Exam 1 Flashcards
What are the 6 steps to resolve a clinical ethical dilemma?
- Clearly state the ethical question
- Collect relevant information
- Identify ethical principles and guidelines
- Delineate and relate options to values and principles
- Evaluate the different options
- Make an action plan
Each step is crucial in navigating ethical dilemmas in clinical settings.
What is the professional term for ‘Patient DRUNK and LATE TO clinic again’?
Intoxicated person tardy to scheduled appointment
This change reflects a more neutral and professional approach in documentation.
Define validity in the context of clinical measurements.
A measure of how accurately a measurement or study reflects the concept it is trying to measure.
Validity is crucial for ensuring the reliability of clinical assessments.
What does the acronym OLD CARTS stand for in symptom assessment?
- Onset
- Location
- Duration
- Character
- Aggravating/alleviating factors
- Radiation
- Timing
- Setting
OLD CARTS is a mnemonic used to gather detailed information about a patient’s symptoms.
What are the components of an illness script?
- Epidemiology/pathophysiology
- Time course
- Clinical Presentation
- Diagnostic Studies
Understanding these components is essential for effective clinical reasoning.
What is the definition of orthostatic hypotension?
A sustained reduction in SBP of at least 20 mm Hg or in DBP of at least 10 mm Hg within 3 minutes of standing.
This condition can indicate underlying cardiovascular issues.
List three red flags in family history.
- Multiple affected family members with the same or related disorders
- Earlier age at onset of disease than expected
- Condition in the less-often-affected sex
These flags help in assessing genetic risks for certain conditions.
What are the three levels of prevention in healthcare?
- Primary prevention
- Secondary prevention
- Tertiary prevention
Each level focuses on different aspects of disease prevention and management.
What is the importance of assessing the symmetry of the neck during examination?
Ensure both sides of the neck are symmetrical.
Asymmetry may indicate underlying pathology.
What does the acronym OPQRST stand for in assessing pain?
- Onset
- Precipitating and Palliating factors
- Quality
- Region/or radiation
- Severity
- Timing/Temporal characteristics
OPQRST helps clinicians gather comprehensive information about a patient’s pain.
What is the definition of sensitivity in clinical testing?
The probability that a person with disease has a positive test.
High sensitivity reduces the risk of false negatives.
What should be included in a summary statement?
- Chief complaint in context of overall health
- Pertinent history, examination, and lab data
- Succinct and short (no more than 2-3 sentences)
- Demonstrates clinical reasoning skills
- Makes a case for the diagnosis
- Distillation of understanding of the case
A well-crafted summary statement is essential for effective communication in clinical practice.
What are three basic questions to ask when evaluating evidence?
- Are the results valid?
- What are the results?
- How can you apply the results to patient care?
These questions help assess the reliability and applicability of clinical evidence.
What are the attributes of a symptom for a sore throat using OLD CARTS?
- Onset: When did your sore throat start?
- Location: Where exactly does it hurt?
- Duration: How long does the sore throat last?
- Character: Can you describe the pain for me?
- Aggravating/alleviating factors: Does anything make it better or worse?
- Radiation: Does the pain move to other parts of the body?
- Timing: Is there a time of day it gets worse or better?
- Setting: Are there other things that happen when you experience this sore throat?
These questions guide the clinician in understanding the patient’s experience.
What are three clinical pearls when performing a physical exam?
- Positioning for respiratory exam in dyspnea patients
- Modifying the exam for a patient with acute abdominal pain
- Adjusting the neurological exam in elderly patients
These pearls enhance the effectiveness of physical examinations.
What is the professional term for ‘Addict’?
Person who uses/injects drugs, a person with an addiction
This terminology promotes a more respectful and neutral discourse.
What is the professional term for ‘Prostitute’?
Sex worker, a person who is involved in transactional or survival sex
This change reflects a more neutral and respectful approach in documentation.
What are the key observations during a head examination?
- Size and Shape
- Skull
- Scalp
- Hair
- Face
- Skin
- Cervical lymph nodes
- Trachea
- Thyroid gland
Each observation is critical for identifying abnormalities.
What are the important aspects to observe in the neck during examination?
- Symmetry
- Masses or Swelling
- Trachea Position
- Range of Motion
- Skin
These elements are vital for detecting potential health issues.
What is the definition of specificity in clinical testing?
The probability that a non-diseased person has a negative test.
High specificity reduces the risk of false positives.
What are the vital signs to document during a general survey?
- Blood Pressure (BP)
- Temperature (Temp)
- Respiratory Rate (RR) and Rhythm
- Pulse or Heart Rate (HR) and Rhythm
Vital signs are essential indicators of a patient’s health status.
What is assessed to evaluate the neck’s flexibility and movement?
Range of Motion
What should be examined on the skin of the neck?
Lesions, scars, or color changes
What questions should be asked regarding neck lumps?
Have you noticed any lumps or swollen glands in your neck? When did you first notice the lump? How did you notice it? Was it noticed accidentally or told by others? How does the lump bother you? Are there any other symptoms such as discharge, pain in swallowing, difficulty breathing? Have you had any other lumps before this?
What should raise suspicion for malignancy in neck masses?
A persistent neck mass in an adult older than 40 years
What commonly accompanies pharyngitis?
Enlarged tender lymph nodes
List the different chains of lymph nodes in the head and neck.
- Preauricular: In front of the ears
- Posterior Auricular: Behind the ears, superficial to the mastoid process
- Occipital: At the base of the skull posteriorly
- Tonsillar (Jugulodigastric): At the angle of the mandible
- Submandibular: Midway between the angle and tip of the mandible
- Submental: In the midline, a few centimeters behind the tip of the mandible
- Anterior Superficial Cervical: Along the sternocleidomastoid muscle
- Posterior Cervical: Along the anterior edge of the trapezius
- Deep Cervical: Deep under the sternocleidomastoid muscle
- Supraclavicular: Above the clavicle
How do you assess thyroid function?
Assess for any thyroid gland enlargement or goiter
What symptoms point to hypothyroidism?
- Intolerance to cold
- Weight gain
- Dry skin
- Slowed heart rate
What symptoms suggest possible hyperthyroidism?
- Intolerance to heat
- Weight loss
- Moist, velvety skin
- Palpitations
What is the first step in assessing the thyroid?
Inspection of the neck for swelling or asymmetry
What are the three main components of a thyroid assessment?
- Inspection
- Palpation
- Auscultation
What is the function of the conjunctiva?
Lubricate and protect the eye
What part of the eye is responsible for focusing light onto the retina?
Lens
What is the central area of the retina responsible for detailed vision called?
Macula
What should you ask patients regarding their eyes?
- Have you noticed any changes in vision?
- Do you experience pain, redness, or discharge?
- Have you had recent eye trauma?
- Do you have a history of eye conditions?
How do you assess the visual fields?
Use the confrontation test by covering one eye and comparing peripheral vision with the examiner
What additional information is needed if a patient reports a change in vision?
Is vision worse during close work or at distances?
What are the two types of hearing loss?
- Conductive
- Sensorineural
What causes conductive hearing loss?
Blockage in the external or middle ear
What is a common symptom of sensorineural hearing loss?
Trouble understanding speech
List three differential diagnoses for ear pain.
- Otitis externa
- Otitis media
- TMJ dysfunction
What is important to observe during an ear examination?
- External ear shape
- Canal patency
- Tympanic membrane color
What are the steps for using an otoscope?
- Pull the auricle upward and back
- Insert otoscope gently
- Inspect tympanic membrane
What is rhinorrhea?
Drainage from the nose
List three causes of rhinorrhea.
- Viral infections
- Allergic rhinitis
- Vasomotor rhinitis
What question helps clarify the type of dizziness a patient is experiencing?
Describe how you are feeling without using the word dizzy
What should you look for when examining the conjunctiva?
Color, vascular pattern, nodules, swelling
What is the first step in using an ophthalmoscope?
Darken the room
What is the function of the lacrimal apparatus?
Produces and drains tears
What should be assessed regarding the pupils during an eye examination?
Size, shape, symmetry
What is the normal response of the pupil to light called?
Pupillary reaction to light
What indicates a problem with the ocular surface, cornea, lens, or muscle?
Monocular diplopia
What are the common causes of nasal congestion?
Viral infections, allergic rhinitis, and vasomotor rhinitis
Itching favors an allergic cause.
What symptoms suggest allergic rhinitis?
Seasonal onset or environmental triggers
Symptoms may include sneezing, itchy nose, eyes, or throat, and clear nasal discharge.
What characterizes drug-induced rhinitis?
Excessive use of topical decongestants or intranasal cocaine
This condition can lead to persistent nasal congestion.
What are the key symptoms of acute bacterial sinusitis?
Purulent nasal discharge and facial pain
Symptoms should persist more than 7 days for diagnosis.
What should be assessed if nasal congestion occurs only on one side?
Consider deviated nasal septum, nasal polyps, foreign body, granulomatous disease, or carcinoma.
What distinguishes viral upper respiratory infections from sinusitis?
Sinusitis symptoms persist for more than 10 days without improvement or worsen after initial improvement.
What is epistaxis?
Bleeding from the nasal passages
Can originate from paranasal sinuses or nasopharynx.
What are local causes of epistaxis?
Trauma, inflammation, drying of mucosa, tumors, foreign bodies
Nose picking is a common cause.
What are the steps for assessing the nose and sinuses?
- Inspection of the external nose
- Palpation of the nasal bridge
- Internal examination with an otoscope
- Sinus palpation for tenderness.
List three differential diagnoses for sore throat.
- Viral Pharyngitis
- Bacterial Pharyngitis (e.g., Group A Streptococcus)
- Infectious Mononucleosis.
What is the typical history and symptoms of viral pharyngitis?
Gradual onset of sore throat, associated symptoms like cough, nasal congestion, and absence of high fever.
What are the key symptoms of bacterial pharyngitis?
Abrupt onset of sore throat, fever greater than 38°C, tender cervical lymphadenopathy, and tonsillar exudates.
What are the normal findings for the oral mucosa during examination?
Pink, moist, and free from lesions.
How is Jugular Venous Pressure (JVP) measured?
From pulsation in the right internal jugular vein, assessing the height of the pulsation above the sternal angle.
What are the locations of the heart valves?
- Aortic Valve: 2nd intercostal space (left sternal border)
- Pulmonic Valve: 2nd intercostal space (right sternal border)
- Tricuspid Valve: Between 3rd and 4th intercostal spaces (right sternal border)
- Mitral Valve: Mid clavicular line (5th intercostal space).
What is the difference between a regurgitant murmur and a turbulent forward flow murmur?
Regurgitant murmurs result from backward flow through an incompletely closed valve; turbulent forward flow murmurs occur with abnormal flow through narrowed valves.
What are the characteristics of innocent murmurs?
Location: Left second to fourth intercostal spaces
Radiation: Minimal
Intensity: Grades 1 to 2, possibly 3
Pitch: Soft to medium.
Fill in the blank: Epistaxis is often associated with _______.
[local causes such as trauma, inflammation, or drying of the nasal mucosa]
What is the best position to assess JVP?
Patient sitting and leaning forward.
How is JVP measured?
By finding the highest point of oscillation in the internal jugular vein or the point above the external jugular vein that appears collapsed.
What is the reference point for measuring JVP?
Sternal angle, located around T4 adjacent to the second rib.
What patient position is recommended for measuring JVP?
Head of bed at 30 degrees and patient turning head slightly to the left.
Define heave in cardiac assessment.
Sustained impulses that rhythmically lift your fingers, usually produced by an enlarged ventricle.
What causes a thrill in cardiac examination?
A buzzing or vibratory sensation caused by underlying turbulent flow.
What is a bruit?
A murmur-like sound arising from turbulent arterial blood flow.
What does PMI stand for?
Point of maximal impulse.
What is the purpose of grading a murmur?
To describe the intensity and characteristics of the heart murmur.
At what age should routine cardiovascular disease screening begin?
At 20 years.
List three risk factors for cardiovascular diseases.
- Family history of premature CVD
- Cigarette smoking
- Unhealthy diet.
Which lung lobe is predominantly visible anteriorly in the right lung?
Upper lobe.
Where can you hear the right middle lobe best?
Between the 4th and 6th ribs at the midclavicular line.
What is the best location to auscultate all three lobes of the right lung?
Right lateral chest (midaxillary line between the 4th and 8th ribs).
What does the acronym O.L.D.C.A.R.T.S. stand for in assessing dyspnea?
Onset, Location, Duration, Character, Aggravating factors, Relieving factors, Timing, Severity.
How should a patient be positioned for percussion of the chest?
Sitting upright with arms crossed over the chest.
What is the normal percussion sound associated with normal lung tissue?
Resonant.
What percussion sound suggests pneumonia or pleural effusion?
Dull.
Where are bronchial breath sounds normally heard?
Over the trachea and manubrium.
What are the USPSTF recommendations for lung cancer screening?
Annual LDCT for adults aged 50 to 80 years with at least a 20 pack-year smoking history.
What should be the criteria for discontinuing lung cancer screening?
If the individual has not smoked for 15+ years or develops a health condition that limits life expectancy.
What is the clinical significance of diminished vesicular breath sounds?
May indicate emphysema, pleural effusion, or obesity.
What is the normal location for tracheal breath sounds?
Heard over the trachea in the neck.
What is a common cause of hyperresonant percussion sounds?
Pneumothorax, COPD, emphysema.
What is the normal range for diaphragmatic excursion?
3-5 cm.
What does paroxysmal nocturnal dyspnea indicate?
Heart failure.
What screening method significantly reduces lung cancer mortality?
LDCT (Low-Dose Computed Tomography)
LDCT is recommended for high-risk populations for early detection of lung cancer.
Is chest X-ray recommended for lung cancer screening?
No
Chest X-rays are not effective for lung cancer screening compared to LDCT.
What is the most effective strategy to reduce lung cancer risk?
Smoking cessation
Quitting smoking greatly decreases the risk of developing lung cancer.
Is routine screening recommended for children and adolescents?
No
Emphasis is placed on smoking prevention and reducing secondhand smoke exposure.
What are some additional risk factors that may justify lung cancer screening?
- Occupational exposures (e.g., asbestos, radon)
- Family history of lung cancer
- History of chronic lung disease (e.g., COPD, pulmonary fibrosis)
- Secondhand smoke exposure
- History of radiation therapy to the chest
What are the limitations and risks of lung cancer screening?
- False positives can lead to unnecessary procedures
- Radiation exposure from LDCT
- Overdiagnosis may result in treating slow-growing tumors that wouldn’t impact lifespan
How many lobes does the right lung have?
3 lobes
The right lung consists of the right upper, right middle, and right lower lobes.
How many lobes does the left lung have?
2 lobes
The left lung consists of the left upper and left lower lobes.
What is the most common cause of an acute cough?
Viral upper respiratory infections
Other considerations include acute bronchitis, pneumonia, and asthma.
What are the classifications of cough based on duration?
- Acute: less than 3 weeks
- Subacute: 3-8 weeks
- Chronic: more than 8 weeks
What does hemoptysis refer to?
Blood coughed up from the lower respiratory tract
It can vary from blood-streaked sputum to frank blood.
What are some common causes of chest pain?
- Angina pectoris
- Myocardial infarction
- Pericarditis
- Pneumonia
- Costochondritis
- GERD
What is the normal respiratory rate for adults?
12-20 breaths per minute
This range differs for children and newborns.
What is tachypnea?
Rapid breathing (>20 bpm)
It indicates potential respiratory distress.
What is the significance of clubbing in nails?
Suggests chronic hypoxia
Associated with conditions like cystic fibrosis and lung cancer.
What is the purpose of palpation in lung examination?
Assessing tenderness, fremitus, and chest expansion
It helps identify abnormalities in the thoracic structures.
What does increased tactile fremitus indicate?
Pneumonia or lung consolidation
Increased fremitus occurs when lung tissue becomes solid.
What percussion sound indicates a large pleural effusion?
Flat sound
This sound suggests fluid accumulation in the pleural space.
What are normal breath sounds?
- Bronchial: Loud, high-pitched
- Bronchovesicular: Moderate intensity
- Vesicular: Soft, low-pitched
What does stridor indicate?
Upper airway obstruction
Stridor is a medical emergency that requires urgent evaluation.
What are crackles (rales) associated with?
Fluid in alveoli
Commonly heard in conditions like pneumonia and pulmonary edema.
What is the clinical significance of diminished or absent breath sounds?
Reduced airflow or lung collapse
Conditions include pneumothorax, pleural effusion, and severe emphysema.
What is the normal range for diaphragmatic excursion?
3-5 cm
Reduced movement may indicate conditions like COPD or phrenic nerve paralysis.
What are adventitious breath sounds?
Added sounds superimposed on usual breath sounds
Includes crackles, wheezes, and rhonchi, indicating possible cardiac and pulmonary conditions.
What are crackles also known as?
Rales
Intermittent, nonmusical sounds that indicate lung or airway abnormalities.
What are the characteristics of fine crackles?
Soft, high pitched, very brief
Frequency is around -650 Hz and duration is 5-10 ms.
What are coarse crackles characterized by?
Louder in pitch, brief, and somewhat longer in duration
Frequency is around -350 Hz and duration is 15-30 ms.
What conditions can cause crackles?
- Pneumonia
- Interstitial lung disease
- Pulmonary fibrosis
- Atelectasis
- Heart failure
- Bronchitis
- Bronchiectasis
Crackles can arise from abnormalities in lung parenchyma or airways.
What are wheezes and their characteristics?
Sinusoidal, musical, prolonged sounds
High-pitched (>400 Hz) with a hissing or shrill quality.
What can cause wheezing?
- Asthma
- COPD
- Bronchitis
Wheezes can occur in narrowed airways and may become absent in severe asthma due to low airflow.
What are rhonchi characterized by?
Relatively low-pitched with a snoring quality
Often associated with secretions in large airways.
What is stridor?
A continuous, high-frequency, high-pitched musical sound
Produced during airflow through narrowing in the upper respiratory tract.
What is a pleural rub?
A low-frequency, grating sound from inflammation of the pleura
Best heard in the axilla and base of the lungs.
What is mediastinal crunch?
A series of precordial crackles synchronous with the heartbeat
Arises from air entry into the mediastinum, often associated with trauma or certain medical conditions.
What are the normal transmitted voice sounds in air-filled lungs?
- Spoken words muffled and indistinct
- Spoken ‘ee’ heard as ‘ee’
- Whispered words faint and indistinct
Indicates normal lung function.
What are signs of consolidated airless lung (lobar pneumonia)?
- Bronchial or bronchovesicular breath sounds
- Spoken ‘ee’ heard as ‘ay’ (egophony)
- Whispered words louder (whispered pectoriloquy)
Indicates lung consolidation due to conditions like pneumonia.
What causes dyspnea in left-sided heart failure?
- Elevated pressure in pulmonary capillary bed
- Transduction of fluid into interstitial spaces and alveoli
- Decreased lung compliance
Results in increased work of breathing.
What is the typical presentation of chronic bronchitis?
- Chronic productive cough
- Slowly progressive dyspnea
- Symptoms may worsen with exertion or irritants
Associated with excessive mucus production and airway obstruction.
What is the primary issue in chronic obstructive pulmonary disease (COPD)?
Overdistention of air spaces and limitation of expiratory airflow
Symptoms include slowly progressive dyspnea and a mild cough.
What characterizes asthma?
Reversible bronchial hyperresponsiveness
Involves release of inflammatory mediators and bronchoconstriction.
What are common findings in pneumonia?
- Pleuritic pain
- Cough
- Sputum
- Fever
Symptoms may not always be present.
What is spontaneous pneumothorax?
Leakage of air into pleural space causing lung collapse
Sudden onset of dyspnea is typical.
What is the effect of pulmonary embolism on breathing?
Sudden onset of tachypnea and dyspnea
Often associated with pleuritic pain and may lead to severe complications.
What physical finding is noted in left-sided heart failure?
Late inspiratory crackles in dependent portions of the lungs
Indicates pulmonary congestion and edema.
What percussion note is expected in lobar pneumonia?
Dull over the airless area
Indicates lung consolidation.
What is the triangle of safety?
An anatomical area for safe needle insertion
Important for procedures like thoracentesis and chest tube placement.
What are the landmark intercostal spaces for needle insertion?
- 2nd intercostal space for tension pneumothorax
- 4th and 5th for chest tube
- 7th and 8th for thoracentesis
Proper identification is crucial for safe medical procedures.
What is the Midclavicular Line (MCL)?
Runs vertically through the midpoint of the clavicle
What does the Anterior Axillary Line (AAL) represent?
Runs vertically along the anterior axillary fold
What is the Midaxillary Line (MAL)?
Runs vertically through the middle of the axilla
Define the Posterior Axillary Line (PAL)
Runs vertically along the posterior axillary fold
What does the Vertebral Line indicate?
Overlies the spinous processes
What is the Scapular Line?
Runs vertically through the inferior angle of the scapula
What is the ‘triangle of safety’?
An anatomical region in the midaxillary line for chest tube insertion
What borders define the ‘triangle of safety’?
- Lateral border of the pectoralis major muscle (anteriorly)
- Lateral border of the latissimus dorsi (posteriorly)
- Nipple line (4th and 5th intercostal space) (inferiorly)
Where does the apex of each lung rise anteriorly?
Approximately 2-4 cm above the inner third of the clavicle
At what rib does the lower border of the lung cross at the midclavicular line?
The 6th rib
Where does the lower border of the lung lie posteriorly?
About the level of T10 spinous process
What is the oblique (major) fissure?
Divides each lung roughly in half
What is the anatomical location of the Right Upper Lobe (RUL)?
- Anteriorly: Extends from the apex down to the 4th rib
- Posteriorly: Reaches down to T3-T4
- Laterally: Extends from the 1st to 4th rib
Where is the Right Middle Lobe (RML) located?
- Anteriorly: Located between the 4th and 6th ribs
- Laterally: Positioned between the 4th and 6th ribs along the anterior axillary line
What is unique about the accessibility of the Right Middle Lobe (RML)?
Not accessible posteriorly
What is the anatomical location of the Left Upper Lobe (LUL)?
- Anteriorly: Extends from the apex down to the 6th rib
- Posteriorly: Reaches down to about T3-T4
What does the lingula in the Left Upper Lobe correspond to?
Functionally similar to the Right Middle Lobe (RML)
Where is the best place to hear all three lobes of the right lung?
Right lateral chest (midaxillary line between the 4th and 8th ribs)
What is the significance of the right main bronchus?
It is more vertical, making aspiration pneumonia more common in the right middle and lower lobes
What is the trachea’s bifurcation point?
Levels of the sternal angle anteriorly and the T4 spinous process posteriorly
What covers the outer surface of the lungs?
Visceral pleura
What lines the pleural cavity?
Parietal pleura
What is the pleural space?
Contains serous pleural fluid between the visceral and parietal pleura
What are common symptoms indicating respiratory issues?
- Shortness of breath (SOB)
- Cough
- Blood-streaked sputum (hemoptysis)
- Chest pain
- Daytime sleepiness, snoring, and disordered sleep
What is pleuritic pain?
Pain produced by irritation of the parietal pleura
What are the components of health history?
Chief complaint, HPI, past medical history, family history, social history, review of systems.
What does the ‘S’ in SOAP note stand for?
Subjective (Patient’s Report).
Define Chief Complaint (CC).
The reason the patient is seeking care, stated in their own words.
What is HPI and what does it explore?
History of Present Illness; it explores the chief complaint in detail.
What does OLDCARTS stand for?
- Onset
- Location
- Duration
- Characteristics
- Aggravating/Alleviating factors
- Radiation
- Timing
- Severity
What is the purpose of Past Medical History (PMH)?
Includes chronic illnesses, previous hospitalizations, medications, allergies, and surgeries.
What is included in Family History (FH)?
A record of diseases in immediate family members.
Define Social History (SH).
Lifestyle factors impacting health.
What does Review of Systems (ROS) entail?
A subjective, system-based checklist of symptoms.
What does the ‘O’ in SOAP note stand for?
Objective (Clinician’s Observations).
What are vital signs typically included in the Objective section?
- BP
- HR
- RR
- Temp
- O2 Sat
What is the primary diagnosis in the Assessment section?
Based on the subjective and objective findings.
What is the purpose of the Plan section in a SOAP note?
Management including diagnostics, medications, patient education, and follow-up.
When should a Comprehensive Exam be performed?
New patient visits, annual physical exams, hospital admissions, complex symptoms, preoperative evaluations.
What is a Focused Exam?
A targeted assessment performed on established patients with a specific complaint.
When is a Focused Exam appropriate?
Follow-up visits for chronic conditions, acute complaints, emergency visits, and specialty consultations.
What is the key difference between a Comprehensive Exam and a Focused Exam?
- Comprehensive Exam: Establishes baseline health data
- Focused Exam: Assesses specific complaint/concern
What are Open-Ended Questions in therapeutic communication?
Questions that encourage patients to express themselves freely.
What is the role of Active Listening in patient interviews?
Involves eye contact, nodding, and verbal affirmations to show attentiveness.
What does Empathy involve in patient communication?
Acknowledging and validating the patient’s feelings.
What is Motivational Interviewing (MI)?
A patient-centered approach that encourages behavior change.
What are the stages of change in the Transtheoretical Model?
- Precontemplation
- Contemplation
- Preparation
- Action
- Maintenance
- Relapse
What is the importance of Nonverbal Communication in patient interviews?
Influences rapport, trust, and accuracy of information gathered.
What are key nonverbal cues to establish rapport?
- Eye Contact
- Facial Expressions
- Nods and Encouragement
- Silence
What does the ‘Inspection’ technique involve in physical examination?
Visual observation of the patient’s general appearance and any obvious abnormalities.
What is the purpose of proper patient positioning and draping?
Ensures comfort and privacy during the examination.
What should be documented in the findings of a physical examination?
All relevant observations made during the examination.
What are the four fundamental techniques used in a physical examination?
Inspection, Palpation, Percussion, Auscultation
What is the purpose of Inspection in a physical examination?
Visual observation of the patient’s general appearance, posture, skin color, movements, and any obvious abnormalities
What should you consider during the Inspection of a newborn?
Awareness, alertness, responsiveness, and parent-child interaction
What does Palpation assess?
Texture, temperature, moisture, tenderness, swelling, and organ size
What is a tip for effective Palpation?
Palpate the most tender areas last to avoid unnecessary discomfort
What is Percussion used for?
Assessing underlying structures based on sound differences
What types of percussion sounds can be identified?
- Flat
- Dull
- Resonant
- Hyperresonant
- Tympanic
What is the purpose of Auscultation?
Listening to internal body sounds using a stethoscope
When should the diaphragm and bell of a stethoscope be used?
Diaphragm for high-pitched sounds; Bell for low-pitched sounds
What are the proper patient positions for different examinations?
- Supine: Abdominal exams
- Fowler’s: Respiratory exams
- Left Lateral Decubitus: Auscultating low-pitched heart sounds
- Lithotomy: Pelvic exams
- Prone: Assessing the back or spine
What are Standard Precautions in infection control?
- Hand hygiene
- Use of gloves
- Masks
- Eye protection
- Gowning as needed
What does accurate and organized documentation in a clinical setting ensure?
Legal and clinical purposes
What does the SOAP format stand for?
- Subjective
- Objective
- Assessment
- Plan
What are the components of the General Survey?
- Level of Consciousness
- Signs of Distress
- Posture, Gait, and Mobility
- Nutritional Status
- Hygiene and Grooming
What is the normal range for respiratory rate?
12-20 breaths per minute
What is the significance of Cheyne-Stokes respiration?
Cyclic breathing with periods of apnea, seen in heart failure, stroke, brain injury
What is the proper technique for measuring blood pressure?
Patient seated, feet flat, arm at heart level, with appropriate cuff size
What indicates orthostatic hypotension?
A drop of ≥20 mmHg systolic or ≥10 mmHg diastolic when standing
What are the routes for temperature measurement?
- Oral
- Rectal
- Axillary
- Tympanic
What factors can affect the accuracy of pulse assessment?
- Patient movement
- Incorrect palpation pressure
- Anxiety or recent physical activity
What is the normal pulse rate range?
60-100 bpm
What are the abnormal respiratory patterns mentioned?
- Cheyne-Stokes
- Kussmaul
- Biot’s
- Ataxic
What is the definition of hyperthermia?
Body temperature >100.4°F (38°C)
What is the significance of ‘white coat hypertension’?
BP high in clinic but normal at home
What constitutes a red flag for cardiac assessment?
Exertional chest pain → Angina, MI
What should be assessed in the subjective data collection for cardiac issues?
- Chest Pain
- Palpitations
- Dyspnea
- Syncope
- Edema
- Fatigue
What does the acronym OLDCARTS stand for in assessing symptoms?
- Onset
- Location
- Duration
- Character
- Alleviating/Aggravating factors
- Radiation
- Timing
- Severity
What is the documentation example for Level of Consciousness?
“Patient is alert and oriented to person, place, and time (A&O x3)”
What does a well-nourished status indicate?
Adequate weight, healthy skin tone
What are common characteristics of chest pain?
Pressure, tightness, stabbing, burning
These characteristics help in distinguishing types of cardiac issues.
What factors can aggravate chest pain?
Exertion, meals, breathing
These factors can indicate the nature of the cardiac problem.
What is the significance of radiation in chest pain?
Referred pain (e.g., shoulder, back)
Radiation may suggest specific cardiac conditions.
What does the timing of chest pain indicate?
Occurs at rest or with exertion
This helps differentiate between stable and unstable angina.
How is severity of pain measured?
1-10 pain scale
This subjective measure helps gauge the intensity of the pain.
What does exertional chest pain indicate?
Angina, MI
These are serious cardiac conditions requiring immediate attention.
What does severe ‘tearing’ pain suggest?
Aortic dissection
This is a life-threatening condition that needs urgent care.
What does sudden onset syncope signify?
Arrhythmia, severe aortic stenosis
These conditions can lead to sudden cardiac events.
What does PND and orthopnea indicate?
CHF, fluid overload
These symptoms are often associated with heart failure.
What does bilateral pitting edema suggest?
Right heart failure
This finding indicates systemic issues with cardiac function.
What do palpitations with dizziness or syncope indicate?
Arrhythmia
These symptoms require further cardiovascular evaluation.
List modifiable risk factors for cardiac disease.
- Hypertension (HTN)
- Hyperlipidemia
- Diabetes mellitus (DM)
- Smoking
- Obesity (BMI >30)
- Physical inactivity
- Excessive alcohol intake
- Diet high in saturated fats/sodium
Addressing these factors can significantly reduce cardiac disease risk.
List non-modifiable risk factors for cardiac disease.
- Family history of premature CAD (male <55, female <65)
- Age (Men >45, Women >55)
- Gender (Male > risk until menopause)
- Ethnicity (African American, Hispanic higher risk)
These factors cannot be changed but are important for risk assessment.
How can socioeconomic status affect cardiac disease?
Limited healthcare access → Delayed diagnosis
This can lead to worse outcomes in cardiac patients.
What role does stress and mental health play in cardiac disease?
Increased cortisol levels contribute to HTN, arrhythmias
Mental health is a significant but often overlooked factor in cardiac health.
How does substance use affect cardiac risk?
Cocaine/meth increases MI risk
Substance abuse is a critical factor in acute cardiac events.
What environmental factors are linked to cardiac disease?
Air pollution linked to HTN and heart disease
Environmental conditions can exacerbate existing cardiac risks.
What is considered a normal blood pressure reading?
<120/80
Readings above this can indicate hypertension.
What does high blood pressure (>140/90) indicate?
HTN, shock
These conditions require urgent management.
What does low blood pressure (<90/60) signify?
Hypoperfusion, cardiogenic shock
This can indicate serious underlying cardiac issues.
What is the normal heart rate range?
60-100 bpm, regular
Deviations from this range may suggest arrhythmias or other cardiac issues.
What does bradycardia (<50 bpm) indicate?
Heart block
This can result in decreased cardiac output and requires evaluation.
What does tachycardia (>100 bpm) indicate?
Shock, arrhythmia
These conditions may necessitate immediate intervention.
What are normal respiratory rates?
12-20 bpm
Rates outside this range may indicate respiratory distress.
What does tachypnea (>20 bpm) suggest?
CHF, PE
Increased respiratory rates can be a sign of heart failure or pulmonary embolism.
What is considered a normal oxygen saturation level?
> 95%
Levels below this may indicate hypoxia.
What does hypoxia (<90%) indicate?
CHF, pulmonary congestion
This requires immediate medical attention.
What does JVD >3 cm indicate?
Right heart failure
This is a significant finding during physical examination.
What does clubbing indicate?
Chronic hypoxia (congenital heart disease)
This sign suggests long-term oxygen deprivation.
What does peripheral edema suggest?
Heart failure
This finding indicates fluid overload in the body.
What is the significance of auscultation in cardiac exams?
Identifies normal and abnormal heart sounds
This is essential for diagnosing cardiac conditions.
What are the normal heart sounds heard during auscultation?
S1 < S2
This indicates the normal functioning of the heart valves.
What does a systolic murmur indicate?
Aortic stenosis, mitral regurgitation
These murmurs require further evaluation to determine severity.
What does a diastolic murmur indicate?
Aortic regurgitation, mitral stenosis
Diastolic murmurs are always considered pathologic.
What does an S3 heart sound indicate?
CHF, volume overload
This sound is often associated with heart failure.
What does an S4 heart sound indicate?
LVH, hypertension
This sound suggests a stiff left ventricle.
What should be done if a patient presents with chest pain + diaphoresis, SOB, and radiation?
Immediate referral to ED
This combination of symptoms is indicative of a myocardial infarction.
What does new, loud diastolic murmur indicate?
Pathologic condition
This could signify serious valvular heart disease.
What are the steps to assess JVD?
- Position patient supine at 30-45 degrees
- Identify jugular vein pulsation
- Measure vertical height of JVP
- Interpret findings
This assessment is crucial for evaluating right-sided heart function.
What does elevated JVP (>3 cm above the sternal angle) suggest?
Right-sided heart failure, constrictive pericarditis, cardiac tamponade, fluid overload
Elevated JVP indicates increased central venous pressure.
What does a heave at the left sternal border suggest?
Right ventricular hypertrophy
A heave is a palpable impulse that can indicate underlying cardiac conditions.
What does a heave at the apex suggest?
Left ventricular hypertrophy (LVH)
LVH is often associated with conditions like hypertension and aortic stenosis.
What does a palpable thrill almost always indicate?
A murmur of grade 4 or higher
A thrill is a vibration felt on the chest wall and is often associated with significant heart murmurs.
What are the normal heart sounds?
S1, S2
S1 and S2 are the first and second heart sounds, respectively, representing normal cardiac cycle events.
What are the abnormal heart sounds?
S3, S4
S3 is often termed a ‘ventricular gallop,’ while S4 is an ‘atrial gallop.’
Where is S1 best heard?
Apex (Mitral area – 5th ICS, MCL)
S1 occurs with the closure of the mitral and tricuspid valves.
What does a louder S1 indicate?
Increased cardiac output states (exercise, fever, hyperthyroidism)
Increased blood flow can lead to a more pronounced first heart sound.
What does a softer S1 suggest?
Mitral regurgitation, first-degree AV block
Softer S1 can occur in conditions where valve closure is affected.
Where is S2 best heard?
Base of the heart (Aortic – 2nd ICS, right sternal border; Pulmonic – 2nd ICS, left sternal border)
S2 occurs with the closure of the aortic and pulmonic valves.
What does physiologic splitting of S2 indicate?
Increases with inspiration
This is due to delayed closure of the pulmonic valve during inspiration.
What is S3 commonly associated with?
Heart failure or volume overload
S3 can be normal in children and young adults but is often a sign of pathology in older adults.
What does S4 indicate?
Atrial contraction into a non-compliant ventricle
S4 is often associated with conditions like left ventricular hypertrophy and hypertension.
How should murmurs be documented?
Timing, shape, pitch, quality, radiation, and grade
Each of these characteristics helps in identifying the nature and significance of the murmur.
What is the grading scale for murmurs?
1/6 to 6/6
Grade 1 is barely audible, while grade 6 is audible without a stethoscope.
Where is the Aortic valve auscultated?
2nd right ICS
Conditions such as aortic stenosis can be detected at this location.
What does a pericardial friction rub indicate?
Pericarditis
This sound is a high-pitched, scratching noise best heard with the patient leaning forward.
What is the first step in interpreting an EKG?
Determine the heart rate
This can be done using the 300 rule for regular rhythms.
What indicates a regular rhythm on an EKG?
Equal R-R intervals
Irregular rhythms may suggest arrhythmias such as atrial fibrillation.
What does a peaked, notched P-wave suggest?
Atrial hypertrophy or abnormal atrial depolarization
Changes in P-wave morphology can indicate underlying atrial conditions.
What is the normal range for the PR interval?
0.12 - 0.20 sec
A prolonged PR interval suggests a first-degree AV block.
What does ST elevation indicate?
Acute myocardial infarction (STEMI)
ST elevation in contiguous leads is a critical finding in acute coronary syndrome.
What is a red flag for sudden onset dyspnea?
Possible pulmonary embolism (PE), pneumothorax, or myocardial infarction
Immediate evaluation is necessary in these cases.
What does increased tactile fremitus suggest?
Pneumonia or lung consolidation
Tactile fremitus is assessed by palpating the chest while the patient speaks.
What does increased tactile fremitus suggest?
Pneumonia or lung consolidation
Increased tactile fremitus indicates denser lung tissue which transmits sound vibrations better.
What may dull percussion notes indicate?
Pleural effusion, pneumonia, or lung mass
Dullness suggests fluid or solid tissue replacement of air.
What does hyperresonance suggest?
Pneumothorax or emphysema
Hyperresonance indicates increased air in the thoracic cavity.
What does absent breath sounds over one lung field indicate?
Pneumothorax, pleural effusion, or atelectasis
Absent breath sounds suggest a lack of air movement in that area.
What does stridor suggest?
Upper airway obstruction (life-threatening)
Stridor is a high-pitched inspiratory sound indicating severe airway compromise.
What does egophony indicate?
Lung consolidation (pneumonia)
Egophony occurs when ‘E’ sounds like ‘A’ due to consolidated lung tissue.
What does whispered pectoriloquy suggest?
Lung consolidation
Increased clarity of whispered sounds indicates denser lung tissue.
What do crackles (rales) suggest?
Pneumonia, CHF, pulmonary fibrosis
Crackles are abnormal lung sounds associated with fluid in the airways.
What does wheezing suggest?
Asthma, COPD, or airway obstruction
Wheezing is a high-pitched sound caused by narrowed airways.
What is clubbing of fingers associated with?
Chronic hypoxia (lung cancer, cystic fibrosis, ILD)
Clubbing is characterized by an increased angle between the nail and nail bed.
What does paradoxical breathing indicate?
Diaphragmatic dysfunction or respiratory failure
Paradoxical breathing is when the abdomen moves inward during inspiration.
What does pink frothy sputum indicate?
Pulmonary edema from CHF
Pink frothy sputum is often a sign of fluid overload in the lungs.
What is the OLDCARTS method used for?
To ask about the history of present illness (HPI)
OLDCARTS stands for Onset, Location, Duration, Character, Aggravating factors, Relieving factors, Timing, Severity.
What are key aspects to consider for respiratory effort during inspection?
- Labored breathing
- Accessory muscle use
- Retractions
- Tripod position
- Nasal flaring
- Pursed lip breathing
Observing these signs helps assess the severity of respiratory distress.
What does cyanosis indicate?
Hypoxia
Cyanosis is a bluish discoloration of the skin indicating insufficient oxygenation.
What is the normal AP-to-transverse diameter ratio in adults?
Approximately 1:2
This ratio indicates normal chest shape and symmetry.
What does severe dyspnea with accessory muscle use suggest?
Impending respiratory failure
This is a critical sign that requires urgent evaluation.
What does pulsus paradoxus indicate?
Severe asthma or cardiac tamponade
Pulsus paradoxus is a drop in blood pressure during inspiration greater than 10 mmHg.
What does tracheal deviation suggest?
- Tension pneumothorax
- Pleural effusion
- Lung collapse
Tracheal deviation indicates significant thoracic pathology.
What is the percussion note for healthy lung tissue?
Resonance (normal)
Resonance is a low-pitched, hollow sound over normal air-filled lungs.
What does dullness on percussion indicate?
Fluid or solid structures
Dullness may be caused by pneumonia, pleural effusion, or a lung mass.
What does hyperresonance on percussion suggest?
Pneumothorax or COPD
Hyperresonance indicates excess air in the thoracic cavity.
What are normal breath sounds?
- Vesicular
- Bronchial
- Bronchovesicular
These sounds are heard during auscultation of healthy lungs.
What are adventitious sounds?
- Crackles
- Wheezes
- Rhonchi
- Stridor
Adventitious sounds indicate abnormalities in the respiratory system.
What are the normal lung sounds?
- Vesicular
- Bronchovesicular
- Bronchial
Normal lung sounds vary by location and include vesicular sounds over most lung fields, bronchovesicular sounds over the mainstem bronchi, and bronchial sounds over the trachea.
Where are vesicular sounds heard?
Over most of the lung fields (periphery)
Vesicular sounds are characterized by being soft and low-pitched, with inspiration greater than expiration.
What indicates lung consolidation when auscultating?
Bronchial sounds heard over lung fields
This finding suggests the presence of conditions such as pneumonia.
What are adventitious sounds?
Abnormal sounds superimposed on normal breath sounds indicating pathology
These include crackles, wheezes, rhonchi, stridor, and pleural friction rub.
What is the description of crackles (rales)?
Discontinuous popping sounds heard during inspiration
Common causes include pneumonia, pulmonary edema, and fibrosis.
What does stridor indicate?
Life-threatening upper airway obstruction
Conditions such as croup, foreign body, or anaphylaxis can cause stridor.
Fill in the blank: Increased tactile fremitus suggests ______.
[lung consolidation (pneumonia)]
What are the red flags associated with headaches?
- Worst headache of my life → Subarachnoid hemorrhage
- New headache in patient >50 years old → Giant cell arteritis, tumor
- Headache with fever & neck stiffness → Meningitis
- Sudden onset severe unilateral eye pain with halos → Acute angle-closure glaucoma
These symptoms warrant immediate medical evaluation.
What should be assessed in the head exam regarding symmetry?
Equal size and shape of facial features
Symmetry is crucial in identifying potential neurological or structural abnormalities.
What is the purpose of the Snellen chart in the eye exam?
Evaluates central vision and detects refractive errors
It measures visual acuity by having patients read letters from a distance.
What does PERRLA stand for?
Pupils Equal, Round, Reactive to Light, and Accommodation
PERRLA is used to assess pupil function during neurological examinations.
What are the abnormal findings associated with pupil reactions?
- Anisocoria
- Miosis
- Mydriasis
- Marcus Gunn Pupil
Each condition can indicate different underlying issues, such as neurological or systemic problems.
What does the extraocular movements test assess?
The six cardinal directions of gaze and cranial nerves III, IV, VI
This test helps identify issues with eye muscle function and coordination.
What are the signs of TMJ dysfunction?
- Clicking
- Popping
- Limited movement
These signs are assessed during palpation of the temporomandibular joint.
What does dullness on percussion indicate?
Possible pleural effusion, pneumonia, or mass
This finding suggests fluid or solid mass in the thoracic cavity.
What is the significance of asymmetric breath sounds?
Suggests pneumonia, mass, or pleural effusion
Asymmetry may indicate localized pathology in the lungs.
What is the normal finding for TMJ movement?
Smooth, painless movement
Abnormal findings may indicate dysfunction or pathology within the joint.
What is a key takeaway from a thorough HEENT history?
Differentiate between benign vs. emergent conditions
Targeted questions are essential for identifying potential urgent issues.
True or False: Hyperresonance on percussion is seen in pneumothorax or emphysema.
True
What cranial nerves are involved in the directions of gaze?
CN III (Oculomotor), CN IV (Trochlear), CN VI (Abducens)
These cranial nerves control extraocular movements of the eyes.
What is the procedure to assess extraocular movements?
Have the patient follow your finger in an ‘H’ pattern
This assesses all six extraocular muscles.
What are the normal findings when assessing extraocular movements?
Smooth tracking, no nystagmus, no strabismus
These indicate normal eye muscle function.
What does CN III (Oculomotor) control?
Superior, inferior, and medial rectus + Inferior oblique
Responsible for most eye movements and pupil constriction.
What does CN IV (Trochlear) control?
Superior oblique (down & inward)
This nerve is critical for rotational eye movement.
What does CN VI (Abducens) control?
Lateral rectus (outward movement)
This nerve allows for lateral gaze.
What condition can cause nystagmus?
Multiple sclerosis, vestibular dysfunction, intoxication
Nystagmus is characterized by involuntary eye movements.
What is strabismus?
Misalignment of the eyes (exotropia, esotropia)
This condition can lead to double vision.
What are the findings associated with CN III Palsy?
Ptosis, pupil dilation, ‘down & out’ eye
Indicates dysfunction of the oculomotor nerve.
What is the purpose of a fundoscopic exam?
Examines the optic disc, retinal vessels, macula, and retina for pathology
Essential for diagnosing eye diseases.
What is a normal finding for the optic disc?
Sharp margins, pink-orange color
Indicates healthy optic nerve.
What does a cup-to-disc ratio > 0.5 indicate?
Possible glaucoma
An enlarged ratio suggests optic nerve damage.
What are the signs of diabetic retinopathy?
Hemorrhages, microaneurysms
These findings are indicative of retinal damage due to diabetes.
What is the significance of the Whisper Test?
Assesses gross hearing function
A basic screening for hearing loss.
What does the Weber Test differentiate?
Conductive vs. sensorineural hearing loss
It helps identify the type of hearing impairment.
What indicates conductive hearing loss in the Rinne Test?
BC > AC (negative Rinne test)
This suggests issues in the middle or outer ear.
What are common findings in oral mucosa examination?
Color, moisture, lesions, swelling, asymmetry
Abnormal findings can indicate various conditions.
What does an enlarged, erythematous tonsil with exudates suggest?
Tonsillitis
This can be either bacterial or viral.
What does a ‘thumb sign’ on X-ray indicate?
Epiglottitis
This is a critical airway emergency.
What does a goiter indicate?
Iodine deficiency, hyper/hypothyroidism
An enlarged thyroid gland.
What does a hard, fixed, non-tender lymph node suggest?
Possible malignancy (lymphoma, metastatic cancer)
This finding is concerning for cancer.
What is the primary purpose of assessing nasal patency?
Evaluates obstruction of nasal passages
Helps identify conditions like deviated septum or polyps.
What does turbinate inflammation indicate?
Possible viral infection or allergic rhinitis
It can be characterized by red, swollen mucosa.
What are common signs of acute bacterial sinusitis?
Tenderness with purulent nasal drainage
This indicates possible infection of the sinuses.
What condition is indicated by asymmetrically enlarged tonsils, fever, and difficulty swallowing?
Peritonsillar abscess
This condition is often associated with bacterial infections and can lead to airway obstruction if untreated.
Which symptoms characterize epiglottitis?
Stridor, drooling, dysphagia
Epiglottitis is considered an airway emergency and requires immediate medical attention.
What does a hard, fixed, painless lymph node suggest?
Possible malignancy (lymphoma, metastatic cancer)
Such lymph nodes should be evaluated further due to the risk of cancer.
An enlarged supraclavicular node may indicate what?
Thoracic or abdominal malignancy
This finding can be a sign of serious underlying conditions.
What triad of symptoms may indicate possible thyroid cancer?
Thyroid nodule, hoarseness, dysphagia
These symptoms warrant further investigation to rule out malignancy.
What should be assessed in the throat during an examination?
Oral mucosa, tonsils, and pharynx for infections, lesions, and masses
Thorough examination helps in early detection of potential issues.
What aspects should be evaluated in a thyroid examination?
Size, consistency, symmetry, and mobility; auscultate for bruits
These factors can help identify thyroid disorders.
What characteristics of lymph nodes should be examined?
Size, tenderness, mobility, and fixed/non-fixed consistency
These characteristics provide important diagnostic information.
True or False: Recognizing red flags in examinations ensures early detection of serious conditions.
True
Early recognition can significantly impact patient outcomes.
