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89 Cards in this Set
- Front
- Back
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How many bones are there in the face?
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14
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How many cervical vertebrae support the skull?
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7
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Which cervical vertebrae helps flex your head?
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C7
*to locate, find the vertebra that sticks out the most during neck flexion |
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What are fontanelles?
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Areas on the infantile skull that feel like "soft spots"
There should be NO protrusion |
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What are possible findings in fontanelle assessment
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1. normal: soft & flat
2. full, bulging: brain injury? 3. sunken: dehydration |
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Describe the shape of the ANTERIOR fontanelle and when it closes.
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Anterior fontanelle:
1. diamond 2. 4mo - 26 months |
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Describe the shape of the POSTERIOR fontanelle and when it closes.
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Posterior fontanelle:
1. triangle 2. 2 months |
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Which questions about the head should you ask during the health history?
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1. headache?
2. head injury? 3. dizziness? 4. history of head injury or surgery? *pay attention to a severe headache |
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What are additional questions that you should ask when taking the history of an aging adult?
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1. If dizziness is a problem, how does it affect your ADLs?
2. Are you able to drive safely? 3. Are you able to maneuver around the house safely? |
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What are 4 aspects of the head that you should inspect and palpate?
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1. skull
2. scalp 3. hair 4. face |
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What are 4 facial features that you should pay attention to during the physical exam?
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1. Symmetry of features
2. CN VII, V 3. TMJ 4. Temporal arteries |
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What are 3 descriptions of head size?
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1. Macrocephaly
2. Normocephalic 3. Microcephaly |
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What is macrocephaly? Potential cause?
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>90th percentile for gestational age
hydrocephaly |
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What is microcephaly? Potential causes?
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<10th percentile for gestational age
chromosomal abnormalities intrauterine infection maternal alcohol/drug abuse |
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What are 4 reasons why you should inspect the face?
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1. symmetry (eyebrows, palpebral fissures lined up with top of ear, nasoliabial folds)
2. facial expression 3. abnormal structures 4. abnormal movements |
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What is acromegaly?
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A disease in which the pituitary gland produces too much GH...causes excessive frontal bone and soft tissue growth
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What are some features that appear in a person with fetal alcohol syndrome?
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1. epicanthal folds
2. think upper lip |
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What is CN VII and what does it innervate?
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Facial
mediates facial muscles |
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How can you assess CN VII?
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1. expressions should be symmetrical
2. palpebral fissures should be equal bilaterally 3. nasolabial folds should be symmetric |
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What is a condition that occurs from paralysis of one side of CN VII?
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Bell's Palsy
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What is CN V and what does it innervate?
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trigeminal nerve
forehead, cheeks, and chin bilaterally |
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What are the 3 distributions of CN V?
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1. ophthalmic
2. maxillary 3. mandibular |
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How can you assess the SENSORY function of CN V?
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gently rub a cotton ball over the innervated area (ie cheeks, forehead, chin) and ask if patient feels it
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How can you assess the MOTOR function of CN V?
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Ask the patient to clench teeth and open mouth while you palpate temporal and masseter muscles bilaterally
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What is the most active joint in the body?
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TMJ: temporomandibular joint
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Where is the TMJ located?
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below the temporal artery and anterior to the tragus
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What should you assess while palpating the TMJ?
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Palpate while the person opens his/her mouth.
-check for normal smooth movement with no limitation or tenderness -check for ROM (range of motion) |
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What are problems that could occur in the TMJ?
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-decreased ROM (arthritis)
-Click: meniscus tear, poor occlusion, synovial swelling |
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What should the temporal artery NOT feel like?
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-indurated (hard)
-torturous (twisty) |
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Inflammation of the temporal artery may cause...
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blindness
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When eyes are approximate, what does that mean?
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they're closed
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What is a caruncle?
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the fleshy part in the medial canthus that has sebaceous glands
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What is a palpebral fissure?
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opening between the 2 eyelids
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What are tarsal plates of the eye?
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plates of dense connective tissue that gives the eyelid form and support
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What are meibomian glands?
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Sebaceous glands that secrete oil to lubricate the eye
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What are 2 types of conjunctiva and what do they line?
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1. bulbar (lies over cornea)
2. palpebral (lines the lids) |
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What color should the conjunctiva normally be?
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pink
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How can you diagnose conjunctivitis?
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Since the conjunctiva are swollen, you can see the mucus membrane of the BULBAR conjunctiva sticking away from the eye
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What does the lacrimal apparatus do?
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Provides constant irrigation by secreting tears
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What is the pathway of tear flow?
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lacrimal gland secretes-->
flows across eye--> drains into puncta--> drain to nasolacrimal sac--> nose |
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Which two parts of the eye are continuous with each other
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sclera and cornea
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What does the choroid do?
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gives blood to the retina
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Why is the retina significant?
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It is the place where light rays become nerve impulses
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What are 3 layers of the eye?
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1. Sclera
2. Choroid 3. Retina |
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What is the anterior compartment and what fluid does it contain?
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Located between the cornea and iris; filled with aqueous humor
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What eye part makes the aqueous humor?
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ciliary body
*aqueous humor meant to drain waste |
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What disease occurs when problems in the anterior compartment occur?
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glaucoma
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What fluid does the posterior chamber contain?
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vitreous humor
*watch for floaters |
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Describe the 6 extraocular muscles.
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straight (4): rectus muscles
oblique (2): rotation of eye |
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What are 2 possible causes of problems with eye movement?
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1. problem with nerve
2. problem with muscle |
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Name the cranial nerves that innervate the extraocular muscles.
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1. CN VI (abducens)
2. CN IV (trochlear) 3. CN III (oculomotor) |
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Which muscles does CN VI innervate?
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the LATERAL rectus muscles
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Which muscles does CN IV innervate?
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superior oblique muscles
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Which muscles does CN III innervate?
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Superior, inferior, medial rectus
Inferior oblique |
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What eye movement does CN VI enable?
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looking at the sides
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What eye movement does CN IV enable?
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down and in
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What is the "red reflex"?
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When the opthalmoscope light reflects off the retina
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What eye parts can you see through the opthalmoscope?
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1. retinal vessels
2. retinal field or background 3. optic disc 4. macula |
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What should the optic disc look like through the opthalmoscope?
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creamy color; round or oval; blurred edge on nasal side, demarcated edge on temporal side
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How many sets of retinal vessels should you look for?
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4, each set consists of a vein + artery, 2 sets are superior, 2 sets are inferior
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How are visual pathways projected?
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upside down and reversed right to left
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What is the visual pathway of nerve impulses?
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nerve impulses are conducted through the..
retina--> optic nerve--> optic chiasm--> optic tract on each side--> through a curving tract called the optic radiation |
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What are 2 types of pupillary light reflexes?
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1. direct
2. consensual |
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How do you test the direct pupillary light reflex?
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shine the light into the left eye, the left pupil constricts
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How do you test the consensual pupillary light reflex?
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shine the light into the left eye, the right pupil constricts
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Accomodation: At far vision, pupils..
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dilate
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Accomodation: At near vision, pupils...
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constrict and converge
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How do you use the Snellen chart?
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Place the chart 20 ft from the patient.
Shield 1 eye and instruct the patient to read the line that they can see best. *leave glasses on if needed! |
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What does the Snellen chart test
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distance visual acuity
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Interpret 20/50 vision.
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What that person read at 20 ft could be read by a person with perfect vision (20/20) at 50 ft.
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What occurs in myopia?
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near vision; the anterior-posterior measurement is too long
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What occurs in hyperopia?
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far vision; the anterior-posterior measurement is too short
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What is presbyopia?
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when the ability of the lens to accommodate decreases
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What disease would you expect if the outer 1/3 of the eyebrow is missing?
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thyroid disease
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What is ptosis?
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drooping of the upper eyelid; may be congenital or caused by a disease
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What is anisocoria?
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When people are born with 1 pupil bigger than the other
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How can you decide if aniscocoria is benign?
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if the pupils respond to light
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What is a normal pupil size?
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3mm-5mm
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What are the 5 tests for eye function that you should perform during the physical?
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1. Corneal light reflex
2. Direct and consensual (pupillary light reflex) 3. Accomodation 4. Extraocular muscles 5. Visual fields |
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Which pathway does light travel in order to instruct the pupil to constrict?
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light-->
CN II--> cortex--> CN III--> constrict |
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How far away do you need to be in order to test the 6 cardinal positions of a gaze?
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~1 foot away from the patient
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How do you test the range of peripheral visual fields?
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Fishbowl
*do one eye at a time if you expect an eye problem |
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What are the normal peripheral visual field limits?
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nasally: 60 degrees
temporally: 90 degrees superiorly: 50 degrees inferiorly: 70 degrees |
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What is bitemporal hemianopsia?
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involves the fibers crossing over tot he opposite side.
since the fibers originate in the NASAL half of each retina, visual loss involves the temporal half of each field |
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What is left homonymous hemianopsia?
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lesion in the RIGHT optic tract inturrupts fibers originating on the same side of both eyes
Visual loss in the eyes is therefore similar and involves half of each eye; in this case left temporal and right nasal |
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What is A-V nicking?
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when the artery crosses over in the vein
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When is A-V nicking often seen?
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-diabetics
-hypertension |
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What is papilledema?
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Choking of the disc from increased ICP pressing on the optic nerve
It looks puffed up; normally veins pulsate, but not in this case If you must change your focus to visualize the optic disc, you may have edema |
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What are causes of papilledema?
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1. headache
2. injury |
