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CS 2 Flashcards

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1
Q

When are changes in mental status most noticeable?

A

When there is an abrupt onset. Facing to have a slow and progressive decline in function will not be bright until it is advanced and a family member who hasn’t seen them in a long time notices

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2
Q

Elderly patients who have acute medical illnesses such as acute cystitis may present in what way, instead of the classic way?

A

May present with derilium instead of urgency, frequency, dysuria.

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3
Q

What are the precipitating factors for delirium?

A

Metabolic derrangements, drugs, electrolytes, Infections, systemic illnesses, central nervous system problems

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4
Q

What patients are more likely to develop derilium during acute illness?

A

Patient with dementia

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5
Q

Before coming up with a differential for the derilium what should you screen for?

A

Sensory defect or aphasia can be confused with confusion. Also patient’s affective disorders may also present similar to dementia patients

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6
Q

Confusion can be divided into what two categories?

A

Chronica/progressive (Dementia), acute/fluctuating (derilium)

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7
Q

What are the questions to ask for the purpose of assessing Activities of daily living?

A

Are you able to do regular activities for yourself? Are you able to manage your own finances? Are you able to do work around the house? Are you able to drive?

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8
Q

What does the cognition portion of neurologic exam for the derilium patients Intel⁉️

A

Memory (3 words), concentration (spell world backwards), abstraction, insight, Estimate of intelligence

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9
Q

What are some of the diagnostic Test that can be done for patients who are confused?

A

Complete blood count with differential, electrolytes, glucose, renal function markers, liver function test, urine analysis and culture, urine toxicology, CT head, Vitamin B 12 lumbar puncture/cerebral spinal fluid analysis eeg

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10
Q

If the diagnosis is not clear at the end of your encounter what should be done?

A

State your uncertainty honestly. Do not provide false reassurance but expressed that you will work with them To evaluate their condition and you’ll inform them about your findings in a timely manner

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11
Q

Explain neurologic physical examination for confused patients?

A

Cognition, cranial nerves, gait, sensory and motor function

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12
Q

Abnormal urine color is usually due to disorders from what systems?

A

RenoUrinary tract, hepatobiliary system, blood/hematologic system, musculoskeletal system

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13
Q

What are the different urine color that can guide differential diagnoses⁉️

A

Red: Blood, food pigments (eg, beets, rhubarb), medications (eg, phenazopyridine, rifampin), porphyrins
Blue/green: Food dyes, medications (eg, indomethacin, amitriptyline), Pseudomonas urinary tract infection
Browne: Medications (eg, metronidazole, senna), liver/kidney disease, myoglobin/rhabdomyolysis
Orange: Hepatobiliary disease, dehydration

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14
Q

How can Hematuria be categorized?

A

the pattern through urination

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15
Q

What hematuria pattern is indicative of urethral source? Prostate source? bladder Source? Upper tract (kidney and collecting system) source?

A

Blood at the start of voiding that clears is usually from a urethral source. Blood at the end of voiding suggests a bladder or prostate source. Visible blood throughout voiding may represent an upper tract (kidney and collecting system) source.

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16
Q

How may Biliary obstruction present?

A

Biliary obstruction may cause dark-yellow/orange urine with jaundice, pale stools, and right upper quandrant pain

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17
Q

What suggest rhabdomyolysis?

A

Dark urine following a crush injury or extreme physical exertion suggests rhabdomyolysis.

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18
Q

What should be suspected in a patient with dark urine and fatigue, jaundice, Abdominal or back pain?

A

Hemolysis

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19
Q

Before ordering a cystoscopy what should be assessed and explained?

A

Must explain your rationale if any invasive diagnostic test are needed (cystoscopy). Patients readiness to undergo studies

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20
Q

Diagnostic studies should be done for patient with dark urine?

A

Electrolytes, blood urea nitrogen, creatinine
Liver function tests (eg, direct and indirect bilirubin)
Urine culture
Complete blood count (and peripheral smear, reticulocyte count)
Muscle enzymes (eg, creatinine kinase, aspartate aminotransferase [AST])
CT urogram (for identifying kidney stones)
Liver/biliary CT scan, ultrasound
Cystoscopy

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21
Q

What labs should be done is hemolytic anemia is suspected?

A

If hemolytic anemia is suspected, start with a complete blood count, reticulocyte count, and peripheral smear. Supportive findings include elevated lactate dehydrogenase, low haptoglobin, and elevated unconjugated bilirubin

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22
Q

What are some questions you can ask in order to screen for manic or hypomanic episodes?

A

Has there been a time you felt so good and energetic that it got you in trouble⁉️
Have you been feeling more energetic however getting less sleep?
Have you spend excessive amounts of money recently or during episodes have you done things that you thought were foolish question

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23
Q

What are the differential diagnosis for depression?

A

Major depression disorder, persistent depressive disorder (dysthymia), adjustment disorder with depressed mood, substance-abuse metabolic disorder neurologic disorders

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24
Q

Explain the psychiatric physical examination?

A

Mood and affect, psychomotor activity, and psychotic features, thought processes and speech

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25
What is the main outcome measure for diabetes⁉️
glycemic control, which is assessed with fasting glucose, hemoglobin A1c, and home glucose monitoring
26
What periodic examinations should be done for diabetic patients?
feet, including monofilament testing for sensory neuropathy dilated eye examination for retinopathy (usually performed by an ophthalmologist Nephropathy screening is typically performed with a urine microalbumin assay
27
What are other topics that should be discussed with a diabetic patient?
Because diabetes is a major risk factor for cardiovascular disease, other risk factors (eg, blood pressure, smoking) should be addressed.
28
What are the questions should be asked about blood sugar levels that are monitored by the patient?
Do you check your blood sugar at home? What is the highest reading you have had recently? The lowest? The average?
29
What are the questions should be asked to diabetic patients about the eye?
Have you had changes in vision? When was the last time you had a dilated eye examination?
30
How should an encounter be closed with a diabetic patient?
Discuss what tests need to be performed to monitor therapy and how the results may alter management. Finally, counsel the patient on a personalized care plan, including diet, exercise, home glucose monitoring, and sick-day recommendations
31
When would TSH be ordered for diabetic patient?
TSH test is not routinely ordered in management of diabetes but might be considered if the patient has unexpectedly gained weight or the blood pressure is unexpectedly elevated
32
What are the Common tests to evaluate diabetes?
Fasting glucose and hemoglobin A1c (An oral glucose tolerance test is used in the initial diagnosis but not for follow-up.) Electrolytes (especially if on blood pressure medication) Blood urea nitrogen and creatinine Liver function tests (if the patient is taking medication that can affect the liver) Lipid panel Urine microalbumin
33
What are the anti-bodies that are implicated in thrombophilia states? Hypercoagulability testing
Proteins C and S deficiency. Antithrombin deficiency. Prothrombin gene mutation. Factor V Leiden, hyperhomocystinemia, Antiphospholipid antibody syndrome, and proximal nocturnal hemoglobinuria
34
When patient should undergo hypercoagulability testing?
Patients with no predisposing factors, recurrent DVT, family history of DVT
35
What can cause hyperprolactinemia?
Pregnancy, medications, hypothyroidism, liver/kidney failure, pituitary lesion
36
Would test should be ran in order to screen for partially reversible causes of dementia?
Serum B 12, TSH, RPR
37
What are the medical conditions that may present with cognitive dysfunction? What test should be ran?
Hypernatremia, hypercalcemia, hyperglycemia, Uremia; electrolytes, calcium, glucose, BUN/Cr
38
What are the side effects for Metformin? What patients should not get drunk?
Gastrointestinal upset, lactic acidosis, weight loss; renal insufficiency
39
What is the benefit for monitoring outcome for diabetic patient?
Treatment targets, and of course overtime
40
What are the main outcome measurement for diabetic patients?
Fasting glucose, hemoglobin A-1 C, Glucose monitoring at home
41
What should be addressed besides the questions for diabetic patients?
Check the feet, eyes, kidneys, cardiovascular risk factors such as smoking and hypertension.
42
How does the differential diagnosis for diabetic patients appear?
Diagnosis that are incomplete or erroneous
43
With test should be ran for diabetic patients?
Fasting glucose, hemoglobin A-1 C, BUN/Cr, urine microalbumin, Liver function test, lipid panel, electrolytes
44
Where is the first question that should be asked to do the patients for discerning the type of dizziness?
Allow the patient to describe dizziness in their own words
45
What should be explained in the closure of the Encounter?
Most likely diagnosis Pathonognomic findings assessment necessary for and certain diagnoses
46
What should be observed in a patient with depression?
Mental Status, Fluidity and organization of speech, Affect, Psychomotor activity
47
What does should be assessed during the closing encounter for a patient with depression?
Insight, willingness for treatment
48
What are the two most common diagnostic tests that are given for depressed patients? What are the rest?
Complete blood count, TSH; Electrolytes, glucose, Urine Toxicology, liver function test, Viral hepatitis serology, HIV screening vitamin B 12 levels, Therapeutic drug levels such as digoxin and carbamazepine
49
When should a MRI be used in depressed patients?
Suspicion for dementia or multiple sclerosis
50
What is the common side effect of Glimepiride and Repaglinide⁉️
Hypoglycemia in which renal failure increases risk of. And Weight gain
51
What are the side effects of Metformin⁉️
G.I. upset, weight loss, lactic acidosis Therefore contraindicated in Renal failure. Weight loss
52
What are the most common causes of dizziness?
Vestibular dysfunction, cardiac/hemodynamic instability, sensory dysfunction, psychiatric disorders.
53
When a patient presents with a chief complaint of possible loss of consciousness (dizziness, seizure) what are the follow up questions?
Duration of loss of consciousness, Time to recovery, injuries/fall
54
What are the common causes of dizziness?
Disequilibrium, vertigo, pre-syncope, nonspecific
55
What are the differential for vertigo?
Benign proximal positional vertigo, vestibular neuritis, Ménière disease, migraine, vertebrobasilar stroke
56
What are the differential diagnoses for pre-syncope?
Cardiac arrhythmias, aortic stenosis, orthostasis, vasovagal event
57
What is vertigo? What is the most common cause? And how is it provoked?
Abnormal sensation of moving, tilting, Spinning; BPPV, provoked by changes in head position
58
What causes prolonged vertigo followed by viral illness?
Vestibular neuritis
59
How does Meniere’s disease present?
Vertigo, hearing loss, sensation of fullness in the ear
60
How does vertebrobasilar stroke present?
Debilitating vertigo often with other neurologic defects
61
How does presyncope present?
Lightheadedness, often associated with visual disturbances, occurs in an upright position
62
How does vasovagal event present?
Often common in young healthy patients, associated with sweating and nausea. Sudden onset
63
Pre-syncope occurs in patients with exertional symptoms?
Valvular heart disease like aortic stenosis
64
What patients can experience orthostatic symptoms?
Neuropathic conditions or certain medications that include diuretics and beta blockers and alpha blockers
65
What is disequilibrium? Who is it normally seen in?
Sense of imbalance with walking. Sensory disorders like peripheral neuropathy, loss of peripheral vision. Neuromuscular disorders like myanstenia gravis. Central nervous system disorders like Parkinson’s disease or normal pressure hydrocephalus
66
What is the Dix-Hallpike maneuver, how is it performed?
Specific task for BPPV. Turn patients head 45° in the seated position. Lied to patient back quickly. Watch for nystagmus an ask patient if feels dizzy. Suggestions of vertigo suggest BPPV
67
What are the possible diagnostic studies for a patient with a chief complaint of dizziness?
ECG, echocardiogram, Complete blood count, fasting glucose Electrolytes, BUN, creatinine CT scan or MRI of the brain, Electroencephalogram
68
What are the common sulfonylureas? What are there is scientific and Brand names?
Glipizide: Glucotrol Glimepiride: Amaryl Glyburide: Diabeta Glyburide and Metformin: Glucovance
69
With our the outcome questions that should be asked to a diabetic patients?
When? Ask for the symptoms that they presented when first diagnosed with diabetes, and then ask if it has subsided? Ask for treatment targets if achieved or not, discuss disease course overtime stable better or worse.
70
What are the diagnoses questions for diabetes?
When were you diagnosed with diabetes? What symptoms are you experiencing before your initial diagnosis? Has those symptoms gotten better?
71
What are the questions for diabetes medications?
What medications are you taking for your diabetes? Are you taking the medications regularly? Any current side effects what did medications? Have you taking different medications in the past, what caused the change in treatment?
72
What are the glucose measurements questions to ask a diabetic patient?
Do you check your blood glucose sugar at home? How frequently, when? What was the highest rating? Lowest reading? Averages?
73
What are the screening test that should be asked to diabetic patient?
Any vision changes? When was the last time he had a dilated eye examination? Have you ever been to the podiatrist for any foot problems? Monofilament test?
74
What consist of personalizing a care plan for a diabetic patient during the closing of the encounter
Diet exercise I’m glucose monitoring and sick day recommendations such as how to prevent hypoglycemia
75
What diagnostic studies should be done for diabetic patients?
``` Fasting glucose and hemoglobin A-1C Electrolytes BUN and creatinine Liver function test (if take statins) Lipid panel Urine microalbumin ```
76
What are the conditions that must be met in order to be considered major depressive disorder?
Five out of nine with depressed mood Greater than two weeks Significant functional impairment
77
Persistent depressive disorder (dysthymia) criteria‘s?
Depressed mood for more than two years | At least two out of nine
78
Criteria for adjustment disorder with depressed mood?
On set within three months of identifiable stressor | Functional impairment
79
Examples of such a substance-abuse, metabolic disorders, neurologic disorders causing depression?
Alcohol and illicit drugs. Hypothyroidism. Dementia and multiple sclerosis
80
What are the diagnostic test should be run for a patient who is depressed?
CBC and TSH Urine toxicology/drug screen Vitamin B 12 level
81
What are the liver centric diagnostic test that should be ran for patients with depression as Chief complaint?
Liver function test, viral hepatitis serologies. HIV test. Therapeutic drug levels (digoxin, carbamazepine)

CS STUDY GUIDE (6 decks)

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