Health Assessment Exam 2 (Ch 17, 18, 19, 20, 22, 23)
Tear of Rotator Cuff
"hunched" position and limited abduction of arm
(AV) Atrioventricular valves
(R) tricuspid valve (L) mitral valve opens during diastole (filling stage)
superficial reflex
(corneal reflex, abdominal reflex)
deep tendon reflex
(myotatic) patellar or knee jerk
Common symptoms of stroke include sudden:
-weakness or numbness in the face, arms, or legs, especially on one side of the body -confusion, trouble speaking -changes in vision such as blurry vision -trouble walking -severe headache
Absent pulse
0
Testing Stretch reflexes or DTR
0-2+ is normal 3+ brisker than average- probably normal 4+ very brisk- indicative of disease
Weak pulse
1+ (usually occurs with PAD patients or people with shock)
Men @ age 70 or younger need how much calcium daily?
1,000 mg
Men @ age 71 or older need how much calcium daily?
1,200 mg
What are the four major functions of the respiratory system?
1. Supplying oxygen to the body for energy production 2. Removing CO2 as a waste product of energy reactions 3.Maintaining homeostasis (acid-base balance) 4. Maintaining heat exchange (less important in humans)
Glasgow Coma Scale
15 fully alert 7 or less reflects coma
Normal jugular venous pulsation
2 cm or less
Normal pulse
2+
When should women have a clinical breast examination (CBE) ?
20-39 years of age, every 3 years Women after age 40 should get an annual CBE
Abnormal jugular venous pulsation
3 cm or greater means heart failure, cardiac tamponade, and constrictive pericarditis
Increase, full bounding pulse
3+ (usually occurs with anxiety, anemia, hyperthyroidism)
What is the normal time for full expiration?
4 seconds or less
What is the normal amount of blood pumped throughout the body?
4-6 L of blood per minute
Moderate obstruction of airflow is a FEV1/FVC ratio of...
50%-60%
Where is the apical impulse located?
5th intercostal space
Mild obstruction of airflow is a FEV1/FVC ratio of...
60% to 70%
A normal FEV1/FVC ratio of...
75% or greater means there is no significant obstruction of airflow present
Scoliosis
A lateral S shaped curvature of the thoracic and lumbar spine usually with involved vertebrae rotation Note: unequal shoulder, scapular height, unequal hip levels, rib interspaces flared on convex side
The peripheral nerves carry input to the CNS via..
Afferent fibers
Among all racial group, which has the highest prevalence of hypertension?
African Americans
Do White women or African-American women have a higher incidence of breast cancer before age 45?
African-American
Venous Ulcer (elephant skin)
After acute DVT or chronic incompetent valves in deep veins- UNEVEN edges & bleeding occurs
What causes the breast grandular tissue to atrophy?
After menopause ovarian secretion of estrogen and progesterone decreases-- causing boob to sag
At what age does loss of bone matrix occur?
Age 40
At what age does respiratory muscle strength decline?
Age 50 The aging lung is a more rigid structure that is harder to inflate
What relieves senile tremors?
Alcohol -- not recommended treatment
Nipple Dimpling
Also called skin tether. Cancer causes fibrosis, which contracts the suspensory ligaments
Kyphosis
An exaggerated posterior curvature of the thoracic and lumbar spine, usually with involved
Hypoventilation
An irregular shallow pattern caused by an overdose of narcotics or anesthetics
Where should one auscultate the lungs?
Apices at C7 to the bases (around T10) and laterally from the axilla down to the 7th or 8th rib
Hemiparesis
Arm is immobile against the body , with flexion of the shoulder, elbow, wrist, and fingers and adduction of shoulder; does not swing freely leg is stiff an extended cause: stroke, trauma
Midsystolic click
Associated with mitral valve prolapse
Fixation
Asymmetry, distortion, or decreased mobility with the elevated arm maneuver. As cancer becomes more invasive, the fibrosis fixes the breast to the underlying pectoral muscles
Why does unequal expansion occur?
Atelectasis, lobar pneumonia, pleural effusion, thoracic trauma such as broken ribs
Pathologic (abnormal) reflex
Babinski reflex
What causes yellow or green mucoid?
Bacterial infection (requires antibiotic)
Gynecomastia (in older adult)
Benign enlargement of male breast that occurs when estrogen concentration exceeds testosterone levels
Fibroadenoma
Benign tumors; most commonly present as self-detected in late adolescence. Solitary nontender, solid, firm, rubbery and elastic. Usually no axillary lymphadenopathy
What adventitious sound do you hear with Asthma?
Bilateral wheezing
What is pneumoconiosis and who is at risk?
Black lung & coal miners.
Carcinoma
Bloody discharge that is unilateral and from a single duct requires further investigation
Heberden and Bouchard nodules (happens w/ Osteoarthritis)
Bouchards (proximal) Heberden (distal)
What is the best way to detect a person's risk for breast cancer?
By asking the right history questions
How would you test Cranial nerves III, IV, and VI (Oculomotor, Trochlear, and Abducens) ?
Check pupils for size, symmetry, regularity and reaction to light
How would you test Cranial nerve II (Optic) ?
Confrontation
Where does the right lower lobe extend?
Continues from 5th rib to the 8th rib in the midaxillary line
What adventitious sound do you hear with Heart Failure?
Crackles at the lung bases
What adventitious sound do you hear with Pleural Effusion?
Crackles, pleural rub
Hypoxemia
Decrease of oxygen in the blood
The peripheral nerves carry output from the CNS via...
Efferent fibers
F.A.S.T.
Face drooping Arm weakness Speech difficulty Time to call 9-1-1
The Mitral valve area can be found...
Fifth intercostal space
Where does the right middle lobe extend?
From the horizontal fissure down and forward to the 6th rib at the midclavicular line
Balance test
Gait-- have person walk 10-12 feet turn and return to starting spot-- gait should be smooth rhythmic and effortless
What histologic changes increase the older person's risk for postoperative pulmonary complications?
Gradual loss of intra-alveolar septa and a decreased number of alveoli
Tophi with chronic gout
Hard painless nodule (tophi) over metatarsophalangeal joint of first toe-- tophi are collections of sodium urate crystals caused by chronic gout in and around the joint
Systole
Heart contracts Blood is pumped from the ventricles and fills the pulmonary and systemic arteries
Bronchial (tracheal)
High Pitched, loud, greater on expiration, harsh hollow Location: Trachea and larynx
Hyperventilation
Increase in both rate and depth-- happens with anxiety, fear, and extreme exertion
Hypercapnia
Increase of CO2 in the blood
Genu valgum
Knock-knees
Abducens (Cranial nerve VI)
Lateral eye movement
Vesicular
Low pitch, soft sound, inspiration is greater than expiration, rustling like the sound of the wind in the trees Location: Over peripheral
Edema (Peau d'Orange)
Lymphatic obstruction produces edema. This thickens the skin and exaggerates the hair follicles, giving a pigskin or orange-peel look. This condition suggests cancer
Bronchovesicular
Moderate pitch, moderate loudness, inspiration is equal to expiration, mixed Location: over major bronchi where few alveoli are located posterior
Trigeminal (Cranial nerve V)
Muscles of mastication (chewing)
What adventitious sound do you hear with Pneumothorax?
None.
What causes Crepitus?
Occurs in subcutaneous emphysema when air escapes from the lung and enters the subcutaneous tissue
Decreased Tactile Fremitus
Occurs when anything obstructs transmission of vibrations [an obstructed bronchus, pleural effusion or thickening, pneumothorax, and emphysema]
Increased Tactile Fremitus
Occurs with conditions that increase the density of lung tissue, thereby making a better conducting medium vibrations [ex: pneumonia]
Decreased fremitus
Occurs with obstructed bronchus, pleural effusion or thickening, pneumothorax, or emphysema
What type of patients do you see barreled chest?
Patients with emphysema
Apical Impulse
Point of maximum intensity (PMI)
Pleural Friction Fremitus
Produced when inflammation of the parietal or visceral pleura causes a decrease in the normal lubricating fluid- cause course grating sound when breathing
What carries venous blood to the lungs?
Pulmonary artery
What causes pink, frothy mucoid?
Pulmonary edema, some sympathomimetic medications have a side effect of pink-tinged mucus
What returns the freshly oxygenated blood back to the heart?
Pulmonary veins
Crackles
Rales- discontinuous
Normal Adult
Rate: 10-20 breaths/min Depth: 500-500 mL Pattern: even Ratio of Respiration: 4:1
What is a healthy sound from the lung tissue?
Resonance
What is the result of supplying oxygen to the blood and removing CO2?
Respiration maintains the pH or the acid-base balance of the blood
Cheyne-Stokes Respiration
Respirations gradually wax and wane in a regular pattern, increasing in rate and depth -- happens in infants and aging people while they sleep
Barrel Chest
Ribs are horizontal instead of the normal downward slope. This is associated with normal aging and also with chronic emphysema and asthma as a result of hyperinflation of lungs
ventricular gallop
S3-- persists when sitting up
atrial gallop
S4--occurs with decreased compliance of the ventricles
dyspnea
SOB
Cancer
Solitary, unilateral, nontender mass. Solid, hard, dense, and fixed to underlying tissues or skin as cancer becomes invasive. Signs are skin dimpling, nipple retraction, and discharge
Signs and Symptoms of Lung Cancer
Subjective: Fatigue, nausea, and vomiting, change in taste perception, dull localized chest pain Inspection: Weight loss, clubbing, hoarseness, anemia
Signs and Symptoms of Pulmonary Embolism:
Subjective: chest pain, worse on deep inspiration, dyspnea Inspection: Apprehensive, restless, anxious, cyanosis, hemoptysis, diaphoresis, tachycardia
Signs and Symptoms of Acute Respiratory Distress Syndrome (ARDS)
Subjective: dyspnea, apprehension Inspection: Disorientation, rapid shallow breathing, productive cough, frothy sputum
Swan Neck or boutonneire deformity
Swan Neck- DIP Boutonneire- PIP
What should the general appearance of a normal breast look like?
Symmetry of size and shape. It is common to have a slight asymmetry in size; often the left breast is slightly larger than the right
What causes rust colored sputum?
TB, pneumococcal pneumonia
Posterior (dorsal) Column Tract test with vibration
Test the person's ability to feel vibrations with the metal thing they use in the training room if you think you broke bone (called a tuning fork)
Where does the right upper lobe extend from?
The apex of the axilla down to the horizontal fissure at the 5th rib
What causes the thorax to be less mobile?
The costal cartilages become calcified-- can't expand fully
Intraductal Papilloma
These are discrete benign tumors that arise in a single or multiple papillary duct. May have serous or serosanguineous discharge
S3 (third heart sound)
This occurs when the ventricles are resistant to filling during the early rapid filling phase. Occurs immediately after S2, when the AV valves open and atrial blood first pours into the ventricles
What does a hyperactive reflex with sustained clonus mean?
UMN (upper motor neuron) disease
What is coccidiodomycosis and who is at risk for it?
Valley fever- have flu-like symptoms. Those in Southwest and Mexico.
What is the best way to detect a breast mass?
Vertical strip pattern, start high by axilla and palpate down
Rhonchal Fremitus
Vibration felt when inhaled air passes through thick secretions in the larger bronchi. This may decrease somewhat by coughing
Shingles showing on dermatome...
Viruses that infect spinal nerves, such as herpes zoster infections (shingles), can reveal their origin by showing up as a painful dermatomic area. Herpes zoster, a virus that can be dormant in the dorsal root ganglion, migrates along the spinal nerve to affect only the area of skin served by that nerve.
What adventitious sound do you hear with Emphysema?
Wheezing
Varicosities
When veins become abnormally thick, full of twists and turns, or enlarged, they are called varicose vein. This happens most commonly in the veins in the legs and thighs
Do White women or African-American women have a higher incidence of breast cancer starting at 45 years of age?
White Women
Intention Tremor
Worse with voluntary movement occurs with cerebellar disease or multiple sclerosis
DVT
a deep vein is occluded by a thrombus, causing inflammation, blocked venous return, cyanosis, and edema S: intense sharp muscle pain O: warmth, swollen, redness, dependent cyanosis, *If not treated- can cause PE
What causes unilateral distention of the external jugular veins?
a local cause (kinking or aneurysm)
Where do the great vessels lie on the heart?
above the base
Raynaud Phenomenon
abrupt, progressive tricolor change of the fingers in response to cold, vibration, or stress -could be white, blue, rubor
active and passive ROM
active- person is able to do their own movement passive- person's muscle is relaxed while you move the body part
Cough continuous throughout the day
acute illness (Respiratory infection)
Peripheral Artery Disease (PAD)
affects noncoronary arteries and usually refers to arteries supplying the limbs-- usually caused by atherosclerosis (in strokes and MI)
Diastolic BP decreases with...
age
(SL) Semilunar valves
are set between the ventricles and the arteries-- open during systole
Elevational pallor suggests
arterial insufficiency
How would you test Cranial nerve XI (Spinal Accessory) ?
ask person to shrug shoulders or to put hand on face and ask to move head against hand
What is an adventitious sound that is NONPATHOLOGIC?
atelectatic crackles: short, popping, crackling sounds that last only a few hours
Bruit
auscultated for @ carotid artery-- if present, it indicates turbulence from a local vascular cause and is a marker for atherosclerotic disease
What type of cough does Croup cause?
barking
flexion
bending a limb at a joint
DXA
bone density exam
Genu varum
bowlegs
Galactorrhea
breast discharge not related to normal breast feeding milk-- bloody or blood-tinged discharge always is significant
Mastalgia
breast pain that occurs with trauma, inflammation, infection, and benign breast disease
Reasons for decreased breath sounds
bronchial tree is obstructed by mucus/secretions/foreign body, emphysema, pleurisy or pleural thickening
Arterial Ulcer
build up of fatty plaques on intima (atherosclerosis) occurs at the toes, metatarsal heads, feels, ankle- WELL DEFINED edges with no bleeding
Edema is independent when...
caused by heart failure
What causes decreased height?
caused by shortening of the vertebral column, which is caused by a loss of water content and thinning of the intervertebral disks and by a decrease in the height of individual vertebrae from osteoporosis
Cough early morning
chronic bronchial inflammation from smoking
Chronic Venous Symptoms v. Acute Venous Symptoms
chronic: gets ulcers, chronic pain, gets worse by the day goes on acute: red swollen leg- sudden onset (1 hr)
People with peripheral artery disease (PAD) have pain doing what?
claudication (walking)
What causes white or clear mucoid?
colds, bronchitis, viral infection
Atelectasis
collapsing of the lung
Paroxysmal dyspnea
comes and goes
recumbent dyspnea
comes when lying down flat
dislocation
complete loss of contact between the two bones in a joint
What type of cough do colds, bronchitis, and pneumonia cause?
congested
Constant or intermittent dyspnea
constant
Rigidity
constant state of resistance resists to passive movement in any direction occurs in injury to extrapyramidal motor tracts (basal ganglia in parkinsonism)
Where does the left lower lobe extend?
continues down to the 8th rib in the midaxillary line
Hemoptysis
coughing up blood
Flaccidity
decreased muscle tone or hypotonia, feels limp and soft occurs with lower motor neuron injury
How would you test Cranial nerve IX and X (Glossopharyngeal and Vagus) ?
depress with a tongue blade and note pharyngeal movement as the person says "ahhh" or yawns
Orthopnea
difficulty breathing when supine it is important to state # of pillows needed to achieve comfort for patient
Trochlear (Cranial nerve IV)
down and inward movement of the eye
What type of cough does early heart failure cause?
dry
What are common sites of inflammation?
epicondyles, head of the radius, and tendons
seizures occur with...
epilepsy, a paroxysmal disease characterized by altered or loss of consciousness, involuntary muscle movements
Diaphoresis
excessive sweating
Cough during the afternoon/evening
exposed to irritants at work
Polydactyly
extra digits are a congenital deformity, usually next to pinkie or thumb
Facial (Cranial nerve VII)
facial muscles, close eye, labial speech, mucous membranes of mouth and nose
Micturition Syncope
fainting during urination
What is the best prevention for osteoporosis?
fast walking
What are some prophylactic actions you can take for osteoporosis?
fast walking, Vitamin D, and Calcium
How should nulliparous women's breast feel like?
feels firm, smooth, and elastic
Ascitis
fluid in peritoneal cavity
Lymphedema
for breast cancer patients-- arm will swell (unilateral)
Atelectatic crackles
found in agings adults that are bed ridden persons or in persons just aroused from sleep
Where does the left upper lobe extend?
from the apex of the axilla down to the 5th rib at the midaxillary line
What type of cough does mycoplasma pneumonia cause?
hacking
How would you test Cranial nerve VII (Facial) ?
have patient smile and look for abnormalities
Acoustic (Cranial nerve VIII)
hearing and equilibrium
What does cyanosis signal?
hypoxia
A positive Lasegue test...
if it reproduces sciatic pain
How do people with COPD often sit?
in a tripod position
What is the normal capillary refill time?
in less than 1 or 2 seconds
Absence of rhythmic reciprocal gait occurs
in people with Parkinsons
When is rheumatoid arthritis the worse?
in the morning when arising
Spasticity
increased tone or hypertonia, increased passive lengthening; then may suddenly give way occurs with upper motor neuron injury
Innocent murmur
indicates no valvular or pathologic causes
How would you test Cranial nerve XII (Hypoglossal) ?
inspect tongue-- note forward thrust have them say "light tight dynamite" should be clear and distinct
Parkinsons
involuntary shaking, trembling
Nerve
is a bundle of fibers outside the CNS
Rheumatoid Arthritis
is a chronic autoimmune disease with inflammation of synovial tissues and hyperplasia or swelling
What is carotid sinus hypersensitivity & with what population does this occur?
is a condition in which pressure over the carotid sinus leads to decreased HR, decreased BP. Occurs in older adults with hypertension or occlusion
Ischemia
is a deficient supply of oxygenated arterial blood to a tissue caused by obstruction of a blood vessel
Tandem walking
is a gait (method of walking or running) where the toes of the back foot touch the heel of the front foot at each step.
Hyperresonance
is a lower-pitched, booming sound found when too much air is present such as in emphysema
Ballottement
is a medical sign which indicates increased fluid in the suprapatellar pouch over the patella at the knee joint. To test ballottement the examiner would apply downward pressure towards the foot with one hand, while pushing the patella backwards against the femur with one finger of the opposite hand.
Thrill
is a palpable vibration-- feels like a purring cat-- indicates turbulent blood flow
Paresis
is a partial or incomplete paralysis
Aura
is a subjective sensation that precedes a seizure; it could be auditory, visual, or motor migraine
Syncope
is a sudden loss of strength, a temporary loss of consciousness (faint) caused by lack of cerebral blood flow (Low BP)
Lasegue Test or Straight Leg Test
is a test done during the physical examination to determine whether a patient with low back pain has an underlying herniated disk, often located at L5 (fifth lumbar spinal nerve).
What is histoplasmosis and who is at risk?
is a type of lung infection. It is caused by inhaling Histoplasma capsulatum fungal spores. People who live in rural Midwest.
Tinel Sign
is a way to detect irritated nerves. It is performed by lightly tapping (percussing) over the nerve to elicit a sensation of tingling or "pins and needles" in the distribution of the nerve.
Parethesia
is an abnormal sensation ex: burning, tingling
crepitation
is an audible and palpable crunching or grating that accompanies movement- occurs when articular surfaces in the joints are roughened as with RA
egophony
is an increased resonance of voice sounds heard when auscultating the lungs, often caused by lung consolidation and fibrosis. It is due to enhanced transmission of high-frequency sound across fluid, such as in abnormal lung tissue, with lower frequencies filtered out.
Stroke
is an interruption of blood supply to the brain and is fourth most common cause of death in America
Paroxysmal nocturnal dyspnea
is awakening from sleep with SOB and needing to be upright to achieve comfort
Functional murmur
is caused by increased blood flow in the heart (anemia, fever, pregnancy)
crepitus
is coarse, crackling sensation palpable over the skin surface
Paralysis
is complete loss of motor function caused by lesion in the neurologic or muscular system or loss of sensory innervation
Dysarthria
is difficulty forming words
Dysphagia
is difficulty with language comprehension
Structural Scoliosis
is fixed; the curvature shows both on standing and on bending forward. Note hip hump woth forward flexion -- common in young girls (age 10)
Functional Scoliosis
is flexible; it is apparent with standing and disappears with forward bending. It may be compensatory for other abnormalities such as leg length discrepancy
Popliteal artery
is located behind the knee
Carotid artery
is located in the groove between the trachea and the sternomastoid muscle, medial to and alongside that muscle
Dorsalis Pedis
is located on the dorsum of the foot
Femoral artery
is located under the inguinal ligament
Pleural fremitus
is palpable with inflammation of the pleura
Rhonchal fremitus
is palpable with thick bronchial secretions
Vertigo
is rotational spinning caused by neurologic disease in the vestibular apparatus in the ear or the vestibular nuclei in the brainstem
Claudication distance
is the # of blocks walked or stairs climbed to produce pain
Graphesthesia
is the ability to "read" a # that is being traced on skin
bronchophony
is the abnormal transmission of sounds from the lungs or bronchi. Bronchophony is a type of pectoriloquy. It is a general medical sign detected by auscultation.
Astereognosis
is the inability to identity objects correctly-- occurs in sensory cortex lesions (stroke)
Myocardium
is the muscular wall of the heart; it does the pumping
Afterload
is the opposing pressure the ventricle must generate to open the aortic valve against the higher aortic pressure
Endocardium
is the thin layer of endothelial tissue that lines the inner surface of the heart chambers
forced vital capacity (FVC)
is the total volume of air exhaled
Preload
is the venous return that builds during diastole q
forced expiratory volume in 1 sec (FEV1)
is the volume exhaled in the first measured second
What is the 6 minute walk test used for?
is used as an outcome measure for people in pulmonary rehab because it mirrors conditions that are lived in daily life >300 meters in 6min is more likely to engage in activities of daily living
McMurray Test
is used to evaluate individuals for tears in the meniscus of the knee. It is a rotation test for demonstrating torn cartilage of the knee. A tear in the meniscus may cause a pedunculated tag of the meniscus which may become jammed between the joint surfaces. To perform the test, the knee is held by one hand, which is placed along the joint line, and flexed to complete flexion while the foot is held by the sole of the foot with the other hand. The examiner then places one hand on the medial side of the knee to pull the knee towards varus position, pulling the knee laterally (bow legged). The other hand rotates the leg internally while extending the knee.If pain or a "click" is felt, this constitutes a "positive McMurray test" for a tear in the lateral meniscus.
Modified Allen test
is used to evaluate the adequacy of collateral circulation before cannulating the radial artery--- a normal color of the hand should return in 2 to 5 seconds
myalgia
is usually felt as cramping or aching
Gouty Arthritis
joint effusion or synovial thickening--- seen first as bulge or fullness in grooves on either side of olecranon process. Redness and heat in area , soft boggy, or fluctuant fullness to palpation
In women, what causes an accelerated bone loss?
lack of estrogen in women 5 years after menopause
Olecranon Bursitis
large soft knob and redness from inflammation of olecranon bursa
The Tricuspid valve area can be found...
left lower sternal border
Hemorrhagic stroke
less common-- occurs when a blood vessel in the brain ruptures and causes bleeding
How long does an acute cough last?
less than 2-3 weeks
Severe obstruction of airflow is FEV1/FVC ratio of...
less than 50%
Peripheral Neuropathy
loss of sensation involves all modalities- loss in hands or feet causes: diabetes, chronic alcoholism, nutritional deficiency
Gynecomastia
man boobs- common in adolescence. it is temporary
Oculomotor (Cranial nerve III)
most EOM movement, and opening of the eyelids, pupil constriction, lens shape
Glossopharyngeal (Cranial nerve IX)
motor- pharynx (pronation and swallowing), taste, gag reflex
What helps rheumatoid arthritis?
movement decreases pain
Hypoglossal (Cranial nerve XII)
movement of the tongue
Spinal Accessory (Cranial nerve XI)
movement of trapezius and sternomastoid muscles
abduction
moving a limb away from the midline of the body
adduction
moving a limb toward the midline of the body
circumduction
moving the arm in a circle around the shoulder
inversion
moving the sole of the foot inward at the ankle
eversion
moving the sole of the foot outward at the ankle
atrophy
muscle wasting
Clonus
muscular spasm involving repeated, often rhythmic, contractions.
Osteoporosis (degenerative joint disease)
noninflammatory, localized, progressive disorder involving the deterioration of articular cartilages @ age 60 some changes OA occur usually
Where is Lordosis common?
obese people
Sigh
occasional sighs punctuate the normal breathing pattern and are purposeful to expand alveoli. frequent sighs may indicate emotional and also may lead to hyperventilation and dizziness.
Sinus arrythmia
occurs normally in young adults-- the rhythm varies with the person's breathing, increasing at the peak of inspiration
Ischemic stroke
occurs when a blood clot blocks a blood vessel in the brain
Rest tremor
occurs when muscles are quiet and supported against gravity (hand in lap)- disappears with voluntary movement ex: pill rolling tremor with Parkinsons
fourth heart sound
occurs when the atria contract late in diastole - heard immediately after S1
S1 (first heart sound)
occurs with closure of the AV valves and thus signals the beginning of systole loudest at the apex
S2 (second heart sound)
occurs with closure of the semilunar valves and signals the end of systole loudest at the base
Increased fremitus
occurs with compression or consolidation of lung tissue (lobar pneumonia)
paroxysmal nocturnal dyspnea (PND)
occurs with heart failure -- person will wake up every 2 hours with the perception to get fresh air
What causes Gynecomastia?
occurs with use of anabolic steroids, some medications, cirrhosis
Bulge sign
occurs with very small amounts of effusion, 4 to 8 mL, from fluid flowing across the joint
What medications cause nipple discharge?
oral contraceptives, phenothiazines, diuretics, digitalis, steroids, methyldopa, calcium channel blockers
How long does a chronic cough last?
over 2 months
How would you test Cranial nerve V (Trigeminal) ?
palpating the temporal and masseter muscles as the person clenches teeth
Quadriplegia
paralysis in all four extremities
What people are more likely to get PAD?
people with years of smoking or people with diabetes
Loss of Vibration with tuning fork occurs with...
peripheral neuropathy (diabetes and alcoholism)
Normal and abnormal response to a plantar reflex
plantar flexion of the toes and inversion and flexion of the forefoot (A) fanning of the toes in adults is abnormal-- normal in infants (B)
What diseases can cause atrophy?
polio and diabetic neuropathy
Cough during night
postnasal drip; sinusitis
Parkinsonian (Festinating)
posture is stooped; trunk is pitched forward; elbows hips and knees are flexed. steps are short and shuffling, difficulty changing direction
Phalen test
produces numbness and burning for people with carpal tunnel syndrome
Aging is accompanied by...
progressive decrease in cerebral blood flow and oxygen consumption
Thrill in the 2nd and 3rd LEFT interspaces means
pulmonic stenosis (narrowing=stenosis) and pulmonic hypertension
Visceral (organic) reflex
pupillary response to light and accommodation
Nystagmus
rapid involuntary movements of the eyes--occurs with disease of the vestibular system , cerebellum, or brainstem
Fasciculation
rapid, continous twitching of resting muscle or part of muscle without movement of limb fine: occurs with LMN disease coarse: occurs with cold exposure, or fatigue
Tachypnea
rapid, shallow breathing >24 per minute
whispered pectoriloquy
refers to an increased loudness of whispering noted during auscultation with a stethoscope on the lung fields on a patient's torso. Usually spoken sounds of a whispered volume by the patient would not be heard by the clinician auscultating a lung field with a stethoscope.
Joint pain 10-14 days after an untreated strep throat suggests...
rheumatic fever
When is the best time to perform BSE?
right after the menstrual period (day 4 to 7 of the cycle), when the breast are smallest and least congested
wheeze
ronchi- continuous musical sounds
Ganglion Cyst
round, cystic, nontender nodule overlying a tendon sheath or joint capsule, usually on dorsum of wrist
What does a functional assessment assess for?
screens the safety of independent living, the need for home health services, and quality of life
The Pulmonic valve area can be found...
second left intercostal space
The aortic valve area can be found...
second right intercostal space
Thrill in the 2nd and 3rd RIGHT interspaces means
severe aortic stenosis (narrowing= stenosis) and systemic hypertension
Pulmonary Embolism
sharp, stabbing pain in chest, back, shoulder, or upper abdomen- can experience hemoptysis, dyspnea
contracture
shortening of a muscle leading to limited ROM of joint will happen to patients who are bedridden- ex stoke patient
A dull note
signals abnormal density in the lungs, as with pneumonia, pleural effusion, atelectasis, or tumor
What causes full distended external jugular veins above 45 degrees?
signifies increased CVP as with heart failure
Biot Respiration
similar to Cheyne-Stokes but the pattern is irregular
What is the pace maker of the heart?
sinoatrial node (SA) node
Bradypnea
slow breathing <10 per minute, as in drug-induced depression of the respiratory center in the medulla
Olfactory (Cranial nerve I)
smell
What are some factors that increase your risk of CVD?
smoking, high levels of serum cholesterol, obesity, Type 2 diabetes, & sex differences
Hemiplegia
spastic of flaccid paralysis of one side of the body and extremities
Arteriosclerosis
stiffening of the large arteries- occurs with aging- creates an increase in pulse wave velocity
ankylosis
stiffness or fixation of a joint
extension
straightening a limb at the joint
Chorea
sudden rapid jerky, purposeless movement involving face, drunk or limbs. occurs at irregular intervals common with Sydenham chorea and Huntington disease
Testing clonus
support leg in one hand with your other hand dorsiflexing the foot- no other movement should occur
Paraplegia
symmetric paralysis of both lower extremities
Vagus (Cranial nerve X)
talking and swallowing,
Stereognosis
test the person's ability to recognize objects by feeling their forms, sizes and weights with their eyes closed
hallux valgus
the distal part of the great toe is directed away from the body midline
Osteoporosis
the gradual loss of bone density
The higher the venous pressure means...
the higher the position you need
What side of the lungs pumps blood into the body?
the left side
Romberg test
the patient stands upright and asked to close his eyes. A loss of balance is interpreted as a positive Romberg sign.
What side of the lungs pumps blood into the lungs?
the right side
What brings unoxygenated blood to the right side of the heart?
the superior and inferior vena cava
Normal adult
the thorax has an elliptical shape with an anteroposterior to transverse diameter documented 1:2 or 0.70
Pericardium
the tough outer layer of the heart that surrounds and protects it
What does retraction signs mean?
there are fibrosis in the breast tissue, usually caused by growing neoplasms
Dysrhythmia
they increase with age-- ectopic beats are common in aging people
osteopenia
thinning of the bones
pronation
turning the forearm so the palm is down
supination
turning the forearm so the palm is up
subluxation
two bones stay in contact, but their alignment is off
Cogwheel rigidity
type of rigidity in which the increased tone if released by degrees during passive range of motion- feels like small, regular jerks occurs in parkinsonism
Ataxia
uncoordinated or unsteady gait
Diastole
ventricles relax and fills with blood
Optic (Cranial nerve II)
vision
Syndactyly
webbed fingers are a congenital deformity
Dermatomes
which forms the connective tissues, including the dermis
How would you test Cranial nerve VIII (Acoustic) ?
whispered voice test
When does pallor or cyanosis occur?
with MI or low cardiac output
When does brown discoloration occur?
with chronic venous stasis caused by hemosiderin deposits from RBC degradation
Where is Kyphosis common?
with old people
When is cardiac edema at its worse/best?
worse in the evening and better in the morning because the legs were elevated
