H&P block 1

what is the normal range for pulse

60-100 bpm

vesicle

< 1 cm and fluid filled

normal BP reading

<120/<80

bulla

>1 cm and fluid filled

what CN does auditory acuity test

CN VIII- vestibulocochelar

examining the tongue tests for what CN

CN XII- hypoglossal

pitting nails

Focal areas of abnormal keratinization of the nail matrix that produce foci of parakeratotic cells in the dorsal nail plate as it grows beyond the cuticle

examining the palate and uvula tests for which 2 CNs

IX (glossopharyngeal) and X (vagus)--> gag reflex

what is hutchinson sign associated with

Longitudinal melanonychia, increased suspicion for ungual melanoma

onychomycosis

Nail thickening and debris, Usually a dermatophyte infection

paronychia

Superficial infection of nail folds adjacent to plate (Staphylococcus aureus, Streptococcus spp., Pseudomonas aeruginosa)

how shoud a BP cuff be positioned

- palpate brachial artery and position at level of heart - center bladder over brachial artery - lower border of cuff anout 2.5 cm above antecubital crease

onycholysis

associated with SCC, distal or distolateral separation of nail plate, appears white

what is the ABDCE rule

asymmetry border irregularity color variation- more than two colors (especially concerning if blue-black) diameter (>6 mm) evolving

what is transverse leukonychia

discoloration in bands or striae that run parallel to nail base

what is a less frequent cause of clubbing

extrathoracic disease (graves, IBS, liver cirrhosis)

horizontal eye defect

occlusion of a branch of the central retinal artery (can also be a cause of ischemia of the optic nerve)

what side should the examiner be on during the exam

on the patients right side

Homonymous Left Superior Quadrantic Defect

partial lesion of optic radiation in the temporal lobe, may involve only a portion of nerve fibers (pie in the sky defect)

how do you document oxygen saturation

pergentage and oxygen source

terry's nails

plate turns white with distal band of reddish brown, lunula is not visible, associated with cirrhosis, HF, DM

when is visual acuity tested and how is it performed

prior to manipulating or shining light on/in eyes test each eye individually, opposite eye covered, and at appropriate distance

what are the most often causes of clubbing

pulmonary or CV disease

nodules

raised, discrete, may be isolated or grouped, larger and deeper than a papule, can be vascular

papule

raised, not fluid filled, <1 cm, discrete, isolated or grouped

plaque

raised, not fluid filled, >1cm, superficial, often formed by multiple papules

onychogryphosis

rams horn nail

what components do you document for respirations

rate, effort, rythm, depth

which temperature location is closet to core temp

rectal

petechiae (<5 mm) and purpura (>5 mm)

results from extravasion of blood from cutaneous vessels into the skin, red/purple lesions, do not blanch, may be raised

transverse grooves on nails

temporary arrest of proximal nail matrix proliferation and appear as transverse lines that move distally with nail growth

how can you ensure you measure an accurate BP

- pt should not have smoked, drank caffeine, or exsercised in the past 30 min - room should be warm and quiet - patient should sit for at least 5 minutes with back and feet supported with legs uncrossed - arm should be free of clothing, indwelling catheters, lymphedema, scarring - ask pt for arm pref

telogen

- resting phase - duration: 2-3 months - 10% of follicles at any one time - normally 50-150 hairs are shed per day

catagen phase of hair

- transformation phase - 3 week duration - 1% of follicles at anny one time

anagen phase of hair

- varies by location - lasts 2-6 years; eyebrows 2-3 months - 90% of hair follicles on scalp at any one time

what is the correct size of a cuff

- width of bladder is 40% of upper arm circumference - length of bladder should be about 80% of circumference

risk determination for ethos abuse in men under 65

-More than 14 standard drinks per week on average -More than 4 drinks on any day

risk determination for ethos abuse in women and adults over 65

-More than 7 standard drinks per week on average -More than 3 drinks on any day

according to CMS, you can document 3 of the 7 vital signs. List all the vital signs

1. sitting or standing BP 2. supine BP 3. pulse rate and regularity 4. respiration 5. temp 6. height 7. weight

what is a normal adult range of respirations

10-12 to 20 rpm

elevated BP reading

120-129/<80

stage 1 HTN reading

130-139/80-89

Left homonymous hemianopsia

A lesion of the optic tract, interrupts fibers originating on the same side of both eyes, visual loss involves half of each field

subungal hyperkeratosis

Abnormal keratinization of distal nail bed with accumulation of scales under distal nail plate, common causes- oncychomycosis, trauma, eczema

Longitudinal melanonychia

Banded, brown to black pigmentation of nail due to melanin in nail plate

leukonychia

Defective keratinization of distal matrix with persistence of parakeratotic cells in ventral nail plate

herpetic whitlow

HSV, involves skin or periungual area, occupational work or children who suck their finger

clubbing

Increased distal mass at tips of fingers and increased longitudinal and transverse nail plate curvature

Longitudinal erythronychia

Pink to red streak in plate that corresponds to band of thinned, more transparent nail plate, caused by focal reduction of function in distal matrix

green nail syndrome

Pseudomonas aeruginosa

splinter hemorrhages

Red to black, small thin longitudinal lines under nail plate, common causes are trauma and nail psoriasis

Left Homonymous Hemianopsia (Right Optic Radiation, Complete)

a complete interruption of fibers in the optic radiation

Bitemporal hemianopsia

a lesion at the optic chasm may involve only fibers crossing over to the opposite side, visual loss involves the temporal half of each field

blind right eye

a lesion of the optic nerve produced unilateral monocular blindness

scar

abnormal fibrous tissue, replaces normal tissue after injury

what is monodacylous associated with

benign or malignant nail tumors, Longitudinal erythronychia

Onychoschizia

brittle, lamellar (layer) exfoliation

onychorrhexis

brittle, splitting at the distal margin of the nail plate

what is xanthelasma

cholesterol filled plaques commonly associated with hyperlipidemia and biliary cirrhosis

vesicles and bullae

circumscribed, contain serous material, raised

what to inspect on hair exam

color, follicle anatomy, distribution, quantitiy palpate texture, dryness, brittleness

how are visual fields tested

confrontation- position your finger halfway between you and the pt and move from outside visual field to in and not any deficits

telangiesctasia

dilated superficial blood vessel that will blanch with pressure

what cranial nerves are tested with corneal reflex

corneal sensitivity- CN V (trigeminal) motor response- CN VII (facial)- response is to blink

what are the 5 parts of the plan

counseling and patient education medical therapy consults/referrals diagnostic studies follow up/disposition

atrophy

decreased skin thickness due to thinning

fissure

deep slit extending into the dermis

crust

dried exudate

subcutaneous cyst

encapsulated collections of fluid or semisolid fluid, can be mobile or fixed

what is a fever defined as

equal to or greater than 38 C (100.4 F)

what can happen to BP reading if the cuff is to small

falsely high BP

what can happen to BP reading if the cuff is to large

fasely low BP

patch

flat lesion > 1 cm

macule

flat lesion measuring less than 1 cm in diameter

longitudinal grooves on nails

focal compression of nail matrix, distinguished by physiologic furrows and ridges

ulceration

focal loss of epidermis extending into the dermis

nail dystrophy

general term referring to altered/distributed nail growth (affecting nail matirx)

stage 2 HTN reading

greater or eaqual to 140/90

how do you accurately determine how high to inflate the cuff

have to estimate systolic pressure with the palpated pressure--> palpate radial artery and inflate cuff until you cant feel the pulse then add 30 mmHg and wait 15-30 seconds before taking BP

what is the diaphragm on a stethoscope used for

high frequency, press high

where is Punctate leukonychia usually seen

in children due to microtrauma

retronychia

incomplete nail shedding leads to embedding proximal nail plat into proximal nail fold, mostly due to repititive trauma

Lichenification

increased skin markings and thickening, indurated secondary to chronic inflammation, caused by scratching or other irritation

what eye muscle moves the top of the eye away from the nose and upward

inferior oblique

what eye muscle moves the eye downward

inferior rectus (depression)

what is episcleritis

inflammation of superficial layers of sclera, can be idiopathic or associated with autoimmune diseases

furuncles

inflammed hair follicle, palpable, multiple form a carbuncle

wheals

irregularly shaped, elevated, edematous, erythematous, sharp borders, can migrate to uninolved areas over periods of hours, hives

what eye muscle moves the eye outward away from the nose (abduction)

lateral rectus

burrow

linear or spreading pathway in epidermis associated with scabies mite

what is the bell on a stethoscope used for

low sounds, press light

what eye muscle moves the eye inward toward the nose (adduction)

medial rectus

pustules

small, circumscribed, papable, contain purulent material

expected findings of sensorineural hearing loss in Rinne

sound is heard longer through air

expected findings of weber test in unilateral CHL

sound is heard more in the impaired ear

expected findings of weber test in unilateral sensorineural hearing loss

sound is heard more in the normal ear

expected findings of CHL in Rinne

sound is heard through bones as long as or longer than air

koilonychia

spoon nails, upward curving of distal nail plate, occupational change or idiopoathic

what is nonblanching

suggests nonvascular or hemorrhagic

what is blanching

suggests vascular (inflammation)

scale

superficial epidermal cells that are dead and cast off from skin

excoriations

superficial linear erosions

erosion

superficial, focal loss of epidermis

what eye muscle rotates the top of the eye toward the nose and downward

superior oblique

what eye muscle moves the eye upward (elevation)

superior rectus

what is the most comon viral infection of nails

warts (HPV)

how to measure orthostatic hypotension

•Patients who have drop in BP upon standing or sometimes sitting •Check and document BP supine and then standing •Have patient supine for 3-10 minutes and check •Have patient stand and check within 3 minutes •Orthostatic hypotension: -Systolic drops at least 20 mmHg -Diastolic drops at least 10 mmHg