Week 3 + 4 Flashcards
Obligation to Report (Children)
any physician who even suspects abuse/neglect of a minor must report.
Physical Abuse Signs of children
- Caregiver should have consistent story that is consistent with the age of the child and no pattern of repeated injuries. Medical care should not be unreasonable delayed
- Bilateral Injuries
- Fractured Femur
- Bruises on ear, cigarette burns, immersion burns, scalt burns.
- Abusive head trauma (Shaken baby syndrome), retinal hemorrhages and bilateral hematomas.
(Children) Alternative Diagnoses: Osteogenesis imperfecta
- inherited disorder with fragile bones
- SX: Blue sclera, hypotonia, recurrent fractures, osteopenia, and easy bruising.
(Children) Alternative Diagnoses: Ehlers-Danlos Syndrome
- Autosomal dominant disorder with fragile skin and hyperextensibility
(Children) Alternative Diagnoses: Rickets (Vit D Def.)
- SX: Fraying of the metaphyses, rib and long bone fractures.
(Children) Alternative Diagnoses: Birth Injury
- SX: Clavicle, Humerus, or Femoral fractures or cephalohematoma. Will present really young.
(Children) Alternative Diagnoses: Coagulation disorder/Acute Leukemia
- SX: Easy bruising.
(Children) Alternative Diagnoses: Self injury
-SX: Cutting, attempted suicide.
(Children) Medical Abuse of Child: Munchausen Syndrome (by proxy)
People who create facitious illness about their children.
Significant Hx or SX of the Medical Abuse of Child:
- HX: of an infant who had died previously
- SX: Seizures, apnea, prolonged diarrhea, recurrent febrile episodes.
Death Anxiety
Not afraid of dying but rather how they will die (the pain, the burden, etc.) = cope via changes of lifestyle, avoidance or engaging activities that confront death.
Elderly: reporting to adult protective services leads to ______ risk of death
Increased risk of death by 3 fold.
Marker of elder mistreatment
Depression (other risk factors: Age, Gender, Ethnicity, Dementia, etc.)
USPSTF: Screening and assessment of elderly person for abuse
AMA and AA of Neurology
USPSTF: Lack of proven effectiveness (Grade I)
AMA and AAN: Screen individuals 65+ for abuse
3 Questions for brief screening of elder abuse
Note: Official = Elder Assessment Instrument (General assessment + possible abuse and neglect)
1) Do you feel safe where you live? (Safety)
2) Who prepares your meals at home? (Caretaker+ Nutrition)
3) Who handles your checkbook? (Caretaker + Finance)
Types of Abusers
1) Borderline or Dysphoric batterer (Jekyll and Hyde) = drug and alcohol + hx of violence
2) Antisocial or generally violent batterer = narcissistic, lack empathy, view partner as possession.
3) Family only, no psychopathology batterer = Rigid and Rule bound, seems okay on the outside.
USPSTF: Screening for IPV (Intimate Partner Violence)
B Grade: recommends that asymptomatic women of child=bearing age be screened for IPV.
Boundary Crossing vs. Boundary Violations
- Boundary Crossing = Departure from usual practice that are not exploitative
- Boundary Violations = Crossings that are harmful to the patient
- Sexual Exploitation = Final stage of a series of boundary crossings
Meds that cause Transient Short-Term insomnia (Star)
Theophyllin, steroids, B-agonists, thyroxin
Fatigue: Non-Sleep: Chronic Disease + Main Lab difference
Heart Failure = BNP > 300. (if BNP
Fatigue: Non-Sleep: Endocrine/Metabolic
Diabetes = A1C >6.5%, 2h OGTT > 200 mg/dl, or Fasting plasma glucose >126 mg/ml)
Fatigue: Non-Sleep: Hematologic/Neoplastic
Anemia = Bleeding with bowel movements.
- Note: Microcytic = MCV
Central Sleep Apnea
- Inspiratory/Expiratory Control
Dorsal Medulla = Inspiratory Control Center
Ventral Medulla = Expiratory Control Center
Central Sleep Apnea
- Apneustic vs Pneumotoxic Center
Apneustic Center = Found in Lower Pons
- When stim: Increase inspiratory duration, decrease expiratory periods.
Pneumotoxic Center = Found in Upper Pons
- When stim: Turn off inspiration, decrease phrenic nerve activity.
- If lesions: Normal breathing rhythm resumes.
