vitals week 1 Flashcards
(27 cards)
appropriate cuff size: width of cuff is _____% of upper arm circumference.
if the cuff is too big the the reading will be ______
if the cuff is too small the the reading will be ______
40%
reading will be too low
reading will be too high
a normal pulse rate is between _____ and ____
indications if pulse is:
a) < 50bpm
b) > 90bpm
c) Pulse missing on one side
d) Arrhythmia
between 50-90 BPM
a) Bradycardia: hypothyroidism, well trained athlete
b) Tachycardia: hyperthyroidism, caffeine, nervousness, exercise, hypertension
c) Stenosis, blocked artery, TOS or intermittent claudication
d) Decrease = hypervolemia, heart failure, aortic stenosis, atherosclerosis
- Increase = fever, exercise, hypothyroidism, anemia, aortic regurgitation, Arteriosclerosis
a NORMAL respiratory rate is between ____ and ____ RPM
positive findings if:
a) < 50rpm
b) > 90rpm
c) Hyperpnea (hyperventilation)
d) Orthopnea
e) Paroxysmal Nocturnal Dyspnea
-12- 20 RPM
a) Bradypnea: old age, well trained athlete, diabetic coma, increased intracranial pressure
b) Tachypnea: hyperthermia, anxiety, restrictive lung disease (COPD), elevated diaphragm, pleurisy
c) Rapid deep breathing caused by exercise, anxiety, metabolic acidosis, brainstem damage
d) Shortness of breath
e) Shortness of breath after a period of sleep
A normal tempreature is between ____ and _____
positive findings of:
a) < 96.4°F
b) > 99.1°F
c) > 106 °F
Normal Rate: 96.4-99.1° F
a) Hypothermia: cold drink, old age, slow metabolism, nutritional deficiency, hypothyroidism, hypoglycemia
b) Pyrexia (fever): emotion, infection, exercise, hot drink, trauma, acute immune disorder, hyperthyroidism
c) Hyperpyrexia
a normal blood pressure reading can be seen as ____ Over ______
positive findings:
a) 120-139mmHg (systolic) or 80-89mmHg (diastolic)
b) 140-159mmHg (systolic) or 90-99mmHg (diastolic)
c) >=160mmHg (systolic) or >=100mmHg (diastolic)
d) 80-89mmHg
e)
Normal Rate: 120/80mmHg
a) Pre-hypertension
b) Stage 1 Hypertension: stress, obesity, high blood viscosity, type II diabetes mellitus, high cholesterol, atherosclerosis
c) Stage 2 Hypertension
d) Pre-hypotension
e) Hypotension: hypothyroidism, thin/small person
the Confrontation test checks what nerve?
if the patient cannot see your fingers or indicates blind spots in vision possible indications include:
(CN2 - Optic)
-Scotoma (blind spot), diminished peripheral vision, glaucoma, macular degeneration, MS, CN2 lesion, retinal disorder
the Cardinal Fields of Gaze makes us of which 3 nerves?
positive findings of this test include:
a) Nystagmus (eye has trouble following the pen; staggering, shaking)
b) Strabissmus (eye doesn’t follow)
(CN3 - Oculomotor, CN4 - Trochlear, CN6 - Abducens)
a) Eye not following laterally – CN6: Abducens (lateral rectus muscle)
b) Eye doesn’t go down and IN (clinical test) – CN4: Trochlear (superior oblique muscle)
- All other directions – CN3: Oculomotor (med, sup. Inf. Rectus, inf. Oblique muscles)
- Lesion to eye muscle
the Accomodation test makes use of which nerve and is testing which distinct muscle?
- if eyes do not converge there most likely is a _________.
(CN3 - Oculomotor - Medial Rectus muscle)
-Lesion to CN3 - Oculomotor
Pupillary Light Reflex Test:
Scenario:
if there’s Lack of constriction in L eye, what could it be? and what test would you do to narrow it down?
- if there’s convergence rules out___a___–> __a____=Lack of constriction in R eye, light in L constricts L but not R
- if there’s a R oculomotor lesion Light in L eye, both constrict; Light in R eye, no constriction in ___b___ eye.
- Damage to EDW nucleus motor, symptom of ___c___ ___c____ disease
-it could be EDW or CN III. To decide, perform accommodation
a- CN 3; EDW
b- either
c- teritary Syphillis
the Levator Palpebrae Superioris test checks what nerve?
some positive findings include:
a) Any grade (1-5) less than 5, pain (ask)
b) Right side is stronger
c) Left side is stronger
(CN 3 - Oculomotor)
a) CN3 – Oculomotor lesion
b) Left sided CN3 – Oculomotor lesion
c) Right sided CN3 – Oculomotor lesion
The Corneal Reflex tests which nerves? and what specific muscle?
Scenario:
Cotton in R eye, both eyes blink; cotton in L eye, no eyes blink
a) wheres the Lesion?
Cotton in R eye, L doesn’t blink
b) wheres the Lesion?
c) One or both eyes fail to blink…
(CN 5 – Ophthalmic Divison of Trigeminal: Sensory, CN 7 – Facial: Motor to Orbicularis Oculi)
a) L CN V1
b) L CN7 Facial
c) Afferent or sensory loss to CN5 (trigeminal)
- Or Efferent or motor loss to CN7 (facial) to Orbicularis Oculi Muscle
how do you perform the Light test with the Ophthalmoscope?
Instruction: Patient focuses straight ahead at distant object, relax
Dr: Use same eye to inspect, focus lens on hand then 18” (2ft away) with hand on shoulder, find red reflex and move directly towards it, focus past pupil, look lateral to medial to inspect fovea, arteries, retinal integrity
Possible positive findings of Light test?
a) c
b) AV nicking/hemorrhaging
c) Papilledema
d) Increased cup to disc ratio (>1:2)
e) Macular Degeneration
f) Cotton wool patches
a) Cataracts
b) Retinopathy
c) Increased intracranial pressure
d) Glaucoma
e) Old age
f) Diabetes, hypertension
how do you perform an examination of the ear with the otoscope?
OtoscopeDr: pull pina up and back and put specula in to observecone of light and ear drum
some possible findings of the otoscope test are:
what are the indications of these findings?
a) Absence of cone of light
b) Redness in canal (w/ purulent effusion)
c) Bony exostoses around perimeter
d) Perforated tympanic membrane
e) Amber Fluid behind eardrum
f) Largee chalky white patch
a) Intracranial pressure
b) Otitis Media: acute (no pain), externa (pain)
c) Swimmer’s Ear (common in children)
d) Trauma caused by sharp object put into ear
e) Serous effusion
f) tympanosclerosis
Renee’s Test (Bone conduction vs. air conduction, confirms ______)
how do you perform Renee’s test?
Weber’s
Instruction: Patient tells Dr. when sound no longer heard
Dr: Time bone conduction: bottom of tuning fork to mastoid process; then airconduction: tuning fork parallel to ear. Add bone conduction time for total airconduction time.Normal Response: 2:1 air:bone ratio
here are some positive findings of Renee’s test, what are the indicatings of each?
a) Bone conduction >= air conduction(Example: 4:1)
b) Bone conduction
a) Conductive hearing loss
b) Sensory neural hearing loss
How do you perform weber’s hearing test?
Weber’s Test (top of head, confirms Gross hearing)
Instruction: Patient closes eyes, listens for louder ear
Dr: 512 Hz tuning fork at top of head
what are some indications of the listed positive findings to weber’s test?
a) Lateralization to bad/impairedear
b) Lateralization to good ear
a) Conductive hearing loss due to obstruction (ex:wax), otitis media, tympanic membrane rupture
b) Sensory neural hearing loss (CN8 - Cochlear) due topresbycusis (old age degeneration), excessive loudnoise, cochlear damage, otitis interna
how do you perfprm the gross hearing test? what cranial nerve does it test?
Gross Hearing
Instruction: Patient closes eyes, and listens for sliding hands
Dr: If asymmetrical, do Weber’s and Renee’s
-(CN 8 – Cochlear)
how is the snellen eye chart administered and graded?
Snellen Eye Chart
Instruction: patient reads smallest line that is readable to them
Dr: Grading – 20/20-1 (if only 1 letter is missed on line 8)If patient misses 3 or more, grade on line above; if only 2 are missed, grade that line minus 1 or minus 220/15 – patient at 20 ft can see better than someone at 15 ft
list the 10 lymph nodes in the cervical palpation series.
- Pre- auricular
- post- auricular
- tonsilar
- submandibular
- submental
- supra clavicular
- superficial cervical
- deep cervical (push SCM out of the way)
- occipital
- posterior
while palpating cervical lymph nodes the dr. needs to be looking for hard, fixed, matted, enlarged (Hemf) lymph nodes. some possible findings are: list the indications.
a) Enlarrged, warm, tender
b) Not warm, non-tender, rubbery
c) Hard, fixed, non-tender, not warm
d) Rubbery, warm, non-tender, larger than 1cm
** if the submandibular or parotid glands are enlarged it could be a sign of MUMPS
a) Active infection
b) Past infection
c) Malignancy, cancer
d) lymphoma
How do you perfprm the gag reflex? and what cranial nerve does it test?
Gag Reflex
Instruction: Patient sticks out tongue
Dr: Touch soft palate pharyngeal arches and posteriortongue root bilaterallyNormal Response: Symmetrical elevation of Soft Palate(contraction done by Vagus)
Scenario:L posterior arch both contract, R nothing R glossopharyngeal nerve lesion
(CN9 - Glossopharyngeal, CN10 - Vagus)
