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Physical Diagnosis Exam 2 > Quiz 2 > Flashcards

Quiz 2 Flashcards

1
Q

What is TEMPERATURE an indicator of?

A

infection & metabolism

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2
Q

What is PULSE an indicator of?

A

cardiovascular health

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3
Q

What is RESPIRATION an indicator of?

A

respiratory system & metabolic function

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4
Q

What is BLOOD PRESSURE an indicator of?

A

peripheral measurement of cardiovascular function

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5
Q

What is PAIN an indicator of?

A

uncomfortable sensation and emotional experience associated with tissue damage

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6
Q

Temperature is regulated by what?

A

Hypothalamus

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7
Q

What is a fever response called?

A

pyrexia

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8
Q

What is the average respiration rate for a resting adult?

A

12-20/min

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9
Q

What are the 2 respiration rhythms?

A

regular & irregular

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10
Q

What are the different respiration depths?

A

shallow, moderate, deep

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11
Q

Systolic BP is a result of what?

A

Cardiac output
Blood volume
Compliance of the arteries

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12
Q

BP is highest in?

A

systole

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13
Q

BP is the lowest in?

A

diastole

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14
Q

What is pulse pressure?

A

the difference b/w systolic and diastolic pressures

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15
Q

What should the pulse pressure be?

A

40mm Hg

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16
Q

What is normal body temperature?

A

98.6

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17
Q

What is the “normal” body temperature range?

A

97.2 (36.2) - 99.9 (37.7)

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18
Q

Temperature above 99.9 means what?

A

fever
hyperthermia
pyrexia

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19
Q

A fever in a child will show what temperatures for these areas?
Rectal?
Oral?
Axillary?

A

Rectal - 100.4 (38)
Oral - 99.5 (37.5)
Axillary - 99 (37.2)

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20
Q

At what temperature does an adult show signs of a fever?

A

above 99-99.5 (37.2-37.5) depending on time of day

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21
Q

What is the normal pulse rate?

A

60-100 bpm

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22
Q

Pulse rate faster than 100bpm?

A

tachycardia

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23
Q

Pulse rate slower than 60 bpm?

A

bradycardia

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24
Q

What is described as normal pulse contour?

A

smooth & rounded

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25
Q

Pulse amplitude is described on a scale of 0-4, what do each number represent?

A 
0 - Absent, not palpable 
1 - Diminished, barely palpable 
2 - Expected 
3 - Full, increased
4 - Bounding, aneurysmal
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26
Q

How does too big of cuff size influence BP?

A

decreases

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27
Q

How does too small of cuff size influence BP?

A

increases

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28
Q

What is the recommended bladder width? (BP)

A

1/3-1/2 of arm circumference

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29
Q

What is the recommended cuff length (BP)?

A

80% of arm circumference

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30
Q

Where should the cuff be applied?

A

2-3cm above the antecubital crease

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31
Q

After determining the palpable systolic pressure, how much do you inflate the cuff?

A

20-30mm Hg above the found palpable systolic BP

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32
Q

At what speed do you deflate the BP cuff?

A

2-3 mm Hg per second

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33
Q

Turbulent blood flow through the narrowed lumen causes what type of sounds?

A

Korotkoff

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34
Q

What is the normal range for adult systolic BP?

A

100-120 mm Hg

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35
Q

What is the normal range for adult diatonic BP?

A

60-80mm Hg

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36
Q

This occurs when the Korotkoff sounds are soft or absent temporarily when the cuff pressure is lowered.

A

Auscultatory Gaps

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37
Q

What are the 4 vital signs?

A
  1. Temperature
  2. Pulse
  3. Respiration
  4. Blood Pressure
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38
Q

What can be considered the 5th vital sign?

A

Pain

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39
Q

What are the 5 methods of measuring temperature?

A
  1. Oral
  2. Rectal
  3. Axillary
  4. Tympanic
  5. Forehead
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40
Q

How does the body generate heat?

A

shivering, a rapid contraction and relaxation of the skeletal muscles

vasodilation, which increases heat loss through the skin

evaporation of perspiration

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41
Q

What is arterial pulse and pressure?

A

the palpable and sometimes visible arterial pulses that are a result of ventricular systole

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42
Q

How long does the arterial pulse wave take to be felt in the dorsal pedis artery?

A

0.2 seconds

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43
Q

How long does it take for a red blood cell to travel to the dorsal pedis artery?

A

2 seconds

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44
Q

What variables contributes to the characteristics of the pulse? (5)

A
  1. Volume of blood ejected (stroke volume)
  2. Distensibility of the aorta and large arteries
  3. Obstruction of blood flow (e.g. narrowing of the aortic valve [stenosis] or aorta [coarctation], vasculitis -blood vessels inflammation with narrowing-or PAD
  4. Peripheral arteriol resistance
  5. Viscosity of the blood
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45
Q

What is the dominant muscle during respiration that contracts and moves downward during inspiration to increase intrathoracic pressure?

A

Diaphragm

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46
Q

What do external intercostal muscles do during respiration?

A

increase anteroposterior chest diameter during inspiration

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47
Q

What do internal intercostal muscles do during respiration?

A

decrease the lateral diameter during expiration

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48
Q

What happens to a woman’s BP beginning at about 8 weeks gestation?

A

commonly decreases

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49
Q

When is BP at it’s lowest point in pregnancy?

A

mid pregnancy

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50
Q

This gradually rises to prepregnant levels by term

A

Diastolic BP

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51
Q

This is referred to as the transmission of pain injuries from the site of injury or tissue damage to the dorsal horn of the spinal cord and brain.

A

Nociception

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52
Q

What is Nociception?

A

the transmission of pain impulses from the site of injury or tissue damage to the dorsal horn of the spinal cord and brain

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53
Q

What are the 2 specialized nerve fibers that nociception is mediated by?

A
  1. Myelinated A-delta fibers (LARGE): carry sharp, well-localized pain, which is quickly transmitted
  2. Unmyelinated C-polymodal fibers (small): carry dull, burning, diffuse, and chronic pain, which is slowly transmitted
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54
Q

What do Myelinated A-delta fibers (LARGE) carry?

A

sharp, well-localized pain, which is quickly transmitted

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55
Q

What do Unmyelinated C-polymodal fibers (small) carry?

A

dull, burning, diffuse, and chronic pain, which is slowly transmitted

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56
Q

After the sensory information reaches the dorsal horn of the spinal cord, there is a ____-____ control of nociceptive transmission within the spinal tracts.

A

two-way

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57
Q

Biochemical mediators produced in response to tissue damage help move the pain impulse form the nociceptors (pain receptors) to: (4)

A
  1. dorsal horn of the spinal cord
  2. Ascending spinal tracts
  3. Thalamus
  4. Cerebral Cortex
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58
Q

What are the biochemical mediators? (7)

A
  1. Bradykinin
  2. Prostaglandin
  3. Leukotrienes
  4. Serotonin
  5. Histamine
  6. Catecholamines
  7. Substance P
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59
Q

What stimuli present from the brain or periphery can modify pain impulses once they have reached the spinal cord? (4)

A
  1. Endorphins
  2. Serotonin
  3. Norepinephrine
  4. Non-pain impulses (light touch sensation such as massage)
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60
Q

Emotions, cultural background, sleep deprivation, pervious pain experience, and age are among those factors that have an impact on the perception and interpretation of _______?

A

pain

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61
Q

What are the 4 reasons older adults may not report pain?

A
  1. they believe it to be a normal part of aging
  2. they do not want to be a nuisance
  3. they believe reporting pain will lead to expensive testing or hospitalization
  4. they are hesitant to take pain medications
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62
Q

Words used for pain, what they told their parents, what caused the hurt in the past, and pain behaviors are especially important to note when seeing what patient population?

A

children

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63
Q

What is the temporary increase in the body’s temperature in response to disease or illness?

64
Q

At what locations can the pulse best be palpated? (7)

A
  1. Carotid
  2. Brachial
  3. Radial
  4. Femoral
  5. Popliteal
  6. Dorsal Pedis
  7. Posterior Tibial
65
Q

What are the pulse characteristics you should be looking for? (7)

A
  1. Rate
  2. Rhythm
  3. Contour (waveform)
  4. Amplitude (force)
  5. Symmetry
  6. Obstruction
  7. Variations
66
Q

If you find that the patients pulse is irregular, how long should you palpate it for?

A

60 seconds

67
Q

Rates as close to ______bpm may occur in neonates?

68
Q

The rapid decrease in neonates pulse rate is relatively rapid, and the rate may be closer to _____bpm at a few hours of age.

69
Q

A newborn’s pulse rate is more variable than that of older infants with activities such as feeding, sleeping, and waking. True or False?

70
Q

During pregnancy, HR gradually increases until is it how much higher at term?

71
Q

HR may be slower in older adults, what is the wide range?

72
Q

Stiffness of blood vessels and increased vascular resistance in older adults causes the BP to INCREASE or DECREASE?

73
Q

T/F? Children are more variable than those of adults and react with wider swings related to exercise, fever, or stress.

74
Q

Term for faster than normal respiratory rate?

75
Q

Term for slower than normal respiratory rate?

76
Q

What is the expected respiratory rate for neonates?

A

40-60

* rates of 80 may be noted

77
Q

T/F Babies delivered by cesarean section may have a slower respiratory rate than babies delivered vaginally.

A

F * babies delivered via C-section have a faster respiratory rate than those delivered vaginally

78
Q

When is the greatest variation of respiratory rate without significant gender difference?

A

first 2 years of life

79
Q

T/F BP taken supine position tend to be lower than those taken in sitting position.

80
Q

How many phases are there during the Korotkoff sounds?

81
Q

What are the 5 phases of Korotkoff sounds?

A
  1. sharp “thud”
  2. blowing or swishing sound
  3. softer thud than phase 1, still crisp
  4. softer blowing sound that disappears
  5. silence
82
Q

How many consecutive beats indicate the systolic pressure reading?

83
Q

Point at which the initial crisp sound becomes muffled, this is recorded as?

A

first diastolic sound

84
Q

BP standards for children are provided by what 3 percentiles?

A
  1. gender
  2. age
  3. height
85
Q

What is the expected newborn BP range for both systolic and diastolic?

A

60-96 mm Hg -Systolic

30-62 mm Hg - Diastolic

86
Q

T/F A sustained increase in BP is almost always significant.

87
Q

During what trimester of pregnancy is their a gradual increase in BP?

A

second -third trimester

88
Q

Preeclampsia is determined by what BP reading?

A

BP reading greater or equal to 160 mm Hg systolic or 110 mm Hg diastolic

89
Q

What 3 things are seen during preeclampsia?

A
  1. Hypertension
  2. swelling
  3. protein in urine
90
Q

Gestational Hypertension is shown by what BP reading?

A

greater than 140 mm Hg systolic or 90 mm Hg diastolic

91
Q

T/F Gestational Hypertension risk in lower in women with multiple gestations.

92
Q

How long does the Visual Analog Scale (VAS) for pain need to be?

A

10cm or 100mm

93
Q

When assessing pain behaviors what should you look for?

A

Guarded, protective behavior, hands over painful area, distorted posture, irritability

Facial mask of pain: distorted expression

Vocalizations: groaning, crying, or talkative patient becomes quiet

Body movements such as head rocking, pacing, inability to keep hands still

94
Q

These things can be recorded when assessing pain behaviors (5)

A
  1. changes in vital signs
  2. pallor and diaphoresis
  3. pupil dialation
  4. dry mouth
  5. decreased attention span, greater confusion
95
Q

What does the CRIES scale assess?

A

Pain assessment for surgical pain in newborns

96
Q

What does the CRIES scale stand for?

A 
Crying
Requires Oxygen 
Increased Vital Signs 
Expression 
Sleeplessness
97
Q

What scale can be used for assessing pain in children that has faces on it?

A

Wong/Baker Faces Rating Scale & Oucher Scale

98
Q

When is FLACC used?

A

pain assessment in nonverbal children

99
Q

What does FLACC stand for?

A 
Face
Legs
Activity 
Cry
Consolability
100
Q

This scale is used most commonly to assess acute pain associated with surgery in children between 2 months and 7 years

101
Q

This type of fever varies during the day and DOES return to normal.

A

Intermittent

102
Q

This type of fever varies during the day but DOES NOT return to normal.

103
Q

This type of fever either remittent or intermittent with difference between peak and baseline of more than 1.4 degrees C.

104
Q

This type of fever can be seen with abscess or pyogenic infection such as pyelonephritis and ascending cholangitis, but may also be seen with TB, hypernephromas, lymphomas, and drug reactions

105
Q

This type of fever occurs, resolves, & recurs again days to weeks.

A

Relapsing

* rare in the US, can be seen with Hodgkin’s disease (Pel-Ebstein fever), Malaria, Borrelia infection from ticks

106
Q

This type of fever is associated with bile duct obstruction and biliary colic.

A

Charcot intermittent fever

107
Q

This fever has little change during the day, can be seen with typhoid fever, bacterial endocarditis, TB, fungal diseases, bacterial pneumonia, neoplasm, connective tissue disease, and drug induced fever.

108
Q

T/F The height of temperature elevation has little diagnosis significance.

109
Q

Hypothermia

A

temp below 98.6

*chronic renal failure, antipyretic drugs acetaminophen and NSAIDs

110
Q

For every degree of increases temp, the pulse increases by?

A

around 10 bpm

111
Q

This pulse contour occurs with left ventricular failure.

A

Alternating OR Pulsus alternans

* more significant if pulse is slow

112
Q

This pulse contour occurs with aortic stenosis combined with aortic insufficiency.

A

Pluses Bisferians

* best detected by palpating the carotid artery.

113
Q

This pulse contour is characterized by two main peaks.

A

Pulses Bisferians
* first peak is percussion wave & second peak is tidal wave (1st is thought to be the pulse pressure and 2nd reverberation from the periphery)

114
Q

This pulse contour occurs with disordered rhythm.

A

Bigeminal pulse
* result from a normal pulsation followed by a premature contraction. Amplitude and pulsation of the premature contraction is less than that of normal pulsation)

115
Q

This pulse contour occurs with exercise, anxiety, fever, hyperthyroidism, aortic rigidity or atherosclerosis.

A

Large, bounding pulse (also called hyperkinetic or strong)

  • readily palpable, doesn’t “fade out” and is not easily obliterated by the examining fingers.
  • recorded as 3+
116
Q

This pulse contour occurs do to premature cardiac contraction, tracheobronchial obstruction, bronchial asthma, emphysema, pericardial effusion, constrictive pericarditis.

A

Paradoxic pulse (pulses paradoxus)

117
Q

Pulse contour characterized by an exaggerated decrease (>10 mm Hg) in the amplitude of pulsation during inspiration and increased amplitude during expiration.

A

Paradoxic pulse

118
Q

Pulse contour occurs with patent ductus arteriosus and aortic regurgitation.

A

Water-hammer pulse

* also known as collapsing pulse

119
Q

This pulse contour has a greater amplitude than expected, a rapid rise to a narrow summit, and a sudden descent.

A

Water-hammer pulse

120
Q

T/F Essential hypertension is pathologic origin is poorly understood.

121
Q

Secondary hypertension potential causes include: (6)

A
  1. renal disease
  2. renal artery stenosis
  3. aldosteronism
  4. thyroid disorders
  5. coarctation of the aorta
  6. pheochromocytoma
122
Q

Hypothyroidism, CNS disorder and narcotics can show this type of abnormal respiration

123
Q

COPD and pursed lips breathing can show this types of abnormal respiration.

124
Q

Metabolic acidosis and compensation for pH by hyperventilation can show this type of abnormal respiration.

A

Kussmaul breathing

125
Q

Respiration described as faster than 20 breaths per min and deep breathing.

A

Hyperventilation

126
Q

Respiration described as frequently interspersed deeper breath.

127
Q

Respiration described as increasing difficulty in getting breath out.

A

Air trapping

128
Q

Respiration described as varying periods of increasing depth interspersed with apnea.

A

Cheyne-Strokes

129
Q

Respiration described as rapid, deep, and labored.

130
Q

Respiration described as irregularity interspersed periods of apnea in a disorganized sequence of breaths.

131
Q

Respiration described as significant diagnosis with irregular and varying depths or respiration.

132
Q

A form of chronic pain caused by a primary lesion or dysfunction of the CNS that persists beyond expected after healing.

A

Neuropathic pain

133
Q

What are the potential causes for neuropathic pain?

A

postherptic neuralgia, diabetic peripheral neuropathy, trigeminal neuralgia, or radiculopathy

134
Q

Damaged peripheral nerves fire repeatedly

A

Neuropathic pain

135
Q

A syndrome in which regional pain extends beyond a specific peripheral nerve injury in an extremity with motor, sensory, an autonomic changes.

A

Complex Regional Pain Syndrome

136
Q

This syndrome has no relationship between the original trauma severity and the severity and cause of the symptoms.

A

Complex Regional Pain Syndrome

137
Q

Splinting from pain (rib fx, pleurisy) is a cause of what respiration pattern?

138
Q

Neurologic, electrolyte disturbance, infection, pain are causes of what respiration pattern?

139
Q

Anxiety, exercise, and CNS or metabolic disease can cause what respiratory pattern?

A

Hyperventilation

140
Q

Deep and most often rapid breaths caused by metabolic acidosis.

141
Q

Shallow respirations caused by pain.

142
Q

Apnea periods (may be sleep apnea) due to cerebral CNS damage or a drug reaction.

A

Cheyne-stokes

143
Q

Respiration pattern caused by emotional stress.

144
Q

The respirations pattern is seen in someone who has an obstruction and is barrel chested.

A

Air trapping

145
Q

Respiration that is irregular with apnea periods caused by increased intracranial pressure, drugs, or brain damage at the medulla.

A

Biot respiration

146
Q

Respiration that is significantly disorganized, caused by increased intracranial pressure, drugs, or brain damage at the medulla.

A

ataxic respiration

147
Q

Symptoms of?
Essential- asymptomatic
Malignant - headache, blurred vision, dyspnea, encephalopathy

A

Hypertension DDX

148
Q

what are the long term consequences for hypertension?

A

heart failure and papilledema

149
Q

DDX for hypertension?

A

rental disease, renal artery stenosis, aldosteronism, thyroid disorders, coarctation of the aorta, pheochromocytoma

150
Q

DDX for Neuropathic pain?

A

Postherapetic neuralgia, diabetic peripheral neuropathy, trigeminal neuralgia, radiculopathy

151
Q

Symptoms of?
burning, intense tightness, shooting, stabbing, shock-like sensation, may be worse at night, hyperalgesia, allodynia, sleep disturbance

A

Neuropathic pain

152
Q

What are the objective findings of Neuropathic pain?

A

pain (e.g. stocking and glove), pain with non-painful stimuli, Neuro symptoms: decreased light touch, pin prik, vibration, proprioception, numbness, weakness, deep tendon reflexes.

153
Q

Cause is unknown, sympathetic nervous system disfunction.

A

Complex regional pain syndrome

154
Q

Symptoms of?

Burning, shooting, aching pain, cold sensitive, pain with pressure, allodynia, numbness possible.

A

Complex regional pain syndrome

155
Q

What are the objective findings of Complex regional pain syndrome?

A

edema, red and hot, cyanotic, increased sweating, temperature difference between affected and unaffected.

Physical Diagnosis Exam 2 (1 decks)

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