Health Assessment Exam 2
What are the first signs of chronic venous insufficiency (CVI)?
Hair loss, shiny skin -> brown skin. You can relieve CVI by raising the lower legs.
Because veins do not have the same muscular walls as arteries, they rely on the calf muscle pump to combat the pull of gravity and promote venous return to the central part of the body and the brain. Lacking this musculature makes veins more prone to what?
Pooling/collecting blood
What infection is suspected with inflammation of the supraclavicular lymph nodes?
Possible metastatic cancer
Primary vs secondary lesions?
Primary (arise from normal skin) -Maculae; papules; nodules; tumors; polyps; wheals; blisters; cysts; pustules; abscesses Secondary (follow primary lesions) -Scar tissue; crusts (from dried burns)
What do parathyroid glands do?
Produce the hormone calcitonin, which helps move calcium into bones.
In what disease process do you see pitting of the nails?
Psoriasis
What are the common symptoms of thrombophlebitis?
*Seen with DVT Palpable mass or cord along the vein
Describe the pitting edema scale.
+1: slight pitting, 2mm depression +2: increased pitting, 4mm depression +3: deeper pitting, 6mm depression; obvious edema of extremity +4: severe pitting, 8mm depression; extremity appears very edematous
What are the characteristics of pain with spinal cord injuries?
-Headache; neck pain -Limited neck movement -Vision and Hearing -Facial pain -Lumps/masses -Hypo/hyperthyroidism -Sleepiness It is an EMERGENCY if a patient has an accident and cannot feel part of their body. We must immobilize the neck and spinal cord.
A 22-year-old patient presents to the clinic with a large firm mass on her left earlobe. She had her ears pierced approximately 3 weeks ago. The mass began as a small bump and progressively enlarged to its current size of approximately 2.5 cm (1 in.) in diameter. It is not tender, reddened, or seeping any drainage. What is the term used to describe this secondary skin lesion? A. Crust B. Lichenification C. Keloid D. Scale
.C. Keloid. Rationale: Keloid is an excessive accumulation of fibrin tissue in response to wound healing. Lichenifications are exaggerated skin lines as a result of chronic irritation or scratching. Crust is a dried secretion from a primary lesion, and a scale results from excessive proliferation of the upper epidermal skin layers without normal shedding of dead cells.
Explain the pulse grading system.
0: nonpalpable or absent (you will want to then assess using a Doppler to see if the pulse is actually absent) 1+: faint or weak 2+: normal 3+: higher 4+: bounding ** chart pulse as "radial pulse 2+/4"
Nursing diagnosis for decreased circulation in an extremity?
1. Ineffective peripheral tissue perfusion 2. Risk for peripheral neurovascular dysfunction 3. Activity intolerance
What are the common symptoms of acute arterial occlusion? (7 P's)
1. Pain 2. Pallor - pale skin color 3. Polar (poikilothermia) - inability to regulate core body temp 4. Parasthesia - numbness and tingling 5. Pulselessness 6. Paralysis - complete loss of function 7. Perfusion - capillary refilll
Which organs lie in the RLQ?
APPENDIX, reproductive organs, right ureter
What is a pustule?
Purulent, fluid-filled, raised of ANY SIZE Ex: pustular acne, folliculitis
What is the manual compression test used for?
To asses for valve competency in varicose veins.
How does a hernia occur?
A hernia occurs when an organ or fatty tissue (usually bowel) protrudes through a weak spot in the abdominal muscle.
Which organs lie in the LUQ?
A small portion of the liver, most of the stomach, PANCREAS, left kidney, left adrenal gland, and SPLEEN
Jaw pain, especially associated with shoulder or arm pain, could indicate....
cardiac involvement.
While examining the patient's neck, the nurse finds the trachea midline but has difficulty palpating the thyroid. What action would the nurse take next? A. Document this finding as normal. B. Tell the patient that this finding is unexpected. C. Report to the physician a suspicion of a slow-growing goiter. D. Look for signs of hypothyroidism.
A. Document this finding as normal. Rationale: The thyroid gland is often not palpable. With no signs or symptoms of hypothyroidism or hyperthyroidism, a nonpalpable thyroid would be a normal finding
When documenting a finding over the stomach, the nurse most accurately identifies the region as A. epigastric. B. hypogastric. C. RUQ. D. LUQ.
A. Epigastric. Rationale: The epigastric region is located above the umbilicus and straddles the midline between the right and left upper quadrants.
A fair-skinned, blonde, 18-year-old woman is at the clinic for a skin examination. She reports that she always turns red within 10 minutes of going outside. She is planning a trip to Mexico and wants to avoid getting sunburned. Which of the following would be included in the teaching? (Select all that apply) A. Excessive exposure to UVA and UVB rays increases risk of sunburn and skin cancer. B. Apply a sunscreen or sunblock at least 15 to 30 minutes before sun exposure. C. Avoid sun exposure between 10 am & 4 pm to reduce UVA and UVB exposure. D. A mild sunburn is acceptable in a fair-skinned blonde person.
A. Excessive exposure to UVA and UVB rays increases risk of sunburn and skin cancer; B. Apply a sunscreen or sunblock at least 15 to 30 minutes before sun exposure; C. Avoid sun exposure between 10 AM and 4 PM to reduce UVA and UVB exposure. Rationale: Teaching the patient about the harmful effects of UVA and UVB exposure will help her understand the importance of sun protection. Sunscreens or sunblocks applied in time for the skin to fully absorb them afford the best protection. Avoiding the sun during the midday decreases exposure to intense and harmful UVA and UVB rays.
During history taking, a patient reports cramping in his calf when walking a few blocks. He states that it goes away when he sits down for a few minutes. How would the nurse document this symptom? A. Intermittent claudication B. Rest pain C. Poikilothermia D. Venous stasis
A. Intermittent claudication. Rationale: Intermittent claudication is the appropriate terminology when a patient has pain that comes on with activity or exercise and goes away with rest.
When percussing the abdomen, the nurse notices a dullness at the anterior right costal margin at the right midclavicular line. Which organ is most likely involved? A. Liver B. Spleen C. Sigmoid colon D. Kidney
A. Liver. Rationale: The spleen is normally found in the 9th to 11th left intercostal space (ICS) in the left midaxillary line (MAL). The colon is in the lower quadrants of the abdomen. The kidney is located in the posterior flank, in the lower rib cage. It is percussed for tenderness and is not always palpable.
A patient with a tympanic abdomen complains of pain in the RUQ. Which sign would the nurse expect to be positive? A. Murphy sign B. Psoas sign C. Rovsing sign D. Obturator sign
A. Murphy sign. Rationale: The Murphy sign tests for gallbladder pain. The other signs test for peritoneal irritation in the lower quadrants.
While evaluating the inguinal lymph nodes of a patient, the nurse palpates a 1-cm (about ½-in.) soft and freely movable node. What action should the nurse take next? A. Nothing—this finding is normal. B. Refer this patient to a specialist. C. Immediately check the patient's dorsalis pedis pulse. D. Refer the patient for immediate management of a life-threatening condition.
A. Nothing—this finding is normal. Rationale: The documentation reflects findings consistent with a normal lymph node.
4.A nurse observes a skin lesion with well-defined borders on the upper left thigh. It is 1.5 cm in diameter, flat, hypopigmented, and nonpalpable. What is the correct terminology for this lesion? A. Patch B. Plaque C. Papule D. Macule
A. Patch. Rationale: Patches are nonpalpable, defined lesions larger than 1.0 cm. Macules have the same characteristics of patches but are less than 1.0 cm. Papules are solid, raised, palpable lesions less than 1.0 cm. Plaques are papules larger than 1.0 cm.
The lymph nodes that lie in front of the mastoid bone are the A. preauricular nodes. B. occipital nodes. C. superficial cervical nodes. D. supraclavicular nodes.
A. Preauricular nodes. Rationale: The preauricular are, as the name implies, in front of (or pre-) the ear (auricle). Occipital nodes are at the base of the skull posteriorly. Cervical nodes are in the neck, and supraclavicular are above the clavicle.
While assessing a patient, the nurse finds a palpable lymph node in the left supraclavicular region. Which of the following should be the next action? A. Recognize that it is not common to palpate lymph nodes in this region and they must be carefully evaluated. B. Recognize that enlarged lymph nodes in this area indicate sinus inflammation. C. Recognize that this is a common area for lymph nodes to be enlarged with minor infections. D. Recognize that a palpable lymph node in this region is always indicative of malignancy.
A. Recognize that it is not common to palpate lymph nodes in this region and that they must be carefully evaluated. Rationale: Cancers of the lung, breast, and abdomen may metastasize to the lymph nodes and be first accessible during clinical assessment in the supraclavicular region.
A 24-year-old patient reports an itchy red rash under her breasts. Examination reveals large, reddened, moist patches under both breasts in the skin folds. Several smaller, raised, red lesions surround the edges of the larger patch. What is the correct terminology for the distribution pattern of these smaller lesions? A. Satellite B. Discrete C. Confluent D. Zosteriform
A. Satellite. Rationale: Single lesions in close proximity to a larger lesion are termed satellite lesions. Discrete distribution identifies lesions that are totally separate from one another. Confluent lesions are several lesions that have merged together, and zosteriform distribution identifies lesions, which follow a dermatomal pathway.
An 83-year-old woman is undergoing a routine physical examination. Which of the following assessment findings would the nurse consider an expected age-related variation? A. Thinning of the skin B. Increased skin turgor C. Hypopigmented flat macules and patches over sun-exposed areas D. Multiple purplish bruises on the arms and legs
A. Thinning of the skin. Rationale: The skin layers thin with aging, resulting in decreased skin turgor. Thinned skin is subject to increased trauma from shearing or friction, which increases the risk for purpuric lesions. Nevertheless, such lesions are not a normal variant of aging skin. Hyperpigmented macules and papules (commonly seborrheic keratoses) are present on sun-damaged skin.
A patient presents to the clinic with erythematous vesicles on the face and chest. Some vesicles have broken open, revealing a moist, shallow, ulcerated surface; some have scabbed over. Which of the following infectious illnesses does the nurse suspect? A. Varicella B. Measles C. Roseola D. Herpes simplex
A. Varicella. Rationale: Varicella (chicken pox) is a highly contagious infectious disease. It occurs most frequently in children. It is characterized by single to multiple erythematous vesicles anywhere on the body. As the disease progresses, the vesicles progress into shallow ulcers covered with scabs. Measles is a rash of macules and papules. Herpes simplex is generally localized to one area of the body and consists of grouped vesicles on an erythematous base. Roseola is a macular and papular rash.
What is the function of the lymphatic system and what does it consist of?
Function is to maintain fluid and protein balance and functions with the immune system to fight infection. It consists of the lymph nodes, lymph vessels, spleen, tonsils, and thymus.
What is Murphy's sign?
Place 2 fingers at liver boarder, have patient hold breath, and when they release they feel pain. Do this with GALLBLADDER.
What type of cells line the inner layer of all blood vessels and play a critical role in the prevention of platelet adhesion and thrombus formation?
Smooth endothelial cells; injury to the endothelial layer contributes to the development of atherosclerosis
What are venous hums and what do they indicate?
Soft-pitch humming noise in the vessels. There is a systolic and diastolic component. Normal finding in children and in pregnancy. Venous hums indicate partial arterial obstruction.
Arterial ulcers vs Venous ulcers? Occlusion results in what for each? What are the diagnostic testing for each?
ARTERIAL ulcers result from chronic ISCHEMIA as a consequence of poor arterial circulation to an extremity. Usually located distally BELOW THE ANKLE, on the ends of toes or fingers. Generally painful. Occlusion of arteries results in seven P's. Use an arteriogram to diagnose. VENOUS ulcers develop from chronic POOLING of blood in the extremities. Usually occurs BETWEEN THE ANKLE AND THE KNEE in a "gaiter" distribution. Generally painless. Occlusion of veins results in DVT. Use a serum D-dimer and ultrasound to diagnose. Intervene with anticoagulants.
Describe the grading system of Wagner's Classification of Ulcers.
Aim is to PREVENT infection while wound is healing. 0 - preulcerative lesion, healed ulcers, presence of bony deformity 1 - superficial ulcer without subq tissue involvement 2 - penetration through the subq tissue (may be expose bone, tendon, ligament, or joint capsule) 3 - osteitis, abcess, or osteomyelitis 4 - gangrene of the forefoot 5 - gangrene of the entire foot
What are the ways to assess for arterial occlusions? Complete arterial occlusion is a medical emergency as it is a limb-threatening situation. What are the symptoms of complete arterial occlusion?
Allen test Pain, numbness, coolness, or color change.
What vessel has more smooth muscle and is where blood pressure is controlled?
Arterioles
Name the ABCDE's of melanoma detection.
Asymmetry Boarder irregularity Color variety Diameter of more than 6mm Evolution of lesion over time
The ABCDEs of melanoma identification do not include A. Asymmetry: one half does not match the other half. B. Birthmark: café au lait spot that does not fade. C. Color: pigmentation is not uniform; there may be shades of tan, brown, and black as well as red, white, and blue. D. Diameter: greater than 6 mm. E. Evolving: any change in size, shape, color, elevation—or any new symptom such as bleeding, itching, or crusting.
B. Birthmark: Café au lait spot that does not fade. Rationale: The B in ABCDE stands for irregular border of the lesion.
When assessing the lower extremities, it is critical that the examiner A. starts at the feet. B. compares side to side. C. evaluates the venous system and then the arterial system. D. starts at the femoral area.
B. Compares side to side. Rationale: Bilateral comparison is essential for accurate assessment of the peripheral vascular system.
A patient with diabetes mellitus who closely monitors and controls her blood glucose level is very interested in preventing complications of her illness. Which teaching is a priority for the patient related to peripheral vascular circulation? A. How to count calories. B. How to assess her feet daily. C. Choosing complex carbohydrates D. Identifying venous insufficiency.
B. How to assess her feet daily. Rationale: Meticulous foot care is essential for patients with diabetes to prevent complications of ulcers.
While reviewing laboratory values for thyroid function in an adult patient, the nurse sees that the TSH is elevated, and T3 and T4 are decreased. The nurse recognizes that these findings are indicative of A. normal thyroid function. B. hypothyroidism. C. hyperthyroidism. D. thyroid cancer.
B. Hypothyroidism. Rationale: With hypothyroidism, TSH from the pituitary gland usually is increased. Because of decreased thyroid function, there is a decrease in circulating thyroid hormones as measured by T3 and T4 levels in the blood.
A dorsalis pedis of +1/4 may indicate A. DVT. B. PAD. C. Raynaud disease. D. Lymphadenopathy.
B. PAD. Rationale: A weak pulse is most closely correlated with PAD.
A patient with a history of cirrhosis tells the nurse that his abdomen seems to be getting larger and that he has gained 9.7 kg (20 lb) in the past 6 months. How will the nurse determine whether the abdominal enlargement is from accumulation of fluid or fat from the weight gain? A. Listen for a fluid wave B. Percuss the abdomen for shifting dullness C. Auscultate for lymph nodes D. Stroke the abdomen to elicit the abdominal reflex
B. Percuss the abdomen for shifting dullness. Rationale: Percussing elicits a change from tympany to dullness when the abdomen is in its most dependent position. Fat remains static.
A patient has several red, inflamed, superficial, palpable lesions containing a thickened yellowish substance. How would the nurse document this lesion? A. Papule B. Pustule C. Cyst
B. Pustule. Rationale: Pustules are palpable erythematous lesions containing pus or other infectious material. Papules are solid. Cysts can contain serous as well as infectious substances and extend into the deeper layers of skin. Vesicles are small, thin-roofed lesions containing clear serous fluid.
Which of the following peripheral vascular diseases is not known to have a hereditary component? A. Lymphadenopathy B. Raynaud disease C. Abdominal aortic aneurysm D. PAD
B. Raynaud disease. Rationale: Raynaud disease has an unknown etiology.
Which of the following descriptions is most consistent with a patient who has hypothyroidism? A. Slightly obese, perspiring female, who complains of feeling cold all the time and having diarrhea. B. Slightly obese female with periorbital edema, who complains of cold intolerance, brittle hair, dry skin. C. Thin, anxious-appearing female with exophthalmos and a rapid pulse and who complains of diarrhea. D. Thin, perspiring male with a deep hoarse voice, facial edema, a thick tongue, and reports of diarrhea.
B. Slightly obese female with periorbital edema who compaints of cold intolerance, brittle hair, and dry skin. Rationale: The patient with hypothyroidism would likely demonstrate clinical signs and symptoms of a low metabolic rate resulting from relative depletion of circulating thyroid hormone.
A patient reports changes in bowel pattern. Which is the best question to determine normal bowel habits? A. How often do you have a bowel movement? B. What was your bowel pattern before you noticed the change? C. Is there a family history of irritable bowel syndrome? D. Have any of your parents or siblings had cancer of the colon?
B. What was your bowel pattern before you noticed the change? Rationale: Determining the patient's bowel pattern before symptoms began is most valid in establishing the normal pattern.
Gallbladder referred pain to where?
Back and scapula
What is a barium enema used for? What patients should you not give it to?
Barium enema used to assess GI function, such as constipation, IBS, tumors, etc. You should not give this to patients with any kind of rupture.
What are the symptoms of AAA? What are the symptoms if it dissects/ruptures?
Bruits and laterally pulsating abdominal mass. Chest pain, abdominal pain, back pain, SOB
What are the common symptoms of nueropathy?
Burning pain, numbness, paresthesias
Which of the following is a normal ABI? A. 56 B. 87 C. 1.0 D. 24
C. 1.0. Rationale: A normal ankle-brachial index (ABI) is 1.0 to 1.29. All other options represent problematic findings.
The nurse is admitting a 75-year-old man with a 50-year history of smoking 1 pack of cigarettes per day. Among the patient's concerns is his chronic shortness of breath. One nail finding that demonstrates chronic hypoxia is: A. pitting. B. thickening and discoloration of the nail bed. C. clubbing. D. brittleness and cracking of the nails.
C. Clubbing. Rationale: Chronic hypoxia decreases oxygenation of the distal extremities. Associated clubbing changes will be evident.
Physical examination of a patient reveals an enlarged tonsillar node. Acutely infected nodes would be A. hard and nontender. B. fixed and soft. C. firm but movable and tender. D. irregular and hard.
C. Firm but movable and tender. Rationale: Infected lymph nodes are usually tender. Fixed, hard, or irregular nodes should be further evaluated as a sign of possible cancer.
A patient with a history of kidney stones presents with complaints of pain, hematuria, and nausea with vomiting. What assessment technique will elicit kidney pain? A. Inspection with indirect lighting B. Iliopsoas muscle sign C. Indirect percussion for CVA tenderness D. Blumberg sign
C. Indirect percussion for CVA tenderness. Rationale: Fist percussion over the costovertebral angle (CVA) is the only technique listed that reflects a technique for assessing the kidney. The two specialty techniques are used to assess peritoneal inflammation.
When performing an abdominal assessment, what is the correct sequence? A. Inspection, palpation, percussion, auscultation B. Palpation, percussion, inspection, auscultation C. Inspection, auscultation, percussion, palpation D. Auscultation, inspection, palpation, percussion
C. Inspection, auscultation, percussion, palpation. Rationale: For the abdomen, auscultation must be performed before percussion and palpation to prevent minimizing bowel sounds.
A history of smoking has an extremely significant role in the development of which of the following? A. Venous insufficiency B. DVT C. PAD D. Raynaud disease
C. PAD. Rationale: Smoking is one of the most devastating risk factors for peripheral arterial disease (PAD).
When assessing hydration, the nurse will A. pinch a fold of skin on the medial aspect of the forearm and observe for recoil to normal. B. pinch a fold of skin on the abdomen and observe for recoil to normal. C. pinch a fold of skin just below the midpoint of one of the clavicles and allow the skin to recoil to normal. D. pinch a fold of skin on the head and allow for skin to recoil in children.
C. Pinch a fold of skin just below the midpoint of one of the clavicles and allow the skin to recoil to normal. Rationale: To assess turgor in an adult, the most reliable method is to pinch a fold of skin on the anterior chest, release, and observe for the skin to promptly recoil to its original state.
The seven Ps of an acute arterial occlusion include A. polythermia. B. popliteal pallor. C. poikilothermia. D. pitting edema.
C. Poikilothermia. Rationale: The seven "Ps" are pain, polar (poikilothermia), paresthesia, paralysis, pallor, pulse, and perfusion.
When auscultating the abdomen, the nurse hears a bruit to the right of the midline slightly below the umbilicus. The nurse documents this finding as a bruit of which of the following? A. Right renal artery B. Right femoral artery C. Right iliac artery D. Abdominal aorta
C. Right iliac artery. Rationale: The iliac arteries are located to the left and right of the midline of the abdomen, below the umbilicus. The aorta is midline, the renal artery is above the umbilicus, and the femoral artery is located in the groin.
The nurse can best evaluate the strength of the sternocleidomastoid muscle by having the patient A. clench his or her teeth during muscle palpation. B. bring his or her head to the chest. C. turn his or her head against resistance. D. extend his or her arms against resistance.
C. Turn his or her head against resistance. Rationale: The sternocleidomastoid muscles play an important role in turning the head from side to side. Asking the patient to turn the head against resistance is one way to determine that the strength of these muscles is symmetrical and equal.
What diagnostic tests are used to evaluate headaches?
CT, MRI, and lumbar puncture
When one extremity is red, swollen, pitting edema, and painful, what does the nurse do?
Call the doctor.
When someone falls and lands on their head, what is the vertebrae we are most concerned about?
Cervical
What are the common symptoms of peripheral artery disease (PAD)? What are the risk factors?
Common symptoms: Claudication and rest pain Risk factors: smoking, HTN, diabetes, peripheral neuropathy
What is ankle-brachial index (ABI)? What populations should this be assessed in? How is it assessed? What is a normal ABI?
Comparison of the brachial vs ankle pulse to assess for arterial insufficiency (PAD). Screening for high risk groups - Individuals >65y/o, 50-64y/o with risk factors and family history, <50 with diabetes and one additional risk factor, and individuals with vascular disease. It's assessed by using a doppler scanner and BP cuff on arm and then ankle. Normal: 1-1.40
What is uremic frost?
Crystallized urea deposits, itchy Indicative of Kidney/Renal failure
While assessing the skin of a 24-year-old patient, the nurse notes decreased skin turgor. The nurse should further assess for signs and symptoms of A. hyperthyroidism. B. hypothyroidism. C. malnutrition. D. dehydration.
D. Dehydration. Rationale: When water is lost from subcutaneous tissues, the skin becomes less elastic. The result is "tenting," which results when the skin is pulled away from the body and released. This is a sign of possible dehydration.
All of the following skin lesions may be papular except A. warts. B. acne. C. nevi. D. herpes zoster.
D. Herpes zoster. Rationale: The lesions of herpes zoster are vesicular, warts and nevi or moles are benign papules, and acne lesions include papules as well as pustules.
Which assessment technique best confirms splenic enlargement? A. Deep palpation under the left costal margin B. Fist percussion of the spleen with the patient in a sitting position C. Deep palpation over the RUQ with the patient lying on the right side D. Percussion along the left MAL spleen and gentle palpation
D. Percussion along the left MAL spleen and gentle palpation. Rationale: Percussion is the best technique to estimate the size of the spleen; gentle palpation is necessary to reduce the risk of splenic rupture.
Which of the following best describes the instructions the nurse should give a patient when assessing the thyroid from the posterior approach? A. Please tilt your head back as far as possible. B. Please turn your head as far to the right as you can. C. Please bring your chin down toward your neck. D. Please tilt your head slightly down and to one side.
D. Please tilt your head slightly down and to one side. Rationale: During assessment of the thyroid, it is helpful for the patient to relax the sternocleidomastoid muscle by turning the head slightly and lowering it slightly toward the chin. This position makes it easier for the nurse to palpate each lobe of the thyroid.
A patient reports swelling in her ankles. How would the nurse proceed with physical examination? A. Have the patient elevate her feet to better visualize her ankles. B. Measure her ankles at their widest point. C. Evaluate further for the brown hyperpigmentation associated with venous insufficiency. D. Press the fingers in the edematous area evaluating for a remaining indentation after the nurse removes his or her fingers.
D. Press the fingers in the edematous area evaluating for a remaining indentation after the nurse removes his or her fingers. Rationale: Swelling requires evaluation for pitting edema.
A patient presents with a complaint of drooping of the eyelid on one side. This finding is documented as which of the following? A. Kernig sign B. Pharyngitis C. Thyroglossal cyst D. Ptosis
D. Ptosis. Rationale: Kernig sign is found with meningitis. Pharyngitis is inflamed and sore throat. A thyroglossal cyst is a birth defect mass found in the neck.
What is a macule?
Flat, circumscribed, discolored, LESS THAN 1CM DIAMETER Ex: freckles, tattoo, stork bite
What is a vesicule?
Fluid-filled, LESS THAN 1CM DIAMETER Ex: herpes simplex, chicken pox
What percussion sound is heard over most of the abdomen? A. Resonance B. Hyperresonance C. Dullness D. Tympany
D. Tympany. Rationale: The small intestine and colon, which are hollow organs, are predominant over most of the abdominal cavity. The result is tympany as the percussion sound.
What is a zosteriform rash?
Distributed along a dermatone Ex: herpes zoster (shingles)
Where do the bilateral upper extremities (BUE) drain lymph?
Drains into the epitrochlear, axillary, and infraclavicular nodes
Where do the bilateral lower extremities (BLE) drain lymph?
Drains into the inguinal nodes
What allows arteries to constrict and recoil with systole and diastole?
Elastic fibers
What is a keloid?
Excessive fibrosis tissue replacement, resulting in enlarged scar and deformity. Ex: injury
Differentiate between hypothyroidism and hyperthyroidism. How do we examine the thyroid? What are the diagnostic tests?
HYPOthyroidism: SLOW metabolism HIGH TSH, LOW free T4, LOW total T3, LOW total T4 Fatigue Anorexia COLD intolerance Brittle coarse hair Menstrual irregularities WEIGHT GAIN or difficulty losing weight Decreased libido Hoarse/slow speech Cool dry/coarse skin BRADYCARDIA Delayed reflexes HYPERthyroidism: FAST metabolism LOW TSH, HIGH free T4, HIGH total T3, HIGH total T4 Fatigue WEIGHT LOSS Anxiety Palpitations/rapid pulse HEAT intolerance Fine limp hair Diaphoresis Muscle weakness Eyelid retraction/ eyelid lag, finger tremor Moist/warm skin TACHYCARDIA Brisk reflexes Palpate the area as the patient takes a sip of water/swallows Diagnostic tests: T3, T4, and TSH
How do you assess the abdomen? How long do you listen to the abdomen before documenting "absent bowel sounds"?
IAPP: Inspect Auscultate Percuss Palpate 5 minutes
Where does the exchange of nutrients, gases, and metabolites between vessels and tissues occur?
In the capillary beds
What are beau lines?
Indention in the nail. Results from slowed or halted nail growth in response to illness, physical trauma or poisoning.
Where is the thyroid located?
Just below the cricoid cartilage.
What are the qualities of a cancerous lymph node? An enlarged anterior cervical lymph node is evidence of what?
Lymph nodes that are non painful, larger than 1cm, fixed, irregular, hard, or rubbery. Infection upstream. Normal lymph nodes should be non-palpable and non-tender.
What infection is suspected with inflammation of the posterior cervical lymph nodes?
Mono
Which organs lie in the RUQ?
Most of the LIVER, small portion of the stomach, GALLBLADDER, duodenum, right KIDNEY, right ADRENAL gland, pancreas, some of the small intestine and colon
What is neck pain usually related to?
Neck pain is usually related to muscle tension/spasm. However; neck pain can be indicative of a cardiac issue. Neck pain, fever, and headache can be indicative of meningitis
CVA tenderness is associated with what diagnoses?
Nephrolithiasis (kidney stones), pyelonephritis (kidney infection), or kidney inflammation
Is longitudinal ridging an abnormal finding?
No, it is NORMAL. Seen more with aging.
What is delayed capillary refill? What is normal/expected?
Normal is <3 secs; DELAYED is 5secs
What infection is suspected with inflammation of the posterior auricular lymph nodes?
Otitis media
What infection is suspected with inflammation of the anterior cervical lymph nodes?
Phayngitis
What can result from deep vein thrombosis (DVT)? What are the signs and symptoms of DVT? What intervention should be put in place?
Pulmonary embolism (PE) can result from a DVT. The signs of DVT are pain, warmth, erythema, and unilateral edema of an extremity. Immediate intervention of anticoagulants is necessary to prevent extension of the clot. ** DVTs are more prone to occur after surgery.
What is a papule?
Raised, defined, any color, LESS THAN 1CM DIAMETER Ex: wart, insect bite, molluscom contagiousum
Plaque
Raised, defined, any color, MORE THAN 1CM DIAMETES Ex: psoriasis, lichen sclerosis
What is a Bull's Eye Rash?
Rash with an iris in the center Ex: lyme disease, erythema nodosum
What is the Blumberg sign?
Rebound tenderness with release of pressure, seen a lot in APENDESCITIS.
What is clubbing of the fingers and in what diseases do we see this?
Results from chronic hypoxia to distal fingers. Seen in emphysema and congestive heart failure.
What is Rovsing's sign?
Rovsing's sign (a.k.a. indirect tenderness) is RLQ pain elicited by pressure applied on the LLQ. Indicated acute APPENDESCITIS.
What node is the first node that exchanges fluid and lymph with cancer cells?
Sentinel node
What is onycholysis?
Separation of a portion of the nail plate from the nail bed; results in opacity to the affected part of the nail, appearing white with yellow growth. Common causes are trauma, fungal infection, topical irritants.
List some potentially life-threatening symptoms that require prompt attention.
Severe dehydration- causes nausea, vomiting Fever Acute abdominal, pelvic, or thoracic pain Abdominal rigidity (hot abdomen/peritonitis) - do NOT palpate ** do not confuse ascites with a hot abdomen, ascites is chronic, not acute
What is the burn classification system?
Superficial - BRISK bleeding, PAIN, RAPID capillary refill, moist and red Superficial dermal - BRISK bleeding, PAIN, SLOWED capillary refill, dry and pale pink Dermal - DELAYED bleeding, NO pain, NO capillary refill, mottled cherry red color Full thickness - NO bleeding, NO pain, NO blanching, dry, leathered, or waxy hard wound surface
What is the most common sign of thyroid storm?
Tachycardia. Thyroid storm causes HYPERmetabolism in all body systems.
What is the stemmer sign?
The inability to pinch skin due to swelling, like in lymphedema and edema.
What is McBarney's point?
The point in the RLQ at which direct tenderness is maximal in cases of acute APPENDESCITIS.
What are the major muscles of the neck?
The sternocleidomastoid and trapezius.
What are the different types of skin glands?
The sweat glands are eccrine and apocrine glands. There's also the sebaceous glands. Eccrine glands cover most of the body, with numerous on the palms and soles. Eccrine glands open directly onto the skin surface and secrete a weak saline solution (sweat) in response to environmental or psychological stimuli. Sweat assists in THERMOREGULATION. Apocrine glands are located in the axillae and genital areas, and open into hair follicles and become active during puberty. Apocrine glands secrete a thicker MILKY SWEAT and mixes with bacteria to create a musky BODY ODOR. Functioning of apocrine glands decreases with age. Sebaceous glands are located throughout the body, EXCEPT the palms and soles, and open into hair follicles. These glands secrete SEBUM, which assists the skin with moisture retention and friction protection. INFLAMMATION of the sebaceous glands may cause ACNE.
What is the purpose of deep palpations?
To assess MASSES, TUMORS, organs for shape and size, determine any deep tenderness, rebound tenderness.
What is the Allen test used for?
To assess collateral circulation
When is the homan sign used? What test is now used instead?
To assess for presence of DVT. This test proved to be inaccurate, so now we use the Wells Score System. It is often used in conjunction with the D-dimer and venous duplex scan.
What is the Trendelenburg test used for?
To assess the saphenous vein valve competency.
What is the whisper test used for?
To evaluate for loss of high-frequency sounds.
In what disease do you see koiyloinchia (spoon nails)?
Trauma, iron deficiency anemia, and hemochromatosis
What are T3 and T4?
Triiodothyronine and thyroxine. They are thyroid hormones which control metabolic rates that affect almost every body system.
What are the 3 layers of arteries and arterioles?
Tuinca intima Tunica media Tunica externa
What is turgor? Where is it assessed?
Turgor is the rapid return of flat skin after it's pinched. It is assessed at the subclavicular.
What is Psoas sign?
When leg is raised and you push down on it and the patient feels pain. Indicates APPENDESCITIS.
How does lymphedema occur? What is the common symptom? What is primary vs secondary lymphedema? What common procedure causes lymphedema?
When the amount of lymph in the interstitial tissue exceeds the capacity of the lymphatic vessels. Common symptom of lymphedema is unilateral edema. Primary lymphedema is congenital and secondary lymphedema may result from scarring, removal of lymph nodes, radiation therapy, or chronic infection. Mastectomy is a common procedure that can cause lymphedema.
What is a fluid wave?
When you tap the abdomen and see a ripple, often seen with ASCITES.
What is abdominal reflex?
Where the provider stroke each quadrant of the abdomen and the umbillicus will move towards the area.
What are the common symptoms of chronic venous insufficiency?
edema of the extremity and dull, aching pain
What organs lie in the LLQ?
left ureter, reproductive organs, SIGMOID COLON
What is the Wallace Rule of Nines?
to estimate % of total body surface area burned in adults. the head (both anterior and posterior) is 9%, anterior thorax is 18%, posterior thorax is 18%, left arm 9%, right arm 9%, pubic area 1%, right leg 18%, and left leg 18%
