ITP Flashcards
conservative treatment
beneficence/nonmaleficence
spinal accessory
pressure on either side of shoulders and face
consequenntialism
ends justify the means. Number game. Action is judged based on outcome. Pros is that its useful daily life. Risk management. Avoids inaction BUT no action is off limits and outcome isn’t always clear prior to action. RESEARCH AND POLICY. Clinical treatment
history of present illness
chronological order of events leading to current complaint. illness, symptoms, previous treatment
- narrative in paragraph form
- attributes of symptoms
- avoid leading qns
valued habits, customs, behaviours, communication patterns, health beliefs, nutritional factors, religions, sociologic, psychologic factors
Alternative health care and therapy
Darby cultural assessment guide
comprehensive patient evaluation steps
demographic, medical and dental history, physical exam, clinical reasoning (lab and imagining results), data review and problem list, summary and treatment plan
medical chart
documentation, communication, research’s statistics, legal, symptoms over time
Chart is also professional standard, ethical obligation, educational tool
Helps track which services are used, changes in healthcare over time, population health, allocation of resources
watch the patient. How they walk, look, etc.
- inspection
perioral and intraoral examination
- lips, all mucosa (buccal, labial, pallatal), palate, floor of mouth and tongue
- salivary gland hypofunction is dry lips, mouth opening from denture, cheilitis (yeast in corners), papilla atrophy
- labial mucosa is inside lip. most common area for trauma bumps NO MIRROR
- linea alba is keratin buildup white line from biting down normal
- tongue is high risk area. papilla can show nutritional deficiency
- floor of mouth check salivary glands (sublingual + mandibular)
- palate is great area for lesions since glands and nerves here. depress the anterior tongue to see (no gag reflex)
corrigan’s sign
carotid pulse in clavicle area
- aortic insufficency and bounding pulse with widened pressure due to some blockage
family history
parents, siblings, offspring, genetics, assess risk for diabetes, heart disease, cancers like breast/ovarian, pulmonary disease, bleeding disorders, connective tissue disease
summary of presentation
CC and related, medical illness, anything that requires special attention
140+ or 90+
stage 2
Argument from authority
important people can be wrong
child and elder abuse. Forgery
legal veracity
own choices and beliefs based on upbringing, faith and experiences
morals
optic nerve does what innervation of brain
cerebrum
neck extraoral exam
lymph nodes, masses, deviation of trachea, sound of breathing, thyroid gland
180+ and 120+
hypertensive crisis
assessment of patient with cardiac disease
- chest pain, freq and what makes it hurt
- SOB, dizzy, lower extremity edema, palpitations, claudication is a sign of peripheral arter disease that causes severe wounds in lower extremities
- blue stuff is cyanosis.
honesty, truthfulness
veracity
chart components
CC, history of present illness, medical history, physical exam, imaging, lab studies, assessment, treatment record, notes
what to check in throat
lips, mucosa, gums, teeth, tongue, palate, tonsils, pharynx
- inspection and then palpate/percussion
- start out to in
cross cultural index
must have flexibility and openness emotional resilience perceptual acuity, personal autonomy
7 attributes of symptoms
quality, severity, location and radiation, timing and course, context, modifying factors, associated symptoms with pertinent negatives
eyes in HEENT****
position and alignment, pupils and light reaction, extraocular movements
- symmetry, PERRLA: pupils equal, round, reactive to light and accommodation
- check CN 3,4,6 for ocular
- 5 for blink
- cn 7
- check iris, pupil, eyelid, sclera (whites)
ptosis (droopy from botox)
- miosis (pupil conscrition)
- anisocoria (diff between pupils)
- pinpoint pupils are opioids dialated is cocaine
- dry eyes from pilocarpine
- icterus is jaundice
- visual acuity is first signs of stuff
present, on time, dependable, honest, cite sources, fight bias, put patient first, integrity of profession. Its NOT innate
basis of medicines contract with society. Put patient about physician. Standards of competence and integrity, expert advice
Professional Behaciour
brainstem nerves
- trigeminnal, facial, glossopharyngeal, vagus
tmj ligaments
- capsular which goes up and down
- TM ligament which goes sideways
- OOP is outer oblique portion that limits rotation
0 IHP is inner horizontal portion that limits posterior movement
disability accommodation
justice
HPI OLDCARDS ***
onset, location, duration, character, aggravating factors, relieving factors, temporal factors, severity
when two or more ethical principles are in conflict, must be different causes of action. No perfect solution
Dilemma
evaluates actions and behaviours for clarity and consistency
ethics
superficial cervical nodes
soft tissue of face and neck
- oropharangeal cancer
treated equally before the law. Punishment fits the crime
legal justice
nose HEENT
- nasal deviation, patency (how open it is), secretions, congestion, epistaxis (bleeding)
clicks and crepitation of TMJ
click is disk displaced
crepitation is arthritis (crinkly)
unique medical record number
MRN is NOT SSN. Different from govt id
symptoms vs sign
symptom is subjective, sign is objective
general appearance, apparent state of health, consciousness, signs of distress, inspection of lesions and behaviour, height and weight
general survey
its for decayed, missing, filled teeth
odontogram
specialized skill and knowledge, highly valued aspects of human life depend on this, requires lengthy theoretical education and training, “profess” = make a vow to follow a universal moral code
Profession
source and reliability
source can be patient, guardian, old chart. must be dated and source must be oriented and competent
auscultation **
breath sounds
- bronchial is midline of body (exhalation)
- vesicular is all over lung (air filling alveoli)
- wheezing is for fluid filled
- stridor is high pitch from foreign body stuck in upper lung (can be heard over trachea)
- Stuff can go down Right main bronchus more easily than left OR the right upper lobe
ethics that a person identifies with in respect to people and situations in daily life
personal ethics
social history
living environment, social determinant of health like drugs, occupational hazards, diet, sex orientation, sources of support,
techniques of skilled interviewing
active listening, adaptive qns, facilitation, echoing, empathetic response, validation, reassurance, summarization, highlighting transition
facial nerve
motor
- test 5 divisions: temporal, zygomatic, buccal, mandibular, cervical
- face movements
- taste to test sensory
ethics a person MUST adhere to to respect their interactions and business dealings in professional life
Professional ethics
unethical consequence
- reputation, integrity and trust, profession
paranasal sinus exam
- frontal and maxillary via percussion
life long process of self assessment and commitment to patient centred care
cultural humility
TMJR innervation and vasculature
mandibular branch of trigeminal. treat using local anesthesia or botox
maxillary artery
ears HEENT
- tmj
- discharge for infection
- rinne test is side head movement
- weber test is top of head
- conductive hearing loss is structural issue while sensorineural is neural problem
non lexical component of communication by speech
paralanguage
CN III, 4 and 6
- extraocular muscles
- check movement
- nystagmus is repetitive uncrolled eye movement (not always problem in CCN)
- could also be seizure disorder
- check pupil reactions by general, light reflec (pupil should constrict) then make sure BOTH do ot (consensual), accommodation is when eyes move to midline, pupils should shift
mask wearing
nonmaleficence
honesty (informed consent), empowerment, primacy of these desires. Do we meet all patient requests?
patient autonomy
4% skin cancer. Rapidly increasing in frequency. Grow fast
melanoma
salivary gland ranula
mucosal is in duct where saliva is exvreted and ruptures so can’t get to destination and leaks into tissue
- lip, floor of mouth, above thyroid
provide timely care to improve condition, quality and competent care, respect
individual beneficence
vital signs**
body temp, pulse rate, respiration rate, blood pressure
Burden of proof
claiming one is right because the other opposition hasn’t been proven right
ad hominem
attack person not content
TMJ range of opening
35-55 mm
condylar rotation is up to 22 mm
- transition is 20 mm+
blood pressure
- arm at heart level over branchial artery
- 2.5 cm above elbow crease
- bell of stethoscope
- deflate and listen to korotkoff sounds (systolic) dial starts to bounce
- no sound is diastolic pressure
- how much to inflate is either 150-180 OR feel pulse and inflate till it goes away and then inflate 30 more
- cuff error is common or heart level problem
- timing of anxiety
- must be consistently high to get hypertension
Right to make decisions about self, informed consen
Autonomy
chart ownership and dates
consent belongs to patient but physical record belongs to u
Patient, doc, anyone the patient lets, legal guardians, researchers, billing can see file
Maintain treatment details for 7 years, keep their information forever (demographic, treatment dates, name of providers, diagnoses, procedures, discharge summary)
AV valves
tricuspid (right. 1st one) mitral (left)
s1 sound in systole. lub
semilunar valves
pumonary (right) aortic (left)
s2 sound in diastole. dub
HPI PQRST
precipitating/palliating factors, quality, radiation, severity, temporal factors
Cole and bird 5 basic relationship skills:
listen to words and emotions, read non verbal displays, empathetic skills through reflection, provide personal support, focus on forming partnership
diagnosis
history of illness, meds, ROS, physical exam, make differential diagnosis, plan with working diagnosis, definitive diagnosis, treatment
TMJ anatomy names
- ginglymoarthroidal joint, compound joint, synovial joint
- has articular cartilage with dense fibrous CT (wears down from arthritis)
- retrodiscal tissue that is highly vascular (holds cart in place. open lock is when jaw stays open and closed lock is stuck closed. painful)
hypoglossal
motor to tongue muscles. evaluate tongue in and out for deviation (does it come right out or crooked)
- fasciculation (muscle should be relaxed)
firm adherence to a strong moral code. Being honest and acting in accordance to ones beliefs
Integrity
glossopharyngeal and vagus
do throat area
0 check rise and fall of soft pallate and uvula in AHH
- gag reflex
cardinal techniques
inspection, asultation, palpation, percussion
oral cancer
- men, old (40+), nutrition, fair skin, drugs, HPC, immunocomp, history of cancer
- incidence has increased but mortality down
of squam cell carcinoma - hpv causes oropharyngeal cancer. increasing incidence of anterior tongue in white ppl
- check floor of mouth
- 60-67% survival
- surgical resection is best treatment
- radiation causes osteoradionecrosis (bone death)
TMJ muscles
temporalis (temple) and masseter (from cheek to jaw, clenching, CN5)
medial pterygoid and lateral pterygoid (goes into joint)
fairness. Fiar doesn’t mean equal, equal doesn’t mean fair
justice
serving interest of the patient, altruistic behaviour, no pressures must compromise this. Balance your interests (diagnosis, busy schedule, self worth) with patient (feeling better, understanding the problem, obtaining value)
primacy of patient welfare
both sides swollen
mumps OR eating disorders, HIV, diabetes
- if eating disorder then acid erosion and russel signs on fingers from throat
tmj neck muscles
- sternocleidomastoir muscle is from back head to neck
- it can cause pain in massater
- temporalis (goes down this muscle)
knowledge that enhances self awareness and ability to provide good care
cultural competence
health history qn types
neutral, simple direct, leading, loaded, supplementary remarks
act conservatively in a manner that does not harm patient
individual non maleficence
vestibulocochlear
balance and coordination
- hearing by rubbing fingers by ear
- hearing loss using fork
hoarse throat, cough, hard to swallow, inferior to adams apple
- thyroid goiter ! iodine def
the right to exercise professional judgement
Professional autonomy is
16% of skin cancers. Crusted, scaly, ulcerated, metastasize
squamous cell carcinoma
HARMM melanoma
HARMM: history of previous melanoma, age over 50, regular dermatologist absent, mole changing, male
More than 50 types of moles, more than 1-4 weird moles (dysplastic)
Red or light hair
Sun spot areas
Heavy sun exposure and childhood sun burns
Light eye or skin color
Family history of melanoma
large lower jaw with assymetrical inflam and firm. tiredness
lymphoma
decision matrix
what is qn, gut reaction, facts, who is involved, what are the options, what should I do, what justifies my choice, how can I prevent this problem
grades reflect knowledge and skill
academic justice
ensure all personnel are well educated and competent, prevent others from doing harm, influence authorities to change laws and policies that cause harm
Community non maleficence
trust relies on standards, applies equally to proxies acting for a patient, ease of access via electronic systems and spread of genetic information
confidentiality
respiratory rate
- normal is 20, 44 in kids
0 factors that change are ashtma or emphesema - pulse of helps monitor atrial ox 97-99% 80 is bad
- limitations are that its sensitive to skin, daylight, nailpolish, dirty finger
ear thing in kids that fluctuates
developmental cyst. normal
three tenets of self regulation
establish standards for practice, teach them, enforce them and judge punishment for those who violate
- licensure is way to do this
lung percussion sound
resonant is normal (banging a melon)
tympanic (hollow when air filled)
dull (mass). consolidation or collapse. dense area
flat
hyperresonant is louder and longer pitch sound. lung collapse
maintain competence, work collaboratively to reduce error, increase safety, minimize overuse of resources, optimize care outcomes, develop quality assurance measures, support implementation of mechanisms to improve ___
quality of care
privacy
nonmaleficence and veracity
see lecture 10 slide 25
name it
integrity so cheating, plagiarism, research
academic veracity
general appearance
health state, level of consciousness (AAO), distress, skin, grooming, facial expressions, disability, social determinants of health
discomfort when two cognitions, thoughts, beliefs, ideas, are incompatible with each other. Triggered by new info, pressure or making a choice. Leads to negative feelings. Resolving it involves admitting truths, examining deeply held beliefs, changing ingrained behaviours`
Cognitive dissonance
young kid, cats, one side inflam
cat scratch diseas
asultation
- listening for sounds. Stethoscope in quiet environment on bare skin. Listen for intensity, pitch, duration, quality. Reserve this for last!
triangular mass thing under tongue that moves as you drink and stick out tongue
this is when tissue moves during embryogenesis and stays stuck (epithelial trail) thyroglossal duct cyst
- congenital
share findings, maintain integrity, participate in community efforts
Community beneficence
Deontology
what would happen if everyone copied me? Judge action by whether it conforms to principles. People have infinite worth. Nobody should be used. Useful in broad questions, professional world, universal. BUT unyielding so action vs inaction. What to do when duties conflict? PATIENT CARE AND ACADEMIC INTEGRITY
heart auscultating
- APT - M 2245
- aortic is right 2nd intercostal
- pulmonic is l second
- tricuspid is right 4
0 mitral is 5 left
130-139 OR 80-89
hypertension stage 1
palpation
- touch to feel using palm surfaces (more sensitive than tips)
Ulnar surface of hands and fingers for vibration (side hand), dorsal surface of hand (back of hand) for temperature estimation
Can be light or deep (1 cm vs 4). Always do light first. Keep short fingernails, hands warm, always use gloves, “laying of the hands” touching patient before physical exam
standards we use to measure beliefs and behaviours
values
unilateral salivary gland swelling with dry mouth, infla, no saliva
shogen syndrome
supraclavicular nodes
- thoracic and abdominal cavity
carotid pulse assessment
head at 30 degrees
- brisk is normal
- delayed suggests aortic stenosis
- never palpate both sides together since baro receptor = pass out
- listen for bruits (woosh = turbulence)
hypohidrotic ectodermal dysplasia
- ectoderm bad so missing teeth, no sweat and can’t cool down
Straw man
exaggeration
Milton Bennet development of cultural competence
insensitive to sensitive: denial, defense, minimization, acceptance, adaptation, integration
occipital nodes and preauricular nodes catch drainage
scalp
120-129 and less than 80
elevated
where is heart loudest
apical impulse closest to chest wall
- near 5th intercostal space
mallampati classification
- class 1 is can see all hard palate, soft, uvula and pillars
- class 3 is cover up all but soft palate
less than 120/80
normal
HR and BP vital signs
less than 60 bpm is brady. 100 is tachy
90/60 is hypotension 130/90 is hypertensive
less than 10 breaths is hypo, more than 20 is hyper
health promotion
see suspicious moles, skin care, sun exposure, stop smoking and alcohol
False dichotomy
black vs white
soap chart
subjective, objective, assessment, plan
midline neck
- first check thyroid isthmus (feel than BAD)
- check if thyroid cartilege, cricoid cart and thyroid gland move when swallow
- palate lobes of thyroid by displaching trachea and measuring space btw trachea and sternum mastoid and palpate right lobe
HIPAA
health information portability and accountability act
Can give info to legal authorities to prevent harm BUT not for legal charges
Insurance, worker compensation, will, personal injury, malpractice
ABCDE screening
asymmetry, irregular borders, variations in color, diameter over 6 mm, elevation or enlargement
Slippery slope fallacy
occurence of one event will bald to other which is bad
patient care without discrimination, maintain standard of care, fairness in fees
clinical justice
heart and lungs
- 12-16 breaths per min
- when valves don’t close its heart murmur
- mitral valve prolapse common in women. murmur that goes woosh
past medical history
Record a history of certain disease (pertinent negatives)
Hypertension, angine, liver or kidney disease, diabetes, asthma, seizure disorder, heart disease
Current medications, supplements, allergies and reactions, hospitalizations
These effect oral cavity or medications we use in dentistry
- identify allergens and reaction!! prominently
large bruises is
purpura
based on moral values. Inner voice
Consncious
There is a code for every illness and procedure that allows for retrieval of data.
Use ICD (international statistical classification of diseases). Code on dental procedures (CDT), systemized nomenclature for dentistry (SNODENT)
other argument problems
Correlation vs causation, sounds good: doesn’t mean its right
What about… distraction, changing subject or bringing up something not relevant
parotid is swollen
Sialadenosis
- systematic disease from diabetes or alcoholism
- malnutrition, bulimia, autoimmune
rule out emergency, help in diagnosis, status of medical conditiosn
why ros is important
small pinpoints of blood
petechiae
facial, head and neck, lymph node and salivary gland, thyroid, TMJ, cranial nerve
Facial symmetry, skin, lips, thyroid
extraoral
Appealing to emotions or power
anything other than reason
radial pulse
- absent pulse is acute mitral regurgitation
- thready is fast, small and weak
- weak is low cardiac output
0 bounding is exercise of hemorrhage/ poor health - normal is called sinus rhythm
- irregularly regular or ireg ireg (atrial fibrulation)
lymph node exam
- palpate for infection by checking temp, tenderness, fluid moveemnt
- neoplastic is nodes larger than 1.5 cm and matted/firm
- age helps. if younger then probably infection vs over 50 being cancer
Do good
beneficence
old patient, firm and matted lump in neck
carcinoma
respiratory assessment
- lungs by collarbone
- emphesema is form of COPD
- check smoking and heart disease (social and comorbidities)
- paroxysmal nocturnal dyspnea (sleep sitting up)
- wheezing
- percussion or inspection
- respiratory rate, intercostal recession (other muscles used to breath = bad)
- cough is productive (wet) or dry non productive
- finger clubbing is COPD sign
- tripod position to breathe
- trachea percussed
uphold trust, serve all people, pass knowledge, self regulation (ensure all members of profession uphold the ethics, behaviours, responsibilities)
Professional Responsibilities
submandibular and submental nodes catch drainage
oral cavity
informed consent
autonomy and veracity
vital signs hot and cold temp
- core temp is 36.2-37.5 and higher in places and varies. men vs women
- tachycardia (higher than 100 bpm) is when 1 degree increase causes hr 10 beats increase
- fever causes: infection, heat stroke, congenical problems
- cold causes death due to ventricular fibrulation
- heat from muscle contration is sweat but also hypovolemia (low BP = faint)
- heat synncope is heat stroke in 105F or 40C. classic in old and kids but exertional in athletes. cool patient down to get rid of mental confusion
- endocrine messes your temp
- cold stops cellular function (even thru alcohol!)
- bradycardia in cold. 36C or 86F is when ppl can faint
Appeal to fear
opponent is wrong because if he isn’t then bad things will happen
School teaching behaviour
Hidden curriculum
Begging the question
circular reasoning. Will avoid x because I don’t want y
dental and mucosa examination
intraoral
Health information technology for economic and clinical health (HITECH) act
encourages online records BUT they take longer and take away from patient listening
trigeminal nerve
- check 3 branches ophthalmic, macillary, mandibular
- sensory (light touch, sharp/dull test, cold) and motor fxn (jaw clench, jerk)
percussion
- triking one object against another. Finger is used as the hammer. Sound waves are heard as percussion tones (called resonance) arising 4-6 cm deep
Tympany: hollow drum-like sounds heard over air filled structures during abdomen exam
Hyper resonance: pneumothorax. Similar sound to puffed up cheeks. Lower, louder and longer pitch
Resonance: normal. Low pitched and short.
Dullness: liver mass sound
Flatness
do no harm
non maleficence
components of the health history
source and reliability, chief complaint, history of present illness, past medical history, social history, family history, review of systems, summary and oral presentation
systems reviewed in ROS
HEENT, respiratory, cardio, DI, hematologic, endocrine and OTHERS
**tell them a separate part has begun!
- patients either have it OR they are just complaning
private info, touching, respect and held in high esteem, trust, need, seen as good
Profession Priveldge
lymphadenopathy (LAD)
inflamed and malignant
learned and shared beliefs from social interactions
culture
diziness cranial nerve
8
5 kinds of information
evidence, context, insight, impact and person
its for decayed, missing, filled teeth
odontogram
accurately explain conditions, document all findings, use right codes
Clinical veracity
80% skin cancers. Shiny and translucent, grow slowly and metastasize
Basal cell carcinoma
cyst contains hair and teeth and stuff
this is dermal cyst
establish rapport, id problem, clarify onset and development, tolerence to dental procedures, assess factors to problem, summary of symptom and potentially undiagnosed medical conditions
rational of health history
medical interview
establish trusting relationship, gather info and offer it
- types of qns and 5 kinds of info
approach it by self reflection, reviewing chart, setting goals, review clinical behavior, improve eco, take notes
interview sequence
1) greet, listen to story, establish agenda, test hypothesis, create shared understanding of the problem, negotiate a plan and follow up
midline neck masses
thyroid can be congenital, goiter, neoplasm
nonthyroid is dermal cyst, salivary ranula, lymph
characteristics of heart sounds
freq and pitch, intensity, duration, timing (s1 and s2)
hear pulse on
radial, brachial, femoral, popliteal, dorsalis pedis, posterioral tibial
moral distress
emotional state arising from situation when a provider says ethical action is different from what they are tasted with doing
moral courage
strength to speak up despitre repercussions
moral resilience
internal capacity that providers have to restore and sustain their personal integrity in response to moral distress
