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Advanced Physical Assessment > Midterm 509 > Flashcards

Midterm 509 Flashcards

1
Q

Closely attending to what the patient is communicating, connecting to the patient’s emotional state, and using verbal and nonverbal skills to encourage the patient to expand on his or her own feelings or concerns

A

Active Listening

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2
Q

The capacity to identify with the patient and feel the patient’s pain as your own, then respond in a supportive manner.

A

Empathetic Responses

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3
Q

Guided questions show you sustained interest in the patient’s feelings and deepest disclosures and allows the interviewer to facilitate full communication, in the patient’s own words, without interruption

A

Guided Questions

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4
Q

Includes eye contact, facial expression, posture, head position and movement such as shaking or nodding, interpersonal distance, and placement if the arms or legs. Crossed, neutral or open

A

Non Verbal Comminication

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5
Q

Affirm the legitimacy of the patient’s emotional experience

A

Validation

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6
Q

Help the patient feel that problems have been fully understood and are being addressed

A

Reassurance

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7
Q

Express your commitment to an ongoing relationship

A

Partnering

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8
Q

Giving a summary of the patient’s story to communicate that you have been listening carefully

A

Summarization

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9
Q

Inform your patient when you are changing directions

A

Transitions

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10
Q

Empowering the patients to ask questions, express their concerns and probe your recommendations

A

Empowering the patient

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11
Q

True or False: You should always use peoples first language such as they have diabetes they are not a diabetic

A

True

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12
Q

What does FIFE stand for?

A

Feelings
Ideas
Functional effect
Expectations

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13
Q

What does feelings in FIFE include?

A

Fears or concerns about the problem

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14
Q

What does Ideas in FIFE include?

A

The nature and the cause of the problem

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15
Q

What does Function in FIFE consist of?

A

The problem on the patients life and how they function

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16
Q

What does expectations include in FIFE?

A

What are the patients expectations of the disease, of the clinician, or of the healthcare, this is often based on prior experiences.

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17
Q

What is adaptive questioning?

A

It is the same as guided questioning.

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18
Q

What are some techniques of guided questioning?

Moving from _________ to ___________ ended questioning

A

Open to closed

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19
Q

Using questions that elicit a graded response is a technique of?

A

Adaptive or guided questioning

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20
Q

In adaptive questioning you should ask a ________ of questions, one at a time

A

Series

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21
Q

You should always _______________ what the patient means

A

Clarify

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22
Q

Should you offer multiple choice questions to patients in adaptive questioning?

A

Yes

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23
Q

You should always encourage with ______________, and use ___________ to reiterate what the patient has said

A

Encourage and echoing

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24
Q

Silence in patients can be….

A

Therapeutic for patients or a time of reflection

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25
Q

What do you do with talkative patients?

A

Use summarization and redirection

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26
Q

If the patient has a confusing narrative what should the NP do?

A

Assess mental status, uses guided questioning, clarify and summarize

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27
Q

What if the patient has emotional lability and they begin to cry? What is the best option for the NP to do?

A

Use empathy

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28
Q

If an angry or aggressive patient is seen at the clinic it is important for the NP to?

A

Use active listening and remain calm

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29
Q

A patient comes in flirting with the NP she or he should?

A

Redirect the patient and set clear boundaries

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30
Q

With the Discriminatory patients the NP should assess what?

A

The patient severity

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31
Q

How should an NP handle a discriminatory patient?

A

Create a therapeutic alliance with the patient and create a supportive environment from the healthcare team

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32
Q

How should the NP communicate with someone with hearing loss?

A

Ask the patient what the best way is to communicate with them

Always speak in a normal volume and rate

And use a teach back method

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33
Q

How should a NP handle a patient that is non adherent?

A

Assess socioeconomic factors

Cognition

Cultural beliefs

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34
Q

When should the NP complete a comprehensive exam?

A

When they are seeing the patient for the first time

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35
Q

A focused assessment should only be used in which situation?

A

When the patient is returning to your care

a patient with an “urgent care” need

in the emergency room

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36
Q

Is the ROS subjective or objective?

A

Subjective

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37
Q

When obtaining the HPI what is the acronym used to assess a “problem”?

A

OLDCARTS

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38
Q

What does OLDCARTS stand for?

A 
Onset
Location
Duration
Characteristics
Aggravating Factors
Relieving Factors
Treatment
Severity
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39
Q

When filling out the ROS if you didn’t ask the question should you fill the box in with “denies”

A

No. It should be not assessed

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40
Q

What should be listed under the medical illness?

A

Things such as diabetes, HTN, hepatitis, asthma, and HIV

Also hospitalizations, number and gender of sexual partners, and safety engaging in sex

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41
Q

When obtaining a surgical history what is important to document?

A

Dates

Indications

And types of operations: i.e. c-sections

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42
Q

What is included in OBGYN history?

A

Obstetric history
Menstrual history
Methods of contraception
Sexual function

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43
Q

What is listed in psychiatric history ROS?

A 
Illness
Timeline
Diagnoses
Hospitalizations
Treatments
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44
Q

Summarizes all related problems that support a differential diagnosis is called a

A

Problem list

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45
Q

In a problem list what is listed first the most serious and active problems or past problems?

A

The active and most serious

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46
Q

What is a differential diagnosis?

A

A list of possible diagnoses for a supported problem list

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47
Q

____________ ______________ is abnormal findings that support your diagnosis.

A

Pertinent positives

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48
Q

_______________ ______________ are normal findings that rule out a diagnosis

A

Pertinent Negatives

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49
Q

An elevated A1C to diagnose diabetes is an example of

A

Pertinent positive

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50
Q

A normal A1C when looking for a diagnosis of diabetes is

A

Pertinent negative

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51
Q

If there is no place for OBGYN or psychiatric in the ROS where should you list it?

A

Past medical history

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52
Q

When leaving the arm hanging dependent and taking a blood pressure, this can cause a what type of reading?

A

False high

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53
Q

A blood pressure cuff that is too __________ will cause a false high blood pressure?

A

Small

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54
Q

How many visits are needed to diagnose HTN?

A

2

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55
Q

What stage HTN is a blood pressure that is greater >140/>90?

A

HTN stage 2

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56
Q

When a patient only has a blood pressure reading that is high in the office it is called?

A

White coat syndrome

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57
Q

If a patients blood pressure is always normal at the doctors office what is this called?

A

Masked HTN

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58
Q

How would the provider be able to identify white coat syndrome or masked HTN from an office visit?

A

Ask the patient to check blood pressure at home and bring with them to follow up visit

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59
Q

Anorexia can be what three things?

A
  1. Pathological or intentional
  2. Symptom of a disease
  3. Side effect of a medication such as chemo
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60
Q

True or False Bulimia is never intentional

A

False

It is always a psychological problem

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61
Q

T or F

Hallucinations include external stimuli

A

False

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62
Q

__________ is when you misinterpret external stimulation

A

Illusion

Think magic show it is an optical illusion

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63
Q

HALLUCINATIONS or ILLUSIONS are manifested on one of the 5 senses?

A

Hallucinations

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64
Q

When screening in the office for depression which question are is used?

A

PHQ2

If a patient answers yes to either question you move on to the PHQ9

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65
Q

Sudden interruption of speech in midsentence or before the idea is completed, attributed to “losing the thought.” Blocking occurs in normal people.

A

Blocking

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66
Q

The mildest thought disorder, consisting of speech with unnecessary detail, indirection, and delay in reaching the point. Some topics may have a meaningful connection. Many people without mental disorders have circumstantial speech.

A

Circumstantiality

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67
Q

Speech with choice of words based on sound, rather than meaning, as in rhyming and punning. For example, “Look at my eyes and nose, wise eyes and rosy nose. Two to one, the ayes have it!”

A

Clanging

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68
Q

Fabrication of facts or events in response to questions, to fill in the gaps from impaired memory

A

Confabulation

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69
Q

Tangential speech with shifting topics that are loosely connected or unrelated. The patient is unaware of the lack of association.

A

Derailment (loosening of associations)

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70
Q

Repetition of the words and phrases of others

A

Echolalia

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71
Q

An almost continuous flow of accelerated speech with abrupt changes from one topic to the next. Changes are based on understandable associations, plays on words, or distracting stimuli, but ideas are not well connected.

A

Flight of ideas

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72
Q

Speech that is incomprehensible and illogical, with lack of meaningful connections, abrupt changes in topic, or disordered grammar or word use. Flight of ideas, when severe, may produce incoherence.

A

Incoherence

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73
Q

Invented or distorted words, or words with new and highly idiosyncratic meanings

A

Neologisms

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74
Q

Persistent repetition of words or ideas

A

Perservation

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75
Q

___________ may be striking in schizophrenia

A

Blocking

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76
Q

___________ occurs in people with obsessions

A

Circumstantiality

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77
Q

_____________ occurs in schizophrenia or manic episodes

A

Clanging

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78
Q

_____________ is seen in Korsakoff syndrome from alcoholism

A

Confabulation

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79
Q

_____________ is seen in schizophrenia, manic episodes, and other psychotic disorders

A

Derailment

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80
Q

________ occurs in manic episodes and schizophrenia

A

Echolalia

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81
Q

__________ ____ __________ is most frequently noted in manic episodes

A

Flight of ideas

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82
Q

______________ is seen in severe psychotic disturbances

A

Incoherence

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83
Q

___________ are observed in schizophrenia, psychotic disorders, and aphasia

A

Neologisms

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84
Q

______________ occurs in schizophrenia and other psychotic disorders

A

Perservation

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85
Q

What does the visual acuity 20/100 mean?

A

It means that at 20 feet the patient can read a print that a person with normal vision could read at 100 ft.

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86
Q

The ________ the second number in visual acuity the worse the patient vision is

A

Larger

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87
Q

What visual acuity is termed legally blind?

A

20/200

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88
Q

What is the diagnosis of sudden painless vision loss that is unilateral?

A

Retinal Detachment

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89
Q

How can you differentiate between retinal detachment and another cause?

A

Is there pain and is it unilateral or bilateral

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90
Q

What conditions do not have a red reflex?

A

In patients with cataracts

Patients that have an artificial eye

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91
Q

What are less common for absence of red reflex?

A

Detached retina or children with a retinoblastoma

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92
Q

What would you do if you suspected a retinoblastoma in a child?

A

Send them out quick especially since it is fast growing.

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93
Q

If a patient has nystagmus when they turn their head side to side what would the NP think the culprit was?

A

Inner ear

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94
Q

What is nystagmus?

A

An involuntary eye movement which may cause the eye to rapidly move from side to side, up or down, or in a circle. It can cause slightly blurry vision

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95
Q

Nystagmus is seen in ___________ disease.

A

Cerebellar

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96
Q

Nystagmus is seen with what other symptoms?

A

Gait ataxia
Dysarthria (increases with retinal fixation)
Internuclear Opthalmoplegia

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97
Q

What is important for the NP to note when seeing nystagmus?

A

The direction of gaze in which it appears, the plan of the nystagmus (horizontal, vertical, rotary, or mixed) and the direction of the quick and slow components

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98
Q

If you see nystagmus what should you ask the patient to do so you can observe it increases in speed or decreases?

A

Fix their vision

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99
Q

Sudden visual loss that is unilateral and painful is associated with ________ _________ and called ______________

A

Multiple sclerosis and called Optic Neuritis

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100
Q

If the NP suspects Optic Neuritis what should they do?

A

Treat it quickly

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101
Q

What are signs of an increase in ICP?

A 
Papillodemia of the optic disc
Headache
Blurred vision
Feeling less alert than usual
Nausea 
Vomiting 
Behavior
Weakness or problems with moving or talking
Lack of energy or sleepiness
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102
Q

In what diagnoses does hallucinations occur?

A

Delirium, Dementia (is less common), PTSD, schizophrenia and substance abuse

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103
Q

Which test would you use for dementia?

A

Mini-cog

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104
Q

In an eye what is typically transparent but become injected (blood shot) during times of injury, infection or inflammation?

A

The conjunctiva

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105
Q

This picture is an example of?

A

Papillodema

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106
Q

What is an important cause of poor central vision in older adults?

A

Macular degeneration

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107
Q

There are two types of macular degeneration what are they?

A

Dry Atrophic which is more common and less severe. And wet exudative or neovascular.

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108
Q

What is a drusen in the eye?

A

They are YELLOW deposits in the eye under the retina. They are made up of lipids and proteins. They can increase the risk of Macular degeneration

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109
Q

Ptosis is what?

A

Drooping of an eye lid

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110
Q

What can cause ptosis?

A

Damage to cranial nerve 3 which is the oculomotor nerve

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111
Q

What is cranial nerve 1?

A

Olfactory which innervated the nose

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112
Q

What is cranial nerve II?

A

Optic which is sensory of the eye

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113
Q

What is cranial nerve III?

A

Occulomotor nerver: All eye muscles except those supplied by IV and VI

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114
Q

Cranial nerve IV?

A

Trochlear motor which deals with the superior oblique muscle of the eye

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115
Q

What is cranial nerve V?

A

Trigeminal

Sensory: Face, sinuses, teeth, etc

Motor: muscles of mastication

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116
Q

What is cranial nerve VI?

A

Abducent muscle

Motor: external recuts muscle in the eye

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117
Q

What is cranial nerve VII?

A

Facial

Motor: muscles of the face

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118
Q

What is cranial nerve VIII?

A

Vestibular cochlear

Sensory: inner ear

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119
Q

What is cranial nerve IX?

A

Glossopharyngeal

Motor: pharyngeal musculature
Sensory: Posterior part of the tongue, tonsils, pharynx

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120
Q

What is cranial nerve X?

A

Vagus Nerve
Motor: Heart, lungs, bronchi, GI tract
Sensory: Heart, lungs,bronchi, trachea, larynx, pharynx, GI tract and outer ear

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121
Q

What is cranial nerve XI?

A

Accessory Motor nerve

Motor: sternocleidomastoid and trapezius muscle

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122
Q

What is cranial nerve XII?

A

Hypoglossal nerve

Motor: muscles of the tongue

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123
Q

What does this picture represent? What causes it?

A

Glaucomatous Cupping

This is caused by increased IOP within the eye and leads to increased cupping and atrophy. The base of the enlarged cup is pale.

Appearance: Death of optic nerve fibers leads to loss of the tiny disc vessels.

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124
Q

What does this picture represent? And what causes it?

A

Optic Atrophy

Process: The physiologic cup is enlarged, occupying more than half of the disc’s diameter, at times extending to the edge of the disc. Retinal vessels sink in and under the cup, and may be displaced nasally.

Appearance: Color white
Tiny disc vessels are absent

This is seen in: Optic neuritis, multiple sclerosis, temporal arteritis

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125
Q

What is this picture? And what does it mean?

A

This is medullated nerve fibers. They are benign. They are not common.

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126
Q

What is this and what does it mean?

A

Superficial retinal hemorrhage this is caused by severe HTN, papillodema , and occlusion of the retinal vein

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127
Q

What does this picture show and what causes this?

A

Preretinal hemorrhage

This is typically larger that retinal hemorrhages

Causes: sudden increases in intracranial pressure

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128
Q

What does this picture show and what causes this?

A

Deep retinal hemorrhage

They are small and rounded, slightly irregular

They occur in the deeper layer of the retina than a flame shaped hemorrhage.

Common Cause: diabetes

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129
Q

What does this picture show and what does it mean?

A

Microaneurysm

Tiny, round, red dots in and around and in the macular area

Hallmark sign of diabetic retinopathy

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130
Q

What does this picture show and what does it mean?

A

Neovascularization

Refers to the formation of new blood vessels.

They are more tortuous and narrower than the neighboring blood vessels.

This is common feature of diabetic retinopathy

These vessels can grow into the virtuous and cause retinal detachment or hemorrhage may cause a loss of vision.

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131
Q

What does this picture show and what are the causes?

A

Soft Exudates: Cotton wool spots

Ovoid lesions that are WHITE OR GRAYISH with irregular or soft borders.

Caused by microinfarcts of the retinal nerve fiber layer

Seen in HTN, diabetes HIV and other viruses, and numerous other conditions

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132
Q

What does this picture show and what causes it?

A

Hard exudates

They are CREAMY AND YELLOWISH, often bright, lesions with WELL DEFINED “hard” borders. They are small and round

Often occur in CLUSTERS or in circular, linear, or star shaped patterns

They are lipid residues or serous leakage from damaged capillaries

Causes: Diabetes and vascular dysplasia’s

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133
Q

What does this picture show and what does it mean?

A

Drusen

Yellowish round spots that vary from tiny to small

The edges can be soft or hard

They are HAPHAZARDLY distributed but may concentrate at the posterior pole between the optic disc and macula

they are dead retinal pigment epithelial cells

Seen in normal aging and are related degeneration

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134
Q

What does this picture show and what does it mean?

A

Healed Chorioretinitis

These are inflammation that has destroyed the superficial tissues to reveal a well-defined, irregular patch of white sclera marked with DARK pigment

This is seen in toxoplasmosis, or if similar in nature could be caused by a laser.

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135
Q

What type of retinal hemorrhage is benign and requires no treatment?

A

Sub conjunctival hemorrhage

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136
Q

How long does it take for a subconjunctival hemorrhage take to heal?

A

2 weeks

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137
Q

What causes a sub conjunctival hemorrhage?

A

Leakage of blood outside the vessel producing homogenous red area, no ocular discharge, vision not affected, usually resulting from trauma, or sudden increase in venous pressure

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138
Q

What are signs and symptoms of conjunctivitis?

A

Diffuse dilation of conjunctival vessels with redness that tens to be maximal peripherally

There is generally mild discomfort rather than pain

Vision is not affected except for mild temporary blurriness due to discharge

Ocular discharge: Watery, mucoid, or mucopurulent

Pupil isn’t affected

Cornea: clear

Significance: bacterial, viral, and other infection, HIGHLY CONTAGIOUS, allergy or irritation

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139
Q

What is a normal finding of cranial nerve I (olfactory nerve)

A

That smell is decreased in the elderly

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140
Q

What can cause a loss of smell cranial nerve I (olfactory)

A

Elderly, head trauma, smoking (nicotine damages CN I), cocaine use and Parkinson’s disease

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141
Q

What causes epistaxis?

A

Trauma (esp. nose picking)

Inflammation

Drying and crusting of the nasal mucosa

Tumors

Foreign bodies

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142
Q

If a patient is coughing up blood what other cause besides lungs should you rule out?

A

Nose bleeding

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143
Q

What are signs of seasonal allergies?

A

Itching, watery eyes, sneezing, ear congestion, post nasal drainage

144
Q

What might you see on otoscope evaluation on a patient with allergies?

A

Slight bulging when the allergies are bad

145
Q

What is the difference between otitis media and otitis external?

A

Otitis media is a middle ear infection

Otitis external is the outer ear

146
Q

What’s a quick way to determine if a patient has otitis external versus media?

A

If you move the ear it is super painful in otitis externa

Movement of the auricle and tragic is painful in acute otitis externa (inflammation of the ear canal), but not in otitis media (Inflammation of the middle ear)

147
Q

If there is tenderness behind the ear would you suspect otitis externa or otitis media?

A

Otitis media

148
Q

In otitis externa the ________ is often swollen, narrowed, moist, pale and tender. It may be reddened.

A

Canal

149
Q

What cranial nerve is tested when the patient is told to shrug their shoulders?

A

CN XI the spinal accessory nerve

150
Q

If a patient has generalized weakness would you suspect the shoulder shrug to also be weak?

A

No. This should not be weak in a patient that has generalized weakness

If it is weak you should suspect a peripheral nerve disorder

151
Q

What muscle are you testing with the shoulder shrug test?

A

Strength of the trapezii

152
Q

When you see Acanthosis nigricans what should it clue you in on?

A

Insulin resistance

Diabetes and PCOS are two patients you may see this in.

153
Q

Where would you see acanthosis nigricans?

A

In the skin folds around the neck, under the arms

154
Q

If a patient has acanthosis nigricans does it indicate acute or chronic insulin resistance?

A

Chronic

155
Q

What does gradual vision loss come from?

A

Cataracts, glaucoma, or macular degeneration

156
Q

What condition would you see peripheral vision loss?

A

Open angle glaucoma

157
Q

Pallor color in skin indicates?

A

Anemia

158
Q

If there is cyanosis in the skin this can be indicative of what underlying cause?

A

Decreased oxygen in the blood or decreased blood flow from being cold

159
Q

What causes jaundice?

A

Increased bilirubin

160
Q

A ________ is circumscribed FLAT area of change in color of the skin < 1 cm in diameter

A

Macula

161
Q

A __________ is a circumscribed flat area of change in color of the skin > 1 cm in diameter

A

Patch

162
Q

A _______ is a small solid elevation of the skin < 1 cm in diameter

A

Papule

163
Q

What are some examples of papules?

A

Nevi, warts, lichens planus, insect bites, seborrheic keratoses, actinic keratoses, some lesions of acne, and skin cancers

164
Q

A _________ is a large flatter elevation of the skin, sometimes formed by papules coalescing

A

Plaque

165
Q

What are some examples of plaques?

A

Psoriasis and granuloma annulare

166
Q

A ___________ is a solid elevation of the skin > 1 cm in diameter that usually extends into the deeper skin layers

A

Nodule

167
Q

What are some examples of nodules?

A

Cyst, lipomas and fibromas

168
Q

A __________ is small circumscribed elevation of the epidermis filled with purulent fluid

A

Pustules

169
Q

Examples of pustules

A

Are common in bacterial infections and folliculitis

170
Q

A _______ is a small circumscribed elevation of the epidermis containing clear fluid < 1 cm in diameter

A

Vesicle

171
Q

What are some common examples of a vesicle?

A

Herpes, acute allergic contact dermatitis, and some autoimmune blistering disorders such as dermatitis herpetiformis

172
Q

A _______ is s a circumscribed elevation of the epidermis containing clear fluid > 1cm in diameter.

A

Bulla

173
Q

Where are bullas commonly seen?

A

Autoimmune bullous diseases include pemphigus Calgary’s and billows pemphigoid

174
Q

A ________ is a circumscribed, raised lesion consisting of dermal edema and is also known as hives or urticaria

A

Wheals

175
Q

How long to wheals typically last?

A

24 hours

176
Q

What causes wheals to appear?

A

Common causes include:

Hypersensitivity to drugs

Stings or bites

Autoimmunity

And less commonly physical stimuli including temperature, pressure and sunlight

177
Q

What area of the body does psoriasis frequently affect?

A

Scalp, extensor surfaces of the elbows and knees, umbilicus, and the gluteal cleft

178
Q

Where would you see lichen planus?

A

Arises on the wrist, forearms, genitals and lower legs

179
Q

Discoid lupus erythematosus has characteristic lesions on sun exposed skin such as the …

A

Face, especially the forehead nose and the ear

180
Q

Hidradenitis suppurativa involves skin containing high levels of ___________ glands which is in what region of the body.

A

Apocrine

Axillae, groin and under the breast

181
Q

Oval lesions on trunk, that in older children often are in a Christmas tree pattern is called

A

Pityrasis rosacea

182
Q

Cherry angiomas are benign or malignant?

A

Benign

183
Q

What can cherry angiomas mimick?

A

Petechia

184
Q

What’s the difference between cherry angiomas and petechia?

A

Cherry angiomas are age related and PAPULAR

Petechia are flat and ruptured capillaries

185
Q

What are the signs of lymes disease?

A

Rash that is often in a bulls eye pattern also called erythema migrans

Flu like symptoms, fever and headache, fatigue

186
Q

What is the coloration of a Mongolian spot and where are they located?

A

Dark or bluish pigmentation over the buttocks and lower lumbar regions

187
Q

Who typically has Mongolian spots?

A

Common in newborns that are African, Asian and Mediterranean descent

188
Q

What is another name for Mongolian spots?

A

Slate Blue patches

189
Q

Do Mongolian spots disappear with age?

A

Yes

190
Q

What should the nurse practitioner do if she sees a mongolian spot?

A

Document this so that later it isn’t confused for bruising

191
Q

What are common labs that you should check with vitiligo?

A

Thyroid labs TSH, Free T3, and free t4

CBC

192
Q

If a patient has vitiligo what are they more likely to have?

A

Other autoimmune diseases

193
Q

What skin cancer is the most common?

A

Basal cell carcinoma

194
Q

What is the most common characteristic of basal cell?

A

Pink patch that does not heal

May have focal scaling

195
Q

What is the rule to diagnose and find melanoma or skin irregularities

A

The ABCDE rule

196
Q

What does ABCDE stand for?

A 
A- asymmetry 
B- Border
C- Color 
D- Diameter 
E- evolving
197
Q

What are concerning color variations of a mole?

A

A blue or black appearance, brown red, loss of pigment or redness

198
Q

When looking at a patient with a lot of moles what are you looking for?

A

The ugly duckling the mole that is different from the others

199
Q

What are the risk factors to melanoma?

A

Family history
> or = 50 common moles
Atypical or large moles, esp if dysplastic
Red or light hair
Solar letigines (acquired brown macules on sun exposed areas
Freckles which are inherited brown macules
UV radiation from heavy sun exposure, sunlamps, or tanning beds
Light eye or skin color, esp skin that freckles or burns easily
Severe blistering sunburns as a child (due to altering the genetic coating of the basal cells)
Immunosuppressive from HIV or chemo
Personal history

200
Q

What cranial nerve do you assess when you touch the soft palate and view the uvula?

A

Vagus nerve

201
Q

What is this called and what is the cause?

A

Paronychia

A superficial of the proximal and lateral nail folds adjacent to the nail plate

Usually a staph aureus or strep species

202
Q

What does this picture show and what does it mean?

A

Clubbing

Possibly from hypoxia, changes in innervation, genetics, or a platelet derived growth factor from fragments of platelet clumps

203
Q

What is this picture and what causes it?

A

Depression of the central nail with a Christmas tree appearance from small horizontal depressions

Caused from rubbing the index finger over the thumb or vice versa

204
Q
A

Melanonychia

Caused by increased pigmentation in the nail matrix

This could be normal in patients of ethnic decent

It also could be a nevus
If a wide streak and irregular could be a subungal melanoma

205
Q

What is this and what causes it?

A

This is a painless separation of the whitened opaque nail plait from the pinker translucent nail bed.

Causes: excess manicuring

Psoriasis

Fungal infection, and allergic reactions to nail cosmetics

Systemic causes: diabetes, anemia, photosensitive drug reactions, bronchiectasis and syphilis

206
Q

What does this picture show and what causes this?

A

This is the most common cause of nail thickening and subungal debris.

Most often from the dermatophyte Trichophyton rubrum

Affect 1 in 5 over the age of 60

Best way to treat this is to treat and prevent tinea pedis

207
Q

What does this picture show and what causes it?

A

Terry nails

The nail plate turns white with a ground glass appearance
A distal band of reddish brown and obliteration of the lunula

Common affects all fingers, but may appear in only one finger

Seen in liver disease, usually cirrhosis
Heart failure
Diabetes

208
Q

With a goiter can the thyroid function be normal? High? Or low?

A

All three

209
Q

Intolerance to cold, weight gain, dry skin, and bradycardia point to which underlying disease?

A

Hypothyroidism

210
Q

Intolerance to heat, moist velvety skin, and palpitations point to what disease process?

A

Hyperthyroidism

211
Q

Fine hair is seen in hypo or hyperthyroidism?

A

Hyperthyroidism

212
Q

Course hair is seen in hypo or hyperthyroidism?

A

Hypothyroidism

213
Q

An enlarged skull could be due to what two things?

A

Paget’s disease or hydrocephalus

214
Q

Enlargement of a supraclavicular node especially on the left side (virchows node) suggest what possible disease?

A

Thoracic or abdominal metastatic disease

215
Q

Tender lymph nodes suggest what?

A

Inflammation

216
Q

Hard and fixed lymph nodes suggest?

A

Malignancy

217
Q

What diseases would you see generalized lymphadenopathy?

A

HIV or AIDS

Infectious mononucleosis

Lymphoma

Luekemia

And sarcoidosis

218
Q

Masses in the neck that cause deviation of the trachea are suspicious for what type of issues?

A

Thoracic or mediastinal mass

Atelactisis

Large pneumothorax

219
Q

____________ is an ominous high pitched musical sound from severe subglottic or tracheal obstruction that signals a respiratory emergency

A

Stridor

220
Q

What are causes of Stridor?

A

epiglottis, foreign body, goiter, and stenosis from an artificial airway

221
Q

Retrosternal goiters can cause what symptoms?

A

Hoarseness, stridor, SOA, stridor or dysphagia

222
Q

What is the pemberton sign?

A

Neck hyper extension and arm elevation may cause flushing from compression of the thoracic inlet from the gland itself or from clavicular movement

223
Q

The thyroid is ________ in Graves’ disease and may be modular

A

Soft

224
Q

The thyroid is ________ in Hashemito thyroiditis and thyroid cancer

A

Firm

225
Q

A localized systolic or continuous _______ may be heard in __________ from Graves’ disease or toxic multinodular goiter.

A

Bruit

Hyperthyroidism

226
Q

What would you do if you felt nodules on the thyroid?

A

Order and ultrasound and possible fine needle aspiration are advised

227
Q

What type of vein distends in heart failure?

A

Jugular

228
Q

What causes cushing sydrome?

A

An increase in adrenal cortisol production

229
Q

What are some signs you may see in a patient that has Cushings disease?

A

“Moon” face
Red cheeks
Excessive hair growth in the mustache, sideburn, and chin areas

230
Q

What causes nephrotic syndrome?

A

Excess albumin excretion which reduces intravascular colloid osmotic pressure causing hypovolemia and NA and H20 retention

231
Q

What signs would lead you to suspect nephrotic syndrome?

A

Swelling in the face

Pallor in the face

232
Q

What disease would you see myxedema as a secondary issue in?

A

Hypothyroidism

233
Q

What are signs of myxedema?

A

Dull edema in the face typically around the eyes. They do not pit when you push on them

234
Q

Hearing disorders of the external and middle ear are called?

A

Conductive hearing loss

235
Q

What are some causes of conductive hearing loss?

A 
Cerulean impaction
Ear infection 
Trauma 
Squamous cell carcinoma 
Benign bony growths such as exotosis
236
Q

What is exotosis?

A

A type of bony growths that is extra bone that grows from an already existing bone

237
Q

Disorders of the inner ear cause what kind of hearing loss?

A

Sensoneural hearing loss

238
Q

Presbycussis is an example of which hearing loss?

A

Sensoneural

239
Q

What can cause Sensoneural hearing loss

A 
Hereditary conditions 
Presbycussis 
Viral infections such as rubella or CMV
Ménière’s disease 
Noise exposure 
Ototoxic meds 
Acoustic neuromas
240
Q

In which hearing loss do others have issues hearing others complaining that they mumble?

A

Sensoneural

241
Q

In which hearing loss does loud background noise hinder?

A

Sensoneural

242
Q

IN what hearing loss is background noise helpful?

A

Conductive

243
Q

What is an antibiotic that can cause permanent hearing loss?

A

Aminoglycosides such as gentamicin

244
Q

What caustic medication can cause hearing loss?

A

Chemotherapy agents

245
Q

Temporary hearing loss may be caused by what over the counter medications

A

ASA

NSAIDS

246
Q

Temporary damage can be caused by which antibiotics?

A

Quinines and loop diuretics

247
Q

What ear condition causes perforation with usual presence of yellow green discharge?

A

Acute or chronic otitis media

248
Q

What other causes can cause ear pain?

A

Referred pain from the mouth, throat or neck

249
Q

what is a common symptom increasing frequency with age?

A

Tinnitus

250
Q

When a patient has fluctuating hearing loss and vertigo what disease would you suspect?

A

Meniere disease

251
Q

___________ is the sensation of true rotational movement of the patient or the surroundings

A

Vertigo

252
Q

What causes vertigo?

A

Issues of the inner ear

Peripheral lesions of CN VIII

Lesions in its central pathways or nuclei in the brain

253
Q

What should you do if you suspect vertigo in the patient?

A

Distinguish peripheral from central neurological causes

254
Q

If a patient has meniers disease, ataxia, and diplopia and dysarthria what cause would you suspect?

A

Central neurological causes in the cerebellum or brain stem or posterior fossa tumor

255
Q

What another issue can cause menieres, diplopia, ataxia?

A

Vestibular migraine

256
Q

If a patient feels faint, lightheaded, weak in the legs?

A

Presyncope from an arrhythmia, orthostatic hypotension, or vasovagal stimulation

257
Q

Drug induced rhinitis occurs with excessive use of what?

A

Topical decongestants

Cocaine

258
Q

How many days should a “sinus infection” be present before deeming it bacterial?

A

More than 7 with purulent drainage and facial pain

259
Q

What common medications can cause nasal stuffiness?

A

OCP’s
Alcohol
Cocaine

260
Q

What if the nasal congestion is only one sided?

A 
Consider a deviated septum 
Nasal polyp
Foreign body 
Granulomatous disease 
Carcinoma
261
Q

If movement of the auricle and tragus are sensitive what is the most likely cause?

A

Otitis externa

262
Q

What type of myringitis is also a common painful hemorrhagic vesicle on the tympanic membrane.

A

Bullous myringitis

263
Q

What would you need to do if you see bullous myringitis?

A

Send them to a otolaryngology for surgical management

264
Q

Nontender modular swellings covered by normal skin deep in the ear canals suggest what?

A

Osteomas or exostoses

NON MALIGNANT overgrowths that may obscure the tympanic membrane

265
Q

What does this picture show?

A

Acute otitis externa

266
Q

In _______ ________ _______ the canal is often swollen, narrowed, moist, erythematous or pale, and tender

A

Acute otitis externa

267
Q

In ____________ otitis e=sterna the skin of the canal is often thickened red and itchy

A

Chronic

268
Q

An unusually prominent short process and a prominent handle that looks more horizontal suggest a ?

A

Retraced tympanic membrane

269
Q

If you test the ear drum with pneumatic otoscope the mobility of a serous effusion would be?

A

A thickened tympanic membrane and decreased

270
Q

A tuning for does or does not distinguish normal hearing from bilateral sensorineural loss

A

Does not

271
Q

In unilateral conductive hearing loss the use of the tuning fork would be heard in the ________ ear

A

The impaired

272
Q

In unilateral sensorineural hearing loss using a tuning for which ear is the sound heard?

A

The good ear

273
Q

In conductive hearing loss sound from the tuning fork is heard for longer through bone or air?

A

For as long or longer through bone than air

274
Q

In sensorineural hearing loss using the tuning fork the sound is heard longer through air or bone?

A

Air

275
Q

What would tenderness of the nasal tip or ala suggest?

A

Infection such as a faruncle

276
Q

In viral rhinitis the mucosa is what color

A

Red and swollen

277
Q

In allergic rhinitis the mucosa is what color?

A

Pale, blue or red

278
Q

What are causes of septal perforation?

A

Trauma, surgery, and intranasal use of cocaine

279
Q

______ ______ are pale sacklike growths of the inflamed tissue that can obstruct the air passage of sinuses

A

Nasal polyps

280
Q

When would you see nasal polyps?

A 
In allergic rhinitis
ASA sensitivity 
Asthma 
Chronic sinusitis 
Cystic fibrosis
281
Q

Local tenderness together with symptoms such as facial pain, pressure or fullness purulent nasal discharge, nasal obstruction, and small disorder esp present for more than 7 days, suggest what?

A

Bacterial rhinosinusitis involving the frontal or maxillary sinuses

282
Q

What does this show?

A

A normal tympanic membrane

283
Q

What does this picture show

A

Perforation of the tympanic membrane

284
Q

What does this picture show?

A

Tympanosclerosis

285
Q

What is tympanosclerosis?

A

Scarring process of the middle ear from otitis media

When severe it can cause conductive hearing loss

286
Q

What does this picture show?

A

Serous effusion

287
Q

What are serous effusions caused by?

A

Viral infections and flying

288
Q

What does this picture show?

A

Otitis media with effusion

289
Q

What does this picture show and what does it mean?

A

Bullous Myringitis

290
Q

If ____________ lasts over 2 weeks, refer for laryngoscopy and consider causes such as reflux; vocal cord nodules; hypothyroidism; head and neck cancers including thyroid masses; and neurologic disorders like Parkinson disease, amyotrophic lateral sclerosis, or myasthenia gravis.5

A

Hoarseness

291
Q

What does this picture show?

A

Torrous palatinus

Benign

292
Q

What is this and what is it indicative of?

A

Asymmetric protrusion suggests a lesion of CN XII (tongue points toward the side of the lesion

293
Q

What does this show?

A

Angular Cheilitis

Angular cheilitis starts with softening of the skin at the angles of the mouth, followed by fissuring. It may be due to nutritional deficiency or, more commonly, overclosure of the mouth, seen in people with no teeth or with ill-fitting dentures. Saliva wets and macerates the infolded skin, often leading to secondary infection with Candida, as seen here.

294
Q

What does the show?

A

Angular Cheilitis
Angular cheilitis starts with softening of the skin at the angles of the mouth, followed by fissuring. It may be due to nutritional deficiency or, more commonly, overclosure of the mouth, seen in people with no teeth or with ill-fitting dentures. Saliva wets and macerates the infolded skin, often leading to secondary infection with Candida, as seen here.

295
Q

What does the show?

A

Actinic Cheilitis
Actinic cheilitis is a precancerous condition that results from excessive exposure to sunlight and affects primarily the lower lip. Fair-skinned men who work outdoors are most often affected. The lip loses its normal redness and may become scaly, somewhat thickened, and slightly everted. Solar damage predisposes to squamous cell carcinoma of the lip, so examine these skin lesions carefully.

296
Q

What does the show?

A

Herpes

297
Q

What does the show?

A

Angioedema

298
Q

What does this show?

A

Hereditary Hemorrhagic Telangiectasia (Osler–Weber–Rendu syndrome)

Multiple small red spots on the lips strongly suggest hereditary hemorrhagic telangiectasia, an autosomal dominant endothelial disorder causing vascular fragility and arteriovenous malformations (AVMs). Telangiectasias are also visible on the oral mucosa, nasal septal mucosa, and fingertips. Nosebleeds, gastrointestinal bleeding, and iron deficiency anemia are common. AVMs in the lungs and brain can cause life-threatening hemorrhage and embolic disease

299
Q

What does this show?

A

Peutz–Jeghers Syndrome

Look for prominent small brown pigmented spots in the dermal layer of the lips, buccal mucosa, and perioral area. These spots may also appear on the hands and feet. In this autosomal dominant syndrome, these characteristic skin changes accompany numerous intestinal polyps. The risk of gastrointestinal and other cancers ranges from 40–90%. Note that these spots rarely appear around the nose and mouth

300
Q

What does this show?

A

Chancre of Primary Syphilis

This ulcerated papule with an indurated edge usually appears after 3–6 wks of incubating infection from the spirochete Treponema pallidum. These lesions may resemble a carcinoma or crusted cold sore. Similar primary lesions are common in the pharynx, anus, and vagina but may escape detection since they are painless, nonsuppurative, and usually heal spontaneously in 3–6 wks. Wear gloves during palpation since these chancres are infectious.

301
Q

What does the show?

A

Carcinoma of the Lip
Like actinic cheilitis, squamous cell carcinoma usually affects the lower lip. It may appear as a scaly plaque, as an ulcer with or without a crust, or as a nodular lesion, as illustrated here. Fair skin and prolonged exposure to the sun are common risk factors.

302
Q

What is this show?

A

Normal large tonsils

303
Q

What does this show?

A

Exudative Tonsillitis
This red throat has thick white exudates on the tonsils. This, together with fever and enlarged cervical nodes, increases the probability of group A streptococcal infection or infectious mononucleosis. Anterior cervical lymph nodes are usually enlarged in the former, posterior nodes in the latter.

304
Q

What does this show?

A

Pharyngitis
This photo shows a reddened throat without exudate. Redness and vascularity of the pillars and uvula are mild to moderate.

305
Q

What does this show?

A

Diphtheria

Diphtheria, an acute infection caused by Corynebacterium diphtheriae, is now rare but still important. Prompt diagnosis may lead to life-saving treatment. The throat is dull red, and a gray exudate (pseudomembrane) is present on the uvula, pharynx, and tongue. The airway may become obstructed. Prompt diagnosis may lead to life-saving treatment.

306
Q

What does this show?

A

Thrush on the Palate (Candidiasis)

Thrush is a yeast infection from Candida species. Shown here on the palate, it may appear as cream-colored or bluish white pseudomembranous patches on the tongue, mouth, or pharynx (see p. 968). Thick, white plaques are somewhat adherent to the underlying mucosa. Predisposing factors include prolonged treatment with antibiotics or corticosteroids and immunocompromised status.

307
Q

What does this show?

A

Kaposi Sarcoma in AIDS

The deep purple color of these lesions suggests Kaposi sarcoma (KS), a low-grade vascular tumor associated with human herpesvirus 8 (HHV-8). These nontender lesions may be raised or flat. About a third of patients with KS have lesions in the oral cavity; other affected sites are the gastrointestinal tract and the lungs

308
Q

What does this show?

A

Fordyce Spots (Fordyce Granules)

Fordyce spots are normal sebaceous glands that appear as small yellowish spots in the buccal mucosa or on the lips. Here they are seen best anterior to the tongue and lower jaw. These spots are usually not numerous.

309
Q

What does the show?

A

Koplik Spots

Koplik spots are an early sign of measles (rubeola). Search for small white specks that resemble grains of salt on a red background. They usually appear on the buccal mucosa near the first and second molars. In this photo, look also in the upper third of the mucosa. The rash of measles appears within a day.

310
Q

What does this show?

A

Petechiae

Petechiae are small red spots caused by blood that escapes from capillaries into the tissues. Petechiae in the buccal mucosa, as shown, are often caused by accidentally biting the cheek. Oral petechiae may be due to infection or decreased platelets, and trauma.

311
Q

What does this show?

A

Leukoplakia

A thickened white patch (leukoplakia) may occur anywhere in the oral mucosa. The extensive example shown on this buccal mucosa resulted from frequent chewing of tobacco, a local irritant. This benign reactive process of the squamous epithelium may lead to cancer and should be biopsied. Another risk factor is human papillomavirus infection.

312
Q

What does this show?

A

Black Hairy Tongue.

Note the “hairy” yellowish to brown and black hypertrophied and elongated papillae on the tongue’s dorsum. This benign condition is associated with Candida and bacterial overgrowth, antibiotic therapy, and poor dental hygiene. It also may occur spontaneously.

313
Q

What does this show?

A

Mucous Patch of Syphilis.

This painless lesion of secondary syphilis is highly infectious. It is slightly raised, oval, and covered by a grayish membrane. It may be multiple and occur elsewhere in the mouth.

314
Q

What intercostal space for a needle decompression of a tension pneumothorax

A

2nd

315
Q

Between what intercostal space is a chest tube placed?

A

4th and 5th

316
Q

When looking at an X-ray when would you see the correct placement of an ET tube?

A

Level of the 4th rib

317
Q

Aspiration pneumonia is more common in which lung and which lobes?

A

Right middle and lower lobes

318
Q

Why is aspiration pneumonia more common in the right lung?

A

Because the bronchus is more vertical. This is why when advancing an advanced airway it goes too far into the right lung.

319
Q

What are some causes of pleural effusions?

A

Heart failure cirrhosis and nephrotic syndrome

320
Q

What are causes of pleural exudates?

A 
Pneumonia 
Pulmonary embolism 
TB
Pancreatitis 
Malignancy
321
Q

Irritation of the parietal pluura produces pleuritic pain upon what?

A

Taking a deep inspiration in viral pleurisy, pneumonia, PE, pericarditis, and collagen vascular disease

322
Q

What are key components to diagnosis of COPD?

A

Degree of dyspnea combined spirometer

323
Q

___________ occurs in partial lower airway obstruction from secretions and tissue inflammation in asthma or from a foreign body.

A

Wheezing

324
Q

Cough can signal which side heart failure?

A

Left

325
Q

What are causes of cough and hemoptysis?

A

Bronchitis, malignancy, cystic fibrosis,and less commonly to bronchiactesis

326
Q

Blood that originates in the stomach is usually __________ than blood from the respiratory tract and may be mixed with food particles

A

Darker

327
Q

If a patient presents with a clenched fist over their chest think?

A

Angina pectoris

328
Q

If a patient points to the pain on the chest think?

A

Musculoskeletal pain

329
Q

When a patient presents with a hand moving from the neck to the epigastric region it suggest?

A

Heartburn

330
Q

unilateral decrease or delay in chest expansion occurs in _________ fibrosis of the underlying lung or pleura, pleural effusion, lobar pneumonia, plural pain with associated splinting, unilateral bronchial obstruction and paralysis of the hemidiaphragm.

A

Chronic

331
Q

What is tactile fremitus?

A

refers to the vibration of the chest wall that results from sound vibrations created by speech or other vocal sounds

332
Q

Tactile fremitus is _________ or _________ when the voice is higher pitched or soft or when the transmission of vibrations from the larynx to the surface of the chest is impeded by a thick chest wall, an obstructed bronchus, COPD, pleural effusion, fibrosis, air (pneumothorax) or an infiltrating tumor.

A

Decreased or absent

333
Q

What does asymmetric fremitus suggest?

A

The likelihood of unilateral pleural effusions, pneumothorax, neoplasm

334
Q

What would increase unilateral tactile fremitus?

A

Unilateral pneumonia which increases transmission through consolidated tissue

335
Q

__________ replaces resonance when fluid or solid tissue replaces air containing lung or occupies the pleural space beneath percussing fingers.

A

Dullness

336
Q

If you have a unilateral hyperressonance sound in lungs what would you suspect?

A

Large pneumothorax or air filled bulla

337
Q

When would you hear crackles?

A

Abnormalities of the lung parenchyma (pneumonia, interstitial lung disease, pulmonary fibrosis, atelactasis, heart failure

Or in the airways such as bronchitis or bronchiectasis

338
Q

When are wheezes heard?

A

Arise due to narrowed airways in COPD and asthma

Bronchitis

339
Q

Rhonchi is used to decried sounds from __________ in large airways that may change with coughing

A

Secretions

340
Q

Fine latte inspiration crackles that persist from breath to breath suggest?

A

Abnormal lung tissue

341
Q

Where are the crackles of heart failure are usually best heard where?

A

In the posterior inferior lung fields

342
Q

Clearing of crackles, wheezing or rhonchi after coughing or position change suggest?

A

Inspissated secretions (thickened) seen in bronchitis and atelectasis

343
Q

What is a clinical emergency seen in asthma or COPD?

A

Silent chest

344
Q

Where would you hear stridor and laryngeal sounds the loudest?

A

Neck

345
Q

True wheezes or rhonchi are _________ over the neck

A

Faint or absent

346
Q

Where would you hear pleural friction rubs?

A

Pleurisy
Pneumonia
Pulmonary embolism

347
Q

Increased or decreased

Transmitted voice sounds suggest that embedded airways are blocked by inflammation or secretions

A

Increased

348
Q

If the “ee” sound more like a “A” and has a nasal bleating quality this would be indicative of?

A

Egophony

349
Q

If the patient says 99 and it is muffled and in distinct it is normal, if they are louder this is called

A

Bronchophony

350
Q

What conditions would you see localized bronchophony and egophony?

A

In lobar consilidation from pneumonia.

351
Q

When the patient whispers 99 this is normally heard faintly or not at all. If it is heard loudly this would be called

A

Whispered pectoriloquy

352
Q

When checking the right middle lobe using percussion what must you first do to minimize the risk of missing the dullness?

A

Move the breast

353
Q

Rarely in ____________ the PMI is located on the right side of the chest

A

Dextrocardia

354
Q

A PMI greater than _____ cm is evidence of the left ventricular hypertrophy

A

2.5 cm

355
Q

When would you see left ventricular hypertrophy

A

In HTN or dilated cardiomyopathy

356
Q

Where would the PMI possibly be found in someone with COPD

A

Xiphoid or epigastric region

Advanced Physical Assessment (1 decks)

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