SUNY Downstate College of Nursing – Health Assessment & Differential Diagnosis Exam 1 | Complete Study Guide | 100% Updated 2025–2026.

SUNY Downstate College of Nursing Health Assessment and Differential Diagnosis Spring 2026 Exam #1 Study Guide. General Survey, history Be well versed in the components of a health history (i.e. CC, HPI, PMH, PSH, Social, Family, ROS, PE etc). What do they mean Components of the Comprehensive Health History: Identifying Data - Identifying data - such as age, gender, occupation, marital status Source of the history - usually the patient, but can be a family member or friend, letter of referral, or the clinical record. Reliability - Varies according to the patient’s memory, trust, and mood. Chief Complaint (CC) -The one or more symptoms or concerns causing the patient to seek care; “quote patient” and can include duration of complaint. History of Present Illness (HPI) - Amplifies the Chief Complaint; describes how each symptom developed includes patient’s thoughts and feelings about the illness; Pulls in relevant portions of the Review of Systems, called “pertinent positives and negatives.” Signs (objective) and symptoms (subjective) including duration. Includes 7 attributes (OLD CARTS) May include medications, allergies, and tobacco use and alcohol, which are frequently pertinent to the present illness; VS H&P (full history and physical; not centered around a complaint) Past History (PMH) - Lists childhood illnesses. Lists adult illnesses with dates for events in at least four categories: medical (DM, HTN), surgical (DATE, TYPE OF SURGERY), obstetric/gynecologic (BIRTH CONTR, SEX FUNCT, MENSTR.), and psychiatric (HOSPITALIZ, TREATMENT, DIAGNOSIS); Includes health maintenance practices such as immunizations, screening tests, lifestyle issues, and home safety; Family History - Outlines or diagrams age and health, or age and cause of death, of siblings, parents, and grandparents; Documents presence or absence of specific illnesses in family, such as hypertension, diabetes, or type of cancer. Personal and Social History - describes educational level, family of origin, current household, personal interests, and lifestyle (DIET, EXERCISE, RELIGION) Review of Systems (ROS) - Documents presence or absence of common symptoms related to each of the major body systems. “YES/NO” QUEST FROM HEAD TO TOE OLD CARTS, or Onset, Location, Duration, Character, Aggravating Factors, Relieving Factors, Treatments, Severity Where would data go in the health history?: Be prepared to know where in the health history a patient statement or piece of health information would go. Example: (1) A patient who already had a colorectal screening (colonoscopy) would have that test and results listed in the ‘screening’ section of H&P. If they have never had a colonoscopy, but it is appropriate to start colorectal screening at their age, include it in the ‘health maintenance’ section. Understand the rationale for completing health histories on a patient (i.e. Why is this important?) This is the important framework for organizing the patient’s story into various categories pertinent to the patient’s present, past, and family health. By knowing the content and relevance of the different components of the comprehensive health history, you are able to select the elements most pertinent to the visit and shared goals for the patient’s health. (Chapter 2) Obtain subjective info from patient based on CC, be able to perform an assessment and ask ROS questions based on history, be able to diagnose patient properly Be able to differentiate subjective from objective data · Know the stages of a physical exam Inspection- Close observation of the details of the patient’s appearance, behavior, and movement such as facial expression, mood, body habitus and conditioning, skin conditions such as petechiae or ecchymoses, eye movements, pharyngeal color, symmetry of thorax, height of jugular venous pulsations, abdominal contour, lower extremity edema, and gait. Palpation- Tactile pressure from the palmar fingers or fingertips to assess areas of skin elevation, depression, warmth, or tenderness, lymph nodes, pulses, contours and sizes of organs and masses, and crepitus in the joints. Percussion- Use of the striking or plexor finger, usually the third, to deliver a rapid tap or blow against the distal pleximeter finger, usually the distal third finger of the left hand laid against the surface of the chest or abdomen, to evoke a sound wave such as resonance or dullness from the underlying tissue or organs. This sound wave also generates a tactile vibration against the pleximeter finger. Auscultation- Use of the diaphragm and bell of the stethoscope to detect the characteristics of heart, lung, and bowel sounds, including location, timing, duration, pitch, and intensity. For the heart, this involves sounds from closure of the four valves, extra sounds from blood flow into the atria and ventricles, and murmurs. Auscultation also permits detection of bruits or turbulence over arter144ial vessels; BUT for the MSK exam we use IPROMS (I promise..), which includes Inspection, Palpation of bony structures and related joint and soft tissue structures, assessment of ROM, and Special maneuvers to test specific movements. For abdominal examination we use: inspection, auscultation, palpation, and percussion. ^ Reason for this is that we could alter the current abdominal sounds by palpation or percussion before auscultating. · Understand how to create a therapeutic environment with a patient Empathetic responses, listening, naming, respecting, draping/chaperone, announce what you are going to do before you do it, move head to toe etc Skin: · Understand common skin and hair assessment techniques Skin turgor, pull test To examine the hair for shedding from the roots, perform a hair pull test by gently grasping 50 to 60 hairs with your thumb and index and middle fingers, pulling firmly away from the scalp. If a few hairs come out, this is normal. If all the hairs have telogen bulbs, the most likely diagnosis is -- Hair shedding at the roots is common in telogen effluvium and alopecia areata. To examine the hair for fragility, perform the tug test by holding a group of hairs in one hand, pulling along the hair shafts with the other; if any hairs break, it is abnormal. Most (97%) hair loss is nonscarring, but any scarring, namely shiny spots without any hair follicles on close examination with a magnifying glass, should prompt referral to dermatology for scalp biopsy. Hair breaks along the shaft suggest damage from hair care or tinea capitis. Possible internal causes of diffuse non-scarring hair shedding in young women are iron deficiency anemia and hyper- or hypothyroidism. Be prepared to identify types of primary and secondary lesions including their defining characteristics: Primary lesions: • Flat: • Flat and less than 1 cm = MACULE Examples: freckles, flat moles, and port-wine stains and the rashes of rickettsial infections, rubella, and measles.3 • Flat and 1 cm = PATCH • Raised: • Palpable with eyes closed, 1 cm and NOT fluid filled = PAPULE - solid Examples include nevi, warts, lichen planus, insect bites, seborrheic keratoses, actinic keratoses, some lesions of acne, and skin cancers. • Palpable, 1 cm and Not fluid filled = PLAQUE A plaque is a large flatter elevation of the skin, sometimes formed by papules coalescing. Lesions of psoriasis and granuloma annulare commonly form plaques. • Palpable, 1 cm and filled with fluid = VESICLE Vesicles are characteristic of herpes infections, acute allergic contact dermatitis, and some autoimmune blistering disorders such as dermatitis herpetiformis. • Palpable, 1 cm and filled with fluid = BULLA Classic autoimmune bullous diseases include pemphigus vulgaris and • Other primary lesions include: Erosions: Skin erosion is a loss of some or all of the epidermis (the outer layer) leaving a denuded surface. Erosion is an eating away of a surface. Ulcers: A skin ulcer is an open wound that develops on the skin as a result of injury, poor circulation, or pressure. Skin ulcers can take a very long time to heal. If left untreated, they can become infected and cause other medical complications Nodules: nodules are a growth of abnormal tissue. Nodules can develop just below the skin. They can also develop in deeper skin tissues or internal organs. Dermatologists use nodules as a general term to describe any lump underneath the skin that's at least 1 centimeter in size. A nodule is a solid elevation of the skin 1 cm in diameter that extends into the deeper skin layers. Examples include cysts, lipomas, and fibromas. Ecchymoses: bruising on the skin Petechiae: pinpoint, round spots that appear on the skin as a result of bleeding. The bleeding causes the petechiae to appear red, brown or purple. usually flat to the touch, petechiae don't lose color when you press on them. Purpura: occurs when small blood vessels burst, causing blood to pool under the skin. This can create purple spots on the skin that range in size from small dots to large patches. Pustule is a small circumscribed elevation of the epidermis filled with purulent fluid (a pimple containing pus). Pustules are common in bacterial infections and folliculitis. Wheal is a circumscribed, raised lesion consisting of dermal edema and is also known as hives or urticaria. Wheals typically last 24 hours. Wheals are a common manifestation of hypersensitivity to drugs; stings or bites; autoimmunity; and, less commonly, physical stimuli including temperature, pressure, and sunlight. Secondary lesions happen on top of primary lesions: Scales: the loss of the outer layer of the epidermis in large, scale-like flakes. ex) peeling skin from sunburn Crust: A dried exudate on the skin surface, either serum, blood or pus or a combination. Crusts are commonly seen in diseases with a pustular component (eg canine pyoderma, pemphigus foliaceus), and where the exudate from erosions and ulcers dries on the surface of the lesion. Excoriation: Excoriations or itchy, small, red maculo- papules , suggest pediculosis pubis (lice or “crabs”), often found at the bases of the pubic hairs. *** Excoriation can also occur just by scratching - if somebody is itching and scratches a rash to the point where it opens, it is an excoriation. Usually broken skin, possibly with dried fluids (from the WBC’s that leaked out at the point of opening). Fissure: cutaneous condition in which there is a linear-like cleavage of skin, sometimes defined as extending into the dermis. • Lichenification: thickening of the skin related to persistent rubbing or itching of an area that occurs over an extended period of time Comedo: acne. Open comedo: blackheads (open to the surface), closed comedo: whitehead Milium: A small cyst containing keratin. They present as pearly white bumps under the surface of the skin. Telangiectasia: dilated blood vessels due to pregnancy, advanced age, genetics, sun exposure, or varicose veins Scar: is an area of fibrous tissue that replaces normal skin after an injury. Scars result from the biological process of wound repair in the skin, as well as in other organs and tissues of the body. Atrophy: loss of muscle due to immobility, not using the muscle, etc. Know the ABCDEFG’s of skin cancer assessment: • A for asymmetry. B for irregular borders, especially ragged, notched or blurred • C for variation or change in color, especially blue or black • D for diameter ≥6 mm or different from other moles, especially changing, itching, or bleeding • E for elevation, enlargement and evolving F for firmness G for growing progressively over several weeks · Recognize common skin manifestations and their characteristics (examples include but NOT limited to contact dermatitis, atopic dermatitis, shingles, acne, psoriasis, etc) Shingles (herpes zoster) - pain and tingling sensation in one dermatome (limited area on one side of the face, back, abdomen) followed by a cluster formation of vesicles. Varicella (chickenpox) - highly contagious disease caused by the initial infection with varicella zoster virus (VZV). The disease results in a characteristic skin rash that forms small, itchy blisters, which eventually scab over (usually affects children). Although shingles and chickenpox are caused by the same virus, they are not the same illness. Chickenpox is usually a milder illness that affects children. Shingles results from a reactivation of the virus long after the chickenpox illness has disappeared. The chickenpox virus stays in the body even after recovery. Atopic dermatitis (eczema) - chronic & recurring condition, skin is red, itchy and most often appears as patches on the hands, feet, ankles, neck, upper chest, scalp, arms, popliteal and antecubital folds. Ill-defined, scaly, lichenified and/or exudative eruption. Acute: widespread redness with weeping, either diffusely or in discrete plaques. Chronic: skin is dry, leathery, lichenified. Contact dermatitis - due to exposure to irritant/allergen, confined to the local area where exposure happened, a well-demarcated red patch with a glazed surface but there may be swelling, blistering and scaling of the damaged area. It can be very itchy with pain. Acne - open and closed comedones is hallmark sign, papulopustules, nodules, cysts, raised lesions, inflammation and erythema. Acne occurs when your hair follicles become plugged with oil and dead skin cells. It causes whiteheads, blackheads or pimples. Acne is most common among teenagers, though it affects people of all ages. Psoriasis - chronic but benign immune mediated skin condition, characterized by raised red plaques on the skin that may be covered with silvery/white papules; skin that is cracked & bleeding; skin alterations on but not limited to the lower back, elbows, knees, legs, soles of feet, scalp, face and palms with + dry scaling spots. Pitting of fingernails is also suggestive of psoriasis. Scabies I · Understand common age-related changes in the skin Skin gets thinner, less elasticity, age spots, senile/actinic purpura (easy bruising)... The Skin wrinkles becomes lax (loose) and loses its turgor. Dermis is less vascular, which causes skin to look paler and more opaque Skin on the backs of hands and forearms appears thin, fragile, loose, and transparent. Possible presence of actinic purpura from loose unsupported capillaries. (Page 958). HEENT: · Understand how to assess the external eye: -Place yourself directly in front of the patient. Assess eyebrows for quantity and distribution. -check the width of the palpebral fissures (the separation of the lower and upper eyelids). This is altered in genetic syndromes such as down syndrome. -Check the condition and direction of the eyelashes. (should be facing upwards) -Check for lid lag (when the upper lid is in a static situation that is higher than normal with the gaze facing downward.) connected to hyperthyroidism. -Press on the lacrimal gland and check for swelling Check the conjunctiva and sclera for discoloration, vascular pattern by asking the patient to look up while the HCP depresses the lower lid with their thumb. Check the cornea and lens for opacities Assess the iris for clearly defined borders with no opacities Check for PERRLA · EOMI, Pupil response, convergence, visual fields, and the rationale for doing these tests Extraocular movement intact. Testing extraocular muscles conjugate movements through the 6 cardinal directions of gaze (Tests CN III (movement of R eye) & IV (movement of L eye). Any deviations may signal brain tumor or injury. Lead the patient in an H gaze and convergence. Nystagmus: fine rhythmic oscillation of the eyes on lateral gaze. Sustained with neurological conditions. Test for corneal light reflex test for balance of extraocular muscles. Normally light is reflected symmetrically. Pupillary response to light tests CN II (optic nerve) and CN III (Oculomotor nerve). Visual fields. You will screen both eyes at the same time for peripheral visual fields. Defects may detect dysfunction in central and peripheral vision which may be caused by various medical conditions such as glaucoma, stroke, pituitary disease, brain tumor or other neurological deficits. If the near reaction hasn’t already been tested, test for convergence. The converging eyes normally follow the object within 5 cm to 8 cm of the nose. e · Be prepared to discuss common and abnormal findings for external and internal eye exam Catching the red light reflex with ophthalmoscope - absence of red flex suggests an opacity of the lens (cataract). ● Abnormal findings: Papilledema (indicates elevated ICP, Meningitis, SAH); ● Cotton wool patches (indicates diabetic and hypertensive retinopathy); ● Proptosis/exophthalmos -abnormal protrusion of the eyeballs seen in pt with hyperthyroidism · Understand the Snellen chart and how to interpret the results Patient stands 20 feet away. Wears corrective lenses. Test one eye at time. The patient’s vision score is the smallest line of print from. Which patient can identify ½ the letters. Example 20/40 vision means that the patient sees in 20 feet what a person with a normal vision sees at 40 feet. A patient is legally blind with a vision score of 20/200. · Understand the Weber and Rinne test and the rationale for their use Helpful video: Understand the normal external and internal ear exam and abnormal findings Normal eardrum is pearly grey Abnormal findings- otitis externa (ear canal is swollen, narrow, moist, pale & tender - movement of auricle and tragus “tug test” produces pain *hallmark sign), otitis media (red building eardrum), exostosis (non malignant overgrowths in ear drum) · Be prepared to discuss the importance of oral health and its link to systemic disease 1. The oral cavity is where the first stages of digestion begin 2. There is a link between oral health and cardiovascular health 3. Crooked, misaligned or missing teeth can have a negative impact on speech and the ability to eat Know the lymph nodes : [go to HEENT lecture rec, skip to 1:38:30 and prof shows the landmarks there] The physical Assessment of the Neck • Inspect : Symmetry, masses, scars, enlarged glands or lymph nodes • Trachea – position, alignment •Thyroid gland - symmetry. • Watch patient swallow • Palpate: for deviation, masses, pain • Auscultate: will talk more about this in cardiovascular assessment Common or concerning symptoms: • Enlarged lymph nodes • Goiter • Change in voice quality • Changes in ability to swallow • Masses or scars • Asymmetry: tracheal deviation Examining the Thyroid: -Flex neck slightly back -Place fingers of both hands below the cricoid cartilage. -Ask pt to swallow and feel thyroid isthmus rise up under your fingers -Displace trachea to R to palpate R lobe of thyroid. Repeat for L lobe -If enlarged, listen for bruit -Thyroid isthmus may not always be palpable P - Be prepared to identify common illnesses that are seen in the primary care setting in the HEENT system Conjunctivitis (bacterial, viral, allergy/irritation) “Pink eye”, diffuse dilation of conjunctival vessels with redness. Discharge can be watery, mucoid or mucopurulent. HIGHLY CONTAGIOUS Sinusitis Headache, facial pain and pressure on palpation of frontal & maxillary sinuses, nasal discharge - nasal discharge is prominent in sinusitis because the mucous membrane of the nose and sinuses are attached. The drainage can be cloudy or colored green or yellow, thick, blood-tinged and foul-smelling. This increase in discharge is why people need to blow their nose consecutively. Incase discharge trickles down the throat it may cause an unpleasant taste in the mouth and an itching sensation at the back of the throat which is referred to as a post-nasal drip. nasal congestion, distorted sense of smell URI Runny nose, nasal congestion, sneezing, cough and mucus production are hallmark sx Sore throat, HA, generalized malaise Group A strep (GAS) pharyngitis Systemic ℅ (fever 100.4, anterior cervical lymphadenopathy), tonsillar exudate, HA, sore throat, absence of cough Musculoskeletal: Examination: IPROMS (“I promise…”), which includes Inspection, Palpation of bony structures and related joint and soft tissue structures, assessment of Range Of Motion, and Special maneuvers to test specific movements. Know the types of joints: Synovial, Cartilaginous, and Fibrous. - Synovial: freely movable. Ex: shoulder, knee. - Cartilaginous: slightly movable. Ex: vertebral bodies of the spine. - Fibrous: no appreciable movement. Ex: suture of the skull. + Differentiate OA from RA: Helpful video: Causes of polyarthritis/pain in more than 4 joints include viral or inflammatory from RA. Pain In RA, the pattern is additive and progressive with symmetric involvement, immune-related. OA - Noninflammatory disorder.- Wear and tear (degenerative - Worse at night) In inflammatory joint disorders (e.g., RA), rest tends to worsen the pain, whereas activity improves it. In mechanical joint disorders (e.g., OA), activity tends to increase the pain and stiffness, and rest improves the symptoms. Low-grade fever can be present in crystal-induced arthritis or inflammatory arthritis like RA - typically polyarticular and symmetrical (Systemic Autoimmune - Worse in Morning) Yes NSAIDS Stiffness lasting more than 1 hour represents severe inflammation commonly seen in RA and PMR. Morning stiffness that gradually improves with activity is more common in inflammatory disorders like RA and PMR.7–9 Intermittent stiffness or gelling that worsens over the course of the day is commonly seen in OA. Look for subcutaneous nodules in RA or rheumatic fever, effusion in trauma, and crepitus over inflamed joints in OA or over the inflamed tendon sheaths of tenosynovitis. Redness over a tender joint suggests acute inflammation of the joint or synovium, like in septic, crystal-induced, or rheumatoid arthritis. Diffuse tenderness and warmth over a thickened synovium suggest arthritis. Know your special maneuvers/tests for each joint, know how to perform them, and why they are done: Lachman stress test: for anterior cruciate ligament (ACL) Lachman Test. Place the knee in 15° of flexion and mild external rotation. Grasp the distal femur on the lateral side with one hand and the proximal tibia on the medial side with the other. With the thumb of the tibial hand on the joint line, forcefully and simultaneously pull the tibia forward and the femur back. Estimate the degree of forward excursion. There should be a firm endpoint to any forward movement. Lack of a firm endpoint with excessive movement may indicate the ACL is no longer intact. Anterior drawer sign : ACL/Anterior Cruciate Ligament test Anterior Drawer Sign. With the patient supine, hips flexed, and knees flexed to 90° and feet flat on the table, cup your hands around the knee with the thumbs on the medial and lateral joint line and the fingers on the medial and lateral insertions of the hamstrings. Sit on the patient’s foot to ensure it does not move during the maneuver. Draw the tibia forward and observe if it slides forward (like a drawer) from under the femur. Compare the degree of forward movement with that of the opposite knee. The knee should have a firm endpoint with minimal movement. Lack of a firm endpoint with excessive movement may indicate the ACL is no longer intact. Posterior drawer sign: PCL/Posterior Cruciate Ligament test Mcmurray’s test: lateral meniscus test (internal rotating) and medial collateral ligament test (external rotating) Valgus test: medial collateral ligament/MCL Varus test: lateral collateral ligament/LCL Adduction (or Varus) Stress Test. With the thigh and knee in the same position, change your position so that you can place one hand against the medial surface of the knee and the other around the lateral ankle. Push laterally against the knee and pull medially at the ankle to open the knee joint on the lateral side (varus stress). Feel for excessive widening of the joint and lack of endpoint that may signal the ligament is no longer intact. The special maneuvers of specific joints that can help identify common pathologic conditions, to evaluate underlying mechanisms of a patient's symptom, often pain, or an underlying structural abnormality such as a joint laxity or weakness. · Be prepared to identify common manifestations that are seen in the primary care setting in the MSK system Gout, arthritis, plantar fasciitis, bunion, rotator cuff tear, efusion, polymyalgia rheumatica, ● Gout - inflammatory reaction to microcrystals of monosodium urate, common locations is the base of the big toe (first MTP joint - 50% of cases), ankle, knees, elbows and instep of dorsa of the feet. Early attacks confined to one joint, sudden onset, often at night. Joint will be painful, tender, hot and dusky red. 3 ● Polymyalgia rheumatica - disease of unclear etiology in people over 50 y/o especially women, affects muscles of the hip, shoulder and neck symmetrically. ● Hallux Valgus (bunion)- enlargement of the head of the first metatarsal on its medial side, forming a bursa or bunion. Bursa may become inflamed, women 10 x more affected than men. ● Plantar Fasciitis - common cause of primary care visits for heel pain For every joint, look up a pathology In general: · Make sure you can identify appropriate review of systems questions for each system we have covered so far Fall, trauma... · KNOW YOUR BASIC ANATOMY For students in Differentials, follow the above and also: · Please be familiar with the differential diagnoses presented in class by your colleagues (presentations are posted on BB). Any diagnosis presented last week or this week is fair game for inclusion on the exam · The exam will be presented in a more case study type format but the differentials will be differentials seen in primary care. Know the presentation of the differential diagnoses discussed in the health assessment lectures · Know common presentations for differentials for each system. Some we have discussed and some are in your textbook (this not an exhaustive list) SKIN: skin cancers (BCC, SCC, Melanoma) Skin CA is the most common CA in the US; most prevalent on hands, face, neck HARMM risk factors for melanoma: ● History of previous melanoma ● Age over 50 ● Regular dermatologist absent ● Mole changing ● Male gender Additional risk factors for melanoma: ● ≥50 common moles ● ≥1-4 atypical or unusual moles (especially if dysplastic) ● Red or light hair ● Actinic lentigines, macular brown or tan spots (usually on sun exposed areas) ● Heavy sun exposure (especially severe childhood sunburns) ● Light eye or skin color (especially freckles/burns easily) ● Family history of melanoma atopic dermatitis, psoriasis, rosacea Rosacea - broken blood vessels, usually in the face, resembles acne Varicella (chickenpox - VZV) - a highly contagious viral infection causing an itchy, blister-like rash on the skin VARICELLA = CHICKEN POX OR SHINGLES Acne contact dermatitis Senile purpura Phenomenon is so-called “senile purpura,” which is seen in patients over age 65 years . Senile purpura are non-palpable, purple bruises with small red patches that fade to brown over a span of a few weeks. They are found on the forearms and legs due to loss of subcutaneous tissue with aging. Psychogenic purpura is a rare and poorly understood clinical presentation of unexplained painful lesions, mostly on the extremities and/or the face, and is virtually always associated with psychiatric illness. (info from up-to-date) Seborrheic keratoses mHEENT: GAS pharyngitis: Strep Group A Streptococcus- Classic signs and symptoms of GAS pharyngitis include acute-onset sore throat, fever, pharyngeal edema, patchy tonsillar exudates, and prominent, tender, anterior cervical lymphadenopathy. Other features that support the diagnosis include palatal petechiae, a scarlatiniform rash, and a strawberry tongue (eg, Scarlet fever). Occurrence in a younger adult and exposure to others with GAS pharyngitis also make the diagnosis more likely. URI (bacterial vs viral): viral vs bacterial conjunctivitis: head and neck cancer: Don't need to know specific ones as per review however important to know that many cancers can form in the HEENT system. Common areas to check in the oral cavity: buccal mucosa, sides of the tongue, roof and base of the mouth . Sinusitis: otitis media: Glaucoma: Cataracts: Laryngitis: peritonsillar abscess: Erythema and asymmetric enlargement of one tonsil, pain and lateral displacement of the uvula (p.875, 12th ed). influenza: MSK: Polymyalgia rheumatica: Unclear in etiology, women older than 50, overlaps with giant cell arteritis, common location: hip, shoulder, neck. Onset of pain is insidious or abrupt, even appearing at night, stiffness prominent in the morning Rheumatoid arthritis: Autoimmune, symmetric involvement of joints, pain is worse in the morning and improves throughout the day, can be associated with systemic symptoms such as fever & malaise, warmth and redness noted in the affected joints, affects primarily the PIP & MCP joints and the wrists. Chronic RA can lead to ulnar deviation, “swan neck” deformities in the hand and less commonly boutonnieredeformity. Osetoarthritis: Not autoimmune - degenerative and related to overuse of the joints, asymmetrical joint pain, primarily affects DIP joints, occurs in older age, pain is worse throughout the day when the joint is used in daily activities compared to morning, no warmth, enlargement of the affected joint not associated w/systemic symptoms like fever etc.. Gout: CTS: Carpal tunnel syndrome (CTS) is a medical condition due to compression of the median nerve as it travels through the wrist at the carpal tunnel. The main symptoms are pain, numbness and tingling in the thumb, index finger, middle finger and the thumb side of the ring finger. Tests for carpal tunnel syndrome: Tinel's sign, or Phalen's maneuver Helpful video about CTS tests: Sciatica: Pain radiating along the sciatic nerve, which runs down one or both legs from the lower back. It's usually caused when a herniated disk or bone spur in the spine presses on the nerve. Pain originates in the spine and radiates down the back of the leg. Sciatica typically affects only one side of the body. Positive straight leg raise test is indicative of sciatica Positive crossed straight leg raise test is indicative of disc herniation in lumbosacral region (opposite leg raised) plantar fasciitis: De Quervain’s tenosynovitis A painful condition affecting the tendons on the thumb side of the wrist.Repetitive hand or wrist movements can make the condition worse.The main symptoms are pain and tenderness in the wrist, often below the base of the thumb.Treatment may include medication, physical therapy, or in rare cases surgery. Treatment is generally successful when begun early. *Positive Finklestein test is indicative of De Quervain's Tenosynovitis hallux valgus: This is a bunion. Hallus = Big toe Valgus = displacement away from the midline. Tendonitis: rotator cuff tear: Drop arm test - positive test is indicative of rotator cuff tear Neer Impingement Test - positive test is indicative of rotator cuff impingement swimmer’s shoulder: shoulder impingement, is a condition where swimmers often aggravate their shoulders while they swim due to the constant joint rotation Cauda equina syndrome - Medical emergency; caused by damage to the bundle of nerves below the end of the spinal cord known as the cauda equina or “horse tail” - Symptoms vary in intensity and may evolve slowly over time. The patient may exhibit an unusual gait pattern, bladder and/or bowel dysfunction, urinary retention, severe or progressive problems in the lower extremities, including loss of or altered sensation between the legs, over the buttocks, along the inner thighs known as “saddle anesthesia” as well as the back of the legs and feet. - example of saddle anesthesia. QUIZ QS 1. What does HPI stand for? a. History of present illness b. History and physical exam c. History of present exam d. Review of systems 2. What does the “D” stand for in OLD CARTS? a. Diagnosis b. Duration c. Differential d. Demeanor 3. Which of the following is an example of subjective data when performing a history and physical (H&P)? a. HbA1c 5.8 b. BP 120/80 c. Chest pain d. Lymphadenopathy 4. Which of the following is an example of a screening tool for alcohol use? a. Social history b. CAGE c. OLD CARTS d. OPQRST 5. Which of the following APPs would you use for age based screenings? a. Epocrates b. UpToDate c. CDC d. United states preventive services task force (USPSTF) 6. The Nurse Practitioner student shows good understanding of describing skin lesions using the “ABCDE” method when they state: a. The “A” stands for asymmetry b. The “B” stands for background c. The “C” stands for consistency d. The “D” stands for dimension 7. The difference between a vesicle and a bulla is: a. A vesicle has no fluid b. A vesicle is a large flat elevation of the skin c. A vesicle is 1cm in diameter d. A vesicle is 1cm in diameter 8. Which if the following is not a risk factor for the development of melanoma? a. Light hair and eyes b. Severe sunburn in childhood c. 1-4 dysplastic moles d. Female gender 9. A very common type of hair loss in men and women is: a. Actinic Lentigines b. Androgenetic alopecia c. Contact dermatitis d. Tinea pedis 10. The NP assesses a pt’s feet and finds nail thickening and subungual debris. The NP is concerned for a nail fungus. Which term is this likely called? a. Beau lines b. Onychomycosis c. Osteoporosis d. Comedo 11. "Red flag" or concerning signs of the oral/ throat assessment include all of the following except: a. Changes in voice quality (tone, hoarseness, quality, volume) b. Masses c. A midline Uvula d. Asymmetry 12. The NP performs a vision screening on a patient using the Snellen chart. The result is 20/40 in both eyes. The NP understands this means that: a. The pt is legally blind b. The pt sees at 20ft what a person with normal vision sees at 40ft c. The pt sees at 40ft what a person with normal vision sees at 40ft d. The pt should be referred immediately to an eye dr. 13. A patient states that they have noted nasal congestion and sinus tenderness for the past 2 days. The NP has a good understanding of how to assess the sinuses when they palpate: a. The occipital and inguinal sinuses b. The axilla and carotid sinuses c. The frontal and maxillary sinuses d. The temporal and ventricular sinuses 14. Educating patients on good oral hygiene is important because: a. There is a link between good oral hygiene and cardiovascular health b. Crooked, misaligned, or missing teeth can have a negative impact on speech and the ability to eat c. The oral cavity is where the first stages of digestion begin d. All of the above are correct 15. When performing a Rinne test, the NP knows that: a. Air conduction should be greater than bone conduction b. Air conduction should be less than bone conduction c. Air conduction and bone conduction should be equal d. The Rinne is not a test for conduction