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Exam 4 Advanced health assessment
- Myofascial pain - correct answer asymmetrical trigger points that are medial to the scapula and over the trapezius, Caused by stress and/or previous neck injuries
- Subacromial bursitis - correct answer tenderness that can be palpated over the head of the humorous many times on the dominant extremities, pain elicited with internal and external rotation at 90 degrees and abduction greater than 30 degrees. Pain at night, abrupt onset, overuse pattern.
- Acromioclavicular joint separation - correct answer history of direct fall or blow to part of the shoulder
- Shoulder dislocation - correct answer Any trauma to the shoulder with a mechanism of injury involving external rotation with abduction, loss of normal contour of shoulder, marked instability ( moves too far back or forward)
- Frozen shoulder - correct answer total restriction of normal range of motion with an insidious onset of pain. Inflammatory process. Common in women over 50 and diabetics.
- Clavicle fractures - correct answer direct trauma to the clavicle, obvious deformity mid shaft, pain on palpation at region
- Colles fracture - correct answer history of fall on an outstretched hand (FOSH), pain, edema and limited range of motion with an obvious deformity (dinner fork) of the wrist.
- Navicular fracture - correct answer History of FOSH with impact on fingers or distal palms, tenderness over the anatomical snuffbox, increases with movement of the wrist, possible swelling
- Carpul Tunnel - correct answer pain increases at night, clumsiness with distribution of numbness location in the median nerve distribution, possible wasting of thenar eminence, tinel's sign (percussing over median nerve produces pain and tingling), history of performing repetitive movements, often seen in pregnant women( edema), alcoholics, pts with arthritis and HTN.
- DeQuevain's tenosynovitis - correct answer Pain in the radial aspect of the wrist that is aggravation with ulnar deviation of the hand with a thumb flexed (opening a door knob), a thickening sheath or nodule in the area of tenderness upon palpation, positive Finkelstein test (having the patient flex his thumb into his palm and then cover with the other fingers, and passively ulner-devatiting the wrist elicits pain in the affected area)
- Ganglion cyst - correct answer A nodule on the dorsum aspect of the wrist ( this nodule is really a synovial cyst from a herniated tendon lining), painless to a dull ache if the nodule is really large
- Gamekeepers thumb/skiers thumb (ulner collateral ligament tear) - correct answer history of sudden, forceful abduction of the thumb, pain on the ulner side, stress testing reveals laxity (stress testing is performed by stabilizing the metacarpophalangeal joint in flexion and radially deviating the thumb. More than 30 degrees deviation or more than 20 degrees deviation compared to the opposite side suggests significant damage.
- Slipped capital femoral epiphysis - correct answer child with history of hip, knee, groin, and/or thigh pain and a limp, decreased ROM during internal rotation of the femur, possible pain with abduction/ adduction, flexion causes external rotation
- Legg Clave Perthes disease - correct answer child limps( often painless and intermittent), possible pain noted in the anterior groin inner thigh or knee, atrophy of the thigh, limitation and pain are noted with internal rotation, limitation of abduction, particularly in flexion, positive Catterall's sign( passive hip flexion causes external rotation)
- Stress fracture - correct answer pain on palpation at the iliac crest, due to poor running technique( running with arms swinging from side to side, causing abd muscles to pull on the iliac crest)
- Avulsion fracture - correct answer pain on palpation at the greater trochanter or at the anterior superior iliac spine(ASIS), possible crepitus or bony fragments felt during palpation, pain with active. Movement and passive stretching of the involved muscles, popping with acute pain, history of running
- Ischial bursitis - correct answer pain radiating to the hamstrings when the patient lies on her side with the hip flexed, history of long distance running
- Shin splints - correct answer history of dull intermittent pain over the distal third of the tibia that is often developed slowly and became aggravated after a period of time.
- Osgood - correct answer Schlatter disease- onset of pain is gradual and begins as a mild ache im the AM when the pt gets out of bed. Pain worsens over a 2 week period. Pain over tibial tubercle that is exacerbated by activities of repeated extension and flexion (climbing stairs, squatting), tenderness and swelling, looks like a second knee due to bump below the patella, tight hamstrings
- Bakers cyst - correct answer swelling behind the medial knee, intense pain in the joint with the area around the knee being hot and erythematous, septic arthritis is seen most commonly in the knee but can involve the hip, shoulder, wrist, ankle, and elbow.
- Septic arthritis - correct answer history of fever, chills and malaise, intense pain in the joint with area around the knee frequently being hot and erythematous, seen in patients with RA, immunocompromised and IV drug users
- Shin splints (medial tibial stress syndrome) - correct answer pain due to the periosteum separating from the bone; onset of pain is gradual after exercise, not stretching well before exercise, doing a lot of jumping
- Stress fracture - correct answer history of pain with exercise, unbearable pain, obesity, history of jobs that require standing for long times on hard surfaces
- Achilles tendinitis - correct answer pain at the insertion or areas 2-6cm proximal to the insertions of the tendon on heel, crepitus noted with chronic conditions, wears poor fitting shoes or heels, long distance running, not stretching before or after.
- Achilles tendon rupture - correct answer weekend athlete, heard a pop at the back of the heel and is not able to bear weight on the area, positive thompsons test
- Plantar fasciitis - correct answer heel pain with bearing weight, pain usually at its maximum after long periods of non weight bearing or first thing in the morning, increased pain with dorsiflexion of toe, no edema of redness, flat feet and high arches are prone to this
- Calcaneal apophysitis (sever's disease) - correct answer pediatric pt who is 9-12 and active, heel pain that is worsened by jumping or running, palpation at the posterior plantar junction reveals pain, increased pain with stretching of the heel cord, may or may not have edema, never war or red
- Jones fracture - correct answer pain at the base of the 5th metatarsal after an inversion type of injury, possible swelling at the area
- Talar dome fractures - correct answer history of inversion and eversion ankle injury
- Compression fracture/back pain - correct answer point tenderness to any bony area of the geriatric patient after a minor trauma, weakness, pain ,
- Low back strain - correct answer limited ROM, slow gait, pain to low back, reflexes intact proprioception intact, abd without bruises/masses
- Malignancy/tumor - correct answer back pain that lasts longer than 2-4weeks, point tenderness, weight changes, diminishing reflexes, pain at night when supine
- Ankylosing spondylitis - correct answer back pain that improves with activity, decreased chest expansion, decreased spinal flexion
- Cauda equina syndrome - correct answer back pain, urinary or fecal incont., saddle anesthesia decreased sensation in the perianal area, sphincter laxity, recent chiropractic manipulation, infection or tumor
- Herniated disk - correct answer pain that is exacerbated by Valsalva maneuver or coughing, pain radiating below the knee. s/s of reduced thenar eminence; - correct answer numbness, tingling, decreased sensation, worse symptoms with repetitive use, radiation of pain up the forearm
- Causes of vasodilation - correct answer Increase of PaCO2 causes vasodilation , hypoxemia causes vasodilation
- Causes of vasoconstriction - correct answer Decrease in PaCO2 causes vasoconstriction Causes of decreased PCO2 - correct answer hyperventilation, anxiety, pregnancy, hypoxia, Pulm embolism Signs of adequately developing cerebellar function - correct answer tone in shoulders, balance when walking, no limp movements, talking, proper eye movement. Circle of Willis - correct answer provides multiple paths for oxygenated blood to supply the brain if any of the principal suppliers of oxygenated blood (i.e., the vertebral and internal carotid arteries) are constricted by physical pressure, occluded by disease, or interrupted by injury
- Ascending Reticular Activating Systems - correct answer arousal from sleep, alert wakefulness, attention and perceptual association
- Descending Reticular Activating Systems - correct answer inhibits activity of motor neurons controlling musculature Adrenal cortex - correct answer secretes steroid hormones, including glucocorticoids, mineralocorticoids and androgens and estrogens.- increases sodium absorption, potassium lost by kidney's, affects metabolism of nutrients, regulates blood glucose levels, , affects growth, has anti-inflammatory actions, decreases effects of stress. Sensory cortex - correct answer vision, sound, smell, taste and touch- found in the parietal lobe. The sensory cortex receives all sensory input from the body. Upper Brainstem - correct answer Pons and midbrain
Pons (upper BS) - correct answer sleeping, resp, swallowing, bladder control, hearing, equilibrium, taste, eye movement, facial expression facial sensation and posture Midbrain (upper BS) - correct answer vision, hearing, motor control, sleep/wake cycles, alertness and temp regulation Lower brain stem ( medulla oblongata) - correct answer cardiac, respiratory, vomiting, vasomotor centers regulating HR, breathing and BP Cerebellum - correct answer located in the posterior and inferior to the cerebrum. It aids in the motor cortex of the cerebrum in influencing muscle tone and coordinating muscle action. It also utilized the sensory data for reflexive control of the equilibrium and posture. Commissural fibers - correct answer interconnect the counterpart areas in each hemisphere, permitting the coordination of activities between hemispheres. Dendrites - correct answer branching fibers that extend only a short distance from each cell body and conduct impulses towards the cell body. Nodes of Ranvier - correct answer a gap in the myelin sheath of a nerve between adjacent Schwann cells where the axon is exposed. As a result, the action potential signal jumps along the axon, from node to node, rather than propagating smoothly, as they do in axons that lack a myelin sheath. This facilitates the rapid conduction of nerve impulses. •CN1 - correct answer Olfactory smell
. CN2 - correct answer Optic vision CN3 - correct answer Oculomotor- extraocular movement, pupil constriction, upper eyelid movement, CN 4 - correct answer. Trochlear extraocular eye movement
Hippocratic facies - correct answer eyes are sunken, temples collapsed, nose is pinched with crusts on the lips and the forehead is clammy. A sign of impending death
- Migraine headache - correct answer gradual onset of severe, unilateral throbbing headaches, nausea, vomiting, photophobia, reoccurring and frequencies vary. Tension, menses and excessive noise can precipitate migraines
- Cluster headaches - correct answer sudden, sharp, unilateral pain, occurs in clusters of 2-6 weeks, unilateral excessive tearing or redness of eye
- Vascular headaches - correct answer characterized by their intermittence and throbbing pain
- Tension headaches - correct answer mild/moderate in severity and cause tightness
- Benign exertional headaches - correct answer related to coughing, sneezing and physical exertion. Nuchal rigidity - correct answer stiffness in the neck. Can be caused be meningitis, rupture of an intracranial aneurysm or arteriovenous malformation. Meningeal irritation - correct answer may be identified with Brudzinski's sign (involuntary flexion of hip and knees when neck is flexed
- Posterior fontanelle - correct answer should close by 4 months
- Anterior fontanelle - correct answer should close by 9-18 months, 24 months at the latest Best position for examining thyroid - correct answer standing behind the patient and having both hands on either side of the trachea, have the patient turn the head and swallow. Repeat on the other side and determine abnormalities.
Torticollis - correct answer A rare condition in which the neck muscles contract, causing the head to twist to one side. Torticollis can be inherited and is seen soon after birth. This form may resolve without treatment.
- CN 1 assessment - correct answer odor identification
- CN 2 assessment - correct answer test visual acuity, test visual fields, eye exam
- CN 3 assessment - correct answer motor eye movement, pupil size, eye lid opening
- CN 4 assessment - correct answer motor eye movement, pupil size, eye lid opening
- CN 5 assessment - correct answer muscle tone and sensation, palpate jaw for tone and strength, corneal reflex
- CN 6 assessment - correct answer motor eye movement, pupil size, eye lid opening
- CN 7 assessment - correct answer face expressions and taste, sweet and sour
- CN 8 assessment - correct answer hearing, air to bone conduction
- CN 9 assessment - correct answer gag reflex/ swallow
- CN 10 assessment - correct answer swallow, speech
- CN 11 assessment - correct answer trapezius (shoulder shrug)
- CN 12 assessment - correct answer tongue strength
What does the hypothalamus do - correct answer Secretes the thyrotropin-releasing hormone which stimulates secretion of the TSH, Corticotropin-releasing hormone which stimulates the release of adrenocorticotropic hormone (ACTH), Growth hormone releasing hormone which stimulates the release of growth hormone, Prolactin-inhibiting factor (PIF) which inhibits the release of prolactin. Hypophysis - correct answer his is another name for the pituitary gland and it consist of an anterior and posterior component Thyroiditis: Hashimoto's thyroiditis-autoimmnue disease - correct answer Juvenile hypothyroidism, s/s on palpation the thyroid feels firm with diffuse nontender enlargement. In children delayed growth, delayed tooth eruption. Most cases of acquired juvenile hypothyroidism are caused by Hashimoto's thyroiditis. Autoimmune antibodies that attack the thyroid gland. Often cause hypothyroidism. More common in children and women between 30-50 years. Progresses slowly Goiter - correct answer seen in hyperthyroidism, or hypothyroidism Hypothyroidism - correct answer Patient presents with weight gain, cold intolerance, fatigue, Altered emotional state (lethargy, complacent, disinterested), constipation, thick puffy skin and hair loss, brittle thin hair, hoarseness, menorrhagia, bradycardia, hypoventilation. Periorbital edema, reduced attention span. Hypothyroidism is the most frequent thyroid disorder; it is easy to misdiagnose because hair, eye, and nail changes are often associated with aging. Diagnostic test-thyroid profile Labs: Increased TSH, decreased tt4-total thyroxine Signs That Suggest Hypothyroidism in the Term Newborn - correct answer Hypothermia , Delayed meconium passage, Enlarged posterior fontanelle, Signs of respiratory distress , Prolonged neonatal jaundice Hyperthyroidism - correct answer May present with gradual onset of constant fatigue nervousness/anxiety, rapid pulse, heat intolerance, muscle weakness, profuse perspiration and moist skin. Increased frequency of BMs, goiter, weight loss amenorrhea/scant flow, increasing weakness, exophthalmos, thin face from weight loss. Thyroid gland may be palpable. Diagnostic test- thyroid profile, MRI or thyroid scan. Labs: decreased TSH, increased total throxine (TT4). NB FT3 is used in confirming early hyperthyroidism as it rises before tt4 an tt3, see table 14-2 pg 352. Hyperthyroidism can occur in the pregnant client from increased secretion of human chorionic gonadotropin with a molar pregnancy
Plummer nails - correct answer A patient with endocrine disease may have friable nails that separate, known as Plummer's nails, seen in hypothyroidism and thyrotoxicosis Addison's disease - correct answer Caused by adrenocortical insufficient, that the adrenal cortex does not secrete its hormones s/s: fatigue, weight loss, dehydration, GI problems, increased skin pigmentation, lack of body hair and bronzing, bradycardia, orthostatic hypotension, low BP, weight loss: diagnosis: CBC, 24 hour urine studies. Hint: low cortisol, low aldosterone Conn's syndrome - correct answer Hyperaldosteronism, too much aldosterone secreted from an abnormality in the adrenal cortex, usually a benign tumor. s/s HTN, hypokalemia, renal potassium wasting Cushing disease - correct answer Caused by prolonged /increased secretion of glucocorticoids, conditions that cause excessive secretion of ACTH, most commonly by medically prescribed corticosteroids. May present with heavy trunk, buffalo hump, and moon face. Thin fragile skin, pink- purple striae and ecchymoses, hirsutism, acne. Purple striae over the abdomen, bruises easily, poor skin healing weigh gain, proximal muscle weakness. Facial hair or male pattern baldness in females Cushing's triad - correct answer indicates increased ICP s/s bradycardia, HTN, irregular respirations Acromegaly - correct answer A rare disease of excessive growth and distorted proportions caused by hypersecretion of growth hormone and insulin-like growth factor after closure of the epiphyses. May be caused by a benign pituitary adenoma. Most common in middle-age adults s/s: soft tissue enlargement- increased shoe or ring size, pain in joints and hands, no change in height, oily and sweaty skin. Prominent brow-forehead, enlarged tissue of nose and lips, prominent jaw, large hands, joint enlargement, swelling and pain, decreased exercise intolerance due to cardiac ventricular enlargement Thyrotoxicosis - correct answer This is a form of hyperthyroidism. S/S: reddish color to skin, weight loss, palpitations, exophthalmos, increased perspiration, elevated BP, pulses (increased stroke volume and HR with palpitations) and increased respirations. The resting heart rate may be 90 or greater. CHF may occur with palpitations in a patient with thyrotoxicosis because of increased metabolism and increased adrenergic-like sensitivity of the heart to catecholamines. Note that 40% of older patients with thyrotoxicosis will have atrial fibrillation. In addition, patient may have petechiae and bruising because of excessive thyroid hormones which breakdown protein faster than synthesis. Crackles, increased respiratory rate with dyspnea. Bright eye stare with retracted eyelid, and lid lag see page 345, thin hair. Individuals older than 60 years of age may have clinical manifestations of thyrotoxicosis that are subtler or dramatically different than that of younger patients. • In the older adult, the thyroid may become fibrotic, feeling more nodular or irregular on palpation
Secondary sexual characteristics - correct answer regulated in males by the testes which secretes androgens, mainly testosterone which affects the development of male organs and secondary sex characteristics. In females, the ovaries secrete estrogen and progesterone. Estrogen is responsible for the development of female sex organs and secondary sex characteristics Thyroid bruit - correct answer A soft, rushing sound heard when auscultating the thyroid. To distinguish a bruit from a venous hum, ask the patient to stop breathing momentarily. A bruit may indicate thyrotoxicosis. Grave's disease: - correct answer This is an autoimmune disease where there is overactive thyroid due to over stimulation of the TSH. It's common in women. s/s: palpitations, tachycardia, weight loss, fatigue, increased appetite, diffuse thyroid enlargement, exophthalmos, weight loss. More common in women during 3rd and fourth decade. Myxedema - correct answer Skin and tissue disorder usually due to severe prolonged hypothyroidism. S/s edema of facial features. Cognitive impairment, slowed mentation, apathy, depressed mood, coarse skin swollen lips, puffiness around eyes, slow speech, weight gain, thin brittle hair, muscle pain, deafness, constipation The best position to examine the thyroid - correct answer is in front of the patient and observe them swallow before you palpate. Ask the patient to flex neck slightly forward, to relax the sternomastoid muscles, and move the neck laterally toward the side being examined. The thyroid should be small 4cm, smooth, and rubbery, the isthmus should rise when the patient swallows. You can palpate the thyroid by the posterior technique or the anterior technique. A trachea that is slightly deviated to the right is normal, but markedly deviated trachea indicates thyroid disease Sever's disease - correct answer Also called Calcaneal apophysitis. Pain on back of the heel. Affects a pediatric (9 to 12 yrs) patient who is active. Walks with limp, complains of heel pain worsened by jumping or running. The area is never warm, or red. Palpation of the posterior-plantar junction reveals pain. Increased pain with stretching of the heel cord. Legg-Calve-Perthes disease - correct answer Avascular necrosis of the femoral head. Most common in boys between 3 and 11 yrs. S/s varies on age of child and stage of disease. This is hip disease. Child displays a limp which is often painless and intermittent. Possible pain in the anterior groin, inner thigh, or knee, atrophy of the thigh and buttocks. Positive Catterall's sign: Passive hip flexion causes external rotation. Limitation of abduction especially in flexion. Limitation and pain are noted in internal rotation
Genu valgum - correct answer This called knock-knees When comparing the patellae and knees, noted that women usually have knock-knees or genu valgum. The excess angling of the Q angle (where the femur and lower leg meet) causes the patient to bear weight on the inside of the knee. A Q angle greater than 10 degrees in men and 15 degrees in women predisposes them to knee problems. Osteoarthritis; - correct answer The deterioration of the articular cartilage covering the ends of bone in synovial joints. Pain in hand feet, hip, knees, cervical and lumbar spine. The joint may be enlarged due to bone growth-(osteophytes). May have crepitus and limited, painful range of motion. Strain - correct answer Muscle strain can be due to excessive stretching or forceful contraction beyond the muscle's functional capacity. Associated with improper warm up exercise, fatigue or previous injury. S/s : muscle pain, temporary muscle weakness, spasms, pain and contusion. Undisplaced fracture (non-displaced fracture) - correct answer The bone breaks in a spot and stays aligned. The ends of the fracture are touching each other Displaced fracture - correct answer Complete break. The bone snaps into 2 or more parts. Carpal tunnel syndrome - correct answer Pain that increases at night, positive Tinel's sign-see below, history of performing repetitive movements, possible wasting of thenar eminence. Clumsiness with numbness in median nerve distribution, that is numbness in the thumb, index, long fingers, and the radial aspect of the ring finger. NB: Carpal tunnel syndrome is often seen pregnant women due to edema, alcoholics, and patients with arthritis, and hypothyroidism De Quervain's tendonitis - correct answer Pain in the radial aspect of the wrist that is aggravated with ulnar deviation of the hand with the thumb flexed-such as when turning a door knob. There is a thickening sheath or nodule in the area of tenderness upon palpation. It reveals a positive Finkelstein test: having the patient flex the thumb into his or her palm and then cover with the other fingers, and passively ulnar-deviating the wrist elicits pain in affected area Scaphoid fracture - correct answer The scaphoid is a bone in the hand. It is usually the most injured carpal bone. This bone is also called the Navicular. Thus, Navicular fracture. Hx of fall on an outstretched hand with impact on the fingers or palm. Tenderness over the anatomical snuffbox, which increases with movement of the wrist.z
of time. There is tenderness and swelling. Pain with palpation over the tibial tuberosity. Child walks with a limp. Gout - correct answer This is a disorder of purine metabolism that's results from elevated uric acid level. Primarily affects men over 40 yrs and postmenopausal women. S/s sudden onset of a hot, swollen joint, limited ROM. Usually affects the proximal phalange of the great toe. The skin over the swollen joint may be shiny and red or purple. Uric acid crystals may form as tophi under skin with chronic gout. gouty arthritis - correct answer A form of arthritis, characterized by severe joint pain and redness.
