307 CH 19/22/23/24 Flashcards
1
Q
A person with a neurocognitive disorder or depression may exhibit what disease?
A
Bradykinesia
2
Q
A person under the influence of a stimulant drug or having a manic episode may exhibit what disease?
A
Hyperkinesia
3
Q
What are the 5 levels of consciousness?
A
Alert
Lethargy
Obtunded
Stupor
Coma
4
Q
Difference in speech pertaining to depression? How about speech patterns related to Mania?
A
With depression the speech is slow and with mania the speech is louder and accelerated.
5
Q
What do we look at when assessing speech and language?
A
Quantity
Rate
Loudness
Articulation of Words
Fluency
6
Q
What is aphasia?
A
A disorder of language.
7
Q
how do you test for Aphasia?
A
Word comprehension
repetition
naming
reading comprehension
writing
8
Q
What does the assessment of thought content include?
A
Delusions
Obsessions
Phobias
Suicidal
9
Q
Assessments used for Attention and Concentration
A
Digit Span
Serial 7s
Spelling Backward.
10
Q
Does remote memory or recent memory get impaired in the late stages of dementia?
A
Remote Memory
11
Q
Describe the new learning ability for memory assessments.
A
Give patient 3-4 words to repeat back in a span of about 3-4 minutes. So… Ice.. Watermelon… Pineapple..
12
Q
MMSE
A
Mini Mental State Examination
-Screening cognitive dysfunction or dementia.
13
Q
A person who scores 0-17 on the MMSE would have what?
A
Severe cognitive Impairment
14
Q
What health promotion screenings are done during a mental status assessment?
A
Screening for anxiety
Screening for PTSD
Screening for Depression
Screening for risk of Suicide
Screening for substance use disorders, including alcohol and prescription drugs
15
Q
What condition may be a spectrum disorder in patients with ANXIETY, depression, or somatic symptoms
A
Chronic Pain
16
Q
Symptoms of generalized anxiety include what?
A
difficulty relaxing
annoyed or irritable
feeling fearful bad things will occur
restless and unable to sit still
unable to control worrying
feeling nervous, anxious, or on edge.
17
Q
T/F Anxiety disorders occur in isolation?
A
F. They do not always occur in isolation.
18
Q
Treatments for Generalized anxiety include what?
A
relax techniques
Stress manangement
Support Systems
Exercises
Counceling
medications
19
Q
What do the symptoms of PTSD include
A
Flashbacks
nightmares
isolation
disruptive behaviors
fear
anger
trigger sensitivity
20
Q
What screening is commonly used for depression in adults?
A
The Patient Health Questionnaire
21
Q
What screening tool is used for older adults?
A
Geriatric Depression Scale for older adults
22
Q
Screening for depression in pregnant woman?
A
Edinburgh Postnatal Depression Scale
23
Q
What are the risk factors for Suicide?
A
Gender ( Males at higher risk for suicide success.)
Race (White people make up 90% of cases)
Age (Younger people attempt suicide more)
24
Q
What are the EARLY signs of depression?
A
Low self esteem
loss of pleasure in daily activities
Sleep disorders
Difficulty concentrating
Difficulty making decisions
25
What is Anhedonia?
Loss of pleasure in daily activities (early sign of depression)
26
What does DAST stand for?
Drug and Alcohol Abuse Screening Test
27
What does AUDIT stand for?
The Alcohol Use Disorder Identification Test
28
Chapter 22
Putting the Physical Examination together
29
In General what order is a complete head to toe done?
Cephalic to Caudal and comparing side to side for symmetry. (p823)
30
At what part of the Physical examination do we take Vital Signs?
At the end of the history interview
31
What is CN VIII?
The Acoustic nerve otherwise known as the vestibulocochlear nerve
32
What is CN III
Oculomotor
33
What is CN IV
Trochlear Nerve
34
What is CN VI
Abducens
35
CN II
Optic Nerve
36
Walk through the Physical Eye examination
Inspect:
Eyelids
Eyelashes
Eyebrows
Lacrimal Apparatus
Conjunctiva
Sclera for color
Cornea and Lens
Iris for color
Pupils for Perla
Test visual fields
Eye Muscle Exam
6 cardinal directions of gaze
Convergence
Near Reaction (accommodation)
Cover Uncover Test
Ophthalmoscope examination
Optic Disc
Retina
Arteries
37
Inspect position, edema, color, lesions, closure
Eyelids
38
Inspect for quantity and distribution?
Eyelashes
&
Eyebrows
39
Inspect for swelling, drainage, dryness and crusting
The Lacrimal apparatus
40
Inspect for color, nodules or lesions
Conjunctiva
41
Inspect for visual patterns, nodules or lesions
Sclera
42
Inspect opacities?
Cornea and lens
43
Inspect crescentic shadow and color
Iris
44
CN connected to the 6 cardinal directions of gaze?
CN III
45
What do we need to inspect for the posterior thorax?
Shape
Deformities
Retractions
Symmetry
Skin integrity
46
What do we need to palpate for?
Tenderness
Tactile fremitus
Respiration expansion
47
T/F you may assess the patients CVA tenderness while standing OR sitting?
True you can assess from either position.
48
Chapter 23
Assessing Children
49
T/F A Childs development proceeds along a predictable pathway?
True
50
Who are the biggest agents of health promotion for children?
Their Parents
51
What is covered during a general survey of a child?
Measuring the Infants body size: Weight, length, head circumference and vital signs such as pulse, respritory and temperature.
52
At age 3 what vital sign can we include?
Blood pressure
53
What are chronic conditions in infants that can cause reduced length or height?
Neurologic, renal, cardiac, gastrointestinal and endocrine disorders as well as cystic fibrosis
54
What is Failure to thrive describe?
Inadequate weight gain for age.
55
Some scenarios that cause children failure to thrive include
Growth below 5% for age
Growth drop greater than two quartiles in 6 months
Weight for height below fifth%
56
Causes of Failure to thrive include
Environmental
psychosocial factors
gastrointestinal
Neurologic
And Cardiac
Endocrine
Renal
And others.
57
What is microcephaly?
Premature closure of the sutures causing a small head size.
58
Macrocephaly?
Abnormally large size head
59
Potential causes of Macrocephaly?
Hydrocephalus, subdural hematoma or rare causes like brain tumor or inherited syndromes.
60
T/F is familial megaloencephaly a benign condition with normal brain growth?
TRUE
61
What are causes of sustained hypertension in infants?
Renal artery disease
aka (stenosis or thrombosis) congenital renal malformations
Coarctation of the aorta
62
average heart rate an infant from birth-2 months and the range/min
HR-140 Range/min-90-165
63
0-6 Months Heart rate and range/min
HR 130 Range/min 80-175
64
6-12 months Heart Range and Range/min
HR 115 Range/min 75-170
65
What is the most common dysrhythmia in children?
Paroxysmal supra ventricular tachycardia (SVT)
66
How do infants present with SVT?
Some can look well or pale with tachypnea but have a heart rate of 240 beats/min or greater.
Other infants look ill and are in cardiovascular collapse.
67
T/F SVT in infants is sustained requiring medical therapy to convert to a normal rate and rhythm.
True.
68
In older children the episodes of varying duration and frequency of SVT symptoms is called what?
Truly paroxysmal.
69
Can hypertension begin in childhood?
Yes!
70
What age group is most likely to have primary or essential hypertension?
Adolescents
71
T/F Children tend to say in the same age group as they age?
True.
72
What pulse rate would indicate PSVT?
usually greater than 180/ min
73
Tachypnea and increased respiratory effort in an infant are signs of lower respiratory disease such as what?
Bronchiolitis or pneumonia
74
What temperature indicates serious infection or disease in infants (Younger than 2) and require prompt evaluation?
100.4 degrees
75
What could cause temperature instability in newborns?
sepsis, metabolic abnormality or other serious condition.
76
What does central cyanosis in a baby or child of any age indicate?
Congenital heart disease.
77
What should we worry about if jaundice persists beyond 2-3 weeks?
Biliary obstruction or liver disease.
78
Why would an infant show signs of dehydration?
Insufficient intake or excess loss of fluids from diarrhea
79
Isolated and pigmented light brown lesions (less than1-2cm) are what?
Cafe-Au-Lait Spots
80
Difference between neurofibromatosis and cafe-Au-Lait spots?
Neurofibromatosis have sharp borders and multiple lesions
81
What is a salmon patch and what patient presents with this skin condition?
Infants present with a salmon patch that is a vascular marking and result from distended capillaries.
82
Stork bite, angel kisses, nevus simplex are all names for what skin condition?
salmon patch.
83
Common among dark skinned babies and important to deduct that they are not bruises?
Mongolian spots.
84
What is Erythema Toxicum?
Common yellow or white pustules that are surrounded by a red base. Found on the face.
85
Red pustules and papule are most prominent over the cheeks and nose of some normal newborns.
Neonatal Acne
86
The Salmon red, scaly eruption often involves the face, neck, axilla, diaper area, and behind the ears.
Seborrhea
87
Erythema, scaling, dry skin, and intense itching characterize this condition in infants.
Atopic Dermatitis (Eczema)
88
This bright red rash involves the intertriginous folds, with small "satellite lesions" along the edges
Candidal Diaper Dermatitis
89
The irritant rash is secondary to diarrhea or irritation and is noted along the contact areas (here, the area touching the diaper)
Contact diaper dermatitis
90
This infections is due to bacteria and can appear bulbous or crusty and yellowed with come pus
Impetigo
91
A child with abnormal shape or length of palpebral fissures shortness of this fissure indicates what?
Fetal Alcohol effects.
92
Facial characteristics of Fetal Alcohol Syndrome ?
Short palpebral fissures, a wide and flattened philtrum (the vertical groove in the midline of the upper lip, thin lips.
93
What is Echolalia?
Children on the Autism spectrum use this speech recognition, they repeat others words or sentences. When children repeat things right after they hear them this is called Echolalia.
94
In what condition, is the nasal passages in newborns obstructed by bone or membranes in the Choana (Back of the nasal passage)
Choanal atresia
95
What is the most important assessment of the sinus and nose of the child?
Patency
96
What is it called when an infant has trouble breathing through their mouth?
Obligate nasal breathers
97
T/F you should occlude both nares of the infant at the same time
FALSE
98
Inspect the Nose to ensure the nasal septum is?
Midline.
99
What does a progressive increase in deep tendon reflexes within the first year of infancy suggest?
Central nervous system disease such as cerebral palsy, especially if it's coupled with increased tone.
100
are deep tendon reflexes in infants reliable diagnostic source?
NO, the corticospinal pathways may not be fully developed.
101
What tool is used at the instrument for testing reflexes of infants?
The doctors finger.
102
If an infant has no anal reflex what does this suggest?
Loss of innervation of the external sphincter muscles.
103
What is loss of the innervation of the external sphincter muscles caused by?
A spinal cord abnormality such as, spina bifida, tumors or injury.
104
Babinski response
a response to plantar stimulation
Dorsiflexion of the big toe and fanning of the other toes)
105
When contractions are continuous (sustained ankle clonus) what should be suspected in the infant?
central nervous system CNS disease.
106
another name for infantile automatisms
primitive reflexes
107
What do the primitive reflexes include?
Palmar grasp reflex
Plantar grasp reflex
Moro reflex (startle reflex)
Asymmetric tonic neck reflex
Positive support reflex
Rooting Reflex
Trunk incurvation (Galant) reflex
Stepping reflex
Landau reflex
Parachute reflex
108
-Hold baby hand watch for them to grasp finger is what reflex?
- Persistence of a palmar grasp reflex beyond 4 months suggests what?
(Palmer grasp reflex)
pyramidal tract dysfunction-
109
Touch the soles at base of toes, toes curl (6-8month) what primitive reflex is this?
(Plantar grasp reflex)
Persistence of a plantar grasp reflex beyond 8 months suggests what?pyramidal tract dysfunction
110
Holding baby supine supporting the head and back and legs abruptly lower the body 2 ft (birth-4month)
If baby has an asymmetric response what does this suggest?
Fracture of the clavicle, humerus or brachial plexus injury.
111
with the baby supine turn the head to to one side , holding jaw over shoulder. The side the head is turned arm and leg will extend while the opposite arm and leg will flex.
(Birth-2 month)
persistence beyond 2 months suggest what?
asymmetric CNS development can predict the development of cerebral palsy
112
During a positive support reflex test Lack of reflex in infants suggests?
Hypotonia or Flaccidity-- (Asymmetric tonic neck reflex)
113
Fixed extension and adduction of legs suggests spasticity from a neurologic disease named what?
Cerebral palsy--(Positive Support Reflex)
114
What does absence of rooting in infants indicates?
severe generalized or CNS disease--(Rooting Reflex)
115
An infant has no trunk incurvation what does this suggest?
transverse spinal cord lesion or injury and persistence with this could mean delayed development.--(Trunk incurvation (Galant) reflex
116
During the Stepping reflex test An infant with absence of stepping may indicate what?
Paralysis
117
Laying baby in your hand and letting them pick up both head and legs like superman is what primitive reflex? (birth-6 month)
Landau reflex-- persistence may indicate delayed development.
118
suspend baby prone and forward arms and legs will extend in a protective motion (4-6) month does not disappear?
Parachute reflex-- Delay in appearance may predict delays in voluntary motor development.
119
When would we see transient hypertension in children?
with them taking medications for asthma and ADHD
120
Why would a child have sustained hypertension?
Renal parenchymal or artery disease.
121
Interpret children's BMI
Underweight --- <5th percentile
Healthy weight --- 5th to <85th percentile
Overweight--- 85 to <95th percentile
Obesity--- >95%
Severe Obesity--->120% of the 95th percentile.
122
if you hear three sounds including the Korotkoff during blood pressure what do you record?
(98/62/0) Three sounds.
123
Pulse Rates of Children at rest
1-2 year 115-125.
2-6 year 95-115.
6-10 year 85-95.
124
Heart rate less than 100 beats per minute in infants and toddlers and less than 60 beats per minute in children 3-9 years old indicate what?
Sinus Bradycardia
125
Average RR of children?
early childhood 20-40
15-20 in late childhood.
126
What is the single best physical finding for ruling out pneumonia?
Absence of tachypnea
127
symptoms of bronchiolitis or pneumonia?
Rapid respirations increased work of breathing like grunting and nasal flaring or use of accessory muscles.
128
Preferred method of temperature for children?
Auditory canal or temporal artery.
129
Verruca Vulgaris?
Dry, rough, warts on hands
130
Verruca Plana
Small, flat warts
131
Plantar Warts?
Tender warts on feet
132
Molluscum Contagiosum?
Dome, shaped fleshy lesions
133
Adolescent Acne?
Open comedones and closed comedones and inflamed pustules on bottom.
134
Insect Bites?
Intensely Pruritic, red, distinct papule characterize these lesions.
135
Urticaria (Hives)?
This pruritic, allergic sensitivity reaction changes shape quickly
136
Tinea Capitis?
Scaling and crusting and hair loss are seen along the scalp. Along with painful plaque and occipital lymph node (arrow)
137
Tinea Corporis
This annular lesion has central clearing and papule along the border.
138
Scabies
Intensely itchy papule and vesicles, sometimes burrows, most often on extremities.
139
Pityriasis Rosea
Oval lesions on trunk in older children often in a pine tree pattern.
140
what can Amblyopia lead to?
Lazy eye and reduced visual acuity.
141
Expected visual acuity?
3 months --- Eyes converge, baby reaches for object
12 month --- -20/200
Younger than 4 years old --- 20/40
4 years and older --- 20/30
142
Where is the external auditory canal located?
Directed downwards similar to infants and the auricle must be pulled downward and back.
143
Two ways to hold an otoscope
Holding handle facing downwards or with the handle facing upwards.
144
Red, bulging tympanic membrane with a dull or absent light reflex
Acute otitis media
145
Does movement of the auricle elicit pain with the otitis external or the otitis media?
Otitis externa
146
The auricle may protrude forward and outward and the area over the mastoid bone is red swollen and tender
Acute mastoiditis
147
Physical and Motor milestones of early childhood
1yr Walks, 2-3 words, plays peek a boo
2yr. throws, 2-3 word phrase Imitates activities
3yr Jumps in place balances on one foot, sentences, feeds self
4yr hops pedals trike, speech all understandable, imaginative sings
5yr skips balances well, copies figures defines words, dresses self, plays games.
148
Pale and boggy nasal mucous membranes are found in children with what?
Perennial- Alergic rhinitis.
149
Common findings of strep throat?
Erythema of the posterior pharynx and palatal petechiae (on top) with a foul smelling exudate (bottom) is noted.
150
Where would we auscultate patent ductus arteriosus
upper left sternal border and to left radiation. Sometimes to the back.
151
Where would we auscultate for atrial septal defect?
Upper left sternal border with radiation to the back.
152
Location on a child of a Still murmur?
Mid/lower left sternal border
153
venous hum location?
under clavicle
154
Carotid bruit location?
carotids
155
pulmonary flow murmur
supine position loudest at the pulmonary auscultation area.
156
T/F the purpose of confidentiality is to keep secrets not improve healthcare?
FALSE the purpose of confidentiality is to improve the quality of healthcare
157
What does HEEADSSS assess for?
Home
Education/Employment
Eating
Activities
Drugs and alcohol
Sexuality
Suicide depression and self-harm
Safety from injury and violence
This is to assess teenagers at risk for risky behaviors.
158
What is Tanner Stages for Females?
over a 44 year period the rests progress through 5 stages called Tanner Stages.
159
Preadolescents- Only a small elevated nipple what tanner stage is this?
1
160
breast bud stage is a small mound of breast and nipple develops (areola widens) what stage is this?
2 11-12 Years old
161
breast and areola enlarge one flush against the other what Tanner stage is this?
3 12-13 Years old
162
the areola and nipple form a secondary mound over the breast what stage is this?
4 13-15 Years old
163
Mature breast what Tanner stage?
5 Older than 15 years old
164
Thelarche
Normal range of breast development
165
SMR of boys and girls is?
Sexual Maturity Ratings
166
Tanner stages of boys
Stage 1 Starts at 10 years old
Stage 2 11.5-12.5 Years old
Stage 3 12.5-13.5 Years Old
Stage 4 13.5-15 Years Old
Stage 5 Older than 15 years old
167
How does a teen ager get hepatomegaly?
infections like hepatitis mononucleosis inflammatory bowel disease or tumors
168
Most common cause of delayed puberty?
constitutional delay.
169
What evaluations for scoliosis are there?
Adams forward bend test if detected then use a scoliometer to test for the degree of scoliosis. Greater than 7 degrees is cause for concern.
170
Other evaluations for scoliosis
Plumb line.
171
Apparent scoliosis including abnormal plumb line test can be caused by a leg length discrepancy T/F?
TRUE.
172
What is pertussis
whooping cough it's highly contagious respiratory tract infection that's marked by severe hacking cough followed by a high pitched intake of breath that sounds like "whoop"
173
Normal attention span for age
2 years is 4-6 minutes
4 years is 8-12 minutes
6 year is 12-18 minutes
8 years is 16-24 minutes
10 years is 20-30 minutes
12 years is 24-36 minutes
14 years is 28-42 minutes
16 years is 32-48 minutes
174
What happens to temperature regulation in older adults?
RR and temp are unchanged in older adulthood but changes in temperature regulation lead to a susceptibility to hypothermia.
175
What are some age related skin conditions for older adults?
Skin Wrinkles
Skin Lax
loses turgor
vascularity of the dermis decreases causing lighter skin to look pale and opaque
Skin might have purple patches or macules (Actinic Purpura) they fade over time.
176
Actinic Purpura why does it disappear overtime?
They come from blood that has leaked through the capillary that's poorly supported and spread out under the dermis.
177
Congestive heart failure
Your heart is not pumping blood well enough to give your body supply, overtime blood collects in your lungs and legs causing swelling that need medications to control.
178
How does aging affect vascular sounds like those in the neck?
Adds to the significance of an extra heart sound like S3 and S4
179
T/F after age 40 the S3 suggests heart failure
True
180
what condition causes overload of the left ventricle?
Heart failure or valvular heart disease (mitral regurgitation)
181
T/F you can hear a S4 sound on well conditioned athletes?
TRUE
182
Distinguish aortic stenosis from aortic sclerosis
Using a brisk carotid upstroke
Aortic stenosis has a delayed carotid upstroke.
183
Impedes normal valve closure during systole, causing the systolic murmur of what?
Mitral Regurgitation. Volume overload increase in the LVentricle.
184
SPICES stands for what?
Sleep disorders
Problems with eating or feeding
Incontinence
Confusion
Evidence of falls
Skin breakdown
This mnemonic focuses on frequent geriatric syndromes of the older adult
185
What is a geriatric syndromes?
serious issues for older adults and is often related to functional decline. They impact quality of life big time.
186
Vision
Hearing
Leg Mobility
Urinary Incontinence
Nutrition/Weight loss
Memory
Depression
Physical disability
What screening is this?
The 10 minute Geriatric Screener.
187
Positive Vision Screen?
Inability to read greater than 20/40 on the Snellen chart
188
Positive hearing screen?
inability to hear 1000-2000Hz in both ears or either of these frequencies in one ear
189
Positive leg mobility screening?
Unable to complete task in 15 seconds
tasks are rise from the chair and walk 20 ft briskly and come back and sit down.
190
Positive urinary incontinence screen?
yes to questions like in the past year have you been unable to hold your urine and gotten wet?
191
Positive screen for nutrition and weight loss?
Have you lost 10lbs over the past 6 months without trying to do so? If they say yes or are less than 100 pounds the test is positive.
192
positive screen for memory?
Three item recall and a positive screen would be the patient cannot remember all three items.
193
positive screen for depression?
Ask if they often feel sad or depressed? if they say yes that's a positive sign for depression.
194
positive screen for physical disability?
6 questions are you unable to... Yes to any of these is a positive screen.
195
Risk factors for adverse drug reactions for older adults include what?
4 or more comorbid conditions
heart failure renal failure or liver disease
80 or older
number of drugs if 8 or more
use warfarin insulins oral anti platelet agents
previous adverse drug reaction
hyperlipidemia
raised of white cell count
use of anti diabetic agents
length of stay 12 days or longer.
196
What does a through med HX include?
name, dose, frequency, patients view of the reason they take each drug.
197
What are the physical activities of ADL's?
Bathing
Dressing
Toileting
Transferring
Continence
Feeding
198
What are the instrumental activities of ADL's
Using the Telephone
Shopping
Preparing food
Housekeeping
Doing Laundry
Transportation including driving, taking medicine and managing money
199
DRIP what does it do and what does it mean?
D: Delirium
R: Restricted mobility, retention
I: Infection, inflammation, impaction
P: Polyuria, Pharmaceuticals
It assesses potential causes of transient incontinence.
200
What is PLISS IT and what does it assess for?
P: Obtaining PERMISSION from the client to initiate sexual discussion
LI: Providing the limited information needed to function sexually.
SS: Giving specific suggestions for the individual to proceed with sexual relations
IT:Providing intensive therapy surrounding the issues of sexuality for client.
201
PLISS IT
To initiate the discussion of Sex.
202
Why is not smoking crucial for older adults?
reduce the risk of heart disease, pulmonary disease, malignancy and loss of daily function
203
The AUDIT C what is it and what does is screen for?
It is used to determine risky drinking
204
What does a score of 1 on the AUDIT C screen tell us about the patient?
little to no alcohol use in men a score of 4 or less is positive.
205
What does a 12 score on the AUDIT C screen tell us?
drinking is GREATLY affecting the clients health and safety.
206
What's assessed in the General survey?
Pt's gait to the chair, move onto exam table? changes in posture or involuntary movements? Hygiene and dress, assess the patients apparent state of health, degree of vitality and mood and affect.
207
Frailty is suggested from what?
Undernutrition
Loss of muscle mass
weakness
slowed motor performance.
208
kyphosis or abnormal gait can impair balance and increase risk of falls T/F
True
209
When do we see flat, impoverished affect?
Depression, Alzheimer's or Parkinson disease
210
Solar or Actinic lentigines are what?
Liver spots
211
Melanoma?
A dark raised asymmetric lesion with irregular borders
212
Cherry angionomas?
Appear early in adulthood
213
Hyperthyroidism and related health problems
Causes of hyperthyroidism are graves disease and toxic multi nodular goiter.
214
Describe stress incontinence
increased pressure on abdominal area.
215
describe urge incontinence
Involuntary contraction of the bladder
216
describe overflow incontinence
due to blockage of urethra
217
describe neurogenic incontinence
due to impaired functioning of the nervous system. FUNCTIONAL changes.
218
Metabolic syndrome risk factors?
Abdominal obesity
high blood pressure
impaired fasting glucose
high triglyceride levels
low HDL cholesterol levels.
