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PDR II > Introduction to PE, General Survey, Review on Vital Signs, and Spx Aspects of Interviewing > Flashcards

Introduction to PE, General Survey, Review on Vital Signs, and Spx Aspects of Interviewing Flashcards

1
Q

What are the steps in preparing for PE?

A
  1. Reflect on you approach to px
  2. Adjust the lighting and the environment
  3. Check equipment
  4. Make px comfy
  5. Observe SOP
  6. Sequence, scope, and position of exam: CARDINAL TECHNIQUES
  7. Sequence, scope, and position of exam: SEQUENCE OD EXAMINATION
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2
Q
  • optimal for inspection
  • jugular, pulses, thyroid gland
  • apical impulses of the heart
A

Tangential

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3
Q

Reduced shadows

A

Perpendicular

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4
Q

What are the cardinal techniques?

A

Inspection
Palpation
Percussion
Auscultation

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5
Q

Close observation of the px (appearance, behavior, and movement)

A

Inspection

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6
Q

Tactile pressure from the palmar fingers or fingerpads

A

Palpation

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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

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8
Q

Heart, lung, bowel sounds, bruit, and turbulence over arterial vessels

A

Auscultation

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9
Q

What is the sequence of examination?

A
  1. Head to toe
  2. Notes for reminders
  3. Develop your examination
  4. Right side
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10
Q

What estimates in examining px on right side more reliable?

A

JVP (Jugular venous pressure)

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11
Q

Palpating hand rests more comfortably where?

A

On the apical impulse

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12
Q

Which side of the kidney is more palpable?

A

Right

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13
Q

Sitting position

A 
Gen survey
VS
Skin
Head and neck
Thorax and lungs
Breasts
Musculoskeletal system
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14
Q

Positions for cardiovascular

A
  • lying supine, w head of bed raised 30°
  • lying supine, turned partly to left side
  • sitting, leaning forward
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15
Q

What is the position for breast & axilla, abdomen, peripheral vascular system, nervous system?

A

Lying position

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16
Q

What are the positions for musculoskeletal system, skin, and nervous system?

A

Standing and sitting

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17
Q

Position for pelvic and rectal exam

A

Lying supine, w hips flexed, abducted, and externally rotated, and knees flexed (lithotomy position)

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18
Q

Position for prostate and rectal exam

A

Lying on the left side (left lateral decubitus)

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19
Q

Skinny body type

A

Ectomorph

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20
Q

Medium body type

A

Mesomorph

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21
Q

Body type that has a larger bone structure and fat mass

A

Endomorph

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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

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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

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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

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25
Q

What is the technique and response for a consciousness of STUPOR?

A

Technique: apply painful stimulus

Response: arouses fr sleep; verbal responses are slow or absent; lapses into unresponsive state when the stimulus ceases

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26
Q

What is the technique and response for a consciousness of COMA?

A

Technique: apply REPEATED painful stimulus

Response: unarousable, eyes closed; no evidence of response

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27
Q

What composes the General Survey?

A
  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)
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28
Q

Macule and patch, tumor, papule, plaque, nodule, vesicle and bullae, pustule, wheal. These are what type of lesions?

A

Primary lesions

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29
Q

In PE of the eyes, what do you check?

A

V/A
Position
Alignment
-> inspect eyelids, eyebrows, sclera, conjunctiva, ocular fundi
-> pupillary size and rxns, EOM (Extraocular movement)

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30
Q

In PE of the ears, what do you check?

A

Inspect auricle canals and eardrums

Auditory acuity and bone conductionn

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31
Q

In PE of the nose and sinuses, what do you check?

A

Inspect: external nose, nasal mucosa, septum and turbinates
Palpates: tenderness maxillary; frontal sinuses

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32
Q

In PE of the throat, mouth, and pharynx, what do you check?

A

Inspect: lips, oral mucosa, gums, teeth, tongue, palate, tonsils, pharynx

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33
Q

In PE of the thoras/lungs, what do you check?

A

Inspect and palpate: spine and muscles of upper back

Inspect, palpate and percuss: the chest

Auscultate: breath sounds

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34
Q

Duration of sound: Inspiratory, lasts longer than expiratory

Expiratory intensity: Soft

Expiratory pitch: Relatively low

Loc: Both lungs

A

Vesicular

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35
Q

Duration of sound: Inspiratory and expiratory are equal

Expiratory intensity: Intermediate

Expiratory pitch: Intermediate

Loc: 1st and 2nd interspaces anteriorly and between the scapulae

A

Broncho-vesicular

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36
Q

Duration of sound: expiratory, lasts longer than inspiratory

Expiratory intensity: Loud

Expiratory pitch: Relatively high

Loc: Over the manubrium (larger proximal airways)

A

Bronchial

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37
Q

Duration of sound: Inspiratory and expiratory are equal

Expiratory intensity: Very loud

Expiratory pitch: Relatively high

Loc: Over the trachea in the neck

A

Tracheal

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38
Q

Cardiovascular system: inspect and palpate what?

A

The precordium: location, diameter, and amplitude

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39
Q

Cardiovascular system: auscultate what?

A

Abn sounds and murmurs

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40
Q

What are the 3 systems involved in the lower extremities?

A

1) Peripheral vascular system
2) Musculoskeletal
3) Nervous

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41
Q

PVS: Inspect and palpate what?

A

Inspect: edema, discoloration, ulcers

Palpate: pulses and edema

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42
Q

2mm or less disappears immediately

A

1+

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43
Q

2-4mm few second rebound

A

2+

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44
Q

4-6mm

10-12 s rebound

A

3+

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45
Q

6-8mm

>20 s rebound

A

4+

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46
Q

Musculoske: Inspect and palpate what?

A

Inspect: deformities, enlarged joints

Palpate: joints, check the range of motion

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47
Q

Observe for gait and ability to walk

A

Nervous sys

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48
Q

MMSE (Mini Mental State Examination)

A
  • Orientation to time
  • Registration - let px repeat 3 words u said
  • Naming -ID
  • Reading
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49
Q

12 Cranial Nerves

Nerve type: SENSORY

A

I - Olfactory - Smell
II - Optic - Vision
VIII - Vestibulocochlear - Hearing, balance

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50
Q

12 Cranial Nerves

Nerve type: MOTOR

A 
III - Oculomotor - Most eye movement
IV - Trochlear - Moves eye
VI - Abducens - abducts eye
XI - Accessory - Shoulder shrug
XII - Hypoglossal Swallowing, speech
51
Q

12 Cranial Nerves

Nerve type: SENSORY AND MOTOR

A

V - Trigeminal - Face sensation, mastication
VII - Facial - Facial expression, taste
IX - Glossopharyngeal - Taste, gag reflex
X - Vagus - Gag reflex, parasympa innervation

52
Q
  • Muscle bulk, tone, and strength

- Cerebellar fxns, gait

A

Motor sys

53
Q

Assess for pain, temp, touch, vibration and discrimination

A

Sensory sys

54
Q

Complete paralysis

A

Grade 0

55
Q

A flicker of contraction only

A

Grade 1

56
Q

Power detectable only when gravity is excluded by postural adjustment

A

Grade 2

57
Q

Limb can be held against gravity but not resistance

A

Grade 3

58
Q

Limb can be held against gravity and some resistance

A

Grade 4

59
Q

Normal power

A

Grade 5

60
Q

NS: Very brisk response, w spread to other muscle grps and clonus

A

4+

61
Q

NS: Brisk response, often w spread to other muscle grps

A

3+

62
Q

NS: Active response, Normal or average

A

2+

63
Q

NS: Diminished response; elicitation may require re-enforcement

A

1+

64
Q

Absent

A

0 response grade

65
Q

Atria fill w bld wc begins to flow into ventricles as soon as their walls relax

A

Diastole

66
Q

Contraction of ventricles pumps bld into aorta and pulmonary arteries

A

Ventricular systole

67
Q

What is c/b turbulence in the blood flow d/t compression of artery?

A

Korotkoff sound

68
Q

First appearance of faint clear tapping sounds wc gradually increase in intensity

A

Phase 1

69
Q

The softening of sounds wc may become swishing

A

Phase 2

70
Q

The return of louder sounds

A

Phase 3

71
Q

Muffling of sounds

A

Phase 4

72
Q

The complete disappearance of sounds

A

Phase 5

73
Q

Which is the systolic and diastolic pressure in the phases?

A

Phase 1: Systolic pressure

Phase 5: Diastolic pressure

74
Q

CO

A

SV

HR

75
Q

Peripheral resistance

A

Vascular structure

Vascular fxn

76
Q

What are the physiologic factors affecting BP?

A
  1. CO
  2. Vascular resistance
  3. BV
  4. Bld viscosity
  5. Elasticity of arterial wall
77
Q

What should be the width of the inflatable bladder of the cuff?

A

About 40% of the upper arm circumference (12-14 cm in ave adult)

78
Q

What should be the length of the inflatable bladder?

A

About 80% of upper arm circumference

79
Q

Standard cuff

A

12 x 23 cm

80
Q

Cuff size discrepancy:

  • Too small (narrow):
  • Too large (wide)
    > on small arm:
    > on large arm:
A
  • Too small (narrow): Inc BP
  • Too large (wide)
    > on small arm: Dec BP
    > on large arm: Inc BP
81
Q

Brachial artery below and above heart lvl

A

Below: Inc
Above: Dec

82
Q

Slow or repetitive inflations of the cuff, venous congestion is?

A

Decreased systolic, increase diastolic

83
Q

Artery when you get BP on the legs

A

Dorsal pedal artery

84
Q

Artery when you get BP on the thighs

A

Popliteal artery

85
Q

Normal BP

A

<120, <80

86
Q

Pre HPN

A

120-139

80-89

87
Q

Stage 1 HPN:

Ages 18-60; diabetes/renal dse

A

140-159

90-99

88
Q

Stage 1 HPN:

Age >60 y.o.

A

150-159

90-99

89
Q

Stage 2 HPN:

A

> 160, >100

90
Q

JNC 8 Recommendations

A

> 60: <150, <90
<60: <140, <90
18 w CKD or w diabetes: <140, <90

91
Q

> 140/90 medical setting;

<135/85 ambulatory reading

A

Whitecoat HPN (Isolated clinic HPN)

92
Q

<140/90 office;

>135/85 ambulatory testing

A

Masked HPN

93
Q

What is more serious, inc risk CVD and end organ damage?

A

Masked HPN

94
Q

<10% fall of BP: >20% rise

A

Nocturnal HPN

95
Q

dp of SBP at least 20mmHg or in DBP at least 10mmHg

A

Orthostatic HPN

96
Q

What give info on the elasticity of large vessels and resistance in the arterioles and capillary?

A

Pulse

97
Q

What give info on the circulatory status?

A

Pulse

98
Q

What is used to assess the apical pulse when the peripheral pulse is difficult to locate?

A

Auscultation

99
Q

What is the most accurate pulse?

A

Apical pulse

100
Q

Device used when pulse can’t be detected by palpation

A

Doppler

101
Q

Bounding

A

+3

102
Q

Normal, brisk

A

+2

103
Q

weak, thread, diminished - shock

A

+1

104
Q

absent pulse

A

0

105
Q

Normal respiration for adults

A

16-20 bpm

106
Q

Normal respiration for NB

A

40-60 bpm

107
Q

What is the normal PR to RR ratio?

A

4:1

108
Q

When is our temperature lowest?

A

Early morning

109
Q

When is our temperature highest?

A

Afternoon and evening

110
Q

“gold std” blood temp

A

in the pulmonary artery

111
Q

Pyrexia

A

body temp: 37.7

oral: >37.5
rectal: >38

112
Q

Hyperpyrexia

A

> 41.1

113
Q

Hypothermia

A

<35

114
Q

What is more accurate than axillary, less than rectal?

A

Oral

115
Q

Oral is lower than rectal by average of?

A

0.4-0.5C

116
Q

Oral is higher than axillary by

A

1C

117
Q

What is the most accurate of all routes?

A

Rectal temp

118
Q

What are used in px w rapid respi rates?

A

Rectal temp

119
Q

CIx of rectal temp

A

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
Q

Underwt

A

<18.5

121
Q

N BMI

A

18.5-24.9

122
Q

Overwt

A

25-29.9

123
Q

Obese

A

I: 30-34.9
II: 35-39.9
III (extreme): >/=40

124
Q

What is a primary chronic neurobiological dse w genetic, psychosocial, envi factors influencing its development and manifestation?

A

Addiction

PDR II (6 decks)

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