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REGIS. NU 650 FINAL EXAM STUDY GUIDE COMPLETE SOLUTION GUIDE FOR THE REGIS. NU 650 FINAL COMPLETE SOLUTION GUIDE FOR THE FINALS NEWSOLUTION 2021- 2022 EXAM STUDY GUIDE 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- 7 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
REGIS. NU 650 FINAL EXAM STUDY GUIDE COMPLETE SOLUTION GUIDE FOR THE 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 UE Arteries - CORRECT ANSWER radial-thumb side, ulnar pinky side Pulse grading - CORRECT ANSWER 0 absent 1+ weak 2+ normal 3+ increased 4+ bounding
REGIS. NU 650 FINAL EXAM STUDY GUIDE COMPLETE SOLUTION GUIDE FOR THE PMI - CORRECT ANSWER point of maximal impulse mid-clavicular and 5th ICS S1 - CORRECT ANSWER normal, closure of AV, Start of systole, loudest at Apex, contraction of ventricles S2 - CORRECT ANSWER normal, closure of semilunar, end of systole, loudest at base, filling of ventricles S3 - CORRECT ANSWER third heart sound (normal in pregnant young adults, and children), gallop S4 - CORRECT ANSWER extra heart sound, end of diastole, indicative of disease-AFIB murmur grading scale - CORRECT ANSWER I-Barely Audible II-Quiet, Clearly Audible III-moderately Loud IV-loud, thrill V-Very loud, can palpate thrill VI-Very loud, thrill palpable and visible 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 - 5 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
REGIS. NU 650 FINAL EXAM STUDY GUIDE COMPLETE SOLUTION GUIDE FOR THE release from palpation
REGIS. NU 650 FINAL EXAM STUDY GUIDE COMPLETE SOLUTION GUIDE FOR THE INDICATES: overuse injury to the supraspinatus and possibly biceps tendon
REGIS. NU 650 FINAL EXAM STUDY GUIDE COMPLETE SOLUTION GUIDE FOR THE 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 Phalen's sign - CORRECT ANSWER Tingling, numbness, or pain in the fingers within 60 seconds of performing Phalen's maneuver, a diagnostic test for carpal tunnel syndrome Tinel's sign - CORRECT ANSWER A distal tingling sensation on percussion of median nerve of the inner wrist; characteristic of carpal tunnel syndrome Drawer Test - knee - CORRECT ANSWER Patient supine, examiner flexes the hip and the knee of the patient's affected leg until the foot is flat on the table. Examiner sits on the foot of thepatient's afectedleg. Examinergrasps behindthe patient'sflexed knee and exerts a pushing and pulling pressure into the affected knee. +(1) Gapping > 6mm (tibia moves posterior) when the leg is pushed. +(2) same when the leg is pulled. INDIC:(1) Torn posterior cruciate ligament. (2) Torn anterior cruciate ligament. Confirmation Test: Lachman'sTest Lachman's Test - CORRECT ANSWER pivot shift test (ACL tear) Ballottment sign - CORRECT ANSWER medical sign which indicates increased fluid over the patella at the knee joint Straight Leg Raise Test - CORRECT ANSWER test often performed to determine whether a patient with low back pain has an underlying herniated disk or sciatica Cerebrum vs cerebellum - CORRECT ANSWER cerebrum-mental status, cerebellum-balance
REGIS. NU 650 FINAL EXAM STUDY GUIDE COMPLETE SOLUTION GUIDE FOR THE 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
REGIS. NU 650 FINAL EXAM STUDY GUIDE COMPLETE SOLUTION GUIDE FOR THE 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 Sterognosis test - CORRECT ANSWER identifying object with eyes closed Two point discrimination test - CORRECT ANSWER provides a measure of receptive field size for touch receptors. Moro reflex (startle reflex) - CORRECT ANSWER Sudden loud noise will cause symmetric abduction and extension of the arms followed by adduction and fl exion of the arms over the body. Disappears by 3 to 4 months.
REGIS. NU 650 FINAL EXAM STUDY GUIDE COMPLETE SOLUTION GUIDE FOR THE ■ Absence on both sides: Rule out spinal cord or brain lesion. ■ Older infant: Persistence of Moro refl ex abnormal. Rule out brain pathology. rooting reflex - CORRECT ANSWER a baby's tendency, when touched on the cheek, to turn toward the touch, open the mouth, and search for the nipple, 3 - 4 months palmar grasp reflex - CORRECT ANSWER in response to stroking a baby's palm, the baby's hand will grasp. This reflex lasts a few months gone by 3 - 4 months Prostate screening - CORRECT ANSWER Yearly PSA blood test and digital rectal examination starting at age 50 or at age 45 if at high risk testicular self-examination - CORRECT ANSWER a self-help step in early detection of testicular cancer by detecting lumps, swelling, 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
REGIS. NU 650 FINAL EXAM STUDY GUIDE COMPLETE SOLUTION GUIDE FOR THE 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
REGIS. NU 650 FINAL EXAM STUDY GUIDE COMPLETE SOLUTION GUIDE FOR THE 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 Indirect hernia - CORRECT ANSWER most common goes through internal inguinal ring, most common will touch finger tip, Will extend into scrotum Fibrocystic breast disease - CORRECT ANSWER benign, fluid filled cysts, tender to touch, vary in size with periods, caffeine may exacerbate
- estrogen and progesterone dependent rope like Fibroadenoma - CORRECT ANSWER a round, firm, rubbery mass that arises from excess growth of glandular and connective tissue in the breast Cysts in breast - CORRECT ANSWER Squishy (can move and change in size during menstrual cycle) breast cancer - CORRECT ANSWER a carcinoma that develops from the cells of the breast and can spread to adjacent lymph nodes and other body sites, nodular, fixed, non mobile Cervical Motion Tenderness (CMT) - CORRECT ANSWER tenderness when moving the cerix (during bimanual exam) (PE GU) pain and temperature - CORRECT ANSWER spinothalamic tract position and vibration sense - CORRECT ANSWER posterior column Discrimination - CORRECT ANSWER cortex and tract/column
REGIS. NU 650 FINAL EXAM STUDY GUIDE COMPLETE SOLUTION GUIDE FOR THE 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
REGIS. NU 650 FINAL EXAM STUDY GUIDE COMPLETE SOLUTION GUIDE FOR THE 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 myelopathy - CORRECT ANSWER cervical cord compression, head to chest shock test Turner's sign - CORRECT ANSWER flank grayish blue (turn around to see your flanks) pancreatitis Murphy's sign - CORRECT ANSWER Pain with palplation of gall bladder (seen with cholecystitis) Cullen's sign - CORRECT ANSWER ecchymosis in umbilical area, seen with pancreatitis normal bowel sounds - CORRECT ANSWER high-pitched, gurgling, cascading sounds, occurring irregularly anywhere from 5 to 30 times per minute. Cholecystitis/Cholelithiasis - CORRECT ANSWER cholelithiasis- gallstones
REGIS. NU 650 FINAL EXAM STUDY GUIDE COMPLETE SOLUTION GUIDE FOR THE Cholecystitis - obstruction of the bile duct-colicky epigastric RUQ pain, right shoulder; after fat meal Appendicitis signs and symptoms - CORRECT ANSWER Pain in the periumbilical area that descends to the right lower quadrant. Rebound tenderness and abdominal rigidity Low-grade fever Elevated WBC Anorexia, nausea and vomiting Constipation or diarrhea 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
