Phycishianship- Physical Dagnosis I
Terms in this set (67)
Describe a patient's general appearance in terms of:
○ Signs of distress
○ Level of consciousness
○ Weight, height and build
○ Skin color, lesions
○ Dress, grooming
○ Facial expression
○ Body/breath odors
○ Gait/posture/motor activity
Blood pressure average values
-stage 1 hypertension
-stage 2 hypertension
Normal: 90-119, 60-79
Prehypertension: 120-139, 80-89
Stage 1 hypertension: 140-159, 90-99
Stage 2 hypertension: greater than 160, grater than 100
If the systolic and diastolic fall in different categories, the overall blood pressure is in the higher of the two categories
Normal respiratory rate
10-14 breaths per minute
Average pulse rate
60-100 beats per minute
Grade of pulses on the peripheral examination:
It is customary to explain pulses as +1
Orthostatic blood pressure
Blood pressure immediately after standing from lying down
Period with no Korotkoff sounds
lower than normal breathing rate
faster than normal breathing rate
faster than normal heart beat
slower than normal heart beat
significant involuntary weight loss
>5% in 6 months, >10% in 12 months
percentage calculated by the following equation:
%wt change = [(usual wt-current wt)/usual wt]*100%
Describe weight loss using parameters of body weight: BMI calculation and the average values
BMI= weight (kg)/ height (meters) ^2
BMI=weight (pounds)/ height (inches)^ 2 x 703
→ Underweight less than 18.5
→ Healthy weight 18.5-25.0
→ Overweight 25.1-29.9
→ Obese over 30
Mechanisms through which weight loss can occur (3)
1. Biological: nutrition, exercise, illness
2. Psychological: depression, anxiety/stress, self consciousness
3. Social: sleep, school, support, pressures
37C or 98.6 F
Pros and Cons of BMI
Pros: easy to calculate, may be used for comparisons between men and women
Cons: doesn't measure body composition (Ie. muscle tone)
BMI and waist circumference
Waist circumference is more indicative of risk.
Increased waist circumference, indicates an increased risk because of excess abdominal fat. It is a hallmark of metabolic syndrome
Men: greater than 40 inches
Women: greater than 30 inches
what is a cause for blog pressure discrepancy measurements?
Auscultatory gap. The interval of blood pressure when korotkoff sounds indicating true systolic pressure fade away and then return at a lower pressure (this can lead to incorrectly estimating the systolic BP as too low and the diastolic BP as too high).
How do you calculate the point of maximal impulse (PMI)?
Stand to pt's right with pt seated. (if not palpable, have pt lie supine or in left lateral decubitus), can test for displacement (ie. cardiomegaly)
What is the anatomical location of the PMI?
5th intercostal space, midclavicular line
Explain the difference between passive and active range of motion
Active ROM is done when a person can do the exercises by himself.
Passive ROM exercises are done for a person by a helper.
Define drawer test and Recognize a positive anterior drawer sign
Tests for the integrity of the cruciate ligaments of the knee
With knee flexed at 90 degrees, if the tibia can be drawn too far forward, there is a rupture of the anterior cruciate ligaments
If the tibia is drawn too far back, there is a rupture of the posterior cruciate ligaments
What is collateral ligament integrity
Medial and lateral collateral ligament tests: with knee flexed about 25 degrees push lower leg laterally then medially against hand at knee
List sign of inflammation
Pain, Redness, Immobility, Swelling, Heat
flexion away from the zero position, extension is return to the position. Most joints.
movement in the direction of the dorsal surface (ankles, toes wrist, fingers)
movement to the midline (shoulder, hip, MCP, MTP), away from the midline.
turning the plantar surface of the foot inward (subtalar and midtarsal joints of the foot), turning the plantar surface of the foot outward, subtalar and midtarsal joints of the foot.
Internal rotation/ external rotation
turning of the anterior surface of a limb inward, turning of the anterior surface of a limb outward. shoulder, hip.
rotation so that the palmar surface of the hand is directed downward, rotation so that the palmar surface of the hand is directed upward.
swan neck deformity
shortening of the interosseous muscles, produces flexion of the MCP joints, hyperextension of the proximal interphalangeal joints, and flexion of the distal interphalangeal joints.
flexion deformity of the proximal interphalangeal joints with hyperextension of the proximal interphalangeal joints, and flexion of the distal interphalangeal joints.
progressive enlargement of the distal interphalangeal joint
progressive enlargement of the proximal interphalgeal joint
high level of uric acid, subcutaneous and periarticular deposits of urate crystals commonly over the first metatarsophalangeal joint, finger, ear, elbow, and Achilles tendon.
acute attack of gout manifesting with severe pain, swelling, and inflammation in the first metatarsophalangeal joint.
tenosynovitis of the thumb abductors and extensors. Weakness of grip and pain at the base of thumb aggravated by wrist movements. Test - flex thumb and close fingers over it and move wrist into ulnar deviation.
carpal tunnel syndrome
median nerve pass through carpal tunnel - entrapment. Known as carpal tunnel syndrome produces symptoms of numbness and tingling. Tinel's sign (sharp tap or pressure over median nerve to produce paresthesias of syndrome) diagnoses it.
lateral epicondylitis, pain in the region of the lateral epicondyle of the humerus. Radiates down the extensor surface of the forearm. Test via flex patients elbow and fully pronante hand. Pain over lateral epicondyle.
diagnoses de quervain's tenosynovitis. Grasp thumb and ulnar deviate the hand sharply. Pain occurring the distal radius.
A sharp tap or pressure directly over the median nerve may reproduce the parasthesias of carpal tunnel syndrome.
Test for carpal tunnel syndrome. Have the patient hold the backs of both hands together at right angles to the wrists for 2 minutes (compresses median nerve). If numbness or tingling develops along the distribution of the median nerve, this suggests carpal tunnel disease
Progressive enlargement of the distal interphalangeal joint of the hands
Proximal interphalangeal joint enlargement
Inspection for each of the following joints for:
Palpation of each of the following joints for:
Identify the appropriate method of measuring blood pressure
Remember the following when assessing blood pressure:
-The patient should be in a comfortable chair for at least 5 minutes
-The patient's arm should be supported at heart level
-The arm should be free of clothing
-The cuff should be applied with bladder centered over the brachial
-artery and the lower edge of the cuff should be ~ 2-3cm above the antecubital fossa.
-Use the right sized cuff (approximately 20% wider than diameter of arm)
-Do not release the cuff faster that 2mmHg per second
Round off readings to the nearest 2mmHg. (Swartz says 5mmHg)
Assessing blood pressure by palpation
-in what patient is this technique especially helpful?
palpation involves using a sphygmomanometer to
determine the pressure at which the patient's pulse is obliterated. We generally use either the right brachial or right radial pulse for this.
This technique is especially useful in patients with hypotension, with faint korotkoff sounds or in those with an auscultatory gap. The artery is palpated while the cuff is inflated above the pressure needed to obliterate the pulse (i.e. when you can no longer feel the pulse). Then slowly deflate the cuff and identify the pressure at which the pulse reappears. This is the systolic blood pressure. (Note: You cannot assess the DBP by this method)
How do you use the sphygmomanometer to determine the blood pressure
After obtaining the SBP by palpation, deflate the cuff entirely and wait for at least 30 seconds. Place the diaphragm of your stethoscope over the brachial artery. You can palpate the brachial artery just medial to the insertion of the biceps tendon in the antecubital fossa. Inflate the cuff to ~ 20-30mmHg over the palpable SBP.
Start deflating the cuff no faster than 2mmHg per second.
What are the different types of normal breath sounds?
● Vesicular- inspiration longer than expiration, present over most of the lung, soft, low pitch
● Bronchial- expiration longer than inspiration, present over the manubrium, relatively high pitch
● Bronchovesicular- inspiration and expiration are about equal, often heard in the 1st /2nd intercostals spaces, medium pitch
● Tracheal- inspiration and expiration are about equal, high pitch, heard over the trachea (neck)
in popliteal fossa responsible for swelling in the popliteal fossa, causing calf pain.
Pain from entrapment of the sciatic nerve. Burning sensation, pain, or aching in the buttocks radiating down the posterior thigh to the posterolateral aspect of the calf. Worsened by sneezing, laughing, or straining at stool.
aka rotator cuff tendinitis. Clinical syndrome when the tendons of the rotator cuff muscles become irritated and inflamed as they pass through the subacromial space, the passage beneath the acromion. Pain, weakness and loss of movement at the shoulder. This condition is often caused by or associated with repetitive overhead activities such as throwing, raking, washing cars or windows and many other types of highly repetitive motions. It may also occur as a result of an injury. Rotator cuff injuries are the most common cause of shoulder pain and limitation of activities in sports in all age groups. Rotator cuff tendonitis is the mildest form of rotator cuff injury.
bleeding into the joint
deformity of the proximal interphalangeal joint of the second, third, or fourth toe causing it to be permanently bent, resembling a hammer.
deformity by lateral deviation of the great toe, creating what appears to be an enlargement of bone around the joint at the head of the big toe. The bump is due to the swollen bursal sac or an osseous anomaly on the metatarsophalangeal joint.
inflammation caused by excessive stretching of the plantar fascia a broad band of fibrous tissue that runs along the bottom of the foot, attaching at the bottom of the calcaneus and extending to the forefront. Can cause heel pain, arch pain and heel spurs.
athletes foot, macerated, scaling, fissured toe webs, inflammatory epidermis, thick hypertrophic discolored nails. A fungal infection.
test for rupture of cruciate ligaments. Flex knee to 90 degrees. Steady foot. Grasp leg below the knee with boths hands and jerk tibia forward. Mobility of 2 cm or more suggestive of rupture of the anterior. Backward 2cm or more is posterior cruciate ligament.
Straight leg raise
for sciatica. Lie supine while examiner flexes extended leg to the trunk at the hip. Presence of pain is positive test. Also plantar flex and dorsiflex foot.
Collateral ligament integrity
Palpate collateral ligament at 90 degrees flexed. Grasp patient's leg and using thumbs try to elicit tenderness over the patellar tendon beneath the femoral condyles.
grating, crackling or popping sounds and sensations experienced under the skin and joints or a crackling sensation due to the presence of air in the subcutaneous tissue.
inflammation of the bursae
an instance of giving off something such as a liquid, light, or smell
increased fluid in the suprapatellar pouch over the patella at the knee joint.
Common symptoms of musculoskeletal disease
pain, weakness, deformity, limitation of movement, stiffness, joint clicking
When describing the general appearance, include?
signs of distress, level of consciousness, weight, height, build, skin color, lesions, dress, grooming, facial expressions, body odors, gait, posture
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