Vitals, General, Head, Face, Hair, Eyes Flashcards
What are the four major components of a physical exam?
Four major components of a physical exam:
- Inspection
- Palpation
- Percussion
- Auscultation
Exception to this order: during an abdominal exam you do auscultation second
Routes for checking temperature - when do you add or subtract a degree?
Routes for checking temperature
- Axillary + 1 = oral
- Forehead + 1 = oral
- Rectal - 1 = oral
- TM - 1 = oral
What is the average temperature?
What is the definition of a fever?
Average temperature is 98.6 F
Fever is 100.4 F
What is the normal heart rate?
Normal heart rate is 60-100 bpm
Less than 60 is bradycardia
Greater than 100 is tachycardia
What is respiratory sinus arrhythmia?
Respiratory sinus arrhythmia
- Heart rate increases with inspiration and decreases with expiration
- Pronounced in children
- Gradually disappears in adolescence
- May be heart in adults who are in excellent cardiovascular health
What are the following PEx findings for:
- Bisferiens pulse
- Pulsus alternans
- Bigeminal pulse
- Paradoxical pulse
Bisferiens pulse
- increased pulse with double systolic peak
Pulsus alternans
- regular pulse rhythm that alternates strong and weak beats
Bigeminal pulse
- mimics pulsus alternans
- but caused by normal beat alternating with premature contraction
- almost impossible to tell the difference
Paradoxical pulse
- palpable decrease in pulse amplitude on inspiration
What is the normal respiration rate?
Normal respiration rate for an adult is 14 - 20 per minute
Below 14 is bradypnea
Above 20 is tachypnea
Infant rate may be as high as 44 per minute
What are the following PEx findings for:
- Sighing respirations
- Cheyne-Stokes breathing
Sighing respirations
- regular breathing with frequent sighs
Cheyne-Stokes breathing
- periods of deep breathing alternating with periods of apnea (no breathing)
What are the following PEx findings for:
- Obstructive breathing
- Rapid, deep breathing
- Kussmaul breathing
- Ataxic (biot) breathing
Obstructive breathing
- prolonged expiratory phase
Rapid, deep breathing
- hyperpnea
- hyperventilation
-
Kussmaul breathing
- deep breathing due to metabolic acidosis
Ataxic (biot) breathing
- unpredictable irregular breathing
What is orthostatic hypotension and how do you measure it?
Orthostatic (postural) hypotension
- decreased BP with postitional changes
- Assess by monitoring pulse and BP in different positions
- After being supine for 3-10 minutes
- Then, within 3 minutes of standing
What are the components of a general survery?
General survey
-
General appearance / state of health
- Frail, fit, ill
- Awake, alert, responsive
- Anxious, depressed
- Skin color
- Facial expression
-
Signs of distress
- Cardiac
- Respiratory
- Pain
-
Grooming and hygiene
- Clothes appropriate for weather
- Clean clothing
- Body or breath odors
-
Posture and gait
- Restless, changing positions often
- Sitting quietly
- Involuntary motor activity
- Immobility
- Smooth, balanced gait
- Limping, loss of balance
- BMI, height, and weight
Cranial nerve testing - how do you test for:
- Facial nerve (CN VII)
- Trigeminal nerve (CN V)
Cranial nerve testing
Facial nerve (CN VII)
- facial symmetry
- wrinkle forehead / raise eyebrows
- squeez eye shuts
- smile
- puff out cheeks
Trigeminal nerve (CN V)
- check for sensation to face with cotton swab
- opthalmic
- maxillary
- mandibular
How do you palpate TMJ?
Palpate TMJ
- Listen and feel for clicks
- Check ROM
- Open / close mouth
- Move side to side
- Check for motor function of masseter (CN V)
- Close mouth and bite down
Temporal artery assessment
- How to perform?
- Indicated when?
- Often associated with?
Temporal artery assessment
- Palpate the temporal arteries for tenderness
- Indicated when temporal arteritis is a ddx
- Temporal arteritis is often associated with polymyalgia rheumatica
Acromegaly - abnormal facies
- What causes acromegaly?
- What are the PEx findings?
Acromegaly - abnormal facies
- Results from excessive growth hormone
- Usually due to benign tumor on pituitary gland
- Physical exam:
- Generalized expansion of skull
- Pronounced brow protrusion
- Pronounced lower jaw protrusion
- Macroglossia (large tongue)
- Teeth gapping
Cushing syndrome - abnormal facies
- What causes this?
- What are the PEx findings?
Cushing syndrome - abnormal facies
- caused by excess cortisol
- facial swelling / rounding (“moon face”)
- red cheeks
- hirsutism
- “patient appears cushingoid”
Myxedema - abnormal facies
- What causes it?
- What are the PEx findings?
Myxedema - abnormal facies
- Caused by severe hypothyroidism
- Dry, course, and sparse hair
- Thin, lateral eyebrows
- Puffy face and eyes
Parkinson disease - abnormal facies
- What are the PEx findings?
Parkinson disease - abnormal facies
- “Mrs. Doubtfire face”
- mask like face
- decreased facial mobility
- stare
- blunted expression
