Clinical Assessment Quiz 1 Drexel PA Program

Clinical Assessment Quiz 1 Drexel PA Program Which of the following is considered objective information? A. The patient is complaining of fatigue B. The patient smokes 3 packs of cigarettes daily C. The patient live ...

Clinical Assessment Quiz 1 Drexel PA Program Which of the following is considered objective information? A. The patient is complaining of fatigue B. The patient smokes 3 packs of cigarettes daily C. The patient lives in a two story row home D. The patient weighs 225 pounds E. The patient states that her left arm is tingling - ✔✔D. The patient weighs 225 pounds Which of the following is considered subjective information? A. Patient is agitated B. Patient BP is 140/90 C. Patient is complaining of a sore throat D. Patient's foot is swollen E. Patient's wound is bleeding - ✔✔C. Patient is complaining of a sore throat Which of the following CC is correctly documented? A. " I have pneumonia" X 1 d B. " I am in for a knee replacement" X 1 h C. " diarrhea and vomiting" X 2 d D. "migraines" X 4 yrs Diagnosis wrong E. "my nose won't stop bleeding" X 2hrs - ✔✔E. "my nose won't stop bleeding" X 2hrs Components of the Comprehensive History? - ✔✔Past Medical History (PMH) Family History (FH) Social History (SH) Medications Allergies Review of Systems (ROS) Which of the following ROS is pertinent for a 32 y/o woman with the CC of dysuria ( painful urination)? A. respiratory B. General C. neurological D. cardiovascular - ✔✔B. General Which of the following historical information should be included in the first sentence of the HPI? A. History of measles as a child B. Penicillin allergy C. Patient's weight D. History of a MI in 2007 E. all of the above - ✔✔D. History of a MI in 2007 Which of the following ROS is pertinent for a 55 yo man with H/O prostate cancer complaining of a sudden onset of low back pain? A. Genitourinary B. neck C. eyes D. throat - ✔✔A. Genitourinary Past medical history includes? - ✔✔Surgeries Hospitalizations Major Injuries Immunizations and screening tests Childhood medical illnesses Adult medical illnesses Pack years calculation? - ✔✔# packs/day x years smoked = # pack years Mr. Jones has smoked ½ PPD for 6 years, 1 PPD for 7 years, and 2 PPD for 5 years. What is the total number of pack-years smoked? - ✔✔20 BMI Guidelines? - ✔✔Underweight < 18.5 Normal 18.5 - 24.9 Overweight 25.0 - 29.9 Obesity I 30.0 - 34.9 Obesity II 35.0 - 39.9 Extreme Obesity >40 Pyrexia - ✔✔Elevated body Temperature The 4 vital signs? - ✔✔Blood pressure Heart rate Respiratory rate Temperature Temperature ranges by region? - ✔✔Oral - 98.6 - hot or cold drinks before taking could alter temp Tympanic -- no cerumen, direct at TM, more variable than oral/rectal Axillary- 97.6 - less accurate, take 5-10 mins to register Rectal - 99.6/ - higher than oral most accurate Normal adult heart rate? - ✔✔60-100 bpm Tachycardia adult? - ✔✔> 100 bpm Bradycardia adult? - ✔✔< 60 bpm Level's of Consciousness - ✔✔-Alert - eyes open, responds fully -Lethargic - you may need to speak loudly, appears drowsy but responds to questions and opens eyes -Obtunded - opens eyes, responds slowly and is somewhat confused, less interested -Stuporous - arouses after painful stimuli. Painful stimuli can be elicited by pinching a tendon, rubbing the sternum. This patient has very slow or absent verbal responses -Comatose - remains unarousable, eyes closed Skin color observations? - ✔✔Pallor - Pale Cyanosis - Blue Jaundice - Yellowing Obvious rashes Bruises Breath odors? - ✔✔Acetone - diabetes, fruity breath Uremia - ammonia Fetor hepaticus - liver failure, musty fish odor Halitosis - respiratory infections, gingivitis Why take vital signs? - ✔✔-Rapid Assessment of an acute medical condition -Quantifies the body's physiologic response to illness or injury -Provides a marker for chronic disease states Blood pressure definition? - ✔✔Pressure of the blood on the walls of the vessels and arteries. What determines the blood pressure? - ✔✔ventricular contraction (volume) of blood being pumped the size and flexibility of the arteries (resistance) Systolic - ✔✔Pressure of blood against the artery walls after left ventricular contraction. Diastolic - ✔✔Pressure of blood against the artery walls during left ventricular relaxation or filling. Korotkoff sounds - ✔✔Sound made by blood flow through a vessel. Auscultatory gap - ✔✔Silent interval between the systolic and diastolic pressures Steps in measuring BP? - ✔✔-Properly position cuff -Palpate radial pulse -Inflate cuff until pulse disappears. Add 30 mmHg -Deflate the cuff; wait 15 seconds -Place diaphragm of stethoscope over brachial artery. -Inflate the cuff to the predetermined number, and slowly deflate. BP readings? - ✔✔Normal BP Systolic < 120 Diastolic <80 Pre-hypertension Systolic 120-139 Diastolic 80-89 Stage 1 Hypertension Systolic 140-159 Diastolic 90-99 Stage 2 Hypertension Systolic >160 Diastolic >100 Begin measuring BP at what age? - ✔✔2-3 Causes of Abnormal BP readings in children? - ✔✔Renal artery disease/ congenital renal abnormality Adolescents - drug induced, obesity Coarctation of aorta Causes of fever (pyrexia)? - ✔✔Infection Trauma Infarction Substance abuse Malignancy Causes of hypothermia? - ✔✔Hypothalamic dysfunction Prolonged cold exposure elderly Define Coarctation of the aorta? - ✔✔If BP is higher in both arms when compare to one legs >20 mmHg, further investigation is needed. Possible interferences in BP readings? - ✔✔Wrong size cuff Unsupported arm (higher) Caffeine/tobacco/exercise Auscultatory gap Equipment not calibrated "white coat" hypertension Arrhythmias Common causes of essential HTN? - ✔✔Idiopathic (we don't know) Common causes of secondary HTN - ✔✔isolated systolic HTN hormonal drug induced renal malignant pregnancy Common cause of hypotension? - ✔✔hemorrhage, fluid loss, drug induced Orthostatic - more common in elderly Tilt test? - ✔✔Measure BP lying and then have pt stand up for 2-3 and recheck. When would a Tilt test be considered positive? - ✔✔A drop in systolic BP by 20 mmHg or diastolic of 10 mmHg within 3 mins of standing. What is the respiratory range in Adults, late/Early childhood, and newborns? - ✔✔Normal adults - 14-20 rpm Later childhood - 15-25 rpm Early childhood - 20-40 rpm Newborn - 30-60 rpm Dyspnea - ✔✔General difficulty breathing with SOB Tachypnea - ✔✔Rapid shallow respiratory rate > 20 rpm Apnea - ✔✔No breathing Paroxysmal nocturnal dyspnea (PND) - ✔✔Sudden onset of SOB after a period of sleep Orthopnea - ✔✔Difficulty breathing when pt. lies down Bradypnea? - ✔✔Slow breathing, < 12 rpm Hypopnea - ✔✔Abnormally shallow respirations Pleuritic pain Hyperpnea - ✔✔Rapid labored breathing > 20 Kussmaul breathing EX: DKA - ✔✔Single deep fast breaths Cheynes-Stokes EX: Close to death - ✔✔Shallow breaths with wide intervals Physical exam order? - ✔✔Inspection Palpation Percussion Auscultation When do you palpate tender areas? - ✔✔Last Diaphragm of stethoscope is for what kind of sounds? - ✔✔High pitched -> apply firm pressure Bell of stethoscope is for what kind of sounds - ✔✔low pitched sounds -> don't apply pressure Composition of the skin in order? - ✔✔Epidermis Dermis Subcutaneous adipose Abrasion to the epidermis (avascular) - ✔✔Shiney no blood Excoriation - ✔✔cate scratch (blood) Hypothermia - ✔✔95F Hyperpyrexia - ✔✔106F Irregular rhythm suggest - ✔✔Atrial fibrillation What effect would using a small cuff on an obese PT have? - ✔✔over estimation of the systolic pressure Which of the following skin lesions best describe a macule? A. café-au-lait spot B. keloid C. freckle D. urticaria - ✔✔C. freckle A 10 year old boy is brought in to the office by his mother with an extremely itchy rash on his lower legs and ankles for two days. He just return form a camping trip. On examination you note erythema , excoriations and vesicles in a linear pattern over the anterior aspects of both shins. Witch of the following is the most likely diagnosis? A. Acne B. Vitiligo C. Herpes zoster D. Poison oak E. impetigo - ✔✔D. Poison oak Macule - ✔✔Flat <1 Primary lesion is? - ✔✔Flat or raised Patch - ✔✔Flat >1 Papule - ✔✔Raised (no fluid) <1 Plaque - ✔✔Raised (no fluid) >1 Vessicle - ✔✔Raised (Fluid) <1 Bulla - ✔✔Raised (fluid) >1 Morbilliform drug eruption - ✔✔Multiple 3-8 mm erythematous confluent round (wheels) on chest, back and arms Tinea versicolor - ✔✔Multiple 2-5 mm hypo/ hyperpigmented, or tan round oval macules on the upper neck, back, chest and arms with scaling on scraping Benign melanocytic nevi - ✔✔Multiple scattered 2-4 mm round oval brown macules, symmetrically pigmented, on back, chest w/ reticular pattern