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South College Advanced Clinical Practice > 2-1: Do Not Want to Miss List 1 > Flashcards

2-1: Do Not Want to Miss List 1 Flashcards

1
Q

Don’t want to miss list

A
  • Major depression
  • Suicide risk
  • Femoral head and neck fractures
  • Cauda equina syndrome
  • Cervical myelopathy
  • Abdominal aortic aneurysm
  • Deep venous thrombosis
  • Pulmonary embolism
  • Atypical myocardial infarction
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2
Q

Rates of depression for men and women

A

10-25% (women)

5-12% (men)

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3
Q

Clinical manifestations of depression 1

A

Patient responds “yes” to one or either of the following:
- Over the past 2 weeks have you felt: (1) down, depressed or hopeless, (2) little interest or pleasure in doing things?

Follow with #2

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4
Q

Clinical manifestations of depression 2

A

Noting 3-4 of the following:

  • Significant weight change
  • Insomnia or hypersomnia
  • Psychomotor agitation, retardation
  • Fatigue
  • Feelings of worthlessness, guilt
  • Difficulty concentrating, thinking
  • Recurrent thoughts of suicide
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5
Q

Common Risk Factors associated w/ suicide risk

A
  • Gender
  • Widowed, divorced, living along
  • Hx of psychiatric illness
  • Previous attempt
  • Hx of chronic progressive illnesses
  • Recent significant loss
  • Unemployed
  • Sense of hopelessness
  • Family hx of suicide completion or attempts
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6
Q

Gender and suicide

A
  • Males –> higher rate of completion

- Females –> high rate of attempts

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7
Q

Psychiatric illness and suicide

A

Primarily major depression and/or alcohol abuse

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8
Q

Diagnostic use of pt expressing thoughts of death

A
  • 100% sensitive
  • 81% specificity
  • 5-9% positive predictive value
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9
Q

Diagnostic use of pt wishing they were dead

A
  • 92% sensitivity
  • 93% specificity
  • 14% positive predictive value
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10
Q

Management of suicidal patients

A
  • Find out if they have a plan in place
  • Are resources related to patient readily available (i.e. gun or meds)
  • Who should be contacted?
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11
Q

Clinical manifestations of femoral head/neck fracture

A
  • Pain and local tenderness
  • Deformity
  • Edema
  • Ecchymosis
  • Loss of general function and mobility
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12
Q

Ecchymosis

A

a discoloration of the skin resulting from bleeding underneath, typically caused by bruising

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13
Q

What percentage of those suffering a hip fracture die w/in a year?

A

30%

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14
Q

Mechanisms of injury potentially causing a fracture

A
  • Trama
  • Slip vs fall
  • Sneeze
  • Lifting a gallon jug
  • Opening a stuck window
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15
Q

Disorders associated w/ compromised bone density

A
  • Chronic renal failure
  • GI malabsorption syndrome
  • RA
  • Ankylosing sponylitits
  • Hyperparathryroidism
  • Hyperthyroidism
  • Hypogonadism
  • Type II diabetes
  • Multiple sclerosis
  • Chronic alcohol dependency
  • Cushing’s syndrome
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16
Q

Medications or substances associated w/ compromised bone density

A
  • Aluminum
  • Anticonvulsants
  • Corticosteroids
  • Cytotoxic drugs
  • Excessive thyroxine
  • Heparin, warfarin
  • Methotrexate
  • Caffeine (>3 cups of coffee worth)
  • Tobacco
  • Soft drinks
17
Q

Risk factors for fatigue fractures

A
  • Female
  • Hormonal mentrual irregularities
  • Involved in running, jumping, marching activities
  • Change in training program or routine (new, increased activity, footwear, surface, etc)
  • Nutrition deficiencies
  • Leg length discrepancy
  • Diminished strength
18
Q

Clinical exam for fracture

A
  • Patellar-pubuc percussion test

- Fulcrum

19
Q

Clinical manifestations of cauda equina syndrome

A
  • Saddle anesthesia
  • Bowel incontinence
  • Reduced anal tone
  • Leg pain
  • Back pain
20
Q

Are urinary symptoms used for CES?

A

No

21
Q

What are considered good screenings for CES according to Gooding et al? More specific or sensitive?

A
  • Bilateral LE weakness/sensory change
  • Abnormal reflexes
  • Specific
22
Q

Clinical manifestations for cervical myelopathy (history)

A
  • Impaired hand dexterity
  • Gait, balance difficulties (legs are weak, stiff)
  • Numbness, paresthesia (upper and possibly lower ex)
  • Neck stiffness
  • Urinary dysfunction (retention, possibly urgency and frequency)
23
Q

Clinical manifestations for cervical myelopathy (physical exam)

A
  • Hand intrinsic atrophy
  • Muscle weakness, often of triceps or hand intrinsic
  • Muscle weakness of LE (proximal muscles)
  • UMN signs (hyperactive DTR, clonus, + Babinski and Hoffman)
24
Q

Risk factors for cervical myelopahy

A
  • C-spine spondylotic changes
  • Mid 50s-60s and beyond
  • Hx of neck trauma (MVA, sports injury)
  • RA

South College Advanced Clinical Practice (13 decks)

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