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PDX lab

vitals, mouth and throat, head and face,neck, nose mouth and oropharynx

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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