General Skills Flashcards
What are the subjects for the general survey
Alertness
Age
Distress
Body habitus (type/BMI)
Movement (posture/gait/strength/tremors/tics/etc.)
Appearance/hygiene
Behavior
Normal HR
60-100 bpm
Normal RR
12-20/min
Normal temperature (C)
35.8 - 37.3
Normal temperature (F)
96.4 - 99.1
Fever temperature
38 C or 100.3 F
Hypothermia temperature
<35 C or <95 F
Normal BP
<120/80
Elevated BP
> 120/80
Hypertensive BP
<130/>80
Hypotensive BP
<90/60
What do we look at on the head exam
Hair
Scalp
Skull
Face
Skin
What tests are run on the eye exam
Visual acuity
Visual fields
Inspection
Pupillary reaction
Extraocular muscles
Ophthalmoscope
Normal optic disc features
Blurring on nasal side
Yellow-creamy pink
Cup is half the size of the disc
Symmetrical
What does a papilledema indicate
Meningitis
Subarachnoid hemorrhage
Trauma
Lesions
What is the diopter setting for anterior structures and why
+10 or +12
For opacities in vitreous humor or lens
When assessing tenderness on the external ear, what are we looking for
Pain with otitis externa (auricle and tragus)
Pain with mastoiditis (mastoid process)
Most common CN II tests
Visual fields
Pupillary light reflex
Test for CN III, IV, and VI
“H” Test
Most common CN V test
Facial sensation
Corneal reflex
Most common CN VII test
Smile
Raise eyebrows
Clench eyes
Most common CN VIII test
Finger rub
Most common CN IX, X test
“AH” while observing soft palate
Most common CN XI test
Shoulder shrug
Turn head
Most common CN XII test
Stick out tongue
Scale of muscle strength
0-5
0 - no contraction
1 - barely detectable
2 - activation w/ gravity eliminated
3 - active movement against gravity
4 - active movement against gravity and resistance
5 - active movement against full resistance (normal)
What muscle and spinal level is tested with motor strength for abduction at shoulder
Deltoid
C5 - C6
What muscle and spinal level is tested with motor strength for elbow flexion
Biceps
C5 - C6
What muscle and spinal level is tested with motor strength for elbow extension
Triceps
C6 - C8
What spinal level is tested with motor strength for hand grip
C7 - T1 (includes C8)
What muscle and spinal level is tested with motor strength for hip flexion
Iliopsoas
L2 - L4
What muscles and spinal levels are tested with motor strength for knee flexion
Hamstrings
L4 - S2
What muscle and spinal level is tested with motor strength for knee extension
Quadriceps
L2 - L4
What spinal level is tested with motor strength for foot dorsiflexion
L4 - L5
What spinal level is tested with motor strength for foot plantar flexion
S1
Scale for reflex grading
0 - 4
0+ - absent
1+ - diminished
2+ - average
3+ - brisk but not pathologic
4+ - very brisk/hyperactive
What does a hyperactive reflex indicate
Upper motor neuron lesion
What does an absent reflex indicate
Lower motor neuron lesion
Upper extremity reflexes are tested where and for what spinal levels
Biceps (C5-C6)
Brachioradialis (C6)
Triceps (C7)
Lower extremity reflexes are tested where and for what spinal levels
Patellar (L4)
Achilles (S1)
Plantar response
What is the Romberg test
Stand with feet together, arms crossed or at side. Eyes open and eyes closed to look for swaying/imbalance
Which of the following is the most accurate measure of core body temperature
Rectal
What is not part of the general survey
Temperature
What is most closely associated with the sounds of turbulent blood flow
Korotkoff
What respiratory rate is consistent with bradypnea
Less than 10/min
What BMI is consistent with ectomorph
<18.5
What BMI is consistent with mesomorph
18.6 - 24.9
What BMI is consistent with endomorph
> 25
If the initial BP reading is too high, what is the next alternative
Change arms
What is the top number on the vision test
Standard 20 foot vision
What is the bottom number on the vision test
Where a standard person would be able to see what the patient sees at 20 feet
What is the best lighting during a fundoscopic exam
Dim
Where are the hands placed while palpating the thyroid
Below cricoid cartilage
What is the S1 heart sound
Tricuspid and mitral valve closure
What is the S2 heart sound
Aortic and pulmonic valve closure
Where is the aortic valve auscultated
Right second intercostal space at right sternal border
Where is the pulmonic valve auscultated
Left second intercostal space at left sternal border
Where is the tricuspid valve auscultated
Left fourth intercostal space at left sternal border
Where is the mitral valve auscultated
Left fifth intercostal space at midclavicular line
How many grades are there for murmurs
1 - 6
What is a grade 1 murmur
Very faint, must “tune in”, may not be heard in all positions
What is a grade 2 murmur
Quiet but heard immediately
What is a grade 3 murmur
Moderately loud
What is a grade 4 murmur
Loud with palpable thrill
What is a grade 5 murmur
Very loud, with thrill, may be heard with stethoscope barely on chest
What is a grade 6 murmur
Very loud, with thrill, may be heard with stethoscope entirely off chest
Shapes of murmurs
Crescendo
Crescendo-decrescendo
Decrescendo
Plateau
Sequence of thorax examination
Inspection
Palpation
Percussion
Auscultation
What is indicative by hyperresonance when percussing thorax
Pathological -
COPD/emphysema
Pneumothorax
What is indicative by dullness when percussing thorax
Over heart, liver, below diaphragm
Also heard with effusion or consolidation
What is indicative by typmany when percussing thorax
Gastric bubble
Types of breath sounds
Vesicular (lateral, distal lung)
Bronchovesicular (bronchial tree)
Bronchial (trachea, primary bronchials)
Adventitial lung sounds
Crackles (course and fine)
Wheezes
Rhonchi
