PEP final

general inspection hyperthyroid

diaphoresis and tremor

general inspection hypothyroid

facial edema

integumentary hypothyroid

cool, dry skin

thinning hair

thinning lateral eyebrows

dry, brittle nails

integumentary hyperthyroid

fine hair

warm, moist skin

HEENT hyperthyroidism

conjunctival redness

exophthalmos and lid lag

HEENT hypothyroidism

conjunctival pallor

eyelid edema

tips for thyroid inspection

neck in slight extension

tangential lighting pointing downwards from the chin

diffuse and symmetrical thyroid enlargement

goiter

localized and asymmetrical thyroid enlargement

nodule or cyst

normal thyroid with swallowing

should move upwards

when would a thyroid bruit be heard

hyper metabolic state when the blood flow is increased

___ is the largest endocrine in the body and produces ___

thyroid gland

thyroxine (T4) and triiodothyronine (T3)

the lobes of the thyroid gland are covered by the ____

sternocleidomastoid muscles

normal thyroid dimensions

5cm long

3cm wide

2cm thick

thyroid in older adults

rate of T4 production and degradation gradually decrease

thyroid gland becomes more fibrotic

TSH may increase

thyrotropin releasing hormone

TRH

master regulator

released from hypothalamus targeting the pituitary gland

TSH

released by pituitary gland in response to TRH

targets the thyroid to release T3 and T4

primary hypothyroidism

chronic autoimmune (hashimoto) is the most common: thyroperoxidase and thyroglobulin antibodies against thyroid gland

transient hypothyroidism causes

subacute thyroiditis

postpartum thyroiditis

subtotal thyroidectomy

CC secondary hypothyroidism

pituitary lesions

hypothalamic lesions

pts receiving radiation or sx removal of the pituitary gland

trauma

CC tertiary hypothyroidism

tumor

trauma

radiation therapy

med that can cause hyperthyroidism

amiodarone

graves disease

AI antibodies called thyroid-stimulating immunoglobulins bind to TSH receptors on the thyroid

subacute thyroiditis is also called

de Quervain thyroiditis

granulomatous thyroiditis

females are ___ more likely to have thyroid cancer than males

3x

thyroid palpation

find landmarks: thyroid cartilage and cricoid cartilage below

locate isthmus, usually overlying the 2nd, 3rd, and 4th tracheal rings

sternocleidomastoid should be relaxed: ask pt to flex neck slightly forward

if the lower pole of the thyroid gland is not palpable suspect

retrosternal goiter

firm thyroid

hashimotos

coarse or gritty thyroid

inflammation

multiple thyroid nodules sugests

metabolic rather than neoplastic process

P/E RF thyroid nodules

hardness

size over 2cm

rapid growth

fixation to surrounding tissues

associated enlarged lymph nodes

GYN thyroid abnormalities

hyper: decreased menstrual flow

hypo: menorrhagia

healthy adults maintain cognitive function into their ___ and ____

60s and 70s

speed of information processing and psychomotor speed begin declining after age ____

30

declines in ____ may precede memory loss and other impairments

executive functioning (planning, developing strategies)

1 in __ people will experience a menta illness in their lifetime

4

hypothyroidism can present as ____ and ____ can be mistaken for MI

depression

panic disorder

when to do mental status exam

any pt complaining of memory problems o difficulty thinking

a pt whose family member notices a decline in functioning

to est a baseline and document progress or decline in a diagnosed condition

all known psychiatric pts

frontal lobe contains ___ cortex and ___ area

motor

brocas

parietal lobe is primarily responsible for

receiving and processing sensory data

temporal lobe contains ___ and is responsible for ____

wernicke’s area

perception and interpretation of sounds

limbic system

mediates patterns of behavior that determine survival

memory consolidation and long-term memory

reticular system

regulates vital reflexes

maintains wakefulness

depression neurotransmitters

low levels of dopamine, serotonin and norepinephrine

anxiety neurotransmitters

low serotonin and high norepinephrine

psychosis and mania neurotransmitters

high dopamine and low serotonin

serotonin synthesis location and regulatory function

raphe nuclei

regulates mood, arousal, and cognition

norepinephrine synthesis location and regulatory function

locus coeruleus

regulates mood, arousal, attention, and cognition

dopamine synthesis location and regulatory function

substantia nigra

regulates mood, arousal, attention and cognition

acetylcholine synthesis location and regulatory function

basal forebrain, basal nucleus of meynert

regulate sleep, arousal, and attention

aim for a psychiatric history

ascertain what is normal for the patient and what is now different

appearance and behavior

appearance: hygiene, grooming, and appropriate of dress for age and season

behavior: carelessness, apathy, hostility, rage, eye contact, posture, facial expressions

poor hygiene, lack of concern of appearance, or inappropriate dress in a previously well-groomed individual may indicate _____

new onset of depression, schizophrenia, or dementia

slumped posture and lack of facial expression may indicate ____

depression or parkinson

excessive energetic movements suggest _____

tension, mania, anxiety, metabolic disorder or effects of recreational or prescription drugs

confused

disoriented, impaired thinking and responses

delirious

restless, hallucinations, agitation

lethargic

sleepy or excessive drowsiness, incoherent mumbles, requires verbal stimuli for response

obtunded

moderate reduction in alertness, slowed psychomotor responses, requires tactile stimuli for response

stuporous

sleep-like state, little to no spontaneous activity, only responds to vigorous and repetitive stimuli

comatose

cannot be aroused, no response to stimuli

insight

pts awareness and understanding of their illness and how it affects their interactions with the world around them

judgment

process of comparing and evaluating alternatives when deciding on a course of action

impaired in intellectual disability, emotional disturbance, frontal lobe injury, dementia, psychosis

pts voice should ____

have inflections, be clear and strong, be able to change in volume without monotony

voice quality

note if there is any difficulty or discomfort during phonation

dysphonia

disorder of voice volume or quality

problem with laryngeal innervation or disease of larynx

dysprosody

speech disorder characterized by abnormalities in rhythm, pitch, and tone

suggests neurological condition, TBI, or psychiatric condition

dysarthria

disturbance of muscular control leading to trouble with articulation

associated with stroke, parkinson, alcohol, cerebral palsy

broca aphasia

fair to good word comprehension

impaired spontaneous speech

intact reading comprehension

impaired writing

wernickes aphasia

can hear words, but not relate them to previous experiences

fluent speech with inappropriate words

impaired reading and writing

global aphasia

absent or reduced word comprehension and spontaneous speech

severely impaired reading and writing

comprehension

ask pt to follow simple one and two step directions

“fold the paper in half and place it on the floor”

coherence

integration and logical connection between a persons thoughts, emotions and life experiences

intentions and perceptions should be clear

emotional stability evaluated when

pt does not seem to be coping well or does not have the resources to meet his or her personal needs

mood

words the pt tells you that describes their internal emotional state

affect

external emotional state that is observed via speech, facial expression, body habitus, gestures

parts of affect

quality and strength: euthymic, dysphoric, euphoric

range and reactivity: full and reactive, restricted, blunted, flat, stable, labile

appropriateness: quality and strength matches the content and situation

congruency

does the mood match the affect

thought process

the logic, organization, coherence, and relevance of the patients thought as it leads to selected goals

stream: normal, slow, fast, pressured, blocked

form: connection of ideas

circumlocution

thought process

word substitution to avoid revealing the word that was forgotten

perseveration

thought process

repetition of a word, phrase, or gesture

flight of ideas

thought process

rapid, continuous flow of ideas with vague association

loose associations

thought process

lack of connection between ideas

word salad

thought process

meaningless, disconnected word choices

neologisms

thought process

made up words that have meaning only to the patient

clang association

thought process

word choice bases on sound so that words rhyme in a non-sensical way

echolalia

thought process

repetition of another person’s words

poverty of ideas

thought process: form

minimal thoughts and slow pace

tangential

thought process: form

point of conversation never reached due to lack of goal-directed associations between ideas

circumstantial

thought process: form

point of conversation reached after a round about path

thought content

what the person thinks about

content: themes, delusions, obsessions

possession: own thoughts, thought insertion or control by others

derealization

alterations in the perception or experience of the external world so that is seems unreal

patient is aware the thoughts are abnormal

depersonalization

sensation of detachment within the self, or being detached observer of oneself

ideas of reference

thought content

misinterpretation of incidents and events in the outside world having direct personal reference to the pt

phobia

thought content

persisten, irrational fear

obsession

thought content

repetitive, intrusive thoughts

compulsion

thought content

repetitive behaviors

delusion

fixed, false beliefs firmly held despite contradictory evidence

control/unspecified delusions

outside forces are controlling thoughts, feelings, and actions

grandiose delusions

inflated sense of self-worth, power, or wealth