Ch. 4 General Survey, Vital Signs, Pain

Question 1

Fatigue is a common symptom of what?

Answer 1

• Depression and anxiety
• Infections (such as hepatitis, infectious mononucleosis, & tuberculosis)
• Endocrine disorders (hypothyroidism, adrenal insufficiency, diabete mellitus, panhypopituitarism)
• Heart failure
• Chronic disease of the lungs, kidneys, or liver
• Electrolyte imbalance
• Moderate to severe anemia
• Malignancies
• Nutritional deficits
• Medications

Question 2

Weakness, especially if localized in a neuroanatomical pattern, suggests what?

Answer 2

Possible neuropathy or myopathy

Question 3

What do recurrent shaking chills suggest?

Answer 3

More extreme swings in temperature and systemic bacteremia

Question 4

What does feeling hot and sweating accompany?

Answer 4

Menopause

Question 5

What do night sweats occur with?

Answer 5

Tuberculosis and malignancy

Question 6

What do rapid changes in weight over a few days suggest?

Answer 6

changes in body fluids, not tissues

Question 7

In what conditions is edema from extravascular fluid retention visible?

Answer 7

heart failure, nephrotic syndrome, and liver failure

Question 8

What drugs are associated with weight gain?

Answer 8

• tricyclic antidepressants
• insulin & sulfonylurea
• contraceptives, glucocorticoids, & progestational steroids
• mirtazapine & paroxetine
• gabapentin & valproate
• propranolol

Question 9

Causes of weight loss include what?

Answer 9

• gastrointestinal diseases
• endocrine disorders (diabetes mellitus, hyperthyroidism, adrenal insufficiency)
• chronic infections, HIV/AIDS
• malignancy
• chronic cardiac, pulmonary, or renal failure
• depression
• anorexia nervosa or bulimia

Question 10

Weight loss with relatively high food intake suggests what?

Answer 10

• diabetes mellitus, hyperthyroidism, or malabsorption

- consider also binge eating (bulimia) with clandestine vomiting

Question 11

What factors increase the likelihood of malnutrition?

Answer 11

poverty, old age, social isolation, physical disability, emotional or mental impairment, lack of teeth, ill-fitting dentures, alcoholism, and drug abuse

Question 12

What drugs are associated with weight loss?

Answer 12

anticonvulsants, anti-depressants, levodopa, digoxin, metformin, and thyroid medication

Question 13

Metabolic syndrome risk factors increase the risk of what?

Answer 13

CVD and diabetes

Question 14

According to the American Heart Association and the Institute of Medicine, what is the max sodium you should intake per day?

Answer 14

1,500 mg/day

Question 15

What details should you observe when judging a patient’s apparent state of health?

Answer 15

Is the patient acutely or chronically ill, frail, or fit and robust?

Question 16

Signs of cardiac or respiratory distress.

Answer 16

clutching of the chest, pallor, diaphoresis, labored breathing, wheezing, coughing

Question 17

Signs of pain.

Answer 17

wincing, sweating, protectiveness of a painful area, facial grimacing, or an unusual posture favoring one limb or body area

Question 18

Signs of anxiety or depression.

Answer 18

anxious facial expressions, fidgety movements, cold and moist palms, inexpressive or flat affect, poor eye contact, or psychomotor slowing

Question 19

When assessing a patient’s skin, what should you take note of?

Answer 19

pallor, cyanosis, jaundice, rashes, bruises should be pursues

Question 20

What might excess clothing on a patient reflect?

Answer 20

cold intolerance of hypothyroidism, hide skin rash or needle marks, mask anorexia, or signal personal lifestyle preferences

Question 21

Patient’s wearing slippers or shoes with cut-out holes may indicate what?

Answer 21

gout, bunions, edema, or other painful foot conditions

Question 22

What can run-down shoes contribute to?

Answer 22

foot and back pain, calluses, falls, and infection

Question 23

Copper bracelets can be worn for what?

Answer 23

arthritis

Question 24

Significance of “grown-out” hair and nail polish?

Answer 24

can help you estimate the length of an illness

Question 25

What do fingernails chewed to the quick reflect?

Answer 25

stress

Question 26

What can unkempt appearance be seen in?

Answer 26

depression and dementia, but this appearance must be compared with the patient's probable norm

Question 27

What does a blank stare suggest?

Answer 27

hyperthyroidism

Question 28

What does an immobile face suggest?

Answer 28

parkinsonism

Question 29

what does a flat or sad affect suggest?

Answer 29

depression

Question 30

what does decreased eye contact suggest?

Answer 30

may be cultural or may suggest anxiety, fear, or sadness

Question 31

Breath odors can indicate what?

Answer 31

the presence of alcohol, acetone (diabetes), pulmonary infections, uremia, or liver failure

Question 32

What are other serious and potentially correctable problems from alcoholism?

Answer 32

hypoglycemia, subdural hematoma, or postictal state

Question 33

When is there a preference for sitting upright?

Answer 33

in left-sided heart failure

Question 34

when is there a preference for leaning forward with arms braced?

Answer 34

in chronic obstructive pulmonary disease

Question 35

how do anxious patients appear?

Answer 35

agitated and restless

Question 36

how to patients in pain act?

Answer 36

they often avoid movements

Question 37

what motor activity should you look for in a patient?

Answer 37

tremors, other involuntary movements, or paralysis

Question 38

an impaired gait increases the risk of what?

Answer 38

falls

Question 39

what conditions can cause very short stature?

Answer 39

Turner's syndrome, childhood renal failure, and achondroplastic and hypopituitary dwarfism

Question 40

what conditions cause long limbs in proportion to the trunk?

Answer 40

hypogonadism and Marfan's syndrome

Question 41

what conditions cause height loss?

Answer 41

osteoporosis and vertebral compression fractures

Question 42

what causes generalized fat?

Answer 42

simple obesity

Question 43

what causes truncal fat with relatively thin limbs?

Answer 43

Cushing's syndrome and metabolic syndrome

Question 44

what are causes of weight loss?

Answer 44

malignancy, diabetes mellitus, hyperthyroidism, chronic infection, depression, diuresis, and successful dieting

Question 45

what improves blood pressure control?

Answer 45

self-monitoring of blood pressure by well-instructed patients using approved devices (done twice a day at the upper arm with automatic readouts)

Question 46

what happens if the blood pressure cuff is too small (narrow)?

Answer 46

the blood pressure will read high

Question 47

what happens if the blood pressure cuff is too large (wide)?

Answer 47

the blood pressure will read low on a small arm and high on a large arm

Question 48

what happens if the brachial artery is 7 to 8 cm below heart level?

Answer 48

the blood pressure will read approximately 6 cm higher

Question 49

what happens if the brachial artery is 6 to 7 cm higher than the heart level?

Answer 49

the blood pressure will read 5 cm lower

Question 50

what does a loose cuff or a bladder that balloons outside the cuff lead to?

Answer 50

falsely high readings

Question 51

what can an unrecognized auscultatory gap lead to?

Answer 51

serious underestimation of systolic pressure or overestimation of diastolic pressure

Question 52

what should you do if you find an auscultatory gap?

Answer 52

record your findings completely

Question 53

what is an auscultatory gap associated with?

Answer 53

arterial stiffness and atherosclerotic disease

Question 54

when do the muffling point and disappearing point never disappear?

Answer 54

in aortic regurgitation

Question 55

when should you record both the muffling point AND the disappearing point when taking blood pressure?

Answer 55

if the difference is 10 mmHg or greater (in some people they are farther apart)

Question 56

When venous congestion makes the heart sounds less audible, what can this produce?

Answer 56

artificially low systolic and high diastolic pressures

Question 57

when do pressure differences of more than 10-15 mmHg occur?

Answer 57

in subclavian steal syndrome and aortic dissection

Question 58

what are the target "end organs" of hypertension?

Answer 58

the eyes, heart, brain, and kidneys

Question 59

What do hypertensive retinopathy, left ventricular hypertrophy, and neurologic deficits suggest?

Answer 59

stroke

Question 60

what does renal assessment require?

Answer 60

urinalysis and blood tests of renal function

Question 61

what does treatment of isolated systolic hypertension in patients 60 years or older reduce?

Answer 61

total mortality and both mortality and complications from cardiovascular disease

Question 62

Is a blood pressure of 110/70 mmHg normal?

Answer 62

usually is normal, but could also indicate significant hypotension if past pressures have been high

Question 63

what does a fall in systolic pressure of 20 mmHg ore more, especially when accompanied by symptoms and tachycardia, indicate?

Answer 63

orthostatic (postural) hypotension

Question 64

what can cause a fall in systolic pressure of 20 mmHg or more?

Answer 64

drugs, moderate or severe blood loss, prolonged bed rest, and diseases of the autonomic nervous system

Question 65

in what rare cases are patients pulseless?

Answer 65

due to occlusive disease in the arteries of the limbs from Takayasu arteritis, giant cell arteritis, or atherosclerosis

Question 66

what is white coat hypertension?

Answer 66

constitutes roughly 15-20% of Stage 1 hypertensives, the office blood pressure is high but ambulatory pressures are normal, so cardiovascular risk is low

Question 67

What does using a small cuff overestimate?

Answer 67

systolic blood pressure in obese patients

Question 68

palpation of an irregularly irregular rhythm indicates what?

Answer 68

atrial fibrillation

Question 69

what is needed to identify all irregular patterns?

Answer 69

an ECG is needed to identify the type of rhythm

Question 70

what does coarctation of the aorta result from?

Answer 70

narrowing of the thoracic aorta, usually proximal but sometimes distal to the left subclavian artery

Question 71

how are coarctation of the aorta and occlusive aortic disease distinguished?

Answer 71

by hypertension in the upper extremities and low blood pressure in the legs, and by diminished or delayed femoral pulses

Question 72

what is prolonged expiration common in?

Answer 72

COPD

Question 73

what does fever or pyrexia refer to?

Answer 73

elevated body temperature

Question 74

what does hyperpyrexia refer to?

Answer 74

extreme elevation in temperature, above 41.1 celsius (106 fahrenheit)

Question 75

what does hypothermia refer to?

Answer 75

an abnormally low temperature, below 35 celsius (95 fahrenheit) rectally

Question 76

what are causes of fever?

Answer 76

infection, trauma such as surgery or crush injuries, malignancy, blood disorders such as acute hemolytic anemia, drug reactions, and immune disorders such as collagen vascular disease

Question 77

what is the chief cause of hypothermia?

Answer 77

exposure to cold

Question 78

who is especially susceptible to hypothermia and less likely to develop a fever?

Answer 78

older adults

Question 79

what are other predisposing causes oh hypothermia, aside from exposure to cold?

Answer 79

reduced movement as in paralysis, interference with vasoconstriction from sepsis or excess alcohol, starvation, hypothyroidism, and hypoglycemia

Question 80

what do rapid respiratory rates tend to increase?

Answer 80

the discrepancy between oral and rectal temperatures (in these situations, rectal temperatures are more reliable)

Question 81

what kind of disorder may chronic pain be?

Answer 81

a spectrum disorder related to mental health and somatic conditions

Question 82

What are the four A's to monitor patient outcomes of pain management?

Answer 82

Analgesia, Activities of daily living, Adverse effects, Aberrant drug-related behaviors