ADVANCED PHYSICAL ASSESSMENT NR 509 WEEK 1-4 MIDTERM EXAM NR509 ADVANCED PHYSICAL ASSESSMENT MIDTERM WEEK 1-4 LATEST ACTUAL EXAM REAL QUESTIONS AND CORRECT DETAILED ANSWERS

NR 509 Advanced Physical Assessment
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Midterm Exam Study Guide
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• Articular structures include joint capsule and articular cartilage, the syno
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vium and synovial fluid, intra-articular ligaments and juxta-articular bone
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o Articular disease involves: g g g


Swelling
Tenderness of the joint Crepitu g g g g


s
Instability “locking” g


Deformity g


Limits active and passive range of motion due to stiffness or pai
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n
• Extra-
articular structures include periarticular ligaments, tendons, bursa
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e, muscle, fascia, bone, nerve and overlying skin o Extra-
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articular disease involves:
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g“point of focal tenderness in regions adjacent to articular struc
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tures
Limits active range of motion
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RARELY causes swelling, instability, joint deformity
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Know the sources of joint pain(pg. 627 algorithm) g g g g g g g


• Nonarticular conditions: trauma/fracture, fibromyalgia, polymyalgia
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rheumatica, bursitis, tendinitis g g


• Intra-
articular (acute, < 6 weeks): acute arthritis o infectious arthriti
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s
o gout

, o pseudogoutgo
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me
• Intra-
articular (chronic, > 6 weeks): chronic inflammatory arthritis vs chroni
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c noninflammatory arthritis o Chronic inflammatory arthritis with 1-
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3 joints involved:
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Indolent infection g


Psoriatic arthritis g g g


Reiter syndrome g


Periarticular JA o Chronic inflammatory arthritis with >3 joints g g g g g g g g


involved: g


Psoriatic arthritis or Reiter syndrome (no symmetry) rheumato g g g g g g g


id arthritis if not RA then g g g g g g


scleroderma, polymyositis
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*Know what causes saddle numbness and urinary retention (pg. 678?)
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• CES (cauda equina syndrome) most commonly results from a massive
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herniated disc in the lumbar region. g g g g g


• A single excessive strain or injury may cause a herniated disc.
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• However, disc material degenerates naturally as a person ages, and t
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he ligaments that hold it in place begin to weaken. As this degenerati
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on progresses, a relatively minor strain or twisting movement can ca
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use a disc to rupture.g g g g


The following are other potential causes of CES:
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• Spinal lesions and tumors g g g


• Spinal infections or inflammation
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• Lumbar spinal stenosis g g


• Violent injuries to the lower back (gunshots, falls, auto accidents)
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• Birth abnormalities g


• Spinal arteriovenous malformations (AVMs)
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• Spinal hemorrhages (subarachnoid, subdural, epidural)
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• Postoperative lumbar spine surgery complications g g g g


• Spinal anesthesia g




Know how retinal detachment presents (p.217)
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,• Sudden, painless vision loss that is unilateral
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Know what the word obtunded means (p. 769)
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• The obtunded patient opens eyes and looks at you but responds s
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lowly and is somewhat confused. Alertness and interest in the en
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vironment are decreased. g g




Know what cranial nerve you're assessing when checking lateral gaze(
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p. 237) g


• Cranial nerve VI: abducens g g g




Know what should be listed under adult illnesses in health history (pg.
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10)
• Medical illnesses: such as diabetes, hypertension, hepatitis, asthma,
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and HIV. Also hospitalizations, number and gender of sexual partners,
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and risk-
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Surgical: dates, indicatio g g


ns, and types of operations
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• Obstetric/Gynecologic: obstetric history, menstrual history, methods g g g g g g


of contraception, and sexual function
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• Psychiatric: illness and timeframe, diagnoses, hospitalizations, and t
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reatments

Know what conditions do not have red reflexes (p. 239)
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• Absence of red reflex suggests an opacity of the lens (cataract), or p
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ossibly the vitreous (or even an artificial eye).
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• Less commonly, a detached retina, or in children a retinoblastoma
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may obscure this reflex.
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Know the signs of seasonal allergies (p
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. 27)
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• itching, watery eyes, sneezing, ear congestion, postnasal drainage
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Know how optic neuritis presents(p. 217
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, • Sudden visual loss that is unilateral and can be painful, associated
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with multiple sclerosis
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Know how pityriasis rosacea presents(p. 912)
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• Oval lesions on trunk, in older children often in a Christmas tree patt
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ern, sometimes a Harold patch (a large patch that appears first)
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Know where the acromion process is (be able to identify it on a picture)
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• Complete, clear, and chronologic description of the problems prompt
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ing the patient’s visit, including the onset of the problem, the setting i
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n which it developed, it’s manifestation and any treatments to date.
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• (OLDCART) Onset, Location, Duration, Characteristics, Aggravating
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factors, Relieving factors, Treatments (past)
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Know where the acromion process is(be able to identify it on a picture)
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• Located between the clavicle and the shoulder
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*Knowgwhatgtogdogifgyoughavegag+gfindinggongphysicalgexamgbutgotherwisegnegativegwork-
upg(p.gg30)