Physical Examination (Exam I) Flashcards
1
Q
How deep would one palpate with light palpation technique?
Deep palpation technique?
A
- 1-2 cm
- 4-5 cm
2
Q
What would be expected with tympanic, drum-like percussion?
A
- Air-containg space (puffed out cheek, gastric air bubble, etc.)
3
Q
What would be expected with resonant, hollow sounding percussion?
A
- Normal lungs
4
Q
What would be an expected finding with assessed hyper-resonant, booming percussive sounds?
A
- Emphysematous lungs
5
Q
What would be an expected finding with assessed dull, thud-like percussive sounds?
A
- Softer organs (ex. Liver)
6
Q
What would be an expected finding with assessed flat percussive sounds?
A
- Denser organs (ex. muscle)
7
Q
What temperature does one need to be to go to PACU?
A
96°
8
Q
Approximately what should the axillary temp be in comparison to a core temperature?
A
- 1° lower
9
Q
What is Anthropometry?
A
- Scientific study of the measurements and proportions of the human body (height, weight, etc.)
10
Q
What is Mediate or Indirect Percussion?
How is it performed and what is its purpose?
A
- Plexor (striking finger) & pleximeter (finger being struck).
- Evaluation of abdomen and thorax
11
Q
What is Immediate percussion? What is it utilized for?
A
- Striking of surface directly with fingers of the hand.
- Adult sinus or infant thorax evaluation.
12
Q
What is Fist percussion? What is it utilized for?
A
- Flat hand on area to be evaluated being struck with a fist.
- Used to evaluate the back & kidney for tenderness.
13
Q
What are the three forms of percussion?
A
- Mediate/Indirect percussion
- Immediate percussion
- Fist percussion
14
Q
When is circumoral cyanosis primarily seen?
How might circumoral cyanosis present on patients with darker skin tones?
A
- In infants primarily above the upper lip.
- gray or white rather than blue
15
Q
What are situations that can cause jaundice?
A
- Acute liver inflammation
- Inflammation/obstruction of the bile duct
- Cholestasis
- Hemolytic anemia
- Gilbert’s syndrome
- Crigler-Najjar syndrome
- Dubin-Johnson syndrome
- Pseudojaundice
16
Q
What causes pseudojaundice? How harmful is it?
A
- Harmless condition caused by excess carrots, pumpkins or melon consumption (↑ β-carotene)
17
Q
What is Gilbert’s syndrome?
A
- Inherited condition where enzymes CAN’T PROCESS THE EXCRETION OF BILE.
18
Q
What is Crigler-Najjar’s syndrome?
A
- Inherited condition that impairs the SPECIFIC ENZYME RESPONSIBLE FOR PROCESSING BILIRUBIN .
19
Q
What is Dubin-Johnson syndrome?
A
- Inherited chronic jaundice where conjugated bilirubin can’t be secreted from the hepatic cells.
20
Q
What type of cells does vitiligo attack?
A
- Melanocytes
21
Q
What is the sign name of periorbital ecchymosis? What does it indicate?
A
- raccoon eyes ( can be accompanied by Battle’s Sign - ecchymosis behind the ears): indicates basilar skull fracture.
22
Q
What are petechiae indicative of?
A
- Thrombocytopenia
- Leukemia
- Infectious disease
- Medications
- Prolonged straining
23
Q
What is koilonychia? What is it often indicative of?
A
- Spoon-nails where nails become flat or convex. (opposite of clubbing)
- Iron-deficiency anemia.
24
Q
What is nail clubbing? What is it often indicative of?
A
- Increased concavity of nails
- Heart/lung diseases, also potential osteoarthropathies.
25
What is paronychia?
- Inflammation of skin around the nail.
26
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.
27
What is hirsutism? What is a common cause?
- Excessive hair growth often caused by PCOS.
28
What is the name of notable difference in pupillary size between both eyes called?
- Anisocoria
29
What is ectropion?
- Eversion of eyelid/outward turning of the lower eyelid
30
What is entropion?
- Inversion of eyelid / inward turning of the lower eyelid
31
What is Ptosis?
- Abnormal drooping of eyelid
32
What is Arcus Senilis?
- Deposition of phospholipids/cholesterol in the peripheral cornea of older patients. (benign usually)
33
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
34
What is ocular accomodation?
- Ability of eye to focus in on objects far away and close.
35
What is most often the most important anesthetic consideration regarding the ears?
- Padding during surgery to prevent injury
36
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.
37
What are cherry-colored lips most often indicative of?
- Carbon monoxide poisoning
38
Differentiate pallor & cyanosis presentations as well as what usually causes each.
- Pallor = pale (usually anemia)
- Cyanosis = blue (hypoxia or hypoperfusion)
39
What would be indicated by the presence of "spongy" gums?
- Bleeding due to Vit-C deficiency (scurvy?)
40
What is Leukoplakia? What causes it?
- Thick white patches on the gums from smoking and/or alcohol
41
Where is the apical pulse located?
- 5th Intercostal space, left of sternum, medial to left mid-clavicular line.
42
How much assistance should a patient receive when a Mallampati assessment is being done?
- None
43
Chest pain in sync with respiratory movement could be indicative of what?
- Musculoskeletal abnormality or infection
44
What can cause radial pulses to become unsymmetric?
- Clavicular fracture or aortic dissection
45
How can Mg⁺⁺ evaluations be done in OB patients?
- Knee extension/flexion
46
What capability is lost with peroneal nerve injury?
- Dorsiflexion
47
What anesthetic consideration should one have for a patient with significant lordosis?
- ↑ abdominal pressure could = worse GERD.
- Difficult spinal/epidural
48
What anesthetic consideration should one have for a patient with significant kyphosis?
- Airway, ventilation, and positioning issues
49
Patient judgement is relevant to obtaining _______ ________ whilst ________ is pertinent to the patient's understanding of whats going on.
- informed consent; insight
50
What test evaluates proprioception?
How is this test performed?
- Romberg Test
- Standing with eyes closing and palms down; loss of balance is a + test
51
What is a VAN exam?
What does being VAN positive indicate?
- Palms up, checking for downward drift.
- VAN (+) = ↑ risk for LVO (large vessel occlusion)
52
What is another name for plantar reflex?
Babinski reflex
53
When would a gluteal reflex be performed?
- Trauma patients in assessing pelvic injury
54
How does one calculate BMI in imperial measurement?
(703 x lbs) / inches²
55
What endocrine disorder makes it difficult to manage fluid status?
- Pituitary tumors (*think neurohypophysis ADH*)
56
What is G6PD deficiency?
- Lack of enzyme that results in RBCs breaking down faster than they are made. (can cause hemolytic anemia).
57
What are seizure meds effects on anesthesia?
- Seizure meds make anesthetics work **less effectively**.
58
Which court case determined how informed consent should be obtained?
- Salgo vs Leland Stanford Univ.
59
What MET capacity would indicate a patient is good to go for surgery from a cardiovascular fitness standpoint?
- MET of 5 or greater.
60
What class of meds commonly given in anesthesia are teratogenic?
- Benzodiazepines
61
What component of "ester" medications are people allergic to?
- PABA (Para-aminobenzoic acid)
62
Which cardiac hypertension meds need to be discontinued prior to surgery? Why?
- ACEi & ARBs - can lead to severe hypotension.
63
What needs to be checked pre-op with psych patients? Why?
- EKG for prolonged QT interval. Many psych meds prolong QT interval.
64
Which meds cannot be given to a patient taking an MAOI?
- Meperidine & ephedrine
65
P2Y12's inhibitors and aspirin need to be discontinued ______ days prior to surgery.
When is the exception?
- 7 days
- Exception: patient needs to complete 6 months of dual therapy before discontinuation of anything.
66
Which herb tends to cause an allergic reaction peri-operatively?
- Echinacea
67
Which surgery times put one at a greater risk for PONV?
- prolong surgeries
68
How is a pack-year calculated?
20 cigs per pack. 1ppd x 365
69
Bedridden, wheelchair-bound patients should not receive what drug?
Succinylcholine
70
What symptoms/signs point to Horner syndrome?
What most often causes it?
- One sided miosis, ptosis, & anhidrosis
- Interscalene blocks
71
Pill-rolling tremors are associated with what disorder?
- Parkinson's
72
What sign is it when one experiences RUQ pain along with cholecystitis?
- Murphy's sign
73
What vision change accompanies glaucoma?
- Tunnel vision
74
What is the name for chest-clutching that occurs during MI?
- Levine's sign
75
What nerve runs along the breast that we should be aware of?
- Long thoracic nerve
76
Where is the apical pulse?
- 5th ICS, left of sternum, mid-clavicular line
77
What is the importance of blood in the urine when doing a c-section?
Possible severed ureter
78
Who is most at-risk for urinary retention post-operatively?
- BPH patients (old men)
79
What drug treats preeclampsia?
How can you check for overdose with this drug?
- Magnesium
- hypermagnesemia will cause patellar reflexes to disappear.
80
Chipmunk face is associated with what disorder?
- Bulimia
81
Leoning face is associated with what disease?
Leprosy
82
Spider angioma is associated with what liver disorder?
- Cirrhosis
83
Pyloric stenosis is associated with what shape mass?
- Olive
