General Assessment & Intro To Instruments

Question 1

Universal precautions for pt care

Answer 1

Standards set by CDC
Protect the pt and provider from the spread of infectious diseases
Wash hands before and after wearing gloves

Question 2

When should gloves be worn?

Answer 2

If there is obvious blood, body fluid and pt presenting with diarrhea

Question 3

What are the CDC standards for pt care?

Answer 3

Perform hand hygiene
Use PPE if possible exposure to infectious material
Follow respiratory hygiene/cough etiquette principles
Ensure appropriate pt placement/isolation
Properly handle, clean and disinfect pt care equipment and instruments
Follow safe injection practices (face shield for LP)
Proper handling of needles and sharps

Question 4

What are the 4 types of hand hygiene based on CDC guidelines?

Answer 4

Hand washing, antiseptic hand wash, alcohol based hand rub, and surgical hand hygiene/antisepsis

Question 5

Hand rubbing with an alcohol based hand rub

Answer 5

The gold standard technique to perform hand hygiene on all occasions except for those described for hand washing with soap and water
Recommended for health care works for the routine, day to day decontamination of hands

Question 6

Hand washing with soap and water

Answer 6

Occupies a central place in hand hygiene and should be employed when hands are visibly dirty or soiled with blood/other body fluids; after using the toilet; and when exposure to potential spore forming pathogens (C. Diff) is strongly suspected or proven including outbreaks of diarrhea

Question 7

What are the 4 main vital signs?

Answer 7

BP, pulse, respiratory rate and temperature

Question 8

The bell of the stethoscope is used for

Answer 8

Low pitched sounds (bruits)

Question 9

The diaphragm of the stethoscope is used for

Answer 9

High pitched sounds (breath sound and heart tones)

Question 10

What are the three types of sphygmomanometers?

Answer 10

Mercury, aneroid and digital

Question 11

What is the gold standard for reading BP?

Answer 11

By auscultation

Question 12

Cuff selection for BP measurement

Answer 12

The length of the cuff’s bladder should be at least equal to 80% of the circumference of the upper arm and the width of the bladder should be at least equal to 40% of the length of the upper arm

Question 13

Korotkoff sound

Answer 13

The first knocking sound heard when taking BP measurements and it indicates the pt’s systolic pressure
When the sound disappears it marks the diastolic pressure

Question 14

Which other factors should be noted when taking BP?

Answer 14

Pressure difference in both arms, pt position, which arm was used and the cuff size

Question 15

What environment is ideal for taking BP?

Answer 15

Pt should avoid smoking, caffeine and exercise >30 min prior to measuring BP
Exam room quiet and warm
Pt should sit quiet for 5 min with feet on the floor (not on exam table)
Arm should be free of clothing, dialysis fistulas, cut down scares and lymphedema

Question 16

What are the three common errors in BP monitoring?

Answer 16

Falsely high BP, falsely low BP and auscultatory gap

Question 17

Falsely high BP

Answer 17

Brachial artery below the heart
Cuff too small (narrow)
Cuff too large (wide) on a large arm

Question 18

Falsely low BP

Answer 18

Brachial artery above heart

Cuff too large (wide) on a small arm

Question 19

Auscultatory gap

Answer 19

Period of diminished or absent Korotkoff sounds during the manual measurement of BP
Improper interpretation of this gap may lead to BP monitoring errors: namely an underestimation of systolic BP and/or an overestimation of diastolic BP

Question 20

Checking the pulse rate

Answer 20

Use your index finger not thumb
Report whether pulse is regular or irregular
Pulse rate is by convention reported per minute
Count for 30 seconds and multiply by 2
Can also count for 15 sec and multiply by 4

Question 21

What are the different locations in which you can check the pt’s pulse?

Answer 21

Radial artery, dorsalis pedis artery, carotid artery, brachial artery, abdominal aorta, femoral artery and popliteal artery

Question 22

Scale for grading pulses

Answer 22

3+ Bounding
2+ Brisk, expected (normal)
1+ Diminished, weaker than expected
0 Absent, unable to palpate

Question 23

Two methods for measuring respiratory rate

Answer 23

Look for chest rise and count
Listen while examine heart or lungs with stethoscope
-count for 30 seconds and multiply by 2
-most adults breathe at about 15-20 breaths per min
-dont call attention to the fact that you are counting

Question 24

Where can you take a pt’s temperature?

Answer 24

Orally (measures body temp)
Rectally (higher than when taken by mouth)
Axillary (lower than when taken by mouth)
Ear (core temp/internal organs)
Skin (quick)

Question 25

When is the general assessment of the pt made?

Answer 25

Once you have first looked at the pt and as you are doing your interview and PE

Question 26

The general assessment of the pt consists of noting their

Answer 26

Apartment state of health (general judgment) Level of consciousness (alert, awake and responsive) Signs of distress (cardiac or respiratory, pain, anxiety or depression) Skin color and obvious lesions (skin color, scars, plaques or nevi)

Question 27

When observing the general appearance of the pt, which factors should also be noted?

Answer 27

Nutritional status (normal, slim, cachectic, obese, etc) State of hydration if obvious Posture (stooped, erect, flaccid) Gait (normal, shuffling, antalgic, asymmetrical, unsteady) Dress (causal, meticulous, disheveled, nude) Hygiene Cooperation (personable, conversational, aloof, distracted) Height/weight (stated with vitals) Odor Primary survey (seconds) Secondary survey (minutes)

Question 28

What are some signs of distress that can be noted when observing general appearance?

Answer 28

Affect/mood: pleasant, depressed, flat affect Verbal tones: anger, frustration, obnoxious, impatient Posture: restless, gait, shifting PE findings: sweating, flushed

Question 29

When completing the overall assessment of the skin you should

Answer 29

Scan the skin for variations in skin tone looking for features such as pigment variations, erythema, flushing, jaundice, pallor (pale) or cyanosis

Question 30

Macule

Answer 30

Flat lesion <1 cm

Question 31

Patch

Answer 31

Flat lesion >1cm

Question 32

Papule

Answer 32

Raised lesion, <1cm, not fluid filled

Question 33

Plaque

Answer 33

Raised lesion, >1cm, not fluid filled

Question 34

Vesicle

Answer 34

Raised lesion, <1cm and fluid filled

Question 35

Bulla

Answer 35

Raised lesion, >1cm and fluid filled

Question 36

Primary lesions

Answer 36

Flat or raised Examples: macule, patch, papule, plaque, vesicle, bulla, erosion, ulcers, nodules, ecchymoses, petechiae and palpable purpura

Question 37

When observing the pt’s scalp and hair you should

Answer 37

Evaluate scalp for scars, deformities, bumps, etc Evaluate hair for any abnormal changes in texture and pattern loss (alopecia) Assess for presence of excess hair distribution (hrisutism) or virilization (male secondary sx characteristics in female)

Question 38

Ophthalmoscope

Answer 38

Used to visualize inner aspect of eye including retina, vascular supply, optic nerve, etc Ask pt to look over shoulder, look through aperture, approach pt, hand on pt forehead, R eye to examine R eye, start 15 degrees from center laterally and move toward the pt to identify red reflex

Question 39

Large/medium/small light source - ophthalmoscope setting

Answer 39

Small light is used when the pupil is very constricted (ex. In a well lit room) Large light is best if using mydriatic eye drops to dilate Medium sized light is used in a dark non dilated pupil

Question 40

Half light ophthalmoscope setting

Answer 40

If the pupil is partially obstructed by a lens with cataracts, the half circle can be used to pass light through only the clear portion of the pupil to avoid light reflecting back

Question 41

Red free ophthalmoscope setting

Answer 41

Used to visualize the vessels and hemorrhages in better detail by improving contrast Will make the retina look black and white

Question 42

Slit beam ophthalmoscope setting

Answer 42

Used to examine contour abnormalities of the cornea, lens and retina

Question 43

Blue light ophthalmoscope setting

Answer 43

Can be used to observe corneal abrasions and ulcers after fluorscein staining

Question 44

Grid ophthalmoscope setting

Answer 44

Used to make rough approximations of relative distance between retinal lesions

Question 45

When checking the ear of a child >12 months or an adult you should hold the otoscope in one hand and use your free hand to

Answer 45

Pull the other ear gently up and back which straightens the ear canal and improves visualization

Question 46

When observing the ear canal in a child less than 12 months old you should gently pull the outer ear

Answer 46

Down and back

Question 47

Using a tuning fork for hearing evaluation

Answer 47

Air conduction - lasts longer than bone conduction; hold the fork in front of external auditory meatus Bone conduction - hold handle on bones area behind the ear

Question 48

Evaluating vibratory sense with a tuning fork

Answer 48

Place handle on patella and compare L and R for duration

Question 49

The tuning fork can be used to perform two

Answer 49

Neurological tests: gross hearing for CN and vibration sense

Question 50

Upper extremity deep tendon reflexes

Answer 50

Biceps (hammer strikes thumb), triceps (hammer strikes ligament) and brachioradialis (hammer strikes ligament)

Question 51

Lower extremity deep tendon reflexes (LE DTRs)

Answer 51

Patellar and Achilles reflex

Question 52

Scale for grading reflexes

Answer 52

4 - very brisk, hyperactive with clonus (rhythmic oscillations between flexion and extension) 3 - brisker than average; possible but not necessarily indicative of disease 2 - average; normal 1 - somewhat diminished; low normal 0 - reflex absent

Question 53

Osteopathic Structural Exam (OSE) integrates information about the

Answer 53

Musculoskeletal system even when dealing with non musculoskeletal complaints

Question 54

Documenting OSE includes

Answer 54

Tissue texture changes, asymmetry, range of motion and tenderness