Physical Assessment Flashcards
1
Q
Skin cancer is 20% more likely in which race?
A
Caucasian
2
Q
Prostate CA is more prevalent in which race?
A
African American
3
Q
What kinds of abnormalities in the back can affect how easy it is to intubate someone?
A
Scoliosis
Kyphosis
4
Q
Fruity breath is a sign of_
A
Ketoacidosis
5
Q
As anesthesia providers we are not going to contact authorities for ___ drug use
A
Illicit. Just need the patient to be honest if they have used them recently so that we can alter our medication regimen.
6
Q
Why is meth a problem with anesthesia?
A
The patient has likely had chronic HTN due to usage. Their auto-regulation has shifted. So when the patient gets drugs in the OR that may decrease their pressure, it will be difficult to get it to come back up
7
Q
Is abdominal girth included in baseline data?
A
Yes. It can be good to know pt’s measurements before the OR, so if they come out distended you notice the change. Also, can help you to probe to see what else is going on. (ETOH, CA).
8
Q
What are 2 core measures for the OR that we discussed in class?
A
1.) Temp (must be 96 degrees before going to PACU). Arm pit is not acceptable because their core temp is warmer after the OR has been cold and paralytics/pain meds given
2.) B blocker. If pt is on BB they are to take it before sx because their body is used to the HR and BP
9
Q
What is anthropometry? (think of pom pom as stomach).
A
The study of the measurements and proportions of the human body.
10
Q
Snoring and redundant neck issues can often mean that patient’s are prone to airway obstruction with _
A
Sedation
11
Q
What is emaciated?
A
Abnormally thin or weak
12
Q
Are thin and obese people prone to positioning injuries?
A
Yes
13
Q
Some thermometers are calibrated for __ use. So be careful when taking an oral temp because it may not be accurate.
A
Axillary
14
Q
Axillary temp should be about 1 degree F (more/less) than core temp?
A
1 less
15
Q
Just need a yes or no on vices, ppl will usually lie about how much they have had anyway. The one thing we will want numbers on is:
A
-cigarettes.
16
Q
How many cigarettes in a pack?
A
20
17
Q
What is a pack year?
A
1 PPDx 365 days
18
Q
Adult pt’s greater than how old with how many years of pack year hx should be screened with a CT before sx?
A
55
30
19
Q
Pt’s who have worked in a cole mine for long periods of time often have:
A
Black lung
20
Q
How does a pt get Legionella’s dz?
A
Hot tub
AC vents
Water
21
Q
One of the leading causes of beta blocker OD’s is:
A
accidental excess intake
22
Q
Why is Sch contraindicated in strokes, paralyzed pt’s, denervation disorders?
A
Because it is a depolarizing agent. It is going to bind to Ach receptors not just at the NMJ like Ach would but also outside of that. Ppl with these disorders have no communication b/w the neuron and the muscle at the NMJ so their body starts to make more Ach-R. They end up making several in the post junctional areas and they are fetal immature-R that behave differently. If you give this pt Sch it will activate all of those additional-R and allow potassium to flow out at an even faster rate resulting in deadly K levels.
23
Q
What are 5 skills of physical assessment?
A
Inspection
Palpation
Percussion
Auscultation
Olfaction
24
Q
How far do you push down with light palpation?
A
1-2 cm
25
Do you start with deep palpation?
Absolutely not, start with light and if it hurts stop.
26
How far do you push down with deep palpation?
4-5 cm
27
What is bimanual palpation?
Use one hand as a sensing hand. Place it over area of interest and use other hand to push down over that hand so that the mass or organ is not moving around
28
If concerned patient has a pneumo you could use what kind of technique?
Percussion. Listen to hear if pt has fluid in the cavity
29
Percussion is used to tell you if there is fluid or air in body tissues or cavities? T or F
T
30
There are 3 types of percussion, what are they?
Mediate or indirect percussion
Immediate percussion
Fist percussion
31
What is mediate percussion and what is it used to evaluate?
Use pointer finger of one hand and middle finger of the other. Strike one with the other. Used to eval abdomen or thorax (large areas)
32
What is immediate percussion and what is it used to evaluate?
Strike the surface directly with your fingers
To assess sinus or infant thorax (small areas)
33
What is fist percussion and what is it used to evaluate?
Used to eval back and kidney for tenderness
-Put one hand flat on body surface and strike it with your fist of other hand
34
Tympany is a sound produced by percussion. What does it sound like? Where would you hear it? (think of symphany)
Loud and drumlike in air containing spaces
35
Resonance is a sound produced by percussion. What does it sound like? Where would you hear it?
Loud and hallow. Heard in normal lungs
36
When would you hear hyper resonance?
Pt with emphysema (trapped air). It is a loud and booming noise.
37
Where do you hear dullness with percusion?
Liver. It is thudlike.
38
Where do you hear flatness with percussion?
Muscle. Soft intensity
39
What is circumoral cyanosis?
Blue discoloration around the mouth only. Usually seen in infants.
40
Cholelithiasis is a gallbladder with stones. It is seen in young people and the tx is __
ERCP
41
Jaundice is always caused by excess level of ___. That would be elevated because the function of the liver is impaired and unable to clear it.
Bilirubin
42
The liver is responsible for conjugating and secreting ___. If it is inflamed it may not be able to do that effectively so it may build up
Bilirubin
43
What is bile?
Bile is a digestive fluid produced in your liver and stored in your gallbladder. When you eat, your gallbladder contracts and empties bile into your small intestine (duodenum).
44
Bile helps to carry waste and break down ___
fats.
45
Bilirubin is found in bile. If you have an inflamed bile duct or it is obstructed, bile may not be able to pass from the gallbladder to the small intestine therefore building up and causing _
Jaundice
46
Bilirubin is a biproduct from broken down RBC's. With hemolytic anemia it would make sense that the pt would show signs of ___ due to the excess bilirubin
Jaundice
47
What is Gilbert's syndrome?
An inherited condition. Impairs body's ability of enzymes to EXCRETE bile
48
CholeSTASIS is:
Interrupted flow of bile from liver. Back up of bile causing jaundice
49
_ Najjar syndrome is an inherited condition that impairs the enzymes responsible for PROCCESSING bilirubin
Crigler
50
Dubin johnson syndrome prevents bili from being secreted from the _
Cells of the liver
51
What is pseudojaundice? What foods could cause it?
harmless. Jaundice is not being caused from an excess of bili but an excess of beta carotene.
Carrot, pumpkin, melon
52
What is vitiligo?
Autoimmune disorder. Fight the melanocytes that control the color of skin. This usually first shows up after a triggering event like a cut (Did not know that)
53
Racoon eyes are a sign of _
Basilar skull fx, orbital injury
54
Can Kaposis sarcoma lead to lesions?
Yes
55
Grade edema. Grade 0 means
None
56
Grade edema. Grade 1 means
Trace. 2 mm. Disappears quick
57
Grade edema. Grade 2 means
Moderate. 4 mm. 10-15 sec
58
Grade edema. Grade 3 means
Deep
6 mm
lasts greater than a min
59
Grade edema. Grade 4 means
Very deep
8 mm
2-5 min
60
Angle b/w nail and base should be
160
61
What are beau lines of the nails?
Indentations. More than one line is usually a sign of repeated external injury. Could be a sign of chronic illness
62
What is the opposite of clubbed nails and what is the cause?
Spoon nails, Koilonychia
Caused by iron deficiency
63
Does clubbing necessarily have to do with dz?
No. It can run in families. It is usually associated with heart and lung dz's where the pt has a hard time oxygenating
64
What is paronchia and what causes it?
Inflammation in the skin around the nail. Caused by infection like staph or candida
65
What is the difference b/w terminal and vellus hair?
Terminal is long, thick, found on axilla and pubic area.
Vellus is soft small and found everywhere but soles
66
What is PCOS?
Cysts on ovaries that lead to hormone imbalances, excess hair growth and irregular periods
67
Cushing syndrome is from long exposure to prednisone or the body making excess _
Cortisol
68
What is entropion?
Lid margin turns in
69
What is Ectropion?
Lid margin turns out
70
Miosis is _ pupil while midriosis is
constriction
dilation
71
What is anisocoria?
Notable difference in pupil size
72
What is anhidrosis?
Little or no sweating either on entire side of face or an isolated patch of skin on affected side
73
What is Horner's syndrome?
A disrupted nerve pathway on one side from the brain to the face and eye.
Horner's syndrome is the result of another medical condition, such as a stroke, tumor, or spinal cord injury.
Symptoms include a smaller pupil, drooping eyelid, and little or no sweating on the affected side.
There's no specific treatment for Horner's syndrome, but treatment for the underlying cause may restore normal nerve function
74
Pupils tell us a lot about anesthesia level. What is happening in stage 1?
This is the stage of analgesia. Extends from the start of inhaling anesthesia to loss of consciousness.
75
Pupils tell us a lot about anesthesia level. What is happening in stage 2?
This is the stage of delirium or excitement! One of the two!
It extends from the loss of consciousness to the beginning of regular respiration.
Have permanent deconjugate gaze here.
Pupil is partially dilated.
Loss of eyelash reflex which is the first reflex to be lost.
NO LOSS of eyelid reflex.
76
Pupils tell us a lot about anesthesia level. What is happening in stage 3?
Surgical anesthesia.
77
When would you not want to extubate, which stage?
Stage 2.
78
What is arcus snelis?
Cholesterol deposits around the cornea in patients over 60. There is a hazy color around it.
Common and benign when in elderly patients
79
If you give your pt opioids what will there pupils look like?
Miosis
Constricted
80
What is happening when you test accomodation?
The pt should be able to shift focus from an object right in front of their face to an object 1-3 feet away. If they cannot do that then their eyes are not accommodating. That could be an issue with the optic nerve
81
Snellen test you stand
14-20 ft away
82
What if pt cannot read? Use the E test.
State whether the E is upside down or right side up
83
Glaucoma can lead to loss of peripheral vision. (Tunnel vision). Due to-
Optic nerve damage from glaucoma. Remember, there is fluid in the back of the eye that is not draining properly which leads to pressure on the ON
84
What is an eye stroke and what can in cause?
Occlusion of normal BF to the eye which will cause loss of peripheral vision
85
Think issues with the ___ if pt has tunnel vision
optic nerve
86
What is the Weber's test?
Place the base of a struck tuning fork on the bridge of the forehead, nose, or teeth. In a normal test, there is no lateralization of sound.
With unilateral conductive loss, sound lateralizes toward affected ear. With unilateral sensorineural loss, sound lateralizes to the normal or better-hearing side.
(depends on what kind of loss it is to determine which way the noise will be heard most)
87
What is the Rinne test?
The doctor strikes a tuning fork and places it on the mastoid bone behind one ear. When you can no longer hear the sound, you signal to the doctor. Then, the doctor moves the tuning fork next to your ear canal. When you can no longer hear that sound, you once again signal the doctor.
Compares perception of sounds transmitted by bone conduction through the mastoid and sounds by air conduction
88
Weber and rinne test are used to eval for
Hearing loss
89
What gas can cause air trapping and should be avoided in pt's with sinusitis?
Nitrous
90
Pretreat the nose prior to nasal intubation with _
Cocaine and Affrin to cause vasoconstriction
Cocaine can caugh high BP
91
Why would you see bright red tongue?
Iron B12 deficiency, or niacin deficiency
92
Which nostril is usually the largest?
Right side
93
What are the names of the 4 sinuses?
1. Maxillary
2. Frontal
3. Ethmoid
4. Sphenoid
94
Why might a pt have cherry red lips?
Carbon monoxid poisoning
95
What is halitosis?
Bad breath
96
When would you have spongy gums that bleed easily?
Vitamin C deficiency
97
Leukoplakia on tongue is thick white patches due to __
Smoking and alcohol
98
How do you assess fxn of the sternocleidomastoid muscle?
Ask the patient to flex the neck with chin to chest
99
How do you assess fxn of the trapezius muscles?
Move the head sideways toward the ear
100
What are goiters? How can you assess them?
Enlarged thyroid gland
Ask the pt to drink water then you can see them better
101
If you want to palpate the goiters be sure to ask the pt to extend their neck and laterally toward the side you are _
Examining
102
Decreased turgor means the skin is loose or supple?
Loose, it does not return to its flat position right away
103
To test accommodation ask the patient to look at your finger then to look far away. What does this scenario look like if they do not have good accomodation?
Pupils will be nonreactive to accommodation, they wont adjust when pt tries to switch focus of what that are looking at. Near to far or far to close up.
104
What type of vision loss do you get with glaucoma?
Tunnel
105
What type of vision loss do you get with retinitis pigmentosa?
Tunnel
106
What type of vision loss do you get with eye strokes/occlusions?
Tunnel
107
What type of vision loss do you get with detached retina?
Tunnel
108
What type of vision loss do you get with compressed optic nerve (papilledema)?
Tunnel
109
What is pectus excivatum?
Breast bone sinks in and leads to cardiac/pulmonary issues
110
Having a ureter severed is common in which type of sx?
C section
111
If patient has existing infection are they clear to have hard ware placed?
Nope
112
If the patient has pus from kidney stones and it gets broken up, what is your concern?
Can go systemic.
113
What notion do you make with plantar flexion?
Foot on the gas
114
If pt has lordosis what is your concern for spinal/epidural?
Spinous processes are stacked on ea. other. Instead of ML approach, try going in from the lateral side.
115
Romberg test is used to test _. What is considered a positive result?
Proprioception. Drifting or falling
116
How do you test bicep reflex and what is the response?
Find tendon by having pt flex elbow, against resistance and palpate in the AC area until you feel the tendon.
Place arm so its bent 90 degrees
Strike tendon with finger
Response: Flexion of arm at elbow
117
How do you test tricep reflex and what is the response?
Flex pt's arm at elbow. Hold upper arm horizontally. Strike triceps tendon just above elbow.
Reflex: Extension at elbow
118
How do you test patellar reflex and what is the response?
Have pt sit with leg dangling. Tap patellar tendon just below patella.
Response: Extension of lower leg
119
How do you assess the Achilles tendon reflex? What is the response?
Have the patient assume the same position as patellar reflex.
Slightly dorsiflex pt's ankle
Strike Achilles tendon just above the heel at the ankle malleolus
Reflex: Plantar flexion of foot
120
How do you assess the plantar reflex? What is the response?
Have the pt lie supine with legs straight and feet relaxed.
Take the 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: Plantar flexion of all toes (toes fan down). This is a negative Babinski, babies have + Babinski, their toes will fan up
121
How do you assess the gluteal reflex? What is the response?
Have pt assume side lying position.
Spread the buttocks apart and stimulate perineal area with cotton applicator.
Reflex: Contraction of anal sphincter
122
What is conductive hearing loss?
Conductive hearing loss can happen any time something prevents sounds from getting across the outer and middle ear.
