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Questions and Answers
During a general physical examination, from which side of the patient should you ideally stand?
During a general physical examination, from which side of the patient should you ideally stand?
- Left hand side
- The side with better lighting
- Either side, depending on examiner preference
- Right hand side (correct)
Which of the following is a key step in preparing for a physical examination?
Which of the following is a key step in preparing for a physical examination?
- Administering a preliminary diagnosis questionnaire
- Introducing yourself to the patient (correct)
- Inquiring about the patient's insurance coverage
- Ensuring the patient has comfortable clothing
What is the primary purpose of hand washing before a physical examination?
What is the primary purpose of hand washing before a physical examination?
- To prevent the spread of infection (correct)
- To warm the hands
- To comply with hospital policy
- To give a good impression to the patient
Which of the following is typically assessed during a general examination?
Which of the following is typically assessed during a general examination?
What facial appearance is often associated with Cushing's syndrome?
What facial appearance is often associated with Cushing's syndrome?
Which of the following best describes the appearance of a patient described as 'emaciated' or 'cachectic'?
Which of the following best describes the appearance of a patient described as 'emaciated' or 'cachectic'?
What does the 'A' stand for in the AVPU scale?
What does the 'A' stand for in the AVPU scale?
What is the lowest possible total score on the Glasgow Coma Scale (GCS)?
What is the lowest possible total score on the Glasgow Coma Scale (GCS)?
A patient opens their eyes to pain, makes incomprehensible sounds, and withdraws from pain. Using the Glasgow Coma Scale, what is their likely GCS score?
A patient opens their eyes to pain, makes incomprehensible sounds, and withdraws from pain. Using the Glasgow Coma Scale, what is their likely GCS score?
Which of the following best defines 'built' in the context of a general examination?
Which of the following best defines 'built' in the context of a general examination?
What does BMI assess as part of a nutritional assessment?
What does BMI assess as part of a nutritional assessment?
According to standard BMI classifications, what range defines 'overweight'?
According to standard BMI classifications, what range defines 'overweight'?
Which anthropometric measurement is an indicator of muscle mass?
Which anthropometric measurement is an indicator of muscle mass?
What is commonly used for assessing Mid-Upper Arm Circumference (MUAC)?
What is commonly used for assessing Mid-Upper Arm Circumference (MUAC)?
For women, a waist circumference greater than what measurement is suggestive of elevated risk?
For women, a waist circumference greater than what measurement is suggestive of elevated risk?
What vitamin deficiency is typically associated with bleeding gums and delayed wound healing?
What vitamin deficiency is typically associated with bleeding gums and delayed wound healing?
What is the term for difficulty breathing when lying down that is relieved by sitting upright?
What is the term for difficulty breathing when lying down that is relieved by sitting upright?
What term describes dyspnea that occurs in the upright position and is relieved by lying down?
What term describes dyspnea that occurs in the upright position and is relieved by lying down?
What position defines a 'professorial attitude'?
What position defines a 'professorial attitude'?
During a nutritional assessment, what does SFT refer to?
During a nutritional assessment, what does SFT refer to?
What is the clinical significance of observing a patient in a 'prayer' position?
What is the clinical significance of observing a patient in a 'prayer' position?
During a general examination, what does assessment of 'gait' primarily evaluate?
During a general examination, what does assessment of 'gait' primarily evaluate?
The Glasgow Coma Scale assesses all of the following EXCEPT:
The Glasgow Coma Scale assesses all of the following EXCEPT:
A patient presents with a brown desquamated rash in a butterfly distribution on their face, along with dementia and diarrhea. Which vitamin deficiency is most likely?
A patient presents with a brown desquamated rash in a butterfly distribution on their face, along with dementia and diarrhea. Which vitamin deficiency is most likely?
Decerebrate posturing is characterized by which of the following?
Decerebrate posturing is characterized by which of the following?
After performing hand hygiene, which is the most appropriate next step in preparing for a physical examination?
After performing hand hygiene, which is the most appropriate next step in preparing for a physical examination?
During assessment of 'built,' if a patient's arm span significantly exceeds their height, which condition might the examiner suspect?
During assessment of 'built,' if a patient's arm span significantly exceeds their height, which condition might the examiner suspect?
Which vitamin deficiency is most likely indicated by the presence of angular stomatitis (inflammation at the corners of the mouth) and sulfur granules?
Which vitamin deficiency is most likely indicated by the presence of angular stomatitis (inflammation at the corners of the mouth) and sulfur granules?
A patient presents with difficulty breathing that improves when leaning forward or in a 'prayer position'. This is most indicative of:
A patient presents with difficulty breathing that improves when leaning forward or in a 'prayer position'. This is most indicative of:
A GCS score of 14 indicates:
A GCS score of 14 indicates:
When performing skin fold thickness measurements to assess nutritional status, repeatedly measuring the triceps skinfold and consistently obtaining values less than 5 mm should raise suspicion for:
When performing skin fold thickness measurements to assess nutritional status, repeatedly measuring the triceps skinfold and consistently obtaining values less than 5 mm should raise suspicion for:
In the context of vital signs, what constitutes the most accurate assessment of a patient's body temperature in a clinical setting?
In the context of vital signs, what constitutes the most accurate assessment of a patient's body temperature in a clinical setting?
A patient presents with the following signs: eyes opening to painful stimulus, incomprehensible sounds, and abnormal flexion to pain. What is their Glasgow Coma Scale score, and what level of brain injury does this suggest?
A patient presents with the following signs: eyes opening to painful stimulus, incomprehensible sounds, and abnormal flexion to pain. What is their Glasgow Coma Scale score, and what level of brain injury does this suggest?
Which of the following hand-washing techniques would be MOST effective at preventing the spread of infectious diseases in a hospital?
Which of the following hand-washing techniques would be MOST effective at preventing the spread of infectious diseases in a hospital?
In assessing a patient's 'built,' the ratio between height and arm span deviates significantly from expected norms based on age, sex, and race. If a patient's arm span is notably less than their height, which underlying condition would be highly improbable?
In assessing a patient's 'built,' the ratio between height and arm span deviates significantly from expected norms based on age, sex, and race. If a patient's arm span is notably less than their height, which underlying condition would be highly improbable?
A patient exhibits the following triad: dermatitis, diarrhea, and dementia. If this condition is due to a dietary deficiency and NOT a malabsorption syndrome or drug interaction, the consumption of which food group is most likely inadequate?
A patient exhibits the following triad: dermatitis, diarrhea, and dementia. If this condition is due to a dietary deficiency and NOT a malabsorption syndrome or drug interaction, the consumption of which food group is most likely inadequate?
Flashcards
Patient's right side
Patient's right side
Always stand at the patient's right hand side during a physical examination.
Preparing a physical examination
Preparing a physical examination
Introduce yourself, shake hands, use relevant equipment, maintain privacy, and ask permission.
AVPU
AVPU
A simplified score for rapid consciousness assessment by non-specialist nurses.
AVPU breakdown
AVPU breakdown
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GCS
GCS
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Built
Built
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Height
Height
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Span
Span
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Nutrition clinical assessment
Nutrition clinical assessment
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BMI Formula
BMI Formula
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Skin fold thickness
Skin fold thickness
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Mid arm circumference (MUAC)
Mid arm circumference (MUAC)
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Non-stretchable insertion tape
Non-stretchable insertion tape
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Waist circumference
Waist circumference
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Orthopnea
Orthopnea
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Platypnea
Platypnea
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Study Notes
- A general physical examination is performed by medical professionals
The Right Approach
- An important rule during physical examination is to always stand on the patient's right-hand side
Preparing for a Physical Examination
- Introduce yourself to the patient
- Shake their hands
- Have the required equipment
- Maintain privacy
- Seek the patient's consent
Hand Washing
- Wash the palms and fingers
- Wash the back of your hands
- Wash fingers and knuckles
- Wash the thumbs
- Wash the finger tips
- Wash the wrists
General Examination Elements
- Patient appearance
- Corporation
- Consciousness
- Build
- Nutrition assessment
- Decubitus
- Gait and posture
- Vital signs
- Complexion
- Head and neck examination
- Upper and lower limb examination
- Skin assessment
- Lymph node examination
- Examination of other systems
Patient Appearance
- Normal appearance is the expected presentation
- Toxic appearance means the face is flushed due to the VasoDilation effect of infection
- Emaciated or "Cachectic" appearance involves the wasting of face muscles and fat
- Ape-like appearance can presents in acromegaly, with a large jaw, tongue, nose and ears
- Moon face appearance is found in Cushing's syndrome
Assessing Consciousness
- Rapid and initial assessment of a patient's conscious level can be made using:
AVPU Scale
- AVPU (Alert, Voice, Pain, Unresponsive) is a simplified consciousness assessment tool
- A = Alert, meaning the patient is fully aware and responsive
- V = Responds to Voice, meaning the patient reacts when spoken to
- P = Responds to Pain, meaning the patient reacts when painful stimulation is applied
- U = Unresponsive, meaning the patient does not respond to voice or pain
Glasgow Coma Scale (GCS)
- This is an objective score of consciousness, ranging from 3 to 15
- Eye Opening Response includes:
- Eyes open spontaneously resulting 4 points
- Eyes open to verbal command, speech, or shout resulting 3 points
- Eyes open to pain (not applied to face) resulting 2 points
- No eye opening resulting 1 point
- Verbal Response includes:
- Oriented resulting 5 points
- Confused conversation, but able to answer questions resulting 4 points
- Inappropriate responses, words discernible resulting 3 points
- Incomprehensible sounds or speech resulting 2 points
- No verbal response resulting 1 point
- Motor Response includes:
- Obeys commands for movement resulting 6 Points
- Purposeful movement to painful stimulus resulting 5 Points
- Withdraws from pain resulting 4 Points
- Abnormal (spastic) flexion, decorticate posture resulting 3 Points
- Extensor (rigid) response, decerebrate posture resulting 2 Points
- No motor response resulting 1 Point
- Minor Brain Injury score is 13-15 points
- Moderate Brain Injury score is 9-12 points
- Severe Brain Injury score is 3-8 points
- Decorticate posturing is a sign of severe brain damage
- Decerebrate posturing is a sign of severe brain damage
Build Assessment
- Build refers to the relationship between height and span, considering age, sex, and race
- Height is gauged from head to heal
- Span is the distance between distal phalanx of middle fingers in both outstretched arms
Nutrition Assessment
- Assessing nutrition involves assessment of:
- BMI
- Fat levels
- Protein levels
- Vitamins and minerals
BMI Calculation
- BMI is calculated as weight in kilograms divided by height in meters squared
- Example: Gina is 1.6 meters tall and weights 70 kilograms, so the BMI = 70 / (1.6 x 1.6) = 27.34
- Underweight has a score of less than 18.5
- Normal scores 18.5-24.9
- Overweight scores 25-29.9
- Obese scroes 30-39.9
- Morbidly obese scores over 40
Anthropometric Measurements
- Skin Fold Thickness using callipers indicates body fat levels
- Mid-Arm Circumference indicates muscle mass, normally 25cm
- Patient's Waist Circumference indicates elevated risk greater than 102cm (40in) for men and 88cm (35in) in women
Skin Fold Thickness Measurement Sites
- Sites can be:
- Triceps
- Subscapular
- A triceps skinfold of less than 5 mm nearly always indicates low body fat stores
Mid-Arm Circumference (MUAC)
- MUAC measures the sum of muscle and subcutaneous fat in the upper arm
- A non-stretchable insertion tape, graduated in millimetres, is used to assess MUAC and arm length
Waist Circumference
- It is highly correlated with visceral fat and has recently been included as a clinical risk factor
- In metabolic syndrome, waist circumferences are greater than 102 cm (40 inches)
- Elevated risk is suggested in men with waist size greater than 102 cm (40 inches) and in women with 88 cm (35 inches)
Signs of Vitamin Deficiency
- Nutritional edema may point to hypoalbuminemia
- Anemia may point to iron or vitamin B12 deficiency
- Peripheral neuropathy suggests vitamin B complex deficiency
- Sulpher granules & angular stomatitis indicate vitamin B2 "riboflavin" deficiency
- Brown desquamated rash in butterfly area of the face & neck lace area and dementia and diarrhea may point to vitamin B3 "niacin" deficiency (Pellagra)
- Bleeding gums & delayed wound healing points to vitamin C deficiency "Scurvy"
Decubitus and Gait Posture
- Orthopnea refers to dyspnea when lying down which is relieved by sitting upright
- Platypnea refers to dyspnea in the upright position which is relieved by taking the lying down
- Professorial attitude, marked by a patient standing and supporting their extended arms on a table
- Prayer position refers to when the patient prefers to lean forward
- Squatting position is also observed
Observed Actions
- Clenching of the fist can be observed
- Finger pointing can be observed
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