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?

Amount of blood ejected by LV per beat

How do you calculate CO?

What is pulse pressure?

What are 2 deep veins in the thigh region?

What kind of veins are at risk of developing a thrombosis?

Where is the epitrochlear node of the lymph system located?

If you have a swollen epitrochlear node, or any lymph node, where will the problem be coming from?

What regions host nodular clusters?

Where do lymphatic capillaries receive their fluid from?

Why do fetuses have right to left shunting?

When do the foramen ovale & ductus arteriosus close

What should you consider when assessing lymph nodes in children?

What assessment changes occur with a pregnant patient?

What happens r/t pressure of the uterus on the inferior vena cava & iliac veins?

What happens to BP in older adults?

What does the normal enlargement of calf veins in older adults place them at greater risk for?

What is the definition of orthostatic BP?

The pain caused by ischemia

Outside of BP parameters, what other findings would indicate positive orthostatic VS?

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?

What are the 2 causes of orthostatic hypotension?

Regarding normal vascular compensation, what's the normal expected shifting values associated w/HR & BP in orthostatics?

What parameters equate to orthostatic hypotension?

How fast must the orthostatic recordings happen after the patient stands?

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?

What is bruit?

What does bruit cause?

When assessing jugular veins, what position do you start with, and which one do you move to?

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

1. What part of stethoscope do you use to listen to normal heart sounds (S1/S2)?
2. What part for extra sounds (S3/S4)?

What sound does S1 make, & what does it represent?

Where is S1 loudest?

What sound does S2 make, & what does it represent?

Where is S2 loudest?

1. When precordium is too "quiet", how should you position patient?

2. What does this do?

What is S3?

What is S4?

May be a normal heart sound; disappears w/sitting; if pathologic, indicates early heart failure

Generally not a normal heart sound; extra heart sound

What are gallops a result of?

When do S3/S4 occur?

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?

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?

What should you report when assessing a patient’s pulses?

What are 2 ways to check for vascular insufficiency?

This disease process is usually associated with the femoral artery & its branches; produces thigh/calf symptoms

What are some of the treatments for PAD?

What are some medications used to treat PAD?

Arterial insufficiency can lead to ulcers developing where?

Ulceration due to arterial insufficiency leads to ulcers that look like what? What does the surrounding skin look like?

Ulceration due to venous insufficiency leads to ulcers that look like what?

Complication of ulcers r/t arterial insufficiency

Complication of ulcers r/t venous insufficiency

This variation of ulcer r/t insufficiency isn't caused by a lack of blood flow

This variation of ulcer r/t insufficiency IS caused by a lack of blood flow

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)?

What's the best position to listen for a pericardial friction rub?

What's your first step in auscultating the heart?

Where will you hear a split S2 most clearly?

Why should the bell of the stethoscope be pressed lightly against the skin?

A murmur heard after S1 & before S2 is classified as this

Where & how should you palpate the carotid artery during your assessment?

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?

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)

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?

What should you NOT do when working with blind/low-vision persons?

What does the American Foundation for the Blind suggest when interacting with the disabled?

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?

What participates in the motor function of the eye?

Which cranial nerve functions both with extraocular muscles & pupillary reflexes?

CN II

What does CN II control?

CN III

CN IV

CN VI

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?

What action does the Oculomotor (CN III) induce?

What action does the Trochlear (CN IV) induce?

What action does the Abducens (CN VI) induce?

How does the flow of the eye exam go?

Which reflex is both sensory & motor?

Testing sensory function for the eye includes what tests?

What test assesses peripheral vision?

Testing motor function for the eye includes what tests?

If patient has corrective lenses, should the snellen test be performed with or without correction?

Snellen Test:

How many mistakes are allowed per line?

1. What's the first number in the Snellen Test?

2. What's the second?

Abbreviation for right eye

Abbreviation for left eye

Abbreviation for both eyes

Near-sightedness

20/80 or worse in better eye; visually impaired

Snellen score for legally blind determination

Farsightedness

Connects central command with body

What does the inspection part of the head/face/neck exam entail?

When palpating the head & scalp, what do you assess bilaterally for strength & palpability?

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?

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?

If lymph nodes are palpable, what's a potential sign of malignancy within them while palpating them?

What are some functions of the nose?

When does salivation start for infants?

What does the oral cavity contain?

What systems does the mouth belong to?

Location of the nasopharnyx

What are some common developmental subjective findings for children r/t the nose/mouth/throat?

What are some common developmental subjective findings for older adults r/t nose/mouth/throat?

What's the order for the exam that assesses nose/mouth/throat?

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?

When inspecting the internal nose, when would you not need to wear gloves?

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

What equipment is needed to exam oral cavity?

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?

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?

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?

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. Name/location?

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?

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?

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?

3 parallel bony projections that increase surface area to warm inhaled air; superior, middle, & inferior

Location of frontal sinuses

Location of maxillary sinuses

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

The isthmus of the thyroid lies just below this cartilage

Highest bone in neck; even with chin

What might precipitate cluster headaches?

Symptom that is least likely to indicate malignancy

Providing resistance while patient shrugs shoulders tests cranial nerve _____

Upon examination, the fontanels should feel

If thyroid gland is enlarged bilaterally, which maneuver is appropriate?

Characteristics of normal palpable lymph nodes in neck

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?

A 70-year-old woman c/o dry mouth (xerostomia). The most frequent cause is

What's the best action to take if a deviated septum is noted upon assessment?

If tonsils were recorded at 3+, they would be

The opening of the adult's parotid gland (Stensen's duct) is opposite what?

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?

When assessing the tongue, the examiner should

Open space between the eyelids

Corneal reflex mediated by these cranial nerves

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?

The six muscles that control eye movement are innervated by what cranial nerves?

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

What causes the red reflex?

Color of normal TM

Type of hearing loss associated with gradual nerve degeneration

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?

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?

Congenital, painless nodule at the helix

How should patient's head be positioned when using an otoscope?

Location of hearing receptors

The sensation of vertigo is the result of what?

Common cause of conductive hearing loss

With acute purulent otitis media, how would the TM look?

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?

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?

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

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

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

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

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...

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?

To screen for DVT, you would

When assessing for arterial deficit, a normal color return in the lower extremities after raising them would be?

Most characteristic sign of varicose veins

Atrophic skin changes that occur with peripheral arterial insufficiency include

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)

Nearsightedness

Farsightedness

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?

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

When assessing for nystagmus, what should you do as you move your tool outward (as patient is following it with their eyes)?

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

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

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?

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 _____ & _____

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

What common thing could blunt the response to the corneal reflex?

Nearsighted individuals have difficulty seeing things at this distance

Farsighted individuals have difficulty seeing things at this distance

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?

Newborns can only focus on objects 8-10 inches away until what age?

What eye changes can occur during pregnancy?

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

What does mastoid tenderness possibly indicate?

The cone of light is at __1__ in the right ear and __2__ in the left ear

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)?

Hearing loss r/t external or middle ear; caused by obstruction, impacted cerumen, or fluid in middle ear

What would the formation of spongy bone in the ears cause?

Hearing loss r/t deterioration of cochlea (organ of Corti) or damage to CN VIII

What can damage the cochlea (organ of Corti)?

What is the sensory structure/organ of the inner ear?

8 symptom (pain) dimensions

Nervous system transmission of the pain signal

4 parts of nociceptive response, from beginning

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

Type of pain considered deep squeezing pressure, local tenderness & referred, poorly localized

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

Type of pain associated with liver metastases, pancreatic cancer

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

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

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

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

This happens late in diastole - just before S1; almost always a pathological issue

This happens early in diastole - just after S2; can be benign or normal, or it can be pathological

These types of murmurs are always pathological

These types of murmurs may or may not be of a pathological significance