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Health Assessment > Test 1 > Flashcards

Test 1 Flashcards

1
Q

Diagnostic Process order

A

1) Identify the problem
2) Frame the differential diagnosis in a way that facilitates recall
3) Organize differential diagnosis
4) limit the differentials by using pivotal points to create a pt specific differential
5) Explore pt specific differentials - using history and physical exam findings
6) Rank the differentials using results of exploration
- select leading differential
- select must not miss
- select additional alternatives
7) Test
8) re-rank
9) Test

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2
Q

What is the most precise way of estimating pretest probability.

A

CDRs ( clinical decision rule )

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3
Q

which system reasoning is used based on memory

A

System 1

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4
Q

Which system reasoning is a more analytical approach

A

System 2

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5
Q

How should problem lists be organized?

A

Acute problems
chronic active problems
ending with inactive problems.

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6
Q

What are the components used for assessing pretest probability

A

use a validated clinical decision rule (CDR)

use prevalence data regarding the causes/etiologies of a symptom

use your overall clinical impression

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7
Q

probability above which the diagnosis is so likely you would treat the patient without further testing

A

treatment threshold

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8
Q

the probability below which the diagnosis is so unlikely it is excluded without further testing

A

test threshold

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9
Q

the probability of disease after the test is done

A

posttest probability

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10
Q

How likely can we “rule this in”

A

Sensitivity

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11
Q

the higher a sensitivity is (and the more symptoms/findings usually), the more likely we can

A

“rule in” a disease.

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12
Q

“rule this out”

A

Specificity

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13
Q

USPSTF levels of certainty regarding net benefit

A

net benefit = benefit – harm as implemented in a primary care population

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14
Q

Consistent results from well-designed studies in representative primary care populations that assess the effects of the preventive service on health outcomes; it is unlikely that these conclusions will change based on future studies.

A

USPSTF levels of certainty - High

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15
Q

Evidence sufficient to determine the effects of the preventive service on health outcomes, but methodologic issues such as limited generalizability, inconsistent findings, or inadequate size or number of studies exist; these conclusions could change based on future studies.

A

USPSTF levels of certainty - Moderate

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16
Q

Insufficient evidence to assess effects on health outcomes, due to limited number or size of studies, flaws in study designs, inconsistency of findings, lack of generalizability.

A

USPSTF levels of certainty - Low

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17
Q

The USPSTF recommends this service. There is high certainty that the net benefit is substantial.

A

Grades of recommendations - Grade A

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18
Q

The USPSTF recommends this service. There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial

A

Grades of recommendations - Grade B

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19
Q

The USPSTF recommends selectively offering or providing this service to individual patients based on professional judgment and patient preferences. There is at least moderate certainty that the net benefit is small.

A

Grades of recommendations - Grade C

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20
Q

The USPSTF recommends against the service. There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.

A

Grades of recommendations - Grade D

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21
Q

The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the service. Evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined.

A

Grades of recommendations - Grade I statement

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22
Q

higher the specificity is, the more likely we can

A

“rule out” a disease

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23
Q

OLDCARTS

A 
onset
location
duration
character
aggravating or associated factors
relieving factors
temporal factors
severity
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24
Q

are the physiological links, predisposing factors, and complications for this disease present in the patient?

A

coherence

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25
Q

Does the suspected disease encompass all of the patients normal and abnormal findings?

A

Adequacy

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26
Q

Is it the simplest explanation of the patients findings?

crucial step bc patients must find the treatment recommendations acceptable

A

Parsimony

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27
Q

is the diagnosis confirmed by a radiographic or lab tests?

A

Diagnostic probability

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28
Q

rules of thumb that guide the inductive or inferential process of diagnostic reasoning. Generally accurate and useful rules to make the task of information gathering more manageable.

A

Heuristics

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29
Q

“Are the physiological links, predisposing factors, and complications for this process present in the patient?”

(All the things present in the disease, does the patient have symptoms?)

A

Coherence

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30
Q

“Does the suspected disease encompass all of the patient’s normal and abnormal findings?”

(Symptoms patients have…does this match the disease?)

A

Adequacy

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31
Q

when the practitioner suspects a cause of symptoms based on previous clinical knowledge, practitioner gathers relevant information at a quicker speed

A

Diagnostic reasoning:

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32
Q

form of reasoning acknowledging that there are many variables (environmental & social) present in an actual clinical situation

A

Clinical reasoning

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33
Q

PICO

A

Problem
Intervention/exposure
Comparison
Outcome

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34
Q

ratio of risk in the experimental group compared with the risk in the control group

A

RElative Risk

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35
Q

Is the difference between groups large enough to be worth achieving

A

Clinical versus statistical significance

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36
Q

odds of previous exposure in a case divided by the odds of exposure in a control patient

A

Odds ratio

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37
Q

Measure of the precision of results

A

Confidence Intervals (CIs)

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38
Q

in Confidence intervals the wider the CIs indicate a ____ _____

A

lower precision

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39
Q

what source of evidence provides sound evidence of cause and effect and can control for bias

A

RCTS (Randomized controlled clinical trials)

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40
Q

what source of evidence examines a number of valid studies on a topic and mathematically combines the results to report them as if they were one large study

A

meta analysis

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41
Q

what source of evidence is based on clinical experience, collective experience and knowledge of professional organizations

A

Expert opinion

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42
Q

what level of prevention involves activities directed at improving general well-being while also providing specific protection for selected diseases.

A

Primary prevention

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43
Q

screening, counseling or preventive medicines such as vaccines or dental sealants is what level of prevention

A

primary

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44
Q

Common model used to guide behavioral counseling (5As)

A

Ask about the behavior
Advise about the health risks and benefits of change
Agree to set a goal
Assist with identifying and overcoming barriers
Arrange for a follow up

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45
Q

what level of prevention goal is to identify and detect disease in its earliest stages before symptoms appear

A

Secondary prevention

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46
Q

What level of prevention includes

screening interventions to identify elevated BP or risk of DM with A1C measurement

A

secondary prevention

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47
Q

What level of prevention aims to improve the quality of life for people with various conditions by limiting complications and disabilities, reducing the severity and progression of disease and providing rehab therapy to maximize functionality and self-sufficiency.

A

Tertiary prevention

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48
Q

What level of prevention includes

optimizing treatment for chronic conditions such as asthma, DM, physical or cognitive disability

A

Tertiary prevention

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49
Q

what type of screening includes all members of a population

A

Population screening

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50
Q

what type of screening is more selective and focuses on a population at risk

A

Targeted screening

ie) STI screening in sexually active adolescents and young adults in a specific age groups

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51
Q

Name that Bias

Considering easily remembered diagnoses more likely irrespective of prevalence

A

Availability

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52
Q

Name that Bias

Pursuing Zebras

A

Base Rate Neglect

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53
Q

Name that Bias

Ignoring atypical features that are inconsistent with the favored diagnosis

A

Representativeness

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54
Q

Name that Bias

Seeking data to confirm, rather than refute the initial hypothesis

A

Confirmation Bias

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55
Q

Name that Bias

Stopping the diagnostic process too soon

A

Premature closure

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56
Q

What does the term Pursuing zebras mean

A

People ignore base rate (what is more likely) in favor of given individual information (the way someone appears)

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57
Q

Pt comes in with cough 1-3 weeks
myalgias
low grade fevers
what are you thinking?

A

Acute Bronchitis

R/o flu, Covid, Pneumonia, RSV

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58
Q

Etiology for Acute bronchitis

A

Viral
Bacterial (<10%)
Noninfectious

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59
Q

Impaired mentation/swallowing
elderly
intoxicated (alcoholics)
poor dentition

think…

A

Aspiration pneumonia

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60
Q 
Signs and symptoms
Fever
cough
chest pain 
Putrid Sputum
Evolved over days not acute 
Involves the basal segment of lower lobes
can also involve posterior segments of upper lobes
A

think aspiration pneumonia

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61
Q 
productive cough
crackles
higher fevers
may have chest pain
SOB
Chills
could be viral or bacterial
A

Community acquired pneumonia

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62
Q

what views for chest x ray for pneumonia

A

PA and Lat better than AP

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63
Q

What are your differentials for Acute cough and congestion

A 
Common cold
Sinusitis
bronchitis
influenza
Pertusis
Pneumonia
  -CAP
  -HAP
  -AP
  -TB
  -PJP (fungal)
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64
Q

If Pneumonia develops more than 48 hours post hospital admission

A

Hospital acquired pneumonia

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65
Q

If pt develops pneumonia more than 48 hrs post intubation

A

Ventilator acquired pneumonia

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66
Q 
abrupt onset
myalgia
diffuse pain
cough
rhinitis
pharyngitis
high fevers (peaks within 12 hours 40-41C)
Rigors
chills 
headache
A

Influenza

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67
Q

when is flu season

A

December - march

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68
Q

time line of flu

A

1-5 days (3 typical)

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69
Q

If fever is increasing gradually over several days think

A

bacterial pneumonia

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70
Q 
cough
rhinorrhea
sore throat
sneezing
but does not resolve after 3-7 days
may have posttussive emesis
A

pertussis

side note Whooping at end of cough is rare in adults

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71
Q

median duration of pertussis

A

42 days

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72
Q 
immunocompromised
diagnosed/undiagnosed HIV
Progressive SOB
Dry cough 1-3 weeks
Often before diagnosed to aids
Chest x ray shows diffuse bilat pneumonia (diffuse symmetric bilat alveolar or interstitial infiltrates
cough
Progressive dyspnea
Lung sounds may be normal
CT scan shows patchy nodular ground glass appearance
A

PJP (Pneumocystis jirovecii pneumonia)

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73
Q 
Mycobacteria in upper lobes
chronic cough, fever, weigh loss, 
night sweats
economically disadvantaged
nursing homes
drug dependent
homeless
prison inmates
weeks to months
A

TB

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74
Q

People at high risk for TB

A 
HIV
AIDS
Alcoholics
immunocompromised
Cancer
Diabetes
ESRD
Transplants
Malnutrition
TB previously on x ray
PPD+
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75
Q 
Fever
Consolidation Xray
Lower middle lobes
PPD may be negative
may resolve on its own
A

Primary TB

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76
Q

Increased risk first 2 years
decline immune fx
typical tb symptoms
progresses unless pt is tx

A

Reactivated TB

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77
Q

Associated with at least 3 of the following:

  • Easy fatigability
  • Feeling restless or on edge
  • Trouble concentrating
  • Irritability
  • Muscle tension
  • Sleep disturbance

Daily functioning and performance is affected.

Symptoms cannot be explained by another psychiatric or medical condition.

A

Generalized anxiety disorder

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78
Q

Intense fear of social situations

Lifetime prevalence: 13%, 12-month prevalence: 7.4%

A

Social Anxiety disorder

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79
Q

Episodic attacks not brought on by a specific trigger

Characterized by an abrupt surge in fear or discomfort, peaking within a few minutes, accompanied by at least 4 of the following symptoms:

  • Sweating
  • Trembling or shaking
  • Shortness of breath or feeling of smothering
  • Chest pain or discomfort
  • Feelings of choking
  • Nausea or abdominal discomfort
  • Feeling dizzy, lightheaded or faint
  • Chills or heat sensations
  • Paresthesias
  • Feeling of feeling disconnected
  • Fear of losing control
  • Fear of dying

Lifetime prevalence: 6.8%, 12-month prevalence: 2.4%

A

Panic Disorder

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80
Q

Metabolic: Decreased metabolism that can lead to weight gain, cold intolerance, and increased total and low-density lipoprotein (LDL) cholesterol (due to decreased clearance)

Cardiac: Reduction in myocardial contractility and heart rate

Skin: Nonpitting edema, due to accumulation of glycosaminoglycans; dry skin; coarse, fragile hair

Central nervous system: fatigue, delayed relaxation phase of the deep tendon reflexes

Pulmonary: hypoventilation seen with severe hypothyroidism

Gastrointestinal: reduced intestinal motility causes constipation

Reproductive: menstrual abnormalities, reduced fertility, increased risk of miscarriage

A

Hypothyroidism

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81
Q

Labs for Hypothyroidism

A

TSH and free T4

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82
Q

screening questions for Insomnia

A

Difficulty initiating sleep, staying asleep, or both?

Early awakening?

Nonrestorative sleep?

Daytime consequences? (Lack of daytime fatigue or sleepiness suggests the insomnia is not clinically significant.)

Frequency and duration?

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83
Q

follow up questions for insomnia

A

Precipitating events, progression, ameliorating or exacerbating factors?

Sleep-wake schedule?

Cognitive attitude toward sleep?

Negative expectations regarding the ability to sleep and distortions about the effects of insomnia lead to perpetuation of the insomnia.

Attitudes toward previous treatments are also important.

Psychiatric disorder present?

Substance misuse or medication use?

Medical illness with nocturnal symptoms?

Symptoms of sleep apnea, restless legs? (See discussion below.)

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84
Q

complain of daytime sleepiness or fatigue. Bed partners often note snoring or actual apneic episodes. Most patients are obese.

A

obstructive sleep apnea

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85
Q

obstructive sleep apnea is more common in what gender?

A

men

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86
Q

Is obstructive sleep apnea more common pre or post menopausal

A

post menopausal

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87
Q

what questions would you ask about fatigue for a focused history and why

A

Can you tell me what you mean by fatigue?
How old are you?
Do you notice other symptoms with feelings of fatigue?

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88
Q

what are some other things that get confused with fatigue?

A

Weakness

Frailty

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89
Q

frailty can be measured based on the presence of 5 symptoms

A 
unintentional weight loss
slow mobility
weakness
decreased reduced activities
fatigue
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90
Q

Frailty increases the risk for

A

falls

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91
Q

5 key questions to tell if fatigue is physiologic?

A 
Lifestyle habits? (exercise and diet)
Sleep pattern?
Do you require naps? how often?
Do you feel rested when you wake up in the morning?
Last menstrual period?
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92
Q

adequate amount of sleep for adults

A

6-8 hours

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93
Q

adequate amount of sleep for adolescents

A

8-9 hours

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94
Q

adequate amount of sleep for children

A

10 hours

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95
Q

sleep pattern related to depression

A

early-morning wakening and excessive sleeping during the day

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96
Q

Men over 50 with fatigue due to nocturia associated with

A

BPH

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97
Q

last normal menstrual period might tell us what about fatigue

A

early sign of pregnancy
symptom after childbirth
associated with menopause
perimenopausal adults as a r/o disrupted sleep due to hot flashes

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98
Q

what might finding out if someone practices safe sex tell us about fatigue

A

may be the initial and most prominent symptom of hepatitis, HIV, AIDS

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99
Q

What might finding out if someone takes medications have to do with fatigue

A

May be a side effect.

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100
Q

most common drugs that cause fatigue

A 
antihypertensive drugs
cardiovascular meds
psychotropic meds
opiates
sedatives
antihistamines
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101
Q

What will asking about drinking alcohol tell us about fatigue

A

Alcohol abuse and use of recreational drugs may be overlooked as a cause of chronic fatigue in adolescents and school age children.

usually alcohol or marijuana

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102
Q

useful screening tool to assess for alcohol abuse

A

CAGE questionnaire

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103
Q

what does appetite tell us about fatigue

A

increased appetite may indicate hypoglycemia or hyperglycemia
increased thirst - hyperglycemia
decreased appetite - infectious process

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104
Q

What does weight loss tell us about fatigue

A

weight loss - malignancy, infection, poor nutrition r/t depression or lack of info on a healthy diet

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105
Q

weight loss of greater than 10lbs in the past year and may be associated with other signs and symptoms

A

unintentional weight loss

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106
Q

what will joint tenderness or pain tell us about fatigue

A

In children with Juvenile RA - severe fatigue

young and middle aged patients - can involve multiple tender points on the body that are over joints

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107
Q

Increased urination and fatigue

A

Diabetes mellitus (esp type 2) often presents with fatigue along with Polydipsia, polyphagia and polyuria

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108
Q

Fatigue with specific symptoms that worsen over time such as dry skin, nails

A

Hypothyroid

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109
Q

Fatigue with shortness of breath with exertion or when laying flat

A

heart failure

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110
Q

what does fatigue have to do with where you work

A

occupational exposure - heavy metals and pesticides may cause fatigue and other neurologic symptoms

military returning from combat zones from unknown cause

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111
Q

what does fatigue have to do with if they have been camping

A

lyme disease is carried by the deer tick. They may present with weeks of malaise and chronic fatigue before any skin manifestations appear

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112
Q

fatigue that has a slow and progressive onset could be associated with ______

A

metabolic causes

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113
Q

What timeline is considered significant fatigue

A

greater than 2 weeks

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114
Q

what type of fatigue is usually worse in the morning

A

psychological fatigue

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115
Q

what will help relieve psychological fatigue

A

physical activity

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116
Q

what type of fatigue is not associated with intensity or duration of activity and is not relieved with rest or sleep

A

organic fatigue

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117
Q

why would you ask if they were a caregiver if they are having fatigue

A

Burnout

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118
Q

why would you ask if you or anyone in your family has a problem with anxiety or depression for someone with fatigue

A

children who have family members with depression are at a greater risk for depression.

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119
Q

Generally the first episode of major depression occurs between the ages of —– and effects ____-

A

20 and 30 and effects women and transgender individuals more often then men

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120
Q

cc - fatigue

fever

A

inflammation or infection

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121
Q

CC fatigue

elevated HR

A

anxiety
anemia
dehydration
hyperthyroidism

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122
Q

CC fatigue

abnormal BMI

A

poor nutritional status

cardiovascular risk

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123
Q

cc fatigue
coarse, dry hair and skin
thickening of nails

A

hypothyroidism

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124
Q

cc fatigue
fine, limp hair
warm skin

A

hyperthyroidsim

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125
Q

cc fatigue

faint maculopapular rash

A

mononucleosis

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126
Q

CC fatigue

macular lesion with a clear center

A

lyme disease

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127
Q

cc fatigue

atrophic skin of the lower extremities

A

arterial insufficiency and underlying areriovascular disease

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128
Q

cc fatigue

swelling of ankles
varicose veins
skin ulcers

A

venous stasis

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129
Q

CC fatigue

evidence of nail biting
self inflicted excoriation lesions

A

Anxiety disorders

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130
Q

CC fatigue

petechiae on the palate

A

mononucleosis

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131
Q

CC fatigue

dry, cracked, ulcerated mucosa

A

nutritional deficiency or dehydration

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132
Q

CC fatigue

audible third or fourth heart sounds (S3, S4) in an adult

A

Heart failure

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133
Q

cc fatigue

increased AP diameter of the thorax

A

COPD

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134
Q

CC fatigue

Bilateral basilar rales

A

Congestive heart failure

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135
Q

Most pneumonia is on what sides

A

unilaterally

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136
Q

Barely audible breath sounds are associated with

A

COPD

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137
Q

CC fatigue

generalized symmetrical abdominal distension

A

obesity
enlarged organs
fluid (ascites)
gas

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138
Q

CC fatigue

concave contour of abdomen

A

dehydration or malnutrition

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139
Q

CC fatigue

a change in deep tendon reflexes may indicate

A

thyroid dysfunction

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140
Q

CC fatigue

diet history shows inadequate dietary intake of iron

A

Anemia

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141
Q

Pt reports cold intolerance, constipation, weight gain, hoarseness, depression, fatigue

physical exam shows bradycardia, dry skin, generalized edema, delayed recovery of deep tendon reflexes.

A

Hypothyroidism (myxedema)

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142
Q

Pt has increased sweating, heat intolerance, weight loss, irritability, disturbed sleep, menstrual irregularity.

Physical exam shows tachycardia, a-fib, tremor, warm moist skin, lid lag, exophthalmos

A

Hyperthyroidism (Graves disease)

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143
Q

What antihypertensive med is often associated with fatigue

A

B blockers

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144
Q

associated with dyspnea, orthopnea, paroxysmal nocturnal dyspnea, peripheral edema, weight gain, cough with forthy sputum, palpitations and fatigue

A

heart failure

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145
Q 
gradual onset of low grade fever
sore throat
posterior cervical lymphadenopathy
fatigue 
malaise
A

mononucleosis

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146
Q 
malaise
fatigue
flulike symptoms
abd pain
arthralgia
aversion to smoking
A

hepatitis

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147
Q

occurs most often in women 20-50
chronic pain and stiffness of trunk and extremities esp in neck, shoulders, low back and hips
fatigue, headaches, sleep disturbance, bowel irritability

A

fibromyalgia

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148
Q

severe pain lasting longer than 6 mos and associated with impaired memory or concentration
sore throat, tender cervical or axillary lymph nodes
muscle pain
multiple joint pain
new onset headaches
nonrestorative sleep
postexertional malaise

A

chronic fatigue syndrome

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149
Q

Agitation and restlessness are common manifestations of

A

depression
anxiety
substance abuse

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150
Q

agitation, hypertension, and tachycardia occurring during the first 2 days after hospital admission

A

Alcohol withdrawal

Seizures may soon follow with delusions and delirium occurring during the first 3–5 days.

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151
Q

hallucinosis usually have a clear sensorium

A

Alcoholic hallucinosis (this is a distinguishing factor setting it apart from delirium)

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152
Q

Confusion, disorientation, and autonomic hyperactivity are hallmarks

A

delirium tremens (can be fatal)

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153
Q

Wernicke encephalopathy is not an alcohol withdrawal syndrome but is caused by

A

thiamine deficiency

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154
Q

Alcohol abuse is the most common cause of ___ deficeincy

A

Thiamine

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155
Q

Wernicke encephalopathy may occur when a patient, who is thiamine deficient, receives

A

intravenous glucose

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156
Q

Symptoms include the triad of confusion, disorders of ocular movement, and ataxia. The confusion commonly manifests as disorientation and indifference.

A

Wernicke encephalopathy

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157
Q

presents with memory problems and resulting confabulation

A

Korsakoff syndrome is the chronic form of Wernicke encephalopathy.

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158
Q

Adrenergic overactivity (hypertension, tachycardia, fever) is always present unless masked by medications.

A

delirium tremens

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159
Q

Alzheimer Disease most commonly occurs after the age of

A

65

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160
Q

Memory loss, behavioral or personality change, functional impairments, and social withdrawal

A

common early symptoms of AD.

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161
Q

most-evaluated instrument for diagnostic cognitive impairment

A

MMSE (mini mental status exam)

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162
Q

fluent aphasia, paraphasia, and word substitutions

A

language disturbances associated with AD

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163
Q

Highly educated patients are more likely or less likely to receive an early diagnosis for AD

A

less likely

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164
Q

3 tests for dementia

A

MMSE (mini mental status exam)
Mini-Cog
MoCA
IQCODE

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165
Q

which mental screening exam includes 3-item recall and clock drawing

A

mini-cog

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166
Q

which mental screening exam was Initially developed and validated as a screening test for MCI (mild cognitive impairment)

A

MoCA

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167
Q

which mental screening exam is a Short form is a 16-item questionnaire.

A

IQCODE

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168
Q

Considered the clinical gold standard for diagnosing dementia

A

Neuropsychiatric testing

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169
Q

Reasons to explore for reversible dementia

A

CNS infections

Hypothyroidism

Vitamin B12 deficiency

CNS masses

Neoplasms

Subdural hematomas

Normal-pressure hydrocephalus

Medications

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170
Q

tests for dementia

A

CBC

Thyroid-stimulating hormone (TSH)

Basic metabolic panel and liver biochemical tests

Vitamin B12 level

Tests to exclude neurosyphilis

Consider neuroimaging (MRI or CT)

Imaging is not required in most patients with dementia.

In practice, most patients will undergo imaging both to assess for diagnoses other than AD and to detect brain atrophy that may support the diagnosis of AD.

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171
Q

manifests as inattention and confusion

A

Delirium

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172
Q

Several conditions are more likely to cause delirium than others.

A

Severe illness

Drug toxicity

Fluid and electrolyte disturbances (hyponatremia and azotemia)

Infections

Hypothermia or hyperthermia

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173
Q

Delirium is very common in

A

sick, hospitalized patients over the age of 65

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174
Q

The prognosis of delirium is

A

poor

patients who experienced delirium had a higher risk of death, institutionalization, and dementia during follow-up.

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175
Q

the best-validated and most widely used tool for diagnosing delirium.

A

The Confusion Assessment Method (CAM)

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176
Q

typically seen in a patient with Parkinson disease who has dementia. In patients without a previous diagnosis of Parkinson disease, motor symptoms similar to those seen in Parkinson disease are often present.

A

Dementia with Lewy Bodies (DLB)

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177
Q

screening tool for Validated for use in older adults to assist in depression diagnosis

A

PHQ-9 (Personal Health Questionaire):

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178
Q

what type of dementia - Visual hallucinations are common

A

Dementia with Lewy Bodies (DLB)

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179
Q

Mild extrapyramidal motor symptoms (rigidity and bradykinesis) are often seen early in this type of dementia

A

Dementia with Lewy Bodies (DLB)

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180
Q

Repeated falls

Syncope

Transient loss of consciousness

Neuroleptic sensitivity

Systematized delusions and hallucinations

A

Dementia with Lewy Bodies (DLB)

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181
Q

what does SOAP note include

A 
Chief Complaint (subjective)
History of Present Illness (subjective)
Family/medical/surgical histories (subjective)
Review of systems (subjective)
Physical exam (objective)
Assessment
Plan
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182
Q

most likely diagnosis based on prevalence, demographics, risk factors, signs & symptoms

A

Leading hypothesis

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183
Q

Hypothesis generating starts with

A

patient’s demographics

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184
Q

most significant factor of pt demographics

A

Age

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185
Q

problem specific framework for Frequently used for chest pain

A

anatomic

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186
Q

problem specific framework Used for problems with very broad differentials such as fatigue

A

Organ based /system based

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187
Q

PQRST

A

P(provocative, palliative) What brings it on, what makes it better
Quality - what does it feel like
Region/radiate where is it at and where does it radiate
Severity and setting - how bad is it? What were you doing at the time
Temporal - when did it start, how long does it last, have you had it before

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188
Q

what framework?

What could be happening pathologically(what diseases could) to make this symptom happen

A

organic

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189
Q

VINDICATE

A 
Vascular, 
Infection
Neoplastic
 Degenerative,
Idiopathic/Inflammatory
Congenital
Autoimmune,
Traumatic
Endocrine
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190
Q

MEDICINE

A 
Metabolic/Medication
Endocrine
Degenerative,
Infection/Ischemia/Infarction
Congenital
Neoplastic,
Electrical( Neuro/Psych)
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191
Q

VITAMINCDE

A 
Vascular
Infection/Ischemic/Infarction
Trauma/Toxin
Autoimmune
Metabolic/Medications
Iatrogenic/Idiopathic,
Neoplastic
Congenital
Degenerative
Electrical (Neuro/psych)
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192
Q

What is the order problems should be listed in a problem list

A

begin with the acute problems, followed by chronic active problems, ending with inactive problems (past medical history)

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193
Q

Organic (chronic) causes of fatigue

A

sleep apnea, medications, HF, cancer, EBV, hepatitis, fibromyalgia, chronic fatigue syndrome

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194
Q

Organic (acute) causes of fatigue

A

infection, drugs/alcohol, anemia, hypothyroidism, hyperthyroidism

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195
Q

fatigue presentation in children

A

Withdrawn from social and recreational activities → mood disturbances

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196
Q

fatigue presentation in adolescents

A

Withdrawn from social/recreational activities → mood disturbances
Decreased academic performance and decreased productivity
Recreational drug and alcohol use, high caffeine intake

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197
Q

an older patient complaining of memory loss. Common complaints are difficulty remembering names and appointments or solving complex problems

A

mild cognitive impairment

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198
Q

people have memory loss and no other deficits

A

Single domain amnestic MCI

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199
Q

people have memory loss as well as other deficits

A

Multiple domain amnestic MCI

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200
Q

people have impairment in a single, non–memory-related, cognitive domain.

A

Single domain non-amnestic MCI

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201
Q

people have impairment in multiple, non–memory-related, cognitive domain.

A

Multiple domain non-amnestic MCI

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202
Q

may be abrupt or gradual. The patient usually has risk factors for, or has previously diagnosed, vascular disease. The patient may have gait disturbance during the neurologic exam.

A

Multi-infarct Dementia (Vascular Dementia, VaD)

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203
Q

the most common cause of dementia after AD.

A

Multi-infarct Dementia (Vascular Dementia, VaD)

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204
Q

Most common in patients with risk factors for vascular disease or an embolic stroke

A

Multi-infarct Dementia (Vascular Dementia, VaD)

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205
Q

Screening tool for Multi-infarct Dementia (Vascular Dementia, VaD)

A

DSM-5 criteria

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206
Q

Exaggeration of deep tendon reflexes

Extensor plantar response

Gait abnormalities (consider history of unsteadiness and frequent, unprovoked falls)

Pseudobulbar palsy (pathologic laughing, crying, grimacing; and weakness of the muscles associated with cranial nerves V, VII, IX, X, XI, and XII)

Focal neurologic signs

A

Multi-infarct Dementia (Vascular Dementia, VaD)

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207
Q

clinically useful test for determining whether ischemic disease is playing a role in a patient’s dementia.

A

Hachinski Ischemic Score

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208
Q

cc fever

why is it important to ask about recent head trauma?

A

recent head trauma esp at base of skull may provide entrance for infectious organisms

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209
Q

cc fever

why ask about recurrent ear infections

A

may have mastoiditis spreading to meninges

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210
Q 
headache 
fever
lethargy
confusion
vomiting
stiff neck
A

meningitis

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211
Q

why is fever younger than 2 mos significant

A

neonates and young infants are less able to mount a febrile response so when they do it is significant

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212
Q

fevers in a neonate may also be an indication of an

A

underlying anatomical defect

URI and bacteremia is often the first indications of a structural abnormality of the urinary tract

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213
Q

genetic disorder that may present in the first weeks to 1 month of life with gram negative sepsis

A

galactosemia - rare genetic metabolic disorder (affects ability to metabolize the sugar (galactose) properly

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214
Q

all infants younger than 2 months with fever are considered to have ____ or ____ until proven otherwise

A

Sepsis or meningitis

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215
Q

in adults fevers from acute process usually resolves in

A

1-2 weeks

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216
Q

fevers that last > 3 weeks that exceed temp of 38.4 (101.1) and remain undiagnosed after 1 week of intensive diagnostic study are classified as

A

FUOS

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217
Q

fever in children with short duration, readily diagnosed and resolves within 1 week

A

short term fever

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218
Q

fever in children < 10 days that is not explained by findings on history or physical exam

A

fever without localizing signs

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219
Q

fever in children greater than 38.5 (101.2) that lasts longer than 2 weeks on more than 4 occasions

A

FUOs

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220
Q

Fever greater than 41.1C (106) are seen in

A

heat illness
CNS disease
infection

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221
Q

the higher the fever, the greater likelihood of

A

bacteremia

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222
Q

most common infection in girls younger than 2 years old who present with a high fever and in all infants younger than 90 days with a fever

A

UTI

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223
Q

fever

increased amount of vaginal discharge and bleeding after intercourse

A

PID

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224
Q 
chills 
high fever
urinary frequency and urgency
perineal pain
low back pain 
penile discharge
A

acute UTI in male

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225
Q

CC fever

joint pain

A

connective tissue disorder in adults and children older than 6.

osteomyelitis or septic arthritis

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226
Q

rash for hand foot mouth usually erupts on what day

A

3 days

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227
Q

rash for measles usually erupts on what day

A

4 days

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228
Q

Rash for roseola infantum usually erupts on what day

A

5 days

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229
Q

rash for scarlet fever usually erupts on what day

A

2 day

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230
Q

rash for varicella, rubella, erythema infectiosiosum usually erupts on what day

A

1

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231
Q

infections to r/o with history of travel outside the country

A 
amebiasis
malaria
schistosomiasis
typhoid fever
hepatitis A or B
Dengue
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232
Q

the most common vector borne disease worldwide and is a diff diagnosis for pt who live or have recently traveled to the tropics or subtropical areas of the US

A

Dengue

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233
Q

recent camping or exposure to wooded areas may indicate

A 
exposure to ticks
Q fever
tularemia
rocky mountain spotted fever
giardia
lyme disease
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234
Q

what overdose can cause fever

A

ASA

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235
Q

food poisoning fevers can occur up to ____ hours after ingestion of contaminated food

A

72

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236
Q

what plants can cause fever

A

plants containing the alkaloid atropine (deadly nightshade, jessamine, and thornapple)

cause dilated pupils, flushed skin and fever

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237
Q

bacterial infection transmitted by cats (changing kitty litter boxes. )

A

Cat-Scratch disease or toxoplasmosis (single node or regional adenopathy is the dominant clinical feature)

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238
Q

What is the etiologic agent of Cat Scratch disease

A

Gram neg bacillus

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239
Q

bacterial infection transmitted by dogs

A

brucellosis and leptospirosis

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240
Q

bacterial infection transmitted by rabbits

A

tularemia

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241
Q

bacterial infection transmitted by birds

A

ornithosis
histoplasmosis
psittacosis

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242
Q

bacterial infection transmitted by hamsters or cats

A

lymphocytic choriomeningitis

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243
Q

hyperthermia and change in LOC

A

classic heat stroke

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244
Q

causes of fever of unknown orgin in child

A 
infectious disease (localized and systemic)
collagen/inflammatory diseases
neoplastic diseases
drug fever
factitious fever
kawasaki disease
inflammatory bowel disease
immunodeficiency
CNS dysfunction
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245
Q

CC fever

petechial eruptions on the hard and soft palate

A

mononucleosis

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246
Q

cc fever

splinter hemorrhages found in the nail beds and petechiae of the conjunctivae

A

endocarditis

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247
Q

cc fever

petechial skin rash

A

meningococcemia
rocky mountain spotted fever
anticoagulation treatment outside of therapeutic range

indicates a serious infection that requires immediate referral and hospitalization

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248
Q

inspecting the fontanel of an infant is best noted if the patient is in what position

A

sitting

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249
Q

cc fever

palpable anterior cervical lymph nodes

A

suspect viral or bacterial pharyngitis

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250
Q

cc fever

palpable preauricular or postauricular lymph nodes

A

suspect ear infection

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251
Q

cc fever

palpable submental and submandibular lymph nodes

A

suspect tooth abscess

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252
Q

cc fever

palpable posterior cervical lymph nodes

A

suspect mononucleosis

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253
Q

cc fever

palpable supraclavicular lymph nodes

A

suspect neoplasm

254
Q

cc fever

palpable axillary lymph nodes

A

suspect breast inflammation, local infection or neoplasm

255
Q

cc fever

palpable inguinal lymph nodes

A

Suspect a STI

256
Q

cc fever

localized lymphadenopathy

A

suspect local infectious process

257
Q

cc fever

generalized lymphadenopathy

A

suspect immunosuppression such as HIV positive or neoplasm

258
Q

yellow green sputum

A

suspect bacterial infection

259
Q

brown sputum

A

check smoking history

260
Q

blood streaked sputum

A

Suspect URI or bronchitis

261
Q

hemoptysis

A

suspect tumor, trauma, pneumonia, TB or PE

262
Q

Clear sputum

A

COPD or emphysema without infection

263
Q

cervical motion tenderness
discharge
adnexal tenderness
lower abd tenderness

A

PID

264
Q

Penis with fever and discharge

A

STI
UTI
prostatitis

265
Q

tenderness and discharge during a rectal exam

A

rectal abscess/infection

retrocecal appendicitis

266
Q

If you suspect prostatitis, do not

A

perform a vigorous exam or massage the prostate bc this can release bacteria and produce septicemia

267
Q

Osteomyelitis may occur in young children most commonly between ages

A

3-10

268
Q

Septic arthritis can occur in children

A

under the age of 3 and in young women who are sexually active

269
Q

Brudzinski sign

A

with the patient supine, attempt to flex the neck cause the knees and hips to rise from the bed to reduce the pull on the meninges. test for meningitis

270
Q

kernig sign

A

attempt to extend the knee joint when the hip joint is flexed are resisted and the other limb may flex at the hip . - meningitis

271
Q 
disturbances in mentation
irritability 
lethargy
somnolence
coma
A

indicates increased intracranial pressure

272
Q

a seizure in a febrile infant younger than 6 months old is suggestive of

A

meningitis rather than simple febrile seizures

273
Q

fever, sinuses that are tender to percussion or do not transilluminate. Pt often report a frontal headache that worsens as they lean forward. sometimes an upper incisor toothache, sore throat, cough from postnasal discharge

A

Acute sinusitis

274
Q

a vasculitic syndrome affects infants and young children younger than age 9. Acute mucocutaneous lymph node syndrome. fevers range 38C-40C (100.4-104) and persist despite antibiotics and antipyretics. Seizures may be present …febrile phase lasting 5-25 days. Rash.

A

Kawasaki disease

275
Q

fever lasting at least 5 days
and at least four of the following:
Bilat conjunctival hyperemia
mouth lesions: dry fissured lips, injected pharynx or strawberry tongue
changes in peripheral extremities (edema, erythema, desquamation of skin at 10-14 days)
Nonvesicular erythematous rash
cervical lymphadenopathy

A

Kawasaki disease

276
Q

fever lasting at least 5 days
and at least four of the following:
Bilat conjunctival hyperemia
mouth lesions: dry fissured lips, injected pharynx or strawberry tongue
changes in peripheral extremities (edema, erythema, desquamation of skin at 10-14 days)
Non-vesicular erythematous rash
cervical lymphadenopathy

A

Kawasaki disease

277
Q

the most common exanthema (skin rash) of children younger than 3 yrs old with irritability, high fever, rash that appears on day 3-4 and lasts 1-2 days

A

Roseola Infantum

278
Q

mild nonspecific, febrile illness that lasts 2-5 days
herpangina
nonexudative pharyngitis with or without lymphadenopathy

A

enterovirus

279
Q

fever in child older than 3 months who have pos blood cultures but do not have the usual clinical manifestations of sepsis.

A

occult bacteremia

occult means hidden

280
Q

peak ages for bacteremia are ages

A

6-24 months

281
Q

what organism is most commonly responsible for bacteremia in peak age group

A

streptococcus pneumoniae

282
Q

condition characterized by an abrupt fever that occurs in children ages 2-5 on a regularly recurring basis every 6 weeks. Lasts average of 4 days. other symptoms include malaise, sore throat, cervical adenopathy and aphthous stomatitis

A

Periodic fever in children

no associated diseases or other physical exam or lab findings with normal growth and development

283
Q

Weight loss after birth is normal, but expected to start to gain weight within the

A

first 2 weeks of life

284
Q

In newborns Decrease in weight of more than ___ and necessitates _____

A

8% necessitates follow up within 48 hours and a bilirubin check

285
Q

in newborns Loss of more than 10% of birth weight necessitates

A

careful assessment and potential hospital admission

286
Q

Components of a Mental health history (

A

Acute (days to weeks) or chronic (weeks to months)

Alertness, orientation, attention, mood, judgement, affect, language, cognitive function, thought process/perception (unusual thoughts)

Use OLDCARTS/COLDSPA

Find out about developmental age (ex: prematurity, autism)

Academic history (ex: learning disabilities)

Difficulty with authority (ex: teachers, parents)

Pertinent past medical history (including mental health, medications)

Substance use (ex: drugs, alcohol, OTC, herbal, caffeine)

Culture/religion, coping/support systems

Sleep pattern (ex: hours/night, disrupted sleep)

287
Q

somatic

A

Physical symptoms

288
Q

Somatic symptoms are either very distressing or result in significant disruption of functioning, as well as excessive and disproportionate thoughts, feelings, and behaviors related to those symptoms. Symptoms should be specific if with predominant pain.

A

Somatic symptom disorder

289
Q

Preoccupation with having or acquiring a serious illness where somatic symptoms, if present, are only mild in intensity.

A

Illness anxiety disorder

290
Q

Syndrome of symptoms of deficits mimicking neurologic or medical illness in which psychological factors are judged to be of etiologic importance.

A

Conversion disorder

291
Q

Presence of one or more clinically significant psychological or behavioral factors that adversely affect a medical condition by increasing the risk for suffering, death, or disability

A

Psychological factors affecting other medical conditions

292
Q

Falsification of physical or psychological signs or symptoms, or induction of injury or disease, associated with identified deception. The individual presents himself or herself as ill, impaired, or injured even in the absence of external rewards.

A

Factitious disorder

293
Q

Preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear only slight to others.

A

Body dysmorphic disorder

294
Q

Disruption of and/or discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior.

A

Dissociative disorder

295
Q

for the five most common disorders in primary care: depression, anxiety, alcohol, somatoform, and eating disorders

however, it contains 26 questions and takes up to 10 minutes to complete

what is the shorter version?

A

PRIME-MD (Primary Care Evaluation of Mental Disorders);

PRIME-MD Patient Health Questionnaire, available as patient health questionnaire for self-rating; takes approximately 3 minutes.

296
Q

high yield questions for Depression

A

Over the past 2 weeks, have you felt down, depressed, or hopeless?22,28,29

Over the past 2 weeks, have you felt little interest or pleasure in doing things (anhedonia)?

297
Q

High yield questions for anxiety

A

Over the past 2 weeks, have you been feeling nervous, anxious, or on edge?

Over the past 2 weeks, have you been unable to stop or control worrying?

Over the past 4 weeks, have you had an anxiety attack—suddenly feeling fear or panic?

298
Q

screening tool for anxiety

A

Whiteley Index: 14-item self-rating scale

299
Q

Distrust and suspiciousness
Detachment from social relations with a restricted emotional range
Eccentricities in behavior and cognitive distortions; acute discomfort in close relationships

A

Paranoid

Schizoid

Schizotypal

cluster personality type A for DSM 5

300
Q

Disregard for, and violation of, the rights of others
Instability in interpersonal relationships, self-image and affective regulation; impulsivity
Excessive emotionality and attention seeking
Persisting grandiosity, need for admiration and lack of empathy

A

Antisocial

Borderline

Histrionic

Narcissistic

cluster personality type B for DSM 5

301
Q

Social inhibition, feelings of inadequacy and hypersensitivity to negative evaluation
Submissive and clinging behavior related to an excessive need to be taken care of
Preoccupation with orderliness, perfectionism, and control

A

Avoidant

Dependent

Obsessive–compulsive

cluster personality type C for DSM 5

302
Q

These patients show “a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity.”[12] They make “frantic efforts to avoid real or imagined abandonment” and show recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.

Patients often report feeling depressed and empty, with mood swings that spiral out of control leading to feelings of rage, sadness, and anxiety. To clinicians, these patients may appear demanding, disruptive, or manipulative.

A

Borderline Personality Disorder

303
Q

The ability to focus or concentrate over time on a particular stimulus or activity—an inattentive person is easily distractible and may have difficulty giving a history or responding to questions.

A

Attention

304
Q

The process of registering or recording information, tested by asking for immediate repetition of material, followed by storage or retention of information. Recent or short-term memory covers minutes, hours, or days; remote or long-term memory refers to intervals of years.

A

Memory

305
Q

Awareness of personal identity, place, and time; requires both memory and attention

A

Orientation

306
Q

Sensory awareness of objects in the environment and their interrelationships (external stimuli); also refers to internal stimuli such as dreams or hallucinations.

A

Perceptions

307
Q

The logic, coherence, and relevance of the patient’s thought as it leads to selected goals; how people think

A

Thought processes

308
Q

What the patient thinks about, including level of insight and judgment

A

Thought content

309
Q

Awareness that symptoms or disturbed behaviors are normal or abnormal; for example, distinguishing between daydreams and hallucinations that seem real.

A

Insight

310
Q

Process of comparing and evaluating alternatives when deciding on a course of action; reflects values that may or may not be based on reality and social conventions or norms

A

Judgment

311
Q

A fluctuating pattern of observable behaviors that expresses subjective feelings or emotions through tone of voice, facial expression, and demeanor. Disturbed affect may be flat, blunted, labile, or inappropriate.

A

Affect

312
Q

A more pervasive and sustained emotion that colors the person’s perception of the world. (Affect is to mood as weather is to climate.) Mood may be euthymic (in the normal range), elevated, or dysphoric (unpleasant, possibly as sad, anxious, or irritable), for example.

A

Mood

313
Q

A complex symbolic system for expressing, receiving, and comprehending words; as with consciousness, attention, and memory, language is essential for assessing other mental functions

A

Language

314
Q

Assessed by vocabulary, fund of information, abstract thinking, calculations, construction of objects that have two or three dimensions

A

Higher cognitive functions

315
Q

characterized by re-experiencing, avoidance,

A

posttraumatic stress disorder

316
Q

with recurrent panic attacks followed by a period of anxiety about further attacks

A

panic disorder

317
Q

depression is twice as common in what gender

A

women

318
Q

loss of pleasure in daily activities

A

anhedonia

319
Q

Mental Status Examination consists of five components

A

appearance and behavior; speech and language; mood; thoughts and perceptions; and cognitive function

320
Q

Lethargic patients vs Obtunded

A

Lethargic patients are drowsy, but open their eyes and look at you, respond to questions, and then fall asleep.

Obtunded patients open their eyes and look at you, but respond slowly and are somewhat confused.

321
Q

Grooming and personal hygiene may deteriorate in

A

depression, schizophrenia, and dementia.

322
Q

One-sided neglect may result from

A

a lesion in the opposite parietal cortex, usually the nondominant side.

323
Q

Watch for the anger, hostility, suspiciousness, or evasiveness of patients with

A

paranoia

324
Q

flat affect and remoteness of

A

schizophrenia

325
Q

the apathy (dulled affect with detachment and indifference) of

A

dementia

and anxiety or depression

326
Q

Hallucinations occur in

A

schizophrenia, alcohol withdrawal, and systemic toxicity.

327
Q

refers to defective articulation

A

Dysarthria

328
Q

is a disorder of language.

A

Aphasia

329
Q

results from impaired volume, quality, or pitch of the voice

A

Dysphonia

330
Q

reflects the rate, flow, and melody of speech and the content and use of words.

A

Fluency

331
Q

which phrases or sentences are substituted for a word the person cannot think of, such as “what you write with” for “pen”

A

Circumlocutions

332
Q

in which words are malformed (“I write with a den”), wrong (“I write with a bar”), or invented (“I write with a dar”).

A

Paraphasias

333
Q

The mildest thought disorder, consisting of speech with unnecessary detail, indirection, and delay in reaching the point. Some topics may have a meaningful connection. Many people without mental disorders have circumstantial speech.

A

Circumstantiality

334
Q

“Tangential” speech with shifting topics that are loosely connected or unrelated. The patient is unaware of the lack of association.

A

Derailment (loosening of associations)

335
Q

An almost continuous flow of accelerated speech with abrupt changes from one topic to the next. Changes are based on understandable associations, plays on words, or distracting stimuli, but ideas are not well connected

A

Flight of Ideas

336
Q

Invented or distorted words, or words with new and highly idiosyncratic meanings.

A

Neologisms

337
Q

Speech that is incomprehensible and illogical, with lack of meaningful connections, abrupt changes in topic, or disordered grammar or word use. Flight of ideas, when severe, may produce incoherence.

A

Incoherence

338
Q

Sudden interruption of speech in midsentence or before the idea is completed, attributed to “losing the thought.” Blocking occurs in normal people.

A

Blocking

339
Q

Fabrication of facts or events in response to questions, to fill in the gaps from impaired memory.

A

Confabulation

340
Q

Persistent repetition of words or ideas.

A

Perseveration

341
Q

Repetition of the words and phrases of others.

A

Echolalia

342
Q

Speech with choice of words based on sound, rather than meaning, as in rhyming and punning. For example, “Look at my eyes and nose, wise eyes and rosy nose. Two to one, the ayes have it!”

A

Clanging

343
Q

Circumstantiality occurs in people with

A

obsessions.

344
Q

Derailment is seen in

A

schizophrenia, manic episodes, and other psychotic disorders.

345
Q

Flight of ideas is most frequently noted in

A

manic episodes.

346
Q

Neologisms are observed in

A

schizophrenia, psychotic disorders, and aphasia.

347
Q

Incoherence is seen in

A

severe psychotic disturbances (usually schizophrenia).

348
Q

Blocking may be striking in

A

schizophrenia.

349
Q

Confabulation is seen in

A

Korsakoff syndrome from alcoholism.

350
Q

Perseveration occurs in

A

schizophrenia and other psychotic disorders.

351
Q

Echolalia occurs in

A

manic episodes and schizophrenia.

352
Q

Clanging occurs in

A

schizophrenia and manic episodes.

353
Q

A sense that one’s self or identity is different, changed, unreal; lost; or detached from one’s mind or body

A

Depersonalization

354
Q

Compulsions, obsessions, phobias, and anxieties often occur in

A

anxiety disorders.

355
Q

Misinterpretations of real external stimuli, such as mistaking rustling leaves for the sound of voices.1

A

Illusions

356
Q

Perception-like experiences that seem real but, unlike illusions, lack actual external stimulation. The person may or may not recognize the experiences as false. Hallucinations may be auditory, visual, olfactory, gustatory, tactile, or somatic. False perceptions associated with dreaming, falling asleep, and awakening are not classified as hallucinations.

A

Hallucinations

357
Q

Illusions may occur in

A

grief reactions, delirium, acute and posttraumatic stress disorders, and schizophrenia.

358
Q

Hallucinations may occur in

A

delirium, dementia (less commonly), posttraumatic stress disorder, schizophrenia, and alcoholism.

359
Q

Remote memory may be impaired in

(Inquire about birthdays, anniversaries, social security number, names of schools attended, jobs held, or past historical events such as wars relevant to the patient’s past. )

A

late stage of dementia.

360
Q

Recent memory is impaired in

A

dementia and delirium

361
Q

impair memory or new learning ability and reduce social or occupational functioning, but lack the global features of delirium or dementia

A

Amnestic disorders

362
Q

delirium causes

A

acute onset

Metabolic (temp, electrolytes, dehydration), medication, infectious, psychiatric, or cardiac causes

363
Q

High risk of developing delirium

A

poor vision, severe illness, cognitive impairment, high BUN/Cr

364
Q

delirium vs dementia

Chronic over weeks to months, insidious in onset

A

dementia

365
Q

delirium vs dementia

acute onset

A

delirium

366
Q

delirium vs dementia

Attention intact with impaired cognition and may have CNS symptoms or risk factors

A

dementia

367
Q

reversible causes of dementia

A

hydrocephalus, HIV, B12 deficiency, hypothyroidism, subdural hematoma

368
Q

irreversible causes of dementia

A

Alzheimer’s, vascular dementia, Lewy bodies, TBI, Parkinson’s

369
Q

screening tool
Less sensitive for mild dementia, better at detecting moderate to severe dementia
High sensitivity and specificity
Influenced by age and education level (highly educated are less likely to receive early diagnosis)

A

MMSE (mini mental status exam): most-evaluated instrument for diagnostic cognitive impairment

370
Q

Test for dementia, MCI

Highly sensitive

A

MoCA (Montreal Cognitive Assessment):

371
Q

screening tool

Validated for use in older adults to assist in depression diagnosis

A

PHQ-9 (Personal Health Questionnaire):

372
Q

2 Questions for Suicide Screening:

A

In the past week have you wished you were dead or wished that you could fall asleep and not wake up?
In the past week, have you had any actual thoughts of killing yourself?

373
Q

CAGE (substance abuse screen) what does this stand for

A

Cutting down, Annoyance, Guilty feeling, Eye openers

374
Q

T-ACE, CRAFT screen for what

A

alcohol screen

375
Q

Adolescent screen for situational stress, substance abuse, relationship, safety screening:

A

HEEADSSS

376
Q

Relationship screening (domestic violence):

A

“Have you been hit, kicked, punched, or otherwise hurt by someone within the past year?”
“Do you feel safe in your current relationship?”
“Is there a partner from a previous relationship who is making you feel unsafe now?”

377
Q

BATHE model:

is for what

A

situational stress

378
Q

BATHE

A

Background: context of the visit
Affect: elicits the emotional response and allows the patient to label the feeling
Trouble: determines the symbolic meaning of the situation for the patient
Handling: helps to assess patient’s resources and responses to the situation
Empathy: reflects an understanding that the patient’s response is reasonable under the circumstances

379
Q

Issues affecting sleep in women

A

Menopause: causes sleep disturbances, hot-flashes can awaken from sleep, reduce total sleep time, prolonged time to initiate sleep, and reduced REM sleep

380
Q

Allow children to fall asleep on their own using self-comforting measures so that they can

A

fall back asleep during the night on their own

381
Q

recommendations for a bedtime routine

A

no vigorous activity before bedtime, no caffeine, too-early bedtime can lead to problems falling asleep

382
Q

Children may use resistance to bedtime as an issue of

A

control or pattern of oppositional behavior

383
Q

nocturnal episodes of inconsolability, screaming, crying for up to 30 minutes (age 3-10 years)

A

Night terrors -

384
Q

viral causes of sore throat

A

Rhinovirus (common cold)
Coronavirus (common cold)
Adenovirus (Acute respiratory disease)
Herpes simplex virus (HSV) 1 & 2 (stomatitis, pharyngitis)
Influenza A and B (Influenza)
Parainfluenza virus (common cold)
Epstein-Barr Virus (EBV) (Infectious mononucleosis)
Cytomegalovirus (CMV) (Infectious mononucleosis)
Human Herpesvirus (HHV) 6
HIV (primary HIV infection)

385
Q

Group A B-hemolytic streptococcus (pharyngitis, tonsillitis)
Fusobacterium Necrophorum (pharyngitis, peritonsillar abscess, Lemierre syndrome (rare))
Group C beta-hemolytic streptococci (pharyngitis, tonsillitis)
Neisseria gonorrhoeae (pharyngitis)
Corynebacterium diphtheria (Diphtheria)
Mycoplasma pneumoniae (pneumonia, bronchitis)
Chlamydophila pneumoniae (pneumonia, bronchitis)

A

bacterial causes of sore throat

386
Q

noninfectious reasons for sore throat

A 
Persistent cough
Postnasal drip
Gastroesophageal reflux disease
Acute thyroiditis
Neoplasm 
Allergies
Smoking
387
Q

Fever, sore throat, muffled hot potato voice, drooling, and stridor presenting symptoms
Airway obstruction causing- wheezing, stridor, and drooling
Caused by H influenzae (swelling of epiglottis) and other viruses
Airway emergency

A

Epiglottitis

388
Q

Diagnostic for Epiglottitis

A

Direct or indirect laryngoscopy

Be prepared to intubate patient or trach

Patient sitting in an erect position with stridor big sign
“Thumb sign” of swollen epiglottis on lateral neck films, negative film does not rule it out.

389
Q

Rapid onset of severe throat pain
Moderate fever (39-40.5C)
Malaise
Headaches
Throat Examination
Edema, erythema of posterior pharynx and tonsils are often covered with grey/white exudates
Tender anterior cervical lymph nodes
GI symptoms: nausea, vomiting, abdominal pain (especially in children)
Untreated last 8-10 days
Postinfectious symptoms: acute rheumatic fever and post-streptococcal glomerulonephritis

A

Group A Beta- Hemolytic Streptococci pharyngitis

390
Q

diagnosing Group A Beta- Hemolytic Streptococci pharyngitis

A 
Throat culture-
 high sensitivity, high specificity
24-72 delay in results
RADT (rapid antigen detection test)
Results a few minutes
Sensitivity 70-90%
Specificity 90-100%
391
Q

S/S
Fever, malaise, chills, and sweats. The classic triad of severe sore throat, fever and lymphadenopathy
15-24 years of age
Usually caused by EBV, but can be caused by CMV or HHV 6
Shed via salivary secretions
90% of adults are EBV seropositive
Physical exam findings
Enlarged tonsils, pharyngeal erythema, thick coating, pharyngeal exudate, palatal petechiae, and tender anterior and/or posterior cervical adenopathy (very specific for EBV)

A

Infectious Mononucleosis

392
Q

Diagnostic Testing

Infectious Mononucleosis

A

Monospot test
-Specificity 99%
-Sensitivity
-False negatives 25% in first week
Serum IgM antibody
-Highly accurate test, takes longer
-Used when mono suspected but negative monospot
Elevated aminotransferases
Lymphocytosis and the presence of atypical lymphocytes

393
Q

Severe fever, respiratory illness, begins abruptly (hit by a train), diffuse pain, respiratory symptoms (cough, rhinitis, pharyngitis), may have chills and headache, crackles in 25%
Usually have cough but may not in the elderly
Winter months
Usually no GI symptoms

A

Influenza

394
Q

Diagnostic flu

A

History, physical exam, and vaccination status, also flu season vs. non flu season time.
RT- PCR (gold standard)
Rapid test
Patients with pneumonia should have additional testing for co-infection including a sputum gram stain, sputum and blood cultures, and urine for streptococcal and legionella antigen.

395
Q

Septic thrombophlebitis of the internal jugular vein

A

Lemierre Syndrome

396
Q

High fevers, rigors, respiratory distress, and neck/throat pain
Exam may reveal ulceration, pseudomembrane or erythema
Tenderness and swelling may be observed overlying the jugular vein
May have no abnormal physical findings
Rare but life threatening
Usually caused by 81% F necrophorum
Some symptoms sometimes seen but not seen in pharyngitis is dyspnea, pleuritic chest pain, abdominal pain, and trismus
Can see emboli from septic thrombophlebitis also cause bone and joint complications, liver abscess, CNS complications
Septic thrombophlebitis and septic emboli can mask the initial complications of oropharyngeal symptoms

A

Lemierre Syndrome

397
Q

Diagnostic for Lemierre Syndrome

A

Anaerobic primary infection of the oropharynx
Subsequent septicemia (1 positive blood culture)
Metastatic infection of 1 or more distant site
Thrombophlebitis of the internal jugular vein
CT scan of neck with contrast is best diagnostic modality

398
Q

S/S- severe unilateral sore throat, fever, muffled hot potato voice, malaise,
dysphagia, otalgia, pain when swallowing, drooling of saliva, trismus (difficulty opening mouth d/t pain)
Exam reveals- extremely swollen tonsil with the displacement of the uvula to the unaffected side, bulging soft palate on the affected side, tender cervical lymphadenitis on the affected side

A

Peritonsillar Abscess

399
Q

nonspecific and resolve spontaneously without treatment
Fever, lymphadenopathy, sore throat, rash, myalgia/arthralgia, headache, and mucocutaneous ulcers
Highest in men who have sex with men, injection drug users, commercial sex workers, high number of sexual partners

A

Primary HIV Infection- Acute Retroviral Syndrome

400
Q

testing for Primary HIV Infection- Acute Retroviral Syndrome

A

Fourth generation HIV immunoassay

HIV viral load assay

401
Q

Children and/or adults
Symptoms similar to epiglottitis but recent hx of upper respiratory infection or trauma from recent ingested material (bones) or procedures

A

Retropharyngeal Abscess

402
Q

Epiglottitis vs retropharyngeal abscess

A

Sense lump in throat

Comfortable supine with neck extended (opposite of epiglottitis

403
Q

Diagnosis of Retropharyngeal Abscess

A

Thickening of the retropharyngeal tissues is seen on lateral neck radiographs
If xray normal CT scan should be done to verify the diagnosis

404
Q

viral vs bacterial pharyngitis

Cough, coryza, rhinorrhea, and hoarseness, congestion, conjunctivitis, sometimes diarrhea
Usually rhino, adeno, corona

A

viral

405
Q

Fevers, throat pain, but usually associated with cough and myalgias

A

Influenza (Viral)

406
Q

-fever, sore throat, ages 15-24, and associated with malaise and marked adenopathy

A

EBV

407
Q

Nonspecific symptoms of pharyngitis, fever, mucocutaneous ulcers, adenopathy, fatigue, and should be considered in people with high risk behaviors

A

HIV (Viral)

408
Q

Fever, tender anterior cervical lymphadenopathy, tonsillar erythema with or without tonsillar swelling and exudates.

A

Bacterial

409
Q

Early stage
Signs- microaneurysms and retinal hemorrhages
Lack of perfusion leads to ischemia due to cotton wool spots, venous bleeding, and intraretinal vascular abnormalities

A

nonproliferative retinopathy

410
Q

Advanced
New blood vessels on the retina or optic disk d/t ischemia
Vision loss occurs due to vitreous hemorrhage, fibrosis, or retinal detachment

A

Proliferative diabetic retinopathy

411
Q

Happens at any stage of retinopathy
Leading cause of vision loss in persons with diabetes
Increased vascular permeability causes plasma leaks from the macular vessels, leading to swelling and formation of hard exudates at the central retina

A

Diabetic macular edema

412
Q

Eye changes are more likely to occur when

A

risk factors are present such as duration of DM, elevated HbA1C level, hypertension, dyslipidemia, pregnancy, and nephropathy

413
Q

Type 1 and 2 DM common complications

A 
Retinopathy
Peripheral neuropathy and foot ulcers
Nephropathy
Dyslipidemia
Hypertension
Smoking
Obesity
Coronary artery disease
Cerebrovascular disease
HHS
DKA
Peripheral arterial disease 
Foot ulcers
Osteomyelitis
414
Q

when do you screen for diabetic retinopathy in Type 1DM

A

within 5 years of dx onset and annual exams

415
Q

when do you screen for diabetic retinopathy in Type 2DM

A

time of diagnosis and at least annual exams

416
Q

Important physical examinations specific to individual with DM

A

Obesity, particularly central
Hypertension
Eye-hemorrhages, exudates, neovascularization
Skin-acanthosis nigricans (particularly in the dark skinned ethnic and racial groups) candida infections
Neurologic-decreased or absent light touch, temperature sensation and proprioception; loss of deep tendon reflexes in ankles
Feet-dry, muscle atrophy, claw toes, ulcers.

417
Q

cc earache

why would you ask if anyone around them smokes

A

secondhand cigarette smoke exposure has been associated with a 2-3fold increased risk of otitis media (leads to functional eustachian tube obstruction and decreases the protective ciliary action in the tube.)

418
Q

what does recent trip in airplane or scuba diving have to do with earrache

A

barotrauma is a cause of acute serous otitis r/t pressure changes from flying or scuba diving.

419
Q

diabetes and earrache

A

predisposes adults to malignant otitis externa (cellulitis involving ear and surrounding tissue)
also at increased r/o otitis media, mastoiditis, osteomyelitis

420
Q

immunosuppression and earrache

A

increased risk for malignant otitis externa (cellulitis involving ear and surrounding tissue)
also at increased r/o otitis media, mastoiditis, osteomyelitis

421
Q

history of seborrheic dermatitis or psoriasis and earrache

A

overproduction of sebum in external canal can cause otitis externa

422
Q

history of cleft palate and earrache

A

anomalies that are not repaired anatomically predispose a child to otitis media because of functional obstruction of eustachian tubes

423
Q

jaw pain described as severe lasting a few min and returning 3-4 times per day sometimes associated with headache. worse in morning.

A

TMJ

424
Q

infant crying when sucking

A

pain with compression and increased pressure in ears

425
Q

itching or drainage from ear

A

infection or inflammation of external canal

426
Q

Itching, burning or tingling of ear can be a precursor to

A

herpes zoster of the trigeminal nerve (cranial nerve V) which can cause paroxysmal pain of face and jaw and hyperalgesia to minimal stimulation such as tooth brushing, cold air and grimacing

427
Q

foul smelling discharge from ear

A

perforation of TM

428
Q

Why do you ask about recent trauma to ear, head trauma and how do you clean your ears?

in cc of earrache

A

perforation of eardrum can be caused by blunt or penetrating trauma. Blunt trauma might include a slap to ear, barotrauma. Penetrating trauma to canal or TM may be self induced with cotton tipped swabs or other sharp objects when trying to remove cerumen

429
Q 
hearing loss
tinnitus
pressure sensation
vertigo 
infection
A

cerumen impaction

self cleaning can produce trauma
cerumen softening solutions can cause chemical irritation to canal tissue

430
Q

ear pain and inflammation

A

foreign bodies such as feathers, beads, and insects (cockroaches) can produce ear pain and inflammation

431
Q

exposure to high pitched and loud noises for a prolonged period of time destroys ____

A

cochlear hair cells. increases risk of injury and eventually hearing loss.

432
Q

the most frequent cause of hearing loss is conductive hearing loss caused by

A

blockage of the external canal, usually by cerumen

433
Q

presbycusis

A

age related hearing loss - adults older than 65

434
Q

chronic otitis media in children causes a _____ hearing loss

A

conductive

negative middle ear pressure, presence of effusion in middle ear, or structural damage to the TM or ossicles

435
Q

Hearing loss associated with dizziness, vertigo, tinnitus may indicate a

A

serious inner ear condition such as acoustic neuroma or Meniere disease

436
Q 
young infants 
irritability 
poor feeding
congestion
fever
A

otitis media

437
Q

older infants and young toddlers
pull on the painful ear
bang their head on affected side

A

otitis media

438
Q

battle sign

A

hemorrhage over mastoid bone - may occur with a basal skull fracture

439
Q

appear as white or dark patches to ear

A

fungal or yeast infections

440
Q

a hot swollen and erythemous ear and surrounding skin

A

cellulitis

441
Q

redness and painful swelling over the mastoid process is a

A

sign of infection in the mastoid air cells

442
Q

In mastoiditis the pinna is _______

A

displaced forward

443
Q

pain on manipulation of the pinna and tragus

A

otitis externa

444
Q

Postauricular swelling may indicate

A

extension of infection into the mastoid cavity

445
Q

Vesicles on the external ear canal and auricle may indicate

A

herpes zoster (Ramsay hunt syndrome)

446
Q

what kind of discharge can be seen with otitis externa

A

cheesy, green-blue or gray discharge

447
Q

what does a normal TM look like

A

translucent and pearly gray in color

448
Q

Mild diffuse redness of the tympanic membrane can occur from

A

cyring or coughing

449
Q

scarring and effusion can cause what to the TM

A

whitening and opacification

450
Q

the contour of the normal TM is somewhat

A

concave

451
Q

fullness or bulging of the TM indicates

A

either
increased air pressure
increased hydrostatic pressure in the middle ear

452
Q

Fullness of the eardrum is seen first around the

A

periphery of the TM. As pressure increases, central fullness becomes visible

453
Q

what is associated with negative middle ear pressure or postinflammatory adhesions

A

concavity or retraction of the eardrum

454
Q

As the eardrum retracts, the handle of the malleus short process becomes

A

more visible

455
Q

red inflamed eardrum without effusion

A

myringitis

456
Q

extremely painful condition of small blisters on the TM caused by bacterial otitis media

A

Bullous myringitis

457
Q

chronic otitis media can lead to

A

cholesteatoma - a cyst like mass behind the eardrum

458
Q

what cranial nerve is acoustic for hearing

A

CN VIII

459
Q

which hearing test is performed with the tuning fork

A

Weber test

460
Q

what type of hearing loss results when sound transmission is impaired through the external or middle ear

A

conductive hearing loss

461
Q

what type of hearing loss results from a defect in the inner ear

A

sensorineural hearing loss

462
Q

what tests help differentiate conductive hearing loss from sensorineural hearing loss

A

Webber and Rinne

463
Q

how do you evaluate the trigeminal nerve (CNV)

A

observe jaw and facial muscle movement for symmetry and strength by palpating over the masseter muscles and ask the pt to bite and clench their teeth.

Assess intactness of sensation to pain and light touch using a sharp and dull stimulus over the 3 branches of CN V

464
Q

how do you evaluate CN VII and CN IX

A

taste and sensation to tongue and sensation to external ear. Have pt protrude the tongue and apply sweet and salty substances separately to each half of the tongue to test CN VII and bitter and sour substances to test CN IX

465
Q

most often occurs in children younger than 6 and associated with URIs

A

Acute otitis media

466
Q

painless ear infection caused by a mechanical process or eustachian tube blockage that leads to inadequate ventilation of middle ear

A

otitis media with effusion

467
Q

anterior cervical lymphadenitis is a common cause of

A

referred ear pain in children. may be seen with strep throat and mono

468
Q

what cranial nerves are associated with referred ear pain

A

V, VII, IX and X

469
Q

CN V

A

trigeminal

470
Q

CN VII

A

facial

471
Q

CN X

A

vagus

472
Q

CN IX

A

glossopharyngeal

473
Q

chronic laryngitis (longer than 2 weeks) needs to be evaluated for

A

neoplasm - most often squamous cell carcinoma. Chronic laryngitis rarely has an infectious cause

474
Q

recurrent episodes of hoarseness may indicate

A

allergies
sinusitis with postnasal drip
laryngeal reflux
systemic disease

475
Q

progressive hoarseness usually indicates

A

lesion such as laryngeal or hypopharyngeal cyst

476
Q

hoarseness from birth may indicate

A 
a congenital problem such as laryngeal web
cyst
palsy
angioma
congenital anomaly 
papilloma
vocal cord paralysis
477
Q

hoarseness or voice change is a sign of what cranial nerve

A

X (vagus nerve)

478
Q

damage to CN X can be the result of

A

hormone imbalance
bacterial infection
tumor

voice surgery by transgender population can injure the tissues of the vocal fold

479
Q

children with epiglottitis are not hoarse but as the epiglottis swells the voice becomes

A

muffled and drooling is observed

480
Q

Chronic consumption of smoking and hard liquor is a direct irritant and associated with

A

laryngeal cancer

481
Q

what should be considered in patients with hoarseness who have failed to update their diphtheria and acellular pertussis (Td/Tdap) vaccination

A

Laryngeal diphtheria

482
Q

Td/Tdap vaccination is recommended once then Td boosters every

A

10 years, pregnant women are advised to get Tdap during each pregnancy

483
Q

Hoarseness that is altered by a position change suggests

A

a mobile lesion such as a pedunculated polyp

484
Q

pt who has normal voice in the morning with progressive hoarseness throughout the day

A

Myasthenia Gravis

485
Q

the presence of cough , sob, weight loss, dysphagia, ear pain or throat pain should raise concerns about

A

neoplasm

486
Q

Hoarseness and thyroid

A

associated with late sign of hypothyroidism

487
Q 
dysphagia
hoarseness
vomiting
chronic cough
in child
A

GERD

488
Q

habit of frequent throat clearing and sensation of lump in the throat
chronic cough or throat clearing. hoarseness in morning and coughing at night

A

GERD

489
Q

voice or whisper test assesses what cranial nerve

A

VIII

490
Q

adults will report severe and rapidly progressing symptoms of sore throat, dyspnea and hoarseness. In children there is no cough or hoarseness but drooling with a forward leaning posture. Voice quality is froglike

A

Acute epiglottitis

491
Q

croup is most often caused by

A

parainfluenza virus 1

492
Q

croup is most common in children ages

A

3mos - 3 years

493
Q

leukoplakia (white scaly appearance to vocal cords)

do not usually report pain

A

laryngeal cancer

pain secondary to ulceration is late and often perceived as ear pain, esp when swallowing

494
Q

associated with a low gravelly voice

A

hypothyroidism - the degree of hoarseness depends on the severity of thyroid deficiency

495
Q

weak, breathy voice

A

vocal cord paralysis
usually unilateral caused by pressure on the vagus or recurrent laryngeal nerve by a mass of malignant glands in the superior mediastinum or carcinoma of thyroid or esophagus

496
Q

low breathy voice with no found cause usually after a traumatic event

A

psychogenic hoarseness

497
Q

most common laryngeal lesions in childhood between ages 2-7

A

laryngeal papilloma

can be seen in newborn caused by HPV

498
Q

acute symptoms of rhinitis or sinus congestion usually lasts and caused by

A

48 - 72 hrs

caused by edematous mucosa obstructing the sinus ostia

499
Q

fever
myalgias
chills
acute infectious rhinitis are caused by

A

rhinoviruses

Parainfluenza virus

500
Q

adults with symptoms that last more than 3 weeks
upper molar pain or headache
postnasal drip
nausea

A

chronic rhinitis rarely infectious

anatomical abnormalities that impair sinus drainage system

501
Q

in children chronic sinusitis is defined as presence of symptoms for longer than

A

30 days

502
Q

produces pain that worsens with bending or leaning forward. The postnasal produces a cough that worsens when laying down

A

Maxillary sinusitis

503
Q

chronic sinusitis can be attributed to

A

infection
growths in the sinuses (polyps)
deviation in nasal septum

504
Q

seropurulent nasal discharge is often present with

A

acute bacterial infection of the nasal and sinus mucosa

505
Q

sneezing
nasal congestion
clear and profuse rhinorrhea
pruritis of nose, palate, pharynx, and middle ear
conjunctival irritation
feeling of fullness in ears
pressure or pain of cheeks, forehead or behind eyes

A

allergic rhinitis

506
Q

unilateral rhinitis symptoms are more indicative of

A

anatomical cause or foreign body

507
Q

the use of topical sympathomimetic sprays or drops for more than 1 week can lead to

A

rebound congestion or vasodilation after short periods of vasoconstriction

508
Q

what medications may cause nasal congestion

A

oral contraceptives
phenothiazines
ACE inhibitors
B blockers

509
Q

what rec drug can cause rebound nasal congestion

A

chronic or acute cocaine use

510
Q

facial inspection for rhinitis/sinusitis

A

allergic salute - a crease on nose from continued wiping up of nasal drainage

allergic shiners - dark circles under eyes suggestive of venous congestion and stasis

511
Q

halitosis can be a sign of

A

dental abscess or sinusitis

512
Q

lymphoid hyperplasia or cobblestoning

A

may be seen on the posterior pharynx with chronic allergies

513
Q

pale swollen and wet turbinates are seen with

A

allergic rhinitis

514
Q

produces a violet colored mucous membrane

A

allergic rhinitis

515
Q

foul smelling unilateral purlent discharge may indicate

A

a foreign body in the nasal cavity

516
Q

how do you identify CSF leak

A

test nasal drainage for glucose and protein levels

517
Q

foul smelling nasal discharge is characteristic of

A

sinusitis of dental orgin

518
Q

light will pass through

A

air filled sinuses

519
Q

normal transillumination of the frontal sinus r/o _____ in 90% of cases

A

frontal sinusitis

520
Q

presence of yellow or green purulent discharge and red nasal mucosa

A

Infectious rhinitis

521
Q

recurrent rhinorrhea with clear watery mucus, sneezing and pruritis

A

allergic rhinitis

522
Q

associated with eosinophilia on a nasal smear

A

nonallergic rhinitis

523
Q

drug induced rebound congestion that can follow the use of topical nasal decongestants

A

rhinitis medicamentosa

524
Q

purulent nasal discharge, postnasal drip and localized facial pain over the sinus involved. often follows a URI

A

Acute sinusitis

525
Q

the diagnosis of sinusitis in children requires

A

2/3 major criterion

  • cough
  • purulent nasal discharge
  • purulent pharyngeal drainage

or 1 major and 2 minor

  • sore throat
  • wheezing
  • foul breath
  • facial pain
  • periorbital edema
  • headache
  • earache
  • fever
  • toothache
526
Q

persistent symptoms of low grade infection and intermittent acute exacerbations typical of acute sinusitis

A

chronic sinusitis

527
Q

this syndrome has multiple causative factors including history of asthma and aspirin intolerance.

A

nasal polyposis

the polyps are translucent, grape like growths that are mobile, rarely bleed and prolapse into nasal cavity. any suspicious polyps should be biopsied

528
Q

can occur as a complication of sinusitis. may also follow head trauma or scuba diving

A

osteomyelitis of frontal bone

529
Q

pt appear severely ill and may have edema of upper eyelid and puffy swelling over the frontal bone

A

osteomyelitis of frontal bone

530
Q

what type of chemical burn is worse to the eye

A

alkali more damage than acid burns because they penetrate ocular tissues more rapidly

531
Q

what do you do for a chemical burn

A

immediate and profuse irrigation to eye with water or saline wash for at least 15 min

referral to ophthalmology

532
Q

acute redness can be caused by infection of the conjunctiva or eyelids

A

conjunctivitis

533
Q

unilateral eye redness is more likely to indicate

A

trauma or infection

534
Q

bilateral eye redness is more likely to indicate

A

allergy or underlying systemic pprocess

535
Q

inflammation of the eyelids
causes itching and crusting of the lash line
usually bilat

A

Blepharitis

536
Q

produces redness at base of eyelashes and usually unilateral

A

Hordeolum (stye)

537
Q

chronic granulomatous inflammation of the meibomian gland which is in the middle of the eyelid, often on the conjunctival side. Usually unilateral but may involve both eyes

A

chalazion

538
Q

unilateral painful, inflamed eye with photophobia and often a foreign body sensation without a history of significant trauma may indicate

A

glaucoma

keratitis with corneal ulceration

539
Q

constant, boring, throbbing pain often severe enough to interfere with sleep can result from

A

ocular inflammation associated with iritis
acute glaucoma
scleritis

540
Q

produce a gritty sensation in eye

A

viral causes of conjuncivitis

541
Q

vision changes in conjunctivitis?

A

no

542
Q

vision is mildly decreased in

A

iritis

543
Q

vision is markedly decreased with

A

acute glaucoma, corneal abrasions or ulcers

544
Q

sudden diminution in or loss of visual acuity is

A

an ocular emergency and may indicate corneal or uveal tract disorders
retinal tears or detachment
acute glaucoma
orbital cellulitis

545
Q

true double vision becomes single vision when

A

one eye is covered

546
Q

visual halos

A

corneal edema

water drops in cornea or lens (seen in corneal edema or cataract)

547
Q

visual floaters or flashing lights

A

may occur with vitreo-retinal traction. May progress to a retinal tear or detachment

548
Q

patients will give a history of blurred or blackened vision over several hours that progresses to complete or partial monocular blindness often described as curtains dropping

A

retinal detachment

549
Q

copious purulent discharge to eyes

A

N. gonorrhoeae infection

550
Q

watery discharge that may affect only one eye

A

viral conjunctivitis

551
Q

a neonate who is 24 hours old with mucoid or purlent ocular discharge indicates

A

chemical conjunctivitis from prophylactic instillation of erythromycin ophthalmic ointment

552
Q

severe bilat purulent conjunctivitis 3-7 days after birth may indicate

A

gonococcal infection of the eye

553
Q

discharge 5-30 days postpartum may indicate

A

chlamydial conjunctivitis

554
Q

photophobia indicates

A

ocular inflamation or irritation

555
Q

in infants and young children, photophobia signals

A 
a serious condition 
such as juvenile arthritis
intraocular tumors
congenital glaucoma
keratitis
trauma
556
Q

Epiphora

A

excessive production of tears is common with viral conjunctivitis, corneal abrasions, infantile glaucoma, nasal lacrimal duct stenosis

557
Q

itching and tearing disproportionate to findings are hallmark of

A

allergic conjunctivitis

558
Q

low grade to moderate fever,
mucopurulent rhinorrhea
cough
crusting of eyelashes

A

otitis-conjunctivitis syndrome

559
Q

what virus has emerged as an infection contracted in warmer climates and may appear as viral conjunctivitis and often accompanied by fever, rash and arthralgia

A

Zika Virus

560
Q

for young children or adults not able to use the snellen or sloan chart, use

A

HOTV characters or LEA symbols

561
Q

visual acuity chart for children older than 3 1/2 and adults

A

use snellen, tumbling E or Lippman chart

562
Q

in children the referral standard for visual acuity is

A

20/40 or worse in both eyes or a 2 line difference between eyes

563
Q

infection of the lacrimal sac that occurs secondary to obstruction

A

Dacryocystitis

564
Q

scratchy sensation, no photophobia, purulent discharge and matted eyelids

A

bacterial conjunctivitis

565
Q

scratchy sensation
watery discharge
eyelids may have follicular changes in the palpebral conjunctiva

A

viral conjunctivitis

566
Q

chronic seasonal condition caused by hypersensitivity to a specific allergen
bilat
itchy
painless
ropy, mucoid discharge
palpebral conjunctiva has a cobblestone appearance

A

allergic conjunctivitis

567
Q

blood in the anterior chamber of eye, usually produced by trauma to eye. Marked decrease in vision with RBCs present. pupil is irregular and poorly reactive

A

Hyphema

568
Q

no discharge
lacrimation
photophobia
visual acuity unimpaired

A

episcleritis

569
Q

inflammation of sclera can result in severe destructive disease. unilateral associated with RA, or other autoimmune
pain
Lacrimation is present
visual acuity is variable

A

Scleritis

570
Q 
bacterial, fungal and viral organisms can cause infection to the cornea, which leads to corneal ulceration and potential destruction of the cornea
moderate to severe eye pain
some discharge
visual acuity decreased
cornea appears cloudy
A

keratitis

571
Q

moderate to severe pain with discharge present

photophobia

A

corneal abrasion

fluorescein stain is taken into the ulcer and can be seen under a wood lamp

572
Q 
pain
photophobia
diffuse or ciliary injection
possibly discharge
visual acuity markely decreased
dendritic lesions seen with fluorescein staining
A

Herpetic infection cause by herpes simplex virus

573
Q

severe or chronic outbreaks of herpes zoster may cause

A

glaucoma
cataract formation
double vision
scarring of cornea

574
Q

unilateral eyelid swelling
redness
fever
Conjunctiva is clear,

A

periorbital cellulitis

575
Q 
unilateral eyelid swelling
fever
pain
proptosis
chemosis
conjunctivitis
A

orbital cellulitis

life threatening and requires immediate attention

576
Q

inflammation of iris and ciliary body

A

iritis

577
Q

chronic glaucoma

A

open-angle glaucoma

578
Q

acute glaucoma

A

angle -closure glaucoma

579
Q 
unilateral deep eye pain
photophobia
halos around visualized objects
decreased visual acuity
pupil is mid dilated and decreased reactivity to light
cornea is cloudy
A

angle closure glaucoma

emergency

580
Q

doughnut lesions (red, raised hemorrhagic lesions with yellow center)

A

streptococcal pharyngitis

581
Q

a bright red uvula and presence of petechiae on posterior pharynx and palate indicate

A

group A streptococcal pharyngitis

582
Q

curdlike patches that bleed on scraping are characteristic of

A

oral candidiasis

583
Q

in ____ ____ the anterior cervical lymph nodes are often enlarged and tender

A

streptococcal pharyngitis

584
Q

in ____ _____ the posterior cervical nodes are often enlarged

A

viral infections

585
Q

what type of pneumonia is associated with sore throat

A

mycoplasma pneumoniae

586
Q

splenomegaly is found in about half the cases of

A

mononucleosis

587
Q 
history of resp symptoms
difficulty swallowing
otalgia
malaise
fever
toxic appearance
refusal to swallow - drooling, stridor
A

peritonsillar or retropharyngeal abscess

588
Q

fever temp 38.5/101.5 or higher
tonsillar exudate
anterior cervical adenopathy
history of recent exposure

A

streptococcal pharyngitis

589
Q

causative agent for mononucleosis is

A

EBV

590
Q 
low grade fever
mild sore throat
posterior cervical lymphadenopathy
weight loss
pronounced malaise and fatigue
A

Mononucleosis

591
Q

Diagnosis for mononucleosis

A

monospot
CBC
splenomegaly

592
Q

exudative pharyngitis
bilat cervical lymphadenopathy
history of orogenital sexual activity
may have no symptoms

A

gonococcal pharyngitis

gram staining or culture to confirm diagnosis

593
Q

herpangina caused by

A

cox sackievirus

594
Q 
painful sore throat
fever
malaise
headache
anorexia
neck, abd and extremity pain may occur
small grayis papulovesicular lesions on solft palate, pharynce
A

cox sackievirus

595
Q

caused by a fusospirochetal infection that results in necrotizing ulcerative gingivostomatitis

painful ulcers
foul breath
bleeding gums
usually no fever
gray necrotic ulcers without vesicles on the gingivae and interdental papillae
A

vincent angina

to confirm do gram staining to show spirochetes

596
Q

discrete ulcers without preceding vesicles

located on inner lip, tongue and buccal mucosa

lasts 1-2 weeks

A

Aphthous stomatitis “canker sores”

597
Q

fever
headache
sore throat
lymphadenitis
characteristic clusters of yellow vesicles appear on the palate, pharynx and gingiva that last 2-3 weeks
recurrent lesions have prodromal symptoms of burning, tingling, or itching

A

Herpes simplex virus type I

598
Q

yeast infection that produces white plaques over tongue and oral mucosa with erythema . Bleeds when scraped

A

candidiasis

599
Q

who do you see oral candidiasis in

A

infants in the first 5 weeks of life
immunocompromised people
diabetics
people taking abx or using inhaled steroids

600
Q

device that measures intraocular pressure

A

tonometer

IOP > 21 is high risk for glaucoma

601
Q

the most common cause of vision loss in children is

A

amblyopia (lazy eye) and strabismus (2 eyes do not point in the same direction)

602
Q

when the cornea and lens of the eye focus on the image in front of the retina

A

myopia (nearsightedness)

603
Q

a refractive error where the focus of an image is behind the retina

A

hyperopia (farsightednes)

604
Q

an irregularity in the refractive system of the eye that prevents light from being focused onto the retina

A

astigmatism

605
Q

any opacity of the crystalline lens of the eye

A

cataracts

606
Q

first sign of opacity

A

the inability to focus on near objects (presbyopia) and altered color vision

607
Q

associated with MS, after viral infection and with granulomatous inflammatory conditions. Seen in adults 20-50.

vision loss occurs over a few hous to days. Pain precedes vision loss in most patients

A

optic neuritis

608
Q

some have loss of peripheral vision and others lose central vision

affects optic nerve

A

optic nerve hypoplasia

609
Q

most common intraocular tumor of childhood

A

retinoblastoma

610
Q

common symptom is strabismus

can spread to brain through optic nerve or into bone marrow

A

retinoblastoma

611
Q

seen in premature infants
refers to changes of ischemia, blood vessel growth and fibrosis that occur bc of inadequate oxygen delivery to peripheral retina.

A

Retinopathy of prematurity

612
Q

what infants are at greatest risk for retinopathy of prematurity

A

infants who weigh less than 1500g

613
Q

sudden onset of severe vision loss in one eye. no associated pain. caused by plaque lodging at level of the lamina cribrosa

a few hours later the retina becomes edematous and white or opaque. There is a reddish-orange reflex from the intact choroidal vascular and foveola that creates a cherry red spot

A

central retinal artery occlusion

with time the retinal artery opens and the retinal edema clears.

614
Q

loss of vision caused by increased pressure in the eye. characterized by defects in the visual field and optic nerve damage.

A

glaucoma

615
Q

leading cause of blindness in the US

A

glaucoma

616
Q

what type of glaucoma is associated with another ocular or nonocular event

A

secondary glaucoma

617
Q

brief flashes of light (photopsia) or floaters (entopsia)

A

retinal detachement

618
Q

risk factors for macular degeneration

A 
advanced age
family history
cigarette smoking
hyperopia
hypertension
619
Q

rapid vision loss caused by development of abnormal blood vessels that grow from the choroid into the macular portion of the retina. leak blood and fluid.
blurred vision is common early symptom. vision loss may be rapid and severe

A

Wet (exudative) macular degeneration

620
Q

associated with breakdown of light sensitive macular cells and gradual loss of central vision. distortion upon testing with amsler grid

A

dry (nonexudative) macular degeneration

621
Q

micro aneurysms
macular edema
lipid exudates
intraretinal hemorrhages

may be asymptomatic or have decreased vision or floaters

A

diabetic retinopathy

622
Q

inflammatory activity of the iris, ciliary body and choroid

decrease in vision
light sensitivity
tearing

A

uveitis

623
Q

inflammation of the cornea that creates pain, redness and blurred vision

A

keratitis

624
Q

optic nerve gliomas present as what in adults

A

malignant glioblastomas

625
Q

optic nerve gliomas present as what in children

A

benign pilocytic astrocytomas

626
Q

optic nerve gliomas that appear in children younger than 10 are highly associated with

A

neurofibromatosis - associated with cafe au lait lesions of the skin

627
Q

in children

rapid onset of vision loss with headache

A

optic nerve glioma

628
Q

tumors that arise from squamous epithelial cells of the brain

A

craniopharyngioma

629
Q 
headache 
visual disturbance caused by increased intracranial pressure
nystagmus
bitemporal hemianopsia
children
A

craniopharyngioma

630
Q

infants
retinitis
optic nerve hypoplasia
maternal exposure to measles

A

Congenial TORCH infections

631
Q

screening tool for depression

A

PHQ - 9

632
Q

what pneumonic do you use to dig into depression more

A 
Sleep disorder
interest deficit
guilt
energy deficit
concentration deficit, appetite disorder, psychomotor retardation agitation
suicidality

Health Assessment (5 decks)

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