Download Mental Health Terminology: Emotional States, Cognition, and Substance Disorders and more Exams Physiology in PDF only on Docsity!
flat affect (blunted affect) - CORRECT ANSWER -lack of emotional response; no expression of feelings; voice monotonous and face immobile
depression - CORRECT ANSWER -sad, gloomy, dejected; symptoms may occur with rainy weather, after a holiday, or with an illness; if the situation is temporary, symptoms fade quickly
depersonalization (lack of ego boundaries - CORRECT ANSWER -loss of identity, feels estranged, perplexed about own identity and meaning of existence
elation - CORRECT ANSWER -joy and optimism, overconfidence, increased motor activity; not necessarily pathologic
euphoria - CORRECT ANSWER -excessive well-being; unusually cheerful or elated, which is inappropriate considering physical and mental condition; implies a pathologic mood
anxiety - CORRECT ANSWER -worried, uneasy, apprehensive from the anticipation of a danger whose source is unknown
fear - CORRECT ANSWER -worried, uneasy, apprehensive; the external danger is known and identified
irritability - CORRECT ANSWER -annoyed, easily provoked, impatient
rage - CORRECT ANSWER -furious, loss of control
ambivalence - CORRECT ANSWER -the existence of opposing emotions towards an idea, object, person
lability - CORRECT ANSWER -a rapid shift of emotions
inappropriate affect - CORRECT ANSWER -affect clearly discordant with content of person's speech
orientation - CORRECT ANSWER -assessment of this through the interview by asking time, place, or person
delirium - CORRECT ANSWER -acute confusional state, potentially preventable in hospitalized persons. Characterized by disorientation, disordered thinking, and perceptions (illusions and hallucinations), defective memory, agitation, inattention.
Onset: sudden, over hours to days
Cause or Contributing Factors: hypoglycemia, fever, dehydration, hypotension; infection, other conditions that disrupt body homeostasis; adverse drug reaction; head injury; change in environment (e.g., hospitalization); pain; emotional stress; substance abuse
Cognition: impaired memory, judgment, calculations, attention span; can fluctuate through the day
Level of Consciousness: altered
Activity Level: can be increased or reduced; restlessness; behaviors may worsen in the evening (sundowning); sleep/wake cycle may be reversed
Emotional State: rapid swings; can be fearful, anxious, suspicious, aggressive, have hallucinations and/or delusions
Speech and Language: rapid, inappropriate, incoherent, rambling
Prognosis: reversible with proper and timely treatment
depression - CORRECT ANSWER -long-term depressed mood ( greater than/ equal to 2 weeks) with lack of pleasure; disturbed sleep and appetite; feelings of hopelessness, guilt, worthlessness, sadness, loneliness, and despair; suicide ideation
Onset: may be gradual, with exacerbation during crisis or stress
Cause or Contributing Factors: lifelong history, losses, loneliness, crises, declining health, medical conditions
tolerance - CORRECT ANSWER -requires an increased amount of substance to produce the same effect
withdrawal - CORRECT ANSWER -cessation of a substance produces a syndrome of physiologic symptoms
low-to-moderate drinking - CORRECT ANSWER -Men: less than or equal to 2 drinks/ day
Women: less than or equal to 1 drink/day
65+ years: less than or equal to 1 drink/day
Even lower limits or abstinence for patients who take medications that interact with alcohol, have a health condition exacerbated by alcohol, or are pregnant (advise abstinence here).
heavy or "at-risk" - CORRECT ANSWER -Men: greater than or equal to 15 drinks/ week
Women: greater than or equal to 8 drinks/ week
1+ heavy drinking days
Alcohol Intoxication - CORRECT ANSWER -Appearance: unsteady gait, incoordination, nystagmus, flushed face
Behavior: sedation; relief of anxiety; dulled concentration; impaired judgment; expansive, uninhibited behavior; talkativeness; slurred speech; impaired memory; irritability; depression; emotional lability
Alcohol Withdrawal: Uncomplicated - CORRECT ANSWER -(shortly after cessation of drinking, peaks at 2nd day, improves by 4th to 5th day.) Coarse tremor of hands, tongue, eyelids; anorexia; nausea and vomiting; malaise; autonomic hyperactivity (tachycardia, sweating, elevated blood pressure); headache; insomnia; anxiety; depression or irritability; transient hallucinations or illusions
Alcohol Withdrawal: Delirium "delirium tremens" - CORRECT ANSWER -(much less common than uncomplicated, occurs within 1 week of cessation.) Coarse, irregular tremor; marked autonomic hyperactivity (tachycardia, sweating); vivid hallucinations; delusions; agitated behavior; fever
Sedatives, hypnotics (benzodiazepines) - CORRECT ANSWER -similar to alcohol
Sedatives, hypnotics (benzodiazepines) Intoxication - CORRECT ANSWER -Appearance: unsteady gait, incoordination
Behavior: talkativeness, slurred speech, inattention, impaired memory, irritability, emotional lability, sexual aggressiveness, impaired judgment, impaired social or occupational functioning
Sedatives, hypnotics (benzodiazepines) Withdrawal - CORRECT ANSWER -anxiety or irritability; nausea or vomiting; malaise; autonomic hyperactivity (tachycardia, sweating); orthostatic hypotension; coarse tremor of hands, tongue, and eyelids; marked insomnia; grand mal seizures
Cocaine (including crack) Intoxication - CORRECT ANSWER -Appearance: pupillary dilation, tachycardia or bradycardia, elevated or lowered blood pressure, sweating, chills, nausea, vomiting, weight loss
Behavior: euphoria, talkativeness, hypervigilance, pacing, psychomotor agitation, impaired social or occupational functioning, fighting, grandiosity, visual or tactile hallucinations
Cocaine (including crack) Withdrawal - CORRECT ANSWER -dysphoric mood (anxiety, depression, irritability), fatigue, insomnia or hypersomnia, psychomotor agitation
Amphetamines - CORRECT ANSWER -similar to cocaine
Amphetamines Intoxication - CORRECT ANSWER -Appearance: pupillary dilation, tachycardia or bradycardia, elevated or lowered blood pressure, sweating or chills, nausea, and vomiting, weight loss
Behavior: elation, talkativeness, hypervigilance, psychomotor agitation, fighting, grandiosity, impaired judgment, impaired social and occupational functioning
Amphetamines Withdrawal - CORRECT ANSWER -dysphoric mood (anxiety, depression, irritability), fatigue, insomnia or hypersomnia, psychomotor agitation
Opiates (morphine, heroin, meperidine) Intoxication - CORRECT ANSWER -Appearance: pinpoint pupils; decreased blood pressure, pulse, respirations, and temperature
Behavior: lethargy, somnolence; slurred speech; initial euphoria followed by apathy, dysphoria, and psychomotor retardation; inattention; impaired memory; impaired judgment; impaired social or occupational functioning
lesion - CORRECT ANSWER -a broad term referring to any pathologic or traumatic discontinuity of tissue or loss of function of a part
patterned injury - CORRECT ANSWER -an injury caused by an object that leaves a distinct pattern on the skin and/or organ (e.g., being whipped with an extension cord) or an injury caused by a unique mechanism of injury (e.g., immersion burns to the hands [glove burns] or feet [sock burns])
pattern of injuries - CORRECT ANSWER -usually bruises and fractures in various stages of healing
petechiae - CORRECT ANSWER -minute, pinpoint, non-raised, perfectly round purplish-red spots caused by intra-dermal or submucosal hemorrhage, which later turn blue or yellow
puncture - CORRECT ANSWER -the act of piercing or penetrating with a pointed object or instrument
stab wound - CORRECT ANSWER -a penetrating, sharp, cutting injury that is deeper than it is wide
traumatic alopecia - CORRECT ANSWER -loss of hair from pulling and yanking or by other traumatic means
wound - CORRECT ANSWER -a general term referring to a bodily injury caused by physical means
Elder Abuse: Physical - CORRECT ANSWER -when an elder is intentionally injured, assaulted, threatened with a weapon, or inappropriately restrained
Elder Abuse: Sexual - CORRECT ANSWER -includes any sexual contact against the elder's will, including sexual contact with a person unable to understand the act or communicate consent
Elder Abuse: Psychological/ Emotional - CORRECT ANSWER -includes verbal and nonverbal behaviors meant to inflict dear and distress. Includes: humiliation, embarrassment, controlling behavior, social isolation, and damaging property
Neglect - CORRECT ANSWER -failure of the caregiver to prevent harm. Includes failure to meet basic needs such as hygiene, nutrition/hydration, clothing, shelter, and medical care
Financial Abuse/ Exploitation - CORRECT ANSWER -unauthorized or improper use of the elder's resources for monetary or personal benefit, profit, or gains, such as forgery, theft, or improper use of guardianship or power of attorney
responsibilities of a mandated reporter - CORRECT ANSWER -~Required by law to report any known or suspected child abuse or neglect
~Required by law to report any known or suspected elder and vulnerable (developmentally disabled and mentally ill) abuse
~Need to know requirements in the area
~Only need to have a suspicion of abuse and/or neglect has occurred to generate a call to the authorities
~Not required to have proof before reporting suspected abuse
Who should be screened for IPV? - CORRECT ANSWER -USPSTF: all women of childbearing age (14-46)
inspection - CORRECT ANSWER -concentrated watching; both sides of the body; requires good lighting, adequate exposure, and occasional use of certain instruments.
palpation - CORRECT ANSWER -applies a sense of touch to assess: texture, temperature, moisture, organ location, size, swelling, vibration, pulsation, rigidity, spasticity, crepitation, lumps, masses, tenderness, pain
Fingertips: fine tactile discrimination (texture, swelling, pulsations, lumps)
Grasping of fingers and thumb: detect the position, shape, and consistency of an organ or mass
Backs of hands and fingers: temperature
The base of fingers or ulnar surface: vibration
percussion - CORRECT ANSWER -tapping the person's skin with short, sharp strokes to assess underlying structures
Maps location and size of an organ
Nociceptive Pain: Somatic - CORRECT ANSWER -Pain Descriptors: dull, aching, well-localized, nocturnal
Associated Disorders: postoperative pain, bone metastases, arthritis, sports injury, mechanical back pain
Treatment Options: treat the underlying cause, NSAIDs, opioids, muscle relaxant, corticosteroid, bisphosphonate
Nociceptive Pain - CORRECT ANSWER -activity of nociceptors in cutaneous and deep musculoskeletal tissue in response to tissue-damaging stimuli; inflammation
Nociceptive Pain: Visceral - CORRECT ANSWER -Pain Descriptors: deep, squeezing pressure, local tenderness and referred poorly localized pain
Associated Disorders: liver metastases & pancreatic cancer
Treatment Options: treat the underlying cause, NSAIDs, opioids, muscle relaxant, corticosteroid, bisphosphonate
Neuropathic Pain - CORRECT ANSWER -primary lesion (neuroma) or dysfunction in the nervous system causing ectopic charges within the nervous system
Pain Descriptors: A constant dull ache, burning, stabbing, viselike, electric shock-like, numbness, tingling, allodynia, hyperalgesia, hyperpathia
Associated Disorders: Distal polyneuropathy (diabetes, HIV), central poststroke pain, herpes zoster, trigeminal neuralgia, neuropathic back pain, complex regional pain syndrome
Treatment Options: TCA, anticonvulsant, antidepressant, anti neuroleptic, local anesthetic, bisphosphonate, corticosteroid, opioid, interventional
Prescription medications? Nonprescription? Use over a 24- hour period? - CORRECT ANSWER - Analgesics, antacids, anticonvulsants, antibiotics, diuretics, laxatives, antineoplastic drugs, steroids, and oral contraceptives are drugs that interact with nutrients, impairing their digestion, absorption, metabolism, or use
Type of vitamin/mineral supplement? Amount? Duration of use? - CORRECT ANSWER -Vitamin/mineral supplements have harmful side effects if taken in large amounts. The majority are due to the cardiovascular effects of weight loss and energy supplements in younger adults and swallowing problems among older adults.
Herbal and botanical products? Functional foods or foods enhanced with nutrients? Specific type/brand and where obtained? How often used? Who recommended it? How does it help you? Any problems? - CORRECT ANSWER -Use of herbal/botanical supplements is often not reported; therefore ask and discuss proper use and potential adverse effects
Test Central Visual Acuity - CORRECT ANSWER -Snellen eye chart & Near vision
Test Visual Fields - CORRECT ANSWER -Confrontation test (peripheral vision)
Corneal Light Reflex (Hirschberg Test) - CORRECT ANSWER -assess the parallel alignment of eye axes by shining a light toward a person's eyes
Diagnostics Positions Test - CORRECT ANSWER -six cardinal positions of gaze elicits any muscle weakness during movement
Unequal Pupil Size (Anisocoria) - CORRECT ANSWER -5% of population, consider CNS disease
Monocular Blindness - CORRECT ANSWER -When light is directed to the blind eye, no response occurs in either eye. When light is directed to the normal eye, both pupils constrict (direct & consensual response to light) as long as the oculomotor nerve is intact
Dilated and Fixed Pupils (Mydriasis) - CORRECT ANSWER -Enlarged pupils occur with stimulation of the sympathetic nervous system, reaction to sympathomimetic drugs, use of dilating drops, acute glaucoma, or past or recent trauma. They also herald CNS injury, circulatory arrest, or deep anesthesia
Constricted and Fixed Pupils (Miosis) - CORRECT ANSWER -Occurs with the use of pilocarpine drops for glaucoma treatment, the use of narcotics, with iritis, and with brain damage of pons
Conductive Loss: sound lateralizes to "poorer" ear from background room noise, which masks hearing in the normal ear. "Poorer" ear (the one with conductive loss) is not distracted by background noise and thus has a better chance to hear the bone-conducted sound. Examples: transient conductive loss with serous or purulent otitis media
Sensorineural Loss: sound lateralizes to "better" ear or unaffected ear. Poor ear (one with nerve loss) is unable to perceive the sound. However, many people with unilateral loss (conductive or sensorineural) still localize the sound in the midline. Confirm with audiometry
Rinne Test - CORRECT ANSWER -Normal: sound is heard twice as long by air conduction (AC) as by bone conduction (BC); a positive or AC > BC
Conductive Loss: A person hears equally long by bone conduction as by air conduction (AC=BC) or even longer (AC<BC). The test may be accurate to detect conductive loss, and loss can be confirmed by audiometry
Sensorineural Loss: Normal ratio of AC>BC intact but is reduced overall. That is, the person hears poorly both ways. Confirm with audiometry
Breast Cancer Risk Factors in Women: 4.0+ - CORRECT ANSWER -ages 65+ (until 80 years), biopsy- confirmed atypical hyperplasia, certain inherited genetic mutations for breast CA, ductal carcinoma in situ, lobular carcinoma in situ, mammography dense breasts, personal history early-onset (<40 years) breast cancer, 2+ first-degree relatives with breast cancer diagnosed at an early age
Breast Cancer Risk Factors in Women: 2.1-4.0 - CORRECT ANSWER -personal history breast CA (40+ years), high endogenous estrogen or testosterone levels (postmenopausal), high-dose radiation to the chest, 1 first-degree relative with breast CA
Breast Cancer Risk Factors in Women: 1.1-2.0 - CORRECT ANSWER -alcohol consumption, Ashkenazi Jewish heritage, DES exposure, early menarche (<12 years), height (tall), high socioeconomic status, late age at first full-term pregnancy (>30 years), late menopause (>55 years), never breastfed a child, no full- term pregnancies, obesity (postmenopausal)/ adult weight gain, personal history of endometrial, ovarian, or colon cancer, proliferative breast disease without atypia (ductal hyperplasia and fibroadenoma), recent and long-term use of menopausal HT containing estrogen and progestin, recent oral contraceptive use
Bronchial (Tracheal) - CORRECT ANSWER -Pitch: high
Amplitude: loud
Duration: inspiration < expiration
Quality: harsh, hollow tubular
Normal Location: trachea & larynx
Broncho-vesicular - CORRECT ANSWER -Pitch: moderate
Amplitude: moderate
Duration: inspiration = expiration
Quality: mixed
Normal Location: over major bronchi where fewer alveoli are located: posterior, between scapulae especially on right; anterior, around upper sternum in 1st and 2nd intercostal spaces
Vesicular - CORRECT ANSWER -Pitch: low
Amplitude: soft
Duration: inspiration > expiration
Quality: rustling, like the sound of wind in the trees
Normal Location: over peripheral lung fields where air flows through smaller bronchioles and alveoli
discontinuous sounds - CORRECT ANSWER -discrete, crackling sounds; fine crackles, coarse crackles, atelectatic crackles, pleural friction rub
Fine Crackles (Rales) - CORRECT ANSWER -discontinuous, high-pitched, short crackling, popping sounds heard during inspiration that is not cleared by coughing; you can stimulate this sound by rolling a strand of hair between your fingers near your ear or by moistening your thumb and index finger and separating them near your ear
Fine Crackles (Rales) Mechanism: Inspiratory - CORRECT ANSWER -inhaled air collides with previously deflated airways; airways suddenly pop open, creating an explosive crackling sound
Fine Crackles (Rales) Mechanism: Expiratory - CORRECT ANSWER -sudden airway closing
to the ear; sounds louder if you push the stethoscope harder onto the chest wall; the sound is inspiratory and expiratory
Pleural Friction Rub Mechanism - CORRECT ANSWER -caused when pleurae become inflamed and lose their normal lubricating fluid; their opposing roughened pleural surfaces rub together during respiration; heard best in the anterolateral wall where greatest lung mobility exists
Pleural Friction Rub Clinical Example - CORRECT ANSWER -pleuritis, accompanied by pain with breathing (rub disappears after a few days if pleural fluid accumulates and separates pleurae)
Continuous Sounds - CORRECT ANSWER -connected, musical sounds; wheeze (low + high), stridor
Wheeze (High-Pitched; Sibilant) - CORRECT ANSWER -high-pitched, musical, squeaking sounds that sound polyphonic (multiple notes as in a musical chord); predominate in expiration but may occur in both expiration and inspiration
Wheeze (High-Pitched; Sibilant) Mechanism - CORRECT ANSWER -air squeezed or compressed through passageways narrowed almost to closure by collapsing, swelling, secretions, or tumors; the passageway walls oscillate in apposition between the closed and barely open positions; the resulting sound is similar to that of a vibrating reed
Wheeze (High-Pitched; Sibilant) Clinical Example - CORRECT ANSWER -diffuse airway obstruction from acute asthma or chronic emphysema
Wheeze (Low-Pitched; Sonorous Rhonchi) - CORRECT ANSWER -low-pitched; monophonic, a single note, musical snoring, moaning sounds; they are heard throughout the cycle, although they are more prominent on expiration; may be clear somewhat by coughing
Wheeze (Low-Pitched; Sonorous Rhonchi) Mechanism - CORRECT ANSWER -airflow obstruction as described earlier by the vibrating reed mechanism; the pitch of the wheeze cannot be correlated to the size of the passageway that generates it
Wheeze (Low-Pitched; Sonorous Rhonchi) Clinical Example - CORRECT ANSWER -bronchitis, single bronchus obstruction from airway tumor
Stridor - CORRECT ANSWER -high-pitched, monophonic, inspiratory, crowing sound; louder in the neck than over chest wall
Stridor Mechanism - CORRECT ANSWER -originating in larynx or trachea, upper airway obstruction from swollen, inflamed tissues or lodged foreign body
Stridor Clinical Example - CORRECT ANSWER -croup and acute epiglottitis in children and foreign inhalation; obstructed airway may be life-threatening
Mitral Regurgitation - CORRECT ANSWER -Stream of blood regurgitates back into LA during systole through the incompetent mitral valve. In diastole, blood passes back into LV again along with new flow; results in LV dilation and hypertrophy
Mitral Regurgitation: Clinical Data - CORRECT ANSWER -Subjective: fatigue, palpitation, orthopnea, PND
Objective: thrill in systole at the apex. Lift at the apex. Apical impulse displaced down and to the left. S diminished, S2 accentuated, S3 at apex often is present
Murmur: pansystolic, often loud, blowing; best heard at apex; radiate well to left axilla
Clinical Portrait of Heart Failure - CORRECT ANSWER -~Dilated pupils (SNS response)
~Skin pale, gray, or cyanotic
~Dyspnea (SOBOE is an early symptom from pulmonary congestion)
~Orthopnea (cannot breathe unless sitting up)
~Crackles, wheeze (adventitious breath sounds)
~Cough (frothy pink or white sputum)
~Decreased blood pressure (stimulates SNS, which acts on the heart to increased rate and force of contraction)
~Nausea and vomiting (as peristalsis slows and bile and fluids back up into stomach)
~Ascites (fluid in the peritoneal cavity)
~Dependent, pitting edema (in the sacrum, legs)
~Anxiety (gasping from pulmonary congestion)
Pathologic S3 (Ventricular gallop) - CORRECT ANSWER -persists when sitting up; indicates decreased compliance of ventricles; occurs with heart failure (earliest sign) and volume overload (mitral regurgitation and aortic or tricuspid regurgitation); may originate in L or R ventricle; L: at the apex in left lateral; R: left lower sternal border with person supine and louder in inspiration
Fourth Heart Sound - CORRECT ANSWER -The ventricular filling sound that occurs when the atria contracts late in diastole and is heard immediately before S1. A very soft sound of very low pitch. Heard best at the apex with the person in the left lateral position
Physiologic S4 - CORRECT ANSWER -may occur in adults > 40 or 50 years with no evidence of cardiovascular disease, especially after exercise
pathologic S4 (atrial gallop) - CORRECT ANSWER -occurs with decreased compliance of the ventricle (CAD, cardiomyopathy) and systolic overload (afterload), including outflow obstruction to the ventricle (aortic stenosis) and systemic hypertension. Left-sided S4 occurs with these conditions. Right-sided S4 is less common and is heard at the left lower sternal border and may increase with inspiration. Occurs with pulmonary stenosis or pulmonary hypertension
Capillary Refill Time - CORRECT ANSWER -The time it takes for the vessels in the mucous membranes to return to normal after being pressed
Normal: color returns in less than 1 to 2 seconds
Grading Edema - CORRECT ANSWER -1+ mild pitting, slight indentation, no perceptible swelling of the leg
2+ moderate pitting, indentation, subsides rapidly
3+ deep pitting, indentation remains for a short time, leg looks swollen
4+ very deep pitting, indentation lasts a long time, leg is grossly swollen and distorted
Doppler Ultrasonic Probe - CORRECT ANSWER -Use this device to detect a weak peripheral pulse, to monitor BP in infants or children, or to measure a low blood pressure or blood pressure in a lower extremity. It magnifies pulsatile sounds from the heart and blood vessels. Position the person supine, with the legs externally rotated so you can reach the medial ankles easily. Place a drop of coupling gel on the end of the handheld transducer. Place the transducer over a pulse sit at a 90-degree angle. Apply very light pressure; locate the pulse site by the swishing, whooshing sound.
Can be used for Ankle-Brachial Index (ABI) to determine peripheral artery disease extent (PAD)
Chronic Arterial Disease (PAD) - CORRECT ANSWER -~oxygen deficit
~Location: deep muscle pain, usually in calf, but may be lower leg or dorsum of foot
~Character: intermittent claudication, feels like "cramp," "numbness and tingling," "feeling of cold"
~Onset and duration: chronic pain, onset gradual after exertion
~Aggravating factors: activity (walking, stairs); "claudication distance" is the specific number of blocks, stairs it takes to produce pain; elevation (rest pain indicates severe involvement)
~Relieving Factors: rest (usually within 2 min [e.g., standing]); dangling (severe involvement)
~Associated symptoms: low ankle-brachial index; cool, pale skin; diminished pulses, pallor on elevation
~Those at risk: older and middle-age adults; African Americans have twice the incidence as other racial/ethnic groups; smoking is strongest risk, also hypertension, diabetes, hypercholesterolemia, obesity, vascular disease
Acute Arterial Disease - CORRECT ANSWER -~Location: varies, distal to occlusion, may involve entire leg
~Character: throbbing
~Onset and duration: sudden onset (within 1 hr)
~Aggravating factors:
~Relieving Factors:
~Associated symptoms: six Ps: pain, pallor, pulselessness, paresthesia, poikilothermia (coldness), paralysis (indicates severe)
~Those at risk: history of vascular surgery; arterial invasive procedure; abdominal aneurysm (emboli); trauma, including injured arteries; chronic atrial fibrillation
Chronic Venous Disease - CORRECT ANSWER -~metabolic waste buildup
~Location: calf, lower leg
~Character: aching, tiredness, feeling of fullness
~Onset and duration: chronic pain, increased at end of day
~Aggravating factors: prolonged standing, sitting
~Relieving Factors: elevation, lying, walking
