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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?

A

Fever

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?

A

200

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.

A

120

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?

A

True

70
Q

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

A

10-30%

71
Q

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

A

40-100bpm

72
Q

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

A

increase

73
Q

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

A

T

74
Q

Term for faster than normal respiratory rate?

A

Tachypnea

75
Q

Term for slower than normal respiratory rate?

A

Bradypnea

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.

A

T

80
Q

How many phases are there during the Korotkoff sounds?

A

5 Phases

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?

A

2

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.

A

T

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.

A

F

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

A

FLACC

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.

A

Remittent

103
Q

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

A

Hectic

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

A

Hectic

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.

A

Sustained

108
Q

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

A

T

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.

A

T

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

A

Bradypnea

123
Q

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

A

Hyperpnea

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.

A

Sighing

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.

A

Kussmaul

130
Q

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

A

Biot

131
Q

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

A

Ataxic

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?

A

Tachypnea

138
Q

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

A

Bradypnea

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.

A

Kussmaul

141
Q

Shallow respirations caused by pain.

A

Hypopnea

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.

A

sigh

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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