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Patient Care and Physical Diagnosis Test 1

STUDY
PLAY
What are the four paranasal sinuses?
Frontal
Maxillary
Sphenoid
Ethmoid
What is the most common site of sinusitis?
maxillary
What are salivary glands that are all over the tongue, palate, lips, and the lining of the cheek?
intrinsic
What are extrinsic salivary glands?
glands that secrete more saliva when eating
What are the extrinsic salivary glands?
Parotid
Submandibular
Sublingual
What is a sialadentis?
a salivary gland infection
What is the most common immunologic disorder associated with salivary gland disease?
Sjogren's Syndrome
What are the demographics of most Sjogren's cases?
women 50 and older
What is the difference in primary vs secondary Sjogren's syndrome
primary only involves the exocrine glands and secondary is autoimmune associated ie RA
What makes a swollen lymph node more likely to be malignant than infected?
slowly progressive
firm
multiple nodes involved
not mobile
WHat node do the throat and thyroid drain too?
ant cervical
What drains into the sub-mandibular lymph node?
floor of the mouth
What drains into the Supra-clavicular node?
thorax
What is the usual site of an emergency tracheotomy?
cricothyroid ligament
What is the chronic enlargement of the thyroid gland not due to neoplasm?
Goiter
Which of the following is not a cause of goiter nodules to form?

a. Hashimotos
b. Graves Disease
c. Iodine deficiency
d. Neoplasm
iodine deficiency
When should a suspicious thyroid lesion be re-evaluated?
2-weeks
What is the sensation of being unsteady?
dysequilibrium
Sudden onset of dizziness raises suspicious for what?
arrhythmia
If one feels lightheaded under exertion it is likely caused by__________?
aortic stenosis
A conductive hearing loss is associated with what part of the ear?
outer and middle
A sensorineural hearing loss is associated with what parts of the auditory system?
cochlea, cochlear nerve, central pathways
What is a positive Rinne test?
indicates perceptive loss; heard longer by air conduction then bone
What is a negative Rinne test?
heard longer on the bone; indicates a conductive hearing loss
If air conduction is greater than bone conduction is this always an indication of hearing loss?
no it is normal OR sensorineural
When is the Weber test useful?
in asymmetrical hearing loss
Which ear hears the sound the loudest in conductive deafness during Webber testing?
the affected ear
During Webber testing what ear hears the sound the loudest in sensorineural deafness?
the un-affected ear
What are the four vital signs?
Breathing
Pulse
Temperature
Blood Pressure
WHen should a pulse be counted for the full 60 seconds?
if the pulse is irregular
What are the two central pulse points?
Carotid and Femoral
Where is a childs pulse under 1 felt for?
Brachial
Which pulse most accurately reflects the aortic pulsation?
Carotid
What is the normal pulse rate?
60-100
Which of the following is not a way to accurately describe a pulse?

a. Bounding
b. Regular
c. Thready
d. Weak
all of the above are ways to describe the pulse
The cardiac pacemaker is the _______?
SA node
True or False the AV node conducts faster than the bundle of His?
False
What parasympathetic receptor dominates the sinus rhythm?
M2
What part of the brain controls the cardiovascular center?
medulla
The lub sound of the heart is associated with what valve?
A-V valve closure and the start of systole
The dub sound of the heart is associated with valves?
closure of the pulmonary and aortic valve and start of diastole
A cuff that is of an improper size will give what type of BP reading?
false High
What is the standard for BP monitoring?
Mercury Sphygmomanometer
What is Korotkoff sounds?
the sound of the blood in the brachial artery during bp measurment
Systolic and Diastolic pressure should be measured to the nearest ____ mm hg
2
A patient who is nervous will give what type of diastolic reading?
False high
Where is a BP taken to rule out coarctation of the aota?
the leg
True or False
It is normal to have a higher systolic pressure in the legs than the arms?
False
What are the only two conditions that cardiac arrest doesn't override?
external hemorrhage or airway obstruction
What is the primary cause of cardiac arrest?
electrical dysfunction
What is the major rhythm in pre-hospital cardiac arrest?
V-fib
Where is the AV node located?
interatrial septum
What is the purpose of the AV node slowing the conduction?
to permit completion of atrial contraction
What is the function of the bundle of His?
functional passage of the impulse from atria to ventricles
What is the p-wave caused by?
arial depolarization
What causes the QRS complex?
ventricular depolarization
Which wave is usually not seen in EKG?
U wave
What is electromechanical dissociation?
organized electrical depolarization without mechanical contractions
What muscles change the pleural pressure?
diaphragm, intercostal and abdominal walls
What are the two types of respiratory neurons?
inspiratory and expiratory
Respiratory neurons generate an efferent signal via what nerves?
phrenic to the diaphragm and the spinal nerves to the intercostal and abdominal walls
Half of the mass of the lung is made up of_______?
blood volume
What is the purpose of surfactant in the lungs?
reduces surface tension that allows the alveoli to expand
Fibromyalgia syndrome is characterized by what three things?
chronic pain
tender points
fatigue
What is a possible cause of Fibromyalgia?
abnormally high levels of substance P in the spinal fluid that can turn up the brains pain center
What is the Criteria for Fibromyalgia?
widespread pain for 3 months and pain in 11 out of 18 points
What are some treatments for fibromyalgia?
antidepressants
anti-epileptics
gabapentin
What is polymyositis?
a group of disorders that present with progressive symmetric proximal muscle weakness and inflammation of skeletal muscle
What are the demographics of a typical polymyositis patient?
40-60 yr old black woman
What is dermatomyositis?
a skin rash associated with myositis symptoms that is often associated with malignancy
What are the characteristics of osteoporosis?
low bone mass
microarchitectural deterioration of bone tissue
bone mineral density T score < 2.5
What type of osteoporosis is caused by lack of estrogen?
type 1
What is type II osteoporosis?
increased bone turnover
What is the gold standard for evaluating osteoporosis?
Dual enrgy X-Ray Absorptiometry
What is the difference in arthralgia and arthritis?
arthralgia is joint pain but may not have any inflammation
What is the most common type of arthritis in the US?
osteoarthritis
True or False
Arthritis pain most often comes from the cartilage.
False, cartilage is aneural
Where do heberdens nodes form?
distal interphlangeal joints
What nodes form at proximal interphalangeal joints?
Bouchards
What are some of the complications of juvenile rheumatoid arthritis?
leg length discrepancy
eye involvement; anterior uveitis
active arthritis in adults
radiographic joint damage
What are the treatments of JRA?
NSAIDS and steroids
ENBREL
Methotrexate
HLA-B27 has association with what diseases?
Spondyloarthropathies
What is the RF factor of Psoriatic arthritis?
RF negative
Who is more likely to get ankylosing spondylitis?
men 3x more likely
How does ankylosing spondylitis cause its problems?
chronic inflammation leads to joint remodeling and destruction
What are three diagnostic tools for ankylosing spondylitis?
Schober test
lateral spine flexion test
Chest expansion test
What is the triad of Reiter's syndrome?
seronegative asymmetric arthritis
inflammation of the urinary tract
conjunctivitis
What is Pagets disease?
excess bone destruction and unorganized bone formation and repair and osetoclasts show abnormal morphology