Block 1 Objectives part 1 Flashcards
(151 cards)
1
Q
otoscope
A
provides illumination for examining the external auditory canal and the tympanic membrane.
2
Q
ophthalmoscope
A
has system of lenses and mirrors to visualize the interior structures of the eye.
3
Q
ophthalmoscope apertures
A
large aperture – (most commonly used) produces a large round beam
small aperture – for small pupils
red free filter – produces green beam for examination of the optic disk for pale appearance and vessel changes. Recognition of retinal hemorrhages (blood appears black)
slit – for anterior eye and elevation of lenses
Grid – Estimation of the size of fundal lesions.
4
Q
sphygmomanometer
A
a device used to manually measure blood pressure with the use of a stethoscope. The inflatable bladder restricts blood flow, measurements of pressure are recorded when blood flow is just starting and when it ceases to be unimpeded.
5
Q
thermometers
A
used to measure body temperature which can be a clue to a pt’s illness/current state
6
Q
oral temp
A
oral – placed under the tounge (98.6) (abnormal >100)
7
Q
rectal temp
A
rectal – commonly used for infants for accurate reading. (99.6) (abnormal >101)
8
Q
axillary temp
A
axillary – held between body and arm. (97.6)
9
Q
tympanic temp
A
tympanic – used in the ear – tympanic membrane shares blood supply with hypothalamus. (99.6) (abnormal >101)
10
Q
stethoscope
A
can be acoustic, magnetic, or electronic
b. Bell – Low pitched sounds – light pressure (harder to hear sounds)
c. Used to listen to heart and adnominal sounds
Diaphragm – high pitched sounds – firm pressure
11
Q
Snellen visual acuity
A
a. Used for screening and examination of far vision for literate, English, verbal adults and school aged children
b. Recorded as a fraction – numerator = # of feet between chart and pt. and denominator = distance from which a normal person can read the lettering
12
Q
Rosenbaum visual acuity charts
A
used to test near vision at distance of 14 in.
13
Q
512 tuning fork
A
auditory evaluation via estimating hearing loss in the range of normal speech. This is the lowest intensity of sounds at which an auditory stimulus can be heard.
14
Q
128 tuning fork
A
vibratory sensation applied to bony prominence the patient should feel the vibration/tingling.
15
Q
percussion hammer
A
used to test deep tendon reflexes, tap should be brisk and direct
16
Q
tape measure
A
used to determine circumference, length, diameter. Pull tape tightly without causing depression in skin.
17
Q
transilluminator
A
strong light source with narrow beam directed into body cavity to differentiate between various media present in that cavity (air, fluid, tissue). Place beam of light directly against area to observe the presence or absence of illumination and any irregularities.
18
Q
palmar surface palpation
A
used for distinguishing size and texture. Any examination that requires fine detail/texture should be done with palmar surface. More nerve endings on this portion of the hand.
19
Q
ulnar surface palpation
A
used for detection of vibration
20
Q
dorsal surface palpation
A
used for detection of temperature. better than palmar surface because your own body heat does not interfere.
21
Q
Diaphragm sounds
A
best for high-pitched sounds (heart sounds and abdominal/bowel sounds)
with firm pressure skin converts bell to a diaphragm end piece
22
Q
Bell Sounds
A
best for low-pitched sounds when light pressure is used
23
Q
bruits -
A
turbulent blood flow through artery & heart
24
Q
murmurs
A
turbulent blood flow through heart valve)
25
normal pulse
Normal: 60-100 beats per minute
26
resting pulse
number of heart beats per minute while at complete rest; generally 60-100 beats per minute; average 70 bpm; this can vary widely based on general health and fitness, age, underlying medical conditions
27
Tachycardia pulse
pulse rate>100 beats per minute
28
Bradycardia: pulse
rate<60 beats per minute
29
tachycardia
If oxygen demand or metabolic activity increases, blood volume decreases, the body is working, or the sympathetic nervous system is activated (stress, certain drugs), this can induce tachycardia
30
bradycardia
While the body is at rest there is less oxygen demand and metabolic activity, so the pulse rate decreases. Parasympathetic stimulation and certain drugs can decrease the heart rate significantly below a normal resting heart rate.
31
Korotkoff sounds. (Seidel/Mosby pg 54-55)
Low-pitched sounds produced by turbulence of blood flow in the artery
32
ausculatory gap
Korotkoff sounds may disappear 10-15 mmHg below first systolic reading = this is normal and called the ausculatory gap
33
First and Second Korotkoff sounds
First two audible consecutive beats indicate systolic pressure reading and beginning of Korotkoff sounds
when the Korotkoff sounds disappear, this is the second diastolic sound
34
Guarding
: protective behavior, distorted posture, reluctance to be moved
35
Facial mask of pain:
lackluster eyes, wrinkled forehead, tightly closed or opened eyes, fixed or scattered movement
36
Vocalizations:
grunting, groaning, crying, talkative patient becomes quiet
37
Body movements
:head rocking, pacing or rubbing; an inability to keep the hands still
38
Changes in vital signs: Pain
blood pressure, pulse, respiratory rate and depth, with acute onset of pain. Fewer changes in vital signs are found in patients with persistent pain or after they adapt to acute pain.
39
Premature Infant Pain Profile (PIPP) for 28-40 wks gestation
physiology(heart rate, O2 saturation)
| o pain behaviors (brow bulge, eye squeeze, nasolabial furrow)
40
Neonatal Infant Pain Scale (0-6wks)
Facial expression, cry, breathing pattern, arm and leg movements, sate of arousal observed/scored
41
CRIES Scale
(Crying, Requires oxygen to keep saturation above 95, Increased vital signs, Expression, Sleeplessness.
Score: crying, expression, sleeplessness, O2 sat, heart rate, BP
42
Older Adults non-verbal pain scoring:
“Nonverbal Checklist for Pain Scoring”. Score 0 if behavior not observed, score 1 if the behavior was observed. Score ranges 0-5.
Vocal Complaints: verbal expression of pain using words such as “ouch” or “that hurts”.
Bracing: clutching or holding onto siderails, bed, tray table, or affected area during movement
Restlessness: constant or intermittent shifting of position, rocking.
Rubbing: massaging affected area
Facial Grimace and Winces: furrowed brow, narrowed eyes, tightened lips, dropped jaw, clenched teeth, distorted expression
Vocal Complaints: nonverbal expression of pain demonstrated by moans, groans, grunts, cries, gasps, sighs
43
Facies:
expression or appearance of the face and features of the head and neck indicating a clinical
condition or syndrome
certain conditions impart a “classic” physical appearance to the face indicating an underlying disease or syndrome. In GA, facies can be used to diagnose condition or syndrome (most often an endocrine disorder, but could be congenital or infectious disease). (PKM lecture on GA)
44
Hyperthyroid disease
exopthalamos (prominent eyes, lid retraction)
45
Sclera
The outer layer of the posterior eye, which is a dense, avascular structure. It supports the internal structure of the eye. It also encases the Optic nerve
46
optic nerve
Optic nerve, which passes through the optic foramen along with the ophthalmic artery and vein, sends signals to the CNS.
47
cornea
The Cornea is the outer layer of the anterior eye. It is continuous with the Sclera. It is optically clear, has rich sensory innervations, and is also avascular.
48
Uveal Tract
The Uveal tract consists of the Iris, Ciliary body, and Choroids. T
49
Iris
(the color of the eye) is a circular, contractile muscular disc that controls the amount of light that is able to reach teh retina.
50
pupil
The central aperture of the iris is the pupil, which light travels to the retina.
51
ciliary body
The ciliary body produces the aqueous humor (fluid that circulates between the lens and cornea) and contains the muscles that control accommodation.
52
Choroid
The Choroid is a pigmented, richly vascular layer that supplies oxygen to the outer layer of the retina.
53
lens
The Lens is a biconvex, transparent structure located behind the iris. It is supported by fibers that come from the ciliary body. It is highly elastic, and contraction or relaxation of the ciliary body changes its thickness, allowing images of various distances to be focused by the retina.
54
Retina
The Retina is the sensory network of the eye. It transforms light impulses into electrical impulses, which are transmitted through the optic nerve, optic tract and optic radiation to the visual cortex of the brain, the cerebral cortex. Other landmarks of the retina include the optic disc, where the optic nerve originates, together with the central retinal artery and vein. The Macula, or fovea is the site of central vision.
55
eyelid
The eyelid is composed of skin, striated muscle, the tarsal plate and conjunctivae. Meibomian glands provide oils to the tear film. The tarsus provides a skeleton to the lid. The eyelid distributes tears over the surface of the eye, limits the amount of lights entering it, and protects the eye from foreign bodies.
56
The Conjunctiva
is a clear, thin mucous membrane. The palpebral conjunctiva is the part of the conjunctiva that coats the inside of the eyelid. The bulbar conjunctiva is the part that covers the outer surface of the eye. The conjunctiva should be observed for erythema and exudate.
57
Eye Muscles
superior, inferior, medial, and lateral rectus muscles.
| superior and inferior oblique muscles, which allow you to move your eyes at an angle.
58
The Lacrimal Gland
is located in the temporal region of the superior eyelid and is responsible for tear production.
59
Head Bones
```
made up of 7 bones:
frontalx2,
parietalx2,
occipital,
temporalx2;
```
60
Face Bones
```
mandible,
maxilla,
zygomatic,
sphenoid,
lacrimal, and nasal bones.
```
61
Externally visible head tissue
Eyes (inner&outer canthus),
nose (ala, nares, philtrum, nasal bridge),
Ears (tragus, pinna)
62
landmarks on face
palpebral fissures, eyelids, eyebrows, nasolabial fold, mouth
63
neck location
begins at base of skull, ends at clavicles/sternum.
64
neck formed by
cervical vertebrae, ligaments, sternocleidomastoid muscle, and trapezius muslce
65
neck contains
trachea, esophagus, jugular veins, carotids, and thyroid.
66
cyanosis:
bluish; lack of oxygen or circulation
67
pallor:
unhealthy/pale skin; rubor: redness; response to inflammation/irritation
68
leukonychia:
white spots on the nail plate; cuticle manipulation or mild trauma
69
paronychia:
infection or disease around the nail; pain, swelling, redness
70
koilonychia:
“spoon nail”; nail takes on a spoon-like appearance; can be due to
anemia, hypothyroidism
71
nail pitting:
small pock-mark type indentations in the nail; psoriasis
72
peau d’orange:
on the breast; skin puckers and resembles an orange peel; lymphatic blockage or advanced breast cancer
73
edema/dependent edema:
swelling/ extracellular fluid accumulation; in dependent edema, the fluid remains in low points (i.e. the lower extremities); can be due to cardiac insufficiency
74
striae:
skin irregularity that resembles stripes; many causes and presentations (stretch marks, endocrine disorders, etc.)
75
alopecia:
hair loss
76
onycholysis:
spontaneous painless separation of the nail from the bed; trauma,
medications, infection, many causes
77
varicosities:
varicose (enlarged, twisted) veins; due to failure of the valves to
prevent backflow; often seen in superficial veins in lower extremities
78
Beau's lines:
horizontal/transverse grooves on nail plate; infection,
| trauma, systemic disease, many causes
79
hirsutism:
(females) the growth of terminal hair in patterns normally associated with male hair distribution (facial hair, increased body hair); associated with endocrine disorder
80
clubbing:
instead of growing (relatively) flat and straight, the nail angle increases,
leading to a club-like appearance; can be due to prolonged cardiac or respiratory
disease or can be idiopathic
81
sensorineural hearing loss
- PERMANENT
- Associated with damage to cochlear hair cells or auditory nerve
- EX: old age, noise-induced hearing loss, trauma, chemotherapy, radiation, genetics, etc.
- Typically addressed with hearing aids
82
conductive hearing loss
- NOT TYPICALLY PERMANENT
- Associated with any obstruction of sound transmission
- EX: fluid in middle ear, ear infections, holes in TM, abnormal bone growth, cerumen impaction, etc.
- Typically addressed with medical intervention or surgery (most cases are NOT permanent)
83
Normal respiration range for adults
12 to 20 breaths per minute
84
Wood's light
used to dx fungal infections
| epidermal hypo and hyper pigmented lesions, distinguish fluorescing lesions
85
Diascopy
blanchabilty of a lesion - differentate between vascular (inflammation), nonvascular (nevi), or hemorrhagic (petechia)
86
Direct microscopy
samples of flaked skin (scales) - used to determine if fungal infection is present
87
4 types of biopsy
shave, punch, incisional, excisional
88
Type of test used for allergy testing
patch or prick test
89
I
P
P
A
Inspection
Palpation
Percussion
Auscultation
90
Wood's light
used to dx fungal infections
| epidermal hypo and hyper pigmented lesions, distinguish fluorescing lesions
91
Diascopy
blanchabilty of a lesion - differentate between vascular (inflammation), nonvascular (nevi), or hemorrhagic (petechia)
92
Direct microscopy
samples of flaked skin (scales) - used to determine if fungal infection is present
93
4 types of biopsy
shave, punch, incisional, excisional
94
Type of test used for allergy testing
patch or prick test
95
I
P
P
A
Inspection
Palpation
Percussion
Auscultation
96
Wood's light
used to dx fungal infections
| epidermal hypo and hyper pigmented lesions, distinguish fluorescing lesions
97
Diascopy
blanchabilty of a lesion - differentate between vascular (inflammation), nonvascular (nevi), or hemorrhagic (petechia)
98
Direct microscopy
samples of flaked skin (scales) - used to determine if fungal infection is present
99
4 types of biopsy
shave, punch, incisional, excisional
100
Type of test used for allergy testing
patch or prick test
101
I
P
P
A
Inspection
Palpation
Percussion
Auscultation
102
5 types of notes produced by percussion:
1) Tympanic
2) Hyperresonant
3) Resonant
4) Dull
5) Flat
103
Tympanic percussion tone:
```
Intensity: loud
Pitch: High
Duration: Moderate
Quality: Drumlike
Example where heard: Gastric bubble
```
104
Hyperresonant percussion tone:
```
Intensity: Very loud
Pitch: Low
Duration: Long
Quality: Boomlike
Example of where heard: Emphysematous lungs
```
105
Resonant percussion tone:
```
Intensity: Loud
Pitch: Low
Duration: Long
Quality: Hollow
Example of where heard: Healthy lung tissue
```
106
Dull percussion tone:
```
Intensity: Soft to moderate
Pitch: Moderate to high
Duration: Moderate
Quality: Thudlike
Example of where heard: Over liver
```
107
Flat percussion tone:
```
Intensity: Soft
Pitch: High
Duration: Short
Quality: Very dull
Example of where heard: Over muscle
```
108
3 phases of hair growth:
I. Anagen: the phase of active growth. Last approximately 3-4 years. Approximately 84% of the scalp follicles are in anagen growth.
II. Catagen: the phase that marks follicular regression. Last approximately 2-3 weeks. 1-2% of scalp follicles are in catagen phase.
III. Telogen: the phase that represents a resting period. Lasts approximately 3 months. 10-15% of scalp follicles are in telogen phase.
109
Why is pain considered the "5th Vital Sign"?
Pain is associated with tissue damage. As a chief complaint, pain is a subjective measure of a Pt’s emotional response to the pathophysiological effect of tissue damage on body systems. The Pt’s report of pain is the most reliable indicator of pain. (Seidel’s, ‘Clinical Pearl’, Ch. 4, p. 56)
110
Universal Precautions
* Used to reduce risk of infection
* Assume all blood, body fluids, secretions, excretions (except sweat), nonintact skin, and mucous membranes may transmit infectious agents
111
Hand Hygiene
* After touching blood, body fluids, secretions, excretions, or contaminated items
* Immediately after removing gloves
* Before touching a patient, in front of the patient
* Between patients
* Have short, smooth fingernails
112
Universal Precautions with Blood
* Always wear gloves if blood may be involved
* Double glove if possible, especially when blood borne pathogens are known or suspected
* Protect body with a gown and face with mask, eye protection, or face shield during procedures that could generate splashes or sprays of blood (Ex: suction, intubation)
113
Universal Precautions with Airborne Pathogens
• Instruct patients on cough etiquette
-Cover mouth/nose when sneezing/coughing
-Use tissues and dispose in no touch receptacle
• Wash hands after soiling hands
• Wear surgical mask if maintaining less than 3 feet of separation from patient
114
Universal Precautions with Body Fluids
• Always wear gloves for open wound and mucous membrane exams
-Optional for dry wound exam
-No gloves for breast exam!
• “If it’s moist, you don’t want it” - Pat
• Use eye protection if under pressure or oozing
• Protect body with a gown and face with mask, eye protection, or face shield during procedures that could generate splashes or sprays of blood (Ex: suction, intubation)
115
Traditions of PE
- -Usually conducted from pt's R side
- -Pt usually seated or supine
- -Make precautions part of your tradition (gloves, mask, etc)
- -Reposition yourself and pt as needed
116
Pattern of PE
```
IPPA:
Inspection
Palpation
Percussion
Auscultation
(specifics are discussed on other cards)
```
117
Epidermis
Topmost, thin layer of skin, made of 3 sub-layers:
- -Stratum corneum (horny layer): sheds dead keratinocytes from below; keratin is waterproof, protects
- -Cellular stratum: melanocytes (pigment) + keratinocytes (makes protective keratin)
- -Basal layer/basement membrane: continually makes new keratinocytes that migrate upward every 4 weeks
118
Dermis
- -Middle of 3 layers
- -Richly vascular and innervated, hair follicles, sweat glands
- -Supports and separates epidermis from cutaneous adipose
- -Elastin, collagen, reticulum : strength, stretchiness
119
Hypodermis (aka subcutis, aka subcutaneous)
Deepest of 3 layers
| --Collagen + fat: shock absorber, generates heat/insulation
120
Hair shaft
The section of hair that protrudes above the level of the skin (from follicle up)
121
Apocrine glands
- -Larger and deeper than eccrine glands
- -Found only in the axillae, nipples, areolae, anogenital area, eyelids, external ears
- -Secrete odorless white fluid (“apocrine sweat”) w/ protein, carbohydrates, etc (not stinky in and of itself; it’s bacterial metabolism that makes BO)
122
Eccrine glands
- -Sweat glands that open directly onto surface of skin
| - -Regulate body temperature by secreting water
123
Nail plate
- -The hard, visible part of the nail
- -Made of keratin
- -What you apply polish to when you paint your nails
124
Three segments of hair follicle
--Lower = bulb and suprabulb
(from the base of follicle to insertion of erector pili muscle)
--Middle = isthmus
(short section that extends from insertion of erector pili muscle to entrance of sebaceous gland duct)
--Upper = infundibulum
(from entrance of sebaceous gland duct to follicular orifice)
125
Paronychium
- -Skin at the lateral edges of the nail plate
- -Like eponychium, but laterally instead of at the base of nail
- -Infection = paronychia
126
Sebaceous gland
Secrete sebum (lipid-rich, keeps skin from drying out)
127
Hair root
--Round area at base of hair shaft
--Houses the hair matrix
Note: Follicle = root + its covering
128
Hair follicle
- -The root and its covering
- -Three segments:
- Lower = bulb and suprabulb, from the base of follicle to insertion of erector pili muscle
- Middle = isthmus, short section that extends from insertion of erector pili muscle to entrance of sebaceous gland duct
- Upper = infundibulum, from entrance of sebaceous gland duct to follicular orifice
129
Three segments of hair follicle
- -Lower = bulb and suprabulb, from the base of follicle to insertion of erector pili muscle
- -Middle = isthmus, short section that extends from insertion of erector pili muscle to entrance of sebaceous gland duct
- -Upper = infundibulum, from entrance of sebaceous gland duct to follicular orifice
130
amastia
absence of breast tissue. May be due to rare congenital abnormality, or more often a bilateral mastectomy.
131
lactation
production and release of milk by mammary glands.
132
polymastia
The condition of having more than two breasts
133
galactorrhea
Lactation not associated with childbearing. Often due to a disruption of communication between the hypothalamus and pituitary glands which leads to elevated levels of prolactin, a hormone that stimulates milk production.
134
mastalgia
pain in the breast. May be due to hormonal fluctuations (e.g. menstrual cycle), trauma, cyst, infection.
135
inverted nipple(s)
nipple(s) that are retracted/tucked inward. May affect one or both nipples and can be congenital or acquired. If acquired, can be suggestive of inflammatory or malignant tissue.
136
everted nipple(s)
nipple(s) that point outward; most nipples have this appearance
137
gynecomastia
enlargement of breast tissue in males. May occur briefly at birth, briefly around puberty, or in adults >50 years old. Causes include hormonal stimulation (e.g. maternal hormones in newborns), pituitary or testicular tumors, excess body fat (causes increased estrogen production), medications.
138
Montgomery's tubercles
sebaceous glands in the areola that produce oily secretions to lubricate and protect the nipple
139
supernumerary nipple
congenital accessory breast tissue, that may or may not contain glandular tissue. Located along the “milk line” an embryonic ridge that stretches from the from the axilla to the groin; most frequently found inferior to the “normal” breast. More common in black women than white women.
140
Physiologic factors influencing arterial blood pressure.
BP is affected by three factors:
a. stroke volume (amount of blood pumped by left ventricle in one contraction)
b. heart rate (beats per minute)
c. peripheral vascular resistance (resistance to expansion of vessel walls by circulating blood)
Conditions that affect one of the above factors influence blood pressure: exercise, diet (e.g. sodium), alcohol/drugs, caffeine, stress/anxiety, weight, pain, fever, vascular resistance (e.g. atherosclerosis).
141
diaphragmatic respirations
synonymous with "abdominal respirations", "belly breathing"; the diaphragm does most of the work while the chest wall muscles are mostly a rest; normal, quiet breathing
142
abdominal respirations
synonymous with "diaphragmatic respirations", "belly breathing"; the diaphragm does most of the work while the chest wall muscles are mostly a rest; normal, quiet breathing
143
thoracic respirations
performed entirely by expansion of the chest by using the chest wall muscles; the abdomen does not move
144
paradoxic breathing
a portion of the chest wall sinks inward with each inspiration, common with chest trauma; also a condition seen in diaphragm paralysis when the diaphragm ascends during inspiration
145
hyperpnea
rapid and deep respirations >20 breaths per minute
146
apnea
literally "no breathing", the absence of spontaneous respiration
147
tachypnea
literally "rapid breathing", faster than normal respirations >20 breaths per minute
148
bradynea
literally "slow breathing", slower than normal <12 breaths per minute
149
hyperventilation
can be due to tachypnea, hyperpnea or both; an increased amount of air enters the lungs, which results in lowered CO2 levels
150
Cheyne-Stokes repirations
periodic breathing; repetitive pattern of apnea
| followed by gradual increasing depth and frequency of respirations
151
Kussmaul breathing
rapid, very deep, labored and gasping respirations associated with metabolic acidosis
