In Exercises 4346, insert either or in the shaded area

Study Guide for Exam III , April 18 2016 1. Cells circulating in the blood (3, 4, 25, 30)  Complete Blood Count: most commonly ordered lab in healthcare (overview of patient’s general health status) o White blood cells (leukocytes) o Red blood cells (erythrocytes) o Platelets or thrombocytes 2. Cells associated with allergies and parasitic conditions  Eosinophils:  Numbers increase with allergic and/or parasitic conditions  Found in the skin and airways  Ingest antigen-antibody complexes  If steroids increase, from production of the adrenal gland or by administration, eosinophil decrease in number 3. Cells that are the first line of defense  Polymorphonuclear neutrophils are the most numerous o They respond more rapidly to the inflammatory and tissue injury sites than other types of WBCs o Considered body’s first line of defense during an acute infection o Segments are mature neutrophils o Bands are immature ones that multiply quickly during an acute infection 4. Inspection of the abdomen  contour: shape  symmetry:  umbilicus midline and inverted  Skin: striae: stretch marks, recent striae pink or blue, then turn silvery, moles common in abdomen, good skin turgor  Pulsation: normal in thinner people, veins usually not seen  Hair distribution: men diamond shape women: inverted triangle  Demeanor: relaxed 5. Organs located in: RUQ, RLQ, LUQ, and LLQ  RUQ – liver, gallbladder, duodenum, head of pancreas, right adrenal gland and kidney, hepatic flexure of colon, part of ascending and transverse colon.  LUQ – stomach, spleen, left lobe of liver, body of pancreas, left adrenal gland and kidney, splenic flexure of colon, part of transverse and descending colon.  RLQ – cecum, appendix, right ovary and fallopian tube, right ureter, and right spermatic cord  LLQ – part of descending colon, sigmoid colon, left ovary and tube, left ureter, and left spermatic cord. 6. Hyperactive bowel sounds  loud, high pitched, rushing, tinkling sounds that signal increased motility  hyperperistalsis: when stomach is growling boraborygmus 7. Hypoactive bowel sounds  follow abdominal surgery or with inflammation of the peritoneum 8. Absent bowel sounds  must be after five minutes  very uncommon  ** completely absent is medical emergency because it means there is blockage or obstruction 9. Vascular vessels in the abdomen  aorta, renal, iliac, femoral  note presence of bruits  especially in people with hypertension  4-20% people may have a normal bruit originating from celiac artery 10. Auscultation technique  don’t auscultate in presence of nasogastric feeding tubes  listen for a full minute in each quadrant  use diaphragm, press lightly, start at ileocecal valve  percussion and palpation can increase peristalsis which would give a false interpretation of bowel sounds 11. Pronation and supination  movement of the wrist  turning forearm so palm is down (PRO)  turning forearm so palm is up (SUP)  tests elbow joint and skeletal muscles 12. Assessment of the shoulder  inspect and compare  pg. 593 is that all we need to know  local or referred from hiatal hernia or a cardiac or pleural condition which could be potentially serious  local pain reproduces by palpation or motion  note muscle spasms or atrophy, swelling, heat or tenderness  start at clavicle and methodically explore the acromioclavicular joint, scapula, greater tubercle of the humurus, area of the sub acromial bursa, biceps groove, and anterior aspect or glenohumeral joint  note masses or adenopathy  ROM: back to forward, back rotation, abduction and adduction 13. Bulge Sign  notes presence of small amounts of fluid (4-8mL)  occurs with very small amounts of effusion  stroke up then side to side 14. Phalen’s test  hands back to back at 90 degrees  reproduces numbness and burning in a person with carpal tunnel syndrome 15. Tinel sign  direct percussion of location of median nerve at the wrist produces no symptoms in normal hand  burning and tingling with with carpal tunnel 16. Hematopoiesis  production of red blood cells  start as hematopoietic stem cells and mature into myeloid cells (erythrocytes, megakaryocytes, monocytes, neutrophils, basophils, or eosinophils) or lymphoid cells (t and b lymphocytes) 17. Assessment of Cerebellar function (648-649)  to test balance  Coordination & Skilled Movements o Rapid Alternating Movement: pat knees with palms then lift up, flip, and pat knees with backs of hands/ have patient tough thumb to each finger on both hands at the same time o Finger-to-Finger Test: eyes open; have patient meet your finger with their index finger/ have patient meet their nose with their index finger o Finger-to-Nose Test: close eyes; have patient bring index finger to nose alternating hands o Heel-to-Shin Test: move the heel down the shin from the knee to the ankle (should move in a straight line)  Balance o Gait: observe patient’s walk 10-20 ft./ gait is smooth, rhythmic, effortless/ then have patient walk heel to toe to test balance o Romberg Test: feet together and arms at sides, close their eyes and wait 20 seconds, normally a parson can maintain balance and “catch themselves” 18. Babinski reflex  reflex present at birth and disappears by 2 years  pos. reflex after two years occurs with pyramidal tract disease  stroke bottom of foot, toes fan out 19. Cranial Nerves and functions (Lexi’s Quizlet) 20. Instructing a patient on assessment of hernia (703)  you need to ask man to bear down and palpate for bulge 21. Male Scrotum and testes  #21 how to assess, what is the incidence, who is at risk  22. Incidence of testicular cancer (704)  overall incidence is rare  8000 new cases each year  rare before 15 years old  occurs most often 15-35 y/o  associated with history of cryptorchidism 23. How to examine testes (704-705)  see textbook pages 24. Hypospadias (714)  opening is on underside rather than the top  opens on ventral side  important to recognize at birth b/c you cannot circumcise 25. Anal canal (721)  3.8 cm long  lined with modified skin, no hair or sebaceous skin  skin merges with rectal mucosa at anorectal junction  two sphincters  inner: involuntary by ANS  external is voluntary  tightly closed  intersphincteric grove separates the two and is palpable  anal columns are folds of mucosa, extend down from the rectum and end in the anorectal junction: NON palpable but visible with with PROCTOSIS  outlet of GI tract 26. Prostate gland normal findings and abnormal findings (728)  also see page 727 27. Steatorrhea  excretion of abnormal qualities of fat with the feces bc of the reduced absorption of fat by small intestine  bloody stool, black or tarry stool, stool with pus  severe abdominal pain or cramping  fever of over 101  fowl, smelling stool, diarrhea, gas, nausea with or without vomiting 28. Differentiate Vertigo, syncope and dizziness  Vertigo and dizziness are the same. Syncope is passing out.  Vertigo: rotational spinning caused by neurological disease in the vestibular apparatus in the ear or the vestibular nuclei in the brain stem o obj: room in spinning o subj: you feel like you are spinning  Syncope: sudden loss of strength, temporary loss of consciousness caused by lack of cerebral blood flow  Dizziness: lightheaded, swimming sensations, feeling faint 29. Function of the Prostate Gland  job is it doesn’t produce sperm but produces semen  which is fluid that keeps sperm alive  secretes thin, milky, alkaline fluid that helps sperm viability 30. Cervix appearance and findings  color: pink and even, after menopause is pale, blue second month of pregnancy (chadwicks sign)  position: midline, projects 1-3 cm into vagina  size: 2.5  Os: small and round in nulliparous women, parous woman: horizontal, irregular slit, show healed lacerations  surface: smooth 31. Causes of thick white discharge  candidiasis which also moniliasis  STD  intense pruritus, thick, whitish, clumpy discharge, like cottage cheese  use of antibiotics, higher chance on birth control and undiagnosed or uncontrolled diabetes, douching that disrupts normal flora, tight or nylon underwear, pregnancy, more alkaline vaginal ph., post partum and menopause 32. Assessing for HPV  painless warty growths, pink or flesh colored  vinegar (acetic acid) white HPV dissolve mucus, intracellar dehydration (turns white)  most common STI, especially in adolesants 33. Chandelier sign  term referring to sever pain during pelvic examination of a patient with PID  patients reaches up towards ceiling for relief  leaps out of stirrups 34. Normal findings of gyn examination (746, 751) 35. Chlamydia, gonorrhea, Syphilis, and Trichomoniasis  Chlamydia: most common o S: Minimal or no symptoms. May have urinary frequency, dysuria, vaginal discharge, postcoital bleeding o O: May have yellow or green mucopurulent discharge, friable cervix , cervical motion tenderness. Signs are subtle and can easily be mistaken for gonorrhea. If untreated or mistreated, chlamydia can ascend to cause PID and result in infertility. A common STI; the highest prevalence is among sexually active adolescents. Urine chlamydia testing using nucleic acid amplification tests is a noninvasive method to screen.  Gonorrhea: second most common o S: Variable- Vaginal discharge, dysuria, abnormal uterine bleeding, abscess in Bartholin or Skene glands; 95% of cases are asymptomatic o O: Often no signs are apparent. May have purulent vaginal discharge. Diagnose by positive culture of organism. If the condition is untreated, it may progress to acute salpingitis, PID. Treat with antibiotics and retest in 3 to 6 months.  Syphilis: more common in adults 25+ o Painless sore on the genitals, rectum, or mouth o  Trichmoniasis: more common in women than men o S: Pruritus, watery and often malodorous vaginal discharge, urinary frequency, terminal dysuria, itching. Symptoms are worse during menstruation when the pH is optimal for organism’s growth o O: Vulva may be erythematous. Vagina diffusely red; granular; occasionally with red, raised papules and petechiae (strawberry appearance). Frothy, yellow-green, foul smelling discharge. Vaginal pH greater than 4.5/ Microscopic examination of saline wet mount specimen shows characteristic flagellated cells 36. Cremasteric response  not done routinely  for a male  lightly stroke inner aspect of the thigh with reflex hammer or tongue blade  note elevation of ipsilateral testicle 37. Smoking and oral contraceptives  oral contraceptives with cigarette smoking increase risk of vascular problems, increase chance of strokes times 10  oral contraceptives: prolong safer life