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primary care > Lecture 1A 1B and 1C > Flashcards

Lecture 1A 1B and 1C Flashcards

1
Q

“accessible, comprehensive, coordinated and continual care delivered by accountable providers of personal health services”

A

IOM definition of primary care

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2
Q

T or F: in 2015, all 50 US states, DC, and US have some direct access

A

true

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3
Q

How much direct access does Texas have?

A

10-15 days (depending on training)

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4
Q

!!! what is the 1st question that must be answered prior to any others when seeing a pt? what are the answer choices?

A

do you belong here??

YES- Tx
Yes & No- Refer and Tx
NO- Refer

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5
Q

Nine conditions not to miss

A

Depression
Suicide
Femoral head/neck fx
cauda equina syndrome
cervical myelopathy
abdominal aortic aneurysm
DVT
PE
atypical MI

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6
Q

risk factors of major depression :(

A

current/PMH
female- postpartum/pregnant
Hx of DM,MI, cancer, chem dependency
significant loss
family Hx

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7
Q

___% of PT formally screen for depression

A

18%

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8
Q

Risk factors for suicide

A

males - increased complete
females- increased attempt
Hx of psychiatric illness
Hx of progressive illness, attempts, family Hx

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9
Q

conditions assoc with femoral fx rates

A

osteoporosis
stress/fatigue
major trauma

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10
Q

medicines associated with compromised bone density

A

Corticosteroid, anti-convulsants, cytotoxic drugs, blood thinner, aluminum, throxine, caffeine, tobacco

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11
Q

risk factors with fatigue fx

A

female
high impact
change in training
nutritional def
leg length discrepancy
decreased muscle strength

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12
Q

clinical manifestation of fem neck/head fx

A

pain and localized tenderness- worse w/ WB
deformity- shortened limb
edema, ecchymosis
LOF
+ patellar-pubic percussion test
+ fulcrum test

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13
Q

risk factors for cauda equina syndrome

A

LBP, central disc herniation
congenital/acquired spinal stenosis
spinal fx
ankylosing spondylitis
TB, Potts

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14
Q

clinical manifestations of cauda equina

A

LB/LE pain
neurologic compromise
ataxia/poor balance
LE “heavy”

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15
Q

neurologic compromise of cauda equina

A

motor and sensory def
urinary, bowel. sexual dysfunction
! urinary retention most frequently noted !!

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16
Q

T or F: cauda equina syndrome onset of symptoms is quick

A

F: onset of symptoms can be quick OR gradual

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17
Q

risk factors for cervical myelopathy

A
  • typically w/ C-spine spondylosis
  • c-spine instability leading to compromise
  • wide variation in natural HX -older over time, young folks due to trauma
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18
Q

What is the most common cause of non-traumatic paraparesis and quadriparesis?

A

cervical myelopathy

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19
Q

clinical manifestions of cervical myelopathy

A

S/S worsen in slow, step wise progression
neurologic compromise includes: impaired hand dexterity, gait/balance issues, paresthesis, neck stiffness, urinary retention, UE / LE weakness, UMN signs

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20
Q

aneurysm distal to the renal arteries

A

abdominal aortic aneurysm

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21
Q

risk of AAA rupture increases when diameter approaches

A

5-6 cm

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22
Q

risk factors for AAA

A

over 60 y/o
male
Hx of smoking, high cholesterol, CAD
family Hx

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23
Q

clinical manifestations of AAA

A

back, ab, hip, groin, buttock pain
non mech pain
insidious onset (slow or fast)
early satiety, weight loss, nausea
palpable mass, visible pulse
bruit +

if pt reports hot, searing, ripping, or tearing- STOP

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24
Q

T o F: most pt w AAA are asymptomatic

A

True

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25
Q

DVT risk factors

A

Hx, cancer, CHF, SLE
infection
chemo, Central Venous cath
surgery, trauma
immobility, paralysis
women during pregnancy/post
over 60

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26
Q

clinical manifestations of DVT

A

tightness, tenderness
edema
pitting edema
increased skin temp

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27
Q

__% of individuals w/ DVT are asymptomatic in early stages

A

50

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28
Q

DVT decision rule

A

> or = 2 points DVT likely
<2 points = DVT unlikely

-2 score only for when alternative dx

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29
Q

PE most associate with

A

DVT, air, fat, bone marrow embolism

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30
Q

proximal LE DVT compromise about what percent of PE?

A

70%

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31
Q

risk factors of PE

A

Hx PE/DVT, surgery
THR, TKR
immobility
lower limb fx
late stage pregnancy

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32
Q

clinical manifestations of PE

A

dyspnea
tachypnea
pleuritic chest pain
persistent cough
apprehension, anxiety
tachycardia/ palpitations

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33
Q

___ of deaths related to PE are potentially preventable

A

> 50%

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34
Q

clinical decision rule for PE: Wells Criteria

A

<2 points = low
2-6 = moderate
>6 = high

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35
Q

~ __% of women experience chest pain w MI

A

50%

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36
Q

T or F: cardiac death is the 2nd leading COD in women of all ages

A

F,
cardiac death is the LEADING COD in women of all ages

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37
Q

risk factors of atypical MI

A

smoking, high cholesterol, HTN, DM, obesity, sedentary
age > 55 for women
age > 45 for men
fam Hx
ethnicity

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38
Q

clinical manifestations of atypical MI

A

SOB, fatigue, nausea
dizziness, diaphoresis, anxiety, sleep disturbance
chest pain (w/ or w/o UE pain)
upper ab, epigastric, jaw, neck tooth pain
pain w/ w/o exertion

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39
Q

what is the first step if you assume an MI

A

Take vital signs!!!

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40
Q

What is reliability vs validity?

A

Reliability- consistently gives the same score

Validity- Measures what it’s suppose to measure

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41
Q

What is “Responsiveness” in a study?

A

Ability to detect change over time

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42
Q

Sensitivity is good for ruling a condition __________

A

OUT

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43
Q

Specificity is good for ruling a condition ______

A

IN

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44
Q

“Given that the individual has the condiiton, the probability that the test will be +”

Is this sensitivity or specificity?

A

Sensitivity

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45
Q

Specifity definition

A

Given that the individual does NOT have a condition, this is the probability that the test will be negative

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46
Q

How do you calculate sensitivity

A

True positive / (True Positive + False Negative)

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47
Q

How do you calculate Specificity

A

True negative / (False positive + True negative)

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48
Q

A study that easily picks up symptoms but has a lot of false positives has high __________

A

Sensitivity

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49
Q

Sensitivity is good for __________ (screening/diagnositc)

A

Screening

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50
Q

Specifity is good for (Screening/Diagnostic)

A

Diagnostic

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51
Q

How do you calculate positive predictive value

A

True positive / ( True positive + False positive)

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52
Q

What is this definition:

Given a (+) test result, the probability that the individual DOES have the condition

A

positive predictive value

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52
Q

How do you calculate negative predictive value?

A

True negative / (true negative + false negative)

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53
Q

What is this definition:

Given a (-) test result, the probability that the individual DOES NOT have the condition

A

Negative predicitive value

54
Q

Conditions with very low prevelance will have a

______ positive predictive value

______ negative predicitve value

A

Lower positive predictive value (lower amount of true positives)

Higher negative predictive value (higher amount of true negatives)

55
Q

How do you calculate positive likelihood ratio?

A

Sensitivity / (1-specificity)

56
Q

How do you calculate negative likelihood ratio

A

1-sensitivity / specifity

57
Q

Definition of Positive likelihood ratio

A

Given the result of + test, the increase in the odds favoring the condition

58
Q

Negative likelihood ratio definition

A

Given the result of - test, the decrease in the odds favoring the condition

59
Q

What is considered a large positive likelihood ratio?

What is considered a good negative likelihood ratio?

A

10

0.10

60
Q

What is considered a bad positive likelihood ratio?

What is considered a bad negative likelihood ratio?

A

1-2

0.5-1

61
Q

If the negative LR is 0.75, is a negative result to this test reliable?

A

Not helpful, too high

62
Q

What is considered the most powerful tool for quantifying importance of a particular test?

A

Likelihood ratios

63
Q

T or F, very few tests have a good positive likelihood ratio and negative likelihood ratio

A

T

64
Q

Minimal detectable change

A

Amount of change needed to exceed the measurement of error of the test

65
Q

What is the MCID (minimal clinical importance difference)?

A

Smallest difference detected that represents important improvement for individuals with the condition

66
Q

Increased reliability of test leads to ___________ Minimal detectable change

A

Lower

67
Q

What should be higher:

Minimal Clincial Important Difference
or
Minimal Detectable Change

A

MCID

68
Q

What are 5 parts of patient history that can help identify mechanical pain

A

Severity

Irritability

Nature

Stage

Stability

69
Q

Severity

A

describes clinician’s assessment of intensity of pt’s symptoms as they relate to a functional activity

70
Q

Irritability

A

describes clinician’s assessment of ease w/ which symptoms can be provoked or stirred up

71
Q

Nature of symptoms

A
  1. Hypotheses of structures, syndrome/classification or pathoanatomic structures or syndromes responsible for producing pt’s pain
  2. Anything about the problem or condition that may warrant caution w/ physical exam
  3. Character of presenting pt or problem (i.e. psychological, personality, ethnicity, SES factors
72
Q

Stage of symptoms

A

Describes clinician’s assessment of stage in which pt is presenting (acute, sub-acute, chronic, acute on
chronic); may be obtained from past & present hx

73
Q

Stability of symptoms

A

describes progression of pt’s symptoms over time (i.e. getting better, worse or staying the same)

74
Q

When collective subjective data you should start with _____ questions and follow up with ______ ended questions

A

Open Ended

Closed ended

75
Q

T or F: You should let the patient tell their story, but make sure you get the info your need to direct your exam

A

True

76
Q

Unexplained weightloss of over 10lbs in 3 months is an example of a

A

red flag

77
Q

T or F: Being over 50 years old is an example of a red flag

A

T, due to increased risk of cancer, infection, AAA

78
Q

B

Resting/night pain is an example of a…..

A

Red Flag

79
Q

What is saddle anesthesia

A

Absence of sensation in the 2nd-5th sacral nerve roots

RED FLAG

80
Q

Bowel and bladder dysfunction is an example of a

A

potential red flag

81
Q

Differential diagnosis is based on pt’s health history and subjective interview,

Differential diagnosis is ________________ what is going on with the patient

A

What is most likely going on

82
Q

When creating differential diagnosis you should have a top ____ in mind after the subjective interview

A

Top 3

83
Q

T or F: Referred pan can be mechanical OR non-mechanical

A

T

84
Q

Pain that fluctuates over a 24 hour period is likely:

Pain that does not fluctuate over 24 hours or with positive/activity is likely:

A

Mechanical

Non-Mechanical

85
Q

Pain with inconsistent location, insidious onset, and with a dull ache not located near MSK structures is likely

A

nonmechanical

86
Q

Pain that comes on after eating or urinating is likely

A

nonmechanical

87
Q

Throbbing pounding and pulsating pain is likely from _____ disorders

A

Vascular

88
Q

Pain that is sharp, lancinating, shocking, and burning is likely from ____ disorders

A

Neurological

89
Q

Pain that is aching, squeezing, gnawing, burning, cramping is likely from _____ disorders

A

Visceral

90
Q

Low back region pain with Hx of cancer, weight loss, failure of conservative treatment, and over 50?

A

Potential tumor

91
Q

Back pain w/ history of recent infection, IV drug abuse, immunosupressive disorder

A

Possible back-related infection

(spinal osteomyelitis)

92
Q

Low back pain w/ history of spinal stenosis and history of DDD, saddle anesthesia, urinary problems, progressive weakness?

A

Potential cauda equina

93
Q

Back pain w/ Hx of trauma, long term corticosteroid use, and over 70?

Edema in area w/ tenderness at palpation

A

Potential spinal fracture

94
Q

What are the signs of an abdominal aneurysm

A

Back/groin pain

PVD/CAD and risk factors

Over 50

Symptoms unrelated to movement

Abnormal width of aortic/iliac artry pulses

Presence of bruit in central epigastric area upon auscultation

95
Q

Medical screening questionare for LBP

A

Recent fall or trauma/MVA?

Osteoporosis?

Cancer?

Pain at rest?

Fever?

Weight loss?

antibiotics/infection?

96
Q

Hip pain w/ bowel disturbances, weight loss, hx of cancer, pain unchanged by position?

A

Colon cancer

97
Q

Hip pain in older women (70+)

Hx of fall

Constant severe pain

Shortened and ER LE

A

Fx of femoral neck

98
Q

Pelvis/hip pain in 5-8 year old boys, antalgic gait, pain complaints aggrevated w/ hip movement especially IR and ABD

A

Legg-Calve-Perthes disease

99
Q

Hip/pelvis pain w/ Hx of corticosteroid

Hx of osteonecrosis/trauma

Gradual onset of pain that worsens w/ weightbearing

A

Osteonecrosis of femoral head

100
Q

Pelvis/Hip pain in overweight adolescent

HX of recent growth spurt

Aching in groin that gets worse with weight bearing

Leg held in ER

Hip ROM limited into IR

A

Slipped capital femoral epiphysis

101
Q

Pelvis/Hip screening questions

A

Recent fall?

Osteoporosis?

Blood circulation problems in hip?

Corticosteroids?

Pain in different positions?

Hx of cancer in yourself or family?

102
Q

Knee/leg/ankle/foot pain w/

60+ Y/O

Hx of Diabetes

Hx of ischemic heart disease

Smoking hx

sedentary lifestyle

prolonged vascular filling time

cool to touch extremity

A

Peripheral Arterial Occlusive Disease

103
Q

Knee/leg/anke/foot pain w/

Recent surgery/cancer/pregnancy/trauma

Calf pain/edema/tenderness/warmth

Weight bearing makes it worse

A

Potential DVT

104
Q

Knee/leg/anke/foot pain w/

Hx of blunt trauma, crush injury, or unaccustomed exercise

Severe persistent pain that intensifies with stretch to muscles

A

potential compartment syndrome

105
Q

Knee/leg/anke/foot pain w/

Hx of infection, surgery, or immunosuppresant disorder

Constant throbbing, warmth, swelling

elevated body temperature

A

possible septic arthritis

106
Q

Knee/leg/anke/foot pain w/

Hx of recent skin ulceration or abrasion

venous insufficiency

Coronary heart failure

pain/swelling/warmth

Advancing irregular margin of redness

Fever/chills/weakness

A

Cellulitis

107
Q

Knee/leg/anke/foot pain

screening questions

A

Recent Fever?

Antibiotics?

Surgery/injections?

Cut/wounds?

Immunosupressant disorder, heart disorder, or cancer?

Recent long trip?

Bed ridden?

108
Q

Thoracic/rib pain w/

Hx of CAD/HTN/ elevated cholesterol

Men 40+, Women 50+

Chest pain

Pallor/dyspenia/nausea

A

Potential Myocardial infarction

109
Q

Thoracic/rib pain w/

Hx of autoimmune disorder

myocardial infection

sharp/stabbing pain that refers to lateral neck or shoulder

pain is position dependent

A

Pericarditis

110
Q

Stable angina pectoralis is most common in people ______

A

65+

men

111
Q

Thoracic/Rib pain W/

Hx of DVT, Immobility, Trauma, Cancer

Pt is experiencing Tachypnea, Dyspenia, Or Tachycardia w/ Chest pain

A

Potential Pulmonary Ebolism

112
Q

Thoracic/Rib pain W/

Hx of recent respiratory disorder/infection/pneumonia, tumor

Severe/sharp pain w/ inspiration

Dyspenia and decreased chest wall excursion

A

Possible Pleurisy

113
Q

Thoracic/Rib pain W/

Recent bout of coughing/strenous exercise or trauma

Chest pain w/ inspiration/ difficulty ventilating

Decreased breathsounds

Hyperresonance on percussion

A

Possible Pneumothorax

114
Q

Thoracic/Rib pain W/

Hx of infection

Pleuritic pain

Fever/ Chills/Nausea

A

Possible pneumonia

115
Q

Thoracic/Rib pain W/

Middle aged women

Elevated WBC count

Colicky pain in R upper abdominal quadrant/ R scapular pain

Symptoms worse with ingestion of fatty food

A

Cholecystitis

116
Q

Thoracic/Rib pain W/

Dull/Gnawing pain or burning in epigastrium midback region

symptoms reliefed w/ food

hx of infection

hx of stress

constipation/vomiting

coffee ground emesis

A

Possible peptic ulcer

117
Q
A

pyelonephritis

118
Q
A

nephrolithiasis

119
Q
A

Spinal Fx

120
Q

Questions to ask for thoracic/rib pain

A

Hx of heart problems?

Nitroglycerin use?

Diabetes?

HTN?

Smoking?

Position dependent pain?

Surgery?

Bedridden?

Difficulty breathing,sneezing,coughing?

Recent infection?

121
Q
A

Meningitis

121
Q

Additional rib/thoracic questions

A

Recent trauma to chest/MVA?

Coughing up sputum?

Symptoms relieved w/ eating?

Fatty foods increase symptoms?

UTI?

Kidney Stone?

Severe back/flank pain?

122
Q
A

1 brain tumor

123
Q
A

subarachnoid hemorrage

124
Q

Questions for screening head/face/tmj pain

A

Depressed immune system?

Recent intestinal infection, mumps, or herpes?

Contact w/ pigeon droppings?

Living in close quarters w/ lot of people like military or dormatory?

Recent trauma?

High fever

Nausea/vomiting

light sensitivity?

Inability to concentrate?

125
Q

C Spine and shoulder pain presenting w/

A

Cervical ligamentous instability w/ possible cord compromise

126
Q

C Spine and shoulder pain presenting w/

A

Cervical and shoulder girdle peripheral entrapment

127
Q

Cervical spine/shoulder pain w/

A

Pancoast’s tumor (superior sulcus lung tumor)

128
Q

Medical screening questions for shoulder/ C spine

A

Direct blow?

Excessive use?

Traction injury?

FOOSH?

Difficulty lifting arm?

Pin needle sensation?

Do you experience pain that doesn’t improve w/ rest?

129
Q

elbow/wrist/hand pain w/

A

Radial head fx

130
Q

elbow/wrist/hand pain w/

A

Distal radius/colle’s fracture

131
Q

Elbow/Wrist/Hand pain w/

A

Scaphoid fracture

132
Q

Elbow/Wrist/Hand pain w/

A

Lunate Fx or dislocation

primary care (6 decks)

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