Advanced Assessment NURS 6023
Exam 2
Common HEET patient CC - answer head, neck, face mass or lump, pain, headache,
neck pain
Thyroid CC - answer thyroid mass, module or goiter
Head and Neck exam includes - answer hair, scalp, skull, head and face skin, trachea,
thyroid, cervical lymph
hair exam - answer quantity, distribution, texture, hair loss, infestation
scalp exam - answer scaling, lumps, nevi, lesions
skull exam - answer size, contour, symmetry, deformities
skin of head and face exam - answernote expression, contour, involuntary movements,
symmetry, edema, masses
trachea exam - answerdeviation from midline, breath sounds
thyroid gland exam - answersize, shape, consistency, nodules
Cervical lymph - answersize, shape, consistency, mobility, tenderness with palpation,
assess bilaterally at same time, description of enlargement uses cm's
cervical lymph node locations - answersubmental, submandibular, tonsillar,
preauricular, posterior auricular, occipital, Anterior superficial, superficial cervical,
posterior cervical, deep cervical, supraclavicular
trachea exam - answerinspect: deviation, auscultate breath sounds (stridor=ER-high
pitch for obstruction, epiglottitis, goiter, artificial airway),
thyroid exam - answerinspect tilt head back, observe swallow, check movement of
thyroid, observe contour and symmetry. palpate for nodules, auscultate - localized
continuous bruit can be Grave's or toxic multinodular goiter
thyroid function - answeramino acid hormones: thyroxine T4 and triiodothyronine T3,
requires iodine to synthesize, created and stored in cells of thyroid gland, levels
controlled by TSH secreted by anterior pituitary. Also produces calcitonin which causes
calcium to deposit into bones and decreases extracellular Ca+
,parathyroid function - answersecretes parathyroid hormone regulates serum Ca+ by
increasing absorption in intestines, kidneys and pulling from bones
Overt hypothyroidism - answerelevated TSH, low T4, marked symptoms. Risk: older
age, caucasian, autoimmune thyroiditis, radiation of head/neck, DM, down's
subclinical hypothyroid - answerelevated TSH, normal T4. long term risk for cardiac
issues, afib, bone density issues.
hyperthyroid - answerlow TSH, elevated T4, Risk: AA, amioderone, female, older age.
Risk for thyroid cancer - answerradiation of head/neck, 1st level family member with
thyroid cancer, multiple endocrine neoplasia syndrome or medullary thyroid cancer,
nodules suspect should be US or needle biopsy
diagnostic test for thyroid - answerlab: TSH, total T3, free T3, T3 uptake, total T4, free
T4. imaging: radioactive iodine uptake scan, thyroid US, CT, MRI, fine needle aspiration
cytology
Thyroid disorders - answerhyperthyroidism (thyrotoxicosis), hypothyroidism, Grave's,
Thyroid storm, Hashimoto's
signs of hyperthyroidism - answerwarm, moist skin, fine hair, onycholysis,
exophthalmos, eyelid retraction, tachycardia, tremor, gynecomastia
Grave's - answerautoimmune disease: IgG binds to TSH activating secretion of T3, T4
increasing size of thyroid, nail clubbing, pretibial myxedema
Thyroid Storm - answerEmergent, fever > 103, tachycardia, dehydration, coma,
delirium, n/v/d.
caused by trauma, infection, sx, radioactive iodine tx, withdrawal from antithyroid meds
hypothyroidism symptoms - answerdry skin, cold intolerance, bradycardia, weight gain,
constipation, weakness, lethargy, fatigue, muscle cramps, myalgia, coarse hair/skin,
periorbital puffiness, slowed speech, loss of ambition
Hashimoto's - answerAutoimmune disease, forms antibodies that attack and damage
thyroid gland. sometimes goiter, heart failure, angina, AMI, reduced bone density,
flushing, alopecia
hypoparathyroidism - answerlow PTH, lowered serum Ca+, neck surgery on
parathyroid. sx: tingling in hands and feet, unusual muscle movements, muscle cramps,
anxiety, depression, irritability, dry, thick skin, Coarse hair
, hyperparathyroidism - answertx: parathyroidectomy if serum Ca+ > 1.9mg/dL aobve the
upper limit, CrCl < 60mL/min, bone density T score < 2.5, less than 50 yr.
sx: fatigue, weakness, mild depression, memory impairment, n/v/c
Hypothalamus function - answersecretes TRH, CRH > ACTH, GHRH, Somatostatin
inhibits release of GH, PIF inhibits prolactin
Pituitary function - answerusual disorder d/t adenoma. Anterior : GH, TSH, ACTH,
Prolactin, FSH, LH. Posterior stores : ADH, Oxytocin
Anterior Pituitary disorders - answerGH (somatotropin): gigantism, acromegaly. hyper:
thickened heel pads, thick tongue, dental changes, HTN, DM, HA, visual disturbance
due to pressure on optic nerve, lethargy, sinus congestion, decreased libido.
hypo: weakness, fatigue, HA, sexual dysfunction, fasting, hypoglycemia, dry sallow skin,
decreased tolerance for stress, poor resistance to infections. children=growth
retardation
Posterior pituitary disorder - answerDiabetes Insipidus (under), SIADH (over)
SIADH - answerdecreased urine output, wt gain, crackles in lungs, JVD, AMS, serum
Na decline, sudden wt gain
DI - answerunder secretion; oliguria, thirst, dilute urine. severe dehydration. check for
head injury, LOC, wt loss, dehydration, 5-20 L urine per day, severe hypotension =
cardiac collapse
Eye related Cranial Nerves - answerCN II = vision, pupil constriction/eye opening: CN
III, rotation of eyeballs: CN II, IV, VI
Intraocular structures - answersclera, cornea, anterior/posterior/vitreous chamber, iris,
pupil, lens, ciliary body, fundus, retina
intraocular pressure is determined by - answerthe difference between the production of
aqueous and the resistance of aqueous outflow at the anterior chamber angles
what controls pupillary size - answerthe muscles of the iris
posterior fundus - answerportion of the inner eye seen by an ophthalmoscope
Eye CC & history - answerCC: vision changes (near or far), eye pain, redness, tearing,
foreign body (gradual/sudden) sensation. HPI content, contacts of glasses, last eye
exam. FH. occ hx, smoking, etoh use, illicit drug use, blurred vision (sudden or gradual).
photophobia or halos
Eye vision exam and tools - answerSnellen chart (far vision 20[distance from
chart]/40[pt vision each eye - "corrected" with lenses]), Rosenbaum (near vision), cover
Exam 2
Common HEET patient CC - answer head, neck, face mass or lump, pain, headache,
neck pain
Thyroid CC - answer thyroid mass, module or goiter
Head and Neck exam includes - answer hair, scalp, skull, head and face skin, trachea,
thyroid, cervical lymph
hair exam - answer quantity, distribution, texture, hair loss, infestation
scalp exam - answer scaling, lumps, nevi, lesions
skull exam - answer size, contour, symmetry, deformities
skin of head and face exam - answernote expression, contour, involuntary movements,
symmetry, edema, masses
trachea exam - answerdeviation from midline, breath sounds
thyroid gland exam - answersize, shape, consistency, nodules
Cervical lymph - answersize, shape, consistency, mobility, tenderness with palpation,
assess bilaterally at same time, description of enlargement uses cm's
cervical lymph node locations - answersubmental, submandibular, tonsillar,
preauricular, posterior auricular, occipital, Anterior superficial, superficial cervical,
posterior cervical, deep cervical, supraclavicular
trachea exam - answerinspect: deviation, auscultate breath sounds (stridor=ER-high
pitch for obstruction, epiglottitis, goiter, artificial airway),
thyroid exam - answerinspect tilt head back, observe swallow, check movement of
thyroid, observe contour and symmetry. palpate for nodules, auscultate - localized
continuous bruit can be Grave's or toxic multinodular goiter
thyroid function - answeramino acid hormones: thyroxine T4 and triiodothyronine T3,
requires iodine to synthesize, created and stored in cells of thyroid gland, levels
controlled by TSH secreted by anterior pituitary. Also produces calcitonin which causes
calcium to deposit into bones and decreases extracellular Ca+
,parathyroid function - answersecretes parathyroid hormone regulates serum Ca+ by
increasing absorption in intestines, kidneys and pulling from bones
Overt hypothyroidism - answerelevated TSH, low T4, marked symptoms. Risk: older
age, caucasian, autoimmune thyroiditis, radiation of head/neck, DM, down's
subclinical hypothyroid - answerelevated TSH, normal T4. long term risk for cardiac
issues, afib, bone density issues.
hyperthyroid - answerlow TSH, elevated T4, Risk: AA, amioderone, female, older age.
Risk for thyroid cancer - answerradiation of head/neck, 1st level family member with
thyroid cancer, multiple endocrine neoplasia syndrome or medullary thyroid cancer,
nodules suspect should be US or needle biopsy
diagnostic test for thyroid - answerlab: TSH, total T3, free T3, T3 uptake, total T4, free
T4. imaging: radioactive iodine uptake scan, thyroid US, CT, MRI, fine needle aspiration
cytology
Thyroid disorders - answerhyperthyroidism (thyrotoxicosis), hypothyroidism, Grave's,
Thyroid storm, Hashimoto's
signs of hyperthyroidism - answerwarm, moist skin, fine hair, onycholysis,
exophthalmos, eyelid retraction, tachycardia, tremor, gynecomastia
Grave's - answerautoimmune disease: IgG binds to TSH activating secretion of T3, T4
increasing size of thyroid, nail clubbing, pretibial myxedema
Thyroid Storm - answerEmergent, fever > 103, tachycardia, dehydration, coma,
delirium, n/v/d.
caused by trauma, infection, sx, radioactive iodine tx, withdrawal from antithyroid meds
hypothyroidism symptoms - answerdry skin, cold intolerance, bradycardia, weight gain,
constipation, weakness, lethargy, fatigue, muscle cramps, myalgia, coarse hair/skin,
periorbital puffiness, slowed speech, loss of ambition
Hashimoto's - answerAutoimmune disease, forms antibodies that attack and damage
thyroid gland. sometimes goiter, heart failure, angina, AMI, reduced bone density,
flushing, alopecia
hypoparathyroidism - answerlow PTH, lowered serum Ca+, neck surgery on
parathyroid. sx: tingling in hands and feet, unusual muscle movements, muscle cramps,
anxiety, depression, irritability, dry, thick skin, Coarse hair
, hyperparathyroidism - answertx: parathyroidectomy if serum Ca+ > 1.9mg/dL aobve the
upper limit, CrCl < 60mL/min, bone density T score < 2.5, less than 50 yr.
sx: fatigue, weakness, mild depression, memory impairment, n/v/c
Hypothalamus function - answersecretes TRH, CRH > ACTH, GHRH, Somatostatin
inhibits release of GH, PIF inhibits prolactin
Pituitary function - answerusual disorder d/t adenoma. Anterior : GH, TSH, ACTH,
Prolactin, FSH, LH. Posterior stores : ADH, Oxytocin
Anterior Pituitary disorders - answerGH (somatotropin): gigantism, acromegaly. hyper:
thickened heel pads, thick tongue, dental changes, HTN, DM, HA, visual disturbance
due to pressure on optic nerve, lethargy, sinus congestion, decreased libido.
hypo: weakness, fatigue, HA, sexual dysfunction, fasting, hypoglycemia, dry sallow skin,
decreased tolerance for stress, poor resistance to infections. children=growth
retardation
Posterior pituitary disorder - answerDiabetes Insipidus (under), SIADH (over)
SIADH - answerdecreased urine output, wt gain, crackles in lungs, JVD, AMS, serum
Na decline, sudden wt gain
DI - answerunder secretion; oliguria, thirst, dilute urine. severe dehydration. check for
head injury, LOC, wt loss, dehydration, 5-20 L urine per day, severe hypotension =
cardiac collapse
Eye related Cranial Nerves - answerCN II = vision, pupil constriction/eye opening: CN
III, rotation of eyeballs: CN II, IV, VI
Intraocular structures - answersclera, cornea, anterior/posterior/vitreous chamber, iris,
pupil, lens, ciliary body, fundus, retina
intraocular pressure is determined by - answerthe difference between the production of
aqueous and the resistance of aqueous outflow at the anterior chamber angles
what controls pupillary size - answerthe muscles of the iris
posterior fundus - answerportion of the inner eye seen by an ophthalmoscope
Eye CC & history - answerCC: vision changes (near or far), eye pain, redness, tearing,
foreign body (gradual/sudden) sensation. HPI content, contacts of glasses, last eye
exam. FH. occ hx, smoking, etoh use, illicit drug use, blurred vision (sudden or gradual).
photophobia or halos
Eye vision exam and tools - answerSnellen chart (far vision 20[distance from
chart]/40[pt vision each eye - "corrected" with lenses]), Rosenbaum (near vision), cover
