Ch. 6 Advanced Health Assessment Flashcards
All of these are primitive reflexes that should be checked in infants except:
a. head lag b. ulnar c. rooting d. grasping e. Moro f. Babinski g. glabellar
b. ulnar
In infants, which of these is demonstrated when the head is not righted but lags posteriorly behind the trunk as a result of poor head and neck control:
a. head lag b. Moro reflex c. Babinski sign d. glabellar
a. head lag
Which of these is a normal reflex for an infant when he or she is startled or feels like they are falling. Arms will fling out sideways with the palms up and the thumbs flexed:
a. head lag b. Moro reflex c. Babinski sign d. glabellar
b. Moro (startle reflex)
Which of these is positive when the sole of the foot is firmly stroked, dorsiflexion of the great toe and fanning of the other toes occurs (normal up to 2 years of age):
a. head lag b. Moro reflex c. Babinski sign d. glabellar
c. Babinski sign
Which of these is a reflex that is elicited by repetitive tapping on the forehead. Normal subjects usually blink in response to the first several taps:
a. head lag b. Moro reflex c. Babinski sign d. glabellar
d. glabellar reflex, if blinking persists, the response is abnormal and considered to be a sign of frontal release
Cranial Nerve I and test
Olfactory - Test sense of smell, nasal passages patent, have client close eyes and test each nostril separate
Cranial Nerve II and test
Optic - Relay messages from eyes to the brain to create visual images
- Test vision using Snellen chart (or other chart), examen inner aspect of eyes, test peripheral vision w/ confrontation test
Cranial Nerve III and test
Oculomotor : Allows movement of the eye muscles, constriction of the pupil, focusing the eyes and the position of the upper eyelid. Works with other cranial nerves to control eye movements.
-Test EOMs, check pupils (PERRLA), corneal reflex
-Test this nerve with IV and VI
Cranial Nerve IV and test
Trochlear: Enables movement in the eye’s superior oblique muscle. Makes it possible to look down. Enables you to move your eyes toward your nose or away from it
-Test w/ III and VI
Cranial Nerve V and test
Trigeminal: 3 branches of the trigeminal nerve (the ophthalmic, mandibular, and maxillary divisions). The ophthalmic and maxillary nerves are purely sensory. The mandibular nerve has sensory and motor functions
Test: -Motor - palpate masseter muscles while client clenches teeth, look for disparity between the two muscles, tremor of lips, involuntary chewing, masticatory muscle spams
-Sensory-: Test tactile perception of facial skin, corneal reflex, superficial pain, sense of touch in oral mucosa
Cranial Nerve VI and Test
Abducens: Innervates the ipsilateral lateral rectus muscle and partially innervate the contralateral medial rectus muscle - able to move eye outwards
Test w/ III and IV
Cranial Nerve VII and Test
Facial- controls the muscles that help with smile, frown, wrinkle the nose, and raise the eyebrows and forehead
-Inspect face for flaccid paralysis
-Have client elevate eyebrows, wrinkle forehead, close eyes, frown, smile, puff cheeks
Cranial Nerve VIII and Test
Acoustic - transfers auditory information from the cochlea (auditory area of the inner ear) to the brain
-enables effective hearing
check hearing w/ audiometer or by whisper test
-check hearing loss using Weber and Rinne tests
Cranial Nerve IX and Test
Glossopharyngeal - provides motor, parasympathetic and sensory information to your mouth and throat
-test with cranial nerve X
Cranial Nerve X and Test
Vagus- main nerves of the parasympathetic nervous system. This system controls specific body functions such as digestion, heart rate and immune system
-Test for elevation of uvula by having client open their mouth and say “ah”, test gag reflex
Cranial Nerve XI and Test
Accessory spinal- essential for neck and shoulder movement, the intrinsic musculature of the larynx, and the sensitive afferences of the trapezius and sternocleidomastoid musculature
-test strength of the sternocleidomastoid and trapezius muscles against resistance of your hands
Cranial Nerve XII and Test
Hypoglossal -enables tongue movement -controls the hyoglossus, intrinsic, genioglossus and styloglossus muscles. These muscles allow pt to speak, swallow and move substances around in their mouth
-Look for tremors and other involuntary movements when client protrudes their tongue
Test equilibrium of pt
Romberg test - have client stand straight w/ feet together, arms by sides, eyes closed. Slight swaying is normal, should be able to sustain pose for approx 5 sec. More than slight swaying suggests cerebellar ataxia or vestibular dysfunction
Which of these is the ability to perform rapid alternating movements (pat knees alternating palm and back of hands, touch thumb to each finger):
a. diadochokinesia b. dyssynergia c. stereogenesis d. graphesthesia
a. diadochokinesia, Pt should be able to smoothly execute and maintain rhythm.
-Inability to perform rapids alternating movements; result of a lesion to the posterior lobe of the cerebellum
Which of these includes finger-to-nose test and heel-to-knee test?:
a. diadochokinesia b. dyssynergia c. stereogenesis d. graphesthesia
b. dyssynergia
Which of these test ability for pt to distinguish forms by placing objects in their hand while their eyes are closed:
a. diadochokinesia b. dyssynergia c. stereogenesis d. graphesthesia
c. stereogenesis
Which of these tests ability to identify figures, letters, words by tracing the figure on the skin of the palm of the hand:
a. diadochokinesia b. dyssynergia c. stereogenesis d. graphesthesia
d. graphesthesia
Inability to discriminate between objects based on touch alone is called ______; can be the result of a lesion in the ____lobe
-astereogenesis
-parietal
Inability to recognize letters/numbers “drawn” on the pts hand w/ a pointed object is called ______
-agraphesthesia
Greater than what percentile for BMI places a child at increased risk for being overweight?
> 85th percentile
Normal, Overweight and Obese BMI range
Normal: 20-25
Overweight: 26-29
Obese: 30-35
High BMI = risk factor for all of the following except: a. diabetes b. heart disease c. stroke d. hypotension e. osteoarthritis f. some forms of cancer
d. hypotension, instead is risk factor for hypertension
Pt taking carbamazepine or clozapine with an elevated temp… what should you be concerned about?
Agranulocytosis (pg.83)
Cancerous mole acronym
ABCDE- Asymmetry, Border irregularity, Color variation, Diameter greater than 6 mm, and Elevation
Be alert for Steven-Johnson syndrome with which meds (2)?
Meds like carbamazepine, lamotrigine
Many psychotropics can cause blurry vision, which one has increased risk of cataracts (hint: one of the atypical antipsychotics)?
Quetiapine (Seroquel)
Tympanic membrane normal appearance
translucent pearly gray w/out retractions or bulges
Normal breath sounds include all of the following except:
a. vesicular over peripheral lung b. bronchovesicular over 1st and 2nd intercostal spaces at sternal border c. bronchial over the trachea d. bronchial over the peripheral lunch
bronchial over peripheral lung,
True or False: Lithium and anorexia nervosa can cause peripheral edema
True
True or False: It is normal to hear tympany over the small and large intestine
True
True or False: It is normal to hear tympany over organs and a distended bladder
False, it is normal to hear dullness
True or False: The liver and spleen can normally be palpated
False, but the liver can sometimes be palpable in thin pts
Common indicators of child abuse include all except: a. hx of unexplained multiple fractures b. burns, hand or bite marks c. injuries at various stages of healing d. bruises on knees e. evidence of neglect
d. bruises on knees, instead would be bruises on padded parts of the body
Thyroid gland function:
Take _____ from circulating blood, combine it with the amino acid ______, and convert to the thyroid hormones ____ and _____.
-iodine from circulating blood
-tyrosine
-T3 and T4
-Also stores T3, T4 until they’re released into bloodstream under influence of TSH (released from pituitary)
True or False: Only a small amount of T3 and T4 are bound to protein
True
True or False: The free portion of the thyroid hormones is the true determinant of thyroid status
True
Free thyroxine T4 (FT4) normal value
FT4 (0.8 to 2.8 ng/dl)
FT4 test commonly done for all of the following except:
a. determine thyroid status b. rule out hypothyroidism c. rule out hyperthyroidism d. evaluate thyroid therapy e. all of these are correct
e. all are correct
Diseases that have increased thyroid levels include all of the following except:
a. Graves disease b. primary hypotension c. thyrotoxicosis due to T4 d. Hashimoto’s thyroiditis e. acute thyroiditis
b. primary hypotension, this has decreased thyroid levels
Diseases that have decreased thyroid levels include all of these except:
a. Graves disease b. Primary, secondary, and tertiary hypothyroidism c. thyrotoxicosis due to T3 d. renal failure e. Cushing’s syndrome f. cirrhosis
a. Graves, this is due to increased thyroid levels
note that:
-Secondary hypothyroidism (pituitary insufficiency)
-Tertiary hypothyroidism (hypothalamic failure)
All of these might increase thyroid values during treatment except:
a. heparin b. methadone c. aspirin d. propranolol
b. methadone, which might decrease thyroid values (pg. 87)
What meds might decrease thyroid values during treatment? (2 things)
furosemide (Lasix) or methadone (pg. 87)
Thyroid-stimulating hormone (TSH) normal value
TSH (2-10 mU/l)
Stimulation of thyroid gland by TSH causes…
release and distribution of stored thyroid hormones
True or False: when T4 and T3 are high, TSH secretion decreases
True,
and when T3,T4 are low, TSH increases
Why do TSH levels rise in primary hyperthyroidism?
Because of low levels of thyroid hormone
What happens with TSH if pituitary gland fails
TSH not secreted and blood levels of TSH fall
Diseases w/ increased TSH levels include (2)
-Primary hypothyroidism
-Thyroiditis
Diseases w/ decreased TSH levels (2)
-Hyperthyroidism
-Secondary or tertiary hypothyroidism
What meds might decrease TSH
Tx w/ T3, acetylsalicylic acid, corticosteroids, and heparin
True or False: Systemic effects of hyperthyroidism can mimic symptoms of bipolar affective disorders
True
Systemic effects of hyperthyroidism include all of these except:
a. heat intolerance/excess sweating b. tremor
c. palpitations, tachycardia, dysrhythmias d. increased appetite, weight loss e. muscle aches or stiffness f. motor restlessness, fatigue, insomnia
e. muscle aches and stiffness are signs of hypothyroidism
other sings of hyperthyroidism include:
-short attention span, emotional lability, compulsive movement
-impotence
-abdominal pain
-flushing
-elevated upper eyelid leading to decreased blinking, staring, fine tremor of eyelid
-anxiety
-increased frequency of bowel movements, and shortness of breath
Systemic effects of hypothyroidism include all of these except:
a. confusion b. decreased appetite, constipation, weight gain c. headaches
-confusion, lethargy, memory loss
-decrease libido, impotence
-decrease appetite, constipation, weight gain, fluid retention
-headaches
-slow or clumsy movements, syncope
-muscle aching and stiffness, slowed reflexes
-somatic discomfort (aching and joint stiffness)
-sensory disturbance (hearing)
-cerebellar ataxia
-loss of amplitude in ECG
