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Physical Exam I > PT encounter, gen survery, V/S, skin, hair, nails > Flashcards

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

1
Q

What is the most critical portion of the physical exam?

A

General appearance and vital signs

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2
Q

What is Subjective information?

A

What PT says

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3
Q

What is Objective info?

A

What detected during exam

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4
Q

What are the 7 parts of the General Survey?

A
  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
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5
Q

BMI for obesity?

A

30+

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6
Q

What percent of US adults are obese?

A

35%

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7
Q

If BMI 35+ what to measure?

A

Waist circumference just above hips

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8
Q

Waist circumference where DM, HTN, CAD risk increased?

A

Men >40”

Women >35”

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9
Q

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

A

NO!

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10
Q

Sitting upright may indicate what?

A

Left sided HF

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11
Q

Learning forward with arms braced may indicate what?

A

COPD

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12
Q

What are the 4 vital signs?

A

BP, HR, RR, temp

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13
Q

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

A

Repeat them

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14
Q

What is “True Blood Pressure”?

A

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

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15
Q

How often to take BP in both arms?

A

At least once

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16
Q

Defintion of HTN?

A

140/90+

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17
Q

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

A

Home and ambulatory more predictive than office measurments

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18
Q

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

A

Home/ambulatory

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19
Q

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

A

135/80 (lower than manual office BP)

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20
Q

What is White Coat HTN?

A

Increased BP in office but normal when ambulatory

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21
Q

What does White Coat HTN signify?

A

CV risk is normal to slightly increased

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22
Q

What is Masked HTN?

A

Normal office BP but increased ambulatory BP

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23
Q

What does Masket HTN signify?

A

High risk of CV disease!

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24
Q

What is Nocturnal HTN?

A

Fall of <10% when sleeping.

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25
Q

What does Nocturnal HTN signify?

A

Poor CV outcomes

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26
Q

How to diagnose Nocturnal HTN?

A

24h ambulatory BP monitoring

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27
Q

No smoking or caffeine for how long before taking BP?

A

30 minutes

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28
Q

What to do with sleeve when taking BP?

A

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

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29
Q

Brachial Artery and antecubital crease at what level for BP?

A

Heart level

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30
Q

Width percent of inflatable bladder? Avg cm in adult?

A

40%

12-14cm in avg adult.

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31
Q

Length percent of inflatable bladder?

A

80% of arm circumference. Almost encircle entire arm.

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32
Q

Too small a cuff does what to BP?

A

Falsely high BP

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33
Q

Too large a cuff does what to BP?

A

Falsely low BP

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34
Q

Standard cuff dimensions? Good for up to what circumference?

A

12x23. Up to 28cm.

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35
Q

Where to inflate the BP bladder?

A

Over brachial artery

36
Q

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

A

About 2.5cm

37
Q

What to feel while rapidly inflating cuff?

A

Radial pulse and pressure when it disappears

38
Q

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

A

30mmHg

39
Q

What is the “disappear pressure + 30” used for?

A

Subsequent inflations to prevent discomfort and prevent ausclatory gap

40
Q

What is Ausculatory Gap? How to prevent it?

A

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

41
Q

How long to keep deflated after getting “disappear pressure”?

A

15-30 seconds

42
Q

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

A

Over brachial artery. Full air seal.

43
Q

Which part of stethoscope hears Korotkoff sounds better?

A

Bell

44
Q

After reinflating BP cuff how slowly to let out air?

A

2-3mmHg/second

45
Q

What does Systolic sound like?

A

Sound of at least two consecutive beats

46
Q

What does Diastolic sound like?

A

Disppearance of sound, a few mmHg below muffling point

47
Q

BP is read to what nearest point?

A

2 mmHg

48
Q

When to repeat BP?

A

2 minutes

49
Q

What is normal diff range in BP between arms?

A

5-10 mmHg

50
Q

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

A
  1. Subclavian Steel Syndrome

2. Aortic dissection

51
Q

Subclavian Steel Syndrome and Aortic Dissection do what to BP?

A

> 10-15 difference between arms

52
Q

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

A
  1. Coarctation of aorta

2. Occlusive aortic disease

53
Q

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

A

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

54
Q

Most common site to assess HR?

A

Radial pulse

55
Q

Which fingers and which parts to use for radial pulse?

A

Pads of index and middle fingers

56
Q

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

A

30 seconds then x 2

57
Q

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

A

60 seconds

58
Q

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

A

Apex of heart

59
Q

Why to check HR at apex of heart?

A

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

60
Q

Irregular rhythm MC d/t which arrythmia?

A

Sinus arrythmia

61
Q

What 4 things to check with respirations?

A

Rate, rhythm, depth, and effort of breathing

62
Q

How to count respirations?

A

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

63
Q

Normal adult respirations?

A

20 breaths/minute in quiet, regular pattern

64
Q

Respiratory rate in bronchitis? Pneumonia and PE?

A

Bronchitis=normal resp rate

Pneumonia and PE=increased resp rate

65
Q

Normal PO temperature?

A

37 C

66
Q

Rectal temp reading vs PO?

A

Rectal is 0.4-0.5C higher than PO.

67
Q

Axillary temp reading vs PO?

A

1C lower than PO

68
Q

Tympanic membrane temp?

A

Quick, safe, reliable if done properly.

69
Q

What is the most variable temp method?

A

Tympanic membrane. Different temps in ears of same person.

70
Q

When not to take PO temp?

A

Unconscious, restless, unable to close mouth

71
Q

Most reliable temp method?

A

Rectal

72
Q

4 classic techniques of physical exam?

A
  1. Inspection
  2. Palpation
  3. Percussion
  4. Auscultation
73
Q

Which side to examine PT on?

A

PT’s right side

74
Q

When to do a Comprehensive Assessment?

A

Annual physical, new PT in office or hospital

75
Q

When to do a Focused Assessment?

A

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

76
Q

Universal precaution do what?

A

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

77
Q

Function of skin?

A

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

78
Q

What are the three “appendates of the skin”?

A
  1. Hair
  2. Nails
  3. Sebaceous sweat glands
79
Q

Layers of skin?

A

Epidermis, dermis, subcutaneous adipose tissue

80
Q

Central Cyanosis?

A

Low level of O2 in blood

81
Q

Peripheral Cyanosis?

A

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

82
Q

Perhipheral Cyanosis can be normal in response to what?

A

Anxiety or cold

83
Q

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

A

Concerning issues

84
Q

What percent of melanomas are detected by the patient?

A

Half

85
Q

Acronym for melanoma detection?

A 
A=asymmetry of mole
B=irregular borders
C=color variation
D=diameter ≥6mm
E=evolution or change in size, symptoms, or morphology
86
Q

Skin mobility is what?

A

How easily skin lifts up

87
Q

Skin turgot is what?

A

How quickly skin returns into place

Physical Exam I (8 decks)

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