PE Exam 2

• Cardiac output
• Elasticity of arteries (inverse relationship)
• Viscosity of blood
• Circulating blood volume
• Peripheral vascular resistance

False high systolic

Falsely high systolic and diastolic (because artery pressure + gravity)

False low systolic (miss 1st korkoroff sound)

Falsely high systolic (needs excessive pressure to occlude artery)

False low systolic (requires less pressure to occlude artery)

False high systolic (excessive pressure needed to occlude artery)

Falsely low systolic and high diastolic (poor resolution)

Low systolic, high diastolic (venous congestion in forearm makes sound less audible)

• HR <60bpm
• Slowing of impulse formation at SA node
• Due to hypothyroidism, infectious disease, medications
• Occurs frequenyl in elderly and CV fit patients

• HR >100bpm
• Due to increased sympathetic tone from anxiety, heart failure, exercise, hemorrhage, hyperthyroidism, sympathomimetic drugs
• Bad for people with ischemic heart disease

• Pulsus paradoxus - exaggerated decrease in pressure of pulsation during inspiration and increase in pressure during expiration
• Second degree heart block - disturbances in conduction of electrical impulses through heart - missed ventricular contractions

• Premature ventricular contractions (PVC)
• - most common form of ventricular arrhythmia
• - premature, bizzare waves on ECG
• - ectopic foci in ventricle
• - can degenerate into ventricular tachycardia or fibrillation

30-40mmHg

Alternation of a pulsation of a small amplitude with the pulsation of large amplitude while the rhythm is normal

12-20/min

• Slower than 12 breaths/min
• CNS depressants (alcohol, narcotics, benzodiazepines)
• Hypoglycemia

• Faster than 20 breaths/min
• Infection
• COPD
• Congestive heart failure
• Metabolic acidosis

Faster than 20 breaths/min, deep breathing

Absence of spontaneous breathing

Difficult and labored breathing with shortness of breath

shortness of breath that begins or increases when patient lies down

Sudden onset of shortness of breath after a period of sleep

Hypothalamus

Hypothalamus

• Oral sublingual
• Tympanic membrane

• Diurnal cycle
• Menstrual cycle
• Exercise
• Increased age

• Elevated temp
• Oral >100
• Tympanic >101.4
• Due to infections, trauma, malignancies, hyperthyroidism, various drugs

• Abnormally low temp
• Oral <95
• Tympanic <96.4
• Hypometabolic states, decreased muscular movement, interference with vasoconstriction (alcohol, sepsis), exposure to cold environment

• Neurologic
• CV
• GI
• Respiratory
• Endocrine
• Genitourinary
• Musculoskeletal
• Integument
• Immune
• Hematologic

• Cyanosis
• Heart failure

• Poor lymphatic drainage
• Heart failure
• Pitting peripheral edema

• Protrusion of eyeball
• Hyperthyroidism

• Sjogren's syndrome
• Autoimmune disease
• Affects salivary glands, lacrimal glands

• Pinpoint areas of bleeding
• Von Willenbrands disease
• Thrombocytopenia
• Medication induced (platelet aggregation inhibitors)
• Liver disease

Are not

moveable, discrete, soft, nontender

• Sign of a disease affecting lymph nodes
• Indicated by enlargement of lymph nodes

• Infection
• Often but not always bilateral, tender, and firm but freely movable

• Ludwigs angina
• Thyroid gland
• - Graves disease
• - Hashimotos thyroiditis
• - Thyroid carcinoma

• Severe cellulitis from mandibular 2nd or 3rd molar
• swelling of submandibular space
• elevation of tongue
• life threatening due to loss of airway

• Distended jugular veins
• Carotid aneurysm
• Mononucleosis

• Congestive heart failure
• Obstruction of venous return dur to constrictive pericarditis, mediastinal tumor, or obstructed superior vena cava

• localized distension of carotid artery
• pulsatile enlargement

• Epstein-barr virus
• young adults
• pharyngitis
• fever
• fatigue
• malaise
• discrete, occasionally tender lymph nodes
• vary in firmness

• Assess nostril patency
• Present aromatic substances w/eyes closed - pt should ID with each nostril

• decrease or loss of smell
• bilateral - smoking, allergic rhinitis, cocaine, aging
• unilateral - neurogenic, frontal lobe masses

Vision charts

nearsightedness

Farsightedness

Loss of accomodation (CN III)

• Diabetic retinopathy (means diabetes more severe)
• Hypertension

• you and patient each cover one eye, place hand outside of both of your fields of vision, measure when each of you can see hand first
• Gives information about patients field of vision relative to yours

• Direct - efferent nerve constricts pupil in same eye
• Consensual - constricts pupil, opposite eye
• Absent or delayed light reflex - CNS trauma, increased intracranial pressure

• Accomodation - contraction of ciliary muscles (curvature of lens), constriction of pupillary constrictor muscles, contraction of medial rectus (adduction)
• Cardinal fields of gaze (tests III, IV, and VI)

• Vision impairment as child
• Vestibular disorders
• Cerebellar disorders
• Drug toxicity

• Pt closes eyes, touch face with cotton, safety pin
• Assess ability to detect sharp, dull, light pressure, hot, and cold
• Corneal reflex

Difficulty swallowing - motor dysfunction of X

• Elevates
• Lateral excursion
• Protrudes (minor)

• Opens
• Lateral excursion
• Protrudes (major)

Muscle inflammation

Decreased active vertical range of mandibular motion

• Rough, grating, gravel like sound in TMJ
• Fine, coarse, popping

• Symptoms: Clicking/popping noise, may feel catching in TMJ
• Signs: Reciprocal/reproducible click, may have deviation in ROM and/or protrusion, no restriction in active vertical mandibular ROM

• Symp: hx of clicking/popping, limited range of motion
• Signs: no TMJ sounds, restriction in vertical mandibular ROM and laterotrusion, may have deflection

• Symp: pain in TMJ or front of ear, exacerbated by jaw function, limited mandibular function secondary to pain
• Signs: TMJ tender to palpation, TMJ pain worsened upon clenching, limited active mandibular range of motion, laterotrusion, protrusion

• Symptoms: Pain in TMJ or in front of ear, Pain worsened by jaw function, may have limited mandibular function
• Signs: TMJ tender to palpation, TMJ pain worsened upon clenching, Limited active mandibular ROM, TMJ sound (fine to coarse crepitus), radiographic imaging shows bony changes

• Symptoms: jaw catches open, pain in TMJ when jaw gets stuck, loud pop when opening wide
• Signs: excessive mandibular ROM, eminence pop, residual tenderness in TMJ upon palpation if recent episode

Freckle on lip

Yellowish dots on lip, ectopic sebaceous glands

fungal infections in corner of lips due to overclosed lips

sun damage (typically more on lower lip), swollen, vermillion border is less defined, areas of white and red, essentially sunburn of lip

• Cold sores
• fluid filled elevations of skin, rupture easily, fluid caries virus

From chewing tobacco, whitish in color, like a callous, forms a pouch

• Canker sores
• Autoimmune response triggered by trauma or stress

• diffuse grey-white, milky opaque appearance of the buccal mucosa
• MOSTLY DISAPPEARS upon stretching

• Cheek chewing
• Cheek becomes calloused in response

black stain on mucosa due to presence of amalgam

• Lumps/lesions in hard palate
• More concerning when not in midline
• Should feel like a bone upon palpation

• in person who smokes a lot
• whitish covering of hard palate wiht little red dots

• red spots on hard palate, only found on attached mucosa
• look like ulcers after they have popped
• If on hard palate more likely to be herpes

• Yeast infection in mouth
• Forms white plaque
• Wipes off and leaves red base