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