Baker's Exam 3: Baker's Exam 3: Disease State Parameters

• Normal: SBP= <120 & DBP= <80
• PreHTN: SBP= 120-139 & DBP= 80-89
• HTN Stage 1: SBP= 140-159 & DBP= 90-99
• HTN Stage 2: SBP= =or>160 & DBP= =or>100

• No limitation of physical activity
• No dypnea, fatigue or palpitations w/ordinary activity
• *Provide routine care

• Slight limitation of physical activity
• Fatigue, palpitations and dyspnea w/ordinary physical activity but comfortable at rest
• *Elective care OK and recommend consult w/physician

• Marked limitation of activity
• Less than ordinary physical activity results in symptoms but comfortable at rest
• *AVOID elective care; if tx necessary consult physician and consider referral to specian pt care setting; avoid vasoconstrictors

• Symptoms present at rest and any physical activity exacerbates the symptoms
• *AVOID elective care; if tx necessary consult physician and consider referral to specian pt care setting; avoid vasoconstrictors

• Normal: Fasting Blood Glc = <110 & Post prandial = <140
• Impaired Glc Met: Fasting Blood Glc = 110-125 & Post prandial =140-199
• DM: Fasting Blood Glc = >or=126 & Post prandial = 200+

• One of the following: Depressed mood or loss of interest OR Diminished sense of pleasure
• + 4 for the 7 following: Wt or appetite change, Sleep disorder on most days, Change in psychomoter, Fatigue/Dec energy, Feelings of guilt/worthlessness, Dec concentration/decisiveness, Suicidal ideation or attemp

A-Appetite

• S-Sleep
• A-Anhedonia
• D-Depressed mood

• F-Fatigue
• A-Agitation
• C-Concentration
• E-Esteem
• S-Suicidal

• Intermittent: Symptoms <or= 2day/wk, no nighttime awakenings, use of B₂ ag to control symptoms <or= 2days/wk, no interferences with normal activity
• Persistent (Mild): Symptoms > 2day/wk, nighttime awakenings 1-2X/mo, use of B₂ ag to control symptoms > 2days/wk not daily, minor interferences with normal activity
• Persistent (Moderate): Symptoms daily, nighttime awakenings 3-4X/mo, use of B₂ ag to control symptoms daily, some interferences with normal activity
• Persistent (Severe): Symptom throughout day, nighttime awakenings >1x/wk, use of B₂ ag to control symptoms several times/day, extreme interferences with normal activity

• HTN
• Angina
• Cardiac Arrhythmia
• Epilepsy
• Asthma

• (Most to least common)
• Complex partial
• Generalized tonic-clonic
• Simple partial
• Other generalized
• Unknown partial
• Absence (Petit mal)
• Myoclonic
• Unclassified

• Hx,physical
• Blood tests: CBC, Electrolytes, Glc, Ca, Mg, Phosphate, hepatic and renal function
• Lumbar puncture (if meningitis or encephalitis suspected)
• Blood or urine screen for drugs
• EEF
• CT or MR brain scan

• Prenatal or birth injury
• Inborn error of metabolism
• Congenital malformation

• Idiopathic/genetic syndrome
• CNS infection
• Trauma

• Head trauma
• Drug intoxication and withdrawal (Seizure not epilepsy)

• Stroke
• Brain tumor
• Acute metabolic disturbance (seizures not epilepsy)
• Neuordegenerative

More than 10 min of continuous seizure activity OR 2+ sequential seizures w/o full recovery b/w seizures

• sudden, unexpected death in a patient with epilepsy where the postpartem exam does not reveal a toxicologic or anatomic cause of death w/ or w/o evidence of seizure and excluding SE.
• Risk of sudden death in epilepsy pts 24X gen pop.
• Risk factors: hx and # of GTCS, freq seizures, subtherapeutic AED levels, young adults, long epilepsy duration, IQ<70

• Trigger: Sycope (C)/Seizure(R)
• Sweating & Nausea: Syncope (C)/Seizure(R)
• Aura(deja vu, smell) or unilat symptoms: Syncope(R)/Seizure(C)

• Pallor: Syncope(C)/Seizure(R)
• Cyanosis: Syncope(R)/Seizure(C)
• Loss of consciousness: Syncope(<20sec)/Seizure(>60sec)
• Automatisms: Syncope(Occasional)/Seizure(C)
• Lat. Tongue biting: Syncope(R)/Seizure(Occasional)
• Frothing/hyper-salivation: Syncope(R)/Seizure(C)
• Movements: Syncope(few clonic or myclonic jerks)/Seizure(Prolonged tonic phase-rhythmic clonic mvmts)
• Durations: Syncope(<15sec)/Seizure(30-120sec)

• Confusion/Disorientation: Syncope(R<30sec)/Seizure(C sev +mins)
• Diffuse myalgias: Syncope(R,brief, shoulders/chest)/Seizures(C, hr-days)
• Creatine kinase elevation: Syncope(R)/Seizure(C)

• W/somatosensory or special sensory symptoms
• W/motor signs
• W/autonomic symptoms or signs
• W/psychic or experiential symptoms

• Impaired consciousness
• Clinical manifestations vary: presence and nature of aura, automatisms, other motor activity
• Duration: <2min

• Begins focally w/ or w/o focal neurological symptoms
• Variable symmetry, intensity, and duration of tonic (stiffening) and clonic (jerking) phases
• Duration: 1-3 min
• Postical confusion, somnolence, w/ or w/o transient focal deficit

• Brief staring spells w/impairment of awareness
• Duration: 3-20 sec
• Sudden onset and sudden resolution
• Often provoked by hyperventilation
• Onset usually b/w 4-14 yrs old
• Often resolved by 18 yrs
• Normal development and intelligence

• Brief staring spells w/variably reduced responsiveness
• 5-30 sec
• Gradual onset and resolution
• Gen not provoked by hyperventilation
• Onset >6 yrs
• Often in children w/global cognitive impairment

Brief, shock-like jerk of a muscle or group of muscles

• Sudden loss of postural tone (Severe:fall vs. Mild:head nod or jaw drop)
• Consciousness usually impaired
• Duration: Seconds, rarely >1min

• Symmetric, tonic muscle contraction of extremities w/tonic flexion of waist and neck
• Duration: 2-20 sec

• Assoc w/loss of consciousness and post-ictal confusion/lethargy
• Duration: 30-120 sec
• Tonic Phase: Stiffening and fall, often assoc w/ictal cry
• Clonic Phase: Rhythmic extremity jerking

• No coughing or wheezing
• No SOB or rapid breathing
• No waking up at night
• Normal physical activities
• No school absences due to asthma
• No missed time from work for parent or caregiver

• Breathless at rest
• Hunched forward
• Speaks in words rather than complete sentences
• Agitated
• Peak flow rate less than 60% of normal