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Physical Diagnosis > Lecture 1- Intro to PD > Flashcards

Lecture 1- Intro to PD Flashcards

1
Q

What are the four aspects to a basic exam?

A
  1. ) inspection
  2. ) palpation
  3. ) auscultation
  4. ) percussion
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2
Q

least mechanical but hardest technique to learn, constantly collecting information, see how much you can learn without asking a question, need direct lighting, full exposure to examining area

A

inspection

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3
Q

laying hands on the patient, touch is informative, tips of fingers for fine discrimination, dorsum of hand for temperature sense, can be light or deep

A

palpation

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4
Q

technique by which body is struck to produce sounds that vary in quality according to density of the underlying tissue, common method is left middle finger on body, right middle finger used to strike

A

percussion

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5
Q

higher pitched sound of air-filled stomach or bowel

A

tympany

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6
Q

normal lungs are resonant, but hyperesonance occurs when ________, or ___________ is present

A

COPD, PTX

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7
Q

when air in lungs is replaced by fluid/solid tissue in the lungs or pleural space

A

dullness

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8
Q

not done through clothing or gown, listen for characteristics of sound, not just presence (intensity, pitch, duration, quality), usually performed last except for abdomen, need a quiet room, used for breath, heart and bowel sounds

A

auscultation

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9
Q

What are some of the main vital signs?

A
  1. ) general appearance
  2. ) height
  3. ) weight
  4. ) blood pressure
  5. ) pulse
  6. ) respirations
  7. ) temperature
  8. ) pulse oximetry
  9. ) pain
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10
Q

What is included in general appearance?

A
  1. ) apparent state of health
  2. ) apparent vs. stated age
  3. ) dress, grooming, hygiene
  4. ) facial expression
  5. ) other odors
  6. ) arm/leg movements (rigors)
  7. ) posture
  8. ) verbal cues
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11
Q

height and weight should be __________ to each other

A

proportionate

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12
Q

Why are height and weight measured?

A
  1. ) growth and development of a child
  2. ) nutritional status
  3. ) fluid status
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13
Q

1 inch = ______ cm

A

2.54

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14
Q

2.2 lbs = _______ kg

A

1

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15
Q

girls experience their peak growth spurt at age ____, boys experience their peak growth spurt at age ____.

A

12

14

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16
Q

What influences height?

A
  1. ) genetics
  2. ) endocrine system
  3. ) nutrition
  4. ) age
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17
Q

the _____ chart is a more accurate measure of body fat than weight alone

A

BMI

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18
Q

occurs before the epiphyses close, results in an enlarged skeleton that is perfectly proportioned

A

gigantism

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19
Q

occurs after the epiphyses close, hands, feet, face, head, and soft tissues are enlarged

A

acromeagly

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20
Q

usually affects men and women aged 30-50 equally, symptoms include headaches, deepening of voice, sweating, muscle weakness, sleep apnea

A

acromeagly

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21
Q

What are some signs of acromeagly?

A

prominent brow, soft tissues of nose/lips/ears enlarged, prominent jaw, enlargement of hands and feet, elongated head and exaggerated supraorbital ridges

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22
Q

rapid excessive growth, weakness, body proportions relatively normal, increased intracranial pressure, hyperplasia of all organs

A

gigantism

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23
Q

autosomal dominant disease, most die in 4th or 5th decade of life, death often due to arterial dissections and MVP, people have tall, extremely slender build, armspan greater, joint laxity and spontaneous pneumothorax

A

Marfan Syndrome

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24
Q

hereditary dominant disease of cartilage and endochondral bone growth, little people, normal sized head and trunk with a slightly distended abdomen, short muscular limbs with stubby hands and thick fingers

A

achondroplasia

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25
Q

GH deficiency results in child with short stature appearing younger than chronologic age, body and extremities in proportion, growth is normal for 1-2 years then slows and leads to dwarfism if not detected early and treated

A

hypopituitary dwarfism

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26
Q

genetic mucopolysaccharidosis disorder, characterized by pigeon chest, appears normal at birth, but defects become apparent by age 2

A

morquio syndrome

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27
Q

What causes weight gain?

A
  1. ) dietary intake (exceeds metabolic usage, generally increase in body fat slowly over time)
  2. ) water retention (renal dysfunction, increased salt intake, malnutrition, cardiac/vascular disorders, medications, can develop very quickly)
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28
Q

What causes weight loss?

A

malignancy, depression, alcoholism, poor nutrition, chronic infection, high metabolic demand, sleep disorders, etc.

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29
Q

balance between heat production and heat loss, 85% of heat is lost through the skin, regulatory center in hypothalamus, 98.6F and 37C, most consider fever to be greater than 101

A

temperature

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30
Q

lowest temperature in early morning hours, highest in late afternoon/early evening

A

diural variation

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31
Q

What methods exist for obtaining a temperature?

A
  1. ) oral
  2. ) rectal (generally higher than oral by 1 degree)
  3. ) axillary (generally lower than oral by 1 degree)
  4. ) tympanic (used frequently, same as oral)
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32
Q

equal to cardiac output X peripheral vascular resistance, heart, arteries and blood all influence pressure within the system

A

blood pressure

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33
Q

What 3 things affect PVR?

A
  1. ) lumen size
  2. ) compliance
  3. ) viscosity
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34
Q

relative to the state of vasoconstriction and smooth muscle contraction

A

lumen size

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35
Q

related to the cyclical relaxation and retraction of the arterial walls during systole and diastole, respectively

A

compliance

36
Q

replacement of elastic and muscular tissue with that of fibrous tissue

A

arteriosclerosis

37
Q

deposition of fatty plaques within arteries leading to narrowed lumen and loss of compliance

A

atherosclerosis

38
Q

physical property of fluid related to friction

A

viscosity

39
Q

How much blood enters the heart during diastole?

A

approximately 120 mL of blood

40
Q

How much blood leaves the heart in the ejection fraction?

A

60% of blood, approx 70 mL

41
Q

How much blood do people circulate per minute?

A

males 5.5 L of blood

females 5.0 L of blood

42
Q

What factors affect blood pressure?

A

age, sex, stress, exercise, race, obesity, medications, disease processes, hydration status

43
Q

How does age affect blood pressure?

A

lower in children, both SBP and DBP increase in elderly due to loss of compliance, normal SBP equals (2 x age) + 80

44
Q

What is SBP?

A

systolic blood pressure, pressure in the arterial system with the ventricles contract

45
Q

What is DBP?

A

diastolic blood pressure, pressure when the ventricles are filling

46
Q

when using a properly fitting sphygmomanometer, the width of the bladder should be about ____ of the upper arm circumference

A

40%

47
Q

when using a properly sphygmomanometer, the length of the bladder should be about ___ of the upper arm circumference

A

80%

48
Q

if the bladder is too narrow, the BP will be ___________

A

falsely elevated

49
Q

if the bladder is too wide, the BP will be ____________

A

falsely lowered

50
Q

What are the phases of the Korotkoff Sounds?

A

Phase I- first tapping sound, become more intense

Phase II- sounds develop a swishing quality

Phase III- crisp, intense sounds

Phase IV- muffled, soft, blowing sounds

Phase V- sounds disappear

51
Q

When BP’s vary by more than 10mmHg btwn arms may indicate __________

A

arterial compression or obstruction

52
Q

True or False

During the first visit, BP should be obtained in both arms

A

true

53
Q

In the popliteal artery, BP is generally __________ higher

A

10-40mmHg

54
Q

Normal blood pressure

A

<80

55
Q

BP for Prehypertension

A

120-139/80-89

56
Q

BP for Stage I Hypertension

A

140-159/90-99

57
Q

BP for Stage II Hypertension

A

greater than 160/greater than 100

58
Q

When do you need to check orthostatics?

A
  • history of fainting
  • dizziness
  • syncope
  • suspect volume depletion (hypovolemia or dehydration)
59
Q

How do you check orthostatics?

A
  1. ) Take BP when supine, wait 2-3 mins.
  2. ) Take BP when sitting up, wait 2-3 mins
  3. ) Take BP when standing
60
Q

What is orthostatic hypotension?

A

When SBP drops by 20mmHg or more, or the rise of the pulse by 20 BMP or more

61
Q

A rise in pulse rate, but no change in BP suggests mild ____________

A

hypovolemia

62
Q

What causes orthostatic hypotension?

A
  • dehydration
  • blood loss
  • drugs
  • prolonged bedrest
  • anemia
  • pregnancy
  • vasovagal
63
Q

normal phenomenon in which there is a drop in systolic blood pressure within inspiration

A

pulsus paradoxus

64
Q

A drop in SBP by greater than 10mmHg is significant, and can be due to…

A
  • cardiac tamponade
  • pericarditis
  • shock
  • emphysema
  • severe asthma
65
Q

Where can you easily palpate a pulse?

A
  • temporal arteries
  • carotid arteries
  • brachial arteries
  • radial arteries
  • ulnar arteries
  • femoral arteries
  • popliteal arteries
  • posterior tibialis arteries
  • dorsalis pedis arteries
66
Q

When taking a pulse, you should…..

A
  1. ) fingerpads of index and middle figers
  2. ) never use thumb!
  3. ) count beats for 15 secs. and multiply by 4
  4. ) if irregular, fast, or slow, count for a full minute
67
Q

What range of BPM is considered normal?

A

60bpm-100bpm

68
Q

Normal pulse rate of a newborn

A

80-180

69
Q

Normal pulse rate of an infant

A

75-160

70
Q

Normal pulse rate of a toddler

A

60-110

71
Q

Normal pulse rate of a child

A

60-110

72
Q

Normal pulse rate of an adolescent

A

50-90

73
Q

What factors influence pulse?

A
  • volume of blood ejected
  • compliance of aorta and arteries
  • viscosity of blood
  • cardiac output
  • peripheral resistance

-evaluate rate, rhythm, and amplitude

74
Q

What is a pulse rate of regularly irregular?

A

3 beats, miss 1, 3 beats, miss 1

75
Q

What is a pulse of irregularly irregular?

A

atrial fibrillation

76
Q

normal pulsation followed by a premature contraction (PVC) amplitude of PVC is also less than normal pulse

A

bigeminal pulse

77
Q

The force of a pulse is rated out of 4. What do the numbers represent?

A 
4 = bounding
3 = full (increased
2 = normal 
1 = diminished (thready)
0 = absent (non-palpable)
78
Q

smaller amplitude alternating with large and normal rhythm, due to left ventricular failure

A

pulsus alternans

79
Q

exaggerated decrease in amplitude during inspiration and increased amplitude during expiration, due to pericardial effusion, constrictive pericarditis, asthma, or emphysema

A

pulsus paradoxus

80
Q

an automatic act that is controlled by brainstem, diaphragm is primary muscle of inspiration, evaluated based on rate , rhythm, and quality

A

respirations

81
Q

what is a normal respiration rate?

A

12-20 per minute

82
Q

deep, regular, sighing respirations (rate can be normal, slow, or fast), occurs in metabolic acidosis, uremia, anxiety, severe hemorrhage, hypoxia

A

Kussmaul breathing

83
Q

pattern waxes and wanes clinically so that periods of deep breathing alternate with episodes of apnea, may be normal in children and elderly, occurs in alteration in cerebral circulation, left sided heart failure

A

Cheyne- Strokes Breathing

84
Q

ataxic breathing, characterized by breaths that are shallow or deep then stop for short periods, unpredictable, occurs in meningitis (brain damage typically at medullary level)

A

Biot’s Breathing

85
Q

seen in obstructive lung diseases, expiration is prolonged due to increased airway resistance, breathing rate may become shallow

A

obstructive breathing

Physical Diagnosis (1 decks)

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