HA FINAL
Milia
*Your patient is 2 weeks old. During your assessment you note that she has pinhead size, smooth, white, raised...forehead. You document this as (a):
Grade 3
58 year old dentist presents to your office for a routine checkup. He has been healthy. He is a nonsmoker and does not drink alcohol. On physical examination of the heart, you hear a moderately loud murmur, and there is no palpable thrill. What is the grade of this murmur?
Oral cancer
A firm, painless, relatively fixed submandibular node would most likely indicate what diagnosis:
Recent antibiotic use (candidiases)
A young adult female client presents with a history of vaginal itching and heavy white discharge. The client gives a history of no sexual activity. On exam, the nurse practitioner finds a red, edematous vulva and white patches on the vaginal walls. There is no odor to the discharge. The nurse practitioner expects what factor in the client's history?
norm: feel xyphoid process, liver edge, muscle borders, cecum/ascending colon, sigmoid, full bladder
Abdomen: Deep Palpation
4 years
At what age do children approximate adult vision?
indirect fist percussion causes tissues to vibrate place hand over 12th rib at CVA thump hand with ulnar edge of fist norm: thud no pain abn: pain occurs w/ inflammation of kidney or paranephric area
Costovertebral Angle (CVA) Tenderness
Dermatophyte
Lou F., a 50 year old homeless man is diagnosed with tinea capitis. You realize this is caused by a(n):
Rovsings
Palpation of abdomen elicits pain in RLQ by palpation of LLQ. Positive what?
Cerebellum
Tandem gait tests (part of brain):
anosmia
Upon examination of Sam, you note a loss of the sense of smell. You document this as
Mitral stenosis
a 60 year old landscaper presents.... early diastolic sound as opening snap.
palpate aortic pulsation 2.5 cm - 4cm wide in adult abn: widened w/aneurysm
abdominal aorta palpation
small, solid, raised lesion on surface of the skin solid, elevated, circumscribed, < 1cm eg: elevated nevus (mole), molluscum, wart (verruca)
papule
ecchymosis at the umbilicus due to retroperitoneal bleed
what is Cullens sign?
superficial, raised, transient, erythematous, irregular eg: insect bite, allergic reaction
wheal
Bulla
*A circumscribed, elevated lesion > 1 cm in diameter and containing clear serous fluid is best described as a:
Refer immediately to a dermatologist
*An adult female presents with an irregular variegated nevus on her lower left back that has doubled in size in the...NP should:
Basal cell carcinoma
*An elderly retired farmer presents with a rolled border, pearly, firm nodule with telangiectasis on his nose. In...the nurse practitioner recognizes this to be:
A new 2-mm mole that is brown with a red, irregular border, and is occasionally pruritic.
*In performing a skin assessment, the NP understand that the following characteristics of a mole that requires intervention:
Macule
*On examination of a client's skin, the nurse practitioner finds a lesion that is about 0.75 cm in diameter, brown, nonpalpable. The correct term for this lesion is:
B (bridging): connection across sides
*The ABCDs of melanoma identification includes all of the following except:
A circle or ring shape.
*The NP describes an annular skin lesion usually arranged in:
Dark eyes.
*The NP educating patients realizes that risk factors for skin cancer include all except:
Rough, thickened epidermis; accentuated skin markings
*The history and physical of a client indicated past occurrences of lichenification. The NP identifies the lesion as:
Intense intermittent sun exposure
*Which of the following in a client's history would place the client most at risk for melanoma?
Actinic keratosis
*Which skin lesions are directly related to chronic sun exposure and photo damage?
not until you are 21
19 yo pt calls to ask if she should have PAP. What do you say?
wheezing on inspiration and expiration
21 yo college senior comes to campus clinic because she's been increasingly SOB for past 3 days. History of asthma but had been well controlled with medication. Pt has had sxs of UPI and temp as high as 100.8. Rescue inhaler is being used more frequently. On PE, what sound would you expect to hear?
class 3
52 yo with known CHF reports dyspnea with minimal exertion. What NYHA class is she?
grade 3
58 yo dentist presents for routine checkup. On PE of heart, you hear: Moderately loud murmur, and NO palpable thrill. What appropriate grade?
Diffuse apical impulse greater than 3.0cm that occupies more than 1 interspace
70yo farmer comes for checkup. Hx of chronic congestive HF but condition well controlled by meds. Pt in L lateral decubitus position, most likely finding when palpating for his apical impulse?
Testicular torsion
A 15-year-old high school student is brought to the emergency room by his father because of the sudden onset of excruciating pain in his right testicle. The pain started 2 hours prior and has gotten worse in intensity. He denies fever, chills, or urethral discharge. He is not sexually active. On physical examination, the testicle is swollen and tender to palpation. It appears to be retracted upward in the scrotum. He has no other evidence of infection. What is your most likely diagnosis?
Osgood-Schlatter disease
A 15yo male patient presents w/complaints of pain and swelling of the left knee, he plays high school basketball. On physical exam, you note tenderness over the anterior tubercle of the left knee. Which of the following is the most likely?
Genital herpes
A 19-year-old college student presents to the Student Health Clinic because she has noticed a growth on her vagina. She is sexually active. She denies fever, chills, abdominal pain, or vaginal discharge. On physical examination, you see four shallow, small, painful ulcers with red bases. What is your most likely diagnosis?
Wheezes during inspiration and expiration
A 21 year old college senior comes to campus clinic...asthma...physical examination of the lungs, what sound would you expect to hear?
Sty (hordeolum)
A 22-year-old nursing assistant presents to your clinic because of a painful bump on the edge of her eyelid that appeared this morning. On physical examination, there is an erythematous bump that is tender to palpation on the lower lid margin, located around a hair follicle. What is your most likely diagnosis?
Obtunded
A 22-year-old woman is brought to the emergency room for evaluation of changes in her mental status. You are the first to examine her. She is able to open her eyes and look at you but responds slowly and is somewhat confused. She is not interested in her current surroundings. You would characterize her level of consciousness as:
Tinel's test
A 23-year-old computer programmer presents to your office for evaluation of numbness in his fingers. Initially, he noticed that the numbness gradually worsened during the day, but it is now present upon awakening. On physical examination, his thenar eminence is atrophic, and you localize the numbness to the thumb, second finger, and part of the third finger on the dorsal surface. Which test would you perform to confirm your tentative diagnosis?
Bartholin's cyst
A 25-year-old executive assistant presents to the family practice clinic because of a painful bulge in her vagina. The bulge initially appeared 3 days ago and has increased in size. She denies fever or chills. The patient is sexually active in a monogamous relationship. On physical examination, she has a tense, hot, tender circumscribed mass beneath the labia. There is erythema around a small opening. What is your most likely diagnosis?
median nerve There would not be a normal shoulder, forearm and arm exam if axillary, ulnar, or radial nerves were involved
A 28-year-old pharmaceutical sales representative comes to the clinic because she has had pain in her wrists accompanied by tingling in the thumb, second finger, and third finger of both hands for the past several months. On physical examination, she has atrophy of the thenar eminence and weak opposition of the thumb. Examination of the forearm, arm, and shoulder are normal. These findings are most consistent with damage to which one of the following nerves?
Varicocele
A 29-year-old radio disc jockey comes to your office because he has noticed a mass on his testicle. He denies fever or chills. He is in a monogamous relationship with his wife. They have been married for 5 years and have been unable to get pregnant, although they have been trying for the past 2 years. On physical examination, the appearance of his penis is normal. He has a soft rubbery mass in the left scrotum, near the testis. It does not transilluminate. When the patient is supine, the mass slowly collapses. What is your most likely diagnosis?
otitis media acute- red serous- yellow/amber chronic- loss of landmarks
A 3-year-old boy is brought to the office because he has had a fever and has been tugging on his right ear since yesterday. He has had clear drainage from his nose. On physical examination of the ear, the right tympanic membrane is red and bulging with loss of landmarks. There is no purulent drainage. What is your most likely diagnosis?
Mitral Valve Prolapse (MVP)
A 30 year old female is at the office c/o palpitations and some light-headedness for the past 6 months...the NP notices a mid-systolic click with a late systolic murmur heard best in the apical area during auscultation of the chest. You would suspect:
Bacterial vaginosis
A 33-year-old environmental scientist presents to the clinic because she has had a *foul-smelling discharge from her vagina for the past 3 weeks. She has tried to douche, but it has not improved the odor. She denies itching or burning. On physical examination, you see a *gray, thin, homogenous discharge in the vagina without discharge from the cervix. The *discharge has a musty odor. The vulva and vaginal mucosa appear normal. You obtain a sample for a wet mount and see epithelial cells with irregular and *broken membrane borders. What is your most likely diagnosis?
Bloody
A 34 year old woman notes that she has had breast nipple discharge for 2 months...which of the following characteristics is the most concerning?
Rotator cuff tear
A 40-year-old accountant presents to the office for pain in his right shoulder with decreased ability to move. He played the position of pitcher on his college baseball team and had injured his shoulder at that time; however, with physical therapy, he had a full recovery. Over the past weekend, he was moving furniture into a new office, including file boxes. He has normal bulk of the muscles of the shoulder. He has pain to palpation of the supraspinatus and infraspinatus muscles. He has severely impaired abduction of the right glenohumeral joint & + drop arm. Based on this information, what is your most likely diagnosis?
Cranial Nerve VII
A 42-year-old welder comes to the emergency room because he has noticed drooping in his face and a constantly watering right eye. He had an upper respiratory infection 2 weeks before these symptoms started. On physical examination, his pupils are equal, round, and reactive to light and accommodation; the right side of his face droops both above and below the forehead when he tries to smile; and he is unable to close his right eye completely. There is no tongue deviation. You diagnose him with Bell s palsy. Which cranial nerve is affected in this condition?
Cranial Nerve VII
A 42-year-old welder comes to the emergency room because he has noticed drooping in his face and a constantly watering right eye. He had an upper respiratory infection 2 weeks before these symptoms started. On physical examination, his pupils are equal, round, and reactive to light and accommodation; the right side of his face droops both above and below the forehead when he tries to smile; and he is unable to close his right eye completely. There is no tongue deviation. You diagnose him with Bell's palsy. Which cranial nerve is affected in this condition?
Cervical polyp
A 45-year-old nurse presents to the gynecologist for her annual checkup. She is currently divorced and is sexually active; she has had more than 10 partners in her lifetime. On physical examination, you see a bright red, pedunculated mass protruding from the cervix. What is your most likely diagnosis?
Referral for biopsy
A 52 year old woman has a palpable breast lump. An attempt at FNA does not results in aspiration of fluid. Her mother was diagnosed with breast cancer...does not smoke but socially drinks alcohol. She currently uses low-dose estrogen contraception. Which of the following is the appropriate next step?
Leukoplakia
A 56 year old salesman comes to your office for evaluation of an area on his tongue that has been present 3 months and tries to brush it off when brushing his teeth but has been unsuccessful.
Right-sided heart failure
A 57 year old college professor is hospitalized for shortness of breath. As you examine her in the ER, you note her JVP @ 45 degrees is 7 cm above the clavicle. Understanding the formula for determining JVP in relation to the right atria, this finding is most consistent with which of the following diagnoses?
CHF
A 59 year old man with a known history of COPD presents with worsening dyspnea. On examination, he is afebrile, breath sounds are decreased bilaterally, he is noted to have JVD and 2+ pitting edema of the lower extremities. Which of the following is most likely causing this?
Parkinsonism
A 60-year-old lawyer comes to the office because he has had a progressively worsening tremor. He denies any family history of tremor. On physical examination, his tremor is most prominent at rest and decreases with voluntary movement. It has a slow, fine, pill-rolling quality. What is the most likely cause of the tremor?
Osteoarthritis
A 60-year-old sculptor comes to the office for treatment of pain in his fingers. He has a history of arthritis. On physical examination of the hands, he has nodules on the dorsolateral aspect of his proximal (PIP) & distal interphalangeal (DIP) joints R>L. These nodules are hard and painless. Based on this information, what type of arthritis does this patient have?
Acute gouty arthritis
A 65-year-old truck driver comes to the emergency room because he had a sudden onset of intense pain in his left great toe. He denies any trauma or injury to his foot. On physical examination, he has a red, swollen, painful metatarsalphalangeal (MTP) joint on the great toe. The swelling extends beyond the margin of the joint. He denies fever or chills. There is no fluctuance during palpation of the swollen area. What is your most likely diagnosis?
have patient bear down
A 66 yo man presents to your office to establish care. He has a history of hyperlipidemia and hypertension. He sees a cardiologist but cannot remember what his diagnoses are. He was told that he has a murmur that needs to be followed every year, which is why he came in for evaluation. On auscultation of his heart, you hear a midsystolic crescendoUdecrescendo murmur, best heard at the right second interspace and radiating into the neck. What maneuver do you use to accentuate this sound to help you make the diagnosis?
Cataract
A 70 year old client comes to the clinic complaining of blurred vision that has been getting increasingly worse over the last 2 years and the client also has a problem with glare but no problems with pain. The NP would first check for the presence of:
Primary prevention
A charitable foundation plans to build a community youth center in a large urban area with a history of gang violence. What type of health prevention is being done?
cystitis
A dancer from an adult club down the street comes in for renewal of her birth control pills. She says she is fine. Upon exam you find grayish-white vaginal discharge, greenish cervical discharge & + CMT. You might suspect all except.... gonorrhea cystitis bacterial vaginosis chlamydia
Murphy's sign, the client has cholecystitis
A middle-aged woman who is overweight had right upper quadrant pain that radiates to her right subscapular...The abdomen is tender in the right upper quadrant and, if there is a positive:
An inverted nipple
A patient states that she has had a rash on her breast for about 2 weeks. In order to determine if it is Paget's disease, you would expect to find all of the following on physical exam except:
Dullness on percussion
A positive clinical sign on the physical examination indicating pneumonia is:
Inflammation of the spleen
A positive fluid wave test may occur with all of the following conditions except:
trichomoniasis
A young women presents w/the Cc of "irritation in the vaginal area". This is the first time it has occurred. On examination you note the cervix to be inflamed and friable. Flagellated protozoa are seen on wet prep. The most likely diagnosis is:
A: assessment of risk, anticoagulation, anti platelet therapy B: blood pressure C: cholesterol, cigarrette, cessation D: Diet, diabetes prevention E: exercise
ABCDE approach to preventative cardiology
done for ascites, supine fluid settles by gravity into flanks ○ percuss top of abdomen to hear tympany ○ percuss down side and it changes to dullness ○ mark this spot ○ turn PT to side percuss upper side of abdomen downwards until you hear dullness ○ the fluid shifted w/movement indicating ascites it will not detect < than 500 ml
Abdomen: shifting dullness
Screening of women should be done at 65
According to the USPSTF guidelines for osteoporosis screening, what is true?
pink & scaly macule or papule d/t prolonged sun exposure
Actinic keratosis
Candidiasis
After a vaginal exam you prepare a slide with potassium hydroxide on wet preparation and visualize hyphae and pseudohyphae. Your diagnosis is
Condyloma acuminata
All of the following are associated with syphilis except:
It is most often found on abdomen or trunk
All of the following statements concerning basal cell carcinoma are true except:
Auscultation
All of the following tests require the patient's voice to perform correctly except:
Louder, harsher sounds
All of these are signs of abnormal breathing in the infant except:
Asymmetry between right and left sides
All these areas are important observations to make during a neuro exam. The most important exam is:
Venereal wart
An 18-year-old college student comes to the Student Health Clinic because he has found a growth on his penis. He has had 10 sexual partners in the past 2 years. He is unsure of his sexual partners' medical histories. Upon examination, you find a cauliflower-like growth that is somewhat moist on the surface of the circumcised penis. There is no inguinal adenopathy. What is your most likely diagnosis?
Mini-Mental Status Exam
An NP is evaluating an 85-year-old male from a nursing home. The NP instructs the patient to remember the words orange, street, and tiger. The patient is instructed to repeat these words back to the NP in 10 minutes. Which of the tests is being described:
Pneumonia
An abnormal symmetric expansion would be most likely noted on which of the following patients:
Decerebrate rigidity
An unconscious patient who appears to be approximately in his mid-40s is brought to the emergency room by the Emergency Medical Services (EMS) team. He has been unconscious for an unknown length of time. You note that his jaws are clenched and his neck is extended. His arms are adducted and stiffly extended at the elbows, with the forearms pronated and the wrists and fingers flexed. His legs are stiffly extended at the knees with the feet plantar flexed. What type of posture does this patient have?
Increase in average life expectancy
As an APN you believe strongly in anticipatory guidance and preventative education. You explain to your patient that the development of screening and prevention guidelines is based on:
What object is in his hand
As part of your neuro exam, you perform stereogenesis. You ask the patient to close his eyes and tell you
Ballotement sign
As the NP compresses the suprapratellar pouch back against the femur & feeling for fluid with Mrs. Staples, s/he is performing the
Kernig's
As the NP intensivist your patient in the ICU is exhibiting signs of meningeal irritation as you flex the knee then attempt to extend it. You would document this as a positive
A normal finding
As the NP you have given you patient the mini-mental exam. The patient scored a 29. This alerts you to the fact that:
inspection, auscultation, percussion, palpation
As you approach Lou with a c/o abdomenal pain, you recall that the proper order of assessing the abdomen is...
Vesicular breath sounds
As you approach your patient and begin your respiratory exam you ask yourself "what type of breath sounds are heard over the base of the lungs"?
Cushings disease
As you are assessing the abdomen you notice purple-blue striae. You suspect...
Thyroid
As you are getting your patient's history, you notice bilateral lid lag of the eye. You make a mental note to yourself to ask the patient about possible problems with:
History of alcoholism
As you assess Mr. Ray you note that he first notes + vibratory sense bilateral at knees. You would further assess for
Fatigue
As you assess Ms. Jones you recall that the most prevalent cardiac symptom is
Emphysema
As you assess Ms. L., you understand that dyspnea is basically a dysfunction with external respiratory physiology due to her
Emphysema
As you assess Ms. L., you understand that dyspnea is basically a dysfunction with external respiratory physiology. Due to her
Posterior column
As you assess above for stereogenesis (in the above question), you realize that you are testing which system?
Weber Test
As you assess the cranial nerves you realize that the best indication of an intact CN VIII is the ...
decerebrate rigidity extension is decerebrate, decorticate is felexed to the "core"
As you assess your patient in the ICU you note rigid posture w/legs stiffly extended and the feet plantar flexed. You document...
Endocarditis
As you assess your patient you document Oslers nodes. You realize this could be a sign of:
Epicondylitis
As you enter a room to see a patient you note a diagnosis of "Golfer's "elbow. You realize that this is
BPH
As you examine Mr. Gander, age 67, you note a "boggy" prostate. What do you suspect??
Asthma
As you gather a history from a patient with atophic dermatitis, what other items in the personal or family history would you see with this patient?
Cerebellar function
As you instruct your patient to perform the Romberg test, you realize that you are assessing his
Appendicitis
As you palpate the abdomen, + rebound tenderness at McBurney's point would alert you to:
History, exam, and decision-making
As you review your note for Mr. P, you realize the keys to select the right level for billing include:
softer and more distant
Auscultating lungs of obese patient.. you would expect breath sounds to be?
Place stethoscope just above symphysis pubis ML; Scratch downward from umbilicus 1cm when sound intensifies locates upper edge of bladder
Bladder scratch test
average risk: starting at 50 every 10 years positive family history: 40 yo or 10 years before person was diagnosed every 5 years Hereditary nonpolyposis/Lynch: starting at 20-25 every 1-2 years or 10 years before person was diagnosed Familial adenomatous polyposis: sigmoidoscopy or colonoscopy every year starting at 10-12 IBD (UC/Crohns): 10 years or sooner after being diagnosed
Colorectal Screening
Uses self-awareness and reflection
Cultural competence is best enhanced when the health care provider:
Fungi that cause infection of the hair, skin, and nails. body= tinea corpis= ringworm
Dermatophytes
CBC
During a routine H & P you note thin spoon shaped nails. You would want to order a...
This inversion may be a recent change.
During a routine physical examination of a 44 year old woman, you note that she has an inverted left nipple. You decide to investigate because:
+ Chadwicks
During examination of the cervical os, which of the following would be considered as a diagnostic finding?
Obtain a specimen for culture.
During examination of the male client's external genitalia, you observe a discharge from the urethra when compressing the glans. What is your best action?
Document the observation
During pulmonary assessment, you observe the client to have a diaphragmatic excursion of 4 cm bilaterally. What is your best action?
Presence of fluid or solid mass within the lungs.
During the assessment of a geriatric client's respiratory status, the NP determines the presence of increased tactile fremitus with:
Presence of fluid or solid mass within the lungs.
During the assessment of a geriatric client's respiratory status, the NP determines the presence of increased tactile fremitus:
Tell her to return in 1 week after her menses for a recheck
During the breast examination of a 30 year old nulliparous female, the NP palpates several rubbery multifocal areas in breat tissue. There are no skin changes and no nipple discharge. Which of the following interventions is the best:
Blurring of the nasal outline is normal
During the eye exam the NP should attempt to visualize the physiologic cup. Which of the following is true about the physiologic cup?
Calculate cardiac risk
During the physical exam of 72 yo Mary Rose, you note a BP of 140/90. According to JNC 8, what would you do first?
hydrocele
During transillumination of the scrotum a red glow is seen. This is most likely represents which of the following?
Ask about heat/cold intolerances
During your abdominal assessment you note purple striae. Your next step would be to:
mitral stenosis
Early diastolic sound best characterized by opening snap. Best heard just medial to apex and along the lower left sternal border... Diagnosis?
STDs
Elaine, age 20 is very concerned about her reproductive health. What is she most at risk for at this time?
mild rash illness most commonly in children "slapped-cheek" rash on the face and a lacy red rash on the trunk and limbs the rash may itch An ill child may have a low-grade fever, malaise, or a "cold" a few days before the rash breaks out. The child is usually not very ill, and the rash resolves in 7 to 10 days. Caused by human parvovirus B19 Adults may get it as well Before the rash develops they are contagious after rash develops no longer and may return to school
Fifth's Disease (Erythema Infectiosum)
positive dimpling and retraction of the lesion beneath the skin with lateral compression, seen w/ dermatofibromas
Fitzpatrick's sign
Liver atrophy
Harold Williams' abdominal exam includes a liver span of 3.0 cm MCL. Your assessment is:
grade 3+
How would you grade tonsils that touch the uvula?
lentigo maligna long-standing pigmentation of the middle third of the face that the melanoma develops from
Hutchinson's freckle
Associated w/abdominal pain /appendicitis Irritation of the underlying lateral iliopsoas muscle Place hand right thigh & push down as pt raises leg Pain in RLQ = + assoc w/ inflamed appendix
Iliopsoas muscle test
A change in testosterone
In an older man, gynecomastia may be secondary to:
HTN, DM, CHF
In assessing a patient with positive cardiac history, you utilize the CHADS scoring. What are the elements that this scoring system is based on to determine risk...
Increase
In assessing for pneumonia, you would expect to find an ________ in tactile vocal fremitus over the affected side. (increase of decrease)
Increase
In assessing for pneumonia, you would expect to find an ________ in tactile vocal fremitus over the affected side. (increase or decrease)
Mitral stenosis
In assessing murmurs, it is important to be able to document your findings. You come across documentation that states the murmur was found in the 5th ICS, timing of diastole with radiation to axilla. What type of murmur?
change in testosterone
In older man, gynecomastia may be secondary to..
multiple partners
In reviewing a patient's health history, she asks you what would be a risk factor for cervical cancer. You would mention:
a very thin patient
In which one of the following patients would a slight pulsation in the epigastric area be expected?
older adult
In which one of the following populations are liver spots most commonly noted?
BUN & Creatinine
In your assessment you note that Mrs. Angel has white nail syndrome. You order:
Pyelonephritis
In your examination of Gordon, age 28, you elicit left costo-verterbral angle tenderness. What do you suspect?
Bronchitis
James Jones is a 55 year old male smoker w/a thick sputum producing cough. Upon examination you note + tactile fremitus, resonant percussion, and normal voice sounds. You suspect:
Seat belt use
James is a 17-year-old patient who presents for a school physical. You have set aside time for screening prevention. Based on the leading cause of mortality for this student what should you discuss?
"No not until you are twenty-one."
Jane Smith age 19 calls about a Pap test, she wants to know if she should have one. Which information do you give/ask her?
Muscle strain
Jay Smith presents with abdominal pain. As you assess him you chart +AWT. This leads you to what possible diagnosis?
Subjective information
Jill Basket's daughter is explaining to you why her mother is here. This is an example of:
Stage 2
Joe Garden is a weekend athlete and explains his injury to you. He is able to point to the area of pain, there is a small area of ecchymosis and he has a slight limp. You would stage this strain as a
0.6 (1 is normal)
Joe Tiger presents with complaints of pain in his leg when walking that is relieved with rest. You perform an ABI. Which result would be consistent with physical symptoms?
refer to a specialist
Joe comes in for an evaluation after testicular self-examination. He states that his testicle doesn't hurt but he did find a tiny hard nodule. This is confirmed by your examination. Your plan is ....
A Hydrocele
John, age 20, presents with scrotal pain. You document + Transillumination of the scrotum. This is most likely
a palpated click
Larry 35, was playing tennis and injured his knee, within 12 hrs it was swollen and unstable. You perform a McMurray for a + documentation you would find
99211 - know this for anesthesia boards
Larry is a 25-year-old male who presents to have a TB test read. This visit should be billed at:
Tertiary prevention
Learning how to drive with a therapist after a stroke is considered:
Benign, chronic disease that affects the skin and oral mucosa salmon colored with slight amount of scale unknown cause- maybe autoimmune?
Lichen Planus
secondary lesion prolonged intense itching thickens skin produces increased visibility of skin furrows
Lichenification
Wheeze
Lilly age 3 months in being seen for a "cold", which physical finding is more common in the infant?
Apple shape
Lisa T. is a 53-year-old female who presents for a physical. According to the ABCDE approach to preventive cardiology, the items assessed for the "A" include all of the following except:
Begin RMCL in lung resonance until dullness percussed, find abdominal tympany and percuss up until tympany changes to dullness (mark both with pen). normal= 6-12 cm (longer in taller person)
Liver Span Percussion
Place stethoscope over the xiphoid while stroking the skin from the RLQ up the MCL When you reach the liver edge, the sound is magnified in the stethoscope
Liver scratch test
Ms. Smith a 42yo Caucasian female who is cachectic & takes prednisone 10mg daily for asthma
Looking at your list of patients for the day, you realize that which of the following individuals is at highest risk for osteoporosis:
L4/L5
Lou age 55, is a postal worker who drives a truck every day. He presents w/LBP and has decreased sensation to pinprick in the lateral leg and web of the great toe. This indicates which area of involvement?
flat skin lesion with only a color change flat, circumscribed, nonpalpable, small up to 1 cm a color change eg: freckle,measles, nevus solar lentigos- sun induced, well circumscribed, seen in older patients
Macule
Macules
Mary D., an 84 year old female has multiple solar lentingos < 1 cm. These are not uncommon for her age. You would document these as:
Straight leg raise
Mary Rose is c/o back pain upon physical exam you note a decreased Achilles DTR w/a corresponding sensory loss in her great toe. You would expect to find a positive
cholecystitis
Mary's physical examination is unremarkable except for RUQ tenderness & a positive Murphy's sign. Which of the following would be the most likely differential at this point?
rebound tenderness Associated w/peritoneal inflammation Apply several secs of pressure @ point quickly release Pain = + associated w/ appendicitis
McBurney's point
aortic stenosis
Medium-pitched harsh systolic murmur during a routine exam in right upper border of sternum. Which of the following is most likely the diagnosis?
CAD and DM
Middle-aged patient has a BMI of 29. You would tell him that he is at risk for
Murphy's sign= cholecystitis
Middle-aged woman, overweight, RUQ pain and radiates to scapular area, experiencing anorexia, Nausea, Fever. She just ate a double quarter pound hamburger with cheese, french fries. Tender abdomen and there is a positive:
CHTN
Most common cause for left ventricular hypertrophy in US?
Atrial fibrillation
Mr. Bear presents with a c/o excessive daytime sleepiness. Upon exam you document a man with a flushed face. SOB ambulating to the room, BM > 30, +JVD, +HJR, HTN. Your possible list of diagnosis includes all except:
Overweight
Mr. Bill presents to your office for a physical. You note that his BMI is 27. You inform him that this is considered...
ischial bursa
Mr. Henry presents with a c/o hip pain. In your focused assessment, you apply direct pressure to his mid buttock. You are assessing his ?
Vague symptoms & often little or no abdominal pain
Mr. Java is an 85 year old male, you realize that abdominal disorders in the older patient are more difficult to diagnose because they usually present with:
50% of visit
Mr. Jones is a new patient and newly diagnosed diabetes. You realize that in order to get reimbursed at a higher level for the diabetic education you have done, you must document the time spent on this education at least what percentage of the visit?
begin DRE & PSA at age 40
Mr. Jones is an AA male who is concerned about prostate cancer. What should you advise him to do?
When did it begin?
Mr. P complains of a "pain in his stomach". In your note you document his c/o pain in the LLQ radiating with increasing intensity to the umbilicus. Pain is a 6 (1-10 scale), he denies N/V/D. In order to have a complete HPI for your CPT code, what is missing?
Jugular
Mr. Random is being seen for SOB. You are assessing his neck veins and need to distinguish the jugular from the carotid. You understand that there is a change in respiration with the:
Hyperthyroidism
Mr. Smith has a + bruit upon examination of the thyroid, this most likely indicates:
Associated symptom
Mr. Smith presents with RLQ pain, as you document his HPI you note his c/o nausea in your symptom analysis this would be considered:
Do you have an upset stomach?
Mr. White comes to your office and during your exam you notice a black tongue what do you want to ask him next?
Waist of 42 inches
Mr. Williams is a new patient and has no complaints, but wants a physical. His physical is unremarkable but which of the following finding puts him at risk and in the need of anticipatory guidance?
Scratch test
Mrs. Jones is a female patient with a history of ETOH abuse. Your abdominal exam should include:
+ book test
Mrs. Thomas was seen, complaining of pain and point tenderness in the area of her elbow which has increased since one week ago, following a day of gardening. A physical finding you might expect is
Frontal & maxillary
Ms Shell presents with sinus pain, pressure, and yellow nasal discharge. Your examination of the patient would include palpation & transillumination of the...
Cervical dysplasia
Ms. Bench presents with *HPV and wonders about possible complications. You explain that it can lead to .
Hordeolum
Ms. Iris presents with eye pain. As you examine her external eye, you note a red, tender, swollen, raised area, pointing up along the lower lash border. You document this as a:
How long have you been doing this?
Ms. Waters is being assessed for a job physical. you ask her about her exercise regimen. She uses the treadmill every day for 30 minutes, Whats your next question?
absent breath sounds
Mucus plug over mainstem bronchus would produce?
gallbladder Seen w/ cholecystitis (sonographic Murphy's) Palpate at inspiration at liver margin Pain at inspiration = + (pt stops their breath)
Murphy's sign
top layers of the skin slip away from the lower layers when slightly rubbed. documented as positive or negative. positive result may be present in several different medical conditions. People with a positive sign have loose skin that slips free from the underlying layers when rubbed. The area beneath is pink and moist and usually very tender. Common Causes: Autoimmune condition (Pemphigus vulgaris) Bacterial infection ( Scalded skin syndrome) Toxic drug reaction (Toxic epidermal necrolysis)
Nikolsky's sign
CN VI
Nolan, a 22 yo, has lost the ability to control lateral eye movement. Which CN is this?
7 seconds
Normal flush for Allen test?
mitral regurg
Noted a thrill at 5 ICS MCL, apex during systole during physical exam on patients anterior chest. this could indicate?
The client needs to be evaluated for chronic hypertension
On ophalmic examination, there appears to a narrowing or blocking of the vessels. The significance of this finding is...
The client needs to be evaluated for chronic hypertension
On ophthalmic examination, there appears to be a narrowing or blocking of the vessels. The significance of this finding is:
Hip flexion
Paula, a truck driver, presents with pain. Upon examination the NP elicits a positive Thomas test. This indicates an issue with
is a rare autoimmune disorder. The immune system produces antibodies against specific proteins in the skin and mucus membranes. antibodies break the bonds between skin cells. Leads to the formation of a blister.Exact cause is unknown Meds that can cause it: Penicillamine ACE inhibitors
Pemphigus
Sharply demarcated erythematous papules & plaques of varying size & shape w/white overlying scales Removal of scale =dot of blood - Auspitz sign Peak incidence of onset 3rd decade Strong yet unidentified genetic influence M=F 1-2% of population
Psoriasis
Status Asthmaticus
Pulsus Paradoxus is more likely associate with:
hearing acuity test performed with a vibrating tuning fork that is first placed on the mastoid process and then in front of the external auditory canal to test bone and air conduction AC>BC conductive hearing loss
Rinne test
4+
Ron R. presents with dependent edema. As you assess he has a > 1" indentation up to mid-tibia bilaterally. This should be documented as:
Associated w/ peritoneal inflammation Press deeply for 5 secs in LLQ Pain felt in RLQ = + associated w/ appendicitis
Rosving's sign
30
Rudy Smith is a 27 year old male diagnosed with ulcerative colitis at age 18. While doing anticipatory guidance, you would tell him he needs a colonoscopy by age ___ because he is at risk for colon cancer.
Maxillary
Sally age 19 presents with pain and pressure over her cheeks and discolored nasal discharges. You cannot transilluminate the sinuses. You suspect which common sinus to be affected:
secondary
Screening is considered _____ prevention
Be direct toward sxs suggesting causes of HTN Include eval of dietary intake and physical activity Evaluate all OTC drugs, herbal remedies or illicit drug use
Shirley age 56 present with BP of 156/94, your history taking should:
Asymmetry in shape - 1/2 unlike other Border irregular - scalloped Color is mottled - many shades Diameter is large > 6 mm (size of pencil eraser) Elevation is usual - tangential lighting Enlargement, Evolving- h/o increased size, most important Feeling- presence of sensation itching, tenderness, or pain
Signs of malignant melanoma
stage 3 pressure ulcer
Sophie brings in her husband nathan age 72 who is in a wheelchair. on his sacral area he has a deep crater with a full thickness skin loss involving necrosis of subcutaneous tissue that extends down to the underlying fascia. You would document this as a ...
Percuss posterior to MAL L side Resonance of lungs changes to dullness Last IC space deep breath & percuss should sound resonant abn: dullness may indicate splenic enlargement as w/mono, trauma, infection just ate poor technique
Spleen percussion
Established
Susie Lee presents for a checkup to your office. You have not seen her before but she was last seen by the MD in your group for a URI 2 years ago. According to CPT definition, she is:
False
T/F - You are assessing a neonate and note breast engorgement. You document this as an abnormality.
False
T/F: Breast cancer in men is similar to breast cancer in women and the provider should be suspicious of the Tale of Spence.
Breast bud stage, some small straight pubic hair
Tanner Stage 2
d) All of the above
Ted, who is 15 years old, has just moved into the community and is staying in a foster home temporarily. There is no record of immunizations. His foster mother wants him to be checked before he enters the local high school. Which of the following does this patient need? a) meningococcal b) MMR c) Tdap d) All of the above
82
The 55 year old client tells you that she has smoked 2 packs of cigarettes per days since she was 14 years old. How many pack-years should be recorded in the client's history?
year, beginning at age 50 for 2 years, then every 3-5 years thereafter
The American Cancer Society recommends a sigmoidoscopy for colon cancer screening in persons at average risk every:
History of HTN
The NP denotes a bruit above and to the left of the umbilicus. This finding is consistent with:
Paroxysms of coughing that is dry or productive of mucoid sputum
The NP is aware that acute bronchitis is characterized by:
Extension of elbow
The NP is performing a neuro exam. His documentation of a +2/4 triceps reflex indicates that the patient's response was
Vesicular
The NP knows that normal breath sounds that have a low pitch and soft intensity and are heard better on inspiration are called:
Clench both hands together and pull while the reflex is checked
The NP notes an absent patellar reflex in a healthy individual. What might the NP ask the client to do?
Is an expected finding with emphysema
The NP understands the following about hyperresonance in percussion of the lungs
Arcus senilis
The NP upon examination notes a bilateral gray ring around the irises of the 80 yo patient. The patient denies visual change of pain. What should she document?
Palpate the left side of the abdomen, then gently palpate the right side, noting guarding and tenderness.
The client complains of extreme pain in his abdomen and points to the right lower quadrant. In examining acute abdomen, the NP would:
"It is the rushing sound blood makes moving through narrow places. Some murmurs are harmless..."
The client has been told that he has a heart murmur. He asks you "What exactly is a heart murmur?" What is your best response?
Corticosteroids
The client is taking all of the following medications daily. Which one increases the risk for osteoporosis?
Why are you taking aspirin daily?"
The client tells you that he takes aspirin every day. What question should be asked next?
Diabetes mellitus
The client with all of the following health problems has bilateral hypoactive deep tendon reflexes of knees and Achilles tendons. Which health problem is probably responsible for this abnormality?
Leaning over examination table w/chest and shoulders resting on table
The correct position to place a healthy male patient for a rectal & prostate examination is:
Chief complaint
The key element for all levels of CPT code documentation is:
Superficial
The most common type of melanoma is
Superficial
The most common type of melanoma is the
Rule our emergent conditions
The most important goal of assessing a client with abdominal pain is to
Have you ever had this before?
The most important question to ask as you build your HPI is:
Rheumatoid arthritis
The nurse practitioner understands that finding Boutonniere's nodes on a physical exam of a client is a cardinal sign of
Air conduction twice as long as bone conduction.
The purpose of conducting the Rinne test is to determine conduction of sound through the bone and through the auditory canal. The Rinne test is described as:
Passively rotates the right hip from the 90 degree hip/knee flexion position
The test for a positive obturator sign in a client with abdominal pain, the NP
Under the right axillae
To rule out middle lobe pneumonia, you would make sure to auscultate:
testicular torsion
Tommy age 15 comes to the clinic in acute distress with "pain". He fell off his bike this morning. Upon exam you determine the pain to be left-sided groin pain or left testicular. He is afebrile & reports no dysuria. You suspect...
False - it is primary
True or False: Limiting public smoking is an example of secondary prevention.
False
True or False: The SCOFF screening tool is used to diagnose eating disorders?
Have elicited an expected response with ALS
Upon assessment you note that 75 yo Mr. Lucas has demonstrated a positive snout reflex. You..
Rovsings
Upon palpation of the abdomen you elicit pain on RLQ by palpation of LLQ. This would be documented as a positive...
Test done by placing the stem of a vibrating tuning fork on the midline of the head and having the patient indicate in which ear the tone can be heard. sensorineural hearing loss
Weber test
All of the above (Distribution, Configuration, Palpable features, Pattern)
What are the major components to be documented regarding the morphology of a skin lesion?
Tobacco use, alcohol abuse, stress associated with work & recent divorce, inactivity, family history of heart disease, obesity, elevated blood pressure. Screen for alcoholism using the CAGE questionnaire. Smoking, elevated blood pressure, family history, age 45
What health problems does Mr. S present with? (Mr. Sherman is a 45-year-old accountant...) How would you further assess Mr. S's problem with alcohol? What risk factors for coronary artery disease does Mr. S have at this time?
Have the client lower his chin and lean his head slightly toward the side being evaluated.
What is the correct procedure for palpation of a client's thyroid gland?
Chronic Hypertension
What is the most common cause of left ventricular hypertrophy in the United States
closing of mitral valve
What makes the first heart sound? S1
Place the diaphragm of the stethoscope at the 2nd ICS at the base of the heart.
What technique should be used to best auscultate the second heart sound?
carpal tunnel syndrome due to fluid and hormonal changes
What temporary disorder may be expressed by pregnant women during their 3rd trimester?
You can see at 20 feet with your right eye that the normal person can see at 50 feet.
When Judy age 15 asks you to explain the 20/50 vision in her right eye, you respond:
3+/4
When assessing a client's deep tendon reflexes, you note they are more brisk than normal. You document them as:
Specific by Gender
When assessing an infant's Neuro system the NP realizes that important components include all except:
The abdominal aorta
When auscultating a patient's abdomen, the NP hears a systolic bruit in the epigastric area. It occurs at a fixed interval after the apical impulse. The most likely source of the bruit is:
Positive egophony
When auscultating for vocal resonance in a client with possible consolidation of lung tissue, the NP hears "a-a-a" when the client says "e-e-e". This is called:
An increased resistance to ventricular filling.
When auscultating the heart sounds of a 72 year old client with a history of hypertension, the nurse practitioner notes an S4. This finding could indicate:
Yes, avoid having intercourse for 24 hours before the test." :(
When calling to schedule an annual pelvic examination and pap smear, the client asks if she should abstain from intercourse before the test. What is your best response?
Determine contour and mobility of mass
When examining a patients breast, you palpate mass in UOQ of right breast. To assess further, you would...
Normal visual accommodation
When examining the eyes, the NP realizes that the pupils change in size when the client focuses on a close object to a distant object. This is interpreted as:
Asymmetrical sac with the left side lower than the right side
When examining the scrotum of an adult Hispanic male, a normal finding is
Auditory acuity is the most common sensory loss in the aged population and may hinder the interview
When obtaining a health history from an older, which characteristics of the older client must be taken into consideration?
Auditory acuity is the most common sensory loss in the aged population and may hinder the interview
When obtaining a health history, which characteristics of the older client must be taken into consideration?
True
When palpating the abdomen of an infant, the NP realizes that the spleen is easily palpable.
Gaseous distention
When percussing the abdomen, you document hyperresonance. This most likely represents:
The upper outer quadrant is the most frequent location of breast cancer
When performing a clinical breast examination, you take special care to examine the upper outer quadrants and axillae because:
Child's developmental level
When performing a history & physical on a pediatric patient, which important factor affects the outcome the most?
Bacterial prostatitis
When performing a prostate examination, you note a tender, warm prostate. What do you suspect?
Fifth ICS, Left MCL
Where would you expect to hear best an abnormal heart sound when the client has mitral valve insufficiency?
Fifth ICS, LMCL
Where would you expect to hear the best abnormal heart sound when client has mitral valve insufficiency?
Single, firm, non-tender, ill-defined breast lump
Which description is most characteristic of breast cancer
The presence of pseudohyphae
Which is not a criterion for the diagnosis of bacterial vaginosis?
Asymmetric breast development
Which is not a risk factor for breast cancer
The client has a difficult time forming his or her words.
Which of the following client responses during the history taking alerts you to the possibility of a neurological problem?
Grade II/IV is associated with thrill.
Which of the following is NOT a typical murmur and its description
Physical Examination
Which of the following is NOT one of the components of the adult health history?
trichomonal vaginitis
Which of the following is a sexually transmitted disease? monilial vaginitis trichomonal vaginitis atrophic vaginitis bacterial vaginitis
Construction worker who drinks 1 beer a night
Which of the following is the least likely to become an alcohol abuser?
Later disease presentation often includes iron deficiency anemia
Which of the following is true regarding colorectal cancer?
xanthoma of the inner canthus
Which of the following physical exam findings would lead you to suspect hyperlipidemia?
Lesion with border irregularity
Which of the following presentations suggests a diagnosis of a malignant melanoma?
visual acuity
Which of the following should be assessed in a client with a potential corneal abrasion?
Often has a keratinous horn
Which of the following statements best describes squamous cell carcinoma?
The breast is composed fibrous, glandular, and adipose tissue.
Which of the following statements is true regarding the internal structures of the breast?
I feel a lump in my breast before my periods."
Which one of the following statements is most suggestive of a fibrocystic breast condition?
"Breast self-examination on a monthly basis will help you to become familiar with your breast tissues and its normal variation."
Which one of the following statements is the best way to promote breast self-examination?
Scattered wheezing or rhonchi
Which physical findings is most suggestive of bronchitis?
Normal
While examining the abdomen, of a post-op patient, you note that the bowel sounds are noted in 20 secs. You would document this finding as:
Contraction of the abdominal muscles and pulling of the umbilicus toward the stroked side
While examining the abdomen, you stroke each quadrant of the abdomen lightly with a cotton-tipped swab or the end of a reflex hammer, moving outward from the umbilicus. What does this cause?
Swollen, boggy, pale, & gray
With a chronic allergy the nasal mucosa appear?
+ Brudzinski's sign
With the client in supine position, the NP gently flexes the client's neck so the chin touches the chest. If there is pain & resistance to the flexion and the hips & knees flex at the same time, the NP describes the finding as
25 year old woman with a single, firm, rubbery lump
With which of the following clients having a breast lump are you alerted to the possibility of a fibroademona?
Psoriasis
You are assessing Arlene C.'s skin complaint. You get a + Auspitzs sign. This aides you in the diagnosis of:
"I hurt it about 4 days ago."
You are assessing Jenna's broken arm in the ER and you suspect she may be a victim of violence. What statement triggered concern?
Cruciate ligament
You are assessing Mike, age 16, after a football injury to his right knee. You elicit a positive anterior/posterior drawer sign. This test indicates an injury to the
1 week
You are assessing a newborn and note that the baby is jaundiced. He is 3 days old. You realize that for this to be a normal finding it should resolve i
1 week
You are assessing a newborn and note that the baby is jaundiced. He is 3 days old. You realize that for this to be a normal finding it should resolve in:
Stridor
You are assessing a pediatric patient with croup. What clinical finding would you expect to discover?
Macule
You are describing a lesion noted on Mr Smith. It is flat, nonpalpable lesion less than 1 cm in size
macule
You are describing a lesion noted on Mr. Smith a 55yo male. It is flat nonpalpable lesion less than 1 cm in size it is a..
45-55 years of age
You are doing a physical on a male patient when he tells you that he was reading stuff on the internet...he wants to know what would be the risks for him to get breast cancer. All of the following are risk factors EXCEPT:
drawer test
You are doing a sports physical on a 17 yr old male. You realize that to assess the ACL you should perform the.....
Total caloric intake needs to increase
You are evaluating an elderly man who was brought in by his distraught daughter. You explain that there are many physical changes that occur as we age that affect nutrition. These including all of the following EXCEPT:
Hypospadias
You are examining an infant in the newborn nursery. You notice that he is urinating in an odd manner. You examine his penis and find that the urethra is on the inferior surface of the penis. This physical examination finding is most consistent with a diagnosis of:
Ectropion
You are giving an 85 year old nursing home resident her annual physical examination...you notice that the margin of the lower lid is turned outward and the palpebral conjunctiva is exposed. The patient states that she has trouble with her eye constantly tearing.
Secondary prevention
You are going to organize a BP screening fair at the mall. You are involved in:
HEADS & RAFFT
You are meeting for the first time a 14 year old female patient. You would want to include the following in your exam:
primary prevention
You are planning to promote flu vaccine with your patients... Example of?
change in temperature
You are teaching your patient to note changes in her skin lesions. You tell her to be alert to all of the following EXCEPT..... a. change in sensation b. change in shape c. change in color d. change in temperature
torn meniscus
You are working a soccer tournament as the NP on site for injuries and you are called to assess a 20 yr old female. You ellicit a + McMurray what is your diagnosis?
Intra-abdominal bleeding
You assess for Cullen's sign in Dan, age 62, after surgery. Cullen's sign may indicate:
multiple bulla on right ring finger
You diagnose Ms. Lime with contact dermatitis. In your decription you would most likely note...
dullness
You diagnose lobar pneumonia in a 63 yo mail carrier who has had productive green sputum for 2 weeks, accompanied by fever... What sound would you get with percussion?
sudden onset of pain w/a firm, tender mass in the scrotum
You diagnose your patient w/testicular torsion, what were your pertinent positive(s)?
He has physical dependence and needs intervention
You have administered the CAGE questionnaire as part of a screening policy and the patient answers yes to 2 & 4. What is the significance of this if any?
He has physical dependence and needs intervention (cut down, annoyed by peoples comments, feel guilty, eye opener?) for alcohol abuse
You have administered the CAGE questionnaire as part of a screening policy and the patient answers yes to 2 & 4. What is the significance of this if any?
Ask the client to hold their breath and repeat.
You hear a split S2 on auscultation of a 25 year old client. What is your best action?
Insert nothing in the vagina for 24 hours prior to the exam
You instruct your patient that at her next visit she will recieve a pap test. Information that you give her regarding this include...
Have the client shrug their shoulders against resistance
You need to assess the patient's cranial nerves. You remember back to a class long ago that the best way to assess cranial nerve XI is to:
bacterial vaginosis
You note a positive "whiff' test upon a pelvic exam. You suspect...
hepatitis cirrhosis= bumpy
You note that the span of a patient's liver is 18 cm. On palpation, the liver is enlarged, soft, and tender, suggesting:
Aortic Stenosis
You notice a harsh, medium-pitched harsh systolic murmer during a routine exam on the right upper border of the sternum. What of the following is the most likely?
portal hypertension
You observe a proliferation of superficial veins over the abdomen and upper chest of a patient, suggesting:
Be nonjudgemental
You realize as an Advanced Practice Nurse you must ask questions regarding sensitive topics. To be most effective, you employ the basic principles that guide responses to sensitive topics. The most important rule is:
Abnormal - loud and clear finding
You review a chart of a patient seen 2 days ago by your colleague. You see a + whisper pectorilloquy, you understand this is an:
Pre-auricular and anterior cervical
Your client presents with conjunctivitis. Which lymph nodes would you expect to find enlarged?
Fluent aphasia
Your patient has a diagnosis of Wernicke's aphasia. You realize that this is a subtype of
VIII
Your patient has a diagnosis of vestibular dysfunction. You explain that this is a defect in Cranial Nerve:
Cotton wool patches and flame hemorrhages
Your patient has chronic hypertension. You would expect to visualize which of the following on fundoscopic examination:
changes in vision
Your patient has damage to the occipital lobe. You would expect to see what on exam?
Cranial nerve III & VI
Your patient has documentation of difficulty performing EOM. You interpret this as a problem with
submental
Your patient has herpes simplex of the bottom lip. Which lymph glands would you pay the most attention to?
Headache becomes more & more painful
Your patient presents w/a c/o a severe headache. What would be a sign that this could have a more serious cause?
lichenification
Your patient presents with an area of itchy dry skin that you describe as thickened, normal in color,w/out drainage, vesicles, edema. It is most likely..
Paronchyia
Your pt is c/o pain in her right index fingernail. You note that the nail is erythematous, edematous, & painful. What is the likely condition?
Sound lateralizes to the right ear
Zeke Gilbert, a 72 year old retired factory worker has hearing loss in his right ear due to excessive cerumen. When performing a Weber test you would expect to find:
done to assess ascites seen w/CHF, portal HTN, cirrhosis, hepatitis, pancreatitis, ○ place ulnar edge of PT's hand midline on abdomen ○ place your hand on R flank & tap L side abn: blow will generate fluid wave that is felt by examiner if distended from gas of fat you will feel no change
abdomen: fluid wave
location size shape consistency (soft, hard, firm) Surface (smooth, nodular) Mobility (include r/t resp) Pulsatility- don't push on it, go get an ultrasound tenderness
abdomen: identifying a mass
pain on inspiration
all of the following are symptoms associated with chest pain and represent CAD except....
erythematous papules & plaques, appearance of vesicles, pustules weeping and crusting Secondary changes occur from chronic excoriation, linear erosion and lichenification triad of A's- atopic dermatitis, allergic rhinitis, asthma
atopic dermatitis
Most common type of skin cancer, malignant, slow growing but can be invasive & destructive Long term exposure over lifetime & occasional intense leading to sunburn sun exposure sites, >40 yrs, M.>F Open sore that oozes & crusts, goes away & returns, area of irritation, shiny bump or nodule, pink growth, scar like area
basal cell carcinoma
primary lesion as above but > 1cm thin walled, ruptures easily eg: friction blister, 2nd burn, contact dermatitis
bulla
Done to detect muscle weakness during movement With head and gaze steady follow the movement As you move to each spot hold momentarily and always return to center At end bring object close to about 5 in and observe for convergence Normal: tracking of object w/both eyes Abnormal: failure to follow indicates EOM weakness or CN dysfunction Nystagmus or lid lag
cardinal fields of gaze
Older age AA highest incidence in the US, Jews highest in world Lifestyle: obesity, inactive lifestyle, smoking, ETOH Diet high in red and processed meats, frying, grilling, broiling, cooking at high heat Personal history T2DM Strong family history of colorectal cancer or polyps Cancer or polyps in a one first-degree or second degree relative [parent, sibling, or child] diagnosed at 55 or older or in 2 or more first-degree relatives of any age) Known family history of hereditary colorectal cancer syndromes such as familial adenomatous polyposis (FAP) or hereditary non-polyposis colon cancer (HNPCC) Personal history of ovarian, endometrial, or breast cancer Personal history of inflammatory bowel disease (chronic UC, crohns)
colorectal cancer risk factors
genital/ anal wart
condyloma
gross measure of peripheral vision compares pt's vision to examiners stand 2 ft away from pt at eye level staring into each others eyes enter your flickering finger and have the pt say "now" when they see it abn: suggestive of peripheral loss needs more specialized testing
confrontation
asses parallel alignment of the eye axis hine light from 12 in away while PT stares straight ahead Reflection of light on corneas should symmetrical in the center of each cornea Abnormal : deviation in alignment may be due to muscle weakness or paralysis
corneal light reflex
detects small degrees of deviated alignment Pt stares straight ahead at your nose Cover 1 eye- note uncovered eye- gaze should remain normal if weakness exists would have the uncovered drifted into a relaxed position, as eye is uncovered there will be movement
cover/uncover test
surface debris thickened dry out exudate left when pustules burst or dry up, color depends on fluids ingredients eg: impetigo (dry, honey colored), weeping eczema, scab after abrasion
crust
secondary lesion scooped out but shallow depression, superficial epidermis loss, moist no bleeding, heals w/out scar
erosions
secondary lesion self inflicted abrasion , superficial, from intense itching eg: insect bites, scabies, varicella
excoriation
secondary lesion linear cracks, extends into dermis, dry or moist eg: cheilosis (cracks around mouth), athletes foot, eczema
fissures
solid, elevated, hard or soft, > 1cm may extend deeper into the dermis than a papule eg: xanthoma, fibroma, carcinoma
nodule
Muffled voice sounds and symmetric tactile fremitus.
normal adult breath sounds
high-pitched, gurgling, cascading sounds, occurring irregularly anywhere from 5 to 30 times per minute.
normal bowel sounds
Irritation of the obturator internus muscle Flex r leg at hip & knee, rotate leg internally & externally Pain in hypogastric area = + assoc w/ruptured appendix or pelvic abscess
obturator test
• Vessels - follow a paired artery/ vein to periphery • Color: ○ arteries bright light red w/a central white reflex stripe ○ veins are 1⁄4 larger ,darker & have no white reflex stripe • A:V width ratio: 2/3 or 4/5 diameter of vein • Caliber: a/v decrease as they extend outward • A-V crossing : should be w/in 2 DD (diameter) of disc • Tortuosity: mild in both eyes usually congenital • Macula: 1 DD in size 2DD temporal to the disc
ocular fundus
nasal side of retina Color - creamy yellow - orange Shape - round or oval Margins - distinct sharply demarcated Cup - disc ratio: horizontal diameter not > 1/2 disc diameter
optic disc
macules > 1cm eg: mongolian spot, vitiligo, café au lait
patch
papules > 1cm plateau like, disc shaped confined to superficial dermis, may result from confluence of papules eg: lichen planus an acute or chronic inflammatory dermatosis tinea corporis (ringworm) a dermatophyte infection of the trunk, legs, arms psoriasis a hereditary disorder of silvery white scales,
plaque
1. nonblanchable erythema of intact skin, epidermal redness, swelling, heat or pain 2. Partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, without slough. 3. Full thickness tissue loss involving damage of subcutaneous fat may be visible but bone, tendon or muscle are not exposed 4. Full thickness skin loss w/extensive destruction. -Extends to muscle &/or bone, may or may not be infected unstageable- Full-thickness skin and tissue loss in which the extent of tissue damage within the ulcer cannot be confirmed because it is obscured by slough or eschar.
pressure ulcer staging
primary lesion circumscribed, elevated & filled w/pus in the cavity eg: acne, impetigo, folliculitus
pustule
surface debris compact desiccated flakes of skin, dry or greasy, from shedding of dead excess keratin cells eg: psoriasis, seborrheic dermatitis, dry skin
scale
secondary lesion connective tissue (collagen) that replaces healed damaged normal tissue eg: after surgery, acne, injury keloid- hypertrophic scar, elevated, invasive
scar
most common types of noncancerous skin growths in older adults. usually appears as a brown, black or pale growth on the face, chest, shoulders or back round or oval, waxy scaly appearance, single or multiple growths, "stuck-on" look
seborrheic keratosis
SCC is mainly caused by cumulative ultraviolet (UV) exposure over the course of a lifetime Daily year-round exposure to the sun's UV light, Intense exposure in the summer months, UV produced by tanning beds >55, M > F, but are being seen in younger Anyone with a history of substantial sun exposure is at increased risk Occupations requiring long hours outdoors or who spend extensive leisure or recreation time in the sun (especially playing golf or other sports) are at increased risk
squamous cell carcinoma
solid, elevated, hard or soft, > 2 cm may extend deeper into the dermis than a papule eg: lipoma, hemangioma - benign or malignant
tumor
Normal is shiny, pearly gray, Cone- shapes light reflex 5'oclock in right ear, 7'oclock left ear Umbro, manubrium, short process
tympanic membrane
secondary lesion deep depression, extends into dermis & beyond, irregular shape, may bleed, leaves scar eg: stasis, pressure, chancre
ulcer
wheals coalesce (come together) to form extensive reaction very pruritic
urticaia
primary lesion elevated cavity w/ free fluid up to 1 cm, clear serum flows if opened eg: herpes simplex, varicella, herpes zoster,
vesicle
Kernig's Sign
which of the following maneuvers may be positive in a patient who is complaining of acute onset high fever, chills, severe headache, and nausea accompanied by limited range of motion of the neck
