Physical Assessment (1) Flashcards
who is at high risk for skin cancer and what is the percentage??
Caucasian 20% higher than african american
Who has a higher risk for prostate cancer?
African americans more at risk than caucasian
WHo is more prone to infection?
Elderly and children
What are some signs of distress?
Pain and difficulty breathing.
Diaphoresis
how is legionairres disease spread?
through air conditioning systems and hot tubs. Its a type of pneumonia caused by legionella virus
What two illicit drugs do we worry about in anesthesia and why?
Meth and coke, can make it hard to control their BP
If a teen comes in with recent weight loss without trying what should you worry about?
Type 1 DM
What type of injury are obese patients prone to during surgery?
What might we have to worry about for them afterwards?
Positioning injury,
Wound healing
Who came up with BMI?
Insurance companies
When taking a childs temp what is a good way to get them to avoid biting the temp probe?
tell them to “kiss” face
If using a normal temp probe what should you remember when using it on axilla?
It will be one degree less
What patients should we avoid rectal temps in and why?
there is risk of perforation, avoid in patients on anticoagulants, GI bleeds, Hemorroids and immunosuppressed
How many cigarettes in a pack
20
What is a Pack year
1 PPD x365 days
If you have lung cancer and have >15 pack year history what are your chances of overall survival?
What if you have <15 pack year history
10.8 months
14.6 months
adult patients ≥ ____ years old with
≥ ___ pack year history of smoking are generally considered high risk for lung cancer and should undergo what procedure?
55 years and 30 pack year, screening with low dose CT
Light Palpation?
when to use?
1-2 cm deep
things just under the skin
Deep Palpation ___ cm deep?
When to use?
4-5 cm deep at and angle
to detect abdomen masses
Bimanual palpation?
When to use?
use both hands to trap a structure between. Active hand that applies pressure and a sensing hand that you push against.
Spleen, kidneys, breast, ovary, abscess in neck
What can paper thin skin indicate?
Steroid use
Why is percussion used?
to evaluate for presence of air or fluid in body tissues
Mediate or indirect Percussion
when to use?
It can be performed by using the finger on one hand as a plexor (Striking finger) and the middle finger of the other hand as a pleximeter (the finger being struck).
Used mainly to evaluate the abdomen or thorax.
immediate percussion
when to use?
It can be performed by striking the surface directly with the fingers of the hand.
Used mainly to evaluate the sinus or an infant thorax.
Fist percussion
When to use?
Involves placing one hand flat against the body surface and striking the back of the hand with a clenched fist of the other hand.
Used to evaluate the back and kidney for tenderness.
Wat can be used instead of percussing to look for fluid in lungs or pneumo?
ULTRASOUND
Tympany
Intensity : Loud
Pitch : High
Duration : Moderate
Quality : Drumlike
Common location : Air containing space, enclosed area, gastric air bubble, Puffed out cheek
Resonance
Intensity :Moderate to Loud
Pitch : Low
Duration : Long
Quality : Hollow
Common location : Normal lungs
Hyper Resonance
Intensity :Very Loud
Pitch :Very Low
Duration : Longer than resonance Quality : Booming
Common location: Emphysematous lungs
Dullness
Intensity :Soft to moderate
Pitch :High
Duration : Moderate
Quality : Thudlike
Common location : Liver
Flatness
Intensity :Soft
Pitch :High
Duration : Short
Quality : Flat
Common location : Muscle
Circumoral cyanosis common in what population?
Where is it usually seen?
What color could this be if darker skin color?
Circumoral cyanosis refers to blue discoloration around the mouth only.
infants, especially above the upper lip.
darker skin, thediscolorationmight look more gray or white.
You might also notice it on their hands and feet.
Jaundice?
What should you think about if you see this?
Most common disorder that may cause this in young adults and what procedure do we do for them?
Yellow discoloration of skin and eyes
All causes occur from an elevated bilirubin, assume liver function is impaired.
COAGULATION PROBLEMS!
Cholestasis–> ERCP
raccoon eye?
basilar skull fracture
Edema Scale Range?
Describe each.
Pitting v. non-pitting
*Grade 0: (none)
*Grade +1:(trace, 2mm) - Disappear rapidly
*Grade +2: (moderate , 4mm) -10-15 sec
*Grade +3: (deep, 6 mm) - 1min
*Grade +4: (very deep, 8 mm) - 2-5min
Whats the normal angle between nail and base?
160 degrees
Koilonychia?
Describe what it looks like?
What condition might this sign be associated with?
SPOON NAILS
anemia,
thin nails, flat or even concave in shape.. In early stages nails may be brittle and chip or break easily.
Nail clubbing?
Describe the look?
What diseases is it associated with?
Club like finger nails.
Typically associated with lung and CV disease.
Can occur unassociated from any disease tho.
Paronychia?
an inflammation of the skin around the nail, which can occur suddenly, when it is usually due to the bacterium Staphylococcus aureus, or gradually when it is commonly caused by the fungus Candida
albicans.
Beau’s lines ?
if you have more than one nail with Beau’s lines, the cause is likely a systemic illness, prolonged exposure to certain environmental factors, or chronic disease.
Acute kidney failure, Mumps, Thyroid disease, Syphilis, S/Echemotherapy, Endocarditis, Melanoma, Diabetes, Pneumonia, Scarlet fever, Zinc deficiency
Ectropion
eversion, lid margin turned out
Entropion
inversion (lid margin turned in)
Ptosis
Abnormal drooping of lid over pupil
Horners syndrome
H partial ptosis (drooping or falling of the upper eyelid),
miosis (constricted pupil),
and facial anhidrosis (absence of sweating)
Caused by a disruption in the sympathetic nerve supply. It is primarily acquired following damage to the sympathetic nerve supply
Stage 1 of anesthesia
-wide awake or losing consciousness
-Stage of analgesia.
-Extends from beginning of anesthetic inhalation to loss of consciousness.
Stage 2 of anesthesia
-Stage of delirium or excitement.
-Extends fromloss of conciousness to beginningof regular respiration.
-(NYSTAGMUS may occur with ketamine, CONJUGATE GAZE) this means they are not appropriately anesthetized.
-Increased risk of bronchospasms.
Stage 3
Stage of surgical anesthesia
Arcus senilis
depositing of phospholipid and cholesterol in the peripheral cornea in patients over the age of 60 which appears as a hazy white, grey, or blue opaque ring (peripheral corneal opacity). Arcus is common and benign when it is in elderly patients.
What can cause peripheral vision loss?
optic nerve damage from glaucoma
Retinitis pigmentosa
Eye strokes or occlusions
Detached retina
Brain damage from stroke, disease or injury
Neurological damage such as fromoptic neuritis
Compressed optic nerve head (papilledema)
Concussions (head injuries)*
Weber’s and Rinne’s Test
These test’s evaluate hearing through air and bone conduction. This test is used on Craniotomy patients preop and intraop
What gas do we avoid on patients who we are concerned about barotrauma and air trapping?
Nitrous oxide
What should you consider doing before placing a tube in someones nose?
Pretreat with phenylephrine.
Cocaine can also be used as vasoconstrictor and it numbs
Which side of the nose is usually the largest?
Right nare
What nerve runs under he breast that we should be concerned about?
Long thoracic nerve
Apical pulse
(5th ICS, left, midclavicular line),
What is a common post op GI complication?
Ileus
Wrist Extension v Flexion
Elbow Flexion v Extension
Shoulder abduction v adduction
Knee extension v flexion
Dorsiflexion v plantar flexion
Lordosis
why do we worry about this?
Lumbar curve that makes abdomen protrude and this pressure on the abdomen can put them at risk for aspiration.
May be more difficult to do spinal or epidural on these patients, may need alternative approach
What population do we check knee extension on frequently?
OB patients because of Mag
Why do we worry about dorsiflexion ? Whats the most common nerve injury we see in anesthesia?
Foot drop! The can’t dorsiflex Peroneal nerve injury can cause this.
Scoliosis
how is it corrected?
Lateral spinal curvature
Cotrel Cast: this a cast that corrects scoliosis. They are uncomfortable so anesthesia gets involved in putting these on. These may need holes cut in them so patient can breathe
Kyphosis
exaggeration of posterior curvature of thoracic spine
Romberg test
used to evaluate proprioception (sense of position of joints)
-Close eyes and stand still with feet together, if the fall then its positive
Pronator drift test
Arms out eyes closed watch for drift
VAN exam
If they have weakness in arms (a positive drift) then they have a high likelihood of Large Vessel Occlusion (LVO)
Bicep reflex
Identify biceps tendon have patient flex elbow against resistance while you palpate antecubital fossa
Place arm so it’s bent ~ 90 degrees
Place one of your fingers on tendon and strike it.
Reflex: Flexion of arm at elbow.
Triceps Reflex
Flex patient’s arm at elbow, holding arm across chest or hold upper arm horizontally.
Strike triceps tendon just above elbow.
**Reflex: Extension at elbow. **
Patellar Reflex
Have client sit with leg hanging freely over side of table.
Tap patellar tendon just below patella.
Reflex: Extension of lower leg.
*OB – Mg gtt for preeclampsia/preterm labor
Achilles Reflex
Have patient assume same position as for patellar reflex.
Slightly dorsiflex patient’s ankle by grasping toes in palm of your hand.
Strike Achilles tendon just above heel at ankle malleolus.
Reflex: Planter flexion of foot
Plantar
Have patient lie supine with legs straight and feet relaxed.
Take handle end of reflex hammer and stroke lateral aspect of sole from heel to ball of foot, curving across ball of foot toward big toe.
**Reflex: Planter flexion of all toes. **
Similar to Babinski reflex
Gluteal Reflex
Have patient assume side lying position.
Spread buttocks apart and lightly stimulate perineal area with cotton applicator.
**Reflex: Contraction of anal sphincter **
*insert finger to check for presence of blood and prostate
*Pelvic trauma – may not be able to feel prostate
*trauma – check for prostate before foley!
