FINAL Flashcards
(154 cards)
1
Q
Describe the flow of blood through the heart.
A
- Vena cava
- Right atrium
• Tricuspid valve - Right ventricle
- Pulmonary arteries
- Lungs
- Pulmonary veins
- Left atrium
- Mitral valve
- Left ventricle
- Aorta
- Right atrium
2
Q
____________: the ventricles relax and fill with blood. Relaxation.
A
diastole
3
Q
____________: blood is pumped from the ventricles and fills the pulmonary and systemic arteries. Contraction
A
systole
4
Q
5 Areas where heart valve closures can be heard
A
- precordium
- Aortic Valve Area
- Pulmonic Valve Area
- Tricuspid Valve Area
- mitral valve area
5
Q
WHICH HEART SOUND? Closure of the AV valves. Can be heard all over the precordium, loudest at the apex. “LUB” is the sound heard.
A
FIRST
6
Q
WHICH HEART SOUND? Closure of the semilunar valves. Can be heard all over the precordium, loudest at the base. “DUP” is the sound heard.
A
SECOND
7
Q
2 components of assessment of the carotid arteries in older patients:
A
- PALPATE each carotid artery medial to the sternomastoid muscle in the neck.
- AUSCULTATE each carotid artery for the presence of a bruit (blowing, swishing sound)
8
Q
3 areas to AUSCULTATE on the carotid artery when checking for bruits
A
- angle of the jaw
- midcervical area
- base of the neck
9
Q
TRUE OR FALSE? excessive pressure on the sinus area higher in the neck & excessive vagal stimulation here could slow down the heart rate.
A
TRUE
10
Q
TRUE OR FALSE? Palpate firmly and both carotid arteries at the same time to avoid compromising blood to the brain.
A
FALSE - one at a time
11
Q
WHAT PART OF THE STETHOSCOPE DO YOU USE AUSCULATE THE HEART?
A
DIAPHRAGM
12
Q
WHAT PATTERN DO YOU USE TO AUSCULTATE THE HEART?
A
Z PATTERN STARTING AT THE BASE AND GOING TO THE APEX
13
Q
Area of palpation of apical impulse
A
the fourth or fifth and be at the medial to the midclavicular line.
14
Q
TRUE OR FALSE? APICAL IMPULSE IS PALPABLE IN EVERYBODY.
A
FALSE. Apical pulse is palpable in about half of adults, not palpable in obese persons or in persons with thick chest walls.
15
Q
How do you estimate the Jugular venous pressure.
A
- Use the angle of Louis (sternal angle) as an arbitrary reference point and compare it with the highest level of venous pulsation.
- Hold a vertical ruler on the sternal angle
- Align a straight edge on the ruler like a T-Square
- Adjust the level of the horizontal straight edge to the level of pulsation
- Read the level of intersection not he vertical ruler
16
Q
What is normal jugular venous pressure
A
2cm or less above the sternal angle
17
Q
This is a palpable vibration, it feels like the throat of a purring cat.
A
thrill
18
Q
What does a thrill signify?
A
signifies turbulent blood flow and accompanies loud murmurs.
19
Q
TRUE OR FALSE? Absence of a thrill rules out the presence of a murmur.
A
FALSE
20
Q
________________ is the area on the anterior chest overlying the heart and great vessels.
A
Precordium
21
Q
9 areas are palpable for pulse?
A
- Dosalis Pedis
- Radial
- Ulner
- Temporal
- Carotid
- Femoral
- Bracial
- Popliteal
- Posterior Tibial
22
Q
TRUE OR FALSE? It is normal to find palpable nodes that are small (1cm or less), movable, and nontender.
A
False.
23
Q
Enlargement of these nodes could signal a possible infection as this area drains most of the lymph of the lower extremity and genitalia and the anterior abdominal wall.
A
Inguinal lymph nodes
24
Q
Describe the lymphatic system of a healthy 3 year old child
A
- Well developed
- lymph nodes are relatively large and the superficial ones often are palpable even when the child is healthy.
- Lymph nodes are firm, mobile and nontender.
25
Typical capillary refill time
Normally the vessels refill within a fraction of a second up to 2 seconds.
26
What does capillary refill lasting more than 1 or 2 seconds indicate
vasoconstriction or decreased cardiac output.
27
This occurs in 20% of cases of deep vein thrombosis.
Positive Homan’s sign
28
thrombophlebitis (possible complications)
inflammation
blocked venous return
cyanosis
edema
29
This is also present in a variety of other conditions such as muscle injury, achilles tendonitis and plantar muscle injury.
positive Homan's sign
30
What are the SUBJECTIVE signs of venous stasis?
aching pain in calf or lower leg, worse at end of the day, worse with prolonged standing or sitting.
31
What are the OBJECTIVE signs of venous stasis?
```
Firm brawny edema
coarse, thickened skin
pulses normal
brown pigment discolouration
petechiae
dermatitis
```
32
This will show discoloured feet (dark colour)
venous stasis
33
This causes increased venous pressure, which then causes RBCs to leak out of veins and into the skin. As these RBCs break down, they leave hemosiderin (iron deposits) behind, which are the brown pigment deposits.
venous stasis
34
This can occur after acute deep vein thrombosis
venous stasis
35
Documentation for edema
* 0+=no pitting edema
* 1+: Mild pitting, slight indentation, no perceptible swelling of the leg
* 2+: Moderate pitting, indentation subsides rapidly
* 3+: Deep pitting, indentation remains for a short time, leg looks swollen
* 4+: Very deep pitting, indentation lasts a long time, leg is very swollen.
36
Grading of pulses (amplitude) on three point scale (0-3+)
* 0: Absent
* 1+: Weak
* 2+: Normal
* 3+: increased, full, bounding
37
Distended bladder assessment
- Percuss lightly in all four quadrants to determine the prevailing amount of tympani and dullness.
- tympany occurs over intestines
- dullness occurs over full bladder
38
A dull note forward of the midaxillary line indicates enlargement of the ___________, as occurs with mononucleosis, trauma, and infection.
spleen
39
The splenic dullness normally is not wider than _____ cm in the adult and should not encroach on the normal tympani over the gastric air bubble.
7
40
Reason for auscultation preceding percussion and palpation
* This is done because percussion and palpation can increase peristalsis, which would give a false interpretation of bowel sounds.
41
what are Borborygmi
- hyper active bowel sounds
- occur with early mechanical bowel obstruction (high pitched), gastroenteritis, brisk diarrhea, laxative use, and subsiding paralytic ileus
42
Possible percussion notes of abdomen
TYMPANY should predominate because air in the intestines rises to the surface when the person is supine
DULLNESS over the liver and spleen
43
DESCRIBE THE DEPTHS OF Light and deep palpation
light: 1 cm
deep: 5-8 cm
44
Objective of light palpation
Objective is not to search for organs but to form an overall impression of the skin surface and musculature
45
Objective of deep palpation
Palate for specific organs
- liver
- spleen
- kidneys
46
Assessment for abdominal aortic aneurysm
AUSCULTATE: murmur is harsh, systolic, or continuous and accentuated with systole.
If a bruit is heard, do not palpate the area for fear of rupturing!
PALPATE the aortic pulsation in the upper abdomen slightly to the left of midline - normally it is 2.5 cm to 4cm wide
47
Murphy’s sign (Inspiratory Arrest)
A normal response is to complete the deep breath without pain
Pain occurs with inflammation of the gallbladder. The descending liver pushes the inflamed gallbladder onto the examining hand, the person feels sharp pain and abruptly stops inspiration midway
48
Range of liver span
Normal liver span ranges from 6 to 12 cm
Average is 10.5 for males and 7cm for females
49
7 organs in Right Upper Quadrant (RUQ)
1. Liver
2. Gallbladder
3. Duodenum
4. Pancreas (head)
5. Kidney & adrenal (right)
6. Colon (hepatic flexure)
7. Colon (part of ascending and transverse)
50
7 organs in Left Upper Quadrant (LUQ)
1. Stomach
2. Spleen
3. Liver (left lobe)
4. pancreas (body)
5. kidney & adrenal (left)
6. Colon (Splenic flexure)
7. Colon (part of transverse and descending)
51
5 organs in Right Lower Quadrant (RLQ)
1. Cecum
2. Appendix
3. ovary and tube (right)
4. ureter (right)
5. spermatic cord (right)
52
5 organs in Left Lower Quadrant (LLQ)
1. Colon (Part of descending)
2. Sigmoid colon
3. ovary and tube (left)
4. ureter (left)
5. spermatic cord (left
53
3 organs found midline
1. Aorta
2. Uterus (if enlarged)
3. Bladder (if distended)
54
Positive obturator test
With patient in supine, lift the right leg, flexing at the hip and 90 degrees at the knee. Hold the ankle and rotate the leg internally and externally
* Negative or normal response is no pain
* Positive response is pain.
55
When is the obturator test performed?
when appendicitis is suspected.
56
What does fecal occult blood indicate?
Occult bleeding usually indicates cancer of colon
57
TRUE OR FALSE? Fecal occult test may have a false positive response if the person has ingested significant amounts of red meat within 3 days of the test
True.
58
2 common conditions of intense itching and irritated skin in children
* Diaper rash
| * Pin Worms
59
What causes hemmorhoids
increased portal venous pressure from:
- straining to poo
- chronic constipation
- pregnancy
- obesity
- chronic liver disease
- low fibre diet
60
SUBJECTIVE Symptoms of Benign prostatic hypertrophy
urinary frequency, urgency, hesitancy, straining to urinate, weak stream, intermittent stream, sensation of incomplete emptying, nocturia
61
OBJECTIVE Symptoms of Benign prostatic hypertrophy
a symmetrical nontender enlargement, commonly occurs in males beginning in the middle years
62
NAME THE Skeletal muscle movement: bending a limb at a joint
FLEXION
63
NAME THE Skeletal muscle movement: straightening a limb at a joint
EXTENSION
64
NAME THE Skeletal muscle movement: moving a limb away from the midline of the body
Abduction
65
NAME THE Skeletal muscle movement: moving a limb toward the midline of the body
Adduction
66
NAME THE Skeletal muscle movement: turning the forearm so that the palm is down
Pronation
67
NAME THE Skeletal muscle movement: turning the forearm so that the palm is up
Supination
68
NAME THE Skeletal muscle movement: moving the arm in a circle around the shoulder
Circumduction
69
NAME THE Skeletal muscle movement: moving the sole of the foot inward at the ankle
Inversion
70
NAME THE Skeletal muscle movement: moving the sole of the foot outward at the ankle
Eversion
71
NAME THE Skeletal muscle movement: moving the head around a central axis
Rotation
72
NAME THE Skeletal muscle movement: moving a body part forward and parallel to the ground
Protraction
73
NAME THE Skeletal muscle movement: moving a body part backward and parallel to the ground
Retraction
74
NAME THE Skeletal muscle movement: raising a body part
Elevation
75
NAME THE Skeletal muscle movement: lowering a body part
Depression
76
Temporomandibular joint assessment
Ask the person to open mouth maximally, partially open mouth, move jaw side to side and stick out lower jaw
Should be easily performed
77
Number of cervical vertebrae
7
78
Number of thoracic vertebrae
12
79
Number of Lumbar vertebrae
5
80
Number of Sacral vertebrae
5
81
Number of coccygeal vertebrae
3-4
82
Assessment of glenohumoral
INSPECT and compare both shoulders posteriorly and anteriorly ~ check for abnormal swelling
PALPATE both shoulders anteriorly and posteriorly, noticing any muscular spasm or atrophy, swelling, heat or tenderness
83
ROM TEST FOR Assessment of glenohumoral
1. With arms at sides and elbows extended, MOVE BOTH ARMS FORWARD AND UP in a wide vertical arcs, then move then back.
2. ROTATE arms internally behind back, place back of hands as high as possible toward the scapulae.
3. With arms at sides and elbows extended, RAISE BOTH ARMS in wide arcs in the coronal plane. Touch palms together above head.
4. Touch both hands behind the head with elbows flexed and rotated posteriorly.
84
Potential Injuries OF glenohumoral
rotator cuff lesions
| dislocated shoulder
85
WHAT IS OSTEOPOROSIS
Decrease in skeletal bone mass occurring when rate of bone resorption is greater than that of bone formation
86
This occurs primarily in postmenopausal White women
osteoporosis
87
Risk of developing this is also associated with smaller height and weight, younger age at menopause, lack of physical activity and lack of estrogen replacement therapy.
osteoporosis
88
Signs of wrist fracture
sharp pain that increases with movement
89
* an audible and palpable crunching or grating that accompanies movement. It occurs when the articular surfaces in the joints are roughened as with rheumatoid arthritis
Crepitation
90
Chronic disabling pain at lateral epicondyle of humerus, radiates down extensor surface of forearm
Tennis elbow
91
Occurs with activities combining excessive pronation and supination of forearm with an extended wrist
Tennis elbow
92
2 Tests for carpal tunnel syndrome
1. phalen's test
| 2. tinel's sign
93
NAME THE TEST FOR CARPEL TUNNEL SYNDROME: Ask the person to hold both hands back to back while flexing the wrists 90 degrees. Acute flexion of the wrist for 60 seconds produces no symptoms in the normal hand but produces numbness and burning in a person with carpal tunnel syndrome
phalen's test
94
NAME THE TEST FOR CARPEL TUNNEL SYNDROME: Direct percussion of the location of the median nerve at the wrist produces no symptoms in the normal hand. produces burning and tingling in carpal tunnel syndrome
tinel's sign
95
Ortolani sign - positive
Hip instability feels like a clunk as the head of the femur pops back into place, positive Ortolani sign
96
Ortolani sign - negative
Normally feels smooth and produces no sound
97
Muscle strength testing (0-5+)
* Grade 5: Full ROM against gravity, full resistance
* Grade 4: Full ROM against gravity, some resistance
* Grade 3: Full ROM with gravity
* Grade 2: Full ROM with gravity eliminated
* Grade 1: Slight contraction
* Grade 0: No contraction
98
Assessment of patella
* Inspect the skin and lower leg alignment. The lower leg should extend in the same axis as the thigh
* Inspect the knee's shape and contour. There are normal concavities or hollows on either side of the patella. Check for swelling
* Check the quadriceps muscle in the anterior thigh for any atrophy because it is the prime mover of knee extension, important for joint stability
* Palpate, start on the high anterior thigh, palpate with left thumb and fingers in a grasping fashion
* Explore the tibiofemoral joint, palpate the infra patellar fat pad and the patella, check for crepitus by holding your hand not he patella as the knee is flexed and extended.
* Check ROM, bend each knee, extend each knee, ambulate
99
Instrument used to assess angles of joint flexion
Goniometer
100
Bones of the knee
* Femur
* Tibia
* Patella
101
Osteoarthritis assessment
can't find
102
5 Functions of the musculoskeletal system
1. support
2. movement
3. protection
4. hematopoesis
5. mineral storage
103
Normal scrotum
* Loose protective sac, which is a continuation of the abdominal wall.
* After adolescence, the scrotal skin is deeply pigmented and has large sebaceous follicles.
* Scrotal wall consists of thin skin lying in folds, or ruggae, and the underlying cremaster muscle.
104
Cremaster muscle function
controls the size of the scrotum by responding to ambient temperature, to keep the testes at 3 degrees celsius below abdominal temperature. (best to produce sperm)
hot: scrotum lowers
cold: scrotum rises
105
Hernia
* Swelling, may have pain with straining
* Inspection--enlarged, may reduce when supine, does not transilluminate
* Palpation--soft mushy mass, palpating fingers cannot get above mass; mass is distinct from testicle that is normal
106
First sign of male puberty
Enlargement of the testes, next public hair, next penis size increases
107
Dysuria
* Burning/pain with urinating
| * common with acute cystitis, prostatitis, urethritis
108
Stress incontinence
Loss of urine with physical strain due to weakness of sphincters.
109
Hesitancy
* Straining
* Loss of force and decreased calibre
* Terminal dribbling
* Sense of residual urine
110
foreskin is advanced and fixed so tight it is impossible to retract over glans.
Phimosis:
111
Foreskin is retracted and fixed, once retracted behind glans, a tight or inflamed foreskin cannot return to its original position.
Paraphimosis:
112
* urethral meatus opens on the ventral side of glans, shaft, or at the penoscrotal junction. A groove extends from the meatus to the normal location at the tip.
Hypospadias:
113
Meatus opens on the dorsal side of glans or shaft above a broad, spade like penis.
Epispadias:
114
Hard, nontender subcutaneous plaques palpated on dorsal or lateral surface of penis, may be single or multiple and asymmetrical
Peyronie's Disease:
115
Pinpoint constricted opening at meatus or inside along urethra
Urethral Stricture:
116
Prolonged painful erection of penis without sexual desire
Priaspism:
117
Assessment for serous fluid in the scrotum
* Serous fluid does not transilluminate and shows as a red glow.
* Transillumination (darken the room and shine a strong flashlight from behind the scrotal contents)
* normal scrotal contents do not transilluminate.
118
Condylomata acuminata (genital warts)
* Soft, pointed, moist, fleshy, painless papules may be single or multiple in a cauliflower like patch.
* Colour may be grey, pale yellow, or pink in White males and black or translucent grey black in black males
* They occur on shaft of penis, behind corona, or around the anus where they may grow into large grape like clusters
* Caused by HPV (human papillomavirus)
119
Indirect inguinal hernia
* Sac herniates through internal inguinal ring, can remain in canal or pass into scrotum
* Pain with straining; soft swelling that increases with increased intra-abdominal pressure, may decrease when lying down
* Most common
* Congenital or acquired
120
Vestibule comprises which labile structures
* Urethral meatus
* Opening of Skene's gland
* Hymen
* Opening of Bartholin's gland
121
Changes associated with menopause
* Decrease in estrogen production
* Pubic hair decreases (thin and sparse)
* Skin is thinner and fat deposits decrease, leaving the mons pubic smaller and the labia flatter
* Clitoris size decreases
* Rugae of the vaginal walls decrease
* Walls look pale pin because of thinned epithelium
* Cervix shrinks and looks pale and glistening, may retract
122
Goodell’s sign
Cervix softens at 4 to 6 weeks of pregnancy
123
Chadwick’s sign
* Vaginal mucosa and cervix look cyanotic at 8 to 12 weeks (increased vascularity and edema of the cervix)
124
number of pregnancies "How many times?"
Gravida:
125
number of births "How many babies have you had?"
Para:
126
interrupted pregnancies, including elective abortions and spontaneous miscarriages "Any miscarriage or abortion?"
Abortions:
127
* Loss of urine with physical strain from muscle weakness
| * "urinate with a sneeze, laugh, cough, bearing down?"
Stress incontinence
128
is considered after 1 year of engaging in unprotected sexual intercourse without conceiving.
infertile
129
Lithotomy position during genitalia examination – methods to provide comfort
* Have her empty the bladder before the exam
* Position the examination table so that her perineum is not exposed to an inadvertent open door
* Ask if she would like a friend, family member, or chaperone present. Position this person by the woman's head to maintain privacy.
* Elevate her head and shoulders to a semisitting position to maintain eye contact.
* Place the stirrups so that the legs are not abducted too far.
* Explain each step in the examination before you do it.
* Assure the woman she can stop the exam at any point should she feel any discomfort.
* use a gentle, firm touch, and gradual movements.
* Communicate throughout the exam. Maintain a dialogue to share information.
130
Order of examination of the internal genitalia
1. Speculum Examination
2. Inspect the Cervix and Its Os
3. Obtain Cervical Smears and Cultures
4. Inspect Vaginal Wall
5. Bimanual Examination
131
Assessment findings for candidiasis of the vagina
* Intense pruritus, thick whitish discharge
* Vulva and vagina are erythematous and oedematous. Discharge is usually thick, white, curdy.
* Diagnose by microscopic examination of discharge on potassium hydroxide wet mount
132
Sexual Maturity Rating Scale 1
* No pubic hair
| * Mons and labia covered with fine vellus hair as on abdomen
133
Sexual Maturity Rating Scale 2
* Growth sparse and mostly on labia
| * Long, downy hair, slightly pigmented, straight or only slightly curly.
134
Sexual Maturity Rating Scale 3
* Growth sparse and spreading over mons pubis.
| * Hair is darker, coarser, curlier
135
Sexual Maturity Rating Scale 4
* Hair is adult in type but over smaller area
| * none on medial thigh
136
Sexual Maturity Rating Scale 5
* Adult in type and pattern
| * Inverse Triangle
137
Parts of General Appearance documentation
1. Appears stated age
2. level of consciousness
3. Skin colour
4. Nutritional status
5. Posture and position; comfortably erect
6. Obvious physical deformities
7. Mobility/Gait/use of assistive devices/ROM/No involuntary movement;able to rise from a seated position easily
8. Facial expression
9. Mood and affect
10. Speech: articulation, pattern, content appropriate, first language
11. Hearing
12. Personal Hygiene
138
Reason for trans-illuminating the sinuses
Only if sinuses are tender
139
Cranial nerves for extraocular muscle examination
Cranial Nerves III, IV, VI
140
Cranial nerve involved with tongue protrusion
Cranial Nerve XII
141
Cerebellar function testing
* Test cerebellar function of the upper extremities using finger-to-nose test or rapid-alternating movements test
* Test the cerebellar function of the lower extremities by asking the person to run each hell down the opposite shin
142
something you can feel caused by superficial thickening in the epidermis
papule -
143
od
right eye
144
os
left eye
145
Decrease in power of accommodation with aging, is suggested when he person moves the card farther away
Presbyopia
146
subjective sensation that the person feels from the disorder
symptom:
147
Mental Status Examinations
Appearance,
Behaviour,
Cognition,
Thought processes
148
General Survey
* overall impression of the patient
| * begins when you first encounter him or her
149
Description of abnormal skin lesion
Immediate result of a specific causative factor, develop on previously unaltered skin
150
Normal breath sounds
* Bronchial: Trachea and Larynx
* Bronchovesicular: Over major bronchi
* Vesicular: Over peripheral lung fields, where air flows through smaller bronchioles and alveoli
151
Heart auscultation areas
* Over the entire precordium (area on the anterior chest overlying the heart and great vessels)
* Second right interspace: Aortic Valve Area
* Second Left Interspace: Pulmonic Valve Area
* Left Lower Sternal Border: Tricuspid Valve Area
* Fifth Interspace at around left midclavicular line: mitral valve area
152
Arteries that can be palpated
* Dosalis Pedis
* Radial
* Ulner
* Temporal
* Carotid
* Femoral
* Bracial
* Popliteal
* Posterior Tibial
153
Movement of joints
Joint motion normally causes no tenderness, pain, or crepitation.
154
6 Tests for Cerebellar function
1. Balance Test
2. Romberg Test (Holding a straight position while eyes are closed)
3. Rapid Alternating Movements
4. Finger-to-Finger Test
5. Finger-to-Nose Test
6. Heel-to-Shin Test
