ICM 1 - Exam 1 Flashcards
Descriptive ethics
describes what people believe is right and wrong
Normative ethics
attempts to ascertain what are right and wrong courses of action
Clinical bioethics is primarily concerned with normative ethics
Opinion
Supported not by empirical evidence but intellectual logic and emotional enagement
Position
Dictated by evidence; something you can defend with reason
Rational
Take the reasons for or against something, look at them, and then move toward a conclusion
Rationalizing
Psychological tool by getting to our conclusion and then finding reasons to support it
Consequential/Utilitarian Ethical Theories
Emphasize weighing of all possible consequences to produce best outcome
Deontological/Kantian Ethical Theories
Emphasize ethical rules developed independent of consequences
rule-oriented approach; everyone needs to follow that rule
Major ethical principles in medicine
- Respect for autonomy (respect of persons to make their own choices)
- Beneficence (promoting positive benefits, minimizing harm)
- Justice (treating similar cases in a similar manner)
CAGE Questions
- Cut down on your drinking
- Annoyed by people criticizing your drinking?
- Felt guilty about drinking?
- Drink in the morning (eye opener)?
Morphology
the form and structure of something
These skin lesions are flat
macules and patches
These skin lesions are elevated
Papules and plaques
These skin lesions include loss
Erosion (partial loss of epidermis) and ulcers (full loss of epidermis)
These skin lesions are fluid-filled
Vesicles and bullas
A pustule is like a vesicle but
cloudier (due to neutrophils)
Macule
flat, not palpable
variable color, up to .5cm
no surface texture change
Patch
flat area larger than .5cm
variable color and size
may have scale, wrinkling or textural accentuation
Papule
Raised “bump”
Equal or less than .5cm in diameter
Variable color or “flesh toned”
May have surface change, scale, crust
Plaque
Raised “plateau-like”
Larger than .5cm
Variable color and textural change, scale
Vesicle
fluid-filled blister
usually less than .5cm
if filled with pus - “pustule”
if filled with blood - “hemorrhagic vesicle”
Bulla
fluid-filled blister usually larger than .5cm
Pustule
A pus filled papule most of the time (cloudy from neutrophils)
Something larger might be termed an abscess
Nodule
raised “marble like” lump
usually larger than .5cm in diameter
variable color and occasional textural changes
Cyst
A nodule filled with liquid or semisolid matter
variable in size
Fissure
thin tear in skin
Wheal
papule or plaque of irregular dermal swelling (hives)
Comedo
keratin-plugged follicular opening
open dark (blackhead)
closed light (whitehead)
Secondary modifiers in dermatology
crust, scale, indurated (thickened), and Lichenified (thickened from rubbing)
NIAA Single Question Screener
“How many times in the past 12 months have you had 5 (4) drinks in one day?”
Principles of cross cultural communication
Curiosity
Respect
Empathy
What gives collagen its triple helical structure?
Hydroxylation of proline, lysine cross-linking
Mechanisms of healing
- Contraction
- Epithelialization
- Connective tissue deposition
Normal wound healing
- Hemostasis (platelets come)
- Inflammation (macrophages and neutrophils come)
- Proliferation (collagen, epithelial cells, etc)
- Remodeling (scar maturation and collagen cross-linking)
Where does wound strength peak at in humans?
60-80%
What stimulates angiogenesis?
hypoxia (lack of oxygen to the tissues), lactic acid, nitric acid, cytokines & growth factors
Contraction
process by which the area of an open wound decreases by a concentric reduction in the size of the wound
Contracture
pathologic condition resulting from excessive wound and scar contracture across amobile surface
What is the mechanism of wound contraction?
Myofibroblasts (specialized fibroblasts with actin) exert a contractile force upon the matrix which leads to a reduction in wound size
Matrix is reorganized by fibroblasts, leads to reduction in wound size
Skin graft
Tissue transferred without blood supply
Survival dependent on recipient site
Skin flap
tissue transferred with intact blood supply
Survival NOT dependent on the recipient site
hyperechoic
In relation to the structures around it, a spot on the ultrasound is bright
(high amplitude like bones and calcifications)
hypoechoic
In relation to the structures around it, a spot on an ultrasound is dark
(lower amplitude like soft tissue)
Anechoic
Has no echoes on an ultrasound. An example is a fluid-filled cyst
Four major types of diagnostic imaging
- X-Ray & CT
- MRI (magnetic resonance imaging)
- Ultrasound
- Nuclear Scintigraphy (nuclear medicine)
Role of interventional radiology
Radiologists do invasive procedures guided by images for either diagnosis or treatment
Ultrasound
Transducer produces high frequency sound (and then detects the sound) to make images
MRI
radio waves are pulsed into the patient & the machine listens for return radio waves caused by interaction with protons (water) in the patient’s body. The frequency and phase of the returned signals is processed to create an image
How to tell the difference between MRI and CT images?
Cortical bone is white on CT images
Cortical bone is black on MRI images
Nuclear scintigraphy
Uses radioactive tracers that emit radiation. Images are made by detecting the radiation coming out of the patient
ACR appropriateness criteria
Evidence-based guidelines that assist providers in making the most appropriate imaging/treatment decisions for a specific medical condition
Examples of primary lesion descriptors in derm
Macule, papule, nodule, bulla, fissure, erosion, wheal, comedo, etc
Examples of secondary changes/modifiers in derm
crust, scale, lichenified (thickened due to rubbing), indurated
Derm lesion configurations
linear, grouped, annular, gyrate/polyannular/polycyclic, dermatomal
Derm lesion distributions
regional (scalp, palms, oral, etc), area of exposure (mechanical trauma, chemical, etc), anatomic (generalized, central, acral)
X-ray uses?
screening for metal and foregin bodies; limited use in trauma
CT uses?
Detailed anatomy
trauma, acute hemorrhage, post surgery
Why is a CT contrast used?
So soft tissue detail becomes more apparent (lymph nodes, soft tissue mass, vasculature)
Not typically used in trauma
Ultrasound uses?
Thyroid, carotid artery, ultrasound guided biopsies
Is the thyroid hyper-, hypo-, or an- echoic relative to surrounding tissues?
Always hyperechoic
MRI uses?
Soft tissue detail, great for head and neck cancer
BUT longer scan time & requirement to lie still
What imaging modality is best for trauma and bone detail?
noncontrast CT
What are the two types of hearing loss?
- conductive - sound wave transmission is impeded through the external and/or middle ear
- sensorineural - sound wave transmission is impeded through the inner ear apparatus (cochlea and CN 8 [vestibulococchlear]}
In the Weber Test, if unilateral conductive hearing loss is found, where is sound lateralized to?
The impaired ear
If the patient hears sound in their good ear, its sensorineural hearing loss
What is the Rinne test?
A hearing test where air and bone conduction is compared
Is sound usually heard longer through air or bone?
Normally in air
If it’s heard longer through bone then conductive hearing loss should be considered
What is the purpose of completing a review of systems (ROS)?
- to uncover potentially significant symptoms related to the HPI not otherwise elicited during the HPI
- to learn about other active problems that may not be related to the chief complaint
- to make sure documentation is compliant with medicare billing
When do you perform a full review of systems?
With any new patient (in clinic or in the hospital) and those with vague complaints
When do you perform a focused ROS?
During most follow-up appointments for established diseases
Ex: Diabetics are at a higher risk for heart disease so you may perform a cardiac ROS
When do you skip ROS?
In most urgent visits for isolated, acute problems
Why is taking a sexual history challenging?
Cultural factors, communication factors, patient demographics
What is the SAFE screening question?
“Have you ever been in a relationship where you felt emotional or physical abuse from a loved one?”
S in SAFE?
Stress/Safety
Do you feel safe? What stresses do you have? Should I be concerned about your safety?
A in SAFE?
Afraid/Abused
F in SAFE?
Friends/Family
Do your friends and family know? Can you tell them?
E in SAFE?
Emergency plan
Do you have a safe space to go?
What are the elements of informed consent?
Appropriate disclosure of information, patient understanding of information, voluntary decision/no coercion
Is signature on an informed consent form conclusive proof that a valid informed consent has occurred?
No, its just evidence of consent. These forms are good for documentation but should not be confused with the fact of consent
What is the Professional Practice Standard?
minimal ethical standard where a physician considers what his or her colleagues in the field would disclose/are doing and then do that.
Focuses on what a physician thinks a patient should know rather than what patients want to know.
Legally sufficient in roughly half of US states