Midterm Flashcards
Subjective Data
Demographic Reliability Chief Complaint HPI PMH/FM/PSH ROS
Objective Data
Physical Exam Vitals Lungs CV Labs Radiology EKG
Macule
Flat, smaller than 1 cm (Freckle, measles)
Patch
Flat, circumscribed, >1cm
Papules
Smaller than 1 cm, firm solid. (Wart)
Plaque
Papules together >1cm (eczema, psoriasis)
Nodules
Solid elevations, hard or soft. >1cm (sebaceous cyst, fibromatosis)
Wheals
Superficial, raised, irregular. Caused by edema in epidermis. Transient. (PPD)
Uritcaria
When wheals cohilesce to form reactions to allergens.
Vesicle
Elevated blister like cavities with fluid in up to 1cm (herpes, chicken pox)
Bullae
Elevated, >1 cm cavities. Blister like. (Sunburn)
Primary lesions
Macules Patches Papules Plauqe Nodules Wheals Uriticaria Vesicles Bullae Pustule
Secondary Lesions
Cyst Scales Fissures Crusts Excoriations/abraisons Erosions Ulcers Scars Keloid Atrophy
Vascular Lesions
Spider angiomas
Spider veins
Cherry angiomas
Purpuric Lesions
Ecchymosis
Petechia
Blood outside the vessel
Pustules
Vessicles filled with thicker fluid (acne, impetigo)
Cyst
Encapsulated, fluid filled cavity in the SQ or dermis. Hard and taught.
Scales
Compact, flakes of skin. Dry or greasy. Silver, white, yellow.
Fissures
Linear cracks with abrupt edges that extend (corners of mouth, athletes foot cracks)
Crusts
Dried serum, pus, or blood mixed with debris.
Excoriations/abraisons
Punctate or linear produced by mechanical means usually only the epidermis. Rarely dermis.
Erosions
Loss of all or portion of the epidermis.
Ulcers
Round or irregular excavations that result in loss of dermis and epidermis.
Scars
New formations in the dermis or deeper parts as a result of injury. Healing process.
Keloid
Firm, irregular shaped, thickened, hypertrophic, fibrous. Pink/red.
ABCDE
Asymmtery Border Color Diameter (6mm or greater) Evolving
Impetigo
Red sores that form around the nose and mouth. Bacterial infection, sores burst and develop honey-colored crusts. (pustules, erosions)
Wood light
Blue light that uses long wave UV light. When a scalp has ringwork, the fungus glows. A dermascope is a magnifying glass with woodlight and measuring tool.
Cranial Nerve XI
Sternocleidomastoid
Lymph nodes
Preauricular/Postauricular Occipital Cervical Submental Submaxillary Submandibular Clavicular
Lymph Node Assessment
Location Size Delineation Surface characteristics Shape Tenderness Heat Mobility Consistency
Clubbing
Result of low oxygen saturation in the blood. The tips of fingers enlarge and the nails curve around the fingertips.
Normal 160
Clubbing 180
Reasons for Hair Loss
Hereditary Age Alopecia Childbirth Illnesses Hormones Cancer treatment Hair styles Chemicals Scalp infection Medications Psoriasis STI Thyroid disease Decreased Iron, Protein, Zinc Friction Poison
When do patients ALWAYS need to seen by an opthamologist.
HTN, DM, Multiple Scleriosis, Arthritis (Lupus).
Vision Tests
Snellen, Visual Fields, Occular Movements, Fundoscopy
Bruckner, Hirshberg, Corneal Light Reflex, Cover/Uncover
Snellen Chart
20/20
Visual Acuity
1st- the distance the patient reads the chart
2nd- the distance at which a person with normal vision can read the same line
Visual Fields
Peripheral vision
Occular Movements
Alignment, cardinal gaze
Bruckner
Color of red reflex, size of pupil, location of pinpoint of light
Hirschberg
Strabismus, same spot on each side
Cover/uncover
Strabismus (nystagmus)
Conjunctivitis
Bacterial/viral inflammation of the conjunctiva. Contagious, red, itchy, painful eyes.
Hordeolum
Sty. Red, painful lump near the edge of the eyelid. Acute, localized swelling of the eyelid, eyelash follicle, and glands. Infected hair follice, usually staph.
Chalazion
Non-infectious obstruction of a meibomian gland causing extravasation of irritating lipid material in the eyelid soft tissues with focal secondary granulomatous inflammation.
Blepharitis
Inflammation of the eyelid that affects the eyelashes or tear production. Tiny oil glands of the inner eyelid become inflammed.
Tear Ducts
Lubricates and protects.
Gives shape to the eyes.
Inspection of the Uvula
Press tongue down and ask to say “ah”. Should look like a pendent, midline, and rise along the soft palate.
Cranial Nerve 9 and 10
Vagus and Glossopharyngeal
Tongue and salivary glands.
Have pt touch tip of tonuge to roof of mouth and inspect ventral surgace. Stick out; inspect deviation, color, texture, massess.
Parotid- cheek area below and in front of the ears; secrete saliva via stensons duct.
Submandibular-located in the floor of the oral cavity; saliva into mouth.
Sublingual- found under the tonuge.
Tonsils
To assess the tonsils, a patient opens their mouth and a tongue blade is used to depress the tongue. A penlight is used to inspect the back of the patient’s throat, looking for pink, symmetrical and normal-size tonsils. Tonsil size is graded as follows:
1+ Visible
2+ Halfway between the tonsillar pillars and the uvula
3+ Touching the uvula
4+ Touching each other
Ear
Balance and equilibrium
Ear Tests
Weber- laterilization using a tuning fork on top of head. Louder in the bad ear because its not distracted by background noise.
Rinne- AC>BC. Mastoid processess.
Otitis Externa vs Otitis Media
Otitis externa (swimmers ear)- infection of the outer ear canal that runs from eardrum to the outside of the head. Warmth and pain.
Otitis Media- Infection of the air filled space behind the ear drum (middle ear).
Ear exam and structures you would see
Otoscopy- canal and TM
Use largest speculum possible. Up and back for adult/ Down and back for kids/smaller adults
Cone of light reflex- 5 R/ 7 L
Malleous handle, short process, incus, pars flaccid
Pearly, white, shiney (normal)
Pneumatic Otoscopy
Introduce air to assess movement of the TM
Performation- no mobility
normal- vibrates
Reasons for Epistaxis
Copious and short-term- Trauma or isolated incident
Chronic-drug therapies, chemotherapies, dry environment and fragile nasal mucosa
Reasons for Hearing Loss
Cerumen impaction Paranoia/agitation Aging Presbycusis- degenerating hair cells (decreased hearing high pitches) Syphallis Rubella Diabetes Meningitis Ear infections Ototoxic agents Headphones
Normal Breathe Sounds
Tracheal
Bronchial
Bronchovesicular
Vesicular
Adventitious Breathe Sounds
Crackles Wheezes Rhonchi Stridor Pleural Rubs
Ribs
12 ribs posterior.
7-8 ICS landmark for thoracentesis
Chostrochondritis- inflammation of ICS
Tactile Fremitus
Palmer or side of hand.
Vibration, assessment of the low-frequency vibration of a patients chest. Indirect measure of the amount of air and density of tissue present within the lungs. “99”
Deformities of chest wall
AP diameter 2:1
Pectus excavatum “Funnel chest”
Pectus carinatum “Pidgeon” chest
Scoliosis
Kyphosis
Murmur Grades
1 2 3 4 5 6
Systolic Murmurs
Mitral Regurgitation
Physiological Murmurs
Aortic Stenosis
Mitral Valve Prolapse
Diastolic Murmurs
Aoritic regurg
Mitral Stenosis
Cardiac Valves
Tricuspid
Pulmonic
Mitral
Aortic
Aortic Stenosis
Narrowing of the opening of the valve that obstructs the flow of blood out of the left ventricle.
Aortic Regurgitation
Leakage of blood from aorta back into the left ventricle during diastole
Mitral Valve Prolapse
Inappropriate closure of the MV leaflet
Mitral Stenosis
Narrowing of the MV, decreased blood flow into left ventricle during diastole.
Mitral Regurgitation
Leakage of blood during systole from the left ventircle stroke volume back into the left atrium.
What is listened for when assessing a murmur?
Timing, location, radiation, pitch, quality.
Systole
S1
The contraction of the cardiac muscle tissue in the ventricles. S1 is the mitral and tricuspid closure, loudest at the apex. Synchronous with the carotid pulse.
Diastole
S2
The relaxation of the cardiac muscle tissue in the ventricles. Coincides with the S2. Aortic and pulmonic closure, loudest at the base.
Ejection Fraction
test that determines how well your heart pumps with each beat.
Echocardiogram
Wall Motion EF and valves Pericardial effusion or tamponade Aortic root Dissection Pulmonary artery pressure
Cardiac Palpation
PMI- 5th ICS
Massess, pain, tenderness, costocondritis
Subcutaneous emphysema
PVD Tests
Allen’s- radial and ulnar hand circulation.
Buergers- leg circulation
Homans sign-DVT
Cap Refill- <2, 2.9 women
Edema
Depress pretibial area and medial malleolus for 5 seconds. Grade +1-+4.
