Unit 2 Test Flashcards
(217 cards)
1
Q
What is included in the physical exam of the head and face?
A
- Palpate temporal arteries. elastic and nontender? pulse palpable?
- Palpate temporomandibular joint. no swelling, tenderness, crepitation? headaches?
2
Q
What is included in the physical exam of the neck?
A
- inspect neck. symmetry, centered, no masses? movement & swallow? cervical vertebrae.
- Palpate trachea. midline?
- Palpate thyroid. usually not palpable. only auscultate if enlarged.
3
Q
How should you examine the thyroid?
A
You should stand behind the patient. palpate one side at a time while they swallow. isthmus is midline. Gland not usually palpable. If palpable should be smooth, firm, non tender.
4
Q
What is an abnormal thyroid considered?
A
goiter
5
Q
What do you auscultate for in an enlarged thyroid?
A
You check for bruit.
6
Q
What is bruit?
A
soft whoosing sound.
7
Q
What does bruit indicate?
A
Can indicate increased blood flow to the gland.
8
Q
What is included in the physical exam of lymph nodes?
A
assess using light palpation with 2-3 fingers. size and shape should be round and < 1 cm, if palpable. Assess for delimitation (discrete/confluent) tenderness. Mobility and consistency.
9
Q
What are the lymph nodes in the head and neck?
A
preauricular, posterior auricular, occipital, superficial cervical, deep cervical chain, posterior cervical, supraclavicular, tonsillar, submental, and submandibular.
10
Q
What are characteristics of normal lymph nodes?
A
Round, <1 cm in size, discrete, nontender, no enlargement.
11
Q
What are abnormal characteristics of lymph nodes?
A
enlarged nodes, swelling, tenderness, hardness, immobility.
12
Q
What are some geriatric considerations for head and neck assessments?
A
osteoarthritis or osteoporosis of neck? facial wrinkles prominent. TA pulse strength decreased. cervical curve- kyphosis or dowager's hump thyroid more nodular and lower.
13
Q
What do you look for/ask about with a present concern of the mouth, throat, nose, or sinus?
A
sores or lesions to mouth/tongue? bleeding of gums or from nose? pain? nasal drainage or stuffy nose? dysphagia or odynophagia? sore throat? radiating? hoarseness? how long?
14
Q
What lifestyle practices effect health of the mouth, throat, nose, and sinuses?
A
smoker or use smokeless tobacco? alcohol use? teeth grinding? oral care? denture care? sunscreen on lips? dietary intake?
15
Q
What is included on the physical exam of the mouth?
A
Lips- color, moisture, lesions,
Teeth/Gums- dentures, missing teeth, dental caries, discoloration, bleeding
Buccal Mucosa- Pink or darker with dark-skinned
Tongue- color, symmetry, lesions.
Hard/Soft Palate
Uvula
16
Q
What is indicated by Pallor on lips?
A
anemia
17
Q
What is indicated by cyanosis on lips?
A
hypoxia
18
Q
What is indicated by red on lips?
A
carbon monoxide.
19
Q
What is indicated by white plaques on the hard/soft palate?
A
candida
20
Q
What is indicated by a yellow tint of the hard/soft palate?
A
jaundice.
21
Q
What are common abnormalities of the mouth and throat?
A
herpes simplex type 1, cheilosis of lips, carcinoma of lip, leukoplakia, candida albicans infection (thrush), black hairy tongue, canker sore, gingivitis, receding gums, Kaposi’s sarcoma lesions, and acute tonsillitis and pharyngitis.
22
Q
What is included in the physical exam of the throat?
A
Tonsils- color, size, presence of exudate or lesions.
23
Q
What are the levels (or grades) of tonsils?
A
1+ tonsils are visible
2+ tonsils are midway b/t tonsillar pillars and uvula
3+ tonsils touch the uvula
4+ tonsils touch each other
24
Q
What is included in the physical exam of the nose?
A
inspect externally & test nostril patency. inpsect internally:
mucosa-color, swelling
septum- bleeding, perforation, deviation
nasal passage- narrow
Assess for discharge, foreign body. mucosa.
25
What are common abnormalities of the nose?
nasal polyp and perforated septum.
26
What does bluish/gray mucosa of the nose indicate?
allergies
27
What does redness and edema of the nasal mucosa indicate?
upper respiratory infection
28
What does yellow-green excaudate from the nose indicate?
Upper respiratory infection
29
What does purulent of the nose indicate?
Bacterial Rhinosinusitis
30
What is purulent?
discharge containing pus.
31
What does ulcers of the nasal septum indicate?
cocaine use or trauma.
32
What are the two types of sinuses?
frontal sinus and maxillary sinus
33
What do you do when you transilluminate the sinuses?
Shining a light against the skin into the sinuses.
34
If you transilluminate a sinus and it glows red, what does this indicate?
normal, clear sinuses
35
What are some geriatric variations to mouth, nose, throat and sinus exams?
gums recede. varicosities under tongue. tooth surfaces worn down, may wear dentures. decreased ability to smell and taste. oral mucosa drier and fragile. nose may appear larger due to loss of facial sq
36
What are some pediatric variations to mouth, nose, throat, and sinus exams?
number and condition of teeth. 20 deciduous teeth. lose teeth between 6-12 years of age. thumb sucking? pacifier use?
37
What are some abnormal pediatric findings of the mouth?
Cleft lip/palate
koplik's spots (measles)
bottle carries syndrome
teeth erosion (bulimia)
38
What are some visual problems?
acuity. spots/floaters. halos/rings. night vision. diplopia.
39
What are some lifestyle concerns with eyes?
exposure to harmful substances, sunglasses, diet, cigarettes.
40
What does the Amsler's chart test for?
macular degeneration
41
What does the IOP test for
determines intraocular pressure
42
What are risk factors for glaucoma?
increased IOP, advancing age, diabetes, family history, hypothyroidism, eye injuries, prolonged corticosteroid use, or nearsightedness.
43
What are ways to prevent glaucoma?
regular eye exams, treat any elevated IOP, maintain optimum body weight and blood pressure. eat a varied, well-rounded, and healthy diet.
44
What are ways to screen for glaucoma?
IOP tests and early POAG tests.
45
What are some risk factors of macular degeneration?
family history, advancing age, smoking, gender (female more likely), obesity, race (Caucasians more likely), light eye color, hypertension, CVD, genetic predisposition.
46
What are ways to prevent macular degeneration?
Don't smoke, get regular exercise, keep blood pressure in normal range, maintain healthy weight, protect eyes from sun exposure, and eat a varied and nutritious diet.
47
What are ways to screen for macular degeneration?
Amsler's grid test and visual acuity test
48
What are risk factors for cataracts?
diabetes, drinking excessive alcohol, increasing age, exposure to ionizing radiation, family history, high blood pressure, obesity, previous eye injury, prolonged use of corticosteroid medications, and smoking.
49
What are some ways to prevent cataracts?
Have regular eye exams. wear sunglasses, protect eyes from radiation, avoid smoking, avoid excess alcohol intake, maintain healthy weight, exercise, eat a well-rounded diet, seek medical care for eye injury.
50
What are some ways to screen for cataracts?
frequent eye exams
51
What does the Snellen eye chart assess?
distant visual acuity by standing 20ft from chart and reading lines off the chart
52
What is a normal result from a Snellen eye test?
20/20
| means that from 20 feet away, client can read the 20/20 line on the chart.
53
What is myopia?
impaired far vision 20/30 >
54
How often do you need have a Snellen test performed?
q2 yrs ages 18-60
| q1 yr ages >60 or at risk
55
What does the hand-held vision chart assess?
near visual acuity by holding chart 14 inches from eye, covering one eye, and reading from biggest to smallest letters.
56
What is a normal result from a hand-held vision chart?
14/14
57
What is presbyopia?
impaired near vision 14/20 or >
58
When do you assess near visual acuity?
middle aged or greater and those with complaints of
59
What does the confrontation test assess?
peripheral vision by standing 2 ft distance from patient, covering one eye. fully extend arm, in all four directions, bring finger inward until patient can see it.
60
What does the corneal light reflex test assess?
parallel alignment of the eyes
61
What is strabismus?
malalignment of the eyes
62
What does the cover test assess?
deviation in alignment
63
What is phoria?
deviation in alignment of eyes
64
What does the positions test assess?
eye muscle strength
65
What is nystagmus?
fine oscillating movements of the eye
66
What does PERRLA mean?
pupils equal round and reactive to light and accommodation
67
What is accommodation?
as object nears, eyes normally converse and constrict.
68
What is ptosis?
drooping eye
69
What causes ptosis?
oculomotor nerve damage, myasthenia gravis, or weakened muscles or tissue.
70
What is exophthalmos?
protruding eyeballs
71
What causes exophthalmos?
graves disease
72
What is conjunctivitis?
pink eye
73
What is hordeolum?
stye
74
What causes hordeolum?
hair follicle infection
75
What does OU mean?
both eyes
76
What does OS mean?
left eye
77
What does OD mean?
right eye
78
What is miosis?
pinpoint pupils
79
What is anisocoria?
unequal pupils
80
What is mydriasis?
dilated & fixed pupils
81
What is glaucoma?
enlarged physiologic cup
82
What is vertigo?
spinning feeling due to equilibrium issues
83
What is included in the physical exam of the external structures of the ear?
inspect external ear- size, shape, position, lesions, discolorations, tags
palpate external ear- tenderness
palpate mastoid process- pain, warmth, edema
84
What does tenderness of the auricle or tragus indicate?
otitis externa (swimmers ear)
85
What does tenderness behind the ear indicate?
otitis media (inner ear infection)
86
What does pain, warmth, and edema of the mastoid process indicate?
mastoiditis.
87
What is included in the physical exam of the internal structures of the ear?
inspect using otoscope.
external canal- look for cerumen, redness, swelling, foreign body, drainage, and lesions.
tympanic membrane- note color and characteristics, positon, and integrity.
88
What is a light reflex?
cone shaped reflection of otoscope light seen at 5 o'clock in the right ear and 7 o'clock in the left ear
89
What are some abnormalities of the external ear and ear canal?
lesions, otitis externa, buildup of cerumen, polyp, and exostosis.
90
What are some abnormalities of the tympanic membrane?
acute otitis media, blue/dark red, perforated TM, serous otitis media, scarred TM, and retracted TM.
91
What are some ear acuity tests?
whisper test, weber tests, and rinne test.
92
What does the whisper test?
gross hearing ability.
93
How is the whisper test performed?
stand 2 ft behind patient, ask them to repeat 6 2-syllable words. must have 3 out of 6 to pass
94
What is the weber test used for?
if a patient reports diminished or lost hearing in one ear. helps distinguish between conductive hearing loss or sensorineural hearing loss.
95
How is the weber test performed?
strike tuning fork with and then place on top of the patients head.
if heard better in ear with hearing loss, conductive hearing.
if heard better in good ear, sensorineural loss.
96
What is the rinne test used for?
compares air and bone conduction sounds
97
How is the rinne test performed?
strike tuning fork and place the base of the fork on the client's mastoid process. ask the patient to tell you when they no longer hear the sound, note length of time. move fork to front of external auditory canal, ask patient to tell you when they can hear and when they cannot, note length of time. normally air conduction is heard longer than bone conduction.
98
What is the Romberg test use for?
tests equilibrium
99
How is the Romberg test performed?
patient stands with feet together, arms at sides, eyes open, and then with eyes closes. patient must maintain position for 20 sec without swaying or minimal swaying.
100
What is entropion?
eyelids turn inward, can cause corneal abrasions
101
What is ectropion?
eyelids turn outward.
102
What are normal variations of the eyes and vision for geriatric patients?
dryness, redness, sensisitivty to light or wind, scratchy, arcus senilis, and decreased iris pigmentation, decreased pupillary response, presbyopia, floaters.
103
What are normal variations of the ears and hearing for geriatric patients?
coarse hair, elongated lobes, decreased cerumen or dryness, tympanic memebrane may be cloudy, and presbycusis.
104
What is presbycusis?
high frequency hearing loss.
105
What are some abnormal findings in eyes of pediatric patients?
yellow sclera or blue sclera, cataracts, and sunsetting eyes.
106
What does yellow sclera indicate?
jaundice
107
What does a blue sclera indicate?
osteogenesis imperfecta
108
What are characteristics of the eyes related to down's syndrome?
wide set eyes, upward slant, thick epicanthal folds, and brushfield's spots.
109
What is hypertelorism?
wide-spread eyes
110
What is epicanthal folds?
skin fold of upper eye lid covering inner corner
111
What is brusfield's spots?
small white or grayish/brown spots on the periphery of the iris.
112
What is photophobia?
eye pain with bright light
113
what is diplopia?
double vision
114
What is epiphora?
excessive tearing
115
What is an amsler's chart?
grid with black dot in center used to screen macular degeneration
116
What is glaucoma?
increased intraocular pressure
117
What is a Jaeger test?
chart used to test near vision
118
What is an ophthalmoscope?
hand held instrument allowing for examiner to view fundus of the eye
119
What is blepharitis?
inflamed eye lid
120
What is arcus senilus?
white arc around limbus, normal in older adults.
121
What is otorrhea?
drainage from ear
122
What is cerumen?
ear wax
123
What is otalgia?
ear pain
124
What is tinnitus?
ringing in ears
125
What is otorhinolaryngologist?
ears, nose, and throat doctor
126
What is an otoscope?
flashlight-type viewer used to visualize the eardrum and external ear canal.
127
What is the normal appearance of the tympanic membrane?
pearly, gray, shiny, translucent.
128
What is dyspnea?
difficulty breathing
129
What does DOE stand for?
dyspnea of exertion
130
What is sleep apnea?
when you stop breathing while sleeping
131
What is myocardial infarction?
heart attack
132
What is myocardial ischemia?
angina.
133
What is pleuritic pain?
when the two linings of the lungs are inflamed and rubbing together. pain increasese with movement.
134
What does PND mean?
paroxysmal nocturnal dyspnea
135
What does it mean when you have clubbing of the fingers/nails?
chronic hypoxia
136
What does it mean when a person exhibits a barrel chest?
Chronic lung hyper inflation - COPD.
137
What is tachypnea?
regular rhythm, fast rate breathing, often seen with respiratory disease.
138
What is bradypnea?
regular rhythm, slow rate breathing.
139
What is Kussmaul respiration pattern?
rapid, deep, labored breathing. .
140
What is hyperventilation?
increased rate and increased depth.
141
What is hypoventilation?
decreased rate, decreased depth, and irregular pattern.
142
When does hyperventilation occur?
usually occurs with extreme exercise, fear, or anxiety. causes include disorders of the CNS or severe anxiety.
143
When does kussmaul respirations occur?
a type of hyperventilation associated with diabetic ketoacidosis
144
When does hypoventilation occur?
usually associated with overdose of narcotics
145
What is cheyne-stokes respirations?
regular pattern characterized by alternating periods of deep, rapid breathing followed by periods of apnea
146
When does cheyne-stokes respirations occur?
may result from severe congestive heart failure, drug overdose, increased intracranial pressure, or renal failure.
147
What is crepitus?
air bubbles in the subcutaneous tissue.
148
What is a pneumothorax?
air in the chest wall, a collapsed lung. causes asymmetrical chest rise.
149
What is fremitus?
vibrations felt throughout the chest when patient is vocal.
150
How do you assess fremitus?
use the ball of your hand, have patient say 99, to feel vibrations.
151
What do you hear when you percuss over the scapula?
flat
152
What do you hear when you percuss over the lungs?
resonance
153
What abnormal sounds would you hear when you percuss over the lungs?
hyperresonance- air trapping
| dullness- fluid/solid tissue
154
What are adventitious breath sounds?
abnormal breath sounds. ex. crackles, wheezing, friction rub, etc.
155
What are fine crackles (or rales)?
high-pitched, short, popping sounds heard during inspiration, no cleared with coughing.
156
What are coarse crackles?
low-pitched, bubbling, moist sounds that persist from early inspiration to early expiration. described as softly separating Velcro. may clear with cough.
157
What is pleural friction rub?
low-pitched, dry, grating sound. sounds like crackles but more superficial and occurring during both inspiration and expiration.
158
What is sibilant wheezes?
high-pitched, musical sounds heard primarily during expiration but may also be heard on inspiration.
159
What is sonorous wheezes (or rhonci)?
low-pitched, snoring or moaning sounds heard primarily during expiration but may be heard throughout the respiratory cycle. may clear with coughing.
160
What diseases do you hear crackles (fine and coarse)?
pneumonia, CHF, pulmonary edema.
161
What diseases do you hear sibilant wheezes?
asthma and COPD
162
What diseases do you hear sonorous wheezes (Rhonchi)?
bronchitis and snoring.
163
What is stridor?
high-pitched wheezing/barking cough
164
What diseases causes stridor?
broncholaryngospasm (or croup)
165
What disease causes pleural friction rub?
pleuritis
166
What is included in a focused respiratory assessment?
behavior change, respiratory effort, respiratory rate, respiratory rhythm, pt position, color, cough, breath sounds, and o2 stats.
167
What occurs when someone has too much co2?
patient is stuporous.`
168
What are pediatric variations of the thorax?
rounded chest, will become normal by age 5-6.
breath sounds are louder, harsher, and hyperresonant. children under the age of 6-7 are belly breathers.
ages 2-10 y/o RR 20-28
ages 10-18 y/o RR 12-20
169
What are geriatric variations of the thorax?
- decreased elasticity, fewer capillaries -> dyspnea
- decreased feeling of pain -> chest pain may be absent
- increased rigidity of chest -> decreased ability to cough effectively.
- kyphotic changes in spine
- calcification of costal cartilage & loss of accessory muscles -> decreased thoracic expansion
- loss of SQ tissue -> prominent sternum and ribs
170
What to assess when inspecting breast?
size and symmetry. areola and nipples -> direction and discharge. shape -> retraction and dimpling. surface characteristics.
171
What is gynecomastia?
breast tissue in males. caused by hormonal imbalance or other conditions.
172
What is paget disease?
cancer that only affects the nipple.
173
How do you screen for retraction?
lift arms over head.
lower arms, hands on hips.
press hands together fingers in opposite direction.
lean forward.
174
What portion of the breast is breast cancer most often found?
upper outer quadrant.
175
What does enlarged lymph nodes indicate?
> 1 cm, indicates infection or malignancy.
176
What does peau d'orange skin indicate?
blockage of subcuticular lymphatics with edema of the skin. looks dimpled and leathery. typically caused by the shortening of the suspensory ligament because of cancerous invasion.
177
What are normal geriatric variations of the brest?
decreased fat and elasticity. feels more glandular. ducts are more fibrotic and palpable. nipples may turn in slightly. areola may disappear.
178
What are some risk factors of breast cancer?
gender, age, genetics. race/ethnicity. early menarche, late menopause. no children or children after age 30. not breast feeding. hormone exposure. dense breast.
179
When should you screen for breast cancer?
yearly mammograms after age 40.
clinical breast exam every three years.
Breast self exam every month after menstrual cycle.
180
What can you do to prevent breast cancer?
healthy living, maintain healthy weight, exercise, decrease alcohol intake, no smoking, report any changes to breast to HCP.
181
What is pyrosis?
heartburn
182
What is hepatitis?
inflammation of the liver
183
What is pyelonephritis?
kidney infection
184
What is nephrolithiasis?
kidney stones
185
What is cholecystitis?
inflammation of the gall bladder.
186
What is anorexia?
loss of appetite
187
What is gastritis?
inflammation of the stomach
188
What is gasteroenterologist?
specialist for stomach and intestines.
189
What is emesis?
vomit
190
What is hematemesis?
bloody vomit
191
What is flatus?
intestinal gas
192
What is hemoccult?
test for blood in stool
193
What is striae?
stretch marks
194
What is hernia?
loop of bowel protruding through weak spot in abdominal muscles.
195
What is hepatomegaly?
enlarged liver
196
What is splenomegaly?
enlarged spleen
197
What is Grey-Turner sign?
purplish discoloration at flank, indication of bleeding.
198
What is Cullen's sign?
purple discoloration around the umbilicus, indicates bleeding in abdomen.
199
What is ascites?
excessive accumulation of fluid in the peritoneal cavity.
200
What is scaphoid abdomen?
sunken appearance of the abdomen
201
What is CVA tenderness?
costovertebral angle tenderness, indicates inflammation of the kidneys.
202
What is dyspepsia?
pain or uncomfortable feeling in the upper middle part of the stomach.
203
What lifestyle and health practices would you ask about when assessing the abdomen?
alcohol consumption. food. fluids (caffeine). exercise. stress. ADLs.
204
In what order do you assess the abdomen?
inspect, auscultate, percuss, then palpate.
205
What do you inspect during an abdominal assessment?
skin-color, venous pattern, straie, scars, lesions, integrity.
umbilicus- color, location.
abdomen- contour, symmetry, visible masses/herniation, peristaltic waves, pulsations.
206
What causes abdominal distension?
fluid, fat, feces, flatus, fetus.
207
What is Caput medusa?
engorged paraumbilical veins. portal hypertension.
208
What types of stomas are there?
colostomy, ileostomy, urostomy.
209
How do you auscultate the abdomen?
use diaphragm to hear bowel sounds. usually occur every 5-15 seconds. may be absent after surgery. listen to all 4 quadrants. start in RLQ, go clockwise.
210
What are normal percussion sounds with the abdomen?
liver and spleen- dullness
stomach and intestines- tympany
kidney- no CVA tenderness
211
What are abnormal percussion sounds with the abdomen?
resonance and hyperresonance
212
What types of palpation are used for assessing the abdomen?
light palpation first- tenderness and muscle tension
deep palpation - subtle masses and organs
Palpate tender areas last.
213
What are normal palpation findings when assessing the abdomen?
soft, non tender. sometimes mild tenderness.
214
What are abnormal palpation findings when assessing the abdomen?
involuntary guarding, rebound tenderness or pain, and easily palpated liver or spleen.
215
What are some abnormalities in the abdomen?
umbilical hernia, marked peristaltic waves, rigid abdomen, or enlarged liver and spleen.
216
What are geriatric considerations when assessing the abdomen?
sensitivity to pain may decrease. risk for dehydration related to higher fat ration. risk for UTI increases. appetite declines. risk for constipation related to decreased motility.
217
What are pediatric considerations when assessing the abdomen?
toddlers appear pot-bellied. peristaltic waves seen in thin child. liver and spleen may be palpated in young child.
