Medical Exam Review: Anatomy, Symptoms, and Diagnostic Tests, Exams of Nursing

Download Medical Exam Review: Anatomy, Symptoms, and Diagnostic Tests and more Exams Nursing in PDF only on Docsity! Advanced Health Assessment Midterm Exam(192 Questions and Answers) what is included in subjective information? - Correct answer CC, HPI, PMH, SH, FH, ROS objective data includes: - Correct answer Heard, felt, seen, or smelled. Obtained by observation or physical examination ROS includes - Correct answer Patient reported-not physical component -constitutional (weight loss, fever, etc.) -skin -HEENT (head, ears, nose, throat) -cardiovascular -respiratory -gastrointestinal -genitourinary -hematologic -immunologic/ allergic -musculoskeletal -neurologic -endocrine -psychiatric OLD CART pneumonic stands for - Correct answer Onset Location Duration Characteristics Aggravating factors Relieving factors Treatment Duke Activity Status Index - Correct answer measure's patient's functional capacity. Rough estimate of peak oxygen uptake. <15=transplant candidate, >20=none to mild impairment Mini Mental State Exam - Correct answer Concentrates only on cognitive functioning, not on mood or thought processes Standard set of 11 questions, requires only 5 to 10 minutes to administer Useful for both initial and serial measurement, so worsening or improvement of cognition over time and with treatment can be assessed Good screening tool to detect dementia and delirium and to differentiate these from psychiatric mental illness Normal mental status average 27; scores between 24 and 30 indicate no cognitive impairment MMSE score of 20 or less - Correct answer dementia, delirium, schizophrenia or an affective disorder Montreal Cognitive Assessment (MoCA) - Correct answer screening for mild cognitive dysfunction; assesses different cognitive domains like attention, visuconstructional, memory, etc. and scored up to 30 points >26 = normal Can weed of problems with people who score normally on MMSE. mild cognitive impairment (MCI) is a risk factor for - Correct answer dementia Primary prevention - Correct answer Efforts to prevent an injury or illness from ever occurring. ex. immunizations secondary prevention - Correct answer Detecting and treating asymptomatic risk factors. ex. health fair screening for HTN or testicular cancer Cranial Nerve 1: Olfactory - Correct answer sensory, smell Cranial Nerve 2 - Correct answer Optic screening rec for those over 65 y.o - Correct answer +-Readdress smoking status at every visit- One-time U/S for AA men who smoked 65-75- Consider PFT for all long-term smokers (COPD)-Vaccinate all smokers PV & flu- Screen all post-menopausal women (& men w/risk factors) for osteoporosis- Reassess vaccination status at age 56- Screen for dementia and depression- Screen for visual & hearing problems, elder abuse, & home and safety issues ABCDE approach - Correct answer Assess risk, anti-platelet, anticoagulants Blood Pressure Cholesterol and cigarette smoking cessation Diet and weight management, DM prevention and treatment Exercise A routine health care examination should be performed every 1-__ years before age 50 and every year thereafter. - Correct answer 1-3 yrs Lung cancer screening recommendations - Correct answer •Adults aged 55-80 who are at high risk for lung cancer •Undergo annual lung cancer screening with low dose CT scans •Recommendation by US preventative Services Task Force •Based on RCT studies that identified patients at risk as 30 pack year history who currently smoke or who have quit in the last 15 years CPT stands for - Correct answer Current Procedural Terminology -describes the procedures, services or supplies you provide to your patients ICD-10 - Correct answer International classification of diseases A system to classify and code diagnoses, symptoms, and procedures A NEW patient is defined as - Correct answer has not received any professional service from provider or another provider (same specialty) in same practice w/in last 3 years An established patient is defined as - Correct answer has received services from provider or another in group w/in last 3 years Tail of Spence - Correct answer superior lateral corner of breast tissue, projects up and laterally into axilla many breast cancers found here Normal BMI range - Correct answer 18.5-24.9 most common breast cancer site for men - Correct answer behind areola not tail of spence How often should a person at average risk have a colonoscopy? - Correct answer age 45 for 2 years, then Q3-5 years depending on risk factors what grade is a moderately loud murmur without a palpable thrill - Correct answer grade 3 the following indicate what? SOB +JVP @45 degrees - Correct answer R sided heart failure what area do you hear 2nd heart sound? - Correct answer 2nd intercostal space split S2 in a young person with no medical history, what is your intervention? - Correct answer ask pt to hold breath to differentiate pathological from physiological splitting. What is a heart murmur? - Correct answer the sound of rushing blood through narrow spaces When a pt has pulmonary valve insufficiency, you would expect to hear murmur where? - Correct answer 2nd intercostal space at L sternal border when auscultating heart sounds of an elderly pt with HTN what would you expect to hear? - Correct answer S4 indicating increased resistance to vascular filling Associated with stiff, low compliant ventricle (e.g., ventricular hypertrophy; ischemic ventricle) what does S3 sound indicate - Correct answer increased volume Results from increased atrial pressure leading to increased flow rates, as seen in congestive heart failure, which is the most common cause of a S3. Associated dilated cardiomyopathy with dilated ventricles also contribute to the sound most prevalent cardiac symptom is - Correct answer fatigue ABI test - Correct answer compares BP in upper and lower limbs. Calculated by dividing BP in artery of ankle by BP in artery of arm. Expected ABI in a person with heart problems - Correct answer .6 Normal ABI range - Correct answer 0.9-1.3 lower the number, worse the symptoms pt with c/o SOB that occurs usually after 2-3 hours of sleep causing sudden awakening is - Correct answer paroxsymal nocturnal dyspnea sleep apnea - Correct answer a sleep disorder characterized by temporary cessations of breathing during sleep and repeated momentary awakenings heart sound with a short, high frequency click, an opening snap and S2, during the beginning of diastole indicates - Correct answer mitral stenosis A grey ring around a 80 y. o pt's iris is most likely - Correct answer arcus senilus-common with old age where would you expect the PMI to be in a patient with dilated cardiomyopathy - Correct answer shifted laterally, not at 5th intercostal space MCL as it normally would be. Would be louder as you approach the axilla (armpit). In a 30 y.o female with palpitations and lightheadedness for past 6 months with no identifiable pattern would you suspect mitral valve stenosis or prolapse? - Correct answer mitral valve prolapse mitral valve stenosis is uncommon in young people and is mostly seen in the elderly. field during this articulation will detect a sound matching that received through normal hearing; that is, the sound articulated by the patient will be clearly transmitted through the lung field and heard unchanged by the clinician. When the lung field is consolidated (filled with liquid or other solid mass such as tumor or fungus ball), the patient's spoken English long E will sound like a "pure-voweled" long E or a modern English long A When the pt's A turns to E this is known as - Correct answer positive egophony which indicates consolidation of lung and possible lung collapse. If you ask the pt to say "99" it should normally sound very faint and muffled to you when auscultating with stethoscope over lung fields. If it sounds clear, there is probably lung consolidation of the lung and this is a positive ___________________ test - Correct answer positive bronchophony test Hyperresonant to percussion in the lungs means - Correct answer air trapping disorders like: emphysema, COPD, chronic bronchitis Smoking Pack Year History is Calculated How? - Correct answer # of years smoked x # packs per day. Normal diaphragmatic excursion - Correct answer 3-5 cm diseases of internal respiratory physiology - Correct answer what happens at the cellular level diseases of external respiratory physiology - Correct answer what happens within the lung mechanically Normal tactile fremitus - Correct answer symmetric bilaterally, vibrations decreases as you go down Tactile fremitus is normally found over the mainstem bronchi near the clavicles in the front or between the scapulae in the back. As you move your hands downward and outward, fremitus should decrease. Decreased fremitus in areas where fremitus is normally expected indicates obstruction, pnemothorax, or emphysema. Decreased tactile fremitus indicates - Correct answer hyperinflation of lungs-ex. COPD, emphysema, asthma ^ increased tactile fremitis - Correct answer excess fluid or air can collect in pleural space. pneumothorax - Correct answer air in the pleural cavity positive bronchophony - Correct answer louder, clearer voice sounds Dahl's sign - Correct answer calluses on legs in patients with orthopnea from COPD-tripod positioning breast cancer signs - Correct answer single, firm, non-tender lump=suspicious asymmetric breasts are NOT a risk factor Fibroadenoma - Correct answer usually occurs in young women, single, firm, rubbery lump, poorly delineated, hard to palpate fibrocystic breast disease - Correct answer numerous small sacs of fluid surrounded by dense strands of fibrous tissue in the breast. Occurs before period, tender, rubbery lumps. If pt presents with lumps, have them follow up after period is over In a pt at high risk of breast cancer with negative fluid aspiration, next intervention should be - Correct answer refer pt for biopsy high risk pts should also not be on hormone replacement therapy since it increases risk. potential sign of mitral regurgitation is - Correct answer a thrill during systole at apex on pt's anterior chest mitral regurgitation - Correct answer mitral insufficiency; incompetent mitral valve allows regurgitation of blood back into left atrium during systole pt with excessive daytime sleepiness, flushed face, SOB, BMI>30, with positive JVP may have - Correct answer perwickian syndrome aka obesity hypoventilation syndrome metabolic syndrome - Correct answer A syndrome marked by the presence of usually three or more of a group of factors (as high blood pressure, abdominal obesity, high triglyceride levels, low HDL levels, and high fasting levels of blood sugar) that are linked to increased risk of cardiovascular disease and Type 2 diabetes. ^ JVP indicates - Correct answer right sided heart failure HJR - Correct answer Hepatojugular reflex Dissension of the neck veins precipitated by the maneuver of firm pressure over the liver. Seen in tricuspid regurgitation, heart failure due to non valvular causes, constrictive pericarditis, cardiac tamponade and inferior vena cava syndrome. tactile fremitus in a pt with asthma would be _____________ if they aren't having an exacerbation - Correct answer normal tactile fremitus occurs when there is air trapping or fluid trapping which physical finding is more common in an infant? - Correct answer wheezing due to smaller airways-with a cold pt with COPD, worsening dyspnea, afebrile, decreased lung sounds bilaterally, positive JVD, 2+ pitting edema BLE, what is the most likely cause of his symptoms? - Correct answer CHF abnormal symmetrical expansion is most likely caused by - Correct answer pneumonia because of uneven consolidation of infiltrates, ex. LLL pneumonia air isn't effectively moving into sick lobe on one side. A pediatric pt with croup will most likely have this finding on lung auscultation - Correct answer stridor pt presenting with SOB in order to distinguish jugular vein from carotid artery you understand that there is a change in respiration with _______________ the __________________ will continue to pulsate even if holding your breath - Correct answer jugular vein carotid artery coronary artery calcium score - Correct answer calcium in coronary arteries is a sign of a buildup of plaque. Recommended for patient's whose 10 year risk is between 5 percent and 20 percent. JNC8 recommendations - Correct answer -treat with medication BP over 150 systolic or above 90 diastolic in those 60 years and older and 90 -in those younger than 60, treat with medication if DBP 90 or higher to a goal of less than 90 for 30-59 years What does ABI predict? - Correct answer severity of peripheral artery disease .91-1.30=normal .41-.90=mild to moderate PAD 0.0-.40=severe PAD stage 2 pressure ulcer - Correct answer partial thickness skin loss involving epidermis, dermis, or both skin no longer intact stage 3 pressure ulcer - Correct answer full thickness tissue loss with visible fat stage 4 pressure ulcer - Correct answer Full-thickness tissue loss with exposed bone, muscle, or tendon Impetigo - Correct answer bacterial skin infection characterized by isolated pustules that become crusted and rupture a wart is a - Correct answer papule plaque - Correct answer papules > 1cm plateau like, disc shaped confined to superficial dermis, may result from confluence of papules Lichen Planus - Correct answer Benign, chronic disease that affects the skin and oral mucosa-Inflammatory dermatitis salmon-colored w/ a slight amount of scale: cause unknown possibly autoimmune can affect your skin and mucous membranes patch - Correct answer macules > 1cm • eg: mongolian spot, vitiligo, café au lait Macule - Correct answer flat, circumscribed, nonpalpable, small up to 1 cm a color change • eg: freckle,measles, nevus • solar lentigos-sun induced well circumscribed freckles are macules Tinea corporis (ringworm) - Correct answer Red lesions in a circular pattern blanched in the center caused by fungus, NOT a worm Psoriasis - Correct answer chronic skin condition producing red lesions covered with silvery scales heriditary Weight gain, smoking, and stress are all documented triggers • + family history of psoriasis is noted in about 30% of suspected cases, but a negative history does not rule out the diagnosis. • Certain medications, such as β-blockers and lithium, can trigger exacerbations of psoriasis. • Psoriasis often presents with what appear to be unrelated findings, such as scalp rash, nail pits, genital involvement, and intergluteal pinking. • Associated with significant psychologic pathology, including poor body image, depression, isolation, increased incidence of drug and alcohol abuse, and suicide. • Almost 30% of psoriasis patients will develop a related form of arthritis called psoriatic arthropathy Lichen Planus - Correct answer Solar lentigo - Correct answer "liver spot" in elderly; increased melanocytes vitiligo - Correct answer loss of pigment in areas of the skin-loss of melanocytes -Increased risk of thyroid disease, DM, pernicious anemia Autoimmune, M=F, 30% familial 1-2% of pop wheal - Correct answer raised red skin lesion due to interstitial fluid hives a tumor is what kind of lesion - Correct answer nodule of > 2cm • eg: lipoma, hemangioma - benign or malignant Vesicle - Correct answer elevated cavity w/ free fluid up to 1 cm, clear serum flows if opened • eg: herpes simplex, varicella, herpes zoster, nodule - Correct answer solid, elevated, hard or soft, > 1cm may extend deeper into the dermis than a papule chlondyloma - Correct answer anal warts Molluscum contagiosum - Correct answer What virus causes small pink benign wartlike tumors and is associated with HIV-positive patients? contact dermatitis often presents as - Correct answer multiple,easily, ruptured bulla-blisters erosion skin lesion - Correct answer focal loss of epidermis, usually doesn't leave scar. Lichenification - Correct answer Prolonged, intense scratching eventually thickens the skin and produces tightly packed sets of papules; looks like surface of moss (or lichen) "area of itchy dry skin that you describe as thickened, normal in color,w/out drainage, vesicles, edema" scales - Correct answer flakes or dry patches made up of excess dead epidermal cells Nevis - Correct answer mole papule - Correct answer can be type of acne- but doesnt have to be acne, just describes shape and characteristic of a skin lesion. Doesn't have pus, a small, raised, solid pimple or swelling, often forming part of a rash on the skin and typically inflamed but not producing pus. solid, elevated, circumscribed, < 1cm • eg: elevated nevus (mole), molluscum, wart (verruca) pustule - Correct answer acne lesion elevation of skin containing pus Fitzpatrick sign - Correct answer Positive is the dimpling and retraction of the lesion beneath the skin with lateral compression seen with Dermatofibromas: • Nodules derived from mesodermal and dermal cells • Firm, raised papules, plaques, or nodules that vary in size from 3 to 10 mm in diameter • Range in color from brown to purple, red, yellow, and pink • Multiple dermatofibromas (i.e., > 15) on a person have been described as being associated with autoimmune disorders, such as SLE, or immunocompromised • Usually asymptomatic but need to be investigated b/c they could be melanomas annular rash - Correct answer ring shaped Gyrate Rash - Correct answer rash appears to be whirling in a circle paronchia - Correct answer infection around the nail Oncholysis - Correct answer separation of the nail from the nail bed Koilonchyia - Correct answer associated with FE deficiency -spooning Beau's lines - Correct answer indentations that run across the nails. ... Conditions associated with Beau's lines include uncontrolled diabetes and peripheral vascular disease, as well as illnesses associated with a high fever, such as scarlet fever, measles, mumps and pneumonia. Beau's lines can also be a sign of zinc deficiency. typical nail finding of subacute bacterial Endocarditis or more commonly from trauma - Correct answer Splinter hemorrhages - auspitz sign, psoriasis - Correct answer Removal of scale =dot of blood - Fifth's Disease (Erythema Infectiosum) - Correct answer 1st stage: slapped cheek appearance or rash w/ circumoral pallor 2nd: lace like maculopapular rash on arms and legs 3rd: rash may recur for 2-3 weeks if aggravated by sunlight or heat lasts 5-10 days symptomatic tx only Folliculitis - Correct answer inflammation of the hair follicles closed and open commedomes - Correct answer acne white heads are closed black heads are open bulla vs pustulles - Correct answer bulla -no pus pustulles-pus fissure - Correct answer : linear cracks, extends into dermis, dry or moist • eg: cheilosis, athletes foot, eczema keloid - Correct answer hypertrophic scar, elevated beyond site of original injury Seborrheic Keratosis - Correct answer Most common types of noncancerous skin growths in older adults. usually appears as a brown, black or pale growth on the face, chest, shoulders or back round or oval, waxy scaly appearance, single or multiple growths, "stuck-on" look spider angioma - Correct answer -red center with radiating red legs -up to 2 cm -can be raised Nikolsky's sign - Correct answer rubbing of the epidermis, resulting in exfoliation or separation from the dermal layer Autoimmune condition (Pemphigus vulgaris) Bacterial infection ( Scalded skin syndrome) Toxic drug reaction (Toxic epidermal necrolysis) Pemphigus - Correct answer rare autoimmune disorder. The immune system produces antibodies against specific proteins in the skin and mucus membranes. antibodies break the bonds between skin cells. Leads to the formation of a blister. Exact cause is unknown Meds that can cause it: Penicillamine ACE inhibitors pitting edema scale - Correct answer O= no pitting • +1 = 0-1/4" pitting (mild) • +2 = ¼ - ½" pitting (moderate) • +3 = ½ - 1" pitting (severe) • +4 = > 1" (severe) Actinic Keratosis - Correct answer -precursor for Squamous Cell Carcinoma -common pre-cancer; it affects more than 58 million Americans. -Flat to slightly raised, scaly, crusty, rough, sometimes with a raised horn shape or bump 2. Red, tan, pink, skin-colored, brown or silvery. 3. Dimensions vary from a tiny spot to as much as an inch in diameter 4. UV exposed areas including the face, lips, ears, scalp, shoulders, neck, back of the hands and forearms. Actinic cheilitis is a variant of AK that arises on the lower lip. basal cell carcinoma - Correct answer Most common type of skin cancer, malignant, slow growing but can be invasive & destructive Open sore that oozes & crusts, goes away & returns, area of irritation, shiny bump or nodule, pink growth, scar like area squamous cell carcinoma - Correct answer 2nd most common type of skin cancer • Erythematous scaly patch w/sharp margins 1cm or > • Develops central ulcer • Solar (actinic) keratosis precancerous for SCC • Any persistent (>1mon) nodule, plaque, or ulcer is suspicious Melanoma - Correct answer risk factors Exp to U/V from sunshine & tanning beds • Intense, intermittent • H/O 2 or more blistering sunburns before 20 • Triggers mutations (genetic defects) • Genetic predisposition • Personal history • Family history: 2 or more 1st degree relatives • Nevi: dysplastic, Congenital nevomelanocytic (>1.5cm), numerous or acquired nevi • Immunosuppression HARMM acranym