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110 Cards in this Set

  • Front
  • Back
What are the foundations of western medicine?
History and Physical examinations
What are the professional behaviors upon approach to the patient? (five examples)
Nonjudgmental, patient centered, listener, establish relation, body language
What doest the selection of comprehensive or focused health history depend on?
Patients Problem
Doctors Goals for assesment
Clinical setting (in/out patient, specialty or primary care)
Time availability
What's the difference between subjective and objective data?
Subjective: The patients chief complaint
Objective: What the Dr. detects and all physical examination findings.
What are the components of the adult health history?
Identifying data
Reliability
CC (chief complaint), HPI (history present illness), PMH (past medical history), FMH (family medical history), PSH (personal and social history), ROS (review of systems)
How is cigarette smoking reported?
"Pack Years"

# of packs per day X # years
What are the CAGE questions pertaining to alcohol abuse?
"Cutting down, Annoyed by criticism, Guilty feelings, Eye-Opener"
What are clinical associations or complications of SMOKING?
Respiratory diseases, Cardiovascular diseases, Cancers, Pregnancy, Drug interactions
What are the clinical associations or complications for alcohol abuse?
GI diseases, Cardiovascular diseases, Neurological diseases,
Hematological diseases, Genitourinary diseases, among others...
Where should all positive answers from review of systems be added?
To the past or present history
What would be the best open ended question at the closure of review of systems?
"Is there anything else you'd like to talk about?"
What is the correct sequence of a comprehensive physical examination?
General Survey
Vitals
Skin
Head, eyes, ears, nose, throat
Neck
Back
Posterior thorax and lungs
Breast, axillae, epitrochlear nodes
Upper extremities
Anterior thorax and lungs
Cardiovascular system
Abdomen
Lower extremeties
Nervous system
Additional (rectal, genital, pelvic exams)
What are the four elements of physical examination?
Inspection
Palpation
Percussion
Auscultation
Name the five different percussion sounds
Dull, Stony dull/ flat, Resonant,
hyperressonant, Tympanic,
Percussion over a solid structure, such as the liver or a consolidated section of the lung (eg: Lobar Pnuemonia) produces a ________ percussion sound
DULL
Percussion over a fluid filled area such as a pleural effusion produces a _______ sound
Stony Dull or Flat
Percussion over the normal lung produces a _______ sound
Resonant
Percussion over a hollow structure such as the bowel or a pneumothorax or emphysema produces a ________ sound
Hyperresonant
Percussion over a gastric air bubble or puffed out cheek produces a _________ note
Tympanic
What do SOAP notes stand for?
Subjective, Objective, Assessment, Plan
Percussion over a fluid filled area such as a pleural effusion produces a _______ sound
Stony Dull or Flat
Percussion over the normal lung produces a _______ sound
Resonant
Percussion over a hollow structure such as the bowel or a pneumothorax or emphysema produces a ________ sound
Hyperresonant
Percussion over a gastric air bubble or puffed out cheek produces a _________ note
Tympanic
What do SOAP notes stand for?
Subjective, Objective, Assessment, Plan
What are the seven attributes of a symptom, such as pain?
Location, Quantity or Severity, Quality, Timing, Setting in which it occurs, Remitting (relieving) or Exacerbating (aggravating factors), Associated manifestations
What is the difference between disease and illness?
Disease is an "official" name given by a medical Dr. Illness is a patients experience of symptoms.
What are the common techniques for skilled interviewing?
Active listening
Guided Questioning
Nonverbal Communication
Empathetic Responses
Validation
Reassurance
Partnering
Summarization
Transitions
Empowering the patient
What are the clues to possible physical abuse?
Injuries are unexplained, inconsistent with the patients story, concealed by the patient or cause embarassment.
Patient has delayed getting treatment for trauma.
Past history of injury or "accidents".
The patient or person close to the patient has a history of drug or alcohol abuse.
The partner tries to dominate the interview, will not leave the room, or seems unusually anxious or solicitous.
Define Maleficence:
First, do no harm
Define Beneficence:
The Dr needs to do good for the patient. The Dr's actions are motivated by what is in the patients best interest
Define Autonomy
The patient has the right to determine what is in his/her own best interest
Confidentiality
The Dr is obligated not to repeat what he or she learns from or knows about the patient
What are the normal steps in clinical reasoning?
Identify abnormal findings
Localize findings anatomically
Interpret findings in terms of probable process
Make hypotheses about the nature of the patient's problem
Test the hypotheses and establish a working diagnosis
Develop a plan agreeable to the patient.
What is Glasgow scale clinically used to asses?
Level of Consciousness
What three aspects are evaluated in Glasgow scale?
Eyes, best motor response, best verbal response
According to the BMI, what is the definition of "Underweight"
BMI = <18
According to the BMI a normal weight is:
18.5 - 24.9
According to the BMI, Overweight is:
25.0 - 29.9
According to the BMI, Obesity is:
30.0 - 34.9 (Obesity I)
35.0 - 39.9 (Obesity II)
>/= 40 (Obesity III)
What is sudden weight loss indicative of?
Malignancy, DM, Hyperthyroidism, chronic infection, depression, diuresis, dieting
Sudden weight gain is indicative of what?
Sudden (over a few days): Water retention
Gradual gain: Metabolic disorders
What is the difference between fatigue and weakness?
Fatigue: a sense of weariness or loss of energy
Weakness: a demonstrable loss of muscle power
What three medical conditions are associated with night sweating?
Menopause, Malignancy, TB
DEHYDRATION: <5% about 2.5 L defecit characterized by _____ thirst, dry mucous membranes, and concentrated urine
MILD dehydration
DEHYDRATION: 5%-8% about 4 L deficit is characterized by: ________ thirst, reduced skin turgur (elasticity), especially arms, chest, abdomen, and tachycardia
MODERATE Thirst
DEHYDRATION: 9%-12% about six liter deficit: GREAT thirst, reduced skin turgor and DECREASED eyeball pressure, collapsed veins, sunken eyes, "gaunt" face, postural hypotension, oliguria (<400 ml urine per 24 hrs)
SEVERE dehydration
DEHYDRATION: >12%: Over 6 L deficit: comotose, moribund, and signs of shock
VERY SEVERE dehydration
What are the normal vital signs?
BP: <120 systolic/ <80 diastolic
HR: 60-100 bmp
Respiration: 14-20 cpm
Temp: 37 C or 98.6 F
How is hypertension defined according to the new standard of classification? (Pre, stage 1, stage 2)
Prehypertension: 120-139/ 80-89
Stage 1: 140-159/ 90-99
Stage 2: >160/ >100
What is the difference between central cyanosis and peripheral cyanosis?
Central the tongue will be blue/purple vs extremities may express this quality in both
What needs to be described for a skin lesion? (LPTC)
LOCATION and distribution
PATTERN and shape
TYPE of rashes (macule, papule, vesicle, ulcer, etc.)
COLOR
What are the risk factors for skin cancer?
50 or more moles with 1-4 or more atypical or dysplastic, light skinned, heavy sun exposure, family history
What is the ABCDE method for screening moles or melanomas?
ASYMETRY, irregular BORDER, COLOR (variation or change), DIAMETER >/= 6mm or 1/4 inch, ELEVATION or ENLARGMENT
What diseases are koilonychias and onycholysis associated with?
Koilonychias: spoon shaped nails in IRON DEFICIENCY.
Onycholysis: nail destruction in PSORIASIS
What are the diagnostic faces? Name at least 6..
Down Syndrome (MONGOLISM), Cushings Syndrome (MOON FACE)
Parkinson's Disease (MASK FACE: lack of coordination, no facial expression)
Nephrotic Syndrome (PUFFY PALE and PERIORBITAL EDEMA)
Myxedema (PUFFY DULL with DRY SKIN)
Exophthalmos (EYEBALL PROTRUSION)
Acromegaly (SOFT TISSUE ENLARGMENT, JAW AND BROW PROMINENT)
What are the causes of loss of smell sensation?
URT infection, Head Trauma (skull fracture), smoking, aging, use of cocaine
What cranial nerves control 6 extraccular movements?
(3 REALLY)
3, 4, and 6
BOARDS: Failure to move eye laterally is damage what cranial neve?
CN VI
What does TONOMETRY check for?
INTRAOCULAR PRESSURE (Optic Nerve (CN II) for vision)
What does FUNDOSCOPY (opthalmoscopy) check for?
Checks RETINA, OPTIC DISK, and BLOOD VESSELS for retinopathy in cases of high BP
What does OTOSCOPY check for?
VESTIBULOCOCHLEAR or ACOUSTIC NERVE (CN VIII) for balance, hearing and auditory acuity
Which cranial nerve is involved in Bell's Palsy?
CN VII
What are the Weber and Rhinne tests used for?
To test CN VII (vestibulocochlear or acoustic nerve for hearing and balance)
How is the spinal accessory nerve examined?
??
Define MUMUR:
an abnormal HEART sound
Define BRUIT:
The sound blood makes when it rushes past an obstruction in an ARTERY.
HUM pertains to ______ and souffle pertains to ______
VEIN, MAMMARY GLANDS
What is the difference between primary and secondary headaches?
Primary: Tension (muscular), Migraine (Vascular), Cluster (Neural) VS. Secondary: Analgesic rebound, eye, ear, sinus, and TMJ disorders, Meningitis, temporal arteritis, post traumatic injuries (head injuries), subarachnoid hemorrhage (MAY BE FATAL!!!), brain tumor, and trigeminal nueraligia
What are the characteristics of tension headache?
Feeling as though the head is being squeezed on both sides, also steady pain in the forehead.
What is the most common type of headache?
TENSION
What are the characteristics of MIGRAINE headaches?
VASCULAR: Pulsing, throbbing, localized pain maybe accompanied by nausea
What are the characteristics of CLUSTER headaches?
NEURO: comes on quickly, crescendos in 2- 15 minutes with excruciating pain, deep, non fluctuating, and explosive in quality. Attacks last 30 min to 2 hrs
The EAR: Benign posistional vertigo, vestibular neuronitis, Meniere's disease, drug toxicity (alcohol intoxication, loop diuretics, aminoglycosides, aspirin), and acoustic neuroma fall under _________ Vertigo
PERIPHERAL
In the brain (center) : Atherosclerosis, Multiple sclerosis, Vertebobasilar migraine, and Transient ischemic attacks (mini stroke) fall under ________ Vertigo
CENTRAL
What points for Meniere's disease?
Ren 12, St 36, 40, and SP 6 "Phlegm misting the mind"
What are the causes of chest pain?
CARDIOVASCULAR: angina pectoris, MI, pericarditis, dissecting aortic aneurysm
PULMONARY: tracheobronchitis, pleural pain
GI: reflux esophagitis, diffuse esophageal spasm

OTHERS: Chest wall pain, anxiety
Difficulty or labored breathing:
Dyspnea
The inability to breathe easily unless sitting or standing
Orthopnea
What are the differential diagnoses of cough with sputum?
Cough, sputum or phlegm:
Acute or chronic inflammation, infection (purulent, foul-smelling, or blood-tinged), neoplasm, left ventricular failure (pink, frothy sputum due to pulmonary edema), pulmonary embolism (dark, bright red, or mixed with blood), irritating particles, chemicals or gases.
What is the differential diagnosis of hemoptysis?
seen most often in Cystic Fibrosis.
Audible _______ :(high-pitched wheeze, INSPIRATORY NOISE IN THE NECK than over the chest wall) is an ominous sign of partial airway obstruction in the larynx or trachea
STRIDOR
_________ (or rales, intermittent, nonmusical, and brief, like dots in time, due to pulmonary structural abnormalities),
CRACKLES
________ and _______ (continuous, MUSICAL, prolonged, like dashes in time, due to narrowed airways or secretions in airways)
WHEEZES AND RONCHI
What does a barrel shaped chest indicate?
Most likely the later stages of COPD may also be indicative of osteoarthritis.

ANTERIOR- POSTERIOR diameter changes
Percussion: Emphysema or pneumothorax: ________
hyperresonant
Percussion: Normal Lung: _______
resonant
Percussion: Lobar pneumonia: ______
dull
Percussion: Pleural effusion: _______
stony dull
What is tactile fremitus?
99, 99, 99, listen to the transmission of the sound (low vibratory sounds)

Fremitus: a vibration felt on palpation
Tactile Fremitus: felt on the chest wall
What is friction rub indicative of?
Pleural membrane problem
What are the clinical findings in pneumothorax
sudden difficulty breathing, chest pain, fast breathing, maybe cyanosis (lack of oxygen), tactile fremitus DEACREASES b/c lack of air, HYPERRESSONANCE upon percussion, when listening breath sounds DEACREASE
What are the causes of edema?
Heart, LV, Ki, lymphatic problems
High cholesterol, LDL
Diet, lifestyle, family history
At what age are routine screening for LDLs performed?
35 for male and 45 for female
What does increased right sided jugar venous pressure suggest?
right sided heart failure
What method of cardiovascular examinations generates the least amount of information?
percussion
Pertaining to the cardiac valve areas: left sternal border, in the 3rd, 4th, and 5th intercostal spaces covers the _______valve.
TRICUSPID
Pertaining to the cardiac valve areas for auscultation: the 5th intercostal space and medial to the midclavicular line pertains to the ______valve
MITRAL
Pertaining to the cardiac valve areas: the 2nd intercostal space on the right border of the sternum pertains to the ________ valve.
AORTIC
Pertaining to the cardiac valve areas: the 2nd intercostal space on the left border of the sternum pertains to the _______ valve
PULMONARY
What are the seven attributes of heart murmurs?
Timing
Shape
Location of maximum intensity
Radiation
Intensity (grading 1-6 omitting 1 and 6)
Pitch
Quality
A soft, quiet, but heard immediately after placing the stethoscope on the chest MURMUR would be graded a _____ on the scale of 1-6
2
A murmur that is moderately loud with no thrill is graded a _____
3
A murmur that is loud with a thrill that is just hardly palpable is graded a ______
4
A murmur that is very loud with a thrill that is easily felt is graded a ______
5
Sensory/motor components of the cranial nerves:
Cornea reflex/ Light reflex (pupil constricts): CN II (sensory) and III (sensory/motor)
Corneal REFLEX (blinking)/
Touching: CN V and VII
Gag reflex: CN IX and X
Jaw deviation is controlled by what cranial nerve
Facial Nerve (CN VII)
Uvula deviation is controlled by what CN?
CN X
Tongue deviation is controlled by what CN?
CN XII