Nurs 6011 Fall Advanced Physical Assessment Questions
With Complete Solutions
*rapid assessment of acute/emergent ab pain: physical exam*
Correct Answers REMEMBER to reorder
-Inspection:always first!
-Auscultation: no bowel sounds or abnormal highly predictive of
obstruction
-Percussion:gently and may elicit peritonitis; ascites and
hepatomegaly
-Palpation: start in area of least pain
24yo FHPI: Headaches off and on, worse around finals time.
Hurts all over head, feels like a vice grip, sometimes has pain in
neck. Headache usually lasts for a few hours. Pain 5/10. No
associated symptoms. NSAIDs help some. Diagnosis? Correct
Answers none
abd pain in elderly is commonly Correct Answers cancer
acute medical abd Correct Answers vomiting before pain
Acute/surgical abdomen Correct Answers pain before vomiting
alarming features requiring endoscopy Correct Answers •
>55yo new onset
• Family hx of upper GI CA
•Weight loss
• GI bleeding
• Dysphagia or *odynophagia*
• Iron deficiency anemia
,• Persistent vomiting
• Palpable mass or lymphadenopathy
• Jaundice
•*All patients with GERD not controlled on meds need
endoscopy*
ancillary testing Correct Answers CT: Trauma, CVA,
suspected subarachnoid hemorrhage
MRI: Neoplasm, demyelinating dz, abscess
B12: Hx of gastric surgery, poss/s, diabetics
ENMG: Neuropathy, carpal tunnel
articular structures Correct Answers joint capsule, articular
cartilage, synovium and synovial fluid, intra-articular ligaments
and juxta-articular bone
ascites assessment Correct Answers Suspicious sign:
- Protuberant abdomen, bulging flank
- Commonly seen with cirrhosis
• Fluid moves with gravity
- Test for shifting dullness- Fluid wave
• Often negative until ascites is obvious
assessment of non-urgent or chronic ab pain Correct Answers •
Can often diagnose and treat without many (or any) diagnostic
tests
• Important to remember that multiple systems can present as
abdominal pain:
-CARDIOVASCULAR
- Respiratory
- Musculoskeletal
,- Genitourinary
Bacterial Vaginosis microscopic finding Correct Answers clue
cells on saline wet mount
binkley table 11-1 p. 488-489 Correct Answers
bouchard node Correct Answers any of the abnormal
enlargements seen at the proximal interphalangeal joints in
people with osteoarthritis
brain and nerves: red flags Correct Answers Loss of
consciousness
Thunderclap headache
Stiff neck and fever
New onset: paralysis, seizures, HA >age 50
Gait or motor abnormality
Brudzinski's sign Correct Answers flex neck, watch for flexion
of hips and knees
bursa Correct Answers pouches of synovial fluid that cushion
movements of tendons, muscle, and skin over bony prominences
BV (bacterial vaginosis) Correct Answers grey, thin, coats
vaginal walls
candida Correct Answers yellow/white, cottage cheese
Candidal Vaginitis microscopic finding Correct Answers
branching hyphae on KOH prep
, CC: abnormal uterine bleeding Correct Answers Unpredictable
or episodic heavy or light bleeding
Amenorrhea
Irregular Menses
Metromenorrhagia
Menorrhagia
*UPT -always rule out pregnancy & TVUS if indicated
Rule out endometrial carcinoma in all patients at high risk for
the condition, including those with the following characteristics:
◦ Morbid obesity
◦ Diabetes or chronic hypertension
◦ Age over 35 years
Also check for:
◦ Thyroid enlargement or manifestations of hyperthyroidism or
hypothyroidism
◦ Galactorrhea: May suggest hyperprolactinemia
◦ Visual field deficits: Raise suspicion of intracranial/pituitary
lesion
◦ Ecchymosis, purpura: Signs of bleeding disorde
CC: amenorrhea Correct Answers Weight loss
Low BMI/Anorexia/Athlete
Polycystic Ovarian Syndrome (PCOS)
Pregnancy
Endocrine disorders◦Thyroid
CC: dysuria/urgency Correct Answers Suprapubic tenderness
and/or LBP
CVA tenderness
◦+positive = pyelonephritis
With Complete Solutions
*rapid assessment of acute/emergent ab pain: physical exam*
Correct Answers REMEMBER to reorder
-Inspection:always first!
-Auscultation: no bowel sounds or abnormal highly predictive of
obstruction
-Percussion:gently and may elicit peritonitis; ascites and
hepatomegaly
-Palpation: start in area of least pain
24yo FHPI: Headaches off and on, worse around finals time.
Hurts all over head, feels like a vice grip, sometimes has pain in
neck. Headache usually lasts for a few hours. Pain 5/10. No
associated symptoms. NSAIDs help some. Diagnosis? Correct
Answers none
abd pain in elderly is commonly Correct Answers cancer
acute medical abd Correct Answers vomiting before pain
Acute/surgical abdomen Correct Answers pain before vomiting
alarming features requiring endoscopy Correct Answers •
>55yo new onset
• Family hx of upper GI CA
•Weight loss
• GI bleeding
• Dysphagia or *odynophagia*
• Iron deficiency anemia
,• Persistent vomiting
• Palpable mass or lymphadenopathy
• Jaundice
•*All patients with GERD not controlled on meds need
endoscopy*
ancillary testing Correct Answers CT: Trauma, CVA,
suspected subarachnoid hemorrhage
MRI: Neoplasm, demyelinating dz, abscess
B12: Hx of gastric surgery, poss/s, diabetics
ENMG: Neuropathy, carpal tunnel
articular structures Correct Answers joint capsule, articular
cartilage, synovium and synovial fluid, intra-articular ligaments
and juxta-articular bone
ascites assessment Correct Answers Suspicious sign:
- Protuberant abdomen, bulging flank
- Commonly seen with cirrhosis
• Fluid moves with gravity
- Test for shifting dullness- Fluid wave
• Often negative until ascites is obvious
assessment of non-urgent or chronic ab pain Correct Answers •
Can often diagnose and treat without many (or any) diagnostic
tests
• Important to remember that multiple systems can present as
abdominal pain:
-CARDIOVASCULAR
- Respiratory
- Musculoskeletal
,- Genitourinary
Bacterial Vaginosis microscopic finding Correct Answers clue
cells on saline wet mount
binkley table 11-1 p. 488-489 Correct Answers
bouchard node Correct Answers any of the abnormal
enlargements seen at the proximal interphalangeal joints in
people with osteoarthritis
brain and nerves: red flags Correct Answers Loss of
consciousness
Thunderclap headache
Stiff neck and fever
New onset: paralysis, seizures, HA >age 50
Gait or motor abnormality
Brudzinski's sign Correct Answers flex neck, watch for flexion
of hips and knees
bursa Correct Answers pouches of synovial fluid that cushion
movements of tendons, muscle, and skin over bony prominences
BV (bacterial vaginosis) Correct Answers grey, thin, coats
vaginal walls
candida Correct Answers yellow/white, cottage cheese
Candidal Vaginitis microscopic finding Correct Answers
branching hyphae on KOH prep
, CC: abnormal uterine bleeding Correct Answers Unpredictable
or episodic heavy or light bleeding
Amenorrhea
Irregular Menses
Metromenorrhagia
Menorrhagia
*UPT -always rule out pregnancy & TVUS if indicated
Rule out endometrial carcinoma in all patients at high risk for
the condition, including those with the following characteristics:
◦ Morbid obesity
◦ Diabetes or chronic hypertension
◦ Age over 35 years
Also check for:
◦ Thyroid enlargement or manifestations of hyperthyroidism or
hypothyroidism
◦ Galactorrhea: May suggest hyperprolactinemia
◦ Visual field deficits: Raise suspicion of intracranial/pituitary
lesion
◦ Ecchymosis, purpura: Signs of bleeding disorde
CC: amenorrhea Correct Answers Weight loss
Low BMI/Anorexia/Athlete
Polycystic Ovarian Syndrome (PCOS)
Pregnancy
Endocrine disorders◦Thyroid
CC: dysuria/urgency Correct Answers Suprapubic tenderness
and/or LBP
CVA tenderness
◦+positive = pyelonephritis
