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Questions and Answers
Which condition is characterized by an inward deviation of the eye?
What are symptoms associated with lacrimal gland enlargement?
What is a recommended practice for communicating with a blind patient?
Which treatment is appropriate for viral conditions causing lacrimal gland swelling?
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Which approach should be avoided when establishing rapport with patients with disabilities?
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Which of the following is NOT typically gathered in a clinical assessment?
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What is the primary purpose of assessing the thyroid eye disease in a patient?
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What is a common cause of lacrimal gland enlargement known as dacryoadenitis?
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Which cranial nerve is associated with clenching the jaw and sensory functions?
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What is the primary function of the Vagus nerve (Nerve X)?
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Which area of examination does palpating lymph nodes fall under?
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The Snellen chart is primarily used to assess the function of which cranial nerve?
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What is the significance of asking a patient to say 'Aaaa' during an examination?
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In which context should patient assessments about social challenges be conducted?
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Which cranial nerve is assessed by having a patient perform extra ocular movements by following fingers?
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What might indicate a need for further investigation regarding a patient's fatigue?
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Which of the following is NOT a characteristic feature indicating Alzheimer's disease?
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What is the primary function of cholinesterase inhibitors in the treatment of Alzheimer's disease?
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Which of the following conditions can contribute to fatigue aside from depression and anxiety?
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What diagnostic criteria must be met to support a diagnosis of Alzheimer's disease?
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Which drug is primarily used to block the effects of glutamate in Alzheimer's treatment?
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Which stage of Alzheimer's disease is marked by impaired judgment and confusion in performing tasks?
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Which of the following best describes person-centered care in the context of Alzheimer's management?
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Which medication type should only be considered after other strategies for managing behavioral symptoms in Alzheimer's disease have been tried?
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Which of the following is NOT a common cause of breath odor (halitosis)?
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What is the primary organism responsible for primary syphilis?
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Which of the following triggers localized swelling in angioedema?
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Among the following, which is NOT a risk factor for carcinoma of the lip?
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What is the most frequently reported illicit drug use in the USA?
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What characteristic is commonly observed in inguinal lymphadenopathy associated with syphilis?
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Which treatment is considered the preferred method for early-stage syphilis?
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During which examination phase would a doctor ask questions to determine the stage of syphilis infection?
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What symptom is commonly associated with streptococcal pharyngitis?
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Which of the following foods is NOT high in potassium?
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Which of the following drugs is most commonly associated with overdose cases?
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What characteristic is typical of the primary chancre in syphilis?
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Which of the following factors is NOT a risk factor for developing carcinoma of the lip?
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What is a common cause of halitosis?
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Which screening test is typically performed to assess for dementia?
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What is a characteristic feature of hypertropia?
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Which condition is often mistaken for lacrimal gland enlargement but is primarily due to dryness of the eyes?
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What is an important consideration when communicating with patients who have hearing impairments?
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Which of the following assessments is NOT typically part of a clinical assessment?
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Which behavior should be avoided when establishing rapport with patients who have disabilities?
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What is a common symptom of thyroid eye disease?
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Which of the following systems may be affected by lacrimal gland tumors?
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What is the primary cause of acute dacryoadenitis?
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What is a common symptom associated with the later stages of Alzheimer's disease?
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Which medication type is commonly the first line of treatment for behavioral symptoms in Alzheimer's disease?
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What type of care focuses on tailoring treatment to a patient's interests and personality in Alzheimer's management?
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Which of the following is considered a characteristic of Alzheimer's disease?
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What condition is indicated by experiencing fatigue along with symptoms of depression and anxiety?
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Which treatment is used to slow the progression of symptoms in moderate to severe Alzheimer's disease?
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Which of the following drugs targets beta-amyloid to reduce amyloid plaques in Alzheimer's treatment?
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Which characteristic feature is NOT associated with Alzheimer's disease?
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What is the main focus during the examination of the Trigeminal nerve (Nerve V)?
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What is one of the key roles of the Vagus nerve (Nerve X)?
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Which cranial nerve is assessed by asking a patient to raise their eyebrows, puff their cheeks, and smile?
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In conducting a thorough patient assessment, what is the significance of auscultation?
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What aspect is NOT typically checked during the examination of the abdominal area?
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Which cranial nerve’s function includes the assessment of voice quality and the gag reflex?
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What is the purpose of checking neurological/psychiatric functions during a patient assessment?
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Which practice is essential in addressing health disparities at the community level?
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What is a common physical characteristic of the lymph nodes in inguinal lymphadenopathy associated with syphilis?
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What is the main purpose of the blood tests ordered for syphilis diagnosis?
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What is the recommended antibiotic for the treatment of early-stage syphilis?
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Which symptom is NOT typically present in streptococcal pharyngitis?
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Which of the following foods is considered high in potassium?
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What is the primary screening test used to assess for dementia?
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Which of the following is a common risk factor for carcinoma of the lip?
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What food category is known to help reduce cardiovascular risks?
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What is a common cause of halitosis?
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Which of these drugs is commonly associated with overdose cases?
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What is a common feature of inguinal lymphadenopathy associated with syphilis?
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What is the preferred treatment for early-stage syphilis?
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What diagnostic test is primarily used to detect group A streptococcus in cases of streptococcal pharyngitis?
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Which food is known to be high in potassium?
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Which condition can develop in 20-30% of patients while chancre lesions are still present?
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What is the defining characteristic of hypertropia?
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Which condition is most commonly associated with inflammation of the lacrimal gland?
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What is the primary communication strategy for patients with hearing impairments?
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How can pressure on the eye be a symptom of lacrimal gland enlargement?
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What is an ineffective way to build rapport with patients with disabilities?
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Which of the following symptoms is typically NOT associated with thyroid eye disease?
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What type of health assessment typically includes evaluating the sclera and conjunctiva?
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Which approach is recommended when establishing contact with a blind or low-vision patient?
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Which symptom is commonly associated with the later stages of Alzheimer's disease?
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What type of drug is typically the first choice for managing behavioral symptoms in Alzheimer's patients?
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Which feature is essential for a diagnosis of Alzheimer's disease?
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Which of the following is a characteristic treatment for cognitive decline in Alzheimer's disease?
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Which option describes the function of memantine in Alzheimer's treatment?
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What symptom may occur due to the later stages of Alzheimer's disease?
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Which aspect is pivotal in person-centered care for Alzheimer's patients?
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Which condition is associated with cognitive decline but is not Alzheimer's disease?
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What is the primary assessment method for evaluating cranial nerve function associated with eye movements?
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Which cranial nerve is assessed by asking the patient to raise their eyebrows and smile?
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What ability is primarily evaluated by the whisper test?
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How can a healthcare provider address health disparities at the community level?
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Which examination technique is useful for assessing lung function?
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What is a common cause of fatigue that should be further investigated?
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Which cranial nerve is primarily involved with the gag reflex?
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What is a key aspect to investigate when a patient presents with fatigue?
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Study Notes
Eye Deviation Terms
- Esotropia: Inward deviation of the eye.
- Exotropia: Outward deviation of the eye.
- Hypertropia: Upward deviation of the eye.
- Hypotropia: Downward deviation of the eye.
Lacrimal Gland Disorders
- Lacrimal gland enlargement (dacryoadenitis) causes: Infections, inflammation, autoimmune diseases (acute and chronic dacryoadenitis), lacrimal gland tumors, Sjögren Syndrome.
- Lacrimal gland swelling symptoms: Pressure on the eye, distorted vision.
- Lacrimal gland swelling treatment: Varies based on the cause. For example, viral conditions like mumps can be treated with rest and warm compresses. If you notice any swelling, pain, or discoloration near your eye, consult an eye care specialist or healthcare provider.
Therapeutic Communication
- For blind/low-vision patients: Establish contact by shaking hands, introduce yourself and others in the room, verbally orient the patient to the environment, encourage the use of glasses if applicable, explain things verbally as gestures may not be perceived.
- For patients with hearing impairment: Determine the preferred method of communication, consider using an ASL interpreter, encourage the use of hearing aids.
Effective Patient Encounters
- Establishing rapport with patients with disabilities: Make eye contact, engage in casual conversation, avoid talking down to the patient, be compassionate and respectful.
Clues to the Patient's Perspective on Illness
- Bickley's text provides clues to understanding a patient's perspective on their illness.
Clinical Assessment
- Vitals: Essential for understanding patient health status.
- General Assessment: Observe orientation, mood, memory, odors, grooming, etc.
- Eye Examination: Assess pupil size, accommodation, conjunctiva, sclera, otoscope, visual acuity.
- HEENT Examination: Assess scalp, hair, face, ear canal (otoscope), nose, mouth (symmetry, color, moisture, lesions, mucosa, teeth, palate, tongue), Weber test/Rinhe test.
-
Cranial Nerve Assessment:
- Nerve I (Olfactory): Not tested during a routine exam.
- Nerve II (Optic): Visual acuity testing using a Snellen chart.
- Nerves III (Oculomotor), IV (Trochlear), and VI (Abducens): Assess extra-ocular movements by following fingers.
- Nerve V (Trigeminal): Assess motor function by having the patient clench their jaw, sensory function by touching the skin, and corneal reflex.
- Nerve VII (Facial): Assess by having the patient raise eyebrows, puff cheeks, and smile.
- Nerve VIII (Vestibulocochlear): Whispering something to test hearing.
- Nerve IX (Glossopharyngeal): Assess by having the patient say "Aaaa," evaluating the quality of voice for hoarseness, and checking the gag reflex with a tongue depressor.
- Nerve X (Vagus): Not directly tested, but assessed indirectly through other cranial nerve assessments.
- Nerve XI (Spinal Accessory): Assess trapezius muscles by having the patient shrug shoulders, turn their neck side to side.
- Nerve XII (Hypoglossal): Assess by having the patient stick out their tongue, evaluating for symmetry.
- Neck Examination: Palpate lymph nodes, masses, neck pulsations, assess trachea midline, observe swallowing, check the thyroid.
- Respiratory System Assessment: Observe rate, rhythm, and depth of respiration, auscultate lungs, and assess under the axilla.
- Cardiovascular System Assessment: Observe Jugular vein, carotid pulse, listen for bruits in the neck, auscultate the heart at six locations.
- Gastrointestinal System Assessment: Listen to bowel sounds, palpate abdomen lightly then with more pressure, percuss the liver.
- Musculoskeletal System Assessment: Assess gait, knee bends, range of motion.
- Integumentary System Assessment: Assess skin for moisture, ulcers, pallor, discoloration, and moles.
- Neurologic/Psychiatric Assessment: Assess mental status, cranial nerves, motor system, reflexes, and cognitive functions.
- Genitourinary System Assessment: General genitalia, females: Pap smear and bimanual palpation of the uterus, anorectal fistula.
Understanding Racism and Bias and Social Determinants of Health
- How to improve patient health and reduce inequities: This is a complex issue requiring multi-level strategies.
-
Addressing health disparities:
- Patient Level: Engage patients about social challenges and guide them to resources like Medicaid, community health clinics, etc. to access benefits/support services.
- Practice Level: Offer culturally safe care, utilize patient care navigators, ensure accessibility of care to those most in need.
- Community Level: Partner with local organizations and public health agencies to address social determinants of health.
Purpose of Essential Assessment Techniques
- Inspection: Visual assessment, observing the patient's appearance and behaviors.
- Palpation: Using touch to assess different body parts for texture, temperature, moisture, masses, and tenderness.
- Auscultation: Listening to sounds within the body with a stethoscope, assessing the heart, lungs, and bowels.
- Percussion: Tapping lightly on the patient's body using fingers, which produces sound waves that help evaluate underlying structures and tissues.
Fatigue
- Causes: Depression, anxiety, normal response to hard work/stress/grief. Investigate further when fatigue is unrelated to these usual causes.
- Assessment: Consider depression/anxiety, infectious, endocrine, adrenal issues, heart failure, COPD/CKD, anemia, electrolyte imbalance, malignancy, nutritional deficiencies, and medication side effects.
Thyroid Disorders
- Hypothyroidism: Bickley's text lists the signs and symptoms of hypothyroidism.
- Hyperthyroidism: Bickley's text lists the signs and symptoms of hyperthyroidism.
Alzheimer's Disease
- Characteristics: Evidence of causative genetic mutation, cognitive decline in at least two domains, clear evidence of decline in memory and learning, steady progressive decline in cognition, no evidence of other contributing conditions, preserved alertness and attention.
- Diagnostic Tests: Family history, genetic testing, evaluation of cognitive decline.
- Treatment: There is no cure, but therapies like cholinesterase inhibitors (donepezil, galantamine, rivastigmine), memantine, immunotherapy drugs (lecanemab, donanemab), antidepressants, antipsychotics, anti-anxiety drugs, and person-centered care can help manage symptoms and slow progression.
Suicide Risk
- Highest Incidence: Bickley's text mentions who has the highest incidence of suicide.
Dementia Screening
- Montreal Cognitive Assessment (MoCa): A commonly used screening tool.
Substance Abuse
- Common Illicit Drugs: Marijuana, cocaine, and psychotherapeutic drugs.
- Common Overdose Drugs: Opioids and Fentanyl.
Cardiovascular Risk Reduction
- Foods High in Potassium: Examples include avocados, bananas, melons, oranges, prunes, raisins, artichokes, winter squash, plantains, spinach, potatoes, tomatoes, bran, wild rice, baked beans, certain fish, chicken, beef.
Halitosis (Breath Odor)
- Common Causes: Poor oral hygiene, tobacco smoking, plaque retention on teeth, dentures, and periodontal disease.
Bacterial Throat Infection
- Diagnostic Tests: Rapid antigen testing for streptococcus and fusobacterium.
Carcinoma of the Lip
- Risk Factors: Tobacco use, fair skin, excessive sun exposure, weakened immune system.
Angioedema
- Cause: Localized swelling beneath the skin or mucous membranes due to leaking fluid into the interstitial tissue. Triggered by mast cells. May be associated with urticaria and pruritus. Usually resolves within 24-48 hours. Can be life-threatening if it affects the larynx, tongue, or upper airway.
Primary Syphilis
- Characteristics: Small red papule that develops into a chancre - a painless erosion up to 2 cm in diameter, smooth and glistening base, raised indurated borders. Heals within 2-3 weeks. Inguinal lymphadenopathy (rubber, non-tender, mobile lymph nodes) may occur. May develop secondary syphilis while chancre is present.
- Causative Organism: Treponema pallidum (spirochete). Incubation period 9-90 days after exposure.
- Diagnostic tests: Blood tests, physical exam.
- Treatment: Penicillin (single shot for early stages), alternatives available for penicillin allergy.
Exudative Tonsillitis
- Characteristics: Streptococcal pharyngitis often presents with white or yellow exudates on tonsils or posterior pharynx, red beefy uvula, and palatal petechiae.
- Diagnostic Tests: Rapid antigen strep test to detect Group A streptococcus.
- Treatment: Treatment for strep throat.
Eye Deviation Terms
- Esotropia is an inward deviation of the eye.
- Exotropia is an outward deviation of the eye.
- Hypertropia is an upward deviation of the eye.
- Hypotropia is a downward deviation of the eye.
Lacrimal Gland Conditions
-
Lacrimal gland enlargement can be caused by infections, inflammation, or autoimmune diseases, such as:
- Acute dacryoadenitis
- Chronic dacryoadenitis
- Lacrimal gland tumors
- Sjögren Syndrome
- Symptoms of lacrimal gland swelling include: pressure on the eye and distorted vision.
Therapeutic Communication
-
When communicating with blind or low-vision patients:
- Shake hands to establish contact.
- Verbally explain your name and role.
- Introduce anyone else in the room.
- Verbally orient the patient to the room.
- Encourage the use of glasses if they wear them.
-
When communicating with patients with hearing impairments:
- Find out the patient's preferred method of communication.
- Consider using an ASL interpreter if necessary.
- Encourage the use of hearing aids.
Effective Patient Encounter
-
Establish rapport by:
- Making eye contact.
- Engaging in simple conversations.
- Avoiding talking down to the patient or being condescending.
Patient Perspective on Illness
-
Clues to a patient's perspective on illness include:
- The patient's understanding of their illness or condition.
- The patient's level of concern or anxiety.
- The patient's expectations for treatment.
- The patient's willingness or ability to participate in treatment.
Clinical Assessment Information
- Vitals: Temperature, pulse, respiration, blood pressure
- General: Orientation, mood, memory, odors, grooming
- Eyes: Pupil size, accommodation, conjunctiva, sclera, otoscope, acuity (Snellen chart)
-
HENT:
- Scalp, hair, face, ear canal (otoscope), nose, mouth (symmetry, colour, moisture, lesions, mucosa, teeth, palate, tongue)
- Weber and Rinne tests
-
Cranial Nerves:
- Nerve I (Olfactory): Not tested during a routine exam.
- Nerve II (Optic): Snellen chart.
- Nerve III (Oculomotor), IV (Trochlear), VI (Abducens): Extraocular movement testing (follow fingers).
- Nerve V (Trigeminal): Motor (clench jaw), Sensory (touch skin), Corneal reflex.
- Nerve VII (Facial): Raise eyebrows, puff cheeks, smile.
- Nerve VIII (Vestibulocochlear): Whisper test.
- Nerve IX (Glossopharyngeal): Say "Aaaa". Note quality of voice, hoarseness, and gag reflex.
- Nerve X (Vagus): Assessed during other cranial nerve testing.
- Nerve XI (Spinal Accessory): Shrug shoulders, turn neck side to side.
- Nerve XII (Hypoglossal): Stick out tongue, assess symmetry.
- Neck: Palpate lymph nodes, masses, neck pulsations, check trachea midline, swallow, assess thyroid.
- Respiratory: Rate, rhythm, depth of breathing, auscultate lungs (front and back, under axilla).
- Cardiovascular: Thorax observation (jugular vein, carotid pulse, listen for bruits), auscultate heart in all six spots.
- Gastrointestinal: Listen to bowel sounds, palpate abdomen (light then harder), percuss liver.
- Musculoskeletal: Gait, knee bends.
- Integumentary: Moisture, ulcers, pallor, discoloration, moles.
- Neurologic/Psychiatric: Mental status exam, cranial nerves, motor system, reflexes, BUE and BLE reflexes.
-
Genitourinary:
- General genitalia.
- Females: Pap smear and bimanual palpation of uterus, anorectal fistula.
FIFE Mnemonic
-
FIFE is a mnemonic for understanding a patient’s perspective on their illness.
- Feeling: How the patient feels about their illness.
- Ideas: What the patient believes is causing their illness.
- Fears: What the patient is afraid of regarding their illness.
- Expectations: What the patient expects from treatment.
Racism and Bias, Social Determinants of Health
-
Social Determinants of Health: Factors that influence a person’s health, including:
- Economic status
- Education
- Social support
- Housing
- Transportation
- Access to healthcare
Reducing Health Inequalities
-
At the patient level:
- Ask about social challenges.
- Provide guidance on accessing benefits and support services (e.g., Medicaid, health clinics).
-
At the practice level:
- Offer culturally safe care.
- Implement patient care navigators.
- Ensure care is accessible to those most in need.
-
At the community level:
- Partner with local organizations and public health agencies.
Purpose of Physical Examination Techniques
- Inspection: Visual observation of the patient's appearance and behavior.
- Palpation: Using the hands to feel for abnormalities in the body.
- Auscultation: Using a stethoscope to listen to internal body sounds.
- Percussion: Tapping on the body to assess the underlying structures.
Fatigue Assessment
-
Causes: Fatigue is a normal response to hard work, sustained stress, and grief, but can also be a symptom of:
- Depression and anxiety
- Infectious diseases
- Endocrine disorders
- Adrenal insufficiency
- Heart failure
- COPD/CKD
- Anemia
- Electrolyte imbalances
- Malignancy
- Nutritional deficiencies
- Medication side effects
Hypothyroidism vs. Hyperthyroidism
-
Hypothyroidism: Characterized by:
- Weight gain
- Fatigue
- Cold intolerance
- Constipation
- Dry skin and hair
- Depression
-
Hyperthyroidism: Characterized by:
- Weight loss
- Increased appetite
- Heat intolerance
- Tremors
- Insomnia
- Anxiety
- Increased heart rate
- Goiter
Alzheimer’s Disease
-
Characteristics: **
- Evidence of a causative genetic mutation from family history or genetic testing.
- Cognitive decline in TWO or MORE cognitive domains.
- Clear evidence of decline in memory and learning and at least one other cognitive domain.
- Steady progressive decline in cognition without extended plateaus.
- No evidence of mixed etiology from other neurodegenerative, cerebrovascular, mental, or systemic disease.
- Alertness and attention are preserved.
-
Diagnostic Tests:
- Physical exam.
- Thorough history.
- Imaging scans, such as a CT scan or MRI of the brain.
- Neuropsychological tests, such as the Mini-Mental State Examination (MMSE) or the Montreal Cognitive Assessment (MoCA).
-
Treatment Plan:
- Cholinesterase inhibitors: Increase levels of acetylcholine in the brain to improve memory and behavioral symptoms (e.g., donepezil, galantamine, rivastigmine).
- Memantine: Slows the progression of symptoms in moderate to severe Alzheimer's disease.
- Immunotherapy drugs: Target beta-amyloid to reduce amyloid plaques (e.g., lecanemab, donanemab).
- Antidepressants, antipsychotics, and anti-anxiety drugs: Help with behavioral and psychological symptoms.
- Person-centered care: Tailored treatment plans based on individual needs, interests, and abilities.
Suicide Incidence
- The highest incidence of suicide is among males over the age of 85.
Dementia Screening Test
- The Montreal Cognitive Assessment (MoCA) is a common screening test for dementia.
Common Illicit Drugs
-
Most common illicit drugs in the United States include:
- Marijuana
- Cocaine
- Psychotherapeutic drugs
Common Drug Overdose
- Opioids and Fentanyl are commonly overdosed drugs.
Cardiovascular Risk Reduction Foods
- Foods that reduce cardiovascular risk include:
- Fruits and vegetables
- Whole grains
- Lean protein
- Low-fat dairy
Halitosis (Bad Breath)
-
Common causes:
- Poor oral hygiene
- Tobacco smoking
- Plaque retention on teeth
- Dentures
- Periodontal disease
Bacterial Throat Infection (Strep Throat)
-
Diagnostic tests:
- Rapid antigen testing for streptococcus and fusobacterium.
Carcinoma of the Lip Risk Factors
-
Risk factors for lip cancer include:
- Tobacco use (cigarettes, cigars, pipes, chewing tobacco, snuff)
- Fair skin
- Excessive sun exposure to the lips
- Weakened immune system
Angioedema
- Cause: Localized subcutaneous or submucosal swelling caused by leakage of intravascular fluid into interstitial tissue, triggered by mast cells.
- Associated symptoms: Urticaria (hives) and pruritus (itching).
- Usually resolves within 24-48 hours.
- Life-threatening if it involves the larynx, tongue, or upper airway and develops into anaphylaxis
Primary Syphilis
- Characteristics: Small red papule that becomes a chancre (painless erosion up to 2 cm in diameter with a smooth, red, glistening base and raised, indurated borders). Chancre heals within 2-3 weeks.
- Causative organism: Treponema pallidum (a spirochete).
- Incubation period: 9-90 days after exposure.
- May develop inguinal lymphadenopathy within 7 days: Lymph nodes are rubbery, non-tender, and mobile.
- 20-30% of patients develop secondary syphilis while the chancre is still present: This suggests HIV infection.
- Diagnostic tests: Blood tests, physical exam.
- Treatment Plan: Antibiotics (e.g., penicillin).
Exudative Tonsillitis
- Characteristics: Streptococcal pharyngitis typically produces white/yellow exudates on the tonsils or posterior pharynx, with a red beefy uvula and palatal petechiae.
- Diagnostic tests: Rapid antigen strep test (detects group A streptococcus).
- Treatment: Antibiotics (e.g., penicillin) for strep throat.
Foods High in Potassium
-
Examples:
- Avocado, banana, melons, oranges, prunes, raisins
- Artichokes, winter squash, plantains, spinach, potatoes, tomatoes
- Bran products, granola
- Beans
- Brown or wild rice
- Fish
- Chicken
- Beef
Eye Deviation
- Esotropia (inward deviation)
- Exotropia (outward deviation)
- Hypertropia (Upward deviation)
- Hypotropia (Downward deviation)
Lacrimal Gland Issues
- Lacrimal gland enlargement can be caused by infections, inflammation, or autoimmune diseases
- Acute dacryoadenitis
- Chronic dacryoadenitis
- Lacrimal gland tumors
- Sjögren Syndrome
- Symptoms of lacrimal gland swelling: Pressure on the eye and Distorted vision
- Treatment for lacrimal gland swelling depends on the cause
Communicating with Patients
- Blind/Low-Vision: Establish contact through shaking hands, verbally explain your name and your role, verbally orient the patient to the room, encourage them to wear their glasses if they have them.
- Hearing impairment: Find out the patient's preferred method of communication, consider using an ASL interpreter, encourage the patient to use hearing aids.
Establishing Rapport
- Make eye contact and engage in simple conversations
- Avoid talking down to patients or being condescending.
Clues to the Patient's Perspective on Illness
- Be aware that your patient has unique perspectives and experiences that contribute to their understanding of their health and illness
- Use open ended questions to elicit information
- Listen empathetically and attempt to understand the patient's lived experience
Clinical Assessment
- Vitals
- General: Orientation, mood, memory odors, grooming, etc.
- Eye: Pupils size, accommodation, conjunctiva, sclera, otoscope. Acuity.
- HENT: Neck: palpate lymph nodes, masses, neck pulsations, trachea midline? Swallow. Check thyroid.
- Respiratory: Rate, rhythm depth, Auscultate lungs, under the axilla.
- Cardiovascular: Observation of Jugular vein, carotid pulse, listen bruit. Apex with bell. Heart listen x 6 spots.
- Gastrointestinal: Listen to Bowel sounds. Palpate light then harder. Percuss the liver.
- Musculoskeletal: Gait. Knee bends.
- Integumentary: Moist, ulcers, pallor, discolorations, molds.
- Neurologic/Psychiatric: Mental, status, cranial nerves, motor system, reflexes. BUE, BLE reflexes.
- Genitourinary: General genitalia. Females: Pap smear and bimanual palpation uterus, anorectal fistula.
FIFE mnemonic
- The FIFE mnemonic is used to help providers collect information from patients
- Feelings: How does this affect you?
- Ideas: What do you think is going on?
- Function: What are you able to do or not able to do?
- Expectations: What help do you expect from us?
Understanding Racism and Bias in Healthcare & Social Determinants of Health
- Health Disparities are the differences in the health status of different groups of people. These disparities are often due to Social Determinants of Health, which are the conditions in which people are born, grow, live, work, and age. These include factors like socioeconomic status, education, employment, housing, transportation, discrimination, and access to healthcare.
- Racism and Bias play a significant role in perpetuating health disparities. Racial bias can lead to implicit biases in treatment and healthcare decisions. These biases can impact the quality of care that patients receive, resulting in worse health outcomes for people of color.
Improving Patient Health and Reducing Health Inequities
- Patient Level
- Ask patients about social challenges
- Guide patients to resources to access benefits and support services (Medicaid, local community clinics, etc.)
- Practice/Provider Level
- Offer culturally safe care
- Utilize patient care navigators
- Ensure that care is accessible to people who need it most. -Community Level
- Partner with local organizations and public health agencies.
Inspection, Palpation, Auscultation, and Percussion
- Inspection: Visual examination of the patient, including their appearance, skin, gait, posture, behavior, and facial expressions.
- Palpation: Using your hands to feel for abnormalities, such as tenderness, pain, masses, swelling, muscle rigidity, and lymph nodes.
- Auscultation: Listening to sounds produced by the body, such as heart sounds, lung sounds, bowel sounds, and vascular bruits.
- Percussion: Tapping on the body to elicit sounds that can help determine the density of underlying tissues, organs, and cavities.
Fatigue
- Causes: Fatigue is a common symptom of many conditions including depression, anxiety, hard work, sustained stress, and grief.
- Assessment: Investigate further if fatigue is unrelated to hard work, stress, or grief. Consider conditions such as:
- Infectious diseases
- Endocrine disorders
- Adrenal insufficiency
- Heart failure
- COPD/CKD
- Anemia
- Electrolyte imbalance
- Malignancy
- Nutritional deficiencies
- Medication side effects
Hypothyroidism and Hyperthyroidism
- Hypothyroidism: A condition where the thyroid gland does not produce enough thyroid hormone (T4).
- Symptoms: Fatigue, weight gain, constipation, depression, cold intolerance, dry skin, and hair loss.
- Hyperthyroidism: A condition where the thyroid gland produces too much thyroid hormone (T4).
- Symptoms: Weight loss, increased appetite, fast heart rate, heat intolerance, sweating, anxiety, and insomnia.
Alzheimer's Disease
- Characteristics
- Consists of evidence of a causative genetic mutation from family history or genetic testing
- Presence of cognitive decline in TWO or MORE cognitive domains
- Clear evidence of decline in memory and learning and at least one other cognitive domain
- Steady progressive decline in cognition without extended plateaus
- No evidence of mixed etiology from other neurodegenerative, cerebrovascular, mental, or systemic disease
- Alertness and attention are preserved
- Diagnostic Tests
- Medical history and physical exam
- Neuropsychological testing (e.g., Mini-Mental State Examination, Montreal Cognitive Assessment)
- Brain imaging tests (e.g., MRI, PET scan)
- Genetic testing
- Treatment Plans
- No cure
- Treatments focus on managing symptoms and slowing the progression of the disease
- Cholinesterase Inhibitors: These drugs increase acetylcholine levels, which help nerve cells communicate. Examples are donepezil (Aricept), galantamine (Razadyne), and rivastigmine (Exelon).
- Memantine (Namenda): This drugs blocks the effects of glutamate, a brain chemical.
- Immunotherapy Drugs: These drugs target the protein beta-amyloid to reduce amyloid plaques. Examples include lecanemab and donanemab.
- Other Drugs: Antidepressants, antipsychotics, and anti-anxiety drugs may be used to help with behavioral and psychological symptoms.
- **Person-centered care: Tailoring care to the patient's needs, interests, abilities, history, and personality.
- **Support services: Support groups, counseling, help with daily living
Suicide
- Highest Risk Groups: Individuals with a history of mental health disorders, substance use disorders, and physical health problems.
- Other factors: History of suicide attempts, family history of suicide, social isolation, financial difficulties, relationship problems, and stress.
Screening Tests for Dementia
- Montreal Cognitive Assessment (MoCa) – Can assess several cognitive domains
Common Illicit Drugs
- Marijuana
- Cocaine
- Psychotherapeutic drugs
Drugs commonly associated with overdose
- Opioids
- Fentanyl
Foods That Reduce Cardiovascular Risk
- Fruits and Vegetables (high in vitamins, minerals, and antioxidants)
- Whole Grains (high in fiber)
- Nuts and Seeds (high in healthy fats, fiber, and vitamins)
- Fatty Fish (high in omega-3 fatty acids)
- Lean Protein (low in saturated fat)
- Low-Fat Dairy Products (high in calcium and vitamin D)
Common Causes of Breath Odor
- Poor Oral Hygiene
- Tobacco Smoking
- Plaque Retention on Teeth
- Dentures
- Periodontal Disease
Diagnostic Tests for Bacterial Throat Infection
- Rapid Antigen Testing for streptococcal and fusobacterium
Risk Factors for Carcinoma of the Lip
- Tobacco Use
- Fair Skin
- Excessive Sun Exposure
- Weakened Immune System
Angioedema
- Cause: Localized subq or submucosal swelling caused by leakage of the intravascular fluid into the interstitial tissue. It is a mast cell-mediated reaction.
- Common Signs and Symptoms: Swelling in the face, lips, tongue, and throat. May be associated with urticaria and pruritus
- Treatment: Antihistamines, corticosteroids, and epinephrine.
- Life-threatening complications: Involvement of the larynx, tongue, and upper airway, which could develop into anaphylaxis.
Primary Syphilis
- Characteristics: A small red papule that turns into a chancre, a painless erosion. It is usually up to 2 cm in diameter and has a smooth, red, and glistening base, and raised, indurated borders. The chancre typically heals within 2-3 weeks.
- Causative Organism: Treponema pallidum, a spirochete. -Incubation Period: 9-90 days after exposure. -Lymph Node Involvement: May develop inguinal lymphadenopathy within 7 days. Lymph nodes are rubbery, nontender, and mobile.
-
Diagnostic Tests:
- Blood tests
- Medical exam
-
Treatment:
- Penicillin (given as a single shot in the early stages)
- Alternative antibiotics (if allergic to penicillin)
Exudative Tonsillitis
- Characteristics: Streptococcal pharyngitis typically produces white/yellow exudates on the tonsils or posterior pharynx, along with a red, beefy uvula, and palatal petechiae.
- Diagnostic Tests: Rapid antigen strep test to detect group A streptococcus.
- Treatment: Treatment for strep throat. ( antibiotics)
Foods High in Potassium
- Avocados, bananas, melons, oranges, prunes and raisins
- Artichokes, winter squash, plantains, spinach, potatoes and tomatoes
- Bran products and granola
- Beans (baked, black, pinto, etc.)
- Brown or wild rice
- Certain fishes
- Chicken
- Beef
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Description
This quiz covers key terms related to eye deviations such as esotropia and exotropia, as well as disorders of the lacrimal gland. You'll test your knowledge on symptoms, causes, and treatments, along with techniques for communicating with visually impaired patients. It's essential for students and professionals in ophthalmology and healthcare.
