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PAMercer Physical Diagnosis - General Survey and Vitals
General Survey and Vitals Lecture
66
Medical
Graduate
01/30/2010

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Cards

Term

 

 

Sthenic

Definition

Mesomorph

 

Heavy bones, very muscular

Term
Asthenic
Definition

Ectomorph

 

Thin, small body frame

Term
Hypersthenic
Definition

Endomorph

 

Obese

Term
Cachexia
Definition

No body fat or muscle

 

Often causes Cardiac arrhythmias

 

(anorexic patients, for example)

Term
Obesity
Definition
Above normal BMI causing orthopedic and Cardivascular compromise (endomorph)
Term
Acromegaly
Definition

Increased GH after plates have closed

 

Causes thickened bones and skull and enlarged hands and feet

Term
Gigantism
Definition

Increased GH during childhood

 

Normal proportions but VERY tall

Term
Dwarfism
Definition

Small body but equally proportioned

 

An adult is less than 4'6" tall

Term
Achondroplasia
Definition
Normal head and trunk but short arms and legs
Term
Marfan's syndrome
Definition
Normal head and trunk but elongated limbs (very long hands and feet)
Term
Signs of Cardiac Distress
Definition

Clutching Chest

Pallor

Diaphoresis

Term
Signs of Respiratory Distress
Definition

Labored breathing

Cyanosis

Pallor

Wheezing

Uncontrollable Cough

Leaning forward

Term

Level of Consciousness:

 

Alert

Definition

awake & aware

 

understands "date and situation"

Term

Level of Consciousness:

 

Confused

Definition

Disoriented

Inattentive

Making no sense

Term

Level of Consciousness:

 

Lethargy

Definition
Sleepy but able to be woken up fairly easily
Term

Level of Consciousness:

 

Obtundant

Definition
Extremely sleepy and hard to wake up
Term

Level of Consciousness:

 

Stuporous

Definition
Not arousable except by painful stimuli
Term

Level of Consciousness:

 

Comatose

Definition

Semi-Comatose: unarousable, even with painful stimuli

 

Deep-Comatose: unresponsive reflexes

Term

Level of Consciousness:

 

 

Delirious

Definition

Confused

Disoriented

Hallucinations

Agitated

Term
Antalgic Gait
Definition
Limping, Painful gait
Term
Parkinsonian Gait
Definition
tremor-like, shuffling steps
Term
Spastic Hemiparesis
Definition
Stiff, Affected Limb
Term
Tremors
Definition

Continuous quivering

 

Involuntary movement from alternating contractions of opposing muscles

Term
Tics
Definition

Spasmodic muscular contraction

 

Primarily within the face, head, neck and shoulder

Term
Myoclonus
Definition
Jerky uncontrolled movement
Term
Athetosis
Definition

Twisting, writhing movments

associated with Cerebral Palsy

Term
Expressive Aphasia
Definition

Nonfluent

Good Comprehension

Labors with words

 

Defect in Broca's Area

Term
Receptive Aphasia
Definition

Loss of ability to understand native tongue

 

Fluent, but sentences lack meaning

 

Minimal comprehension

 

Defect in Wernicke's Area

Term
Anarthria
Definition
Difficulty with Articulation
Term
Dysarcria
Definition
Tongue-tied, Clumsiness with words
Term
Aphonia
Definition

Inability to make sound

Loss of voice

Term
Conversion of inches into meters
Definition

2.54 cm = 1 inch

 

100 cm = 1 meter

Term
Conversion of pounds into kilograms
Definition
2.2 lbs = 1 kg
Term
Ideal Body Weight
Definition

Men = 106 lbs (5') + 6 lbs (per inch)

 

Women = 100 lbs (5') +5 lbs (per inch)

Term
Temperature Conversion of Celsius to Farenheit and vice versa
Definition

(Celsius x 9/5) + 32 = temp in F

 

(Farenheit - 32) x 5/9 = temp in C

Term
Guidelines for BMI
Definition

The Body Mass Index using ratio of weight to heigh

 

BMI 19-25 = Healthy

BMI > 25: consider nutrition counseling (overweight)

BMI < 17 = possible eating disorder

BMI > 30 = obese

BMI > 35, measure waist circumfrence

BMI > 40 = morbidly obese

Term
Normal Ranges for Temperature
Definition

 

  • Oral  98.6˚F (37˚C)
  • Axillary  97.6˚F(36.4˚C)
  • Rectal  99.4˚F(37.5˚C)
  • Ear  99.4˚F(37.5˚C)
  • Skin  98.6˚F (37˚C)
Term
Normals for Respiration
Definition

 

nAdult   16-20
nChildren  20-25
nInfants (1-2 yrs)  20-40
nNewborn  30-80
Term
Fever (Pyrexia)
Definition
Temperature > 100 F
Term
Hyperpyrexia (Hyperthermia)
Definition
Temperature > 105 F
Term
Malignant Hyperthermia
Definition

temperature: 105 F - 109 F

 

Caused by Drugs, Cancer, Autoimmune

Term
Heat Stroke
Definition

Temperature > or = 105 F

 

Malfunction of the thermal regulation of the hypothalamus

 

Hot, Red, Dry skin

Term
Heat Exhaustion
Definition

Temperature < 98.6 F

 

Cold, Clammy Moist skin

 

Weakness due to excessive loss of water, sodium

Term
Hyperthermic Anhydrosis
Definition

No sweating

Lethargic

Stuporous

Altered Mental state (AMS

Term
Hypothermia
Definition

Temperature < 95 F

 

nSigns & Symptoms
¨Shivering
¨Pale, cold, clammy skin
¨Listlessness
¨↓ pulse
¨↓ respiration
Those at risk: severe burn patients and alcoholics
Term
Bradypnea
Definition

Slow (< 8 breaths/min)

 

Due to CNS problems, Drugs

Term
Tachypnea
Definition

Rapid, shallow breathing (32-40 breaths/min)

 

Due to Restrictive lung disease, COPD or Pleuritic CP

Term
Hyperpnea
Definition

Rapid, deep breathing (32-40 breaths/min)

 

Etiology (Hyperventilation): exercise, anxiety, metabolic acidosis or brain stem injury

Term
Kussmaul Respirations
Definition

Deep breathing at a variable rate

 

Due to Metabolic Acidosis

Term
Dyspnea
Definition

Difficulty breathing

 

Symptoms: nares flaring, gasping, anxious

Term
Cheyne-Stokes Respirations
Definition

Alternating periods of hyperpnea and apnea

 

From deep, to shallow and quiet

 

Due to: 

¨Normal during sleep
¨Brain damage
¨Severe cardiopulmonary distress
¨HF
¨Drug induced
¨Severe depression
Term
Biot's Respirations (Ataxic)
Definition

Unpredictable with no pattern

Irregular depth and rate

Etiology: brain damage or respiratory depression

Term
Orthopnea
Definition

Difficulty breathing when lying in a supine position

 

Etiology: Heart Disease

Term
Paroxysmal Nocturnal Dyspnea (PND)
Definition

 

Paroxysmal Nocturnal Dyspnea (PND)

nAwake gasping at night
nMay pace, go to window
nEtiology
¨Heart failure
¨Anxiety
Term
Stridor
Definition

High pitched sound when inspiration

 

Etiology: upper airway or pharyngeal d/o

 

 

Term
Normal Pulse Rate Ranges
Definition

 

nAdult -  60 – 100 beats/ min
nChildren  75 – 110 beats/ min
nInfants  80 – 120 beats/ min
nNeonate  120 – 170 beats/ min
Term
Pulse Rate Defecit
Definition

 

nApical vs radial pulse
nShould not be a major difference
nOccurs when:
¨Radial pulse < apical pulse
¨18 – 20 = 2
¨Atrial fibrillation
¨Congenital aortic defects
Term
Pulse Pressure
Definition

 

nDifference betw. Systolic  vs diastolic pressure
nExpressive of tone of arterial walls
n120 – 80 = 40
nAbnormal PP:
¨> 50
¨< 30
Term
Bisferiens Pulse
Definition

 

n↑ arterial pulse w/ double systolic peak
nEtiology
¨Aortic valve abnormalities
¨Carotid abnormalities
¨Hypertrophic cardiomyopathy
Term
Pulsus Alternans
Definition

 

nPulse alternates in amplitude from beat to beat
nStrong & weak alternating
nRhythm is regular
nEtiology
¨Heart failure
Term
Bigeminal Pulse
Definition

 

nDisorder of rhythm
nNormal beat alternating w/ premature contraction
nNormal beat → premature beat → pause
nMistaken for Pulse alternans
nPulse varies in amplitude
Term
Paradoxical Pulse
Definition

 

nPalpable in pulse amplitude on quiet inspiration
nRate goes up slightly
nSystolic pressure ↓ by > 10mmHg during inspiration
nEtiology
¨Pericardial tamponade (cardiac)
¨Constrictive pericarditis
¨Obstructive lung disease
Term
Stages of Hypertension
Definition

 

Normal    < 120     < 80

Prehypertension  120-139    80-89 

HTN Stage 1  140-159    90-99

HTN Stage 2  > 160    > 100

Term
Orthostatic Hypotension
Definition

 

nSitting BP → Standing BP
¨Normally drop in systolic by 10-15 mmHg
¨Normally rise in diastolic by 5 mmHg
¨If drops 20-30 mmHg → not normal
nCalled Orthostasis or Orthostatic Hypotension
nDue to Volume Loss:
¨Dehydration
¨Bleeding
¨CNS dysfunction
¨BP medication
Term
Isolated Hypertension
Definition

 

nOnly systolic BP is elevated
nDiastolic BP is normal
nExample:  140/ 78
nSeen in geriatric patients
nArteries are less elastic, thus increase pressure
Term
Auscultatory Gap
Definition

 

nGap between Korotkoff sounds
nHear beat at 180 mHg, disappears at 110 mmHg
nThen hear again at 90 mmHg, disappears at 75 mmHg
n180 → 110 → 90 → 75
nUse first and last reading 180/75 mmHg
nEtiology:
¨Arterial sclerosis Hypertension
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