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Human Development > Week 3 + 4 > Flashcards

Week 3 + 4 Flashcards

1
Q

Obligation to Report (Children)

A

any physician who even suspects abuse/neglect of a minor must report.

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2
Q

Physical Abuse Signs of children

A
  • 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.
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3
Q

(Children) Alternative Diagnoses: Osteogenesis imperfecta

A
  • inherited disorder with fragile bones

- SX: Blue sclera, hypotonia, recurrent fractures, osteopenia, and easy bruising.

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4
Q

(Children) Alternative Diagnoses: Ehlers-Danlos Syndrome

A
  • Autosomal dominant disorder with fragile skin and hyperextensibility
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5
Q

(Children) Alternative Diagnoses: Rickets (Vit D Def.)

A
  • SX: Fraying of the metaphyses, rib and long bone fractures.
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6
Q

(Children) Alternative Diagnoses: Birth Injury

A
  • SX: Clavicle, Humerus, or Femoral fractures or cephalohematoma. Will present really young.
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7
Q

(Children) Alternative Diagnoses: Coagulation disorder/Acute Leukemia

A
  • SX: Easy bruising.
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8
Q

(Children) Alternative Diagnoses: Self injury

A

-SX: Cutting, attempted suicide.

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9
Q

(Children) Medical Abuse of Child: Munchausen Syndrome (by proxy)

A

People who create facitious illness about their children.

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10
Q

Significant Hx or SX of the Medical Abuse of Child:

A
  • HX: of an infant who had died previously

- SX: Seizures, apnea, prolonged diarrhea, recurrent febrile episodes.

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11
Q

Death Anxiety

A

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.

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12
Q

Elderly: reporting to adult protective services leads to ______ risk of death

A

Increased risk of death by 3 fold.

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13
Q

Marker of elder mistreatment

A

Depression (other risk factors: Age, Gender, Ethnicity, Dementia, etc.)

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14
Q

USPSTF: Screening and assessment of elderly person for abuse

AMA and AA of Neurology

A

USPSTF: Lack of proven effectiveness (Grade I)

AMA and AAN: Screen individuals 65+ for abuse

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15
Q

3 Questions for brief screening of elder abuse

Note: Official = Elder Assessment Instrument (General assessment + possible abuse and neglect)

A

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)

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16
Q

Types of Abusers

A

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.

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17
Q

USPSTF: Screening for IPV (Intimate Partner Violence)

A

B Grade: recommends that asymptomatic women of child=bearing age be screened for IPV.

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18
Q

Boundary Crossing vs. Boundary Violations

A
  • 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
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19
Q

Meds that cause Transient Short-Term insomnia (Star)

A

Theophyllin, steroids, B-agonists, thyroxin

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20
Q

Fatigue: Non-Sleep: Chronic Disease + Main Lab difference

A

Heart Failure = BNP > 300. (if BNP

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21
Q

Fatigue: Non-Sleep: Endocrine/Metabolic

A

Diabetes = A1C >6.5%, 2h OGTT > 200 mg/dl, or Fasting plasma glucose >126 mg/ml)

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22
Q

Fatigue: Non-Sleep: Hematologic/Neoplastic

A

Anemia = Bleeding with bowel movements.

- Note: Microcytic = MCV

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23
Q

Central Sleep Apnea

- Inspiratory/Expiratory Control

A

Dorsal Medulla = Inspiratory Control Center

Ventral Medulla = Expiratory Control Center

24
Q

Central Sleep Apnea

- Apneustic vs Pneumotoxic Center

A

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.
25
Q

Risk Factors of Sleep Apnea

A
  • Acromegaly: Increase tissue growth around respiratory muscles
  • Cushing Syndrome: Central Obesity + Buffalo Hump
  • DM II: Obesity
  • Hypothyroidism: Myxedema
26
Q

Complications of Sleep Apnea

A
  • Secondary Pulmonary Hypertension: Closing of blood flow to areas of lungs
  • Cor Pulmonale: Right Heart Failure due to pulmonary hypertension
  • Polycythemia: Increase RBC count due to hypoxic environment.
27
Q

Stage of sleep when Apneic event occurs

A

REM.

28
Q

Refeeding Syndrome

A
  • Risk Factor: Not having had eaten for 5+ days
  • Occurs during hyperalimentation (refeeding) of malnourished (too quickly) resulting in major shifts in fluid and electrolytes = produces ANABOLIC response (building up)
  • Hallmark: Hypophosphatemia! As well as hypokalemia, hypomagnesemia, and thyamine deficiency.
  • Correct Tx: refeeding at 50% of energy requirements + thiamine.

Note: Malnourishment is catabolic (breaking down)

29
Q

Estimate of BMR

A

25 kcal/kg/day

30
Q

Fats

A

9 kcal/gram - Fatty acids are heart’s main source of fuel via phosphates
- Fat needs = 30-40% of total calories

31
Q

Protein

A

4 kcal/gram - Arginine and Glutamine: Helps repair, heal, build muscle.
- Protein needs = 0.8 g/kg per day

32
Q

Sugar/Carbohydrates

A
  1. 4 kcal/gram - Brain’s sole source of fuel.

- Leftover Calories after fat and protein.

33
Q

Non-Protein Calories/Grams of Nitrogen

A

150: 1 Ratio
- Note: Renal Failure = you want > 150:1 ratio because increase protein can harm the kidney
- Note: COPD = you want

34
Q

Hydration/Fluid Requirement

A
  • 100 cc/kg for the first 10 kg
  • 50 cc/kg for the next 10 kg
  • 20 cc/kg for the remaining kgs.

Fluid boluses: Calculated at 20 cc/kg of body weight.

35
Q

Minimum fluids needed based on urine output

A

0.5 - 1 cc/kg/hr

36
Q

Metabolic equivalent

A

1 kcal/(kg * h)

37
Q

Respiratory Quotient for Carbohydrates, Proteins, Ketones (eucaloric), Ketones (hypocaloric), and triolein (fat)

A

Respiratory Quotient: CO2 eliminated/O2 consumed

  • Carbohydrates = 1
  • Protein = 0.9 - 0.9
  • Ketone (eucaloric) = 0.73
  • Ketone (hypocaloric) = 0.66
  • Triolein (fat) = 0.7
38
Q

Kjeldhal Method

A
  • Method for estimating protein content in food.
  • If patient needs to keep his nitrogen to build protein, you’ll see less nitrogen in the urine. Therefore decrease in nitrogen = need for protein.
39
Q

Method of measuring success.

A
  • Pre-albumin
  • Transferrin
  • Retinol-binding protein
40
Q

Confirmation tests for Brain Death

A
  • Angiography
  • Electroencephalography
  • Transcranial ultrasound
  • Technitium-99m brain scan
41
Q

Selye’s Stress Triad

A
  • Enlarged Adrenal Glands, Shrinking of lymphatic organ, and GI Ulcer
42
Q

Stress of Changes

A
  • Limbic system is stimulated
  • Ant pituitary: Increase ACTH and Cortisol
  • Sympathetic Center: Increase Catecholamines + Aldosterone
  • Post. pituitary: Increase ADH
43
Q

AV anastomosis: Which layer?

A

Reticular layer, get rid of heat.

Dermal ridge + papillae (or papillary dermis) = fingerprints

44
Q

Which skin layer is aging most evident?

A

Subcutaneous tissue

45
Q

What kind of changes occur in the epidermis and stratum corneum?

A

Epidermis things a little but not changes to the stratum corneum. Aging mainly affects extracellular matrix.

46
Q

What affects everything in terms of aging/dying physiologically?

A

Hypoperfusion

  • Anaerobic metabolism
  • Vasoconstriction = peripheral pooling of blood
  • Efflux of Potassium
  • Influx of sodium and water
47
Q

Respiratory Muscles that atrophy + Respiratory Sign of dying

A
  • Type IIa muscle fibers

- Death rattle: Terminal respiratory secretions.

48
Q

FAST

A
  • Functional Assessment Scale
  • Focuses on an individual level of f(x) and ADL versus cognitive decline
  • 7A or greater = necessary to qualify someone for hospice.
  • Speech ability
49
Q

PPS

A

Pallative Performance Scale

- Relates well to cancer patients.

50
Q

Dangers of QT Prolongation

A

Progression to Torsades de Pointes

51
Q

Drugs that Increase QT Interval

A

SSRI, Antiobiotics (specifically fluoroquinolone)

52
Q

Wolf-Parkinson-White Syndrome

A

Delta wave due to Bundle of Kent which bypasses AV node.

53
Q

Drugs contraindicated in WPWS

A

Beta blockers, calcium channel blockers

- Treatment: catheter ablation is symptomatic

54
Q

Pericarditis

A

Diffuse ST elevation + gets better when sitting up/leaning forward

55
Q

Drug to slow down heart rate

A

adenosine

56
Q

Only murmur that doesn’t get louder with increase venous return (squatting + respiration)

A
  • Hypertrophic cardiomypoathy. Get’s louder with valsalva (Phase 2) + abrupt standing.

Human Development (3 decks)

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