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NU 650 Final Exam SG Questions
With Complete Solutions
Order of Assessment correct answer: Inspection, Palpation, Percussion and Auscultation. EXCEPT with abdomen Comprehensive Health History correct answer: chief complaint, reason for visit, ROS, past medical and surgical history, social history and family history Pediatric Body measurements correct answer: length, height, weight, head circumference fro birth to 36 months Normal/Hypertension cut off correct answer: <130 normal 140+ hypertension Fontanel Closure correct answer: posterior 1-2 months, anterior 9mo-2years otoscope correct answer: adult-up and back, peds- down and back, using largest speculum that will fit comforably tympanic membrane correct answer: Cone of light R-5 l- EOM testing correct answer: CN III, IV, VI AP diameter of chest correct answer: 1:2 (AP less than transverse)
barrel chest correct answer: COPD Flat or Dull percussion correct answer: effusion or pneumonia normal resonant percussion correct answer: healthy lung Hyperressonance (percussion) correct answer: trapped air crackles/rales correct answer: high pitched, discontinuous Wheezes correct answer: high-pitched whistling or squeaking sounds during inspiration or expiration Rhonchi correct answer: snoring, rumbling sounds heard upon auscultation of the chest during respiration-low pitched tactile fremitus correct answer: • INCREASED FREMITUS
- Means there is liquid or solid inside the lungs (consolidation such as with pneumonia)
- Remember Liquid or solid transmits vibrations better than air
- DECREASED FREMITUS Means air trapping such as with emphysema or bronchial obstruction. Bronchophony correct answer: the spoken voice sound heard through the stethoscope, which sounds soft, muffled, and indistinct over normal lung tissue, clearer over disease Egophony correct answer: abnormal change in tone of voice that is heard when auscultating the lungs EE-->AA
clubbing correct answer: bulbous enlargement of distal phalanges of fingers and toes that occurs with chronic cyanotic heart and lung conditions edema scale correct answer: 1+ = disappears rapidly. 2+ = last 10-15 seconds. 3+ = lasts more than one minute. 4+ = lasts 2- minutes. These are signs used in what scale? normal/abnormal findings spleen correct answer: normal=tympanic, dullness could be enlargement not normally felt on exam Blumberg Sign: Rebound Test correct answer: peritoneal inflammation, hurts more when release from palpation shifting dullness correct answer: a sign of free peritoneal fluid wherein the dullness of percussion shifts, generally from one side to the other, as the patient is turned from side to side. Psoas sign correct answer: RLQ pain with extension of right thigh indicative of appendicitis Obturator sign correct answer: RLQ on internal rotation of right thigh indicative of appendicitis assessment of hernia correct answer: pt may report a lump. observe pt while lying and standing, hernia may disappear while lying. ask pt to strain or perform Valsalva maneuver and observe for bulging. absent bowel sounds may indicate strangulation.
cardinal signs of Musculoskeletal disease correct answer: pain, erythema, swelling, increased warmth, deformity, loss of function Scoliosis correct answer: abnormal lateral curvature of the spine kyphosis correct answer: excessive outward curvature of the spine, causing hunching of the back. Knock-knee (genu valgum) correct answer: Legs curved inward so knees come together as person walks bow-legged correct answer: knees too far apart anatomic snuffbox correct answer: landmark depression on the radial aspect of the dorsal wrist; overlays the scaphoid bone Impingement Sign correct answer: POSITIVE: pain in the shoulder INDICATES: overuse injury to the supraspinatus and possibly biceps tendon Drop Arm Test correct answer: identifies tear and/or full rupture of rotator cuff Allen test correct answer: determining the patency of the radial and ulnar arteries by compressing one artery site and observing return of skin color as evidence of patency of the other artery
Cranial Nerves correct answer: I. Olfactory-smell II. Optic-VA III. Oculomotor-EOM, PERRLA IV. Trochlear-EOM V. Trigeminal-facial sensation, chewing VI. Abducens-EOM VII. Facial-face actions VIII. Vestibulocochlear-hearing IX. Glossopharyngeal-gag, tongue X. Vagus-ahh XI. Accessory-raise shoulders XII. Hypoglossal-ahh Weber test correct answer: Test done by placing the stem of a vibrating tuning fork on the midline of the head and having the patient indicate in which ear the tone can be heard. conductive in lateral side or sensory in opposite Rinne test correct answer: hearing test using a tuning fork; checks for differences in bone conduction and air conduction rinne usually conductive hearing loss Muscle strength scale correct answer: 0 - no movement 1 - flicker of muscle 2 - joint movement, not against gravity 3 - moves against gravity, not resistance 4 - moves against resistance, but weak 5 - strong against resistance. Denominator is always 5.
Strength is only tested with "normal" movement pronator drift test correct answer: Have pt stretch out arms with palms facing up and close eyes. Positive if one arm goes downward or drifts. Romberg test correct answer: assesses ability of vestibular apparatus in inner ear to help maintain standing balance Reflex grading scale correct answer: 0= no response, always abnormal 1+ = diminishes/depressed response, may or may not be normal 2+ = active normal response, normal 3+ = Brisk/exaggerated response, may or may not be normal 4+ = Very brisk/hyperactive: abnormal response, always abnormal Babinski reflex correct answer: in response to the sole of the foot being stroked, a baby's big toe moves upward or toward the top surface of the foot and the other toes fan out Position sense (proprioception) correct answer: Passively move the great toe up and down by grasping along the sides of the interphalangeal joint only a few mms. and ask patient which direction you are moving the toe Reduced perception (including falsely perceived motion) indicates large-fiber disease or DM Graphesthesia correct answer: ability to recognize writing on the skin purely by the sensation of touch
or changes in the skin of the scrotum, 1 x per month with warm water in shower breast self-examination correct answer: a self-care procedure for the early detection of breast cancer, raise arms for retraction or dimpling, best done 5-7 days after period Pap smear test correct answer: microscopic examination of stained cells removed from the vagina and cervix, in order form vag pool, cervical scrape, endocervical infant milestones correct answer: 2 months - holds up head 4 months - rolls from abdomen to back 7 months - sits alone 9 months - crawls 8 - 15 months - standing with support & walking neonate - palmer grasp reflex teething at 6 months aortic stenosis murmur correct answer: second right intercostal, crescendo-decrescendo Aortic regurgitation murmur correct answer: early diastolic murmur-high pitched "blowing" Mitral stenosis murmur correct answer: "early to mid diastolic low pitch rumble murmur best heard at apex in left lateral decubitus position. May also have presystolic murmur." Mitral regurgitation murmur correct answer: pansystolic murmur, loudest at the apex with radiation to the axilla
MR PASS MVP correct answer: mitral regurgitation, physiologic, aortic stenosis, systolic MS ARD correct answer: Mitral Stenosis Aortic Regurgitation Diastolic AS SAD correct answer: Aortic stenosis syncope, angina, dyspnea harsh sounds murmur correct answer: stenosis blowing sounds murmur correct answer: regurgitation Tanner stage girls correct answer: Stage 1-Prepuberty Stage 2-Brest bud(onset of thelarche or breast development) Stage 3-Breast tissue and areola are in one mound Stage 4-Areola/nipples separate and form a secondary mound) Stage 5-Adult pattern Tanner stage Boys correct answer: 1. Prepuberty II. enlargement of scrotum & testes III. lengthening of penis IV. increase in size of penis V. Mature stage direct hernia correct answer: inguinal hernia does not extend into scrotum, external ring, most common men over 50
breast cancer risk factors correct answer: age, family history, early menses, null/late parity, hormone replacement testicular cancer risk factors correct answer: Cryptochordism, prior testicular cancer or family hx; race (Caucasian 5X greater risk than African American) Baker's cyst correct answer: accumulation of synovial fluid in the knee joint rheumatoid arthritis (RA) correct answer: chronic systemic disease characterized by autoimmune inflammatory changes in the connective tissue throughout the body herbeden's (DIP) and bouchard's nodes(PIP) correct answer: OA McMurray Test correct answer: compression of the meniscus of the knee combined with internal and external rotation while the patient is face-up to assess the integrity of the meniscus Osteoporosis T score correct answer: T score < -2. Osteopenia T score correct answer: between -1 and -2. Joint types correct answer: 1. Ball -and-Socket joint: Allows movement in all directions (hip & shoulder joints) 2. Hinge Joint: Allows movement in one direction (elbow) 3. Pivot Joint: Allows turning from side to side (a pivot joint connects the skull to the spine)
Ortolani test correct answer: -hip abduction w/a resulting clunk as the head relocates into the joint Allis test correct answer: used to check for hip dislocation in infants by comparing leg lengths. Place on back on the table with feet flat on the table and flex knees up. Looking for uneven/even height of knees. Finkelstein's test correct answer: stretching or lengthening of the thumb tendon to assess the possibility of de Quervain's disease, or tenosynovitis of the thumb tendon Trigger Finger correct answer: Inflammation and thickening of the tendons of the finger makes it difficult to flex or extend the finger, may become stuck and then snap into position Tennis elbow (lateral epicondylitis) correct answer: The extensor muscles of the forearm attach to the lateral epicondyle of humerus Overuse or trauma Golfer's Elbow Test correct answer: INSTRUCT: pt seated, ex instructs pt to extend the elbow and supinate the hand; ex instructs pt to flex the wrist against resistance POSITIVE: pain over the medial epicondyle INDICATES: medial epicondylitis radiculopathy correct answer: disease of the nerve roots, compression, weak biceps
Pediatric Assessment correct answer: toe to head Elderly Assessment correct answer: functional status falls, hearing considerations Normal Order of Physical Assessment correct answer: 1) Inspect
- Palpate
- Percuss
- Auscultate birthmarks, nevus correct answer: red from hemangioma, a proliferation of blood vessels, brown from nevus, a mole or birthmark from overgrowth of melanin-forming cells stork bite correct answer: A patch of deep pink skin found at the nape of the neck Cafe au lait spots correct answer: Smooth edged tan-to-brown pigmentations on the skin seen in NF Mongolian spots correct answer: bluish purple spots of pigmentation congenital moles (nevi) correct answer: can grow anywhere on the body. vary in size and shape. most are brown port-wine stain correct answer: a flat vascular birthmark made up of dilated blood capillaries, creating a large, reddish-purple discoloration on the face or neck
ABCDEs of melanoma correct answer: asymmetry, border, color, diameter, evolution Lichenification correct answer: Prolonged, intense scratching eventually thickens the skin and produces tightly packed sets of papules; looks like surface of moss (or lichen) Excoriation correct answer: Skin sore or abrasion produced by scratching or scraping Annular correct answer: ring-shaped Zosteriform correct answer: linear shape of skin lesion along a nerve route teleangiectasia correct answer: Dilation of single small blood vessels in the skin or mucous membranes primary lesions correct answer: Macule (<1cm) & Patch (> 1 cm)flat Papule (<1cm)and Plaque (>1 cm) raised Nodule and Tumor larger and deeper Vesicle and Bulla fluid filled Wheal hives Pustule pus Cyst fluid tonsilar grading correct answer: 1+ visible 2+ swollen 3+ touching uvula 4+ touching each other (kissing-ME)
it tends to squeeze the urethra, resulting in frequent or difficult urination right lung lobes correct answer: superior, middle, inferior, upper and middle auscultated anteriorly and laterally left lung lobes correct answer: superior and inferior, superior anterior and lateral, lower lateral and posterior vesicular breath sounds correct answer: normal sound of respirations heard on auscultation over peripheral lung areas, inspiration greater than expiration as it takes longer for the lungs to travel to that area bronchovesicular breath sounds correct answer: medium- pitched and quieter sounds normally heard over the mainstem bronchi bronchial sounds correct answer: those heard over the trachea; high in pitch and intensity, with expiration being longer than inspiration
