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620 Cards in this Set
- Front
- Back
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subjective |
what a person says about him or herself |
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objective |
what you observe during your examination |
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examples of subjective data |
source of hx reason for seeking care hx of present illness |
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OPQRSTU |
onset provokes/palliates quality/quantity region/radiation severity timing understand what pt thinks it is |
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vital signs |
temperature pulse respirations BP 5th = pain oxygen saturation? |
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IPPA stands for |
inspection palpation percussion auscultation |
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IPPA is a list of the components of |
physical exam |
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SOAP stands for |
subjective data objective data assessment plan |
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percussion |
bang on your own finger on the person's body can tell if there is fluid in the organ |
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auscultation |
listening with stethoscope |
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purpose of health hx |
collect subjective data |
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components of health hx |
whole person interaction with environment health strengths - what they are doing to stay well coping skills
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7 components of hx (in order) |
1. biographical data 2. reason for seeking care 3. HPI (or present health) 4. past hx 5. fam hx 6. review of systems 7. functional assessment/activities of daily living |
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components of biographical data (10) |
pt name address phone # birthdate birthplace gender marital status occupation language ethnocultural background |
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what should be noted about a source of hx |
how reliable they seem how willing they are to communicate |
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what is important about reason for seeking care |
spontaneous document in patients own words with quotations around it if they give a self-diagnosis, ask why they think that and write the why instead don't write ur impression focus on most important part by asking why they are seeking help now |
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present health statement (for the well person) |
short statement about general health |
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chief complaint is not a term we like any more. instead we like |
reason for seeking care |
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HPI |
chronological story of present illness why seeking care NOW (and not b4) |
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advice for gathering HPI |
do not add your opinion, write what they say |
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which part of hx taking is PQRSTU from |
HPI |
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how to describe severity of pain |
how did it interfere with activities |
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how to describe quality of pain |
descriptive terms similes |
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components of past health |
childhood illnesses (especially those likely to have sequelae later in life) injuries (fractures, head injuries, burns) serious or chronic disease hospitalizations operations obstetric hx immunizations last exam date allergies medications
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what not to write in psat health |
usual childhood illnesses b/c what was usual in a person's childhood may not be usual any more |
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detail needed for hospitalization hx |
cause name of hospital name of physician tx length of stay |
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components of obstetric hx |
1. gravidity (# pregnancies) 2. term (#that went to term) 3. preterm (# preterm) 4. abortions 5. living 6. for complete pregnancies (labour and delivery, sex, weight, condition) 7. for incomplete (duration, spontaneous or induced abortion) |
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4 things ppl dont htink of as medications |
vitamins OCP ASA antacids |
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symbols on fam tree |
square is man circle is women cross out when dead square brackets around adopted line thru marriage if separated triangle = pregnancy loss |
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order of review of systems |
roughly head to toe
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3 purposes of ROS |
1. evaluate past and present health of each body system 2. double check in case any significant data were omitted in present illness section 3. evaluate health promotion practices |
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tips for ROS |
1. dont write negative for a section - specificaly write absence or presence of ____ so the reader knows which factors you asked about
2. do not write any objective data - subjective only (what the person says) |
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steps of ROS |
general health state skin hair head eyes ears nose and sinuses mouth and throat neck breast axilla resp system CV system peripheral vasculature GI urinary genital sexual health - are u sexually active? safe sex blabla MSK neuro hematological endocrine |
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measures of functional assessment |
Katz Index of Activities of Daily Living |
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components of functional assessment |
1. self-esteem/self-concept 2. activity and mobility (what do you do in a typcial day) 3. sleep and rest 4. typical diet 5. interpersonal relationships 6. spirituality 7. coping and stress management 8. smoking 9. alcohol and drugs 10. environmental hazards 11. intimate partner violence 12. occupational health |
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drinking screening tests |
Alcohol use disorder identification test (AUDIT) Cut down, annoyed, guilty, eye opener (CAGE) TWEAK (tolerance, worried, eye-opener, amnesia, Cut down)
Have you thought u should cut down do u get annoyed by criticism of ur drinking do u feel guilty about ur drinking do u ever drink in the morning |
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components of environmental hazards |
housing and neighbourhood adequate heat and utilities
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how to ask about intimate partner violence |
open ended questions "how are things at home" |
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considerations of HPI for kids |
ask parent how do you know ur kid is in pain parent's intuition |
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how does hx taking differ for children |
Normal: 1.biographical data 2. reason for seeking care 3. HPI (or present health) 4. past hx 5. fam hx 6. review of systems 7. functional assessment/activities of daily living
past health adds: prenatal status (planned? wanted? supervised preg? how did preg go?) labour and delivery (Birth weight, Agpar scores, need for cyanosis, etc.) postnatal status (how did nursing go, etc.) growth (height and weight) milestones (age when rolled over)
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nutritional hx for children |
younger child = more detailed and specific |
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HEEADSSS |
home environment education/employment eating peer-related Activities (What do u do for fun) drugs sexuality suicide/depression safety from injury and violence (Do you drive with drunk ppl) |
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how does the HEEADSSS tool minimize adolescent stress |
moves from expected and less threatening to more threatening |
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differences for old ppl |
if past menopause dont need to collect detailed account of each preg
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definition of inspection |
concentrated watching |
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which component of IPPA comes first |
inspection |
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tips for inspection |
1. hold hands behind back to prevent rushing inspection
2. use person as own control (L, R) |
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3 things needed for inspection |
1. good lighting 2. adequate exposure 3. occasional use of certain instruments to enlarge view |
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fingertips are best for |
texture swelling pulsation presence of lumps |
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what part of hand best for feeling swelling |
fingertips |
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what part of hand for detecting lumps |
fingertips |
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how to detect position, shape, consistency of organ or mass |
grasping action of fingers and thumb |
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best part of hands for temperature determination |
dorsa (backs) |
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best part of hands for vibration |
base of fingers |
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tips for palpation |
1. go slow - when you touch ppl suddenly they stiffen and you cant feel anything
2. warm your hands by rubbing together
3. start light (sense of touch becomes blunted with heavy pressure)
4. palpate tender areas last
5. when deep palpation is used, intermittent pressure is better than continuous |
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what type of tapping to use for percussion |
short sharp strokes |
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2 outputs of percussion |
palpable vibration sound |
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3 things you can clean from percussion |
1. location 2. size 3. density |
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why learn percussion when x-ray more accurate |
hands always available easily portable give instant feedback |
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uses of percussion |
1. map location and size of organ by exploring where the percussion ntoe changes
2. density (air/fluid/solid) of a structure
3. detecting abnormal mass (<5cm from surface)
4. hurts if underlying structure is inflamed
5. eliciting deep tendon reflex |
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2 methods of percussion |
direct (immediate) indirect (mediate) |
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direct percussion |
the striking hand directly contacts the body wall |
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when is direct percussion used |
infant thorax adult sinus area |
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which of direct and indirect pressure is more common |
indirect |
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indirect percussion |
striking hand contacts stationary hand fixed on the person's skin |
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technique of indirect percussion |
1. hyperextend middle finger 2. place distal portion firmly against the skin (avoid ribs or scapulae) 3. llift the rest of the hand off the person's skin (or it will dampen vibrations) 4. middle finger of dominant hand = striking finger 5. action in wrist only - bounce middle finger off stationary one at right angle (aim for just behind nail bed goal is to hit the part that is pushing the hardest) 6. percuss twice - staccato blows 7. lift striking finger off quickly 8. repeat at new location
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what happens if you percuss over a bone |
yields no data b/c it always sounds dull
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what does force of blow determine in percussion |
loudness |
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how much force is needed in percussion |
just enough to achieve a clear note need stronger for fatties or thick muscle
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percussion notes are differentiated by which components |
1. amplitude 2. pitch 3. quality 4. duration
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amplitude AKA |
intensity |
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intensity AKA |
amplitude |
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definition of amplitude |
louder sound = greater amplitude |
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louder sound = greater _____ |
amplitude |
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loudness depends on 2 things |
force of blow structure's ability to vibrate |
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pitch AKA |
frequency |
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definition of pitch |
number of vibrations per second (measured in cycles per second) |
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number of vibrations per second (measured in cycles per second) |
pitch |
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quality AKA |
timbre |
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definition of quality of sound |
subjective difference due to a sound's distinctive overtones
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pure sound |
sound of one frequency |
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what allows you to distinguish a C on the piano from a C on the violin |
overtones |
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sound of structure with more air (ex. lung) vs. denser, solid structure (ex. liver) |
lung: louder, deeper, longer liver: softer, higher, shorter |
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definition of auscultation |
listening to sounds produced by the body |
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how should stethoscope fit |
slope of earpiece should point forward you can twist the earpiece to parallel the slope of your ear canals should be snug but if they hurt they are inserting too far
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how does stethoscope work |
does not magnify sound |
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length of stethoscope tube |
40cmish |
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5 percussion notes |
resonant hyperresonant tympany dull flat |
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memorize page 22 of reading 1 |
ok |
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2 end parts of stethoscope |
diaphragm bell |
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what is the flat edge of the stethoscope called |
diaphragm |
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what is the diaphragm |
flat side |
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what is the deep hollow cup shape on the stethoscope |
bell |
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what is the bell of the stethoscope |
deep, hollow cup-like |
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what is the bell good for |
soft low pitched sounds like extra heart sounds or murmur
bbs |
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what is the diaphragm good for |
high pitched sounds breath, bowel, normal heart sounds |
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how hard should you hold a stethoscope against someone's skin |
light just enough hat it forms a seal |
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what happens if you hold the stethoscope too hard against the skin |
skin acts as a diaphragm obliterating the low pitched sound |
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tunable diaphragm |
allows you to listen to high and low freq sounds w/o rotation of the endpiece pressing it hard allows you to hear high-freq sound |
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how to eliminate artifacts when using stethoscope |
1.extra room noise can produce roaring 2. keep exam room warm b/c shivering muscle contractions drown out other sounds 3. friction from a hairy mans chest causes a crackling sound that mimics an abnormal breath - wet the hair 4. must be done on bare skin 5. don't breath on the tubing or bump the tubing
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define otoscope |
funnels light into ear canal and onto tympanic membrane |
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otoscope specula |
different size end doodles |
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which specula should you use with the otoscope |
biggest that fits in the ear |
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opthalmascope |
illuminates internal eye structures enables you to look thru the pupil at the fundus |
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5 parts of the head of the opthalmascope |
1. viewing aperture (with 5 different apertures) 2. aperture selector dial on the front 3. mirror window on the front 4. lens selector dial 5. lens indicator |
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types of aperture for ophthalmascope (and when do you use each) |
large for dilated pupils small for undilated pupils red-free (green beam to examine optic disc for hemorrhage and melanin deposits) grid - to assess size and location of lesions on the fundus slit to examine anterior portion of eye and assess elevation or depression of lesions on the fundus |
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role of lens in opthlamascope |
compensate for myopia and hyperopia in the examiner but not astigmatism |
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how to keep stuff clean |
2 separate areas distinguish the clean area by one or two disposable always pick up equipment from the clean area and put it down in the dirty area |
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when to wear gloves |
when the potential exists for contact with body fluids |
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why cant you wear gloves without washing your hands |
could already have or could get holes in them |
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when should you wear gown, mask, protective eyewear |
potential for spatter of body fluids |
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what are protective measures that should be used with all patients called |
routine practices |
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routine practices |
protective measures that should be used with all patients |
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routine practices apply to all body fluids except |
sweat |
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list routine practices |
1. wash hands (after touching body fluids and contaminated items regardless of whether you are wearing gloves, between patient contacts)
2. gloves when potential for body fluid contact
3. mask, eye-protection, gown if splash potential
4. private room for pts who contaminate the environment or cant or wont assist in proper hygiene or enviornmental control
5. never recap used needles
6. never direct point of needle toward any part of the body
7. use protection when doing mouth to mouth
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how to prevent contamination from mouth to mouth |
mouthpiece resusitation bag instead ventilation device instead |
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precautions for patients with documented or suspected infections |
transmission-based precautions additional precautions |
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when to examine a bb |
1-2h after feeding so bb is not too drowsy or hungry |
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Steps for putting on and taking off PPE |
1. hand hygiene put on cap 2. put on gown 3. put on mask/N95 respirator 4. put on protective eyewear 5. put on gloves |
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where must a mask be |
over nose under chin |
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what order should you take off PPE |
1. remove gloves 2. remove gown 3. perform hand hygiene 4. remove eye protection 5. remove mask/N95 respirator 6. remove cap 7. perform hand hygiene |
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how to remove gloves |
glove to glove skin to skin roll first glove inside out reach under second glove and peel away |
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health care environment |
environment beyond pt's immediate area |
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pt environment |
where the pt is and all the stuff in it in a single room = the whole room for bb in glass box it could just be the box |
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4 moments of hand hygiene |
1. before initial pt/environment contact 2. before aseptic procedure 3. after body fluid exposure risk 4. after pt/environment contact |
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IPAC stands for |
infection prevention and control |
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HAI |
health care associated infections acquired after admissionq |
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4 components of course of infection |
1. incubation period 2. prodromal stage 3. illness stage 4. convalescence |
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definition of incubation period |
time between pathogen enters the body and first appearance of symptoms |
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prodromal stage |
onset of nonspecific symptoms to more specific symptoms patient may be more capable of spreading infection |
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symptoms of prodromal vs. illness stage |
illness = more specific |
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what is convalescence |
acute symptoms disappear body tries to replenish homeostasis |
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reservoir |
place where pathogens can survive (may or may not multiply) |
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colonization |
pathogen in body but does not cause harm |
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components of the chain of transmission |
1. infectious agent 2. reservoir 3. portals of exit 4. modes of transmission 5. portals of entry 6. susceptible host |
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6 means of transmission |
1. direct contact 2. indirect contact 3. droplet 4. airborne 5. vector 6. vehicle |
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indirect transmission |
touch table and someone else touches a table |
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direct transmission |
actually touching the person |
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droplet vs. airborne |
droplets travel up to 2 meters when forcibly expelled. Do not remain in air but deposited on surfaces
airborne - remain suspended in air or travel on air currents. requires control of air flow in room |
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which of droplet and airborne require control of air flow in room |
airborne |
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3 categories of additional precautions |
contact precautions droplet precautions airborne precautions |
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when are addition contact precautions needed |
gastroenteritis draining wound scabies lice antibiotic resistant organisms |
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5 additional contact precautions (ex. for gastroenteritis) |
1. HH 2. gloves 3. gown 4. dedicated equipment 5. single room 6. signage |
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when are additional droplet precautions needed |
1. respiratory viruses 2. mumps 3. bacterial meningitis |
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what are the additional droplet precautions neeeded |
1. HH 2. gloves 3. dedicated equipment 4. single room 5. face shield/goggles 6. signage |
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airborne precautions are required for |
1. varicella zoster (chicken pox, shingles) 2. pulmonary TB 3. measles |
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airborne precautions |
1. single negative pressure room 2. HH 3. N95 mask 4. signage |
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when is N95 mask needed |
airborne precautions |
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medical asepsis |
area or object is considered contaminated if it contains or is suspected of containing pathogens |
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technique required for medical asepsis |
clean technique |
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technique required for surgical asepsis |
sterile technique |
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goal of surgical asepsis |
eliminate all microorganisms from an object or area |
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principles of surgical asepsis |
1. sterile object remains sterile only when touched by another sterile object 2. only sterile objects may be placed on sterile field 3. out of range of vision = contaminated 4. below waist = contaminated 5. prolonged exposure to air = contamination 6. when a sterile surface comes in contact with wet contaminated surface the sterile object becomes contaminated by capillary action 7. fluid flows in the direction of gravity 8. edges of sterile field or container are considered contaminated |
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body temperature = |
heat produced - heat loss |
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thermoregulation |
balance of heat produced and lost |
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factors that affect temperature (6) |
1. age 2. exercise 3. environent 4. hormones 5. stress 6. circadian rhythm (trough early AM, peak late afternoon) |
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color of rectal thermometer |
red |
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where can you measure core temperature |
rectum tympanic membrane temporal artery esophagus pulmonary artery urinary bladder |
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core temp vs. surface temperature |
core = constant surface = rises and falls in response to environment |
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where can you measure surface temperature |
skin axillae oral |
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why are certain things thought to be core temp |
they share blood supply with hypothalamus |
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average oral or tympanic T |
37 |
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average rectal T |
37.5 |
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average axillary T |
36.5 |
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definition of pulse |
palpable bounding of blood flow |
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components of pulse |
rate rhythm (regular or irregular strength or force elasticity |
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words for strength of pulse |
bounding or strong weak or thready |
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normal pulse rate bbs |
120-160 |
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normal pulse rate toddler |
90-140 |
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normal pulse rate preschool |
80-110 |
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normal pulse rate school age |
75-100 |
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normal pulse rate adolescent |
60-90 |
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normal pulse rate adult |
60-100 |
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pulse at wrist is called |
radial pulse |
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how long do you count pulse for |
if pulse regular: 30s if irregular: 60s (and/or follow by checking apical pulse) |
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how to assess apical pulse |
locate point of maximum impulse (fifth intercostal space mid clavicular line)
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when to use apical pulse instead of radial pulse |
little babies certain cardiac medications |
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what pulse to use for old bbs |
femoral pulse |
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normal RR for bbs |
30-60 |
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normal RR for adults |
12-20 |
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what to assess about respirations |
rate depth rhythm sound |
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how to assess respirations |
if rhythm regular, count for 30s if rhythm irregular or <12/>20 count for 60s |
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normal BP <1 month |
85/54 |
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normal BP 6 years |
105/65 |
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normal BP >18 |
<120/80 |
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high normal BP |
135-139/85-89
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how often should high normal BP be monitored |
annually |
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definition of hypotension |
<90 |
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different methods of assessing BP |
1. invasive methods (arterial lines ICU) 2. stethoscope and a sphygmomanometer 3. automated |
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other word for bp cuff |
sphygmomanometer |
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when not to use automated BP device |
systolic <90 seizure activity uncooperative patient irregular HR
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tips for BP measure |
initially verify in both arms use lower extremities can be used if arms not accessible |
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cuff size requirements |
1. bladder width must cover 40% of circumference of arm
2. bladder length must cover 80% of circumference of arm |
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where to not perform BP |
same side of body as recent masectomy arm with IV line or dialysis shunt arm with trauma or bandaging |
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name of BP sounds |
korotkoff sounds |
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5 korotkoff sounds |
1. sharp thump 2. blowing or whooshing 3. softer thump than 1 4. softer blowing sound that fades 5. silence |
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2 step method of BP |
1. take palpable bp 2. auscultate BP |
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how to take palpable BP |
cuff in position palpate radial or brachial pulse inflate to 30mmHg above pulse disappears deflate cuff and note where pulse reppears this is SBP |
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how to auscultate BP |
inflate cuff 30mmHg above palpated systolic |
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1 step method |
measures BP by auscultation alone |
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when is 1 step used |
already know baseline bp |
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auscultatory gap |
period when sounds disappear during auscultation of BP |
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who more commonly gets auscultatory gap |
HT elderly |
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how long is auscultatory gap |
10-40mmHg |
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effect of auscultatory gap |
if we pump up the cuff to somewhere in silent area: underestimation of systolic overestimation of diastolic |
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BP technique |
1. place cuff 1inch above site of brachial pulse (elbow pit)
2. pump up to 30mmHg higher than baseline or palpated SBP
3. deflate slowly and evenly 2-3mmHg per heartbeat
4. Note I and V Korotkoff sounds (when tapping begins and when it ends)
5. wait 1-2 minutes before repeating the BP |
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proper word for elbow pit |
antecubital fossa |
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how long you cant have caffeine or smoking before BP measure |
30 mins
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how to sit for BP measure |
feet on floor legs not crossed arm supported at level of heart |
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common errors in BP measure |
eye not level with mercury too much pressure on brachial artery with diaphragm of stethoscope too slow/too fast deflation of cuff not accounting for dysrrhythmia or very slow pulse observer error
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observer error in BP measure |
haste poor hearing poor equipment digit preference |
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original definition of pain |
whatever the experiencing person says it is |
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currently well-accepted definition of pain |
unpleasant sensory and emotional experience associated with actual or potential damage or described in terms of such damage |
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components of physical appearance assessment of general survey |
1. person appears their age 2. sexual development appropriate for gender and age 3. LOC (alert and oriented) 4. skin color - even 5. facial features are symmetrical |
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Components of general survey |
physical appearance body structure mobility behaviour
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how to assess body structure |
stature (normal height) nutrition (normal weight) symmetry posture position body build (arm span=height, crown to pubis = pubis to sole) |
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toddler lordosis |
normally protruberant abdomen |
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what to assess for mobility |
gait range of motion |
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what to assess for behaviour |
expression (eye contact) mood and affect speech dress personal hygiene |
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calculation of BMI |
weight in KG/height in M or
(weight in lbs/height inches) x 703 |
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BMI categories |
<18.5 under 18.5-24.9 normal 25-29.9 over 30-39.9 obese 40 extreme obese |
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BMI for kids 2-20 |
85th-95% percentile = risk for overweight |
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normal waist to hip ratio |
men <1 women <0.8 |
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who might have cold temp |
oldies |
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how to take oral temperature |
put under tongue at the back leave for 4mins if afebrile, 8 mins if febrile wait 20 mins if they just had hot or cold stuff in their mouth wait 5 mins after chewing gum |
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what temperature to use for little kids and bbs |
axilla |
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when to do rectal temperature |
when other routes arent practical coma confusion can't close mouth |
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what temperature method is normally used |
mouth |
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how far to insert rectal thermom |
2-3cm for adults leave glass ones in for 2.5 min |
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common irregularity in pulse rhythm |
sinus arrhythmia |
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sinus arrhythmia |
HR varies with respiratory cycle fast at speak of inspiration normal durig expiration |
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who commonly gets sinus arrhythmia |
children and young adults |
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what does strength of pulse indicate |
stroke volume |
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numerical rating of force of pulse |
3+ full, bounding 2+ normal 1+ weak, thready 0 absent |
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4 qualities of normal breathing |
relaxed regular automatic silent |
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pulse pressure |
SBP - DBP |
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MAP stands for |
mean arterial pressure |
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gender diff in BP |
after puberty females lower after menopause females higher |
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race with high bp |
black |
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diurnal BP rhythm |
high late afternoon low early morning |
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5 factors that determine BP |
1. CO 2. Peripheral resistance 3. Blood volume 4. viscosity 5. elasticity of BV walls |
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peripheral resistance vs. elasticity of BV walls |
PR = constriction/dilation elasticity = atheroscleoriss |
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what happens if you use a cuff that is too narrow |
falsely high BP takes extra pressure to compress the artery |
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when do both arms need to be used for BP |
first time u see the pt |
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|
what textbook says about which side of stethoscope to use for BP |
use bell diaphragm is usually accurate but bell can pick up low pitched sounds such as the sounds of a BP reading |
|
|
why the first sound you hear in BP measure is silence |
cuff inflation compresses artery cuff pressure exceeds SBP flow occluded |
|
|
why sound 1 is tapping |
SBP arterial occlusion is relieved blood spurts into the artery BP is high velocity b/c of pressure gradient this creates turbulent flow (which is audible) |
|
|
what is happening during sound 2 (swooshing) |
turbulent blood flow through still partially occluded artery |
|
|
what is happening during sound 3 (knocking) |
longer duration of blood flow through artery closed only briefly during late diastole |
|
|
what is happening during sound 4 (muffling) |
artery no longer closes for any part of the cardiac cycle |
|
|
what is happening during sound 5 (silence) |
DBP bloodflow is streamlined and therefore silent |
|
|
when to check thigh pressure (and why) |
when arm BP too high especially in young adults or teenagers
to check for coarctation of aorta (congenital narrowing) |
|
|
what finding would indicate coarctation of aorta |
normally thigh pressure lower than arm pressure (SBP 10-30 higher, DBP same)
arm pressures are high in coractation because blood supply to thigh decreases |
|
|
how to measure thigh pressure |
prone position large cuff around lower third of thigh centre on popliteal artery on back of knee auscultate popliteal artery
|
|
|
at what age do you move from lying down to standing height measure |
2 |
|
|
who needs head circumference measures |
birth children at all medical visits up to age 2 annually up to age 6 |
|
|
order of vital signs for bbs |
reversd b/c rectal temperature might make them cry and then RR and HR increase |
|
|
what temperature method for preschooler |
avoid rectal tympanic inguinal axillary
rectal = squirm when restrained, dont wanna be nakey cant cooperate for oral tympanic is quick |
|
|
bottom line on temp taking choices |
<2: rectal 2-5: rectal >5: oral (then axillary, tympanic) |
|
|
where to measure pulse in <2 |
apical |
|
|
how to measure pulse for kids |
60s normal irregularities such as sinus arrhythmia are common |
|
|
how long to count bb RR |
60s |
|
|
how much does crying elevate SBP (for bbs) |
30-50mmHg |
|
|
temperature in old ppl |
more susceptible to hypothermia less likely to get fever therefore temp less reliable |
|
|
what measures O2 sat |
pulse oximeter |
|
|
how does pulse oximeter work |
sensor on finger emits light detector measures ratio of light emitted to light absorbed b/c oxyhemoglobin absorbs differently than other Hb |
|
|
SpO2 |
O2 saturation |
|
|
normal SpO2 |
97-98% |
|
|
who doesnt have normal SpO2 |
lung disease anemia |
|
|
Doppler ultrasonic flowmeter |
pitch is higher when sound source is closer sound source = blood in artery a transducer amplifies changes in sound frequency
|
|
|
who is Doppler techinique useful for |
critically ill with low BP bbs with small arms obese ppl |
|
|
how to use the doppler technique |
1. apply gel to transducer 2. touch probe to skin 3. pulsatile whooshing sound indicates location of artery 4. inflate cuff until sound disappear, then proceed 20-30mmHg beyond that point 5. deflate until whooshing appears (=SBP) 6. DBP is hard to detect with this method |
|
|
how serious does an alternation in thought, experience or emotion have to be to be considered a mental disorder |
cause distress impair functioning |
|
|
WHO definition of mental health |
state of well being in which individuals realized their own abilities, cope with normal stressors of life, work productively and contribute meaningfully to the community |
|
|
elements of mental health hx |
1. interview 2. observation 3. examination 4. interview with pex 5. collab with health care team |
|
|
4 components of mental status assessment |
ABCT behaviour (LOC, facial expression, mood) cognition thinking |
|
|
cognitive functions |
1. consciousness 2. orientation (where do you live, what city are we in) 3. memory 4. attention and concentration 5. comprehension and abstract reasoning |
|
|
consciousness |
awareness of one's own existance thoughts, feelings, environment |
|
|
awareness of thoughts, feelings, environment |
consciousness |
|
|
orientation |
awareness of objective world in relation to self |
|
|
awareness of objective world in relation to self |
orientation |
|
|
attention and concentration |
power to direct thinking toward and object or topic w/o distraction |
|
|
comprehension and abstract reasoning |
pondering deeper meaning beyond concrete and literal |
|
|
pondering deeper meaning beyond concrete and literal |
comprehension and abstract reasoning |
|
|
5 levels of consciousness |
1. alert 2. lethargic or somnolent 3. obtunded 4. stupor or semi-comatose 5. comatose |
|
|
MMSE |
mini mental status exam 11 questions focus on cognitive functioning not mood or thought processes |
|
|
good tool for delirium and dementia |
Montreal Cognitive Assessment |
|
|
ideal light to assess skin |
natural sun |
|
|
where to start assessing skin |
hands, fingernails |
|
|
mobility and turgor - role in skin assessment |
if you pinch skin on back of hand and it stays up = dehydration |
|
|
what can peau d'orange indicate |
edema |
|
|
primary lesion |
develops on unaltered skin |
|
|
secondary lesion |
lesion that changes over time (ex. mole becomes cancerous) |
|
|
6 things to note about lesions |
1. color 2. elevation 3. pattern/shape 4. size 5. location/distribution 6. exudate color and odor |
|
|
lesion danger signs |
ABCDE border irregularity color variation diameter elevation and enlargement |
|
|
4 things to note about nails |
1. shape and contour 2. consistency 3. color 4. capillary refill |
|
|
what does capillary refill mean |
press nail should go back to normal after <2s |
|
|
weird angle thing with nails |
angle at nail bed should be normal (160degrees) or curved (less than 160)
it should not be flat - this is called clubbing |
|
|
what can cause clubbing |
cardiac illnesses with oxygenation problems |
|
|
how often should adults assess their skin with ABCDE |
monthly |
|
|
how often should diabetes or PVDs check their feet |
daily |
|
|
affect vs. mood |
affect = temporary state of mind mood = more prolonged display of feelings that colors the whole emotional life |
|
|
proper word for round |
annular |
|
|
bulla |
skin lesion >1cm single chambered thin walled ruptures easily |
|
|
confluent |
merging |
|
|
crust |
thick dried up exudate left when vesicles/pustules burst or dry up color depends on fluid's ingredients |
|
|
cyanosis |
blue purple coloration |
|
|
erosion |
scooped out but shallow depression superficial epidermis lost but no bleeding heals without scar b/c not in dermis |
|
|
fissure |
linear crack with abrupt edges extends into dermis |
|
|
furuncle |
red swolen hard tender pus filled caused by bacterial infection of hair follicle
|
|
|
hemangioma |
benign proliferation of BVs in dermis |
|
|
iris |
concentric rings of culture in a lesion |
|
|
keloid |
hypertrophic scar scar invades beyond site of initial injury may increase long after healing occurs
|
|
|
lipoma |
slow growing fatty lump |
|
|
maceration |
skin that is constantly wet gets white and soft |
|
|
macule |
flat <1cm circumscribed |
|
|
nevus |
mole proliferation of melanocytes flat or raised |
|
|
nodule |
solid elevated hard or soft >1cm extend deeper into dermis that papule |
|
|
papule |
solid elevated hard or soft <1cm |
|
|
plaque |
when papules coalesce and make something bigger than 1cm |
|
|
lichenification |
itching thickens the skin and produces tightly packed sets of papules |
|
|
purpura |
red/purple discolorations that do not blanch upon applying pressure caused by bleeding under the skin purpura are 0.3-1cm |
|
|
pustule |
cavity containing pus elevated |
|
|
scale |
compact dessicated flakes of skin from sheedding of excess dead keratin cells |
|
|
telangiectasia |
permanently enlarged and dilated BVs visible on skin surface |
|
|
ulcer |
depression into dermis irregular shape may bleed leaves scar |
|
|
vesicle |
elevated cavity containing fluid up to 1cm |
|
|
wheal |
superficial raised transient erythematous irregular shape |
|
|
zosteriform |
linear arrangement along a nerve route |
|
|
see p 24,25 of reading 6 |
know all the label
|
|
|
functions of the skin |
communication (blush) absorption and excretion (ex. patch) prevent penetration identification (ppl look different) vitamin D production temperature regulation wound repair protection (of underlying tissue from injury) sensory perception |
|
|
sebaceous glands produce what |
sebum |
|
|
what is sebum |
protective lipid substance that retards water loss from skin |
|
|
protective lipid substance that retards water loss from skin and lubricates skin and hair |
sebum |
|
|
where are sebaceous glands |
everywhere except palms and soles most abundant on face, scalp |
|
|
2 types of sweat glands |
eccrine apocrine |
|
|
coiled tubules that open directly onto skin surface and produce sweat |
eccrine |
|
|
composition of sweat |
dilute saline solution |
|
|
where are eccrine glands |
everywhere |
|
|
which of apocrine and eccrine open onto surface |
eccrine |
|
|
apocrine glands open onto/into |
hair follicles |
|
|
which of apocrine and eccrine are widely distributed |
eccrine |
|
|
where are apocrine glands |
axilae anogenital nipples navel |
|
|
importance of apocrine glands |
vestigeal in humans |
|
|
what do apocrine glands produce |
thick milky secretion |
|
|
when do apocrine glands activate |
puberty |
|
|
when do apocrine glands secrete |
emotional and sexual stimulation |
|
|
why we have musky BO |
bacterial flora + apocrine sweat |
|
|
role of sebum |
retards water loss from skin and lubricates skin and hair |
|
|
when are eccrine glands active |
2 month old bb |
|
|
cultural variations wrt assessment of skin and hair |
1. melanoma 20x more likely in light skinned ppl
2. Inuits sweat less on their trunks and extremities but more on their faces (this allows temp regulation without wetting their clothes)
3. ABoriginals and Asians get Asian glow
4. African hair is dry, requires daily combing and application of oil. Hair also becomes dry and brittle with inadequate nutrition. Africans who are severely malnourished: hair less kinky, becomes copper-red |
|
|
common rash that appears in the first 3-4 days of life |
erythema toxicum tiny red punctate macules and papules unknown cause no tx required |
|
|
blue back to purple macular area at sacrum or buttocks that gradually changes during the first year |
mongolian spot |
|
|
raised, thickened areas of pigmentation that look crusted, scaly, warty |
keratoses |
|
|
tiny white papules on cheeks, forehead, nose, chin caused by sebum occluding opening of follicles |
milia |
|
|
who gets milia |
newborn bbs |
|
|
raised yellow papules with a central depression |
sebaceus hyperplasia |
|
|
skin tag AKA |
acrochordon |
|
|
AID's skin lesion |
Kaposi's sarcoma |
|
|
large round or oval patch of light brown pigmentation usually present at birth |
cafe au lait spot |
|
|
cafe au lait spot |
large round or oval patch of light brown pigmentation usually present at birth |
|
|
liver spots |
senile lentigines |
|
|
aphasia |
impairment of language ability |
|
|
impairment of language ability |
aphasia |
|
|
why is order of mental exam important |
basic functions are assessed first b/c if (for example) consciousness is clouded, full attention cannot be expected |
|
|
alert |
awake or readily aroused fully aware of stimuli responds appropriately conducts meaningful interpersonal interactions |
|
|
awake or readily aroused fully aware of stimuli responds appropriately conducts meaningful interpersonal interactions |
alert |
|
|
lethargic (somnolent) |
drifts to sleep when not stimulated can be aroused to name when called in normal voice responds appropriately but slow or fuzzy
|
|
|
drifts to sleep when not stimulated can be aroused to name when called in normal voice responds appropriately but slow or fuzzy inattentive loses train of thought |
lethargic (somnolent) |
|
|
obtunded |
needs loud shout or vigorous shake to arouse mumbly or incoherent requires constant stimulation for even marginal cooperation |
|
|
sleeps most of time difficult to arouse needs loud shout or vigorous shake confused when aroused converses in monosyllables mumbly or incoherent requires constant stimulation for even marginal cooperation |
obtunded |
|
|
stupor or semi coma |
arouses to persistent vigorous shake or pain withdraws hand to avoid pain reflex activity persists can only groan, mumble |
|
|
arouses to persistent vigorous shake or pain withdraws hand to avoid pain reflex activity persists can only groan, mumble |
stupor or semi-coma |
|
|
coma |
no response to anything may or may not have reflex activity |
|
|
dysphonia |
disorder of voice laryngeal disease |
|
|
dysarthria |
disorder of articulation speech sound uninteligible basic language intact |
|
|
disorder of articulation speech sound uninteligible basic language intact |
dysarthria |
|
|
aphasia |
true language disturbance defect in word choice and comprehension |
|
|
true language disturbance defect in word choice and comprehension |
aphasia |
|
|
Broca's aphasia |
can understand but cannot express language |
|
|
can understand but cannot express language |
Broca's aphasia |
|
|
lesion in Broca's aphasia |
anterior language area |
|
|
Wernicke's aphasia |
can |
|
|
confabulation |
fabricates events to fill in memory gaps |
|
|
neologism |
coining a new word |
|
|
circumlocution |
thing you open door with instead of "key" |
|
|
blocking |
sudden interuption in train of thought |
|
|
perseveration |
persistent repeating on verbal or motor response |
|
|
persistent repeating on verbal or motor response |
perseveration |
|
|
echolalia |
repeating others often in a mocking or mechanical tone |
|
|
repeating others often in a mocking or mechanical tone |
echolalia |
|
|
clanging |
word choice based on sound not meaning includes nonsense rhymes and puns |
|
|
hallucination vs. illusion vs. delusion |
halucination: sensory perception for which there are no stimuli
delusion: firm, fixed, false beliefs that a person clings to despite evidence to the contrary
illusion: misperception of actual existing stimulus (ex. folds of bedsheets appear animated) |
|
|
grading edema |
1+: mild pitting, slight indentation, no swelling 2+: moderate pitting, indentation subsides rapidly 3+ deep pitting, indentation remains for a short time, leg is very swollen 4+: very deep pitting, indendation lasts a long time, leg very swollen
|
|
|
what is pitting edema |
if you imprint thumbs on the skin and it leaves a dent - pitting edema present |
|
|
abstract reasoning |
ability to consider a hypothetical situation |
|
|
delirium |
disturbance of consciousness change in cognition (memory, disorientation, language) develops over short period (hrs to days) tends to fluctuate during the day |
|
|
dementia |
memory impairment + 1 of: apraxia (intact motor function but impaired motor ability) agnosia (failure to recognize) disturbance in executive functioning (planning, organizing, sequencing, abstracting) |
|
|
perception |
awareness of objects through the 5 senses |
|
|
convenient ways to assess orientation conveniently within the context of initial health hx |
date? year? season? where do you live? present location? name? age? who examiner is? |
|
|
what does the four unrelated words test test |
new learning ability to lay down new memories |
|
|
emotion associated with loss of control |
rage |
|
|
anxiety vs. fear |
fear = worried about known external danger anxiety = apprehension from anticipation of a danger whose source is unknown |
|
|
parts of syringe |
plunger barrel tip |
|
|
where to measure dose in syringe |
look at slide 3 |
|
|
hypodermic syringe AKA |
Luer-Lock |
|
|
parts of needle |
bevel (pointy bit) shaft hub (plastic that attaches to syringe) |
|
|
gauge |
diameter of shaft bigger number = smaller diameter |
|
|
gauge for taking blood |
18 |
|
|
gauge for IM |
20-23 |
|
|
gauge for subq |
25 |
|
|
gauge for insulin or ID (intradermal) |
27 |
|
|
word for top of vial |
diaphragm |
|
|
where to insert needle into vial |
bullseye |
|
|
what to write down when you reconstitute a multidose vial |
date and time amount of diluent signature |
|
|
why is prefilling syringes generally discourages |
increases risk of inappropriate storage no stability data for vaccines stored in plastic syringes |
|
|
vaccines and reconstitution - considerations |
check for ppt reconsituted have different shelf lives |
|
|
angles for different types of injections |
IM 90 subq 45 ID 5-15 |
|
|
2 examples of ID needles |
TB test allergy test
|
|
|
sites of ID injection |
inner arm upper back |
|
|
how to give ID injection |
bevel up no aspiration no massage |
|
|
max volume for ID injection |
0.01-0.1mL |
|
|
what absorbs faster - sc or IM |
IM |
|
|
when to give different angles of injection for sc |
45 if little fat 90 if fat |
|
|
when is "bevel up" optional |
sc |
|
|
max V for sc |
0.5-1mL |
|
|
do you aspirate for sc |
no |
|
|
site for sc injection |
tricep L and R lower abdomen L and R upper butt lateral thigh |
|
|
why choose IM |
fast absorption due to vascularity less risk of causing tissue damage also less pain b/c fewer nerve endings |
|
|
common sites for IM |
ventrogluteal dorsogluteal vastus lateralis deltoid |
|
|
how long is IM needlel |
long enough to reach muscle |
|
|
max volumes for IM route |
(smaller for deltoid) little kids 1mL kids, oldies, thin ppl 2mL normal adults 3mL |
|
|
safest IM site |
ventrogluteal |
|
|
sites of choice for IM injection |
ventrogluteal preferred for IM injections in general (age >1)
deltoid for immunization (age >1)
vastus lateralis (<1) |
|
|
why ventrogluteal is safest |
underlying muscles thick free of nerves and BVs easily palpable bony landmarks sc fat thinner than dorsogluteal - less likelihod of injecting into sc |
|
|
how to landmark VG |
lie on side or back flex knee and hip to relax muscle use R hand for L hip heel of hand on greater trochanter of hip point thumb toward groin, index finger toward anterior superior iliac spine extend middle finger along iliac crest toward the buttock index finger, middle finger, iliac crest form the triangle injection site = centre of triangle |
|
|
why dorsogluteal is not recommended |
slowest absorption of all 4 sites thicker sc = more likely to inject into sc and thus poor absorption higher risk of complications punctate injury to superior gluteal artery sciatic nerve injury ranging from footdrop to paralysis of lower limb |
|
|
how to landmark dorsolateral |
palpate PSIS (posterior superior iliac spine) palpate greater trochanter of femur draw imaginary line between these injection site is above and lateral to the line
|
|
|
benefits of vastus lateralis site |
free of major nerves and BVs easy to access amenable to self-admin |
|
|
how to do vastus lateralis |
supine or sitting knee flexed to relax muscle divide thigh in thirds - give in the middle third |
|
|
2 uses of deltoid site |
immunization emergency |
|
|
volume used at deltoid site |
<1mL best |
|
|
which IM site has fastest absorption |
deltoid |
|
|
BVs and nerves at the deltoid site |
axillary nerve radial nerve brachial nerve ulnar nerve brachial artery |
|
|
landmarks for deltoid injection |
acromium process deltoid tuberosity |
|
|
deltoid injection should never be given where |
below the level of the axilla |
|
|
best practices for IM injections |
1. sometimes need to change needles after drawing up
2. always use bony landmarks
3. swab site with alcohol wipe. |
|
|
do you have to wear gloves for injection |
no |
|
|
3 considerations when swabbing the site of injection |
mechanical friction circular motion |
|
|
amount of shaft that should be exposed during IM injection |
1/3 |
|
|
when should you not aspirate |
sc id immunizations children
|
|
|
type of injection w/ no massage |
ID |
|
|
what to do if you aspirate and there is blood in the syringe |
discard syringe and repeat procedure |
|
|
how fast to inject IM |
1mL/10s (no faster) |
|
|
when to not massage |
ID |
|
|
when is Z track method used |
highly irritating substances depot injections |
|
|
how to z track |
hold skin taut and to the side inject over 10s leave needle for 10s withdraw needle release skin no massage |
|
|
which type of injection has lower incidence of complications |
sc ID |
|
|
rights of safe admin |
medication person route dose time |
|
|
position for anaphylaxis recovery |
recumbent with elevated feet |
|
|
dosing of Epi for anaphylaxis |
up to 3 admis diff limb for each dose |
|
|
site of choice LMWH |
abdomen rotate sites within and between sites |
|
|
how to clean site for insulin |
soap and water - alcohol swab only in hospital |
|
|
massage for insulin ? |
no |
|
|
causes of needle stick injuries |
1. equipment design 2. recapping 3. insufficient training 4. work conditions (ex. crowded) 5. disposal practices |
|
|
risk of different diseases after needle stick injury |
hep B 30% if unvaccinated hep C 2% HIV 0.3% |
|
|
how to avoid needle stick |
hep B vaccine + titre gloves sharps handling allow to bleed for 30-60s without pressure wash with soap and water report medical attention post-exposure-prophylaxis (within 4h) test source
|
|
|
sharps rules |
never recap horizontal drop container nearby dont overfill containers use one handed scoop if necessary to recap |
|
|
when performing subjective assessment of head/neck what additional info is needed for children |
prenatal drug exposure delivery growth |
|
|
symptoms of hypothyroid (10) |
decreased BMR myxedematous features deep voice sluggish bradycardia constipation decreased appetite hypoventilation cold intolerance decreased sweating coarse and dry skin and hair weight gain |
|
|
symptoms of hyperthyroid (12) |
increased BMR lid lag anxiety insomnia tachycardia palpitations increased appetite dyspnea heat intolerance increased sweating thin and silky skin and hair weight loss |
|
|
what does nasal mucosa look like in allergic rhinitis |
pale |
|
|
Aboriginals and Asians more commonly have |
bifid uvula cleft lip/palate torus palatinus |
|
|
leukedema |
blue/white/grey buccal mucosa |
|
|
who gets Leukoedema |
African |
|
|
ratings of tonsil size |
1+ 25% 2+ halfway to uvula 3+ touching uvula 4+ touching each other |
|
|
acromegaly |
pituitary gland produces too much growth hormone during adulthood b |
|
|
bruit |
soft pulsatile whooshing sound best heard with bell of stethoscopec |
|
|
caries |
tooth decay initially looks chalky white then turns brown or black and forms a cavity |
|
|
dysphagia |
difficulty swallowing |
|
|
hydrocephaly |
accumulation of CSF |
|
|
Koplik spots |
prodromal sign of measles buccal mucosa blue white spots |
|
|
malocclusion |
misalignment of the teeth |
|
|
moulding |
overriding of cranial bones usually the parietal bone overrides the frontal or occipital bone happens during birth it goes awayp |
|
|
papillae |
rough bumpy elevations on tongue |
|
|
polyp |
smooth pale grey avascular mobile nontender |
|
|
palpebral fissure |
opening between eyelid |
|
|
suture |
immovable joints of the cranial bones |
|
|
stenson's ducts |
duct that gets saliva from parotid gland into mouthm |
|
|
major salivary gland |
tparotid |
|
|
tics |
involuntary movements in the facial muscles |
|
|
tracheal tug |
rhythmic downward pull snychronous with systoly occurs with aortic arch aneurysm |
|
|
turbinates |
bony projections that increase SA within nasal cavity |
|
|
Virchow's node |
single, enlarged, nontender supraclavicular node indicates neoplasm in thorax or abdomen |
|
|
wharton's ducts |
duct of the submandibular salivary gland opens on either side of the frenulum |
|
|
when is the thyroid gland palpable |
when swallowing |
|
|
when does anterior fontanelle close |
9 months - 2 years w |
|
|
when does posterior fontanelle close |
1-2 months |
|
|
what type of gland is thyroidn |
endocrine |
|
|
vertigo |
sensation of spinning |
|
|
dizziness |
lightheadedness sense of swimming or falling |
|
|
macrocephaly |
enlarged head for age |
|
|
senile tremors |
head nodding and tongue protrusion |
|
|
caput succedaneum |
edematous swelling and eccymosis (subq purpura) of part of head caused by birth trauma) |
|
|
kyphosis |
increased curvature of cervical spine in oldies |
|
|
normal finding for skull size and shape |
round symmetrical |
|
|
abnormal finding for skull size and shape |
microcephaly lump |
|
|
normal finding for temporal area |
tempormandibular joint as person opens mouth = smooth movement with no limitation or tenderness |
|
|
abnormal finding for temporal area |
limited ROM |
|
|
normal finding facial structures |
symmetry |
|
|
abnormal finding facial structures |
tics |
|
|
normal neck symmetry |
head position in the middle |
|
|
abnormal neck symmetry |
head tilt |
|
|
normal range of motion of neck |
no limitation |
|
|
abnormal ROM of neck |
pain |
|
|
normal lymph nodes |
movable |
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abnormal lymph nodes |
>1cm |
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normal trachea |
midline |
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abnormal trachea |
tracheal shift (ie. not midline) |
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normal thyroid gland |
not palpable |
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abnormal thyroid gland |
enlarged |
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normal ausculatate thyroid |
no bruit |
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acute infection lymph nodes |
enlarged bilateral warm tender firm movable |
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chronic inflam lymph nodes |
clumped |
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cancerous nodes |
hard unilateral nontender fixed |
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HIV nodes |
enlarged firm nontender mobile occipital node enlargement common |
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what featues of fontanelles are assesed |
firm slightly concave well defined |
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middle part of nose inferior view |
colurnella |
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outer part of nose inferior view |
ala |
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very back of tongue is called |
vallate papilla |
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label right behind upper teeth |
hard palate |
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label above uvula |
soft palate |
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label on the tongue |
dorsum of tongue |
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back of throat label |
posterior pharyngeal wall |
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flap between tonsil and uvula |
posterior pillar |
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side of mouth by tonsil |
anterior pillar |
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2 pairs of sinuses that are accessible for examination |
frontal maxillary |
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name for children's teeth |
deciduous |
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functions of sinuses |
lighten skull resonators for sound production provide mucus |
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canker sore AKA |
aphthous ulcer |
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sucking tubercle |
small pad in middle of upper lip from friction of breast or bottle feeding |
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most common site of nosebleed |
kiesselbach's plexus |
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why does the thyroid enlarge during preg |
hyperplasia of tissue increased vascularity |
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ePSTEIN PEARLS |
NORMALin bbs small white glistening pearly papules along hard palate and gums small retention cysts
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bony ridge running down hard palate |
cltorus palatinus |
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cluster headache |
pain around eye, temple, forhead, cheek |
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name of muscles on top and bottom of eye |
superior/inferior oblique |
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thin layer that covers exposed part of eye |
conjunctiva |
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vision at birth |
20/400 |
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at what age does macula mature |
8 months |
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at what age does eyeball reach adult size |
8 |
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presbyopia |
far-sightednesswhat |
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what happens to old ppl lens |
loses elasticity results in far-sightedness |
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arcus senilis |
greyish area at limbus |
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what is the eye chart called |
snellen |
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how many errors allowed per line of snellen test |
up to 3 |
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what to record for snellen results |
last successful line read (with <4 mistakes) and # errors |
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interpreting visual acuity |
top number = distance person standing from chart bottom number = distance at which a normal person could have read that linea |
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alternatives for snellen chart |
tumbling e chart allen chart (pics) counting fingers light perception (for very poor vision - can the pt see the light) |
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test for visual field is called |
controntation test |
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eye muscles and their clock positions |
1: inferior obliquie 3: medial rectus 5: superior oblique 7: inferior rectus 9: lateral rectus 11: superior rectus |
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drooping of upper elyelid |
ptosis |
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inflammation of eyelid |
blepharitis |
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exophthalmos |
protruding eyese |
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enophthalmos |
sunken eyes |
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pink eye is inflammation of |
conjunctiva |
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yellow eyes = |
scleral icterus |
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PERRLA |
pupils equal round react to light accomodation |
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for far vision pupils (dilate/constrict) |
dilate |
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what is in the middle ear |
air auditory ossicles malleus (hammer) incus (anvil) stapes (stirrup) |
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tube that conducts sound from tympanic membrane to inner ear |
eustachian tube |
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what controls balance |
vestibular apparatus |
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describe vestibular apparatus |
3 semicircular canals at right angles |
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role of vestibular apparatus |
info about 3D position in space |
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auditory nerve |
CNVIII |
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role of cerebellum |
automatic adjustments to body position to maintain balance |
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effect of preggo rubella |
damages organ of corti deafness |
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why bbs get ear infections |
short wide horizontal |
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presbycusis |
nerve degeneration in inner ear starts with loss of high freq sounds |
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Romberg |
patient stands straight feet together sides arms close eyes should be able to maintain balance |
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patient stands straight feet together sides arms close eyes should be able to maintain balance |
romberg |
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how to screen for high frequency hearing loss |
whispered voice test w |
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wat does whispered voice test screen for |
high freq hearing loss |
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RInne's test |
compares pts ability to hear a tone conducted via air and bone hold tuning fork against mastoid bone and ask when the sound is no longer heard then quickly mov the still vibrating fork 1-2cm from canal and ask when they can hear normally audible at external meatus
air conduction should be better than bone condution
abnromal result could mean something inhibiting passage of sound (conductive hearing loss)
in sensorinerual loss bone and air are equally diminished |
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WEber test |
hold tuning fork on top of head detects unilateral hearing loss distinguishes between true and false Rinnes test |
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how to pull pinna for adults |
up and backh |
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ow to pull pinna for kids |
straight back |
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do you wear glasses when doing visual acuity testing |
yes |
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what is chart for ppl who cant read |
snellen picture chart |
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how hard should jaeger card be held from the eye |
35cm b/c at this distance, the print size equals that on the chart used at 20 feet |
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how to use the jaeger card |
test each eye separately normal result is 14/14 (inches) without hesistancy and without moving card closer or further |
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pink eye AKA |
conjunctivitis
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wisp of cotton is used to test the reflex of __ |
cornea |
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lens opacity |
cataract |
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double vision |
diplopia |
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reflex caused by the reflection of examination light off the inner retina |
red reflex |
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which of miosis and mydriasis is constriction |
miosis |
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what is the double letter in perla |
r round reactive to light |
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loss of central vision |
macular degeneration |
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sticky out bit opposite tragus |
antitragus |
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outer part of ear canal |
external auditory meatus |
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where i have a piercing |
lobule |
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place where some ppl have ear piercings but not me |
helix |
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3 functions of middle ear |
1. conducts sound vibrations 2. protection: reduces amplitudes of loud sounds 3. eustachian tube allows equalization of pressure on each side of the eardrum so the membrane dose not rupture
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organ of corti |
receptor organ for hearing transduces vibrations into APs |
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why conductive hearing loss is partial |
if amplitude is high enough they can still hear |
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darwin's tubercle |
small painless nodule on helix |
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who commonly gets dry grey ear wax |
natives and asians |
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macrotia |
large ears greater than 10cm in length |
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otosclerosis |
conductive hear loss common in young adults caused by hardening of the stapes |
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red reflex |
red capillarys on handle of malleous seen in cryng children |
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presbycusis |
slow progressive sensorineural hearing loss that occurs with aging |
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swimmers ear |
otitis externa |
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when is a rinne test normal |
when a sound is heard twice as long by air conduction as by bone conduction |
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when is a weber test normal |
when sound is equally loud in both ears |
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which test is normal when sounds are eqally loud in both ears |
weber |
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annulus |
outer fibrous rim of ear drum |
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auricle |
cexternal ear |
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cochlea |
contains central hearing apparatus |
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tophus |
deposit of uric acid crystals |
