FCM M1 Final Exam Review
Terms
undefined, object
copy deck
- what is the most important clinical tool that physicians use for the diagnosis and treatment of patients?
- the medical interview
- what are the three basic functions of the medical interview?
-
(1) data gathering
(2) building rapport and responding to emotions
(3) patient education and negotiation of treatment plans - what are the eight components of the comprehensive adult medical history?
-
(1) identifying data
(2) source and reliability of history
(3) chief complaint
(4) HPI
(5) PMH
(6) FH
(7) SH
(8) Review of Systems - what are the two components one would add to a normal comprehensibe adult medical history to make a comprehensive geriatric medical history?
-
(1) functional assessment
(2) mental status exam (in the physical exam) - what are the two components one would add to a normal comprehensibe adult medical history to make a comprehensive pediatric medical history?
-
(1) developmental history
(2) nutrition history - what are the three fxns of the physical exam?
-
(1) to ascertain the cause(s) of illness and to follow the progression of disease
(2) to screen for asymptomatic disease(s)
(3) to reassure the patient and to support a therapeutic patient-physician relationship - what side of the exam table does the examiner usually stand on?
- the right side
- what is a smart way to modify the order of the physical exam for young children?
- least distressing aspects of the exam are done first
- what is the HPI mnemonic?
- LQQTSMA
- differentiate between disease / illness
-
disease: what is causing the patient's symptoms
illness: how the patient experiences the symptoms - body mass index
- calculated by weight (kg) / height squared (m2)
- when might BMI be falsely elevated or falsely normal?
-
falsely elevated in a muscular but lean person
falsely normal in an elderly and wasted person - waist circumference, what measurements suggest excess body fat?
-
>35 inches in women
>40 inches in men - what are the three layers of the skin?
-
(1) epidermis: thin, avascular layer
(2) dermis: vascular
(3) subcutaneous tissue: fat - vellus (hair)
- short, fine unpigmented hair
- terminal hair
- head, underarm, pubic regions
- macule
-
small flat spot, up to 1.0 cm
e.g. freckle, petechia - patch
- big flat spot, greater than 1.0 cm
- papule
- small solid bump, up to 1.0 cm
- plaque
- big solid bump, greater than 1.0 cm, often made up of papules that run together
- nodule
- deep, round, hard bump greater than 0.5 cm
- wheal
- an irregularly shaped raised area
- vesicle
- fluid filled bump, up to 1.0 cm, filled with serous fluid
- bulla
- big fluid filled bump, 1.0 cm or larger, filled with serous fluid
- pustule
- filled with pus
- erosion
- loss of the superficial skin that does not bleed
- ulcer
- deeper loss of skin that may bleed and scar
- fissure
- a linear crack in the skin
- crust
- dried pus, blood, serum on the skin
- scale
- flakes of skin
- lichenification
- when skin becomes rough and thick
- atrophy
- thinning of the skin with loss of furrows; the skin looks more transparent and shiny
- excoriation
- scratch mark
- scar
- thick and pink (hypertrophic) vs. thin and white (atrophic)
- comedo
- blackhead
- what are the four components used for most medical records?
-
(1) medical history
(2) physical examination
(3) assessment
(4) plan - rectal temp is different value than oral temp?
- rectal temp is about 0.5 degree C above oral temp
- axillary temp is different value than oral temp?
- axillary temp is about one degree below oral temp (least accurate)
- tympanic membrane is different value than oral temp?
- tympanic membrane is about 0.8 degrees C above oral temp
- blood pressure cuff size
- choose cuff size so bladder nearly (80%) or completely encircles arm
- deflating the BP cuff too fast can result in what?
- underestimating the systolic P and overestimating the diastolic P
- if excessive pressure is hold on the stethoscope head a falsely ______ diastolic reading may be seen
- low
- normal BP
- <120/<80
- prehypertension
- 120-139/80-89
- Stage 1 Hypertension
- 140-159/90-99
- Stage 2 Hypertension
- >=160/>=100
- width of the inflatable BP bladder should be what % of upper arm circumference?
- 40%
- name 5 factors associated with increased risk for breast cancer
-
(1) onset menstruation before 13 years
(2) menopause after 55 years
(3) prior history of breast cancer
(4) first-degree family history of breast cancer
(5) history of never being pregnant - CAGE
-
have you ever felt the need to cut down on your drinking?
Have you ever felt annoyed by the criticism of your drinking?
Have you ever felt guilty about drinking?
Have you ever needed a drink first thing in the morning (eye-opener)? -
hypertension
- general definition - at least two elevated BP measurements at two or more visits
- a femoral pulse that is smaller and later than the radial pulse is suggestive of what?
- coarctation of the aorta or occlusive vascular disease
-
pelse rates
Birth:
1-2 years:
6-10 years:
10-14 years: -
Birth: 140
1-2 years: 110
6-10 years: 95
10-14 years: 85 -
RR
Newborn:
Early Childhood:
Late Childhood: -
Newborn: 30-60
Early Childhood: 20-40
Late Childhood: 15-25 - what are the four parts of the denver developmental screening test?
-
(1) personal-social
(2) fine motor-adaptive
(3) language
(4) gross motor - HEADSS
-
Home
Education
Activities
Sex
Suicide - SIG E CAPS
-
Sleep decreased (Insomnia with 2-4 am awakening)
Interest decreased in activities (anhedonia)
Guilt or worthlessness (Not a major criteria)
Energy decreased
Concentration difficulties
Appetite disturbance or weight loss
Psychomotor retardation/agitation
Suicidal thoughts - where is the costovertebral angle?
- formed by the lower border of the 12th rib and the transverse processes of the upper lumbar vertebrae
- tenderness in the area of the costovertebral angle may signify what?
- kidney problem
- when does the posterior fontanelle close?
- 2 months
- when does the anterior fontanelle close?
- by two years of age
- what are the names used in the three quadrant system for abdomen?
-
epigastric (upper)
umbilical
hypogastric (lower) - odynophagia
- pain on swallowing
- obstipation
- no passage of either feces or gas
- what is the normal liver span at the right midclavicular line?
- 6-12 cm
- on inspiration, the liver is palpable ___ cm below the right costal margin in the midclavicular line?
- 3 cm
- boundaries of the anterior triangle of the neck
- bounded above by the mandible, laterally by the sternocleidomastoid, and medially by the midline of the neck
- boundaries of the posterior triangle of the neck
- extends from the sternocleidomastoid to the trapezius and is bounded below by the clavicle
- palpebral conjunctiva lines what?
- the eyelids
- bulbar conjunctiva covers what?
- the eyeball
- what are the three glands of the eye that produce tears?
- meibomian, conjunctival, and lacrimal
- lacrimal puncta
- the "drains" of the eyes that drain tears
- ciliary body fxn
- adjusts the thickness of the lens
- describe the flow of aqueous humor
- flows from the "posterior chamber" to the "anterior chamber" then drains out through canal of schlemm
- glaucoma
- inc eye pressure
- optic disc
- orangish to pinkish oval structure, 1.5 mm in diameter
- near reaction
- involves convergence and accommodation
- presbyopia
- gradual dec in near vision caused by stiffening of the lens
- large pupil
- >5 mm
- small pupil
- <3 mm
- synovial joint
-
freely moveable
e.g. knee, shoulder - catilaginous joint
-
lightly moveable
e.g. vertebral bodies of the spine - fibrous joint
-
immovable
e.g. skull sutures -
shoulder:
where does the supraspinatous insert? - greater tubercle
-
shoulder
insfraspinatous and teres minor - cross the glenohumoral joint posteriorly, insert on the greater tubercle
-
shoulder:
where does the subscapularis insert? - on the lesser tubercle
- axioscapular group
- attaches the trunk to the scapula and includes the trapezius, rhomboids, serratus anterior, and levator scapulae; rotate the scapula
- axiohumeral group
- this group attaches the trunk to the humerus and includes the pectoralis major and minor and the latissimus dorsi; these muscles produce internal rotation of the shoulder
- biceps tendon
- tendon of the long head of the biceps; runs in the bicipital groove between the greater and lesser tubercles
- primary hip flexor
- iliopsoas
- primary hip extensor
- gluteus maximus
- kyphosis
- hunchback
- valgus stress test -- inward or outward?
- inward
- varus stress test -- inward or outward?
- outward
- pectoral nodes drain what?
- anterior of the chest
- subscapular nodes drain what?
- posterior chest wall and portions of the arm
- lateral nodes drain what?
- most of the arm
- where do the pectoral / subscapular / lateral nodes drain into?
- drain to central axillary nodes --> to infraclavicular and supraclavicular nodes
- when is the best time to perform a breast exam?
- 5-7 days after menstruation
- where does the trachea bifurcate?
- at the level of the sternal angle anteriorly and at the T4 spinous process posteriorly
- dyspnea
- awareness of breathing that is inappropriate to the level of breathing
- hemoptysis
- coughing up blood from the lungs
- Hoover's sign
- infant's abdomen bulges outward while the chest moves inward during inspiration
- where does the lower border of the lung cross at midclavicular and midaxillary lines?
-
6th rib midclavicular
8th rib midaxillary - posterior lower border of lung?
- at level of T10 spinous process
- where is the PMI?
- found in the 5th interspace 7-9 cm lateral to the midsternal line
- axvy
- atrial contraction, relaxation, filling, emptying