Relaxation of ventricles; filling of atria; atrial contraction; filling of ventricles
Ventricular contraction (AV valves close); ends with closure of semilunar valves
Mitral/tricuspid valves closing
Pulmonic/aortic valves closing
When do the coronary arteries receive oxygenated blood to feed itself?
Difference between ischemia & infarct?
Ischemia is lack of blood flow; infarct is muscle death from that lack of blood flow
Amount of blood ejected by LV per beat
How do you calculate CO?
HR x SV
What is pulse pressure?
SBP - DBP
What are 2 deep veins in the thigh region?
Great saphenous & femoral
What kind of veins are at risk of developing a thrombosis?
Deep veins (DVT) such as popliteal, anterior tibial, femoral, great saphenous, etc
Where is the epitrochlear node of the lymph system located?
Bilaterally inside above elbow
If you have a swollen epitrochlear node, or any lymph node, where will the problem be coming from?
Distal to blocked node/s
What regions host nodular clusters?
Axillary, inguinal, & cervical
Where do lymphatic capillaries receive their fluid from?
Interstitial tissue spaces & passively due to muscle contraction moving fluid into vessels
Why do fetuses have right to left shunting?
No need for full pulmonary perfusion due to receiving oxygenation from mother
When do the foramen ovale & ductus arteriosus close
Shortly after birth (<24 hrs)
What should you consider when assessing lymph nodes in children?
Nodes are larger in children; often palpable
Larger response w/infection
What assessment changes occur with a pregnant patient?
-Increased blood volume
-Loud S3 (gallop)
What happens r/t pressure of the uterus on the inferior vena cava & iliac veins?
Edema & varicosities
What happens to BP in older adults?
SBP increases over time
What does the normal enlargement of calf veins in older adults place them at greater risk for?
What is the definition of orthostatic BP?
Within 3 minutes of going from lying to standing, a SBP drop of 20 or more or DBP drops by 10 or more
The pain caused by ischemia
Outside of BP parameters, what other findings would indicate positive orthostatic VS?
Increase in HR of 20
How long do you lie down before taking first BP/Pulse with orthostatic VS?
How long do you wait after each position change?
What happens with fluid volume as the body shifts from supine to upright position?
500mL - 1000mL shifts to lower body
What are the 2 causes of orthostatic hypotension?
-Reduced venous return = less circulatory volume
-Vasoconstriction in order to maintain same supply w/lower volume
Regarding normal vascular compensation, what's the normal expected shifting values associated w/HR & BP in orthostatics?
HR: Increase around 5-20
SBP: A drop less than or equal to 10
DBP: A rise of around 5
What parameters equate to orthostatic hypotension?
-SBP drop of at least 20
-DBP drop of at least 10
-HR rise of at least 20
*Must be within 3 minutes of standing
How fast must the orthostatic recordings happen after the patient stands?
Within 3 minutes of standing
When auscultating the carotid (or other vessel) for bruit, what part of stethoscope do you use?
What position do you start the patient in for the neck exam?
What do jugular pulses greater than normal indicate?
What is considered normal when auscultating the carotid arteries?
No sound = normal!
What is bruit?
Turbulent blood flow (swooshing)
What does bruit cause?
When assessing jugular veins, what position do you start with, and which one do you move to?
Seated, then supine
What does volume overload/increased venous pressure, revealed by JVD, cause?
What would be suspected if the apical pulse was lower than the 5th ICS & was lateral to MCL
Cardiomegaly (enlarged heart)
1. What part of stethoscope do you use to listen to normal heart sounds (S1/S2)?
2. What part for extra sounds (S3/S4)?
1. Diaphragm (high pitch)
2. Bell (low pitch)
What sound does S1 make, & what does it represent?
"Lub"; closure of AV valves
Where is S1 loudest?
What sound does S2 make, & what does it represent?
"Dub"; closure of aortic/pulmonic valves
Where is S2 loudest?
1. When precordium is too "quiet", how should you position patient?
2. What does this do?
1. Place patient on L side
2. Brings apex to chest wall - easier to look, feel, & listen
What is S3?
What is S4?
May be a normal heart sound; disappears w/sitting; if pathologic, indicates early heart failure
S3 - "Kentucky" gallop
Generally not a normal heart sound; extra heart sound
S4 - "Tennessee" gallop
What are gallops a result of?
Ventricular filling or valve problems
When do S3/S4 occur?
-Both in diastole
-S3 early, S4 late
Identified when in the cardiac cycle they occur; caused by turbulent blood flow (valve regurgitation, stiffness)
What would a murmur occurring in systole be termed?
When assessing lymph nodes, what do you note?
When assessing legs, what would coolness or pallor indicate?
What are the depths for 1+ through 4+ pitting edema?
1+ = 2mm
2+ = 4mm
3+ = 6mm
4+ = 8mm
This type of edema may be caused by lymphedema or hyperthyroidism
With the exception of the femoral & popliteal pulses, how should you assess the patient’s various pulses?
Assess both sides at same time
What should you report when assessing a patient’s pulses?
Rhythm, symmetry, amplitude (rate is recorded in VS)
What are 2 ways to check for vascular insufficiency?
Manual compression test & color change with position change of legs
This disease process is usually associated with the femoral artery & its branches; produces thigh/calf symptoms
Peripheral Artery Disease (PAD)
What are some of the treatments for PAD?
-Assess risk factors (i.e. smoking)
-Vessel bypass graft
What are some medications used to treat PAD?
Statins & anticoagulants
Arterial insufficiency can lead to ulcers developing where?
Toes or outside of ankle
Ulceration due to arterial insufficiency leads to ulcers that look like what? What does the surrounding skin look like?
Round ulcer, minimal drainage; surrounding area is shiny/hard/cold (diminished pulses)
Ulceration due to venous insufficiency leads to ulcers that look like what?
Irregularly shaped (not round), wet/oozing
Complication of ulcers r/t arterial insufficiency
Complication of ulcers r/t venous insufficiency
Blood clots causing fluid to leak into tissue = ischemia
This variation of ulcer r/t insufficiency isn't caused by a lack of blood flow
Venous insufficiency ulcer
This variation of ulcer r/t insufficiency IS caused by a lack of blood flow
Arterial insufficiency ulcer
In PAD, the arteries that supply blood to the legs are narrowed, typically because of atherosclerosis, causing a cluster of pain symptoms referred to as this
The examiner is palpating the apical pulse. What's the normal size of this impulse?
How do you differentiate a split S2 from S3 (Kentucky gallop)?
S3 is lower pitched & is heard at the apex
What's the best position to listen for a pericardial friction rub?
With diaphragm; patient sitting up, leaning forward, breath held in expiration
What's your first step in auscultating the heart?
Identify S1 & S2
Where will you hear a split S2 most clearly?
Why should the bell of the stethoscope be pressed lightly against the skin?
So as to not act as a diaphragm
A murmur heard after S1 & before S2 is classified as this
Systolic (possibly benign); think of where in the cardiac cycle "after S1" occurs (during ventricular systole)
Where & how should you palpate the carotid artery during your assessment?
Medial to sternocleidomastoid, one side at a time
S1 coincides with what pulse?
S2 coincides with what wave on the ECG?
Inflammation of a vein associated with a clot
What are 2 causes of DVT?
-Hypercoagulability (r/t pain, stress, Sx)
A process involving superficial vein enlargement due to incompetent valves; can be painful, but isn't associated with DVT
2 treatments for varicose veins
Is lymphedema considered venous or arterial?
What special circumstances affect patients who suffer from lymphedema (i.e. flying, saunas)
-Wear compression sleeve due to lower pressure in airplanes
-Avoid saunas r/t increased temp encouraging swelling
Assumption that able-bodied individuals are the norm & differences from full ability are "bad"; can include discrimination vs. disabled
Any change in the work environment or in the way things are customarily done that enables an individual w/a disability to enjoy equal employment opportunities
What should you DO when working with blind/low-vision persons?
-Address directly & by name
-Use words like "look" & "see"
What should you NOT do when working with blind/low-vision persons?
-Grab their arm
-Pet guide dogs
-Relocate objects w/out telling them
What does the American Foundation for the Blind suggest when interacting with the disabled?
"Interact w/the person, not the disability."
Blind persons are more sensitive to touch, thus perhaps better at acupressure
If a patient has damaged right sided vision in one or both eyes, where is the damage stemming from in the brain?
What are the refractive parts of the eye?
What are the nerve receptors in the eye?
-Optic nerve (CN II), optic chiasm
What participates in the motor function of the eye?
-Extraocular muscles (CN III, IV, VI)
-Pupillary reflexes (CN III)
Which cranial nerve functions both with extraocular muscles & pupillary reflexes?
Optic nerve (sensory)
What does CN II control?
Cranial nerves III, IV, and VI work together to control what?
Regarding the 3 cranial nerves that control the extraocular muscles, what would help you identify which nerve was affected were an issue to arise?
Location of muscle problem
What action does the Oculomotor (CN III) induce?
Moves eye upward or temporally
What action does the Trochlear (CN IV) induce?
Moves eye down or nasally
What action does the Abducens (CN VI) induce?
General eye movement
How does the flow of the eye exam go?
2. Special procedures
3. Inspect/palpate external eye
4. Inspect internal structure (only red reflex)
Which reflex is both sensory & motor?
Pupillary reflex (CN III)
Testing sensory function for the eye includes what tests?
-Peripheral vision (confrontation test)
What test assesses peripheral vision?
Testing motor function for the eye includes what tests?
-Corneal light reflex
-Diagnostic positions test
If patient has corrective lenses, should the snellen test be performed with or without correction?
How many mistakes are allowed per line?
Up to 2
1. What's the first number in the Snellen Test?
2. What's the second?
1. Distance from chart
2. The distance from which a normal person could read the line
Abbreviation for right eye
Abbreviation for left eye
Abbreviation for both eyes
20/80 or worse in better eye; visually impaired
Snellen score for legally blind determination
20/200 in better eye
Connects central command with body
What does the inspection part of the head/face/neck exam entail?
Observing movement of head, face, and eyes
When palpating the head & scalp, what do you assess bilaterally for strength & palpability?
Temporal artery (i.e. 2+ bilaterally)
What would an abnormal finding for testing ROM with the TMJ be?
Sound of bones clicking or rubbing together; can indicate fracture or misalignment
How do you palpate lymph nodes?
With pads of fingers, very light pressure, circular motion
What's a normal finding for palpating lymph nodes?
If lymph nodes are palpable, what's a good sign that they're likely NOT cancerous?
-Moveable (not fixed)
-Small (pea sized)
If lymph nodes are palpable, what's a potential sign of malignancy within them while palpating them?
What are some functions of the nose?
-Resonance chamber for speech
-Houses olfactory receptors
-Sensory nerve endings (sneeze reflex, irritation from particles)
When does salivation start for infants?
At 3 months
What does the oral cavity contain?
What systems does the mouth belong to?
Digestive & respiratory
Location of the nasopharnyx
Behind soft palate
What are some common developmental subjective findings for children r/t the nose/mouth/throat?
-Teeth erupting/changing to permanent
What are some common developmental subjective findings for older adults r/t nose/mouth/throat?
-Changes in smell or taste
-Loss of teeth
What's the order for the exam that assesses nose/mouth/throat?
1. Inspect/palpate/percuss nose & sinuses, then...
2. Organize by region - outside to inside
When assessing the nose/mouth/throat, where you begin with inspection/palpation/percussion of nose & sinuses before moving to an organized regional assessment from outside to inside, how does this organization lay out?
1. Inspect & palpate lips & tongue
2. Inspect mouth & throat
When inspecting the internal nose, when would you not need to wear gloves?
When there's no discharge
What do you do prior to and immediately following inspection of the patient's internal nose?
Inflammation of the lips
Cracking/fissures at corners of the mouth are called __1__ and r/t __2__ deficiency
2. Vitamin B
What equipment is needed to exam oral cavity?
At least penlight & tongue depressor
The term referring to alignment of teeth when jaw is closed
Another term for tooth decay or cavities
Poor alignment of teeth when jaw is closed
What tool will help when assessing the tongue?
Using gauze to hold tongue
Abnormality of the tongue where it is tied or anchored to the front, reducing mobility
What are 2 abnormalities we may find when assessing the tongue?
Who is susceptible to candidiasis?
-Immunosuppressed patients (i.e. AIDS, steroids, chemo, transplants)
-Patients on ABX therapy
This tongue abnormality causes difficulty in speaking & feeding; often recognized by lactation specialists & is easily fixed with clipping of the frenulum
Anatomical name for throat
Grade of tonsils when touching each other (kissing)
Grade of tonsils when touching uvula
Grade of tonsils when between tonsillar pillars & uvula
Grade of tonsils when they extend to arches (normal)
How could you state "normal" for the uvula?
Midline, rises with phonation
Term referring to the grinding of teeth
Know the locations of the cranial bones
Meshed immovable joints uniting adjacent cranial bones
Crowns head from ear to ear at union of frontal & parietal bones
Separates head lengthwise between 2 parietal bones
Separates parietal bones crosswise from occipital bone
Cervical vertebrae; "atlas"
Cervical vertebrae; "axis"
1. How many pairs of salivary glands are accessible to examination on the face?
2. Parotid (in cheeks over mandible) & submandibular
Prominent "Adam's apple" in males
Lymph nodes located behind ear
Lymph nodes located in front of ear
Lymph nodes located at base of skull(just below ear level)
Lymph nodes located just below ear lobe; under angle of mandible
Lymph nodes located under lower jaw bone (mandible)
Lymph nodes located under chin
Lymph nodes overlying sternocleidomastoid muscle
Lymph nodes located in posterior triangle along edge of trapezius muscle
Lymph nodes located deep under sternocleidomastoid muscle
When lymph nodes are abnormal, you should check for the area they drain, which would be where?
Proximal (upstream) to abnormal lymph node
This type of headache usually involves a family history
With __1__, people lie down to feel better. With __2__ headaches, they need to move (even pace the floor) to feel better
Loss of consciousness before a fall may have this cause
Light-headed, swimming sensation, feeling of falling
True rotational spinning from neurological disease; can be either objective or subjective types
This phrase r/t a person feeling like the room is spinning
This phrase r/t the perception that a person is spinning
Acute onset of neck stiffness w/headache & fever may indicate this
Where do you palpate the TMJ, and how?
In front of tragus; have person open mouth to feel for smooth motion
Enlargement of the lymph nodes (>1cm) from infection, allergy, or neoplasm
Edematous swelling & ecchymosis of the presenting part of head caused by birth trauma; gradually resolves during first few days of life & needs no treatment
Subperiosteal hemorrhage; result of birth trauma; blood reabsorbs over first few weeks of life & usually requires no treatment
Resistance to neck flexion; indicative of meningeal irritation or meningitis
Excessive secretion of GH from pituitary after puberty creates enlarged skull & thickened cranial bones; head elongates with massive face & features
Chronic enlargement of thyroid gland due to low iodine in diet (i.e. some regions of world where iodine levels in soil are low)
Excessive secretion of ACTH & chronic steroid use; rounded, "moonlike" face
Deficiency of dopamine; immobility of face produces flat, expressionless, "masklike" facial appearance
Non-pitting edema r/t hypothyroidism
Accompanies chronic wasting diseases such as cancer, dehydration, and starvation
Rich vascular network in anterior part of septum; most common site of nosebleeds
Why is nasal mucosa redder than oral mucosa?
Rich blood supply to warm inhaled air
3 parallel bony projections that increase surface area to warm inhaled air; superior, middle, & inferior
Location of frontal sinuses
Bilaterally superior to eyes
Location of maxillary sinuses
Bilaterally below eyes - each side of nose
Midline fold of tissue that connects tongue to floor of mouth
Children have 20 of these temporary teeth
Dry mouth; side effect of many drugs
What facial bone articulates at a joint instead of a suture?
Blood vessel that runs diagonally across sternocleidomastoid muscle
External jugular vein
The isthmus of the thyroid lies just below this cartilage
Highest bone in neck; even with chin
What might precipitate cluster headaches?
ETOH & daytime napping
Symptom that is least likely to indicate malignancy
Providing resistance while patient shrugs shoulders tests cranial nerve _____
Upon examination, the fontanels should feel
firm, slightly concave, well defined
If thyroid gland is enlarged bilaterally, which maneuver is appropriate?
Listen for bruit over thyroid lobes
Characteristics of normal palpable lymph nodes in neck
Mobile, soft, nontender
Cephalhematoma is associated with this
What size are normal cervical lymph nodes?
This is usually linked to throbbing, unilateral pain with N/V, & photophobia
Unilateral paralysis of half the face
If you suspect an infant's head to be of abnormal size, what tool should you use to make sure?
Most common site of nosebleeds
What is the largest salivary gland, and where is it located?
Parotid gland - in cheeks in front of ear
A 70-year-old woman c/o dry mouth (xerostomia). The most frequent cause is
R/t medications she may be taking (side effect)
What's the best action to take if a deviated septum is noted upon assessment?
Document in record in event person needs to be suctioned
If tonsils were recorded at 3+, they would be
Touching the uvula
The opening of the adult's parotid gland (Stensen's duct) is opposite what?
Upper 2nd molar
What are 3 ways a nasal polyp may be distinguished from turbinates?
You notice small, round, white shiny papules on the hard palate & gums of a 2-month-old. What's the significance of this finding?
Normal - called Epstein pearls
When assessing the tongue, the examiner should
Palpate the U-shaped area under the tongue
Open space between the eyelids
Corneal reflex mediated by these cranial nerves
V & VII
Retinal structures viewed through ophthalmoscope
The thickening/yellowing of the lens, as a normal change in aging, is referred to as
What is the cover test (eye) used to assess for?
When using ophthalmoscope with glasses, how would you approach left eye of patient?
Remove glasses and approach patient's left eye with your left eye
The six muscles that control eye movement are innervated by what cranial nerves?
III, IV, VI
CN that moves eye laterally outward (i.e. left eye moves to 3 o'clock position, or right eye to 9 o'clock position)
CN that moves eye laterally inward and down (i.e. left eye moves to 7 o'clock position or right eye to 5 o'clock position)
Besides eye movements to the 3/9 o'clock positions (CN VI) or 5/7 o'clock positions (IV), all other cardinal directions are controlled by what CN?
A patient has blurred peripheral vision. You suspect glaucoma, and test the visual fields. A person with normal vision would see your finger temporally at
Will you get bilateral pupillary constriction in a person who is blind in one eye?
When using the ophthalmoscope, an interruption of the red reflex occurs when
There's an opacity in the cornea or lens
What causes the red reflex?
Light reflecting from retina
Color of normal TM
Type of hearing loss associated with gradual nerve degeneration
Sensorineural hearing loss
Parts of ear you should palpate before using otoscope
During an otoscopic exam of a child <3 yrs, how do you position the ear for visualization?
Pull pinna down
While viewing with an otoscope, you ask the person to hold their nose & swallow. You expect to see the eardrum do what during this maneuver?
How do you pull ear to perform otoscopic exam on an adult?
Up & back
Congenital, painless nodule at the helix
How should patient's head be positioned when using an otoscope?
Tilted away from examiner
Location of hearing receptors
The sensation of vertigo is the result of what?
Pathology in the semicircular canals
Common cause of conductive hearing loss
With acute purulent otitis media, how would the TM look?
Absent light reflex
If the TM appears yellow in color, what do you suspect is in the middle ear?
If a person with a head injury has clear, watery drainage coming from the ear, what should you do?
Check drainage for glucose
At what phase during nociception does the patient become aware of a painful sensation?
A description of a burning, painful sensation that moves around toes & bottom of feet would be symptoms indicative of what type of pain?
While examining your patient, he becomes pale & diaphoretic & c/o LUQ pain. This would be categorized as what type of pain?
What difference is present with preterm infants r/t pain perception/tolerance?
More sensitive to painful stimuli
Most reliable indicator of pain in the adult
Best tool to assess pain of a 4-year-old with a broken arm
When a person presents with acute ABD pain, and after the initial examination, is it best to withhold pain meds until DX testing is complete & a diagnosis is made?
Poorly controlled pain in geriatric post-op patients places them at greater risk for
Increased myocardial O2 demand
Impaired wound healing
A 30-year-old female reports having persistent intense pain in her right arm r/t MVA x5 months ago. The slightest touch or clothing can exacerbate the pain. This is suggestive of
Complex Regional Pain I
Appropriate pain assessment tool for preterm & term neonates
A pain problem should be anticipated in a cognitively impaired older adult with a HX of this type of vascular insufficiency
Peripheral vascular disease
Is pain in the aging adult considered to be part of the aging process?
Common physiologic change accompanying pain
Function of venous system r/t increased blood volume
Blood & volume reservoir
Organs that aid the lymphatic system
Ms. T. has come for a prenatal visit. She c/o dependent edema, varicosities in the legs, & hemorrhoids. The best response to her is...
Normal pregnancy S/S caused by pressure of growing uterus on veins
A 3+ pulse would be described as
Inspection of a person's right hand reveals a red, swollen area. To further assess for infection, you would palpate what?
Epitrochlear node (elbow)
To screen for DVT, you would
Measure widest point with tape measure
When assessing for arterial deficit, a normal color return in the lower extremities after raising them would be?
10 seconds or less
Most characteristic sign of varicose veins
Dilated, tortuous superficial bluish vessels
Atrophic skin changes that occur with peripheral arterial insufficiency include
Thin, shiny skin with loss of hair
Muscular pain brought on by exercise
Known risk factor for venous ulcer development
A change typical of chronic venous insufficiency; term refers to non-pitting edema
Loss of elasticity of the walls of blood vessels
Occurs in hands & feet r/t exposure to cold, vibration, & stress
Be familiar with inner structures of eye - except for scleral venous sinus & choroid (see opposite side for picture)
Be familiar with outer structures of eye (see opposite side for picture)
Farsightedness due to age; gradual loss of your eyes' ability to focus on nearby objects. It's a natural, often annoying part of aging; usually becomes noticeable in your early to mid-40s and continues to worsen until around age 65.
To test color vision, what 2 tests could you use?
Snellen (ID colors on chart)
Ishihara chart (dots/numbers)
Gross measure of peripheral vision; compares person's vision with your own
Leading cause of blindness; increased IOP; damage to optic nerve (CN II)
2 methods used to assess cardinal fields of gaze
Spokes or H
When assessing for nystagmus, what should you do as you move your tool outward (as patient is following it with their eyes)?
Pause at lateral aspect and watch for fast, uncontrollable movements
Occurs w/disease of semicircular canals (ears), paretic eye muscle, multiple sclerosis, or brain lesions
This test involves shining light at patient's eyes (midline), approx. 2 feet in front, while looking for a reflection of the light in the medial aspect of the bilateral pupils - reflection should be equal and towards nasal aspect
Corneal light reflex
Inward turning of the eye (strabismus)
Outward turning of the eyes (strabismus)
A finding of asymmetrical corneal light reflex, such as the light being reflected at 12 in the R eye but 3 in the L eye, is indicative of this
Strabismus (esotropia or exotropia)
Detects muscle weakness of the eyes
If a patient has a stronger left eye and it is covered during the Cover-Uncover Test, what do you expect the right eye to do?
Drift toward left eye
Normal size of pupils in adults
PERLLA - Shining the light __1__ times per eye tests both the __2__ and __3__ reflexes
Accommodation occurs when the pupils _____ & _____
Constrict & converge
Type of reflex tested by Corneal Light Reflex
Type of reflex tested by Confrontation Test
Type of reflex tested by near/distant vision & color vision tests
Type of reflex tested by Corneal Reflex
Mixed Sensory/Motor (CN V sensation of cornea; CN VII motor response)
What common thing could blunt the response to the corneal reflex?
Nearsighted individuals have difficulty seeing things at this distance
Far away things
Farsighted individuals have difficulty seeing things at this distance
Up close things
Distance vision of this measure in a preschooler can be a cause for referral
How long does it take for a newborn to be able to focus?
About 2 weeks
Newborns can only focus on objects 8-10 inches away until what age?
What eye changes can occur during pregnancy?
Visual acuity (r/t hormones)
A white, grey, or blue opaque ring in the corneal margin r/t lipid deposition; no effect on vision
Leading cause of blindness; happens around 75-85 years of age
Know where the following external ear structures are located:
Helix, antihelix, lobule, mastoid process, tragus, external auditory meatus
Mastoid process is behind ear on temporal bone
What does mastoid tenderness possibly indicate?
Middle ear infection
The cone of light is at __1__ in the right ear and __2__ in the left ear
1. 5 o'clock
2. 7 o'clock
Age-related hearing loss
Drain fluid to prevent TM perforation
If a boil (furuncle) forms on the cartilaginous part of the ear (most common), and occludes the meatus due to inflammation, what lymph node/s would become palpable & tender?
General hearing screening involving the use of 3 random letters and/or numbers, spoken lightly and at least 2 feet behind patient; patient occludes & rubs external auditory meatus of non-tested ear
How does the examiner adequately prepare to whisper for the Whisper Test (hearing test)?
Full breath - exhale - whisper
Hearing loss r/t external or middle ear; caused by obstruction, impacted cerumen, or fluid in middle ear
Conductive hearing loss
What would the formation of spongy bone in the ears cause?
Deafness (particularly low tones)
Results in ankylosis (immobility) of the stapes
Hearing loss r/t deterioration of cochlea (organ of Corti) or damage to CN VIII
Sensorineural hearing loss
What can damage the cochlea (organ of Corti)?
What is the sensory structure/organ of the inner ear?
Organ of Corti
8 symptom (pain) dimensions
PQRSTU + associated factors & setting
Nervous system transmission of the pain signal
4 parts of nociceptive response, from beginning
1. Transduction (from injury site to spine)
2. Transmission (spine to brain)
3. Perception (conscious recognition)
4. Modulation (descending influence on pain signal)
Pain causes nervous system to become more efficient at transmitting pain; learns to relay pain impulse better
State of severe distress associated with events that threaten the intactness of the person
Type of pain considered dull, aching, well-localized, nocturnal
Somatic (nociceptive) pain
Type of pain considered deep squeezing pressure, local tenderness & referred, poorly localized
Visceral (nociceptive) pain
Type of pain considered burning, stabbing, vice-like, electric shock-like, etc.
Type of pain associated with post-op, bone metastases, arthritis, sports injury, or mechanical back pain
Somatic (nociceptive) pain
Type of pain associated with liver metastases, pancreatic cancer
Visceral (nociceptive) pain
Type of pain associated with stroke, herpes zoster, trigeminal neuralgia, complex regional pain syndrome
Excessive sensitivity to pain
Non-painful stimulus causes pain
Maximum pain that a person can endure
Medication approach for the different types of pain: acute, chronic, neuropathic, and cancer
Acute: NSAIDs, Opioids
Chronic: Tylenol (1st line), start w/non-opioid, then long-acting opioid
Neuropathic: Opioids don't work well (except methadone), use antidepressants, anticonvulsants
Cancer: If terminal, high dose opioids
What's the first line medication for chronic pain?
Looks like addiction, but patient wants medication because they are really in pain
Your patient’s right calf is cool, and the popliteal pulse is a weak 1+. There is no swelling. The patient reports calf pain upon walking. You find an ulcer on the outside of the ankle. Based on these findings, which of the following characteristics would be expected of this ulcer?
a. Irregular edges
b. Oozing, wet appearance
c. Edema in the calf
d. Round appearance
D - round appearance
While assessing an 80 year-old patient you notice some signs of dental caries. This finding is most likely related to what age-related physiological change?
a. Increased bruxism (teeth gnashing)
b. Shift from nasal breathing to mouth breathing
c. Decreased salivation
d. None of the above
C - decreased salivation
The nurse is testing a patient’s visual accommodation, which refers to which action?
a. Pupillary constriction when looking at a near object
b. Pupillary dilation when looking at a far object
c. Changes in peripheral vision in response to light
d. Involuntary blinking in the presence of bright light
To assess the function of the optic nerve (CN II) which equipment would be used?
a. Finger, to test the cardinal fields
b. Flashlight, to test corneal light reflexes
c. Snellen chart, to test visual acuity
d. Piece of cotton, to test corneal sensitivity
C - visual acuity & snellenhis
This happens late in diastole - just before S1; almost always a pathological issue
S4 - "Tennessee" gallop
Goes S4,S1...(normal pause)...S2
This happens early in diastole - just after S2; can be benign or normal, or it can be pathological
S3 - "Kentucky" gallop
Goes S1...(normal pause)...S2,S3
These types of murmurs are always pathological
These types of murmurs may or may not be of a pathological significance