| Terms |
Definitions |
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Ear History
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vertigo/dizziness
nausea/vomiting
earaches
hearing loss
auricular discharge
cerumen impaction
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Tachycardia can indicate...
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CHF
excitement
fever
anemia
arrhythmia
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alopecia
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loss of hair
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What is gibbus?
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extreme kyphosis
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palpate the thyroid for:
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size
shape
configuration
consistency
tenderness
nodules
if its large, auscultate for bruits
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Bradycardia can indicate...
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good conditioning
heart block
digoxin intoxicity
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Clinical picture of RDS includes...
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tachypnea
retractions
grunting
cyanosis
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Females exhibit mostly _________ movement with respiration
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costal
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Exam sequence for the heart
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inspection
palpation
percussion?
auscultation
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auscultate the temporal arteries for:
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bruits
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Anisocoria
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unequal pupils;
congenital, 20% have size difference but normal reflexes,
could be caused by local eye meds,
or unilateral symathetic or parasympathetic pupillary pathway destruction
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a medial carrying angle
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cubitus varus
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Which heart sounds corresponds with the carotid pulse?
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S1
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Fine crackles may be associated with...
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CHF
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Retained mucous...
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encourages bacterial growth and predisposes the older adult to respiratory infection
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midsystolic (ejection) murmur, coarse, crescendo - decrescendo, thrill
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aortic stenosis
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Abdominal PMH questions
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GI disorders
hepatitis or cirrhosis
ab or UT surgery or injury
UTI
major illness
blood transfusions
hep vaccines
colorectal cancer or related cancers
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Inspect the neck for:
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symmetry
alignment of trachea
fullness
masses, webbing and skinfolds
Jugular venous distention
carotid artery prominance
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what are some retinal findings?
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glaucoma
papilledema
hypertensive retinopathy
diabetic retinopathy
retinal detachment
retinal artery or vein occlusion
optic atrophy
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you inspect the auditory canal for:
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cerumen
discharge
redness
scaling
lesions
foreign bodies
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what are some thyroid related problems?
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hypothyroidism
hyperthyroidism
myxedema
grave's disease
hashimoto's disease
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skeletal complaints
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difficulty with gait or limping
numbness
tingling
pressure sensation
pain with mvt
crepitus
deformity or change in skeletal contour
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mm tone is often evaluated ______________
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simultaneously
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diastolic rumble
early and late in diastole
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tricuspid stenosis
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Maternal blood volume increases...
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40-50% over pre-pregnancy level
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What is in the RUQ?
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liver and gallbladder
pylorus
duodenum
head of pancreas
right adrenal gland
portion of right kidney
hepatic flexure
portions of ascending and transverse colon
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What is scoliosis?
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when the spine deviated laterally
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What is kyphosis?
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when the spine deviated posteriorly
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Mental Status: common abnormalities in infants and children
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mental retardation
ADHD
Austism
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what does a pinhole test eliminate?
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refractive error
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Argyll Robertson pupil
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bilateral, miotic, irregularly shaped pupils that fail to constrict with light but retain constriction with convergence, may or may not be equal in size
commonly caused by neurosyphilis or lesions in midbrain where afferent pupillary fibers synapse
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pink eye is...
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a viral conjunctivitis
with teary discharge
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what does a bruit indicate?
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a vascular anomaly
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Hyperresonance in the lungs is associated with...
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hyperinflation
may indicate emphysema, pneumothorax, or asthma
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Which sound is sometimes thought to be a form of rhochus?
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wheezes
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What is crepitus?
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a crackly or crinkly sensation
a gentle bubbly feeling
always a sign requiring attention
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The most common form of "innocent" midsystolic murmur in older adults is caused by...
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aortic sclerosis
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A pleural effusion can result in...
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permanent fibrotic thickening
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Atelectasis is...
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the incomplete expansion of the lung at birth or the collapse of the lung at any age
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What are some familial lung related problems you need to ask about?
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TB
Cystic fibrosis
Emphysema
allergy, asthma, atopic dermatitis
malignancy
bronchiectasis
bronchitis
clotting disorders (PE risk)
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personal and social history for mental status
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emotional status
discouragment
intellectual level
sleeping or eating patterns
use of alcohol or drugs
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where do you specifically check for skin cancer on the ear?
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the pina
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papilledema
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the central vessels in the eyes are pushed forward, and the veins are markedly dilated
venous pulsations are not visible and cannot be induced by pressure applied to the eye
venous hemorrhages may occur
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you should inspect the gums and gingiva for:
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color
moisture
swelling
bleeding
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you should inspect and palpate the lips for:
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symmetry
color
edema
surface abnormalities
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how do you test musculoskeletal function?
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active motions
passive motions
resisted movements
traction/compression
gliding
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What are some possible cardiac causes of chest pain?
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typical angina
atypical angina
prinzmetal variant angina
unstable angina
coronary insufficiency
MI
MVP
aortic dissection
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What is Cheyne-Stokes respiration?(periodic breathing)
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a regular periodic pattern of breathing with intervals of apnea followed by crescendo/decrescendo sequence of respiration
in seriously ill
brain damage at the cerebral level
drug-caused respiratory compromise
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An S3 gallop can be assc with what problem?
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CHF
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What are some PMH questions for heart?
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cardiac surgery, hospitalization
rhythm disorder
acute rheumatic fever, unexplained fever
swollen joints, inflam. rheumatism
St. Vitus dance
chronic illness: HTN, bleeding disorder, hyperlipidemia, DM, thyroid dysfunction, CAD, obesity, Congenital heart defect
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You need to listen to heart sounds in at least how many positions?
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2
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Decreased S1 may be caused by:
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slowed ventricular ejection rate/volume
mitral sufficiency
increased chest wall thickness
pericardial effusion
hypothyroidism
cardiomyopathy
LBBB
shock
aortic insufficiency
first degree AV block
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Lupus erythematosus facies
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butterfly rash over malar surfaces and bridge of nose
either a blush with swelling or scaly, red, maculopapular lesions may be present
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pingueculum
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a bump of inflamed fatty tissue on the eye but not encroaching on the cornea
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you palpate the auricles and mastoid area for:
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tenderness or pain
swelling
nodules
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Review of related history for mental status exam in adolescents
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school performance
family interactions, reluctance to communicate and to speak attitudes and experience
anger management
risk-taking behaviors
(safety, drug/alcohol use, sexual activity)
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the inferior oblique mm moves the eye...
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up and in
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you inspect the auditory canal from the _________ to the ___________
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meatus
tympanic membrane
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Orientation questions for the Mini Mental status exam
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what is the...
date name of this hospital
month floor we are on
day town
season city
year state
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the musculoskeletal system provides...
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the stability and mobility for physical activity
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why should you percuss the spinal processes?
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for spinal tenderness
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What position should the patient be in if you have a hard time feeling the apical impulse?
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left lateral recumbant
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What is orthopnea?
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SOB that begins or increases when the patient lies down
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What are some causes of LUQ pain?
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ruptured spleen
gastric ulcer
aortic aneurysm
perforated colon
pneumonia
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How wide should the aorta be?
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no more than 4-6 cms
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What can S4 be associated with?
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CHF
HCM
HTN
pulm HTN
AS w/ severe LV disease
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What is tactile fremitus?
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a palpable vibration of the chest wall that results from speech or other verbalizations
"99" or "Mickey Mouse"
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where are the lacrimal glands located?
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the superior temporal orbital rim
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what is glaucoma?
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a disease of the optic nerve wherein the nerve cells die, producing a characteristic appearance of the optic nerve (increased cupping)
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Suspect facial n weakness when...
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only the lower face is involved
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With hair make sure you note:
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texture, color and distribution
also any split ends or cracking
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what does tonic pupil mean?
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affected pupil dilated and reacts slowly or fails to react to light; responds to convergence
cause by impairment of postganglionic parasympathetic inn to sphincter pupillae mm or ciliary malfunction
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you want to evert the upper and lower lids to inspect for:
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color
discharge
lacrimal system
foreign bodies
scratches
odd vasculature
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what are some muscular complaints patients will come in with?
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limitation of mvt
weakness or fatigue
paralysis
tremor or tic
spasms
clumsiness
wasting
aching
pain
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the tibiotalar joint permits what kind of movement?
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dorsiflexion and plantar flexion
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What does sudden standing do to the heart ?
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decreases afterload
decreases venous return and SV
increased HR
increased SVR
accentuates murmur and S4 of MVP and HOCM
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What do you inspect the body for in regards to heart problems?
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peripheral edema
clubbing, cyanosis
bounding pulses/head nodding
hyperthyroidism-exopthalmos
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What is in the LLQ?
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lower pole of the left kidney
sigmoid colon
portion of the descending colon
bladder (if distended)
ovary and salpinx
uterus (if enlarged)
left spermatic cord
left ureter
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Where would you best hear an S1 split?
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the tricuspid auscultatory area
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Which positions bring out mitral and aortic valve murmurs?
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left lateral decubitus
or leaning forward in an upright position
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The longer the wheeze and the higher the pitch...
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the worse the obstruction
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Absence of bowel sounds in established only after...
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5 minutes of continuous listening
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what is a indispensible aid for proper examination of the thyroid?
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a glass of water
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what are some factors that can cause hearing loss?
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age
occupational or loud music
trauma
antibiotic use (gentamycin, streptomycin)
radiation
auricular, nasal, facial or oral surgery
syphillis
hypoxic event
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what do you use to test for macular degeneration?
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the Amsler grid
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when you swing your leg behind the body without arching the back you should expect an ROM of...
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30 degrees or less
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what do the 2 cruciate ligaments add to the knee?
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anterior and posterior stability
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The trachea may be pushed to the side by...
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tension pneumothorax
a tumor
nodal enlargements on the contralateral side
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In the older adult the alveoli become...
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less elastic and relatively more fibrous.
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in distance visual acuity recording, what do the upper and lower numbers mean?
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upper number: distance in feet from the patient to the chart
lower number: distance in feet at which a person w/ excellant vision would see the same letter
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What should you inspect in infants, in terms of the head and neck?
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head circumference
head symmetry and shape
fontanels
facial features
facial symmetry
neck symmetry, size and shape
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what does the ciliary body do?
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it produces the aqueous humor
and contains the mm controlling accommodation
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what is the difference btwn miosis and mydriasis?
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miosis is pupillary constriction
mydriasis is pupillary dilation >6mm
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Is ROM of motion is often greater during passive or active movements?
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passive, by about 5 degrees
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Cardiologically, what is a v wave?
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occurs after the start of the carotid upstroke and during ventricular systole
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Aging mucous membranes tend to become...
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drier and less able to rid themselves of mucus.
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Where on the sternum does the second rib articulate?
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the manubriosternal junction (angle of Louis)
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what are you looking for when you do an ophthamoscopic exam?
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lens clarity
red reflex
retinal color and lesions
chars. of blood vessels
disc characteristics
macula chars.
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Why is a barrel chest characteristic in many older adults?
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- loss of mm strength in thorax & diaphragm
- loss of lung resiliency
- skeletal changes of aging tend to emphasize the dorsal curve of the thoracic spine resulting in increasing the AP diameter
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If only the mouth is involved in a facial problem suspect...
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a problem with the peripheral trigeminal nerve
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the light reflex from the tympanic membrane should point in what direction?
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it should point toward the front, like towards your cheek
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pain, limitation of mvt, spastic mvt, joint instability, deformity and contracture suggest a problem with...
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the joint, related mm group or nn supply
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Is the AP diameter or the transverse diameter normally larger?
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AP << transverse
at times by as much as half
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what would cause a bruit to be heard over the thyroid?
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a hypermetabolic state where the blood supply is dramatically increased
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to assess muscle strength have the patient:
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1. contract the mm
2. to resist as you apply forace against the mm contraction
3. tell the pt to push against your hand to feel resistance
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Anatomically where do you listen for the mitral valve area?
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at the apex of the heart in the fifth left intercostal space at the midclavicular line
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what are the mm function level grades
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0 = no evidence of mvt
1 = trace of mvt
2 = full ROM, but no against gravity
3= full ROM against gravity but not against resistance
4= full ROM against gravity & some resist., but weak
5 = full ROM against gravity, full resistance
gravity = passive mvt
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