Nr 509 / Nr509 Final Exam. Questions With 100% Correct Answers.

Know the best way to examine the lateral portion of the breast Ask the patient to roll onto the opposite hip, placing her hand on her forehead but keeping the shoulders pressed against the bed or examining table. This flattens the lateral breast tissue. Begin palpation in the axilla, moving in a straight line down to the bra line, then move the fingers medially and palpate in a vertical strip up the chest to the clavicle. Continue in vertical overlapping strips until you reach the nipple, then reposition the patient to flatten the medial portion of the breast. Know what functional syndrome is has been applied to several related syndromes characterized more by symptoms, suffering, and disability, than by consistently demonstrable tissue abnormality. Examples include IBS, fibromyalgia, chronic fatigue, TMJ disorder, and multiple chemical sensitivity. Have been shown to "frequently co-occur and share key symptoms and selected objective abnormalities." The co-occurrence rates for IBS, fibromyalgia, chronic fatigue, TMJ disorder, and multiple chemical sensitivity reach 30-90%, depending on the disorders compared. The prevalence of symptom overlap is high, name complaints of fatigue, sleep disturbance, musculoskeletal pain, HA, and GI problems. Also overlap in rates of functional impairment, psychiatric comorbidity, and response to cognitive and antidepressant therapy. Internal hemorrhoid enlargements of the normal vascular cushions located above the pectinate line, usually not palpable. May cause bright red bleeding, especially during defecation. They may also prolapse through the anal canal and appear as reddish, moist, protruding masses. Polyps of the rectum fairly common and variable in size and number, they can develop on a stalk (pedunculated) or lie on the mucosal surface (sessile). They are soft and may be difficult or impossible to feel even when in reach of the examining finger. Endoscopy and biopsy are needed for differentiation of benign from malignant lesions. Cancer of the rectum usually firm, nodular, rolled edge. Know what causes a split S2 During inspiration the right heart filling time is increased, which increases right ventricular stroke volume and the duration of right ventricular ejection compared with the neighboring left ventricle. This delays the closure of the pulmonic valve, P2, splitting S2 into its two audible components. Can be heard at the 2nd and 3rd left intercostal spaces close to the sternum. Postural color changes of chronic arterial insufficiency if pain or diminished pulses suggest arterial insufficiency, consider looking for postural color changes using the Buerger test. Raise both legs to about 90 degrees for up to 2 min until there is maximal pallor of the feet. Then ask the patient to sit up with legs dangling down, compare both feeling noting the time required for: -Return of pinkness of the skin, normally about 10 sec or less -Filling of the veins of the feet and ankles, normally about 15 Know the causes of increased jugular venous pressure Elevated JVP is highly correlated with both acute and chronic heart failure. It is also seen in tricuspid stenosis, chronic pulmonary hypertension, SVC obstruction, cardia tamponade, and constrictive pericarditis