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Module 2 Flashcards

1
Q

Key to developing a complete understanding of patient’s concerns

A

Problem list

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2
Q

The bits of information that are distracting and draw your thinking away from central issues

A

Red herrings

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3
Q

Three diagnosis for every disease:

A

The one that unifies what you’ve learned
The one you cannot afford to miss
The one it actually is

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4
Q

States that the single simplest cause is the most likely diagnosis

A

Occam’s Razor

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5
Q

Implies that there can be several simultaneous diagnosis

A

Hickman’s Dictum

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6
Q

T or F; Clinial reasoning becomes complex because of the emotions of ONLY the patient

A

False, it is the patient and the healthcare provider

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7
Q

The patient’s need for self determination

A

Autonomy

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8
Q

Suggests that choices exist and a patient may choose between alternatives

A

Autonomy

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9
Q

Do good for the patient

A

Beneficence

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10
Q

Do no harm to the patient

A

Nonmalificence

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11
Q

Consider appropriate use of resources with concern for the greater good of the larger community

A

Utilitarianism

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12
Q

Recognize the balance between autonomy and competing interests of the family and community

A

Fairness and justice

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13
Q

Our dutiful responsibilities for offering care are established by tradition and in cultural contexts

A

Deontologic imperatives

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14
Q

Knowledge is to be free of ________, _________, and __________

A

Beliefs, attitudes, and values

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15
Q

Our decision making must have a balance between ___________ and _____________

A

Mechanism and probabilism

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16
Q

T or F: certainty in knowledge is impossible

A

True

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17
Q

The ability of an observation to identify correctly those who have a disease

A

Sensitivity

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18
Q

The ability of an observation to identify correctly those who do not have a Disease

A

Specificity

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19
Q

An expected observation that is found when the disease characterized by that observation is present

A

True positive

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20
Q

An expected observation that is not found when the disease characterized by that observation is not present

A

True negative

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21
Q

An observation made that suggests a disease when that disease is not present

A

False positive

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22
Q

An observation that suggests a disease is not present when in fact it is

A

False negative

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23
Q

The proportion of persons with an observation characteristic of a disease who have it

A

Positive predictive value

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24
Q

The proportion of persons with an expected observation who ultimately prove not to have the expected condition

A

Negative predictive value

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25
Q

A system that incorporates the best available scientific evidence to clinical decision making in the care of the individual patient

A

EBP

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26
Q

Assesses an individual’s readiness to change

A

Transtheoretical model of behavior change

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27
Q

Stage of change: not yet admitting there is a problem behavior that needs to be changed, or not intending to take action

A

Precontemplation

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28
Q

Stage of change: admitting that there is a problem but not yet ready or sure of wanting to make a change, starting to think about pros and cons for continued action

A

Contemplation

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29
Q

Stage of change: intending to take action in the immediate future, beginning to take small steps toward change

A

Preparation

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30
Q

Stage of change: changing behavior, overt modification in behavior

A

Action

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31
Q

Stage of change: being able to sustain action and working to prevent relapse

A

Maintenance

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32
Q

Stage of change: no temptation and confidence in not returning to old behavior

A

Termination

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33
Q

Stage of change: not considered a stage itself but rather the shift from action or maintenance to an earlier stage (precontemplation or contemplation)

A

Relapse

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34
Q

Overwhelming the reader with volumes of insignificant data can be referred to as….

A

Note bloat

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35
Q

T or F: the patient’s health record is a legal document

A

True

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36
Q

Has been a major emphasis in achieving meaningful use of the EHR

A

Computerized Provider Order Entry (CPOE)

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37
Q

Can facilitate clinicians in assigning risks of specific clincial outcomes to subgroups of patients

A

Risk stratification

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38
Q

Is a term used to signify the synergistic activity if various organizations to improve the health outcomes of the communities that they serve

A

Population health

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39
Q

Are standardized evidence based healthcare plans and processes designed for patient within a specific clinical setting to enhance their care

A

Care pathways

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40
Q

Allows clinicians and patients, and when designated, their family members to secure access to pertinent and appropriate portions of the patient’s health record

A

Electronic health information exchange (HIE)

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41
Q

POHR

A

ProblemOriented health record

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42
Q

What is the SOAP format

A

Subjective, objective, Assessment, and Plan

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43
Q

What is the APSO format

A

Assessment, plan, subjective, objective

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44
Q

The information, including the absence or presence of pertinent symptoms, that the patient tells you

A

Subjective data

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45
Q

your direct observations from what you see, hear, smell, and touch and from diagnostic test results

A

Objective date

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46
Q

your interpretations and conclusions, your rationale, the diagnostic possibilities, and present and anticipated problems

A

Assessment

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47
Q

diagnostic testing, therapeutic modalities, need for consultants, and rationale for these decisions

A

Plan

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48
Q

6 components of the POHR

A
  1. health history
  2. physical exam
  3. Problem list
  4. Assessment and plan
  5. Baseline and problem directed lab/radiology studies
  6. Progress notes
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49
Q

A ____________ may be defined as anything that will require further evaluation or attention

A

Problem

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50
Q

is composed of your interpretations and conclusions, their rationale, the diagnostic strategy, present and anticipated problems, and the needs of ongoing as well as future care— what you think

A

Assessment section

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51
Q

In an assessment of POHR, avoid using _______

A

WNL

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52
Q

Develop a __________ for each problem on the problem list

A

Plan

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53
Q

Part of plan: List the diagnostic tests and consultations to be performed or ordered.

A

Diagnostics

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54
Q

Part of plan: Describe the therapeutic treatment plan. Provide a rationale for any change or addition to an established treatment plan. List any referrals initiated with their purpose and to whom the referral is made. State the target date for reevaluating the plan.

A

Therapeutics

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55
Q

Part of plan: This should address the role of new therapies initiated and plans for patient requirements upon discharge. Include materials dispensed and evidence of the patient’s understanding or lack thereof

A

Patient education

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56
Q

is a critical part of every visit in order to prevent adverse drug events.

A

Medication reconciliation

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57
Q

is an ongoing record of a patient’s medical problems, allergies with associated reactions, medications with dosages and instructions of how these are administered, and past immunizations.

A

The PAMI (problems, allergies, medications, immunizations) list

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58
Q

is a brief description of the patient’s main reason for seeking care

A

Chief concern or presenting problem

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59
Q

Always include the ___________ of the chief concern or problem

A

Duration

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60
Q

when the problem or symptom first started; chronologic order of events; setting and circumstances; manner of onset

A

Onset

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61
Q

Exact location of pain

A

Location

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62
Q

length of problem or episode; if intermittent, how long each episode is

A

Duration

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63
Q

nature of pain (e.g., stabbing, burning, sharp, dull, gnawing)

A

Character

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64
Q

Frequency of occurrence; describe typical attack; change in symptom intensity, improvement or worsening over Time

A

Temporal factors

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65
Q

Rated on a 0-10 scale, ask about effect on lifestyle, work performance

A

Severity of symptoms

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66
Q

Mnemonic for recording characteristics of a problem in HPI

A

OLDCARTS

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67
Q

includes general health over the patient’s lifetime and disabilities and functional limitations, as the patient perceives them

A

past medical history (PMH)

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68
Q

For infant with no growth or development problems it may be recorded as:

A

History, ROS, or in a separate category

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69
Q

Considered baseline indicator for patient’s health status

A

Vital signs

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70
Q

Considered the 5th vital sign

A

Pain assessment

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71
Q

Body temperature is regulated and maintained by the ___________

A

Hypothalamus

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72
Q

results when the ventricular heart contraction pushes a pressure wave of blood throughout the arterial system.

A

The arterial pulse

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73
Q

Primary muscles of respiration

A

Diaphragm and the intercostal muscles

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74
Q

The diaphragm contracts and moves ________ during ____________ to increase the intrathoracic space

A

Downward, inspiration

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75
Q

The ______________ intercostal muscles increase the anteroposterior chest diameter during inspiration, and the _____________ intercostal muscles decrease the lateral diameter during expiration.

A

External; internal

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76
Q

the force of the blood against the wall of an artery as the ventricles of the heart contract and relax.

A

Arterial blood pressure

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77
Q

the force exerted when the ventricles contract

A

Systolic BP

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78
Q

is largely the result of cardiac output, blood volume, and compliance of the arteries

A

Systolic BP

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79
Q

is the force exerted by peripheral vascular resistance when the heart is in the filling or relaxed state.

A

Diastolic BP

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80
Q

is the difference between the systolic and diastolic

A

Pulse pressure

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81
Q

helps sustain the pain response.

A

Inflammation

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82
Q

Defined as long-term pain associated with damage or dysfunction of the central or peripheral nervous system

A

Neuropathic pain

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83
Q

are free nerve endings in the peripheral nervous system activated by tissue damage from injury or inflammation.

A

Nociceptors

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84
Q

Biochemical mediators that facilitate the transmission of pain impulses from the nerve endings along nerve pathways

A

bradykinin, prostaglandins, serotonin, glutamate, and substance P

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85
Q

Pain impulses travel from the site of tissue damage to the dorsal horn of the spinal cord through the ascending spinal tracts to the __________ and ______________

A

Thalamus and cerebral cortex

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86
Q

Sharp, well- localized pain is quickly transmitted by

A

Large, myelinated A-delta fibers

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87
Q

Dull, burning, diffuse, and chronic pain is slowly transmitted by:

A

Small unmyelinated C fibers

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88
Q

Substances that can change or inhibit the pain received

A

Endorphins or GABA

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89
Q

Why does ice or massage reduce pain impulses

A

compete to transmit sensations along the same spinal pathways to the brain

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90
Q

Response to pain is affected by:

A

Physiologic, behavioral, and emotional phenomenon

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91
Q

Average body temp

A

97.2-99.9

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92
Q

Core body temps is _____ higher than oral temperature

A

0.9 degrees F

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93
Q

Average resting HR

A

70 BPM

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94
Q

Expected RR in adults

A

12-20 breaths per minute

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95
Q

Ratio of RR to HR

A

1:4

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96
Q

Use the _______ of the stethoscope over the brachial artery during manual BP readings

A

Bell

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97
Q

Turbulence of blood flow in the artery

A

Korotkoff sounds

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98
Q

For selecting BP size: choose a width that is __________ the circumference of the limb

A

1/3 to 1/2

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99
Q

The auscultatory gap widens with systolic hypertension in older persons due to loss of

A

Arterial pliability

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100
Q

The auscultation gap widens with a drop in diastolic pressure when

A

Severe aortic regurgitation is present

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101
Q

Auscultation gap narrows in the case of _________

A

Pulses paradoxes d/t cardiac tamponade

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102
Q

T or F: infants delivered by vaginal birth have a higher RR

A

F: C-section babies have a higher RR

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103
Q

Common HR for neonates

A

Up to 200 BPM

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104
Q

Expected RR for neonates

A

40-60 (up to 80) breaths per minute

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105
Q

Expected newborn BP

A

Systolic: 60-90 mmHg
——————————-
Diastolic: 30-62 mmHg

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106
Q

Hypertension in newborn is concerning because it could be symbolic of:

A

Thrombosis (after use of umbilical artery catheter), coarctation of aorta, renal disorders, congenital adrenal hyperplasia, CNS diseases

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107
Q

Normal capillary refill in infants

A

<2 seconds

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108
Q

T or F; Neonatal/infant pain scales are not designed to measure pain intensity

A

True

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109
Q

is used to assess procedural pain in preterm and full-term neonates between 28- and 40-weeks’ gestation. It measures physiologic signs (heart rate and oxygen saturation), pain behaviors (brow bulge, eye squeeze, and nasolabial furrow), gestational age, and behavioral state

A

Premature Infant Pain Profile (PIPP)

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110
Q

is used to assess procedure pain in preterm and full-term infants up to 6 weeks of age. The infant’s facial expression, cry, breathing patterns arm and leg movements, and state of arousal are observed and scored

A

The neonatal Infant Pain scale

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111
Q

is used to assess acute pain, ongoing pain, agitation, and sedation of critically ill newborns. The pain portion of the scale involves observation of crying/irritability, behavioral state, facial expression, extremity tone, and vital signs for scoring

A

Neonatal Pain, Agitation, and Sedation Scale (N-PASS)

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112
Q

is designed to evaluate postoperative pain in newborns and infants. The infant’s behaviors (crying, expression, and sleeplessness) as well as physiologic signs (oxygen saturation, heart rate, and blood pressure) are scored

A

CRIES scale

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113
Q

What does “CRIES” scale stand for

A

Crying, Requires oxygen to keep sats > 95, Increased vitals, Expression, Sleeplessness

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114
Q

True of False: the mean resting HR ranges gradually increase with age in children and adolescents

A

False, they decrease

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115
Q

Expect the child’s systolic and diastolic blood pressure values to be below the ________ percentile for age and height percentile

A

90th

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116
Q

Use the adult ranges for adolescents older than _______ years in reference to BP normals

A

13 year old

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117
Q

In a child: • The cuff width should cover approximately _______ % of the distance between the acromion and the olecranon (tip of the elbow)

A

70

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118
Q

In a child: when measuring BP, the bladder width should be at least ________ % of the arm circumference at the midpoint of the acromion–olecranon distance.

A

40

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119
Q

The number of children and adolescents with persistently elevated BP is estimated to be __________ %

A

2.2-3.5%

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120
Q

Two reliable pain scales for children

A

Wong-baker faces rating scale and ouches scale

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121
Q

Pain scale used in nonverbal children

A

FLACC behavioral pain assessment scale

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122
Q

FLACC scale typically used for acute pain associated with surgery in children between ____________ of age; Also typically used in nonverbal children

A

2 months and 7 years

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123
Q

The HR gradually increases through pregnancy until it is ___________ % higher at term

A

10-30%

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124
Q

When is a gradual increase in BP expected in pregnancy

A

From 2nd to 3rd trimester

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125
Q

Gestational HTN is when BP is > _________systolic and > __________ diastolic

A

140 mmHg; 90 mmHg

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126
Q

Gestational HTN develops in what percentage of women

A

5-10%

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127
Q

BP > _______ is a sign of preeclampsia in pregnant woman

A

160 mmHg systolic; 110 mmHg diastolic

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128
Q

Hypertension In older adults is defined as a BP > __________

A

140/90

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129
Q

Recent studies suggest that individuals who are normotensive at 55 years of age will have a _____ %lifetime risk of developing hypertension

A

90

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130
Q

has good validity and reliability for scoring pain behaviors in older adults with dementia and the inability to communicate

A

The PAINAD tool

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131
Q

Scale for older adults scoring 0-2 on items such as: breathing, negative vocalization, facial expression, body language, consolability

A

PAINAD

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132
Q

Hypertension in older adults is defined as a BP consistently > than __________

A

130/80

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133
Q

A form of chronic pain caused by a primary lesion or dysfunction of the central nervous system that persists beyond expected after healing

A

Neuropathic pain

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134
Q

potential causes include renal Disease, renal artery stenosis, primary aldosteronism, thyroid disorders, coarctation of the aorta, or pheochromocytoma

A

Secondary hypertension

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135
Q

Chronic condition (greater than 6 months) in which regional pain extends beyond a specific peripheral nerve injury in an extremity with motor, sensory, and autonomic changes.

A

Chronic condition

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136
Q

primarily responsible for a person’s mental status

A

Cerebrum of brain

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137
Q

houses the higher mental functions and is responsible for perception and behavior

A

Cerebral cortex aka the gray outer layer

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138
Q

Which lobe is associated with speech formation

A

Frontal lobe

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139
Q

This lobe is responsible for decision making, problem solving, the ability to concentrate, and short-term memory

A

Frontal lobe

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140
Q

Area of brain handling to emotions, affect, drive, and awareness of self and the autonomic responses related to emotional states

A

Frontal lobe

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141
Q

lobe that is primarily responsible for receiving and processing sensory data.

A

Parietal

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142
Q

The lobe that is responsible for the perception and interpretation of sounds as well as localizing their source

A

Temporal lobe

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143
Q

Lobe containing the Wernicke speech area

A

Temporal lobe

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144
Q

area which allows a person to understand spoken and written language

A

Wernicke speech area

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145
Q

Lobe that is also involved in the integration of behavior, emotion, and personality, as well as long-term memory

A

Temporal lobe

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146
Q

mediates certain patterns of behavior that determine survival such as mating, aggression, fear, affection

A

Limbic system

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147
Q

Where do reactions to emotions such as anger, love, hostility, and envy originate

A

The limbic system

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148
Q

the expression of emotion and behavior is mediated by connections between

A

The limbic system and frontal lobe

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149
Q

_________________ major function is memory consolidation needed for long term memory

A

Limbic system

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150
Q

What is the reticular system

A

A collection of nuclei in the brainstem

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151
Q

regulates vital reflexes such as heart and respiratory functioning

A

Reticular system

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152
Q

Part of brain that maintains wakefulness, which is important for consciousness and for awareness and arousal functions

A

Reticular system

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153
Q

Disruption of the _________________ can lead to altered mental status

A

ascending reticular activating system

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154
Q

T or F: All brain neurons are present at birth in a full-term infant

A

True

155
Q

In adolescents, ______________ develops

A

Abstract thinking

156
Q

_____________ disorientation results from cerebral trauma, seizures, or amnesia

A

Person

157
Q

______________ disorientation occurs with psychiatric disorders, delirium, and cognitive impairment

A

Place

158
Q

is associated with anxiety, delirium, depression, and cognitive impairment.

A

Time disorientation

159
Q

is used to quantify the level of consciousness after an acute brain injury or medical condition

A

Glasgow Coma Scale

160
Q

An inability to understand similarities/differences of analogies may indicate what…

A

Lesion of the left or dominant cerebral hemisphere

161
Q

With regards to abstract reasoning, inability to explain a phrase may indicate:

A
  1. poor cognition
  2. dementia
  3. brain damage
  4. schizophrenia.
162
Q

With concern to writing ability, Uncoordinated writing or drawing in an older adults may indicate

A
  1. dementia
  2. parietal lobe damage
  3. a cerebellar lesion
  4. peripheral neuropathy.
163
Q

the inability to translate an intention into action that is unrelated to paralysis or lack of comprehension

A

Apraxia

164
Q

Apraxia may indicate

A

A cerebral disorder

165
Q

Memory loss may result from:

A
  1. Disease
  2. Infection
  3. Temporal lobe trauma
166
Q

Loss of immediate and recent memory with retention of remote memory suggests ______________

A

Dementia

167
Q

The ability to perform arithmetic calculations is another test for ______________

A

Attention span

168
Q

Impaired judgement may indicate

A
  1. Intellectual disability
  2. Emotional disturbance
  3. Frontal lobe injury
  4. Dementia
  5. Psychosis
169
Q

Expressive word comprehension originates at

A

Broca area

170
Q

a disorder of voice volume, quality, or pitch

A

Dysphonia

171
Q

suggests a problem with laryngeal innervation or disease of the larynx.

A

Dysphonia

172
Q

a motor speech disorder

A

Dysarthria

173
Q

is associated with many conditions of the nervous system such as stroke, inebriation, cerebral palsy, and Parkinson disease.

A

Dysarthria

174
Q

pantomime or word substitution to avoid revealing that a word was forgotten

A

Circumloculation

175
Q

repetition of a word, phrase, or gesture

A

Preservation

176
Q

disordered words or sentences

A

Flight of ideas or use of loose associations

177
Q

meaningless, disconnected word choices

A

Word salad

178
Q

made-up words that have meaning only to the patient

A

Neoplasms

179
Q

word choice based on sound so that words rhyme in a nonsensical way

A

Clang association

180
Q

Repetition of another person’s words

A

Echolalia

181
Q

A speech disorder that can be receptive or expressive

A

Aphasia

182
Q

may be indicated by hesitations and other speech rhythm disturbances, omission of syllables or words, word transposition, circumlocutions, and neologisms.

A

Aphasia

183
Q

can result from facial muscle or tongue weakness or from neurologic damage to brain regions controlling speech and language.

A

Aphasia

184
Q

is evaluated when the patient does not seem to be coping well or does not have the resources to meet their personal need

A

Emotional stability

185
Q

What are the two versions of the PHQ

A

A two and a nine item version

186
Q

What does PHQ stand for

A

Patient Health Questionnaire

187
Q

The U.S. Preventive Health Task Force recommends depression screening of all adults using the self-administered

A

Patient Health Questionnaire

188
Q

Two questions from this can help identify the patient at higher risk for suicide ideation and behavior

A

Columbia-Suicide Severity Risk Screener (C-SSRS)

189
Q

Illogical, disorganized, or unrealistic thought processes, flight of ideas, blocking, or an impaired stream of thinking indicates

A

an emotional disturbance or a psychiatric disorder

190
Q

Obsessive thoughts, compulsive behaviors, phobias, or anxieties that interfere with daily life may indicate

A

mental dysfunction or a psychiatric disorder

191
Q

A patient who demonstrates an unrealistic sense of persecution, jealousy, grandiose ideas, or ideas of reference (e.g., neutral things in the environment have a special meaning to the person) may be experiencing what

A

Distorted thinking

192
Q

Auditory and visual hallucinations are associated with

A
  1. psychiatric disorders
  2. severe depression
  3. acute intoxication
  4. withdrawal
  5. delirium
  6. dementia.
193
Q

What is mostly commonly associated with alcohol withdrawal

A

Tactile hallucinations

194
Q

By ______ months of age, the infant should appear alert, quiet, and content and should recognize the face of a primary caregiver

A

2

195
Q

What does a shrill or whiny, high-pitched cry or catlike screeching cry suggest in an infant

A

A CNS disorder

196
Q

What age are cooing and babbling expected?

A

3-4 months

197
Q

Questionnaires completed by parents that are effective screening tools recommended for developmental assessment during routine well child visits

A

Ages and stages questionnaire & Parents evaluation of developmental status

198
Q

Attempt memory testing questions at around what age

A

4 years old

199
Q

When testing immediate recall, a 4-year-old can repeat ________ digits or words, a 5-year-old can repeat ________ digits or words, and a 6-year- old can repeat __________ digits or words

A

3, 4, 5

200
Q

How can you test remote memory in a child

A

Asking them to recite nursery rhyme, tell you what they ate at dinner last night, or tell you their addresss

201
Q

Concerns about behaviors and mood disorders may be assessed in children 4 to 18 years of age with tools like the …

A

Pediatric Symptom Checklist

202
Q

What do you use to screen for depression in adolescents

A

Adolescent version of 9 question PHQ

203
Q

An estimated ___% of patients who have depression during pregnancy have postpartum depression

A

39

204
Q

An estimated ____% of patients have postpartum depression

A

13

205
Q

postpartum psychosis occurs in up to ___% of postpartum patients

A

3

206
Q

Risk factors for postpartum depression include …

A
  1. PMH of depression
  2. Prior Postpartum depression
  3. Poor social support
207
Q

is a 10- item self-administered screening test that may be used during pregnancy and the postpartum period to screen for depression

A

The Edinburgh Postnatal Depression Scale

208
Q

T or F: you can use the PHQ-2 to assess for symptoms of depression in postpartum patients

A

True

209
Q

is a tool initially designed to detect mild cognitive impairment that may identify a transition between normal aging and dementia.

A

The Montreal Cognitive Assessment (MoCA)

210
Q

_________ is a version for low literacy adults of the Montreal Cognitive Assessment tool

A

MoCA- basic

211
Q

The MoCA-basic has a sensitivity of _______% and specificity of _________%

A

81; 86

212
Q

brief screening tool for measuring cognitive function in older adults

A

Mini-Cog

213
Q

include items in the following domains providing a broader assessment of cognitive status than the Mini-Mental State Examination (MMSE)

A

Montreal Cognitive Assessment tools (MoCA and low literacy MoCA-basic)

214
Q

On a. Mini-cog, a score of what may be associated with dementia

A

Score of 2 or less

215
Q

The mini-cog has a sensitivity of _____% and a specificity of ______% for detecting probable dementia

A

87; 85

216
Q

What does MMSE stand for

A

Mini mental state examination

217
Q

A score of __________ may be associated its dementia on the MMSE

A

20 or less

218
Q

An alteration in mental status resulting from a blow to the head, face, or neck, or a penetrating injury

A

Traumatic brain injury

219
Q

A direct blow to the head or face that bruises the brain as it moves within and against the skull and causes inflammation; often caused by a sports injury

A

Concussion

220
Q

A mood disorder in which feelings of sadness, loss, anger, or frustration interfere with everyday life for an extended period (weeks or longer)

A

Depression

221
Q

Higher forces cause acceleration-deceleration and rotationalmovement of the brain in the skull. Nerve fibers are stretched, compressed, or torn. Brain chemicals responsible for brain functioning are disrupted and inflammation leads to brain swelling

A

Moderate to severe brain injury

222
Q

A persistently elevated, expansive, euphoric, or irritable and agitated mood lasting longer than a week; one phase of the bipolar psychiatric disorder

A

Mania

223
Q

While the cause is unknown, abnormalities are found in neuroendocrine pathways that result in aberrant regulation of one or more amine neurotransmitter systems

A

Mania

224
Q

A genetic autosomal dominance inheritance with variable penetrance is possible

A

Mania

225
Q

A group of disorders with such marked anxiety or fear that it causes significant interference with personal, social, and occupational functioning

A

Anxiety disorders

226
Q

Abnormalities in the norepinephrine and serotonin systems; may have genetic predisposition; increased sensitivity of brain pH chemosensors in sites that modulate fear and arousal, such as the prefrontal cortex and amygdala

A

Anxiety disorders

227
Q

5 anxiety disorders

A
  1. Panic attacks
  2. Generalized anxiety disorder
  3. Specific phobias
  4. OCD
  5. PTSD
228
Q

A severe, persistent, psychotic syndrome with impaired reality that relapses throughout life

A

Schizophrenia

229
Q

A complex genetic disorder that involves many genes on different chromosomes in patients who are vulnerable due to factors such as intrauterine infection, maternal nutritional deficiencies, perinatal complications, and neonatal hypoxia

A

Schizophrenia

230
Q

Structural brain abnormalities exist such as enlarged lateral and third ventricles, reduced size of the temporal lobe and thalamus, and abnormal amygdala connectivity which has a role in social and emotional processing networks

A

Schizophrenia

231
Q

A developmental, cognitive, or intellectual deficit that begins before 18 years of age, with accompanying deficits in adaptive behavior, academic performance, and adaptive functioning

A

Intellectual disability

232
Q

A neurobehavioral problem of impaired attention and hyperactive Behavior affecting 5% to 6% of children worldwide

A

ADHD

233
Q

A disorder with a strong genetic component affecting dopamine transport and reception leading to ina inattentive, hyperactivity, and behavioral inhibition. It may be associated with birth injuries, severe traumatic brain injury, or abnormal brain structures

A

ADHD

234
Q

The onset of ADHD is typically before _______ years old

A

7

235
Q

Is Autism more prevalent in boys or girls?

A

Boys

236
Q

A pervasive neurodevelopmental disorder of unknown etiology

A

Autism

237
Q

autistic disorder, Asperger syndrome, pervasive developmental disorder not otherwise specified [PDD-NOS] are all examples of

A

Autism

238
Q

A strong genetic influence that inactivates areas of the genome that affect early brain development; potential intrauterine toxic insults leading to abnormal brain growth in the frontal, temporal, cerebellar, and limbic areas

A

Autism

239
Q

Impaired cognition, arousal, consciousness, mood and behavioral dysfunction of acute onset

A

Delirium

240
Q

Disorder that may arise from disturbances in neurotransmitters, inflammatory pathways, stress response, and anatomic changes in the brain, but causes are usually multi factorial. Advanced age is a predisposing factor

A

Delirium

241
Q

A chronic, slowly progressive disorder of failing memory, cognitive impairment, behavioral abnormalities, and personality changes that often begins after age 60 years.

A

Dementia

242
Q

accumulation of amyloid plaques and

neurofibrillary tangles, deteriorating synapses, and neuron death

A

Most common cause of dementia of Alzheimer’s type

243
Q

Presence of e4 allele gene for apolipoprotein E is present in 60% of affected persons

A

Dementia of Alzheimer Type

244
Q

associated with reduced blood flow to the brain from multiple emboli and hemorrhages in different parts of the brain, stroke, or small blood vessel narrowing (under the category of dementia)

A

Vascular Dementia

245
Q

Associated with diffuse Lewy bodies in the brain,

Parkinson disease, and frontal lobe degeneration

A

Other dementias

246
Q

an observation made that suggests a condition is not present when it actually is present

A

False negative

247
Q

process of merging knowledge of the patient from interview and physical assessment, clinical experience, and current best evidence to determine patient care.

A

Clinical reasoning

248
Q

the proportion of persons with an expected observation who ultimately prove not to have the expected condition

A

Negative predictive value

249
Q

the ability of an observation to identify correctly those who have a disease.

A

Sensitivity

250
Q

the likelihood of a diagnosis being related to the findings depends on the probability of those findings being associated with that diagnosis

A

Bayes Formula

251
Q

an expected observation that is not found when the disease characterized by that observation is not present

A

True negative

252
Q

a system that incorporates the best available scientific evidence to clinical decision making in the care of the individual patient

A

EBP

253
Q

a process involving progress through a series of stages.

A

Behavior change

254
Q

an expected observation that is found when the disease characterized by that observation is present

A

True positive

255
Q

a principle stating that all findings should be unified into one diagnosis; this is not always true.

A

Occam’s razor

256
Q

the ability of an observation to identify correctly those who do not have the disease

A

Specificity

257
Q

an observation made that suggests a condition is present when it is not

A

False positive

258
Q

The proportion of persons with an observation characteristic of a disease who actually have it.

A

Positive predictive value

259
Q

self determination; the right to choose between alternatives

A

Autonomy

260
Q

do no harm to the patient

A

Nonmaleficence

261
Q

Body systems that may be involved in: Chest Pain

A

CV, respiratory, musculoskeletal

262
Q

Body systems that may be involved in: Headaches

A

Neuro, CV, Visual, auditory

263
Q

Body systems that may be involved in: abdominal pain

A

CV, GI, GU

264
Q

Body systems that may be involved in: pain in the legs

A

Musculoskeletal, Neuro, integumentary, CV

265
Q

What concept is utilized in this scenario: The examiner notes a positive Chvostek sign in the absence of hypocalcemia

A

False positive

266
Q

What Concept is used in this scenario: The patient does not demonstrate tenderness at the McBurney point and does not have appendicitis.

A

True negative

267
Q

What Concept is used in this scenario: A numeric value is assigned, predicting the probability that a patient with negative findings does not have a given illness.

A

Negative predictive value

268
Q

What Concept is used in this scenario: A diagnosis of hepatitis B infection is made based on the patient’s symptoms and the population of intravenous drug abusers, of which he is part.

A

Bayes Formula

269
Q

What concept is used in this scenario: A patient with cholecystitis has a positive Murphy sign.

A

True positive

270
Q

What concept is used in this scenario: The examiner notes normal findings in a patient with prostate cancer.

A

False negative

271
Q

What concept is used in this scenario: With acute myocardial infarction, 90% of patients demonstrate diaphoresis.

A

Positive predictive value

272
Q

What is the first step in clinical reasoning?

A

Assessing the value and significance of information

obtained from the patient

273
Q

What is the foundation of clinical reasoning?

A

Problem list

274
Q

After an examiner has identified and confirmed a problem,

the next step is to

A

Determine the management plan

275
Q

What does Bayes Theorem describe?

A

the likelihood of your diagnosis being related to your

findings

276
Q

Unless a life-threatening situation exists, the best guide to
determining the priority for the patient’s condition should be based on

A

Probability and utility

277
Q 
Each of the following could become a barrier to the clinical reasoning process, except for the examiner’s
a. feelings.
b. attitudes
C. Values
D. Objectivity
A

D

278
Q

Laboratory tests should be used to

A

Confirm a presumes diagnosis

279
Q

A 62-year-old patient has been diagnosed with alcohol
addiction. After discussing his situation, he tells you that he is intending to take action regarding his alcohol use in the immediate future. Which stage of change is he in?

A

Preparation

280
Q

EBP is defined as

A

a system bringing to bear the best available scientific

evidence to clinical decision making

281
Q

a format for recording health history and physical examination findings by documenting the problem assessment process.

A

Problem oriented medial record (POMR)

282
Q

scenario in which a patient seeks care for an acute problem, which is usually rapidly resolved.

A

Episodic illness visit

283
Q

onset, location, duration, character, aggravating factors, relieving factors, temporal factors, and severity of symptoms.

A

OLDCARTS mnemonic

284
Q

dependability of information, that is, accuracy, consistency, and reliability of information content.

A

Information integrity

285
Q

a brief description of the patient’s main reason for seeking care, stated verbatim in quotation marks

A

Chief concern

286
Q

part of the medical record that includes cultural background, birthplace, education, family, marital status, general life satisfaction, hobbies, sources of stress, and religious practices

A

Personal and social history

287
Q

a list of
interventions divided into three categories—diagnosis, treatment, and patient education—based on each problem in the problem list

A

Plan

288
Q

record that must include all data collected, both positive and negative, that contribute to the examiner’s assessment

A

Comprehensive health history and physical examination

289
Q

information about general health over the patient’s lifetime as well as disabilities and functional limitations as the patient perceives them.

A

Past medical history

290
Q

a detailed description of all symptoms that may be related to the chief concern; describes the concern for problem chronologically, dating events, and symptoms.

A

History or present illness

291
Q

a pedigree with at least three generations and information about major health or genetic disorders.

A

Family history

292
Q

a running log of problem number, date of onset, description of problem, and date the problem was resolved

A

Problem list

293
Q

____________ data are collected during the history and are based on patient reports.

A

Subjective

294
Q

A brief description of the patient’s main reason for seeking healthcare is referred to as the _____________.

A

Chief concern

295
Q

_____________ is a format used to document health history notes, especially for care beyond the initial evaluation.

A

SOAP

296
Q

The use of stick people to document findings is an example of using a(n) _____________.

A

Illustration

297
Q

_____________ data are collected while conducting the physical examination.

A

Objective

298
Q

_____________ is the use of recorded numbers to represent findings by variable degrees.

A

Incremental grading

299
Q

_____________ is a widely accepted medical record format consisting of six components.

A

Problem oriented medical record (POMR)

300
Q

_____________ is the part of the record where information from a patient interview is recorded.

A

Health history

301
Q

Clinical findings are recorded during the _____________.

A

Physical examination

302
Q

How are “normal findings” best documented?

A

Document what was actually assessed in specific terms

303
Q

One way that a health history for an infant differs from that of an adult is the inclusion of

A

Prenatal history

304
Q

If a mistake is made in a paper patient record, it is suggested that a line be drawn through the mistake so that it is still legible and then signed. The basis for this action is related to the fact that

A

The chart is a legal document

305
Q

The examiner can substantially reduce the possibility of legal problems by

A

Maintaining clear medical records

306
Q

Your patient presents to the office with a chief concern of shoulder pain that he reports as stabbing. In using the mnemonic OLDCARTS, this is noted as

A

Character

307
Q

faster than normal respiratory rate

A

Tachypnea

308
Q

the fever response triggered by prostaglandins.

A

Pyrexia

309
Q

the force of the blood against the wall of an artery as the ventricles of the heart contract and relax

A

Blood pressure

310
Q

tool for scoring pain behaviors in non-communicative older adults with dementia

A

PAINAD

311
Q

a form of chronic pain caused by a primary lesion or by dysfunction of the central nervous system that persists longer than expected after healing.

A

Neuropathic pain

312
Q

this assessment is most commonly performed by oral, rectal, axillary, tympanic, or forehead routes.

A

Temperature

313
Q

The presence of regional pain beyond the original nerve injury with motor, sensory, and autonomic changes after a predominately traumatic, noxious event, with or without specific nerve injury.

A

Complex regional pain syndrome

314
Q

palpated over an artery close to the body surface that lies over bones

A

Pulse rate

315
Q

turbulence of blood flow in the artery.

A

Korotkoff sounds

316
Q

assessed by inspecting the rise and fall of the chest; the expected adult rate is 12 to 20 breaths/min.

A

Respiratory rate

317
Q

a pain scale for children using a scale of 0 to 5.

A

Wong baker faces rating scale

318
Q

rapid contraction and relaxation of the skeletal muscles.

A

Shivering

319
Q

the difference between the systolic and diastolic pressures.

A

Pulse pressure

320
Q

What is an important consideration when assessing pain in a 32-year-old postoperative patient?

A

Previous experiences with pain will influence both pain perception and interpretation.

321
Q

When obtaining a patient’s blood pressure, how can the

examiner protect against an incorrect reading because of the auscultatory gap?

A

Palpate the systolic pressure prior to taking the blood

pressure with a stethoscope

322
Q

What term is commonly used by a child expressing pain

A

Hurt

323
Q

At about what age is a child able to respond to a pediatric pain scale?

A

3 years old

324
Q

The CRIES scale would appropriately be used when assessing what type of patient?

A

A 2 month old postoperative infant

325
Q

When you are completing an assessment on a patient with pain, it is important to

A

learn the patient’s customary terminology.

326
Q

The gold standard in pain assessment is the patient’s

A

Perception of his or her own pain

327
Q

51-year-old patient is admitted with burning, shock-like pain in the left hand. This finding suggests a problem involving which type of tissue

A

Nerve

328
Q

On what basis does an examiner determine the correct size of a BP cuff for an adult

A

Relationship between cuff bladder size and limb size

329
Q

How is a BP reading affected if an adult cuff is used on a

small child?

A

BP reading will be falsely low

330
Q

Assessment using the PAINAD tool should be done during…

A

some patient activity, such as turning or transferring, is in progress

331
Q

The expected respiratory rate for children age 6 years old is between

A

16 to 22 breaths/min

332
Q 
You are assessing a 10-year-old boy. What pulse rate is within the normal range for a child of this age?
A. 68 bpm
B. 74 BPM
C. 82 BPM
D. 96 BPM
A

82 BPM

333
Q

A 14 year-old boy weighing 108 pounds is having a routine physical examination. His BP is 138/78 mm Hg. Which factor must you consider as a potential cause of his elevated systolic BP

A

Anxiety

334
Q

Potential causes of secondary hypertension include all of the following except

a. increased water intake.
b. renal artery stenosis.
c. thyroid disorders.
d. coarctation of the aorta

A

A

335
Q

When checking a patient’s respiratory rate, which guideline should the examiner follow?

A

Keep the patient unaware that RR is being counted

336
Q

What is the best method for checking the patient’s pulse?

A

Count for 30 seconds and multiply by 2

337
Q

Which is the effect of a too-loose cuff on blood pressure measurement?

A

Inaccurate diastolic reading

338
Q

Which blood pressure change occurring when a patient goes from a sitting to a standing position is indicative of orthostatic hypertension

A

Systolic BP drop greater than 20 mm Hg and a diastolic drop of 10 mm Hg.

339
Q

events in the brain—such as trauma, infection, or chemical imbalance —that can damage brain cells that may result in serious permanent dysfunction in mental status

A

Insults

340
Q

clear, logical flow of ideas, intentions, and perceptions.

A

Coherence

341
Q

area of the temporal lobe that permits comprehension of spoken and written language

A

Wernicke

342
Q

the inability to translate an intention into action that is unrelated to paralysis or lack of comprehension; may indicate a cerebral disorder.

A

Apraxia

343
Q

a disorder of voice volume, quality, or pitch

A

Dysphoria

344
Q

an emotional response or feeling

A

Affect

345
Q

a scale used to assess the function of the cerebral cortex and brainstem and to quantify consciousness.

A

GCS

346
Q

area associated with speech formation.

A

Broca

347
Q

a speech disorder that can be receptive (understanding language) or expressive (speaking language); it may be indicated by hesitations and other speech rhythm disturbances, omission of syllables or words, word transposition, circumlocutions, and neologisms.

A

Aphasia

348
Q

The ability to reason

A

Judgement

349
Q

pertaining to mental processes of memory, judgment, and reasoning; cognitive impairment is characterized by a loss of memory, confusion, and inappropriate affect.

A

Cognitive

350
Q

a motor speech disorder defect associated with many conditions of the nervous system such as stroke, inebriation, cerebral palsy, and Parkinson disease.

A

Dysarthria

351
Q

capacity of the mind to understand; demonstrated by an ability to follow simple instructions

A

Comprehension

352
Q

a sensory experience not due to external stimulus

A

Hallucinations

353
Q

Feelings of helplessness

A

Depression

354
Q

Feeling of Apprehension

A

Anxiety

355
Q

Excessive happiness

A

Euphoria

356
Q

Rapid shift of emotions

A

Mood lability

357
Q

Lack of emotional response

A

Flat affect

358
Q

Annoyed response to stimulus

A

Irritability

359
Q

A patient’s inability to follow simple instructions could indicate what finding?

A

Depression

360
Q

A patient scores a 3 on the Mini-Cog Assessment Instrument for Dementia. What does this score indicate?

A

Negative screen for dementia

361
Q

The examiner asks the patient to complete this statement: “A bird is to air as a fish is to….” This is an example of what type of testing?

A

Analogy

362
Q

Which type of assessment should be used to evaluate the mental status of a patient with head trauma?

A

GCS

363
Q

A patient who has difficulty writing or drawing is most likely to have which condition?

A

Peripheral neuropathy

364
Q

A mother brings her 18-month-old son to the clinic. She states that the child rarely talks or smiles or makes eye contact. She has also noticed that he does not like to be held. She says his motor development seems to be normal. These symptoms are consistent with what condition?

A

Autistic disorder

365
Q

A patient with Alzheimer disease classically displays which of the following?

a. Alternating periods of mania and stupor
b. Hallucinations and decorticate posturing
c. Disintegration of personality
d. Rapid onset of symptoms

A

C

366
Q

Two ways the body generates heat:

A

Shivering and vasoconstriction

367
Q

What does the O in OLDCARTS stand for

A

Onset

368
Q

What does the L in OLDCARTS stand for

A

Location

369
Q

What does the D in OLDCARTS stand for

A

Duration

370
Q

What does the C in OLDCARTS stand for

A

Character

371
Q

What does the A in OLDCARTS stand for

A

Aggravating and associated factors

372
Q

What does the R in OLDCARTS stand for

A

Relieving factors

373
Q

What does the T in OLDCARTS stand for

A

Temporal factors

374
Q

What does the S in OLDCARTS stand for

A

Severity of symptoms

375
Q

A problem may be defined as:
A. The chief concern that the patient tells you when they come in for a visit
B. Developed from thw Review of Systems
C. Absence for findings that denote health tor well-being
D. Anything that will need further evaluation and/or attention

A

D

376
Q

The History of present illness includes which of the following?
A. The historian’s identity
B. Detailed description of the problem
C. Information that influenced the the health problem
D. General health over the patient’s lifetime

A

B

377
Q 
Differential diagnoses belong in the:
A. Plan
B. History
C. Physical Examination
D. Assessment
A

D

378
Q 
Recording Information for infants different from adults because it includes: 
A. Developmental history
B. Family history related to children 
C. Injury prevention 
D. Immunization status
A

A

379
Q 
Potential causes of secondary hypertension include all of the following except:
A. Coarctation of the aorta
B. Increased water intake 
C. Thyroid disorders
D. Renal artery stenosis
A

B

380
Q 
The primary muscles of inspiration are
A. Diaphragm and intercostal
B. Internal intercostal
C. Ribs and sternum
D. External intercostal
A

A …… uncertain of answer but the rationale was: the external intercostal muscles increase the AP chest diameter during inspiration and the internal intercostal decrease the lateral diameter during expiration

381
Q

The perception of pain:
A. Is impacted by emotions and quality of sleep
B. Is the same across cultures
C. Is predictable with the same circumstances
D. Does not apply to neonates

A

A

382
Q 
Assessing orientation to person, place, and time helps determine:
A. Abstract reasoning 
B. Attention span
C. State of consciousness 
D. Ability to understand analogies
A

C

383
Q 
one method to evaluate mental status, cognitive function, and assess for dementia is:
A. Coherence testing scale 
B. Glasgow Coma Scale 
C. Mini-Cog
D. Geriatric depression inventory
A

C

384
Q 
Testing the patient’s arithmetic calculation will assist in determining:
A. Depression and diffuse brain disease 
B. Dementia and Parkinson’s disease 
C. Schizophrenia and brain damage 
D. Intellectual disability
A

A

Advanced HA (13 decks)

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