Clinical Medicine

Question 1

CAGE

Answer 1

Alcohol dependency assessment: Cut, Annoyed, Guilty, Eye Opener

Question 2

Five steps of the “Evidence Cycle”

Answer 2

1. ask foreground questions, 2. access the best evidence, 3. appraise the evidence critically, 4. apply the evidence to the patient/situation, 5. assess the performance of your plan

Question 3

The four parts of a ‘foreground’ question (a question answerable by EBM) are?

Answer 3

patient population, intervention, comparison/control, outcome

Question 4

Three questions to ask when appraising a study

Answer 4

1. is it valid?, 2. what are the results?, 3. how can it be applied to your situation

Question 5

criteria for the validity of a diagnostic study

Answer 5

1. diagnostic uncertainty? 2 blind comparison btw the test and an independent gold standard, 3. the results of the test must not influence the decision to use the gold standard (verification bias)

Question 6

hand grasp reflex

Answer 6

after birth to 3 months, grasp increases as the finger is withdrawn

Question 7

head righting

Answer 7

one month lag, 2-3 month no lag, 5-6 month anticipation

Question 8

asymmetric toni neck reflex

Answer 8

2-3 weeks to 6 months, fencer’s position

Question 9

moro reflex

Answer 9

birth till 4 months, startle reflex (pick me up)

Question 10

parachute response

Answer 10

9 months till death, superman stance

Question 11

protective equilibrium response

Answer 11

6 months till death, when pushed laterally stakes hand on opposite side

Question 12

rooting reflex

Answer 12

lowered lip and tongue movement towards the stimulated part

Question 13

differences of a pediatric history

Answer 13

birth history, nutrition, growth assessment, developmental history, immunizations, social history in an adolescent BDINGS

Question 14

diet: birth to two years

Answer 14

formula/fruit juice/solids/vitamins

Question 15

HEADSS

Answer 15

Social history: Home, Education/Employment, Activity, Drugs/Drinking, Sexuality, Suicide/Depression/Self Image

Question 16

growth vs. development

Answer 16

growth is the process of growing larger, development is the gradual progression towards potential as a mature adult

Question 17

development

Answer 17

proceeds from cephalic to caudal and proximal to distal. from generalized reflexes to discrete voluntary actions

Question 18

a child’s developmental stage impacts

Answer 18

how you approach the history and physical exam

Question 19

gross motor

Answer 19

goal is to gain independent movement, is not predictive of intelligence

Question 20

fine motor

Answer 20

use of upper extremities to engage with and manipulate the environment

Question 21

receptive vs. expressive language

Answer 21

receptive: hearing/seeing, understanding, and responding appropriately; expressive: speech development (audible/oral expressions of language)

Question 22

cognitive development

Answer 22

ability to respond to changes in environment

Question 23

social and emotional development

Answer 23

understanding of self, bonding, attachment, and trust in caregivers, adaptability, temperament, and response to new stimuli

Question 24

term gestation

Answer 24

37-42 weeks

Question 25

three of the most often evaluated signs of postnatal growth

Answer 25

length/height, weight, and head circumference

Question 26

genetic channel for growth

Answer 26

child enters this from 3-18 months

Question 27

primary short stature

Answer 27

intrinsic disorder present at birth, normal bone age

Question 28

normal variants in height

Answer 28

include genetic short stature and constitutional delay (delayed bone age)

Question 29

examples of primary sort stature

Answer 29

turners, noonan, down's, achondroplasia, IUGR

Question 30

secondary short stature

Answer 30

delayed bone age, results from factors outside the skeletal system that effect growth

Question 31

secondary short stature examples

Answer 31

major organ disease, nutritional deficiency, endocrine abnormalities (cushing's, hypothyroidism), poorly controlled diabetes, metabolic disorders, meds (steroids)

Question 32

failure to thrive

Answer 32

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

Question 33

three broad causes of FTT

Answer 33

inadequate caloric intake, malabsorption, inappropriate utilization

Question 34

most brain growth

Answer 34

occurs during the first year of life

Question 35

macro/microcephaly, FOC (head circumference)

Answer 35

>97th percentile, <3rd percentile, macro due to hydrocephalus, micro due to primary and secondary reasons

Question 36

Fetal Alcohol Syndrome (FAS)

Answer 36

facial anomalies, growth retardation, CNS neurodevelopmental, unexplained behavioral abnormalities

Question 37

requirements to diagnose FAS

Answer 37

1. confirmed maternal alcohol exposure, 2. facial anomalies, 3. growth retardation, 4. CNS neuro-developmental findings

Question 38

normal age of puberty

Answer 38

precocious is before 7yrs in females, 9yrs in males; early is before 9(f), 10(m), late is after 12 (m/f)

Question 39

secondary sexual development

Answer 39

development as a result of androgen secretion -- tanner stages

Question 40

earliest signs of secondary sexual development

Answer 40

breast budding in females and testicular enlargements in males

Question 41

adrenarche

Answer 41

1. none, 2. light, 3. thick, 4. full genital, 5. some on thighs

Question 42

know tanner stages!!

Answer 42

do it

Question 43

newborn

Answer 43

R:30-60, P:120-160, BP:60-80

Question 44

6mo-1yr

Answer 44

R:30-40, P:120-140, BP:70-80

Question 45

2-4yrs

Answer 45

R:20-30, P:100-110, BP:80-95

Question 46

5-8yrs

Answer 46

R:14-20, P:90-100, BP:90-100

Question 47

8-12yrs

Answer 47

R:12-20, P:80-100, BP:100-110

Question 48

>12yrs

Answer 48

R:12-20, P:60-90, BP:100-120

Question 49

proper BP cuff

Answer 49

is wide enough to cover 2/3 of the upper arm

Question 50

coarctation of the aorta

Answer 50

higher BP in upper vs. lower extremities

Question 51

stranger anxiety

Answer 51

at 9 months of age

Question 52

PMI

Answer 52

located just left of the sterna border at the 4th intercostal space

Question 53

at 11 years of age you can

Answer 53

ask parents to leave the room for a personal history

Question 54

peds exam

Answer 54

is no different than adult exam

Question 55

scoliosis screening at

Answer 55

10 & 12 in girls, once at 13/14 in boys