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Bates' Guide To The Physical Exam (IPA emory) > General Survey & Vital Signs > Flashcards

General Survey & Vital Signs Flashcards

1
Q

State of Health

A

Is the patient acutely or chronically ill?

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2
Q

Alert

A

Lucid and responds to commands

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3
Q

Confused

A

Awake but may not respond correctly to stimuli

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4
Q

Lethargic

A

drowsy, opens eyes, and follows commands to loud voice

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5
Q

Obtundation

A

will awaken to touch but slow to respond, somewhat confused

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6
Q

Stupor

A

only arouses to pain

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7
Q

Comatose

A

unresponsive

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8
Q

Delirious

A

confused, agitated, may be hallucinating

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9
Q

Cardiac/Pulmonary Signs of Distress

A

clutching chest, pallor, diaphoresis, labored breathing, wheezing, coughing

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10
Q

Pain Signs of Distress

A

wincing, sweating, facial grimace, posture preference

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11
Q

Anxiety/Depression signs of distress

A

fidgety movements, cold/moist palms, poor eye contact, flat affect

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12
Q

Unkempt appearance may suggest…

A

depression or dementia

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13
Q

breath odors can indicate…

A

alcohol use, uremia, liver failure, fruity breath of metabolic acidosis (DKA), ammonia (renal disease or urinary incontinence)

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14
Q

Holes in shoes may suggest…

A

gout, bunions, other painful foot conditions, or lower extremity edema

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15
Q

Is the patient articulate? If not, think…

A

expressive aphasia, TIA, receptive aphasia, aphonia

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16
Q

Proptosis

A

Stare of Hyperthyroidism

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17
Q

Myxedema is indicative of…

A

Severe Hypothyroidism

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18
Q

Myxedema is…

A

Edema around the eyes does not pit with pressure, dry skin, thinning hair

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19
Q

Immobile face is indicative of…

A

Parkinsonism

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20
Q

Flat or sad affect is indicative of…

A

Depression

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21
Q

A moon face with red cheeks and excessive facial hair growth is indicative of…

A

Cushing’s Syndrome

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22
Q

Acromegaly is…

A

increased growth hormone production leads to prominent jaw and brow, enlarged nose, lips, ears

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23
Q

Tripod posture indicates…

A

COPD

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24
Q

Parkinsonian Gait

A

Shuffle Step

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25
Q

Spastic hemiparesis

A

Pt. with stroke or brain tumor may drag foot

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26
Q

Antalgic gait

A

Painful or limping gait

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27
Q

Obvious tremors can secondary to

A

Liver failure, alcoholism, Parkinson’s

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28
Q

Athetosis

A

Writhing snakelike movements of cerebral palsy

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29
Q

Kleinfelter’s

A

Lacking secondary sexual characteristics in a male

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30
Q

Reasons for an abnormally short patient

A

Turner’s syndrome, achondroplastic and hypopituitary dwarfism

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31
Q

Reasons for an abnormally tall patient

A

Marfan’s syndrome

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32
Q

Height loss can be due to…

A

osteoporosis and vertebral compression fxs

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33
Q

Generalized fat

A

Simple obesity

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34
Q

Truncal fat

A

Cushing’s Syndrome

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35
Q

Sthenic

A

Muscular

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36
Q

Asthenic

A

Thin

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37
Q

Hypersthenic

A

Stocky, high fat distribution

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38
Q

Cachexia

A

Wasting

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39
Q

BMI

A

underweight

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40
Q

BMI 18.5-24.9

A

normal

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41
Q

BMI 25-29.9

A

overweight

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42
Q

BMI 30-34.9

A

Obese I

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43
Q

BMI 35-39.9

A

Obese II

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44
Q

BMI > 40

A

Obese III (morbid)

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45
Q

Calculation for BMI

A

Weight (kg)/Height (m2) or (Weight (lbs) x 700)/Height (in)2

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46
Q

Width of the BP cuff bladder should be

A

approx 40% of the upper arm circumference

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47
Q

Length of BP cuff bladder should be

A

approx 80% of upper arm circumference

48
Q

If the BP cuff is too SMALL

A

will artificially RAISE BP

49
Q

If the BP cuff is too LARGE

A

will artificially LOWER BP in a small arm and will artificially RAISE BP in a large arm

50
Q

Normal BP

A

90-120 (systolic) / 60-80 (diastolic) with pulse pressure between 30-40 mmHg

51
Q

Prehypertension

A

120-139 (systolic) / 80-89 (diastolic)

52
Q

Stage 1 Hypertension

A

140-159 (systolic) / 90-99 (diastolic)

53
Q

Stage 2 Hypertension

A

> 160 (systolic) / >90 (diastolic)

54
Q

Body temperature is controlled by

A

Hypothalamus

55
Q

What part of stethoscope should be used for auscultating BP?

A

Bell

56
Q

An auscultatory gap may be indicative of…

A

arterial stiffness and atherosclerotic disease

57
Q

Orthostatic Hypotension

A

Drop in BP 20 mmHg

58
Q

Causes of Orthostatic Hypertension

A

drugs, moderate or severe blood loss, prolonged bed rest, diseases of ANS

59
Q

Oral Temp Norm

A

37.0 C / 98.6 F

60
Q

Aural/Rectal/Temporal Temp Norm

A

37.5 C / 99.6 F

61
Q

Axillary Temp Norm

A

36.4 C / 97.6 F

62
Q

Convert Celsius to Fahrenheit

A

(C x 1.8) + 32

63
Q

Convert Fahrenheit to Celsius

A

(F - 32) x .55

64
Q

Normal Heart Rate

A

50-90 BPM

65
Q

Respiratory rate controlled by

A

Medulla Oblongata

66
Q

3 Characteristics of Respiration

A

Rate, Rhythm, Quality

67
Q

Bradypnea

A

Slow breathing may be secondary to

diabetic coma, drug-induced respiratory depression, and increased intracranial pressure.

68
Q

Normal Respiratory Rate

A

The respiratory rate is about 14–20 per min in normal adults and up to 44 per min in infants.

69
Q

Sighing Respiration

A

Breathing punctuated by frequent sighs should alert you to the possibility of hyperventilation syndrome—a common cause of dyspnea and dizziness. Occasional sighs are normal.

70
Q

Tachypnea

A

Rapid shallow breathing has a number of

causes, including restrictive lung disease, pleuritic chest pain, and an elevated diaphragm.

71
Q

Cheyne-Stokes Breathing

A

Periods of deep breathing alternate with periods of apnea (no breathing). Children and aging people normally may show this pattern in sleep. Other causes include heart failure, uremia, drug-induced respiratory depression, and brain damage (typically on both sides of the cerebral hemispheres or diencephalon)

72
Q

Obstructive Breathing

A

In obstructive lung disease, expiration is prolonged because narrowed airways increase the resistance to air flow. Causes include asthma, chronic bronchitis, and COPD.

73
Q

Hyperpnea, Hyperventilation

A

Rapid deep breathing has several causes, including exercise, anxiety, and metabolic acidosis. In the comatose patient, consider infarction, hypoxia, or hypoglycemia affecting the midbrain or pons.

74
Q

Kussmaul breathing

A

deep breathing due to metabolic acidosis. It may be fast,

normal in rate, or slow.

75
Q

Ataxic Breathing (Biot’s Breathing)

A

characterized by unpredictable irregularity. Breaths may be shallow or deep, and stop for short periods. Causes include respiratory depression and brain damage, typically at the medullary level.

76
Q

Hyperpyrexia

A

extreme elevation in temperature, above 41.1°C (106°F)

77
Q

hypothermia

A

Abnormally low temperature, below 35°C (95°F) rectally

78
Q

Fever or Pyrexia

A

37.4 C, 100F

79
Q

Causes of fever

A
  1. Microbial infection
  2. Inflammatory disorders
  3. Cancer/malignancy
  4. Autoimmune response
  5. Drug reactions
  6. Fever of unknown origin
  7. Trauma/surgery
  8. Blood disorders (hemolytic anemia)
80
Q

Heat stroke

A

Core temp > or = 105F/41C with altered mental status and hot/dry skin (anhydrosis)

81
Q

Difference of BP in both arms should be no more than…

A

10mmHg

82
Q

If BP is more than 10mmHg different between arms what can be the cause?

A

Aortic dissection or subclavian steal syndrome

83
Q

Laying down should cause BP to…

A

Decrease

84
Q

Lower extremities should have ________ BP than upper.

A

Equal or Higher

85
Q

If lower extremities have lower BP than upper extremities expect…

A

PAD or Aortic Dissection

86
Q

How should an orthostatic BP be taken?

A

After resting 3 min measure supine, then within 3 min of standing

87
Q

Hypertension accounts for what percent of MIs and strokes?

A

35%

88
Q

Hypertension accounts for what percent of heart failures?

A

49%

89
Q

Hypertension accounts for what percent of premature deaths?

A

24%

90
Q

Dyspnea

A

difficulty breathing, use of accessory muscles

91
Q

Apnea

A

lack of breathing

92
Q

Stridor

A

“crouping sound” – suggests problem is not with in lungs but with in Upper Airways (May indicate inspiration of Foreign Body in infant)

93
Q

Orthopnea

A

can breathe OK sitting UPRIGHT, but can’t breathe lying down (supine)

94
Q

Orthopnea is indicative of…

A

Cardio/Pulmonary disease (i.e. CHF, pulmonary edema)

95
Q

Paroxysmal Nocturnal Dyspnea (PND)

A

SOB and coughing at night

96
Q

Paroxysmal Nocturnal Dyspnea (PND) is indicative of…

A

CHF (fluid from extremities begins to pool in lungs when lying)

97
Q

Ataxic Breathing

A

irregular but without a pattern

98
Q

Ataxic Breathing is indicative of…

A

Disorder/trauma affecting medulla

99
Q

Prolonged expiration

A

seen with COPD (takes longer to get air out than to get air in)

100
Q

Tachycardia

A

> 100

101
Q

sinus tachycardia

A

100-180

102
Q

supraventricular (atrial or nodal) tachycardia

A

150-250

103
Q

Sporadic (Arrhythmia)

A

premature or extra beats at random intervals but normal underlying rhythm

104
Q

Regularly Irregular (Arrhythmia)

A

regular pattern of cadences (i.e. ventricular trigeminy)

105
Q

Irregularly Irregular (Arrhythmia)

A

No discernible regularity (i.e. a-fib, a-flutter)

106
Q

Pulsus Alterans

A

strong pulse alternating with weak pulse pulse, regular rhythm.

Cause: Heart failure

107
Q

Bisferiens Pulse

A

increased arterial pulse w/ double systolic peak

Cause: aortic stenosis, aortic regurgitation

108
Q

Bigeminal Pulse

A

Irregular rhythm may mimic pulsus alterans.

Cause: normal beat alternating w/ premature contraction

109
Q

Paradoxial Pulse

A

rapid fall in systolic BP when pt inspires

Causes: Pericardial Tamponade, pulmonary hypertension, asthma & COPD

110
Q

Large, Bounding Pulses

A

pulse pressure is increased/feels strong and bounding. Rise & Fall may feel rapid.

Causes: increased stroke volume, hyperthyroidism, aortic regurgitation, patent ductus arteriosis; seen more commonly with elderly patients.

111
Q

Small, Weak pulses

A

pulse pressure is diminished, feels weak and small.

Causes: decreased stroke volume as in heart failure, PAD, shock, hypovolemia, aortic stenosis

112
Q

Nociceptive (somatic) (Pain)

A

linked to tissue damage to skin

113
Q

Neuropathic (Pain)

A

consequence of a lesion or dx affecting the somatosensory system

114
Q

Central Sensitization (Pain)

A

alteration of CNS processing of sensation leading to amplification of pain signals (i.e. fibromyalgia).

115
Q

Bradycardia

A

HR

116
Q

BP should be maintained at…. for patients with diabetes or renal failure

A

Bates' Guide To The Physical Exam (IPA emory) (4 decks)

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