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
2
Q
What signs point to temperature change?
A
Chills/shivers/rigors
3
Q
What is a benign cause of elevated temperature?
A
Menopause; can cause hot flashes
4
Q
What does true shaking raise concerns for?
A
Bacteremia.
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
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
7
Q
When should you investigate weight loss in a patient?
A
Weight loss of more than 5% over 6 months needs further investigation
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
9
Q
What can reducing weight by 10% do?
A
Improve BP, lipids, glucose tolerance, and reduce DM risk
10
Q
What can the right patient education do?
A
The right patient education can pull someone from the brink of prediabetes
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
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
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?
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
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
16
Q
How is orientation quantified?
A
Oriented x [. . .]
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
18
Q
Define grossly oriented
A
Patient is generally able to interact without obvious deficits
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”
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
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
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)
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
24
Q
What should you base your final BP number on?
A
The highest of your readings; do the same with your diagnosis
25
What is orthostatic hypotension?
Dizziness when going from sitting/ laying to standing
26
Why can orthostatic hypotension occur? (5 reasons)
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)
27
How do you measure orthostatic HTN?
Measure BP and HR in 2 positions:
1) First supine after 3 minutes rest
2) Then within 3 minutes after standing
28
When does a pt have orthostatic HTN?
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!
29
What is normal radial pulse?
60-100 (if pt is very athletic, 50 can be normal)
30
What are the 5 types of pain?
1) Nociceptive pain
2) Neuropathic
3) Central sensitization pain
4) Psychogenic pain
5) Idiopathic pain
31
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?
1) “Is this rapid or gradual? Is this intentional?”
2) Fluid retention.
3) Potential for heart failure, nephrotic syndrome, liver failure, and venous stasis
32
How do you calculate BMI?
Take lbs x 700 and divide by the height in inches twice
33
What 4 things should you consider when interpreting a BP reading?
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?)
34
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?
1) <120/<80
2) Systolic: 120-139, Diastolic: 80-89
3) Systolic: 140-159, Diastolic: 90-99
35
1) What is HTN stage 1 60+ y/o systolic? What about diastolic?
2) What is stage 2 HTN systolic? What abt diastolic?
1) Systolic: 150-159, Diastolic: 90-99
2) Systolic: >/= 160, Diastolic: >/= 100
36
How do you measure radial pulse?
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
37
1) What is nociceptive pain?
2) What causes nociceptive pain?
3) What mediates it?
1) Plain ol’ pain pain
2) Tissue damage of skin, musculoskeletal (MSK), or viscera
3) C fibers of sensory system
38
1) What causes neuropathic pain?
2) How long does it last?
3) What does it feel like?
1) Direct damage to nervous system
2) May last beyond initial injury
3) Takes a burning, or shock-like character
39
What is central sensitization pain?
Ongoing research on this, but includes fibromyalgia and somatization disorders
40
What can cause psychogenic pain?
Anxiety/depression, personality, and coping style
41
What is idiopathic pain?
Unknown pain
42
1) Define attention
2) Define memory
3) Define orientation
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)
43
What requires both memory and attention?
Orientation
44
1) Define perceptions
2) Define thought processes
3) Define thought content
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
45
1) Define insight
2) Define judgement
3) Define affect
1) Awareness of their own condition
2) The process of evaluating options when making a decision
3) Facial expression
46
1) Define mood
2) Define language
3) Define higher cognitive function
1) Pervasive sustained emotion
2) Language the pt uses
3) Includes vocab, fund of information, abstract thinking, calculations
47
Give 12 terms important to consider when conducting a psych eval
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
What are the two high-yield questions to ask about depression?
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
Give 5 examples of anxiety disorders
1) GAD
2) Social phobia
3) Panic disorder
4) PTSD
5) Acute stress disorder
50
What are the 3 high-yield questions to ask about anxiety?
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
1) Define delirium
2) Define dementia
3) Give some causes of dementia
4) Who is usually the first to notice dementia?
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
1) What should you watch for when looking for dementia? (2 things)
2) How is it screened?
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
What is an acute and transient change in mental status marked by confusion and emotional disruption?
Delirium
54
1) Define flight of ideas
2) Give examples of what is seen during this phenomenon
3) What condition is this seen in?
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
1) Define neologisms
2) What is this seen in?
1) The creation of new words
2) Schizophrenia, psychotic disorders, and aphasia
56
1) Define incoherence
2) What is it characterized by?
3) What is it seen in?
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
1) Define blocking
2) What does it occur in?
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
Give 4 examples of variations in thought processes
1) Flight of ideas
2) Neologisms
3) Incoherence
4) Blocking
*doesn't include all we talked about
59
How do you go about assessing abnormality in thought content of a patient?
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
1) Define compulsions
2) What are compulsions aimed at?
3) Differentiate compulsions from perseveration
4) What is it seen in?
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
1) Define obsessions
2) Can obsessions be ignored?
1) Recurring, persistent thoughts, images, or urges experienced as intrusive
2) Pts try to ignore these but cannot
62
Define phobias
Persistent irrational fears (accompanied by avoidance)
63
Define anxieties
Anticipation of future danger accompanied by worry
64
1) Define "feeling of unreality"
2) What is it associated with?
1) A sense that the environment is strange, unreal, or remote
2) Psychotic disorders
65
Define "feeling of depersonalization"
1) Sense that self or identify is different or changed; unreal or lost
2) Associated with psychotic disorders
66
1) Define delusions
2) What are they seen in?
1) False, fixed, personal belief that will not change when shown to be false
2) Seen in psychosis, severe mood disorders, dementia
67
What are the 6 flavors of delusions? Give an example of each
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
1) Define illusions
2) Give an example
3) What can they occur in?
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
1) Define hallucinations
2) What conditions are they seen in?
1) Perceptions that seem real but are not at all
2) Delirium, dementia, alcohol withdraw, schizophrenia
70
Define insight
Whether they seem to be able to identify what is wrong or seem oblivious to variation/abnormality
71
1) Define judgement
2) How may it be assessed?
3) What may affect it?
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
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?
1) Provides baseline of pts abilities
2) By asking about hobbies, TV, current events
3) Virtually unaffected by psychiatric illness
73
1) Define calculating ability
2) What should you consider when evaluating this?
3) What affects this ability?
1) Serial addition
2) A patient’s baseline and education
3) TBI, CVA, and dementia
74
Give 8 examples of abnormality in thought content
1) Compulsions
2) Obsessions
3) Phobias
4) Anxieties
5) Feeling of unreality
6) Feeling of depersonalization
7) Delusions
75
What are 4 things we assess to see if a pt has any abnormality of perception?
1) Illusions
2) Hallucinations
3) Insight
4) Judgement
76
Give 3 examples of factors we should consider when evaluating a pts higher cognitive function
1) Information and vocabulary
2) Calculating ability
3) Abstract thinking
77
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?
1) By interpreting proverbs
2) By making similarities: what are the things in common?
3) Psychosis, dementia, delirium, intoxication, intellectual disability
78
Asking a patient to interpret “Don’t count your chickens before they hatch” is testing what?
Their abstract thinking
79
Asking a patient to tell you the similarities between an orange and an apple is testing what?
Abstract thinking
80
List the groups of personality disorders
1) A: Odd or eccentric: paranoid, schizoid, or schizotypal
2) B: Dramatic: Antisocial, borderline*, histrionic
3) C: Anxious: avoidant, dependent, and obsessive-compulsive
81
Name 3 disorders that fall under the A/ odd or eccentric class of personality disorders
1) Paranoid
2) Schizoid
3) Schizotypal
82
Name 4 disorders that fall under the B/ dramatic class of personality disorders
1) Antisocial
2) Borderline*
3) Histrionic
4) Narcissistic
83
Name 3 disorders that fall under the C/ anxious class of personality disorders
1) Avoidant
2) Dependent
3) Obsessive-compulsive
84
What kind of patients may appear especially demanding, disruptive, or manipulative?
Borderline
85
List 3 important red flags for skin
Pallor, cyanosis, and jaundice
86
1) What does pallor indicate?
2) Why?
1) Anemia
2) Hemoglobin in RBC’s transports oxygen and gives a red color to oxygenated blood and skin
87
1) What does cyanosis indicate?
2) Why?
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
Why do veins look blue?
Light shift as they pass through pella lucidum
89
1) What does jaundice indicate?
2) What is this?
1) Jaundice indicates buildup of bilirubin (yellow)
2) Biproduct of the breakdown of heme in RBC’s
90
What should you ask about rashes?
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
What is the most common symptom with rashes?
Itching
92
What can generalized itching without apparent rash indicate?
Includes:
1) Xerodermata (dry skin)
2) Pregnancy
3) Uremia
4) Jaundice
5) Lymphoma and leukemia
6) Drug reaction
7) Polycythemia vera
93
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?
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
1) What does hair breaking at the shaft suggest?
2) What can changes in hair or nails (thickening or thinning) be due to?
1) Tinea capitis
2) Thyroid disease
95
1) What are causes of hair loss?
2) What two things could hair shedding at the roots indicate?
1) MC causes are pattern baldness
2) Telogen effluvium and alopecia areata
96
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?
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
List 10 risk factors for melanoma
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
List the ABCs of melanoma
Asymmetry
Border irregularity
Color variation
Diameter greater than 6mm
Evolving (changing over time)
99
What is the most important ABC of melanoma?
Evolution (changing over time)
100
What are the two types of flat lesions? How are they differentiated?
1) Macule: flat and < 1cm
2) Patch: flat and >1cm
101
What are the two types of raised lesions? How are they differentiated?
1) Papule: raised and < 1 cm
2) Plaque: raised and > 1cm
102
What are the two types of fluid filled lesions? How are they differentiated?
1) Vesicles: raised and fluid filled < 1 cm
2) Bulla: raised and fluid filled > 1 cm
103
What types of lesions can be palpated? What kind can't?
Raised lesions can be palpated, flat lesions cannot be palpated with eyes closed
104
What are two things you need to note about fluid filled lesions?
1) Number
2) Size (good to measure)
105
What should you do for all skin lesions? (2 things)
1) Inspect and palpate all skin lesions
2) Ascertain their relatability to any descriptive words you know
106
1) What should you note about a rash?
2) What descriptive words should you use for this?
1) Shape of the rash
2) Circular, oval, annular (ring-like with central clearing), nummular (coin like, no central clearing)
107
What is an annular shaped rash?
Ring-like with central clearing
108
What is a nummular shaped rash?
Coin like, no central clearing
109
What should you note about a rash's color
Whether or not it's skin colored (same color as pts skin)
110
What words should you use to describe a rash's texture?
Smooth, fleshy, verrucous or warty, scaly, sandpaper-ish, rough, etc
111
What things should you describe about a rash?
(First, inspect and palpate)
1) Shape
2) Color
3) Texture
4) Location
5) Configuration
6) Blanching or non-blanching?
112
1) What should you note about a rash's configuration?
2) What can this suggest or rule out?
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
What type of rash can be described as dermatomal?
Herpes zoster
114
What occurs in grouped vesicles or pustules?
Herpes simplex
115
What is a pustule?
A small, palpable collection of neutrophils or keratin that appears white
116
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?
1) Blanching lesions are erythematous
2) Blanching suggests inflammation
3) Non-blanching include petechiae purpura
4) Vasculature structures are affected
117
What should you always check regarding a rash?
Always see if the rash you are investigating blanches
