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HMS PDR > Vitals and the HEENT Exam > Flashcards

Vitals and the HEENT Exam Flashcards

1
Q

The Vital Signs

A

Heart Rate

Temperature

Blood Pressure

Respiratory Rate

O2 Saturation

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2
Q

Normal heart rate

A

60-100 bpm

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3
Q

Normal breathing rate

A

8-12 breaths per minute

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4
Q

Preparation for taking proper blood pressure

A

Quiet and comfortable environment

Sitting for at least 5 minutes

No caffeine or smoking prior

Arm free of clothing and supported

Brachial artery at heart level

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5
Q

Method for taking blood pressure via palpation

A
  1. Place BP cuff above the elbow
  2. While palpating the brachial pulse, keep inflating until it disappears, then add 20-30mm Hg more pressure.
  3. Deflate slowly until the pulse returns
  4. Read the pressure at which the pulse returns. This is the systolic blood pressure.
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6
Q

Method for taking blood pressure via auscultation

A
  1. Place the cuff above the elbow
  2. Inflate to 20-30 mmHg past where you can no longer hear the heart beat
  3. Deflate slowly at a rate of ~2-4 mmHg per second
  4. Record the pressure at which you hear two consecutive beats (Korotkoff sounds). This is the systolic pressure.
  5. Continue to deflate.
  6. Record the pressure at which the sounds muffle and then disappear. This is the diastolic blood pressure.
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7
Q

Elevated blood pressure

A

120-129 / <80

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8
Q

High blood pressure / Stage I Hypertension

A

130-139 / 80-89

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9
Q

Stage II Hypertension

A

140-179 / >90

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10
Q

Hypertensive Crisis

A

>180 / >120

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11
Q

Normal Temperature

A

~98.6 degrees Fahrenheit

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12
Q

Definition of Clinical Fever

A

Single reading >101 Fahrenheit

OR

>100.4 Fahrenheit for one hour

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13
Q

____ can interfere with pulse oximeter reading.

A

Nail polish

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14
Q

Format for Vital Signs

A
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15
Q

Sphygmomanometer

A

blood pressure cuff

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16
Q

Tachypnea

A

Increased breathing rate

>20 breaths per minute

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17
Q

Bradypnea

A

Decreased respiratory rate

<8 breaths per minute

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18
Q

Accomadation

A

As you move your finger towrads the patient’s nose, while they are following with their eyes, their pupils contract. As you move it away, they dilate.

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19
Q

Testing light reflexes of the pupil

A

First without blocking, shine a light in each eye one at a time and observe contraction.

Then, while blocking light along the nose bridge with one hand, do the same, and this time note both eyes.

This tests ipsilateral and contralateral light reflexes.

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20
Q

Examining the retina

A

Have the patient remove glasses

Using an opthalmoscope, have your patient look at a fixed point straight ahead of them (pick an actual object) and adjust the aperture to the size of their pupil. Adjust the diopter to see properly (you will not need glasses). Find an artery and follow it to the optic disc.

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21
Q

Otoscope view

A
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22
Q

“Say ahh” view

A
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23
Q

A typical thyroid is ____g

A

A typical thyroid is ~25-30g

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24
Q

HEENOT

A

Head

Ears

Eyes

Nose

Oral

Throat

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25
Q
A

Ptosis

26
Q
A
27
Q

PERRLA

A

Pupils equal

Reactive to Light

Accomodation

28
Q

Retinal projection diagram

A
29
Q

Innear ear diagram

A
30
Q

Tinnitus

A

ringing of the ears

31
Q

Inner ear view (via otoscope)

A
32
Q

Teeth and gum view

A
33
Q

Neck muscles and lymph nodes

A
34
Q

Palpation of lymph nodes

A

Have the patient flex their head slightly forward. Notice:

Size

Texture (hard or soft)

Flexibility (fixed or immovable)

Large, hard, immovable lymph nodes suggest malignancy.

35
Q

Palpation for the supraclavicular node

A

Place hands at approximately the midclavicular point. Node’s position should be superior and inbetween two muscles around this point.

Any palpable node is a sign of GI tract malignancy.

36
Q

Lymph node findings and interpretation

A
37
Q

Local vs General Lymphadenopathy

A

Local: Local infection, inflammation, or malignancy

General: Systemic infection, inflammation, or malignancy

38
Q

If you find lymphadenopathy in one lymph node. . .

A

check more!!!!

39
Q

The thyroid. Where the hell is it?

A
40
Q

Example thyroid presentation

A

Thyroid gland elevates symmetrically with swallowing. No nodules, enlargement or tenderness

41
Q

scleral icterus

A

Jaundiced (yellow) sclera

42
Q

Conjunctiva

A

clear mucous membrane that covers the anterior eyeball and the eyelids.

43
Q

Miosis

A

constriction of the pupil (<3mm). This can be caused by many drugs. One example is opiates.

44
Q

Mydriasis

A

dilation of the pupil (>5mm). This can be caused by many drugs.

45
Q

Extra Ocular Movements

A

this tests the 6 extra ocular muscles that control the eyes and these are controlled by 3 cranial nerves (III, IV, VI).

46
Q

Visual acuity

A

expressed as two numbers (20/40.) The first number indicates the distance of the patient from the Snellen eye chart (ie 20 feet) and the second, the distance at which a normal eye can read the line of letters. 20/40 means that at 20 feet the patient can read the read the print that someone with normal vision could read at 40 feet.

The larger the second number then the worse the vision.

47
Q

Nasal septum

A

This is a wall of cartilage and bone that separates the nose into a right and left airway. If crooked (deviated) it can impact the nasal airway.

48
Q

Nasal turbinates

A

These cylindrical shaped bones covered in a mucosal lining act as the humidifiers of the nose. They have a lot of vascular tissue and are responsible for several properties of nasal physiology including, but not limited to, congestion and decongestion of the nose as well as helping to filter the air.

49
Q

Hard palate

A

bony portion of the roof of the mouth, separating the nose from the mouth.

50
Q

Soft palate

A

soft tissue that makes up the roof of the mouth. This is situated posterior to the hard palate and includes several muscles responsible for closing off the nose from the mouth during acts of swallowing and speaking. It contains the uvula.

51
Q

The thyroid isthmus sits right below the. . .

A

Circothyroid cartilage

52
Q

Nodule

A

a growth within the thyroid gland which may be “hot” (producing excess hormone) or “cold” (not producing excess hormone). Nodules can be solid, fluid-filled (cystic), or have mixed components. They can be malignant or benign. Assessing for nodules is done by both inspection AND palpation of the thyroid gland.

Thyroid nodules are very common.

53
Q

Goiter

A

Enlargement of the thyroid gland. This can be associated with overproduction, underproduction, or normal production of thyroid hormone. It is associated with several different conditions; therefore, is NOT a diagnosis of the condition, but rather a finding. Small goiters rarely cause symptoms; however, large ones can lead to symptoms of coughing, hoarseness, difficulty swallowing, or difficulty breathing.

54
Q

Hyperthyroid/Hyperthyroidism

A

Disorder in which the thyroid gland produces too much thyroid hormone (“overactive” or “high thyroid state”). Symptoms and signs can include unintentional weight loss, palpitations secondary to tachycardia, arrhythmia (atrial fibrillation), anxiety, tremor, sweating, heat intolerance, changes to the menstrual cycle, skin thinning, brittle hair, increased bowel movements, weakness, hyperreflexia. A goiter may also be present depending on the cause.

55
Q

Hypothyroid/Hypothyroidism

A

Disorder in which the thyroid gland does not produce enough thyroid hormone (“underactive” or “low thyroid state”). Symptoms can include fatigue, cold intolerance, muscle weakness, constipation, weight gain, dry and thick skin, increased body hair, irregular menses. Signs can include bradycardia and delayed relaxation of or “hung up” reflexes. A goiter may also be present depending on the cause.

56
Q

Submandibular lymph node

A

Under the mandible and are usually small and smooth compared the submandibular gland.

57
Q

Anterior cervical lymph node

A

superficial to the sternocleidomastoid muscle

58
Q

Posterior cervical lymph node

A

along the anterior edge of the trapezius muscle

59
Q

Supraclavicular lymph node

A

Deep in the angle formed by the clavicle and the sternocleidomastoid muscle. (An enlarged supraclavicular lymph node on the left can be a sign of a metastasis from a thoracic or abdominal malignancy.)

60
Q

Blood pressure cuff sizing

A
  • Width of the inflatable bladder of the cuff should be approximately 40% of the arm circumference
  • Length of the inflatable bladder of the cuff should be approximately 80% of the arm circumference
  • If the cuff is too small (narrow), the blood pressure will read higher than the patient’s actual pressure; if the cuff is too large (wide), the blood pressure will read lower than the patient’s actual pressure.
  • The patient should avoid smoking, caffeine, or exercise for 30 minutes prior to measurement.

HMS PDR (30 decks)

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