Comprehensive Health Assessment and Clinical Examination Review

Comprehensive set of 100 flashcards covering cardiovascular, peripheral vascular, lymphatic, neurological, musculoskeletal, integumentary, nutritional, abdominal, and HEENT clinical assessments based on lecture notes.

S1 ("lub")

The first heart sound caused by the closure of the atrioventricular (AV) valves (mitral and tricuspid) at the start of systole; it is heard loudest at the apex of the heart.

S2 ("dub")

The second heart sound caused by the closure of the semilunar valves (aortic and pulmonic) at the start of diastole; it is heard loudest at the base of the heart.

S3 (Ventricular Gallop)

An abnormal heart sound occurring in early diastole during rapid ventricular filling; an expected finding in children and young adults, but indicative of volume overload or fluid backup in older adults.

S4 (Atrial Gallop)

An abnormal heart sound occurring in late diastole just before $S_1$ when the atrium contracts against a stiff or non-compliant ventricle.

Heart Murmurs

Harsh, blowing, or turbulent sounds caused by turbulent blood flow through heart valves; classified by timing, loudness (grade I to VI), shape, and radiation pattern.

Indicators of Decreased Tissue Perfusion

Clinical findings presenting as cool, pale, or cyanotic extremities, delayed capillary refill ($> 2 - 3\,\text{seconds}$), diminished or absent peripheral pulses, trophic skin changes, and ischemic tissue pain.

Intermittent Claudication

Cramp-like calf pain provoked by walking or exercise and relieved by rest, serving as the hallmark symptom of peripheral arterial disease (PAD).

The "6 Ps" of Severe PAD / Acute Arterial Occlusion

Six classic clinical signs: Pain, Pallor, Pulselessness, Paresthesia (numbness/tingling), Poikilothermia (coldness to touch), and Paralysis (a late sign).

Elevation Pallor and Dependent Rubor

Physical signs of peripheral arterial disease where legs develop pallor when elevated and turn a deep red color (dependent rubor) when dangled.

Arterial Ulcers

Ischemic ulcers located on toes, metatarsal heads, heels, or lateral malleolus characterized by a pale base, well-defined punched-out edges, and an absence of drainage.

Chronic Venous Insufficiency (CVI)

Impaired venous return causing lower extremity blood pooling, presenting with calf aching or heaviness that worsens at the end of the day or after prolonged standing, and relieves with elevation.

TED Mnemonic (Chronic Venous Insufficiency)

A diagnostic mnemonic: T for Thick skin (coarse, firm, leathery, brawny), E for Edema (worsens by evening), and D for Discoloration (brownish hyperpigmentation alongside varicosities).

Venous Stasis Ulcers

Shallow ulcers located over the medial malleolus (inner ankle) or tibia characterized by irregular borders and a moist, red, weeping granulation base.

Deep Vein Thrombosis (DVT)

A venous thromboembolic condition presenting with unilateral leg swelling, localized severe pain/tenderness, warmth, and erythema, evaluated clinically using the Wells Score.

Wells Score

A clinical risk assessment tool for deep vein thrombosis evaluating factors such as active cancer, recent immobilization or surgery within $12\,\text{weeks}$, and tenderness along deep veins.

+1 Edema

Mild pitting edema defined by a slight indentation of $2\,\text{mm}$ depth with rapid tissue rebound and no visible extremity distortion.

+2 Edema

Moderate pitting edema defined by a deeper indentation of $4\,\text{mm}$ depth where tissue rebound occurs within a few seconds.

+3 Edema

Deep pitting edema defined by a deep indentation of $6\,\text{mm}$ depth that persists for $10\text{ to }20\,\text{seconds}$, accompanied by visible extremity swelling.

+4 Edema

Very deep pitting edema defined by a severe indentation of $8\,\text{mm}$ depth persisting for $> 20\,\text{seconds}$, with marked extremity distortion.

Jugular Venous Distension (JVD)

An indirect clinical measurement of right atrial pressure assessed at a $30^−45^\circ$ angle; distension elevated $> 3 - 4\,\text{cm}$ above the sternal angle indicates increased central venous pressure.

Modifiable Cardiovascular Disease Risk Factors

Alterable lifestyle and health conditions including hypertension, dyslipidemia, tobacco use, diabetes mellitus, physical inactivity, and obesity.

Non-Modifiable Cardiovascular Disease Risk Factors

Inherent patient risk characteristics including advancing age, male gender, and a family history of premature coronary artery disease.

Left-Sided Heart Failure

Inability of the left ventricle to pump effectively causing pulmonary congestion; presents with dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea (PND), tachypnea, and bilateral fine crackles.

Right-Sided Heart Failure

Inability of the right ventricle to pump effectively causing systemic venous congestion; presents with jugular venous distention (JVD), dependent pitting edema, hepatomegaly, ascites, and sudden weight gain.

Normal Lymph Nodes

Lymphatic structures that are typically non-palpable or small ($< 1\,\text{cm}$), mobile, soft, non-tender, and discrete.

Acute Infection (Lymph Nodes)

Lymphadenopathy lasting $< 14\,\text{days}$ characterized by bilateral, tender, warm, firm, and freely movable lymph nodes.

Malignant Lymph Nodes

Abnormal nodes measuring $> 3\,\text{cm}$ in size that are unilateral, non-tender, stony hard, and fixed (immobile to surrounding tissues).

Lymphedema

High-protein fluid accumulation in interstitial spaces caused by lymphatic flow obstruction; presents with non-pitting, asymmetric swelling, tightness, and hyperkeratosis leading to fibrosis.

Glasgow Coma Scale (GCS)

A standardized framework evaluating level of consciousness, alertness, and cognitive function across eye opening (E), motor response (M), and verbal response (V), scoring from $3\text{ to }15$.

Cranial Nerve I (Olfactory)

A sensory nerve responsible for smell perception, evaluated by having the patient identify familiar, non-irritating scents.

Cranial Nerve II (Optic)

A sensory nerve responsible for visual acuity and visual fields, evaluated using the Snellen chart and confrontation testing.

Cranial Nerve III (Oculomotor)

A motor nerve responsible for pupil constriction and extraocular movements (EOMs).

Cranial Nerve IV (Trochlear)

A motor nerve controlling downward and inward movement of the eye.

Cranial Nerve V (Trigeminal)

A mixed nerve governing facial sensation (tested with light touch across dermatomes) and motor mastication (tested by clenching teeth).

Cranial Nerve VI (Abducens)

A motor nerve responsible for lateral, outward movement of the eye.

Cranial Nerve VII (Facial)

A mixed nerve controlling facial movements (smiling, puffing cheeks, raising eyebrows) and taste sensation on the anterior $2/3$ of the tongue.

Cranial Nerve VIII (Vestibulocochlear)

A sensory nerve responsible for hearing and balance, screened clinically using the whispered voice test.

Cranial Nerve IX (Glossopharyngeal)

A mixed nerve mediating swallowing, the gag reflex, and taste sensation on the posterior $1/3$ of the tongue.

Cranial Nerve X (Vagus)

A mixed nerve governing swallowing and phonation, assessed by checking that the uvula and soft palate rise symmetrically in the midline when saying "ah".

Cranial Nerve XI (Accessory)

A motor nerve tested by having the patient shrug shoulders and turn the head against resistance, evaluating the trapezius and sternocleidomastoid muscles.

Cranial Nerve XII (Hypoglossal)

A motor nerve governing tongue movement and speech articulation, assessed by having the patient protrude the tongue and inspecting for midline position.

PERRLA

A clinical finding documenting that Pupils are Equal, Round, Reactive to Light (direct and consensual), and Accommodation.

Anisocoria

An abnormal pupillary finding defined by unequal pupil sizes.

Stereognosis

A cortical sensory test requiring an intact parietal lobe that assesses the patient's ability to identify a familiar object placed in their hand solely by touch with eyes closed.

Graphesthesia

A cortical sensory test that assesses the patient's ability to correctly identify a number or letter traced onto the palm of their hand with eyes closed.

10-Gram Monofilament Testing

A localized diagnostic tool for diabetic peripheral neuropathy applied for $1 - 2\,\text{seconds}$ across standardized sites on the plantar foot to detect sensory loss.

Pronator Drift

A downward turning and drifting of an outstretched arm when held with palms up and eyes closed, indicating an upper motor neuron deficit.

FAST Protocol

An acute stroke triage screening tool: F for Facial droop, A for Arm weakness/drift, S for Speech difficulties, and T for Time to immediately activate emergency services.

Lordosis

An exaggerated inward curvature of the lumbar spine; an expected postural variation in toddlers and pregnant women.

Kyphosis

An exaggerated outward thoracic curvature ("humpback") commonly observed in older adults secondary to osteoporotic vertebral compression changes.

Scoliosis

A lateral S-shaped curvature of the thoracic and lumbar spine, screened during adolescence using the Forward Bend Test to detect rib hump asymmetry.

Timed Up and Go (TUG) Test

A fall-risk mobility test where standing from an armchair, walking $10\,\text{feet}$ ($3\,\text{meters}$), turning, and sitting in $\ge 12\,\text{seconds}$ indicates elevated fall risk.

Genu Varum

The clinical term for "bowlegs," representing a normal developmental lower-extremity alignment in infants and toddlers up to age $2$.

Genu Valgum

The clinical term for "knock knees," representing a common developmental variation in children between ages $2\text{ and }7$.

Ortolani Maneuver

A screening maneuver for developmental dysplasia of the hip where the infant's hip is flexed and abducted; a positive finding is an audible/palpable "clunk" as the femoral head relocates.

Barlow Maneuver

A pediatric screening maneuver where the infant's hip is adducted with gentle downward pressure; a positive result is feeling the femoral head slip out of the acetabulum.

Muscle Strength Grade 5/5

Normal muscle strength defined as full active range of motion against gravity with full opposing resistance.

Muscle Strength Grade 3/5

Fair muscle strength defined as full active range of motion against gravity alone, without manual resistance.

Muscle Strength Grade 0/5

Complete absence of muscle contraction or joint motion (zero strength).

Osteoarthritis (OA)

A non-inflammatory, progressive destruction and wear-and-tear of articular cartilage causing asymmetric joint pain worse at the end of the day, with morning stiffness lasting $< 30\,\text{minutes}$.

Rheumatoid Arthritis (RA)

An autoimmune, systemic inflammatory disease of the synovial membrane presenting with bilateral, symmetric joint swelling and prolonged morning stiffness lasting $> 1\,\text{hour}$.

Gout

A metabolic disorder characterized by uric acid crystal accumulation causing sudden, excruciating, throbbing pain, heat, and swelling, classically at the first metatarsophalangeal joint.

Heberden's and Bouchard's Nodes

Bony nodules of osteoarthritis; Heberden's nodes affect the distal interphalangeal (DIP) joints, while Bouchard's nodes affect the proximal interphalangeal (PIP) joints.

Hallmark Deformities of Rheumatoid Arthritis

Specific structural finger changes consisting of swan-neck deformity, boutonnière deformity, and ulnar drift/deviation.

Tophi

Hard, painless subcutaneous nodules composed of uric acid crystals visible under the skin in chronic gout cases.

Phalen Test

A screening maneuver for carpal tunnel syndrome where wrists are held in deep flexion back-to-back for up to $60\,\text{seconds}$; numbness or tingling along the median nerve indicates a positive result.

Tinel Sign

A carpal tunnel screening maneuver where light percussion directly over the median nerve on the palmar wrist elicits a tingling sensation.

Macule and Patch

Flat, non-palpable skin color changes; a macule is $< 1\,\text{cm}$ (e.g., freckle, petechiae), whereas a patch is $> 1\,\text{cm}$ (e.g., vitiligo, measles rash).

Papule and Plaque

Solid, elevated skin lesions; a papule is $< 1\,\text{cm}$ (e.g., wart, elevated nevus), whereas a plaque is a disk-shaped plateau $> 1\,\text{cm}$ (e.g., psoriasis).

Nodule

A solid, elevated, hard or soft lesion extending deeper into the dermis that measures $> 1\,\text{cm}$.

Wheal

A superficial, raised, transient, erythematous lesion with irregular borders caused by localized edema (e.g., mosquito bite, hives/urticaria).

Vesicle and Bulla

Fluid-filled cavities; a vesicle measures $< 1\,\text{cm}$ (e.g., herpes simplex, shingles), whereas a bulla is $> 1\,\text{cm}$ (e.g., friction blister, second-degree burn).

Pustule

A circumscribed, elevated cavity filled with turbid pus, commonly seen in acne and impetigo.

Lichenification

A secondary skin lesion characterized by thickened, leathery skin with tightly packed papules resulting from prolonged, intense scratching.

Keloid

A hypertrophic, elevated scar extending beyond the original boundaries of a cutaneous wound.

ABCDEF Rule for Melanoma

Screening criteria for malignant skin lesions: Asymmetry, Border irregularity, Color variation, Diameter ($> 6\,\text{mm}$), Evolution/Evolving, and "Funny Looking" (ugly duckling sign).

Stage 1 Pressure Injury

Intact skin presenting with localized non-blanchable erythema, typically over a bony prominence.

Stage 2 Pressure Injury

Partial-thickness skin loss involving the epidermis and/or dermis, presenting as a shallow open ulcer with a red-pink wound bed or an intact/ruptured serum blister.

Stage 3 Pressure Injury

Full-thickness skin loss where subcutaneous fat may be visible, but bone, tendon, and muscle remain unexposed.

Stage 4 Pressure Injury

Full-thickness tissue loss characterized by directly exposed muscle, tendon, cartilage, or bone, frequently accompanied by slough or eschar.

Unstageable Pressure Injury

Full-thickness tissue loss where the true depth of the wound cannot be confirmed because it is completely obscured by slough or eschar in the wound bed.

Deep Tissue Pressure Injury (DTPI)

Intact or non-intact skin presenting with persistent, localized non-blanchable deep red, maroon, or purple discoloration, or epidermal detachment over a dark bed.

Braden Scale Domains

Six clinical risk domains for pressure injuries: Sensory perception, Moisture, Activity, Mobility, Nutrition, and Friction & shear.

Body Mass Index (BMI) Classifications

Standard clinical categories: Underweight ($< 18.5$), Normal ($18.5 - 24.9$), Overweight ($25.0 - 29.9$), Obesity Class I ($30.0 - 34.9$), Obesity Class II ($35.0 - 39.9$), and Extreme/Class III Obesity ($\ge 40.0$).

Waist Circumference Risk Thresholds

Thresholds identifying increased cardiovascular/metabolic disease risk: $> 35\,\text{inches}$ ($88\,\text{cm}$) for women and $> 40\,\text{inches}$ ($102\,\text{cm}$) for men.

Kwashiorkor

Severe malnutrition caused by protein deficiency despite adequate calorie intake, presenting with edema, abdominal distention/ascites, sparse hair, and preserved subcutaneous fat.

Marasmus

Severe protein and calorie starvation resulting in generalized somatic muscle wasting, profound subcutaneous fat loss, and an emaciated appearance.

Scurvy

Vitamin C deficiency presenting with swollen bleeding gums (scorbutic gums), petechiae, ecchymosis, and impaired wound healing.

Pellagra

Niacin (Vitamin B3) deficiency characterized by a pigmented, red maculopapular rash on sun-exposed cutaneous areas and stomatitis.

Koilonychia

Brittle, ridged, spoon-shaped nail deformities indicative of chronic iron deficiency anemia.

Sequence of Abdominal Assessment

The precise clinical order: Inspection $\rightarrow$ Auscultation $\rightarrow$ Percussion $\rightarrow$ Palpation; auscultation precedes touch to avoid artificially inducing peristalsis.

Right Lower Quadrant (RLQ) Auscultation Landmark

The starting quadrant for abdominal auscultation located at the ileocecal valve area, chosen because bowel sounds are normally consistently audible here.

Five-Minute Rule for Absent Bowel Sounds

The nursing assessment standard requiring continuous listening for $5\,\text{full minutes}$ in a single abdominal quadrant before documenting bowel sounds as completely absent.

Blumberg Sign (Rebound Tenderness)

Severe pain produced by the sudden release of deep abdominal pressure, signifying peritoneal irritation, peritonitis, or acute appendicitis.

Murphy Sign (Inspiratory Arrest)

A painful cessation of breath when palpating underneath the right liver border during deep inspiration, serving as a sign of acute cholecystitis.

Abdominal Aortic Aneurysm (AAA) Assessment Precaution

A pulsatile mass in the upper abdomen left of midline with an audible bruit; deep palpation is strictly contraindicated due to the risk of vascular rupture.

Costovertebral Angle (CVA) Tenderness

Sharp pain elicited by direct or indirect percussion over the 12th rib at the costovertebral angle, indicating kidney inflammation or pyelonephritis.

Otoscopic Technique (Adult vs. Pediatric)

Pulling the pinna up and back in adults, but pulling the pinna straight down (or down and back) in infants and children under $3\,\text{years old}$ to straighten the canal.

Universal Hearing Screening (1-3-6 Rule)

Screen all newborns for hearing within $1\,\text{month}$, evaluate failed screens via audiology within $3\,\text{months}$, and begin interventions by $6\,\text{months}$.

Cluster Headaches

Severe, sharp, unilateral orbital pain lasting $15 - 180\,\text{minutes}$ in recurring clusters, accompanied by ipsilateral rhinorrhea, lacrimation, ptosis, and severe restlessness.