Clinical Methods Exam Flashcards

Health Care
Terms Definitions
nose history
allergies                              nosebleeds
URIs                                   sinus infections
post nasal drip                     loss of smell
breathing                             nasal surgery/trauma
snoring
Sonorous wheezes =
rhonchi
Hypothyroidism sxs:
puffy eyes                   feels cold; sensitive to cold
no goiter                     weight gain
constipation                coarse/breakable hair
menorrhagia                scaly, dry skin
lethargy                      thick nails
 
Stridor occurs in...
croup
laryngitis
epiglottitis
vocal cord dysfunction
tumors
stenosis of the extrathoracic trachea
dull colored tympanic membrane
fibrosis
presbyopia
progressive weakening of accommodation
occurs with aging
Rhonchi are more pronounced during...
expiration
crouzon syndrome facies
severe, severe maxillary and midfacial hypoplasia
low set ears
Schema of the musculoskeletal exam
observation
function
palpation
neurological tests
special tests
High crackles are described as ___________
sibilant
An inflammation of the mucous membranes of the bronchial tubes is called....
bronchitis
Crackles are heard more often during...
inspiration
What can cause tachypnea?
hyperventilation
protective splinting from pain of a broken rib or pleurisy
massive liver enlargement
abdominal ascites
what is another name for icterus?
jaundice
epiglotitis
an acute ilfe threatening disease almost always caused by haemophilus influenzae
 
progressive full obstruction of airway resulting in death
 
medical emergency
acromegaly
coarsening of features with broadening of the nasal alae
prominence of the zygomatic arches
bossing forehead
What is a goiter?
an enlarged thyroid
you should inspect the tongue for:
swelling
size
color
variations
coating
ulcerations
craniofacial dystosis facies
mandibular prognathism
drooping lower lip
short upper lip
parrot beak nose
proptotic eyes
tonsillitis
inflammation or infection of the tonsils
commonly caused by streptococci
 
sxs: sore throat, referred pain to the ears, dysphagia, fever, fetid breath, malaise
 
tonsils appear red and swollen, crypts are filled with purulent exudate
you should always test the _______________ side first
uninvolved
What are some possible gastrointestinal problems that can cause chest pain?
hiatus hernia
reflux esophagitis
esophageal spasm
cholecystitis
Peptic ulcer disease
pancreatitis
5 Fs for an enlarged, nonpainful gallbladder:
Fat
Forty
Fertile
Flatulent
Female
Wheezes mostly occur with asthma, but they also occur with...
COPD
bronchiolitis
HF
Which sound (crackles or rhonchi) tend to disappear after coughing?
rhonchi
how is mental status assessed?
throughout the PE
sleep apnea
periodic cessation of breathing during sleep that is assc with either an obstruction to airflow or with failure of the CNS to stimulate the respiratory effort to breathe.
the macula is...
the site of central vision
xanthalasma
yellow fatty deposits on the eye lids
 
need to check for high cholersterol
which 2 joints comprise the shoulder girdle?
glenohumeral
acromioclavicular
sternoclavicular
Which unexpected lung sounds are continuous and which are discontinuous?
crackles are discontinuous
 
rhonchi and wheezes are continuous
When the obstruction is high in the respiratory tree, breathing is characterized by...
stridor.
What are some causes of RUQ pain?
duodenal ulcer
hepatitis
hepatomegaly
pneumonia
cholecystitis
If bronchophony is extreme even a whisper can be heard clearly and intelligibly through the stethoscope.
 
this is called:
whispered pectoriloquy
Early crackles are often heard in patients with...
asthma
emphysema
chronic bronchitis
What is a wheeze?
a high pitched shrill sound
What is clubbing?
enlargement of the terminal phalanges of the fingers and/or toes
It is associated with chronic fibrotic changes of the lungs, CHD, CF
What are some common cardiovascular disorder symptoms in older adults?
confusion, dizziness, blackouts, syncope
palpitations
coughs and wheezes
hemoptysis
SOB
chest pains and tighness
impotence
fatigue
leg edema
peritonsillar abscess
infection of the tissue btwn the tonsil and tonsillar pillar occurs as a complication of tonsillitis
 
sxs: dysphagia, drooling, severe sore throat with pain radiating to the ear, muffled voice, malaise and fever
 
red and swollen
oral cancer
may appear as an ulcerative lesion that may be erythematous, white or pigmented, appearing as piled pu edges around a core that often appears on the lateral border or floor of the mouth
 
Signs: sore in the mouth that will not heal, a white or red patch on the gums, tongue, tonsil or buccal mucosa, bledding, ulceration and a lump of thickening in the cheek
what are some causes of nonparalytic strabismus?
infantile cataract
retinoblastoma
throat and pharynx history
dental problems
ulcers
lip and mouth lesions
difficulty talking or swallowing
what do you inspect the external ear canal for?
discharge
odor
what are some different eye problems that could be noted in a FH?
glaucoma
macular degeneration
cataracts
a lateral carrying angle > 15 is:
cubitus valgus
What is bradypnea?
a respiratory rate slower than 12 respirations per minute
Retractions of the lower chest occurs with...
asthma and bronchiolitis
Where should the trachea be?
midline, directly above the suprasternal notch
What are some causes of periumbilical pain?
intestinal obstruction
acute pancreatitis
early appendicitis
mesenteric thrombosis
aortic aneurysm
diverticulitis
What is croup?
a syndrome that generally results from infection with a variety of viral agents, particularly the parainfluenza viruses
 
harsh, bark-like cough
labored breathing
retraction
hoarseness
inspiratory stridor
What is cor pulmonale?
an acute or chronic condition involving right-sided heart failure
 
most often a direct result of PE
Where does a friction rub occur?
outside the respiratory tree
What can a single and loud P2 mean
 
pulmonary HTN
Aspiration of a foreign body down one or the other bronchii causes...
unilateral retraction
what is chorioretinal inflammation?
an inflammatory process that involves both the choroid and the retina.  it results in a sharply defined lesion that is generally whitish yellow and becomes stippled with dark pigment in later stages ending with a scar.
what are the different types of HAs?
classic migraines
common migraines
cluster
hypertensive
muscular tension
temporal arteritis
investigate cognitive abilities by assessing:
state of consciousness
response to questions
reasoning
arithmetic ability
memory
attention span
the superior rectus mm moves the eye...
up and out
the superior oblique mm moves the eye...
down and in
blue or deep red tympanic membrane
blood in middle ear
musculoskeletal exam: examine each region of the body for...
limb and trunk stability
muscular strength and function
joint function
 
position the extremities uniformly so you can check for asymmetry
where are the ligaments that protect the ankle located?
medially and laterally
Dullness on chest percussion can indicate...
pleural effusion and lobar pneumonia.
Pursing of lips is an accompaniment of...
increased respiratory effort
 
it reduces the effort of dyspnea
What can cause crepitus?
a rupture somewhere in the respiratory system
 
infection with a gas-producing organism
 
 
What causes a pleural friction rub?
inflammation of the pleural surfaces
 
 
A palpable pull of the trachea out of midline with respiration is called:
a tug
A dull or flat sound from the lungs suggest...
alelectasis
pleural effusion
pneumothorax
asthma
evaluate mm balance and movement of eyes with...
corneal light reflex
cover-uncover test
six cardinal fields of gaze
nystagmus
inspect the buccal mucosa for:
color and moisture
aphthous ulcers or fordyce spots
parotid (stenson's) ducts
what bony structure do you see in the middle of the tympanic membrane?
the umbo
what is strabismis?
a condition where both eyes do not focus on an object simultaneously
(can be paralytic or nonparalytic)
 
light reflects in different places in the eyes
you want to inspect the conjunctiva and sclera for:
redness
vessels
growths or lesions, foreign bodies
proptosis (exophthalmus)
enophthalmus
what ligament protects the knee from hyperextension?
the anterior cruciate ligament
at what angle should the arm be flexed to palpate the extensor surface of the ulna?
70 degrees
Murphy's sign is used to feel what?
if a gallbladder is enlarged
What is in the RLQ?
lower pole of right kidney
cecum and appendix
portion of ascending colon
bladder (if distended)
overy and salpinx
uterus (if enlarged)
right spermatic cord
right ureter
Amphoric breath sounds are most often heard with...
a large, relatively stiff-walled pulmonary cavity or
tension pneumothorax with bronchopleural fistula
Crackles with a dry quality, more crisp than gurgling are apt to occur where?
higher in the respiratory tree
the oblique fissure of the left lung divides it into...
upper and lower portions
When do children start to use intercostal musculature for respiration?
at age 6 or 7
what are some different ways to access distance vision?
Snellen charts
E Charts
pinhole test
tympanic membrane: mobility with negative pressure only
obstruction of eustachian tube with or without effusion
the lateral rectus mm moves the eyes...
laterally, out towards your ears
what equipment would you need to do a musculoskeletal exam?
skin-marking pencil
goniometer
tape measure
reflex hammer
What is the difference in breath sounds and tactile fremitis between pulmonary effusion and lobar pneumonia?
pulmonary effusion: no breath sounds, absent tactile fremitis
 
lobar pneumonia: bronchial breath sounds, increased tactile fremitis
Vocal resonance diminishes and loses intensity when there is:
blockage of the respiratory tree for any reason
things to check for mental status exams in children
- speech and language
- behavior: tantrums, hyperactivity, attention span, seperation abilities
- performance of self-care activities
- personality and behavoir patterns
- learning or school difficulties
 
assessed in the Denver Dev. Test
Head and Neck Exam in Pregnant women
inspect for chloasma (mask of preg)
palpate for hypertrophy of thyroid
auscultate for thyroid bruit
in what patients is lordosis common?
those who are markedly obese
or pregnant
Where do you listen for venous hums?
the epigastric region and around the umbilicus
(use the bell)
When should a child grow out of having a round (barrel) chest?
by 2 years of age
The apical impulse should be seen where?
about the midclavicular line in the fifth left intercostal space
what does the tracheobronchial tree do?
provides a pathway along which air if filtered, humidified and warmed
the medial rectus mm moves the eye...
medially, towards your nose, makes you make cross eyed faces
what is a consensual response?
when you shine light into one eye the other pupil constricts too
normal ROM of the back
bend forward and try to touch toes -- 75-90 degs
 
bend back at waist as far as possible -- 30 deg
 
bend to each side as far as possible -- 35 degs bilaterally
 
swing the upper trunk from the waist in a circular motion front to side to back to side while you stabilize the pelvis -- 30 degs forward and backward
How do you do the iliopsoas mm test?
if positive, they are experiencing LQ pain
 
pt lies supine and then place your hand over the lower thigh. Ask the pt to raise the leg, flexing at the hip as you push down against the leg
what part of the eye is continuously with the sclera?
the cornea
 
a major part of the refractive power of the eye
how do you test an elbow's ROM?
with the elbow fully extended at 0 degrees, bend and straigthen the elbow. Expect flexion of 160 degrees and extension returning to 0 or 180 degrees of full extension
 
with the elbow flexed at a right angle, rotate the hand from palm side down to palm side up. expect pronation and supination of 90 degrees
Is S1 or S2 louder at the pulmonic and aortic valves?
S2
 
because the closure of these valves is associated with the second heart sound, S2
Some patients will tilt their head to one side to...
favor a good eye or ear
occurs w/ unilateral hearing or vision loss
 
can also be associated with the shortening of the SCM muscle (torticollis)
Why could the right lung be higher than the left?
because of the fullness of the dome of the liver
how do you check the patients anterior chamber?
by shining a light into the eye from the side
 
normal, iris has no shadow
shallow anterior chamber, a portion of the iris is shadowed
With the weber test if you have AC loss it will lateralize to what ear?
to the ear that has the air conduction problem, like too much wax
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