Physical Diagnosis - Final Exam

Front 1

Observations about patient's appearance and behavior begin when?

Back 1

-begin moment you meet and continue throughout
- note: body type, posture, clothes, grooming, alertness, level of comfort, ambulation status, unusual/inappropriate/repetitive behaviors

Front 2

Describe 4 parameters of motor activity: amount, speed, posture, gait

Back 2

- amount: does patient move a lot or a little
- speed: are patients movements slow, normal, fast?
- posture
- gait: normal, slow, antalgic, parkinsonian?

Front 3

Mood is the patient's _______, whereas affect is _____

Back 3

- mood is the patients self-described emotional state
- affect is the emotional response observed by the examine

Front 4

Describe the parameters of affect: range, intensity, stability, appropriateness, relatedness

Back 4

- range: amount of variation in affect (ex: no variation = flat affect)
- intensity: how extreme it appears (mild - high)
- stability: affect is normally variable, and changes only with change in content of speech or thinking
-appropriateness: match between affect and content of speech or thinking at one point in time (ex: laughing while talking about death of a loved one = lack of appropriateness)
- relatedness: how the patient interacts with the examiner

Front 5

5 parameters of speech?

Back 5

1. amount 2. speed 3. volume 4. clarity (how well can the patient articulate?) 5. fluency (how smooth is the flow of speech?)

Front 6

3 parameters of language?

Back 6

1. complexity: complex or simple word phrases?
2. comprehension: how well can the patient comprehend language?
3. coherence: how well is the patient's language logically ordered?

Front 7

Dysarthria

Back 7

unclear speech due to poor articulation

Front 8

aphasia (receptive vs. expressive)

Back 8

language deficit
- receptive: inability to understand speech/language
- expressive: inability to express thought via speech or language

Front 9

What are the parameters of thought process?

Back 9

quantity of thought, tempo of thought, form (coherence) of thought

Front 10

Quantity of thought? --> poverty of thought? thought preservation?

Back 10

amount of thinking that the patient is engaged in
- poverty of thought: global reduction in amount of thought
- thought preservation: thought restricted to a limited set of ideas

Front 11

Tempo of thought --> flight of ideas vs. retarted thinking

Back 11

flight of ideas = continuous flow of speech/thought that jumps from topic to topic, series of loose connections
- retarted thinking: thought proceeds slowly

Front 12

form (coherence) of thought --> linear, circumstantial, tangential, loosening of associations, clang associations

Back 12

- linear thought: follows logical, progressive course
- circumstantial: symptom of disordered thought = tedious, unnecessary detail but speak eventually reaches point
- tangential: subsequent thoughts are linked but proceed in new direction
- loosening of associations: jumping from subject to subject without apparent logical or sequential connections
- clang associations: words or phrases connected due to chracteristics of the words themselves (rhyming, punning) rather than the meaning they convey

Front 13

Thought Content

Back 13

what the patient thinks about
- divided into 1. preoccupations and 2. disturbances
- ex: suicidal thoughts or plans, homicidal thoughts, delusions, obsessions, phobias, hypochondriasis

Front 14

Perception - abnormalities? types? example?

Back 14

awareness and undersatnding of internal or external sensory information
- perceptual abnormalities: auditory, visual, gustatory, olfactory, or tactile
- types: positive, negative, and distorted
- ex: auditory hallucinations, illusions, neglect, perceptual inattention, depersonalization, derealization

Front 15

Insight

Back 15

the patient's awareness that his symptoms are normal/abnormal
- denial, minimization, indifference

- it is appropriate for physician to ask questions about if the patient knows or believes their condition

Front 16

Judgement - question ask by physician?

Back 16

Process of evaluating and comparing alternatives
- "stamped letter" --> ask patient what they would do if they found a stamped addressed letter on teh street
- ask about paying bills on time, cooking meals

Front 17

Cognition
- when is it tested?
- three describing factors

Back 17

General ability of the patient to think and reason
- tested during mini mental exam
- 1. level of consciousness: normal alertness --> coma
2. general intellecutal function: asking patient about current events
3. abstraction: similarities/differences questions ( how are a car and a train alike?)

Front 18

Mini Mental Status Examination
- what 5 areas does it test?
- score less than 20? score greater than 26?

Back 18

- abbreviated, standardized mental status exam that has 30 max point score
- brief, reproducible examination of mental status and congition
- tests: orientation, registration, attention and calculation, recall, language
- less than 20 = rules in dementia
less than 26 = rules out dementia

Front 19

Delirium

Back 19

mental disturbance of usually short duration
- usually reflects toxic state
- marked by hallucinations, illusions, delusions, excitement, restelessness and incoherences

Front 20

Dementia

Back 20

organic mental syndrome characterized by loss of intellectual abilities
- loss of memory, judgment, abstract thinking
- *delirium may be superimposed on dementia

Front 21

Delirium vs. dementia

Back 21

onset: delirium = acute, dementia = insidious
course: delirium = fluctuating w/lucid intervals (worse at night), dementia = slowly progressive
duration: delirium = hours to weeks, dementia = months to years
sleep/wake cycle: delirium = always disrupted, dementia = sleep fragmented
general medical illness or drug toxicity: delirium = either or both present, dementia = often absent

Front 22

Causes of delirium

Back 22

delirium tremens (withdrawal from alcohol), uremia, acute hepatic failure, acute cerebral vasculities, atropine poisoning

Front 23

causes of dementia

Back 23

- reversible = vitamin b12 deficiency, thyroid disorder
- irreversible = alzheimer's disease, vascular dementia, dementia due to head trauma