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Advanced Health Assessment > Quiz 1 > Flashcards

Quiz 1 Flashcards

1
Q

purpose of cultural competence

A
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2
Q

reason cultural competence is important

A

Understanding of a particular culture may be useful in the solution of problems that may at first have seemed intractable.

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3
Q

How culture may impact aspects of an exam of emotional health

A

cultural definitions of health and illness differ

Beliefs and behaviors that will have an impact on patient assessment include the following:
Modes of communication
Health beliefs and practices
Nature of relationships within a family
Diet and nutritional practices

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4
Q

Steps of assessment in order

A
  1. inspection & continue throughout exam: use eyes & nose (smell, gait, eye contact, demeanor, clothing, color/moisture of skin
  2. palpate
  3. percussion
  4. Auscultation last WITH EXCEPTION of abdominal exam
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5
Q

what part of hand to use for distinguishing vibration w/ palpation

A

ulnar surface of the hand & fingers (pinky side)

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6
Q

what part of hand best to palpate temperature

A

dorsal (back); not exact but general understanding to compare to other areas of body

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7
Q

What are normal percussion notes, know where they are found (5)

A
  1. tympany/tympanic= loudest (drumlike; gastric bubble)
  2. flatness= soft/quietest (very dull; over muscle)
  3. hyperresonant= very loud (boom like; emphysematous lungs)
  4. resonant= loud & hollow (healthy lung tissue)
  5. dull= soft-mod (thudlike; over liver)
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8
Q

best way to distinguish degree of resonance in percussion

A

listening to sound change as you move from one area to another; easier to hear change from resonance to dullness

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9
Q

immediate/direct percussion

A

striking the finger/hand directly against body (tip not pad of finger)

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10
Q

indirect/mediate percussion

A

finger of one hand acts as hammer (plexor) and a finger of the hand acts a striking surface (tip not pad of finger); keep distal phalanx of middle finger on body with other fingers elevated, snap the wrist of other hand downward and with the tip of middle finger sharply tap the interphalangeal joint of the finger that is on the body surface

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11
Q

when to use fist percussion

A

elicit tenderness arising from liver, gallbladder or kidneys. Use ulnar aspect of fist to give firm blow to flank and back

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12
Q

how deep can percussion notes (resonance) arise from

A

vibrations from 4-6cm deep in body tissue; density determines degree of tone

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13
Q

what can impact percussion note tone?

A

density; the more dense= the quieter the tone

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14
Q

what part of hands are more sensitive for palpation

A

palmar surface fingers and finger pads > fingertips

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15
Q

when to palpate w/ palmar surface of fingers & finger pads

A

whenever discriminatory touch is needed for determining position, texture, size, consistency, masses, fluid, crepitus

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16
Q

what to listen for with auscultation

A

sound: intensity, pitch, duration, quality

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17
Q

How to use/apply an otoscope

A
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18
Q

Types and how to use/apply a stethoscope

A

acoustic (diaphragm & bell), magnetic (just a diaphragm), electronic/digital

press diaphragm firmly against SKIN and hold end piece between fingers; don’t touch bell or tubing

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19
Q

when to use diaphragm vs bell of stethoscope

A

The diaphragm is best for higher pitched sounds, like breath sounds and normal heart sounds. The bell is best for detecting lower pitch sounds, like some heart murmurs, and some bowel sounds

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20
Q

pneumatic otoscope what they are for, how they are used, & any differences with pediatrics

A

pneumatic attachment used to eval the fluctuating capacity of the TM
produces puffs of air that causes the TM to move

For adults and older children, the pinna is gently retracted in a posterior and cephalad vector. For neonates, the examiner pulls the pinna posteriorly and inferiorly.

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21
Q

reflex hammer what they are for, how they are used, & any differences with pediatrics

A

used to test deep tendon reflexes
hold loosely between thumb and index so it moves in swift arc and controlled direction; tap quick and firm with snap of wrist

pediatric- use finger instead, less threatening; many providers let child hold hammer while they use finger to tap

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22
Q

ophthalmoscope what they are for, how they are used, & any differences with pediatrics

A

visualize interior structures of eye using system of lenses and mirror, projects various apertures of light into eye, lens number corresponds to magnification power (diopter)
Positive numbers (plus lenses)= black; clockwise rotation of lens selector
negative numbers (minus lenses)= red; counterclockwise
large aperture used most often= large round beam

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23
Q

whats a panoptic/panoramic ophthalmoscope

A

allows a larger field of view (25 degrees instead of 5) and increases magnification

fundus 5x larger in undilated eye

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24
Q

what can the plus/minus system on ophthalmoscope compensate for

A

myopia or hyperopia in both the examiner and the patient; no compensation for astigmatism

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25
Q

Wood’s lamp & what they are for, how they are used, any differences with pediatrics

A

used to detect fungal infection on skin
light source with a wavelength of 360 mm. It’s a black light that causes certain substances to fluoresce

darken room, shine line on lesion, green/yellow= fungus

pediatric= dark room intimidating. shine lamp on something fluorescent (nondigital watch) to give them sense of what you’re looking for

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26
Q

Indications of cognitive impairment (history or PE findings)

A

significant memory loss
confusion (impaired cognitive function with disorientation, attention and memory deficits and difficulty answering questions or following multi step directions)
impaired communication
inappropriate affect
personal care difficulties
hazardous behavior
agitation
suspiciousness

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27
Q

Areas of the brain and their function

A

*** Refer to pic in book pg. 89

transverse gyrus= auditory
broca area= motor speech
prefrontal= behavioral ethical moral social
premotor= intellectual
precentral gyrus= motor
central sulcus
postcentral gyrus= sensory
primary tases area of postcentral gyrus
somatic sensory association area
visual association area
visual cortex
wernicke area (sensory speech area)

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28
Q

Main findings & patho in acromegaly

A

excessive growth and distorted proportions caused by hypersecretion of GH and insulin-like growth factor (benign tumor most common cause); middle-aged adults

Subjective
slow progressive facial feature exaggeration
increased shoe, ring sizes
same height
oily/sweaty skin
snoring
pain in joints
decrease exercise tol.

objective
frontal skull bossing, cranial ridges, mandibular overgrowth, maxillary widening, teeth separation, malocclusion, overbite
skin thickening on face/tongue/lips/nose, hands/feet = enlargement
joint enlargement/swelling/pain
vertebral enlargement, kyphoscoliosis
cardiac ventricular enlargement bilaterally w/ decreased exercise tol.

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29
Q

main findings in Turner syndrome

A

partial/complete absence of second X chromosome

subjective
poor height growth
lack of breast development, amenorrhea
normal intelligence

objective
short stature
webbed neck
broad chest, widely spaced nipples
wide carrying ankle of elbow
low posterior hairline, misshapen/rotated ears, narrow palate/crowded teeth
coarctation of aorta, bicuspid aortic valve
sensorineural hearing loss
infertility

30
Q

main findings in Cushing syndrome

A

prolonged excessive glucocorticoids

subjective
weight gain, change in appetite
depression, irritable, decrease libido
decreased concentration, impaired short term memory
easy bruising
menstrual abnorms
weight gain but slow height velocity in children

objective
obesity “buffalo hump”
facial plethora “moon face”
thin skin, red/purple striae, poor skin healing
proximal muscle weak
hirsutism or female balding
peripheral edema
children= short stature, abnormal genital virilization, delayed puberty

31
Q

main findings in precocious puberty

A

onset of secondary sexual characteristics (breast tissue, pubic hair, enlarged testes then penis) before 7 y/o in white girls, 6 y/o black girls, 9 y/o males

32
Q

Exam findings indicative of nutritional deficiency, assessment of nutrition and protein status

A
33
Q

Growth and development milestones in children, walk, talk, use sentences (Expressive language milestones for infants and children)

A
34
Q

Difference between an objective and subjective finding, know examples

A

subjective= what the patient tells us

objective= what we are seeing, hearing, assessing, discovering

35
Q

Description of common macule, papule, vesicle, wheal and ex

A

macule= flat, circumscribed area that is a change in color of the skin. < 1cm diameter . Ex freckle, measles

papule= elevated firm circumscribed area < 1 cm diameter. Ex: wart, elevated mole, lichen planus

wheal= elevated, irregular shaped area of cutaneous edema, solid, transient variable diameter. Ex insect bite, urticaria, allergic rxn

vesicle= elevated circumscribed superficial not into dermis filled with serous fluid < 1 cm diameter. Ex varicella, herpes zoster

36
Q

What are lesions that require further investigation; what do they look like

A
37
Q

Other common skin abnormalities; staph and strep infections

A

Staph:

furuncle (red hot tender pus)
cellulitis (or strep)
impetigo

38
Q

What do herpes, basal cell, malignant melanoma and seborrheic keratosis look like

A

herpes zoster= pain/itch/burn before eruption, single dermatome w/ red swollen plaques/vesicles that fill w/ purulent fluid. Does NOT cross midline

herpes simplex= (1 oral, 2 genital) tender/pain/paresthesia/burning, grouped vesicles red at base then crust.

basal cell= not healing lesion, crusting, itch, bleed, won’t heal. pink red black, brown, white. Rolled boarder indent center. White/yellow waxy taut/shiny

malignant melanoma= new/changing mole, irregular pigmented lesion, asymmetry, irregular boarders, diff shade colors, diameter > 6 mm, evolution/change in existing pigmented lesions esp. nonuniform/asymmetric

seborrheic keratosis= chronic/reccurrent red scaling where sebaceous glads are (scalp, back, diaper area). Scaling, adherent, thick, yellow, crusted

39
Q

What are common normal skin lesions on an older adult

A

Normal lesions:
1. cherry angiomas (tiny/bright ruby red-dark blue round papules that may get brown over time)
2. seborrheic keratoses (pigmented raised warty on trunk. *must be differentiated from nevi or acitinic keratoses that could be malignant)
3. sebaceous hyperplasia (yellow flat papules w/ central depressions hard to discern from basal cell carcinoma)
4. cutaneous tags/acrochordon (small soft skin colored pedunculated papules of skin neck/chest)
5. cutaneous horns (small hard projections of epidermis on forehead/face and can mean underlying squamous cell carcinoma or wart
6. solar lentigines= irregular gray/brown macules over sun areas. “Age spots”

Normal characteristics:
skin more pale
increased freckling
hypopigmented patches
flaking/scaling d/t dry skin on extremities
thin skin esp over bone, loose hanging skin d/t lost elasticity/gravity/lost adipose = tenting w/ turgor
wrinkles
senile purpura (bruise) dorsal hands and arms

40
Q

What to expect when palpating lymph nodes

A

easily palpable nodes not generally found in healthy adult
may detect small movable discrete shotty nodes (may feel like BBs under skin) less than 1 cm in diameter that move under fingers
when enlarged nodes found explore adjacent areas and regions drained by them for s/sx infection or malignancy

41
Q

lymph nodes: Differentiating infection from malignancy

A

malignant= hard fixed painless nodes; palpable supraclavicular node on left (Virchow node) is clue to thoracic or abdominal malignancy

infection= tender

*slow nodal enlargement over weeks= benign, rapid enlargement without signs of inflammation= malignancy

42
Q

lymph nodes: normal changes in adult

A

diminish and size decrease w/ advanced age. Nodes of older adults more fibrotic and fatty

43
Q

lymph nodes: where they’re palpable

A

neck: occipital, postauricular, posterior cervical, preauricular, parotid, retropharyngeal (tonsillar), submandibular, submental, anterior cervical, supraclavicular (felt when disease)

epitrochlear

inguinal and popliteal

44
Q

lymph nodes: how to differentiate between cyst

A

check if it transilluminates
nodes do NOT, cysts do

45
Q

lymph nodes: painful vs non painful meaning

A

tender= infection
not= malignant if enlarged

46
Q

lymph nodes: when does enlarged need further investigation

A

hard fixed painful
rapid enlargement
tender
> 1 cm

47
Q

How to palpate the thyroid; what will you expect to feel

A
48
Q

History and physical findings suggestive of hypo and hyperthyroidism

A
49
Q

. History findings suggestive of different types of headaches; migraine, tension, cluster

A
50
Q

gold standard for pain assessment

A

self-report pain scale ? numerical rating scale
let them pick if more than one available

51
Q

How to assess pain in child, when can a pain scale be used

A

children as young as 3 can self report; assess ability to understand higher-lower and more-less
practice using scale using old injury
wong-baker faces rating scale
oucher scale
FLACC for non verbal

52
Q

Overall changes in the older adult to differentiate normal from abnormal

A
53
Q

Nutrition: What is normal BMI; overweight BMI, obese BMI; physical signs of nutritional deficiency

A

undernutrition= < 18.5
appropriate= 18.5-24.9
overweight= 25-29.9
obesity= 30 or >

54
Q

What is physiologic jaundice in the newborn, when is it normal and what does it indicate if abnormal

A

1st day of life, disappears by 8-10th day, can persist 3-4 weeks. Intense/persistent jaundice= liver disease, hemolytic process, or severe infection
examine mucosa and sclera in daylight

55
Q

How to transilluminate the skull of an infant, what is seen, what is normal

A

In general, when using a standard 2-cell flashlight held tight (press firmly to skull) to the anterior fontanelle, transillumination of more than 2 cm around the edge of the beam or asymmetry of the transillumination suggests underlying pathology

56
Q

What are normal/abnormal skin changes in pregnancy

A

normal= striae gravidarum (stretch marks), telangiectasias (dilate blood vessels) ace/neck/chest/arms, hemangiomas (benign vascular tumor), cutaneous tags, increased pigment areolae, vulva, perianal, axillae, linea alba, preexisting nevi darken/grow or new nevi, melasma (dark blotchy skin) forehead/cheeks/nose/chin, palmar erythema, itching on breasts and abdomen, hair lengthened & hair loss decreased

abnormal= itching with rash esp on palms & soles

57
Q

What is SLUMS for

A

The Saint Louis University Mental Status (SLUMS) test is an assessment tool for dementia and mild cognitive impairment

58
Q

What is the PHQ9 for

A

depression screening

59
Q

What is the GAD7 for

A

anxiety screening
Anxiety can affect a person in numerous ways including insomnia and weight change (whether increase or decrease). When assessing for anxiety, be sure to complete a GAD-7 screening and score in order to give your diagnosis credibility through using medically approved criteria. When using the GAD-7 score, you can then determine the level of anxiety your patient is experiencing whether mild, moderate, or severe. This will help guide you in your decision making regarding the plan/medications you will give your patient.

60
Q

What meds do you typically start with for anxiety and depression

A

When thinking about giving medications for anxiety/depression…we typically start with an SSRI or SSNI. These medications are effective and do not have the major side effects of benzos or TCAs.

61
Q

Maslow’s hierarchy of needs

A

1- physiological

2- safety
3- belonging and love
4- esteem
5- self actualization

62
Q

Important diagnostics if cognitive decline is found

A

If you determine they have a cognitive decline, it is important to get a MRI or CT of their brain. The MRI or CT will help determine what type of dementia they possess.

63
Q

different types of dementia

A

alzheimer, vascular, frontotemporal, lewy body, korsakoff syndrome

64
Q

Alzheimer s/s and diagnostic findings

A

Signs/Symptoms
Memory Impairment – forgets people
Executive function
Problem solving
Behavioral and psychologic symptoms
Apraxia – Difficulty with movement
Olfactory Dysfunction
Sleep Disturbance

PET/MRI Reading
MRI: Generalized/focal atrophy, white matter lesions, reduced hippocampal volume, medial temporal lobe atrophy
PET: Hypometabolism and hypoperfusion, neurofibrillary tangles

65
Q

Vascular dementia s/s and diagnostic findings

A

S/sx
Sudden significant cognitive impairment
*Damage to multiple brain regions
*Strategic infarction - damage to single brain location

PET/MRI reading
MRI: Cerebral small vessel disease including microbleeds, Infarcts >15 mm or any size in cerebral cortex, Infarcts <15 mm in subcortical brain regions, white matter hyperintensities or hypodensities of presumed vascular origin, demyelination, axon loss, and oligodendrocyte loss

66
Q

frontotemporal dementia s/sx and PET/MRI reading

A

s/sx
Disinhibition – socially inappropriate behavior
Apathy or loss of empathy – losing interest/motivation/relationships
Hyperorality – altered food preferences such as craving carbohydrates or sweets/binge eating, increase alcohol or tobacco, attempting to eat inedible objects
Compulsive behavior – ritualistic behavior such as hoarding, checking, cleaning; pursuing hobby/religious aspects obsessively

MRI: Frontal or temporal atrophy; Atrophy may affect one brain hemisphere more than the other

67
Q

Lewy body s/sx and PET/MRI findings

A

s/sx
Progressive cognitive decline
Abnormal social/occupational functions
Deficit in attention, executive function, and visuoperceptual function
Hallucinations/delusions
Insomnia
Does not forget people

PET: low dopaminergic activity in striatum which is also seen in Parkinson’s Disease, multiple system atrophy, progressive supranuclear palsy

68
Q

Korsakoff Syndrome s/sx and diagnostic findings

A

s/sx
Marked deficit in anterograde and retrograde memory
Apathy
Intact sensorium
Relative preservation of long-term memory and cognitive skills

MRI: Reduction in cerebral metabolic rate for glucose and decrease in benzodiazepine receptor; Results from Wernicke encephalopathy, enlargement of cerebral ventricles and sulci

Patient has hx of alcohol use disorder

69
Q

how to initially address insomnia

A

When helping a patient with insomnia, do NOT automatically go to a medication such as Ambien, Lunesta, or Restoril. These type of medications are highly addictive and can cause more harm. ALWAYS start with melatonin as this is a natural hormone and one that may be lacking in the patient which is the pathophysiology regarding our sleep-wake cycle. Be careful how you treat your patients. Also getting them to do sleep hygiene also helps with insomnia. Turning off computers/phones allows the brain to relax and prepares one for sleep.

70
Q

tuning fork 500-1000 hz used for what?

A

hearing range for normal speech since normal speech can range from 300-3000 hz

71
Q

a 69 y/o truck driver presents w/ sudden inability to understand spoken language. this indicates a lesion in which area of the brain?

A

temporal lobe- responsible for comprehension of spoken and written language

72
Q
A

Advanced Health Assessment (3 decks)

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