Health Assessment Test 2

Front 1

The aging process carries a slow atrophy of skin structures- it loses its elasticity, it folds and sags, it looks parchment thing, lax, dry, and wrinkled.
• We lose elastin, collagen, subcutaneous fat and muscle tone.

Back 1

The aging Adult

Front 2

Patient with acne-certain complaints

Back 2

• The medications that they are on increase sunlight sensitivity and give a burn response.
• Some drugs are sulfonamides, thiazide diuretics, oral hypoglycemic agents, and tetracycline

Front 3

the complete absence of melanin pigment in patchy areas of white or light skin on the face, neck, hands, feet, body folds, and around orifices.

Back 3

Vitiligo

Front 4

• Patchy depigmentation from destruction of melanocytes.

Back 4

Vitiligo

Front 5

• Light and dark skin develops patchy milky white spots, often symmetrical bilaterally.

Back 5

Vitiligo

Front 6

ABCDE

Back 6

• Asymmetry- not regularly round or oval, two halves of lesion do not look the same.
• Border irregularity- notching, scalloping, ragged edges or poorly defines margins.
• Color variation- areas of brown, tan, black, blue, red, white, or mix.
• Diameter- greater the 6mm, although melanoma can occur at smaller size.
• Elevation and Enlargement-

Front 7

• When red pink tones from the oxygenated hemoglobin in the blood are lost, the skin takes on the color of connective tissue.

Back 7

Pallor

Front 8

• Common in acute, high stress states, anxiety or shock.

Back 8

Pallor

Front 9

• In dark skin or marked _____ in whites, an ashen gray dull color occurs with anemia, shock, and arterial insufficiency. Skin loses healthy glow.

Back 9

Pallor

Front 10

• Increased serum bilirubin, more than 2 to 3 mg/100 ml from liver inflammation or hemolytic disease, such as after sever burns, some infections.

Back 10

Jaundice

Front 11

• In light skin- look for yellow in sclera, hard palate, mucous membranes, then over skin.

Back 11

Jaundice

Front 12

• In dark skin- look for yellow in sclera near limbus, do not mistake normal yellowish fatty deposits under eyelids for ______, best noted in junction of hard and soft palate and also in palms.

Back 12

Jaundice

Front 13

an intense redness of skin from excess blood in dilated superficial capillaries.

Back 13

• Erythema

Front 14

Erythema and Inflammation

Back 14

• Associated with fever and localized inflammation.
• Dark skin person- since you can’t see inflammation you must palpate skin for increased warmth, taut or tightly pulled surfaces, and hardening of deep tissue or blood vessels.

Front 15

• Mucous membranes look dry and the lips looked parched and cracked. With extreme dryness the skin is fissured.

Back 15

Dehydration

Front 16

• Poor tugor is evident in severe cases- skin receded slowly or “tents” and stands by itself.

Back 16

Dehydration

Front 17

• Confluent lesion

Back 17

lesions run together Ex/ hives

Front 18

• Occurs with congenital chronic cyanotic heart disease and with emphysema and chronic bronchitis.

Back 18

Clubbing of nails

• In early clubbing, the angle straightens out to 180 degrees and the nail base feels spongy to palpation.

Front 19

jagged linear “stretch marks” of silver to pink color that appear during the second trimester on the abdomen, breasts, and sometimes thighs.

Back 19

• Striae

Pregnant Female

Front 20

an irregular brown patch of hyperpigmentation on the face.

Back 20

• Chloasma

Pregnant female

Front 21

Lesions are red-tan scaly plaques that increase over the years to become raised and roughened.

Back 21

Senile (actinic) Keratosis

Front 22

• May have silvery-white scale adherent to the plaque.
• Occur on sun-exposed surfaces and are directly related to sun exposure.
• Premalignant and may develop into squamous cell carcinoma.

Back 22

Senile (actinic) Keratosis

Front 23

• Prolonged intense scratching eventually thickens the skin and produces tightly packed sets of papules, looks like surface of moss.
• Patient complains of itchy skin and scratches it a lot this is the cause which leads to scaring.

Back 23

Lichenification

Front 24

• Not fatal, but may have serious arthritic, cardiac, or neurological sequelae.
• Caused by a spirochete bacterium carried by the black or dark brown deer tick.
• First stage have a distinctive bull’s eye, red macular or popular rash in 50% cases. IT radiates from the site of the tick bite. Fades in 4 weeks.

Back 24

Lyme’s disease

Front 25

Nails of iron deficiency

Back 25

• Thin, depressed nails with lateral edges tilted up, forming a concave profile.

Front 26

scales, hyperpigmented in whites, depigmented in dark skinned persons. On chest, abdomen, back of arms forming multiple circular lesions with clear centers.

Back 26

• Tinea Corporis (Ringworm of the body)-

Front 27

fungal infection that first appears as small vesicles between toes, sides of feet, and soles. Grows scaly and hard. Found in chronically warm moist feet, athletes, aging adults who can’t dry feet completely, kids.

Back 27

• Tinea Pedis (Ringworm of the foot)- “Athlete’s foot”

Front 28

Fine, scaling, round patches of pink, tan, or white that do not tan in the sunlight, caused by superficial fungal infection. On neck, trunk, upper arms.

Back 28

• Tinea Versicolor

Front 29

Rounded patchy hair loss on scalp, leaving broken off hairs, pustules, and scales on skin. Caused by fungal infections. Seen in children and farmers.

Back 29

• Tinea Capitis (Scalp Ringworm)-

Front 30

Neck

Back 30

• The major neck muscles are the sternomastoid and the trapezius, they are innervated by cranial nerve XI, the spinal accessory

Front 31

in front of the ear

Back 31

• Preauricular

Front 32

superficial to the mastoid process

Back 32

• Posterior auricular

Front 33

at the base of the skull

Back 33

• Occipital

Front 34

midline, behind the tip of the mandible

Back 34

• Submental

Front 35

halfway between the angle and the tip of the mandible

Back 35

• Submandibular

Front 36

under the angle of the mandible

Back 36

• Jugulodigastric

Front 37

overlying the sternomastoid muscle

Back 37

• Superficial cervical

Front 38

deep under the sternomastoid muscle

Back 38

• Deep cervical

Front 39

in the posterior triangle along the edge of the trapezius muscle

Back 39

• Posterior cervical

Front 40

just above and behind the clavicle, at the sternomastoid muscle

Back 40

• Supraclavicular

Front 41

Drainage pattern of the lymph node

Back 41

look at the area proximal, upstream to the location of the abnormal node.

Front 42

tends to be occipital, frontal, or with bandlike tightness.

Back 42

• Tension headache

o Viselike character with tension headaches.
o Anxiety and stress are associated with tension headaches.

Front 43

• Migraines

Back 43

tend to be supraorbital, retro-orbital, or frontotemporal.
o Throbbing character or temporal arteritis
o Quantity is severe with migraines about two per month each lasting 1 to 3 days.
o Precipitated by alcohol, letdown after stress, menstruation, eating chocolate or cheese.
o Nausea, vomiting, and visual disturbances associated.
o Associated with family history
o People lie down to feel better

Front 44

produce pain around the eye, temple, forehead, and cheek.

Back 44

• Cluster headaches

Front 45

• Cluster headaches

Back 45

o Quantity excruciating with cluster, one to two occur per day lasting a half to two hours for 1 or 2 months. Complete remission last for months or year.
o Alcohol ingestions, daytime naps precipitate cluster.
o Associated with eye reddening and tearing, eyelid drooping, rhinorrhea, and nasal congestion
o Need to move around and pace the floor to feel better.

Front 46

• Test muscle strength and status of this nerve by trying to resist person’s movements with your hands as the person shrugs the shoulders and turns the head to each side.

Back 46

Cranial nerve XI

Front 47

Trachea shift

Back 47

• Evaluate by placing your index finger on the trachea in the sternal notch, and slip it off to each side. Should be symmetric on both side
• Trachea is pushed to the unaffected side with an aortic aneurysm, a tumor, unilateral thyroid lobe enlargement, and pneumothorax.
• Trachea is pulled toward the affected side with large atelectasis, pleural adhesions, or fibrosis

Front 48

• Abnormal findings- enlarged lobes that are easily palpate before swallowing, or are tender to palpations, or the presence of nodules or lumps.

Back 48

Thyroid gland

Front 49

if person has this you will hear a soft, pulsatile, whooshing, blowing sound heard best with the bell of the stethoscope.

Back 49

• Hyperthyroidism

Front 50

occurs with accelerate or turbulent flow, indicating hyperplasia of the thyroid. Not present normally. Listen to this with the bell side of stethoscope

Back 50

Bruit

Front 51

Difference between dizziness and vertigo is:

Back 51

the room is spinning during vertigo, lightheaded is dizziness.

Front 52

Brain attack is another word for

Back 52

Cerebrovascular accident

Front 53

difficulty swallowing

Back 53

Dysphagia

Front 54

an enlarged head for age, rapidly increasing in size

Back 54

Macrocephalic

Front 55

Literally means hard skin, a rare connective tissue disease

Back 55

Scleroderma

Front 56

enlargement of lymph nodes, greater then 1 cm from infection, allergy, or neoplasm.

Back 56

Lymphadenopathy

Front 57

Excessive excretion of growth hormone from pituitary gland after puberty which creates, an enlarged skull and thickened cranial bones

Back 57

Acromegaly

Front 58

occurs because of excessive secretion of corticotrophin hormone (ACTH) and chronic steroid use, the person develops a rounded “moonlike” face, red cheeks, hirsutism on upper lip

Back 58

Cushing’s syndrome

Front 59

is an increase in the size of the thyroid gland and occurs with hyperthyroidism

Back 59

Goiter

Front 60

Difference between Bell’s Palsy and CVA

Back 60

temporary paralysis, drooping, asymmetrical, Rt. Side of the face, cranial nerve XII

Front 61

The purpose is to protect the nose and filter the coarsest matter from inhaled air

Back 61

• Cilia in the nose

Front 62

- the lateral walls of each nasal cavity contain three parallel bony projections- the superior, middle, and inferior turbinates.

Back 62

• Turbinates

o They increase the surface area so that more blood vessels and mucous membranes are available to warm, humidify, and filter the inhaled air.

Front 63

a gradual loss of subcutaneous fat starts during later middle adult years, making the nose appear more prominent in some people. Nasal hairs grow coarser and stiffer and may not filter the air as well. Sense of smell may diminish. This happens in the...

Back 63

• Older adult

Front 64

Nose History Questions

Back 64

• Any nasal discharge (Rhinorrhea) or runny nose?
• Any sinus pain? Pain is not normal they should only feel pressure.
• Any nosebleeds? How often? Correlated with something?

Front 65

Nose exam

Back 65

• Use an otoscope with a speculum on the end. Insert it into the patients nasal cavity with their head tilted back and your finger pushing up on their nose. Avoid pressure on the nasal septum

Front 66

Stop Epistaxis- (nosebleed)

Back 66

• Person should sit up with head tilted forward, pinch nose between thumb and forefinger for 5 to 15 minutes.

Front 67

Sinus pressure

Back 67

Important for the patient to feel pressure not pain!

Front 68

the largest of the three salivary glands in the mouth.
o Lies within the cheeks in front of the ear extending from the zygomatic arch down to the angle of the jaw
o It’s duct, Stensens’s duct, runs forward to open on the buccal mucosa opposite the second molar.

Back 68

• Parotid gland

Ask the person to say AHH and note the soft palate and uvula rise in the midline. This tests one function of cranial nerve X, the vagus nerve.

Front 69

this occurs after the use of antibiotics, it inhibits normal bacteria and allows proliferation of fungus.

Back 69

• Black Hairy Tongue

Front 70

Tongue

Back 70

• Enlarged tongue occurs with mental retardation, hypothyroidism, acromegaly.
• Small tongue accompanies malnutrition
• Dry mouth occurs with dehydration, tongue has deep vertical fissures.
• Saliva is decreased while the person is taking anticholinergic and other medications.

Front 71

Tonsils grade scale

Back 71

• 1+=visible
• 2+= halfway between tonsillar pillars and uvula
• 3+= Touching uvula
• 4+= Touching each other

Front 72

a condition which the uvula is split either completely or partially. 18% Native Americans and 10% of Asians

Back 72

• Bifid uvula

Front 73

• Cleft lip

Back 73

most common in Asians and Native Americans and least common in blacks.

Front 74

a grayish white benign lesion occurring on the buccal mucosa present in 68%-90% of blacks and 43% of whites.

Back 74

• Leukoedema

Front 75

• Hyperpigmentation

Back 75

by age 50 10% of whites and 50-90% of blacks will show oral hyperpigmentation.