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Year 3 - Paramedic Care of Minor Illnesses > General Exam > Flashcards

General Exam Flashcards

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1
Q

What must you ensure you do before beginning your general assessment?

A

Introduce yourself
Explain procedure
Gain consent
Report distress
Wash hands

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2
Q

How would you begin your general assessment?

A

Full set of observations (blood pressure, respiration rate, oxygen saturations and blood glucose, temperature)
Consider ECG, ETCO2
Feel radial pulse for regularity

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3
Q

What should you assess a radial pulse for?

A

Regularity, rate and strength

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4
Q

What could a regularly irregular radial pulse indicate?

A

A heart block

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5
Q

What could an irregularly irregular radial pulse indicate?

A

Atrial fibrillation

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6
Q

What range would we expect to see when taking a patients blood sugars? What if it was out of range?

A

4-7 mmol/L

< 4 mmol/L indicates hypoglycaemia
> 11 mmol/L indicates hyperglycaemia

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7
Q

What range would we expect to see when taking a patients blood pressure? What if it was out of range?

A

120/80 is ideal target value

90/60 indicates hypotension
140/90 indicates hypertension

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8
Q

What range would we expect to see when taking a patients respiration rate? What if it was out of range?

A

12-20 regular even respirations

> 20 indicates tachypnoea
< 12 indicates bradypnoea

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9
Q

What range would we expect to see when taking a patients oxygen saturations? What if it was out of range?

A

92-100%

< 92% indicates hypoxia

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10
Q

What ranges would we expect to see when taking a patients temperature? What if it was out of range?

A

Normothermia is defined as 36.5 to 37.5 degrees celsius as stated in NICE guidelines, although some deviation is normal

Hypothermia is defined as a temperature of less than 35 degrees celsius

Pyrexia/hyperthermia is defined as a temp of more than 37.8 degrees celsius

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11
Q

What is the significance of collecting a full set of vital signs?

A

On their own they may not indicate a specific disease, however when used collectively and in conjunction with results from other assessments they can be useful

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12
Q

When assessing the general appearance of the patient, what should you consider?

A

Weight
Position
Colour
Odours
Pain
Alertness

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13
Q

What is the significance of a patient appearing underweight?

A

Could be a result of an eating disorder such as anorexia or conditions such as malnutrition and hyperthyroidism

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14
Q

What is the significance of a patient appearing overweight?

A

Could be due to a poor diet or hypothyroidism - increasing the risk of heart disease and diabetes

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15
Q

When assessing a patients posture what common conditions might you be observing for?

A

Underlying spinal disease ; scoliosis (sideways curvature of the spine), kyphosis (forwards curvature of the spine)

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16
Q

What is the significance of scoliosis and kyphosis on the body?

A

Both can have an impact on the cardiopulmonary function in the body

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17
Q

What are you observing for when assessing a patients colour?

A

Yellow
Flushed
Cyanosed

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18
Q

What could yellow skin indicate?

A

Sign of jaundice - can indicate liver disease

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19
Q

What can flushed and cyanosed skin be a sign of?

A

Hypoxia

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20
Q

What is the significance of observing any odours present with your patient?

A

Odours can indicate a person’s general hygiene and habits

Including the smell of cigarette smoke in a smoker, alcohol in potential alcohol dependency.

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21
Q

What are two common signs that a patient is in pain/discomfort?

A

Grimacing and fidgeting

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22
Q

What common conditions can reduce consciousness level?

A

UTI
Hypoglycaemia
Alcohol intoxication

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23
Q

How can you rule out concerns of confusion without having to assess a patient in depth?

A

You have been interacting with the patient, so far, they are alert and show no signs of confusion - reassess if changes present

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24
Q

When assessing the patients hands, what are you observing for?

A

Size
Cold
Warm
Sweaty
Tremor
Muscle wasting
Erythema
Contracture

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25
Q

What can abnormally large hands be an indication of?

A

Marfans syndrome

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26
Q

What should you be feeling for when assessing a patients hands?

A

That hands are warm and both an equal temperature

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27
Q

What could cold hands potentially indicate?

A

Low cardiac output
Raynauds disease

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28
Q

What is Raynaud’s disease, what causes it?

A

Raynaud’s is usually triggered by cold temperatures, anxiety or stress.

The condition occurs because your blood vessels go into a temporary spasm, which blocks the flow of blood.

This causes the affected area to change colour to white, then blue and then red, as the bloodflow returns.

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29
Q

What could warm hands potentially indicate?

A

High cardiac output, commonly due to anaemia

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30
Q

What could hands of unequal temperature indicate?

A

Consider trauma that may have impaired circulation

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31
Q

What is hyperhidrosis?

A

common condition in which a person sweats excessively, often affects the hands

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32
Q

What could hyperhidrosis of the hands indicate?

A

Hyperhidrosis can result from thyroid issues
But in a clinical situation sweating can be due to anxiety

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33
Q

Which 2 ways can you assess for tremor of the hands?

A

Ask patient to hold hands out as if they were trying to stop a bus - flapping tremor

Ask patient to hold both hands out with palms facing downwards

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34
Q

How would you assess for flapping tremor?

A

Ask patient to hold hands out as if they were trying to stop a bus

A positive result would be if the hands flap backwards and forwards

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35
Q

What can a flapping tremor be a sign of?

A

CO2 retention for instance in COPD

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36
Q

What can tremors of the hands be a sign of?

A

Can have numerous causes, notably; parkinsons, anxiety and alcohol withdrawal

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37
Q

Where would we look for muscle wasting of the hands?

A

Muscle atrophy at the hypo and hyperthenar eminences (palms of hands)

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38
Q

What is muscle atrophy of the palms of the hands a sign of?

A

Commonly associated with ageing, although can be a sign of carpal tunnel syndrome

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39
Q

What is palmar erythema?

A

a skin condition that makes the palms of your hands turn red

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40
Q

What is palmar erythema often linked too?

A

Pregnancy and liver disease

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41
Q

What condition can be seen here?

A

Dupuytren’s contracture

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42
Q

What is Dupuytren’s contracture?

A

A hand deformity that usually develops over years.

The condition affects a layer of tissue that lies under the skin of your palm. Knots of tissue form under the skin - eventually creating a thick cord that can pull one or more fingers into a bent position

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43
Q

When is Dupuytren’s contracture often seen?

A

Patients with alcohol-related liver disease and patients with impaired glucose-tolerance

44
Q

What are you looking for when observing a patients nails?

A

Shape
Contour
Condition
Colour/discolouration
Clubbing
Pitting
Splinter haemorrhages

45
Q

What specific abnormalities should you observe for on a patients nails?

A

Splinter haemorrhage
Spoon nails
Leukonychia
Clubbing

46
Q

What abnormality of the nails can be observed here?

A

Splinter haemorrhage

47
Q

What abnormality of the nails can be observed here?

A

Spoon nails

48
Q

What abnormality of the nails can be observed here?

A

Leukonychia

49
Q

What abnormality of the nails can be observed here?

A

Pitting

50
Q

What abnormality of the nails can be observed here?

A

Clubbing

51
Q

What are spoon nails often a result of?

A

iron deficiency or anaemia

52
Q

What can splinter haemorrhages be indicative of?

A

bacterial endocarditis

53
Q

Why do leukonychia occur?

A

zinc deficiency

54
Q

What causes pitting of the nails?

A

can be a sign of eczema and joint inflammation.

55
Q

How do you test for clubbing?

A

Ask patient to rest index finger nails against each other

If clubbing is not present you should be able to see a diamond shaped window between the nails

56
Q

What is clubbing of the nails often suggestive of?

A

COPD and CO2 retention

57
Q

When inspecting/palpating the joints and tendons of the hand and forearm, what are you assessing for?

A

symmetrical, asymmetrical, swelling or nodes on fingers or tendons, deviation, posture, deformity, xanthomas

58
Q

When feeling the patients hand/wrist joints and tendons, what are you check for?

A

Any pain
Making sure they appear symmetrical with no deformities

59
Q

When feeling the fingers, what landmarks are we observing?

A

Feel down each finger to check the metacarpals, phalanges and proximal and distal interphalangeal joints

60
Q

If nodes are observed in the distal interphalangeal joint, what are they called?

A

Heberden’s nodes

61
Q

If nodes are observed in the proximal interphalangeal joint, what are they called?

A

Bouchard’s nodes

62
Q

What are Heberdens and Bouchard’s nodes indicative of?

A

osteoarthritis

63
Q

What is xanthomas of the hands?

A

fatty, yellow subcutaneous lesions

64
Q

When is xanthomas commonly observed?

A

Seen in those with high cholesterol - risk factor for heart disease

65
Q

Aside from nodes in the fingers, what else are we assessing for that is a common sign of arthritis?

A

ulnar or radial deviation

If no history, but deviation present - consider trauma

66
Q

What is ulnar/radial deviation?

A

Refers to the movement of the wrist from side to side

These movements flex the hand toward either the radial or ulnar bone in the arm. The action is a flexion movement reducing the angle of the joint of the wrist and the respective bone of the arm.

67
Q

What should you assess when looking at the skin?

A

Colour
Texture
Temperature
Hair distribution

68
Q

Aside from colour, texture, temperature and hair distribution of skin, what should you also assess for?

A

Sweating
Dryness
Lesions
Elasticity
Turgor

69
Q

What could thinning of the skin indicate?

A

Cushing’s Syndrome
Long term steroid use

70
Q

What could thickening and dryness of the skin indicate?

A

Hypothyroidism

71
Q

What can rashes/lesions be a sign of?

A

Infection
Allergy

72
Q

When are spider naevi often observed?

A

Liver disease
Can be normal in pregnancy

73
Q

What are spider naevi?

A

small, broken beds of capillaries, observed under the skin

74
Q

How do you test skin turgor?

A

Pinch the skin on the back of the hand

Skin should immediately spring back down - if it remains tented it can be a sign of dehydration

75
Q

What can inappropriate or excessive hair distribution indicate?

A

Endocrine problems such as; PCOS in females and commonly Cushings Syndrome in males

76
Q

When checking the lips and tongue, what are we assessing?

A

Check lips and tongue for cyanosis
Assess the tongue for size, moisture, dryness, colour, smoothness

77
Q

You notice that a patients lips are blue, what could this indicate?

A

Cyanosis often suggests hypoxia

78
Q

You notice that a patients lips are dry, what could this indicate?

A

Dehydration

79
Q

What are you assessing for when looking at the tongue?

A

Assess texture, colour and size

80
Q

What could a white coloured tongue indicate?

A

Thrush

81
Q

What could a large swollen tongue indicate?

A

Allergy

82
Q

You notice a patients tongue is large and swollen, why is this concerning?

A

Increases risk of airway occlusion

83
Q

How should the ducal mucosa/gums of the patient look?

A

Moist with good colour

84
Q

You notice a patients gums appear pale, what could this indicate?

A

Anaemia
Dehydration

85
Q

When looking at the back of the throat, what are we observing for?

A

Swelling and/or redness particularly around the tonsils

86
Q

What would swelling and/or redness around the tonsils often indicate?

A

tonsilitis

87
Q

What should you be observing for when looking at a patients teeth?

A

No obvious erosion to the teeth or teeth loss

88
Q

What could excessive erosion of the teeth indicate?

A

gastro-oesophageal reflux disease (GORD) commonly causes excessive erosion of the teeth due to increased acidity

89
Q

What main thing are we assessing for regarding a patients breath?

A

Fruity smelling teeth
Faecel smell

90
Q

What can fruity smelling teeth indicate?

A

indicates the presence of ketones - sweet pear drop smell
Often associated with diabetic ketoacidosis (DKA)

91
Q

When assessing the eyes, what are we observing for?

A

exophthalmos - bulging
redness/lesions
conjunctiva for anaemia
sclera for jaundice
cornea - corneal arcus
xanthelasma

92
Q

What is exophthalmos?

A

medical term for a bulging or protruding eyeball or eyeballs

93
Q

What is often the cause of exophthalmos?

A

Caused by both hyper and hypothyroidism

94
Q

You note redness and lesions when observing a patients eyes, what could this indicate?

A

Infection

95
Q

What colour should conjunctiva be in a healthy patient?

A

pink

96
Q

How would you check a patients conjunctiva for excessive pallor?

A

Pull patients eye lid down
If found to be pink this is a normal finding

97
Q

You note excessive palor of a patients conjunctiva, what could this indicate?

A

Anaemia

98
Q

Where is the sclera?

A

the white outer layer of the eyeball

99
Q

What are we observing for when assessing a patients sclera?

A

Any yellowing - the sclera should be white in healthy patients

100
Q

What could yellowing of the sclera indicate?

A

Jaundice, commonly seen in liver disease

101
Q

What causes the yellowing of the sclera?

A

Jaundice - occurs when excess amounts of bilirubin circulating in the blood stream dissolve into the skin and surrounding tissues

102
Q

When observing the corneas of a patient what abnormal finding are we looking for?

A

Observe for corneal arcus - characterised by a grey/white ring around the eye of the patient

103
Q

When is corneal arcus often observed?

A

Common sign of ageing in those over 60
Also observed in patients with high cholesterol due to excess lipid deposits

104
Q

How should you conclude a general assessment?

A

Summarise and conclude your findings

Base decision for next examination based on a combination of history taking and general assessment findings

105
Q

What can be observed in this photo?

A

xanthelasma

106
Q

What is xanthelasma?

A

yellow growths that appears on or by the corners of your eyelids next to your nose, these are due to a build up of cholesterol

Year 3 - Paramedic Care of Minor Illnesses (6 decks)

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