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Medicine - Year 1 > Clinical Skills and Reasoning > Flashcards

Clinical Skills and Reasoning Flashcards

1
Q

Define clinical reasoning

A

The ability to sort through the features presented by the patient, accurately diagnose and develop a treatment strategy

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2
Q

Consequences of a poor doctor-patient relationship

A 
Inaccurate diagnosis
No recognition of ICE
Decreased patient satisfaction
Poor compliance and adherance
More complaints
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3
Q

What three things does patient centred care lead to?

A

Increased prevention
Health promotion and enhancement
Early identification –> decreased problems

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4
Q

What is the decision called when the clinician decides?

A

Professional choice

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5
Q

What is the decision called when the patient decides?

A

Consumer choice

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6
Q

What is the decision called when the clinician and patient decide together?

A

Shared decision making

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7
Q

3 obligations of a patient in the sick role

A

Must want to recover ASAP
Seek professional advice
Cooperate

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8
Q

2 privileges of a patient in the sick role

A

Allowed and expected to drop normal activities and responsibilities
In need of care

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9
Q

4 expectations of the doctor in the sick role

A

Possess skill and knowledge
Act for patient and community welfare
Objective and emotionally detached
Guided by the rules of professional practise

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10
Q

4 rights of the doctor in the sick role

A

Right to physically examine
Right to inquire personal details
Granted autonomy
Have a position of authority

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11
Q

What do doctors do in the sick role?

A

They legitimise illness

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12
Q

What are the two models of patient care?

A

Conventional medical model

Patient centred model

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13
Q

What is the conventional medical model?

A

Focus on biology only

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14
Q

What is the patient centred model?

A

Disease is due to biological, social, psychological and behavioural reasons

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15
Q

What words describe disease and illness?

A

Disease: Objective
Illness: Subjective

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16
Q

What does FIFE stand for?

A

Feelings
Ideas
impact on Function
Expectations on function

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17
Q

What type of approach does the two agendas form?

A

A holistic approach

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18
Q

Define symptom

A

What the patient complains about

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19
Q

Define sign

A

A physical abnormality

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20
Q

What is a normal respiratory rate ?

A

14 breaths per minute

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21
Q

What is a fast respiratory rate ?

A

10 breaths per minute

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22
Q

What is a slow respiratory rate?

A

24 breaths per minute

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23
Q

What do you look for in a patient when they inhale?

HINT: not on their chest

A

Look to see if they are using accessory muscles in the arms

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24
Q

What two things make a dull sound on percussion

A

Fluid or tissue

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25
Q

How many times do you percuss on the front and back?

A

Front: 3/4
Back: 4/5

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26
Q

What are normal breath sounds called?

A

Vesicular

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27
Q

What are breath sounds caused by?

A

Turbulent flow

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28
Q

When are breath sounds more apparent?

What is an exception to this?

A

In inspiration

Pneumonia

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29
Q

What is the difference between the sounds heard by the bell and diaphragm?

A

Bell: Low frequency sounds
Diaphragm: High frequency sounds

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30
Q

What are the two severities of cyanosis

A

Peripheral and central

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31
Q

Give 2 areas of the body where you can find scars relating to a heart surgery

A

Chest and legs (vein harvesting)

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32
Q

What two things do you look for when feeling the arterial pulse?

A

Rhythm: Regular/irregular
Volume: Normal, collapsing or slow rising

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33
Q

What does the pulse in the wrist reflect?

A

The aortic valve

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34
Q

What does the JVP tell you information about?

Why?

A

The pressure in the right atria as there are no valves between the right atria and the JVP

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35
Q

Where do you measure the JVP from?

A

The Angle of Louis

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36
Q

Which line is the apex beat in?

A

Mid-clavicular

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37
Q

What are thrills?

A

Palpable murmurs of the heart

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38
Q

What are heaves?

A

Felt when palpating the right ventricle

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39
Q

What two things do you auscultate for (other than heart sounds)?

A

Heart sounds, added sounds and murmurs

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40
Q

What are the 4 heart sounds caused by?

A

1st: Closure of AV valves due to pressure
2nd: Aortic THEN pulmonary valve closes
3rd: Rapid ventricular filling in early diastole causes the LUB DUB sound
4th: Same as 3rd but when the atria contract

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41
Q

Define stenosis

A

Narrowed

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42
Q

What happens in mitral stenosis?

A

The mitral valve doesn’t open properly

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43
Q

What happens when you have a stenosed aortic valve?

A

You get an ‘ejection click’

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44
Q

Explain what happens during inspiration and expiration which causes S2 splitting
What sounds are made?

A

Inspiration: Lub de dub
Increased thoracic pressure causes blood to drain into the thorax and thus into the right of the heart
Expiration: Lub dub
Blood squeezed out of the left of the heart

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45
Q

6 questions to ask yourself when you find a murmur?

A 
Where is it on the chest?
When does it occur during the cardiac cycle?
What is the volume?
What is the pitch?
What are the effects of respiration?
What are the effects of posture?
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46
Q

Which 2 valves can you hear murmurs in?

A

Aortic and mitral

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47
Q

Define ‘heart murmur’

A

The noise of blood flow caused by a difference in blood pressure

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48
Q

What are the 4 types of heart murmurs?

A

Aortic stenosis
Mitral stenosis
Aortic regurgitation
Mitral regurgitation

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49
Q

What causes aortic stenosis?
When does it become louder?
Where and when is it loudest?
Where does the sound radiate?

A
  • Turbulent blood through through a narrowed aortic valve during systole when the mitral valve shuts
  • Becomes louder as the pressure increases then fades out
  • Loudest in the aortic area when the patient is sitting and holding their breath in expiration
  • Sound radiates to the neck
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50
Q

What causes mitral stenosis?
What sound is it and when is it heard?
When is the sound the loudest and what is this called?
What is this murmur caused by?

A
  • Blood flow across a stenosed mitral valve in diastole
  • Low-pitched rumbling sound in mid-late diastole
  • Louder at the end of diastole (opening-snap)
  • Caused by rheumatic fever
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51
Q

What causes aortic regurgitation?
What happens to the pulse, pitch and pressure?
What is the noise like and where is it heard?
When is the noise the loudest?

A
  • Collapsing pulse after the 2nd heart sound when the aortic valve shuts in early diastole
  • Decreased pitch and pressure
  • Blowing noise in the tri-cuspid area
  • Loudest with the patient sitting and holding their breath in inspiration
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52
Q

What causes mitral regurgitation?
When is the murmur heard - what is this called?
Where it it loudest?
What type of sound is it and where does it radiate?
When is the noise the loudest?

A

Turbulent blood flow back through a leaky mitral valve due to a pressure gradient in systole
Heard between S1 and S2 (pansystolic)
Loudest at the apex
A harsh sound that radiates into the auxilla
Loudest with the patient laid on their left in expiration

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53
Q

What are the 2 types of medicine?

A

Scientific

Everyday

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54
Q

Define culture

A

Cumulative deposit of knowledge, experience, beliefs, values, attitudes, meanings, material objects and possessions shared by a group of people

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55
Q

What is knolwege transmission?

A

When people’s cultures clash

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56
Q

Define enculturation

A

Simple learning

No knowledge to begin with

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57
Q

Define acculturation

A

A complex interaction between science and everyday life

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58
Q

What do CAM professionals need?

Who gives this?

A

Statutory regulation

The general chiropractic/osteopathic council

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59
Q

6 positives of CAM

A

Controlled, builds up a relationship, effective, focus on well-being, non-invasive, safe

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60
Q

4 reasons why CAM is used?

A

Depression, increased waiting lists, poor doctor-patient relationship, side effects

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61
Q

What is a narrative-based experience?

A

The fact that a patient’s illness comes with a story and the patient has an agenda that needs to be fulfilled

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62
Q

Which gender uses CAM more?

A

Women

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63
Q

Define medicalisation

A

Defining an increased number of life problems as medical issues

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64
Q

Define pharmaceuticalisation

A

A complex social process encompassing development, commercialisation and use that uses human capabilities and chemistry-based technologies to allow intervention
An understanding that you can’t cure everything

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65
Q

Who is in charge in a consultation?

A

Doctor is in charge but must follow the patient’s agenda

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66
Q

Where is the trans-pyloric plane?

A

Half way between the sternal notch and symphysis pubis

One hand below the xiphoid

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67
Q

What does the trans-pyloric plane contain?

A

Duo-jejunal flexture, hila of the kidneys, pylorus, pancreatic neck

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68
Q

Where is the liver?

A

Just below the nipples

RUQ-LUQ

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69
Q

Where is the spleen?

A

Under the ribs

Posterior left subcostal region

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70
Q

Where is the splenic notch

A

In the middle of the spleen

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71
Q

Where are the kidneys?

A

Renal angle

More medial than you would expect

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72
Q

What happens to the kidneys during inspiration?

A

They move down slightly

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73
Q

What is the surface marking of the gallbladder?

A

RHS of costal margin

Tip of the right rib

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74
Q

What three things can go wrong with the stomach organs?

A

Inflammation
Bursting
Enlargement

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75
Q

What are the signs of appendicitis?

A

Pain, fever, guarding, decreased bowel sounds, holding abdomen

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76
Q

What are the signs of a perforated ulcer?

A

Increased pulse, decreased blood pressure, guarding, pain, no bowel sounds, holding the abdomen

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77
Q

What are the signs of polycystic kidneys?

A

Dialysis

Kidneys are easy to feel

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78
Q

What do the spinous and transverse processes attach?

A

Ligaments and tendons

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79
Q

What does the inter-vertebral column contain?

A

Nerves and vessels

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80
Q

What joint allows movement in the spinal cord?

A

The zygo-apophyseal (Facet) joint

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81
Q

What joint is found in the neck between C1 and C2?

What does it allow?

A

Atlanto-occipital joint

Rotation

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82
Q

How are C1 and C2 joined

A

They are joined by a peg in the onontoid process

83
Q

What orientation is the zygo-apophyseal joint in each 3 vertebral sections?
What does this mean for movement?

A

Cervical: Horizontal (increased movement)

Thoracic and Lumbar: Vertical (decreased movement)

84
Q

How are the ribs joined to the spinal cord?

A

Costal facets

85
Q

What happens to the size of the vertebral arches as you descend down the vertebral column?

A

They get larger

86
Q

Why do the thoracic and lumbar vertebrae have large transverse and spinous processes?

A

To attach muscles

87
Q

What can you see on an x-ray of there is a break in the spinal vertebrae?

A

Bone alignment lost
Soft tissue disrupted
Unequal space between the vertebrae

88
Q

What spinal level is the spinal vertebrae?

A

L2-L5

89
Q

What does damage to the anal sphincters cause in cauda equina syndrome?

A

Bladder and bowel dysfunction
Perineal numbness
Sexual dysfunctiom
Leg weakness

90
Q

Why does a slipped disc cause an inflammatory response?

A

The body has never seen the nucleus populous before so an immune response occurs

91
Q

What are the three normal curves of the spine?

A

Cervical lordosis
Thoracic kyphosis
Lumbar lordosis

92
Q

How can you tell if the normal curves of the spine are damaged?

A

They appear straight

93
Q

What are the three spinal deformities?

A

Structural: Fixed and not correctable
Postural: Correctable/acquired
Development: Occurs if the spinal cord doesn’t zip up

94
Q

What do you feel the parasternal muscles for?

A

Warmth and tenderness

95
Q

How can you gently assess passive movement in someone with a broken spine?

A

Lifting the limbs

96
Q

What is the normal range of motion when bending forwards?

A

80-90 degrees

97
Q

What is the normal range of motion when bending backwards?

A

20 degrees

98
Q

What is the normal range of motion when bending left and right?

A

20-30 degrees

99
Q

What is the normal range of motion when rotating?

A

Variable

100
Q

Where does the sciatic nerve arise from?
Where does it run to?
What does it supply?

A

Arises from the L5-S2 nerve root
Runs in the posterior compartment of the thigh
Supplies the knee flexors

101
Q

When does the femoral nerve arise from?

What does it supply?

A

Arises from L2-L4

Supplies the hip and knee joints, quadriceps and skin of the thigh

102
Q

What 4 movements do you do for the sciatic stretch?

A

Straight leg raiging
Dorsiflexion of the foot
Knee flexion
Knee extension

103
Q

What 2 movements do you do for the femoral stretch?

A

Knee flexion

Hip extension

104
Q

What dermatomes does the sciatica nerve control?

One exception

A

Every dermatome below the knee

Apart from L4

105
Q

What are the two dermatomes on the trunk?

A

T4: nipple
T10: umbilicus

106
Q

What 2 structures and 4 tracts in the brain does the extra-pyramidal system include?

A

Cerebellum and Basal ganglia

Tracts: Ruberospinal, Tectospinal, Vestibulospinal, Reticulospinal

107
Q

What 3 things does the extra-pyramidal system coordinate?

A

Movements, posture and tone

108
Q

What type of motor neurone are cranial nerves?

A

Lower motor neurones

109
Q

What is Guillian Barre Syndrome?

A

An autoimmune disease that causes weakness

It occurs after food poisoning

110
Q

What happens to the spinal cord in Brown Sequard Syndrome?

A

Half of the spinal cord is lost

111
Q

3 examples of conditions caused by extra-pyramidal lesions in the spinal cord

A

Dystonia, Akathisia, Parkinsonism

112
Q

Define dystonia

A

Spasms and contractions

113
Q

Define akathisia

A

Motor restlessness

114
Q

Define parkinsonism

A

Rigidity and tremor

115
Q

Give 5 examples of things which can cause extra-pyramidal lesions in the basal ganglia

A

Drugs, alcohol, stroke, infection and parkinsons

116
Q

What does skeletal muscle need in order to grow?

A

Increased number of myofibrils

117
Q

How does muscle strengthen?

A

By strengthening the tendons

118
Q

Symptoms of an upper motor neurone lesion

A 
Muscle weakness
Increased muscle tone
Increased reflexes
Clasp knife and Babinski
Disuse atrophy
119
Q

Causes of an upper motor neurone lesion

A

Stroke, MS, Cerebral Palsy, Brain Injury

120
Q

Symptos of a lower motor neurone lesion

A

Muscle weakness
Decreased muscle tone
Decrease reflexes
Disuse atrophy and fasiculation

121
Q

Causes of a lower motor neurone lesion

A

ALS, Bell’s Palsy, Guillian Barre Syndrome

122
Q

Symptoms of a cerebellar lesion

A 
Decreased coordination of movement
Ataxia
Slurred speech
Hypotonia
Resting and intention tremor
Past-poiniting
Nystagmus
123
Q

Define ataxia

A

Cannot walk in a straight line

124
Q

Define spastic

A

Increased muscle tone

125
Q

Define flaccid

A

Decreased muscle tone

126
Q

Define disuse atrophy

A

Wasting of muscles

127
Q

Define concentric contraction

A

Muscle shortening

128
Q

Define eccentric contraction

A

Increase in muscle length

129
Q

Define isometric contraction

A

Muscle contracted but held at a constant length

130
Q

Define isotonic contraction

A

Contraction against resistance

131
Q

Define isokinetic contraction

A

Contraction against concomitant force at constant speed

132
Q

Define passive stretch

A

No definition I just need to know it exists LOL

133
Q

What does muscle length change with?

A

Joint angle

134
Q

What lesion does hypERtonia indicate?

A

UMNL

135
Q

What lesion does hypOtonia indicate?

A

LMNL

136
Q

What is the cause of rigidity?

A

An extra-pyramidal lesion

137
Q

What is the cause of spasticity?

A

UMN pyramidal lesion

138
Q

What are the 5 deep tendon reflexes?

A 
Ankle jerk
Knee jerk
Biceps reflex
Supinator reflex
Triceps reflex
139
Q

What is the nerve root and nerve for the ankle jerk

reflex?

A

S1/S2

Tibial

140
Q

What is the nerve root and nerve for the knee jerk reflex?

A

L3/L4

Femoral

141
Q

What is the nerve root and nerve for the biceps reflex?

A

C5/C6

Musculocutaneous

142
Q

What is the nerve root and nerve for the supinator reflex?

A

C5/C6

Radial

143
Q

What is the nerve root and nerve for the triceps reflex?

A

C7/C8

Radial

144
Q

What is the MRC scale for muscle power?

A

5: Full power
4: Decreased power against resistance
3: Active movement against gravity, resistance eliminated
2: Active movement with gravity eliminated
1: Flicker of movement
0: No movement

145
Q

Define echopraxia

A

Imitation of movement

146
Q

Define posturing

A

Adopting a strange position for a long period of time

147
Q

Define tics

A

Irregular movements in a muscle group

148
Q

Define pressure of speech

A

Increased rate and quantity

149
Q

Define poverty of speech

A

Decreased quantity of speech

150
Q

Define dysarthria

A

Hard to articulate speech

151
Q

3 examples of overactive movement

A

Stupor
Depressive retardation
Obsessional slowness

152
Q

2 examples of overactive movements

A

Psychomotor agitation

Compulsion

153
Q

What is stupor?

A

Mute, immobile and concious

154
Q

What is depressive retardation?

A

Takes a long time to do something

155
Q

What is obsessional slowness?

A

Doubts and obsessive rituals

156
Q

What is psycho-motor agitation?

A

Restless and unproductive

157
Q

What is compulsion?

Example

A

Repetitive and seemingly ‘purposeful’ behaviour (e.g. cleaning)

158
Q

Define thought disorder

A

A pattern of disordered language that reflects disordered thinking

159
Q

Give 5 examples of ‘forms of thinking’

A 
Flight of ideas
Neologism
Echolalia
Thought blocking
Knight's move thinking
160
Q

What is ‘flight of ideas’?

A

Accelerated thoughts with no direction

Topic changes

161
Q

What is neologism?

A

A new word made by the patient

162
Q

What is thought blocking?

A

Interruption of a thought and inability to recall it

163
Q

What is knight’s move thinking

A

Odd associations between ideas

164
Q

Define mood

A

A persuasive and sustained emotion that changes the perception of the world

165
Q

What is the difference between objective and subjective?

A

Objective: Doctor’s diagnosis
Subjective: Patient’s ideas

166
Q

What are the 5 types of mood?

A

Dysphoric, Annedonia, Euphoria, Elation, Irritaible

167
Q

Define dysphoric

A

Unpleasant mood

168
Q

Define annedonia

A

Loss of interest in activities which are usually pleasurable

169
Q

Define euphoria

A

Unconcern and contentment

170
Q

Define elation

A

Elevated and exaggerated mood

171
Q

Define affect

A

A pattern of observable behaviours that concern the expression of emotion

172
Q

What are the two types of affect?

A

Inappropriate or flat

173
Q

Define anxiety

A

Feeling of apprehension, tension and uneasiness to anticipation of a danger

174
Q

What are the 3 types of anxiety?

A

Phobic, free-floating, panic attack

175
Q

Give 4 examples of abnormal thought content

A

Preoccupations, obsessions, phobias and suicidal/homicidal thoughts

176
Q

Define obsession

A

Repetitive, senseless thoughts that are recognised as irrational and are resisted

177
Q

Define phobias

A

Persistent, irrational fear of an activity, object or situation
Leads to avoidance due to a fear of extreme danger

178
Q

3 examples of abnormal beliefs or interpretations of events

A

Over-valued ideas, delusions and passivity phenomena

179
Q

Define delusion

A

Fixed and false personal belief based on incorrect inference about an external reality

180
Q

Give 5 examples of delusions

A 
Persecutory/reference
Doubles
Ninilistic
Erotomania 
Perception
181
Q

Give an example of a persecutory/reference delusion?

A

TV taking about them

182
Q

Give an examples of a double delusion

A

Relative is replaced by a double

183
Q

Give an example of ninilistic delusion

A

Part of the body is missing

184
Q

Give an example of a erotomania delusion

A

Madly in love with someone in a higher position

185
Q

Define passivity phenomena

A

The belief that an external agency is controlling them

186
Q

Give 3 examples of passivity phenomena

A

Thought insertion, thought withdrawal and thought broadcasting

187
Q

Define delusion perception

Example

A

The patient attaches a delusion to a real thing

Example: If the traffic light goes red then I am the queen

188
Q

Define primary delusion

A

No connection to previous events

Wake up with it

189
Q

Define secondary delusion

Example

A

When someone is trying to make sense of something

Example: An alien has taken my thoughts

190
Q

Give 3 examples of abnormal experiences associated with the environment

A

Hallucinations, illusions and derealisation

191
Q

Give 2 examples of abnormal experiences associated with the body

A

Altering somatic sensation and halucination

192
Q

Give 2 examples of self-awareness disorders

A

Depersonalisation

Derealisation

193
Q

Define depersonalisation

A

Decreased self awareness

Patient doesn’t feel real

194
Q

Define derealisation

A

Surroundings not real

195
Q

When can depersonalisation and derealisation occur naturally?

A

When you are tired

196
Q

What is the difference between illusion and delusion

A

Both false perceptions
Illusion: Real external stimulus
Delusion: No external stimulus

197
Q

4 examples of hallucinations

A

Auditory, visual, gustatory or somatic

198
Q

What is pareidolia?

A

When you look at something and see something else

199
Q

What 4 things do you assess under cognitive state?

A

Orientation, attention/concentration, general knowledge and memory

200
Q

How can you assess orientation?

A

Time, person, place

201
Q

How can you assess attention/concentration?

A

Backwards from 100 in 7’s

202
Q

3 ways by which you can you assess memory

A

Immediate recall and short term memory
Long term events (e.g. birth)
Mini mental state examination

203
Q

What are the 9 states to the mental state examination?

A
  1. Appearance and behaviour
  2. Posture and movement
  3. Speech
  4. Mood
  5. Thought content
  6. Abnormal beliefs/interpretations of events
  7. Abnormal experiences
  8. Cognitive state
  9. Insight

Medicine - Year 1 (20 decks)

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