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JG > PD block 1 > Flashcards

PD block 1 Flashcards

1
Q

otoscope

A

provides illumination for examining the external auditory canal and the tympanic membrane.

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2
Q

ophthalmoscope

A

has system of lenses and mirrors to visualize the interior structures of the eye.

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3
Q

ophthalmoscope apertures large

A

large aperture – (most commonly used) produces a large round beam

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4
Q

sphygmomanometer

A

a device used to manually measure blood pressure with the use of a stethoscope. The inflatable bladder restricts blood flow, measurements of pressure are recorded when blood flow is just starting and when it ceases to be unimpeded.

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5
Q

thermometers

A

used to measure body temperature which can be a clue to a pt’s illness/current state

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6
Q

oral temp

A

oral – placed under the tounge (98.6) (abnormal >100)

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7
Q

rectal temp

A

rectal – commonly used for infants for accurate reading. (99.6) (abnormal >101)

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8
Q

axillary temp

A

axillary – held between body and arm. (97.6)

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9
Q

tympanic temp

A

tympanic – used in the ear – tympanic membrane shares blood supply with hypothalamus. (99.6) (abnormal >101)

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10
Q

stethoscope

A

can be acoustic, magnetic, or electronicb. Bell – Low pitched sounds – light pressure (harder to hear sounds)c. Used to listen to heart and adnominal sounds Diaphragm – high pitched sounds – firm pressure

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11
Q

Snellen visual acuity

A

a. Used for screening and examination of far vision for literate, English, verbal adults and school aged childrenb. Recorded as a fraction – numerator = # of feet between chart and pt. and denominator = distance from which a normal person can read the lettering

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12
Q

Rosenbaum visual acuity charts

A

used to test near vision at distance of 14 in.

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13
Q

512 tuning fork

A

auditory evaluation via estimating hearing loss in the range of normal speech. This is the lowest intensity of sounds at which an auditory stimulus can be heard.

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14
Q

128 tuning fork

A

vibratory sensation applied to bony prominence the patient should feel the vibration/tingling.

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15
Q

percussion hammer

A

used to test deep tendon reflexes, tap should be brisk and direct

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16
Q

tape measure

A

used to determine circumference, length, diameter. Pull tape tightly without causing depression in skin.

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17
Q

transilluminator

A

strong light source with narrow beam directed into body cavity to differentiate between various media present in that cavity (air, fluid, tissue). Place beam of light directly against area to observe the presence or absence of illumination and any irregularities.

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18
Q

palmar surface palpation

A

used for distinguishing size and texture. Any examination that requires fine detail/texture should be done with palmar surface. More nerve endings on this portion of the hand.

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19
Q

ulnar surface palpation

A

used for detection of vibration

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20
Q

dorsal surface palpation

A

used for detection of temperature. better than palmar surface because your own body heat does not interfere.

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21
Q

Diaphragm sounds

A

best for high-pitched sounds (heart sounds and abdominal/bowel sounds)with firm pressure skin converts bell to a diaphragm end piece

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22
Q

Bell Sounds

A

best for low-pitched sounds when light pressure is used

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23
Q

bruits -

A

turbulent blood flow through artery & heart

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24
Q

murmurs

A

turbulent blood flow through heart valve)

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25
Q

normal pulse

A

Normal: 60-100 beats per minute

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26
Q

resting pulse

A

number of heart beats per minute while at complete rest; generally 60-100 beats per minute; average 70 bpm; this can vary widely based on general health and fitness, age, underlying medical conditions

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27
Q

Tachycardia pulse

A

pulse rate>100 beats per minutefever, anxiety, drugs, anemia, exercise, HYPERthryroidism

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28
Q

Bradycardia: pulse

A

rate<60 beats per minuteHYPOthyroidismdrugs, physical shape, hypothermia

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29
Q

tachycardia

A

If oxygen demand or metabolic activity increases, blood volume decreases, the body is working, or the sympathetic nervous system is activated (stress, certain drugs), this can induce tachycardia

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30
Q

bradycardia

A

While the body is at rest there is less oxygen demand and metabolic activity, so the pulse rate decreases. Parasympathetic stimulation and certain drugs can decrease the heart rate significantly below a normal resting heart rate.

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31
Q

Korotkoff sounds. (Seidel/Mosby pg 54-55)

A

Low-pitched sounds produced by turbulence of blood flow in the artery

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32
Q

ausculatory gap

A

Korotkoff sounds may disappear 10-15 mmHg below first systolic reading = this is normal and called the ausculatory gap

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33
Q

First and Second Korotkoff sounds

A

First two audible consecutive beats indicate systolic pressure reading and beginning of Korotkoff soundswhen the Korotkoff sounds disappear, this is the second diastolic sound

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34
Q

Guarding

A

: protective behavior, distorted posture, reluctance to be moved

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35
Q

Facial mask of pain:

physical pain behavior

A

lackluster eyes, wrinkled forehead, tightly closed or opened eyes, fixed or scattered movement

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36
Q

Vocalizations:

physical pain behavior

A

grunting, groaning, crying, talkative patient becomes quiet

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37
Q

Body movements

physical pain behavior

A

:head rocking, pacing or rubbing; an inability to keep the hands still

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38
Q

Changes in vital signs: Pain

A

blood pressure, pulse, respiratory rate and depth, with acute onset of pain. Fewer changes in vital signs are found in patients with persistent pain or after they adapt to acute pain.

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39
Q

Facies:

A

expression or appearance of the face and features of the head and neck indicating a clinical condition or syndromecertain conditions impart a “classic” physical appearance to the face indicating an underlying disease or syndrome. In GA, facies can be used to diagnose condition or syndrome (most often an endocrine disorder, but could be congenital or infectious disease). (PKM lecture on GA)

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40
Q

Hyperthyroid disease

A

exopthalamos (prominent eyes, lid retraction)

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41
Q

Sclera

A

The outer layer of the posterior eye, which is a dense, avascular structure. It supports the internal structure of the eye. It also encases the Optic nerve

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42
Q

optic nerve

A

Optic nerve, which passes through the optic foramen along with the ophthalmic artery and vein, sends signals to the CNS.

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43
Q

cornea

A

The Cornea is the outer layer of the anterior eye. It is continuous with the Sclera. It is optically clear, has rich sensory innervations, and is also avascular.

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44
Q

Uveal Tract

A

The Uveal tract consists of the Iris, Ciliary body, and Choroids. T

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45
Q

Iris

A

(the color of the eye) is a circular, contractile muscular disc that controls the amount of light that is able to reach teh retina.

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46
Q

pupil

A

The central aperture of the iris is the pupil, which light travels to the retina.

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47
Q

ciliary body

A

The ciliary body produces the aqueous humor (fluid that circulates between the lens and cornea) and contains the muscles that control accommodation.

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48
Q

Choroid

A

The Choroid is a pigmented, richly vascular layer that supplies oxygen to the outer layer of the retina.

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49
Q

lens

A

The Lens is a biconvex, transparent structure located behind the iris. It is supported by fibers that come from the ciliary body. It is highly elastic, and contraction or relaxation of the ciliary body changes its thickness, allowing images of various distances to be focused by the retina.

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50
Q

Retina

A

The Retina is the sensory network of the eye. It transforms light impulses into electrical impulses, which are transmitted through the optic nerve, optic tract and optic radiation to the visual cortex of the brain, the cerebral cortex. Other landmarks of the retina include the optic disc, where the optic nerve originates, together with the central retinal artery and vein. The Macula, or fovea is the site of central vision.

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51
Q

eyelid

A

The eyelid is composed of skin, striated muscle, the tarsal plate and conjunctivae. Meibomian glands provide oils to the tear film. The tarsus provides a skeleton to the lid. The eyelid distributes tears over the surface of the eye, limits the amount of lights entering it, and protects the eye from foreign bodies.

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52
Q

The Conjunctiva

A

is a clear, thin mucous membrane. The palpebral conjunctiva is the part of the conjunctiva that coats the inside of the eyelid. The bulbar conjunctiva is the part that covers the outer surface of the eye. The conjunctiva should be observed for erythema and exudate.

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53
Q

Eye Muscles

A

superior, inferior, medial, and lateral rectus muscles. superior and inferior oblique muscles, which allow you to move your eyes at an angle.

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54
Q

The Lacrimal Gland

A

is located in the temporal region of the superior eyelid and is responsible for tear production.

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55
Q

Head Bones

A

made up of 7 bones: frontalx2, parietalx2, occipital, temporalx2;

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56
Q

Face Bones

A

mandible, maxilla, zygomatic, sphenoid, lacrimal, and nasal bones.

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57
Q

Externally visible head tissue

A

Eyes (inner&outer canthus), nose (ala, nares, philtrum, nasal bridge), Ears (tragus, pinna)

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58
Q

landmarks on face

A

palpebral fissures, eyelids, eyebrows, nasolabial fold, mouth

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59
Q

neck location

A

begins at base of skull, ends at clavicles/sternum.

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60
Q

neck formed by

A

cervical vertebrae, ligaments, sternocleidomastoid muscle, and trapezius muslce

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61
Q

neck contains

A

trachea, esophagus, jugular veins, carotids, and thyroid.

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62
Q

cyanosis:

A

bluish; lack of oxygen or circulation

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63
Q

pallor:

A

unhealthy/pale skin;

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64
Q

leukonychia:

A

white spots on the nail plate; cuticle manipulation or mild trauma

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65
Q

paronychia:

A

infection or disease around the nail; pain, swelling, redness

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66
Q

koilonychia:

A

“spoon nail”; nail takes on a spoon-like appearance; can be due to anemia, hypothyroidism

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67
Q

nail pitting:

A

small pock-mark type indentations in the nail; psoriasis

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68
Q

peau d’orange:

A

on the breast; skin puckers and resembles an orange peel; lymphatic blockage or advanced breast cancer

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69
Q

edema/dependent edema:

A

swelling/ extracellular fluid accumulation; in dependent edema, the fluid remains in low points (i.e. the lower extremities); can be due to cardiac insufficiency

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70
Q

striae:

A

skin irregularity that resembles stripes; many causes and presentations (stretch marks, endocrine disorders, etc.)

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71
Q

alopecia:

A

hair loss

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72
Q

onycholysis:

A

spontaneous painless separation of the nail from the bed; trauma, medications, infection, many causes

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73
Q

varicosities:

A

varicose (enlarged, twisted) veins; due to failure of the valves to prevent backflow; often seen in superficial veins in lower extremities

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74
Q

Beau’s lines:

A

horizontal/transverse grooves on nail plate; infection, trauma, systemic disease, many causes

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75
Q

hirsutism:

A

(females) the growth of terminal hair in patterns normally associated with male hair distribution (facial hair, increased body hair); associated with endocrine disorder

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76
Q

clubbing:

A

instead of growing (relatively) flat and straight, the nail angle increases, leading to a club-like appearance; can be due to prolonged cardiac or respiratory disease or can be idiopathic

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77
Q

sensorineural hearing loss

A

-PERMANENT-Associated with damage to cochlear hair cells or auditory nerve-EX: old age, noise-induced hearing loss, trauma, chemotherapy, radiation, genetics, etc.-Typically addressed with hearing aids

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78
Q

conductive hearing loss

A

-NOT TYPICALLY PERMANENT-Associated with any obstruction of sound transmission-EX: fluid in middle ear, ear infections, holes in TM, abnormal bone growth, cerumen impaction, etc.-Typically addressed with medical intervention or surgery (most cases are NOT permanent)

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79
Q

Normal respiration range for adults

A

12 to 20 breaths per minute

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80
Q

Wood’s light

A

used to dx fungal infections(epidermal hypo and hyper pigmented lesions, distinguish fluorescing lesions)

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81
Q

Diascopy

A

blanchabilty of a lesion - differentate between vascular (inflammation), nonvascular (nevi), or hemorrhagic (petechia)

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82
Q

Direct microscopy

A

samples of flaked skin (scales) - used to determine if fungal infection is present

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83
Q

4 types of biopsy

A

shave, punch, incisional, excisional

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84
Q

Type of test used for allergy testing

A

patch or prick test

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85
Q

Wood’s light

A

used to dx fungal infections(epidermal hypo and hyper pigmented lesions, distinguish fluorescing lesions)

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86
Q

Diascopy

A

blanchabilty of a lesion - differentate between vascular (inflammation), nonvascular (nevi), or hemorrhagic (petechia)

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87
Q

Direct microscopy

A

samples of flaked skin (scales) - used to determine if fungal infection is present

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88
Q

4 types of biopsy

A

shave, punch, incisional, excisional

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89
Q

I P P A

A

InspectionPalpation Percussion Auscultation

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90
Q

5 types of notes produced by percussion:

A

1) Tympanic2) Hyperresonant3) Resonant4) Dull5) Flat

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91
Q

Tympanic percussion tone:

A

Loud, drumlike, gastric bubble

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92
Q

Hyperresonant percussion tone:

A

Abnormal, very loud, boomlike, Emphysematous lungs

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93
Q

Resonant percussion tone:

A

Loud, Hollow, Healthy lung tissue

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94
Q

Dull percussion tone:

A

Thudlike, Over liver

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95
Q

Flat percussion tone:

A

soft, Over muscle

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96
Q

3 phases of hair growth:

A

I. Anagen: the phase of active growth. Last approximately 3-4 years. Approximately 84% of the scalp follicles are in anagen growth.II. Catagen: the phase that marks follicular regression. Last approximately 2-3 weeks. 1-2% of scalp follicles are in catagen phase.III. Telogen: the phase that represents a resting period. Lasts approximately 3 months. 10-15% of scalp follicles are in telogen phase.

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97
Q

Traditions of PE

A

–Usually conducted from pt’s R side –Pt usually seated or supine– Reposition yourself and pt as neededlet pt talksit downexercise a chaperone

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98
Q

Pattern of PE

A

IPPA:InspectionPalpationPercussionAuscultation(specifics are discussed on other cards)

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99
Q

Epidermis

A

Topmost, thin layer of skin, made of 3 sub-layers:–Stratum corneum (horny layer): sheds dead keratinocytes from below; keratin is waterproof, protects–Cellular stratum: melanocytes (pigment) + keratinocytes (makes protective keratin)–Basal layer/basement membrane: continually makes new keratinocytes that migrate upward every 4 weeks

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100
Q

Dermis

A

–Middle of 3 layers–Richly vascular and innervated, hair follicles, sweat glands–Supports and separates epidermis from cutaneous adipose–Elastin, collagen, reticulum : strength, stretchiness

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101
Q

Hypodermis (aka subcutis, aka subcutaneous)

A

Deepest of 3 layers–Collagen + fat: shock absorber, generates heat/insulation

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102
Q

Hair shaft

A

The section of hair that protrudes above the level of the skin (from follicle up)

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103
Q

Apocrine glands

A

–Larger and deeper than eccrine glands–Found only in the axillae, nipples, areolae, anogenital area, eyelids, external ears–Secrete odorless white fluid (“apocrine sweat”) w/ protein, carbohydrates, etc (not stinky in and of itself; it’s bacterial metabolism that makes BO)

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104
Q

Eccrine glands

A

–Sweat glands that open directly onto surface of skin–Regulate body temperature by secreting water

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105
Q

Nail plate

A

–The hard, visible part of the nail –Made of keratin–What you apply polish to when you paint your nails

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106
Q

Three segments of hair follicle

A

–Lower = bulb and suprabulb(from the base of follicle to insertion of erector pili muscle)–Middle = isthmus(short section that extends from insertion of erector pili muscle to entrance of sebaceous gland duct)–Upper = infundibulum(from entrance of sebaceous gland duct to follicular orifice)

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107
Q

Paronychium

A

–Skin at the lateral edges of the nail plate–Like eponychium, but laterally instead of at the base of nail–Infection = paronychia

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108
Q

Sebaceous gland

A

Secrete sebum (lipid-rich, keeps skin from drying out)

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109
Q

Hair root

A

–Round area at base of hair shaft–Houses the hair matrixNote: Follicle = root + its covering

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110
Q

Hair follicle

A

–The root and its covering–Three segments:-Lower = bulb and suprabulb, from the base of follicle to insertion of erector pili muscle-Middle = isthmus, short section that extends from insertion of erector pili muscle to entrance of sebaceous gland duct-Upper = infundibulum, from entrance of sebaceous gland duct to follicular orifice

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111
Q

Three segments of hair follicle

A

–Lower = bulb and suprabulb, from the base of follicle to insertion of erector pili muscle–Middle = isthmus, short section that extends from insertion of erector pili muscle to entrance of sebaceous gland duct–Upper = infundibulum, from entrance of sebaceous gland duct to follicular orifice

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112
Q

amastia

A

absence of breast tissue. May be due to rare congenital abnormality, or more often a bilateral mastectomy.

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113
Q

lactation

A

production and release of milk by mammary glands.

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114
Q

polymastia

A

The condition of having more than two breasts

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115
Q

galactorrhea

A

Lactation not associated with childbearing. Often due to a disruption of communication between the hypothalamus and pituitary glands which leads to elevated levels of prolactin, a hormone that stimulates milk production.

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116
Q

mastalgia

A

pain in the breast. May be due to hormonal fluctuations (e.g. menstrual cycle), trauma, cyst, infection.

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117
Q

inverted nipple(s)

A

nipple(s) that are retracted/tucked inward. May affect one or both nipples and can be congenital or acquired. If acquired, can be suggestive of inflammatory or malignant tissue.

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118
Q

everted nipple(s)

A

nipple(s) that point outward; most nipples have this appearance

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119
Q

gynecomastia

A

enlargement of breast tissue in males. May occur briefly at birth, briefly around puberty, or in adults >50 years old. Causes include hormonal stimulation (e.g. maternal hormones in newborns), pituitary or testicular tumors, excess body fat (causes increased estrogen production), medications.

120
Q

Montgomery’s tubercles

A

sebaceous glands in the areola that produce oily secretions to lubricate and protect the nipple

121
Q

supernumerary nipple

A

congenital accessory breast tissue, that may or may not contain glandular tissue. Located along the “milk line” an embryonic ridge that stretches from the from the axilla to the groin; most frequently found inferior to the “normal” breast. More common in black women than white women.

122
Q

Physiologic factors influencing arterial blood pressure.

A

BP is affected by three factors:
a. stroke volume (amount of blood pumped by left ventricle in one contraction)
b. heart rate (beats per minute)
c. peripheral vascular resistance (resistance to expansion of vessel walls by circulating blood)
Conditions that affect one of the above factors influence blood pressure: exercise, diet (e.g. sodium), alcohol/drugs, caffeine, stress/anxiety, weight, pain, fever, vascular resistance (e.g. atherosclerosis).

123
Q

diaphragmatic respirations

A

synonymous with “abdominal respirations”, “belly breathing”; the diaphragm does most of the work while the chest wall muscles are mostly a rest; normal, quiet breathing

124
Q

abdominal respirations

A

synonymous with “diaphragmatic respirations”, “belly breathing”; the diaphragm does most of the work while the chest wall muscles are mostly a rest; normal, quiet breathing

125
Q

thoracic respirations

A

performed entirely by expansion of the chest by using the chest wall muscles; the abdomen does not move

126
Q

paradoxic breathing

A

a portion of the chest wall sinks inward with each inspiration, common with chest trauma; also a condition seen in diaphragm paralysis when the diaphragm ascends during inspiration

127
Q

hyperpnea

A

rapid and deep respirations >20 breaths per minute

128
Q

apnea

A

literally “no breathing”, the absence of spontaneous respiration

129
Q

tachypnea

A

literally “rapid breathing”, faster than normal respirations >20 breaths per minute

130
Q

bradynea

A

literally “slow breathing”, slower than normal

131
Q

hyperventilation

A

can be due to tachypnea, hyperpnea or both; an increased amount of air enters the lungs, which results in lowered CO2 levels

132
Q

Cheyne-Stokes repirations

A

periodic breathing; repetitive pattern of apnea followed by gradual increasing depth and frequency of respirations

133
Q

Kussmaul breathing

A

rapid, very deep, labored and gasping respirations associated with metabolic acidosis

134
Q

7 dimension of a complaint

A

LocationqualitySeverityTimingContextmodifying factorsassociated symptoms

135
Q

IPPA Inspection

A

use all sensesassess for shape, color, size, symmetry, moisture, intactuse appropriate lighting

136
Q

IPPA Palpation palmar

A

fine details/textures, mobility

137
Q

IPPA Palpation Dorsal

A

temperature

138
Q

IPPA Palpation Ulnar

A

vibrations

139
Q

IPPA Percussion

A

increased density, decreased sound

140
Q

IPPA Percussion Plexor and Pleximeter

A

Plexor dominate hand, Pleximeter - hand that gets struck

141
Q

IPPA Ausculation

A

quiet room, bare skin, ID Characteristics of each sound. Always last exp for ABD.

142
Q

Heart Rate

A

radial pulse15x4irregular do for 1 mincheck amplitude 0-4, 2 is normal.

143
Q

heart rate can identify

A

distress, anxiety, drugs, cardio and neuro state, psychogenic

144
Q

temp can indicate

A

illness or infection

145
Q

respiration can indicate

A

signs of distress, brady/tachy, use of accessory muscles

146
Q

respiration normal

A

12-20 /min

147
Q

blood pressure can indicate

A

peripheral measurement of cardiovascular disease

Represents force of blood against arterial wall

148
Q

heigh/weight

A

development

149
Q

BMI normal

A

18-24

150
Q

Hypothermia

A

radiation, conduction, vaporization (sweating), respiratoryLess than 95

151
Q

Hyperthermia

A

fever, metabolic process, environment, activity, hot drinksgreater than 100

152
Q

Pulse rate

A

of contractions/min

153
Q

pulse rhythm

A

regular (predictable pattern) irregular (not) assess for 1 min

154
Q

Pulse deficit

A

absence of palpable pulse for 1+ heartbeatsweaker pulse on one sidedifference btwn apical and radial pulse

155
Q

Apical Pulse

A

pulse at Apex (bottom) of heart5-6 intercostal space

156
Q

Pulse amplitude

A

force which bolus of blood moves through artery 0-4, 2 is normal

157
Q

pulse pressure

A

difference btwn systolic and diastolic S-D=force generated with each contractionnormal - 30-50 mmhg

158
Q

Pulse paradoxus

A

exaggerated decrease in amplitude of pulsation with inspirationincrease during expiration

159
Q

Purpose of taking heart rate (pulse)

A

Number of cardiac cycles/minute may give clues to cardiovascular or neurologic status, psychogenic factors, or drug use

160
Q

Adult average pulse

A

60-90 bmp

161
Q

Standard “normal” temperature range for adults

A

97.3 - ~99.5 (oral)

162
Q

Most average (oral) temperature

A

98.6F/37C (decreases with age)

163
Q

Average rectal temperature

A

99.6

164
Q

Average axillary temperature

A

97.6

165
Q

Average tympanic membrane temperature

A

99.6

166
Q

Most accurate temperature measurement method

A

rectal

167
Q

How to take respiratory rate

A

Without patient’s knowledge, observe rise and fall of chest for 15 seconds. Multiply x 4. May be performed while still holding wrist after taking pulse.

168
Q

Normal respiratory rate range for adults

A

12-20 respirations/minute

169
Q

4 parameters to assess for respiration

A

(1) respiratory rate (2) respiratory pattern (3) respiratory depth (4) signs of distress

170
Q

Signs of distress in respiration

A

nasal flaring, cyanosis, labored breathing, tensed accessory muscles, wheezing, tachypnea or bradypnea

171
Q

Adult blood pressure range

A

<90

172
Q

Systole

A

Maximal ventricular contraction (top number)

173
Q

Diastole

A

Maximal ventricular relaxation (bottom number)

174
Q

Cardiac outout

A

Stroke volume x heart rate

175
Q

Stroke volume

A

Blood pumped by left ventricle in 1 contraction

176
Q

How to measure cuff size for BP

A

Bladder length must cover 80% circumference of upper arm, width should be ⅓ - ½ circumference

177
Q

How to take BP

A

Locate brachial artery and center cuff (arrow toward) arteryWhile palpating radial pulse, inflate cuff until pulse disappears, deflate cuffRe-inflate cuff to 20-30 mm Hg above reading when pulse disappeared (this is the auscultatory gap)Deflate cuff slowly, note mm Hg when Korotkoff sounds start and stopRepeat in other arm (right tends to be higher)

178
Q

What can affect BP?

A

Anxiety, hyper/hypotension, vascular resistance, pain, fever, weight, lifestyle, caffeine, alcohol, drugs

179
Q

BMI formula

A

weight (kg) / height (m^2)

180
Q

Describe the auscultatory gap, method for obtaining it, and the clinical usefulness of it

A

The auscultatory gap is the period of silence between the Korotkoff sounds Phase 1 and Phase 2. It’s obtained by palpating the blood pressure and adding 20-30 mm Hg to the systolic number. This is useful because it prevents providers from being misled into underestimating the systolic or overestimating the diastolic

181
Q

What is the most appropriate time in the female menstrual cycle to perform a breast exam?

A

The week after menses. hormonal changes are least noticeable during this time (breast enlargement, tenderness, increased nodularity)

182
Q

Korotkoff sounds

A

Low-pitched sounds produced by turbulence of blood flow in the artery

183
Q

T/F: Korotkoff sounds are best heard with the bell of a stethoscope.

A

True, they are LOW-pitched (light pressure with “tunable” stethoscope)

184
Q

Stated Age vs. Apparent Age

A

Stated age is the patient’s chronological age.Apparent age is based off appearance, may be older, younger or equal to stated age.

185
Q

Level of toxicity

A

Most important in assessing an ill patient. Only mention if the patient is ill; not mentioned if patient is not ill. How sick does the patient appears to you; toxic vs nontoxic appearing.

186
Q

Acutely ill vs. chronically ill

A

Acute: sudden, temporary onset of symptoms.Chronic: longer, more generalized pain.

187
Q

Affect appropriate for situation

A

Assessing a patient’s mood and behavior. Behavior should usually be cooperative and friendly.

188
Q

Level of alertness

A

Patient’s ability to interact and respond to you.

189
Q

Orientation

A

Patient’s ability to recognize where the pt is, who the pt is and what time it is.

190
Q

Tanner Stage

A

Stages of sexual development in males and females beginning with the adolescent stage through adult stage. Breast development is measured from M1-M5. Pubic Hair development in both males and females is measured from P1-P6. Testes/Scrotum development is measured from G1-G5.

191
Q

What BMI is considered obese?

A

30-39.9

192
Q

What does cachectic mean?

A

Looks like pt is at the end of his/her lifetime; physical wasting

193
Q

Weber test- purpose?

A

Helps to assess unilateral hearing loss

194
Q

Weber test- procedure?

A

Place a vibrating tuning fork on the middle of the patient’s head, ask the patient if the sound is heard, ask if sound is heard equally in both ears or better in one. Check this by covering one ear and asking again which ear sounds better (the occluded ear should sound better).

195
Q

Weber test- what is expected with conductive hearing loss?

A

The sound is heard better in the bad ear.

196
Q

Weber test- what is expected with sensorineural hearing loss?

A

The sound is heard better in the good ear.

197
Q

Rinne test- purpose?

A

Helps distinguish whether patient hears better by air or bone conduction

198
Q

Rinne test- procedure?

A

Place vibrating tuning fork against patient’s mastoid bone, ask patient if sound is heard, have patient tell you when they no longer hear the sound (count seconds), then move 1-2cm in front of ear, ask patient’s if they can hear it, then have the patient tell you when they no longer hear the sound (count seconds)

199
Q

Rinne test- expected/normal results?

A

Aka Rinne positive findings.AC>BC in 2:1 ratio

200
Q

Rinne test- what is expected with conductive hearing loss?

A

Aka Rinne negative findings.BC>AC on affected side

201
Q

Rinne test- what is expected with sensorineural hearing loss?

A

AC>BC but less than a 2:1 ratio

202
Q

Whisper test- procedure?

A

Occlude patient’s untested ear, stand out of line of vision about 1-2 ft away from side being tested (open ear), whisper word with 2 syllables, ask patient to repeat the word, move to other side and do the same with different words, ask patient to repeat the word, exhale fully to produce whisper sound.

203
Q

Audiogram- what is it?

A

Audiogram is a graphical display of the hearing tests, graphing frequency (in Hz) vs the intensity/loudness of sounds (in dB).

204
Q

Audiogram- what’s the purpose?

A

It is used to show the amount of hearing loss that an individual has for each ear.

205
Q

Diaphragmatic breathing

A

Movement of the diaphragm responding to intrathoracic pressure.

206
Q

Abdominal breathing

A

Involves contraction of the diaphragm responding and the use of abdominal muscles resulting in the expansion and recoil of the abdominal walls.

207
Q

Thoracic breathing

A

The result of the use of intercostal muscles.

208
Q

Define and discuss Korotkoff sounds.

A

The low-pitched sounds produced by the turbulence of the blood flow in the artery (pg. 439 Mosby’s). Korotkoff divided the heart sounds heard while taking a BP into 5 phases:
• Phase 1: two consecutive beats indicate the systolic pressure.
• Phase 2: a period of silence know as the auscultatory gap. The gap should be about 10-15 mm Hg from the phase 1 sounds to the phase 3 sounds. Variability in the size of the gap can indicate cardiac abnormalities.
• Phase 3: Crisp heart sounds return.
• Phase 4: Heart sounds become muffled. This is first diastolic number.
• Phase 5: Heart sounds disappear. This is the second diastolic number. The second diastolic number is the one most commonly reported.

209
Q

physiologic factors influencing arterial blood pressure.

A

Stroke volume (strength of contractions and volume of circulating blood)
• Heart rate
• Peripheral Vascular Resistance (how much the vessel walls resist exspansion by the circulating blood)

210
Q

determining orthostatic blood

A
  • Measure BP first in supine, then sitting, then standing positions
  • Significant change (pulse increase by more than 15-20bpm or drop in systolic BP of more than 20mmHg within 3 minutes) can indicate disease
  • Suggests antihypertensive use, depleted fluid volume (hypovolemia), drug use, autonomic nervous system disease (M 441)
  • Indicated when pt is on antihypertensives, complains of fainting/postural lightheadedness, prolonged time in recumbent position (M 441)
211
Q

acute pain

A

sudden onset, short duration. Generally associated with surgery, injury, or acute illness

212
Q

chronic pain

A

persistent (6 months or longer), associated with prolonged disease

213
Q

Nociceptive Pain:

A

A type of time limited pain that resolves when tissue damage has healed. Examples include sprains, bone fractures, cuts, and burns. Nociceptors at the site of tissue damage are activated and signal is conducted via peripheral nerves to the CNS 2 types of nociceptive pain: somatic and visceral

214
Q

visceral pain

A

originating from internal organs

215
Q

somatic pain

A

originating from superficial/muscular structures of the body

216
Q

Neuropathic Pain:

A

Neruopathic pain is also known as chronic pain caused by a primary lesion or dysfunction of the nervous system beyond expected healing. When peripheral nerves are damaged, repeated signals are fired, causing hyperexcitability of the dorsal horn, transmitting a pain signal to the brain causing sustained pain.

217
Q

parts of GA

A

a. gender
b. general age category
c. presenting appearance
- level of toxicity
- relative comfort vs. discomfort
- acutely ill vs. chronically ill
- affect appropriate for situation
- posture
- speech
d. mental status
- level of alertness
- orientation
e. body development
- development / general features
- Tanner stage
- body habitus - height / weight / proportionality
- nutritional status (i.e., obese, thin, frail, anorexic, cachectic, etc.)
f. ethnic/racial background (when clinically appropriate)

218
Q

Visual Acuity: Direct Central Vision

A
  • Snellen chart used for examining far vision by the ability to read sized letters from a distance of 20 feet.
  • Rosenbaum chart is used for near sighted vision acuity. It is to be held at 14 inches from eye, `
219
Q

Visual Acuity: b. Peripheral Vision:

A

You cover one of your eyes, the patient covers one of theirs but the opposite. You should be looking at each other’s uncovered eye.
• Fully extend you arm (on the side of the open eye) midway between the patient and yourself, and then move your arm slowly centrally, having the patient tell you when the fingers are first seen

Test nasal, temporal, superior, and inferior fields

220
Q

visual acuity: color vision

A

ishara color test
Red testing make be helpful in determining optic nerve disease, an afferent pupillary defect often coexists with a red defect.

221
Q

small aperature

A

for small pupils slit – for anterior eye and elevation of lenses

222
Q

red free aperature/polarizing

A

red free filter – produces green beam for examination of the optic disk for pale appearance and vessel changes. Recognition of retinal hemorrhages (blood appears black)

223
Q

grid aperature

A

Grid – Estimation of the size of fundal lesions.

224
Q

diopter settings

A

There is an inverse relationship, the higher the diopter, the closer the object. more in the green, closer up.

225
Q

Cobalt Blue Light:

A

Aperture setting used to aid in diagnosis in corneal abrasions or ulcers after staining the cornea with an fluorescein.

226
Q

eye exam external

A

inspect:
eyebrows, periorbital regions, canthus, conjunctiva, lid covering part of iris, lacrimal gland, duct,

assess:
Extraocular movements (EOM), acuity, accomodation
227
Q

eye exam internal

A

red reflex,

adjust settings to visualize macula, disk, cup, vessels.

228
Q

a. Visual Impairment/Loss

A

blurred vision/loss of vision

229
Q

Legal Blindness:

A

blurred vision/loss of vision 20/200

230
Q

Proptosis/Exophthalmos:

A

Bulging of the eye anteriorly out of the orbit

231
Q

Ptosis:

A

A drooping of the upper eyelid - indicates a congenital or acquired weakness of the levator muscle or a paresis of a branch of the third cranial nerve.

232
Q

Nystagmus:

A

Involuntary rhythmic movements of the eyes; the oscillations may be horizontal, vertical, rotary or mixed.

233
Q

Strabismus

A

A crossed eye - both eyes not looking in the same place at the same time

234
Q

Diplopia

A

he perception of two images – may be monocular or binocular.
• Monocular diplopia is an optical problem,
• Binocular diplopia is an alignment problem

235
Q

h. Emmetropia:

A

The condition of the normal eye when parallel rays are focused exactly on the retina and vision is perfect.

236
Q

Hyperopia:

A

Farsightedness, a refractive error in which light rays entering the eye are focused behind the retina

237
Q

Myopia

A

Nearsightedness, a condition resulting from a refractive error in which light rays entering the eye are brought into focus in front of the retina.

238
Q

Astigmatism

A

An abnormal condition in which the light rays cannot be focused clearly in a point on the retina because of an irregular curvature of the córnea or lens

239
Q

Presbyopia:

A

Hyperopia and impaired near vision from loss of lens elasticity, generally devloping during middle age.

240
Q

Anisocoria

A

Unequal pupil size

241
Q

soft neck tissue anterior triangle

A

hyoid bone, cricoid cartilage, trachea, thyroid cartilage, thyroid, anterior cervical lymph nodes

242
Q

soft neck tissue posterior triangle

A

the trapezius and sternocleidomastoid and clavicle. Structures within this include posterior cervical lymph nodes

243
Q

rubor: redness;

A

response to inflammation/irritation

244
Q

turgor

A

i. Gently pinch skin on forearm or sternal area between thumb and forefinger and then release the skin.
ii. Should not be tested on back of patients hand
iii. Skin should feel resilient, move easily when pinched, and return to place immediately when released.

245
Q

physiologic/hormonal control of breast development

A

Hormonal control of breast development:
• Estrogen secreted by ovaries during puberty stimulates growth and development of duct system.
• Progesterone secreted by corpus luteum and placenta during pregnancy act with estrogen to bring areola to complete development

246
Q

hormonal production of milk during lactation

A
  • Prolactin, secreted from pituitary gland, together with adrenal steroids induces lactation. The marked decrease in estrogen and progesterone following childbirth signals the start of prolactin secretion.
  • Oxytocin, secreted from hypothalamus stimulates contraction of muscular cells in the milk ducts and mammary glands
247
Q

Physiologic control of the production of milk during lactation:

A

• Sucking: The baby nursing from the mother stimulates pulsatile increase in prolactin secretion, stimulating milk secretion and discharge of milk.

248
Q

lactation-

A

production and release of milk by mammary glands.

249
Q

a. mass:

A

A swelling, growth, or lump in the breast tissue. Note temporal sequence (onset, length of time, come and go), tenderness or pain, size, character, location, shape, consistency (firm, soft, hard), mobility, border, relationship to menses. Most are non-cancerous (e.g. fibrocystic changes, fibroadenoma).

250
Q

Fibrocystic Changes –

A

• Benign cysts that are cyclic w/ menses

Usually tender to palpation  
•	Fluid filled cysts that USUALLY occur bilaterally  
•	Single or multiple cysts can occur  
•	Masses are round and well delineated  
•	Mobile  
•	Consistency ranges soft -→firm
•	No signs of retraction (dimpling) on nipple/skin surface
•	Age range: 20-49
251
Q

Fibroadenoma

A

Benign tumors not cyclic to menses
• Usually non-tender to palpation
• Single, sometimes multiple – usually bilateral
• Round/discoid – Firm/rubbery consistency – well delineated - mobile
• No signs of retraction.
• Age range 15-55

252
Q

Cancer breast

A

– Malignant tumors
• Mass is not cyclic to menses
• Usually non-tender
• Consistency is hard/stonelike – irregular shaped - fixed
• Single and usually unilateral
• Signs of retraction in skin/nipples – prominent vasculature (veins)
• Age range 30-80

253
Q

Fat Necrosis

A

– Benign lump caused by inflammatory response to local injury.
• Firm. Irregular. Discoloration at site – can be mistaken for Malignant tumor. Biopsy required.
• Can occur at site of past injury/trauma to breast

254
Q

d. retraction:

A

Aka dimpling, is a pulling back of the skin on breast or areola/nipple indicating inward pulling by inflammatory or malignant tissue. Note temporal sequence, severity, and associated symptoms e.g. pain.

255
Q

c. nipple discharge:

A

Any fluid that seeps out of the nipple of the breast. Note character (spontaneous vs provoked, uni-/bilateral, temporal sequence, color, consistency, odor, amount, associated sx e.g. inflammation. In women, discuss pregnancy, lactation.

256
Q

b. pain: breast

A

Aka mastalgia, is any tenderness, discomfort, or pain associated with the breast tissue. Note temporal sequence, character (pulling, stinging, burning, aching), location on breast, radiation to armpit, relationship menses (cyclic-timing/severity), and recent trauma to breast.

257
Q

Features included in documenting breast masses

A
  • Location: clock positions and distance from nipple
  • Size: in centimeters: length, width, thickness
  • Shape: round, discoid, lobular, stellate, regular or irregular
  • Consistency: film, soft, hard
  • Tenderness
  • Mobility: movable or fixed to overlying skin or subajacent fascia
  • Borders: discrete or poorly defined
  • Retraction: presence or absence of dimpling: altered contour
258
Q

Morphology: macule

A

flat, cutaneous color change, less than 5mm (freckle)

259
Q

Morphology papule

A

elevated, circumscribed area different from skin color; <.5cm in diameter (wort)

260
Q

Morphology plaque

A

(psoraisis) elevated, firm, and rough with flat top; greater than .5cm diameter

261
Q

Morphology patch

A

flat, non palpable, greater than .5 cm, irregular shape

262
Q

Morphology Nodule

A

elevated, firm, extends to dermis, deeper than papule, 1-2 cm.

263
Q

Morphology • vesicle-

A

(ex. chickenpox) elevated, superficial; filled with serous fluid; less than .5cm in diameter

264
Q

Morphology Bulla

A

-(ex. blister) vesicle >.5cm in diameter

265
Q

morphology • pustule

A

-(ex. impetigo, acne) similar to vesicle but filled with purulent fluid

266
Q

skin exam: location

A

Region of the body lesion is located.

o   Sun-exposed areas
o   Flexural and extensor aspects of extremities
o   Stocking and glove regions
o   Truncal
o   Face, shoulder, back
267
Q

skin exam size

A

Determine size of lesion using a small ruler.

Determining size will allow you to differentiate between lesions

268
Q

skin exam distribution

A

localized vs. regional

269
Q

skin localized distribution

A

Appears in one small area

- Example: Impetigo, tinea corporis

270
Q

skin regional distribution

A

Lesions found in a specific region of the body

271
Q

skin color

A

flesh colored, tan, light brown, brown, black, or red/pink

272
Q

grouping annular

A

• Annular- arranged in a circle/ring (i.e. ringworm)

273
Q

grouping arcuate

A

• Arcuate (arciform)- shaped in a semi-circle, with a trail

274
Q

grouping circinate

A

Circinate- shaped like a C

275
Q

grouping grouped

A

Grouped- distributed in clearly defined groups

276
Q

grouping iris

A

• Iris- dark center with surrounding lighter halo

277
Q

grouping keratotic

A

Keratotic- linear scales grouped together

278
Q

grouping linear

A

Linear- distributed in a line

279
Q

grouping reticulated

A

Reticulated- distributed in a mesh-like pattern

280
Q

grouping serpiginous

A

Serpiginous- snake-like distribution

281
Q

grouping telangiectatic

A

Telangiectatic- look like broken blood vessels, spider-web like

282
Q

grouping dermatomal

A

Dermatomal- lesions follow a dermatome

283
Q

grouping confluent

A

Confluent- closely grouped together in no particular pattern

284
Q

grouping discoid

A

• Discoid- closely clumped together in a filled-in circle

285
Q

grouping eczematoid

A

• Eczematoid- raised plaque of confluent papules

286
Q

Effusion: x

A

Effusion: Loss of fluid from blood vessels or lymphatics into the tissues or a body cavity

287
Q

Frontal Bossing:

A

an unusually prominent forehead, sometimes associated with a heavier than normal brow ridge. This is a rare physical finding often associated with syndromes in which excess growth hormone is present. Most commonly identified in infants and children.

288
Q

strawberry tongue –

A

initially tongue appears white with prominent papillae, white gradually decreases leaving tongue bright red, looks like a strawberry, characteristic of scarlet fever

289
Q

blood supply to breasts

A

primarily 1) internal mammary artery and 2) lateral thoracic artery.

290
Q

drainage for breast

A
  • Blood Drainage:
  • To the axillary vein
  • Lymphatic drainage: 75% to axillary nodes
  • Primarily radially & deep around breast towards axillary nodes.
291
Q

external exam of head

A

inspect head, palpate scalp and face head

292
Q

external exam ears

A

hearing assistance?
inspect/palpate auricle and mastoid area
test gross hearing
otoscopy - finger strut, canal, TM, Bones

293
Q

external nose

A

inspect shape, palpate
patency
nasoscopy - septum, turbinates, vestibule, membranes

294
Q

external mouth

A 
dentures?
inspect lips
state of dentention 
ducts, gums, soft/hard palate, pharynx
breath
295
Q

external neck

A 
gross appearance
palpate
thyroid exam
palpate glands
cervico-facial lymph nodes
296
Q

breast exam

A

assistant in room,
warm hands,
undress waist up
inspect with arms hanging on sides, on head, on hips, leaning over

palpate all 4 quads and up arm
3 levels of depth
and nipples
in stripe format

297
Q

skin hair nails exam

A

sunexposed areas, color, uniformity, moistness, turgor, lesions,

texture, distribution, quantity, resilience

discoloration, symmetry, cleanliness, thickness, adherance, cap refill

JG (6 decks)

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