Midterm for PA 2 Health care questions with answers

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1. Pt with malignant melanoma; risk factors; what will the skin look like? ABCDE
 ABCDE of Melanoma
 Asymmetry
 Border Irregularity
 Color Variation
 Diameter Greater than 6mm
 Evolving Changes

 Risk Factors
 Sun sensitivity, difficulty tanning, hx of prolonged sun exposure, use of tanning booths, occupational
exposure to chemicals like tar and radiation

 QUIZ QUESTION: Nevi this big and has color variation should be alerted for? – Malignant Melanoma

2. How to assess for central cyanosis?
 Look at patient’s oral mucosa
 QUIZ QUESTION: How to assess central cyanosis? – check the oral mucosa

3. Contact dermatitis
 Inflammation of the skin due to an allergy to a substance that comes into contact with the skin
 Redness, hives, vesicles or scales accompanied by intense itching

4. 3 Tineas; signs and symptom
 Tinea Corporis – fungal infection of the body
 Tinea Capitis – fungal infection of the scalp
 Need to further assess the cause of pruritus of the scalp because this can be due to lice
 Tinea Pedis – fungal infection of the feet (athlete’s foot)

5. COPD, configuration of chest
 Barrel chest; AP:T diameter is equal
 QUIZ QUESTION: Expected finding with patient with COPD?
 Barrel chest
 Kyphosis
 Hollow Clavicle
 Protruding Sternum  angle of Louie

6. Scoliosis, kyphosis, lordosis, torticollis
 Scoliosis – lateral curvature and rotation of the thoracic and lumbar spine (S back); most common in female
 Kyphosis – exaggerated posterior curvature of the thoracic spine (hunchback); associated with aging.
 Lordosis – exaggerated curvature of the lumbar spine (swayback); compensation for pregnancy, obesity, and
skeletal changes.
 Torticollis – muscle spasm by spinal accessory nerve, causing lateral flexion contracture of neck muscle

7. Physiological changes in older adult for all the systems discussed
 Skin, Hair, and Nails
 Decreased elasticity, sebum production, perspiration, and melanin
 Increased sensitivity to light
 Nails become thicker, and more brittle

 Head, Neck and Lymphatics
 Loss of subcutaneous fat in the face
 Decreased reproductive hormone
 Hair change, tooth loss, limited ROM
 Complaints of tired or weak feeling due to thyroid dysfunction

 Eye
 Decreased vision acuity
 Presbyopia – age-related near vision difficulty
 Cataract – thickened yellow lens; decreased lens clarity
 Macular Degeneration – loss of central vision

 Ears, Nose, Mouth and Throat
 Loss of hearing frequency
 Gradual hearing loss (presbycusis)
 Chelitis (angular stomatitis)
 Decreased sense of taste and smell, saliva production,
 Receding gum, tooth loss

,  Respiratory
 Decreased respiratory efficiency, cough ability
 Changes in breath depth
 Increased RR, effect of infection

 Breast and Axillae
 Limited ROM for examinations
 Modification of BSE
 Changes in breast tissue composition
 Gynecomastia in males
 Increased breast cancer risk with aging

 Cardiovascular
 Loss of ventricular compliance and vascular rigidity
 Conduction system loses automaticity

 Peripheral Vascular
 Increased BP
 Decreased pulse with irregularities
 Enlarged calf vessel

8. Different types of color – jaundice, pallor etc; What requires immediate intervention
 Cyanosis – mottled blue color in skin (REQUIRES IMMEDIATE INTERVENTION)
 Pallor – loss of skin color due to the absence of oxygen
 Uremia – pale yellow tone due to urinary retention
 Erythema – redness of the skin due to increase visibility of the oxyhemoglobin
 Jaundice – yellow undertone due to increase bilirubin in the blood
 QUIZ QUESTION: CYANOSIS is a priority because it indicates hypoxemia

9. How to assess jaundice, central cyanosis?
 Look for discoloration with the patient’s oral mucosa, then conjunctiva next

10. How to assess temperature
 Use the dorsal surface of the hand and feel for the temp
 QUIZ QUESTION: If assessing for temperature, use the DORSAL surface of the hand

11. Sxs of infection; patient suspecting with infection
 Older patient with pneumonia will present CONFUSION
 QUIZ QUESTION: patient suspected of fungal infection? – have you taken antibiotics recently

12. Assessing for pain; expected findings with acute pain /chronic pain
 Self-reported pain from patient is the most accurate assessment of pain
 QUIZ QUESTION: Best way to assess for pain is SELF-REPORTED pain from patient

13. Cranial nerves I, II, III,IV, VI; how to assess the different cranial nerves?
 CN I: Olfactory – smell
 Assessment: have the patient close their eyes, obstruct one nare then make patient sniff a common
substance, and then do the other nare
 Anosmia – inability to detect odor
 Unilateral or bilateral anosmia

 CN II: Optic – sight
 Assessment: Snelling and Rosenbaum
 Optic atrophy, papilledema, amblyopia, field defects

 CN III: Oculomotor – eyelids and pupil
 Direct Constriction – shine light directly to the pupil; failure of the pupil to constrict shows defect in the
direct pupillary response; defect in CN III
 Consensual Constriction – simultaneous constriction of the pupil that is not illuminated.
 6 Cardinal Fields of Gaze – evaluates the movement of the eyes
o Nystagmus – weakness of the extraocular muscles; repetitive uncontrolled eye movements
o Looking up and down without moving the head
 Confrontational Test – tests peripheral vision by covering one eye together with patient; examiner moves
finger in peripheral field
 ABNORMAL: can’t move eye upward, and downward
 Diplopia, ptosis, dilated pupils, inability to focus on close objects

,  CN IV: Trochlear – eyeball
 ABNORMAL: can’t move eye down or nasally
 Convergent strabismus, diplopia

 CN VI: Abducens – eyeball
 ABNORMAL: can’t move eye temporally
 Diplopia, strabismus
 QUIZ QUESTIONS:
 Test for CN II (Optic Nerve) – Snellen and Rosenbaum
 CN III (Oculomotor Nerve) – look up and down without moving the head

14. Assess for clubbing
 Normal nails will form a diamond-shaped opening when put together; convex curve
 have the dorsal surface of the fingers together
 QUIZ QUESTION: How to assess for clubbing of fingers? – dorsal surface of fingers next to each other

15. Assessing for coordination? What tests? What is positive and negative Romberg’s
 Romberg’s Test
 Used to test for equilibrium
 Have the patient stand with feet together and arms to the side, eyes open first then closed.
 Mild swaying is a NEGATIVE Romberg
 If patient is unable to maintain balance or needs to have feet further apart, then there may be a problem
with the vestibular apparatus (inner ear).
 QUIZ QUESTION:
 Minimal swaying during Romberg’s test – NEGATIVE FINDING
 Swaying and feet apart – POSITIVE ROMBERG

16. Assess for weber or Rinne or whisper test? Normal and abnormal findings
 Weber Test
 Use of tuning fork;
 Place activated tuning fork on top of head; sound should be heard equally (no lateralization)
 Lateralization may be due to poor conduction (sound heard better in impaired ear) or nerve damage
(sound is referred to the better ear)

 Rinne Test – use of tuning fork
 Bone Conduction – tuning fork against the mastoid process
 Air Conduction – tuning fork in front of the external meatus
 Air conduction should be TWICE longer than Bone Conduction (AC 2x > BC)

 Whisper Test
 Whisper a phrase or sentence from a distance and have the patient repeat it; inability to repeat phrase
may indicate hearing loss; check for high frequency sounds

 QUIZ QUESTIONS:
 Rinne Test – air conduction is twice longer than the bone conduction
 Hearing Test – whisper random phrases to the patient and make them repeat it
 Rinne Test – air conduction of 32 and bone conduction of 15; still normal finding, slight
difference is okay.

17. Types of adventitious breath sounds and normal breath sounds
 NORMAL BREATH SOUNDS
 Tracheal – harsh, high pitched
 Bronchial – loud, high pitched
 Bronchovesicular – medium loudness, medium pitch
 Vesicular – soft, low pitched

 ADVENTITIOUS BREATH SOUNDS (ABNORMAL)
 Fine Rales/Crackles – high pitched, short crackling
 Coarse Rales/Crackles – loud, moist, low pitched bubbling
 Wheezes – high pitched, continuous
 Rhonchi – low pitched, continuous, snoring, rattling
 Stridor – loud, high pitched, crowing heard without a stethoscope
 Friction rub – low-pitched grating, rubbing

 QUIZ QUESTIONS:
 Low-pitched continuous, snoring sound – RHONCHI
 Asthma like symptoms -WHEEZING

18. Patient with breast cancer, mastectomy with dissection with lymph nodes; precautions?
 No BP on the affected arm
 QUIZ QUESTION: What to tell nurse during assessment? – don’t take BP on the side of mastectomy

19. Assess for orthostatic hypotension