mini cog test
three-item recall test and clock-drawing test
MMSE (mini-mental state examination)
test of cognitive functions of the mental status. must be able to follow a three-stage command. The person has to be able to write and have no vision impairment. spelling "world" backward, copying intersecting pentagons, performing serial 7s. Max score is 30. 24-30= normal. 18-23= mild cog impairment. 0-7= severe.
receptive aphasia
difficulty understanding language
expressive aphasia
difficulty producing language
delirium v. dementia
delirium- an acute confusional change or loss of consciousness and perceptual disturbance. May accompany acute illness- usually resolved when underlying condition is resolved.Dementia- a gradual progressive process-causing decreased cognitive function even though the person is fully conscious and awake- not reversible.
Infant: head circumference v. chest circumference
head size is greater than chest circumference at birth and reaches 90% of final size at age 6
large v. enlarge
large- soft and mobileenlarged- infection, hard, not mobile, tender
How do you assess thyroid? What are you looking for?
from behind, push thyroid to side and palpate it. Have the patient swallow. Looking for an enlarged thyroid, can auscultate for bruit
what are the frontels?
spaces where sutures interest- "soft spots" in infants to allow the brain to grow for the first year
How do you palpate lymph nodes?
pads of fingers
PQRST
P- provocation/palliationQ- quality/quantityR- radiate? region? S- severity scaleT- time of onset? how long does it last?
What is the cotton ball test on the face used for?
Used to test sensation ability in stroke patients and to check for symmetry
what do you check for in a pneumothorax?
lung collapse- cyanosis, tachypnea, decreased or absent tactile fremitus, breath sounds decreased or absent
Cranial nerve III
oculomotor nerve- innervates superior, inferior, and medial rectus
cranial nerve IV
trochlear nerve- innervates superior oblique muscle
cranial nerve VI
abducens nerve- abducts eye
cranial nerve IX
glossopharyngeal nerve
cranial nerve X
vagus nerve
cranial nerve XII
hypoglossal nerve
why do we test for accommodation in the eyes?
tests for the adaptation of the eyes for near vision
what ages can an infant identify, focus, and track with their eyes
identify- birth to 2 weeksfocus- 2-4 weekstrack- by 1 month
how do you read the snellen chart and what do the scores mean?
20/20 or 2/2 is normal. Read through chart to smallest line of letters possible. Shorten distance if needed. 10/20 (patient reads at 10 feet what is normally read at 20 feet)
Confrontation test-peripheral test
tests for peripheral vision- holds arm out and moves forward until patient can see it out of the peripheral
what is the procedure for looking in the ears?
inspect, palpate external. use otoscope to inspect interior ear. tilt head slightly away from you, pull pinna up and back on adult (pull pinna down on an infant < 3 years)
How do we grade the tonsils? and what are the complications of having a 4+ tonsil?
1+ - means they are visible2+ - halfway between tonsillar pillars and uvula3+ - touching the uvula4+ - touching one another*trouble breathing and swallowing
What sinuses do we palpate? Which do we assess? What changes can occur in the elderly?
Frontal sinuses, maxillary sinuses, ethmoid, sphenoid.* only maxillary and ethmoid are present at birth* loss of fat in elderly, nose more prominent
What is one of the first things we want to do when inserting an NG tube?
Inspect the nose for a deviated septum
bronchophony
auscultate while the patient says "99
egophony
auscultate while the patient says "eeee" (abnormal is to hear "aaaaaa
pectoriloquy
auscultate while the person whispers a phrase
friction rub
when plurae rub and the lubricating is gone (low, course, two pieces of leather rubbing together)
wheezing
diffused airflow obstruction
rales (crackles)
inhaled air collides with a closed airway
rhonci stridor
low wheeze (bronchitis)
What is tactile fremitus and why do we do it?
the feeling of the vibrations on the lungs with the palm on the posterior of the patietn as they say 99; it provides information on the density of the lungs.
Apgar scoring? whats normal?
test performed on newborns at 1 minute and 5 minutes after birth to test fofr successful transition to extrauterine life. normal score = 7-10
6 grades of murmurs
grade 1- barely audiblegrade 2- clearly audible but faintgrade 3- moderately loud; easy to heargrade 4- loud, a thrill palpable on the chest wallgrade 5- very loud, heard with just one corner of the stethoscope lifted off the wallgrade 6- heard with stethoscope lifted off the wall
signs and symptoms of CVD
chest pain, dyspnea, orthopnea, cough fatigue, cyanosis/pallor, edema, nocturia, family/personal history
where do we hear s1-s4 and what produces them?
s1- Apex of the heart (M and T)s2- base of the heart (semilunar valves)s3- rapid ventricular filling during early diastoles4- atrial contraction and decreased ventricular compliance during late diastole
when we would expect to hear the extra heart sounds-when is that a good thing and when is it a bad thing?
s3 is common in young children, pregnant women and young adults. s3 also present in CHF patients (not good)S3 comes immediately after S2
how do we assess JVD and what are we looking for?
patient supine with the torso elevated to 30/45 degrees, turn head slightly to the left, inspect for JVD distention (bulging of 45 degrees more)
intermittent claudication- what is it, what causes it and how do we treat it?
pain in the calf muscles when walking but resides when at rest. caused by PAD. treated by stopping smoking, treat underlying conditions, exercise)
PAD v. PVD
PVD occurs in both arteries and veins/PAD occurs in just arteries. PAD is a form of PVD. skin color change on arms and leg, swelling in arms and legs, and leg pain and cramps.
What are the parts of the abdominal assessment and what order?
inspection, auscultate (LR, UR, UL, LL), percuss, palpate
McBurney's sign
RLQ palpation that results in pain is a positive test
Obturator muscle test-
flex right leg at hip in supine position and rotate internally and externally- positive test results in pain
Rovsing's sign-
palpate LLQ and if pain is felt in RLQ it is positive
iliopsoas muscle test-
apply pressure on lower right thigh while patient pushes up against your hand, pain in RLQ = positive
What are some of the risk factors of heart disease?
nutrition (obesity), smoking, alcohol, exercise (lack of), drugs
how do we listen to the carotids and what are we listening for?
one at a time! auscultate first with the bell of the stethoscope, then palpate one at a time. listening for a bruit, bounding pule, weak pulse, or variation in strength
white/clear cough production
bronchitis
yellow/green cough production
bacterial infection
rust colored cough production
TB
pink frothy cough production
pulmonary efema/CHF