Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
79 Cards in this Set
- Front
- Back
|
Exceptions to informed consent
|
Patient lacks decision-making capacity or is legally incomopetent
Implied consent in emergency Minor |
|
|
When can minors be treated without parental consent?
|
Pregnancy
Contraceptives STDs Drug addiction |
|
|
Exceptions to confidentiality
|
Potential harm to others/self is great
Infectious diseases Child and/or elder abuse--even if it's a suspicion! Impaired automobile drivers Suicidal/homicidal patients |
|
|
What do you do?
Child wishes to know more about illness. |
Ask what parents have told child about illness
Parents decide what info can be relayed about illness |
|
|
What do you do?
17 year-old girl is pregnant and requests an abortion |
Many states require parental notification or consent for minors for an abortion.
Unless she is at medical risk, do not advise pt to have an abortion regardless of age. |
|
|
What do you do?
15-year old girl is pregnant want wants to keep child. Parents tell you to tell her to giver child up for adoption. |
Patient retains right to make decisions regarding child, even if parents disagree. Encourage discussion between teen and parents.
|
|
|
What do you do?
Patient is suicidal. |
Assess seriousness of threat.
If serious, suggest patient remain in hospital voluntarily, if refuses, patient can be hospitalized involuntarily. |
|
|
What do you do?
Middle-aged married woman who had mastectomy says she feels "ugly" when she undresses at night |
Find out why she feels this way. Do not offer falsely reassuring statements, e.g., "you still look good."
|
|
|
What do you do?
A drug company offers a referral fee for every patient a physician enrolls in a study. |
Eligible patients who may benefit from study may be enrolled, but it's never acceptable to receive compensation from a drug company.
Anti-kickback law! |
|
|
What do you do?
You smell alcohol on a physician's breath while that physician is practicing medicine. |
Notify superior (chief of service).
|
|
|
Case-control vs Cohort Study:
General Goals |
Case-control: observational, retrospective; looking for risk factors
Cohort: observational, prospective; confirm risk factors |
|
|
A clinical trial is a type of ______ study.
|
Clinical trial = cohort study for a drug (prospective)
|
|
|
APGAR acronym
|
APGAR based on:
Appearance Pulse Grimace Activity Respiration |
|
|
What is cutoff for low birth weight?
|
<2500 g
|
|
|
Milestones for children.
Begin at birth, end at 5 years. |
Birth: rooting reflex, orients to voice
3m: holds head up, social smiles 7-9m: sits alone, crawls; stranger anxiety 15m: walks, Babisnki disappears, few words, separation anxiety 12-24m: climbs stairs, stacks 3 blocks at 1 yea, 6 blocks at 2 years; 200 words and 2-word sentences 24-36m: core gender identity, parallel play; wash hands 30-60m: stack 9 blocks; toilet training (pee at 3) 3 yrs: rides tricycle (3-wheels, 3 years old), copies line or circle drawing;complete sentences 4 yrs: simple drawings (stick figure), hops on 1 foot; cooperative play, imaginary friends, grooms self, brushes teeth, buttons, zips |
|
|
Number of blocks stacked = ______
|
Number of blocks stacked = Number of Age in years x 3
|
|
|
Considers opposite gender to be "yucky".
How old? |
between 6 and 11 years old
|
|
|
Tanner Stages and events
|
Stage 1: Prepubertal
Stage 5: Adult; in girls: only papillar projects as areola recesses Now fill in the rest! Stage 2: Boys: Enlargement of scrotum, testes Breasts: Bud with elevation of breast and papilla; areola enlarges (MAY BE PAINFUL) Pubic hair: sparse long, slightly pigmented Tanner stage 3: Boys: Enlargement of penis (length first) Girls: Further enlargement of breasts Pubic hair: Darker, coarser, curled Stage 4: Boys: Penis--growth in breadth and development of glans Testes enlarge Scrotum larger and darker Breasts: areola and papilla form secondary mound above level of breast Pubic hair: adult hair in type but covering smaller area |
|
|
When does breast development occur in girls? Growth spurt?
Menarche? |
11, with growth spurt at 12, menarche at 13
|
|
|
Wen does penis enlargement occur in boys? Growth spurt?
|
Tanner Stage 2 at 12
Growth spurt at 14-15 |
|
|
What changes occur in the elderly?
What does NOT change? |
Men--slower erection/ejaculation, longer refractory period
Women--vaginal shortening, thinning, dryness Sleep: Dec'd REM, slow-wave sleep; inc'd awakening Dec'd renal, pulm, GI fn Dec'd muscle mass, inc'd fat (impt for drug doses) What does NOT change: Sexual interest Intelligence |
|
|
What constitutes pathologic grief?
|
Depression at least 2 weeks after 2 months following loss
GEneralized feelings of hopelessness, helplessness, worthlessness Suicidal ideation Distressing feelings do not diminish by 6 months Inability to move-on, trust others |
|
|
Kübler-Ross grief stages
|
Death Arrives Bringing Grave Adjustments:
Denial Anger Bargaining Grieving (Depression) Acceptance Don't go in this order. Can skip stages, etc. Not just grief, but can be due to stressors (marriage, etc) |
|
|
Sexual Dysfunction:
Causes |
1) Drugs (beta-blockers, neuroleptics, SSRIs, EtOH)
2) Dz (depression, DM, hyper-PL, low Testosterone) 3) Psychological (performance anxiety)--if no nocturnal erections, likely not a psych issue |
|
|
60-year old male complains of sexual dysfunction. One year ago, he had an MI.
Cause of problem? |
Could be many things:
Atherosclerosis (DM does this too btw) Beta-blockers Fear of sudden death during intercourse |
|
|
Formula for BMI
|
weight in kg/(height in meters^2)
|
|
|
What is bruxism?
Stage of sleep? |
Teeth grinding
Stage 2 |
|
|
What is induresis?
Stage of sleep? |
Bed weeting
Stage 3-4 |
|
|
List EEG waveforms by stage of sleep.
|
Remember: at night, BATS Drink Blood.
Awake (eyes open), alert: Beta waves (highest freq, lowest amp) Awake (eyes closed): Alpha waves Stage 1: Light sleep; Theta Stage 2: Deeper sleep, bruxism (teeth grind); Sleep spindles, K complexes Stage3/4: Sleep walking, night terrors, bedwetting--slow wave sleep; Delta (lowest freq; highest amp) REM: Dreaming, lose motor tone, erections, inc'd brain O2 use; beta |
|
|
Principal neurotransmitter involved in REM sleep.
|
ACh
|
|
|
Neurotransmitter that initiaties sleep.
|
5-HT from Raphe Nucleus
|
|
|
Neurotransmitter that reduces REM sleep.
|
NE
|
|
|
Paramedian Pontine Reticular Formation:
Role in sleep |
PPRF: responsible for extraocular movements during REM
Note: PPRF = rapid ocular movement; fast phase of nystagmus, saccade |
|
|
REM sleep has the same wave form as ______.
|
Alert state; "paradoxical sleep"
|
|
|
This drug is used to treat enuresis. How does it do this?
|
Imipramine; decreases stage 4 sleep
|
|
|
These sleep stages constitute 50% of sleep.
|
Stage 3/4: 25%
REM: 25% |
|
|
During which sleep stage would a man have variable BP, penile tumescence, and a variable EEG?
|
REM
|
|
|
Restless leg syndrome:
What is it? Treatment |
Sensation of unpleasant paresthesias that compels pt to have voluntary, spontaneous, leg mvmts ("crawling on the legs", "
Primarily idiopathic Tx: Pramipexole, ropinirole (lveodopa/carbidopa)--drugs for PD |
|
|
Narcolepsy:
What is it? How are sleep cycles different? Treatment |
Dysregulation of sleep-wake cycle; may include hallucinations.
Go from awake directly to REM Tx: Stimulants: Amphetamines, modafinil |
|
|
What is cataplexy?
|
Loss of all muscle tone following strong emotional stimulus; in narcolepsy, it's usually laughter
|
|
|
Region of brain that controls circadian rhythm.
|
Suprachiasmatic nucleus
|
|
|
Hormone critical to circadian rhythm.
What releases this? |
Melatonin; rel'd by pineal gland
|
|
|
Complications associated with low birth weight.
|
Infection: listeria, e. coli, group b strep
Resp distress syndrome Necrotizing enterocolitis (premie baby eats too soon) Intraventricular hemorrhage |
|
|
When does necrotizing enterocolitis occur?
|
When neonate eats too soon
|
|
|
Age:
Jumps up Eats with spoon 2-3 word sentences |
2 year-old
|
|
|
Age:
Regards face Responds to sound Not able to roll over |
Less than 3 months
|
|
|
Age:
Stands with support 1-3 words Stranger anxiety Drinks from cup |
1 year-old
|
|
|
Age:
Rides tricycle Understandable sentences Plays board games |
3 year-old
|
|
|
What drugs are used to shorten stage 4 sleep?
Why is this useful? |
Imipramine
Bendodiazepines Useful for enuresis (bed wetting) |
|
|
What is the pathway by which retinal information induces the release of melatonin?
|
Presence of darkness-->NE released from Suprachiasmatic nucleus-->pineal gland releases melotonin
|
|
|
Pink complexion
Dyspnea Hyperventilation |
Pink puffer--emphysema: centroacinar (smoking), panacinar (alpha-antitrypsin deficiency)
|
|
|
Polyuria
Acidosis Growth Failure Electrolyte Imbalances |
Fanconi's syndrome (proximal tubular reabsorption defect)
|
|
|
Positive anterior drawer sign
|
ACL tear
|
|
|
Ptosis
Miosis Anhidrosis |
Horner's syndrome (symp chain lzn)
|
|
|
Pupil accommodates but doesn't react
|
Neurosyphilis
|
|
|
Rapidly progressive leg weakness that ascends
Following GI/upper resp infection |
Guillain-Barre Syndrome-autoimmune inflammatory demyelinating polyneuropathy
ASCENDING PARALYSIS; no sensory loss, just motor loss |
|
|
Rash on palms and soles
|
Secondary syphilis
Rocky Mountain spotted fever Coxsackie A (foot and mouth) |
|
|
Recurrent colds
Unusual eczema High serum IgE |
Job's syndrome (Hyper-IgE; nphil chemotaxis abnlty)
TRUNCAL ECZEMA |
|
|
Red currant jelly sputum in alcoholic or diabetic patient
|
Klebsiella pneumoniae
|
|
|
Red, itchy, swollen rash of nipple/areola
|
Paget's dz of breast (underlying neoplasm)
|
|
|
Rusty colored sputum
|
Strep pneumo
|
|
|
Red currant stool
|
Pediatric intussusception
|
|
|
Red urine in morning
Fragile RBCs |
Paroxysmal nocturnal hemoglobinuria
|
|
|
Renal cell carcinoma
Hemangioblastomas Angiomatosis Pheochromocytoma |
von Hippel-Lindau dz (dominant tumor suppressor gene mutation)
|
|
|
Resting tremor
Rigidity Akinesia Postural instability |
PD (nigrostriatal DA depletion)
|
|
|
Restrictive cardiomyopathy
Exercise intolerance |
Pompe's Dz (lysosomal glucosidase def)
|
|
|
Retinal hemorrhages with pale centers
|
Roth spots (bacterial endocarditis)
|
|
|
Severe jaundice in neonate
|
Crigler-Najjar syndrome (congenital unconjd hyperbilirubinemia)
|
|
|
Severe RLQ with rebound tenderness
|
Appendicitis (McBurney's sign)
|
|
|
Short stature
Inc'd incidence of tumors/leukemia Aplastic anemia |
Fanconi's anemia (genetic; often progresses to AML)
|
|
|
Janeway lesions
Osler nodes Splinter hemorrhages |
Bacterial endocarditis
|
|
|
Single palm crease
|
Down Syndrome (Simian crease)
|
|
|
Situs inversus
Chronic sinusitis Bronchiectasis |
Kartagener's Syndrome (dynein defect affecting cilia)
|
|
|
Skin hyperpigmentation
|
Addison's Dz (primary adrenocortical insufficiency of autoimmune or infectious etiology)
|
|
|
Slow, progressive muscle weakness in boys
|
Becker's MD (x-linked, defective dystrophin; less severe than Duchenne's)
|
|
|
Small, irregular red spots on buccal/lingual mucosa with blue-white centers
|
Measles (Koplik spots)
|
|
|
Smooth, flat, moist white lesions on genitals
|
Condylomata Lata--secondary syphilis
|
|
|
Splinter hemorrhages in fingernails
|
Bacterial endocarditis
|
|
|
Strawberry tongue
|
Scarlet fever
Kawasaki syndrome TSS |
