Unit I Flashcards
(344 cards)
1
Q
what are the seven attributes of a symptom
A
- location
- quality
- quantity/severity
- timing
- onset
- remitting/exacerbating factors
- associated manifestations
2
Q
what are the seven components of the medical interview
A
- chief concern
- HPI
- medications
- past medical history
- family history
- social history
- review of systems
3
Q
signs
A
object observable phenomena associated with a disease
4
Q
symptoms
A
subjective patient reported phenomena associated with disease
5
Q
what are at least four ways that providers interact nonverbally with a patient
A
- eye contact
- facial expression
- posture
- head position and movement
- interpersonal distance
- placement of arms and legs
6
Q
open ended questions
A
questions that allow the patient to tell a story
7
Q
closed ended questions
A
questions that are focused on trying to find a particular piece of information
8
Q
leading questions
A
questions that suggest a particular answer
9
Q
what are ten techniques of skilled medical interviewing
A
- active listening
- empathic responses
- guided questioning
- nonverbal communication
- validation
- reassurance
- partnering
- summerization
- transitions
- empowering the patient
10
Q
three aspects of active listening
A
- being closely attentive to the patient
- taking into consideration the patients emotional state
- using verbal and non verball cues
11
Q
what are three examples of empathic responses
A
- how do you feel about that
- that sounds upsetting
- you must be feeling sad
12
Q
what is the goal of guided questioning
A
allowing the patient to communcate their story in their own words without interruption
13
Q
what are three examples of guided questions
A
- moving from open to focused questions
- asking questions that need a guided response
- asking a series of questions one at a time
14
Q
paralanguage
A
pacing, tone, and volume of speech
15
Q
validation
A
affirm the legitimacy of the patients experiences
16
Q
why is reassurance different for a provider than a casual person? what is a good starting point when reassuring the patient
A
because the instinctual response is telling someone everything will be ok when as a provider that might be premature
identifying and acknowledging patient concerns
17
Q
partnering
A
building rapport with patients
18
Q
rapport
A
trust between the patient and the provider
19
Q
what are two reasons why summarization an example of skilled interviewing
A
- it proves to the patient that you were listening
- it gives you a chance to pick on something you missed
20
Q
why are transitions considered a sign of being a skilled interview
A
it can put the patient at ease when you change from one part of the interview to the other
21
Q
what is empowering the patient and why is it a sign of skilled interviewing
A
giving the patients a feeling of control over their illness
allowing them to ask questions and take part in their treatment plan
22
Q
empathy
A
the capacity to identify with the patient and feel their pain as your own
23
Q
what is an example of an empathic repsonse
A
i cannot imagine what you are going through
24
Q
what are 6 of the 11 indications that a mental health screening should be done
A
- Medically unexplained physical symptoms—more than half have depression
- or anxiety disorder
- Multiple physical or somatic symptoms or “high symptom count”
- High severity of the presenting somatic symptom
- Chronic pain
- Symptoms for more than 6 weeks
- Physician rating as a “difficult encounter”
- Recent stress
- Low self-rating of overall health
- Frequent use of health care
- substance abuse
25
what are the five most common mental disorders encountered in practice
1. anxiety
2. depression
3. alcohol
4. somatoform
5. eating disorders
26
what are two high yield questions to idenift depression
1. Over the past 2 weeks, have you felt down, depressed, or hopeless?22,28,29
2. Over the past 2 weeks, have you felt little interest or pleasure in doing things (anhedonia)?
27
what are three high yield questions to identify anxiety
1. Over the past 2 weeks, have you been feeling nervous, anxious, or on edge?
2. Over the past 2 weeks, have you been unable to stop or control worrying?
3. Over the past 4 weeks, have you had an anxiety attack—suddenly feeling fear or panic?
28
what are 12 terms related to the mental status exam
1. attention
2. thought process
3. affect
4. memory
5. thought content
6. mood
7. orientation
8. insight
9. language
10. perceptions
11. judgement
12. higher cognitive function
29
attention
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.
30
thought process
The process of registering or recording information,
tested by asking for immediate repetition of
material, followed by storage or retention of
information.
31
orientation
Awareness of personal identity, place, and time;
requires both memory and attention
32
perception
Sensory awareness of objects in the environment
and their interrelationships (external stimuli);
also refers to internal stimuli such as dreams or
hallucinations.
33
thought processes
The logic, coherence, and relevance of the patient’s
thought as it leads to selected goals; how people
think
34
insight
Awareness that symptoms or disturbed behaviors
are normal or abnormal; for example, distinguishing
between daydreams and hallucinations that
seem real.
35
judgement
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
36
affect
A fluctuating pattern of observable behaviors that
expresses subjective feelings or emotions through
tone of voice, facial expression, and demeanor
37
mood
A more pervasive and sustained emotion that colors
the person’s perception of the world.
38
language
A complex symbolic system for expressing, receiving,
and comprehending words
39
higher congnitive function
Assessed by vocabulary, fund of information, abstract
thinking, calculations, construction of objects that
have two or three dimensions
40
what are five strategies to facilitate effective communication
1. active listening
2. empathic responses
3. guided questioning
4. nonverbal communication
5. validation
41
five questions for general review of symptoms
1. Usual weight
2. recent weight change
3. clothing that fits more tightly or
4. loosely than before
5. weakness, fatigue, or fever.
42
name 7 of the 13 questions for the skin ROS
1. When did it first appear? Other symptoms that started along with this?
2. Any changes over time? Fever?
3. Any new areas involved? Any joint pain?
4. Ever had anything like this before? Fatigue?
5. Does it itch? (pruritis) Burn? Hurt? Numbness?
6. Any new medications?
7. What makes it better? Worse?
8. Tried any new foods?
9. Does sun exposure affect it?
10. Any changes in skin color or texture? Localized?
11. What treatments have you tried?
12. Changes in dryness or sweating?
13. Anyone else have a similar skin problem?
43
4 questions for head ROS
1. Headache,
2. head injury,
3. dizziness,
4. lightheadedness.
44
11 ROS questions for eyes
1. Vision,
2. glasses or contact lenses,
3. last examination,
4. pain,
5. redness,
6. excessive tearing,
7. double or blurred vision,
8. spots,
9. specks,
10. flashing lights,
11. glaucoma, cataracts
45
7 ROS Questions for ears
1. Hearing,
2. tinnitus,
3. vertigo,
4. earaches,
5. infection,
6. discharge.
7. If hearing is decreased, use or nonuse of hearing aids
46
5 ROS questions for nose ROS
1. Frequent colds,
2. nasal stuffiness, discharge, itching,
3. hay fever,
4. nosebleeds,
5. sinus trouble
47
8 questions for mouth ROS
1. Condition of teeth and gums,
2. bleeding gums,
3. dentures, if any, and how they fit,
4. last dental examination,
5. sore tongue,
6. dry mouth,
7. frequent sore throats,
8. hoarseness
48
6 questions for neck ROS
1. “Swollen glands”
2. Goiter
3. Lumps
4. Pain
5. Stiffness in neck
6. Reduced motion in the neck
49
5 questions for breast ROS
1. Lumps
2. Pain
3. Discomfort
4. Nipple discharge
5. Does the pt. do self-breast exams?
50
seven questions for respiratory ROS
1. Cough
2. Sputum (color, quantity)
3. Hemoptysis
4. Shortness of breath (SOB)/dyspnea
5. Wheezing
6. Pain with a deep breath pleurisy
7. Last CXR
51
nine questions for cardiovascular ROS
1. Heart trouble”
2. High blood pressure
3. Chest pain or discomfort
4. Palpitations
5. Shortness of breath
6. Need to use pillows at night to ease breathing (orthopnea)
7. Need to sit up at night to ease breathing (Paroxysmal nocturnal dyspnea)
8. Swelling in the hands, ankles, or feet (edema)
9. Results of past electrocardiograms or other cardiovascular tests
52
15 questions for the gastrointestinal ROS
1. Appetite
2. Trouble swallowing
3. Heartburn
4. Nausea
5. Bowel movements (stool color and size, change in bowel habits)
6. Pain with defacation
7. Rectal bleeding or black or tarry stools
8. Hemorrhoids
9. Constipation
10. Diarrhea
11. Abdominal pain
12. Food intolerance
13. Excessive belching or flatulence
14. Jaundice
15. Liver or gallbladder trouble
53
7 questions for the peripheral vascular ROS
1. Intermittent leg pain with exertion (claudication)
2. Leg cramps
3. Varicose veins
4. Previous clots in the veins
5. Swelling in the calves, legs, or feet
6. Color change in the fingertips or toes during cold weather
7. Swelling with redness or tenderness
54
15 questions for the urinary ROS
1. Frequency of urination
2. Polyuria (large quantities of urine)
3. Nocturia
4. Urgency
5. Burning or pain during urination (dysuria)
6. Blood in the urine (hematuria)
7. Urinary infections ok to leave in ROS
8. Kidney or flank pain
9. Kidney stones
10. Ureteral colic
11. Suprapubic pain
12. Incontinence
13. Reduced caliber or force of urinary stream (males)
14. Hesitancy
15. Dribbling
55
8 questions for the male genital ROS
1. Hernias
2. Discharge from or sores on the penis
3. Testicular pain or masses
4. Scrotal pain or swelling
5. History of sexually transmitted infections (STIs) and their treatments
6. Sexual habits, interest, function, satisfaction,
7. birth control methods, condom use, problems.
8. Concerns about HIV infection
56
ten questions for the female genital ROS
1. Age at menarche
2. Regularity
3. Frequency
4. Duration of periods
5. Amount of bleeding
6. Bleeding between periods or after intercourse
7. Last menstrual period (LMP)
8. Dysmenorrhea
9. Premenstrual tension
10. Age at menopause, menopausal symptoms, postmenopausal bleeding
57
seven questions for the musculoskeletal ROS
1. Muscle or joint pain
2. Stiffness
3. Arthritis
4. Gout
5. Backache
6. Neck or low back pain
7. Joint pain with systemic symptoms
58
if there are any positives on the musculoskeletal exam, what are eight follow up questions
1. Location of affected joints or muscles
2. Swelling
3. Redness
4. Pain
5. Tenderness
6. Stiffness
7. Weakness
8. Limitation of motion or activity
59
nine questions for the psychiatric ROS
1. Nervousness
2. Tension
3. Mood
4. Depression
5. Behavior change-staying up all night, spending sprees, gambling, sexual promiscuity
6. Memory change
7. Suicidal ideation
8. Suicide plans or attempts
9. Past counseling, psychotherapy, or psychiatric admissions
60
four questions for the hematologic ROS
1. Anemia
2. Easy bruising or bleeding
3. Past transfusions
4. Transfusion reactions
61
6 questions for the endocrine ROS
1. Thyroid trouble”
2. Heat or cold intolerance
3. Excessive sweating
4. Excessive thirst or hunger
5. Polyuria
6. Change in glove or shoe size
62
why should providers be aware of personal biases during the patient interview
because biases can create tunnel vision that might exclude symptoms outside the providers bias
63
what is the DSM and what is its purpose
the diagnostic and statistical manual of mental disorders
to codify what the primary indications are for diagnosis of mental disorders
64
what are the 8 components of the general survery
1. apparent state of health
2. level of consciousness
3. signs of distress
4. skin color or obvious lesions
5. dress/grooming/hygiene
6. facial expression
7. breath or body odor
8. posture, gait, motor activity
65
what are three purposes of the physical exam
1. to validate findings from the health history
2. investigate problems
3. screen for diseases
66
what are the limitations of the physical exam
1. detection and measuring errors
2. limited sensitivity to distinguish health from disease
67
what are four advantages to the physical exam
1. objective
2. sensity to certain signs of disease
3. cheap
4. laying on hands builds a relationship with patient
68
what are seven errors common to the physical exam
1. technique
2. errors of omission
3. errors of detection
4. errors of interpretation
5. errors in documentation
6. variability in clinical measurements
7. legitimate disagreement
69
what are the four cardinal techniques of the physical exam and what is the order of these techniques
1. inspect
2. palpate
3. percuss
4. auscultate
70
what is the exception to the general sequence of the physical exam
the abdomen, where you inspect, auscultate, percuss, then palpate the abdomen first shallow then deeply
71
what is the suggested sequence to proceed through the physical exam
1. general survey
2. vital signs
3. skin and nails
4. head
5. eyes
6. ears
7. nose
8. mouth
9. neck
10. lymph nodes
11. pulmonary
12. breasts
13. heart
14. abdomen
15. GU/rectal
16. extremities
17. musculoskeletal
18. neurological
19. psychological
72
what is normal BMI
18.5 to 24.9
73
what is a normal BP
120/80
74
what is a normal pulse
60-100 bpm
75
what is a normal respiratory rate
20 breaths per minute
76
what is normal temp
98.6 degrees F
77
78
jaundice
a yellowing of the skin, eyes, lips, tongue, and TM caused by excess bilirubin related to liver disease or hemolysis
79
carotenemia
yellow color on the palms, soles, and face caused by high levels of carotene in the diet
80
when is carotenemia common
when babies are starting on solid food
81
where is central cyanosis best seen
lips, oral mucosa, tongue
82
where can peripheral cyanosis be seen
nails, hands, feet
83
what should be noted during inspection and palpation of the skin
1. color
2. temp
3. moisture
4. texture
5. turgor
6. mobility
7. lesions
84
what are 6 ways to describe abnormal skin color
1. jaundice
2. carotenima
3. erythema
4. cyanosis
5. pallor
6. absence of pigment
85
what are three consideration to take into account when assessing skin moisture
1. chronic vs acute dryness
2. age
3. oily skin
86
how is skin temp assesed
with the back of the hand
87
what are four reasons to expect increased skin temp
1. exercise
2. inflammation
3. fever/infection
4. hyperthyroid
88
what are three reasons to expect decreased skin temp
1. poor circulation
2. hypothyroid
3. inadequate clothing
89
when would you expect rough skin? velvety skin?
rough from hypothyroid
smooth from hyperthyroid
90
what are two conditions that would result in loss of skin mobility
1. edema
2. scleroderma
91
what are 11 features to note about skin lesions
1. size
2. shape
3. location
4. generalized/localized
5. patterned
6. single/multiple
7. type of lesion
8. color of lesion
9. painful
10. associated warmth
11. drainage
92
what are the ABCDEs of assessing a skin lesion for cancer risk
A) asymmetry
B) borders (irregular)
C) color
D) diameter
E) evolution
93
T/F a skin lesion that is smaller than 6mm does not fit the criteria for skin cancer
false, it may fit the criteria if it is significantly larger than other skin lesions
94
what percentage of skin cancer is basal cell carcinoma
80%
95
where is someone most likely to get skin cancer
on sun exposed areas
96
describe how a basal cell carcinoma looks
pearly erythmatous translucent papule
97
T/F basal cell and squamous cell carcinomas rarely metastize
false, squamous cell carcinomas metastize approx 1% of the time
98
how common are squamous cell carcinomas
16% of all skin cancers are squamous cell carcinomas
99
a patient presents with a dry, hyperkeratotic lesion on the face, what is a likely diagnosis
squamous cell carcinoma
100
how common is melanoma
4-5% of all skin cancer is melanoma
101
T/F melanoma is the least likely type of skin cancer reported in patients ages 25-29
false, it is the most
102
which of the three skin cancers is potentially most lethal? why
melanoma, because it is more likely to metastize
103
what is the HARMM acronym and what is it used for
H) hx of previous melanoma
A) age over 50
R) regular dermatologist absent
M) mole changing
M) male
used to delineate risk factors for melanoma
104
what are three other risk factors associated with melanoma
1. red/light hair
2. freckles
3. severe blistered sunburns as a child
105
macule/patch
a flat, non-palpable lesion with changes in skin color
106
what is the difference in size between a macule and a patch
macules are up to 1cm
patches are larger than 1cm
107
papule (example)
a solid elevated lesion up to 1 cm (warts, moles)
108
plaque (example)
palpable, elevated lesion greater than 1cm, sometimes formed from plaques
psoriasis
109
nodule (example)
knot like lesion deeper and firmer than a papule, less than .5cm in size (dermatofibroma)
110
cyst (example)
nodule filled with expressible material (ganglion, sebaceous)
111
wheal (example)
somewhat irregular, reletively transient superficial area of localized skin edema (uticarial wheals/hives)
112
vesicle/bulla (example)
a palpable elevation filled with serous fluid (chicken pox blisters, herpes blisters)
113
what is the difference in size between a vesicle and a bulla
vesciles are up to 1cm
bulla are 1cm or greater
114
pustule (example)
a palpable elevation filled with pus (acne, insect bites)
115
burrow (example)
a small, slightly raised tunnel in the epidermis that looks like a short curved grey line with a small vesicle, papule, or crust (scabies)
116
where are burrows usually found
finger sides and webs
117
scale (example)
a thin flake of dead exfoliated epidermis (peeling sunburn)
118
crust (example)
a dried residue from exudate such as blood, pus, or serum (scab)
119
lichenification (example)
a visible and palpable thickening of the epidermis and roughening of the skin with increased visability of the normal skin furrows (atopic dermatitis)
120
what is usually the cause of lichenification
chronic rubbing and scratching
121
scar
an area with increased connective tissue that arises from injury or disease
122
keloid
a hypertrophic scar that extends beyond the borders of the original injury
123
atrophy (example)
an area of deceased skin or muscle growth (pit caused by chronic steroid injections
124
erosion (example)
nonscarring loss of superficial epidermis (aphthous stomatitis)
125
ulcer
a deep erosion that may cause a scar
126
excoriation (example)
linear or punctate erosions caused by scratching (atopic dermatitis)
127
fissure
a linear crack in the skin, often caused by dryness
128
induration (example)
hardening or sclerosis of skin (infection, scleroderma)
129
telangiectasia
chronic dilation of a group of capilaries
130
milia
superficial inclusion cysts filled with keritinaceous debris
131
where are milia often found
on the face of newborns
132
two types of hair
velus and terminal
133
velus hair
short fine hair found all over
134
terminal hair
hair the scalp, eyebrows
135
what are four qualities to note when inspecting the hair
1. quantity
2. texture
3. distribution
4. pattern of hair loss
136
alopecia
hair loss that can be diffuse, patchy, or total
137
would hair loss be expected in a patient with hyperthyroidism?
no, you would expect fine silky hair with hyperthyroid
138
A) nail plate
B) nail groove
C) lunula
D) eponychium
139
what should noted when inspecting and palpating the finger and toe nails
1. color
2. shapes
3. lesions
4. infections
140
paronychia (cause)
superficial infection of the proximal and lateral nail folds adjacent to the nail plate (staph infection)
141
onychomycosis
fungal infection of the toenails
142
what is the most common disease of the nails
onychomycosis
143
clubbing
a bulbous swelling of the soft tissue at the nail base, with loss of the normal angle between the nail and proximal nail fold
144
what causes clubbing
vasodilation in response to heart, lung, or metastatic malignancies causes increased blood flow to the digits
145
onycholysis
a painless separation from distal to proximal of the nail plate from the nail bed
146
what are three common causes of onycholysis
1. trauma
2. fungal infection
3. allergic reations
147
leukonychia
white spots that grow out with the nail caused by trauma
148
mee's lines
curving transverse white bands that cross the nail parallel to the lunula
149
what are three causes of mees lines
1. arsenic poisoning
2. heart failure
3. hodgkins disease
150
beaus lines
transverse depressons of the nail plates resulting from disruption of proximal nail growth
151
what are three causes of beaus lines
1. illness
2. trauma
3. raunauds disease
152
terrys nails
a condition where the nail plate turns white with a ground glass appearance
153
what are three conditions associated with terrys nails
1. liver disease
2. heart failure
3. DM
154
actinic keratosis
155
atrophy
156
basal cell carcinoma
157
beaus lines
158
bulla
159
1cm in diameter or greater
bulla
160
burrow
161
burrow
162
carotenema
163
cherry angioma
164
less than 1cm in diameter
chickenpox vesicle
165
clubbing
166
crust
167
cyst
168
cyst
169
ecchymosis
170
erosion
171
erythema
172
excoriation
173
herpes zoster
174
fissure
175
jaundice
176
keloid
177
leukonychia
178
lichenification
179
greater than 0.5cm in size, deep and firm on palpation
nodule
180
greater than 0.5cm in size, deep and firm on palpation
nodule
181
onycholysis
182
onychomycosis
183
solid, elevated, less than 1cm
papule
184
papule
185
paronychia
186
greater than 1cm in size
patch
187
plaque
188
pitting
189
greater than 1cm
plaque
190
larger than 1cm
bulla
191
purpura
192
pustule
193
pustule
194
scale
195
scar
196
seborrheic dermatitis
197
seborrheic keratosis
198
spider angioma
199
squamous cell carcinoma
200
squamous cell carcinoma
201
telangiectasia
202
terrys nails
203
ulcer
204
vescile
205
vesicle
206
vitalago
207
wheal
208
wheal
209
what is the differene between assessment and plan
assessment is what you think, plan is what you do
210
what are some issues to take into consideration when developing a plan?
why?
financial status, patient goals, family structure
some people will not have the financial or social support for lab tests or adherence to medication
211
three types of clincial reasoning
1. pattern recognition
2. development of schemas
3. application of science
212
how does pattern recognition play a role in clincial reasoning
through experience practitioners will come to understand disease processes and recongize their progression
213
two examples of schemas
algorithms
mnemonic
214
what is the VINDICATE mnemonic stand for
**V**ascular
**I**nfection/inflammatory/autoimmune
**N**eoplasm
**D**rugs
**I**atrogenic
**C**ongenital/Development/inherited
**A**natomic
**T**rauma
**E**nvironmental Exposure/Endocrine/Metabolic
215
what is the purpose of the vindicate mnemonic
to brainstorm about what disease processes might be in play
216
what is one way to narrow down problems when trying to diagnose
think about what structures are anatomically close to symptoms
217
steps of clinical reasoning
1. identify abnormal findings
2. localize findings anatomically
3. cluster clinical findings
4. interpret the findings in terms of a probable disease process
5. form a hypothesis
6. confirm with tests
7. establish a working diagnosis
218
what are some considerations when clustering clinical findings
1. there may be more than one cluster
2. older patients have more chronic/systemic disease
3. temporal relationship between problems
4. localized vs systemic problems
5. multisystemic issues
219
three whys to interpret findings and translate them into a disease process
1. Pathologic (diseases of body system or structure)
2. Pathophysiologic (problems in biologic function
3. psychopathologic
220
what is especially important when developing a hypothesis
recognition and treatment for potentially lifethreatening situations
221
T/F the plan is a finality and must take into consideration all aspects of care
false, each problem should have their own plan and will change for each visit
222
what are five pitfalls of clinical reasoning
1. Anchoring
2. Search satisficing
3. Diagnostic momentum
4. psych-out error
5. premature closing
223
anchoring
being stuck on a particular diagnosis despite contrary evidence
224
search satisficing
choosing the first diagnosis that fits all the symptoms
225
premature closing
making a snap decision based on limited evidence
226
diagnostic momentum
when a diagnosis becomes a matter of fact: treat all patients like they have no diagnosis
227
psych out error
when somatic diagnoses are ignored in favor of psychological ones
228
what is the problem list? what is it used for?
a running list of all problems
to keep a tab on all a patients problems, treatment, and duration of problem
229
three attributes of well organized medical records
1. clear
2. concise
3. comprehensive
230
why is it important to be precise whend documenting findings
1. things you don't record aren;t part of the record and can't be used in treatment going forward
2. you cant record abnormalities you don't observe
231
validity
how closely a given observation is to the truth
232
reliability
how well a measurement can be repeated
233
sensitivity
a test that provides a reliable positive to people who have the disease
234
what is a good indication that test is sensitive?
when will a sensitive test be most useful?
a 90% sensitivity
best to rule out diseases because there are few false positives for specific disease
235
SnNout
when a sensitivity of a symptom or sign is high, a negative response rules out the disease in question
236
a negative on a sensitive test means what
you can rule out a disease and be confident that the patient doesn;t really have it
237
specificity
identifies the proportion of people who test negative in a group that don't have a disease
238
SpPin
when specificity is high, a positive test rules in the target disorder
239
predictive value
indication of how well a given symptom, sign, or test predicts the presence or absence of a disease
240
positive predictive value
the proportion of true positives out of the total population with the disease
241
negative predictive value
the proportion of true negatives out of the total population without the disease
242
LR
likelihood ratio, the odds that a finding occurs in a patient with the condition compared to a patient without the condition
243
what LR value is most useful when trying to rule out a disease? when trying to rule in
to rule in, choose the test with the highest positive LR
to rule out, choose the test with the lowest negative LR
244
negative LR
the odds that a negative finding will accurately rule out a disease
245
positive LR
the odds that a positive test will accurately indicate the person has a disease
246
what test would you choose to rule in an infection? which would you use to rule out?
to rule in, use the test with the highest positive LR, procalcitonin
to rule out, use the test with the lowest negative LR, CRP
247
what does it mean to say that a test has a high level of certainty
the available evidence comes from well designed studies and the findings are representative of primary care populations
248
what are the sections of the health history in order including the ROS (24)
1. Identifying info
2. CC
3. HPI
4. Medications
5. Allergies
6. Alcohol/Tobacco/Drugs
7. PMI
8. Family History
9. Social History
10. ROS (general)
11. Skin
12. HEENT
13. Neck
14. Breasts
15. Respiratory
16. Cardiovascular
17. GI
18. Peripheral Vascular
19. Urinary
20. Genital
21. Musculoskeletal
22. Pyschiatric
23. Neurologic
24. Hematologic
249
what is the order of the physical exam (18)
1. General
2. MEntal
3. Vitals
4. Skin
5. Hands/Nails
6. Head
7. Neck
8. Eyes
9. Nose
10. Mouth and throat
11. Ears
12. Axillary and Epitrochlear nodes
13. Chest
14. Cardiovascular
15. peripheral vascular
16. Abdomen
17. Musculoskeletal
18. Neuro
250
how will the patient be postioned during the physical exam
* sitting for general, vitals, skin, head, neck, breasts
* lay back for cardiovascular, then roll partly to the left, then sit up and lean forward
* lay flat for the abdomen
* stand if needed as needed for musculoskeletal, neuro, skin
* women lay back for pelvic, men on their left side for prostate
251
T/F Depression is the leading cause of disability world wide
True
252
what are five physical symptoms of depression
1. Fatigue
2. Sleep disturbances
3. musculoskeletal pain
4. headache
5. GI problems
253
Approx what percent of unexplained symptoms are related to depression
50%
254
T/F Sleep disturbances happen when a patient wakes up frequently in the night
false, it can mean getting too much sleep as well as too little
255
when should a mental health screen be performed
there are many possible key factors but the US preventative service task force reccommends one for all patients
256
what are the five components of a mental health exam
1. apperance and behavior
2. speech and language
3. mood
4. thoughts and perceptions
5. cognitive function
257
what four patient qualities should be examined when assessing apperance and behavior
1. level of consciousness
2. posture and motor behavior
3. dress/grooming/hygiene
4. manner/affect/relationships
258
what are five ways to describe level of consciousness
1. alert
2. lethargic
3. obtunded
4. stupor
5. coma
259
three indicators a person is alert
1. responds to normal tone of voice
2. good eye contact
3. appropriate responses
260
three indicators a person is lethargic
1. drowsiness
2. opens eyes only to look at you
3. responds to questions then falls asleep
261
five indicators that a patient is obtunded
1. opens eyes to look at you
2. responds slowly
3. somewhat confused
4. decreased alertness
5. might need a shake awake
262
three indicators a patient is stuporous
1. arouses only with painful stimuli
2. slow or absent verbal response
3. minimal awareness of environment
263
two indictors of a comatose patient
1. unrousable with eyes closed
2. no response to painful stimuli
264
what are four ways to introduce painful stimuli
1. trap squeeze
2. sternal rub
3. pencil on nail bed
4. pinch
265
what are four examples of abnormal posture and motor behavior
1. pacing
2. abnormal posture
3. spastic movement
4. complaining of a level of pain that doesn't match presentation
266
what are 4 examples of variation in affect
1. labile
2. blunt
3. exaggerated
4. pleasant
267
labile affect
someone who expresses in appropriate or excessive displays of emotion
268
when assessing manner/affect/relationships what are five factors to examine
1. affect
2. level of approachability
3. appropriate reactions to others
4. possible hallucinations
5. euphoria
269
what are five ways to evaluate speech and language in a mental health exam
1. quantity
2. rate
3. volume
4. articulation
5. fluency
270
pressured speech
an abnormal speech pattern where the patient continuously talks with no breaks
271
what are two issues that might present with pressured speech
1. mania
2. substance abuse
272
what are three issues that might present with slowed speech
1. depression
2. stroke
3. sedation
273
T/F slowed speech can involve speaking slowly or the inability to get words out
true
274
four disorders of speech
1. aphasia
2. apraxia
3. dysarthria
4. dysphonia
275
what is aphasia
a communcation disorder caused by damage to the language centers of the brain
276
what is the defining characteristic of aphasia
difficulties communicating (speech, writiing, reading) with no decrease intelligence
277
apraxia
a motor disorder in which the signal conduction from the brain to the mouth is interrupted, causing the person to be unable to move their mouth properly to speak
278
dysarthria
a motor speech disorder resulting from impaired muscles used in speech
279
what determines the type and severity of dysarthria
the area of the nervous system that is affected
280
dysphonia
a voice disorder caused by impairment of the mouth, tongue, throat, or vocal cords resulting in hoarseness
281
what is the goal of assessing a patients thoughts and persceptions during a mental health exam
the assess the logic, relevance, organization, and coherence of a patients thought process
282
what are 5 examples of a derranged thought process
1. circumstantial
2. tangential
3. flight of ideas
4. incoherent
5. echolalia
283
what are circumstantial thoughts? what disorder might they indicate
speech with pointless, unnecessary detail
OCD
284
what are tangential thoughts? what disorder might they indicate
shifting between unrelated topics
psychotic
285
if a patient was described as having a flight of ideas, what kind of thought process would that describe? What might be the cause
non-stop, pressured speech with quickly changing topics
severe schizophrenia
286
what is echolalia? what might it indicate
repetition of words and phrases of others
mania, schizophrenia, autism
287
what is a good method to encourage a patient to describe there thought content
follow their lead, ask open ended questions
288
what are five terms to describe the content of a patients thoughts
1. complusions
2. delusions
3. phobias
4. anxiety
5. obessions
289
compulsion
a repetitive response to a stimuli
290
obession
recurrent, persistant thoughts, feelings, or urges
291
phobias
persistent, irrational fears
292
delusions
false, fixed beliefs
293
three types of delusion
1. persecutory
2. grandiose
3. erotomania
294
persecutory delusion
the feeling someone is out to get them
295
grandiose delusions
an inflated sense of importance
296
erotomania
the delusion that another person is in love with the patient but has not reason to be
297
what are six types of hallucinations
1. auditory
2. visual
3. olfactory
4. gustatory
5. tactile
6. somatic
298
what is the most common form of hallucinations
auditory
299
how might a patient behave tactile hallucinations
an exaggerated reaction to a imagined stimuli (somone touched my head)
300
somatic hallucinations
believing your body is filled with parasites
301
what are five ways to examine cognitive function
1. orientation
2. attention
3. remote memory
4. recent memory
5. new learning ability
302
what are three ways to test attention
1. digital span
2. serial 7s
3. spelling backwards
303
how to test remote memory
asking to recall past events
304
how to test learning ability
give the patient three words to remember, have them repeat the words, then ask them again in 3-5 minutes
305
what are four ways to test higher cognitive function
1. knowledge and vocabulary
2. calculating ability
3. abstract thinking
4. constructional ability
306
what is one way to test abstract cognitive ability
ask the patient to define a common proverb
307
what is one way to assess a patients constructional ability
ask them to draw a shape or a clock
308
what is the most widely used cognitive test for dementia in the US
the mini-mental state exam
309
what are the six factors tested on the mini-mental state exam
1. orientation
2. recall
3. attention
4. calculation
5. language
6. constuctional praxis
310
what are two weaknesses of the mini-mental health exam
1. not sensitive to severe or mild dementia
2. maybe influenced by age, education, language, etc
311
why should to room be dark for opthalmoscopic exam
because it promotes pupil dilation and visibility of the fundus
312
G-P-M-L
gravida
parity
miscarriages
living
313
gravida
the number of pregnancies
314
parity
number of deliveries
315
what is the national institute of alcohol abuse and alcoholism definiton of low risk drinking for men, women, and older individuals
1. men no more than 4 drinks on a single day or 14 in a week
2. women no more than 3 drinks a day or 7 in a week
3. over the age of 65 with no medications no more than 3 drinks a day or 7 in a week
316
why is fatigue a ambiguous diagnosis
because it can be a symptom of a mental disorder (depression, anxiety) but also can be a physical disorder (cancer, infection, diabetes)
317
when would weakness be associated with myopathy or neuropathy
when it is localized to a specific neuroanatomical pattern
318
recurrent fever and chills are indicative of what
systemic bacteremia
319
what is the suspected cause of rapid weight loss over a few days
change in fluid retention, not tissue
320
what are four possible causes of weight loss with relatively stable diet
1. hyperthyroid
2. DM
3. malabsorption
4. bulemia with vomitting
321
what are three example of pathgnomonic faces
1. hyperthyroid bulging staring
2. immobile face parkinsons
3. flat affect depression
322
auscultory gap
a lag time where heart beats will be heard, stop briefly, then start again during blood pressure recordings
323
what is the risk of an ausculatory gap
a very high systolic pressure or a very low diastolic pressure
324
what condition is ausculatory gap associated with
atherosclerotic disease
325
what is the benefit of treating isolated systolic hypertension in patients greater than 60 yrs
reduction of morbitity and complications from cardiovascular disease
326
what happens if a blood pressure cuff is too small? too large?
too small = higher BP
too big = lower BP
327
what are four ways to monitor patient outcomes
1. analgesia
2. ADLs
3. adverse effects
4. abberant drug related behaviors
328
what are four sources of urticaria with no apparent rash
1. dry skin
2. pregnancy
3. leukemia
4. polycythemia vera
329
what is the difference between a blanching and non-blanching lesion
blanching lesions are erythematous, non-blanching lesions are vascular bright red or violaceous
330
what are three examples of a non-blanching lesion
1. petechiea
2. purpura
3. cherry angioma
331
what can local redness of the skin be indicative of in a bed bound patient
nercosis associated with bed sores
332
what is the size division beween petechia and ecchymosis
petechia is 1-3mm, ecchymosis is larger than 1 cm
333
annular skin lesion
ring shaped with a central clearing
334
nummular
circular or coin shaped
335
pendunuclated
attached to the skin by a narrow stalk
336
confluent vs coalescing
confluent lessions run together
coalescing are distinct lesions that touch
337
follicular lesions
involve the hair follice
338
truncal
favors the trunk
339
intertriginous
affecting the body folds
340
what sort of lesion might be described as honey colored
a crust
341
guttate
looks like it was dropped with an eye dropper
342
serpiginous
snake like
343
eschar
a hard darkened plaque usually covering areas of extensive tissue infarcts or gangrene
344
umbilicated
lesions with a central indentation
