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377 Cards in this Set
- Front
- Back
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Alopecia
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Baldness
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Bulla
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large vesicle or blister
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Confluent
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flowing together, blending into one
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Cyanosis
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bluish discoloration of skin caused by an inadequate amount of oxygen in blood, can be associated with SOB, lung disease, heart failure, or suffocation
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Crust
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hard, crisp covering or surface - dried bodily exudate
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Erosion
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superficial destruction of a surface by friction, pressure, ulceration, or trauma
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Erythema
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redness of skin due to congestion of capillaries
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Excoriation
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superficial loss of substance, scratching skin
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Fissure
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any cleft/groove, normal or otherwise
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Hemangioma
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benign tumor, usually in infants or children, made of newly formed blood vessels and resulting from malformation of angioblastic tissue of fetal life
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Jaundice
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yellowing of skin caused by excessive bilirubin in blood, indication of liver disease or obstruction of bile ducts by gallstones
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Keloid
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sharply elevated, irregularly shaped, progressively enlarging scar due to excessive collagen formation in dermis during connective tissue repair
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Lipoma
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benign, soft, rubbery, encapsulated tumor of adipose tissue, usually mature fat cells
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Maceration
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softening of the tissues due to constant wetness - turns white and can easily get infected with bacteria or fungi
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Pallor
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abnormal paleness of skin resulting from reduced blood flow or decreased hemoglobin level, associated with many diseases (anemia, shock, cancer)
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Pruritus
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severe itching, often of undamaged skin
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Purpura
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hemorrhage into the skin with obvious discoloration
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Telangiectasia
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chronic dilation of groups of capillaries causing elevated dark red blothes on the skin
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Wheal
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localized area of edema on body surface, often attended with severe itching and usually evanescent, typical lesion of urticaria (hives)
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Zosteriform
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band-like unilateral skin lesion located along cutaneous ditribution of a spinal or a branch of trigeminal nerves
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Arcus senilis
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gray-white arc or circle aroun cornea
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Cataracts
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opacity of the lens
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Conjunctivitis
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an inflammation of the clear mucous membrane of the eye and can be infectious (bacterial, viral) or noninfectious (allergic, dry eye, toxic, contact lens use, neoplasm, foreign body, factitious, and idiopathic)
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Ectropion
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turning outward of the lower lid
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Exophthalmos
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bilateral proptosis (bulging eyes) - may indicate thyroid disease
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Glaucoma
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group of eye disorders involving optic neuropathy - changes in the optic disc and loss of visual sensitivity and field
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Mydriasis
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long-continued or excessive dilation of the pupil
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Nystagmus
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involuntary oscillating eye movements
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Otalgia
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ear pain
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Otitis externa
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inflammation of the skin lining of the external auditory canal
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Otitis media
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inflammation of the middle ear that is frequently diagnosed in infants and toddlers, primarily because of their short, wide, and minimally sloped eustachian tube
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Presbycusis
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hearing loss that occurs with aging as the auditory nerve degenerates - normal onset in fifties with diffiulty hearing consonants
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Presbyopia
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far-sightedness
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Proptosis
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bulging eyes
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Pseudoptosis
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upper lid resting on lashes
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Scotoma
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blind spot in the visual field surrounded by an area of normal or decreased vision - occurs with glaucoma, optic nerve and visual pathway disorders
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Strabismus
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deviation of one eye - inability to focus one eye on an object the other eye is focused on
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Styes
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acute pustular infections of an eyelash follicle or sebaceous glands of the eye
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Xanthelasma
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soft, raised, yellow plaques on lid at inner canthus
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Xanthomas
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soft, yellowish, raised waxy lesions either on or beneath the eyelid, may be associated with hyperlipidemia
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Cerumen
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ear wax
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Otorrhea
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discharge from ear
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Pinna
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outer part of the ear, fleshy part before external auditory canal
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Tinnitus
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ringing of ears
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Vertigo
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dizziness, room spinning
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Acromegaly
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abnormal enlargement of both the facial and skull bones may result from hyperactivity of the pituitary gland
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Acute sinusitis
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symptomatology like that of a common cold (purulent nasal discharge, facial pain, fever, cough, and nasal obstruction) that remains for more than 7-10 days, associated with bacterial and viral infections of the upper respiratory tract
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Chronic sinusitis
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may be diagnosed if the disease has been present for 8 weeks, symptoms have been present for periods greater than 10 days on more than 4 occasions over a 1-year period or an individual repeatedly fails to respond to medical therapy
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Cushing's Disease
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abnormal roundness of the face, often accompanied by reddened skin and excess hair above the lip and on the chin from corticosteroids or excessive production of adrenocorticotropic hormone
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Gingivitis
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inflammation of the gingivae, is the most - and mildest - form of periodontal disease caused by accumulated bacterial plaque
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Graves' disease
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excess thyroid hormone resulting in thinning of the face in conjunction with protruding or bulging eyes
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Hydrocephalus
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excess fluid in the skull (enlargement of head without changes in face)
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Macroencephalopathy
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enlarged skull size
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Microencephalopathy
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decreased skull size
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Periodontitis
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inflammaton of the tissue supporting the teeth
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Pharyngitis
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inflammation of the pharynx and surrounding lymphoid tissues that is often caused by viruses or bacteria
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Phonophobia
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sensitivity to sound
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Photophobia
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sensitivity to light
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Rhinitis
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inflammation of the nasal mucous membrane
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Rhinorrhea
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recurrent or chronic watery nasal discharge caused by inflammatory or noninflammatory processes
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Ascites
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effusion and collection of serous fluid in abdominal cavity
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Bruit
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blowing, murmur-like sound of vascular rather than cardiac origin
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Cholecystitis
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inflammation of gallbladder
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Costal Margin
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portion of inferior aperture of thorax formed by articulated cartillages of the 7-10th ribs
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Costovertebral angle
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produced by the 12th ribs angle connecting to the vertebral column
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Dysphagia
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difficulty swallowing
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Hepatomegaliy
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enlarged liver
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Pyrosis
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burning sensation, associated with regurgitation of acid-peptic gastric juice into the esophagus
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Scaphoid
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largest bone of the proximal row of the carpus on the side
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Striae
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pregnancy related, silver to pink jagged lines on the skin, commonly known as stretch marks
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Tympany
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low-pitched, resonant, drumlike note obtained by percussing surface of a large air-containing space
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Urinalysis
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dipstick examination of urine specimen
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Viscera
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internal organs of body - within chest specifically
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Absence seizures
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more common in children and may be initially confused with daydreaming, loss of consciousnes as well as return to consciousness occurs very rapidly
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Atonic seizures
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sudden loss of postural muscle tone, usually lasting only for 1-2 seconds
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Cerebrovascular Accidents
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hemorrhagic, cardiogenic, and ischemic are 3 major causes - strokes; sudden neurologic afflictions usually related to cerebral blood supply
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Cerebrovascular disease
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broad term encompassing diseases relating to the blood vessels of the central nervous system
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Cluster headache
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frequent at night, excruciating stabbing pain, unilateral, clusters over an eye
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Epilepsy
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2+ unprovoked seizures without an identifiable cause
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Generalized seizures
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usually cause a patient to lose consciousness and are primarily differentiated on symptomatology
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Hyperrefelxia
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exaggerated response - may be seen during a CVA
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Ischemia
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decreased blood flow to the brain
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Migraine headaches
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combination of vascular and neurohormonal mechanisms, women more often affected
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Myoclonic seizures
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sudden and brief muscle contractions, either in a single part of the body or entire body
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Neuropathy
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disease of the peripheral nerves, resulting from destruction or dysfunction of the nerve cell body
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Paresthesia
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spontaneously occurring, abnormal tingling sensation
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Parkinson's Disease
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chronic, progressive disease starting with aching pains, numbness, paresthesias, and coldness and advancing to dramatic symptoms like tremor, weakness, drooling, and difficulty swallowing. Disease of the extrapyramidal system of the brain (basal ganglia) responsible for the maintenance of posture and muscle tone and regulation of the voluntary smooth motor activity
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Partial seizures
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begin in an area of the brain that is limited to one hemisphere and often suggestive of an underlying focal braine lesion
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Retropulsion
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falling backward when you pull on the patient's shoulders - sign of Parkinson's disease
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Seizure
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focal/generalized disturbance of neuronal electrical activity that may manifest by abnormal movements or sensations and a loss of reflexes, memory, or consciousness
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Status epilepticus
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repetitive seizure activity with or without convulsions and without recovery of consciousness between attacks lasting 30 minutes or more
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Stereognosis
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ability to recognize items by touch and manipulation
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Tension headaches
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most common type of headache, pressing/tightening, non-pulsating, bilateral pain
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Tonic-clonic seizures
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prolonged post-seizure, or postictal, stage during which the person can experience symptoms such as fatigue, muscle pain, and confusion
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Transient ischemic attacks
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"mini-strokes" neurologic deficits resultin from emoblism rather than ischemia and typically last fewer than 24 hours
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Agraphia
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loss of ability to write
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Aphasia
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loss of language skills (spoken or written)
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Apraxia
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impaired ability to perform motor activities despite intact motor abilities, sensory function, and comprehension of the task
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Ataxia
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staggering, unsteady gait that can occur with excessive alcohol or drug ingestion
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Dysphasia
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difficulty speaking
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Cranial nerve I
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should be able to recognize smell in both nostrils
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cranial nerve II
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confrontation test - peripheral vision, ophthalmoscope exam, Snellen Eye chart
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Cranial nerve V
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motor function - palpate clenching teeth, light touch to ophthalmic, maxillary, and mandibular areas, corneal reflex
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Cranial nerve VII
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Smile, frown, close eyes tightly, lift eyebrows, show teeth, puff cheeks with air and press out
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Cranial nerve VIII
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whispered voice test, Weber test, Rinne test
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Cranial nerves IX/X
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depress tongue and say "ah", gag reflex, note voice, taste on tongue
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Cranial nerve XI
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examine sternomastoid/trapezius muscles for equal size
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Cranial nerve XII
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inspect tongue, articulation of words
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Asthma
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chronic inflammatory disorder of the airways in which many different cells (mast cells, eosinophils, T lymphocytes, neutrophils, and epithelial cells) play a role - inflammation causes recurrent episodes of widespread but variable airflow obstruction resulting from increased responsiveness of the rachea and bronchi to various stimuli
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Bradypnea
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slow breathing and may occur with central nervous sytem depression
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Bronchitis
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characterized by inflammation and edema of bronchioles, which causes excessive mucus production and airway obstruction - persistent productive cough on most days
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Bronchophony
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sound of the voice as heard through the stethoscope applied over a healthy large bronchus
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Chronic obstructive pulmonary disease
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characterized by airflow limitation (primarily expiratory flow) that is not fully reversible - progressive
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Crackles
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short, sharp, or rough sounds heard with a stethoscope over the chest
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Cyanosis
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bluish discoloration of the skin caused by an inadequate amount of oxygen in the blood; can be associated with shortness of breath, lung disease, heart failure, or suffocation
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Dyspnea
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shortness of breath
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Egophony
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condition in which the sound "ee" spoken by the patient is heard as "ay" through a stethoscope place over the lungs, possible indicating consolidation. In a normal test, a muffled "ee" sound would be heard
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Emphysema
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respiratory disease characterized by an abnormal, permanent enlargement of airspaces distal to the bronchioles
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Friction rub
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The sound, heard on auscultation, made by the rubbing of two opposed serous surfaces roughened by an inflammatory exudate, or, if chronic, by nonadhesive fibrosis
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Hyperpnea
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fast, deep breathing that occurs normally with exercise or with forms of metabolic acidosis; also known as Kussmaul respirations
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Hyperresonance
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Abnormally long, low-pitched sound that is heard with emphysema or a pneumothorax in which a large amount of air is present
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Hypoxemia
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low oxygen concentration in the blood
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Orthopnea
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shortness of breath that occurs while patient is lying flat
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Pallor
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abnormal palesness of the skin resulting from reduced blood flow or decreased hemoglobin level; can be associated with a ride range of diseases
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Paroxysmal nocturnal dyspnea
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sudden gasping of air that occurs while sleeping at night
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Pneumonia
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inflammation of the lungs; most commonly caused by a community-acquired bacterial infection
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Resonance
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long, low-pitched sound that can usually be heard over all the lung fields
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Rhonchi
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an added sound with a musical pitch occurring during inspiration or expiration, heard on ausculation of the chest, and caused by air passing through bronchi that are narrowed by inflammation, spasm of smooth muscle, or presence of mucus in the lumen
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Tachypnea
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adult respiratory rate greater than 20 rpm
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Tactile fremitus
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palpable vibraions that are transmitted through the bronchila tree to the chest wall when a patient speaks
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Wheezes
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whistling respiratory sounds caused by turbulent airflow through constricted bronchi
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Whispered pectoriloquy
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condition in which the words "one-two-three" whispered by the patient are heard distinctively and clearly through a stethoscope placed over the lungs; possibly indicative of consolidation and pleural effusions. In a normal test, words would sound faint and muffled
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Acne
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inflammatory disease of the skin with follicular, papular, and pustular eruption involving the pilosebaceous apparatus
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Candidiasis
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fungal infections caused by Candida albicans
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Carbuncle
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boil that forms from the coalescence of adjacent furuncles and that can penetrate beyond the dermis into the subcutaneous layer
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Chicken pox (varicella)
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highly infectious childhood disease caused by the varicella-zoster virus
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Chloasma
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hyperpigmentation of the face
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Diaper Rash
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acute inflammatory condition in the area of the buttocks, genitalia, perineum, and abdomen
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Eczema
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broad term used for a variety of inflammatory skin conditions
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Furuncle
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deep-seated folliculitis caused by Staph aureus
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Folliculitis
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inflammation of the hair follicles
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Impetigo
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cutaneous bacterial infection caused by Staph aureus and group A beta-hemolytic Strep pyogenes
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linea nigra
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pregnancy-related, brownish-black line down the middle of the abdomen
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Measles
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highly infectious childhood viral disease, causative organism has been categorized as a paramyxovirus
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Onychomycosis
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infection of the nail caused by yeasts, molds, and/or fungi
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pediculosis
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louse-borne infestations; typically involve the head (pediculosis capitis), body (corporis), or pubic region (pubis)
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Purpura
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hemorrhage into the skin with obvious discoloration
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Stevens-Johnson Syndrome
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serious, drug-related cutaneous diseases that are characterized by widespread lesions covering most of the body, including the mucous membranes
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Striae
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pregnancy-related, silver to pink jagged lines on the skin, more commonly known as stretch marks
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Xerosis
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pathologic dryness of the skin (xeroderma), the conjunctive (xerophthalmia), or mucous membranes
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Gallop
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extra heart sounds, not normal in adults
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Erb's Point
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2nd pulmonic area
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DOE
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dyspnea on exertion - difficulty breathing with activity
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Afterload
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vascular resistance against which the ventricle must contract
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Angina pectoris
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presence of intermittent chest pain caused by temporary oxygen insufficiency and myocardial ischemia
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Angioplasty
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nonsurgical method of mechanically dilating a partially obstructed coronary artery
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Arrhythmia
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irregular pulse rhythm or rate of cardiac contraction
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Arteriosclerosis
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condition in which the blood vessels become more rigid, lose elasticity, and become thicker as the body ages; calcification of weakened vessel walls
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Blood pressure
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force of blood as it pushes against the arterial walls; dependent on cardiac output, volume of blood ejected by the ventricles per minute, and peripheral vascular resistance
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Bradycardia
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adult heart rate of less than 60 bpm
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Bruit
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blowing, murmur-like sound of vascular rather than cardiac origin
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Cardiac output
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volume of blood pumped from each ventricle in 1 minute; product of the heart rate and stroke volume
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Circus senilis
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White circle around the cornea that results from deposits of fat
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Congestive heart failure
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condition in which the heart cannot pump a sufficient amount of blood to meet the metabolic needs of the body
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Contractility
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ability of the cardiac muscle, when given a load, to shorten and contract
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Corneal arcus
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lipid deposits in the periphery of eye that may be detected when light is directed to the iris
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Coronary heart disease
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degenerative changes in coronary circulation that are caused by an imbalance between myocardial oxygen demand and blood supply; also termed coronary artery disease or ischemic heart disease
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Diastole
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phase of the cardiac cycle during which the ventricles relax, the atrioventricular valves open, and blood passively flows from the pressure-filled atria into the low-pressure ventricles
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First heart sound
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S1, heart sound that is produced by closure of the atrioventricular valves and that signals the beginning of systole, characterized as "lub" and usually loudest over the apex area of the heart
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Hepatojugular reflex
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sustained elevated jugular venous pressure that occurs during abdominal compression; indicates that hepatic venous congestion is present
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Hypertension
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elevated systolic blood pressure (>140 mmHg) and/or diastolic blood pressure (<90 mmHg) measured on at least two separate occasions; classified according to severity as stage 1 or 2
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Murmur
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gentle, blowing, swishing sound heard on the chest wall of cardiac or vascular origin
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Myocardial infarction
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occurrence of myocardial cell death and necrosis caused by local, severe, or proloned ischemia
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orthopnea
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shortness of breath that occurs while the patient is lying flat
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Paroxysmal nocturnal dyspnea
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sudden gasping for air that occurs while sleeping at night
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Preload
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passive stretching of the ventricular muscle as the volume of blood in the ventricle at the end of diastole increases
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Prinzmetal angina
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a variant angina pectoris that occurs at rest
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Pulse pressure
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difference between the systolic and diastolic pressure; reflects stroke volume
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Second heart sound
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S2, heart sound produced by closure of the semilunar valves; signals the ending of systole
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Stable angina
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angina that occurs most commonly when the workload of the heart increases through exertion or stress; usually associated with a significant amount of atherosclerotic narrowing of one or more coronary arteries
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Stroke volume
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amount of blood ejected in one full heartbeat
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Systole
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phase of the cardiac cycle during which pressure in the ventricles exceeds pressure in the aorta and pulmonary artery, the ventricles contract, the semilunar valves open, and blood is ejected into the pulmonary and systemic arteries
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Tachycardia
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adult heart rate greater than 100 bpm
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Unstable angina
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angina characteriazed by an increased frequency of anginal pain; anginal attacks are usually precipitated by less exertion or may occur at rest, are more intense, and last loner than episodes of stable angina
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Constipation
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sporadic or arduous passage of stool
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Crohn's Disease
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chronic inflammatory process involving any portion of the GI tract from the mouth to the anus
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Diarrhea
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increase in the number and fluid content of bowel movements
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Gastroesophageal reflux disease
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disorder in which gastric onctents are refluxed into the esophagus
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Peptic ulcer disease
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an ulceration of the mucous membrane of the esophagus, stomach, or duodenum
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Peristalsis
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progressive, involuntary, wave-like movements of the alimentary canal
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Ulcerative colitis
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chronic inflammatory process affecting the mucosa and submucosa of the colon only
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Hepatitis
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inflammation of the liver
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Cranial Nerve XI
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examine sternomastoid/trapezius muscles for equal size
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Cirrhosis
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chronic disease of the liver in which widespread hepatic cell destruction leads to the formation of connective tissue and nodular regeneration, with consequent disorganization of the normal architecture
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Pancreatitis
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inflammation of the pancreas
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Cranial Nerve XII
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inspect tongue, articulation or words
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atherosclerosis
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condition in which atherosclerotic plaques are deposited in the vascular system as the body ages
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deep venous thrombosis (thrombophlebitis)
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presence of a thrombus (i.e. a blood clot) in a deep vein and an accompanying inflammatory process in the vessel wall; also known as thrombophlebitis
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Hypoxia
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lack of oxygen
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Pulmonary embolism
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movement of a thrombus to the lung
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PVD
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Peripheral Vascular Disease
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ABI
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Ankle-Brachial Index (Ischemic Index)
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DVT
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Deep Vein Thrombosis
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LLE
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Left Lower Extremity
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RLE
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Right Lower Extremity
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LUE
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Left Upper Extremity
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RUE
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Right Upper Extremity
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MMSE
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Mini Mental Status Exam
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RAM
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Rapid Alternating Movements
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DTR
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Deep Tendon Reflex
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MCL
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Midclavicular Line
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(+) BS
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bowel sounds present
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N/V/D/C
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Nausea, vomiting, diarrhea, constipation
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PUD
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peptic ulcer disease
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RCM
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Right costal margin
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NT/ND
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non tender/non distended (refers to abdominal exam)
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CVA
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costovertebral angle
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ARF
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acute renal failure
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CRF
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chronic renal failure
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HSM
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hepatosplenomegaly
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RUQ
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Right upper quadrant
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LUQ
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Left upper quadrant
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RLQ
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right lower quadrant
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LLQ
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left lower quadrant
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ROM
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range of motion
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NC/AT
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normocephalic/atraumatic (skull)
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TMJ
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temporomandibular joint
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AC
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Air conduction
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BC
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Bone conduction
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AOM
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Acute otitis media
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AU
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both ears
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EOMI
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Extra-ocular muscles intact
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PERRL
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Pupils equal round and reactive to light
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PERRLA
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Pupils equal round and reactive to light and accommodation
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OD
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right eye
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OS
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left eye
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DOE
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dyspnea on exertion
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PND
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paroxysmal nocturnal dyspnea
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JVD
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jugular venous distension
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HJR
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hepatojugular reflux
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m/r/g
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murmurs, rubs or gallops
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RRR
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regular rate and rhythm
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LA
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left atrium
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LV
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left ventricle
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RA
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right atrium
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RV
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right ventricle
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CHF
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congestive heart failure
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AO
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aortic valve
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PA
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Pulmonic valve
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JVP
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jugular venous pulse
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CP
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chest pain
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seborrhea
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excessive flaking
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xerosis
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dry skin
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MMM
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mucus membranes moist
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Malignant Melonoma Recognition
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Asymmetry, Border, Color, Diameter, Enlargement
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COPD
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chronic obstructive pulmonary disease
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PEF
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peak expiratory flow - maximal flow rate (L/min) produced during forced expiration
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AP
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anteroposterior (chest)
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A&Ox3
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alert and oriented to person, place, and time
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NAD
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no apparent distress
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WDWN
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well-developed, well-nourished
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CVA
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costovertebral angle
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NT
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not tender
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ND
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non-distension
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HSM
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hepatosplenomegaly
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CN
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cranial nerves
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S/P
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status post
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AAW
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Alive and well
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ROS
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Review of systems
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HLP
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hyperlipidemia
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MCP
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metacarpophalangeal
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DIP
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distal interphalangeal
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kyphosis
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curvature of spine - hump/hunch
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lordosis
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curvature of spine - inward curve of lower spine
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Skin color and condition
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Abnormal: cyanosis, clubbing of fingers
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Respirations
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Normal: equal chest expansion
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Neck muscles
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Abnormal: using during normal breathing
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Chest inspection
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Anteroposterior diameter should be less than transverse diameter - abnormal: barrel chest where two diameters are equal
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Tactile fremitus
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place balls of hand on the patient's posterior chest and repeat "99." Normal: vibration should feel the same in the corresponding area on each side. Abnormal: decreased fremitus - pleural effusion, pneumothorax, emphysema; increased fremitus - pneumonia
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Percuss the posterior chest
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compare sides - "resonance" should sound the same - Normal resonance: long low pitched sound; Abnormal: hyperresonance - emphysema, pneumothorax; Dull - thud w/ dense tissues - pneumonia, tumor
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Auscultate Breath Sounds
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Normal: side to side intensity and duration of breath sound equal. Bronchial (Tracheal) - pitch high, amplitude loud, inspiration<expiration, heard over trachea and larynx. Bronchovesicular - pitch and amplitude moderate, inspiration = expiration, heard over major bronchi where few alveoli found. Vesicular: pitch low, amplitude soft, inspiration>expiration, peripheral lung fields
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Fine crackles
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Abnormal: high pitched, short crackling, popping sound during inspiration - pneumonia, CHF, bronchitis, asthma
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Coarse Crackles
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Abnormal: loud, low pitched, bubbling and gurgling sounds - pulonary edema, pneumonia, pulmonary fibrosis, terminally ill
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Wheeze
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Abnormal: high pitch musical sound - asthma, emphysema
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Stridor
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Abnormal: high pitched, crowing sound, louder in the neck - croup
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Broncophony
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Abnormal: hear "99" clearly through stethoscope because of increased lung density - consolidation or compression of lung tissue
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egophony
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Normal: hear "ee"
Abnormal: consolidation or compression of lung tissue - "aa" heard |
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Whispered pectoriloquy
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patient whispers "1,2,3"
Normal: response is faint, muffled and hard to hear Abnormal: transmission of voice is clear and distinct from consolidation/compression of lung tissue |
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Peak Flow Meter
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Red: medical alert and severe exacerbation (< 50% of personal best)
Yellow: caution - moderate exacerbation (50-80% of personal best) Green: good control (>80% of personal best) |
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Edema - use thumb to firmly depress areas over ankle malleolus, tibia or sacral region
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Abnormal: if pressure leaves a dent in the skin then "pitting edema" is present:
1+ mild pitting, slight indentation, no perceptible swelling of the leg 2+ moderate pitting, indentation subsides rapidly 3+ deep pitting, inentation remains for a short time, area looks swollen 4+ very deep pitting, indentation lasts for a long time, area is very swollen |
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Skin color
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Abnormal: erythema, pallor, cyanosis, jaundice
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Skin temperature
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Normal: general vs. localized, check bilaterally and use dorsa of your hands
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Skin moisture
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Normal: look for mucus membranes moist in oral mucous mumbranes
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Skin texture
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Normal: feels smooth and firm with an even surface
Abnormal: atrophy or calluses |
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Skin mobility
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Normal: large fold of skin - ease with which it lifts up
Abnormal: decreased when edema present |
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Skin turgor
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Normal: quickly with which it returns to place
Abnormal: decreased when dehydration present or extreme weight loss |
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Profile Sign
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shape and contour of nail
Normal: 160 degree angle, nail base firm Abnormal (clubbing): angle 180 degrees, nail base feels spongy |
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Capillary Refill
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Depress nail edge to blanch and then released
Normal: color return should be instant Abnormal: longer than 1-2 seconds indicates peripheral circulation complications |
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Gallops
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not normal - extra heart sounds - S3 & S4; normal in young children
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murmurs
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abnormal - structural defects in heart or heart valves - worens during exercise (velocity of blood increases), anemia (permanent murmur) - viscosity of blood decreases
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Carotid Artery Pulse
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palpate one artery at a time - medial to sternomastoid muscle in the neck. Normal: synchronous on right and left - 2+
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Auscultate carotid artery
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should hold breath, abnormal: hearing a bruit
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Jugular Venous Pulse
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Direct light onto neck to note external jugular veins and pulse; hold a cm ruler on the sternal angle to note JVP
Normal: 2 cm or less above sternal angle Abnormal: greater than 2 cm (JVD) |
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Apical Impulse
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patient in supine position and find apical pulse. Normal: between 4th or 5th intercostal space at mid clavicular lines, occupies < 3 cm in diameter. Abnormal: larger than 3 cm in CHF because heart hypertrophied
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Snellen Alphabet Chart
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tests visual acuity, read smallest line possible with one eye covered. Numerator = distance from chart, denominator = distance normal eye could read that line
Normal: 20/20 - record if any missed letters and with glasses/contacts |
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Near Vision
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tests visual acuity, for patients greater than 40 and difficulty reading, handheld vision screener card held 14 nches from eye - normal is 14/14
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Confrontation test
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for peripheral vision, patient covers one eye and you cover opposite and move finger from periphery in several directions - patient should tell when target first seen and examiner should see at same time
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Corneal Light Reflex
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tests extraocular muscle function, patient stares straight ahead and hold pen light 12 inches away, note reflection of light on corneas - should be in same spot on both eyes
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Dianostic Positions Test
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follow movement of finer with eyes, normal is parallel tracking of obect with both eyes, note any nystagmus
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Pupil
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normal is 3-5 mm for size
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Pupillary light reflex
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darken room and have patient gaze into distance - advance light from side. Normal: direct light reflex (constriction of same sided pupil), consensual light reflex (simultaneous constriction of opposite pupil
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Accommodation
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patient focuses on a distant object and then to your finger about 3 inches away - Normal: pupils constrict and convergence of eyes
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Red reflex
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glow filling the person's pupil caused by the reflection of the light off their retina
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Sensorineural Hearing Loss
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sound reaches inner ear but still unable to hear - damage in the inner ear or damage to nerve pathways from the inner ear to the brain - increase in volume may not compensate
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Conductive Hearing Loss
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sound is not transferred from the outer and middle ear to the inner ear - partial loss: increase volume can often reach inner and they can hear
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Tympanic Membrane
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Normal: shiny and translucent, with pearly gray color
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Voice Test
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test for auditory acuity, occlude 1 of patient's ears and cover your mouth, stand 1-2 feet away from the patient and exhale fully and whisper softly toward the unoccluded ear. Normal: person repeats words correctly back to you
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Weber Test
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place a vibrating tuning fork in the middle of the person's skull; ask patient if sound is the same in both ears; abnormal: conductive hearing loss - hear sound in bad ear
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Rinne Test
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place stem of tuning fork on patient's mastoid process and signal when sound goes away - move to ear canal and should still be able to hear the sound.
Normal: AC > BC Conductive hearing loss: AC = BC or AC < BC Sensorineural loss: AC > BC but is reduced overall |
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Transillumination
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Place penlight in supraorbital ring and direct light upward - diffuse, red glow in area of frontal sinus is normal response. Penlight on patient's cheekbone - should see dull glow on corresponding area of hard palate when patient opens mouth
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Tonsils
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graded in size:
1+ visible 2+ halfway between tonsillar pillars and uvula 3+ touching the uvula 4+ touching each other |
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Facial muscles
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should be symmetric, expressions are mediated by cranial nerve VII
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Preauricular lymph node
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in front of the ear
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Posterior Auricular lymph node
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superficial to the mastoid process
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Occipital lymph node
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at the base of the skull posteriorly
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Submental lymph node
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midline, behind the tip of the mandible
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Submandibular lymph node
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halfway between the angle and the tip of the mandible
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jugulodigastric lymph node
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at the angle of the mandible
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superficial cervical lymph node
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overlying the sternomastroid muscle
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Deep cervical chain lymph node
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deep under the sternomastoid muscle
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Posterior Cervical lymph node
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posterior triangle along edge of the trapezius muscle
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Supraclavicular lymph node
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deep in the angle formed by clavicle and sternomastoid
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lymph nodes
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Normal: round or ovoid, smooth, moveable and non-tender
Acute infection: bilateral, enlarged, warm, tender and firm but freely moveable Chronic inflammation: nodes are clumped Cancerous: hard, unilateral, nontender and fixed |
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Size of skull
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Normocephalic: round symmetric skull that is appropriately related to body size
Microencephalopathy: abnormally small Macroencephalopathy: abnormally large |
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Temporomandibular Joint
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audible or palpable snapping is not unusual
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Thyroid gland
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should move up with a swallow, normally cannot palpate, if auscultate when enlarged - bruit means more blood flow - abnormal
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Trachea
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should be midline with symmetric space on each side
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Auscultation of vascular sounds
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listen over aorta, renal arteries, iliac artery, femoral artery - usually no sound is present, not any bruits
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Percuss general tympany
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lightly percuss all 3 quadrants to assess tympany and dulness - tympany should predominate, dullness heard over organs, solid masses, full bladder
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Percuss for liver span
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percuss downward until sound changes to dull - mark spot usually between 5th to 7th intercostal space, find abdominal tympany and percuss up until sound changes to dull. normal liver span 6-12 cm, lower liver border normally <2cm below the costal margin
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voluntary guarding
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muscle tense in abdomen palpation, response to cold, ticklish, bilateral -- NORMAL
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involuntary rigidity of abdomen
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constant tenseness due to acute inflammation of the peritoneum - unilateral - ABNORMAL
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Rebound tenderness
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palpate deeply and then quickly release - if it hurts more when you release - indication of peritoneal irritation
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Percussion for Costovertebral Angle (CVA) tenderness
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1 hand over the 12th rib at the CVA on the back - thump that hand with the ulnar edge of your other fist.
Normal: patient feels a thud but no pain - causes tissues to vibrate instead of producing a sound Abnormal: patient feels pain sharp pain seen with inflammation of the kidney |
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Cerebral Cortex
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controls thought, memory, reasoning, sensation & voluntary movements
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Frontal cerebrum
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personality, behavior, emotions, intellectual function
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Parietal cerebrum
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sensation
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Occipital cerebrum
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visual receptive center
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Temporal cerebrum
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auditory reception center
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thalamus (diencephalon)
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processes sensory impulses and relays them to the cerebral cortex
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hypothalamus (diencephalon)
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maintains homeostasis and regulates temperature, heart rate, blood pressure
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Pineal gland (diencephalon)
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secretes melatonin which regulates circadian rhythms
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Cerebellum
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concerned with equilibrium, muscle tone and subconscious skeletal motor movements
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Brain Stem
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pathway between the cerebral cortex and the spinal cord
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Spinal cord
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cranial: involve cranial nerves
somatic: involve skeletal muscle contraction autonomic: cardiac, smooth muscle, glands |
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Muscle tone
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Normal: mild resistance to passive stretch
Flaccidity: decreased muscle tone, muscle weak or limp Spasticity: increased muscle tone Rigidity: constant state of resistance |
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Balance Tests
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as patient to walk 10-20 feet away from you and a straight line heel to toe.
Normal: smooth, rhythmic, effortless Ataxia: uncoordinated or unsteady gait |
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Romberg Test
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stand with feet together and arms at sides, close eyes and hold this posture for 20 seconds
Positive: patient loses balance -- ABNORMAL |
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Rapid Alternating Movements
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pat knees with both hands and flip hands over repeating faster and faster
Normal: equal turning, quick rhythmic pace Abnormal: lack of coordination |
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Finger to finger test
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index finger to touch your finger then their nose
Normal: smooth and accurate Abnormal: clumsy movement, overshooting the spot, deviation to one side |
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Finger to nose test
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alternate touching tip of nose with each index finger, increasing speed
Normal: able to perform smoothly Abnormal: misses nose; worsening of coordination when eyes are closed |
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heel to shin test
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heel on opposite knee and run down shin
Normal; patient moves heel in a straight line down the shin Abnormal: heel falls off shin |
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LIght touch
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wisp of cotton to skin in a random order - compare symmetric points
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test for vibration
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hold vibrating tuning fork over bony prominences and ask patient to tell you when vibration starts and stops - compare symmetry
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Tactile discrimination
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stereognosis - identifying an object placed in hand (abnormal = astereognosis)
graphesthesia - identify digit traced on palm |
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Deep Tendon Reflexes
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Normal: 2+ - compare sides for both knees and elbows
Higher: hyperreflexia Lower: diminished |
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Biceps Reflex
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support patient's forearm and place thumb on biceps tendon, strike thumb
Normal: contraction of the biceps muscle and flexion of the forearm |
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Triceps Reflex
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patient let arm go dead as it is supported, strike tricep tendon just above elbow
Normal: extension of the forearm |
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Brachioradial Reflex
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hold patient's thumbs to suspend forearms in relaxation, strike forearm about 2-3 cm above radial process
Normal: flexion and supination of the forearm |
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Quadricepts Reflex (Knee jerk)
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strike tendon just below the patella
Normal: extension of the lower leg |
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Achilles Reflex
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knee flexed, hip externally rotated, hold the foot in dorseflexion, strike Achilles tendon
Normal: foot plantar flexes against your hand |
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Plantar Reflex
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lie down with leg stretched out in front, draw a light stroke up the lateral side of the sole and inward across the ball
Normal: plantar flexion of all the toes, inversion and flexion of the forefoot Positive Babinski Sign: abnormal - dorsiflexion of the big toe and fanning of all toes |
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Ischemic Index
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ankle systolic pressure/brachial systolic pressure
Normal: 1.0-1.2 Less than 0.9 indicates presence of PVD - claudication |
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monofilament test
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patient should be able to feel light touches - if not, may be diabetic neuropathy
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popliteal pulse
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pulse posterior to knee
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dorsalis pedis pulse
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top of foot
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posterior tibial pulse
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back of calf
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