PT encounter, gen survery, V/S, skin, hair, nails

Question 1

What is the most critical portion of the physical exam?

Answer 1

General appearance and vital signs

Question 2

What is Subjective information?

Answer 2

What PT says

Question 3

What is Objective info?

Answer 3

What detected during exam

Question 4

What are the 7 parts of the General Survey?

Answer 4

1. PT general appearance
2. Level of consciousness
3. Signs of distress
4. Apparent state of health
5. Facial expressions
6. Height, weight, build
7. Vital signs

Question 5

BMI for obesity?

Answer 5

30+

Question 6

What percent of US adults are obese?

Answer 6

35%

Question 7

If BMI 35+ what to measure?

Answer 7

Waist circumference just above hips

Question 8

Waist circumference where DM, HTN, CAD risk increased?

Answer 8

Men >40”

Women >35”

Question 9

OK to ever assume alcohol on breath explains change in mental status?

Answer 9

NO!

Question 10

Sitting upright may indicate what?

Answer 10

Left sided HF

Question 11

Learning forward with arms braced may indicate what?

Answer 11

COPD

Question 12

What are the 4 vital signs?

Answer 12

BP, HR, RR, temp

Question 13

What do to if any of the vital signs are abnormal?

Answer 13

Repeat them

Question 14

What is “True Blood Pressure”?

Answer 14

Average pressure measured over several office visits or at home over one week period

Question 15

How often to take BP in both arms?

Answer 15

At least once

Question 16

Defintion of HTN?

Answer 16

140/90+

Question 17

Which (where) BP measurments are more predictive of CV disease and end-organ damage?

Answer 17

Home and ambulatory more predictive than office measurments

Question 18

Is home/ambulatory or office BP measurement more predictive of CV disease and end-organ damage?

Answer 18

Home/ambulatory

Question 19

What is the normal BP for home/ambulatory/automatic office BP?

Answer 19

135/80 (lower than manual office BP)

Question 20

What is White Coat HTN?

Answer 20

Increased BP in office but normal when ambulatory

Question 21

What does White Coat HTN signify?

Answer 21

CV risk is normal to slightly increased

Question 22

What is Masked HTN?

Answer 22

Normal office BP but increased ambulatory BP

Question 23

What does Masket HTN signify?

Answer 23

High risk of CV disease!

Question 24

What is Nocturnal HTN?

Answer 24

Fall of <10% when sleeping.

Question 25

What does Nocturnal HTN signify?

Answer 25

Poor CV outcomes

Question 26

How to diagnose Nocturnal HTN?

Answer 26

24h ambulatory BP monitoring

Question 27

No smoking or caffeine for how long before taking BP?

Answer 27

30 minutes

Question 28

What to do with sleeve when taking BP?

Answer 28

Disrobe sleeve. Don't roll up d/t increased BP reading.

Question 29

Brachial Artery and antecubital crease at what level for BP?

Answer 29

Heart level

Question 30

Width percent of inflatable bladder? Avg cm in adult?

Answer 30

40% | 12-14cm in avg adult.

Question 31

Length percent of inflatable bladder?

Answer 31

80% of arm circumference. Almost encircle entire arm.

Question 32

Too small a cuff does what to BP?

Answer 32

Falsely high BP

Question 33

Too large a cuff does what to BP?

Answer 33

Falsely low BP

Question 34

Standard cuff dimensions? Good for up to what circumference?

Answer 34

12x23. Up to 28cm.

Question 35

Where to inflate the BP bladder?

Answer 35

Over brachial artery

Question 36

How much above the antecubital crease should the BP cuff be?

Answer 36

About 2.5cm

Question 37

What to feel while rapidly inflating cuff?

Answer 37

Radial pulse and pressure when it disappears

Question 38

What to add to the pressure when radial pulse disappears during cuff inflation?

Answer 38

30mmHg

Question 39

What is the "disappear pressure + 30" used for?

Answer 39

Subsequent inflations to prevent discomfort and prevent ausclatory gap

Question 40

What is Ausculatory Gap? How to prevent it?

Answer 40

Silent interval between systolic and diastolic. Prevent by using "diappear pressure + 30".

Question 41

How long to keep deflated after getting "disappear pressure"?

Answer 41

15-30 seconds

Question 42

Where is the bell placed in BP? What sort of seal?

Answer 42

Over brachial artery. Full air seal.

Question 43

Which part of stethoscope hears Korotkoff sounds better?

Answer 43

Bell

Question 44

After reinflating BP cuff how slowly to let out air?

Answer 44

2-3mmHg/second

Question 45

What does Systolic sound like?

Answer 45

Sound of at least two consecutive beats

Question 46

What does Diastolic sound like?

Answer 46

Disppearance of sound, a few mmHg below muffling point

Question 47

BP is read to what nearest point?

Answer 47

2 mmHg

Question 48

When to repeat BP?

Answer 48

2 minutes

Question 49

What is normal diff range in BP between arms?

Answer 49

5-10 mmHg

Question 50

A 10-15 mmHg diff in BP between arms can mean what two things?

Answer 50

1. Subclavian Steel Syndrome | 2. Aortic dissection

Question 51

Subclavian Steel Syndrome and Aortic Dissection do what to BP?

Answer 51

>10-15 difference between arms

Question 52

Increased HTN in upper extremities but low BP in legs from which 2 conditions?

Answer 52

1. Coarctation of aorta | 2. Occlusive aortic disease

Question 53

Coarctation of aorta and Occlusive aortic disease do what to BP around body?

Answer 53

HTN in upper extremities, low BP in legs, and diminished or delayed femoral pulses

Question 54

Most common site to assess HR?

Answer 54

Radial pulse

Question 55

Which fingers and which parts to use for radial pulse?

Answer 55

Pads of index and middle fingers

Question 56

If pulse rate and rhytm are normal how long to take?

Answer 56

30 seconds then x 2

Question 57

If pulse rate and rhytm seem abnormal how long to take?

Answer 57

60 seconds

Question 58

If radial pulse is abnormal where else to take check HR?

Answer 58

Apex of heart

Question 59

Why to check HR at apex of heart?

Answer 59

Peripheral pulses may not detect premature beats and HR can seem slow

Question 60

Irregular rhythm MC d/t which arrythmia?

Answer 60

Sinus arrythmia

Question 61

What 4 things to check with respirations?

Answer 61

Rate, rhythm, depth, and effort of breathing

Question 62

How to count respirations?

Answer 62

Visually count resps in 1 minute while listening to PT's trachea with stethoscope -OR- while holding wrist

Question 63

Normal adult respirations?

Answer 63

20 breaths/minute in quiet, regular pattern

Question 64

Respiratory rate in bronchitis? Pneumonia and PE?

Answer 64

Bronchitis=normal resp rate | Pneumonia and PE=increased resp rate

Question 65

Normal PO temperature?

Answer 65

37 C

Question 66

Rectal temp reading vs PO?

Answer 66

Rectal is 0.4-0.5C higher than PO.

Question 67

Axillary temp reading vs PO?

Answer 67

1C lower than PO

Question 68

Tympanic membrane temp?

Answer 68

Quick, safe, reliable if done properly.

Question 69

What is the most variable temp method?

Answer 69

Tympanic membrane. Different temps in ears of same person.

Question 70

When not to take PO temp?

Answer 70

Unconscious, restless, unable to close mouth

Question 71

Most reliable temp method?

Answer 71

Rectal

Question 72

4 classic techniques of physical exam?

Answer 72

1. Inspection 2. Palpation 3. Percussion 4. Auscultation

Question 73

Which side to examine PT on?

Answer 73

PT's right side

Question 74

When to do a Comprehensive Assessment?

Answer 74

Annual physical, new PT in office or hospital

Question 75

When to do a Focused Assessment?

Answer 75

Established PT during routine or urgent care, problem/symptom focused

Question 76

Universal precaution do what?

Answer 76

Prevent transmission of HIV, HepB, and other blood borne pathogens when providing first aid or health care

Question 77

Function of skin?

Answer 77

Keep body in homeostatis despite daily environmental assault. Modules body temp, synthesizes vitamin d.

Question 78

What are the three "appendates of the skin"?

Answer 78

1. Hair 2. Nails 3. Sebaceous sweat glands

Question 79

Layers of skin?

Answer 79

Epidermis, dermis, subcutaneous adipose tissue

Question 80

Central Cyanosis?

Answer 80

Low level of O2 in blood

Question 81

Peripheral Cyanosis?

Answer 81

Normal O2 levels in blood. When cutaneous blood flow decreases or slows.

Question 82

Perhipheral Cyanosis can be normal in response to what?

Answer 82

Anxiety or cold

Question 83

Hair loss, nail changes, rashes, and growths are what?

Answer 83

Concerning issues

Question 84

What percent of melanomas are detected by the patient?

Answer 84

Half

Question 85

Acronym for melanoma detection?

Answer 85

``` A=asymmetry of mole B=irregular borders C=color variation D=diameter ≥6mm E=evolution or change in size, symptoms, or morphology ```

Question 86

Skin mobility is what?

Answer 86

How easily skin lifts up

Question 87

Skin turgot is what?

Answer 87

How quickly skin returns into place