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Advanced Health Assessment > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

Health history

A

Is 90% of diagnosis ability
Should just confirm what you already know
See the world of the patient as that patient sees itE

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2
Q

Effective communication

A

Establishing a positive patient relationship depends on communication built on courtesy, comfort, connection, confirmation, confidentiality

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3
Q

Outline of the patient history

A 
Chief complaint
History of present illness
Past medical history
Family history
Personal and social history
Review of systems 
How much of each component helps determine the billing code 
Try to find 3 chief complaints
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4
Q

7 dimensions of chief complaint

A 
LOCATES
Location
Other associated symptoms 
Character (quality)
Alleviating or Aggravating factors
Timing
Environment/Setting 
Severity
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5
Q

Past medical history

A 
Medical illnesses
Immunizations 
Surgery
Hospitalizations
Injuries
Allergies 
Current medications
Past transfusions
Recent screening tests
Emotional status
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6
Q

Important immunizations to note in adults

A

Influenza, varicella, pneumonia, last tdap, meningococcal

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7
Q

Important allergies to note

A

Food, medications, latex, environment

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8
Q

Recent screening tests to note

A

Gynecological exam, eye exam, dental exam, pap, colonoscopy, DRE, PSA, A1C, FBS

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9
Q

Assessing family history

A

Assess 3 generations–children, siblings, parents or siblings, parents, grandparents
Identify family member, living status, age

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10
Q

Social History

A 
Personal status
Habits: smoking, alcohol, drugs, exercise
Sexual history, preference, STIs
Home conditions and safety
Environmental hazards/occupation
Military
Religion
Access to care
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11
Q

General constitutional symptoms

A

Weight loss/gain
Frequent/recurrent illness
Appetite
Fever, chills, malaise, fatigue, night sweats, sleep patterns

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12
Q

Skin, hair and nail history

A

Rash, moles, acne, texture or pigmentation change, sweating, abnormal nail or hair growth or loss, dryness, itching

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13
Q

Head and neck history

A

Head injuries, loss of consciousness, lymph nodes enlarged, neck pain or injury, snoring

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14
Q

Eyes history

A

Blurring, diplopia, phototobia, pain, discharge, infections, vision changes, glaucoma, eye medications, trauma, glasses

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15
Q

Ear history

A

hearing loss, pain, discharge, tinnitus, frequent ear infections

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16
Q

Nose history

A

Sense of smell, colds, obstruction, epistaxis, postnasal discharge, sinus pain

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17
Q

Throat/mouth history

A

Hoarseness/change in voice, sore throat, bleeding gums, tooth pain, soreness or ulcers, taste changes, history of tonsillectomy

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18
Q

CV history

A

Chest pain, palpitations, edema, varicosities, syncope, history of MI or Htn, exercise intolerance

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19
Q

Respiratory history

A

Pain, asthma, dyspnea, infections, cyanosis, wheezing, cough, sputum, hemoptysis, TB exposure, last chest x ray, orthopnea

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20
Q

GI history

A

Appetite, digestion, food intolerance, dysphagia, heartburn, N/V, hematemesis, incontinence, bowels, constipation, diarrhea, change in stool, hemorrhoids, jaundice, pain or cramping

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21
Q

GU history

A

Dysuria, pain, urgency, frequency, nocturia, hematuria, polyuria, hesistancy, dribbling, force of stream, passage of stone, edema, hernias

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22
Q

Musculoskeletal history

A

Joint stiffness, restriction of motion, swelling or redness, bony deformity, history of fractures, weakness, injuries

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23
Q

Neurologic history

A

Seizures, weakness, tremors, loss of memory, abnormalities of sensation or coordination, vertigo, headache, tingling or numbness, spine injury

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24
Q

Psych history

A

Depression, mood changes, difficulty concentrating, nervousness, tension, suicidal thoughts, sleep disturbances, anxiety

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25
Q

Endocrine history

A

Thyroid enlargement, heat/cold intolerance, weight change, polyphasia, polydipsia, polyuria, changes in facial or body hair, increased hat or glove size, skin striae

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26
Q

CAGE questionnaire for alcohol

A

Cutting down?
Annoyance by criticism?
Guilty feeling?
Eye-openers?–drinking in the morning

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27
Q

Domestic Violence: HITS

A 
In the last year, how often did your partner:
Hurt you physically?
Insult or talk down to you?
Threaten you with physical harm?
Scream or curse at you?
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28
Q

Spirituality: FICA

A

Faith
Importance and Influence
Community
Address/action of care

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29
Q

Concluding history questions

A

Is there anything else you think I should know?
What problem concerns you the most?
What do you think is wrong?
What worries you the most?

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30
Q

Adolescents: PACES

A 
Parents/Peers
Accidents/Alcohol/Drugs
Cigarettes
Emotional Issues
School/Sexuality
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31
Q

General Appearance description

A

Apparent state of health, level of consciousness, signs of distress, skin color and obvious lesions, dress/grooming/personal hygiene, facial expressions, odors, posture/gait/motor activity
Height, weight, BMI

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32
Q

Rapid weight change over few days suggest

A

Changes in fluid, not fat tissue

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33
Q

Order of examination techniques

A

Inspection, palpation, percussion, auscultation

EXCEPT ABDOMEN: Inspection, auscultation, percussion, palpation

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34
Q

Tympany percussion

A

Loud, high, drumlike

Gastric bubble

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35
Q

Hyperresonance percussion

A

Very loud, low, booming

Emphysematous lungs

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36
Q

Resonance percussion

A

loud, low, hollow

Healthy lung tissue

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37
Q

Dullness percussion

A

Soft, moderate, thudlike

Over liver

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38
Q

Flatness percussion

A

Soft, high, dull

Over muscle

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39
Q

Order of percussion

A

From resonance to dullness

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40
Q

Amsler grid

A

Used to test for macular degeneration

Grid of perpendicular straight lines with central black dot as fixation point

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41
Q

Transilluminator

A

Light source used to distinguish whether a body cavity contains fluid, air or tissue

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42
Q

Goniometer

A

Determines degree of joint flexion and extension

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43
Q

Objective skin data

A

Color, temperature, moisture, texture, thickness, edema, mobility and turgor, vascularity and ecchymosis, lesions

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44
Q

Function of skin

A

Protection, prevents penetration, perception, temperature regulation, identification, communication, wound repair, absorption and excretion, production of vitamin D

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45
Q

Palpate skin surface for

A

Moisture, temperature, texture, turgor, mobility

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46
Q

Inspect hair for

A

Color, distribution, quantity

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47
Q

Inspect nails for

A

Pigmentation of nails and beds, length, symmetry, ridging/beading/pitting/peeling, redness, swelling, pain, exudate, warts/cysts/tumors

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48
Q

Fluid filled lesions with transillumination

A

Will transilluminate with a red glow; solid lesions will not

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49
Q

Where do dysplastic moles usually occur

A

Upper back in men and legs in women

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50
Q

Characteristics of skin lesions

A

size, shape, color, texture, elevation or depression, attachment at base, exudates, configuration (annular, grouped, linear, arciform), location and distribution

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51
Q

Helpful hints for assessing skin lesions

A

Are there associated symptoms such as pruritus?
What is the chronology of the appearance of these lesions?
Are they changing in morphology? Are they disappearing?

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52
Q

Associated variables of skin

A

Environmental exposures, injuries, infection, use of medications, diet, clothing, emotional factors, personal care items

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53
Q

Screening for melanoma

A

Asymmetry, border irregularity, color variations, diameter >6mm, evolving

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54
Q 
Macule
Patch
Papule
Plaque
Vesicle
Bulla
A 
Macule: flat <1cm
Patch: flat >1cm
Papule: raised, <1cm, not fluid filled 
Plaque: raised, >1cm, not fluid filled
Vesicle: raised, <1cm, fluid filled
Bulla: raised, >1cm, fluid filled
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55
Q

Spider angioma

A

Normal and common on face and chest

Also seen in pregnancy and liver disease

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56
Q

Spider veins

A

most often in legs

Often accompanies increased pressure in superficial veins as in varicose veins

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57
Q

Cherry angioma

A

Normal; increase in size and number with aging

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58
Q

Ecchymosis

A

Blood outside the vessels
Secondary to bruising or trauma
Can be seen in bleeding disorders

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59
Q

Male pattern baldness

A

Frontal hairline regression and thinning of the posterior vertex

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60
Q

Alopecia Areata

A

Sudden onset of clearly demarcated, usually localized, round or oval patches of hair loss leaving smooth skin without hairs. No visible scaling or erythema

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61
Q

Tinea capitis

A

Round, scaling patches of alopecia

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62
Q

Paronychia

A

Superficial infection of the proximal and lateral nail folds adjacent to the nail plate
Often red, swollen and tender
usually due to staph aureus or strep

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63
Q

Clubbing of the fingers

A

Bulbous swelling of soft tissue at the nail base, with loss of normal angle between the nail and the proximal nail fold
Mechanism involves vasodilation with increased blood flow to the distal portion of the digits possibly due to hypoxia, changes in innervation, platelet derived growth factor
Seen in congenital heart disease, interstitial lung disease, lung cancer, IBS, malignancies

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64
Q

Stage 1 pressure ulcer

A

Reddened area that fails to blanch with pressure

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65
Q

Stage 2 pressure ulcer

A

Skin forms a blister or sore

Partial thickness skin loss of ulceration involving the epidermis, dermis, or both

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66
Q

Stage 3 pressure ulcer

A

Crater appears in the skin with full thickness skin loss and damage to or necrosis of subcutaneous tissue that may extend to muscle

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67
Q

Stage 4 pressure ulcer

A

Full thickness skin loss with destruction, tissue necrosis or damage to underlying muscle, bone and sometimes tendons and joints

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68
Q

Past medical history for head/neck

A

Head trauma, radiation treatment, headaches (type), surgery for tumor or goiter, seizures, thyroid

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69
Q

Family history for head/neck

A

Headaches and thyroid function

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70
Q

Personal/social history for head/neck

A

Employment, stress, injury risks, nutrition, use of alcohol or drugs, sports played, new activities, weight training

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71
Q

Headache characteristics

A

Onset, duration, location, character, severity, visual prodrome, pattern, change in LOC, associated symptoms, precipitating factors, treatment, medications

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72
Q

Thyroid questions

A

Change in temperature preference, swelling of neck, change in texture of hair or skin or nails, change in emotional stability, exopthalmos, tachycardia or palpitations, change in menstrual flow, change in bowel habits, medications

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73
Q

Nodding movement of head may indicate

A

Aortic insufficiency

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74
Q

Assessment of bruits

A

Use bell of stethoscope

Could indicate cerebral aneurysm or temporal arteritis

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75
Q

Tracheal tugging suggest

A

Presence of aortic aneurysm

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76
Q

Auscultation of thyroid

A

In a hypermetabolic state, the blood supply is increased and a vascular bruit may be heard

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77
Q

Warning signs of headaches

A

Increasingly frequent over .3 months, sudden onset like thunderclap, new onset after age 50, aggravated or relieved by change in position, precipitated by vasalva maneuver, fever and night sweats and weight loss, presence of cancer or HIV or pregnancy, recent head trauma, change in pattern from past headaches, lack of a similar headache in the pass, associated with papilledema or neck stiffness or focal neurologic deficits

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78
Q

3 most important attributes of a headache

A

Severity, chronologic pattern, associated patterns

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79
Q

Red painless eye indicates

A

Subconjunctival hemorrhage

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80
Q

Red eye with gritty sensation indicates

A

Viral conjunctivitis

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81
Q

Red painful eye indicates

A

Glaucoma, herpes, foreign body, hyphema

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82
Q

Diplopia is seen in

A

Lesions in the brainstem and cerebellum and with weakness of one or more extraocular muscles

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83
Q

Sensorineural hearing loss

A

People have trouble understanding speech often complaining that people mumble; noisy environments make it worse
Problems in the inner ear, cochlear nerve or central connection to brain

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84
Q

Conductive hearing loss

A

Problems in external or middle ear

Noisy environments may help

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85
Q

if earache or pain in the ear ask about

A

Associated fever, sore throat, cough, concurrent upper respiratory infection, discharge from the ear

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86
Q

Clinical prediction for strep throat

A

Fever, tonsular exudates, swollen tender anterior cervical adenopathy, absence of cough

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87
Q

Causes of throat hoarseness

A

Voice overuse, acute viral laryngitis, environmental allergies, acid reflux smoking, alcohol, inhalation of fumes, talking a lot

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88
Q

Vertigo

A

False sense of motion

Benign paroxysmal vertigo–inner ear issue (room feels like it is spinning)

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89
Q

Nasal discharge HPI

A

Character and color, associated symptoms, seasonality, tenderness over sinuses, face pain and headache, time of onset and changes

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90
Q

Sinus pain HPI

A

Fever, malaise, cough, headache, maxillary toothache, eye pain, nasal congestion, colored nasal discharge, pain increased when bending forward, seasonal allergies

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91
Q

Hoarseness getting worse over time may indicate

A

Laryngeal lesion or cyst

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92
Q

Recurrent hoarseness could indicate

A

Allergic rhinitis

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93
Q

For adults, a history of frequent recurring HEENT infections may suggest

A

Primary immunodeficienc y problem

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94
Q

Alport syndrome

A

Hematuria, proteinsuria, frequently develop sensorineural hearing loss, eye abnormalities with mishhapen lenses

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95
Q

Weber test

A

Assesses unilateral hearing loss

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96
Q

Rinne test

A

Air heard longer than bone

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97
Q

Gag reflex tests which cranial nerves

A

9 (glossopharyngeal) and 10 (vagus)

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98
Q

Eustachian tube in infant vs adult

A

Infant is more horizontal–more risk for ear infections

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99
Q

Ear examination of child vs adult

A

Child: pull auricle down to view tympanic membrane
Adult: pull auricle up and out

100
Q

Presbycusis

A

Sensorineural hearing loss

Due to the natural aging of the auditory canal and auditory bones; mostly affects the higher frequency sounds

101
Q

Chronic illnesses that can affect vision

A

Hypertension, CAD, diabetes, glaucoma, IBS, thyroid dysfunction, autoimmune disease, HIV

102
Q

Lymph nodes tenderness

A

The harder the node, the more likely the malignancy
The more tender the node, the more likely inflammation
Palpable supraclavicular node on the left is a clue to abdominal or thoracic malignancy

103
Q

Macular degeneration

A

Common disease of aging

Results in central vision loss and is often bilateral

104
Q

Meniere disease

A

Vertigo and tinnitus

105
Q

Amblyopia

A

Lazy eye

Eye and brain are not in sync

106
Q

Hordeolum

A

Stye

Localized swelling of eyelid caused mostly by staph aureus

107
Q

Chalazion

A

Caused by noninfectious gland occlusion of the eye

108
Q

Pterygium

A

Pinkish, triangular tissue growth on the cornea–surfers eye

109
Q

Papilledema

A

Increased pressure in the brain

Can be associated with visual disturbances, headaches, vomiting or combination

110
Q

Optic nerve in glaucoma

A

Enlarged

111
Q

Drusen bodies in eye

A

Can be an early sign of dry age-related macular degeneration

112
Q

Cotton wool bodies

A

Fluffy white patches on the retina seen with DM, hypertension, AIDS

113
Q

At what age can you start snellen vision test

A

at 3 years

114
Q

Disorders of the lymph system are present with 3 physical signs:

A

Enlarged lymph nodes, red streaks in the skin, lymphedema

115
Q

Angle of Louis

A

Sternal angle

5cm below the sternal notch

116
Q

First 7 ribs

A

Articulate with the sternum

117
Q

Inferior tip of the scapula

A

Landmark for the level of the 7th rib or interspace

118
Q

Most protruding spinous process when neck flexed forward

A

Usually C7

119
Q

Location of trachea bifurcation

A

Levels of sternal angle anteriorly anteriorly and T4 spinous process posteriorly

120
Q

SOB history

A

Onset, pattern, position most comfortable and number of pillows used at night, relate to extent of exercise, certain activities, time of day and eating, is it harder to inhale or exhale, severity, associated symptoms, efforts to treat

121
Q

5 A’s for tobacco cessation

A 
Ask about smoking at each visit
Advise patients regularly to stop smoking 
Assess patient's readiness
Assist patients to set stop dates 
Arrange for follow up visits
122
Q

Normal AP diameter of chest

A

1:2 of posterior: anterior

123
Q

AP diameter for barrel chest

A

1:1

124
Q

Chest retractions

A

When the chest wall seems to cave in at the sternum, between the ribs, at the suprasternal notch, above the clavicles, and at the lowest coastal margins
Suggests an obstruction to inspiration at any point in the respiratory tract

125
Q

Paradoxic breathing

A

On inspiration, the lower thorax is drawn in and on expiration, the opposite occurs

126
Q

Crepitus

A

Crackly or crinkly sensation that can be both palpated and heard
Indicates air in the subcutaneous tissue due to rupture somewhere in the respiratory system or infection with a gas producing organism

127
Q

Friction rub

A

Palpable, coarse, grating vibration, usually on inspiration

128
Q

Fremitus

A

Palpable vibratory sensation to the chest wall

Can be detected by placing ulnar aspects of hands against each side of chest while patient says “ninety nine”

129
Q

Abnormal fremitus could mean

A

Lung consolidation due to fluid or tissue usually due to pneumonia
Could also indicate obesity, COPD, effusion, tumor or fibrosis

130
Q

Hyperresonance of lung

A

Hyperinflation of lungs

131
Q

Normal percussion sound of lung

A

Resonant

132
Q

Dullness of percussion of lung

A

When fluid or tissue replaces air containing lungs or occupies pleural space

133
Q

Breath sounds are markedly decreased in

A

Emphysema

134
Q

Vesicular breath sounds

A

Soft and low pitched

Heard over most of both lungs

135
Q

Broncho-vesicular Breath sounds

A

Intermediate intensity and pitch

Heard over the 1st and 2nd interspaces anteriorly, and between the scapulae

136
Q

Bronchial breath sounds

A

Louder and higher in pitch

Heard over the manubrium

137
Q

Tracheal breath sounds

A

Very loud and high pitched

Heard over the trachea

138
Q

Bronchial breath sounds distally suggests

A

Consolidation and cavitation

139
Q

Alveolar atelactasis

A

Decreased or absent breath sounds over atelecatasis

Fine crackles may be present

140
Q

Rhonchi and wheezes

A

Continuous, musical, prolonged
Wheezes: high pitched (due to asthma, COPD or bronchitis)
Rhonchi: low pitched like snoring (due to secretions in large airways)

141
Q

Rales or crackles

A

Discontinuous–fine or coarse

CHF, fibrosis, pneumonia or bronchiectasis

142
Q

Stridor

A

Present entirely or predominantly on inspiration louder in the neck than over the chest wall
Indicates partial obstruction of trachea or larynx

143
Q

Friction rub breath sounds

A

Occurs outside the respiratory tree
Dry, crackly, grating, low pitched sound and is heard in both expiration and inspiration
Caused by inflamed, roughened surfaces rubbing together

144
Q

Mediastinal crunch

A

Found with mediastinal emphysema
Variety of sounds: loud crackles, clicking and gurgling sounds are synchronous with the heartbeat and not particularly so with respiration

145
Q

Bronchophony, egophony, pectoriloquy

A

May be present in any condition that consolidates lung tissue
Increased vocal resonance

146
Q

Decreased vocal resonance

A

Due to loss of tissue within respiratory tissue as in barrel chest of emphysema

147
Q

Bronchophony

A

Spoken words louder and clearer on auscultation

Lobar pneumonia

148
Q

Egophony

A

Spoken “ee” heard as “ay” on auscultation

Lobar pneumonia

149
Q

Pectoriloquy

A

Whispered words louder and clearer on auscultation

Lobar pneumonia

150
Q

Respiratory findings with consolidation or atelactasis

A

Dull percussion
Increased fremitus
Bronchial breath sounds
Crackles present

151
Q

Respiratory findings with emphysema

A 
Hyperresonant percussion
Decreased fremitus 
Decreased breath sounds 
Decreased voice transmission
Absent crackles
152
Q

Respiratory findings with pneumothorax

A 
Hyperresonant percussion
Decreased fremitus 
Decreased breath sounds 
Decreased voice transmission
Absent crackles
153
Q

Respiratory findings in pleural effusion

A

Dull percussion, decreased fremitus, decreased breath sounds, decreased voice transmission, absent crackles

154
Q

Breathing in infants

A

Coughing rare, sneezing and hiccups frequent
Breathing primarily diaphragmatic and use of intercostal muscles is gradual
Paradoxic breathing–chest wall collapses as the abdomen distends on inspiration

155
Q

When do children use the intercostal (thoracic) musculature for respiration

A

By the age of 6 or 7

156
Q

Mucoid sputum

A

Translucent, white or gray

Seen in viral infections and cystic fibrosis

157
Q

Purulent sputum

A

Yellow or green

Often accompanies bacterial infection

158
Q

Foul smelling sputum

A

Present in anaerobic lung abscess

159
Q

Fever + productive cough usually signifies

A

Pneumonia

160
Q

Chest pain, dyspnea and orthopnea usually indicates

A

Acute coronary syndromes

161
Q

Crackles that clear after coughing or position change suggests

A

Secretions seen in bronchitis or atelactasis

162
Q

Crackles of heart failure best heard

A

Posterior inferior lung fields

163
Q

Barrel chest

A

increased AP diameter–often accompanies COPD

164
Q

Flail chest

A

Moves inward with inspiration and outward with expiration

165
Q

Pigeon chest

A

Congenital abnormality in which the sternum is displaced anteriorly
Pectus Carinatum

166
Q

Thoracic kyphoscoliosis

A

Abnormal spinal curvatures and vertebral rotation

167
Q

Base/Apex of the heart

A

Base: Flat part on top of the heart
Apex: tip facing downward and left

168
Q

Anterior surface of the heart

A

Right ventricle is most of it

The most likely part to be harmed by external force or trauma

169
Q

S1

A

Closure of mitral/tricuspid valves

170
Q

S2

A

Closure of aortic/pulmonic valves

171
Q

Physiologic splitting of S2

A

With respiration

RV filling is delayed causing the audible split

172
Q

Paradoxical split of S2

A

On end expiration

Significant for delay in closure of aortic valve–left bundle branch block

173
Q

S3 heart sound

A

Vibration from ventricular filling

Fluid overload states such as CHF or pregnancy

174
Q

S4 heart sound

A

Atrial gallop
Occurs at end-diastole (pre-systole) as atria contract and try to bush blood into a resistant ventricle
Left ventricular hypertrophy, restrictive cardiomyopathy, MI, chronic hypertension

175
Q

Indications of heart disease during pregnancy

A

Progressive or severe dyspnea, progressive orthopnea, paroxysmal nocturnal dyspnea, hemoptysis, syncope with exertion, chest pain related to effort or emotion

176
Q

Inspection of heart

A

Apical impulse, pulsations, heaves or lifts

177
Q

Apical impulse

A

Should be visible at the midclavicular line in the 5th left intercostal space
Should not be seen in more than one space
Obscured by obesity, large breasts or muscularity

178
Q

Thrill

A

A fine, palpable, rushing vibration, a palpable murmur

179
Q

Acronym for heart sounds

A 
Aortic valve
Pulmonic valve
Erb's point
Tricuspid valve
Mitral valve
180
Q

Aortic valve location

A

2nd right intercostal space

181
Q

Pulmonic valve location

A

2nd left intercostal space

182
Q

Erb’s point location

A

3rd left intercostal space

Listen for murmurs

183
Q

Tricuspid valve location

A

4th left intercostal space

184
Q

Mitral valve location

A

5th left intercostal space at midclavicular line

PMI

185
Q

Assess for what characteristics of murmurs

A

timing and duration, pitch, intensity, pattern, quality, location, radiation, variation with respiratory

186
Q

Apical pulse in pregnant woman

A

Shifts up and laterally

187
Q

HPI for leg pain/cramps

A

Onset and duration, character, continuous burning in toes, pain in thighs or buttocks, skin changes, limping, waking at night with leg pain

188
Q

Palpate arteries and note

A

Rate and rhythm, pulse contour, amplitude, symmetry, obstructions, variations

189
Q

Amplitude of pulse

A

0: absent
1: diminished
2: normal
3: full and increased
4: bounding and aneurysma

190
Q

Bruits could indicate

A

Radiation of murmurs or obstructive arterial disease

191
Q

4 P’s for assessment of peripheral artery disease occlusion

A

Pain, pallor, pulselessness, paresthesia

192
Q

Claudication

A

Dull ache, muscle fatigue and cramps, usually appears during sustained exercise such as walking a distance or climbing stairs
Rest usually relieves

193
Q

Conditions that make JVP inspection difficult

A

Severe right heart failure, severe volume depletion and obesity

194
Q

Abnormal JVP

A

> 8-9cm

195
Q

S/S for venous obstruction and insufficiency

A

Swelling and tenderness over the muscles, engorgement of superficial veins, erythema and/or cyanosis

196
Q

Homan sign

A

Calf pain with passive dorsiflexion of foot

Sign of venous insufficiency

197
Q

PMI in patients with COPD

A

Displaced to epigastric area due to right ventricular hypertrophy

198
Q

PMI >2.5cm

A

evidence of left ventricular hypertrophy from hypertension or aortic stenosis

199
Q

Displacement of PMI lateral to midclavicular line

A

Occurs in left ventricular hypertrophy or ventricular dilation due to MI or heart failure

200
Q

Heart murmurs

A

Distinct heart sounds distinguished by their pitch and longer duration; attributed to turbulent blood flow and are usually diagnostic of valvular heart disease
Can occur in regurgitation or stenosis of valves

201
Q

ECG waves

A

P: atrial depolarization
QRS: ventricular depolarization
T: ventricular repolarization

202
Q

Periorbital puffiness and right rings

A

Nephrotic syndrome

203
Q

Enlarged waistline could indicate

A

Ascites dur to liver failure

204
Q

Routine screenings for CVD

A

Every 5 years if low risk
Every 2 years if high risk
Every 3 years if diabetic

205
Q

Causes of decreased carotid pulse

A

Decreased stroke volume from shock or MI, local atherosclerotic narrowing or occlusion

206
Q

Bell vs diaphragm for heart

A

Diaphragm: high pitched sounds of S1 + S2; murmurs of aortic and mitral regurgitation and pericardial friction rubs
Bell: low pitched sounds of S3 and S4; murmurs of mitral stenosis

207
Q

Systolic murmur

A

Falls between S1 and S2

Coincide with the carotid upstroke

208
Q

Diastolic murmur

A

Falls between S2 and S1

209
Q

Grade 1 murmur

A

Very faint, may not be heard in all positions

210
Q

Grade 2 murmur

A

Heard immediately

211
Q

Grade 3-6 murmur

A

Increasingly louder with a palpable thrill

212
Q

Pulmonary hypertension and PMI

A

Results in right ventricular hypertrophy and displaces PMI medially

213
Q

Hair loss over the anterior tibiae points to

A

Decreased arterial perfusion

214
Q

PAD warning signs

A

fatigue, aching, numbness and pain that limits walking
Any poorly healing or non healing wounds of legs/feet, pain present when at rest in lower leg, abdominal pain after meals associated with food fear and weight loss, first degree relatives with an aortic aneurysm

215
Q

Ankle-brachial index

A

Ratio of blood pressure in the foot and arm

Values <0.9 abnormal

216
Q

Risk factors for aortic abdominal aneurysm

A

Older age, male, smoking, family history

217
Q

Asymmetric blood pressures in arms

A

Coarctation of aorta and dissecting aortic aneurysm

218
Q

Unilateral calf and ankle swelling suggests

A

Venous thromboembolic disease from DVT, chronic venous insufficiency or incompetent venous valves

219
Q

Bilateral edema of legs seen in

A

Heart failure, cirrhosis, nephrotic syndrome

220
Q

Structures present in RUQ

A

Right lobe of liver, gallbladder, bile duct, part of transverse colon, ascending colon

221
Q

Structures present in RLQ

A

Cecum, appendix

222
Q

Structures present in LUQ

A

Stomach, left lobe of liver, spleen, pancreas, descending colon, part of transverse colon

223
Q

Stuctures present in LLQ

A

Rectum, anus

224
Q

Order for abdominal examination

A

Inspection, auscultation, percussion, palpation

225
Q

Hirschsprung disease

A

Developmental disorder characterized by the absence of ganglia in the distal colon, resulting in functional obstruction

226
Q

Increased bowel sounds may occur with

A

Gastroenteritis, early intestinal obstruction or hunger

227
Q

High pitched tinkling bowel sounds

A

Suggest intestinal fluid and air under pressure, as in early obstruction

228
Q

Decreased bowel sounds occur with

A

Peritonitis and paralytic ileus

229
Q

Friction rubs in abdomen

A

Indicate inflammation of the peritoneal surface of the organ from tumor, infection, or infarct

230
Q

Normal liver span

A

6-12cm

Measure height of liver in right midclavicular line

231
Q

Usual spot of liver dullness when going down from lungs

A

5th intercostal space on right side midclavicular line

232
Q

Where is spleen dullness usually percussed

A

From 9th-11th intercostal space just behind left midaxillary line

233
Q

McBurney’s point

A

Corresponds to the most common location of the base of the appendix
Pain on release may indicate appendicitis

234
Q

Murphy sign

A

Palpate right and left midclavicular, breath in, pain on palpate may be sign of gall bladder issues

235
Q

Grey turner sign

A

Bruising of the flanks

Sign of retroperitoneal hemorrhage or bleeding behind the peritoneum

236
Q

Cullen sign

A

Can predict acute pancreatitis

Bruising around umbilicus

237
Q

Rovsing sign

A

Palpating LLQ can elicit referred pain to RLQ

Can indicate appendicitis

238
Q

Cotton wisp on face is measuring what CN

A

5

239
Q

Keeping eyes closed on resistance, raising eyebrows, grown and smile is measuring what CN

A

7

240
Q

Extra ocular movements is measuring what CN

A

2, 4, 6

241
Q

Pupillary response is measuring what CN

A

3

242
Q

Visual acuity is measuring what CN

A

2

243
Q

Whisper test is measuring what CN

A

8

244
Q

Psoas sign

A

Hand on right thigh/knee, have patient raise leg against resistance
Pain in RLQ may indicate peritonitis

245
Q

Obturator sign

A

Patient on left side; flex hip and knee and internally rotate
Pain in RLQ may indicate peritonitis

Advanced Health Assessment (4 decks)

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