Unit 4 Flashcards
1
Q
What are the 4 quadrants of the abdomin
A
RUQ-right upper quadrant
LUQ
LLQ
RLQ
2
Q
What are the 3 named divsions of the abdomen
A
Epigastric
Umbilical
Hypogastric (suprapubic)
3
Q
Infants and Children
How many arteries and veins are in the umbilical cord
A
Arteries x2
Veins x1
4
Q
At what time phrase does the umbilical cord dries off and falls
A
10-14 days
5
Q
What is unique about the liver from infants development to adult
A
The liver takes up more space in the abdomen than later in life
6
Q
What is unique in infants and children’s bladder development
A
The urinary bladder is high in the abdomen than in adults
7
Q
What is unique in the abdominal wall in children
A
The abdominal wall is thinner-easier to palpate
8
Q
What is the physiology of heartburn?
A
Heartburn is pressure upon stomach (Prosis)
9
Q
What happens to the Gi motility when pregnant?
A
Decreased GI motility which can cause constipation
10
Q
What are some characteristic of the abdomin when pregnant?
A
Morning sickness (not only in morning)
Heartburn
Decreases GI motility
Prolonged gastric emptying time
Increased water reabsorption
Constipation
Hemorrhoids
Diminished bowel sounds
Appendix displaced
Stria—stretch marks
11
Q
T/F aging females have more incidence gallstones
A
True
12
Q
What are some characteristics of aging adults with their abdomen
A
Abdominal wall musculature reflexes weaker
Decreased salivation (altered taste—dry mouth)
Gastric Secretions delayed (malabsorption)
Increased gallstones
Live size decreases (20–70 yo 20%decreased)
Increased constipation
13
Q
What are some causes from gastric secretions delayed
A
Malabsorption nutrients, pernicious anemia, iron anemia
14
Q
What are some common causes of constipation in older adults
A
Decreased physical activity
Inadequate intake of water
Low-fiber diet
Side effects of medication
IBS
Bowel obstruction
Hypothyroidism
15
Q
What are subjective data for infants and children
A
Breast or bottle fed—tolerance?
Table food introduced—when?allergies?
How do they eat? Meals? Snacks
Abdominal pain
Constipation
Overweight?
16
Q
What are subjective data in adolescents?
A
Regular meals? 3 meals
Breakfast?
Snacks? What snacks? Healthy or junk?
Screen for anorexia nervosa if weight less than body requirements(laxative abuse, vomiting)
17
Q
What is the average calories for males and females if exercised regularly?
A
Males 4000 a day
Females 3200 a day
18
Q
What are subjective data for aging adults
A
Access to groceries—physical limitations?financial?
Shared meals?
24 hour dietary recall
Swallowing difficulties
Bowel heath
Medications
19
Q
Why is it risky to lay down after after mealtimes?
A
When laying down there is a greater risk for aspiration
20
Q
T/F auscultate prior to palpitation and percussion the abdomen
A
T
Palpitation can cause bowel sounds that wouldn’t of been there
21
Q
Where do bowel sounds come from?
A
Parastalsis- movement of air/food
22
Q
What is considered active bowels?
A
30 or more in 1 minute to be normal
23
Q
What is a hypoactive bowel
A
Closure to 5 or 6 in a minute—-after surgery
24
Q
What is a hyperactive bowel
A
Almost nonstop gurgling
IBS, after eating, diarrhea
25
What is defined as a silent abdomen
Completely absent bowel sounds for 5 minutes between all 4 quadrants
26
Where do you listen for vascular sounds?
In midline location
27
What is the condition to use nasogastric tube placement?
Always check placement before using it
28
Is it accurate to percussion the spleen
No it is not recommended to complete because it can do more harm than good if enlarged
29
What structures are normal palpatable?
Stomach, colon, part of liver
30
What quadrant is normally mild tender
LLQ
31
Mass Identification.. what do you assess
Location
Size
Shape
Consistency (soft, firm, hard)
Surface (smooth, modular)
Mobility-benign mostly moves
Pulsatility-at or around mass
Tenderness with areas
32
Where do you place your hands to hook the liver?
Place left hand on back 11th and 12th ribs
33
Should you palpate the spleen?
You should not, it can be dangerous
34
What is the fluid wave and what does it inspect?
Smack opposite side, thud indicates fluid in abdomen
35
What is shifting dullness?
It is moving pain, mark pain when supine, and on side. This can indicate where the fluid is
36
What is Wharton’s jelly?
Whitish yellow goo that encases umbilical cord
37
What can you palpate in an infant?
Liver (bigger)
tip of spleen
Both kidneys
Bladder
Cecum and sigmoid colon
38
What can you palpate on a child?
Liver
Spleen
Right kidney
39
What is true about the abdominal musculature in aging adults
Thinner and less tones
Lover and kidneys may be easier to palpate
40
What are some reasons for abdominal distention
Obesity
Air or gas
Ascites (excessive abdominal fluid)
Ovarian cyst
Pregnancy
Feces
Tumor
41
What are 3 of the most common sites for referred pain?
Liver—RUQ
Esophagus—behind lower sternum
Ulcer—Cho ulcer
Gallbladder—RUQ
Appendix—RLQ
Pancreas—mid scapular
Kidney—flank pain
Small intestine-diffuse
Colon—colicky pain and bloating
42
What are some abnormal inspection signs for abdomen?
Umbilical hernia—buldging
Epigastric hernia
Incisional hernia
Diastasis recti
43
What are some abnormal friction rubs and vascular sounds?
Peritoneal friction rub
Arterial bruit—area where blood is turbulent (aneurysm)’
Venous hum—very rare lower umbilical area—indication of partially occluded femoral artery
44
What are some abnormal bowel sounds
Succession splash—upper and. When rocking infant side to side—-pyloric obstruction or large hiatal hernia
Hypoactive bowel sounds
Hyperactive bowel sounds
45
What are some abnormal palpation finding for abdomen
Enlarged liver
Enlarged modular liver
Enlarged gallbladder
Enlarged spleen
Enlarged kidney
Aortic aneurysm
46
What are some genital development characteristics of infants?
External genitalia large at birth (resolves couple weeks)
Structures remain small until puberty
47
What are the developmental characteristics of adolescents? What is crucial of knowing this?
Model is designed for white individuals
First sign of puberty are breast development
—the more overweight, the younger the puberty age
48
What are the Tanner Stages?
Stage 1-nothing
Stage 2- hair growth sparse mostly on labia
Stage 3- growth sparse; spreading over mons pubis
Stage 4- adult type; over smaller area-not on medial thigh
Stage 5- adult in type and pattern; inverse triangle, on medial thigh surface
49
When is the greatest change in the uterus?
Pregnancy
50
What are the developmental competencies of pregnancy
Greatest change in uterus
Cervical and vaginal secretions—thicker white to help protect fetus
PH is more basic
Increase in glycogen— greater risk for yeast infection
51
T/F lesbians are at lower risk for cervical cancer for not having sex with men
F
52
T/F After menopause secretions are more alkaline
True
53
Does female’s hormones increase or decrease due to menopause
Females rapidly decrease hormones due to menopause
—full months with no menstruation
54
What do you do to provide comfort for the aging females?
Smaller instruments
Lost of lubricant
One finger not 2
55
What is the position called when seeing the GYNO
Lithotomy position
56
What is the normal variation of the cervix after childbirth
Parous
57
In what conditions do you assess a pelvic exam?
Abnormal vaginal discharge
Missed periods
Positive pregnancy test
Over 25 years old
58
What are the 3 layers associated with the skin, and describe the contents of each layer?
Epidermis—outer layer protective barrier
Dermis—layer consists of connective tissues (collagen, fibrous protein, nerves, blood vessels)
Subcutaneous—stores fat, insulation, aids protection
59
Differentiate among sebaceous, eccrine, and aprocrine glands
Sebaceous glands—produce sebum (protects skin, hair) scalp, forehead, face, chin
Eccrine glands—sweat glands
Apocrine glands—sweat glands in axillae, anogenital, nipples, navel, activated by puberty (musty body odor)
60
List at least 5 functions of the skin
Protection
Wound repair
Temp regulation
Communication
Absorption/excretion
61
Describe the appearance of pallor, erythema, cyanosis, and jaundice in dark skinned persons?
Pallor—gray color in dark skin
Erythema—increased warmth in dark skin
Cyanosis—blush lips, nose, cheeks, ears, oral mucous harder too see
Jaundice—harder differentiate since yellow fatty deposits in sclera is normal
62
The white linear markings that are noramally visible through the nail and on the pink nail bed are termed ______
Leukonychia striata
63
What are the stages of injury development?
Stage 1–intact skin appearance red but unbroken
Stage 2– partial and thickness skin erosion
Stage 3–fluid thickness pressure over extending into subcutaneous tissue
Stage 4 full thickness pressure ulcer involves all skin layers and extends to bone
64
You are conducting a class for new graduates on skin assessment. Which statement is true regarding the epidermis?
A. The epidermis consists mostly of connective tissue or collagen
B the epidermis contains the blood vessels
C the epidermal cells are continually lost and replaced with new cells
D a paper cut stimulates nerve cells in the epidermis
C
65
You are preparing to care for a 63 yo black man with a history of heart attack who now presents with heart failure. What is the best technique to assess for cyanosis?
A palpate the skin for increased heat
B inspect the hard palate of the mouth
C inspect the feel for an ashen gray look
D inspect the nail beds for a dusky pale color
D
66
You are taking a history for a 25 yo woman with a rash on her upper chest and neck. Which question would give you further information on the woman’s rash?
A job much alcohol would you say you drink each week?
B have you tried a new food or medicine?
C have you recently started oral contraceptives?
D with which racial ethnic group do you identify?
B
67
You are caring for a 48 yo with a history of chronic alcohol abuse and liver disease. Which site is the best technique to assess for early jaundice
A sclera and hard palate
B nail beds
C lips
D visible skin surfaces
A
68
You are assessing the skin of a 57 yo during a clinic appointment. Which technique is the best to assess for increased skin temperature?
A a grasping with your fingertips of both the hands
B laying the palmar surface of your hands on the abdomen
C placing the ventral surface of your hands on the person’s shin and feet
D laying the dorsal surface of your hands on the person’s neck
D
69
You are assessing the general skin color of a darkly pigmented person. You would expect which findings?
A lighter pigmentation on the palms of the hands
B a reddened color the lips
C patchy pigmentation on the dorsal surface of the hands
D small flat macules of browner pigment melanin on the chest
A
70
You are in the ED when a 70 yo woman is brought by ambulance after falling in her assisted living space and the not being found for 14 hours. Vital signs are stable. Imaging shows no broken bones. She is alert and oriented. One of your assessment findings is that the skin on her upper chest “tents” after you lift it. This findings is consistent with:
A edema
B dehydration
C dry skin (xerox is) of aging
D a normal finding for her age and upper chest
B
71
During your skin assessment of a 65 year old white landscape worker,you notice a raised, thickened area of increased pigmentation of 1.5 cm that looks dark brown and greasy. What is your next most appropriate action?
A interpret this as seborrheic keratosis and move on with the examination
B notify the physician
C inquire about recent exposure to toxic outdoor plants
D inquire about recent exposure to deer ticks
A
72
A 78 yo retired physical examination teacher comes to your clinic for a routine assessment. The teacher asks about small, round, flat, evenly brown macules on the backs of the hands. After assessing the area, what is your best response?
A these are the result of sun exposure and do not require treatment
B these are related to sun exposure and may become cancerous
C these are skin tags that occur with older age and do not require treatment
D I’m glad you brought this to my attention. I will refer you for a biopsy
A
73
A 50 year old is admitted to your medical surgical unit with chronic obstructive lung disease. Signs are: alert and oriented, on low-flow oxygen, with BP 156/78 mm Hg, Hr 88 bpm and regular, respirations 20 per minute and unlabored. During initial assessment, you observe a rounded appearance of the nail beds to their base in all 10 fingers. You next most appropriate action is to:
A notify the physician
B increase the oxygen flow
C note this is an expected finding for this person and move on
D take his vital signs again
C
74
Linear streaks on nail beds are recorded as?
Leukonychia striata
75
A 3 day old infant has had healthy assessments since birth. On this 3rd day, you notice a yellowing of the skin, sclera, and mucous membranes. Your next most appropriate action is
A ask the breast-feeding mom to avoid carotene-rich foods
B notify the physician that this may be hemolytic disease of the newborn
C record this as physiological jaundice and proceed with the assessment
D perform deep palpation on the abdomen to elicit possible pain associated with biliary tract obstruction
C
76
During a sports physical for a 14 year old adolescent, you observe many papules, pustules, nodules, and blackheads covering the cheeks and jaw on the face. Which of these statements would be your most appropriate ones?
A have you heard any other kids say anything about your acne
B you have servers acne; it is at its peak and will get better in a year
C how do you feel about the acne on your face
D would you say your acne has made you feel depressed
C
77
You are collecting a health history on a 52 year old woman. Viral signs and weight are within normal range. At one point, she reports, the last few weeks, I have had sudden drenching sweating through my skirt. How would you proceed with data collection?
A can you tell me the data of your last menstrual period?
B do you have chest pain at this time?
C would you say you are depressed
D what was your activity level at these times
A
78
A 74 year old woman presents with a history of intense itching and a raised red linear rash on one side of her upper back. You know that these findings are consistent with SATA
A a bacterial skin infection
B herpes zoster infection
C poison ivy contact
D history of childhood chicken pox infection
B D
79
A father brings his 18 month old infant to your clinic because of a red blotch rash on the face and neck. Father reports cough, runny nose, and “doesn’t want to eat or drink much.” Vital signs are 39 C, HR 120 bmp, respirations 24/min. Infant looks sick and miserable. What are the best techniques to continue with the assessment? SATA
A check for immunization history for the infant
B ask if any other children at home or daycare with the same rash?
C inspect infant’s inner cheeks for blue-white “pearls” on the mucosa
D check nail beds for capillary refill
ABC
80
What skin layer is the….
Basal cell layer
Aids protection by cushioning
Collagen
Adipose tissue
Uniformly thin
Stratum corneum
Elastic tissue
Basal cell layer—epidermis
Aids protection by cushioning— subcutaneous layer
Collagen— dermis
Adipose tissue—subcutaneous layer
Uniformly thin— epidermis
Stratum corneum—epidermis
Elastic tissue— dermis
81
Match these: Pallor, erythema, cyanosis, jaundice
A intense redness of the skin due to excess blood in the dilated superficial capillaries
B Bluish mottled color that signifies decreased perfusion
C absence of red-pink tones form the oxygenated hemoglobin in blood
D increase in bilirubin in the blood causing a yellow color in the skin
Pallor— absence of red-pink tones from the oxygenated hemoglobin in blood
Erythema—intense redness of the skin due to excess blood in the dilated superficial capillaries
Cyanosis—blush mottled color that signifies decreased perfusion
Jaundice—increase in bilirubin in the blood causing a yellow color in the skin
82
What are tiny punctuate red macules and papules on the cheeks, trunk, chest, back, and buttocks
Erythema toxicum
83
What describes lower half of the body turns red, upper half blanches
Harlequin
84
What describes transient mottling on the trunk and extremities
Cutis marmorata
85
What describes bluish color around the lips, hands, fingernails, feet, and toenails
Acrocyanosis
86
What describes large round or oval patch of light brown usually present at birth
Cafe au lait spot
87
Yellowing of skin, sclera, and mucous membranes due to increased numbers of red blood cells hemolyzed after birth
Physiological jaundice
88
Yellow-orange color in the light-skinned person from large amounts of food containing carotene
Carotenemia
89
What is the proper positioning and preparation of the patient for the abdominal examination
Empty bladder
Supine-pillow under butt and knees bent
Inquire painful areas
Use distraction techniques
90
What is bruit for abdominal examination
Bruit-pulsatic blowing sound indicating turbulent blood flow
91
What are four considerations that may alter normal percussion notes heard over the abdomen
Gas feces mass fluid
92
What is the difference between visceral pain and somatic pain
Visceral pain- internal organ, dull, general, poorly localized
Somatic-pain due to inflammation of overlying peritoneum, sharp precisely localized, aggravated by movement
93
What is the sequence of techniques used during an exam of the abdomen
Inspection, auscultation, percussion, palpitation
94
You are auscultating a pt’s abdomen and hear a soft, high pitched, irregular gurgling sound over the RLQ what is the next best action?
A move on to percussion of the abdomen, as this is a normal finding
B continue auscultating the abdomen in all four quadrants, moving clockwise
C contact the practitioner as the pt may have a bowel obstruction
D continue listening to the RLQ for a full 5 minutes
A
95
The absence of bowel sounds is established after listening for …
5 full minutes
96
You are palpating the left lower quadrant, the patient grimaces slightly and states the area is tender. What is your next best action
Document the finding, which is normal, and ove on with the exam
97
Auscultation of the abdomen may reveal bruit in which arteries?
Aortic, renal, iliac, femoral
98
A woman has pink striae on the abdomen. What additional questions should you ask?SATA
A tell me the date of your last menstrual period
B have you gained any weight recently
C have you recently been or is there a chance you could be pregnant
D what caused these scares on your abdomen
ABC
99
Why do we auscultate the RLQ first
Bowel sounds are always normally present here
100
A positive Blumberg sign indicates….
Peritoneal inflammation
101
A positive Murphy sign is best described as:
A pain felt when eh examiner hand is rapidly removed from an inflamed appendix
B pain felt when taking a deep breath when the examiner’s fingers are on teh approximate location of the inflamed gallbladder
C a sharp pain felt by the pt when one hand off the examiner is used to thump the other at the costovertebral angle
D this is not reliable exam technique and is no longer recommended
B
102
Bloating gas and diarrhea after drinking milk or ice cream are presented in a pt. You suspect lactose intolerance. What is your best statement to the pt
A you probably should avoid all dairy products. ave you tried nondairy milks as an alternative
B consider taking an over the counter antacids to help manage these symptoms
C you may need to reduce the amont of lactose in your diet; I will talk to the physician about testing for lactose intolerance
D. I think you should ray low lactose foods and probiotics for a while and see how your symptoms are affected
C
103
A pt complains of a burning upper left abdominal pain that is worse on an empty stomach. What do you suspect as the cause?
A cholecystitis
B diverticulitis
C dysphasia
D gastric ulcers
D
104
You are assessing the area of the abdominal tenderness in RLQ. Which findings supports involuntary guarding?
A muscles contract, feels firm, and pt grimaces during palpation. When relaxed the area feels soft when the pt is exhaled
B the muscles contract, the area feels board like, the pt grimaces during palpitation; the changes are not affected by exhalation and recure when the pt attempts to sit up
C the pain is caused by your palpation of the opposite sides when you push in on the left lower quardrant, the pt reports pain in the RLQ when the pressure is released
B
105
You are able to palpate the spleen in the lower quadrant. What is your best next action
A thorough palpate the borders to document a detailed description of its size and location
B proceed with the exam this is normal finding
C push into the spleen firmly while observing the facial expression for signs of tenderness
D stop palpating the spleen and notify the practitioner or physical of possible enlarged spleen
D
106
A 13 yo girl comes to your clinic for a sports physical exam. You inspect her abdomen and note occasional 1 to 2 times per minute wavy rippling across her skin. What is your next best action
This sis normal finding for a young teen, proceed
107
What is the first physical sign of puberty in male genitalia?
Testes and scrotum begin to enlarge
108
A man says he “never has sex anymore” check the following appropriate follow-up question you could use that are associated with withdrawal from sex SATA
A have you been told about any side effects of your medication
B lets ask ou provider for a blood test to detect decreased sperm production
C would ou say you have had feelings of depression in the last few months
D how many alcohol drink do you have each day
E this is an expected outcome in aging men
F have you experienced the loss of your spouse or partner?
A C D F
109
You perform a genital exam on a 48 yo man and note deeply pigmented wrinkled scrotal skin, with multiple yellowish 1cm firm nontender nodules. What is the next action
A ask about any family history of testicular cancer in the father or brothers
B consider these sebaceous follicles an expected finding and proceed with the examination
C assess the scrotum using transillumination
D obtain a detailed history focusing on any scrotal abnormalities the man has noticed
B
110
There are adhesions of the prepuce of the head of the penis, making for skin impossible to retract. What is this?
Phimosis
111
You are caring for a person with jaundice from hepatitis. You expect the person’s rune to be
A orange in color
B red from blood in urine
C normal, clear yellow
D dark gray in color
A
112
What are examples of high fiber foods and soluble?
Beans, prunes, barely, carrots, broccoli, cabbage
113
What are examples of high fiber foods that are insoluble?
Cereal, wheat germ
114
What are advantages of fiber in diet?
What are advantages of high fiber soluble foods
What are advantages of high fiber insoluble foods?
High fiber diet—fight obesity, stabilize blood glucose, help GI disorders
HF insoluble- decrease risk of colon cancer
HF soluble- decrease risk of cholesterol
115
At what age do you recommend for early detection of colon-rectal cancer and prostate?
45
116
What does a prostate gland do?
It makes a thin, milky fluid to help the sperm stay alive during intercourse
117
What does the first dark green stool mean for a baby?
The dark green stool shows the rectum and anus are open and working
118
You inspect the perinatal area of a 38 year old woman and note: anal pigment darker than surrounding skin, anal opening closed, a shiny blue skin sac. The woman reports pain with bowel movements and an occasional spot of red blood. These findings most likely indicate…
Thrombosed hemorrhoids
119
While teaching a 63 yo man with a family history of colorectal cancer, you cover lifestyle factors to reduce future CRC risk. Which foods are helpful to reduce CRC risk?
High in fiber
120
What to do to help a person reduce future CRC risk SATA
A stop smoking
B annual colonoscopy
C stop heavy alcohol use
D medication or yoga
E daily fruit and vegetable intake
F keeping a healthy wright
G daily exercise
H animal blood test for CRC marker
I biennial ultrasound of lower abdomen
A c e f g
121
What is lanugo
Fine downy hair of newborn
122
Explain what is vernix caseosa
Thick cheesy substance made of sebum and shed epitheal cells
123
What is Mongolian Spot
Common variation of hyperpigmentation in black, Asian, and native Americans
124
What is the first stool of an infant called?
Meconium
125
When do pediactics have voluntary control of bowel movements
1.5 years old
Due to myelination
126
When do pediactics have voluntary control of bowel movements
1.5 years
127
How much does the prostate grow during puberty
Twice its size
128
what does black tarry stool indicate
Upper Gi bleed
129
What does patency in newborns rectum indicate
Patency indicates bowel function
Meconium first stool
130
For individuals screening for colorectal cancer, what can they do and when do they start it?
Colonoscopy—50 years old
FIT- fecal immunochemical test-age 40
131
Who is recommended for HPV vaccine
Most common STI
Men under 26 years
Earliest 11
Under 14 only have to get 2 doses, over 14 3 doses
132
What is the difference between primary and secondary lesions?
Primary-develops previously unaltered skin
Secondary-Changes over time or changes due to scratching or infection causing alteration to the skin
