CS 3 Flashcards
Victims of domestic violence should be screened for what?
Depression, suicidal, self harm
What is the most important initial intervention? How should it be asked?
Identify a emergency safety plan; Where is a safe place that you can go when you are afraid⁉️
What should be mentioned in the closure for domestic renovations?
Community resources such as domestic violence shelters Counseling
What test should be ran for a patient with sexual assault?
Nucleic acid amplification test for chlamydia and gonorrhea
HIV and Hepatitis B Screen
VDRL or RPR for syphilis
Urine HCG
What is secondary enuresis?
Incontinence after a patient Has had a period of dryness for six months
What are the causes of secondary enuresis?
Urinary tract infection, psychological, diabetes mellitus, diabetes insipidus, Obstructive sleep apnea
What are the associated symptoms for urinary tract infection? Diabetes mellitus? Psychologic enuresis etiology?
Dysuria, hesitancy, urgency, Abdominal pain.
Polyuria, polydipsia, polyphagia, weight loss, Lethargy, Candidiasis
Behavior regression, moved liability.
What is psychogenic polydipsia?
Abnormal fluid intake. Cause of enuresis
Genitourinary causes for nocturnal enuresis are usually associated with?
Daytime incontinence, voiding problems, frequent small avoiding, Holding maneuvers
What system will you use for enuresis patients?
Determine whether it’s primary or secondary, Whether monosymptomatic or non mono-symptomatic (daytime incontinence)
How often? Days? Times a day?
Etiologies of secondary enuresis
What can be told to patient’s parents with enuresis in order to calm them?
Enuresis is a common problem and usually resolves spontaneously
What are the dementia/forgetfulness differential?
Alzheimer’s disease, vascular dementia, frontotemporal dementia, dementia with Lewis bodies, normal pressure hydrocephalus, Prion disease
What are the ass. Symptoms for frontotemporal dementia?
Apathy, disinhibition, compulsive behavior, personality changes, frontotemporal atrophy on imaging
What are associated symptoms for prion disease?
Behavior changes, rapid progression, Monoclonus, seizures
What neuropsychiatric disorders may affect memory?
Depression, multiple sclerosis
What metabolic disorders may affect memory?
Hypothyroidism, vitamin B deficiency
In addition to alcohol abuse, what medications can cause memory impairment/cognitive dysfunction?
trycyclic antidepressants, benzodiazepines, digoxin
What test should be ran for patients with memory impairment?
Serum Vitamin B12, TSH, BUN/Cr, CBC Electrolytes, liver function panel, UA and culture, Utox
What test can be done for female patients who are victims of domestic violence?
NAAT for chlamydia and gonorrhea VDRL or RPR HIV Screen Urine HCG Hepatitis B screen
When should CT Scan be done for domestic abuse patients?
CT Scan for Craniofacial injuries
Excessive fluid intake with frequent large volume of your nature can be a sign for what?
Psychogenic enuresis, diabetes or kidney problems
What is an injury that children can have that can lead to enuresis?
Spinal injury
What test can be done if retained feces is suspected?
Abdominal x-ray
How is plantar fasciitis present?
Point tenderness upon Dorsi-flexion of toes. Pain maximum upon first stepping out of the bed, May improve as the day progresses. Chronic pain. Point tenderness at the insertion of the plantar fascia on the calcaneus with increased pain associated with dorsiflexion of toes
How does a ruptured plantar fascia present?
Sudden onset. Loss of height of the arch. Visible swelling or ecchymosis
Bone infection/metastasis?
Constant throbbing pain. Nocturnal worsening.
Calcaneal stress fracture?
Worse with activity. Palpation at the bone elicits tenderness
Tarsal tunnel syndrome?
Pain, parenthesis, and numbness on the soles of the feet. Percussion tenderness over to posterior tibial nerve in the tarsal tunnel
What are the risk factors for plantar fasciitis?
Running jogging dancing, obesity, pes planus (flat feet)
When are imaging warranted for patients with bone pain.?
Chronic issues that are not improving as it is expected. Acute injuries.
For heel pain what can film x-rays look for?
Acute fractures and some chronic disorders such as osteoarthritis. Can also review bone deformities they can predispose a patient to chronic complications. Low sensitivity to soft tissues
What consists in joint aspiration?
Gram stain, culture, cell count, polarized microscopy for crystals
What test can be ran for heel pain?
Inflammatory markers, Serologic studies, and joint aspiration X-ray
What is in the Mnemonic for patients who have a headache with a potential serious cause?
SNOOP Systemic symptoms (weight loss, fever) or disease (cancer, HIV/AIDS) Neurologic symptoms (focal neurologic deficit, altered sensorium) Sudden onset, older age at first occurrence, change from previous headache
Describe the different characters of the various types of headaches?
Migraine are pulsatile and throbbing
Cluster headaches are excruciating sharp and steady
Tension headaches are tight dull and persistent
What are the associated symptoms for common types of headaches?
Tension muscle tenderness in head neck and shoulders
Cluster sweating facial flushing nasal congestion lacrimation and pupillary changes
Migraine aura is photophobia phonophobia and nausea
How long does migraine headaches last?
Greater than four hours
What type of headache presents with a family history?
Migraine headaches
Describe the location of the common types of headaches?
Cluster behind her eye. Migraine unilateral usually. Tension by lateral band like pattern around the head
What headache presents as migraine variance?
Sinus headaches
What are the triggers for migraine headaches?
Food/beverages chocolate red wine, menstruation, caffeine rapid onset
When her headache secondary to intracranial neoplasm worsen? What are some of the associated symptoms that a pathoMonic?
Worse in the morning, nocturnal headaches, worse and when bending over; Seizures, neurologic deficits
How does subarachnoid hemorrhage headaches present?
Sudden severe worst headache of my life, vomiting, loss of consciousness, neck stiffness
Angle closure glaucoma headaches present how?
Periorbital pain, vomiting, visual symptoms, abnormal ocular examination
How does Headaches secondary to bacteria meningitis present?
Fever, confusion, Nuchal rigidity
Headache secondary to giant cell arteritis?
Age greater than 50, Temporal location, Jaw Claudication, shoulder or hip pain
Headache secondary to hypertensive encephalopathy?
Rapid rise in blood pressure >(180/120mmHg)
What are the differential diagnoses for secondary headaches?
SIGMA Intracranial neoplasm, subarachnoid hemorrhage, angle closure glaucoma, bacterial meningitis, giant cell arteritis, hypertensive encephalopathy
During the closure of a headache encounter what should be said about test that should be ran?
There are no tests to confirm migraine or tension headaches but test are done to rule out other disorders
What is done initially for Subarachnoid hemorrhage? What is done to confirm?
CT scan, lumbar puncture to confirm
What are the indications for LP?
Bacterial meningitis, subarachnoid hemorrhage, idiopathic intracranial hypertension (pseudotumor cerebri)
What should a patient with possible giant cell arteritis receive as a test? What should a patient with a headache and fever or Constitutional symptoms receive as a test?
Erythrocyte sedimentation rate or C-reactive protein. CBC
Patients with hypertension should receive what to test immediately?
ECG and renal function test (BUN, creatinine, urinalysis)
What is the differential diagnosis for forgetfulness in the elderly?
Normal aging, mild cognitive impairment, dementia, major depression
What are the differential for forgetfulness/dementia/confusion?
Picks disease (frontotemporal dementia), prion disease, dementia with Lewy bodies, Alzheimer’s disease, Normal pressure hydrocephalus, vascular dementia
How does Alzheimer’s disease present?
Early short term memory loss. Late personality change.
Language defects and spatial disorientation.
How does vascular dementia present?
Perceptible stepwise declined. Early executive dysfunction.
Neuroimaging will show deep white matter changes
Frontotemporal dementia presents like what?
Early personality changes. Apathy, this inhibition and compulsive behavior. Frontotemporal atrophy on neural imaging
Dementia with Lewy bodies presents how?
Visual hallucinations, spontaneous parkinsonism, fluctuating cognition
Normal pressure hydrocephalus presents how?
Ataxia early. Urinary incontinence. Dilated ventricles on Nero imaging
How does prion disease present?
Behavior changes. Rapid progression. Myoclonus and or seizures
What are the metabolic disorders that can cause forgetfulness/dementia/confusion? Medications?
Hypothyroidism, vitamin B 12 deficiency. Tricyclic antidepressants. Benzodiazepines. Alcohol abuse.
What are the test that should be ran for a patient with forgetfulness?
Liver function test, CBC, BUN and creatinine, urinalysis, Urine toxicology screen, Electrolytes and glucose
What is the definition of enuresis?
Nocturnal urinary incontinence in children equal to a greater than five.
What should be told to quell the anxiety about enuresis for the parents?
This occurs in 15% of children at age 5 and is more common in boys.
What are the associated symptoms for enuresis secondary to psychological stress?
Behavior regression, mood liability
You should ask the mother who has a child with and you recess about additional symptoms that may suggest what?
Neurologic disorder, urinary tract infection, and caprices/constipation, or a metabolic disorders including diabetes insipidus and malice.
What is the differential for secondary enuresis?
Psychological stress, psychoVenice polydipsia, urinary tract infection diabetes mellitus, diabetes insipidus, obstructive sleep apnea, irritative lower gastrointestinal disorders pinworms
What are the diagnostic studies that can be done for patients with enuresis?
Serum glucose, electrolytes, creatinine BUN, urine culture, urinalysis.
What are the screening exams to test for STDs?
Nucleic acid amplification test for chlamydia and gonorrhea.
HIV screen, hepatitis B screen, VDRL or rapid plasma reagin screen for syphilis
Pregnancy test
What should you say to a patient most likely domestic abuse patient who refuses to perform a physical examination?
Explain the reason why you need to do a physical examination, if still resistant abide by her wishes.
