Beginning the Physical Exam: General Survey, Vitals, Pain (Bates ch. 4) Flashcards
(121 cards)
1
Q
fatigue and weakness
Fatigue is a ____ _____ with many causes
A
nonspecific symptom
2
Q
fatigue and weakness
Fatigue refers to
A
a sense of weariness or loss of energy that can be described in many ways
3
Q
fatigue and weakness
weakness is a form of ____
A
fatigue
4
Q
fatigue and weakness
Weakness denotes…
A
a demonstrable loss of muscle power
5
Q
fatigue and weakness
Fatigue is a common symptom of
A
- depression and anxiety
- infections
- endocrine disorders
- adrenal insufficiency
- heart failure
- chronic disease of the lungs, kidneys, or liver
- electrolyte imbalance
- moderate to severe anemia
- malignancies
- nutritional deficits
- medications
6
Q
fatigue and weakness
Weakness, especially if localized in a neuroanatomical pattern, suggests possible ____ or ____
A
neuropathy or myopathy
7
Q
fever chills and sweats
recurrent shaking chills suggest more extreme swings in temp and systemic _____
A
bacteremia
8
Q
fever chills and sweats
feeling hot and sweaty also accompany menopause. night sweats occur in _____ and _____
A
tuberculosis and malignancy
9
Q
_____ refers to an abnormal elevation in body temperature
A
fever
10
Q
________, _______, and _______ accompany a rising temperature
A
feeling cold, goosebumps, and shivering
11
Q
____ and ____ accmpanies a falling temperature
A
feeling hot and sweating
12
Q
Normally the temperature _____ during the day and _____ during the night
A
rises during the day and falls during the night
13
Q
_____ occurs when fever exaggerates the swing in temperature between day and night
A
night sweats
14
Q
True or False: In immunocompromised patients, fever may be absent, low-grade, or drop below normal
A
True
15
Q
True or false: rapid changes in weight over a few days suggests changes in body tissue not body fluid
A
False, rapid changes over a few days is related to body fluid
16
Q
What to ask about if weight change appears to be a problem
A
- amount of change
- timing of change
- setting in which it occurred
- associated symptoms
17
Q
Weight gain occurrs when ______ exceeds _______ over time
A
caloric intake exceeds caloric expenditure
18
Q
Edema from extravascular fluid retention is visible in ____, ______, _____, and _____
A
- heart failure
- nephrotic syndrome
- liver failure
- venous stasis
19
Q
BMI
overweight is defined as a BMI of
A
25 to 29
20
Q
BMI
obesity is defined as a BMI of
A
greater than or equal to 30
21
Q
Types of medications associated with weight gain
A
- tricyclic antidepressants
- insulin
- sulfonylurea
- contraceptives
- glucocorticoids
- progestational steroids
- mirtazapine and paraxotine
- gabapentin and valproate
- propranolol
22
Q
clinically significant weight loss is defined as loss of ___% or more of usual body weight over a ____ month period
A
5% over 6 months
23
Q
causes of weight loss include
A
- gastrointestinal disease
- endocrine disorders
- chronic infections
- HIV/AIDS
- malignancy
- chronic cardiac pulmonary or renal failure
- depression
- anorexia nervosa or bulimia
24
Q
weight loss with relatively high food intake suggests ____
(4 possibilities)
A
- diabetes mellitus
- hyperthyroidism
- malabsorption
- binge eating (bulimia) with clandestine vomiting
25
Poverty, old age, social isolation ,physical disability, emotional or mental impairment, lack of teeth, ill fitting dentures, alcohol and substance use increase the risk of _____
malnutrition
26
signs and symptoms of malnutrition
- weakness
- fatigue
- cold intolerance
- flaky dermatitis
- ankle swelling
27
____ is one of the most common presenting symptoms in office practices
pain
28
4 steps to promote optimal weight and nutrition
- measure BMI and waist circumference
- assess dietary intake
- assess the patient's motivation to change
- provide counseling about nutrition and exercise
29
Increases risk factors for heart disease and other obesity related diseases
| adult BMI, waist circumference (m/f), waist to hip ratio (m/f) over 75y
- Adult BMI greater than or equal to 25 kg/m^2
- waist circumference in men greater than 40 inches
- waist circumference in women greater than 35 inches
- waist ratio in men greater than 0.95
- waist ratio in women greater than 0.85
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# weight classification
BMI less than 18.5
underweight
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# weight classification
BMI 18.5 to 24.9
normal weight
32
# weight classification
BMI 25 to 29.9
overweight
33
# weight classification
BMI 30 to 34.9
Obesity class I
34
# weight classification
BMI 35 to 39.9
Obesity class II
35
# weight classification
BMI greater than or equal to 40
Extreme obesity class III
36
Dream weight is often as much as ___% below initial body weight and is unrealistic for an initial goal
30%
37
Weight loss of ___ to ___% is more realistic and proven to reduce risk kof diabetes and other associated health problems
5% to 10%
38
A safe goal for weight loss is ___ to ___ lbs per week
0.5 to 2 lbs
39
USDA dietary guidelines emphasize consuming nutrient dense food such as ___, ___, ___, ___, ____, ____, ____, ____, ____, ____, ____
- veggies
- fruits
- whole grains
- fat free/low fat milk/milk products
- seafood
- lean meats
- poultry
- eggs
- beans
- peas
- nuts and seeds
40
Sodium intake should be less than _____ mg per day
2,300 mg
41
Sat fats should be less than or equal to __% of total calories
10%
42
dietary cholesterol should be less than or equal to ___ mg per day
300 mg
43
adolescent females and women of childbearing age should increase intake of ___, ___, and ___
iron, vitamin C, folic acid
44
adults older than 50 should identify foods rich in ___
vitamin B12
45
advise older adults, those with dark skin, and those with low exposure to sunlight to increase intake of ____
vitamin D
46
excess sodium intake can lead to ____, a major risk factor for CV disease
hypertension
47
reducing sodium intake by at least _____ mg per day lowers blood pressure
1,000 mg per day
48
Those with hypertension or high sodium diets should consider the ____ diet
DASH diet (dietary approaches to stop hypertension)
49
Adults should to at least ___ minutes of moderate intensity cardiorespiratory activity per week
150 minute (2.5 hours)
50
Adults can engage in vigorous intensity aerobic activity for ____ per week
75 minutes (1hr and 15 min)
51
Things included in the general survey
- appearance
- height
- weight
- mood
- build
- behavior
- BP
- posture
- alertness
- facial and skin coloration
- condition of dentition tongue and gingiva
- color of nail beds
- BMI
- how well they hear you when you enter the room
- movement
52
# general appearance
apparent state of health
## Footnote
examples
acutely or chronically ill, frail, fit, robust
53
# general appearance
level of consciousness
## Footnote
examples
awake, alert, resonsive to you an dothers in room
54
# general appearance
signs of distress
## Footnote
examples
- cardiac/respiratory distress (wheezing, clutching chest)
- pain (wincing)
- anxiety/depression (fidgety, flat affect)
55
# general appearance
skin color/condition
## Footnote
examples
scars, plaques, pallor, cyanosis, rashes, bruises
56
# general appearance
dress, grooming, hygiene
## Footnote
examples
- clothing suitable for weather (clothing can hide things like needle marks or show intolerance to cold)
- holes in shoes or slippers (can indicate edema, bunions, etc)
- jewelry (copper bracelets = joint pain, tattoos/piercings = sub use)
- grown out hair/nails suggest length of illness or neglect from depression/dementia
57
# general appearance
facial expression
## Footnote
examples
- the stare of hyperthyroidism
- immobile facies of parkinsonism
- flat/sad affect for depression
- decreased eye contact in anxiety, fear, sadness
58
# general appearance
odors of body and breath
## Footnote
examples
- alcohol/acetone = diabetes or infection, liver failure, uremia
59
# general appearance
posture, gait, motor activity
## Footnote
examples
- patients prefer to sit upright with L sided heart failure or leaning forward with arms braced in COPD
- anxious pts can appear restless
- look for tremors
- look for loss of balance
60
# general appearance
height and weight
- short stature = Turner syndrome, childhood renal failure, achondroplastic and hypopituitary dwarfism
- long limbs = hypogonadism, marfan syndrom
- height loss = osteoporosis and vertebral compression fractures
61
Vital signs include
BP, HR, RR, Temp
62
Systolic pressure _____ in distal arteries whereas diastolic pressure ____ in distal arteries
systolic pressure increases in distal arteries whereas diastolic pressure decreases in distal arteries
63
________ ______ introduce errors due to differences in position relative to the heart
hydrostatic effects
64
3 types of hypertension
white coat, masked, nocturnal
65
White coat hypertension
BP >= 140/90 in medical office, mean awake ambulatory reading <135/85
| anxiety response
66
Masked Hypertension
office BP <140/90 but elevated daytime BP >135/85 at home or ambulatory testing
67
Nocturnal Hypertension
Fall of <10% daytime values, fall of >20% daytime values, or nocturnal rising
68
If BP cuff is too small/narrow the pressure will read _____
high
69
If the BP cuff is too large/wide the BP will read ____ on a small arm and _____ on a large arm
low on a small arm, high on a large arm
70
If the brachial artery is below the heart, the BP will read _____, if the brachial artery is above the heart, the BP will read _____
below = high, above = low
71
A loose BP cuff will lead to readings that are falsely ____
high
72
Define auscultatory gap
a silen tinterval between the systolic and diastolic pressures
| underestimate systolic, overestimate diastolic
73
74
How to record an auscultatory gap
200/98 with an auscultattory gap from 170 to 150
75
What is an auscultatory gap associated with?
arterial stiffness and atherosclerotic disease
76
What is the sound heard when taking a BP?
Koratkoff sounds
77
How to record diastolic and muffling sounds if greater than 10mm Hg apart
150/80/68
| sounds never disappearing = aortic regurgitation
78
____ _____ may make produce artificially low systolic and high diastolic pressures
Venous congestion from slow repetitive inflations of cuff
79
What may be present if a repeat BP is more than 10 to 15 mmHg difference?
subclavian steal syndrome, supravalvular aortic stenosis, aortic dissection
80
How should someone's average BP be determined?
using the mean of two or more properly measured seated BPs across two or more office visits and should be verified in the other arm
81
For adults >= 18, treatment to lower BP is recommended if measures are ...
>= 90 for diastolic
>= 140 for systolic
82
For adults >= 60, treatment to lower BP is recommended if measures are..
>= 150/90
83
For adults with diabetes and chronic kidney disease, treatment to lower BP is recommended if measures are...
>= 140/90
84
# BP classifications
Normal
<120 over <80
85
# BP classifications
prehypertension
120-139/80-89
86
# BP classifications
Stage 1 Hypertension (ages 18-69 or with diabetes/renal disease)
140-159/90-99
87
# BP classifications
Stage 1 Hypertension (age 60+)
150-159/90-99
88
# BP classifications
Stage 2 hypertension
>=160/>=100
89
Causes of orthostatic hypotension
- drugs
- moderate to severe blood loss
- prolonged bed rest
- diseases of autonomic nervous system
90
Why would a patient be pulseless or have no Korotkoff sounds in BP?
- user error with stethoscope
- venous engorgement from repeated BP
- vascular disease or shock
- occlusive diseases
91
Detection of an irregular rhythm in BP suggests ______ and should be followed up with an ECG
atrial fibrillation
92
BP should be higher in the legs and lower in the arms, what happens if this is opposite?
coarctation of the aorta and occlusive aortic disease
93
How does coarctation of the aorta arise
narrowing of the thoracic aorta (usually distal to the origin of the L subclavian artery)
94
How to take HR
- normal rhythm - palpate radial pulse 30 seconds x2
- abnormal rhythm - palpate radial pulse 60 seconds
95
How long to count respirations
1 minute
96
Internal core body temperature
98.6F (37C)
| Fluctuates 1C over the day
97
Hyperpyrexia is a fever over ____, hypothermia is a temp lower than _____
Hyper = 106F (41.1C)
Hypo = 95F (35C)
98
Tympanic membrane shares blood supply with which part of the body
Hypothalamus, where temp regulation occurs
99
Temporal artery takes advantage of which blood vessels
The temporal artery which branches off the esternal carotid artery
100
Define chronic pain
- pain not associated with cancer or other conditions
- persists more than 3 to 6 months
- lasting more than 1 month beyond an acute illness or injury
- recurring at intervals of months or years
101
Nociceptive (somatic) pain
- linked to tissue damage of skin, musculoskeletal system, viscera
- acute or chronic
- mediated by A-delta and C-fibers of sensory system
- can be sensitized by inflammatory mediators
- modulated by neurotransmitters
102
Neuropathic pain
- lesion or disease affecting somatosensory system
- may become independent of inciting injury
- burning, lancing, shock like
- CNS or spinal cord can evoke pain from trauma or stroke
- PNS disorders involved
103
Central sensitization pain
- alteration of CNS processing of sensation
- lower pain threshold
- fibromyalgia
- responds to meds that modify neurotransmitters
104
Psychogenic pain
- involves psychiatric conditions
- social and cultural factors
105
Idiopathic pain
- pain without identifiable etiology
106
5 things to measure when managing chronic pain
- pain intensity/interference
- mood
- effect on sleep
- risk of co-occurring substance abuse
- opioid dose
107
# Obesity related health conditions
Cardiovascular
- hypertension
- coronary artery disease
- atrial fibrillation
- heart failure
- cor pulmonale
- varicose veins
108
# obesity related health conditions
endocrine
- metabolic syndrome
- T2DM
- dyslipidemia
- polycystic ovarian syndrome/androgenicity
- amenorrhea/infertility/menstrual disorders
109
# obesity related health conditions
gastrointestinal
- gastroesophageal reflux disease
- nonalcoholic fatty liver disease
- cholelithiasis
- hernias
- cancer of colon, pancreas, esophagus, liver
110
# obesity related health conditions
genitourinary
- urinary stress incontinence
- obesity related glomerulopathy
- hypogonadism in males
- cancer of breast, cervical, ovarian, uterine
- pregnancy complications
- nephrolithiasis, chronic renal disease
111
# obesity related health conditions
integument
- striae distensae (stretch marks)
- status pigmentation of legs
- lymphedema
- cellulitis
- intertrigo, carbuncles
- acanthosis nigricans/skin tags
112
# obesity related health conditions
musculoskeletal
- hyperuricemia and gout
- immobility
- osteoarthritis in knees/hips
- low back pain
113
# obesity related health conditions
neurologic
- stroke
- idiopathic intracranial hypertension
- meralgia parasthetica
114
115
# obesity related health conditions
psychological
- depression/low self esteem
- body image disturbance
- social stigmatization
116
# obesity related health conditions
respiratory
- dyspnea
- obstructive sleep apnea
- hypoventilation syndrome/Pickwickian syndrome
- pulmonary embolism
- asthma
117
Stages of Change
- precontemplation
- contemplation
- preparation
- action
- maintenance
118
# Nutrition counseling
foods with calcium
- dairy such as milk, cheese, yogurt
- fortified cereals, fruit juice, soy milk, tofu
- dark leafy greens
- sardines
119
# nutrition counseling
foods with iron
- lean and dark meats
- seafood like clams, mussels, oysters, sardines, anchovies
- fortified cereals
- enriched whole grain bread
- spinach, peas, lentil, turnip, artichoke
- dried prunes and raisins
120
# nutrition counseling
foods with folate
- cooked dried beans and peas
- oranges
- liver
- spinach, mustard greens
- black eyed peas, lentils, okra, chick peas, peanuts
- fortified cereals
121
# nutrition counseling
foods with vitamin D
- fortified milk, orange juice, cereals
- cod liver oil, swordfish, salmon, herring, mackerel, tuna, trout
- egg yolk
- mushrooms
