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becky: Primary Care > 1A > Flashcards

1A Flashcards

1
Q

nine DEADLY conditions

A
  1. depression
  2. suicidal
  3. cervical myelopathy
  4. cauda equina
  5. AAA
  6. DVT
  7. PE
  8. femoral head/neck fx
  9. atypical MI
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2
Q

risk factors for depression

A

Current or PMH of depression
Female (especially during pregnancy or post-partum)
Hx of DM, MI, cancer, CVA, chemical dependency
Significant loss suffered
(+) family hx (1º relative)

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3
Q

2 question depression screening tool

A
  1. over past 2 weeks have you felt down, depressed, hopeless?
  2. have you had little interest/pleasure in doing things?
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4
Q

suicide risk factors

A

solo
-90% have history of psychiatric illness (depression, substance abuse)
-previous attempt/fam hx
-history of CHRONIC progressive illness
-sense of hopelessness
-unemployed
-recent significant loss

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5
Q

what is the 2nd leading cause of death in ages 10-14 and 20-34?

A

SUICIDE

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6
Q

what 2 questions to ask after asking do you have thoughts of trying to harm yourself?

A
  1. plan?
  2. access to resources?
    if yes-ambulance
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7
Q

Patient comes in with groin pain, hurts to WB. There is edema, bruising, and LLD. What could it be?

A

femoral head and neck fx

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8
Q

If I am suspecting femoral head/neck fx, what two tests?

A

patellar-pubic percussion test
fulcrum test

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9
Q

Patient comes in with lower back pain, gait ataxia, LOB, heavy legs, and urinary retention. What could it be?

A

cauda equina!
risk factors: stenosis, spinal fx, AS, TB and potts

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10
Q

Patient comes in with UE and LE numbness, urinary retention, STIFF NECK, and weak triceps/grip. Gait problems. What could it be?

A

CERVICAL MYELOPATHY

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11
Q

most common cause of non-traumatic para/quadriparesis?

A

cervical myelopathy

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12
Q

AAA can also present with

A

back, ab, hip, groin, butt pain! but NON MSK pain behaviors
insidious onset.

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13
Q

most people with AAA are symptomatic or asymptomatic?

A

asymptomatic

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14
Q

risk factors for AAA

A

over 60
male
smoking, high cholesterol, CAD
fam hx

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15
Q

patient presents with back pain. doesn’t change with rest/activity
insidious onset
also has weight loss, nausea, early satiety. On palpation, abdominal mass with VISIBLE PULSE!
What do they have?

A

AAA
+test: bruit

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16
Q

DVT presents as…

A

edema
aching, tight, tender
pitting edema
superficial venous plexus
HOT

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17
Q

clinical decision rule for DVT

A

1 point each!

  1. cancer
  2. immobilized
  3. bed ridden 3+ days, major surgery in past 3 months
  4. tender
  5. whole leg is swollen
  6. calf swelling more than 3 cm
  7. pitting edema
  8. collateral superficial viens
  9. hx of DVT
  10. -2 points if theres another diff dx also as likely

2+ = DVT likely

18
Q

risk factors for PE!

A
  1. DVT
  2. immobile
  3. hx PE
  4. hx of ab/pelvic surgyer
  5. THR, TKR (bone or fat embolism)
  6. pregnancy late stage
  7. leg fx
  8. cancer in pelvis/abdomen
19
Q

what does PE present as?

A

fast/abnormal breath
chest pain worse with cough
COUGH
anxiety
FAST HEART RATE
PALPITATIONS

20
Q

Well’s criteria for PE

A

signs of DVT 3+
HR over 100 bpm 1.5+
immob 3+ days/surgery in last month 1.5+
previous PE/DVT 1.5+
hemoptysis 1+
cancer 1+
other diff dx are less likely 3+

2-6 mod, over 6 high

21
Q

leading cause of death in women

A

MI

22
Q

signs of MI

A

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

23
Q

primary care is defined as…

A

“Accessible, comprehensive, coordinated and continual care delivered by accountable providers of personal health services.”

24
Q

PTs have how many days of direct access?

A

10-15 days

25
Q

How many PTs formally screen for depression?

A

18%

25
Q

How does femoral head/neck fx present?

A

pain in groin/anterio-medial thigh, GT, butt, WORSE WITH WB

-bruising, edema, loss of function/mobility
-leg is shortened

26
Q

+ patellar-pubic percussion test and +fulcrum test are for what condition?

A

femoral head/neck fx

27
Q

risk factors for cauda equina

A

-LBP, central disc hern
-spinal stenosis
-spinal fx
-ankylosing spondylitis
-TB, Potts

28
Q

Clinical manifestations of CAUDA EQUINA

A

1: urinary retention
neuro compromise (motor, sensory LE, urinary/B&B, sexual dysfunction)
-LBP
-LE pain/heavy weak legs
-LOB, gait ataxia

can be quick or gradual!

29
Q

risk factors for cervical myelopathy

A

c-spine spondylosis or instability
-young people: RA, trauma
-older: 50-60s gradual

30
Q

what does cervical myelopathy look like?

A

usually gradual, step-wise progression
lots of neuro signs!
1. hand intrinsic atrophy
2. tricep weakness/UE weakness
3. gait/balance loss
4. NECK STIFFNESS*
5. prox LE weaknes
6. UMN signs
7. urinary retention*

31
Q

What does AAA look like?

A
  1. MSK pain in back, abs, pelvis, butt! But non-MSK pain behaviors
  2. weight loss, nausea, full easily
  3. abdominal mass with VISIBLE PULSE

*if you hear bruit with ab ascultation, AMBULANCE
*if they say pain is HOT, SEARING, RIPPING, TEARING= S T O P all activity!

32
Q

What are 5 risk factors for AAA?

A
  1. over 60
  2. male
  3. smoking hx
  4. high cholesterol/CAD
  5. AAA in fam hx
33
Q

what is an AAA?

A

Aneurysm distal to the renal arteries (>3 cm in diameter)
Risk for rupture ↑’s when diameter approaches 5-6 cm
Requires surgical intervention that is not w/o risks

34
Q

What are the risk factors for DVT?

A
  1. previous DVT
  2. cancer/CHF, SLE
  3. infection
  4. chemo
  5. central venous cath
  6. major surgery
  7. major trauma
  8. immobility
  9. paralysis
  10. pregnancy/6 weeks post partum
  11. over 60
35
Q

What does a DVT look like?

A
  1. Achy, tight, tender
  2. general swelling
  3. pitting edema
  4. prominent superficial venous plexus
  5. HOT
36
Q

What percent of people with DVT are asymptomatic in early stages?

A

50%

37
Q

Patient presents with fast, abnormal breathing. They have chest pain that gets worse with breathing/coughing. Heart rate is fast.
What do they have?

A

maybe PE!
-pleuritic chest pain, worse w breath/cough
-cough
-tachypnea/dyspnea
-tachycardia
-palpitations

38
Q

Proximal LE DVTs comprise what percent of pulmonary embolisms?

A

70%

39
Q

If diagnosed earlier, what percent of PE related deaths are potentially preventable?

A

over 50%

40
Q

What are the risk factors for atypical MI?

A

smoking
high cholesterol, HTN, DM, obesity
sedentary lifestyle
excess alcohol
women over 55, men over 45
fam hx
ethnicity (highest for african american)

becky: Primary Care (7 decks)

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