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Doctoring > Bates Physical Exam > Flashcards

Bates Physical Exam Flashcards

1
Q

apparent state of health fits in what part of physical exam?

A

general survey

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2
Q

level of consciousness fits in what part of physical exam?

A

general survey

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3
Q

signs of distress fit in what part of physical exam?

ie cardiac or respiratory distress, pain, or anxiety/depression

A

general survey

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4
Q

dress, grooming, and personal hygiene fits in what part of physical exam?

A

general survey

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5
Q

facial expression fits in what part of physical exam?

A

general survey

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6
Q

odors of body and breath fits in what part of physical exam?

A

general survey

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7
Q

height and weight fits in what part of physical exam?

A

general survey

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8
Q

BMI calculation

A

(Lbs * 700)/inches
OR
Kg/m^2

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9
Q

what is masked hypertension

A
  • 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
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10
Q

what is nocturnal hypertension and how is it tested for

A
  • a nocturnal fall of <10% of daytime values
  • associated with poor cardiovascular outcomes
  • requires 24 hour ambulatory BP monitoring to identify
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11
Q

what happens if BP cuff is too small

A

BP will read high

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12
Q

what happens if BP cuff is too large

A

BP will read low on a small arm and high on a large arm

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13
Q

what’s the proper width of a the inflatable bladder on a BP cuff

A

about 40% of the upper arm circumference

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14
Q

what’s the proper length of the inflatable bladder on a BP cuff

A

about 80% of the upper arm circumference

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15
Q

what happens if brachial artery is below heart level during BP measurement

A

BP will read high

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16
Q

what happens if brachial artery is above the heart level during BP measurement

A

BP will ready low

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17
Q

how and why to estimate systolic pressure

A
  • 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
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18
Q

what is auscultatory gap and what is it associated with

A
  • silent interval that may be present between systolic and diastolic pressures
  • associated with arterial stiffness and atherosclerotic disease
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19
Q

korotkoff sounds

A
  • the blood flow sounds heard while taking blood pressure

* they are low in pitch and better heard with the bell

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20
Q

When do you find the systolic pressure

A

this is the level when you hear the sounds of at least 2 consecutive beats

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21
Q

When do you find the diastolic pressure

A
  • once the korotkoff sounds become muffled and then disappear
  • continue listening another 10-20 mmHg to confirm disappearance point
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22
Q

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?

A
  • subclavian steal syndrome
  • supravalvular aortic stenosis
  • aortic dissection
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23
Q

consensual reaction to light

A

when light is shined into one eye, the opposite pupil will also constrict (the reaction in the first eye is called the direct reaction)

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24
Q

what nerves are involved in the pupillary reaction

A

CN II senses the light

CN III transmits the motor innervation to constrict the pupil

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25
Q

the near reaction (eye)

A

when shifting gaze from a far object to a near one, the pupils constrict

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26
Q

visual acuity

A
  • 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
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27
Q

myopia

A
  • nearsightedness

* focusing problems for distance vision

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28
Q

presbyopia

A
  • causes focusing problems for near vision

* found in middle-aged and older adults

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29
Q

hyperopia

A
  • farsightedness

* focusing problems for near vision

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30
Q

normal pupils size range

A

between 3 and 5 mm

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31
Q

what is anisocoria

A

difference in pupillary diameter between eyes

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32
Q

what is nystagmus

A
  • fine rhythmic oscillation of the eyes

* a few beat of nystagmus on extreme lateral gaze are normal

33
Q

what is lid lag and what might it indicate

A
  • rim of sclera is visible above the iris with downward gaze

* hyperthyroidism

34
Q

preauricular lymph node

A

in front of ear

35
Q

posterior auricular lymph node

A

superficial to the mastoid process

36
Q

occipital lymph node

A

at the base of the skull posteriorly

37
Q

tonsillar lymph node

A

at the angle of the mandible

38
Q

submandibular lymph node

A

midway between the angle and the tip of the mandible

39
Q

submental lymph node

A

in the midline a few centimeters behind the tip of the mandible

40
Q

superficial cervical lymph node

A

superficial to the SCM

41
Q

posterior cervical lymph node

A

along the anterior edge of the trapezius

42
Q

deep cervical chain lymph node

A

deep to the SCM and often inaccessible to examination

43
Q

supraclavicular lymph node

A

deep in the angle formed by the clavicle and SCM

44
Q

what is stridor

A

high-pitched musical sound from subglottic or tracheal obstruction that signals a respiratory emergency

45
Q

how to measure for orthostatic hypotension

A
  • measure BP supine after patient has rested 3-10 minutes

* measure BP once patient stands up (take within 3 minutes of the supine reading)

46
Q

what defines orthostatic hypotention

A

a drop in systolic BP of at least 20 mmHg or in diastolic BP of at least 10 mmHg within 3 minutes of standing

47
Q

coarctation of the aorta

A

•arises from narrowing of the thoracic aorta and classically presents with systolic HTN greater in the arms than the legs

48
Q

what is pyrexia

A

fever

hyperpyrexia is an extreme fever >41.1 C (106 F)

49
Q

level of hypthermia

A

below 35 C (95F)

50
Q

when do retractions occur

A

sever asthma, COPD or upper airway obstruction

51
Q

when might you see asymmetric expansion in respiration

A

large pleural effusions

52
Q

what does dullness to percussion in a lung field indicate

A
  • fluid or solid tissue has replaced the air-containing space
  • ie pneumonia, pleural effusion, hemothorax, fibrous tissue, tumor, etc
53
Q

hyperresonance to percussion in a lung field indicates

A
  • hyperinflated lungs
  • ie COPD or asthma
  • if unilateral, could indicated large pneumothorax
54
Q

vesicular breath sounds

A
  • soft and low pitched

* inspiratory sounds longer than expiratory

55
Q

bronchovesicular breath sounds

A

inspiratory and expiratory sounds about equal in length; at times, separated by a silent interval

56
Q

bronchial breath sounds

A
  • louder, harsher, and higher in pitch
  • short silence between inspiratory and expiratory sounds
  • expiratory sounds last longer than inspiratory
57
Q

tracheal breath sounds

A

•loud, harsh sound heard over trachea in neck

58
Q

adventitious sounds

A
  • added sounds that are superimposed on usual breath sounds

* ie crackes (rales), wheezes, rhonchi

59
Q

crackles arise from abnormalities of

A
  • lung parenchyma (pneumonia, interstitial lung disease, pulmonary fibrosis, atelactasis, heart failure)
  • airways (bronchitis or bronchiectasis)
60
Q

wheezes arise

A

in narrowed airways of asthma, COPD, and bronchitis

61
Q

S1 and S2 and indications of systole and diastole

A
  • from S1 to S2 is systole
  • from S2 to S1 is diastole
  • Diastole should last longer than systole
62
Q

bounding (3+) carotid, radial, and femoral pulses are present in

A

aortic regurgitation

63
Q

asymmetric diminished pulses point to

A

arterial occlusion from atherosclerosis or embolism

64
Q

brownish discoloration or ulcers just above the malleolus suggests

A

chronic venous insufficiency

65
Q

asymmetry in the abdomen could suggest

A

a hernia, enlarged organ, or a mass

66
Q

areas dull to percussion in the abdomen can indicate

A

pregnant uterus, ovarian tumor, distended bladder, large liver, large spleen

67
Q

light palpation of the abdomen is for

A

aids detection of tenderness, muscular resistance, and some superficial organs and masses

68
Q

deep palpation of the abdomen is for

A

delineating the liver edge, kidneys, and abdominal masses

69
Q

signs of peritonitis

A

guarding, rigidity, rebound tenderness, percussion tenderness

70
Q

possible causes of peritonitis

A

appendicitis, cholecystitis, perforation of bowel wall

71
Q

what is guarding

A

voluntary contraction of abdominal wall, may diminish when pt distracted

72
Q

what is abdominal rigidity

A

involuntary reflex contraction of abdominal wall from peritoneal inflammation that persists over several examinations

73
Q

possible causes of splenomegaly

A

portal hypertension, hematologic malignancies, HIV, infiltrative diseases (ie amyloidosis, splenic infarct, hematoma)

74
Q

what is paresis

A

impaired strength or weakness

75
Q

what is the name for absent strength

A

paralysis or plegia

76
Q

wrist extensor weakness is seen in

A

peripheral radial nerve damage or hemiplegia of things like stroke or multiple sclerosis

77
Q

a weak grip can be seen in

A

cervical radiculopathy

median or ulnar peripheral nerve disease

78
Q

weak finger abduction occurs in

A

ulnar nerve disorders

79
Q

heel-to-toe walking (AKA tandem walking or stressed gait) can reveal

A

ataxia that is not otherwise obvious

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