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164 Cards in this Set

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What is the palpebral fissure?
Area between the opening of the eyelids.
What are tarsal plates?
CT w/in eyelids-->each plate has parallel row of meibomian glands, which open on lid margin.
What is responsible for raising the upper eyelid & what is its innervation?
1. Levator palpebrae muscle: by CNIII
2. Smooth muscle innervated by sympathetic nervous system assists.
What are the three sources of tear fluid and what is its function?
Fxn: protects conjunctiva & cornea from drying, inhibits microbial growth, gives smooth optical surface to cornea.
Sources of fluid: meibomian glands, conjunctival glands, lacrimal gland.
What do the muscles on the iris do? What do muscles of ciliary body to?
Iris muscles-->control pupillary size.
Ciliary body muscles-->control lens thickness, lets eye focus on distant objects.
What is the pathway of tears within the eye?
Lacrimal gland (above & lateral to eye)-->fluids speads across eye & drains medially into 2 tiny holes called lacrimal puncta-->lacrimal sac-->& into nose thru nasolacrimal duct.
Describe the circulation path of the aqueous humor and its fxn.
Fxn: to control P inside eye.
Aqueous humor produced by ciliary body in posterior chamber-->thru pupil to anterior chamber-->drains out thru Canal of Schlemm
What is the fxn of the vitrous body?
Its a transparent mass of gelatinous material that fills eyeball behind lens. It helps to maintain SHAPE of lens.
Why and where do we have a blind spot?
B/c of lack of retinal receptors at optic disc, oval blind spot in normal field of each eye, 15 degrees temporal to line of gaze
Which CN mediates the near reaction?
Oculomotor N
What is the pathway of the sympathetic fibers to the eye?
Starts in hypothalamus & passes down thru brainstem & cervical cord into neck. From there, it follows carotid A or its branches into orbit. Lesion anywhere on this pathway may impair sympathetic effects on pupil.
What are the compartments of the ear?
external ear (auricle & ear canal thru tympanic membrane), middle ear (ossicles: malleus, incus, stapes), inner ear
Are you able to directly examine the inner ear?
No, you can't directly examine the inner or ,ost of external ear, but you can make inferences based on tests of auditory fxn.
Describe the pathway of hearing.
Vibrations thru external ear, transmitted thru eardrum & ossicles of middle ear to cochlea (pt of inner ear)-->cochlea senses vibrations-->N impulses sent to brain thru cochlear N.
What is conductive hearing loss?
A disorder in the conductive phase of hearing, so from external ear to middle ear.
How does one get sensorineural hearing loss?
Involves 2nd pt of pathway: Cochlea & cochlear N.;
The __________ w/in inner ear senses position & movements of head & helps to maintain balance.
Labyrinth
Which pathway is used for testing hearing loss?
Bone conduction pathway which bypasses external & middle ear. Set tuning fork on bone w/ vibration, & this vibration will stimulate cochlea directly.
In normal hearing person, which is more sensitive: air conduction or bone conduction?
Air conduction
Which part of the nasal cavity is covered with hair-bearing skin rather than mucosa, unlike the rest of the nasal cavity?
Vestibule
What are the curving bony structures covered by highly vascular mucous membranes that protrude into nasal cavity?
Turbinates
What can be seen on examination of the nasal cavity thru the anterior naris?
Vestibule, anterior pt of septum, lower & middle turbinates.
A tooth is composed mainly of ______.
dentin
What structure connects the tongue to the floor of the mouth?
Lingual frenulum
Where does each parotid gland empty in the mouth?
near the upper 2nd molar--Stensen's duct.
What are the submandibular gland ducts called that open on papillae that lie on each side of lingual frenulum?
Wharton's ducts.
The neck is divided into 2 triangles by the sternomastoid muscle. What are the borders of the 2 triangles?
Anterior triangle bounded by mandible above, laterally by sternomastoid, medially by midline of neck. Posterior triangle: clavicle below, sternomastoid to trapezius.
What vessels line deep to sternomastoid?
Carotid artery & internal jugular vein. External jugular vein passes diagonally over surface of sternomastoid.
Lists the lymph nodes of the head & neck region.
Preauricular, posterior auricular, occipital, tonsillar, superficial cervical, posterior cervical, supraclavicular, submental, submandibular, deep cervical chain.
What happens to the tonsils & other lymphoid tissue with age?
(composed of lymphoid tissue). After age 5, they get gradually smaller. In adults-->invisible. Frequency of palpable lymph nodes also dec with age.
In contrast to the lymph nodes, what becomes easier to feel in older people?
Submandibular glands
How does vision change w/ age?
-Visual acuity fairly constant b/w 20-50 & then diminishes until 70 & then more rapidly.
-Elderly-->near vision begins to become blurry for everyone
-From childhood on, lens gradually loses its elasticity & eye gets less able to focus on nearby objects=PRESBYOPIA (obvious in 40s)
What happens to the tissues around the eyes w/ age?
-Fat surrounding & cushioning eye atrophies-->eyeball recedes in orbit.
-skin of eyelid gets wrinkled
-fat may push fascia of eyelids forward, creating soft bulges.
-eyes produce fewer lacrimal secretions, so they have dry eyes.
What happens to the eyeball w/ aging?
-corneal arcus (arcus senilis) common in elderly, no clinical significance;
-corneas lose luster, pupils get smaller & irregular (but should still respond to light).
-lenses thicken & yellow, so hard to get passage of light into eye;
-cataracts are common (1:10 in 60s, 1:3 in 80s)
-Glaucoma: lens can push iris forward & narrow angle b/w iris & cornea and inc risk of narrow-angle glaucoma.
-arteries narrowed, paler, straigher, less brillian
-may see vitrous floaters
-macular degeneration, glaucoma, retinal hemorrhages, retinal detachment.
Describe the types of hearing loss that occur w/ age.
Early loss: start in young adulthood, involve high-pitched sounds beyond range of human speech, little fxn'al significance.
-PRESYCUSIS: hearing loss associated w/ aging, also involves middle & lower rangles, usually after 50 y/o
What is the chief cause of tooth loss in adults?
peridontal disease
Overclosure of the mouth may lead to what?
Maceration of the skin @ corners--angular cheilitis
What are the common & concerning sx's of head & neck?
HA, Change in vision (hyperopia, presbyopia, myopia, scotomas), double vision or diplopia, hearing loss, earache; tinnitus, vertigo, nosebleed (epistaxis), sore throat; hoarsness; swollen glands, goiter.
What are the most important attributes of headache?
chronologic pattern & severity.
What are the most common kinds of recurring headaches?
Tension & migrains headaches
Tension HA's arise where?
Temporal areas.
Cluster headaches occur where?
Retro-orbital
Changing or progressively severe headaches inc the likelihood of what?
Tumor, abscess, or other mass lesion.
Extremely severe headaches suggest what?
Subarachnoid hemorrhage or meningitis.
Which condition has visual auras or scintillating scotomas?
Migraines (fam hx may also be positive w/ migraines)
N & V common w/ migraine, but occur with what other conditions?
Brain tumors & subarachnoid hemorrhage.
If coughing, sneezing, or changing head position have an effect on HA, what could this be a sign of?
These maneuvers inc pain from brain tumor & acute sinusitis.
How might high blood pressure affect vision?
May cause blurring
Refractive errors most commonly explain what?
Gradual blurring
Sudden visual loss suggests what?
Retinal detachment, vitrous hemorrhage, or occlusion of central retinal artery.
What is the difference b/w HYPEROPIA, PRESBYOPIA, and MYOPIA?
Hyperopia: farsightedness, presbyopia:aging vision, myopia: difficulty: nearsightedness
Slow central loss of vision occurs in which 2 conditions?
Nuclear cataract & macular degeneration
Peripheral loss of vision occurs in which 2 conditions?
Advanced open-angle glaucoma
One-sided loss of vision occurs in which conditions?
Hemianopsia & quadrantic defects.
Moving specks or strands in vision suggest what?
Vitreous floaters
Fixed defects (scotomas) suggest what?
Lesions in retinas or visual pathways.
Flashing lights across the visual field or new vitrous floaters suggest what?
Detachment of vitreous from retina. Need prompt eye consultation!
What are the causes of diplopia in adults?
Lesion in brainstem or cerebellum, or from wkness or paralysis of one of more extraocular muscles as in horizontal diplopia from palsy of CN III or VI, or vertical diplopia from palsy of CN III or CN IV.
Diplopia in 1 eye w/ the other closed suggests what?
Problem in cornea or lens
What is the difference b/w horizontal and vertical diplopia?
Horizontal: 2 images side by side;
Vertical: 2 images on top of each other
What are the symptoms of someone w/ sensorineural hearing loss?
(problem in inner hear, cochlear nerve, or its central connection to brain);
Sx: trouble understanding speech, often complaining others mumble; noisy environments make hearing worse. In conductive hearing loss, noise environments HELP!
What are some medications that affect hearing?
Aminoglycosides, aspirin, NSAIDS, quinine, furosemide.
What are some differences in sx's b/w otitis externa & otitis media?
Pain in external ear=otitis externa.
If assoc w/ respiratory infection sx's in inner ear=otitis media.
Acute or chronic otitis media causes from what type of discharge from the ear?
Unusually soft wax, debris from inflammation or rash in ear canal, or discharge thru perforated eardrum secondary to acute or chronic otitis media.
When tinnitus is associated w/ hearing loss & vertigo, it suggests what condition?
Meniere's disease.
Feeling unsteady, light-headed, or 'dizzy in the legs" sometimes suggest what?
Cardiovascular etiology
Feeling of being pulled suggests what?
true vertigo from an inner ear problem or a central or peripheral lesion of CN VIII
What are some causes of rhinorrhea?
Viral infections, allergic rhinitis (hay fever), & vasomotor rhinitis. Excessive decongestant use may worsen sx's.
What are some symptoms of allergies?
Rhinorrhea w/ itching in eyes, nose, throat. Relation to season and environment.
What drugs may cause stuffiness?
oral contraceptives, reserpine, guanethidine, & alcohol
Rhinorrhea, congestion, w/ pain & tenderness in face or over sinuses, local HA, or fever suggest what?
Sinusitis
If nasal congestion is limited to one side, what should you think of?
Deviated nasal septum, foreign body, tumor.
What are some local causes of epistaxis?
Trauma (esp nose picking), inflammation, drying & crusting of nasal mucosa, tumors, & foreign bodes. Bleeding d/o's contribute to epistaxis.
What are the sx's of streptococcal pharyngitis or strep throat?
fever, pharyngeal exudates, anterior lymphadenopathy, esp w/o cough
Sore smooth tongue indicates what?
Nutritional deficiency
Bleeding gums are most often caused by what?
Gingivitis
What are the most common causes of hoarseness?
overuse of voice, acute infections, allergy, smoking, or other inhaled irritants; If > 2wks, need indirect or directly laryngoscopy.
What are some sx's of hypothyroidism?
intolerance to cold, preference for warm clothing, decreased sweating, coarse hair, lateral sparseness of eyebrows
What are some sx's of hyperthyroidism?
palpitations, involuntary weight loss, fine hair, poor convergencce, lid lag
What are some impt topics for health promotion & counseling in head & neck?
-changes in vision: cataracts, macular degeneration, glaucoma;
-hearing loss
-oral health
What is the leading cause of blindness in African Americans & second leading cause of blindness overall?
Glaucoma (gradual loss of vision w/ damage to optic N, loss of visual fields beginning in periphery, & pallor & inc size of optic cup (enlarges to more than 1/2 of optic cup). Elevated IOP in 80% of cases)
What are the risk factors of glaucoma?
>65, African American, DM, myopia, family hx of glaucoma, ocular hypertension.
What are some risk factors for hearing loss?
hx of congenital or familial hearing loss, syphilis, rubella, meningitis, exposure to hazardous noise levels.
What 2 conditions give you an enlarged skull?
hydrocephalus & Paget's dz of bone
What does vision of 20/200 mean?
@ 20 feet person can read print that a pt w/ nl vision could read at 200 feet. The larger the second number, the worse the vision.
When is a person considered legally blind?
20/200. Legal blindness also results from constricted field of vision: 20 degrees or less in better eye.
How far do you use a hand-held Snellen eye chart?
14 inches.
You get an enlarged blind spot in which conditions?
Those affecting the optic N like glaucoma, optic neuritis, papilledema
What test result would make a patient positive for a left temporal hemianopsia?
When w/ peripheral vision test, if patient's left eye repeatedly doesn't see your fingers until they've crossed line of gaze.
When do you have abnormal protrusion of eyes?
Graves disease or ocular tumors
What is Blepharitis?
inflammation of eyelids along lid margins, often w/ crusting or scales.
Scaliness of skin under eyebrows is with which condition?
Seborrheic dermatitis
What are the causes of excessive tearing?
May be due to increased production (causes: conjunctival inflammation & corneal irritation) or impaired drainage of tears (nasolacrimal duct obstruction).
What is the most common type of glaucoma?
Narrow-angle glaucoma-->sudden inc in intraocular P when drainage of aqueous humor is blocked.
When is anisocoria considered benign?
If pupillary rxns are normal
When should you pause when doing the H to check for nystagmus?
when upward & lateral
What are contraindications for using mydriatic eye drops?
1)head injury & coma, in which continuing observations of pupillary rxns are essential.
2) any suspicion of narrow-angle glaucoma.
Which hand should you be holding the opthalmoscope with to check each eye?
Right hand w/ right eye and vice versa.
What is the red reflex?
When you shine the light on the pupil and get an orange glow in the pupil--you want to note any opacities interrupting red reflex
What is hippus?
spasm of pupil--may be from brightness of light in their eye
Absence of red reflex suggests what?
Opacity of lens (cataract) or possibly of vitreous. Less commonly, a detached retina, or in kids, a retinoblastoma may obscure this reflex. Don't be fooled by artificial eye, which has no red reflex!!!
An enlarged physiologic cup suggests what?
chronic open angle glaucoma
Loss of venous pulsations is in what pathologic conditions?
Head trauma, meningitis, or mass lesions-->early sign of inc ICP
What are the 2 types of macular degeneration (big cause of poor central vision in elderly)?
Dry atrophic (more common but less severe) & wet exudative (neovascular)
'tug test' of auricle painful in which condition?
Acute otitis externa (inflammation of ear canal--swollen, narrow, moist, pale, tender, reddened, canal) NOT otitis media (inflammation of middle ear-->but have tenderness BEHIND ear)
What are exostoses?
Nontender nodular swellings covered by nl skin deep in ear canals; nonmalignant overgrowths which may obscure ear drum.
What does the ear canal look like chronic otitis externa?
Skin of canal is thickened, red, itchy.
What does a red bulging ear drum indicate? Amber drum?
Perulent otitis media, serous effusion.
What does an unusually prominent short process & prominent handle of malleus that looks more horizontal indicate?
Retracted ear drum
What are some causes of unilateral conductive hearing loss (w/ Weber's test-->sound heard in impaired ear)?
acute otitis media, perforation of eardrum, obstruction of ear canal by cerumen.
In unilateral sensorineural hearing loss, where is sound heard?
Good ear
How does the nasal mucosa look difference in viral and allergic rhinitis?
Viral rhinitis: mucosa reddened & swollen;
Allergic rhinitis: pale, bluish, red.
What are some causes of septal perforation?
Intranasal use of cocaine (can also lead to nasal ulcers) & amphetamines.
What's the test for CN XIII
stick out your tongue (lesion if asymmetric)
Whats the 2nd most common cause of cancer of the mouth (after lips)?
tongue, usually on side (esp w/ tobacco, alcohol)
What happens in CN X paralysis?
open mouth, soft palate fails to rise & uvula deviates to OPPOSITE side
Tender lymph nodes suggest what? Hard/fixed nodes suggest what?
Inflammation; Malignancy
How can you notice masses in neck?
May push trachea to 1 side; can also show impt problems in thorax like mass, atelectasis, or lg pneumothorax.
Where is the angle of louis or sternal angle?
Adjacent to 2nd rib & costal cartilage.
Which ribs articular w/ costal cartilages?
1-7
Inferior tip of scapula lies @ which rib level?
7th rib or interspace
Lower border of lung lies @ which level?
T10
What are the fissures of the R lung?
Major (oblique) and minor (horizontal) fissure
Signs in the R middle lung field laterally are from what pt of lung?
Any of three lobes
Signs in R upper lung field are from what area?
R upper area
Where does the trachea bifurcate?
sternal angle anteriorly; T4 posteriorly;
What are visceral & parietal pleurae?
-Visceral pleurae are serous membranes that cover outer surface of each lung;
-Parietal pleura line inner rib cage & upper surfaces of diaphragm
What is pleural space?
Potential space b/w visceral & parietal pleura
What is the primary muscle of inspiration?
Diaphragm (w/ contraction, it descends)
In ______ position, mvmts of thorax become more prominent.
Seated
What are the accessory muscles of inspiration>
Most impt: sternomastoids;
scalenes; Abdominal muscles w/ expiration
What are the common or concerning sx's of thorax & lungs?
chest pain, dyspnea, wheezing, cough, blood-streaked sputum (hemoptysis)
What are the changes of thorax & lungs w/ aging process?
dec capacity for exercise, chest wall stiffer, harder to move, respiratory muscles weakens, lungs lose some elastic recoil, speed of breathing out w/ max effort dec, skeletal changes-->kyphosis, inc anteroposterior diameter of chest-->barrel chest.
A clenched fist over sternum suggest what?
Angina pectoris
A finger pointing to a tender area on chest wall suggests what?
musculoskeletal pain
A hand moving from neck to epigatrum suggests what?
heartburn
Whats the most frequent cause of chest pain in kids?
Anxiety, constochonrditis also common
Does lung tissue have pain fibers? How do we sense pain in chest?
Lung tissue has NO pain fibers. Pain in lung conditions like pneumonia or pulm infarction arises from adjacent parietal pleura. May also be from muscle strain from prolonged recurrent coughing.
Define dyspnea
Nonpainful but uncomfortable awareness of breathe thats inappropriate to level of exertion
Since you can't really quantify dyspnea, whats the best way to determine severity?
Based it on pt's daily activities.
Wheezing suggests what?
partial airway obstruction from secretions, tissue inflammation, or foreign body
What is an important sx of L-sided heart failure?
cough
Mycoplasmal pneumonia gives you what type of cough? Bronchitis, viral, bacterial pneumonia?
dry hacking; productive cough;
Mucoid sputum cs purulent sputum?
Mucoid: translucent, white or gray; perulent: yellowish or greenish
Sputum in CF?
tenacious sputum; also hemoptysis;
Sputum in anaerobic lung abscess?
Foul-smelling
How is hemoptysis different for blood originating from stomach vs/ respiratory tract?
Stomach: darker & maybe mixed w/ food particles;
Lg volumes of purulent sputum in which conditions?
Bronchiectasis or lung abscess
Whats the leading cause of preventable death?
smoking
What are the 4 A's of smoking cessation?
-Ask about smoking @ each visit.
-Advise pts regularly to stop smoking in clear personalized message.
-Assist pts to set stop dates & provide educational materails for self-help.
-Arrange for follow-up visits to monitor & support progress
What should be included in initial survey of respiration?
Rate (14-20x/min), rhythm, depth, breathing effort
What are signs of resp difficulty?
Pts color for cyanosis (signals hypoxia, clubbing of nails in COPD or congenital heart disease, listen to breathing (stridor--high-pitched wheeze), inspiratory contraction of sternomastoids @ rest:severe difficulty breathing, lateral displacement of trachea in pneumothorax, pleural effusion, atelectasis), COPD-->AP diameter inc
Unilateral impairment or lagging of respiratory mvmt suggests what?
dz of underlying lung or pleura.
When placing your hands @ level of 10th rib, whats the cause of unilateral dec or delay in chest expansion?
Chronic fibrotic dz of underlying lung or pleura, pleural effusion, lobar pneumonia, pleural pain w/ associated splinting, and unilateral bronchial obstruction
What are causes of dec or absent fremitus?
obstructed bronchus, COPD, separation of pleural surfaces by fluid (pleural thickening), fibrosis (pleural thickening), air (pneumothorac), or an infiltrating tumor, very thick chest wall.
Fremitus is more prominent in what region?
Intrascapular region
When does dullness replace resonance?
When fluid or solid tissue replaces air-containing lung or occupies pleural space beneath percussing fibers. ex. lobar pneumonia
Describe the characteristics of flatness.
intensity: soft, pitch: high, duration: short, location: thigh;path: lg pleural effusion
Describe dullness.
intensity: medium; pitch: medium; duration: medium: location: liver; path: lobar pneumonia
Describe resonance
intensity: loud, pitch: low; duration: long; location: nl lung; path: simple chronic bronchitis
Describe hyperresonance
intensity: very loud, pitch: lower, duration: long, location: none normally; path: emphysema, pneumothorax
Describe tympany.
intensity: loud, pitch: high, location: gatric air bubble or puffed out cheek. path: large pneumothorax
What are normal breath sounds?
vesicular, bronchovesicular, bronchial
What is the nl amt of diaphragmatic excursion?
5-6 cm