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133 Cards in this Set

  • Front
  • Back
Extraocular Muscles
6 muscles attach eyeball to its orbit and direct eye. Give straight and rotary movement. Each is coordinated or yoked with one in the other eye. Ensures when the two eyes move, their axes always remain parallel=conjugate movement. Human brain can only see one image. Binocular, single-image visual system, move as a pair.
Conjugate movement
Ensures when the two eyes move, their axes always remain parallel
Cranial Nerves associated with extraoccular muscle movements
C.N. VI; C.N. IV; C.N. III
Cranial Nerve VI
abducens nerve. Intervates lateral rectus muscle. Abducts the eye.
Cranial Nerve IV
Trochlear nerve. Innervates the superior oblique muscle.
Cranial Nerve III
Oculomotor Nerve. Innervates all the other eye muscles.
Sclera
Tough protective white, covering outer most layer-covers iris and pupil extremely dense, hard, fibrous membrane, maintains shape of the eye.
Glaucoma
Increased intraoccular pressure. Increases with age. 72% at age 75 to 85 yo. Affecting men at higher rate than women.
Corneal Light Reflex
(Hirschberg Test)
Assess the parallel alightment of the eye axes by shining a light toward the person's eyes. Direct person to stare straight ahead as you hold the light about 30 cm- 12 in away. Note reflection of the light on the corneas; should be in exactly the same spot on each eye.
Diagnostic Positions Test
Leading the eyes through the 6 Cardinal positions of gaze will elicit any muscle weakness during movement. Ask person to hold head steady and follow pen/light with their eyes only. Hold target 12 in back from person so they can comfortable focus on it. Moving to each 6 positions stopping momentarily then back to center. Progress clockwise. Normal response is parallel tracking of the object with both eyes.
Conjunctiva
thin mucus membrane folded like an envelope between the eyelids and the eyeball. Enclosed part of the eye has a transparent protective covering.
Contains Palpebral conjunctiva and Bulbar conjunctiva.
Palpebral Conjunctiva
lines the lids and is clear, with many small blood vessels. It forms a deep recess and then folds back over the eye.
Bulbar Conjunctiva
overlays the eyeball, with the white sclera showing through. Sits on top of the eye.
Iris
Functions as a diaphragm, varying the opening at its center, the pupil controls amount of light admitted into the retina. The muscle fibers of the iris contract the pupil in bright light and to accommodate for near vision. Also dilate the pupil when the light is dim and for far vision. Color varies from person to person.
Pupil
Round and regular. Size determined by a balance between the parasympathetic and sympathetic chaings of the autonomic nervous system. Simulation of the parasympathetic branch through C.N. III causes constriction of the pupil. Simulation of the sympathetic branch dilates the pupil and elevates the eyelid. Pupil size also reacts to the amount of ambient light and to accommodation of focusing an object on the retina.
Pupillary Light Reflex
normal constriction of the pupils when bright light shines on the retina. Subcortical reflex Arc- not conscious control over this. Afferent link is C.N. II, optic nerve, the efferent path is C.N. III. Test with consensual light reflex or by using direct light reflex which make up pupillary light reflex. Pupils Equal Round React to Light and Accommodation.
Prebyopia
pupil size decreases lens loose elasticity, become hard, and glasslike. Glasslike quality-decreased lens ability or change shape to accommodate for near vision.
Floaters
Common with myopia after middle age. as a result of condensed vitreous fibers may occur with retinal detachment.
Central Visual Acuity
C.N. II, ways to test distant vs close vision.
Snellen Eye Chart & Jaeger Card test.
Snellen Eye Chart
Line and Letters arranged in decreasing size stand ~20 ft from chart. Shield one eye, try to read smallest row on chart. If wear glasses/contacts do again with them on or in. Record results for each eye using fraction at end of successful line read at the end of the row on the actual chart. Test for far vision. Normal is 20/20. The top 20 indicates distance the person is standing from the chart. The bottom 20 gives the distance at which a normal eye could have read that particular line.
Retina
Is the inner layer of the eye. It is a direct extension tot he optic nerve. Contains rods and cons that change light waves into neuroimpulses. Only place you can view blood vessels directly in the Human body. Contains optic disc; retinal vessels; and general background.
Optic Disc
Made up of fibers from retina converge to form optic nerve. Blood vessels enter and exit at the retina. Close to nasla side. Creamy yellow-orange-pink color.
Retinal Vessels
Normally paired artery and vein one to each quadrant smaller towards periphery Artery look bright red and narrower than veins, thin sliver of light on them.
General background of the eye.
Varies in color based on person's skin color.
Macula
temporal side of fundus. Slightly darker pigment region surrounding. Receives and transduces light from center of the visual field.
Jaeger Card
tests near vision for people over 40 yoa those who report difficulty reading should be tested for near vision with a hand held card. Various sizes of print appear on card. Hold card ~35 cm from the eye. Test each eye seperately and with glasses on and off. Normal is 14/14 in each eye. Read by moving card if necessary can use magazine or newspaper if don't have a card on hand.
Anisocoria
the pupils normally appear round, regular, and of equal size in both eyes. Adult resting is from 3-5mm. A small 5% of people have pupils of two different sizes normally. Irregular shape. Although it may be normal for that individual it could be a consideration of central nervous system injury.
Lacrimal Apparatus
provides constant irrigation to keep the conjunctiva and cornea moist and lubricated. It is located in the upper outer corner over the person's eye. Secretes tears. Tears wash over eye drawn up evenly by lid blinks then drain into puncta. Located on upper and lower lids at inner canthus or corner of the eye. Tears drain into nasolacrimal duct and empty into inferior meatus inside of nose.
Lacrimal Apparatus testing
Have pt look down thumbs slide outer part of upper lid up along bony orbit to expose under lid. Look for redness or swelling. Excessive tears may mean nasolacrimal duct is blocked. Press index finger against sac to test. Inside lower orbital rim not inside of nose. Normal should be no response to pressure.
Red Reflex
Have person stare at fixed object across room. Helps dialate pupils. Match up sides with person. View with right eye to look at the person's right eye. Place free hand on person's head or shoulder for spacial orientation. ~25 cm or 10 in away at ~15 degree angle lateral to person's line of vision look through Opthalmoscope the red glow filling the person's pupil is reflection of light on the Opthalmoscope off inner retina.
Normal shouldn't see any opacities, shadows, black dots, or abnormalities.
Weber Test
Good for testing person who hears better with one ear than the other. Place vibrating tuning fork in the middle of the person's skull and ask whether the tone sounds the same in both ears or better in one than the other. The person should hear the tone by bone conduction through the skull and it should sound equally loud in both ears.
Cranial Nerve I
Olfactory Sensory Smell transmits to temporal lobe of the brain from hair cells (olfactory cells) that lie at the roof of the nasal cavity and in the upper 1/3 of the septum. Adding to nutrition enhances pleasure and taste of foods.
Rinne Test
Compares air conduction with bone conduction sound. Place stem of vibrating tuning fork on person's mastoid process and ask them to signal when sound goes away. Quickly invert the fork so the vibrating end is near the ear canal; they should hear a sound. Normally sound is heard twice as long by air conduction as by bone conduction. Normal response is a positive test of AC>BC. Repeat on both ears.
Tympanostomy Tubes
polyethylene tubes are inserted surgically into the eardrum to relieve middle ear pressure and promote drainage of chronic or recurrent middle ear infections. Number of acute infections tend to decrease because of improved aeration. Tubes extrude spontaneously in 12 to 18 months.
Cerumen
A yellow waxy substance that lubricates and protects the ear. A sticky barrier that helps keep foreign bodies from entering and reaching the sensitive tympanic membrane. Migrates out of the meatus by the movements of chewing and talking. In excess may cause hearing loss. Get drier with age due to atrophy of apocrine glands. Comes in dry or wet form. Not related to hygiene. Can clog 90% to 95 % of canal and have no hearing loss.
Auricle of pinna
External ear structure. Moveable cartilage and skin, funnels sound waves into ear opening.
External Auditory Canal
opening where sound waves are funneled into ear. 2.5 to 3 cm long in adult. Terminates at the eardrum/TM. Lined with glands that secrete cerumen.
Tragus
External ear structure. stiff protection that protects the auditory meatus.
External Auditory Meatus
opening where sound waves are funneled into the ear.
Lobule
small flap of tissue at the end of auricle where women pierce their ears.
Tympanic Membrane
seperates the external from the middle ear. Tilted obliquly to the ear canal. Facing downward and forward. Translycent membrane with a pearly gray color and prominent cone of light. Separates external and middle ear.
Malleus
shows through the drum.
Umbo
Part of the malleus. Round corner elbow looking part.
Manubrium
the handle of the malleus.
Short Process
the piece from the manubrium out it is a part of the malleus.
Pars flaccida
superior section of the TM. Blood vessels located here.
Pars tensa
thicker more taut part of the drum
Eustachian tubes
opening that connects the middle ear with the nasopharynx allowing passage of air. Normally closed. Opens when yawning or swallowing. Equalizes pressure on both sides of TM.
Reason to pull Pinna
Child: straight/horizontal easier for pathogens to get into the ear.
Pull down to view.
Adult: ^sloped need to pull up and back to straighten out canal to be able to see.
Middle Ear Functions
tiny air filled cavity inside the temporal bone contains tiny ear bones or auditory ossicles. Contains Malleus; Incus; & Stapes.
Tympanic Membrane
Opening to outer ear is covered by this structure.
Oval Window
opening to inner ear and it is at the end of the stapes and the round window.
Eustachian tube
Connects the middle ear with the nasopharnyx allows passage of air.
Eustachian tube Functions
Conducts sound from outer ear into central hearing apparatus in inner ear. Protects inner ear by reducing amplitude of loud sounds.
Allows for equalization of air pressure on each side of TM to prevent TM from rupturing.
Inner Ear
Contains bony labyrinth; vestibular apparatus; and cochlea.
Body labyrinth
holds sensory organs for equilibrium and hearing.
Vestibule
inside the inner ear. Central chamber of labyrinth
Semicircular canals
responsible for equilibrium.
Cochlea
Contains central hearing apparatus. Receptors for hearing. Organ of Hearing. Transmits sounds to C.N VIII
Whispered Voice Test
test one ear at a time mask hearing of other ear preventing sound transmission. Shield lips. With your head ~30-60 cm from person's ear exhale, whisper, slowly, two-syllable words. Person repeats each word back to you after you say it. Do on both ears. Crude test.
Tympanic Membrane
Red, White, Yellow. Normal color is pink, grey, translucent. Malleus lies oblique position behind upper part of ear drum. Mobile with air inflation. L cone of grey at 7 position. R cone of grey at 5 position.
Otitis Media
amber=yellow=serum in middle ear usually from blocked eustachian tibe might be air/fluid leel with fine black diving ling or air bubble visible behind ear drum. Infected middle ear will be absent of light reflex increasing middle ear pressure. Redness and bulging in superior part of drum along with earache and fever are common.
Aging Adult
Cilia lining ear become coarse and stiff=Oxidized cerumen. May have scarring on drum from history of infections. Hearing loss over time. High frequency tone loss -consonants- than vowels. Words sound garbles. Auditory reaction time decreases after 70 yo longer to process sensory input and respond to it.
Presbycusis
hearing loss occurs with aging. Gradual sensorineural loss caused by nerve degeneration in inner ear or auditory nerve.
PERRLA
Pupillary Light Reflex Test
Pupils Equal Round React to Light Accommodation/Assessment:Constriction/Convergence
PERRLA test
Use eye chart to determine pupil size and symmetry comparred to one another. Use light pen place in front of one eye. Watch pupil then remove and place in front of same eye watching other eye's pupil to test for direct and indirect reaction to light.
To test Accommedation
Have person focus on something in the distance. Ask them to follow tip of pen as move in closer and closer to see that eyes converge in a pupil constrict.
Nasal Cavity
Internal Nose Structure. Much larger than enternal nose extends over roof of mouth. Lined with nasal hairs.
Ciliated mucus membranes
Hairs filter air coarsest matter mucous blanket filters out dust and bacteria. Nasal mucosa is redder than oral mucosa due to rich blood supply and warm air.
Septum
Divides nasal cavity medially not always straight can deviate. Anterior part holds Kiesselbach's plexus.
Kiesselbach's plexus
where nosebleeds normally occur due to rich vascular network.
Turbinates
are found on lateral walls of each nasal cavity. Three bony parallel projections: superior, middle, and inferior. Increase surface area more blood vessels and mucous membranse available to warm, humidify, and filter air.
Paranasal sinuses
air filled pockets within the cranium communitcate with nasal cavity lined with ciliated mucous membranes. Lighten weight of skull. Creat air pockets, sound resonators, provide mucus.
Frontal Sinuses
in frontal bone above the eyes. Medially.
Maxillary Sinuses
in maxilla (cheekbone) along sides of nasal cavities present at birth.
Dehydration in the Mouth Signs
dry lips; dry, white tounge; cheeks, palate, are dry, and white or gray; fissured/scrotal tounge with deep furrows divide papillae into small irregular rows.
Diaphragm
As relaxes passively causes expiration. Floor of thoracic cage. Musculotendinous septum that seperates thoracic cavity from abdomen. Major muscle responsible for increase of thoracic container=inspiration. Vertical diameter lengthens, shortens by downward/upward movement.
Ribs
12 pairs 1st 7 attach directly to sternum via costal cartilages. 8,9,10 attach to costal cartilages. 11, 12 are floating costochondrial(not palpable)
Inspiration
Intercoastal Muscles lift sternum, elevate ribs, moving horizontal increasing diameter.
Respiration
anteroposterior diameter increases or decreases by elevation and depression of ribs. Vertical diameter lengthens, shortens by downward, upward movement of diaphragm.
Sternomastoids
Scaleni & Trapezii. Used for forced air inspiration after heavy exercise heave up sternum and rib cage.
Paroxysmal ncoturnal dyspnea
PND awakening from sleep with SOB and needing to upright to achieve comfort. Usually due to Congestive Heart Failure.
Orthopnea
Difficulty breathing when supine. Determine using number of pillows needed to achieve comfort. Lungs can not inflate due to diaphragm collapsing on organs. SOB lying flat occurs.
Dyspnea
SOB Difficulty breathing.
Tachypnea
RR>25 Beats/minute
Increased respiratory rate.
Bradypnea
RR<8 Beats/minute
Decreased respiratory rate.
Platypnea
SOB sitting up better when lying flat opposit of orthopnea. Usually due to cirrossis of liver.
Trepopnea
Due to fluid shifting in lungs SOB in one lateral decubitus position. Improved by turning on side.
Tactile Fremitus
palpable vibration sounds generated from larynx are transmitted through pt. bronchi and through the lung parenchyma to the chest wall, where vibrations are felt.
Use palmar base or ulnar edge of one's hand touch person's chest while they say "99". Start over apices of lung and palpate from side to side.
Normal should feel same on both sides=symmerrical.
Increased Fremitus
consolidation compression sound better in dense structure than porous structure. Ex. Pneumonia=Pus in Lungs.
Decreased Fremitus
Anything that obstructs transmission of vibrations. Obstructed bronchus, collapsed lung=pneumothorax, pleural effusion, emphysema= Fluid in lungs.
Chest Expansion Symmetry
place thumbs at T9 and T10 slide hands medially to pinch up a small fold of skin between thumbs. Have patient take deep breath thumbs should move apart symmetrically.
Atelectasis
unequal movement colapse of aveoli
Pneumonia
unequal movement fluid filled lung
Fractured rib
unequal movement extremely painful
Pneumothorax
unequal movement air in lung large portion is collapsed
Normal breath sounds
Decrease in intensity as move down the body.
Bronchial
loud high pitched normal breath sounds
Bronchovesicular
medium loudness medium pitch normal breath sounds
Vesicular
soft low pitched normal breath sounds.
Decreased or Absent Sounds
Obstruction
obstructed bronchial tree emphysema
pneumothorax
Increased Sounds
Consolidation
Pneumonia
Fluid is present.
Crackles-Rales
moving air colliding with secretions in tracheobrachial passageway. Fine: soft, high pitched, brief.
Course: louder, lower in pitch , longer.
Don't go away.
Pneumonia, bronchiolitis, atelectasis, cystic fibrosis.
Pleural Friction Rub
sounds like leather rubbing on leather palpable with inflammation of the pleura.
Atelectatic Crackles
short popping crackling sounds only in dependent portions of the lung disappear few breaths, not pathological.
Continuous sounds
continuous sounds musical longer than rales don't necessarily persist through entire cycle.
Wheeze/ Sibilant rhonchi
high pitched musical squealing sounds that are polyphonic (multiple notes) predominatly in expiration.
Asthma, bronchiolitis, foreign body aspirated.
Wheeze/Sonorous rhonchi
low pitched monophonic (single note) musical snooring, moaning sounds, heard througout cycle. Snooring sound.
Stridor
high pitched monophonic crowing sound louder in neck and chest wall means blockage.
Croup, foreign body aspirated, acute epigiottitis.
Bronchophony
ask person to say 99. Normal voice transmission is soft, muffled and indistinct you can hear sound through stethoscope but can't distinguish exactly what is being said. Abnormal pathology increases lung density will enhance transmission of voice sounds. Hear clear 99 should be more distinct than normal and sound close to your ear.
Pleural Friction Fremitus
inflammation of the parietal/visceral pleura causes a decrease in normal lubricating fluid. Make a course grating sound when rubbed together during breathing. Synchphous with respiration excursion. Palpable friction rub also detected by ausculation.
Egophony
"eeeee" should hear e. If hear a is abnormal. Over consolidation or compression area eee changes to aaa.
Whispered Pectoriloquy
whisper 1,2,3. Normal is faint, muffled, almost inaudiable. Small amounts of consolidation whispered is very clear and distinct sounds like whispering directly into stethoscope.
Kaposi's sarcoma
Most common early lesion in people with AIDS. Bruiselike dark red or violet confluent macule usually on hard palate may be on soft palate or gingival margin. Oral lesions may be among earliest lesions to develop in AIDS pts.
Leukoplakia
chalky white thick raised patch with well defined borders. Firmly attached doesn't scrape off. Lateral edges of tounge. Due to chronic irritation, occurs more frequently with heavy smoking and heavy alcohol use. Lesions are precancerous. Should be referred if seen.
Fordyce granules
small isolated white or yellow papules on the mucosa of cheek, tounge, and lips. Painless cycts not significant.
Nose bleeds Procedure to care for:
sit with head tilted forward, pinch nose between thumb and forefinger 5- 15 minutes.
Darwin's turbercle
small painless nodule at the helix of upper ear lobe/pinna. Congenital variation not significant. Don't mistake for tophi.
Papilledema
rare in infants. Fontanels/open sutures will absorb any increased ICP if it occurs. Increased ICP causes venous stasis in the slobe, showing redness, congestion, elevation of disc, blurred margins, hemorrhages, absent venous pulsations. Serious skin of ICP usually caused by space occuping mass.(brain tumor, hematoma) Visual acuity isn't affected.
Nystasmus
occurs with disease of semi circular canals in ears, a paretic eye muscle, MS or brain lesions. Fine oscillating movement best seen around iris.
Macular Degenration
Breakdown of cells in the macula of the retina. Loss of central vision, area of clearest vision, most common cause of blindness, Women more so then men. Peripheral vision not affected maintain self-care.
Black Hairy Tongue
elongation of filiform papillae and painless overgrowth of mycelial threads of fungus infection on tongue. Color varies black, brown, yellow. Occurs after antibiotics, inhibit normal bacteria and allow prolacration of fungus.
Differences in African Americans
Have darker retinas. Primary open-angle glaucoma affects them 3-6 times more often than whites. 6 times more likely to cause blindness than whites. More than 40 yo cataracts and open-angle glaucoma together cause 60% of blindness. Scalera
Darker color.
Mouth
First segment of digestive system and an airway for respiratory system.
Tongue
mass of striated muscle arranged in crosswise pattern so it can change shape and position. Contains frenulum. Helps with masticaton, swallowing, cleansing the teeth, formation of speech. Taste sensation, taste buds, salivary glands.
Tonsils
Mass of lymphoid tissue, same color, more grandular, deep crypts. Large in children. Sometimes show blood vessels on them. Measured by how close to Uvula they are +1,+2, +3, or +4.
Teeth
Children have 20
Adults have 32
Used for mastication
Erupt earlier in girls than boys.
Meatus
under turbinates in nose a cleft named for turbinate about it. Sinuses drain into middle and tears from the nasolacrimal duct drain into the inferior meatus.
Resonance
low pitched, clear, hollow sound that predominates in healthy lung tissue in an adult.
Hyperresonance
lower pitched booming sound found when too much air is present as in emphysema or pneumothorax.
Anterior vs Transverse Measurement
2 hands : 1 hand.
Atelectasis
collapse of lung, section of alveoli, airway obstruction, compression on lung, lack of surfactant.
Angle of Louis
Sternal angle. Continuous with 2nd rib. Articulation of manubrium and body of sternum useful to start counting ribs. Localize a respiratory finding horizontally.