Week 1: General Appearance Flashcards
What are the steps you must follow when first meeting a patient?
What are the steps to being systemic and ensuring pt comfort?
When should a provider converse with the patient or discuss abnormal findings?
While pt is draped or dressed
What is the exam sequence?
Inspect, palpation, percussion, auscultation
What is the exam sequence for the abdomen?
Inspect, Auscultaton, palpatation, percussion
What should be done during an inspection?
What are the steps of palpation in an exam?
- involves use of hands and fingers to gather information through touch
- maintain short fingernails, warm hands if possible
- use palmer surface & finger pads for sensitivity
- use ulnar surface of hands to discern vibration
- use dorsal surface of hands to discern skin temperature
What is the ulnar surface of hands used to inspect?
vibration
What is the dorsal surface of the hands used to inspect?
skin temperature
How are percussions examined?
How are auscultations examined?
uses sound waves to detect body tissue density
percussion
When should auscultations be examined?
last except for abdomen
transmits low frequency sounds (when held lightly against area of auscultation)
bell of stethoscope
transmits high frequency sounds
diaphragm of stethoscope
What technique should be used when using a stethoscope?
less pressure for bell
more pressure for diaphragm
combine both bell (low frequency) and diaphragm (high frequency) into a single side of the chest piece. You control bell and diaphragm modes by pressure on the chest piece rather than by turning it over
The dual frequency diaphragm
What can be covered together during an examiniation?
general appearance/ mental status
What is the general survey for appearance?
What the components of the mental status examination?
What are common signs of distress that can be seen and adressed through observation?
What pain scale is used in adults, geratrics, adolescents, and children?
What are the steps used when a patient us unresponsive?
drowsy, open eyes and look at you, respond to questions, and then fall asleep, must speak to pt in a loud forceful manner
lethargic
open their eyes and look at you, but respond slowly and are somewhat confused, must shake a patient to get a response
obtunded
completely unarousable except by painful stimuli ( sternal rub)
stupor
completely unanarousable (out)
coma
the patient is awake and aware
alert
What are three ways to ask if a pt is orientented?
- aware of person (who they are)
- place (where they are)
- time (when is it does not need to be specific)
How can orientation be assesed?
How is orientation documented?
How to examine posture and motor behavior?
How to examine patients hygiene and grooming?
What can odors say about a pt?
What can facial expressions tell you about a pt?
awareness of the object in the environment to the five senses and their interraltionships (percieve surrondings)
perceptions
the logic, coherence, and relevance of a patient’s thoughts as they lead to thoughts and goals; how people think
Thought processes
awarness that thought, symptoms, or behaviors are normal or abnormal; distinguishing that a daydream or hallucination is not ral
insight
process of comparing and evaluating different possible courses of action
judgment
memory, attention, information and vocabulary, calculations, abstract thinking, and constructional ability
cognitive function
the observable mood of a person expressed through facial expression, body movements, and voice
affect
the sustained emotion of the patient
mood
What are three levels of mood?
- Euthymic - normal
- dysthymic- depressed
- maniac - elated
the complex symbolic system for expressing written and verbal thoughts, emotion, attention, and memory
language
level of intelligence assessed by vocabulary, knowledge base, calculations, and abstract thinking
higher cognitive functions
What are the seven moods?
How are moods assessed?
What are the steps and questions to take when a pt has a depressed mood?
What should be examined and documented for speech and language
- quantity - is the pt talkative or silent
- rate- is the speech fast or slow (speed)
- loud/volume - is speech loud or soft?
- articulation of words- does the patient speak clearly and distinctly? is there nasal quality to the speech? ex drunk - slurring, skipping words
- fluency - involves the rate, flow, and melody of speech (words not there)
What are examples of fluency in speech?
What are some abnormalities in the thought process?
- circumstantiality
- derailment
- flight of ideas
- neologisms
- incoherence
- blocking
- confabulation
- perseveration
- echolalia
- clanging
speech with unnecessary detail, indirection, and delay in reaching the point (mildest disorder, seen in pts with obsessions)
circumstantiality
tangential speech with shifting topics that are loosely connected or unrelated. pt unaware of lack of association ( pt with schisophrenis, manic episodes, extreme anxiety)
derailment
almost continous flow of accelerated speech with abrupt changes from one topic to the next. changes are based on understandable associations, plays on words or distracting stimuli, but ideas are not well connected ( manic episodes, stress reaction)
flight ideas
invented or distorted words (schizophrenia, psychotic disorders, and aphasia)
neologisms
speech that is incomprehensible and illogical (severe psychotic disturbances, usually schizophrenia)
incoherence
sudden interruption of speech, before the completion of an idea, occurs in normal people
blocking
fabrication of facts to hide memory impairment, aware of memory impairment (kosakoff syndrome from alcoholism)
confabulation
persistent repetition of words or ideas
perseveration
repetition of the words or phrases of others
echolalia
choosing a word on the basis of sound rather than meaning
clanging
What are abnormailities of thought content?
- compulsions
- obsession
- phobias
- anxieties
- delusions
repetitive behaviors that a person feels driven to perform in response to an obsession aimed at preventing or reducing anxiety or a dreaded event or situation
compulsions (actions)
recurrent presistent thoughts, images, or urges experienced as intrusive and unwanted that the person tries to ignore, suppress, or neutralize with other thoughts or actions
obsessions
presistent irrational fears, accompanied by a compelling desire to avoid the provoking stimulus
phobias
apprehensive anticipation of future danger or misfortune accompanied by feelings of worry, distress, and/or somatic symptoms
anxieties
false fixed personal beliefs that are not amenable to change in light of conflictiing evidence
delusions
a sense that the enviornment is stange, unreal, or remote
feelings of unreality
a sense that ones self or identity is different, changed, unreal; lost; or detached from one’s mind or body
feeling of depersonalization
What are the types of delusions?
What are the abnormailities of perception?
misinterpretations of real external stimuli. such as mistaking rustling leaves for the sound of voices
illusions
perception-like experiences that seem real, but unlike illusions lack actual external stimulation
hallucinations
Halluctions can occur in what ways?
auditory, visual, olfactory, gustatory, tactile, or somatic
What questions can be asked to assess perceptions?
What questions can be asked to assess insight?
What questions can be asked to assess judgment?
How is cognitive function assessed?
- orientation
- attention
- memory
- short term memory
- long term memory
How can attention in cognitive function be assessed?
How is higher cognitive function assessed?
- information and vocabulary
- calculating ability
- abstract thinking
- proverbs
- similarities
What is constructional ability?
What is the mini-mental state exam?
What are examples of mini-mental state exam?
What are examples of poor and great mental status documentation?
heaviest organ of the body and what are its appendages?
skin
hair, nails, sebaceous and seat glands
what are the three layesr of the skin?
epidermis, dermis, hypodermis (subcutaneous tissue)
short, fine, less pigmentation
vellus hair
coarser, pigmented hair
terminal hair
protect distal ends of fingers/ toes
nails
present all surfaces except palms/soles; produce a fatty substance secreted onto skin surface through hair follicles
sebaceous glands
what are the two types of sweat glands and their functions?
Which part of nail anatomy tells if pt had a thumb injury?
lunula
Lable the nail anatomy
What are common questions to obatin when exmaining hair, skin, abd nails?
What is the proper way to screen moles for possible melanoma?
What are additional risk factors for melanoma?
What are the specific techniques to follow when examining the skin, hair, and nails?
What are techniques to follow when performing a physical examination?
How should color be inspected when performing a physical examination of the skin?
How should lseions be inspected during a physical examination of hair, skin, and nails?
What are the steps to inspecting the scalp, hair, and nails?
When palpatating the skin, what are you inspecting for?
How should skin lesions and rashes be recorded?
- number - solitary or multiple, estimate total number
- size-measure in mm or cm
- color0 including erythematous of blanching; if nonblanching, vascular-like cherry angiomas and vascular malformations, petachiae, or purpura
- shape- circular, oval, annular (ring-like with central clearing, nummular (coin-like with no central clearing, or polygonal) * texture- smooth, fleshy, verrucous or warty, keratotic; greasy if scaling
- primary lesion-flat- macula vs. patch; raised: papule vs plaque; fluid-filled - vesicle vs bulla
- location - including measured distance from other landmarks
- configuration- grouped, annular, or linear
What are the flat or raised primary skin lseions?
primary skin lesion can be ____ or ____
flat or raised
multiple 3-8 erythematous on chest, back, and arms; morbilliform drug eruption
macules
large confluent completely depigmented on dorsal hands and distal forearms; vitiligo
patches
multiple 3-5 mm pink firm smooth domed, wiith central ubillications, in mons pubis, and penile shaft; molluscum contagiosum
papules
scattered erythematous to bright pink well- circumscribed flat- tpped plaques on extensor knees and elbows with overlying silvery scale , shiney
plaques
multiple 2-4 mm, pustules on erythematous base, grouped together on left neck; herpes simplex virus, blisters
vesicles
groupes 2-5 mm, on erythematous base on left upeer abdomen and trunk in a dermatomal distribution that does not cross the midline; herpes zoster or shingles
vesicles
What are types of secoundary lesions and why do they occur?
b/c of a certain condition
1. scales
2. crusts
3. excoriations
4. erosions
5. ulcers
6. fissurs
7. scars
8. keloids
are shed dead kertanized cells, that occur with psoriases and eczema. theyre irregular, flaky, and variable in size. usually silver, whte, or tan, they can be thick, thin, dry, or oily
scales
in contrast, are dried exudates. slightly elevated, they vary in size and color depending on the amount and type of excudate. Abrasion scabs and impetigo
crusts
such as abrasions represent a loss of epidermis and a exposed dermis. they may be linear or have hollowed-out crusted areas
excoriations
resemble excoriations, except that the depressed area is moist and glistening. they follow a vesicular rupture. an example of this type of lesion occurs and varicella
erosions
are also concave, exudative, and variable in size. some types, are graded to depth and severity
ulcers
are linear breaks in the skin extending from the epidermis to the dermis. usually small, deep, and red. ex. tinea pedis ( a fungal infection better known as athelets foot)
fissures
are collagenous tissues that permanently replace injured dermis. can be red, white, blue, and silver. can be thick, thin, hypertrophic, or atrophic
scars
are progressively enlarging scars that grow beyound the boudaries of the initial wound or incision. excessive collagen production during healing is generally responsible of the formation
keloids
Who are suspceptable to secoundary lesions and how should they be assessed?
What is the most common etiology for ulcers?
poor vascularization and pressure
ex. diabetics (not painful)
How should hair be examined?
What are the different type of nail conditions and what is their cause?
vertical ridging can be caused by?
normal aging, thyroid disease, eczema
What are beau’s lines?
What disease me be present with central nail canal damage?
What disease can be present with paronychia?
time taken for color to return to an external capillary bed after pressure is applied
capillary refill
(2 secounds)
What can cause capillary refill to be slowed down?
dehydration, shock, hypothermia, vascular disease
