CS 4 Flashcards
Are the four criteria for insomnia?
Trouble initiating and maintaining sleep. Adequate opportunity for sleep. Daytime functioning distracted. No other sleep disorder.
His normal sleep latency? Sleep latency in insomnia patients?
20-30; >30 Or periods of waking greater than 30 minutes in duration
What is short-term and chronic insomnia?
Less than 3 months, greater than 3 months
What is initial insomnia? What are the classical cause?
Problems with initiation asleep. Think of poor sleep hygiene, anxiety, a stimulus.
What is terminal insomnia? What are the classical causes?
Maintain sleep Or waking up too early. Alcohol or depression
Lack of sleep without daytime drowsiness is indicative of what?
Bipolar disorder
Insomnia must be distinguished between what two disorders?
Nonrestorative sleep (OSA) or altered sleep schedule (cAcadian rhythm disorder)
What should be discussed in the closing encounter for insomnia patients?
Discuss how insomnia can affect well-being social interactions and functional status. Should counsel patients on keeping a sleep diary
What should sleep diary consist of?
What time you go to sleep, how long it takes you to fall asleep, number/duration of awakenings, estimated sleep time, daytime symptoms, exercise and dietary habits
What are the diagnostic studies that can be done for insomnia patients?
Fasting glucose and HbA1c. Liver function panel Sleep study/polysomnography Urine toxicology TSH
What are the clinical features for menopause?
Remember VOCALS☝🏾
Cognitive decline, irritability, hot flashes, oligomenorrhea/amenorrhea, vaginal atrophy, sleep disturbances, Depression, decreased libido
What is menopause?
Permanent cessation of menses, clinically diagnosed at 45 for duration of 12 months. Average age being 51
What is perimenopause or menopause transition? What is considered premature?
Irregular menstrual bleeding for seven years before menopause. 28+-7days; less than 40 yo
What are the common reasons a menopausal woman comes office?
Vasomotor (hot flashes) hypo estrogenic vaginal dryness. Fertility problems and Osteoporosis
What disorders may mimic menopause, what are the differential diagnosis? What are the associated symptoms?
Thyroid disorders such as hyperthyroidism, palpitations tremor heat intolerance Weight loss hyperreflexia. Pituitary disorders: menstrual disturbances, galactorrhea, mass defects (headache visual field defects). Pregnancy especially if younger than45
What is the follow up question for hot flashes? Irregular periods?
How often do they occur? When did the irregular periods start occurring?
What question should be asked to a menopausal patient for past medical history?
And we had a hysterectomy or any other surgeries?
Any problems with your ovaries or uterus including cancers?
If a patient is having hot flashes what should be noted?
If the patient has any contraindications for hormone therapy (smoking, History of breast cancer)
When should FSH be ordered in menopausal patients?
Patients with significant symptoms less than 45 or older patients with uncertain diagnosis (hysterectomy)
What diagnostic test should be ran for menopause patients?
TSH Prolactin Estradiol and progesterone and FSH Serum HCG and urine HCG Genital and pelvic examination
What are the differential diagnosis for a patient with carpal tunnel syndrome?
Fractured, sprained, ligament avulsion.
Carpal tunnel syndrome, ulnar neuropathy, rheumatoid arthritis, Osteoarthritis, de quervain tenosynovitis
What are the physical test For carpal tunnel syndrome?
Phalen test and tinel sign
Night sweats can arise from what disorders?
Infection, malignancy, Metabolic derangement
What causes hot flashes? What causes flushing? Hyperhidrosis?
Hot flashes can because by menopause or male or female hypergonadism. Flushing can be caused by menopause or medication such as Niacin or carcinoid syndrome. Typically is during the day typically affects axilla palms and soles
What are the differential for night sweats?
Infection, malignancy, alcohol or Opioid withdrawal,
Hypoglycemia, medications such as antidepressants, Systemic Inflammatory/autoimmune diseases, gastroesophageal reflux
What are the diagnostic test necessary for patients with Night Sweats?
CBC, HIV screen, PPD, CXR, ESR, TSH, glucose and electrolytes
What the causes for Hemoptysis?
Bronchitis, lung cancer, bronchiectasis, tuberculosis, lung abscess, bacteria pneumonia, Asperogillosis, mitral valve stenosis/Acute pulmonary edema, Granulomatous with polyangitis, Goodpastures, pulmonary embolism, AV malformation, trauma, cocaine (inhalation)
What are the common features besides Hemoptysis for TB? Lung abscess?
Cough, weight lost, low grade fever; systemic sx and purulent.
Orthopedic this order should be classified how?
Traumatic or aTraumatic. Acute or chronic/repetitive
What examination should be done for orthopedic cases?
Examination of the joints immediately above and below the symptomatic area
What are the risk factors for plantar fasciitis?
Jogging/running, prolonged standing, dancing, pes planus, obesity
Other than mechanical causes for orthopedic disorders what else should be considered?
Rheumatology
What orthopedic patients should be evaluated with imaging?
Chronic symptoms that are not improving as expected, acute trauma
For orthopedic patients what should be done if patient is experiencing gradual improvement?
Counsel the patient (activity modification) and write “no studies indicated”
Evaluation of hands symptoms should address what two aspects?
Symptoms itself (like pain and stiffness). Effect on function (including occupational function)
Where is the location of pain for Decore vein tenosynovitis? All their neuropathy? Carpal tunnel syndrome?
Base of the thumb. Medial wrist, hand and fifth digit. Palmer aspect of first three or four digits
