Term
| What are the 6 ethical principles? |
|
Definition
| Autonomy, Beneficence, Nonmaleficence, Utilitarianism, Fairness and Justice, and Deontologic imeratives |
|
|
Term
|
Definition
| The patient's need for self-determination: the ability to choose between alternatives. |
|
|
Term
| What does Beneficence mean? |
|
Definition
|
|
Term
| What does Nonmalficence mean? |
|
Definition
| Do no harm to the patient. |
|
|
Term
| What does Utilitaraianism mean? |
|
Definition
| Consider appropriate use of resources with concern for the greater good of the larger community. |
|
|
Term
| What does Fairness and Justice mean? |
|
Definition
| Recognize balance between patient's autonomy and the interests of family and community. |
|
|
Term
| What does Deontologic imperatives mean? |
|
Definition
| Responsibilities for offering care are established by tradition and cultural contexts and vary by culture. |
|
|
Term
| What does establishing a positive patient relationship depend on? |
|
Definition
| communication, courtesy, comfort, connection, and confirmation |
|
|
Term
| What are 3 types of questions? |
|
Definition
| open-ended, direct, leading |
|
|
Term
| What is the structure of the history? |
|
Definition
| Identifiers, cheif complaint, history of present illness, past medical history, family history, personal and social history, review of symptoms. |
|
|
Term
|
Definition
| name, date, time, age, gender, race, occupation, and referral source |
|
|
Term
| What is the chief complaint? |
|
Definition
| direct quote from the patient explaining why they are seeking care |
|
|
Term
| What is the history of present illness? |
|
Definition
| the circumstances that surround the primary reason for the patient's visit. |
|
|
Term
| What is the past medical history? |
|
Definition
| past medical and surgical history |
|
|
Term
| What is the family history? |
|
Definition
| Family's health, past medical history, illnesses, deaths, genetic, social, and environmental influences of family. |
|
|
Term
| What is the personal and social history? |
|
Definition
| Work, family, and school relationships |
|
|
Term
| What is the review of symptoms? |
|
Definition
| Detailed review of possible complaints in each of the body's systems |
|
|
Term
| What are the 4 steps to approach a sensitive topic? |
|
Definition
| 1. Introduce the topic 2. open-ended quesions 3. interpret and repeat the patient's words 4. ask relevant questions |
|
|
Term
| What is the CAGE questionnaire? |
|
Definition
| Cut down, Annoyance, Guilt, Eye-opener |
|
|
Term
|
Definition
| Adults and pregnant women. |
|
|
Term
|
Definition
|
|
Term
| What is the TACE questionaire? |
|
Definition
| How many drinks does it take to feel high, Annoyance, Cut Down, Eye-Opener |
|
|
Term
| What is the CRAFFT questionnaire? |
|
Definition
| Car with impaired driver, Relax with drugs, Alone using, Forget things you did, Family/Friends told you to cut down, Trouble for using them |
|
|
Term
| What is the HITS questionnaire? |
|
Definition
| Hurt, Insult, Threaten, Scream |
|
|
Term
| What questionnaires can be used for alcohol in adults? |
|
Definition
|
|
Term
| What questionnaire is used for substance abuse in adolescents? |
|
Definition
|
|
Term
| What questionnaire is used for spirituality? |
|
Definition
|
|
Term
|
Definition
| Faith, Importance/Influence, Community, Address how it affects health care decisions |
|
|
Term
| What are similar terms to describe chief complaint? |
|
Definition
| presenting problem and reason for seeking care |
|
|
Term
| What 4 questions give a basis of understanding of the unique experience of each patient? |
|
Definition
| Why is it happening now? How is this patient different from others? Can I assume that what is true for this patient is true for others? How does this bear on my ultimate interpretation? |
|
|
Term
| What are risk factors for Type II Diabetes? |
|
Definition
| Children: obesity and dyslipidemia. Adults: 1 or more second degree relatives with diabetes or CVD. |
|
|
Term
| What are 2 mnemonics for adolescent screening? |
|
Definition
| HEADSSS: Home, Edu/Employment, Eating, Activities/Affect/Anger, Drugs, Sexuality, Suicide, Safety. PACES: Parents/peers, Accidents/Alcohol/Drugs, Cigarettes, Emotions, School/Sexuality. |
|
|
Term
| What state or federal laws control the need for confidentiality in adolescents? |
|
Definition
| pregnancy, abortion, substance abuse, physical abuse. |
|
|
Term
| What takes on a dominant role during middle adolescence? |
|
Definition
| risky behavior, immature decisions, arguments with parents |
|
|
Term
| What takes on a dominant role during late adolescence? |
|
Definition
| understanding of consequences and self takes hold |
|
|
Term
| How frequent is postpartum depression? |
|
Definition
| 1 out of 8 women after delivery |
|
|
Term
| When are advanced directives needed? |
|
Definition
| When cognitive impairment deprives a patient (of any age) of the ability to join in the decision-making process. |
|
|
Term
| What should compliment advanced directives? |
|
Definition
| The appointment of a surrogate who has legally executed durable power of attorney for healthcare. |
|
|
Term
|
Definition
| Loss of physical reserve and increased risk of loss of physical function and independence |
|
|
Term
| What findings suggest frailty? |
|
Definition
| 3 or more of the following: muscle weakness, fatigue, decline in activity, slow or unsteady gait, unintentional weight loss. OR the PT needs help with 2 or more ADLs |
|
|
Term
| What describes mobility disability? |
|
Definition
| Difficulty walking, climbing stairs, balance. |
|
|
Term
| What describes housework disability? |
|
Definition
| Heavy, light, meal preparation, shopping, medication use, money management. |
|
|
Term
| What describes upper extremity function disability? |
|
Definition
| Grasping, opening jars, reaching overhead. |
|
|
Term
| What describes ADL disability? |
|
Definition
| Bathing, dressing, toileting, moving, eating, walking in home. |
|
|
Term
|
Definition
| Comprehensive management of phys, emot, and spirit or PTs with life-limiting conditions. |
|
|
Term
| What are the 4 types of histories? |
|
Definition
| Complete, inventory, problem aka focuesd, interim. |
|
|
Term
| When is an inventory history taken? |
|
Definition
| Touches on major points without going into detail, used when the entire history will be taken in more than one session. |
|
|
Term
| When is a problem aka focused history taken? |
|
Definition
| During an acute possibly life threatening problem. |
|
|
Term
| When is an interim history taken? |
|
Definition
| Chronicles events that have occurred since your last meeting. |
|
|
Term
| What are standard precautions? |
|
Definition
| Hand hygeine, PPEs, cough etiquette, safe injections, masks for catheter insert/ subarachnoid puncture, contaminated surface containment. |
|
|
Term
| How can health care professionals minimize their vulnerability? |
|
Definition
| Follow standard precautions, minnimize latex exposure, use good body mechanics. |
|
|
Term
| When should hand hygiene be used? |
|
Definition
| After touching blood, body fluid, secretions, excretions, contaminated items, after removing gloves, and between patient contacts. |
|
|
Term
| When should gloves be used? |
|
Definition
| Touching blood, bodily fluids, secretions, excretions, contaminated items, mucous membranes, and nonintact skin. |
|
|
Term
| When should a gown be used? |
|
Definition
| When contact of your body is expected with blood/body fluids, secretions, and excretions. |
|
|
Term
| When should a mask or goggles be used? |
|
Definition
| Splashed or sprays of blood, body fluid, secretions, suctioning, or endotracheal intubation. |
|
|
Term
| How should needles/ sharps be handled? |
|
Definition
| Do not recap, bend, break, or hand manipulate. If recapping is required, use a 1-hand scoop technique |
|
|
Term
| What are 3 types of latex reactions? |
|
Definition
| Irritant contact dermatitis, Type IV dermatitis, Type I systemic reactions. |
|
|
Term
| What is Irritant contact dermatitis? |
|
Definition
| Chemical irritation that does not involve the immune system. |
|
|
Term
| What is Type IV dermatitis? |
|
Definition
| aka Delayed hypersensitivity: involves immune system, onset 24-48 hrs. |
|
|
Term
| What is Type I systemic reactions? |
|
Definition
| True allergic reaction caused by IgE, releasing histamine, leukotrienes, prostaglandins, and kinins. |
|
|
Term
| What are the symptoms of Irritant contact dermatitis? |
|
Definition
| Dry, itchy, irritated hands. |
|
|
Term
| What are the symptoms of Type IV dermatitis? |
|
Definition
| Resembles poison ivy and may lead to oozing skin blisters. |
|
|
Term
| What are the symptoms of Type I systemic reactions? |
|
Definition
| Local utricaria (wheals), generalized utricaria with angioedema, asthma, eye-nose itching, GI symptoms, anaphylaxis, chronic asthma, and permanent lung damage. |
|
|
Term
| What is the dorsal recumbent position used for? |
|
Definition
| Examination of genital and rectal areas. |
|
|
Term
| What is the lithotomy position used for? |
|
Definition
|
|
Term
| Describe the Sims position. |
|
Definition
| PT in lateral recumbent rolls torso toward prone, sharply flex top leg, gently flex bottom leg: rectal exam. |
|
|
Term
| What odor can be detected for inborn errors of metabolism? |
|
Definition
| PAH defect: mousy, Tyrosinemia: fishy |
|
|
Term
| What odor can be detected for infectious diseases? |
|
Definition
| TB: stale beer, Diptheria: Sweetish |
|
|
Term
| What odor can be detected for poison/ intoxication? |
|
Definition
| Cyanide: bitter almond, Chloroform and Salicylates: fruity |
|
|
Term
| What odor can be detected for physiologic non-disease states? |
|
Definition
|
|
Term
| What odor can be detected for foreign bodies? |
|
Definition
| lodged organic material: foul-smelling discharge. |
|
|
Term
| What part of your hand is used for discriminatory touch? |
|
Definition
| Palmar surface of fingers and finger pads (not fingertips) |
|
|
Term
| What part of your hand is used to sense vibration? |
|
Definition
| ulnar surface of hands and fingers |
|
|
Term
| What part of your hand is used to sense temperature? |
|
Definition
|
|
Term
| What depth yields percussion tones? |
|
Definition
|
|
Term
| What are the percussion sounds from loudest to quietest? |
|
Definition
| Tympany, hyperressonance, ressonance, dullness, and flatness |
|
|
Term
| How do you perform percussion? |
|
Definition
| Place distal phalynx of middle finger nondominant hand over target area, elevate other fingers. Snap wrist to bring down dominand middle finger TIP (plexor) down on target finger. |
|
|
Term
| What is the tone, intensity, pitch, duration, and quality of a gastric bubble? |
|
Definition
| tympanic, loud, high, moderate, and drumlike |
|
|
Term
| What is the tone, intensity, pitch, duration, and quality of emphysematous lungs? |
|
Definition
| hyperresonant, very loud, low, long, boomlike |
|
|
Term
| What is the tone, intensity, pitch, duration, and quality of healthy lung tissue? |
|
Definition
| resonant, loud, low, long, hollow |
|
|
Term
| What is the tone, intensity, pitch, duration, and quality of the liver? |
|
Definition
| dull, soft-moderate, moderate-high, moderate, thudlike |
|
|
Term
| What is the tone, intensity, pitch, duration, and quality of muscle? |
|
Definition
| flat, soft, high, short, very dull. |
|
|
Term
| How are indirect measurements of blood pressure taken? |
|
Definition
| stethoscope and either aneroid or mercury sphygmomanometer |
|
|
Term
| How wide should an adult blood pressure cuff be? |
|
Definition
| 1/3 - 1/2 the circumference of the limb |
|
|
Term
| How long should the cuff bladder be? |
|
Definition
| 2x the width (80% of limb circumference) |
|
|
Term
| How wide should a child's blood pressure cuff be? |
|
Definition
| 2/3 or upper arm or thigh (40% of circumference) |
|
|
Term
| How much of the distance between the acromion and olecranon should the child's cuff cover? |
|
Definition
|
|
Term
| How long should a child's cuff bladder length/ width be? |
|
Definition
| 80-100% of arm circumference/ 40% arm circumference |
|
|
Term
| What method of measuring temperature is best for children ages 2 months- 16 years? |
|
Definition
|
|
Term
| Why does ear temperature reflect body temperature? |
|
Definition
| tympanic membrane shares blood supply with hypothalamus in the brain. |
|
|
Term
| Why does axillary temperature correlate well with a newborn's core temperature? |
|
Definition
| infant has small body mass and uniform skin blood flow. |
|
|
Term
|
Definition
| pulse oximitry (healthy = 97-99%) |
|
|
Term
| What are 4 types of patient transfer? |
|
Definition
| Pivot, Cradle, 2-person, and Equipment |
|
|
Term
| What is the natural frequency of the diaphragm of an acoustic stethoscope? |
|
Definition
| 300Hz (best for low frequency sounds) |
|
|
Term
| What is the bell of the acoustic stethoscope used for? |
|
Definition
| low pitches sounds with light pressure (higher with firm) |
|
|
Term
| What are the components of a magnetic stethoscope? |
|
Definition
| Convex single diaphragm over iron disk, compression activates air column. Dial adjusts for high, low, and full frequency sounds. |
|
|
Term
| What is unique about a stereophonic stethoscope? |
|
Definition
| Right and left ear can hear right and left auscultory sounds independently. |
|
|
Term
| How does a pulse oximiter work? |
|
Definition
| One diode sends out invisible infrared, and the other visible red. oxygenated Hb = more red light passes through to other side. |
|
|
Term
| How does Doppler Detect Blood Flow? |
|
Definition
| Low power high frequency wave reflects at various tissue interfaces, resulting in audible sounds. |
|
|
Term
| What frequency does Doppler measure? |
|
Definition
|
|
Term
| What is used to determine fetal heart rate? |
|
Definition
| A fetoscope or a Leff scope. |
|
|
Term
| At what age can a fetoscope or Leff scope detect HR? |
|
Definition
|
|
Term
| What is the small aperture of the opthalmoscope used for? |
|
Definition
|
|
Term
| What is the red-free filter aperture of the opthalmoscope used for? |
|
Definition
| green beam: optic pallor, minute vessel changes, retinal hemorrhages, blood appears black. |
|
|
Term
| What is the slit aperture of the opthalmoscope used for? |
|
Definition
| Anterior eye to determine lesion elevation. |
|
|
Term
| What is the grid aperture of the opthalmoscope used for? |
|
Definition
|
|
Term
| What is the magnification power (diopter) of an opthalmascope? |
|
Definition
| pos or neg 20 to pos or neg 140 |
|
|
Term
| Can an opthalmoscope compensate for myopia or hyperopia? |
|
Definition
| Yes, using plus and minus lenses, HOWEVER there is no compensation for astigmatism. |
|
|
Term
| How should an opthalmoscope be seated in the handle? |
|
Definition
| Fit the adapter of the handle into the head receptacle and push downward while turning the head in a clockwise direction. |
|
|
Term
| How do you use a strabismoscope? |
|
Definition
| Have child focus on accomodative target, cover one eye with scope, watch for movement in both eyes, switch. |
|
|
Term
| What the the numerator and denominator of visual acuity represent? |
|
Definition
| Numerator: distance in feet between patient and chart. Denominator: distance from which a person with normal vision could read the lettering. |
|
|
Term
| What does a Snellen chart measure? |
|
Definition
|
|
Term
| When should the Tubling E or HOTV tests be used? |
|
Definition
|
|
Term
| What is an LH (LEA) symbols chart? |
|
Definition
| Presents 4 optotypes: circle, square, apple, house: recorded as smallest symbol/ testing distance |
|
|
Term
| What is a broken wheel (Landolt) test? |
|
Definition
| Child must identify broken wheel on a card. Each card has a different size card to ID different acuities. |
|
|
Term
| What tests are used for near vision? |
|
Definition
| Rosenbaum or Jaeger chart: series of numbers, E, X, and O in graduated sized. |
|
|
Term
| What is used to test macular degeneration? |
|
Definition
| Amsler grid: PT views grid one eye at a time noting line distortion or scotoma. Used when PT has retinal drusen bodies of family Hx. |
|
|
Term
| Which otoscope speculum is used for a tympanic membrane/ external auditory canal exam? |
|
Definition
| Largest that will comfortably fit. |
|
|
Term
| What otoscope speculum is used for naris? |
|
Definition
|
|
Term
| What evaluates the fluctuating capacity of the tympanic membrane? |
|
Definition
| pneumatic attachment for otoscope, apply pufs of air. |
|
|
Term
| What does tympanometry assess? |
|
Definition
| Functions of ossicular chain, eustachian tube, and tympanic membrane |
|
|
Term
| What is a nasal speculum used for? |
|
Definition
| To visualize lower and middle turbinates. |
|
|
Term
| What frequency tuning fork is used for auditory evaluation? |
|
Definition
| 500-1000Hz (speech is 300-3000 Hz) |
|
|
Term
| What frequency tuning fork is used for vibratory sensation? |
|
Definition
| 100-400Hz: tap against heel of hand, apply base of fork to bony prominence |
|
|
Term
| What are the 3 types of vaginal specula? |
|
Definition
| Graves: 3.5-5 x 0.75-1.25, Penderson: narrower and flatter blades, Pediatric: smaller in all dimesions |
|
|
Term
| What is a Goniometer used for? |
|
Definition
| Degree of joint flexion and extension |
|
|
Term
| What does a Wood's lamp do? |
|
Definition
| 300nm black light that causes fungi to flouresce |
|
|
Term
| What does a dermatoscope measure? |
|
Definition
| (Digital) Epiluminesence microscopy examines skin lesions |
|
|
Term
| What do Lange and Harpenden calipers measure? |
|
Definition
| Thickness of subcutaneous tissue. |
|
|
Term
| What does a monofilament test? |
|
Definition
| Loss of protective sensation such as on plantar surface of foot. |
|
|
Term
| What is the proper way to use a monofilament? |
|
Definition
| Depress on foot until it bends (under 10 g of pressure) |
|
|
Term
| What is necessary equipment? |
|
Definition
| Stethoscope, opthalmoscope, BP cuff and manometer, cm ruler, tape measure, reflex hammer, auditory and vibratory tuning forks, penlight, near vision screenign chart. |
|
|
Term
| Which phase of heart contraction produces a pressure wave resulting in an arterial pulse? |
|
Definition
|
|
Term
| How much time does it take for an impulse from ventricular systole to be felt as the dorsalis pedis pulse? |
|
Definition
|
|
Term
| How long does it take for an RBC in the aorta to reach the dorsalis pedis? |
|
Definition
|
|
Term
| What are the 3 factors that influence systolic pressure? |
|
Definition
| cardiac output, blood volume, and compliance of the arterial tree |
|
|
Term
| How is pulse affected when the aortic valve closes? |
|
Definition
| There is a small upstroke in the descending part of the pulse called the dicrotic notch |
|
|
Term
| What factor influences diastolic pressure? |
|
Definition
| peripheral vascular resistence |
|
|
Term
|
Definition
|
|
Term
| What 4 factors contribute to the characteristics of the pulses? |
|
Definition
| stroke volume, distensibility of great vessels, blood viscosity, peripheral resistence |
|
|
Term
| Where are the external jugular veins most visible? |
|
Definition
| above the clavicle, close to the insertion of SCM |
|
|
Term
| The activity of the right side of the heart is transmitted back through the _____ as a pulse. |
|
Definition
|
|
Term
| What do the 3 peaks of the jugular vein pulse represent? |
|
Definition
| a- brief backflow during R atrial contraction, c- backward push during R ventricular systole, v- increasing volume and pressure on right atrium |
|
|
Term
| What do the 2 descending slopes of the jugular vein pulse represent? |
|
Definition
| x- passive atrial filling, y- open tricuspid ie rapid filling of right ventricle |
|
|
Term
| When does the ductus arteriosus close? |
|
Definition
|
|
Term
| In the infant, what causes blood to flow into pulmonary arteries rather than across the foramen ovale? |
|
Definition
| pulmonary resistance becomes lower than systemic resistance when the infant starts breathing |
|
|
Term
| What closes the foramen ovale? |
|
Definition
| pressure in the left side of the heart becomes higher than the right |
|
|
Term
| How is systemic vascular resistance altered in pregnant women? |
|
Definition
| systemic vascular resistance decreases causing peripheral vasodilation -> palmar erythema and spider telangietasias |
|
|
Term
| What changes are seen in the arterial walls of the elderly? |
|
Definition
| calcification, dilation, and tortuousity |
|
|
Term
| What are the risk factors for preeclampsia? |
|
Definition
| 40+, 1st pregnancy, preexisting hypertension, obesity, renal Dx, or diabetes mellitus, family Hx |
|
|
Term
| What are the risk factors for varicose veins? |
|
Definition
| Women 4x more likely than men, Irish & German descent, sedentary, age |
|
|
Term
| A healthy pulse contour should be _____. |
|
Definition
|
|
Term
| What is a possible cause of an alternating pulse (pulsus alternans)? |
|
Definition
|
|
Term
| What is a possible cause of a pulsus bisiferans? |
|
Definition
| aortic stenosis combined with aortic insufficiency |
|
|
Term
| What are possible causes of a large, bounding pulse? |
|
Definition
| exercise, anxiety, fever, hyperthyroidism, aortic rigidity or atherosclerosis |
|
|
Term
| What is a possible cause of a bigeminal pulse? |
|
Definition
|
|
Term
| What are possible causes of a paradoxic pulse (pulsus paradoxus)? |
|
Definition
| premature cardiac contraction, tracheobronchial obstrction, bronchial athsma, emphysema, pericardial effusion, constrictive pericarditis |
|
|
Term
| What are possible causesof a Water-hammer (Corrigan) pulse? |
|
Definition
| patent ductus arteriosus, aortic regurgitation |
|
|
Term
| What is normal resting hear rate? |
|
Definition
|
|
Term
| What is the pule rate of tachycardia? |
|
Definition
|
|
Term
| What is the pulse rate of bradycardia? |
|
Definition
|
|
Term
| A heart rate that is irregular but that occurs in a repeated pattern may indicate: |
|
Definition
|
|
Term
| Lack of pulse symmetry between right and left may indicate: |
|
Definition
|
|
Term
| What arteries can be auscultated fro bruits? |
|
Definition
| temporal, carotid, subclavian, abdominal aorta, renal, iliac, and femoral |
|
|
Term
|
Definition
| a clinically insignificant sound that can be auscultated at the medial clavicle anterior to SCM, can be confused with other pathologies |
|
|
Term
| What can cause carotid artery bruits? |
|
Definition
| valvular aortic stenosis, mitral valve damage, aortic regurgitation, stenosis |
|
|
Term
|
Definition
| Pain brought on by exercise and relieved with rest, pain is distal to stenosis. |
|
|
Term
| What are the 5 P's of arterial occlusion? |
|
Definition
| Pallor, Pain, Pulselessness, Paresthesia, Paralysis |
|
|
Term
| Where would pain present in an obstructed superficial femoral artery? |
|
Definition
|
|
Term
| Where would pain present in an obstructed common femoral or external iliac artery artery? |
|
Definition
|
|
Term
| Where would pain present in an obstructed common artery or distal aorta? |
|
Definition
|
|
Term
| What sound is produced during a blood pressure reading? |
|
Definition
|
|
Term
| What indicates the beginning of the Korotkoff sounds? |
|
Definition
| 2 consecutive systolic beats |
|
|
Term
| What is the term for when Korotkoff sounds appear, disappear, and reappear 10-15 mmHg lower? |
|
Definition
|
|
Term
| What can cause the auscultory gap to widen? |
|
Definition
| systolic hypertension, chronic severe aortic regurgitation |
|
|
Term
| What can cause the auscultory gap to narrow? |
|
Definition
| pulsus paradoxis with cardiac tamponade or other cardiac constrictions |
|
|
Term
| Define phases 1 of Korotkoff sounds. |
|
Definition
| First 2 consecutive beats = systolic pressure |
|
|
Term
| Define phases 2 of Korotkoff sounds. |
|
Definition
| reappearance of sounds after auscultory gap |
|
|
Term
| Define phases 3 of Korotkoff sounds. |
|
Definition
| point as which sounds are first crisp |
|
|
Term
| Define phases 4 of Korotkoff sounds. |
|
Definition
| point at which crisp sounds become muffled: 1st diastole |
|
|
Term
| Define phases 5 of Korotkoff sounds. |
|
Definition
| disappearance of sound: 2nd disatole |
|
|
Term
| What is optimal blood pressure? |
|
Definition
|
|
Term
| What is the range of prehypertension? |
|
Definition
|
|
Term
| What is the range of stage 1 hypertension? |
|
Definition
|
|
Term
| What is stage 2 hypertension? |
|
Definition
|
|
Term
| What is considered an exaggerated paradoxical pulse? |
|
Definition
| >10 mHg difference in systolic pressures between inhalation ans exhalation |
|
|
Term
| What can cause an exaggerated paradoxical pulse? |
|
Definition
| cardiac tamponade, pericarditis, emphysema |
|
|
Term
| How is postural hypertension defined? |
|
Definition
| Drop in systolic (>15mmHg) and diastolic pressures when the patients stands after being supine |
|
|
Term
| What can cause portal hypertension? |
|
Definition
| blood loss, drugs, ANS disease |
|
|
Term
| What can undermine the accuracy of blood pressure readings? |
|
Definition
| cardiac dysrhythmias, aortic regurgitation, venous congestion, valve replacement |
|
|
Term
| What is the expected value for jugular venous pressure? |
|
Definition
| 9 cm H2O (divide by 1.3 for mmHg |
|
|
Term
| What is the quality and character of a jugular vs carotid pulse? |
|
Definition
| 3 undulating waves / one brisk wave |
|
|
Term
| What is the effect of respiration of a jugular vs carotid pulse? |
|
Definition
| decreased on inspiration and increased on expiration/ no effect |
|
|
Term
| What is the effect of venous compression on a jugular vs carotid pulse? |
|
Definition
| easily eliminates pulse wave/ no effect |
|
|
Term
| What is effect of abdominal pressure on a jugular vs carotid pulse? |
|
Definition
| increased prominence/ no effect |
|
|
Term
| What can the hepatojugular reflex measure? |
|
Definition
| right-sided heart failure is suspected when JVP elevates after the hepatojugular reflex is tested |
|
|
Term
| How do you perform the hepatojugular reflex? |
|
Definition
| While measuring JVP, apply firm sustained pressure over the midepigastric region |
|
|
Term
| What measurement taken in the hands is equivalent to mean JVP? |
|
Definition
| elevate hand, measure from midaxillary line at nipple to the level of collapsed hand veins |
|
|
Term
| What are the signs of acute venous obstruction? |
|
Definition
| constant pain with swelling & tenderness, enorgement of superficial veins, erythema & cyanosis |
|
|
Term
|
Definition
| Flex patient's knee and dorsiflex foot. Calf pain may indicate venous thrombosis |
|
|
Term
| Edema with skin thickening and ulceration indicates: |
|
Definition
|
|
Term
| Unilateral edema indicates: |
|
Definition
| occlusion of a major vein |
|
|
Term
| Bilateral pitting edema indicates |
|
Definition
|
|
Term
| Nonpitting edema indicates |
|
Definition
| arterial insufficiency or lymphedema |
|
|
Term
|
Definition
| slight pitting that disappears rapidly, can be felt not seen |
|
|
Term
|
Definition
| deeper pit that disappears in 10-15 sec |
|
|
Term
|
Definition
| deep pit that lasts 1 min+, the tested extremity appears swollen |
|
|
Term
|
Definition
| very deep pit that lasts 2-5 min, tested extremity is grossly distorted |
|
|
Term
| How can the presence of varicose veins in the leg be tested? |
|
Definition
| Have patient stand on their toes 10 times in succession to build leg pressure. Pressure disappears in competent veins and persists in incompetent veins. |
|
|
Term
| How can the presence of collateral veins be tested? |
|
Definition
| Compress the vein with one hand and strip it of blood moving towards the heart with the other hand. If stripped veins fills, there are collaterals. |
|
|
Term
| How can the competency of venous valves be tested? |
|
Definition
| Compress the vein with one hand and strip it of blood moving towards the heart with the other hand, then release cephalad hand. If the entire column fills, the valves are incompetent. |
|
|
Term
| What should also be tested with blood pressure in the infant? |
|
Definition
|
|
Term
| What does a bounding infant pulse indicate? |
|
Definition
|
|
Term
| What type of specialized sphygmomanometer can be used for infants and children? |
|
Definition
| one that includes Doppler or other oscillometric technique |
|
|
Term
| What is usual newborn blood pressure? |
|
Definition
|
|
Term
| What can capillary refill time > 2sec in an infant or your child indicate? |
|
Definition
| dehydration or hypovolemic shock |
|
|
Term
| What can newborn hypertension indicate? |
|
Definition
| thromosis from umbilical catheter, stenosis, kidney disease, neuroblastoma, Wilms tumor, hydronephrosis, adrenal hyperplasia, or CNS disease |
|
|
Term
| Which phase of the Korotkoff sound is the appropriate measurement for diastole for ages 3-adolescence? |
|
Definition
| Phase 4, after which use phase 5 |
|
|
Term
| In children, radial artery BP will read ____ less that brachial artery BP? |
|
Definition
|
|
Term
| 50% of the time, hypertension in adolescents is ___. |
|
Definition
|
|
Term
| Hypertension in children younger that 10 is ______. |
|
Definition
| secondary due to kidney disease, renal artery disease, coarctation of the aorta, or pheochromocytoma |
|
|
Term
| Hypotension in pregnant women peaks at ____. |
|
Definition
|
|
Term
| What is considered elevated blood pressure in a 2nd trimester pregnant woman? |
|
Definition
|
|
Term
| What is considered elevated blood pressure in a 3rd trimester pregnant woman? |
|
Definition
|
|
Term
| During pregnancy, a rise in ____ above the 1st trimester baseline should be monitored, and sustained pressure of _____ indicates a BP disorder. |
|
Definition
| 30/ 15 mmHg, >140/ 90 mmHg or |
|
|
Term
| Hypertension in older adults is defined as: |
|
Definition
|
|
Term
| What is temporal aka giant cell arteritis? |
|
Definition
| inflammatory disease of he branches of the aortic arch including temporal arteries |
|
|
Term
| How is an arterial aneurism defined? |
|
Definition
| 1.5x the diameter of the normal artery |
|
|
Term
| What is peripheral artery disease? |
|
Definition
| stenosis of the extremities caused by atherosclerotic plaques |
|
|
Term
| What is Raynaud's Disease? |
|
Definition
| Exaggerated spasm of the digital arterioles and sometimes nose and ears due to cold exposure. |
|
|
Term
| What is arterial embolic disease? |
|
Definition
| atrial fibrillation that leads to clot formation within the atrium, may lead to dispersed emboli |
|
|
Term
| What causes venous thrombosis? |
|
Definition
| Trauma or prolonged immobilization |
|
|
Term
| What can hypertension cause? |
|
Definition
| stroke, renal failure, congestive heart failure |
|
|
Term
| How does constrictive pericarditis arise? |
|
Definition
| chronic inflammation and subsequent scarring of the pericardium |
|
|
Term
| Where is coarctation of the aorta most commonly seen? |
|
Definition
| stenosis is seen in descending aortic arch near the origin of the left subclavian artery and ligamentum arteriosum |
|
|
Term
| What is Kawasaki disease? |
|
Definition
| acute vasculitis unknown ETO affecting the young, may be due to cardiac involvement leading to aneurisms of coronary artery |
|
|
Term
|
Definition
| hypertesion that occurs after the 20th week of pregnancy with proteinuria |
|
|
Term
|
Definition
| preeclampsia with seizures when no other cause for seizures can be found |
|
|
Term
| What causes venous ulcers? |
|
Definition
| Chronic venous insufficiency in which lack of venous flow leads to lower extremity venous hypertension |
|
|
Term
| What is the only useful information for ruling in DVT? |
|
Definition
| malignancy, previous DVT, recent immobilization, difference in calf diameter, and recent surgury |
|
|
Term
| What is useful information for ruling out DVT? |
|
Definition
| absence of calf swelling or diameter difference |
|
|
Term
| What is the pathophysiology of temporal arteritis? |
|
Definition
| unknown ETO, inflammatory infiltrates develop of thoracic aorta, arterial intimal thickening can affect structures in the head. |
|
|
Term
| What are the subjective findings of temporal arteritis? |
|
Definition
| age 50+, flu-like, headache esp temporal region, occular symptoms, ischemia of jaw and tongue |
|
|
Term
| What are the objective findings of temporal arteritis aka giant cell arteritis? |
|
Definition
| Area over temporal area red, swollen, tender, nodular. Temporal pulse varies. |
|
|
Term
| What is the pathophysiology of arterial aneurism? |
|
Definition
| result of atherosclerosis + tobacco and hypertension, 4x more common in men |
|
|
Term
| What are the subjective findings of arterial aneurism? |
|
Definition
| asymptomatic until dissection causes ripping pain |
|
|
Term
| What are the objective findings of arterial aneurism? |
|
Definition
| pulsatile swelling, thrill or bruit may be present over aneurism |
|
|
Term
| What is the pathophysiology of arteriovenous fistula? |
|
Definition
| congenital or caused by catheterization |
|
|
Term
| What are the subjective findings of arteriovenous fistula? |
|
Definition
| low extremity edema, varicose veins, claudication, high cardiac output |
|
|
Term
| What are the objective findings of arteriovenous fistula? |
|
Definition
| weak or absent pulses, foot or leg is painful at rest, cold and numb, and dry with poor hair growth. Ulceration, muscle atrophy, no edema. |
|
|
Term
| What is the pathophysiology of peripheral arterial disease? |
|
Definition
| peripheral atherosclerosis, diabetes, hypertension, dyslipidemia, tobacco use, vascular trauma, radiation, vasculitis |
|
|
Term
| What are the subjective findings of peripheral arterial disease? |
|
Definition
| predictable anount of exercise produces pain, ache, or cramp in exercised muscle |
|
|
Term
| What are the objective findings of peripheral arterial disease peripheral arterial disease? |
|
Definition
| severe ischemia, leg or foot is painful at rest, cold and numb, and skin is scaling with poor hair growth. Ulceration and muscle atrophy, no edema. |
|
|
Term
| What is the pathophysiology of Reynaud phenomenon? |
|
Definition
| primary: young, healthy women, unknown ETO. Secondary: CT disease such as sclerodoma or systemic lupus erythematosus |
|
|
Term
| What are the subjective findings of Reynaud phenomenon? |
|
Definition
| Involved areas feel cold and achy, which improves when warmed. Secondary Renaud: intense pain with digital ischemia and necrosis. |
|
|
Term
| What are the objective findings of Reynaud phenomenon? |
|
Definition
| Primary: red white and blue extremities, vasospasm lasts < 1 hr. Secondary: fingertip ulcers or skin over digits appears smooth, shiny, tight |
|
|
Term
| What is the pathophysiology of arterial embolic disease? |
|
Definition
| emboli caused by atherosclerotic plaques, infectious material from fungal and bacterial endocarditis, or atrial myxomas |
|
|
Term
| What are the subjective findings of arterial embolic disease? |
|
Definition
|
|
Term
| What are the objective findings of arterial embolic disease? |
|
Definition
| occlusion of small arteries and necrosis of their tissues. endocarditis leads to splinter hemmorhages in nail beds |
|
|
Term
| What is the pathophysiology of venous thrombosis? |
|
Definition
| prolonged immobilization, malignancy, birth control meds, trauma, or previous DVT |
|
|
Term
| What are the subjective findings of venous thrombosis? |
|
Definition
| tenderness along iliac vessels or femoral canal, popliteal space, or deep calf veins, pulmonary embolism may occur without warning, |
|
|
Term
| What are the objective findings of venous thrombosis? |
|
Definition
| difference in circumference of upper and lower legs, mininal ankle edema, high-grade fever, and tachycardia, Howman sign useful |
|
|
Term
| What is the pathophysiology of hypertension? |
|
Definition
| BP consistently at 140/ 90 mmHg or higher |
|
|
Term
| What are the subjective findings of hypertension? |
|
Definition
| Essential hypertension is asymptomatic, malignant hypertension has headache, visual symptoms, and encephalopathy |
|
|
Term
| What are the objective findings of hypertension? |
|
Definition
| In addition to BP, end organ damage, papilledema, or heart failure may be present |
|
|
Term
| What is the pathophysiology of tricuspid regurgitation? |
|
Definition
| due to conditions that lead to dilation of the right ventricle such as hypertension and pulmonary thrombosis, can also result from primary valvular disease |
|
|
Term
| What are the subjective findings of tricuspid regurgitation? |
|
Definition
| no symptoms if mild-medium, severe shows right-sides heart failure with ascites or peripheral edema |
|
|
Term
| What are the objective findings of tricuspid regurgitation? |
|
Definition
| v wave is early, prominent, and often merges with c wave, holocystolic murmur in tricuspid, pulsatile liver, peripheral edema |
|
|
Term
| What is the pathophysiology of atrial fibrillation? |
|
Definition
| heart disease leading to enlargement or elevated pressures |
|
|
Term
| What are the subjective findings of atrial fibrillation? |
|
Definition
| asymptomatic then palpations, lightheadedness, or dyspnea |
|
|
Term
| What are the objective findings of atrial fibrillation? |
|
Definition
| absent wave withan irregularly irregular pulse: 2 venous pulsations for each arterial pulsation, variable interval between v waves |
|
|
Term
| What is the pathophysiology of cardiac tamponade? |
|
Definition
| pericardial fluid from infection, malignancy, or autoimmune disease impairs cardiac ooutput |
|
|
Term
| What are the subjective findings of cardiac tamponade? |
|
Definition
| acute sudden onset chest pain and dyspnea or chronic heart failure symptoms |
|
|
Term
| What are the objective findings of cardiac tamponade? |
|
Definition
| Y-descent is abolished and JVP is elevated 15-25cm of H2O, JVP falls with inspiration, pulsus paradoxus (decrease in systolic >10mm Hg) |
|
|
Term
| What is the pathophysiology of constrictive pericarditis? |
|
Definition
| pericardial thickening and inelasticity, diminished cardiac filling and output |
|
|
Term
| What are the subjective findings of constrictive pericarditis? |
|
Definition
| progressive cardiac insufficiency such as worsening of lower extremity edema or dyspnea |
|
|
Term
| What are the objective findings of constrictive pericarditis? |
|
Definition
| Elevated JVP with prominent Y descent, peripheral edema and ascites due to right-sided heart failure |
|
|
Term
| What is the pathophysiology of coarctation of the aorta? |
|
Definition
| congenital defect of vascular wall or acquired inflammatory aortic disease or severe atherosclerosis |
|
|
Term
| What are the subjective findings of coarctation of the aorta? |
|
Definition
| asymptomatic unless severe hypertension or vascular insufficiency develops |
|
|
Term
| What are the objective findings of coarctation of the aorta? |
|
Definition
| differences in systolic BP when radial and femoral pulses are palpated simultaneously |
|
|
Term
| What is the pathophysiology of Kawasaki Disease? |
|
Definition
| ETO of vasculitis is unknown, immune-mediated blood vessel damage can result in both vascular stenosis and aneurism formation |
|
|
Term
| What are the subjective findings of Kawasaki Disease? |
|
Definition
| diffuse symptoms of varied duration, wieght loss, fatique, myalgias, or arthritis |
|
|
Term
| What are the objective findings of Kawasaki Disease? |
|
Definition
| Conjunctival injection, strawberry tongue, edema of hands and feet, lymphadenopathy and polymorphous nonvesicular rashes |
|
|
Term
| What is the pathophysiology of preeclampsia-eclampsia? |
|
Definition
| vascular and immunologic abnormalities within uteroplacental circulation |
|
|
Term
| What are the subjective findings of preeclampsia-eclampsia? |
|
Definition
| may be diagnosed without proteinuria if visual changes, headache, abdominal pain, and pulmonary edema are present |
|
|
Term
| What are the objective findings of preeclampsia-eclampsia? |
|
Definition
| sustained elevation of blood pressure > 160/ 110 mmHg |
|
|
Term
| What is the pathophysiology of venous ulcers? |
|
Definition
| incompetent valves, obstruction of blood flow, or loss of pumping effect of blood vessels |
|
|
Term
| What are the subjective findings of venous ulcers? |
|
Definition
| asymptomatic then leg heaviness and discomfort progressing to edema and ulceration |
|
|
Term
| What are the objective findings of venous ulcers? |
|
Definition
| ulcers on medial and lateral aspects of lower limbs, induration, edema, and hyperpigmentation |
|
|
Term
| How do you test CN V and VII? |
|
Definition
| Ask PT to clench teeth, squeeze eyes tightly shut, wrinkle forehead, smile, stick out tongue, puff out cheeks |
|
|
Term
|
Definition
| Test light touch sensation on forehead, cheeks, chin, and corneal reflexes |
|
|
Term
|
Definition
| Rosenbaum chart near vision screening and visual fields |
|
|
Term
| How do you test CN III, IV, and VI? |
|
Definition
| extra ocular eye movements |
|
|
Term
|
Definition
| Assess hearing with whisper or ticking watch |
|
|
Term
|
Definition
| Inspect tongue for symmetry and movement |
|
|
Term
| How do you test CN IX and X? |
|
Definition
|
|
Term
| How do you test CN VII and IX? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| What are Rinne and Weber tests used for? |
|
Definition
|
|
Term
| What is the Romberg test used for? |
|
Definition
|
|
Term
| What does an Apgar indicate? |
|
Definition
| information about the baby's pre, during, and post birth state |
|
|
Term
| What are physical signs unique to an infant aged 36 weeks or less? |
|
Definition
| <2 transverse creases on sole of foot, breast nodule is <3mm, no cartilage in ear helix, scrotum doesn't contain testis or have rugae |
|
|
Term
| Is apnea common in a premature infant? |
|
Definition
| yes, it may last for up to 20 sec |
|
|
Term
| What puts the infant at risk for diaphragmatic hernia? |
|
Definition
| If the mother has fever during or after delivery or herpetic lesions |
|
|
Term
| How do you assess CN IX, X, and XII in an infant? |
|
Definition
| Observe cry, tactile fremitus, facial symmetry, integrity or mouth, pharynx, and soft pallate. |
|
|
Term
| How do you assess CN XII in an infant? |
|
Definition
| Observe sucking and swallowing |
|
|
Term
| What does the Denver II test evaluate? |
|
Definition
| language, motor coordination, and social skills |
|
|
Term
|
Definition
| bathing, dressing, toileting, ambulation, feeding |
|
|
Term
| What are instrumental ADL's? |
|
Definition
| housekeeping, shopping, cooking, taking meds, communication, money management |
|
|
Term
| What is the traditional and essential component of critical thinking? |
|
Definition
|
|
Term
| What is CFM Saint's philosophy of medicine? |
|
Definition
| Many diagnoses can be made |
|
|
Term
| How is Occam's razor applied to medicine? |
|
Definition
| Plurality (of diagnoses) must not be posited without necesity. |
|
|
Term
|
Definition
| Diagnosis is based on probabilities |
|
|
Term
| What are prohibited abbreviations? |
|
Definition
| U, IU, QD, QOD or any variant, trailing zero (X.0), lack of leading zero, MS, MSO4, or MgSO4 |
|
|
Term
| What is the difference between pain and tenderness? |
|
Definition
| pain is a symptom and tenderness is a sign |
|
|
Term
|
Definition
| What you can see, hear, and touch |
|
|
Term
| What are the 6 components of POMR? |
|
Definition
| Comprehensive health history, phys exam, problem list, assessment and plan, needed lab and imaging tests, and progress notes |
|
|
Term
| What does the Assessment include? |
|
Definition
| Your interpretations and conclusions, their rationale, the diagnostic strategy, present and anticipated problems, and the needs of ongoing and future care. |
|
|
Term
| What does the Plan include? |
|
Definition
| diagnostics, therapeutics, and patient education |
|
|
Term
| What is included in an interval hisotry? |
|
Definition
| Subjective: status of problem, current medications and ROS, Objective: vitals, exam, results of tests since last visit, Assessment: diagnosis, Plan: 3 components |
|
|
Term
|
Definition
| Problems, allergies, and medications |
|
|
Term
| What is identifying information? |
|
Definition
| Name, DOB, and assigned history number |
|
|
Term
| What is general patient information? |
|
Definition
| Additional identifying information |
|
|
Term
| What mnemonic is used for HOPI? |
|
Definition
|
|
Term
| How many generations should a family history include? |
|
Definition
|
|
Term
| What obstetric information is taken for women? |
|
Definition
| Preterm pregnancies,Term Pregnancies Abortions/ Miscarriages, Living Children |
|
|
Term
| What is included in the general statement of the physical exam? |
|
Definition
| age, race, gender, general appearance, weight, height, BMI, and vitals |
|
|
