Health Assessment Flashcards

Question

When should new providers use DD

Answer 1

Until they learn to synthesize information into their practice

Answer 2

Clinical judgment

Answer 3

When you pick up the chart and start gathering information on the patient.

Answer 4

Identify the problem. Most will be identified by the patient but as the NP we must look at other issues that could lead to the complaint. (Dysuria at night - maybe its a mobility issue and not a bladder issue).

Answer 5

Generating using framework approaches. DD are more than just a list of illnesses that explain s/s or diagnostic results exist but rather DD distinguish a disease or condition from others that present in a similar pattern. done by novice or in situations that are unfamiliar

Answer 6

In order to organize the DD it is very important to look at labs, clinical presentation, and physical examination as a whole in order to prioritize the differential diagnosis based on data

Answer 7

Narrow the list. Consider age, gender and ethnicity into your DD to narrow your list of problems

Answer 8

Assess for clinical clues during your physical examination and focused on positive assessment findings to confirm your working diagnosis Eliminate prostetitis in a female patient

Answer 9

Always rank your #1 potential diagnosis at the top of your list based on the information from step five

Answer 10

Obtain additional data to test, supplement and validate your hypotheses

Answer 11

Be flexible and organize your DD based on new information. If a working diagnosis cannot be reached and things just don't make sense, go back to your interview process and see what missing information you can find in order to guide in the right direction. Always reassess and reprioritize new information to support your statements

Answer 12

Medical history (acute and chronic) Surgical history Ob/Gyn Hereditary conditions Health maintenance such as vaccines and screenings Allergies Family history Social history ROS MSOHHAFSR Mary Should Of Had Happiness After Fighting Socialist Reform

Answer 13

CC, HPI, PMH, PSH, FAMILY HX, current medications (otc or herbal). Allergies to meds, latex or food, Social history (smoking, etoh, drugs, mental health). Review of pertinent systems such as HEENT or review of all symptoms for a comprehensive visit. Physical exam.

Answer 14

CC, HPI, PMH, PSH, FAMILY HX, current medications (otc or herbal). Allergies to meds, latex or food, Social history (smoking, EtOH, drugs, mental health). Review of pertinent systems such as HEENT or review of all symptoms for a comprehensive visit. Physical exam.

Answer 15

S - subjective - what the patient reports O - objective - what the clinician observes and assesses A - assessment - the diagnosis of diagnostic assessment with rationale P - plan - the plan of care for the pt including pharmacological and nonpharmacological and patient education

Answer 16

Patients point of view. Hx. from the patient, describes patients concerns, symptoms or unexpected findings

Answer 17

The finding from direct observations, what you smell, see, hear or touch. Objective data is observable and measurable and can be obtained through vital signs, physical examination, labs and diagnostic test.

Answer 18

Pulls together the findings and collected in the subjective and objective section to form a diagnosis \*For a sick visit only list pertinent information r/the CC. Do not cover all the systems. Come up w/DD and a working diagnosis. \*For a follow up no DD needed \*For a comprehensive visit - address every system in detail

Answer 19

Develop a plan for each working diagnosis

Answer 20

The main reason for a visit, describes the sx, problem, condition, or diagnosis for the visit - it is in "" and in the patient's own words

Answer 21

HPI contains 8 core elements - location, quality, severity, duration, timing, context, modifying factors, associated signs and symptoms. USE OLDCARTSA

Answer 22

the patients record is a legal document. Court, legal proceedings, as well as incurances can have access to it. It is important to chart in the EMR as soon as possible to maintain information accurately. The patient record provides an opportunity for the clinician to document the care provided at the visit and track how bothe patient

Answer 23

the focused and comprehensive assessment have similar components such as demographics, age, gender, ethnicity, CC, HPI, PMH, Social history, etc. However, in the focused visit, only pertinent information will be addressed to the CC and potential body system affected. Comprehensive visits are more in depth and require more detail information to assess or prevent potential medical problems.

Answer 24

Use OLDCARTSA

Answer 25

Inspection Palpation Percussion Auscultation

Answer 26

Process of observation beginning with the initial meeting of the patient and continuing through the history and physical examination. Use adequate lighting, take time to carefully inspect the areas you want to see and validate findings with patient

Answer 27

The use of hands and fingers to gather information through the sense of touch. Keep fingernails short, warm hands, be gentle, use correct palpation approach and use appropriate hand surface. Use palmar surface of the hands and finger pads Palmer and pads - position and texture, size, crepitus, mass or structure Ulnar - vibration Dorsal (back of hand) - temperature

Answer 28

The use or striking of one object or one finger against another produces vibrations and sound waves. Tapping fingers produces vibrations by impact on underlying tissues

Answer 29

Listening to sounds produced by the body. always do this last in the examination sequence, except with abdominal examination, place the stethoscope on naked skin, listen to one sound at a time, take time to identify characteristics of sound, and do not anticipate the next sound.

Answer 30

1. Immediate (direct) - finger strikes directly against body 2. Mediate (indirect) Middle finger of dominant hand is hammer; middle finger of non-dominant hand is placed on body and struck. 3. Fist-nondominant hand is placed on body and struck with fist of dominant hand. Most commonly used to elicit tenderness from liver, gallbladder or kidneys

Answer 31

loud, high drum like Ex. gastric bubble

Answer 32

very loud, low, booming Ex emphysematous lung

Answer 33

loud, low, hollow. Ex healthy lung tissue

Answer 34

soft, moderate, thudlike Ex over liver

Answer 35

soft, high, dull Ex over muscle

Answer 36

Determines degree of joint flexion. Two straight arms that intersect and can be angled and rotated around a protractor

Answer 37

Bell - light pressure to hear low frequency sounds Diaphragm - use pressure to hear high frequencies

Answer 38

Tests for near sightedness

Answer 39

used to detect damage to the macula (central part of the retina or optic nerve / macular degeneration. Grid with dot will have blurred area

Answer 40

Color blind chart

Answer 41

Systematic assessment of the individual's health status. The initial general survey includes assessing for problems, instability, or alterations in the airway, breathing, circulation, and neurologic status. Assessment of mental and physical status includes the general survey, measurements of vital signs, habitus, and evaluation of pain.

Answer 42

Temp 96.4 - 99.1 Pulse 60 - 100 bpm RR 12 - 20 bpm BP SBP \<120 and DBP \<80

Answer 43

Start at age 3

Answer 44

Systematic assessment of the individual's health status. Initial general survey includes assessing for problems, instability, or alterations in airway, breathing, circulation, and neurologic status. Assessment of mental and physical status include the general survey, measurements of vital signs, habitus, and evaluation of pain.

Answer 45

Wong/Baker Faces Rating Scale, the Oucher Scale FLACC (nonverbal kids or adults) are examples of faces rating scales reliable for children.

Answer 46

ouchy sore achy

Answer 47

increased pulse and respiratory rate lower b/p behavioral cues less able to modify pain impulses easily distracted but still have pain different pain scales

Answer 48

No diminished perception of pain Decreased pain threshold Pain from chronic conditions

Answer 49

A general survey is the systematic assessment of the individual's health status. Initial general survey includes assessing for problems, instability, or alterations in airway, breathing, circulation, and neurologic status. Assessment of mental and physical status include the general survey, measurements of vital signs, habitus, and evaluation of pain.

Answer 50

I 30-34.9 II 35-39.9

Answer 51

Diaphragm moves down using external intercostal muscles

Answer 52

Internal intercostal muscles

Answer 53

External intercostals increase the anteroposterior chest diameter during inspiration. Internal intercostals decrease the lateral diameter during expiration.

Answer 54

The difference between systolic and diastolic pressures ex: 120/80 Pulse pressure would be 40mm Hg

Answer 55

Width: 40% of upper arm circumference Length: 80% of upper arm circumference

Answer 56

Apocrine sweat glands: think stinky adolescent Secretion begins at puberty Secrete thick viscous cloudy fluid in sac of air follicle and eventually to the surface of the skin Good source for bacteria -\> odor Ears (cerumen), eye lids, Armpits, areola of the breast, anogenital regions.

Answer 57

Eccrine sweat glands: think everywhere. Secrete clear thin fluid (sweat) directly onto the skin Present all over the body. Temperature control, cooling off and excretion of unwanted substances, protection of the skin

Answer 58

Crucial to obtain a history before proceeding to the examination in order to understand the backgrounds of the problem. Use OLDCARTSA to obtain info about the problem. Assess PMH, PSH, Fam History, Social History

Answer 59

KOH - diagnosis of fungal infections. KOH dissolves everything but hyphae walls. Look at branching structures

Answer 60

Test for herpes zoster and multinucleated giant cells such as viruses

Answer 61

Emits UV light. Coral Pink - bacterial Greenish-blue - tinea (fungal)

Answer 62

used to determine the presence of fluid in cysts and masses. Will glow red with fluid.

Answer 63

Examination consists of both inspection and palpation. PE can be conducted as head to toe assessment, region as other systems are being examined or localized to the specific disease area

Answer 64

Premature infants-poor epidermal barrier with a few cornified layers and a deficiency of structural proteins in the dermal layer

Answer 65

Balding - Nonscarring natural progressive miniaturization of the hair follicle

Answer 66

TE refers to an acute hair loss subsequent to a variety of stresses - crash diet, hypothyroidism, etc Self limiting

Answer 67

non scarring hair disorder with acute onset. Oval rounded bald patches Autoimmune with possible herideratary. May grow back

Answer 68

Can affect part of the scalp or body structures (beard)

Answer 69

Loss of all scalp hair follicles

Answer 70

Loss of ALL body hair follicles

Answer 71

Normal 160 Clubbing 180 Test with Schamroth technique

Answer 72

Detachment of the nail from the nail bed inflammatory: psoriasis, dermatitis, fungus trauma

Answer 73

Spoon nail - celiac disease, malignancy, malnutrition

Answer 74

Infection (bacterial or viral) affecting the distal phalanx Most common form is herpetic. Affect ppl who who in water: housewives, dentist, nurses (gloves) bartenders, waiters

Answer 75

Nail formation results in a transverse groove that rund parallel to the lunula When nail growth in interrupted from trauma, chemo, or sickness

Answer 76

Transverse white bands Liver failure DM CHF Hyperthyroidism Malnutrition

Answer 77

Fungal infection

Answer 78

Onychocryptosis - ingrown nail

Answer 79

any pathologic skin change or occurrence Primary―those that occur as initial spontaneous manifestations of a pathologic process Secondary―those that result from later evolution of or external trauma to a primary lesion. Examples of secondary lesions: scales, crusts, excoriations, erosions, ulcers, fissures, scars, keloids

Answer 80

Anatomical location Distribution of multiple lesions Morphology: Primary lesion, color and exudate Morphology: Secondary change if present

Answer 81

Macule - Flat less than 1cm in size Petechiae \<4mm nonblanching purpuric macules - broken capillaries. Etiology: PCN, Phenytoin, fungal, bacterial, viral inf. vaculitis, thrombocytopenia, leukemia, Vit C and Vit K deficiency

Answer 82

A patch is flat but it is larger that 1cm Tinea Versicolor - hypopigmentation from fungal infections Cafe au lait - larger patches of color from sun or genetics

Answer 83

Elevated or depressed lesion less than 0.5cm, may be solid or cystic. Sessile (no stalk) or Pedunculated (stalk) Scabies-small red papules with some vesicles and crusting. lesions are LINEAR Molluscum Contageosum - caused by the DNA poxvirus. Burning and purtius. Smooth surface with central indentation

Answer 84

Wart: cause by HPV, hyperkeratotic lesions Acrochordons (skin tags)

Answer 85

Raised defined any color \>1cm Psoriasis: chronic immune mediated condition. Well demarcated silvery plaques can r/t arthritis Seborrheic Keratosis: benign and asymptomatic in older persons. Commonly found in sun exposed areas.

Answer 86

Plaque - on eyes indicates hyperlipidemia

Answer 87

Can be papules or plaques, pre malignant lesions in sun exposed areas

Answer 88

Elevated irregular shaped area of cutaneous edema Caused by insect bites. Urticaria - aka hives, edematous papules or plaques that appear suddenly post allergic reaction

Answer 89

Elevated and solid, firm confined lesion deeper than a papule in the dermis Less than 2cm Basal Cell Carcinoma

Answer 90

Nodule, most common type of skin ca, sun exposed area, slow growing. non-healing sore, waxy pearly appearance with some central indentions, well circumscribed

Answer 91

Elevated and solid \>2cm firm or not may or may not be well demarcated. Lesion deeper than plaque in the dermis LIPOMA - benign fat tumor soft to touch movable and painless

Answer 92

Similar to vesicle but filled with puss Pustular Acne Vulgaris - obstruction and inflammation of pilosebaceous units (hair follicles and accompanying sebaceous gland) Acne Rosacea Folliculitis - inf of hair follicle. Start as red papules then crust staph or strep, shaving, hot tub

Answer 93

Deep seated inflammatory nodule Furuncle, Carbuncle

Answer 94

Elevated encapsulated lesion deep in the dermis, filled with liquid or semisolid material 1cm or larger. Sebaceous cyst

Answer 95

Elevated fluid filled round circumscribed with thin, translucent wall \< 0.5cm Herpes simplex: viral infection HSV1

Answer 96

Elevated fluid filled round circumscribed with thin, translucent wall \< 0.5cm Herpes simplex: viral infection HSV1 Herpetic Whitlow Varicella Zoster (chicken pox) Herpes Zoster (Shingles)

Answer 97

Elevated fluid filled round or oval shaped with thin translucent walls more than 0.5cm Bullous Impetigo

Answer 98

Lichenification: A rough, thickened, hardened area of the epidermis resulting from chronic irritation such as scratching or rubbing (often involves flexor surfaces Secondary lesion

Answer 99

- CONTACT DERMATITIS (80% of cases) - ALLERGIC CONTACT DERMATITIS - ATOPIC DERMATITIS

Answer 100

Contact Dermatitis (80% of cases) nonimmunologic response to a chemical or physical agent. Well demarcated with glazed appearance. Erythema, swelling, blistering and scaling.

Answer 101

A cell-mediated, delayed, type IV hypersensitivity reaction, resulting from contact with a specific allergen to which a patient has developed a specific sensitivity. Acute Type: Presents as papules and vesicles on an erythematous base

Answer 102

ECZEMA Genetic susceptibility and environmental triggers. 75% will report a family history of atopy (allergic rhinitis, asthma, and dermatitis RAD) Closely r/t asthma and rhinitis Presents as: Excoriations, erythematous, scaly papules and plaques, vesicles, serous drainage, and crusts are common findings.

Answer 103

An idiopathic,(may be viral) self-limited skin eruption characterized by widespread papulosquamous lesions Lesions average 1 to 2 cm in diameter Christmas tree pattern and presence of Herald Patch

Answer 104

Fifth’s Disease Also called erythema infectiosum Caused by parvovirus B19 Transmitted through respiratory secretions and blood Often have fever, rhinorrhea, myalgias, and a headache Facial rash that has a “slapped cheek” appearance Can get a second itchy rash a few days after the facial rash that appears on the chest, back, buttocks, or arms and legs

Answer 105

Caused by a virus called coxsackievirus A16 Transmitted through respiratory secretions, fecal–oral route, or vesicle fluid Usually affects infants and children 5 years old or younger Typically occurs in summer and early fall Starts with fever, malaise, sore throat, and anorexia Painful macular or vesicular lesions can develop in the mouth several days after the fever starts Rash on the palms of the hands and soles of the feet may also develop over 1 or 2 days as a macular and/or vesicular red rash; it may also appear on the knees, elbows, buttocks, or genital area

Answer 106

Caused by group A hemolytic streptococcus Rash caused by an erythrogenic exotoxin emitted by the streptococci Most common in children 5–15 years Most commonly seen in conjunction with strep pharyngitis Typically starts with a high fever and sore throat Rash appears after 1–2 days Maculopapular exanthematous rash that looks like a sunburn and feels like sandpaper Rash initially appears on the neck and chest, then spreads over the body Pastia’s sign (linear bright red coloration of the creases in the axillary and inguinal folds) Tongue may appear white, with red, swollen papillae (white strawberry tongue), but by the fourth or fifth day, it becomes bright red (red strawberry tongue) Other symptoms include headache, chills, flushed face, nausea, and vomiting Rash usually fades in 4–5 days and is followed by diffuse desquamation

Answer 107

PUTON - Put on Sunscreen P - pearly papule U - ulcerating T - telangiectasia O - on face, scalp, pinnae N - nodules S - slow growing

Answer 108

NOSUN N - Nodular O - Opaque S - Sun exposed areas U- Ulcerating N - Non distinct borders More aggressive than basal cell, highly treatable

Answer 109

ABCDE A - Asymmetric B - Borders Irregular C - Color not uniform D - Diameter unusual \>6mm E - Evolving lesions Starts in the melanocytes deep. Spreads quickly but is treatable if caught early

Answer 110

Rough scaly patches. Years of sun exposure. Can develop into skin cancer

Answer 111

The lymphatic system is examined region by region during the examination of the other body parts and by palpating the spleen, an integral part of the system. Assess the areas of the lymphatic system where the nodes are palpable and accessible.

Answer 112

occipital nodes, post auricular, pre auricular, tonsillar, submandibular, submental, posterior cervical, anterior cervical, supraclavicular, axillary, mammary, epitrochlear, superior and inferior inguinal lymph nodes

Answer 113

Scalp, neck, head (throat, ears) Scalp, with STDs (syphilis, HIV) and Throat and ear infections other lymph node affected Is there an infestations, or infections of the scalp, throat,ear periorbital cellulitis?

Answer 114

Scalp, ears Scalp and ears localized infections As above and do you have fever, chills, ear pain or dranage

Answer 115

Eyelids, temporal region flu/covid Eye and ear, temporal infections As above plus Eye pain, drainage?

Answer 116

Tongue, lips, mouth, conjunctiva, pharynx Infections of head, neck, sinuses, ears, eyes, conjunctiva, scalp, pharynx, mouth and lips Sore mouth? Dental conditions? Lip or tongue infections?

Answer 117

Lower lips, floor of mouth, tongue and skin of cheek Infection or cancer of Floor of the mouth, lip, tongue, Mono, toxoplasmosis Sore mouth? Dental conditions? Lip or mouth infections? Exposure to cats.

Answer 118

Scalp, neck, ears Localized skin infection, scalp, mononucleosis, toxoplasmosis Recent contact with other who are ill? Do you have a cat?

Answer 119

Larynx, tongue, neck, oropharynx head Head, neck, throat infections (strept throat) or malignancies Do you have fever, chills, sweats, sore throat?

Answer 120

Sentinel nodes: Lungs, upper GI Thyroid and larynx Consider sentinel nodes for Cancer: Lung,esophagus, upper GI Have you ever smoke? Do you have a cough?

Answer 121

Sentinel nodes for Abdomen, GU cancers Thyroid and larynx Consider sentinel nodes for abdomen, gastric Lower GI, GU cancers Do you have heartburn? Have you been screen for colon cancer? What is the color of your fecal material?

Answer 122

Breast, upper arms, thorax Breast, upper arms, thorax infection or malignancies When was your last mammogram? And breast discomfort or change in breast tissue? Any injuries to upper arms? Cough?

Answer 123

Ulnar, forearm and hand Usually not palpable but present with patho of lower arms, hands, fingers If both axillary and epitrochlear noted decreased likelihood of breast CA Any injuries, swelling to your arms hands or fingers?

Answer 124

Lower abdomen, buttock, anus, perineum, genitalia and lower extremities Superior lateral: drain: Buttock and abdomen, Superior medial: Drain perineum and genitalia Inferior nodes: Drain upper legs Depending on the cluster involved: -Abdominal or buttock, -rectal infection, cancer? -STD: any drainage or sore on the genitalia - Any recent injury or rash to legs or feet?

Answer 125

MIAMI Malignancies Infections Autoimmune disorders Miscellaneous/unusual disorders Iatrogenic causes

Answer 126

Enlarged lymph nodes (lymphadenopathy) Red streaks in the skin (lymphangitis) Lymphedema

Answer 127

The harder the node, the more likely the malignancy The more tender the node, the more likely inflammation Nodes do not pulsate; arteries do A palpable supraclavicular node on the left or right: Further evaluation to r/o Ca. look at them as sentinel nodes for cancer Left supraclavicular node AKA Virchow node

Answer 128

Common to find firm, discrete, not warm nor tender small node in postauricular/occipital not unusual in children younger than age 2 Past 2 years of age, benign lymph enlargement is uncommon

Answer 129

Size Consistency Mobility Discrete borders or matting Tenderness Warmth

Answer 130

a bacterial infection caused from the organism Bartonella henselae. Cats (mostly kitten) are the reservoirs and vectors acquire the bacteria from fleas or flea dirt The infected cat licks a person’s open wound or bites or scratches hard enough to break the surface of the skin.

Answer 131

an inflammation of the lymphatic channels that occurs as a result of infection at a site distal to the channel. Gram positive strept pyogenes or staph aureus

Answer 132

Massive accumulation of lymphedema throughout the body Most common cause of secondary lymphedema worldwide

Answer 133

Type of cancer that affects the lymphocytes, a type of white blood cell that plays an important role in the immune system.

Answer 134

Malignant lymphoma with presence of reed-Sternberg cells Usually arise upper body, neck chest or axillae Usually able to diagnosed earlier so higher survival rate

Answer 135

Malignant lymphoma with absence of reed Sternberg cells. Most common form of lymphoma. May arise in any lymph nodes of the body

Answer 136

Newborn Skull is considered pliable Two major fontanels: Occipital (posterior) Fontanel close within 2 months Frontal fontanel close by 15 months some by 24 months At birth Head = ¼ body Adult = 1/7 of the body NO FRONTAL SINUSES IN TODDLERS

Answer 137

neck pain assoc with chest pain recent trauma fever

Answer 138

Inspection Palpation Percussion Auscultation

Answer 139

Note sunken appearance of the eyes, cheeks, and temporal areas; sharp nose; and dry, rough skin seen in this patient in the terminal stages of throat cancer.

Answer 140

Flattened face, Slanted eyes with inner epicanthal folds, short flat nose, protruding tongue , short neck, single line across the palm of the hands

Answer 141

Decreased facial mobility blunt expression. A mask like face with decreased blinking and a characteristic stare. Peeping upward, oily skin, drooling

Answer 142

Transverse nasal crease, allergic salute, allergic shiners (red puffy eyes)

Answer 143

Painful disorder of CNV produces episodic, paroxysmal, severe, lancinating facial pain lasting seconds to minutes in the distribution of ≥1 divisions of the nerve No facial drop present, Nasolabial fold present

Answer 144

CN VII, asymmetry of one side of face, eyelid not closing completely, drooping of lower eyelid corner of mouth and loss of NL fold

Answer 145

Severe hypothyroidism: Note dull, puffy, yellowed skin; coarse, sparse hair; temporal loss of eyebrows; periorbital edema; and prominent tongue

Answer 146

percussion on the masseter muscle may produce a hyperactive masseteric reflex Evaluation for hypocalcemia other than that no percussion on face

Answer 147

intracranial bruits are considered common in childhood, and uncommon in neonates a bruit is highly suggestive of a vascular anomaly Individuals who have developed diplopia may rarely have a bruit or blowing sound over the orbit indicating an expanding cerebral aneurysm can be associated with temporal arteritis

Answer 148

Suggests the presence of aortic aneurysm

Answer 149

Inspection Symmetry Swallowing symmetry Palpation Size and shape Configuration and consistency Tenderness Nodules During palpation ask the patient to slightly bend her head toward the thyroid lobe you are palpating Auscultation If thyroid gland is enlarged, auscultate for  vascular sounds In a hypermetabolic state, the blood supply is dramatically increased and a vascular bruit, a soft rushing sound, may be heard

Answer 150

Systemic symptoms or conditions Neurologic signs or symptoms Onset Older age Pattern change - 4P's

Answer 151

The 4P's of pattern change 1. progressing to daily 2. precipitated by Valsalva 3. postural aggravation, and 4. papilledema (optic disk swelling from ICP) can indicate malignancy, vascular, or inflammatory disorders

Answer 152

Sinus: pain is behind the forehead and/or cheek Cluster: pain is around one eye. 30 min to 3 hours. Deep and continuous pain. Ipsilateral lacrimation, red eye, stuffy nose, horner syndrome (miosis. - a constricted pupil, ptosis, anhydrosis - decreased sweating) Tension: pain is like a band squeezing the head Migraine: pain, nausea, and visual changes are typical of classic form

Answer 153

Birth trauma, tumors, trauma, cranial nerve palsy, muscle spasms, infection, drug ingestion

Answer 154

Underactive thyroid Hashimoto disease Autoimmune antibodies against thyroid gland, often causing hypothyroidism Myxedema Skin and tissue disorder usually due to severe prolonged hypothyroidism TSH \>4 Low T4

Answer 155

Overactive thyroid Graves disease Autoimmune antibodies to thyroid-stimulating hormone receptor, leading to overactive thyroid Low TSH high T4

Answer 156

If enlarged: Auscultate with bell to see if you hear bruit which is a sign of hyperthyroidism. Thyroid difficult to palpate. Pregnant women palpate for hyperthyroidism. Older adult thyroid can feel hard

Answer 157

Measure head and compare to last exam and normal growth. Posterior fontanel close by 2 months. Palpate gently the suture lines. Transillumination used for skull of infant to measure or see any intracranial lesions - due with any rapid change in head circumference. Macewen sign- abscess or hydrocephalus - cannot be done after 24 months of age

Answer 158

Vision depends on the maturation of the nervous system. Babies are generally born slightly hyperopic (FARSIGHTED). This farsightedness decreases with age. This results in a vision condition in which distant objects can be seen clearly, but close ones look blurry) Although peripheral vision is fully developed at birth, central vision develops later. By 2 to 3 weeks of age, lacrimal ducts produce tears, and the infant has control of the eye muscles. By 3 to 4 months of age, binocular vision (SYNC RIGHT AND LEFT SIDE VISION) development is complete. By age 6 months, the infant can differentiate colors. Young children become less hyperopic with growth. The globe of the eye grows as the child’s head and brain grow, and adult visual acuity is achieved at about 4 years of age.

Answer 159

* Essential to have regular eye exams and visual assessments for children; screenings begin at ages 4–5 and then every other year beginning at 6 * Newborn to 3 years: Visual assessment, inspection of eyes, assessment of corneal light reflex and EOMs, pupillary function, and red reflex

Answer 160

* Hypersensitivity and changes in the refractory power of the eye * Tears contain an increased level of lysozyme, resulting in a greasy sensation and perhaps blurred vision for contact lens wearers * Corneal thickening and change of curvature occurs * decreased or transient loss of accommodation * Diabetic retinopathy may worsen * Intraocular pressure falls * Subconjunctival hemorrhages may occur/resolve spontaneously Pregnant women: Mild corneal edema occurs, especially in the third trimester, along with corneal thickening. Tears contain increased levels of lysozyme, making contact lenses greasy, which is important to know if a pregnant woman comes to your office with such a problem. A complaint of blurry vision and I can’t keep my contact in without any cardiovascular or neurological abnormalities is actually a normal physiological change, which will resolve by itself after delivery.

Answer 161

* Presbyopia age related farsightness. Gradual loss of the eye's ability to focus on nearby objects. * Farsightedness (Presbyopia) usually becomes noticeable in the early to mid-40s and worsens until around age 65. * Symptoms include a need to hold reading material at arm’s length to make letters clearer, blurred vision at normal reading distance, and eyestrain after reading. * Decrease contrast sensitivity * Complaints of glare * reduction in the ability to adapt to sudden changes in illumination. * Dry eye * Lacrimal glands begin to involute and tear production decreases * Loss of lens clarity and cataract formation * Most common causes of decreased visual function include glaucoma, cataracts, and macular degeneration there are still a number of changes in the aging eye leading to diminished vision. Changes in refractive error in older adults may cause reduced vision (near vision). In all adults, the crystalline lens gradually becomes less flexible and less able to change its curvature (accommodate) with age. This results in the condition known as presbyopia, in which patients lose the ability to focus their eyes on near objects. Starts mid 40’s Contrast sensitivity is the ability to distinguish objects from the background when they are similar in brightness, and this ability decreases slightly with age. In addition, largely due to neural changes in the retina, there is an age-related reduction in the ability to adapt to sudden changes in illumination. Finally, dry eye, especially in older women, is also common. cataract formation or a decrease in clarity of the lens. Presbyopia – farsightedness, cannot see reading material near and dry eye are a complaint of most older adults Cataracts, glaucoma, and macular degeneration are common in older adults but not normal findings

Answer 162

Begin with open-ended questions such as what bring you here, and usually with eye people all believe there have pink eye, lot of them do, but surely not all of them… you always need to ask “How is your vision?” and “Have you had any trouble with your eyes?” If the patient reports a change in vision, pursue the related details. Honestly in primary care regarding complaint with the eye, first you get your red eye, allergies related symptoms, itchiness…etc… corneal abrasion mostly due to scractch from eye contact, and your stye…. Or pathologies of the eyelids.

Answer 163

•History of present illness: Presenting symptoms Eye pain, swelling, itching, redness, or drainage; changes in vision; photophobia OLDCAARTS * Past medical history: Recent injury, trauma, or infection; medications and drugs; allergies; history of eye problems; corrective measures for vision; contact lens practices; systemic disease/disorder with ocular signs and symptoms * Family history: Ocular and vision history, history of diseases impacting vision Retinoblastoma (retinal cancer) Often an autosomal dominant disorder Glaucoma, macular degeneration, diabetes, hypertension, or other conditions that may impact vision or eye health Cataracts Color blindness, cataract formation, retinal detachment, retinitis pigmentosa, or allergies affecting the eye Nearsightedness, farsightedness, strabismus, or amblyopia * Social history: Smoking history, ETOH, sleep history, risk factors for HIV exposure, stress and coping, vision requirements, Employment/activities exposure * Use of protective devices during work or activities that might endanger the eye * Preventive care considerations: Vitamin A, antioxidants, sunglasses use, cleanliness of contact with eyes, routine eye exams, protective eyewear as needed, limitations on screen time and avoiding eye strain * Review of systems: General, skin, head/neck, HEENT, CV and pulmonary, GI/GU, M/s, neurologic, endocrine,, and psychiatric Relevant data include employment, for instance working outside may lead to running eye, and rubbing of the eye, which may introduce bacteria and a pink eye…. activities, allergies, medications, eye lenses, will keep your business going, from pink eye, to corneal abrasion and protective device use. Exposure to irritants and activity risks should be delineated. Routine care of eyes and eye devices should be explored. Positive history of drug such as cocaine, barbiturates or ETOH ingestion may be responsible to visual changes * Social history: Smoking history, ETOH, sleep history, risk factors for HIV exposure, stress and coping, vision requirements * Preventive care considerations: Vitamin A, antioxidants, sunglasses use, cleanliness of contact with eyes, routine eye exams, protective eyewear as needed, limitations on screen time and avoiding eye strain * Review of systems: General, skin, head/neck, HEENT, CV and pulmonary, GI/GU, M/s, neurologic, endocrine,, and psychiatric

Answer 164

* Review of systems * General: Weight changes, fatigue, fever, pain * Head/Neck: Acute/recurrent headache, neck pain, lymphadenopathy * ENT: Ear pain; nasal congestion; rhinorrhea; sinus pain; sore throat; itchy ears, nose, throat * Eyes: Additional symptoms of redness, discharge, eye pain, vision changes * Cardio/Resp: Shortness of breath, cough, chest pain, orthopnea * GI/GU: Nausea, vomiting, likelihood of pregnancy, LMP * Musculoskeletal: Inflamed joints, arthritis, weakness, gait/posture defects, need for assistive devices * Neurologic: Numbness, dizziness, light sensitivity, asymmetric facial movements * Endocrine: Polyuria, polydipsia, polyphagia * Integumentary: Itching, rashes, lesion changes, nonhealing sores/wounds * Psychiatric: Depression, worry, insomnia, changes in memory/concentration

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* Always be alert with a unilateral presentation * Severe and deep eye pain * Acute visual changes * Foreign body or penetrating wound * Recent history of Chemical injury * Change in pupil size * pupil irregularity (not baseline) * sluggish pupillary reaction to light * corneal opacification or edema, * Hyphema (blood between the cornea and the iris, do not confused with subconjunctival hemorrhage

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So you have a patient that present to your clinic with CC bilateral eye redness. Which feel like sand in my eyes? Potential etiologies: Red eye can be caused by viral illness, most common is the adenovirus, but as well less common is the herpes simplex virus What do we know about the patho for viral conjunctivitis Has a gradual onset with unilateral symptoms early and can affect both eyes later on, Visual acuity is intact Watery discharge is apparent. Bacterial infection can also cause red eyes by staph aureus, strept pneumo, N gonnorhea are the most common causes Bacterial conjunctivitis has a gradual onset, unilateral early, bilateral late, scratchy feeling, Thick crusty discharge may cause blurry vision Allergic conjunctivitis. Chronic seasonal conditions can both eyes to be red and itchy, painless and cause watery discharge. Injuries Trauma to the eye can also cause redness, usually improper contact lens care can damage the sclera and cause redness.

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Snellen eye chart: distant central vision. Assess at 20 ft distance Rosenbaum: Central near vision. Assess at 14" Penlight: pupillary reaction Cotton wisp: CNV sensory Ophthalmoscope Eye cover, gauze, or opaque card

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Essential to have regular eye exams and visual assessments for children; screenings begin at ages 4–5 and then every year beginning * Young children: Vision screening at least once between 3–5 years of age (USPSTF) * School-aged children: Comprehensive eye/vision examination before entering school and annually thereafter (AOA) * Adults: Comprehensive eye/vision examination at least every 2 years for asymptomatic, low-risk persons aged 40–64 years of age (AOA)

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Peripheral vision which is a further assessment of CN2….. So peripheral can be assess through confrontation visual field testing. Position yourself about 3 feet from your patient at your eyes should be at the same level as your patient… in confromtation testing you are comparing your visual field with your patient visual field. Have patient cover his left eye while you close your right eye, so you are comparing your field of vision. Ask you patient to look at your eye, some patient get shy so tell them to focus on your eye brow…. Place your hand equidistant between you are your patient and test each quadrant by holding one two or three fingers. Repeat procedure for the other eyes

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When eyelids turn inward can cause corneal abrasion from eyelashes or infection

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Gray or white arc visible above and below the outer part of the cornea. High risk for hyperlipidemia

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Unequal pupil size. Not an issue if born with it. 20% of the population minor to the noticeable pupil size difference

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Hyperthyroidism

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•External examination without ptosis, strabismus, or exophthalmos. EOM intact. Conjunctiva pink without exudate. Sclera without injection or icterus (jaundice). Cornea clear. Iris without lesions or shallow anterior chamber. PERRLA. Corneal reflex intact.

Answer 175

So here is a retina, first your will see blood vessels…. Arteries are brighter and narrower than the veins , by a ratio of 3/5 or 2/3 remember you only see a portion of the retina at one time so slightly move the angle of the ophathamolscope. Optic nerve is like a beautiful donut. Always examine pts right eye with your right eye and pts left eye with your left eye

Answer 176

![]() ## Footnote poorly controlled hypertension causes the following: Permanent arterial narrowing Arteriovenous crossing abnormalities (arteriovenous nicking) Arteriosclerosis with moderate vascular wall changes (copper wiring) to more severe vascular wall hyperplasia and thickening (silver wiring)

Answer 177

Photoscreening is a form of vision screening for children. It uses a camera to take images of a child's undilated eyes, by 5 you can test with a modified vision test instead of letter you might have pictures •Photoscreening is recommended as an alternative to visual acuity screening for ages 3 to 5

Answer 178

Horner syndrome (Horner’s syndrome) results from an interruption of the sympathetic nerve supply to the eye and is characterized by the classic triad of miosis (ie, constricted pupil), partial ptosis, and loss of hemifacial sweating (ie, anhidrosis) more prominent with people with heterochromia, meaning eye colors are different It is caused by the interruption of sympathetic nervous system innervation to the head, neck, and eye.

Answer 179

Diabetic retinopathy with presence of microaneurysms and the presence of hard and soft exudate and eventually the Development of new vessels as result of anoxic environment. New vessels are fragile and easily break creating some area of hemorrhages

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* Disease of the optic nerve resulting from increased intraocular pressure * Nerve cells die, producing a characteristic appearance of the optic nerve (increased cupping) * Opened angle * Progressive painless visual loss mostly peripheral in nature * Closed angle * Acute painful peripheral vision loss often accompanied by conjunctival injectionGlaucoma Disease of the optic nerve wherein the nerve cells die usually because of excessively high intraocular pressure

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•Abnormal growth of conjunctiva that extends over the cornea from the limbus. Ofen seen in patients in the sun alot aka Surfer's eye

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A tool used to detect macular degeneration. Macular degeneration is a age-related disease of the macula (central portion of the retina) that results in loss of central vision. A common disorder in people over 50.

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High frequency sounds

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Low-frequency sounds

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A general survey is a systematic assessment of the individual's health status. Starts with physiologic stability using the pneumonic ABCDE (airway, breathing, circulation, disability, exposure). Once it is determined the individual isn't in any acute distress next it is ABC (appearance, behavior, cognition) The initial general survey includes assessing for problems, instability, or alterations in the airway, breathing, circulation, and neurologic status, which involves exposing an individual as needed in order to safely and effectively complete the exam. Assessments of mental and physical status include the general survey, measurements of vital signs and body habitus, and evaluation of pain.