(4) General Survey, VS, Pain

Question 1

health history: common or concerning symptoms

Answer 1

fatigue & weakness
fever, chills, night sweats
weight change
pain

Question 2

fatigue - abnormal dx?

Answer 2

depression/anxiety
infections (hepatitis, mono, TB)
endocrine disorders (hypothyroid, adrenal insufficiency, DM)
heart failure
chronic dz of kidney, lungs, liver
electrolyte imbalance
moderate-severe anemia
malignancies
nutritional deficiency
medications

Question 3

weakness - abnormal dx?

Answer 3

localized in neuroanatomical pattern: neuropathy or myopathy

Question 4

recurrent chills - abnormal dx?

Answer 4

systemic bactermia

Question 5

night sweats - abnormal dx?

Answer 5

TB

malignancy

Question 6

low temp - abnormal dx?

Answer 6

immunocompromised pt w/ sepsis

Question 7

edema - abnormal dx?

Answer 7

heart failure
nephrotic syndrome
liver failure
venous stasis

Question 8

clinically significant weight loss?

abnormal dx?

Answer 8

loss of 5% or more of usual body weight over 6 months

GI, endocrine, infections, HIV, malignancy, chronic cardiac, pulmonary, renal failure, depression, eating disorder

Question 9

weight loss w/ high food intake - abnormal dx?

Answer 9

DM
hyperthyroid
malabsorption
bulimia

Question 10

drugs associated w/ weight loss

Answer 10

anticonvulsants
antidepressants
levodopa
digoxin
metformin
thyroid meds

Question 11

drugs associated w/ weight gain

Answer 11

TCAs
insulin and sulfonylurea
contraceptives
glucocorticosteroids
pregestational steroids
mitrazapine
paroxetine
propanolol

Question 12

BMI chart levels

Answer 12

underweight <18.5
normal 18.5-24.9
overweight 25.0-29.9
obesity (I) 30.0-34.9
obesity (II) 35.0-39.9
extreme obesity >40.0

Question 13

waist circumference w/ increased risk

Answer 13

women >35”

men > 40”

Question 14

4 steps to promote optimal weight and nutrition

Answer 14

1. measure BMI and assess risk factors
2. asses dietary intake
3. assess motivation to change
4. provide counseling about nutrition and exercise

Question 15

exercise needed to achieve health benefits

Answer 15

150 minutes (2hr30min) of moderate intensity cardio activity a week
OR 75 minutes (1hr15min) of vigorous-intensity cardio a week

Question 16

General Appearance

Answer 16

apparent state of health
level of consciousness
signs of distress
skin color / obvious lesions
dress, grooming, personal hygiene
facial expression
odors of body and breath
posture, gait, motor activity
height and weight
BMI
waist circumference

Question 17

excess clothing - abnormal dx?

Answer 17

hypothyroid
hide rash or needle marks
hide anorexia
personal lifestyle choice

Question 18

how to count heart rate

Answer 18

palpate radial pulse

listen to apical pulse

Question 19

definitions of HTN

Answer 19

office BP on 2 separate occasions >140/90
home BP >135/85
ambulatory automated BP
- 24hr average >130/80
- daytime average >135/85
- nighttime average >120/70

Question 20

types of HTN

Answer 20

white coat - conditioned anxiety response
masked - office BP < 140/90 but daytime BP > 135/85
nocturnal - nocturnal fall of <10% of daytime is associated w/ poor cardiovascular outcomes (can only be IDed on 24 hr ambulatory BP monitoring)

Question 21

correct BP cuff size

Answer 21

-width of inflatable bladder of cuff 40% of upper arm circumference
length of inflatable bladder 80% of upper arm circumference
- lower border of cuff 2.5 cm above AC crease

Question 22

Ausculatory gap - abnormal dx?

Answer 22

arterial stiffness
atherosclerotic disease

(if unrecognized may lead to underestimation of SBP or overestimation of DBP)

Question 23

stage II HTN

Answer 23

> 160/100

Question 24

BP arms vs legs

Answer 24

normal: SBP 5-10 higher in legs than arms

abnormal dx = coarctation of aorta, occlusive aortic disease

Question 25

types of pain

Answer 25

``` nociceptive neuropathic central sensitization psychogenic idiopathic ```

Question 26

Nociceptive Pain

Answer 26

linked to tissue damage to the skin, musculoskeletal system, or viscera but sensory nervous system is intact ex: arthritis, spinal stenosis - acute or chronic - mediated by afferent A-delta and C-fibers of the sensory system - involved afferent nociceptors can eb sensitized by inflammatory mediators and modulated by both psychological processes and neurotransmitters like endorphins, histamines, acetylcholine, serotonin, norepinephrine, dopamine

Question 27

Neuropathic Pain

Answer 27

- direct consequence of a lesion or dz affecting somatosensory system - may become independent of inciting injury, become burning, lancinating, or shock like - may persist after healing from initial injury - central nervous system injury (stroke, trauma), spinal nerve issues - triggers induce changes in pain signal processing through neuronal plasticity leading to pain that persists beyond healing from initial injury

Question 28

Central Sensitization Pain

Answer 28

- alteration of central nervous system processing of sensation, leasing to amplification of pain signals - lower pain threshold to non painful stimuli and response pain may be more severe than expected ex: fibromyalgia w/ psych overlap & somatization disorders that respond best to medications that modify neurotransmitters like serotonin and dopamine

Question 29

Idiopathic Pain

Answer 29

w/o identifiable etiology

Question 30

Idiopathic Pain

Answer 30

w/o identifiable etiology

Question 31

steps to manage chronic pain

Answer 31

1. measure pain intensity and pain interference 2. measure mood 3. measure effect of pain on sleep 4. measure risk of substance abuse 5. measure opioid dose

Question 32

readiness to change model

Answer 32

``` Precontemplation Contemplation Preparation Action Maintenance ```

Question 33

calcium food source

Answer 33

dairy calcium fortified cereal, juice, soy milk. tofu dark green leafy veggies sardines

Question 34

iron food source

Answer 34

lean meat, dark turkey, liver clams, mussels, oysters, sardines, anchovies iron fortified cereal enriched whole grain bread spinach, peas, lentil. turnip greens, artichokes prunes, raisins

Question 35

folate food source

Answer 35

``` cooked dried beans and peas oranges liver spinach, mustard greens black eyed peas, lentils, okra, chick peas, peanuts floated fortified cereals ```

Question 36

vitamin D food source

Answer 36

fortified milk, OJ, cereal cod liver oil, swordfish, salmon, herring, mackerel, tuna, trout egg yolk mushrooms

Question 37

diet changes : HTN

Answer 37

``` increase K (white/sweet potatoes, white beans, beet greens, soybeans, spinach, lentils, kidney beans, yogurt, tomato, bananas, plantains, dried fruit, OJ) decrease NA (canned foods, pretzels, potato chips, pizza, pickles, olives, processed foods, butter fried foods, table salt) ```