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Advanced Health Assessment > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

Lymph drainage from the penis passes primarily to

A

The deep inguinal and external inguinal lymph nodes

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2
Q

Lymph vessels from the scrotum drain into the

A

superficial inguinal lymph nodes

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3
Q

Indirect inguinal hernias develop at

A

The internal inguinal ring, where spermatic cord exists the abdomen

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4
Q

Direct inguinal hernias arise

A

more medially due to weakness in the floor of the inguinal canal and are associated with straining and heavy lifting

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5
Q

Low libido may be due to

A

Depression, endocrine dysfunction, side effects from medications

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6
Q

ED may be due to

A

psychogenic causes, decreased testosterone, decreased blood flow in the hypogastric arterial system, diabetes

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7
Q

Discharge in gonorrhea

A

Yellow

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8
Q

Discharge in non-gonococcal urethritis from chlamydia

A

White

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9
Q

Penis pain due to

A

Testicular torsion, epididymitis, orchitis

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10
Q

Testicular self-examination

A

Not recommended for asymptomatic adolescent or adult males

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11
Q

Phimosis

A

Tight prepuce that can not be retracted over the glans

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12
Q

Paraphimosis

A

Tight prepuce that, once retracted, can not be returned and edema ensues

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13
Q

Balanitis

A

inflammation of the glans

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14
Q

How to check for varicocele

A

have patient stand and palpate spermatic cord while the patient bears down

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15
Q

Cystic structure in the spermatic cord suggests

A

hydrocele of the cord

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16
Q

Corpora cavernosa

A

2 structures within the shaft of the penis that become engorged with venous blood during erection

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17
Q

Peyronie disease

A

Development of fibrous scar tissue within the penis that causes disfigured and painful erections

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18
Q

Powerful vasodilators for erection

A

NO and cGMP

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19
Q

FSH in males

A

Regulates sperm production in the testes

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20
Q

LH in males

A

Simulates synthesis of testosterone

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21
Q

Spermatocele

A

Benign, typically painless, movable cystic mass just above the testes that will typically transilluminate with strong light source

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22
Q

Acute epididymitis

A

Results from bacterial infection such as chlamydia and presents with scrotal swelling and pain

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23
Q

Hydrocele

A

Nontender, fluid filled mass within tunica vaginalis surrounding the testicle; usually congenital defect in which peritoneal fluid travels down in between the testicle and tunica vaginalis from a patent communication that normally closes

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24
Q

5a-reductase

A

Enzyme that converts testosterone to 5a-dihydrotestosterone–hormone that triggers pubertal growth of male genitalia, prostate, seminal vesicles, secondary sexual characteristics

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25
Q

If male if having problems with infertility

A

It is usually problem with FSH

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26
Q

Area where pap smear is done

A

Transformation zone–area at risk for later dysplasia

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27
Q

Weakness of pelvic floor muscles may cause

A

Pain, urinary incontinence, fecal incontinence, prolapse of pelvic organs that can cause cystocele, rectocele, enterocele

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28
Q

Primary dysmenorrhea due to

A

Increased prostaglandin production during luteal phase of menstrual cycle, when estrogen and progesterone levels decline

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29
Q

Secondary dysmenorrhea due to

A

Endometriosis, adenomyosis, pelvic inflammatory disease, endometrial polyps

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30
Q

Post-coital bleeding suggests

A

Cervical polyps or cancer; atrophic vaginitis in older adults

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31
Q

Causes of post menopausal bleeding

A

Endometrial cancer, hormone replacement therapy, uterine or cervical polyps

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32
Q

Amenorrhea followed by heavy bleeding

A

Suggests threatened abortion or dysfunctional uterine bleeding related to lack of ovulation

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33
Q

Decreased libido may be due to

A

lack of estrogen, clinical illness, trauma or abuse, surgery, pelvic anatomy, psychiatric conditions

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34
Q

Superficial vaginal pain with sex suggests

A

Local inflammation, atrophic vaginitis, inadequate lubrication

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35
Q

Deeper pain with sex suggests

A

Pelvic disorders or pressure on a normal ovary

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36
Q

Most common cause of acute pelvic pain

A

PID, followed by ruptured ovarian cysts and appendicitis

Always rule out ectopic pregnancy first

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37
Q

Chronic pelvic pain red flag for

A

History of sexual abuse

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38
Q

When to begin pap smears

A

Age 21

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39
Q

Pap smears screening

A

Every 3 years or 5 years with concomittant HPV testing
End screening >65 assuming 3 negative consecutive results
Not recommended after hysterectomy
Start HPV vaccine at 11/12 years

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40
Q

3 symptoms indicating ovarian cancer

A

Abdominal distention, abdominal bloating and urinary frequency >50 years

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41
Q

Lateral displacement of cervix

A

Suggests endometriosis

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42
Q

Cervical motion tenderness

A

Hallmark for PID, ectopic pregnancy and appendicitis

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43
Q

Palpate uterus from outside, noting its

A

Size, shape, consistency, mobility

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44
Q

Where will you usually feel ovarian masses

A

in the adnexal area

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45
Q

Colon cancer screening

A

<50 years old, annual screening with high-sensitivity fecal occult blood tests, colonoscopy every 10 years or sigmoidoscopy every 5 years

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46
Q

Median lobe of the prostate

A

Located anterior to the urethra and is not palpable on DRE

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47
Q

Normal prostate size

A

2.5cm

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48
Q

Small caliber stools

A

May be caused by narrowing of the colon due to a mass–indicative of colon cancer

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49
Q

Black, tarry stools

A

Represents blood in GI tract, not the colon

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50
Q

Risk factors for prostate cancer

A

family history, african american, unusual history of cancers that may be associated with BRCA gene

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51
Q

4 key features to characterize patient’s complaint of musculoskeletal disorders

A

Articular or extra-articular
Acute (<6 weeks) or chronic (>12 weeks)
Inflammatory or non-inflammatory
Localized or diffuse

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52
Q

<60 years with musculoskeletal issues, think

A

Tendinitis, bursitis, RA, psoriatic arthritis, infectious arthritis from gonorrhea, viral or bacterial infection

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53
Q

> 60 years with musculoskeletal issues, think

A

OA, gout, osteoporotic fracture, septic bacterial arthritis

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54
Q

Synovial joints

A

freely moveable–knee and shoulder

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55
Q

Cartilaginous joints

A

slightly moveable–vertebral bodies of the spin and symphis pubis

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56
Q

Fibrous joints

A

Immovable–skull sutures

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57
Q

Pain in single joint

A

Suggests injury, monoarticular arthritis, tendinitis, or bursitis

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58
Q

Severe pain or rapid onset in red swollen joint suggests

A

Acute septic arthritis

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59
Q

In non-inflammatory disorders, consider

A

Trauma, repetitive use, degenerative changes, fibromyalgia

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60
Q

4 cardinal features of inflammation

A

Swelling, warmth, redness, pain

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61
Q

Morning stiffness that improves with activity

A

RA

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62
Q

Intermittent stiffness not improved by activity

A

OA

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63
Q

Symmetric musculoskeletal pain

A

RA, SLE, ankylosing spondylitis

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64
Q

Asymmetric musculoskeletal pain

A

Psoriatic, reactive and IBD associated arthritis

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65
Q

Midline low back pain

A

injury, disc herniation, vertebral collapse, spinal cord metastases

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66
Q

Off midline low back pain

A

Muscle strain, bursitis, sciatica, hip arthritis, pyelonephritis, kidney stones

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67
Q

Leg pain that resolves with rest and/or lumbar forward flexion

A

Spinal stenosis

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68
Q

Bladder/bowel dysfunction with low back pain

A

Cauda equina syndrome

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69
Q

Red flags for low back pain

A

Age <20, >50, history of cancer, unexplained weight loss, fever, decline in general health, pain >1 month, pain at night or rest, drug use or immunosuppression, active infection, long term steroid use, bladder or bowel incontinence, neurologic ysmptoms

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70
Q

Risk factors for osteoporosis

A

Postmenopausal, age >50, low BMI, low calcium or vitamin D, tobacco or alcohol use, immobilization, inadequate physical activity, family history, medications

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71
Q

Temperomandibular joint swelling and tenderness

A

Signal TMJ inflammation or arthritis

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72
Q

Restricted ROM in shoulder

A

bursitits, capsulitis, rotator cuff tears or sprains, tendinitis

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73
Q

Local swelling in wrist suggests

A

Ganglion

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74
Q

Torticollis

A

Lateral deviation and rotation of the head; from contraction of the sternocleidomastoid muscle

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75
Q

Vertebral tenderness raises concerns for

A

Fracture, dislocation, underlying infection, arthritis

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76
Q

Tenderness over knee tendon or inability to extend the knee

A

Suggests a partial or complete tear of the patellar tendon

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77
Q

Pain on percussion of the spine

A

May be osteoporosis

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78
Q

Role of sternocleidomastoid muscle

A

Flexes and rotates the neck

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79
Q

Role of trapezius muscle

A

Extends the neck

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80
Q

Assessing ability to laterally bend is assessing function of

A

Scalene and small intrinsic neck muscles

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81
Q

Assessing ability to extend the back assesses the function of

A

Deep intrinsic muscles of the back

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82
Q

Tinnel sign

A

Strike patient’s wrist with finger where the median nerve passes under the flexor retinaculum and volar carpal ligament
Tingling sensation is positive sign

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83
Q

Phalen test

A

Patient holds both wrists in fully palmar flexed position with dorsal surfaces pressed together for 1 minute
Numbness and paresthesia is suggestive of carpal tunnel syndrome

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84
Q

Neer test

A

Tests for shoulder impingement
Internally rotate and forward flex arm at shoulder
Positive finding: pain in anterior lateral aspect of shoulder

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85
Q

Hawkin’s test

A

Tests for shoulder impingement
Forward flexing of shoulder to 90 degrees, flexing elbow to 90 degrees and internally rotating arms
Positive finding: pain in the superior-lateral aspect of the shoulder

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86
Q

Empty can test

A

Tests for possible rotator cuff tear

Internally rotate arms and resist downward pressure

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87
Q

Drop arm test/Codman’s sign

A

Tests for rotator cuff tear

Positive finding: patient can not control descent of the arm as it drops

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88
Q

Assess temporomandibular joint for

A

Pain, crepitus, locking and popping
ROM–Open and close, lateral movement, protrusion, contraction
Strength–temporalis and masseter

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89
Q

Assess cervical spine for

A

Tone, symmetry, tenderness, spasm, head alignment, symmetry of muscles and skinfolds
ROM–expect flexion 45 degrees, extension 45 degrees, rotation 70 degrees
Assess sternocleidomastoid and trapezius muscles

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90
Q

Assess hips for

A

Symmetry, size, gluteal folds
Palpate for stability and tenderness
ROM–flexion 90 degrees, hyperextension 30 degrees, internal rotation 40 degrees, external rotation 45 degrees

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91
Q

Thomas test

A

Observe patient’s ability to keep extended leg flat on the exam table as other leg is flexed towards chest
Lifting extended leg indicates hip flexion contracture in extended leg

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92
Q

Trendelenburg test

A

Detects weak hip abductor muscle

Balance on each foot and note any asymmetry

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93
Q

Barlow-Ortolani maneuver

A

Detects hip dislocation or subluxation in infants

Positive: clunk or sensation felt as femoral head exits acetabulum posteriorly

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94
Q

Assess legs/knees for

A

Landmarks, concavities, alignment, swelling, tenderness, bogginess, crepitus
ROM–flexion 130 degrees, extension 30 degrees, hyperextention 15 degrees

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95
Q

Ballottement

A

Excess fluid or effusion in knees

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96
Q

Bulge sign

A

Excess fluid in knees

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97
Q

McMurray test

A

tests for torn medial or lateral meniscus

Positive: palpable or audible click, pain, grinding, lack of tension during outward and inward flexion of knee

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98
Q

Anterior and posterior drawer test

A

Draw tibia forward and backward forcing tibia to slide forward of the femur
Unexpected finding is movement of knee greater than 5mm

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99
Q

Lachman test

A

Tests ACL integrity

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100
Q

Assess feet/ankles for

A

Contour and position, size and number of toes, alignment, weight bearing, arch, heat, swelling ,tenderness

101
Q

Straight leg raising test

A

Tests for nerve root irritation or lumbar disc herniation at L4, L5, S1 levels
No pain should be felt below the knee with leg raising
Radicular pain below the knee in a dermatome pattern may be associated with disc herniation

102
Q

Femoral stretch test

A

Used to detect inflammation of the nerve root at L1, L2, L3, L4 level
Presence of pain is positive

103
Q

Basal ganglia

A

Affects movement

104
Q

Thalamus

A

Processes sensory impulses and relays them to cerebral cortex

105
Q

Hypothalamus

A

Maintains homeostasis and regulates temperature, heart rate and BP

106
Q

Cerebellum

A

Coordinates all movement and helps maintain body upright

107
Q

CN1

A

Olfactory–sense of smell

Test with different scents

108
Q

CN 2

A

Optic–vision
Inspect fundi with opthalmoscope
Inspect for bulging and blurred margins, pallor and cup enlargement

109
Q

CN 3

A

Oculomotor
Pupillary constriction, opening of eye and most extraocular movements
Test pupillary reaction to light, check near response, convergence and accommodation of the lens

110
Q

CN 4

A

Trochlear

Downward and internal rotation of the eye

111
Q

CN 5

A

Trigeminal
Motor: jaw clenching, lateral jaw movement
Sensory: opthalmic, maxillary and mandibular
Ask patient to firmly clench teeth and open jaw from side to side; use pin and cotton swab for pain; wisp of cotton on eye for corneal reflex

112
Q

CN 6

A

Abducens

Lateral deviations of eye

113
Q

CN 7

A

Facial
Motor: facial movements such as facial expression, closing the eye and closing the mouth
Sensory: taste for salty, sweet, sour and bitter and sensations from the ear
Ask to raise both eyebrows, frown, close both eyes tightly , puff out both cheeks

114
Q

CN 8

A

Acoustic
Hearing and balance
Whispered voice test, rinne test, weber test

115
Q

CN 9

A

Glossopharyngeal
Motor: pharynx
Sensory: posterior portions of the eardrum and ear canal; pharynx and posterior tongue, including taste
Patient’s voice quality, difficulty swallowing, say ahh, test gag reflex

116
Q

CN 10

A

Vagus
Motor: palate, pharynx, larynx
Sensory: pharynx, larynx

117
Q

CN 11

A

Spinal accessory
Motor: sternocleidomastoid muscles and upper portion of the trapezius
Move shoulders against resistance

118
Q

CN 12

A

Hypoglossal
Motor: tongue
Listen to articulation of words, inspect patient’s tongue, ask to move tongue side to side

119
Q

Pyramidal tract

A

Mediates voluntary movement and integrated skilled, complicated or delicate movements by stimulating selected muscular actions and inhibiting others

120
Q

Diabetic patients with small-fiber neuropathy report

A

Sharp, burning or shooting foot fain

121
Q

Diabetic patients with large-fiber neuropathy report

A

Numbness and tingling or no sensation at all

122
Q

Proximal limb weakness, when symmetric with intact sensation

A

Occurs in myopathies from alcohol, drugs such as glucocorticoids, and inflammatory muscle disorders
Ask about difficulty combing hair, reaching shelf, climbing stairs

123
Q

Parkinson disease s/s

A

low frequency, unilateral resting tremor, rigidity, and bradykinesia

124
Q

Essential tremors

A

High frequency, bilateral, upper extremity tremors that occur with both limb movement and sustained posture and subside when limb is relaxed
Relieved by alcohol

125
Q

Causes of restless leg syndrome

A

Pregnancy, renal disease, iron deficiency

126
Q

Mental status exam includes

A

Level of alertness, appropriateness of responses, orientation to date and place

127
Q

Dysarthria

A

Impairment of the voice due to dysfunction of the muscles that allow speech but does not affect ability to understand or express oneself

128
Q

Broca’s aphasia

A

Verbose, meaningless, verbal expression with sparing of language interpretation
Usually due to lesion in the posterior inferior frontal lobe

129
Q

Automatism for seizures

A

Eyelid fluttering, chewing, lip smacking, swallowing

130
Q

Brudzinski sign

A

Involuntary flexion of the hips and knees when flexing the neck is positive meningeal irritation
Positive for meningeal irritation

131
Q

Kernig sign

A

Pain in lower back when flexing the leg at the knee and attempting to straighten the leg
Positive for meningeal irritation

132
Q

Circumstantiality

A

Speech with unnecessary detail, indirection and delay in reaching the point

133
Q

Derailment

A

Shifting topics that are loosely connected or unrelated

134
Q

Flight of ideas

A

Continuous flow of accelerated speech with abrupt changes from one topic to another

135
Q

Neologisms

A

Invented or distorted words

136
Q

Most common issue in early cognitive decline

A

Short term memory storing

137
Q

Possible causes of delirium

A

Hypoglycemia, hypoxia, injury, medications

138
Q

Delirium Tremens

A

Brain’s response to withdrawal from alcohol consumed in large quantities over time
Withdrawal signs: agitation, confusion, combativeness, panic, seizures, hallucinations, illusions

139
Q

Depression differential diagnosis medical reasons

A

Adrenal disease, thyroid disorder, diabetes, hypercalcemia, lupus, chronic fatigue syndrome, fibromyalgia, anemia, substance abuse, bipolar, dementia

140
Q

Dysthmyic disorder

A

Symptoms of depression for most of the day, more days than not, for at least 2 years

141
Q

In kids with OCD, check for

A

Precedent strep infection

142
Q

Sensitivity

A

Percentage of individuals with the target condition who would have an abnormal or positive result
Higher sensitivity means a greater percentage of people with the given condition will have an abnormal result

143
Q

Specificity

A

Percentage of healthy individuals who would have a normal result

144
Q

Patients with anxiety typically present initially with

A

Chest pain, irritable bowel syndrome, unexplained dizziness, migraines, chronic fatigue

145
Q

Medications that can cause anxiety

A

Caffeine, thyroid medications, theophylline, albuterol

146
Q

GAD

A

Worried most of the time about many different concerns, both reasonable and unfounded; occurs on most days for at least 6 months

147
Q

Drugs that can cause depression

A

Antihypertensives, corticosteroids, estrogen and progesterone, antiparkinsonian drugs, antianxiety drugs, accutane, birth control

148
Q

Assessment of depression should always be followed up with

A

Assessment for bipolar disorder

149
Q

Bipolar 1

A

one or more manic episodes or mixed episodes

Suicide ideation and attempts more likely to occur in depressive or mixed state

150
Q

Bipolar 2

A

Clinical course includes one or more major depressive episodes and at least one hypomanic episode; no manic or mixed episodes

151
Q

Cyclothymic disorder

A

Chronic, fluctuating mood disturbance, including hypomanic and depressive symptoms that do not meet criteria for manic episode; does not lack severity to meet criteria for depressive episode
Symptoms present for 2 years

152
Q

Physical findings with bulimia

A

Loss of dental enamel due to recurrent vomiting, increased parotid glands, calluses on hand from inducing vomiting, electrolyte imbalances

153
Q

How to differentiate between delirium and psychosis

A

Ask patient to state time of day when hallucinations occur

154
Q

Anticholinergics and delirium

A

Can cause it–especially in elderly

155
Q

Reactive attachment disorder

A

Emotionally withdrawn/inhibited
Indiscriminately social/disinhibited
Due to social neglect or other situations that limit a young child’s opportunity to form selective attachments

156
Q

4 major groups of musculoskeletal complaints

A

Mechanical problems, soft tissue conditions, inflammatory diseases, noninflammatory diseases

157
Q

Conditions commonly associated with joint pain

A

OA, tendonitis, infection, gout, RA, lupus

158
Q

Medications that may cause rhabdomyolysis

A

Anti-inflammatories, statins, fibrates, erythromycin

159
Q

SE of quinolones

A

Tendinitis and tendon rupture

160
Q

Polyarthralgia

A

pain in 5 or more joints
Joint pain and discomfort rather than joint inflammation or degeneration
X ray first line dx

161
Q

RA

A

Progressive, inflammatory and erosive condition affecting multiple joints
Symmetric joints
Prolongedm orning stiffness and fatigue with tender, swollen and warm joints

162
Q

OA

A

Loss of cartilage and progressive erosion of bone
Pain and stiffness improves with moderate use and worsens after long periods of rest
X ray Dx

163
Q

Fibromyalgia

A

Noninflammatory soft tissue disorder

Generalized pain, stiffness, decreased ROM and multiple point tenderness in 11/18 sites for >3 months

164
Q

SLE

A

Chronic autoimmune disorder: malar rash, arthralgias, myalgias, fever, fatigue, Raynaud’s syndrome, neuropathy

165
Q

Sarcoidosis

A

Inflammatory disorder; develop granulomas and joint pain, fatigue, fever, altered appetite, cough, wheezing, SOB
Dx: biopsy and chest x ray

166
Q

Gonococcal arthritis

A

Migratory and affects lower extremities and hands

Nonpruritic dermatitis and tenosynovitis with generalized muscle aches

167
Q

Lyme Disease

A

Transmitted by deer tick bite
Migratory polyarthralgia, myalgia, neurologic findings including meningitis or neuropathy
Early finding: solitary target lesion followed by multiple lesions
Dx: ELISA

168
Q

Acute rheumatic fever

A

Occurs following infection with streptococcal pharyngitis usually
Migratory pain in larger joints; cardiac symptoms may be present, subcutaneous nodules

169
Q

Cervical disk disease

A

Morning stiffness, tightness and pain, coughing and straining increase the pain, which may radiate to shoulder and arm
Elevating arm may provide relief
Numbness along scapula may occur
Altered upper extremity DTR, weakness, sensation

170
Q

Cervical stenosis/spondylosis

A

Bony osteophytes compress the spinal cord

Dx- X ray

171
Q

Syringomyelia

A

Fluid cavity in spinal cord; usually caused by Chiari malformation
Burning pain in the neck or thoracic area and paresthesia/numbness in the neck or thoracic area and extremities
Progressive weakness

172
Q

Mechanical low back pain

A

Onset occurs after new or unusual exertion

Pain relief achieved by lying down

173
Q

Herniated intervetebral disk

A

Sciatica symptoms
Lying with hips flexed provides pain relief
May have diminished reflexes and strengths

174
Q

Spinal stenosis

A

Pain usually worse during the day; aggravated by standing; relieved by rest and leaning forward
May have weakness and bladder/bowel dysfunction

175
Q

Spinal infection

A

Fever, chills, possible weight loss, pain worse at night, point percussive tenderness and elevated skin temperature

176
Q

Ankylosing spondylitis

A

Early symptoms: lower back pain and stiffness
Bony tenderness, malaise, loss of appetite, fever, fatigue, loss of spine mobility
Neck pain is late symptom

177
Q

Rotator cuff syndrome/impingement

A

Anterior and lateral shoulder pain that increases with arm elevation and reaching overhead; Pain is progressive and associated with repetitive activities; ROM usually preserved

178
Q

Rotator cuff tear

A

Usually follows chronic impingement
Pain sudden and worse at night
Associated weakness and atrophy of surrounding structures occurs

179
Q

Radiating pain to shoulder from

A

Cardiac, pulmonary and gallbladder disease

180
Q

Olecranon bursitis

A

Swelling and tenderness at the tip of the elbow over the olecranon; point tenderness common

181
Q

Most common cause of hip pain

A

OA

182
Q

Avascular necrosis of the femoral head

A

Bone deterioration associated with diminished circulation from trauma or malignancy or infection
Hip pain and difficulty bearing weight
Coughing increases pain and it persists at rest and night
Radiates down thigh

183
Q

Slipped femoral capital epiphysis

A

Hip pain in adolescents
Involves slippage of the femoral epiphysis on the femoral neck; more common in overweight male adolescents during time of rapid growth
Referred pain to groin, thigh, knee
Gradual progression with stiffness progressing to pain and development of hip
Comfort increased with external rotation of hip

184
Q

ACL injury

A

Usually due to deceleration combined with sudden turning or pivoting
Hear a pop at time of injury

185
Q

Plantar fascitis

A

Caused by prolonged standing, walking or running in poorly designed shoes with no arch support
Pain on undersurface of heel, worse upon weight bearing

186
Q

Achilles tendinitis

A

Chronic overuse of the calf muscles from activities such as jumping
Patient can not stand on ball of foot and has tenderness and hemorrhage at site of rupture; ROM diminished

187
Q

Tests to test for coordination

A

Finger to nose
Rapid alternating movements
Heel to shin
Romberg

188
Q

Migraine

A

Generally lasts 4-76 hours can be associated with menstrual cycle
Unilateral initially but can become generalized
Aggravated by movement, light, noise
Accompanying symptoms: nausea, vomiting, phototobia, phonophobia, dizziness, chills, ataxia

189
Q

Cluster headaches

A

Most incapacitating
Episodic and unpredictable headaches that may be cyclic, occurring more in spring and fall
Cluster periods last 2-3 months and may remit for months to years
Unilateral, penetrating, sharp, excruciating, and unrelenting pain

190
Q

Tension headache

A

Mild to moderate non-throbbing pressure or squeezing pain that can occur anywhere in neck or head

191
Q

Subdural hematoma

A

Dull and aching headache that may be transient

Usually due to blow to the head, fall or other injury

192
Q

Subarachnoid hemorrhage

A

Severe and acute pain; thunderbolt headache; made worse by lying down
Usually due to head trauma, ruptured aneurysm, vascular malformation, uncontrolled hypertension

193
Q

Viral/bacterial meningitis

A

Diffuse and throbbing headache + fever, phototobia, nausea, vomiting, nuchal rigidity

194
Q

Chiari malformation

A

Persistent headache in occipital area radiating behind eyes; triggered or worsened by vasalva maneuver or flexion/extension of neck
May have dizziness, tinnitus, decreased hearing, weakness, numbness, paresthesias, extremity pain, fatigue

195
Q

Temporal arteritis

A

Chronic inflammation and presence of giant cells in large arteries usually in temporal artery
Can lead to blindness
Bitemporal, frontal or vertex head pain that is lancinating, sharp, or ice pick in nature
Visual changes, scalp and jaw tenderness, facial pain, tenderness to palpation over affected artery

196
Q

Normal pressure hydrocephalus

A

Gait disorder followed by clouding of thought processes and urinary incontinence
Increased DTR, inability to tandem walk, positive babinski, positive romberg

197
Q

Meniere disease

A

Due to increased fluid and pressure in the labyrinth
Severe vertigo, tinnitus, hearing loss
Vertigo associated with N/V

198
Q

Benign paroxysmal positional vertigo

A

Due to otolithic crystals/particles detaching from the utricle membrane and migrating to the semicircular canal
Sudden onset dizziness lasting less than 30 seconds and following head position change
Sensation of room spinning

199
Q

Multiple sclerosis

A

Inflammation and degeneration of myelin of the brain’s white matter–leads to decreased brain mass and obstructed transmission of nerve impulses

200
Q

Encephalitis

A

Acute inflammation of brain and spinal cord, involving meninges, often due to virus such as HSV

201
Q

Trigeminal neuralgia

A

Recurrent paroxysmal sharp pain that radiates into one or more branches of 5th cranial nerve

202
Q

Peripheral neuropathy can be due to

A

Diabetes, B12, folate deficiency, Lyme disease, HIV

203
Q

Dx for ADHD

A

Symptoms must occur before age 12 but after 6 months and be noticed in at least 2 settings, not explained by another disorder

204
Q

Horner’s syndrome

A

Sympathetic innervation to the head, neck, and eye is interrupted somewhere along the 3rd neuron arc
Triad of ipsilateral miosis, eyelid ptosis, and anhidrosis of face and neck (inability to sweat)
Loss of facial flushing in pediatrics

205
Q

Bell’s palsy

A

CN7 issue; flaccid muscles of face unilaterally; impaired ability to raise eyebrows, impaired closure of eye, impaired smile, grin and pursed lip

206
Q

Bacterial meningitis

A

Triad of fever, neck stiffness, altered mental status

May have meningococcal rash

207
Q

PD

A

Decreased emotional display, general motor slowing and stiffness, resting tremor, soft and muffled speech, history of falling

208
Q

MS

A

Fatigue, depression, emotional instability, epilepsy, memory loss, diplopia, sudden vision loss, facial palsy, dysphagia, muscle weakness and spasm, vertigo, falls, bladder/bowel incontinence
Optic disc swelling or pallor, nystagmus

209
Q

lidocaine injection test for rotator cuff

A

If complete resolution of pain–impigement syndrome rather than rotator cuff

210
Q

MCL injury

A

Twisting or hyperflexion mechanism of injury, increased pain with stairs, squatting locking or catching, sensation of giving out

211
Q

Paget Disease

A

Frequently asymptomatic; resting or nocturnal bone pain; hearing loss; headaches; head enlargement; pathologic fractures and muscle weakness
CVA tenderness from renal calculi
Serum alkaline phosphatase elevated

212
Q

With fatigue, pay particular attention to

A

Thyroid + lymph system, arrhythmias or murmurs, skin changes, neurologic system

213
Q

Addison’s disease

A

Chronic, progressive, hypofunctioning of the adrenals caused by atrophy or destruction of adrenal cortex
Hyperkalemia + hyponatremia
Cortisol deficiency leads to hypoglycemia

214
Q

How can you alleviate restless leg syndrome symptoms

A

eliminate tobacco and alcohol and add exercise to daily routine

215
Q

Myasthenia gravis

A

Limb weakness and fatigability of affected muscles diagnostic sign
Ocular, facial, masticatory and pharyngeal muscles most affected
Sustained activity increases weakness; symptoms improve with rest
Administer edrophonium chloride to test

216
Q

ALS

A

muscle weakness and atrophy usually starting in the hands and progressing randomly and asymmetrically

217
Q

Cushing Disease

A

Excess cortisol and corticosteroid hormones due to adrenal tumors, pituitary adenomas, administration of steroids
Amenorrhea and hirsutism may be first symptom
Moon face + buffalo hump + central obesity
Purple striae around thighs. breasts and abdomen
Dx: give IV dexamethasone at bedtime and check cortisol levels 8-10 hours later

218
Q

Weight loss is significant if

A

> 5% of the usual body weight over 6-12 month period

219
Q

Top differential dx for weight loss

A

diabetes, digestive disease, thyroid disease, depression

220
Q

Signs of malnutrition

A

dry skin and hair, pale conjunctivae, glossitis, bruising, lethargy, decreased vibratory sensation, decreased DTR, bone demineralization, muscle wasting

221
Q

Hemolytic uremic syndrome

A

Triad of microangiopathic hemolytic anema, thrombocytopenia, and uremia

222
Q

Cholecystitis/cholelithiasis

A

Episodic RUQ pain radiating to back, worse pain after meal high in fat, /V, indigestion with bloating
Positive murphy’s sign, fever, jaundice, RUQ pain

223
Q

Cirrhosis

A

Fatigue, malaise, weakness, anorexia, weight loss, RUQ pain, irregular menses, ED, tea colored urine, clay colored stools, abdominal swelling, spider angiomas, ecchymosis, hepatomegaly, splenomegaly, pitting edema, muscle wasting

224
Q

Pancreatitis

A

Acute onset of epigastric pain which may radiate to back, N/V, alcohol use, history of gall stones, abdominal trauma
Epigastric tenderness, decreased bowel sounds, jaundice, percussive dullness in lungs, flank discoloration, elevated lipase levels

225
Q

PUD

A

Epigastric gnawing or burning pain after meals or on empty stomach, nocturnal pain, heartburn, loss of appetite

226
Q

Diverticulitis/diverticulosis

A

Abdominal pain, dull and colicky primarily in LLQ, exacerbated by eating and bowel movement, diarrhea or constipation, anorexia, N/V, dysuria or frequency, hematochexia, melena
Rebound tenderness in LLQ

227
Q

When does bacterial gastroenteritis develop

A

6-24 hours after ingestion of contaminated food

228
Q

Crohn disease

A

Fatigue, fever, weight loss, prolonged idarrhea, perianal disease, cramping abdominal pain
Rectal bleeding

229
Q

Ulcerative colitis

A

Bloody diarrhea, cramping rectal pain, abdominal pain, rectal urgency, fecal incontinence

230
Q

Chlamydia

A

White discharge, pain with urination, urgency to urinate, abdominal and genital pain

231
Q

Gonorrhea

A

yellow, green or white thick discharge, pain with urination, urgency to urinate, abdominal and genital pain

232
Q

Trichomoniasis

A

Itching to genitals, burning with urination, yellow or green or white discharge, urgency to urinate

233
Q

Herpes

A

Flu like symptoms, small and painful blisters on mouth or genitals

234
Q

Hepatitis B

A

flu like symptoms, tiredness, yellowing skin, dark urine, light stool

235
Q

Galactorrhea

A

Milky discharge not associated with pregnancy usually bilaterally
Check breasts and visual fields
May be due to pituitary gland overproduction

236
Q

Mastitis

A

Fever, N/V, breast tenderness, swelling, redness, malaise

237
Q

Balanitis

A

Pain, drainage, dysuria, odor, ballooning of foreskin when voiding, redness
Erythema, tenderness, edema, discharge, ulceration, plaque

238
Q

Varicocele

A

Scrotal pain and heaviness
Feeling of bag of worms in scrotum
Can cause infertility

239
Q

Hydrocele

A

Acute or chronic swelling of scrotum or inguinal canal; usually painless; feeling of heaviness; edema of scrotum or inguinal canal that transilluminates

240
Q

Spermatocele

A

Smooth, soft, well-circumscribed mass at head of epididimysis that will transilluminate

241
Q

Epididymitis

A

Scrotal pain and swelling usually unilateral; have have discharge
Epididymis very tender and asymmetric
Usually due to STD

242
Q

Testicular torsion

A

Acute onset of pain, often during inactivity; N/V; enlarged, erythemic, painful scrotum ; testicular swelling; severe testicular pain; testes may be high in the scrotal sac
Contraction of cremasteric muscle during trauma, exercise, cold and sex may precede

243
Q

Endometriosis

A

Dysmenorrhea, dyspareunia, chronic pelvic pain that worsens with menstruation, hematochezia, abdominal distention
Focal pain and tenderness on pelvic exam; pelvic mass present; immobile pelvic pain

244
Q

Hemorrhoids

A

Bright red rectal bleeding, constipation or diarrhea, straining with defecation
May report itching
Can be associated with pregnancy, liver disease, HTN, constipation

245
Q

BV

A

abnormal vaginal discharge, fishy odor

246
Q

Yeast infection

A

Itching, burning, irritation, dyspareunia, white and thick discharge that may look like cottage cheese , may smell like bread

247
Q

Trichomonias

A

Abnormal discharge, itching, burning, postcoital bleeding

Greenish discharge with amine odor may be seen

248
Q

PID

A

Lower abdominal pain, pelvic pain that is dull, crampy, bilateral and constant; worse pain with exercise, coitus or motion; new or abnormal discharge; fever, chills, cramping, low back pain, postcoital vaginal bleeding
Fever and lower abdominal pain with cervical motion tenderness on pelvic exam

Advanced Health Assessment (4 decks)

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