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Advanced Health Assessment > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

Good facial landmarks for symmetry

A

nasolabial fold and palpebral fissure

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2
Q

anterior triangle

A

sternocleidomastoid

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3
Q

posterior triangle

A

trapezius

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4
Q

lymphs behind ear

A

posterior auricular, occipital, posterior cervical

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5
Q

lymphs before ear

A

preauricular, tonsilar, submandibular, submental, deep cervical, supraclaviluar

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6
Q

normal lymph nodes

A

less than 1/2 cm, movable, non-tender

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7
Q

infected lymph node

A

enlarged, tender

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8
Q

malignant lymph node

A

hard, non-tender, irregular, fixed

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9
Q

CN1

A

olfactory

  • sensory
  • smell
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10
Q

CNII

A

optic, sensory, sight

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11
Q

CNIII

A

oculomotor, pupils, EOM

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12
Q

CN IV

A

trochlear, EOM

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13
Q

CN V

A

trigeminal, facial sensation and motor muscles of mastication

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14
Q

CN VI

A

abducen, EOM

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15
Q

CN VII

A

facial, muscles, sensory, taste, anterior tongue

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16
Q

CN VIII

A

acoustic, sensory hearing/balance

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17
Q

CN IX

A

glossopharyngeal, sensory/motor gag, swallow, cough reflex, taste, posterior tongue

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18
Q

CN X

A

vagus, sensory and motor

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19
Q

CN XI

A

accessory, motor neck and shoulder strength

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20
Q

CN XII

A

hypoglossal, motor, tongue, “you can’t teach an old dog new tricks”

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21
Q

test CNI

A

Occlude each nostril and breathe to make sure they’re patent

Have pt identify a distinct scent (close eye and occlude one nostril at a time)

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22
Q

test CNII

A

Have pt read, do Snellen eye chart when covering one eye and then both together (no more than 2 mistakes)

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23
Q

test CN 3,4,6

A

follow finger through 6 vision fields (EOM)

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24
Q

test CN 5

A

Sensory- forehead, cheek and chin feel with cotton ball

Motor- strength of jaw muscle, bite on tongue blade and try to pull out on both sides of mouth

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25
Q

test CN 7

A

Have pt make faces: smile, raise eyebrows, frown, puff out cheeks

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26
Q

test CN 8

A

Cover L ear and whisper, cover R ear and whisper

Inner ear responsible for balance

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27
Q

test CN 9, 10

A

Control gag reflex, swallow, cough, symmetrical rise of uvula
Get tongue blade and look for symmetrical rise of uvula, stick tongue out and say “ahh”

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28
Q

test CN 11

A

Raise shoulders against hands

-turn head left and right against hand

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29
Q

test CN 12

A

Stick tongue out, move all around, push against sides of mouth
Say “you can’t teach an old dog new tricks”

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30
Q

head stuff in children

A
  • large lymph nodes, open fontanels

- measure head circ

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31
Q

normal thyroid enlargement

A

teens and pregnancy- high metabolic activity

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32
Q

can assess for bruit in thyroid

A

tell pt to hold breath, normal is no sound

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33
Q

Cushings

A

moon face, could be caused by steriods

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34
Q

fetal alcohol face

A

-short palpebral fissure, thin upper lip, flat midface

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35
Q

TMJ

A
  • can have referred pain

- headache, ear problems, jaw, etc

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36
Q

exam neck

A

neutral, hyperextended and swallowing for masses, symmetry, condition of the skin, ROM

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37
Q

exam thyroid gland

A

Use anterior or posterior approach; locate isthmus below cricoid cartilage; note size, shape, consistency, tenderness, and nodules; auscultate bruits

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38
Q

examine cervical lymph nodes

A

Note size, shape, symmetry, consistency, mobility, location, tenderness, and temperature

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39
Q

Head, face and neck focused assessment

A
  • facial symmetry
  • sensation (CN 5,7)
  • skin/membranes
  • edema, wasting
  • masses, tenderness
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40
Q

PMH head face neck

A

ca history, toxins, allergies, ENT surgeries

  • sexual practices (HIV risk)
  • thyroid in family
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41
Q

ROS head face neck

A

wt changes, palpitations, bowel changes, temp intolerance, fever, chills, itching
-ETOH and tobacco

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42
Q

head face and neck PE

A

Palpation of thyroid, lymph nodes
Inspect hair, skin, periorbital edema
Reflexes (deep tendon)
Examination of mouth, throat, ears, eyes- look or evidence of infection; if evidence of mono- abdominal exam to see if spleen enlarged

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43
Q

tests for head face and neck

A 
TSH
CBC
Monospot if evidence consistent with mono
CXR if lymphadenopathy present 
Chalmydia, Gonorrhea, HIV testing
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44
Q

hyperthyroid s/s

A

heat intolerance, bulging eyes, flushed, enlarged thyroid, tachy, weight loss

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45
Q

hypothyroid s/s

A

-cold intolerance, weak heartbeat, depression, big tongue, high LDL

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46
Q

external ear inspection

A
  • low set is down syndrome
  • malformed in kids could mean malformed kidneys
  • angle of attachment near 10 degrees
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47
Q

external ear inspection

A
  • low set is down syndrome
  • malformed in kids could mean malformed kidneys
  • angle of attachment near 10 degrees
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48
Q

ears and aging

A

hearing loss, thick cerumen, less flexible TM, presbycusis, tinntitis, otoslerosis
-vestibular changes, menieres

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49
Q

presbycusis

A

lose hearing of higher frequency

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50
Q

tinnitius

A
  • many with hearing loss, most elderly

- can be caused by drugs

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51
Q

otoslerosis

A

caused by abnormal bone growth, often herediatary

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52
Q

vestibular (inner ear) changes

A

sensory, dysequillibrium, vertigo

-decrease in receptors, bony labrynth changes

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53
Q

meneieres dx

A

bone labryrinth dysfunction

  • vertigo, ear pressure, tinnitis, neurosensory hearing loss
  • *typically unilateral
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54
Q

history of ear

A 
Hearing loss
 Vertigo
 Ringing in the ears (tinnitus)
 Ear drainage (otorrhea)
 Earache (otalgia)
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55
Q

whispered voice test

A

assesses gross hearing

Cover one ear and whisper into opposite ear, standing a few feet away

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56
Q

weber test

A

Tuning fork top of head or forehead

Should be equal in both ears

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57
Q

rinne test

A

compare bone conduction to air conduction
Air is twice as long as bone, put tuning fork on mastoid process behind ear
Problems in external or middle ear

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58
Q

palpate ear

A

tragus, mastoid, helix for tenderness

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59
Q

to straighten adult ear

A

up and back

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60
Q

normal TM

A

pearly gray, 5 o clock right and 7 o clock left cone of light

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61
Q

assess cornea

A

shoot air over eye causing them to blink

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62
Q

assess anterior chamber of eye

A

space between cornea and iris, should be clear, shine light from side

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63
Q

acute closed angle glaucoma

A

medical emergency

  • dilated pupil, red sclera
  • pt can go blind
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64
Q

adolescent vision

A

more nearsighted

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65
Q

children born with ___ vision

A

2200

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66
Q

aging eyes

A

-thick cornea, astigmatism, arcus senilus, glaucoma, acuity issues, floaters, presyopia

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67
Q

arcus senilus

A

white fat deposits around rim of cornea

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68
Q

floaters

A

loose cells in vitreous cast shadows on retina, can be worrisome

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69
Q

presbyopia

A

lose close vision as you age

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70
Q

history eye assessment

A 
Vision loss		 Eye pain
 -Double vision	 -Blurred vision
 Eye tearing	-Dry eyes
 Eye drainage    -Floaters
 Eye appearance changes
-glaucoma, surgery, cataracts
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71
Q

exam far vision

A

snellen chart, 20 20 normal

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72
Q

exam near vision

A

read newspaper 13-15” away

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73
Q

exam color vision

A

color bars on snellen or color plates

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74
Q

assess peripheral vision

A

come in from the periphery in all fields and note field cuts (wiggle fingers)
*will only see gross field cuts, not small changes

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75
Q

extraocular tests

A
  • parallel on inspection
  • corneal light reflex (sparkle in same spot)
  • 6 fields of gaze
  • cover/uncover for drifting (accomodation)
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76
Q

what CNs control eye movement

A

CN 3,4,6

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77
Q

pupil tests

A
  • reaction to direct light and consensual

- accomodation as finger moves toward patient

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78
Q

conjunctivitis

A

pink eye

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79
Q

pterygium

A

benign, abnormal growth of tissue

-can affect vision if it extends over pupil

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80
Q

what to see eyes with otoscope

A

-red reflex, optic disc, retinal vessels, retina, macula and fovea

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81
Q

optic disc assessment

A

-round, white in center

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82
Q

macula assessment

A

area of most acute vision, dark area, not well defined

83
Q

eye questions

A

Precipitating event? Previous history? Duration? Contacts??

Associated sx: burning itching, pain, exudate, allergies, trauma, tearing, dryness, photosensitve, visual changes

84
Q

PE eye

A 
Visual acuity
EOM
External Structures
Corneal clarity
Exudate
Tearing
Facial characteristics
Regional lymphadenopathy
85
Q

conjunctival exam

A 
Note palpebral and bulbar portions
Redness
Cloudiness
Lesions
Follicles
Edema
86
Q

differentials for eye

A 
Corneal injury/trauma
Blepharitis
Scleritis
Conjunctivitis
Anterior uveitis or iritis
Acute angle glaucoma
Chemical burn
Hordeolum
87
Q

glaucoma

A

Usually complain about peripheral vision
Open angle
Closed angle- severe pain, red conjunctiva, dilated pupil, medical emergency

88
Q

macular degeneration

A

loss of central vision

89
Q

frontal sinus

A

above the eye

90
Q

maxillary sinus

A

either side of nose

91
Q

mumps

A

parotiditis

92
Q

taste and smell aging changes

A
  • less sensitive taste (nutrition deficiencies)
  • less able to identify odors (safety issue?)
  • olfactory dysfunction
93
Q

olfactory dysfunction associated with

A

alz, parkinsons, huntingtons

94
Q

PE nose

A
  • salivary gland- large, tender
  • nose, septal deviation, patency
  • sinuses- edema, tenderness
  • parotid and submandibular glands- edema, red, tender
95
Q

PE oropharynx

A

test gag reflex

96
Q

tonsils PE

A

color, exudates, enlarge

97
Q

uvula PE

A

symmetical rise (CN 9 and 10)

98
Q

to test trigeminal nerve

A

bite down on stick both sides of mouth

-stick tongue out and move around

99
Q

chilitis

A

crack at corner of mouth

100
Q

angioedema

A

need to maintain airway, s/e of ACEi

101
Q

leukoplakia

A
  • white spots on tongue

* *precancerous

102
Q

anterior nosebleed

A

trauma

103
Q

posterior nosebleed

A

anticoag, OTC meds, drug use, sinus infection

104
Q

pharyngitis PE

A

Include assessment of the upper and lower respiratory systems; eyes, ears, nose, mouth, throat, and lungs.
Also palpate cervical LN
More thorough neck exam if symptoms warrant

105
Q

respiratory viruses

A
  • s/s HA, fever, chills, rhinnitis, conjunctivities, cough, GI
  • inflammed pharynx, present anterior adenopathy
106
Q

herpes pharyngitis

A

malaise, fever

-inflammed and ulcered

107
Q

herpangitis (hand foot and mouth)

A

malaise, lesions on hand feet buttock gentials

-inflamed and ulcered

108
Q

group a strep

A

quick onset, malaise, n/v HA sandpaper rash, cough, conjuncitibvies, inflammation with white/gray tonsilar exudate

109
Q

peritonsillar abscess

A

Usually associated with tonsillitis
Most common pathogen GABHS
Key S/S- worsening unilateral sore throat over days, fever, malaise, increasing difficulty with swallowing, speaking, foul smelling breath, drooling
Exam may be difficult= trismus, area adjacent to tonsil swollen, tonsil & uvula deviated, voice muffled

110
Q

mono

A

exudates on tonsils

111
Q

ludwigs angina

A

medical emergency

  • can happen after dental work
  • lose airway!
112
Q

additional throat tests

A 
Strep screen or culture
CBC
Mono spot 
Other cultures for viruses, GC
ESR if thyroiditis suspected
113
Q

strep vs mono

A

anterior nodes-strep

posterior nodes-mono

114
Q

infant skin

A
  • lanugo, vernix caseosa
  • stork bite, cradle cap, milia
  • more prone to fluid loss (poor temp regulation)
115
Q

adolescent skin

A
  • increase in subQ fat
  • inc sebaceous gland activity
  • secondary sex characteristics
116
Q

pregnant skin

A
  • linea nigra, cholasma on face, striae gravidarum (stretch marks)
  • inc body temp, inc fat deposit
117
Q

aging skin

A
  • dec collagen and elastin, dec subQ fat
  • inc risk of tearing
  • dec ability to cool due to dec sweat glands
  • more skin lesions
118
Q

HPI skin

A

Changes in pigmentation, birthmarks, or moles (size, shape, color)
-skin and hair self care

119
Q

ROS skin

A 
Neuro
GI- ex: liver/jaundice, crohns/lesions
CV- HF/edema
Respiratory
Endocrine
120
Q

woods light

A

fungal infection

121
Q

cyanosis

A

central vs peripheral

122
Q

jaundice

A

locations, sclera

123
Q

pallor

A

local vs systemic, low hgb?

124
Q

dependent rubor

A

vascular dx

125
Q

distribution of lesions

A

can help you diagnose (ex: shingles)

126
Q

petechiae

A

small pinpoint red lesions, small capillaries are breaking

127
Q

purpura

A

larger than petechiae

-small bursted blood vessels

128
Q

hematoma

A

walled off collection of blood, can be evacuated

129
Q

inspection

A

-moisture, temp, texture

130
Q

primary lesion

A

initial change

131
Q

secondary lesion

A

change to primary- can add or take away

-ex: scaling, ulcers, fissures, crusts

132
Q

serpiginous

A

snakelike

-seen with hookworm or scabies

133
Q

arrangement of lesions

A

discrete- one here and there

  • reticular- network like structure
  • annular- fungal
134
Q

wheal

A

palpable

-temporary elevation of skin, ex: PPD

135
Q

Lesions < 1cm

A 
Macule (flat)- freckle
Papule (elevated)
Nodule (deep)
Vesicle (clear fluid)
Pustule (pus)
136
Q

lesions > 1cm

A

Patch (flat)- birthmark
Plaque (elevated)
Tumor (Deep)
Bulla (clear fluid)

137
Q

psoriasis

A

a plaque

-silvery appearance

138
Q

hive

A

palpable

>1 cm

139
Q

vesicle

A

fluid filled

140
Q

bulla

A

-fluid filled, often seen in burns

141
Q

hidradenitis suppurativa

A

example of a cyst

142
Q

lichenification

A

secondary lesions

  • thickened elephant like skin
  • seen in venous insufficiency
143
Q

healing pressure ulcer

A

-doesn’t get better stages at it heals

“healing stage 4” etc.

144
Q

tilangectasis

A

-spider angiomas on face

145
Q

vascular lesions

A

spider angioma vs cherry angioma

146
Q

turgor

A
  • decreased = dehydration

- not accurate in elderly due to dec skin elasticity

147
Q

acne

A

inflammation of pilosebaceous units with comedones, papulopustules and/or nodular cysts; more severe in males than females

148
Q

roseacea

A

-disorder of pilosebaceous units coupled with hyperreactivity of capillaries to heat
-flushing and telangiectasia
Onset 30-59 years. Predominant in females

149
Q

hidradenitis suppurativa

A

Major characteristics: chronic, suppurative disease of apocrine gland-bearing skin. May be associated with severe nodulocystic acne and pilonidal sinuses. Onset at puberty, affects females> males.

150
Q

eczema/dermatitis

A

polymorphic inflammatory reaction patterns involving the epidermis and dermis. Acute-pruritis, erythema, vesiculation. Chronic-pruritis, xerosis, hyperkeratosis, +/- fissuring

151
Q

psoriasis

A
  • scaly plaques on extensor surfaces, chronic and recurring

- herediatry, physical trauma is key factor, may flare with stress (BB, steroids, antimalarials, interferon)

152
Q

erythroderma

A

severe form of psoriasis

-involves entire body

153
Q

psoriasis arthritis

A

arthritis-a seronegative spondyloarthropathy, asymmetric peripheral joint disease, usually in UE esp. in small joints.

154
Q

seborrheic dermatitis

A

a common chronic dermatosis with red, scaly lesions where sebaceous glands most active- face, scalp, skin folds. Yellow-red or gray-white scaly macules & papules with sticky appearance“Cradle cap” in infants, pityriasis sicca(dandruff)

155
Q

dermatophytosis

A

infection of hair skin nails

156
Q

tinea pedis

A

Fungal infection of the feet (athlete’s foot) characterized by erythema, scaling, maceration and/or bulla. Often starts on the feet and spreads to other areas of the body.

157
Q

tinea manum

A

Chronic dermatophytic infection of the hand(s) often unilateral, on the dominant hand, associated with tinea pedis.

158
Q

tinea corpus

A

Refers to dermatophyte infection of the trunk, arms, legs and/or neck, excludes feet, hands and groin.

159
Q

tinea capitis

A

Capable of invading the hair follicles and shaft. Appearance may vary, with mild scaling and broken-off hair, to severe painful inflammation with boggy, nodules draining pus, resulting in scarring and alopecia.

160
Q

cutaneous candidiasis

A
  • skin folds
  • treated with nystatin
  • at risk: diabetes, systemic alterations in immunity, use of broad spectrum antibiotics.
161
Q

impetigo

A
  • infection caused by staph or strep.
  • Itching is only symptom.
  • *honey comb colored lesions
  • common in kids
162
Q

herpes simplex

A

primary or recurrrent often appears as clustered vesicles on an erythematous base or keratinized skin or MM.

163
Q

herpes zoster

A

acute dermatomal infection associated with reactivation of varicella-zoster characterized by unilateral pain and vesicular or bullous lesions limited to a dermatome. (shingles)
***can be eye emergency

164
Q

herpes simplex details

A
  • keratinocyte infection

- HSV 1 and 2

165
Q

HSV2

A

Fever, lymphadenopathy, perineum pain
Grouped vesicles that ulcerate
Peri-anal lesions
Eruption lasts 18-21 days (8 if recurrent)
Recurrent usually less painful and shorter
Need to distinguish from genital zoster

166
Q

HARMM melanoma risk model

A
  • hx previous melanoma
  • age > 50
  • reg dermatologist absent
  • mole change
  • male gender
167
Q

ABCDE for lesions

A 
A (asymmetrical)
B (borders) irregular
C (color) is it changing or multicolored
D (diameter) > ½ cm *head of an eraser
E (elevation)- is it enlarging?
168
Q

basal cell carcinoma

A

translucent nodule, firm border with depressed center
Normally on sun exposed areas
Very common

169
Q

squamous cell carcinoma

A

firm scale; often face or back of hand

scaly!

170
Q

actinic keratosis

A

pre-cancerous squamous cell

-white scale

171
Q

malignant melanoma

A
  • irregular, can be dark
  • blacks can get this in nail
  • can be anywhere on body
172
Q

leukonychia

A

white lines or dots, harmless

173
Q

mees lines

A

white bands across, can be metal poisoning

174
Q

beaus lines

A

indentations, can be from DM, PVD, zinc deficiency

175
Q

pitting nails

A

common in psoriasis

176
Q

skin disorders assoc with crohns and UC

A

erythema nodusum, pyoderma gangrenosum, aphthous ulcers

177
Q

skin disorders associated with diabetes

A

-diabetic dermopathy, acantosis nigraicans, necrobiosis lipoidica diabeticorum

178
Q

comprehensive health history

A
  • patient identifiers
  • reliability
  • chief complaint
  • HPI, PMH, FH, SH, ROS
179
Q

OLDCART

A

part of HPI

-onset, location, duration, character, aggravating, relieving, treatment

180
Q

PQRST

A

part of HPI

-Precipitating/palliative factors, Quality/quantity, Region/radiation/related symptoms, Severity, Timing

181
Q

purpose of HPI

A

symptom analysis

182
Q

chief complaint

A

expressed in pts own words, quote them, reason for visit

183
Q

PMH

A
  • childhood/adult illness
  • allergies, meds
  • hospitalizations, injuries
  • vaccines, screening exams
  • psych/mental health issues
184
Q

FH

A

Major illnesses and health status of relatives- ask about age, health status, and presence or absence of blood relatives. Ask specifically about cancer (what kind), HTN, stroke, MI, CAD, neurologic disorders such as epilepsy, Huntington’s disease, dementia, DM, TB, asthma and allergic disorders, arthritis, anemia, thyroid disease, mental illness
Genetic defects- CF, Tay-Sachs, beta thalassemia, hemophilia
Deaths-note cause of death and relationship to pt.
Ethnicity

185
Q

SH

A

-relationship status, education, occupation, housing, safety, diet, exercise, sleep, drug alc use, stress, military service

186
Q

ROS

A
  • list of questions you ask about each system

- chart peritinent pos and negs

187
Q

general ROS questions

A

wt. changes, fever, chills, night sweats, changes in appetite, energy level, exercise tolerance, ability to carry out usual ADLs

188
Q

skin ROS

A

Any changes including- rashes, itching, pigment changes, moisture or dryness, changes in texture, changes in color, shape of moles, changes in nails, hair growth or loss

189
Q

eye ROS

A

any injuries, double vision, changes in acuity, sudden loss of vision, tearing or dryness, blind spots, floaters or seeing spots, eye pain, inability to see at night, photophobia, haloes around lights.

190
Q

ear ROS

A

pain, discharge, injury ( including barotrauma), changes in hearing acuity, tinnitus, balance problems, frequency & severity of ear infections, care of ears, including wax removal.

191
Q

nose ROS

A

nosebleeds, colds, obstruction, discharge (color & quantity), changes in sense of smell, polyps, sneezing, PND.

192
Q

mouth/throat ROS

A

dental problems, lesions, gum problems, bleeding, dentures, adequacy of saliva, hoarseness, dysarthria, sore throats (frequency, severity & duration), changes in tongue appearance, sense of taste. Neck stiffness, pain or tenderness, masses in thyroid, lymph nodes, or other areas.

193
Q

CV ROS

A

Chest pain, substernal discomfort, palpitations, syncope, DOE, orthopnea, paroxysmal nocturnal dyspnea, edema, cyanosis, HTN, heart murmurs, varicose veins, phlebitis, claudication, hemoptysis, coldness or color changes in extremities.

194
Q

Respiratory ROS

A

Pain (associated with location, quality, relation to breathing, SOB, dyspnea, wheezing, stridor, cough-note time, of day, +sputum production (amount, color), hemoptysis, respiratory infections, TB exposure or infection, fever, night sweats, recent CXR if applicable.

195
Q

GI ROS

A

Appetite, dysphagia, indigestions, food intolerance, abdominal pain, heartburn, eructation, nausea, vomiting, hematemesis, jaundice, polyps, constipations, diarrhea, abnormal stools ( change in color, odor, clay or tarry colored, bloody), flatulence, hemorrhoids, recent change in bowel habits.

196
Q

GU ROS

A

urgency, frequency, dysuria, colicky pain in flanks, suprapubic pain, facial swelling, nocturia, hematuria, polyuria, oliguria, unusual color or odor of urine. History of stones, infection, nephritis, hernia, hesitancy, changes in force of stream, dribbling, acute retention or incontinence, change in libido, potency, genital lesions, discharge, STIs.

197
Q

breast ROS

A

Ask about breast masses or lumps, lesions, tenderness, swelling, nipple discharge, dimpling/retraction, BSE. Remember breast cancer can occur in men as well as women.

198
Q

musculoskeletal ROS

A

pain, swelling, redness, heat of muscles, or joints; bone deformity, limited movements, muscle weakness, atrophy, or cramps.

199
Q

neuro ROS

A

any headaches, lightheadedness, seizures, paralysis, incoordination, sensory changes, changes in mentation, loss of consciousness, difficulty with memory, or speech, motor disturbances, changes with balance, irregular movements or tremors.

200
Q

mental ROS

A

mood changes, emotional problems, anxiety, depression, including suicidal ideation, if appropriate, difficulty with concentration, previous psychiatric care, unusual perceptions, hallucinations.

201
Q

hemo ROS

A

anemia, abnormal bleeding or bruising, clotting disorders, history of transfusion, reactions?

202
Q

endo ROS

A

polyuria polydipsia, polyphagia, unexplained weight changes, changes in texture of hair, skin, changes in hair distribution, changes in energy, appetite, thyroid enlargement or tenderness, changes in hat, glove, or shoe size, changes in secondary sex characteristics, intolerance to heat or cold.

203
Q

percussion can tell you

A

Density (air, fluid, solid)
Size and shape
Tenderness
Deep tendon reflexes

204
Q

percussion sounds

A
  • resonance- normal lungs
  • hyper-resonance- COPD
  • dull- organs
  • flat- muscle or soft itssue
  • tympany- abdomen

Advanced Health Assessment (3 decks)

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