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exam 2 Flashcards

1
Q

geriatric HEENT

A 
temporal arteritis
decreased lens accomadation
presbycusis
poor dentition/false teeth
decreased olfaction
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2
Q

geriatric chest and lung exam

A

kyphotic changes -> decreased lung capacity

increased risk of breast cancer

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3
Q

geriatric CV exam

A

thrills and bruis

murmurs much more prevalent after 80

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4
Q

geriatric abdominal exam

A

compression fractures -> altered contour
often present atypical/asymptomatic
perforation, ischemia, inflammation, bleeding

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5
Q

geriatric GU exam

A

prostatic hypertrophy
vaginal and labial atrophy
squamous cell cancer
vaginal bleeding

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6
Q

geriatric MSK exam

A

deformities related to arthritis

compression fractions and kyphosis

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7
Q

geriatric neuro exam

A

olfaction
cognition
gag/speech- aspiration
gait

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8
Q

focus of geriatric care

A

reduce nursing home placement
reduce hospitalization
quality vs quantity of life (what are the patients goals of care)
socio-econoic issues

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9
Q

falls H&P

A 
full Hx including meds
lower extremity weakness
gait and and balance
vision
arthritis
pain
neuro exam
CV exam
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10
Q

Falls- lab tests

A

CBC, blood chem, EKG, HbAC1, holter monitor, Vit D

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11
Q

falls- treatment

A

PT and OT
medication review (reduce)
pacemaker
treat underlying conditions

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12
Q

urinary incontinence

A 
more common in females
types:
-stress
-urge
-overflow
-functional
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13
Q

evaluation of urinary incontinence

A

fnx alertness, CHF, abdominal, genital exams
CBC, U/A, blood sugar, imagins, culture
post void residual

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14
Q

causes of urinary incontinence

A 
DIAPERS
drugs
infection
atrophic vaginitis
psychiatric
endocrine
restricted mobility
stool impaction
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15
Q

urge incontinence

A

bladder training/toilet schedule
medication- anticholinergic for detrusor stability
reduce/eliminate caffeine
treat underlying infection

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16
Q

stress incontinence

A

kegels
meds- estrogen? alpah adrenergic agonists
surgery- urethropexy or pubovaginal sligns
pessary- uteriine prolapse

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17
Q

overflow incontinece

A 
important to treat for preservation of renal fnx
post void residual volume elevated
fecal impaction
prostatic enlargement 
meds- finasteride, alpha adrenergic antagonists
treatment w/augments voiding maneuvers:
-suprapubic pressure
-valsalva maneuver
-intermittent catheterization
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18
Q

causes of constipation

A

meds- opiates, anticholinergics, antidopaminergics, CaCh blockers
mechanical obstruction- tumor, prolapse, adhesions
neuro- CVA, MS
systemic- hypothyroid, diabetes, inflammation, electrolyte disorders
dehydration and inactivity

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19
Q

constipation H&P

A 
meds, fluid intake, disease Hx
Abdominal distention and pain
rectal exam- tone, impacted stool, hemorrhoids, stricutes, or fissures
neuro exam (rectal tone)
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20
Q

constipation tests

A

electrolytes, BUN, creatinine, TSH, Ca
colonoscopy
ab Xray
CT

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21
Q

contipation treatment

A 
bulk laxatives (don't use w/opiate induced)
osmotic agents
enemas
stool softener
hydration
maintaing physical activity
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22
Q

pressure ulcers

A

ischemic soft tissue injury usually over a boney prominence
risk factors- immobility, poor nutrition, incontinence, vascular insufficiency, altered level of consciousness
braden scale to access risk

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23
Q

treatment of pressure ulcers

A

prevention- pressure relieving devices/mattresses, turning and barrier creams, reduce moisture
antibiotics, bandages

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24
Q

cognitive impairment

A

benign senescent forgetfulness

dementia

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25
Q

deression

A

inadequate finances, loss of spouse/children, fnxal decline
widely under recognized due to its non-specific presentation
pseudo-dementia

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26
Q

sensory impairment

A 
increased safety risks
olfaction -> spoiled food
vision loss
hearing loss -> isolation, frustration
decreased thirst perception
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27
Q

dementia

A 
presents as slow progressive disease
impaired memory and learning
behavior and personality changes
hallucinations
safety -> wondering, high risk for injury
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28
Q

causes of dementia

A 
B-12 deficiency
normal pressure hydrocephalus
neurosyphillis 
hypothyroidism
seizure disorder
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29
Q

types of dementia

A 
multi-infarct (vascular) 
lewy body
alcoholic 
parkinsons disease
alzheimers 
pseudo-dementia (depression)
picks disease
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30
Q

dementia H&P

A

meds and substance Hx
living and safety arrangements
basic activities of daily living (ADLs)
instrumental activities of daily living (IADLs) aka executive fnxs
weight loss, missed appointment, inappropriate phone calls, repeatedly wearing same clothes, driving
MMSE, GDS

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31
Q

management of dementia

A 
rule out reversible cause
cholinesterase inhibitors and/or NMDA receptor antagonists
antidepressents
structured day
simple calm direct communication
reorientation 
realistic goals
attention to safety
agitated or agreeive
restraints
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32
Q

polypharmacy

A

greater than 5 meds
drug interactions
med errors
altered pharmacodynamics and kinetics

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33
Q

components of mental status exam

A 
appearance and behavior
affect/mood
language/speech
thoughts/perceptions
cognitive/executive
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34
Q

lethargic

A

awake, but tending to fall asleep w/out gentle stimulation

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35
Q

stuporous

A

falling asleep unless vigorously stimulated

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36
Q

comatose

A

a sleep like stance from which the patient cannot be awakened

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37
Q

anomia

A

cannot name common objects

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38
Q

dysphasia

A

impairment in use of speech

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39
Q

dysarthria

A

imperfect articulation due to lack of motor coordination

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40
Q

apraxia

A

inability to turn verbal command into motor performance

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41
Q

thoughts/perceptions

A

process
content
insight
judgement

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42
Q

process

A

coherence

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43
Q

content

A

phobias, anxieties, obsessions, delusions

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44
Q

insight

A

ability to understand own problem

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45
Q

judgement

A

appropriate decisions/actions

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46
Q

cognative

A

orientation
attention
memory

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47
Q

executive

A

abstract thinking/insight
calculation
constructional ability

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48
Q

orientation

A

person, place, time

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49
Q

testing insight

A

proverbs
situational questions
similarities

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50
Q

mini mental exam status

A

23-30 normal
19-23 borderline
<19 impaired

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51
Q

cerebellar testing

A

gait
heel to knee and slide down shin
rhomberg/pronator drift

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52
Q

rhomberg

A

stand with feet close and close eyes

PCML test

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53
Q

pronator drft

A

contralateral corticospinal tract

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54
Q

pupillary reflex

A

II and III

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55
Q

esotropia

A

medial deviation

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56
Q

exotropia

A

lateral deviation

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57
Q

IV

A

moves eye down and out

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58
Q

gag reflex

A

sensory- IX

motor- X

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59
Q

3 layers of skin

A

epidermis
dermis
sub Q

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60
Q

phases of hair

A

catagen phase- transitional 3%
telogen phase- resting phase 10-15%
anagen- growing phase- 85-90%

61
Q

clubbing of nails

A

rounding, soft, spongy

congenital, chronic hypoxia, heart disease, lung cancer, hepatic cirrhosis

62
Q

psoriasis of nails

A

small pits thick nail

63
Q

mee’s lines

A

change in color due to acute or chronic illness

64
Q

beau’s lines

A

actual depression in nail due to chronic or acute illness

65
Q

brown skin

66
Q

yellow skin

A

carotene, bilirubin

67
Q

red skin

A

carboxyhemoglobin, polycythemia

68
Q

blueish-red skin

A

deoxyhemoglobin

69
Q

things to check on skin exam

A

moisture
temp
texture
mobility and turgor

70
Q

tinea

A

groin and feet

71
Q

lues

A

aka syphilis

hands

72
Q

macule

A

circumscribed change in color
flush w/surrounding skin
lesion <1 cm

73
Q

examples of macule

A

solar lentigo

traumatic purpura

74
Q

patch

A

circumcised change in skin color
flush with w/surrounding skin
lesion > 1cm

75
Q

patch examples

A

cafe au lait spot

vitiligo

76
Q

papule

A

solid or cystic elevation

< 1cm

77
Q

examples of papule

A

acne

eruptive xanthoma

78
Q

nodule

A

solid or cystic elevation

>1 cm < 2cm

79
Q

examples of nodule

A

dermatofibroma

80
Q

tumor

A

a solid or cystic elevation

>2 cm

81
Q

tumor example

A

follicular cyst

82
Q

plaque

A

an elevated lesion

>1cm

83
Q

examples of plaque

84
Q

scale

A

desiccated, thin plates of cornified epidermal cells that form flakes on skin surface

85
Q

examples of scale

A

ichthyosis

86
Q

wheal

A

circumscribed elevated lesion containing clear serous or hemorrhagic fluid
red, blanche w/pressure
< 1 cm

87
Q

examples of wheal

A

contact dermatitis

herpes simplex

88
Q

bulla

A

circumscribed elevated lesion containing clear serous or hemorrhagic fluid
> 2cm

89
Q

examples of bulla

A

bullous pemphigoid

90
Q

atrophy

A

a depression from surface of skin w/loss of all or part of epidermis or dermal substance

91
Q

atrophy example

A

lichen sclerosis et atrophic

92
Q

erosion

A

a depression from the surface of skin w/loss of all or part of epidermis
can be secondary lesion

93
Q

ulcerations

A

a depression from the surface of the skin w/loss of entire epi and at least some of dermis
can be secondary lesion

94
Q

examples of erosion

A

burn

ruptured bulla

95
Q

examples of ulceration

A

ecthyma

excoriation of acne papule

96
Q

lichenifcation

A

seconday

dry leathery thick skin w/exaggerated skin markings

97
Q

lichenification example

A

chronic eczema

98
Q

scar

A

secondary

elevated or depressed area of fibrosis of dermis or sub Q tissue resulting from an antecedent destructive process

99
Q

fissure

A

secondary

a deep linear split in skin extending thru epi

100
Q

crust

A

dried exudates of serum, blood, sebrum, or purulent material on surface of skin

101
Q

examples of fissure

A

traumatized eczema

102
Q

examples of crust

A

acute and or secondarily infected eczema

103
Q

ABCDE

A 
A- asymmetry
B- border irregular
C- variation or change in color, especially blue or black
D- diameter > 6mm
E- elevation
104
Q

basal cell carcinoma

A

pearl white

rodent ulcer

105
Q

geographic

A

mycosis fungoides

106
Q

serpiginous

A

tinea corporis

107
Q

annular

A

tinea faciale

108
Q

heliotrope

A

over and around eyelids

109
Q

staph

110
Q

strep

111
Q

herpes

A

multinucleated giant cells

112
Q

hyperopia

A

farsightedness, can’t see up close

113
Q

myopia

A

nearsightedness, can’t see far away

114
Q

presbyopia

A

aging vision, progressive difficulty seeing near objects

115
Q

heterophoria

A

failure of visual exes to remain parallel

116
Q

esophoria

A

deviates medially

117
Q

exophoria

A

deviates outward

118
Q

blepharitis

A

inflamed lid margins

119
Q

entropion

A

eyelids turn inward

120
Q

ectropion

A

eyelids turn outward

121
Q

osterogenesis imperfecta

A

blue sclera, hypocalcemic

122
Q

anisocoria

A

unequal pupils greater then .5mm

123
Q

pinguecula

A

small nodule on bulbar conjunctiva, does not cross over to cornea

124
Q

pterygium

A

thickening of bulbar conjuctiva which grows across cornea

125
Q

sty

A

infection at margin of eyelid

126
Q

chlazion

A

painless nodule involving meiobomian gland

127
Q

xantehlasma

A

flat yellow plaques found under eye

associated w/hyperlipidemias

128
Q

subconjuctivial hemorrhage

A

leakage of blood under conjuctiva
painless sharply demarcated
resolves on own

129
Q

ciliary injection

A

inflammation of radiating vessesl around limbus

emergency

130
Q

hyphema

A

blood in ant chamber, trauma

131
Q

galcomatous cupping

A

increased IOP causes increases disc cupping

physiologic cup more then half disc diameter

132
Q

cotton wool patches

A

infarcted n fibers

133
Q

brachioradialis

134
Q

biceps

135
Q

Triceps

136
Q

patellar

137
Q

Achilles

138
Q

PNS disorders

A 
polio, amyotrophic lateral sclerosis (ALS)
herniated disc
carpel tunnel, bells palsy
diabetes, alcoholic neuropathy
myesthenia gravis
muscular dystrophy
139
Q

anterior horn cell

A

polio, ALS
fasiculations and weakness in segemental pattern
sensation intact
weak DTR

140
Q

spinal n roots

A

herniated dsic
dermatomal sensory changes
weakness -> atrophy
weak DTR

141
Q

peripherhal mononeuropathy

A

carpel tunnel, bells palsy
weakness and sensor loss in peripheral n distribution
weak DTR

142
Q

peripheral mononeuropathy

A

diabetes, alcoholic neuropathy
weakness and sensory loss in stocking glove distribution
weak DTR

143
Q

neuromuscular jnx

A

myasthenia gravis
mm fatigability
sensation intact
DTR intact

144
Q

muscle

A

muscular dystrophy
weakness primarily in prox mm
sensation intact
DTR intact or possibly decreased

145
Q

upper brachial plexus injury

A

waiters tip

146
Q

median n

A

damage in C6-T1
ape hand
resisting pronation reproducing symptoms

147
Q

ulnar n

A

damage in C6-8 region

claw hand

148
Q

radial n

A

wrist drop

PCM II (2 decks)

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