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FMPR and INDE > INDE Yr 2 Term 2 > Flashcards

INDE Yr 2 Term 2 Flashcards

1
Q

When to ideally do a breast exam

A

at the end of bleeding (first day of OCP)

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2
Q

peau d’orange

A

edema, but the skin is tethered by sweat ducts

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3
Q

what technique do we use for breast exam

A

vertical strip, 3 min per breast

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4
Q

where would supernuemary breasts be found?

A

anywhere along the milk line…subject to the same diseases as regular breasts

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5
Q

If you are doing a bimanual exam, which hand would feel an anteverted uterus and which hand would feel a retroverted uterus?

A

Anteverted: the abdominal hand
Retroverted: the internal hand, through the posterior vagina

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6
Q

How much to rotate the spatula and the cytobrush when you are doing a pap?

A

spatula: 360
cytobrush: 180

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7
Q

Should you do a pap on a menstruating woman?

A

technically no…

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8
Q

When to start cervical cancer screening? How often to screen?

A

21 y.o or 3 yrs after first sexual contact (including, digital and oral contact).

q12/12 until 3 normal, then at 24/12 intervals

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9
Q

What has a mocassin-like distribution?

A

tinea pedis

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10
Q

What might the toenails of a patient with DM neuropathy look like?

A

thickened

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11
Q

What do oncomychotic (is that a word?) nails look like? Occurs more often in…
What is the sequela we are trying to avoid?

A

In this condition, fungus is eating up the keratin in the nails. The toenails are thick, hyperkeratotic and friable (oncholysis)

adults

can develop into cellulitis

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12
Q

Do we recommend that women do self-exams?

A

Yes, they should do everything but the axilla part.

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13
Q

Drugs/exposures commonly associated with tinea effluvium?

A

antidepressants
OCP
sudden diet changes

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14
Q

What do the following techniques identify:

  • woods lamp
  • oil microscopy
  • Tzanck smear
  • KOH
A
  • woods lamp: tinea capitis
  • oil microscopy: scabies
  • Tzanck smear: herpes
  • KOH: fungal
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15
Q

Where is psoriasis normally found? Differentiate from eczema.

A

Psoriasis:

  • extensor surfaces, scalp, post-auricular, lumbar, shins
  • salmon red, papule, silver scale, sharp borders

Eczema:

  • flexor surfaces
  • intensely pruritic, moist, not well-circumscribed
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16
Q

Differentiate features of basal cell, actinic keratosis (–>SCC), nevi, melanoma

A

Basal cell: raised, pearly, red, sun exposed areas.

Actinic keratosis (–>squamous cell): well defined, scaly, nodular

Melanoma: brown/black/blue/white

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17
Q

What could cause hair coming out by the roots, vs. hair breaking off?

A

Coming out:

  • telogen effluvium
  • alopecia areata (T-cell mediated)
  • androgenetic alopecia

Breaking:

  • tinea capitis (infxn of follicle by Trichophyton tonsurans and microsporum canis
  • hair shaft abnormalities (?genetic)
  • traumatic hair practices
  • trichotillomania
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18
Q

What is the DDx of cicatricial and non-cicatricial hair loss?

A

Cicatricial (scarring, loss of follicular ostia) :

  • discoid lupus
  • lichen planopilaris

Non-cicatricial- pretty much everything else

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19
Q

How many hairs is a normal and abnormal

A

6-10 is normal, 60 is NOT

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20
Q

What are the integuement signs of hypothyroid? Hyperthyroid?

A

HYPOTHYROID

  • brittle, slow growing nails
  • skin: swollen, waxy, cool, dry
  • hair: thin and brittle

HYPERTHYROID

  • fine, silky hair
  • pretibial myexedma (incl. papules, nodules, plaques in pretibial region)
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21
Q

What are the components of the MSE?

A

ASEPTIC

Appearance
Speech
Emotion (mood and affect)
Perception (hallucinations, illusion)
Thought form and content (delusions)
Insight & Judgement
Cognition
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22
Q

asking the meaning of a proverb assesses what?

asking patients to identify similarities between objects tests what?

A

abstract thinking

logical thinking

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23
Q

Dominant and non-dominant parietal lesion may have the following symptoms…

A

Dominant:

  • dyscalculia
  • R-L confusion
  • body part agnosia
  • apraxia (?….not according to some textbooks)

non-dominant:

  • directional sense
  • construction
  • dressing
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24
Q

Pronator drift is a sign of….

A

cerebellar

upper limb weakness? And possibly inability to simultaneously activate both cerebral hemispheres.

25
Q

How to decide if a droopy eyelid is “ptosis”

A

if it encroaches on the pupil

26
Q

Tuning forks to use for:

vibration

A

128 Hz

27
Q

Which test to do first: Rinne or Weber?

A

Rinne- decide first is BC>AC and then see if it lateralizes.

28
Q

Where to touch to elicit the gag reflex?

A

The pillar in front of the tonsil

29
Q

Which border of the optic cup is papilledema more easily visualized?

A

The temporal border is normally very crisp, so a blurred border is bad

30
Q

Differential of ptosis

A
  • Horner’s (partial)
  • CN III palsy (complete , and eye will be down and out)
  • myasthenia gravis (affects muscles used more frequently first)
  • Autosomal dominant ptosis
31
Q

differentiate bulbar and pseudobulbar palsy

A

Bulbar: LMN lesion of CN IX-XII (medulla=bulb)…seen in ALS
Pseudobulbar: UMN of the corticobulbar nerves…could get with MS

32
Q

When would you see chorea? When would you see athetosis?

A

Chorea: huntington’s classically
Athethosis: cerebral palsy (slow, convoluted, writhing movements)

33
Q

Muscle power scale

A 
0- nothing
1- flicker
2- w/o gravity
3-with gravity
4-  with gravity and some resistance
5- full strength
34
Q

Reflex rating scale

A 
0- absent
1+ weak
2+ normal
3+ brisk
4+ clonus
35
Q

An ataxic gait with titubation is characteristic of….

A

MS

36
Q

Limb ataxia vs. truncal ataxia signs

A

Trunk: wide gait, inability to do tandem
Limb: impaired heel-shin tests, dysmetria, dysdiadochokinesia

37
Q

triad for normal pressure hydrocephalus

A

gait disturbance, decline in cognition, urinary incontinence

38
Q

A waddling gait with increased lumbar lordosis could be…

A

muscular distrophy….has proximal muscle weakness

39
Q

When taking a vision history what is the possible significance of the following complaints:

  • halos around lights
  • floaters
  • flashes
  • curtain that obscures part of vision
A

Halos: ?cartaracts

Floaters: normal vitreous condensations with age, retinal detachement, vitritis, tumours

Flashes: retinal detachment, papilledema

Curtain: amaurosis fugax (symptomatice carotid artery disease)

40
Q

Is the cause of diplopia more likely to be supratentorial or infratentorial?

A

Infratententorial.

41
Q

What might cause monocular diplopia vs. bionocular diplopia?

A

Monocular: an opthalmologic cause (e.g. corneal deformity)

Binocular: a neurologic lesion

42
Q

Diplopia made worse by looking down and in (e.g. walking down the stairs) is suggestive of…

A

CN IV palsy- these pts also tend to tilt their head away from the lesion.

43
Q

Morning headaches are suggestive of:

A

space occupying intracranial lesions…or OSA.

44
Q

What is bilateral proximal weakness vs. bilateral distal weakness suggestive of?

A

Proximal: myopathy
Distal: neuropathy

45
Q

Paresthesia around the mouth and hands, lasting for several minutes is most indicative of…

A

an anxiety disorder/panic attack

46
Q

Ataxia that is significantly worse (or only present when) a person is navigating in the dark is likely…

A

sensory ataxia vs. cerebellar ataxia

47
Q

Components of the Folstein (MMSE)

A

Orientation to Time and Place (-/10):

  • year
  • season
  • month
  • date
  • day
  • floor
  • building
  • city
  • province
  • country
Immediate recall (-/3)
Attention (-/5) (WORLD-DLROW)
Delayed recall (-/3)
Naming (-/2)
Repetition (-/1)
3-stage command (-/3)
Reading (-/1)
Writing (-/1)
48
Q

What does ADMIT stand for?

A 
Admit/Activity
Diet
Monitor (e.g. vitals)
Investigations
Therapy
49
Q

How to do an APGAR?

A

Appearance (0=blue, 1=acrocyanosis. 2= pink all over)

Pulse (0=absent, 1=100)

Grimace (0=none, 1=grimace, 2= vigorous cry)

Activity (0=flaccid, 1= some flexion, 2= active motion)

Respiration (0= absent, 1= slow/irregular, 2= good, crying)

50
Q

What newborn features can be used to assessed gestational age?

A 
foot creases
ear cartilage
genitalia
scalp hair
breast buds
51
Q

What are the following primitive reflexes:

  • Moro
  • Root
  • Babinski
  • Galant
A

Moro: “drop” baby, they splay arms out
Root: a newborn will search for their mother’s breast
Babinski: upgoing plantar
Galant: hold baby face down, stroke along the spine, the baby laterally flexes to the stroked side

52
Q

Social and Cognitive Levels of Play

A

Social:

  • solitary
  • paralell
  • interactive/group

Cognitive

  • functional
  • constructive
  • dramatic
  • games with rules
53
Q

Significant delays in the toddler years

A
  • not sitting by 9 months
  • not mobile by 1 year
  • not walking or speaking by 18 months
  • not forming sentences by 3 yrs
54
Q

What is the age of sexual consent in BC?

A
  • 16 if it is non-exploitive
  • 14-15 if 5 yr difference (or less)
  • 12-13 if 2 yr difference (or less)
55
Q

What is the significance of the BC Infants Act and the BC Mental Health Act and the Child, Family and Community Services Act?

A

BC Infants Act: all patients from 0-19 yrs are legally able to consent to treatment as long as they are competent (e.g. understand risks and benefits)

BC Mental Health Act: patients can only accept/reject treatment if they are over 16 y.o. Younger than that it is parents job.

there is no age limit to certify someone

Child, Family and Community Services Act: have to protect kids <19 y.o (e.g report abuse

56
Q

What is the CRAFT screen?

A

For problem/risky substance use in teens.

Car (been driving high)
Relax (use drugs to relax)
Alone (use drugs alone)
Family/Friends concerns
Forget (use drugs to forget)
Trouble
57
Q

What is PBIND?

A 
Things you should ask in a pediatric history
Prenatal
Birth
Immunization
Nutrition
Development
58
Q

When is jaundice in the neonate pathologic?

A

<10 days

FMPR and INDE (5 decks)

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