Physical Examination (Exam I) Flashcards
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-containing 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°F 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
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
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?
- Raccoon Eyes, 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/drooping of bottom eyelid
What is entropion?
- Inversion/inward bottom eyelid
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
- 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 Test
- 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
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.
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
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
How is a pack-year calculated?
(Cigs per day / 20) x years smoked
Bedridden, wheelchair-bound patients should not receive what drug?
Succinylcholine
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
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
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
Which two signs are common with meningitis?
kernig & brudzinski
Which two signs are commonly associated with hypocalcemia?
Chvostek & Trousseau
