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GCU NUR 634 MIDTERM EXAM LATEST
ACTUAL SUMMER WITH VERIFIED
QUESTIONS AND ANSWERS GRADED A
Question-olfactory (cn 1) - answer-smell, occlude each nostril Question-optic (cn 2) - answer-vision-snellen chart, an enlarged blind spot affects optic nerve Caused by glaucoma, optic neuritis, and papilledema. Question-oculomotor nerve (cn iii) - answer-test perrla, paralysis if the pupil is dilated, fixed to light and near accommodation with ptosis, lateral deviation of the eye. Impaired ability to look up, down, or inward. (a conjugate gauze is a normal gaze=both eyes move in same direction at same time). Ptosis=cniii problem. Question-trochlear nerve (cn iv) - answer-controls superior oblique muscle-moves eye down towards nose, damage from head trauma or central lesions=diplopia. Diplopia is also seen in cataracts, astigmatism, or cn iii, iv, or vi neuropathy, or myasthenia gravis, trauma, or lesions in brainstem or cerebellum. Subjective history components - answer-chief complaint, hpi, pmh, family history, social history, & review of systems: what patient tells you. Question-objective history components - answer-general survey, vitals, physical exam, diagnostic results, what you observe or see. Question-presbyopia - answer-age-related near-vision loss. Can see far away better. Question-examples of sudden, painful unilateral vision loss - answer-corneal ulcer, acute closed angle glaucoma, uveitis, or traumatic hyphema. Question-examples of sudden, painless unilateral vision loss - answer-retinal detachment, macular degeneration, or retinal vein occlusion.
Question-trigeminal (cn v): - answer-facial sensation, nasal and buccal mucosa, & teeth, mastication muscles. Test corneal reflex, have pt clench teeth/palpate masseter/temporal muscles, sharp/dull sensations on cheek/forehead. Question-abducens (cnvi) - answer-movement of lateral rectus muscle, moves eye laterally. Question-facial (cn vii) - answer-facial muscles, taste anterior 2/3rd of tongue. Have pt smile, show teeth, raise eyebrows, frown, close eyes tight, puff out cheeks. Bell's palsy. Question-vestibulocochlear (cn viii) - answer-sensation to pharynx, posterior 1/3rd of tongue, and tympanic membrane. Test gag reflex. Question-vagus nerve (cn x) - answer-supplies parasympathetic nerve fibers to viscera of chest, abdomen, motor fibers to pharynx, larynx. *a deviated uvula without swelling indicates vagus nerve lesion. Question-spinal accessory (cn xi): - answer-supplies motor fibers to sternocleidomastoid & trapezius muscle, ask pt to shrug shoulders against your hands. Question-hypoglossal (cn xii): - answer-tongue muscles, ask pt to move tongue all around. Question-glaucoma - answer-gradual loss of peripheral vision, optic nerve damage. Open angle=asymptomatic, bilateral, gradual increased cup-to-disk ratio from increased intraocular pressure=notching of optic cup. Acute closed angle rapid onset of sudden vision loss, unilateral, deep eye pain, dilated and fixed pupil with cloudy cornea=emergency if increased intraocular pressure. Question-macular degeneration - answer-gradual loss of central vision d/t damaged retina.
Question-retinoblastoma - answer-rapidly developing cancer of the retina w/ absent red reflex. Question-corneal scar - answer-superficial grayish-white opacity in cornea. Question-tonic pupil (adele's pupil): - answer-pupil is large, regular, slow reaction to light unilateral. Question-normal optic disk: - answer-yellowish-orange to creamy pink with sharp margins. Question-optic atrophy - answer-death of optic nerve fibers=loss of disc vessels=white appearance. Question-glaucomatous cupping: - answer-the optic disk is pale with a backward depression caused by Increased iop. Question-papilledema - answer-the optic disk is pink and hyperemic. Question-ectropion - answer-outward turning of lower eyelid. Question-entropion: - answer-inward turning of lower eyelid. Question-superficial (flame) retinal hemorrhages: - answer-small, linear, flame-shaped, red streaks in fundus from htn or dm, papilledema, & occluded retinal vein. Question-preretinal hemorrhages - answer-blood anterior to the retina that obscures retinal vessels.
Question-deep retinal hemorrhages - answer-small, rounded, irregular red spots in deep layer of retina Caused by diabetes. Question-hordeolum (stye): - answer-staph infection of hair follicles at lid margin: painful, red, swollen pustule. Question-blepharitis: - answer-chronic inflammation or infection of eyelids, burning, itching, tearing, eye pain, conjunctival erythema, red eyes, gritty sensation, scaly, greasy flakes, crusted margins, light sensitivity. Posterior more common, dysfunction of meibomian gland within eyelid: this gland secretes oil to lubricate the eye. Tx: topical erythromycin ointment and warm compresses to release obstructions in meibomian gland. Question-chalazion - answer-chronic inflammatory painless lesion d/t obstructed meibomian gland=beady nodule on lower lid. Tx: warm compresses only, no antibiotics cuz granulomatous condition. Question-conjunctivitis (pink eye) - answer-inflammation of conjunctiva, highly contagious if bacterial/viral. Conjunctival erythema, burning, itching, exudate, sensation of foreign body, preauricular adenopathy (swollen lymph nodes in front of ears drain fluid from eyes), tearing, normal visual acuity. Question-viral conjunctivitis: - answer-red eye with gritty sensation Question-dacryocystitis - answer-infection of lacrimal sac/duct=pain, redness around eye near nose below inner canthus. Question-dacryostenosis: obstructed nasolacrimal duct: - answer-mucopurulent discharge from puncta of eye, excessive tearing called epiphora. Question-pinguecula - answer-harmless, yellow triangular nodule in bulbar conjunctiva beside the iris seen in aging or chronic dust exposure.
Question-cone of light: - answer-at 4-5 o'clock mark for right tm, 7-8 o'clock for left tm. Question-rinne test - answer-screens for conductive hearing loss, compares air conduction to bone conduction through mastoid. Hold tuning fork on mastoid bone (bc) until pt no longer hears vibration, then move fork near ear until they stop hearing it again (ac). Normally, ac>bc. In conductive hearing loss, bc>ac. Question-weber test: - answer-detects both conductive and sensorineural hearing loss. Hold fork on top of head and ask if they can hear it equally in both ears. Question-whispered voice test: - answer-screens for general hearing loss, tests for auditory acuity. Question-presbycusis: - answer-age-related hearing loss, high-frequency hearing loss, consonants are not heard as they are higher frequency sounds than vowels. Question-hearing loss: - answer-conductive is inability of ossicles to conduct sound from problems of the external auditory canal or middle ear: cerumen impaction, damage to ossicles, cholesteatoma, tumor, foreign body, repeated otitis scaring, serous otitis media. Sensorineural is inability of eardrum (cochlea) to vibrate in response to sound from cn iii dysfunction, mé niè re's disease, ototoxic drugs like aminoglycosides, aspirin, or furosemide, or presbycusis. Question-maxillary sinuses - answer-are on each side of the nose Question-ethmoidal sinuses - answer-are between the eyes, Question-frontal sinuses - answer-are above the eyebrows. Question-transillumination of frontal sinuses - answer-is normal if a dim red glow is observed=clear
Question-cholecystitis - answer-inflammation of gallbladder, obstruction of cystic duct by gallstones, ruq or epigastric pain radiates to right shoulder/scapula, gradual onset, course longer than in biliary colic, anorexia, n/v/fever but no jaundice. + murphy's sign with ruq tenderness to palpation with inspiration. Question-appendicitis: - answer-inflammation of appendix w/distention or obstruction, poorly localized periumbilical pain migrating to rlq at mcburney's point: between umbilicus & anterior superior iliac spine, if pain subsides=perforation, n/v from pain. Question-+ obturator sign - answer-right hypogastric pain, irritation of obturator muscle by inflamed appendix: flex pt's right thigh, bend knee, rotate leg internally to stretch obturator muscle. Question-+ psoas sign: - answer-irritation of psoas muscle by inflamed appendix, place hand above pt's right knee, ask pt to raise thigh against hand, or flex leg at hip=pain. Question-+ rovsing sign: - answer-rebound tenderness in rlq during llq quick palpation. Question-+ dunphy sign - answer-(sharp pain in rlq elicited by voluntary cough) Question-biliary colic: - answer-sudden obstruction of cystic duct or common bile duct by a gallstone, ruq or epigastric pain radiates to right shoulder/scapula, steady aching not colicky lasting >3hrs, rapid onset over minutes subsiding gradually, worsened by fatty meals, precedes cholecystitis, anorexia, n/v. Question-pancreatitis: - answer-autodigestion/inflammation of pancreas by pancreatic enzymes, epigastric pain radiates to back, acute onset, n/v/abd. Distention, fever, from etoh abuse or gallstones. Question-diverticulitis - answer-inflammation of colonic diverticula outpouchings in colon=cramping pain in llq, gradual onset, fever, constipation, n/v, abdominal mass, rebound tenderness.
Question-proper sequence of abdominal assessment - answer-inspection, auscultation, percussion, palpation Question-order/technique for exam of lung/chest - answer-inspection, palpation, percussion, auscultation Question-test chest expansion and lung excursion: - answer-place hands on back, thumbs at 10th ribs, ask pt to inhale deep, watch distance between thumbs as they move apart during inspiration. Question-palpate for symmetric tactile fremitus: - answer-should be symmetric, if asymmetric, may be pleural effusion, pneumothorax, or cancer, if asymmetrically increased, then may be pneumonia. Question-ruq: - answer-liver and gallbladder, lower pole of right kidney tip of 12th floating rib. Ddx: cirrhosis, cholelithiasis, cholecystitis, hepatitis. Question-luq: - answer-ddx: splenomegaly. Question-llq - answer-sigmoid colon, uterus, ovaries, ddx: diverticulitis-palpable mass, peritonitis, colon Cancer, ibs Question-rlq - answer-ddx: appendicitis or if periumbilical, ectopic pregnancy. Question-epigastric - answer-ddx: pancreatitis-may be referred to back, gerd, perforated ulcers, mi, esophagitis Question-liver span/size - answer-soft consistency, lower margin/edge is palpable at right costal margin. Span=4-8cm in midsternal line & 6-12 cm in right midclavicular line. Span is 60-70% correlated to actual span by percussion. Percuss from below umbilicus in area of tympany up until meet dullness and from nipple down to mark size. Dullness=liver=normal.
Question-gerd: - answer-epigastric pain after meals and spicy foods, dysphagia, regurgitation, hoarseness, sore throat, laryngitis, or atypical respiratory complaints like chest pain, cough, wheezing, aspiration pneumonia, risk factors: reduced salivary flow, obesity, incompetent lower esophageal sphincter, delayed gastric emptying, hiatal hernia. Screen for barrett's esophagus. History: aggravated by alcohol, citrus fruits, coffee, chocolate, onions, peppermint, exacerbated by lifting, bending over, or lying supine. Question-pud: - answer-h. Pylori infection, epigastric pain may radiate to back. If gastric, pain with food intake, if duodenal, pain 1hr after eating. Duodenal ulcers (most common) are relieved by food and antacids. Risk factors: nsaid use, corticosteroids, antiplatelets, h. Pylori, age, alcohol, smoking. Question-oropharyngeal dysphagia - answer-drooling, regurgitation, cough from aspiration, if points below sternoclavicular notch=esophageal dysphagia. Question-achalasia - answer-les does not open during swallowing. Question-hepatitis a: - answer-fecal-oral, poor hand hygiene, contaminated food/water, does not cause chronic hepatitis, self-limited. 2-dose vaccine Question-hepatitis b: - answer-can become chronic, 95% self-limited with viral elimination and development of immunity, iv drug users, men have sex with men, bloodborne/body fluids. Three-dose vaccine at birth, 2 months, & 6 months. Question-hepatitis c - answer-no cure, longest incubation period of 2-26 weeks, only bloodborne- iv drug use, leads to liver failure and cancer if untreated, needs antiviral therapy. Question-pap smears - answer-start at age 21, then cytology every 3 years until age 30-65, now every 5 years plus hpv testing, cessation at age >65 after 3 negative results or hysterectomy w/ removal of the cervix. Question-mammograms: - answer-start at age 40-annual, then 50-74 biennially (every 2 years), cessation at age 75.
O blood pressure: >130/85, or on tx Question-chronic pain: - answer-not associated w/cancer for>3-6 months, pain longer than 1month beyond acute illness, may be related to mental health /somatic conditions. Measure pain intensity/interference, mood, effect of pain on sleep, risk of co-occurring substance abuse, & measure opioid dose. Usually no tachycardia like in acute pain. Question-jaw pain - answer-could be caused by angina pectoris, mi, diffuse esophageal spasm, tmj Question-elbow problems: olecranon bursitis - answer-swelling/inflammation of olecranon bursa from trauma, gout, or ra. Question-elbow problems: rheumatoid nodules - answer-subcutaneous firm nontender nodules along extensor surface of ulna in pts with ra Question-elbow problems: lateral epicondylitis - answer-tennis elbow, repetitive extension of wrist or pronation/supination of forearm, pain 1cm distal to lateral epicondyle. Question-elbow problems: medial epicondylitis - answer-golfer/pitcher's elbow from repetitive wrist flexion from throwing, pain lateral/distal to medial epicondyle. Question-elbow arthritis: - answer-synovial inflammation/fluid felt in grooves between olecranon process & epicondyles caused by ra, gout, oa, & trauma. Stiffness, pain, restricted motion. Question-muscles of shoulder and back: scapulohumeral group - answer-extends from scapula to humerus, this group rotates shoulder laterally (the rotator cuff)-abduction Question-muscles of shoulder and back: supraspinatus - answer-(top) runs above glenohumeral joint, inserts on greater tubercle
Question-muscles of shoulder and back: infraspinatus (below supraspinatus) & teres minor(below infraspinatus) - answer-cross glenohumeral joint posteriorly, inserts on greater tubercle Question-muscles of shoulder and back: subscapularis - answer-on anterior surface of scapula, inserts on lesser tubercle Question-muscles of shoulder and back: axioscapular group - answer-attaches scapula to trunk, includes trapezius, rhomboids, serratus anterior, & levator scapulae. These muscles rotate the scapula & pull shoulder posteriorly. Question-normal breath sounds: - answer-start by auscultating posterior chest @ c7 near lung apices. Question-bronchial breath sounds - answer-full inspiratory & expiratory phase w/ louder inspiration that is heard over trachea & larynx Question-bronchovesicular breath sounds - answer-full inspiratory phase with short and soft expiratory phase, heard over hilar region (center of lungs near heart). Question-vesicular breath sounds - answer-quiet wispy inspiratory phase, short, almost silent expiration heard over periphery of lung field. Question-to assess aortic pulsations w/carotid obstruction, - answer-assess pulse using brachial artery Question-costal angle: - answer-located where right & left costal margins form angle meeting xiphoid process. Question-bronchitis: - answer-excessive mucus production in bronchi, chronic obstruction of airways, chronic productive cough, progressive dyspnea, recurrent resp infections, aggravated by smoking, exertion, alleviated by rest and expectoration, hx: copd, smoking.
Question-copd: - answer-slowly progressive disorder, distal air spaces enlarge/lungs are hyperinflated, percussion=diffusely hyperresonant, breath sounds decreased to absent w/delayed expiration, may have crackles/wheezes if have bronchitis, tactile fremitus decreased. S/s: cough, dyspnea. Hx of smoking, alpha-1 antitrypsin deficiency, air pollutants. Question-asthma: - answer-reversible airflow obstruction w/ bronchial hyperresponsiveness & inflammation. Percussion=resonant to diffusely hyperresonant, breath sounds=wheezes or possible crackles, tactile fremitus decreased. S/s: expiratory wheezing, chest tightness, dry cough, hx: allergies. Question-pneumonia: - answer-infection of lung parenchyma, from bronchioles to alveoli, alveoli fill w/ fluid, consolidation or dullness over fluid-filled areas of lung, breath sounds=bronchial or inspiratory crackles, tactile fremitus increases over involved area w/egophony (consolidation), bronchophony (indicates density), & whispered pectoriloquy. S/s: dyspnea, weakness, fatigue, fever, cough. Question-jnc 7 guidelines: - answer-o prehypertension: 120-139 over 80- 89 O stage 1 htn: 140-159 over 90- 99 O stage 2 htn: >160 over > O if dm or renal disease: <140 over < Question-pulses: - answer-aorta: epigastric area, femoral: below inguinal ligament, popliteal: behind knee, dorsalis pedis: top of foot, posterior tibialis: behind medial malleolus. Radial: lateral, ulnar: medial. Brachial: medial portion near elbow. Carotid=neck. Question-normal pulse ratings - answer- 60 - 100 for adults, 70-150 for 1-2yrs, 65-125 for 6- 10 yrs. Question-pmi: - answer-5th intercostal space, midclavicular line. Displacement of pmi lateral to midclavicular line=left ventricular hypertrophy & ventricular dilatation from a mi or heart failure. If copd=pmi in epigastric or xiphoid area from right ventricular hypertrophy. If<7 yrs, pmi is 3rd or 4th ics lateral to midclavicular line.
Question-causes of changes in pulses: - answer-cardiogenic shock=thready, weak. Bounding=aortic insufficiency, chronic arterial insufficiency=absent/weak pulses. Question-murmurs - answer-turbulent blood flow through heart d/t stenosis, regurgitation, anemia, or septal defects. Question-systolic murmurs: - answer-innocent murmurs, audible with or after s1. Question-aortic stenosis: - answer-systolic ejection @ ursb, crescendo-decrescendo best Heard leaning forward. Question-pulmonary stenosis: - answer-systolic ejection @ ulsb Question-mitral valve insufficiency/regurgitation: - answer-s4 gallop, holosystolic, mid- systolic click radiates to left axilla. Question-tricuspid regurgitation: - answer-llsb, right sided hf symptoms like peripheral edema Question-ventricular septal defect: - answer-holosystolic @ llsb, most common congenital heart defect! Question-diastolic murmurs - answer-all diastolic murmurs are bad, audible with or after s2. Question-mitral stenosis: - answer-low pitched, snapping sounds, apical. Question-tricuspid stenosis: - answer-low pitched decrescendo Question-aortic regurgitation: - answer-high pitched, decrescendo, lsb, "crushing" angina, dyspnea, bounding pulses.
pallor on elevation and dusky rubor on dependency, in chronic stages skin is thin, shiny, atrophic, looses hair over foot/ toe, nails are thick/ridged Question-lower extremity arterial problems: - answer-atherosclerotic peripheral vascular disease is symptomatic limb ischemia w/exertion. Intermittent claudication is pain/cramping in legs with exertion that is relieved by rest-associated w/peripheral arterial disease from atherosclerosis, prolonged cap refill, abdominal/femoral bruits. Question-ekg: - answer-pr=0.12-0.20, qrs<0.11: p wave - atrial depolarization, qrs- ventricular depolarization, q wave- downward deflection from septal depolarization, r wave- upward deflection from ventricular depolarization, s wave- downward deflection following an r wave, t wave- ventricular repolarization or recovery. Prolonged qt from fluoroquinolones, st elevation from mi. Question-cardiac cycle: systole - answer-ventricular contraction, aortic valve is open, allowing ejection of blood from left ventricle into aorta; mitral valve is closed preventing blood from regurging into the l. Atrium. During systole, pulmonic valve opens, tricuspid closes as blood is ejected from right ventricle into pulmonary artery. Question-cardiac cycle: diastole - answer-ventricular relaxation, aortic valve is closed preventing regurg from aorta to left ventricle, mitral valve is open allowing blood to flow from l. Atrium to l. Ventricle, pulmonic valve closes, tricuspid valve opens as blood flows into right atrium. Question-cardiac cycle: blood flow - answer-deoxygenated blood to svc to right atrium through tricuspid valve, to right ventricle, to pulmonary artery to lungs to become oxygenated, to pulmonary veins to left atrium, through mitral valve, to left ventricle, to aorta to systemic circ. Question-heart sounds - answer-o closure of mitral valve produces s1=loudest at apex, closures of aortic valve produces s2=loudest at base, s3 may be heart failure or mitral regurgitation/s may mean acute myocardial ischemia, htn, or chf. O if 1st heart sound is loud=mitral stenosis, if 1st heart sound is soft=mitral regurgitation Question-apetm - answer-aortic: right 2nd intercostal space. pulmonic: left 2nd intercostal space
erbs: left 3rd intercostal space tricuspid: near left lower sternal border, 4th intercostal space mitral: pmi, 5th intercostal space, midclavicular line. Question-dvt: - answer-distal, deep calf veins, or proximal in popliteal, femoral, or iliac veins, painful calf swelling with erythema, can be painless, risks: immobilization, recent surgery, pregnancy, trauma, hypercoagulable state, high risk of pe. Question-pe: - answer-hemoptysis or dry cough, acute onset of tachypnea, chest/pleuritic pain, dyspnea, fever, anxiety, syncope, if had dvt that dislodged. Ct Question-5a's: assesses pt's readiness to quit smoking. - answer-o ask about tobacco use O advise to quit O assess willingness to attempt to quit O assist in quitting attempt O arrange follow up Question-how to calculate pack/year smoking history: - answer-multiply number of packs per day by the number of years smoked. Ex: 1 pack per day for 20 years=20 pack-years. Question-recommendation for bp monitoring with atrial fibrillation: - answer-once per day Question-anemia of chronic disease: - answer-normochromic, normocytic, caused by chronic systemic infection, inflammation, or malignancy, or decreased erythropoietin in kidney failure. Rdw: normal, mcv: normal. Question-iron deficiency anemia: - answer-microcytic, hypochromic r/t chronic blood loss, gastritis, heavy menses, gross hematuria, vegetarians, mcv: decreased <80, rdw: increased, tibc: increased.
