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CMS practical Flashcards

1
Q

anthropometric findings (height and weight) in fatty liver disease

A

increase BMI; central adiposity

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2
Q

blood pressure findings in fatty liver disases

A

increased blood pressure

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3
Q

skin exam findings in fatty liver disease

A

Spider Angiomas

Signs of portal hypertension: Edema, ascites, caput medusae

Palmar erythema

Jaundice (eyes, skin)

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4
Q

liver percussion and palpation findings in fatty liver disease

A

Hepatomegaly

Liver larger than 12 cm (mid-clavicular) or 8 cm (midsternal)

Palpation: firmness - cirrhosis

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5
Q

spleen percussion and palpation findings in fatty liver disease

A

Splenomegaly (due to portal hypertension associated w/ liver fibrosis)

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6
Q

ascites findings in fatty liver disease

A

Ascites (due to portal hypertension + fluid retention)

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7
Q

blood pressure in obesity

A

hypertension

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8
Q

heart rate in obesity

A

increased

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9
Q

respiratory rate in obesity

A

increased

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10
Q

waist circumference in obesity

A

increased

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11
Q

skin exam in obesity

A

Acanthosis Nigricans (IR)
Striae (stretch marks)
Acrochordons (skin tags) -associated w/ IR
Edema
Xanthoma

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12
Q

external eye exam in obesity

A

xanthoma

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13
Q

liver percussion and palpation in obesity

A

Hepatomegaly (due to NAFLD – comorbidity)

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14
Q

heart auscultation in obesity

A

Extra sounds (S3 + S4) due to cardiovascular comorbidities

Stenosis + regurgitation due to cardiovascular comorbidities

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15
Q

ascites findings in obesity

A

Fluid accumulation (due to comorbidities)

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16
Q

peripheral edema findings in obesity

A

yes Due to comorbidities (CHF, venous insufficiency)

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17
Q

blood pressure in diabetes

A

high

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18
Q

skin exam in T2DM

A

T2DM:
-acanthosis nigricans
-eruptive xanthomas
-central adiposity/weight gain
-diabetic dermopathy
- skin tags (?)

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19
Q

feet findings in T2DM (part of skin exam)

A

-ulcers
- pre-ulcerative callus/ corn

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20
Q

opthalamoscopic exam in diabetes

A

Diabetic Retinopathy:
-Microaneurysms: small swellings attached to vessels
-Flame hemorrhages
-Hard exudates
-neovascularization
-glaucoma
-AV nicking
-proliferative diabetic retinopathy

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21
Q

peripheral pulses (post tibial and dorsals pedis) in diabetes

A

Diminished (grade 0 or 1) due to peripheral artery disease (atherosclerosis) or diabetic neuropathy (poor circulation due to n. damage that control vessel constriction/ dilation)
-PAD presence in over 50% of pts

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22
Q

sensory exam (Ipswich touch test, soft touch, vibration, pain) findings in diabetes

A

128 Hz tuning fork (vibration) test: absence of vibratory perception

Ipswich touch test: absence of light touch on 2 or more sites (out of 6) is + for diabetic neuropathy

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23
Q

shoulder inspection findings

A
  1. Inspect the anterior + lateral aspects of the shoulder
    - note: scares, bruising, swelling, abnormal bony prominence, deltoid wasting
  2. Inspect scapulae + related muscles
    - note: scars, muscle symmetry, scoliosis, winged scapula

-erythema, swelling, gross deformities, bruising/trauma, scars, asymmetry

Normal: well perfused consistent skin colour, all bony landmarks visible, no swelling, shoulder intact bilaterally with no gross deformities, bruising, no indications of lesions, scars or surgeries

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24
Q

palpation of shoulder findings

A

Sternoclavicular joint, clavicle, acromioclavicular joint, acromion, coracoid process, spine of scapula, greater tubercle (humerus), biceps tendon, subacromial and subdeltoid bursae + SITS m. insertions
-proximal humerus, tendon insertions, local muscles

-assess for tenderness and crepitus

25
ROM in shoulder findings
Flexion, Extension, Abduction, Adduction, Internal + External Rotation - for adduction - cross arm in front of body AROM: state expected degree range PROM: assess for instability, laxity, apprehension, pain, popping, clicking, crepitus RROM: indicate muscles being assessed, hold for 5 seconds * Flexion: deltoid, biceps, * Extension: triceps, posterior deltoids * Abduction: supraspinatus (up to 90 degrees), deltoids (past 90 degrees) * Adduction: infraspinatus, subscapularis * External rotation: teres minor, infraspinatus * Internal rotation: subscapularis
26
external rotation lag in shoulder findings
1. Flex pts elbow to 90 and lift 20 in scapular plane 2. Passively take pt to mx external rotation + instruct pt to hold (+): shoulder internally rotates/ cannot maintain position for 2 seconds - supraspinatus + infraspinatus tear
27
internal rotation lag findings in shoulder
1.Brings arm into max internal rotation behind pts back 2. Lift forearm away from back into 20 degrees of ext 3. ask pt to maintain position but remain support at elbow (+): If pt cannot maintain position for 2 seconds - Subscapularis tear
28
painful arc test in shoulder
1. Ask pt to raise their arms w/ thumbs pointing upward 2. Assess for smooth, pain-free movement Pain < 60 = frozen shoulder (+): pain btwn 60-120 → supraspinatus impingement, rotator cuff tendonitis/ tear Pain > 180 degrees = AC joint In pts w/ RC tendonitis, ROM is all normal in pts w/ cuff tears, ROM is normal RROM strength is reduced
29
drop arm test in shoulder
1. Passively adduct pts arm to 90 while supported the elbow 2. Tell pt that when they release their arm, to lower it back slowly to neutral position (+): sudden drop/ pain → supraspinatus tear
30
blood pressure in hypothyroid
diastolic hypertension
31
temperature in hypothyroid
slightly low
32
heart rate in hypotension
bradycardia
33
waist to hip ratio in hypothyroid
weight gain (5 lbs)
34
skin exam in hypothyroid
Lateral 1/3 eyebrow thinning Puffy face/ eyelids Skin pallor or yellowing (carotenemia) Dry Skin
35
hair and nails in hypothyroid
Thin brittle nails Thinning hair/ alopecia
36
thyroid findings in hypothryoid
Goiter, bogginess, nodules, tenderness If healthy should feel cartilaginous rings
37
deep tendon reflex in hypothyroid
*ACHILES reflex Delayed DTRs (grade 1) *grade 2 is normal
38
blood pressure in non-organic fatigue
mild hyoptension
39
temperature in non-organic fatigue
low grade fever
40
heart rate in non-organic fatigue
tachycardia
41
respiratory rate in non orngaic fatigue
tachypnea
42
oropharyngeal exam in non-organic fatigeu
Non-exudative pharyngitis -erythematous posterior pharynx * Normal findings (that are also present in CSF): * Uniformly coloured, soft, moister soft and hard palate * Thin white coat on tongue * Tonsils not enlarged (0 or 1+) * Lateral margins * Uvula positioned midline
43
cervical and axillary lymph nodes in non-organic fatigue
Lymphadenopathy Tender lymph nodes * <2cm is normal, >3cm is enlarged * Should be soft * If rubbery or hard= bad
44
oropharyngeal exam for insomnia
tonsil size grading 0-4 if its at 3+ or 4+ it would maybe be obstruction Mallampati score: tonsils, soft palette + uvula ** pt must stick out tongue as much as possible** no tongue depressor used Class 1: The patient’s tonsils, uvula, and soft palate are completely visible. Class 2: Hard and soft palate, upper tonsils, and uvula are visible. Class 3: Hard and soft palate are visible; uvula is somewhat obscured. Class 4: Only hard palate is visible. Class 3 + 4 = higher risk of OSA Also assess posterior pharynx: -evidence of post nasal drip (erythema) -evidence of GERD (ulceration, enamel erosion) - cobble stoning
45
nose and sinus exam (external, internal, sinus) findings for insomnia
Asymmetry may be deviated septum – trouble breathing waking them up internally swollen turbinate’s –rhinitis, allergies – obstruction that causes them to wake up constantly mucous – can lead to post nasal drip Polyps, redness of mucous – may indicate sinusitis Test breathing through nose to *must comment on the inferior turbinate** Nasal septum is intact not perforated If sinus palpation tender – increase suspicion of post nasal drip – increase suspicion of insomnia septal deviation , nasal poylps (OSA)
46
neck circumference in insomnia
≤ 40cm increases risk of OSA landmarks to measure: hyoid – sternum – half way in between measure
47
lung auscultation in insomnia
Fluid / crackles due to heart failure ** when doing back: make sure to tell patient to cross their arms and want to see at least 2 areas along the sides**
48
heart auscultation in insomnia
Heart failure – extra heart sounds (s3) – backflow fluid into lungs causes difficulty breathing causes them to wake up hypoxic episodes if severe regurgitation possible s4 if they have hypertension
49
abdominal palpation in insomnia
IBS (waking up for diarrhea) – palpation may be sensitive/ tender to touch GERD: lying down, acid can flow up to esophagus Emphasize no epigastric pain (GERD)
50
when testing for peripheral artery disease what must u do
do bilaterally i.e. bp, pulses
51
blood pressure in both arms of peripheral artery disease findings
hypertension
52
skin exam in peripheral artery disease
Cold skin temp Presence of foot ulcers (between toes too “kissing ulcers) Discolouration (leads to gangrene) Skin perfusion (pallor (10 sec) upon elevation in supine OR prone + rubor (10sec) when seated pr prone/ supine - soft for like 5 sec) Shiny skin Distal hair loss * Back of hands to assess for rubor * Purple blue discolouration * Temperature bilaterally on legs on multiple points Elevation pallor then dependent rubor
53
hair and nails in peripheral artery disease
Dystrophic nail changes (discolouration, hypertrophic nails, splinter hemorrhages) Hair loss on toes + distal ankles
54
pulses in peripheral artery disease
Rate (0-3+) – diminished in PAD (radial, carotid, femoral, posterior tibial, dorsalis pedis) do bilaterally at same time, except for carotid
55
auscultation of bruits using what side of stethoscope
bell
56
bruits in peripheral artery disease
Shows: stenosis or atherosclerosis. Use bell (diaphragm for carotid) Presence of carotid (hold breath), aorta, renal, femoral, iliac, popliteal bruit *most reliable for PVD = femoral*
57
neurological testing in peripheral artery disease (sensory: soft touch, vibration, pain)
Soft touch – 2 spots on hand (palm + back of wrist) + 2 spots on feet (1 sole + 1 on ankle) – bilaterally Sharp vs dull same 8 locations – use cotton swab – one side is dull one sharp Vibration: 1st joint of thumb + toe, ask them what they feel – vibration, ask them when it stops + then stop the vibration (4 spots) – 128 hz TF
58
WEEK 11 headaches DOOOO

CMS200 (22 decks)

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