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NR 509 Midterm Exam Review 100% Verified A+ 2024
Cause of saddle numbness and urinary retention - ANS-✔✔Cauda equina syndrome
Presentation of retinal detachment - ANS-✔✔If sudden visual loss is unilateral and painless,
Obtunded - ANS-✔✔patient opens the eyes and looks at you but responds slowly and is somewhat confused. Alertness and interest in the environment are decreased.
Cranial nerve for lateral gaze - ANS-✔✔CN6: Abducens
Adult Illnesses - ANS-✔✔Medical: Illnesses such as diabetes, hypertension, hepatitis, asthma, and human immunodeficiency virus (HIV); hospitalizations; number and gender of sexual partners; and risk- taking sexual practices
■ Surgical: Dates, indications, and types of operations
■ Obstetric/Gynecologic: Obstetric history, menstrual history, methods of contraception, and sexual function
■ Psychiatric: Illness and time frame, diagnoses, hospitalizations, and treatments
Present Illness - ANS-✔✔chronologic description of the problems prompting the patient's visit, including the onset of the problem, the setting in which it developed, its manifestations, and any treatments to date.Each problem/symptom needs: (1) location; (2) quality; (3) quantity or severity; (4) timing, including onset, duration, and frequency; (5) the setting in which it occurs; (6) factors that have aggravated
-meds, allergies, tobacco use, ETOH and drug use
Absence of red reflex - ANS-✔✔an opacity of the lens (cataract) or, possibly, the vitreous (or even an artificial eye). Less commonly, a detached retina or, in children, a retinoblastoma may obscure this reflex.
S/S of seasonal allergies - ANS-✔✔Itching, watery eyes, sneezing, ear congestion, postnasal drainage
Presentation of optic neuritis - ANS-✔✔Enlarged blind spot, vision loss in 1 eye, loss of color vision, hole in center of vision, trouble seeing to the side, eye pain
pityriasis rosea - ANS-✔✔Multiple round to oval scaling violaceous plaques on abdomen and back
Acromion - ANS-✔✔tip of shoulder
What to do for + finding on physical exam, but - workup - ANS-✔✔continue using test, but less lab and diagnostics
Cause of falsely high BP - ANS-✔✔-too small of a BP cuff
- if the brachial artery is below heart level
- loose cuff
- bladder that balloons outside the cuff
Check for nystagmus - ANS-✔✔-involuntary jerking movement of the eyes with quick and slow components.
- It is named for the direction of the quick component
- seen in cerebellar disease and vestibular disorders and in internuclear ophthalmoplegia
Jaundice - ANS-✔✔yellow sclera
how do get a patient to open up when upset - ANS-✔✔effective reassurance is simply identifying and acknowledging the patient's feelings.
-Partnering
● Present illness ● Past history
● Family history
● Personal and social history ● Review of systems
Rotator cuff injury - ANS-✔✔Atrophy of the supraspinatus and infraspinatus with increased prominence of scapular spine can appear within 2 to 3 weeks of a rotator cuff tear; infraspinatus atrophy has a positive likelihood ratio (LR) of 2 for rotator cuff disease.
prioritizing patient complaints - ANS-✔✔Problem list
- Most active and serious problems first
- then, problems that need future observation and attention
Condylar joints - ANS-✔✔Knee & TMJ
-Movement of two articulating surfaces not dissociable
Acute RA - ANS-✔✔Tender, painful, stiff joints in RA, usually with symmetric involvement on both sides of the body. The distal interphalangeal (DIP), metacarpophalangeal (MCP), and wrist joints are the most frequently affected. Note the fusiform or spindle-shaped swelling of the PIP joints in acute disease.
Chronic RA - ANS-✔✔swelling and thickening of the MCP and PIP joints. Range of motion becomes limited, and fingers may deviate toward the ulnar side. The interosseous muscles atrophy. The fingers may show "swan neck" deformities (hyperextension of the PIP joints with fixed flexion of the distal interphalangeal [DIP] joints). Less common is a boutonnière deformity (persistent flexion of the PIP joint with hyperextension of the DIP joint). Rheumatoid nodules are seen in the acute or the chronic stage.
subjective data - ANS-✔✔- Symptoms
-goes under ROS
sources of joint pain - ANS-✔✔-If age <60 years, consider repetitive strain or overuse syndromes like tendinitis or bursitis, crystalline arthritis (gout; crystalline pyrophosphate deposition disease [CPPD]) (males), rheumatoid arthritis (RA), psoriatic arthritis and reactive (Reiter) arthritis (in inflammatory bowel disease [IBD]), and infectious arthritis from gonorrhea, Lyme disease, or viral or bacterial infections.
- If age >60 years, look for OA, gout and pseudogout, polymyalgia rheumatica (PMR), osteoporotic fracture, and septic bacterial arthritis.
- congenital, inflammatory or infectious, immunologic, neoplastic, metabolic, nutritional, degenerative, vascular, traumatic, and toxic?
CN 1-6 - ANS-✔✔1) Olfactory- smell
2)Optic- visual acuity with eye chart & pupil response
3)Oculomotor- conjugate gaze with EOM
4)Trochlear- conjugate gaze with EOM
Trigeminal- palpate masseter & touch face and have pt identify where
Abducens- Conjugate gaze with EOM
CN 7-12 - ANS-✔✔7)Facial- Blow cheeks out, smile, frown, pucker lips
8)Vestibulocochlear (Acoustic)- Whisper test
- Glossopharyngeal- Gag reflex
10)Vagus- say "ahhh". soft palate and uvula rise symmetrically
Accessory- shrug shoulders
Hypoglossal- Stick out tongue and move left to right
epistaxis causes - ANS-✔✔nosebleed
- cause: trauma, inflammation, drying and crusting of the mucosa, tumors and foreign bodies
● Atypical or large moles, especially if dysplastic
● Red or light hair
● Solar lentigines (acquired brown macules on sun-exposed areas)
● Freckles (inherited brown macules)
● Ultraviolet radiation from heavy sun exposure, sunlamps, or tanning booths
● Light eye or skin color, especially skin that freckles or burns easily
● Severe blistering sunburns in childhood
●Immunosuppression from human immunodeficiency virus (HIV) or from chemotherapy
● Personal history of nonmelanoma skin cancer
Symptoms of a SAH - ANS-✔✔Headache with severe and sudden onset
-thunderclap headache reaching maximal intensity over several minutes
Headache warning signs - ANS-✔✔Progressively frequent or severe over a 3-month period
● Sudden onset like a "thunderclap" or "the worst headache of my life"
● New onset after age 50 years
● Aggravated or relieved by change in position
● Precipitated by Valsalva maneuver or exertion
● Associated symptoms of fever, night sweats, or weight loss
● Presence of cancer, HIV infection, or pregnancy
● Recent head trauma
● Change in pattern from past headaches
● Lack of a similar headache in the past
● Associated papilledema, neck stiffness, or focal neurologic deficits
Making a pelvic exam more comfortable - ANS-✔✔Obtains permission; selects chaperone Explains each step of the examination in advance
Drapes the patient from mid-abdomen to knees; depresses the drape between the knees to provide eye contact with patient
Avoids unexpected or sudden movements
Chooses a speculum that is the correct size
Warms the speculum with tap water Monitors the comfort of the examination by watching the patient's face
Uses excellent but gentle technique, especially when inserting the speculum
if one patient comes from another country - ANS-✔✔You still need to be selective in who you screen for malaria
Signs of increased ICP - ANS-✔✔Papilledema ( pink, hyperemic, loss of venous pulsations, disc more visible, disc swollen with blurred margins, physiologic cup not visible)
signs of respiratory distress - ANS-✔✔Tachypnea, cyanosis or pallor, audible whistling during inspiration over neck or lungs, stridor, use of accessory muscles,
objective information - ANS-✔✔Vitals, info you detect during examination, physical exam findings
Signs of otitis externa - ANS-✔✔-After swimming
- inflammation of the ear canal
-pain, itching, redness, swelling, hearing loss
Symptoms of pneumonia - ANS-✔✔- fever
-may have normal VS
- dim lung sounds or crackles
-Scattered erythematous to bright pink well-circumscribed flat-topped plaques on extensor knees and elbows, with overlying silvery scale; plaque psoriasis
vasovagal syncope - ANS-✔✔-neurocardiogenic (also called neutrally mediated vasodepressor syncope or vasovagal syncope) and of cardiac origin from arrhythmias in only ∼20% of cases
Angina pectoris - ANS-✔✔Consider this as a differential diagnosis for chest pain
subconjunctival hemorrhage - ANS-✔✔-no pain
-vision not affected
-pupil not affected
-clear cornea
- benign, spontaneous, doesn't need treatment.
Sternocleidomastoid lymph nodes - ANS-✔✔Considered posterior cervical
Tension Pneumo - ANS-✔✔Use 2nd intercostal space for needle insertion
listening to the heart - ANS-✔✔Patient must lay down to listen for S1, S2, and murmurs
Heroin overdose - ANS-✔✔pinpoint pupils
Lymph nodes - ANS-✔✔Small, discrete, mobile mass
Tension headache - ANS-✔✔A headache located all over the head, is a tightness, and is noted after looking at a computer all day
Dysfunction of the cerebellum - ANS-✔✔Impaired speech and judgement with an otherwise normal exam
Silent patient - ANS-✔✔A patient who looks to her family member to answer a question
Talkative patient - ANS-✔✔repeat what she said in the first 5 minutes and get her to focus on one aspect of what she told you
Glaucoma - ANS-✔✔Increased cup-to-disc ratio
Bulging discs - ANS-✔✔Vertebral bodies of the spin associated with bulging disc are cartilaginous
