Introduction to PE, General Survey, Review on Vital Signs, and Spx Aspects of Interviewing Flashcards
(124 cards)
1
Q
What are the steps in preparing for PE?
A
- Reflect on you approach to px
- Adjust the lighting and the environment
- Check equipment
- Make px comfy
- Observe SOP
- Sequence, scope, and position of exam: CARDINAL TECHNIQUES
- Sequence, scope, and position of exam: SEQUENCE OD EXAMINATION
2
Q
- optimal for inspection
- jugular, pulses, thyroid gland
- apical impulses of the heart
A
Tangential
3
Q
Reduced shadows
A
Perpendicular
4
Q
What are the cardinal techniques?
A
Inspection
Palpation
Percussion
Auscultation
5
Q
Close observation of the px (appearance, behavior, and movement)
A
Inspection
6
Q
Tactile pressure from the palmar fingers or fingerpads
A
Palpation
7
Q
Use the striking or plexor finger (usually the 3rd finger) to deliver a rapid tap to the pleximeter finger (3rd distal finger of the left hand)
A
Percussion
8
Q
Heart, lung, bowel sounds, bruit, and turbulence over arterial vessels
A
Auscultation
9
Q
What is the sequence of examination?
A
- Head to toe
- Notes for reminders
- Develop your examination
- Right side
10
Q
What estimates in examining px on right side more reliable?
A
JVP (Jugular venous pressure)
11
Q
Palpating hand rests more comfortably where?
A
On the apical impulse
12
Q
Which side of the kidney is more palpable?
A
Right
13
Q
Sitting position
A
Gen survey VS Skin Head and neck Thorax and lungs Breasts Musculoskeletal system
14
Q
Positions for cardiovascular
A
- lying supine, w head of bed raised 30°
- lying supine, turned partly to left side
- sitting, leaning forward
15
Q
What is the position for breast & axilla, abdomen, peripheral vascular system, nervous system?
A
Lying position
16
Q
What are the positions for musculoskeletal system, skin, and nervous system?
A
Standing and sitting
17
Q
Position for pelvic and rectal exam
A
Lying supine, w hips flexed, abducted, and externally rotated, and knees flexed (lithotomy position)
18
Q
Position for prostate and rectal exam
A
Lying on the left side (left lateral decubitus)
19
Q
Skinny body type
A
Ectomorph
20
Q
Medium body type
A
Mesomorph
21
Q
Body type that has a larger bone structure and fat mass
A
Endomorph
22
Q
What is the technique and response for a consciousness of an ALERT person?
A
Technique: speak to px in normal voice tone
Response: opens eyes, looks at you, responds appropriately
23
Q
What is the technique and response for a consciousness of LETHARGY?
A
Technique: speak in loud voice
Response: drowsy, but opens eyes and looks, responds to questions then falls asleep
24
Q
What is the technique and response for a consciousness of OBDUNTATION?
A
Technique: shake px as if awakening a sleeper
Response: opens eyes and looks, but responds slowly and somewhat confused
25
What is the technique and response for a consciousness of STUPOR?
Technique: apply painful stimulus
Response: arouses fr sleep; verbal responses are slow or absent; lapses into unresponsive state when the stimulus ceases
26
What is the technique and response for a consciousness of COMA?
Technique: apply REPEATED painful stimulus
Response: unarousable, eyes closed; no evidence of response
27
What composes the General Survey?
1. General state of health
2. Appearance
3. Behavior
4. Grooming, personal hygiene, odor, breath
5. Body type
6. Lvl of consciousness
7. VS
8. Ht and wt (BMI)
28
Macule and patch, tumor, papule, plaque, nodule, vesicle and bullae, pustule, wheal. These are what type of lesions?
Primary lesions
29
In PE of the eyes, what do you check?
V/A
Position
Alignment
-> inspect eyelids, eyebrows, sclera, conjunctiva, ocular fundi
-> pupillary size and rxns, EOM (Extraocular movement)
30
In PE of the ears, what do you check?
Inspect auricle canals and eardrums
| Auditory acuity and bone conductionn
31
In PE of the nose and sinuses, what do you check?
Inspect: external nose, nasal mucosa, septum and turbinates
Palpates: tenderness maxillary; frontal sinuses
32
In PE of the throat, mouth, and pharynx, what do you check?
Inspect: lips, oral mucosa, gums, teeth, tongue, palate, tonsils, pharynx
33
In PE of the thoras/lungs, what do you check?
Inspect and palpate: spine and muscles of upper back
Inspect, palpate and percuss: the chest
Auscultate: breath sounds
34
Duration of sound: Inspiratory, lasts longer than expiratory
Expiratory intensity: Soft
Expiratory pitch: Relatively low
Loc: Both lungs
Vesicular
35
Duration of sound: Inspiratory and expiratory are equal
Expiratory intensity: Intermediate
Expiratory pitch: Intermediate
Loc: 1st and 2nd interspaces anteriorly and between the scapulae
Broncho-vesicular
36
Duration of sound: expiratory, lasts longer than inspiratory
Expiratory intensity: Loud
Expiratory pitch: Relatively high
Loc: Over the manubrium (larger proximal airways)
Bronchial
37
Duration of sound: Inspiratory and expiratory are equal
Expiratory intensity: Very loud
Expiratory pitch: Relatively high
Loc: Over the trachea in the neck
Tracheal
38
Cardiovascular system: inspect and palpate what?
The precordium: location, diameter, and amplitude
39
Cardiovascular system: auscultate what?
Abn sounds and murmurs
40
What are the 3 systems involved in the lower extremities?
1) Peripheral vascular system
2) Musculoskeletal
3) Nervous
41
PVS: Inspect and palpate what?
Inspect: edema, discoloration, ulcers
Palpate: pulses and edema
42
2mm or less disappears immediately
1+
43
2-4mm few second rebound
2+
44
4-6mm
| 10-12 s rebound
3+
45
6-8mm
| >20 s rebound
4+
46
Musculoske: Inspect and palpate what?
Inspect: deformities, enlarged joints
Palpate: joints, check the range of motion
47
Observe for gait and ability to walk
Nervous sys
48
MMSE (Mini Mental State Examination)
- Orientation to time
- Registration - let px repeat 3 words u said
- Naming -ID
- Reading
49
12 Cranial Nerves
Nerve type: SENSORY
I - Olfactory - Smell
II - Optic - Vision
VIII - Vestibulocochlear - Hearing, balance
50
12 Cranial Nerves
Nerve type: MOTOR
```
III - Oculomotor - Most eye movement
IV - Trochlear - Moves eye
VI - Abducens - abducts eye
XI - Accessory - Shoulder shrug
XII - Hypoglossal Swallowing, speech
```
51
12 Cranial Nerves
Nerve type: SENSORY AND MOTOR
V - Trigeminal - Face sensation, mastication
VII - Facial - Facial expression, taste
IX - Glossopharyngeal - Taste, gag reflex
X - Vagus - Gag reflex, parasympa innervation
52
- Muscle bulk, tone, and strength
| - Cerebellar fxns, gait
Motor sys
53
Assess for pain, temp, touch, vibration and discrimination
Sensory sys
54
Complete paralysis
Grade 0
55
A flicker of contraction only
Grade 1
56
Power detectable only when gravity is excluded by postural adjustment
Grade 2
57
Limb can be held against gravity but not resistance
Grade 3
58
Limb can be held against gravity and some resistance
Grade 4
59
Normal power
Grade 5
60
NS: Very brisk response, w spread to other muscle grps and clonus
4+
61
NS: Brisk response, often w spread to other muscle grps
3+
62
NS: Active response, Normal or average
2+
63
NS: Diminished response; elicitation may require re-enforcement
1+
64
Absent
0 response grade
65
Atria fill w bld wc begins to flow into ventricles as soon as their walls relax
Diastole
66
Contraction of ventricles pumps bld into aorta and pulmonary arteries
Ventricular systole
67
What is c/b turbulence in the blood flow d/t compression of artery?
Korotkoff sound
68
First appearance of faint clear tapping sounds wc gradually increase in intensity
Phase 1
69
The softening of sounds wc may become swishing
Phase 2
70
The return of louder sounds
Phase 3
71
Muffling of sounds
Phase 4
72
The complete disappearance of sounds
Phase 5
73
Which is the systolic and diastolic pressure in the phases?
Phase 1: Systolic pressure
| Phase 5: Diastolic pressure
74
CO
SV
| HR
75
Peripheral resistance
Vascular structure
| Vascular fxn
76
What are the physiologic factors affecting BP?
1. CO
2. Vascular resistance
3. BV
4. Bld viscosity
5. Elasticity of arterial wall
77
What should be the width of the inflatable bladder of the cuff?
About 40% of the upper arm circumference (12-14 cm in ave adult)
78
What should be the length of the inflatable bladder?
About 80% of upper arm circumference
79
Standard cuff
12 x 23 cm
80
Cuff size discrepancy:
- Too small (narrow):
- Too large (wide)
> on small arm:
> on large arm:
- Too small (narrow): Inc BP
- Too large (wide)
> on small arm: Dec BP
> on large arm: Inc BP
81
Brachial artery below and above heart lvl
Below: Inc
Above: Dec
82
Slow or repetitive inflations of the cuff, venous congestion is?
Decreased systolic, increase diastolic
83
Artery when you get BP on the legs
Dorsal pedal artery
84
Artery when you get BP on the thighs
Popliteal artery
85
Normal BP
<120, <80
86
Pre HPN
120-139
| 80-89
87
Stage 1 HPN:
| Ages 18-60; diabetes/renal dse
140-159
| 90-99
88
Stage 1 HPN:
| Age >60 y.o.
150-159
| 90-99
89
Stage 2 HPN:
>160, >100
90
JNC 8 Recommendations
>60: <150, <90
<60: <140, <90
>18 w CKD or w diabetes: <140, <90
91
>140/90 medical setting;
| <135/85 ambulatory reading
Whitecoat HPN (Isolated clinic HPN)
92
<140/90 office;
| >135/85 ambulatory testing
Masked HPN
93
What is more serious, inc risk CVD and end organ damage?
Masked HPN
94
<10% fall of BP: >20% rise
Nocturnal HPN
95
dp of SBP at least 20mmHg or in DBP at least 10mmHg
Orthostatic HPN
96
What give info on the elasticity of large vessels and resistance in the arterioles and capillary?
Pulse
97
What give info on the circulatory status?
Pulse
98
What is used to assess the apical pulse when the peripheral pulse is difficult to locate?
Auscultation
99
What is the most accurate pulse?
Apical pulse
100
Device used when pulse can't be detected by palpation
Doppler
101
Bounding
+3
102
Normal, brisk
+2
103
weak, thread, diminished - shock
+1
104
absent pulse
0
105
Normal respiration for adults
16-20 bpm
106
Normal respiration for NB
40-60 bpm
107
What is the normal PR to RR ratio?
4:1
108
When is our temperature lowest?
Early morning
109
When is our temperature highest?
Afternoon and evening
110
"gold std" blood temp
in the pulmonary artery
111
Pyrexia
body temp: 37.7
oral: >37.5
rectal: >38
112
Hyperpyrexia
>41.1
113
Hypothermia
<35
114
What is more accurate than axillary, less than rectal?
Oral
115
Oral is lower than rectal by average of?
0.4-0.5C
116
Oral is higher than axillary by
1C
117
What is the most accurate of all routes?
Rectal temp
118
What are used in px w rapid respi rates?
Rectal temp
119
CIx of rectal temp
1 px w cardiovascular dse
2 px has hemorrhoids
3 rectal, vag and prostate surgery
4. diarrhea, colitis or cancer of rectum fecal impaction and rectal bleeding
120
Underwt
<18.5
121
N BMI
18.5-24.9
122
Overwt
25-29.9
123
Obese
I: 30-34.9
II: 35-39.9
III (extreme): >/=40
124
What is a primary chronic neurobiological dse w genetic, psychosocial, envi factors influencing its development and manifestation?
Addiction
