Midterm Flashcards
COMPREHENSIVE hx
New patients
Hospital admission patients
Consultations
Annual Physicals
quiet pt
open ended
talkative pt
Use direct questions to fill in the gaps or direct the encounter. Transitional statements and summarizing works well.
INCAPACITATED PATIENT
Seek information from other people, EMT, family members, old records.
Detailed physical exam is essential.
Confusing Patient
Use direct questioning.
most impt reason for dr selection
provider’s interpersonal skills
Para linguistics
Tone, Rhythm, Pace/rate, Vibrancy, Volume, Pauses/silence, Encouraging gestures/sounds/nodding
health
A state of complete physical, mental and social well being and not merely the absence of disease or infirmity.”
global health 3 criteria
for the poor
1) Equitable access (to both prevention and treatment services, rural and urban)
2) Affordability regardless of income
3) Sustainability of services through long term political and financial support
leading risk factor of health
poverty
best prevention
education
4 leading causes of death overall
1) Ischemic Heart Disease
2) Cerebrovascular Disease/stroke
3) COPD
4) Lower Respiratory Infections
4 leading causes of infectious disease death
LRI
diarrhea
HIV/AIDS
TB
top 3 single organism killers
HIV/AIDS
Tuberculosis
Malaria
leading killer of HIV+ pts
TB is a leading killer of HIV-positive people
ebola
Human to human transmission via direct contact with blood or body fluids from an infected person.
secondary lesion
evolve from primary skin lesions, either because of the natural history of the disorder (e.g., crusts in chicken pox) or because of scratching or infection.
vellus hair
terminal hair
vellus-peach fuzz
terminal-pubic
3 phases of hair growth
Catagen phase – transitional phase – 3%
Telogen phase – resting phase – 10-15%
Anagen phase – Growing phase – 85-90%
clubbing causes
Congenital Chronic hypoxia Heart disease Lung cancer Hepatic cirrhosis
nail pits
psoriosis
mees and beaus lines
chemo
mobility and turgor
Note ease with which it lifts up (mobility) and speed with which it returns to place (turgor).
extensor surface skin lesion
psoriosis
flexor surface
atopic dermatitis
Macule
vitiligo
flat less than 1cm
patch
cafe au lait
flat more than 1cm
papule
psoriosis
small raised lesion
plaque
large raised lesion
nodule
dermafibroma
firm, hard lesion, deeper than a papule, greater than 0.5 cm
cyst
nodule filled with material, liquid or semi-solid.
Often encapsulated.
vesicles
herpes
fluid filled lesions less than 1.0 cm.
Single or in clusters.
bulla
fluid filled lesion greater than 2.0 cm.
wheal
urticaria
superficial localized raised area of skin.
Blanche with pressure.
scale
Ichthyosis vulgaris
flaking of dead exfoliated epidermis.
crust
impetigo
dried residue of skin exudates such as serum, pus or blood.
fissure
tinea pedis
ulcer
deep epidermis loss
Lichenification
thickening of the epidermis and roughing of the skin surface often from rubbing or scratching.
Excoriation
linear erosions caused by scratching.
Koebner phenomena
skin trauma from scratching may cause new lesions spreading poisin ivy.
KOH
fungus-hyphae
tzanck
herpes (giant cells)
oil mount
scabies
BCC
80% of the skin cancers
Grow slowly, rarely metastasize
“rodent ulcer”
pearly white with talengitelisis
SCC
Arise from the upper layer of the epidermis
Can metastasize
actinic keratoses
left shift Neutrophil
more immature cells-May indicate Bacterial Infection, toxemia, hemorrhage, more acute problems
right shift neutrophil
more mature cells Liver disease, megaloblastic anemia, iron def. disease, more chronic problems?
hyperglycemia
DM
hypoglycemia
pancreatic disease
high bun:creatine
low bun: Creatine
prerenal-dehydration
renal issue
AST>ALT
alchoholic hep
ALT>AST
viral hep
JNC-VII
pre=120-39/80-89
stage 1= 140-59/90-99
Start drugs
stage 2= >160/>100
JNC-VIII
In general population, initiate pharmacologic tx when
BP is 150/90 or greater ; adults age 60 or older
BP is 140/90 or greater; adults younger 60 years
In patients with HTN and diabetes, initiate pharm tx when BP is 140/90 or greater*, regardless of age.
orthostatic hypotension
Drop of >20mm systolic or >10mm diastolic
BMI
18.5-24.9=normal
25-29.9=overweight
30-39=obese
>40= extreme obese
most impt part of eye exam
visual acuity
autophony
chronically open Eustachian Tube
parts to see in ear
malleus, cone of light, incus, pars tensa and pars flaccida
Nonmobile TM
fluid, mass, sclerosis
Hypermobile TM:
ossicle bones disrupted
conductive loss
BC>AC, external and middle ear, foreign body, ottits media, perforated eardrum, osteoclerosis
sensoneurial loss
When the inner ear cochlear nerve is abnormal, this defines sensorineural hearing loss and both bone and air conduction is poor.
loud noise, inner ear infxn, tumors, aging
Sudden vision loss
retinal detachment
vitreous hemmorage
CVA (stroke)
gradual vision loss
cataracts glaucoma HIV-CMV Diabetes macular degeneration
presbyopia
aging vision- hard seeing close
heterophoria
cross eye (bad eye moves in cover test)
2 types
esophoria-inward
exophoria-outward
anterior chamber
bw cornea and iris
post chamber
bw iris and lens
homonymous hemianopsia
w/b w/b left to right
named for region you can’t see out of
bitemporal hemianopsia
b/w w/b left to right
caused by pituitary tumor
horizontal defect
top to bottom difference
blephoritis
inflamed lid margins
entropion
eyelid inwards
ectropion
eyelid outward
Bulbar conjunctiva
Palpebral conjunctiva
covers the anterior eye
lines the eyelids
anisocoria
unequal pupils
accomadation
near and far
convergence
near coming closer
fundus
Optic disc (blind spot) in middle of physiologic cup
Retina
Retinal vessels
medial to lateral in eye
disc, macula, fovea
Pinguecula
small nodule on the bulbar conjunctiva, does not cross over to the cornea.
Pterygium
thickening of the bulbar conjunctiva which grows across the cornea.
sty
infxn at margin of eyelid
chalazion
painless nodule involving the meibomian gland
bells palsy
CN 7
conjunctivitis
bottom up
ciliary injection
limbus to out;
corneal injury, iritis, glaucoma
inflammation of the radiating vessels around the limbus. Very painful, vision affected. Can be a ocular emergency.
papilledema
disc is swollen with blurred margins. Physiologic cup is not visible. Increased intracranial pressure.
Glaucomatous cupping
Increased intraocular pressure. Causes increased disc cupping. The physiologic cup is enlarged occupying more than half of the Disc’s diameter.
HTN eye chnages
AV nicking-veins taper as artery crosses
copper wiring-thickened arteries
Cotton wool patches – infarcted nerve fibers.
Can also be seen in patients with diabetes.
av nicking
veins taper as artery passes in HTN
cotton wool patches
infarcted nerve fibers.
Can be seen in patients with HTN or diabetes.
List things that factor in health determination
- Income
- Education
- Knowledge of healthy behaviors
- Social status
- Sex
- Genetic makeup
- Access to health care
Explain why we have multi-drug resistant and XDR tuberculosis.
Multi-drug resistant: Once diagnosed, insufficient means to follow through with full treatment, causing some of organism to become drug-resistant
- Can be due to price, insufficient infection control, side effects of the medications
- Complacency of government acknowledgement and response to disease itself (in wealthy and disease-endemic countries)
XDR: Extensively drug-resistant
