Nursing APEA Exam
- Gestational diabetes screening occurs between what weeks gestation? 24-48
- When you ask the patient to take a deep breath in and then palpate over the RUQ abdomen. Positive when pain is elicited. This is a sign of ___________.Murphy’s sign; cholecystitis
- What are names of LABA medications?salmeterol
- What is encopresis in children? stool incontinence after the age of being toilet trained
- The medical term for being cross-eyed strabismus
- What is atopic dermatitis? eczema
- Tests used to diagnose developmental hip dysplasia? Barlow and Ortolani maneuvers
- What is the female athlete triad? disordered eating, amenorrhea, osteoporosis
- How do patients with aortic regurgitation typically present? they will have a long asymptomatic period followed by exercise intolerance, then dyspnea at rest. The left ventricle eventually fails unless the aortic valve is replaced.
- What does the rash of fifth disease (a viral exanthem) look like? maculopapular rash that blanches easily and may be accompanied by joint aches
- What cardiac abnormalities are expected to be heard on auscultation of a pregnant patient? a venous hum murmur and an S3
When a headache accompanies a stroke, is this most often hemorrhagic or ischemic?
AV nicking is most commonly seen on retinal exam of which chronic condition?
Within 6 months of being started on a TCA or SSRI, what is a common side effect that occurs?
When does otitis media with effusion usually occur?
either before or after an episode of acute otitis media. This effusion is not infected fluid but it is considered a breeding ground for bacteria. This should not be treated with antibiotics.
The medical term for jock itch
Tinea cruris “jock itch” is a common __________ infection and should be treated with what? fungal; OTC antifungal cream
What are teaching points for males to avoid contracting tinea cruris? dry off after swimming and don’t stay in a wet bathing suit
Tinea cruris can affect the inner thighs but never what else? the penis or scrotum
On microscopic exam, what is most likely to be seen in the presence of a bacterial infection? cocci and rods
On microscopic exam, what is most likely to be seen in the presence of a candidal infection? yeasts
What are dermatophytes? fungi
On microscopic exam, what is most likely to be seen in the presence of a dermatophytic (fungal) infection?
hyphae that are long, thin, and branching (such as in the case of tinea pedis, tinea cruris, and tinea corporis)
The medical term for ringworm
What is the most common cause of viral pneumonia in peds?
Viral pneumonia is the most common type of pneumonia in children of what ages?
6 months to 5 years
What is the simplest way to screen for nutritional adequacy in older adults?
measure their weight
How are scabies treated?
via permethrin and good hygiene
What are common side effects of NSAIDs?
renal impairment, acute renal failure, gastritis
What is the most common cause of pernicious anemias?
vitamin B12 deficiency
How should oral iron supplements be taken?
on an empty stomach with something acidic and high in calcium such as orange juice
Group A strep pharyngitis can be accompanied by what symptoms other than the classic Centor criteria?
abdominal pain, nausea, and vomiting
A stool specimen that is positive for WBCs is a sign of what?
a viral or bacterial infection
The only type of incontinence that would not benefit from pelvic floor therapy is what?
What do the skin manifestations of a penicillin allergy look like?
What are symptoms that someone will experience as soon as they are started on a SSRI and when will this resolve?
headache, nausea, insomnia, restlessness, agitation; will resolve in 2 weeks
What causes the dry cough in people taking an ACEI?
the buildup of bradykinin which is usually degraded by ACE
ACEI induced coughs usually begin how soon after starting the medication?
within 2 weeks
COPD is often associated with what sequelae?
anxiety and depression
When should an antiviral be started in a patient with shingles?
within 72 hours of the onset of symptoms
What is the drug of choice for treating UTIs in male patients?
bactrim for 7-10 days
What is the leading cause of CKD and ESRD in the united states?
What is the usual recommendation about administering MMR and varicella immunizations?
they should be given on the same day or at least one month apart
What are the classic symptoms of an atopic pregnancy?
amenorrhea, vaginal bleeding, abdominal pain
What is sideroblastic anemia?
when the bone marrow is unable to incorporate iron into hemoglobin. This may be either inherited or acquired.
Can a pregnant woman get the MMR vaccine while pregnant?
Why are the carotid arteries auscultated for bruits?
this is indicative of generalized atherosclerosis
What is roseola?
a viral exanthem characterized by a high fever for 3 days then abrupt stopping of the fever and a maculopapular rash that blanches. also known as exanthem subitum.
What are signs indicative of a meningitis infection?
Kernig and Brudzinski’s signs
Cancer in the bone marrow that results in skeletal destruction
What is the average age of diagnosis of multiple myeloma?
a skin disorder that causes the nose to enlarge and become red, bumpy, and bulbous
What are physical exam findings common in alcohol abuse?
tremors, macrocytosis (due to vitamin B12 and folate deficiencies common in alcoholics), hypertension, rhinophyma, peripheral neuropathy, teleangectasia, hepatosplenomegaly
What is the first sign of sexual maturation in a male?
an increase in testicular size (tanner stage 2)
The inability to name a familiar object
What happens to a womans vital signs when she is in her second trimester of pregnancy?
her blood pressure decreases
What is the most common cause of acute pharyngitis in children?
A depressed patient is started on an SSRI. When should another antidepressant be tried if there is no response?
If the number of bacteria on a urinalysis are greater than ____________________, this is indicative of a UTI.
What are signs of a ruptured TM other than the obviously ruptured TM?
muffled hearing and bright red blood in the canal
Osgood Schlatter disease produces pain where?
in the knees
Growing pains usually occur when?
Children with complaints of midbone pain should be worked for what MNM differential?
acute lymphocytic leukemia
NSAIDs should be used in caution with what patient population?
anyone with hypertension because they cause sodium retention and increase blood pressure
What is the most common cause of secondary dysmenorrhea?
endometriosis; symptoms include spotting in between periods, cervical stenosis or displacement, nodular or tender uterosacral ligaments
When should AAA screening be performed via US?
once for all males age 65-75 who have ever smoked
What is responsible for the transmission of poison ivy?
the oils from the plant itself. So the only way someone can pass it on to another person is if they still have oil from the plant on their skin (like if they haven’t bathed). Note that the fluid inside the blisters is not contagious
Actinic keratosis is a precursor for what?
squamos cell carcinoma
What is papilledema?
swelling of the optic nerve and disc secondary to increased ICP. Often co-occurring with a headache
Is sexual activity safe during pregnancy?
it can expose someone to STDs and it can also stimulate preterm labor due to stimulation of the lower uterine segment and release of oxtocin
A report of “knee locking” is a classic complaint of what?
a meniscal tear
Can a pregnant woman be on levothyroxine during pregnancy?
yes, she should continue it and have TSH checked monthly because she may need a higher dose as thyroid hormone needs increase during pregnancy
What characterizes mild persistent asthma?
asthma where symptoms occur more than twice weekly
People who do not have a spleen (asplenic) are at a greater risk of what?
more susceptible to bacterial infections
What 2 things put someone at the highest risk of developing pancreatitis?
gallstones and alcohol abuse. Hypertriglyceridemia can also cause it.
What are the RF for GI bleeding?
age 75 or older, warfarin use, daily NSAID use, chronic steroid use, PMHx of GI bleed
When two or more RF for a GI bleed are present, we should not start a patient on aspirin without what?
a daily PPI
What medication is first line for the treatment of asymptomatic bacteriuria or UTI in pregnancy?
Athletic amenorrhea increases one’s risk of developing what?
osteoporosis; this is because there is a loss of body fat and body fat is what produces estrogen so estrogen levels decline
An intervention being performed to prevent the occurrence of the same event happening again is an example of ___________ prevention. Give an example.
secondary; taking a daily aspirin to prevent another stroke after already having one
What is Strattera (atomoxetine) used for?
ADHD; side effect includes increased BP and HR so monitor closely
What is the drug Danazol and what is it used for?
an androgen used in the treatment of endometriosis and fibrocystic breast disease
Danazol, an androgen, has what potential side effects?
edema, hirsutism, hair loss, vocal changes
The Mirena (Levonorgestrol) IUD stays in for how long?
What is the most common reason for persistent gonorrhea infections?
failure of the patient to abstain from unprotected sexual intercourse
What class of drug is theophylline? What does it do?
methylxanthine; it’s a bronchodilator
Beta blockers are contraindicated in which cardiovascular condition?
variant (prinzmetal) angina bc they may induce coronary vasospasm from unopposed alpha receptor activity
What class of drug is Ropinirole (requip) and what is it used for?
dopamine agonist; restless leg syndrome
Are males or females more likely to commit suicide?
How do depression vs. anxiety differ in the way that they affect sleep?
anxiety usually causes people to have problems falling asleep whereas depression causes early morning wakening
What is the most common cause of pneumonia in all ages?
What is the most common cause of hemorrhagic stroke?
What helps prevent infection by maintaining the acidic environment of the ear canal?
Mortality associated with Kawasaki disease is most likely related to what?
coronary artery aneurysm
What is Kawasaki disease?
an acute febrile illness of early childhood characterized by vasculitis of the medium sized arteries, most noticeable in the coronary vessels
Serial echos must be performed in a patient with Kawasaki disease in order to rule out coronary artery aneurysms. When should these occur?
at the time of diagnosis, 1-2 weeks after onset of illness, 5-6 weeks after onset of illness
What is the most common cause of croup?
What are the two subsets of impetigo?
bullous (fluid filled) or nonbullous (honey crusts)
Which protein is an important mediator of the inflammatory response and serves as a messenger at the site of antigen (allergen) invasion?
cytokines; they are released by mast cells in response to an invading antigen and recruit leukocytes and eosinophils
Paroxysmal events associated with abnormal electrical discharges of neurons in the brain
What is HELLP syndrome in pregnancy?
stands for hemolysis, elevated liver enzymes, and low platelets; is characterized by thrombocytopenia, hemolytic anemia, and liver dysfunction
HELLP syndrome in pregnancy is due to what?
Patients with acute coronary syndrome typically have plaque erosion caused by what?
accumulation of hyaluronan and neutrophils
Which diagnostic study is most helpful for differentiating Alzheimer’s disease from dementia with Lewy bodies?
ADHD is a risk factor for both depression and what else?
Epididymitis with orchitis is commonly related to what?
Mycoplasma genitalium is most commonly associated with which disease presentation in men?
urethritis, especially if persistent or recurrent
- trachomatis stands for what common type of bacteria infection?
Chlamydia passed from a mother to a newborn can result in which problems for the newborn?
conjunctivitis and pneumonia
In a patient with patent ductus arteriosus, where is the murmur best heard?
localized at the left clavicle and is both systolic and diastolic
What is the ductus arteriosus?
provides the fetus with a pathway from the pulmonary artery to the aorta in utero in order to skip the lungs
What are examples of some conditions that have multifactorial inheritance?
diabetes, obesity, arthritis, cancer, Alzheimers
Seborrheic dermatitis is basically the same thing as what?
eczema of the scalp
The flow of air coming in and out of the lungs in one inhalation and one exhalation
peak expiratory flow
What does an incentive spirometer measure?
peak expiratory flow
What happens in the luteal phase of the menstrual cycle?
LH and FSH decrease, the ruptured follicle closes after an egg has been released and forms the corpus luteum, which produces progesterone. Estrogen and progesterone remain high and it is those two things that cause the lining of the uterus to thicken further in preparation for fertilization
What is a sign of the initial appearance of measurable histamines in a patient with allergic rhinitis?
The bacteria responsible for syphilis is called what?
The STI, chancroid, is caused by what responsible bacteria?
What is the most common cause of septic arthritis?
The STI, mycoplasma genitalium, is unique in what way?
it lacks a cell wall and has a terminal tip-like structure which allows it to attach to and enter other cells. It then modulates the host’s immune response
What are the 3 secondary causes of type 2 diabetes?
prolonged physical or emotional stress, pregnancy, drugs such as steroids and hormonal contraceptives
How does hyperinsulinemia in PCOS work?
insulin resistance occurs in all places except for the ovary which remains sensitive to insulin. This insulin upregulates androgen production.
Which drug classes are responsible for causing urinary retention?
antihistamines, TCAs, antispasmodics, bronchodilators, antipsychotics, carbidopa levodopa
A 75 year old patient is experiencing progressive confusion and memory deterioration. Which condition mimics dementia that this patient should be tested for?
Which hormones in late pregnancy can block insulin and cause gestational diabetes?
cortisol, estrogen, and placental lactogen
Target shaped skin lesions as a result of a hypersensitivity reaction to certain infections and drugs
An abnormal growth of squamos epithelium in the middle ear and mastoid
The cremasteric reflex is assessed in infants for what purpose?
to assess for retractile testicles; this occurs when the reflex is too strong and it pulls the testicle out of the body and into the groin; this is normal and should go away by puberty
Patient populations who may present atypically when having a MI include who?
diabetics, females, elderly
A disorder that results in the destruction of platelets due to an autoimmune response
idiopathic thrombocytopenia purpura
Pelvic inflammatory disease is most commonly caused by what?
chlamydia and gonorrhea
A protruding abdominal mass after bending over, lifting, or coughing, and is painful with coughing, is often what in adults?
Hiatal hernias cause what type of symptoms?
What is the name of an immature female gamete?
The fused ovum and sperm once fertilization has occurred
What are conditions that are often co-occurring with alopecia areata?
atopic dermatitis, vitiligo, thyroid disease, collagen-vascular diseases, Down syndrome
The medical term for eczema
The leading cause of death in infants under the age of 1
sudden unexplained infant death
How is varicella zoster transmitted?
via the respiratory tract
The presence of pruritic papules, macules, and vesicles in various stages of healing
What is presbycusis?
age related hearing loss
Age is the most common cause of presbycusis, but what other conditions may play a role in quickening the onset of this?
white, infections, smoking, hypertenson, diabetes, vascular disease, immune disorders, hormonal factors
The fascia layer of the male anatomy that the anterior 2/3s of the testicle resides in
A subtype of strabismus that describes an inward turning of the eye
The abducens nerve (CN VI) is responsible for what?
lateral movement of the eye outward
The trochlear nerve is responsible for what extraocular movement?
down and inward movement
Why is primary open-angle glaucoma considered a chronic glaucoma?
there is a SLOW rise in intraocular pressure
A benign epidermal tumor that is a well-demarcated, coin-like, pigmented lesion with a stuck on appearance
The most common precancerous skin lesion that results from years of repeated sun exposure
What happens during the follicular phase of the menstrual cycle?
FSH and LH increase which stimulate the production of estrogen. Ultimately, it is estrogen that prepares the uterus for ovum fertilization
A superficial dermatophyte/fungal infection of the skin of the scalp, eyebrows, and eyelashes
Bacterial invasion of the renal parenchyma
What is phimosis vs. paraphimosis?
phimosis is tightening of the foreskin over the glans that prevents retraction; paraphimosis is when you can retract the foreskin but you can’t pull it back up
What is a common characteristic of a person with Graves disease?
ophthalmopathy causing lymphocytes to infiltrate the extraocular muscle, resulting in paralysis of EOMs, involvement of the optic nerve, and corneal ulcers
Which phase of the menstrual cycle begins with a surge in LH and FSH?
What is the pathophys of HIV?
causes destruction of the CD4 T cells resulting in eventual immune suppression
Cells within the epidermis that are primarily responsible for protecting the skin from UV rays in sunlight
Body lice primarily live where?
on bedding and clothing, not people
Body lice are vectors for which diseases?
epidemic typhus, trench fever, relapsing fever
Fifth disease is spread via how?
What are other names of fifth disease?
parvovirus, slapped cheek disease
What is the life span of lice?
The hypersensitivity and pain crescendo experienced in conjunction with a migraine is thought to be related to the release of what?
substance P; a neurotransmitter which functions as the pain transmitter of the dorsal horn and is responsible for causing nausea, vomiting, stress, and anxiety
Where is the location of the tricuspid valve?
separates the right atrium and ventricle
What does a tricuspid regurgitation murmur sound like?
best heard at the left sternal border, on both systole and diastole. Increases with inspiration
When can you hear the murmur associated with pulmonic stenosis?
mid-late systolic murmur
When can you hear the murmur associated with aortic regurg?
When can you hear the murmur associated with mitral valve stenosis?
What EKG changes may be present during episodes of angina?
transient ST elevation, T wave changes such as inversions, ST depressionals, Q waves
Children and teens present with depression most commonly how?
Are the sickling of RBCS in sickle cell anemia reversible?
initially, yes they are reversible with oxygenation. But repeated episodes cause the cells to become irreversibly sickled.
When the brain is exposed to something rewarding, it responds by increasing the release of what?
Where are T cells produced?
in the thymus
Where are B cells produced?
in the bone marrow
What is the pathophys behind a thyrotoxic crisis (aka thyroid storm)?
T3 and T4 are overproduced which leads to increased production of epinephrine and severe hypermetabolism
What causes a reduction in the number of RBCs in pregnancy?
iron deficiency anemia due to blood volume expansion and a decrease in hemoglobin levels so the iron stores are depleted because they are needed to be used for the expanded blood volume
When should the ductus arteriosus close in an infant?
within the first 1-2 days of birth
The minimum arterial pressure exerted during relaxation and dilation of the ventricles
Lyme disease is caused by what spirochete present on ticks?
What are the potential sequelae of strep pharyngitis?
acute glomerulonephritis, peritonsillar abscess, toxic shock disease, rheumatic heart disease (although rare)
The medical term for pubic lice aka crabs
Petechiae noted on the cervix during a pelvic exam is a sign of what disease process?
trichomoniasis; also called “strawberry cervix”
What is the difference between a folliculitis and a furuncle?
folliculitis is an inflammation of the follice whereas a furuncle is an abscess that results from folliculitis
Urea is eliminated by the kidneys, but where does it come from originally?
from the liver as a byproduct of protein metabolism
What are the 5 primary structures of the immune system?
lymph nodes, thymus, tonsils, spleen, bone marrow
Bacteria most commonly responsible for pyelonephritis
What causes back pain in pregnancy?
curvature of the lumbosacral vertebrae
What is dacrocystitis?
inflammation of the nasolacrimal duct due to duct obstruction or infection
What are potential causes of blepharitis?
bacterial infection, dry eyes, rosacea
What are s/s of croup?
hoarseness, cough, inspiratory stridor, possible respiratory distress due to narrowing of the larynx
Women who become pregnant later in life have an increased risk of what?
What are things women can do to decrease their risk of breast cancer?
regular physical activity, breastfeeding
Does an increase or decrease in blood pH affect the rate and degree of sickling in sickle cell anemia?
a decrease in blood pH increases the rate
What is the difference between Prinzmetals and stable (classic angina)?
Prinzmetals may occur randomly and while at rest, whereas stable angina is usually only with physical activity
Why may infection of the palatine tonsils become serious very quickly?
the area is composed of loose connective tissue
What are cutaneous xanthomas?
localized lipid deposits caused by elevated lipids or LDL
Uterine prolpase is caused by stretching of the uterine ____________
What causes bacterial vaginosis?
a decrease in lactobacillus species within the vagina
Where is acanthosis nigricans most likely to occur?
axillae, neck, groin
What causes subjective tinnitus?
abnormal neuronal activity
HIV produces cellular immunity deficiency by depleting what?
helper T cells
What is the function of B cells in the immune system?
development of antibodies
When does the male fetus begin to produce testosterone and how?
around 9 weeks gestation due to the Leydig cells
What is the pathophys of Addison’s disease?
causes decreased or absent aldosterone levels resulting in increased excretion of sodium and water by the kidneys, and hyperkalemia
What is the most serious complication of Addison’s disease?
acute adrenal insufficiency or adrenal crisis
What are the 4 heart defects of Tetralogy of Fallot?
VSD, right ventricular hypertrophy, overriding aorta, pulmonary stenosis
What are the s/s of Kawasaki disease?
think CREAM; conjunctivitis, rash, erythema of hands and soles of feet, adenopathy (cervical), mucous membranes (strawberry tongue)
A palpable softening of the cervical isthmus during pregnancy
A bluish tint to the vagina and cervix due to increased vascularity during pregnancy
What is Paget’s disease?
where there is abnormal bone destruction or growth of bone. It is also a malignant disease of the breast.
Does Meniere’s disease result in hearing loss?
yes, gradual but progressive sensorineural hearing loss
What is another term for chronic bladder pain syndrome?
What classifies someone as having “prediabetes”?
hgba1c between 5.7 and 6.4
What classifies someone as having diabetes?
hgba1c 6.5 or greater
A reduction in vision in one or both eyes causing loss of binocular vision
What is Brudzinski’s sign?
the patient lies supine and the NP flexes the patients neck forward. If both hips and knees flex at the same time, this is indicative of meningitis
A child presents with erythematous papules and vesicles, that are weeping, oozing, and crusty. They are located all over the forehead, wrists, elbows, and backs of knees. What is this most likely to be?
In older adults, what is an audible S3 sound usually a sign of?
left ventricular hypertrophy from heart failure, or cardiomyopathy
How is cervical radiculopathy different from cervical myelopathy?
in radiculopathy, there is nerve root compression that results in burning pain and n/t in the neck and one arm. In myelopathy, there is pain with bilateral weakness and n/t in both the upper and lower extremities
Other than scratching the medial aspect of the thigh, how else can we elicit the cremasteric reflex in a child?
have them sit cross legged and blow into a balloon. This will increase intraabdominal pressure and stimulate the reflex.
What is the Lachman’s test and what does it identify?
used to assess for ACL tear; the knee is held passively at 30 degrees flexed and then one hand stabilizes the femur while the other applies a gentle anterior force to the proximal tibia. If it moves beyond it’s normal ROM, there may be an ACL tear
When should the testicles fully descend into the scrotum by in an infant?
6 months of age. If not descended by this time, then refer to Urology at 6 months although surgical correction (orchipexy) may not be performed until 1 year
What is another name for the moro reflex?
the startle reflex; both arms should extend outwards when this is positive
If a moro reflex in an infant is only positive in one arm, then what do you need to consider?
examine the clavicle for a potential fracture
Which model is used to designate risk factors for melanoma?
think HARMM; history, age, regular dermatologist absent, mole changing, male gender
What is a sign of an ankle fracture on physical exam?
point tenderness over the posterior malleolus with an inability to bear weight after 4 or more steps
What is an acoustic neuroma?
something pressing, likely a tumor, on the acoustic nerve that results in dizziness, loss of balance, facial numbness, hearing loss, and tinnitus
The axillary lymph nodes drain lymphatic fluid from where?
breast, upper abdomen, upper back, pectoral region, and upper limbs
International travelers to endemic areas are at a risk for what form of hepatitis?
hepatitis A because it can be transmitted through contaminated food or drink
Adrenarche is the early presence of pubic hair in girls aged __________
5-8 years old
A condition that presents with symptomatic limb ischemia upon exertion is termed:
atherosclerotic peripheral arterial disease
The largest salivary gland is the parotid gland, and where does it drain to?
Stensen’s duct which has an opening on the buccal mucosa opposite the second molar
The varus stress test assesses for a tear in which part of the lower extremities?
The valgus stress test assesses for a tear in which part of the lower extremities?
To evaluate the uterus during a bimanual exam, the examiner would lubricate the index and middle fingers of one hand and insert them into the vagina. The other hand would be placed on the abdomen where?
about midway betwee the umbilicus and symphysis pubis while elevating the cervix and uterus with the other hand
A feeling of constantly needing to pass stool
Severe constipation resulting from intestinal obstruction
What does the vaginal discharge associated with trich look like?
profuse, yellowish green that is malodorous
What does the discharge associated with bacterial vaginosis look like?
gray or white, thin, malodorous (fishy) and not profuse
The nurse practitioner instructs the patient to place on hand behind his back and touch his shoulder blade. This shoulder movement elicits what?
How do we test for flexion and extension of the shoulder?
extension is asking the patient to move their arm behind themself. Flexion is asking the patient to move their arm in front of the body
Symptoms related to Shaken Baby Syndrome are due to what?
uncontrollable cerebral edema and hypoxia
What are the symptoms of Shaken Baby Syndrome?
blindness, inability to perform previously learned milestones, flaccid muscle tone
Koplik’s spots are indicative of what disease?
The medical term for measles
What do Koplik’s spots of measles look like?
small white specks that resemble grains of salt on a red background
Round or oval shaped lesions surrounded by erythematous mucosa found anywhere on the oral mucosa
Excessive or prolonged menstrual flow occurring at regular intervals
Intermenstrual bleeding (aka spotting in between periods)
Polymenorrhea is when there are fewer than ________ between periods
Oligomenorrhea is when there are more than _______ between periods; or only 4-9 menstrual cycles per year
Retraction of the nipple and areola are suggestive of what?
an underlying breast mass; this is never considered normal
What is the straight leg raise test?
used to evaluate for sciatica; the NP raises the straight leg while flexing the hip and then dorsiflexes the foot. Positive if pain is elicited.
What is Tinel’s sign?
positive for carpal tunnel; the NP taps over the median nerve and is positive if n/t is felt
What is Phalen’s sign?
positive for carpal tunnel; patient holds their wrists together to form right angles for 60 seconds and is positive if n/t is felt
Test used to identify de Quervain’s tenosynovitis
Test of thumb movement by instructing the patient to place his thumb in the palm and then move the wrist toward the midline in ulnar deviation
What does the murmur associated with mitral regurg sound like?
pansystolic, harsh murmur heard loudest at the apex with radiation toward the left axilla
When auscultating the apex of the heart in a child older than 7, the bell of the stethoscope should be placed where?
fifth intercostal space to the left of the midclavicular line; if younger than 7, it is best heard at the third or fourth intercostal space
What is the main sign of Kaposi’s sarcoma?
raised or flat deep purple lesions in the mouth
Where do lesions of Kaposi’s sarcoma usually manifest?
in the mouth, GI tract, or lungs
A patient is experiencing a dull achy pain in the epigastric area with eating. This type of pain is consistent with what?
a gastric ulcer
How is the pain of a gastric ulcer vs. a duodenal ulcer different?
the pain is worsened with eating with a gastric ulcer but improved with eating in a duodenal ulcer
What are s/s of glaucoma?
loss of peripheral vision, halos around lights, difficulty focusing on near objects
Higher level functioning, such as using the telephone, doing laundry, taking medicine, etc. are considered to be called what?
instrumental activities of daily living
An inability to extend the knee is a sign of what?
a partial or complete patellar tendon tear
Which part of the spine controls the ankle DTRs?
sacral nerve 1
Which part of the spine controls the knee DTRs?
lumbar nerves 2, 3, 4
Which part of the spine controls the biceps DTRs?
cervical nerves 5 and 6
Which part of the spine controls the triceps DTRs?
cervical nerves 6 and 7
What are s/s of carpal tunnel syndrome?
dropping objects, unable to twist lids off of jars, aching at the wrist or forearm, numbness of the first 3 digits of the hand
Which movement indicates a nuchal rigidity sign when working a patient up for meningitis?
neck stiffness and resistance when flexing the neck forward
What is Kernig’s sign?
flex the patients leg at both the hip and the knee, then straighten the knee. Pain and resistance to extension of the knee are positive for meningitis.
A patient who is unable to touch his left scapula with his right hand likely has what?
a rotator cuff tear
A widened pulse pressure greater than or equal to 60 in an older adult is a risk factor for what?
cardiovascular disease, stroke, renal disease
The ethmoidal sinuses are located where?
between the eyes
Where do the sphenoid sinuses lie?
just behind the ethmoid sinuses
Where do the maxillary sinuses lie?
around the nasal cavity
What describes a stage III pressure ulcer?
full thickness tissue loss and subcutanous fat may be present, but bone, tendon, or muscle are not exposed
Dislocation of the elbow joint caused by the sudden pull on the extended pronated forearm
Localized tenderness over the ankle joint is a sign of what?
a ligamentous injury; point tenderness and inability to bear weight is more of a sign of an ankle fracture
Describe renal adaptation of the newborn
the kidneys are structurally complete but physiologically immature. the infant is at increased risk of metabolic acidosis due to the kidneys inability to concentrate urine and adapt to fluid and electrolyte stress
Where is the best place to locate the twelfth rib?
between the spine and lateral chest
What is biliary colic?
pain in the epigastric region or RUQ that radiates to the right scapula or shoulder; indicative of cholecystitis
Costochondritis occurs when there is inflammation of the cartilage where?
that connects the ribs to the sternum
What aggravates costochondritis?
movement of the chest, trunk, and arms
Which segments of the spine control the plantar reflexes?
lumbar 5 and sacral 1
A softening of the skin at the angles of the mouth which may be due to nutritional deficiency
Angular cheilitis can be caused by what?
What causes actinic cheilitis?
excessive exposure to sunlight; most often affects the lower lip
Intention tremors appear with movement and worsen when?
as the target gets closer
Nausea, diaphoresis, and pallor triggered by a fearful or unpleasant event
Which conditions are known to cause polyuria?
lithium toxicity, uncontrolled diabetes, disorders of the posterior pituitary and hypothalamus (hypogonadism), and hypokalemic nephropathy
Breath sounds heard over the periphery of the lung fields are what?
vesicular; they are quiet and wispy
What do bronchovesicular breath sounds sound like?
full inspiratory phase with a shortened and quieter expiratory phase
Thenar atrophy suggests what?
a median nerve disorder
Does the ulnar nerve innervate the pinky or the thumb?
The pregnant woman who has a BMI of less than 18.5 should gain how many pounds in pregnancy?
The pregnant woman who has a BMI of 18.5-24.9 (normal) should gain how many pounds in pregnancy?
The pregnant woman who has a BMI of 25-29.9 (overweight) should gain how many pounds in pregnancy?
The pregnant woman with a BMI over 30 should gain how many pounds in pregnancy?
A BMI of less than _____ is considered underweight
The term used to refer to skin that is peeling
What will a basal cell carcinoma on the eyelid look like?
papule with an ulcerated center, most often on the lower lid and medial canthus
What is Rovsing’s sign?
positive for appendicitis; palpation on the LLQ elicits pain in the RLQ
What causes plantar warts?
human papillomavirus; usually occur on the sole of the foot
In second degree uterine prolapse, where is the cervix located?
at the introitus
In third degree uterine prolapse, where is the cervix located?
both the cervix and vagina are outside the introitus
The anterior cervical lymph node chain is located where?
anterior and superficial to the sternocleidomastoid muscle
How do we diagnose a migraine headache?
if 3 of the 5 POUND symptoms are present: pulsatile or throbbing, one day duration or 4-72 hours if left untreated, unilateral, nausea or vomiting, disabiling or intense causing interruption of daily activity
What causes the S4 sound?
the atrium forcefully contracting against a stiffened ventricle
During the vaginal exam of a pregnant woman in her first trimester, an adnexal mass with tenderness is palpated. This is consistent with what?
an ectopic pregnancy
Stridor indicates a partial or complete obstruction of the _________ and is best heard where?
When assessing an african american person, black, dusky mucous membranes are related to what
Persistent, sharp, and knife-like chest pain is indicative of what?
pericarditis or pleuritic chest pain
Thin, pencil-like stool can be associated with what?
a lesion in the sigmoid colon
An acute viral illness that presents with a burning retrosternal discomfort and a dry cough is suggestive of what?
The shiny, pink area located around the cervical os is known as what?
Tenderness of the posterior medial malleolus may be a sign of what?
When performing a rectal exam on a female, a hard nodular rectal “shelf” is palpable at the tip of the examiner’s finger. What is this suggestive of? metastatic tissue in the rectouterine pouch