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Doctoring > Bates Physical Exam > Flashcards

Bates Physical Exam Flashcards

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1
Q

apparent state of health fits in what part of physical exam?

A

general survey

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2
Q

level of consciousness fits in what part of physical exam?

A

general survey

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3
Q

signs of distress fit in what part of physical exam?

ie cardiac or respiratory distress, pain, or anxiety/depression

A

general survey

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4
Q

dress, grooming, and personal hygiene fits in what part of physical exam?

A

general survey

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5
Q

facial expression fits in what part of physical exam?

A

general survey

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6
Q

odors of body and breath fits in what part of physical exam?

A

general survey

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7
Q

height and weight fits in what part of physical exam?

A

general survey

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8
Q

BMI calculation

A

(Lbs * 700)/inches
OR
Kg/m^2

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9
Q

what is masked hypertension

A
  • 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
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10
Q

what is nocturnal hypertension and how is it tested for

A
  • a nocturnal fall of <10% of daytime values
  • associated with poor cardiovascular outcomes
  • requires 24 hour ambulatory BP monitoring to identify
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11
Q

what happens if BP cuff is too small

A

BP will read high

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12
Q

what happens if BP cuff is too large

A

BP will read low on a small arm and high on a large arm

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13
Q

what’s the proper width of a the inflatable bladder on a BP cuff

A

about 40% of the upper arm circumference

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14
Q

what’s the proper length of the inflatable bladder on a BP cuff

A

about 80% of the upper arm circumference

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15
Q

what happens if brachial artery is below heart level during BP measurement

A

BP will read high

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16
Q

what happens if brachial artery is above the heart level during BP measurement

A

BP will ready low

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17
Q

how and why to estimate systolic pressure

A
  • 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
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18
Q

what is auscultatory gap and what is it associated with

A
  • silent interval that may be present between systolic and diastolic pressures
  • associated with arterial stiffness and atherosclerotic disease
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19
Q

korotkoff sounds

A
  • the blood flow sounds heard while taking blood pressure

* they are low in pitch and better heard with the bell

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20
Q

When do you find the systolic pressure

A

this is the level when you hear the sounds of at least 2 consecutive beats

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21
Q

When do you find the diastolic pressure

A
  • once the korotkoff sounds become muffled and then disappear
  • continue listening another 10-20 mmHg to confirm disappearance point
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22
Q

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?

A
  • subclavian steal syndrome
  • supravalvular aortic stenosis
  • aortic dissection
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23
Q

consensual reaction to light

A

when light is shined into one eye, the opposite pupil will also constrict (the reaction in the first eye is called the direct reaction)

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24
Q

what nerves are involved in the pupillary reaction

A

CN II senses the light

CN III transmits the motor innervation to constrict the pupil

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25
the near reaction (eye)
when shifting gaze from a far object to a near one, the pupils constrict
26
visual acuity
* 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
27
myopia
* nearsightedness | * focusing problems for distance vision
28
presbyopia
* causes focusing problems for near vision | * found in middle-aged and older adults
29
hyperopia
* farsightedness | * focusing problems for near vision
30
normal pupils size range
between 3 and 5 mm
31
what is anisocoria
difference in pupillary diameter between eyes
32
what is nystagmus
* fine rhythmic oscillation of the eyes | * a few beat of nystagmus on extreme lateral gaze are normal
33
what is lid lag and what might it indicate
* rim of sclera is visible above the iris with downward gaze | * hyperthyroidism
34
preauricular lymph node
in front of ear
35
posterior auricular lymph node
superficial to the mastoid process
36
occipital lymph node
at the base of the skull posteriorly
37
tonsillar lymph node
at the angle of the mandible
38
submandibular lymph node
midway between the angle and the tip of the mandible
39
submental lymph node
in the midline a few centimeters behind the tip of the mandible
40
superficial cervical lymph node
superficial to the SCM
41
posterior cervical lymph node
along the anterior edge of the trapezius
42
deep cervical chain lymph node
deep to the SCM and often inaccessible to examination
43
supraclavicular lymph node
deep in the angle formed by the clavicle and SCM
44
what is stridor
high-pitched musical sound from subglottic or tracheal obstruction that signals a respiratory emergency
45
how to measure for orthostatic hypotension
* measure BP supine after patient has rested 3-10 minutes | * measure BP once patient stands up (take within 3 minutes of the supine reading)
46
what defines orthostatic hypotention
a drop in systolic BP of at least 20 mmHg or in diastolic BP of at least 10 mmHg within 3 minutes of standing
47
coarctation of the aorta
•arises from narrowing of the thoracic aorta and classically presents with systolic HTN greater in the arms than the legs
48
what is pyrexia
fever | hyperpyrexia is an extreme fever >41.1 C (106 F)
49
level of hypthermia
below 35 C (95F)
50
when do retractions occur
sever asthma, COPD or upper airway obstruction
51
when might you see asymmetric expansion in respiration
large pleural effusions
52
what does dullness to percussion in a lung field indicate
* fluid or solid tissue has replaced the air-containing space * ie pneumonia, pleural effusion, hemothorax, fibrous tissue, tumor, etc
53
hyperresonance to percussion in a lung field indicates
* hyperinflated lungs * ie COPD or asthma * if unilateral, could indicated large pneumothorax
54
vesicular breath sounds
* soft and low pitched | * inspiratory sounds longer than expiratory
55
bronchovesicular breath sounds
inspiratory and expiratory sounds about equal in length; at times, separated by a silent interval
56
bronchial breath sounds
* louder, harsher, and higher in pitch * short silence between inspiratory and expiratory sounds * expiratory sounds last longer than inspiratory
57
tracheal breath sounds
•loud, harsh sound heard over trachea in neck
58
adventitious sounds
* added sounds that are superimposed on usual breath sounds | * ie crackes (rales), wheezes, rhonchi
59
crackles arise from abnormalities of
* lung parenchyma (pneumonia, interstitial lung disease, pulmonary fibrosis, atelactasis, heart failure) * airways (bronchitis or bronchiectasis)
60
wheezes arise
in narrowed airways of asthma, COPD, and bronchitis
61
S1 and S2 and indications of systole and diastole
* from S1 to S2 is systole * from S2 to S1 is diastole * Diastole should last longer than systole
62
bounding (3+) carotid, radial, and femoral pulses are present in
aortic regurgitation
63
asymmetric diminished pulses point to
arterial occlusion from atherosclerosis or embolism
64
brownish discoloration or ulcers just above the malleolus suggests
chronic venous insufficiency
65
asymmetry in the abdomen could suggest
a hernia, enlarged organ, or a mass
66
areas dull to percussion in the abdomen can indicate
pregnant uterus, ovarian tumor, distended bladder, large liver, large spleen
67
light palpation of the abdomen is for
aids detection of tenderness, muscular resistance, and some superficial organs and masses
68
deep palpation of the abdomen is for
delineating the liver edge, kidneys, and abdominal masses
69
signs of peritonitis
guarding, rigidity, rebound tenderness, percussion tenderness
70
possible causes of peritonitis
appendicitis, cholecystitis, perforation of bowel wall
71
what is guarding
voluntary contraction of abdominal wall, may diminish when pt distracted
72
what is abdominal rigidity
involuntary reflex contraction of abdominal wall from peritoneal inflammation that persists over several examinations
73
possible causes of splenomegaly
portal hypertension, hematologic malignancies, HIV, infiltrative diseases (ie amyloidosis, splenic infarct, hematoma)
74
what is paresis
impaired strength or weakness
75
what is the name for absent strength
paralysis or plegia
76
wrist extensor weakness is seen in
peripheral radial nerve damage or hemiplegia of things like stroke or multiple sclerosis
77
a weak grip can be seen in
cervical radiculopathy | median or ulnar peripheral nerve disease
78
weak finger abduction occurs in
ulnar nerve disorders
79
heel-to-toe walking (AKA tandem walking or stressed gait) can reveal
ataxia that is not otherwise obvious

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