Midterm

Question 1

the parts of a health history

Answer 1

biological data
reason for seeking care
history of present illness or present health
past medical history
family history/cultural assessment 
review of symptoms
functional assessment of ADL's

Question 2

the components in performing a physical assessment

Answer 2

inspection- use of vision and smell
palpation- use of touch; always palpate tender areas last
- light palpation- assesses surface area for temperature, texture, moisture, swelling, vibration, tenderness, crepitus, rigidity
–fingertips are best used for fine tactile discrimination, as of skin texture, swelling pulsation, and determining the presence of lumps
–the dorsa of hands are best used determining temperature because the skin here is thinner than on the palms
–base of finger or ulnar surface of the hand is best used for vibrations
-deep palpation- assesses internal organs or masses
percussion- involves tapping of fingers to body part and listening to sounds; identifies density, organ shape, and organ position
- characteristic of percussion notes:resonant (ie. normal lung), hyperresonant (pneumothorax), tympany (ie. abdomen), dull (ie. bones), and flat
- direct percussion- tapping finger or hand directly on the body
- indirect percussion- involves a stationary finger and a striking hand
auscultation- use of sound; listening to heart, lung, bowel, and carotid sounds
- diaphragm- use to listen to high-itched sounds (ie. breath and bowel)
- bell- use to listen to low-pitched sounds (ie. vascular sounds, extra heart sounds)

Question 3

subjective symptoms

Answer 3

"symptoms"
what the patient complains of 
health history
chief complaint
review of symptoms
PQRSTU
- provocative vs palliative
- quality and quantity
- region and radiation
- severity and scale
- timing and type of onset
- understanding

Question 4

objective symptoms

Answer 4

“signs”
what is observed of the patient
- includes physical examination, diagnostic testing, lab results, etc.
primarily factual and descriptive

Question 5

secondary lesions

Answer 5

crust- a drying of blood or sebum from healing
scale- a collection of dry or greasy dead skin cells
fissure- a crack in the skin
erosion- skin breakage at the epidermis level; no bleeding; may appear moist; may occur after a bulla has burst
ulcer- skin breakage may occur at the epidermis, dermis, and subcutaneous level
excoriation- skin breakage of the epidermis and the dermis; blood may be present
scar- replacement of lost normal tissue; often caused by injury or laceration
atrophic scar
lichenification- a thickening and roughening of the skin; may occur after extreme scratching has taken place
keloid- occurrence where scar tissue has over-grown itself

Question 6

lesion configuration

Answer 6

annular or circular
confluent- when a rash meshes all over the place with no particular pattern
discrete- singular and randomly spread on one part or on different parts of the body
grouped- singular and bunched together
linear
zosteriform or dermatomal- lesions occur on one side of the body usually following a nerve dermatone

Question 7

anatomy of the ear

Answer 7

auricle or pinna (external ear)
- funnels sound into the external auditory ear canal which ends at the tympanic membrane
middle ear
- directly after the tympanic membrane
- conducts sound to the inner ear via three ossicles:
-- malleus
-- incus
--stapes
- the eustachian tube connects the middle ear and the nasopharynx
inner ear
- made of:
-- semicircular canals
--cochlea
-- acoustic nerve (cranial nerve VIII)

Question 8

external ear examination

Answer 8

inspection
- size and shape: equal size bilaterally without swelling or thickening
- skin condition: intact, with no lumps or lesions
palpation
- mastoid process, pinna and tragus: no tenderness
- lymph nodes: no lymphadenopathy

Question 9

otoscopic examination

Answer 9

canal: no discharge, lesions, redness, or swelling
- cerumen: presence without blockage; gray-yellow to light brown and black; moist and waxy to dry
tympanic membrane
- color and characteristics
- intact, not bulging or retracted
- position of cone of light
- integrity of membrane
- visualize the umbo, manubrium, and short process of the malleus

Question 10

aging process with the ears

Answer 10

adults > 50 years old

• decreased hearing
• high-pitched sound diminishes first
• decreased speech discrimination
• there may be social-safety implications

Question 11

aging process with the eyes

Answer 11

aging adult

• visual acuity decreases
• • perform same examination as adult
• central acuity may decrease, particularly after 70 years of age; peripheral vision may be diminished
• ocular structures
• • pupils small in old age; pupillary light reflex may be slowed
• • eyebrows may show loos of hair
• • arcus senilis- a deposition of fat around the cornea. it looks yellow-white and is considered normal after age 45 to 50. it has no effect on vision

Question 12

eye examination

Answer 12

visual acuity
- snellen eye chart
– patient should have at least 20/20 vision
visual fields
- confrontation test
– assuming the tester has intact peripheral vision, the pt. should see object coming into their peripheral vision when the tester does
PERRLA- pupils equal round reactive to light and accommodation
- pupil size
- pupillary light reflex
– pupils should constrict directly and consensually
- accommodation
– pupils should constrict or dilate when presented with a close object or far-away object, respectively
extraocular muscle function
- corneal light reflex (hirschberg test)
– light should shine in the same spot on both eyes
- six cardinal positions of gaze
– eyes should parallel track
- cover-uncover test

Question 13

ophthalmic examination

Answer 13

ask the patient to stare at a fixed, distant object
- dilates pupils and steadies retinal structures
ten inches away from the pt. come in at a 15 degree angle towards the front
red reflex should fill the pupil
at a closer view, the optic disc, vessels, fundus, and the macula may be present

Question 14

macular degeneration

Answer 14

a disease that destroys your sharp, central vision; affects ability to see fine detail

Question 15

glacoma

Answer 15

group of diseases that can damage the eye’s optic nerve; straight-ahead vision may decrease until no vision remains; may develop as a result of metabolic disorders, trauma, or heredity

Question 16

cataract

Answer 16

a clouding of the lens in your eye

Question 17

cranial nerves

Answer 17

1S olfactory- sense of smell
2S optic- visual acuity and visual fields
3M oculomotor- pupil constriction and accommodation; extraocular motor function
4M trochlear- corneal light reflex; extraocular motor function
5 trigeminal
- S cornea, nasal and oral mucosa, facial skin
- M muscles of mastication
6M abducens- corneal light reflect; extraocular motor function
7 facial
- S taste (anterior 2/3 tongue)
- M facial muscle symmetry
8S acoustic- sense of hearing
9 glossopharyngela
- S taste (posterior 1/3 tongue)
- M swallowing, salivation, and specch
10 vagus
- S palate and uvula upward movement upon phonation
- M swallowing and voice quality
11M spinal accessory
- sternomastoid and trapezius muscle strength
12M hypoglossal- tongue movements; tongue at midline

Question 18

deep tendon reflexes (DTR) grading

Answer 18

4+ very brisk, hyperactive with possible clonus
3+ brisker than average may indicate disease
2+ average, normal
1+ diminished, low normal
0 no response

Question 19

clonus

Answer 19

rapid contraction of the plantar muscle upon flexion

indicative of disease

Question 20

reinforcement

Answer 20

regarding DTR’s
done to enhance a reflex
person performs an isometric exercise in a muscle group somewhat away from the one being tested
used as a distraction technique

Question 21

mini mental examination

Answer 21

tests cognitive functioning
standard set of 11 questions
scoring:
- optimal 30
- no cognitive impairment 24-30
- cognitive impairment <24

Question 22

mental status

Answer 22

ABC-T

• alertness/appearance
• • alert
• • lethargy
• • obtundation
• • stupor
• • coma
• • grooming and personal appearance
• • level of consciousness (note the ease of arousal)
• behavior
• • affect
• • mood
• • speech (aphonia, dysarthia, aphasia)
• cognitive function
• • orientation (place, place, and time)
• thought processes
• • processes- how a person thinks
• • content- what a person thinks about

Question 23

alert

Answer 23

awake

readily aroused

Question 24

lethargy

Answer 24

drowsy
drifts off to sleep when not stimulated
responds to commands slowly

Question 25

obtundation

Answer 25

sleeps most of time difficult to arouse needs vigorous shake or loud voice monosyllabic responses

Question 26

stupor

Answer 26

semi-comatose | responds only to painful stimuli

Question 27

coma

Answer 27

completely unconscious | no response to pain

Question 28

affect

Answer 28

objective observable, external expression of emotional tone it is the behavior that expresses a subjectively experienced feeling state

Question 29

mood

Answer 29

subjective internal emotional tone a pervasive and sustained tone that color the person's perception of the world

Question 30

aphonia

Answer 30

loss of voice

Question 31

dysarthia

Answer 31

difficulty in articulating or forming words

Question 32

aphasia

Answer 32

disorder of language dominant in the left cerebral hemisphere - broca's aphasia - - loss of ability to produce verbal conversation - - person know what they want to say but cannot say it - wernicke's aphasia - - loss of ability to understand verbal communication

Question 33

cerebellar testing

Answer 33

``` balance tests - gait - tandem walking hop on one foot or balance on one foot - romberg test -- should be able to stand in place with minimal swaying with eyes closed for 20 seconds rapid alternating movements (RAM) - knee-hand test - finger-to-finger test coordination and skilled movements - finger-to-nose test - finger-nose-finger test - heel down shin test ```

Question 34

sensory testing

Answer 34

``` spinothalamic tract - light touch test - pain -- sharp versus dull - temperature -- performed if there are pain deficits posterior column tract - vibration test - position test -- placement of phalanges in space - tactile discrimination -- stereognosis- identification of a familiar object with eyes closed -- graphesthesia- sensation of written number on palm of hand with eyes closed -- point location -- two-point discrimination ```

Question 35

function of the frontal lobe

Answer 35

``` personality behavior emotion intellectual functions broca's area - motor speech precentral gyrus - primary motor area ```

Question 36

function of the temporal lobe

Answer 36

``` hearing taste smell wernicke's speech - speech comprehension ```

Question 37

function of the occipital lobe

Answer 37

visual reception

Question 38

function of the parietal lobe

Answer 38

sensation postcentral gyrus - primary sensory area

Question 39

function of the cerebellum

Answer 39

motor coordination equilibrium balance

Question 40

dizziness

Answer 40

imprecise term commonly used to describe various symptoms such as faintness, giddiness, imbalance, lightheadedness, unsteadiness, or vertigo

Question 41

vertigo

Answer 41

a sensation of spinning or whirling motion implies a definite sensation of rotation of the subject (subjective vertigo) or of objects about the subject (objective vertigo) in any plane

Question 42

syncope

Answer 42

loss of consciousness and postural tone caused by diminished cerebral blood flow

Question 43

glasgow coma scale

Answer 43

a clinical scale to assess impaired consciousness assessment may include motor responsiveness, verbal performance, and eye opening ability highest score is 15 score of <9 implies comatose state

Question 44

lung assessment

Answer 44

``` inspection - general appearance - position - breathing patterns -- presence of pursed lips, use of accessory muscles - audible breathe sounds - patient's surroundings - patient's skin color - patient's hands -- presence of clubbing, tar staining, pallor, cyanosis - thoracic cage -- symmetry -- shape and configuration (2:1) - thorax -- costal angle- < 90 degrees -- respiration rate, rhythm, and type -- retraction or bulging of interspaces -- symmetry -- use of abdominal/accessory muscles palpation - anterior/posterior chest -- symmetric chest expansion -- crepitus -- tenderness -- tactile fremitus auscultation - posterior chest -- brochovesicular- I=E -- vesicular- I>E - anterior chest -- bronchial- I

Question 45

normal breath sounds

Answer 45

bronchial - rough sound hear over trachea and larynx - short inspiration and long expiration - may only be auscultated anteriorly bronchovesicular - heard over major bronchi between scapula and upper sternum - inspiration and expiration are equal in length vesicular - heard over periphery of lung - long inspiration and short expiration - most common auscultated sound of lungs

Question 46

fine crackles or rales

Answer 46

discontinuous, short popping sounds usually heard during inspiration caused by air colliding with previously deflated airways cannot be cleared by coughing

Question 47

course crackles

Answer 47

discontinuous, bubbling or gurgling sound usually heard on inspiration caused by inhaled air colliding with secretions in the trachea or bronchi may be temporarily cleared by coughing

Question 48

sibilant wheezes

Answer 48

high-pitched sounds may be heard on inspiration and expiration caused by air trying to squeeze through a passage narrowed by airway obstruction from collapse or swelling

Question 49

sonorous rhonchi (wheezes)

Answer 49

low-pitched rumbling or snoring sound usually heard more prominently on expiration caused by passage of airflow obstruction by thick secretions may be temporarily cleared by coughing

Question 50

stridor

Answer 50

high-pitched crowing sound heard on inspiration caused by upper airway obstruction - swollen tissue or lodged foreign body

Question 51

pleural friction rub

Answer 51

grating or creaking sound heard on inspiration and expiration over the anterolateral wall caused by rubbing together of inflamed or roughened pleurae

Question 52

absent breath

Answer 52

reduction in the intensity or volume of breath sounds

Question 53

head and neck lymph nodes

Answer 53

``` preauricular postauricular occipital jugulodigastic submandibular submental superficial cervical deep cervical chain posterior cervical supraclavicular ```

Question 54

assessment of the head

Answer 54

skull - note the general size and shape of skull - should be round, symmetrical, and in proportion to the rest of the body - note any lumps, deformities, or tenderness - temporomandibular joint -- as the person and closes mouth palpate the joint normally moves smooth, freely and without tenderness scalp - should be smooth - note any lumps, deformities, or tenderness face - inspect facial expression -- should be appropriate to behavior and reported mood - observe for facial symmetry as the person speaks or moves -- note any tics, edema, or lesions

Question 55

assessment of the nose

Answer 55

assess that it is mid-line, symmetrical, and free of lesions of deformities check patentcy inspect nasal mucosa, septum, and turbinates - mucosa should be smooth, moist, and red and should have no swelling, discharge, or bleeding - septum should show no bleeding, perforation or significant deviation - turbinates should match nasal mucosa color and texture

Question 56

thyroid exam

Answer 56

palpate the thyroid gland from behind the pt. - have the pt. slightly tilt their head forward and slightly to the right - using the three middle fingers, align them along the outer margins of the trachea - have pt. perform a swallowing motion to feel ass the thyroid moves vertically underneath your finger pads repeat on the other side the thyroid gland is not normally palpable

Question 57

anatomy of the lungs

Answer 57

``` left - left upper lobe - left oblique fissure - left lower lobe right - right upper lobe - horizontal fissure - right middle lobe - right oblique fissure - right lower lobe ```