Lecture 2 Flashcards
Exam 1 content
What must be kept in mind regarding temperature in critically ill patients?
Core temperature will likely be different than a temporal/axillary temperature and can affect the temperature which can affect the QI measure
What is anthropometry?
The scientific study of the measurements and proportions of the human body
What areas can be used for a BP measurement?
Radial, PT/DP, brachial and popliteal. Any of these spots can be used for an arterial line too
What risks are involved with a rectal temperature?
Perforation, and avoid in uncooperative or immuno-suppressed patients
Define a pack year for a smoker
1 PPD x 365 days = 1 pack year. Anyone with 55 years or older with a 30+ PPD history = high risk lung cancer
What is the leading cause of beta blocker OD?
Accidental excess intake, particularly with the elderly
What is mediate or indirect percussion used to evaluate?
The abdomen and thorax
What is percussion used to evaluate for?
The presence of air or fluid in body tissues
What is immediate percussion used to evaluate?
The sinus or an infant thorax
What is fist percussion used to evaluate?
The back and kidney
What is circumferential cyanosis?
Blue-ish discoloration around the mouth and NOT on the lips. It is not harmful and should go away with gentle external warming
What are some common causes of jaundice?
Acute inflammation of the liver, inflammation or obstruction of the bile duct, hemolytic anemia, Cholestasis, and pseudo-jaundice (harmless, results from excess of beta-carotene - eating large amounts of carrot, pumpkin or melon)
What are some genetic causes of jaundice?
Crigler-Najjar syndrome - inherited condition that impairs an enzyme responsible for processing bilirubin
Gilberts syndrome - inherited condition that impairs the ability to excrete bile
Dubin-Johnson syndrome - inherited form of chronic jaundice that prevents conjugated bilirubin from being secreted from the cells of the liver
Describe the physiology of Vitiligo
An auto-immune issue where the melanocytes are attacked. Generally shows up after a triggering event like a cut, scrape or bruise
What are “raccoon eyes”?
Battles sign - symptom of a basilar skull fracture
Causes of petechiae?
Prolonged straining, medications, infectious disease, leukemia, thrombocytopenia
Suspect cause of unilateral edema? Bilateral?
Uni = think clot, parasite or injury
Bilat = suspect a central issue such as CHF or systemic infection
What is Koilonychia?
Spoon nails - sign of hypochromic anemia or iron-deficiency anemia. The nails are flat or even concave in shape.
What causes nail clubbing?
Generally a cardiovascular or pulmonary problem, such as lung cancer, ILD or cystic fibrosis.
What is Paronychia?
inflammation around the nail, usually due to a staph aureus infection or candida albicans
What do beau’s lines indicate?
Can indicate a wide variety of issues, such as external injury, infection if its only on one nail.
Multiple nails = systemic illness (ARF, mumps, thyroid, syphilis, chemotherapy, endocarditis, melanoma, DM, pneumonia, scarlet fever, zinc deficiency)
What are some causes of hirsutism?
Polycystic ovary syndrome, cushing syndrome (high levels of cortisol, either an adrenal issue or too much prednisone over time), congenital adrenal hyperplasia, tumors, medications (hair growth medications, minoxidil, rogaine, androgel, testime)
What is ptosis?
Drooping of the eye lid
Ectropion vs entropion?
Ectropion = eversion, eye lid margin turned out
Entropion = inversion, lid margin turns inwards
What is horners syndrome?
When we paralyze a nerve supplying the eye causing miosis (pupil constriction) and a droopy eyelid (ptosis)
Snellen test? Random E test?
Snellen = this is the letter chart you use to assess vision
E = vision test, you use a capital E and rotate it and you have to visually identify it’s position
Webers vs Rinnes test?
W = Tuning fork on the head and feel for vibrations
R = Tuning fork outside the ear or placed on the post-auricular bone
What causes a bright red tongue?
iron, b12 or niacin deficiency
What does cherry lips, bright red skin and bright red blood indicate? Treatment?
Carbon monoxide poisoning. Tx = oxygen, hyperbaric chamber, cyanokit
What is the Romberg test?
Ask patient to hold out their arms and close their eyes. Assesses balance.
How to check biceps reflex?
Flex the elbow against resistance, bend arm at 90 degrees, strike the antecubital tendon and the arm should flex
How to check patellar reflex?
Hammer test on the knee, make sure patient is sitting freely
How to check plantar relfex?
lie supine, feet relaxed and stroke the sole of their foot, the toes should flex. Negative babinski bade (babies have positive babinski)
How to check gluteal reflex?
Side lying, spread the cheeks and stimulate the perineal area, sphincter should contract. Could be the result of an epidural hematoma if this reflex is lacking.
What is Levine’s sign?
clutching chest commonly associated with an MI
What is Murphy’s sign?
RUQ pain associated with cholecystitis
What is Turner’s sign?
bruising of the flanks associated with retroperitoneal bleeding
what vision changes accompany glaucoma?
tunnel vision
Facial features associated with Leoning are associated with which disease?
Leprosy
Chipmunk face is associated with which eating disorder?
bulimia nervosa
Spider angioma is commonly associated with which liver disorder?
cirrhosis
Pyloric stenosis is associated with what shape of mass?
olive shaped on CT scan
rice water stool is commonly associated with what GI illness?
cholera
