WHNP NCC EXAM
Tympany - Answer- loud, high pitched, "drum" sound heard on percussion
- heard over abdomen (except for organs/masses)
Resonance - Answer- loud, low pitched, hollow sound heard on percussion
Hyperresonance - Answer- very loud, low pitch, "boom" sound heard on percussion
40 - Answer- Waist circumference has little value if BMI is >/= ______
35 in - Answer- waist circumference >____ in a woman = inc. risks
Snellen chart - Answer- tests visual acuity; central vision (i.e. 20/20)
Rosenbaum card - Answer- tests visual acuity; near vision
Presbyopia - Answer- Near vision is impaired (Farsighted)
Myopia - Answer- Far vision is impaired (Nearsighted)
Confrontation test - Answer- Tests peripheral vision/estimates visual fields
Extraocular muscle function - Answer- symmetrical movement to the 6 cardinal fields of gaze test what?
Normal opthalmoscopic exam - Answer- - Red reflex present
- Yellow to pink optic disc w/ distinct margins
- Light red arterioles (2/3 diameter of veins) w/ bright light reflex
- Veins dark red
- No venous tapering at AV crossings
Weber test - Answer- - Stem of a vibrating tuning fork on the midline of the head, patient indicates in which ear the tone is
heard
- Lateralization of sound through bone conduction
- Unilateral conductive loss - sound lateralizes toward affected ear
Unilateral sensorineural loss - sound lateralizes to the normal or better-hearing side.
Rinne test - Answer- - Vibrating tuning fork 1st placed on mastoid process, then in front of external auditory canal to test
bone vs air conduction of sound (AC:BC = 2:1)
- Test of conductive hearing loss
AC:BC = 2:1 - Answer- Normal results of Rinne test
Sensorineural hearing loss - Answer- caused by defect in inner ear distorting sound, age, trauma from loud noises,
genetics
Conductive hearing loss - Answer- impaired through external/middle ear; caused by fluid, object, swelling, ruptured
eardrum, ear wax
Normal otoscopic exam - Answer- Tympanic membrane intact, pearly gray, translucent, with cone light at 5-7:00
Acute otitis media - Answer- infx of middle ear; often preceded by URI or allergies/smoke
Full/bulging tympanic membrane with no/obscured bony landmarks, distorted light reflex, post-auricular cervical
lymphadenopaty
tx: amoxicillin (augmentin, azith, trimethoprim-sulfamethoxazole)
Malignant melanoma - Answer- - Asymmetry
- Borders irregular
- Color blue or black
- Diameter > 6 mm
,- Elevation
Leukoplakia - Answer- thickened, white, leathery patch in mouth/tongue can develop into squamous cell carcinoma
Pharyngitis - Answer- Erythematous pharynx, tonsils 3+, white exudate, enlarged tender anterior cervical nodes
tx:
GABHS - PCN PO/benzathine PCN IM (erythromycin if allergy)
Normal breath sounds - Answer- Vesicular; bronchial over trachea, bronchovesicular near main bronchus
Resonant - Answer- Normal sound of lung percussion
< - Answer- Respiratory: Normal = AP diameter (> / <) transverse
Decreased - Answer- Tactile fremitus is (increased/decreased) with emphysema, asthma, and pleural effusion
Increased - Answer- Tactile fremitus is (increased/decreased) with global pneumonia and pulmonary edema
Vocal resonance - Answer- This is usually muffled/indistinct; if it is not = fluid/solid mass in lungs
Crackles - Answer- Air flowing by fluid; sign of early heart failure, pneumonia, or bronchitis
Fine crackles - Answer- Heard at end of inspiration, high pitch, popping, short duration
Coarse crackle - Answer- - Heard during inspiration (may be during exp), low pitch, loud, bubbling, longer duration
- Does not disappear with coughing
Rhonchi - Answer- - Air passing over solid/thick secretions in large airways
- Bronchitis, pneumonia
- Heard with inspiration and expiration
- Low pitch, loud, snore-like
- Disappears w/ cough
Wheezing - Answer- - Air flow through constricted passage
- Chronic emphysema, asthma
- High pitch, louder during expiration, squeaky
Pleural friction rub - Answer- - Inflammation of pleural tissue
- Pleuritis, pericarditis, heard with inspiration/expiration
- Dry, rubbing, grating
Apical impulse - Answer- 4th-5h left intercostal space medial to midclavicular line
S1 - Answer- Occurs at start of systole at apex
S2 - Answer- Occurs at start of diastole at base
Physiologic split S2 - Answer- - Heard at inspiration at base, normal
- Best heard w/ diaphragm
Fixed split S2 - Answer- - Heard at inspiration and expiration at base
- Delayed closure of pulmonic valve - caused by atrial septal defect, right ventricular failure
- Best heard w/ diaphragm
Increased S3 - Answer- - Ventricular gallop, best heard at apex with bell
- Early diastole, low pitch, increases w/ inspiration
- Normal in young adults & late preg.
- Dec myocardial contractility/heart failure/volume overload = rapid ventricular filling
Increased S4 - Answer- - Atrial gallop, best heard at apex w/ bell
- Late diastole, low pitch, increases w/ inspiration
- Normal in athletes, old
- Aortic stenosis, HTN heart disease, & cardiomyopathy = forceful atrial ejection into distended ventricle
Physiologic murmur - Answer- - 2-4th left ICS bw left sternal border & apex
,- Mid-systole, soft-medium pitch, improves/gone when sitting, standing, valsalva
- Normal, common in pregnancy
Murmur of mitral stenosis - Answer- - Best heard at apex w/ bell
- Early to late diastole, low-pitched
Systolic click - Answer- - Best heard at apex with diaphragm
- Mid-to late systole, high pitch, inc w/ inspiration
- Mitral valve prolapse
Liver - Answer- - Smooth edge, sharp, nontender, </= 2 cm below right costal margin
- Spans 6-12 cm at right MCL
Aorta - Answer- Left of midline in upper abdomen, <3 cm wide
Splenic dullness - Answer- 6-10th ICS posterior to midaxillary line - suspect splenomegaly
Peritonitis - Answer- Guarding, rigidity, rebound tenderness is a sign of?
Appendicitis - Answer- Mcburney's point, Rovsing, and Psoas/obturator are tests for what?
McBurney - Answer- localized RLQ tenderness
Rovsing - Answer- Referred rebound tenderness; RLQ pain when Left side pressure is applied & withdrawn
Psoas/obturator - Answer- Extension/rotation of thigh/hip causes right side muscle irritation and pain
Cholecystitis - Answer- + Murphy sign indicates what?
Murphy - Answer- Sharp increase in tenderness and cessation of breathing when upward pressure placed under right
costal margin
Colorectal screen - Answer- for all adults 45+ with structural (visual) or high sensitivity stool test; screen until 75 y.o.
-guaiac fecal occult: multiple stools, at home, annual
-stool DNA - 1 sample, at home, cancer/polyp DNA, q3y
-colonoscopy q10y
-flexible sigmoidoscopy q5y
-CT colonography q5y
start younger if risks like inflammatory bowel disease, hx/fhx colon polyps/colon cancer, lynch syndrome,
1945-1965 - Answer- Anyone born between these years or with risk factors should be tested for Hep C
DM - Answer- screen for this q3 years starting at 45 y.o.
hx GDM - screen q3y for life
Dx made by:
- sx hyperglycemia & random non-fasting glucose 200+
- fasting glucose 126+
- 2 hour GTT - 200+
Must be repeated on another day to confirm
40-75 - Answer- Lipids should be screened starting at what age; (or starting at 20 if risk factors for CV disease)
done q5y
Cranial nerves - Answer- - I - olfactory; familiar smells
- II - optic; acuity, peripheral vision, optic disc
- III, IV, VI - oculomotor/trochlear/abducens - PERRLA, EOM function, ptosis
- V - trigeminal - palpate temporal/masseter muscle strength, sharp/dull touch on forehead/cheeks/chin
, - VII - facial - weakness, asymmetry, abnormal movement
- VIII - acoustic - auditory acuity
- IX & X - glossopharyngeal & vagus - swallow, soft palate symmetry, uvula movement w/ "ah", gag, voice
- XI - spinal accessory - strength/symmetry, trapezius & sternocleidomastoid muscles
XII - Hypoglossal - tongue deviation, asymmetry
Cerebellum - Answer- Coordination, gait, walk heel-toe, Romberg, rapid alternating movement
Romberg - Answer- test balance with eyes closed
Pederson speculum - Answer- - Straight-sided
- Comes in pediatric, narrow, and regular sizes
Graves speculum - Answer- - Duck-billed shape, used for lax musculature
- Submucosal fat impedes visualization
5.5-8 cm; 2-3 cm - Answer- Normal uterus size; usually this much larger in parous women
Normal adnexa - Answer- Fallopian non-palpable, ovoid ovaries
epididymis - Answer- posterolateral surface of tests, comma shape
spermatic cord - Answer- from lower end of epididymis and extends to external inguinal ring
prostate gland - Answer- surrounds urethra at bladder neck, heart shaped, 4x3x2 cm, smooth, rubbery, nontender
Hypospadias - Answer- congenital displacement of urethral meatus to inferior (ventral) surface of penis
peyronie's - Answer- palpable nontender hard plaque under skin along dorsum of penis, crooked/painful erections
varicocele - Answer- - abnormal dilation of peritesticular veins causing varicose veins of spermatic cord; bag of worms
feeling separate from testes
- assoc w/ infertility
acute epididymitis - Answer- - acutely inflamed, tender, swollen epididymis, scrotum red, low grade fever
- usually caused by CT/GC
spermatic cord torsion - Answer- - twisted testicle, pain, swelling, testes retract into scrotum (red, edema)
- usually in teens
- surgical emergency
sperm - Answer- hypothalamic-pituitary-testicular axis is responsible for production of what?
anterior pituitary - Answer- -FSH
-LH
-ACTH
-TSH
-Prolactin
-Endorphins
-GH
posterior pituitary - Answer- oxytocin, vasopressin
GnRH - Answer- FSH/LH produced in response to secretion of this
FSH & LH - Answer- hormones responsible for testicular production of sperm and testosterone
72 days - Answer- spermatogenesis takes how long to produce fully mature sperm
3-5 days - Answer- how long can sperm live in a vagina
RBC - Answer- 4.2-5.4 mill
Low - hemorrhage, hemolysis, hemoglobinopathy, bone marrow failure
High - dehydration, chronic hypoxia (congenital heart disease), polycythemia vera
HCT - Answer- percent of blood volume made of RBCs
