Lecture 1A 1B and 1C Flashcards
“accessible, comprehensive, coordinated and continual care delivered by accountable providers of personal health services”
IOM definition of primary care
T or F: in 2015, all 50 US states, DC, and US have some direct access
true
How much direct access does Texas have?
10-15 days (depending on training)
!!! what is the 1st question that must be answered prior to any others when seeing a pt? what are the answer choices?
do you belong here??
YES- Tx
Yes & No- Refer and Tx
NO- Refer
Nine conditions not to miss
Depression
Suicide
Femoral head/neck fx
cauda equina syndrome
cervical myelopathy
abdominal aortic aneurysm
DVT
PE
atypical MI
risk factors of major depression :(
current/PMH
female- postpartum/pregnant
Hx of DM,MI, cancer, chem dependency
significant loss
family Hx
___% of PT formally screen for depression
18%
Risk factors for suicide
males - increased complete
females- increased attempt
Hx of psychiatric illness
Hx of progressive illness, attempts, family Hx
conditions assoc with femoral fx rates
osteoporosis
stress/fatigue
major trauma
medicines associated with compromised bone density
Corticosteroid, anti-convulsants, cytotoxic drugs, blood thinner, aluminum, throxine, caffeine, tobacco
risk factors with fatigue fx
female
high impact
change in training
nutritional def
leg length discrepancy
decreased muscle strength
clinical manifestation of fem neck/head fx
pain and localized tenderness- worse w/ WB
deformity- shortened limb
edema, ecchymosis
LOF
+ patellar-pubic percussion test
+ fulcrum test
risk factors for cauda equina syndrome
LBP, central disc herniation
congenital/acquired spinal stenosis
spinal fx
ankylosing spondylitis
TB, Potts
clinical manifestations of cauda equina
LB/LE pain
neurologic compromise
ataxia/poor balance
LE “heavy”
neurologic compromise of cauda equina
motor and sensory def
urinary, bowel. sexual dysfunction
! urinary retention most frequently noted !!
T or F: cauda equina syndrome onset of symptoms is quick
F: onset of symptoms can be quick OR gradual
risk factors for cervical myelopathy
- typically w/ C-spine spondylosis
- c-spine instability leading to compromise
- wide variation in natural HX -older over time, young folks due to trauma
What is the most common cause of non-traumatic paraparesis and quadriparesis?
cervical myelopathy
clinical manifestions of cervical myelopathy
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
aneurysm distal to the renal arteries
abdominal aortic aneurysm
risk of AAA rupture increases when diameter approaches
5-6 cm
risk factors for AAA
over 60 y/o
male
Hx of smoking, high cholesterol, CAD
family Hx
clinical manifestations of AAA
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
T o F: most pt w AAA are asymptomatic
True
DVT risk factors
Hx, cancer, CHF, SLE
infection
chemo, Central Venous cath
surgery, trauma
immobility, paralysis
women during pregnancy/post
over 60
clinical manifestations of DVT
tightness, tenderness
edema
pitting edema
increased skin temp
__% of individuals w/ DVT are asymptomatic in early stages
50
DVT decision rule
> or = 2 points DVT likely
<2 points = DVT unlikely
-2 score only for when alternative dx
PE most associate with
DVT, air, fat, bone marrow embolism
proximal LE DVT compromise about what percent of PE?
70%
risk factors of PE
Hx PE/DVT, surgery
THR, TKR
immobility
lower limb fx
late stage pregnancy
clinical manifestations of PE
dyspnea
tachypnea
pleuritic chest pain
persistent cough
apprehension, anxiety
tachycardia/ palpitations
___ of deaths related to PE are potentially preventable
> 50%
clinical decision rule for PE: Wells Criteria
<2 points = low
2-6 = moderate
>6 = high
~ __% of women experience chest pain w MI
50%
T or F: cardiac death is the 2nd leading COD in women of all ages
F,
cardiac death is the LEADING COD in women of all ages
risk factors of atypical MI
smoking, high cholesterol, HTN, DM, obesity, sedentary
age > 55 for women
age > 45 for men
fam Hx
ethnicity
clinical manifestations of atypical MI
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
what is the first step if you assume an MI
Take vital signs!!!
What is reliability vs validity?
Reliability- consistently gives the same score
Validity- Measures what it’s suppose to measure
What is “Responsiveness” in a study?
Ability to detect change over time
Sensitivity is good for ruling a condition __________
OUT
Specificity is good for ruling a condition ______
IN
“Given that the individual has the condiiton, the probability that the test will be +”
Is this sensitivity or specificity?
Sensitivity
Specifity definition
Given that the individual does NOT have a condition, this is the probability that the test will be negative
How do you calculate sensitivity
True positive / (True Positive + False Negative)
How do you calculate Specificity
True negative / (False positive + True negative)
A study that easily picks up symptoms but has a lot of false positives has high __________
Sensitivity
Sensitivity is good for __________ (screening/diagnositc)
Screening
Specifity is good for (Screening/Diagnostic)
Diagnostic
How do you calculate positive predictive value
True positive / ( True positive + False positive)
What is this definition:
Given a (+) test result, the probability that the individual DOES have the condition
positive predictive value
How do you calculate negative predictive value?
True negative / (true negative + false negative)