NR509 Final Exam Study Guide Physical
Examination
Know that in a 47-year-old man ED is usually ___________ rather than testosterone
psychologic
Erectile dysfunction may be from psychogenic causes, especially if
early morning erection is preserved.
it may also reflect decreased testosterone, decreased blood flow in the hypogastric arterial system,
impaired neural innervation, and diabetes
When performing a breast exam, know what abnormal masses should do when the arm
may be fixed to skin or underlying tissues (may cause dimpling of skin or retraction when arms are lifted
over head or hands are pressed against hips)
Fibroadenoma and cysts mobility
very mobile/mobile
Know that a high proportion of breast masses are noted during ________
BSE
Breast stage 1
preadolescent- elevation of nipple only
Breast stage 2
breast bud stage- elevation of breast and nipple as a small mound; enlargement of areolar diameter
breast stage 3
further enlargement of elevation of breast and areola, with no separation of their contours
breast stage 4
projection of areola and nipple to form a secondary mound above the level of breast
breast stage 5
mature stage- projection of nipple only; areola has receded to general contour of the breast (although in
some individuals the areola continues to form a secondary mound)
Know where pain is located with pancreatitis: acute
epigastric, may radiation straight to the back of other areas of the abdomen; 20% with severe sequelae
of organ failure
Know where pain is located with pancreatitis: chronic
epigastric, radiating to back
, NR509 Final Exam Study Guide Physical
Examination
Know how hepatitis A is transmitted
Transmitted through fecal-oral route. Fecal shedding followed by poor handwashing contaminates water
and foods leading to infection of household and sexual contacts
Stress incontinence
the urethral sphincter is weakened so that transient increases in intra-abdominal pressure raise the
bladder pressure to levels that exceed urethral resistance. Causes include childbirth and surgery,
postmenopausal atrophy of the mucosa, and urethral infection. May follow prostate surgery in men.
urge incontinence
detrusor contractions are stronger than normal and overcome the normal urethral resistance. The
bladder is typically small. Mechanisms: Decreased cortical inhibition of detrusor contractions from
stroke, brain tumor, dementia, and lesions of the spinal cord above sacral level. Also hyperexcitability of
sensory pathways ie: bladder infections, tumors, and fecal impaction. Deconditioning of voiding reflexes
ie: frequent voluntary voiding at low bladder volumes.
overflow incontinence
detrusor contractions are insufficient to overcome urethral resistance, causing urinary retention. The
bladder is typically flaccid and large, even after an effort to void. Mechanisms: obstruction of the
bladder outlet ie: BPH or tumor. Weakness of the detrusor muscle associated with peripheral nerve
disease at S2-4 level. Impaired bladder sensation that interrupts the reflex arc ie: diabetic neuropathy.
functional incontinence
the patient is functionally able to reach the toilet in time because of impaired health or environmental
conditions. Mechanism: problems in mobility resulting from weakness, arthritis, poor vision, or other
conditions. Also environmental factors such as an unfamiliar setting, distant bathroom facilities, bed
rails, or physical restraints.
Incontinence secondary to medications
drugs may contribute to any type of incontinence listed. Ex: sedatives, tranquilizers, anticholinergics,
sympathetic blockers, and potent diuretics
Know where lymph nodes should be with strep
· Strep throat àstreptococcal pharyngitis, bacterial infection that may cause a sore, scratchy throat
· Common childhood infection has a classic presentation of erythema of the posterior pharynx and
palatal petechiae
· Enlarged swollen cervical lymph nodes -> superficial cervical lymph nodes
Superficial cervical -> superficial to the sternocleidomastoid
What vaccines are safe during pregnancy
Examination
Know that in a 47-year-old man ED is usually ___________ rather than testosterone
psychologic
Erectile dysfunction may be from psychogenic causes, especially if
early morning erection is preserved.
it may also reflect decreased testosterone, decreased blood flow in the hypogastric arterial system,
impaired neural innervation, and diabetes
When performing a breast exam, know what abnormal masses should do when the arm
may be fixed to skin or underlying tissues (may cause dimpling of skin or retraction when arms are lifted
over head or hands are pressed against hips)
Fibroadenoma and cysts mobility
very mobile/mobile
Know that a high proportion of breast masses are noted during ________
BSE
Breast stage 1
preadolescent- elevation of nipple only
Breast stage 2
breast bud stage- elevation of breast and nipple as a small mound; enlargement of areolar diameter
breast stage 3
further enlargement of elevation of breast and areola, with no separation of their contours
breast stage 4
projection of areola and nipple to form a secondary mound above the level of breast
breast stage 5
mature stage- projection of nipple only; areola has receded to general contour of the breast (although in
some individuals the areola continues to form a secondary mound)
Know where pain is located with pancreatitis: acute
epigastric, may radiation straight to the back of other areas of the abdomen; 20% with severe sequelae
of organ failure
Know where pain is located with pancreatitis: chronic
epigastric, radiating to back
, NR509 Final Exam Study Guide Physical
Examination
Know how hepatitis A is transmitted
Transmitted through fecal-oral route. Fecal shedding followed by poor handwashing contaminates water
and foods leading to infection of household and sexual contacts
Stress incontinence
the urethral sphincter is weakened so that transient increases in intra-abdominal pressure raise the
bladder pressure to levels that exceed urethral resistance. Causes include childbirth and surgery,
postmenopausal atrophy of the mucosa, and urethral infection. May follow prostate surgery in men.
urge incontinence
detrusor contractions are stronger than normal and overcome the normal urethral resistance. The
bladder is typically small. Mechanisms: Decreased cortical inhibition of detrusor contractions from
stroke, brain tumor, dementia, and lesions of the spinal cord above sacral level. Also hyperexcitability of
sensory pathways ie: bladder infections, tumors, and fecal impaction. Deconditioning of voiding reflexes
ie: frequent voluntary voiding at low bladder volumes.
overflow incontinence
detrusor contractions are insufficient to overcome urethral resistance, causing urinary retention. The
bladder is typically flaccid and large, even after an effort to void. Mechanisms: obstruction of the
bladder outlet ie: BPH or tumor. Weakness of the detrusor muscle associated with peripheral nerve
disease at S2-4 level. Impaired bladder sensation that interrupts the reflex arc ie: diabetic neuropathy.
functional incontinence
the patient is functionally able to reach the toilet in time because of impaired health or environmental
conditions. Mechanism: problems in mobility resulting from weakness, arthritis, poor vision, or other
conditions. Also environmental factors such as an unfamiliar setting, distant bathroom facilities, bed
rails, or physical restraints.
Incontinence secondary to medications
drugs may contribute to any type of incontinence listed. Ex: sedatives, tranquilizers, anticholinergics,
sympathetic blockers, and potent diuretics
Know where lymph nodes should be with strep
· Strep throat àstreptococcal pharyngitis, bacterial infection that may cause a sore, scratchy throat
· Common childhood infection has a classic presentation of erythema of the posterior pharynx and
palatal petechiae
· Enlarged swollen cervical lymph nodes -> superficial cervical lymph nodes
Superficial cervical -> superficial to the sternocleidomastoid
What vaccines are safe during pregnancy
