HA Final Flashcards
artery is somewhat obstructed, increased risk of stroke (don’t mistake this w/ murmur), swooshing sound
bruits
nail abnormality due to chronic hypoxia to distal fingers (pts w/ COPD, emphysema, congestive heart failure)
clubbing
nail abnormality d/t chronic renal failure (proximal white, distal brown)
half and half nails
nail abnormality d/t slowed or halted nail growth (w/ deep horizontal line) in response to illness, physical trauma, or poisoning
Beau’s line
what causes longitudinal ridging nails
aging
nail abnormality d/t lesions from psoriasis, crating on nail bed
pitted nails
nail abnormality that is spoon-like (indentation) d/t trauma, iron deficiency aka hemochromatosis (may be normal in infants) or anemia .. nail is lifted along edgers, indented near center
Koilonychia
nail abnormality where nail plate and nail bed separation d/t trauma, fungal infections, topical irritants, psoriasis, sublingual neoplasms or warts
Onycholysis
what causes yellow nails
lung disorders or lymphedema
this nail abnormality is normal in dark-skinned pts
Dark longitudinal streaks
this nail abnormality is d/t damaged capillaries supplying the nail matrix caused by micro emboli
splinter hemorrhages
s/s of hypothyroidism
weight gain, fatigue, constipation, cold, large neck goiters, dysthymia (depression), dry skin, brittle nails, low b/p, low HR,
high TSH, low T3/T4
s/s of hyperthyroidism
weight loss, heat intolerance, tachy (high HR), high bp, warm aka heat intolerance, oily skin/hair, anxious, energetic, hyper,
low TSH, high T3/T4
method used to test peripheral vision
Confrontation
this is used to test near vision
jaeger chart
this is used to test color blindness
Ishihara chart
this is used to test distance vision, most common eye exam
Snellen chart
referred to as lazy eye
Amblyopia
term for eye strain
Asthenopia
exposure to UV can cause this (foggy/cloudiness/dull), it obstructs light that is going through the eyes
cataracts
normal part of aging for eyes
decreased depth perception & decreased night vision
this is nearsightedness aka can only see close up
Myopia
this is term for far sighted, so pt can only see far, due to aging
Presbyopia
2 types of hearing loss
conductive- blockage in ear like cerumen, hearing loss can be reversed .. middle/external ear
sensorineural- due to loud noises, hearing loss can’t be reversed, inner ear
Webber vs. Rinne Test
Webber: tuning fork goes on the middle of the head.. evaluates unilateral hearing loss.. determines if someones has SNHL or conductive HL
Rinne: tuning fork is placed behind the ear on the MASTOID PROCESS once , evaluates AC & BC (AC should be twice as long as BC)
epistaxis
nose bleeds
anosmia
loss of smell
3 sinus locations
frontal, maxillary, ethmoid
pt w/ allergies might have hx of what?
frequent upper respiratory infections
6 Ps of acute arterial occlusion
- Pain
- pallor (pale)
- poikilothermia
- paresthesia (tingly)
- pulselessness
- paralysis
coolness of an extremity may indicate this
other s/s include: pain, paresthesia (tingly), pallor (pale)
arterial occlusion
difference between DVT vs acute arterial occlusion
DVT- clot that forms in vein
erythema (red)
acute arterial occlusion- blockage in peripheral artery impacting flow to limbs
pallor (pale)
this is the result of a DVT, when the DVT breaks free & starts traveling which could lead to a PE (to lung) or MI (to heart) or stroke (to brain)
VTE (venous thromboembolism)
This is louder in aortic and pulmonic areas
S2
This is louder in mitral and tricuspid areas
S1
S1 & S2 are equal at this location
Erb’s pt
the amount of pressure in the great vessels, arteries/arterioles, the resistance
Afterload
the volume in the right atrium at the end of diastole, an indicator of how much blood will be forward to & ejected from the ventricles. More blood in the RV causes a stronger force of contraction
Preload
amount of blood ejected from LV each minute. It can be calculated by multiplying HR x stroke volume (How much blood is ejected with each beat or stroke)
cardiac output
3 layers of heart
Endocardium: thin; lines interiors of chambers, valves
Myocardium: thick; muscular for pumping
Epicardium: thin; muscle, exterior layer
dark brown leg due to old blood, warm and pink leg
venous insufficiency
pale, cold, pulseless leg
arterial insufficiency
this is the change in arterial blood flow d/t plaque, resulting in coolness, paleness, lower HR, paresthesia (tingling), hypoesthesia (numb)
PVD (peripheral vascular disease)
how does the PVS work (Peripheral vascular system)
blood vessels that carry oxygenated blood away from the heart to the periphery and carry deoxygenated blood back to the heart and to the lungs for reoxygenation
diastole vs systole
diastole: where the heart chamber is in a state of relaxation and fills with blood that receives from the veins
systole: where the heart chambers are contracting and pumps the blood towards the periphery via the arteries
abdominal vs lung assessment
abdominal:
1. inspect
2. auscultate
3. percuss
4. palpate
lung:
1. inspect
2. palpate
3. percuss
4. auscultate
DTR grading
*0 no response
*1+ diminished, low normal
*2+ average, normal
*3+ brisker than average
*4+ very brisk, hyperactive with clonus
RA vs OA
RA- systemic s/s include fatigue, fever, rash, splenomegaly, subcutaneous rheumatoid nodules, lymphadenopathy. Joints are more symmetrical, often in smaller joints, ulnar deviation, joint pain/tenderness, redness, swelling, joint deformity, worse in the AM and gets better with movement.
OA- not systemic s/s joints are less symmetrical, minimal redness, heat and swelling of joints. worsens throughout day and worsens with movement.
venous vs arterial ulcer
Venous ulcer- develops from chronic pooling of blood in extremity. Usually painless. Larger, more shallow.
Arterial ulcer- result from chronic ischemia as a consequence of impaired arterial circulation to an extremity. Usually located distally, such as at the ends of toes or fingers. Painful and usually infected. Smaller, deeper.
branden scale
tool used to assess pt’s risk for developing pressure ulcer
higher score (over 18) = less at risk
lower score (under 9) = high risk
sign of Lyme disease
bull’s eye rash
main 2 female hormones
estrogen and progesterone
this test tests for collateral circulation of radial & ulnar arteries, performed prior to drawing ABGs or insertion of an arterial line
Allen test
3 things GCS evaluates …?
what does the score mean?
- eye response (do their eyes respond to voice, pain, touch, nothing, etc)
- motor response (what movement do they make)
- verbal response (do they talk/nonverbal)
** 3 = deep coma, 15 = normal
burn classifications (fine to worst)
- superficial (brisk bleeding, pain, rapid cap refill)
- superficial dermal (brisk bleeding, pain, slow cap refill)
- dermal (delayed bleeding, no pain, no cap refill)
- full thickness (worst one, not painful and no bleeding)
3 layers of skin
- Epidermis, the top layer (protective barrier)
- Dermis, the middle layer (collagen/elastin, produces sweat/oil)
- Hypodermis, the bottom or fatty layer (cushions muscles and bones)
what kind of pt would have ascites?
pts with cirrhosis secondary to chronic alcoholism
location of appendix pain
McBurney’s point , near RLQ umbilical and ileac crest … this would be painful for appendicitis
what are the 2 signs for appendicitis?
Psoas sign: place hand right above pt’s right knee and ask them to raise that thigh against your hand, extend the right leg at the hip to stretch the iliopsoas muscle (if painful then positive for appendicitis)
Obturator sign: flex the pt’s right thigh at the hip w/ the knee bent and rotate the leg internally at the hip stretching the internal obturator muscle (if painful then positive for appendicitis)
what does it mean for a positive Murphy’s sign?
cholecystitis
pt is having right abdominal pain that radiates to the right scapula .. what could be wrong?
cholecystitis
vibration, have pt say “99” and feel for vibrations using ulnar surfaces
Tactile fremitus /
Bronchophony
breath sounds
Bronchial BS– over the trachea and larynx, loud, coarse high pitch
Broncho vesicular BS – over major bronchi
Vesicular BS – soft, low-pitched, found at distal airways
PNA, fluid in lung, or collapse of lung, consolidation
atelectasis
feels like Rice Krispies or bubble wrap, can’t see it but CAN feel this air leak
crepitis
what part of lungs is responsible for gas exchange?
Bronchioles and alveoli responsible for gas exchange
PNA will congregate where?
lower lobes first then go up, more common in right lung!
boney ridge that joins the sternum to the manubrium
sternal angle AKA Angle of Luis or Manubrio
S3 vs S4
S3 = ventricular gallop
Kentucky
S4 = Atrial gallop
Tennessee
normal BMI
19 - 24
underweight = less than 18
obese = over 30
extreme obese = over 40
how would you measure fluid volume overload?
by obtaining jugular venous pressure (JVP)
what is the main trigger for breathing?
increased level of CO2 in blood
*(but not COPD pts due to them already having increased CO2 in their blood
pneumonia is more likely to be found in which lung?
right lung bc it’s larger
mitral & tricuspid valve closure, occurs during systole
S1
sounds like balloons high pitched, scratching, grating. Heard at the left sternal border.
pericardial friction rub
diastole, the relaxation phase
S2
Systole, the contraction phase
S1
what is the carina?
where the bronchi bifurcate
aortic & pulmonic valve close. this occurs during diastole
S2
mitral stenosis, quickly after S2, hard to differentiate, sudden bulge of aortic or pulmonic valve
snaps
heart disease, aortic or pulmonic valve, quickly after S1
clicks
heart sound heard in pregnant women or athletes, S3 gallop happens before S2, S4 gallop occurs before S1
gallops
continuous, coarse, low pitched snoring sound, results from secretions moving around, may clear w/ coughing
rhonchi
musical & high pitched, narrowing or partially obstructed airway, typically occurs w/ inspiration
wheezes
fluid in airway, velcro sound, chest hair can sound like this too
crackles, rales
percussion sounds
-resonance (loud, low pitched heard over lung tissue)
-tympany (loud, higher pitched sound over air filled spaces)
-dullness (heard over solid spaces)
-flat (higher pitched over dense tissue like pleural effusions & ascites)
sympathy vs empathy
sympathy = feeling what the pt feels, you’re not being therapeutic bc you’re interpreting the situation as YOU perceive it
empathy = feeing what the pt is feeling from THEIR perspective, keeps the focus on the pt & what they’re feeling
Pain in the epigastric area that radiates to the scapula with SOB aka dyspnea , sharp and stabbing pain!
this might be a sign of an aortic aneurism (ruptured aorta)
skin of elderly
dry, no hair, shiny due to poor venous blood flow
pitting vs non pitting edema, what’s the scale
pitting- leaves fingerprint
non pitting- does not leave mark
pitting scale:
1+ slight pitting, 2mm depression
2+ increased pitting, 4mm depression
3+ deeper pitting, 6mm depression, obvious edema of extremity
4+ severe pitting, 8mm depression, extremity appears very edematous
what can lead to odynophagia (painful swallowing) or dysphagia (difficulty swallowing)
GERD, Parkinson’s disease, hiatal hernia, stroke pts
pinpoint of cervical/spine
C7
Need to assess respiratory first if this area is injured
C4 and above
where is the Dorsalis pedis pulse
top of foot lateral to extensor longus tendon
what can cause enlarged spleen and enlarged liver
spleen - EBV
liver- cirrhosis or hepatitis
s/s of a PE resulting from a DVT
acute dyspnea (SOB), chest pain, tachycardia (high HR), diaphoresis (sweating), anxiety
difference between Dysphagia vs Odynophagia
Odynophagia - painful swallowing
Dysphagia - difficulty swallowing
s/s of venous stasis?
swelling/edema in legs, shiny skin, no hair growth, red/brown color due to old blood
pt can also get ulcers due to impaired skin integrity
what is a pt at risk for if venous stasis occurs?
at risk for impaired skin integrity which can cause ULCERS
**due to lack of O2 rich blood flow to capillaries in tissue (slow death of tissues)
how to assess thyroid gland
- thyroid cartilage (at top)
- cricoid cartilage (aka Adam’s apple)
- thyroid gland (at bottom)
3 types of sweat glands
-Eccrine: sweat secretion, assist in thermoregulation
-Apocrine: located in axillae and genital areas, active during puberty- the stench! decreases w/ age
-Sebaceous: secrete sebum (oily substance that hydrates skin), decrease w/ age
clear/slightly yellow tinged fluid filled blisters less than 1cm (small!)
aka serous fluid filled vesicles
chicken pox
type of rash that is clear/blister like appearance
vesicular rash
refers to a pattern of skin lesions that resemble the distribution of herpes zoster (shingles), distributed along dermatome, specific area of skin that is innervated by a single spinal nerve root
*unilateral on one side of body
*vesicular (blister-like) rash, serous fluid
Zosteriform
ABCDE of Melanoma detection
-Asymmetric
-Borders (irregular)
-Color (coffee, multicolor, blue, green)
-Diameter (more than 6mm aka bigger than pencil erase)
-Evolution (change is bad)
high pressure in eye, causes tunnel vision, damage to optic nerve
glaucoma
involuntary twitching
fasciculation
involuntary/ voluntary contraction
tremor
what causes ptosis?
stroke, MS
intentional vs resting tremors
intentional - worse w/ movement, better at resting
resting tremor - Parkinson’s , tremors get better w/ movement.. worse w/ rest
this is caused primarily by brain edema, tumors, trauma
symptoms include mobility issues, severe case of this is stiff neck before going unconscious
cerebellar herniation
this is irregular gait…
what can cause this?
-ataxia is irregular gait
-can be caused by vestibular abnormality aka inflamed labyrinth which causes vertigo
this is known as “sway back”, the spine is curved inward
Lordosis
most common site of anterior nosebleeds aka epistaxis
Kiesselbach plexus
dry mouth
xerostomia
this test evaluates high pitched hearing loss
whisper test
this is thought to be an inability to filter internal noise from the external input of sound.. ringing in the ear
tinnitus
this is the sensation of the room spinning, indicates dysfunction of the bony labyrinth in the inner ear
vertigo
these may indicate barotrauma from pressure changes or a basilar skull fracture
hemotympanum, otorrhea, or TM rupture
the term for unequal pupils
anisocoria (defect in oculomotor nerve)
this condition causes blurred distance and near vision
astigmatism
this condition is where your eyes make rapid, repetitive, uncontrolled movements
nystagmus
How many spinal nerves are there? What are the 5 regions?
31 spinal nerve pairs
- Cervical (C1-8)
- Thoracic (T1-12)
- Lumbar (L1-5)
- Sacral (S1-5)
- Coccygel (Co1)
What is the name of the fall risk scale?
Morse Palmer Scale
This is what connects the muscle to the bone
tendon
what are physical signs of dehydration
-dry skin
-cracked/dry lips
-increased HR
-lower B/P
what separates the middle and external ear?
the tympanic ear drum
the test evaluates cortical sensory function and is not usually done. ask the pt to close the eyes and identify a familiar object (coin, key) placed in their palm
stereognosis
a pt will have control of their legs and walk, but may have loss of bowel and bladder control with this type of injury
S4-5 (sacral) injury
a pt will have arm movement and sensation, but no leg movement & will be in a wheelchair with this type of injury
T5 (thoracic) injury
a pt will not be able to cough or breathe on their own with this type of injury
C3 (cervical) injury
what can cause herniation of the brain which can lead to change in basic vital functions such as breathing, reduced LOC, death
increases in CSF
what is global aphasia
both expressive and receptive aphasia
a pt that has damage to their Broca area (frontal lobe) causes what?
problems with speaking or finding words aka expressive aphasia
a pt w/ a stroke in the brain’s left hemisphere/temporal are more likely to have what?
damage to the wernicke area so will have language deficits- difficulty understanding verbal communication aka receptive aphasia
broca vs wernicke
wernicke- integrates understanding of spoken and written words (language is processed).. temporal lobe/ left hemisphere
broca- regulates verbal expression and writing ability.. the frontal lobe
this area regulates verbal expression and writing ability, the frontal lobe
broca area
this area integrates understanding of spoken and written words, language is processed here in the temporal lobe/left hemisphere
wernicke area
type of flexion that moves the foot so that the toes move away from the heel
plantar flexion
type of flexion that is bending the ankle so that toes move toward the heel
dorsiflexion
these are synovial (diarthrotic) joints known as the gliding joints
intervertebral
**Gliding joints are numerous, mostly small, allow very little motion.
Ex: carpal joints of the wrist, the tarsal joints of the ankle, and the facet joints of the spine
these are synovial (diarthrotic) joints known as saddle joint
thumb
these are synovial (diarthrotic) joints known as the condyloid joint
wrists
Condyloid joints perform flexion, extension, abduction, and adduction movements.
these are synovial (diarthrotic) joints that are known as the pivot joints
***allows bone rotation about another bone
atlas & axis
**this is the 1st & 2nd cervical vertebrae directly under the skull… allows for turning of the head from side to side
these are synovial (diarthrotic) joints that are known as the ball and socket joints
hip and shoulder
these are synovial (diarthrotic) joints that are known as the hinge joints & only perform flexion and extension
knee and elbow
**extension - increases angle
**flexion- decreases angle between bone or brings bones together
what is the area where two bones come together, what is it’s function
joint, provides mobility to the skeleton
if a patient had a hip replacement, what should they not do when it comes to ROM? & why?
they should not test adduction or flexion greater than 90 degrees b/c it could cause dislocation
what are signs of meningeal irritation? (spinal cord meninges / intracranial hemorrhage)
-Flexion of the knee when the leg is pulled up, pt will also have stiffness in neck (nuchal rigidity) w neck pain (kernig and brudzinski signs)
-photophobia
-headaches
-fever
A condition that affects the arteries, causing them to narrow or become blocked.
Peripheral arterial disease (PAD)
