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Physical Assessment > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

Nursing diagnosis is concerned with?

A

Impact of of health on the individual and caring

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2
Q

SOAP

A

Subjective, objective, assessment, plan

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3
Q

Subjective?

A

Symptoms as reported by patient

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4
Q

Objective?

A

Observed signs

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5
Q

Comprehensive database

A

Traditional H&P

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6
Q

Episodic databse

A

Problem centered

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7
Q

Follow Up Database

A

Problem centered, f/u on stable patient

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8
Q

Emergency Database

A

ABCs

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9
Q

Components of classic H&P

A

Chief complaint, history of present illness, past medical history, current health history, social/occupational/family history, functional assessment, review of systems, physical exam

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10
Q

Analyze symptom using…

A

PQRSTU. Provocative/Palliative, Quality/Quantity, Region/Radiation, Severity Scale, Timing, Understand

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11
Q

Para

A

of live births

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12
Q

Gravata

A

of pregnancies

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13
Q

BMI formula

A

weight (kg) / height (m) squared

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14
Q

Average oral temp

A

37 degrees c

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15
Q

average pulse rate

A

60-100

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16
Q

Average respiration rate

A

10-20

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17
Q

Average blood pressure

A

120/80

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18
Q

What can high bp lead to?

A

Heart failure, left ventricular hypertrophy, stroke, ischemic attack, chronic kidney disease, peripheral arterial disease, retinopathy

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19
Q

Ausculatory gap

A

silent interval that may be present between systole and diastole

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20
Q

Orthostatic hypertension

A

Drop in systole of 20 or pulse increase of 20 when changing positions (sit -> stand)

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21
Q

Canthus

A

corner of eye

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22
Q

caruncle

A

pink tissue in medial canthus

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23
Q

limbus

A

dark line surrounding iris

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24
Q

tarsal plate

A

strips of connective tissue that gives eye shape, contains meibomian glands which secrete oily lubricant

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25
Q

Palpebral conjunctiva

A

lines eyelids

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26
Q

Bulbar conjunctiva

A

Overlays eyeball anteriorly

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27
Q

Lacrimal apparatus

A

Constantly irrigates eye, tears drain into the puncta which drains into nasolacrimal sac which drains into inferior meatus

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28
Q

Sclera

A

fibrous layer of eye

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29
Q

Choroid

A

Vascular layer of eye

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30
Q

Retina

A

nervous layer of eye

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31
Q

What can you see in ophthalmoscope view?

A

4 sets of retinal vessels, retinal field, optic disc, macula

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32
Q

Optic disc

A

on the nasal side of retina, where fibers converge to form optic nerve (CNII), blind spot because no receptors

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33
Q

Macula

A

on the temporal side of the retina, surrounds fovea centralis (point of sharpest vision)

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34
Q

How many extrocular muscles?

A

4 rectus, 2 oblique

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35
Q

Which cranial nerves innervates the lateral rectus muscle?

A

CNVI (abducens) and abducts eye

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36
Q

Which CN innervates the superior oblique muscle?

A

CN IV (trochlear), down and towards nose

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37
Q

Which muscles does CNIII innervate?

A

Oculomotor, all the muscles except superior oblique and lateral rectus muscle

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38
Q

Visual pathway

A

light off object –> retina –> optic nerve –> optic chiasm –> optic tract –> optic radiation –> occipital lobe

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39
Q

Images are projected?

A

upside down and reveresed right to left

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40
Q

Direct pupillary light reflex CNs

A

subcortical reflex arc (subconscious), afferent link is CNII and efferent link is CNIII

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41
Q

How are infant eyes different?

A

macula are not fully developed, poorly coordinated eye muscles, less pigmentation in iris

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42
Q

How are elderly eyes different?

A

Skin loses elasticity, floaters in vitreous humor, lens can’t accomodate as well so vision is blurry

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43
Q

Arcus senilis

A

degenerative lipid material forms a grey ring around iris

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44
Q

Presbyopia

A

farsightedness caused by loss of elasticity of lens

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45
Q

Cataracts

A

lens discolors and thickens, gets cloudy

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46
Q

Glaucoma

A

increased intraocular pressure damages optic nerve, happens more in men

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47
Q

Macular degeneration

A

macula degenerates, happens more in women

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48
Q

Strabismus

A

Test with corneal light reflex, cross eye/lazy eye, diplopia (double vision)

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49
Q

Myopia

A

nearsighted

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50
Q

Hyperopia

A

farsighted

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51
Q

Legally blind

A

20/200

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52
Q

Anisocoria

A

pupils are different sizes

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53
Q

Entropion

A

Eyelashes fold in and irritate cornea

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54
Q

Nystagmus

A

Oscillation of eyes, can be a sign of drug use, test with 6 cardinal positions of gaze

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55
Q

bitemporal hemianopsia

A

optic chiasm is cut so fibers can’t cross over so visual loss of temporal half of each field

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56
Q

left homonymous hemianopsia

A

right optic tract is cut/lesion, visual loss involves same half of each eye, in this case the right side of the retina so left temporal vision field and right nasal field are disrupted

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57
Q

AV Nicking

A

Arterial venous nicking, sign of hypertension, artery and vein cross in eye causing compression of vein

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58
Q

Papilledema

A

Inflammation of optic disc from increased intracranial pressure, disc is cloudy, usually bilateral, if untreated can lead to blindness

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59
Q

3 main facial muscles

A

frontalis, temporalis and masseter

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60
Q

CNVII

A

facial nerve, innervates frontalis, temporalis and masseter, facial expressions

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61
Q

CNV

A

trigeminal nerve, pain and touch of facial muscles

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62
Q

What are flat nasal labial folds a sign of?

A

Stroke or bells palsy

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63
Q

What are enlarged parotid glands a sign of?

A

mumps

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64
Q

Where are the parotid glands?

A

located in cheeks over mandible

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65
Q

sternoclidomastoid muscle innervation and movement

A

CNXI (accessory), rotation and flexion of head

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66
Q

trapezius muscle innervation and movement

A

CNXI (accessory), move shoulders and extend head

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67
Q

preauricular lymph nodes

A

in front of ears, drain scalp, forehead, ears and eyelid

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68
Q

posterior auricular nodes

A

behind ears, drains parietal scalp and external ear

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69
Q

occipital nodes

A

at the base of skull, drains parietal scalp

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70
Q

How to test CNXI?

A

shrug shoulders and turn head

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71
Q

what is an off center trachea the sign of?

A

sign of collapsed lung or tumor pushing it off center

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72
Q

what is a bruey in carotid the sign of?

A

artery is at least 70% occluded

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73
Q

Tonsilor nodes

A

at angle of jaw, drains tonsils, floor of mouth, posterior palette, thyroid gland

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74
Q

submandibular nodes

A

drains mucosa of mouth an dlips, tongue, conjunctiva, submaxillary glands

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75
Q

submental glands

A

drains tongue, floor of mouth, mucosa of mouth and lips

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76
Q

superficial cervical nodes

A

overlying sternoclidomastoid muscle, drains ear and skin of neck

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77
Q

posterior cervical nodes

A

drains thyroid, posterior scalp and posterior neck skin

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78
Q

deep cervical nodes

A

drains thyroid, trachea, posterior scalp and posterior neck skin

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79
Q

superclavicular nodes

A

closest to heart, right node drains mediastinum/lungs/esophagus, left node drains thorax and abdomen

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80
Q

thyroid gland

A

isthmus lies over trachea, largest endocrine gland, makes T3 and T4 hormones to regulate cellular metabolism and growth

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81
Q

acromegaly

A

pituitary gland makes too much growth hormone, enlarged bones

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82
Q

fetal alcohol syndrome

A

thin upper lip, flat nose, wide eyed

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83
Q

bell’s palsy

A

peripheral lesion of CNVII (facial), partial facial paralysis

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84
Q

goiter

A

enlarged thyroid

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85
Q

how often do you need to measure infant’s skull?

A

ages 0-6, every visit until age 2 and yearly after

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86
Q

anterior fontanel

A

between frontal and parietal bone, intersection of coronal and metopic sutures, closes 12-18 months, diamond shape

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87
Q

posterior fontanel

A

triangle shape, sagittal and lamboid sutures, between parietal and occiptial bones, closes 6 weeks - 2 months

88
Q

what are the 3 layers of skin?

A

epidermis, dermis and subcutaneous

89
Q

epidermis

A

stratefied squamos epithelium, avascular

90
Q

stratum corneum

A

part of the epidermis, top protective barrier of keratinized cells, regulates water loss

91
Q

stratum germinativum

A

deepest layer that lies closest to dermis where there is active cell generation

92
Q

dermis

A

highly vascular, regulates body temperature by dilating/constricting blood vessels, contains sensory fibers and nourishes epidermis, can stretch/contract

93
Q

subcutaneous/hyperdermis

A

structures/anchor, loose connective tissue and subcutaneous fat, retains heat/calories/cushion

94
Q

eccrine sweat glands

A

regulates body temperature via water secretion, almost everywhere

95
Q

apocrine sweat glands

A

deeper, only in axilla, nipples, anogenital area, eyelids, external ear, responds to emotions by secreting fluid with proteins, decomposes to make BO

96
Q

sebaceous glands

A

secretes sebum to prevent dry hair and skin, in face and scalp but not in hands and feet

97
Q

papilla

A

capillary loop at follicle that provides nourishment

98
Q

nail is made of?

A

epidermal cells converted to hard plates of keratin

99
Q

lunula

A

new nail growth

100
Q

pitting in nails is a sign of?

A

psoriasis

101
Q

erythema

A

reddening of skin in patches

102
Q

vitiligo

A

loss of color in blotches

103
Q

acanthosis nigricans

A

area of dark, velvety discoloration in body folds

104
Q

mongolian spots

A

on babies, does not blanch when pressed on, goes away with age, blue/brown

105
Q

cafe au lait spot

A

flat, pigmented birthmarks, light brown, only worry if 6 or more

106
Q

acrocyanosis

A

persistent blue extremities, usually benign and goes away

107
Q

cutis marmorata

A

blue/red veiny pattern when cold, worry for babies b/c they need more O2 when it is cold

108
Q

comedonal acne

A

white head or black head

109
Q

pustular acne

A

infected red pimple

110
Q

seborrheic keratosis

A

scaly, warty, raised growths, not malignant, black or brown

111
Q

senile lentigines

A

sun spots/liver spots

112
Q

diaphoresis

A

excess sweat

113
Q

edema causes?

A

DVT, chronic, venous insufficiency, lymphedema, orthostatic edema, congestive heart failure

114
Q

mobility

A

skin’s ease of rising

115
Q

turgor

A

skin’s ability to return to place, reflects moisture and elasticity

116
Q

purulent

A

pus drainage

117
Q

serous

A

yellow-clear serum

118
Q

serosanguinous

A

serous + blood

119
Q

eschar

A

dead tissue, contains necrotic tissue, black

120
Q

ecchymosis

A

bruise

121
Q

excoriation

A

scratch

122
Q

decubitus

A

lying down ulcer

123
Q

macule

A

primary, circumscribed, flat, nonpalpable change in skin color, up to 1 cm, ex. freckles, ptechiae

124
Q

patch

A

primary, macule larger than 1 cm, ex. liver spots, mongolian spot

125
Q

papule

A

primary, palpable, elevated, circumscribed, solid mass with no fluid inside, up to 1cm

126
Q

plaque

A

primary, flat, elevated surface larger than 0.5cm, lots of papules together

127
Q

nodule

A

primary, solid, elevated, firm or soft mass less than 1-2cm, can extend deeper into the dermis than a papule, ex. fibroma, intradermal nevi

128
Q

tumor

A

primary, solid, elevated firm or soft mass larger than 1-2cm, extend deeper into dermis, can be benign or malignant

129
Q

lipoma

A

primary, fatty tumor

130
Q

hemangioma

A

primary, pink growth filled with blood

131
Q

wheal

A

primary, superficial, raised, red, transient lesion, with somewhat irregular borders due to localized edema, fluid is held diffusely in the tissues, ex. mosquito bite

132
Q

urticaria

A

primary, wheals that are super itchy, like hives

133
Q

vesicle

A

primary, circumscribed, superficial, elevated cavity containing free fluid, up to 1cm, ex. herpes simplex

134
Q

bullae

A

primary, larger vesicle, single chambered, superficial in epidermis, thin walled, larger than 1cm, ex. friction blister

135
Q

cyst

A

primary, incapsulated fluid/pus filled cavity in dermis or subcutaneous layer, larger than 1cm, ex. sebaceous cyst

136
Q

pustule

A

primary, circumscribed, superficial, elevated cavity, contains turbid fluid (pus), up to 1cm, ex. impitigo, acne

137
Q

crust

A

secondary, dried residue of burst vesicle

138
Q

scaling of tinea pedis

A

secondary, compact desiccated flakes of skin, dry/greasy, from shedding of dead excess keratin, visible white/silver exfoliation of dermis

139
Q

fissures

A

secondary, linear crack with abrupt edges, can extend to dermis

140
Q

erosion

A

secondary, superficial, circumscribed loss of epidermis, leaves scooped out shallow depression, moist but no blood, heals w/o scar, stage 2 pressure sores

141
Q

ulcer

A

secondary, extends into dermis, may bleed, leaves scar

142
Q

scar

A

secondary, fibrous connective tissue

143
Q

atrophy

A

secondary, stretch marks, thinning epidermis leads to depressed skin level

144
Q

lichenification

A

secondary, thickening/roughening of skin as a result from intense scratching, ex. eczema

145
Q

annular

A

circular

146
Q

confluent

A

lesions running together

147
Q

discrete

A

lesion is alone

148
Q

grouped

A

cluster of lesions

149
Q

gyrate

A

twisted, coiled

150
Q

target

A

lyme disease

151
Q

polycyclic

A

circular lesions

152
Q

zosteriform

A

along dermatome

153
Q

petechiae

A

secondary, flat, red, pin sized macules of blood,

154
Q

purpura

A

larger macule/papule of blood, 0.3-1cm, does not blanch

155
Q

ecchymosis

A

1cm, non-elevated, rounded/irregular, blue/purple patch

156
Q

cherry angioma

A

bright red papule, benign

157
Q

spider angioma

A

legs radiating from center, disappears when pressed down, sign of liver disease

158
Q

telangiectasia

A

permanently dilated vessels, can be in basal cell carcinomas/nifedi pine

159
Q

nevus flammeus

A

port wine stain, present at birth, dilated dermal capillaries, pale pink to purple macules, face & trunk

160
Q

herpes simplex I

A

cold sore vesicles, oral

161
Q

herpes simplex II

A

genital

162
Q

varicella

A

chicken pox

163
Q

herpes zoster

A

shingles, on one side of body, can cause deafness/blindness/facial paralysis

164
Q

skin cancer warning signs

A

ABCDEE, asymmetry, border, color, diameter, elevation, enlargement

165
Q

basal cell carcinoma

A

most common, slow growing, rarely metastisized, translucent, dome-shaped papule with overlying telangiectasia

166
Q

actinic keratosis

A

malignant potential, flaky patches

167
Q

squamous cell carcinoma

A

invasive malignancy, can arise from actinic keratosis, heals/breaks down

168
Q

alopecia areata

A

non-scarring hair loss, sharply defined area, usually immunological

169
Q

hirsution

A

excessive female hairiness

170
Q

clubbing

A

nails rounded, angle flattens out, can be a sign of lung disease or cancer

171
Q

CNI

A

olfactory, smell

172
Q

CNII

A

optic

173
Q

CNIII

A

oculomotor

174
Q

CNIV

A

trochlear

175
Q

CNV

A

trigeminal

176
Q

CNVI

A

abducens

177
Q

CNVII

A

facial

178
Q

CNVIII

A

vestibulocochlear

179
Q

CNIX

A

glossopharyngeal

180
Q

CNX

A

vagus

181
Q

CNXI

A

accessory

182
Q

CNXII

A

hypoglossal

183
Q

Middle ear ossicles

A

malleus, incus, stapes

184
Q

otosclerosis

A

abnormal bone growth in the middle ear that causes hearing loss

185
Q

presbycusis

A

age-related hearing loss

186
Q

conductive hearing loss

A

mechanical dysfunction of external or middle ear, can be a partial loss

187
Q

sensorineural loss

A

damage to either inner ear, CNVIII or auditory cerebral cortex, can be from age or ototoxic drugs

188
Q

What can cause vertigo or staggering gait?

A

inflammed labrynth of the ear

189
Q

Tinnitus

A

ear ringing, associated with nerve damage

190
Q

weber test

A

512 fork at midline of head, laterlizing midline is normal

191
Q

weber test for conductive loss

A

lateralizes to bad ear because air doesn’t influence hearing so all through the bone

192
Q

weber test for sensorineural loss

A

no sound in bad ear, louder in left ear

193
Q

Rinne test

A

press tuning for to mastoid process, move away until pt can’t hear, move fork to outside of ear

194
Q

rinne test for conductive loss

A

AC

195
Q

rinne test for sensorineural loss

A

AC>BC but in a smaller ratio in the or no sound in bad ear, AC>BC in normal ratio

196
Q

what can cause sensorineural loss

A

asprin, antibiotics, diuretics, aging, loud noises

197
Q

what is pain in mastoid process a sign of?

A

otitis media, mastoiditis

198
Q

tragus pain is a sign of?

A

otitis externa (swimmers ear)

199
Q

What does impacted cerumen cause?

A

partial deafness, tinnitus, dizziness

200
Q

exostosis

A

formation of new bone outcropping, seen in swimmers and surfers, can cause infections, pain, plugging, hearing loss

201
Q

otitis externa

A

scaling, crusting, inflammation, discharge in external canal, painful tragus, swimmers ear

202
Q

serous otitis media

A

tympanic membrane is retracted and decreased mobility, thin serous fluid

203
Q

bacterial otitis media

A

red & inflammed, pus

204
Q

perforated typmanic membrane

A

white scarring tightens membrane

205
Q

most common site for nosebleeds?

A

Kiesselbach region

206
Q

which sinus is not present at birth

A

frontal

207
Q

which gland opens to stenson’s duct

A

parotid

208
Q

which gland opens to wartons duct

A

submandibular

209
Q

what can cause nasal polyps

A

allergies

210
Q

which gland has many openings

A

sublingual

211
Q

are fordyce spots and torus palatinus normal

A

yes (white spots on tongue and ridge on mouth)

212
Q

which side does the tongue deviate to (abnormal)

A

paralyzed side

213
Q

what test is done for CNXII

A

hypoglossal, stick tongue out

214
Q

what test is done for CNX

A

vagus, see that uvula rises

215
Q

viral pharyngitis

A

red scratchy throat

216
Q

bacterial pharyngitis

A

red scratchy throat with exudate, fever, enlarged cervical nodes, probably strep a or mono

Physical Assessment (3 decks)

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