PE Exam 2

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bbberg
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145639
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PE Exam 2
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2012-04-04 02:40:57
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Physical Evaluation Exam
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Physical Evaluation Exam 2
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  1. Blood pressure controlled by 5 factors
    • Cardiac output
    • Elasticity of arteries (inverse relationship)
    • Viscosity of blood
    • Circulating blood volume
    • Peripheral vascular resistance
  2. Error - patient is anxious, angry, or recently active
    False high systolic
  3. Error- antecubital crease is below heart
    Falsely high systolic and diastolic (because artery pressure + gravity)
  4. Failure to estimate systolic pressure
    False low systolic (miss 1st korkoroff sound)
  5. Cuff too short/narrow
    Falsely high systolic (needs excessive pressure to occlude artery)
  6. error- cuff too long/wide
    False low systolic (requires less pressure to occlude artery)
  7. Error - cuff too loose, uneven, or bladder balloons out of wrap
    False high systolic (excessive pressure needed to occlude artery)
  8. Error - Deflate too quickly
    Falsely low systolic and high diastolic (poor resolution)
  9. Error - reinflate cuff during deflation
    Low systolic, high diastolic (venous congestion in forearm makes sound less audible)
  10. Sinus bradycardia
    • HR <60bpm
    • Slowing of impulse formation at SA node
    • Due to hypothyroidism, infectious disease, medications
    • Occurs frequenyl in elderly and CV fit patients
  11. Tachycardia
    • HR >100bpm
    • Due to increased sympathetic tone from anxiety, heart failure, exercise, hemorrhage, hyperthyroidism, sympathomimetic drugs
    • Bad for people with ischemic heart disease
  12. Regular irregular pulses
    • Pulsus paradoxus - exaggerated decrease in pressure of pulsation during inspiration and increase in pressure during expiration
    • Second degree heart block - disturbances in conduction of electrical impulses through heart - missed ventricular contractions
  13. Irregular irregular pulses
    • Premature ventricular contractions (PVC)
    • - most common form of ventricular arrhythmia
    • - premature, bizzare waves on ECG
    • - ectopic foci in ventricle
    • - can degenerate into ventricular tachycardia or fibrillation
  14. Normal pulse pressure
    30-40mmHg
  15. Pulsus alternans
    Alternation of a pulsation of a small amplitude with the pulsation of large amplitude while the rhythm is normal
  16. Normal respiration rate
    12-20/min
  17. Bradypnea
    • Slower than 12 breaths/min
    • CNS depressants (alcohol, narcotics, benzodiazepines)
    • Hypoglycemia
  18. Tachypnea
    • Faster than 20 breaths/min
    • Infection
    • COPD
    • Congestive heart failure
    • Metabolic acidosis
  19. Hyperventilation
    Faster than 20 breaths/min, deep breathing
  20. Apnea
    Absence of spontaneous breathing
  21. Dyspnea
    Difficult and labored breathing with shortness of breath
  22. Orthopnea
    shortness of breath that begins or increases when patient lies down
  23. Paroxysmal nocturnal dyspnea
    Sudden onset of shortness of breath after a period of sleep
  24. What regulates body temp?
    Hypothalamus
  25. Tympanic membrane has same blood supply as:
    Hypothalamus
  26. Which two places give accurate temperature readings?
    • Oral sublingual
    • Tympanic membrane
  27. Normal temperature is influenced by:
    • Diurnal cycle
    • Menstrual cycle
    • Exercise
    • Increased age
  28. Pyrexia
    • Elevated temp
    • Oral >100
    • Tympanic >101.4
    • Due to infections, trauma, malignancies, hyperthyroidism, various drugs
  29. Hypothermia
    • Abnormally low temp
    • Oral <95
    • Tympanic <96.4
    • Hypometabolic states, decreased muscular movement, interference with vasoconstriction (alcohol, sepsis), exposure to cold environment
  30. Which systems checked in ROS?
    • Neurologic
    • CV
    • GI
    • Respiratory
    • Endocrine
    • Genitourinary
    • Musculoskeletal
    • Integument
    • Immune
    • Hematologic
  31. Clubbing of fingers caused by:
    • Cyanosis
    • Heart failure
  32. Peripheral edema caused by:
    • Poor lymphatic drainage
    • Heart failure
    • Pitting peripheral edema
  33. Exophtalamos
    • Protrusion of eyeball
    • Hyperthyroidism
  34. Parotid hypertrophy/sensitivity to light
    • Sjogren's syndrome
    • Autoimmune disease
    • Affects salivary glands, lacrimal glands
  35. Petechiae (also Hematoma has same causes)
    • Pinpoint areas of bleeding
    • Von Willenbrands disease
    • Thrombocytopenia
    • Medication induced (platelet aggregation inhibitors)
    • Liver disease
  36. Normally lymph nodes _____ palpable
    Are not
  37. Fibrotic lymph nodes
    moveable, discrete, soft, nontender
  38. Lymphadenopathy
    • Sign of a disease affecting lymph nodes
    • Indicated by enlargement of lymph nodes
  39. Lymphadenitis
    • Infection
    • Often but not always bilateral, tender, and firm but freely movable
  40. Nonvascular midline enlargements
    • Ludwigs angina
    • Thyroid gland
    • - Graves disease
    • - Hashimotos thyroiditis
    • - Thyroid carcinoma
  41. Ludwigs angina
    • Severe cellulitis from mandibular 2nd or 3rd molar
    • swelling of submandibular space
    • elevation of tongue
    • life threatening due to loss of airway
  42. Vascular disorders (sign of systemic disorder)
    • Distended jugular veins
    • Carotid aneurysm
    • Mononucleosis
  43. Distended jugular veins
    • Congestive heart failure
    • Obstruction of venous return dur to constrictive pericarditis, mediastinal tumor, or obstructed superior vena cava
  44. Carotid aneurysm
    • localized distension of carotid artery
    • pulsatile enlargement
  45. Mononucleosis
    • Epstein-barr virus
    • young adults
    • pharyngitis
    • fever
    • fatigue
    • malaise
    • discrete, occasionally tender lymph nodes
    • vary in firmness
  46. CN I Exam
    • Assess nostril patency
    • Present aromatic substances w/eyes closed - pt should ID with each nostril
  47. Anosmia
    • decrease or loss of smell
    • bilateral - smoking, allergic rhinitis, cocaine, aging
    • unilateral - neurogenic, frontal lobe masses
  48. CNII Exam
    Vision charts
  49. Myopia
    nearsightedness
  50. Hyperopia
    Farsightedness
  51. Presbyopia
    Loss of accomodation (CN III)
  52. Systemic disorders that affect visual acuity
    • Diabetic retinopathy (means diabetes more severe)
    • Hypertension
  53. Confrontation test
    • you and patient each cover one eye, place hand outside of both of your fields of vision, measure when each of you can see hand first
    • Gives information about patients field of vision relative to yours
  54. Pupillary light reflex
    • Direct - efferent nerve constricts pupil in same eye
    • Consensual - constricts pupil, opposite eye
    • Absent or delayed light reflex - CNS trauma, increased intracranial pressure
  55. CN III Exam
    • Accomodation - contraction of ciliary muscles (curvature of lens), constriction of pupillary constrictor muscles, contraction of medial rectus (adduction)
    • Cardinal fields of gaze (tests III, IV, and VI)
  56. Nystagmus etiologies
    • Vision impairment as child
    • Vestibular disorders
    • Cerebellar disorders
    • Drug toxicity
  57. CN V Exam
    • Pt closes eyes, touch face with cotton, safety pin
    • Assess ability to detect sharp, dull, light pressure, hot, and cold
    • Corneal reflex
  58. Dysphagia
    Difficulty swallowing - motor dysfunction of X
  59. Medial pterygoid
    • Elevates
    • Lateral excursion
    • Protrudes (minor)
  60. Lateral pterygoid
    • Opens
    • Lateral excursion
    • Protrudes (major)
  61. Myositis
    Muscle inflammation
  62. Trismus
    Decreased active vertical range of mandibular motion
  63. Crepitus
    • Rough, grating, gravel like sound in TMJ
    • Fine, coarse, popping
  64. Disk displacement with reduction
    • Symptoms: Clicking/popping noise, may feel catching in TMJ
    • Signs: Reciprocal/reproducible click, may have deviation in ROM and/or protrusion, no restriction in active vertical mandibular ROM
  65. Disk displacement without reduction
    • Symp: hx of clicking/popping, limited range of motion
    • Signs: no TMJ sounds, restriction in vertical mandibular ROM and laterotrusion, may have deflection
  66. Capsulitis/arthritis
    • Symp: pain in TMJ or front of ear, exacerbated by jaw function, limited mandibular function secondary to pain
    • Signs: TMJ tender to palpation, TMJ pain worsened upon clenching, limited active mandibular range of motion, laterotrusion, protrusion
  67. Arthritis of TMJ
    • Symptoms: Pain in TMJ or in front of ear, Pain worsened by jaw function, may have limited mandibular function
    • Signs: TMJ tender to palpation, TMJ pain worsened upon clenching, Limited active mandibular ROM, TMJ sound (fine to coarse crepitus), radiographic imaging shows bony changes
  68. Subluxation/Dislocation of TMJ
    • Symptoms: jaw catches open, pain in TMJ when jaw gets stuck, loud pop when opening wide
    • Signs: excessive mandibular ROM, eminence pop, residual tenderness in TMJ upon palpation if recent episode
  69. Melanotic macule
    Freckle on lip
  70. Fordyce's granules
    Yellowish dots on lip, ectopic sebaceous glands
  71. Angular chelitis
    fungal infections in corner of lips due to overclosed lips
  72. Actinic cheilosis
    sun damage (typically more on lower lip), swollen, vermillion border is less defined, areas of white and red, essentially sunburn of lip
  73. Recurrent herpes labialis
    • Cold sores
    • fluid filled elevations of skin, rupture easily, fluid caries virus
  74. Snuff pouch hyperkeratosis
    From chewing tobacco, whitish in color, like a callous, forms a pouch
  75. Aphthous stomatitis
    • Canker sores
    • Autoimmune response triggered by trauma or stress
  76. Leukoedema
    • diffuse grey-white, milky opaque appearance of the buccal mucosa
    • MOSTLY DISAPPEARS upon stretching
  77. Morsicatio buccarum
    • Cheek chewing
    • Cheek becomes calloused in response
  78. Amalgam tatoo
    black stain on mucosa due to presence of amalgam
  79. Torus palatinus
    • Lumps/lesions in hard palate
    • More concerning when not in midline
    • Should feel like a bone upon palpation
  80. Nicotinic stomatitis
    • in person who smokes a lot
    • whitish covering of hard palate wiht little red dots
  81. Recurrent intraoral herpes
    • red spots on hard palate, only found on attached mucosa
    • look like ulcers after they have popped
    • If on hard palate more likely to be herpes
  82. Pseudomembranous candidiasis
    • Yeast infection in mouth
    • Forms white plaque
    • Wipes off and leaves red base

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