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