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632 Final Quiz
Substance abuse/Domestic viol./Pain/Nutritional/Child exam
| Question | Answer |
|---|---|
| How many times in the past year have you had 5 or more drinks a day | one or more heavy drinking days means this person is an at risk drinker |
| At risk drinking for men | >14 drinks/week or >4 drinks/occasion |
| At risk drinking for women | >7 drinks/week or >3 drinks/occasion |
| AUDIT | The alcohol use disorders identification test |
| The AUDIT covers 3 domains | alcohol consumption, drinking behavior or dependence, and adverse consequences from alcohol |
| CAGE questionnaire | Cutdown, Annoyed, Guilty, Eye-opener (answering yes to greater than 2 questions signal possible abuse |
| Screening women for alcohol problems- TWEAK | Tolerance, Worry, Eye-opener, Amnesia, Kut down |
| Screening aging adults- SMAST-G | Short Michigan Alcohol Screening Test- Geriatric Version |
| GGT (gamma glutamyl transferase) | most commonly used biochemical marker of alcohol drinking. Chronic alcohol drinking of >4 drinks/day for 4 to 8 weeks significantly raises GGT. |
| Serum aspartate aminotransferase (AST) is an enzyme found in high concentrations in the heart and liver | months of chronic drinking increases AST |
| MCV (mean corpuscular volume is an index of red blood cell size. | heavy alcohol drinking for 4 to 8 weeks increases MCV |
| Blood alcohol concentration | BAC of >0.08 = legal intoxication in most states (3 standard drinks) |
| Dependence | physiologic dependence on substance |
| Tolerance | requires increased amount of substance to produce same effect |
| Cocaine inoxication | Pupillary dilation |
| Opiate intoxication | Pupillary constriction |
| Opiate withdrawal | similar to influenza symptoms and pupillary dilation |
| IPV screening- Primary care | every first visit for a new chief complaint, every new patient encounter, every new intimate relationship, and all periodic exams |
| IPV screening- ER/Urgent care | all women/all visits |
| IPV screening- OB/GYN | each prenatal and postpartum visit, each new intimate relationship, all routine GYN visits, all family planning visits, and all visits in STI visits |
| IPV screening- Inpatient | part of all admissions and discharge |
| Abrasion | a wound caused by rubbing the skin or mucous membrane |
| avulsion | the tearing away of a structure or part |
| bruise | superficial discoloration due to hemorrhage into the tissues from the ruptured blood vessels beneath the skin surface, without the skin itself being broken; also called contusion |
| contusion | a bruise; injury to tissues without breaking of skin; blood from broken blood vessels accumulates, producing pain, swelling tenderness |
| cut | incision |
| ecchymosis | a hemorrhagic spot or blotch, larger than petechial, in the skin or mucous membrane, forming a non-elevated, rounded or regular, blue or purplish patch |
| hematoma | a localized collection of extravasated blood usually clotted in an organ, space, or tissue |
| hemorrhage | the escape of blood from a ruptured vessel, which can be external, internal, and/or into the skin or other organ |
| incision | a cut or wound made by a sharp instrument; the act of cutting |
| laceration | the act of tearing or splitting; a wound produced by the tearing and or splitting of body tissue usually from blunt impact over a bony surface |
| lesion | a broad term referring to any pathologic or traumatic discontinuity of tissue or loss of function of a part |
| Nociceptors | designed to detect painful sensations from the periphery and transmit them to the CNS |
| Nociceptors are located within the: | skin, connective tissue, muscle, and the thoracic, abdominal, and pelvic viscera |
| Nociceptors carry the pain signal to the CNS by 2 afferent fibers | A& and C |
| A& fibers | are myelinated an larger in diameter so they transmit the pain signal rapidly to the CNS |
| C fibers | are unmyelinated and smaller and they transmit the signal more slowly. These are diffuse and aching and last longer after the injury. |
| transduction | occurs when a noxious stimulus in the form of traumatic or chemical injury, burn, incision, or tumor takes place in the periphery. |
| transmission (second phase) | the pain impulse moves from the level of the spinal cord to the brain. |
| perception (third phase) | indicates the conscious awareness of a painful sensation. |
| modulation (fourth phase) | the pain message is inhibited through this phase or else we would continue to experience pain. |
| Examples of nociceptive pain | skinned knee, kidney stones, menstrual cramps, muscle strain, venipuncture, or arthritic joint pain. |
| Neuropathic pain implies: | an abnormal processing of the pain message from an injury to the nerve fibers. |
| Deep somatic pain comes from | sources such as the blood vessels, joints, tendons, muscles, and bone. |
| Cutaneous pain comes from | skin surface and subcutaneous tissues |
| Rating scales can be introduced at what age | 4 to 5 years of age |
| PAIN AID scale | Pain assessment in advanced dementia scale- score of 4 or more indicates need for pain management. |
| Reflexive sympathetic dystrophy (RSD) or complex regional pain syndrome (CRPS) | chronic progressive nerve condition, characterized by burning pain, swelling, stiffness, and discoloration of the affected extremity. |
| Mini Nutritional assessment (MNA) score of 8-11 | at risk for malnutrition |
| MNA tool score 0-7 | needs a more comprehensive assessment |
| Bleeding gums | Vitamin C deficiency |
| Glossitis (beefy red tongue) | Vitamin B deficiency |
| Waist circumference at risk for men | >40 in. |
| Waist circumference at risk for women | >35 in. |
| Mid arm circumference norm for 20 y.o. woman | 23-34.5cm |
| Mid arm circumference norm for 20 y.o. man | 27.2-37.2cm |
| Arm span is nearly equivalent to height | measure from sternal notch to the longest finger on the dominant hand, then multiply by 2 |
| Elbow breadth, a measure of skeletal breadth | is the most accurate method to determine frame size. |
| Hemoglobin/Hct- infant | 14.5-22.5/44-72 |
| Hemoglobin/Hct -2 months | 9-14/28-42 |
| Hemoglobin/Hct Children 6-12 | 11.5-15.5/35-45 |
| Hemoglobin/Hct adult males | 14-18/37-49 |
| Hemoglobin/Hct adult females | 12-16/36-46 |
| Total cholesterol | 120-200 |
| Triglycerides age 0-19 | 10-100 |
| Triglycerides age 20-65 | <150 |
| Serum albumin is a common measurement of | visceral protein status |
| Serum albumin half-life | 17-20 days |
| Normal serum albumin | 3.5-5.5g/dL |
| Serum transferrin half life | 8-10 days |
| True /False- Serum transferrin may be a more sensitive indicator of visceral protein status than albumin. | True |
| C-reactive protein (CRP ) | a plasma protein marker of inflammatory status produced by the liver, is used to monitor metabolic stress. |
| CRP normal values | < 0.1 mg/dL |
| Marasmus (protein calorie malnutrition) | is due to inadequate intake of protein and calories or prolonged starvation. |
| Kwashiorkor (protein malnutrition) | is due to diets high in calories but contain little or no protein, example; low protein liquid diets, fad diets, and long term use of dextrose containing IV fluids. Appear well-nourished or obese. |
| Pellagra | pigmented keratotic scaling lesions resulting from a deficiency of niacin |
| Magenta tongue | a sign of riboflavin deficiency |
| Pale tongue | Iron deficiency |
| Follicular hyperkeratosis | dry bumpy skin associated with vitamin A and/or linoleic acid (essential fatty acid) deficiency. |
| Rickets | sign of vitamin D and calcium deficiency |
| Bitot's Spots | Foamy plaques of the cornea that are a sign of vitamin A deficiency |
| Erikson | an individual's psychosocial development throughout the life stages, which he delineated |
| Piaget | a child's cognitive development and the way in which the child learns about the world as his or her abilities to reason correspond to cognitive growth |
| Kohlberg expanded on Piaget | focused on the moral development in children |
| More than six 5mm Café-au-lait spots and axillary freckling are associated with: | neurofibromatosis |
| Facial port wine stains are seen in: | Sturge Weber syndrome (often mental retardation present) |
| Low frontal hairline and thick, markedly arched eyebrows joined at the midline are clinical findings in: | Brachmann-de-Lange syndrome (which causes cognitive, speech, behavior, and growth abnormalities) |
| Upward slanting palpebral fissures and midface hypoplasia are seen in: | Down Syndrome |
| A smooth philtrum, flattened nose bridge, upturned nose, and thin upper lip are signs of: | FAS-fetal alcohol syndrome |
| Cataracts and microphthalmia are seen in: | congenital rubella |
| Low-set ears are seen in | Noonan syndrome |
| Primitive reflexes should not persist past | 4 months- if present cerebral palsy is suspected |
| Developmental surveillance | occurs within the context of the health maintenance visit. |
| Developmental screening | entails the use of standardized screening checklist to whether the child achieving expected developmental milestones. |
| Developmental evaluation | in-depth assessment that is performed when a child is suspected of having a developmental delay or disorder. |
| The AAP recommends screening for autism spectrum disorders at: | the 18 and 24 month well child visit. |
| Interval history | recent illness, update any changes in family situation, living conditions |
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