Health Assessment Final Exam

What is subjective data?

Information reported by the patient (pain, nausea, feelings)

What is objective data?

Measurable or observable findings (vital signs, labs, exam findings)

What are common interview traps?

Bias, stigmatizing language, leading questions, interrupting, medical jargon, excessive talking, discomfort with silence, over-informing, “I know how you feel”

What are components of the general survey?

Appearance, distress level, posture/gait, mobility, hygiene, first impression

What can cause elevated BP in clinic?

Exercise, incorrect cuff size, medications, caffeine, smoking, stress, full bladder

Normal adult respiratory rate?

12–20 breaths/min

Normal adult pulse?

60–100 bpm

Normal adult BP?

<120/<80

Normal temperature range?

97–99°F (36.1–37.2°C)

Normal O2 saturation?

95–100%

Orthostatic hypotension definition?

Drop ≥20 mmHg systolic or ≥10 mmHg diastolic within 1–3 minutes of standing

Causes of tachycardia?

Stress, stimulants, smoking, pain, fever, dehydration, blood loss

What are the components of the skin exam?

Inspection (color, lesions, ABCDE) and palpation (temperature, moisture, turgor, edema)

How do you assess pallor?

Conjunctiva, palms, nail beds

What is a macule?

Flat lesion <1 cm

What is a papule?

Raised lesion <1 cm

What is a pustule?

Pus-filled lesion

What is 4+ pitting edema?

Very deep indentation (8 mm) lasting >2 minutes, limb misshapen

What is 3+ pitting edema?

indentation lasts more than 1 minute, 6 mm

What is 2+ pitting edema?

deeper indentation, lasts 10–15 seconds, 4 mm

What is 1+ pitting edema?

  slight indentation, disappears quickly, 2 mm

What is 0 pitting edema?

normal

What does PERRLA stand for?

Pupils Equal Round Reactive to Light and Accommodation

What does 20/40 vision mean?

Sees at 20 ft what normal sees at 40 ft

What is ptosis?

Drooping of the upper eyelid

What is CN I responsible for?

Smell

What is CN II responsible for?

Vision

What is CN III responsible for?

Eye movement

What is CN V responsible for?

Facial sensation and chewing

What is CN VIII responsible for?

Hearing and balance

What is CN X responsible for?

Swallowing and uvula movement

What is CN XII responsible for?

Tongue movement

What is a normal Romberg test?

No swaying with eyes closed

What does a positive Romberg indicate?

Loss of balance/proprioception issue

What are signs of respiratory distress?

Retractions, nasal flaring, tachypnea, SOB, cyanosis, altered mental status

What is stridor?

High-pitched inspiratory sound indicating airway obstruction (emergency)

What is wheezing?

Expiratory sound from airway narrowing

What are rhonchi?

Low-pitched mucus sounds that may clear with coughing

What are crackles?

Fluid in alveoli

What is a pleural rub?

Grating/grinding sound

How do you assess fremitus?

Patient says “99” while palpating chest

What does increased fremitus indicate?

Consolidation (pneumonia)

What does decreased fremitus indicate?

Fluid, air, or obstruction

Primary treatment for atelectasis?

Incentive spirometry

Priority in respiratory distress?

Airway (stridor = emergency)

Signs of fluid overload?

Edema, crackles, weight gain, orthopnea, JVD, S3, SOB

What is the flow of blood through the heart?

Vena cava → RA → tricuspid → RV → pulmonary artery → lungs → pulmonary vein → LA → mitral → LV → aorta

Right side

deoxygenated blood pumped to lungs

left side

oxygenated blood pumped to body

What is systole?

Ventricular contraction (S1)

What is diastole?

Ventricular relaxation (S2)

What is preload?

Volume entering the heart

What is afterload?

Resistance the heart pumps against

Stroke volume

 volume of blood ejected per beat

Cardiac output

volume of blood ejected from the ventricle in 1 minute

Ejection fraction?

% of ventricular volume ejected with each beat (normal 60–70%)

What are heart auscultation landmarks?

Aortic (2RICS), Pulmonic (2LICS), Erb’s (3LICS), Tricuspid (4LICS), Mitral (5th MCL)

Risk factors for DVT?

Immobility, pregnancy, OCPs, obesity, smoking, cancer, heart failure

What is a thrill?

palpable vibration felt with palm of hand — indicates a significant murmur

Murmurs

turbulent blood flow through valves; graded I–VI

What is S3?

“Kentucky” sound; early diastole; may indicate heart failure

What is S4?

“Tennessee” sound; late diastole; always abnormal

heaves

impulses that lift fingers off chest wall; indicates ventricular enlargement

Signs of acute abdomen?

Rigidity (board-like abdomen), rebound tenderness, absent bowel sounds, percussive tenderness, positive cough test, positive rovsings sign, positive murphy’s sign

What is Murphy’s sign?

RUQ pain on inspiration (cholecystitis)

What is Rovsing’s sign?

RLQ pain when LLQ is pressed (appendicitis)

Correct abdominal exam order?

Inspection → Auscultation → Percussion → Palpation

Signs of dehydration?

Poor turgor, dry mucosa, dark urine, decreased output

Normal percussion findings?

Tympany over most abdomen, dullness over organs

Normal bowel sounds?

5–35 clicks/gurgles per minute

What is scoliosis?

Lateral spinal curvature

What is lordosis?

Inward lumbar curve

What is kyphosis?

Outward thoracic curve

How do you prevent osteoporosis?

weight bearing exercise, calcium/Vit D, stop smoking, limit alcohol, avoid prolonged steroid use

Osteoarthritis (OA)

degenerative/mechanical,

onset- gradual over years,

age- later in life,

joints affected- hands, knees, hips, spine

pattern- unilateral

joint appearance- aching, little swelling

Morning stiffness- less than one hour

no systemic symptoms

Rheumatoid arthritis

autoimmune disease

onset- weeks to months

age- any age

joints affected- hands, knees, hips, spine

pattern-bilateral

joint appearance- painful, swollen

Morning stiffness- greater than one hour

systemic symptoms- fatigue, fever, other organs affected

What are the 6 Ps of compartment syndrome?

Pain, pallor, pulselessness, paresthesia, paralysis, poikilothermia

What is normal muscle strength?

5/5- Full ROM against gravity with full resistance

+4- muscle strength

good; Full ROM against gravity with some resistance

+3- muscle strength

fair; Full ROM against gravity only

+2- muscle strength

poor; Full ROM with gravity eliminated

+1- muscle strength

trace; viseible or palpable contraction but no movement

+0- muscle strength

no contraction detected

Order of vital signs in children?

RR → HR → Temp → BP → O2

When does posterior fontanelle close?

2–3 months

When does anterior fontanelle close?

12–18 months

Is HR of 140 normal in infants?

yes, normal HR for infants is 100-190

infant RR

30-53

toddler RR

22-37

preschool RR

20-28

school age RR

18-25

Adolescent RR

12-20

neonate HR

100-205

infant HR

100-190

toddler HR

98-140

preschool HR

80-120

school age HR

75-118

adolescent

60-100

neonate BP

67-84/35-53

infant BP

72-104/37/56