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If a female is having abdominal pain, what is an important question to ask the patient about?
Pregnancy
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Solid organs _____ their shape.
What are some examples?
- MAINTAIN
- liver, spleen, pancreas, adrenal glands, kidneys, ovaries and uterus
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Hollow organs shape depends on ______.
What are some examples of hollow organs?
- Depends on their content.
- stomach, gallbladder, small intestines, colon and bladder
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If a patient was recently on IV antibiotics what are you concerned about?
Cdiff infection
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Name 3 types of meds that cause constipation.
- Nsaids
- Narcotics
- Antibiotics
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What is the correct sequence for examination of the abdomen?
- 1. Inspection
- 2. Auscultation
- 3. Percussion
- 4. Palpation
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If a patient is greater than 60 years old, what lab should you run routinely?
Hepatitis Panel
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Upon assessment, you notice your patient has an enlarged spleen, what diagnosis are you concerned about?
Mononucleosis
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Upon assessment, you realize your patient has an enlarged liver, what diagnosis are you concerned about?
What tests would you perform to confirm your diagnosis?
- Cirrhosis
- LFTs, Hep Panel
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What is an associated symptom noticed on examination of a patient with a neoplasm of the esophagus or stomach?
severe bad breath
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If a patient has peptic ulcers, what would you expect their breath to be like?
acid like -- BAD breath
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If a patient has hepatic failure, what would you expect their breath to be like?
sickly, sweet odor
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If your patient has esophageal diverticulum, what would you expect their breath to be like?
odor of something decaying
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If your patient has a severe bowel obstruction, what would you expect their breath to be like?
odor of feces
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If your patient has cirrhosis with portal shunting, what would you expect their breath to be like?
odor of rotten eggs and garlic
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What are bruits?
vascular sounds resembling heart sounds
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What do venous hums indicate?
Are these common?
What do they sound like?
- -indicate increased collateral circulation between the portal and venous system
- -rare
- -sound like continuous humming
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Are friction rubs common?
What do they sound like?
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If you notice pulsating in the abdomen what do you suspect?
Can this be a normal finding?
- AAA
- yes if the patient is very thin/frail
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If you believe your patient has an AAA what would you order?
US
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If an AAA is >5cm what should you do?
consult vascular surgeon
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What is a symptom noted in the abdomen with CHF?
possible edema in abdomen
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Ascites in the abdomen can be related to what disease?
hepatic failure
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What is rebound tenderness?
What abdomen complication is it associated with?
- -provider will palpate deeply in the abdomen and then will suddenly release pressure, if pain is worse when the provider releases pressure + rebound tenderness
- -significant with peritoneal irritation and appendicitis
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What is a positive Murphy's sign?
What abdominal complication does it correlate with?
- -Palpate below the right costal margin. As the patient to take a deep breath. If the patient stops breathing mid-inspiration because of pain, the sign is positive.
- -Acute Cholecystitis (may also be present with hepatitis)
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What is a positive McBurney's sign?
What abdominal complication is it associated with?
- -McBurneys sign is tenderness and rigidity from the umbilicus to the right anterosuperior iliac spine. (rebound tenderness)
- -Appendicitis
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What is the obturator test?
What acute complication is it associated with?
- -With this test, the patient is placed in the supine position and their right leg is flexed at the hip and knee. A hand is placed just above the patient's knee with another hand at the patient's ankle. The leg will be rotated internally and externally. If that patient experiences pain in the abdomen the test is positive.
- -Ruptured appendix or pelvic infection
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If that patient were to stand on his/her toes and then drops down to their feet real fast and severe pain is felt, what condition are you suspicious of?
appendicitis
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When is morning sickness with pregnancy most common?
First trimester
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A neonate should pass meconium within ___.
If they pass meconium in utero what are you concerned about?
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What is a common assessment finding of the abdomen in a neonate?
- protuberant abdomen
- (round belly)
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When a neonate has jaundice, the yellowness will fade in what direction??
- fades from toes to head
- -may need phototherapy to help!
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Why does diverticulosis occur in the elderly?
changes in elastic tissue and colonic pressure
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How should a patient be laying to assess the abdomen?
Flat... with knees bent to prevent flexion of the abdominal muscles. Make sure to drape patient appropriately. Patient's hands will be to their sides with their head resting on a pillow.
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If you hear tympany when assessing a patients abdomen what do you assume is in this space?
- space is hollow (air or gas)
- -the abdomen is mostly hollow
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What would dullness on abdominal percussion be indicative of?
- feces or fluid
- organs (such as liver, spleen -- will only have dullness if enlarged)
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When a patient comes in complaining of a complication with the abdomen, which part should you assess last?
- most painful area last
- watch facial expressions when palpating painful area!
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What is located in the RUQ?
- gallbladder
- liver
- some pancreas
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What is located in the LUQ?
- pancreas
- spleen
- stomach
- intestines
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What is located in the RLQ?
- intestines
- appendix
- ovaries/testicles
- part of bladder (sits in the middle of abd.)
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What is located in the LLQ?
- intestines
- part of bladder
- ovaries/testicles
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How can you assess for Kidney infection/tenderness?
place your hand on the patients back at the costovertebral angle.. make your hand into a fist and lightly strike the hand on the patients back.. will feel pain if there is a complication with the kidneys
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Jaundice is usually first noted where?
- conjunctiva
- --use natural light when assessing for jaundice... incandescent light can mask the appearance of jaundice on the skin
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What are spider angiomas?
When are they seen? (3)
- -dilated blood vessels noted above the umbilicus
- 1. liver disease
- 2. pregnancy
- 3. malnutrition
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What is palmar erythema?
redness of the hands, often seen with spider angiomas
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What is koilonychia?
spoon shaped nails
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What is blue lunula?
and what is it associated with?
- -Blueness to the lunula of the nails (Cresant shaped area by the nail base)
- -Wilson's disease
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Half and half nails (where there is an increase in the size of the luluna) is associated with ____.
cirrhosis
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What is spider nevi?
What disease is it associated with?
- -spider like cluster of capillaries (like spider veins)
- -liver disease
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What is acanthosis nigricans?
brown to black, poorly defined, velvety hyperpigmentation of the skin. It is usually found in body folds, such as the posterior and lateral folds of the neck, the armpits, groin, navel, forehead, and other areas (associated with DM)
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What is Xanthalasma?
sharply demarcated yellowish deposit of fat underneath the skin, usually on or around the eyelids. While they are neither harmful nor painful, these minor growths may be disfiguring and can be removed
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Aphthous also means...
canker sores
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Fetorhepaticus means?
Bad breath --- breath of the dead!
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What is leukoplakia?
- White/gray patches in the mouth
- characteristic of oral cancer
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What is odenophagia?
painful swallowing
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What is dyspepsia?
pain and burning (acidic)
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What is tenesmus?
Painful but unproductive urge to defecate
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What is grey turners sign?
- Bluish discoloration to the flanks
- associated with pancreatitis
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What is cullens sign?
Bluish discoloration the belly button... associated with pancreatitis
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What is hematochezia?
passage of bright red stools
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What are some common findings associated with advanced liver disease?
- 1. Hyperbilirubinemia
- 2. Ascites
- 3. Increased estrogen levels (breast development, testicular atrophy, spider angioma)
- 4. Lower extremity edema
- 5. Varices (dilated veins)
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What is icterus?
- yellow discoloration of the sclera
- associated with liver disease
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What is bilirubinuria?
golden-brown discoloration of the urine
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What symptoms would be present with cholecystitis?
severe epigastic pain, RUQ pain, referred to shoulder, + Murphy's sign
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What symptoms would be present with diverticulitis?
epigastic pain, radiates to L side especially after eating
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What symptoms would be present with intestinal obstruction?
severe pain, spasmlike
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What symptoms would be present with pancreatitis?
acute, excruciating pain, LUQ, referred flank and L shoulder pain, guarding, N/V
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What symptoms would be present with a perforated ulcer?
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What symptoms would be present with the rupture of an organ?
nonlocalized pain
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What symptoms would be present with bilary stones?
- intense RUQ pain
- "cramping"
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Level of consciousness
How aware the person is of his environment
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Attention
The ability to focus or concentrate
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Alert
Patient is awake and aware
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Lethargic
Must speak in a loud forceful manner to illicit a response
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Obtunded
Must shake patient to get a response
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Stupurous
Pt unarousable except with painful stimuli
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coma
completely unarousable
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memory
Process of recording and retrieving info
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Short term memory vs Long term memory
Mins to days vs Months to years
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Orientation
Aware of person, place and time (requires memory and attention)
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Perceptions
Awareness of the objective in the environment to the 5 senses and their interrelationships
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thought processes
The logic, coherence and relevance of a patient’s thoughts as they lead to thoughts and goals; how people think
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insight
Awareness that thought, symptoms or behaviors are normal or abnormal; distinguishes that a daydream or hallucination are not real
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Judgement
Process of comparing and evaluation different possible courses of action
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affect
The observable mood of a person expressed through facial expression, body movements and voice
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mood
The sustained emotion of the patient
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Fluency
Involves the rate, flow and melody of speech
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Circumlocutions
Words of phrases are substituted for the word a person cannot remember “the thing you block out your writing with” ---eraser
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Paraphasias
Words are malformed, wrong or invented (“I write with a den”, I write with a branch”)
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Delrailment
Speech in which a person shifts topics with no apparent relation between the topics
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flight of ideas
Accelerated change of topics in a very fast but generally coherent(organized)manner
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Neologisms
Invented or distorted words
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incoherence
Distorting words
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confabulation
Remember things differently than others did, may make things up
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Perserveration
can't let things go. constantly bringing them up
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Echolalia
repetition of words
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Schizophrenia
disorder in which people interpret reality abnormally. Schizophrenia may result in some combination of hallucinations, delusions, and disordered thinking and behavior. – “split mind”
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OCD
characterized by unreasonable thoughts and fears (obsessions) that lead you to do repetitive behaviors (compulsions). With obsessive-compulsive disorder, you may realize that your obsessions aren't reasonable, and you may try to ignore them or stop them. But that only increases your distress and anxiety. Ultimately, you feel driven to perform compulsive acts in an effort to ease your stressful feelings.
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malingering
To pretend you’re ill to get out of work – exaggerating symptoms to gain something
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Conversion disorder
Physical symptoms occur without specific cause such as blindness or paralysis – all in the patient’s head
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Somatization disorder
Physical complaints but there is no physical reason for your complaints, believe something is wrong even tho it’s not
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CAGE Questionnaire r/t to Alcohol&Illicit Drugs
Have you ever felt the need to CUT down on drinking? Have you ever felt ANNOYED by criticism of your drinking? Have you ever felt GUILTY about drinking? Have you ever taken a drink first thing in the morning (EYE OPENER) to steady your nerves or get rid of a hangover?
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Bipolar DIGFAST
Distractibility, indiscretion, grandiosity, flight of ideas, activity increase, sleep deficit, talkativeness
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Depression SIGECAPS
Sleep, interest, guilt, energy, concentration, appetite, psychomotor activity, suicide
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Clanging
Speaking with rhyming words even tho it doesn’t make any sense
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delusions
Fake, fixed beliefs that are not shared by other members of the person’s culture
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compulsions
Strong irresistible impulse to perform an act
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Obsessions
The domination of ones thoughts by an idea, image or desire
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Anxiety
Excess anxiety and worry about a number of topics of most days for 6 months
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Delusion of Reference
Person believes an outside event or object has an unusual personal reference to them (comet passing the earth means they should buy a car)
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Believing one has a disease or defect that he does not
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Illusions
Misinterpretations of the real stimuli (postman leaves mail, patient believes he is trying to poison him)
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