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258 Cards in this Set
- Front
- Back
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Width of inflatable bladder of cuff should be of upper arm circumference
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40 %
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Length of inflatable bladder of cuff should be of upper arm circumference
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80%
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If cuff is too narrow, the blood pressure will read
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high
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If cuff is too wide, the blood pressure will read ____on a small arm and on a large arm
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low, high
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If brachial artery is 7-8 cm below heart level, blood pressure will read cm higher
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6
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If brachial artery is 6-7 cm above heart level, blood pressure will read cm lower
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5
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A loose cuff will give falsely readings
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high
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To determine how high to raise the cuff pressure, palpate the pulse, and inflate the cuff until the pulse disappears. Add ? to this number.
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30
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An unrecognized auscultatory gap may lead to serious underestimation of ? pressure or overestimation of ? pressure
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systolic, diastolic
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An ?is associated with arterial stiffness and atherosclerotic disease
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ausculatory gap
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In some ppl, the muffling point and disappearance point are farther apart. With aortic regurgitation, the sounds never disappear. If the difference is more than ? mm Hg, record both figures
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10
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By making the sounds less audible, ? may produce artificially low systolic and high diastolic pressures.
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venous congestion
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Pressure difference of more than ?mm Hg in subclavian steal syndrome, aortic dissection
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10/15/2012
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Normal blood pressure = ? 120/80
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less than
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?= 120-139/80-89
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prehypertension
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?= 140-159/90-99
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Hypertension 1
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?= More than or equal to 160/100
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Hypertension II
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Renal assessment requirements ?
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urinalysis and blood tests
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Treatment of isolated systolic hypertension in patients age? or more reduces totally mortality and both mortality and complications from cardiovascular disease
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60
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? arises from the narrowing of the thoracic aorta, usually proximal but sometimes distal to the left subclavian artery
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Coarctation of the aorta
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? and occlusive aortic disease are distinguished by hypertension in the upper extremities and low blood pressure in the legs and by diminished or delayed femoral pulses
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Coarctation of the aorta
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? is the most commonly used to assess the heart rate. If needed, orthostatic or postural blood pressure maybe called for.
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Radial pulse
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A fall in systolic pressure of 20 mm Hg or more especially when accompanied by tachycardia indicates orthostatic (postural) hypertension. Causes included ?
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drugs, blood loss, prolonged bed rest, and autonomic nervous system diseases
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Normal adult breathing rate is? in a regular pattern
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20 breaths per minute
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? in COPD
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Prolonged expiration in COPD
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Average oral temperature is ? but can fall as low as 96.4 or rise as high as 99.1.
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37 C, 98.6 F
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Rectal temperatures are higher than oral temperatures by an average of ?
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0.4 to 0.5 degrees, or 0.7 to 0.9 degrees F.
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For rectal thermometers, make sure to use a thermometer with a stubby tip, lube it, and insert it in a direction toward the ? Remove after 3 minutes.
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umbilicus.
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Tympanic temperatures: this method involves inserting the thermometer into the auditory temperature to take a reading that is higher than the oral temperature by about ?
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0.8 degrees C or 1.4 degrees F.
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Fever: elevated body temperature of ? degrees or higher.
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99.1 F
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? extremely elevated body temperature of 106 degrees F or higher
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Hyperpyrexia
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Extremely low body temperature of 95 degrees or lower rectally
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Hypothermia
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If there is rapid respiration, ? temperature is the preferred option to oral.
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rectal
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infection, trauma, crush injuries, malignancy, blood disorders, acute
hemolysis, drug reactions, immune disorders, collagen vascular disease, infarctions. |
Causes of fever:
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Causes of Hypothermia: Mainly exposure to cold. Also can be from reduced movement, interference with vasoconstriction, sepsis, excess alcohol, starvation, hypothyroidism, hypoglycemia, old age.
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Causes of Hypothermia:
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are less likely to develop a fever, and are especially susceptible to hypothermia
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The elderly
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If Kortokoff’s sounds are inaudible, consider the possibility of ? or problems with the cuff.
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shock
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Hypertension in ppl whose bp readings are higher in the
office rather than at home or more relaxed places. Usually greater than 140/90. Common in women and anxious patients, the phenomenon occurs in 10 to 25% of all patients. |
White Coat Hypertension:
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For an obese patient, a ? maybe needed. For a thin patient, a pediatric cuff maybe needed.
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thigh cuff
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Palpation of an irregularly irregular rhythm reliably indicates ?. Anything else requires ECG confirmation
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atrial fibrillation
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? unlike white coat hypertension, signals increases risk of cardiovascular disease.
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Home hypertension,
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bp of 160/95, hr of 108 and 101.2 degree body temperature suggest ?
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Chronic Obstructive Pulmonary Disease
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Normal respiratory rate in adults: ? breaths per minute. In infants, up to ? breaths per minute
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14-20, 44
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? Slow breathing. Can be due to causes such as diabetic coma, drug induced respiratory depression, and increased intercranial pressure.
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Bradypnea- slow breathing
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? Breathing with lots of sighs should suggest hyperventilation syndrome. This is a common cause of dyspnea and dizziness. A few sighs are normal.
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Sighing Respiration-
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? Could be from restrictive lung disease, pleuritic chest pain, elevated diaphragm, empyema, or broken rib
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Tachypnea-rapid breathing
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? Periods of deep breathing alternate with periods of apnea. Children and aging ppl normally may show this pattern in sleep. Other causes include heart failure, uremia, drug induced respiratory depression, brain damage.
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Chyene Stokes Breathing:
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? Expiration is prolonged, because narrowed airways increase the resistance to airflow. Causes include asthma, chronic bronchitis, and COPD.
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Obstructive Breathing:
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? Can be caused by exercise, asthma, anxiety, and metabolic acidosis. In comatose patient, consider infarction, hypoxia, or hypoglycemia affecting the brain.
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Rapid deep breathing: Tachypnea+Hyperventilation.
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? deep breathing due to metabolic acidosis. It can be fast, normal in rate, or slow.
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Kussmaul breathing:
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? Unpredictable irregularity. Can be caused by respiratory depression, brain damage.
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Ataxic Breathing or Biot’s Breathing:
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BP peaks during the systole and falls to its lowest strength during diastole. The difference between the systole and diastole is called ?
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pulse pressure.
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T/F Arterial pressure can be influenced by left ventricular stroke volume, distensibility of the aorta and large arteries, peripheral vascular resistance, volume of blood in the arterial system
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TRUE
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? decreased stroke volume, heart failure, hypoglycemia, aortic stenosis, increased peripheral resistance, exposure to cold, severe congestive heart failure
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Small weak pulses:
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Large Bounding Pulses aka Waterhammer pulses: Can be caused by increased stroke volume, deceased peripheral resistance, or both, as in anemia, hyperthyroidism, aortic regurgitation, arteriovenous fistula, patent ductus arteriosus.
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Large Bounding Pulses aka Waterhammer pulses:
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? increased arterial pulse with a double systole peak. Can be caused by pure aortic regurgitation, combined aortic stenosis, regurgitation, hypertrophic cardiomyopathy
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Bisferiens pulse:
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? Pulse alternated is amplitude from beat to beat. When the difference between stronger and weaker beats is slight, it can only be detected by sphygmomanometer. Indicates left ventricular failure
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Pulsus Alternans:
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? A normal beat alternating with a premature contraction. Pulse varies in amplitude and stroke volume
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Bigeminal Pulse:
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? Can be detected by a palpable decrease in the pulses amplitude on quiet inspiration. Systolic pressure decreases by more than 10 mmHg during inspiration. A paradoxical pulse is found in pericardial tamponade, constrictive pericarditis, and obstructive lung disease.
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Paradoxical Pulse:
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Doppler method is preferred when taking the blood pressure of an?
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infant.
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Systolic blood pressure gradually ? throughout childhood.
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increases
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Rate of respiration in infants is between ____ breaths per minute.
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30 an 60
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Rectal temperature is preferred in obtaining body temperature of an infant. The average rectal temperature is higher in infancy and early childhood, usually above ? until age of 3. Body temperature can fluctuate as much as 3 degrees.
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99 degrees
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Fever can raise respiratory rates in infants by up to ? respirations per degree C of fever
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10
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Fever of greater than ? in infants of less than 2 to 3 months maybe a sign o serious infection or disease.
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100 degrees
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Birth-2: avg heart rate =
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140 with a range from 90-190 (std dev of 50)
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0-6 months: avg heart rate=
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30 with a range of 80-180 (std dev of 50)
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6-12 months: avg heart rate=
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115 with a rate of 75 to 155 (std dev of 40)
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BMI in children: underweight =
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under 5th percentile
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At risk child=
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greater than or equal to 85th percentile
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Overweight child=
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greater than or equal to 95th percentile
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In children, like in adults, bp readings from the thigh are ? higher than those in the arm. If the readings are the same, suspect coarctation of the aorta.
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10 mmHg higher
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Blood pressure in children: normal =
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less than 90th percentile
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Prehypertensive child=
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between 90th and 95th percentile
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Hypertensive child=
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greater than 95th percentile
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1-2 yrs: Avg= 110. Range= 70-150 (2 standard dev= 40)
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Avg= 110. Range= 70-150 (2 standard dev= 40)
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2-6 yrs: Avg= 103. Range= 68-138 (2 standard dev= 35)
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Avg= 103. Range= 68-138 (2 standard dev= 35)
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6-10 yrs: Avg= 95. Range= 65-125 (2 standard dev=30)
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Avg= 95. Range= 65-125 (2 standard dev=30)
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In early childhood, respiratory rate ranges from ? during early childhood to 15-25 during late childhood
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20-40
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The cutoff for tachypnea in children of 1 yr age or greater is more than ? breaths per min
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40
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Sinus Bradycardia is a heart rate of less than ? bpm in children younger than 3 years and less than 60 beats per minute in children 3 to 9 years.
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100
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? is legally blind the US
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20/200
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Asymmetry of the tongue is a sign of a lesion on ?
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CN XII
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In ? paralysis, the soft palate fails to rise and the uvula deviates to the opposite side
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CN X
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? Face is edematous and often pale. Swelling is usually around the eyes, and in th morning. Eyes may become slitlike when edema is severe
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Nephrotic syndrome
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? Patient with severe hypothyroidism has dull, puffy facies. Edema is pronounced around eyes and does not pit with pressure. Hair and eyebrows are dry, coarse and thinned. Skin is dry.
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Myxedema:
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? Chronic bilateral asymptomatic parotid gland enlargement maybe associated with obesity, diabetes, cirrhosis, and other conditions. Gradual unilateral enlargement suggests neoplasm. Acute enlargement is seen in mumps.
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Parotid Gland enlargement:
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? Increased growth hormone of this condition produces enlargement of both bone and soft tissue. Head is often elongated, with bony prominence of forehead, nose, and lower jaw. Soft tissues of the nose, lips and ears also enlarge.
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Acromegaly:
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? Decreased facial mobility blunts expression. A maskilike face may result with decreased blinking, and a characteristic stare. Since the neck and upper trunk tend to flex forward, the patient seems to peer upward toward the observer. Facial skin becomes oily, and drooling may occur
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Parkinson’s Disease:
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? Occlusion of a small branch of the central retinal artery may cause a horizontal defect. Ischemia of the optic nerve can also produce a similar effect
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Parkinson’s Disease:
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Blind Right Eye (? nerve): A lesion of the optic nerve and of course the eye itself can produce unilateral blindness
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right optic
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? (Optic Chiasm): A lesion in the optic chiasm may involve only fibers crossing over to the opposite side. Since these fibers originate in the nasal half of each retina, visual loss involves the temporal half of each field
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Bilateral Hemianopsia
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? (Right Optic Tract): A lesion of the optic tract interrupts fibers originating on the same side of both eyes. Visual loss in the eyes is therefore similar (homonymous) and involves half of each field (hemianopsia)
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Left Homonymous Hemianopsia
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? (Right Optic Radiation, Partial): A partial lesion of the optic radiation in the temporal lobe may involve only a portion of the nerve fibers producing for example, a homonymous quarantic defect
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Homonymous Left Superior Quadrantic Defect
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? (Right Optic Radiation): A complete interruption of fibers in the optic radiation produces a visual defect similar to that produced by a lesion of the optic tract.
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Left Homonymous Hemianopsia
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? Drooping of the upper lid. Causes can include myasthenia gravis, damage to the occulomotor nerve, and damage to the sympathetic nerve supply (Horner’s Syndrome). Can be congenital
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Ptosis:
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Lid Retraction is suggested by wide eyed stared. Retracted lids and a lid lag are often due to ?
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hyperthyroidism.
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In ? the eyeball protrudes forward. When bilateral, it suggests the infiltrative opthalmopathy of Grave’s Hyperthyroidism. Edema of the eyelids and conjunctival injection may be associated. Unilateral exopthalmos is seen in Grave’s Disease or a tumor or inflammation in the orbit.
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exopthalmos,
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? is a harmless yellowish triangular nodule in the bulbar conjunctivaon either side of the iris. Appears frequently with aging, first on the nasal and then on the temporal side.
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Pingecula
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? A painful tender red infection in a gland at the margin of the eyelid
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Sty:
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? Slightly yellow, raised well defined plaques that appear along the nasal portions of one or both eyelids. May accompany lipid disorders
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Xanthelasma:
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? A localized ocular redness from inflammation of the episcleral vessels. Vessles appear pink and are movable over the scleral surface. Maybe nodular or may show only redness and dilated vessels.
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Episcleritis:
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? A subacute nontender and usually painless nodule involving a meibomian gland. May become inflamed but unlike a sty, usually points inside the lid rather than on the lid margin
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Chalzaion:
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? A swelling between the lower eyelid and nose. An acute inflammation is painful, red, and tender. Chronic inflammation is associated with obstruction of the nasolacrimal duct. Tearing I prominent and pressure on the sac produces regurgitation of the material through the puncta of the eyelids.
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Dacryocystitis:
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? Conjunctival injection diffuse dilation of conjunctival vessel with redness that tends to be maximal peripherally. Causes mild discomfort rather than pain. Vision not affected much except for a bit of blurring due to discharge. Discharge is watery, mucoid or nonpurulent. Pupil is not affected. Cornea is clear. Can be from bacteria, viruses, allergy or irritation.
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Conjunctivitis:
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? Leakage of blood outside of the vessels producing a homogenous, sharply defined red area that fades over days and then disappears. No pain. Vision not affected. No discharge. Pupil not affected. Cornea clear. May not have a significance, or may result from trauma, bleeding disorders, or a sudden increase in venous pressure
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Subconjunctival Hemorrhage:
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?: pain maybe moderate to severe and superficial. Vision is usually decreased. Discharge either purulent or watery. Pupil is not affected unless iritis develops. Cornea changes depending on course. Can be caused by abrasions, other injuries, viral and bacterial infections
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Corneal injury or infection
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? Moderate, deep, aching pain. Decreased vision. No discharge. Pupil maybe small and irregular with time. Cornea can be clear or slightly clouded. Can be from many disorders.
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Acute Iritis:
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?: Severe, deep, aching pain. Decreased vision. No ocular discharge. Pupil is dilated and fixed. Cornea is hazy. Acute increase in intraocular pressure.
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Glaucoma
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?: A thin grayish white arc or circle near the edge of the cornea. Accompanies normal aging but also seen in younger people. In young people, it suggests possible hyperlipoproteinemia.
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Corneal Arcus:
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?: A superficial grayish white opcacity in the cornea, secondary to an old injury or to inflammation. Size and shape are variable. NOT a cataract.
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Corneal Scar:
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? A thickening of the bulbar conjunctiva that grows slowly across the outer surface of the cornea, usually from the nasal side. Redenning may occur. May interfere with vision since it encroaches on the pupil.
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Pterygium:
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? Opacities of the lenses visible through the pupil, most common in old age. Nuclear cataract: A nuclear cataract looks gray when seen by a flashlight. If the pupil is widely dilated, the gray opacity is surrounded by a black rim.
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Cataracts:
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?: Produces spokelike shadows that point inward, gray against black, as seen with a flashlight or black against red with an opthalmoscope. A dilated pupil facilitates this observation.
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Peripheral Cataract
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? unequal pupils. When anisocoria is greater in bright light than in dim light, the larger pupil cannot constrict properly. Can be due to blunt trauma to the eye, open angle glaucoma, and impaired parasympathetic nerve supply to the iris. When anisocoria is greater in dim light, the smaller pupil cannot dilate properly as in Horner’s Syndrome, caused by an interruption in Sympathetic Nerve Supply.
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Anisocoria=
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? A swelling between the lower eyelid and nose. An acute inflammation is painful, red, and tender. Chronic inflammation is associated with obstruction of the nasolacrimal duct. Tearing I prominent and pressure on the sac produces regurgitation of the material through the puncta of the eyelids.
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Dacryocystitis:
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? Leakage of blood outside of the vessels producing a homogenous, sharply defined red area that fades over days and then disappears. No pain. Vision not affected. No discharge. Pupil not affected. Cornea clear. May not have a significance, or may result from trauma, bleeding disorders, or a sudden increase in venous pressure
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Subconjunctival Hemorrhage:
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?: pain maybe moderate to severe and superficial. Vision is usually decreased. Discharge either purulent or watery. Pupil is not affected unless iritis develops. Cornea changes depending on course. Can be caused by abrasions, other injuries, viral and bacterial infections
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Corneal injury or infection
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? Moderate, deep, aching pain. Decreased vision. No discharge. Pupil maybe small and irregular with time. Cornea can be clear or slightly clouded. Can be from many disorders.
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Acute Iritis:
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?: Pupil is large, regular, and usually unilateral. Reaction to light is greatly reduced and slowed, possibly absent. Near reaction, though slow, is present. Slow accommodation causes blurred vision. Deep tendon reflexes are often decreased.
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onic Pupil (Adie’s Pupil)
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? The dilated pupil is fixed to light and near effort. Ptosis of the upper eyelid and lateral deviation of the eye are almost always present.
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Oculomotor Nerve Paralysis:
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? The affected pupil though small, reacts briskly to light. Ptosis of the eyelid is present, perhaps with loss of sweating on the forehead. In Congenital Horner’s Syndrome, the involved iris is lighter in color than its fellow (heterochroma).
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Horner’s Syndrome:
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? They can accommodate, but do not react to light indicate Argyll Robertson pupils. Seen in central nervous system syphilis.
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Small, Irregular Pupils:
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A left ? paralysis: When looking to the right, eyes are conjugate. Looking straight ahead, esotropia appears. Looking to the left, Esotropia is maximum
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CN VI
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A left ? Paralysis: The eye is pulled outward by action of CN VI. Upward, downward, and inward movements are impaired or lost. Ptosis an pupillary dilation maybe associated.
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Cranial Nerve III
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? A firm, nodular hypertrophic mass of scar tissue extending beyond the area of injury. It may develop in any scarred area, but is most common on the shoulders and upper chest. A keloid on a pierced earlobe may have troublesome cosmetic effects. Keloids are more common in darker skinned people. Recurrence may follow treatment.
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Keloid:
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? A deposit of uric acid crystals characteristic of chronic tophaceous gout. It appears as hard nodules in the helix or antihelix and may discharge chalky white crystals through the skin. It may also appear near the joints, hands, feet and other areas. It usually develops after chronic sustained high levels or uric acid.
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Tophi:
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? Also called a sebaceous cyst. A dome shaped lump in the dermis forms a benign closed firm sac attached to the epidermis. A blackhead might be visible on its surface. It can be an epidermoid cyst, common on the face and neck or a pilar cyst that is common in the scalp. Both can become inflamed.
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Cutaneous Cyst:
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Conductive Hearing Loss: External or middle ear disorder impairs sound conduction to the inner ear. Causes include foreign body, otitis media, perforated eardrum,and otosclerosis of ossicles. Can occur in ages between childhood and age 40. Abnormality in ear canal and drum usually visible, except in otoscleoris Little effect on sound, hearing seems to improve in noisy environment, voice becomes soft because inner ear and cochlear nerve are intact.
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Weber test: tuning fork at vertex. Sound lateralizes to impaired ear. Room noise not well heard, so detection of vibrations improves. Rinne Test: Tuning fork at external auditory meatus then on mastoid bone. Bone conduction is greater than or equal to air conduction. While air conduction through the external or middle ear is impaired, vibrations through bone bypass the problem to reach the cochlea.
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Width of inflatable bladder of cuff should be of upper arm circumference
|
40 %
|
|
|
Length of inflatable bladder of cuff should be of upper arm circumference
|
80%
|
|
|
If cuff is too narrow, the blood pressure will read
|
high
|
|
|
If cuff is too wide, the blood pressure will read ____on a small arm and on a large arm
|
low, high
|
|
|
If brachial artery is 7-8 cm below heart level, blood pressure will read cm higher
|
6
|
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If brachial artery is 6-7 cm above heart level, blood pressure will read cm lower
|
5
|
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|
A loose cuff will give falsely readings
|
high
|
|
|
To determine how high to raise the cuff pressure, palpate the pulse, and inflate the cuff until the pulse disappears. Add ? to this number.
|
30
|
|
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An unrecognized auscultatory gap may lead to serious underestimation of ? pressure or overestimation of ? pressure
|
systolic, diastolic
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|
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An ?is associated with arterial stiffness and atherosclerotic disease
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ausculatory gap
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|
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In some ppl, the muffling point and disappearance point are farther apart. With aortic regurgitation, the sounds never disappear. If the difference is more than ? mm Hg, record both figures
|
10
|
|
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By making the sounds less audible, ? may produce artificially low systolic and high diastolic pressures.
|
venous congestion
|
|
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Pressure difference of more than ?mm Hg in subclavian steal syndrome, aortic dissection
|
10/15/2012
|
|
|
Normal blood pressure = ? 120/80
|
less than
|
|
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?= 120-139/80-89
|
prehypertension
|
|
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?= 140-159/90-99
|
Hypertension 1
|
|
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?= More than or equal to 160/100
|
Hypertension II
|
|
|
Renal assessment requirements ?
|
urinalysis and blood tests
|
|
|
Treatment of isolated systolic hypertension in patients age? or more reduces totally mortality and both mortality and complications from cardiovascular disease
|
60
|
|
|
? arises from the narrowing of the thoracic aorta, usually proximal but sometimes distal to the left subclavian artery
|
Coarctation of the aorta
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|
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? and occlusive aortic disease are distinguished by hypertension in the upper extremities and low blood pressure in the legs and by diminished or delayed femoral pulses
|
Coarctation of the aorta
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|
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? is the most commonly used to assess the heart rate. If needed, orthostatic or postural blood pressure maybe called for.
|
Radial pulse
|
|
|
A fall in systolic pressure of 20 mm Hg or more especially when accompanied by tachycardia indicates orthostatic (postural) hypertension. Causes included ?
|
drugs, blood loss, prolonged bed rest, and autonomic nervous system diseases
|
|
|
Normal adult breathing rate is? in a regular pattern
|
20 breaths per minute
|
|
|
? in COPD
|
Prolonged expiration in COPD
|
|
|
Average oral temperature is ? but can fall as low as 96.4 or rise as high as 99.1.
|
37 C, 98.6 F
|
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Rectal temperatures are higher than oral temperatures by an average of ?
|
0.4 to 0.5 degrees, or 0.7 to 0.9 degrees F.
|
|
|
For rectal thermometers, make sure to use a thermometer with a stubby tip, lube it, and insert it in a direction toward the ? Remove after 3 minutes.
|
umbilicus.
|
|
|
Tympanic temperatures: this method involves inserting the thermometer into the auditory temperature to take a reading that is higher than the oral temperature by about ?
|
0.8 degrees C or 1.4 degrees F.
|
|
|
Fever: elevated body temperature of ? degrees or higher.
|
99.1 F
|
|
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? extremely elevated body temperature of 106 degrees F or higher
|
Hyperpyrexia
|
|
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Extremely low body temperature of 95 degrees or lower rectally
|
Hypothermia
|
|
|
If there is rapid respiration, ? temperature is the preferred option to oral.
|
rectal
|
|
|
infection, trauma, crush injuries, malignancy, blood disorders, acute
hemolysis, drug reactions, immune disorders, collagen vascular disease, infarctions. |
Causes of fever:
|
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Causes of Hypothermia: Mainly exposure to cold. Also can be from reduced movement, interference with vasoconstriction, sepsis, excess alcohol, starvation, hypothyroidism, hypoglycemia, old age.
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Causes of Hypothermia:
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are less likely to develop a fever, and are especially susceptible to hypothermia
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The elderly
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If Kortokoff’s sounds are inaudible, consider the possibility of ? or problems with the cuff.
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shock
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Hypertension in ppl whose bp readings are higher in the
office rather than at home or more relaxed places. Usually greater than 140/90. Common in women and anxious patients, the phenomenon occurs in 10 to 25% of all patients. |
White Coat Hypertension:
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For an obese patient, a ? maybe needed. For a thin patient, a pediatric cuff maybe needed.
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thigh cuff
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Palpation of an irregularly irregular rhythm reliably indicates ?. Anything else requires ECG confirmation
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atrial fibrillation
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? unlike white coat hypertension, signals increases risk of cardiovascular disease.
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Home hypertension,
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bp of 160/95, hr of 108 and 101.2 degree body temperature suggest ?
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Chronic Obstructive Pulmonary Disease
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Normal respiratory rate in adults: ? breaths per minute. In infants, up to ? breaths per minute
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14-20, 44
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? Slow breathing. Can be due to causes such as diabetic coma, drug induced respiratory depression, and increased intercranial pressure.
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Bradypnea- slow breathing
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? Breathing with lots of sighs should suggest hyperventilation syndrome. This is a common cause of dyspnea and dizziness. A few sighs are normal.
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Sighing Respiration-
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? Could be from restrictive lung disease, pleuritic chest pain, elevated diaphragm, empyema, or broken rib
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Tachypnea-rapid breathing
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? Periods of deep breathing alternate with periods of apnea. Children and aging ppl normally may show this pattern in sleep. Other causes include heart failure, uremia, drug induced respiratory depression, brain damage.
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Chyene Stokes Breathing:
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? Expiration is prolonged, because narrowed airways increase the resistance to airflow. Causes include asthma, chronic bronchitis, and COPD.
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Obstructive Breathing:
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? Can be caused by exercise, asthma, anxiety, and metabolic acidosis. In comatose patient, consider infarction, hypoxia, or hypoglycemia affecting the brain.
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Rapid deep breathing: Tachypnea+Hyperventilation.
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? deep breathing due to metabolic acidosis. It can be fast, normal in rate, or slow.
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Kussmaul breathing:
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? Unpredictable irregularity. Can be caused by respiratory depression, brain damage.
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Ataxic Breathing or Biot’s Breathing:
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BP peaks during the systole and falls to its lowest strength during diastole. The difference between the systole and diastole is called ?
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pulse pressure.
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T/F Arterial pressure can be influenced by left ventricular stroke volume, distensibility of the aorta and large arteries, peripheral vascular resistance, volume of blood in the arterial system
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TRUE
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? decreased stroke volume, heart failure, hypoglycemia, aortic stenosis, increased peripheral resistance, exposure to cold, severe congestive heart failure
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Small weak pulses:
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Large Bounding Pulses aka Waterhammer pulses: Can be caused by increased stroke volume, deceased peripheral resistance, or both, as in anemia, hyperthyroidism, aortic regurgitation, arteriovenous fistula, patent ductus arteriosus.
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Large Bounding Pulses aka Waterhammer pulses:
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? increased arterial pulse with a double systole peak. Can be caused by pure aortic regurgitation, combined aortic stenosis, regurgitation, hypertrophic cardiomyopathy
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Bisferiens pulse:
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? Pulse alternated is amplitude from beat to beat. When the difference between stronger and weaker beats is slight, it can only be detected by sphygmomanometer. Indicates left ventricular failure
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Pulsus Alternans:
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? A normal beat alternating with a premature contraction. Pulse varies in amplitude and stroke volume
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Bigeminal Pulse:
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? Can be detected by a palpable decrease in the pulses amplitude on quiet inspiration. Systolic pressure decreases by more than 10 mmHg during inspiration. A paradoxical pulse is found in pericardial tamponade, constrictive pericarditis, and obstructive lung disease.
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Paradoxical Pulse:
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Doppler method is preferred when taking the blood pressure of an?
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infant.
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Systolic blood pressure gradually ? throughout childhood.
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increases
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Rate of respiration in infants is between ____ breaths per minute.
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30 an 60
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Rectal temperature is preferred in obtaining body temperature of an infant. The average rectal temperature is higher in infancy and early childhood, usually above ? until age of 3. Body temperature can fluctuate as much as 3 degrees.
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99 degrees
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Fever can raise respiratory rates in infants by up to ? respirations per degree C of fever
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10
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Fever of greater than ? in infants of less than 2 to 3 months maybe a sign o serious infection or disease.
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100 degrees
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Birth-2: avg heart rate =
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140 with a range from 90-190 (std dev of 50)
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0-6 months: avg heart rate=
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30 with a range of 80-180 (std dev of 50)
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6-12 months: avg heart rate=
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115 with a rate of 75 to 155 (std dev of 40)
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BMI in children: underweight =
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under 5th percentile
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At risk child=
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greater than or equal to 85th percentile
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Overweight child=
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greater than or equal to 95th percentile
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In children, like in adults, bp readings from the thigh are ? higher than those in the arm. If the readings are the same, suspect coarctation of the aorta.
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10 mmHg higher
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Blood pressure in children: normal =
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less than 90th percentile
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Prehypertensive child=
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between 90th and 95th percentile
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Hypertensive child=
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greater than 95th percentile
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1-2 yrs: Avg= 110. Range= 70-150 (2 standard dev= 40)
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Avg= 110. Range= 70-150 (2 standard dev= 40)
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2-6 yrs: Avg= 103. Range= 68-138 (2 standard dev= 35)
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Avg= 103. Range= 68-138 (2 standard dev= 35)
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6-10 yrs: Avg= 95. Range= 65-125 (2 standard dev=30)
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Avg= 95. Range= 65-125 (2 standard dev=30)
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In early childhood, respiratory rate ranges from ? during early childhood to 15-25 during late childhood
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20-40
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The cutoff for tachypnea in children of 1 yr age or greater is more than ? breaths per min
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40
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Sinus Bradycardia is a heart rate of less than ? bpm in children younger than 3 years and less than 60 beats per minute in children 3 to 9 years.
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100
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? is legally blind the US
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20/200
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Asymmetry of the tongue is a sign of a lesion on ?
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CN XII
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In ? paralysis, the soft palate fails to rise and the uvula deviates to the opposite side
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CN X
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? Face is edematous and often pale. Swelling is usually around the eyes, and in th morning. Eyes may become slitlike when edema is severe
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Nephrotic syndrome
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? Patient with severe hypothyroidism has dull, puffy facies. Edema is pronounced around eyes and does not pit with pressure. Hair and eyebrows are dry, coarse and thinned. Skin is dry.
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Myxedema:
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? Chronic bilateral asymptomatic parotid gland enlargement maybe associated with obesity, diabetes, cirrhosis, and other conditions. Gradual unilateral enlargement suggests neoplasm. Acute enlargement is seen in mumps.
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Parotid Gland enlargement:
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? Increased growth hormone of this condition produces enlargement of both bone and soft tissue. Head is often elongated, with bony prominence of forehead, nose, and lower jaw. Soft tissues of the nose, lips and ears also enlarge.
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Acromegaly:
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? Decreased facial mobility blunts expression. A maskilike face may result with decreased blinking, and a characteristic stare. Since the neck and upper trunk tend to flex forward, the patient seems to peer upward toward the observer. Facial skin becomes oily, and drooling may occur
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Parkinson’s Disease:
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? Occlusion of a small branch of the central retinal artery may cause a horizontal defect. Ischemia of the optic nerve can also produce a similar effect
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Parkinson’s Disease:
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Blind Right Eye (? nerve): A lesion of the optic nerve and of course the eye itself can produce unilateral blindness
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right optic
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? (Optic Chiasm): A lesion in the optic chiasm may involve only fibers crossing over to the opposite side. Since these fibers originate in the nasal half of each retina, visual loss involves the temporal half of each field
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Bilateral Hemianopsia
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? (Right Optic Tract): A lesion of the optic tract interrupts fibers originating on the same side of both eyes. Visual loss in the eyes is therefore similar (homonymous) and involves half of each field (hemianopsia)
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Left Homonymous Hemianopsia
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? (Right Optic Radiation, Partial): A partial lesion of the optic radiation in the temporal lobe may involve only a portion of the nerve fibers producing for example, a homonymous quarantic defect
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Homonymous Left Superior Quadrantic Defect
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? (Right Optic Radiation): A complete interruption of fibers in the optic radiation produces a visual defect similar to that produced by a lesion of the optic tract.
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Left Homonymous Hemianopsia
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? Drooping of the upper lid. Causes can include myasthenia gravis, damage to the occulomotor nerve, and damage to the sympathetic nerve supply (Horner’s Syndrome). Can be congenital
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Ptosis:
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Lid Retraction is suggested by wide eyed stared. Retracted lids and a lid lag are often due to ?
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hyperthyroidism.
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In ? the eyeball protrudes forward. When bilateral, it suggests the infiltrative opthalmopathy of Grave’s Hyperthyroidism. Edema of the eyelids and conjunctival injection may be associated. Unilateral exopthalmos is seen in Grave’s Disease or a tumor or inflammation in the orbit.
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exopthalmos,
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? is a harmless yellowish triangular nodule in the bulbar conjunctivaon either side of the iris. Appears frequently with aging, first on the nasal and then on the temporal side.
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Pingecula
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? A painful tender red infection in a gland at the margin of the eyelid
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Sty:
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? Slightly yellow, raised well defined plaques that appear along the nasal portions of one or both eyelids. May accompany lipid disorders
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Xanthelasma:
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? A localized ocular redness from inflammation of the episcleral vessels. Vessles appear pink and are movable over the scleral surface. Maybe nodular or may show only redness and dilated vessels.
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Episcleritis:
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? A subacute nontender and usually painless nodule involving a meibomian gland. May become inflamed but unlike a sty, usually points inside the lid rather than on the lid margin
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Chalzaion:
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? A swelling between the lower eyelid and nose. An acute inflammation is painful, red, and tender. Chronic inflammation is associated with obstruction of the nasolacrimal duct. Tearing I prominent and pressure on the sac produces regurgitation of the material through the puncta of the eyelids.
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Dacryocystitis:
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? Conjunctival injection diffuse dilation of conjunctival vessel with redness that tends to be maximal peripherally. Causes mild discomfort rather than pain. Vision not affected much except for a bit of blurring due to discharge. Discharge is watery, mucoid or nonpurulent. Pupil is not affected. Cornea is clear. Can be from bacteria, viruses, allergy or irritation.
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Conjunctivitis:
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? Leakage of blood outside of the vessels producing a homogenous, sharply defined red area that fades over days and then disappears. No pain. Vision not affected. No discharge. Pupil not affected. Cornea clear. May not have a significance, or may result from trauma, bleeding disorders, or a sudden increase in venous pressure
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Subconjunctival Hemorrhage:
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?: pain maybe moderate to severe and superficial. Vision is usually decreased. Discharge either purulent or watery. Pupil is not affected unless iritis develops. Cornea changes depending on course. Can be caused by abrasions, other injuries, viral and bacterial infections
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Corneal injury or infection
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? Moderate, deep, aching pain. Decreased vision. No discharge. Pupil maybe small and irregular with time. Cornea can be clear or slightly clouded. Can be from many disorders.
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Acute Iritis:
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?: Severe, deep, aching pain. Decreased vision. No ocular discharge. Pupil is dilated and fixed. Cornea is hazy. Acute increase in intraocular pressure.
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Glaucoma
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?: A thin grayish white arc or circle near the edge of the cornea. Accompanies normal aging but also seen in younger people. In young people, it suggests possible hyperlipoproteinemia.
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Corneal Arcus:
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?: A superficial grayish white opcacity in the cornea, secondary to an old injury or to inflammation. Size and shape are variable. NOT a cataract.
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Corneal Scar:
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? A thickening of the bulbar conjunctiva that grows slowly across the outer surface of the cornea, usually from the nasal side. Redenning may occur. May interfere with vision since it encroaches on the pupil.
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Pterygium:
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? Opacities of the lenses visible through the pupil, most common in old age. Nuclear cataract: A nuclear cataract looks gray when seen by a flashlight. If the pupil is widely dilated, the gray opacity is surrounded by a black rim.
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Cataracts:
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?: Produces spokelike shadows that point inward, gray against black, as seen with a flashlight or black against red with an opthalmoscope. A dilated pupil facilitates this observation.
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Peripheral Cataract
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? unequal pupils. When anisocoria is greater in bright light than in dim light, the larger pupil cannot constrict properly. Can be due to blunt trauma to the eye, open angle glaucoma, and impaired parasympathetic nerve supply to the iris. When anisocoria is greater in dim light, the smaller pupil cannot dilate properly as in Horner’s Syndrome, caused by an interruption in Sympathetic Nerve Supply.
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Anisocoria=
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? A swelling between the lower eyelid and nose. An acute inflammation is painful, red, and tender. Chronic inflammation is associated with obstruction of the nasolacrimal duct. Tearing I prominent and pressure on the sac produces regurgitation of the material through the puncta of the eyelids.
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Dacryocystitis:
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? Leakage of blood outside of the vessels producing a homogenous, sharply defined red area that fades over days and then disappears. No pain. Vision not affected. No discharge. Pupil not affected. Cornea clear. May not have a significance, or may result from trauma, bleeding disorders, or a sudden increase in venous pressure
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Subconjunctival Hemorrhage:
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?: pain maybe moderate to severe and superficial. Vision is usually decreased. Discharge either purulent or watery. Pupil is not affected unless iritis develops. Cornea changes depending on course. Can be caused by abrasions, other injuries, viral and bacterial infections
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Corneal injury or infection
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? Moderate, deep, aching pain. Decreased vision. No discharge. Pupil maybe small and irregular with time. Cornea can be clear or slightly clouded. Can be from many disorders.
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Acute Iritis:
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?: Pupil is large, regular, and usually unilateral. Reaction to light is greatly reduced and slowed, possibly absent. Near reaction, though slow, is present. Slow accommodation causes blurred vision. Deep tendon reflexes are often decreased.
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onic Pupil (Adie’s Pupil)
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? The dilated pupil is fixed to light and near effort. Ptosis of the upper eyelid and lateral deviation of the eye are almost always present.
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Oculomotor Nerve Paralysis:
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? The affected pupil though small, reacts briskly to light. Ptosis of the eyelid is present, perhaps with loss of sweating on the forehead. In Congenital Horner’s Syndrome, the involved iris is lighter in color than its fellow (heterochroma).
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Horner’s Syndrome:
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? They can accommodate, but do not react to light indicate Argyll Robertson pupils. Seen in central nervous system syphilis.
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Small, Irregular Pupils:
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A left ? paralysis: When looking to the right, eyes are conjugate. Looking straight ahead, esotropia appears. Looking to the left, Esotropia is maximum
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CN VI
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A left ? Paralysis: The eye is pulled outward by action of CN VI. Upward, downward, and inward movements are impaired or lost. Ptosis an pupillary dilation maybe associated.
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Cranial Nerve III
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? A firm, nodular hypertrophic mass of scar tissue extending beyond the area of injury. It may develop in any scarred area, but is most common on the shoulders and upper chest. A keloid on a pierced earlobe may have troublesome cosmetic effects. Keloids are more common in darker skinned people. Recurrence may follow treatment.
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Keloid:
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? A deposit of uric acid crystals characteristic of chronic tophaceous gout. It appears as hard nodules in the helix or antihelix and may discharge chalky white crystals through the skin. It may also appear near the joints, hands, feet and other areas. It usually develops after chronic sustained high levels or uric acid.
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Tophi:
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? Also called a sebaceous cyst. A dome shaped lump in the dermis forms a benign closed firm sac attached to the epidermis. A blackhead might be visible on its surface. It can be an epidermoid cyst, common on the face and neck or a pilar cyst that is common in the scalp. Both can become inflamed.
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Cutaneous Cyst:
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Conductive Hearing Loss: External or middle ear disorder impairs sound conduction to the inner ear. Causes include foreign body, otitis media, perforated eardrum,and otosclerosis of ossicles. Can occur in ages between childhood and age 40. Abnormality in ear canal and drum usually visible, except in otoscleoris Little effect on sound, hearing seems to improve in noisy environment, voice becomes soft because inner ear and cochlear nerve are intact.
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Weber test: tuning fork at vertex. Sound lateralizes to impaired ear. Room noise not well heard, so detection of vibrations improves. Rinne Test: Tuning fork at external auditory meatus then on mastoid bone. Bone conduction is greater than or equal to air conduction. While air conduction through the external or middle ear is impaired, vibrations through bone bypass the problem to reach the cochlea.
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