Advanced Health Assessment Midterm Exam (198 Questions with VERIFIED ANSWERS 2024 GRADED A, Exams of Nursing

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Advanced Health Assessment Midterm

Exam (198 Questions with VERIFIED

ANSWERS 2024 GRADED A )

Risk factors cardiovascular disease (5) - SOLUTION HTN, hyperlipidemia, smoking, obesity, family history What conditions would you see an abnormal fundoscopic exam? Name 4 - SOLUTION HTN, diabetes, increased ICP Describe carotid pulse/auscultation findings - SOLUTION Vigorous upstroke, level of pulsations not changed by position or respiration Describe internal jugular pulse/auscultation findings - SOLUTION Rarely palpable, soft, 2 elevations per heart beat, level of pulsations change with position and drops with inspriration Normal JVP - SOLUTION 6-8cmH Where do you feel for PMI? - SOLUTION 5th ICS slightly medial to MCV (if deviated to L or >2cm, abnormal) What are forceful cardiac contractions referred to as? - SOLUTION Lifts, heaves What are vibrations of loud cardiac murmurs referred to as? - SOLUTION Thrills What are yellowish plaques/skin lesions caused by the accumulation of fat macrophage immune cells? - SOLUTION Xanthomas (increased risk coronary artery disease) Poor oxygen perfusion to distal tissues of hands and feet results in? - SOLUTION Clubbing

Poor oxygen delivery to peripheral tissues hands and feet? - SOLUTION Cyanosis What does LLD position accentuate for heart sounds? - SOLUTION Left- sided S3, S4, mitral murmurs (stenosis) What does leaning forward, exhaling completely and holding breath accentuate for heart sounds? - SOLUTION Aortic murmurs (regurgitation) What does squatting/handgrip accentuate for heart sounds? - SOLUTION Mitral valve prolapse (increased afterload and increased ventricular volume) What heart sound: closure of mitral and tricuspid valves, heard best at apex with the bell, immediately precedes carotid upstroke - SOLUTION S What heart sound: closure of aortic and pulmonic valves, best heard at base (R and L 2nd ICS) with diaphragm, louder than S1 - SOLUTION S Where and when (insp/exp) do you hear splitting of S2? - SOLUTION Pulmonic area during peak inspiration What causes splitting of S2? - SOLUTION Delayed closure of pulmonic valve; increased blood flow What causes S3 gallop? When does it occur? Where do you listen for it? - SOLUTION Rapid ventricular filling. The third heart sound is caused by vibration of the ventricular walls, resulting from the first rapid filling so it is heard just after S2. The third heart sound is low in frequency and intensity. Sloshing sound. "Ken-tuck-ee". Occurs in early diastole. Associated dilated cardiomyopathy. Apex with bell in LLD. What extra heart sound may be physiologic in children and in pregnancy? When is it considered pathologic? - SOLUTION S3; >40 pathologic What causes S4? When does it occur? Where do you listen for it? - SOLUTION Atrial contraction. Atrial sound related to vibrations caused by atrial systole (caused by increased resistance to LV filling by atrial contraction). Increased atrial resistance. Occurs late diastole right before

S1. Soft, low-pitched sound. Common in HTN patients. Apex with bell in LLD. What heart sound is physiologic in infants, small kids, and adults >50 years old? - SOLUTION S Conditions with stiffened L ventricles (from conditions like HTN, aortic stenosis, hypertrophic cardiomyopathy) would have what extra heart sound? - SOLUTION S Systolic extra heart sounds? - SOLUTION Clicks (MVP), Ejection sounds What sound is associated with MVP? Diastolic or systolic heart sound? - SOLUTION Click, systolic Diastolic extra heart sounds? - SOLUTION S3, S4, OS (opening snap- forceful opening mitral valve after S2) Grading of systolic murmurs? - SOLUTION 1-6. 3=easily audible, 4=easily audible with thrill Grading diastolic murmurs? - SOLUTION 1-4; 2=audible but soft, 3=easily audible Describe different kinds of shapes of murmurs? - SOLUTION Holo (pan) systolic, crescendo, decrescendo, continuous, crescendo-decrescendo Where do you listen for mitral murmurs? - SOLUTION 5th ICS, MCL (apex) Where do you listen for aortic murmurs? - SOLUTION 2nd ICS, RSB Is this murmur innocent? Grade 1-2, mid-systolic, little or no radiation, heard 2-4th ICS, when recumbent goes away - SOLUTION Yes innocent Physiologic murmurs are caused by? - SOLUTION Increased blood flow. Fever, anemia, pregnancy, hyperthyroidism Name the systolic murmurs: 7 - SOLUTION aortic/pulmonic stenosis, mitral/tricuspid regurgitation, MVP , ASD, VSD

What murmur radiates to the carotids? - SOLUTION Aortic stenosis What murmur is holosystolic and worse with hand grip/squat? Where do you listen for it? - SOLUTION Mitral regurgitation; 5th ICS MCL What murmur has a mid-systolic click? - SOLUTION MVP Name the diastolic murmurs: 4 - SOLUTION aortic/pulmonic regurg, mitral/tricuspid stenosis What type of murmurs are ASD, VSD, pericardial friction (scratchy) rub? - SOLUTION Continuous "harsh machinery" murmurs Aortic aneurysm from syphilis or Marfan's, pericarditis, prostehtic valves and subacute bacterial endocarditis can cause what sounds? - SOLUTION Murmurs When you hear a systolic ejection murmur, what could the possible diagnosis be? - SOLUTION Normal, aortic stenosis, pulmonic stenosis, hypertrophic obstructive cardiomyopathy, ASD, TEF When you hear a early diastolic murmur, what could the possible diagnosis be? - SOLUTION Aortic or pulmonic regurgitation When you hear an ejection sound, what could the diagnosis be? - SOLUTION Aortic valve disease When you hear a holosystolic murmur, would could the diagnosis be? - SOLUTION Mitral or tricuspid regurgitation When you hear a late diastolic murmur, would could the diagnosis be? - SOLUTION Mitral or tricuspid stenosis You hear a systolic click with a late systolic murmur. What is your diagnosis? - SOLUTION MVP You hear an opening snap with a diastolic rumble. What is it? - SOLUTION Mitral stenosis

What heart sound is normal in children and occurs in heart failure? - SOLUTION S What heart sounds is physiological and is in various diseases? - SOLUTION S History for peripheral vascular disease - SOLUTION site, quality, exacerbating factors, relieving factors, timing, progression Name the artery that feeds the buttock and hip - SOLUTION Aortoiliac Name the artery that can cause erectile dysfunction - SOLUTION Iliac- pudendal Name the artery that feeds the thigh - SOLUTION Common femoral or aortoiliac Name the artery that feeds the upper calf - SOLUTION Superficial femoral Name the artery that feeds the lower calf - SOLUTION Popliteal Name the artery that feeds the foot - SOLUTION Tibial or peroneal The following are symptoms of what? Persistent swelling of lower legs, edema improves with raising legs (worsens later in day), leg pain is dull, aching. Heaviness or cramping noted. Bluish discoloration of skin at the ankles. - SOLUTION Chronic venous insufficiency (CVI) How do we grade edema? On a scale of _ to _ - SOLUTION 1-4. Innocent venous hum in very small children normal CV finding? - SOLUTION Yes Older adult CV exam findings? - SOLUTION Widened pulse pressure, orthostatic hypotension, apical impulse (chest deepens-AP diameter increases), splitting of S2 less audible. S3 or S4 >40 normal or abnormal? - SOLUTION S3: abnormal S4: common

Very old can have systolic murmurs from what? - SOLUTION Mitral regurgitation Decreased exercise tolerance, peripheral edema, palmar erythema, spider telgectasias, tachycardia, bounding pulse, displaced apical pulse, wide pulse pressures, BP decrease initially found in what type of person? - SOLUTION Pregnancy Normal CV findings in pregnancy? - SOLUTION Splitting heart sounds, S increased intensity, S3, grade 2 systolic murmur at pulmonary area, innocent diastolic low murmur Listen to S1 where and with what side of stethoscope? - SOLUTION Apex with bell Listen to S2 where and with what side of stethoscope? - SOLUTION 2nd L/R ICS w diaphragm Is S1 or S2 louder? - SOLUTION S Is Raynaud's an arterial or venous disorder? - SOLUTION Arterial Thrombophlebitis arterial or venous disorder? - SOLUTION Venous Femoral arteries do you listen with diaphragm or bell? - SOLUTION Diaphragm What area does neck level 2 drain? - SOLUTION Upper jugular. Oropharynx, parotid. What area does neck level 1 drain? - SOLUTION Submental and submandibular nodes: lip, oral cavity, skin of lower face What area does neck level 6 drain? - SOLUTION Paratracheal nodes: thyroid, larynx What area does neck level 4 drain? - SOLUTION Supraclavicular nodes: larynx, hypopharynx, thyroid, non-neck sides (lung, breast, GI, GU)

What area does neck level 3 drain? - SOLUTION Mid-jugular nodes: hypopharynx, thyroid What scale do you use to evaluate CN VII function? What scale is it? - SOLUTION House-Brackmann scale; 1-6. 4 = cannot close eye. 6 = complete paralysis. Opening snap is characteristic of what heart murmur? - SOLUTION Mitral stenosis Where is JVP located? - SOLUTION Assessed from pulsation in R internal jugular vein, which is directly in line with the superior vena cava and right atrium. Pregnancy may shift the apical impulse upwards and to the - SOLUTION Expiratory splitting (rather than inspiratory) is indicative of what type of abnormality? - SOLUTION Valvular S3 (ventricular gallop) pathologic in what population? - SOLUTION Adults

40 (caused by high L ventricular filling pressures and abrupt deceleration of inflow) S4 (atrial gallup) pathologic in what population? - SOLUTION L sided S4: HTN, aortic stenosis, ischemic and hypertrophic cardiomyopathy Types of tinnitus? - SOLUTION Tonal and pulsatile External auditory canal: what is behind the anterior wall, posterior wall, and superior wall? - SOLUTION Anterior: TMJ, Posterior: mastoid, Superior: Temporal lobe 5 branches of CN VII - SOLUTION temporal, zygomatic, buccal, mandibular, cervical (platysmal) What is CN VII and what is it responsible for? - SOLUTION Facial nerve, facial movement (5 branches) What cranial nerve runs through the inner ear? What is it responsible for? - SOLUTION CN VIII (vestibulocochlear); balance/sensation

Range of Hz inner ear? - SOLUTION 200-20, Where is the base and apex of inner ear? What Hz can be heard at each? - SOLUTION Base: 20,000 (high freq) Apex: 200 (low freq) Sound lateralizes to affected ear in what type of hearing loss? - SOLUTION Conductive Sound lateralizes to unaffected ear in what type of hearing loss? - SOLUTION Sensory AC>BC - SOLUTION Normal or sensory hearing loss BC>AC - SOLUTION Conductive hearing loss Name 3 parts of vestibular exam - SOLUTION Oculomotor testing, cerebellar testing, basic balance function 3 parts oculomotor exam - SOLUTION Unidirectinoal nystagmus, head thrust, dix-hallpike Balance function tests (3) - SOLUTION Gait, Romberg, Fakuda step test Important rhinnorhea history? - SOLUTION History skull base fracture Important smell loss history? - SOLUTION Nutritional deficiency: zinc What is CN1? - SOLUTION Olfactory nerve What drains into middle meatus? - SOLUTION Maxillary sinuses Dysphonia important history? - SOLUTION Thyroid or anterior cervical disc fusion surgery, occupational voice demands, steroid inhalers Important dysphagia history? - SOLUTION History radiation, thyroid surgery, stroke, neurodegenerative disease Mallampati grading. Used for what? - SOLUTION 1-4. Assess airway patency. 4 = completely occluded, tonsils touching.

Symmetric rise of uvula tests what cranial nerve? - SOLUTION CNX Where are most tumors/cancers found in the parotid gland? - SOLUTION The tail What is GRBAS? - SOLUTION Grade, raspyness, brethiness, asthenia (weakness), strain. 1-15 scale, 15 worst. What sinuses look like little beans on cross-section view? - SOLUTION Sphenoid What sinuses are below frontal sinuses? Which are in front? - SOLUTION Ethmoid in front of sphenoid Torus palatinus - SOLUTION bony growth hard palate, normal What is CN V? - SOLUTION Trigeminal nerve How do we test CN V? - SOLUTION Light touch three areas on face. Give answer as %. I.E. 80% RV2 in tact. Where do majority of breast cancers occur? - SOLUTION Tail of spence UOQ Where do central axillary nodes drain? - SOLUTION infra/supraclavicular nodes Name lymph nodes you assess for breast exam and where they drain - SOLUTION Central axillary (infra/supraclavicular nodes), pectoral (central axillary), subscapular (central axillary) and lateral (central axillary) Breast development - SOLUTION Secondary sex characteristics occur between age 8-13 with breast buds What stages does breast development occur? On average, how long does breast development take? - SOLUTION Stage 2-5. Takes about 4 years on average.

What stage does menarche occur? - SOLUTION Stage 3-4, about 2 years after bud development Stage 1-5 development breasts - SOLUTION Stage 1: Preadolescent Stage 2: breast bud stage Stage 3: further enlargemnt/elevation of breast and areola Stage 4: projection of areola and nipple to form secondary mound Stage 5: mature stage, projection of nipple Breast history/health part of what part of exam? What do you ask about? - SOLUTION health maintenance. Pain,redness, discharge, contour, change mass, size, personal history, family history BRCA Lifespan Changes of the breast. Explain what happens to breast in each stage: Menstrual Pregnancy Lactation Menopause - SOLUTION menstrual: cyclic pattern of size change, nodularity, tenderness Pregnancy: increase in size, pigmented areas darken, fat replaced by functional ducts, Montgomery glands lubricate Lactation: increase in size and vascularization, spontaneous milk discharge Menopause: glandular tissue replaced with fat, inframmary ridge thickens, relaxation of suspensary ligament Arm positions breast exam - SOLUTION At sides, raised, on hips, leaning forward When is best time to do breast exam? - SOLUTION 5-7 days after menstruation. 2 min per breast. What do these findings describe? Location, size, deliniation of borders, consistency, mass, shape, mobility, tenderness, skin changes - SOLUTION Mass findings for breast What are supernumerary breasts? - SOLUTION Non-functional embryonic milk line from groin to axilla. Glandular tissue or pigmented lesion.

Axillary adenopathy is due to what? - SOLUTION Arm or breast infection. Small lump under armpit. What causes gynecomastia? - SOLUTION Common in adolescents due to decreased ratio of androgens to estrogens. Name the condition: Peak incidence 35-50 years of age, commonly UOQ, tenderness with menses, rapid development, firm or fluctuant. - SOLUTION Cyst Name the condition: common benign solid tumor, <25 years old, common UOQ, non-tender, mobile, smooth rubbery firm. Most common finding. - SOLUTION Fibroadenoma. Cyclic or non-cyclic pain? No relationship to menses, post-menopausal, calcification and ductal dilation - SOLUTION Non-cyclic pain Malignant neoplasm findings - SOLUTION solitary, unilaterla, firm, fixed, non-tender, dimpling, edema, scaling, retraction ACOG recommendations for clinical breast exam: - SOLUTION 1-3 years age 20-39, yearly >40. Mammography recommendations: ACS, ACOG, USPSTF - SOLUTION ACS: 45-54 yearly, >55 q2 years ACOG: annually 40-74 years old USPSTF: Q2 years 50- What fissure divides each lung in half? - SOLUTION Oblique fissure How do you approximate oblique fissure? Use anatomical locations. - SOLUTION Runs from T3 spinous process obliquely down and around the chest to the 6th rib at the midclavidular line. R lung divided with which two fissures? - SOLUTION Oblique and horizontal fissures. Where does horizontal fissure go from? Anatomical landmarks - SOLUTION 4th rib and meets oblique fissure in midaxillary line near 5th rib.

How many cm does the apex of the lungs rise above the inner third of clavicle on inspiration? - SOLUTION 2-4 cm. Where does the anterior lower border of the lung lie? - SOLUTION Crosses the 6th rib at the MCL and the 8th rib at the MAL Where does the posterior lower border of the lung lie? - SOLUTION Level of T10 spinous process. Important history regarding chest/thorax? - SOLUTION alpha-1 anti-trypsin deficiency, SIDS siblings, smoking habits, home nevironment What are symptoms of alpha-1 anti-trypsin deficiency similar to? - SOLUTION COPD More likely site of foreign body aspiration? Right or left mainstem - SOLUTION Right mainstem. Shorter, wider, more vertical. What is most prominent vertebrae with head bending forward? - SOLUTION C How do you listen to the RML? - SOLUTION Right lateral field (under armpit) mid-axillary You would see a widened costal angle in what type of person? - SOLUTION Pregnant When checking for tactile fremitus "99" where will you feel vibrations the greatest? Will it stay the same as you move peripherally? Where do you put your hands to check for symmetry? - SOLUTION Over large airways is greatest. will diminish as you move peripherally. 10th rib. Decreased/absent palpation is due to? - SOLUTION trapped air, thick pleura, effusion, obstructive, massive pulmonary edema Increased palpation due to? - SOLUTION lung consolidation/compression/mass; excess fluids or non-obstructive secretions Normal percussion sounds. - SOLUTION Resonant (adult)

Hyperresonant (child) If you hear hyperresonnance upon percussion for an adult, what do you think is going on? - SOLUTION Increased air. Pneumothorax or emphysema. Is 5-6cm diaphramatic excursion findings normal? - SOLUTION Yes What type of breath sound? Exp > Insp or about equal - SOLUTION Bronchial/tracheal (tubular) What type of breath sound? Insp = Exp. Heard over bronchus and upper right posterior field, medium pitch. - SOLUTION Bronchovesicular (not normal if heard peripherally) What type of breath sound? Insp > Exp. Soft and whispery quality, low pitched. - SOLUTION Vesicular Represents opening of small airways or air bubbling through secretions. Early mid or late inspiration. Fine, medium or coarse. - SOLUTION Crackles (rales) Represents secretions in large airways. "Snoring". Low pitched. During inspiration and expiration. May change with cough. - SOLUTION Ronchi A continuous breath sound with a high-pitched musical quality during inspiration or expiration. Occurs due to obstruction of small airways. - SOLUTION Wheezes During inspiration and expiration, low-pitched grating sound. Indicates inflammation of pleural surfaces. - SOLUTION Friction rub Voice transmission ______ (improved/worsened) if underlying lung field is consolidated (pneumonia) - SOLUTION improved 3 terms that indicate abnormal voice transmission terminology: - SOLUTION bronchophony, egophony, whispered pectorliloquy What type of percussion note would you hear in hyperinflated lungs of COPD or asthma? - SOLUTION Hyperresonnance

When fluid or solid tissue replaces air containing lung (pneumonia, pleural effusion, hemothorax) what percussion note do you hear? - SOLUTION Dullness What lung sounds would you hear with abnormalities of the lung parenchyma (pneumonia, interstitial lung disease, pulmonary fibrosis, atelectasis, heart filaure) - SOLUTION crackles What lung sounds would you hear with narrowed airways? (asthma, COPD, bronchitis) - SOLUTION wheezes In pregnant women, for cervical exam, what do you use in place of a cervical brush? - SOLUTION Cotton tipped applicator dipped in saline. What is the ectropion? - SOLUTION Broad band of columnar epithelium encircling the os Transformation zone - SOLUTION Squmocolumnar junction migrates towards the os What type of exam is this? helps palpate a retroverted uterus, the utersacral ligaments, cul-de-sac and adnexa. Screens for colorectal cancer in woen >50 years old. Assesses for pelvic pathology - SOLUTION Recto- vaginal exam purposes What direction does the uterus tilt in a retroverted uterus? What direction is the cervix? - SOLUTION Backwards. Cervix is forward. Can't be felt on abdominal exam. Retroflexion of uterus. - SOLUTION Most extreme retroversion. Backward angulation of the body of the uterus in relation to the cervix. Body of uterus often palpable through the rectum. Benign uterine tumors - SOLUTION Myomas of the uterus (fibroid) How many degrees of prolapse are there of the uterus and what is the worst? - SOLUTION 3 degrees. 3rd degree is worst, cervix and vagina are outside of the introitus.

Inguinal node location and where they drain - SOLUTION Deep inguinal nodes located medial to the femoral vein and under the cribriform fascia. 3- 5 deep nodes. lymph from vulva and lower vagina. When does menopause usually occur? What hormone drops during this time and what does it cause? - SOLUTION 45-52 years of age. Estrogen drops. Hot flahses, flushing, sweating, sleep disurptions, vaginal dryness. What happens to ovaries during menopause? - SOLUTION 3-5 years after menopause, the ovaries become atrophic and usually non-palpable. Describe anteverted, retroverted, retroflexed positioning of the uterus. - SOLUTION Ante (forward) flexed Retro (backwards leaning) Retroflexed (backwards-bent) In 2nd trimester, fetus pushes the uterus into what position? - SOLUTION Anteflexed Chadwick's sign - SOLUTION Bluish color of vagina due to increased vascularity in the pelvis What happens to cervix after conception? What sign can you feel - SOLUTION Softens, turns bluish. Increased vascularity, edema, and glandular hyperplasia. ACOG recommendations for first reproductive health visit - SOLUTION 13- 15 years old PAP smear guidelines - SOLUTION 1st at age 21, then every 3 years til 29. Then Q 3 yeras age 30-65 and cotesting with HPV CDC recommendations screening STIs - SOLUTION Qyear sexually active adolescents and women <25 years old Anterior compartment prolapse: AKA cystocele is prolapse of what organ? - SOLUTION Bladder Posterior compartment prolapse: rectocele is prolapse of what organ? - SOLUTION Rectum

Hernia of intestines into vaginal wall? (seen posteriorly usually) - SOLUTION Enterocele Apical compartment prolapse is also known as? - SOLUTION Uterine prolapse. 1-3, 3 outside introitus. 2 at hymen. 1 into lower vagina. What are the common, 1 cm, smooth round yellow lesions that are found on the cervix? - SOLUTION Nabothian cysts (transient) What are the findings that are usually friable and should be removed on the uterus? - SOLUTION Polyps Where do a majority of cervical cancers appear? - SOLUTION Squamocolumnar junction As we age, which direction does the squamocolumnar junction go? Inside or outside the canal. - SOLUTION Inside Use what type of medium for bloody samples? - SOLUTION liquid-based Anterior cervix means what direction uterus? - SOLUTION Retroverted Midline cervix means what direction uterus? - SOLUTION mid position uterus Posterior cervix means what direction uterus? - SOLUTION anteverted uterus Are fallopian tubes normally felt on exam? - SOLUTION No What organs are in the adnexa? - SOLUTION Ovaries, fallopian tbes, pelvic muslc eintegrity Rectovaginal exam performed in asymptomatic women? - SOLUTION no Vulva is thin, atrophic, redder and more sensitive to touch. What type of patient? - SOLUTION Prepubertal girl.