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PRIMARY CARE > 1A > Flashcards

1A Flashcards

1
Q

when did the US military health care system include PTs as an entry point

A

1970

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2
Q

the institute of medicine defines primary care as what 4 things delivered by accountable provides of personal health services

A

accessible , comprehensive , coordinated and continual care

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3
Q

in 2000 who challenged pts to develop a pt focused societal identities to address health care delivery in future

A

ruth purtilo

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4
Q

how many days of direct access does texas have

A

10-15

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5
Q

what is the 1st question that must be answer prior to any others

A

DO THEY BELONG

if yes then tx
if no then refer
if yes but refer , refer and tx

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6
Q

what are the nine conditions on ‘do not want to miss list’

A
  1. Major depression
  2. Suicide risk
  3. Femoral Head & neck fx’s
  4. Cauda equina syndrome
  5. Cervical myelopathy
  6. Abdominal aortic aneurysm
    (AAA)
  7. Deep venous thrombosis (DVT)
  8. Pulmonary embolism (PE)
  9. Atypical myocardial infarction
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7
Q

what is the primary relative for a risk factor from depression

A

family hx

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8
Q

what is the percent of PTs formally screen for depression

A

18%

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9
Q

do males or females have a higher risk factor for sucicide completion

A

males , females have more attempts

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10
Q

HX of psychiatric illness (depression , ETOH, abuse) is a risk factor for what

A

suicide

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11
Q

what was the 2nd leading COD in ages 10-14 and 20-34

A

suicide

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12
Q

what 3 conditions are associated with increase fx rates

A

-osteoporosis
- stress/fatigue
- major trauma

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13
Q

• Female
• Running, jumping, marching
• △ in training program or routine
• Nutritional deficiencies
• Leg length discrepancy
• ↓ muscle strength

these are all risk factors associated with what

A

fatigue FX

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14
Q

what are some clinical manifestation for femoral head and neck fx

A

-Pain & localized tenderness in
groin/anterio-medial thigh, greater
trochanter, buttock regions
• Worse w/ WB
• Deformity (shortened limb)
• Edema
• Ecchymosis
• Loss of general function & mobility

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15
Q

what 2 test are positive with femoral head and neck fxs

A

patellar pubic percussion test (do this first)
fulcrum test

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16
Q

• Low back injury, central disc
herniation
• Congenital or acquired spinal
stenosis
• Spinal fx
• Ankylosing spondylitis
• TB, Pott’s disease

these are all risk factors for what serious condition

A

cauda equina

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17
Q

what are the neurologic compromise clinical manifestation for cauda equina

A

• Motor & sensory deficits
• Urinary, bowel & sexual dysfunction
• Urinary retention most frequently
noted

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18
Q

how are the onset of symptoms for cauda equina

A

quick or gradual

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19
Q

what are 3 other clinical manifestations for cauda equina

A

LB &/or LE pain

gait ataxia&/or poor balance

C/O of LE “feeling heavy and weak”

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20
Q

what is the most common causes of non traumatic paraparesis and quadriparesis

A

cervical myelopathy

21
Q

• Typically, associated w/ c-spine
spondylosis
• Associated c-spine instability can&raquo_space;
spinal cord compromise
• MOST common cause of non-
traumatic paraparesis &
quadriparesis
• Wide variation in natural hx
• Neurologic S&S begin in mid-50’s to
60’s (↑’s w/ every decade of life)
• Can occur in younger folks following
significant neck trauma or RA

these are risk factors of what serious condition

A

cervical myelopathy

22
Q

these Neurologic compromise clinical manifestations are a part of what disease

• Impaired hand dexterity
• May see atrophy in intrinsics
• Gait, balance difficulties
• Paresthesias (UEs & possibly LEs)
• Neck stiffness
• Urinary retention
• UE weakness (triceps, hand intrinsics)
• Proximal LE weakness
• UMN signs

A

cervical myelopathy

23
Q

what is the definition for abdominal aortic aneurysm

A

aneurysm distal to the renal arteries (>3 cm in diameter)

24
Q

when is there a risk for rupture for an AAA

A

when the diameter approaches 5-6 cm

25
Q

• >60 y/o (risk ↑’s w/ age)
• Male
• Hx of smoking
• Hx of hypercholesterolemia & CAD

these are all risk factors for what serious condition

A

AAA

26
Q

where will you have pain from an AAA

A

back , abdominal , hip , groin &/or buttock

27
Q

what type of onset is an AAA

A

insidious

28
Q

if you hear abdominal auscultations along midline and 2in superior to umbilicus what is that mean

A

possible AAA

29
Q

if someone has a AAA and they report hot, searing , ripping or tearing pain what do you do

A

stop all activity

30
Q

are most pateints with AA symptomatic or asymptomatic

A

asymptomatic

31
Q

• Hx of cancer, CHF &/or SLE
• Severe infection
• Receiving chemo
• Central venous catheter
• Major surgery
• Major trauma
• Immobility
• Limb paralysis
• Women during pregnancy or are up
to 6 wks post-partum
• Age >60 y

these are all risk factors for what serious condition

A

DVT

32
Q

what are the 5 clinical manifestations for a DVT

A

• Ache, tightness, tenderness near
site
• General edema
• Pitting edema
• Prominent superficial venous plexus
• ↑ local skin temperature

33
Q

what percent of individuals with DVT are asymptomatic in early stages

A

50%

34
Q

if a person scores >/= 2 points on the clinical decision rule for DVT what does that mean

A

dvt likely

35
Q

what are some of these questions asked on the clinical decisions rule forDVT

A

cancer

paralysis

bedridden/ major sx

tenderness

leg swollen

calf swelling

pitting edem

36
Q

what is the only negative scoring on clinical decision rule for DVT

A

alternative DX at least as likely as DVT

37
Q

what is most associated with DVT , air , fat or bone marrow embolism

A

pulmonary embolism

38
Q

what comprise the most PE’s

A

proximal LE DVTs

39
Q

• Hx of DVT
• Immobility
• Hx of abdominal, pelvic surgery
• Total hip, knee replacement
• Late-stage pregnancy
• Lower limb fx
• Malignancy of pelvis or abdomen

these are all risk factors for what serious conditions

A

PE

40
Q

• Dyspnea
• Tachypnea
• Pleuritic chest pain, intensified w/ deep respiration or cough
• Persistent cough
• Apprehension, anxiety
• Tachycardia
• Palpitations

these are all clinical manifestations for which serious condition

A

PE

41
Q

what percent of deaths related to PE are potentially preventable if DX earlier

A

> 50

42
Q

what are the numbers for th pre test probability of PE

A

<2 = low
2-6= moderate
>6= high

43
Q

what is included the clinical decision rule for PE and what is it called

A

clinical signs of DVT

HR > 100

immobilization for 3 days

previous DVT

hemoptysis

pt with cancer getting treatment

alternative dx

called wells creitiera

44
Q

50% of ___ experience chest pain with MI

A

women

45
Q

what is the leading COD in women of ALL ages

A

cardiac death

46
Q

• Smoking
• High cholesterol levels
• HTN, DM
• Obesity
• Sedentary lifestyle
• Excessive ETOH consumption
• Age: women >55 y/o; men >45 y/o
• Family hx
• Ethnicity (highest in African-Americans

these are all risk factors for what serious condition

A

atypical myocardial infarction

47
Q

• SOB
• Fatigue
• Sleep disturbance
• Nausea (w/ & w/o vomiting)
• Palpitations
• Dizziness
• Diaphoresis
• Anxiety
• Chest pain (w/ & w/o L UE pain)
• Upper abdominal, epigastric, jaw, neck &/or tooth pain
• Pain may or may not be associated w/
exertion

these are all clinical manifestations of what serious condition

A

atypical myocardial infarction

48
Q

what is a major thing to do for atypical myocardial infarction

A

take vital signs

PRIMARY CARE (9 decks)

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