NBCE - Chiropractic Boards Part 2 & 3 Irene Gold Exam 100% Correct

Normal *oral temperature* - Answer 98.6 F Normal *rectal and tympanic temperature* - Answer 99.6 F Normal *axillary temperature* - Answer 97.6 F Normal *temperature range* - Answer 96.0-99.5 F or 35.0- 37.5 C Normal *adult pulse* - Answer 60-100 bpm Normal *newborn pulse* - Answer 120-160 Normal *elderly pulse* - Answer 70-80 bpm Normal *adult respiratory rate* - Answer 14-18 cycles per minute Normal *newborn respiratory rate* - Answer 44 cycles per minute Normal *adult blood pressure* - Answer 90-120/60-80 Hypertension values - Answer over 140/90 Hypotension values - Answer under 90/60 *Adie's pupil* - Answer *Sluggish pupillary reaction to light* that is *unilateral* and caused by a *parasympathetic lesion of CN III* *Anisocoria* - Answer *Unequal pupil size* *Argyll Robertson* - Answer *Bilaterally small and irregular pupils that accommodate but do not react to light* Seen with *syphilis*. AKA prostitute's pupil *Arroyo sign* - Answer *Sluggish pupillary reaction do due hypo-adrenalism*. Associated with *Addison's disease* *Blepharitis* - Answer *Inflammation of the eyelid* seen with *seborrhea, staph infection, or inflammatory processes* *Cataracts* - Answer *Opacities seen in the lens* and also has an *absent red light reflex* commonly seen in with *diabetes* and in the elderly, *Chalazion* - Answer An *infection of the meibomian gland causing a nodule which points inside the lid* *Conjunctiva* a) pink = ____ b) pale = _____ c) red = ____ - Answer Conjunctiva: a) pink = normal b) pale = anemia c) red = infection *Corneal arcus*: a) what is it b) < 50 years old c) over 50 years old - Answer a) *Grayish opaque ring around the cornea* b) *hypercholesterolemia* c) *normal* *Diabetic retinopathy:* a) affects _____ b) presents with ____ - Answer a) Affects the *veins* more than arteries b) presents with *micro aneurysms, hard exudates, and neovascularization* *Extropion* - Answer *Lid is turned outward* most commonly seen in the *elderly* *Entropion* - Answer *Lid is turned inward*, most commonly seen in the *elderly* *Exophthalmos* a) what is it b) bilateral = ____ c) unilateral = _____ - Answer *Lid lag/ failure to cover the eyeball*, can be seen bilaterally with *Graves' disease* unilaterally with *tumor* *Glaucoma* a) what is it b) what will patient notice c) what sign is present - Answer *Increased intraocular pressure causing cupping of the optic disc* The *patient will notice blurring of their vision especially in the peripheral fields* as well as *rings around lights* *Crescent sign* will be present upon tangential lighting of the cornea *Normal cup to disc ratio* - Answer Greater than 1:2 *Hordoleum* - Answer AKA sty *An infection of the sebaceous glands causing a pimple or boil on the eyelid* *Horner's syndrome* - Answer *Ptosis, miosis, and anhydrosis* is on the same side as an interruption to the cervical sympathetics *Hypertensive retinopathy* a) what is it b) what signs - Answer *Damage to the retinal vessels/ background* will show these signs: copper wire deformity silver wire deformity A-V nicking flame hemorrhage cotton wool soft exudates *Internal ophthalmoplegia* - Answer *Dilated pupil with ptosis and lateral deviation* *does not react to light or accommodation* associated with *multiple sclerosis* *Iritis/ uveitis* - Answer *Inflammation of the iris* associated with *ankylosing spondylitis* *Macular degeneration* - Answer *Most common reason for blindness in the elderly* *central vision lost* *macular drusen* is an early sign (yellow deposits under the retina) *Miosis* - Answer *Fixed and constricted pupils* that react to light and accommodate. Associated with *severe brain damage, pilocarpine medications, and narcotic use* *Mydriasis* - Answer *Dilated and fixed pupils* seen with *anticholinergic drugs (atropine, mushrooms/death)* *Papilledema* - Answer AKA choked disc. *Swelling of the optic disc due to increased intracranial pressure*, no visual loss. May be seen with a *brain tumor or brain hemorrhage* *Periodical edema* - Answer Swelling around the eye seen with allergies, myxedema, and nephrotic syndrome *Pinquecula* - Answer A *yellowish triangular nodule in the bulbar conjunctiva* that is harmless and indicates aging *Pterygium* - Answer *Triangular thickening of the bulbar conjunctiva that grows across the cornea* and is brought on by *dry eyes* *Ptosis* - Answer *Drooping of the eyelid* seen with conditions such as Horner's, CN III paralysis, myasthenia gravis, multiple sclerosis *Retinal detachement* - Answer *Painless sudden onset of blindness* described as curtains closing over vision, lightening flashes, and floaters are seen prior to visual loss *Sclera* a) white = _____ b) yellow = ____ c) blue = _____ - Answer Normally is white, yellow indicates jaundice, blue indicates osteogenesis imperfecta *Xanthelasma* - Answer *Fatty plaques* on the nasal surface of the eyelids that may be *normal or an indication of hypercholesterolemia* *Emmetropia* - Answer Normal vision *Myopia* - Answer Near sighted *Hyperopia* - Answer Farsighted *Presbyopia* - Answer Loss of lens elasticity due to aging *Direct Light Reflex* - Answer II and III *Consensual Light Reflex* - Answer III *Accomadation* - Answer II and III *Visual Acuity* - Answer snellen *Fields of Gaze* - Answer III, IV, VI *Acoustic neuroma* - Answer *Benign tumor of CNVIII, schwannoma* characterized by *hearing loss, tinnitus, vertigo, and presence of tumor on CT or MRI* *Acute mastoiditis* - Answer *Bacterial infection of the mastoid process* presents clinically with the same signs and symptoms as acute otitis medial with the addition of *inflammation and palpatory tenderness over the mastoid*, hearing loss is commonly associated with it *Acute otitis externa* - Answer *Infection of the outer ear*, commonly associated with *swimming* (AKA swimmer's ear), *patient experiences inflammation and pain of the outer ear*, tugging on the *pinna will be painful* *Benign paroxysmal positional vertigo* - Answer *Brief episode of vertigo brought on by a change of head position. Diagnosed by having the patient* perform the Dix-Hallpike Maneuver and treated with Epley's Maneuver *Eustachian tube block* - Answer Retraction of the tympanic membrane *Meniere's disease* - Answer Disorder characterized by *recurrent prostrating vertigo, sensory hearing loss, tinnitus, and feeling of fullness in the ear* *Presbycussis* - Answer *Sensorineural hearing loss that occurs in people as they age*, may be affected by genetic or aquired factors *Purulent Otitis Media* - Answer AKA bacterial otitis media; *bacterial or viral infection in the middle ear* *the tympanic membrane presents with a red appearance dilated blood vessels, and bulging* *Serous Otitis Media* - Answer *Effusion in the middle ear* resulting from *incomplete resolution of acute otitis media or obstruction of the Eustachian tube*. The condition is usually chronic and the fluid is *amber with bubbles* *Tinnitus* - Answer Ringing in the ears *Vertigo* - Answer Abnormal sensation of rotary movement associated with difficulty in balance, gait, and navigation of the environment Normal Hearing: a) *Weber Test* b) *Rinne Test* - Answer Normal Hearing: a) *Weber Test* equal bilaterally b) *Rinne Test* AC > BC (+) Conductive Hearing Loss: a) *Weber Test* b) *Rinne Test* - Answer Conductive Hearing Loss: a) *Weber Test* sound lateralizes to bad ear b) *Rinne Test* AC < BC or AC = BC (-) Sensorineural Hearing Loss: a) *Weber Test* b) *Rinne Test* - Answer Sensorineural Hearing Loss: a) *Weber Test* sound lateralizes to good ear b) *Rinne Test* AC > BC with less time in bad ear *Allergic rhinitis* - Answer Nasal mucosa appears *pale or blue and boggy* *Atrophic rhinitis* - Answer *Thinning of the nasal mucosa with sclerosis, crust formation, and foul odor* *Polyps* - Answer Typically occur as a consequence of *chronic inflammation of the nasal mucosa* *Viral rhinitis* - Answer *Nasal mucosa appears red and swollen with a clear runny nose* *Angular stomatitis* - Answer AKA Cheilosis; *red sores at the corner of the mouth* can be caused by a *vitamin B2 (riboflavin) deficiency* *Atrophic glossitis* - Answer Caused by a *deficiency of B vitamins (B12) or iron* that cause the *tongue to appear smooth and glossy* *Candidiasis* - Answer AKA Thrush *thick white fungal patches* that are easily scraped off *Fissured tongue* - Answer AKA scrotal tongue *deep furrows on the surface of the tongue* scraped off easily considered a normal variant *Leukoplakia* - Answer *Pre-cancerous lesion of white patches that are adherent to the surface of the tongue* and not easily scraped off *Acromegaly* - Answer *Excessive production of growth hormone* beginning in middle age; results in *abnormal growth in the hands, feet, and facial bones* *Gigantism* - Answer *Excessive production of growth hormone prior to skeletal maturity* Hyperthyroidism vs Hypothyroidism - Answer Hyper mc = autoimmune Graves Hypo mc is Hashimotos hypo congenital = cretinism (decreased mental and physical capacity) *Common migraine* 1) Age/sex 2) Site 3) Characteristics 4) Provocation 5) Lab - Answer 1) *Sex*: Female, most commonly in the reproductive years 2) *Site* unilateral or bilateral, 3) *photophobia, throbbing, nausea, sound sensitivity* 4) *provoked* by bright light, red wine, and menstration, and stress, *Classic migraine* 1) Age/sex 2) Site 3) Characteristics 4) Provocation 5) Lab - Answer 1) *Sex*: Female, most commonly in the reproductive years 2) *Site* unilateral 3) *AURA* and *photophobia, throbbing, nausea, sound sensitivity* 4) *provoked* by bright light, red wine, and menstration, and stress, *Hypertension headache* 1) Age/sex 2) Site 3) Characteristics 4) Provocation 5) Lab - Answer 1) *Sex* Adult usually overweight male 2) *Site*occiput and vertex 3) *charactersitics* complain of throbbing in the occipital area and wake up with the headache, 5) follow up by *checking blood pressure and ordering a lipid panel*, suggest weight loss *Cluster headache* 1) Age/sex 2) Site 3) Characteristics 4) Provocation 5) Lab - Answer AKA autonomic headache 1) *Sex* most commonly seen in males in their 30's 2) *site* headache is unilateral in the orbital or temporal region, 3) *characterized* by pain so intense it wakes the patient up at night, lasts 15 minutes to 3 hours, accompanied by rhinorrhea, lacrimation, sweating on half of the face, Miosis, 4) *aggravated* by alcohol, occur in clusters and are seasonal 5) follow up by referring to a neurologist *Tension headache* 1) Age/sex 2) Site 3) Characteristics 4) Provocation 5) Lab - Answer 1) Occur at any age, 2) *site* band around head 3) *characterized* by band-like pressure and muscle tightness, 4) *worsened by* fatigue, tension, stress, and work *Temporal arteritis* 1) Age/sex 2) Site 3) Characteristics 4) Provocation 5) Lab - Answer 1) Patient is over 50 years old 2) complains of a headache that is unilateral and temporal 3)persistent burning, aching, throbbing headache over one eye, 4) scalp is sensitive and arteries are tender 5) labs will show elevated ESR and CRP, special test to do is biopsy and will see giant cells *Polymyalgia Rheumatica* is _____ - Answer Headache with neck and shoulder stiffness and pain *Cervicogenic headache* 1) Age/sex 2) Site 3) Characteristics 4) Provocation 5) Lab - Answer AKA vertebrogenic 1) seen in adults, 2) pain in occipital or upper cervical region 3) decreased ROM in upper cervical and occiput 4) head movement makes headache worse, 5) do flexion/extension X-rays first, then adjust *Sinus headache* 1) Age/sex 2) Site 3) Characteristics 4) Provocation 5) Lab - Answer 2) Localized headache that changes with body position 3) a steady throb, with local tenderness over the maxillary or frontal sinuses 4) provoked by chronic sinusitis *Subarachnoid hemorrage* 1) Age/sex 2) Site 3) Characteristics 4) Provocation 5) Lab - Answer 1) any age 2) Headache with abrupt onset, pain is located in the basilar area, 3) constant and excruciating like never experienced before, stiff nec 4) provoked by hypertension, stress, or trauma, 5) this is a 911 immediate ER referral! $$$$$ Increased intracranial pressure-> papillodema *Subdural hematoma* 1) Age/sex 2) Site 3) Characteristics 4) Provocation 5) Lab - Answer 1) any age 3) Slow bleed following trauma, signs and symptoms evident days to weeks after the injury, 4) trauma 5) this is an ER referral $$$$$ Increased intracranial pressure -> papillodema *Brain tumor headache* 1) Age/sex 2) Site 3) Characteristics 4) Provocation 5) Lab - Answer 1) any age 2) any place with pain changing with body position 3) Symptoms have been occurring for a while and are progressively worsening, throbbing headache that doesn't respond to pain medication, patient has no history of high blood pressure or head trauma 5) refer for MRI and CT of brain and to a neurologist. $$$$$ Increased intracranial pressure-> papillodema Meningeal irritation headache 1) Age/sex 2) Site 3) Characteristics 4) Provocation 5) Lab - Answer 1) any age 2) Neck pain and headache, that is intense, deep pain never experienced before 3) nuchal rigidity or neck stiffness that is worse in flexion, Patient presents with fever, headache, photophobia, and nuchal rigidity. 4/5) do Kernig/Brudzinski orthos, refer to ER for CSF tap. CSF tap shows increase in protein indicating viral infection, decrease in glucose indicates bacterial infection *Hypoglycemic headache* 1) Age/sex 2) Site 3) Characteristics 4) Provocation 5) Lab - Answer Generalized headache caused by skipping meals, refer for fasting blood glucose labs *Post Concussive headache* 1) Age/sex 2) Site 3) Characteristics 4) Provocation 5) Lab - Answer Localized general pain with loss of memory, visual disturbances following a fall, motor vehicle accident, whiplash injury, or some sort of trauma, refer to a neurologist (in reality chiropractors are totally equipped to treat these patients) *Barrel chest* - Answer *AP=lateral diameter* seen with *COPD and cystic fibrosis* *Pectus excavatum* - Answer AKA funnel chest *marked depression noted in the sternum, sunken in* marfan Pectus carinatum - Answer AKA pigeon chest *forward protrusion of the sternum, like the keep of a ship* marfan and ehler danlos *Tachypnea* - Answer Rapid shallow breathing *Bradypnea* - Answer Slow breathing *Biots breathing* - Answer Characterized by groups of *quick, shallow inspirations followed by irregular periods of apnea, no pattern to breathing* *Cheyne Stokes respiration* - Answer Breathing pattern characterized by *alternating periods of apnea and hyperpnea*, it has a pattern, associated with *respiratory acidosis* *Kussmaul's breathing* - Answer Breathing is *first rapid and shallow but as metabolic acidosis worsens, breathing gradually becomes deep, slow, labored, and gasping* "air hunger breathing" Pitted nails - Answer Unguinal indentations, seen with psoriasis, *psoriatic arthritis* *Splinter hemorrhage* - Answer *Subacute bacterial endocarditis caused by a strep organism* *Beau's lines* - Answer *Transverse ridging associated* with acute *severs disease* *Paronychia* - Answer *Inflammation of the nail fold near the cuticle* *Clubbing* - Answer *Nail base has an angle greater than 180* associated with hypoxia (early), COPD (late). If see them do a heart and lung exam! *Koilonychia* - Answer Spoon nail, associated with *iron deficiency anemia*; "eat your iron with a spoon" Respiratory excursion - Answer Performed during palpation, place hands over the posterior ribs and have the patient take deep breaths Tactile fremitus - Answer Palpable vibration, have the patient say 99 repeatedly; *increased with fluid like in pneumonia* decreased with air like in emphysema and pneumothorax, decreased with atelectasis and pleurisy because a sound barrier is created Resonate - Answer Normal tone over lung tissue with percussion Hyperresonant - Answer Increased air int the chest as in *emphysema or pneumothorax*, a finding with lung percussion Dull - Answer Increased density with percussion as in *pneumonia or atelectasis* Diaphragmatic excursion - Answer Done in the percussion portion of lung exam, if less than 3-5 cm the patient may have *pneumonia or a pneumothorax* Tracheal sounds - Answer Inspiration equal to expiration heard over the trachea Bronchial sounds - Answer Expiration longer than inspiration heard over the manubrium Bronchovesicular sounds - Answer Inspiration equal to expiration, heard between the 1st-2nd ribs anteriorly and between the scapulae posteriorly Vesicular sounds - Answer Inspiration longer than expiration, heard over the remaining lung field, sound that is heard over the majority of the lung field Rales - Answer Clicking, bubbling, or rattling sounds in the lung, can be further describes as moist, dry, fine, and course. Associated with *Bronchitis* Rhonchi - Answer Resemble snoring. Associated with *bronchiectasis* Wheezes - Answer High pitched sounds heard on exhalation. Associated with *asthma in young people and emphysema in older people* Stridor - Answer Wheeze-like sounds heard on inspiration usually due to a *blockage of airflow* like in choking *Bronchophony* - Answer Patient says 99 and clear distinct sounds heard *consolidation is present* *Egophony* - Answer If hear "aaa" as the patient says "eee" *consolidation is present* *Whispered pectoriloquy* - Answer If words "1,2,3" heard clearly and distinctly *consolidation is present* _______________: Resonant percussion decreased fremitus wheezing breath sounds - Answer *asthma* _______________: Dull/flat percussion decreased fremitus absent breath sound - Answer *Atelectasis* _____________: Resonant percussion normal fremitus rhonchi - Answer *Bronchiectasis* _____________: Resonant percussion normal fremitus rales - Answer *Bronchitis* _____________: Hyperresonant decreased fremitus wheezing - Answer *Emphysema* _____________: Dull percussion decreased fremitus crackles (friction rub) - Answer *Pleurisy* ____________________: Hyperresonant decreased fremitus decreased breath sounds - Answer Pneumothorax ________________: Dull percussion increased fremitus egophony Bronchophony whispered pectoriloquy crackles - Answer *Pneumonia* *Lobar pneumonia* 1) what is it 2) patient presentation 3) test findings - Answer *1* Consolidation of the lung, *2* patient presents with productive cough for 10 days with rusty brown sputum and fever. Percussion is dull; rales; increased tactile fremitus. *3* On X-ray see silhouette sign, air bronchogram, labs show increased WBC *Friedlander's pneumonia* 1) what is it caused by 2) patient presentation