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NCC Exam - WHNP > Assessment, Diagnostic Testing, Interpretation > Flashcards

Assessment, Diagnostic Testing, Interpretation Flashcards

12% of exam, ~21 questions 1. Health History & Physical Exam 2. Diagnostic/Lab Studies 3. Imaging

1
Q

Define: chief concern

A

client’s own brief statement in their words for seeking care

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2
Q

Define: HPI

A

chronological account of problems for which client is seeking care

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3
Q

Pain dimension mnemonic

A

OLD-CARTS

onset, location duration, characteristics, aggravating/associated factors, relieving factors, temporal factors, severity

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4
Q

Adolescent psychosocial mnemonic

A

HEADSS

home, education, activities, drugs, sex, suicide

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5
Q

Define: gravidity

A

total # of pregnancies, regardless of outcome

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6
Q

Define: parity

A

total # of pregnancies reaching 20 weeks or beyond

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7
Q

OB history mnemonic

A

GTPAL

gravida, term, preterm, abortion, living children

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8
Q

Patient risks can be related to (9)

A

age, gender, ethnic/racial background, family hx, environmental exposures, military service, lifestyle, geographic area, preventive healthcare adequacy

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9
Q

Problem-oriented medical record mnemonic for notes

A 
SOAP
Subjective
Objective
Assessment
Plan
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10
Q

Subjective information

A

information obtained during history. Use ‘reports,’ ‘endorses,’ ‘describes,’ instead of ‘complains of.’

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11
Q

Objective information

A

information obtained through physical exam and lab/diagnostic tests

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12
Q

Assessment information

A

determination of diagnosis w/ rationale, or prioritized differential diagnosis, using subjective and objective info.

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13
Q

Plan information

A

information about diagnostic tests, therapeutic treatment regimen, client education, referrals, and date of reevaluation.

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14
Q

Order of exam techniques

abdomen alternative

A

inspection, palpation, percussion, auscultation

inspection, auscultation, percussion, palpation

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15
Q

Diaphragm of stethascope is used to hear…

A

high pitched sounds (S1, S2 heart sounds)

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16
Q

Bell of stethoscope is used to hear…

A

low pitched sounds (large blood vessels)

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17
Q

percussion: Tympany

A

loud, high-pitched drum-like sound (gastic bubbles, gas-filled bowel)

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18
Q

Hyperresonance

A

very loud, low-pitched, boom-like sound (lungs with emphysema)

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19
Q

Resonance

A

loud, low-pitched, hollow sound (healthy lungs)

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20
Q

percussion: dull

A

soft to moderate, moderate-pitched, thud-like sound (liver, heart)

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21
Q

Flat

A

soft, high-pitched sound, very dull (muscle, bone)

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22
Q

Depth of light palpation, and what you are looking for

A

1 cm

muscle resistance, tenderness, large masses, distention

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23
Q

Depth of deep palpation, and what you are looking for

A

4 cm

delineate organs, ID less obvious masses

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24
Q

BMI ranges

A 
< 18.5: underweight
18.5 - 24.9: normal
25.0 - 29.9: overweight
30.0 - 39.9: obesity
40+ : extreme obesity
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25
Q

Waist circumference can serve as a risk predictor for which diseases in which BMI range?

A

DMT2, dyslipidemia, hypertension, CVD

25 - 39.9

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26
Q

Waist circumference of how much is an increased relative risk?

A

> 35 inches

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27
Q

Types of primary skin lesions (5)

A

macule, papule, pustule, vesicle, wheal

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28
Q

Types of secondary skin lesions (4)

A

ulcer, fissure, crust, scar

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29
Q

Malignant melanoma mnemonic

A

ABCDE

asymmetry, borders irregular, color blue/black or variegated, diameter > 6mm, elevation

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30
Q

Normal findings of lymph nodes

A

< 1 cm, nontender, mobile, soft, discrete

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31
Q

Normal conjunctiva

A

clear

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32
Q

Normal sclera

A

white/buff colored

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33
Q

Normal pupil mnemonic

A

PERRLA

pupils equal, round, reactive to light, and accommodate

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34
Q

Increased tactile fremitus could be…

A

lobar pneumonia, pulmonary edema

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35
Q

Decreased tactile fremitus could be…

A

emphysema, asthma pleural effusion

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36
Q

Normal sound of percussed lung fields

A

resonance

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37
Q

Normal sound of auscultated lungs

A

vesicular/bronchovesicular

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38
Q

Normal transmitted voice sounds

A

muffled/indistinct

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39
Q

What could bronchophony, egophony, whispered pectoriloquy indicate?

A

fluid or solid mass in lungs

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40
Q

Adventitious breath sound types (4)

A

crackles, ronchi, wheezes, pleural friction rub

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41
Q

What causes crackles?

A

air flowing by fluid (pneumonia, bronchitis, early HF)

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42
Q

What causes ronchi?

A

air passing over solid or thick secretions in large airways (pneumonia, bronchitis)

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43
Q

What causes wheezes?

A

air flowing through constrictions (asthma, chronic emphysema)

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44
Q

What causes pleural friction rub?

A

Inflamed pleural tissue (pleuritis, pericarditis)

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45
Q

What is S1? Where is it best heard?

A

occurs at start of systole

apex

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46
Q

What is S2? Where is it best heard

A

occurs at start of diastole

base

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47
Q

Fixed split S2 could indicate…

A

atrial septal defect, RVF (delayed closure of pulmonic valve)

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48
Q

Increased S3 could indicate…

A

also called ventricular gallop
normal in young adults and late pregnancy
decreased myocardial contractility, HF, volume overload (rapid ventricular filling)

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49
Q

Increased S4 could indicate…

A

also called atrial gallop
normal in well-trained athletes and older adults
aortic stenosis, hypertensive heart disease, cardiomyopathy (forceful arterial ejection into distended ventricle)

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50
Q

Physiologic murmur…

A

normal finding, common in pregnancy

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51
Q

Murmur of mitral stenosis caused by…

A

narrowed mitral valve that restricts forward flow, causes forceful ejection into ventricle

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52
Q

Systolic click could indicate…

A

mitral valve prolapse

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53
Q

Pericardial friction rub (heart sound) could indicate…

A

pericarditis

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54
Q

Palpating the liver…

A

should not extend more than 2 cm beyond right costal margin

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55
Q

Palpating spleen and kidneys…

A

normally should not be able to

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56
Q

Typical percussive sound of abdomen

A

tympany, dullness over organs/masses

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57
Q

Tenderness at McBurney’s (RLQ) point could indicate…

A

appendicitis

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58
Q

Guarding, rigidity, rebound tenderness in abdomen could indicate…

A

peritonitis

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59
Q

What is Rovsig’s sign?

A

pain in RLQ when left-sided pressure is applied and then quickly withdrawn
referred rebound tenderness

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60
Q

+ R psoas/obturator signs could indicate…

A

appendicitis

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61
Q

What is Murphy’s sign? What can it indicate?

A

sharp increase in tenderness and sudden stop in inspiratory effort with upward pressure under the R costal margin while patient takes a deep breath
cholecystitis

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62
Q

CN I

A

olfactory (smell)

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63
Q

CN II

A

optic (vision)

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64
Q

CN III

A

ocularmotor (PERRLA)

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65
Q

CN IV

A

trochlear (PERRLA)

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66
Q

CN VI

A

abducens (PERRLA)

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67
Q

CN V

A

trigeminal (sharp/dull/light touch on face)

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68
Q

CN VII

A

facial (smile)

69
Q

CN VIII

A

acoustic (auditory acuity)

70
Q

CN IX

A

glossopharyngeal (swalow)

71
Q

CN X

A

vagus (“Ah”)

72
Q

CN XI

A

spinal accessory (traps)

73
Q

CN XII

A

hypoglossal (tongue)

74
Q

Normal size of clitoris

A

no more than 2 cm by 0.5 cm

75
Q

Normal size of cervix

A

2.5 cm diameter

76
Q

Normal size of uterus

A

5.5 cm - 8 cm

could be 2-3 cm larger in parous patient

77
Q

Normal ovary size

A

3 cm by 2 cm by 1 cm

78
Q

Components of CBC w/ diff

A

RBC, Hct/Hgb, RBC indices (MCV, MCH, MCHC), WBC, peripheral blood smear

79
Q

Define w/ normal range: RBC

A

red blood cell (RBCs per cubic mm of blood)

4.2 - 5.4 million/cubic mm

80
Q

Define w/ normal range: Hct

A

hematocrit (percentage of total blood volume that is made up of RBCs)
nonpregnant: 37 - 47%
pregnant:
1st & 3rd trimester: 33% or more; 31% or more for black patients
2nd trimester: 32% or more; 30% or more for black patients

81
Q

Define w/ normal range: Hgb

A

hemoglobin (measurement of total hemoglobin [which carries oxygen] in the blood)
nonpregnant: 12 - 16 g/dL
1st & 3rd trimester: 11 g/dL or more; 10.2 g/dL or more for black patients
2nd trimester: 10.5 g/dL or more; 9.5 g/dL or more for black patients

82
Q

Define w/ normal range: MCV

A

mean corpuscular volume (average volume/size of a single RBC)
80 - 95

83
Q

Microcytic anemias

A

Fe-deficiency and thalassemia

84
Q

Macrocytic anemias

A

Vit B-deficiency and folic acid-deficiency (megaloblastic)

85
Q

Define w/ normal range: MCH

A

mean corpuscular hemoglobin (average amount/weight of Hgb within an RBC)
27 - 31 pg/cell

86
Q

Define w/ normal range: MCHC

A

mean corpsucular hemoglobin concentration (average concentration/percentage of Hgb within a single RBC)
32 - 36 g/dL

87
Q

decreased MCHC and associated anemias

A

hypochromic

Fe-deficiency and thalassemia

88
Q

Define w/ normal range: WBC

A

white blood cell count

5000 - 10000/cubic mm

89
Q

components/breakdown/high value associations of WBC w/ diff (5)

A

neutrophils 30 - 70% (bacterial infx, inflammation, ‘left shift’)
basophils 0 - 3% (hypersensitivity rx)
eosinophils 0 - 5% (allergic rx)
lymphocytes 15 - 40% (viral infx, chronic bacterial infx/inflammation)
monocytes 2 - 8% (recovery phase of infx, chronic infx)

90
Q

What does a peripheral blood smear look at?

A

microscopic examination of RBCs, platelets, leukocytes

91
Q

Components of blood clotting studies (4)

A

platelet count
prothrombin time (PT)
partial thromboplastin time (PTT)
coagulation factors

92
Q

Define w/ normal range: platelets

A

150000 - 400000/cubic mm

93
Q

Components of CMP (13)

A

glucose, albumin, total protein, sodium, potassium, CO2, chloride, BUN, creatinine, ALP, ALT, AST, bilirubin

94
Q

Define w/ normal range: fasting glucose

A

8 hours fasting
normal: < 100 mg/dL
impaired fasting: 100 - 125 mg/dL
diagnostic for DM: 126 mg/dL or greater

95
Q

Define w/ normal range: OGTT (2 hr postload 75g glucose)

A

2 hours after 75 g glucose
normal: <140 mg/dL
impaired tolerance: 140 - 199 mg/dL
diagnostic for DM: 200mg/dL or greater

96
Q

Define w/ normal range: HbA1c

A 
measures glycemic control over 60 - 90 days
normal: <5.7%
prediabetes: 5.7 - 6.4%
diabetes: >6.5%
good control in a diabetic is <7%
97
Q

components of lipid profile (4)

A

total, triglycerides, HDL, LDL

98
Q

Define w/ normal range: total cholesterol

A

normal: 200 mg/dL

can be elevated in pregnancy

99
Q

Define w/ normal range: triglycerides

A

35 - 135 mg/dL

can be elevated in pregnancy

100
Q

Define w/ normal range: HDL

A

> 40 mg/dL

101
Q

Define w/ normal range: LDL

A

<130 mg/dL

102
Q

Define w/ normal range: TSH

A

0.4 - 4.12 mU/mL

upper limit during pregnancy: 2.5 - 3.5 mU/mL

103
Q

Define w/ normal range: free T4

A

0.58 - 1.64 ng/dL

104
Q

Define w/ normal range: total T4

A

4.5 - 12.0 micrograms/dL

measurement can be affected by increased TBG (pregnancy)

105
Q

What could a positive antithyroid peroxidase antibody test (anti-TPO) indicate?

A

Grave’s, Hashimoto’s

106
Q

Define w/ normal range: bilirubin

A

0.3 - 1.0 mg/dL
direct/conjugated: 0.1 - 0.3 mg/dL
indirect/unconjugated: 0.2-0.8 mg/dL

107
Q

What can a protein/creatinine ratio tell us? What is it?

A

kidney damage/disease, preeclampsia, diabetes

random urine sample

108
Q

Fecal occult blood testing: positive test can indicate

A

GI cx, polyps, PUD, IBD, trauma, GI bleed

109
Q

How does blood type/Rh factor testing work?

A

Looking for antigens A, B, Rh on RBCs
0- is universal donor because ot has no antigens
AB+ is universal receiver because it will have no antiBODIES to react to transfused blood

110
Q

What does screening for sickle cell look like?

A

+ test (presence of Hgb S indicates disease or trait)

refer for Hgb electrophoresis to identify Hgb type and amount

111
Q

Causes of increased estradiol (4)

A

adrenal tumor, estrogen-producing tumor, hepatic cirrhosis, hyperthyroidism

112
Q

Causes of decreased estradiol (5)

A

postmenopausal, ovarian failure, hypogonadism, Turner’s, anorexia nervosa

113
Q

Causes of increased progesterone (5)

A

pregnancy, ovulation, progesterone-secreting tumor or cyst of ovary, congenital adrenal hyperplasia, hydatiform mole

114
Q

Causes of decreased progesterone (5)

A

hypogonadism, threatened abortion, fetal demise, preeclampsia, short luteal phase syndrome

115
Q

Causes of increased FSH (5)

A

postmenopause, gonadatropin-secreting pituitary tumor, ovarian failure, primary hypogonadism, Turner’s

116
Q

Causes of decreased FSH (4)

A

pregnancy, pituitary or hypothalamic dysfx, hyperprolactinemia, anorexia nervosa

117
Q

Causes of increased LH (3)

A

postmenopause, primary hypogonadism, gonadal failure

118
Q

Causes of decreased LH (2)

A

pituitary or hypothalamic dysfx, anorexia nervosa

119
Q

Components of UA (14)

A

appearance, color, odor, pH, protein, specific gravity, leukocyte esterase, nitrites, ketones, crystals, casts, glucose, WBCs, RBCs

120
Q

Define w/ normal range: UA pH

A

4.6 - 8

121
Q

Define w/ normal range: UA protein

A

0 - 8 mg/dL

122
Q

Define w/ normal range: UA SG

A

1.005 - 1.030

123
Q

Define w/ normal range: UA WBCs

A

0 - 4 per HPF

124
Q

Define w/ normal range: UA RBCs

A

2 or less

125
Q

What should be negative on a UA? (6)

A

nitrites, ketones, crystals, casts, glucose, leukocyte esterase

126
Q

Positive urine culture indicates

A

UTI

127
Q

Positive urine culture is typically defined as

A

100000 CFU/mL of single type of bacteria
OR
1000 CFU/mL with symptoms of UTI

128
Q

Normal vaginal pH

A

3.8 - 4.5

129
Q

BV clinical/microscopy findings (5)

A 
pH > 4.5
\+ whiff test
> 20% of epithelial cells are clue cells
0 - 1 WBCs per epithelial cell
lactobacillus reduced or absent
130
Q

Trich clinical/microscopy findings (5)

A 
pH > 4.5
\+/- whiff test
motile trichomonads
> 1 WBC per epithelial cell
lactobacillus reduced or absent
131
Q

Yeast clinical/microscopy findings

A 
PH = 4.5
- whiff test
hyphae/spores
> 1 WBC per epithelial cell
lactobacillus present
132
Q

other test for trich

A

NAAT

133
Q

other test for yeast

A

culture

134
Q

1st screening for HIV

A

EIA

135
Q

if EIA reactive for HIV, confirm with?

A

western blot or IFA

136
Q

test for Gonorrhea

A

NAAT

137
Q

test for Chlamydia

A

NAAT

138
Q

test for syph

A 
Nontreponemal tests (VDRL or RPR): reactive or nonreactive
Treponemal tests (FTA-ABS, TPI): positive or negative
139
Q

test for HSV

A

PCR assay or tissue culture

serologic tests differentiate between HSV-1 and HSV-2

140
Q

IgM antibodies typically indicate

A

active infx

141
Q

IgG antibodies typically indicate

A

previous infection and current protection from another primary infx

142
Q

CMV test is

A

an antibody test

143
Q

Toxo test is

A

an antibody test

144
Q

Hep C test is

A

an antibody assay, followed if reactive with RNA test to determine if current infection or past resolved infection

145
Q

Hep B test is

A

a lot of stuff that you can find on page 22 if you care

146
Q

Rapid strep test tells us

A

if pharyngitis is caused by group a beta hemolytic streptococci (GABHS)
it’s positive or negative (viral if negative)

147
Q

When would we get a throat culture?

A

If you’re considering other pathogens for pharyngitis

148
Q

When would we get a skin culture?

A

wound that is tender, red, swollen, draining fluid/pus, slow to heal, fever

149
Q

Types of breast biopsy

A 
fine-needle aspiration
tissue biopsy (diagnostic)
150
Q

Gene

A

basic unit of heredity passed from parents to offspring

~23000

151
Q

Chromosome

A

live in nucleus
46
22 pairs are autosomes
1 pair is sex chromosomes

152
Q

Karyotype

A

an individual’s collection of chromosomes

153
Q

Gene mutation

A

change in the DNA sequence

154
Q

Types of gene mutations

A

somatic: acquired

germ cell: inherited

155
Q

Genetic marker

A

DNA sequence with a known physical location on a chromosome

156
Q

Autosomal dominant and examples

A

only one copy of gene in each cell is needed
one affected parent
50% chance of inheriting
examples: Huntington, BRCA1/2, Lynch

157
Q

Autosomal recessive and examples

A

2 copies of gene needed
parents usually unaffected (carriers only)
50% chance of carrying, 25% chance of having disease
examples: CF, SS anemia

158
Q

X-linked dominant and example

A 
genes on X-chromosome are mutated
females more frequently affected
fathers can't pass trait to sons
if mother is affected, 50% chance of inheriting disorder for both M and F offspring
fragile x syndrome
159
Q

X-linked recessive and example

A

genes on X-chromosome are mutated
males more frequently affected
fathers can’t pass trait to sons
F offspring need to inherit affected X from both parents
M offspring need to only inherit the affect X from mother
hemophilia

160
Q

Pelvic US used to (7)

A

distinguish between solid and cystic pelvic masses
confirm viability/location of products of conception
determine endometrial thickness
evaluate size/location of uterine myomas
evaluate adnexal masses/fullness
evaluate fetal growth
detect fetal anomalies/abnormalities

161
Q

Types of pelvic US

A

transabdominal (full bladder)

transvaginal (empty bladder) better resolution

162
Q

Mammography used to

A

detect cancerous, precancerous, benign lesions

screening and diagnostic

163
Q

Types of mammography

A

digital, conventional film, 3D/tomosynthesis

164
Q

Mammography findings standardized by

A

BI-RADS (0-5)

165
Q

Breast US is used to

A

diagnose in adjunct w/ mammogram
not a screening tool
differentiated between cystic and solid masses
can be a guide for localized procedures

166
Q

Bone densitometry/bone density testing used for

A

screening, diagnosis, and monitoring treatment for osteopenia and osteoporosis

167
Q

What is the T-score based on?

A

comparing bone density in post-menopausal women to young adult female reference population

168
Q

T-scoring ranges

A

normal: > -1
osteopenia: -1 to -2.5
osteoporosis: @ or < -2.5

NCC Exam - WHNP (6 decks)

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