assessment_exam_2_20200730034734 Flashcards
(119 cards)
1
Q
CC to look out for
A
RashHivesDry skinAcneHair lossIngrown nails
2
Q
HPI to look out for
A
OLDCARTSEnvironmental exposuresTravelImmunizations
3
Q
Past/present medical hx to look out for
A
SkinSkin cancerAcnePrev. lesions/proceduresSystemic disorders
4
Q
Family Hx to look out for
A
Skin cancerAtopy (genetic tendency to develop allergic diseases)Balding
5
Q
Social Hx to look out for
A
TobaccoAlcoholDrug useSun exposureTanning boothsCosmeticsSkin care
6
Q
Examination of the skin is performed by
A
Inspection and palpation
7
Q
Skin inspection requirements
A
Adequate lighting (tangential for contour)Room temperatureOnly expose the skin that needs to be exposedFull body sweep
8
Q
Skin inspection points to look out for while performing inspection on the entire skin surface
A
PallorScars, bruises, lesionsEdemaMoistureHydration
9
Q
8 Steps of skin lesion description
A
LocationDistributionPrimary or secondaryShape/arrangementBorders/marginsAssociated changesPigmentationSize
10
Q
Palpation of skin for
A
Moisture (should be minimal sweat/oil)Temp. (use dorsal surface of hands/fingersTexture (smooth, soft, even)Turgor (3 seconds or less for tenting)
11
Q
Where do you check for tenting in the elderly?
A
Over the sternum
12
Q
Normal tenting time
A
3 seconds or less
13
Q
Inspect hair for
A
ColorDistributionQuantity (look for Hirsutism/alopecia)
14
Q
Palpate hair for
A
Texture
15
Q
Inspect nails for
A
ColorShapeContour (clubbing)
16
Q
Palpate nails for
A
TextureThicknessCapillary refill
17
Q
Risk assessment consists of
A
Sun exposureTanning boothsUse of sunscreen
18
Q
ABCDE of melanoma
A
AsymmetryBorders are irregularColor variations (black, blue, red)Diameter over 6mmElevation/evolution
19
Q
A of melanoma
A
Asymmetry
20
Q
B of melanoma
A
Borders are irregular
21
Q
C of melanoma
A
Color variations (black, blue, red)
22
Q
D of melanoma
A
Diameter over 6mm
23
Q
E of melanoma
A
ElevationEvolution (growth)
24
Q
Present/past medical Hx to look out for
A
Eye disordersEar infectionsSinus infectionsThroat infectionsAllergiesThyroid diseaseCancer
25
Past surgical Hx to look out for
Head and neck procedures/medicationCataract correctionLasik eye correctionEar tubesTonsillectomyWisdom teeth removal
26
Family hx to look out for
Thyroid, atopic triad
27
General signs to look out for
FeverChills weight changes
28
Integumentary signs to look out for
Rashes
29
Face signs to look out for
Tenderness/swelling
30
Eyes signs to look out for
painrednessdrainageitching
31
Ear signs to look out for
tinnitusear paindrainage
32
Nose signs to look out for
congestionrhinorrheasneezingepistaxis
33
Throat signs to look out for
Paindysphagiahoarseness
34
Neck signs to look out for
lymphadenopathy
35
Gordon health patterns to reference
SleepSexuality (infections)Nutrition/metabolic
36
Head exam:
Aligned?Normocephalic
37
Face exam
ScarsLesionsSymmetryMuscle weakness
38
Tell-tale signs on initial exam
Allergic shinersNasal crease in allergiesNoisy nasal breathing
39
Patient voice points to listen to
Breathy voiceNasalyStridor?
40
External eye points of interest
Eyebrow thinning/symmetryEyelashes (even distribution and direction of curl, infestations)Able to close eyelids fully/lesions
41
Eye abnormalities
PtosisEntropionHordeolum (sty)
42
PERRLA for eye assessment
PupilsEqualRound (should be perfectly round)Reactive (should react to:Light: dilation/contractionAccommodation(Looking far away pupils dilate, looking close pupils constrict)
43
Red light reflex
Detect cataract and retinoblastomaReddish-orange reflection of light from fundus
44
How to hold opthalamascope
Hold right hand, use your right eye and examine the patient's right eyeVice versa for left
45
Cataracts
Clouding of lensLeading cause of blindness worldwideRisk factors: AgeUV B lightDiabetesCigarettesHTNSteroid useObesityBeta blockersFemale
46
Further eye testing
Peripheral vision6 cardinal fields (slowly) (three descending vertical on left side, three descending vertical on right side)
47
Ear external exam
AlignmentDeformitiesNodulesUlcersLesions
48
Otoscopy use
External auditory canal for erythema, stenosis, debris/discharge
49
Examine tympanic membrane for
Normal: shiny, translucent, visible light reflex (R 5o clock vs. L 7 o clock)White= scarringRedness, bulging, dull, retraction= infectionPerforations and tubes
50
Whisper test
6 words on each side, should hear at least 3/6
51
What size otoscope?
Biggest that will fit
52
Rinne test for ears
determine conductive or sensorineural hearing lossPlace tuning fork on mastoid behind earPatient will tell you when sound disappearsThen put tuning fork to earIf air conduction>bone conduction they should hear it
53
Weber test for hearing
Tuning fork on top/center of headNormal=equal on both sidesCheck if sound is lateralized
54
ear abnormalities
Otitis externa (swimmers ear)=crusty, inflammed, nasty afOtitis media (ear infection)=red and opaqueTympanostomy tubesScarring= opaque white
55
Which ear has cone of light at 7 O clock
Left ear
56
Which ear has cone of light at 5 o clock
Right ear
57
Nose external exam
Deformities, symmetry, size/nare patencyPress on maxillary and frontal sinus
58
Nasal speculum to find
Septum (deviation)RhinorrheaMassesPolyps (peeled grapes)Prominent vessels (snorting drugs)Allergies (pale/blue, puffy)
59
Abnormal nose findings
SinusitisEpistaxisDeviated septumsPolyps
60
Grading tonsils
1 and 2 normal1+: fills <25% oropharynx between tonsil pillars2+: 25-50%3+: 50-75%4+: >75% (almost or fully touching each other)
61
Posterior pharyngeal wall look for
ErythemaDrainagePurulenceExudatesCobblestone appearance (allergies)
62
Black harry tonge
Smokers, pepto bismol, antibiotics
63
Leukoplakia in mouth
Permanent white marks in mouthCan turn to oral cancer
64
Head lymph nodes should be
Less than 1cm or invisibleSoft Doesnt move
65
Meniere's disease
Inner ear disease that causes dizzy spells (verigo) and hearing loss. Can affect one or both ears.
66
atopic triad
Eczema, allergies, asthma
67
Delayed gagging is common in
Elderly
68
ectropion vs entropion
Ectropion: eyelid turns outwardsEntropion: eyelid inwards
69
Allergic shiners
Allergy symptom Looks like you got punched in the eye
70
Neurological assessment components
Mental status examLOCCranial nerve assessmentReflex testingSensory sys. assesmentMotor system assessment
71
Musculoskeletal assessment components
Inspection of skeleton and extremities for alignment and symmetryMuscles for symmetry and size: should be bilaterally equalPalpation of bones/joints for pain, temp, edemaROM head to toeMuscle strength 0-5 scale
72
Muscle strength grading scale
0: 0% normal strength, complete paralysis1: 10% strength, no movement, muscle contraction is palpable/visible2: 25% strength, full movement against gravity w/support3: 50% strength, normal movement against gravity4: 75% normal strength, full movement against gravity and min. resistance5: 100% normal, full movement against gravity and full resistance
73
Present/past Hx to look for
Trauma, disease, congenital anomalies, migraines, strokes, surgeries, fractures/sprains/strainsMental health hxMedications
74
Family Hx to look out for
Migraines, seizures, stroke, brain tumors, MS, arthritis
75
Elderly life span changes
Decreased sens. to outside stimuliFallsMay not realize temp is too hot/coldvision worsensPupils smallerDecreased hearing
76
Mental status exam
A&O x 4Languagememoryattention span and calculation
77
Glasgow coma scale
Eye openingVerbal responseMotor responseDeclared coma from 3-8 points
78
If all cranial nerves are normal chart
"II-XII grossly intact"
79
CN IIOptic sensory nerve assessment
Snellen Leave glasses/contacts onLeft eye then right eyePeripheral visionOpthalmoscope for red light reflex
80
CN III Oculomotor nerve assessment
PERRLAEqualRoundReact to lightAccommodate to near/far vision
81
CN III (oculomotor), IV (trochlear), VI (Abducens) motor nerve asessment
Examined together, control of eyelid elevation, eye movement, and pupil constrictionFinger of penlight follow with just eyes6 fieldsAbnormal reaction: nystagmus
82
CN III eye movements
CNIII: Up and outUp and inCross eyesDown and out
83
CN IV trochlear eye movements
Superior Oblique (down and in)
84
CN VI abducens eye movement
Lateral rectus (middle out)
85
CN V Trigeminal assessment
Corneal sensation (often deferred)Palpate jaw/temples while patient clenches teethCotton ball: swipe across different areas of face bilaterally
86
CN VII Facial (motor and sensory) assessment
Symmetry and mobility of face:-smile-frown-close eyes-lift eyebrows-puff cheeksAsymmetrical in trauma, bells balsy, CVA, tumorAbility to taste (often deferred)
87
CN VIII assessment (sensory) vestibulocochlear
Ability to hear spoken wordEyes closedWhisper 6 words bilaterally or rub fingers near earsSlowly move hand away while continuing to rub fingers Repeat bilaterallyAbnormal finding caused by: Occlusion, drug toxicity, tumor
88
CN IX glossopharyngealand CN X vagus motor and sensory
Ability to swallowAssess voice for hoarsenessTaste (often deferred)
89
Abnormal IX and X ( motor)
Motor deficits can indicate brain stem tumor or neck injury
90
CN XI spinal accessory assessment
Hands on patients cheek and see if they resist head turnHands on shoulders, gently push down shoulders while they shrug
91
CN XII hypoglossal assessment
Motor Assess tongue controlHave them stick it out straight, back and forth, up and down
92
Reflex grades
4+ hyperactive3+ brisker than normal2+ normal1+ diminished0 absent
93
Sensory neurological tests
Sharp and dull-show patient difference between sharp and dull-close their eyes-touch arms/legs randomly-Have them identify area and sensation
94
Cortical sensory function
Discriminatory sensory functionBoth with eyes closedSterognosis (guess object in hand)Graphesthesis (number written on hand)
95
Fine motor coordination test of upper extremities
Finger to finger test (eyes open and to examiners finger)Finger to nose test (eyes closed)
96
Fine motor coordination test of lower extremities
Patient moves heel of one foot up and down shin of other foot
97
Fine motor tests for general coordination
Rapid alternating movementsPatient pats knees with both hands alternating supination and pronationorpatient touches thumb to each finger on same hand
98
Romberg test
Tests for balance Stand with feet together, arms at side and close eyesLook for swaying or lack of balance for 30 secondsNormal to have slight sway
99
Opposition
Thumb to palm
100
Reposition
Thumb back to normal position
101
Circumduction
Move in circular fashion (ex. moving back and forth from hand supination to pronation)
102
Inversion
Turn inwards
103
Eversion
Turn outwards
104
Retraction
move backwards
105
Protraction
move forwards
106
Lordosis
Accentuated lumbar curvecommon in pregnancies
107
Left/right lateral bending
Moving head to the respective shoulder
108
Plantar flexion
Pointing toes down
109
Kyphosis
Hunchback
110
1+
2mm or lessslight pittingdisappears rapidly
111
2+
2-4mmSomewhat deeper pitDisappears in 10-15 seconds
112
3+
4-6mmPit noticeably deep1 min or longerExtremity looks swollen
113
4+
6-8mmVery deep2-5 minutesExtremity grossly distorted
114
plantar (babinski) reflex
Poke heeltoes should curl in
115
Biceps reflex
Antecubital area (inside of elbow)
116
Brachioradialis reflex
Radial process Palm supinated, hit like 3 inches up on radius
117
Triceps reflex
Back of arm right above elbow
118
Patellar reflex
Right below kneecap
119
Achilles reflex
Right on achilles tendon at heelShould cause foot to point down
