Health Assessment Exam 1

·       Internal factors: help maximize communication skills

o   Liking others, empathy, ability to listen, and self-awareness (implicit bias)

·       External factors: ensure privacy, avoid interruptions, equal status seating, dress, and limit note taking and give them your full attention

Ten Traps of Interviewing

  1. Providing false assurance or reassurance
  2. Giving unwanted advice
  3. Using authority
  4. Using avoidance language
  5. Engaging in distancing
  6. Using professional jargon
  7. Using leading or biased questions
  8. Talking too much
  9. Interrupting
    1. Using “why” questions

o   Lanugo: fine downy hair of newborn infant

o   Vernix caseosa: cheesy substance on infant when fresh from the womb

·       Macules: pigmented area <1 cm

o   Patches: macules >1cm

·       Papules: thickened area of epidermis

o   Plaques: papule >1cm

·       Nodules: solid, elevated, extending deeper into dermis, >1 cm

·       Wheals: transient, erythematous, irregular in shape

o   Urticaria (hives): collection of wheals forming an extensive pruritic reaction

·       Tumors: deep into dermis, benign or malignant, larger in diameter, firm or soft

·       Vesicles (blister): elevated cavity containing fluid

o   Bullas: >1cm

·       Cysts: encapsulated fluid filled cavity

·       Pustules: pus in cavity; elevated

o   Lichenifications: prolonged scratching, thickened skin, tightly packed papules

·       Telangiectasis: spider/ star angiomas, venous lake

·       Pupuric lesions: petechiae, ecchymosis, purpura

o   Zosteriform: linear arrangement on nerve route (shingles)

o   Gyrate: twisted, coiled, or snakelike

Arciform: bow shaped

·       Tinea corporis: ringworm of the body

·       Tinea pedis: ringworm of the foot (athlete’s foot)

·       Labial herpes simplex (cold sores)

Herpes zoster (shingles)

·       Seborrheic dermatitis (cradle cap)

·       Pediculosis capitis (head lice)

·       Folliculitis barbae (razor bumps)

o   Hodgkin’s Lymphoma: cancer of the immune system; rare; involves neck, armpits, and groin; swelling and enlargement of the lymph nodes; fever, chills, night sweats, fatigue, neck pain

o   non-Hodgkin’s Lymphoma: swollen nodes, fever, abdominal and chest pain; cancer of the immune system

o   Epstein-Barr virus Mononucleosis: “mono”; severe malaise and fatigue, chills, fever, stiffness and pain in the neck, enlargement of the spleen

o   Plagiocephaly

§  Positional or deformational due to sleeping position

o   Craniosynostosis

§  Premature closing of one or more cranial sutures that leads to head malformation

o   Atopic (allergic) facies

§  A variety of presentations seen in children who have chronic allergies

§  Include exhausted face, allergic shiners, Morgan lines, central facial pallor and allergic gaping

o   Fetal alcohol spectrum disorders (FASD)

§  Narrow palpebral fissures, epicanthal folds, thin upper lip, and midfacial hypoplasia

o   Allergic salute and crease

§  Appearance of transverse line on the nose in response to chronically repeated use of hand to push the nose up and back

o   Congenital torticollis

§  Hematoma in one sternomastoid muscle, probably injured by intrauterine malposition, results in head tilt to one side and limited neck ROM to opposite side

o   Bells palsy

§  Paralysis on one side of the face as a result of LMN

§  Can be seen with pregnancy

§  Paralysis of CN VII

§  Stroke or brain attack

§  UMN lesion leading to paralysis of lower facial muscles

o   Parkinson syndrome

§  Classic “maskline” appearance, elevated eyebrows, staring gaze, oily skin and drooling due to dopamine deficiency

§  Cachectic appearance, sunken eyes, hollow cheeks, and defeated expression that accompanies chronic wasting diseases

·       Age-related macular degeneration (AMD): breakdown of cells in macula; loss of central vision

o   Risk factors: cigarette smoking, HTN, hypercholesterolemia, family Hx, females

·       Diabetic retinopathy: causes blindness; leading cause age 25-74

o   Changes occur within the retina (hemorrhages, lipid exudates)

o   Can be new vessel formations that increase the risk of retinal detachment or vitreous hemorrhage

o   Proliferative: worsening

·       Blepharitis: inflammation of the eyelid

·       Chalazion: inflamed or infected oil gland on the lid

·       Hordeolum: stye; inflamed hair follicle on eyelash

·       Anisocoria: unequal pupil size

·       Miosis: excessive constriction of pupils (glaucoma drops, narcotic use, brain damage)

·       Mydriasis: enlarged pupils (use of drugs, dilating drops, acute glaucoma, past or recent trauma)

·       Horners syndrome: unilateral small regular pupil, reacts to light and accommodation.  A lesion of the sympathetic nerve, also see ptosis on same side.

·       Primary angle-closure glaucoma (PACG): hazy pupil

o   Pupil is oval, dilated, cornea looks “steamy”.  Acute glaucoma occurs with sudden increase in intraocular pressure from blocked outflow from anterior chamber, patient has sudden clouding of vision, eye pain, and halos around lights, requires emergency treatment to avoid permanent vision loss.

·       Subconjunctival hemorrhage: looks alarming but not serious; d/t increased intraocular pressure from coughing, vomiting, heavy lifting, straining, or trauma

·       Pterygium: overgrowth of conjunctiva toward the center of the cornea from chronic exposure to hot, dry, sandy climate

·       Corneal abrasion

·       Shallow anterior chamber

·       Hyphema: blood in anterior chamber d/t herpes infection, blunt trauma, or spontaneous hemorrhage

·       Hypopyon: layer of WBCs in anterior chamber; s/s pain, red eye, decreased vision

o   Occurs with iritis and inflammation of anterior chamber

·       Optic atrophy: disc pallor; from partial or complete death of the optic nerve, decreased visual acuity, decreased color vision, disc has white to gray color

·       Papilledema: venous stasis from increased ICP, redness congestion and elevation of disc

o   d/t brain tumor or hematoma in the brain