Exam 1 - Physical Exam Flashcards
When should patient identification be completed?
Who is important to be involved?
- Prior to administration of mind altering substances
- The patient
Why is it important to chart core temperatures and have accurate post-op temperatures?
- Core temperatures are most accurate
- Post-op temperatures are typically a QI measure ($)
What is anthropometry?
The study of the measurements and proportions of the body
What does someone with redundant neck tissue and snoring alert you to?
The patient may have a difficuly airway and be prone to obstruct
What might recent weight gain or loss alert you to?
- Weight loss: cancer or undiagnosed T1DM
- Weight gain: CHF, hypothyroidsim
Approximately what should the axillary temp be in comparison to a core temperature?
- 1° lower
Why is it important to investigate patient reported allergies?
- Some reported allergies may just be medication side effects (ex: lido w/ epi can cause tachycardia, sedation from benzos)
What should we focus on with patients that have known or suspected drug abuse?
- Yes or no primarily, not necissarily doses
- Focus on drugs with high clinical significance like coke and meth
Why is an accurate pack year history important?
- Pack year history correlates to risk of lung cancer and median survival rate if diagnosed
Why is it important to review lab data trends for each specific patient?
Example?
- What may be normal for one patient, could be abnormal for another.
- Smokers are typically hemoconentrated, so is it from them smoking or are they dehydrated?
What is palpation used to assess?
- Texture
- Masses (firm or soft?)
- Fluid
- Skin temperature
How deep would one palpate with light palpation technique?
Deep palpation technique?
- 1-2 cm
- 4-5 cm
What is percussion used to assess?
- Evaluation of the prescence of air or fluid in body tissues
What is Mediate or Indirect Percussion?
How is it performed and what is its purpose?
- Plexor (striking finger) & pleximeter (finger being struck).
- Evaluation of abdomen and thorax
What is Immediate percussion? What is it utilized for?
- Striking of surface directly with fingers of the hand.
- Adult sinus or infant thorax evaluation.
What is Fist percussion? What is it utilized for?
- Flat hand on area to be evaluated being struck with a fist.
- Used to evaluate the back & kidney for tenderness.
What are the three forms of percussion?
- Mediate/Indirect percussion
- Immediate percussion
- Fist percussion
What would be expected with tympanic, drum-like percussion?
- Air-containg space (puffed out cheek, gastric air bubble, etc.)
What would be expected with resonant, hollow sounding percussion?
- Normal lungs
What would be an expected finding with assessed hyper-resonant, booming percussive sounds?
- Emphysematous lungs
What would be an expected finding with assessed dull, thud-like percussive sounds?
- Softer organs (ex. Liver)
What would be an expected finding with assessed flat percussive sounds?
- Denser organs (ex. muscle)
What temperature does one need to be to go to PACU?
96°
When is circumoral cyanosis primarily seen?
How might circumoral cyanosis present on patients with darker skin tones?
- In infants primarily above the upper lip.
- gray or white rather than blue
What is the cause of jaundice?
Elevated bilirubin, assumer impaired liver function
What are situations that can cause jaundice?
- Acute liver inflammation
- Inflammation/obstruction of the bile duct
- Cholestasis
- Hemolytic anemia
- Gilbert’s syndrome
- Crigler-Najjar syndrome
- Dubin-Johnson syndrome
- Pseudojaundice
Always Inform Clients How Great Crnas Deliver Perioperatively
What causes pseudojaundice? How harmful is it?
- Harmless condition caused by excess carrots, pumpkins or melon consumption (↑ β-carotene)
What is Gilbert’s syndrome?
- Inherited condition where enzymes can’t process bile excretion.
What is Crigler-Najjar’s syndrome?
- Inherited condition where enzyme that processes bilirubin is ineffective.
What is Dubin-Johnson syndrome?
- Inherited chronic jaundice where bilirubin can’t be secreted from the hepatic cells.
What type of cells does vitiligo attack?
When does it usually appear?
- Melanocytes
- After a triggering event like a cut, scrape, or bruise
What is the sign name of periorbital ecchymosis?
What does it indicate?
- Battle’s Sign: indicates basilar skull fracture.
What are petechiae indicative of?
- Thrombocytopenia
- Leukemia
- Infectious disease
- Medications
- Prolonged straining (coughing)
What are Kaposis sarcoma a result of?
AIDS
What is koilonychia? What is it often indicative of?
- Spoon-nails where nails become flat or convex. (opposite of clubbing)
- Iron-deficiency anemia.
What is nail clubbing? What is it often indicative of?
- Increased concavity of nails
- Heart/lung diseases, also potential osteoarthropathies.
What is paronychia?
- Inflammation of skin around the nail.
What are Beau’s lines? What are they indicative of?
- Horizontal striations that develop on the nail.
- Lots of things. Nail trauma, kidney failure, mumps, thyroid disorders, syphilis, etc.
What is hirsutism?
What are some of the causes?
- Abnormal hair-growth in places where men usually have hair
- PCOS
- Cushings
- congenital adrenal hyperplasia
- tumors
- medications
What should you be concerned about with funny looking kids?
- They may have a genetic syndrome and they are typically difficult airways (Down’s)
- Always assess the parents also…per Cornelius “sometimes funny looking kids have funny looking parents”
What is the eye chart used for visual acuity called?
Snellen’s Chart
What should we be concerned about for patients undergoing opthalmic procedures?
What anesthetic procedure can induce it?
- Horner’s Syndrome
- Interscalene block
What are the symptoms Horner’s Syndrome?
- Miosis: persistently small pupil
- Anisocoria: a notable difference in pupil size between the two eyes
- Ptosis: drooping of the upper eyelid
- Little or delayed opening (dilation) of the affected pupil in dim light
- Anhidrosis - little or no sweating either on the entire side of the face or an isolated patch of skin on the affected side
What is ectropion?
- Eversion of eyelid; lid margin turns out
What is entropion?
- Inversion of eyelid; lid margin turns in
What is stage I of anesthesia?
Stage of analgesia
Extends from beginning of anesthetic inhalation to loss of conciousness.
What is Arcus Senilis?
- Deposition of phospholipids/cholesterol in the peripheral cornea of older patients. (benign usually)
What occurs with the eyes during stage 2 of anesthesia?
- Roving eyeball
- Partial pupillary dilation
- Loss of eyelash reflex (1st reflex lost)
- No loss of eyelid reflex
What is stage II of anesthesia?
Stage of delirium or excitement.
Extends fromloss of conciousness to beginningof regular respiration.
What is stage III of anesthesia?
Stage of surgical anesthesia.
What is ocular accomodation?
Ability of the eye to focus in on objects far away and close.
What is the Random E test?
Used for those who cannot read or don’t know the alphabet. They must correctly identify the position of the ‘E’ as it gets smaller
What opthalmic condition is a medical emergency?
Entrapment of occular nerves or muscles
What condition causes loss of peripheral vision?
What class of medications is contraindicated in these patients?
- Glaucoma
- Anticholinergics
What is most often the most important anesthetic consideration regarding the ears?
Padding during surgery to prevent injury
Differentiate Weber’s & Rinne’s tests
- Weber: tuning fork held on the head (assesses left vs right ear hearing)
- Rinne: tuning fork held to each ear (bone vs air conduction)
What are cherry colored lips a sign of?
Late sign of carbon monoxide poisioning
What is Leukoplakia? What causes it?
Thick white patches on the gums from smoking and/or alcohol (usually precancerous)
What 2 conditions can cause a bright red tongue?
B-12 and niacin deficiency
What condition can cause spongy gums that bleed easily?
Vitamin C deficiency
How do you assess function of the sternoclediomastoid muscle?
Ask the patient to flex the neck with the chin to the chest.
How do you assess function of the trapezius muscle?
Ask the patient to move their head to their shoulder
What needs to be checked pre-op with psych patients? Why?
- EKG for prolonged QT interval. Many psych meds prolong QT interval.
Which herb tends to cause an allergic reaction peri-operatively?
- Echinacea
Bedridden, wheelchair-bound patients should not receive what drug?
Succinylcholine
Why should we not use nitrous on patients with full sinuses?
Nitrous can diffuse into the sinuses and increase pressure leading to postoperative pain and discomfort
Where is the apical pulse located?
- 5th Intercostal space, left of sternum, medial to left mid-clavicular line.
What drug treats preeclampsia?
How can you check for overdose with this drug?
- Magnesium
- hypermagnesemia will cause patellar reflexes to disappear.
Chipmunk face is associated with what disorder?
- Bulimia
Leoning face is associated with what disease?
Leprosy
Spider angioma is associated with what liver disorder?
- Cirrhosis
Pyloric stenosis is associated with what shape mass?
- Olive
What is the Romberg test?
Assesses proprioception
Ask patient to stand with eyes closed and arms outstretched
Positive = unsteadiness
When would we need to assess the gluteal nerve?
If a patient reports incontinence and has no gluteal nerve reflex they may have an epidural hematoma
What is the name of the sign for RUQ pain?
Murphy’s sign
What disease is associated with exopthalamus?
Hyperthyroidsim
What disease causes a buffalo hump?
Cushing’s
What disease is characteristic of rice water stool?
What was invented to treat this?
- Cholera
- Normal Saline
What is the name for chest-clutching that occurs during MI?
- Levine’s sign
What capability is lost with peroneal nerve injury?
- Dorsiflexion
What is a VAN exam?
What does being VAN positive indicate?
- A bedside assessment tool that assess risk for large cerebral vessel stroke
- VAN (+) = ↑ risk for LVO (large vessel occlusion)
What is another name for plantar reflex?
Babinski reflex
What are seizure meds effects on anesthesia?
- Seizure meds make anesthetics work less effectively.
Pill-rolling tremors are associated with what disorder?
- Parkinson’s
