Test Bank for Textbook of Physical Diagnosis 7th Edition Mark H. Swartz

TEST BANK FOR TEXTBOOK OF PHYSICAL DIAGNOSIS 7TH EDITION MARK H. SWARTZ Copyright © 2010 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Wecker: Brody’s Human Pharmacology, 5th Edition Chapter 01: Pharmacodynamics: Receptors and Concentration-Response Relationships Test Bank Multiple Choice 1. The majority of medications available today act on which superfamily of cellular membrane receptor? A. Ligand-gated ion channel B. G-protein-coupled receptor C. Receptor tyrosine kinase D. Nuclear hormone receptor E. Cytokine receptor ANS: B. The majority of drugs available act on G-protein-coupled receptors. 2. Nalbuphine is an effective pain reliever because of its activity at mu-opioid receptors. However, if given to a patient who has recently received morphine (which also affects mu-opioid receptors) for postoperative pain, nalbuphine can worsen his or her pain. Thus nalbuphine is said to have what kind of activity at mu-opioid receptors? A. Full agonist B. Partial agonist C. Competitive antagonist D. Non-competitive antagonist E. Allosteric modifier ANS: B. Nalbuphine is a partial agonist at opioid receptors. cause 85% of all malpractice lawsuits poor communication skills successful interviews must be: patient-centered an interpreter must be a: disinterested observer (avoid bias from family members) INTERPRET mnemonic Introductions Note goals (diagnosis, treatment, follow up) Transparency Ethics (use quality interpreters) Respect (belief and culture) Patient (focus on the patient) Retain control (do not allow interpreter to take over) Explain (simple language) Thanks studies show physicians interrupt the patient within the first ___ of the interview 15 seconds The most important rule of interviewing listen rule of five vowels audition evaluation inquiry observation understanding speech patterns (intonation, rate, emphasis, volume) paralanguage body language kinesics most important for body language EXCEPT face hands genetically inherited body language facial expression (happiness, sadness, fear, disgust, surprise, anger - first claimed by Charles Darwin 1872) body langauge indicating defensiveness crossed arms personal space proxemics True or False: body language should be interpreted via single signals False (body language should be interpreted by combinations of signals that support an overall conclusion, especially for signals that can mean two or more quite different things) The _____ a patient, the more important touch is. older areas considered threatening to touch leg (thigh) patient privacy legislation HIPAA (1996) what the patient feels symptoms (subjective) symptoms that commonly occur with problems in any of the body systems constitutional (fever, chills, weight loss, diaphoresis) what the examiner finds signs (objective) True or False: the interviewer should address the patient by their first name False (patients should be addressed as Mr or Ms in order to preserve the professional nature of the first meeting) Ideal distance from patients 3-4 feet (5+ too impersonal, 3 interferes with personal space) 4 parts of interview closure summary questions (allow the patient to ask) reassurance (appropriately) follow up (open ended / direct) questions should be used at the beginning of an interview open instead of saying "why" say "what is the reason" The use of medical jargon doctorese (or medicalese) (do not use) a question carrying a suggestion for the type of response the interviewer is looking for leading question (do not use) What type of patients should respond well to interviewer silence? silent patients (allows them to talk more) a technique of verbal or nonverbal communication that encourages a patient to continue speaking but does not direct him or her to a topic facilitation (saying "unhuh" or "go on") a response based on an observation by the interviewer that points out some- thing striking about the patient's behavior or previous statement confrontation (saying "you look upset" or "you seem angry") a type of confrontation that is based on inference rather than on observation interpretation ("are you afraid because you've done something wrong?") response that mirrors or echoes that which has just been expressed by the patient reflection (patient: "I was so sick i haven't been working" - doctor: "you haven't been working??") a response that indicates an interest in or an understanding of the patient support ("i understand" - two subgroups empathy and reassurance) a response that conveys to the patient that the interviewer understands what has been expressed reassurance ("That's wonderful you were able to stop smoking" - subgroup of support) never tell a patient to _______ relax (Patients are often nervous and are entitled to be upset or worried. Try to instill confidence in your patient instead of trying to talk the patient out of being nervous.) a response that recognizes the patient's feeling and does not criticize it empathy ("you must have been very sad" - a subgroup of support) statements used as guides to allow the patient to understand better the logic of the interviewer's questioning and for the interview to flow more smoothly from one topic to another transition ("I am now going to ask you some questions about your family") economic cost of untreated pain in the United States $80 billion population type least likely to receive adequate pain management ethnic minorities (Sixty-five percent of minority patients did not receive guidelinerecommended analgesic prescriptions. Latino patients reported less pain relief than did African-American patients.) single most alterable risk factor contributing to premature morbidity and mortality in the United States smoking patient who smokes 10 cigarettes daily for the past 30 years has a ________ pack-year history of smoking 15 (20 cigarettes = 1 pack, packs smoked daily x years smoked = pack-year history) questionnaire acronym for alcohol consumption CAGE ("Have you ever felt you should CUT down on your drinking?" "Have people ANNOYED you by criticizing your drinking?" "Have you ever felt GUILTY about your drinking?" "Have you ever taken a drink first thing in the morning (EYE-OPENER)?") Other alcohol questionnaires HALT BUMP FATAL DT ("Do you usually drink to get HIGH?" "Do you drink ALONE?" "Do you ever find yourself LOOKING forward to drinking?" "Have you noticed whether you seem to be becoming TOLERANT of alcohol?") ("Have you ever had BLACKOUTS?" "Have you ever used alcohol in an UNPLANNED way?" "Do you ever drink alcohol for MEDICINAL reasons?" "Do you find yourself PROTECTING your supply of alcohol?") ("Is there a FAMILY history of alcoholic problems?" "Have you ever been a member of ALCOHOLICS Anonymous?" "Do you THINK you are an alcoholic?" "Have you ever ATTEMPTED or had thoughts of suicide?" "Have you ever had any LEGAL problems related to alcohol consumption?" "Do you ever DRIVE while intoxicated?" "Do you ever use TRANQUILIZERS to steady your nerves?") In the late stages of alcoholism, a person may suffer_____________ (DTs). DTs are the most severe form of withdrawal and are fatal in one of every four cases. delirium tremens (hallucinations and convulsions) More than 60% of patients with psychiatric problems complain of _______ disturbed sleep pattern If patients use tobacco, they should be offered _________ at every visit smoking cessation treatment behavior counseling is only successful if the patient ____________ wants to change "irrational fear of, aversion to, or discrimination against homosexuality or homosexuals." homophobia symptoms that have possible relevance to the present illness (ROS) pertinent positives symptoms that are not present but are often related to the present illness (ROS) pertinent negatives What is auscultatory gap? The interval of blood pressure when korotkoff sounds indicating true systolic pressure fade away and then return at a lower pressure (this can lead to incorrectly estimating the systolic BP as too low and the diastolic BP as too high). Identify the anatomical location of the PMI PMI = point of maximal impulse Stand to pt's right with pt seated. (if not palpable, have pt lie supine or in left lateral decubitus), can test for displacement Listen at 5th intercostal space, midclavicular line Define significant involuntary weight loss 5% in 6 months, 10% in 12 months %wt change = [(usual wt-current wt)/usual wt]*100% How to measure BMI BMI = weight in kilograms/ height in meters squared (kg/m2) //// ( Weight in Pounds / ( Height in inches squared) ) x 703 BMI ranges Underweight = BMI 18.5 Health weight = BMI 18.5-24.9 Overweight = BMI 25-29.9 Obesity = Over 30 Explain the difference between passive and active range of motion Active ROM is done when a person can do the exercises by himself. Passive ROM exercises are done for a person by a helper. Grade pulses on the peripheral examination 0 absent, 1 diminished, 2 normal, 3 increased, 4 bounding (customary to describe pulses as 1+) Identify the appropriate method of measuring blood pressure 1. The patient should be in a comfortable chair for at least 5 minutes 2. The patient's arm should be supported at heart level 3. The cuff should be applied with bladder centered over the brachial artery and the lower edge of the cuff should be ~ 2-3cm above the antecubital fossa. 4. Use the right sized cuff (approximately 20% wider than diameter of arm) 5. Do not release the cuff faster that 2mmHg per second 6. Round off readings to the nearest 2mmHg. (Swartz says 5mmHg) Assessing blood pressure by palpation Useful in patients with hypotension, with faint korotkoff sounds, or auscultatory gap ONLY CAN ASSESS SYSTOLIC BP. CANNOT ASSESS DIASTOLIC BP BY THIS METHOD Categorization of blood pressure readings Describe a patient's general appearance in terms of: o Signs of distress o Level of consciousness o Weight, height and build o Skin color, lesions o Dress, grooming o Facial expression o Body/breath odors o Gait/posture/motor activity 1. Acute/mild/no signs of distress 2. Alert/groggy 3. Well-developed/obese/thin/frail 4. Pink/warm/soft 5. Unkempt/well-groomed 6. Appears to be in pain 7. Symmetry/breath has normal/foul odor 8. Coordinated, has good posture, has normal gait Normal pulse 60-100 bpm Normal respiratory rate 10-14 breaths/minute Mechanisms through which weight loss can occur 1. Decreased calorie intake 2. Impaired metabolism 3. Malabsorption/Maldigestion 4. Increased excretion Signs of weight loss on physical exam Skin: dry, flaky, pallor, pigmentation changes Mouth: bleeding gums, dry & cracked Muscles: muscle wasting, weakness Observations: emaciated, cachetic Pros and cons of using BMI ... Compare and contrast BMI and waist circumference Measuring waist circumference more directly measures body composition than BMI because it is a direct measure of abdominal fat, which tells of risk of developing metabolic syndrome. Waist circumference isn't useful measure if BMI 35 Pros and cons of BMI Pro: measure of body fat, which tells of risk of metabolic syndrome Con: Doesn't differentiate between fat and muscle Name and locate the 4 classic auscultator areas evaluated during the heart exam Aortic: 2nd intercostal space, right side Pulmonary: 2nd intercostal space, left side Tricuspid: 5th intercostal space, left side near sternum Mitral: 5th intercostal space, left side mid-clavicular Describe the physiology, clinical significance, and timing of classic heart sounds s3: end of rapid fill phase of ventricles (120-170 ms after s2) ie. me TOO (normal in children and young adults), age 30 is volume overload of ventricle (SLOSH-ing-in) s4: end of diastole (atrial contraction) may be indicative of stiff (noncompliant) ventricle, (can be from pressure overload causing hypertrophy= noncompliant ventricle) i.e.. MIDdle (s3 or s4 sounds like a GALLOP) (a-STIFF-wall) splitting of first heart sound: may be heard in tricuspid area splitting of s2: enlarged right ventricle causes longer time for blood to be ejected into pulmonary artery, pulmonic valve stays open longer. Differentiate timing of S1 and S2 S1 precedes carotid pulse and S2 follows it.