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Professional Development > Part 4 > Flashcards

Part 4 Flashcards

1
Q

Physical exam definition

A

Process by which the clinician investigates the body of a patient for signs of disease

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2
Q

Always approach patients from the…

A

right (patient right)

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3
Q

128 Hz tuning fork

A

Larger fork that tests for vibratory sensation

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4
Q

512 Hz tuning fork

A

Smaller tuning fork to allow for Weber & Renne’ hearing test

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5
Q

Pan-optic opthalmoscope

A

Gives a more magnified image of the retina

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6
Q

Diaphragm of stethescope

A

Large dial on end of stethoscope that listens to high pitched sounds

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7
Q

Bell of stethoscope

A

Small dial on end of stethoscope that listens to low pitched sounds

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8
Q

The 5 vital signs (sometimes a 6th is included)

A

1) Temp
2) Blood pressure
3) Respiration rate
4) Heart Rate
5) BMI
6) SOMETIMES Pulse ox

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9
Q

Temperature is regulated by what organ

A

hypothalamus

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10
Q

Normal oral temp

A

98.6F/37c

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11
Q

5 ways to measure temp

A

1) oral
2) Axillary
3) Rectal (patient unconscious, restless, cannot close mouth)
4) Tympanic membrane
5) laser thermometer of the forehead temporal artery

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12
Q

Hypothermic thermometer

A

Accurate for temperatures a normal thermometer is not, below 94 degrees F

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13
Q

Noninfectious causes of pyrexia

A
  • ovulation
  • thyroid storm
  • drug effect
  • trauma
  • cancer
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14
Q

Hyperpyrexia

A

Fever greater than 104 degrees F, typically resulting from infection

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15
Q

Hypothermia

A

Temp less than 95 degrees F, exposure to cold, shock, hypothyroidism, hypoglycemia

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16
Q

6 pulse sites

A

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

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17
Q

Carotid baroreceptor mechanism and nerve responsible

A

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

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18
Q

Sinus tachycardia and some common causes

A

Rapid regular >100 beats, caused by

  • heart disease
  • fever
  • exercise
  • anemia
  • dehydration
  • hyperthyroidism
  • drugs
  • smoking
    -anxiety
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19
Q

Sinus bradycardia and common causes

A

Slow regular <50 bpm, caused by

  • heart disease
  • hypothyroidism
  • irregular electrolytes
  • athlete
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20
Q

Pulsus alternans deinition and cause

A

Alternating strong and weak pulse, indicates left ventricular heart failure

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21
Q

Pulsus bisferiens and cause

A

Biphasic pulse, indicates aortic valve problem

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22
Q

Dicrotic pulse and cause

A

2 distinguishable palpable pulses, indicates low cardiac output

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23
Q

Pulsus parvus et tardus definition and cause

A

Pulse is weak and has late carotid upstroke, caused by aortic valve stenosis

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24
Q

Pulsus paradoxus definition and cause

A

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

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25
Q

Regulator of O2 and CO2 in bloodstream

A

Brainstem - medulla oblongata, pons, midbrain

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26
Q

Kussmaul breathing definition and cause

A

Fluctuating breathing rates, caused by metabolic acidosis

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27
Q

Cheyne stokes respiration and cause

A

Breaths with periods of apnea (strict apnea differentiating from kussmaul), seen in head injuries with brain tumors, or strokes

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28
Q

korotkoff sounds

A

5 phases of taking BP with the start represents systolic and end being silence representing diastolic

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29
Q

Elevated vs narrow pulse pressure and what these could mean

A

Elevated is >60, predictor of arterial stiffness and CVD, narrow is <40, predictor of shock or cardiac tamponade

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30
Q

Koebner phenomenon (isomorphic response) and what 2 conditions is it seen with?

A

Skin disease appearance along the region of trauma often seen in skin conditions such as psoriasis and vitiligo

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31
Q

annular vs arciform skin descriptors

A

annular is a complete ring, arciform is an incomplete

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32
Q

Herpetiform definition

A

Random grouping

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33
Q

Zosteriform definition

A

Grouping in dermatomes

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34
Q

Secondary lesions

A

Changes in skin which are superimposed or the consequence of the primary process

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35
Q

ABCDE for melanoma

A

1) Asymmetry
2) Border irregular
3) Color variation
4) Diameter larger than 6mm
5) Elevation or Evolving

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36
Q

Autonomy

A

Patient’s need for self determination and ability to make their own decisions

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37
Q

Beneficence

A

Provider’s inherent need to do good

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38
Q

Non-maleficence

A

Provider’s responsibility to first do no harm

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39
Q

Range of motion tests should be ____ first then ___

A

Active, passive

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40
Q

Apley’s scratch test

A

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

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41
Q

Empty can test looks for what?

A

Supraspinatus rotator cuff instability

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42
Q

Lift off test looks for what?

A

Subscapularis rotator cuff instability

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43
Q

Rhomboid test

A

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

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44
Q

Neer’s impingement test

A

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

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45
Q

Hawkin’s Kennedy test

A

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

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46
Q

Range of motion on wrist

A

Flexion, extension, ulnar deviation, radial deviation

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47
Q

Adson’s test

A

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

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48
Q

Modified adson test

A

Has the patient look the opposite way of the arm being tested and take a deep breath and hold to check for pulse drop

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49
Q

Range of motion on elbow

A

Flexion, extension, pronation, supination

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50
Q

sulcus sign

A

Physical exam test where the humerus is pulled downward and an indentation of skin forms on the top of the shoulder

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51
Q

Lateral epicondylitis test

A

Pain elicited in the lateral epicondyle with resisted wrist extension

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52
Q

medial epicondylitis test

A

Patient with arm extended and supine tries to flex and prontate wrist against resistance from examiner, if pain at the medial epicondyle considered positive

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53
Q

Finklestein’s test

A

Physical exam test involving wrapping the thumb in the 4 other digits then performing ulnar deviation, if painful then positive for dequarvain’s tenosynovitis

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54
Q

Phalen’s test

A

Pushing dorsum of the wrists against each other and holding if numbness or pain develops after 30-60 seconds considered positive

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55
Q

Tinel’s sign

A

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

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56
Q

Bouchard’s nodes

A

Swelling and nodule formation at the PIP joint of the hands indicative of osteoarthritis

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57
Q

Heberden’s nodes

A

Swelling and nodule formation at the DIP joint of the hands indicative of osteoarthritis

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58
Q

ulnar deviation

A

Hand deformity where the metacarpophylangeal joints cause the fingers to deviate in the ulnar direction indicative of rheumatoid arthiritis

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59
Q

Swan neck deformity

A

finding of the finger with the DIP bent and the PIP hyperextended

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60
Q

Boutonniere deformity

A

finding of the finger with the PIP bend and the DIP hyperextended

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61
Q

Patrick’s FABER test

A

Test for SI joint dysfunction or severe OA of hip, flexion and abduction of the femur, external rotation crossing one leg over the other then putting pressure down onto the knee and the opposing hip

62
Q

Thomas test

A

Physical exam test for flexion contracture of hip

63
Q

How to measure leg length

A

ASIS to medial malleolus bilateral

64
Q

Genu varum definition

A

out bowing knees

65
Q

Genu valgus definition

A

Inward bowing knees

66
Q

Anterior and posterior drawer test

A

With a slightly flexed knee, pushing and pulling on the lower leg to assess the integrity of the ACL/PCL WHILE examiner is sitting on it, not very accurate

67
Q

Lachman’s test

A

Test for ACL laxity or injury involving patient laying flat, knee slightly flexed and supported by examiner’s hands as they draw forward the lower leg

68
Q

Range of motion on ankle

A

Flexion, extension, inversion, eversion, medial and lateral rotation

69
Q

3 tests for meniscal tear and their description

A

1) Thesalay’s test, have pt stand and twist
2) Mcmurray’s test, pt is lying supine and pick up leg and twist it
3) apley’s grind test, have pt lay prone and push and twist at the knee

70
Q

Kleiger’s test

A

Physical exam test for anterior tibiofibular ligament or interosseous membrane of tib fib sprain, involves supporting the tib fib with one hand by examiner and then dorsiflexing and laterally rotating the ankle and if pain occurs up high then needs ortho referral and possible casting to allow healing

71
Q

Talar tilt test

A

Physical exam test to look for sprain of the calcaneofibular ligament or the anterior talofibular ligament involving plantar flexing and inverting the ankle, significant laxity is positive

72
Q

Thompson test

A

squeezing calf to assess achilles tendon integrity

73
Q

Bradypnea vs hypopnea

A

Bradypnea is slow breathing, hypopnea is shallow and infrequent

74
Q

Tachypnea vs hyperpnea

A

tachypnea is rapid shallow breathing, hyperpnea is deep and frequent

75
Q

Hepatic necrotic nail appearance

A

Half and half coloration of nail

76
Q

Anemia appearance of nail

A

White pale color

77
Q

Hypoxia appearance of nail

A

Clubbing

78
Q

Anxiety appearance of nail

A

Bitten

79
Q

Nephrotic syndrome appearance of nail

A

White and pink bands

80
Q

Hypothyroidism appearance of nail

A

brittleness

81
Q

Cranial nerve IV movement

A

Superior oblique, moves eyes inferiorally and convergently

82
Q

Cranial nerve VI movement

A

Lateral rectus, allows movements laterally away from the nose (activated once on each side)

83
Q

Vertical eye defects are usually caused by…

A

…vascular problems

84
Q

Hyperopia

A

Farsightedness, difficulty focusing on a near object

85
Q

Myopia

A

Nearsightedness, inability to focus on distant objects

86
Q

Nystagmus

A

Abnormal movement of eye in the vertical, horizontal, or torsional direction

87
Q

Visual fields by confrontation assessment

A

Have patient cover one eye, hold up different fingers in each quadrant of visual field

88
Q

Frontal sinus development period

A

Do not appear until age 7-8 so no such thing as frontal sinusitis in these children

89
Q

Optic disc

A

Entry point into the retina for ganglion cells forming the optic nerve and small vessels entering the posterior eye, lacks any rods or cones and forms the blind spot of the eye, 3-4mm toward the nasal side of the fovea, has an optic cup central depression within

90
Q

Fovea

A

Small pit of closely packed cones in the eye at the center of the macula of the retina, forming central vision

91
Q

A large optic cup to optic disc ratio (close to 1) indicates…

A

…Glaucoma or other pathology

92
Q

Tonometry

A

Testing of intraocular pressure, either via numbing the eye (contact) or via air puff method

93
Q

Fluorescein eye exam

A

Applied via drops to most medial area of eye, use cobalt blue light to examine eyes with lights dimmed where abrasions will appear yellow

94
Q

Weber tuning fork exam

A

Place tuning fork on top of patient’s head and ask if they hear it equally in both ears or if one is louder, conductive hearing loss sound is heard in impaired ear, sensorineural hearing loss, sound is heard in good ear

95
Q

Rinne tuning fork exam

A

Place sound through bone until they lose it, then move to ear, if they can still hear than normal hearing or sensorineural hearing loss, if conductive hearing loss bone is as long or longer than airr

96
Q

Indirect percussion, plexor versus pleximeter

A

Plexor is the finger doing the tapping, pleximeter is the finger receiving the tap, important to strike the same location with the same technique

97
Q

Pyrexia vs hyperpyrexia

A

Pyrexia is body temp above 98.6 Fand 37C but below hyperpyrexia, hyperpyrexia is temp greataer than 41.1C or 106F,

98
Q

Hypothermia

A

Body temp below 35 C or 95 F

99
Q

Biot’s breathing

A

Unpredictable irregular breathing, shallow, deep, stopping for periods, sign of respiratory depression or brain damage at medullary level

100
Q

Auscultory gap

A

Silent period present between blood pressure reading between systole and diastole, indicative of arterial stiffness

101
Q

Review of systems order and acronym

A 
General Endo Head Loves Brass, Crass and Gas to Pass Near the Mass
General
Endocrine
HEENT
Lungs
Breast
Cardiovascular
Abdominal/GI
Genitourinary
Psychological
Neurological
Musculoskeletal
102
Q

Q angle

A

Angle formed from the vertical of the inward displacement of the thigh and legs,larger in females than males generally

103
Q

Patient with nephrotic syndrome facial features

A

Periorbital edema, puffy pale face

104
Q

Patient with cushing syndrome facial features

A

Red cheeks, moon face, hirsutism, buffalo hump on back of neck

105
Q

Patient with acromegaly facial features

A

Prominant jaw, soft tissues of nose, ears, and lips enlarged, prominant brow

106
Q

Presbyopia

A

Hyperopia (farsightedness) occuring with age

107
Q

Inferior oblique muscle moves the eye….

A

….upward and inward

108
Q

Buccul gingival sulcus

A

Space where gums lining meet the inside of the cheek lining

109
Q

The uvula deviates to which side when there is a weakness? What about the tongue?

A
  • Uvula to the opposite side to which the lesion is (vagus nerve)
  • Tongue to same side the lesion is (hypoglossal nerve)
110
Q

RALS system

A

Determines the orientation of the pulmonary arteries in the hilus of the lung, with the right lung having anterior placed 2 pulmonary arteries to the main bronchus and the left lung having superior 1 placed pulmonary artery to the main bronchus

111
Q

The left side has ____ bronchial arteries, the right side has ___

A

2, 1

112
Q

Which bronchus has a more direct path to the lung?

A

Right

113
Q

Where is the carina of the bronchus located?

A

Directly behind the sternal angle, about the 2nd rib

114
Q

Pectus excavatum and carinatum

A

caved in chest vs outward bowing chest wall

115
Q

Vesicular breath sounds definition and where they can be heard

A

Normal breath sounds at a higher pitch with a longer inspiratory and shorter expiratory phase, heard throughout most of lung fields and not the sternal borders

116
Q

Bronchial breath sounds definition and where they can be heard

A

Normal breath sounds at a lower pitch with a longer expiratory phase and shorter inspiratory phase, heard over large airways, between the scapulae, or on the sternum best

117
Q

Rales breath sound definition and what it indicates (3 things)

A

Adventitious breath sound like a cracking pop indicating atelectasis, chronic bronchitis, or COPD

118
Q

Rhonchi breath sound definition and what it indicates (2 things)

A

Adventitious breath sound like snoring rough coarse sound indicating bronchitis or COPD

119
Q

Bronchovesicular breath sounds definition and where they can be heard

A

Normal breath sound at medium pitch with equal length inspiratory and expiratory phases, heard best between scapula

120
Q

Diaphragm normal size measured during diaphragmatic excursion

A

3-5 cm

121
Q

Wheeze breath sound definition and what it indicates (3 things)

A

Adventitious breath sound like high pitched squeal with musical quality indicating asthma, bronchitis, or COPD

122
Q

Bronchophony

A

Amplification of sound by fluid in a certain space, heard when ascultating by having a patient say 99, it will be louder where there’s consolidation

123
Q

Egophony

A

Alteration of sound heard when auscultating by having a patient say eeee and you may hear aaaa if egophony is present, indicative of lung or pleural disease

124
Q

Whispered Pectriloquy

A

Loudness due to consolidation tranmission of sound by having a patient whisper 99 while ausculatating, should be barely heard in healthy lungs

125
Q

Bronchitis findings on lung exam

A
  • Tachypnea
  • rhonchi and rales
  • clears up with cough
126
Q

Mitral valve is on the ___ side of the heart and part of the__ circulation, what is the tricuspid?

A

Left, systemic, right, pulmonary

127
Q

Apex of heart location

A

5th intercostal space mdiclavicular line on left side

128
Q

PMI

A

Point of maximal impulse, typically same as apical impulse in a healthy individual

129
Q

S1 heart sound

A

Closure of mitral and tricuspid valves at the beginning of systole

130
Q

S2 heart sound

A

Closure of aortic and pulmonic valves at the end of systole indicating the beginning of diastole

131
Q

S3 heart sound and associated pathology

A

Also known as an early diastolic sound heard quickly after S2, indicates heart failure, large ventricle, and ventricular dysfunction most of the time except in young people

132
Q

S4 heart sound and associated pathology

A

Also known as a latae diastolic sound heard shortly before S1, indicates atria trying to push blood into a noncompliant ventricle, causes include diastolic dysfunction and LV hypertrophy

133
Q

Aortic area cardiac exam

A

Right 2nd intercostal space

134
Q

Pulmonic area cardiac exam

A

Left 2nnd intercostal space

135
Q

Tricuspid area cardiac exam

A

4th left intercostal space

136
Q

Mitral or apex area cardiac exam

A

5th left intercostal space, midclavicular line

137
Q

Erb’s point cardiac exam

A

Left 3rd intercostal space, left sternal border

138
Q

Systolic vs diastolic heart murmurs

A

Systolic are often benign and present in 60% of people, diastolic is always pathology

139
Q

Murmur scale heart

A

1-4 diastolic, 1-6 systolic
1 very faint
2 loud enough to be obvious
3 louder than 2
4 has thrill
5 heard with stethoscope partially off chest with thrill
6 heard with stethoscope completely off chest with thrill

140
Q

What value for JVP’s measured from sternal angle is considered elevated

A

> 3cm

141
Q

Leaning patient forward and listening at the aortic area while they hold their breath exhaled tests for….

A

….aortic stenosis

142
Q

Left lateral decibutus and listening to the mitral area tests for….

A

….mitral stenosis

143
Q

Virchow’s triad and what it indicates

A

Intimal trauma
coagulopathy, hypercoagulable state
venous stasis

Indicates DVT

144
Q

Neurogenic claudication

A

Indicative of spinal stenosis, improves leaning forward

145
Q

Subclavian steal syndrome

A

Stenosis of subclavian artery between the common carotid and vertebral arteries, with exertion causes blood to reverse flow leading to vertebrobasilar insuffiency and sometimes causing syncope

146
Q

ABI index

A

Measurement of systolic blood pressure with doppler ultrasound in each arm then in dorsal pedis and posterior tibial, should get higgher ankle pressure than arm by dividing ankle/arm, .9-1.3 is normal, .410.9 is mild pvd, 0-.41 is severe pvd

147
Q

How to record pulse

A 
4- boudning
3- increased 
2- brisk 
1- weak 
0- abscen
148
Q

Allen’s test

A

Shows interconnection between between superfical and deep palmar arch arteries still intact between radial and ulnar part of hand by occluding and then testing

149
Q

Elevated protein and globulin levels, other than repeating these what should you do if persistently high?

A

Protein electrophoresis, evaluate for monoclonal gammopathy of undetermined significance (MGUS)

150
Q

classic pheo triad and what is important to know about it?

A

Episodic headache, sweating, and tachycardia, most patients do NOT have these 3 classic symptoms

Professional Development (21 decks)

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