Health Assessment - Lecture 4

Front 1

Functions of the Nose (CN?)? Sinuses?

Back 1

Beginning respiratory tract, sense of smell (Olfactory nerve CN#1) -lighten weight of head, gives resonance to voice

Front 2

Function of Thyroid? Cervical lymph nodes?

Back 2

Metabolism, helps regulate calcium and phosphorus. -fights infection

Front 3

What are some development variations for: Children - teeth? tonsil development?

Back 3

Fontanels(close 1 year), cleft palate, Ethmoid & maxillary sinus fully developed at birth, -first incisors at 6 mos; 6-7 lose 20 teeth, replaced by 32 adult - small at infancy, large at childhood, small by 12

Front 4

What are developmental variations for: Pregnant women? (3) Older adults?

Back 4

-palpable thyroids(stimmed by estrogen & develops increased vascular supply), Cholasma(dark skin discolor), hypertrophy of gums
-Teeth loss, decreased saliva, olfactory & taste diminished(affects nutrition)

Front 5

What are three types of headaches? (with description, duration of pain, associated with?, onset?)

Back 5

migraine(aura visual/sensory, pulsating pain localized, 4-6hrs, nausea, vertigo, 2/month)- cluster(severe pain around eye, temple, forehead, cheek, minutes to hours, ETOH, stress, sudden) tension-(muscle contraction head, neck, upper back; stress, PMS, sinus; gradual)

Front 6

What are symptoms of the head(6) and neck(2)?

Back 6

Headache, head injury, LOC, Seizures, Dizziness(Vertigo objective-room spins subjective-person spins), Jaw tightness/TMJ pain -Neck pain/stiffness, neck mass(lumps/swelling)

Front 7

Symptoms of the nose?(7)

Back 7

-Discharge, frequent colds, sinus pain, trauma, epistaxis(nosebleeds), allergies, altered smell

Front 8

Symptoms of mouth?(6) throat?(2)

Back 8

-sores/lesions, bleeding gums, toothache, hoarse voice, altered taste, self care(oral hygeine, dentures)
-sore throat(strep>>rheumatic fever), dysphagia(difficulty swallowing),

Front 9

Name and describe three anatomical landmarks for Assessment of Face & neck?

Back 9

Nasolabial folds (smile lines), Palpebral fissure (between upper & lower eyelids), anterior/posterior triangle(a-medial to sternocleido, p-lateral to sternocleido)

Front 10

For physical assessment of head, face neck, what assessment techniques can be used? position? assessment type?

Back 10

All 4 -sitting -general survey and head to toe scan

Front 11

What are we observing for inspection of head? face? nose? frontal/maxillary sinus?

Back 11

-size, shape, symmetry(normocephalic), position - facial expression, symmetry, abnormal movements, lesions, hair
-position, deformity, septal deviation, discharge, flaring -transilluminate, diffuse red glow, WNL may not transilluminate

Front 12

In palpation of the head, what are nurses observing? How about Face? Which cranial nerves innervate the face?

Back 12

-Masses, tenderness, scalp mobility -symmetry, tenderness, muscle tone, TMJ Function -CN 5 (trigeminal) - CN 7(facial)

Front 13

What are palpative measures for Frontal & maxillary sinuses? Nose?

Back 13

-tenderness -patency (unblocked?), deformity, and tenderness

Front 14

For inspection of oral structures, what objective measures are we looking for: Lips?(4) Teeth?(5) Oral(buccal) mucosa?(5) Gingivae?(5)

Back 14

-Color, lesions, breath odor, purse lip -color, number, condition, caries, occlusion -color, condition, lesions, apthous ulcers(canker sore), koplik's spots(small blue-white spots w/red halo>>measles) -color, bleeding, lesions, hypertrophy or retraction

Front 15

For inspection of oral structures, what objective measures are we looking for: Hard/soft palate?(4) What is Torus Palanitus? What are Stensen's and Wharton's ducts and what we looking for?

Back 15

-color, condition, lesions, intactness -bony ridge running in middle of hard palate -S(paratid gland opening upper 2nd molor) W(notch under tongue in sublingual area) - inflammation

Front 16

For inspection of oral structures, what objective measures are we looking for: Tongue(4)-which cranial nerve?, Tonsils(4), Uvula-which 2 cranial nerves?

Back 16

-color, texture, lesions, mobility(12, hypoglossal) -colors, exudates, enlargement, grading(1+visible, 2+ halfway pillars to uvula, 3+ nearly touching uvula, 4+ touching each other)
-symmetrical rise (9-glassopharyngeal, 10-vagus)

Front 17

For inspection of the neck, which objective measures? For ROM, what are the motions? Which cranial nerve?

Back 17

-ROM, masses, symmetry -flexion, neutral, hyperextension, lateral bend, rotation -11, spinal

Front 18

For palpation of neck, what are we feeling for: Cervical nodes, Trachea, Tracheal shift** (w/examples)

Back 18

-size, shape, symmetry, mobility, location, tenderness, and temperature(also movable, discrete, soft, nontender) -midline sternal notch(index finger either side of trachea) -unaffected side(healthy)(pneumothorax, aortic aneurysm, tumor, thyroid enlarge), affected side (diseased)(atelectasis, pleural adhesions, fibrosis)

Front 19

Why would you want to percuss the frontal/maxillary sinuses? auscultate enlarged thyroid?

Back 19

-for tenderness - for bruits

Front 20

It is normal to palpate a few lymph nodes in the neck of a healthy person. What are the characteristics of these nodes?
A)Mobile, soft, nontender
B)Large, clumped, tender
C)Matted, fixed, tender, hard
D)Matted, fixed, nontender

Back 20

A

Front 21

In a medical record, the tonsils are graded as 3+. The tonsils would be:
A)Visible
B)Halfway between the tonsillar pillars and uvula
C)Touching the uvula
D)Touching each other

Back 21

C

Front 22

What are the functions of the: Eyelids/Lashes, Lacrimal Glands, Conjunctiva, Sclera, Iris, Extraocular muscles, Cornea, Anterior chamber, Pupil

Back 22

-protect eyes -produce tears -provide lubrication -shape and structure to eye - controls light entering eye, eye color -control eye movement -transparent avascular outer layer -aqueous humor -aperture of iris

Front 23

What are developmental eye variations for: Children, object fixation? visual acuity?

Back 23

-infants (iris blue-gray in light skin, brown in dark skin, real color=9mos) -2-4wk -20/200(infant) 20/30(school age),

Front 24

Explain the following developmental variations for Older adults: Presbyobia, Ectropion, Entropion, Arcus senilis, Senile cataract

Back 24

-inability to focus nearby objects -eyelid sags away from globe, -eyelid inward toward globe -white opague ring edge of cornea(fat deposit) -clouding of lens

Front 25

What are some eye developmental variations for the following cultures: Dark-skinned African Americans, Asians

Back 25

-more & severe glaucoma, brown pigment spots/muddy sclera, blue grey/yellow cast at peripheral margins
-Epicanthal fold at medial canthus, almond shaped

Front 26

What symptoms are we looking for in subjective interview? (6)

Back 26

-Vision loss, eye pain, double vision(diplopia), eye tearing, dry eyes, discharge

Front 27

For Physical assessment, what anatomical landmarks are used? assessment techniques used? Position? Assessment will include?

Back 27

-visual fields (superior, inferior, nasal, temporal) -inspection, palpation -sitting -general survey, head to toe scan

Front 28

When you test for visual acuity, what chart do you use for distant measure(20ft)? Nearby? What visual acuity is considered legally blind?
How can you test for color vision?

Back 28

-Snellen - Rosenbaum charts -20/200 w/corrective lenses -color bars on snellen, color plates Ishihara

Front 29

What is the purpose of the confrontation test? What angles are used for the landmarks?

Back 29

-measures peripheral vision compared to examiners(assuming normal) -superior 50, nasal 60, inferior 70, temporal 90

Front 30

What are two ways to measure Extraocular Movements(EOMS)? Which three cranial nerves innervate these muscles? Pneumonic for these movements? What abnormalities may be present?

Back 30

Diagnostic positions test using Six cardinal fields of gaze,(using star or H) -CN 3 Oculomotor, CN 4 Trochlear, CN 5 Abducen
LR6SO4 (Laterus Rectus CN6, Superior Oblique CN4, all other muscles are CN3) -Nystagmus(fine oscillating movement around the iris(normal at extremes))

Front 31

What is the purpose of the corneal light reflex test? Good result? Abnormal?

Back 31

-paralell alignment of the eyes - Reflection of light should be identical on each eye. -Assymetry of light indicates weakness/paralysis

Front 32

In what situation would the Cover test be performed? How do you do the cover test? What if the covered eye jumps to fixate?

Back 32

-if after Corneal Reflex test, deviation in alignment is present -cover one eye, focus on distant object, remove card to observe uncovered eye for movement -indication of eye muscle weakness/out of alignment

Front 33

What is strabismus? This lead to? Pseudostrabismus?

Back 33

Axes of eyes cannot be directed at same object(cross eyed) -Amblyopia (visual impairment, dimness of vision, visual image shut down, double vision) -appearance of strabismus because of epicanthic fold, but is normal for young child.

Front 34

Explain the following eye conditions: Esotropia, Exotropia, Esophoria, Exophoria

Back 34

-eyes deviate inward - eyes deviate outward -eyes turn inward - eyes turn outward

Front 35

When inspecting the pupillary response, what are we looking for? Light test?

Back 35

-should be round, equal in size/shape, and in center of eye -consensual and direct constriction

Front 36

What are we looking for in Accomdation of pupil response? How do we test for this? What mnemonic can be used for a successful pupil test?

Back 36

Convergence and constriction -stare at a distant object, hold penlight in front, ask to shift gaze from distant object to pen. PERRLA (Pupils Equal Round Reactive to Light Accommodation)

Front 37

When inspecting external structures of the eye, what are we observing for: Lids & Lashes(6), Lacrimial Glands(4), Conjuctiva(5), Sclera (4)

Back 37

-color, lesions, edema, symmetry, position, lashes distribution
-color, edema, excess tearing/drain -color, moisture, lesions, foreign bodies -color, moisture, lesion, tears

Front 38

When inspecting external structures of the eye, what are we observing for: Cornea(3), Anterior Chamber(4), Iris(4)
What is arcus senilis?

Back 38

-clarity, abrasions, corneal reflex(shine light from side) -clarity, bulging iris, blood -color, size, shape, symmetry - grey-white arc around limbus(deposit of lipids)

Front 39

The examiner records “positive consensual light reflex.” This is:
A)The convergence of the axes of the eyeballs
B)The simultaneous constriction of the other pupil when one eye is exposed to bright light
C)A reflex direction of the eye toward an object attracting a person’s attention
D)The adaptation of the eye for near vision

Back 39

B

Front 40

The cover test is used to assess for:
A)Nystagmus
B)Peripheral vision
C)Muscle weakness
D)Visual acuity

Back 40

C

Front 41

Differentiate the terms: Myopia and Hyperopia, Diopeter use?

Back 41

Myopia(nearsighted) longer/flatter eyeball, which makes light rays focus in FRONT of retina D-
Hyperopia(farsighted) shorter/taller eyeball, which makes light rays focus BEHIND the retina D+

Front 42

Describe the functions of the following ear structures: Auricle and external ear canal, Tympanic membrane, Ossicles

Back 42

-collect and transmit sound waves -divides external from middle ear, transmits sound waves -three smallest bones in body, transmit sound waves (malleus, incus, and stapes)

Front 43

Describe the functions of the following ear structures: Eustachian tube, Cochlea (CN#?), Semicircular canals

Back 43

-equilizes pressure on both sides of TM -organ of corti transmits sound waves to CN 8, -affects equilibrium

Front 44

Why are children more likely to experience ear infections? What is a Typanosotomy? Myringectomy?

Back 44

-eustachian tube is shorter, wider, and more horizontal (easier for pathogen entry) -tube inserted in eardrum to aereate -incision in eardrum to relieve pressure/drain

Front 45

What type of hearing loss is most common in young aged and middle adults? Older adults?

Back 45

-noise damage -Presbycusis(nerve degeneration of inner ear, 50+(normal)), buildup of cerumen from stiff cilia

Front 46

What are cultural variations for ears in Asians and Native americans? Whites and blacks?

Back 46

-Incidence and severity of Otitis Media(middle ear infection), cerumen dry white flaky.
-brown, wet, sticky cerumen

Front 47

Describe Meniere's disease. Trx? Acoustic Neuroma? Labyrinthitis?

Back 47

progressive deafness, tinnitius, dizziness, and fullness/pressure in ears; recurrent, lasts up to 24 hrs. -bed rest, antihistamine, sedavies, low salt diet, diuretics -benign tumor of CN8 (hear loss, tinnitus, balance probs, pain, HA) -symptoms of vertigo, vomit, nystagmus

Front 48

Explain the following symptoms: Tinnitus, Otorrhea, Otalgia, Vertigo

Back 48

-ringing in ears, ear drainage, ear ache, Sub-person spins, Obj-room spins

Front 49

For Physical assessment, which assessment techniques are used? position? Tools?

Back 49

-inspection, palpation -sitting -512 tuning fork, watch, otoscope, thermometer

Front 50

What are you Objectively measuring/Inspecting on the external ear?(4) Palpate which parts?

Back 50

-angle of attachment/position; size/shape/symmetry; drainage: clear, blood, or purulent; consistency/tenderness
-tragus, and mastoid for tenderness

Front 51

How do you test Acoustic hearing? which cranial nerve?

Back 51

-Whisper test(rapidly push tragus in one ear, whisper in other 1-2ft away), Rubbing fingers -CN8=acoustic nerve

Front 52

What does the Rinne test tell you about hearing? How do you test? Normal expected result? BC>AC indicates? AC=BC indicates?

Back 52

-bone conduction vs. air conduction -strike tune fork and place on mastoid process, count and tell pt to say "now" when they no longer hear, then put tune fork over ear, count again, note time till "now" -AC>BC 2:1 -conductive loss, sensorineural loss.

Front 53

What is the purpose of the Weber Test? How do you test? Normal result? If sound lateralizes to bad ear, what is indicated? good ear?

Back 53

-if the sound lateralizes to one side(hear better on one side) -place midline of skull -no lateralization(hear equal on both sides), -conductive hearing loss -sensorineural loss

Front 54

What does the Romberg test assess?

Back 54

-vestibular apparatus in inner ear to maintain standing balance.

Front 55

To differentiate between air conduction and bone conduction hearing loss, the examiner would perform:
A)Weber test
B)Romberg test
C)Rinne test
D)Whisper test

Back 55

C

Front 56

A common cause of conductive hearing loss is:
A)Otitis externa
B)CVA
C)Impacted cerumen
D)Acute rheumatic fever

Back 56

C

Front 57

Color blindness is what type of trait? % white males? black males? Test criteria? Test used? Vision screening?

Back 57

inherited rcessive X-linked -8, 4 - boys only, b/w 4-8 yo. -Ishihara, series of polychromatic cards(pattern of dots printed against background of many colored dots) - state mandated vision test in kinder, 2nd, and 5th grade

Front 58

When would you auscultate for a bruit? What does it sound like? Instrument? What also occurs with bruit?

Back 58

-enlarged thyroid gland -soft, pulsatile whoosing blowing sound -bell of stethescope -accelerated blood flow>> hyperplasia(hyperthyroidism)

Front 59

What does ear discharge indicate? Explain External otitis, Acute otitis media, Cholesteatoma? association with pain? Blood behind ear drum indicates?

Back 59

otorrhea-infection canal or perforated eardrum -purulent, sanguiteous/watery discharge -purulent -dirty yellow/gray discharge foul odor. -ear pain first, then pops, then drains - skull fracture/ trauma

Front 60

Identify procedure functions for the following nerves(And number!): Acoustic, Trochlear, Glossopharygeal

Back 60

-VIII-hearing by whisper test, AC vs BC, Sound lateralization(weber) -IV-Test extraocular eye movements(SO), -IXsour bitter taste, gag reflex/swallow

Front 61

Identify procedure functions for the following nerves(And number!): Vagus, Olfactory, Abducens

Back 61

- X-palate/uvula symmetry, speech sounds, gag reflex, swallowing difficulty, gut speech sounds -I- identify odors -VI- test extraocular eye movements(LR)

Front 62

Identify procedure functions for the following nerves(And number!): Spinal Accessory, Optic nerve, Hypoglossal

Back 62

-XI-trapezius muscle str(shrug shoulders against resist), sternocleido muscle str(head against resist) -II-visual accuity(snellen/rosenbaum), visual fields(periphery) by confrontation -XII-tongue moving in mouth, protruding, toward nose & chin, l,t,d,n(lingual), tongue str vs index

Front 63

Identify procedure functions for the following nerves(And number!): Occulomotor, Trigeminal, Facial

Back 63

-III-droopy eyelids, PERRLA(and consensual), extraocular eye movements -V-face muscles (mastication), corneal reflex -face symmetry, expressions

Front 64

Identify all twelve Cranial nerves: I, II, III, IV, V, VI, VII, VIII, IX, X, XI, XII. mnemonic for identifying function?

Back 64

-Olfactory -Optic - Occulomotor -Trochlear -Trigeminal -Abducens -Facial -Acoustic -Glossopharygeal -Vagus -Spinal Accessory, Hypoglossal
-SSMMBMBSBBMM

Front 65

Identify all 11 lymph nodes of head and neck:

Back 65

Preauricular, Postauricaular, Occipital, Submental, Submandibular, Tonsilar, Superficial cervical chain(on sterno), deep cervical chain(under sterno), posterior cervical chain(triangle edge of traps), supraclavicular, infraclavicular