AHAFINALEXAMQUIZ

Health Assessment Exam #1 Blueprint

• Know the difference between hypertropia, exotropia, esotropia, and hypotropia.

  • Esotropia (inward deviation)
  • Exotropia (outward deviation)
  • Hypertropia (upward deviation)
  • Hypotropia (downward deviation)

• Know the difference between Lacrimal gland enlargement, Dryness of the eyes, Nasolacrimal duct obstruction, and Thyroid eye disease.

  • Lacrimal gland enlargement (dacryoadenitis) can be caused by infections, inflammation, or autoimmune diseases.
    • Acute dacryoadenitis is most common in children and young adults, often caused by viral or bacterial infections (e.g., mumps, Epstein-Barr virus, staphylococcus, gonococcus) and causes tenderness, redness, and swelling of the gland, potentially causing the eyelid to droop.
    • Chronic dacryoadenitis can be caused by inflammatory disorders like thyroid eye disease, sarcoidosis, or orbital pseudotumor.
    • Lacrimal gland tumors, including pleomorphic adenomas (can cause diplopia and limited ocular motility) and lymphomas (more common in patients over 60, but can also occur in children)
  • Sjögren Syndrome is an autoimmune disorder causing progressive degeneration of the lacrimal glands, leading to symptoms like pressure on the eye and distorted vision.
  • Treatment for lacrimal gland swelling varies based on the cause.

Patient Encounters

• What is therapeutic communication and special consideration for blind/low-vision patients and patients hard of hearing?
  • For blind/low-vision patients: Establish contact by shaking hands, explain name/role, and verbally orient to the room. Encourage glasses if worn, and explain verbally with gestures.
  • For hearing impaired patients: Establish contact and find out preferred method of communication (e.g., ASL). Encourage use of hearing aids.

Effective Patient Encounters

• How do we establish an effective patient encounter?
  • Step 1: Initiating the encounter
    • Setting the stage/preparation
    • Greeting the patient and establishing initial rapport
  • Step 2: Gathering information
    • Initiating information gathering
    • Exploring patient's perspective of illness
  • Step 3 and 4: Performing the physical exam, explaining and planning
    • Provide correct information and plans of actions
    • Decide and Negotiate the plan of action
    • Shared decision making
  • Step 5: Closing the encounter

Clues to the Patient's Perspective on Illness

• Direct statement(s) by the patient about feelings, effects, and understanding.
• Expression of feelings or concerns and attempts to explain illness.
• Speech clues (repetition, pauses, sharing a personal story) to show the person's understanding and perspective on illness.
• Behavioral clues that indicate unmet needs, such as reluctance to a second opinion, an early return, or a lack of acceptance to the situation.

Physical Exam

• General (orientation, mood, etc.)
• Eyes (pupils, conjuctiva, sclera, acuities)
• Head, Ears, Nose, and Throat (HENT)
• Nerves (I-XII)
• Neck
• Cardiovascular
• Gastrointestinal
• Musculoskeletal
• Neurological/psychiatric
• integumentary
• Genitourinary
• Other important parts to check

Causes of Fatigue

• Fatigue is a common symptom of depression and anxiety, but consider infectious, endocrine, adrenal, heart failure, COPD/CKD, anemia, electrolyte imbalance, malignancy, nutritional deficits and medications side effects.
• Fatigue is a normal response to hard work, sustained stresses, or grief.

Hypothyroidism vs Hyperthyroidism

• Hypothyroidism: low production of thyroid hormone, characterized by fatigue, weight gain, cold intolerance, dry skin and hair
• Hyperthyroidism: excessive production of thyroid hormone, characterized by weight loss, nervousness, heat intolerance, and rapid pulse

Alzheimer's Disease

• Consists of: Clear evidence of cognitive decline in two or more cognitive domains, steady progressive decline in cognition without extended plateaus, and no other diseases/conditions.
• Alertness and attention are preserved, memory difficulties include repetition of questions, losing objects, or confusion while performing tasks such as shopping
• Late stages include reduced judgement and disorientation, progressing to aphasia, problems with daily life activities.

No Cure for Alzheimer's Disease

• Treatments include cholinesterase inhibitors (increase acetylcholine), memantine(blocks glutamate), and immunotherapy drugs (reduce amyloid plaques)

Other Common Drugs and Overdose

• Opioids (morphine, oxycodone), and fentanyl are commonly overdosed.
• Marijuana, cocaine, and psychotherapeutic are also common stimulants to overdose

Important Foods to Reduce Risk of Cardiovascular Risks

• Vegetables: leafy greens, carrots, broccoli
• Fruits: apples, bananas, oranges, grapes, prunes
• Whole grains: oatmeal, brown rice, grain bread, tortillas
• Low-fat dairy: milk, cheese, yogurt
• High-protein foods: fish (high in omega-3 fatty acids like salmon, tuna), lean meat, turkey
• Eggs, nuts, seeds, soy products, legumes (beans, lentils)
• Oils and foods high in monounsaturated and polyunsaturated fats (canola, corn, olive, safflower, sunflower, and soybean)
• Nuts, seeds, and soy products (tofu)
• Legumes (kidney beans, lentils, chickpeas, black-eyed peas, and lima beans)
• Oils: Canola, corn, olive, safflower, sesame, sunflower, and soybean oils (not coconut or palm oil)
• Nuts: Walnuts, almonds, pine nuts
• Nut butter
• Salmon, trout
• Seeds: sesame, sunflower, pumpkin, flax
• Avocados

Common Breath Odor (Halitosis)

• Poor oral hygiene, tobacco smoking, plaque retention on teeth, dentures, periodontal disease

Clues to the Patient's Perspective on Illness

• Direct statements, feelings, attempts to understand, speech clues, and behavioral clues

Health Disparities

• At the patient level: Ask patient about social challenges, guide to resources to access benefits/support services
• At the practice level: offer culturally safe care, use patient care navigators
• At the community level: partner with local organizations/public health agencies