HESI HA- points to review

Somnolent

The patient appears excessively sleepy or drowsy, often responding to speech with incoherent mumbles or brief movements before drifting back to sleep.

Obtunded

The patient has a moderate-to-severe reduction in alertness, shows little interest in the environment, and gives slow or confused responses requiring tactile stimuli (such as a gentle shake) to engage

Stuporous

The patient is in a deep, sleep-like state with little-to-no spontaneous activity, and can only be briefly aroused through vigorous or painful physical stimuli (such as a sternal rub) before lapsing back into unresponsiveness

Mean Arterial Blood Pressure

It is the average pressure of the blood in a person's arteries during one complete heart cycle.A MAP of at least 60 mm Hg is generally needed to adequately perfuse vital organs like the brain, heart, and kidneys.

Calculating MAP

MAP = Diastolic pressure + 1/3 (Pulse pressure)

Where pulse pressure is the difference between the systolic and diastolic pressure

PP= SBP−DBP

Nociception

First Phase (Transduction): Occurs when a noxious stimulus (injury, heat, chemical) triggers nociceptors to convert the energy into an electrical action potential.

Second Phase (Transmission): The pain impulse travels along nerve fibers from the peripheral site to the spinal cord, and up to the brain stem and thalamus.

Third Phase (Perception): Signifies the conscious awareness of a painful sensation as the brain cortex interprets the signals, identifying their location, intensity, and quality.

 Fourth Phase (Modulation): The body releases neurotransmitters (such as endorphins, serotonin, and norepinephrine) to inhibit or reduce the painful impulse.   

Testicular Torsion

A medical emergency that happens when a testicle rotates and twists the spermatic cord, cutting off blood flow to the testicle. Commonly affects adolescents and young adults, an absent cremasteric reflex on the affected side is a highly sensitive physical finding for testicular torsion. Scrotal discoloration and extreme tenderness

Head bobbing in babies

sign of respiratory distress, apply supplemental oxygen

Cooper ligaments in breasts

Provide support for the breast tissue. Fibrous, flexible connective tissue bands that run from the chest wall and pectoral muscles through the breast tissue to the skin dermis, helping maintain breast shape, contour, and position.

appropriate percussion sounds

• Resonance: A low-pitched, hollow sound heard over normal, air-filled lung tissue.

• Hyperresonance: A louder, lower-pitched, booming sound indicating excess air, such as in emphysema, asthma, or a pneumothorax.

• Dullness: A soft, high-pitched, thud-like sound heard over solid organs (like the liver or spleen) or dense tissue. In the lungs, dullness suggests fluid or a mass (such as pneumonia or a pleural effusion).

• Flatness: A short, quiet, high-pitched sound heard over dense structures like heavy muscle and bone.

• Tympany: A high-pitched, drum-like sound heard over air-filled, hollow organs like the stomach and intestines

Prehypertension in children

a blood pressure reading that is higher than normal, sitting between the 90th percentile and the 95th percentile for a child's age, sex, and height.

The most common place to find breast tissue changes or primary breast lumps

upper outer quadrant

assessing fro a pulse deficit

measure the apical heart rate and a peripheral pulse (such as the radial pulse) at the exact same time for a full 60 seconds

rectocele

a herniation or bulge of the front wall of the rectum into the posterior (back) wall of the vagina caused by a weakening of the rectovaginal septum and pelvic floor muscles

first degree prolapse

refers to the descent of the uterus or cervix pathway down into the vaginal canal, not a rectal bulge

urethral caruncle

a small, benign, red growth on the posterior lip of the urethral meatus, not a posterior vaginal bulge

Chronic otitis media

a long-standing inflammation or infection of the middle ear and mastoid cavity that involves a persistent eardrum perforation (usually lasting more than 6 weeks) or recurrent ear discharge

tension headache

patients normally describe the pain as a tight band squeezing around the forehead or the back of the head, is usually non-throbbing and bilateral

glaucoma

group of eye diseases that damage the optic nerve—often caused by a buildup of fluid and increased pressure inside the eye—which can lead to permanent vision loss or blindness

miosis

the medical term for when the pupil—the black center of the eye—shrinks to less than 2 millimeters in diameter and stays unusually small

onychomycosis

• Onychomycosis (tinea unguium) is a fungal or dermatophyte infection of the nail unit

• clinical features: yellow brownish discoloration starting at the distal nail plate, accumulation of hyperkeratotic debris under the plate, and onycholysis (the separation or elevation of the nail plate from the underlying nail bed)

Guillain-Barré syndrome (GBS)

• autoimmune process and a rare demyelinating disorder caused by antibody and cell-mediated immunologic reaction directed at the peripheral nerves

• Key symptoms include:

  Weakness, paresthesia (numbness and tingling), and hypotonia (reduced muscle tone) of the limbs

  Reflexes in the affected limbs are weak or absent with areflexia

  Autonomic nervous system instability (low blood pressure and arrhythmias)

  Cranial nerve involvement manifests as facial weakness and paresthesia, extraocular eye movement problems, and dysphagia

Korotkoff sounds

• the arterial sounds heard during blood pressure measurement when using a manual sphygmomanometer and stethoscope

• Phase 1: Systolic Pressure

The first sound is a clear rhythmic tapping corresponding to the pulse rate that gradually increases in intensity. Onset of the sound corresponds to the systolic pressure 1. This is the point where blood begins spurting through the constricted artery as you deflate the cuff.

• Phase 2: Swishing Sound

A blowing or swishing sound occurs as the cuff continues to deflate [1, 3]. As the artery distends there is turbulence in blood flow 1.

• Phase 3: Crisp Tapping

The third sound is a crisper and more intense tapping 1. This represents continued turbulent blood flow as the artery opens further.

• Phase 4: Muffled Sound

The fourth sound becomes muffled and low pitched as the cuff is further deflated. At this point the cuff pressure has fallen below the pressure within the vessel walls. This sound is the diastolic pressure in infants and children .

• Phase 5: Silence (Diastolic Pressure)

The fifth sound marks the disappearance of sound. In adolescents and adults, the fifth sound corresponds with the diastolic pressure 2. The manometer pressure noted at the fifth Korotkoff sound is the diastolic pressure 3, indicating that the artery is completely open 3.

Graves Disease

• an autoimmune disease characterized by thyroid enlargement and excess thyroid hormone secretion

• Risk factors, such as a lack of iodine, smoking, infection, and stress, may interact with genetic factors to cause Graves disease

• Manifestations are related to the effect of excess circulating thyroid hormones and include:

  • Tremor, increased cardiac output, weight loss, flushing, heat intolerance, amenorrhea, hyperreflexia

  • Exophthalmos (protrusion of the eyeballs from the orbits) resulting from increased fat deposits and fluid (edema) in the orbital tissues and ocular muscles

  • Diplopia (double vision) due to extraocular muscle weakness

  • Pretibial myxedema (Graves dermopathy) in some patients with very high TSI levels, characterized by subcutaneous swelling on the anterior portions of the legs and by indurated and erythematous skin

  • Goiter on palpation

ulcerative colitis

a chronic inflammatory bowel disease (IBD) that causes long-term inflammation and open sores, or ulcers, in the inner lining of the large intestine (colon) and rectum

cramping, pain, dehydration, urgency, diarrhea

diverticulosis

• a common condition where small, bulging pouches called diverticula form in the lining of the large intestine (colon)

• They most frequently appear in the lower part of the colon, known as the sigmoid colon.

• Symptoms: Most people have no symptoms and discover the pouches by accident during a routine colonoscopy or CT scan.

• Mild signs: When symptoms do happen, they can include mild lower abdominal pain, bloating, constipation, or alternating bowel habits.