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242 Cards in this Set
- Front
- Back
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What are the six categories that should be commented on in the general survey of a patient?
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1. State of Health
2. Appearance 3. Level of Consciousness 4. Signs of Distress 5. Posture, Gait and Motor Acitivity 6. Affect, Speech, Facial expression |
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This is a general statement based on observation and known past/current medical history.
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State of Health
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What are the four categories that need to be addressed when observing a patient's appearance?
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Development
Nutritional Status Age Habitus |
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What are the five categories that a patient can be categorized into when discussing level of consciousness?
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Alert
Letheargic Obtunded Stuporous Coma |
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This is when a patient will respond to a loud voice, appear drowsy, open their eyes, but fall back to sleep.
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Lethargic
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This is when a patient does not respond to a loud voice and you have to shake the patient gently to awaken them. They open their eyes but respond slowly.
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Obtunded
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This state of conciousness requires painful stimuli to awaken a patient. This is usually done through a sternal rub. The patient may have slow or absent verbal response, lapses back to their original state, if you remove the painful stimuli.
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Stuporous
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This is a level of consciousness when the patient will not respond to painful stimuli.
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Coma
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What are the five things to look for when observing Affect?
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Mood
Mannerisms Voice and Speech Pattern Facial Expressions Eye Contact |
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When are the two times that you repeat vital signs yourself, if they have already been done for you?
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If they are abnormal
Certain patient populations |
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What 8 things are included in the vital signs?
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Temperature
Pulse (Heart Rate and Rhythm) Respiratory Rate Blood Pressure Height Weight Pain Oxygen Saturation |
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What is considered hyperpyrexia?
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>41.1 degrees Celsius, or 106 degrees Fahrenheit.
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What is considered Pyrexia?
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>38 degrees Celsius, or 101 degrees Fahrenheit.
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What is considered Hypothermia?
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<35 degrees Celsius, or 95 degrees Fahrenheit.
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What is the average oral temperature?
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37 degrees Celsius, 98.6 degrees Fahrenheit
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What type of temperature is considered to be most accurate?
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Rectal
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Is rectal temperature higher or lower than oral?
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Higher, by about .4 degrees Celsius to .5 degrees Celsius, or .7 degrees Fahrenheit to .9 degrees Fahrenheit
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Which temp is considered to be the least accurate?
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Axillary
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This temperature measures core body temperature.
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Tympanic
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What is a normal pulse rate?
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60-100 beats
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In regards to pulse, what are the five measurements of amplitude?
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0-Absent, not palpable
1-Diminished, barely palpable 2-Expected 3-Full, increased 4-Bounding |
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What is the normal adult respiratory rate?
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14-20 breaths per minute
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This is rapid shallow breathing at over 20 breaths per minute.
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Tachypnea
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This is slow breathing that is less than 14 breaths per minute.
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Bradypnea
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This is very abnormal and seen in heart failure, strokes, traumatic brain injury, carbon monoxide poisoning, hospice or hospital patients on morphine drips as palliative care.
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Cheyne Stokes
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This is hyperpnea followed by apnea.
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Cheyne Stokes
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This respiratory rate is seen in intercranial bleeds or cranial pressure
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Biot breathing, or Biot respiration
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This respiratory rate has prolonged expiratory phase?
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COPD or Obstructive respiratory rate.
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What is considered normal BP?
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<120/<80
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What is considered pre-HTN?
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120-139/80-89
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What is considered to be Stage I HTN?
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140-159/90-99
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What is considered to be Stage II HTN?
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>160/>100
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What is the target range for diabetics or renal patients in regards to BP?
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<130/80
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This is sometimes seen in elderly patients due to a decreased elasticity in arteries due to artherosclerosis. This is characterized by BP = >140/<90
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Isolated Systolic Hypertension
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Hypertension should be diagnosed only when a higher than normal level has been found on at least ___ visits after the initial screening.
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Two
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The width of the inflatable bladder of the sphygmomanometer should be about __ of the upper arm.
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40%
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The length of the inflatable bladder of a sphygmomanometer should be ____ the width.
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Twice
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A big cuff on a small arm will do what to BP?
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Decrease BP reading.
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A small cuff on a large arm will do what to BP?
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Increase BP reading
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If the BP cuff is too short, how will it affect the BP reading?
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It will give a false high reading.
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How long should a patient rest before taking BP?
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5 minutes
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The patient should not have smoked, or ingested caffeine or alcohol for at least __ minutes prior to having their BP taken.
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30 minutes
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If you notice high vital measurements, what should you do?
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Let the patient sit through the exam before you re-check the vitals.
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What are the three rules for choosing an arm to measure BP?
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1. Bare arm, not through clothing
2. Free of AV fistulas, IV's, Scarring, and Lymphedema 3. Never use the arm on the side of mastectomy. |
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The interval of pressure where Korotkoff sounds indicating true systolic pressure fade away and reappear at a lower pressure point during the manual measurement of blood pressure. The improper interpretation of this gap may lead to blood pressure monitoring errors: namely, an underestimation of systolic blood pressure and/or an overestimation of diastolic blood pressure.
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Auscultatory Gap
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How do you calculate the pulse pressure?
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You subtract the systolic from the diastolic.
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What is a normal pulse pressure?
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30-40 mmHg
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In what population is the pulse pressure usually widened?
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The elderly
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A widened pulse pressure is characteristic of ?
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Isolated systolic hypertension
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A diminished pulse pressure, <30mmHg, is representative of?
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Decreased Stroke Volume - increased peripheral resistance.
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This is usually seen at >40mmHg, represents and increased stroke volume, and can be seen with fever, hyperthyroidism, patent ductus arteriosus, decreased compliance of aortic or arterial walls.
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Increased (Widened) Pulse Pressure
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To determine if a patient is orthostatic, take BP and Pulse how?
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In three positions:
Supine Sitting Standing Wait 1-3 minutes between positional changes and then re-take BP and pulse |
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This causes a decrease in systolic pressure of >20mmHg and/or a decrease in diastolic pressure of >10mmHG, tachycardia may or may not be associated with the decrease in BP.
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Orthostasis
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Orthostasis is usually associated with what?
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Volume Hypovolemia
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What two units can you use to measure height?
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Inches or centimeters
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What two units can you use to measure weight?
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Pounds or kilograms
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What units do you use for height and weight measurements in children?
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Centimeters and Kilograms
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This is the international designation of relative weight for stature.
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BMI
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How do you calculate BMI
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Weight X 700/height in inches
_________________________ Height in inches |
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What is a healthy BMI?
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18.5-24.9
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What is considered to be an overweight BMI?
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25-29.9
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What is considered obese with BMI?
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>30
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What is considered underweight with BMI?
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< 18.5
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This is when there is pain, but the work up hasn't revealed why there is pain.
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Idiopathic pain
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This is pain related to tissue damage.
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Nocioceptive or somatic
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This is when there is pain caused by trauma to the central and peripheral nervous system.
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Neuropathic pain
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This is pain caused by the medical staff.
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Iatrogenic pain
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Relates to how the patient feels pain and relates to pain, ie. depression, low threshold, high threshold, cultural.
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Psychogenic
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This measures the percentage of hemoglobin binding sites in the bloodstream occupied by oxygen. (arterial oxygen saturation).
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SaO2 (02Sat), Oxygen Saturation
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If an 02 sat is below 90% then it is termed?
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Hypoxemic/Hypoxemia
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Anyone with an Oxygen saturation below 90% is a candidate for?
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Intubation
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What is something you must do prior to the examination in the presence of the patient?
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Wash your hands.
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What does IPPA stand for?
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Inspection, Palpation, Percussion, Auscultation
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What are the four categories of inspection?
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Size, Shape, Symmetry, Color
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What are the three categories of palpation?
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Position, Vibration, Temperature
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Percussion: What is the
Intensity: ? Pitch: ? for. . . Tympany Resonance Hyper-Resonance Dull Flat |
Tone: Intensity: Pitch:
Tympany Loud High Resonance Loud Low Hyper-Res.Very Loud Low Dull Soft Mod. Flat Soft High |
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This is the type of percussion you hear when you are over stool or organs.
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Dull Tone
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This is the type of percussion you hear when you are over muscles.
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Flat Tone
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This is the type of percussion you hear when you are over air trapped in an empty space.
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Hyper-Resonance
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This type of percussion is what you hear when you imagine the sound of an empty bottle.
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Tympany
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Auscultation includes what four things?
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Heart sounds, Breath sounds, Bowel sounds, and Bruits
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How do you measure BMI in kilograms?
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Weight (kg)
_________________________ height (meters) squared |
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What are the six main functions of the skin?
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1. Protects from microbial invation
2. Protects from minor physical trauma 3. Prevents body fluid loss 4. Regulates body temperature via perspiration. 5. Provides sensory perception 6. Produces vitamin D3-from sunlight. |
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This is avascular, and is composed of the stratum corneum-an outer horny layer, and the cellular stratum-the inner cellular layer.
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Epidermis
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This is vascular, is composed of connective tissue, sebaceous and sweat glands, hair follicles, sensory and autonomic fibers.
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Dermis
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This layer of skin is composed of fat.
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Subcutaneous tissue.
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This is a brownish pigment whose amount is genetically determine and it increases in sunlight.
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Melanin
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This is a golden yellow skin pigment, that is found in subcutaenous fat, heavy areas of keratinized skin (palms and soles).
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Carotene
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This gives the skin a bright red/pink pigment, It is from oxygenated rich blood found in arteries and capillaries. An increase in blood flow causes reddening, and a decrease in blood flow causes pallor.
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Oxyhemoglobin
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This gives skin a bluish pigment - cyanosis. Increases in this results in cyanosis, central versus peripheral.
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Deoxyhemoglobin
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Hair gets is color from what?
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Melanocytes in the shaft.
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This is a type of hair that is short, fine, soft and nonpigmented.
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Vellus
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This is a type of hair that is course, long, thick and pigmented.
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Terminal
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These are hard plates of keratin that protect the vascular nail bed.
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Nails
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How fast do fingernails grow?
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0.1mm a day, and toenails grow slower.
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What are the parts of the nail in order?
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Free edge
Nail Plate Lunula Cuticle proximal nail fold There is also lateral nail folds at the side of the nails |
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This plays a major role in kids getting acne?
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Sebaceous glands.
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These secrete sebum, they are stimulated by sex hormones, they are present all over skin except for palms and soles.
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Sebaceous glands.
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These are widely distributed sweat glands that open directly onto the skin. They regulate body temperature.
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Eccrine glands.
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These sweat glands are in the axillary and genital areas. They open into hair follicles. They are stimulated by stress and can cause body odor.
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Apocrine glands.
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When examining the skin, what is the sequence?
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Inspection
Palpation Measurement-if applicable |
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This is an example of hyperpigmentation.
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Cafe-au-lait spots
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These are examples of hypopigmentation.
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Tinea versicolor and vitiligo.
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This is a new lesion, that is an initial, spontaneous manifestation from previously normal skin.
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Primary skin lesion
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This is a skin lesion that later evolved or changed because of an external trauma to the primary lesion.
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Secondary skin lesion
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These are primary skin lesions, that are flat, nonpalpable, and well circumscribed.
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Macules and Patches.
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What is the difference between a macule and a patch?
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A macule is <1 cm and a patch is >1 cm.
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These are primary skin lesions that are elevated, palpable and solid. There are four of them.
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Papule, Plaque, Nodule, Wheal
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This is an elevated, palpable solid that is less than 1 cm.
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Papule
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This is an elevated, palpable solid that is greater than 1cm, superficiel and the surface area is greater than the height. It can be a coalescence of papules.
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Plaque
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These are elevated, palpable and solid, and are marble like. They measure less than .5cm. They are deeper and firmer than a papule.
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Nodule.
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These are elevated, palpable and solid. They are irregular, superficial, localized and have edema.
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Wheal.
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What are the three elevated, palpable, fluid filled primary skin lesions?
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Vesicles, Bullae and Pustules.
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These are elevated, palpable and fluid filled and they are less than 1 cm, filled with a serous fluid.
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Vesicle
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These are elevated, palpable and fluid filled and they are 1 cm or greater, and filled with serous fluid.
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Bulla
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This is a bulla filled with pus, and it is elevated, palpable and fluid filled.
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Pustule
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This is an example of a vesicle.
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Herpes.
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This is an example of a Pustule.
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Severe acne and small pox
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This is a plugged opening of a sebaceous gland.
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Comedo
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This is a pus filled cyst.
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Abcess
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This is an example of a burrow.
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Scabies, or a raised tunnel.
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These are primary skin lesions that are palpable, solid, semi-liquid material, fluid involvement.
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Cyst - and they are under the skin.
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What are the secondary skin lesions below the skin plane?
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Erosion
Ulcer Fissure Excoriation Atrophy |
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What are the secondary skin lesions above the skin plane?
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Scaling
Crusting |
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This is a secondary skin lesion that is below the skin. It is a loss of superficial epidermis, with no bleeding, and the surface is moist.
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Erosion
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This is a secondary skin lesion that is below the skin plane. It is a loss of epidermis and dermis, and it may bleed.
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Ulcer
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Secondary skin lesion, that is below the skin plane, it is a linear crack from epidermis to dermis. This is what happens in angular cheilitis and cracks between toes with tinea pedis.
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Fissure
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This is a secondary skin lesion, below the skin plane, that can be seen with obsessive behavior and meth addicts. It can appear to be like scratches, superficial linear or "dug out", traumatized areas.
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Excoriation
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This is a secondary skin lesion that is thinning of the dermis and epidermis causing a depression. Stretch marks are an example.
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Atrophy
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This is a secondary skin lesion that is above the skin plane and is characterized by flaky, exfoliated skin.
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Scaling
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This is a secondary skin lesion, that is above the skin plane, there is dried blood, pus or serum visible. Impetigo is an example.
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Crusting
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These are purpuric skin lesions that are 1-3cm, reddish-purple, non-blanching.
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Petechiae
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This is a purpuric skin lesion that is over 3cm, reddish-purple, non-blanching.
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Purpura
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This is a purpuric skin lesion that can be black and blue, variable size, reddish-bluish-purple, fades to green-yellow-brown, non blanching.
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Ecchymosis
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What are the three types of purpuric skin lesions?
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Petechiae, Purpura, and Ecchymosis
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This is a vascular skin lesion that is 1-3 cm in diameter, bright or ruby red, partial blanching, no significance.
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Cherry Angioma, Totally Benign
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This is a vascular skin lesion that is associated with liver disease, vitamin B deficiency, but also normal in pregnancy. It has a central red body with radiating arms and central blanching.
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Spider Angioma
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This is a vascular skin lesion that is bluish, spider like or linear, and non blanching.
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Spider vein
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This is fibrous tissue, hypertrophic vs. atrophic, limited to wound boundaries.
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Scar
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This is a hypertrophic elevated scar, extends beyond wound boundaries.
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Keloid
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If you have fine hair it could be a sign of what?
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Hyperthyroidism
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If you have course hair it could be a sign of what?
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Hypothyroidism
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This is secondary to pituitary gland producing too much growth hormone.
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Acromegaly
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This is from high levels of cortisol from the adrenal glands.
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Cushing's Syndrome
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In this syndrome you see periorbital edema, puffy pale face, lips may be swollen.
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Nephrotic syndrome
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This can be seen with hypothyroidism, dry, course, sparse hair, lateral eyebrows thin or absent, periorbital edema, puffy dull face with dry skin.
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Myxedema
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This is secondary to damage of cranial nerve 7. Raising eyebrows, forehead not wrinkled, eyebrow not raised, paralysis of lower face.
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Bell's Palsy
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Positive diopters view what part of the eye?
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The front portion of the eye
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What is the sequence of the eye examination?
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Visual acuity
Color Blindness Visual Fields Extraocular Movements Esotropia and Exotropia Inspection Fundoscopy |
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Which cranial nerve is tested with visual acuity?
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CN II
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What is low vision?
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20/60
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What is considered legally blind?
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20/200
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What is considered blind?
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20/400
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This is called near sightedness.
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Myopia
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This is inability to focus on near objects, begins around 40-45 years old.
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Presbyopia
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This is called farsightedness.
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Hyperopia
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This is double vision?
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Diplopia
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This is a result of a lack of one or more of the types of color receptors. About 10% of males have a color perception defect. This is rare in females.
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Color Blindness
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Most color perception defects are for what two colors?
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Red, Green or Both
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When you test extraocular movement using the six cardinal directions of gaze what CN's are being tested?
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CN III, IV, VI
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This can sometimes be caused by hyperthyroidism, possibly associated with exopthalmia.
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Lid lag
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This is when you have lateral eye movement and you get significant beating of the eye.
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Nystagmus
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This is when the lens is adjusting from near/far or far/near.
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Accommodation
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The eyes normally follow the object within 5cm to 8cm of the bridge of the nose.
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Convergence
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When you have a corneal reflection show up asymmetrical this is called?
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Disconjugate gaze.
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This is when the eye moves nasally to laterally and is known as convergent strabismus.
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Exotropia
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This is when the eye moves from the lateral aspect to the nasal aspect and is known as convergent strabismus.
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Esotropia
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This is associated with yellowish plaques in lipid disorders.
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Xanthelasma
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This is a stye, painful and at lid margin.
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Hordeolum
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This is a painless nodule on inside of eye lid that involves meibian.
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Chalazion
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This can be caused by myasthenia gravis, Horner's Syndrome, it can also be secondary to occulomotor damage to nerve supply.
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Ptosis
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This is when the eyelid is inverted.
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Entropion
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This is when the eyelid is everted.
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Ectropion
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1. If you have a ichteric sclera what does that mean?
2. If you have a erythematous sclera what does that mean? |
1. Hepatobiliary problems
2. Conjunctivitis |
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an inflammation of the eyelash follicles
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Blepharitis
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Pupils constricted are called?
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Myosis
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Pupils dialated are called?
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Mydriasis
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20% of people have a difference in pupil size called?
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Aniscoria
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What are the normal sizes for pupils?
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<3mm is small, >5mm is big, usually equal in size.
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This is usually caused by secondary neurologic damage that affects the postganglionic fibers of the parasympathetic innervation of the eye usually caused by viral or bacterial infection.
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Tonic (Adie's Pupil)
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These pupils will accomodate, but they don't react to light. This is a highly specific sign for neural syphilis, can be bilateral or unilateral.
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Argyll Robertson Pupils
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These pupils can happen from heroine, morphine, oxycontin-opiods, Pons hemmorhage. If the pupil goes below 2.5 then damage and sympopathic pathways in hypothalamus or metabolic encepalopathy could be involved.
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Pinpoint pupils
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This type of pupil can be seen with cocaine, amphetamines, crystal meth. If unilateral it can be an ominous sign of single side temporal lobe damage.
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Blown pupil
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is a white or gray opaque ring in the corneal margin (peripheral corneal opacity) present at birth or appearing later in life and becoming quite frequent after age 50.
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Arcus senilis (or arcus senilis corneae)
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If a baby has no red reflex what is the diagnosis?
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Retinoblastoma
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If there is no red reflex in the elderly, what is the diagnosis?
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Cataracts
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This is caused by increased intercranial pressure and is seen in the eye.
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Papilledema
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This can be seen within the eyes, and is a sign of diabetes and HTN.
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Cotton wool spots.
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These are protein spots seen in normal aging as well as macular degeneration.
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Drusen
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This is the divider between the external and middle ear. It should be translucent, pearly gray with blood vessels at periphery and have a concave shape.
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Tympanic membrane
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This is the passageway between the middle ear and nasopharynx. It equalizes the middle ear and atmospheric pressure.
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Eustachian tube
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This part of the ear is for sound identification and localization. It protects from foreign substances.
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External ear
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This part of the ear is for sound transmission.
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Middle ear
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This part of the ear is for sound interpretation, position sense and equilibrium maintenance.
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Inner ear
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This phase of hearing is from the external ear through middle ear.
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Conductive phase
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This phase of hearing is from the inner ear and cochlear functions.
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Sensorineural phase
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This results from problems in external and or middle ear. Can be an impediment to air conduction. It is usually treatable. Hearing loss is at all frequencies, typically speak softly, generally hear better in noisy environment.
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Conductive hearing loss
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What type of hearing loss can otitis media, otitis externa, cerumen inpaction and perferated TM cause?
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Conductive hearing loss
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This results from problems in the inner ear, cochlear nerve, usually irreversible hearing loss. Greater loss in higher frequencies. Noisy environments make hearing worse. Complain that others are mumbling. Talk loudly.
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Sensironeural hearing loss
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What is the Tx for sensorineural hearing loss?
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Hearing aids, implants
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This kind of hearing loss is associated with loud noise exposure and neurofibromas.
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Sensorineural hearing loss
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What is focused on with the inspection of the ear?
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Alignment
Position Size Color Deformity Lesions Sign of Trauma |
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What areas do you palpate to check for pain in the outer ear?
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Palpate the helix, auricle and push the tragus.
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What four things do you inspect the ear canal for?
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Color
Cerumen Exudate Lesions, foreign bodies, edema |
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What are you looking for when inspecting the TM?
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Intact vs. perforated
Color Contour Bony Landmarks Cone of Light |
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What CN is responsible for gross hearing?
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CN VIII
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In in tact hearing AC to BC ?
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AC>BC 2:1
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In conductive hearing loss AC to BC?
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BC>AC
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In sensorineural hearing loss AC to BC?
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AC>BC, but less than 2:1
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What two tests are used to distinguish type of hearing loss?
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Weber and Rinne Test
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In the Weber test, explain how do you decipher the test?
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Intact hearing - Bilaterally equal
Conductive hearing loss - Sound is lateralized to affected ear. This is if there is visual damage to the ear Sensorineural hearing loss - Sound is lateralized to unaffected ear. This is if there is no visual damage to the ear. |
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Rinne Test:
AC>BC 2 to 1 means what? |
Intact hearing.
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Rinne Test:
AC = BC or BC>AC in affected ear. |
Conductive hearing loss.
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Rinne Test:
AC>BC (less than 2:1) in affected ear |
Sensorineural hearing loss
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the loss of hearing that gradually occurs in most individuals as they grow older.
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Presbycusis
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When inspecting the nose what should be focused on?
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Size
Shape Symmetry Lesions Drainage |
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When palpating the nose what should be focused on?
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Tenderness
Masses |
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How do you examine the patency of the nose?
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Occlude one nostril, have patient breathe in and out. Do both sides.
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When inspecting the nose what specific internal structures should be focused on?
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Mucosa - color, edema, bleeding
Airway - exudate, polyps Turbinates - edema, erythema Septum - perforation, esp. in drug use |
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When examining the lips what are you supposed to focus on?
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Color
Moisture Lesions Cracks |
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This is common in children, can mean yeast infection, HIV or nutritional deficits. Seen at the side of the mouth.
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Angular Cheilitis
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This can be on the buccal mucosa and hands. It is an autosomal dominant condition that can have polyps in the GI tract.
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Peutz-Jeghers Syndrome
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If you see lesions on the buccal mucosa what could it possibly be a sign of. 2 things.
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Kaposi Sarcoma
Apthous ulcers - Chancre sore |
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If the tonsils appear to be cobblestonish what could this be a sign of?
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Allergic rhinitis, or rhinorrhea
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This is seen when the Uvual deviates to the unaffected side of the mouth. You can observe the rise and the fall of soft palate. Have the patient say "AH" during exam.
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Cranial Nerve X (Vagus) Palsy
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If you see geographic tongue what can it mean?
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That the tastebuds on the geographic areas do not work
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This is benign, seen with increase in age, AKA scrotal tongue. Food can get caught and can cause inflammation and hallitosis.
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Fissured tongue
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This is caused by Atrophic glossitis, it is seen in vitamin B and thymine deficiency.
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Smooth tongue
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Smooth tongue is a hallmark for what condition?
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Pernicious anemia
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This is benign, can occur spontaneously or after someone has been on antibiotics.
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Hairy tongue
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This is formed by the mandible, the sternomastoid and the midline of the neck.
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Anterior triangle
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This is formed by the sternomastoid, trapezius and the clavicle.
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Posterior triangle
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What are six things the lymphatic system is involved in?
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Maintains fluid balance
Produces lymphocytes Produces antibodies Blood cell formation Phagocytosis Spread of Malignancy |
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These lymph nodes are found in the subcutaneous connective tissues.
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superficial nodes
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These lymph nodes are in the fascia of muscle and within body cavities.
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deep nodes
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This is when there is a presence of palpable lymph nodes in 3 or more separate chains. This is associated with lymphoma, leukemia, systemic infections.
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Generalized Lymphadenopathy
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Tender nodes usually indicate what?
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Inflammation
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Hard, discrete, nontender nodes usually indicate?
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Malignancy
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What is a condition that you can see the trachea deviate?
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Tension pneumothorax
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This condition does not have palpable nodules. This is caused by hyperthyroidism and Hashimotos thyroiditis.
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Goiter
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Enlarged nodes palpated
PALS stands for? |
Primary site
All associated nodes Liver Spleen |
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When do you perform auscultation of the thyroid?
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When it is enlarged and you use the bell of the stethoscope, listen for bruits.
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