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Medical screening > medical screening deck 1 > Flashcards

medical screening deck 1 Flashcards

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USMLE® Step 1 flashcards
1
Q

What is the difference between differential diagnosis and medical screening

A
  1. DD is the breakdown of movement impairments and functional limitations 2. medical screen gin is the identification of co-morbid medical conditions
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2
Q

What are the different parts of the physical therapy diagnosis per Duval

A

1- Medical screening clear 2- movement impairment diagnosis 3- model of pathology 4- functional limitations 5 - etiologic variables (causes) 6- prognosis

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3
Q

What is the hypothetic-deductive method of evaluation proposed by Sackett

A

clinical creates a short list of potential diagnosis and then tries to eliminate choice with testing

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4
Q

What is diagnostic test sensitivity

A
  1. True Positive Rate
  2. Portion of the patients who have a positive test result
  3. Tests with high sensitivity have a low false negatives, therefore a negative result rules out the condition (SnOUT)
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5
Q

what is diagnostic test specificity

A
  1. True Negative Rate
  2. Portions of patients w/o the condition who have a negative test result
  3. Tests with high specificity have few false positives therefore a positive result rules in the condition (SpIN)
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6
Q

What are likelihood ratios

A
  1. Combines the information contained in sensitivity and specificity values
  2. Permits comparisons among competing tests
  3. Positive LR: Expresses the change in odds favoring the disorder given a positive test
  4. Negative LR: Expresses the change in odds favoring the disorder given a negative test
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7
Q

What is the value of a large LR

A
  1. Large LR (>5.0)
  2. Increases the odds favoring the Diagnosis given a positive test
  3. Helpful for ruling in the condition
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8
Q

What is the value of a small LR

A
  1. Small LR (<0.30)
  2. Reduces the odds of favoring the Diagnosis given a negative test
  3. Helpful for r/o the condition
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9
Q

What are the different parts of the DVT CPR

A
  • Active cancer (within 6 months)
  • Paralysis, paresis, or recent plasterimmobilization of lower extremity
  • Recently bedridden >3 days or major surgery within 4 weeks of application of clinical decision
  • Localized tenderness along distribution of the deep venous systema
  • Entire lower-extremity swelling
  • Calf swelling by >3 cm compared with asymptomatic lower extremityb
  • Pitting edema (greater in the symptomatic lower extremity)
  • Collateral superficial veins (nonvaricose)
  • Alternative diagnosis as likely or greater than that of deep vein thrombosisc
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10
Q

What pain questionnaire takes into account the value of word choice?

A

MeGill University pain questionnaire (long form)

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11
Q

Rapid weight gain is associated with what disease

A

CHF, liver and renal disease (fluid retention problems)

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12
Q

What are the categories of weight loss

A
  1. decreased caloric intake, 2. malabsorption or malgigestion 3. impaired metabolize 4. increase losses or excretion
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13
Q

what are the BMI norms

A

< 18.5 underweight
18.5 to 25.0 healthy
25.1 to 29.9 overweight
> 30 obese

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14
Q

what areas should you assess to determine nutrition al statues of a person based on their appearance

A

skin eyes,mouth, skeletal muscles, fat stores

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15
Q

what are the four principles of physical examination

A
  • inspection - palpation - percussion - auscultionation
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16
Q

What is cachectic

A

wasted looking appearance

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17
Q

What are the different ways of describing body habitus

A
  • asthenic (ectomophic)- thin
- sthenic (mesomorpic) - athletic
- hypersthenic (endomorphic) - show good development heavy
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18
Q

What conclusions can you reach when you finish the patient’s history?

A
  1. Identify medical screening hypothesis 
2. identify movement impairment hypothesis
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19
Q

What is pruritus?

A

Itching

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20
Q

What are Beau’s Line?

A
  1. transverse grooves or depressions in the nails
2. Can occur with infections, nutritions disorders, circulatory disorders and dysmetabolic states
3. occurs when the nail stops growing for brief periods of time
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21
Q

What are Mee’s bands?

A

transverse white lines associated with poisoning or acute systemic illness

22
Q

What are Lindsay’s Nails?

A
  1. proximal portion of nails is white distal half is red or pink
2. occurs with chronic renal disease
23
Q

What are terry’s nail?

A
  1. White nail bed to within 1-2 mm of distal border of the nail
2. occurs with cirrhosis, hypoalbuminemia, CHF, adult onset DM
24
Q

What are splinter hemorrhage

A
  1. extravasation of blood from the longitudinal nail bed blood vessels into adjacent troughs
2. bacterial endocarditis, leukemia, vasculitis, RA, lupus, renal and liver disease, DM
25
Q

What is Koilonychia?

A
  1. spoon nail
2. iron deficient anemia
26
Q

What is pitting of the nails associated with?

A
  1. psoriasis and psoriatic arthorpathy
27
Q

What does the thyroid do?

A
  1. Uses iodine to produce thyroid hormones
2. regulates the rate of metabolism and growth rates via impact on other systems 
3. produces calcitonin that helps with Ca blood levels
28
Q

Describe the process for palpating the thyroid

A
  1. Sitting face to face, flex the patient’s neck or turn the chin slightly to the right.
  2. Relax the sternocleidomastoid muscle on that side, making the examination easier to perform.
  3. The left hand should displace the larynx to the left and during swallowing the displaced left thyroid lobe is palpated between the examiner’s right thumb and the left sternocleidomastoid muscle.
29
Q

What condition could produce an enlarged thyroid

A

hyperthyroid, hypothyroid or mulitnodular goiter of normal function

30
Q

What is Pemberton’s sign?

A

Pemberton’s sign detects latent obstruction in the thoracic inlet. Ask the patient to elevate both arms until they touch the sides of the head. If the test is positive (indicating Pemberton’s sign), facial suffusion with dilatation of the cervical veins will develop within a few seconds.

31
Q

Symptoms of hyperthyroidism

A
  • General Preference for the cold, Weight loss with good appetite
  • Eyes Prominence of eyeballs proptosis, Puffiness of eyelids, Double vision, Decreased motility
  • Neck Goiter
  • Cardiac Palpitations, Peripheral edema
  • Gastrointestinal Increased bowel movements
  • Genitourinary Polyuria, Decreased fertility
  • Neuromuscular Fatigue, Weakness, Tremulousness
  • Emotional Nervousness, Irritability
  • Dermatologic Hair thinning, Increased perspiration, Change in skin texture, Change in pigmentation
32
Q

What disease is related to hyperthyroid

A
  • graves and plumber’s
33
Q

Symptom of hypothyroidism

A 
Dry skin
Sparse hair
Hoarse voice
Develops insidiously
Often the only complaint is a tired or “rundown” feeling
Hung, or delayed, reflexes
34
Q

describe Rinne Test

A

Cochlear nerve CN8 
- Patients are normally able to hear the fork at the external auditory meatus after they can no longer hear it on the mastoid tip. This is a Rinne Positive (AC > BC).

  • Patients with a conductive hearing loss have bone conduction that is better than air conduction and will get a Rinne Negative (BC>AC).
  • Patients with sensorineural deafness have impaired air and bone conduction but maintain the normal response (AC>BC). The middle ear amplifies the sound in both positions.
  • If there is total deafness, the patient may hear the tuning fork even when it is placed on the mastoid process of the deaf ear due to the transmission of vibrations by bone across the skull to the opposite side. This is a False-negative Rinne.
35
Q

Describe Weber test

A
  • Compares bone conduction in both ears and determines whether monaural impairment is neural or conductive in origin.
  • Stand in front of the patient and place a vibrating 512Hz tuning fork firmly against the center of the patient’s forehead.
  • Ask the patient to indicate whether he or she hears or feels the sound in the right ear, left ear or in the middle of the forehead.
  • The middle is the normal response.
  • If the sound is not heard in the middle it is said to be lateralized and hearing loss is present.
  • Sound is lateralized to the affected side in conductive deafness.
36
Q

Describe the lobes of the lungs

A
  1. 2 lobed left is smaller than the 3 lobed right
37
Q

where will you find the super lobes of the lungs

A

anterior - supraclavicular, 1st and 2nd intercostal space
posterior - T2-T4

38
Q

Where do find the inferior lobes

A
  • posterior T5-T9
39
Q

where do find the right middle lobe

A

right axillary line T4-T6

40
Q

What is a barrel chest and flail chest

A
  • barrel - horizontal orientation of the ribs
- flail - pradoxal movement of ribs often associated with collapsed lung
41
Q

what’s the difference between pectus excavated and carinatum

A
  • excavatum - caved chest
- carinatum - pigeon chest
42
Q

What is tactile Fremitus

A

palpable vibration felt by the hand placed on the chest during caught or speaking

43
Q

Describe the different sounds you can expect with percussion of the chest and abdomen

A
  • Percussion over a solid organ (i.e. the liver) produces a dull, low-amplitude, short duration note without resonance.
  • Percussion over a structure containing air within the tissue (i.e. the lung) produces a resonant, high-amplitude, lower-pitched note.
  • Percussion over a hollow air-containing structure (i.e. the stomach) produces a tympanic, high-pitched, hollow-quality note.
  • Percussion over a large muscle mass (i.e. the thigh) produces a flat, high-pitched note.
44
Q

What are the different type of breath sounds

A
  1. tracheal - very load, very high pitch, 1:1 I/E, extra thoracic region
2. branchial - loud, high pitch, 1:3 I/E ration, manubium
3. bronchovesicular - moderate load, moderate pitch, 1:1 I/E, over stem of bronchi
4. Vesicular - soft, low pitch, 3:1 I/E, most peripheral lung
45
Q

What are some pathologic breath sounds

A

crackles, wheezes, Rhonchi, pleural rubs

46
Q

What are breath crackers

A
  • AKA rales or crepitation, short, discontinuous, nonmusical sounds mostly during inspiration
- caused by opening and collapse of distal airways
- common in pulmonary edema, CHF, PF
47
Q

what are wheezes

A
  • Continuous, musical, high-pitched sounds heard mostly during expiration.
  • Produced by airflow through narrowed bronchi.
  • This narrowing may be due to swelling, secretions, spasm, tumor or foreign body.
  • Wheezes are commonly associated with the bronchospasm of asthma.
48
Q

What is egophony?

A
  • Present when the spoken word heard through the lungs is increased in intensity and takes on a nasal or bleating quality.
  • The patient is asked to say “eeee” while the examiner listens to an area in which consolidation is suspected.
  • If egophony is present, the “eeee” will be heard as “aaaa”. This “e to a” change is seen in consolidation of lung tissue.
  • The area of compressed lung above a pleural effusion often produces egophony.
49
Q

What is a bruit?

A

eddy in the vascular system

50
Q

What is rebound tenderness of the abdomen?

A
  • pain after your release press
- suggests peritonitis

Medical screening (2 decks)

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