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Diagnostics > Test 1 > Flashcards

Test 1 Flashcards

1
Q

Gastroenteritis

A

Assess: History of illness, physical exam

  • duration of symptoms, blood in stool? Cdiff sample or stool culture
  • check electrolytes
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2
Q

GERD

A

Assessment: patients often complain of sour taste in mouth, rule out cardiac problems

-educate on aggravating factors

  • if treatment ineffective, may need endoscopy with biopsy
  • watch for Barrett esophagus which is precursor to cancer
  • h.pylori is not helpful in dx or tx
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3
Q

Appendicitis Signs

A

1) rebound tenderness
2) heal tap
3) psoas
4) obturator
5) rovsings
6) cutaneous hyperesthesia

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4
Q

heal tap

A

raise heal 10-20% and hit the heal firmly with the palm of the hand

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5
Q

psoas sign

A

place hand above the patients right knee and have them raise it

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6
Q

Obturator Sign

A

flex the patients right thigh at the hip, with the knee bent, and rotate the leg internal at the hip

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7
Q

rovsing sign

A

pain in the RLQ during left sided pressure

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8
Q

cutaneous hyperesthesia

A

pick up folds of the skin on the abdominal wall

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9
Q

sign of cholecystitis

A

Murphy sign = take a deep breath; pain when pressing in RUQ

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10
Q

Appendicitis

A

-Most common 5-50 years old

Tests

  • elevated WBC (>20,000 = perforation)
  • UA - hematuria and pyuria
  • Pregnancy test and US (rule out ectopic pregnancy)
  • CT scan ***
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11
Q

Cholecystitis

A

GALLSTONES

lab tests

  • WBC elevated (12-20,000)
  • Alk.Phos, AST, ALT, bilirubin elevated
  • GGT can be elevated if bile duct obstructed

imaging

  • US (most sensitive and specific)
  • HIDA scan
  • ERCP
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12
Q

Crohn’s Disease

A

15-25 years old

DX = colonoscopy with biopsy
-mostly small intestine but can occur anywhere

labs

  • Antiglycan antibody - elevated in 75%
  • sed rates and c-reactive proteins elevated due to inflammation
  • CBC for anemia

IMAGING
Barium X-rays and enema

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13
Q

Ulcerative Colitis

A

15-40 years old

DX = colonoscopy or sigmoidoscopy with biopsy
-mostly in large intestine and rectum

tests

  • pANCA antibodies elevated in 85%
  • barium enema
  • CBC for anemia
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14
Q

Diverticulitis

A

assess = abdominal, pelvis, and rectal exam

  • most common exam = ABDOMINAL CT
  • Colonoscopy is not necessary with uncomplicated diverticulitis, but may do 4-6 weeks after resolution
  • may check: CBC (anemia), WBC (infection), and CMP (electrolytes)
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15
Q

Pancreatitis

A

Send to ER quickly

Diagnostics (2 of 3)

1) abdominal pain
2) CT scan
3) serum lipase and amylase (greater than 3x normal, but etoh pt may not produce these enzymes anymore)

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16
Q

Pyloric Stenosis

A

onset from 3-4 weeks to 5 months old

baby who is dehydrated from projectile vomiting

-obtain ultrasound and upper GI series (thin elongated pyloric canal, called “string sign”)

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17
Q

Hirschsprung’s Disease

A

dilated bowels causing lack of motility in those areas

obtain:

  • cbc
  • abdominal xrays (dilated loops of bowel)
  • biopsy (absence of ganglion cells)
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18
Q

Intussusception

A

Bowel goes into itself- “jelly stools”

GOLD STANDARD: barium enema (will see “coiled springs”, may reduce the intussception

  • abdominal xray (rule out perforation before obtaining a barium enema)
  • stool occult blood
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19
Q

Patient presents with HIGH TSH, and LOW T3, T4 levels- the patient has….

A

Hypothyroid

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20
Q

Patient presents with LOW TSH, and HIGH T3, T4 levels- the patient has….

A

Hyperthyroid

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21
Q

Hypothyroid Symptoms

A
  • Fatigue
  • Dry skin, hair loss, brittle nails
  • cold intolerant
  • weight gain
  • memory loss
  • delayed deep tendon reflex
  • edema
  • depression
  • bradycardia
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22
Q

Hyperthyroid Symptoms

A
  • Nervousness
  • exopthalmos (protruding eyes)
  • heat intolerant, sweaty
  • weight loss
  • tachycardia
  • tremors
  • accelerated growth in children
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23
Q

Testing for thyroid

A

Hypothyroid = test every 6-8 weeks until normal. Check TSH, T3, T4

Hyperthyroid = Check TSH and T4, check CBC and liver function. Assess growth and development in children

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24
Q

Type 1 DM

A

DX ages 8-12 but can occur 30’s and 40’s

polydipsia, polyphasic, polyuria

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25
Q

Type 2 DM

A

DX adults but increases to all ages

3 P’s, chronic skin infections, vision changes, and yeast infections in women

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26
Q

A1C

A

diabetes = > or equal to 6.5%

prediabetes = 5.7-6.4%

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27
Q

Diabetes Diagnosis- Fasting plasma glucose levels

A

Diabetes = > or equal to 126

Prediabetes = 100-125

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28
Q

2hr oral glucose tolerance testing (OGTT)

A

diabetes = > or equal to 200

prediabetes = 140-199

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29
Q

random glucose

A

diabetes = > 200

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30
Q

screening for diabetes

A

begin at age 45 and performed every 3 years.

fasting plasma glucose (FPG) is recommended as the screening test

31
Q

Adrenal Insufficiency or Addison’s

A

Most often autoimmune, but can occur after DC long term steroid treatment

average 30-50 years

SX: fatigue, weak, cold intolerant, hypotension

Labs: low sodium, high potassium, low glucose

DX: ACTH. morning cortisol <165 = adrenal insufficiency

32
Q

Cushing’s

A

Too much glucocorticoid from excess production of ACTH

SX: truncal obesity, buffalo hump, amenorrhea, moon face, hypertension

Late night salivary cortisol or 24hr free urinary free cortisol (elevated = positive)

33
Q

Two types of decision making

A

1) pattern recognition

2) probabilistic

34
Q

Thresholds of Probability

A

1) Test Threshold - when probability of the disease is low, you do not treat or test
2) Treatment Threshold - when probability of disease is high, you treat empirically
3) Diagnostic Tests - when probability of disease is in the middle between the two, further testing needs to occur, send more tests

35
Q

Sensitivity

A

SNOUT

negative test result rules out having the disease- fewer false negatives.

correctly identifies people who have the disease

true positive

90% sensitivity test - 90% of those who are tested are positively identified, and 10% have negative test but are actually positive

36
Q

Specificity

A

SPIN

positive test results rules in having the disease, fewer false positives

correctly identifies people who do not have the disease

true negative

90% specificity test - 90% of those who are tested and test negative are correctly identified, 10% chance of false positive

37
Q

screening test

A

ID a disease in a healthy person

38
Q

diagnosis testing

A

testing for a diagnosis in someone with symptoms

39
Q

CLIA

A

Clinical Laboratory Improvement Amendments

40
Q

Tests that are waived under CLIA

A 
UA - dipstick
Urine - pregnancy
Blood Glucose Monitor
Hemoglobin
Blood Count
Blood Chemistry
41
Q

PPM

A

Provider-performed microscopy procedures

42
Q

Examples of PPMs

A 
Wet mounts
KOH preparations
Pinworm examinations
FERN tests
UA
Semen Analysis
43
Q

When should Pap smears begin?

A

21 years old

44
Q

Womens Health routine exams- what data should be collected

A
  • ht, wt, bmi

- vs, blood pressure (every 1-2 years)

45
Q

When should colonoscopy’s begin

A

50 years unless family history

45 years (ACS)

rectal exam for occult blood

46
Q

when to get Dexa Scan?

A

under 65 years for postmenopausal women with risk factors

over 65 years and older as needed

47
Q

how often should cholesterol be tested

A

every 4-6 years in adulthood (>21)

48
Q

how often should blood glucose be tested

A

peds: over age 10 if family hx DM2

adults:
18-44 if overweight and RF
45 if overweight

49
Q

how often should test for STI

A

1) if sexually active

2) 24 years old

50
Q

How often should Pap smears be performed?

A

21-29: every 3 years
30-65: every 3 years with HPV testing every 5 years

after 65 can stop if no abnormal paps in history and 3 negative HPV co-testing

51
Q

How often should Clinical Breast exams occur

A

annually for women age 19 and older

52
Q

Mammograms and how often for screening

A

Start: age 40 and every 1-2 years

screening until at least 75

family history and risk factors can start 10 years earlier

53
Q

Pregnancy tests

A

Urine Qualitative: highly sensitive at 10 days post-conception

Serum Qualitative hCG: positive or negative. if positive, continues to rise in first trimester

Serum QUANtitative hCG: continues to rise through first trimester. Testing levels can help with diagnosis of miscarriage

54
Q

KOH Prep

A

10% potassium hydroxide

“whiff” test: fishy odor indicates BV

after 5 mins: examine for yeast, KOH will kill every other element except yeast because its fungal

55
Q

RBCs on Wet Prep

A

typically not seen unless bleeding

round with donut depression

56
Q

WBCs on Wet Prep

A

Very few should be seen

present in infectious or inflammatory disorder

lots of WBCs- suspicious for chlamydia or gonorhhea

57
Q

pH of vagina

A

<4.5, very acidic

lactobacilli are normal

58
Q

Vaginitis differentiation: BV

A

presentation: odor, discharge, itchy
discharge: thin, milky white, foul fishy smell

pH: >4.5,

KOH whiff: positive

Wet Mount: Clue cell (scrambled eggs with pepper), few WBC

59
Q

Vaginitis differentiation: Yeast

A

presentation: itchy, dysuria, discomfort, thick discharge
discharge: “cottage cheese”

clinical findings: inflammed and swollen

vaginal pH: <4.5

wet mount: few WBCs, pseudohyphae and yeast buds

60
Q

Vaginitis differentiation: Trichomoniasis

A

presentation: itch, discharge, 50% asymptomatic

vaginal discharge: frothy, grey-green, malodorous

clinical findings: strawberry red cervix with petechiae

pH: > 4.5

whiff test: often positive

wet mount: motile flagellated (pulsate) protozoa, many WBCs

there is point of care testing for trichomoniasis but expensive

61
Q

BPH

A

symptoms: frequency, urgency, dribbling, nocturne, retention

firm, smooth, symmetrical enlarged prostate

diagnosis:
BPH self-administer tool for BPH diagnosis, DRE, PSA, urinalysis, US

62
Q

Prostate Cancer

A

most common after age 60

ASSESSMENT: may be asymptomatic, prostate feels hard (nodules) upon DRE, pt may be anemic

diagnosis:
-DRE, prostate ultrasound, PSA can be normal or elevate (>10 refer to urologist)

African American and family history are RF

63
Q

Acute Prostatitis

A

incidence = 30-50 year old, very sexually active

Assessment= high suspicion for STD’s- abrupt onset- fevers, chills, malaise, enlarged tender prostate and pain on urination, ejaculation, and defication

Diagnosis = STI testing -culture and sensitivity of expressed prostate secretions,

UA (WBC present), fractional urine exam, urine culture

**don’t check PSA because will be elevated from infection, so wait 4 weeks after treated

64
Q

Chronic Prostatitis

A

Incidence = after 50 years old

Assessment = asymptomatic or mild tenderness with enlargement. Dysuria, hematuria

Diagnosis = same as acute, test expressed prostate secretions and urine for culture and sensitivity

UA (WBC, RBCs), fractional urine exam

CT TO CONSIDER FOR CANCER

65
Q

Cryptorchidism

A

Common in premature infants

Assessment = absence of one or both testes on palpation (assess not laying down)

Diagnosis = Ultrasound to identify the location and presence of testes

  • refer to urologist if they haven’t descended by 4 months
  • increased lifelong consequence of testicular cancer (20-60% risk)
66
Q

Epididymitis

A

Incidence = <35 years old, sexually active

Assessment = very tender epididymis (posterior testes), and enlarged and hardened (induration).

-Decreased pain when testes are lifted/elevated

Diagnostics = Look for STI’s (Urine, urethral, discharge culture and testing for gonorrhea and chlamydia), Syphilis serology, HIV screen

Doppler US of scrotum, UA

67
Q

Testicular Torsion

A

Incidence = peak at age 14, puberty

Assessment = sudden, severe UNILATERAL pain. Scrotal edema and mass that appears to retracted up. Absent cremasteric reflex. Nausea, vomiting, lower abdominal pain

Diagnostics = send immediately to ER, emergency and doppler ultrasound needed

68
Q

Hydocele

A

Collection of peritoneal fluid in scrotum in infants.

painless, large scrotum - resolves on own

Diagnose = scrotal US

69
Q

Spermatocele

A

Mass in scrotum along spermatic cord containing sperm.

Assess: freely moveable and painless, easily transilluminated

Diagnosis = scrotal US, urologist if bothersome

70
Q

Varicocele

A

Collection of abnormally large dilated veins in scrotum (“bag of worms”) in older adolescents

Assess = Often Left scrotum that resembles a bag of worms (if occurs in right could be a cancer risk)

Diagnosis - doppler US, sperm count (infertility issues)

71
Q

Testicular Cancer

A

Incidence 15-35 years old

Assess = solid firm, contender testicular mass, sensation of heaviness and fullness in scrotum. MASS DOES NOT TRANSILLUMINATE

Diagnosis = Gold standard (SCROTAL US), test tumor markers, refer to urologist

Abdominal and chest CT for metastasis, biopsy

72
Q

Inguinal Hernia

A

80% of hernias

indirect - 3-5% kids. more common
direct = adults

assessment = heaviness in group, scrotum increases with size when standing or straining - strangulated hernia is a medical emergency

DX = US, refer to surgeon

73
Q

Erectile Dysfunction

A

Higher incidence in men who are being treated for hypertension

if the patient is young, you want to investigate further

Diagnose = CBC, Hormone levels, fasting blood sugar, TSH, digital rectal exam

refer to urologist, surgeon, neurologist etc

Diagnostics (4 decks)

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