Advanced Phs Asses 1
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In sytole, which valves are open / closed?
- 1. Mitral and tricuspid - closed
- 2. Aortic and Pulmonic - open
Major hearts are caused by?
Contraction of the ventricles causes?
1. Closure of AV valves
1. S1 is caused by.....
2. Initiates.....(Systole or Diastole)
3. And heard loudest at.....
1. Caused by AV valve closure
3. the Apex (mitral); "lub"
1. S2 is caused by...
2. Initiates.....(Systole or Diastole)
3. And heard loudest at....
1. Aortic and Pulomonic Valve closure
3. base (Aortic) "dub"
Identify the location of the 5 listening areas of the heart?
- Aoritic (Base)-2nd ICS on R Sternal Borde
- Pulmonic-2nd ICS on L Sternal Border
- Erbs Point-3rd ICS on L Sternal Border
- Tricuspid - 4th ICS on Sternal Border
- Mitral(Apex)- 5th ICS on L Mid clavicular line
If there is an S3 does it occur in systole or diastole
Due to decreased elasticity from overfilling of ventricle - associated with CHF. "Ketucky"
S4 Happens when?
Due to stiff ventricles, HTN, CAD, LVH
Sounds like "Tenessee"
Where is the PMI?
L ICS MCL
Murmurs are heard through?
Closed Valves - Regurgitation
Stenosis is heard through
During Systole in which valves would you hear regurgitation / Stenosis
- Systole - Mitral Regurg
- Tricuspid Regurg
- Aortic Stenosis
- Pulmonic Stenosis
During Diastole in which valves would you hear regurgitation / Stenosis
- Diastoley Mitral Stenosis
- Tricuspid Stenosis
- Aortic Regurg
- Pulmonic Regurg
Pt in ER for poss MI; has family HX father died from heart trouble. What should you ask?
What age was your father at his time of death?
2 types of body hair -
Vellus - downy body hair
Terminal - scalp hair
Most comon sign of cardio vascular disease in older adults?
Apical PMI beyond 5th ICS may indicate?
Left Ventricular Hypertrophy
Most prevalent heart sounds heard in aortic and pulmonic area is...
S2 - Valve closure of Aortic and pulmonic
While doing pt cardiac assessment, notice a grade III murmur. The intensity is:
- a. Grade I Moderately loud
- b. Grade II- soft, readily detected
- c. Grade III
- c. Grade IV- loud and usually palpable
- d. Grade V- very loud
- e. Grade VI- heard w/o stethoscope
Aching, cramping, and possibly numbness or severe fatigue that appear with walking and disappear promptly with rest typify intermittent claudication.
79yo diabetic pt c/o claudication. Physical findings w/arterial occlusion:
Loss of hair over extremity; cool, shiny skin; pallor or cyanosis; thickened nails; pulses weak or absent; numb/cool temp; ulcers distal
- G=# of pregnancies
- P = Outcomes
- b = # of term
- c = # of preterm
- d = Aborted
- e = Full term
Primary prevention focuses on?
- Primary prevention: focuses on preventing or slowing the onset of disease
- Examples include: counseling and education, immunizations, use of safety measures
Secondary preventions focuses on?
Secondary prevention: involves risk assessment and risk reduction for chronic diseases
All screening tests smoking cessation to reduce risk.
Tertiary prevention involves?
Slowing or halting diseases that are already in progress.
US Preventative Services Task Force
- A - High certainty benefit
- B- Moderat certainty benefit
- C- Recommends AGAINST ROUTINE serv., benfit is small
- D- Recommends AGAINST Serv. Risks outweigh
- I - Insufficient evidence to determine
What is Sensativity?
Sensitivity: The proportion of persons with a condition who correctly test positive when screened
Poor sensitivity will miss many cases
What is Specificity?
Specificity: the proportion of persons without the condition who correctly test negative when screened
Poor specificity incorrectly labels persons as having condition
What does CAGE stand for?
Cut down, Annoyance, guilt, eye-opener
One study found 75% sensitivity and 96% specificity
What are the stages of hypertension?
Normal <120 <80
Pre-HTN 120-139 80-89
Stage I 140-159 90-99
Stage II >160 >100
When should you start Pap smear testing
Start Pap smearing testing 3 years after onset of sexual activity or age 21(USPTF).
What is the PSA Cut point?
4 ng /ml
What is the most superficial layer of skin?
Epidermis: Most superficial layer, thin, no blood vessels.
Dermis: Well supplied with blood. Contains connective tissue, the sebaceous glands, and some of the hair follicles.
Subcutaeous tissues: Fat and sweat glands, and remaining hair follicles.
What is a Macule?
Macule: Flat, change in skin color. It is < 1 cm. (freckle)
What is a Patch?
Patch: Larger than macule. >1 cm. (Vitiligo)
What is a Papule?
Papule: Firm, raised, up to 1 cm (raised nevus)
What is a Plaque?
Plaque: Flat, elevated surface, > 1 cm. (coalescence of papules)
What is a nodule?
Nodule: >0.5 cm. Often deeper and firmer than papule.
What is a tumor?
Tumor: Larger 1-2 cm. A large nodule.
What is a Wheal?
Wheal: Transient, irregular, superficial area of localized skin edema. (hive, mosquito bite)
What is a Vesicle?
Vesicle: Up to 1 cm. Filled with serous fluid.
What is a Bulla?
Bulla: 1 cm or greater. Filled with serous fluid.
What is a Pustule?
Pustule: Filled with pus. (Acne, impetigo).
What is an erosion?
Loss of the epidermis
What is Lichenification?
Lichenification: Thickening and roughening of the skin with increased visibility of the normal furrows, can be caused by scratching.(atopic dermatitis)
What is skin atrophy?
Atrophy: Thinning of the skin with loss of furrows. Skin appears shiner and translucent. (arterial insufficiency)
What is Eschar?
Eschar: Crust and necrosis.
What is a Keloid?
Keloid: Raised, firm, thickened red scar that may grow for a prolonged period of time.
What is a spider Angioma?
Spider angioma: Very small to 2 cm. Central body surrounded by radiating legs. Face, neck, arms, and upper trunk. (Liver disease, Vit. B def., pregnancy)
What is a cherry angioma?
Cherry angioma: 1-3 mm, round, flat or sometimes raised. No clinical significance.
What is a spider vein?
Spider vein: Blue in color, size varies. Legs and anterior chest. Accompanies increased pressure on superficial veins.
What are petechia?
Petechia: 1-3 mm, emboli to skin
What is Purpura?
Purpura: Larger than petechia, blood outside the vessels.
What is Telangiectasias?
Telangiectasias: Chronic dilated small vessels, blanch minimally.
What is a comedo?
Comedo:(closed) The common blackhead. (open) Whitehead
What do constitutional symptoms in ROS refer to?
Symptoms that can be associated with multiple systems such as fever, chills, malaise, weightloss.
1. What do the meibomian glans secrete?
What is an inflamation of the meibomian gland called?
1. Meibomian gland: glands that provide oils to the tear film
2. Chalazion - usually painless and points inside not on the margin of the lid.
Entropion: inverted eyelashes
Ectropion: everted eyelashes
An infection of the eyelash hair folicle is called?
Acute Hordeolum (STY) usually painful, looks like a pimple on the margin of the eye lid.
What is (margninal)Blepharitis?
Blepharitis is an inflamation of the eyelids along the lid margins often with crusting or scales.
Dacryocystitis is what?
Dacryocystitis - inflammation of lacrimal sac.
Conjunctiva in two areas called?
Bulbar: covers most of anterior eyeball
Palprebral: lines the eyelids
Pterygium - triangular thickening of the bulbar conjuntiva that grows slowly on the outer surface of the cornea - usually from the nasal side. May interfere with vision as it approaches the pupil.
Pinguecula - A yellowish, somewhat triangular nodule in the bulbar conjuctiva on either side of the iris. Harmless accumulation of protein.
What does 20/20 mean?
- top #-patient distance from chart;
bottom #-distance at which normal eye can read
A cataract is an opacity of the lens seen through the pupil.
Accomodation when evaluating the eyes describes?
Convergence of the eyes with constriction of the pupil when focused on a near object.
Dilation of the pupil when looking at a far object.
Describe the direct and consensual reaction to light of the eyes?
Direct: pupillary constriction in the same eye
Consensual: pupillary constriction in the opposite eye
Describe a the Weber Test?
Weber test - Strike tuning fork and place on top of head /forehead
Abnormal: “Positive Lateralization” > vibration in one ear over the other.
Conductive hearing loss- lateralization to “impaired” ear
Sensorineural loss- lateralization to “good” ear
Describe the Rinne test?
Place vibrating tuning fork on mastoid
- Normal :AC>BC
- Conductive loss- sound through bone is as long or longer than through air. (BC=AC or BC>AC)
Sensorineural loss- sound is heard longer through air (AC>BC) (normal pattern prevails because the vibrations reach the cochlea)
Cupping of the optic disc is a sign of...
What position is the cone of light in the right ear?
Cone of light (Right: 5 o’clock Left: 7o’clock)
The cone of light eminates from what bone?
Nervousness, weightloss with increased apetit, sweating and heat intolerence.
Hypertension, tachycardia, AFIB, warm moist skin.
Associatedwith GRAVES disease
Fatigue, lethargy, modest weigt gain with anorexia.
Dry course skin, cold intolerance. Hypotension, bradycardia, hypothermia
Describe the grading of Tonsils
- Tonsil 0: Tonsils fit within tonsillar fossa
- Tonsil 1+: Tonsils <25% of space between pillars
- Tonsil 2+: Tonsils <50% of space between pillars
- Tonsil 3+: Tonsils <75% of space between pillars
- Tonsil 4+: Tonsils >75% of space between pillars
Describe the order of a respiratory examination...
- 1. inspection
- 2. palpation
- 3. percussion
- 4. auscultation from the anterior, lateral and posterior approaches
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