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POM Unit 6 > U6 Exam > Flashcards

U6 Exam Flashcards

1
Q

Where is the mental state exam used?

A

Used as part of the physical exam in primary care, etc. (not instead)

It can be used in its entirety or use the parts that are relevant to describe your patient’s mental state of being during the physical examination or more typically your interview

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2
Q

What questions are asked as part of the “thought process” in the MSE?

A

Organized? Goal Directed?

Circumstantial, Tangential, Loose Associations

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3
Q

What questions are asked as part of the “thought conent” in the MSE?

A

Obsessions, Delusions,

Suicidal/homicidal Ideation

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4
Q

What is relevant in assessing speech in the MSE?

A

Rate (slowed – pressured), Rhythm, Prosody

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5
Q

What is relevant in assessing cogniriton in the MSE?

A
  • Orientation, Attention, Concentration • short/long term memory
  • Abstraction
  • Judgment, Insight
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6
Q

Difference between mood vs. affect?

A

Mood “ what patient reports’

Affect = what clinician sees

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7
Q

How to make sure older pts can hear you?

A

 Ask patient if they can hear you

 Speak slowly and clearly, but don’t

shout

 Sit at eye level, face-to-face, hands away from face

 Avoid high pitch tones

 Reduce background noises

 Repeat numbers, letters

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8
Q

tips for communicating with elderly pt with cog. impairment?

A

 Don’t assume patient can not understand

 Use simple phrases, short words

 Be patient and repetitive

 Write down instructions

 Don’t exclude patient from the conversation

 Families are crucial!

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9
Q

What is in ADLs?

A
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10
Q

What is in IDLs?

A
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11
Q

what does the minicog test involve?

A
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12
Q

how to score mini cog test?

what is not impaired?

A

recalled all 3 words

OR recalled 1-2 words, and the clock was normal

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13
Q

Social assessments in elderly involves

A

Formal and Informal Supports Financial Resources
Area Resources

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14
Q

How should you check pulse pressure in elderly?

A

in 2 places

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15
Q

pulse press ___ with aging

A

increases

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16
Q

vital sign changes in elderly?

increases – pulse pressure, premature and atrial ventricular beats

decreases - max heart rate, pulse oximetry, temp

no change - HR, respiratory rate

A
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17
Q

what is actinic keratosis?

A

precancerous lesion

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18
Q

what is arcus senilus? what is it a sign of?

A

a white, gray, or blue opaque ring in the corneal margin

a sign of hypercholesterima

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19
Q

How do you account for cognitive impairment?

A

First of all, don’t assume the patient can’t understand.

Use simple phrases.

Be patient and repetitive if necessary

Use family members but DO NOT exclude patient from the conversation

Use written instructions if necessary

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20
Q

senile ptosis is caused by the

A

Fat pads around eyes atrophy and eyelids can become more elastic

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21
Q

in geriatric exam

what are found on cardiovascualr exam?

A

bruits over carotids

systolic murmurs at right upper sternal border

aortic sclerosis: thickening of wall

aortic stenosis: narrowing of wall

S3 can be heard in CHF, S4 will reveal stiffening of vessels

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22
Q

S3 will be heard in ___. S4 will be heard in ___.

A

S3 is CHF

S4 is stiffening of the vessels

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23
Q

geriatric

___ rounded back due to overcurvature of spine (disc degeneration)

A

kyphosis

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24
Q

Older female exam:

A

breasts atrophy

lithotomy position (where feet are separated in stirrups) can be painful

ovaries no longer palpable

decrease in pubic hair and drier, more delicate vaginal mucosa

uterine/bladder prolapse can be seen

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25
Q

older male exam

A

decrease in pubic hair and penis size, atrophy of testicles

hyperplasia of prostate, usually benign

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26
Q

common abdomonal exam findings

A

abdominal bruits

potbellies!

aorta might be widened, so palpate

look for guarding and rebound

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27
Q

common on MSK findings

A

loss of height and decreased range of motion

less muscle mass

changes in joints due to osteoarthritis

complete wasting of interosseus muscle so that hands are thin and bony

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28
Q

in elderly you have complete wasting of ____ muscle so that hands are thin and bony

A

interosseus

29
Q

___ is the

Leading cause of death in adults over the age of 65

A

falls

30
Q

why is age (esp over 75) a risk factor for fall

A

Broad based gate, flexion of cervical spine, hips, knees

Poor gait initiation, stiff turns

Decreased baroreceptor sensitivity

Postural hypotension, vision changes

Decreased total body H2O

Decreased proprioception

31
Q

risk factors for falls

A

age

female

low mobility and body weight

impaired gait and blaance

acute illnesses and meds

32
Q

chronic illnesses that can inc risk of falls

A

HTN, stroke, MI, arthritis, UTI, depression, diabetes, poor nutrition, chronic pain, pneumonia, arrhythmia

33
Q

medications that inc the risk of falls include

benzodiazepines, antidepressents, any meds with side effects, ____, _____, and ___.

A

benzodiazepines, antidepressents, any meds with side effects, caffeine, antihistamines, ACE inhibitors

34
Q

Intrinsic factors contributing to falls= changes in the person themselves

A

Slower reflexes, increased postural sway, cognitive impairment, alcohol, meds etc.

35
Q

falls are associated with

A

Decline in functional status

“long lie” = need help to get up; predicts decline in functional status

· Nursing home placement

· Increased use of medical services

· Fear of falling

36
Q

____ predicts decline in functional status after a fall

A

needing help to get up

37
Q

Get up and go test

what is normal?

what is impaired?

A

Less than 10 sec, freely mobile

Less than 20 sec, mostly independent

20-29 sec, variable mobility

Greater than 30 sec, impaired mobility

38
Q

Single fall = check for

A

balance/gait problems

39
Q

Multiple falls = determine multifactorial falls risk (H&P, tests)

A

Check BP, pulse (supine, standing), vision, cardio, musculoskeletal, neuro

EKG, brain imaging, spine radiographic studies

Hemoglobin, serum urea nitrogen, creatine, glucose

Carotid sinus massage = can uncover carotid sinus hypersensitivity

Mini-Cognitive Exam:

gait/balance evaluation

40
Q

____ affect is - a large range, “even keel”

A

euthymia

41
Q

Normal Development of 18mo

  • Motor: walks alone, may ___.
A

run or climb stairs

42
Q

Normal Development of 18mo

  • Fine motor: drinks from a cup, feeds self with spoon, can help ____.
A

undress

43
Q

Nml development of 18 mo

Social/emotional: temper tantrums, ____, affectionate towards familiar face, shows interest in ___ and ___.

A

Social/emotional: temper tantrums, stranger anxiety, affectionate towards familiar face, shows interest in objects and wants

44
Q

NML language in 18mo

Language:_____ words, no and can shake head

A

Language: several single words, no and can shake head

45
Q

NML cognitive in 18mo

Name simple objects, points to one body part, scribbles, can____ without gesture

A

follow one step command

46
Q

Examining an 18mo

  • Place child on ____.
  • Leave most intrusive parts for last
  • Distractions
  • Be flexible with order of the exam
A

Examining an 18mo

  • Place child on parents lap, make them feel comfortable
  • Leave most intrusive parts for last
  • Distractions
  • Be flexible with order of the exam
47
Q

How to tell if a baby is healthy just by walking in the room:

  • tone/posture
  • ____
  • color
  • RR
A

attitude

48
Q

Determining sick versus well

-Sick:

Color : blue, pale, yellow, rash, red, petechiae

Posture: limp, floppy, tripod position, curled up

Respirations: Shallow, fast, noisy, slow, ______, nasal flare

Attitude: _____.

A

Determining sick versus well

-Sick:

Color : blue, pale, yellow, rash, red, petechiae

Posture: limp, floppy, tripod position, curled up

Respirations: Shallow, fast, noisy, slow, retractions, nasal flare

Attitude: Irritable, ca’t be consoled

49
Q

-Healthy childre

Color: _____

-Healthy:

Color: pink

Posture: good tone, comfortable

Respirations: Normal

Attitude: consolable

Posture: good tone, comfortable

Respirations: Normal

Attitude: consolable

A

-Healthy:

Color: pink

Posture: good tone, comfortable

Respirations: Normal

Attitude: consolable

50
Q

Croup:

3 months to 3 years

low grade fever, _____ always pathological, _____ cough

_____ sign: narrowing of the airway on x-ray

Supportive airway management

A

Croup:

3 months to 3 years

low grade fever, stridor* always pathological, hoarse cough

steeple sign: narrowing of the airway on x-ray

Supportive airway management

51
Q

long prodrome of low grade fever, runny nose, cough, vommiting occurs after coughing and coughing is worse with exercise, cough progressively worse, won’t eat or drink, not sleeping well, coughing at night, cough improves with steam.

this is ____.

A

croup

52
Q

____ is an abnormal, high-pitched, musical breathing sound that is almost always pathological.

A

Stridor

53
Q

Stridor is seen in

Trauma, congenital abnormalities, foreign body,___, Inflammatory disease

A

Trauma, congenital abnormalities, foreign body, metabolic disorders, Inflammatory disease

54
Q

Epiglotitis

Age: over____ years

stridor, sore throat, drooling, fever

Cough is _____ sounding

thumb print on lateral neck film

inflammation of the epiglottis

Emergency airway management

A

Epiglotitis

Age: over 3-5 years

stridor, sore throat, drooling, fever

Cough is bark sounding

thumb print on lateral neck film

inflammation of the epiglottis

Emergency airway management

55
Q

thumb print sign on film indicates ___

A

epiglottis

56
Q

Fever breaks in a few days with ___

A

roseola

57
Q

tx for roseola

A

no tx necessary

58
Q

Once the ____ with Roseola (HHV 6), the child is no longer contagious

A

rash appears

59
Q

Pyloric stenosis

Boys more often affected

Usually ____ weeks old

Tx is _____.

A

Boys more often affected

Usually 2-8 weeks old

Tx is surgery.

60
Q

_____ stenosis

Projectile vomiting

Electrolyte abnormalities

Hungry!

A

Pyloric stenosis

Projectile vomiting

Electrolyte abnormalities

Hungry!

61
Q

Meningococcemia

Flu like symptoms (nonspecific prodrome)

Rash

Slightly ____

____ in color.

A

Meningococcemia

Flu like symptoms (nonspecific prodrome)

Rash

Slightly raised

Purpelish in color.

62
Q

Meningococcemia

Gets out of control quickly

EMERGENCY; can be fatal!

Antibiotics first, cultures later

Should give _____.

Watch for signs of sepsis

A

Penicillin (little resistance)

63
Q

Meningococcemia (Neisseria meningitidis)

____ classic (soldiers too)

Immunization avaialbile

A

College student classic

64
Q

Group A Streptococci scarlet fever

6 year old

Fever

Abdominal pain

Inflammation of the oropharynx with ______ on the soft palate

May be the only pertinent positive

“Sandpaper rash”

“Strawberry tongue”

A

Group A Streptococci scarlet fever

6 year old

Fever

Abdominal pain

Inflammation of the oropharynx with petechiae on the soft palate

May be the only pertinent positive

“Sandpaper rash”

“Strawberry tongue”

65
Q

Exam in Group A strep scarlet fever find what

A

Abdominal pain

Inflammation of the oropharynx with petechiae on the soft palate

May be the only pertinent positive

“Sandpaper rash”

“Strawberry tongue”

Abdominal exam normal

Rash may present on other parts of the body (like palms)

66
Q

Group A Streptococci scarlet fever

6 year old

Fever

_______ pain

Inflammation of the oropharynx with petechiae on the soft palate

Rash may present on other parts of the body (like palms)

Antibiotics

Treat ____, but not an emergency

A

Strep A Scarlet fever

6 year old

Fever

abominal pain

Inflammation of the oropharynx with petechiae on the soft palate

Rash may present on other parts of the body (like palms)

Antibiotics

Treat early, but not an emergency

67
Q

Cigarette burns: Abuse

“Rash” on top of ____.

Parents don’t know how it got there

LACK of info makes diagnosis

Symmetric, suddenly ____.

Finding doesn’t fit with story

A

Cigarette burns: Abuse

“Rash” on top of foot.

Parents don’t know how it got there

LACK of info makes diagnosis

Symmetric, suddenly appears.

Finding doesn’t fit with story

68
Q

Intussusception

Intermittent, colicky abdominal pain

Currant ____ stool

Vomiting

Elevated _____ level is a clue

Indicates _____ necrosis

A

Intermittent, colicky abdominal pain

Currant jelly stool

Vomiting

Elevated lactate level is a clue

Indicates intestinal necrosis

69
Q

Intussusception

Emergency

3 months-1 year of age

Radiographic “____ sign”

A

Emergency

3 months-1 year of age

Radiographic “donut sign”

POM Unit 6 (1 decks)

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