Midterm Review (not finished) Flashcards
What are the 3 components of taking a patient history?
- emotional
- factual
- therapeutic
What are the types of questions that may be asked when taking a patient history?
- open-ended
- direct
- minimal facilitators
- laundry lists/menus
- closed-ended
- yes/no
- leading
- multiple/complex
Name 7 pitfalls encountered when taking a patient history.
- curiosity about you
- silence
- crying
- differing beliefs
- anger
- holding back info
- seduction
What type of question is this:
“What brings you here today?”
open-ended
What type of question is this:
“Where is the pain?”
direct
(sorted as qualifiers & quantifiers)
What type of question is this:
“And what else?”
minimal facilitators (active listening)
What type of question is this:
“Is the pain sharp or dull?”
laundry list/menu
(use only when non-directive approach fails)
What type of question is this:
“What is your occupation?”
closed-ended
What type of question is this:
“Is your problem better with rest?”
yes/no
What type of question is this:
“You don’t smoke, do you?”
leading question
What type of question is this:
“Have you ever had palpitations and does anyone in your family have heart disease?”
multiple/complex
The one or more symptoms or other concern(s) for which the patient is seeking your advice is termed ____
chief complaint (CC)
What is the present illness (PI)?
as full a description as possible of the CC, is the story about the patient’s problem
What acronym helps you get all pertinent information about the chief complaint/present illness?
Location
Mechanism
Neurological
Onset
Palliative/Provocative
Quality
Radiation/Referral
Severity
Temporal
Universal/anything else going on
An explanation of prior illnesses, injuries, and medical interventions is called ____
past medical history (PMH)
A picture of the current health status (or cause(s) of death) of any 1st- or 2nd-order blood-related relatives is called ____
family history (FH)
A description that captures important information about the patient as a person is called ____
personal/social history (P/SH)
(eg. life-style, stressors, hobbies, occupation, activity level, etc.)
A review of the patient’s history as it regards general health status and symptoms in each body system is called ____
review of systems (ROS)
Name 5 special areas of concern when taking a patient history.
- ETOH (alcohol) and substance abuse
- domestic violence/child abuse
- depression/suicide risks
- dementia & fall risks of elders
- nutritional risk
What special screening tool can be used when concerned for alcohol (ETOH) abuse?
CAGE questionnaire
Describe the CAGE questionnaire.
- have you ever felt the need to cut down on drinking? ; are you concerned about your amount of ETOH (alcohol)
- have you been annoyed if others mention your drinking as a problem?
- have you felt guilty about how much you drank or what you did?
- have you needed an eye-opener?
What are 2 questions you could ask to screen for abuse?
- do you feel safe at home?
- have you been in any threatening situations?
What are 2 questions you could ask to screen for depression?
(from PRIME-MD)
- have you been bothered by little interest or pleasure in doing things?
- have you been feeling down, depressed, or hopeless in the last month?
Asking a patient what they think might be causing their pain is what type of question?
open-ended
What is included in general inspection of a patient?
- observations of general health status, level of discomfort, mobility
- overt gross inspection of non-gowned exposed skin, hair, nails, throat, etc.
Upon general inspection, you notice your patient has fine tremors, swelling in the front of their neck, swelling in the legs, and excessive visibility of the sclera above the iris. What disease might you expect?
Hyperthyroidism
Upon general inspection, you notice your patient has thin, patchy hair loss on their head and later 1/3 of their eyebrows. Their face appears puffy, and their skin looks dry. What disease might you expect?
Hypothyroidism
What are vital signs?
qualitative measurements to ascertain 3 body processes essential to life:
- body temp
- hear function (pulse, BP)
- breathing (respiration)
What is the average normal oral temperature?
98.6 F (37 C)
What is considered an elevated oral temperature?
99.6 F (37.6 C)
Name 6 factors that can affect temperature.
- age (^ in kids)
- diurnal/circadian variations (^ in evening)
- exercise
- hormones (^ at ovulation, lower before ov.)
- stress
- environment (extreme temps over prolonged time)
What is the term for normal pulse rate (PR)?
eucardia
What is the range for eucardia?
60-100 bpm
What is pulse deficit?
when HR exceeds peripheral pulse rate
Describe the grading scale for pulse quality.
4 = bounding
3 = full, increased
2 = expected
1 = diminished, thready
0 = absent, not palpable
Name 8 factors that may increase pulse rate.
- age (infants & kids)
- exercise
- fever (^10bpm for every 1 deg fever)
- hemorrhage
- stress
- drugs
- hormones (thyroid)
- position
Name 4 factors that may decrease pulse rate.
- being supine
- some meds or street drugs
- life threatening diseases as a “vital sign”
- conscious meditation, stress reduction techniques
What is the normal range for respirations?
12-20 cpm
What is tachypnea?
increased respirations
What is bradypnea?
decreased respirations
What is eupnea?
normal respirations
What is dyspnea?
difficulty breathing
What is orthopnea?
difficulty breathing when lying down
What is paroxysmal nocturnal dyspnea?
difficulty breathing when lying down at night
What is apnea?
period of no respiration (i.e., sleep apnea)
What pathological breathing pattern is described as marked rhythmic waxing and waning of respiratory rate and depth with periods of apnea?
Cheyene-Stokes
What pathological breathing pattern is described as irregularly shallow and deep breaths interrupted by irregular periods of apnea?
Biot’s respirations
What pathological breathing pattern is described as increased respiratory rate and depth?
Kussmaul (hyperventilation)
What is the normal range for blood pressure?
90/60 - <120/<80 mmHg
Name 9 factors which can affect blood pressure.
- age
- exercise
- race
- weight
- gender
- diurnal/circadian variations
- drugs
- stress
- technique
What technique factors can affect blood pressure readings?
- cuff size
- over clothing
- arm not relaxed or at heart level
- pt. not relaxed (white coat HTN)
- back/feet unsupported or legs crossed
- pt talking
How would you estimate systolic blood pressure?
- palpate for brachial/radial pulse to disappear as you inflate the cuff
- inflate 30 mmHg above
- deflate while feeling for pulse to return (this point = systolic)
What is the clinical relevance for doing an external eye exam?
visual evidence of local or systemic disorders
What is the clinical relevance for doing cranial nerve assessments?
neurologic or muscular dysfunction, head trauma
What is the clinical relevance for doing a funduscopic/ophthalmoscopic exam of the eye?
- direct diseases of the eye
- complications of HTN/diabetes
- head trauma
What are we looking for when asking patient history questions about the eye?
- progressive changes in vision over a short time frame (<1yr)
- acute changes in SSx = red flag for referral
What is emmotropia?
normal vision
What is ametropia?
refractive errors needing correction
What is myopia?
see better near vision (eyeball too long compared to curvature of lens)
What is hyperopia?
see better far (eyeball to short compared to curve of lens)
What is astygmatism?
abnormal curvature of the eyeball:
light focusses on multiple points of retina, affecting near and far vision
What is presbyopia?
- near vision deficit due to stiffness of lens with aging
- cannot accommodate (need reading glasses)
- onset ~40yrs
What is the term for small, constricted pupils?
miosis
What is the term for large, dilated pupils?
mydriasis
What does the term “fixed” pupils mean?
pupils do not react to light
What is the term for “crossed eyes”?
strabismus
What is the term for when the pupils constrict when the patient focuses onto a nearby object, but does not constrict when exposed to bright light?
Argyll Robertson Pupil
(accommodation reflex present, light reflex absent)
Argyll Robertson Pupil is a specific sign of ____
neurosyphilis
What is the term for a neurologic disorder which causes one or both pupils to be abnormally dilated (mydriasis) with delayed constriction in response to light?
Adies pupil
(pts commonly present w/ areflexia of the knee or ankles in addition to tonic pupil)
What is the Snellen Wall Chart used for?
visual acuity (CN III)
What does the corneal light reflex test for?
overt strabismus (cross-eyed) d/t cranial n problem
(or covert strabismus)
What does the cover-uncover test for?
covert strabismus (lazy eye, not getting input and does not align when stressed)
How is the cover-uncover test performed?
- focus on distant object w/ eyes open
- cover 1 eye with card for 20-30 seconds
- quickly remove card
- look for covered eye to drift and come back to binocular yoking
What are the normal eye inspection findings?
- sclera: white w/o redness/discolouration, not visible below upper eyelid
- conjunctiva: pink, no discharge
- no swelling or obvious abnormalities
- corneal light reflection: symmetrical
- eyebrows: symmetrical hair distribution
What would a yellow sclera suggest?
jaundice - liver pathology
What would redness in the sclera or conjunctiva suggest?
- an “eye-itis” (eye-tis… haha get it;))
- conjunctivitis (allergic, viral, bacterial)
- trauma (direct; foreign body)
What would a pink conjunctiva suggest?
normal finding
Bilateral, watery eyes with mild redness of the conjunctiva or sclera may be due to what?
allergic conjunctivitis
Unilateral, watery eyes with mild redness of the conjunctiva or sclera may be due to what?
viral conjunctivitis
Unilateral, purulent discharge with mild to gross redness of the conjunctiva or sclera may be due to what?
bacterial conjunctivitis
What does loss of the lateral 1/3 of the eyebrows suggest?
hypothyroidism
What are the findings of Horners syndrome?
- ptosis
- miosis
- anhydrosis
What does swollen upper eyelid (myxedema) suggest?
advanced hypothyroidism
Lower eyelids turned outward exposing the lower conjunctiva in elderly patients is called ____
ectroption
Lower eyelid turned inward with the eyelashes irritating the conjunctiva in elderly patients is called ____
entropion
Patients with myxedema (hypothyroidism) may present in your office with what 2 other complaints?
- carpal tunnel syndrome
- hyporeflexia
What is ptosis?
droopy eyelid and loss of upper sclera visibility
What are the possible causes of ptosis?
- myasthenia gravis
- CN III damage
- Horners syndrome
- congenital
What is exophthalmos?
bulging of the eye with lid retraction (hyperthyroidism), more sclera visible
Raised yellowish circumscribed plaques of periorbital skin seen with hyperlipidemia is called ____
xanthelasma
Inflammation of the lacrimal sac characterized by crusting from punctal discharge and prominent lacrimal sac is termed ____
dacrocystitis
Benign local inflammation characterized by redness of the conjunctiva which resolves on its own is called ____
episcleritis
A triangular thickening of fleshy tissue on the nasal side conjunctiva that grows slowly and impinges on the cornea/pupil is called ____
pterygium
A yellowish growth due to deposition of protein & fat on either side of the conjunctiva (usually nasal side first, then temporal) which does not affect vision is called ____
pinguecula
An infected hair follicle on the eyelid is called a ____
Hordeolum (stye)
A non-infectious cyst of an oil gland on the eyelid is called a ____
chalazion (cyst)
What finding on an eye examination would suggest cataracts?
no red right reflex when using ophthalmoscope, or see fundus of eye in advanced stages
What structures should be assessed on a funduscopic exam?
- red light reflection (unfocused retina)
- optic disc
- optic cup
- arteries
- venules
- macular area
- fovea
What is the normal finding of the optic cup?
<50% size of optic disc
What funduscopic findings may suggest hypertension?
- AV nicking/tapering
- copper/silver wire arterioles
- soft (cotton wool) exudates
- hard exudates (sharp borders, yellow deposits)
What funduscopic findings may suggest diabetes?
- neovascularization
- soft & hard exudates
What symptoms and funduscopic findings may suggest glaucoma?
- enlarged optic cup (<50% size of disc)
- Sx = loss of peripheral vision
What symptoms and funduscopic findings may suggest age-related macular degeneration (ARMD)?
- excessive drusen deposits/hemorrhages in macular area
- Sx = loss of central vision
What funduscopic findings may suggest papilledema?
- cotton wool spots (damaged axons)
- flame hemorrhages (damaged vessels)
What causes cotton wool spots?
infarcted nerve fibers (damaged axons) due to HTN
What conditions may cause hard exudates?
HTN or DM
What condition may cause neovascularization on a funduscopic exam?
DM
What funduscopic findings may suggest diabetic retinopathy?
- hard & soft exudates
- neovascularization
- hemorrhages
Name 4 causes of acute hearing loss
- foreign body (cerumen)
- URI or congestion
- sudden loud music
- otitis media/externa/interna
Name 4 causes of chronic/progressive hearing loss
- otosclerosis
- presbycusis
- Meniere’s Dz
- acoustic neuroma
What is the term for progressive age-related hearing loss?
presbycusis
What is the triad of symptoms of Meniere’s disease?
sudden onset:
- vertigo
- tinnitus
- sensorineural hearing loss (can become chronic)
What are the red flag findings for ears?
- sudden unilateral hearing loss (stroke/CVA/TIA)
- hearing/balance loss (TIA/CVA)
- vertigo (inner vestibular problem)
While taking a patient history, what observations may suggest hearing difficulties?
- postures
- asking for repetition of questions
- appropriateness of answers
What are the possible findings of a malformed/misaligned ear?
- low set auricle
- craniofacial asymmetries
Thickening along the upper ridge of the helix upon inspection of the ear is called ____
Darwin’s tubercle
A small induration or protuberance found in front of the ear is called ____
preauricular pits or skin tags
What are keloids?
excessive scar tissue formation
What is cauliflower ear?
a scarred deformed contour of the auricle
(d/t blunt trauma followed by necrosis)
How might gout present upon external inspection of the ear?
gouty tophi
What is Lichtenstein’s sign and what does it suggest?
earlobe crease
- sign of atherosclerotic changes
- “red flag” finding for CVD risk
Erythematous and edematous mastoid region is indicative of ____
mastoiditis
(*immediate referral)
Otitis externa is also called ____
swimmer’s ear
What are the findings of otitis externa?
- crusting & exudative discharge
- swelling & erythema (unable to do otoscope exam)
- pain on palpation
