NR 509 / NR509 Advanced Physical Assessment
Final Exam Week 5 to 8 Review
1. Breast Exam
Answer
5-7 days after the first day of menstruation
-Inspect for symmetry, contours, and retractions
-Palpitation with patient supine with arm above head
-Palpate in ladder pattern, circular motion for each location
2. Lactation
Answer
Physiological secretion with pregnancy, lactation, chest wall stimula- tion, sleep
and stress.
3. Montgomery glands:
Answer sebaceous glands that secrete a protective lipid substance during lactation
4. Galactorrhea
,: Answer a milky discharge from the nipple unrelated to normal breast
feeding
5. Mammary souffle:
Answer "puff of air" heard during pregnancy and lactation (venous hum)
6. Breast Cancer
Answer
Redness
-Peau d'orange: thickening and prominent pores
-Flattening instead of normal convexity
-Asymmetry
-Change in nipple direction
-Paget disease: rash, scaling, ulceration of nipple and areola
7. Breast cancer risk factors
Answer
Increasing age
-First degree family member
-Genetic mutations (BRCA1 & BRCA2)
-Personal history of precancerous breast mass
-Denser breast (confirmed by a mammogram)
-High dose radiation exposure
-High levels estrogen hormones
,8. Abdominal Exam
: Answer Inspection-contours
Auscultation-bowel sounds/bruits
Percussion-liver size, dullness or tympany in colon
Palpation-liver size, splenomegaly, masses in colon (fecal matter, cancer, divertic-
ulitis)
Special maneuvers- murphy (gallbladder), appendix tests
9. Abdominal Pain: Visceral:
Answer Hollow abdominal organs forcefully contract or dis- tention
-nonspecific, difficult to localize
-Gnawing, cramping, aching
-Sweating, pallor, nausea, vomiting, restlessness
10. Abdominal Pain: Somatic/parietal:
Answer Inflammation of the parietal peritoneum
-localized or diffuse
-Steady and aching pain, more severe than visceral
-Aggravated by movement or coughing
11. GERD
Answer
Rising retrosternal burning pain or discomfort
-Aggravated by certain foods (alcohol, chocolate, citrus, coffee. onions, peppermint)
, and positional changes (supine or bending forward)
-Coughing after eating or laying down
12. Risk factor for Barretts's esophagus:
Answer Esophageal cancer
13. PUD:
Answer Common causes: H.Pylori and NSAIDs
Pain after meals (2-3 hr delay for duodenal)
GERD
Hematemesis
Melena
Treat with PPI, H2RA, antacids
14. Appendicitis:
Answer McBurney's point: tenderness on direct palpation Rovsing:
rebound tenderness when palpating LLQ
Psoas: raise thigh (flexion), contracts psoas muscle
Obturator: flex the right thigh at the hip, bend knee, rotate leg internally, contracts
obturator muscle
Rectal exam: right side rectal tenderness
Pelvic exam: palpable appendix through the pelvis
May also presents with leukocytosis, high fever, nausea, vomiting, bowel changes
15. Diverticulitis:
Answer
Diverticulosis: benign form (pockets only) LLQ pain,
Final Exam Week 5 to 8 Review
1. Breast Exam
Answer
5-7 days after the first day of menstruation
-Inspect for symmetry, contours, and retractions
-Palpitation with patient supine with arm above head
-Palpate in ladder pattern, circular motion for each location
2. Lactation
Answer
Physiological secretion with pregnancy, lactation, chest wall stimula- tion, sleep
and stress.
3. Montgomery glands:
Answer sebaceous glands that secrete a protective lipid substance during lactation
4. Galactorrhea
,: Answer a milky discharge from the nipple unrelated to normal breast
feeding
5. Mammary souffle:
Answer "puff of air" heard during pregnancy and lactation (venous hum)
6. Breast Cancer
Answer
Redness
-Peau d'orange: thickening and prominent pores
-Flattening instead of normal convexity
-Asymmetry
-Change in nipple direction
-Paget disease: rash, scaling, ulceration of nipple and areola
7. Breast cancer risk factors
Answer
Increasing age
-First degree family member
-Genetic mutations (BRCA1 & BRCA2)
-Personal history of precancerous breast mass
-Denser breast (confirmed by a mammogram)
-High dose radiation exposure
-High levels estrogen hormones
,8. Abdominal Exam
: Answer Inspection-contours
Auscultation-bowel sounds/bruits
Percussion-liver size, dullness or tympany in colon
Palpation-liver size, splenomegaly, masses in colon (fecal matter, cancer, divertic-
ulitis)
Special maneuvers- murphy (gallbladder), appendix tests
9. Abdominal Pain: Visceral:
Answer Hollow abdominal organs forcefully contract or dis- tention
-nonspecific, difficult to localize
-Gnawing, cramping, aching
-Sweating, pallor, nausea, vomiting, restlessness
10. Abdominal Pain: Somatic/parietal:
Answer Inflammation of the parietal peritoneum
-localized or diffuse
-Steady and aching pain, more severe than visceral
-Aggravated by movement or coughing
11. GERD
Answer
Rising retrosternal burning pain or discomfort
-Aggravated by certain foods (alcohol, chocolate, citrus, coffee. onions, peppermint)
, and positional changes (supine or bending forward)
-Coughing after eating or laying down
12. Risk factor for Barretts's esophagus:
Answer Esophageal cancer
13. PUD:
Answer Common causes: H.Pylori and NSAIDs
Pain after meals (2-3 hr delay for duodenal)
GERD
Hematemesis
Melena
Treat with PPI, H2RA, antacids
14. Appendicitis:
Answer McBurney's point: tenderness on direct palpation Rovsing:
rebound tenderness when palpating LLQ
Psoas: raise thigh (flexion), contracts psoas muscle
Obturator: flex the right thigh at the hip, bend knee, rotate leg internally, contracts
obturator muscle
Rectal exam: right side rectal tenderness
Pelvic exam: palpable appendix through the pelvis
May also presents with leukocytosis, high fever, nausea, vomiting, bowel changes
15. Diverticulitis:
Answer
Diverticulosis: benign form (pockets only) LLQ pain,
