Advanced Health Assessment and Diagnostic Midterm Exam 2022

Advanced Health Assessment and Diagnostic Midterm Exam 2022 The majority of Diagnsosis can be made on History alone? True Evidence Based Practice is the provision of care based on 1. The highest level of evidence 2. The wishes and desires of the patient and family 3. The expertise of the practitioner The review of systems is the physical examination of each body system False A Likelihood Ratio (LR) of 1.0 means the post-test probability is exactly the same as the pretest probability. True When a test result suggests that a disease is present when that disease is not present, this is called a: False Positive A focused health assessment includes which of the following? Chief Complaint, History of present illness, and physical exam Randomized control trials are the highest level of evidence. False- Systematic review is the highest level of evidence Which of the following are components of the history of the present illness (HPI)? Onset, relieving factors, and effect on function A short list of possible diagnoses consistent with the patient's presenting signs and symptoms is the: Differential Diagnosis Which of the following are tests of auditory acuity? Whisper Test and Weber test Risk Factors for Skin Cancer Include Age 50 Male Fair, freckled, Ruddy complexion sunburns easily Living near the equator Family History Precancerous Dermatoses Overexposure to frost, wind, UV, and radium What thyroid problem should be suspected in a patient who presents with swelling in the neck area, tachycardia and palpitations? Hyperthyroidism Signs of Skin Cancer ABC's Asymmetry- unequal halves of mole or lesion Borders- Irregular, notched, scalloped, or indistinct Color- variation or change in color Diameter- 6mm or pencil eraser Elevation- Raised Blue to Red Lesions that blanch when compressed are Vascular lesions Lesions that do not blanch completely when compressed are Purpuric lesions The best form of adequate lighting for a skin assessment is natural light Weber Test Test: Place vibrating tuning fork anywhere on midline of skill Normal- Negative weber; vibration heard equally Abnormal- Positive weber Rinne Test Test: Place vibrating tuning fork on mastoid bone until patient no longer hears it, then place in front of external auditory canal. Measure amount of seconds at each. Normal- Positive Rinne; AC 2x BC Abnormal- Negative Rinne; AC 2x BC What could an abnormal Rinne test signify? Conductive hearing loss You have performed a Weber test on your patient and have determined it to be positive. This means that the vibrations were heard: More in one ear than the other Kissing tonsils would be documented as Tonsillar grade: 4 If a patient reports seeing "halos" around the lights, you would be suspicious of cataracts Otitis Externa is commonly known as Swimmers ear Basal Skin Carcinoma 90% of all cancerous lesions Slow growing, nodular, superficial, rarely spreads Squamous cell carcinoma Small, firm, hyperkeratotic, nodule on inflamed base It is slow growing but more likely to spread than basal! Melanoma Typically black or brown but can be any color. Caused by intense, occasional, UV exposure (leading to sunburn). Pityriasis Rosea - Occurs between ages of 10-35 - Unknown Cause - Starts with herald's patch (single round patch that is scaly with raised borders) - progresses to 1-2 cm salmon colored rash on abdomen, chest, back, and legs in CHRISTMAS TREE PATTERN Seborrheic Dermatitis dandruff, cradle cap, oily scales Tinea versicolor Fungal sun spots Vitiligo Depigmentation of sections of skin; pathology is suspected to be autoimmune, genetic, oxidative, stress, neural, or viral. Atopic Dermatitis AKA Atopic Eczema "The itch that rashes" A chronic common recurring sensitive skin reaction to food and environment. Often accompanied by asthma and hay fever. Scratchleakcrust Impetigo highly contagious infection in children and infants. Starts as a red sore that ruptures, oozes for a few days, and then forms HONEY COLORED CRUST Androgenic Alopecia male pattern baldness Telogen Effluvium Increased loss of hair; "flooding of hairs"; due to stress, post partum, trauma, surgery, drugs, diet, vaccination Nail Disorders Beau's Lines- Horizontal ridging from trauma, metabolic disease, or infection Yellow Nails- Genetic with lung dx and lymphedema Spoon Nails- Iron deficiency Terry's Nails- Liver disease, CHF, DM Oncymycosis Tinea unguium; fungal infection of the nail Paronchyia Torn cuticle; bacterial or viral Herpetic Whitlow Herpes of the finger, Think dental profession! Lupus Butterfly Rash Paget's Disease Indicative of cancer; unilateral eczematous plaque of the nipple and areola Acanthosis Nigricans Seen in Diabetes; velvety darkening of skin in body folds and creases, especially the neck, groin, and axilla; skin tags Syphillis Secondary stage; rash on palms and soles Lyme Disease Bulls Eye Target; Don't confuse with Tinea (fungal infection) HIV/AIDS Kaposis Sarcoma; Cancer of the lymph tissues and blood Molluscum Contagiosum Viral; flat, warty, non fluid-filled. Usually acquired in locker room (warm, hot) Verruca Warts; may be caused by HPV, slightly contagious Battle Sign Basilar skull fx; bruising behind ear Cullen Sign Periumbilical brusing; indicative of hemorrhage Osler Sign Painful erythematous lesions on pads of fingers and toes, indicative of infective bacterial endocarditis Janeway Lesion Non-tender macular lesions on palms and soles; indicative of septic emboli Grey Turner Sign Bruised flanks; indicative of acute pancreatitis Normal Neonatal Integument Variations Acrocyanosis- cyanosis of hands and feet harlequin color changes, Mongolian spots, Telangiectasia's, physiologic jaundice, diaper rash Normal Infant Integument Variations Mongolian Spots- concentrated melanocytes Milia- trapped skin cells Cafe au lait Spots- flat pigmented spots (6 associated with neurofibromatosis) Erythema Toxicum- baby acne; 50% will develop newborn rash (red with white indurated center) Hemangioma- abnormally dense blood vessels, resolves by 10 yo Exanthum- widespread rash patterns with childhood Pregnancy Integument Variations - Striae gravidarum - Linea Nigra - Chloasma - Preexisting moles may darken - Palmar Erythema - Pruritic and Urticarial papules and plaques of pregnancy (PUPPS) Older Adult Integument Variations Skin is more transparent, dry, and wrinkly Xanthelasma Typically beginning in 5th decade, if 50 yo consider hyperlipidemia During percussion of Tina's chest you hear dullness in the LLL. What is the most likely diagnosis? Pneumonia- dullness is r/t consolidation Bradypnea may accompany an excellent level of cardiovascular fitness A third heart sound Is created by Diastolic Filling The purpose of the Allen Test is to evaluate patency of: The ulnar artery What is the most accurate way to determine the location of the area for auscultating the aortic valve? Locate the manubriosternal Junction When listening to the apex of the lungs, where do you place the stethoscope? Directly above the clavicles