General survey and vital signs

Question 1

What are possible causes of fatigue?

Answer 1

-depression or anxiety
-Infections
-Endocrine
Heart failure, chronic lung disease, kindey or liver
- electrolyte imbalance, anemia, malignancies, nutrition, medications

Question 2

What should you consider if there is localized weakness in a neuroanatomic pattern?

Answer 2

• suggests mypopathy or neuropathy

Question 3

What questions can you ask related to weight?

Answer 3

• How is your weight compared to a year ago?

- Why do you think?

Question 4

What do you observe in the general survey aspect of the PE?

Answer 4

• sick or not sick
• walks unassisted, w/ a limp
• appears comfortable or distressed
• appears well or ill
• obese, thin, cachectic
• well nourished or hydrated
• appears older or younger than stated age
• are they conscious/alert?

Question 5

What is Cachexia?

Answer 5

• weight and muscle loss

Question 6

What are some signs of cardiorespiratory distress?

Answer 6

• clutching chest or throat
• diaphoresis
• labored breathing, wheezing
• coughing

Question 7

What are some signs of pain?

Answer 7

• stillness/guarding
• unusual posture
• grimacing

Question 8

What are some signs of anxiety?

Answer 8

• fidgety
• poor eye contact
• psychomotor slowing
• flat affect

Question 9

How do you check for pallor?

Answer 9

ask pt to look upward, gently draw down lower eyelid w/ you thumb

Question 10

What could be causing pallor?

Answer 10

severe anemia.

Check: palpebral conjunctiva, nail beds, palmar skin

Question 11

What is cyanosis and what tests must you f/u with if it is observed?

Answer 11

• is bluish discoloration of the skin.

- must do pulse oximetry and other tests

Question 12

What is juandice (icterus)?

Answer 12

yellowish pigmentation of tissues that contain elastin, bilirubin. best seen in fair and brown skin

Question 13

What is carotonemia?

Answer 13

pt’s skin is yellow, sclera remains white

Question 14

What should you be concerned about with moon face?

Answer 14

Cushings syndrome

Question 15

What should you be concerned about with proptosis or exophthalmos?

Answer 15

Grave’s disease

Question 16

What should you be concerned about if the pt is sitting in obvious postures to facilitate easier breathing (sitting up straight, leaning forward w/ arms braced, tripoding and drooling)?

Answer 16

• L heart failure
• COPD
• epiglottitis

(perform a detailed heart/lung exam)

Question 17

What must you evaluate if the pt has an abnormal gait?

Answer 17

nuerologic exam

Question 18

What is the formula for BMI?

Answer 18

BMI=weight(lbs)*703/height2 (in2)

Question 19

What are the vital signs?

Answer 19

BP, heart rate, respiratory rate, temperature, pain

Question 20

What is the difference between thigh and arm BP measurements?

Answer 20

thigh BP: systolic reading will be 10-40mmhg higher than the UE

Question 21

What must you do if a pt has a arrhythmia?

Answer 21

Get an EKG, and if it is stable, perform ambulatory monitoring

Question 22

What are four different ways temperature can be measured?

Answer 22

• oral
• axillary
• Rectal
• Aural
  (axillary least, rectal most accurate)

Question 23

What are some pulse patterns you may observe?

Answer 23

• Regular: evenly spaced beats, may vary slightly w/ respiration
• regularly irregular: regular pattern overall w/ “skipped” beats. (GET EKG if they have heart block)
• Irregularly irregular - chaotic, no real pattern, difficult to measure accurately (Afib, get EKG)

Question 24

What are you observing when measuring respiration?

Answer 24

• rate
• rhythm
• depth
• effort of breathing

Question 25

What is tachypnea?

Answer 25

fast shallow breathing >20 breaths/min

Question 26

What is bradypnea?

Answer 26

breathing <10-12 breaths/minute

Question 27

What is Cheyen-Stokes?

Answer 27

-periods of deep breathing alternate with periods of apnea (gradual increase/decrease w/ abpnea 10-30 seconds) -Could suggest increasing intracranial pressure or brainstem injury- call 911

Question 28

What is Kussmaul's?

Answer 28

tachypnea and hyperapnea (deep respirations)

Question 29

Why do you use the bell of the stethoscope to hear the karotkoff sounds when measuring BP?

Answer 29

Because the Karotkoff sounds are relatively low in pitch

Question 30

What is associated with and auscultatory gap?

Answer 30

arterial stiffness and atherosclerotic disease

Question 31

What is hyperpyrexia?

Answer 31

A temperature above 106 F or 41.1 C

Question 32

What is hypothermia?

Answer 32

Temp less then 35 C or 95 F rectally

Question 33

What can cause hyperpyrexia?

Answer 33

infection, trauma like surgery or crush injury, malignancy, blood disorder (acute hemolytic anemia), drug reactions and immune disorders

Question 34

What can cause hypothermia?

Answer 34

- chief cause is exposure to cold | - could also be reduced movement in paralysis, interference w/ vasoconstriction and older age

Question 35

What should you be concerned about with cachexia?

Answer 35

Malignancy, until proven otherwise

Question 36

What can cause central cyanosis?

Answer 36

advanced lung disease, congential heart disease and hemoglobinopathies

Question 37

What should you be concerned about if you see jaundice?

Answer 37

Liver disease or excess hemolysis of RBC's

Question 38

What should you be concerned about with pallor?

Answer 38

decreased RBC's in anemia | decreased blood flow (fainting or arterial occlusion)

Question 39

What is the pulse pressure?

Answer 39

The difference between systolic and diastolic pressure

Question 40

What is systolic BP?

Answer 40

highest BP in the cycle, level at which you hear sounds of at least two consecutive beats

Question 41

What is diastolic BP?

Answer 41

lowest BP in the cycle, level at which sounds become muffled and dissapear

Question 42

What can happen if you do not recognize an auscultatory gap?

Answer 42

- underestimation of systolic BP | - overestimation of diastolic BP

Question 43

If you have bradycardia what should you be concerned about?

Answer 43

- sinus bradycardia - second-degree AV block - Complete heart block

Question 44

If you have tachycardia, what should you be concerned about?

Answer 44

- sinus tachycardia - supraventricular tachycardia - atrial flutter - ventricular tachycardia

Question 45

What should you be concerned about w/ bradypnea?

Answer 45

uremia, alcohol, increased intracranial pressure, sedatives, opioids, cholinergic agents

Question 46

What should you be concerned about w/ tachypnea?

Answer 46

restrictive lung disease, pleuritic CP and elevated diaphragm