Vital signs Flashcards
Sequence the following from medial to lateral at the wrist:
- Median nerve
- Ulnar nerve
- Radial artery
- Ulnar artery
- Ulnar nerve
- Ulnar artery
- Median nerve
- Radial artery
Is the brachial pulse medial or lateral to the biceps tendon?
Medial
Factors affecting pulse rate (8)
pain
physical activity
posture
respiration
infection
smoking
caffeine
anxiety
Pulse rate refers to?
PR refers to the pressure rhythm generated by the heart.
Pulsus paradoxus definition
This is a decrease in pulse wave volume (ie not palpable) during inspiration. Despite its very confusing name, pulsus paradoxus is best measured by BP, with a fall of systolic blood pressure of >10 mmHg during the inspiratory phase.
Systolic blood pressure normally falls during quiet inspiration in normal individuals. Pulsus paradoxus occurs in conditions where intrathoracic pressure changes between inspiration and expiration are large such as severe acute asthma or exacerbation of COPD.
Normal respiratory rate
12-20, but varies depending on clinical context
Apnoea definition
Pauses in breathing lasting 15 seconds or longer.
Seen in opioid overdoses, sleep apnoea and respiratory arrest.
Kussmauls breathing definition
Rapid deep breathing, occurs in metabolic acidosis as carbon dioxide is blown off to restore the pH of the blood.
Diabetic ketoacidosis is a common cause.
Cheyne-stokes breathing definition
Crescendo-decrescendo breathing often associated with end-stage disease.
Occurs in metabolic disarrangement and Central Nervous System (CNS) insults.
Apneustic breathing definition
Increased inspiratory time with short expiratory time.
May sound like grunting. Caused by a CNS insult.
Ataxic breathing definition
Irregular pattern of breathing, depth of breaths may be irregular also.
Can degenerate into agonal gasps.
CNS insult is a common cause.
Prolonged expiratory phase breathing definition
Occurs in obstructive airway diseases, such as chronic obstructive pulmonary disease, and acutely in asthma.
Systolic BP definition
The SYSTOLIC blood pressure is the maximum pressure in the artery following ventricular systole (contraction).
Diastolic BP definition
The DIASTOLIC blood pressure is the lowest pressure in the artery during ventricular diastole (relaxation).
Blood pressure measurement recommendations
Routine blood pressure should be measured in the sitting position when the patient is relaxed, following a short period of rest and preferably having avoided caffeine and smoking in the previous 2 hours (Hypertension Management Guide (HMG) p8). If the initial reading is high, repeat the measurement after 5 minutes of quiet rest.
What will a small or tight cuff do to a persons BP reading
Gives high reading
Normal blood pressure
<140 systolic and <90 diastolic
Orthostatic hypertension definition
The consensus definition is a ‘sustained reduction of systolic blood pressure of at least 20mmHg or diastolic blood pressure of 10 mmHg within 3 minutes of standing’
Which source of temperature measurement give the highest average reading
Rectal (0.4 to 0.5 C higher than oral)
Oral
Axillary (0.4 to 0.7 C lower than oral)
Normal temperature range
Varies from person to person
Diurnal variation (usually lowest at 6am and peaks at 4-6pm)
Varies with age (becoming lower with increasing age)
Sex (women slightly higher than men)
Higher premenstrually
35.5-37.5 C
Cardiac valve auscultation sites
Aortic valve - right of the sternal border in the second intercostal space
Pulmonary valve - left of the sternal border in the second intercostal space
Tricuspid valve - left sternal border in the fourth intercostal space
Mitral valve - the apex of the heart in the fifth intercostal space in the midclavicular line.
Lung surface markings posterior
- oblique fissures
The oblique fissures start at the 4th thoracic vertebral spine posteriorly. They then travel diagonally down to the anterior edge of the lung at the 6th costochondral junction. The right and left oblique fissures divide upper and lower lobes of the lungs and are symmetrical.
lung surface markings lateral
- base
- oblique fissures
Base - rib 10
To find the level of the 6th rib in the midaxillary line, ask your patient to fully abduct their arm, then follow the medial border of the scapula to the midaxillary line. This will be at the level of the 6th rib which overlies the oblique fissures, and the start of the transverse fissure on the right.
Lung surface markings anterior
- oblique fissures
- transverse fissure
- base
Oblique fissure - 6th rib
Transerve fissure - 4th rib
Base - Rib 10
What spinal level is the transverse umbilical line
L3
What causes pectus carinatum?
(Pigeon chest) - sequalae of chronic respiratory disease in childhood, usually asthma
What causes cushings syndrome?
Excessive stimulation of glucocorticoid receptors, most commonly iatrogenic, for example long term treatment with glucocorticoid for asthma.
Examples of ACTH dependent cushings syndrome (3)
- Pituitary dependent bilateral adrenal hyperplasia (cushings disease)
- Ectopic ACTH syndrome (bronchial carcinoid, small cell lung cancer, pancreatic cancer)
- Iatrogenic (ACTH therapy)
Examples of non-ACTH dependent cushings syndrome (3)
- Iatrogenic (chronic glucocorticoid therapy)
- Adrenal adenoma
- Adrenal carcinoma (rare)
Examples of pseudo cushings syndrome (i.e. cortisol excess) (3)
- Alcohol excess
- Major depressive illness
- Primary obesity
Signs of cushings syndrome on general inspection (11)
Central obesity
Striae
Wasting of proximal thigh muscles
Excessive pigmentation (due to ACTH having melanocyte stimulating activity
Moon face
Buffalo hump
Hirsutism
Ecchymoses
Acne
Oedema
Hypertension
What is addisons disease?
Adrenocortical hypofunction with reduced secretion of glucocorticoids and mineralocorticoids
Clinical features of addisons disease (2)
Cachexia
Pigmentation of palmar creases, elbows, gums, buccal mucosa, genital areas and scars (due to ACTH having melanocyte stimulating activity)
What is pseudohypoparathyroidism?
A genetic condition which resembles hypoparathyroidism, but caused by inability to respond to rather than deficiency of parathyroid hormone. Major cause is defective G proteins required for signal transduction. Characterised by hypocalcaemia and hyperphosphataemia. It is commonly associated with short stature, obesity, short metacarpals and ectopic calcification.
Klinefelters body shape
Tall, with female body shape, female hair and fat distribution and atrophic testes (XXY)
Turners syndrome body shape
Short female with masculine shape and amenorrhea (XO)
Psoriatic arthritis hand/feet changes (2)
Nail dystrophy - pitting and onycholysis
Sausage digits
Sites of rheumatoid arthritis (most common to less common)
Fingers (thumb less common)
Feet
Wrists
Knees
Elbows
Sites of psoriatic arthritis
Index finger and first + second toe
Ankles
Knees
Elbows
Hand and elbow changes in rheumatoid arthritis
Ulnar deviation of fingers
Wasting of small muscles
Synovial swelling of MCP, PIP joints and extensor tendon sheaths
Swan neck deformity
Rheumatoid nodules
Olecranon bursitis
Z deformity
Clinical features of systemic lupus erythematous
- Raynauds phenomenom (caused by vasospasm, followed by period of cyanosis due to presence of deoxygenated blood, followed by rubor (redness) due to reactive hyperaemia
- Butterfly rash
- Livedo reticularis (livedo - a discoloured spot or patch on the skin, often due to passive congestion, reticularis - vascular response caused by dilation of subpapillary venous plexus as a result of increased viscosity of the blood and changes in the vessels that delay blood flow away from skin)
What is scleroderma?
Generalised disorder of connective tissue which affects the skin, internal organs and vasculature.
Clinical hallmark is sclerodactyly (flexion contracture of fingers and thickening of tendon sheath) in combination with raynauds phenomenom or digital ischemia.
Peak age 40-50s
CREST syndrome - calcinosis, raynauds, esophagitis, sclerodactyly, telangectasia)
