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Block 1 - Fundamental Principles > Clinical Medicine > Flashcards

Clinical Medicine Flashcards

0
Q

What are the four components of a question answerable by the method of EBM?

A
  1. Patient population
  2. Intervention
  3. Comparison or control
  4. Outcome
  5. (Methods)
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1
Q

What are the five steps in the evidence cycle in the method of EBM?

A
  1. Asking foreground questions
  2. Accessing the best evidence
  3. Appraising that evidence critically
  4. Applying that evidence to your patient or situation
  5. Assessing the performance of your plan
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2
Q

What are the three steps to literature appraisal per the method of EBM?

A
  1. Is the study valid?
  2. What are the results?
  3. How can the results be applied to your situation?
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3
Q

How can the three steps to literature appraisal be applied to a study of a diagnostic test?

A
  1. The clinicians must face diagnostic uncertainty.
  2. There must be a blind comparison of the test to an independent gold standard.
  3. The results of the test must not influence the decision to perform the gold standard.
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4
Q

What is the difference between a background and a foreground question?

A

Background questions - general questions best answered by a textbook or journal review

Foreground questions - specific questions best answered by scientific studies

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5
Q

What are the main differences of a pediatric history?

A 
Birth history
Nutrition
Growth assessment
Developmental history
Immunizations
Social history in an adolescent
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6
Q

What nutrition info is important to know for children birth to two years, preschool aged children, and older children?

A

Birth to two - methods of feeding, formula info, amount of fruit juice, start of solid food
Preschool age - typical diet for a day, idiosyncrasies
Older - meal patterns, intake of junk, supplements, possible deficiencies

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7
Q

What is the HEADSS interview for adolescents?

A 
H - home
E - education and employment
A - activity
D - drinking and drugs
S - sexuality
S - suicide, depression, self image
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8
Q

What are red flags during motor development?

A

4 months - lack of steady head control while sitting
9 months - inability to sit independently
18 months - inability to walk independently

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9
Q

What are red flags in language and cognitive development?

A

2 mo - lack of fixation
4 mo - lack of visual tracking
6 mo - failure to turn to voice or sound
9 mo - lack of babbling consonant sounds
24 mo - failure to use single words
36 mo - failure to speak in three word sentences

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10
Q

What are red flags in social and emotional development?

A

6 mo - lack of smiles or joyful expressions
9 mo - lack of reciprocal vocalizations, smiles, or facial expressions
15 mo - lack of pointing or showing gestures
18 mo - lack of simple pretend play

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11
Q

What are the three broad categories of short stature?

A

Normal variant
Primary short stature - Normal bone age
Secondary short stature - delayed bone age

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12
Q

What are the two normal variants of short stature?

A

Genetic short stature - normal bone age

Constitutional delay - delayed bone age and delayed puberty

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13
Q

What are some examples of primary short stature?

A 
1. Fetal problems (genetic)
Turner syndrome - 45x karyotype 
Noonan syndrome 
Down's syndrome
Achondroplasia
  1. Intrauterine growth restriction
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14
Q

What are some examples of secondary short stature?

A 
Significant major organ disease
Nutritional deficiency 
Endocrine abnormalities - Cushing syndrome, hypothyroidism, GH deficiency
Metabolic disorders
Medications - steroids
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15
Q

What are four possible causes of excess height?

A

Normal variant
Endocrine causes - precocious puberty, CAH, GH excess
Chromosomal causes - Klinefelter (47xxy), xyy, Marfans
Obesity

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16
Q

What is the definition of failure to thrive?

A

Weight below the third percentile for age or inadequate weight gain resulting in crossing of percentile lines

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17
Q

What are the three broad causes of failure to thrive?

A

Inadequate caloric intake
Malabsorption
Inappropriate utilization

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18
Q

How can you differentiate between exogenous and pathological causes of obesity?

A

Pathological causes associated with short stature while exogenous associated with tall

19
Q

What are the three main pathological causes of obesity?

A

Prader willi syndrome
Hypothyroidism
Cushing’s syndrome

20
Q

What measurements are associated with microcephaly and macrocephaly?

A

Micro - FOC less than 2 SD, less than 32 cm

Macro - FOC more than 2 SD, more than 38 cm

21
Q

What is the most common cause of macrocephaly in the pediatric population?

A

Hydrocephalus

22
Q

What are the two broad types of microcephaly?

A

Primary - infants born with head circumference below third percentile
Secondary - after birth as a result of injury

23
Q

What are the four things necessary to diagnose fetal alcohol syndrome?

A
  1. Confirmed maternal alcohol exposure
  2. Characteristic facial anomalies
  3. Growth retardation
  4. CNS neurodevelopmental findings
24
Q

What are the two main physiological process encompassed in puberty?

A
  1. Gonadarche - changes in secondary sexual characteristics caused by production of sex hormones
  2. Adenarche - onset of adrenal androgen production/DHEAS
25
Q

What is precocious puberty and what age does it occur at for males and females?

A

Onset of puberty occurs outside 2 SD on normal bell curve
African American females - less than 6.5 years of age
Caucasian females - 7 to 7.5 years of age
Males - 9 years

26
Q

When is delayed puberty?

A

Onset after 12 years of age

27
Q

What is the earliest evidence of secondary sexual development in girls and boys?

A

Girls - breast budding

Boys - testicular enlargement

28
Q

What are the five tanner stages of development of pubic hair?

A
  1. nothing
  2. Light, downy hair
  3. Coarser hair, not full adult pattern
  4. Full adult pattern but not on thighs
  5. Onto thighs
29
Q

What are the five tanner stages of development of breasts?

A
  1. Nothing
  2. Small breast bud
  3. Larger breast bud
  4. Secondary mound of areola
  5. Lose secondary mound, normal adult breast
30
Q

How is heart rate best taken in young children and why?

A

By auscultation because it is too fast to feel by palpation

31
Q

How much of the arm should a blood pressure cuff cover?

A

Two thirds of the upper arm

32
Q

How is respiratory rate best determined in newborns?

A

Count respirations for a full minute via observation of palpation of the chest, not auscultation

33
Q

What are abnormal findings in exam of the head in newborns and infants?

A

Split sutures, bulging fontanels, asymmetry of the head

34
Q

What are abnormal findings in respiratory or chest exam of a newborn or infant?

A

Obstruction in the nares, absence of or decreased breath sounds or bowel sounds heard over left chest

35
Q

What are abnormal findings in eye exam of newborn or infant?

A

Absence or asymmetry of red reflex, excessive tearing

36
Q

What are abnormal findings on the skin exam of a newborn or infant?

A

Jaundice after one or two weeks

37
Q

What are abnormal findings on the neck exam of a newborn or infant?

A

Clavicle might be broken, decreased range of motion in the neck with mass in scm

38
Q

Where will edema in young children often be seen first?

A

Eyelids

39
Q

Why might children have skin tones mimicking jaundice that aren’t dangerous?

A

If they eat a lot of carrots may have yellow orange skin tones

40
Q

What conditions might delayed closure of the fontanels be associated with?

A

Hypothyroidism
Rickets
Downs
With split suture could be sign of hydrocephalus

41
Q

Until when is some asymmetry in the red reflex normal?

A

4 months

42
Q

What is the best way to diagnose an effusion in the middle ear of a child?

A

Lack of motion of the TM during insufflations

43
Q

What are two signs of strabismus in children?

A
  1. Asymmetric corneal light reflex

2. Motion in eye that was always uncovered when eye is uncovered in cover/uncover test

44
Q

How many primary and secondary teeth do children have?

A

20 primary

32 secondary

45
Q

When is scoliosis recommended by the AAP?

A

Ages 10 and 12 in girls

Once at age 13 or 14 in boys

Block 1 - Fundamental Principles (6 decks)

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