Exam 1 Terminology - PAP 580

persistent, complusive dependence on a behavior or substance

an observable, usually episodic, feeling or tone expresses through voice, facial expression, and demeanor

an irrational and often disabling fear of being out in public (fear of the marketplace)

loss of memory

Absence of sweating

a depression at the bend of the elbow

condition where blood passes through the inner lining and between the layers of the aorta - potentially fatal

A silent interval that may be present between the systolic and diastolic blood pressures, i.e. the sound disappears for a while, then reappears. Associated with atherosclerosis.

Located in or near the armpit

interruption of an afferent nerve pathway

episodic binge eating usually followed by behavior designed to negate the caloric intake of the ingested food, most commonly purging behaviors such as self-induced vomiting or laxative abuse but sometimes other methods such as excessive exercise or fasting

The presence of excess carotene in the blood, often resulting in yellowing of the skin. Also called xanthemia

characterized by dysfunctional interpersonal coping styles that disrupt and destabilize relationships, including those with health care providers - (paranoid, schizoid, schizotypal, antisocial, borderline, histrionic, narcissistic, avoidant, dependent, obessive-compulsive)

A feeling of cold, with shivering and pallor, sometimes accompanied by an elevation of temperature in the interior of the body

not associated with cancer or other medical condition that persists for more than 3-6 months

A disturbance in the thought process by detail that is often tangential and irrelevant

a pattern of speech in which words are selected because of sound rather than meaning, resulting in rhyming and punning (clang association) instead of logic; normal in young children but a sign of mental disturbance in older persons

A condition affecting the fingers and toes in which the extremities are broadened and the nails are shiny and abnormally curved

constriction of the aorta at the site of entry of the ductus arteriosus causing syndrome similar to stenosis of the aortic valve

A plug of keratin and sebum within a hair follicle that is blackened at the surface (blackhead)

actual medical conditions characterized by multiple symptoms that cannot be validated by PE or diagnostic testing (IBS, fibromyalgia, chronic fatigue syndrome)

• Changes in weight
• Fatigue
• Muscle weakness
• Fever, chills
• Night sweats

An uncontrollable impulse to perform an act, often repetitively, as an unconscious mechanism to avoid unacceptable ideas and desires which, by themselves, arouse anxiety.

unconscious filling in of gaps in memory by telling imaginary experiences

blue coloration of the skin and mucous membranes due to the presence of >5g/dl deoxygenated hemoglobin in blood vessels near the skin surface

due to circulatory or ventilatory problems that leads to poor blood oxygenation in the lungs or greater oxygen extraction due to the slowing down of blood circulation in the skin's blood vessels

blue tint in fingers or extremities due to inadequate circulation. All factors contributing to central cyanosis can also cause peripheral symptoms to appear, however peripheral cyanosis can be observed without there being heart or lung failures

A mild mood disorder characterized by alternating periods of elation and depression

To establish the limits or boundaries of; demarcate

A false belief strongly held in spite of invalidating evidence

A state in which the normal sense of personal identity and reality is lost

loosening of associations - speech in which a person shifts from one subject to others that are unrelated or related only obliquely without realizing that the subjects are not meaningfully connected

Indifference to or remoteness from the concerns of others; aloofness

perceptible and excessive sweating

The normal rhythmically occurring relaxation and dilatation of the heart chambers, especially the ventricles, during which they fill with blood

Difficulty in swallowing

bruise (black and blue)

The immediate and involuntary repetition of words or phrases just spoken by others, often a symptom of autism or some types of schizophrenia

An excessive accumulation of serous fluid in tissue spaces or a body cavity

A projection on the outer side of the distal end of the humerus; the external condyle

A feeling of great happiness or well-being

pain rating scale for pain severity using Wong-Baker faces

The decreased capacity or complete inability of an organism, an organ, or a part to function normally because of excessive stimulation or prolonged exertion

an almost continuous flow of accelerated speech in which a person changes abruply from topic to topic. Changes are usually based on understandable associations, plays on words or distracting stimuli but the ideas do not progress to sensible converstaion

Readily crumbled; brittle

gastroesophageal reflux disease

Perception of visual, auditory, tactile, olfactory, or gustatory experiences without an external stimulus and with a compelling sense of their reality, usually resulting from a mental disorder or as a response to a drug

A localized swelling filled with blood resulting from a break in a blood vessel.

excess hair growth

an extremely elevated temperature that sometimes occurs in acute infectious diseases, especially in young children

Abnormally low body temperature

unknown (without recognizable cause), pain without identifiable etiology

misinterpretation of real external stimuli

The hardening of a normally soft tissue or organ, especially the skin, because of inflammation, infiltration of a neoplasm, or an accumulation of blood

the capacity for understanding one's own or another's mental processes

yellowing of skin and eyes

The capacity to assess situations or circumstances and draw sound conclusions; good sense

Blood sounds during assessment of blood pressure. Low in pitch - generally better heard with bell of stethoscope

awake, alert, responsive to others in the environment

Affected with or marked by depression of the spirits

The invention of new words regarded as a symptom of certain psychotic disorders, such as schizophrenia.

mole, moles (NEE-vus, NEE-vi)

• occurrence of excessive sweating during sleep, (sleep hyperhidrosis)
• Hormonal changes
• GERD
• Sleep disorders
• Medications
• Infection
• Malignancy

tissue damage to skin, musculoskeletal system or viscera, but sensory nervous system is intact

fixation

awareness of one's environment with reference to time, place, and people.

abnormal decrease in blood pressure when person stands up - can lead to syncope

paleness, as of the skin

Perceptible to touch

thought processes, thought content, perceptions, insight & judgement

The tendency to continue or repeat an act or activity after the cessation of the original stimulus

intense but unrealistic fear that can interfere with the ability to socialize, work, or go about everyday life, brought on by an object, event or situation

relating to movement or muscular activity associated with mental processes, especially affects, associated with depression

part of obsessive-complusive disorder

redness of complextion

an induration or hardening, especially from inflammation and in diseases of the interstitial substance; applied chiefly to such hardening of the nervous system or to hardening of the blood vessels

liver spot (macule - small, flat spot up to 1.0 cm)

does patient show evidence of cardiac/respiratory distress, pain, anxiety/depression

linear hemorrhages beneath the nail

Occurring or existing at the same time

phase of blood circulation in which the heart's pumping chambers (ventricles) are actively pumping blood

heart rate >100 bpm

decreased susceptibility to the effects of a drug due to its continued administration

a condition of being feeble, fragile, frail, or decrepit or lacking physical strength, energy, or vigor

process of closely attending to what the patient is communicating, being aware of the patient's emotional state, using verbal and non-verbal skills to encourage the speaker to continue and expand upon important concerns

simple repetition of the patient's last words, encourages the patient to expand on factual details and feelings

the capacity of the clinician to identify with the patient and feel the patient's pain as the clinician's own.

Sharing power with the patient over their medical care by: evoking patient's perspective, conveying interest in the person not just the problem, following the patient's lead, elicit and validate emotional content, share information with the patient (especially at transition points during visit), make clinical reasoning transparent to patient, reveal the limits of your knowledge

questions aimed to elicit more focused responses

shows sustained interest in the patient's feelings and deepest disclosures - moving from open-ended to focused questions, using questions to elicit graded response, series of questions, multiple choices for answers, clarifying what the patient means, encouraging with continuers, using echoing

"hmmm", "mm-hm", "go on", encourages the patinet to say more

Onset, Location, Duration, Character, Aggravating/Alleviating Factors, Radiation, Timing

general questions, can elicit a number of responses, allow full freedom of response

Onset, Palliating/Provoking Factors, Quality, Radiation, Site, Timing

provider indicates understanding of patient's story and encourages the patient to express deeper feelings

when building relationships with your patients, be explicit about your commitment to an ongoing partnership - make the patient feel that regardless of what happens with their illness, you envision continuing their care

encourages patient to express what is most important to them, personal concerns in addition to symptoms

identifying and acknowledging the patient's feelings, later after examination/lab studies interpret for patient what you think is happening and deal openly with expressed concerns.  Reassurance comes from making the patient feel confident that problems have been fully understood and are being addressed.

self-disclosure-part of relationship building skills-and indirect inquiry-"I had a similar experience, it made me feel...."

giving a capsule summary of the patient's story during the course of the interview serves to show you have been listening carefully, identifies what you know and don't know, let's the patient add any other information or correct any misunderstandings

Patients may be apprehensive during a health care visit, to put them more at ease, tell them when you are changing directions during the interview.  Moving from one part of the history to the next, or moving to the physical examination. "Now I would like to examine you, I'll step out while you change into a gown."

to affirm the patient by acknowledging the legitimacy of his/her emotional experience

hair loss

disruption of the normal hair growth cycle resulting in sudden hair loss (attributed to medical or psychological causes)

male-pattern baldness

a compulsive urge to pull out one’s own hair

abnormal new growth of tissue

color, primary/secondary, lesions all same or variable, exudate

round, oval, annular (ring-shaped), iris (target-shaped), serpiginous (snake-like)

localized, generalized, symmetrical, acral (hands and feet), light-exposed areas, intertriginous (skin folds), clustered, dermatomal

painful, itching/burning, oozing/bleeding, scaly/crusty, suddenly different in size, shape, color or elevation

• epidermis
• dermis
• subcutaneous tissue

most superficial layer of skin

contains the blood supple for the skin, connective tissue, glands, and hair follicles

• sub = under, cutaneous = skin
• where adipose tissue is found

hair, nails, sebaceous and sweat glands

tissue under the nail

fingernail

seals the space between the nail fold and plate

• present in all surfaces except palms/soles;
• produce a fatty substance secreted onto skin surface through hair follicles

• eccrine
• apocrine

widely distributed, open directly onto skin surface, help control body temperature

found in axilla and groin, stimulated by emotional stress

measure of the elasticity of the skin, reflecting the pt's state of hydration (can also change with age)

• 80% of skin cancers
• shiny and translucent
• grow slowly and rarely metastasize

• 16% of skin cancers
• crusted, scaly, and ulcerated
• can metastasize

• 4% of skin cancers
• spread rapidly

• A:asymmetry
• B:borders (ragged, notched, blurred
• C:color (variation, change, blue/black)
• D:diameter (>=6mm)
• E:elevation/enlargement

does it turn white when pressed on

• color
• moisture
• temperature
• texture
• turgor
• lesions

extra pigmentation (e.g. melasma)

lack of pigmentation (e.g. vitiligo)

red hue, increased blood flow, used to describe rashes/lesions

tiny dots of color

around mouth

warty

• felt the need to CUT down on your drinking
• felt ANNOYED by criticism about your drinking
• had GUILTY feelings about your drinking
• taken a morning EYE opener

(each is a point, 2 or more suggests pt has alcohol or drug problem)

• anxiety
• confusion
• depression
• memory loss

existing at the same time

physical symptoms caused by mental illness

• unable to find interest in any activities
• (eating, working, etc)

acute confusional state, comes on quickly

chronic condition, progressive loss of cognitive function, starts slowly, gradually gets worse

specific type of dementia, memory loss

• MMSE
• Mini-cog
• Clock drawing test

an intellectual process by which one becomes aware of, perceives, or comprehends ideas.  Involves all aspects of perception, thinking, reasoning, and remembering, orientation, attention, remote & recent memory, new learning ability

symptoms that tend to be persistent or recurrent and for which no explanation can be found

actual medical conditions characterized by multiple symptoms that cannot be validated by PE or diagnostic testing (IBS, fibromyalgia, chronic fatigue syndrome)

symptoms seen in several of the functional syndromes (fatigue, sleep disturbance, muslculoskeletal pain, head ache, GI symptoms

one with unexplained and somatoform symptoms who becomes a frequent user of health care systems

• characterized by dysfunctional interpersonal coping styles that disrupt and destabilize relationships, including those with health care providers
• (paranoid, schizoid, schizotypal, antisocial, borderline, histrionic, narcissistic, avoidant, dependent, obessive-compulsive)

• group of psychiatric disorders that cause unexplained physical symptoms:
• somatization disorder {multisystem physical symptoms}
• conversion disorder {voluntary motor or sensory function symptoms}
• pain disorder {pain with strong psychological involvement}
• hypochondriasis {fear of having a life-threatening illness/condition}
• body dysmorphic disorder {leads to anorexia/bulimia}

panic disorder, obsessive-compulsive disorder, PTSD, social phobia, generalized anxiety disorder

• major depression, bipolar disorder, dysthymic disorder, cyclothymic disorder
• (AKA: affective disorders)

• delusions: false beliefs, someone plotting against you
• hallucinations: false perceptions, hearing, seeing or feeling something that is not there
• (schizophrenia, schizoaffective disorder, delusional disorder, substance-induced psychotic disorder)

• appearance and behavior
• speech and language
• mood
• thoughts and perception
• cognitive functions

• level of consciousness
• posture and motor behavior
• dress, grooming, personal hygiene
• facial expression
• manner, affect, relationship to people and things

quantity, rate, volume, articulation of words, fluency

thought processes, thought content, perceptions, insight & judgement

Mental Status Examination: Assessment of a pt's level of cognitive ability, appearance, emotional mood, and speech and thought patterns.  Includes full neuro exam as well as observations of pt's attitude and cooperativeness and pt's answers to specific questions

Mini-Mental Status Exam: commonly used test of cognitive functioning only, most commonly used in the assessment of dementia

temporal mandibular joint pain

swollen glands

• primary: migraine, tension, cluster, chronic daily HA
• secondary: underlying pathology - structural, systemic or infectious - may be life-threatening

bearing down to move bowels

progressively frequent or severe over 3 month period, sudden onset, new onset after 50yo, HA precipitated by Valsalva maneuver, assoc. symptoms of (fever, night sweats, weight loss), cocomitant cancer, HIV infection, assoc. eye symptoms or papilledema, neck stiffness or focal neurologic deficits

optic disk swelling

• Location
• Quality
• Severity
• Timing/Onset
• Setting
• Aggrevate
• Alleviate
• Associated symptoms

review of systems

problems, issues or conditions directly related to incident (head trauma leading to weakness, seizures etc)

head and all major organs of the head are in a normal condition and without significant abnormalities

Increased GH, bony prominences (brow, jaw), enlarged nose, lips, ears, hands

"moon face" and red cheeks due to increased adrenal hormone, possible hirsutism

severe hypothyroidism - puffy face, hair and eyebrows are dry, coarse, thinned, dry skin, parotitis

• swelling above angle(s) of jaw
• (also seen in mumps)

pen light shined from side to observe shadow/outline of structures

audible turbulant blood flow on auscultation (brew-EE)

over-production of thyroid hormone

• specifically distinctive or characteristic of a disease or pathologic condition
• (exophthalmos indicates hyperthyroidsm)

bulging eyes (most likely from hyperthyroidism) 

head/skull is normocephalic/atraumatic

excess fluid in the space between the tissues lining the abdomen and abdominal organs (the peritoneal cavity)

body mass index

chronic disorder of excessive weight characterized by excessive body fat and high health risk (BMI >= 30 kg/m²)

weight above the established normal range but below the criteria for obesity (BMI between 25 and 29.9)

cause or origin of symptoms

irregular rhythm - can produce variations in pressure

office blood pressure is normal but ambulatory pressure is high - increased risk of cardiovascular disease

office blood pressure is high but ambulatory pressures are normal - cardiovascular risk is low

activities normally performed over the course of a normal day (personal grooming, dressing, work, eating, leisure activities)

unpleasant sensory and emotional experience associated with tissue damage

absence of sensibility to pain

direct consequences of a lesion or disease affecting somatosensory systems

scale for rating pain (0-10)

synthetic narcotic that has opiate-like activities but not derived from opium

pharmacological/nonpharmacological approaches to reduce/stop pain

factors that influence a patient's report of pain (anxiety, depression, personality, coping style, cultural norms, social support systems)

substance dependence where there is evidence of tolerance/withdrawal

• small, flat spot up to 1.0 cm
• (hemangioma, vitiligo)
• Primary lesion

• flat spot, 1.0 cm or larger
• (café-au-lait spot)
• Primary lesion

• elevated lesion 1.0 cm or larger, often formed by coalescence of papules
• Primary lesion

• up to 1.0 cm
• (psoriasis)
• Primary lesion

• knot like lesion larger than 0.5 cm, deeper and firmer than a papule 
• (dermatofibroma)
• Primary lesion

• nodule filled with expressible material, either liquid or semisolid
• (epidermal inclusion cyst)
• Primary lesion

• somewhat irregular, relatively transient, superficial area of localized skin edema
• (uticaria)
• Primary lesion

• up to 1.0 cm; filled with serous fluid
• (herpes simplex herpes zoster)
• Primary lesion

• pl-bullae
• 1.0 cm or larger, filled with serous fluid
• (insect bite)
• Primary lesion

• filled with pus (yellow proteinacceous fluid filled with neutrophils)
• (acne, small pox)
• Primary lesion

• minute, slightly raised tunnel in the epidermis, commonly found on the finger webs and on the sides of the fingers.  Looks like short (5-15 mm), linear or curved gray line and may end in a tiny vesticle.
• (scabies)
• Primary lesion

• thin flake of dead exfoliated epidermis
• (ichthyosis vulgaris, dry skin)
• Secondary lesion

• dried residue of skin exudates such as serum, pus, or blood
• (impetigo)
• Secondary lesion

• visible and palpable thickening of the epidermis and roughening of the skin with increased visibility of the normal skin furrows (often from chronic rubbing)
• (neurodermatitis)
• Secondary lesion

• increased connective tissue that arises from injury or disease
• (hypertrophic scar from steroid injections)
• Secondary lesion

• hypertrophic scarring that extends beyond the borders of the initiating injury
• Secondary lesion

• nonscarring loss of the superficial epidermis; surface is moist but does not bleed
• (aphthous stomatitis, moist area after the rupture of a vesicle, as in chickenpox)
• Secondary lesion

• linear or punctate erosions caused by scratching
• (cat scratches)
• Secondary lesion

• linear crack in the skin, often resulting from dryness
• (athlete's foot)
• Secondary lesion

• a deeper loss of epidermis and dermis; may bleed and scar
• (stasus ulcer of venous insufficiency, syphilitic chancre)
• Secondary lesion

• Obstruction of the subclavian artery proximal to the origin of the vertebral artery. Blood flow through the vertebral artery is reversed, causing symptoms of cerebrovascular insufficiency.
• Steal -  diversion, as of blood flow, of something from its normal course, as in occlusive arterial disease

Non-directive questions that allow the patient to elaborate on the most important symptoms. This open-ended dialogue includes skills that don’t actually involve questions

• encourage the patient to talk with:
• Silence – saying nothing while continuing to be attentive
• Nonverbal encouragement – urges the patient to talk (hand motion, facial expression, or body language such as leaning forward)
• Neutral utterances and continuers also known as minimal facilitators) – brief noncommittal statements (“Oh”, “Uh-huh”, “Mmm”)

• The process of transmitting information without the use of words
• (Eye contact, facial expression, posture, head position, and movement such as shaking or nodding, hand and arm gestures, movement of the legs and feet, personal space, leaning in)

Objective data is information you learn during the physical exam, as well as any results from immediate diagnostic testing. Objective findings are always observable

• Open-ended Questions (tell me more about that)
• Closed-ended Questions (yes/no)

(echoing) repeating what the patient has just said, signals that the interviewer has heard what was said, and encourages the patient to elaborate

• Emotion-seeking
• Emotion-building (NURS)
• Name, Understanding, Respect, Support

• Part of NURS:
• Name or label the patient’s expressed emotions: “That scares you.”

• Part of NURS:
• Make an Understanding statement: “I can understand how that might upset you.”

• Part of NURS:
• Respect the patient by praising them or acknowledging their concerns: “You did the right thing.”

• Part of NURS:
• Offer Support and partnership: “We’ll get through this together.”

• Subjective information is what the patient tells you;
• Data obtained during the history taking part of the encounter

• Where - where exactly is it on your body?
• What - tell me what it feels like
• When - when does it start? Does it come and go?
• How - How is it affected by sleep, food, exertion, etc?
• Why - Why do you think you have this problem?
• Who - Who is affected by it? (consequences to patient and other people

Systolic <120, Diastolic <80

Systolic 120-139, Diastolic 80-89

Systolic 140-159, Diastolic 90-99

Systolic >=160, Diastolic >=100

Systolic <130, Diastolic <80