AHA NURO 528 FINAL REVIEW |390 QUESTIONS AND ANSWERS 2024.

What is a normal measurement for diaphragmatic excursion and which side is higher on? Measure 3-6cms and higher on the right than left What do palpable supraclavicular lymphnodes indicate? Malignancy/Hodgkins What cranial nerve are we testing for when doing the near vision test with the rosenbaum chart? CN II The normal liver span ranges from ____ to ____. 6 - 12cm Where are the Bartholin's glands located? Posteriorly on either side of the vaginal opening (usually not visible) What is a major risk factor is associated with cervical cancer? multiple sex partners What test is used to assess for a torn meniscus? McMurray test Nuchal rigidity is sometimes seen in: meningeal irritation What is a Glasgow scale used for? quantify consciousness For a 65 year old smoker with COPD, what do you expect to find? Increased AP diameter For a patient with pleural effusion and lobar Pneumonia what do you expect to find on percussion? Dullness Profectile vomiting is an indication for _____. Pyloric Stenosis Positive McBurney's point is an indication for: a. Spleen rupture b. Appendicitis c. Hepatitis d. Cholecystitis b. Appendicitis What would you tell your patient to relax his/her abdominal muscles? Flex your knees Sudden onset vague lower quadrant abdominal pain that becomes more severe, you would suspect? a. Appendicitis b. Cholelithiasis c. Ectopic pregnancy c. Ectopic pregnancy Murphy's sign is a positive indication for ______. Cholecystitis/Cholelithiasis How long should you listen for absent bowel sounds? 5 minutes in each quadrant if necessary Pregnant women are at risk for ____ because of decreased peristalsis and increased water absorption from the stool. Constipation What is an emergent finding in the newborn: a. Babinski reflex b. abdominal breathing c. 1 umbilical artery & 1 umbilical vein c. 1 umbilical artery & 1 umbilical vein Positive Kehr sign or pain traveling to the L shoulder is an indication for this emergent finding: Splenic rupture. What are the visible landmarks of the tympanic membrane? umbo, handle of malleus, light reflex What color due you expect a normal tympanic membrane be? Translucent, pearly gray How do you conduct a Weber test and what are the expected findings? Place base of vibrating tuning fork on midline vertex of head. Repeat with one ear occluded. Sound sound be heard equally in both ears (unoccluded). Sound heard better in occluded ear. How do you conduct a Rinne test and what are the expected findings? Place base of vibrating tuning fork against mastoid bone, not seconds until sound is no longer heard; then quickly move fork 1 o 2 cm from auditory canal and note seconds until sound is no longer heard. Repeat with other ear. MEASUREMENT: AIR-CONDUCTION sound TWICE AS LONG as measurement of bone conduction sound. How do you conduct a Rinne test and what are the expected findings? Place base of vibrating tuning fork against mastoid bone, note seconds until sound is no longer heard; then quickly move fork 1 o 2 cm from auditory canal and note seconds until sound is no longer heard. Repeat with other ear. MEASUREMENT: AIR-CONDUCTION sound TWICE AS LONG as measurement of bone conduction sound. When inspecting a infant you notice that their auricles (ears) are poorly shaped and/or positioned too low. What could should you suspect? renal disorder or congenital anomalies What kind of breathers are newborns? Obligatory nose breathers therefore it is important to assess nasal patency at birth. What kind of breath sounds are HEARD OVER MOST LUNG FIELDS; low pitch; soft and short expirations and will be accentuated in a thin person or a child and diminished in overweight or muscular individuals? Vesicular What kind of adventitious breath sounds resemble a musical noise sounding like a squeak and are most often heard continuously during inspiration or expiration; usually louder during expiration? Wheeze (Sibilant wheeze) What kind of adventitious breath sound is described as a loud, bubbly noise heard during inspiration and is NOT cleared by a cough? Coarse Crackles What kids of adventitious breath sound is described as a loud, low, coarse sound like a snore and coughing may clear sound? Rhonchi (sonorous wheeze) What are the three main layers of the skin? Epidermis Dermis (More vascular) Subcutaneous tissue Why are people more prone to acne during puberty? Increase in appocrine glands and an increase in sebaceous glands production of sebum. What are some skin changes that happen with aging? Epidermis thins, decrease in elasticity and a decrease in subcutaneous tissue leading to an increase in the prominence of joints and bones. What are some of the main risk factors for developing skin cancer? Over age 50 Male Family Hx of skin cancer Repeated Trauma/irritation to skin What is the most common form of skin cancer. A: Basal Cell B: Squamous Cell C: Melanoma A: Basal cell carcinoma is the most common form of skin cancer. It is most commonly seen on sun exposed areas and is described as a persistent sore that doesn't heal and can be itchy. Sometimes described as "shiney and pearly" in appearance. What is the most deadly form of skin cancer? Melanoma What are the ABCDE of melanoma? A: Asymmetry B: Borders (irregular, notched) C: Color (changes in coloring) D: Diameter (Generally 6mm) E: Elevated What is the name of the condition that presents with hair loss that is "spotty" and localized loss without inflammation? A: Alopecia Areata B: Hirsutism: C: Alopecia A: Alopecia Areata Hirsutism: Excessive hair growth in females and is seen androgen dependent areas. Can be associated with Polycystic Ovarian Syndrome. A 9 year old boy presents to your clinic with balding spots on his hair caused from his compulsive urges to pull his hair out. What is the name for this condition? Trichotillomania This condition can be difficult to treat. It is most commonly seen in ages 9-13 and can be triggered by depression or stressed. A male CAUCASIAN presents to your clinic with pigmented bands under the nail. What should you suspect? A: Normal finding B: Subungual Melanoma B: Subungual Melanoma NOTE: Pigmented bands under the nail can be a normal finding in persons with darker skin. It is NOT a normal finding in a Caucasian. Impaired cognition, consciousness, mood and behavioral dysfunction of acute onset is: a. delirium b. depression c. dementia a. delirium A common psychiatric disorder with a neurochemical imbalance, a decreased level of monoamines or increased plasma cortisol: a. delirium b. depression c. dementia b. depression A pervasive neurodevelopmental disorder of unknown etiology; refers to a wide spectrum of disorders typically prior to 3 years of age Autism You are performing a breast exam and you palpate supraclavicular lymph nodes. You are concerned because you know that this could possible indicate.....? A malignancy Note: A palpable supraclavicular node on the left side is a clue to abdominal or thoracic malignancy. What are some red flags when someone presents to you clinic with a headache? *Onset less then 6 months *Onset after 50 years old *Acute onset like a "thunderclap". "worse headache of their life" *Markedly elevated BP *Presence of rash or signs of infection Presence of HIV, Cancer, or Pregnancy *Vomiting *Recent head trauma. A patient presents with unilateral leg swelling, a calf that is hot to the touch and has a positive homan's sign? What is this indicative of? A: Cellulitis B: Blood clot in the leg C: Monkey bite B: Blood clot in the leg When performing an exam of the lymphatics. What kind of node are you most concerned about? A: A node that is tender B: A node that is swollen and patient also has a sore throat. C: A node that is rock hard. C: A hard node could be a sign of malignancy. Side note: A tender node is more likely to be caused by inflammation. However tender and swollen nodes are also abnormal findings and need to be evaluated. When palpating the thyroid you note diffuse enlargement of thyroid isthmus and lateral lobes without a palpable node. What could this indicate? Graves Disease, Hasimoto's Thyroiditis or Endemic Goiter A patient presents to your office with complaints of heart palpitations, heat intolerance, weight loss, fatigue and increased appetite. Upon assessment of physical findings you note thyroid enlargement and prominent eyes (exophthalmos). What do you suspect this patient has? Graves Disease *Autoimmune, antibodies to thyroid-stimulating hormone receptor leading to overactive thyroid. What is Caput Succedaneum? It is most commonly found in and infant following delivery. * subcutaneous edema over the presenting part of the head at delivery. It is the most common form of birth trauma of the scalp and usually occurs over the occiput and crosses suture lines. Affected part of scalp feels soft, and margins are poorly defined. Generally the edema goes away after a few days. Page 252 in Mosby Upon examining a 6 month old you are able to palpate a posterior fontanel. This is a normal finding. A: True B: False FALSE The posterior fontanel is usually more difficult to palpate and often closes by 2 months of age. When does the anterior fontanel usually close in child? Usually it is closed by 12-18 months of age. However in some children it may stay open until they turn 2. A mother brings her two year old child into your clinic. He has green nasal discharge and the mother is convinced that he has a frontal sinus infection? What do you do? A: Prescribe antibiotics for frontal sinusitis. B: Tell the mother to go to another clinic because you don't appreciate her diagnosing her child without evaluation by a medical provider. C: Educate the the mother that the child cannot have a frontal sinus infection because the frontal and sphenoid sinuses being to develop around C: The frontal and sphenoid sinuses develop around age 3. Upon examination of the ear you see inflammation of the middle ear resulting in a collection of serous, mucous, or purulent fluid (effusion) when the tympanic membrane is intact. Your diagnosis is... A: Otitis media with effusion B: Acute Otitis media C: Otitis externa A: Otitis media with effusion Note: it will have a bulging appearance and distorted light reflex. Upon examining the ear you note inflammation in the middle ear, associated with a middle ear effusion that becomes infected by bacterial organisms? You diagnose this as...? A: Otitis Media with effusion B: Otitis externa C: Acute Otitis media C. Acute otitis media True or false. Peripheral vision is fully developed at birth? True *Although peripheral vision is developed at birth, central vision matures later. By 3-4 months of age binocular vision development is complete. By 6 months, vision has developed sufficiently so that the infant can differentiate colors. What are some changes to vision that happen during pregnancy? Physiologic and hormonal adaptations cause the changes. These changes can result in hypersensitivity and can change the refractory power of the eye. Tears contain and increased level of lysozyme, resulting in a greasy sensation and perhaps blurred vision for contact lens wearers. Diabetic retinopathy may worse. Mild corneal edema and thickening associated with blurred vision may occur, especially in the third trimester. What is the major physiological eye change that occurs with aging? A progressive weakening of accommodation (focusing power) known as presbyopia. Your elderly patient presents with complaints of nocturnal eye pain? What could this indicate? A: Sign of subacute angle closure and a symptoms of glaucoma. B: Cataract A: Symptom of glaucoma SIde note: Cataract formation (forming of the lens that can become partially or totally opaque. Risk factors for developing cataracts include; steroids, exposure to ultraviolet lights, cigarette smoking, diabetes and aging.