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POM Unit 6 > U6 Exam > Flashcards

U6 Exam Flashcards

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1
Q

Where is the mental state exam used?

A

Used as part of the physical exam in primary care, etc. (not instead)

It can be used in its entirety or use the parts that are relevant to describe your patient’s mental state of being during the physical examination or more typically your interview

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2
Q

What questions are asked as part of the “thought process” in the MSE?

A

Organized? Goal Directed?

Circumstantial, Tangential, Loose Associations

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3
Q

What questions are asked as part of the “thought conent” in the MSE?

A

Obsessions, Delusions,

Suicidal/homicidal Ideation

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4
Q

What is relevant in assessing speech in the MSE?

A

Rate (slowed – pressured), Rhythm, Prosody

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5
Q

What is relevant in assessing cogniriton in the MSE?

A
  • Orientation, Attention, Concentration • short/long term memory
  • Abstraction
  • Judgment, Insight
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6
Q

Difference between mood vs. affect?

A

Mood “ what patient reports’

Affect = what clinician sees

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7
Q

How to make sure older pts can hear you?

A

 Ask patient if they can hear you

 Speak slowly and clearly, but don’t

shout

 Sit at eye level, face-to-face, hands away from face

 Avoid high pitch tones

 Reduce background noises

 Repeat numbers, letters

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8
Q

tips for communicating with elderly pt with cog. impairment?

A

 Don’t assume patient can not understand

 Use simple phrases, short words

 Be patient and repetitive

 Write down instructions

 Don’t exclude patient from the conversation

 Families are crucial!

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9
Q

What is in ADLs?

A
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10
Q

What is in IDLs?

A
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11
Q

what does the minicog test involve?

A
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12
Q

how to score mini cog test?

what is not impaired?

A

recalled all 3 words

OR recalled 1-2 words, and the clock was normal

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13
Q

Social assessments in elderly involves

A

Formal and Informal Supports Financial Resources
Area Resources

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14
Q

How should you check pulse pressure in elderly?

A

in 2 places

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15
Q

pulse press ___ with aging

A

increases

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16
Q

vital sign changes in elderly?

increases – pulse pressure, premature and atrial ventricular beats

decreases - max heart rate, pulse oximetry, temp

no change - HR, respiratory rate

A
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17
Q

what is actinic keratosis?

A

precancerous lesion

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18
Q

what is arcus senilus? what is it a sign of?

A

a white, gray, or blue opaque ring in the corneal margin

a sign of hypercholesterima

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19
Q

How do you account for cognitive impairment?

A

First of all, don’t assume the patient can’t understand.

Use simple phrases.

Be patient and repetitive if necessary

Use family members but DO NOT exclude patient from the conversation

Use written instructions if necessary

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20
Q

senile ptosis is caused by the

A

Fat pads around eyes atrophy and eyelids can become more elastic

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21
Q

in geriatric exam

what are found on cardiovascualr exam?

A

bruits over carotids

systolic murmurs at right upper sternal border

aortic sclerosis: thickening of wall

aortic stenosis: narrowing of wall

S3 can be heard in CHF, S4 will reveal stiffening of vessels

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22
Q

S3 will be heard in ___. S4 will be heard in ___.

A

S3 is CHF

S4 is stiffening of the vessels

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23
Q

geriatric

___ rounded back due to overcurvature of spine (disc degeneration)

A

kyphosis

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24
Q

Older female exam:

A

breasts atrophy

lithotomy position (where feet are separated in stirrups) can be painful

ovaries no longer palpable

decrease in pubic hair and drier, more delicate vaginal mucosa

uterine/bladder prolapse can be seen

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25
older male exam
decrease in pubic hair and penis size, atrophy of testicles hyperplasia of prostate, usually benign
26
common abdomonal exam findings
abdominal bruits potbellies! aorta might be widened, so palpate look for guarding and rebound
27
common on MSK findings
loss of height and decreased range of motion less muscle mass changes in joints due to osteoarthritis complete wasting of interosseus muscle so that hands are thin and bony
28
in elderly you have complete wasting of ____ muscle so that hands are thin and bony
interosseus
29
\_\_\_ is the Leading cause of death in adults over the age of 65
falls
30
why is age (esp over 75) a risk factor for fall
Broad based gate, flexion of cervical spine, hips, knees Poor gait initiation, stiff turns **Decreased baroreceptor sensitivity** Postural hypotension, vision changes **Decreased total body H2O** Decreased proprioception
31
risk factors for falls
age female low mobility and body weight impaired gait and blaance acute illnesses and meds
32
chronic illnesses that can inc risk of falls
HTN, stroke, MI, arthritis, UTI, depression, **diabetes**, poor nutrition, **chronic pain,** pneumonia, **_arrhythmia_**
33
medications that inc the risk of falls include ## Footnote benzodiazepines, antidepressents, any meds with side effects, \_\_\_\_, \_\_\_\_\_, and \_\_\_.
benzodiazepines, antidepressents, any meds with side effects, **caffeine, antihistamines, ACE inhibitors**
34
Intrinsic factors contributing to falls= changes in the person themselves
Slower reflexes, increased postural sway, cognitive impairment, alcohol, meds etc.
35
falls are associated with
Decline in functional status “long lie” = need help to get up; predicts decline in functional status · Nursing home placement · Increased use of medical services · Fear of falling
36
\_\_\_\_ predicts decline in functional status after a fall
needing help to get up
37
Get up and go test what is normal? what is impaired?
Less than 10 sec, freely mobile Less than 20 sec, mostly independent 20-29 sec, variable mobility Greater than 30 sec, impaired mobility
38
Single fall = check for
balance/gait problems
39
Multiple falls = determine multifactorial falls risk (H&P, tests)
Check BP, pulse (supine, standing), vision, cardio, musculoskeletal, neuro EKG, brain imaging, spine radiographic studies Hemoglobin, serum urea nitrogen, creatine, glucose Carotid sinus massage = can uncover carotid sinus hypersensitivity Mini-Cognitive Exam: gait/balance evaluation
40
\_\_\_\_ affect is - a large range, “even keel”
euthymia
41
Normal Development of 18mo - Motor: **walks alone**, may \_\_\_.
run or climb stairs
42
Normal Development of 18mo - Fine motor: drinks from a cup, feeds self with spoon, can help \_\_\_\_.
undress
43
Nml development of 18 mo Social/emotional: temper tantrums, \_\_\_\_, affectionate towards familiar face, shows interest in ___ and \_\_\_.
Social/emotional: temper tantrums, **stranger anxiety**, affectionate towards familiar face, shows interest in **objects and wants**
44
NML language in 18mo Language:\_\_\_\_\_ words, no and can shake head
Language: **several single** words, no and can shake head
45
NML cognitive in 18mo Name simple objects, points to one body part, scribbles, can\_\_\_\_ without gesture
follow one step command
46
Examining an 18mo - Place child on \_\_\_\_. - Leave most intrusive parts for last - Distractions - Be flexible with order of the exam
Examining an 18mo - Place **child on parents lap,** make them feel **comfortable** - Leave most intrusive parts for last - Distractions - Be flexible with order of the exam
47
How to tell if a baby is **healthy** just by walking in the room: - tone/posture - \_\_\_\_ - color - RR
attitude
48
Determining sick versus well -Sick: Color : blue, pale, yellow, rash, red, petechiae Posture: limp, floppy, tripod position, curled up Respirations: Shallow, fast, noisy, slow, \_\_\_\_\_\_, nasal flare Attitude: \_\_\_\_\_.
Determining sick versus well -Sick: Color : blue, pale, yellow, rash, red, petechiae Posture: limp, floppy, tripod position, curled up Respirations: Shallow, fast, noisy, slow, **retractions**, nasal flare Attitude: **Irritable, ca't be consoled**
49
-Healthy childre Color: \_\_\_\_\_ -Healthy: Color: pink Posture: good tone, comfortable Respirations: Normal Attitude: consolable Posture: good tone, comfortable Respirations: Normal Attitude: consolable
-Healthy: Color: **pink** Posture: good tone, comfortable Respirations: Normal Attitude: consolable
50
**Croup:** 3 months to 3 years low grade fever, _____ always pathological, _____ cough \_\_\_\_\_ sign: narrowing of the airway on x-ray Supportive airway management
Croup: 3 months to 3 years low grade fever, **stridor\*** always pathological, **hoarse** cough **steeple** sign: narrowing of the airway on x-ray Supportive airway management
51
long prodrome of **low grade fever**, runny nose, cough, **_vommiting occurs after coughing_** and coughing is **worse with exercise**, cough progressively worse, won't eat or drink, not sleeping well, coughing at night, cough improves with steam. this is \_\_\_\_.
croup
52
\_\_\_\_ is an abnormal, high-pitched, musical breathing sound that is almost always pathological.
Stridor
53
Stridor is seen in Trauma, congenital abnormalities, foreign body,\_\_\_, Inflammatory disease
Trauma, congenital abnormalities, foreign body, **metabolic disorders**, Inflammatory disease
54
**_Epiglotitis_** Age: over\_\_\_\_ years stridor, sore throat, drooling, fever Cough is _____ sounding thumb print on lateral neck film inflammation of the epiglottis Emergency airway management
Epiglotitis Age: over **3-5** years stridor, sore throat, drooling, fever Cough is **bark** sounding thumb print on lateral neck film inflammation of the epiglottis Emergency airway management
55
thumb print sign on film indicates \_\_\_
epiglottis
56
Fever breaks in a few days with \_\_\_
roseola
57
tx for roseola
no tx necessary
58
Once the ____ with Roseola (HHV 6), the child is no longer contagious
rash appears
59
Pyloric stenosis Boys more often affected Usually ____ weeks old Tx is \_\_\_\_\_.
Boys more often affected Usually 2-8 weeks old Tx is surgery.
60
## Footnote \_\_\_\_\_ stenosis Projectile vomiting Electrolyte abnormalities Hungry!
**Pyloric** stenosis Projectile vomiting Electrolyte abnormalities Hungry!
61
Meningococcemia **Flu like** symptoms (nonspecific prodrome) Rash Slightly \_\_\_\_ \_\_\_\_ in color.
**_Meningococcemia_** Flu like symptoms (nonspecific prodrome) Rash Slightly **raised** **Purpelish** in color.
62
Meningococcemia ## Footnote Gets out of control quickly EMERGENCY; can be fatal! Antibiotics first, cultures later Should give \_\_\_\_\_. Watch for signs of sepsis
Penicillin (little resistance)
63
Meningococcemia (Neisseria meningitidis) \_\_\_\_ classic (soldiers too) Immunization avaialbile
College student classic
64
Group A Streptococci scarlet fever 6 year old Fever Abdominal pain Inflammation of the oropharynx with ______ on the soft palate May be the only pertinent positive “Sandpaper rash” “Strawberry tongue”
**Group A Streptococci scarlet fever** 6 year old Fever Abdominal pain Inflammation of the oropharynx with petechiae on the soft palate May be the only pertinent positive “Sandpaper rash” “Strawberry tongue”
65
Exam in Group A strep scarlet fever find what
**Abdominal pain** Inflammation of the oropharynx with petechiae on the soft palate May be the only pertinent positive “Sandpaper rash” “Strawberry tongue” **Abdominal exam normal** Rash may present on other parts of the body (like palms)
66
Group A Streptococci scarlet fever 6 year old Fever \_\_\_\_\_\_\_ pain Inflammation of the oropharynx with petechiae on the soft palate Rash may present on other parts of the body (like palms) Antibiotics Treat \_\_\_\_, but not an emergency
Strep A Scarlet fever 6 year old Fever **abominal** pain Inflammation of the oropharynx with petechiae on the soft palate Rash may present on other parts of the body (like palms) Antibiotics Treat **early**, but not an emergency
67
Cigarette burns: Abuse “Rash” on top of \_\_\_\_. Parents don’t know how it got there LACK of info makes diagnosis Symmetric, suddenly \_\_\_\_. Finding doesn’t fit with story
Cigarette burns: Abuse “Rash” on top of **foot**. Parents don’t know how it got there LACK of info makes diagnosis Symmetric, suddenly **appears**. Finding doesn’t fit with story
68
**Intussusception** Intermittent, colicky abdominal pain Currant ____ stool Vomiting Elevated _____ level is a clue Indicates _____ necrosis
Intermittent, colicky abdominal pain Currant **jelly** stool Vomiting Elevated **lactate** level is a clue Indicates **intestinal** necrosis
69
Intussusception Emergency 3 months-1 year of age Radiographic “\_\_\_\_ sign”
Emergency 3 months-1 year of age Radiographic “donut sign”

POM Unit 6 (1 decks)

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