Exam 2 Flashcards
Mini mental state exam
Most widely used
Mini cog
3 unrelated words
Clock face
Glasgow coma scale
3 is the lowest
15 highest score
Scores on eyes, verbal, and motor to stimuli
Peds mental health
Edinburgh for PPD 0-2 months
Ages and stages questionnaires 4-60 months
Social and emotional scale
Pediatric evaluation of developmental status 0-8 yrs
PHQ 9 for adolescents
Neuro evaluation for coordination and fine motor skill
Accuracy of upper and lower extremity movements
Rapid rhythmic alternating movements
Nose to finger test
Balance test
Romberg test
Stand with feet together and arms at side and close eyes
If they sway this is a positive finding
Face sensory
Use cotton tip and touch face eye closed and see if they can pinpoint location
Cortical sensory
Vibration of tuning fork over joints or bony prominent
Two point discrimination
Sharp and dull on cotton top application
And if they feel one or two objects
Stereognosis
Identity object by touch
Example close eyes place key in hand
Graphesthesia
Eyes closed draw letter or number on palm of hand
Deep tendon reflexes
0-4, 4+ hypperreflexia,2 normal
Plantar flexion
Agnosia
Loss of vision- occipital
Loss of Auditory- temporal
Loss of tactile- parietal
Loss of body and relation- parietal
Aphasia
Auditory receptive- temporal aka wernickes
Expressive speaking- inferior posterior frontal area aka brocas
Visual- receptive- parietal and occipital
Expressive writing- posterior frontal area
Meningeal sign
Patient supine slip hand under head and rise flexing neck
Brudzinski- involuntary flexion of hips and knees when flexing neck
Kernig- flex leg at knee and hip and attempt to straighten leg pain in lower back and resistance is felt
Beevors sign
Abdominal reflex
Rebound on McBurney’s point
Appendicitis
Iliopsoas test
Patient raises leg against resistance positive if pain in RLQ
Obdurator test
Hip knee flexed and rotated leg mediallly and laterally positive if pain in RLQ
Markle test
Tap patient on heel or have drop heel from floor to toe raise position
Murphy test
Press on RUQ under ribs abrupt cessation of inspiration of with palpating if gallbladder is positive
Muscular response
0-5
5 is normal for full muscle strength
Pregnancy skin changes
Itching papules or plaques worry when vesicles (herpes gestationis)
Abdomen to thighs and extremities
May indicate Kidney damage
Can have oily skin or scalp
Cholasma
Pregnancy neck changes
Thyroid palpable
May have hyper trophy with bruit due to to increased vascularity
Pregnancy eye changes
Increased vascularity
Vision may change assess for safety can you read fine print can you see while driving
Check for blurred vision or dark spots may be eclampsia s/s
Pregnancy ENT changes
Nasal congestion
Changes in hearing and bulging TM
Hyper trophy of gums
Gingivitis
Nose bleeds
Pregnancy chest and lung changes
Posture changes
Structural changes
R/V changes
Asthma variations may get better or get worse
Pregnancy heart changes
More volume
Increased HR
May hear murmurs physiologic and S3
Pregnancy vascular changes
BP watch 2nd trimester
3rs can have complications
PIH is 30/15 increase from baseline
Plus visual disturbances, edema, urine protein or epigastric pain 🚩🚩🚩
Pregnancy beast and axilla change
Dark areoles
Striae
Increase in size
Assess for redness, edema or warmth or pain may be mastitis
Pregnancy changes abdomen
Bowl sounds moved
Structural changes
No liver or spleen changes
Pregnancy changes MSK
Gait changes
Discomfort
Spine changes
Carpel tunnel
Pregnancy changes neuro
DTR more pronounced
GTPAL
Gravida total pregnancies
T term pregnancies
P preterm pregnancies
A abortions
L living
Goodells sign
Softening of the cervix
Hegar sign
Softening of the uterine isthmus
McDonald’s sign
Fundus flexes easily on the cervix
Braun von fernwald sign
Fullness and softening of the fundus near the side of implantation
Piskacek sign
Palpable lateral bulge or soft prominence on one uterine cornu
Chadwick’s sign
Bluish cover of the cervix, vagina andvulva
Cullen sign
Bruising below, the belly button can indicate pancreatitis
Grey turners sign
A dirty green bruising developing the right flank indicated for pancreatitis
Tanner stage one breast
Pre-adolescence
Only nipple is raised above the level of the chest
Tanner stage two breast cancer
Body and stage but shaped elevation of the Areola
Areola increase in diameter in sounding area slightly elevated
Tanner stage three breast
Breast and Areola enlarge no contour separation
Tanner stage four breast cancer
Increasing fat deposits
Areola forms a secondary elevation above that of the breast this secondary mound occurs in approximately half of all girls in some cases, persistent adulthood
Tanner stage five breast
Adult stage
Areola is usually part of general breast, contour and strongly pigmented
Nipples project
Tanner stage one pubic hair
Pre-adolescence no growth of pubic hair
Tanner stage two a pubic hair
Initially, scarcely pigmented straight hair, especially along the medial border of the labia
Tanner stage three pubic hair
Parsley, dark visibly pigmented curly pubic hair on labia
Tanner stage four pubic hair
Hair course and curly abundant, but less than adult
Tanner stage five pubic hair
Lateral spreading type and triangle spread of adult hair to medial surface of thighs
Tanner stage six pubic hair
Further extension laterally upward or dispersed, only about 10% of adults
Tanner stage one for males
Testes scrotum and penis are the same size in shape as a young child
Tanner stage two for males
Enlargement of scrotum and testes the skin of the scrotum becomes red or thinner and wrinkled penis no larger or scarcely so
Tanner stage three for males
Enlargement of the penis, especially in length further enlargement of testes descendent of scrotum
Tanner stage four for males
Continued enlargement of the penis and sculpt rate of the glands increased pigmentation of the scrotum. The stage is sometimes best described as not quite adult.
Stage five Tanner for males
Adult stage scrotum, ample penis, reaching nearly to bottom of scrotum
Sports physical
Assess for posture and gentle muscle contour
Duck walk, four steps with knees completely bent
Spine for curvature and lumbar extensions, fingers touching toes with knees straight
shoulder and clavicle for dislocation
Neck, shoulder, elbows, forearm, hand, fingers, and hip ROM
Knee ligaments for drawer sign
Gait
Hop
Walking on heels and tiptoes
Primary assessments
Initial rapid assessment about 39 seconds to several minutes
Addresses BEL and rapid assessment for life threatening injuries
ABCDE- airway, breathing, circulation, disability exposure
Q5 minutes
Secondary assessment
Vitals and head to toe
History
AMPLE- allergies, medications, past illness, last meal, events precipitating
Assess for cervical spine injury
Fall from heater than 3 feet or 5 stairs
MVC with rollover or ejection
All terrain vehicle crash
Bicycle crash
Raccoon eyes
Bruising and swelling around eyes
May indicated basilar skull fracture or facial bone fracture
Ham man sign
Precordial crunching, clicking or knocking sound with heartbeat
May indicate hemothorax, acute mediastinitis, pneumonmediastinum, pneuomothorax, respiratory failure
Battle sign
Bruising and swelling behind either or both ears in line of posterior auricular artery
May indicate basilar skull fracture
Kehr sign
Severe pain in subscapular area of shoulder usually left
May indicate phrenic nerve irritation from rupture of spleen, ectopic pregnancy or GI disease
Which breast tanner stage corresponds to secondary Areola mound development above the breast
Stage 4
You have asked a patient to close his eyes and identify an object in his hand this is
Stereognosis
Inspection of the breast usually begins with the patient in which position
Sitting
You are seeing a 16 year old female gymnast she is athletic and thin radiography of an ankle injury reveals stress fracture you should question this patient about her
Menstrual cycle
The strength of the trapezius muscle is evaluated by having the patient
Push his or her head against the examiners hand
Which medical condition would exclude one from sports participation
Fever
You have a pregnancy patient in clinic she eats a well balanced diet and is usually having a daily BM
You should explain that constipation is common in pregnancy due to changes in Gi such as
Decrease movement through the colon and increase water absorption from stool
Environmental hazards and cognitive function are data needed for personal and social history section of a neurological assessment for
Every patient
A patient presents to the ER after a MVC the patient sustained blunt trauma to the abdomen and complains of pain to the upper left quadrant that radiates to the left shoulder what organ most likely rupture
Spleen
Which of the following is a concern rather than an expected finding in older adults
Bilateral pill rolling of the fingers
Female athlete triad
Low energy with or without eating disorder
Menstrual dysfunction
Low bone mineral density
Expected systolic blood pressure for children, one year or older
80+ (two times child’s age in years)
Three diagnosis for every disease
One that unifies what you have learned
One you cannot afford to miss
One that it actually is
Occam’s razor or Lex parsimoniae
Law of parsimony or law of succinctness
All findings should be unified into one diagnosis
This is not always true
More than one disease process can exist at one time
Autonomy
Right to choose
Beneficence
The act to promote good
Non maleficence
To avoid harm
Utilitarianism
Maximize overall wellbeing and happiness
Bayes theorem
Likelihood of your diagnosis being related to your findings depends on probability of those findings being associated with that diagnosis and prevalence of both that particular diagnosis and that combination of findings in the community in which you serve
Stage of behavioral change
Pre contemplation- not yet admitting problem
Contemplation admit there’s a problem but not ready to change
Preparation- intending to change in near future
