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N270: Advanced Health Assessment [Fall 2016] > For Midterm > Flashcards

For Midterm Flashcards

1
Q

normal adult heart rate

A

60-80 (60-100)

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2
Q

Nodularity (breasts)

A

think fine curd cottage cheese - fine mass of small little bumps, no discrete mass among the background

in the upper outer quadrant of many young women’s breasts you might find fine or medium nodularity

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3
Q

Systolic ejection murmur possible diagnoses:

A

Normal, pulmonic, or aortic stenosis

hypertrophic obstructive cardiomyopathy

ASD

tetralogy of Fallot

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4
Q

Otorrhea

A

drainage from the ear

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5
Q

Whispered pectorliloquy

A

Whispered words easily heard

suggests lung consolidation

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6
Q

How do you distinguish between dimer and perforation?

A

use pneumatic otoscope

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7
Q

Squamocolumnar junction

A

area where the columnar junction of the endocervical canal meets the squamous cells of the external cervix

causes an irregular, deeper red area - usually symmetrical

NORMAL

on younger adolescence, it’s on the outside

later, it regresses

it’s where most HPV lesions occur (cancer)

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8
Q

What would you think of to cause unilateral nasal congestion? Bilateral?

A

unilateral: nasal mass
bilateral: allergic rhinitis, nasal polyps

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9
Q

Normal PMI is how wide and usually located where?

A

1-2 cm

medial to the mid-clavicular line at 5th ICS

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10
Q

When doing physical assessment of popliteal artery, remember what 2 things?

A
  • bend knee slightly
  • push fingers into popliteal fossa
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11
Q

Should imperforate hymen in prepubertal exam be referred?

A

yes

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12
Q

Physiological splitting of S2 (normal) heard where/when?

A

at pulmonic area

during PEAK inspiration

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13
Q

Epistaxis - where do most people commonly bleed?

A

Kisselbach’s plexus (juncture of all the arteries)

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14
Q

Positive Romberg test (swaying, can’t stand straight with arms out and eyes closed) means

A

problem with proprioception or ear balance function

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15
Q

“Natural” pacemaker is

A

SA node

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16
Q

vaginal fornix

A

space around cervix tucked in the back of vaginal canal

important because things can get lost up there

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17
Q

Odynophonia

A

pain when speaking

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18
Q

Expected diaphragmatic excursion

A

5-6cm

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19
Q

What would the patient complain of if they were hyperventilating during your auscultation?

A

feeling dizzy

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20
Q

Are fallopian tubes normally felt?

A

No

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21
Q

An 85-year-old female presents with chest pain and dyspnea that is worsen x 3 months. She had a presyncopal episode last week. What type of murmur is this?

  • Timing? Systolic
  • Location? Left sternal border (LSB) that radiates to apex and carotids
  • Shape? Crescendo-decrescendo
  • Pitch? Harsh
A

aortic stenosis

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22
Q

Murmur (5 key etiologies)

A
  • caused by turbulent flow
  • flow across partial obstruction of abnormal valve
  • backwards through leaky valves
  • across shunts like septal defects
  • increased flow across normal valve
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23
Q

What should ovaries be like?

A

2-3 cm, smooth, firm, ovoid, mobile, sensitive to touch

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24
Q

Diastolic murmur grade I out of IV

A

barely audible

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25
Q

Older adults: be mindful that they may have ___ pulse pressure and ___ hypotension

A

widened

orthostatic

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26
Q

Rinne test

A

Always done after Weber

Strike tuning fork and place it on the mastoid bone. (Here, the sound is bypassing external anatomy and being conducted through skull base directly into cochlea. They’ll be able to hear that.) Then, hold the tuning fork in front of their ear, right in the opening of the ear canal. You ask which one is greater.

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27
Q

Mallampati grading 1-4

A

(tongue extended, mouth open): has to do with the obstruction of the airway in the oropharynx, closely correlated with obstructive sleep apnea

Grade 1: you can see all of the tonsillar pillars, full uvula, all of soft palate (all visible)

Grade 2: can’t see end of uvula or tonsils

Grade 3: root of uvula and end of soft palate

Grade 4: tongue base obstructing all of the posterior oropharynx

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28
Q

Pediatric murmurs are often ___ in children age 3-8

A

innocent systolic flow murmurs and Grade III or less

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29
Q

Systolic murmur grade II (out of VI) - volume/thrill?

A

audible but soft no thrill

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30
Q

most cervixes are in what position

A

midline or downwards

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31
Q

Is tachycardia common during pregnancy? When might you have it?

A

yes

  • 10-20bpm above baseline esp near term
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32
Q

systolic or diastolic? pulmonic stenosis

A

systolic

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33
Q

PDA continuous murmur sounds like what? Is it a diastolic, systolic, or continuous murmur?

A

harsh “machinery” murmur

continuous

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34
Q

CN VII

A

facial nerve

responsible for movement on one side of the face

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35
Q

What do Wheezes represent? Quality?

A

– obstruction of small airways

– High-pitched musical type sound during inspiration and/or expiration

– A “continuous sound”

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36
Q

Secondary sex characteristics (puberty) appear between ages ___ with breast buds

A

8-13

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37
Q

Common Cervical Findings: Polyps

A

Usually friable (crumble/bleed easily), should be removed

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38
Q

Systolic murmur grade IV (out of VI) - volume/thrill?

A

easily audible with thrill

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39
Q

retrouterine pouch

A

opens into abdominal cavity

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40
Q

Non-cyclic breast pain

A

No relationship to menses, post-menopausal

Calcification and ductal dilatation

more common in women 35+

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41
Q

Expected RR for Adult

A

12-20

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42
Q

uterine fundus

A

top of the uterus

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43
Q

Systolic murmur grade V (out of VI) - volume/thrill?

A

easily audible with thrill, heard with stethoscope partially off chest

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44
Q

severe aortic stenosis can radiate where

A

along the whole precordium/chest

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45
Q

problem-oriented or focused health history

A

◆ Used when comprehensive history has already been done

◆ Addresses acute or focused problems

◆ Only the need of the moment given full attention

◆ Will include PMH, PSH, FH, as relevant to the presenting complaint or problem.

◆ Most commonly used in reality of clinical practice

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46
Q

pectus carinatum

A

pigeon chest

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47
Q

How many lobes in right and left lungs?

A

right: 3
left: 2

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48
Q

Dix-Hallpike test

A

Test for benign proxismal positional vertigo (stones in the balance canal that spin)

Lay patient down, turn head to one side –

if present you get obvious rotational nystagmus (eye twitching towards the downwards side)

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49
Q

uterus has ___ openings

A

2

external and internal

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50
Q

Should you be able to palpate ovary in post-menopausal women?

A

No

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51
Q

Location of PVD symptoms: Buttock, hip - what is the associated artery?

A

Aortoiliac

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52
Q

Basic principle of vocal resonance: Voice transmission enhanced (improved) if underlying lung field is ____

A

consolidated (such as in pneumonia)

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53
Q

Expected RR for Newborn

A

30-60

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54
Q

Diastolic murmur grade III out of IV

A

easily audible

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55
Q

Location of PVD symptoms: Erectile dysfunction - what is the associated artery?

A

Iliac-pudendal

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56
Q

What 2 valves are Semilunar?

A

Aortic, Pulmonic

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57
Q

Late diastolic murmur possible diagnoses:

A

Tricuspid or mitral stenosis

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58
Q

Breast self exam should be done which day of menstrual cycle?

A

Day 4-7 of menstrual cycle

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59
Q

Systolic murmur grade III (out of VI) - volume/thrill?

A

easily audible no thrill

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60
Q

Edema is most commonly a sign of what?

A

decreased cardiac function leading to decreased capillary flow

increased fluid perfusion, especially in the gravity dependent areas

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61
Q

In primary care, Problem 1 should usually be

A

“Health Care Maintenance”

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62
Q

Is audible splitting of heart sounds normal during pregnancy?

A

yes

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63
Q

Tinnitus is often an early sign of

A

hearing loss

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64
Q

Pectoral/anterior nodes: where are they located? What do they drain/where do they drain into?

A
  • Lower border of pectorals major inside anterior axillary fold
  • Drains anterior chest wall and most of breast
  • Drains into central axillary nodes
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65
Q

S4 may be physiologic in ___ and ____ and _____

A

infants, small kids, adults over 50

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66
Q

Extra Heart Sounds in Systole

A
  • Clicks – usually MVP
  • Ejection sound (click)
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67
Q

Diastolic murmur grade IV out of IV

A

loud

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68
Q

Rounding in child’s chest should be gone by age

A

1

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69
Q

S3 correlates with time of what?

A

rapid ventricular filling (diastole)

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70
Q

Breast lifespan changes: Pregnancy (4)

A
  • increase in size
  • pigmented areas darken
  • fat replaced by functional ducts
  • Montgomery glands lubricate
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71
Q

Neonates vs adult signs of respiratory distress

A

Neonates: nasal flaring, retractions, paradoxical mvmts., stridor or grunting

Adults: pursed lip breathing (COPD - this is actually helpful for these patients because it allows more time for expiration)

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72
Q

Aortic area murmurs (2nd ICS, right sternal border) - what could they potentially be?

A

aortic stenosis

aortic regurgitation

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73
Q

S3

A

Low-pitched vibration occurring in early diastole after S2

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74
Q

What does Friction rub represent? quality?

A

– Indicates inflammation of pleural surfaces

– Low-pitched, grating sound

– Occurs on inspiration and expiration

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75
Q

A ____ murmur may reflect the increased flow across AV valves in pregnancy, but is much less common and organic disease should be ruled out

A

innocent diastolic flow murmur

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76
Q

4 components of the “Plan” portion of the health history

A
  1. Diagnostic Tests/Consultation
  2. Therapeutic Interventions
  3. Client Education
  4. Follow up
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77
Q

Supernumerary breasts

A

Non-functional embryonic milk line from groin to axilla

Glandular tissue and /or pigmented lesion

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78
Q

Turbulence in the great veins can cause an ___ in very small children

A

innocent venous hum

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79
Q

Systolic click with late systolic murmur possible diagnosis:

A

Mitral valve prolapse

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80
Q

What are contributing factors to tinnitus? (6)

A
  1. TMJ
  2. Cervical spine
  3. Iatrogenic - meds (Aspirin, NSAIDS, chemo agents)
  4. Insomnia
  5. Psychiatric (depression, anxiety will worsen tinnitus)
  6. Caffeine and sodium intake
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81
Q

Diastolic murmur grade II out of IV

A

audible but soft

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82
Q

Bronchophony

A

When there is increased voice clarity and volume

suggests lung consolidation

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83
Q

What do Rhonchi represent? Quality?

A

– represent secretions in large airways

– snoring type of sound

– low pitched

– during insp. and/or exp;

– a “continuous breath sound”***

– may change or clear with coughing

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84
Q

For women 30-65 years, what are the pap recommendations?

A

Pap every 3 years

or

Pap and co-testing with HPV every 5 years if both initial tests negative.

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85
Q

Otalgia

A

pain in ear

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86
Q

ACS mammography recommendations:

A

age 45-54 yearly >55 every two years, as long as in good health or 10+ years life expectancy

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87
Q

S1 should be consistent with ____ and ____

A

carotid pulse and PMI

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88
Q

S4 is common in ___ patients

A

HTN

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89
Q

If the sound from the Weber test is louder in one side, it means either of 2 things?

A

they could have a conductive hearing loss in the side that’s hearing the sound LOUDER

Or it could be that’s the better sensory hearing side, so it could be a sensory hearing loss on the softer side

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90
Q

chronic poor oxygen delivery to the peripheral tissues of the hands and feet

A

cyanosis

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91
Q

S1

A

systole Closure of the mitral (tricuspid) valve (M before T)

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92
Q

systolic or diastolic? mitral valve prolapse

A

systolic

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93
Q

What do these tuning fork tests results indicate?

AC>BC bilaterally; Weber lateralized to the Right

A

sensory hearing loss in the left ear

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94
Q

Systolic murmur grade I (out of VI) - volume/thrill?

A

barely audible no thrill

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95
Q

Adults: Anterior-posterior (A- P) diam. should be what in relation to transverse diem?

A

less than

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96
Q

Expected RR for 10 years

A

16-20

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97
Q

4 important questions to take for history of hearing loss

A
  1. Laterality (most important)
  2. Onset
  3. Fluctuations
  4. communication function
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98
Q

Is increase in intensity of S1 normal during pregnancy?

A

yes

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99
Q

One of the most common forms of vertigo is

A

benign paroxysmal positional vertigo

Lays down rolls over in bed and spins

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100
Q

What position should patients be in for cardiac auscultation

A

Supine at 30-45 degrees

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101
Q

Venous vs. arterial phase of epistaxis

A

Lesser quantity: venous phase

More quantity: arterial phase

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102
Q

2 speculum names and sizes - what’s the difference between the two?

A

Pedersen: small, medium (S-XL)

Graves: medium, large (S-XL)

difference: width of the beaks

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103
Q

Bronchial/tracheal (tubular) breath sounds: where are they heard? Quality?

A

– heard over manubrium/ trachea/ large airways (abnormal in other locations)

– relatively loud

– expiratory phase somewhat longer than inspiratory phase or about equal

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104
Q

Location of PVD symptoms: Thigh - what is the associated artery?

A

Common femoral or aortoiliac

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105
Q

Any time you hear a click, it only refers to

A

mitral valve prolapse

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106
Q

After initial pap smear at 21 years, they should be done every ___ years until what age?

A

every 3 years under age 29

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107
Q

Where do you palpate Bartholin’s glands? Is pain normal

A

5 and 7 o’clock downwards

no pain

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108
Q

Central axillary nodes: where are they located? where do they drain into?

A
  • Palpable high in axilla, close to ribs
  • Drains into infra and supraclavicular nodes
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109
Q

Location of PVD symptoms: Upper calf - what is the associated artery?

A

Superficial femoral

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110
Q

How can slapping someone against the head lead to hearing loss?

A

Slapping someone alongside the head can form a column of air through ear canal and perforate the eardum, leading to hearing loss

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111
Q

If you note Xanthelasmas (yellowish plaques that occur most commonly near the inner canthus of the eyelid, more often on the upper lid than the lower lid) during eye assessment, what might this indicate?

A

hyperlipidemia

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112
Q

Pregnant women have a ____ costal angle

A

widened

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113
Q

Left lateral decubitus position when auscultating accentuates what 3 things?

A
  1. left-sided S3
  2. S4
  3. mitral murmurs (stenosis)
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114
Q

Otalgia (ear pain) could be referred pain from what 3 areas?

A
  1. jaw (bruxism aka teeth grinding)
  2. cervical spine (sleeping position)
  3. throat (lesions)
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115
Q

to palpate cervix during bimanual exam, where should abdominal hand be?

A

midway between umbilicus and pubic bone, applying downward pressure

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116
Q

S1 best heard where?

A

at the apex with bell

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117
Q

7 components of Pediatric History: SUBJECTIVE DATA

A

◆ Identification and client profile

◆ Chief Complaint (CC)

◆ Present Concerns/Illness (HPI)

◆ Past Medical History (PMH): including birth, feeding, growth and development, ADLs (diet, sleep, elimination, childcare arrangements, safety practices)

◆ Current development level, including school history

◆ Social and family history, including discipline practices

◆ Review of Systems

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118
Q

systolic or diastolic? mitral stenosis

A

diastolic

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119
Q

What breath sounds represent opening of small airways or air bubbling through secretions?

A

Crackles/rales

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120
Q

What position accentuates left sided S3, S4, mitral murmurs like stenosis for auscultation?

A

Left lateral decubitus

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121
Q

What do these tuning fork tests results indicate?

AC>BC bilaterally; Weber is midline

A

normal

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122
Q

With head bending forward, ___ usually most prominent vertebrae

A

C7

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123
Q

Sinuses (4 sets)

A
  1. frontal (sometimes - not everyone has them)
  2. ethmoid
  3. sphenoid
  4. maxillary
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124
Q

Some types of xanthoma are indicative of lipid metabolism disorders which indicate increased risk of what?

A

coronary artery heart disease

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125
Q

Lateral nodes: where are they located? What do they drain/where do they drain into?

A
  • On upper humorous
  • Drains most of arm
  • Drains into central axillary nodes
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126
Q

During pregnancy, there is an increase in what 3 things?

A
  1. plasma volume (50% above baseline by 2nd trimester)
  2. maternal cardiac output (during early pregnancy)
  3. uterine blood flow (10x normal)
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127
Q

Problem in inner ear like age-related hearing loss, hair cell deterioration would qualify as ___ hearing loss

A

sensory

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128
Q

When auscultating older adults, especially those who have a cognitive impairment or something like Parkinson’s, where is it best to begin auscultating?

A

at the bottom - work up

you may only get 1 or 2 breaths out of them

may hear basilar crackles

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129
Q

Majority of cervical cancers and HPV lesions appear in what area?

A

Squamocolumnar junction aka transformation zone, ectropian, squamous metaplasia

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130
Q

Vestibulo-ocular reflex

A

signal sent from your ear about where you’re moving in space and allowing eyes to keep focused as you’re moving - when you’re driving in car you can read a sign

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131
Q

Why do you massage parotid and submandibular glands from front to back?

A

to get saliva production and therefore assess patency of ducts

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132
Q

Weber screening test

A

Done first

Strike the tuning fork on the end, then put it in the center of the patient’s forehead.

Can they hear it? Is it louder in one ear or the other?

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133
Q

Most common GYN concerns (6)

A
  1. Vaginal discharge
  2. Abnormal bleeding
  3. Pelvic pain
  4. Urinary problems
  5. Sexual dysfunction
  6. Infertility
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134
Q

tonsillar grading 0-4

A

0 - tonsils removed, not present

1 - most people in here, tonsils tucked into pillars

2 - extend beyond pillars

3 - at least halfway to the uvula

4 - airway issue, the tonsils are touching

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135
Q

Vocal Resonance: normal

A

Normally voice/spoken words heard through stethoscope should be muffled and difficult to understand

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136
Q

Exam: External Neck - when assessing the salivary gland, why do you need to pay attention to parotid tail

A

tucks behind the ear, where a lot of tumors come from

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137
Q

How does Pneumatic otoscope work? What will you see if eardrum is intact? What will you see if fluid behind TM?

A

Pushes air up into the ear canal and against the tympanic membrane

If eardrum is intact, you’ll see mobility - if there’s a hole in the eardrum, you the air will go right through and you won’t see the effect at all

If fluid is present behind the TM, you won’t get any movement either

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138
Q

Tricuspid area murmurs (4th and 5th ICS, left sternal border) - what could they potentially be?

A

tricuspid stenosis, insufficiency, or regurgitation

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139
Q

Is displaced apical impulse common during pregnancy?

A

yes - rotated axis to left

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140
Q

Should speculum be closed or open when removing?

A

closed

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141
Q

thrills

A

vibrations of loud cardiac murmurs

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142
Q

Which is louder, S1 or S2?

A

S2

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143
Q

What do these tuning fork tests results indicate?

Left BC>AC; Right AC>BC; Weber lateralized to the Left

A

left conductive hearing loss

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144
Q

Is fertility/ability to get pregnant affected by uterine position?

A

no

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145
Q

S3 may be physiologic in ___ and ____

A

children and pregnancy

146
Q

Pelvic examinations should begin at age

A

21 years

147
Q

What do each of the following indicate? 4 parts of the plan: DX:

RX:

Pt. Ed.

F/U:

A

DX: diagnostic test

RX: therapeutic interventions

Patient education

Follow up

148
Q

5 key things to note on bimanual exam of cervix

A
  1. position related to axis of uterus
  2. consistency (firm, soft, patency)
  3. wag cervix for CMT (cervical motion tenderness)
  4. surface characteristics
  5. fornices
149
Q

Sequence from Tanner stage 2-5 takes on average __ years

A

4 (1.5 to 6 years)

150
Q

most common cause of hemoptysis is ____

A

bronchitis

151
Q

CDC advises ____ screening of sexually active adolescents and women ≤25 years for gonorrheal and chlamydial infection and HIV

A

annual

152
Q

PVD: arterial disorders (3)

A
  1. Atherosclerosis
  2. Acute Arterial Occlusion
  3. Raynaud’s Disease
153
Q

Opening snap with diastolic rumble murmur possible diagnosis:

A

Mitral stenosis

154
Q

hernia of intestines into vaginal wall

A

enterocele bulging in posterior fornix

155
Q

Pulmonic area murmurs (2nd and 3rd ICS, left sternal border) - what could they potentially be?

A

pulmonic stenosis or pulmonic insufficiency

156
Q

4 major types of pelvic organ prolapse

A
  1. anterior comportment prolapse
  2. posterior compartment prolapse
  3. enterocoele
  4. uterine prolapse (apical compartment prolapse)
157
Q

Most common site for men to get basal cell carcinoma is on where? Where for women?

A

on the helix of the ear

for women it’s the bridge of the nose

158
Q

What type of health history is most commonly used in reality of clinical practice?

A

problem-oriented or focused health history

159
Q

Breast exam: positions for inspection (4)

A
  1. arms at sides
  2. arms raised
  3. hands pressed on hips or against temples (Elicits dimpling if mass has infiltrated suspensory ligament)
  4. leaning forward (with large pendulous breasts reveals asymmetry of breast)
160
Q

Systole - 4 main points

A
  • Ventricular contraction with increasing pressure
  • Mitral/tricuspid valves close (S1) “lubb”
  • Ventricular pressure opens aortic and pulmonary valves (silent)
  • Ejection
161
Q

Sexual maturity rating with pubic development - keep in mind that hair development usually follows ___ of breast development

A

within a few months

162
Q

Systolic murmur grade VI (out of VI) - volume/thrill?

A

easily audible with thrill, heard with stethoscope fully off chest

163
Q

Patient should be in what position when measuring JVP? What side of the neck are you checking?

A

at 30-45 degrees right side because it corresponds to right atrium

measure at the highest point of pulsations

164
Q

What is often an early presenting sign of hearing loss?

A

Tinnitus

165
Q

Widened pulse pressure in pregnancy is due to

A

uterine contraction and endogenous hormones resulting in decline in peripheral vascular resistance

166
Q

Fakuda step test

A

Patient marching in place, have them close eyes, and they’ll rotate towards the side where there’s ear damage

167
Q

Just because sputum is discolored, it doesn’t necessarily indicate bacterial infection - what does the discoloration represent?

A

inflammatory cells which could be either bacterial or viral

168
Q

Axillary adenopathy

A

Due to arm or breast infection

169
Q

Main local causes of edema

A

• Deep Vein Thrombosis

… Or Infection, trauma, lymphatic obstruction

170
Q

4 Objective Components of the Pediatric Health History

A

◆ Physical exam

◆ Laboratory findings

◆ Developmental assessment

◆ Direct observations including parent-child interaction

171
Q

there are __ pneumonia vaccines recommended in adults

A

2

prevnar 13 (age 50 and up)

pneumovax (65 and up)

172
Q

chronic poor oxygen perfusion to the distal tissues of the hand and feet (congenital heart disease)

A

clubbing

173
Q

When palpating for tactile fremitus, remember that vibraton is greatest where?

A

over the large airways

diminishes peripherally

174
Q

Auricular hematoma

A

cauliflower ear - wrestling

175
Q

systolic or diastolic? aortic stenosis

A

systolic

176
Q

Normal weber screening test

A

hearing it equally in both ears

177
Q

When doing physical assessment of femoral artery, remember what 2 things?

A
  • identify femoral pulse
  • listen with diaphragm for bruits
178
Q

Problem with bones of hearing/TM/external anatomy would quality as ___ hearing loss

A

conductive

179
Q

Pertinent history for Rhinology (5)

A
  1. nasal congestion
  2. epistaxis
  3. rhinorrhea
  4. sinus pressure
  5. sense of smell
180
Q

In the presence of blood, which pap technique is more sensitive?

A

liquid-based

181
Q

Innocent murmurs:

  • what grade are the normally?
  • systolic or diastolic?
  • is there radiation?
  • where heard best?
  • in what position?
A
  • Grade I or II, rare III
  • Mid-systolic
  • Little or no radiation
  • Heard at 2nd-4th LICS
  • When patient recumbent – decreases or goes away when sitting
182
Q

When you’re doing auscultation posteriorly, how should patient hold their arms?

A

crossed

183
Q

S2 best heard where?

A

Heard at base (R and L 2nd ICS) with diaphragm

184
Q

Squatting / handgrip position accentuates what?

A

mitral valve prolapse (increased afterload and increased ventricular volume)

185
Q

A 60-year-old male presents with increasing shortness of breath x 6 months. What type of murmur is this?

  • Timing? Systolic
  • Location? Apex
  • Shape? Holosystolic
  • Pitch? Harsh
A

mitral regurgitation

186
Q

Extra Heart Sounds in Diastole (3)

A
  • S3
  • S4
  • OS – Opening Snap
187
Q

interim health history

A

◆ A Follow-up approach

◆ Often used for management of chronic disease i.e – every 6 mo for DM client

◆ Detail events since the last meeting with the client

◆ Presumes an intact complete history

188
Q

Venous PVD:

    • pain
    • mechanism
    • pulses
    • color
    • temperature
    • edema
    • skin changes
    • ulceration
    • gangrene
A

Venous PVD:

  • pain: often painful
  • mechanism: venous hypertension
  • pulses: normal
  • color: normal or cyanotic on dependency; petechiae
  • temperature: normal
  • edema: present
  • skin changes: brown pigmentation around ankle, stasis dermatitis and thickening of leg as scarring develops
  • ulceration: if present, think medial sides of ankles
  • gangrene: none
189
Q

systolic or diastolic? tricuspid stenosis

A

diastolic

190
Q

If split S2 is heard on expiration, this is what?

A

paradoxical (pathologic)

191
Q

Aortic area is where

A

2nd ICS, right sternal border

192
Q

lifts/heaves

A

forceful cardiac contractions

193
Q

S3 possible diagnosis

A

Normal in children; occurs in heart failure

194
Q

Malignant neoplasm

A

May be solitary, unilateral, firm, fixed, non-tender, + dimpling, edema, scaling, retraction

195
Q

Which murmur grades do NOT have a thrill?

A

I, II, III

196
Q

A ___ murmur occurs in greater than 90% of pregnant women.

A

Grade II systolic murmur at pulmonary area

197
Q

Location of PVD symptoms: Foot - what is the associated artery?

A

Tibial or peroneal

198
Q

What breath sounds have long inspiratory phase, short expiratory phase?

A

Vesicular (Soft and whispery quality, low pitched)

199
Q

Tricuspid area is where?

A

4th and 5th ICS, left sternal border

200
Q

are cervical bruits innocent in adults?

A

NO

201
Q

systolic or diastolic? tricuspid regurgitation

A

systolic

202
Q

pectus excavatum

A

Funnel chest

203
Q

Peripheral edema, palmar erythema, and spider telangectasias are all normal or not during pregnancy

A

normal

204
Q

Expected RR for 1 year

A

20-40

205
Q

11 lymph nodes of external neck

A
  1. Pre-auricular
  2. Post-auricular
  3. Occipital
  4. Parotid
  5. Tonsillar
  6. Submandibular
  7. Submental
  8. Superficial cervical
  9. Deep cervical
  10. Posterior cervical
  11. Supraclavicular
206
Q

Vestibular symptoms is an umbrella term for

A

vertigo, vestibular rocking

207
Q

hernia of posterior vaginal segment often associated with descent of rectum

A

posterior compartment prolapse

208
Q

systolic or diastolic? VSD

A

systolic

209
Q

Most common benign solid tumor in <25 years

A

fibroadenoma

210
Q

> 40 years old, S3 is ___, S4 is ____

A

S3 abnormal

S4 common

211
Q

3 Objective Components of the Adult Health History

A
  1. physical exam
  2. lab findings
  3. direct observations
212
Q

If vibration symmetry is decreased or absent upon palpation for tactile fremitus:

A

trapped air in lungs;

thick pleura;

effusion;

obstruction;

massive pulmonary edema

213
Q

physical assessment of dorsalis pedis artery: where is it located? technique tips?

A
  • lateral to extensor tendon of great toe
  • use pads of 2-3 fingers, push gently, grade 0 to 2+
214
Q

S4

A

Soft, low-pitched sound in late diastole before S1, therefore an “atrial” sound

215
Q

Diastole - 4 main points

A
  • Pressure falls aortic & pulmonary valves close – (S2, A2/P2) “dubb”
  • Mitral/tricuspid valves open with filling (S3)
  • Atrial contraction (S4)
  • Ventricles are relaxed
216
Q

All certifying bodies recommend first pap is at age

A

21

217
Q

Key 5 cardiac risk factors

A
  1. HTN
  2. Hyperlipidemia
  3. Smoking
  4. Family history
  5. Obesity
218
Q

Ptotic (sagging) submandibular gland is part of

A

normal aging

219
Q

What’s more concerning, unilateral or bilateral hearing loss?

A

unilateral hearing loss (One-sided, you might think tumor)

220
Q

According to ACOG, pelvic exams should be performed only when indicated by the medical history for patients under __ years

A

21

221
Q

Breast lifespan changes: Menopause (3)

A
  • glandular tissue replaced by fat
  • inframammary ridge thickens
  • relaxation of suspensory ligament
222
Q

Arterial PVD:

  • pain
  • mechanism
  • pulses
  • color
  • temperature
  • edema
  • skin changes
  • ulceration
  • gangrene
A

Arterial PVD:

  • pain: intermittent claudication
  • mechanism: tissue ischemia
  • pulses: decreased/absent
  • color: pale on elevation, dusky/red on dependency
  • temperature: cool
  • edema: absent/mild
  • skin changes: thin, atrophic skin, loss of hair, thick nails
  • ulceration: if present, toes or point of trauma on feet
  • gangrene: may develop
223
Q

2 portions of inner ear anatomy

A
  1. Cochlea (hearing) Arranged in frequencies from high to low - we hear from 200-20,000 hz
  2. semicircular canals (balance input) - 3 planes - sense rotational movement
224
Q

Which female population is HPV more transient in? 21-29 or 30-65?

A

more transient in 21-29

225
Q

Subscapular/posterior nodes: where are they located? What do they drain/where do they drain into?

A
  • Lateral border of scapula in posterior axillary fold
  • Drains posterior chest wall and portion of arm
  • Drains into central axillary nodes
226
Q

Bronchovesicular breath sounds: where are they heard? Quality?

A

– Heard over bronchus and upper right posterior lung field; med. pitch

– Inspiratory and expiratory phases are equal

– Abnormal if heard over peripheral lung fields

– Normal child: Bronchovesicular BS throughout is normal

227
Q

Main systemic causes of edema

A
  • Heart failure
  • Venous stasis

.. Or pulmonary, kidney, or liver disease

228
Q

If wheezes are fixed/localized, think about

A

possible airway obstruction (foreign body, tumor)

229
Q

most cervical cancers happen where

A

squamocolumnar junction in the canal area between the external and internal cervical os - esp in young women (cervical canal)

230
Q

Are labial adhesions common in prepubertal exam

A

YES - usually resolves with estrogen exposure in puberty

231
Q

Normal child percussion:

A

Hyperresonant (very loud intensity, lower pitched, longer duration, “boom like quality”)

232
Q

Fibroadenoma - peak incidence? where located? other key characteristics

A
  • Common benign solid tumor in <25 years
  • Commonly UOQ, non-tender
  • Mobile, smooth, rubbery-firm
233
Q

Summary statement includes: (4)

A

◆ Patient Profile

◆ Chief Complaint

◆ Concurrent Illnesses

◆ Positive and pertinent negative findings from history and PE

234
Q

HPI - OLDCARTS

A
  • Onset
  • Location
  • Duration
  • Character/quality
  • Aggravating factors/associated symptoms
  • Relieving factors
  • Temporal factors
  • Severity (scale 1-10)
235
Q

CN I how do you test?

A

Olfactory

  • University of Pennsylvania Smell Identification Test – UPSIT
  • In clinic exam and takes 30-40 minutes to complete
  • Objective data for sense of smell
236
Q

Mitral area murmurs (5th ICS, mid-clavicular line) - what could they potentially be?

A

mitral stenosis, insufficiency, regurgitation

237
Q

hernia of anterior vaginal wall often associated with descent of bladder

A

anterior compartment prolapse

238
Q

When assessing CN VII, if patient can’t close their eye, that’s automatically what grade on the House-Brackmann Scale?

A

4

239
Q

S1 immediately precedes what?

A

carotid upstroke

240
Q

systolic or diastolic? mitral regurgitation

A

systolic

241
Q

If vibration symmetry is decreased or absent upon palpation for tactile fremitus:

A

Lung consolidation/ compression/mass;

excess fluids or non-obstructive secretions

242
Q

Menarche usually occurs at Tanner stage ___, about __ years after bud development

A

3-4

2

243
Q

Early diastolic murmur possible diagnoses:

A

Aortic or pulmonary regurgitation

244
Q

Delay of pulmonic valve closure will ____ splitting

A

increase

245
Q

systolic or diastolic? ASD

A

systolic

246
Q

Pericardial friction rub continuous murmur sounds like what? Is it a diastolic, systolic, or continuous murmur?

A

scratchy

continuous

247
Q

Is S3 normal during pregnancy?

A

yes

248
Q

when you hear opening snap, think of what?

A

mitral stenosis

249
Q

Venous hum continuous murmur sounds like what? Is it a diastolic, systolic, or continuous murmur?

A

low hum

continuous

250
Q

Xanthomas

A

yellowish plaques / skin lesions caused by the accumulation of fat in macrophage immune cells

251
Q

How do you assess the nasal valve?

A

inhale and look to see if it’s hypermobile

  • stent valve with stick then do Cottle maneuver
  • stretch their cheek to the side and see if breathing improves
252
Q

S3 best heard where?

A

Ventricular sound, at apex, use bell in LLD position kentucky

253
Q

Expected RR for 3 years

A

20-30

254
Q

Fluid cysts - peak incidence? where located? other key characteristics

A
  • Peak incidence age 35-50 years
  • Commonly UOQ, tenderness with menses
  • Rapid development, firm or fluctuant
255
Q

How can retroverted, retroflexed uterus be palpated?

A

rectally or via retrouterine pouch

256
Q

Normal adult percussion:

A

Resonant (loud intensity, low pitch, long duration, “hollow quality”)

257
Q

comprehensive health history

A

The client’s entire story

258
Q

If you note Ophthalmitis and petechial / subconjunctival hemorrhages on eyelids, what might this indicate?

A

bacterial endocarditis

259
Q

Egophony:

A

When the spoken “e” sounds like “a”

suggests lung consolidation

260
Q

Mitral area is where?

A

5th ICS, mid-clavicular line

261
Q

Do electrical impulses happen before or after the mechanical actions of the heart?

A

before

262
Q

Gynecomastia - more common in what age?

A
  • Enlarged breast in male
  • Palpation of glandular tissue instead of fat
  • Common in adolescents due to decreased ratio of androgens to estrogens
263
Q

Pap specimen collection - does order of samples affect the results?

A

no

264
Q

Normal JVP

A

6-8 cm H2O

JVP is distance up from angle to top of pulse wave

265
Q

systolic or diastolic? pulmonic regurgitation

A

diastolic

266
Q

If PMI is shifted to L of mid-clavicular line, what does that indicate?

A

Increased LV dimension

267
Q

timing and quality of crackles/rales

A

Timing: early, mid or late inspiration

Quality: fine, medium or coarse

268
Q

Holosystolic (pansystolic) murmur possible diagnoses:

A

Tricuspid or mitral regurgitation

269
Q

What 2 valves are Atrioventricular?

A

Tricuspid, Mitral

270
Q

Symptoms of Chronic Venous Insufficiency (CVI) - 3

A
  • Persistent swelling of the lower legs
  • Edema improves with raising legs; worsens later in the day
  • Leg pain, dull aching, heaviness or cramping
271
Q

3 types of health histories

A
  1. comprehensive
  2. problem-oriented or focused
  3. interim
272
Q

S3 is considered pathological in what age?

A

>40 y.o.

273
Q

Largest area of glandular tissue in the breast; Majority of breast tumors occur here

A

Tail of spence

274
Q

molluscum

A

viral infection that causes little pock-like lesions, often on inner thighs/buttocks

275
Q

A 15-year-old male presents with shortness of breath over the past 2 weeks. You elicit a recent history of severe sore throat that was not treated with antibiotics. What type of murmur is this? What is the etiology?

  • Timing? Systolic and diastolic
  • Location? Loudest at 2nd RICS
  • Shape? Crescendo-decrescendo
  • Pitch? Harsh
A

Trick question: it’s rheumatoid fever

276
Q

systolic or diastolic? aortic regurgitation

A

diastolic

277
Q

Vestibulo-spinal reflex

A

efferent motor nerve response that happens automatically when your ear turns to the right and head follows, it gives tone to your neck to support your balance

278
Q

ACOG recommends first reproductive health visit between ___ yrs. Scope of exam depends on patient need. Often education.

A

13-15

279
Q

Internal jugular pulsations/auscultation - what is normal? is the level of pulsations changed by position or affected by respirations?

A
  • normal: rarely palpable, soft, 2 elevations per heartbeat
  • Level of pulsations DOES change with position
  • DROPs with inspiration
280
Q

Examining the posterior oropharyngeal wall: what is cobblestoning?

A

lymphoid tissue in little pockets that line the throat - white, gray, yellowish bumps which can be related to anything that would activate the immune system

281
Q

physical assessment of posterior tib artery: where is it located? technique tips?

A
  • posterior to medial malleolus
  • use pads of 2-3 fingers, push gently, grade 0 to 2+
282
Q

Cyanosis in the skin, nails, lips is a ___ sign

A

late

283
Q

Why do you need to be aware of hx of skull base surgery with rhinorrhea?

A

spinal fluid can leak through the surgery site even years afterwards

284
Q

physiologic murmurs associated with what 4 conditions? and remember that they have ___ to innocent murmurs

A
  1. pregnancy
  2. fever
  3. anemia
  4. hyperthyroidism

similar characteristics

285
Q

Location of PVD symptoms: Lower calf - what is the associated artery?

A

Popliteal

286
Q

Superior mediastinum; largest at puberty, then involutes

A

Thymus

287
Q

GRBAS voice grading

A

Grade

Raspy-ness

Breathiness

Asthenia - weakness, can’t project or get volume

Strain

Total is 0-15; 15 is severe vocal disability

288
Q

S3 can be heard in patients who are in ___ failure and are overloaded

A

heart

289
Q

Carotid neck pulsations/auscultation - what is normal? is the level of pulsations changed by position or affected by respirations?

A
  • normally vigorous upstroke
  • level of pulsations NOT changed by position or affected by respirations
290
Q

Ejection sound possible diagnosis:

A

Aortic valve disease

291
Q

CN VIII how to test?

A

Cochlear nerve aka Vestibulocochlear

rubbing

Weber, Rinne

292
Q

one of the leading causes of COPD worldwide is ____

A

exposure to products of combustion during cooking (cooking over an open flame)

293
Q

2 major precipitating factors for otorrhea (drainage) which is the hallmark of otitis media

A
  1. respiratory infection (URI)
  2. water exposure
294
Q

descent of apex of vagina into lower vagina, to the hymen, or beyond vaginal introitus

A

uterine prolapse (apical compartment prolapse)

295
Q

Pulmonic area is where?

A

2nd and 3rd ICS

296
Q

3 components of vestibular exam

A
  1. Oculomotor testing (eye movement)
  2. Cerebellar testing (neurology lecture)
  3. Basic balance function
297
Q

PVD: venous disorders (3)

A
  1. Chronic Venous Insufficiency (CVI)
  2. Deep Vein Thrombosis
  3. Superficial Thrombophlebitis
298
Q

What’s the best way to hold the pediatric handheld otoscope?

A

Brace with fifth finger against child’s temple/face

299
Q

9 components of Adult History: Subjective Data

A

◆ Informant

◆ Patient Profile (PP)

◆ Chief Complaint (CC)

◆ History of Present Illness (HPI)

◆ Past Medical History (PMH)

◆ Family History (FH)

◆ Occupational History (OH)

◆ Personal and Social History (PSH)

◆ Review Of Systems (ROS)

300
Q

In children, AP diameter and transverse diameter should be

A

equal

301
Q

If you note Corneal arcus in <40 y.o. during eye assessment, what might this indicate?

A

hyperlipidemia

302
Q

adnexa of uterus

A

ovaries and fallopian tubes

303
Q

during pregnancy, there is an initial ___ in BP up to 16 weeks, then what happens?

A

increase

then back to pre-pregnancy level

304
Q

Physical Findings of CVI (3)

A
  • Edema (dependent on position)
  • Bluish discoloration of the skin at the ankles
  • With prolonged swelling, venous ulcers can develop at the ankles and these often become infected
305
Q

Always ask about what 6 things when taking an otology history?

A
  1. Hearing loss
  2. Otorrhea
  3. Otalgia
  4. Tinnitus
  5. Aural fullness
  6. Vestibular symptoms
306
Q

When is the Thymus largest?

A

puberty

307
Q

An innocent murmur in pregnancy is only ___. IT may change with ____

A

systolic

posture

308
Q

Proprioception

A

your body’s sense of self in space

309
Q

Common Cervical Findings: Nabothian cysts

A

Common, 1 cm, smooth, round, yellow lesion

Obstruction of cervical gland with squamous metaplasia

310
Q

How do you test CN VII? The House-Brackmann Scale for CN VII - what does I indicate? What does VI indicate?

A

I - normal

VI - complete paralysis

311
Q

Space between lungs; houses heart, large airways, large blood vessels, lymphatics

A

Mediastinum

312
Q

Pertinent history for Laryngology and Head/Neck (6)

A
  1. throat pain
  2. dysphonia
  3. dysphagia
  4. neck masses
  5. oral lesions
  6. facial pain/numbness
313
Q

___ could occur with pneumothorax. This is called subcutaneous emphysema

A

Crepitus like bubble wrap

314
Q

Lingula

A

(not a lobe) - area that’s adjacent to left heart border

315
Q

Components of health history for GU (6)

A
  1. Menstrual history
  2. Sexual/contraceptive history
  3. Obstetrical history
  4. Cervical cytology history
  5. Screening for intimate partner violence
  6. Gynecological history
  • Current symptoms or history of pelvic, vaginal, or vulvar infections
  • Symptoms of pelvic organ prolapse or urinary or anal incontinence
  • History of gynecologic procedures
316
Q

Synkinesis

A

automatically level II on House-Brackmann scale

mis-wiring of facial nerve post-trauma, like after Bells Palsy

317
Q

Expected RR for 6 years

A

16-22

318
Q

S4 is best heard where?

A

at apex in LLD position with bell Tennessee

319
Q

What is happening when the mitral and tricuspid valves close? Is the heart in systole or diastole?

A

systole

320
Q

85% of uteruses are in what position?

A

Anteverted, anteflexed

321
Q

AP diameter ____ with age

A

increases

322
Q

CN V

A

Trigeminal Nerve

  • has 3 branches supplies sensation to face
  • examine via light touch, using Filament or other fine instrument

– Compare touch from side to side in each of the three branches

– Rate by percentage i.e. 80% R V2 intact

323
Q

1/3 of older adults have ___ murmur

A

systolic aortic

324
Q

If adult is Hyperresonant, think about?

A

pneumothorax or emphysema

325
Q

Sit up, lean forward, exhale completely and hold breath – this accentuates what?

A

aortic murmurs (regurg)

326
Q

What is normal S2 splitting caused by

A

increased blood flow

327
Q

Is the heart right or left dominant?

A

Right (70%)

328
Q

paroxysmal nocturnal dyspnea (PND) could be sign that someone’s having problems with ____

A

heart failure

329
Q

Is bounding pulse common during pregnancy?

A

yes

330
Q

Is pain normal when milking skene’s glands?

A

no

331
Q

S2

A

Closure aortic (pulmonic) valve (A before P)

332
Q

Cranial nerves:

  • I
  • II
  • III
  • IV
  • V
  • VI
  • VII
  • VIII
  • IX
  • X
  • XI
  • XII
A
  • I Olfactory (Smell)
  • II Optic (Sight)
  • III Oculomotor (Moves eyelid and eyeball and adjusts the pupil and lens of the eye)
  • IV Trochlear (Moves eyeballs)
  • V Trigeminal (Facial muscles incl. chewing; Facial sensations)
  • VI Abducens (Moves eyeballs)
  • VII Facial (Taste, tears, saliva, facial expressions)
  • VIII Vestibulocochlear (Auditory)
  • IX Glossopharyngeal (Swallowing, saliva, taste)
  • X Vagus (Control of PNS e.g. smooth muscles of GI tract)
  • XI Accessory (Moving head & shoulders, swallowing)
  • XII Hypoglossal (Tongue muscles - speech & swallowing)
333
Q

Purpose of the bimanual exam?

A

assess vaginal tone and cervical motion tenderness (CMT) in case of pelvic inflammatory disease

also to palpate the uterus and ovaries through the abdomen

334
Q

3 components of the past medical history

A
  1. childhood illnesses
  2. adult illnessess
  3. health maintenance behaviors including immunizations and screening test
335
Q

An elderly patient with history of smoking 2 packs of cigarettes/day for 50 years complains of progressive shortness of breath. On cardiac exam, the most prominent PMI is in the xiphoid area. This is most likely result of what condition?

A

pulmonary HTN

336
Q

A 77-year-old man is experiencing shortness of breath and dizziness. After cardiac catheterization, systolic BP in left ventricle is measured at 180 but systolic BP in aorta is 140. This is most likely caused by what valvuar condition?

A

aortic stenosis

337
Q

Patients with aortic stenosis often experience what 3 symptons? What kind of BP discrepancy does it cause?

A
  1. dyspnea with exertion
  2. chest pain
  3. dizziness

BP in left ventricle will be higher than aorta

338
Q

Where is the best place to auscultate the splitting of a second heart sound?

A

Left second and third interspace

339
Q

20 year old college student experiencing dyspnea on exertion and palpitations. On auscultation, the second heart sound is split and fixed on both inspiration and expiration. What is the most likely cardiac condition associated with this finding?

A

ASD (atrial septal defect)

340
Q

Fixed splitting of the second heart sound that does not vary with respiration occurs in ___ defects and also in ____

A

ASD (atrial septal defects) and right sided heart failure

341
Q

A 70 year old retired businessman presents to ED with progressive SOB and 2-pillow orthopnea. BP 140/90, JVD present, lower extremity pitting edema to knee, blowing holosystolic murmur heard best at LLSB. What intervention will best help him?

A

*Removal of intravascular volume with diuresis*

these symptoms are consistent with heart failure

murmur is indicative of tricuspid regurgitation

342
Q
A
343
Q

Normal QRS duration? What would it be after MI with left bundle branch block?

A

Normal = 100 miliseconds

With block = extended (longer)

344
Q

Atrial enlargement would cause changes in what portion of the electrocardiogram?

A

P wave

345
Q

Cardiac output = HR x stroke volume. So if HR decreases by 20%, how much would cardiac output change if stroke volume is consistent?

A

20%

346
Q

39 y/o with 2-day hx of fever, chills, cough with green sputum, dyspnea. Temp is 101.2. Late inspiratory crackles on auscultation of left lower lung posteriorly. “EE” sounds like “AA.” What is this condition? What sound most likely heard on percussion of lungs

A

pneumonia

dullness

347
Q

What breath sounds are most consistent with asthma?

A

wheezes on expiration

348
Q

Depression of lower part of sterum would be what?

A

Pectus excavatum

349
Q

Tingling around the lips can be a symptom of

A

anxiety

350
Q

Patient with SOB - dullness to percussion over right lung base. Breath sounds absent at right lung base. No crackles, wheezes, or ronchi. These findings are characteristic of ___ or ____.

A

Atelectasis or pleural effusion

351
Q

If needing to put a chest tube in 4th ICS, how does the provider determine where this is?

A

Find the sternal angle then move finger laterally to second rib. Then walks down from there. 4th ICS is below the 4th rib.

352
Q

Sensitivity of screening for breast cancer increases with breast MRI at the expense of ____

A

specificity

353
Q

35 y/o G0P0 presents to clinic with biateral nipple discharge. Started several weeks ago, occurs irregularly. no symptoms other than slightly irregular period. On exam, the discharge is found to be breast milk, no pus or blood. Normal other labs. What would this be?

A

Prolactinoma - tumors that secrete prolactin, which causes production of breast milk and suppressing of menstruation

354
Q

Symptoms: elderly, “tearing” chest pain, asymmetric BP in arms. ECG, cardiac enzymes and chest x-ray normal. This is most likely

A

dissecting aortic aneurysm

355
Q

Where is the most important area to obtain cells for a Pap smear?

A

Transformation zone

356
Q

Which muscle group is responsible for support of the pelvic floor?

A

levatori ani

357
Q

On manual BP testing, what indicates true diastolic pressure?

A

disappearance of Korotkoff sounds following initial muffling

358
Q

If heart sound/murmur is heard at the right 2nd interspace to the apex, what would be the typical origin valve?

A

aortic

359
Q

If heart sound/murmur is heard at the left 2nd and 3rd interspace close to the sternum, but also at higher or lower leves, what would be the typical origin valve?

A

Pulmonic

360
Q

If heart sound/murmur is heard at or near the lower left sternal border, what would be the valve of origin?

A

Tricuspid

361
Q

If heart sound/murmur is heard at and around the cardiac apex, what is typically the origin valve?

A

mitral

N270: Advanced Health Assessment [Fall 2016] (2 decks)

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