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health assessment and primary care > health assessment and diagnostic tests > Flashcards

health assessment and diagnostic tests Flashcards

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1
Q

components of health history
1. chief complaint
2. presenting problem- OLD-CARTS
-pertinent negatives
3. Past health history
4. current health history

A
  1. chief complaint: in patients own words why they seek healthcare today
  2. presenting problem- OLD-CARTS (onset, location, duration, characteristics, aggravating/alleviating factors, relieving factors, temporal factors, severity)
    -pertinent negatives
  3. Past health history
  4. current health history
    -medications, allergies, tobacco/alcohol/drugs, nutrition, exercise, etc.
  5. family history
  6. psychosocial history
    -HEADSS for adolescents
  7. obstetrical history
  8. menstrual history
  9. sexual history/contraceptive use
  10. Review of systems
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2
Q

HEADSS for adolescents includes…

A

Home
Education
Activities
Drugs
Sex
Suicide

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3
Q

special focus for review of systems on gynecologic and reproductive health includes:
a. endocrine
b. genitourinary
c. breasts

A

a. endocrine
-amenorrhea or infrequent menses
-heavy or prolonged menses
-PMS
-excessive hair growth or hair loss

b. genitourinary
-painful periods
-pain with sex
-pain with urination

c. breasts
-pain, lumps, masses, nipple discharge

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4
Q

SOAP format

A

S: subjective
-“reports” “endorses” “describes” rather than c/o

O: objective
-obtained through physical exam

A: assessment/diagnosis

P: plan!
-diagnostic tests, client education, referrals, date for reevaluation

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5
Q

diaphragm best for….
bell best for…

A

diaphragm is best for high pitched sounds like S1, S2 heart sounds

bell is best for low pitched sounds (large blood vessels)

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6
Q

percussion provides information about size, shape, location, and density of underlying organ and tissue

a. tympany- loud, high-pitched, drum-like

b. hyperresonance- very loud, low-pitched, boom-like

c. resonance- loud, low pitched, hallow sound

d. dull- soft to moderate, moderate-pitched, thud-like sound

e. flat- soft, high-pitched sound, very dull

A

a. tympany- loud, high-pitched, drum-like (gastric bubble, gas-filled bowel)

b. hyperresonance- very loud, low-pitched, boom-like (lungs with emphysema)

c. resonance- loud, low pitched, hallow sound (healthy lunges)

d. dull- soft to moderate, moderate-pitched, thud-like sound (liver, heart)

e. flat- soft, high-pitched sound, very dull (bone)

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7
Q

waist circumference is only recommended in patients with BMI of…

A

25-39.9

predictor of risk for type 2 DM, hypertension, dyslipidemia, cardiovascular disease

measure at upper most lateral border

in adult female: increased risk if greater than 35 in

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8
Q

primary vs secondary lesions

A

primary: macule, papule, pustule, vesicles, wheal; happens as initial, spontaneous reaction to internal or external stimulus

secondary: results from later evolution or trauma to a primary lesion (ulcer, fissure, crust, scar)

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9
Q

ABCDE’s of malignant melanoma

A

Asymmetry
Border irregular
Color (blue/black)
Diameter greater than 6 mm
Elevation

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10
Q

abnormal eye exam would include…

A

-opacity of lens
-dysconjugate gaze
-nystagmus
-lid lag
-papilledema
-retinal hemorrhages and exudates (diabetes, HTN)

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11
Q

hearing evaluation
-whispered voice
-Weber test
-Rinne test

A

able to hear softly whispered words in each ear at 1-2 ft

weber: tests for lateralization of sound through bone conduction

Rinne: compares. bone and air conduction AC sound is head twice as long as BC sounds

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12
Q

conductive vs sensorinueral hearing loss

A

conductive: sound transmission impaired through external or middle ear; exudate/swelling, perforated ear drum

sensorineural hearing loss: defect in inner ear distorting sound; loud noise exposure, aging

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13
Q

adventitious sounds

a. crackles

b. rhonchi

c. wheezes

d. pleural friction rub

A

a. crackles: fine crackles hear during inspiration: high pitch, crackling; caused by air flowing by fluid (pneumonia, bronchitis)

b. rhonchi: heard during inspiration and expiration; low pitch, loud, sounds like a SNORE, tends to disappear after coughing (air possing over solid or thick secretions in large airways- bronchitis, pneumonia

c. wheezes: heard during inspiration and or expiration; high pitch, continuous, LOUDER during EXPIRATION; sounds like a squeak; caused by air flowing through constricted passageways: asthma, chronic emphysema

d. pleural friction rub: heard during inspiration or expiration; dry, rubbing, grating; cause by inflammation of pleural tissue: pleuritis, pericarditis

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14
Q

apical impulse location

A

fourth to fifth left intercostal space (ICS) medial to midclavicular line (MCL), no lifts or thrills

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15
Q

S1 occurs at the start of ____ and is best hear at ____

S2 occurs at the start of____ and is best heard at ___

A

S1 starts with systole and is best heard at apex

S2 starts with diastole and is best heard at base

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16
Q

Liver span is about __-___ cm at the

A

normally 6 to 12 cm at right MCL

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17
Q

Possible appendicitis
-McBurney’s point
-Rovsing’s sign
-Psoas and obturator signs

A

McBurneys: localized tenderness right lower quadrant

-Rovsing’s sign: referred rebound tenderness, pain in right lower quadrant when left sided pressure applied and quickly withdrawn

-Psoas and obturator signs: irritation of right psoas or obturator muscles by inflamed appendix

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18
Q

possible cholecystitis
-Murphy signs

A

sharp increase in tenderness and sudden stop in inspiratory effort with upward pressure under right costal margin when client takes deep breath

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19
Q

abdomen normal findings
-auscultation
-liver
-spleen and kidneys
-percussion

A

-active bowel sounds, no vascular bruits or friction rubs
-liver border: edge smooth, sharp nontender and no more than 2 cm below right coastal margin
-spleen and kidneys: NOT PALPABLE
-percussion: tympany is predominant tone; dullness over organs

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20
Q

systolic click in mid to late systole, high pitched, and increased with inspiration is probably…

A

mitral valve prolapse

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21
Q

physiologic murmur characteristics

A

-systole
-grades 1 or 2
-normal finding, common in pregnancy
-increases with activity (pregnancy, working out)
-

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22
Q

Cranial nerves:
1. CN I (olfactory)
2. CN II (optic)
3. CN III, IV, VI (oculomotor, trochlear, abducens)

A
  1. CN I (olfactory): identify odors
  2. CN II (optic): test visual acuity, peripheral vision, inspect optic discs
  3. CN III, IV, VI (oculomotor, trochlear, abducens): observe for PERRLA, EOM function, and ptosis
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23
Q

Cranial nerves
4. CN V (trigeminal)
5. CN VII (facial)
6. CN VIII (acoustic)

A
  1. CN V (trigeminal): palpate strength of temporal and masseter muscles; test for sharp/dull and light touch sensation on forehead, cheeks, and chin
  2. CN VII (facial): observe for any weakness, asymmetry, or abnormal movements of face
  3. CN VIII (acoustic): assess auditory acuity
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24
Q

Cranial nerves
7. CN IX and X (glossopharyngeal and vagus)
8. CN XI (spinal accessory)
9. CN XII (hypoglossal)

A
  1. CN IX and X (glossopharyngeal and vagus): observe ability to swallow; symmetry of movement of soft palate and ulva when client says “ah”; gag reflex; any abnormal voice quality
  2. CN XI (spinal accessory): observe and palpate strength and symmetry of trapezius and sternocleidomastoid muscles
  3. CN XII (hypoglossal): observe tongue for any deviation, asymmetry, or abnormal movement
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25
Romberg test assesses...
cerebellar function (eyes closed maintain balance)
26
deep tendon reflexes should be...
brisk and symmetrical
27
breast inspection includes...
-patient sitting with hands above the head -pushing against hips and leaning forward -view breasts from all sides to assess for symmetry and skin changes -some difference in size of breast and areola is common and usually normal -nipples: pointing in same direction -palpate axillary, supraclavicular, infraclavicular lymph nodes when client is sitting -palpate breast with client lying down, arm above head -palpate using finder pads of middle three fingers with overlapping dime shaped circular motions -three levels of pressure: light, medium, and deep
28
T/F do not squeeze nipples unless patient c/o nipple discharge
true
29
how should any palpable mass or lymph nodes be described?
in terms of location according to clock face as examiner faces client: size, shape, mobility, consistency, delimitation, and tenderness
30
perineum consists of tissue between...
the introitus and anus
31
pederson vs grave's speculum
a. Pederson: straight sided, pediatric, narrow and regular sizes b. Grave's: duck billed shape; may be used when lax vaginal musculature or submucosal fat impedes visualization
32
NORMAL VISUAL FINDINGS -vaginal walls -cervix
vaginal walls: pink, rugated, homogenous, may have thing clear/cloudy odorless discharge cervix: midline and smooth, round, pink, 2.5 cm in diameter -points posteriorly with anteverted uterus -anteriorly with retroverted uterus -horizontally with midposition uterus
33
Palpation of internal structures -cervix -uterus -adnexa
-cervix: smooth, firm, mobile, non tender about 2.5 cm in diameter and protrudes 1-3 cm into vagina -uterus: smooth, rounded contour, firm, mobile, nontender; 5.5 to 8 cm long and pear shaped in nulliparous females; may be 2-3 cm larger in parous female -adnexa: fallopian tubes nonpalpable, ovaries avoid, smooth, firm, mobil slightly tender; size during reproductive years: 3 x 2 x 1
34
CBC normal RBC count -low vs high causes
4.2-4.5 million/mm3 low RBC count: hemorrhage, hemolysis, dietary deficiencies, chronic illness, medications high RBC count: dehydration, chronic hypoxia, medications
35
hematocrit and hemoglobin -normal -pregnancy -low vs high causes
a. Hct: percentage of total blood volume made up of RBCs -normally: 37-47% (non pregnant) -pregnant: 33% or greater in first and third, 32% or greater in second (Black women are adjusted -2%: 31%, and 30%, respectively) b. Hgb: measurement of total HgB (which carries oxygen) in the blood -normal: 12 to 16 -pregnancy: 11 in first and third, 10.5 in second low: anemia, cirrhosis, hemorrhage, dietary deficiency, chronic illness, renal failure high: severe hydration, polycythemia vera, COPD/hypoxic states
36
T/F heavy smokers and individuals living at higher elevations may have higher Hgb levels
TRUE
37
CMP includes
glucose, calcium, albumin, total protein, electrolytes (sodium, potassium, CO2, chloride), kidney tests (BUN, creatinine), liver tests (ALP, ALT, AST, bilirubin)
38
blood clotting studies -platelet count -PT -PTT
-platelets: normally between 150-400,000 -PT and PTT: used to evaluate how well coagulation factors in coagulation cascade work together; measures number of time takes for clot to form- prolonged results would indicate clotting is taking longer than normal prolonged PT with normal PTT: liver disease, vitamin K deficiency, anticoagulation drug (warfarin) therapy normal PT with prolonged PTT: von Willebrand disease, SLE anticoagulant
39
White blood cell count with differential: NORMAL: -total WBC count: 5000 to 10,000 -neutrophils 30-70% -basophils: 0-3% -eosinophils 0-5% -lymphocytes: 15-40% -monocytes 2-8% low values, vs high values
WBC count thats low: bone marrow suppression, autoimmune disorders high WBC count values: dehydration, infection, inflammatory conditions, some malignancies, may be elevated in late pregnancy and during labor
40
blood glucose 1. fasting (nothing for 8 hours) 2. two hour postload glucose OGTT (75g)
1. fasting: below 126 2. OGTT: < 200 -impaired: 144-199 -normal: below 140
41
diagnostic criteria for diabetes mellitus with blood glucose:
1. classic sxs of hyperglycemia plus random serum glucose > 200 2. fasting glucose > 126 3. two hour post glucose: >200 4. HbA1c: >6.5% 5. repeat testing on subsequent day to CONFIRM diagnosis
42
lipid panel determines.. -cholesterol, triglycerides, HDLs, LDLs -fasting requirements?
risk for coronary heart disease and evaluates for hyperlipidemia -must fast 12-14 hours prior a. total cholesterol < 200 b. triglycerides: normally 35-135 c. HDL- removes cholesterol from peripheral tissues and transports to liver for secretion HDL: 40 or greater d. LDL-C: normally less than 130
43
BUN is an indirect measure of...
renal and liver function normally between 10-20 increased levels: renal disease decreased levels: liver failure
44
serum creatinine is an..
indirect measure of renal function normally between 0.5-1.1 increased: renal disorders, dehydration
45
TSH and Free T4 -normal
TSH: normally between 0.4 - 4.12 increased TSH: primary hypothyroidism and thyroiditis decreased TSH: seen with hyperthyroidism FT4: normally 4.5-12 increased FT4: hyperthyroidism decreased FT4: hypothyroidism
46
when is antithyroid peroxidase antibodies used?
anti-TPO is used in differential diagnosis of thyroid disorders associated with autoimmune disease a. normal findings: negative antithyroid antibodies b. positive: Grave's disease, Hashimoto's thyroiditis
47
LFTS 1. bilirubin 2. albumin 3. liver enzymes
1. bilirubin: normally 0.3-1.0 elevated direct bili: gallstones elevated indirect bili: seen in hepatitis 2. albumin: normally 3.5-5.0 increased: dehydration decreased: liver disease 3. liver enzymes NORMAL: AST: 0-35, ALT: 4-36 ALP: elevated with liver disease, MI
48
when is GGT helpful?
in assessing for heavy or chronic alcohol use normally between 8-38
49
false positives for occult blood in stool can be caused by....
red meat and some raw fruits and veggies large amounts of vitamin C ^^consumed within 3 days of test
50
universal donor vs universal recipient for blood
universal donor: O negative (OH SHIT they need my blood); no antigens on RBCs universal recipient: AB positive: no antibodies will be present
51
antinuclearl antibodies (ANA) test -used in the workup of...
SLE! 95% of individuals with SLE will be + for ANA higher titers = more active disease
52
pregnancy test detects...
hCG in blood/urine first morning urine is best, most concentrated
53
reproductive hormone studies 1. estradiol 2. progesterone 3. FSH 4. LH -increased vs decreased
1. estradiol -increased: adrenal tumor, -decreased: post menopause, ovarian failure, primary or secondary hypogonadism, Turner's syndrome 2. progesterone -increased: pregnancy, ovulation -decreased: short luteal phase syndrome 3. FSH -increased: postmenopause -decreased: pregnancy, pituitary or hypothalamic dysfunction 4. LH -increased: postmenopause -decreased: pituitary or hypothalamic dysfunction
54
urinalysis -what kind of catch
mid stream clean catch normal findings: -no nitrites, ketones, crystales, glucose -clear, amber yellow -pH 4.6 - 8 -specific gravity 1.005 - 1.030 -leukocyte negative -WBCs 0-4 -RBCs 2 or less
55
Vaginal microscopy/wet mount/pH/amine test 1. normal 2. bacterial vaginosis 3. trich 4. vulvovaginal candidiasis (VVC)
look on low (10x) and high (40x) power 1. normal: pH: 3.8-4.5 whiff test neg wet mount: epithelial cells, no WBC, lactobacilli present 2. bacterial vaginosis pH > 4.5, + whiff test, wet mount: > 20% clue cells 3. trich pH > 4.5, whiff test neg or post, motil trich, lactobacilli reduced 4. vulvovaginal candidiasis (VVC) pH < 4.5, whiff test neg, yeast buds/hyphae/spores present (best seen after KOH applied)
56
additional test for vaginal infection diagnosis includes...
a. NAAT- CDC recommended for trich b. culture; recommended when - for yeast on slide, but symptoms are present or persistent; NOT rec for BV
57
T/F HIV antibody detectable in 95% of individuals within 6 months of infection
TRUE
58
STI + screening diagnosis tests 1. chlamydia 2. gonorrhea 3. syphilis 4. genital herpes/herpes simplex virus (HSV) 5. chancroid 6. Trich
1. chlamydia: NAAT 2. gonorrhea: NAAT 3. syphilis: dark field microscopy examination and direct fluorescent antibody tests of lesion exudate are definitive methods of diagnosing early syphilis: SEROLOGY: nontrep tests (non specific): VDRL, RPR -become + 1-2 weeks post chancre -recative nontrep must be confirmed with treponemal tests (specific) 4. genital herpes/herpes simplex virus (HSV) -tissue culture and PCR for patients presenting with genital lesions -PCR assays are more sensitive than cultures 5. chancroid -culture -gram stain 6. Trich -NAAT (rec by CDC) -NAAT provides option of testing with urine, vaginal specimen; some approved for liquid-based cytology
59
Rubella IgM antibody tited
used if pregnant woman has a rash suspected to be from rubella
60
Hep B surface antigen (HbsAG) vs Hep B surface antibody vs Hep B core antibody (HBcAB) vs hep B e-antigen
antigen: indicates active HBV infection- individual is INFECTIOUS!! antibody: immunity from vaccine or previous infection core antibody: indicates past infection; chronic hepatitis hep B e-antigen: infectious, seen with acute infection
61
Hepatitis C (HCV) test first: HCV antibody assay next: HCV RNA test
if HCV antibody assay is reactive, f/u with HCV RNA test HCV RNA + test: current infection HCV RNA -: past resolved infection or false positive
62
T/F once you have a positive TB reaction, it usually persists for life
true!! whomp whomp
63
false-negative PPD (TB skin test) may results from...
incorrect admin, recent live virus vaccination, or immunosuppresion
64
false positive PPD (TB skin test) may results from
history of BCG vaccine MUST to a interferon gamma release assay (blood test) if history of Bacillus Calmette-Guerin vaccin
65
when is a strep throat test indicated in adults with pharyngitis? must meet TWO or more of the following criteria:
1. fever 2. no cough 3. tonsillar exudate 4. anterior cervical lymphadenopathy/tenderness
66
cervical cytology patient education prior...
-avoid douching, intercourse, and use of vaginal creams 48 hours prior -avoid scheduling on heaviest day of period -
67
vulvar biopsy should be used on lesions smaller than...
0.5 cm steps: -inject with lidocaine -cleanse with betadine -rotate punch biopsy several times with downward pressure over site -elevate specimen with forceps, incise at base with scissors -place specimen in solution for transport to the lab
68
EMBs are useful for...
evaluating abnormal bleeding (pre/postmenopausal bleeding), rule out/confirm endometriosis; determine endometrial response to progesterone in infertile individuals
69
EMB -patient education
take NSAID 30-60 minutes prior to procedure
70
inheritance patterns 1. autosomal dominant 2. autosomal recessive 3. X-linked dominant 4. X-linked recessive -examples??
1. autosomal dominant: only one mutated copy of gene in each cell needed, EX: Huntington disease, BRCA 1/2, Lynch syndrome 2. autosomal recessive: both copies needed- one from each parent; if BOTH parents are carriers: 50% chance of being a carrier, 25% chance of having disease EX: cystic fibrosis, muscular dystrophy, sickle cell anemia 3. X-linked dominant: mutation in genes on X chromosome; females more frequently affected than males EX: fragile X syndrome 4. X-linked recessive: males more frequently affected than females (males only have to inherit affected X chromosome whereas females have to inherit both) EX: hemophilia
71
pelvic u/s
1. use of high-frequency sound waves to evaluate internal pelvic organs/structure for diagnostic purposes: -distinguishes solid vs cystic pelvic masses -confirms viability -determines endometrial thickness -fibroids -adnexal masses -evaluate fetal growth -detect fetal anomalies transabdominal: full bladder transvaginal: empty bladder

health assessment and primary care (5 decks)

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