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Questions and Answers
What does the acronym SOAP stand for in health documentation?
Which aspect does 'HPI' refer to in health assessments?
Which of the following best describes xerosis in the elderly?
Which component is NOT part of the 'Old Carts' mnemonic?
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What is a primary characteristic of stasis dermatitis?
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What common condition is often misdiagnosed in the elderly?
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Which component is included in the PQRST acronym for health assessment?
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What does the 'A' in SOAP represent?
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What is a common characteristic of rosacea in the elderly population?
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What can be a hallmark sign of ocular rosacea?
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Which cranial nerve is primarily responsible for the movements of the eye?
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What does the 'S' in the RSVP mnemonic stand for in eye assessments?
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What condition is characterized by a white or gray ring at the corneal margin?
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When a patient has vertical diplopia, which cranial nerve might be affected?
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What does a visual acuity reading of 20/30-1 indicate?
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What is the outward turning of the lid margin and lashes away from the eye called?
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What can an opaque tympanic membrane indicate?
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What indicates sensorineural hearing loss during the Weber test?
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Which of the following tests compares air conduction to bone conduction?
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What finding in the tympanic membrane suggests the presence of air bubbles?
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A positive Rinne test result indicates which of the following?
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In the Whisper test, what is the distance at which the tester should whisper?
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What could a lack of tympanic membrane flexibility lead to?
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What is the expected position of the light reflex on the right tympanic membrane?
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What does the failure of both eyes to close indicate in terms of medical conditions?
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What is the primary purpose of the fluorescein stain technique?
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In the corneal light reflex test, what indicates an imbalance?
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When performing an ear examination on a child under three years old, how should the ear be pulled?
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Which cranial nerve is associated with sensory impairment when both eyes fail to close?
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What should be performed if the corneal light reflex test shows an imbalance?
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What is the function of the middle ear?
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What is the role of the inner ear?
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Study Notes
Health History and SOAP Documentation
- SOAP notes are a method of documenting patient information, using the categories of subjective, objective, assessment, and plan.
- The history of present illness (HPI) should be documented using mnemonics like PQRST (precipitation, quality, radiation, severity, timing) or Client Outcomes (character, location, impact, expectation, neglect, timing, understanding/beliefs, treatment, complementary, options, modulating, exposure, spirituality) to ensure all relevant information is included.
- While a patient may currently suffer from a comorbidity, past medical history refers to conditions that do not pertain to the current visit.
Skin
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Common Geriatric Lesions
- Xerosis (dry skin) is the most common cause of itch in the elderly.
- Stasis Dermatitis (inflammation of the skin due to poor circulation) is often seen in the lower extremities and can cause dryness, itchiness, and discoloration.
- Rosacea (a chronic skin condition) is characterized by redness, flushing, and dilated blood vessels.
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Common Geriatric Skin Tumors
- Basal cell carcinoma is the most common type of skin malignancy.
Eye Exam
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Eye Assessment
- Use the acronym RSVP (redness, sensitivity to light, vision loss, pain) to assess for urgent ophthalmology consultation.
- Sudden loss of vision is considered an ocular emergency.
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Pupils
- Arcus senilis is a white or gray ring around the cornea caused by fat deposits, commonly seen in older adults.
- Pterygium is a raised growth on the conjunctiva, usually extending from the nasal side and potentially caused by chronic irritation.
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Eyelids
- Endotropion (inward turning of the eyelid) and exotropion (outward turning of the eyelid) can occur as a result of aging.
- Eyelid malignancy is most common in the form of basal cell carcinoma.
- Hordeolum (stye) and chalazion (a cyst on the eyelid) are both common conditions.
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Cranial Nerves
- Cranial nerve III (oculomotor) transmits visual images to the brain.
- Cranial nerves III, IV, and VI are responsible for eye movements.
- Vertical diplopia (double vision) is caused by an issue with cranial nerve IV, while horizontal diplopia is caused by an issue with cranial nerve VI.
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Visual Acuity Test
- Expressed as two numbers, the first represents the distance from the chart (20 feet), and the second indicates the distance at which a normal eye can read the same print that a person with normal vision could read at 30 feet. A negative number indicates the number of errors made during the test. For example, 20/30-1 means the patient can read at 20 feet what a normal eye can read at 30 feet, with one error.
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Corneal Reflex Test
- A light touch with a cotton wisp on the cornea should cause both eyes to close. Failure to close indicates increased intracranial pressure (ICP), which can impair sensory (CN V) and motor (CN VII) functions.
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Eyelid Eversion
- This procedure is used to examine the eyelid for swelling, tenderness, and foreign bodies. Instructions are provided to perform this procedure.
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Fluorescein Stain Technique
- This technique helps detect corneal abrasions by staining the affected area bright green under UV light. Instructions for performing the procedure are provided.
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Corneal Light Reflex Test (Hirschberg Test)
- The reflection of a light source should appear symmetrically in both pupils. An imbalance indicates the need for a cover-uncover test, which helps determine the strength of each eye.
Ear
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Ear Anatomy
- The ear is responsible for hearing and balance.
- The outer ear consists of the pinna (auricle) and the ear canal. For anyone above 3, the ear canal extends intward, forward and downward while for those under 3, it extends inward forward and upward.
- The middle ear consists of the tympanic membrane to the oval window and is responsible for transmitting sound waves.
- The inner ear contains the end organs for hearing and is responsible for balance.
- ** Ear Conditions**
- Otalgia (ear pain) can be primary (infection or inflammation of the middle ear) or secondary (TMJ, dental, periodontal pain, sinus infection, lesions of the tongue). It can also be caused by neuralgia of cranial nerves (V, VII, IX, X) and cervical nerves (I, II, III).
- Hearing loss can be gradual or sudden.
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Tympanic Membrane Assessment
- The tympanic membrane light reflex should be seen in the anterior inferior quadrant at 7 o’clock on the left side and 5 o’clock on the right side.
- An opaque tympanic membrane can indicate chronic otitis media, repeated perforations with healing, or tympanosclerosis.
- Air bubbles behind the tympanic membrane can indicate acute otitis media and serous otitis media.
- Yellow tinged tympanic membrane may suggest an infection with pus.
- Lack of flexibility in the tympanic membrane can cause conductive hearing loss.
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Hearing Tests
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Weber Test
- This test evaluates bone conduction by placing a tuning fork on the patient’s forehead in the middle.
- If the tone is heard evenly, it’s a normal finding.
- If the tone is louder in one ear, it suggests conductive hearing loss.
- If the tone is softer in one ear, it suggests sensorineural hearing loss.
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Rinne Test
- This test compares air conduction to bone conduction.
- It is performed one ear at a time.
- The tuning fork is placed on the mastoid process and the patient is asked to indicate when the sound is no longer heard.
- The tuning fork is then placed 1 inch away from the ear, and the patient is asked to indicate when the sound is no longer heard.
- A positive test means the air conduction is longer than the bone conduction, a good result (AC>BC).
- A negative test suggests conductive hearing loss, where the bone conduction is longer or louder than the air conduction (BC>AC).
- A sensorineural hearing loss manifests when AC is equal to or less than half as long as BC.
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Whisper Test
- This test assesses hearing acuity.
- The examiner whispers numbers or words from two feet away with their mouth covered.
- One vowel sound or two similar vowel sounds should be used.
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Weber Test
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Description
This quiz covers the fundamental concepts of SOAP documentation and how to effectively record health history, particularly in geriatric patients. It includes mnemonics for documenting history of present illness and discusses common skin conditions associated with aging.
