Physical Exam (1) Flashcards
What are the components of a health assessment?
Health History
Physical Assessment
Tactic to use when asking about substance abuse during physical exam:
Blunt conversation to explain you just need to know but dont really care
A collection of subjective and objective data that provide a detailed profile of the client’s health status is known as _______________
Health History
Who is involved in the anesthetic time out?
anesthetist
surgeon
patient
Why does patient monthly income matter to us?
Might have impact on postop care (ability to fill prescription)
What is the scientific study of the measurements and proportions of the human body?
Anthropometry
What are some descriptions for height/build?
Average, Tall, Short, Lanky (long and thin), Muscular
What type of patients are prone to positioning injuries?
Emaciated patients
Large patients
What could be the issue for a patient that has had recent drastic weight loss or weight gain?
Drastic weight loss: Cancer, T1 diabetes
Drastic weight gain: heart failure, hypothyroid
Where are some areas to measure BP?
Radial artery (above wrist)
Dorsalis pedis artery (midcalf)
Popliteal artery (above knee)
Brachial artery (upper arm)
Axillary temps are approx ____ degrees less than core temps
1 degree Fahrenheit less
What vital sign is a big core measure for CRNAs?
temp
In patients who smoke, who is at highest risk for lung cancer and should undergo screening with low-dose CT?
Patients who are 55 or older with 30 or more pack year history
What is meant by a pack year? How many cigarettes per pack?
1 pack per day x 365 days
20 per pack
Why is it important to know patient family information?
Important in peds and for discharge planning
If a patient is crazy before being put under how would you expect them to wake up?
Often the way the patient goes to sleep is the way they wake up
What is the order for physical assessment?
Inspection
Palpation
Percussion
Auscultation
Olfaction
What are the different types of palpation and the order to perform?
Light: 1-2cm depth
Deep: used to detect abdominal masses/fem pulse–4-5cm depth
Bimanual: both hands to trap a structure between then
______ involves tapping the body with the fingertips to evaluate the size, border and consistency of body organs and to discover fluid/air in body cavity
Percussion
Term for sound waves heard as percussion tones:
Resonance
What type of percussion involves putting a hand down and tapping on the hand?
Mediate or indirect percussion
Used mainly to evaluate the abdomen or thorax
What type of percussion is used to evaluate the sinus or an infant thorax?
Immediate percussion
How is immediate percussion performed?
Striking the surface directly with the fingers of the hand
What is fist percussion and what is it used to evaluate?
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 eval back and kidney for tenderness
Where is a common location for tympany and what does it sound like?
Loud, high pitch, drumlike
Common in air containing space, enclosed are, gastric air bubble, puffed out cheek
You are assessing a patient and performing percussion over the upper thorax. You notice a low pitches hollow sound of moderate intensity. What is the name for this sound and what does this finding indicate?
Resonance–normal percussion sound in normal lungs
What type of percussion sound might be presence in lungs with emphysema?
Hyper Resonance–very loud, very low, booming sound
You notice a thudlike percussion when assessing a patients abdomen that has a high pitch and moderate duration. What is this sound produced during percussion and where is this likely to occur in the body?
Dullness–common in the liver
Where is a common location to percuss an area that produces a “flatness” sound?
Muscle- High pitch, short duration, flat quality
What are things that should be noted with auscultation?
Intensity
Pitch
Duration
Quality
What causes the yellow discoloration of the skin and eyes in a patient that is jaundice? What should be considered from a surgical standpoint?
Elevated bilirubin–assume liver function is impaired
Issues with poor clotting
Autoimmune disorder where body systems that fight infection start to fight off healthy cells (melanocytes):
Vitiligo
What are some possible reasons for petechiae?
Prolonged straining (coughing/sneezing)
Meds
Infectious diseases
Leukemia
Thrombocytopenia
What are the grades of pitting edema?
Grade 0: none
Grade +1: trace (2mm) rapidly disappears
Grade +2: moderate (4mm) 10-15 sec
Grade +3: deep (6mm) ≥1min
Grade 4+: very deep (8mm) 2-5 min
What is Koilonychias and what issues can it indicate?
“Spoon nails” abnormally thin nails that become flat or concave
Can be sign of Hypochromic anemia or Iron deficiency anemia
What is associated with nail clubbing?
Mostly associated with heart and lung disease
Lung cancer, lung infections, interstitial lung disease, CF, CV disease (can sometimes be genetic and not disease related)
What is Paronychia?
inflammation of the skin around the nail
Main consideration when assessing the eye:
Think about endocrine disorders (exophthalmoses)
Eye condition that causes eyes to be misaligned:
Strabismus
What block commonly causes ptosis?
Inter-scalene blocks
How does anesthesia cause ptosis?
Blocks
Horners Syndrome: Ptosis, Miosis, loss of temp sensation
Term for when the eye lid margin turns out (eversion):
Ectropion
Term for when the eye lid turn inward (inversion):
Entropion
Abnormal drooping of the lid over the pupil
Ptosis
Notable differences in pupil sizes
Anisocoria
What is the treatment for a sty?
Warm moist towel–increases perfusion and unclogs the duct
What type of eye injury is a surgical emergency?
Open Globe (full thickness wound of the eye wall)
What do we have to consider with anesthesia and eyes?
increasing IOP with succs, face masks pushing on the eye, problems with mask ventilation if they have eye patch
What stage on anesthesia includes roving eye balls and pupils partially dilated?
Stage 2
What is Arcus senilis?
Common build up of fatty substance in the eye that appears as a white, grey, or blue ring around the cornea
What medication causes pupillary constriction?
Opioids
What medications cause pupillary dilation?
Anticholinergics
Differentiate retinal artery occlusion with corneal abrasion:
Retinal artery occlusion: complete loss of vision
Corneal abrasion: Blurry vision, feels like sand in the eye
What does the snellen test evaluate?
Visual acuity by reading chart of letters/symbols
What does extra ocular movement assessment help evaluate?
Optic nerve entrapment of the muscle–emergency
Glaucoma involves loss of ____________ vision
Peripheral vision
(tunnel vision)
How do cataracts impact vision?
Progressive loss of visual acuity
What disorder might low set ears indicate?
Down syndrome–could have problems with airway (smaller neck, weird airway presentations)
What can be used to alleviate pressure on an ear if patient is laying on it?
donut
What could bulging tympanic membrane indicate?
Elevated ICP
Why are we concerned when a patient with basilar skull fracture has fluid leaking from ears or nose?
Could be CSF–Halo test
usually mixed with blood
What is the Rinne test used for?
Primarily used to evaluate air vs bone conduction
In recent years exposure to radiation has been linked to increase risk for _________ and ___________
Cataracts and Hearing loss
What is the Webers test used for?
Used to determine which ear has conductive hearing loss
Why is it important to avoid N2O if a patient has risk for elevated ICP or increased sinus pressure?
N2O can diffuse out into sinus spaces–Further increasing sinus pressure and ICP
What can be used as a pretreatment to vasoconstrict the vessels in the nose and reduce risk of bleeding?
Afrin
Pale lips could be an indicator of…
Anemia
Where is a good site to visualize jaundice?
Buccal mucosa
What vitamin deficiency could a bright red tongue indicate?
B12 or Niacin
What a concern if a patients gums are bleeding?
Concern for hepatic issues and coagulopathy
What can cyanosis or redness in the mouth indicate?
Iron deficiency
White coating on the tongue could mean…
dehydration
How can you assess the sinuses?
Transillumination: Take a light and shine it through the sinuses then ask patient to open their mouth:
-Normal would be to see the light shine through
-If there is build up on mucus the light wont shine through
What issues can be indicated by the following lip colors: Cherry, Pallor, Cyanosis:
Cherry: CO poisoning
Pallor: Anemia
Cyanosis: Hypoxia or hypo perfusion
What do gums look like if someone has a Vit-C deficiency?
Spongy gums that bleed easily
What is Leukoplakia?
Thick white patches on the gums d/t smoking and alcohol
How do you assess the pharynx?
Extend neck slightly, open the mouth widely and say “ah” place tongue depressor on the middle 1/3 of tongue and use pen light
Gag reflex should be present
No gag/ dysphagia= increase risk for aspiration
How is the sternocleidomastoid function assessed?
Ask patient to flex the neck with the chin to the chest
shouldnt have any pain with this
How to assess function of trapezius muscles?
Movement of the head sideways so that the ear moves toward the shoulder
neck should move freely without any pain
What to do if you cant palpate the thyroid gland easily:
Give the patient water, take a sip and swallow as you palpate
Where is the apical pulse located?
5th ICS medial to the mid-clavicular line
What is the most common GU precedure?
Cystoscopy
GU surgeries tend to have a rapid drop in BP, what can you be to try to avoid this? Cant remember why
Volume load
Which cases typically require foleys?
Laparoscopic (need bladder decompressed)
Long cases
What medication affects DTRs?
Mag
Why is kyphosis a worry from airway standpoint?
Compressed chest space/lungs
What are the common pathologic spine curvatures? How would the affect patient positioning?
Lordosis, Kyphosis, Scoliosis
Pad voids when patient is positioned to avoids injuries
What does the Romberg test check for?
Proprioception
Patient closes eyes with arms out and becomes unsteady= positive Romberg (loss of proprioception)
What does the VAN assessment screen for?
Large vessel occlusion
What are the different reflexes discussed in class?
Biceps
Triceps
Patella
Achilles
Planter
Gluteal
How does the arm move when testing bicep tendon?
Flexion on arm at the elbow
How does the arm move when testing tricep tendon?
Extension at elbow
What reflex is common to test on pregnant women who are on mag? How is it tested?
Patellar reflex
Leg hangs freely–tap patellar tendon just below patella
extension of lower leg
How is achilles reflex tested?
Strike achilles tendon–causes plantar flexion of foot (pointed toe)
How to eval plantar reflex? (babinski)
Have patient lie supine w/legs straight
Stoke lateral sole of heel to ball of foot
should cause plantar flexion of all toes
How to assess gluteal reflex
Lightly stimulate perineal area with cotton applicator–should cause contraction of anal sphincter
“Chipmunk face” is associated with what eating disorder?
Bulimia
Spider angioma is commonly associated with what liver disorder?
Cirrhosis
Pyloric stenosis is associated with that shape mass?
Olive
Hyperthyroid is associated with ophthalmic changes?
Exophthalamus
What physical feature is common with Cushing’s?
Buffalo hump
Rice water stool is common with what illness?
Cholera
Leonine face is associated with _______.
Leprosy (Hansen’s Disease)
Leprosy is caused by infection with the bacterium Mycobacterium leprae. It mainly affects the skin, eyes, nose and peripheral nerves.
