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NSG 6020: Advanced Health Assessment
Latest exam |Questions and Answers-
Latest 2025/2026- South University
What is the name of the format commonly used to organize data obtained during the history and physical examination? Problem-Oriented Medical Record What are the components of a SOAP note? S = subjective O = objective A = assessment P = plan In which section of a SOAP note does the following information belong: Patient's heart rate is 72 Objective In which section of a SOAP note does the following information belong: Patient's pain is not well controlled Subjective In which section of a SOAP note does the following information belong: Put patient on heparin for DVT prophylaxis Plan In which section of a SOAP note does the following information belong: Patient didn't sleep well last night Subjective In which section of a SOAP note does the following information belong: Patient's breath sounds are clear Objective What is an example of a well formatted assessment/plan for a patient who come to your office with high cholesterol and a UTI?
- Hyperlipidemia
- On 7/8/18 total cholesterol 275
- Continue on atorvastatin 10 mg PO QD
- Counsel on healthy diet and exercise
- Recheck lipid panel in 3 months
- Uncomplicated cystitis
- Today urine analysis positive for ketones, nitrites, and leukocyte esterase
- Pt experiencing burning with urination x2days
- Start on ciproflaxacin 250 mg PO Q12H x 3 days
- Follow up in 1 week In which section of a SOAP note does the following information belong: Patient has a scar on his right lower abdomen Objective In which section of a SOAP note does the following information belong: Patient's had an MI Assessment In which section of a SOAP note does the following information belong: Schedule patient for psych evaluation Plan What is a pertinent negative? The absence of a sign or symptom that can help you rule out or rule in a diagnosis How should you arrange your physical exam findings? Head to toe by body system What four actions should you think about doing when assessing every body system? Inspect Palpate Percuss Auscultate When writing pertinent review of systems, what should go first?
What is symptom-focused interviewing? The clinician takes charge of the interview to meet his or her need to acquire details and data in order to identify the disease. What is the difference between disease and illness? Disease = the explanation that the clinician brings to the symptoms Illness = the way the patient experiences all aspects of the disease What are the eight attributes you should know for every symptom? What is a good mnemonic that can help you remember them? OLD CARTS: O = Onset L = Location D = Duration C = Character A = Aggravating/alleviating factors R = Radiation T = Timing S = Severity What is cultural competence? A set of attitudes, skills, behaviors, and policies that enable organizations and staff to work effectively in cross- cultural situations. What would you want to include in a description of a breast mass? Tenderness Induration Heat Color Size Nipple discharge Location Consistency Shape Texture Mobility Where are the palpebral fissures? The space between the eyelids Where are the nasolabial folds? What are the useful for?
The skin folds that run from the side of the nose to the corner of the mouth. Helpful for determining facial symmetry. What cranial nerves innervate the facial muscles? V and VII 42 y/o female presents to your office for a well visit. She tells you that her sister was just diagnosed with a "thyroid problem" and she wants to know if she could have it to. What questions do you want to ask her to develop her history of present illness? Neck swelling? Changes in hair, skin, nails? Changes in mood or emotional stability? Palpitations? Changes in mensuration? Changes in bowel habits? Changes in temperature preference? What parts of the face are ideal for checking symmetry of facial features? Nasolabial folds Palpebral fissures Where is the temporal artery located? Between the top of the ear and the eye. What is it called when you percuss the masseter muscle on the side of the face and it twitches? When would you test this? Chvostek sign When checking for hypocalcemia What is a bruit? What does it sound like? A "whooshing" over a vessel formed by turbulent flow of blood through a partially obstructed vessel. How does the skin contribute to blood pressure regulation? Through constriction of skin blood vessels. Your four year old patient presents with an intracranial bruit. What is your course of action? Nothing, that is common Your patient presents with double vision. During physical exam you hear a bruit over the orbit. What are you worried about? A cerebral aneurysm
Tracheal tugging Indicative of an aortic aneurysm What is the anatomy of the thyroid? How do you preform a thyroid exam? First inspect for size, shape, nodules, enlargement, asymmetry Watch patient swallow Stand behind patient and palpate lobes with the tips of your fingers as they swallow Displace the trachea to the right and to the left and feel the lobes of the thyroid If enlarged, auscultate for bruits What are the two major autoimmune thyroid disorders? Graves - hyperthyroid Hashimoto - hypothyroid Thyroglossal duct versus branchial cleft cysts? Thyroglossal - anterior neck by the thyroid gland Branchial - lateral neck Describe fetal thyroid functioning. What does a large thyroid in a pregnant woman usually indicate? The fetal thyroid doesn't become functional until the second trimester so the mother supplies the thyroid hormone. An enlarged thyroid means that mom probably isn't getting enough iodine What is choasma? Also called melasma - dark discolored patches. A "mask of pregnancy." When should the fontanels close? Posterior - 1 - 2 months Anterior - 9 - 18 months Your newborn patient presents with a neural tube defect where there are protrusions of the brain and membranes through openings in the skull. What is this? Encephalocele What is craniosynostosis? Premature closing of cranial sutures before the brain growth is complete.
What is Macewen sign? What is it indicative of? When you percuss the skull with one finger and hear stronger resonant sounds. Indicative of hydrocephalus or a brain abscess What are the layers of the skin? epidermis, dermis, hypodermis What is the outermost layer of the skin? Epidermis What are the layers of the epidermis? And what do they do?
- Stratum Corneum = protects and restricts water loss
- Cellular Stratum = synthesizes keratin cells Epidermis vs. dermis - which is vascular? Dermis is richly vascular, epidermis is avascular and depends on dermis for its nutrients What are the major components of the dermis? Elastin, collagen, reticulin Sensory nerve fibers Autonomic motor nerves What layer of the skin generates heat, provides insulation, shock absorption, and calorie reserve? Hypodermis What is the difference between eccrine and apocrine sweat glands? Eccrine are on the surface, most parts of the body, and regulate temperature through secretion Apocrine are larger, deeper, found in the axilla, anogenital, ears, etc, and secrete protein and carb rich fluid What is body odor caused by? Bacterial decomposition of the apocrine sweat What are the types of hair on the human body? Vellus = short, soft, non pigmented hair Terminal = coarse, thicker, pigmented hair
What parts of the body are absent of eccrine glands? Lips, tympanic membranes, nail beds, prepuce, glans penis What are sebaceous glands? Glands associated with hair follicles that secrete sebum and keep the skin and hair from dying out What do Asian and Native Americans tend to have less body odor? Fewer apocrine glands Define primary versus secondary skin lesions. Primary - initial spontaneous manifestations of a pathologic process Secondary - result from later evolution or external trauma to a primary lesion What are the major characteristic you should be examining/documenting for a skin lesion? Size Shape Color Texture Elevation/Depression Attachment Exudates Configuration Location/distribution In what ways can a skin lesion be attached to the base? With a stalk (pedunculated) Without a stalk (sessile) What is a arciform configured skin lesion? Bow-shaped Macule flat, colored spot on the skin Papule small, solid, raised lesion on surface of the skin Nodule solid, raised clump of skin cells Patch
a flat, discolored area on the skin larger than 1 cm Plaque a solid mass greater than 1 cm in diameter and limited to the surface of the skin Tumor mass of rapidly dividing cells that can damage surrounding tissue Vesicle A small cavity or sac that contains materials Pustule elevation of skin containing pus Bulla a large blister that is usually more than 0.5 cm in diameter Cyst sac containing fluid Keloid Thick scar resulting from excessive growth of fibrous tissue Scale Petechiae vs purpura Spider angioma Venous star Capillary hemangioma Cherry angioma Furuncle versus carbuncle? Infectious boil usually filled with staph aureus that originates in the hair follicle. Carbuncle is bigger involving more hair follicles. Herpes simplex versus herpes zoster? Simplex is genital or oral warts Zoster is the shingles rash Name the fungal infection based on the location:
**1. Athlete's foot
- Jock itch**
Erythema multiforme Steven-Johnson Syndrome (and Toxic Epidermal Necrolysis) You are performing a skin exam on a patient with rheumatoid arthritis. You notice an erythematous, sharply demarcated rash with silvery white scales on the back of both his elbows. He tells you that he's seen the rash before, it comes and goes, and he's noticed it on his scalp before too. What is this? Psoriasis What do you want to look for when you are preforming a skin exam on an obese, diabetic, patient? Acanthosis nigrans - dark, velvety discoloration in the body folds and creases What are the three major types of skin cancer?
- Basal cell carcinoma
- Squamous cell carcinoma
- Melanoma Your patient presents to your office with pearly white, non-healing lesion on his nose. He is a landscaper. What is the likely diagnosis? What is the prognosis? Basal cell carcinoma Good prognosis, most common type of skin cancer and very rarely metastasizes You are preforming a skin exam and you notice a firm, pinkish patch with a poorly defined base on the back of your patient's left ear. What kind of cancer could this be? Squamous cell carcinoma What mnemonic do you use to determine the risk of a skin lesion being cancerous? A - asymmetry B - border C - color D - diameter >6mm E - evolution What is the most malignant type of skin cancer? Melanoma Name three types of alopecia.
- Alopecia areata = sudden patchy hair loss
- Scarring alopecia = skin disorder results in scarring and destruction of hair follicles
- Traction alopecia = prolonged tension breaks the hair shaft
Your 40 y/o female patient presents to you complaining of excess hair growing on her face and upper back. What is this called? Hirsutism What is the name for an infection of the cuticles? Paronychia Define leukonychia punctata White spots on the nail that form from injury Define onycholysis Separation of the nail plate from the underlying and lateral supporting structures. Nails are firm, smooth and without inflammation. What is the term for central depression of the nail with lateral elevation of the nail plate? Koilonychia What are beau lines in the nails? Terry nails? Transverse depressions Transverse white bands What is the term for the white cottage-cheese like substance that covers an infant's body at birth? Vernix caseosa What is the term for the fine, short, silky hair on the newborn's body? Lanugo You are examining the skin of a newborn and you see milia. What is this? How is this different from miliaria? Small white bumps on the baby's face filled with keratin (see below) Miliaria is a disorder of blocked sweat glands You are rotating with a psychiatrist and reading a patient's chart. Under Psychiatric History it says "trichotellimania," what does this mean? Impulse control disorder where the patient pulls out his or her own hair Why may spider veins and hemangiomas increase in size when a patient becomes pregnant? There is increased blood flow to the skin during pregnancy
The ciliary body What is the name of the instrument you use to examine the back of the eye? Ophthalmoscope What is the posterior part of the eye called (the part you look at through the ophthalmoscope)? What 6 structures are located here? Fundus Made up of the:
- retina
- choroid
- fovea
- macula
- optic disc
- retinal vessels (veins and arteries) What vitamin deficiency is associated with night blindness? Vitamin A What does a normal fundus look like? What is the name of the center of vision? Fovea Explain why everyone has a natural blind spot (scotoma)? It is due to the lack of photoreceptors (rods and cons) where the optic nerve exits the retina Exposure to UV radiation predisposes the patient to what eye condition? Cataracts Describe the eye's direct versus consensual reactions reaction to light? Direct = in response to light the pupil on the side you shining the light will constrict Consensual = the pupil of the opposite eye (not the one you are shining the light in) will constrict You are performing an eye exam on your patient. You ask the patient to gaze from a far object to a near one. What do you expect to happen? What is this called? The pupils constrict The Near Reaction Your schizophrenic patient has been put on risperadol by his psychiatrist. What do you want to make sure you assess at every encounter?
Fundoscopic exam for retinitis On your eye exam you notice that your patient's eyes are yellow. Besides hepatitis/biliary issues what else should you be thinking? Your patient may be taking rifampin (tuberculosis) or lovastatin What past medical history do you want to ask about when evaluating a patient's eye complaint? Past eye surgeries Eye trauma Chronic illnesses - HTN, diabetes, glaucoma, IBD, thyroid, autoimmune, HIV. Your patient with newly diagnosed Crohn's disease is in your office for a well check. What eye complains do you want to ask about? Blurry vision, burning, pain, photophobia, loss of acuity What ocular cancer is often hereditary? Retinoblastoma You are performing an eye exam and your patient has a lazy eye. What is the medical term for this? Amblyopia How do you test visual acuity? Smellen eye chart What does it mean if your patient's eyesight it 20/50 on the Snellen Chart? 20 = the distance the patient is from the chart 50 = the patient reads at 20 feet what the average person can read at 50 feet Your patient normally wears glasses and you want to check their vision with a Snellen chart. Do you test him with or without glasses? Both What is the name for the eye chart used for assessing near vision? Jaeger card J2 = 20/20 vision Oculus dexter versus sinister? versus uterque? Dexter = right eye Sinister = left eye
Protects the eye from foreign bodies and dryness What is the term for upper eyelid drooping? Ptosis What is Horner's syndrome? Ptosis, Miosis, Anhydrosis Result from interruption of sympathetic nerve supply to the eye (CN III) Ectropion vs. Entropion Ectropion--loose, lower lid that rolls OUTWARD and does not completely close with the upper eyelid Entropion--a loose, lower lid that rolls INWARD and irritates the eye (the eyelashes consistently rub on the cornea) Hordeolum vs Chalazion? Hordeolum (sty)
- painful, tender, infection around hair follicle of eyelashes on lid margin. Chalazion
- chronic inflammatory "beady nodule" of meibomian gland. Usually inside lid. Your patient presents with redness and crusting along the eyelid margins. What is this called? Blepharitis What is the term for inflammation of the lacrimal tract? Dacrocystitis How does a lacrimal duct obstruction present? Excessive tearing Pterygium vs pinguecula? pterygium - wedge shaped/ fleshy/ over the cornea, surgical fix pinguecula - yellow/small --> leave alone Pale conjunctiva may indicate what? (normally light pink) Anemia What you are testing extra ocular movements what do you want to tell your patient? Follow you finger with eyes only, do not move neck or head What is the corneal light reflex? What if it's not right?
Shining a light towards the persons' nose. Reflection of light should be in the exact same spot on each eye. If it's not right go on to the cover-uncover test What is strabismus? What are the types? Both eyes do not focus on an object simultaneously Paralytic - extraocular muscles or nerve is impaired Nonparalytic - cannot focus with both eyes simultaneously What are the layers of the inner eye? Outer fibrous layer (sclera and cornea) Uvea (choroid, ciliary body, and iris) Retina What is the role of sclera? The white part - Supports the internal eye structures, avascular What is the purpose of the cornea? Sensory innervation for pain, eye refraction What part of the eye supplies the color and controls the light that travels to the pupil? Iris What part of the eye produces the aqueous humor and contains the muscles that control accommodation? Ciliary body What part of the eye supplies oxygen to the outer layer of the retina? Choroid Where is the eye lens located? Directly behind the iris What is the cotton wisp test in your ocular exam? You touch the edge of the cornea with the wisp of a cotton ball to elicit blink and test for cranial nerve VII (movement) and V (sensation)
