Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CCF > Exam I > Flashcards

Exam I Flashcards

1
Q

RASA stands for

A

Receive, Appreciate, Summarize, Ask

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

History and Physical is critical to providing a detailed picture of your patient and should include:

a. reason for encounter, relevant history, physical exam findings and prior diagnostic test results
b. assessment, clinical impression or diagnosis
c. medical plan of care
d. date and legible identity of observer
e. A and B

A

Answer: all of the above

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

True/False: Essential components of a History and Physical Exam include:

a. chief complaint
b. history of present illness
c. past medical history
d. past surgical history
e. family history
f. social history
g. allergies, medications
h. review of systems
i. physical exam
j. labs/imaging
k. assessment, plan

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

________ is a concise statement describing the reason for the encounter. It is stated in the patient’s words (point of view).

Ex: The patient complains of problems with breathing

A

Chief complaint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

_______ is a chronological description of the development of the patient’s present illness from the first sign/symptom or from previous encounter to present

A

History of present illness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

To Obtain A History of Present Illness (HPI), you can use OPQRSTA.

What does this stand for?

A 
O: Onset
P: palliatice/provocative
Q: Quality
R: Region/Radiation
S: Severity (Scale 1-10)
T: Timing/Treatment
A: Associated Symptoms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Onset

A

When did it start?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Palliative/Provokes

A

What makes the problem better? What makes it worse?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Quality

A

Is it sharp, dull, stabbing, aching?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Region/Radiation

A

Where does it hurt? Does it radiate anywhere?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Severity

A

On a scale of 0-10, how severe is the problem?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Timing/Treatment

A

Is it constant or intermittent? How long does it last? What time of day? DOes it wake you at night? What medicines used?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Associated symptoms

A

Are there any other symptoms associated? Headache, nausea, vomiting, weight loss?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the Medical Histories that should be assessed?

A
  1. PMH
    - - past illnesses/medical conditions
  2. PSdiseaseH
    - -operations/traumatic injuries and Tx
  3. Family Hx: 1st degree relatives
    - -hereditary;
  4. Social History
    - -age appropriate review of past and current use: alcohol, tobacco, illicit
    - -diet, occupation, marital status, history of STI’s
  5. Medications
  6. Allergies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

An inventory of body systems obtained by asking a series of questions to identify signs/symptoms

List the systems

A
  • Constitutional symptoms
  • –fever, weight loss
  • EENT
  • CV
  • Resp.
  • GI
  • GU

NOTE: can document pertinent systems and use “all other systems are reviewed and are negative”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q
  1. What fluids do NOT contain tansmissible infectious agents?
  2. What is the single most important means of preventing the spread of disease?
  3. Change coats and clean stethoscope
A
  1. sweat, non-intact and mucous membrane
  2. Hand washing
    - -concern for well-being
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

EKG: True/False: It is possible to measure the amplitude (height) and duration (width) of the P wave, QRS complex, ST segment, and T-wave

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

EKG: The first downward deflection of the QRS movement

They are likely to be in inferior leads (II, III< AVF) in more than half of normal adults.

A

Q waves

  • -duration and amplitude important for old heart attack
  • -not more than 0.04 duration or 0.5 mV
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

EKG: ST segment can aid in identifying what pathological conditions?

A

Myocardial infarction

  • ST elevation
  • point of J (beginning of ST segment)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

EKG: The T-wave represents part of ventricular repolarization. It is positive in all leads EXCEPT:

A

aVR (down deflection)

*normal T-wave (assymetric shape - peaks close to end of wave)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

EKG: Calculate Heart rate by R-R intervales. What are the numbers?

A

300, 150, 100, 75, 60, 50, 43, 37

normal: 60-100 bpm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

EKG: Sinus rhythm originates from the

A

SA node

  • -upright P wave, followed by QRST
  • -check lead AVR (negative) and lead II (upright)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

EKG: List the

  1. Limb Leads
  2. Pre-cordial leads
A
  1. Limb
    - -I, II, III
    - -AVR, AVL, AVF
  2. Pre-cordial
    - -V1-V6
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

EKG: What is the systematic approach to reading an EKG?

A
  • Rate
  • Rhythm
  • Intervals
  • Ischemia (upside down T-wave)
  • Old injury (Q-wave – too deep)
  • Axis
  • R-wave progression
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

EKG: To analyze rhythm, what 3 things must you look at?

A
  1. is it regular? (equal space between QRS spikes)
  2. are there normal P waves present?
    - -sinus (P before every QRS); P within correct axis?
  3. what is the relationship between the p-waves and QRS complexes?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

EKG: What is the most common NON-sinus rhythm?

A

atrial fibrillation (quivering)

  • irregularly irregular
  • -no P waves, no organization
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

EKG: The P-wave represents atrial depolarization. It is a small deflection before the QRS complexes. Typical assessment looks at the amplitude, width and deflection (neg vs. pos)

What are pathologies of the P-waves?

A
  • focus rhythm initiation
  • conduction blocks
  • chamber enlargements
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

EKG: Interval that is measure from the beginning of the P-wave to the beginning of the QRS complex. It includes the P-wave

A

P-R interval

  • time taken for stimulus to spread through atria and pass through AV junction
  • delayed to allow ventricles to fill
29
Q

EKG: What is the normal PR interval? What causes PR prolongation?

A

NOrmal: 0.12 - 0.2
(3-5 small boxes)

Prolongation: >0.2
–1st degree heart block

30
Q

EKG: In a QRS complex:

  1. The initial deflection that is negative is a _____ wave
  2. The first positive deflection is an _____ wave
  3. A negative deflection after the R-wave is an ___ wave
A
  1. Q
  2. R
  3. S

*normal QRS: <3 small boxes

31
Q

EKG: THe interval that is measured from the beginning of the QRS complex to the end of the T-wave.

It represents the return of stimulated ventricules to resting state (vent. repol.)

A

QT interval

*values depend on heart rate

32
Q

EKG: What are influencers of QT prolongation?

A
  1. long QT syndromes
  2. electrolyte abnormalities
  3. drug effects

580ms = prolongation
*more than half of R-R

33
Q

EKG: To determine axis, find the limb lead in which the QRS has equal positive and negative movement.

THe QRS axis will be perpendicular to this lead.

OR you can determine axis by looking at what leads?

A

Lead I and AVF

  • if QRS is positive: normal axis (two thumbs up or 1 thumb up and 1 thumb sideways)
  • normal = -30 to +90

NOTE: Whichever thumb is up determines the axis. ***extreme axis: both thumbs down

34
Q

EKG: __________ refers to the absence of the normal increase in size of the R wave in the precordial leads when advancing from lead V1 to V6.

In lead V1, the R wave should be small. The R wave becomes larger throughout the precordial leads, to the point where the R wave is larger than the S wave in lead V4.

A

Poor R wave progression

*goes from more negative to more positive (anti-clockwise to clockwise)

Causes:

  • *Wolff Parkinson White
  • *Prior anteroseptal MI
35
Q

EKG: What is the zone of transition with regard to R-wave progression?

A

normal depol. of left ventricle

36
Q

EKG: A wide QRS complex (>120ms; >0.12s) represents a ventricular rhythm (fibrillation or tachycardia). Generally the rate of ventricular rhythm is 20-40bpm.

What happens in a Left Bundle Branch block?

A

-wide QRS
-Leads V5, V6 and aVL = broad, notched, or slurred R waves
absent Q wave absent
-prolonged T peak time (>60ms in V5 and V6; normal in leads V1 and V2)

NOTE: affects ability to detect acute MI changes (different stress tests)
**fibrosis or scarring of the heart

37
Q

EKG: A wide QRS complex (>120ms; >0.12s) represents a ventricular rhythm (fibrillation or tachycardia). Generally the rate of ventricular rhythm is 20-40bpm.

What happens in a Right Bundle Branch block?

A
  • wide QRS
  • rsr’ or rSR’ pattern: V1 or V2
  • wide, notched R wave
  • S wave longer than 40ms (or longer than R-wave) in V6

*can be normal or associated with cardiac pathology

38
Q

EKG: Enlargement of this part of the heart is typically seen in lung disease.

It features are:

  1. > 2.5mm in lead II
  2. and/OR 1.5 mm in V1

**look to lead II

A

RIght atrial enlargement

39
Q

EKG: THe following describes what disease patterns?

  1. P-wave duration >0.12 (leads I or II)
  2. biphasic P wave (V1) w/ terminal negative of 0.04
A

Left atrial enlargement, valve disease, HTN, cardiomyopathies

40
Q

EKG: LVH is found in HTN, valvular heart disease, cardiomyopathies and congenital heart disease.

What is the voltage criteria for LVH?

A

> 35 mm

*large S wave (V1 or V2) + large R wave (V5 or V6)

41
Q

What are the 3 main EKG stages of acute MI?

A
  1. T wave peaks, then inverts
  2. ST segment elevates in a distribution
  3. Q waves appear
42
Q

List the Coronary arteries and the Leads that detect them

A
  1. LCx/diagonal branch of LAD: I, AVL, V5-V6
  2. LAD: V1-V4
  3. RCA or LCx: II, III, AVF
43
Q

Hyper acute T wave is indicative of

A

acute myocardial infarction

44
Q

The U wave is a small, rounded deflection sometimes seen after the T-wave. It represents the last phase of ventricular repolarization.

Prominent U waves are characteristic of

A

hypOkalemia

45
Q

Interviewing Skills: True/False: 75-95% of the info needed to make a correct diagnosis is thought to come from the patient reported medical history

A

True

46
Q

Tasks in the patient encounter include Biomedical Tasks and Humanist/Communication tasks:

Which is a part of the biomedical tasks?

a. identify problem
b. fix problem
c. engage
d. empathize

A

Answer: A and B

COmmunication:
-engage, empathize, educate, enlist

47
Q

Which of the following is a benefit of effective patient-centered medical interviewing skills?

a. inc. effectiveness of care
b. improved patient knowledge and satisfaction
c. inc. adherence to medical recommendations
d. decreased patient anxiety and distress

A

all of the above

  • inc. pateint return
  • inc. physician satisfaction
  • dec. lawsuit
48
Q

Which of the following is a relevant core competency for med students?

a. establish/maintain physician-patient relationship
b. listen actively (open body posture, etc.)
c. patient centered interview (identify/respond to emotional cues)
d. exhibit element of altruism and empathy (listen to respective views)

A

All of the above

49
Q

Active listening involves

  1. Reflective listening (what they’re saying)
  2. Empathic listening (what they’re feeling)

What are methods of reflecting listening?

A
  1. paraphrasing
    - -repeat portion of patient’s statements
  2. summarizing
    - -pertinent points
  3. clarifying
    - -determining meaning if unclear
50
Q

Active listening involves

  1. Reflective listening (what they’re saying)
  2. Empathic listening (what they’re feeling)

Empathic listening is the most important skill for building the physician-patient relationship. It communicates your understanding of the patient’s emotions. What are the 2 types of verbal empathic responses?

A
  1. Reflection
    - -tentative communication of your understanding:

“It sounds like you feel….”
“You seem…”
“Are you feeling”

  1. Validation
    - -tell patient their feelings are understandable
    - -name the emotion

“I can understand your irritation…”

“It makese sense..”

51
Q

Which is an example of non-verbal empathic response?

A
  • hand on patient’s shoulder
  • facial expression/tone of voice
  • box of tissues
  • silent but attentive
52
Q

What are the consequences of NOT responding to a patient’s emotions?

a. escalation of emotions
b. dec. accuracy in providing history
c. less able to listen and remember
d. less motivated to cooperate with physician

A

All

*caused by: physcian’s desire to fix problem, time pressure, distress

NOTE: Sequence: empathic listening then suggestions and actions to fix problem

53
Q

True/False: try to make at least one verbal empathic response in every medical interview

A

True

54
Q
  1. being yourself while staiying in the professional role
    - -own emotional response
  2. recognizing or giving positive feedback for a patient’s behavior
  3. explicit statement that physician wants to help
  4. statements to facilitate patient’s participation in his/her own treatment
    - -we need to look at….
    - -research shows…which would you prefer?
A
  1. Genuineness
  2. Praise
  3. Support
  4. Partnership
55
Q

What are the steps for gather information in medical interviews?

A
  1. set the stage and open the interview
  2. obtain px’s agenda w/ general, unoppened questions
  3. facilitate patient telling own story
  4. ask focused, open ended questions
  5. ask close ended questions (clarification)
56
Q

What are the steps for gather information in medical interviews?

A
  1. set the stage and open the interview
  2. obtain px’s agenda w/ general, unoppened questions
    “what brings you in today?”
    “what concerns you the most?”
  3. facilitate patient telling own story
    –general open ended
    “tell me about your headaches”
  4. ask focused, open ended questions
    - -easier and faster than closed-ended
  5. ask close ended questions (clarification)
    “yes or no responses”
    -does it get worse with rest?
  6. Summarize pertinent points
57
Q

FIFE (mnemonic for obtaining patient perspective)

A
  1. Feelings
    - -related to illness (fears, concerns)
  2. Ideas
    –explain cause of symptom
    “do you have any ideas about what caused this?”
  3. Functioning
    - -impact of illness on daily life
  4. Expectations
    –of the doctor
    “what do you hope i can do for you?”
  • use layman’s language
  • avoid why questions
  • avoid yes/no about sensitive issues
58
Q

Neonatal: What should be included in newborn history?

A
  1. Maternal history
    - -1st post-natal
    - -blood type, labs, medications, lactation
  2. Birth history:
    - -where, complications, weight, length of stay
  3. Delivery history
    * *Apgar score
  4. Delivery history
    - -meconium: stool (mucosal cells; bilirubin)
    - -passage prior to delivery = intrautine stress
  5. Nursery Hx and Social Hx
    - -feedings (breast/formula; amount)
    - -voiding and stooling patterns
    - -home life
  6. Family Medical History w/ Pediatric emphasis
59
Q

Neonatal: List the developmental milestones associated with the neonate at birth with regard to:

  1. Gross motor
  2. Language
  3. Fine motor
  4. Personal-Social
A
  1. Gross -motor
    - -equal movements
    - -lift head
    - -head up to 45deg.
  2. Language:
    - -respond to bell
    - -vocalizes
  3. Fine motor
    - -follow to midline
  4. personal: regard face, smile
60
Q

Neonatal: THe apgar score is a standardized way to communicate the clinical status of a newborn infant. It should not guid efforts of neonatal care, or be used to predict neurologic outcomes.

What are the components of the apgar score?

A
  1. Appearance (skin color)
  2. Posture (muscle tone)
  3. Grimace (reflex irritability, heart rate)
  4. Resipirations (respiratory effort)

*1 and 5 min of age

61
Q

Describe the scoring on the Apgar score

A
  1. Score = 0
    - absent heart rate
    - absent resp.
    - flaccid muscle
    - no reflex
    - blue/pale
  2. Score = 1
    - <100 bpm
    - weak cry; hypoventilation
    - some flexion
    - grimace (reflex)
    - acrocyanotic
  3. Score = 2
    - ->100bpm
    - -good cry
    - -active motion/well flexed
    - -cry/cough/sneeze
    - -completely pink
62
Q

Neonateal: True/False: During Physcial exam, one should be on the same level with the patient and complete as much of the exam with the child in the parent’s lap. Also, save invasive items for last.

A

True

63
Q

Neonatal: During pediatric physical exam, observation is very important as it helps to determine state of wellness of patient.

What are some things to look for?

A
  • well vs. ill
  • -acute vs. chronic
  • -alert vs. lethargic
  • -nutrition
  • -face, skin color, rashes
  • -behavior (combative)
64
Q

During observation of the newborn, what are the 3 key things to ask? What are key observations?

A
  1. crying?
  2. pink or blue?
  3. flexed or flaccid?
  • -character of cry
  • -character of resp.
  • -position
  • -odor?
  • -unusual musc. movements
65
Q

How do you check temperature in younger childern?

What is important about pulse?

A
  1. temperature:
    - -rectal (younger)
    - -infants may have normal temps even if sick
  2. pulse more sensitive to illness, exercise and emotions
66
Q

What are the important growth parameters of a child?

A

-weight (weight infants naked or dry diaper)

  • Length
  • Head circumference (cm) [>2y/o BMI]
  • Development
67
Q

Describe normal growth parameters in a baby?

  1. weight
  2. length
A
  1. Weight:
    - -2 weeks: birth weight
    - -6 months: double weight (most growth)
    - -1 year: triple
    * 30g/day (0-3 mos)
    * 20g/day (3-6)
  2. Length (cm)
    - -2 cm/mo (1st year)
    - -5-6cm/year
  3. Head circumference
    - -1cm/mo (1st year)
    - -greatest in 1st year
68
Q

Newborn Exam: The Ballard Assessment of Gestational age is a subjective measure of newborn materuity. It is useful for evaluating infants with unsure dates.

It may be affected b intrauterine drug exposure or stress.

When is it the most accurate? What are some important things it looks at?

A

Most accurate: 12-24 hours after delivery

Important things:
–neuromuscular activity (flexed — term; extended – premature)

–physical maturity and appearance

NOTE: 40 weeks gestation ~ mature (wrinkles on foot, areolar development, joints, cartilage)

69
Q

Compare premature and mature babies in the context of:

  1. Arm recoil and scarf sign
  2. posture and square window
  3. heel to ear and popliteal window
  4. Skin
  5. Genital development
A
  1. Arm Recoil/Scarf:
    - -mature: scarf
    - -premature: extended
  2. Posture and square window:
    - -term baby: flexed
  3. Heel to ear
    - -term baby: 90 degrees
    - -preterm: hyperflexed
  4. skin
    - -preterm: translucent; vessels visible
    mature: peeling skin, inc. lanugo (fine hair)
  5. Cartilage
    - -premature: ears: less recoil and floppy
  6. Genital
    - -mature: prominant labia minora; rugae boys
  7. Feet
    - -mature: transverse creases: toes to heel

CCF (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions