Physical Exam (1)

Question 1

What are the components of a health assessment?

Answer 1

Health History
Physical Assessment

Question 2

Tactic to use when asking about substance abuse during physical exam:

Answer 2

Blunt conversation to explain you just need to know but dont really care

Question 3

A collection of subjective and objective data that provide a detailed profile of the client’s health status is known as _______________

Answer 3

Health History

Question 4

Who is involved in the anesthetic time out?

Answer 4

anesthetist
surgeon
patient

Question 5

Why does patient monthly income matter to us?

Answer 5

Might have impact on postop care (ability to fill prescription)

Question 6

What is the scientific study of the measurements and proportions of the human body?

Answer 6

Anthropometry

Question 7

What are some descriptions for height/build?

Answer 7

Average, Tall, Short, Lanky (long and thin), Muscular

Question 8

What type of patients are prone to positioning injuries?

Answer 8

Emaciated patients
Large patients

Question 9

What could be the issue for a patient that has had recent drastic weight loss or weight gain?

Answer 9

Drastic weight loss: Cancer, T1 diabetes

Drastic weight gain: heart failure, hypothyroid

Question 10

Where are some areas to measure BP?

Answer 10

Radial artery (above wrist)
Dorsalis pedis artery (midcalf)
Popliteal artery (above knee)
Brachial artery (upper arm)

Question 11

Axillary temps are approx ____ degrees less than core temps

Answer 11

1 degree Fahrenheit less

Question 12

What vital sign is a big core measure for CRNAs?

Answer 12

temp

Question 13

In patients who smoke, who is at highest risk for lung cancer and should undergo screening with low-dose CT?

Answer 13

Patients who are 55 or older with 30 or more pack year history

Question 14

What is meant by a pack year? How many cigarettes per pack?

Answer 14

1 pack per day x 365 days

20 per pack

Question 15

Why is it important to know patient family information?

Answer 15

Important in peds and for discharge planning

Question 16

If a patient is crazy before being put under how would you expect them to wake up?

Answer 16

Often the way the patient goes to sleep is the way they wake up

Question 17

What is the order for physical assessment?

Answer 17

Inspection
Palpation
Percussion
Auscultation
Olfaction

Question 18

What are the different types of palpation and the order to perform?

Answer 18

Light: 1-2cm depth

Deep: used to detect abdominal masses/fem pulse–4-5cm depth

Bimanual: both hands to trap a structure between then

Question 19

______ involves tapping the body with the fingertips to evaluate the size, border and consistency of body organs and to discover fluid/air in body cavity

Answer 19

Percussion

Question 20

Term for sound waves heard as percussion tones:

Answer 20

Resonance

Question 21

What type of percussion involves putting a hand down and tapping on the hand?

Answer 21

Mediate or indirect percussion

Used mainly to evaluate the abdomen or thorax

Question 22

What type of percussion is used to evaluate the sinus or an infant thorax?

Answer 22

Immediate percussion

Question 23

How is immediate percussion performed?

Answer 23

Striking the surface directly with the fingers of the hand

Question 24

What is fist percussion and what is it used to evaluate?

Answer 24

Placing one hand flat against the body surface and striking the back of the hand with a clenched fist of the other hand

Used to eval back and kidney for tenderness

Question 25

Where is a common location for tympany and what does it sound like?

Answer 25

Loud, high pitch, drumlike Common in air containing space, enclosed are, gastric air bubble, puffed out cheek

Question 26

You are assessing a patient and performing percussion over the upper thorax. You notice a low pitches hollow sound of moderate intensity. What is the name for this sound and what does this finding indicate?

Answer 26

Resonance--normal percussion sound in normal lungs

Question 27

What type of percussion sound might be presence in lungs with emphysema?

Answer 27

Hyper Resonance--very loud, very low, booming sound

Question 28

You notice a thudlike percussion when assessing a patients abdomen that has a high pitch and moderate duration. What is this sound produced during percussion and where is this likely to occur in the body?

Answer 28

Dullness--common in the liver

Question 29

Where is a common location to percuss an area that produces a "flatness" sound?

Answer 29

Muscle- High pitch, short duration, flat quality

Question 30

What are things that should be noted with auscultation?

Answer 30

Intensity Pitch Duration Quality

Question 31

What causes the yellow discoloration of the skin and eyes in a patient that is jaundice? What should be considered from a surgical standpoint?

Answer 31

Elevated bilirubin--assume liver function is impaired Issues with poor clotting

Question 32

Autoimmune disorder where body systems that fight infection start to fight off healthy cells (melanocytes):

Answer 32

Vitiligo

Question 33

What are some possible reasons for petechiae?

Answer 33

Prolonged straining (coughing/sneezing) Meds Infectious diseases Leukemia Thrombocytopenia

Question 34

What are the grades of pitting edema?

Answer 34

Grade 0: none Grade +1: trace (2mm) rapidly disappears Grade +2: moderate (4mm) 10-15 sec Grade +3: deep (6mm) ≥1min Grade 4+: very deep (8mm) 2-5 min

Question 35

What is Koilonychias and what issues can it indicate?

Answer 35

"Spoon nails" abnormally thin nails that become flat or concave Can be sign of Hypochromic anemia or Iron deficiency anemia

Question 36

What is associated with nail clubbing?

Answer 36

Mostly associated with heart and lung disease Lung cancer, lung infections, interstitial lung disease, CF, CV disease (can sometimes be genetic and not disease related)

Question 37

What is Paronychia?

Answer 37

inflammation of the skin around the nail

Question 38

Main consideration when assessing the eye:

Answer 38

Think about endocrine disorders (exophthalmoses)

Question 39

Eye condition that causes eyes to be misaligned:

Answer 39

Strabismus

Question 40

What block commonly causes ptosis?

Answer 40

Inter-scalene blocks

Question 41

How does anesthesia cause ptosis?

Answer 41

Blocks Horners Syndrome: Ptosis, Miosis, loss of temp sensation

Question 42

Term for when the eye lid margin turns out (eversion):

Answer 42

Ectropion

Question 43

Term for when the eye lid turn inward (inversion):

Answer 43

Entropion

Question 44

Abnormal drooping of the lid over the pupil

Answer 44

Ptosis

Question 45

Notable differences in pupil sizes

Answer 45

Anisocoria

Question 46

What is the treatment for a sty?

Answer 46

Warm moist towel--increases perfusion and unclogs the duct

Question 47

What type of eye injury is a surgical emergency?

Answer 47

Open Globe (full thickness wound of the eye wall)

Question 48

What do we have to consider with anesthesia and eyes?

Answer 48

increasing IOP with succs, face masks pushing on the eye, problems with mask ventilation if they have eye patch

Question 49

What stage on anesthesia includes roving eye balls and pupils partially dilated?

Answer 49

Stage 2

Question 50

What is Arcus senilis?

Answer 50

Common build up of fatty substance in the eye that appears as a white, grey, or blue ring around the cornea

Question 51

What medication causes pupillary constriction?

Answer 51

Opioids

Question 52

What medications cause pupillary dilation?

Answer 52

Anticholinergics

Question 53

Differentiate retinal artery occlusion with corneal abrasion:

Answer 53

Retinal artery occlusion: complete loss of vision Corneal abrasion: Blurry vision, feels like sand in the eye

Question 54

What does the snellen test evaluate?

Answer 54

Visual acuity by reading chart of letters/symbols

Question 55

What does extra ocular movement assessment help evaluate?

Answer 55

Optic nerve entrapment of the muscle--emergency

Question 56

Glaucoma involves loss of ____________ vision

Answer 56

Peripheral vision (tunnel vision)

Question 56

How do cataracts impact vision?

Answer 56

Progressive loss of visual acuity

Question 56

What disorder might low set ears indicate?

Answer 56

Down syndrome--could have problems with airway (smaller neck, weird airway presentations)

Question 57

What can be used to alleviate pressure on an ear if patient is laying on it?

Answer 57

donut

Question 58

What could bulging tympanic membrane indicate?

Answer 58

Elevated ICP

Question 59

Why are we concerned when a patient with basilar skull fracture has fluid leaking from ears or nose?

Answer 59

Could be CSF--Halo test usually mixed with blood

Question 60

What is the Rinne test used for?

Answer 60

Primarily used to evaluate air vs bone conduction

Question 61

In recent years exposure to radiation has been linked to increase risk for _________ and ___________

Answer 61

Cataracts and Hearing loss

Question 62

What is the Webers test used for?

Answer 62

Used to determine which ear has conductive hearing loss

Question 63

Why is it important to avoid N2O if a patient has risk for elevated ICP or increased sinus pressure?

Answer 63

N2O can diffuse out into sinus spaces--Further increasing sinus pressure and ICP

Question 64

What can be used as a pretreatment to vasoconstrict the vessels in the nose and reduce risk of bleeding?

Answer 64

Afrin

Question 65

Pale lips could be an indicator of...

Answer 65

Anemia

Question 66

Where is a good site to visualize jaundice?

Answer 66

Buccal mucosa

Question 67

What vitamin deficiency could a bright red tongue indicate?

Answer 67

B12 or Niacin

Question 68

What a concern if a patients gums are bleeding?

Answer 68

Concern for hepatic issues and coagulopathy

Question 69

What can cyanosis or redness in the mouth indicate?

Answer 69

Iron deficiency

Question 70

White coating on the tongue could mean...

Answer 70

dehydration

Question 71

How can you assess the sinuses?

Answer 71

Transillumination: Take a light and shine it through the sinuses then ask patient to open their mouth: -Normal would be to see the light shine through -If there is build up on mucus the light wont shine through

Question 72

What issues can be indicated by the following lip colors: Cherry, Pallor, Cyanosis:

Answer 72

Cherry: CO poisoning Pallor: Anemia Cyanosis: Hypoxia or hypo perfusion

Question 73

What do gums look like if someone has a Vit-C deficiency?

Answer 73

Spongy gums that bleed easily

Question 74

What is Leukoplakia?

Answer 74

Thick white patches on the gums d/t smoking and alcohol

Question 75

How do you assess the pharynx?

Answer 75

Extend neck slightly, open the mouth widely and say "ah" place tongue depressor on the middle 1/3 of tongue and use pen light Gag reflex should be present No gag/ dysphagia= increase risk for aspiration

Question 76

How is the sternocleidomastoid function assessed?

Answer 76

Ask patient to flex the neck with the chin to the chest shouldnt have any pain with this

Question 77

How to assess function of trapezius muscles?

Answer 77

Movement of the head sideways so that the ear moves toward the shoulder neck should move freely without any pain

Question 78

What to do if you cant palpate the thyroid gland easily:

Answer 78

Give the patient water, take a sip and swallow as you palpate

Question 79

Where is the apical pulse located?

Answer 79

5th ICS medial to the mid-clavicular line

Question 80

What is the most common GU precedure?

Answer 80

Cystoscopy

Question 80

GU surgeries tend to have a rapid drop in BP, what can you be to try to avoid this? Cant remember why

Answer 80

Volume load

Question 81

Which cases typically require foleys?

Answer 81

Laparoscopic (need bladder decompressed) Long cases

Question 82

What medication affects DTRs?

Answer 82

Mag

Question 83

Why is kyphosis a worry from airway standpoint?

Answer 83

Compressed chest space/lungs

Question 84

What are the common pathologic spine curvatures? How would the affect patient positioning?

Answer 84

Lordosis, Kyphosis, Scoliosis Pad voids when patient is positioned to avoids injuries

Question 85

What does the Romberg test check for?

Answer 85

Proprioception Patient closes eyes with arms out and becomes unsteady= positive Romberg (loss of proprioception)

Question 86

What does the VAN assessment screen for?

Answer 86

Large vessel occlusion

Question 87

What are the different reflexes discussed in class?

Answer 87

Biceps Triceps Patella Achilles Planter Gluteal

Question 88

How does the arm move when testing bicep tendon?

Answer 88

Flexion on arm at the elbow

Question 89

How does the arm move when testing tricep tendon?

Answer 89

Extension at elbow

Question 90

What reflex is common to test on pregnant women who are on mag? How is it tested?

Answer 90

Patellar reflex Leg hangs freely--tap patellar tendon just below patella extension of lower leg

Question 91

How is achilles reflex tested?

Answer 91

Strike achilles tendon--causes plantar flexion of foot (pointed toe)

Question 92

How to eval plantar reflex? (babinski)

Answer 92

Have patient lie supine w/legs straight Stoke lateral sole of heel to ball of foot should cause plantar flexion of all toes

Question 93

How to assess gluteal reflex

Answer 93

Lightly stimulate perineal area with cotton applicator--should cause contraction of anal sphincter

Question 94

"Chipmunk face" is associated with what eating disorder?

Answer 94

Bulimia

Question 95

Spider angioma is commonly associated with what liver disorder?

Answer 95

Cirrhosis

Question 96

Pyloric stenosis is associated with that shape mass?

Answer 96

Olive

Question 97

Hyperthyroid is associated with ophthalmic changes?

Answer 97

Exophthalamus

Question 98

What physical feature is common with Cushing's?

Answer 98

Buffalo hump

Question 99

Rice water stool is common with what illness?

Answer 99

Cholera

Question 100

Leonine face is associated with _______.

Answer 100

Leprosy (Hansen’s Disease) Leprosy is caused by infection with the bacterium Mycobacterium leprae. It mainly affects the skin, eyes, nose and peripheral nerves.