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(PA school) HAPE > Beyonce Slides (pre quiz 1) > Flashcards

Beyonce Slides (pre quiz 1) Flashcards

Begins at unit 2.1, done through lecture 2.3

1
Q

1) What temperature will immune compromised patients with sepsis have?
2) What else is this true for?

A

1) Fever may actually be absent or low
2) Recent ingestion of ASA, NSAIDS, and steroids may also mask fever

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2
Q

What signs point to temperature change?

A

Chills/shivers/rigors

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3
Q

What is a benign cause of elevated temperature?

A

Menopause; can cause hot flashes

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4
Q

What does true shaking raise concerns for?

A

Bacteremia.

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5
Q

1) Define pyrexia
2) What is it correlated with?

A

1) Elevated temp
2) Infection, trauma (surgery or crush injury), malignancy, drug rxn (SSRI overdose), and immune disorders

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6
Q

What can induce chronic weight gain?

A

Medications such as:
1) Tricyclic antidepressants
2) Insulin and sulfonylurea
3) *Contraceptives
4) *Glucocorticoids
5) *Some SSRI’s
6) Others
* = important

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7
Q

When should you investigate weight loss in a patient?

A

Weight loss of more than 5% over 6 months needs further investigation

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8
Q

What can unintended weight loss raise suspicion of?

A

1) Cancer
2) Hyperthyroidism
3) HIV/AIDS
4) Anorexia nervosa/bulimia
5) GI absorption disease
6) Malnutrition

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9
Q

What can reducing weight by 10% do?

A

Improve BP, lipids, glucose tolerance, and reduce DM risk

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10
Q

What can the right patient education do?

A

The right patient education can pull someone from the brink of prediabetes

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11
Q

What should you measure and assess regarding weight and nutrition? What should you screen for?

A

Measure objective data
Assess risk factors
Screen for metabolic syndrome

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12
Q

What are the indicators of metabolic syndrome? How many to make a diagnosis?

A

1) Waist circumference >/= 40 in in men and >/= 35 in women
2) Fasting glucose >/= 100
3) HDL < 40 in men and < 50 women
4) Triglycerides >/= 150
5) Blood Pressure >/= 130 over 85
-3 or more = diagnosis

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13
Q

What 5 questions should you ask when considering level of consciousness?

A

1) Awake and alert?
2) Understand questions?
3) Respond appropriately, quickly, or lose track of topic?
4) Silent?
5) Somnolent?

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14
Q

1) Define alert
2) Define lethargic
3) Define obtunded

A

1) Alert: pt opens eyes, looks at you, and responds appropriately
2) Lethargic: pt is drowsy, but opens eyes and responds when you speak loudly
3) Obtunded: pt will open eyes if you shake them, responds slowly and is confused

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15
Q

1) Define stuporous
2) Define comatose

A

1) Stuporous: pt responds to painful stimuli and verbal responses are slow or absent
2) Comatose: pt does not respond

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16
Q

How is orientation quantified?

A

Oriented x [. . .]

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17
Q

1) What does oriented x3 mean?
2) What about oriented x4?

A

1) Oriented x 3: Person, place and time
2) Oriented x4: Person, place, time, and event

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18
Q

Define grossly oriented

A

Patient is generally able to interact without obvious deficits

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19
Q

What are the classifications of overweight and obese based on BMI?

A

1) Underweight < 18.5
2) Normal 18.5 – 24.9
3) Overweight 25 – 29.9
4) Obese I 30 – 34.9
5) Obese II 35 – 39.9
6) Extreme obesity >/= 40
-“Eighteen point five to twenty-five, then count by fives”

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20
Q

1) Define white coat HTN
2) Define masked HTN
3) Define nocturnal HTN

A

1) White coat: Over 140/90 in office and less than 135/80 at home
2) Masked: Less than 140/90 in office and more than 135/80 at home
3) Nocturnal: Less than 10% dip in sleeping pressure

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21
Q

1) If BP is taken at home, what do you need to do?
2) What are the benefits of taking BP at home?

A

1) Must properly educate pt about use of the equipment
2) Benefits: the ability to differentiate white coat HTN and pick up both masked and nocturnal HTN

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22
Q

1) How can the lower extremities affect a BP reading?
2) What are latrogenic affects on BP?

A

1) Lower extremity: Feet are not flat on the floor
2) Latrogenic: Cuff is too narrow or wide
(latrogenic = PAs fault)

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23
Q

1) Describe general effects on BP
2) Describe effects of the mouth on BP
3) Describe effects of the upper extremity on BP

A

1) General: Exercise 30 min prior
2) Mouth: Caffeine, smoking
3) Upper extremity:
-Arm not at heart level
-Clothing on the arm!
-Fistula in the arm
-Scar from brachial artery cutdown (cardiac cath)
-Lymphedema

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24
Q

What should you base your final BP number on?

A

The highest of your readings; do the same with your diagnosis

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25
Q

What is orthostatic hypotension?

A

Dizziness when going from sitting/ laying to standing

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26
Q

Why can orthostatic hypotension occur? (5 reasons)

A

1) Drugs (say, BP meds like metoprolol)
2) Blood loss
3) Bed rest
4) Nervous system disease
5) Elderly patients (20% of people over 65)

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27
Q

How do you measure orthostatic HTN?

A

Measure BP and HR in 2 positions:
1) First supine after 3 minutes rest
2) Then within 3 minutes after standing

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28
Q

When does a pt have orthostatic HTN?

A

1) Systolic drop more than 20mmHg upon standing
2) Diastolic drop more than 10mmHg upon standing
3) HR rise more than 20 bpm upon standing
4) OR GETTING DIZZY!

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29
Q

What is normal radial pulse?

A

60-100 (if pt is very athletic, 50 can be normal)

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30
Q

What are the 5 types of pain?

A

1) Nociceptive pain
2) Neuropathic
3) Central sensitization pain
4) Psychogenic pain
5) Idiopathic pain

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31
Q

1) What two questions should you ask if a patient says their weight changed?
2) What does rapid weight gain over a few days indicate is likely?
3) What does that indicate?

A

1) “Is this rapid or gradual? Is this intentional?”
2) Fluid retention.
3) Potential for heart failure, nephrotic syndrome, liver failure, and venous stasis

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32
Q

How do you calculate BMI?

A

Take lbs x 700 and divide by the height in inches twice

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33
Q

What 4 things should you consider when interpreting a BP reading?

A

1) General (exercise)
2) Mouth (caffeine, smoking)
3) Upper extremity (clothing, fistula, scar, lymphedema, arm too high/low)
4) Lower extremity (feet not flat on floor?)

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34
Q

1) What is normal BP
2) What is prehypertension systolic? What about diastolic?
3) What is stage 1 systolic for ages 18-59? What abt diastolic?

A

1) <120/<80
2) Systolic: 120-139, Diastolic: 80-89
3) Systolic: 140-159, Diastolic: 90-99

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35
Q

1) What is HTN stage 1 60+ y/o systolic? What about diastolic?
2) What is stage 2 HTN systolic? What abt diastolic?

A

1) Systolic: 150-159, Diastolic: 90-99
2) Systolic: >/= 160, Diastolic: >/= 100

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36
Q

How do you measure radial pulse?

A

1) Use pads of index and middle fingers, compress radial artery until pulsation is detected
2) If rhythm is regular, proceed to counting the rate for 30 seconds and multiply by 2 to get BPM
3) But if it appears fast or slow, count for the full minute
-60-100 is normal

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37
Q

1) What is nociceptive pain?
2) What causes nociceptive pain?
3) What mediates it?

A

1) Plain ol’ pain pain
2) Tissue damage of skin, musculoskeletal (MSK), or viscera
3) C fibers of sensory system

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38
Q

1) What causes neuropathic pain?
2) How long does it last?
3) What does it feel like?

A

1) Direct damage to nervous system
2) May last beyond initial injury
3) Takes a burning, or shock-like character

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39
Q

What is central sensitization pain?

A

Ongoing research on this, but includes fibromyalgia and somatization disorders

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40
Q

What can cause psychogenic pain?

A

Anxiety/depression, personality, and coping style

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41
Q

What is idiopathic pain?

A

Unknown pain

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42
Q

1) Define attention
2) Define memory
3) Define orientation

A

1) Ability to concentrate over time
2) Memory: ability to remember things
3) Orientation: Awareness of personal identity, place, and time (requires both memory and attention)

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43
Q

What requires both memory and attention?

A

Orientation

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44
Q

1) Define perceptions
2) Define thought processes
3) Define thought content

A

1) Sensory awareness of objects in the environment and their interrelationships
2) Logic, coherence, and relevance of people’s thought “how people think”
3) What you think about

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45
Q

1) Define insight
2) Define judgement
3) Define affect

A

1) Awareness of their own condition
2) The process of evaluating options when making a decision
3) Facial expression

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46
Q

1) Define mood
2) Define language
3) Define higher cognitive function

A

1) Pervasive sustained emotion
2) Language the pt uses
3) Includes vocab, fund of information, abstract thinking, calculations

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47
Q

Give 12 terms important to consider when conducting a psych eval

A

1) Attention
2) Memory
3) Orientation
4) Perceptions
5) Thought processes
6) Thought content
7) Insight
8) Judgement
9) Affect
10) Mood
11) Language
12) Higher cognitive function

48
Q

What are the two high-yield questions to ask about depression?

A

1) Over the past 2 weeks, have you felt down, depressed, or hopeless?
2) Over the past 2 weeks, have you felt little pleasure in doing things? (anhedonia)

49
Q

Give 5 examples of anxiety disorders

A

1) GAD
2) Social phobia
3) Panic disorder
4) PTSD
5) Acute stress disorder

50
Q

What are the 3 high-yield questions to ask about anxiety?

A

1) Over the past 2 weeks, have you felt nervous, anxious, or on edge?
2) Over the past 2 weeks, have you been unable to stop or control worrying?
3) Over the past 4 weeks, have you had an anxiety attack; suddenly feeling fear or panic?

51
Q

1) Define delirium
2) Define dementia
3) Give some causes of dementia
4) Who is usually the first to notice dementia?

A

1) An acute and transient change in mental status marked by confusion and emotional disruption
2) Long-term progressive cognitive decline
3) Alzheimer’s, Parkinson’s disease, Lewy-Body Dementia, among others
4) Pt’s with dementia are often the first to notice a change in their memory; “If I didn’t tell ya’, you’d never know”

52
Q

1) What should you watch for when looking for dementia? (2 things)
2) How is it screened?

A

1)
-Subtle behavior changes, difficulty taking medicines or performing routine chores
-Loss of interest in usual activities (though this is also very common with depression)
2) With MMSE

53
Q

What is an acute and transient change in mental status marked by confusion and emotional disruption?

A

Delirium

54
Q

1) Define flight of ideas
2) Give examples of what is seen during this phenomenon
3) What condition is this seen in?

A

1) Almost continuous flow of fast speech with abrupt changes in topic; The ideas are understandably related
2) Plays on words, loose associations, distracting events
3) Seen very often in manic episodes

55
Q

1) Define neologisms
2) What is this seen in?

A

1) The creation of new words
2) Schizophrenia, psychotic disorders, and aphasia

56
Q

1) Define incoherence
2) What is it characterized by?
3) What is it seen in?

A

1) Speech that is incomprehensible and illogical
2) Abrupt changes in topic with no meaningful connections; disordered grammar and word use
3) Severe psychotic disturbance or acute traumatic brain injury

57
Q

1) Define blocking
2) What does it occur in?

A

1) Sudden interruption of speech in midsentence or before the ideas completed; “loosing the thought”
2) Occurs in normal mentation sometimes, but also may occur in schizophrenia or dementia

58
Q

Give 4 examples of variations in thought processes

A

1) Flight of ideas
2) Neologisms
3) Incoherence
4) Blocking
*doesn’t include all we talked about

59
Q

How do you go about assessing abnormality in thought content of a patient?

A

Follow the patient’s lead…take their cues.
“You mentioned earlier that your neighbors have been causing your illness. Tell me more about that.”

60
Q

1) Define compulsions
2) What are compulsions aimed at?
3) Differentiate compulsions from perseveration
4) What is it seen in?

A

1) Repetitive behaviors that the person is driven to perform in response to an obsession
2) Aimed at reducing anxiety, or aimed at preventing something feared from happening
3) Broader than perseveration, can include images
4) Phobias and OCD

61
Q

1) Define obsessions
2) Can obsessions be ignored?

A

1) Recurring, persistent thoughts, images, or urges experienced as intrusive
2) Pts try to ignore these but cannot

62
Q

Define phobias

A

Persistent irrational fears (accompanied by avoidance)

63
Q

Define anxieties

A

Anticipation of future danger accompanied by worry

64
Q

1) Define “feeling of unreality”
2) What is it associated with?

A

1) A sense that the environment is strange, unreal, or remote
2) Psychotic disorders

65
Q

Define “feeling of depersonalization”

A

1) Sense that self or identify is different or changed; unreal or lost
2) Associated with psychotic disorders

66
Q

1) Define delusions
2) What are they seen in?

A

1) False, fixed, personal belief that will not change when shown to be false
2) Seen in psychosis, severe mood disorders, dementia

67
Q

What are the 6 flavors of delusions? Give an example of each

A

1) Persecutory: “They’re out to get me”
2) Grandiose: “I’m one of a kind”
3) Jealous: “They’re cheatin’ on me”
4) Erotomaniac: “They’re in love with me”
5) Somatic: “Something’s wrong with my x,y,z”
6) Unspecified: unusual personal significance. . . “The radio is talking to me”

68
Q

1) Define illusions
2) Give an example
3) What can they occur in?

A

1) Misinterpretations of real external stimuli
2) Ex: mistaking rustling leaves for sound of voices
3) Can occur in grief reactions (mistaking persons for the deceased), or delirium, PTSD, and schizophrenia

69
Q

1) Define hallucinations
2) What conditions are they seen in?

A

1) Perceptions that seem real but are not at all
2) Delirium, dementia, alcohol withdraw, schizophrenia

70
Q

Define insight

A

Whether they seem to be able to identify what is wrong or seem oblivious to variation/abnormality

71
Q

1) Define judgement
2) How may it be assessed?
3) What may affect it?

A

1) The formulation of decisions
2) Asking how the pt would plan to deal with a certain scenario, like job-loss, illness, or even leaving the hospital
3) Intellectual disability, thought disorder, and culture

72
Q

1) What does information and vocabulary provide us knowledge of?
2) How can a pts fund of knowledge be tested?
3) Is this affected by psychiatric illness?

A

1) Provides baseline of pts abilities
2) By asking about hobbies, TV, current events
3) Virtually unaffected by psychiatric illness

73
Q

1) Define calculating ability
2) What should you consider when evaluating this?
3) What affects this ability?

A

1) Serial addition
2) A patient’s baseline and education
3) TBI, CVA, and dementia

74
Q

Give 8 examples of abnormality in thought content

A

1) Compulsions
2) Obsessions
3) Phobias
4) Anxieties
5) Feeling of unreality
6) Feeling of depersonalization
7) Delusions

75
Q

What are 4 things we assess to see if a pt has any abnormality of perception?

A

1) Illusions
2) Hallucinations
3) Insight
4) Judgement

76
Q

Give 3 examples of factors we should consider when evaluating a pts higher cognitive function

A

1) Information and vocabulary
2) Calculating ability
3) Abstract thinking

77
Q

1) How is abstract thinking often tested?
2) How else can it be tested?
3) What conditions may alter a pts ability to think abstractly?

A

1) By interpreting proverbs
2) By making similarities: what are the things in common?
3) Psychosis, dementia, delirium, intoxication, intellectual disability

78
Q

Asking a patient to interpret “Don’t count your chickens before they hatch” is testing what?

A

Their abstract thinking

79
Q

Asking a patient to tell you the similarities between an orange and an apple is testing what?

A

Abstract thinking

80
Q

List the groups of personality disorders

A

1) A: Odd or eccentric: paranoid, schizoid, or schizotypal
2) B: Dramatic: Antisocial, borderline*, histrionic
3) C: Anxious: avoidant, dependent, and obsessive-compulsive

81
Q

Name 3 disorders that fall under the A/ odd or eccentric class of personality disorders

A

1) Paranoid
2) Schizoid
3) Schizotypal

82
Q

Name 4 disorders that fall under the B/ dramatic class of personality disorders

A

1) Antisocial
2) Borderline*
3) Histrionic
4) Narcissistic

83
Q

Name 3 disorders that fall under the C/ anxious class of personality disorders

A

1) Avoidant
2) Dependent
3) Obsessive-compulsive

84
Q

What kind of patients may appear especially demanding, disruptive, or manipulative?

A

Borderline

85
Q

List 3 important red flags for skin

A

Pallor, cyanosis, and jaundice

86
Q

1) What does pallor indicate?
2) Why?

A

1) Anemia
2) Hemoglobin in RBC’s transports oxygen and gives a red color to oxygenated blood and skin

87
Q

1) What does cyanosis indicate?
2) Why?

A

1) Low oxygen or decreased blood flow
2) Deoxyhemoglobin has a bluer tint; seen in veins
-Veins also given bluish color due to light shift as it passes through pella lucidum

88
Q

Why do veins look blue?

A

Light shift as they pass through pella lucidum

89
Q

1) What does jaundice indicate?
2) What is this?

A

1) Jaundice indicates buildup of bilirubin (yellow)
2) Biproduct of the breakdown of heme in RBC’s

90
Q

What should you ask about rashes?

A

1) Ask about itching. Most common symptom with ratches
-Did the itching come before or after the rash started?
3) Ask about seasonal allergies: sneezing, watery eyes
4) Ask about asthma
5) Does itching get worse at night?
6) WHERE IS THE RASH?
-Location will give you many clues to the cause; you will learn specifics later
7) HOW LONG HAS IT BEEN THERE?

91
Q

What is the most common symptom with rashes?

A

Itching

92
Q

What can generalized itching without apparent rash indicate?

A

Includes:
1) Xerodermata (dry skin)
2) Pregnancy
3) Uremia
4) Jaundice
5) Lymphoma and leukemia
6) Drug reaction
7) Polycythemia vera

93
Q

1) What 4 things should you ask about hair loss or nail changes?
2) What does shedding at the roots indicate?
3) What about breaking at the shaft?
4) What else can changes in hair or nails be due to?

A

1A) Ask about where the loss is
B) Ask about the timing
C) Learn where the hair breaks
D) Ask about care practices like shampooing and special products
2) Shedding at the roots includes telogen effluvium and alopecia areata
3) Breaking at the shaft suggests tinea capitis
4) Change in hair or nails (thickening or thinning) can also be due to thyroid disease

94
Q

1) What does hair breaking at the shaft suggest?
2) What can changes in hair or nails (thickening or thinning) be due to?

A

1) Tinea capitis
2) Thyroid disease

95
Q

1) What are causes of hair loss?
2) What two things could hair shedding at the roots indicate?

A

1) MC causes are pattern baldness
2) Telogen effluvium and alopecia areata

96
Q

1) Is the metastasis rate of melanoma high? What about mortality
2) Is it rare or common? What percent of skin cancer deaths does this type make up?
3) Is it treatable?

A

1) Yes, has a high metastasis rate and high mortality
2) Rarest form of skin cancer, but accounts for 70% of the deaths
3) If you catch it early it is very treatable

97
Q

List 10 risk factors for melanoma

A

1) Family history of melanoma
2) >/= 50 moles
3) Atypical or large moles, especially if dysplastic
4) Red or light hair, light eye or skin color
5) Solar lentigines (brown macules on sun-exposed areas)
6) Freckles
7) UV radiation from heavy sun exposure, sunlamps, tanning booths
8) Severe blistering sunburns in childhood
9) Immunosuppression (HIV or chemo)
10) Personal Hx of nonmelanoma skin cancer

98
Q

List the ABCs of melanoma

A

Asymmetry
Border irregularity
Color variation
Diameter greater than 6mm
Evolving (changing over time)

99
Q

What is the most important ABC of melanoma?

A

Evolution (changing over time)

100
Q

What are the two types of flat lesions? How are they differentiated?

A

1) Macule: flat and < 1cm
2) Patch: flat and >1cm

101
Q

What are the two types of raised lesions? How are they differentiated?

A

1) Papule: raised and < 1 cm
2) Plaque: raised and > 1cm

102
Q

What are the two types of fluid filled lesions? How are they differentiated?

A

1) Vesicles: raised and fluid filled < 1 cm
2) Bulla: raised and fluid filled > 1 cm

103
Q

What types of lesions can be palpated? What kind can’t?

A

Raised lesions can be palpated, flat lesions cannot be palpated with eyes closed

104
Q

What are two things you need to note about fluid filled lesions?

A

1) Number
2) Size (good to measure)

105
Q

What should you do for all skin lesions? (2 things)

A

1) Inspect and palpate all skin lesions
2) Ascertain their relatability to any descriptive words you know

106
Q

1) What should you note about a rash?
2) What descriptive words should you use for this?

A

1) Shape of the rash
2) Circular, oval, annular (ring-like with central clearing), nummular (coin like, no central clearing)

107
Q

What is an annular shaped rash?

A

Ring-like with central clearing

108
Q

What is a nummular shaped rash?

A

Coin like, no central clearing

109
Q

What should you note about a rash’s color

A

Whether or not it’s skin colored (same color as pts skin)

110
Q

What words should you use to describe a rash’s texture?

A

Smooth, fleshy, verrucous or warty, scaly, sandpaper-ish, rough, etc

111
Q

What things should you describe about a rash?

A

(First, inspect and palpate)
1) Shape
2) Color
3) Texture
4) Location
5) Configuration
6) Blanching or non-blanching?

112
Q

1) What should you note about a rash’s configuration?
2) What can this suggest or rule out?

A

1) Is it a part of a pattern?
2)
-Herpes zoster is dermatomal
-Herpes simplex occurs in grouped vesicles or pustules
-Pustule is a small, palpable collection of neutrophils or keratin that appears white

113
Q

What type of rash can be described as dermatomal?

A

Herpes zoster

114
Q

What occurs in grouped vesicles or pustules?

A

Herpes simplex

115
Q

What is a pustule?

A

A small, palpable collection of neutrophils or keratin that appears white

116
Q

1) Blanching lesions can be described as what?
2) What does blanching suggest?
3) What do non-blanching rashes include?
4) What does a rash not blanching indicate?

A

1) Blanching lesions are erythematous
2) Blanching suggests inflammation
3) Non-blanching include petechiae purpura
4) Vasculature structures are affected

117
Q

What should you always check regarding a rash?

A

Always see if the rash you are investigating blanches

(PA school) HAPE (41 decks)

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