Vital Signs Flashcards
Normal oral temp
98.6 deg Farenheit
Normal adult pulse
60-100 bpm
Normal adult respiratory rate
14-18 breaths per minute
Where are the peripheral pulses located? (9)
Temporal artery Facial artery Carotid artery Brachial artery Radial artery Femoral artery Popliteal artery Posterior tibial artery Dorsalis pedis artery
Normal adult blood pressure
90-120/60-80
What blood pressure indicates hypertension?
over 140/90
What blood pressure indicates hypotension?
under 90/60
What condition consists contains vesicles that are elevated with serous activity .5 cm and follows a thoracic dermatome?
Herpes Zoster
What condition presents with silver scales on the exterior surface?
Psoriasis
What condition contains a “butterfly rash”?
Systemic Lupus Erythymtosis
What two tests, test for vertebrobasilar artery insufficiency?
!. Dekleyn’s
2. Vertebrobasilar Artery Functional Maneuver
Explain how to perform vertebrobasilar artery maneuver.
Patient seated.
Auscultate (Bell) and palpate subclavian AND cartoid arteries
If NO BRUITS, pt rotates and hyper-extends head to each side.
When do you know if a vertebrobasilar artery maneuver test is positive?
Positive test produces:
vertigo, blurred vision, nausea, syncope, nystagmus
What disease is indicated by bilateral ptosis?
Myasthenia Gravis
What disease is indicated by unilateral ptosis?
Horner’s Syndrome (loss of cervical sympathetics, ptosis, miosis, and anhydrosis) OR CN III Lesion.
What eye conditions are observed in the early stages of AS?
Iritis/Uveitis
What eye condition is an indication of increased intracranial pressure?
Papilledema
What (3) eye conditions are indicative of arteriosclerosis?
AV nicking, silver wire arterioles, widened light reflex
What (3) eye conditions are indicative of hypertension?
Flame hemorrhages, cotton wool spots, and narrow light reflex
What (4) eye conditions are indicative of diabetes mellitus?
Yellow, hard, waxy, exudates, neovascularization, microaneurysms, absent red light reflex
What two conditions occur in the external ear?
- Otitis externa
2. Air conduction loss
What three conditions occur in the middle ear?
- Otitis media
- Otosclerosis
- Meniere’s disease
What 5 conditions occur in the inner ear?
- Meniere’s disease
- Labyrinthitis
- Vertigo
- Acoustic Neuroma
- Ototoxicity
How do you interpret findings during the Weber and Rinne Test?
If patient does not hear the sound equally on both sides it is called LATERALIZATION. If they hear louder in one ear it can mean that there is air conduction on the louder side or a nerve deficit on the other side.
Rinne:
This test is used to determine either air conduction or sensorineural problem. 1st check the side that is louder to check for air conduction loss by placing the tuning fork on the mastoid process and asking the patient to verbalize when they can no longer hear it. Then place the tuning form in from on EAM. Normal hearing= EAM for 2X as long as on the mastoid. If not 2X as long, consider air conduction. If normal… consider nerve on the opposite side.
Tenderness of sinuses= ___________.
Sinusitis
Where is the upper lobe of the right lung located?
above the clavicle to the 4th rib
Where is the middle lobe of the right lung located?
from the 4th to the 6th rib medially
Where is the lower lobe of the right lung located?
from the 6th to the 8th rib laterally
Where is the upper lobe of the left lung located?
above the clavicle to the 6th rib
Where is the lower lobe of the left lung located?
from the 6th to the 8th rib laterally
Where are the upper and lower lobes locates on the posterior?
above T3 toward the axilla is the upper lobes
below to T10 is the lower lobes
What does dullness indicate during percussive chest sounds?
Pneumonia, atelectasis, and pleurisy
What does resonance indicate during percussive chest sounds?
Normal and bronchitis
What does hyperresonance indicate during percussive chest sounds?
Emphysema and Pneumothorax
Where are tracheal breath sounds heard?
Over the trachea
Where are bronchial breath sounds heard?
Over the manubrium
Where are bronchovesicular breath sounds heard?
Between the 1st-2nd ribs anteriorly and between the scapulae posteriorly
Where are vesicular breath sounds heard?
The remaining lung field
Explain what you hear with bronchophony.
Clear, distinct sounds are heard as the patient says “99”, consolidation is present
Explain what you hear with egophony.
You hear “aaaa” as the patient says “eeeee”, consolidation is present
Explain what you hear with whispered pectoriloquy.
“99” is heard clearly and distinctly, consolidation is present
Features of lobar pneumonia.
Percussion is dull (over the fluid) Rales aka crackles heard Increased tactile fremitus Productive cough at 10 days Rusty brown sputum Possible fever
Features of tuberculosis.
Caused my mycobacterium tuberculosis Low grade fever Night sweats Productive cough Yellow/green sputum Starts in apices of the lung Crackles in upper lobe Tine test/Mantoux test Positive purified protein derivative MOST definitive test for dx= sputum culture
Features of pleurisy.
Inflammation of pleura Usually produces exudative pleural effusion and stabbing chest pain worsened by respiration and cough Dull on percussion Dry/non-productive cough Decreased respiratory excursion Decreased tactile fremitus Friction rub present Decreased breath sounds \+ Schepelman's Test
Features of pneumothorax.
Ruptured lung causing air to become trapped in the pleural space
Decreased chest expansion
Decreased tactile fremitus
Hyper-resonant
Decreased breath sounds
Can occur in young, previously healthy, tall, thin runners
Unilateral darkening of the chest due to collapse of the lung; tracheal shift away from the lesion
Features of atelectasis.
Collapse of the lung that is usually the result of bronchial obstruction due to a mucous plug
Presents with decreased tactile fremitus
Dull on percussion
Decreased chest expansion
Decreased or absent breath sounds
On x-ray the collapsed lung will display increased density and mediastinal shift to the same side
Features of emphysema.
Destruction of the elastic pulmonary connective tissue results in permanent dilation of the alveoli air sacs
Presents with decreased tactile fremitus, hyperresonant percussion, decreased breath sounds, and prolonged expiration with an expiratory wheeze and 20-30 years of smoking likely.
Fluid will accumulate first in the costophrenic recesses
Bilaterally darkened lung fields; narrowed compressed heart; horizontal ribs; flattening of the diaphragmatic domes
Features of bronchogenic carcinoma.
Primary malignant lung tumor that starts in the area of the bronchus.
Long term history of smoking (20-30 years)
Coughing (non-productive) more than 30 days
Afebrile, dyspnea, weight loss, and clubbing of the fingernails
Features of costochondritis.
Inflammation of the cartilage connection between the ribs and the sternum. It develops as a consequence of physical activity and is worse with exercise.
Pain increased while taking a deep breath.
Palpable tenderness at the 3rd, 4th, or 5th costosternal articulation
Features of Tietze Syndrome.
Inflammation of the costal cartilage at one articulation. This pain can radiate and be chronic in nature.
Features of Herpes Zoster aka Shingles.
Painful rash following the course of a dermatome usually a single nerve.
Primarily involves the dorsal root ganglion but when it does involve CN it is most commonly CN V.
Features of sarcoidosis.
A disease in which abnormal collections of inflammatory cells (granulomas) form as nodules.
Most often appear in the lungs or lymph nodes.
Most commonly seen in people of African American descent
X-ray: bilateral hilar lymphadenopathy
Features of Hodgkin’s
Cancer of the lymphatic system
Most commonly seen in young Caucasian males
Present with fever, night sweats, weight loss, intense pruritis (release of IgE) and enlarged spleen
Best diagnosed from biopsy looking for Reed Sternberg cells
X-ray: unilateral hilar lymphadenopathy
Where do you percuss for the heart?
From the midaxillary line to the right side of the sternum in the 3rd, 4th, and 5th intercostal spaces for cardiomegaly
What do you look for when palpating around the heart?
abnormal pulsations and thrills
What do you listen for when auscultating the heart?
detection of high pitched sounds with the diaphragm or low pitched murmurs with the bell
Where is the aortic valve located?
right sternal border at the 2nd intercostal space
Where is the pulmonic valve located?
left sternal border at the 2nd intercostal space
Where is the tricuspid valve located?
left sternal border at the 4th or 5th intercostal space
Where is the mitral valve located?
mid-clavicular line at the 5th intercostal space
Features of right sided heart failure.
Cardiomegaly jugular venous pulsations/distension
Bilateral leg swelling- pitting edema
Difficulty breathing
What are the common causes of right sided heart failure?
Left sided heart failure and cor pulmonale
Features of angina pectoris- coronary vasospasm
Comes on with exertion
Printzmetal angina comes on with rest (atypical)
Relieved by vasodilators under the tongue (usually nitroglycerin)
Features of myocardial infarction.
Acute heart failure
Comes on with rest
Severe substernal chest pain
Referral to the left arm
Labored breathing caused by atherosclerosis
CPK is elevated
Increased SGOT
Increased LDH
What tests are performed for heart conditions?
Electrocardiogram
Echocardiogram (valves)
Refer to cardiologist!!
Where does gallbladder refer pain?
Right shoulder or tip of the right scapula- VISCEROSOMATIC
What are features of cholecystitis?
MC seen in overweight females over 40 years of age
Most common cause is cholelithiasis
Severe right upper quadrant pain, nausea, vomiting and precipitated by eating a large fatty meal
What are the tests for cholecystitis?
Diagnostic ultrasound
Oral Cholecystogram
What sign confirms cholecystitis?
Murphy’s sign- inspiratory arrest sign
What are features of pancreatitis?
Epigastric pain going straight through the T10-T12 area like a knife- Viscerosomatic
Chronic is seen with alcoholism
Acute= 911 emergency
What sign confirms pancreatitis?
Grey Turner Sign- bleeding into the flank
Cullen’s sign- Periumbilical ecchymosis
What do you find on positive lab tests for pancreatitis?
Increased amylase and lipase
What is diabetes mellitus?
A condition in which the pancreas does not produce a sufficient amount of insulin to take the sugar out of the blood and transport it to the tissues of the body. These starved tissues force the breakdown of fats in order to obtain energy.
What are the types of diabetes mellitus?
Insulin Dependent Type I
non-insulin Dependent Type II
Adult over 40, usually obese
What is diabetes insipidus?
Condition of the posterior pituitary gland in which there is insufficient ADH. May have polydypsia and polyuria but not polyphagia
What is a hiatal hernia?
Protrusion of the stomach above the diaphragm. Presents with palpable tenderness in the LUQ, reflux esophagitis, Dyspepsia (indigestion), made worse after eating a large meal or when lying down
What is reflux esophagitis?
Upward reflux of acid contents of the stomach into the esophagus
Caused by sliding hiatal hernia
worse when lying down, after a big meal, valsalva, or bearing down
Tests: X-ray or upper GI series
What is mononucleosis caused by?
Epstein Barr Virus
What are features of mononucleosis?
Seen in young adults (18-25)
Presents with symptoms similar to the flu- fever, headache, fatigue, lymphadenopathy in the cervical region, splenomegaly
Atypical lymphocytes in blood (Downey cells)
Monospot AKA heterophile agglutination AKA paul bunnell test
What is regional ileitis AKA crohn’s disease?
Nonspecific inflammatory disorder that affects the distal ileum and colon
Features of regional ileitis AKA crohn’s disease?
Inflammation is patchy with healthy tissue between the patches –> COBBLESTONE appearance
They do NOT absorb B12- which is the problem.
Presents with RLQ pain and chronic diarrhea
Leads to malabsorption syndromes: non-tropical sprue/celiac sprue
Diagnose with sigmoidoscopy
Features of ulcerative collitis.
Left side of intestines- MC at colon and rectum
presents with bloody diarrhea and fever
Can lead to sacroiliitis (enteropathic arthropathy)
Test= sigmoidscopy
Features of irritable bowel syndrome AKA spastic colon
Variable degrees of constipation and diarrhea in response to stress.
Seen more commonly in females
Abdominal pain and gas relieved by bowel movements
Features of appendicitis
Dull periumbilical or epigastric pain that radiates to the lower right quadrant
Presents with fever, nausea, vomiting, and anorexia
Increased WBC (Schilling shift to the left)
Tests: McBurney’s Point, Rebound tenderness-peritonitis, blumberg’s rebound tenderness-peritonitis, rovsing’s signs, psoas sign, obturator sign
Special test= CT
Features of Nephrolithiasis
Made of calcium- calcium oxalates=MC, calcium urates and calcium phosphates
Back pain radiating into the groin (ureter stone)
Pain=writhing
Murphy’s kidney punch +
Evaluates by increased BUN, uric acid, creatinine clearance, KUB study
UA reveals hematuria (cut ureters so could have infection)
Staghorn calculi- MC cause is hydronephrosis due to kidney stone
Features of pyelonephritis
E-coli from UTI
WBC casts
Features of urethritis
MC caused by E. Coli in females and N. Gonorrhea in males
Nitrites in urine
Features of cystitis
Noninfectious bladder inflammation that causes burning, painful, and frequent urination with incontinence
Patient will also have suprapubic and low back pain
What is the 2nd MC cause of CANCER death in women?
Breast CA
Features of breast cancer.
MC in females over 50
MC location= upper/outer quadrant
Presents with nipple retraction, bleeding, orange peel appearance, and dimpling (Paget’s disease of the breast)
Mets to the axilla via the lymphatic system and will most likely be lytic when seen in the bone
