Exam 1 Content Flashcards
What is the gold standard for evidence-based practice research?
Randomized controlled trial’s
What is health informatics?
It is the application of computer technology to healthcare delivery.
What are the benefits of delivering evidence-based services? List three
Improving the quality of care, achieving desired health outcomes, reducing healthcare costs
What is the United States preventative services task force?
It is an independent group of experts and prevention evidence-based medicine. It provides recommendations about clinical preventative services such as screenings, counseling, and preventative medication. The task force recommendations are considered the gold standard for clinical preventative services.
What grade of recommendation is this:
The USPSTF recommend selectively offering or providing the service to individual patient based on professional judgment and patient preferences. There is at least moderate certainty that the net benefit is small.
Grade C
What grade of recommendation is this:
They USPSTF recommends the service. There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial.
Grade B
What grade of recommendation is this:
The USPSTF recommends against the service. There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.
Grade D
What grade of recommendation is this:
The USPSTF recommends this service. There is high certainty that the net benefit is substantial.
Grade A
What Grade recommendation is this:
The US PSTF conclude that the current evidence is insufficient to assess the balance of benefits and harms of the service. Evidence is walking of poor quality or conflicting and the balance of benefits in harms cannot be determined
Grade I statement, insufficient
What type of research is this: Examines a number of valid studies on a topic and mathematically combines a result to report them as if they were one large study
Meta-analysis
What research evidence has less robust evidence of cause-and-effect and have less reliability and validity then higher levels of evidence?
Case reports, cohort studies, and qualitative research
What is the best research design?
Randomized controlled trial’s, it can provide sound evidence of cause and effect and can’t control for bias.
The American heart association is an example of what type of research?
Expert opinion
What is the definition of this:
This is the scientific process in which the practitioner suspects the cause of a patient symptoms and signs based on previous knowledge.
Diagnostic reasoning
What is this definition:
It is situational, practice base form of reasoning that acknowledges the many variables that are present in an actual clinical situation, such as environmental and social factors involving the patient, family, community, and a team of healthcare providers.
Clinical reasoning
What type of reasoning involves developing a brief summary and which patient specific details are translated into appropriate diagnostic terminology?
Clinical reasoning
What is coherence?
The psychological links, predisposing factors and complications in a disease that is present in a patient
Describe Parsimony
Simple explanation of the patient’s findings.
 How do you determined parsimony?
The shortest way to make this determination as to ask the patient or caregiver the reason for skin care and the current understanding of the problem and possible treatment options. This is a crucial step because patients must find the treatment recommendation acceptable
Hypothesis must be tested and assess for the following characteristics
Coherence, adequacy, parsimony
What does this describe:
Generally accurate and useful rules to make the task of information gathering more manageable and efficient. Rules such as familiarity, salience, and resemblance to a patient who has a known disease
Heuristics
What is sensitivity?
Testing that is sensitive is a test that will be able to correctly identify persons with the disease that the test has been designed to test for
A negative result is likely a true negative, Is the sensitivity of specificity?
Sensitivit
A positive result is likely a true positive what is this sensitivity and specificity?
Specificity
Snout is for what?
Sensitivity rules out disease
Spin is for what?
Specificity rules in disease
Seeking data to confirm rather than refute the initial hypothesis as what type of bias?
Confirmation bias
Stopping the diagnosis process to soon? What is it
Premature closure 
What is “pursuing zebras” meaning in regards to bias?
Base right neglect
What system of reasoning is this:
Usually a slower process in which the clinician uses an explicit analytic approach and is more complicated or the clinician is less experience
System 2 reasoning
What system of reasoning is this:
Relatively rapid and intuitive.
Based on pattern recognition and involves mashing the patient’s presentation to illness script or prior example of stored in memory, usually a straightforward case.
System one reasoning
What level of prevention is this:
The goal is to identify and detect disease in its earliest stages before symptoms appear
Secondary prevention
What level prevention is this?
Involves activities directed at improving general well-being while also improving specific protection for selected diseases. Interventions can include screening, counseling, or preventative medicine such as immunizations or dental sealants. Counseling about behavior risk such as using seatbelts or bicycle helmets can reduce injury or death
Primary prevention
What level prevention is this?
Programs that aim to improve the quality of life for people with various conditions by limiting complications and disabilities, reducing the severity and progression of the disease, and providing rehabilitation therapy to maximize functionality and self-sufficiency.
Tertiary prevention
Hypothesis generation begins during what phase of care?
Hypothesis generation begins during the assessment of a patient’s age gender race appearance and presenting problem
What is the most significant variable in narrowing the probabilities of a problem?
Age
What is this:
The most likely diagnosis based on prevalence demographics wrist factors symptoms and signs.
Leading hypothesis
True or false a normal exam always excludes a diagnosis
False,
A normal exam does not always roll out a diagnosis
What’s the order for clinical reasoning?
IF OLE RTRT
Identify, frame, organize, limit, explore, rank, test, re-rank, test
What are the four approaches to ranking are prioritizing the differential diagnosis forgiven problem?
Possiblistic, Probabilistic, prognostic, and pragmatic
Which approach is this:
Consider all known causes equally likely in simultaneously test for all of them, not a useful approach
Possiblistic
What type of approach is this:
Consider first as disorders that are more likely that is those with the highest pretest probability, probably that diseases present before further testing is done
Probabilistic
What type of approach is this?
Consider the most serious diagnosis first
Prognostic
What type of approach is this?
Consider the diagnosis most responsive to treatment first
Pragmatic
What do the symptoms represent?
Unintentional weight loss,
Slow mobility, weakness, decreased reduce activities, fatigue
Frailty
Poor sleep and rest and poor nutritional status are examples of what type of causes of fatigue?
Physiological causes
Depression and adults and children and anxiety are what type of causes of fatigue?
Psychological causes
Infection, drug and alcohol, anemia, hypothyroidism, hyper thyroidism are what type of causes for acute fatigue?
Organic causes for acute fatigue
Sleep apnea, medication’s, heart failure, cancer, mononucleosis, hepatitis, fibromyalgia, and chronic fatigue syndrome are examples of what type of cause ?
Organic causes of chronic fatigue
What is the typical presentation of a patient with mononucleosis? Also called Epstein-Barr virus
Young adult, slow onset of malaise, low-grade fever, mild sore throat
What are the physical findings of mononucleosis?
Palatine petechiae, posterior cervical lymphadenopathy, splenomegaly
What are the causes of raising the hypothalamic setpoint ?
This first type of fever is usually caused by infection, collagen disease, vascular disease, malignancy are usually responsible for these type of fevers. Antipyretics are given to lower the hypothalamic setpoint
This fever is the result of heat production exceeding heat loss, the setpoint is normal and heat loss mechanisms are active. It occurs because the body raises its metabolic heat production or because environmental heat load exceeds normal
heat loss mechanisms.
What are the causes?
Aspirin overdose, malignant hyperthermia, hyperthyroidism, or hypernatremia. Antipyretics are not effective
This type of fever is caused by a defective heat loss mechanism that can’t cope with normal heat load,
what are the typical causes of those type of fever?
Heat stroke, poisoning with anticholinergic drugs, ectodermal dysplasia and burns are the cause of this kind of fever
All infants younger than two months with fever are considered to have what two serious illnesses
Sepsis or meningitis until proven otherwise
What type of fever is this:
Define has a fever of short duration, readily diagnosed and that resolves within one week
Short term fever
What type of fever is this:
Fever usually greater than 38.5°C or 101.2°F that last longer than two weeks on more than four occasions
Fever of unknown origin
Varicella, rubella, erythema infectiosum Show rash with fever after how many days?
One day
Scarlet fever shows a fever and rash and how many days?
Two days
Rocky mountain spotted fever shows a fever and rash after how many days?
Three days
Measles shows fever and rash after how many days?
Four days
Roseola infantum Shows fever and rash after how many days?
Five days
Hand foot and mouth disease shows fever and rash in how many days?
Three days
What are the early signs of aspirin overdose?
Early signs of vertigo and tinnitus
What is the Whitley index: 14 item self rating scale used for?
It is used for illness anxiety disorder which replaces hypochondriasis in DSM-5
What questionnaire is used for the five most common disorders in primary care: Depression, anxiety, alcohol, somatoform, and eating disorders
Prime-MD
Primary care evaluation of mental disorders
Also available as patient health questionnaire for self rating takes proximately three minutes
What are the three differential diagnoses for an older patient that presents with confusion
Delirium, dementia, and depression
Warnicke Korsakoff syndrome is caused by what?
Vitamin B 12 deficiency
Dementia affects what?
Dementia is a chronic generalized impairment of brain function that affects thinking but not the level of consciousness
Depression as a closet confusion especially older result is considered what type of cause of dementia?
Reversible cause of dementia
When anxiety symptoms are also present, depression can manifest as what?
Mild delirium
List the three diagnostic criteria for dementia with Lewy bodies
Only 2 out of the 3 need to be present
Fluctuating cognition with pronounced variations in attention and alertness, recurrent visual hallucinations are typically well formed and detailed, spontaneous motor features of parkinsonism
What are the 3 screening tools for dementia?
Mini mental status exam
Moca—Montreal cognitive assessment
Mini cog
What is the screening tool for depression?
PHQ – 9
Low-dose aspirin as indicated as what level prevention in patients with diabetes and increase cardiovascular risk?
Primary prevention
Low-dose aspirin is indicated for what level prevention and all patients with cardiovascular disease?
Secondary prevention
What type of ulcers generally occur about the medial or lateral malleolus?
Venous ulcers
What type of ulcers generally occur on the toes, metatarsal heads, shins?
Arterial ulcers
What is normal albumin/creatinin ratio?
Normal is less than 30
Microalbuminuria is what range
30-299
Macroalbuminuria is what range
Over 300
