Practical exam Flashcards
(48 cards)
OPQRST
- O= onset
- P= provocation/palliation: make it better or worse
- Q= quality: characterization of pain
- R= radiation
- S= severity
- T= time
Renal Sim procedure
- greet proctor
- hand hygiene w/gloves
- greet patient on right side
- ABCs
- analyze & interpret vital signs
- **don’t forget temp from chart**
- focused physical
- general survey
- assessment of pulse
- heart auscultation
- lung auscultation
- abdominal palpation
- describe findings
- differential diagnoses
- 4 appropriate tests
- identify ECG findings
- describe how FENa is used to determine type of renal failure
what is FENa?
fractional excretion of sodium
=100 x [(Naurine x crplasma) / (Naplasma x crurine)]
cr=creatinine
<1%→ prerenal failure, ex. hypovolemia
>2%→ tubular/glomerular damage, ex. kidney failure
1-2%→ obstruction likely, ex. kidney stone
airway sim procedure
- greet proctor
- hand hygiene & gloves
- head tilt
- describe contraindication
- describe anatomic mechanism that open’s airway
- jaw thrust
- describe anatomic mechanism that open’s airway
- demonstrate BVM technique: CE hand
- name airway devices
- advantages & disadvantages of each
- oropharyngeal airway
- demonstrate anatomic landmark for sizing
- place
- nasopharyngeal airway
- demonstrate anatomic landmark for sizing
- place
- absolute contraindication
- state 4 physical findings of a basilar skull fracture
- describe how to assess adequacy of ventilation
Harvey procedure
- greet proctor
- hand hygiene: no gloves required
- inspect from foot of bed & patient’s right side
- respirations
- chest symmetry
- apical impulse
- palpate carotid or femoral pulse & describe
- name & describe location of 4 precordial areas
- palpate them for impulses & thrills
- auscultate them
- heart sounds present
- is S1 or S2 louder
- make diagnosis
- explain mechanism of split S1, split S2, S3, & S4
what is the difference between signs and symptoms?
signs are physical findings & symptoms are patient complaints or observations
what are korotkoff sounds?
pulsations heard during manual blood pressure reading between systolic & diastolic pressures
how should blood pressure be reported?
rounded to the nearest even number
what is determined by the disappearance of the radial pulse under pressure?
systolic blood pressure
where is the carotid pulse located?
medial border of the sternocleidomastoid muscle at the level of the cricoid cartilage
how is orthostatic blood pressure assessed & reported?
- inspect arms for fistulas, edema, or scarring
- take bp while pt is sitting
- take bp again immediately after pt stands up
- if change is >/=10, then orthostatic hypotensive
what should be assessed & reported about the carotid pulse?
- rate
- rhythm: regular or irregular
- volume: bounding, full, or weak
- character: mono- or biphasic
arterial circulation exam procedure
- check carotid arteries
- rate, rhythm, volume, & character
- listen w/bell for bruit (pt. holds breath)
- radial pulses
- brachial pulses
- posterior tibial pulses
- dorsalis pedis pulses
- lower extremities exam
- feel w/back of hands for temperature
- assess for hair loss below the knee
- presence of ulcers or lesions
- don’t forget plantar surface & between toes
- assess capillary refill by pressing on toenail beds
- if wearing nail polish or have toenail pathology, use tips of toes
- normal palor should return in <2sec
where can the brachial pulse be felt?
antecubital fossa medial to the biceps tendon
OR
medial to the biceps muscle on the humerus above the elbow
What is Neer’s sign? how is it performed?
- patient’s hand is fully pronated→thumb towards back
- stabilize pt’s scapula & use other to flex arm
- if pain occurs→ record degree of should flexion
- Neer’s sign
assessment for impingement: most commonly the supraspinatus muscle
what is the difference between a Neer’s sign & a Neer’s test?
sign is when there is pain upon passive arm flexion w/the hand pronated
test is + Neer’s sign, then injected w/local anesthetic, exam is repeated w/ - Neer’s sign
where are Bouchard’s nodes found?
proximal interphalangeal joints
where are Heberden’s nodes found?
distal interphalangeal joints
what are Heberden’s & Bouchard’s nodes?
bony nodules in the phalangeal joints
typically caused by osteoarthritis
wasting of the thenar region is typically caused by?
median nerve damage
wasting of the hypothenar region is typically caused by?
ulnar nerve damage
will also cause muscle wasting of the interosseus muscles
swelling of the MCP joints is a sign of?
systemic inflammatory reaction
commonly rheumatoid arthritis
tenderness in the anatomical snuffbox is associated with?
scaphoid bone fracture
musculoskeletal exam procedure
- inspection: scarring, inflammation, deformities
- palpate for bony landmarks & swelling
- active ROM
- passive ROM
- report findings
