Palmer Physical Diagnosis Exam 2 Dr. Mullin

Front 1

Eye has good far sight but poor near sight

Back 1

Hyperopia

Front 2

Eye has good near sight but poor far sight

Back 2

Myopia

Front 3

With age (> 40 y.o.) the lens loses its elasticity & causes diminished near sight but continued far sight

Back 3

Presbyopia

Front 4

What chart is used to check near vision?

Back 4

Rosenbaum chart

Front 5

What chart checks vision at 20 feet?

Back 5

Snellen eye chart

Front 6

What chart checks vision at 10 feet?

Back 6

Sloan eye chart

Front 7

What is the Rosenbaum chart indirectly screening?

Back 7

Central vision

Front 8

Which test is used to check peripheral vision?

Back 8

Confrontation

Front 9

What kinds of abnormalities can cause visual field deficits?

Back 9

Scratching, scaring or edema of the cornea, cataracts on the lens; pus or blood in the aqueous or vitreous fluids

Front 10

Which cranial nerves are being tested with the cardinal planes of gaze exam?

Back 10

Cranial nerves III, IV and VI

Front 11

What do the corneal light reflect and cover-uncover test assess?

Back 11

symmetrical alignment of the eyes and therefore binocular vision (positives would indicate amblyopia and monocular vision)

Front 12

_______ is an abnormal elevation of the upper lid exposing the sclera between the lid margin & iris. It suggests hyperthyroidism if bilateral or 7th C.N. damage, or tumor behind the eyes if unilateral.

Back 12

Lid (lag) retraction

Front 13

__________ is a congenital or acquired weakness of the levator muscle or paresis of a branch of the third cranial nerve causes the upper lid to droop compared to the opposite eye.

Back 13

Lid (sag) ptosis

Front 14

________ is inflammation of the eyelash follicles and meibomian glands resulting in red, crusty lid margins

Back 14

Blepharitis

Front 15

A stye or ______ is a bacterial infection of a gland in an eyelash causing a well circumscribed red, swollen, tender pustule.

Back 15

hordeolum

Front 16

A hard, painless papule on the eyelid due to an obstruction of a meibowmian gland.

Back 16

Chalazion

Front 17

The loss of orbicularis oculi muscle tone with aging causing the lower lid to turn outward interfering with proper tear drainage; it may also result from 7th C.N. palsy

Back 17

Ectropion

Front 18

Inversion of the lower lid due to scar tissue formation of the inner surface of the lid; eyelashes then irritate the conjunctiva and cornea

Back 18

Entropian

Front 19

Inflammation of the tear sac secondary to chronic obstruction or narrowing of the nasolacrimal duct. A painful, swollen nodule develops between the nose and eye with accompanying tearing and discharge. Rare, but usually occurs in infants.

Back 19

Dacryocystitis

Front 20

A self-limiting bacterial or viral infection causing red, burning, itchy eyes with a discharge that tends to stick the eyelids together overnight. Pain is minimal, vision is not affected, and blood vessels dilate from the periphery towards the center of the eye.

Back 20

Contagious conjunctivitis (pink eye)

Front 21

Have the same signs and symptoms as pink eye but perhaps less thick discharge - caused by environmental irritants

Back 21

Allergic or chemical conjunctivitis

Front 22

Yellow elastic fibers form a plaque on either side of the cornea resulting from chronic irritation (sunny, dusty, windy conditions) to the bulbar conjunctiva

Back 22

Pinguecula

Front 23

Sunny, dusty, windy conditions may stimulate growth of a pinguecula forming a vascular membrane that may extend over the cornea

Back 23

Pterygium

Front 24

Microtraumas like coughing, sneezing or straining may cause a conjunctiva vessel to break trapping blood between the clear mucous membrane and the sclera.

Back 24

Subconjunctival hemorrhage

Front 25

Name 3 things that can cause the sclera of the eye to become yellow.

Back 25

1. aging causes the sclera to thin and fatty deposits may show through 2. jaundice 3. antimalarial drugs

Front 26

Name something that can cause the sclera to appear blue.

Back 26

Osteogenesis imperfecta

Front 27

Name something that can cause the sclera to appear brown.

Back 27

Patches of melanin are common in people with dark complexions

Front 28

A corneal arcus (half way around) or corneal ring (all the way around) is not considered clinically significant in people over 60. If under 40 it may indicate ______

Back 28

Hyperlipidemia

Front 29

A golden-brown band around the limbus of the cornea associated with Wilson's disease

Back 29

Kayser-Fleischer ring (Wilson's disease is a rare inherited disease where copper accumulates in the liver and throughout the body resulting in neurologic symptoms)

Front 30

Inflammation of the iris due to trauma, secondary to another disease or idiopathic in nature.

Back 30

Iritis -- Blood vessels touch edge of iris and work their way out

Front 31

What does the accronym PERRLA stand for?

Back 31

Pupilas should be equal, round & reactive to light & accommodation

Front 32

Congenital condition where pupils are inequal in size, however they react to all reflexes and have no companion symptoms

Back 32

Physiologic anisocoria

Front 33

Inequality of pupil size, which may be congenital or associated with head trauma or diseases of the nervous system

Back 33

Anisocoria

Front 34

A fixed, dilated pupil with poor response to the pupillary reflexes; most cases are idiopathic.

Back 34

Adie's tonic pupil

Front 35

Failure of the iris to close during fetal development resulting in a keyhole-shaped pupil

Back 35

Coloboma

Front 36

An irregular shaped pupil due to an adhesion of part of the iris to the cornea in front of it or the lens behind it; secondary to trauma, surgery, cataracts, glaucoma, iritis or other eye infections

Back 36

Synechia

Front 37

Decreased or absent response to light reflexes yet the pupils respond to accommodation; may be a defect resulting from syphilis

Back 37

Argyll Robertson pupil

Front 38

Interruption of sympathetic nerve supply to the eye resulting in miosis (constricted pupil) and mild eyelid ptosis

Back 38

Horner syndrome

Front 39

If the canal of Schlemm becomes blocked aqueous fluid builds up rapidly in the eye producing sudden severe eye pain, blurred vision, report of seeing colored lights around bright objects, corneal edema, conjunctival & perilimbal injection and a fixed dilated pupil.

Back 39

Acute Glaucoma

Front 40

An abnormal progressive loss of lens transparency (eventually a gray-white opacity) due to degenerative changes usually occurring after age fifty.

Back 40

Cataracts

Front 41

In many myopic patients there are areas of dark pigmentation along the border of the optic disc known as a ____________

Back 41

Choroidal crescent

Front 42

Fundoscopically it is a swollen, distorted optic disc with blurry borders

Back 42

Papilledema

Front 43

Signs include generalized loss of peripheral vision, increased cup size and atrophy (whitening) of nerve fibers in the enlarging cup.

Back 43

Chronic Glaucoma

Front 44

Name 4 common retinopathies

Back 44

1. Papilledema 2. Chronic Glaucoma 3. Diabetes Mellitus 4. Hypertension

Front 45

What are the most common causes of non-traumatic retinal detachment?

Back 45

Aging or inflammation

Front 46

Name 3 red flags of the eye

Back 46

1. Sudden, marked eye pain
2. Visible flashes followed by partial, peripheral vision loss
3. Developing tunnel vision or central blind spot

Front 47

Red, burning itchy eyes with slight pain, purulent discharge and lids may stick together during sleep. Kids and the elderly are prone.

Back 47

Bacterial conjunctivitis

Front 48

The patient reports an eye injury, marked pain, photophobia, decreased visual acuity is possible. Perilimbal injection on physical exam.

Back 48

Corneal abrasion

Front 49

The patient reports marked pain, photophobia in one eye. Physical exam findings are perilimbal injection and pupillary responses are sluggish in that eye.

Back 49

Acute Iritis

Front 50

Patient reports marked pain, photophobia, dimmed vision & halos around lights. Physical exam findings are perilimbal injection, dilated pupil, sluggish pupillary responses, increase eyeball tension & disc cupping in that eye.

Back 50

Acute Glaucoma

Front 51

Patient reports insidious tunnel vision over the course of many years, and is less than 40 years old. Physical exam reveals enlarged physiologic cup.

Back 51

Chronic glaucoma

Front 52

Typical patient is anyone who has had head trauma but spontaneous can occur in elderly. Symptoms are flashes of light, floaters or a dark fixed shadow in periphery.

Back 52

Retinal detachment

Front 53

Typical patient is over 50, has slowly progressing vision loss in one or both eyes. Physical exam findings are altered color & configuration of the macula/ fovea

Back 53

Macular degeneration

Front 54

An abnormal, benign, boney growth of the temporal bone may occasionally be seen protruding into the canal.

Back 54

Exostosis

Front 55

What is the most common cause of otitis externa?

Back 55

bacterial infection

Front 56

Children have a shorter, narrower & more horizontal eustachian tube making them more prone to ______________

Back 56

Suppurative otitis media

Front 57

What are divers and people who fly prone to?

Back 57

Barotrauma

Front 58

________ are cystic masses composed of epithelial cells & cholesterol in the middle ear.

Back 58

Cholesteatomas

Front 59

Age-related hearing loss (#1 reason for sensorineural hearing loss)

Back 59

Presbycusis

Front 60

What is the 2nd most common cause of sensorineural hearing loss?

Back 60

Noise-induced hearing loss

Front 61

Reduced or distorted hearing and vertigo and is generally thought to be caused by a viral infection; it's rarely painful.

Back 61

Labyrinthitis

Front 62

Patients are typically people who irritate the ear canal with excessive cleaning or swimming. They will have a red, swollen canal with debris or discharge.

Back 62

Otitis externa

Front 63

Typical patient is anyone but common in children under 5 who have a URI. Will have an earache and fever, and a red, bulging eardrum with possible purulent discharge.

Back 63

Suppurative otitis media

Front 64

Typical patient is anyone, but adult males are prone to it. Often follows q-tip usage. Patient will have dark wax occluding the canal. Weber lateralizes and Rinne` is negative on affected side.

Back 64

Excessive ear wax

Front 65

Typical patient is anyone, but common in children under 5 who've had an URI. Physical exam reveals normal, yellow or dark tympanic membrane with possible air bubbles or fluid line; Weber lateralizes to affected side and Rinne` is negative.

Back 65

Serrous or mucoid effusions

Front 66

Typical patient is an adult most often with family history. Symptom is progressive hearing loss. Physical exam reveals no abnormalities of the canal or eardrum; Weber lateralizes and Rinne` is negative on the affected side.

Back 66

Otosclerosis

Front 67

Typical patient is anyone with a history of recreational or occupational noise exposure. Physical exam reveals no canal or middle ear signs; Rinne` has AC greater than BC but less than 2:1 ratio.

Back 67

Noise induced hearing loss

Front 68

Typical patient is elderly. Symptoms are complaints that others are mumbling or that can't understand what's being said when their is background noise. Low frequency sounds & whispers are the first to go.

Back 68

Presbycusis

Front 69

What are some classic nose and sinus symptoms?

Back 69

Loss of smell, runny, itchy nose; stuffy nose &/or sinuses; sinus pain or pressure; mouth breathing or snoring

Front 70

A non-specific term used to describe acute infections of the nose, sinuses, phayrnx, trachea & bronchi

Back 70

Upper respiratory infection (URI)

Front 71

Another name for the common cold. Usual symptoms are stuffy nose & sinuses with a watery to thick discharge, sneezing, sore throat, cough & headache. Signs include swollen nasal tissues & cervical lymph nodes.

Back 71

Viral Rhinitis

Front 72

Another name for hayfever. Usual symptoms include stuffy nose & sinuses with a watery discharge, sneezing, post nasal drip, cough, itchy eyes, nose & throat persisting beyond 10 days. Signs include swollen nasal tissues & cervical lymph nodes.

Back 72

Allergic Rhinitis

Front 73

Affects frontal, maxillary or all sinuses. Usual symptoms include stuffy nose & sinuses, with a green purulent discharge, face, teeth or eye pain that is aggravated by bending over. Signs include swollen nasal tissues & cervical lymph nodes. Digital pressure aggravates the sinuses. Most likely bacterial.

Back 73

Acute Sinusitis

Front 74

This is a test of the sinuses using a light to see if the sinuses are clear or blocked.

Back 74

Transillumination

Front 75

All sinuses are involved

Back 75

Pansinusitits

Front 76

Adults who've had allergies &/or chronic sinus infections over the years sometimes develop these, which further interfere with nasal drainage. They are grape-like inflammatory swellings of the nasal linings.

Back 76

Polyps

Front 77

Trauma to the nose is the most common cause; many people can recall the incident and remember that breathing difficulties soon followed.

Back 77

Deviated Septum

Front 78

A normal cycle of mild congestion (unilateral blood vessel engorgement) & decongestion alternating between nostrils about every four hours making it easier to breath out of one nostril more than the other.

Back 78

Nasal Cycle

Front 79

Any child with a one-sided runny nose should be examined for this.

Back 79

Foreign Objects

Front 80

The patient should be able to identify familiar scents with each nostril, eyes closed. More than half of the reported cases of loss of smell are due to head injuries, post URIs and nasal/sinus conditions. Which cranial nerve is affected?

Back 80

C.N. I

Front 81

You should inspect the 5 Ts with a light and tongue depressor for signs of inflammation, sores, discolored patches & exudates. What are the 5 Ts?

Back 81

Teeth (malocclusions), Tongue, Tissues, Tonsils (often atrophied & not visible in the adult), Throat (a very limited view)

Front 82

Another name for a fever blister or cold sore. Caused by a virus and is usually contracted during childhood.

Back 82

Herpes Simplex Type 1

Front 83

Another name for a canker sore.

Back 83

Aphthous stomatitis

Front 84

A red, swollen smooth tongue due to the loss of the papillae.

Back 84

Glossitis

Front 85

A form of glossitis where the papillae are temporarily lost leaving smooth, irregular patches with a white outline. These patches can change locations on a weekly, or sometimes daily basis.

Back 85

Geographic tongue

Front 86

Characterized by grooves in the tongue of varying depths & widths. Benign.

Back 86

Fissured tongue

Front 87

Results from long-term antibiotic use or failure of the papillae to naturally fall off causing them to elongate; either fungus or bacteria attach to the papillae.

Back 87

Black hairy tongue

Front 88

Small white spots on the inside of the cheeks. They precede measels.

Back 88

Koplik spots

Front 89

A noncancerous or precancerous oral lesion common to about 1/2-3/4 of people using smokeless tobacco daily. They appear as white leathery ridges on the buccal mucosa.

Back 89

Leukoplakia

Front 90

Red, swollen, sensitive & bleeding gums. Brushing & flossing can prevent or reverse it.

Back 90

Gingivitis

Front 91

Most commonly affects the sides of the tongue, lips & floor of the mouth. Smoking & smokeless tobacco are associated with 70-80% of the cases. May present as persistent, painless thickening, lump, ulcer or a red or white patch anywhere in the mouth or throat.

Back 91

Oral carcinoma

Front 92

A benign exostosis of either the hard palate or mandible that appear around age 30.

Back 92

Torus palatinus & mandibularis

Front 93

Usually a self-limiting, viral or bacterial infection of the pharyngeal tonsils. Signs and symptoms are sore throat, painful swallowing, thick voice, fever, swollen cervical lymph nodes and red, swollen tonsils that may be coated or have white spots on them.

Back 93

Tonsilitis

Front 94

Stones form when mucous, sulfur-producing bacteria and debris (food particles, post-nasal drip, etc...) condense into small particles and collect in the crypts on the surface of the tonsils.

Back 94

Tonsillar debris (tonsil stones)

Front 95

Accounts for about 60% of sore throats. Clinical features are runny nose, cough, hoarseness, conjunctivitis or diarrhea

Back 95

Viral Pharyngitis

Front 96

Accounts for about 40% of sore throats. Clinical features are rapid onset of throat pain aggravated by swallowing. There is usually fever, tender cervical lymph nodes & inflammation with a purulent, patchy white, yellow or gray exudate.

Back 96

Bacterial Pharyngitis

Front 97

occurs in about 1% of those who had strep throat. Antibiotics are more than 90% effective in preventing it.

Back 97

Rheumatic fever

Front 98

With the onset of puberty oil glands often become overactive and then plugged, resulting in various stages of this condition.

Back 98

Acne Vulgaris

Front 99

Another name for blackheads

Back 99

Comedones

Front 100

What are the 4 stages of acne?

Back 100

1. Comedones (blackheads)
2. Pustules & papules (pimples)
3. Cysts & scarring
4. Involves the thorax & arms

Front 101

Type 1 herpes appearing on the lips or mouth

Back 101

Herpes labialis

Front 102

Type 1 herpes appearing on the eyes

Back 102

Herpes keratitis

Front 103

4-7 days after contact soreness or itchy precede red macules on the genitals, which develop into vesicles then ulcerate; the ulcers become crusted and heal in about 10 days.

Back 103

Genital Herpes (Herpes simplex 2)

Front 104

Infection of the hair follicle, which appears as pustules with hair growing from the center. Sometimes refered to as "razor bumps."

Back 104

Folliculitis

Front 105

An inflamed, expanding, well demarcated patch usually secondary to a preexisting skin infection or wound. It is pretty rare, and is often due to a type "A" beta hemolytic streptococcus.

Back 105

Erysipelas

Front 106

Has the same features as erysipelas, but lacks the sharp raised borders & usually affects the limbs.

Back 106

Cellulitis

Front 107

A chronic inflammatory disorder resulting in new superficial blood vessels mostly affecting middle-aged women.

Back 107

Rosacea

Front 108

Another name for soft tissue swelling that usually occurs in males that is related to Rosacea.

Back 108

Rhinophyma (rhino = nose phyma = swelling)

Front 109

An autoimmune disorder more common in young women. Fever, fatigue and weight loss are presenting symptoms. Usually associated with a malar (butterfly) rash.

Back 109

Systemic Lupus Erythematosus

Front 110

White spots in the nail, usually due to a mild injury.

Back 110

Leukonychia

Front 111

Another name for spoon nail. It is usually a hereditary condition causing thin concave nails, but may occur with trauma or iron deficiency anemia.

Back 111

Koilonychia

Front 112

Name 2 conditions that can cause yellowing of the nails.

Back 112

Fungal infections and psoriasis

Front 113

Red or brown longitudinal streaks may occur in cases of sever psoriasis. Pitting may also occur.

Back 113

Splinter hemorrhages

Front 114

Placing nails from each hand back-to-back normally creates a diamond shaped space due to the normal 160 degree angle at the nail base. Nail clubbing causes the diamond to disappear due to abnormal enlargement of the distal phalanges.

Back 114

Schamroth's technique

Front 115

Name two types of diseases (broad categories) that can cause clubbing of the nails.

Back 115

Respiratory and cardiovascular diseases

Front 116

Transverse, white depressions in the nail associated with acute, severe illness such as malnutrition, coronary artery disease or other systemic disease; may also be trauma induced.

Back 116

Beau's line

Front 117

The nail is white except for a narrow zone at the distal tip; associated with cirrhosis of the liver.

Back 117

Terry nails

Front 118

Infection around the nail presenting as red, swollen, painful tissue

Back 118

Paronychia

Front 119

Another name for warts; usually due to the human papilloma virus.

Back 119

Verrucae Vulgaris

Front 120

Another name for a flat wart - a small, slightly raised, tan or flesh-colored wart

Back 120

Verruca Plana

Front 121

Dyshidrotic eczema which affects hands, sole & sides of the fingers which appear as itchy clusters of small vesicles.

Back 121

Pompholyx