Exam 1 (wks 1-3) Flashcards
1
Q
Defined FLACC as a pain assessment tool
A
- F: face
- L: legs
- A: activity
- C: cry
- C: consolability
2
Q
lbs to kg
kg to lbs
A
- 1 kg = 2.2 lbs
- 1 lb = 0.45 kg
3
Q
in to cm
in to mm
A
- 1 in = 2.54 cm
- 1 in = 25 mm
4
Q
C to F
F to C
A
- (degC x 9/5) + 32 = degF
- (degF - 32) x 5/9 = degC
5
Q
define caloric intake
A
the amount of food consumed each day measured in calories
6
Q
define BMR
A
the rate at which the body uses energy while at rest to keep vital functions going
7
Q
define thermogenesis
A
production of heat in an organism and byproduct of metabolism
8
Q
define acromegaly
A
excessive growth and distorted proportions
usually results from pituitary tumor
9
Q
what causes Cushing’s Syndrome
which hormone
A
due to prolonged, elevated levels of cortisol (glucocorticoids)
10
Q
define Turner’s Syndrome
A
caused by partial/complete absence of 2nd X chromosome
11
Q
define hydrocephalus
A
excess CSF in the brain
usually infectious
12
Q
define failure to thrive
A
downward crossing over the 2% lines on a growth curve
13
Q
define Prader-Willi Syndrome
A
initial FTT followed by insatiable hunger
14
Q
define GH deficiency
A
not having enough growth hormone to support growth
15
Q
define precocious puberty
A
developing of 2nd sex characteristics before 7 in girls and 9 in boys
16
Q
define obesity
A
excess proportions of body with a majority of adult obesity resulting from childhood obesity
17
Q
define anorexia nervosa
A
eating disorder of low body weight and distorted body image
18
Q
define bullimia nervosa
A
eating disorder characterized by overeating and purging
19
Q
what are the macro molecules? micro molcecules?
A
- carbs, proteins, fats
- vitamins, minerals, electrolytes
20
Q
define exogenous
A
maladjustment between intake and exercise
over eating
21
Q
define endogenous
A
lowered metabolism due to disturbances in hypothalmic or endocrine function leading to wt gain
22
Q
give BMI classifications
4 categories
A
- underweight: BMI less than 18.5
- normal: BMI 18.5 to 24.5
- overweight: BMI 25 to 29.9
- obese: BMI greater than 30
23
Q
notes for assessing pain in preg pts
A
- pain to to physiologic changes
- BP changes throughout pregnancy
23
Q
notes for assessing pain in kids
A
- increased pulse & RR
- decreased BP
- behavioral cues, cannot modify pain, easily distracted
24
notes for assessing pain in older pts
* no diminished perception of pain
* decreased pain threshold
* pain from chronic conditions
25
what do pain impulses from the injury synapse onto?
dorsal horn of spinal cord & brain (large myelinated A-delta fibers and small unmyelinated C-polymodal fibers)
26
when are pain impulses reduced?
when non-pain impulses compete to transmit senstation along spinal pathways to brain
27
signs of pain
| 10
1. guarding
2. facial mask of pain
3. vocalization
4. body movement
5. vital sign changes (increased HR, RR, decreased BP)
6. pallor, diaphoresis
7. pupil dilation
8. dry mouth
9. reduced attention span, confusion
10. irritability
28
what are standard precautions?
* hand washing often
* proper PPE (gloves, gown, mask, eye protection, face shield)
29
describe rxn to latex in allergic pts. who is at highest risk for latex allergy?
* rash, itching, blistering, asthma, GI sx, lung damage, anaphylaxis
* healthcare workers and pts with multiple surgeries
30
what is the scale used for?
measuring wt
31
what is stadiometer used for?
measuring ht in kids
32
what is doppler used for?
pick up pulses not heard with a stethoscope
33
what is a fetoscope and leff scope used for?
monitoring fetuses
34
what is tympanometry used for?
to assess the function of the eustachian tube and TM
35
what is transillumination used for?
used to determine whether a cavity contains fluid, air, or tissue
36
what is a goniometer used for?
examines degree of joint flexion and extension
37
what is wood's lamp used for?
used to determine presence of fungi, bacteria, and pigment changes of lesion or corneal abrasion
38
what is monofilament used for?
test for sensation on body parts like the plantar surface of the foot
39
what is scoliometer used for?
measure the degree of rotation in the spine
40
how to know if BP cuff is the right size?
BP cuff should encircle more than 80% of arm's circumference. if the cuff is too small, there will be an elevated BP
41
when is the snellen chart used?
far vision
20 ft away
42
what is the rosenbaum chart used for?
near vision
14 in away
43
which arm will have a higher BP?
L arm due to proximity to heart
44
order of PE components
1. inspect
2. palpate
3. percuss
4. ascultate
45
normal adult:
* pulse
* BP
* pulse: 60-100 bpm
* BP: 120/80
46
IBW for men vs women
* men: 106 lbs + 6 lbs for every inch over 5 ft
* women: 100 lbs + 5 lbs for every inch over 5 ft
* subtract 10% for small frame, add 10% for large frame
47
equation for BMI
* kg / (ht in meters)^2
* if not converted to kg/meters, then do (lbs/in^2) * 103
48
describe the triceps skinfold measurement
* measure on arm halfway between elbow and acromial process of scapula
* males: 12 mm
* females: 23 mm
49
describe waist-to-hip circumference ratio
* males: less than 0.9
* females: less than 0.8
* apple shaped bodies have bigger waist than hip: at risk of obesity, chronic conditions (DM, HTN, ARF, metabolic syndromes)
50
describe role of eccrine sweat glands
* found in dermis of skin, essential for thermoregulation by producing sweat and diffusely spread throughout the body
* begin to function at 1 mo
51
describe role of apocrine sweat glands
* enlarge and become active during adolescence
* found in groin, axilla, breasts
* why we are smelly
52
describe the role of sebaceous glands
* found in the dermis
* produce an oily fluid to lubricate the skin/hair
* activated during adolescence in response to elevated androgen levels
53
describe expected findings for:
* moisture
* temp
* texture
* turgor
* mobility
* moisture: minimal perspiration or oiliness
* temp: change in temp along extremities (dorsal side of hand, to finger tips/toe tips)
* texture: smooth, soft, even
* turgor: tented if pt is dehydrated or has edema
* mobility: skin moves easily when pinched, but goes back in place
54
describe primary lesions
spontaneous manifestations within the skin, pathological process
55
describe secondary lesions
evolution of a primary lesion from aggravation or trauma
56
# primary lesions
define macule
* flat, non-palpable lesion
* less than 1 cm in size
| freckle, mole, measles
57
# primary lesions
patch
* flat, non-palpable, irregularly shaped lesion
* greater than 1 cm in size
| larger macule
58
# primary lesions
papule
* raised, solid, palpable lesion
* less than 1 cm in size
| wart, mole
59
# primary lesions
plaque
* raised, firm, rough lesion
* flat surface
* greater than 1 cm in size
60
# primary lesions
wheal
* elevated, irregular area of edema
* transient with variable presentation
| bug bite, allergic rxn
61
# primary lesions
nodule
* raised, firm, circumscribed lesion
* mid to deep dermis
* 1-2 cm
| lipoma
62
# primary lesions
tumor/mass
* raised, solid lesion
* may or may not be clearly demarcated
* deep dermis
* greater than 2 cm
63
# primary lesions
vesicle
* raised, circumscribed
* superficial lesion
* filled w/ clear to yellow serous fluid
* less than 1 cm in diameter
64
# primary lesions
bulla
* raised, circumscribed
* superficial
* filled with clear/yellow serous fluid
* greater than 1 cm in size
| blister
65
# primary lesions
pustule
* raised, superficial lesion
* filled with purulent fluid
66
# primary lesions
cyst
* raised, circumscribed, encapsulated lesion
* dermis or subQ layer
* filled with liquid or semisolid material
67
# primary lesions
telangiectasia
* fine and irregular red lines produced by capillary dilation from rosacea
68
# secondary lesions
scale
* keritanized cells that are flaky
69
# secondary lesions
lichenification
* rough, thickened epidermis
* from persistant inflammation, rubbing, irritation
70
# secondary lesions
keloid
* irregular, raised, enlarging scar that grows beyond boundaries of the wound
* from excessive collagen formation during healing
71
# secondary lesions
excoriation
* superficial abrasion in the epidermis
72
# secondary lesions
scar
* thin to thick fibrous tissue that replaces normal skin after injury or laceration to dermis
73
# secondary lesions
fissure
* longitudinal crack in epidermis and dermis
74
# secondary lesions
erosion
* loss of some part of the epidermis
* leaves a depressed, moist, glistening surface
| ruptured bulla
75
# secondary lesions
ulceration
* loss of epidermis and dermis
* caved in surface of various sizes
76
# secondary lesions
crust
* dried serum, blood, or purulent exudate
* slightly elevated
* varying color
| scab
77
# secondary lesions
atrophy
* thinning of the skin surface and loss of skin markings leading to translucent and paper like skin
78
# vascular skin lesions
petechiae
* red/purple
* non-blanchable
* less than 5 mm from intravascular defects or infections
79
# vascular skin lesions
purpura
* red/purple
* non-blanchable
* greater than 5mm from infection or intravascular defects
80
# vascular skin lesions
ecchymoses
* red/purple
* non-blanchable
* variable size from vascular wall destruction, trauma, vasculitis
81
# vascular skin lesions
spider angioma
* red, central bodied with radiating legs that blanch with pressure
* caused by vit B deficiency, liver disease, or can be idiopathic
82
# vascular skin lesions
venous star
* blue-ish spider
* linear or irregular
* non-blanchable
* caused by increased pressure on superficial veins
83
# vascular skin lesions
capillary hemangioma
* red
* irregular macular patches
* from dilation of dermal capillaries
84
# lesions of older adults
cherry angioma
* tiny, bright red to dark blue rounded papules
* brown over time
85
# lesions of older adults
seborrheic keratoses
* pigmented, raised
* warty lesions on trunk of body
* brown
86
# lesions of older adults
sebaceous hyperplasia
* yellowish
* flattened papules
* central depressions
| appear like BCC
87
# lesions of older adults
cutaneous tags
* small, soft
* skin colored peduncluated papules
* neck, upper chest
88
# lesions of older adults
cutaneous horns
* small, hard
* projections of epidermis
* forehead, face
89
# lesions of older adults
senile lentigines
* irregular
* gray/brown macules
* ocur from sun exposure
| sun spots
90
# non-malignant skin lesions
corn
* found on pressure points
* slightly raised, circumscribed, painful lesions
91
# non-malignant skin lesions
callus
* type of corn
* non-tender
* not painful
* found on wt bearing surfaces
92
# non-malignant skin lesions
eczematous dermatitis
* inflammatory skin disorder
* can result from contact dermatitis, allergic contact dermatitis, atopic dermatitis
93
# non-malignant skin lesions
furuncle
* deep seated infection of the pilosebaceous unit
* erythema and purulent filled vesicle
94
# non-malignant skin lesions
cellulitis
* diffuse, acute, infection of skin and subQ tissue
* leads to edema, erythema, itchiness from swelling
* hot to touch and tender
95
# non-malignant skin lesions
folliculitis
* inflamation and infection of the hair follicle and surrounding dermis
* warm to touch
* erythematous
96
# non-malignant skin lesions
tinea infections
* group of non-candida infections
* invovle the corneum, nails, pedis, hair, etc
97
# non-malignant skin lesions
pityriasis rosea
* self-limiting inflammation of unk cause w/ possible pruritis
98
# non-malignant skin lesions
psoriasis
* chronic & recurrent disease of keratinocyte proliferation
* scaly
99
# non-malignant skin lesions
rosacea
* chronic, inflammatory disorder
* no itching
* result of sun exposure, hot beverages, flushing from embarrassment, spicy food
100
# non-malignant skin lesions
drug eruption
* cutaneous rxn to meds
* can last up to several wks
101
# non-malignant skin lesions
herpes zoster
* VZV infection found along dermatomes (DOES NOT CROSS MIDLINE)
* painful, itchy, burning pustules
102
# non-malignant skin lesions
herpes simplex
* HSV infection
* HSV 1: oral
* HSV 2: genitalia
* tenderness, pain, burning, vesicles
103
# hair conditions
alopecia areata
* sudden, rapid, coin shaped hair loss
* scalp/face
104
# hair conditions
scarring alopecia
* replacement of hair follicles w/ scar tissue
105
# hair conditions
traction alopecia
* hair loss that is a result of prolonged, tightly pulled back hairstyles
106
# hair conditions
hirsutism
growth of terminal hair in women in the male distrubtion pattern on the face/body/pubic areas
107
# nail conditions
ingrown nails
* lateral nail fold grows into the dermis
108
# nail conditions
subungual hematoma
* trauma to the nail plate severe enough to lead to immediate bleeding/pain
109
# nail conditions
onycholysis
loosening of nail plate from nail bed w/ eventual separation at distal groove
110
# nail conditions
koilonychia
central depression of the nail with lateral elevation of the nail plate
| due to deficiencies, hypothyroidism
111
# nail conditions
beau lines
transverse depressions/pitting of the nails
from systemic disorders (infection, surgeries)
indicate the nail completely stopped growing, ON ALL NAILS
112
# nail conditions
white banding
white spots/bands on nail
113
findings on face/hair for:
* normal
* Cushing's
* Addison's
* normal: even distribution, no infestations, thick/thin, texture
* Cushing's: moon shpaed face, dense w/ extra fat; thin, erythematous skin
* Addison's: very moist skin, fine/thin hair, lid retration with more prominent eyes
114
where are palpebral fissures and nasolabial folds?
1. palpebral fissure is the innermost corner of the eye adjacent to the nose
2. nasolabial fold is the area under the cheek extending frmo the nose toward corners of mouth
115
describe abnormalities w/ CN V and VII paralysis
* CN V and VII innervate the facial muscles
* can paralyze the corner of the mouth, flat nasolabial fold
* eyes unable to close, eyeballs rolled up
* forehead cannot wrinkle, eyebrow cannot raise
116
describe the anterior cervical triangle
* contains the hyoid bone, cricoid cartilage, trachea, thyroid
* formed by the medial border of teh sternocleidomastoid, mandible, and midline
* contains anterior cervical lymph nodes
117
describe the posterior cervical triangle
* contains the hyoid bone, cricoid cartilage, trachea, thyroid
* formed by the trapezius, sternocleidomastoid, and clavicle
* contains posterior cervical lymph nodes
118
where do you check for bruits in head/neck region?
| 3 spots
1. carotid arteries
2. thyroid
3. in infants: just over the orbit to idetnify cerebral aneurysm
119
what are you looking for when you inspect the neck?
| 7 components
* muscle symmetry
* trachea alignment (midline)
* landmarks of the triangles
* fullness at base of neck
* masses, webbing, lesions
* carotid artery prominence, jugular vein distension
* range of motion
120
what is the most inferior landmark to use when palpating the trachea?
sternal notch/clavicles depending on what you are palpating!
121
describe normal thyroid:
* size
* shape
* configuration
* consistency
* tenderness
* not visible
* buterfly shaped
* two lobes, isthmus
* firm yet pliable
* non-tender
122
describe Battle's sign
* bruising over mastoid
* may have internal brain injury
123
describe CSF leaks
* drainage from nose
* salty/metallic mouth taste
* drainage down back of throat
124
what could tenderness over temporal arteries mean?
* decreased blood flow to head/brain
125
brudzinski sign
* flexing neck causes knees to flex unintentionally (sign for meningitis)
126
describe the lacrimal canaliculi
tubes connecting the puncta to the lacrimal sac to clear tears from the eyes
127
describe the canthus
lateral and medial corners of the eye where the upper and lower lid connect
128
describe the caruncle
red medial portion of the eye next to the medial canthus
129
function of cornea
* continuous w/ sclera
* exposed to environment on anterior eye
* clear, rich, sensory innervation
* avascular
* functions to refract light into the eye
130
function of the bulbar conjunctiva
prevents microbial enterance into eye
131
function of the palpebral conjunctiva
lubricates eye
132
function of the limbus
* forms border between the transparent cornea and opaque sclear
* contains the pathway of aqueous humor outflow
* site of surgical incisons
* acts as a barrier to epithelial cells preventing them from migrating onto corneal surface
133
function of sclera
* dense avascular structure that appears anteriorly to white of eye
* supports internal eye structure
134
function of choroid
* pigmented, richly vascular layer that supplies O2 to outer part of retina
135
function of macula
* section of retina responsible for color vision & fine detail processing
136
what CN does vision?
CN II
137
describe visual fields by confrontation
* bilateral
* pt and provider mirror each other
* move finger in all fields
* tests peripheral vision
* CN II
138
what should be examined during external eye exam?
| anatomy, not what you're inspecting for
* eyelid
* conjunctivae
* iris/pupil
* lens
* sclera
* lacrimal apparatus
139
# eye abnormalities
exophthalmos
bulging of eye anteriorly out of orbit
140
# eye abnormalities
acute purulent conjunctivitis
infection of the conjunctiva
141
# eye abnormalities
subconjunctival hemorrhage
* bright red blood that profuses through the conjunctiva
* result of violent coughing, sneezing, straining, vomiting, randomly in pregnancy
142
# eye abnormalities
pterygium
* abnormal growth of the conjunctiva that extends over the cornea
* usually near the nasal side, causes blindness
143
# eye abnormalities
xanthelasma
* elevated plaques of cholesterol deposited in the eyelids by macrophages
144
# eye abnormalities
lagophthalmos
closed eyelids that do not completely shut
145
# eye abnormalities
abnormal globe firmness
indication of glaucoma
146
# eye abnormalities
hypertelorism
wide spacing of the eye
147
# eye abnormalities
ptosis
drooping of the upper eyelid usually from an acquired weakness of levatator muscle
148
# eye abnormalities
extropion
outward turning of lower eyelid
lead to excess tearing because punctum cannot drain the eye
149
# eye abnormalities
entropion
inward turning of lower eyelid
eyelashes may cause corneal and conjunctival irrtation
150
# eye abnormalities
hordeolum
* aka stye
* acute infection of the sebaceous gland leading to ingrown hair
151
describe corneal touch reflex & which CN
* corneal sensitivity to touch w/ cotton wisp
* CN V and VII
152
what CN for direct and consensual response?
CN III
153
what CN does accomodation test?
CN III
154
what CN are associated with EOM?
* Oculomotor: CN III
* Trochlear: CN IV
* Abducens: CN VI
155
# eye abnormalities
lid lag
delay in the movement of the eyelid as the eye moves downward and is common in thyroid diseases
156
# eye abnormalities
nystagmus
involuntary, side to side, up/down, circular motion of eye
157
# eye abnormalities
end-gaze nystagmus
associated with extreme positions in EOM
158
describe red reflex
occurs when light is illuminating the retina and should be red
if black, opacity such as glaucome
159
what should A:V ratio be in retina
* arterioles smaller than venules by ratio of 3:5 or 2:3
160
cup to disc ratio
should be measured to determine extent of glaucoma
161
disc venous pulsations
pulsation of the retinal vein can indicate increased IOP
162
mongonlian vs anti-mongolian slant
* mongolian: lateral canthi above medial
* anti-mongolian: medial canthi above lateral
163
# eye abnormalities
miosis
* pupillary constriction where it is less than 2mm or pinpoints
* indicated opiod abuse
164
# eye abnormalities
mydriasis
* pupillary dilation usually more than 6mm from lesions, hypoxia, glaucoma, stimulant
165
# eye abnormalities
anisocoria
* unequal size of pupils of the eye that is normal as long as the eye responds appropriately to light reflexes
* if not, note which was slower
166
# eye abnormalities
Argyll Robertson Pupil
* bilateral, miotic w/ irregular shaped pupils that do not construct w/ light
* caused by syphilis lesions in midbrain
167
# eye abnormalities
tonic pupil
* affected pupil is dilated & reacts slowly to light or not at all
* can respond to convergence from post-gangliionic PSNS impairment
168
# eye abnormalities
horner syndrome
* interruption of SNS innervation to the eye that can be inherited or from a lesion, stroke, trauma
* leads to ipsilateral miosis and hemifacial sweating
169
# eye abnormalities
vitreous hemorrhage
* red haze
* if pre-retinal hemorrhage, ruptures through hyaloid membrane
170
# eye abnormalities
pre-retinal hemorrhage
* subhyaloid, bowl or boat shaped
171
# eye abnormalities
superficial intraretinal hemorrhage
* flame or splinter
* follow lines of nerve fiber layers
172
# eye abnormalities
deep intraretinal hemorrhage AKA
blot hemorrhages
173
# eye abnormalities
subretinal hemorrhage
* irregular, sharp border
* dark/green
* located beneath rods/cones
174
# eye abnormalities
hard exudates
white clumps of lipid deposits
175
# eye abnormalities
cotton wool patches
* fluffy, white, diffuse borders
* localized retinal ischemia
* HTN
176
# eye abnormalities
drusen bodies
* pink/yellow spots that occur w/ aging
* often seen in macula, indicates macular ddamage
177
# eye abnormalities
bergmeister's papilla
* optic cup embryological remnant
178
anatomic divisions between external, middle, and inner ear
1. outer ear: auricle all the way to the TM
2. middle ear: consists of the tympanic cavity w/ the ossicles and portions of the semi-circular ducts
3. inner ear: consists of the cochlea, cochlear nerve, and auditory tube
179
how to pull ear adult vs peds
1. adult: pull ear up & back & out
2. peds: pull ear down & back & out
180
what could tenderness or pain of pinna or tragus suggest?
* otitis externa if paired with pain and discharge
* if mastoid is also tender, then infection may have spread
181
describe conductive hearing loss
* inability for sound waves to make it through the middle ear to the inner ear usually from occlusion
* causes: cerumen impaction, tympanosclerosis, calcification
182
define sensorineural hearing loss
* reduced transmission of sound within only the inner ear due to cochlear deformities, CN VII problems, congenital infection, genetic syndrome, ototoxic medications, trauma, tumors, degeneration, systemic disease
183
Weber Test
* normal
* conductive loss
* sensorineural loss
* normal: heard at midline
* conductive: lateralize to ear w/ conductive loss
* sensorineural: lateralize away from ear with loss
184
Rinne Test
* normal
* conductive loss
* sensorineural loss
* normal: 2:1
* conductive: BC > AC
* sensorineural: AC > BC
185
Schwabach Test
* normal
* conductive loss
* sensorineural loss
* normal: examiner & pt hear for same duration
* conductive: pt hears longer than examiner
* sensorineural: examiner hears longer than pt
186
these tests:
1. Nylen-Barany
2. Cold Calorics
3. Dix-Hallpike
test for what?
vertigo sx
187
describe the cold caloric test
* cold water enters the ear canal
* causes fast, side to side eye movements, nystagmus
* assesses damage to CN VIII
188
where do the nasolacrimal duct and paranasal sinuses drain?
1. nasolacrimal: inferior meatus
2. paranasal: middle meatus
189
which CN for smell?
CN I
190
ADA tooth numbering
* #1 is upper right
* # 16 is upper left
* # 17 is lower left
* #32 is lower right
191
tongue extension shows which nerve is intact?
CN XII
192
uvula movement shows which nerves intact?
CV IX and X
193
gag reflex sows which CN in tact?
CN IX and X
194
describe mallampati oropharynx classification
* class 1: soft palate, uvula, pillars visible
* class 2: soft palate, uvula visible
* class 3: soft palate, base uvula visible
* class 4: only hard palate visible
195
describe tonsil grades
* 0: absent
* 1+ : visible
* 2+ : halfway between tonsillar pillars and uvula
* 3+ : nearly touching uvula
* 4+ : tonsils and uvula touch each other
196
abnormal mouth
| 4
* TMJ popping
* occulsion, loose teeth, dental abornmalities
* palates: torus palatinus
* buccal muosa: fordyce spots
197
abnormal throat findings
| 3
1. tonsils inflammed/swollen
2. no gag reflex
3. uvula doesn't rise w/ soft palate
198
abnormal neck findings
| 6
1. masses
2. brudzinski sign
3. tracheal tugging
4. trachea not mobile or midline
5. thyroid gland mass upon palpation
6. carotid bruits
