Physical assessment

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Author:
allisond
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28488
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Physical assessment
Updated:
2010-07-31 14:58:39
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Adult
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final notes
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  1. warning signs of skin cancer
    • asymmetry, irregular border, mottled and haphazard display of color
    • unusually large diameter, almost always elevated
    • increase in size is most important sign of malignant melanoma
  2. basal cell carcinoma
    • most common
    • locally invasive
    • slow growing, rarely metastasized
    • almost translucent, dome shaped papule
  3. squamous cell carcinoma
    • invasive malignancy
    • found on hands, head, neck, tips of ears
    • heals and rebreaks over and over
  4. fibradenomas
    • ages 15-25, usually single, round or disc-like
    • firm, well delineated, mobile and non-tender
    • can be left alone
  5. Fibrocystic breast disease
    • ages 30-50
    • can be single or multiple, round, elastic
    • well delineated, mobile and tender
  6. breast cancer
    • 30+, most common over 50
    • single, irregular, firm/hard
    • not clearly delineated, fixed to skin, non-tender
    • can get peau d'orange
  7. tactile fremitus
    • increases over consolidation, anything that makes the lungs more dense- pneumonia
    • decreases over air obstruction: atelectasis
  8. tracheal breath sounds
    • high-pitched
    • inspiration is less than expiration
  9. vesicular breath sounds
    • at base of lungs
    • inspiration is greater than expiration
  10. bronchovesicular breath sounds
    • over the bronchi
    • inspiration is equal to expiration
  11. fine crackles
    • rales
    • air colliding with fluid
    • pneumonia, CHF
  12. coarse crackles
    • sounds like velcro pulling apart
    • bubbly, gurgly
    • can hear with pneumonia
  13. sonorous wheezes
    • ronchi, on inspiration and expiration
    • like snoring, heard with bronchitis
  14. sibilant wheezes
    • more musical, high-pitched
    • heard with asthma
  15. stridor
    • high pitched crowing noises
    • croup, or something caught in the throat
  16. pleural friction rub
    • not enough fluid in pleural space,
    • can hear the layers rubbing together
  17. bronchitis
    wheezes and ronchi as air passes through fluid
  18. emphysema
    • decreased fremitus, hyperresonant percussion,
    • decreased breath sounds, wheezes and ronchi
  19. asthma
    • decreased fremitus and breath sounds
    • sound is obscured by wheezes
  20. pleural effusion
    • accumulation of fluid in pleural space
    • fremitus is decreased or absent
  21. physiological split of S2
    • can be normal, due to more blood on right side of heart so the aortic valve closes before the pulmonic and causes a splitting of S2
    • normal during inspiration
  22. S3 gallop
    • ventricular filling sound, during diastole, can be normal
    • heard directly following S2 due to turbulent blood flow
    • may disappear when sitting up
  23. S4 gallop
    • ventricular filling sound, at end of diastole
    • ventricles are resistant to turbulent blood flow from atrial kick
    • heard right before S1
    • will hear with hypertension, hypertrophy
  24. preload
    • length of ventricular muscle stretch at end of diastole
    • increased stretch=increased contraction is starlings law
  25. afterload
    • opposing pressure the ventricle has to generate to open aortic valve against pressure in the aorta
    • high diastolic is an afterload problem
  26. systolic click
    • similar to aortic stenosis
    • hard time getting blood through the valve
    • heard right after S1, more common than pulmonic
  27. mid-systolic click
    • associated with mitral valve prolapse in middle of systole
    • valve has closed but it prolapses back into the atrium
  28. opening snap
    • same as early systolic click, heard during systole
    • opening of either of the AV valves, right after S2
  29. systolic murmurs
    • pulmonic or aortic stenosis: heard at the base of the heart
    • mitral or tricuspid regurgitation: heard at the apex
    • less severe than diastolic
  30. diastolic murmurs
    • pulmonic or aortic regurgitation: heard at base
    • mitral or tricuspid stenosis: heard at apex
    • more severe than systolic
  31. ascites
    • fluid in the abdomen
    • will hear tympany in the center, dullness in the flanks
  32. aortic aneurysms
    • 95% after the renal arteries but before the iliac arteries
    • decreased femoral pulses
  33. Rovsings sign
    • test for appendicitis
    • push in LLQ and they will feel pain in the RLQ
  34. Iliopsoas muscle test
    • inserts near the appendix, tests for appendicitis
    • raise leg against resistance, will feel pain at the appendix
  35. obturator muscle test
    • also inserts near the appendix
    • internal and external rotation will cause pain at site
  36. Murphy's sign
    • for cholecystitis
    • push under liver, have patient take deep breath
    • push harder and patient wont be able to let breath out because its so painful
  37. ligaments
    connect bone to bone
  38. tendons
    connect muscle to bone
  39. Carpal tunnel tests
    • Phalens sign: put hands back to back for 30-60 seconds and will get numbness is 2nd, 3rd and half of 4th fingers
    • Tinel's sign: tap on media nerve at radius, will get numbness in same fingers
  40. osteoarthritis
    • degenerative joint disease- cartilage destruction
    • causes formation of nodules in joints
    • PIP:Bouchards nodules
    • DIP: heberdens nodules
  41. rheumatoid arthritis
    • auto-immune disease
    • symmetric, affects mostly PIP and metacarpophalangeal joints
    • very tender, stiff and painful
    • Boutonniere: flexion of PIP and extension at DIP
    • Swan neck: fixed hyperextension of PIP, flexion of DIP
  42. Cerebral cortex
    • frontal: personality, behavior
    • Parietal: sensation, feeling
    • occipital: vision centers
    • Wernickes area: auditory reception, in temporal lobe, will hear but not understand the words
    • Broca's area: speech formation, will know what they want to say but not be able to formulate it
  43. diencephalon
    • hypothalamus: temperature, sleep, pituitary
    • thalamus: main relay station from brain to body
    • basal ganglia: autonomic motor movements, swinging of arms
  44. Brain stem
    • midbrain- most anterior
    • Pons: where ascending and descending tracts converge
    • medulla: vital autonomic centers, decussation of motor fibers
  45. cerebellum
    motor coordination of voluntary movements and muscle tone
  46. spinal cord
    • medulla to L1 or L2
    • motor and sensory pathways
  47. Corticospinal pathway
    • motor pathway, also called pyramidal
    • fine discrimination movements like writing
    • originate in cortex
  48. Extrapyramidal tract
    • motor fibers from cortex, any that are outside the pyramidal tract
    • maintains muscle tone, gross movements like walking
    • affected in parkinsons
  49. cerebellar system
    maintains equilibrium, posture
  50. 5 components of reflexes
    • intact motor nerve
    • synapse
    • intact sensory nerve
    • neuromuscular junction
    • muscle
  51. patellar reflex
    L 2, 3,4
  52. ankle reflex
    sacral nerves
  53. upper abdomen
    T 8,9, 10
  54. lower abdomen
    T 10,11,12
  55. bracioradialis and biceps
    C 5,6
  56. triceps
    C 6.7
  57. plantar
    L5
  58. 7 components of Neuro exam
    • mental status
    • cranial nerves
    • motor system
    • sensory system
    • coordination
    • cerebellar function
    • deep tendon reflexes
  59. Mental status
    • alert, lethargic, obtunded, stuporous, comatose
    • orientation- A and O times 3
    • attention: months in reverse, 6-7 numbers forwards, 4 backwards
    • language- 3 step instruction, demented patients will forget 3rd step
    • memory- immediate, short term and long term- repeat 3 words
  60. muscle tone
    normal resistance as you move through passive movements
  61. spastic tone
    • increased resistance to passive lengthening
    • knife clasp phenomenon
  62. cogwheel rigidity
    • opens a little bit at at time
    • always tight, never relaxes
  63. fasciculation
    • rapid continuous twitching of a muscle
    • due to over stress
  64. peripheral lesion of CN VII
    • will paralyze whole side of the face
    • cant raise eyebrows, shut eyes, no forehead wrinkles or nasolabial fold
  65. central lesion of CN VII
    • will affect lower 1/3 of one side of the face
    • can close eye but with some weakness
    • no nasolabial fold
  66. tic
    • repetitive twitching at inappropriate times
    • can be neuro or emotional problem
  67. introitus
    • posterior portion of the opening of the vagina
    • may be covered by the hymen in virgins
  68. cervix
    • portion of the uterus that protrudes into the vagina
    • middle is called the os
  69. cystocele or rectocele
    bladder prolapse or rectal prolapse
  70. bartholins glands
    • lubricating glands inside the vagina, will be very painful if they are infected
    • infection could be caused by chlamydia or gonorrhea
  71. Pap smear results: Ascus
    • atypical squamous cells of unknown significance
    • can be from a yeast infection can still can be HPV negative
  72. LSIL and HSIL
    • low/high grade squamous intra-epithelial lesions
    • both are assumed to be HPV,
    • patient needs a colposcopy
  73. indirect hernias
    • 60% are indirect
    • can be congenital in infants
  74. direct inguinal hernia
    • goes behind and then through the external ring, rarely goes into testicles
    • common in men over 40 from heavy lifting
    • often no pain or discomfort
  75. femoral hernia
    • bulging in upper thigh
    • very painful
  76. prostate gland
    • shouldnt protrude more than 1 cm into rectum, should be smooth and non-nodular, elastic and rubbery
    • infection will make it very tender
    • cancer will be hard, fixed

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