front 1 What is the difference between sensitivity and specificity
What does it mean? | back 1 Sensitivity
- Sensitivity is the probability that a person with disease
has a positive test.
- Sensitivity is also known as the true
positive rate
- SENSITIVE TEST WITH NEGATIVE RESULT= RULES
OUT DISEASE
Specificity
- Specificity is the probability that a non diseased person
has a negative test,
- Specificity is also known as the true
negative rate.
- SPECIFIC TEST WITH POSITIVE RESULTS= RULES
IN DISEASE
|
front 2 What are clues in patient history or clinical manifestations that may
indicate eating disorder? | back 2 Clinical Manifestations
- Excess clothing
- Decreased food intake
- Loss
of appetite
- Excessive physical activity
- Abnormal,
obsessive, or ritualized eating behaviors.
- History of
eating disorders in family
- Bullying regarding weight
|
front 3 How do you take proper BP for most accuracy? | back 3 -
Measure blood
pressure using a sphygmomanometer.
- Select the
appropriate blood pressure–measuring device.
- Prepare the
patient and setting.
- Select the correct size blood pressure
cuff.
- Position the arm and cuff appropriately.
- Use
the palpated radial pulse obliteration pressure to estimate systolic
blood pressure.
-
Position the
stethoscope diaphragm or bell over the brachial
artery.
- Inflate the cuff rapidly to target level
followed by gradual deflation.
- Identify systolic and
diastolic blood pressures.
- Average two or more
readings.
- Measure blood pressure in both arms at least
once
-
If the cuff is too
small (narrow), the blood pressure will read high
-
If the cuff is too
large (wide), the blood pressure will read low on a small
arm and high on a large arm.
|
front 4 Recognize the S&S of depression? | back 4 personal history of a depressive episode, a family history of
first-degree family members with depression, personal history of
recent stressful life events or significant childhood adversity,
chronic and/or disabling medical illness, and female gender
S/S
- crying
- pacing
- hand-wringing of agitated
depression or anxietY
- the hopeless, slumped posture and
slowed movements of depression
- impaired recent memory
- low self-esteem, loss of pleasure in daily activities
(anhedonia), sleep disorders, and difficulty concentrating or making
decisions.
|
| back 5 - Risk Factors:
- include presence of a mental health
disorder
- serious adverse childhood events
- family
history of suicide
- prejudice or discrimination
associated with being lesbian, gay, bisexual, or
transgender
- access to lethal means
- possibly a
history of being bullied
- sleep disturbances
- chronic medical conditions
- MEN- socioeconomic
factors, low income
- OLDER ADULTS-social isolation,
spousal bereavement, neurosis, affective disorders, physical
illness, and functional impairment
- MILITARY- TBI,
PTSD, DC from military service in past 12 months
- If you suspect depression, assess its severity and any
risk of suicide. Ask: Do you feel discouraged or depressed?How low
do you feel?What do you see for yourself in the future?Have you had
thoughts of death?Do you ever feel that life isn’t worth living? Or
that you want to be dead?Have you ever thought of killing
yourself?Have you thought about how or when you would try to kill
yourself? Do you have a plan?What do you expect is going to happen
after you die?It is your responsibility to ask directly about
suicidal thoughts. This may be the only way to uncover suicidal
ideation and plans that launch immediate intervention and
treatment.
- USPSTF has concluded that the current evidence is
insufficient to assess the balance of benefits and harms of
screening for suicide risk in a primary care setting
|
front 6 What is the relationship between substance abuse and depression/anxiety? | back 6 About 16 million adult Americans, or almost 7%, have major
depression, often with coexisting anxiety disorders and substance abuse |
front 7 What is the difference between delirium and dementia? | back 7 Delirium
- A multifactorial syndrome, is an acute confusional
state
- Sudden onset
- Fluctuating course;
inattention; and, at times, changing levels of consciousness
- Confusion Assessment Method screens at risk pts
Dementia
- characterized by a decline in at least two cognitive
domains (e.g., loss of memory, attention, language, or visuospatial
or executive functioning)
- Mini-Mental State Examination is
the best-known screening test for dementia
|
front 8 What are components of the MMSE?
Why are they being assessed? | back 8 - orientation
- registration
- attention
- calculation
- recall
- language
Score of 25 or higher is normal
The Mini-Mental State Examination is the best-known screening test
for dementia |
front 9 What is Beers criteria?
What is the concern regarding anticholinergic medication in elderly? | back 9 Learn about drug–drug interactions and consult the 2019 AGS Beers
Criteria, widely used by health care providers, educators, and
policymakers. In addition to a list of hazardous drugs for older
adults, this new criteria now include lists of select drugs that
should be avoided or have their dose adjusted based on the
individual’s kidney function and select drug–drug interactions
documented to be associated with harms in older adults |
front 10 How to palpate lymph nodes? | back 10 - Using the pads of your index and middle
fingers
-
Palpate gently
in a gentle rotary motion, moving the skin over the underlying
tissues in each area.
- Note lymph node
size, shape, delimitation (discrete or matted together), mobility,
consistency, and any tenderness.
- Small, mobile, discrete,
nontender nodes, sometimes termed “shotty,” are frequently found in
normal people.
- Describe enlarged nodes in two dimensions,
maximal length and width, for example, 1 cm × 2 cm.
- Tender
nodes suggest inflammation
- Hard or fixed nodes (fixed
to underlying structures and not movable on palpation) suggest
malignancy.
|
front 11 Recognize normal neck anatomy? | back 11 - Anterior cervical triangle: the mandible above, the SCM muscle
laterally, and the midline of the neck medially.
- Posterior
cervical triangle: the SCM muscle, the trapezius, and the clavicle.
Note that a portion of the omohyoid muscle crosses the lower portion
of this triangle and can be mistaken for a lymph node or mass.
- Thyroid gland is usually located above the suprasternal
notch
|
front 12 Great Vessels of the Neck
- SCM muscles run the great vessels of the neck: the carotid
artery and the internal jugular vein
- The external jugular
vein passes diagonally over the surface of the SCM muscle and may be
helpful when trying to identify the jugular venous pressure
| back 12 Midline structures of the neck
- (1) the mobile hyoid bone just below the mandible
- (2) the thyroid cartilage, readily identified by the notch on
its superior edge
- (3) the cricoid cartilage
- (4)
the tracheal rings
- (5) the thyroid gland
|
front 13 Midline structures of the neck | |
front 14 What is the best position for palpating the thyroid? | back 14 - Find your landmarks—the notched thyroid cartilage and the
cricoid cartilage below it.
- Locate the thyroid isthmus,
usually overlying the second, third, and fourth tracheal rings.
Posterior Approach
- Stand behind pt
- Ask the patient to flex the neck
slightly forward to relax the SCM muscles.
- Gently place the
fingers of both hands on the patient’s neck so that your index
fingers are just below the cricoid cartilage
- Ask the
patient to sip and swallow water as before.
- Feel for the
thyroid isthmus rising up under your finger pads.
- Displace
the trachea to the right with the fingers of the left hand; with the
right-hand fingers, palpate laterally for the right lobe of the
thyroid in the space between the displaced trachea and the relaxed
SCM muscle
Anterior Approach
- Attempt to locate the thyroid isthmus by palpating between
the cricoid cartilage and the suprasternal notch
- Use one
hand to slightly retract the SCM muscle while using the other to
palpate the thyroid
- Ask the patient to sip some water and to extend the neck
again and swallow.
- Watch for upward movement of the
thyroid gland, noting its contour and symmetry.
Thyroid gland is usually located above the suprasternal notch
Note the size, shape, and consistency (soft, firm, or hard) of the
gland and identify any nodules or tenderness |
front 15 - What is the proper technique when using the
ophthalmoscope?
| back 15 - Darken the room. Switch on the ophthalmoscope light and turn
the lens disc until you see the large round beam of white light.
Shine the light on the back of your hand to check the type of light,
its desired brightness, and the electrical charge of the
ophthalmoscope.
- Turn the focusing wheel to the 0 diopter. (A
diopter is a unit that measures the power of a lens to converge or
diverge light.) At this diopter, the lens neither converges nor
diverges light. Keep your finger on the edge of the lens disc so
that you can turn the focusing wheel to focus the lens when you
examine the fundus.
- Hold the ophthalmoscope in your right
hand and use your right eye to examine the patient’s right eye; hold
it in your left hand and use your left eye to examine the patient’s
left eye. This keeps you from bumping the patient’s nose and gives
you more mobility and closer range for visualizing the fundus. With
practice, you will become accustomed to using your nondominant
eye.
- Hold the ophthalmoscope firmly braced against the medial
aspect of your bony orbit, with the handle tilted laterally at about
20 degrees slant from the vertical. Check to make sure you can see
clearly through the aperture. Instruct the patient to look slightly
up and over your shoulder at a point directly ahead on the
wall.
- Place yourself about 15 inches away from the patient
and at an angle 15° lateral to the patient’s line of vision. Shine
the light beam on the pupil and look for the orange glow in the
pupil—the red reflex. Note any opacities interrupting the red
reflex. If you are nearsighted and have taken off your glasses, you
may need to adjust the focusing wheel toward the minus/red diopters
until the structures you see at a distance is in focus.
- Now
place the thumb of your other hand across the patient’s eyebrow,
which steadies your examining hand. Keeping the light beam focused
on the red reflex, move in with the ophthalmoscope on the 15-degree
angle toward the pupil until you are very close to it, almost
touching the patient’s eyelashes and the thumb of your other
hand.
- Try to keep both eyes open and relaxed, as if gazing
into the distance, to help minimize any fluctuating blurriness as
your eyes attempt to accommodate.
- You may need to lower the
brightness of the light beam to make the examination more
comfortable for the patient, avoid hippus (spasm of the pupil), and
improve your observations.
|
front 16 - What are the following test indicated for?
- Tonometry
- Snellen tests
- Fluorescein
Staining
- Cover/uncover
- Red reflex
| back 16 -
Tonometry
- test to measure the pressure
inside your eyes
-
Snellen tests
- Test the acuity of central
vision
- Position the patient 20 ft from the chart
- Ask to read the smallest line
-
Fluorescein Staining
- staining of the eye
to detect corneal damage
- use the cobalt lamp
-
Cover/uncover
- Used to detect strabismus
- The child is asked to visually fix on a target at
distance or near
- A cover is placed over one eye for
a few seconds and then rapidly removed
- The eye that
was under the cover is observed for movement
- Once
it is uncovered, this eye must shift back into the
straight-ahead position to re-fixate on the object if it
became deviated while covered= strabismus
-
Red reflex
- Screening test for
cataracts
|
front 17 - Recognize Strabismus, Dacryostenosis, significance of eye turn
in infants
| back 17
Strabismus
- dysconjugate gaze
- Visual defect in which the eyes are
misaligned and point in different directions
- Non-paralytic or paralytic type
- Frequently present only when looking at near objects
- The number one cause of amblyopia (lazy eye) in children
- Caused by any disorder that interferes with vision or
with
visual pathways in the brain - Significant
accommodation results in a reflexive ocular convergence, forcing one
eye medially off alignment
- Appears in children from 6
months to seven years of age with an average age of onset at
2-3 years of age
- Risk factors: low birth
weight/prematurity, + family hx
Dacryostenosis- blocked tear duct
- Usually presents within the first few weeks of life with
persistent tearing, crusting of the lashes and
mucopurulent discharge
- Tears spill over
the lower lid and there is a persistent “wet look” in the involved
eye (s)
-
On exam, reflux of
mucopurulent material from either punctum can be elicited by gently
pressing over the nasolacrimal sac of the involved eye
(s)
Eye Turn in infants
- Infantile strabismus (congenital strabismus)
Presents
with profound esotropia before 6 months of age - Apparent by
3 months of age
-
Refraction of each eye is normal
- Full
ocular examination
- Ask if child has abnormal face or head
position
- Ask parents to bring in un-posed photos of the
child
- Test visual acuity using the tumbling E chart or Allen
picture cards (start age 3-4 years)
|
| back 18 - Aging vision
- Found in middle-aged and older
adults
- Causes focusing problems for near
vision
- See better when the card is farther away
|
front 19 What are the symptons of macular degeneration? | back 19 - Sudden
visual loss is unilateral and
painless
- Slow central vision loss in older
adults
-
Drusen
are yellowish round spots that vary from tiny to
small around the posterior pole between the optic disc &
macula
****think of the doctor from Virign River show*** |
front 20 What is clinical presentation of subconjunctival hemorrhage? | back 20 -
RED
PAINLESS EYE
-
Sudden onset of bright red blood
- No vision
loss or pain
-
Unilateral: may have just had coughing, sneezing,
straining
|
front 21 Be able to differentiate between the presentation of chalazion,
hordeolum, blepharitis
What is Chalazion?
What is Hordeolum? | back 21
Hordeolum- Stye
-
PAINFUL, TENDER,
RED infection at the inner or outer margin of the
eyelid
-
Caused by
Staphylococcus aureus
- Inner margin can
be from an obstructed meibomian gland
- Outer margin can
be from an obstructed eyelash follicle or tear gland
Chalazion
- A subacute NONTENDER, usually
painless nodule caused by a blocked
meibomian gland
- May become acutely
inflamed
- Points inside the lid rather than
on the lid margin
|
front 22 What is presentation of blepharitis? | back 22
Blepharitis
- A chronic inflammation of the eyelids at the
base of the hair follicles
- Often caused by S.
aureus.
- There is also a scaling seborrheic
variant
Typical complaints are:
- Scaling and inflammation of eyelid margins
- Crusting
and tearing around the eyes (especially upon awakening)
- Itching and burning of the eyes
- Red eyes
-
Gritty sensation in eyes
- Some
cases may be asymptomatic and identified on routine examination
On examination, may
see the following:
- Eyelid margins erythematous with yellowish,
oily
scales - Lashes often matted with debris within the
lashes
- Conjunctival infection or mild mucus discharge
may
also be present |
front 23 What is the clinical presentation of:
Acute Bacterial conjunctivitis? | back 23 Bacterial
-
Acute
onset of burning
-
Irritation
-
Tearing
and a mucopurulent or purulent discharge
- Patients usually report that their eyelids are matted
together on awakening
- VISION NOT
AFFECTED
-
On examination:
- conjunctival swelling and
mild eyelid edema
- Usually self-limited and
does not cause serious harm
- Infection usually begins in one
eye and then becomes bilateral in 2-5 days
-
Most common microbes:
-
Staphylococcus aureus (most common pathogen in
adults)
- Streptococcus pneumonia (Most common
cause in children)
- Haemophilus influenza (More common
in children)
-
HIGHLY
CONTAGIOUS
- Spread by direct contact
with the patient secretions or with contaminated objects and
surfaces
- Cultures should
be obtained in patients who have severe inflammation (hyperacute
purulent conjunctivitis) or chronic, recurrent conjunctivitis and in
patients who do not respond to treatment
|
front 24 What is the clinical presentation of:
Viral conjunctivitis? | back 24 - Acutely red eye
-
Watery discharge
- Conjunctival
swelling
-
Tender
preauricular node
-
In some cases:
photophobia and a foreign body sensation (gritty,
burning sensation)
- VIRAL AFFECTS BOTH
EYES
- May be affected simultaneously, or the second eye may
become involved a few days after the first eye
-
History
of recent URI common
- Self-limited and rarely results in serious harm
- Herpes simplex conjunctivitis may be accompanied by fever
blister on the lip or face and occurs most frequently in
immunosuppressed persons
- In newborns evaluate parent’s
sexual history, mothers prenatal care and timing of onset
of
symptoms from birth - Viruses:
Adenovirus/Herpes
|
front 25 What is the clinical presentation of:
Allergic conjunctivitis? | back 25 - Presents with
- Intermittent bouts of bilateral
itching
- Tearing
- Redness and mild eyelid
swelling
- On exam
-
Palpebral conjunctiva may have a cobblestone
appearance
- Personal and/or
family history is often positive for other allergic conditions such
as allergic rhinitis, asthma and eczema
|
front 26 What is the evaluation of conjunctivitis | back 26 - Thorough ocular, medical, sexual and medication history
- Determine if symptoms are unilateral or bilateral, acute,
hyperacute or chronic, or intermittent
- In newborns evaluate
parent’s sexual history, mothers prenatal care and timing of onset
of symptoms from birth
- Full eye exam, visual testing and
examination of regional lymph nodes
-
Diagnostic tests
- Cultures usually are
not required in patients with mild conjunctivitis of suspected
bacterial, viral or allergic origin
- Cultures should be
obtained in patients who have severe inflammation (hyperacute
purulent conjunctivitis) or chronic, recurrent conjunctivitis and
in patients who do not respond to treatment
- In
conjunctivitis:
- Redness of the conjunctiva is
diffuse, pain is minimal
- There is no visual loss
- Pupil size and reactivity are normal
|
front 27 What are RED FLAGS: Indicating serious eye issues | back 27 Important to distinguish conjunctivitis from other more serious
conditions causing red eye (iritis, keratitis, acute angle closure
glaucoma, foreign body).
In conjunctivitis:
- Redness of the conjunctiva is diffuse, pain is minimal
- There is no visual loss
- Pupil size and reactivity are
normal
Red flag or warning signs that indicate a more serious ophthalmic
problem than conjunctivitis
- Reduction of visual acuity
- Ciliary flush: A pattern
of injection in which the redness is most pronounced in a ring at
the limbus (the limbus is the transition zone between the cornea and
the sclera)
- Photophobia
- Severe foreign body
sensation that prevents the patient from keeping the eye open
- Corneal opacity
- Fixed pupil
- Severe headache
with nausea
|
front 28 What is papilledema and what does it signify? | back 28 -
Swelling of the optic disc and anterior bulging of the
physiologic cup= increased pressure causes optic
nerve head swelling associated with increased intracranial
pressure
- Color pink, hyperemic
- Often with loss of
venous pulsations
- Disc vessels more visible, more numerous,
curve over the borders of the disc
-
Disc swollen with margins blurred
- The physiologic cup is not visible
-
What does it signify?
- Signals serious
disorders of the brain, such as meningitis, subarachnoid
hemorrhage, trauma, and intracranial mass, lesions
|
front 29 What are eye findings in Thyroid disease? | back 29 - Abnormal protrusion or proptosis
- Lagophthalmos, or
failure of the eyelids to close in thyroid dx
- Exophthalmos
or increased axial projection thyroid dx
HypoT
- Scaliness occurs in seborrheic dermatitis, lateral sparseness
in hypothyroidism
HyperT
- With Graves disease, eye signs such as stare, lid lag, and
exophthalmos
- Lid lag of hyperthyroidism, a rim of sclera is
visible above the iris with downward gaze
- Proptosis, an abnormal protrusion of the eyeballs in
hyperthyroidism
|
front 30
Eye findings for hyperlipidemia disorders
What are findings that indicate hyperlipemia? | back 30
Xanthelasma
- Slightly raised, yellowish, well-circumscribed
cholesterol-filled plaques that appear along the nasal
portions of one or both eyelids
|
front 31
Presentation of a pterygium
What are clinical findings of pterygium? | back 31 - A
triangular
thickening of the bulbar conjunctiva (yellow wedge-shaped
thickening of conjunctiva)
- grows slowly across
the outer surface of the cornea, usually from the nasal
side.
- Reddening and irritation may occur.
- May interfere with vision as it encroaches on the pupil.
- Caused by UV damage
- Treatment: wear sun-glasses, refer
for surgery if affecting vision
|
front 32
Presentation of presentation of a pinguecula
What are clinical findings of pinguecula? | back 32 -
Harmless yellowish triangular nodule
in the bulbar conjunctiva on either side of the iris.
- Appears frequently with aging, first on the nasal and then on
the temporal side.
- Cause UV damage
|
front 33 What are normal findings when checking for PERRLA | back 33
Pupils Equal, Round, Reactive to Light and Accommodation
- Note if the pupils are large (>5 mm), small (<3 mm), or
unequal
- The direct reaction (pupillary constriction in the
same eye)
The consensual reaction (pupillary constriction in
the opposite eye) |
front 34 What are clinical presentations of otitis externa? | back 34 - an inflammation or infection of the ear canal
- Ear pain that presents gradually or sudden
- Sensation
of fullness or obstruction in the ear ** think of ear wax
buildup
- Canal erythematous and edematous
- Purulent
discharge
- Conductive hearing loss may occur
-
Itching
may occur and is the predominant
symptom with
fungal infections - Uncommon to see
fever
Predisposing factors
- Frequent exposure to moisture (swimming,
humid, warm
climates) - Aggressive cleaning of the canal or trauma
- Allergies or skin conditions such as psoriasis
- Wearing
hearing aids, earplugs on regular
basis
Common pathogens
- Pseudomonas (most common)
- Staphylococci
epidermis
- Staphylococci aureus
- Fungal (about 9% of
the cases)
|
front 35 What is the presentation of otitis media with effusion? | back 35 -
Accumulation of serous fluid in the middle ear
without signs of infection
-
CLINICAL
SIGNS of acute infection ARE ABSENT
-
When patients are symptomatic, the predominant symptom
is hearing loss
- Other nonspecific
symptoms that may occur in children with OME include:
- Ear pain
- Sleep disturbance
- A feeling of
fullness in the ear *** because it is full of fluid
-
Tinnitus
- Often occurs after
acute otitis media (AOM), but it also may occur with eustachian tube
obstruction in the absence of AOM
-
Most
frequent cause of air conduction hearing loss in school age
children
- Affects 80% of children by four
years of age
- Can occur in adults but more frequent in
children
Otoscopic findings
- Tympanic membrane in a neutral or retracted position
- Color of TM varies from gray to translucent
- Fluid
behind TM may be amber colored or clear
- Impaired mobility
of the tympanic membrane when positive pressure is applied with the
bulb during pneumatic otoscopy
- An air-fluid level may be
present behind the tympanic membrane
- Audiogram may show a
15-30 dB air conduction loss with normal bone conduction
|
front 36 What is otitis media?
What are clinical presentations of otitis media infection? | back 36 - Infection in the middle ear
- Commonly follows a viral URI
- URI symptoms
- Ear pain
- Otorrhea- ear drainage
- Fever
- Hearing loss and or vertigo
-
Diarrhea, nausea and vomiting are common in
children
-
Irritability (especially in
children)
- Evaluation:
- Hx of symptoms, onset and recent sick
contacts and
other risk factors - PE to include assessment
of :
- Eyes, ears, pharynx, teeth, sinus
tenderness,
nose, lymph nodes and chest
- Diagnosis is based on acute history and the
appearance of
the tympanic membrane: - Full or bulging TM
- Marked
erythema
- Distorted light reflex
- Absent or
obscured landmarks
- Decreased or absent mobility of TM
by pneumatic otoscopy
|
front 37 What is Cholesteatoma presentation? | back 37 Middle ear disorders
Abnormal collection of skin cells deep inside your ear
Complication of AOM |
front 38 What is Epistaxis?
Common causes and management? | back 38 - Bleeding from the nasal passages
- originate in the
paranasal sinuses or nasopharynx
- Causes:
- Trauma (especially nose-picking)
- Tumors
- Foreign Bodies
-
Inflammation- allergic rhinitis
- Drying and crusting of the nasal mucosa- low humidity, dry
air
-
Chronic
excoriation chronic intranasal drug use- cocaine/steroid
spray
- Anticoagulants, NSAIDs, vascular
malformations, and coagulopathies
- Management
- Clinician sprays the nares with
oxymetazoline
(Afrin, if avail) - Patient pinches
the anterior nasal septum (not
the bridge
of the nose) while head is tilted forward; continue
pressure for 10-15 minutes (may also apply ice over the
nose) - If bleeding continues, may need to
cauterize
with sliver nitrate stick and if needed
packing and possible balloon catheters |
front 39 What is rhinitis medicamentosa?
How do you avoid it? | back 39 - Drug-induced rhinitis occurs with excessive use of topical
decongestants
- Inquire about all medications or drugs
|
front 40 What is the Weber test ?
How and why do you perform it? | back 40
How to perform the test:
- Set the fork into light vibration by briskly stroking the
prongs (the “U”) between the thumb and index finger or by tapping
the prongs on your forearm just in front of your elbow.
- Place the base of the lightly vibrating tuning fork firmly on
top of the patient’s head or on the midforehead
- Ask where
the patient hears the sound best: “On one side or both sides?”
Results
- Unilateral conductive hearing loss, sound is heard in the
impaired ear
- Unilateral sensorineural hearing loss, sound
is heard in the good ear
|
front 41 What is the Rinne Test?
How and Why do you perform it? | back 41 Compare air conduction (AC) and bone conduction (BC)
How do you perform it?
- Place the base of a lightly vibrating tuning fork on the
mastoid bone, behind the ear and level with the canal
- When
the patient can no longer hear the sound, quickly place the prongs
of the fork close to the ear canal and ask if the patient hears a
vibration
Results
- Sound is NORMALLY heard longer in air then in bone
- In conductive hearing loss, sound is heard through bone longer
than it is through air (BC = AC or BC > AC).
- In
sensorineural hearing loss, sound is heard longer through air (AC
> BC).
|
front 42 Difference in Conductive and Sensorineural loss? | back 42 - The first part of the hearing pathway, from the external ear
through the middle ear, is known as the conductive phase.
- Hearing disorders of the external and middle ear cause
conductive hearing loss.
- The second part of
the pathway, involving the cochlea and the cochlear branch of CN
VIII, is the sensorineural phase
- Disorders of the inner ear
cause sensorineural hearing loss
- Air conduction (AC) describes the normal first phase in the
hearing pathway, where sound waves travel through the air and are
transmitted from the external and middle ear to the cochlea.
- An alternative pathway, known as bone conduction (BC), bypasses
the external and middle ear and is used for testing purposes.
- A vibrating tuning fork, placed on the head, sets the bone of
the skull into vibration and stimulates the cochlea directly.
- In those with normal hearing, air conduction is more
sensitive than bone conduction (AC > BC).
|
front 43 Presentation of acute bacterial sinusitus | back 43 - Onset with persistent s/sx compatible
with acute
rhinosinusitis, lasting for >10 days without any evidence
of clinical improvement OR - Onset with severe symptoms
or signs
of high fever (>102°F) and purulent nasal
discharge or facial pain lasting for at least 3–4 consecutive
days at the beginning of illness, OR - Onset with
worsening symptoms or
signs characterized by the new
onset of fever, headache, or increase in nasal discharge
following a typical viral URI that lasted 5–6 days and
was initially improving
Objective signs include:
- Edematous and hyperemic nasal mucosa
- Narrowing of
the middle meatus
- Inferior turbinate hypertrophy
- Palpated tenderness over affected sinus (rare
in young
children) - Pain over affected sinus when patient
bends
forward - Purulent nasal discharge or copious
rhinorrhea
- Periorbital swelling may be seen in
ethmoid
sinusitis |
front 44 Expected lab findings in mononucleosis? | back 44 Labs: Elevated LFTs, lymphocytosis |
front 45 What is clinical presentation of viral pharyngitis? | back 45 - Typical
gradual onset of:
- Pharyngeal pain and dysphagia
- Erythema/inflammation
of pharynx and tonsils and possible exudates
- Fever
- Rhinorrhea
- Cough
- Hoarseness
|
front 46 What is clinical presentation of strep throat? | back 46 -
Acute
Onset of the following:
- Pharyngeal
pain and dysphagia
- Fever
- Headache and
malaise
-
Tender and
enlarged anterior cervical nodes
-
Purulent exudates on tonsils
- Tonsils and pharynx intensely erythematous
- Petechia
on soft palate
|
front 47 What are guideline recommendations for oral health? | back 47 - Use of fluoride-containing toothpastes reduces tooth decay, and
brushing and flossing retard periodontal disease by removing
bacterial plaques.
- Urge patients to seek dental care at
least annually to receive the benefits of more specialized
preventive care such as scaling, planing of roots, and topical
fluorides.
- Address diet and tobacco use.
- As with
children, adults should avoid excessive intake of foods high in
starches and refined sugars such as sucrose, which enhance
attachment and colonization of cariogenic bacteria.
- Urge
patients to avoid use of all tobacco products and to limit alcohol
consumption to reduce risk of oral cancer.
- Saliva cleanses
and lubricates the mouth. Many medications reduce salivary flow,
increasing risk for tooth decay, mucositis, and gum disease from
xerostomia, especially for older adults. If medications cannot be
changed, recommend drinking higher amounts of water and chewing
sugarless gum.
- For those wearing dentures, recommend
removal and cleaning each night to reduce bacterial plaque and risk
of malodor.
- Regular massage of the gums relieves soreness
and pressure from dentures on the underlying soft tissue.
|