Exam 3

Head, geriourinary

Canthus of eye

• points where lower and upper lids meet

Caries

• cavities decay of teeth

Cheilosis

• Ulceration of the lips

Edentulous

• Without teeth.

Glossitis

Inflammation of the tongue

Halitosis

• Offensive breath

Pediculosis

• Infestation with lice

Periodontal disease

• Destruction of tooth supporting structure, gums shrink away from teeth.

Periodontitis

• Marked inflammation of the gums that also involves degeneration of the dental periosteum (tissues) and bone

Sordes

• Accumulation of foul, brown crusts on teeth and mucous membranes.

Stomatitis

• Inflammation of the oral mucosa

When evaluating a patient for potential TBI, ask four core screening questions:

1. Trauma: "Have you ever had an injury to your head or face?"

2. Consciousness: "Have you ever lost consciousness?"

3. Behavioral Changes: "Has there been a change in your behavior?"

4. Cognitive Function: "Are you having difficulty concentrating, organizing your thoughts, or remembering?"

Normocephalic

• Head size is symmetric and proportional to body size.

Microcephaly

• Abnormally small head size; often associated with developmental delay or congenital syndromes

Macrocephaly

• Abnormally large head size; may indicate hydrocephalus, acromegaly, or increased intracranial pressure

Tension headache

• Bilateral; "hatband" distribution across forehead and occipital area

• Dull, aching, tight band-like pressure

• muscle tightness in neck and scalp

• stress, fatigue, poor posture

Migraine headache

• Unilateral (one side of head/behind one eye)

• Throbbing, pounding, pulsating

• Visual aura (prodrome), photophobia, phonophobia, nausea, vomiting

• Stress, hormonal changes (menstruation), alcohol, specific foods, sleep deprivation

Cluster headache

• Unilateral; localized in/around one eye or orbit

• Intense, severe, burning, piercing, sharp, shock-like

• Rhinorrhea, nasal congestion, ipsilateral lacrimation (tearing), facial flushing

• Alcohol consumption, night-time/sleep patterns (occurs in clusters)

Sinus headache

• Frontal sinus (forehead) or maxillary sinus (cheeks/under eyes)

• Deep, constant, throbbing, dull ache

• Facial tenderness, purulent nasal discharge, fever, worse when bending forward

• Upper respiratory tract infection, allergies

Assessment technique for Thyroid function

1. Inspection: Inspect neck while patient is neutral and while swallowing.

2. Palpation (Anterior or Posterior Approach): Locate cricoid cartilage, move down to isthmus, move laterally between trachea and sternocleidomastoid (SCM) muscle. Have the patient swallow; the thyroid gland moves superiorly (upward).

3. Auscultation: If the thyroid gland is enlarged (goiter), auscultate over the lobes with the diaphragm of the stethoscope to listen for a bruit (a soft, blowing, vascular sound indicating increased blood flow)

Hypothyroidism

• slow metabolism

• weight gain w/ poor appetite

• cold intolerance

• dry, rough skin, brittle hair, alopecia

• fatigue, lethargy, slow reflexes, memory loss

• bradycardia

• periorbital edema

• goiter may be present

Hyperthyroidism

• accelerated metabolism

• weight loss despite increased appetite

• heat intolerance

• warm, moist smooth skin, fine hair

• restlessness, anxiety, tremors, insomnia

• tachycardia, palpitations

• exophthalmos (bulging eyes)

• goiter with audible bruit

Abnormal finding of scalp and hair

• alopecia

• hirsutism (excess facial/body hair)

• tenderness, lesions, or infestations

Abnormal finding of temporal artery

• tender, hard

• audible bruit

Abnormal finding of TMJ

• pain, clicking, popping

• restricted range of motion

Abnormal finding of skin/face

• asymmetry

• cyanosis or jaudince

• edema, drooling

Abnormal finding of sinuses

• severe tenderness to palpation and percussion

• opaque transillumination (sinusitis)

Abnormal finding of gums and dentition

• gingival hyperplasia (caused by Phenytoin/Dilatin or calcium channel blockers)

• poor dentition affecting nutrition

Abnormal finding of Trachea

• tracheal deviation (pulmonary atelectasis, pneumothorax or large thyroid mass)

Abnormal finding of lymph nodes

• Enlarged (>1 cm), hard, fixed, tender (infection or malignancy)

Subjective assessment: health history and common chief complaints

• heachaches

• jaw, neck and dental pain

• mouth lesions

• sore throat and hoarseness

• epistaxis (nose bleed)

Past medical history

• headaches, head injury, seizures

• allergies, tonsillitis, surgery, medications

• cancer, chronic illness or STDs

Family health history

• malignancy

• recent infections

• Hx of headaches or migraines

• musculoskeletal issues

• thyroid problems

• rhinitis (stuffy nose)

Social Hx and habits

• alcohol, smoking, and drug use

• employment and environment exposures

• coping strategies

TBI screening questions

• Have you ever had an injury to your head or face?

• Have you ever lost consciousness?

• Has there been a change in your behavior

• Are you having difficulty concentrating remembering etc

Comprehensive Headache assessment

• onset

• duration

• pattern

• location

• character (throbbing, constant, pressure)

• aggravating factors

• severity

• visual prodromal event (distortion of object or location)

• associated factors (nausea, photophobia)

• precipitating factors (fever, stress, alcohol)

• treatment efforts

Peds and Head exam

• head measurement at each well child visit up to age 3

• integrate cranial bone structural integrity with scalp inspection for comprehensive ped assessment

Facial assessment

• symmetry

• facial expressions

• edema and color/condition of skin

• palpate and auscultate temporal artery

• assess TMJ

Lymph node assessment

• size, shape, consistency, definition, mobility, tenderness

• locations include: occipital, post/preauricular, submental, sub mandibular, superficial anterior cervical, posterior/inferior anterior cervical and supraclavicular

Thyroid gland exam

• assess for masses, scars, lesions, atrophy/hypertrophy, bulging of eyes, and goiter

• Anterior: located cricoid cartilage move inferiorly to isthmus, feel lobes between trachea and SCM

• ask pt to swallow and feel for masses

• Posterior: reach from behind and locate cricoid, use one hand for each lobe

• Auscultate thyroid with diaphragm

Urethral meatus

• opening at tip of penis

Frenulum

• A fold of foreskin that extends ventrally from the urethral meatus is called the frenulum

Cremaster muscle

• can move scrotum up and down

Spermatic cord

• suspends the testes in the scrotum

Epididymis

• comma shaped, coiled structure where spermatozoa mature

Inguinal area

• Located between the anterior superior iliac spine laterally and symphysis pubis medially

• hernias (protrusion of loops of bowel through weak areas of the musculature) are common in this location

Prostate secretion

• thin, milky substance that promotes sperm motility and neutralizes female acidic vaginal secretions

Prostatic hyperplasia

• enlargement of the prostate gland, has become increasingly common in men over age 40

Risk factors for Prostate Cancer

• rare in men under 40, rises rapidly after age 50

• highest rate for African American/Caribbean males

• most common in N. America and NW Europe, less common in Asia

• family history

• Certain gene changes

• Exposure to agent orange

• Excessive alcohol consumption

• Working on a farm, in a tire plant, with paint, with cadmium or firefighters exposed to toxic chemicals.

• Diet: unclear, but slightly higher risk for those who eat a diet high in red meat or high fat daily, and fewer vegetables. High calcium intake may be a factor. Note that prostate cancer is less common in people who do not eat meat (vegetarians).

• Low melatonin levels (sleeping with even small light source; shift work

Symptoms of Prostate Cancer

• Difficulty starting and maintaining a steady stream of urine, dribbling of urine, excessive urination at night, frequent urination, urge to urinate and leaking, urinary retention, swelling in legs, bone pain, ED

Education Topics; Prostate Cancer

• Frequent ejaculation

• Eating a diet high in fruits and vegetables (at least 2½ cups of a variety of vegetables and fruits daily), staying physically active (exercise most days of the week), and maintaining a healthy weight

• Taking vitamin E and selenium (ambivalent study results)

• Possible preventive effect from medications for benign prostatic hypertrophy; aspirin (unclear results)

• Sleeping in a completely dark room

• Avoiding shift work that requires daytime sleep

• Drink green tea daily

Testicular cancer

• Testicular self-examination (TSE) should be performed once a month. It is normal to find that one testis is larger than the other.

  If you find any evidence of a small, pea-like lump, consult your physician. It may be due to an infection or a tumor growth.

  Start testicular exam at age 15-40

Transilumination of testes

• If an abnormal mass or swelling was noted during inspection and palpation of the scrotum, perform transillumination. Darken the room and shine a light from the back of the scrotum through the mass. Look for a red glow. If during inspection and palpation of the scrotal contents, you palpated a scrotal mass, ask the client to lie down. Note whether the mass disappears. If it remains, auscultate it for bowel sounds. Finally, gently palpate the mass and try to push it upward into the abdomen.

Male pubic area abnormalities

• Rashes, lesions, or lumps may indicate STI or cancer. Tenderness may indicate inflammation or infection. Discoloration of the foreskin may indicate scarring or infection. Chancres (red, oval ulcerations) from syphilis, genital warts, and pimple-like lesions from herpes are sometimes detected on the glans.

Anuria

• Failure of the kidneys to produce urine.

Frequency (urinary)

Urination at short intervals without increase in volume, r/t anxiety, infection, enlarged prostate, decreased bladder capacity

Ileal conduit

Urinary diversion in which the ureters are connected to the ileum with a stoma created on the abdominal wall

Micturition

• Process of emptying the bladder; urination; voiding

Oliguria

• The production of abnormally small amounts of urine.

Polyuria

• Production of abnormally large volumes of dilute urine

Pyuria

• The presence of pus in the urine, typically from bacterial infection

Stress incontinence

• State in which the person experiences a loss of urine of less than 50 mL that occurs with increased abdominal pressure

Phimosis

• tight foreskin that cannot be retracted

Paraphimosis

• a foreskin that once contracted, cannot be returned to cover the glans

Hypospadias

• displacement of urinary meatus to the ventral surface of penis

Epispadias

• displacement of the urinary meatus to the dorsal surface of the penis.

Male urethra discharge

• yellow=gonorrhea

• white=urethrits

Enlarged scrotal sac causes

• fluid, cyst in spermatic cord=Hydrocele

• blood=Hematocele

• bowel=Hernia

Variocele

• enlargemrnt of veins within the scrotum

• can cause low sperm production and quality

• palpable tortuous veins

Prostate findings

• tender and swollen = acute prostatitis

• enlarged, smooth, firm, slightly elastic = BPH

• hard area on prostate or hard foxed nodules = cancer

Mons pubis

• absorbs force and protect the pubic symphysis during coitus

Bartholin glands

• secrete mucus, which lubricates the area during sexual intercourse

Cervical cancer risk factors

• HPV or Chlamydia infection

• smoking

• immunosuppression

• diet low in fruits and veggies

• being overweight

• multiple full term pregnancies or being younger than 17 w/ first full term pregnancy

• poverty

• mother who took DES

• Family Hx

Cervical cancer risk reduction

• avoid risky sexual practices

• HPV vaccination as early as 9 yo and up to 26

• routine pap smears

Cervical cancer incidence

• lowest rates found in eastern Mediterranean countries

• unusually high rats found in African region where income levels are low

Hx of current health problem

• Menstrual cycles, Age at time of first menstrual period

• Menopause

• Vaginal discharge, Pain or itching in genitalia or groin

• Lumps, swelling, or masses in genitalia or groin

• Urinating difficulty, changes in urine color, or developed an odor

• Difficulty controlling urine

• Sexual performance, Sexual activity pattern, Fertility problems

Past and Family Hx

• Previous gynecologic problems and results of any treatment

• Date of last pelvic exam by a physician

• Date of last Pap smear and results

• Ever diagnosed with STD

• Pregnancies

• Reproductive or genital cancer

Bimanual exam

• used to check the size and location of women’s pelvic organs

Vaginal atrophy

• vagina becomes thinner and dryer

• caused by menopause, breast feeding, surgical removal of the ovaries, and radiation or chemotherapy treatments

• The risk increases if the client smokes, has not had a vaginal birth, or rarely has sexual activity

Blue cervix in a non pregnant woman

• indicates cyanosis

Pale cervix

• may indicate anemia

Adnexal masses

• masses in ovaries (mostly benign)

Cervical enlargement/projection

• more than 3cm into vagina may be from prolapse or tumor

3 layers of the detrusor muscle

• inner longitudinal

• middle circular

• outer longitudinal

Urinary system is innervated by

• the autonomic nervous system

Male urethra consists of

• prostatic, membranous and cavernous portions

Micturition

• contraction of detrusor muscle and relaxation of inter sphincters

• with 150ml to 250ml of fluid in bladder, a person fees desire to void

• 
  

Factors impacting Micturition

• alcohol inhibits ADH

• foods high in Na causes retention

• fever and diaphoresis (decreased urine production)

• heart failure (fluid retention and decreased urine output)

• diabetes (increase in urine output)

• 
  

Enuresis

• continued incontinence of urine past the age of toilet training

• Nocturnal enuresis (bedwetting) usually subsides by 6

Diseases assoc. w/ renal problems

• Congenital urinary tract abnormalities

• Polycystic kidney disease

• Urinary tract infection

• Urinary calculi

• Hypertension

• Diabetes mellitus

• Gout

• Connective tissue disorders

Renal failure

• kidneys fail to remove metabolic end products from the blood and are unable to regulate balance

Acute kidney injury

• sudden decline in kidney function and may be caused by dehydration, anaphylactic shock, sepsis, and ureteral obstruction

Chronic kidney disease

• slow loss of kidney function over months or years as a result of ireearable damage to kidneys

• caused by conditions like diabetes, HTN, and glomerulonephritis

• will eventually lead to ESRD

Diuretics and urination

• treat HTN

• prevent reabsorption or water and certain electrolytes in tubules

• depending on dose, can cause moderate to severe increased in production and excretion of dilute urine

Cholingerigc meds and urination

• stimulate contraction of detrusor muscle, producing urination

Analgesics and tranquilizers

• suppress CNS, diminish effectiveness of neural reflex

Urine color and Anticoagulants

• red or pink (due to hematuria)

Urine color and Phenazopyridine

• orange or orange/red urine

• urinary analgesic

Urine color and Amitriptyline/B complex vitamins

• green or blue/green urine

Urine color and Levodopa

• brown or black urine

• drug used to treat parkinson’s