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222 Cards in this Set
- Front
- Back
when using the snellen eye chart, where does the client's head need to be in relation to yours?
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The person's head should be at "my" eye level
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What is the snellen eye chart used to measure?
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visual accuity
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What do you do with reading glasses of the client taking the snellen eye exam?
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remove them
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The top number on the visual acuity test (ie., 20/20) measures what?
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the distance the person is standing from the chart
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the bottom number of 20/20 in regard to vision represents what?
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the person can read at 20 feet what the normal person can read at 20 feet
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The decrease in power of accommodation with aging is called what?
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presbyopia
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What is the name of the test that tests corneal light reflex?
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the hirshberg test
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What eye test detects small degrees of deviated alignment by interrupting the fusion reflex?
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the cover test
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A mild weakness noted only when fusion is blocked of the eye?
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phoria
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A constant malalignment of the eyes is....
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Tropia
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Leading the eyes through the six cardinal positions of gaze to elicit muscle weakness...
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diagnostic positions test
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Failure to follow in a certain direction with the eyes indicates what?
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extraocular muscle weakness or dysfunction of the cranial nerve
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A fine oscillating movenent of the eyes seen during the diagnostic positions test is...
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a nystagmus
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If the upper eyelid does not overlap the superior part of the iris, even during downward movement, it is...
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lid lag
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The normal reaction to the pupillary light reflex
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constriction of the same-sided pupil and simultaneous constriction of the other pupil
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The resting size of the pupil is normally...
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3,4, or 5 mm and decreases equally in response to light
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If the person focuses on a distant objec with her eyes and her pupils dialate, this indicates what?
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accommodation
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A normal response to accommodation would include what two things?
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1. pupillary constriction
2. convergence of the axes of the eyes |
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Diameter of the disk, or DD, is a standard measure for what?
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other fundus structures
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if you saw the words "at 5:00, 3DD from the disk", where would the object be?
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3 disk diameters away from the optic disk
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Which vessels of the eye have the arterial light reflex?
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arteries
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If an artery and vein cross paths, it is called...
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A-V (or arteriovenous crossing)
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What would you expect to see as far as numbers/location of vessels of the eye?
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a paired artery and vein passing next to each other in each quadrant of the eye
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A crossing at more than .....DD away from the disk is abnormal
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2
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Squint or cross eye is known as...
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strabismus
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Strabismus should be measured when?
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early child hood
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Strabismus causes what?
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disconjugate vision because one eye deviates off the fixation point
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When the brain supresses images from the weak eye, it is called...
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a suppression scotoma
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the resulting loss of vision due to disuse is called
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amblyopia exanopsia
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Asymmetry during the corneal light reflex under....is normal
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6 months
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What is a method of getting a newborn to open her eyes?
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hold the baby supine and gently lower the head/hold infant at arms length and turn in one direction
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Holding the baby at arms length and turning in one direction tests for what?
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vestibular function reflex
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the vestibular function reflex disapears after....
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2 months of age
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How long is the external auditory canal?
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2.5 to 3 cm long
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the outer one third of the ear canal is made of....
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cartiledge
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the inner two-thirds of the ear canal is made of..
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bone
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The canal has an...shape in an adult
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s shape
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The inner two thirds of the ear angle towards what?
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down towards the nose
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what separates the external and middle ear and is tilted obliquely to the ear canal?
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the tympanic membrane
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What are the parts of the malleus that show through the ear drum?
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umbo, manubrium, and the short process
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The tiny air-filled cavity inside the temporal bone is the...
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middle ear
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the middle ear holds what bones?
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malleus, incus, stapes
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the opening of the inner ear to the outer ear is covered by what?
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the tympanic membrane
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What connects the middle ear with the nasopharynx and allows passage of air?
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the eustacian tube
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What are the functions of the middle ear?
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conducts sound/protects inner ear by reducing sounds/allows equalization of air pressure
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The inner ear contains what?
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the bony labyrinth which holds the sensory organs for equilibrium and hearing
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what composes the vestibular apparatus and the cochlea?
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the vestibule and the semicircular canals
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the auditory system can be divided into what 3 levels?
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peripheral, brainstem, and cerebral cortex
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what vibrates at a point specific to the frequency of the sound?
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basilar membrane
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what are the numerous fibers along the basilar membrane at its base near the stapes called?
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the organ of corti
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What is the function of the brainstem in hearing?
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binaural interaction
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What cranial nerve sends signals to the brainstem from the ears?
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viii
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The function of the cortex in hearing is...
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interpretation
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What type of conduction is least effective in hearing?
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bone conduction (BC)
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a gradual nerve degeneration that occurs with aging or by ototoxic drugs is called
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presbycusis
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What part of the ear feeds info to the brain about the body's position in space?
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the bony labyrinth
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if the bony labyrinth of the ear becomes inflamed, what can happen?
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vertigo
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what week of gestation do the inner ears start to develop?
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4th week
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describe the postion of the infants eustacian tube in relation to the adults
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it is shorter/wider/ and more horizontal
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what is a gradual hardening that causes the foot plate of the stapes to become fixed in the oval window?
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otosclerosis
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what decade of life does presbycusis normally begin?
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5th
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the normal eardrum is..
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shiny/translucent/pearl-gray color. light reflex: r.ear:5 oclock, l.ear:7 oclock
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what color would the drum be with serous otitis media?
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yellow-amber
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what color would the ear drum be with acute otitis media?
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red
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Air/fluid level or air bubbles behind the drum indicate what?
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serous otitis media
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What would the eardrum do if a person performed the valsalva maneuver or held her nose?
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it would flutter
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ear drum hypomobility is an early sign of ...
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otitis media
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Tuning forks measure hearing by...
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Air conduction (AC) or by bone conduction (BC)
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A person unable to hear whispered words might have what sort of hearing loss?
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high-toned hearing loss
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The test to use when hearing is better in one ear is...
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the weber test
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a test to compare air conduction and bone conduction of the ears
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the Rinne test
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In the air test, sound is heard in what proportion AC:BC?
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AC 2:BC 1
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Sexual maturity rating of girls is called ...
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tanner staging
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The breast bud stage is stage..
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2
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the nipple is flush w/ breast surface is stage...
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3
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the areola and nipple form a secondary mound over breast is stage...
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4
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only the nipple protrudes; the areola is flush w/ breast is stage...
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5
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the beginning of breast development occurs in what relation to menarche?
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breast develpment occurs 2 years before menarchy
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the breast volume is smallest when?
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on days 4-7 of menstrual cycle
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Colustrum is expressed at this time of pregnancy
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4th month
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Atrophied glandular tissue of the post menopausal breast is replaced by...
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fibrous connective tissue
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Most common breast to be larger in assymetry of breasts
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left
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a sudden increase in size of one breast may indicate..
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inflamation or new growth
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Edema gives what sort of appearance to breasts?
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pig skin or orange peel (peau d'orange)
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A supernumerary nipple is usually found along the...
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milk line on the thorax or abdomen, 5-6 sm below breast
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When auscultating for chest sounds of an infant do this:
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use the smaller pediatric diaphragm or the bell over infant's interspaces and not over the ribs
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persistant fine crackles that are scattered over the chest occur with
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pneumonia, bronchiolitis, or atelectasis
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crackles only in upper lungs occur with...
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cystic fibrosis
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crackles only in lower lungs is associated with...
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heart failure
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persistant peristaltic sounds with diminished breath sounds on the same side may indicate
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diaphragmatic hernia
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what is located in the Right Upper Quadrant of the Abdomen?
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liver/gall B/duodenum/ pancreas/right kindey/ hepatic flexure of colon/part of ascending and transverse colon
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What is located in the Left Upper Quadrant (LUQ)?
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stomach/spleen/ left lobe of liver/body of pancreas/ left kidney/splenic flexure of colon/ part of transverse and descending colon
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what is located in theRight lower quadrant?
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cecum/appendix/right ovary and tube/right ureter/right spermatic cord
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What is located in the lower left quadrant (LLQ)?
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part of decending colon/ sigmoid colon/ left ovary and tube/left ureter/ left spermatic cord
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what is located midline on the abdomen?
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aorta/uterus (if enlarged)/ blader (if distended)
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What order is the abdomen auscultated with and with what part of the stethoscope?
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diaphram is used; Inspect, then auscultate, palpate, then percuss
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why is auscultation done before percussion and palpation on abdomen?
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could cause false interpretation of bowel sounds
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where do bowel sounds originate?
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the movement of air and fluid through the small intestine
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how many times/minute should bowel sounds be heard?
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5-30
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how long must you listen before charting "no bowel sounds"?
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5 minutes
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You are most likely to hear bruits at the aorta/renal arteries/iliac/femoral arteries in whom?
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people w/ hypertension
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what sound should predominate the abdomen?
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tympany
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What inderect percussion test would be performed to assess kidneys for pain?
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costovertebral angle tenderness
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diminished or absent bowel sounds (hypoactive bowel sounds) signal....
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inflamation as seen with peritonitis, from paralytic ileus, from late bowel obstruction, or pneumonia
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Hyper active bowel sounds signal...
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increased motility. They occur w/ early mechanical bowel obstruction, gastroenteritis, brisk diarrhea, laxative use, and subsiding paralytic ileus
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loud gurgling sounds of the abdomen are called
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"borbyorygmi"
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Fremitus is most prominent between....on the chest wall
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scapulae and around the sternum; where major bronchi are closest to chest wall
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Fremitus feels greater over what sort of chest wall?
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thin
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What pitch of voice (high or low) generates more fremitus
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a loud, low-pitched
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Decreased fremitus occurs w/ what?
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when anything obstructs transmission of vibrations
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Increased fremitus occurs with...
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compression or consolidation of lung tissue (lobar pneumonia)
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This type of fremitus is palpable w/ thick bronchial secretions
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Rhoncal
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a coarse crackling sensation palpable over the skin surface, commonly noticed w/ emphysema....
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crepitus
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Added sounds that are not normally heard are called
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adventitious
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what type of adventitious sound is not pathalogic?
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atelectatic crackles
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during normal tidal flow, what does wheezing indicate?
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asthma
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connected musical sound: high pitched/squeeking/ predominate in expiration
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sibilant wheeze
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low-pitched; monophonic single note/musical snoring/ most prominant on expiration
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sonorous rhonchi
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high-pitched/monophonic/ inspiratory/crowing sound/ louder in neck than over chest wall
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stridor
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discontinuous/high-pitched/ short, popping sounds heard on inspiration
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crackles
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loud/low-pitched/ bubbling and gurgling that starts in early inspiration/sounds like velcro
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coarse crackles
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superficial sound that is course and low pitced/ grating quality as if 2 pieces of leather are rubbing together
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pleural friction rub
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A sudden loss of strength/ temporary loss of consciousness due to lack of cerebral blood flow/faint
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syncope
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Feeling as if the room is spinning is ....
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objective vertigo
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feeling as if YOU are spinning is...
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subjective vertigo
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heal to toe walking (tandem walking) does what?
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decreases the base of support and accentuates any proplems w/ coordination
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Describe the Romberg Test
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person stands w/ feet together/arms at sides/ closes eyes and holds the position for 20 sec.
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Positive Romberg test is...
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loss of balance that occurs when closing the eyes/occurs w/ cerebeller ataxia,loss of proprioception, and lost of vestibular function
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Patting knees w/ both hands/turning hands over then patting w/ backs of hands and then doing so faster is what test?
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rapid alternating movements (RAM)
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Dysdiadochokinesia is what?
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slow, clumsy, and sloppy responce to rapid alternating movments (RAM)
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When is temperature sensation tested?
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only when pain sensation is abnormal
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Applying a wisp of cotton to the skin tests perception of what?
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light touch
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Decreased touch sensation is called what?
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Hypoestesia
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Absent touch sensation is...
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anestesia
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increased touch sensation is
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hyperesthesia
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Pain, Temperature, and light touch test which 'trac'?
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They test the spinothalamic tract
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Vibration/kinesthesia/ stereognosis/ graphestesia/ 2-point discrimination/ extinction/ and point location test which 'tract'?
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They test the posterior column tract
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Inability to feel vibration can be caused by...
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Alcoholism and diabetes
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Where is peripheral neuropathy the worst?
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the feet (it gradually improves as you move up the leg)
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To test a person's ability to feel vibrations, what would you do?
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Place a vibrating tuning fork over bony prominences
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Testing the person's ability to percieve passive movements of the extremities is...
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Position (which is also called kinesthesia)
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What test would be performed to test the ability to recognize objects by feeling their forms/size/weight?
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stereognosis
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What is the inability to identify felt objects correctly called?
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astereognosis
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Problems w/ tactile discrimination occur w/ what?
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lesions of the sensory cortex or posterior column
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The ability to 'read' a number by having it traced on the skin is....
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graphesthesia
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the ability to distinguish the separation of 2 simultaneous pin points on the skin....
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two-point discrimination
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When does puberty begin for the male?
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sometime between the ages of 9.5 and 13.5 years
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what is the first sign of male puberty?
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the enlargement of the testes
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What is the name of the stages of sexual development for boys?
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tanner's sexual maturity ratings (also called SMR)
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How long does the complete change in development from a pre-adolescent to adult take?
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3 years
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What were Tanner's studies of sexual development based on?
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data from post WWII british youth.
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Sexual characteristics among african american boys and caucasian boys are...
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similar
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How does socioeconomic status effect male sexual development
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according to the US health Examination surveay from 1966-1970, it doesn't
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What stage does the scrotum begin to enlarge/redden/change texture?
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2
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what stage does pupic hair begin to grow at base of penis?
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2
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the stage when penis begins to enlarge, especially in length?
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3
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Thick growth over pubic area but not thights. Hair curly/coarse as in an adult male. Development of glans
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stage 4
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Growth spread over medial thighs, although not yet up toward umbilicus
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stage 5
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What is the outlet of the gastrointestinal tract?
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the anal canal
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how long is the anal canal?
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3.8 cm in the adult
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What separates the internal and external anal sphincters?
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the intersphincteric groove
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What is another name for the anal columns?
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columns of Morgagni
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Where do the folds of mucosa known as anal columns end?
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at the anorectal junction
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enlargement of veins in the anal column can cause what?
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a hemorrhoid
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What small crescent fold of mucus membrane is at the lower end of each column
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the anal valve
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how long is the rectum?
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12 cm long
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The rectum extends from the .....to the.....
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from the sigmoid colon at the level of the 3rd sacral vertebra to the anal canal
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Just above the anal canal, the rectum dilates and turns posteriorly, forming the...
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rectal ampulla
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The rectal interior has 3 semilunar transverse folds called the
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valves of houston
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in the male, the anterior part of the peritoneum reflects down to w/in 7.5cm of the anal opening forming the...
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rectovesical pouch
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The female counterpart of the rectovesical pouch is the..which extends down to w/in 5.5 cm of the anal opening
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rectouterine pouch
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The prostate gland lies in fron of the....
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anterior wall of the rectum
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The prostate gland lies ....cm behind the symphisis pubis
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2
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The prostate gland has ....to...ducts that open into the urethra
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15-30
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The two lateral lobes of the prostate gland are separated by a shallow groove called the.....
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median sulcas
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the two ........ ........ project like rabbit ears above the prostate
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seminal vesicles
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The seminal vesicles secrete a fluid rich in.....that nourish sperm, and also....
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fructose nourish sperm; also secreted are prostaglandins
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What glands are the size of a pea and are located inferior to the prostate on either side of the urethra?
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bulbourethral (also called cowper's glands). they secrete a clear, viscid mucus
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The sigmoid colon is s shaped and extends from the .....and ends at the...
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extends from the iliac flexure of the descending colon; ends at rectum
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how long is the rectum?
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40 cm long
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Where is the first place you place your finger when palpating the anus?
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the anal verge
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What should your finger point to as it enters the anus?
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The umbilicus (never approach the anus at right angles w/ finger extended)
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Using bidigital palpation w/ thumb agains perianal tissue while pressing examing finger towards it highlights what?
|
any swelling or tenderness and helps assess the bulbourethral glands
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Above the anal canal, the rectum turns posteriorly, folowing the curve of the.... and.....
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coccyx and sacrum
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A soft, slightly movable mass may be a....
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polyp
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Internal hemorrhoids above anorectal junction is not palpable unless....
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thrombosed
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a firm hard mass w/ irregular shape or rolled edges may be...
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carcinoma
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On the anterior wall of the rectum of the male,.....can be palpated
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the prostate
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what size should the prostate be?
|
2.5 cm long by 4 cm wide/should not protrude more than 1 cm into rectum
|
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what shape should the prostate be?
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heart shape w/ palpable central groove
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the surface of the prostate should feel.....on palpation
|
smooth
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the prostate should be.....movable
|
slightly
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The sensitivity of the prostate should be:
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nontender to palpation
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any stone-hard irregular fixed nodule of the prostate indicates....
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carcinoma
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Swollen exquisitely tender prostate gland accompanies....
|
prostatitis
|
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Enlarged, firm, smooth prostate gland w/ central groove obliterated suggests...
|
benign prostatic hypertrophy
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A false positive for occult blood in the stool could occur if..
|
large amounts of red meat has been consumed w/in 3 days of test
|
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Bright red blood mixed w/ feces indicates...
|
possible colonic bleeding
|
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black tarry stool w/ distinct malodor indicates
|
upper gastrointestinal bleeding w/ blood partially digested
|
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Gray tan stool indicates..
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obstructive jaundice
|
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pale yellow greesy stool indicates..
|
increased fat content/occurs w/ malabsorption syndrom
|
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steatorrhea is..
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increased fat content of stool
|
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In the newborn, a patent rectum can be confirmed by..
|
passage of stool (meconium) w/in the first 24 to 48 hrs of birth
|
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How should the anus of infants and children be palpated?
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they should not be, unless history or symptoms warrant. If so, then use the fifth finger w/ the child on his or her back w/ legs flexed
|
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Onset of menarche at 16 or 17 years old indicates
|
an endocrine problem
|
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pain w/ menstruation is called...
|
dysmenorrhea
|
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abesent period (or menses) is called
|
amenorrhea
|
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why should the examiner begin w/ menstrual history before the female gynecological exam?
|
it is non threatening
|
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what does clotting indicate during period?
|
heavy flow or vaginal pooling
|
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Gravida is
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number of pregnancies
|
|
number of births is...
|
para
|
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perimenopausal period is from age
|
40-50
|
|
maternal ingestion of DES causes ...
|
cervical and vaginal abnormalities in female offspring
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Initially, before the vaginal exam, the woman should be sitting...
|
up. an equal status position is important to establish trust and rapport
|
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What position should the woman be placed in for vaginal exam
|
lithotomy position. body supine, feet in stirrups, knees apart, and buttocks at edge of exam. table
|
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Why should the woman's arms not be abover her head during a vaginal exam?
|
it causes abdominal muscle tightness
|
|
Where should people the woman brings into the exam with her sit?
|
by her head for privacy
|
|
hair distribution on the female genitalia should be in the shape of...
|
an inverted triangle
|
|
what does the perineum normally feel like?
|
it feels thick, smooth, and muscular in the nulliparous woman, and thin and rigid in the multiparous woman
|
|
What special needs does the adolescent girl need for genital exam?
|
mother shouldn't be present. The girl should be taught self examination techniques
|
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when is a pelvic examination indicated for an adolescent girl?
|
when contraception is desired when the girl's sexual activity includes intercourse, or at age 18 virgins
|
|
during the bimanual axamination, what should not be palpable for an adolescent girl?
|
the adnexa
|