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PA II Midterm
lab midterm
| Question | Answer |
|---|---|
| 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
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