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152 Cards in this Set
- Front
- Back
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what equipment is needed for a cardiovascular exam?
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1) double-headed, double-lumen stethoscope
2) blood pressure cuff 3) moveable light source or pen light |
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what are the general considerations for a cardiovascular exam?
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1. pt must be properly undressed and in a gown
2. exam room must be quiet for auscultation 3. pt should be observed for general signs of cardiovascular disease (finger clubbing, cyanosis, edema) |
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what are the general signs of cardiovascular disease?
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1. finger clubbing
2. cyanosis 3. edema |
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how should pulse rate and rhythm be measured?
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1. compress the radial artery with the index & middle fingers
2. note whether pulse is regular or irregular 3. count the pulse for 15 seconds and multiply by 4 4. count pulse for a full minute if pulse is irregular 5. record rate and rhythm |
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what is a normal number of beats per minute for an adult patient's pulse?
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60-100 beats per minute
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at what rate is a patient's pulse considered bradycardic?
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less than 60 beats per minute
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at what rate is a patient's pulse considered tachycardic?
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greater than 100 beats per minute
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define regular heart rhythm
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evenly spaced beats that may vary slightly only with respiration
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define regularly irregular heart rhythm
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regular pattern overall with "skipped" beats
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define irregularly irregular heart rhythm
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chaotic, with no real pattern
very difficult to measure rate accurately |
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how should one measure the amplitude and contour of a patient's arterial pulses?
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1. observe for carotid pulsations
2. place fingers behind the pt's neck and compress (press firmly, but not to the point of discomfort) the carotid artery of ONE side with your thumb at or below the level of the cricoid cartilage 3. assess the following: - amplitude of pulse - contour of pulse wave - variations in amplitude from beat to beat or with respiration 4. repeat on opposite side |
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when should a physician check a patient for bruits?
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if the patient is late middle aged or older
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a bruit is a sign of what?
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arterial narrowing and increased risk for a stroke
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how should a physician auscultate for bruits?
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1. place the bell of the stethoscope (or the diaphragm if the pt's neck is highly contoured) over each carotid artery in turn
2. ask the pt to stop breathing momentarily 3. listen for a blowing/rushing sound (bruit), making sure that you do not confuse heart sounds or murmurs transmitted from the chest |
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what condition should a pt be in when the physician checks their blood pressure?
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pt should not have eaten, smoked, taken caffeine, or engaged in vigorous exercise within the last 30 minutes
room should be quiet and pt should be comfortable |
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how should a physician check a pt's blood pressure?
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1. position pt's arm so that the antecubital fold is level with the heart
2. center the cuff bladder over the brachial artery about 2cm above the antecubital fold 3. position the pt's arm so it is slightly flexed at the elbow 4. palpate the radial pulse and inflate the cuff until the pulse disappears (this is a rough estimate of the systolic pressure) 5. place the stethoscope over the brachial artery 6. inflate the cuff 20-30mmHg above the estimated systolic pressure 7. release pressure slowly (<5mmHg/sec); the level at which beats are consistently heard is the systolic pressure 8. continue to lower the pressure until the sounds muffle and disappear; this is the diastolic pressure **BP should be taken on both of pt's arms on first encounter** |
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how should a physician ensure that they have a blood pressure cuff of the proper size? why is this important?
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be sure the index line of the blood pressure cuff falls between the size marks when you apply the cuff
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what is a normal blood pressure?
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<130 / <85
high normal is 130-139 / 85-89 |
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what blood pressures are considered hypertension?
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mild HTN: 140-159 / 90-99
moderate HTN: 160-179 / 100-109 severe HTN: 180-209 / 110-119 crisis HTN: >210 / >120 |
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what is the normal pulse and blood pressure of a newborn?
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pulse: 140 bpm
systolic BP: 70 mmHg |
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what is the normal pulse and blood pressure of a 6 month old?
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pulse: 130 bpm
systolic BP: 90 mmHg |
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what is the normal pulse and blood pressure of a 1 year old?
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pulse: 115 bpm
systolic BP: 90 mmHg |
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what is the normal pulse and blood pressure of a 2 year old?
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pulse: 110 bpm
systolic BP: 92 mmHg |
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what is the normal pulse and blood pressure of a 6 year old?
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pulse: 103 bpm
systolic BP: 95 mmHg |
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what is the normal pulse and blood pressure of a 8 year old?
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pulse: 100 bpm
systolic BP: 100 mmHg |
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what is the normal pulse and blood pressure of a 10 year old?
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pulse: 95 bpm
systolic BP: 105 mmHg |
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how should a physician measure a patient's jugular venous pressure?
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1. position the pt supine with the head of the table elevated 30 degrees
2. use tangential, side lighting to observe for venous pulsations in the neck 3. look for a rapid, double/triple wave with each heart beat 4. apply light pressure just above the sternal end of the clavicle to eliminate pulsations and rule out carotid origin 5. adjust the angle of table elevation to bring out the venous pulsation 6. ID the highest point of pulsation 7. use a horizontal line from the highest point of pulsation and measure vertically from the sternal angle (should be <4cm in normal, healthy adult) |
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how should a physician examine a patient's precordial movement?
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1. position the pt supine with the head of the table slighlty elevated
2. always examine from the pt's right side 3. inspect chest for precordial movement (tangential lighting will make mvmts more visible) 4. palpate for precordial activity in general; you may feel "extras" such as thrills or exaggerated ventricular impulses 5. palpate for the point of maximal impulse (PMI/apical pulse); usually located in intercostal space 4/5, just medial to midclavicular line 6. note the location, size, and quality of the impulse |
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where is the point of maximal impulse (PMI or apical pulse) normally located?
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4th or 5th intercostal space, just medial to the midclavicular line
**usually less than the size of a quarter** |
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how does a physician auscultate a patient's cardiovascular system?
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1. position pt supine w/ head of table slightly elevated
2. examine from pt's right side; quiet room is essential 3. listen with diaphragm at the right 2nd intercostal space near the sternum (aortic area), at the left 2nd intercostal space near the sternum (pulmonic area), at the left 3rd, 4th, 5th intercostal spaces near the sternum (tricuspid area), and at the apex (mitral area) 4. listen with the bell of the stethoscope at all of the same areas 5. record S1, S2, (S3), and (S4), as well as the grade and configuration of any murmurs |
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what position can a physician put a patient in to better auscultate S3 sounds?
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1. have the patient roll on their left side
2. listen with the bell at the apex |
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what position can a physician put a patient in to better auscultate mitral murmurs?
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1. have the patient roll on their left side
2. listen with the bell at the apex |
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what position can a physician put a patient in to better auscultate aortic murmurs?
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1. have the pt sit up, lean forward, and hold their breath in exhalation
2. listen with the diaphragm at the left 3rd and 4th intercostal spaces near the sternum |
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how should a physician record murmurs?
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grade: x/6 (e.g. 2/6)
configuration: pansystolic/crescendo |
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what is a pt's diagnosis if they have a crescendo murmur between S1 and S2?
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innocent/physiologic aortic stenosis
OR innocent/physiologic pulmonic stenosis |
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what is a patient's diagnosis if they have a pansystolic murmur (lasts for the entire time btwn S1 and S2) on auscultation?
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mitral/tricuspid valve regurgitation
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what is a patient's diagnosis if they have a late systolic click on auscultation?
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late systolic click = murmur/clicking sound made between S1 and S2, but closer to S2
mitral valve prolapse |
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what is a patient's diagnosis if they have an early diastolic murmur of decreasing intensity?
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early diastolic murmur = beginning AT S2 with sound decreasing in amplitude until disappearing about half way through diastole
diagnosis: aortic regurgitation |
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what is a patient's diagnosis if they have a mid-diastolic murmur of decreasing intensity?
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mid-diastolic murmur = beginning AFTER S2 with sound amplitude decreasing until disappearing shortly BEFORE S1
diagnosis: mitral/tricuspid valve stenosis |
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what is a patient's diagnosis if they have an opening snap or diastolic rumble?
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opening snap is a low grade murmur/rumbling that begins shortly AFTER S2 and lasts until S1
diagnosis: mitral stenosis |
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what is a patient's diagnosis if they have an ejection sound?
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ejection sound is a sharp, high amplitude sound (equal in intensity to the sound of S1 and S2) that occurs shortly after S1, and significantly before S2
diagnosis: aortic valve disease |
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what is the diagnosis of a patient if they have an S3 sound on auscultation?
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S3 is a sharp, low-intensity sound that occurs shortly after S2, but significantly before S1
diagnosis: normal in children; heart failure in adults |
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what produces S1 (the first heart sound)?
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closure of the AV valves during systole
**AV valves are the mitral (bicuspid on left) and tricuspid (on right) valves** |
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what produces S2 (the second heart sound)?
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closure of the semilunar valves during systole
**semilunar valves are aortic (on left) and pulmonic (on right) valves** |
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what is an S3 sound?
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S3 is a rare extra heart sound that occurs soon after the normal two "lub-dub" heart sounds (AFTER S1 AND S2)
"SLOSH’-ing-in" to help with the cadence (SLOSH S1, -ing S2, -in S3), as well as the pathology of the S3 sound caused by the oscillation of blood back and forth between the walls of the ventricles initiated by the inflow of blood from the atria |
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what is an S4 sound?
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S4 is a rare extra heart sound that occurs immediately before the normal two "lub-dub" heart sounds (S1 and S2)
occurs just after atrial contraction and immediately before the systolic S1 "a-STIFF-wall" can help with the cadence (a S4, stiff S1, wall S2), as well as the pathology of the S4 sound caused by the atria contracting forcefully in an effort to overcome an abnormally stiff or hypertrophic ventricle |
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murmur grade 1/6
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very faint murmur, only heard with optimal conditions
no thrill is present |
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murmur grade 2/6
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murmur that is loud enough to be obvious
no thrill is present |
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murmur grade 3/6
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murmur that is louder than grade 2 (which is just loud enough to be obvious)
no thrill is present |
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murmur grade 4/6
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murmur that is louder than grade 3
thrill is present |
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murmur grade 5/6
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murmur that is heard with stethoscope partially off the chest
thrill is present |
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murmur grade 6/6
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murmur that is heard with stethoscope completely off the chest
thrill is present |
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what equipment is needed to check a patient's vital signs?
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stethoscope
blood pressure cuff watch displaying seconds thermometer |
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what general considerations should be kept in mind when checking a patient's vital signs?
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1. pt should not have had alcohol, tobacco, caffeine, or performed vigourous exercise within 30 minutes of the exam
2. ideally, the pt should be sitting with feet on the floor and their back supported 3. exam room should be quiet and patient should be comfortable 4. history of HTN, bradycardia, tachycardia, and current medications should always be obtained |
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what are the four ways to check someone's temperature?
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1. oral (glass, paper, or electronic thermometer)
2. axillary (glass or electronic thermometer) 3. rectal (aka core temp; glass or electronic thermometer) 4. aural (electronic thermometer) |
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what normal temperatures?
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oral: 98.6 deg F
axillary: 97.6 deg F rectal: 99.6 deg F aural: 99.6 deg F |
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what are the most and least accurate methods of checking a patient's temperature?
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most accurate: rectal
least accurate: axillary |
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how should a physician check a patient's respirations?
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1. immediately after taking the patient's pulse don't let go of the patient's wrist, but begin to observe their breathing
2. count breaths for 15 seconds and multiply by 4 3. normal in adults is between 14 and 20 |
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how should a physician check a patient's pulse?
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1. sit or stand facing the pt
2. grasp pt's wrist with non-watch bearing hand (pt's right arm with your right arm or pt's left arm with your left hand) 3. compress the radial artery with the index and middle fingers 4. note whether the pulse is regular or irregular 5. count the pulse for 15 seconds and multiply by 4 (count for a full minute if the pulse is irregular) 6. record rate and rhythm |
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what is a regular pulse?
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pulse with evenly spaced beats that may vary slightly with respiration
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what is a regularly irregular pulse?
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pulse with a regular pattern overall, but with "skipped" beats
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what is an irregularly irregular pulse?
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chaotic pulse with no real pattern; it is very difficult to measure the rate accurately
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what is a normal adult heart rate?
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60-100 beats per minute
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at what pulse rate is a patient considered to be bradycardic?
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heart rate less than 60 beats per minute
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at what pulse rate is a patient considered to be tachycardic?
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heart rate greater than 100 beats per minute
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what equipment is needed to do an examination of the chest and lungs?
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1. stethoscope
2. peak flow meter |
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what general considerations should be kept in mind when doing an examination of a patient's chest and lungs?
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1. pt must be properly undressed and gowned
2. ideally the pt should be sitting on the end of an exam table 3. examination room must be quiet for percussion and auscultation 4. observe pt for general signs of resp. disease (finger clubbing, cyanosis, air hunger, etc.) 5. try to visualize the underlying anatomy as you examine the patient |
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how should a physician inspect a patient's chest?
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1. observe the rate, rhythm, depth, and effort of breathing
2. note whether expiratory phase is prolonged 3. listen for obvious abnormal sounds with breathing (e.g. wheezes) 4. observe for retractions and use of accessory muscles (sternomastoids and abdominals) 5. observe the chest for asymmetry, deformity, or increased anterior-posterior diameter 6. confirm that trachea is near the midline |
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how should a physician palpate a patient's chest?
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1. ID any areas of tenderness or deformity by palpating the ribs and sternum
2. assess expansion and symmetry of the chest by placing hands on pt's back with thumbs together at the midline and asking them to breathe deeply 3. check for tactile fremitus |
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what is indicated by decreased/absent tactile fremitus?
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pleural effusion
pneumothorax **increased space between lung and body wall diminishes or prevents entirely sound transmission** |
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what is indicated by increased tactile fremitus?
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consolidation (pneumonia)
**sound waves are transmitted with less decay in a solid or fluid medium (the consolidation) than in a gaseous medium (aerated lung)** |
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how should a physician percuss a patient's chest?
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1. hyperextend the middle finger of one hand and place the DIP joint firmly against the pt's chest
2. with the end (not the pad) of the opposite middle finger, strike the first middle finger with a quick flick of the wrist 3. categorize what you hear as normal, dull, or hyperresonant |
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where do you percuss on the posterior chest?
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- percuss from side to side and top to bottom
- compare one side to the other looking for asymmetry - note the location and quality of the percussion sounds you hear - find the level of diaphragmatic dullness on both sides |
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how should a physician perform a diaphragmatic excursion?
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1. find the level of the diaphragmatic dullness on both sides
2. ask the pt to inspire deeply 3. find the new level of diaphragmatic dullness on both sides **level of dullness should go down 3-5cm symmetrically** |
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where should a physician percuss on the anterior chest?
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- percuss from side to side and top to bottom
- compare one side to the other looking for asymmetry - note the location and quality of the percussion sounds you hear |
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what is indicated by flat or dull percussion notes?
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pleural effusion
lobar pneumonia |
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what is indicated by normal percussion notes?
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healthy lung
bronchitis |
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what is indicated by hyperresonant percussion notes?
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emphysema
pneumothorax |
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how should a physician auscultate the posterior chest?
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1. use the diaphragm of the stethoscope to auscultate breath sounds
2. auscultate from side to side and top to bottom 3. compare one side to the other looking for asymmetry 4. note the location and quality of the sounds you hear **inspiration should be louder and longer than expiration** |
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how should a physician auscultate the anterior chest?
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1. use the diaphragm of the stethoscope to auscultate breath sounds
2. auscultate from side to side and top to bottom 3. compare one side to the other looking for asymmetry 4. note the location and quality of the sounds you hear **inspiration should be louder and longer than expiration** |
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what causes breath sounds?
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turbulent air flow
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where are vesicular breath sounds heard?
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low-pitched and normally heard over most lung fields
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where are tracheal breath sounds heard?
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over the trachea
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where are bronchovesicular and bronchial sounds heard?
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in between lung fields and trachea
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what is indicated by decreased breath sounds?
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displacement of normal lung by air (emphysema or pneumothorax) or by fluid (pleural effusion)
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what is indicated by shifting of breath sounds from vesicular location to bronchial?
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fluid within the lung itself (pneumonia)
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what are adventitious breath sounds?
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extra sounds that originate in the lungs and airways
they are always abnormal, but not always significant include crackles, wheezes, and rhonchi |
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what are lung crackles? what do they indicate?
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high pitched, discontinuous inspiratory sounds similar to the sound produced by rubbing your hair between your fingers
created when alveoli and small airways open and close with inspiration aka rales |
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what are lung wheezes? what do they indicate?
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high pitched sounds that are musical in quality that are more prominent than crackles
caused by oscillation of airway walls when there is airflow limitation like: - bronchospasm - edema - obstructive asthma - tumor |
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what is a stridor?
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inspiratory wheeze associated with upper airway obstruction (croup)
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what are rhonhci? what do they indicate?
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adventitious lung sounds with a "snoring" or "gurgling" quality (any adventitious sound that is not a crackle or a wheeze)
caused by free liquid in the airway lumen and the interaction between the free liquid and moving air |
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what is a pleural rub?
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inflamed pleural surfaces rubbing each other during both inspiration and expiration
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how does a physician do peak flow monitoring on a patient?
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1. ask the pt to take a deep breath
2. ask pt to exhale as fast as they can through a peak flow meter 3. repeat the measurement 3x and report the average **peak flow meters are inexpensive, hand-held devices used to monitor pulmonary fcn in pts with asthma** **peak flow roughly correlates with FEV1** |
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how should a physician perform tactile fremitus on a patient?
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1. ask the pt to say "ninety-nine" several times in a normal voice
2. palpate using the ball of your hand 3. physician should feel the vibrations transmitted through the airways to the lung 4. increased tactile fremitus suggests consolidation of the underlying lung tissues |
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how does a physician perform bronchophony?
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1. ask the pt to say "ninety-nine" several times in a normal voice
2. auscultate several symmetrical areas over each lung 3. sounds should be muffled and indistinct 4. louder, clearer sounds are called bronchophony |
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how does a physician perform whispered pectoriloquy?
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1. ask the pt to whisper "ninety-nine" several times
2. auscultate several symmetrical areas over each lung 3. physician should hear only faint sounds or nothing at all 4. if sounds are heard clearly, this is referred to as whispered pectoriloquy |
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how does a physician perform egophony?
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1. ask the pt to say "ee" continuously
2. auscultate several symmetrical areas over each lung 3. physician should hear a muffled "ee" sound 4. if you hear an "ay" sound, this is referred to as "E->A" or egophony A with a nasal or blunting quality |
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what equipment is needed for an examination of the head and neck?
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1. otoscope
2. tongue blades 3. cotton tipped applicators 4. latex gloves |
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what should a physician do on examination of the head?
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1. look for scars, lumps, rashes, hair loss, or other lesions
2. look for facial asymmetry, involuntary movements, or edema 3. palpate to identify any areas of tenderness or deformity |
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how should a physician examine a patient's ears?
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1. inspect the auricles and move them around gently, asking the pt if this is painful
2. palpate the mastoid process for tenderness or deformity 3. hold the otoscope with thumb and fingers so that the ulnar aspect of your hand makes contact with the pt 4. pull the ear up and back to straighten the canal 5. insert otoscope to a point just beyond the protective hairs in the ear canal, using the largest speculum that will fit comfortably 6. inspect ear canal and middle ear structures noting redness, drainage, or deformity 7. insufflate the ear and watch for movement of the tympanic membrane 8. repeat 1-7 for other ear |
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how should a physician examine a patient's nose?
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**often convenient to examine immediately after the ears using same speculum**
1. tilt pt's head back slightly 2. ask pt to hold their breath for next few seconds 3. insert otoscope into the nostril, avoiding contact with the septum 4. inspect visible nasal structures 5. note swelling, redness, drainage, or deformity 6. repeat 1-5 for other nostril |
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how should a physician examine a patient's throat?
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1. ask the pt to open their mouth
2. using a wooden tongue blade and a good light source, inspect the inside of the pt's mouth including buccal folds and under the tongue 3. note ulcers, white patches (leukoplakia), or other lesions 4. if abnormalities are discovered, use a gloved finger to palpate anterior structures and floor of mouth 5. inspect posterior oropharynx by depressing the tongue and asking the pt to say "ah" 6. note any tonsillar enlargement, redness, or discharge |
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how should a physician inspect a patient's neck?
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1. inspect the neck for asymmetry, scars, or other lesions
2. palpate the neck to detect areas of tenderness, deformity, or masses |
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what groups of lymph nodes should a physician examine in the head and neck?
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1. preauricular
2. postauricular 3. occipital 4. tonsillar 5. submandibular 6. submental 7. superficial (anterior) cervical 8. supraclavicular 9. deep cervical **note the size and location of any palpable nodes and whether they were soft or hard, non-tender or tender, mobile or fixed** |
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how should a physician palpate the deep cervical chain of lymph nodes?
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1. inform the pt that this procedure will cause some discomfort
2. hook your fingers under the anterior edge of the sternomastoid muscle 3. ask the pt to turn their neck toward the side you are examining 4. move the muscle backward and palpate for the deep nodes underneath |
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how should a physician examine a patient's thyroid gland?
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1. inspect the neck looking for the thyroid gland; note if it is visible and symmetrical
2. move to a position behind the pt 3. ID the cricoid cartilate with the fingers of both hands 4. move downward two or three tracheal rings while palpating for the isthmus 5. move laterally from the midline while palpating for the lobes of the thyroid 6. note the size, symmetry, and position of the lobes, as well as the presence of any nodules 7. the normal gland is often not palpable |
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what is a goiter?
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visibly enlarged thyroid gland
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how should a physician test for facial tenderness?
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1. ask the pt to tell you if the maneuvers cause excessive discomfort or pain
2. press upward under both eyebrows with the thumbs 3. press upward under both maxilla with the thumbs 4. excessive discomfort on one side or significant pain suggests sinusitis |
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how should a physician perform sinus transillumination?
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1. darken the room as much as possible
2. place a bright otoscope or other point light source on the maxilla 3. ask the pt to open their mouth and look for an orange glow on the hard palate 4. decreased or absent glow suggests that the sinus is filled with something other than air |
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how should a physician examine the temporomandibular joint?
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1. place the tips of your index fingers directly in front of the tragus of each ear
2. ask the pt to open and close their mouth 3. note any decreased ROM, tenderness, or swelling |
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what equipment is needed to perform a neurologic examination?
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1. reflex hammer
2. 128 and 512 Hz tuning forks 3. snellen eye chart or pocket vision card 4. pen light or otoscope 5. wooden handled cotton swabs 6. paper clips |
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what are the general considerations to keep in mind when performing a neurologic examination?
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1. always consider left to right symmetry
2. consider central vs. peripheral deficits 3. organize thinking into seven categories: a. mental status b. cranial nerves c. motor d. coordination and gait e. reflexes f. sensory g. special test |
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what observations should be noted on neurologic exam? what cranial nerves do they correspond to?
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ptosis - CN III
facial droop or asymmetry - CN VII hoarse voice - CN X articulation of words - CN V, VII, X, XII abnormal eye position - CN III, IV, VI abnormal or asymmetrical pupils - CN II, III |
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how should CN II be examined?
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1. examine optic fundi
2. test visual acuity 3. screen visual fields by confrontation 4. test pupillary rxns to light 5. test pupillary rxns to accomodation |
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how should a physician test visual acuity?
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1. allow pt to use glasses or contact lens if available (interested in pt's best CORRECTED vision)
2. position pt 20 ft in front of the snellen eye chart (or hold a Rosenbaum pocket card at a 14-inch "reading" distance) 3. have pt cover one eye at a time with a card 4. ask pt to read progressively smaller letters until they can go no further 5. record the smallest line the pt can successfully read (20/20, 20/30, etc.) 6. repeat steps 1-5 with other eye |
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how should a physician screen visual fields?
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1. stand two feet in front of the pt and have them look into your eyes
2. hold your hands about one foot away from the pt's ears and wiggle a finger on one hand 3. ask the pt to indicate which side they see the finger move 4. repeat two/three times to test both temporal fields 5. if an abnormality is suspected, test the four quadrants of each eye while asking the pt to cover the opposite eye with a card |
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how should a physician test a patient's pupillary reactions to light?
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1. dim the room lights as necessary
2. ask the pt to look into the distance 3. shine a bright light obliquely into each pupil in turn 4. look for both the direct (same eye) and consensual (other eye) reactions 5. record pupil size in mm as well as any asymmetry or irregularity 6. if abnormal, proceed with the test for accomodation |
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how should a physician test pupillary reactions to accomodation?
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1. hold finger about 10 cm from pt's nose
2. ask pt to alternate looking into the distance and then at finger 3. observe pupillary response in each eye |
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how should a physician test CN III?
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CN III is the oculomotor nerve
1. observe for ptosis 2. test extraocular movements 3. test pupillary reactions to light |
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how should a physician test extraocular movements?
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1. stand or sit 3-6 feet in front of the pt
2. ask the pt to follow your finger with their eyes (not moving their head) 3. check gaze in the six cardinal directions using a cross or "H" pattern 4. pause during upward and lateral gaze to check for nystagmus 5. check convergence by moving your finger toward the bridge of the pt's nose |
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how should a physician test CN IV?
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CN IV is the trochlear nerve
1. test extraocular movements 2. CN IV is responsible for inward and downward movement |
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how should a physician test CN V?
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CN V is the trigeminal nerve
1. test temporal and masseter muscle strength 2. test three divisions for pain sensation 3. if you find abnormalities, test three divisions for temp sensation or light touch sensation 4. test the corneal reflex |
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how should a physician test the temporal and masseter muscle strength?
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1. ask pt to both open their mouth and clench their teeth
2. palpate temporal and massetter muscles as they do this |
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how should a physician test the three divisions of the trigeminal nerve for pain sensation?
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1. explain what you intend to do
2. use a suitable sharp object to test the forehead, cheeks, and jaw on both sides 3. substitute a blunt object occasionally and ask the pt to report "sharp" or "dull" |
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how should a physician test a patient's corneal reflex?
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1. ask the pt to loop up and away
2. from the other side, touch the cornea lightly with a fine wisp of cotton 3. look for the normal blink rxn of both eyes 4. repeat on other side 5. use of contact lens may decrease the response |
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how should a physician test CN VI?
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CN VI is the abducens nerve
1. test extraocular movements 2. CN VI is responsible for lateral movement |
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how should a physician test CN VII?
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1. observe for any facial droop or asymmetry
2. ask pt to: a. raise eyebrows b. close both eyes against resistance c. smile d. frown e. show teeth f. puff out cheeks 3. test the corneal reflex |
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what two cranial nerves are tested by the corneal reflex?
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CN V (trigeminal)
CN VII (facial) |
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how should a physician test CN VIII?
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CN VIII is the acoustic nerve
1. screen hearing 2. test for lateralization (Weber test) 3. compare air and bone conduction (Rinne test) |
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how should a physician screen a patient's hearing?
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1. face the pt and hold out arms with fingers near each ear
2. rub fingers together on one side while moving the fingers noiselessly with the other 3. ask the pt to tell you when and on which side they hear the rubbing 4. increase intensity as needed and note any assymetry 5. if abnormal, proceed with the Weber and Rinne tests |
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what is the Weber test and how is it done?
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a test for lateralization of hearing
1. use a 512 Hz or 1024 Hz tuning fork 2. tap the fork on the opposite hand 3. place base of tuning fork firmly on top of pt's head 4. ask pt where sound appears to be coming from (normally should be midline) |
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what is the Rinne test and how is it performed?
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a test to compare air and bone conduction
1. use a 512 Hz or 1024Hz tuning fork 2. tap the fork on your opposite hand 3. place the base of the tuning fork against the mastoid process behind the ear 4. when the pt no longer hears the sound, hold the end of the fork near the pt's ear 5. pt should be able to hear tuning fork through air better than through bone |
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how should a physician test CN IX?
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CN IX is the glossopharyngeal nerve
1. test gag reflex |
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how should a physician test CN X?
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CN X is the vagus nerve
1. listen to the pt's voice (hoarse or nasal) 2. ask pt to swallow 3. ask pt to say "Ah" 4. test gag reflex |
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how does a physician test CN XI?
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CN XI is the accessory nerve
1. from behind, look for atrophy or assymetry of the trapezius muscles 2. ask pt to shrug shoulders against resistance 3. ask pt to turn head against resistance (watch and palpate the sternomastoid muscle on opposite side) |
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how does a physician test CN XII?
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CN XII is the hypoglossal nerve
1. listen to the articulation of the pt's words 2. observe the tongue as it lies in the mouth 3. ask pt to: a. protrude tongue b. move tongue from side to side **tongue moves toward the side of the lesion** |
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what observation is required to test motor function in the neurologic examination?
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1. involuntary movements
2. muscle symmetry a. left to right b. proximal vs. distal 3. atrophy a. pay particular attention to hands, shoulders, and thighs 4. gait |
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how does a physician test muscle tone?
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1. ask the patient to relax
2. flex and extend the patient's fingers, wrist, and elbow 3. flex and extend pt's ankle and knee 4. there is normally a small, continuous resistance to passive mvmt 5. observe for decreased (flaccid) or increased (rigid/spastic) tone |
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how does a physician test muscle strength?
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1. have pt move against resistance
2. always compare one side to the other 3. grade strength on a scale from 0 to 5 out of five |
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grade 0/5 motor strength
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no muscle movement
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grade 1/5 motor strength
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visible muscle movement, but no movement at the joint
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grade 2/5 motor strength
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movement at the joint, but not against gravity
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grade 3/5 motor strength
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movement against gravity, but not against added resistance
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grade 4/5 motor strength
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movement against resistance, but less than normal
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grade 5/5 motor strength
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normal strength
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define diarrhea
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passage of abnormally liquid or unformed feces at an increased frequency (>200 g/day)
acute is less than two weeks persistent is 2-4 weeks chronic is greater than 4 weeks |
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define pseudodiarrhea
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frequent passage of small volumes of stool
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what is the leading cause of acute diarrhea?
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infection (>90% of cases)
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with what symptoms is infectious diarrhea associated?
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vomiting
fever abdominal pain |
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what are the causes of acute diarrhea?
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1. infection (90% of cases)
2. medication 3. toxic 4. ischemia 2, 3, and 4 account for only 10% of cases of acute diarrhea |
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how can you differentiate between bacterial diarrhea and viral diarrhea?
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bacterial diarrhea tends to have a higher fever and more abdominal pain
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what is the approach to acute diarrhea?
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most of the time it is mild and self-limited, so no further studies are needed
exceptions: 1. profuse diarrhea with dehydration 2. blood in stool 3. fever >38.5 deg 4. duration > 48 hrs 5. community outbreak 6. severe abdominal pain 7. older than 50 with severe pain 8. older than 70 9. immunocompromised then, do fluid replacement, empiric antibiotic trial, and stool microbiology |
