DIana's Tidbits Flashcards
Parts of the Health History
Identifying Data CC HPI with appropriate ROS in episodic PMH FH Personal/Social Hx
ROS: for comprehensive
DTR regions
Each DTR has region-abnormal can locate pathology Ankle: Sacral 1 Knee: Lumbar 2,3,4 Brachioradialis: Cervical 5,6 Biceps: Cervical 5,6 Triceps: Cervical 6, 7
Grading Reflexes
4+: very brisk, hyperactive with clonus (rhythmic oscillations between flexion and extension)
3+: Brisker than average; possibly but not necessarily indicative of disease
2+: average, normal
1+: somewhat diminished; low normal
0: no response
If diminshed look for other findings such as atrophy, weakness, fasiculations
Delirium Clinical Features
Acute
Fluctuating with lucid intervals; worse at night
Hours to weeks
Sleep always disrupted
General medical illness and/or drug toxicity present
Delirium LOC
LOC: Disturbed-less aware of environment, less able to focus, sustain or shift attention
Delirium Behavior
Abnormally decreased (somnolent) or increased (agitation, hyper vigilance)
Delirium speech
Hesitant, slow, or rapid, incoherent
Delirium mood
fluctuating: labile-from fearful or irritable to normal or depressed
Delirium thought process
disorganized, incoherent
Delirium thought content
delusions common, often transient
Delirium perceptions
illusions, hallucinations, most often visual
Delirium judgement
impaired
Delirium orientation
disoriented-esp for time. a known place may be familiar
Delirium attention
fluctuates-easily distracted, unable to concentrate
Delirium memory
immediate and recent memory impaired
Delirium causes
DTs uremia acute hepatic failure acute cerebral vasculitis atropine poisoning
Dementia clinical features
insidious onset slowly progressive months to years duration sleep fragmented general medical illness or drug toxicity often absent, esp in alzheimers
Dementia LOC
usually normal until late
dementia behavior
normal to slow, may become inappropriate
dementia speech
difficulty finding words, aphasia
dementia mood
often flat, depressed
dementia thought process
impoverished; speech gives little info
dementia thought content
delusions may occur
dementia perceptions
hallucinations may occur
dementia judgement
increasingly impaired over the course of the illness
dementia orientation
fairly well maintained, impaired in later stages
dementia attention
unaffected until late
dementia memory
recent and new learning impaired
Dementia causes
reversible: vit b12 def; thyroid disorders
irreversible: alzheimers, vascular dementia (mutl infarcts); head trauma
illusions
misinterpretation of real external stimuli
hallucinations
subjective sensory perception in the absence of relevant ext stimuli. person may/may not recognize the experiences as false
delusions
false, fixed, personal beliefs that are not shared by other members of the persons culture or subculture.
ex: del of grandeur
persecutions
jealousy
reference: person believes that external events, objects, or people have a particular or unusual personal significance (radio or tv commenting or giving person instructions)
testing remote memory
inquire about birthdays, anniversaries, SSN, names of schools attended, jobs, past historical events as related to patient’s past
Romberg
test of position sense. stand w feet together and eyes open and then close both eyes for 30-60 sec w/o support-note ability to maintain upright posture
- -loses balance=positive
- -maintains=neg
cystocele
bulge of the upper 2/3 of the ANTERIOR bag wall, together w the bladder above it
rectocele
herniation of the rectum into the posterior wall of the vagina resulting from a weakness or defect in the endopelvic fascia
what is the opening between the eyelids
the palpebral fissure
pronator drift
the pronation of one forearm. Is is both specific and sensitive for a corticospinal tract lesion originating in the contralateral hemisphere. down drift of the arm with flexion of the fingers and elbow may also occur. the pt should stnad for 20-30 seconds with both arms straight forward, palms up with eyes closed. Next tap the arms briskly downward. the arms normally return smoothly to the horizontal position. This response requires muscular strength, coordination, and a good sense of position
romberg
test of position sense: pt stands with feet together and the eyes open and then close both eyes for 30-60 seconds w/o support. Note the pt ability to maintain an upright posture. In ataxia from dorsal columnar disease and loss of position sense, vision compensates for the sensory loss. The patient stands fairly well with eyes open but loses balance when eyes closed=+romberg. In cerebellar ataxia pt has difficulty holding position w eyes open or closed
ptosis
drooping upper eyelid
cup to disc ratio
<1:2
Tinnitus
is a perceived sound that has no external stimulus-commonly a musical ringing or a rushing or roaring noise.
Weber Test
tests for lateralization
Tuning fork to vertex of the head and ask the pt where they hear it: one side or both? Normal is to hear it equally on both sides. in unilateral sensorineural hearing loss, pt hears sound in the good ear.
Rinne Test
Compares air conduction vs Bone conduction.
Place tuning fork to mastoid bone behind the ear and level with canal. When pt can no longer hear the sound, place close to the ear canal to see if the sound can be heard again. Normal Results:
pt can hear sound again because AC>BC.
Abnormal Results: the sound is heard longer or as long through bone as through air. If BC=AC or BC>AC then pt has conductive hearing loss.
Lymph Nodes Drainage
Three chains of nodes drain into the Central Nodes:
1. Pectoral Nodes - anterior axillary
2. Subscapular Nodes - posterior axillary
3. Lateral Nodes - Upper Arm
Lymph drains from the central axillary nodes to the infraclavicular and supraclavicular nodes.
Dermatomes - Sensory
A dermatome is a band of skin innervated by the sensory root of a single spinal nerve.
Knowledge and testing of dermatomes help localize a lesion to a specific spinal cord segment.
How would you assess the frontal sinus?
Palpate for sinus tenderness by pressing up on the frontal sinus from under the bony brow, avoiding pressing on the eyes.
What is the prostate gland assessed for?
Sweeping the finger across the surface, feel for the two lateral lobs, and the sulcus between them.
Note the size, shape (heart), and consistency. Identify any nodules or tenderness.
The normal prostate is smooth, rubbery, and non-tender.
Each testis is palpated for what findings?
Note size, shape, consistency, and tenderness; feel for any nodules.
75% of all breast cancers are located in this region of the breast tissue?
The upper outer quadrant.
Assessing skin for yellowing most always look at the eyes, and mucous membranes, and…
The palms of the hands and the soles of the feet.