Midterm Study Flashcards
Don't fail
Identify 2 examples of when you would obtain a comprehensive HH/ exam
new patient
chronic pt with multiple DX
Describe the diff b/t a comprehensive and focused health history/exam
Comprehensive is EVERYTHING
Focused- pertinent- family hx/social hx,ROS, objective ROS, focused assessment and plan
Identify 2 examples of when you would obtain a focused HH/ exam
pt comes in w/ specific concern
urgent care/ED visit
follow up visit
what is the difference b/t subject and objective data
Subjective data is the patient’s personal experiences and feelings
objective data consists of measurable and observable findings gathered by the healthcare provider.
OLDCARTS
onset
Location
Duration
Characteristics
Alleviating/aggravating
Radiation
Timing
Sensitivity
Identify what goes into each section of comprehensive HH
identifying source/data
CC
HOPI
PMHX
FH
Personal/social HX
ROS
Who is the source/are they reliable?
Chief complaint in the pts OWN words
HOPI- how long, any meds/ what makes better/worse, previous tx
PMHX- diagnoses
FH- mother/father, siblings, grandparents
Personal- ETOH/drugs, sexy times, job? living sitch
ROS-comprehensive vs focused
OPQRST
Onset
Provocation
Quality
Radiation
Severity
Timing
BMI range for underweight pt
<19
normal BMI range
19-24
overweight BMI range
25-29
obese BMI range
30-39
obese II range
> 40
define nociceptive pain and what conditions could be nociceptive
Nociceptive pain is caused by tissue damage or injury, signaling that something is wrong in the body.
Common conditions that can cause nociceptive pain include arthritis, sprains, fractures, and surgeries
define neuropathic pain and conditions
Neuropathic pain results from damage to the nerves themselves, often leading to sensations like burning, tingling, or shooting pain.
Common conditions that cause neuropathic pain include diabetes (diabetic neuropathy), shingles (postherpetic neuralgia), and sciatica.
define idiopathic pain and conditions
Idiopathic pain refers to pain with no identifiable cause or underlying medical condition.
It often occurs in situations where the origin is unclear, such as fibromyalgia or certain chronic pain syndromes.
define psychogenic pain and conditions
Psychogenic pain is pain that is influenced or exacerbated by emotional, psychological, or social factors rather than a direct physical cause.
Conditions that may involve psychogenic pain include depression, anxiety disorders, and somatic symptom disorder.
Is the ROS subjective or objective
SUBJECTIVE- you are asking. not assessing
What are the 5 ps in the personal/sexual questionairre
Partners
Practices
Protection of STI
Past History of STI
pregnancy plan
questions to ask about alchohol intake
type
frequency
amount
if quit when
what to ask about smoking
how many years / how mmuch per day
ex- 1 pack a day for 10 years = 10 year pack history
what is the purpose of the clinical note? (3)
accurately record info
* assists other providers to make an accurate dx and provide best txt plan
* written record providing inter-professional communication
how do you calculate BMI
weight in lbs x 700 / height in inches
when is a BP orthostatic
when BP drops >20 mgHg or diastolic drops
>10 after standing
what is the diurnal temperature of people?
35.8-37.3C
Describe visceral abd pain
Visceral abdominal pain originates from the internal organs (viscera) and is often described as a deep, aching, or cramping sensation.
It can be caused by conditions like gastrointestinal issues (e.g., irritable bowel syndrome, pancreatitis), urinary tract problems, or reproductive system disorders. The pain is typically less localized and may be accompanied by other symptoms like nausea or changes in bowel habits.
described parietal abd pain
Parietal abdominal pain arises from the irritation of the lining of the abdominal cavity (the parietal peritoneum) and is usually more localized and sharp compared to visceral pain.
It can be caused by conditions like appendicitis, perforated ulcers, or other inflammatory processes affecting the abdominal wall. This type of pain is often aggravated by movement or coughing and is more easily pinpointed by the patient.
Describe Referred pain
Referred pain is pain felt in a different location from where the actual problem is occurring.
For example, pain from a heart attack may be felt in the left shoulder, neck, or jaw. This happens because of the way nerves from different parts of the body converge in the spinal cord, leading to confusion in the brain about the source of the pain.
what is Murphy’s sign, and what is it indicative of?
RUQ palpitation pain on inspiration
cholecystitis
describe ischemic pain
deep, cont/ pain that worsens w/ activity/o2 demand
ischemic bowel, mesenteric artery ischemia/infarct
what is obturators sign, and what is it indicative of?
Obturator’s sign is a clinical test for appendicitis or pelvic inflammatory disease.
It involves flexing the patient’s right hip and knee and then internally rotating the hip. Pain during this movement suggests irritation of the obturator internus muscle, often due to an inflamed appendix or other pelvic conditions.
common signs of peritonitis (9)
Abdominal pain and tenderness
Rigid or board-like abdomen
Fever
Nausea and vomiting
Loss of appetite
Bowel changes (e.g., constipation or diarrhea)
Rebound tenderness (pain upon releasing pressure)
Decreased bowel sounds
Tachycardia (increased heart rate)
Psoas sign and likely Dx
pain when lifting RLE against resistance
appendicitis
What is Cullens Sign and likely dx
Cullen’s sign is a bluish discoloration around the umbilicus (navel) indicative of internal bleeding,
particularly from conditions like hemorrhagic pancreatitis or ruptured ectopic pregnancy. It suggests retroperitoneal bleeding that has tracked up to the abdominal wall.
What is Grey Turner’s Sign and Dx
Grey Turner’s sign is a bluish discoloration of the flanks, indicative of retroperitoneal bleeding.
It can be associated with conditions like hemorrhagic pancreatitis or ruptured abdominal aortic aneurysm. The presence of this sign suggests significant internal bleeding and requires further evaluation.
What is Rovsing’s Sign and Dx
pain in RLQ w/ palpation of LLQ
Appendicitis
correct sequence to assess the abdomen
Inspection: Observe the abdomen for shape, color, scars, and any visible pulsations or masses.
Auscultation: Listen for bowel sounds in all four quadrants using a stethoscope, noting their frequency and quality.
Percussion: Tap on the abdomen to assess for areas of dullness or tympany, helping to identify fluid, masses, or organ size.
Palpation: Gently press on the abdomen to assess tenderness, rigidity, and any palpable masses, starting with light palpation followed by deeper palpation if necessary.
describe the process for assessing CVA tenderness and what does a positive result indicate?
Positioning: Have the patient sit or stand comfortably.
Palpation: Place one hand over the patient’s CVA, which is located at the lower back, just below the ribs on either side of the spine.
Percussion: Use the fist of the opposite hand to gently strike the area where your hand is positioned.
A positive result is indicated by pain or tenderness in response to the percussion, which may suggest kidney inflammation or infection, such as pyelonephritis.
Describe the risk factors and subjective info of a pt w/ gallbladder disease
alchohol abuse
biliary tract disedase
HL
Meds (diabetic)
vascular dx
hyperparathyroid/hypercalcemia
renal transplant
Pain: Intermittent or constant pain in the upper right abdomen, often after meals.
Nausea/Vomiting: Accompanying gastrointestinal symptoms, particularly after fatty meals.
Bloating: Feeling of fullness or bloating in the abdomen.
Indigestion: Reports of dyspepsia or heartburn.
Jaundice: Yellowing of the skin or eyes if a bile duct is obstructed.
History: Previous episodes of gallbladder-related pain or diagnosed gallstones.
Describe the risk factors and subjective info of a pt w/ pancreatitis
Risk Factors for Pancreatitis:
Alcohol Consumption: Chronic heavy drinking is a major risk factor.
Gallstones: Can block the pancreatic duct, leading to inflammation.
Obesity: Higher body mass index (BMI) increases the risk.
Smoking: Tobacco use is linked to pancreatitis.
Family History: Genetic predisposition to pancreatic diseases.
Medications: Certain drugs can induce pancreatitis.
High Blood Pressure: Hypertension may increase risk.
Diabetes: Individuals with diabetes have a higher incidence.
Subjective Information:
Pain: Severe, persistent abdominal pain that may radiate to the back; often described as a “boring” or “stabbing” sensation.
Nausea/Vomiting: Frequent episodes of nausea, with or without vomiting.
Abdominal Distension: A feeling of fullness or bloating in the abdomen.
Changes in Appetite: Decreased appetite or food aversions.
Diarrhea: Loose, oily stools (steatorrhea) if fat digestion is impaired.
History: Previous episodes of pancreatitis or underlying conditions like gallstones or heavy alcohol use.
Describe the risk factors and subjective info of a pt w/ GERD
risks- medications, triggers (citrus, tomatoes, caffeine, alchohol, chocolate, smoking), hiatal hernia
Sub- heartburn, coughing/wheezing, aspiration, hoarseness, worsening asthma
Describe the risk factors and subjective info of a pt w/ PUD
Risks- H. Pylori, NSAIDS, systemic steroids, age >50-55
Subjective info
gastric- pain after eating, n/anorexia
duodenal- pain better w/ eating,
Describe the risk factors and subjective info of a pt w/ ectopic pregnancy
Risks- endometriosis/tubal cysts/ abortions, tubal infections, infertility, PID
Subjective- amenorreha w/ spotting, sever onset of lower abd pain/back pain
Describe the risk factors and subjective info of a pt w/ urinary caliculi
Risks-= man, dietary high in sodium/protein, hot humid locations, family hx
Subjective- N/V, pain in flank/LLQ/RLQ/Suprapubic, colicky pain, hematuria, urgency/frequency
Describe the risk factors and subjective info of a pt w/ Diverticulitis
Risk- age >60, connective tissue disease, chronic constipation, hx of diverticula
Subjective- NVD/consitpation, fever, generalized LLQ pain
Indications for EGD (BOWED)
bleeding
odynophagia= painful swallow
weight loss
early satiety
dysphagia
? to ask a pt with CP/palpitaions, SOB/ edema
OLDCARTS
Aortic stenosis
S/S, location, systolic/diastolic?
CP/SOB/Fatigue/syncope/palpitations
R. 2nd intercostal mid clavicular
systolic
Pulmonic stenosis
S/S, location, systolic/diastolic?
Chest Pain
Shortness of Breath
Fatigue
Syncope
Cyanosis (in severe cases)
Heart Murmur
L. 2nd intercostal midclavicular
Systolic
Mitral regurg
S/S, location, systolic/diastolic?
Mitral Regurgitation
Signs and Symptoms (S/S):
SOB, Fatigue, Palpitations, Swelling in Legs or Feet, Chest Pain
Heart Murmur
Location:
Auscultation: Best heard at the apex of the heart (fifth intercostal space, midclavicular line) and may radiate to the left axilla.
Systolic/Diastolic:
Type: Holosystolic (or pansystolic) murmur.
Timing: Occurs throughout systole.
Causes:
Mitral Valve Prolapse
Rheumatic Heart Disease
Ischemic Heart Disease
Infective Endocarditis
Cardiomyopathy
Mitral prolapse
S/S, location, systolic/diastolic? cause
Signs and Symptoms (S/S):
Palpitations
Chest Pain
Shortness of Breath
Fatigue
Dizziness or Lightheadedness
Anxiety
Location:
Auscultation: Best heard at the apex of the heart (fifth intercostal space, midclavicular line).
Type: Systolic click followed by a late systolic murmur if mitral regurgitation is present.
Causes:
Genetic Factors: Often familial and associated with connective tissue disorders.
Marfan Syndrome: A connective tissue disorder that can lead to mitral prolapse.
Ehlers-Danlos Syndrome: Another connective tissue disorder linked to mitral valve issues.
Aging: Changes in the valve structure over time.
Tricuspid Stenosis
S/S, location, systolic/diastolic, cause?
Signs and Symptoms (S/S):
Fatigue
Swelling in the Legs and Abdomen
Shortness of Breath
Palpitations
Ascites (fluid accumulation in the abdomen)
Cyanosis (in severe cases)
Location:
Auscultation: Best heard at the left lower sternal border (fourth intercostal space).
Type: Diastolic murmur.
Timing: Occurs during ventricular filling (diastole).
Causes:
Rheumatic Fever: Most common cause, often following untreated strep throat.
Congenital Heart Defects: Such as Ebstein’s anomaly.
Endocarditis: Infection of the heart valves.
Carcinoid Syndrome: Can lead to valve thickening and dysfunction.
aortic regurgitation
s/s, location, type, cause?
Signs and Symptoms (S/S):
Shortness of Breath
Fatigue
Palpitations
Chest Pain
Dizziness or Syncope
Bounding Pulses
Location:
Auscultation: Best heard along the left sternal border (third to fourth intercostal space).
Type: Diastolic murmur.
Timing: Occurs during ventricular relaxation (diastole).
Causes:
Aortic Valve Degeneration: Age-related calcification.
Rheumatic Fever: Can lead to valve damage.
Endocarditis: Infection affecting the valve.
Congenital Heart Defects: Such as a congenitally deformed aortic valve.
Aortic Root Dilation: Conditions like Marfan syndrome.
Pulmonic Regurgitation,
S/S, location, timing, cause?
Signs and Symptoms (S/S):
Shortness of Breath
Fatigue
Palpitations
Swelling in the Legs and Abdomen
Chest Pain (less common)
Location:
Auscultation: Best heard at the left second intercostal space (pulmonic area).
Type: Diastolic murmur.
Timing: Occurs during ventricular relaxation (diastole).
Causes:
Pulmonary Hypertension: Increased pressure in the pulmonary arteries.
Congenital Heart Defects: Such as tetralogy of Fallot.
Infective Endocarditis: Infection of the valve.
Rheumatic Heart Disease: Can lead to valve damage.
Dilated Right Ventricle: Conditions that affect the right ventricle.
Describe Murmur grading 1-6
‣ 1- very faint, not easily heard w/ every beat
‣ II- soft and easily heard w/ each beat
‣ III- moderately loud
‣ IV- loud w/ every beat may feel a thrill
‣ V- very loud w/ every beat, +thrill, and may be heard with stethoscope slightly off the chest
‣ VI- heard with the stethoscope off the chest and + Thrill
* will probs be in the hospital at this point
when are aortic and pulmonic valves OPEN?
systole
when are AV and pulmonic valve CLOSED
diastole
when are MV and TV open?
diastole
when are MV and TV CLOSED?
systole
what is the purpose of an allen test and how do you perform it?
Purpose- evaluates arterial supply to the hand
Procedure Overview
The patient is asked to make a fist, which helps empty the blood from the hand.
The examiner compresses both the radial and ulnar arteries to occlude blood flow.
The patient opens their hand, which should appear pale.
The examiner releases the pressure on the ulnar artery, and the hand should quickly return to a normal pink color if collateral circulation is adequate.
Interpretation
Normal Result: Rapid return of color indicates good blood supply.
Abnormal Result: Slow or absent color return may suggest compromised blood flow through the ulnar artery, indicating potential vascular issues.
name some subjective findings with Peripheral vascular disease
pain
claudication
numbness
weakness
weak/absent DP and PT pulses
pallor
how do you measure the ABI
doppler signals of all 4 extremeties
Right ABI= Doppler of R. Foot / highest doppler of both arms
L. ABI= doppler of L foot/ highest Doppler of both arms
ABI = >1.4
= non compressible calicified vessel
what is a normal ABI?
.9 - 1.4
what is an ABI < .9 indicative of?
PAD
what is an ABI of <.5 indicative of?
severe PAD
objective assessment of arterial insufficiency
decrease/absent pulse
no edema
severe pain
cool extremities
pale with elevation, dusky red w/ dependency
thin, atrophic skin
hairless/shiny
objective assessment for venous insufficiency
normal pulses
significant EDEMA
no/mild pain
normal temp
hyperpigmented skin, cyanosis on dependence
thick/mottled skin
step by step assessment of the thorax/lungs
inspect- chest shape / AP diameter
Palpate- tenderness/symmetry, chest expansion, tactile fremitus (as the to say 99 you should feel palpable vibrations
Percussion
Auscultation
Identify diagnoses associated w/ hyper resonance on percussion
emphysema
pneumothorax
asthma exacerbation (trapped air)
COPD
Identify diagnoses associated w/ resonance
normal lung tissue
Identify diagnoses associated w/ dullness on lung percussion
pleural effusions
pneumonia
atelectasis
describe vesicular breath sounds
location, duration
soft/low pitched
heard through inspiration and 1st third of expiration
heard over most of the lung
describe bronchial breath sounds
location and duration
sounds loud
over manubrium- larger proximal airway
expiratory > inspiratory
describe bronchovesicular lung sound
location and duration
immediate pitch and intensity
1st and 2nd interspaces anteriorly and between the scapulae
= in length
describe tracheal breath sounds
location and duration
very loud
heard over trachea
inspiratory and expiratory sound the same
describe crackles and give diagnoses
intermittent/nonmusical/fine
PN, pulm fibrosis, CHF
describe wheezes and give diagnoses
high pitched, musical sounds heard during inspiration or expiration
asthma, COPD, Bronchitis
describe Rhonchi and give diagnoses
deep, coarse sounds that have snoring quality, primarily in expiration
bronchitis, pneumonia
what is egophony and what does it mean if egophony is present
ask pt to say EE- normally hear a long muffled e sound
if E sounds like A it is a + result indicative of lung consolidation or fluid or pN
describe how to assess for bronchophony and what does a positive result mean
ask pt to say 99- normally sounds muffled and indestinct
louder and more distinct is + indicative of PN d/t lobar consolidation
describe how to assess for whispered pectoriloquy and what does a positive result mean
ask pt to whisper 99 or 1-2-3 while listening w/ diaphragm- normal faint/indestinct or nothing
lung consolidation
Risk factors and subjective info for Asthma
Risk- exposure to environmental factors, smoking, viral respiratory inf, allergies, family hx
subjective
SOB
wheeze
non productive persistent cough
sleep disturbance
exercise intolerance
atopic dermatitis
symptoms increase w/ activity and at night
COPD risk factors and subjective assessment
Risk= CIGARETTE SMOKING, occupational exposures, famiily hx- caucasion <45= alpha 1 anti-trypsin deficiency,
SOB, intermittent wheeze, cough- sometimes w/ mucus, chest tightness, activity intolerance
Symptoms are PROGRESSIVE
Pneumonia Risk factors and subjective assessment
‣ subjective findings
* thick yellow/green mucus
* fever
* chills
* malaise
* chest discomfort
* strep pneumoniae (+)- non-drug resistant ◦ most common in the community
PE risk factors and subjective assessment
◦ risk factors
‣ hx of DVT
‣ malignancy
‣ immobility
‣ polycythemia
◦ subjective findings ‣ acute onset of SOB/pleuritic CP that increases with inspiration ‣ cough ‣ sometimes hemoptysis ‣ asymptomatic * most typical for malignancy
Pneumothorax Risk factors and subjective assessment
◦ risk factors
‣ trauma to anterior thorax - blunt
‣ tall/thin males- marfan syndrome
* often how marfans is diagnosed
‣ COPD
‣ marijuana using
‣ air travel
◦ Subjective ‣ acute SOB ‣ acute pleuritic CP
what is a PFT used for
PFTs help identify and differentiate between various lung conditions, such as:
Chronic Obstructive Pulmonary Disease (COPD): To assess airflow limitation.
Asthma: To evaluate airway responsiveness.
Interstitial Lung Disease: To assess lung restriction and gas exchange.
what is a normal FEV1 to FVC ratio>
normal >70%
<70% indicative of disease (COPD, asthma)
describe FEV1
‣ FEV1= forced expiratory volume in 1 second
* amount of air a person is able to expel in 1 second
* same as peak flow
objective assessment ASTHMA
‣ physical exam
* insp/exp wheezing- exp ALWAYS
* respiratory distress- accessory muscles
* hyper-resonance on percussion- severe exacerbations b/c of excess of air in lungs
diagnostics
Peak flow monitoring
measured by personal best or estimated best
◦ can check at home- let them know when it’s getting worse
* PFT ◦ fully or partially reversible ◦ obstructive airway disease ◦ results are based on post-admin of a short acting bronchodilator
objective assessment COPD
◦ physical exam
‣ diminished lung sounds
‣ increased AP chest diameter
‣ can result in RCHF- cor pulmonale
◦ diagnostics
‣ chest xray
* flattened diaphragm
* increased AP diameter
‣ PFT
* FEV/FVC ration <70% post bronchodilator
* non-reversible obstructive airway disease
‣ lab findings- hypokalemia, hypochloremia, increased NaHCO3
objective assessment for Pneumonia and diagnostics
- physical
◦ fever
◦ crackles
◦ + bronchophony
◦ + whispered pectroliloquy
◦ + egophany
◦ increased fremitus
◦ dullness in percussion because of mucus
◦ tachycardia and tachypnea
◦ low pulse ox- diagnositcs
◦ CXRAY
‣ consolidation in areas of lungs
* lower most common
‣ RML increased concern for fungal
‣ UL concern for aspiration
- diagnositcs
objective and diagnostics for PE
◦ objective
‣ tachycardia
‣ tachypnea
‣ brady- with shock
‣ change in MS
◦ diagnostics ‣ CT of chest * embolus is pulm * large PE from DVT * small PE from malignancy * VQ Scan ◦ back up to *CT
objective assessment and diagnostics for pneumothorax
◦ Objective
‣ tachycardia/tachypnea
‣ hyperresonance on percussion
‣ absent or diminished lung sound
‣ tracheal shift- tension pneumo
◦ diagnostics
‣ CXRAY
* absense of lung markings
* visible pleural line with air noted in pleural space
