Flashcards in Bates Physical Exam Deck (79)
apparent state of health fits in what part of physical exam?
level of consciousness fits in what part of physical exam?
signs of distress fit in what part of physical exam?
ie cardiac or respiratory distress, pain, or anxiety/depression
dress, grooming, and personal hygiene fits in what part of physical exam?
facial expression fits in what part of physical exam?
odors of body and breath fits in what part of physical exam?
height and weight fits in what part of physical exam?
(Lbs * 700)/inches
what is masked hypertension
•office BP <140/90 but elevated daytime BP >135/85 on home or ambulatory testing
•if untreated, estimated increased risk (10-30%) of cardiovascular disease and end-organ damage
what is nocturnal hypertension and how is it tested for
•a nocturnal fall of <10% of daytime values
•associated with poor cardiovascular outcomes
•requires 24 hour ambulatory BP monitoring to identify
what happens if BP cuff is too small
BP will read high
what happens if BP cuff is too large
BP will read low on a small arm and high on a large arm
what's the proper width of a the inflatable bladder on a BP cuff
about 40% of the upper arm circumference
what's the proper length of the inflatable bladder on a BP cuff
about 80% of the upper arm circumference
what happens if brachial artery is below heart level during BP measurement
BP will read high
what happens if brachial artery is above the heart level during BP measurement
BP will ready low
how and why to estimate systolic pressure
•palpate radial artery, rapidly inflate cuff until radial pulse disappears
•we take the number on the manometer and add 30. This is so we can avoid inflating the cuff unnecessarily high and causing discomfort
•also avoid error cause by auscultatory gap
what is auscultatory gap and what is it associated with
•silent interval that may be present between systolic and diastolic pressures
•associated with arterial stiffness and atherosclerotic disease
•the blood flow sounds heard while taking blood pressure
•they are low in pitch and better heard with the bell
When do you find the systolic pressure
this is the level when you hear the sounds of at least 2 consecutive beats
When do you find the diastolic pressure
•once the korotkoff sounds become muffled and then disappear
•continue listening another 10-20 mmHg to confirm disappearance point
when taking the BP in both arms you find a difference between arms greater than 10-15 mmHg. what conditions may be associated with these findings?
•subclavian steal syndrome
•supravalvular aortic stenosis
consensual reaction to light
when light is shined into one eye, the opposite pupil will also constrict (the reaction in the first eye is called the direct reaction)
what nerves are involved in the pupillary reaction
CN II senses the light
CN III transmits the motor innervation to constrict the pupil
the near reaction (eye)
when shifting gaze from a far object to a near one, the pupils constrict
•expressed as 2 numbers (i.e 20/20)
•the first is the distance of the patient from the chart
•the second is the distance at which a normal eye can read the line of letters
•focusing problems for distance vision
•causes focusing problems for near vision
•found in middle-aged and older adults
•focusing problems for near vision