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physical exam > physical exam midterm > Flashcards

physical exam midterm Flashcards

1
Q

ABCDE’s of Melanoma

A 
A: asymmetrical - configuration
B: borders - irregular, esp notching
C: color - especially mixtures of black, blue & red
D: diameter - >6mm
E: elevation or evolution

refer to dermatologist or MD pathologist

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2
Q

xanthelasma

A

slightly, raised yellowish, well-circumscribed plaques that appear along the nasal portions of one or both eyelids. may accompany lipid disorder

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3
Q

weber’s test

A
  • grasp tuning fork by handle and make it vibrate
  • place stem toward back of patient’s head, equidistant from each ear
  • sound should be transmitted equally to both ears, if not the one that can hear better has the blockage
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4
Q

signs of vitiligo

A

disease that causes loss of skin color in blotches

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5
Q

Percussion of Lungs

A

dull: medium intensity & pitch, thud like, solid areas (dyspnea)
resonant: long, loud, low pitched, hollow (normal)
hyper-resonant: very loud found over pneumothorax or stomach (acute asthma-wheezing)
tympanic: loud, very high pitched, drum like, found over air filled areas (emphysema)

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6
Q

Otitis Externa

A

Acute: canal is often swollen, narrowed, moist, pale & tender. -may be reddened
Chronic: skin of canal is often thickened, red & itchy
tug auricle & tragus to test for px

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7
Q

Otitis Media

A
  • look for red bulging drum of acute purulent cases;
  • amber drum of serous effusion
  • press behind ear for px*
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8
Q

7 Attributes to a Condition

A
  1. Location-where & does it radiate
  2. Quality- what does it feel like
  3. Quantity/Severity- intensity scale
  4. Timing-when did it start, how long it lasts, how often it occurs
  5. Setting in which it occurs- activities, emotions, etc
  6. Remitting or Exacerbating Factors- anything make it better or worse
  7. Associated Manifestations- does anything accompany it?
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9
Q

Cancer Masses

A

can be painful or painless

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10
Q

Normal Temperature Readings

A

orally: 98.6 F rectal: 99.1-99.6 F

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11
Q

How to test for appendicitis

A
  • McBurney’s Pt tenderness: 1/3 of distance from ASIS to umbilicus
  • manual muscle test of psoas
  • rebound test
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12
Q

pancreatitis symptoms

A

People may experience:
Pain: in the back or abdomen, can be dull or sudden in the abdomen, severe
Gastrointestinal: vomiting, bloating, indigestion, or fat in stool
Whole body: sweating, nausea, or loss of appetite
Also common: fast heart rate or weight loss

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13
Q

peptic ulcer

A

Pain: in the upper abdomen or chest, can occur at night, can be dull
Gastrointestinal: belching, bloating, indigestion, vomiting, or heartburn
Whole body: nausea or fatigue
Also common: abdominal discomfort

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14
Q

detect sinusitis

A

Palpation
All but the sphenoidal sinuses can be palpated for tenderness:
Frontal sinus - press upward beneath the medial side of the supraorbital ridge.
Maxillary sinus - press against the anterior wall, below the inferior orbital margin.
Ethmoidal sinus - press medially against the medial wall of the orbit

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15
Q

Order of Examination Abdominal/GI

A
  1. question
  2. Inspection
  3. auscultation
  4. palpation
  5. percussion
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16
Q

graves disease (hyperthyroidism)

A 
Goiter (enlarged thyroid)
Trouble sleeping
Irritability or nervousness
Heat sensitivity, increased sweating
Hand tremors
Rapid heartbeat
Thinning of skin or fine, brittle hair
Frequent bowel movements
Weight loss without dieting
Fatigue or muscle weakness
bulging eyes
thickening and reddening of skin, esp shins
17
Q

cushings syndrome

A

People may experience:
Skin: stretch marks, thinning, darkening of the skin, or acne
Psychological: depression or anxiety
Muscular: muscle weakness or loss of muscle
Whole body: osteoporosis, excess sweating, excessive hunger, high blood pressure, flushing, excessive hairiness, or fatigue
Also common: irritability, swelling in extremities, insomnia, easy bruising, pot belly, weight gain, hair loss, headache, round face from gradual swelling, or infertility

18
Q

clubbing of fingers

A

lung cancer or diseases, cirrhosis of liver, diabetes, celiac, infection of heart lining (endocarditis), grave’s disease, overactive thyroid, other types of cancer

19
Q

common sources of chest pain

A

angina, myocardial infarction, dissecting aortic aneurysm, pulmonary embolism, esophageal spasm, anxiety, pericarditis, pneumothorax, peptic ulcer, cholecystits

20
Q

vocal fremitus

A

the vibration of the chest wall as a person speaks or sings that allows the person’s voice to be heard by auscultation of the chest with a stethoscope.

21
Q

egophony

A

is an increased resonance of voice sounds[1] heard when auscultating the lungs, often caused by lung consolidation and fibrosis.

22
Q

grade heart murmurs

A
  1. very faint, only heard in ideal circumstances; no thrill
  2. loud enough to be generally heard; no thrill
  3. louder than 2; no thrill
  4. louder than 3; w/ thrill
  5. heard w/ stethoscope partially off chest; w/ thrill
  6. heard w/ stethoscope entirely off chest; w/ thrill
23
Q

signs of acute pulmonary embolism

A

sudden stabbing px may be accompanied by cyanosis, dyspnea or cough

Symptoms of pulmonary embolism include difficulty breathing, chest pain on inspiration, and palpitations. Clinical signs include low blood oxygen saturation and cyanosis, rapid breathing, and a rapid heart rate

24
Q

risks of breast cancer

A

BRCA1&2 gene, 2 or more first degree relative w/ breast cancer at early age, personal history, high breast tissue density, biopsy confirmed atypical hyperplasia, high dose radiation to chest, high bone density

25
Q

signs of breast cancer

A

lumps, change in size, dimpling, swollen, darkening warmth or red areas, itchy scaly rash or sore on nipple, inversion of nipple, sudden nipple discharge, new px in one spot that doesn’t go away

26
Q

breast exam procedure

A
  1. inspect appearance of skin, size and symmetry, contour, characteristics of nipples, arms over head, hands on hips, leaning forward
  2. palpation w/ patient lying supine, w/ finger pads of 2,3,4 fingers keeping them slightly flexed, rectangular area from clavicle to bra line and mid-sternal line to posterior axillary line & into axilla for tail of the breast; vertical strip pattern using small concentric circles at each examine pt looking for: consistency of tissue, tenderness, nodules
27
Q

heart auscultation

A
  1. Right 2nd intercostal space (aortic area)
  2. Left 2nd intercostal space (pulmonic area)
  3. 3rd intercostal space Erb’s pt, left sternal border (right ventricular area)
  4. Tricuspid area- 4th or 5th intercostal space, left sternal border
  5. mitral area- 5th intercostal space mid-clavicular line (left ventricular area)
28
Q

Best place to hear S4

A

in tricuspid or mitral areas

29
Q

best place to hear S2 and S3

A

over apex of heart w/ patient left side lying

30
Q

eye exam for hypo & hyperthyroidism

A

hypothyroidism- swollen eye lids

hyperthyroidism- graves disease bulging eyes & lid lag & poor convergence

31
Q

daily caloric intake for most active women, most men and older children

A

2200 calories/day

32
Q

Taking Blood Pressure

A
  • take on left arm w/ appropriate size cuff
  • center the bladder of the cuff over brachial artery
  • 1 inch or 2.5cm above antecubital crease
  • position pts arm so that it is slightly flexed at elbow and raised to heart level
33
Q

Skin, Thorax & Lungs Physical Exam Technique

A
  1. inspection
  2. palpation
  3. percussion
  4. auscultation

physical exam (2 decks)

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