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PCM Midterm > Intro to PE and Instruments + Competency > Flashcards

Intro to PE and Instruments + Competency Flashcards

1
Q

Who sets the standards for universal health precautions to protect patient and provider from spread of infectious disease?

A

CDC

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2
Q

When does the CDC specify gloves must be worn during physical exam?

A

Whenever there is obvious blood or body fluid present

[must wash hands before and after wearing gloves]

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3
Q

The CDC requires that a face shield be worn for what type of injection?

A

Lumbar puncture

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4
Q

What are some standard precautions for all patient care set forth by the CDC?

A

Perform hand hygiene
Use PPE for possible exposure
Follow cough etiquette
Ensure proper patient placement/isolation
Properly handle/disinfect patient care equipment
Follow safe injection practices
Proper handling of sharps

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5
Q

Describe proper handwashing according to the world health organization. Include water temp and timing

A

Wet hands with clean running water (can be warm or cold), turn off tap and apply soap. Lather hands by rubbing together, getting backs of hands, between fingers, under nails. Scrub for at least 20 seconds. Rinse under running water. Dry with towel or air dry

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6
Q

What is the gold standard technique for hand hygiene in most situations for day to day decontamination of hands?

A

Hand rubbing with an alcohol based sanitizer

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7
Q

Hand sanitizer is the gold standard for day to day hand hygiene/decontamination. When must handwashing with soap and water be done?

A

When hands are visibly dirty or visibly soiled with blood or other body fluids

After using the toilet

When exposure to potential spore forming pathogens like C diff is suspected or proven

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8
Q

Handwashing with soap and water is required when exposure to spore forming pathogens are suspected or proven. What are some spore forming pathogens?

A

Bacillus anthracis (anthrax)

Bacillus cereus (food poisoning)

Clostridium botulinum (botulism)

Clostridium tetani (tetanus)

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9
Q

What physical exam technique involves tapping over an area to differentiate air, fluid, or solid underneath the surface of area to be examined?

A

Percussion

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10
Q

What are some things to include in your survey of someone’s general appearance for PE?

A 
Apparent state of health
Level of consciousness
Signs of distress
Skin color + obvious lesions
Dress, grooming, personal hygiene
Posture, gait, motor activity
Height and weight
Waist circumference
BMI
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11
Q

What are some odors of the body and breath indicative of someone’s health?

A

Diabetes - sweet and fruity odor (acetone)

Fetor hepaticus “breath of the dead” - sweet musty aroma (dimethyl sulfide)

Uremic fetor - “fishy” urine like odor due to ammonia

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12
Q

What might you notice about someone’s posture if they have CHF?

A

Leaning forward

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13
Q

What are some causes for pathologic weight loss?

A 
Malignancy
Diabetes
Hyperthyroidism
Chronic infection
Depression
Diuresis
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14
Q

How is BMI calculated?

A

Weight (lbs)/height^2 (inches) x 703

OR:

Weight (kg)/height^2 (meters)

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15
Q

What is the difference between BMI measurements in adults vs. children?

A

The BMI for children is based on percentile

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16
Q

Describe use of ophthalmoscope during your PE

A

Used to visualize inner aspect of eye - retina, vascular supply, optic nerve, etc.

Identify the lens selector and select 0

Turn on the light, have patient look over your shoulder

Look through aperture, hand on patient forehead, use your right eye to examine patient right eye and vice versa

Start 15 degrees from center laterally

Identify red reflex

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17
Q

What part of the ophthalmoscope adjusts to your own and patient’s eyesight?

A

Refraction adjustment wheel

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18
Q

What part of the ophthalmoscope allows you to change the color and shape of the light source for different diagnostic purposes?

A

Aperture adjustment

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19
Q

Opthalmoscopes usually have 2 or 3 sizes of light to use depending on the level of _______ ________.

When would you use the small light vs. large light?

What setting is most commonly used?

A

Pupil dilation

Small light for constricted pupil in well lit room (no pupil dilators used); large light if using mydriatic eyedrops to dilate

Most common is dark room, non-dilated pupil, medium-sized light

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20
Q

When would you use the half-light aperture setting on your ophthalmoscope?

A

If pupil is partially obstructed by a lens with cataracts, half circle can be used to pass light through only the clear portion of the pupil to avoid light reflecting back

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21
Q

When would you use the red free light aperture setting on your ophthalmoscope? What appearance will this give the retina?

A

Used to visualize the vessels and hemorrhages in better detail by improving contrast; will make retina appear black and white

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22
Q

When would you use the slit-beam aperture setting on your ophthalmoscope?

A

To see contour abnormalities of cornea, lens, and retina

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23
Q

When would you use the blue light aperture setting on your ophthalmoscope?

A

Observation of corneal abrasions and ulcers after fluorescein staining

(Only some opthalmoscopes have)

24
Q

When would you use the grid aperture setting on your ophthalmoscope?

A

Used to make rough approximations of relative distance between retinal lesions

25
Q

Describe the difference in otoscope use in a child > 12 months/adult vs. a child < 12 months

A

In adults, pull outer ear gently up and back

In children, pull gently down and back

26
Q

Which lasts longer, air conduction or bone conduction of sound?

A

Air

27
Q

What is the vibratory sense test using the tuning fork?

A

Place handle on patella and compare left and right for duration

28
Q

Blockage of the ear canal would cause what type of hearing loss?

A

Conductive

29
Q

Inner ear damage or nerve damage would cause what type of hearing loss?

A

Sensorineural

30
Q

When doing deep tendon reflexes, what qualities are you looking for?

A

Speed and intensity; compare bilaterally

31
Q

What are the upper extremity DTRs that can be tested?

A

Biceps
Triceps
Brachioradialis

32
Q

What are the lower extremity DTRs that can be tested?

A

Patellar

Achilles

33
Q

The larger side of the stethoscope is called the ______, the smaller side is the _____

A

Diaphragm; bell

34
Q

When using your stethoscope, what do you use the bell for vs. the diaphragm?

A

Bell for low pitched sounds (bruits)

Diaphragm for high pitched sounds (breath sounds, heart tones)

35
Q

What are the 3 types of sphygmomanometers used to measure BP?

A

Mercury
Aneroid
Digital

36
Q

Reading BP by _______ is considered the gold standard by the NIH

A

Auscultation

37
Q

Describe cuff selection for BP

A

Length of cuff’s bladder should be at least equal to 80% of the circumference of upper arm

Width of cuff’s bladder should be at least equal to 40% of the length of upper arm

38
Q

When taking BP, wrap cuff around upper arm with cuff’s lower edge ________ above the antecubital fossa

Lightly press the stethoscope bell/diaphragm over the ______ artery just below the cuff’s edge

Rapidly inflate the cuff to _______ or roughly ______ mm Hg higher than their estimated systolic pressure. Release air from cuff at moderate rate (3mm/sec)

Watch sphyg. and listen for first ________ sound, which is subjects systolic pressure. When the sound disappears, that is the diastolic pressure

A

1 inch

Brachial

180; 30

Korotkoff

39
Q

When taking BP, how do you report it (what info must be included?); what if it’s abnormal?

A

Record in both arms and note any differences; also record pt position (supine, seated, etc.), which arm was used, and cuff size

If abnormal, measure BP two additional times, waiting a few minutes between measurements

40
Q

What should patients avoid doing within30 minutes prior to BP measurement?

A

Smoking
Caffeine
Exercise

41
Q

When taking BP, exam room should be quiet and warm. Patient should site quietly for 5 mins with feet on the floor. Arm should be free of clothing, dialysis fistulas, cutdown scars, and lymphedema.

Heart level is roughly ____ intercostal space.

A

4th

42
Q

What 3 errors might give you a falsely high BP?

A

Brachial artery below the heart
Cuff too small (narrow)
Cuff to large (wide) on a large arm

43
Q

What 2 errors might give you a falsely low BP?

A

Brachial artery above heart

Cuff too large (wide) on a small arm

44
Q

__________ _______ = period of diminished or absent korotkoff sounds during the manual measurement of blood pressure; improper interpretation of this phenomenon may lead to BP monitoring errors

A

Ausculatory gap

45
Q

What errors are likely to be made in BP monitoring due to an ausculatory gap?

A

Underestimation of systolic; overestimation of diastolic

46
Q

How is an ausculatory gap in BP reported?

A

Findings recorded completely - for example: 200/100 with an ausculatory gap rfom 170-150

47
Q

What are the 7 locations that pulse can be taken?

A 
Radial artery (most common)
Dorsalis pedis a.
Carotid a.
Brachial a.
Abdominal aorta
Femoral a.
Popliteal a.
48
Q

What are the 2 methods for measuring respiratory rate?

A

Look for chest rise and count

Listen while examining heart/lungs with stethoscope

49
Q

Most modern adults breath about _____ breaths per minute

A

15-20

50
Q

What is the normal range for body temp?

A

97.8-99

51
Q

Temp taken ______ tend to be 0.5 to 0.7 degrees F higher than when taken by mouth

A

Rectally

52
Q

_______ temperatures tend to be 0.3 to 0.4 degrees F lower than those taken by mouth

A

Axillary

53
Q

A special thermometer can quickly measure the temperature of the _____ ____, which reflects the body’s core temp (temp of internal organs)

A

Ear drum

54
Q

What are all the methods used to take someone’s temp?

A 
Orally
Rectally
Axillary
Ear
Skin (forehead)
55
Q

The ______ _______ exam integrates information about the MSK system even when dealing with non-musculoskeletal complaints. This must be utilized for the thoracic spine and/or other spinal levels for all patient encounters

A

Osteopathic structural

56
Q

What are the 4 tenets of osteopathic medicine

A

The body is a unit

The body possesses self regulatory mechanisms

Structure and function are reciprocally interrelated

Rational therapy is based upon understanding of first 3 principles

PCM Midterm (7 decks)

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