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222 Cards in this Set

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when using the snellen eye chart, where does the client's head need to be in relation to yours?
The person's head should be at "my" eye level
What is the snellen eye chart used to measure?
visual accuity
What do you do with reading glasses of the client taking the snellen eye exam?
remove them
The top number on the visual acuity test (ie., 20/20) measures what?
the distance the person is standing from the chart
the bottom number of 20/20 in regard to vision represents what?
the person can read at 20 feet what the normal person can read at 20 feet
The decrease in power of accommodation with aging is called what?
presbyopia
What is the name of the test that tests corneal light reflex?
the hirshberg test
What eye test detects small degrees of deviated alignment by interrupting the fusion reflex?
the cover test
A mild weakness noted only when fusion is blocked of the eye?
phoria
A constant malalignment of the eyes is....
Tropia
Leading the eyes through the six cardinal positions of gaze to elicit muscle weakness...
diagnostic positions test
Failure to follow in a certain direction with the eyes indicates what?
extraocular muscle weakness or dysfunction of the cranial nerve
A fine oscillating movenent of the eyes seen during the diagnostic positions test is...
a nystagmus
If the upper eyelid does not overlap the superior part of the iris, even during downward movement, it is...
lid lag
The normal reaction to the pupillary light reflex
constriction of the same-sided pupil and simultaneous constriction of the other pupil
The resting size of the pupil is normally...
3,4, or 5 mm and decreases equally in response to light
If the person focuses on a distant objec with her eyes and her pupils dialate, this indicates what?
accommodation
A normal response to accommodation would include what two things?
1. pupillary constriction
2. convergence of the axes of the eyes
Diameter of the disk, or DD, is a standard measure for what?
other fundus structures
if you saw the words "at 5:00, 3DD from the disk", where would the object be?
3 disk diameters away from the optic disk
Which vessels of the eye have the arterial light reflex?
arteries
If an artery and vein cross paths, it is called...
A-V (or arteriovenous crossing)
What would you expect to see as far as numbers/location of vessels of the eye?
a paired artery and vein passing next to each other in each quadrant of the eye
A crossing at more than .....DD away from the disk is abnormal
2
Squint or cross eye is known as...
strabismus
Strabismus should be measured when?
early child hood
Strabismus causes what?
disconjugate vision because one eye deviates off the fixation point
When the brain supresses images from the weak eye, it is called...
a suppression scotoma
the resulting loss of vision due to disuse is called
amblyopia exanopsia
Asymmetry during the corneal light reflex under....is normal
6 months
What is a method of getting a newborn to open her eyes?
hold the baby supine and gently lower the head/hold infant at arms length and turn in one direction
Holding the baby at arms length and turning in one direction tests for what?
vestibular function reflex
the vestibular function reflex disapears after....
2 months of age
How long is the external auditory canal?
2.5 to 3 cm long
the outer one third of the ear canal is made of....
cartiledge
the inner two-thirds of the ear canal is made of..
bone
The canal has an...shape in an adult
s shape
The inner two thirds of the ear angle towards what?
down towards the nose
what separates the external and middle ear and is tilted obliquely to the ear canal?
the tympanic membrane
What are the parts of the malleus that show through the ear drum?
umbo, manubrium, and the short process
The tiny air-filled cavity inside the temporal bone is the...
middle ear
the middle ear holds what bones?
malleus, incus, stapes
the opening of the inner ear to the outer ear is covered by what?
the tympanic membrane
What connects the middle ear with the nasopharynx and allows passage of air?
the eustacian tube
What are the functions of the middle ear?
conducts sound/protects inner ear by reducing sounds/allows equalization of air pressure
The inner ear contains what?
the bony labyrinth which holds the sensory organs for equilibrium and hearing
what composes the vestibular apparatus and the cochlea?
the vestibule and the semicircular canals
the auditory system can be divided into what 3 levels?
peripheral, brainstem, and cerebral cortex
what vibrates at a point specific to the frequency of the sound?
basilar membrane
what are the numerous fibers along the basilar membrane at its base near the stapes called?
the organ of corti
What is the function of the brainstem in hearing?
binaural interaction
What cranial nerve sends signals to the brainstem from the ears?
viii
The function of the cortex in hearing is...
interpretation
What type of conduction is least effective in hearing?
bone conduction (BC)
a gradual nerve degeneration that occurs with aging or by ototoxic drugs is called
presbycusis
What part of the ear feeds info to the brain about the body's position in space?
the bony labyrinth
if the bony labyrinth of the ear becomes inflamed, what can happen?
vertigo
what week of gestation do the inner ears start to develop?
4th week
describe the postion of the infants eustacian tube in relation to the adults
it is shorter/wider/ and more horizontal
what is a gradual hardening that causes the foot plate of the stapes to become fixed in the oval window?
otosclerosis
what decade of life does presbycusis normally begin?
5th
the normal eardrum is..
shiny/translucent/pearl-gray color. light reflex: r.ear:5 oclock, l.ear:7 oclock
what color would the drum be with serous otitis media?
yellow-amber
what color would the ear drum be with acute otitis media?
red
Air/fluid level or air bubbles behind the drum indicate what?
serous otitis media
What would the eardrum do if a person performed the valsalva maneuver or held her nose?
it would flutter
ear drum hypomobility is an early sign of ...
otitis media
Tuning forks measure hearing by...
Air conduction (AC) or by bone conduction (BC)
A person unable to hear whispered words might have what sort of hearing loss?
high-toned hearing loss
The test to use when hearing is better in one ear is...
the weber test
a test to compare air conduction and bone conduction of the ears
the Rinne test
In the air test, sound is heard in what proportion AC:BC?
AC 2:BC 1
Sexual maturity rating of girls is called ...
tanner staging
The breast bud stage is stage..
2
the nipple is flush w/ breast surface is stage...
3
the areola and nipple form a secondary mound over breast is stage...
4
only the nipple protrudes; the areola is flush w/ breast is stage...
5
the beginning of breast development occurs in what relation to menarche?
breast develpment occurs 2 years before menarchy
the breast volume is smallest when?
on days 4-7 of menstrual cycle
Colustrum is expressed at this time of pregnancy
4th month
Atrophied glandular tissue of the post menopausal breast is replaced by...
fibrous connective tissue
Most common breast to be larger in assymetry of breasts
left
a sudden increase in size of one breast may indicate..
inflamation or new growth
Edema gives what sort of appearance to breasts?
pig skin or orange peel (peau d'orange)
A supernumerary nipple is usually found along the...
milk line on the thorax or abdomen, 5-6 sm below breast
When auscultating for chest sounds of an infant do this:
use the smaller pediatric diaphragm or the bell over infant's interspaces and not over the ribs
persistant fine crackles that are scattered over the chest occur with
pneumonia, bronchiolitis, or atelectasis
crackles only in upper lungs occur with...
cystic fibrosis
crackles only in lower lungs is associated with...
heart failure
persistant peristaltic sounds with diminished breath sounds on the same side may indicate
diaphragmatic hernia
what is located in the Right Upper Quadrant of the Abdomen?
liver/gall B/duodenum/ pancreas/right kindey/ hepatic flexure of colon/part of ascending and transverse colon
What is located in the Left Upper Quadrant (LUQ)?
stomach/spleen/ left lobe of liver/body of pancreas/ left kidney/splenic flexure of colon/ part of transverse and descending colon
what is located in theRight lower quadrant?
cecum/appendix/right ovary and tube/right ureter/right spermatic cord
What is located in the lower left quadrant (LLQ)?
part of decending colon/ sigmoid colon/ left ovary and tube/left ureter/ left spermatic cord
what is located midline on the abdomen?
aorta/uterus (if enlarged)/ blader (if distended)
What order is the abdomen auscultated with and with what part of the stethoscope?
diaphram is used; Inspect, then auscultate, palpate, then percuss
why is auscultation done before percussion and palpation on abdomen?
could cause false interpretation of bowel sounds
where do bowel sounds originate?
the movement of air and fluid through the small intestine
how many times/minute should bowel sounds be heard?
5-30
how long must you listen before charting "no bowel sounds"?
5 minutes
You are most likely to hear bruits at the aorta/renal arteries/iliac/femoral arteries in whom?
people w/ hypertension
what sound should predominate the abdomen?
tympany
What inderect percussion test would be performed to assess kidneys for pain?
costovertebral angle tenderness
diminished or absent bowel sounds (hypoactive bowel sounds) signal....
inflamation as seen with peritonitis, from paralytic ileus, from late bowel obstruction, or pneumonia
Hyper active bowel sounds signal...
increased motility. They occur w/ early mechanical bowel obstruction, gastroenteritis, brisk diarrhea, laxative use, and subsiding paralytic ileus
loud gurgling sounds of the abdomen are called
"borbyorygmi"
Fremitus is most prominent between....on the chest wall
scapulae and around the sternum; where major bronchi are closest to chest wall
Fremitus feels greater over what sort of chest wall?
thin
What pitch of voice (high or low) generates more fremitus
a loud, low-pitched
Decreased fremitus occurs w/ what?
when anything obstructs transmission of vibrations
Increased fremitus occurs with...
compression or consolidation of lung tissue (lobar pneumonia)
This type of fremitus is palpable w/ thick bronchial secretions
Rhoncal
a coarse crackling sensation palpable over the skin surface, commonly noticed w/ emphysema....
crepitus
Added sounds that are not normally heard are called
adventitious
what type of adventitious sound is not pathalogic?
atelectatic crackles
during normal tidal flow, what does wheezing indicate?
asthma
connected musical sound: high pitched/squeeking/ predominate in expiration
sibilant wheeze
low-pitched; monophonic single note/musical snoring/ most prominant on expiration
sonorous rhonchi
high-pitched/monophonic/ inspiratory/crowing sound/ louder in neck than over chest wall
stridor
discontinuous/high-pitched/ short, popping sounds heard on inspiration
crackles
loud/low-pitched/ bubbling and gurgling that starts in early inspiration/sounds like velcro
coarse crackles
superficial sound that is course and low pitced/ grating quality as if 2 pieces of leather are rubbing together
pleural friction rub
A sudden loss of strength/ temporary loss of consciousness due to lack of cerebral blood flow/faint
syncope
Feeling as if the room is spinning is ....
objective vertigo
feeling as if YOU are spinning is...
subjective vertigo
heal to toe walking (tandem walking) does what?
decreases the base of support and accentuates any proplems w/ coordination
Describe the Romberg Test
person stands w/ feet together/arms at sides/ closes eyes and holds the position for 20 sec.
Positive Romberg test is...
loss of balance that occurs when closing the eyes/occurs w/ cerebeller ataxia,loss of proprioception, and lost of vestibular function
Patting knees w/ both hands/turning hands over then patting w/ backs of hands and then doing so faster is what test?
rapid alternating movements (RAM)
Dysdiadochokinesia is what?
slow, clumsy, and sloppy responce to rapid alternating movments (RAM)
When is temperature sensation tested?
only when pain sensation is abnormal
Applying a wisp of cotton to the skin tests perception of what?
light touch
Decreased touch sensation is called what?
Hypoestesia
Absent touch sensation is...
anestesia
increased touch sensation is
hyperesthesia
Pain, Temperature, and light touch test which 'trac'?
They test the spinothalamic tract
Vibration/kinesthesia/ stereognosis/ graphestesia/ 2-point discrimination/ extinction/ and point location test which 'tract'?
They test the posterior column tract
Inability to feel vibration can be caused by...
Alcoholism and diabetes
Where is peripheral neuropathy the worst?
the feet (it gradually improves as you move up the leg)
To test a person's ability to feel vibrations, what would you do?
Place a vibrating tuning fork over bony prominences
Testing the person's ability to percieve passive movements of the extremities is...
Position (which is also called kinesthesia)
What test would be performed to test the ability to recognize objects by feeling their forms/size/weight?
stereognosis
What is the inability to identify felt objects correctly called?
astereognosis
Problems w/ tactile discrimination occur w/ what?
lesions of the sensory cortex or posterior column
The ability to 'read' a number by having it traced on the skin is....
graphesthesia
the ability to distinguish the separation of 2 simultaneous pin points on the skin....
two-point discrimination
When does puberty begin for the male?
sometime between the ages of 9.5 and 13.5 years
what is the first sign of male puberty?
the enlargement of the testes
What is the name of the stages of sexual development for boys?
tanner's sexual maturity ratings (also called SMR)
How long does the complete change in development from a pre-adolescent to adult take?
3 years
What were Tanner's studies of sexual development based on?
data from post WWII british youth.
Sexual characteristics among african american boys and caucasian boys are...
similar
How does socioeconomic status effect male sexual development
according to the US health Examination surveay from 1966-1970, it doesn't
What stage does the scrotum begin to enlarge/redden/change texture?
2
what stage does pupic hair begin to grow at base of penis?
2
the stage when penis begins to enlarge, especially in length?
3
Thick growth over pubic area but not thights. Hair curly/coarse as in an adult male. Development of glans
stage 4
Growth spread over medial thighs, although not yet up toward umbilicus
stage 5
What is the outlet of the gastrointestinal tract?
the anal canal
how long is the anal canal?
3.8 cm in the adult
What separates the internal and external anal sphincters?
the intersphincteric groove
What is another name for the anal columns?
columns of Morgagni
Where do the folds of mucosa known as anal columns end?
at the anorectal junction
enlargement of veins in the anal column can cause what?
a hemorrhoid
What small crescent fold of mucus membrane is at the lower end of each column
the anal valve
how long is the rectum?
12 cm long
The rectum extends from the .....to the.....
from the sigmoid colon at the level of the 3rd sacral vertebra to the anal canal
Just above the anal canal, the rectum dilates and turns posteriorly, forming the...
rectal ampulla
The rectal interior has 3 semilunar transverse folds called the
valves of houston
in the male, the anterior part of the peritoneum reflects down to w/in 7.5cm of the anal opening forming the...
rectovesical pouch
The female counterpart of the rectovesical pouch is the..which extends down to w/in 5.5 cm of the anal opening
rectouterine pouch
The prostate gland lies in fron of the....
anterior wall of the rectum
The prostate gland lies ....cm behind the symphisis pubis
2
The prostate gland has ....to...ducts that open into the urethra
15-30
The two lateral lobes of the prostate gland are separated by a shallow groove called the.....
median sulcas
the two ........ ........ project like rabbit ears above the prostate
seminal vesicles
The seminal vesicles secrete a fluid rich in.....that nourish sperm, and also....
fructose nourish sperm; also secreted are prostaglandins
What glands are the size of a pea and are located inferior to the prostate on either side of the urethra?
bulbourethral (also called cowper's glands). they secrete a clear, viscid mucus
The sigmoid colon is s shaped and extends from the .....and ends at the...
extends from the iliac flexure of the descending colon; ends at rectum
how long is the rectum?
40 cm long
Where is the first place you place your finger when palpating the anus?
the anal verge
What should your finger point to as it enters the anus?
The umbilicus (never approach the anus at right angles w/ finger extended)
Using bidigital palpation w/ thumb agains perianal tissue while pressing examing finger towards it highlights what?
any swelling or tenderness and helps assess the bulbourethral glands
Above the anal canal, the rectum turns posteriorly, folowing the curve of the.... and.....
coccyx and sacrum
A soft, slightly movable mass may be a....
polyp
Internal hemorrhoids above anorectal junction is not palpable unless....
thrombosed
a firm hard mass w/ irregular shape or rolled edges may be...
carcinoma
On the anterior wall of the rectum of the male,.....can be palpated
the prostate
what size should the prostate be?
2.5 cm long by 4 cm wide/should not protrude more than 1 cm into rectum
what shape should the prostate be?
heart shape w/ palpable central groove
the surface of the prostate should feel.....on palpation
smooth
the prostate should be.....movable
slightly
The sensitivity of the prostate should be:
nontender to palpation
any stone-hard irregular fixed nodule of the prostate indicates....
carcinoma
Swollen exquisitely tender prostate gland accompanies....
prostatitis
Enlarged, firm, smooth prostate gland w/ central groove obliterated suggests...
benign prostatic hypertrophy
A false positive for occult blood in the stool could occur if..
large amounts of red meat has been consumed w/in 3 days of test
Bright red blood mixed w/ feces indicates...
possible colonic bleeding
black tarry stool w/ distinct malodor indicates
upper gastrointestinal bleeding w/ blood partially digested
Gray tan stool indicates..
obstructive jaundice
pale yellow greesy stool indicates..
increased fat content/occurs w/ malabsorption syndrom
steatorrhea is..
increased fat content of stool
In the newborn, a patent rectum can be confirmed by..
passage of stool (meconium) w/in the first 24 to 48 hrs of birth
How should the anus of infants and children be palpated?
they should not be, unless history or symptoms warrant. If so, then use the fifth finger w/ the child on his or her back w/ legs flexed
Onset of menarche at 16 or 17 years old indicates
an endocrine problem
pain w/ menstruation is called...
dysmenorrhea
abesent period (or menses) is called
amenorrhea
why should the examiner begin w/ menstrual history before the female gynecological exam?
it is non threatening
what does clotting indicate during period?
heavy flow or vaginal pooling
Gravida is
number of pregnancies
number of births is...
para
perimenopausal period is from age
40-50
maternal ingestion of DES causes ...
cervical and vaginal abnormalities in female offspring
Initially, before the vaginal exam, the woman should be sitting...
up. an equal status position is important to establish trust and rapport
What position should the woman be placed in for vaginal exam
lithotomy position. body supine, feet in stirrups, knees apart, and buttocks at edge of exam. table
Why should the woman's arms not be abover her head during a vaginal exam?
it causes abdominal muscle tightness
Where should people the woman brings into the exam with her sit?
by her head for privacy
hair distribution on the female genitalia should be in the shape of...
an inverted triangle
what does the perineum normally feel like?
it feels thick, smooth, and muscular in the nulliparous woman, and thin and rigid in the multiparous woman
What special needs does the adolescent girl need for genital exam?
mother shouldn't be present. The girl should be taught self examination techniques
when is a pelvic examination indicated for an adolescent girl?
when contraception is desired when the girl's sexual activity includes intercourse, or at age 18 virgins
during the bimanual axamination, what should not be palpable for an adolescent girl?
the adnexa