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117 Cards in this Set

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  • Back
Primary headaches
have no identifiable underlying cause.
Secondary headaches
arise from other conditions—some of these may endanger the patient’s life
hyperopia
(farsightedness)
presbyopia
(aging vision)
myopia.
(nearsightedness)
If sudden unilateral visual loss is painless, consider.....
vitreous hemorrhage from diabetes or trauma, macular degeneration, retinal detachment, retinal vein occlusion, or central retinal artery occlusion.
If sudden unilateral visual loss is painful, causes are usually.....
in the cornea and anterior chamber as in corneal ulcer, uveitis, traumatic hyphema, and acute glaucoma. Optic neuritis from multiple sclerosis may also be painful
If sudden bilateral visual loss is painless......
medications that change refraction such as cholinergics, anticholinergics, and steroids may contribute.
If sudden bilateral visual loss is painful......
consider chemical or radiation exposures.
Is the onset of bilateral visual loss gradual?
This usually arises from cataracts or macular degeneration.
Moving specks or strands in the vision suggest...
vitreous floaters
fixed defects (scotomas) in the field of vision suggest....
lesions in the retina or visual pathways.
scotomas
areas in the field of vision where the patient cannot see
Flashing lights or new vitreous floaters across the field of vision suggest.....
detachment of vitreous from retina
Diplopia in adults may arise from....
a lesion in the brainstem or cerebellum, or from weakness or paralysis of one or more extraocular muscles, as in horizontal diplopia from palsy of CN III or VI, or vertical diplopia from palsy of CN III or IV
Diplopia in one eye, with the other closed, suggests.....
a problem in the cornea or lens.
diplopia
double vision
People with sensorineural hearing loss have particular trouble.....
understanding speech, often complaining that others mumble; noisy environments make hearing worse.
In people with conductive hearing loss...
noisy environments may help.
conductive loss
results from problems in the external or middle ear
sensorineural loss.
from problems in the inner ear, the cochlear nerve, or its central connections in the brain
Medications that affect hearing include
aminoglycosides, aspirin, NSAIDs, quinine, furosemide, and others.
Tinnitus
a perceived sound that has no external stimulus—commonly a musical ringing or a rushing or roaring noise.
It can involve one or both ears.
may accompany hearing loss and often remains unexplained. Occasionally, popping sounds originate in the temporomandibular joint, or vascular noises from the neck may be audible.
When associated with hearing loss and vertigo, it suggests Ménière’s disease
Vertigo
refers to the perception that the patient or the environment is rotating or spinning. These sensations point primarily to a problem in the labyrinths of the inner ear, peripheral lesions of CN VIII, or lesions in its central pathways or nuclei in the brain.
Feeling unsteady, lightheaded, or “dizzy in the legs” sometimes suggests...
a cardiovascular etiology.
A feeling of being pulled suggests....
true vertigo from an inner ear problem or a central or peripheral lesion of CN VIII
Itching in the nose and sinuses favors....
an allergic cause.
Rhinorrhea
refers to drainage from the nose and is often associated with nasal congestion, a sense of stuffiness or obstruction.
These symptoms are frequently accompanied by sneezing, watery eyes, and throat discomfort, and also by itching in the eyes, nose, and throat.
Local causes of epistaxis include....
trauma (especially nose picking), inflammation, drying and crusting of the nasal mucosa, tumors, and foreign bodies.

Bleeding disorders may contribute to epistaxis.
Epistaxis
means bleeding from the nose.
The blood usually originates from the nose itself, but may come from a paranasal sinus or the nasopharynx
Fever, pharyngeal exudates, and anterior lymphadenopathy, especially in the absence of cough, suggest...
streptococcal pharyngitis, or strep throat
Sore throat
is a frequent complaint, usually associated with acute upper respiratory symptoms.
A sore tongue may result from...
local lesions as well as systemic illness.
Bleeding gums are most often caused by...
gingivitis
Causes of chronic hoarseness include....
smoking, allergy, voice abuse, hypothyroidism, chronic infections such as tuberculosis, and tumors.
Hoarseness
refers to an altered quality of the voice, often described as husky, rough, or harsh.
The pitch may be lower than before.
usually arises from disease of the larynx but may also develop as extralaryngeal lesions press on the laryngeal nerves.
Enlarged tender lymph nodes commonly accompany...
pharyngitis.
With goiter, thyroid function may be...
increased, decreased, or normal.
Intolerance to cold, preference for warm clothing and many blankets, and decreased sweating suggest....
hypothyroidism
Intolerance to heat, preference for sparse clothing/coverage, palpitations, and involuntary weight loss suggest....
hyperthyroidism
goiter
enlarged thyroid gland
POAG
primary open-angle glaucoma
In people with POAG there is...
gradual loss of vision as a result of the loss of retinal ganglion cell axons, initial loss of peripheral visual fields, and pallor and increasing size of the optic cup, which enlarges to more than half the diameter of the optic disc.
Blindness occurs in 5% of those with the disease.
glaucoma symptoms
change in size and color of the optic cup
macular degeneration symptoms
subretinal hemorrhage or exudate
cataracts symptoms
clouding of the lens
Groups at risk for hearing loss are those with....
a history of congenital or familial hearing loss, syphilis, rubella, meningitis, or exposure to hazardous noise levels at work or on the battlefield.
Fine hair accompanies
hyperthyroidism
Course hair accompanies
hypothyroidism
Hirsutism
(excessive facial hair) occurs in some women with polycystic ovary syndrome.
palpebral fissure
The opening between the eyelids
conjunctiva
a clear mucous membrane with two easily visible components: bulbar conjunctiva and palpebral conjuctiva
bulbar conjunctiva
covers most of the anterior eyeball, adhering loosely to the underlying tissue. It meets the cornea at the limbus.
palpebral conjunctiva
lines the eyelids
tarsal plates
firm strips of connective tissue that lie within the eyelids
meibomian glands
a parallel row of glands on each tarsal plate which open on the lid margin
A light beam shining onto one retina causes.....
pupillary constriction in both that eye, termed the direct reaction to light, and in the opposite eye, the consensual reaction.
When a person shifts gaze from a far object to a near one....
the pupils constrict
Coincident with this pupillary constriction, but not part of it, are
(1) convergence of the eyes, an extraocular movement
(2) accommodation, an increased convexity of the lenses caused by contraction of the ciliary muscles. This change in shape of the lenses brings near objects into focus but is not visible to the examiner
When a person looks down and to the right....
the right inferior rectus (CN III) is principally responsible for moving the right eye, whereas the left superior oblique (CN IV) is principally responsible for moving the left
Vision of 20/200 means....
that at 20 feet the patient can read print that a person with normal vision could read at 200 feet. The larger the second number, the worse the vision.
“20/40 corrected” means.....
the patient could read the 40 line with glasses (a correction).
Myopia
impaired far vision.
Visual acuity is expressed as...
two numbers (e.g., 20/30):
the first indicates the distance of the patient from the chart
the second, the distance at which a normal eye can read the line of letters.
Presbyopia
the impaired near vision, found in middle-aged and older people.
A presbyopic person often sees better when the Snellen card is farther away.
Eyebrow Scaliness in...
seborrheic dermatitis
Eyebrow lateral sparseness in...
hypothyroidism
narrow-angle glaucoma
Occasionally the iris bows abnormally far forward, forming a very narrow angle with the cornea causing a sudden increase in intraocular pressure when drainage of the aqueous humor is blocked.
open-angle glaucoma
the common form of glaucoma—the normal spatial relation between iris and cornea is preserved and the iris is fully lit.
Miosis
refers to constriction of the pupils
mydriasis
refers to dilation of the pupils
Asymmetry of the corneal reflections indicates...
a deviation from normal ocular alignment.
A temporal light reflection on one cornea, for example, indicates a nasal deviation of that eye
Nystagmus
a fine rhythmic oscillation of the eyes. A few beats of nystagmus on extreme lateral gaze are normal.
In lid lag of hyperthyroidism...
a rim of sclera is visible above the iris with downward gaze
If you suspect lid lag or hyperthyroidism....
ask the patient to follow your finger again as you move it slowly from up to down in the midline.
The lid should overlap the iris slightly throughout this movement.
proptosis
an abnormal protrusion of the eyeball in hyperthyroidism, leading to a characteristic “stare” on frontal gaze.
Poor convergence in...
hyperthyroidism
Absence of a red reflex suggests...
an opacity of the lens (cataract) or possibly of the vitreous.
Less commonly, a detached retina or, in children, a retinoblastoma may obscure this reflex.
Do not be fooled by an artificial eye, which has no red reflex.
In a refractive error...
light rays from a distance do not focus on the retina.
In myopia, light rays...
focus anterior to the retina.

Retinal structures in a myopic eye look larger than normal.
In hyperopia, light rays...
focus posterior to the retina
Papilledema
describes swelling of the optic disc and anterior bulging of the physiologic cup.

Increased intracranial pressure is transmitted to the optic nerve, causing stasis of axoplasmic flow, intra-axonal edema, and swelling of the optic nerve head.
Papilledema often signals....
serious disorders of the brain, such as meningitis, subarachnoid hemorrhage, trauma, and mass lesions
Can determine if a patient has papilledema...
The presence or absence of spontaneous venous pulsations (SVP).
Loss of venous pulsations in pathologic conditions like head trauma, meningitis, or mass lesions may be an early sign of elevated intracranial pressure.
The external ear comprises...
the auricle and ear canal
the conductive phase
The first part of the hearing pathway—from the external ear through the middle ear.

a disorder here causes conductive hearing loss
the sensorineural phase
The second part of the hearing pathway, involving the cochlea and the cochlear nerve

a disorder here causes sensorineural hearing loss
Air conduction
describes the normal first phase in the hearing pathway
bone conduction
An alternate hearing pathway that bypasses the external and middle ear and is used for testing purposes. A vibrating tuning fork, placed on the head, sets the bone of the skull into vibration and stimulates the cochlea directly.
In a normal person, air conduction is more sensitive than bone conduction.
otitis externa
inflammation of the ear canal

painful movement of the auricle and tragus (the “tug test”)
otitis media
inflammation of the middle ear

no pain in tug test from movement of the auricle and tragus

Tenderness behind the ear may be present
exostoses
suggested by nontender nodular swellings covered by normal skin deep in the ear canals
nonmalignant overgrowths, which may obscure the drum.
Ear canal in otitis externa.....
often swollen, narrowed, moist, pale, and tender. It may be reddened.
In chronic otitis externa....
the skin of the ear canal is often thickened, red, and itchy
May decrease eardrum mobility....
A serous effusion, a thickened drum, or purulent otitis media
In unilateral conductive hearing loss....
sound is heard in (lateralized to) the impaired ear.
Visible explanations include acute otitis media, perforation of the eardrum, and obstruction of the ear canal, as by cerumen

Normally the sound is heard in the midline or equally in both ears
In unilateral sensorineural hearing loss...
sound is heard in the good ear.

Normally the sound is heard in the midline or equally in both ears
In conductive hearing loss...
sound is heard through bone as long as or longer than it is through air (BC = AC or BC > AC).
In sensorineural hearing loss...
sound is heard longer through air than through bone.
(AC > BC).
Weber Test
Test for lateralization

Normally the sound is heard in the midline or equally in both ears.
Rinne Test
Compare air conduction (AC) and bone conduction (BC)

Normally the sound is heard longer through air than through bone (AC > BC).
In viral rhinitis...
the mucosa is reddened and swollen
In allergic rhinitis...
the mucosa may be pale, bluish, or red.
nasal mucosa
covers the septum and turbinates.

The nasal mucosa is normally somewhat redder than the oral mucosa.
Nasal Polyps
pale, semitranslucent masses that usually come from the middle meatus
Local tenderness, together with symptoms such as pain, fever, and nasal discharge, suggest.....
acute sinusitis involving the frontal or maxillary sinuses
Bright red edematous mucosa underneath a denture suggests...
denture sore mouth. There may be ulcers or papillary granulation tissue.
Tongue Cancer occurs most often on...
the side of the tongue, next most often at its base.
the soft palate fails to rise and the uvula deviates to the opposite side from...
CN X paralysis,
A “tonsillar node” that pulsates...
is really the carotid artery.
A small, hard, tender “tonsillar node” high and deep between the mandible and the sternomastoid...
is probably a styloid process.
Enlargement of a supraclavicular node, especially on the left, suggests..
possible metastasis from a thoracic or an abdominal malignancy.
Tender lymph nodes suggest...
inflammation
Hard or fixed lymph nodes suggest...
malignancy
Diffuse lymphadenopathy raises the suspicion of...
HIV or AIDS.
If the thyroid gland is enlarged...
listen over the lateral lobes with a stethoscope to detect a bruit, a sound similar to a cardiac murmur but of noncardiac origin.

A localized systolic or continuous bruit may be heard in hyperthyroidism.
Exophthalmos
an abnormal protrusion of the eye.
Lymph Node inspection order:
1. Preauricular—in front of the ear
2. Posterior auricular—superficial to the mastoid process
3. Occipital—at the base of the skull posteriorly
4. Tonsillar—at the angle of the mandible
5. Submandibular—midway between the angle and the tip of the mandible.
6. Submental—in the midline a few centimeters behind the tip of the mandible
7. Superficial cervical—superficial to the sternomastoid
8. Posterior cervical—along the anterior edge of the trapezius
9. Deep cervical chain—deep to the sternomastoid and often inaccessible to examination.
10. Supraclavicular—deep in the angle formed by the clavicle and the sternomastoid