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44 Cards in this Set

  • Front
  • Back
What do the vital signs consist of?
Blood pressure, heart rate, respiratory rate, temperature, weight, and height
1) What is the normal range of oral body temperature? 2)What are the other means of assessing body temperature and how do these temperatures compare to oral?
96.4 - 99.1
Temperature above 99.1 suggest infection until proven otherwise; also could indicate: malignancy, anemia, drug reaction or immune disorder. Below 95F hypothermia. Other BT assessment: ear, 1.4 + oral; rectal 1 + oral; Axial 1 -oral.
When assessing the pulse, what are you assessing for? Out of these four characteristics, which one is considered most important? What is the normal range for an adult?
Contour, amplitude, rate and rhythm (CARR). Most important is amplitude. nml range: 70-90 bpm, 60-90 bpm (fit), 50's (athletic), infants are tachycardic (140 bpm)
What does assessment of respirations include? What is the normal range? and for infants?
Depth, Accessory muscle involvemnet, rate and rhythm (DARR). Accessory muscles include SCM, Scalenes, upper trap., and intercostals. Adult 12-18, 12-20. infants higher at 44 Rpm.
While taking the pt's blood pressure, why use the palpitory method first?
1) To avoid falling in the auscultory gap, 2) to determine the pressure at which the examiner pumps the cuff for the auscultory method.
How does the examiner perform the auscultory method fro blood pressure? Steps 1-9.
1) The cuff is wrapped around L arm 2-3 cm above antecubital fossa, 2) Pt's arm at heart level, 3) Palpate brachial pulse, 4) pump cuff 30mmHg higher than palpitory method, 5) stethescope diaphragm over brachial artery, 6) release cuff pressure 3 mmHg per second, first sound heard is systolic pressure, 7) last sound heard diastolic reading, listen for Korotkoff sounds, 8) record two reading in pt's medical chart, 9) always compare bilaterally and assess any differences.
What is the normal reading for systolic and diastolic?
Systolic. <120; Diastolic <80
What conditions, or environmental factors can affect BP readings?
Anxiety; Alcohol
Recent exercse

Caffeine; Cuff too small for pt (false high reading)
Atherosclerosis of brachial artery (impaired sounds and reading)
Muscularity; Tortuous veins
Pain (
Peripheral pulses:
What are the key indications for assessing arterial pulses?
1) Pain distal to a compromised arterial supply, usually ischemic origin.
2) Pain distal to sitte of trauma, assess for compromised arterial supply
3) Leg: pain, numbness, coldness, pallor, swelling and/or burning
4)Vascular disease, atherosclerosis, DM
5)Always differential b/t intermittent v. neurogenic claudication.
Which peripheral pulses are assessed when checking for peripheral blood flow? there should be 13.
temporal, mandibular, carotid, brachial, antebrachial, radial, ulnar, abdominal aorta, iliac, femoral, popliteal, posterial tibial, dorsalis pedis.
What does the head examination consist of? List ten things you're looking for.
Inspection and Palpation. (HHT SS FE)

H: Head Posture and position
H: Hair: quantity, distibution, pattern of loss and texture.
Coarse dry hair and skin, loss of 1/3 of lateral the eyebrow = hypothyroidism (myxedema)
Oily, sticky hair and skin = hyperthyroidism (Grave's disease)
T: Tenderness!
Skull and Scalp: Lice, lumps lesions; contour, asymmetry and size, deformity and dandruff (seborrheic dermatitis)
Face and Eyes: Face: asymmetry, facial expression, involuntary movements, edema and masses; Eyes: Proptosis-thyroid dysfxn or mass posteriorly.
What does the neck examination consist of?
List ten things you're looking for.
Inspection, palpation and instrumentation.

Inspect: Swelling, scars asymmetry, or masses. Have the pt extend their head back...describe the size, consistency and symmetry of any masses present.
Inspect for enlargement with the parotid and thyroid glands, and lymph nodes
Ask pt to swallow and protrude tongue, observe neck for asymmetry.
Inspect for any distention of the veins, usually associated with a goiter.
Palpation: Have pt swallow, feel for fixed tissue or asym. Have pt protrude their tongue, observe and feel the elevation, it should be sym.
Outline borders of trachea asses deviation from midline
palpate the isthmus of thyroid
palpate thyroid with and without displacement from midline (push on one side and palpate the other)
Auscultate thyroid gland for bruits.
When assessing lymph nodes, what are you inspecting for, and how do you palpate?
Inspection and palpation
Inspection: enlargement
palpation: palpate using finger pads in a circular motion
When palpating the head and neck lymph nodes what are you assessing for? Be specific, how can you tell malig v. benign?
Assess the following:
Tender v. non tender
soft v. hard
mobile v. nonmobile

B9: tender, soft and mobile
Malig: nontender, hard, and nonmobile
Which lymph nodes are assessed in a head and neck evaluation?
occipital, pre and post auricular (anterior or posterior auricular), tonsillar, submandibular, submental, anterior superficial and deep cervical chain, posterior cervical chain, and supaclavicular
In order to palpate the deep cervical chain of lymph nodes what motions must the doctor induce on the patient?
flexion and ipsilateral rotation

The doctor flexes the pt's head and ipsilaterally rotates the head and neck in order to soften the SCM and palpate deep to the SCM on the anterior border.
In order to palpate the posterior cervical chain of lymph nodes, what motions must the doctor induce on the patient?
extension and ipsilateral lateral flexion

This will soften the trapezius and allow access to the posterior triangle, located at the anterior border of the trapezius in line with C7.
Where and what is Virchow's node? What does it indicate?
Virchow's node is one of the left supraclavicular nodes. A palpable, nontender, hard, nonmobile lymph node in the the left supraclavicular regin could indicate LUNG or ABDOMINAL cancer, but usually not breast cancer. Breast cancer will go to subaxillary nodes.
Mouth and Throat
With external inspection of the mouth, what are you assessing for?
Cyanosis - blue color to the lips
Angular cheilosis - cracking in corners (vit b, riboflavin deficiency, ill fitting dentures)
Lips - chancre of syphilis, herpes symplex (cold sore, fever blister), and CARICINOMA, most common form of oral cancer usually found on lower lip, (crusty plaque, irregular and rough).
With internal inspection of the mouth what anatomical structures are you asessing?
Upper and lower lips
Buccal mucosa
Hard palate
Evaluate tongue (patterns, Whartons duct and any deviations)
Uvula, anterior and posterior pillars and tonsills
Which cranial nerves are evaluated with a mouth and throat exam and how are they evaluated?
CN 9 Glossopharyngeal - sensory to throat - gag reflex
CN 10 Vagus - Motor to throat - gag reflex, say ah
CN 12 hypoglossal - motor to tongue - protrude tongue
With a lesion to the vagus nerve on the right, when the pt says "ah" which side will the uvula deviate towards? The side with or without the lesion?
I will deviate towards the opposite side of the lesion, in this case the Left, the side without the lesion. Reason being muscle are weak on the side with the lesion and cannot contract the pilar to pull the uvula and keep it midline.
When a pt protrudes their tongue with a suspected hypoglossal lesion, which side will the tongue deviate towards, the side with or without the lesion?
The tongue will deviate towards the same side as the lesion. Reason: The hypoglossal muscle pull the base of teh tongue and therefore the tip will move opposite the side of contracton, which is the side of lesion.
Ear examination
What are the test to assess hearing and the CN 8 cochlear portion?
Finger rub, Weber's and Rinne's
How do you perform Weber's test and how do you interpret the results?
Strike the 512 Hz tuning fork and place on the vortex of the pt's head. The sound should be heard equally and bilaterally. If not it indicates conductive hearing loss or a sensorineural loss. Rinne's test should be performed immediatly after in order to distinguish between the two.
How do you perform Rinne's test and how do you interpret the results?
It measures Air Conduction (AC) and Bone Conduction (BC) deficit.

Strike the 512Hz tuning fork and place the handle on the mastoid process. Time how long the patient hears the tuning fork, when the pt no longer hears the tuning fork on the mastoid process, (BC time) place the fork in front of the auditory canal and measure the time the patient hears the tuning fork (AC time). If the pt hears AC>BC it is considered normal and recorded as a positive Rinne's. If BC=AC, or BC>AC it is considered abnormal and recorded as a negetive Rinne's
When assessing Rinne's if AC>BC there is a sensorineural deficit on the opposite side. If BC=AC or BC>AC there is a conduction deficit on the same side.
What are the anatomical structures of the external ear and what abnormalities are you inspecting for?
Pinna, Helix, Antihelix, Tragus, Antitragus

Inspect for deformities, discharge, lesions such as tophi, Darwin's tubercle, subaceous cyst, keloids, etc.
In the ear canal what are you inspecting for?
Swelling, Blood, Redness, cerumen, discharge, and foreign objects
How do you perform the finger rub test?
Explain what you're doing to the pt, cover the opposite ear you are testing by pushing on the tragus, ask the pt to lift there finger when they hear rubbing, and extend your arm inline with the pt's ear, wait a couple seconds then rub your fingers together. If rubbing is heard, or not you move your hand closer to their ear and repeat rubbing. If they hear you would document the distance they heard the sounds.
When palpating the external ear anatomy what structures do you manipulate to invoke a response, and with each test why are you doing it?
Pinna - pull for pain and tenderness, indicates outer ear problem
Tragus - push for pain or tenderness, indicates outer ear problem
Mastoid - push for pain and tenderness indicates middle ear problem

Palpation of the pinna and the tragus positive findings suggests otitis externa (swimmer's ear)
Palpation of the mastoids positive finding suggests otitis media or mastoiditis.
When using the otoscope what position do you want the patient in prior to examining their ear, and in which direction do you insert the speculum? How should you pull the patients ear?...and with a child?
Use the largest speculum that fits.
Have the pt laterally flex their head away from side being examined
Insert the speculum in ear angled toward the nose
Traction the pt's ear up and back for an adult and down and back for a child.
When assessing the internal canal with the otoscope what does acute otitis externa look like?
The canal will appear swollen, narrow, moist, pale and tender.
When assessing the tympanic membrane with the outoscope, what landmarks are seen?
Tympanic membrane (pearl grey)
Cone of light (rt ear at 5:00/ Left ear at 7:00)
Long process of the malleus
Short process of the malleus
Incus (posterior to malleus)
Pars flaccida (superior region)
pars tensa(inferior region anterior and posterior)
What are you assessing the tympanic membrane for?
You are assessing the tympanic membrane for: PEARS

P: Perforations
E: Effusion
A: Acute otitis media with effusion
R: Retraction and bulging of the membrane
S: Sclerosis (tympanosclerosis)
When you are done examing one ear and you want to exam the other, should you change the speculum or not? why?
Yes. The reason is because each canal is seperate from the other and by using the same speculum you run the risk infecting the other canal if a pathology is present in one but not the other.
In an external nose inspection what are you inspecting for?
Discharge (BPM: blood pus mucus)
Deformity (old or new fractures, deviations, hematomas, stuffiness and any other lesions)
When palpating the external nose, how should you palpate and what are you looking for?
Palpate lightly for pain and tenderness, fractures and/or crepitus (a crinkly cracking feeling or sound, like feeling and hearing rice crispy's through a napkin)
How should the patient be positioned for an internal rhinal exam?
Have pt tip head slightly back
Doctor's thumb on the tip of the nose to gently push uo to the nostrils
Insert rhinoscope or speculum carefully into the nose not to injure the spetal mucosa
What are you assessing the internal structures of the nose for?
-BPM (Blood, Pus, Mucus)
-Red and swollen: indicates inflammation (viral rhinitis)
-Blue/steel grey: indicates allergy or possible rhinitis from nasal spray abuse
Deviations- septum
Turbinates (middle and inferior concha)
Growths - (polyps)
What does a clear serous fluid discharge indicate when inspecitng the nose?
CSF due to trauma, pituitary tumor and or increased intracranial pressure.
When performing a sinus inspection what are you looking for?
Redness and puffiness in the frontal and maxillary sinuses
With sinus palpation, what are you looking for if a pathology exist?
pain and tenderness by pressing on the sinuses with your thumbs
what are you assessing the frontal and maxillary sinuses for?
Red glow

Real Cute Females
How is the sinus exam performed using the speculum?
In a dark room place the speculum, with the light on, in the medial superior orbit of the pt's eye to view the frontal sinus making sure to shield the light from your eyes. To view the maxillary sinus have the pt open their mouth then place the speculum on the maxillary sinus located inferior to the orbit. Observe the sinus through the open mouth.