NURS 5220/ NURS5220 Exam 2 – Advanced Health Assessment and Diagnostic Reasoning Review | UTA (Latest Update) 100% Verified Questions & Answers | Complete Exam Preparation Material

NURS 5220/ NURS5220 Exam 2 – Advanced Health Assessment and Diagnostic Reasoning Review | UTA (Latest Update) 100% Verified Questions & Answers | Complete Exam Preparation Material 2026/2027 | GRADED A+ | 100% VERIFIED Question: cranial nerve I Answer Olfactory (smell) Question: cranial nerve II Answer Optic - vision Question: cranial nerve III Answer Oculomotor Question: cranial nerve IV Answer Trochlear Question: how do you test cranial nerve IV? Answer cardinal field test Question: cranial nerve V Answer Trigeminal Question: how do you test trigeminal nerve? Answer Assess facial sensation (hot/cold, dull/sharp), clench teeth, corneal reflex Question: cranial nerve VI Answer Abducens Question: how do you test abducens nerve? Answer 6 fields of gaze for lateral movement Question: what 3 cranial nerves are tested together? Answer III, IV, VI Question: corneal reflex Answer blinking in response to corneal stimulation by a cotton wisp Question: Cranial Nerve VII Answer Facial - controls most facial expressions & secretion of tears & saliva & taste Question: cranial nerve VIII Answer Vestibulocochlear (hearing and balance) Question: cranial nerve IX Answer Glossopharyngeal Question: cranial nerve IX and X Answer ability to identify sour and bitter tastes on each side of the tongue. Test gag reflex and ability to swallow. Inspect palate and uvula for symmetry with speech sounds and gag reflex. Observe for swallowing difficulty. Evaluate quality of guttural speech sounds (presence of nasal or hoarse quality to voice). Question: cranial nerve XI Answer spinal accessory Question: how to test cranial nerve XI? Answer shrug shoulders and rotate head against resistance Question: cranial nerve XII Answer Hypoglossal Question: how to test cranial nerve XII? Answer inspect tongue in mouth and while protruded for symmetry, tremors, atrophy. Inspect tongue movement toward nose and chin. Test tongue strength with index finger when tongue is pressed against cheek. Evaluate quality of lingual speech sounds (l, t, d, n). Question: achilles reflex tests.... Answer plantar flexion of foot Question: DTR 0 Answer no response Question: DTR 1+ Answer sluggish or diminished Question: DTR 2+ Answer active or expected response Question: DTR 3+ Answer more brisk than expected, slightly hyperactive Question: DTR 4+ Answer brisk, hyperactive with intermittent or transient clonus Question: clonus Answer rapidly alternating involuntary contraction and relaxation of a muscle in response to sudden stretch Question: extension of the elbow tests for.... Answer triceps reflex Question: triceps reflex Answer C7-C8 Question: Kernig's sign Answer a diagnostic sign for meningitis marked by the person's inability to extend the leg completely when the thigh is flexed upon the abdomen and the person is sitting or lying down Question: Brudzinski's sign Answer Sign of meningitis; positive when a patient's legs lift involuntarily when lifting a patient's head Question: palmar grasp Answer An infant reflex that occurs when something is placed in the infant's palm; the infant grasps the object. Question: Plantar grasp Answer Touch sole of foot, toes curl downwards Question: Moro reflex Answer Infant reflex where a baby will startle in response to a loud sound or sudden movement. Question: placing reflex Answer Hold the infant upright under the arms, close to a table. Let the dorsal "top" of foot touch the underside of the table. Note flexing of hip and knee, followed by extension at the hip, to place foot on table Reflex appears at 4 days after birth Question: stepping reflex Answer a neonatal reflex in which an infant lifts first one leg and then the other in a coordinated pattern like walking Question: fencing reflex Answer When baby is lying on her back, depending on the direction of the head- that arm will straighten while the other hand raises up at the head Question: cremasteric reflex Answer upward pull of testicles and scrotum due to touch Question: abdominal reflex Answer Normal response is the ipsilateral contraction of the abdominal muscles with an observed deviation of the umbilicus towards the stroke. Question: Babinski reflex Answer Reflex in which a newborn fans out the toes when the sole of the foot is touched Question: Positive Babinski sign Answer dorsiflexion of the big toe and fanning of all toes Question: point location Answer touch skin and withdraw stimulus promptly; ask person to put finger where you touched Graphesthesia Answer ability to "read" a number by having it traced on the skin extinction phenomenon Answer Simultaneously touch two areas on each side of the body. Similar sensations should be felt bilaterally. two point discrimination Answer ability to distinguish the separation of two simultaneous pinpricks on the skin Stereognosis Answer ability to recognize objects by feeling their form, size, and weight while the eyes are closed What is the cerrebellum responsible for? Answer balance and coordination Cerrebellum Answer part of the brain that controls balance, movement, and coordination descending tracts in the spinal cord are primarily responsible for.... Answer voluntary motor activity stereognosis tests the ability of the patient to .... Answer identify an object by touch portions of the body that are innervated by specific spinal nerves are identified as .... Answer dermatomes Tanner stage 1 breast Answer prepubertal tanner stage 2 girls Answer Breast bud stage: A small mound of breast and nipple develops; the areola widens. Tanner stage 3 girls Answer Breast enlargement without separate nipple contour Pubic hair fills out but is straight Tanner stage 4 female Answer Secondary mound occurs in the breast at the areola; Pubic hair is adult like Which breast Tanner stage corresponds to secondary areola mound development above the breast? Answer 4 You have asked a patient to close his eyes and identify an object in his hand. You are evaluating Answer stereognosis Inspection of the breasts usually begins with the patient in which position? Answer sitting You are seeing a 16-year-old female gymnast patient. She is athletic and thin. Radiography of an ankle injury reveals a stress fracture. You should question this patient about her: Answer menstrual cycles The strength of the trapezius muscle is evaluated by having the patient: push his or her head against the examiners head Which medical condition would exclude one from sport's participation? fever You have a pregnant patient in clinic. She eats a well-balanced diet and is usually has a daily soft bowel movement. You should explain that constipation is common during pregnancy due to changes in the colorectal areas such as: decreased movement through the colon and increased water absorption from stool Environmental hazards and cognitive function are data needed for the personal and social history section of a neurologic assessment for: every patient A patient presents to the emergency department after a motor vehicle accident. The patient sustained blunt trauma to the abdomen and complains of pain in the upper left quadrant that radiates to the left shoulder. What organ is most likely injured? spleen Which of the following is a concern, rather than an expected finding in older adults? bilateral pill rolling of the fingers a primitive reflex that is not normally present in a newborn is.... graphestesia mental or neurological status assessment begins with.... observation cerebrum Largest part of the brain; responsible for voluntary muscular activity, vision, speech, taste, hearing, thought, and memory. what part of the brain is primarily responsible for a person's mental status? cerebrum mediates certain patterns of behavior that determines survival limbic system located in the brainstem, it regulates the level of wakefulness or arousal reticular activating system Reticular Activating System (RAS) a dense network of neurons found in the core of the brain stem; it arouses the cortex and screens incoming information what lobe of the brain is not fully developed in children? frontal lobe Are all of the brain's neurons present at birth? yes speed of information processing and psychomotor speed decline after what age? 30 verbal skills and general knowledge increase into the ______ and remain stable until the _____ 60s, 80s Edinburgh Postnatal Depression Scale Screening tool; Self-report assessment; 10 statements static (adj) fixed, not moving or changing, lacking vitality automatism unconscious bodily movements agnosia the inability to recognize familiar objects. visual agnosia occipital lobe damage auditory agnosia temporal lobe damage tactile agnosia parietal lobe damage agnosia of body parts and relationships correspond to posterior-inferior regions of parietal lobe Apraxia inability to perform particular purposive actions, as a result of brain damage. receptive aphasia temporal lobe-wernickes area expressive aphasia inferior-posterior frontal -brocas area visual receptive aphasia Parietal-occipital area Expressive writing aphasia posterior frontal area coordinated sucking and swallowing is a function of the.. cerebellum cremasteric reflex corresponds to what spinal area T12 & L1 biceps reflex corresponds to what spinal area C5 & 6 brachioradial reflex corresponds to what spinal area C5&6 triceps reflex corresponds to what spinal area C 6,7,8 patellar reflex corresponds to what spinal area L 2,3,4 achilles reflex corresponds to what spinal area S 1 &2 Clonus is associated with upper motor neuron disease plantar reflex corresponds to what spinal area S 1 & 2 tinnel sign -tests for nerve sensitivity of the median nerve (tap on volar carpal lig) -tingling into thumb, index, and ½ of ring fingers. myasthenia gravis a chronic autoimmune disease that affects the neuromuscular junction and produces serious weakness of voluntary muscles Gullain-Barre syndrome an inflammation of the myelin sheath of peripheral nerves, characterized by rapidly worsening muscle weakness that may lead to temporary paralysis; also known as infectious polyneuritis trigeminal neuralgia characterized by severe lightning-like pain due to an inflammation of the fifth cranial nerve Bell palsy acute paresis, or paralysis, of one side of the face thelarche onset of breast development Preadolescence tanner stage 1 breast budding stage 2- age 11 continued enlargement stage 3- age 12 areola and papilla form secondary mound stage 4-age 13 mature female breast stage 5- age 15 unilateral venous patterns of breast is a strong indicator of what pathology Tail of Spence extension of breast tissue into the axilla women age 50-74 with average risk for breast cancer should get a mammogram how often every 2 years breasts in infants are enlarged after birth in boys and girls and this is due to maternal transference of what? estrogen _____ is common in male adolescents due to imbalanced hormones gynecomastia galactorrhea the production of breast milk in a women who is not breastfeeding Paget disease of the nipple DCIS that infiltrates the epidermis of the nipple. Nipple erythema, ulceration, and eczematoid changes. mastitis inflammation of the breast fecal incontinence is often related to impaction McBurney's point Pain in RLQ with appendicitis Iliopsoas flexes hip markle test a test for the presence of peritonitis in which the patient stands on his toes, then drops to his heels, or in which the heels are struck together or stuck on the bottom. The jarring of the torso will elicit pain when the peritoneal linings are inflamed. Also called the heel drop test Murphy's sign pain with palpation of the RUQ during inspiration, indicative of cholecystitis Cullen's sign ecchymosis in umbilical area, seen with pancreatitis Grey Turner's sign discoloration over the flanks suggesting intra-abdominal bleeding. Kehr's sign severe left shoulder pain in patient with splenic rupture (referred pain due to diaphragmatic irritation) ectopic pregnancy or renal stone meconium ileus is a red flag for what disorder? cystic fibrosis biliary atresia Congenital absence of the opening from the common bile duct into small intestine (duodenum). Hirschsprung disease congenital megacolon megacolon abnormally large colon Meckel's diverticulum outpouching of distal ileum Barlow maneuver newborn hip evaluation - adduction of hip - evaluates for congenital dislocation Ortalani Test Flex hips and knees to 90 and abduct the hip while pressing the femoral head anteriorly. Allis sign 1 knee significant lower that other knee Suggest Hip Dislocation genu varum bow legged genuvalgum knock-kneed lordosis abnormal anterior curvature of the lumbar spine (sway-back condition) dorsal kyphosis curvature of the thoracic spine ankylosing spondylitis chronic, progressive arthritis with stiffening of joints, primarily of the spine Paget's disease of bone (Osteitis Deformans) Skeletal disease of increase bone resorption and formation, which softens, thickens, and deforms bone. Characterized by bowed long bones, sudden fractures, frontal bossing, and enlarging skull bones that forma an acorn-shaped cranium. Can cause: headache, vertigo, tinnitus, progressive deafness, and optic atrophy and compression of the spinal cord. talipes equinovarus (clubfoot) congenital deformity of the foot in which it is plantar flexed and inverted Metatarsus adductus most common deformity of the foot, marked by the middle bones of the foot pointing in toward the body Legg-Calve-Perthes Disease avascular necrosis of the femoral head Osgood-Schlatter disease inflammation or irritation of the tibia at its point of attachment with the patellar tendon Slipped Capital Femoral Epiphysis (SCFE) This condition usually occurs in 10-16 year olds during rapid growth, when even minor trauma can precipitate its development. The epiphysis appears shorter and the epiphyseal plate wider, with smaller margins. Dupuytren's contracture Thickening and shrinking of the fascia of the palm with fingers being drawn into a flexed position Neer's Test shoulder impingement Hawkins-Kennedy Test shoulder impingement Straight Leg Raise Test test often performed to determine whether a patient with low back pain has an underlying herniated disk Thomas Test hip flexor tightness The Phalen test is used to help diagnose: carpal tunnel syndrome Ballottement test presence of excess fluid in the knee Lachman's Test ACL McMurray Test Meniscal tear Skene's glands glands located in the urethras of some women that are thought to develop from the same embryonic tissue as the man's prostate, and that may be the source of a fluid emitted by some women during orgasm Bartholin's glands produce a mucus secretion to lubricate the vagina Peyronie's disease curvature of the penis due to fibrous tissue deposits around the corpora cavernosa When should the HPV vaccine be given? 11-12 years old hpv vaccone can also be given between the ages of 13-26 and 46 for high risk Phimosis and Paraphimosis Prepuce too tight to retract/return from retracted position Condylomata acuminata genital warts Lymphogranuloma venereum swelling of the inguinal lymph nodes and scarring of genital tissues variocele enlarged veins of the spermatic cord orchitis epididymitis inflammation of the epididymis spermatocele a cyst that develops in the epididymis and is filled with a milky fluid containing sperm hypospadias abnormal congenital opening of the male urethra on the undersurface of the penis hydrocele sac of clear fluid in the scrotum testicular torsion twisting of the spermatic cord Kleinfelter's Syndrome males with XXY sex chromosomes Encopresis involuntary defecation not attributable to physical defects or illness Aaron sign Pain or distress occurs in the area of the patient's heart or stomach on palpation of McBurney's point Appendicitis Ballance sign Fixed dullness to percussion in left flank, and dullness in right flank that disappears on change of position Peritonitis Blumberg sign rebound tenderness peritonitis, appendicitis Cullen sign bruising around umbilicus pancreatitis or ectopic pregnancy Dance sign absence of bowel sounds in RLQ intussusception Grey Turner sign Ecchymosis of flanks Hemoperitoneum; pancreatitis Kehr sign abdominal pain radiating to the left shoulder spleen rupture, ectopic pregnancy, renal calculi Markle sign (heel jar) abdominal pain when running, jumping, RLQ pain when pt drops from tip toes to heel with jarring landing appendicitis, peritonitis McBurney's sign rebound tenderness associated with appendicitis (RLQ) Murphy's sign Abrupt cessation of inspiration with palpation of gall bladder cholecystitis Romberg test Ask client to stand with feet at comfortable distance apart, arms at sides, and eyes closed -expected finding: client should be able to stand with minimal swaying for at least 5 seconds -strangulated obturator hernia Rovsing's sign Pain in RLQ with palpation of LLQ indicative of appendicitis Iliopsoas muscle test RLQ pain that occurs when placing pressure against a raised leg, suggesting appendicitis Obturator muscle test have patient flex right leg at hip and knee; then rotate hip externally and lower leg medially -possible appendicitis, pelvic abscess Percussion for ascites - Fluid associated with ascites will sink with GRAVITY and gas filled loops of bowel will rise to top of abdomen - Percussion sounds will be dull in dependent areas of abdomen - Assess for shifting dullness by having patient lie on the side -fluid wave Tanner Stages Male 1. Pre-pubertal, no hair 2. Pubertal, small amount of downy hair 3. enlargement of penis length, pubic hair darken and is sparse over entire pubis 4. increase size of penis and glans, pubic hair abundant on pubic area 5. adult size and shape, pubic hair spreads to inner thighs Tanner stages for girls Stage 1: No breast development & no pubic hair Stage 2: Puberty starts between ages 9 and 11. First signs of breasts called "buds" start to form under the nipple. The darker area around the nipple (areola) will also expand. Small amounts of pubic hair start growing on the lips of the vulva. Stage 3: Breast buds continue to grow and expand. Pubic hair gets thicker and curlier. Hair starts forming under the armpits. The first sign of acne may appear on the face and back. Hips and thighs start to build up fat. Stage 4: Breast take on a fuller shape, passing the bud stage. Many females start to get their period typically between the ages 12 and 14. Height growth will slow down. Pubic hair gets thicker. Stage 5: Breasts reach approximate adult size and shape, though breasts can continue to change through age 18. Periods become regular after 6 months to 2 years. Females reach adult height 1 to 2 years after their first period. Pubic hair fills out to reach the inner thighs. Reproductive organs and genitals are fully developed. Hips, thighs, and buttocks fill out in shape. Cranial Nerve 1 Sensory, Olfactory Cranial Nerve 2 Sensory, Optic Cranial Nerve 3 Motor, Oculomotor Cranial Nerve 4 Motor, Trochlear Cranial Nerve 5 Both, Trigeminal (facial muscle tone, sensation, and corneal reflex) Cranial Nerve 6 Motor, Abducens Cranial Nerve 7 Both, Facial (expressions, speech, taste sweet and salty) Cranial Nerve 8 Sensory, Vestibulocochlear (hearing and balance) Cranial Nerve 9 Both, Glossopharyngeal (taste sour and bitter, gag reflex) Cranial Nerve 10 Both, Vagus (motor, gag, swallowing, speech) Cranial Nerve 11 Motor, Accessory (shrug shoulders) Cranial Nerve 12 Motor, Hypoglossal (tongue movement and strength, speech) evaluate coordination and fine motor skills -rapid, rhythmic, alternating movements -accuracy of movement (finger-to-nose or heel-to-shin) Balance Romberg test, Recovery, standing and hopping, walking, heel-toe walking, TUG (less than 12 sec) Primary sensory functions superficial touch (lightly, point to where and when), superficial pain (sharp or dull), temperature, deep pressure, protective sensation, vibration, position of joints Cortical sensory functions stereognosis (familiar objects), two point discrimination, extinction phenomenon, graphesthesia (draw on palm), point location Apaxia Loss of ability to carry out learned, purposeful movements Aphasia Affects how one communicates Agnosia Unable to recognize common objects Cortical sensory test tests ability to interpret sensations. Inability to do these tests indicates lesion in sensory cortex or posterior columns of spine Primary sensory test superficial touch and pain, vibration, temperature, deep pressure, and proprioception Upper neuron damage Increase tone, muscle spasticity, decreased strength, hyperactive DTR, positive babinski, no fasciculation. Above BS + opposite, below BS = same side Lower neuron damage decreased tone, flaccid, atrophy, weak DTR, fasciculation, paralysis, same side of body heave/lift apical impulse that is more forceful d/t hypertrophy Hydrocele scrotal swelling caused by a collection of fluid Phimosis stenosis or narrowing of foreskin so that it cannot be retracted over the glans penis Paraphimosis condition in which a retracted prepuce cannot be pulled forward to cover the glans Balantitis inflammation of the glans penis Balanoposthitis inflammation of the glans and prepuce Varicocele enlarged veins of the spermatic cord Molluscum contagiosum viral infection of skin & mucous membranes, considered an STI in adults, in contrast to the non-sexually transmitted common infection in young children. Dome-shaped papule w/ central umbilicationn Syphilis chancre painless ulcer, firm, round, small, indurated borders w/ clear base, often single Hemolytic Uremic Syndrome a condition in which hemolytic anemia and thrombocytopenia cause acute renal failure. Complication of diarrheal infection (E. Coli) Cranial Nerve III (three) Oculomotor Motor Evaluated with IV and VI Eye movement, pupil size, eyelid opening Inspect eyelid for drooping Inspect pupil size and equality Test consensual response and accommodation Test extra-ocular eye movement So tested thru PERLA and six cardinal fields Eyelid dooping/palsy is cranial nerve III Cranial Nerve IV (four) Trochlear Motor Evaluated with III and VI Eye movement, pupil size, eyelid opening Inspect eyelid for drooping Inspect pupil size and equality Test consensual response and accommodation Test extra-ocular eye movement So tested thru PERLA and six cardinal fields Cranial Nerve V (five) Trigeminal Mixed (both sensory and motor) Jaw strength, ask to clench teeth Inspect face for atrophy or tremors Palpate jaw for tone and strength Test for pain and sensation Test corneal reflex Cranial Nerve VI (six) Abducens Motor Evaluated with III and IV Eye movement, pupil size, eyelid opening Inspect eyelid for drooping Inspect pupil size and equality Test consensual response and accommodation Test extra-ocular eye movement So tested thru PERLA and six cardinal fields Cranial Nerve VII (seven) Facial Mixed (both sensory and motor) Facial expressions and taste Inspect facial symmetry Test tongue for salt and sweet Assess smile, frown, puff out cheeks Cranial Nerve VIII (eight) Acoustic Sensory Hearing and balance Test hearing (whisper test) Compare bone and air conduction Test for sound lateralization Cranial Nerve IX (nine) Glossopharyngeal Mixed (both sensory and motor) Taste and swallowing Test tongue for sour and bitter Test gag reflex and swallowing Cranial Nerve X (ten) Vagus Mixed (both sensory and motor) Swallowing and speech Inspect palate and uvula for symmetry Inspect for swallow difficulty Evaluate guttural speech sounds Cranial Nerve XI (eleven) Spinal accessory Motor Muscle strength Test trapezius and sternocleidomastoid muscle strength Shrug shoulders against resistance Cranial Nerve XII (twelve) Hypoglossal Motor Tongue strength Inspect tongue for tremors, symmetry, atrophy Test tongue movements Test tongue strength Evaluate lingual speech sounds Assessing cranial nerves in infants In infants, cranial nerves can be assessed by observing: CN II, III, IV, and VI can be assessed by looking for optical blink reflex, gaze and tracking, doll's eye CN V is evaluated with rooting and sucking reflex CN VII look at facial expression, forehead wrinkling, smiling CN VIII look at acoustic blink reflex, doll's eye manuever CN IX, X evaluate swallow and gag reflex CN XII evaluate sucking and swallowing ability, tongue position with pinch test Types of agnosia: Visual Occipital lobe Types of agnosia: Auditory Temporal lobe (lateral + superior) Types of agnosia: Tactile Parietal lobe Types of agnosia: Body parts and relationships Parietal lobe (posterio-inferior) Types of aphasia: Auditory receptive Temporal lobe (Wernicke's area) Types of aphasia: Expressive speaking Inferior posterior frontal area (Broca's) Types of aphasia: Visual receptive Parietal-occiptal Broca's aphasia Expressive type of aphasia characterized by intact reading comprehension, impaired writing skills, and using only nouns and verbs in speech Broca area (frontal lobe) contains the motor cortex, which is associated with speech formation, as well as decision making, problem solving, the ability to concentrate, and short-term memory Which part of the brain contains the Wernicke's speech area? Temporal lobe The temporal lobe is responsible for perception and interpretation of sounds as well as localizing their source. It contains the Wernicke speech area, which allows a person to understand spoken and written language. It is also involved in the integration of behavior, emotion, and personality, as well as long-term memory Types of aphasia: Expressive writing Posterior frontal What are characteristics of delirium? Characteristics of delirium include a sudden onset of cognitive impairment, illogical flow of ideas, and hallucinations that fluctuates during the day and last hours or days What are characteristics of Parkinson's? Slumped posture and a lack of facial expression may indicate depression or a neurologic condition such as Parkinson disease Shuffling gait What does the limbic system regulate? Emotions The limbic system mediates certain patterns of behavior that determine survival (e.g., mating, aggression, fear, and affection). Reactions to emotions such as anger, love, hostility, and envy originate here, but the expression of emotion and behavior is mediated by connections between the limbic system and the frontal lobe What tool tracks cognitive changes over time? Mini-Mental Status Exam (MMSE) Deep tendon reflexes: Biceps Elbow flexion C5 & 6 Deep tendon reflexes: Brachioradial Forearm pronation and elbow flexion C5 & 6 Deep tendon reflexes: Triceps Elbow extension C6, 7, 8 Deep tendon reflexes: Patellar Lower leg extension L2, 3, 4 Deep tendon reflexes: Clonus Rhythmic oscillating movements Ankle Associated with upper motor neuron disease Deep tendon reflexes: Plantar S1 & 2 Deep tendon reflex scoring 0 no response 1+ sluggish or diminished 2+ active or expected response 3+ more brisk than expected, slightly hyperactive 4+ brisk, hyperactive, with intermittent or transient clonus Tinel sign Medial nerve tingling, carpal tunnel Brudzinski's sign Involuntary flexion of the hips and knees when the neck is passively flexed; indicates meningeal irritation Kernig's sign Evaluated by flexing the leg at the knee and hips and then attempting to straighten the leg Pain in the lower back and resistance to straighten is a positive Kernig sign May indicate meningeal irritation Multiple sclerosis a progressive autoimmune disorder characterized by a combination of inflammation and degeneration of the myelin of the brain's white matter leading to decreased brain mass and obstructed transmission of nerve impulses Seizure disorder (epilepsy) a chronic disorder characterized by recurrent, unprovoked seizures secondary to an underlying brain abnormality Encephalitis acute inflammation of the brain and spinal cord involving the meninges, often due to a virus Meningitis inflammation of the meninges of the brain and spinal cord Intracranial tumor Abnormal growth within the cranial cavity that may be a primary or metastatic cancer Pseudotumor cerebri a clinical syndrome of intracranial hypertension that mimics brain tumors Stroke (Brain attack or CVA) a sudden interruption of blood supply to a part of the brain or the rupture of a blood vessel, spilling blood into the spaces around brain cells Myasthenia gravis Autoimmune disorder that affects the neuromuscular junction involved with muscle activation, autoantibodies directed against the acetylcholine receptors in the neuromuscular junction cause destruction and inflammatory changes in the postsynaptic membranes that lead to muscle dysfunction Guillain-Barre syndrome Postinfectious disorder following a nonspecific gastrointestinal or resp infection that causes an acute neuromuscular paralysis Trigeminal neuralgia (Tic Douloureux) Recurrent paroxysmal sharp pain that radiates into one or more branches of the fifth cranial nerve Bell palsy Acute paralysis or weakness of one side of the face that may have partial or complete resolution Peripheral neuropathy Disorder of the peripheral nervous system that results in motor and sensory loss in the distribution of one or more nerves Cerebral palsy Group of permanent disorders of movement and posture development associated with non-progressive disturbances that occurred in the development of the infant brain Myelomeningocele (spina bifida) a congenital vertebral defect (commonly at the lumbar or sacral level) that allows the spinal cord contents to protrude Shaken baby syndrome a severe form of child abuse resulting from the violent shaking of infants younger than 1 year of age Parkinson disease A slowly progressive degenerative neurological disorder in which motor function is primarily affected along with behavioral and cognitive problems Normal pressure hydrocephalus syndrome simulating degenerative disease that is caused by noncommunicating hydrocephalus (dilated ventricles with intracranial pressure WNL) Post polio syndrome (progressive post poliomyelitis muscular atrophy) The reappearance of neurologic signs 10 or more years after an acute poliomyelitis infection Thelarche Onset of breast development in girls, typically occurs after age 8 and is accompanied by other signs of puberty including a growth spurt Breast abnormalities: fibrocystic changes Benign fluid filled cyst formation caused by ductal enlargement Breast abnormalities: fibroadenoma Benign tumors composed of stromal and epithelial elements that represent a hyperplastic or proliferative process in a single terminal ductal unit Breast abnormalities: malignant breast tumors Ductal carcinoma arises from epithelial lining of ducts; lobular carcinoma originates in glandular tissue of the lobes Breast abnormalities: fat necrosis Benign breast lump occurs as inflammatory response to local injury Breast abnormalities: intraductal papillomas/papilomatosis Benign tumors of subareolar ducts that produce nipple discharge Breast abnormalities: Duct ectasia Benign condition of the subareolar ducts that produce nipple discharge Breast abnormalities: Galactorrhea Lactation that is not associated with childbearing Breast abnormalities: Paget disease Surface manifestation of underlying ductal carcinoma (may look like eczema but will not improve with cortisone) Breast abnormalities: Mastitis Inflammation and infection of the breast tissue Breast abnormalities: Gynecomastia Breast enlargement in males Breast abnormalities: peau d'orange Orange peel skin, symptom, thick and pitted skin like the appearance of an orange This is a red flag that needs further investigation (can also be a normal finding if it's related to cellulitis or weight loss) but can sometimes be a finding of graves dermopathy, inflammatory breast cancer, lymphadema, etc Inflammatory breast cancer rare but aggressive form of breast cancer in which the cancer cells block the lymphatic vessels in the skin of the breast Red, tender, swollen breast Premature thelarche Breast enlargement in girls before puberty (younger than 8 years of age) Benign in the absence of pubic and axillary hair Can be associated with premature puberty Breast imaging "10 year rule" with mammograms If first degree relative has breast cancer, you subtract 10 years from their age and that is the age screening should begin So if patients mom had breast cancer at age 40, screening for the patient would start at age 30 Younger breast tissue - the denser the tissue, harder to identify cancer Older breast tissue - tissue is less dense, makes for a better mammogram Positions for breast exam Started with the patient seated with arms by side, then can have arms overhead or on hips with shoulders rolled forward, seated and leaning forward, and then recumbent position Red flag on breast exam Unilateral venous pattern Tanner staging Stage 1: preadolescent, only a small elevated nipple Stage 2: breast budding stage, small mound of breast and nipple develops (around age 11) Stage 3: breast and areola enlarge; nipple is flush with the breast surface; (around age 12) Stage 4: areola and nipple form a secondary mound over breast (around age 13) Stage 5: Mature breast (around age 15) Order of abdominal exam inspection, auscultation, percussion, palpation Auscultating bowel sounds: Borborygmi Loud prolonged gurgles Auscultating bowel sounds: Friction rub High pitched with respirations Auscultating bowel sounds: Obstruction High pitched tinkling (intestinal fluid/air under pressure) Auscultating bowel sounds: Bruit Harsh/musical intermittent sound (Heard over abdominal aorta) Auscultating bowel sounds: Venous hum Soft/low pitched continuous sound Auscultating bowel sounds: hypoactive No bowel sounds heard for 5 minutes in each quadrant What could hypoactive bowel sounds indicate? Peritonitis, paralytic ileus What could hyperactive bowel sounds indicate? Gastroenteritis, intestinal obstruction, hunger What could absent bowel sounds indicate? Abdominal pain/rigidity, this is a surgical emergency Abdominal percussion sounds Resonance heard over abdominal intestines Dullness heard over liver and spleen (and other organs) Tympany heard over gastric air bubble Beevor's sign This is an abdominal reflex Lightly stroke all 4 quadrants of abdomen around umbilicus, abdominal muscles and umbilicus should contract inward slightly/twitch CVA tenderness Can be indirect or direct percussion Evaluate pain or tenderness If pain or tenderness present, can indicate kidney infection or pyelonephritis McBurney's point Evaluation of rebound tenderness Patient lays supine and press on abdomen at RLQ point, hold down for 60 seconds, and evaluate for sharp stabbing pain after lifting hand (this would be positive sign if there is pain) Can indicate appendicitis Iliopsoas test Straight leg raise against resistance Positive sign is pain in RLQ Can indicate appendicitis Obturator test Pt lays supine. Hip/knee flexed and rotate leg medially and laterally Positive sign if pain in RLQ Can indicate appendicitis (or possible ruptured appendix or pelvis abscess Markle test Heel jar/tap patient's heels or have them jump from exam table to floor Pain with this can indicate appendicitis Murphy test Press at RUQ, under ribs. Abrupt cessation of inspiration with palpation of gallbladder is positive sign Can indicate gallbladder disease Cullen sign Ecchymosis around umbilicus Can indicate an internal bleed or rupture Grey Turner sign Ecchymosis on flanks Kehr sign Radiation of pain to left shoulder Can indicate ectopic pregnancy or renal stones Crohn's disease a chronic inflammatory disorder that can affect any part of the GI tract, producing ulceration, fibrosis, and malabsorption Terminal ileum and colon are most common sites Ulcerative colitis Chronic inflammatory disorder of the colon and rectum that produces mucosal friability and areas of ulceration Hepatitis Can be viral Inflammatory process characterized by diffuse or patchy hepatocellular necrosis cholelithiasis Stone formation in the gallbladder occurs when certain substances reach a high concentration in bile and produce crystals Cholecystitis Inflammation of the gallbladder; usually associated with gallstones Most commonly due to obstruction of the cystic duct from cholelithiasis May be acute or chronic Nonalcoholic fatty liver disease Spectrum of hepatic disorders not associated with excessive alcohol intake ranging from steatosis to cirrhosis and hepatocellular carcinoma Cirrhosis Diffuse hepatic process characterized by fibrosis and alteration of normal liver architecture into structurally abnormal nodules Acute pancreatitis Acute inflammatory process in which release of pancreatic enzymes results in glandular autodigestion Chronic pancreatitis Chronic inflammatory process of the pancreas, characterized by irreversible morphologic changes resulting in atrophy, fibrosis and pancreatic calcifications What is the most commonly injured organ in abdominal trauma? The spleen Because of anatomic location Mono makes the spleen enlarged, so mono patients need to avoid contact sports until spleen is no longer enlarged Acute glomerulonephritis inflammation of the capillary loops of the renal glomeruli Hydronephrosis dilation of the pelvis and calyces of a kidney due to obstruction of urine flow Meconium ileus distal intestinal obstruction caused by thick inspissated impacted meconium in the lower intestine Associated with cystic fibrosis Necrotizing enterocolitis Inflammatory disease of the gastrointestinal mucosa associated with prematurity and immaturity of the gastrointestinal tract Biliary atresia congenital obstruction or absence of some or all of the bile duct system resulting in bile flow obstruction most have complete absence of the entire extrahepatic biliary tree Hirschsprung disease Primary absence of parasympathetic ganglion cells in a segment of the colon, which interrupts intestinal motility Pyloric stenosis hypertrophy of the circular muscle of the pylorus leads to obstruction of the pyloric sphincter Symptoms include projectile vomiting in infant Intussusception prolapse or telescoping of one segment of intestine into another, causing intestinal obstruction Symptoms include crying spells and red jelly stools Meckel diverticulum Outpouching of ileum that varies in size from a small appendiceal process to a segment of bowel several inches long, often in the proximity of the ileocecal valve Neuroblastoma Solid malignancy of embryonal origin in the peripheral sympathetic nervous system Common in children Wilms tumor Most common intra-abdominal tumor of childhood, usually appears at 2-3 years of age Avoid repeated palpation Hemolytic uremic syndrome triad of microangiopathic hemolytic anemia, thrombocytopenia, and uremia Usually caused by E. Coli 0157 Genu varum Bowleg Common in toddlers (up to 18 mo) Genu valgum Knock knees Common in ages 2-4 Signs of autism Lack of eye contact May not want to be touched Odd behavior (may be repetitive) Play differences (preoccupation) Onychomycosis Commonly known as a fungal nail infection, is infection of the fingernails or toenails by forms of fungi and yeast, more common in adults Expected BP range in children (how to calculate) Systolic BP 80 + (2x child's age in years) For children older than 1 year Blumberg's sign rebound tenderness Romberg- Howship sign Pain down the medial aspect of the thigh to the knees Associated with a strangulated obturator hernia Dance sign Absence of palpable viscera in the RLQ indicative of intussusception of the ileum Cullen's sign A bluish periumbilical discoloration (Cullen sign) suggests intraabdominal bleeding Phimosis Occasionally the foreskin is tight and cannot be retracted. This condition is called phimosis and may occur during the first 6 years of life or as a result of recurrent balanitis (inflammation of the glans), or balanoposthitis (inflammation of the glans penis and prepuce) Balantis inflammation of the glans penis Hydrocele Fluid accumulates in the scrotum as a result of a defect in the tunica vaginalis; this condition is common in infancy; if the tunica vaginalis is not patent, the hydrocele will generally disappear spontaneously in the first 6 months of life