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64 Cards in this Set
- Front
- Back
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What does the APGAR score assess? |
Assessment of newborn vital signs following labor, via a 10-point scale evaluated at 1 minute and 5 minutes
- A: Appearance - P: Pulse - G: Grimace - A: Activity - R: Respiration |
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What do the APGAR scores indicate?
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- ≥ 7 = good
- 4-6 = assist and stimulate - <4 = resuscitate If score remains <4 at later time points, there is increased risk the child will develop long-term neurological damage |
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What is the definition of a low birth weight infant?
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< 2500 g
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What can cause low birth weight (<2500g)?
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- Prematurity
- Intrauterine growth retardation |
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What problems are associated with a low birth weight (<2500g)?
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- ↑ Risk of SIDS
- ↑ Overall mortality - Impaired thermoregulation and immune function - Hypoglycemia - Polycythemia - Impaired neurocognitive / emotional development |
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What are the complications of a low birth weight (<2500g)?
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- Infections
- Respiratory distress syndrome - Necrotizing entercolitis - Intraventricular hemorrhage - Persistent fetal circulation |
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What are the motor, social, and verbal/cognitive milestones from birth to 3 months?
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- Motor: rooting reflex, holds head up, Moro reflex disappears
- Social: social smile - Verbal/cognitive: orients and responds to voice |
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What are the motor, social, and verbal/cognitive milestones from 7-9 months?
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- Motor: sits alone, crawls, transfers toys from hand to hand
- Social: stranger anxiety - Verbal/cognitive: responds to name and simple instructions, uses gestures, plays peek-a-boo |
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What are the motor, social, and verbal/cognitive milestones from 12-15 months?
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- Motor: walks, Babinski sign disappears
- Social: separation anxiety - Verbal/cognitive: few words |
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What are the motor, social, and verbal/cognitive milestones from 12-24 months?
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- Motor: climbs stairs, stacks 3 blocks at 1 yr, 6 blocks at 2 yr
- Social: rapprochement (moves away from and then returns to mother) - Verbal/cognitive: 200 words and 2-word phrases at age 2 |
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What are the motor, social, and verbal/cognitive milestones from 24-36 months?
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- Motor: feeds self with fork and spoon, kicks ball
- Social: core gender identity, parallel play - Verbal/cognitive: toilet training ("pee at 3") |
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What are the motor, social, and verbal/cognitive milestones from 3 years?
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- Motor: Rides tricycle (3-cycle at age 3) and copies lines or circle drawings
- Social: comfortably spends part of day away from mother - Verbal/cognitive: 900 words and complete sentences |
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What are the motor, social, and verbal/cognitive milestones from 4 years?
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- Motor: use buttons and zippers, grooms self (brushes teeth), hops on 1 foot, makes simple drawings (stick figures)
- Social: cooperative play, imaginary friends - Verbal/cognitive: can tell detailed stories and use prepositions |
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What are the sexual changes that occur in elderly men?
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- Slower erection and ejaculation
- Longer refractory period |
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What are the sexual changes that occur in elderly women?
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Vaginal shortening, thinning and dryness
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What are the sleep changes that occur in the elderly?
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- ↓ REM and slow wave sleep
- ↑ Latency and awakenings |
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What age group has the highest suicide rate?
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Men 65-74 years of age have the highest suicide rate in the US
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What physiologic changes occur in the elderly?
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- ↓ Vision, hearing, immune response, bladder control
- ↓ Renal, pulmonary, GI function - ↓ Muscle mass and ↑ Fat - Presbycusis: high-frequency hearing loss d/t destruction of hair cells at the cochlear base (preserved low-frequency hearing at apex) |
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What are the characteristics of normal grief and bereavement?
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- Shock
- Denial - Guilt - Somatic symptoms - May experience delusions - Lasts up to 1 year |
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What are the characteristics of pathologic grief and bereavement?
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- Excessively intense grief
- Grief that is delayed, inhibited, or denied - May experience depressive symptoms, delusions, and hallucinations - Prolonged grief lasting >2-6 months |
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What are the types of sexual DESIRE disorders?
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- Hypoactive sexual desire
- Sexual aversion |
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What are the types of sexual AROUSAL disorders?
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Erectile Dysfunction
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What are the types of ORGASMIC disorders?
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- Anorgasmia
- Premature ejaculation |
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What are the types of sexual PAIN disorders?
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- Dyspareunia
- Vaginismus |
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What does a differential diagnosis for sexual dysfunction include?
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- Drugs (eg, anti-hypertensives, neuroleptics, SSRIs, ethanol)
- Diseases (eg, depression, diabetes) - Psychological (eg, performance anxiety) |
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What drugs can cause sexual dysfunction?
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- Anti-hypertensives
- Neuroleptics - SSRIs - Ethanol |
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What diseases can cause sexual dysfunction?
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- Depression
- Diabetes |
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What psychological state can cause sexual dysfunction?
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Performance anxiety
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How do you calculate BMI?
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BMI = weight in kg / (height in meters)^2
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How do you classify the BMI scores?
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< 18.5 is underweight
18.5 - 24.9 is normal weight 25.0 - 29.9 is overweight > 30.0 obesity > 35.0 severe obesity > 40.0 morbid obesity > 45.0 super obesity |
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What are the stages of sleep?
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- Awake (eyes open)
- Awake (eyes closed) - Stage N1 - Stage N2 - Stage N3 - REM |
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How do you remember the EEG waveforms that correspond to the progressive stages of sleep?
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At night, BATS Drink Blood
- β (Beta) - Awake (eyes open) - α (Alpha) - Awake (eyes closed) - 𝚹 (Theta) - Stage N1 - Sleep spindles and K complexes - Stage N2 - δ (Delta) - Stage N3 - β (Beta) - REM |
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What is happening during the awake (eyes open) stage? EEG waveform?
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- Alert, active mental concentration
- β (highest frequency, lowest amplitude) At night, (B)ATS Drink Blood |
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What is happening during the awake (eyes closed) stage? EEG waveform?
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α waves
At night, B(A)TS Drink Blood |
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What is happening during the N1 stage? EEG waveform? Percent of total sleep time in young adults?
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- Light sleep
- Theta waves - 5% of total sleep At night, BA(T)S Drink Blood |
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What is happening during the N2 stage? EEG waveform? Percent of total sleep time in young adults?
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- Deeper sleep, bruxism (teeth grinding)
- Sleep spindles and K complexes - 45% of total sleep At night, BAT(S) Drink Blood |
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What is happening during the N3 stage? EEG waveform? Percent of total sleep time in young adults?
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- Deepest, non-REM sleep (slow-wave sleep)
- Sleepwalking, night terrors, bed-wetting - Delta waves (lowest frequency, highest amplitude) - 25% of total sleep At night, BATS (D)rink Blood |
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What is happening during the REM stage? EEG waveform? Percent of total sleep time in young adults?
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- Dreaming, loss of motor tone
- Possibly a memory processing function - Erections - ↑ Brain O2 use - Beta waves - 25% of total sleep At night, BATS Drink (B)lood |
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What percentage of the total sleep does each of the sleep stages take?
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- Stage N1 (5%)
- Stage N2 (45%) - Stage N3 (25%) - REM (25%) |
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What brain structure is key to initiating sleep?
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Serotonergic predominance in the raphe nucleus
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How do you treat sleep enuresis (bed-wetting)? Mechanism?
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Oral desmopressin acetate (DDAVP)
- Mimics vasopressin (ADH) - Preferred over imipramine because fewer side effects |
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Which drugs affect the quality of sleep? How?
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Alcohol, benzodiazepines, and barbiturates:
- Reduced REM and delta (N3) sleep |
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How do you treat night terrors and sleep-walking?
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Benzodiazepines
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How often does REM sleep occur? How long does it last?
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- Occurs every 90 minutes
- Increases in duration throughout the night - 25% of the total sleep time |
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What neurotransmitters are involved in REM sleep?
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- ACh is the principal NT in REM sleep
- NE reduces REM sleep |
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What are the findings of REM sleep?
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- ↑ and variable pulse and BP
- Extraocular movements during REM sleep d/t hyperactivity of PPRF (paramedian pontine reticular formation / conjugate gaze center) - Penile/clitoral tumescence (swelling) - Paradoxical sleep (REM sleep has the same EEG pattern as wakefulness |
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How can you remember the changes that occur during REM sleep?
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REM sleep is like sex:
- ↑ Pulse - Penile / clitoral tumescence (swelling) - ↓ Frequency with age |
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What causes the extraocular movements during REM sleep?
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Hyperactivity of PPRF (paramedian pontine reticular formation / conjugate gaze center)
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What are the sleep patterns of depressed patients?
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- ↓ Slow-wave sleep
- ↓ REM latency - ↑ REM early in sleep cycle - ↑ Total REM sleep - Repeated nighttime awakenings - Early-morning awakening (important screening question) |
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What is narcolepsy?
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- Disordered regulation of sleep-wake cycles
- Excessive daytime sleepiness |
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When can hallucinations occur in patients with narcolepsy?
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- Just before sleep (hypnagogic)
- Just before awakening (hypnapompic) |
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What happens during the sleep cycle in a patient with narcolepsy?
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Patient starts off with REM sleep
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What symptoms do some patients with Narcolepsy experience?
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- Hypnagogic (just before sleep) or hypnopompic (just before awakening) hallucinations
- Cataplexy (loss of all muscle tone following a strong emotional stimulus) |
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How do you treat narcolepsy?
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- Daytime stimulants (amphetamines, modafinil)
- Nighttime sodium oxybate (GHB) |
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What brain structure drives the Circadian Rhythm?
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Suprachiasmatic Nucleus (SCN) of Hypothalamus
- Controls ACTH, prolactin, melatonin, and nocturnal NE release - SCN → NE release → Pineal Gland → Melatonin - SCN is regulated by environment (eg, light) |
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What characterizes sleep terror disorder?
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- Periods of terror with screaming in the middle of the night
- Occurs during slow wave sleep - Most common in children - Occurs during non-REM sleep (no memory of arousal) - Triggers may include emotional stress during previous day, fever, or lack of sleep - Usually self-limited |
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What characterizes nightmares?
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Occurs during REM sleep (memory of a scary dream)
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What are the common causes of death (US) for patients < 1 year old?
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1. Congenital malformations
2. Preterm birth 3. SIDS |
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What are the common causes of death (US) for patients 1-14 years old?
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1. Unintentional injury
2. Cancer 3. Homicide |
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What are the common causes of death (US) for patients 15-24 years old?
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1. Unintentional injury
2. Homicide 3. Suicide |
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What are the common causes of death (US) for patients 25-34 years old?
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1. Unintentional injury
2. Suicide 3. Homicide |
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What are the common causes of death (US) for patients 35-44 years old?
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1. Unintentional injury
2. Cancer 3. Heart Disease |
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What are the common causes of death (US) for patients 45-64 years old?
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1. Cancer
2. Heart disease 3. Unintentional injury |
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What are the common causes of death (US) for patients 65+ years old?
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1. Heart disease
2. Cancer 3. Chronic respiratory disease |
