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PDX lab
vitals, mouth and throat, head and face,neck, nose mouth and oropharynx
| Question | Answer |
|---|---|
| DURING BLOOD PRESSURE WHERE DOES THE ARM REST? | 4th intercostal space (level of the heart) & not tensed |
| DURING BLOOD PRESSURE where is the artery indicator positioned? | over the brachial artery (medial to the biceps tendon); tubing should rest on the outside of the arm |
| DURING BLOOD PRESSURE where is the lower border of the cuff placed? | 2.5 cm above the antecubital crease. |
| DURING BLOOD PRESSURE the cuff pressure is reduced at? | 3-5mmHg/sec rate |
| DURING BLOOD PRESSURE the first sound heard is identified as? | systolic pressure |
| DURING BLOOD PRESSURE when the cuff pressure is reduced what is the point at which the sounds disappear known as? | diastolic pressure |
| DURING BLOOD PRESSURE how long is auscultation continued to make sure last sounds been identified? | 10 to 20 mm Hg drop |
| DURING BLOOD PRESSURE Prehypertension is? | 120-139/80-89 |
| DURING BLOOD PRESSURE Hypertension Stage 1: is | 140-159/90-99 |
| DURING BLOOD PRESSURE Hypertension stage 2 is: | ≥160/≥100 |
| DURING BLOOD PRESSURE Urgency HTN is? | >220/>120 without evidence of organ damage = normal funduscopic exam |
| DURING BLOOD PRESSURE Emergency: Accelerated HTN is? | Malignant hypertension >220/>120 with evidence of organ damage = abnormal funduscopic exam |
| document pulse respiration and BP | Pulse: 64 bpm; rhythm regular, but amplitude decreases on inspiration Respiration: 16 rpm; rhythm normal, depth BP = 140/82 mmHg R, seated |
| What is normal pulse pressure and contour? | Normal pulse pressure is ~30- 40 mm Hg. Contour is smooth & rounded |
| If Pulse pressure is ↓, what could be the causes? | Causes include ↓ stroke volume (heart failure), hypovolemia, aortic stenosis, ↑ peripheral resistance (cold exposure & CHF) |
| If Pulse pressure is ↑. what could be the causes? | exercise, anxiety, anemia, fever, hyperthyroidism, atherosclerosis or aging |
| A bisferiens pulse is ↑ arterial pulse with high systolic peak... what could be causes? | aortic regurgitation, aortic stenosis & hypertrophic cardiomyopathy |
| Alternating Pulse (pulse alternates in amplitude from beat-to-beat even though the rhythm stays the same) is indicative of? | left ventricular failure |
| Paradoxic(al) Pulse (Pulse ↓ by > 10 mm Hgduring inspiration and ↑during expiration) is caused by? | pericardial tamponade, constrictive pericarditis & obstructive lung disease |
| Causes of Tachypnea (RR rate, shallow) | anxiety, restrictive lung disease, pleurisy & elevated diaphragm |
| Causes of Hyperpnea (RR rate, deep)? and what spwecific type of breathing can happen? | exercise, anxiety & metabolic acidosis; ussmaul breathing |
| Causes of Bradypnea? | diabetic coma, drug-induced respiratory depression, increased intracranial pressure, obesity, myasthenia gravis & cerebral |
| When is Cheyne-strokes seen? | encephalopathy & coma, also heart failure, uremia, and brain damage |
| Causes of Ataxic/Biot’s? | respiratory depression & brain damage |
| Causes of obstructive breathing? | asthma, chronic bronchitis & COPD |
| What's the normal temperature? nl highs and lows | 98.6... Early AM – as low as 96.4 °F & late afternoon or PM – as high as 99.1 °F |
| which may influence accuracy of temperature? | . Eating, drinking, chewing gum or smoking 15 minutes prior to a reading and Talking &/or breathing through the mouth during a reading |
| What can cause hyperpyrexia? | Infection, trauma, malignancy, acute hemolytic anemia, drug reactions & immune disorders |
| What can cause hypothermia? | Exposure to cold, paralysis, excess alcohol, starvation, hypothyroidism & hypoglycemia |
| What is the normal heart rate | 60-100 BPM |
| Prolonged expiration suggests ... | COPD |
| Sighing respiration (occasional sigh normal) suggests | hyperventilation syndrome |
| Tachypnea suggests lung dz; hyperpnea suggests | exercise, pain, anxiety or met. acidosis |
| Ataxic (Biot’s) breathing suggests | CNS disorders |
| Bradypnea suggests | met. alkalosis, cerebral disorders, myasthenia gravis, narcotic overdoses & obesity (extreme) |
| when looking at head and face, what would an Enlarged skull indicate? | Hydrocephalus or Pagets disease |
| when looking at head and face, what would a Elongated head & prominent brow and jaw indicate? | acromegaly |
| When there is rotation without lateral flexion suspect... | torticollis |
| ocular causes of abnormal head position include | strabismus, diplopia |
| non-ocular causes of an abnormal head position include | cerebral palsy, bony abnormalities, occipitocervical synostosis, Parkinsonism syndromes & unilateral hearing loss |
| Cushings Syndrome presents as | Round or “moon” face with red cheeks |
| Edematous face means | nephrotic syndrome, hypothyroidism (myxedema) or pre-eclampsia |
| What would Swelling anterior to the ear lobes & above angles of jaw = parotid gland enlargement indicate? | suspect Mumps |
| if you see a Masked facies think | Parkinson’s |
| if you see ptosis think... | Horner’s syndrome, myasthenia gravis or oculomotor nerve lesion |
| what is entropian and ectropian? | Entropion (turning inward of lid margin) = elderly Ectropion (turning outward of lid margin) = elderly |
| Exophthalmos indicates... | hyperthyroidism |
| thinning of outer 1/3 of eyebrow indicates... | Hypothyroidism |
| Nasal flaring indicates | respiratory distress |
| Pursed lips indicates | COPD |
| Excessive male hair growth is... | Hypertrichosis |
| Excessive hair growth in women & children due to androgen-dominance is | Hirsutism |
| hair loss may suggest hormonal imbalances, aging or hypothyroidism and is known as... | Alopecia |
| coarse hair is found in... | Hypothyroidism |
| fine hair is found in... | Hyperthyroidism |
| when checking out scalp scaling , look for... | Cradle-cap in children; seborrheic dermatitis (redness & scaling) Nits - tiny tan, yellow or brown oval dots close to the scalp or after hatching, shell looks white or clear and continues to be firmly attached to the hair shaft |
| When checking out Scalp & skull for masses look for... | Pilonidal cysts (soft lumps), pigmented nevi |
| What do bruits inTemporal artery auscultation indicate... when might present? | Giant Cell Arteritis... cervical disorders such as seizures, headaches, stroke syndromes, intracranial mass lesions, or carotid bruits |
| What do bruits in Orbital artery auscultation indicate? bilateral bruits? | cervical disorders such as seizures, headaches, stroke syndromes, intracranial mass lesions, or carotid bruits; bilateral bruits of orbital arteries may suggest hyperthyroidism |
| When trachea deviates towards affected side think... | atelectasis |
| When trachea deviates away from affected side think... | large pleural effusion OR large pneumothorax |
| What do thyroid findings indicate? | Soft – Graves disease Firm – Hashimotos thyroiditis, malignancy Diffuse enlargement – Graves disease, Hashimotos thyroiditis, endemic goiter Single nodule – Cyst, benign tumor, malignancy Multinodular – malignancy Multinodular + enlargement metabolic proc |
| What do Tenderness Hard/fixed lymph nodes indicate? | Tenderness = inflammation Hard/fixed nodes = malignancy |
| pathological enlargement of LEFT supraclavicular lymph node is... what's it associated with? | virchows node- associated with the presence of an abdominal or thoracic neoplasm |
| Tenderness of the nasal tip or alae may suggest local infection... what's it known as | faruncle |
| The mucosa is reddened & swollen in the nose indicates... | viral rhinitis |
| Pale, bluish or red in nose indicates | Allergic rhinitis |
| What else are you inspecting in nose? | Septal perforations- trauma, surgery, cocaine or amphetamines. Polyps- pale, semitranslucent masses- the middle meatus; Ulcers -cocaine use. Epistaxis - trauma, chronic nose-blowing, pregnancy, blood-clotting disorders, chronic alcohol/drug abuse |
| If you see Aphthous stomatitis (AKA canker sore or aphthous ulcer) what will it look like? | white or yellow oval with an inflamed red border (sometimes white circle or halo around the lesion |
| Angular cheilitis will look like... | inflammatory lesion at the labial commissure, or corner of the mouth, & often occurs B/L |
| Labial HSV1 looks like... | small, sometimes painful, fluid-filled reddish or purple blisters around the lips or corners of the mouth. Over several days, the blisters tend to merge and then collapse. A yellowish crust often forms over the sores |
| Cheilitis (inflammation of the lip) suggests... | vitamin B12 or iron deficiency, allergy or precursor to skin CA |
| Angioedema (swelling of the lip) is... | allergic reaction |
| Carcinoma of the lip may present as | scaly plaque, ulcer w/ or w/o a crust or as a nodular lesion |
| what is Leukoplakia | patches of keratosis appear as adherent white patches on the mucous membranes of the oral cavity, including the tongue |
| What is Pernicious anemia look like | Beefy, red tongue |
| What is Geographic tongue? | map-like appearance of your tongue due to irregular patches on its surface |
| Cancer of the tongue is the 2nd most common CA of the mouth... when would you suspect it? | Any persistent nodule or ulcer, red or white, is suspect |
| What 2 things could be present when inspecting the cheek? | Petechiae may be present in individuals who bite their cheeks and in those with platelet disorders. Bruxism - Bite marks |
| gums are normally pink, patchy brown may be present... but what could gingival hyperplasia be caused by? | (gingival overgrowth) Dilantin (seizure) therapy, puberty, pregnancy and leukemia |
| what is Ankyloglossia | tongue-tie, is a congenital anomaly characterized by an abnormally short lingual frenulum; often found in infants that have difficulty breast-feeding |
| What could you suspect with saliva issues? | Xerostomia (dry mouth) may be caused by medications, Sjögren’s or nutrition. Sialorrhea(hypersalivation)may be caused by medications, Parkinson’s or GERD |
| what is Torus Palatinus | a midline bony growth in the hard palate that is fairly common in adults; size & lobulation vary. These may be insignificant, contributory to migraines (limited research) or a characteristic of acromegaly |
| What would you be looking for when inspecting pharynx? | Pharyngitis is most common in viral & bacterial infections. Tonsillitis is a red throat with white exudate on the tonsils (due to strep or mono) |
Created by:
abva
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