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S7- Differential Diagnosis > Week 3- Physical Assessment as a Screening Tool > Flashcards

Week 3- Physical Assessment as a Screening Tool Flashcards

1
Q

PART 1

A

PART 1

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2
Q

(SQ)

Why is it important to screen the skin and nail beds for abnormal changes?

A

Changes in skin/nail bed may be the 1st sign of inflammatory, infectious, and immunologic disorders.

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3
Q

New onset of skin lesions (especially in _______) should be medically evaluated.

A

children

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4
Q

What do we want to assess for during a skin assessment? (6)

A

Changes in;

  • texture
  • color
  • temp
  • clubbing
  • circulation
  • edema
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5
Q

What are (3) changes in skin color and what may they indicate?

A

Pallor
-May indicate anemia, arterial insufficiency, fainting, shock.

Jaundice
-May indicate liver condition or hematologic disorder.

Cyanosis
-May indicate advanced lung disease, CHF, or low hemoglobin.

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6
Q

Changes in skin temperature are an indication of vascular supply, what are some other signs of decreased vascularity? (4)

A
  • paresthesia
  • muscle fatigue/discomfort
  • cyanosis w/ numbness
  • pain and loss of hair
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7
Q

(SQ)

Name the ABCDE Criteria utilized for screening suspicious skin lesions.

A
  • Asymmetry
  • Border
  • Color
  • Diameter (>6mm)
  • Evolving
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8
Q

Name (3) specific rashes/skin lesions.

A
  • Dermatitis (eczema)
  • Herpes Zoster (shingles)
  • Rheumatologic Diseases
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9
Q

Dermatitis:

  • What are the (3) types of dermatitis? Describe each.
  • How does it present?
A 
Contact Dermatitis
-Skin reacts to something it has come in contact with.
Dyshidrotic Dermatitis
-Affects skin that gets wet frequently.
Atopic Dermatitis
-Often accompanies asthma or hay fever.

-Skin is red, brown, or grey; sore; itchy and sometimes swollen.

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10
Q

Herpes Zoster (shingles):

  • Rash may last __-__ days.
  • Reports burning, shooting pain and tingling or itching.
  • Lesion appears ________ along the path of _________.
A
  • 1-14 days

- unilaterally along path of spinal nerve

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11
Q

Rheumatologic Diseases:

  • What is often the first sign of underlying rheumatoid disease?
  • What are 3 common rheumatoid diseases?
A
  • Skin lesion/rash

- SLE, Discoid lupus erythematosus, Lyme disease

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12
Q

(SQ)

What characteristics of lymph nodes increase the suspicion of cancer? (3)

A
  • hard
  • immovable
  • nontender
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13
Q

Capillary refill at nail beds should occur in __ seconds.

A

3 seconds

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14
Q

(SQ)

Name 3 nail abnormalities and the disease states associated with them.

A

Beau’s Lines
-acute illness or systemic disease

Splinter Hemorrhages
-may be sign of silent MI or pt may have Hx of MI

Clubbing
-chronic O2 deprivation

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15
Q

Beau’s Lines:

  • What is the presentation?
  • Usually caused by _____ _______ or _______ _______.
  • Name some other associated conditions.
A
  • Transverse grooves across nail plate.
  • acute illness or systemic disease
  • poor peripheral circulation, eating disorders, cirrhosis, recent MI, other trauma
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16
Q

Splinter Hemorrhages:

  • What is the presentation?
  • May be a sign of ______ ____ or Hx of ___.
  • When is it of more concern?
A
  • Red-brown, linear streaks
  • silent MI or Hx of MI
  • More of concern when seen on multiple fingers.
17
Q

Clubbing:

  • Usually results from chronic __________ in tissue beds.
  • Often observed in patients with COPD, congenital heart defects, and cor pulmonale.
  • Can occur within 10 days in patient with acute systemic condition.
  • ______ (__-__ days) development of clubbing requires immediate medical evaluation.
A
  • O2 deprivation

- Rapid (10-14 days)

18
Q

What is Schamroth’s Sign?

A

Way to tell whether clubbing is occurring. Put distal phalanges up to each other to see if it makes a window.

19
Q

PART 2: TESTS

A

PART 2: TESTS

20
Q

Name the tests utilized. (8)

A
  • Kidney Percussion
  • Liver Percussion
  • Spleen Percussion
  • Murphy’s Sign
  • McBurney’s Sign
  • Rovsing’s Sign
  • AAA Palpation
  • AAA Auscultation
21
Q

What is a + Kidney, Liver, or Spleen Percussion Test?

A

Tenderness with percussion.

22
Q 
(SQ)
Murphy's Sign:
-What is the purpose of Murphy's Sign?
-How do we perform it?
-What is an abnormal finding?
A
  • Purpose: Test for Acute Cholecystitis (gall stones)
  • Perform: With pt in hook lying, ask pt to exhale. Perform palpation below costal margin on right side at midclavicular line. Have patient take a deep breath in.
  • Abnormal Finding: Patient stops breathing/winces or reports tenderness.
23
Q 
(SQ)
McBurney's Sign:
-What is the purpose of McBurney's Sign?
-How do we perform it?
-What is an abnormal finding?
A
  • Purpose: Test for appendicitis.
  • Perform: With pt in hook lying, perform a deep palpation 1/2 distance between umbilicus and ASIS on R side. Quickly release and assess for rebounding tenderness.
  • Abnormal Finding: Tenderness
24
Q 
(SQ)
Rovsing's Sign:
-What is the purpose of Rovsing's Sign?
-How do we perform it?
-What is an abnormal finding?
A
  • Purpose: Test for appendicitis.
  • Perform: With pt in hook lying, perform a deep palpation 1/2 distance between umbilicus and ASIS on L side. Quickly release and assess for rebounding tenderness.
  • Abnormal Finding: R sided tenderness with remote rebounding testing on L side.
25
Q

AAA Palpation:

  • How do we perform it?
  • What is an abnormal finding?
A
  • Perform: With pt in supine, palpate for aortic pulse superior and slightly left of umbilicus. Place palms on abdomen with index fingers on each side of aorta.
  • Abnormal Finding: Pulse width >3cm or provocation of symptoms (including tenderness/referred pain to back)
26
Q

AAA Auscultation:

  • How do we perform it?
  • What is an abnormal finding?
A
  • Perform: With pt in supine, auscultate just left of the midline. Apply firm pressure but no dent (can occlude vessel) beginning at level of renal arteries and move towards umbilicus.
  • Abnormal Finding: Presence of bruit (abnormal blowing/swishing sounds). Palpation and auscultation for AAA improves value of techniques as a screening tool for thin patients with aneurysms >5cm.
27
Q

When To Perform Abdominal Palpation and Auscultation:

  • With a suspicion of abdominal pathology causing ____.
  • Who presents with a ___-_______ pattern of LBP unchanging with postures, positions, activities, etc.
  • At high risk for _____.
  • Who are not responding to therapy interventions.
A
  • LBP
  • non-mechanical LBP
  • AAA
28
Q

PART 3: FRACTURE SCREENING

A

PART 3: FRACTURE SCREENING

29
Q

List the Fracture Clinical Decision Rules. (5)

A
  • Canadian C-Spine rules
  • NEXUS Criteria
  • Pittsburg Knee Decision Rule
  • Ottowa Knee Decision Rule
  • Ottowa Ankle Decision Rule
30
Q

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31
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32
Q

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33
Q

1

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34
Q

1

A

1

35
Q

(SQ)

What are the indications for use of a tuning fork to screen for a fracture? (3)

A
  • If you cannot get close with palpation, then it is not beneficial to use a tuning fork.
  • Sensitivity and specificity not great.
  • Positive finding suggests bony involvement (not diagnostic).
36
Q

(SQ)

What tuning fork frequency should be utilized for fracture screening?

A

128 or 256Hz

37
Q

What are (2) tests utilized to screen for fractures?

A
  • Fulcrum Test

- Patellar Pubic Percussion

S7- Differential Diagnosis (15 decks)

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