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110 Cards in this Set
- Front
- Back
What are the foundations of western medicine?
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History and Physical examinations
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What are the professional behaviors upon approach to the patient? (five examples)
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Nonjudgmental, patient centered, listener, establish relation, body language
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What doest the selection of comprehensive or focused health history depend on?
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Patients Problem
Doctors Goals for assesment Clinical setting (in/out patient, specialty or primary care) Time availability |
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What's the difference between subjective and objective data?
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Subjective: The patients chief complaint
Objective: What the Dr. detects and all physical examination findings. |
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What are the components of the adult health history?
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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) |
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How is cigarette smoking reported?
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"Pack Years"
# of packs per day X # years |
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What are the CAGE questions pertaining to alcohol abuse?
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"Cutting down, Annoyed by criticism, Guilty feelings, Eye-Opener"
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What are clinical associations or complications of SMOKING?
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Respiratory diseases, Cardiovascular diseases, Cancers, Pregnancy, Drug interactions
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What are the clinical associations or complications for alcohol abuse?
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GI diseases, Cardiovascular diseases, Neurological diseases,
Hematological diseases, Genitourinary diseases, among others... |
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Where should all positive answers from review of systems be added?
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To the past or present history
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What would be the best open ended question at the closure of review of systems?
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"Is there anything else you'd like to talk about?"
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What is the correct sequence of a comprehensive physical examination?
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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) |
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What are the four elements of physical examination?
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Inspection
Palpation Percussion Auscultation |
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Name the five different percussion sounds
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Dull, Stony dull/ flat, Resonant,
hyperressonant, Tympanic, |
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Percussion over a solid structure, such as the liver or a consolidated section of the lung (eg: Lobar Pnuemonia) produces a ________ percussion sound
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DULL
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Percussion over a fluid filled area such as a pleural effusion produces a _______ sound
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Stony Dull or Flat
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Percussion over the normal lung produces a _______ sound
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Resonant
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Percussion over a hollow structure such as the bowel or a pneumothorax or emphysema produces a ________ sound
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Hyperresonant
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Percussion over a gastric air bubble or puffed out cheek produces a _________ note
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Tympanic
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What do SOAP notes stand for?
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Subjective, Objective, Assessment, Plan
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Percussion over a fluid filled area such as a pleural effusion produces a _______ sound
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Stony Dull or Flat
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Percussion over the normal lung produces a _______ sound
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Resonant
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Percussion over a hollow structure such as the bowel or a pneumothorax or emphysema produces a ________ sound
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Hyperresonant
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Percussion over a gastric air bubble or puffed out cheek produces a _________ note
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Tympanic
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What do SOAP notes stand for?
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Subjective, Objective, Assessment, Plan
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What are the seven attributes of a symptom, such as pain?
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Location, Quantity or Severity, Quality, Timing, Setting in which it occurs, Remitting (relieving) or Exacerbating (aggravating factors), Associated manifestations
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What is the difference between disease and illness?
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Disease is an "official" name given by a medical Dr. Illness is a patients experience of symptoms.
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What are the common techniques for skilled interviewing?
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Active listening
Guided Questioning Nonverbal Communication Empathetic Responses Validation Reassurance Partnering Summarization Transitions Empowering the patient |
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What are the clues to possible physical abuse?
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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. |
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Define Maleficence:
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First, do no harm
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Define Beneficence:
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The Dr needs to do good for the patient. The Dr's actions are motivated by what is in the patients best interest
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Define Autonomy
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The patient has the right to determine what is in his/her own best interest
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Confidentiality
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The Dr is obligated not to repeat what he or she learns from or knows about the patient
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What are the normal steps in clinical reasoning?
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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. |
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What is Glasgow scale clinically used to asses?
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Level of Consciousness
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What three aspects are evaluated in Glasgow scale?
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Eyes, best motor response, best verbal response
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According to the BMI, what is the definition of "Underweight"
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BMI = <18
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According to the BMI a normal weight is:
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18.5 - 24.9
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According to the BMI, Overweight is:
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25.0 - 29.9
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According to the BMI, Obesity is:
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30.0 - 34.9 (Obesity I)
35.0 - 39.9 (Obesity II) >/= 40 (Obesity III) |
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What is sudden weight loss indicative of?
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Malignancy, DM, Hyperthyroidism, chronic infection, depression, diuresis, dieting
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Sudden weight gain is indicative of what?
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Sudden (over a few days): Water retention
Gradual gain: Metabolic disorders |
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What is the difference between fatigue and weakness?
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Fatigue: a sense of weariness or loss of energy
Weakness: a demonstrable loss of muscle power |
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What three medical conditions are associated with night sweating?
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Menopause, Malignancy, TB
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DEHYDRATION: <5% about 2.5 L defecit characterized by _____ thirst, dry mucous membranes, and concentrated urine
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MILD dehydration
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DEHYDRATION: 5%-8% about 4 L deficit is characterized by: ________ thirst, reduced skin turgur (elasticity), especially arms, chest, abdomen, and tachycardia
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MODERATE Thirst
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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)
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SEVERE dehydration
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DEHYDRATION: >12%: Over 6 L deficit: comotose, moribund, and signs of shock
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VERY SEVERE dehydration
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What are the normal vital signs?
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BP: <120 systolic/ <80 diastolic
HR: 60-100 bmp Respiration: 14-20 cpm Temp: 37 C or 98.6 F |
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How is hypertension defined according to the new standard of classification? (Pre, stage 1, stage 2)
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Prehypertension: 120-139/ 80-89
Stage 1: 140-159/ 90-99 Stage 2: >160/ >100 |
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What is the difference between central cyanosis and peripheral cyanosis?
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Central the tongue will be blue/purple vs extremities may express this quality in both
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What needs to be described for a skin lesion? (LPTC)
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LOCATION and distribution
PATTERN and shape TYPE of rashes (macule, papule, vesicle, ulcer, etc.) COLOR |
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What are the risk factors for skin cancer?
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50 or more moles with 1-4 or more atypical or dysplastic, light skinned, heavy sun exposure, family history
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What is the ABCDE method for screening moles or melanomas?
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ASYMETRY, irregular BORDER, COLOR (variation or change), DIAMETER >/= 6mm or 1/4 inch, ELEVATION or ENLARGMENT
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What diseases are koilonychias and onycholysis associated with?
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Koilonychias: spoon shaped nails in IRON DEFICIENCY.
Onycholysis: nail destruction in PSORIASIS |
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What are the diagnostic faces? Name at least 6..
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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) |
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What are the causes of loss of smell sensation?
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URT infection, Head Trauma (skull fracture), smoking, aging, use of cocaine
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What cranial nerves control 6 extraccular movements?
(3 REALLY) |
3, 4, and 6
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BOARDS: Failure to move eye laterally is damage what cranial neve?
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CN VI
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What does TONOMETRY check for?
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INTRAOCULAR PRESSURE (Optic Nerve (CN II) for vision)
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What does FUNDOSCOPY (opthalmoscopy) check for?
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Checks RETINA, OPTIC DISK, and BLOOD VESSELS for retinopathy in cases of high BP
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What does OTOSCOPY check for?
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VESTIBULOCOCHLEAR or ACOUSTIC NERVE (CN VIII) for balance, hearing and auditory acuity
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Which cranial nerve is involved in Bell's Palsy?
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CN VII
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What are the Weber and Rhinne tests used for?
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To test CN VII (vestibulocochlear or acoustic nerve for hearing and balance)
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How is the spinal accessory nerve examined?
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??
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Define MUMUR:
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an abnormal HEART sound
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Define BRUIT:
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The sound blood makes when it rushes past an obstruction in an ARTERY.
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HUM pertains to ______ and souffle pertains to ______
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VEIN, MAMMARY GLANDS
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What is the difference between primary and secondary headaches?
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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
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What are the characteristics of tension headache?
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Feeling as though the head is being squeezed on both sides, also steady pain in the forehead.
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What is the most common type of headache?
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TENSION
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What are the characteristics of MIGRAINE headaches?
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VASCULAR: Pulsing, throbbing, localized pain maybe accompanied by nausea
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What are the characteristics of CLUSTER headaches?
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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
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The EAR: Benign posistional vertigo, vestibular neuronitis, Meniere's disease, drug toxicity (alcohol intoxication, loop diuretics, aminoglycosides, aspirin), and acoustic neuroma fall under _________ Vertigo
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PERIPHERAL
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In the brain (center) : Atherosclerosis, Multiple sclerosis, Vertebobasilar migraine, and Transient ischemic attacks (mini stroke) fall under ________ Vertigo
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CENTRAL
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What points for Meniere's disease?
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Ren 12, St 36, 40, and SP 6 "Phlegm misting the mind"
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What are the causes of chest pain?
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CARDIOVASCULAR: angina pectoris, MI, pericarditis, dissecting aortic aneurysm
PULMONARY: tracheobronchitis, pleural pain GI: reflux esophagitis, diffuse esophageal spasm OTHERS: Chest wall pain, anxiety |
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Difficulty or labored breathing:
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Dyspnea
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The inability to breathe easily unless sitting or standing
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Orthopnea
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What are the differential diagnoses of cough with sputum?
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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. |
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What is the differential diagnosis of hemoptysis?
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seen most often in Cystic Fibrosis.
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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
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STRIDOR
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_________ (or rales, intermittent, nonmusical, and brief, like dots in time, due to pulmonary structural abnormalities),
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CRACKLES
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________ and _______ (continuous, MUSICAL, prolonged, like dashes in time, due to narrowed airways or secretions in airways)
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WHEEZES AND RONCHI
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What does a barrel shaped chest indicate?
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Most likely the later stages of COPD may also be indicative of osteoarthritis.
ANTERIOR- POSTERIOR diameter changes |
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Percussion: Emphysema or pneumothorax: ________
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hyperresonant
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Percussion: Normal Lung: _______
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resonant
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Percussion: Lobar pneumonia: ______
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dull
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Percussion: Pleural effusion: _______
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stony dull
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What is tactile fremitus?
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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 |
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What is friction rub indicative of?
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Pleural membrane problem
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What are the clinical findings in pneumothorax
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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
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What are the causes of edema?
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Heart, LV, Ki, lymphatic problems
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High cholesterol, LDL
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Diet, lifestyle, family history
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At what age are routine screening for LDLs performed?
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35 for male and 45 for female
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What does increased right sided jugar venous pressure suggest?
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right sided heart failure
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What method of cardiovascular examinations generates the least amount of information?
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percussion
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Pertaining to the cardiac valve areas: left sternal border, in the 3rd, 4th, and 5th intercostal spaces covers the _______valve.
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TRICUSPID
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Pertaining to the cardiac valve areas for auscultation: the 5th intercostal space and medial to the midclavicular line pertains to the ______valve
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MITRAL
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Pertaining to the cardiac valve areas: the 2nd intercostal space on the right border of the sternum pertains to the ________ valve.
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AORTIC
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Pertaining to the cardiac valve areas: the 2nd intercostal space on the left border of the sternum pertains to the _______ valve
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PULMONARY
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What are the seven attributes of heart murmurs?
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Timing
Shape Location of maximum intensity Radiation Intensity (grading 1-6 omitting 1 and 6) Pitch Quality |
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A soft, quiet, but heard immediately after placing the stethoscope on the chest MURMUR would be graded a _____ on the scale of 1-6
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2
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A murmur that is moderately loud with no thrill is graded a _____
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3
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A murmur that is loud with a thrill that is just hardly palpable is graded a ______
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4
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A murmur that is very loud with a thrill that is easily felt is graded a ______
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5
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Sensory/motor components of the cranial nerves:
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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 |
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Jaw deviation is controlled by what cranial nerve
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Facial Nerve (CN VII)
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Uvula deviation is controlled by what CN?
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CN X
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Tongue deviation is controlled by what CN?
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CN XII
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