Module 2 Flashcards
Key to developing a complete understanding of patient’s concerns
Problem list
The bits of information that are distracting and draw your thinking away from central issues
Red herrings
Three diagnosis for every disease:
The one that unifies what you’ve learned
The one you cannot afford to miss
The one it actually is
States that the single simplest cause is the most likely diagnosis
Occam’s Razor
Implies that there can be several simultaneous diagnosis
Hickman’s Dictum
T or F; Clinial reasoning becomes complex because of the emotions of ONLY the patient
False, it is the patient and the healthcare provider
The patient’s need for self determination
Autonomy
Suggests that choices exist and a patient may choose between alternatives
Autonomy
Do good for the patient
Beneficence
Do no harm to the patient
Nonmalificence
Consider appropriate use of resources with concern for the greater good of the larger community
Utilitarianism
Recognize the balance between autonomy and competing interests of the family and community
Fairness and justice
Our dutiful responsibilities for offering care are established by tradition and in cultural contexts
Deontologic imperatives
Knowledge is to be free of ________, _________, and __________
Beliefs, attitudes, and values
Our decision making must have a balance between ___________ and _____________
Mechanism and probabilism
T or F: certainty in knowledge is impossible
True
The ability of an observation to identify correctly those who have a disease
Sensitivity
The ability of an observation to identify correctly those who do not have a Disease
Specificity
An expected observation that is found when the disease characterized by that observation is present
True positive
An expected observation that is not found when the disease characterized by that observation is not present
True negative
An observation made that suggests a disease when that disease is not present
False positive
An observation that suggests a disease is not present when in fact it is
False negative
The proportion of persons with an observation characteristic of a disease who have it
Positive predictive value
The proportion of persons with an expected observation who ultimately prove not to have the expected condition
Negative predictive value
A system that incorporates the best available scientific evidence to clinical decision making in the care of the individual patient
EBP
Assesses an individual’s readiness to change
Transtheoretical model of behavior change
Stage of change: not yet admitting there is a problem behavior that needs to be changed, or not intending to take action
Precontemplation
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
Contemplation
Stage of change: intending to take action in the immediate future, beginning to take small steps toward change
Preparation
Stage of change: changing behavior, overt modification in behavior
Action
Stage of change: being able to sustain action and working to prevent relapse
Maintenance
Stage of change: no temptation and confidence in not returning to old behavior
Termination
Stage of change: not considered a stage itself but rather the shift from action or maintenance to an earlier stage (precontemplation or contemplation)
Relapse
Overwhelming the reader with volumes of insignificant data can be referred to as….
Note bloat
T or F: the patient’s health record is a legal document
True
Has been a major emphasis in achieving meaningful use of the EHR
Computerized Provider Order Entry (CPOE)
Can facilitate clinicians in assigning risks of specific clincial outcomes to subgroups of patients
Risk stratification
Is a term used to signify the synergistic activity if various organizations to improve the health outcomes of the communities that they serve
Population health
Are standardized evidence based healthcare plans and processes designed for patient within a specific clinical setting to enhance their care
Care pathways
Allows clinicians and patients, and when designated, their family members to secure access to pertinent and appropriate portions of the patient’s health record
Electronic health information exchange (HIE)
POHR
ProblemOriented health record
What is the SOAP format
Subjective, objective, Assessment, and Plan
What is the APSO format
Assessment, plan, subjective, objective
The information, including the absence or presence of pertinent symptoms, that the patient tells you
Subjective data
your direct observations from what you see, hear, smell, and touch and from diagnostic test results
Objective date
your interpretations and conclusions, your rationale, the diagnostic possibilities, and present and anticipated problems
Assessment
diagnostic testing, therapeutic modalities, need for consultants, and rationale for these decisions
Plan
6 components of the POHR
- health history
- physical exam
- Problem list
- Assessment and plan
- Baseline and problem directed lab/radiology studies
- Progress notes
A ____________ may be defined as anything that will require further evaluation or attention
Problem
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
Assessment section
In an assessment of POHR, avoid using _______
WNL
Develop a __________ for each problem on the problem list
Plan
Part of plan: List the diagnostic tests and consultations to be performed or ordered.
Diagnostics
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.
Therapeutics
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
Patient education
is a critical part of every visit in order to prevent adverse drug events.
Medication reconciliation
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.
The PAMI (problems, allergies, medications, immunizations) list
is a brief description of the patient’s main reason for seeking care
Chief concern or presenting problem
Always include the ___________ of the chief concern or problem
Duration
when the problem or symptom first started; chronologic order of events; setting and circumstances; manner of onset
Onset
Exact location of pain
Location
length of problem or episode; if intermittent, how long each episode is
Duration
nature of pain (e.g., stabbing, burning, sharp, dull, gnawing)
Character
Frequency of occurrence; describe typical attack; change in symptom intensity, improvement or worsening over Time
Temporal factors
Rated on a 0-10 scale, ask about effect on lifestyle, work performance
Severity of symptoms
Mnemonic for recording characteristics of a problem in HPI
OLDCARTS
includes general health over the patient’s lifetime and disabilities and functional limitations, as the patient perceives them
past medical history (PMH)
For infant with no growth or development problems it may be recorded as:
History, ROS, or in a separate category
Considered baseline indicator for patient’s health status
Vital signs
Considered the 5th vital sign
Pain assessment
Body temperature is regulated and maintained by the ___________
Hypothalamus
results when the ventricular heart contraction pushes a pressure wave of blood throughout the arterial system.
The arterial pulse
Primary muscles of respiration
Diaphragm and the intercostal muscles
The diaphragm contracts and moves ________ during ____________ to increase the intrathoracic space
Downward, inspiration
The ______________ intercostal muscles increase the anteroposterior chest diameter during inspiration, and the _____________ intercostal muscles decrease the lateral diameter during expiration.
External; internal
the force of the blood against the wall of an artery as the ventricles of the heart contract and relax.
Arterial blood pressure
the force exerted when the ventricles contract
Systolic BP
is largely the result of cardiac output, blood volume, and compliance of the arteries
Systolic BP
is the force exerted by peripheral vascular resistance when the heart is in the filling or relaxed state.
Diastolic BP
is the difference between the systolic and diastolic
Pulse pressure
helps sustain the pain response.
Inflammation
Defined as long-term pain associated with damage or dysfunction of the central or peripheral nervous system
Neuropathic pain
are free nerve endings in the peripheral nervous system activated by tissue damage from injury or inflammation.
Nociceptors
Biochemical mediators that facilitate the transmission of pain impulses from the nerve endings along nerve pathways
bradykinin, prostaglandins, serotonin, glutamate, and substance P
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 ______________
Thalamus and cerebral cortex
Sharp, well- localized pain is quickly transmitted by
Large, myelinated A-delta fibers
Dull, burning, diffuse, and chronic pain is slowly transmitted by:
Small unmyelinated C fibers
Substances that can change or inhibit the pain received
Endorphins or GABA
Why does ice or massage reduce pain impulses
compete to transmit sensations along the same spinal pathways to the brain
Response to pain is affected by:
Physiologic, behavioral, and emotional phenomenon
Average body temp
97.2-99.9
Core body temps is _____ higher than oral temperature
0.9 degrees F
Average resting HR
70 BPM
Expected RR in adults
12-20 breaths per minute
Ratio of RR to HR
1:4
Use the _______ of the stethoscope over the brachial artery during manual BP readings
Bell
Turbulence of blood flow in the artery
Korotkoff sounds
For selecting BP size: choose a width that is __________ the circumference of the limb
1/3 to 1/2
The auscultatory gap widens with systolic hypertension in older persons due to loss of
Arterial pliability
The auscultation gap widens with a drop in diastolic pressure when
Severe aortic regurgitation is present
Auscultation gap narrows in the case of _________
Pulses paradoxes d/t cardiac tamponade
T or F: infants delivered by vaginal birth have a higher RR
F: C-section babies have a higher RR
Common HR for neonates
Up to 200 BPM
Expected RR for neonates
40-60 (up to 80) breaths per minute
Expected newborn BP
Systolic: 60-90 mmHg
——————————-
Diastolic: 30-62 mmHg
Hypertension in newborn is concerning because it could be symbolic of:
Thrombosis (after use of umbilical artery catheter), coarctation of aorta, renal disorders, congenital adrenal hyperplasia, CNS diseases
Normal capillary refill in infants
<2 seconds
T or F; Neonatal/infant pain scales are not designed to measure pain intensity
True
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
Premature Infant Pain Profile (PIPP)
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
The neonatal Infant Pain scale
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
Neonatal Pain, Agitation, and Sedation Scale (N-PASS)
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
CRIES scale
What does “CRIES” scale stand for
Crying, Requires oxygen to keep sats > 95, Increased vitals, Expression, Sleeplessness
True of False: the mean resting HR ranges gradually increase with age in children and adolescents
False, they decrease
Expect the child’s systolic and diastolic blood pressure values to be below the ________ percentile for age and height percentile
90th
Use the adult ranges for adolescents older than _______ years in reference to BP normals
13 year old
In a child: • The cuff width should cover approximately _______ % of the distance between the acromion and the olecranon (tip of the elbow)
70
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.
40
The number of children and adolescents with persistently elevated BP is estimated to be __________ %
2.2-3.5%
Two reliable pain scales for children
Wong-baker faces rating scale and ouches scale
Pain scale used in nonverbal children
FLACC behavioral pain assessment scale
FLACC scale typically used for acute pain associated with surgery in children between ____________ of age; Also typically used in nonverbal children
2 months and 7 years
The HR gradually increases through pregnancy until it is ___________ % higher at term
10-30%
When is a gradual increase in BP expected in pregnancy
From 2nd to 3rd trimester
Gestational HTN is when BP is > _________systolic and > __________ diastolic
140 mmHg; 90 mmHg
Gestational HTN develops in what percentage of women
5-10%
BP > _______ is a sign of preeclampsia in pregnant woman
160 mmHg systolic; 110 mmHg diastolic
Hypertension In older adults is defined as a BP > __________
140/90
Recent studies suggest that individuals who are normotensive at 55 years of age will have a _____ %lifetime risk of developing hypertension
90
has good validity and reliability for scoring pain behaviors in older adults with dementia and the inability to communicate
The PAINAD tool
Scale for older adults scoring 0-2 on items such as: breathing, negative vocalization, facial expression, body language, consolability
PAINAD
Hypertension in older adults is defined as a BP consistently > than __________
130/80
A form of chronic pain caused by a primary lesion or dysfunction of the central nervous system that persists beyond expected after healing
Neuropathic pain
potential causes include renal Disease, renal artery stenosis, primary aldosteronism, thyroid disorders, coarctation of the aorta, or pheochromocytoma
Secondary hypertension
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.
Chronic condition
primarily responsible for a person’s mental status
Cerebrum of brain
houses the higher mental functions and is responsible for perception and behavior
Cerebral cortex aka the gray outer layer
Which lobe is associated with speech formation
Frontal lobe
This lobe is responsible for decision making, problem solving, the ability to concentrate, and short-term memory
Frontal lobe
Area of brain handling to emotions, affect, drive, and awareness of self and the autonomic responses related to emotional states
Frontal lobe
lobe that is primarily responsible for receiving and processing sensory data.
Parietal
The lobe that is responsible for the perception and interpretation of sounds as well as localizing their source
Temporal lobe
Lobe containing the Wernicke speech area
Temporal lobe
area which allows a person to understand spoken and written language
Wernicke speech area
Lobe that is also involved in the integration of behavior, emotion, and personality, as well as long-term memory
Temporal lobe
mediates certain patterns of behavior that determine survival such as mating, aggression, fear, affection
Limbic system
Where do reactions to emotions such as anger, love, hostility, and envy originate
The limbic system
the expression of emotion and behavior is mediated by connections between
The limbic system and frontal lobe
_________________ major function is memory consolidation needed for long term memory
Limbic system
What is the reticular system
A collection of nuclei in the brainstem
regulates vital reflexes such as heart and respiratory functioning
Reticular system
Part of brain that maintains wakefulness, which is important for consciousness and for awareness and arousal functions
Reticular system
Disruption of the _________________ can lead to altered mental status
ascending reticular activating system
T or F: All brain neurons are present at birth in a full-term infant
True
In adolescents, ______________ develops
Abstract thinking
_____________ disorientation results from cerebral trauma, seizures, or amnesia
Person
______________ disorientation occurs with psychiatric disorders, delirium, and cognitive impairment
Place
is associated with anxiety, delirium, depression, and cognitive impairment.
Time disorientation
is used to quantify the level of consciousness after an acute brain injury or medical condition
Glasgow Coma Scale
An inability to understand similarities/differences of analogies may indicate what…
Lesion of the left or dominant cerebral hemisphere
With regards to abstract reasoning, inability to explain a phrase may indicate:
- poor cognition
- dementia
- brain damage
- schizophrenia.
With concern to writing ability, Uncoordinated writing or drawing in an older adults may indicate
- dementia
- parietal lobe damage
- a cerebellar lesion
- peripheral neuropathy.
the inability to translate an intention into action that is unrelated to paralysis or lack of comprehension
Apraxia
Apraxia may indicate
A cerebral disorder
Memory loss may result from:
- Disease
- Infection
- Temporal lobe trauma
Loss of immediate and recent memory with retention of remote memory suggests ______________
Dementia
The ability to perform arithmetic calculations is another test for ______________
Attention span
Impaired judgement may indicate
- Intellectual disability
- Emotional disturbance
- Frontal lobe injury
- Dementia
- Psychosis
Expressive word comprehension originates at
Broca area
a disorder of voice volume, quality, or pitch
Dysphonia
suggests a problem with laryngeal innervation or disease of the larynx.
Dysphonia
a motor speech disorder
Dysarthria
is associated with many conditions of the nervous system such as stroke, inebriation, cerebral palsy, and Parkinson disease.
Dysarthria
pantomime or word substitution to avoid revealing that a word was forgotten
Circumloculation
repetition of a word, phrase, or gesture
Preservation
disordered words or sentences
Flight of ideas or use of loose associations
meaningless, disconnected word choices
Word salad
made-up words that have meaning only to the patient
Neoplasms
word choice based on sound so that words rhyme in a nonsensical way
Clang association
Repetition of another person’s words
Echolalia
A speech disorder that can be receptive or expressive
Aphasia
may be indicated by hesitations and other speech rhythm disturbances, omission of syllables or words, word transposition, circumlocutions, and neologisms.
Aphasia
can result from facial muscle or tongue weakness or from neurologic damage to brain regions controlling speech and language.
Aphasia
is evaluated when the patient does not seem to be coping well or does not have the resources to meet their personal need
Emotional stability
What are the two versions of the PHQ
A two and a nine item version
What does PHQ stand for
Patient Health Questionnaire
The U.S. Preventive Health Task Force recommends depression screening of all adults using the self-administered
Patient Health Questionnaire
Two questions from this can help identify the patient at higher risk for suicide ideation and behavior
Columbia-Suicide Severity Risk Screener (C-SSRS)
Illogical, disorganized, or unrealistic thought processes, flight of ideas, blocking, or an impaired stream of thinking indicates
an emotional disturbance or a psychiatric disorder
Obsessive thoughts, compulsive behaviors, phobias, or anxieties that interfere with daily life may indicate
mental dysfunction or a psychiatric disorder
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
Distorted thinking
Auditory and visual hallucinations are associated with
- psychiatric disorders
- severe depression
- acute intoxication
- withdrawal
- delirium
- dementia.
What is mostly commonly associated with alcohol withdrawal
Tactile hallucinations
By ______ months of age, the infant should appear alert, quiet, and content and should recognize the face of a primary caregiver
2
What does a shrill or whiny, high-pitched cry or catlike screeching cry suggest in an infant
A CNS disorder
What age are cooing and babbling expected?
3-4 months
Questionnaires completed by parents that are effective screening tools recommended for developmental assessment during routine well child visits
Ages and stages questionnaire & Parents evaluation of developmental status
Attempt memory testing questions at around what age
4 years old
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
3, 4, 5
How can you test remote memory in a child
Asking them to recite nursery rhyme, tell you what they ate at dinner last night, or tell you their addresss
Concerns about behaviors and mood disorders may be assessed in children 4 to 18 years of age with tools like the …
Pediatric Symptom Checklist
What do you use to screen for depression in adolescents
Adolescent version of 9 question PHQ
An estimated ___% of patients who have depression during pregnancy have postpartum depression
39
An estimated ____% of patients have postpartum depression
13
postpartum psychosis occurs in up to ___% of postpartum patients
3
Risk factors for postpartum depression include …
- PMH of depression
- Prior Postpartum depression
- Poor social support
is a 10- item self-administered screening test that may be used during pregnancy and the postpartum period to screen for depression
The Edinburgh Postnatal Depression Scale
T or F: you can use the PHQ-2 to assess for symptoms of depression in postpartum patients
True
is a tool initially designed to detect mild cognitive impairment that may identify a transition between normal aging and dementia.
The Montreal Cognitive Assessment (MoCA)
_________ is a version for low literacy adults of the Montreal Cognitive Assessment tool
MoCA- basic
The MoCA-basic has a sensitivity of _______% and specificity of _________%
81; 86
brief screening tool for measuring cognitive function in older adults
Mini-Cog
include items in the following domains providing a broader assessment of cognitive status than the Mini-Mental State Examination (MMSE)
Montreal Cognitive Assessment tools (MoCA and low literacy MoCA-basic)
On a. Mini-cog, a score of what may be associated with dementia
Score of 2 or less
The mini-cog has a sensitivity of _____% and a specificity of ______% for detecting probable dementia
87; 85
What does MMSE stand for
Mini mental state examination
A score of __________ may be associated its dementia on the MMSE
20 or less
An alteration in mental status resulting from a blow to the head, face, or neck, or a penetrating injury
Traumatic brain injury
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
Concussion
A mood disorder in which feelings of sadness, loss, anger, or frustration interfere with everyday life for an extended period (weeks or longer)
Depression
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
Moderate to severe brain injury
A persistently elevated, expansive, euphoric, or irritable and agitated mood lasting longer than a week; one phase of the bipolar psychiatric disorder
Mania
While the cause is unknown, abnormalities are found in neuroendocrine pathways that result in aberrant regulation of one or more amine neurotransmitter systems
Mania
A genetic autosomal dominance inheritance with variable penetrance is possible
Mania
A group of disorders with such marked anxiety or fear that it causes significant interference with personal, social, and occupational functioning
Anxiety disorders
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
Anxiety disorders
5 anxiety disorders
- Panic attacks
- Generalized anxiety disorder
- Specific phobias
- OCD
- PTSD
A severe, persistent, psychotic syndrome with impaired reality that relapses throughout life
Schizophrenia
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
Schizophrenia
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
Schizophrenia
A developmental, cognitive, or intellectual deficit that begins before 18 years of age, with accompanying deficits in adaptive behavior, academic performance, and adaptive functioning
Intellectual disability
A neurobehavioral problem of impaired attention and hyperactive Behavior affecting 5% to 6% of children worldwide
ADHD
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
ADHD
The onset of ADHD is typically before _______ years old
7
Is Autism more prevalent in boys or girls?
Boys
A pervasive neurodevelopmental disorder of unknown etiology
Autism
autistic disorder, Asperger syndrome, pervasive developmental disorder not otherwise specified [PDD-NOS] are all examples of
Autism
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
Autism
Impaired cognition, arousal, consciousness, mood and behavioral dysfunction of acute onset
Delirium
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
Delirium
A chronic, slowly progressive disorder of failing memory, cognitive impairment, behavioral abnormalities, and personality changes that often begins after age 60 years.
Dementia
accumulation of amyloid plaques and
neurofibrillary tangles, deteriorating synapses, and neuron death
Most common cause of dementia of Alzheimer’s type
Presence of e4 allele gene for apolipoprotein E is present in 60% of affected persons
Dementia of Alzheimer Type
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)
Vascular Dementia
Associated with diffuse Lewy bodies in the brain,
Parkinson disease, and frontal lobe degeneration
Other dementias
an observation made that suggests a condition is not present when it actually is present
False negative
process of merging knowledge of the patient from interview and physical assessment, clinical experience, and current best evidence to determine patient care.
Clinical reasoning
the proportion of persons with an expected observation who ultimately prove not to have the expected condition
Negative predictive value
the ability of an observation to identify correctly those who have a disease.
Sensitivity
the likelihood of a diagnosis being related to the findings depends on the probability of those findings being associated with that diagnosis
Bayes Formula
an expected observation that is not found when the disease characterized by that observation is not present
True negative
a system that incorporates the best available scientific evidence to clinical decision making in the care of the individual patient
EBP
a process involving progress through a series of stages.
Behavior change
an expected observation that is found when the disease characterized by that observation is present
True positive
a principle stating that all findings should be unified into one diagnosis; this is not always true.
Occam’s razor
the ability of an observation to identify correctly those who do not have the disease
Specificity
an observation made that suggests a condition is present when it is not
False positive
The proportion of persons with an observation characteristic of a disease who actually have it.
Positive predictive value
self determination; the right to choose between alternatives
Autonomy
do no harm to the patient
Nonmaleficence
Body systems that may be involved in: Chest Pain
CV, respiratory, musculoskeletal
Body systems that may be involved in: Headaches
Neuro, CV, Visual, auditory
Body systems that may be involved in: abdominal pain
CV, GI, GU
Body systems that may be involved in: pain in the legs
Musculoskeletal, Neuro, integumentary, CV
What concept is utilized in this scenario: The examiner notes a positive Chvostek sign in the absence of hypocalcemia
False positive
What Concept is used in this scenario: The patient does not demonstrate tenderness at the McBurney point and does not have appendicitis.
True negative
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.
Negative predictive value
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.
Bayes Formula
What concept is used in this scenario: A patient with cholecystitis has a positive Murphy sign.
True positive
What concept is used in this scenario: The examiner notes normal findings in a patient with prostate cancer.
False negative
What concept is used in this scenario: With acute myocardial infarction, 90% of patients demonstrate diaphoresis.
Positive predictive value
What is the first step in clinical reasoning?
Assessing the value and significance of information
obtained from the patient
What is the foundation of clinical reasoning?
Problem list
After an examiner has identified and confirmed a problem,
the next step is to
Determine the management plan
What does Bayes Theorem describe?
the likelihood of your diagnosis being related to your
findings
Unless a life-threatening situation exists, the best guide to
determining the priority for the patient’s condition should be based on
Probability and utility
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
D
Laboratory tests should be used to
Confirm a presumes diagnosis
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?
Preparation
EBP is defined as
a system bringing to bear the best available scientific
evidence to clinical decision making
a format for recording health history and physical examination findings by documenting the problem assessment process.
Problem oriented medial record (POMR)
scenario in which a patient seeks care for an acute problem, which is usually rapidly resolved.
Episodic illness visit
onset, location, duration, character, aggravating factors, relieving factors, temporal factors, and severity of symptoms.
OLDCARTS mnemonic
dependability of information, that is, accuracy, consistency, and reliability of information content.
Information integrity
a brief description of the patient’s main reason for seeking care, stated verbatim in quotation marks
Chief concern
part of the medical record that includes cultural background, birthplace, education, family, marital status, general life satisfaction, hobbies, sources of stress, and religious practices
Personal and social history
a list of
interventions divided into three categories—diagnosis, treatment, and patient education—based on each problem in the problem list
Plan
record that must include all data collected, both positive and negative, that contribute to the examiner’s assessment
Comprehensive health history and physical examination
information about general health over the patient’s lifetime as well as disabilities and functional limitations as the patient perceives them.
Past medical history
a detailed description of all symptoms that may be related to the chief concern; describes the concern for problem chronologically, dating events, and symptoms.
History or present illness
a pedigree with at least three generations and information about major health or genetic disorders.
Family history
a running log of problem number, date of onset, description of problem, and date the problem was resolved
Problem list
____________ data are collected during the history and are based on patient reports.
Subjective
A brief description of the patient’s main reason for seeking healthcare is referred to as the _____________.
Chief concern
_____________ is a format used to document health history notes, especially for care beyond the initial evaluation.
SOAP
The use of stick people to document findings is an example of using a(n) _____________.
Illustration
_____________ data are collected while conducting the physical examination.
Objective
_____________ is the use of recorded numbers to represent findings by variable degrees.
Incremental grading
_____________ is a widely accepted medical record format consisting of six components.
Problem oriented medical record (POMR)
_____________ is the part of the record where information from a patient interview is recorded.
Health history
Clinical findings are recorded during the _____________.
Physical examination
How are “normal findings” best documented?
Document what was actually assessed in specific terms
One way that a health history for an infant differs from that of an adult is the inclusion of
Prenatal history
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
The chart is a legal document
The examiner can substantially reduce the possibility of legal problems by
Maintaining clear medical records
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
Character
faster than normal respiratory rate
Tachypnea
the fever response triggered by prostaglandins.
Pyrexia
the force of the blood against the wall of an artery as the ventricles of the heart contract and relax
Blood pressure
tool for scoring pain behaviors in non-communicative older adults with dementia
PAINAD
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.
Neuropathic pain
this assessment is most commonly performed by oral, rectal, axillary, tympanic, or forehead routes.
Temperature
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.
Complex regional pain syndrome
palpated over an artery close to the body surface that lies over bones
Pulse rate
turbulence of blood flow in the artery.
Korotkoff sounds
assessed by inspecting the rise and fall of the chest; the expected adult rate is 12 to 20 breaths/min.
Respiratory rate
a pain scale for children using a scale of 0 to 5.
Wong baker faces rating scale
rapid contraction and relaxation of the skeletal muscles.
Shivering
the difference between the systolic and diastolic pressures.
Pulse pressure
What is an important consideration when assessing pain in a 32-year-old postoperative patient?
Previous experiences with pain will influence both pain perception and interpretation.
When obtaining a patient’s blood pressure, how can the
examiner protect against an incorrect reading because of the auscultatory gap?
Palpate the systolic pressure prior to taking the blood
pressure with a stethoscope
What term is commonly used by a child expressing pain
Hurt
At about what age is a child able to respond to a pediatric pain scale?
3 years old
The CRIES scale would appropriately be used when assessing what type of patient?
A 2 month old postoperative infant
When you are completing an assessment on a patient with pain, it is important to
learn the patient’s customary terminology.
The gold standard in pain assessment is the patient’s
Perception of his or her own pain
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
Nerve
On what basis does an examiner determine the correct size of a BP cuff for an adult
Relationship between cuff bladder size and limb size
How is a BP reading affected if an adult cuff is used on a
small child?
BP reading will be falsely low
Assessment using the PAINAD tool should be done during…
some patient activity, such as turning or transferring, is in progress
The expected respiratory rate for children age 6 years old is between
16 to 22 breaths/min
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
82 BPM
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
Anxiety
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
When checking a patient’s respiratory rate, which guideline should the examiner follow?
Keep the patient unaware that RR is being counted
What is the best method for checking the patient’s pulse?
Count for 30 seconds and multiply by 2
Which is the effect of a too-loose cuff on blood pressure measurement?
Inaccurate diastolic reading
Which blood pressure change occurring when a patient goes from a sitting to a standing position is indicative of orthostatic hypertension
Systolic BP drop greater than 20 mm Hg and a diastolic drop of 10 mm Hg.
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
Insults
clear, logical flow of ideas, intentions, and perceptions.
Coherence
area of the temporal lobe that permits comprehension of spoken and written language
Wernicke
the inability to translate an intention into action that is unrelated to paralysis or lack of comprehension; may indicate a cerebral disorder.
Apraxia
a disorder of voice volume, quality, or pitch
Dysphoria
an emotional response or feeling
Affect
a scale used to assess the function of the cerebral cortex and brainstem and to quantify consciousness.
GCS
area associated with speech formation.
Broca
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.
Aphasia
The ability to reason
Judgement
pertaining to mental processes of memory, judgment, and reasoning; cognitive impairment is characterized by a loss of memory, confusion, and inappropriate affect.
Cognitive
a motor speech disorder defect associated with many conditions of the nervous system such as stroke, inebriation, cerebral palsy, and Parkinson disease.
Dysarthria
capacity of the mind to understand; demonstrated by an ability to follow simple instructions
Comprehension
a sensory experience not due to external stimulus
Hallucinations
Feelings of helplessness
Depression
Feeling of Apprehension
Anxiety
Excessive happiness
Euphoria
Rapid shift of emotions
Mood lability
Lack of emotional response
Flat affect
Annoyed response to stimulus
Irritability
A patient’s inability to follow simple instructions could indicate what finding?
Depression
A patient scores a 3 on the Mini-Cog Assessment Instrument for Dementia. What does this score indicate?
Negative screen for dementia
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?
Analogy
Which type of assessment should be used to evaluate the mental status of a patient with head trauma?
GCS
A patient who has difficulty writing or drawing is most likely to have which condition?
Peripheral neuropathy
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?
Autistic disorder
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
C
Two ways the body generates heat:
Shivering and vasoconstriction
What does the O in OLDCARTS stand for
Onset
What does the L in OLDCARTS stand for
Location
What does the D in OLDCARTS stand for
Duration
What does the C in OLDCARTS stand for
Character
What does the A in OLDCARTS stand for
Aggravating and associated factors
What does the R in OLDCARTS stand for
Relieving factors
What does the T in OLDCARTS stand for
Temporal factors
What does the S in OLDCARTS stand for
Severity of symptoms
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
D
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
B
Differential diagnoses belong in the: A. Plan B. History C. Physical Examination D. Assessment
D
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
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
B
The primary muscles of inspiration are A. Diaphragm and intercostal B. Internal intercostal C. Ribs and sternum D. External intercostal
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
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
Assessing orientation to person, place, and time helps determine: A. Abstract reasoning B. Attention span C. State of consciousness D. Ability to understand analogies
C
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
C
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
