Assessment, Diagnostic Testing, Interpretation Flashcards
12% of exam, ~21 questions 1. Health History & Physical Exam 2. Diagnostic/Lab Studies 3. Imaging
Define: chief concern
client’s own brief statement in their words for seeking care
Define: HPI
chronological account of problems for which client is seeking care
Pain dimension mnemonic
OLD-CARTS
onset, location duration, characteristics, aggravating/associated factors, relieving factors, temporal factors, severity
Adolescent psychosocial mnemonic
HEADSS
home, education, activities, drugs, sex, suicide
Define: gravidity
total # of pregnancies, regardless of outcome
Define: parity
total # of pregnancies reaching 20 weeks or beyond
OB history mnemonic
GTPAL
gravida, term, preterm, abortion, living children
Patient risks can be related to (9)
age, gender, ethnic/racial background, family hx, environmental exposures, military service, lifestyle, geographic area, preventive healthcare adequacy
Problem-oriented medical record mnemonic for notes
SOAP Subjective Objective Assessment Plan
Subjective information
information obtained during history. Use ‘reports,’ ‘endorses,’ ‘describes,’ instead of ‘complains of.’
Objective information
information obtained through physical exam and lab/diagnostic tests
Assessment information
determination of diagnosis w/ rationale, or prioritized differential diagnosis, using subjective and objective info.
Plan information
information about diagnostic tests, therapeutic treatment regimen, client education, referrals, and date of reevaluation.
Order of exam techniques
abdomen alternative
inspection, palpation, percussion, auscultation
inspection, auscultation, percussion, palpation
Diaphragm of stethascope is used to hear…
high pitched sounds (S1, S2 heart sounds)
Bell of stethoscope is used to hear…
low pitched sounds (large blood vessels)
percussion: Tympany
loud, high-pitched drum-like sound (gastic bubbles, gas-filled bowel)
Hyperresonance
very loud, low-pitched, boom-like sound (lungs with emphysema)
Resonance
loud, low-pitched, hollow sound (healthy lungs)
percussion: dull
soft to moderate, moderate-pitched, thud-like sound (liver, heart)
Flat
soft, high-pitched sound, very dull (muscle, bone)
Depth of light palpation, and what you are looking for
1 cm
muscle resistance, tenderness, large masses, distention
Depth of deep palpation, and what you are looking for
4 cm
delineate organs, ID less obvious masses
BMI ranges
< 18.5: underweight 18.5 - 24.9: normal 25.0 - 29.9: overweight 30.0 - 39.9: obesity 40+ : extreme obesity
Waist circumference can serve as a risk predictor for which diseases in which BMI range?
DMT2, dyslipidemia, hypertension, CVD
25 - 39.9
Waist circumference of how much is an increased relative risk?
> 35 inches
Types of primary skin lesions (5)
macule, papule, pustule, vesicle, wheal
Types of secondary skin lesions (4)
ulcer, fissure, crust, scar
Malignant melanoma mnemonic
ABCDE
asymmetry, borders irregular, color blue/black or variegated, diameter > 6mm, elevation
Normal findings of lymph nodes
< 1 cm, nontender, mobile, soft, discrete
Normal conjunctiva
clear
Normal sclera
white/buff colored
Normal pupil mnemonic
PERRLA
pupils equal, round, reactive to light, and accommodate
Increased tactile fremitus could be…
lobar pneumonia, pulmonary edema
Decreased tactile fremitus could be…
emphysema, asthma pleural effusion
Normal sound of percussed lung fields
resonance
Normal sound of auscultated lungs
vesicular/bronchovesicular
Normal transmitted voice sounds
muffled/indistinct
What could bronchophony, egophony, whispered pectoriloquy indicate?
fluid or solid mass in lungs
Adventitious breath sound types (4)
crackles, ronchi, wheezes, pleural friction rub
What causes crackles?
air flowing by fluid (pneumonia, bronchitis, early HF)
What causes ronchi?
air passing over solid or thick secretions in large airways (pneumonia, bronchitis)
What causes wheezes?
air flowing through constrictions (asthma, chronic emphysema)
What causes pleural friction rub?
Inflamed pleural tissue (pleuritis, pericarditis)
What is S1? Where is it best heard?
occurs at start of systole
apex
What is S2? Where is it best heard
occurs at start of diastole
base
Fixed split S2 could indicate…
atrial septal defect, RVF (delayed closure of pulmonic valve)
Increased S3 could indicate…
also called ventricular gallop
normal in young adults and late pregnancy
decreased myocardial contractility, HF, volume overload (rapid ventricular filling)
Increased S4 could indicate…
also called atrial gallop
normal in well-trained athletes and older adults
aortic stenosis, hypertensive heart disease, cardiomyopathy (forceful arterial ejection into distended ventricle)
Physiologic murmur…
normal finding, common in pregnancy
Murmur of mitral stenosis caused by…
narrowed mitral valve that restricts forward flow, causes forceful ejection into ventricle
Systolic click could indicate…
mitral valve prolapse
Pericardial friction rub (heart sound) could indicate…
pericarditis
Palpating the liver…
should not extend more than 2 cm beyond right costal margin
Palpating spleen and kidneys…
normally should not be able to
Typical percussive sound of abdomen
tympany, dullness over organs/masses
Tenderness at McBurney’s (RLQ) point could indicate…
appendicitis
Guarding, rigidity, rebound tenderness in abdomen could indicate…
peritonitis
What is Rovsig’s sign?
pain in RLQ when left-sided pressure is applied and then quickly withdrawn
referred rebound tenderness
+ R psoas/obturator signs could indicate…
appendicitis
What is Murphy’s sign? What can it indicate?
sharp increase in tenderness and sudden stop in inspiratory effort with upward pressure under the R costal margin while patient takes a deep breath
cholecystitis
CN I
olfactory (smell)
CN II
optic (vision)
CN III
ocularmotor (PERRLA)
CN IV
trochlear (PERRLA)
CN VI
abducens (PERRLA)
CN V
trigeminal (sharp/dull/light touch on face)
CN VII
facial (smile)
CN VIII
acoustic (auditory acuity)
CN IX
glossopharyngeal (swalow)
CN X
vagus (“Ah”)
CN XI
spinal accessory (traps)
CN XII
hypoglossal (tongue)
Normal size of clitoris
no more than 2 cm by 0.5 cm
Normal size of cervix
2.5 cm diameter
Normal size of uterus
5.5 cm - 8 cm
could be 2-3 cm larger in parous patient
Normal ovary size
3 cm by 2 cm by 1 cm
Components of CBC w/ diff
RBC, Hct/Hgb, RBC indices (MCV, MCH, MCHC), WBC, peripheral blood smear
Define w/ normal range: RBC
red blood cell (RBCs per cubic mm of blood)
4.2 - 5.4 million/cubic mm
Define w/ normal range: Hct
hematocrit (percentage of total blood volume that is made up of RBCs)
nonpregnant: 37 - 47%
pregnant:
1st & 3rd trimester: 33% or more; 31% or more for black patients
2nd trimester: 32% or more; 30% or more for black patients
Define w/ normal range: Hgb
hemoglobin (measurement of total hemoglobin [which carries oxygen] in the blood)
nonpregnant: 12 - 16 g/dL
1st & 3rd trimester: 11 g/dL or more; 10.2 g/dL or more for black patients
2nd trimester: 10.5 g/dL or more; 9.5 g/dL or more for black patients
Define w/ normal range: MCV
mean corpuscular volume (average volume/size of a single RBC)
80 - 95
Microcytic anemias
Fe-deficiency and thalassemia
Macrocytic anemias
Vit B-deficiency and folic acid-deficiency (megaloblastic)
Define w/ normal range: MCH
mean corpuscular hemoglobin (average amount/weight of Hgb within an RBC)
27 - 31 pg/cell
Define w/ normal range: MCHC
mean corpsucular hemoglobin concentration (average concentration/percentage of Hgb within a single RBC)
32 - 36 g/dL
decreased MCHC and associated anemias
hypochromic
Fe-deficiency and thalassemia
Define w/ normal range: WBC
white blood cell count
5000 - 10000/cubic mm
components/breakdown/high value associations of WBC w/ diff (5)
neutrophils 30 - 70% (bacterial infx, inflammation, ‘left shift’)
basophils 0 - 3% (hypersensitivity rx)
eosinophils 0 - 5% (allergic rx)
lymphocytes 15 - 40% (viral infx, chronic bacterial infx/inflammation)
monocytes 2 - 8% (recovery phase of infx, chronic infx)
What does a peripheral blood smear look at?
microscopic examination of RBCs, platelets, leukocytes
Components of blood clotting studies (4)
platelet count
prothrombin time (PT)
partial thromboplastin time (PTT)
coagulation factors
Define w/ normal range: platelets
150000 - 400000/cubic mm
Components of CMP (13)
glucose, albumin, total protein, sodium, potassium, CO2, chloride, BUN, creatinine, ALP, ALT, AST, bilirubin
Define w/ normal range: fasting glucose
8 hours fasting
normal: < 100 mg/dL
impaired fasting: 100 - 125 mg/dL
diagnostic for DM: 126 mg/dL or greater
Define w/ normal range: OGTT (2 hr postload 75g glucose)
2 hours after 75 g glucose
normal: <140 mg/dL
impaired tolerance: 140 - 199 mg/dL
diagnostic for DM: 200mg/dL or greater
Define w/ normal range: HbA1c
measures glycemic control over 60 - 90 days normal: <5.7% prediabetes: 5.7 - 6.4% diabetes: >6.5% good control in a diabetic is <7%
components of lipid profile (4)
total, triglycerides, HDL, LDL
Define w/ normal range: total cholesterol
normal: 200 mg/dL
can be elevated in pregnancy
Define w/ normal range: triglycerides
35 - 135 mg/dL
can be elevated in pregnancy
Define w/ normal range: HDL
> 40 mg/dL
Define w/ normal range: LDL
<130 mg/dL
Define w/ normal range: TSH
0.4 - 4.12 mU/mL
upper limit during pregnancy: 2.5 - 3.5 mU/mL
Define w/ normal range: free T4
0.58 - 1.64 ng/dL
Define w/ normal range: total T4
4.5 - 12.0 micrograms/dL
measurement can be affected by increased TBG (pregnancy)
What could a positive antithyroid peroxidase antibody test (anti-TPO) indicate?
Grave’s, Hashimoto’s
Define w/ normal range: bilirubin
0.3 - 1.0 mg/dL
direct/conjugated: 0.1 - 0.3 mg/dL
indirect/unconjugated: 0.2-0.8 mg/dL
What can a protein/creatinine ratio tell us? What is it?
kidney damage/disease, preeclampsia, diabetes
random urine sample
Fecal occult blood testing: positive test can indicate
GI cx, polyps, PUD, IBD, trauma, GI bleed
How does blood type/Rh factor testing work?
Looking for antigens A, B, Rh on RBCs
0- is universal donor because ot has no antigens
AB+ is universal receiver because it will have no antiBODIES to react to transfused blood
What does screening for sickle cell look like?
+ test (presence of Hgb S indicates disease or trait)
refer for Hgb electrophoresis to identify Hgb type and amount
Causes of increased estradiol (4)
adrenal tumor, estrogen-producing tumor, hepatic cirrhosis, hyperthyroidism
Causes of decreased estradiol (5)
postmenopausal, ovarian failure, hypogonadism, Turner’s, anorexia nervosa
Causes of increased progesterone (5)
pregnancy, ovulation, progesterone-secreting tumor or cyst of ovary, congenital adrenal hyperplasia, hydatiform mole
Causes of decreased progesterone (5)
hypogonadism, threatened abortion, fetal demise, preeclampsia, short luteal phase syndrome
Causes of increased FSH (5)
postmenopause, gonadatropin-secreting pituitary tumor, ovarian failure, primary hypogonadism, Turner’s
Causes of decreased FSH (4)
pregnancy, pituitary or hypothalamic dysfx, hyperprolactinemia, anorexia nervosa
Causes of increased LH (3)
postmenopause, primary hypogonadism, gonadal failure
Causes of decreased LH (2)
pituitary or hypothalamic dysfx, anorexia nervosa
Components of UA (14)
appearance, color, odor, pH, protein, specific gravity, leukocyte esterase, nitrites, ketones, crystals, casts, glucose, WBCs, RBCs
Define w/ normal range: UA pH
4.6 - 8
Define w/ normal range: UA protein
0 - 8 mg/dL
Define w/ normal range: UA SG
1.005 - 1.030
Define w/ normal range: UA WBCs
0 - 4 per HPF
Define w/ normal range: UA RBCs
2 or less
What should be negative on a UA? (6)
nitrites, ketones, crystals, casts, glucose, leukocyte esterase
Positive urine culture indicates
UTI
Positive urine culture is typically defined as
100000 CFU/mL of single type of bacteria
OR
1000 CFU/mL with symptoms of UTI
Normal vaginal pH
3.8 - 4.5
BV clinical/microscopy findings (5)
pH > 4.5 \+ whiff test > 20% of epithelial cells are clue cells 0 - 1 WBCs per epithelial cell lactobacillus reduced or absent
Trich clinical/microscopy findings (5)
pH > 4.5 \+/- whiff test motile trichomonads > 1 WBC per epithelial cell lactobacillus reduced or absent
Yeast clinical/microscopy findings
PH = 4.5 - whiff test hyphae/spores > 1 WBC per epithelial cell lactobacillus present
other test for trich
NAAT
other test for yeast
culture
1st screening for HIV
EIA
if EIA reactive for HIV, confirm with?
western blot or IFA
test for Gonorrhea
NAAT
test for Chlamydia
NAAT
test for syph
Nontreponemal tests (VDRL or RPR): reactive or nonreactive Treponemal tests (FTA-ABS, TPI): positive or negative
test for HSV
PCR assay or tissue culture
serologic tests differentiate between HSV-1 and HSV-2
IgM antibodies typically indicate
active infx
IgG antibodies typically indicate
previous infection and current protection from another primary infx
CMV test is
an antibody test
Toxo test is
an antibody test
Hep C test is
an antibody assay, followed if reactive with RNA test to determine if current infection or past resolved infection
Hep B test is
a lot of stuff that you can find on page 22 if you care
Rapid strep test tells us
if pharyngitis is caused by group a beta hemolytic streptococci (GABHS)
it’s positive or negative (viral if negative)
When would we get a throat culture?
If you’re considering other pathogens for pharyngitis
When would we get a skin culture?
wound that is tender, red, swollen, draining fluid/pus, slow to heal, fever
Types of breast biopsy
fine-needle aspiration tissue biopsy (diagnostic)
Gene
basic unit of heredity passed from parents to offspring
~23000
Chromosome
live in nucleus
46
22 pairs are autosomes
1 pair is sex chromosomes
Karyotype
an individual’s collection of chromosomes
Gene mutation
change in the DNA sequence
Types of gene mutations
somatic: acquired
germ cell: inherited
Genetic marker
DNA sequence with a known physical location on a chromosome
Autosomal dominant and examples
only one copy of gene in each cell is needed
one affected parent
50% chance of inheriting
examples: Huntington, BRCA1/2, Lynch
Autosomal recessive and examples
2 copies of gene needed
parents usually unaffected (carriers only)
50% chance of carrying, 25% chance of having disease
examples: CF, SS anemia
X-linked dominant and example
genes on X-chromosome are mutated females more frequently affected fathers can't pass trait to sons if mother is affected, 50% chance of inheriting disorder for both M and F offspring fragile x syndrome
X-linked recessive and example
genes on X-chromosome are mutated
males more frequently affected
fathers can’t pass trait to sons
F offspring need to inherit affected X from both parents
M offspring need to only inherit the affect X from mother
hemophilia
Pelvic US used to (7)
distinguish between solid and cystic pelvic masses
confirm viability/location of products of conception
determine endometrial thickness
evaluate size/location of uterine myomas
evaluate adnexal masses/fullness
evaluate fetal growth
detect fetal anomalies/abnormalities
Types of pelvic US
transabdominal (full bladder)
transvaginal (empty bladder) better resolution
Mammography used to
detect cancerous, precancerous, benign lesions
screening and diagnostic
Types of mammography
digital, conventional film, 3D/tomosynthesis
Mammography findings standardized by
BI-RADS (0-5)
Breast US is used to
diagnose in adjunct w/ mammogram
not a screening tool
differentiated between cystic and solid masses
can be a guide for localized procedures
Bone densitometry/bone density testing used for
screening, diagnosis, and monitoring treatment for osteopenia and osteoporosis
What is the T-score based on?
comparing bone density in post-menopausal women to young adult female reference population
T-scoring ranges
normal: > -1
osteopenia: -1 to -2.5
osteoporosis: @ or < -2.5
