Nur Quiz #2 Unit 6,7,8

Lymph from the breasts drains from the central axillary nodes to the infraclavicular and supraclavicular nodes. This is because the lymphatic vessels in the breasts drain into the axillary lymph nodes, which are located in the armpit region. From there, the lymph flows towards the infraclavicular and supraclavicular nodes, which are located below and above the collarbone respectively. This lymphatic drainage pathway helps in the removal of waste products and toxins from the breast tissue.

When a patient squats, the venous return to the heart increases due to increased pressure in the abdomen. This increased venous return leads to an increase in stroke volume and the volume of blood in the left ventricle. Additionally, squatting also increases peripheral vascular resistance, which further contributes to an increase in blood pressure. These changes in blood pressure, stroke volume, and left ventricular volume can help in identifying certain cardiac conditions. For example, in a mitral valve prolapse, squatting may cause a significant increase in left ventricular volume, while in hypertrophic cardiomyopathy, the increase in blood pressure may be more pronounced compared to aortic stenosis.

Periumbilical pain is pain that occurs around the belly button. This type of pain can be an early sign of inflammation in the appendix, a condition known as appendicitis. Appendicitis is a medical emergency that requires immediate attention and possible surgical removal of the appendix. Therefore, the statement "Periumbilical pain could be an early sign of an inflamed appendix" is true.

Inferior wall myocardial infarction angina commonly presents as indigestion and is precipitated by exertion. This means that when someone experiences an inferior wall myocardial infarction, they may mistake the symptoms for indigestion. Additionally, the symptoms are often triggered or worsened by physical exertion. Therefore, the statement is true.

Adventitious breath sounds refer to abnormal sounds heard during breathing. Wheezes, rhonchi, and crackles are all examples of adventitious breath sounds. Wheezes are high-pitched, musical sounds typically heard during expiration and indicate narrowed airways. Rhonchi are low-pitched sounds caused by airway obstruction or mucus accumulation. Crackles are discontinuous, popping sounds heard during inspiration and suggest fluid or inflammation in the lungs. Therefore, all of the above options are correct as they are examples of adventitious breath sounds.

The structures mentioned in the right upper quadrant include the liver, gallbladder, and ascending colon. The liver is a large organ located in the upper right side of the abdomen, responsible for detoxification, metabolism of nutrients, and production of bile. The gallbladder is a small organ located beneath the liver, which stores and concentrates bile produced by the liver. The ascending colon is the part of the large intestine that runs vertically on the right side of the abdomen. Therefore, all of the above structures are found in the right upper quadrant.

The lateral diameter of the adult chest should be larger than its anteroposterior diameter because the lungs are positioned more towards the sides of the chest, resulting in a wider chest width. This allows for greater lung expansion during breathing and accommodates the heart, which is located more towards the center of the chest. Additionally, a larger lateral diameter provides more space for the ribs to move during respiration, facilitating efficient breathing.

GERD, or gastroesophageal reflux disease, is a condition where stomach acid flows back into the esophagus, causing irritation and inflammation. This can lead to symptoms such as heartburn and regurgitation, but it can also cause a chronic cough. The acid irritates the nerves in the throat, triggering a cough reflex. Therefore, it is true that GERD is a common cause of chronic cough in adults.

All of the above symptoms are common or concerning for respiratory health. Shortness of breath (dyspnea) can indicate various respiratory conditions, such as asthma or chronic obstructive pulmonary disease (COPD). Wheezing is a high-pitched whistling sound that occurs during breathing and can be a sign of asthma or bronchitis. Hemoptysis refers to coughing up blood, which can be a symptom of lung infections, tuberculosis, or even lung cancer. Therefore, experiencing any of these symptoms should be taken seriously and prompt medical attention should be sought.

Rovsing sign is a clinical finding in which deep palpation on the left lower quadrant (LLQ) of the abdomen causes pain in the right lower quadrant (RLQ). This is indicative of acute appendicitis, as the inflammation and irritation of the appendix can cause pain to radiate to the RLQ. Russel's sign, Patrick's sign, and Goodman's sign are not associated with this specific finding.

The correct answer is "all of the above." This means that all the options listed, including cancer, asthma/allergies, and gastro-esophageal reflux disease, can be common causes of adult chronic cough. Chronic cough is often a symptom of these conditions, and it is important to consider all possibilities when diagnosing and treating a patient with a persistent cough.

The correct answer is "All of the above". When assessing the gastrointestinal area, it is important to ask the patient about any changes in bowel habits, as this can indicate potential issues such as constipation or diarrhea. Asking about blood in the stool is also crucial, as it can be a sign of gastrointestinal bleeding. Lastly, inquiring about coughing and wheezing is important because it can suggest potential respiratory issues that may be related to the gastrointestinal system.

When auscultating the heart, the first step is to identify S1 and S2. S1 is the first heart sound, which is caused by the closure of the mitral and tricuspid valves. S2 is the second heart sound, which is caused by the closure of the aortic and pulmonic valves. By identifying these two sounds, healthcare professionals can determine if there are any abnormalities in the timing or intensity of the heart sounds, which can help in diagnosing various cardiac conditions.

When crackles, wheezes, or rhonchi clear with a cough, bronchitis is a likely etiology. Bronchitis is an inflammation of the bronchial tubes, which can cause excess mucus production and airway obstruction. The crackles, wheezes, or rhonchi are indicative of airway congestion and inflammation. When a person with bronchitis coughs, it helps to clear the airways and temporarily alleviate the symptoms. Simple asthma and cystic fibrosis are chronic conditions that may not be relieved with a cough, while heart failure typically presents with different symptoms such as fluid retention and shortness of breath.

The correct order of examination of the abdomen is inspection, auscultation, percussion, and palpation. This sequence allows for a systematic approach to assess the abdomen. Inspection involves visually observing the abdomen for any abnormalities such as scars, distention, or masses. Auscultation involves listening to the bowel sounds using a stethoscope to assess for any abnormal sounds or absence of bowel sounds. Percussion involves tapping on the abdomen to assess the density of underlying organs and detect any abnormal fluid or masses. Palpation involves gently pressing on the abdomen to assess for tenderness, organ enlargement, or abnormal masses. This order ensures that the examiner does not disrupt bowel sounds or create false percussion sounds by palpating before auscultation and percussion.

The correct order of examination for the lungs is inspection, palpation, percussion, and auscultation. This order allows the healthcare provider to first visually assess the patient's breathing pattern, chest symmetry, and any visible abnormalities. Palpation follows, where the provider uses their hands to feel for any tenderness, masses, or abnormal movements. Percussion is then performed, involving tapping on the chest to assess the density and resonance of underlying structures. Finally, auscultation is conducted using a stethoscope to listen to the breath sounds, which provides information about air movement and possible abnormalities. This sequential approach allows for a comprehensive assessment of the lungs.

The apical impulse refers to the pulsation felt over the apex of the heart during palpation. The normal size of this impulse is about 2 cm. This means that when the examiner places their hand on the chest, they should feel a slight, gentle pulsation that measures approximately 2 cm in diameter. It is important to note that the size of the apical impulse can vary depending on the size of the person, but on average, it is about 2 cm.

The correct answer is Funnel chest (pectus excavatum). Funnel chest, also known as pectus excavatum, is a condition where the lower portion of the sternum is depressed, causing the chest to have a sunken or caved-in appearance. This condition is usually asymptomatic and may only be noticed by others, such as in this case where the boy's grandmother observed it. Funnel chest can be present from birth or develop during adolescence. It is a common congenital deformity of the chest and can be corrected with surgery if it causes significant cosmetic or functional concerns.

Bronchophony is a test where the patient is asked to say a specific phrase, such as "99," while the healthcare provider listens to their lungs with a stethoscope. This test helps to assess the clarity and intensity of the patient's spoken sounds, which can indicate abnormalities in the lungs, such as consolidation or fluid accumulation. In this case, the question describes the exact procedure of asking Mr. Campbell to say "99" while auscultating his lungs, which aligns with the bronchophony test.

Bronchial lung sounds possess the characteristics described in the question. These sounds are louder and higher in pitch compared to other lung sounds. There is a short silence between inspiration and expiration, and expiration is longer than inspiration. Bronchovesicular sounds have a mix of characteristics from bronchial and vesicular sounds, but they do not match the specific characteristics mentioned in the question. Vesicular sounds are softer and lower in pitch, while tracheal sounds are louder and harsher.

Traveling and eating in areas of poor sanitation or consuming contaminated water or food can increase the risk of exposure to Hepatitis A. Hepatitis A is a viral infection that primarily spreads through the fecal-oral route, meaning that it is transmitted through contact with the feces of an infected person. In areas with poor sanitation, the risk of contamination of water and food with the virus is higher, leading to an increased likelihood of contracting Hepatitis A.

The correct answer is the second left interspace. This is the correct placement for listening to the pulmonic valve area. The pulmonic valve is located in the second left interspace, which is the area between the second and third ribs on the left side of the sternum. Placing the stethoscope in this area allows for optimal auscultation of the pulmonic valve sounds.

When auscultating at the 5th intercostal space at the midclavicular line, the most likely valve to be heard is the mitral valve. The mitral valve is located between the left atrium and left ventricle, and it is best heard at the apex of the heart, which is in the 5th intercostal space at the midclavicular line. The aortic valve is heard best at the 2nd intercostal space at the right sternal border, the pulmonic valve is heard best at the 2nd intercostal space at the left sternal border, and the tricuspid valve is heard best at the 4th intercostal space at the left sternal border.

The straight leg raise test is not used to assess peritoneal inflammation. It is a physical examination maneuver used to evaluate for nerve impingement or irritation in the lower back and legs. Peritoneal inflammation is typically assessed through other methods such as physical examination findings, medical history, and imaging studies.

Symptoms of the peripheral vascular system can include pain, numbness of the legs, and hair loss on the lower extremities. Edema of the calves, legs, or feet can also be a symptom of peripheral vascular disease, but it is not mentioned in the answer choices. These symptoms can indicate a decrease in blood flow to the legs and feet, which may be caused by conditions such as peripheral artery disease or peripheral neuropathy.