NR 509 MidTerm Exam Study Guide
NR 509: Advanced Physical Assessment -
Chamberlain
, NR509 Mid-Term Study Guide
• Articular structures include joint capsule and articular cartilage, the synovium and
synovial fluid, intra-articular ligaments and juxta-articular bone
o Articular disease involves:
▪ Swelling
▪ Tenderness of the joint
▪ Crepitus
▪ Instability “locking”
▪ Deformity
▪ Limits active and passive range of motion due to stiffness or pain
• Extra-articular structures include periarticular ligaments, tendons, bursae,
muscle, fascia, bone, nerve and overlying skin
o Extra-articular disease involves:
▪ “point of focal tenderness in regions adjacent to articular structures
▪ Limits active range of motion
▪ RARELY causes swelling, instability, joint deformity
Know the sources of joint pain (pg. 627 algorithm)
• Nonarticular conditions: trauma/fracture, fibromyalgia, polymyalgia
rheumatica, bursitis, tendinitis
• Intra-articular (acute, < 6 weeks): acute arthritis
o infectious arthritis
o gout
o pseudogout
o Reiter syndrome
• Intra-articular (chronic, > 6 weeks): chronic inflammatory arthritis vs
chronic noninflammatory arthritis
o Chronic inflammatory arthritis with 1-3 joints involved:
▪ Indolent infection
▪ Psoriatic arthritis
▪ Reiter syndrome
▪ Periarticular JA
o Chronic inflammatory arthritis with >3 joints involved:
▪ Psoriatic arthritis or Reiter syndrome (no symmetry)
▪ rheumatoid arthritis if not RA then systemic lupus, scleroderma,
polymyositis
*Know what causes saddle numbness and urinary retention (pg. 678?)
• CES (cauda equina syndrome) most commonly results from a massive herniated disc in
the lumbar region.
• A single excessive strain or injury may cause a herniated disc.
,• However, disc material degenerates naturally as a person ages, and the ligaments that hold
it in place begin to weaken. As this degeneration progresses, a relatively minor strain or
twisting movement can cause a disc to rupture.
, The following are other potential causes of CES:
• Spinal lesions and tumors
• Spinal infections or inflammation
• Lumbar spinal stenosis
• Violent injuries to the lower back (gunshots, falls, auto accidents)
• Birth abnormalities
• Spinal arteriovenous malformations (AVMs)
• Spinal hemorrhages (subarachnoid, subdural, epidural)
• Postoperative lumbar spine surgery complications
• Spinal anesthesia
Know how retinal detachment presents (p.217)
• Sudden, painless vision loss that is unilateral
Know what the word obtunded means (p. 769)
• The obtunded patient opens eyes and looks at you but responds slowly and is somewhat
confused. Alertness and interest in the environment are decreased.
Know what cranial nerve you’re assessing when checking lateral gaze (p. 237)
• Cranial nerve VI: abducens
Know what should be listed under adult illnesses in health history (pg. 10)
• Medical illnesses: such as diabetes, hypertension, hepatitis, asthma, and HIV. Also
hospitalizations, number and gender of sexual partners, and risk-taking sexual practices
• Surgical: dates, indications, and types of operations
• Obstetric/Gynecologic: obstetric history, menstrual history, methods of
contraception, and sexual function
• Psychiatric: illness and timeframe, diagnoses, hospitalizations, and treatments
Know what conditions do not have red reflexes (p. 239)
• Absence of red reflex suggests an opacity of the lens (cataract), or possibly the vitreous
(or even an artificial eye).
• Less commonly, a detached retina, or in children a retinoblastoma may obscure
this reflex.
Know the signs of seasonal allergies (p. 27)
• itching, watery eyes, sneezing, ear congestion, postnasal drainage
Know how optic neuritis presents (p. 217)
• Sudden visual loss that is unilateral and can be painful, associated with multiple sclerosis
Know how pityriasis rosacea presents (p. 912)
NR 509: Advanced Physical Assessment -
Chamberlain
, NR509 Mid-Term Study Guide
• Articular structures include joint capsule and articular cartilage, the synovium and
synovial fluid, intra-articular ligaments and juxta-articular bone
o Articular disease involves:
▪ Swelling
▪ Tenderness of the joint
▪ Crepitus
▪ Instability “locking”
▪ Deformity
▪ Limits active and passive range of motion due to stiffness or pain
• Extra-articular structures include periarticular ligaments, tendons, bursae,
muscle, fascia, bone, nerve and overlying skin
o Extra-articular disease involves:
▪ “point of focal tenderness in regions adjacent to articular structures
▪ Limits active range of motion
▪ RARELY causes swelling, instability, joint deformity
Know the sources of joint pain (pg. 627 algorithm)
• Nonarticular conditions: trauma/fracture, fibromyalgia, polymyalgia
rheumatica, bursitis, tendinitis
• Intra-articular (acute, < 6 weeks): acute arthritis
o infectious arthritis
o gout
o pseudogout
o Reiter syndrome
• Intra-articular (chronic, > 6 weeks): chronic inflammatory arthritis vs
chronic noninflammatory arthritis
o Chronic inflammatory arthritis with 1-3 joints involved:
▪ Indolent infection
▪ Psoriatic arthritis
▪ Reiter syndrome
▪ Periarticular JA
o Chronic inflammatory arthritis with >3 joints involved:
▪ Psoriatic arthritis or Reiter syndrome (no symmetry)
▪ rheumatoid arthritis if not RA then systemic lupus, scleroderma,
polymyositis
*Know what causes saddle numbness and urinary retention (pg. 678?)
• CES (cauda equina syndrome) most commonly results from a massive herniated disc in
the lumbar region.
• A single excessive strain or injury may cause a herniated disc.
,• However, disc material degenerates naturally as a person ages, and the ligaments that hold
it in place begin to weaken. As this degeneration progresses, a relatively minor strain or
twisting movement can cause a disc to rupture.
, The following are other potential causes of CES:
• Spinal lesions and tumors
• Spinal infections or inflammation
• Lumbar spinal stenosis
• Violent injuries to the lower back (gunshots, falls, auto accidents)
• Birth abnormalities
• Spinal arteriovenous malformations (AVMs)
• Spinal hemorrhages (subarachnoid, subdural, epidural)
• Postoperative lumbar spine surgery complications
• Spinal anesthesia
Know how retinal detachment presents (p.217)
• Sudden, painless vision loss that is unilateral
Know what the word obtunded means (p. 769)
• The obtunded patient opens eyes and looks at you but responds slowly and is somewhat
confused. Alertness and interest in the environment are decreased.
Know what cranial nerve you’re assessing when checking lateral gaze (p. 237)
• Cranial nerve VI: abducens
Know what should be listed under adult illnesses in health history (pg. 10)
• Medical illnesses: such as diabetes, hypertension, hepatitis, asthma, and HIV. Also
hospitalizations, number and gender of sexual partners, and risk-taking sexual practices
• Surgical: dates, indications, and types of operations
• Obstetric/Gynecologic: obstetric history, menstrual history, methods of
contraception, and sexual function
• Psychiatric: illness and timeframe, diagnoses, hospitalizations, and treatments
Know what conditions do not have red reflexes (p. 239)
• Absence of red reflex suggests an opacity of the lens (cataract), or possibly the vitreous
(or even an artificial eye).
• Less commonly, a detached retina, or in children a retinoblastoma may obscure
this reflex.
Know the signs of seasonal allergies (p. 27)
• itching, watery eyes, sneezing, ear congestion, postnasal drainage
Know how optic neuritis presents (p. 217)
• Sudden visual loss that is unilateral and can be painful, associated with multiple sclerosis
Know how pityriasis rosacea presents (p. 912)
