Physical Assessment Exam 1 Flashcards by Raymond Bas

How deep would one palpate with light palpation technique?

1-2 cm

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How deep would one palpate with deep palpation technique?

4-5 cm

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What would be expected with tympanic, drum-like percussion?

Air-containing space (puffed out cheek, gastric air bubble, etc.)

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What would be expected with resonant, hollow sounding percussion?

Normal lungs

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What would be an expected finding with assessed hyper-resonant, booming percussive sounds?

Emphysematous lungs

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What would be an expected finding with assessed dull, thud-like percussive sounds?

Softer organs (ex. Liver)

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What would be an expected finding with assessed flat percussive sounds?

Denser organs (ex. muscle)

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What temperature does one need to be to go to PACU?

96° F

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Approximately what should the axillary temp be in comparison to a core temperature?

1°F lower

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What is Anthropometry?

Scientific study of the measurements and proportions of the human body (height, weight, etc.)

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What are the three forms of percussion?

Mediate/Indirect percussion
Immediate percussion
Fist percussion

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What is Mediate or Indirect Percussion? How is it performed and what is its purpose?

Plexor (striking finger) & pleximeter (finger being struck). Evaluation of abdomen and thorax

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What is Immediate percussion? What is it utilized for?

Striking of surface directly with fingers of the hand. Adult sinus or infant thorax evaluation.

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What is Fist percussion? What is it utilized for?

Flat hand on area to be evaluated being struck with a fist. Used to evaluate the back & kidney for tenderness.

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What population is circumoral cyanosis primarily seen? How might circumoral cyanosis present on patients with darker skin tones?

In infants primarily above the upper lip.
Gray or white rather than blue.

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What are situations that can cause jaundice?

Acute liver inflammation, Inflammation/obstruction of the bile duct, Cholestasis, Hemolytic anemia, Gilbert’s syndrome, Crigler-Najjar syndrome, Dubin-Johnson syndrome, Pseudojaundice

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What causes pseudojaundice? How harmful is it?

Harmless condition caused by excess carrots, pumpkins or melon consumption (↑ β-carotene)

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What is Gilbert’s syndrome?

Inherited condition where enzymes can’t process BILE excretion.

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What is Crigler-Najjar’s syndrome?

Inherited condition where enzyme that processes BILIRUBIN is ineffective.

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What is Dubin-Johnson syndrome?

Inherited chronic jaundice where bilirubin can’t be secreted from the hepatic cells.

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What type of cells does vitiligo attack?

Melanocytes

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What is the sign name of periorbital ecchymosis? What does it indicate?

Raccoon Eyes
Battle’s Sign: indicates basilar skull fracture.

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What are petechiae indicative of?

Thrombocytopenia, Leukemia, Infectious disease, Medications, Prolonged straining

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What is koilonychia? What is it often indicative of?

Spoon-nails where nails become flat or convex (opposite of clubbing)
Iron-deficiency anemia.

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What is nail clubbing? What is it often indicative of?

Increased concavity of nails Heart/lung diseases, also potential osteoarthropathies.

What is paronychia?

Inflammation of skin around the nail.

What are Beau’s lines? What are they indicative of?

Horizontal striations that develop on the nail. Indicative of: Acute kidney failure Mumps Thyroid disease Syphilis Side effect of chemotherapy Endocarditis Melanoma Diabetes Pneumonia Scarlet fever Zinc deficiency

What is hirsutism? What is a common cause?

Excessive hair growth often caused by polycystic ovarian syndrome (PCOS) or Cushing syndrome (excess cortisol)

What is the name of notable difference in pupillary size between both eyes called?

Anisocoria

What is ectropion?

Eversion/lid margin **turn out**

What is entropion?

Inversion/lid margin turns **inward**

What is Ptosis?

Abnormal drooping of upper eyelid

What is Arcus Senilis?

Deposition of phospholipids/cholesterol in the peripheral cornea of older patients. (benign usually)

What occurs with the eyes during stage 2 of anesthesia?

Roving eyeball (nystagmus?) Partial pupillary dilation Loss of eyelash reflex (first reflex to be lost) No loss of eyelid reflex

What is ocular accommodation?

Ability of eye to focus in on objects far away and close.

What is most often the most important anesthetic consideration regarding the ears?

Padding during surgery to prevent injury

Differentiate Weber’s & Rinne’s tests.

Weber: tuning fork held on the head (assesses left vs right ear hearing) Rinne: tuning fork held to each ear (bone vs air conduction) AC > BC (normal), BC > AC (sensorineural hearing loss)

What is cherry-colored lips most often indicative of?

Carbon monoxide poisoning

Differentiate pallor & cyanosis presentations as well as what usually causes each.

Pallor = pale (usually anemia) Cyanosis = blue (hypoxia or hypoperfusion)

What would be indicated by the presence of 'spongy' gums?

Bleeding due to Vit-C deficiency (scurvy?)

What is Leukoplakia? What causes it?

Thick white patches on the gums **pre-cancerous sign**

Chest pain in sync with respiratory movement could be indicative of what?

Pleurisy/pleuritis Trauma

What is beck's triad?

1. JVD 2. Hypotension 3. muffled heart sounds 4. widened pulse pressure (eg. 110/70)

What can cause radial pulses to become unsymmetric?

Clavicular fracture or aortic dissection

How can Mg⁺⁺ evaluations be done in OB patients?

Knee extension/flexion

What capability is lost with peroneal nerve injury?

Dorsiflexion (foot)

What anesthetic consideration should one have for a patient with significant lordosis?

↑ abdominal pressure could = worse GERD. Difficult spinal/epidural

What anesthetic consideration should one have for a patient with significant kyphosis?

Airway, ventilation, and positioning issues

Patient judgement is relevant to obtaining _______ ________ whilst ________ is pertinent to the patient’s understanding of whats going on.

informed consent; insight

What test evaluates proprioception? How is this test performed?

Romberg Test Standing with eyes closing and arms out in front with palms down loss of balance is a + test

What is a VAN exam? What does being VAN positive indicate?

**Vision, Aphasia, Neglect** 1. Weakness: hold arms out for 10secs 2. Vision: check for visual field defects or vision loss or double vision 3. Aphasia: name 2 objects and repeat simple phrase 4. Neglect: close eyes and state which arm is being touched VAN (+) = ↑ risk for LVO (large vessel occlusion)

What is another name for plantar reflex?

Babinski reflex

When would a gluteal reflex be performed?

Trauma patients in assessing pelvic injury (Use a cotton swab or a similar soft object to gently touch around the anus)

How does one calculate BMI in imperial measurement?

(703 x lbs) / inches²

What endocrine disorder makes it difficult to manage fluid status?

Pituitary tumors (think neurohypophysis ADH)

What is G6PD deficiency?

Lack of enzyme that results in RBCs breaking down faster than they are made.

What are seizure meds effects on anesthesia?

Seizure meds make anesthetics work **less effectively**.

Which court case determined how informed consent should be obtained?

Salvo vs Leland Stanford Univ.

What MET capacity would indicate a patient is good to go for surgery from a cardiovascular fitness standpoint?

MET of 5 or greater. (ability to walk up 1 flight of stairs)

What class of meds commonly given in anesthesia are teratogenic?

Benzodiazepines

What component of 'ester' medications are people allergic to?

PABA (Para-aminobenzoic acid)

Which cardiac hypertension meds need to be discontinued prior to surgery? Why?

ACEi & ARBs - can lead to severe hypotension.

What needs to be checked pre-op with psych patients? Why?

EKG for prolonged QT interval. Many psych meds prolong QT interval.

Which meds cannot be given to a patient taking an MAOI?

Meperidine & ephedrine Serotonin syndrome?

P2Y12’s inhibitors and aspirin need to be discontinued ______ days prior to surgery. When is the exception?

7 & 10 days Exception: patient needs to complete 6 months of dual therapy before discontinuation of anything.

Which herb tends to cause an allergic reaction peri-operatively?

Echinacea (for immune support)

How is a pack-year calculated?

(Cigs per day / 20) x years smoked

Bedridden, wheelchair-bound patients should not receive what drug?

Succinylcholine High risk for life-threatening hyperkalemia

What symptoms/signs point to **Horner syndrome**? What anesthetic procedure most often causes it?

One sided miosis, ptosis, & anhidrosis Interscalene blocks

Pill-rolling tremors are associated with what disorder?

Parkinson’s

What sign is it when one experiences RUQ pain along with **cholecystitis**?

Murphy’s sign place hand over abdomen, as patient inhales pain is felt (positive sign)

What sign is attributed to retroperitoneal bleed or AAA rupture?

Grey Turner's sign ecchymosis or bruising in the flank area

What vision change accompanies glaucoma?

Tunnel vision

What is the name for chest-clutching that occurs during MI?

Levine’s sign

What nerve runs along the breast that we should be aware of?

Long thoracic nerve

Where is the apical pulse?

5th ICS, left of sternum, mid-clavicular line

What is the importance of blood in the urine when doing a c-section?

Possible severed ureter

Who is most at-risk for urinary retention post-operatively?

BPH patients (old men)

What drug treats preeclampsia? How can you check for overdose with this drug?

Magnesium hypermagnesemia will cause patellar reflexes to disappear.

Chipmunk face is associated with what disorder?

Bulimia

Leoning face is associated with what disease?

Leprosy

Spider angioma is associated with what liver disorder?

Cirrhosis

Pyloric stenosis is associated with what shape mass?

Olive

What is exophthalmos? Enophthalmos?

Exophthalmos = bulging of eyes Enophthalmos = sunken in eyes

What is a common sign of COPD?

Barrel chest

Butterfly rashes are associated with that autoimmune disorder?

Systemic Lupus Erythematosus

Hyperthyroidism is associated with what ophthalmic change?

exophthalmus

What physical feature is commonly associated with Cushing syndrome?

buffalo hump or moon face (excess cortisol)

What is addisons disease? What are the common symptoms?

primary adrenal insufficiency (aldosterone and cortisol deficiency) fatigue, weakness, hypotension, salt cravings

Rice water stool is commonly found with what illness?

cholera

**Cullen sign**, bluish periumbilical discoloration is associated with?

Pancreatitis

Rebound tenderness at McBurney’s point is associated with?

appendicitis

Icteric sclera (yellow sclera) is associated with?

hepatitis

Addison’s disease or adrenal insufficiency is associated with this color skin.

bronze

This condition results in wheezing on expiration.

asthma

Myasthenia gravis results in this facial condition.

ptosis

Which medication should be avoided in adrenal insufficiency?

**etomidate**: inhibits 11-BDH which is an enzyme necessary for production of aldosterone and cortisol

Which two signs are common with meningitis?

**kernig**: The patient lies flat on their back with their hips and knees flexed at 90 degrees (+ if pain is present or resistance to knee extension) **brudzinski**: With the patient lying supine, the examiner passively flexes the neck forward (+ if involuntary flexion of hips and knee occurs)

Which two signs are commonly associated with hypocalcemia?

Chvostek & Trousseau

What do we administer that causes fix constricted pupils? And how do we fix it?

Opioids Narcan