Exam 3 HA Flashcards
1
Q
What are the signs of chronic sun damage?
A
- Numerous solar lentigines on shoulders and upper back
- Melanocytic nevi
- Solar elastosis
- Cutis rhomboidalis nuchae
- Actinic purpura
2
Q
What is the risk increase for melanoma from tanning bed use before age 35?
A
Increases risk by as much as 75%
3
Q
Define a macule.
A
Flat lesion <1 cm
4
Q
Define a patch.
A
Circumscribed flat area of change in color of the skin >1 cm in diameter
5
Q
What is a papule?
A
Small solid elevation of the skin <1 cm in diameter
6
Q
What is a plaque?
A
Large flatter elevation of the skin, sometimes formed by papules coalescing
7
Q
Define a vesicle.
A
Small circumscribed elevation of the epidermis containing clear fluid <1 cm in diameter
8
Q
What is a bulla?
A
Circumscribed elevation of the epidermis containing clear fluid >1 cm in diameter
9
Q
What is a pustule?
A
Small circumscribed elevation of the epidermis filled with purulent fluid
10
Q
What is a furuncle?
A
Inflamed hair follicle
11
Q
Define a nodule.
A
Solid elevation of the skin >1 cm in diameter that usually extends into the deeper skin layers
12
Q
What is a cyst?
A
Raised circumscribed encapsulated with a wall & lumen, filled with fluid or semisolid
13
Q
What is a wheal?
A
Circumscribed, raised lesion consisting of dermal edema, also known as hives or urticaria
14
Q
What are burrows?
A
Small linear or serpiginous pathways in the epidermis created by scabies mite
15
Q
What are erosions?
A
Loss of epidermal or mucosal epithelium
16
Q
What is an ulcer?
A
Deeper loss of the epidermis and at least the upper dermis
17
Q
Define petechiae.
A
Nonblanchable punctate foci of hemorrhage
18
Q
What does purpura refer to?
A
Nonblanchable, raised and palpable lesions caused by RBC leaving circulation
19
Q
What is the diameter threshold for a lesion to be concerning according to the ABCDE-EFG method?
A
> 6 mm
20
Q
What does the ‘A’ in the ABCDE-EFG method stand for?
A
Asymmetry
21
Q
What is a primary risk factor for melanoma?
A
Personal or family history of previous melanoma
22
Q
What is the recommended SPF for sunscreen to prevent skin cancer?
A
At least SPF 30
23
Q
What is the significance of intermittent sun exposure?
A
It appears to be more harmful than chronic exposure, particularly during childhood and adolescence
24
Q
What is the first sign of osteoporosis?
A
Prior fragility fracture
25
What age is considered a risk factor for osteoporosis?
Age ≥50 years
26
What is the USPSTF's recommendation for osteoporosis screening in women?
Grade B recommendation for women age ≥65 years
27
What is the greatest risk factor for subsequent fractures?
Previous low-impact fracture from standing height or lower
28
What does the STEADI Initiative focus on?
Screening community-dwelling older adults about risk for falls
29
What are some warning signs of headaches?
* Progressively frequent or severe headaches
* Sudden onset like a 'thunderclap'
* New onset after age 50
* Aggravated by position change
* Presence of cancer, HIV, or pregnancy
30
What are the components of the mental status examination?
* Appearance and behavior
* Level of consciousness
* Speech and language
* Mood and affect
* Thoughts and perceptions
* Insight and judgment
31
What should be assessed regarding a patient's speech?
* Quantity
* Rate
* Volume
* Articulation
* Fluency
32
What does 'affect' refer to in a mental status exam?
The fluctuating pattern of observable behaviors that expresses subjective feelings or emotions
33
What is a key characteristic to observe in a patient's facial expression?
Changes in expression appropriate to the topics being discussed
34
What should be observed in a patient regarding their openness and reactions?
The patient's openness, approachability, and reactions to others and the surroundings
35
What is language defined as?
A complex symbolic system for expressing, receiving, and comprehending words
36
What characteristics of a patient's speech should be noted during an interview?
* Quantity
* Rate and Volume
* Articulation of Words
* Fluency
37
What does dysarthria refer to?
Defective articulation
38
What is aphasia?
A disorder of language
39
What is dysphonia?
Impaired volume, quality, or pitch of the voice
40
What does fluency reflect in speech?
The rate, flow, melody, content, and use of words
41
What are paraphasias?
Words that are malformed, incorrect, or invented
42
What range of moods should be assessed in a patient?
* Sadness
* Contentment
* Joy
* Anger
* Anxiety
* Detachment
43
What is thought process in the context of a mental assessment?
The logic, organization, coherence, and relevance of the patient’s thoughts
44
What is circumstantiality?
A thought process where a person provides excessive detail, often seen in obsessions
45
What is confabulation?
The fabrication of memories, often seen in Korsakoff syndrome
46
What are the abnormalities of thought process listed?
* Blocking
* Circumstantiality
* Clanging
* Confabulation
* Derailment
* Echolalia
* Flight of ideas
* Incoherence
* Neologism
* Perseveration
47
What does thought content include?
What the patient thinks about, including insight and judgment
48
What are the two types of abnormal perceptions?
* Hallucinations
* Illusions
49
What are hallucinations?
Perception-like experiences that seem real but lack actual external stimulation
50
What is insight in a mental health context?
Awareness of symptoms or disturbed behaviors as normal or abnormal
51
What is judgment in mental health assessment?
The process of evaluating alternatives when deciding on a course of action
52
What are the components of cognitive function?
* Orientation
* Attention
* Memory
* Higher cognitive functions
53
What does orientation refer to?
Awareness of personal identity, place, and time
54
What is digit span used to test?
The patient's ability to concentrate and recall numbers
55
What is the normal score for digit span forward and backward?
At least five digits forward and four backward
56
What does memory involve?
The process of registering or recording information
57
What are the three D's in cognitive assessment?
* Delirium
* Dementia
* Depression
58
What is delirium characterized by?
An acute, often reversible, confusional state with fluctuating levels of consciousness
59
What is dementia?
A chronic, progressive decline in cognitive function affecting memory and thinking abilities
60
What is depression defined as?
A mood disorder characterized by persistent feelings of sadness and lack of interest
61
What is the function of the olfactory nerve (CN I)?
Sense of smell
62
How is the olfactory nerve tested?
Have patient identify familiar scent with each nostril
63
What is the function of the optic nerve (CN II)?
Vision
64
What tests are used for the optic nerve?
* Snellen chart
* Visual fields by confrontation
* Fundoscopic exam
65
What is the normal muscle strength grading scale?
0 to 5 scale: 5 is normal, 0 is no contraction
66
What does light touch testing involve?
Using a cotton swab to the skin and comparing bilaterally
67
What is the normal response for pain testing?
Can correctly distinguish sharp from dull
68
What does the vibration test assess?
The ability to feel vibration on a bony prominence
69
What is proprioception testing?
Moving a finger or toe and asking the patient to identify direction with eyes closed
70
What is graphesthesia?
Tracing a number/letter on palm and asking the patient to identify it
71
What does stereognosis testing involve?
Placing a familiar object in hand and asking the patient to identify it
72
What is the definition of Graphesthesia?
The ability to identify a number or letter traced on the palm with eyes closed.
Inability to identify suggests cortical dysfunction.
73
What is Stereognosis?
The ability to identify a familiar object placed in the hand with eyes closed.
Inability to identify indicates asterognosis, which is a parietal lobe issue.
74
What is the grading scale for reflexes?
* 4: Very brisk, with clonus
* 3: Brisker than average
* 2: Average; normal
* 1: Somewhat diminished
* 0: Reflex absent
Reflex response depends partly on the force of the strike on the tendon.
75
What are the key components to assess in a mental status exam?
* Appearance and behavior
* Speech and language
* Mood and affect
* Thoughts and perceptions
* Insight and judgment
* Cognition
Each component assesses different aspects of mental functioning.
76
What are the CAGE questions used for?
They are used to screen for alcohol use disorders.
Questions include cutting down, annoyance when criticized, guilty feelings, and eye openers.
77
What is the scoring range for the Mini-Cog assessment?
0 to 3, with 0 indicating dementia and 3 indicating non-dementia.
The assessment includes recalling three words and a clock drawing test.
78
What does the Montreal Cognitive Assessment (MoCA) assess?
Attention, executive functions, memory, language, visuoconstructional skills, conceptual thinking, calculations, and orientation.
A score of 26 and above is considered normal.
79
What are the criteria for diagnosing delirium using the Confusion Assessment Method (CAM)?
* Acute change in mental status
* Inattention
* Disorganized thinking or abnormal level of consciousness
Diagnosis requires criteria 1 and 2 plus either 3 or 4.
80
What is the total score range for the PHQ-9 depression screening tool?
0 to 27.
Scores indicate severity from none to severe depression.
81
What are the GAD-7 questions used to assess?
The severity of generalized anxiety disorder symptoms.
Questions include feeling nervous, worrying too much, and trouble relaxing.
82
What are common warning signs of suicide?
* Feeling like a burden
* Increased anxiety
* Expressing hopelessness
* Making plans for suicide
These signs warrant immediate attention.
83
What are the four signs of inflammation?
* Swelling
* Warmth
* Redness
* Pain
Recognizing these signs is crucial for diagnosing inflammatory conditions.
84
What is the mnemonic IPROMS used for?
To remember the systematic approach to the musculoskeletal exam: Inspection, Palpation, Range of Motion, and Special maneuvers.
This helps ensure a thorough examination.
85
How is muscle strength graded?
* 5: Normal strength
* 4: Active movement against resistance
* 3: Active movement against gravity
* 2: Active movement with gravity eliminated
* 1: Flicker or trace of contraction
* 0: No contraction
This grading helps assess neuromuscular function.
86
What is the positive sign for the Neer test?
Pain during the maneuver suggests subacromial impingement or rotator cuff tendonitis disorder.
This test evaluates shoulder conditions.
87
What does a positive Apley scratch test indicate?
Pain suggests a rotator cuff disorder or adhesive capsulitis.
This test assesses overall shoulder rotation.
88
What is the significance of a score of ≥10 on the GAD-7?
It is the typical cutoff for identifying Generalized Anxiety Disorder and may warrant further evaluation or treatment.
Helps monitor treatment progress over time.
89
What are red flags for low back pain?
* Age <20 or >50
* History of cancer
* Unexplained weight loss
* Pain lasting more than 1 month
* History of intravenous drug use
These factors suggest a more serious underlying condition.
90
What is the Hawkins impingement sign?
Flex the patient's shoulder and elbow to 90 with the palm facing down, then rotate internally with one hand on the forearm and one on the arm.
91
What conditions are associated with supraspinatus impingement?
RTC tendonitis, pain.
92
List the strength tests used for shoulder assessment.
* External rotation lag test
* Internal rotation lag test
* Drop arm test
93
What is indicated by an inability to maintain external rotation during a strength test?
Supraspinatus rotator cuff tear or bicipital tendinitis.
94
What is the lift off test used to assess?
Weakness in the subscapularis.
95
What are the composite tests for shoulder disorders?
* External rotation resistance test
* Empty can test
96
What does limited external rotation suggest?
Glenohumeral disease or adhesive capsulitis.
97
What does the Finkelstein test assess?
Tenosynovitis.
98
What symptoms indicate a positive carpal tunnel test?
Aching and numbness over the median nerve.
99
What does the McMurray test assess?
Medial and lateral meniscus tears.
100
What does pain or gap in the medial joint line indicate?
Medial collateral ligament injury.
101
What does the anterior drawer sign test for?
Anterior cruciate ligament injury.
102
What is a significant finding in the Lachman test?
Significant forward excursion of the tibia.
103
What does the posterior drawer test assess?
Posterior cruciate ligament injury.
104
What does the Spurling test indicate?
Cervical nerve root compression.
105
What does a straight leg raise test for?
Lumbosacral disc herniation.
106
What does the talar tilt test assess?
Subtalar joint ligamentous injury.
107
What does the Thompson test evaluate?
Integrity of the Achilles tendon.
108
What does the Barlow-Ortolani maneuver test for?
Unstable hips.
109
What does the Galeazzi or Allis sign indicate?
Unequal leg length or hip dislocation.
110
What is indicated by a weak hip abductor muscle during the Trendelenburg test?
Iliac crest drops when bearing weight on that side.
111
What does asymmetrical rise in the thoracic or lumbar region suggest?
Scoliosis.
112
Fill in the blank: A fluid-filled lesion that is elevated is called a _______.
vesicle.
113
True or False: Skin cancer prevention is not important for the test.
False.
114
What is the most common form of cancer in the U.S.?
Skin cancer
115
Name the three main types of skin cancer.
* Basal Cell Carcinoma (BCC)
* Squamous Cell Carcinoma (SCC)
* Melanoma
116
Which type of skin cancer is the most aggressive?
Melanoma
117
List intrinsic risk factors for skin cancer.
* Fair skin
* Blue/green eyes
* Blond or red hair
* Family history of skin cancer or melanoma
* Genetic syndromes (e.g., xeroderma pigmentosum)
118
What are extrinsic risk factors for skin cancer?
* UV radiation exposure
* Severe or blistering sunburns
* Occupational exposure to arsenic or coal tar
* Immunosuppression
* Chronic non-healing wounds or burns
119
What does USPSTF recommend for high-risk patients regarding skin exams?
Routine full-body skin exams
120
What is the ABCDE-EFG criteria used for?
To inspect for melanoma
121
What does 'A' in ABCDE criteria stand for?
Asymmetry
122
Fill in the blank: Use broad-spectrum sunscreen with SPF _______ and reapply every 2 hours.
30+
123
What are some primary prevention strategies for skin cancer?
* Sun protection
* Education about UV risk
* Self-exam techniques
124
What age should women begin DEXA screening for osteoporosis?
65+ years
125
What tool can estimate fracture risk in osteoporosis screening?
FRAX tool
126
List some risk factors for osteoporosis.
* Postmenopausal women
* Family history of osteoporosis
* Long-term corticosteroid use
* Sedentary lifestyle
* Smoking and alcohol use
127
What type of exercises are recommended for osteoporosis prevention?
Weight-bearing exercises
128
What is the Timed Up and Go (TUG) Test used for?
To assess fall risk in older adults
129
What defines delirium?
Acute, fluctuating confusion with inattention and disorganized thinking
130
What are common causes of dementia?
* Alzheimer’s disease
* Vascular dementia
131
What are screening tools for depression?
* PHQ-2
* PHQ-9
132
What does the SIGECAPS mnemonic stand for?
* Sleep
* Interest
* Guilt
* Energy
* Concentration
* Appetite
* Psychomotor
* Suicidal thoughts
133
What is the strongest predictor of future suicide attempts?
Previous attempt
134
What are common classes of misused prescription drugs?
* Opioids
* Benzodiazepines
* Stimulants
135
What is a significant red flag indicating a possible stroke?
Sudden numbness or weakness of the face, arm, or leg
136
What is the recommended screening question for fall risk?
Did you fall in the past year?
137
What does the acronym OLD CARTS stand for in history taking?
* Onset
* Location
* Duration
* Character
* Aggravating/Alleviating
* Radiation
* Timing
* Severity
138
What should be assessed in the mental status exam?
* Appearance/Behavior
* Mood/Affect
* Thought Process
* Thought Content
* Cognition
* Speech/Language
139
What are the components assessed in the mental status examination?
1) Appearance and behavior 2) Speech and language 3) Mood and affect 4) Thoughts and perceptions 5) Insight and judgment 6) Cognition
140
What does the level of consciousness indicate in a mental status examination?
Alertness, lethargy, obtundation, stupor, coma
141
What aspects are evaluated under 'posture and motor behavior'?
Relaxation, tension, restlessness, motor activity, immobility
142
What can impaired grooming and personal hygiene indicate?
Depression, schizophrenia, dementia, obsessive–compulsive disorder
143
What types of speech characteristics should be noted during assessment?
Quantity, rate, volume, articulation, fluency
144
What is dysarthria?
Defective articulation
145
What is the significance of fluency in speech assessment?
Reflects the rate, flow, melody, and content of speech
146
What should be assessed when evaluating a patient's mood?
Usual mood level, fluctuations related to life events
147
What are the types of thought process abnormalities?
* Blocking * Circumstantiality * Clanging * Confabulation * Derailment * Echolalia * Flight of ideas * Incoherence * Neologism * Perseveration
148
What are the two types of abnormal perceptions?
* Hallucinations * Illusions
149
What does insight refer to in a mental health context?
Awareness of symptoms or disturbed behaviors as normal or abnormal
150
How is judgment assessed during a mental status examination?
By evaluating responses to family situations, jobs, and interpersonal conflicts
151
What are the key components of cognition?
* Orientation * Attention * Memory * Higher cognitive functions
152
What does orientation assess?
Awareness of personal identity, place, and time
153
What is the purpose of the digit span test?
To assess attention and concentration
154
What should be noted when testing memory?
Immediate repetition, storage, and retention of information
155
How is higher cognitive function evaluated?
Through vocabulary, information fund, abstract thinking, calculations, construction
156
What is the function of cranial nerve I?
Olfactory - Smell test
157
What indicates a loss of function in cranial nerve II?
Anosmia
158
What tests are performed for cranial nerves III, IV, and VI?
EOMs, PERRLA
159
What does a score of 0 in muscle strength indicate?
No movement
160
What is the normal score for muscle strength on a scale of 0-5?
5 - Normal
161
What does a patient exhibiting flat affect indicate?
Lack of emotional expression
162
What does circumstantiality in thought processes refer to?
Excessive detail in responses that eventually lead to the point
163
What are the signs of a patient in a manic episode?
Agitated and expansive movements
164
What is the significance of assessing facial expression during a mental status exam?
To observe emotional responses and immobility
165
Fill in the blank: The inability to articulate words clearly is known as _______.
dysarthria
166
True or False: Hallucinations are sensory awareness of real external stimuli.
False
167
What might labile affect indicate?
Fluctuating emotional states
168
In cognitive function, what does 'new learning ability' evaluate?
Ability to learn and recall new information
169
What are the components of the motor system assessment?
Inspection, Tone, Strength (Grade 0–5 scale)
## Footnote
Each component assesses different aspects of motor function.
170
What does a strength grade of 0 indicate?
No movement
This is the lowest grade on the strength scale.
171
What does a strength grade of 5 indicate?
Normal
This indicates full strength against resistance.
172
Which muscle groups are tested for deltoid strength?
C5
The deltoid is primarily innervated by the C5 nerve root.
173
What is the grading scale for Deep Tendon Reflexes (DTRs)?
0 to 4+
This grading scale assesses the reflex response.
174
What does a DTR grade of 2+ indicate?
Normal
This indicates a normal reflex response.
175
What is the Babinski reflex indicative of?
UMN lesion
A positive Babinski sign indicates an upper motor neuron lesion.
176
What are the key components of a mental status exam?
Appearance, Behavior, Attitude, Speech, Mood, Affect, Thought Process, Thought Content, Perception, Cognition, Insight/Judgment
These components help evaluate a patient's mental state.
177
What does the PHQ-2 screening tool assess?
Depression
It includes questions about feeling down or losing interest.
178
What are the warning signs of suicide?
Feeling like a burden, Increased anxiety, Talking about wanting to die
These signs may indicate a need for immediate intervention.
179
What is a key red flag in health history when evaluating joint or back pain?
History of cancer
This may indicate possible bone metastases.
180
What does the Inspection component of a musculoskeletal assessment look for?
Asymmetry, deformities, swelling, erythema, muscle atrophy, gait abnormalities
These observations help identify musculoskeletal issues.
181
What does the Thompson Test assess?
Achilles rupture
A positive test shows no plantarflexion when the calf is squeezed.
182
What is the ABCDE-EFG criteria used for?
Melanoma assessment
It helps evaluate skin lesions for potential malignancy.
183
What is a common characteristic of Basal Cell Carcinoma (BCC)?
Pearly papule with telangiectasia
BCC often bleeds easily and is commonly found on sun-exposed areas.
184
What does the acronym SIGECAPS stand for in depression screening?
Sleep changes, Interest (loss), Guilt, Energy (low), Concentration difficulties, Appetite changes, Psychomotor changes, Suicidal thoughts
These are symptoms to assess for depression.
185
What does a strength grade of 1 indicate?
Flicker
This means there is a trace muscle contraction without movement.
186
What is the significance of the Mini-Cog screening tool?
Cognitive decline assessment
It combines 3-word recall and clock drawing.
187
What does a DTR grade of 4+ indicate?
Very brisk, with clonus
This suggests heightened reflex activity, often seen in upper motor neuron lesions.
188
What is a characteristic feature of Squamous Cell Carcinoma (SCC)?
Firm red nodule or scaly lesion
SCC can ulcerate and is often found on sun-exposed skin.
189
What is the purpose of the CAGE questionnaire?
Substance use disorders screening
It assesses alcohol use and dependency.
190
What does the term 'proprioception' refer to?
Awareness of body position
It is assessed by asking patients to identify toe/finger positions.
191
What is the significance of the Ottawa Ankle Rules?
Determine need for x-ray
They help assess whether a patient requires imaging based on specific pain and tenderness.
192
What does a strength grade of 3 indicate?
Active against gravity
This means the patient can move the limb against gravity but not against resistance.
193
What is a primary skin lesion?
Lesion that arises from previously normal skin
Examples include macules, papules, and vesicles.
194
What is the importance of documenting a mental status exam?
To track cognitive and emotional changes
Clear documentation helps in assessing patient progress and treatment effectiveness.
195
What does the term 'hypesthesia' refer to?
Reduced sensitivity to sensory stimuli
It is often assessed during sensory system evaluations.
196
What is the significance of the Straight Leg Raise test?
L5-S1 radiculopathy assessment
Pain during this test can indicate nerve root issues.
197
What are secondary skin lesions?
Lesions that evolve from primary or due to external forces
Examples include ulcers, scars, and crusts.
198
What is one method to protect against sun damage for infants under 6 months?
Hats, clothing, shade
Sunscreens are not approved for use under 6 months of age.
199
What should be advised to adolescents regarding sun exposure?
Cumulative sun damage and social pressures to tan
It's important for adolescents to understand the long-term effects of sun exposure.
200
What correlation exists between lifetime sun exposure and skin cancer risk?
Increasing lifetime exposure correlates directly with increasing risk of skin cancer.
201
Which type of sun exposure is more harmful during childhood and adolescence?
Intermittent sun exposure
This type of exposure is particularly harmful compared to chronic exposure.
202
What are the best practices for sun protection to prevent skin cancer?
Limit time in the sun, avoid midday sun, use sunscreen, wear protective clothing
Long sleeves and wide-brimmed hats are recommended.
203
What SPF is recommended for sunscreen use?
At least SPF 30 with broad spectrum protection.
204
When should sunscreen be reapplied?
Every 2 hours when outdoors and after being in the water.
205
What does the AAD recommend regarding sunscreen use?
Use sunscreen to cover all exposed skin whenever going outside, even on cloudy days.
206
What are signs of chronic sun damage?
Numerous solar lentigines, melanocytic nevi, solar elastosis, cutis rhomboidalis nuchae, actinic purpura
## Footnote
These are visible signs of prolonged sun exposure.
207
How much does using tanning beds before age 35 increase the risk of melanoma?
By as much as 75%.
