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Foundations > Beginning the Physical Exam: General Survey, Vitals, Pain (Bates ch. 4) > Flashcards

Beginning the Physical Exam: General Survey, Vitals, Pain (Bates ch. 4) Flashcards

1
Q

fatigue and weakness

Fatigue is a ____ _____ with many causes

A

nonspecific symptom

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2
Q

fatigue and weakness

Fatigue refers to

A

a sense of weariness or loss of energy that can be described in many ways

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3
Q

fatigue and weakness

weakness is a form of ____

A

fatigue

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4
Q

fatigue and weakness

Weakness denotes…

A

a demonstrable loss of muscle power

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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
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6
Q

fatigue and weakness

Weakness, especially if localized in a neuroanatomical pattern, suggests possible ____ or ____

A

neuropathy or myopathy

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7
Q

fever chills and sweats

recurrent shaking chills suggest more extreme swings in temp and systemic _____

A

bacteremia

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8
Q

fever chills and sweats

feeling hot and sweaty also accompany menopause. night sweats occur in _____ and _____

A

tuberculosis and malignancy

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9
Q

_____ refers to an abnormal elevation in body temperature

A

fever

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10
Q

________, _______, and _______ accompany a rising temperature

A

feeling cold, goosebumps, and shivering

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11
Q

____ and ____ accmpanies a falling temperature

A

feeling hot and sweating

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12
Q

Normally the temperature _____ during the day and _____ during the night

A

rises during the day and falls during the night

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13
Q

_____ occurs when fever exaggerates the swing in temperature between day and night

A

night sweats

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14
Q

True or False: In immunocompromised patients, fever may be absent, low-grade, or drop below normal

A

True

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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

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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
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17
Q

Weight gain occurrs when ______ exceeds _______ over time

A

caloric intake exceeds caloric expenditure

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18
Q

Edema from extravascular fluid retention is visible in ____, ______, _____, and _____

A
  • heart failure
  • nephrotic syndrome
  • liver failure
  • venous stasis
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19
Q

BMI

overweight is defined as a BMI of

A

25 to 29

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20
Q

BMI

obesity is defined as a BMI of

A

greater than or equal to 30

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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
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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

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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
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24
Q

weight loss with relatively high food intake suggests ____

(4 possibilities)

A
  • diabetes mellitus
  • hyperthyroidism
  • malabsorption
  • binge eating (bulimia) with clandestine vomiting
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25
Q

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 _____

A

malnutrition

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26
Q

signs and symptoms of malnutrition

A
  • weakness
  • fatigue
  • cold intolerance
  • flaky dermatitis
  • ankle swelling
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27
Q

____ is one of the most common presenting symptoms in office practices

A

pain

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28
Q

4 steps to promote optimal weight and nutrition

A
  • measure BMI and waist circumference
  • assess dietary intake
  • assess the patient’s motivation to change
  • provide counseling about nutrition and exercise
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29
Q

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

A
  • 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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30
Q

weight classification

BMI less than 18.5

A

underweight

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31
Q

weight classification

BMI 18.5 to 24.9

A

normal weight

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32
Q

weight classification

BMI 25 to 29.9

A

overweight

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33
Q

weight classification

BMI 30 to 34.9

A

Obesity class I

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34
Q

weight classification

BMI 35 to 39.9

A

Obesity class II

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35
Q

weight classification

BMI greater than or equal to 40

A

Extreme obesity class III

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36
Q

Dream weight is often as much as ___% below initial body weight and is unrealistic for an initial goal

A

30%

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37
Q

Weight loss of ___ to ___% is more realistic and proven to reduce risk kof diabetes and other associated health problems

A

5% to 10%

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38
Q

A safe goal for weight loss is ___ to ___ lbs per week

A

0.5 to 2 lbs

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39
Q

USDA dietary guidelines emphasize consuming nutrient dense food such as ___, ___, ___, ___, ____, ____, ____, ____, ____, ____, ____

A
  • veggies
  • fruits
  • whole grains
  • fat free/low fat milk/milk products
  • seafood
  • lean meats
  • poultry
  • eggs
  • beans
  • peas
  • nuts and seeds
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40
Q

Sodium intake should be less than _____ mg per day

A

2,300 mg

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41
Q

Sat fats should be less than or equal to __% of total calories

A

10%

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42
Q

dietary cholesterol should be less than or equal to ___ mg per day

A

300 mg

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43
Q

adolescent females and women of childbearing age should increase intake of ___, ___, and ___

A

iron, vitamin C, folic acid

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44
Q

adults older than 50 should identify foods rich in ___

A

vitamin B12

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45
Q

advise older adults, those with dark skin, and those with low exposure to sunlight to increase intake of ____

A

vitamin D

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46
Q

excess sodium intake can lead to ____, a major risk factor for CV disease

A

hypertension

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47
Q

reducing sodium intake by at least _____ mg per day lowers blood pressure

A

1,000 mg per day

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48
Q

Those with hypertension or high sodium diets should consider the ____ diet

A

DASH diet (dietary approaches to stop hypertension)

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49
Q

Adults should to at least ___ minutes of moderate intensity cardiorespiratory activity per week

A

150 minute (2.5 hours)

50
Q

Adults can engage in vigorous intensity aerobic activity for ____ per week

A

75 minutes (1hr and 15 min)

51
Q

Things included in the general survey

A
  • 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
Q

general appearance

apparent state of health

examples

A

acutely or chronically ill, frail, fit, robust

53
Q

general appearance

level of consciousness

examples

A

awake, alert, resonsive to you an dothers in room

54
Q

general appearance

signs of distress

examples

A
  • cardiac/respiratory distress (wheezing, clutching chest)
  • pain (wincing)
  • anxiety/depression (fidgety, flat affect)
55
Q

general appearance

skin color/condition

examples

A

scars, plaques, pallor, cyanosis, rashes, bruises

56
Q

general appearance

dress, grooming, hygiene

examples

A
  • 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
Q

general appearance

facial expression

examples

A
  • the stare of hyperthyroidism
  • immobile facies of parkinsonism
  • flat/sad affect for depression
  • decreased eye contact in anxiety, fear, sadness
58
Q

general appearance

odors of body and breath

examples

A
  • alcohol/acetone = diabetes or infection, liver failure, uremia
59
Q

general appearance

posture, gait, motor activity

examples

A
  • 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
Q

general appearance

height and weight

A
  • short stature = Turner syndrome, childhood renal failure, achondroplastic and hypopituitary dwarfism
  • long limbs = hypogonadism, marfan syndrom
  • height loss = osteoporosis and vertebral compression fractures
61
Q

Vital signs include

A

BP, HR, RR, Temp

62
Q

Systolic pressure _____ in distal arteries whereas diastolic pressure ____ in distal arteries

A

systolic pressure increases in distal arteries whereas diastolic pressure decreases in distal arteries

63
Q

________ ______ introduce errors due to differences in position relative to the heart

A

hydrostatic effects

64
Q

3 types of hypertension

A

white coat, masked, nocturnal

65
Q

White coat hypertension

A

BP >= 140/90 in medical office, mean awake ambulatory reading <135/85

anxiety response

66
Q

Masked Hypertension

A

office BP <140/90 but elevated daytime BP >135/85 at home or ambulatory testing

67
Q

Nocturnal Hypertension

A

Fall of <10% daytime values, fall of >20% daytime values, or nocturnal rising

68
Q

If BP cuff is too small/narrow the pressure will read _____

A

high

69
Q

If the BP cuff is too large/wide the BP will read ____ on a small arm and _____ on a large arm

A

low on a small arm, high on a large arm

70
Q

If the brachial artery is below the heart, the BP will read _____, if the brachial artery is above the heart, the BP will read _____

A

below = high, above = low

71
Q

A loose BP cuff will lead to readings that are falsely ____

A

high

72
Q

Define auscultatory gap

A

a silen tinterval between the systolic and diastolic pressures

underestimate systolic, overestimate diastolic

73
Q
A
74
Q

How to record an auscultatory gap

A

200/98 with an auscultattory gap from 170 to 150

75
Q

What is an auscultatory gap associated with?

A

arterial stiffness and atherosclerotic disease

76
Q

What is the sound heard when taking a BP?

A

Koratkoff sounds

77
Q

How to record diastolic and muffling sounds if greater than 10mm Hg apart

A

150/80/68

sounds never disappearing = aortic regurgitation

78
Q

____ _____ may make produce artificially low systolic and high diastolic pressures

A

Venous congestion from slow repetitive inflations of cuff

79
Q

What may be present if a repeat BP is more than 10 to 15 mmHg difference?

A

subclavian steal syndrome, supravalvular aortic stenosis, aortic dissection

80
Q

How should someone’s average BP be determined?

A

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
Q

For adults >= 18, treatment to lower BP is recommended if measures are …

A

> = 90 for diastolic

> = 140 for systolic

82
Q

For adults >= 60, treatment to lower BP is recommended if measures are..

A

> = 150/90

83
Q

For adults with diabetes and chronic kidney disease, treatment to lower BP is recommended if measures are…

A

> = 140/90

84
Q

BP classifications

Normal

A

<120 over <80

85
Q

BP classifications

prehypertension

A

120-139/80-89

86
Q

BP classifications

Stage 1 Hypertension (ages 18-69 or with diabetes/renal disease)

A

140-159/90-99

87
Q

BP classifications

Stage 1 Hypertension (age 60+)

A

150-159/90-99

88
Q

BP classifications

Stage 2 hypertension

A

> =160/>=100

89
Q

Causes of orthostatic hypotension

A
  • drugs
  • moderate to severe blood loss
  • prolonged bed rest
  • diseases of autonomic nervous system
90
Q

Why would a patient be pulseless or have no Korotkoff sounds in BP?

A
  • user error with stethoscope
  • venous engorgement from repeated BP
  • vascular disease or shock
  • occlusive diseases
91
Q

Detection of an irregular rhythm in BP suggests ______ and should be followed up with an ECG

A

atrial fibrillation

92
Q

BP should be higher in the legs and lower in the arms, what happens if this is opposite?

A

coarctation of the aorta and occlusive aortic disease

93
Q

How does coarctation of the aorta arise

A

narrowing of the thoracic aorta (usually distal to the origin of the L subclavian artery)

94
Q

How to take HR

A
  • normal rhythm - palpate radial pulse 30 seconds x2
  • abnormal rhythm - palpate radial pulse 60 seconds
95
Q

How long to count respirations

A

1 minute

96
Q

Internal core body temperature

A

98.6F (37C)

Fluctuates 1C over the day

97
Q

Hyperpyrexia is a fever over ____, hypothermia is a temp lower than _____

A

Hyper = 106F (41.1C)
Hypo = 95F (35C)

98
Q

Tympanic membrane shares blood supply with which part of the body

A

Hypothalamus, where temp regulation occurs

99
Q

Temporal artery takes advantage of which blood vessels

A

The temporal artery which branches off the esternal carotid artery

100
Q

Define chronic pain

A
  • 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
Q

Nociceptive (somatic) pain

A
  • 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
Q

Neuropathic pain

A
  • 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
Q

Central sensitization pain

A
  • alteration of CNS processing of sensation
  • lower pain threshold
  • fibromyalgia
  • responds to meds that modify neurotransmitters
104
Q

Psychogenic pain

A
  • involves psychiatric conditions
  • social and cultural factors
105
Q

Idiopathic pain

A
  • pain without identifiable etiology
106
Q

5 things to measure when managing chronic pain

A
  • pain intensity/interference
  • mood
  • effect on sleep
  • risk of co-occurring substance abuse
  • opioid dose
107
Q

Obesity related health conditions

Cardiovascular

A
  • hypertension
  • coronary artery disease
  • atrial fibrillation
  • heart failure
  • cor pulmonale
  • varicose veins
108
Q

obesity related health conditions

endocrine

A
  • metabolic syndrome
  • T2DM
  • dyslipidemia
  • polycystic ovarian syndrome/androgenicity
  • amenorrhea/infertility/menstrual disorders
109
Q

obesity related health conditions

gastrointestinal

A
  • gastroesophageal reflux disease
  • nonalcoholic fatty liver disease
  • cholelithiasis
  • hernias
  • cancer of colon, pancreas, esophagus, liver
110
Q

obesity related health conditions

genitourinary

A
  • urinary stress incontinence
  • obesity related glomerulopathy
  • hypogonadism in males
  • cancer of breast, cervical, ovarian, uterine
  • pregnancy complications
  • nephrolithiasis, chronic renal disease
111
Q

obesity related health conditions

integument

A
  • striae distensae (stretch marks)
  • status pigmentation of legs
  • lymphedema
  • cellulitis
  • intertrigo, carbuncles
  • acanthosis nigricans/skin tags
112
Q

obesity related health conditions

musculoskeletal

A
  • hyperuricemia and gout
  • immobility
  • osteoarthritis in knees/hips
  • low back pain
113
Q

obesity related health conditions

neurologic

A
  • stroke
  • idiopathic intracranial hypertension
  • meralgia parasthetica
114
Q
A
115
Q

obesity related health conditions

psychological

A
  • depression/low self esteem
  • body image disturbance
  • social stigmatization
116
Q

obesity related health conditions

respiratory

A
  • dyspnea
  • obstructive sleep apnea
  • hypoventilation syndrome/Pickwickian syndrome
  • pulmonary embolism
  • asthma
117
Q

Stages of Change

A
  • precontemplation
  • contemplation
  • preparation
  • action
  • maintenance
118
Q

Nutrition counseling

foods with calcium

A
  • dairy such as milk, cheese, yogurt
  • fortified cereals, fruit juice, soy milk, tofu
  • dark leafy greens
  • sardines
119
Q

nutrition counseling

foods with iron

A
  • 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
Q

nutrition counseling

foods with folate

A
  • cooked dried beans and peas
  • oranges
  • liver
  • spinach, mustard greens
  • black eyed peas, lentils, okra, chick peas, peanuts
  • fortified cereals
121
Q

nutrition counseling

foods with vitamin D

A
  • fortified milk, orange juice, cereals
  • cod liver oil, swordfish, salmon, herring, mackerel, tuna, trout
  • egg yolk
  • mushrooms

Foundations (9 decks)

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