Part 4 Flashcards
Physical exam definition
Process by which the clinician investigates the body of a patient for signs of disease
Always approach patients from the…
right (patient right)
128 Hz tuning fork
Larger fork that tests for vibratory sensation
512 Hz tuning fork
Smaller tuning fork to allow for Weber & Renne’ hearing test
Pan-optic opthalmoscope
Gives a more magnified image of the retina
Diaphragm of stethescope
Large dial on end of stethoscope that listens to high pitched sounds
Bell of stethoscope
Small dial on end of stethoscope that listens to low pitched sounds
The 5 vital signs (sometimes a 6th is included)
1) Temp
2) Blood pressure
3) Respiration rate
4) Heart Rate
5) BMI
6) SOMETIMES Pulse ox
Temperature is regulated by what organ
hypothalamus
Normal oral temp
98.6F/37c
5 ways to measure temp
1) oral
2) Axillary
3) Rectal (patient unconscious, restless, cannot close mouth)
4) Tympanic membrane
5) laser thermometer of the forehead temporal artery
Hypothermic thermometer
Accurate for temperatures a normal thermometer is not, below 94 degrees F
Noninfectious causes of pyrexia
- ovulation
- thyroid storm
- drug effect
- trauma
- cancer
Hyperpyrexia
Fever greater than 104 degrees F, typically resulting from infection
Hypothermia
Temp less than 95 degrees F, exposure to cold, shock, hypothyroidism, hypoglycemia
6 pulse sites
1) radial (easiest)
2) carotid (have to listen for presence of plaque that could be released by pressure)
3) femoral (at about the femoral triangle)
4) apical (on the heart, says nothing about perfusion)
5) Dorsalis pedis
6) Posterior tibial pulse
Carotid baroreceptor mechanism and nerve responsible
Massaging of carotid can cause baroreceptor reflex to stimulate thanks to glossopharangeal nerve that results in a drastic drop in blood pressure and syncope episode
Sinus tachycardia and some common causes
Rapid regular >100 beats, caused by
- heart disease
- fever
- exercise
- anemia
- dehydration
- hyperthyroidism
- drugs
- smoking
-anxiety
Sinus bradycardia and common causes
Slow regular <50 bpm, caused by
- heart disease
- hypothyroidism
- irregular electrolytes
- athlete
Pulsus alternans deinition and cause
Alternating strong and weak pulse, indicates left ventricular heart failure
Pulsus bisferiens and cause
Biphasic pulse, indicates aortic valve problem
Dicrotic pulse and cause
2 distinguishable palpable pulses, indicates low cardiac output
Pulsus parvus et tardus definition and cause
Pulse is weak and has late carotid upstroke, caused by aortic valve stenosis
Pulsus paradoxus definition and cause
Typically SBP falls 3-10mm during inspiration, pulse gets weaker, caused by asthma, COPD, etc…. Note this has NOTHING TO DO WITH PULSE BUT RATHER BP
Regulator of O2 and CO2 in bloodstream
Brainstem - medulla oblongata, pons, midbrain
Kussmaul breathing definition and cause
Fluctuating breathing rates, caused by metabolic acidosis
Cheyne stokes respiration and cause
Breaths with periods of apnea (strict apnea differentiating from kussmaul), seen in head injuries with brain tumors, or strokes
korotkoff sounds
5 phases of taking BP with the start represents systolic and end being silence representing diastolic
Elevated vs narrow pulse pressure and what these could mean
Elevated is >60, predictor of arterial stiffness and CVD, narrow is <40, predictor of shock or cardiac tamponade
Koebner phenomenon (isomorphic response) and what 2 conditions is it seen with?
Skin disease appearance along the region of trauma often seen in skin conditions such as psoriasis and vitiligo
annular vs arciform skin descriptors
annular is a complete ring, arciform is an incomplete
Herpetiform definition
Random grouping
Zosteriform definition
Grouping in dermatomes
Secondary lesions
Changes in skin which are superimposed or the consequence of the primary process
ABCDE for melanoma
1) Asymmetry
2) Border irregular
3) Color variation
4) Diameter larger than 6mm
5) Elevation or Evolving
Autonomy
Patient’s need for self determination and ability to make their own decisions
Beneficence
Provider’s inherent need to do good
Non-maleficence
Provider’s responsibility to first do no harm
Range of motion tests should be ____ first then ___
Active, passive
Apley’s scratch test
common shoulder physical exam technique to test ROM with flexion, extension, abduction, adduction, internal and external rotations where you have the pt scratch the back superioraly with one arm and inferiorally with the other and then switch
Empty can test looks for what?
Supraspinatus rotator cuff instability
Lift off test looks for what?
Subscapularis rotator cuff instability
Rhomboid test
physical exam test performed by having patient place hand on hip and examiner drives the elbow forward while looking at the shoulder, if scapula wings then rhomboid is likely torn
Neer’s impingement test
Passive flexion upward of the patient’s arm with the forearm pronated as to have the thumb pointed downward toward the ground, pain elicited is positive
Hawkin’s Kennedy test
Physical exam test where The examiner places the patient’s arm shoulder in 90 degrees of shoulder flexion with the elbow flexed to 90 degrees and then internally rotates the arm. The test is considered to be positive if the patient experiences pain with internal rotation
Range of motion on wrist
Flexion, extension, ulnar deviation, radial deviation
Adson’s test
Physical exam test for thoracic outlet syndrome involving sitting patient with examiner extending the shoulder maximally and abducting about 30 degrees, patient turns head toward this same side as far as possible and takes a deep breath and holds it, examiner checks the pulse for drop in strength considered positive
Modified adson test
Has the patient look the opposite way of the arm being tested and take a deep breath and hold to check for pulse drop
Range of motion on elbow
Flexion, extension, pronation, supination
sulcus sign
Physical exam test where the humerus is pulled downward and an indentation of skin forms on the top of the shoulder
Lateral epicondylitis test
Pain elicited in the lateral epicondyle with resisted wrist extension
medial epicondylitis test
Patient with arm extended and supine tries to flex and prontate wrist against resistance from examiner, if pain at the medial epicondyle considered positive
Finklestein’s test
Physical exam test involving wrapping the thumb in the 4 other digits then performing ulnar deviation, if painful then positive for dequarvain’s tenosynovitis
Phalen’s test
Pushing dorsum of the wrists against each other and holding if numbness or pain develops after 30-60 seconds considered positive
Tinel’s sign
tapping either on the carpal tunnel or the ulnar tunnel to see if numbness or tingling or pain elicited to test for carpal or ulnar tunnel
Bouchard’s nodes
Swelling and nodule formation at the PIP joint of the hands indicative of osteoarthritis
Heberden’s nodes
Swelling and nodule formation at the DIP joint of the hands indicative of osteoarthritis
ulnar deviation
Hand deformity where the metacarpophylangeal joints cause the fingers to deviate in the ulnar direction indicative of rheumatoid arthiritis
Swan neck deformity
finding of the finger with the DIP bent and the PIP hyperextended
Boutonniere deformity
finding of the finger with the PIP bend and the DIP hyperextended