoma
617
brief flashes of light (photopsia) or floaters (entopsia)
retinal detachement
618
risk factors for macular degeneration
```
advanced age
family history
cigarette smoking
hyperopia
hypertension
```
619
rapid vision loss caused by development of abnormal blood vessels that grow from the choroid into the macular portion of the retina. leak blood and fluid.
blurred vision is common early symptom. vision loss may be rapid and severe
Wet (exudative) macular degeneration
620
associated with breakdown of light sensitive macular cells and gradual loss of central vision. distortion upon testing with amsler grid
dry (nonexudative) macular degeneration
621
micro aneurysms
macular edema
lipid exudates
intraretinal hemorrhages
may be asymptomatic or have decreased vision or floaters
diabetic retinopathy
622
inflammatory activity of the iris, ciliary body and choroid
decrease in vision
light sensitivity
tearing
uveitis
623
inflammation of the cornea that creates pain, redness and blurred vision
keratitis
624
optic nerve gliomas present as what in adults
malignant glioblastomas
625
optic nerve gliomas present as what in children
benign pilocytic astrocytomas
626
optic nerve gliomas that appear in children younger than 10 are highly associated with
neurofibromatosis - associated with cafe au lait lesions of the skin
627
in children
| rapid onset of vision loss with headache
optic nerve glioma
628
tumors that arise from squamous epithelial cells of the brain
craniopharyngioma
629
```
headache
visual disturbance caused by increased intracranial pressure
nystagmus
bitemporal hemianopsia
children
```
craniopharyngioma
630
infants
retinitis
optic nerve hypoplasia
maternal exposure to measles
Congenial TORCH infections
631
screening tool for depression
PHQ - 9
632
what pneumonic do you use to dig into depression more
```
Sleep disorder
interest deficit
guilt
energy deficit
concentration deficit, appetite disorder, psychomotor retardation agitation
suicidality
```
