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Clinical Exam 1
Medical School Clinical exam class: Mosby's 1,3,15, 24-26
327
Medical
Professional
09/20/2011

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Cards

Term
What are the 6 ethical principles?
Definition
Autonomy, Beneficence, Nonmaleficence, Utilitarianism, Fairness and Justice, and Deontologic imeratives
Term
What does Autonomy mean?
Definition
The patient's need for self-determination: the ability to choose between alternatives.
Term
What does Beneficence mean?
Definition
Do good for the patient.
Term
What does Nonmalficence mean?
Definition
Do no harm to the patient.
Term
What does Utilitaraianism mean?
Definition
Consider appropriate use of resources with concern for the greater good of the larger community.
Term
What does Fairness and Justice mean?
Definition
Recognize balance between patient's autonomy and the interests of family and community.
Term
What does Deontologic imperatives mean?
Definition
Responsibilities for offering care are established by tradition and cultural contexts and vary by culture.
Term
What does establishing a positive patient relationship depend on?
Definition
communication, courtesy, comfort, connection, and confirmation
Term
What are 3 types of questions?
Definition
open-ended, direct, leading
Term
What is the structure of the history?
Definition
Identifiers, cheif complaint, history of present illness, past medical history, family history, personal and social history, review of symptoms.
Term
What are identifiers?
Definition
name, date, time, age, gender, race, occupation, and referral source
Term
What is the chief complaint?
Definition
direct quote from the patient explaining why they are seeking care
Term
What is the history of present illness?
Definition
the circumstances that surround the primary reason for the patient's visit.
Term
What is the past medical history?
Definition
past medical and surgical history
Term
What is the family history?
Definition
Family's health, past medical history, illnesses, deaths, genetic, social, and environmental influences of family.
Term
What is the personal and social history?
Definition
Work, family, and school relationships
Term
What is the review of symptoms?
Definition
Detailed review of possible complaints in each of the body's systems
Term
What are the 4 steps to approach a sensitive topic?
Definition
1. Introduce the topic 2. open-ended quesions 3. interpret and repeat the patient's words 4. ask relevant questions
Term
What is the CAGE questionnaire?
Definition
Cut down, Annoyance, Guilt, Eye-opener
Term
What is TACE used for?
Definition
Adults and pregnant women.
Term
What is CRAFFT used for?
Definition
Adolescents
Term
What is the TACE questionaire?
Definition
How many drinks does it take to feel high, Annoyance, Cut Down, Eye-Opener
Term
What is the CRAFFT questionnaire?
Definition
Car with impaired driver, Relax with drugs, Alone using, Forget things you did, Family/Friends told you to cut down, Trouble for using them
Term
What is the HITS questionnaire?
Definition
Hurt, Insult, Threaten, Scream
Term
What questionnaires can be used for alcohol in adults?
Definition
TACE and GAGE
Term
What questionnaire is used for substance abuse in adolescents?
Definition
CRAFFT
Term
What questionnaire is used for spirituality?
Definition
FICA
Term
What is FICA?
Definition
Faith, Importance/Influence, Community, Address how it affects health care decisions
Term
What are similar terms to describe chief complaint?
Definition
presenting problem and reason for seeking care
Term
What 4 questions give a basis of understanding of the unique experience of each patient?
Definition
Why is it happening now? How is this patient different from others? Can I assume that what is true for this patient is true for others? How does this bear on my ultimate interpretation?
Term
What are risk factors for Type II Diabetes?
Definition
Children: obesity and dyslipidemia. Adults: 1 or more second degree relatives with diabetes or CVD.
Term
What are 2 mnemonics for adolescent screening?
Definition
HEADSSS: Home, Edu/Employment, Eating, Activities/Affect/Anger, Drugs, Sexuality, Suicide, Safety. PACES: Parents/peers, Accidents/Alcohol/Drugs, Cigarettes, Emotions, School/Sexuality.
Term
What state or federal laws control the need for confidentiality in adolescents?
Definition
pregnancy, abortion, substance abuse, physical abuse.
Term
What takes on a dominant role during middle adolescence?
Definition
risky behavior, immature decisions, arguments with parents
Term
What takes on a dominant role during late adolescence?
Definition
understanding of consequences and self takes hold
Term
How frequent is postpartum depression?
Definition
1 out of 8 women after delivery
Term
When are advanced directives needed?
Definition
When cognitive impairment deprives a patient (of any age) of the ability to join in the decision-making process.
Term
What should compliment advanced directives?
Definition
The appointment of a surrogate who has legally executed durable power of attorney for healthcare.
Term
What is frailty?
Definition
Loss of physical reserve and increased risk of loss of physical function and independence
Term
What findings suggest frailty?
Definition
3 or more of the following: muscle weakness, fatigue, decline in activity, slow or unsteady gait, unintentional weight loss. OR the PT needs help with 2 or more ADLs
Term
What describes mobility disability?
Definition
Difficulty walking, climbing stairs, balance.
Term
What describes housework disability?
Definition
Heavy, light, meal preparation, shopping, medication use, money management.
Term
What describes upper extremity function disability?
Definition
Grasping, opening jars, reaching overhead.
Term
What describes ADL disability?
Definition
Bathing, dressing, toileting, moving, eating, walking in home.
Term
What is palliative care?
Definition
Comprehensive management of phys, emot, and spirit or PTs with life-limiting conditions.
Term
What are the 4 types of histories?
Definition
Complete, inventory, problem aka focuesd, interim.
Term
When is an inventory history taken?
Definition
Touches on major points without going into detail, used when the entire history will be taken in more than one session.
Term
When is a problem aka focused history taken?
Definition
During an acute possibly life threatening problem.
Term
When is an interim history taken?
Definition
Chronicles events that have occurred since your last meeting.
Term
What are standard precautions?
Definition
Hand hygeine, PPEs, cough etiquette, safe injections, masks for catheter insert/ subarachnoid puncture, contaminated surface containment.
Term
How can health care professionals minimize their vulnerability?
Definition
Follow standard precautions, minnimize latex exposure, use good body mechanics.
Term
When should hand hygiene be used?
Definition
After touching blood, body fluid, secretions, excretions, contaminated items, after removing gloves, and between patient contacts.
Term
When should gloves be used?
Definition
Touching blood, bodily fluids, secretions, excretions, contaminated items, mucous membranes, and nonintact skin.
Term
When should a gown be used?
Definition
When contact of your body is expected with blood/body fluids, secretions, and excretions.
Term
When should a mask or goggles be used?
Definition
Splashed or sprays of blood, body fluid, secretions, suctioning, or endotracheal intubation.
Term
How should needles/ sharps be handled?
Definition
Do not recap, bend, break, or hand manipulate. If recapping is required, use a 1-hand scoop technique
Term
What are 3 types of latex reactions?
Definition
Irritant contact dermatitis, Type IV dermatitis, Type I systemic reactions.
Term
What is Irritant contact dermatitis?
Definition
Chemical irritation that does not involve the immune system.
Term
What is Type IV dermatitis?
Definition
aka Delayed hypersensitivity: involves immune system, onset 24-48 hrs.
Term
What is Type I systemic reactions?
Definition
True allergic reaction caused by IgE, releasing histamine, leukotrienes, prostaglandins, and kinins.
Term
What are the symptoms of Irritant contact dermatitis?
Definition
Dry, itchy, irritated hands.
Term
What are the symptoms of Type IV dermatitis?
Definition
Resembles poison ivy and may lead to oozing skin blisters.
Term
What are the symptoms of Type I systemic reactions?
Definition
Local utricaria (wheals), generalized utricaria with angioedema, asthma, eye-nose itching, GI symptoms, anaphylaxis, chronic asthma, and permanent lung damage.
Term
What is the dorsal recumbent position used for?
Definition
Examination of genital and rectal areas.
Term
What is the lithotomy position used for?
Definition
pelvic exam
Term
Describe the Sims position.
Definition
PT in lateral recumbent rolls torso toward prone, sharply flex top leg, gently flex bottom leg: rectal exam.
Term
What odor can be detected for inborn errors of metabolism?
Definition
PAH defect: mousy, Tyrosinemia: fishy
Term
What odor can be detected for infectious diseases?
Definition
TB: stale beer, Diptheria: Sweetish
Term
What odor can be detected for poison/ intoxication?
Definition
Cyanide: bitter almond, Chloroform and Salicylates: fruity
Term
What odor can be detected for physiologic non-disease states?
Definition
Sweaty feet: cheesy
Term
What odor can be detected for foreign bodies?
Definition
lodged organic material: foul-smelling discharge.
Term
What part of your hand is used for discriminatory touch?
Definition
Palmar surface of fingers and finger pads (not fingertips)
Term
What part of your hand is used to sense vibration?
Definition
ulnar surface of hands and fingers
Term
What part of your hand is used to sense temperature?
Definition
Dorsal surface
Term
What depth yields percussion tones?
Definition
4-6cm deep
Term
What are the percussion sounds from loudest to quietest?
Definition
Tympany, hyperressonance, ressonance, dullness, and flatness
Term
How do you perform percussion?
Definition
Place distal phalynx of middle finger nondominant hand over target area, elevate other fingers. Snap wrist to bring down dominand middle finger TIP (plexor) down on target finger.
Term
What is the tone, intensity, pitch, duration, and quality of a gastric bubble?
Definition
tympanic, loud, high, moderate, and drumlike
Term
What is the tone, intensity, pitch, duration, and quality of emphysematous lungs?
Definition
hyperresonant, very loud, low, long, boomlike
Term
What is the tone, intensity, pitch, duration, and quality of healthy lung tissue?
Definition
resonant, loud, low, long, hollow
Term
What is the tone, intensity, pitch, duration, and quality of the liver?
Definition
dull, soft-moderate, moderate-high, moderate, thudlike
Term
What is the tone, intensity, pitch, duration, and quality of muscle?
Definition
flat, soft, high, short, very dull.
Term
How are indirect measurements of blood pressure taken?
Definition
stethoscope and either aneroid or mercury sphygmomanometer
Term
How wide should an adult blood pressure cuff be?
Definition
1/3 - 1/2 the circumference of the limb
Term
How long should the cuff bladder be?
Definition
2x the width (80% of limb circumference)
Term
How wide should a child's blood pressure cuff be?
Definition
2/3 or upper arm or thigh (40% of circumference)
Term
How much of the distance between the acromion and olecranon should the child's cuff cover?
Definition
0.7
Term
How long should a child's cuff bladder length/ width be?
Definition
80-100% of arm circumference/ 40% arm circumference
Term
What method of measuring temperature is best for children ages 2 months- 16 years?
Definition
tympanic
Term
Why does ear temperature reflect body temperature?
Definition
tympanic membrane shares blood supply with hypothalamus in the brain.
Term
Why does axillary temperature correlate well with a newborn's core temperature?
Definition
infant has small body mass and uniform skin blood flow.
Term
How is sPO2 measured?
Definition
pulse oximitry (healthy = 97-99%)
Term
What are 4 types of patient transfer?
Definition
Pivot, Cradle, 2-person, and Equipment
Term
What is the natural frequency of the diaphragm of an acoustic stethoscope?
Definition
300Hz (best for low frequency sounds)
Term
What is the bell of the acoustic stethoscope used for?
Definition
low pitches sounds with light pressure (higher with firm)
Term
What are the components of a magnetic stethoscope?
Definition
Convex single diaphragm over iron disk, compression activates air column. Dial adjusts for high, low, and full frequency sounds.
Term
What is unique about a stereophonic stethoscope?
Definition
Right and left ear can hear right and left auscultory sounds independently.
Term
How does a pulse oximiter work?
Definition
One diode sends out invisible infrared, and the other visible red. oxygenated Hb = more red light passes through to other side.
Term
How does Doppler Detect Blood Flow?
Definition
Low power high frequency wave reflects at various tissue interfaces, resulting in audible sounds.
Term
What frequency does Doppler measure?
Definition
2-10 MHz
Term
What is used to determine fetal heart rate?
Definition
A fetoscope or a Leff scope.
Term
At what age can a fetoscope or Leff scope detect HR?
Definition
17-19 weeks gestation
Term
What is the small aperture of the opthalmoscope used for?
Definition
small pupils
Term
What is the red-free filter aperture of the opthalmoscope used for?
Definition
green beam: optic pallor, minute vessel changes, retinal hemorrhages, blood appears black.
Term
What is the slit aperture of the opthalmoscope used for?
Definition
Anterior eye to determine lesion elevation.
Term
What is the grid aperture of the opthalmoscope used for?
Definition
Size of fundal lesions
Term
What is the magnification power (diopter) of an opthalmascope?
Definition
pos or neg 20 to pos or neg 140
Term
Can an opthalmoscope compensate for myopia or hyperopia?
Definition
Yes, using plus and minus lenses, HOWEVER there is no compensation for astigmatism.
Term
How should an opthalmoscope be seated in the handle?
Definition
Fit the adapter of the handle into the head receptacle and push downward while turning the head in a clockwise direction.
Term
How do you use a strabismoscope?
Definition
Have child focus on accomodative target, cover one eye with scope, watch for movement in both eyes, switch.
Term
What the the numerator and denominator of visual acuity represent?
Definition
Numerator: distance in feet between patient and chart. Denominator: distance from which a person with normal vision could read the lettering.
Term
What does a Snellen chart measure?
Definition
far vision
Term
When should the Tubling E or HOTV tests be used?
Definition
Children aged 3-5 years.
Term
What is an LH (LEA) symbols chart?
Definition
Presents 4 optotypes: circle, square, apple, house: recorded as smallest symbol/ testing distance
Term
What is a broken wheel (Landolt) test?
Definition
Child must identify broken wheel on a card. Each card has a different size card to ID different acuities.
Term
What tests are used for near vision?
Definition
Rosenbaum or Jaeger chart: series of numbers, E, X, and O in graduated sized.
Term
What is used to test macular degeneration?
Definition
Amsler grid: PT views grid one eye at a time noting line distortion or scotoma. Used when PT has retinal drusen bodies of family Hx.
Term
Which otoscope speculum is used for a tympanic membrane/ external auditory canal exam?
Definition
Largest that will comfortably fit.
Term
What otoscope speculum is used for naris?
Definition
Shortest and widest
Term
What evaluates the fluctuating capacity of the tympanic membrane?
Definition
pneumatic attachment for otoscope, apply pufs of air.
Term
What does tympanometry assess?
Definition
Functions of ossicular chain, eustachian tube, and tympanic membrane
Term
What is a nasal speculum used for?
Definition
To visualize lower and middle turbinates.
Term
What frequency tuning fork is used for auditory evaluation?
Definition
500-1000Hz (speech is 300-3000 Hz)
Term
What frequency tuning fork is used for vibratory sensation?
Definition
100-400Hz: tap against heel of hand, apply base of fork to bony prominence
Term
What are the 3 types of vaginal specula?
Definition
Graves: 3.5-5 x 0.75-1.25, Penderson: narrower and flatter blades, Pediatric: smaller in all dimesions
Term
What is a Goniometer used for?
Definition
Degree of joint flexion and extension
Term
What does a Wood's lamp do?
Definition
300nm black light that causes fungi to flouresce
Term
What does a dermatoscope measure?
Definition
(Digital) Epiluminesence microscopy examines skin lesions
Term
What do Lange and Harpenden calipers measure?
Definition
Thickness of subcutaneous tissue.
Term
What does a monofilament test?
Definition
Loss of protective sensation such as on plantar surface of foot.
Term
What is the proper way to use a monofilament?
Definition
Depress on foot until it bends (under 10 g of pressure)
Term
What is necessary equipment?
Definition
Stethoscope, opthalmoscope, BP cuff and manometer, cm ruler, tape measure, reflex hammer, auditory and vibratory tuning forks, penlight, near vision screenign chart.
Term
Which phase of heart contraction produces a pressure wave resulting in an arterial pulse?
Definition
ventricular systole
Term
How much time does it take for an impulse from ventricular systole to be felt as the dorsalis pedis pulse?
Definition
0.2 sec
Term
How long does it take for an RBC in the aorta to reach the dorsalis pedis?
Definition
2.0 sec
Term
What are the 3 factors that influence systolic pressure?
Definition
cardiac output, blood volume, and compliance of the arterial tree
Term
How is pulse affected when the aortic valve closes?
Definition
There is a small upstroke in the descending part of the pulse called the dicrotic notch
Term
What factor influences diastolic pressure?
Definition
peripheral vascular resistence
Term
systole - diastole =
Definition
pulse pressure
Term
What 4 factors contribute to the characteristics of the pulses?
Definition
stroke volume, distensibility of great vessels, blood viscosity, peripheral resistence
Term
Where are the external jugular veins most visible?
Definition
above the clavicle, close to the insertion of SCM
Term
The activity of the right side of the heart is transmitted back through the _____ as a pulse.
Definition
jugular veins
Term
What do the 3 peaks of the jugular vein pulse represent?
Definition
a- brief backflow during R atrial contraction, c- backward push during R ventricular systole, v- increasing volume and pressure on right atrium
Term
What do the 2 descending slopes of the jugular vein pulse represent?
Definition
x- passive atrial filling, y- open tricuspid ie rapid filling of right ventricle
Term
When does the ductus arteriosus close?
Definition
12-14 hours after birth
Term
In the infant, what causes blood to flow into pulmonary arteries rather than across the foramen ovale?
Definition
pulmonary resistance becomes lower than systemic resistance when the infant starts breathing
Term
What closes the foramen ovale?
Definition
pressure in the left side of the heart becomes higher than the right
Term
How is systemic vascular resistance altered in pregnant women?
Definition
systemic vascular resistance decreases causing peripheral vasodilation -> palmar erythema and spider telangietasias
Term
What changes are seen in the arterial walls of the elderly?
Definition
calcification, dilation, and tortuousity
Term
What are the risk factors for preeclampsia?
Definition
40+, 1st pregnancy, preexisting hypertension, obesity, renal Dx, or diabetes mellitus, family Hx
Term
What are the risk factors for varicose veins?
Definition
Women 4x more likely than men, Irish & German descent, sedentary, age
Term
A healthy pulse contour should be _____.
Definition
smooth, rounded, domed
Term
What is a possible cause of an alternating pulse (pulsus alternans)?
Definition
left ventricular failure
Term
What is a possible cause of a pulsus bisiferans?
Definition
aortic stenosis combined with aortic insufficiency
Term
What are possible causes of a large, bounding pulse?
Definition
exercise, anxiety, fever, hyperthyroidism, aortic rigidity or atherosclerosis
Term
What is a possible cause of a bigeminal pulse?
Definition
disorder of rhythm
Term
What are possible causes of a paradoxic pulse (pulsus paradoxus)?
Definition
premature cardiac contraction, tracheobronchial obstrction, bronchial athsma, emphysema, pericardial effusion, constrictive pericarditis
Term
What are possible causesof a Water-hammer (Corrigan) pulse?
Definition
patent ductus arteriosus, aortic regurgitation
Term
What is normal resting hear rate?
Definition
60-100 BPM
Term
What is the pule rate of tachycardia?
Definition
> 100 BPM
Term
What is the pulse rate of bradycardia?
Definition
< 60 BPM
Term
A heart rate that is irregular but that occurs in a repeated pattern may indicate:
Definition
sinus arrhythmia
Term
Lack of pulse symmetry between right and left may indicate:
Definition
impaired ciculation
Term
What arteries can be auscultated fro bruits?
Definition
temporal, carotid, subclavian, abdominal aorta, renal, iliac, and femoral
Term
What is the venous hum?
Definition
a clinically insignificant sound that can be auscultated at the medial clavicle anterior to SCM, can be confused with other pathologies
Term
What can cause carotid artery bruits?
Definition
valvular aortic stenosis, mitral valve damage, aortic regurgitation, stenosis
Term
What is claudication?
Definition
Pain brought on by exercise and relieved with rest, pain is distal to stenosis.
Term
What are the 5 P's of arterial occlusion?
Definition
Pallor, Pain, Pulselessness, Paresthesia, Paralysis
Term
Where would pain present in an obstructed superficial femoral artery?
Definition
calf muscle
Term
Where would pain present in an obstructed common femoral or external iliac artery artery?
Definition
thigh
Term
Where would pain present in an obstructed common artery or distal aorta?
Definition
aorta
Term
What sound is produced during a blood pressure reading?
Definition
Korotkoff sounds
Term
What indicates the beginning of the Korotkoff sounds?
Definition
2 consecutive systolic beats
Term
What is the term for when Korotkoff sounds appear, disappear, and reappear 10-15 mmHg lower?
Definition
auscultory gap
Term
What can cause the auscultory gap to widen?
Definition
systolic hypertension, chronic severe aortic regurgitation
Term
What can cause the auscultory gap to narrow?
Definition
pulsus paradoxis with cardiac tamponade or other cardiac constrictions
Term
Define phases 1 of Korotkoff sounds.
Definition
First 2 consecutive beats = systolic pressure
Term
Define phases 2 of Korotkoff sounds.
Definition
reappearance of sounds after auscultory gap
Term
Define phases 3 of Korotkoff sounds.
Definition
point as which sounds are first crisp
Term
Define phases 4 of Korotkoff sounds.
Definition
point at which crisp sounds become muffled: 1st diastole
Term
Define phases 5 of Korotkoff sounds.
Definition
disappearance of sound: 2nd disatole
Term
What is optimal blood pressure?
Definition
<120/80
Term
What is the range of prehypertension?
Definition
120-139/ 80-89
Term
What is the range of stage 1 hypertension?
Definition
140-159/ 90-99
Term
What is stage 2 hypertension?
Definition
> 160/100
Term
What is considered an exaggerated paradoxical pulse?
Definition
>10 mHg difference in systolic pressures between inhalation ans exhalation
Term
What can cause an exaggerated paradoxical pulse?
Definition
cardiac tamponade, pericarditis, emphysema
Term
How is postural hypertension defined?
Definition
Drop in systolic (>15mmHg) and diastolic pressures when the patients stands after being supine
Term
What can cause portal hypertension?
Definition
blood loss, drugs, ANS disease
Term
What can undermine the accuracy of blood pressure readings?
Definition
cardiac dysrhythmias, aortic regurgitation, venous congestion, valve replacement
Term
What is the expected value for jugular venous pressure?
Definition
9 cm H2O (divide by 1.3 for mmHg
Term
What is the quality and character of a jugular vs carotid pulse?
Definition
3 undulating waves / one brisk wave
Term
What is the effect of respiration of a jugular vs carotid pulse?
Definition
decreased on inspiration and increased on expiration/ no effect
Term
What is the effect of venous compression on a jugular vs carotid pulse?
Definition
easily eliminates pulse wave/ no effect
Term
What is effect of abdominal pressure on a jugular vs carotid pulse?
Definition
increased prominence/ no effect
Term
What can the hepatojugular reflex measure?
Definition
right-sided heart failure is suspected when JVP elevates after the hepatojugular reflex is tested
Term
How do you perform the hepatojugular reflex?
Definition
While measuring JVP, apply firm sustained pressure over the midepigastric region
Term
What measurement taken in the hands is equivalent to mean JVP?
Definition
elevate hand, measure from midaxillary line at nipple to the level of collapsed hand veins
Term
What are the signs of acute venous obstruction?
Definition
constant pain with swelling & tenderness, enorgement of superficial veins, erythema & cyanosis
Term
What is a Homan sign?
Definition
Flex patient's knee and dorsiflex foot. Calf pain may indicate venous thrombosis
Term
Edema with skin thickening and ulceration indicates:
Definition
deep vein thrombosis
Term
Unilateral edema indicates:
Definition
occlusion of a major vein
Term
Bilateral pitting edema indicates
Definition
congestive heart failure
Term
Nonpitting edema indicates
Definition
arterial insufficiency or lymphedema
Term
Describe Grade 1 Edema
Definition
slight pitting that disappears rapidly, can be felt not seen
Term
Describe Grade 2 Edema
Definition
deeper pit that disappears in 10-15 sec
Term
Describe Grade 3 Edema
Definition
deep pit that lasts 1 min+, the tested extremity appears swollen
Term
Describe Grade 4 Edema
Definition
very deep pit that lasts 2-5 min, tested extremity is grossly distorted
Term
How can the presence of varicose veins in the leg be tested?
Definition
Have patient stand on their toes 10 times in succession to build leg pressure. Pressure disappears in competent veins and persists in incompetent veins.
Term
How can the presence of collateral veins be tested?
Definition
Compress the vein with one hand and strip it of blood moving towards the heart with the other hand. If stripped veins fills, there are collaterals.
Term
How can the competency of venous valves be tested?
Definition
Compress the vein with one hand and strip it of blood moving towards the heart with the other hand, then release cephalad hand. If the entire column fills, the valves are incompetent.
Term
What should also be tested with blood pressure in the infant?
Definition
capillary refill
Term
What does a bounding infant pulse indicate?
Definition
patent ductus arteriosus
Term
What type of specialized sphygmomanometer can be used for infants and children?
Definition
one that includes Doppler or other oscillometric technique
Term
What is usual newborn blood pressure?
Definition
60-96/ 30-62 mmHg
Term
What can capillary refill time > 2sec in an infant or your child indicate?
Definition
dehydration or hypovolemic shock
Term
What can newborn hypertension indicate?
Definition
thromosis from umbilical catheter, stenosis, kidney disease, neuroblastoma, Wilms tumor, hydronephrosis, adrenal hyperplasia, or CNS disease
Term
Which phase of the Korotkoff sound is the appropriate measurement for diastole for ages 3-adolescence?
Definition
Phase 4, after which use phase 5
Term
In children, radial artery BP will read ____ less that brachial artery BP?
Definition
10 mmHg
Term
50% of the time, hypertension in adolescents is ___.
Definition
primary
Term
Hypertension in children younger that 10 is ______.
Definition
secondary due to kidney disease, renal artery disease, coarctation of the aorta, or pheochromocytoma
Term
Hypotension in pregnant women peaks at ____.
Definition
16-20 weeks gestation
Term
What is considered elevated blood pressure in a 2nd trimester pregnant woman?
Definition
>125/ 75 mmHg
Term
What is considered elevated blood pressure in a 3rd trimester pregnant woman?
Definition
>130/ 85 mmHg
Term
During pregnancy, a rise in ____ above the 1st trimester baseline should be monitored, and sustained pressure of _____ indicates a BP disorder.
Definition
30/ 15 mmHg, >140/ 90 mmHg or
Term
Hypertension in older adults is defined as:
Definition
> 140/ 90 mmHg
Term
What is temporal aka giant cell arteritis?
Definition
inflammatory disease of he branches of the aortic arch including temporal arteries
Term
How is an arterial aneurism defined?
Definition
1.5x the diameter of the normal artery
Term
What is peripheral artery disease?
Definition
stenosis of the extremities caused by atherosclerotic plaques
Term
What is Raynaud's Disease?
Definition
Exaggerated spasm of the digital arterioles and sometimes nose and ears due to cold exposure.
Term
What is arterial embolic disease?
Definition
atrial fibrillation that leads to clot formation within the atrium, may lead to dispersed emboli
Term
What causes venous thrombosis?
Definition
Trauma or prolonged immobilization
Term
What can hypertension cause?
Definition
stroke, renal failure, congestive heart failure
Term
How does constrictive pericarditis arise?
Definition
chronic inflammation and subsequent scarring of the pericardium
Term
Where is coarctation of the aorta most commonly seen?
Definition
stenosis is seen in descending aortic arch near the origin of the left subclavian artery and ligamentum arteriosum
Term
What is Kawasaki disease?
Definition
acute vasculitis unknown ETO affecting the young, may be due to cardiac involvement leading to aneurisms of coronary artery
Term
What is preeclampsia?
Definition
hypertesion that occurs after the 20th week of pregnancy with proteinuria
Term
What is eclampsia?
Definition
preeclampsia with seizures when no other cause for seizures can be found
Term
What causes venous ulcers?
Definition
Chronic venous insufficiency in which lack of venous flow leads to lower extremity venous hypertension
Term
What is the only useful information for ruling in DVT?
Definition
malignancy, previous DVT, recent immobilization, difference in calf diameter, and recent surgury
Term
What is useful information for ruling out DVT?
Definition
absence of calf swelling or diameter difference
Term
What is the pathophysiology of temporal arteritis?
Definition
unknown ETO, inflammatory infiltrates develop of thoracic aorta, arterial intimal thickening can affect structures in the head.
Term
What are the subjective findings of temporal arteritis?
Definition
age 50+, flu-like, headache esp temporal region, occular symptoms, ischemia of jaw and tongue
Term
What are the objective findings of temporal arteritis aka giant cell arteritis?
Definition
Area over temporal area red, swollen, tender, nodular. Temporal pulse varies.
Term
What is the pathophysiology of arterial aneurism?
Definition
result of atherosclerosis + tobacco and hypertension, 4x more common in men
Term
What are the subjective findings of arterial aneurism?
Definition
asymptomatic until dissection causes ripping pain
Term
What are the objective findings of arterial aneurism?
Definition
pulsatile swelling, thrill or bruit may be present over aneurism
Term
What is the pathophysiology of arteriovenous fistula?
Definition
congenital or caused by catheterization
Term
What are the subjective findings of arteriovenous fistula?
Definition
low extremity edema, varicose veins, claudication, high cardiac output
Term
What are the objective findings of arteriovenous fistula?
Definition
weak or absent pulses, foot or leg is painful at rest, cold and numb, and dry with poor hair growth. Ulceration, muscle atrophy, no edema.
Term
What is the pathophysiology of peripheral arterial disease?
Definition
peripheral atherosclerosis, diabetes, hypertension, dyslipidemia, tobacco use, vascular trauma, radiation, vasculitis
Term
What are the subjective findings of peripheral arterial disease?
Definition
predictable anount of exercise produces pain, ache, or cramp in exercised muscle
Term
What are the objective findings of peripheral arterial disease peripheral arterial disease?
Definition
severe ischemia, leg or foot is painful at rest, cold and numb, and skin is scaling with poor hair growth. Ulceration and muscle atrophy, no edema.
Term
What is the pathophysiology of Reynaud phenomenon?
Definition
primary: young, healthy women, unknown ETO. Secondary: CT disease such as sclerodoma or systemic lupus erythematosus
Term
What are the subjective findings of Reynaud phenomenon?
Definition
Involved areas feel cold and achy, which improves when warmed. Secondary Renaud: intense pain with digital ischemia and necrosis.
Term
What are the objective findings of Reynaud phenomenon?
Definition
Primary: red white and blue extremities, vasospasm lasts < 1 hr. Secondary: fingertip ulcers or skin over digits appears smooth, shiny, tight
Term
What is the pathophysiology of arterial embolic disease?
Definition
emboli caused by atherosclerotic plaques, infectious material from fungal and bacterial endocarditis, or atrial myxomas
Term
What are the subjective findings of arterial embolic disease?
Definition
pain, parasthesias
Term
What are the objective findings of arterial embolic disease?
Definition
occlusion of small arteries and necrosis of their tissues. endocarditis leads to splinter hemmorhages in nail beds
Term
What is the pathophysiology of venous thrombosis?
Definition
prolonged immobilization, malignancy, birth control meds, trauma, or previous DVT
Term
What are the subjective findings of venous thrombosis?
Definition
tenderness along iliac vessels or femoral canal, popliteal space, or deep calf veins, pulmonary embolism may occur without warning,
Term
What are the objective findings of venous thrombosis?
Definition
difference in circumference of upper and lower legs, mininal ankle edema, high-grade fever, and tachycardia, Howman sign useful
Term
What is the pathophysiology of hypertension?
Definition
BP consistently at 140/ 90 mmHg or higher
Term
What are the subjective findings of hypertension?
Definition
Essential hypertension is asymptomatic, malignant hypertension has headache, visual symptoms, and encephalopathy
Term
What are the objective findings of hypertension?
Definition
In addition to BP, end organ damage, papilledema, or heart failure may be present
Term
What is the pathophysiology of tricuspid regurgitation?
Definition
due to conditions that lead to dilation of the right ventricle such as hypertension and pulmonary thrombosis, can also result from primary valvular disease
Term
What are the subjective findings of tricuspid regurgitation?
Definition
no symptoms if mild-medium, severe shows right-sides heart failure with ascites or peripheral edema
Term
What are the objective findings of tricuspid regurgitation?
Definition
v wave is early, prominent, and often merges with c wave, holocystolic murmur in tricuspid, pulsatile liver, peripheral edema
Term
What is the pathophysiology of atrial fibrillation?
Definition
heart disease leading to enlargement or elevated pressures
Term
What are the subjective findings of atrial fibrillation?
Definition
asymptomatic then palpations, lightheadedness, or dyspnea
Term
What are the objective findings of atrial fibrillation?
Definition
absent wave withan irregularly irregular pulse: 2 venous pulsations for each arterial pulsation, variable interval between v waves
Term
What is the pathophysiology of cardiac tamponade?
Definition
pericardial fluid from infection, malignancy, or autoimmune disease impairs cardiac ooutput
Term
What are the subjective findings of cardiac tamponade?
Definition
acute sudden onset chest pain and dyspnea or chronic heart failure symptoms
Term
What are the objective findings of cardiac tamponade?
Definition
Y-descent is abolished and JVP is elevated 15-25cm of H2O, JVP falls with inspiration, pulsus paradoxus (decrease in systolic >10mm Hg)
Term
What is the pathophysiology of constrictive pericarditis?
Definition
pericardial thickening and inelasticity, diminished cardiac filling and output
Term
What are the subjective findings of constrictive pericarditis?
Definition
progressive cardiac insufficiency such as worsening of lower extremity edema or dyspnea
Term
What are the objective findings of constrictive pericarditis?
Definition
Elevated JVP with prominent Y descent, peripheral edema and ascites due to right-sided heart failure
Term
What is the pathophysiology of coarctation of the aorta?
Definition
congenital defect of vascular wall or acquired inflammatory aortic disease or severe atherosclerosis
Term
What are the subjective findings of coarctation of the aorta?
Definition
asymptomatic unless severe hypertension or vascular insufficiency develops
Term
What are the objective findings of coarctation of the aorta?
Definition
differences in systolic BP when radial and femoral pulses are palpated simultaneously
Term
What is the pathophysiology of Kawasaki Disease?
Definition
ETO of vasculitis is unknown, immune-mediated blood vessel damage can result in both vascular stenosis and aneurism formation
Term
What are the subjective findings of Kawasaki Disease?
Definition
diffuse symptoms of varied duration, wieght loss, fatique, myalgias, or arthritis
Term
What are the objective findings of Kawasaki Disease?
Definition
Conjunctival injection, strawberry tongue, edema of hands and feet, lymphadenopathy and polymorphous nonvesicular rashes
Term
What is the pathophysiology of preeclampsia-eclampsia?
Definition
vascular and immunologic abnormalities within uteroplacental circulation
Term
What are the subjective findings of preeclampsia-eclampsia?
Definition
may be diagnosed without proteinuria if visual changes, headache, abdominal pain, and pulmonary edema are present
Term
What are the objective findings of preeclampsia-eclampsia?
Definition
sustained elevation of blood pressure > 160/ 110 mmHg
Term
What is the pathophysiology of venous ulcers?
Definition
incompetent valves, obstruction of blood flow, or loss of pumping effect of blood vessels
Term
What are the subjective findings of venous ulcers?
Definition
asymptomatic then leg heaviness and discomfort progressing to edema and ulceration
Term
What are the objective findings of venous ulcers?
Definition
ulcers on medial and lateral aspects of lower limbs, induration, edema, and hyperpigmentation
Term
How do you test CN V and VII?
Definition
Ask PT to clench teeth, squeeze eyes tightly shut, wrinkle forehead, smile, stick out tongue, puff out cheeks
Term
How do you test CN V?
Definition
Test light touch sensation on forehead, cheeks, chin, and corneal reflexes
Term
How do you test CN II?
Definition
Rosenbaum chart near vision screening and visual fields
Term
How do you test CN III, IV, and VI?
Definition
extra ocular eye movements
Term
How do you test CN VIII?
Definition
Assess hearing with whisper or ticking watch
Term
How do you test CN XII?
Definition
Inspect tongue for symmetry and movement
Term
How do you test CN IX and X?
Definition
gag and 'ah' reflex
Term
How do you test CN VII and IX?
Definition
taste test
Term
How do you test CN IX?
Definition
shoulder shrug
Term
What are Rinne and Weber tests used for?
Definition
ears
Term
What is the Romberg test used for?
Definition
Neurologic assessment
Term
What does an Apgar indicate?
Definition
information about the baby's pre, during, and post birth state
Term
What are physical signs unique to an infant aged 36 weeks or less?
Definition
<2 transverse creases on sole of foot, breast nodule is <3mm, no cartilage in ear helix, scrotum doesn't contain testis or have rugae
Term
Is apnea common in a premature infant?
Definition
yes, it may last for up to 20 sec
Term
What puts the infant at risk for diaphragmatic hernia?
Definition
If the mother has fever during or after delivery or herpetic lesions
Term
How do you assess CN IX, X, and XII in an infant?
Definition
Observe cry, tactile fremitus, facial symmetry, integrity or mouth, pharynx, and soft pallate.
Term
How do you assess CN XII in an infant?
Definition
Observe sucking and swallowing
Term
What does the Denver II test evaluate?
Definition
language, motor coordination, and social skills
Term
What are basic ADL's?
Definition
bathing, dressing, toileting, ambulation, feeding
Term
What are instrumental ADL's?
Definition
housekeeping, shopping, cooking, taking meds, communication, money management
Term
What is the traditional and essential component of critical thinking?
Definition
evidence-based practice
Term
What is CFM Saint's philosophy of medicine?
Definition
Many diagnoses can be made
Term
How is Occam's razor applied to medicine?
Definition
Plurality (of diagnoses) must not be posited without necesity.
Term
What is Bayes Theorem?
Definition
Diagnosis is based on probabilities
Term
What are prohibited abbreviations?
Definition
U, IU, QD, QOD or any variant, trailing zero (X.0), lack of leading zero, MS, MSO4, or MgSO4
Term
What is the difference between pain and tenderness?
Definition
pain is a symptom and tenderness is a sign
Term
What is objective data?
Definition
What you can see, hear, and touch
Term
What are the 6 components of POMR?
Definition
Comprehensive health history, phys exam, problem list, assessment and plan, needed lab and imaging tests, and progress notes
Term
What does the Assessment include?
Definition
Your interpretations and conclusions, their rationale, the diagnostic strategy, present and anticipated problems, and the needs of ongoing and future care.
Term
What does the Plan include?
Definition
diagnostics, therapeutics, and patient education
Term
What is included in an interval hisotry?
Definition
Subjective: status of problem, current medications and ROS, Objective: vitals, exam, results of tests since last visit, Assessment: diagnosis, Plan: 3 components
Term
What is a PAM list?
Definition
Problems, allergies, and medications
Term
What is identifying information?
Definition
Name, DOB, and assigned history number
Term
What is general patient information?
Definition
Additional identifying information
Term
What mnemonic is used for HOPI?
Definition
OLDCAARTS
Term
How many generations should a family history include?
Definition
3
Term
What obstetric information is taken for women?
Definition
Preterm pregnancies,Term Pregnancies Abortions/ Miscarriages, Living Children
Term
What is included in the general statement of the physical exam?
Definition
age, race, gender, general appearance, weight, height, BMI, and vitals
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