Physical Examination (Exam I) Flashcards
what is pronator drift
weakness or drift of arms when outstretched for short length of time
-high likelihood of large vessel occlusion
-mostly likely to be VAN positive
what is levines sign
a universal sign of ischemic chest pain, defined as an individual holding a clenched fist over the chest that has a low sensitivity but is relatively specific for ischemia
how do you test sternocleidomastoid muscle of pt? how do you test trapezius muscle of pt?
o Ask the patient to flex the neck with the chin to the chest.
o Movement of the head sideway so that the ear moves toward the shoulder.
what are spongy gums indicative of
vitamin C deficiency
what does leukoplakia
thick white patches on tongue. precancerous lesion due to smoking and alcohol
what s/s does cocaine and meth cause for surgery?
-cocaine= bleed and HTN, shift in auto regulation
-meth= low and hard to manage BP problems during surgery. need extra pressors
How deep would one palpate with light palpation technique?
Deep palpation technique?
- 1-2 cm
- 4-5 cm
What would be expected with tympanic, drum-like percussion?
- Air-containg space (puffed out cheek, gastric air bubble, etc.)
What would be expected with resonant, hollow sounding percussion?
- Normal lungs
What would be an expected finding with assessed hyper-resonant, booming percussive sounds?
- Emphysematous lungs
What would be an expected finding with assessed dull, thud-like percussive sounds?
- Softer organs (ex. Liver)
What would be an expected finding with assessed flat percussive sounds?
- Denser organs (ex. muscle)
What temperature does one need to be to go to PACU?
96°
Approximately what should the axillary temp be in comparison to a core temperature?
- 1° lower
What is Anthropometry?
- Scientific study of the measurements and proportions of the human body (height, weight, etc.)
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
What is Immediate percussion? What is it utilized for?
- Striking of surface directly with fingers of the hand.
- Adult sinus or infant thorax evaluation.
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.
What are the three forms of percussion?
- Mediate/Indirect percussion
- Immediate percussion
- Fist percussion
When 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
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
What causes pseudojaundice? How harmful is it?
- Harmless condition caused by excess carrots, pumpkins or melon consumption (↑ β-carotene)
What is Gilbert’s syndrome?
- Inherited condition where enzymes can’t process bile excretion.
What is Crigler-Najjar’s syndrome?
- Inherited condition where enzyme that processes bilirubin is ineffective.
What is Dubin-Johnson syndrome?
- Inherited chronic jaundice where bilirubin can’t be secreted from the hepatic cells.
What type of cells does vitiligo attack?
- Melanocytes
What is the sign name of periorbital ecchymosis? What does it indicate?
- Battle’s Sign: indicates basilar skull fracture.
What are petechiae indicative of?
- Thrombocytopenia
- Leukemia
- Infectious disease
- Medications
- Prolonged straining
What is koilonychia? What is it often indicative of?
- Spoon-nails where nails become flat or convex. (opposite of clubbing)
- Iron-deficiency anemia:
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.
- Lots of things. Nail trauma, kidney failure, mumps, thyroid disorders, syphilis, etc.
What is hirsutism? What is a common cause?
- Excessive hair growth often caused by PCOS.
What is the name of notable difference in pupillary size between both eyes called?
- Anisocoria
What is ectropion?
- Eversion of eyelid
What is entropion?
- Inversion of eyelid
What is Ptosis?
- Abnormal drooping of 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
- No loss of eyelid reflex
What is ocular accomodation?
- 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.
What are 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 from smoking and/or alcohol
Where is the apical pulse located?
- 5th Intercostal space, left of sternum, medial to left mid-clavicular line.
How much assistance should a patient receive when a Mallampati assessment is being done?
- None
Chest pain in sync with respiratory movement could be indicative of what?
- Musculoskeletal abnormality or infection
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
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
- Standing with eyes closing and palms down; loss of balance is a + test
What is a VAN exam?
What does being VAN positive indicate?
- Palms up, checking for downward drift.
- 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
