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Physical Assessment Bates
Bates
177
Health Care
Graduate
11/20/2010

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Term
Alterness or state of awareness of the environment
Definition
Level of consciousness
Term
The process of registering or recording information, tested by asking for immediate repetition of material flowwoed by storage or retention of information.
Definition
Memory
Term
Awereness of personal identity, place, and time requires both memory and attention
Definition
orientation
Term
Sensory awareness of objects in the environment and their interrelationship also refers to internal stimuli such as dreams or hallucinations
Definition
perceptions
Term
The logic, coherence, and rlevance of the patients though as it leads to selected goals or how people think
Definition
thought processes
Term
Awareness that symptoms or distrurbed behaviors are normal or abnormal; for ex distinguishing between daydreams and hallucinations that seem real
Definition
insight
Term
process of comparing and evaluating alternatives when deciding on a course of action; reflects values that may or may not be based on reality and social conventions or norms
Definition
judgment
Term
an observable, usually episodic, feelin or tone expressed through voice, facial expression and demeanor
Definition
affect
Term
A more sustained emotion that may color a person's view of the world (mood is to affect as climate is to weather)
Definition
mood
Term
Assessed by vocabulary, fund of information, abstract thinking, calculations, construction of objects that have 2 or 3 dimensions
Definition
Higher cognitive functions
Term
speech characterized by indirection and delay in reaching the point bc of unnecessary detail, although components of the description have a meaningful connection
Definition
Circumstantiality
Term
speech in which a person shifts from one subject to others that are unrelated or related only obliquely without realizing that the subjects are not meaningfully connected. Ideas slip off the track between clauses, not within them
Definition
Loosening of association or derailment
Term
An almost continuous flow of accelerated speech in which a person changes abruptly from topic to topic. changes are usually based on understandable associations, plays on words, or distracting stimuli, but the ideas do not progress to sensible conversation
Definition
Flight of Ideas
Term
invented or distorted words, or words with new and highly idiosyncratic meanings
Definition
Neologisms
Term
speech that is largely incomprehensible
Definition
incoherence
Term
fabrication of facts or events in response to questions
Definition
Confabulation
Term
persistant repetition of words or ideas
Definition
perseveration
Term
repetition of words and phrases of others
Definition
echolalia
Term
speech in which a person chooses a word on the basis of sound rather than meaning, as in rhyming and punning speech
Definition
Clanging
Term
Repetitive behaviors or mental acts that a person feels driven to perform in order to produce or prevent some future state of affairs
Definition
Compulsions
Term
Recurrent, uncontrollable thoughts, images, or impulses that a person considers unacceptable and alien
Definition
obsessions
Term
persistent irrational fears accompanied by a compelling desire to avoid the stimulus
Definition
phobias
Term
Apprehensions, fears, tensions or uneasiness that may be focused or free floating
Definition
anxieties
Term
false fixed personal beliefs that are not shared by other members of the persons culture or subculture
Definition
delusions
Term
abnormalities of perception:
Misinterpretations of real external stimuli
Definition
illusions
Term
abnormalities of perception: Subjective sensory perceptions in the absence of relevant external stimuli. person may or may not recognize the experience as false.
Definition
hallucinations
Term
a distinct period of abnormally and persistently elevated expansive or irritable mood must be present for at least a week
Definition
manic episode
Term
the mood and symptoms resemble those in a manic episode but are less impairing, donot require hospitalization do not include hallucinations or delusions
Definition
Hypomanic episodes
Term
a depressed mood and symptoms for most of the day, for more days than not, over at least 2 yyears freedom of symptoms lasts no more than 2 months at a time
Definition
dysthymic disorder
Term
Brief test useful in screening for cognitive dysfunction or dementia
Definition
mini mental state exam
Term
The breast is made up of the following tissue
Definition
Glandular, fibrous connective, and adipose
Term
nodes of the breast
Definition
Pectoral nodes, subscapular nodes, lateral nodes
Term
Risk of breast cancer includes:
Definition
previous BC, affect mother or sister, increasing age, early menarche, late menopause, late or no pregnancy, previous radiation to chest wall
Term
Breast palpation with what part of hand?
what technique
Definition
fingerpads of 2nd, 3rd, and 4th fingers
vertical strip pattern in small concentric circles at each examing point. 3 minutes per breast
Term
hard irregular poorly circumscribed breast nodules fixed to the skin or underlying tissues strongly suggests
Definition
breast cancer
Term
how to assess for nipple discharge?
Definition
compress the areolar with you index finger, placed in radial positions around the nipple
Term
usually a single breast nodule usually seen in young adults round disclike o lobular very mobile usually nontender
Definition
Fibroadenoma
Term
round breast nodule that is often tender and mobile
Definition
cysts
Term
usually a single nodule that is irregular shaped firm and not very mobile also not tender
Definition
Cancer
Term
visible signs of breast cancer
Definition
Retraction sign
skin dimpling
nipple retraction and deviation
Edema of the skin
Pagets disease of the nipple: scaley eczemalike lesions that may week, crust or erode
Term
lymphatics from the penile and scrotal surfaces drain into the?
lymphatics of the testes drain into the?
Definition
inguinal nodes
abdominal nodes (unpalpable)
Term
indirect hernia is what?
Definition
hernia of bowel through the internal inquinal ring through the inguinal canal
Term
yellow penile discharge could be
white or clear could be
Definition
gonococcal infection
nongonococcal urethritis
Term
tight prepuce that cannot be retracted over the glans
Definition
Phimosis
Term
tight prepuce that, once retracted cannot be returned and edema ensues
Definition
paraphimosis
Term
ventral displacement of the meatus on the penis
Definition
hypospadias
Term
induration along the ventral surface of the penis suggests a
Definition
urethral stricture or possible cancer
Term
epidermoid cysts on the scrotum are?
Definition
common and normal
Term
multiple tortuous veins usually on the left side of the scrotum indicate
Definition
varicocele
Term
This maneuver makes it easier to evaluate a patient for hernias:
Definition
valsalva maneuver-bear down to increase intraabdominal pressure
Term
if you hear bowl sounds in the scrotum what might be going on?
Definition
Scrotal hernia
Term
when a hernia's contents cannot be returned to the abdominal cavity a hernia is said to be
Definition
incarcerated
Term
most common form of cancer in men between the ages of 15-35
Definition
testicular cancer
Term
palpable notender hard plaques found just beneath the skin usually along the dorsum of the penis and patient complains of crooked, painful erection
Definition
Peyronie's disease
Term
usually an indirect hernia that comes through the external inguinal ring
Definition
scrotal hernia
Term
testes are atrophied and may lie in the inquinal canal or the abdomen resulting in an unfilled scrotum
Definition
Cryptorchidism
Term
testes that are acutely inflamed painful tender and swollen often hard to distinguish from epididymis.
Definition
Acute Orchitis
Term
a painless movable cystic mass just above the testes. they both transilluminate: one contains sperm and the other does not
Definition
Spermatocele
or cyst of the Epididymis
Term
Infection that produces firm enlargement of the epididymis, tender, with thickening or beading of the vas deferens
Definition
TB epididymitis
Term
Three types of hernias in men?
Definition
indirect, direct, femoral hernia
indirect origin: above inquinal ligament, near its midpoint- internal inquinal canal
direct origin: above the inguinal ligament, close to the pubic tubercle near the external inquinal ring.
Femoral Hernia: below the inquinal ligament appears more lateral
Term
these glands lie posterior and on either side of the urethral meatus opening;
Definition
paraurethral (skene's) glands
Term
these glands are located posteriorly on either side of the vaginal opening
Definition
bartholins gland openings
Term
The vagina lies almost at a what angle to the uterus
Definition
right
Term
two parts of the uterus and what joins them
Definition
corpus (body) and the cervix
joined by the isthmus
Term
name the two types of epithelium on the ectocervix
Definition
the ectocervix is covered by the plushy red columnar epithelium surrounding the OS(resembles the endocervix) and a shiny pink squamous epithelium continuous with the vaginal lining. there is a squamous columnar juction that forms the boundary.
Term
the squamocolumnar junction migrates toward the OS creating a transformation zone. This is the area at risk for
Definition
dysplasia and is sampled during a pap
Term
Adnexa when taking about the Female genitalia includes what?
Definition
appendages: ovaries, tubes (normally cannot be felt), and supporting tissue
Term
ovaries have 2 primary functions:
Definition
production of ova and secretion of hormones
Term
lymph from the vulva and lower vagina drains into what nodes
Definition
inguinal nodes
Term
Internal female genitalia lymph drains to
Definition
the pelvic and abdominal lymph nodes
Term
fewer than 21 day intervals between menses
Definition
polymenorrhea
Term
intermenstural bleeding
Definition
Metorrhagia
Term
absence of menses for 12 consecutive months usually between 48-55
Definition
menopause
Term
total number of pregnancies?
outcomes of pregnancies?
Definition
gravida
para
Term
first cervical cancer screen should be when?
Definition
3 years after first sexual intercourse or by 21 years of age whichever comes first
Term
the medium pedersen speculum is usually most comfortable for
Definition
sexually active women
Term
narrow bladed pedersen speculum is best for
Definition
patients with a small introitus such as a virgin or an elderly woman
Term
specula best suited for parous women with vaginal prolapse
Definition
Graves specula
Term
What is a Bimanual Exam?
Definition
index and middle fingers of one of your gloved hands, and from a standing position insert them into the vagina
from above palpate the cervix, uterus, ovaries
Term
translucent nodules on the cervical surface and have no pathologic significance
Definition
Retention cyst also called nabothian cysts
Term
cervical polyps usually arise from where
Definition
the endocervical canal they are bright red soft
Term
the normal OS is
Definition
oval or slit like
Term
Normal variants to uterus positioning are
Definition
retroversion (tilting backwards) or retroflexion (backward angulation of the uterus body in relation to the cervix
Term
the rectal wall contains three inward foldings called
Definition
valves of houston
Term
blood in the stools that is black? red?
Definition
malena
hematochezia
Term
How long is the anal canal
Definition
2.5-4cm long
Term
The rectum is how long?
Definition
12cm
Term
this is positioned at the base of the bladder and surrounds the urethra in men
Definition
prostate gland
Term
The prostate gland is composed of what two tissues
Definition
muscular and glandular and contains r and L lateral lobes as well as a median lobe that is not palpable.
Term
internal and external sphincter control is involuntary until approx
Definition
18-24 months
Term
this occurs with age, resulting from degeneration of afferent neurons in rectal wall interfering with internal sphincter relaxation
Definition
increased stool retention
Term
how to perform a DRE
Definition
spread buttocks apart with left hand, touch lubricated finger to anus and gently insert toward umbilicus, rotate hand to examine anterior posterior and lateral walls
Term
an inflammatory tract from anus or rectum to skin
Definition
anorectal fistula
Term
painful oval-shaped anal ulceration usually midline, sentinel skin tag associated with it
Definition
Anal Fissure
Term
hemorrhoids below the anorectal line usually thrombosed tender, bluish shiny ovoid masses
Definition
external hemorrhoids
Term
hemorrhoids above the anorectal line covered by mucosa soft swelled identified by palpation
Definition
internal hemorrhoids
Term
the penis (crus, shaft, glans) is composed of 2 corpora:
Definition
Corpora cavernosa and corpora spongiosum contains urethra
Term
left testicle may be slightly what than the right
Definition
lower
Term
storage, maturation and transit of sperm:
Definition
epididymis;
vasdeferens begins at the tail of the epididymis
Term
produces the major volume of ejaculatory fluid
Definition
prostate gland
Term
The corpora cavernosa become engorged with blood during
Definition
erection
Term
external genitalia for males and females are identical at what gestational age? differentiation takes place at what gestational age?
by what trimester are the testicles descended from the retro peritoneal space through the inguinal canal
Definition
8 weeks
12 weeks
3rd trimester
Term
prolonged usually painful erection
Definition
priapism
Term
4 abnormal Ps of the penis
Definition
phimosis
paraphimosis
priapism
peyronies
Term
fairly common located midline superficial to the coccyx or the lower sacrum may be a small tuft of hair and surrounded by a halo of erythema
Definition
Pilonidal cyst or sinus
Term
widespread peritoneal metastases from anysource may develop in the area of the peritoneal reflection anterior to the rectum. firm and hard nodular
Definition
rectal shelf
Term
nonmalignant enlargment of the prostate gland that increases with age, present in more than 50% of men
Definition
BPH
Term
type of joint that is freely movable: knee, shoulder
Definition
Synovial
Term
type of joint that is slightly movable: vertebral bodies of spine
Definition
Cartilaginous
Term
immovable joints like skull sutures:
Definition
fibrous joints
Term
types of synovial joints
Definition
Spheroidal
hinge
condylar
Term
ball and socket joint shoulder and hip
Definition
spheroidal joint (synovial joint)
Term
joint with motion in one plane: flexion extension: flat and planar articulating surfaces: like interphalangeal, elbow
Definition
Hinge joint (synovial joint)
Term
movement of 2 articulating surfaces not dissociable: convex and concave articulation: knee, TMJ
Definition
Condylar joint (synovial joint)
Term
disc shaped synovial sacs that allow adjacent muscles or muscles and tendons to glide over each srgace of a bone or joint:
Definition
Bursae
prepatellar bursa
Term
SITS muscles:
Definition
supraspinatus
infraspinatus
teres minor
subscapularis (not palpable)
Term
Neer's Impingement sign: what is it?
Definition
to test for rotator cuff problems: press on the scapula with one hand and raise the patients are with the other hand
Term
Hawkins impingement sign: what is it?
Definition
to test for rotator cuff injury: fex the patients shoulder and elbow to 90 degrees with palm facing down then rotate the arm internally with elbow out
Term
drop arm sign: what is it?
Definition
paient fully abducts the arm to shoulder level and lowers it slowly: if patient cannot hold the arm fully abducted it indicates rotator cuff tear
Term
carpal tunnel structures:
Definition
sheath and flexor tendons of the forearm muscles and the median nerve:
Term
median nerve provides sensation to
Definition
the palm and palmer surface of most of the thumb, 2nd and third digits and half of the fourth digit.
Term
hard dorsolateral nodules on the DIP joints called
Definition
heberdens nodes common in osteoarthritis
Term
radial nerve provides sensation to
Definition
the dorsal surface of thumb 2nd 3rd and half of 4th finger not including the finger tips (median nerve)
Term
nerve that provides sensation to the 5th and half the 4th finger including the finger tips
Definition
ulnar nerve
Term
Finkelsteins test: what is it?
Definition
testing thumb function if there is wrist pain:
Term
What tests can be done to test for carpal tunnel?
Definition
Tinel's test, Thumb abduction, Phalen's test
Term
Tinel's sign what is it?
Definition
check for median nerve compression by tapping lightly over the course of the median nerve in the carpal tunnel
Term
Phalen's sign what is it?
Definition
check for median nerve compression: hold wrists in flexion for 60 seconds by pressing the backs of both hands together to form right angles
Term
L4 is located where
Definition
at the iliac crests
Term
inguinal structures
Definition
NAVEL
nerve, Artery, vein, empty space, lymph nodes
Term
largest joint in the body is the
Definition
knee joint: hinge involving 3 bones: femur, tibia, and the patella
Term
cushions the action of the femur on the tibia
Definition
medial and lateral menisci
Term
genu varum
Definition
Bowlegs
Term
genu valgum
Definition
knock knees
Term
bulge sign what is it?
Definition
check for minor knee effusions: with knee extended place the left hand above the knee and apply pressure on the suprapatellar pouch, displacing or milking the fluid downward
Term
The balloon sign: what is it?
Definition
to check for major effusions of the knee: plce the thumb and index dinger of your right hand on each side of the patella and compress the suprapatellar pouch aganst the femur.
Term
what type of arthritis?
typically polyarticular
pain is usually symmetric
initially is only found in a couple joints
Definition
Rheumatoid arthritis
it is not found most commonly in the hip joints
Term
when inspecting for normal gate one should expect to see?
Definition
abductor contraction stabilizes the pelvis and maintains balance
Term
The trochanteric and ischial bursa can best be palpated with the patient lying?
Definition
lying on his side with his hip flexed and his hip internally rotated
Term
Valgus Stress test: what is it
Definition
assessing the MCL:
Term
Varus stress test
Definition
assessing the LCL
Term
anterior drawer sign
Definition
Assessing the ACL cup hands around the knee at the medial and lateral line drawing the tibia forward and observe if it slides like a drawer under the femur
Term
Lachman test?
Definition
ACL
Term
posterior drawer sign
Definition
PCL
Term
Great toe is abnormally abducted
Definition
Hallux Valgus
Term
what joint is responsible for plantar and dorsiflexion?
Definition
tibiotalar joint
Term
muscle strength grading:
what is the scale and what is normal
Definition
0-5
5 is normal: active movement against full resistance without fatigue
Term
Muscle strength grading 0, 1, 2
Definition
0 no contraction detected
1 barely detectable
2 active movement with gravity eliminated
Term
Muscle strength grading 3, 4, 5
Definition
3 active movement against gravity
4 active movement against gravity and some resistance
5 active movement against full resistance normal
Term
Scale for grading reflexes: what is the range and what is normal
Definition
0-4

2+ is normal
Term
4+
3+ reflexes
Definition
3 Brisker than average possible but not necessarily indicative of disease

4+ very brisk, hyperactive with clonus (rhythmic oscillations between flexion and extension: possible Upper neuron findings
Term
1+
0
reflexes
Definition
1+ somewhat diminished; low normal
0 no response
Hypoactive or absent reflexes usually a spinal nerve problem Lower motor neuron disease
Term
plantar response L4-5 S 1-2 dorsiflexion of the big toe is a positive?
Definition
babinski response: central nervous system lesion
Term
as you flex the neck, the hips and knees flex this is a positive?
Definition
Brudzinski sign
Term
flex patients leg at both the hip and knee if pain and increased resistance is seen when leg is extended this is
Definition
positive Kernigs sign
usually bilateral
Term
Level of consciousness: patient opens the eyes and looks at you but responds slowly and is somewhat confused
Definition
Obtundation
Term
Level of consciousness: patient arouses from sleep only after painful stimuli verbal responses are slow or even absent. paeint lapses into an unresponsive state:
Definition
Stupor
Term
rhythmic oscillation of the eyes analogous to a tremor:

which side is determined by the fast phase
if there is only coarse oscillations then it is called
Definition
Nystagmus

Pendular
Term
Disorders of Muscle tone:
Increased muscle tone hypertonia that is rate dependent: clasp knife resistance
Definition
Spasticity
Stroke
Term
Muscle tone: Increased resistance that persists throughout the movment arc independent of rate of movement call Lead Pipe
Definition
Rigidity
Parkinsonism
Term
Muscle tone: loss of muscle tone hypotonia causing the limb to be loose or floppy: Flail like
Definition
Flaccidity
Guillain Barre
Term
Muscle tone: Sudden changes in tone with passive range of motion, sudden loss of tone that increases the ease of motion is called mitgehen. sudden increase in tone making movement more difficult: gegenhalten:
Definition
Paratonia
Dementia
Term
scoring is based on a 3 point score for newborn assessment. infant score is done at 1 and 5 minutes after birth then 5 min intervals until score is greater than 7
Definition
apgar score
Term
infant HR
resp rate
Definition
120-160
30-60
Term
swelling on the scalp from vaginal delivery...does not cross the midline
Definition
Caput Succedaneum
Term
common skin findings at birth
Definition
petechiae meconium stain jaundice
Term
bluish discoloration usually in palms and soles of a newborn
Definition
acrocyanosis
Term
pinhead-sized smooth white raised areas without surrounding erythema on nose chin and forehead of infant
Definition
milia
Term
heart sound in early diastolic frequently heard in children are are normal
Definition
S3
Term
test to check for posterior hip dislocation in infants
Definition
Ortolani test
Term
test the ability to sublux or dislocate an intact but unstable hip in an infant
Definition
Barlow test:
Term
most common dysrhythmia in children
Definition
Paroxysmal supraventricular tachycardia (SVT)
Term
HTN in children is more likely to have a ________cause
Definition
renal, cardiac, or endocrine cause
Term
in an elderly adult the presence of S3 can signal? presence of S4 can signal?
Definition
S3 Congestive HF
S4 compliance of ventrical
Term
Amyloid deposites in the heart that can cause Heart failure
Definition
Senile Cardiac amyloidosis
Term
Test used for assessing function in the elderly patient
Definition
10 minute geriatric screener
Term
Assesing incontinence in the older adult?
Definition
DIAPERS
Delerium, Infection, Atrophic urethritis/vaginitis, Pharmaceuticals, Excess urine out put, Restricted mobility, Stool impaction

DDRRIIPP:
Delerium, Drug SE, Retention of feces, Restricted mobility, Infectionof urine, Inflammantion, Polyuria, Psychogenic
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