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health assessment and primary care > health assessment and diagnostic tests > Flashcards

health assessment and diagnostic tests Flashcards

1
Q

components of health history
1. chief complaint
2. presenting problem- OLD-CARTS
-pertinent negatives
3. Past health history
4. current health history

A
  1. chief complaint: in patients own words why they seek healthcare today
  2. presenting problem- OLD-CARTS (onset, location, duration, characteristics, aggravating/alleviating factors, relieving factors, temporal factors, severity)
    -pertinent negatives
  3. Past health history
  4. current health history
    -medications, allergies, tobacco/alcohol/drugs, nutrition, exercise, etc.
  5. family history
  6. psychosocial history
    -HEADSS for adolescents
  7. obstetrical history
  8. menstrual history
  9. sexual history/contraceptive use
  10. Review of systems
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2
Q

HEADSS for adolescents includes…

A

Home
Education
Activities
Drugs
Sex
Suicide

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3
Q

special focus for review of systems on gynecologic and reproductive health includes:
a. endocrine
b. genitourinary
c. breasts

A

a. endocrine
-amenorrhea or infrequent menses
-heavy or prolonged menses
-PMS
-excessive hair growth or hair loss

b. genitourinary
-painful periods
-pain with sex
-pain with urination

c. breasts
-pain, lumps, masses, nipple discharge

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4
Q

SOAP format

A

S: subjective
-“reports” “endorses” “describes” rather than c/o

O: objective
-obtained through physical exam

A: assessment/diagnosis

P: plan!
-diagnostic tests, client education, referrals, date for reevaluation

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5
Q

diaphragm best for….
bell best for…

A

diaphragm is best for high pitched sounds like S1, S2 heart sounds

bell is best for low pitched sounds (large blood vessels)

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6
Q

percussion provides information about size, shape, location, and density of underlying organ and tissue

a. tympany- loud, high-pitched, drum-like

b. hyperresonance- very loud, low-pitched, boom-like

c. resonance- loud, low pitched, hallow sound

d. dull- soft to moderate, moderate-pitched, thud-like sound

e. flat- soft, high-pitched sound, very dull

A

a. tympany- loud, high-pitched, drum-like (gastric bubble, gas-filled bowel)

b. hyperresonance- very loud, low-pitched, boom-like (lungs with emphysema)

c. resonance- loud, low pitched, hallow sound (healthy lunges)

d. dull- soft to moderate, moderate-pitched, thud-like sound (liver, heart)

e. flat- soft, high-pitched sound, very dull (bone)

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7
Q

waist circumference is only recommended in patients with BMI of…

A

25-39.9

predictor of risk for type 2 DM, hypertension, dyslipidemia, cardiovascular disease

measure at upper most lateral border

in adult female: increased risk if greater than 35 in

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8
Q

primary vs secondary lesions

A

primary: macule, papule, pustule, vesicles, wheal; happens as initial, spontaneous reaction to internal or external stimulus

secondary: results from later evolution or trauma to a primary lesion (ulcer, fissure, crust, scar)

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9
Q

ABCDE’s of malignant melanoma

A

Asymmetry
Border irregular
Color (blue/black)
Diameter greater than 6 mm
Elevation

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10
Q

abnormal eye exam would include…

A

-opacity of lens
-dysconjugate gaze
-nystagmus
-lid lag
-papilledema
-retinal hemorrhages and exudates (diabetes, HTN)

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11
Q

hearing evaluation
-whispered voice
-Weber test
-Rinne test

A

able to hear softly whispered words in each ear at 1-2 ft

weber: tests for lateralization of sound through bone conduction

Rinne: compares. bone and air conduction AC sound is head twice as long as BC sounds

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12
Q

conductive vs sensorinueral hearing loss

A

conductive: sound transmission impaired through external or middle ear; exudate/swelling, perforated ear drum

sensorineural hearing loss: defect in inner ear distorting sound; loud noise exposure, aging

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13
Q

adventitious sounds

a. crackles

b. rhonchi

c. wheezes

d. pleural friction rub

A

a. crackles: fine crackles hear during inspiration: high pitch, crackling; caused by air flowing by fluid (pneumonia, bronchitis)

b. rhonchi: heard during inspiration and expiration; low pitch, loud, sounds like a SNORE, tends to disappear after coughing (air possing over solid or thick secretions in large airways- bronchitis, pneumonia

c. wheezes: heard during inspiration and or expiration; high pitch, continuous, LOUDER during EXPIRATION; sounds like a squeak; caused by air flowing through constricted passageways: asthma, chronic emphysema

d. pleural friction rub: heard during inspiration or expiration; dry, rubbing, grating; cause by inflammation of pleural tissue: pleuritis, pericarditis

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14
Q

apical impulse location

A

fourth to fifth left intercostal space (ICS) medial to midclavicular line (MCL), no lifts or thrills

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15
Q

S1 occurs at the start of ____ and is best hear at ____

S2 occurs at the start of____ and is best heard at ___

A

S1 starts with systole and is best heard at apex

S2 starts with diastole and is best heard at base

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16
Q

Liver span is about __-___ cm at the

A

normally 6 to 12 cm at right MCL

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17
Q

Possible appendicitis
-McBurney’s point
-Rovsing’s sign
-Psoas and obturator signs

A

McBurneys: localized tenderness right lower quadrant

-Rovsing’s sign: referred rebound tenderness, pain in right lower quadrant when left sided pressure applied and quickly withdrawn

-Psoas and obturator signs: irritation of right psoas or obturator muscles by inflamed appendix

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18
Q

possible cholecystitis
-Murphy signs

A

sharp increase in tenderness and sudden stop in inspiratory effort with upward pressure under right costal margin when client takes deep breath

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19
Q

abdomen normal findings
-auscultation
-liver
-spleen and kidneys
-percussion

A

-active bowel sounds, no vascular bruits or friction rubs
-liver border: edge smooth, sharp nontender and no more than 2 cm below right coastal margin
-spleen and kidneys: NOT PALPABLE
-percussion: tympany is predominant tone; dullness over organs

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20
Q

systolic click in mid to late systole, high pitched, and increased with inspiration is probably…

A

mitral valve prolapse

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21
Q

physiologic murmur characteristics

A

-systole
-grades 1 or 2
-normal finding, common in pregnancy
-increases with activity (pregnancy, working out)
-

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22
Q

Cranial nerves:
1. CN I (olfactory)
2. CN II (optic)
3. CN III, IV, VI (oculomotor, trochlear, abducens)

A
  1. CN I (olfactory): identify odors
  2. CN II (optic): test visual acuity, peripheral vision, inspect optic discs
  3. CN III, IV, VI (oculomotor, trochlear, abducens): observe for PERRLA, EOM function, and ptosis
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23
Q

Cranial nerves
4. CN V (trigeminal)
5. CN VII (facial)
6. CN VIII (acoustic)

A
  1. CN V (trigeminal): palpate strength of temporal and masseter muscles; test for sharp/dull and light touch sensation on forehead, cheeks, and chin
  2. CN VII (facial): observe for any weakness, asymmetry, or abnormal movements of face
  3. CN VIII (acoustic): assess auditory acuity
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24
Q

Cranial nerves
7. CN IX and X (glossopharyngeal and vagus)
8. CN XI (spinal accessory)
9. CN XII (hypoglossal)

A
  1. CN IX and X (glossopharyngeal and vagus): observe ability to swallow; symmetry of movement of soft palate and ulva when client says “ah”; gag reflex; any abnormal voice quality
  2. CN XI (spinal accessory): observe and palpate strength and symmetry of trapezius and sternocleidomastoid muscles
  3. CN XII (hypoglossal): observe tongue for any deviation, asymmetry, or abnormal movement
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25
Q

Romberg test assesses…

A

cerebellar function
(eyes closed maintain balance)

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26
Q

deep tendon reflexes should be…

A

brisk and symmetrical

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27
Q

breast inspection includes…

A

-patient sitting with hands above the head
-pushing against hips and leaning forward
-view breasts from all sides to assess for symmetry and skin changes
-some difference in size of breast and areola is common and usually normal
-nipples: pointing in same direction
-palpate axillary, supraclavicular, infraclavicular lymph nodes when client is sitting
-palpate breast with client lying down, arm above head
-palpate using finder pads of middle three fingers with overlapping dime shaped circular motions
-three levels of pressure: light, medium, and deep

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28
Q

T/F do not squeeze nipples unless patient c/o nipple discharge

A

true

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29
Q

how should any palpable mass or lymph nodes be described?

A

in terms of location according to clock face as examiner faces client: size, shape, mobility, consistency, delimitation, and tenderness

30
Q

perineum consists of tissue between…

A

the introitus and anus

31
Q

pederson vs grave’s speculum

A

a. Pederson: straight sided, pediatric, narrow and regular sizes

b. Grave’s: duck billed shape; may be used when lax vaginal musculature or submucosal fat impedes visualization

32
Q

NORMAL VISUAL FINDINGS
-vaginal walls
-cervix

A

vaginal walls: pink, rugated, homogenous, may have thing clear/cloudy odorless discharge

cervix: midline and smooth, round, pink, 2.5 cm in diameter
-points posteriorly with anteverted uterus
-anteriorly with retroverted uterus
-horizontally with midposition uterus

33
Q

Palpation of internal structures
-cervix
-uterus
-adnexa

A

-cervix: smooth, firm, mobile, non tender about 2.5 cm in diameter and protrudes 1-3 cm into vagina

-uterus: smooth, rounded contour, firm, mobile, nontender; 5.5 to 8 cm long and pear shaped in nulliparous females; may be 2-3 cm larger in parous female

-adnexa: fallopian tubes nonpalpable, ovaries avoid, smooth, firm, mobil slightly tender; size during reproductive years: 3 x 2 x 1

34
Q

CBC normal RBC count
-low vs high causes

A

4.2-4.5 million/mm3

low RBC count: hemorrhage, hemolysis, dietary deficiencies, chronic illness, medications

high RBC count: dehydration, chronic hypoxia, medications

35
Q

hematocrit and hemoglobin
-normal
-pregnancy
-low vs high causes

A

a. Hct: percentage of total blood volume made up of RBCs
-normally: 37-47% (non pregnant)
-pregnant: 33% or greater in first and third, 32% or greater in second (Black women are adjusted -2%: 31%, and 30%, respectively)

b. Hgb: measurement of total HgB (which carries oxygen) in the blood
-normal: 12 to 16
-pregnancy: 11 in first and third, 10.5 in second

low: anemia, cirrhosis, hemorrhage, dietary deficiency, chronic illness, renal failure

high: severe hydration, polycythemia vera, COPD/hypoxic states

36
Q

T/F heavy smokers and individuals living at higher elevations may have higher Hgb levels

A

TRUE

37
Q

CMP includes

A

glucose, calcium, albumin, total protein, electrolytes (sodium, potassium, CO2, chloride), kidney tests (BUN, creatinine), liver tests (ALP, ALT, AST, bilirubin)

38
Q

blood clotting studies
-platelet count
-PT
-PTT

A

-platelets: normally between 150-400,000

-PT and PTT: used to evaluate how well coagulation factors in coagulation cascade work together; measures number of time takes for clot to form- prolonged results would indicate clotting is taking longer than normal

prolonged PT with normal PTT: liver disease, vitamin K deficiency, anticoagulation drug (warfarin) therapy

normal PT with prolonged PTT: von Willebrand disease, SLE anticoagulant

39
Q

White blood cell count with differential:

NORMAL:
-total WBC count: 5000 to 10,000
-neutrophils 30-70%
-basophils: 0-3%
-eosinophils 0-5%
-lymphocytes: 15-40%
-monocytes 2-8%

low values, vs high values

A

WBC count thats low: bone marrow suppression, autoimmune disorders

high WBC count values: dehydration, infection, inflammatory conditions, some malignancies, may be elevated in late pregnancy and during labor

40
Q

blood glucose
1. fasting (nothing for 8 hours)
2. two hour postload glucose OGTT (75g)

A
  1. fasting: below 126
  2. OGTT: < 200
    -impaired: 144-199
    -normal: below 140
41
Q

diagnostic criteria for diabetes mellitus with blood glucose:

A
  1. classic sxs of hyperglycemia plus random serum glucose > 200
  2. fasting glucose > 126
  3. two hour post glucose: >200
  4. HbA1c: >6.5%
  5. repeat testing on subsequent day to CONFIRM diagnosis
42
Q

lipid panel determines..
-cholesterol, triglycerides, HDLs, LDLs
-fasting requirements?

A

risk for coronary heart disease and evaluates for hyperlipidemia
-must fast 12-14 hours prior

a. total cholesterol < 200
b. triglycerides: normally 35-135
c. HDL- removes cholesterol from peripheral tissues and transports to liver for secretion
HDL: 40 or greater
d. LDL-C: normally less than 130

43
Q

BUN is an indirect measure of…

A

renal and liver function
normally between 10-20

increased levels: renal disease
decreased levels: liver failure

44
Q

serum creatinine is an..

A

indirect measure of renal function
normally between 0.5-1.1

increased: renal disorders, dehydration

45
Q

TSH and Free T4
-normal

A

TSH: normally between 0.4 - 4.12
increased TSH: primary hypothyroidism and thyroiditis
decreased TSH: seen with hyperthyroidism

FT4: normally 4.5-12
increased FT4: hyperthyroidism
decreased FT4: hypothyroidism

46
Q

when is antithyroid peroxidase antibodies used?

A

anti-TPO is used in differential diagnosis of thyroid disorders associated with autoimmune disease

a. normal findings: negative antithyroid antibodies
b. positive: Grave’s disease, Hashimoto’s thyroiditis

47
Q

LFTS
1. bilirubin
2. albumin
3. liver enzymes

A
  1. bilirubin: normally 0.3-1.0
    elevated direct bili: gallstones
    elevated indirect bili: seen in hepatitis
  2. albumin: normally 3.5-5.0
    increased: dehydration
    decreased: liver disease
  3. liver enzymes
    NORMAL: AST: 0-35, ALT: 4-36
    ALP: elevated with liver disease, MI
48
Q

when is GGT helpful?

A

in assessing for heavy or chronic alcohol use
normally between 8-38

49
Q

false positives for occult blood in stool can be caused by….

A

red meat and some raw fruits and veggies
large amounts of vitamin C

^^consumed within 3 days of test

50
Q

universal donor vs universal recipient for blood

A

universal donor: O negative (OH SHIT they need my blood); no antigens on RBCs

universal recipient: AB positive: no antibodies will be present

51
Q

antinuclearl antibodies (ANA) test
-used in the workup of…

A

SLE!
95% of individuals with SLE will be + for ANA
higher titers = more active disease

52
Q

pregnancy test detects…

A

hCG in blood/urine

first morning urine is best, most concentrated

53
Q

reproductive hormone studies
1. estradiol
2. progesterone
3. FSH
4. LH

-increased vs decreased

A
  1. estradiol
    -increased: adrenal tumor,
    -decreased: post menopause, ovarian failure, primary or secondary hypogonadism, Turner’s syndrome
  2. progesterone
    -increased: pregnancy, ovulation
    -decreased: short luteal phase syndrome
  3. FSH
    -increased: postmenopause
    -decreased: pregnancy, pituitary or hypothalamic dysfunction
  4. LH
    -increased: postmenopause
    -decreased: pituitary or hypothalamic dysfunction
54
Q

urinalysis
-what kind of catch

A

mid stream clean catch

normal findings:
-no nitrites, ketones, crystales, glucose
-clear, amber yellow
-pH 4.6 - 8
-specific gravity 1.005 - 1.030
-leukocyte negative
-WBCs 0-4
-RBCs 2 or less

55
Q

Vaginal microscopy/wet mount/pH/amine test
1. normal
2. bacterial vaginosis
3. trich
4. vulvovaginal candidiasis (VVC)

A

look on low (10x) and high (40x) power
1. normal:
pH: 3.8-4.5
whiff test neg
wet mount: epithelial cells, no WBC, lactobacilli present

  1. bacterial vaginosis
    pH > 4.5, + whiff test, wet mount: > 20% clue cells
  2. trich
    pH > 4.5, whiff test neg or post, motil trich, lactobacilli reduced
  3. vulvovaginal candidiasis (VVC)
    pH < 4.5, whiff test neg, yeast buds/hyphae/spores present (best seen after KOH applied)
56
Q

additional test for vaginal infection diagnosis includes…

A

a. NAAT- CDC recommended for trich
b. culture; recommended when - for yeast on slide, but symptoms are present or persistent; NOT rec for BV

57
Q

T/F HIV antibody detectable in 95% of individuals within 6 months of infection

A

TRUE

58
Q

STI + screening diagnosis tests
1. chlamydia
2. gonorrhea
3. syphilis
4. genital herpes/herpes simplex virus (HSV)
5. chancroid
6. Trich

A
  1. chlamydia: NAAT
  2. gonorrhea: NAAT
  3. syphilis: dark field microscopy examination and direct fluorescent antibody tests of lesion exudate are definitive methods of diagnosing early syphilis:
    SEROLOGY: nontrep tests (non specific): VDRL, RPR
    -become + 1-2 weeks post chancre
    -recative nontrep must be confirmed with treponemal tests (specific)
  4. genital herpes/herpes simplex virus (HSV)
    -tissue culture and PCR for patients presenting with genital lesions
    -PCR assays are more sensitive than cultures
  5. chancroid
    -culture
    -gram stain
  6. Trich
    -NAAT (rec by CDC)
    -NAAT provides option of testing with urine, vaginal specimen; some approved for liquid-based cytology
59
Q

Rubella IgM antibody tited

A

used if pregnant woman has a rash suspected to be from rubella

60
Q

Hep B surface antigen (HbsAG) vs Hep B surface antibody vs Hep B core antibody (HBcAB) vs hep B e-antigen

A

antigen: indicates active HBV infection- individual is INFECTIOUS!!

antibody: immunity from vaccine or previous infection

core antibody: indicates past infection; chronic hepatitis

hep B e-antigen: infectious, seen with acute infection

61
Q

Hepatitis C (HCV) test

first: HCV antibody assay

next: HCV RNA test

A

if HCV antibody assay is reactive, f/u with HCV RNA test

HCV RNA + test: current infection

HCV RNA -: past resolved infection or false positive

62
Q

T/F once you have a positive TB reaction, it usually persists for life

A

true!!

whomp whomp

63
Q

false-negative PPD (TB skin test) may results from…

A

incorrect admin, recent live virus vaccination, or immunosuppresion

64
Q

false positive PPD (TB skin test) may results from

A

history of BCG vaccine

MUST to a interferon gamma release assay (blood test) if history of Bacillus Calmette-Guerin vaccin

65
Q

when is a strep throat test indicated in adults with pharyngitis?
must meet TWO or more of the following criteria:

A
  1. fever
  2. no cough
  3. tonsillar exudate
  4. anterior cervical lymphadenopathy/tenderness
66
Q

cervical cytology patient education prior…

A

-avoid douching, intercourse, and use of vaginal creams 48 hours prior
-avoid scheduling on heaviest day of period
-

67
Q

vulvar biopsy should be used on lesions smaller than…

A

0.5 cm

steps:
-inject with lidocaine
-cleanse with betadine
-rotate punch biopsy several times with downward pressure over site
-elevate specimen with forceps, incise at base with scissors
-place specimen in solution for transport to the lab

68
Q

EMBs are useful for…

A

evaluating abnormal bleeding (pre/postmenopausal bleeding), rule out/confirm endometriosis; determine endometrial response to progesterone in infertile individuals

69
Q

EMB
-patient education

A

take NSAID 30-60 minutes prior to procedure

70
Q

inheritance patterns
1. autosomal dominant
2. autosomal recessive
3. X-linked dominant
4. X-linked recessive

-examples??

A
  1. autosomal dominant: only one mutated copy of gene in each cell needed, EX: Huntington disease, BRCA 1/2, Lynch syndrome
  2. autosomal recessive: both copies needed- one from each parent; if BOTH parents are carriers: 50% chance of being a carrier, 25% chance of having disease
    EX: cystic fibrosis, muscular dystrophy, sickle cell anemia
  3. X-linked dominant: mutation in genes on X chromosome; females more frequently affected than males
    EX: fragile X syndrome
  4. X-linked recessive: males more frequently affected than females (males only have to inherit affected X chromosome whereas females have to inherit both)
    EX: hemophilia
71
Q

pelvic u/s

A
  1. use of high-frequency sound waves to evaluate internal pelvic organs/structure for diagnostic purposes:
    -distinguishes solid vs cystic pelvic masses
    -confirms viability
    -determines endometrial thickness
    -fibroids
    -adnexal masses
    -evaluate fetal growth
    -detect fetal anomalies

transabdominal: full bladder
transvaginal: empty bladder

health assessment and primary care (5 decks)

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