test 2 Flashcards
(220 cards)
1
Q
what are the skills of examination?
A
inspection, palpation, percussion, auscultation
2
Q
what is percussion
A
tapping a person’s skin with short, sharp strokes
3
Q
what does percussion assess
A
underlying structures
4
Q
how do you properly percuss
A
hyperextend the middle finger, place the distal end firmly against the skin, strike the stationary finger behind the nail bed
5
Q
how does percussion make noise
A
all sound results from vibration of some structure
6
Q
structures with more air produce a ____, ____, and ____ sound.
A
louder, deeper, longer
7
Q
what is the flat edge of the stethoscope
A
diaphragm
8
Q
what is the hallow, cup-like end piece
A
bell
9
Q
which end is the most commonly used
A
diaphragm
10
Q
what does the diaphragm do?
A
it is used to hear high pitched sounds(breath, bowel, normal heart rate)
11
Q
what does the bell do?
A
it is used to hear soft, low pitched sounds(murmurs)
12
Q
what is the most important safety technique
A
hand washing
13
Q
when shouldn’t you use hand sanitizer
A
when the patient has C diff.
14
Q
when should you wear gloves
A
when there is a potential risk of coming in contact with bodily fluids( blood, urine, mucous membranes)
15
Q
how do you prepare of examination of an infant?
A
maintain warm environment, make sure stethoscope and hands are warm, smile
16
Q
how do you position an infant in an exam?
A
place infant flat on a padded surface, parent must always be present, after the baby can sit have them sit on there parent lap, parent should be in full view
17
Q
what is the sequence of the exam of an infant?
A
if baby is sleeping listen to heart, lungs, and abdominal sounds first; perform least stressing tasks first, perform startle reflex last
18
Q
How do you position a toddler during an exam?
A
should be sitting on the parents lap, have the parent help with exam if possible
19
Q
how do you prepare for an exam of a toddle?
A
have a security object, allow them to warm up to you, avoid asking if you can do something- instead tell them you are going to do it, demonstrate the procedure on the parent, tell the child they are doing a good job
20
Q
what is the sequence of the exam for a toddler?
A
begin with games such as the Denver II, start with nonthreatening areas
21
Q
how do you position a preschool child?
A
is 4 or older have them sit on the table
22
Q
how do you prepare for the exam of a preschool child?
A
use short simple sentences, talk to the child and explain things to them, allow child to play with equipment
23
Q
what is the sequence of the exam of a preschool age child?
A
examine the thorax, abdomen, extremities, and genitalia first; then assess the head, eyes, ears, nose and throat
24
Q
what is the position of a school aged child during an exam
A
sitting or lying on exam table, maintain privacy,
25
how do you prepare for the exam of a school age child>
use small talk(family, friends, sports), let them undress themselves, demonstrate equipment, comment of body and how it works,
26
what is the sequence of the exam with a school age child
head to toes
27
what is the position of a adolescent during an exam
sitting on exam table, examine them alone
28
what is the preparation of the exam with an adolescent
give feedback that their body is normal, don't treat them like a child, don't expect too much from them,
29
what is the sequence of the exam with an adolescent
head to toe, genitalia last and do that quickly
30
what is the position of the aging adult during an exam
sitting on exam table, allow for change of position, allow rest periods
31
what is the preparation of the exam of an aging adult
adjust the pace of exam to their needs, use physical touch, don't mistake diminished sight or hearing for confusion, note that they have more life stress
32
how do you exam an ill person?
allow them to alter positions during exam, you might just need to exam body system that pertain to the illness, mini-data base
33
what does the general survey cover?
general health state, any obvious physical characteristics,
34
what is the general survey
introduction to the physical exam
35
when does the general survey start
with your first impression of the patient
36
what are the four things you need to note with all patients?
physical appearance, body structure, mobility, and behavior
37
what is included in the physical appearance of a person
age, sex, level of consciousness, skin color, facial features, overall appearance
38
what should you document about age
if they look significantly older than they are
39
what should you document about sex
sexual development appropriate for age, transgender, note stage of transfiguration
40
what should you document about level of consciousness
if the patient is alert and orientated to person, place, time, and situation
41
what should you notice about the skin color
if the skin color is even throughout, skin is intact and no obvious lesions, make note of tattoos and piercings
42
what should you notice about facial features
facial features are symmetric and stay symmetric when they smile or frown
43
what should you notice about their overall appearance?
no signs of acute distress
44
what is all under the category body structure?
stature, nutrition, symmetry, posture, position, body build, obvious physical deformities
45
what is stature?
height is in normal range for age and genetic heritage
46
what is important about noticing their nutrition?
if the weight is in the normal range for height and body build, body fat is distributed normally
47
what do you need to document about body symmetry
if the body parts look equal and are proportionate to their height
48
what do you need to document about posture
if they sit or stand comfortably, if they are erect or slumped
49
what is a normal position
person sits comfortably with their head erect towards examiner and not fidgeting with their hands
50
what is normal body build for arms?
arm span(fingertip to fingertip) is about equal to their height
51
what is normal body build for body length/
crown to pubis is about equal to length from pubis to sole
52
what is included in the category of mobility
gait, and range of motion
53
what is gait?
how the person walk
54
what is a normal gait
foot placement is accurate, walk is smooth and even, person can maintain balance
55
what is range of motion?
how the person can move each joint
56
what do you need to note about range of motion?
how much mobility they have in all their joints, and if the motion is smooth and coordinated
57
what is included in the category behavior
facial expression, mood and affect, speech, speech pattern, and dress
58
what do you need to note about facial expression
maintain eye contact, is the expressions are appropriate for the situation,
59
what do you need to note about mood and affect
the person is comfortable and cooperative
60
what do you need to document about speech
if their articulation is clear and understandable
61
what do you need to document about speech pattern
if they talk fluently with an even pace, conveys ideas clearly
62
what do you need to observe about their dress
if it is appropriate for the situation and season
63
what do you need to document about their personal hygiene
if they are clean and groomed
64
what is included in measurement?
weight, height, body mass index, waist circumference
65
what is concerning with weight?
abnormal weight loss or weight gain
66
what is considered to be over weight on the BMI scale?
25 and above
67
where do you measure someone's waist circumference
right above the illiac crest
68
where is the temperature of the body regulated
hypothalamus of the brain
69
what is the body's normal range for temperatures
96.4 to 99.1
70
what is the most accurate temperature
rectal
71
what is a normal pulse rate
resting 50-95 beats per minute
72
what is bradycardia
slow pulse under 50 beats per minute
73
what is tachycardia
pulse higher than 95 beats per minute
74
what is the normal rhythm of a pulse
regular, even tempo
75
what is the scale to record force of the pulse
3+ full, bounding
2+ normal
1+ weak, thready
0 no pulse
76
what is the most accurate way to take respirations
don't tell the patient you are doing it, take it for 30 seconds and multiply by 2
77
how many respirations in a minute are normal for a neonate
30-40
78
how many respirations in a minute are normal for an adult
10-20
79
what happens when a blood pressure cuff is too small
abnormally high blood pressure
80
what happens if a cuff is too lose
abnormally low blood pressure
81
what can affect blood pressure
age, sex, race, weight, exercise, emotions, stress,
82
the rubber bladder of the bp cuff should equal what percentage of the circumference of the person's arm
40%
83
what is cortication of the aorta
congenital form of narrowing
84
where should you take the BP is the patient has a cortication of the aorta
take it on the thigh
85
what is orthostatic hypertension?
a drop in the systolic pressure of greater than 20 mm Hg or increase in pulse of greater than 20 beats per minute, with a quick change to a standing position
86
who do you measure the circumference of their head?
infant's
87
how do you measure the circumference of the infant's head?
circle the retractable tape measure around the baby's head aligned with the eyebrows, at the prominent frontal and occiptial bones
88
how often do you measure the circumference of the infant's head?
at each visit up to 2 years
89
What are the ABCD's of skin, moles
A-asymmetry
B-border
C-color
D-diameter
90
what color changes could happen over the entire body?
pallor, erythema, cyanosis, jaundice,
91
what is pallor
skin takes a white color
92
what is erythema
intense redness of the skin
93
what is jaundice
yellowish skin color
94
what is cyanosis
bluish mottled color
95
where is the best place to test turgor
under the clavicle, top of hand, or arm
96
what is clubbing of the nails?
nail becomes convex, could be caused by heart disease, lung cancer, and pulmonary diseases
97
what is a mongolian spot?
variation of hyperpigmentation in African american, Asian, and american Indian and Hispanic newborns
98
what does a mongolian spot look like?
bluish black to purple macular areas at the sacrum or buttocks and sometimes at the abdomen, thighs, shoulders, or arms
99
does a seborrheic keratoses become cancerous?
no
100
are actinic(senile or solar) keratoses precancerous?
yes
101
what are primary lesions?
the immediate result of a specific causative factor, develop primarily of previously altered skin
102
what are types of primary lesions?
macule, papule, patch, plaque, nodule, wheal, tumor, urticaria, vesicle, bulla, cyst, pustule
103
what is a macule?
solely a skin change, flat, less than 1 cm
104
what is a papule?
something you can feel, solid, elevated, less than 1 cm
105
what is a patch?
macules larger than 1 cm
106
what is a plaque
papules that are larger than 1 cm
107
what is a nodule
solid, elevated, hard or soft, larger than 1 cm, may extend deeper than a papule
108
what is a wheal?
superficial, raised, slightly irregular from edema(mosquito bit, allergic reaction)
109
what is a tumor?
larger than a few centimeters in diameter, firm or soft, deeper into the dermis,
110
what is urticaria
hives, wheals that form together
111
what is a vesicle
elevated cavity containing free fluid, up to 1 cm(herpes, chicken pox)
112
what is a bulla?
larger than 1 cm, superficial in epidermis, thin walled, ruptures easily(blister, burns)
113
what is cyst
encapsulated fluid-filled cavity in dermis or subcutaneous layer
114
what is a pustule
pus in the cavity
115
what are secondary lesions
resulting from a change in a primary lesion
116
what are examples of secondary lesion
crust, scale, fissure, erosion, ulcer, excoriation, scar, atrophic scar, lichenification, keloid
117
what is a crust
thickened, dried-out exudate left when vesicles/pustules burst or dry up
118
what is a scale
compact, desiccated flakes of skin, dry or greasy, silvery or white, from shedding of dead excess keratin cells
119
what is a fissure
linear crack with abrupt edges; extends into dermis dry or moist,
120
what is an erosion
scooped out but shallow depression, heals without a scar
121
what is an ulcer
deeper depression extending into the dermis, irregular shape, may bleed, leaves scar when it heals
122
what is an excoriation
self-inflicted abrasion; superficial, sometimes crusted; scratches from intense itching
123
what is a scar?
after a skin lesion is repaired normal tissue is lost and replaces with connective tissue
124
what is a atrophic scar
the resulting skin level is depressed with loss of tissue, thinning of the epidermis(stretch marks)
125
what is a lichenification?
prolonged intense scratching eventually thickens skin and produces tightly packed sets of papules
126
what is keliod
a benign excess of scar tissue beyond sites of original injury
127
what is a bruise
contusion, mechanical injury resulting in hemorrhage into tissues
128
what is a hematoma
bruise you can feel
129
what is purpura
extensive patch of petechiae,
130
what is petechiae
tiny punctate hemorrhages, round and discrete dark red, purple, or brown in color
131
what is toxic alopecia
patchy symmetric balding that accompanies severe illness or use of chemotherapy
132
what is alopecia areata?
sudden appearance of sharply circumscribed, round or oval balding patch
133
what is trichotillomania
traumatic, self-induced hair loss usually the result of compulsive twisting or pulling
134
what diseases are related to clubbing
heart disease, pulmonary diseases,
135
where is the anterior triangle
between the sternomastoid muscle and midline of the body and the base is at eh edge of the mandible
136
where is the posterior triangle
behind the sternomastoid muscle and the trapezius of the other side, the base is at the clavicle
137
what are the fontanels?
the spaces where the sutures intersect, soft spots, allow for the brain to grow
138
when do the fontanels grow closed
posterior fontanel is closed by 1-2 months
| anterior fontanel is closed by 2 years
139
where are the preauricular lymph nodes
in front of the ear
140
where are the posterior auricular lymph noded
superficial to the mastoid process
141
where are the occipital lymph nodes
at the base of the skull
142
where are the submental lymph nodes
behind the tip of the mandible
143
where are the submandibular lymph nodes
halfway between the angle and the tip of the mandible
144
where are the jugulodigastric lymph nodes
under the angle of the mandible
145
where are the superficial cervical lymph nodes
overlying the sternomastoid
146
where are the deep cervical lymph nodes
deep under the sternomastoid
147
where are the posterior cervical lymph nodes
in the posterior triangle along the edge of the trapezius muscle
148
where are the supraclavicular lymph nodes
just above and behind the clavicle at the sternomastoid
149
what is an important question to ask with a head injury?
did you lose consciousness when you hit your head
150
what is a tension headache?
band-like tightness, non throbbing, doesn't pulsate
151
where are tension headaches located?
usually both sides of head, across the frontal, temporal, and/or occipital bones
152
what are aggravating factors of a tension headache?
stress, anxiety, depression, poor posture, not worsened by physical activity
153
what is a migraine?
throbbing and pulsating, can last up to 48 hours, moderate-severe
154
where are migraines located?
pain is often behind the eyes, the temples, or forehead
155
what are aggravating factors of a migraine?
hormonal fluctuations, foods(alcohol, caffeine) hunger, letdown after stress, sleep deprivation, flashing lights, changes in weather, physical activity
156
what is a cluster headache?
always open-sided, behind or around the eye, temple forehead, cheek, continuous, burning, piercing, excruciating
157
what are aggravating factors of a cluster headache?/
alcohol, stress, daytime napping, wind or heat exposure
158
what is fetal alcohol syndrome
fetus is exposed to alcohol in the womb and ends up with severe cognitive and psychosocial impairments
159
what are some physical signs of fetal alcohol syndrome
flat midface, short palpable fissures, short nose, thin upper lip, low nasal bridge,
160
what are signs and symptoms of hypothyroidism?
fatigue, cold intolerance, puffy hand and feet, dry skin, dry hair
161
what are signs and symptoms of hyperthyroidism>
nervousness, fatigue, weight loss, muscle cramps, heat intolerance
162
with aging what is a normal change of the neck
increased concave or inward curve when the head and jaw are extended
163
with aging what is a normal change of the head?
temporal arteries may look twisted and prominent, mild tremor of the head
164
what does allergies look like in the face?
exhausted face, blue shadows under their eyes, central facial pallor, open mouth breathing
165
what is acromegaly
excessive secretion of growth hormone from the pituitary gland after puberty creating a enlarged skill and thickened cranial bones
note elongated head, massive face, over-growth of the nose and lower jaw
166
what is cushing syndrome
moon like face, caused by chronic steroid use
167
what is bell palsy
producing rapid onset of cranial nerve VII paralysis of facial muscles; person cannot wrinkle the forehead, raise eyebrows, close eyelid, whistle, or show teeth
168
what is a stroke?
acute neurologic deficit caused by a blood clot of a cerbral vessel
169
what is parkinson sydrome
deficiency of the neurotransmitter dopamine and degeneration of the basal ganglia in the brain, immobility of features, face is flat and expressionless, elevated eyebrows, staring gaze, oily skin, and drooling,
170
what is cachectic appearance
chronic wasting syndrome, sunken eyes, hollow cheek and exhausted and defeated expression
171
snellen eye chart
tests visual acuity
172
confrontation test
screens for loss of peripheral vision
173
corneal light reflex
assess the parallel alignment of the eye axes,
| note the reflection of the light of the corneas, it should be the same in each eye
174
diagnostic positions test
leading the eyes through the six cardinal positions of gaze elicits any muscle weakness during movement
175
what is pupillary light reflex
normal constriction of the pupils when bright light shines in tthe retina
176
what is fixation
reflex direction of the eye toward an object attracting our attention
177
what is accommodation
adaption for the eye for near vision
178
what is macular degeneration,
a loss of central vision caused by yellow deposits and neovascularity in the macula
179
what is glaucoma
loss of peripheral vision caused by increased intraocular pressure
180
what are cataracts
clouding of the crystalline lens form a clumping of proteins
181
what is nystagmus
fine, oscillating movement best seen around the iris
182
what are you looking at with a fundus exam
internal surface of the retina
183
what is normal for the vision of a child from birth to 2 weeks
refusal to open eyes after exposure to bright lights, increasing alertness to object, infant may fixate on an object
184
what is the normal vision of a child from 2 weeks to 4 weeks
infant can fixate on an object
185
what is the normal vision of a child by one month
infant and fixate and follow a light or bright toy
186
what is the normal vision of a baby by 6 weeks
infant makes some visual respone to your face
187
what is the normal vision of a baby by 3 to4 months
infant can fixate, follow, and reach for the toy
188
what is the normal vision of a baby by 6 to 10 months
infant can fixate and follow the toy in all directions
189
what is ptosis
(drooping upper eyelid) neuromuscular weakness, oculomotor cranial nerve III damage or sympathetic nerve damage
190
what is hordeolum
(stye) acute localized staph infection of the hair follicles at the lid margin
191
what is a chalazion
beady nodule protruding on the lid, infection ofthe gland
192
what is mydriasis
dilated and fixed pupils enlarger pupils occur with stimulation of the sympathetic nervous system
193
what is miosis
constricted and fixed pupils
194
what is conjunctivitis?
pink eye, it is a viral infection, inflammation of the eye, it is highly contagious
195
what is acute angle closure glaucoma?
circumcorneal redness around the iris, with a dilated pupil
196
what are the different types of hearing loss?
conductive, sensorineural, mixed
197
what is conductive hearing loss
involves a mechanical dysfunction of the external or middle ear, partial loss because the person is able to hear if the sound amplitude
198
what is sensorineural hearing loss?
loss signifies pathology of the inner ear, cranial nerve VIII, or the auditory areas of the cerebral cortex
199
what is mixed hearing loss?
loss is a combination of conductive and sensorineural types in the same ear
200
how do you hold the pinna when you are examining the ear of the child
pull the pinna dowards
201
how do you hold the pinna when you are examining the ear of an adult
pull the pinna up and out
202
how do you hold the otoscope when doing the exam
like a pencil
203
what is acute Otis media
results when the middle ear fluid is infected
204
how can you tell if someone is having trouble hearing
leaning forward when someone else is talking, repeating questions
205
when do you not want to put the otoscope in the ear
when there is swelling or tenderness
206
what is the weber test
you hit the fork on your hand and place the stem on the scalp in the middle of the top of the head, this is used to see if one is hears less than the other
207
what is the rinne test
hit the fork against your hand and place it behind the ear, have the patient tell you when they can't hear it anymore and then place it in front of their ear
208
should air conduction or bone conduction be greater
air conduction
209
what findings will you have if a child is hard of hearing?
absence of alerting behavior, failure to localize sound, no speech by age 2
210
what is the septum
the parts of the nose that divides the nasal cavity into 2
211
what is a turbinate
3 bony projections, that increase surface area
| superior, middle and inferior
212
what is patency
being able to breath through both nostrils easily
213
which nerve do we test in the nose
cranial nerve 1 the olfactory nerve
214
what is epistasis
nose bleeds
215
when does epistasis or nosebleeds occur
trauma, vigorous nose blowing, foreign body
216
what are kissing tonsils
when the tonsils touch
217
what are the grades of tonsil
1+ visible
2+ halfway between tonsillar pillars and uvula
3+ touching the uvula
4+ touching one another
218
what are the signs of gingivitis
gum margins are red and swollen, gums bleed easily, may expose roots of teeth
219
cleft palate
failure of fusion of the maxillary processes
220
what does a smooth glossy tongue mean?
surface is slick and shiny, mucosa thins and looks red from decreased papillae
occurs with vitamin B12 deficiency, folic acid deficiency, and iron deficiency
