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PA II Midterm

lab midterm

normal range of pulse 60-100 bpm
normal range of respirations 12-20 cpm
normal range of blood pressure 90/50-140/90
skin pathology psoriasis: localized dryness, scales
hair pathology SLE: alopecia
nail pathology splinter hemorrhages, check for capillary refill
what cranial nerves are involved with direct and indirect response? CN II and CN III
what are the cranial nerves involved with cardinal fields of gaze? CN III, IV, VI
CNs involved with confrontation CN II
CNs involved with corneal reflex? CN V (sensory, VII (motor)
name 5 structures you want to assess with a fundoscopic exam retina, arterioles, venules, optic disc, optic cup, macula, fovea
name one finding of HTN copper wire arterioles
finding of cataract absence of red reflex
finding of diabetes mellitus neovascularization
why do you enter the eye at 15 degrees off the patients gaze keeps pupil from shutting down, don't go directly on macula
what is the red reflex? red reflection of light off the retina
why do you need to keep red reflex in view? guides you to view the retina and other structures through the pupil
what are the three instructions to give the patient before performing a fundoscopic exam? focus on an object in the distance, let me know if the light is too bright, blink if you have to
at the end of the exam don't forget! to tell patient to look into the light
five structures to assess with an otoscopic exam pars flaccida, pars tensa, umbo, malleus, short process of malleus
finding of otitis media? shift in cone of light, unable to see bones, bones are too prominent through membrane (tympanic membrane retracted)
why toynbe maneuver? assess mobility of the drum
where is the cone of light in right and left ear? R: 5 o'clock L: 7 o'clock deviation suggests pathology
what is involved with an exam of the sinuses? Inspection, palpation, percussion, instrumentation
name positive finding with inspection of sinus swelling: sinusitis
positivie finding with palpation and percussion: tenderness
positive finding with instrumentation of sinuses? transillumination : absence of glow--> sinus filled with mucous
ten sturctures to assess with an oro-pharyngeal exam lips, teeth, gums, tongue, stenson's duct, oral mucosa, hard palate, soft palate, phrenulum, uvula, anterior pillar,tonsils, posterior pillar, pharynx
what are all cranial nerves in the mouth? V, VII, IX, X, XII
what are the steps involved with an exam of the thyroid inspection: look up and swallow palpation: three finger palpation on cartilage and thyroid, swallow, feel each side with other hand behind SCM, swallow percussion: manubrium instrumentation: diaphragm and bell superior and inferior bilaterally
positive finding with inspection of thyroid adherence to underlying tissue: tumor or goiter
positive finding with palpation of thyroid enlargement (goiter)
positive finding with percussion of thyroid retrosternal dullness: inferior thyroid enlargement
positive findng with instrumentation of thyroid with diaphragm venous hum
"" with bell: bruit: hyperdynamic circulation
what lymph nodes do you assess? occipital, post auricular, pre auricular, tonsilar, submandibular, submental, posterior cervical, superficial anterior cervical, deep anterior cervical, supraclavicular, infraclavicular, epitrochlear
what are 7 characteristics of a palpable lymph node worht noting? size, shape, consistency, contour, mobility, tenderness, location
what might any positive finding mean? lymphadenopathy
what does inspection and palpation of lung fields include? A-P expansion, anterior and posterior lateral expansion, vocal fremitus (99)
patient instructions for an otoscopic exam? tilt head away, let know if uncomfortable, at end plug nose and blow out, ears should pop
ear exam? external: glasses off, look behind ears, pull on ear, press on tragus internal: hold like pencil, traction ear up out and back, throw out specula right away.
what is virchow's node? left supraclavicular lymph node enlarged, sign of stomach cancer
inspection of lung fields: open back,look at scapula and clavicles, chest motion
palpation of lung fields: 1. chest expansion: ap and ant and post lateral 2. vocal/tactile fremitus: feeling of vibration in hand ARMS CROSSED!
positive finding of inspection: chest motion: one side doesn't move as mch, more motion post with AP expansion: LUNG COLLAPSE
postive finding of palpation: pneumoonia: one side feels stronger vibration
how do you assess right middle lobe pneumonia anterior and lateral aspects
perform percussion of lung fields cross arms, tap oon each spot in pattern.
normal note with percussion? resonance
positive finding with percussion: dull note: pneumonia
ascultation of lung fields only use diaphragm of stethoscope: full breaths at each stop in pattern post, anter and lateral.
finding of pneumonia with ascultation: louder in affected areas
where would you expect to find louder areas with left upper lobe pneumonia anterior, lateral and posterior through that lobe
don't forget to perform diaphragmatic excursion BILATERALLY
what is the normal range of diaphragmatic excursion 3-5 mm
what is a pathology that can be assesed using diaphragmatic excursion and how would the results differ pneumothorax and hemothorax--> no motion hemiparesthesia of diaphragm:--> asymmetrical
if you suspect your patient has pneumonia, what are three special procedures to perform? ascultatory percussion, bronchophony, egophony, whispered pectoriloquy
positive for egophony EEE sounds like EHHHH (fonzi)
positive for whispered pectoriloque whispers can be heard louder
positive for bronchophony and ascultory percussion sound will amplify
steps for performing a complete heart exam? inspection: apical impulse (5th intercostal space, left mid clavicular line) palpation: palpate cardiac valve sites for thrills, PMI and Right ventricular hypertorphy (epigastric region) percussion: NA instrumentation: ascultation
what is particular about inspection with a female heart exam decline to perform (BOOBIES IN WAYY)
where is the apical impulse (when checking a male) 5th IC space, midclavicular line on the left
what is PMI point of maximal impulse: located at 5th ICS Left MCL (same as apical impulse)
how do you palpate for right ventricular hypertrophY? epigastric region, A-P towards L shoulder
pneumonic for palpation of valve sites all patients trust me
all: aortic valve 2nd IC space on the Right sternal border
Patients: pulmonary valve 2nd IC space on the on the left sternal border
trust: tricuspid valve 5th IC space on the L sterneral border
me: mitral valve: 5th IC space, L mid clavicular line
pneumonic for ascultation of valve sites: all patients eventually trust me
ascultatory sites: same as palpation, + Erb's point
where is erb's point 3rd IC space, Left sternal border
why is erb's point assessed? if you can't hear pulmonic sound or if it seems abnormal.
what part of the stethoscope do you use with a heart exam? diaphragm and bell at each valve site
what are the exageratory procedures for aortic and pulmonic valves? leaning foward while sitting
exaggeratory position for mitral valve? left lateral recumbent
define a murmur MERR MERRRR
ok, really define a murmur the sound of tubulent blood through the heart valves
define a bruit turbulence in an artery
what are the bruits we need to assess?
what are two causes for a bruit plaquing and aneurysm
why is it important for a chiro to assess bruit contraindication to adjusting
what pulses do you have to assess for? carotid, brachial, radial, ulnar, popliteal, posterior tibial, dorsalis pedis
how do you grade pulse quality? 0-4
what is normal pulse? 2
pulse grade of 1 diminished
pulse grade of 0 absent
pulse grade of 3 increased
pulse of 4 bounding
what is special about the popliteal pulse it is diffuse: feel skin being moved by artery. bend knee and put both hands in pop fossa
Created by: kclarke15 on 2012-02-26

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