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