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Physical Diagnosis & Assessment > Module 1 > Flashcards

Module 1 Flashcards

1
Q

patient assessment

A 
Chief Complaint (CC)
 History of Present Illness (HPI) 
 Past Medical History
Medical
Surgical
Health Maintenance 
 Family History 
 Social History 
 Medications
 Allergies
 Review of Systems (ROS) 
 Physical Examination 
 Laboratory Data 
 Problem List/Assessment 
 Plan
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2
Q

Comprehensive Assessment

A

includes ALL information for pt assessment
 Useful for new patients
 Pre-operative evaluations
 Work/School physicals

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3
Q

Problem-focused Assessment

A

includes the PERTINENT information for pt assessment
 As related to a particular issue/complaint
 Established patients coming in for specific complaint
ex) pt in the ER w/ Fx

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4
Q

taking pt’s history

A

Utilize Open-ended questions
 Avoid leading questions
 Let the patient tell their story
-May need to direct them if they are going on tangents
ex) pts that get distracted and ramble
*always include worst case scenario (leads to life threatening DiffDx)

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5
Q

chief complaint

A

Why the patient is seeking care
 Can be one or more complaints
 Try to address one at a time

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6
Q

HPI

A

Additional information regarding the Chief Complaint
 Subjective information provided by the patient, family member, guardian, etc.
 document who is providing the information
ex) mother providing hx for peds pt
 Onset of the problem, setting in which it occurred, manifestations associated with
problem
*OPQRST or OLDCARTS

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7
Q

onset

A

How symptoms began
time when sx started (qualitative)
-suddenly vs. gradually

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8
Q

duration

A

how long symptoms have been occurring (hours, minutes, etc)

-ongoing for 1 day, 1 week, etc.

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9
Q

character

A

description of sx
ex)burning, pressure, pulling
cannot get full breath in (pt w/ SOB)

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10
Q

timing

A

how often sx is occurring

  • constant
  • intermittent
  • waxing/waning
  • most of the day
  • constant at night
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11
Q

associated symptoms

A

 Tailor to chief complaint
 Symptoms that can be tied to the complaint
ex) pt presents w/ abdominal p and c/o assoc. n/v and dysuria
ex) presents w/ chest pain and c/o dyspnea on exertion and diaphoresis

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12
Q

past medical history

A 
 Childhood illnesses 
 Adult illnesses 
 Hospitalizations 
 Surgical history 
 OB/GYN history
 Health maintenance:
-Immunizations
-Screening exams
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13
Q

family history

A 
 Helps establish risk factors
 First degree relatives
 Parents, siblings, children
 Grandparents
 Age of onset, age of death
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14
Q

social history

A 
 Marital Status 
 Occupation 
 Education Level 
 Alcohol use 
 Tobacco Use 
 Illegal Drug Use 
 Military Service 
 Sexual Preference
explain to pt why you need this info as they are sensitive topics
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15
Q

sexual history

A

 Determine risks: pregnancy, STDs, AIDS
 Sexual preference
 Men, women or both
 Number of partners: current and past

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16
Q

mental health

A

 History of emotional or mental illnesses
 Diagnoses, hospitalizations, treatments
 Depression screenings
-being done at PCP during annual exams

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17
Q

medications

A

 Prescription  Over-the-counter (OTC)  Vitamins/supplements
 Dosage, route, frequency

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18
Q

allergies

A 
 Medication 
 Environmental 
 Food 
 Insects/Animals
 Describe reaction
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19
Q

review of systems

A 
includes all systems, not as specific as associated sx 
> ask if there are any additional problems beyond CC 
> used to help clarify HPI w/ pertinent positives and negatives
 Constitutional 
 HEENT: Eyes, Ears, Nose, Throat 
 Cardiac
 Pulmonary 
 Gastrointestinal 
 Genitourinary 
 Musculoskeletal 
 Neurologic 
 Skin
 Psychiatric 
 Hematologic
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20
Q

initial differential diagnosis

A

-considered after obtaining CC, HPI, ROS (after you obtain
the subjective data)
*typically should be formulated after obtaining history/chief complaint
-use as guide to determine which parts of PE to be performed -> PE used to r/o possible dx

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21
Q

comprehensive/full physical exam

A

 General Survey  Vital signs  Skin  HEENT  Pulmonary  Cardiovascular  Musculoskeletal
Physical Examination Areas
 Neurologic  Abdominal  Breasts  Genitourinary  Psychiatric

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22
Q

problem-focused physical exam

A

geared more to the complaint and focused on areas in the
differential
> all objective data

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23
Q

working differential diagnosis

A

formulated after PE & obtaining objective data

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24
Q

assessment & plan

A

developed after determined working differential diagnoses

  • consider best interest of pt
    ex) cost/insurance
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25
Q

vital signs

A

provide initial critical information regarding the patient

hallmarks:
• Blood pressure 
• Heart Rate 
• Respiratory Rate 
• Temperature

also includes:
• Height • Weight
• BMI

make sure VS are accurate, repeat manually if abnormal

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26
Q

pain

A 
• Considered 5th vital sign
• Chronic pain is leading cause of disability and impaired performance
at work
• Has effects on:
• ADL (Activities-of-daily-living)
• Mood
• Sleep
• Work
• Sexual activity
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27
Q

nociceptive pain

A

aka somatic pain
-linked to tissue damage of skin, musculoskeletal system or
viscera
-Sensory system in intact
-involved afferent nociceptors can be sensitized by inflammatory mediators
ex) pt w/ arthritis or spinal stenosis

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28
Q

neuropathic pain

A

related to direct effect to somatosensory system

  • pain persists beyond healing from the initial injury
  • due to PNS causing entrapment or pressure on spinal nerves, plexuses, or peripheral nerves = increased/prolonged response to pain
    ex) shingles -> skin intact but painful
    ex) spinal cord injury from stroke or trauma
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29
Q

psychogenic pain

A

no obvious factors contributing to pain, cannot be found until everything is ruled out
• Psychiatric conditions
• Personality/coping styles
• Cultural influences

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30
Q

idiopathic pain

A

pain w/ no identifiable etiology

-cannot be discovered until everything is ruled out

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31
Q

pain scale

A

every pt’s threshold of pain is different

  • quantify severity of pain as much as possible
  • observe if pain scale matches pt’s body language & facial expressions
    ex) chronic pain pts -> ask staff about behavior prior to your exam
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32
Q

attempting to treat pain (4 As)

A 
• Analgesia - how to modify pain
• Activities of daily living 
• Adverse effects - meds or ADLs that may cause problem
• Aberrant drug-related behaviors
ex) dependence, tolerance buildup
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33
Q

types of BP cuffs

A 
• Sphygmomanometer
-Aneroid 
-Electronic 
-Hybrid
• Mercury Blood Pressure Cuffs
• Home Blood pressure Monitoring
• Ambulatory Blood Pressure
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34
Q

when to check BP

A

after pt has been sitting quietly for 5 minutes
Ideal to have patient avoid exercise, tobacco products and caffeine for
30 minutes prior to measurement
Room should be warm and quiet
-arm is unclothed

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35
Q

PE findings and factors that change vascular resistance in arm for BP

A
  • fistula
  • scarring
  • lymphedema
  • incorrect cuff size
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36
Q

level of arm when taking BP

A

brachial artery should be at heart level

-at elbow, arm should be raised slightly over AC fossa (on medial portion)

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37
Q

BP reading when cuff is too small

A

causes falsely elevated reading

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38
Q

BP reading when cuff is too large

A

causes falsely low reading

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39
Q

BP reading when cuff is too loose

A

causes falsely high reading

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40
Q

best indicator for elevated BP readings

A

ambulatory readings & home BP readings
- better predictors of
cardiovascular disease and end-organ damage

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41
Q

venous congestion effect on BP

A

can cause
falsely low systolic and high diastolic reading due to less audible sounds
ex) from slow or repetitive inflations of the cuff

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42
Q

minimum inflation for BP cuff

A

at least 30mmHg above when systolic pulse disappears
~ at least 200mmHg
-for pt w/ HTN, pump higher

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43
Q

Systolic pressure

A

Level when you hear sound of at least 2 consecutive beats

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44
Q

Diastolic pressure

A

The level when sounds become muffled and disappear

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45
Q

5mmHg difference in BP

A

normal for difference in BP in both arms

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46
Q

Pressure differences in arms >10-15 mmHg

A

suggest pathology
• Subclavian steal syndrome
• Aortic Dissection
• Supra-valvular aortic stenosis

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47
Q

Subclavian steal syndrome

A

artery of pt is not pliable -> causes low BP reading

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48
Q

estimation of BP

A

palpation of systolic pressure
• Find radial pulse
• Inflate cuff until you feel radial pulse disappear
ex) use for pts with pain in arm that cannot handle full pump of cuff

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49
Q

auscultatory gap

A

Silent interval that may be present between systolic and diastolic
pressures
• Can lead to under-estimation of systolic pressure or over-estimation of diastolic pressure
-occurs if the cuff is not pumped up high enough when initially listening for the BP

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50
Q

when auscultatory gap is present

A

Associated with arterial stiffness and atherosclerotic disease
ex) elderly pts w/ HLD, comorbidities, 60+

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51
Q

gold standard for

confirmation of elevated BP

A

24 hour Ambulatory blood pressure monitoring

• Limited availability • Insurance coverage is poor

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52
Q

statistic for elevated BP readings not confirmed

A

5-65%

-must be confirmed by ambulatory & home BP readings

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53
Q

diagnosis of HTN

A

diagnosed after 2 office readings >140/90 on 2 separate occasions
• Home readings >135/85
• Ambulatory automated BP 24 hour average >130/80, or daytime >135/85,
sleep readings >120/70

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54
Q

white coat HTN

A 
• BP > 140/90 in medical setting 
ex) office, clinic, ER 
• Ambulatory BP monitoring is < 135/85
• Linked to an anxiety response
• Seen in 20% of patients
• No change in risk of cardiovascular disease
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55
Q

masked HTN

A

BP in medical setting <140/90
-appears normal in office or ER
• Elevated daytime ambulatory BP measurements >135/85
• Seen in 10-30% of patients
Associated with increased risk of cardiovascular and end-organ damage
** must be treated **

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56
Q

JNC-8 classification for normal BP in adults

A

< 120/80

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57
Q

JNC-8 classification for pre-HTN BP in adults

A

120 - 139 / 80 - 89
-pt may present as masked HTN
consider risk factors such as smoking and family history

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58
Q

JNC-8 classification for stage 1 HTN BP in adults

A

140 – 159/90 – 99
-if pt > 60 y/o :
150 – 159/90-99
(vascular system changes over time due to elasticity)

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59
Q

JNC-8 classification for stage 2 HTN BP in adults

A

> 160 / > 100

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60
Q

evaluate for end-organ damage when

A 
.. there is persistent elevation in BP 
• Eyes- look for retinopathy changes in fundoscopic exam
• Heart- obtain EKG
• Brain- evaluate MMSE, Neuro exam
• Kidneys- check labs, urinalysis
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61
Q

contributing factors to low BP readings

A
  • medications
  • recent changes to medications
  • internal bleeding
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62
Q

Normal Orthostatic Blood Pressure Changes

A

Change in position from laying to sitting to standing have normal changes

  • decrease in systolic reading
  • decrease in diastolic reading
    • about 5 mmHg change is normal
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63
Q

indication of orthostatic hypotension

A

BP with decreased systolic reading >20 mmHg or decreased diastolic reading of > 10 mmHg

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64
Q

causes of orthostatic BP changes

A
  • Drugs
  • Blood Loss
  • Prolonged Bed rest
  • Diseases of autonomic nervous system
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65
Q

postural hypotension

A

a drop of > 20mmHg systolic and > 10mmHg diastolic accompanied by 10-20% increase in HR

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66
Q

types of pulses in the body

A
  • Radial pulse
  • Brachial Pulse
  • Femoral Pulse
  • Cardiac apex
  • Carotid pulse
67
Q

pulses to assess in peds patients

A

• Femoral Pulse
since radial pulse is small in babies, this is the first pulse detected in BLE
• Cardiac apex
-L hand side of thorax, lowest part of heart -> mid clavicular line 5th intercostal under L breast

68
Q

normal HR in adults

A

60-90bpm

69
Q

factors that can alter HR

A
  • Anxiety
  • Pain
  • medication effect
  • cardiac conditions
  • pulmonary conditions
  • thyroid disease
  • anemia
70
Q

effect of anemia on HR

A

low blood count -> HR increases

-decreased volume in circulatory system results in heart working faster to move O2 around the body

71
Q

pulse deficit occurs with…

A

atrial fibrillation
heart failure
detects weak heart contractions

72
Q

peripheral pulses

A 
Distal pulses
• Radial pulse
• Posterior tibial
• Dorsalis pedis
Smaller pulse = DP and PT pulses - > habitus varies
73
Q

diminished pulses seen in..

A

patients with arteriosclerotic peripheral vascular
disease, low cardiac output
ex) severe anemia -> decreased periphery = weaker pulse

74
Q

asymmetry of pulses indicates..

A

coarctation of the aorta or aortic
dissection
• Different in lower extremities compared to the upper extremities

75
Q

bounding pulse

A

aka Water hammer pulse
-can be seen with aortic
regurgitation or patent ductus arteriosis
> valve has extra amount of blood -> asystole -> stronger push out

76
Q

pulsus alternans

A

amplitude of pulse alternatives every other beat

associated with pericardial effusions

77
Q

normal respiratory rate in adults

A

14 - 20 breaths per minute

-Occasional sigh is normal

78
Q

when assessing respiratory rate

A

count for at least 20 seconds
- Assess without informing patient what you are looking for
• Watch chest raise
• Place hand on shoulder and feel for chest wall movement

79
Q

sighing respirations

A

frequent sighs occurring every other breath
• May be associated with hyperventilation syndrome
• Causes dyspnea and dizzines

80
Q

bradypnea

A

slow breathing

81
Q

causes of bradypnea

A 
• Physiologic
-good fitness level = lower RR & HR
• Diabetic Coma
 -elevation of glucose > 500 -> slow HR 
• Drug-induced respiratory depression
• Increased intracranial pressure
ex) pt s/p TBI with SAH or SDH causes body to breathe slowe
82
Q

tachypnea

A

• Rapid, shallow breathing

Causes:
• Restrictive lung disease (asthma, COPD)
• Pleuritic chest pain
• Elevated diaphragm

83
Q

Pleuritic chest pain effect on breathing

A

pt w/ URI and painful cough due to pulling of intercostal muscles = increased respiratory rate

84
Q

elevated diaphragm effect on breathing

A

diaphragm muscle is paralyzed - > decreased chest wall movement = increased respiratory rate

85
Q

Obstructive Breathing

A

• Expiration is prolonged due to narrowing of airways that increase
resistance of air flow

Causes:
• Asthma
• Chronic Bronchitis
• COPD

86
Q

hyperpnea/hyperventilation

A 
• Rapid, deep breathing
Causes:
• Exercise
• Anxiety
• Metabolic acidosis
• Kidney Failure • DKA
87
Q

type of breathing in comatose patient

A

hyperpnea/hyperventilation

ex) infarction, hypoxia, hypoglycemia (blood sugar of 40)

88
Q

Cheyne-Stokes Breathing

A

Period of deep breathing alternating with periods of apnea

Causes:
• Normal in children and elderly when sleeping
• Heart failure
• Uremia
• Drug-induced respiratory depression
• Brain damage
89
Q

red flag of Cheyne-Stokes breathing

A

pt using abdomen to breathe

90
Q

Kussmaul’s Respirations

A

pt is in no respiratory distress that is obvious

  • breathing is labored and deeper
  • nares/nasal passages are flared
    ex) common in pt with DKA
91
Q

ataxic breathing

A

Unpredictable breathing irregularity
• Breaths may be shallow or deep, with periods of apneas

Causes:
• Respiratory depression
• Brain damage

92
Q

normal temperature

A

37 degrees C, 98.6 degrees F

93
Q

Celsius to Fahrenheit Formula

A

(°C * 1.8) + 32 = °F

94
Q

Fahrenheit to Celsius Formula

A

(°F - 32) / 1.8 = °C

95
Q

fluctuation in temp throughout the day

A

~1 degree C or 1.8 degree F over the course of a
day
* temp is lower in the morning & higher at night

96
Q

Hyperprexia

A

> 41.1 degrees C or >106 degrees F (severely abnormal)

97
Q

Hypothermia

A

< 35 degrees C or <95 degrees F
• Can be associated with decreased movement
ex) pt that is very sedentary or bed bound have lower temps
• Interference with vasoconstriction
• Hypothyroidism
• hypoglycemia

98
Q

gold standard in obtaining temperature

A

pulmonary artery = most accurate as it is closest to the heart

99
Q

non-invasive temperature checks

A
  • Oral
  • Rectal
  • Axillary
  • Tympanic
  • Temporal
100
Q

axillary temperature

A

obtained in neonates due to need for good seal

101
Q

rectal temperature

A

most accurate way to obtain temp outside of pulmonary artery

102
Q

differentials associated with fever

A
  • Infection
  • Trauma
  • Malignancy
  • Drug reactions
  • Immune disorders
103
Q

vitals for a pt in significant pain from acute trauma

A

elevated HR
shallow & elevated respirations
-elevated BP
-temp is normal to high

104
Q

fatigue

A

common symptom of depression and anxiety
*also consider infections: hepatitis, infectious mononucleosis, and tuberculosis
> endocrine disorders: hypothyroidism, adrenal insufficiency, diabetes mellitus)
> heart failure
> chronic disease of the lungs, kidneys, or liver
> electrolyte imbalance
> moderate to severe anemia
> malignancies
> nutritional deficits
> medications

105
Q

Weakness

A

sx in pt showing demonstrable loss of muscle power

> If localized in neuroanatomical pattern = neuropathy or myopathy

106
Q

recurrent shaking chills

A

sx that suggest more extreme swings in temperature and systemic bacteremia

  • Feel cold, goosebumps, shivering = rising temp
  • Feel hot and sweaty = lowering temp
107
Q

night sweats

A

occur in tuberculosis and malignancy

108
Q

fever in immunocompromised patients with sepsis

A

fever may be absent, low-grade, or drop below normal (hypothermia)

109
Q

rapid changes in weight over a few days suggest …

A

changes in body fluid, not tissue

110
Q

drugs associated with weight gain

A

tricyclic antide- pressants; insulin and sulfonylurea; contraceptives, glucocorticoids, and progestational steroids; mirtazapine and paroxetine; gabapentin and valproate; and propranolol

111
Q

causes of weight loss

A

loss of 5% or more of usual body weight over 6 mo period

  • GI diseases
  • endocrine disorders (diabetes mellitus, hyperthyroidism, adrenal insufficiency)
  • chronic infections, HIV/AIDS;
  • malignancy
  • chronic cardiac, pulmonar y, or renal failure
  • depression
  • anorexia nervosa or bulimia
112
Q

weight loss with high food intake

A

indication of diabetes mellitus, hyperthyroidism, or malabsorption
-Consider also binge eating (bulimia) with clandestine vomiting.

113
Q

risk factors for malnutrition

A

Poverty, old age, social isolation, physical disability, emotional or mental impairment, lack of teeth, ill-fitting dentures, alcoholism, and drug abuse

114
Q

Four Steps to Promote Optimal Weight and Nutrition

A
  1. Measure BMI – identify risk of overweight and obesity, est other risk factors
  2. Assess dietary intake
  3. Assess patient motivation to change
  4. Provide counseling about nutrition and exercise
    Set reasonable goals – realistic weight, helps to lose even 5-10% of their weight (0.5-2 lbs per week)
115
Q

promoting weight loss in patients

A 
Realistic diet
Walk 30-60 mins, 5 or more days a week
Total calorie goal
Behavioral change 
Pharmacologic tx if conventional does not work
116
Q

counseling for pt with low BMI < 18.5

A

encourage Nutrient dense foods and beverages

10 tips to a great plate

117
Q

dietary sodium

A

half a teaspoon of salt per day for pts with borderline BP

118
Q

obesity can lead to increased risk of

A 
heart disease
cancers 
type II DM
stroke
arthritis
sleep apnea
infertility
depression
-may also increase death
119
Q

calorie deficit goal for weight loss

A

500-1000 kilocalories/day

*this is more important than the type of diet

120
Q

behavioral habits for weight loss

A

portion-controlled meals
meal planning
food diaries
activity records

121
Q

goal of the general survey

A

describe distinguishing features of the pt so clearly that colleagues can spot pt in a crowd of strangers
-avoid cliches like middle aged man and in no acute distress

122
Q

factors that affect body habitus

A 
socioeconomic status
nutrition
genetic make up 
physical fitness
modd state 
early illnesses
gender 
geographic location
age cohort
123
Q

features of the skin exam that should be pursued

A 
pallor
cyanosis
jaundice
rashes
bruises
mottling of the extremities
124
Q

Edema from extravascular fluid retention is visible in patients with…

A

heart failure
nephrotic syndrome
liver failure
venous stasis

125
Q

Run-down shoes can contribute to..

A

foot and back pain
calluses
falls
infection

126
Q

copper bracelets suggest…

A

joint pain in RA

-folklore remedy with little evidence of effectiveness to alleviate inflammation/pain

127
Q

facial expression in hyperthyroidism

A

pt exhibits exaggerated stare

128
Q

facial expression in parkinsonism

A

pt exhibits immobile facies

  • “masked”
  • pt can also exhibit anxiety, depression, apathy, anger, elation
129
Q

breath odor of acetone or fruity odors

A

present in diabetic pts (sugary smell)

-acetone breath -> pt in DKA

130
Q

Decreased eye contact

A

can be cultural or suggest anxiety, fear, or sadness

131
Q

posture in pt that prefers sitting upright

A

indication of left-sided heart failure

132
Q

posture in pt that is leaning forward with arms braced

A

indication of COPD

133
Q

avoidance of movement indicates

A

pt in pain

134
Q

very short stature present in pts with

A
  • Turner syndrome
  • childhood renal failure
  • achondroplastic and hypopituitary dwarfism
135
Q

pt’s height in hypogonadism and Marfan syndrome

A

long limbs in proportion to the trunk

136
Q

Cushing syndrome

A

truncal fat with relatively thin limbs

-also present in metabolic syndrome

137
Q

if the brachial level is below heart level…

A

blood pressure reading will be higher

138
Q

if the brachial artery is above heart level…

A

BP reading will be lower

139
Q

target end organs affected by HTN

A

eyes- retinopathy
heart- LVH
brain-neuro deficits
kidneys- labs must be done for eval

140
Q

guidelines for selecting correct BP cuff size

A

width of inflatable bladder of cuff should be ~ 40% of upper arm circumference
-length of cuff should be ~ 80% of upper arm circumference

141
Q

Takayasu arteritis

A

rare type of vasculitis in which pts are pulseless in limbs

142
Q

causes of hypothermia

A 
exposure to cold
> other causes include:
-reduced movement as in paralysis
-interference with vasoconstriction from sepsis or excess alcohol
-starvation
-hypothyroidism
-hypoglycemia
143
Q

rapid resp rate can increase…

A

discrepancy between oral and rectal temperatures -> In these situations, rectal temperatures are more reliable

144
Q

behaviors seen in mood disorders

A

Compulsions, obsessions, phobias, and anxieties

145
Q

lethargic patients

A

appear drowsy but open their eyes and look at you, respond to questions, and then fall asleep

146
Q

obtunded patients

A

slow to respond, somewhat confused

-patients can still open eyes and look at you

147
Q

movements of depression

A

slow, hopeless & slumped posture

148
Q

behaviors of agitated depression

A

crying
pacing
hand wringing

149
Q

behaviors of manic episodes

A

agitation

expansive movements

150
Q

one sided neglect in patients is an indication of…

A

lesion in the opposite parietal cortex, usually the nondominant side

151
Q

behaviors of paranoid patients

A

anger
hostility
suspiciousness
evasivenes

152
Q

affect of schizophrenic patients

A

typically flat and remote

> with manic episodes -> elation and euphoria

153
Q

expressions in patients with dementia

A

apathy

-dulled affect with detachment and indifference

154
Q

hallucinations occur in patients with…

A

schizophrenia
alcohol withdrawal
systemic toxicity

155
Q

dysarthria

A

defective articulation of words

156
Q

aphasia

A

disorder of language, testing for aphasia includes

  1. word comprehension - ask pt 1 stage command
  2. repetition- ask pt to repeat a phrase of one syllable words (ex- “no ifs, ands, or buts”) ** most difficult rep task
  3. naming- ask pt to name parts of a watch
  4. reading comprehension- ask pt to read paragraph aloud
  5. writing- ask pt to write a sentence
157
Q

Broca’s aphasia

A

expressive aphasia
-broken, non-fluent speech in which wordcomprehension is intact
-speech is slow, few words, & effort is laborious
impaired features include:
-repetition
-naming (pt still recognizes objects)
-writing

158
Q

Wernicke aphasia

A 
receptive aphasia: impaired comprehension with fluent speech 
-words are malformed or invented -> speech may be incomprehensible 
impaired features include:
-word comprehension
-repetition
-naming
-reading comprehension
-writing
159
Q

indications for mental health screening

A
  • medically unexplained physical sx
  • multiple physical or somatic sx (“high sx count”)
  • high severity of presenting somatic symptom
  • chronic pain
  • sx > 6 weeks
  • physician rating as a “difficult encounter”
  • recent stress
  • low self-rating of overall health
  • frequent use of health care services
  • substance abuse
160
Q

tangential speech (derailment)

A

speech with shifting topics that are
loosely connected or unrelated
-pt is unaware of the lack of association
- seen in schizophrenia, manic episodes, and other psychotic disorders

161
Q

neologisms

A

invented or distorted words

-words w/ new & highly idiosyncratic meanings

162
Q

circumstantiality

A

mildest thought disorder

  • speech w/ unnecessary detail, indirection, delay in reaching point
  • seen in pts with mental disorders
163
Q

Stuperous

A

Responsive to painful stimuli

Physical Diagnosis & Assessment (7 decks)

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