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