Healh assessment exam 2 set b
Terms
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- when using the snellen eye chart, where does the client's head need to be in relation to yours?
- The person's head should be at "my" eye level
- What is the snellen eye chart used to measure?
- visual accuity
- What do you do with reading glasses of the client taking the snellen eye exam?
- remove them
- The top number on the visual acuity test (ie., 20/20) measures what?
- the distance the person is standing from the chart
- the bottom number of 20/20 in regard to vision represents what?
- the person can read at 20 feet what the normal person can read at 20 feet
- The decrease in power of accommodation with aging is called what?
- presbyopia
- What is the name of the test that tests corneal light reflex?
- the hirshberg test
- What eye test detects small degrees of deviated alignment by interrupting the fusion reflex?
- the cover test
- A mild weakness noted only when fusion is blocked of the eye?
- phoria
- A constant malalignment of the eyes is....
- Tropia
- Leading the eyes through the six cardinal positions of gaze to elicit muscle weakness...
- diagnostic positions test
- Failure to follow in a certain direction with the eyes indicates what?
- extraocular muscle weakness or dysfunction of the cranial nerve
- A fine oscillating movenent of the eyes seen during the diagnostic positions test is...
- a nystagmus
- If the upper eyelid does not overlap the superior part of the iris, even during downward movement, it is...
- lid lag
- The normal reaction to the pupillary light reflex
- constriction of the same-sided pupil and simultaneous constriction of the other pupil
- The resting size of the pupil is normally...
- 3,4, or 5 mm and decreases equally in response to light
- If the person focuses on a distant objec with her eyes and her pupils dialate, this indicates what?
- accommodation
- A normal response to accommodation would include what two things?
-
1. pupillary constriction
2. convergence of the axes of the eyes - Diameter of the disk, or DD, is a standard measure for what?
- other fundus structures
- if you saw the words "at 5:00, 3DD from the disk", where would the object be?
- 3 disk diameters away from the optic disk
- Which vessels of the eye have the arterial light reflex?
- arteries
- If an artery and vein cross paths, it is called...
- A-V (or arteriovenous crossing)
- What would you expect to see as far as numbers/location of vessels of the eye?
- a paired artery and vein passing next to each other in each quadrant of the eye
- A crossing at more than .....DD away from the disk is abnormal
- 2
- Squint or cross eye is known as...
- strabismus
- Strabismus should be measured when?
- early child hood
- Strabismus causes what?
- disconjugate vision because one eye deviates off the fixation point
- When the brain supresses images from the weak eye, it is called...
- a suppression scotoma
- the resulting loss of vision due to disuse is called
- amblyopia exanopsia
- Asymmetry during the corneal light reflex under....is normal
- 6 months
- What is a method of getting a newborn to open her eyes?
- hold the baby supine and gently lower the head/hold infant at arms length and turn in one direction
- Holding the baby at arms length and turning in one direction tests for what?
- vestibular function reflex
- the vestibular function reflex disapears after....
- 2 months of age
- How long is the external auditory canal?
- 2.5 to 3 cm long
- the outer one third of the ear canal is made of....
- cartiledge
- the inner two-thirds of the ear canal is made of..
- bone
- The canal has an...shape in an adult
- s shape
- The inner two thirds of the ear angle towards what?
- down towards the nose
- what separates the external and middle ear and is tilted obliquely to the ear canal?
- the tympanic membrane
- What are the parts of the malleus that show through the ear drum?
- umbo, manubrium, and the short process
- The tiny air-filled cavity inside the temporal bone is the...
- middle ear
- the middle ear holds what bones?
- malleus, incus, stapes
- the opening of the inner ear to the outer ear is covered by what?
- the tympanic membrane
- What connects the middle ear with the nasopharynx and allows passage of air?
- the eustacian tube
- What are the functions of the middle ear?
- conducts sound/protects inner ear by reducing sounds/allows equalization of air pressure
- The inner ear contains what?
- the bony labyrinth which holds the sensory organs for equilibrium and hearing
- what composes the vestibular apparatus and the cochlea?
- the vestibule and the semicircular canals
- the auditory system can be divided into what 3 levels?
- peripheral, brainstem, and cerebral cortex
- what vibrates at a point specific to the frequency of the sound?
- basilar membrane
- what are the numerous fibers along the basilar membrane at its base near the stapes called?
- the organ of corti
- What is the function of the brainstem in hearing?
- binaural interaction
- What cranial nerve sends signals to the brainstem from the ears?
- viii
- The function of the cortex in hearing is...
- interpretation
- What type of conduction is least effective in hearing?
- bone conduction (BC)
- a gradual nerve degeneration that occurs with aging or by ototoxic drugs is called
- presbycusis
- What part of the ear feeds info to the brain about the body's position in space?
- the bony labyrinth
- if the bony labyrinth of the ear becomes inflamed, what can happen?
- vertigo
- what week of gestation do the inner ears start to develop?
- 4th week
- describe the postion of the infants eustacian tube in relation to the adults
- it is shorter/wider/ and more horizontal
- what is a gradual hardening that causes the foot plate of the stapes to become fixed in the oval window?
- otosclerosis
- what decade of life does presbycusis normally begin?
- 5th
- the normal eardrum is..
- shiny/translucent/pearl-gray color. light reflex: r.ear:5 oclock, l.ear:7 oclock
- what color would the drum be with serous otitis media?
- yellow-amber
- what color would the ear drum be with acute otitis media?
- red
- Air/fluid level or air bubbles behind the drum indicate what?
- serous otitis media
- What would the eardrum do if a person performed the valsalva maneuver or held her nose?
- it would flutter
- ear drum hypomobility is an early sign of ...
- otitis media
- Tuning forks measure hearing by...
- Air conduction (AC) or by bone conduction (BC)
- A person unable to hear whispered words might have what sort of hearing loss?
- high-toned hearing loss
- The test to use when hearing is better in one ear is...
- the weber test
- a test to compare air conduction and bone conduction of the ears
- the Rinne test
- In the air test, sound is heard in what proportion AC:BC?
- AC 2:BC 1
- Sexual maturity rating of girls is called ...
- tanner staging
- The breast bud stage is stage..
- 2
- the nipple is flush w/ breast surface is stage...
- 3
- the areola and nipple form a secondary mound over breast is stage...
- 4
- only the nipple protrudes; the areola is flush w/ breast is stage...
- 5
- the beginning of breast development occurs in what relation to menarche?
- breast develpment occurs 2 years before menarchy
- the breast volume is smallest when?
- on days 4-7 of menstrual cycle
- Colustrum is expressed at this time of pregnancy
- 4th month
- Atrophied glandular tissue of the post menopausal breast is replaced by...
- fibrous connective tissue
- Most common breast to be larger in assymetry of breasts
- left
- a sudden increase in size of one breast may indicate..
- inflamation or new growth
- Edema gives what sort of appearance to breasts?
- pig skin or orange peel (peau d'orange)
- A supernumerary nipple is usually found along the...
- milk line on the thorax or abdomen, 5-6 sm below breast
- When auscultating for chest sounds of an infant do this:
- use the smaller pediatric diaphragm or the bell over infant's interspaces and not over the ribs
- persistant fine crackles that are scattered over the chest occur with
- pneumonia, bronchiolitis, or atelectasis
- crackles only in upper lungs occur with...
- cystic fibrosis
- crackles only in lower lungs is associated with...
- heart failure
- persistant peristaltic sounds with diminished breath sounds on the same side may indicate
- diaphragmatic hernia
- what is located in the Right Upper Quadrant of the Abdomen?
- liver/gall B/duodenum/ pancreas/right kindey/ hepatic flexure of colon/part of ascending and transverse colon
- What is located in the Left Upper Quadrant (LUQ)?
- stomach/spleen/ left lobe of liver/body of pancreas/ left kidney/splenic flexure of colon/ part of transverse and descending colon
- what is located in theRight lower quadrant?
- cecum/appendix/right ovary and tube/right ureter/right spermatic cord
- What is located in the lower left quadrant (LLQ)?
- part of decending colon/ sigmoid colon/ left ovary and tube/left ureter/ left spermatic cord
- what is located midline on the abdomen?
- aorta/uterus (if enlarged)/ blader (if distended)
- What order is the abdomen auscultated with and with what part of the stethoscope?
- diaphram is used; Inspect, then auscultate, palpate, then percuss
- why is auscultation done before percussion and palpation on abdomen?
- could cause false interpretation of bowel sounds
- where do bowel sounds originate?
- the movement of air and fluid through the small intestine
- how many times/minute should bowel sounds be heard?
- 5-30
- how long must you listen before charting "no bowel sounds"?
- 5 minutes
- You are most likely to hear bruits at the aorta/renal arteries/iliac/femoral arteries in whom?
- people w/ hypertension
- what sound should predominate the abdomen?
- tympany
- What inderect percussion test would be performed to assess kidneys for pain?
- costovertebral angle tenderness
- diminished or absent bowel sounds (hypoactive bowel sounds) signal....
- inflamation as seen with peritonitis, from paralytic ileus, from late bowel obstruction, or pneumonia
- Hyper active bowel sounds signal...
- increased motility. They occur w/ early mechanical bowel obstruction, gastroenteritis, brisk diarrhea, laxative use, and subsiding paralytic ileus
- loud gurgling sounds of the abdomen are called
- "borbyorygmi"
- Fremitus is most prominent between....on the chest wall
- scapulae and around the sternum; where major bronchi are closest to chest wall
- Fremitus feels greater over what sort of chest wall?
- thin
- What pitch of voice (high or low) generates more fremitus
- a loud, low-pitched
- Decreased fremitus occurs w/ what?
- when anything obstructs transmission of vibrations
- Increased fremitus occurs with...
- compression or consolidation of lung tissue (lobar pneumonia)
- This type of fremitus is palpable w/ thick bronchial secretions
- Rhoncal
- a coarse crackling sensation palpable over the skin surface, commonly noticed w/ emphysema....
- crepitus
- Added sounds that are not normally heard are called
- adventitious
- what type of adventitious sound is not pathalogic?
- atelectatic crackles
- during normal tidal flow, what does wheezing indicate?
- asthma
- connected musical sound: high pitched/squeeking/ predominate in expiration
- sibilant wheeze
- low-pitched; monophonic single note/musical snoring/ most prominant on expiration
- sonorous rhonchi
- high-pitched/monophonic/ inspiratory/crowing sound/ louder in neck than over chest wall
- stridor
- discontinuous/high-pitched/ short, popping sounds heard on inspiration
- crackles
- loud/low-pitched/ bubbling and gurgling that starts in early inspiration/sounds like velcro
- coarse crackles
- superficial sound that is course and low pitced/ grating quality as if 2 pieces of leather are rubbing together
- pleural friction rub
- A sudden loss of strength/ temporary loss of consciousness due to lack of cerebral blood flow/faint
- syncope
- Feeling as if the room is spinning is ....
- objective vertigo
- feeling as if YOU are spinning is...
- subjective vertigo
- heal to toe walking (tandem walking) does what?
- decreases the base of support and accentuates any proplems w/ coordination
- Describe the Romberg Test
- person stands w/ feet together/arms at sides/ closes eyes and holds the position for 20 sec.
- Positive Romberg test is...
- loss of balance that occurs when closing the eyes/occurs w/ cerebeller ataxia,loss of proprioception, and lost of vestibular function
- Patting knees w/ both hands/turning hands over then patting w/ backs of hands and then doing so faster is what test?
- rapid alternating movements (RAM)
- Dysdiadochokinesia is what?
- slow, clumsy, and sloppy responce to rapid alternating movments (RAM)
- When is temperature sensation tested?
- only when pain sensation is abnormal
- Applying a wisp of cotton to the skin tests perception of what?
- light touch
- Decreased touch sensation is called what?
- Hypoestesia
- Absent touch sensation is...
- anestesia
- increased touch sensation is
- hyperesthesia
- Pain, Temperature, and light touch test which 'trac'?
- They test the spinothalamic tract
- Vibration/kinesthesia/ stereognosis/ graphestesia/ 2-point discrimination/ extinction/ and point location test which 'tract'?
- They test the posterior column tract
- Inability to feel vibration can be caused by...
- Alcoholism and diabetes
- Where is peripheral neuropathy the worst?
- the feet (it gradually improves as you move up the leg)
- To test a person's ability to feel vibrations, what would you do?
- Place a vibrating tuning fork over bony prominences
- Testing the person's ability to percieve passive movements of the extremities is...
- Position (which is also called kinesthesia)
- What test would be performed to test the ability to recognize objects by feeling their forms/size/weight?
- stereognosis
- What is the inability to identify felt objects correctly called?
- astereognosis
- Problems w/ tactile discrimination occur w/ what?
- lesions of the sensory cortex or posterior column
- The ability to 'read' a number by having it traced on the skin is....
- graphesthesia
- the ability to distinguish the separation of 2 simultaneous pin points on the skin....
- two-point discrimination
- When does puberty begin for the male?
- sometime between the ages of 9.5 and 13.5 years
- what is the first sign of male puberty?
- the enlargement of the testes
- What is the name of the stages of sexual development for boys?
- tanner's sexual maturity ratings (also called SMR)
- How long does the complete change in development from a pre-adolescent to adult take?
- 3 years
- What were Tanner's studies of sexual development based on?
- data from post WWII british youth.
- Sexual characteristics among african american boys and caucasian boys are...
- similar
- How does socioeconomic status effect male sexual development
- according to the US health Examination surveay from 1966-1970, it doesn't
- What stage does the scrotum begin to enlarge/redden/change texture?
- 2
- what stage does pupic hair begin to grow at base of penis?
- 2
- the stage when penis begins to enlarge, especially in length?
- 3
- Thick growth over pubic area but not thights. Hair curly/coarse as in an adult male. Development of glans
- stage 4
- Growth spread over medial thighs, although not yet up toward umbilicus
- stage 5
- What is the outlet of the gastrointestinal tract?
- the anal canal
- how long is the anal canal?
- 3.8 cm in the adult
- What separates the internal and external anal sphincters?
- the intersphincteric groove
- What is another name for the anal columns?
- columns of Morgagni
- Where do the folds of mucosa known as anal columns end?
- at the anorectal junction
- enlargement of veins in the anal column can cause what?
- a hemorrhoid
- What small crescent fold of mucus membrane is at the lower end of each column
- the anal valve
- how long is the rectum?
- 40 cm long
- The rectum extends from the .....to the.....
- from the sigmoid colon at the level of the 3rd sacral vertebra to the anal canal
- Just above the anal canal, the rectum dilates and turns posteriorly, forming the...
- rectal ampulla
- The rectal interior has 3 semilunar transverse folds called the
- valves of houston
- in the male, the anterior part of the peritoneum reflects down to w/in 7.5cm of the anal opening forming the...
- rectovesical pouch
- The female counterpart of the rectovesical pouch is the..which extends down to w/in 5.5 cm of the anal opening
- rectouterine pouch
- The prostate gland lies in fron of the....
- anterior wall of the rectum
- The prostate gland lies ....cm behind the symphisis pubis
- 2
- The prostate gland has ....to...ducts that open into the urethra
- 15-30
- The two lateral lobes of the prostate gland are separated by a shallow groove called the.....
- median sulcas
- the two ........ ........ project like rabbit ears above the prostate
- seminal vesicles
- The seminal vesicles secrete a fluid rich in.....that nourish sperm, and also....
- fructose nourish sperm; also secreted are prostaglandins
- What glands are the size of a pea and are located inferior to the prostate on either side of the urethra?
- bulbourethral (also called cowper's glands). they secrete a clear, viscid mucus
- The sigmoid colon is s shaped and extends from the .....and ends at the...
- extends from the iliac flexure of the descending colon; ends at rectum
- Where is the first place you place your finger when palpating the anus?
- the anal verge
- What should your finger point to as it enters the anus?
- The umbilicus (never approach the anus at right angles w/ finger extended)
- Using bidigital palpation w/ thumb agains perianal tissue while pressing examing finger towards it highlights what?
- any swelling or tenderness and helps assess the bulbourethral glands
- Above the anal canal, the rectum turns posteriorly, folowing the curve of the.... and.....
- coccyx and sacrum
- A soft, slightly movable mass may be a....
- polyp
- Internal hemorrhoids above anorectal junction is not palpable unless....
- thrombosed
- a firm hard mass w/ irregular shape or rolled edges may be...
- carcinoma
- On the anterior wall of the rectum of the male,.....can be palpated
- the prostate
- what size should the prostate be?
- 2.5 cm long by 4 cm wide/should not protrude more than 1 cm into rectum
- what shape should the prostate be?
- heart shape w/ palpable central groove
- the surface of the prostate should feel.....on palpation
- smooth
- the prostate should be.....movable
- slightly
- The sensitivity of the prostate should be:
- nontender to palpation
- any stone-hard irregular fixed nodule of the prostate indicates....
- carcinoma
- Swollen exquisitely tender prostate gland accompanies....
- prostatitis
- Enlarged, firm, smooth prostate gland w/ central groove obliterated suggests...
- benign prostatic hypertrophy
- A false positive for occult blood in the stool could occur if..
- large amounts of red meat has been consumed w/in 3 days of test
- Bright red blood mixed w/ feces indicates...
- possible colonic bleeding
- black tarry stool w/ distinct malodor indicates
- upper gastrointestinal bleeding w/ blood partially digested
- Gray tan stool indicates..
- obstructive jaundice
- pale yellow greesy stool indicates..
- increased fat content/occurs w/ malabsorption syndrom
- steatorrhea is..
- increased fat content of stool
- In the newborn, a patent rectum can be confirmed by..
- passage of stool (meconium) w/in the first 24 to 48 hrs of birth
- How should the anus of infants and children be palpated?
- they should not be, unless history or symptoms warrant. If so, then use the fifth finger w/ the child on his or her back w/ legs flexed
- Onset of menarche at 16 or 17 years old indicates
- an endocrine problem
- pain w/ menstruation is called...
- dysmenorrhea
- abesent period (or menses) is called
- amenorrhea
- why should the examiner begin w/ menstrual history before the female gynecological exam?
- it is non threatening
- what does clotting indicate during period?
- heavy flow or vaginal pooling
- Gravida is
- number of pregnancies
- number of births is...
- para
- perimenopausal period is from age
- 40-50
- maternal ingestion of DES causes ...
- cervical and vaginal abnormalities in female offspring
- Initially, before the vaginal exam, the woman should be sitting...
- up. an equal status position is important to establish trust and rapport
- What position should the woman be placed in for vaginal exam
- lithotomy position. body supine, feet in stirrups, knees apart, and buttocks at edge of exam. table
- Why should the woman's arms not be abover her head during a vaginal exam?
- it causes abdominal muscle tightness
- Where should people the woman brings into the exam with her sit?
- by her head for privacy
- hair distribution on the female genitalia should be in the shape of...
- an inverted triangle
- what does the perineum normally feel like?
- it feels thick, smooth, and muscular in the nulliparous woman, and thin and rigid in the multiparous woman
- What special needs does the adolescent girl need for genital exam?
- mother shouldn't be present. The girl should be taught self examination techniques
- when is a pelvic examination indicated for an adolescent girl?
- when contraception is desired when the girl's sexual activity includes intercourse, or at age 18 virgins
- during the bimanual axamination, what should not be palpable for an adolescent girl?
- the adnexa