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NU 650 Final Exam SG 2024 PASSED!!

Order of Assessment
Inspection, Palpation, Percussion and Auscultation. EXCEPT with abdomen
Comprehensive Health History
chief complaint, reason for visit, ROS, past medical and surgical history, social history
and family history
Pediatric Body measurements
length, height, weight, head circumference fro birth to 36 months
Normal/Hypertension cut off
<130 normal 140+ hypertension
Fontanel Closure
posterior 1-2 months, anterior 9mo-2years
otoscope
adult-up and back, peds- down and back, using largest speculum that will fit comforably
tympanic membrane
Cone of light R-5 l-7
EOM testing
CN III, IV, VI
AP diameter of chest
1:2 (AP less than transverse)
barrel chest
COPD
Flat or Dull percussion
effusion or pneumonia
normal resonant percussion
healthy lung
Hyperressonance (percussion)
trapped air
crackles/rales
high pitched, discontinuous
Wheezes
high-pitched whistling or squeaking sounds during inspiration or expiration
Rhonchi
snoring, rumbling sounds heard upon auscultation of the chest during respiration-low
pitched
tactile fremitus
• INCREASED FREMITUS
- Means there is liquid or solid inside the lungs (consolidation such as with pneumonia)
- Remember Liquid or solid transmits vibrations better than air

• DECREASED FREMITUS
Means air trapping such as with emphysema or bronchial obstruction.
Bronchophony

, the spoken voice sound heard through the stethoscope, which sounds soft, muffled, and
indistinct over normal lung tissue, clearer over disease
Egophony
abnormal change in tone of voice that is heard when auscultating the lungs EE-->AA
UE Arteries
radial-thumb side, ulnar pinky side
Pulse grading
0 absent
1+ weak
2+ normal
3+ increased
4+ bounding
palpate bilaterally
PMI
point of maximal impulse mid-clavicular and 5th ICS
S1
normal, closure of AV, Start of systole, loudest at Apex, contraction of ventricles
S2
normal, closure of semilunar, end of systole, loudest at base, filling of ventricles
S3
third heart sound (normal in pregnant young adults, and children), gallop
S4
extra heart sound, end of diastole, indicative of disease-AFIB
murmur grading scale
I-Barely Audible
II-Quiet, Clearly Audible
III-moderately Loud
IV-loud, thrill
V-Very loud, can palpate thrill
VI-Very loud, thrill palpable and visible
clubbing
bulbous enlargement of distal phalanges of fingers and toes that occurs with chronic
cyanotic heart and lung conditions
edema scale
1+ = disappears rapidly. 2+ = last 10-15 seconds. 3+ = lasts more than one minute. 4+
= lasts 2-5 minutes. These are signs used in what scale?
normal/abnormal findings spleen
normal=tympanic, dullness could be enlargement not normally felt on exam
Blumberg Sign: Rebound Test
peritoneal inflammation, hurts more when release from palpation
shifting dullness
a sign of free peritoneal fluid wherein the dullness of percussion shifts, generally from
one side to the other, as the patient is turned from side to side.
Psoas sign
RLQ pain with extension of right thigh indicative of appendicitis
Obturator sign

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