Bates Physical Exam Flashcards
apparent state of health fits in what part of physical exam?
general survey
level of consciousness fits in what part of physical exam?
general survey
signs of distress fit in what part of physical exam?
ie cardiac or respiratory distress, pain, or anxiety/depression
general survey
dress, grooming, and personal hygiene fits in what part of physical exam?
general survey
facial expression fits in what part of physical exam?
general survey
odors of body and breath fits in what part of physical exam?
general survey
height and weight fits in what part of physical exam?
general survey
BMI calculation
(Lbs * 700)/inches
OR
Kg/m^2
what is masked hypertension
- office BP <140/90 but elevated daytime BP >135/85 on home or ambulatory testing
- if untreated, estimated increased risk (10-30%) of cardiovascular disease and end-organ damage
what is nocturnal hypertension and how is it tested for
- a nocturnal fall of <10% of daytime values
- associated with poor cardiovascular outcomes
- requires 24 hour ambulatory BP monitoring to identify
what happens if BP cuff is too small
BP will read high
what happens if BP cuff is too large
BP will read low on a small arm and high on a large arm
what’s the proper width of a the inflatable bladder on a BP cuff
about 40% of the upper arm circumference
what’s the proper length of the inflatable bladder on a BP cuff
about 80% of the upper arm circumference
what happens if brachial artery is below heart level during BP measurement
BP will read high
what happens if brachial artery is above the heart level during BP measurement
BP will ready low
how and why to estimate systolic pressure
- palpate radial artery, rapidly inflate cuff until radial pulse disappears
- we take the number on the manometer and add 30. This is so we can avoid inflating the cuff unnecessarily high and causing discomfort
- also avoid error cause by auscultatory gap
what is auscultatory gap and what is it associated with
- silent interval that may be present between systolic and diastolic pressures
- associated with arterial stiffness and atherosclerotic disease
korotkoff sounds
- the blood flow sounds heard while taking blood pressure
* they are low in pitch and better heard with the bell
When do you find the systolic pressure
this is the level when you hear the sounds of at least 2 consecutive beats
When do you find the diastolic pressure
- once the korotkoff sounds become muffled and then disappear
- continue listening another 10-20 mmHg to confirm disappearance point
when taking the BP in both arms you find a difference between arms greater than 10-15 mmHg. what conditions may be associated with these findings?
- subclavian steal syndrome
- supravalvular aortic stenosis
- aortic dissection
consensual reaction to light
when light is shined into one eye, the opposite pupil will also constrict (the reaction in the first eye is called the direct reaction)
what nerves are involved in the pupillary reaction
CN II senses the light
CN III transmits the motor innervation to constrict the pupil
the near reaction (eye)
when shifting gaze from a far object to a near one, the pupils constrict
visual acuity
- expressed as 2 numbers (i.e 20/20)
- the first is the distance of the patient from the chart
- the second is the distance at which a normal eye can read the line of letters
myopia
- nearsightedness
* focusing problems for distance vision
presbyopia
- causes focusing problems for near vision
* found in middle-aged and older adults
hyperopia
- farsightedness
* focusing problems for near vision
normal pupils size range
between 3 and 5 mm
what is anisocoria
difference in pupillary diameter between eyes
what is nystagmus
- fine rhythmic oscillation of the eyes
* a few beat of nystagmus on extreme lateral gaze are normal
what is lid lag and what might it indicate
- rim of sclera is visible above the iris with downward gaze
* hyperthyroidism
preauricular lymph node
in front of ear
posterior auricular lymph node
superficial to the mastoid process
occipital lymph node
at the base of the skull posteriorly
tonsillar lymph node
at the angle of the mandible
submandibular lymph node
midway between the angle and the tip of the mandible
submental lymph node
in the midline a few centimeters behind the tip of the mandible
superficial cervical lymph node
superficial to the SCM
posterior cervical lymph node
along the anterior edge of the trapezius
deep cervical chain lymph node
deep to the SCM and often inaccessible to examination
supraclavicular lymph node
deep in the angle formed by the clavicle and SCM
what is stridor
high-pitched musical sound from subglottic or tracheal obstruction that signals a respiratory emergency
how to measure for orthostatic hypotension
- measure BP supine after patient has rested 3-10 minutes
* measure BP once patient stands up (take within 3 minutes of the supine reading)
what defines orthostatic hypotention
a drop in systolic BP of at least 20 mmHg or in diastolic BP of at least 10 mmHg within 3 minutes of standing
coarctation of the aorta
•arises from narrowing of the thoracic aorta and classically presents with systolic HTN greater in the arms than the legs
what is pyrexia
fever
hyperpyrexia is an extreme fever >41.1 C (106 F)
level of hypthermia
below 35 C (95F)
when do retractions occur
sever asthma, COPD or upper airway obstruction
when might you see asymmetric expansion in respiration
large pleural effusions
what does dullness to percussion in a lung field indicate
- fluid or solid tissue has replaced the air-containing space
- ie pneumonia, pleural effusion, hemothorax, fibrous tissue, tumor, etc
hyperresonance to percussion in a lung field indicates
- hyperinflated lungs
- ie COPD or asthma
- if unilateral, could indicated large pneumothorax
vesicular breath sounds
- soft and low pitched
* inspiratory sounds longer than expiratory
bronchovesicular breath sounds
inspiratory and expiratory sounds about equal in length; at times, separated by a silent interval
bronchial breath sounds
- louder, harsher, and higher in pitch
- short silence between inspiratory and expiratory sounds
- expiratory sounds last longer than inspiratory
tracheal breath sounds
•loud, harsh sound heard over trachea in neck
adventitious sounds
- added sounds that are superimposed on usual breath sounds
* ie crackes (rales), wheezes, rhonchi
crackles arise from abnormalities of
- lung parenchyma (pneumonia, interstitial lung disease, pulmonary fibrosis, atelactasis, heart failure)
- airways (bronchitis or bronchiectasis)
wheezes arise
in narrowed airways of asthma, COPD, and bronchitis
S1 and S2 and indications of systole and diastole
- from S1 to S2 is systole
- from S2 to S1 is diastole
- Diastole should last longer than systole
bounding (3+) carotid, radial, and femoral pulses are present in
aortic regurgitation
asymmetric diminished pulses point to
arterial occlusion from atherosclerosis or embolism
brownish discoloration or ulcers just above the malleolus suggests
chronic venous insufficiency
asymmetry in the abdomen could suggest
a hernia, enlarged organ, or a mass
areas dull to percussion in the abdomen can indicate
pregnant uterus, ovarian tumor, distended bladder, large liver, large spleen
light palpation of the abdomen is for
aids detection of tenderness, muscular resistance, and some superficial organs and masses
deep palpation of the abdomen is for
delineating the liver edge, kidneys, and abdominal masses
signs of peritonitis
guarding, rigidity, rebound tenderness, percussion tenderness
possible causes of peritonitis
appendicitis, cholecystitis, perforation of bowel wall
what is guarding
voluntary contraction of abdominal wall, may diminish when pt distracted
what is abdominal rigidity
involuntary reflex contraction of abdominal wall from peritoneal inflammation that persists over several examinations
possible causes of splenomegaly
portal hypertension, hematologic malignancies, HIV, infiltrative diseases (ie amyloidosis, splenic infarct, hematoma)
what is paresis
impaired strength or weakness
what is the name for absent strength
paralysis or plegia
wrist extensor weakness is seen in
peripheral radial nerve damage or hemiplegia of things like stroke or multiple sclerosis
a weak grip can be seen in
cervical radiculopathy
median or ulnar peripheral nerve disease
weak finger abduction occurs in
ulnar nerve disorders
heel-to-toe walking (AKA tandem walking or stressed gait) can reveal
ataxia that is not otherwise obvious
