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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
How many times do you percuss on the front and back?
Front: 3/4 Back: 4/5
26
What are normal breath sounds called?
Vesicular
27
What are breath sounds caused by?
Turbulent flow
28
When are breath sounds more apparent? | What is an exception to this?
In inspiration | Pneumonia
29
What is the difference between the sounds heard by the bell and diaphragm?
Bell: Low frequency sounds Diaphragm: High frequency sounds
30
What are the two severities of cyanosis
Peripheral and central
31
Give 2 areas of the body where you can find scars relating to a heart surgery
Chest and legs (vein harvesting)
32
What two things do you look for when feeling the arterial pulse?
Rhythm: Regular/irregular Volume: Normal, collapsing or slow rising
33
What does the pulse in the wrist reflect?
The aortic valve
34
What does the JVP tell you information about? | Why?
The pressure in the right atria as there are no valves between the right atria and the JVP
35
Where do you measure the JVP from?
The Angle of Louis
36
Which line is the apex beat in?
Mid-clavicular
37
What are thrills?
Palpable murmurs of the heart
38
What are heaves?
Felt when palpating the right ventricle
39
What two things do you auscultate for (other than heart sounds)?
Heart sounds, added sounds and murmurs
40
What are the 4 heart sounds caused by?
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
41
Define stenosis
Narrowed
42
What happens in mitral stenosis?
The mitral valve doesn't open properly
43
What happens when you have a stenosed aortic valve?
You get an 'ejection click'
44
Explain what happens during inspiration and expiration which causes S2 splitting What sounds are made?
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
45
6 questions to ask yourself when you find a murmur?
``` 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? ```
46
Which 2 valves can you hear murmurs in?
Aortic and mitral
47
Define 'heart murmur'
The noise of blood flow caused by a difference in blood pressure
48
What are the 4 types of heart murmurs?
Aortic stenosis Mitral stenosis Aortic regurgitation Mitral regurgitation
49
What causes aortic stenosis? When does it become louder? Where and when is it loudest? Where does the sound radiate?
- 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
50
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?
- 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
51
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?
- 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
52
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?
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
53
What are the 2 types of medicine?
Scientific | Everyday
54
Define culture
Cumulative deposit of knowledge, experience, beliefs, values, attitudes, meanings, material objects and possessions shared by a group of people
55
What is knolwege transmission?
When people's cultures clash
56
Define enculturation
Simple learning | No knowledge to begin with
57
Define acculturation
A complex interaction between science and everyday life
58
What do CAM professionals need? | Who gives this?
Statutory regulation | The general chiropractic/osteopathic council
59
6 positives of CAM
Controlled, builds up a relationship, effective, focus on well-being, non-invasive, safe
60
4 reasons why CAM is used?
Depression, increased waiting lists, poor doctor-patient relationship, side effects
61
What is a narrative-based experience?
The fact that a patient's illness comes with a story and the patient has an agenda that needs to be fulfilled
62
Which gender uses CAM more?
Women
63
Define medicalisation
Defining an increased number of life problems as medical issues
64
Define pharmaceuticalisation
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
65
Who is in charge in a consultation?
Doctor is in charge but must follow the patient's agenda
66
Where is the trans-pyloric plane?
Half way between the sternal notch and symphysis pubis | One hand below the xiphoid
67
What does the trans-pyloric plane contain?
Duo-jejunal flexture, hila of the kidneys, pylorus, pancreatic neck
68
Where is the liver?
Just below the nipples | RUQ-LUQ
69
Where is the spleen?
Under the ribs | Posterior left subcostal region
70
Where is the splenic notch
In the middle of the spleen
71
Where are the kidneys?
Renal angle | More medial than you would expect
72
What happens to the kidneys during inspiration?
They move down slightly
73
What is the surface marking of the gallbladder?
RHS of costal margin | Tip of the right rib
74
What three things can go wrong with the stomach organs?
Inflammation Bursting Enlargement
75
What are the signs of appendicitis?
Pain, fever, guarding, decreased bowel sounds, holding abdomen
76
What are the signs of a perforated ulcer?
Increased pulse, decreased blood pressure, guarding, pain, no bowel sounds, holding the abdomen
77
What are the signs of polycystic kidneys?
Dialysis | Kidneys are easy to feel
78
What do the spinous and transverse processes attach?
Ligaments and tendons
79
What does the inter-vertebral column contain?
Nerves and vessels
80
What joint allows movement in the spinal cord?
The zygo-apophyseal (Facet) joint
81
What joint is found in the neck between C1 and C2? | What does it allow?
Atlanto-occipital joint | Rotation
82
How are C1 and C2 joined
They are joined by a peg in the onontoid process
83
What orientation is the zygo-apophyseal joint in each 3 vertebral sections? What does this mean for movement?
Cervical: Horizontal (increased movement) | Thoracic and Lumbar: Vertical (decreased movement)
84
How are the ribs joined to the spinal cord?
Costal facets
85
What happens to the size of the vertebral arches as you descend down the vertebral column?
They get larger
86
Why do the thoracic and lumbar vertebrae have large transverse and spinous processes?
To attach muscles
87
What can you see on an x-ray of there is a break in the spinal vertebrae?
Bone alignment lost Soft tissue disrupted Unequal space between the vertebrae
88
What spinal level is the spinal vertebrae?
L2-L5
89
What does damage to the anal sphincters cause in cauda equina syndrome?
Bladder and bowel dysfunction Perineal numbness Sexual dysfunctiom Leg weakness
90
Why does a slipped disc cause an inflammatory response?
The body has never seen the nucleus populous before so an immune response occurs
91
What are the three normal curves of the spine?
Cervical lordosis Thoracic kyphosis Lumbar lordosis
92
How can you tell if the normal curves of the spine are damaged?
They appear straight
93
What are the three spinal deformities?
Structural: Fixed and not correctable Postural: Correctable/acquired Development: Occurs if the spinal cord doesn't zip up
94
What do you feel the parasternal muscles for?
Warmth and tenderness
95
How can you gently assess passive movement in someone with a broken spine?
Lifting the limbs
96
What is the normal range of motion when bending forwards?
80-90 degrees
97
What is the normal range of motion when bending backwards?
20 degrees
98
What is the normal range of motion when bending left and right?
20-30 degrees
99
What is the normal range of motion when rotating?
Variable
100
Where does the sciatic nerve arise from? Where does it run to? What does it supply?
Arises from the L5-S2 nerve root Runs in the posterior compartment of the thigh Supplies the knee flexors
101
When does the femoral nerve arise from? | What does it supply?
Arises from L2-L4 | Supplies the hip and knee joints, quadriceps and skin of the thigh
102
What 4 movements do you do for the sciatic stretch?
Straight leg raiging Dorsiflexion of the foot Knee flexion Knee extension
103
What 2 movements do you do for the femoral stretch?
Knee flexion | Hip extension
104
What dermatomes does the sciatica nerve control? | One exception
Every dermatome below the knee | Apart from L4
105
What are the two dermatomes on the trunk?
T4: nipple T10: umbilicus
106
What 2 structures and 4 tracts in the brain does the extra-pyramidal system include?
Cerebellum and Basal ganglia | Tracts: Ruberospinal, Tectospinal, Vestibulospinal, Reticulospinal
107
What 3 things does the extra-pyramidal system coordinate?
Movements, posture and tone
108
What type of motor neurone are cranial nerves?
Lower motor neurones
109
What is Guillian Barre Syndrome?
An autoimmune disease that causes weakness | It occurs after food poisoning
110
What happens to the spinal cord in Brown Sequard Syndrome?
Half of the spinal cord is lost
111
3 examples of conditions caused by extra-pyramidal lesions in the spinal cord
Dystonia, Akathisia, Parkinsonism
112
Define dystonia
Spasms and contractions
113
Define akathisia
Motor restlessness
114
Define parkinsonism
Rigidity and tremor
115
Give 5 examples of things which can cause extra-pyramidal lesions in the basal ganglia
Drugs, alcohol, stroke, infection and parkinsons
116
What does skeletal muscle need in order to grow?
Increased number of myofibrils
117
How does muscle strengthen?
By strengthening the tendons
118
Symptoms of an upper motor neurone lesion
``` Muscle weakness Increased muscle tone Increased reflexes Clasp knife and Babinski Disuse atrophy ```
119
Causes of an upper motor neurone lesion
Stroke, MS, Cerebral Palsy, Brain Injury
120
Symptos of a lower motor neurone lesion
Muscle weakness Decreased muscle tone Decrease reflexes Disuse atrophy and fasiculation
121
Causes of a lower motor neurone lesion
ALS, Bell's Palsy, Guillian Barre Syndrome
122
Symptoms of a cerebellar lesion
``` Decreased coordination of movement Ataxia Slurred speech Hypotonia Resting and intention tremor Past-poiniting Nystagmus ```
123
Define ataxia
Cannot walk in a straight line
124
Define spastic
Increased muscle tone
125
Define flaccid
Decreased muscle tone
126
Define disuse atrophy
Wasting of muscles
127
Define concentric contraction
Muscle shortening
128
Define eccentric contraction
Increase in muscle length
129
Define isometric contraction
Muscle contracted but held at a constant length
130
Define isotonic contraction
Contraction against resistance
131
Define isokinetic contraction
Contraction against concomitant force at constant speed
132
Define passive stretch
No definition I just need to know it exists LOL
133
What does muscle length change with?
Joint angle
134
What lesion does hypERtonia indicate?
UMNL
135
What lesion does hypOtonia indicate?
LMNL
136
What is the cause of rigidity?
An extra-pyramidal lesion
137
What is the cause of spasticity?
UMN pyramidal lesion
138
What are the 5 deep tendon reflexes?
``` Ankle jerk Knee jerk Biceps reflex Supinator reflex Triceps reflex ```
139
What is the nerve root and nerve for the ankle jerk | reflex?
S1/S2 | Tibial
140
What is the nerve root and nerve for the knee jerk reflex?
L3/L4 | Femoral
141
What is the nerve root and nerve for the biceps reflex?
C5/C6 | Musculocutaneous
142
What is the nerve root and nerve for the supinator reflex?
C5/C6 | Radial
143
What is the nerve root and nerve for the triceps reflex?
C7/C8 | Radial
144
What is the MRC scale for muscle power?
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
Define echopraxia
Imitation of movement
146
Define posturing
Adopting a strange position for a long period of time
147
Define tics
Irregular movements in a muscle group
148
Define pressure of speech
Increased rate and quantity
149
Define poverty of speech
Decreased quantity of speech
150
Define dysarthria
Hard to articulate speech
151
3 examples of overactive movement
Stupor Depressive retardation Obsessional slowness
152
2 examples of overactive movements
Psychomotor agitation | Compulsion
153
What is stupor?
Mute, immobile and concious
154
What is depressive retardation?
Takes a long time to do something
155
What is obsessional slowness?
Doubts and obsessive rituals
156
What is psycho-motor agitation?
Restless and unproductive
157
What is compulsion? | Example
Repetitive and seemingly 'purposeful' behaviour (e.g. cleaning)
158
Define thought disorder
A pattern of disordered language that reflects disordered thinking
159
Give 5 examples of 'forms of thinking'
``` Flight of ideas Neologism Echolalia Thought blocking Knight's move thinking ```
160
What is 'flight of ideas'?
Accelerated thoughts with no direction | Topic changes
161
What is neologism?
A new word made by the patient
162
What is thought blocking?
Interruption of a thought and inability to recall it
163
What is knight's move thinking
Odd associations between ideas
164
Define mood
A persuasive and sustained emotion that changes the perception of the world
165
What is the difference between objective and subjective?
Objective: Doctor's diagnosis Subjective: Patient's ideas
166
What are the 5 types of mood?
Dysphoric, Annedonia, Euphoria, Elation, Irritaible
167
Define dysphoric
Unpleasant mood
168
Define annedonia
Loss of interest in activities which are usually pleasurable
169
Define euphoria
Unconcern and contentment
170
Define elation
Elevated and exaggerated mood
171
Define affect
A pattern of observable behaviours that concern the expression of emotion
172
What are the two types of affect?
Inappropriate or flat
173
Define anxiety
Feeling of apprehension, tension and uneasiness to anticipation of a danger
174
What are the 3 types of anxiety?
Phobic, free-floating, panic attack
175
Give 4 examples of abnormal thought content
Preoccupations, obsessions, phobias and suicidal/homicidal thoughts
176
Define obsession
Repetitive, senseless thoughts that are recognised as irrational and are resisted
177
Define phobias
Persistent, irrational fear of an activity, object or situation Leads to avoidance due to a fear of extreme danger
178
3 examples of abnormal beliefs or interpretations of events
Over-valued ideas, delusions and passivity phenomena
179
Define delusion
Fixed and false personal belief based on incorrect inference about an external reality
180
Give 5 examples of delusions
``` Persecutory/reference Doubles Ninilistic Erotomania Perception ```
181
Give an example of a persecutory/reference delusion?
TV taking about them
182
Give an examples of a double delusion
Relative is replaced by a double
183
Give an example of ninilistic delusion
Part of the body is missing
184
Give an example of a erotomania delusion
Madly in love with someone in a higher position
185
Define passivity phenomena
The belief that an external agency is controlling them
186
Give 3 examples of passivity phenomena
Thought insertion, thought withdrawal and thought broadcasting
187
Define delusion perception | Example
The patient attaches a delusion to a real thing | Example: If the traffic light goes red then I am the queen
188
Define primary delusion
No connection to previous events | Wake up with it
189
Define secondary delusion | Example
When someone is trying to make sense of something | Example: An alien has taken my thoughts
190
Give 3 examples of abnormal experiences associated with the environment
Hallucinations, illusions and derealisation
191
Give 2 examples of abnormal experiences associated with the body
Altering somatic sensation and halucination
192
Give 2 examples of self-awareness disorders
Depersonalisation | Derealisation
193
Define depersonalisation
Decreased self awareness | Patient doesn't feel real
194
Define derealisation
Surroundings not real
195
When can depersonalisation and derealisation occur naturally?
When you are tired
196
What is the difference between illusion and delusion
Both false perceptions Illusion: Real external stimulus Delusion: No external stimulus
197
4 examples of hallucinations
Auditory, visual, gustatory or somatic
198
What is pareidolia?
When you look at something and see something else
199
What 4 things do you assess under cognitive state?
Orientation, attention/concentration, general knowledge and memory
200
How can you assess orientation?
Time, person, place
201
How can you assess attention/concentration?
Backwards from 100 in 7's
202
3 ways by which you can you assess memory
Immediate recall and short term memory Long term events (e.g. birth) Mini mental state examination
203
What are the 9 states to the mental state examination?
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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