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A differential field diagnosis is described as. . . . .
A list of possible causes for your patients symptoms
Open ended questions allow your pt to what?
Explain how he feels in detail, in his own words as opposed to answering yes and no.
Closed end questions elicit what?
Short answers to very direct questions
When speaking of active listening what is reflection?
Repeating your pt's words encouraging him to give more details
When speaking of active listening what is clarification?
Often in crisis, pt's will be vague. Asking for clarification will help narrow down the problem
What is empathy?
The act of feeling for your pt's when they feel frightened or ashamed
Detecting inconsistencies in your pt's story and asking about them.
Interpreting observations and questioning your pt about you believe the problem is.
A pt's chief complaint is what?
Sign or symptom noticed by the pt or a bystander .
The pt's primary problem is what?
The principle medical cause for a pt's chief complaint
What is active listening?
The process of responding to your pt's statements w/words or gestures of understanding
What are the 4 questions in the CAGE questionnaire?
- 1.Have you ever felt the need to CUT down?
- 2.Have you ever felt ANNOYED by criticism?
- 3. Have you ever had GUILTY feelings?
- 4. Have you ever had a drink as an EYE-OPENER in the morning?
How do you calculate pack/yr hx?
By multiplying the # of packs smoked/day by the # of yrs smoking
What is tinnitus?
The sensation of ringing in the ears.
Coughing up blood
Difficulty breathing while lying supine
What is paroxysmal nocturnal dyspnea?
Sudden onset of SOB in the night
What is hematemesis?
Vomiting of blood
What is polyuria?
What is hematuria?
Blood in the urine
What is dysmenorrhea?
Difficult or painful menstruation
Gravida is equal to what?
# of times a woman has been pregnant
Para is equal too what?
# of viable births a woman has had
The process of normal inspiration is a/an ____ process involving ____ & ____ muscles.
- diaphragm and intercostal
In a pt w/a weak or irregular pulse assess the rate for ____ seconds.
The width of a correctly sized BP cuff should be what or what?
- 1/2 - 1/3 the circumference of the pt's arm
- 2/3 length of the pt's upper arm
When taking a BP, deflate the cuf @ a rate of what?
Cyanosis is caused by an increase in ____.
A heavy and greasy scaling under the skin is called ____ ____.
The tern that describes fine jerking movements of the eye is ____.
The term for a common runny nose is ____.
Epistaxis is simply know as a ____ ____.
The most frequently dislocated joint is the ____.
Sound of turbulent through an artery.
- Light, crackling non musical sounds heard usually during inspiration.
- AKA Rales
Continuous high pitched musical sounds similar to a whistle
Continuous sounds w/a lower pitch and a snoring quality
Predominantly inspiratory wheeze asoc w/laryngeal obstruction
What does a pleural friction rub sound like?
Squeaking or grating sound of pleural linings rubbing together
What is bronchophony?
Abnormal clarity of pt's transmitted voice sounds.
Whispered pectoriloquy is what?
Abnormal clarity of pt's transmitted whispers
Egophony is the term used to describe what?
Abnormal change in tone of pt's transmitted voice sounds
What is happening in the heart during diastole?
Ventricles are relaxing
What is happening in the heart during systole?
The ventricles are contracting
The sound in the heart made during S1 is ____ and is caused by what?
- The closing of the tricuspid and mitral valves
The sound in the heart made during S2 is ____ and is caused by what?
- The closing of pulmonic and aortic semilunar valves
Cardiac output is
- The amt of blood the heart ejects each minute in mL's
- CO = HR x stroke vol.
Stroke volume is the ....
Amt of blood the heart ejects in one beat.
What are the 3 factors that determine stroke volume?
- Preload (aka end diastolic pressure)
- Contractile Force
Preload is the amount. . . .
of blood returned to the heart from the body
What is contractile force and what regulates it?
- How forcefully the heart muscle contracts
- Regulated by the autonomic NS and bodily needs
Afterload refers to the . . . . .
Resistance in the vessels that the heart must overcome to eject blood
What is a thrill?
Vibration or humming felt when palpating a pulse
Where do we auscultate heart sounds of S1 & what do they sound like?
- 5th intercostal space @ L sternal border & @ PMI
- They are high pitched sounds
Where do we auscultate heart sounds of S2 & what do they sound like?
- 2nd intercostal space at the R & L sternal borders
- High pitched sounds
Cullin's sign is described as what?
Discoloration around the umbilicus suggestive of intra-abdominal bleeding
What is Grey-Turners sign?
Discoloration over the flanks suggesting intra-abdominal bleeding
Ascites is described as . . . .
Bulges in the flanks & across the abd indicating edema fr CHF
What is borborygmi?
Loud, prolonged gurgling bowel sounds indicating hyperperistalsis.
What are the 5 steps in evaluating a joint?
- 1. Inspection
- 2. Palpation
- 3. Passive range of motion
- 4. Range of motion against gravity
- 5. Range of motion against resistance
What is the curvature of a normal spine?
Concave in cervical & lumbar regions and convex in the thorax
A person w/exaggerated lumbar concavity (swayback) is said to have ____.
A person displaying exaggerated thoracic convexity (hunchback) is said to have ____.
A person displaying lateral curvature of the spine has _____.
What are the 5 areas for a neurologic exam?
- 1. Mental status & speech
- 2. Cranial Nerves
- 3. Motor system
- 4. Sensory System
- 5. Reflexes
The term dysarthria refers to:
Defective speech caused by motor deficits
Describe a lethargic pt.
Drowsy, but answers questions appropriately b/f falling asleep again
Describe the obtunded pt.
Opens eyes and looks @ you but gives slow, confused responses
Describe the stuporous pt.
Arousable for short periods but is not aware of his surroundings
Describe the comatose pt.
State of profound unconsciousness and totally unarousable
Name the 3 grades of memory.
- 1. Immediate
- 2. Recent
- 3. Remote
What are the 12 cranial nerves?
- I Olfactory
- II Optic
- III Oculomotor
- IV Trochlear
- V Trigeminal
- VI Abducens
- VII Facial
- VIII Acoustic
- IX Glossopharyngeal
- X Vagus
- XI Accessory
- XII Hypoglossal
What is CN-I? What does it innervate & how doe we chk it?
- Smell- Chked by evaluating ability to sense odors on each nostril
What is CN-II? What does it innervate & how do we chk it?
- Sight - Test visual acuity & field of view
What is CN-III? What does it innervate & how do we chk it?
- Pupil Constriction - Chk pupils reactions
What is CN-IV? What does it innervate and how do we chk it?
- Superior Oblique muscles - Use "H" pattern test
What is CN-V? What does it innervate and how do we check it?
- Opthalmic, Maxillary & Mandibular muscles - Checked by testing masseter muscle strength & sensation on forehead, cheek, chin & cornea
What is CN-VI? What does it innervate & how do we test it?
- Lateral rectus muscles - Assess w/CN-III, IV using "H" pattern test
What is CN-VII? What does it innervate & how do we test it?
- Tongue & facial muscles - Checked by observing pt's face during conversations, looking for asymmetry, eyelid droop and abnormal movements
What is CN-VIII? What does it innervate & how do we test it?
- Hearing Balance - Checked by testing hearing and balance with eyes closed
What is CN-IX? What does it innervate & how do we test it?
- Posterior pharynx - Hoarseness of voice, difficulty swallowing. Have pt say ahhhh & watch for soft palate & uvula to rise symmetrically
WHat is CN-X? What does it innervate & how do we chk it?
- Taste to posterior tongue, movement of posterior palate and pharynx. Chk by evaluating speech, swallowing, saying "ahhhh" and the gag reflex
What is CN-XI? What does it innervate & how do we chk it?
- Traps & Sternocleidomastoid muscles - Examine for symmetry, Have pt shrug against resistance and hold pt's head & turn against resistance
What is CN-XII? What does it innervated & how do we chk it?
- The tongue - Assess speech articulation, midline projection
What is the normal RR, HR & systolic BP of a newborn?
- RR 30-60
- HR 100-180
- Systolic BP 60-90
What is the normal RR, HR & systolic BP for an infant?
- RR 30-60
- HR 100-160
- BP 85-105
What is the normal RR, HR, & systolic BP for a toddler?
- RR 24-40
- HR 80-110
- BP 95-105
What is the normal RR, HR & systolic BP for a preschooler?
- RR 22-34
- HR 70-110
- BP 95-110
What is the normal RR, HR & systolic BP for a school age child?
- RR 18-30
- HR 65-110
- BP 97-112
What is the normal RR, HR & systolic BP for an adolescent?
- RR 12-26
- HR 60-90
- BP 112-128
Infants are classified as ____ to ____ year(s) old?
Newborn - 1 year
Toddlers are classified as ____ to ____ year(s) old?
1 - 3 yrs old
Preschoolers are classified as ____ to ____ year(s) old?
3 - 6 yrs old
School age children are between the ages of ____ and ____ .
6 and 12
Adolescents are between the ages of ____ and ____ .
13 and 18
What is the pulse pressure of a pt w/ HR 83, RR 14 & BP of 144/96?
In the tilt test what vital sign change is a positive sign of hypovolemia?
BP drops by 10-20 mmHg or HR increases by 10-20 beats/min
Where should a HR be assessed in a small child?
When using an oral glass thermometer, it should be left in the mouth for ___ - ___ mins?
3 - 4
A normal O2 SAT w/o O2 is ____.
96 - 100 %
Bluish discoloration around the orbits is called ____ ____ or ____ ____ & is indicative of what?
- Racoon Eyes or Periorbital Ecchymosis
- Basilar Skull Fx
The CN's that cause eye movements are ___, ___ & ___.
III, IV & VI
Otorrhea is a discharge fr the ear that may contain what 4 things?
Blood, Mucus, Pus or CF
The term for the common nose bleed is ____.
The point of maximal impulse in an adult is located where?
5th intercostal, mid clavicular
What is the order of the heart valves as the blood flows fr the vena cavae?
Tricuspid, Pulmonic, Mitral, Aortic
The "lub" of the heart sounds represents which event of the cardiac cycle?
Closing of the tricuspid & mitral valves
Which abd organ is found in all 4 quadrants?
The type of movement permitted between the phalanges ____/____ .
The type of movement permitted between the radius, ulna & humorous is what?
Flexion/extension and Supination/Pronation
The joint w/the greatest range of motion in the human body is the ____.
The type of movement permitted by the knee is what?
Flexion/Extension w/ limited rotation
Which region of the spine is most mobile?
The mid and lower cervical spine permits which 4 types of movement?
Flexion, extension, lateral bending & rotation
A normal pulse quality would be reported as ?
Pitting edema of 1/4" or less is scored as ____.
Pitting edema of 1/4" - 1/2" is scored as ____ .
Pitting edema scored at 3+ is how deep?
1/2" - 1"
Pitting edema scored @ 3+ is how deep?
1" or more
The term "dysphonia" refers too what?
Voice changes due to vocal cord problems
The term aphasia refers to what?
Defective language due to neurologic problem
The pyramidal pathway within the spinal cord mediates what?
Voluntary Muscle Control
To administer a Romberg test, have the pt what?
Stand w/ eyes closed for 20-30 secs
Babinski's response is pos when the sole of the foot is stroked and . . . .
The big toe dorsiflexes and the others fan out
When caring for a child, it is important too stay calm and be confident, direct and honest. True or False?
Children first recognize their parent's faces at what age?
Infants begin to sit up at about what age?
4 - 6 months
The most difficult pediatric age group to assess is the ____.
Which age group is particularly distrusting of strangers?
The soft spots in the skull called ____, close at about what age?
Bulging along the sutures of the skull of a young child suggests what ?
An increase in ICP
Because the tissues of a child's upper airway are so flexible, injuries, infections or minor obstructions don not adversely effect it as seriously as they would an adults. T or F
What is the patients primary problem?
The underlying cause for their symptoms
What is dysmenorrhea?
Pain during menstruation
What are Korotkoff signs?
Sounds heard during the measurement of BP
Define pulse pressure.
The difference between systolic and diastolic pressure
Anisocoria is defined as what?
Unequal size pupils
Pupillary accommodation is defined as what?
pupils get larger as light gets closer
Tactile fremitis is . . . .
What causes heart murmurs?
Stiffing of the lg arteries caused by atherosclerosis
Loud prolonged gurgling sounds
Dugas Sign presents as an. . . .
inability to bring shoulder to chest when checking for dislocation
Levines sing is what?
Clutching of the chest due to pain
Name the 9 lymph node areas.
- Superficial Cervical
- Retroauricular & Occipital
Describe your test for ascites.
Inspect abd for bulges in the flanks and across the abdomen indicative of edema fr. CHF