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Terms Definitions
Ear History vertigo/dizziness
hearing loss
auricular discharge
cerumen impaction
Tachycardia can indicate... CHF
alopecia loss of hair
What is gibbus? extreme kyphosis
palpate the thyroid for: size
if its large, auscultate for bruits
Bradycardia can indicate... good conditioning
heart block
digoxin intoxicity
Clinical picture of RDS includes... tachypnea
Females exhibit mostly _________ movement with respiration costal
Exam sequence for the heart inspection
auscultate the temporal arteries for: bruits
Anisocoria 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
a medial carrying angle cubitus varus
Which heart sounds corresponds with the carotid pulse? S1
Fine crackles may be associated with... CHF
Retained mucous... encourages bacterial growth and predisposes the older adult to respiratory infection
midsystolic (ejection) murmur, coarse, crescendo - decrescendo, thrill aortic stenosis
Abdominal PMH questions GI disorders
hepatitis or cirrhosis
ab or UT surgery or injury
major illness
blood transfusions
hep vaccines
colorectal cancer or related cancers
Inspect the neck for: symmetry
alignment of trachea
masses, webbing and skinfolds
Jugular venous distention
carotid artery prominance
what are some retinal findings? glaucoma
hypertensive retinopathy
diabetic retinopathy
retinal detachment
retinal artery or vein occlusion
optic atrophy
you inspect the auditory canal for: cerumen
foreign bodies
what are some thyroid related problems? hypothyroidism
grave's disease
hashimoto's disease
skeletal complaints difficulty with gait or limping
pressure sensation
pain with mvt
deformity or change in skeletal contour
mm tone is often evaluated ______________ simultaneously
diastolic rumble
early and late in diastole
tricuspid stenosis
Maternal blood volume increases... 40-50% over pre-pregnancy level
What is in the RUQ? liver and gallbladder
head of pancreas
right adrenal gland
portion of right kidney
hepatic flexure
portions of ascending and transverse colon
What is scoliosis? when the spine deviated laterally
What is kyphosis? when the spine deviated posteriorly
Mental Status: common abnormalities in infants and children mental retardation
what does a pinhole test eliminate? refractive error
Argyll Robertson pupil 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
pink eye is... a viral conjunctivitis
with teary discharge
what does a bruit indicate? a vascular anomaly
Hyperresonance in the lungs is associated with... hyperinflation
may indicate emphysema, pneumothorax, or asthma
Which sound is sometimes thought to be a form of rhochus? wheezes
What is crepitus? a crackly or crinkly sensation
a gentle bubbly feeling
always a sign requiring attention
The most common form of "innocent" midsystolic murmur in older adults is caused by... aortic sclerosis
A pleural effusion can result in... permanent fibrotic thickening
Atelectasis is... the incomplete expansion of the lung at birth or the collapse of the lung at any age
What are some familial lung related problems you need to ask about? TB
Cystic fibrosis
allergy, asthma, atopic dermatitis
clotting disorders (PE risk)
personal and social history for mental status emotional status
intellectual level
sleeping or eating patterns
use of alcohol or drugs
where do you specifically check for skin cancer on the ear? the pina
papilledema 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
you should inspect the gums and gingiva for: color
you should inspect and palpate the lips for: symmetry
surface abnormalities
how do you test musculoskeletal function? active motions
passive motions
resisted movements
What are some possible cardiac causes of chest pain? typical angina
atypical angina
 prinzmetal variant angina
unstable angina
coronary insufficiency
aortic dissection
What is Cheyne-Stokes respiration?(periodic breathing) 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
An S3 gallop can be assc with what problem? CHF
What are some PMH questions for heart? 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
You need to listen to heart sounds in at least how many positions? 2
Decreased S1 may be caused by: slowed ventricular ejection rate/volume
mitral sufficiency
increased chest wall thickness
pericardial effusion
aortic insufficiency
first degree AV block
Lupus erythematosus facies butterfly rash over malar surfaces and bridge of nose
either a blush with swelling or scaly, red, maculopapular lesions may be present
pingueculum a bump of inflamed fatty tissue on the eye but not encroaching on the cornea
you palpate the auricles and mastoid area for: tenderness or pain
Review of related history for mental status exam in adolescents school performance
family interactions, reluctance to communicate and to speak attitudes and experience
anger management
risk-taking behaviors
(safety, drug/alcohol use, sexual activity)
the inferior oblique mm moves the eye... up and in
you inspect the auditory canal from the _________ to the ___________ meatus
tympanic membrane
Orientation questions for the Mini Mental status exam what is the...
     date                 name of this hospital
     month               floor we are on
     day                   town
     season              city
     year                  state
the musculoskeletal system provides... the stability and mobility for physical activity
why should you percuss the spinal processes? for spinal tenderness
What position should the patient be in if you have a hard time feeling the apical impulse? left lateral recumbant
What is orthopnea? SOB that begins or increases when the patient lies down
What are some causes of LUQ pain? ruptured spleen
gastric ulcer
aortic aneurysm
perforated colon
How wide should the aorta be? no more than 4-6 cms
What can S4 be associated with? CHF
pulm HTN
AS w/ severe LV disease
What is tactile fremitus?  a palpable vibration of the chest wall that results from speech or other verbalizations
"99" or "Mickey Mouse"
where are the lacrimal glands located? the superior temporal orbital rim
what is glaucoma? a disease of the optic nerve wherein the nerve cells die, producing a characteristic appearance of the optic nerve (increased cupping)
Suspect facial n weakness when... only the lower face is involved
With hair make sure you note: texture, color and distribution
also any split ends or cracking
what does tonic pupil mean? 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
you want to evert the upper and lower lids to inspect for: color
lacrimal system
foreign bodies
odd vasculature
what are some muscular complaints patients will come in with? limitation of mvt
weakness or fatigue
tremor or tic
the tibiotalar joint permits what kind of movement? dorsiflexion and plantar flexion
What does sudden standing do to the heart ? decreases afterload
decreases venous return and SV
increased HR
increased SVR
accentuates murmur and S4 of MVP and HOCM
What do you inspect the body for in regards to heart problems? peripheral edema
clubbing, cyanosis
bounding pulses/head nodding
What is in the LLQ? 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
Where would you best hear an S1 split? the tricuspid auscultatory area
Which positions bring out mitral and aortic valve murmurs? left lateral decubitus
or leaning forward in an upright position
The longer the wheeze and the higher the pitch... the worse the obstruction
Absence of bowel sounds in established only after... 5 minutes of continuous listening
what is a indispensible aid for proper examination of the thyroid? a glass of water
what are some factors that can cause hearing loss? age
occupational or loud music
antibiotic use (gentamycin, streptomycin)
auricular, nasal, facial or oral surgery
hypoxic event
what do you use to test for macular degeneration? the Amsler grid
when you swing your leg behind the body without arching the back you should expect an ROM of... 30 degrees or less
what do the 2 cruciate ligaments add to the knee? anterior and posterior stability
The trachea may be pushed to the side by... tension pneumothorax
a tumor
nodal enlargements on the contralateral side
In the older adult the alveoli become... less elastic and relatively more fibrous.
in distance visual acuity recording, what do the upper and lower numbers mean? 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
What should you inspect in infants, in terms of the head and neck? head circumference
head symmetry and shape
facial features
facial symmetry
neck symmetry, size and shape
what does the ciliary body do? it produces the aqueous humor
and contains the mm controlling accommodation
what is the difference btwn miosis and mydriasis? miosis is pupillary constriction
mydriasis is pupillary dilation >6mm
Is ROM of motion is often greater during passive or active movements? passive, by about 5 degrees
Cardiologically, what is a v wave? occurs after the start of the carotid upstroke and during ventricular systole
Aging mucous membranes tend to become... drier and less able to rid themselves of mucus.
Where on the sternum does the second rib articulate? the manubriosternal junction (angle of Louis)
what are you looking for when you do an ophthamoscopic exam? lens clarity
red reflex
retinal color and lesions
chars. of blood vessels
disc characteristics
macula chars.
Why is a barrel chest characteristic in many older adults? - 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
If only the mouth is involved in a facial problem suspect... a problem with the peripheral trigeminal nerve
the light reflex from the tympanic membrane should point in what direction? it should point toward the front, like towards your cheek
pain, limitation of mvt, spastic mvt, joint instability, deformity and contracture suggest a problem with... the joint, related mm group or nn supply
Is the AP diameter or the transverse diameter normally larger? AP << transverse
at times by as much as half
what would cause a bruit to be heard over the thyroid? a hypermetabolic state where the blood supply is dramatically increased
to assess muscle strength have the patient: 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 
Anatomically where do you listen for the mitral valve area? at the apex of the heart in the fifth left intercostal space at the midclavicular line
what are the mm function level grades 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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