Physical Assessment Exam 1 Flashcards
During history taking, what key aspects should the therapist find out?
Primary complaint, past medical history, family history, review of systems
What questions should you ask the patient to find out the primary complaint during history taking
“Why are you here today?”
During history taking, what are some key factors that we should know about regarding family history
history of hypertension, coronary artery disease, cancer, heart problems
What useful tool can be used to obtain the review of systems information during history taking
screening forms
In regards to the review of systems, what should you look for when it comes to the skin?
Rashes, sores, lumps
In regards to the review of systems, what should you look for when it comes to the HEENT system
HA, vision, hearing, nasal, horseness, sore throat
In regards to the review of systems, what should you look for when it comes to the neck
lumps, pain, and stiffness
In regards to the review of systems, what should you look for when it comes to the breasts
Lumps, discharge, self-exam
In regards to the review of systems, what should you look for when it comes to the respiratory system
cough and wheeze
In regards to the review of systems, what should you look for when it comes to the cardiovascular system
chest pain, discomfort, orthopnea
In regards to the review of systems, what should you look for when it comes to the GI system
heartburn, change in bowel habits, stool color changes
In regards to the review of systems, what should you look for when it comes to the peripheral vascular system
skin color, changes, swelling, and sensation
In regards to the review of systems, what should you look for when it comes to the genitals
Males: pain, sores, masses
Females: menstrual changes, sores, lumps, masses
In regards to the review of systems, what should you look for when it comes to the urinary system
polyuria, dysuria, incontinence
In regards to the review of systems, what should you look for when it comes to psychiatric issues
mood changes, irritability, and depression
In regards to the review of systems, what should you look for when it comes to the neurologic system
memory, dizziness, speech
In regards to the review of systems, what should you look for when it comes to the hematologic system
bruising, bleeding
In regards to the review of systems, what should you look for when it comes to the endocrine system
heat/cold intolerance, excessive thirst, polyuria
what are the two different types scope of assessment
comprehensive vs focused
How would someone describe comprehensive scope of assessment
“head to toe” like a sports physical
which type of scope of practice develops proficiency in physical assessment skills
Comprehensive
Is a comprehensive scope of practice typically done in a PT setting?
no
How would someone describe focused scope of assessment
more specific problem oriented that should become part of the PT doctoring profession
Which type of scope of assessment would be found in the example, “so, you are having difficulty getting a full breath of air, let me listen and see if I can pick up something
focused
What is the definition of physical assessment
the use of psychomotor skills in the examination of a patient
Physical assessment requires the appropriate application of what four things
inspection, palpation, auscultation, and percussion
What is the purpose of physical assessment
to identify and address signs, symptoms, and other information which lead to appropriate intervention and referral
Feelings of insecurity for the novice practitioner are ________
normal
Patients often feel ___ about physical examination
anxious
As a PT, we should ____ showing alarm with your findings
avoid
What are things to consider in regards to proper environment and equipment
lighting, room temp, examination table height, equipment is available and functional
What are things to consider in order to make the patient more comfortable
proper draping, describe your plans before starting, be sensitive to the patients feelings
What order should the exam sequence occur in?
from head to toe and avoid unnecessary changes in patient position
which cardinal technique involves close observation of patient’s appearance, behavior, movements, expression, mood, skin conditions, gait, etc
inspection
Which of the cardinal techniques involve tactile pressure from your hand and fingers to the patient’s skin to assess elevation, depression, warm, tenderness, masses, crepitus, etc
palpation
Which of the cardinal techniques uses the striking or plexor finger to deliver a rapid tap or blow against the pleximeter finger laid against the surface of the chest or abdomen to assess resonance or dullness from the underlying structures
Percussion
Which of the cardinal techniques uses the stethoscope to detect heart, lung, bowel, and arterial sounds
auscultation
During the health history interview, we want to have a conversation with purpose. What three things will make a conversation purposeful
- Establish a trusting relationship
- Gather information
- Offer information
During the health history interview, we want to effectively relate with the patient. What two things can we do to make this possible
convey respect and promote trust
During the health history interview, we want to formulate a ______ or series of _____ and test them with more detailed questions
hypothesis, hypotheses
During the approach to the interview, what should we consider in regards to establishing the agenda
start with open ended questions like why are you here today or how can I help you
During the approach to interview, what should we do in regards to self reflection
clarify how our own expectations affect what we hear and how we react, be as unbiased as possible
During the approach to the interview, what should we consider in regards to reviewing medical records
age, gender, insurance, meds, intake sheet, pain diagram
During the approach to the interview, what should we consider in regards to behavior and appearance
PT’s send messages through words, attention, voice tone, body language. do not underestimate the affect of hygiene and attire
During the approach to the interview, what should we consider in regards to the proper environment
lighting, temp, necessary equipment, proper draping
During the approach to the interview, what should we consider in regards to note taking
Maintain good eye contact especially when the patient is talking about sensitive/disturbing material
During the approach to the interview, what should we consider when greeting the patient and establishing rapport
Have a proper introduction and a proper title. Be attuned to patient comfort, and always maintain confidentiality if others are present
During the approach to the interview, what should we consider in regards to inviting the patients story
do not interrupt, use phrases to show engagement, use positive body language like nodding
During the approach to the interview, what should we consider in regards to clarifying the patients story
repeat back to the patient what you believe the patient has told you
How should you adapt to the silent patient
understand the patient be be collecting thoughts, they may be depressed or overwhelmed
How should you adapt to the confusing patient
a somatization disorder may be in play and they will have bizarre descriptions may seems peculiar or be psychotic
How should you adapt to the patient with altered capactity
understand they may have dementia
How should you adapt to the talkative patient
allow a few minutes of rambling but you need to courteously interrupt
How should you adapt to the crying patient
pause, be empathetic, offer tissue, be affirmative
How should you adapt to the angry/disruptive patient
accept angry feelings and/or alert security staff maintain non-threatening posture
How should you adapt to the language barrier between you and the patient
find an interpreter
How should you adapt to the patient with low literacy
be aware and ask how comfortable they are filling out a form
How should you adapt to a patient with impaired hearing
know how much loss is there and make appropriate accommodations like ASL or speak up
How should you adapt to a patient with impaired vision
Know how much loss is there and make accommodations like orienting patient to surroundings or adjust lighting
How should you adapt to a patient with personal problems
be a good listener, do not be judgmental and avoid advice outside of your practice act
Fever, chills, and night sweats are ______ symptoms
concerning
What term can be defined as having a high body temperature that could indicate infection
fever
What term can be defined as having recurrent shaking and suggests extreme swings in temperature
chills
What term can be defined as having hormonal changes, menopause, fever, cancer, and hyperhydrosis
night sweats
Is weight change a concerning symptom
yes
What does a rapid change of weight change usually indicate
a loss or gain of fluids
What does a gradual change of weight change usually indicate
an increase or decrease of body fat due to a high or low caloric intake
Gradual changes can be _____ edema due to heart failure, liver disease, venous stasis, or medications
systemic
True or False:
Pain is not a concerning symptom
false, it is concerning
What is the most common presenting symptom
pain
Healthy weight is defined as BMI between ____ and ____
18.5 and 24.9
What is the BMI range to be considered overweight
between 25 and 29.9
what is the BMI range to be considered obese
between 30 and 39.9
What is the BMI range to be considered extremely obese
40 or more
Overweight and obesity increases risk for heart disease, _____, type 2 diabetes, stroke, arthritis, ____ _____, and increased risk of death
cancer, sleep apnea
Is obesity increasing or decreasing worldwide
increasing
True or False:
Most obese adults have not been told by their health care provider that they are overweight and need to lose weight
true
What are three ways to promote weight loss
- set realistic goals
- Exercise
- Encourage behavioral habits
Promoting weight loss involves setting realistic goals. What are two ways to set realistic goals
- Reduce calories 500 to 1000 per day
2. Weight loss of 0.5 to 2 pounds per week
Promoting weight loss involves exercising, how much should a person exercise a day
walk 30 to 60 minutes per day for 5 days a week
Promoting weight loss involves encouraging behavioral habits. What are three habits someone can practiced
- portion controlled meals
- meal planning
- food diaries
When observing general appearance and apparent state of health, what should you look for
ill and frail vs fit a robust
When observing general appearance and level of consciousness, what should you look for
awake and alert vs slow to respond
When observing general appearance and signs of distress, what should you look for
labored breathing, grimacing, guarding/favoring
When observing general appearance and skin color and obvious lesions, what should you look for
pallor, cyanosis, jaundice
When observing general appearance and dress, grooming, and personal hygiene, what should you look for
excess clothing, dirty, unkept/bedraggled
When observing general appearance and facial expression what should you look for
immobile facies, flat expression, sad affect
When observing general appearance and odors of body and breath, what should you look for
alcohol, acetone (fruity or nail polish like)
When observing general appearance and posture, gait, and motor activity, what should you look for
everything PT’s do
Vital signs are used to get a quick assessment essential body functions, what are the vital signs
blood pressure, heart rate, respiratory rate, temperature
What is a normal range of blood pressure systolic and diastolic
less than 120 and less than 80
What is an elevated range of blood pressure systolic and diastolic
120-129 and less than 80
What is a high blood pressure - Hypertension stage 1 - range of blood pressure systolic and diastolic
130-139 or 80-89
What is a high blood pressure - hypertension stage 2 - range of blood pressure systolic and diastolic
140 or higher or 90 or higher
What is a hypertensive crisis range of blood pressure systolic and diastolic
higher than 180 and higher than 120
What is the etiology of hypertension
we don’t know but we tend to use the risk factors to explain.
Etiology of hypertension can be caused by an increased sympathetic nervous system activity which causes what two things
an increase of cardiac output and an increase of arterial pressure
What are the age risk factors for hypertension
men = 45 or older
female 55 or older
What are major risk factors for hypertension
age, family history, cigarette smoking, physical inactivity, dyslipidemia, and diabetes
What is palpated to asses heart rate, rhythm and amplitude
an artery
What is normal heart rate for an adult
60-100 beats per minute
what is the range to have bradycardia
less than 60 beats per minutes
what is the range to have tachycardia
greater than 100 beats per minute
When we palpate for heart rate, what are we actually feeling?
The frequency of the pulsation felt by your fingers follows an even tempo with equal intervals between pulsations which is called normal sinus rhythm
In regards to the respiratory rate and rhythm, what do we observe
the rate, rhythm, depth, and effort of breathing
How do we count the number of respirations per minute
by inspecting the best or shoulder movements of breathing and/or by listening to the tracheal with stetchoscope
What is a normal breathing rate for an adult
14-20
What is the range of breathing to be considered bradypnea
less than 14
What is the range of breathing to be considered tachypnea
greater than 20
what is considered to be a normal rhythm of breathing
equal tempo of inspiration and expiration, an occasional delay or sigh is normal
What is normal effort in regards to breathing rate
effortless with no noticeable use of accessory muscles
What does an elevated temperature usually indicate
an infection
How is temperature usually assessed
an electric thermometer or infrared thermometer
What is normal oral temperature?
98.6 F or 37 C
What are the 6 functions of the skin
Boundary of fluids, sensations, protection, body temp control, eliminate waste, synthesis of vitamin D
The skin has a protective function. What are three things the skin protects against?
- Against disease
- Against physical trauma
- Against electromagnetic energy
What is the rule to use when screening for cancer
The ABCDE rule
In the ABCDE rule to screen for cancer, what does the A stand for
asymmetry from one side of the mole to the other
In the ABCDE rule to screen for cancer, what does the B stand for
Border irregularity like ragged, notched, or blurred
In the ABCDE rule to screen for cancer, what does the C stand for
Color, look for variation and more than 2 colors
In the ABCDE rule to screen for cancer, what does the D stand for
Diameter, greater than 6mm (pencil eraser)
In the ABCDE rule to screen for cancer, what does the E stand for
evolving, does is change rapidly in size, symptoms or morphology
What are risk factors regarding skin cancer
family history, more than 50 common moles, light hair, eyes, or skin pigmentation, severe blistering sunburn in childhood, UV exposure from heavy sun/tanning.
How to prevent skin cancer
avoid excessive sun exposure and tanning booths. Use sun screen
What is the rule for self examination of skin cancer
ABCD rule
What are the types of flat skin lesions
Macule and patched
What are the size parameters for the flat skin lesions
macule = less than 1 cm patch = greater than 1 cm
What are the types of raised skin lesions
papule, nodule, plaque, vesicle, bulla, pustule, cyst
What type of raised skin lesion is less than 1cm and not fluid filled
papule
What type of raised skin lesion is deeper than a papule
nodule
What type of raised skin lesion is rough and flat, greater than 1cm and not fluid filled
plaque
What type of raised skin lesion is less than 1 cm with serous fluid
vesicle
What type of raised skin lesion is greater than 1cm with serous fluid
bulla
What type of raised skin lesion is filled with puss
pustule
What type of raised skin lesion is filled with fluid to semi-solid stuff
cyst
What type of lesion has a linear crack in the skin
fissures
What type of lesion has a deep loss of tissue
ulcers
What are two skin color changes to be looking for
cyanosis and jaundice
What is cyanosis and what is it caused by
It is a bluish tinge of the skin due to deoxygenated blood
What is jaundice and what is it caused by
It is a yellowish tinge due to excess bilirubin that effects the liver, gallbladder, and metabolic problems
What are common or concerning symptoms in regards to HEENT
HA, visual changes, hearing changes, vertigo, nose bleeds, sore throat, and swollen glands
What is a very common symptom of the head
headaches
What are the red flags when it comes to the head
Severe and sudden onset, associated with hypertension, or recent head trauma
What are questions to ask a patient to make sure the head isn’t experiencing pathological signs
- Do they have aura
- Do they have any nausea or vomiting
- Do they have photophobia
- Are they experiencing coughing, change of head positioning caused increased pain
- Any new medication
- Family history
What are visual symptoms to be looking for when it comes to pathology of the eyes
close and far vision, blurred vision, visual field loss, floaters and flashes, diplopia
What are other symptoms to be looking for in regards to the eye besides visual changes
pain, redness, tearing, exudate
What is involved during an exterior assessment of the eyes
Inspect sclera and conjunctiva, finger wiggles test for visual field defects, check for convergence, text extraocular movement, and check corneal reflecion
What is involved during an interior assessment of the eyes
Ophthalmoscope for looking at the interior of eye ball
How is the assessment of vision done
By testing near and far images
What disease is tinnitus related to
Meniere’s disease
Explain weber’s test for assessment of hearing
Bang the thing and set on top of the patients head and ask if they can hear anything
Explain Rinne’s test for assessment of hearing
Bang the thing and set on the mastoid process. Once the patient can’t hear it, move the thing in front of their ear
When does rhinorrhea occur
allergies and URI’s
What is rhinorrhea
runny nose
What is epistaxis
nose bleeds
How can epistaxis occur?
Inflammation and drying of mucosa, foreign bodies, bleeding disorder, and nose picking
If a sore throat is associated with fever and swollen lymph nodes, what should we expect
strept
If a sore throat is not associated with fever and swollen lymph nodes, what is probably the cause of the sore throat
allergies or viral infection
What are some things we should look for when we assess the mouth, throat, and neck
sore throat, inflamed pharynx, bleeding of gums (gingivitis), hoarseness, swollen lymph nodes or thyroid gland
