PCM Flashcards
name the part of medicare: hospital care, limited nursing home & inpatient rehab & hospice
PartA
name the part of medicare: outpatient care, medical equipment & ancillary services
medicare part B
name this part of medicare: medicare advantage plans, administered through private insurance companies
medicare part C
name this part of medicare: prescription meds, doughnut hole
part D
the ACA requires employers with greater than ______ employees to provide health insurance
50
proportion of pts with the dz who have a finding divided by proportion of pts without the dz who have the finding
positive LR
proportion of pts with the dz lacking a finding divided by proportion of pts without the dz also lacking the finding
negative LR
what are 4 clinical findings of hepatocellular jaundice that have a high LR+?
- dilated abdominal veins (LR+ 17.5)
- palmar erythema (LR+9.8)
- spider angiomas (+LR 4.7)
- ascites
can physicians accurately estimate the liver span?
clinical assessment of liver span almost always underestimates the actual value
Pathologically speaking, what are the 3 causes of ascites?
- elevated hydrostatic pressure
- decreased osmotic pressure
- fluid production exceeding resorptive capacity
A complete evaluation for ascites includes what 2 components?
- history
2. physical exam
what should be included in the history when evaluating ascites?
recent ankle edema, weight gain, or change in abdominal girth
Other: hx of liver dz or CHF
a focused PE for ascites includes what 4 components?
- inspection for bulging flanks
- percussion for flank dullness
- a test for shifting dullness
- a test for a fluid wave
ascites is unlikely when pts report no _____________ and is very unlikely in male pts who report no history of recent __________________
abdominal girth, ankle swelling
how much fluid do you have to have in the peritoneum to detect shifting dullness?
500-1100 mL
how could you get a false positive result for shifting dullness?
it can happen with accumulation of fluid w/i loops of the colon (e.g. diarrheal illness)
which finding has a high LR for splenomegaly?
detecting enlarged spleen (in other words if you can palpate the spleen it is most likely enlarged)
what are some causes of splenomegaly (4)?
- hepatic dz (hepatomegaly)
- hematologic disorders (LAD, massive)
- infectious dz
- primary splenic disorders
A finding of palpable spleen detecting ________ in returning travelers with fever has a very high LR+
malaria
what is the gold standard test for ascites?
ultrasound
What are the purposes of gastric acid?
- provide right environement for activation of proteolytic enzymes
- solubilizes divalent minerals in the diet
- prevent conversion of nitrates into nitrites
- release vitamin B12 from protein binding, for attachment to IF& later absorption
bacterial fermentation of carbohydrate breakdown by colonic bacteria result in what 3 products?
acetic, propionic, butyric acid
BMI of 25-29.9 is considered what?
overweight
BMI of 30-34.9 is considered what?
obese
severely obese pts are in what range for BMI?
35.0-40.0
morbidly obese pts have what kind of BMI?
BMI over 40.0
Name this model: individ. health behaviors occur w/i multilayered context encompassing interpersonal relationship w/i a community. Significant racial & ethnic disparities in terms of obesity are seen in the US today.
social ecological model
which 2 races are more likely to be overweight or obese?
blacks & hispanics
describe the 6 parts of the cycle of violence in domestic abuse?
abuse–>guilt–>excuses–>normal behavior–>fantasy–>set-up
what are some signs suggestive of child abuse?
cigarette burns stocking glove burns multi skull fractures rib fractures cerebral edema & retinal hemorrhages (suggest violent shaking)
what provides diagnosis for appendecitis?
CT & clinical exam
what are the findings of appendicitis that have high +LRs?
guarding, rebound tenderness, WBCs >17,000
how do you diagnose biliary colic?
ultrasound
