Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
330 Cards in this Set
- Front
- Back
|
What are the lobes of the right and left lung and where you can see each lobe?
|
Right: 3 lobes. RUL, RML, RLL. All three can be seen from the anterior and lateral views. Only RUL and RLL can be seen posteriorly.
Left: 2 lobes. LUL, LLL. Both can be seen anteriorly, laterally and posteriorly |
|
|
Which ribs directly articulate with the sternum?
|
1-7.
8,9,10 articulate with cartilage. 11 and 12 are floating. |
|
|
What are seven symptoms of pulmonary disease?
|
Cough, Sputum production, Hemoptysis, Dyspnea, Wheezing, Cyanosis, Chest pain
|
|
|
What is the most common symptom of lung disease?
|
Cough
|
|
|
What is the most common cause of CHRONIC cough?
|
Smoking
|
|
|
What are 7 types of cough?
|
Dry, hacking, productive, barking, wheezing, stridor, morning
|
|
|
What 5 things would you want your patient to describe about their sputum production?
|
Color, consistency, quantity, number of times a day, presence of blood
|
|
|
What are the characteristics of an UNinfected sputum?
|
Mucoid, odorless, transparent, whitish gray
|
|
|
What are the characteristics of an infected sputum?
|
Purulent, yellow, greenish or red
|
|
|
What is hemoptysis? And how serious is it?
|
Coughing up blood - can range from blood tinged to clots. Important symptom - must rule out serious disease states
|
|
|
What can cause hemoptysis?
|
Mucosal invasion, tumor necrosis or pneumonia distal to bronchial obstruction by tumor
|
|
|
What is THE most common cause of hemoptysis? What are two other major causes?
|
**Bronchitis.
Bronchiectasis and bronchogenic carcinoma also major causes |
|
|
What is dyspnea and what must you differentiate it from?
|
Subjective sensation of shortness of breath. Differentiate from objective finding of tachypnea.
|
|
|
What is a way you can can quantify dyspnea and provide a framework for exercise tolerance?
|
Ask how many blocks can you walk?
|
|
|
What are the different types of positional dyspnea?
|
Paroxysmal nocturnal dyspnea - sudden onset during sleep. Helps to sit up.
Orthopnea - SOB lying down Platypnea - rare. SOB sitting up, better lying down. Trepopnea - most comfortable lying on either side. |
|
|
What is important to know about the relationship between wheezing and asthma?
|
Asthma is associated with wheezing, but not all wheezing is asthma.
|
|
|
What are clinical correlations with wheezing?
|
Asthma, aspirated foreign body or secretions, tumor, CHF
|
|
|
What kinds of things would you see in central cyanosis?
|
O2 sat <80%, seen in lips, mucous membranes, *doesn't disappear w/ warming the area, exercise makes it worse and *see clubbing.
|
|
|
What is chest pain a cardinal symptom of?
|
Cardiac disease. But can also be seen in pulmonary disease.
|
|
|
What is pleuritic pain commonly associated with and what are the symptoms?
|
Inflammation of parietal pleura.
Sharp, stabbing pain on inspiration. |
|
|
What is anascarca?
|
Generalized edema
|
|
|
What are 7 exam steps when evaluating the posterior chest from behind the patient while they are sitting upright?
|
Inspection, palpation for tenderness, Evaluate thoracic expansion, Evaluate tactile fremitus, Percussion, Measure diaphragmatic excursion, Auscultation
|
|
|
What are 6 exam steps when evaluating the anterior chest from the front while the patient is either seated or lying down?
|
Inspection, Palpation for tenderness, Evaluate anterior thoracic expansion, Evaluate tactile fremitus, Percussion, Ascultation
|
|
|
What is the normal adult respiratory rate?
|
12-20 breaths per minute
|
|
|
What is dyspnea?
|
Difficult and labored breathing with SOB
|
|
|
What is bradypnea?
|
Slow breathing. < 12 bpm,. Caused by neurologic or electrolyte disturbance, infection.
|
|
|
What is tachypnea?
|
Fast breathing. >20 bpm. Caused by splinting from pain of broken rib or pleurisy
|
|
|
What is hyperpnea?
|
Hyperventilation. >20 bpm w/ deep breathing (exercise, anxiety, CNS disease, metabolic disease)
|
|
|
What is hypopnea?
|
Abnormally shallow respirations (pleuritic pain)
|
|
|
What is apnea?
|
Absence of breathing (cardiac arrest)
|
|
|
What is air trapping?
|
Increasing difficulty getting breath out. Air in lungs has difficulty overcoming resistance and getting out of the lung due to obstruction of pulmonary tree. Result of prolonged and inefficinent expiratory effort.
|
|
|
What is ataxic breathing?
|
Significant disorganization w/ irregular and varying depths of respiration
|
|
|
What is biot's breathing?
|
Irregular breathing, varying in depth w/ long periods of apnea. Lacks repetitive pattern of periodic respiration. Due to increased intracranial pressure, drugs, brain damage.
|
|
|
What is Cheyne-Stokes?
|
Periodic breathing. irregular breathing w/ intervals of apnea followed by a crescendo/ decrescendo sequence of resp. Caused by drugs, CHF, brain damage, can occur during sleep
|
|
|
What is Kussmaul's breathing?
|
Rapid, deep labored breathing. Seen in metabolic acidosis.
|
|
|
What can cause clubbing?
|
Intrathoracic tumors, venous-arterial shunts, chronic pulm disease, chronic hepatic fibrosis
|
|
|
What is flail chest?
|
Chest wall moves paradoxically inward during inspiration - multiple rib fx.
|
|
|
What is pectus carinatum?
|
Pigeon breast; anterior protrusion of sternum. Doesn't compromise ventilation
|
|
|
What is a clinical correlation of asymmetry of hand movement when evaluating posterior thoracic expansion?
|
Could indicate localized pulmonary disease if one side moves less than the other.
|
|
|
What could increased tactile fremitus suggest?
|
Consolidation pneumonia
|
|
|
What could decreased tactile fremitus suggest?
|
Unilateral: pneumothorax, pleural effusion, bronchial obstruction, atelectasis.
Bilateral: COPD (overexpansion of lung), chest wall thickening (muscle, fat) |
|
|
What 5 different things are you assessing about percussion?
|
Tone, intensity, pitch, duration, and quality
|
|
|
What should you hear when percussing over the lung?
|
Resonant, high amplitude, low pitched tones
|
|
|
What is hyperresonance and what does it indicate when heard over the lungs?
|
Low pitched, hollow-quality. Indicates hyperinflation. Sustained resonant tones seen in lungs w/ decreased density (ex. emphysema/COPD)
|
|
|
What does dullness percussed over the lungs indicate?
|
Diminished air exchange
|
|
|
What is diaphragmatic excursion?
|
Difference in diaphragmatic motion between inspiration and expiration
|
|
|
How do you evaluate diaphragmatic excursion?
|
As the patient to take a deep breath and hold it. Percuss to find the lower border of the lung and mark it. Then, have the patient breathe and then exhale as much as possible and hold it. Again, percuss to find lower border of lung. Should be 3-5cm difference. Usually higher on the right than on the left due to the liver.
|
|
|
What is the bell used for on the stethescope?
|
Detection of low-piched sounds - apply loosely
|
|
|
What is a vesicular lung sound?
|
Heard over most of the lung fields; low pitch; soft and short expirations; more prominent in a thin person or child, diminished in the overweight or very muscular patient
|
|
|
In what order should you auscultate the lungs?
|
Side to side and top to bottom
|
|
|
Why do you want to use the diaphragm to evaluate lung sounds?
|
Transmits ordinarily high pitched sounds better
|
|
|
What are crackles (rales)?
|
Discrete, short, discontinuous, nonmusical sounds heard during inspiration. Courser crackles related to larger airways.
|
|
|
What causes crackles (rales)?
|
Fluid inside a bronchus leading to a collapse of distal airways and alveoli: pulm edema, CHF, pulm fibrosis, bronchitis, etelactasis
|
|
|
What are rhonchi?
|
Snorous wheezes. Prolonged, continuous, deeper, rumbling, musical sounds heard mostly during expiration.
|
|
|
What causes rhonchi?
|
Airflow through narrowed bronchi. Narrowing may be from swelling, secretions, spasm, tumor or foreign body.
Chronic bronchitis, acute bronchitis, tracheobronchitis, asthma |
|
|
What are wheezes?
|
AKA sibilant wheeze. Form of rhonchus. Continuous, high pitched, musical, almost a whistle, during inspiration or expiration.
|
|
|
What causes wheezes?
|
High-velocity air flow through narrowed airway.
Asthma, chronic bronchitis, COPD, CHF, foreign body, tumor, virus |
|
|
What would you see in obstructive lung disease?
|
Impaired or decreased breath sounds, wheezing, rhonchi, barrel chest, decreased chest expansion, accessory muscle use, cyanosis, diminished diaphragmatic excursion, increased resonance, decreased fremitus.
|
|
|
What do you see in a pleural effusion?
|
Dullness, decreased or absent breath sounds, decreased tactile fremitus, presence of bronchophony, whispered pectoriloquy, egophony in or superior to effusion, occasional friction rub.
|
|
|
What is a pleural friction rub?
|
Dry, crackly, grating low pitched sound produced by motion of pleura impeded by frictional resistance. May sound like "creaking of new leather" Best heard at end of inspiration and beginning of expiration.
|
|
|
What is the difference between a respiratory rub and cardiac rub?
|
A respiratory rub disappears when breath is held. Cardiac rub will not.
|
|
|
What kinds of conditions would cause a pleural friction rub?
|
Pleural effusion (neoplastic), pneumonia, pulmonary infarction, pericarditis, pleurisy
|
|
|
What is bronchophony?
|
Increased transmission of spoken words heard in consolidation of lungs. Pt says "ninety-nine" while examiner listens. Bronchophony present if words are louder than normal.
|
|
|
What would cause presence of bronchophony?
|
Consolidation states like lobar pneumonia
|
|
|
What is egophony (egobronchophony)?
|
Spoken word "Eee" is changed to "ay" in areas of consolidation.
|
|
|
What would cause presence of egophony?
|
Lobar pneumonia, area ABOVE a pleural effusion
|
|
|
What is normal in whispered pectoriloquy?
|
Little or nothing heard
|
|
|
If there is consolidation of the lungs, what would you hear in whispered pectoriloquy?
|
Whispred "one two three" is louder and heard more clearly through the stethescope
|
|
|
In what conditions might you see a positive whispered pectoriloquy?
|
Early pneumonia, infarction and pulmonary atelectasis
|
|
|
The lung is not fully grown at birth. What is the development process after birth?
|
The number of alveoli increases at a rapid rate during first 2 years of life. Slows down by age 8.
|
|
|
What 5 things would give you a clue that chest pain may be originating from the lungs and not the heart?
|
Constant achiness that lasts all day, Does not radiate, Made worse by pressing on the precordium, Fleeting needle-like jab that lasts a second or two, Situated in the shoulders or between the shoulder blades in the back.
|
|
|
What symptoms can cocaine cause that might present as acute chest pain?
|
Tachycardia, hypertension, coronary arterial spasm, pneumothorax. Be sure to ask about drug use.
|
|
|
What 6 things can cause increased rate and depth of breathing?
|
Metabolic acidosis, CNS lesions (pons), Anxiety, Aspirin poisoning, O2 needed, Pain
|
|
|
What 5 things can cause decreased rate and depth of breathing?
|
Metabolic alkalosis, CNS lesions (cerebrum), Myasthenia gravis, Narcotic OD, Obesity (extreme)
|
|
|
What could be a clue to a mediastinal mass?
|
Harsh sound of stridor with more difficulty breathing. Pt my instinctively sit up and lean forward in attempt to relieve compression of the trachea.
|
|
|
What should you do differently in auscultation of the lungs in a patient with CHF?
|
Start at the base of the lungs to detect crackles that may disappear w/ continued exaggerated respiration
|
|
|
What should you consider a possibility in a patient, especially a child, that presents with wheezing for the first time?
|
Foreign body
|
|
|
What could unexplained but persistent tachycardia be a clue to?
|
Minimal pneumothorax. May not be otherwise detected on physical exam.
|
|
|
What is the function of the trigeminal nerve (CN5)?
|
carry SENSORY fibers from face, oral cavity and teeth and carries efferent MOTOR fibers to the muscles of mastication
|
|
|
What are the functions of the facial nerve (CN7)?
|
Expression.
parasympathetic: lacrima, submandibular, sublingual. Taste anterior 2/3, hard and soft palates. Sensation of concha, auricle, behind ear |
|
|
What muscles divides the neck into zones/ triangles? And what is it innervated by?
|
SCMs.
CN VI. Spinal accessory |
|
|
What 9 things are contained within the anterior (medial) triangle which is within the boundaries of the medial border of the SCM and the mandible?
|
Thyroid gland, larynx, pharynx, anterior cervical lymph nodes, submandibular salivary gland, fat, hyoid bone, cricoid cartilage, trachea
|
|
|
How many lymph nodes are in the neck?
|
Over 75 lymph nodes on each side of the neck
|
|
|
What are the 11 lymph nodes of the neck?
|
Occipital, posterior auricular (mastoid), posterior cervical, posterior superficial cervical, anterior deep and superficial cervical, sublingual, submandibular, submental, retropharyngeal, preauricular, supraclavicular
|
|
|
What is the most common symptom of a neck mass?
|
Lump or swelling in the neck
|
|
|
What is a branchial cleft cyst?
|
Benign lateral neck mass; painless.
Most = remnant of 2nd branchial cleft - buildup of cellular debris. Tx = complete excision. |
|
|
What is the rule of thumb regarding a midline vs lateral mass on the neck?
|
Midline = usually benign or congenital.
Lateral = often neoplastic and may be metastatic from another site |
|
|
What is a thyroglossal duct cyst?
|
Painless, mobile structure that moves on swallowing or w/ movement of tongue. May arise anywhere along route of thyroid gland's descent from foramen cecum of tongue to adult location on neck.
|
|
|
What are the clinical correlations of neck stiffness?
|
Spasm of cervical muscles that could lead to tension headaches.
Infectious: bacterial and viral (eg. meningitis). Referred pain from chest (MI, angina) |
|
|
How should your patient be positioned for examining the head and neck?
|
Seated, facing examiner
|
|
|
What 4 things could cause a tracheal deviation toward the affected side?
|
Volume loss, fibrosis, atelectasis, simple pneumothorax
|
|
|
What 3 things could cause a tracheal deviation away from the affected side?
|
Thyroid enlargement, pleural effusions, tension pneumothorax
|
|
|
What is a tracheal tug?
|
Evaluation of the upward motion of the trachea. If the trachea is FIXED in mediastinum could indicate neoplasm or TB. If there is a downward tugging could indicate aneurysm of the aortic arch.
|
|
|
What is a palpable supraclavicular node called and what is it usually indicative of?
|
Sentinel node. Highly suspicious for metastatic GI or breast malignancy.
|
|
|
Is the thyroid normally felt in a normal state? What should you do if it is enlarged?
|
Rarely felt normally. If enlarged, auscultate with bell for bruits (think toxic goiter)
|
|
|
What are the functions of the tongue?
|
Main organ of taste, aids in speech, mastication
|
|
|
What CN supplies motor function to the tongue?
|
12. Hypoglossal
|
|
|
What are the 3 types of papillae of the tongue?
|
Circumvallate - largest, filiform - most common, fungiform - tip and sides
|
|
|
What nerve provides taste to the anterior 2/3 of the tongue?
|
Chorda tympani nerve - division of the facial nerve (VII)
|
|
|
What nerve provides taste to the posterior 1/3 of the tongue?
|
Glossopharyngeal (CN IX)
|
|
|
What are the 4 taste sensations and locations?
|
Sweet: tip of tongue.
Salty: Lateral margin. Sourness: posterior aspect. Bitterness: posterior aspect. |
|
|
What is the most highly calcified tissue in the body?
|
Enamel - covers the tooth
|
|
|
What is in the pulp of teeth?
|
Branches of trigeminal (CN V), blood vessels
|
|
|
What is the cementum of teeth?
|
Covers root of tooth and attaches to bone
|
|
|
What are the functions of the pharynx?
|
Swallowing, speech, airway
|
|
|
What is Waldeyer's ring?
|
Ring that is formed by the lymphatic tissue of the pharynx. Consists of palatine tonsils, Adenoids, Lingual tonsils
|
|
|
What is the nerve supply to the larynx?
|
Superior and recurrent laryngeal branches of vagus (CN X)
|
|
|
What are the most important symptoms of disease of the oral cavity? (7)
|
Pain, Ulceration, Bleeding, Mass, Mouth lesions, Halitosis, Dental problems
|
|
|
What pain in the oral cavity might be referred pain?
|
Teeth pain may be from chest pain/ angina
|
|
|
What is NOT the most common cause of oral cavity ulceration?
|
Cancer. BUT, it must always be considered.
|
|
|
What are the 5 most common symptoms associated with the pharynx?
|
Nasal obstruction, pain, dysphagia, deafness, snoring
|
|
|
What are the most important problems associated with heavy snoring?
|
Obstructive sleep apnea, overweight, hx of excessive daytime sleepiness
|
|
|
What is the most common symptom of laryngeal disease?
|
Change in voice
|
|
|
What is dysphonia?
|
Hoarseness
|
|
|
How many teeth are in normal adult full dentition?
|
32
|
|
|
What is the most common, single, acute oral ulcer?
|
Traumatic ulcer
|
|
|
What is the second most common acute oral ulcer?
|
Aphthous ulcer (canker sore)
|
|
|
What three things can cause candidiasis in the mouth?
|
AIDS, abx use, common in babies
|
|
|
What is the importance of palpating the lateral margins of the tongue?
|
85% of all lingual cancers arise in lateral margins of tongue. Check for induration (hardness) and white lesions.
|
|
|
What do you inspect for on the floor of the mouth?
|
Edema, varicosities, frenulum, sublingual ridge, openings of Wharton's ducts
|
|
|
What is a common finding on the roof of the mouth?
|
Torus palatinus (exostosis) - benign bony growth in midline of hard palate. Painless and asymptomatic.
|
|
|
In inspection of the posterior pharyngeal wall, when you have a patient say "ahhh" what are you inspecting for?
|
Soft palate elevation.
Look for discharge, mass, ulceration or injection |
|
|
How is the larynx visualized?
|
Using a warm laryngeal mirror. Usually done by specialists.
|
|
|
What is a chancre in the oral cavity?
|
Painful sore on lips or tongues. Lasts 2 wks to 3 mos. Indurated borders, lesion w/out central necrotic material. Tender lymphadenitis may be present.
|
|
|
What is the course of erythema multiforme?
|
Sudden onset of multiple burning ulcers in mouth or lips. Can be caused by drug reaction, viruses, endocrine change, malignancy. Hemorrhagic areas of ulceration w/ erythematous bases, often w/ pseudomembrane.
|
|
|
What is acute necrotizing ulcerative gingivitis (ANUG)?
|
AKA Vincent's disease/Trench mouth. Common in young ppl under stress w/ poor hygiene/ nutrition. Painful ulceration. "punched out" interdental papillae. Pseudomembranous tissue, fetid halitosis. Tx: debridement and metronidzole.
|
|
|
What happens in mumps?
|
Painful enlargement of salivary glands, mostly parotid. Complications: orchitis, meningoencephalitis, pancreatitis.
|
|
|
What is sialadenitis?
|
Bacterial infection of a salivary gland. Usually due to obstruction by stone or gland hyposecretion. Swelling, pain, redness, tenderness. Tx: abx
|
|
|
What is a mucocele?
|
Intermittent, painless swelling of lower lip or inside of cheek, slightly bluish, occasionally ruptures. Due to trauma or inflammation,. Dome shaped 1-2 cm. Freely mobile cystic lesion.
|
|
|
What are Fordyce's spots?
|
Asymptomatic. Clusters of small, yellowish, raised lesions - buccal mucosa opposite molar teeth. Common in older ppl. Normal. Represent hyperplastic sebaceous glands.
|
|
|
What is burning mouth syndrome?
|
Glossodynia. Idiopathic. Most common in middle-aged and older women. NO lesions. Just pain. Can sometimes be assoc w/ iron or folate deficiency, glossitis, xerostomia from meds or diabetes.
|
|
|
What is Ludwig's Angina?
|
Submandibular space infection. Acute cellulitis of soft tissues below mouth. Pain, dysphagia, airway obstruction. Tx: airway management, surgical drainiage, IV abx
|
|
|
What is leukoplakia?
|
Painless white area on inside of cheek, tongue, lower lip or floor of mouth. Usually men >40, linked to smoking, AIDS, alcoholism, chewing tobacco.
|
|
|
What are 6 types of meds that reduce salivary flow?
|
Steroids, antihistamines, diuretics, anti-hypertensives, anti-cholinergics, anti-depressants
|
|
|
What are the bones located in the ear? Which part of the ear are they located in?
|
Ossicles (malleus, incus, stapes) are located in the middle ear
|
|
|
What is the function of the ossicles?
|
Transmit sound from TM to oval window of inner ear
|
|
|
What is the reflex you look for in the TM?
|
Light reflex of pars tensa
|
|
|
What is the function of the eustachian tube?
|
Equalize middle ear pressure w/ atmospheric pressure when swallowing, yawning or sneezing.
|
|
|
What is the function of the cochlea and what is the function of the semicircular canals?
|
Concha: transmits sound to CN VIII.
Semicircular canals: Contain end organs for vestibular function. |
|
|
What lobe of the brain interprets sound?
|
Temporal
|
|
|
What is another way that sound can be heard beside through air conduction?
|
Can be transmitted by bone directly to the inner ear
|
|
|
When does fetal inner ear development occur?
|
First trimester
|
|
|
How many olfactory receptor cells are there?
|
>100 million
|
|
|
By what year do the frontal sinuses develop?
|
7-8 years old
|
|
|
How might an estrogen increase during pregnancy effect the ear and nose?
|
Nasal stuffiness, decreased sense of smell, epistaxis, sense of fullness in ears and impaired hearing
|
|
|
What type of hearing usually goes first in older adults?
|
Sensorineural goes first from high freq to low freq tones
|
|
|
What are three things that could cause a conductive hearing loss in older adults?
|
Cerumen obstruction, TM becomes sclerotic, excess deposition of bone cells along ossicle chain
|
|
|
What are the visual clues to possible acute otitis media?
|
Inflammation of mid ear w/ erythamatous TM bulge and purulent effusions.
|
|
|
What often preceeds acute otitis media? What are 4 common organisms that cause it?
|
Often preceeded by URI: RSV, influenza.
S. pneumo, H. influenzae, M. cat, Strep pyo |
|
|
What is the most common affliction necessitating treatment in children < 5yo?
|
Acute otitis media
|
|
|
What are some behaviors in children that could indicate hearing loss?
|
No reaction to loud or strange noises, no babbling after 6 mos age, no communicative speech and reliance on gestures after 15 mos of age. Inattention to kids of same age
|
|
|
What can a ticking watch test - test for?
|
High frequency hearing
|
|
|
What are conductive hearing losses and sensorineural hearing losses?
|
Conductive: sound transmission impaired through external or mid ear.
Sensorineural: defect in inner ear that causes distortion of sound and misinterpretation of speech. |
|
|
What is the weber test?
|
Lateralization test.
Sound would be best hear in occluded ear. |
|
|
What is the Rinne test?
|
AC vs BC. Air conduction should be twice as long as bone conduction
|
|
|
What is the schwaback test?
|
Tuning fork on patients and examiners mastoid bone back and forth
|
|
|
How should a normal auricle look?
|
Should have same color as facial skin, w/out moles, cysts of lesions, nodules, etc.
|
|
|
What are normal variations of the auricle?
|
Darwin tubercle and preauricular pits
|
|
|
What may be indicated by low-set or unusual angle of the auricle?
|
Chromosomal aberrations or renal disorders
|
|
|
What is pain on Pinna Pull indicative of?
|
Should cause no pain. If present, indicates inflammation of external canal.
|
|
|
How would you position the ear to examine the ear in a baby?
|
Pull auricle down to straigten upward curvature of canal
|
|
|
What should you see on exam of the ear in a neonate?
|
Limited mobility, dullness and opacity of pink or red TM
|
|
|
What should you be aware of in examining the ear of a child that is crying or recently cried vigorously?
|
Dilation of blood vessels in TM can cause redness
|
|
|
What is a good way to differentiate a red TM in a child due to crying vs disease?
|
Pneumatic otoscopy. In a crying child: TM still mobile. In diseased TM: immobile
|
|
|
What provides a quantified measure of TM mobility w/ varied air pressure?
|
Tympanometry
|
|
|
What should you look for in older adults with hearing aids?
|
Inspect auditory canal for areas of irritation from ear mold.
|
|
|
What is otitis externa?
|
Swimmer's ear. Infection of external ear canal from bacterial or fungal growth. Can be gram negs, anaerobic or fungal.
|
|
|
What is bacterial otitis media?
|
Often assoc w/ URI. Most common infection of childhood. TM retracted and pink to bulging and very red. Watch for perforation.
|
|
|
What is secretory otitis med
|
Serous fluid in mid ear from obstructed or dysfunctional eustachian tube. TM retracted and decreased mobility. May see air bubbles or air fluid level. Caused by allergies, OM, enlarged lymph tissue in nasopharynx. Tx decongestants
|
|
|
What is a cholesteatoma?
|
Slowly expanding and eroding cyst lied w/ stratified squamous keratinizing epi that invades mid ear. Congenital or from chronic infection. Sx: prog hearing loss, fullness, tinnitus, mild vertigo
|
|
|
What is otosclerosis?
|
Hereditary. > in women late teens to 30. Irregular ossification w/ fixation of stapes.
Tinnitus and conductive hearing loss. |
|
|
What is Meniere's disease?
|
Affects vestibular labyrinth --> profound sensorineural hearing loss over time.
|
|
|
What is presbycusis?
|
Bilat sensorineural hearing loss caused by degenerative changes in inner ear or auditory nerve. Direction of sound can be confusing. Common in older adults.
|
|
|
What is exostosis?
|
Discrete, hard, round or oval outcroppings. May be pedunculated. Seen in ear canal, usually multiple and bilat. Most common in swimmers.
|
|
|
What are the 5 functions of the nose?
|
ID of odors, passage for air, humidification/ filtration/ warmth, resonance of laryngeal sound, cleansing air
|
|
|
What is the columella of the nose?
|
The strip of skin running from the tip of the nose to the upper lip, which separates the nostrils.
|
|
|
What is Kiesselbach plexus?
|
Union of small fragile arteries and veins located superficially on anterior superior portion of septum. **Most common site of anterior nose bleeds.
|
|
|
What is the function of the turbinates?
|
Increases surface area of nose to warm, humidify and filter inspired air
|
|
|
Which two sinuses are accessible for examination?
|
Maxillary and frontal
|
|
|
Do newborns breathe through their mouth or nose?
|
They are obligate nose breathers
|
|
|
What are some of the chronic signs of cocaine use through the nose?
|
Scabs on nasal mucosa, decreased taste/ smell, perforation of septum (ischemic necrosis of septal cartilage from chronic irritation)
|
|
|
What is the correlation between nasal polyps and asthma?
|
70% of pts w/ polyps have asthma
|
|
|
What is Samter's syndrome?
|
Aspirin sensitivity, asthma, nasal polyps
|
|
|
What are meibomian glands?
|
Secrete oily lubricating substance over eye to retard evaporation
|
|
|
What is the general term for the primary muscle that moves an eye in a given direction?
|
Agonist
|
|
|
What is the general term for a muscle that moves the eye in the same direction as the agonist?
|
Syngergist
|
|
|
What is the general term for a muscle that moves the eye in the opposite direction of the agonist?
|
Antagonist
|
|
|
What is the action of the medial rectus? What nerve?
|
Adduction. CN III
|
|
|
What is the action of the lateral rectus? What nerve?
|
Abduction CN VI
|
|
|
What is the action of the inferior rectus? What nerve?
|
Depression, extorsion, adduction. CN III
|
|
|
What is the action of the superior rectus? What nerve?
|
Elevation, Intorsion, Adduction. CN III
|
|
|
What is the action of the superior oblique? What nerve?
|
Intorsion, depression, abduction. CN IV
|
|
|
What is the action of the inferior oblique? What nerve?
|
Extorsion, elevation, abduction. CN III
|
|
|
Why do all babies have blue eyes at birth?
|
There is little pigment in iris. By 6 months, pigmentation is complete.
|
|
|
What is the innermost layer of the eye?
|
Retina - Includes optic disc, retinal vessels and macula.
|
|
|
What is the macula?
|
Fovea. Area composed only of cones.
Rest of the retina are mostly rods. |
|
|
What do cones do?
|
Provide detailed vision and color perception.
|
|
|
What do rods do?
|
Responsible for motion detection and night vision.
|
|
|
What 2 things should you think of if vision loss occurs suddenly?
|
Retinal vascular occlusion, retinal detachment
|
|
|
What should you think of if loss of vision is accompanied by eye pain?
|
Sudden acute narrow angle glaucoma (ANAG), grad-chronic simple glaucoma
|
|
|
What are 6 general things that could cause loss of vision?
|
CNS disease, optic neuritis, detached retina, retinal hemorrhage, central retinal vascular occlusion
|
|
|
What are 10 things that should be in a differential for eye pain?
|
Foreign body, corneal abrasion, uncorrected refractive error, conjunctivitis, acute iritis, sinusitis, eyelid inflammation, iritis, migraine, Sjogrens
|
|
|
What is Sjogrens?
|
Syndrome of unk etiology in middle aged females. Consists of keratoconjunctivitis, xerostomia, connective tissue diesease (RA< SLE, scleroderma, polymyositis)
|
|
|
What should you think of if a patient has redness and pain in the eye?
|
ANAG (acute narrow angle glaucoma)
|
|
|
What should be in your differential for eyelid disorders?
|
Blepharitis, hordeolum, chalazion
|
|
|
What should be in your differential for conjunctivitis?
|
Allergic, viral, bacteral, chemical
|
|
|
What is keratoconjunctivitis sicca?
|
Dry eyes
|
|
|
What is dacryocystitis?
|
Infected or blocked nasolacrimal duct. Pain, tenderness, swelling and redness in tear sac
|
|
|
What is episcleritis?
|
Inflammation of blood vessels and connective tissues. Rapid onset. Localized, unilateral redness, discomfort, no discharge.
|
|
|
What is uveitis/ Iridocyclitis?
|
Inflammation of the iris, choroids, ciliary body. Onset is sudden w/ ocular pain, redness, blurred vision, watery discharge.
|
|
|
What is scleritis?
|
Painful and may be sever. Ocular tenderness, tearing and photophobia. Bluish red appearance. Assoc w/ connective tissue disease like RA.
|
|
|
What is keratitis?
|
Inflammation of cornea. Asymptomatic then pain, photophobia, redness, tearing.
|
|
|
What are the sx of acute angle closure glaucoma?
|
Red, blurred vision, pain, HA, N/V, increased intraocular pressure
|
|
|
What do OD, OS, and OU mean in regards to vision acuity?
|
OD = oculus dexter = right eye.
OS = oculus sinister = left eye. OU = oculus uterque = both eyes. |
|
|
What is the area of depressed vision in confrontation testing called?
|
Scotoma - blind spot.
|
|
|
In confrontation testing, what angle should normal central vision extend to?
|
30 degrees in all directions of central fixation
|
|
|
Where is the physiologic scotoma (blind spot)?
|
Approx 15-20 degrees temporal to central fixation and corresponds to the optic disc.
|
|
|
What is bitemporal hemianopsia? And what usually causes it?
|
Lesion of the optic nerve at optic chiasm. Usually pituitary tumors.
|
|
|
What is homonymoous hemianopsia?
|
Damage to optic tract, optic radiation or occipital cortex. Most common form of field loss, especially with strokes.
|
|
|
What is quadrantanopsia?
|
Field loss in one quadrant.
|
|
|
Is tunnel vision physically possible?
|
No. Usually due to hysteria.
|
|
|
What does positive Optokinetic Nystagmus (OKN) indicate on a pt you are testing for blindness?
|
They are faking blindness.
|
|
|
What is the hirschberg test (corneal light reflex)?
|
Used to test balance of extraocular muscles. Shine penlight on eyes from a distance. Light reflex should be in the center of each cornea.
|
|
|
What is strabismus?
|
Eyes don't line up in the same direction
|
|
|
What is esotropia?
|
Cross eyed - deviation nasally
|
|
|
What is exotropia?
|
Deviation of the eye temporally
|
|
|
What is hypertropia?
|
Deviation upward
|
|
|
What is hypotropia?
|
Deviation downward
|
|
|
What is amblyopia?
|
Reduced vision in a normal eye caused by disuse. Ex in lazy eye.
|
|
|
What is the cover-uncover test?
|
Used to determine if the eyes are straight or deviated. Have patient look at distant target. Cover one eye and see if other eye moves to fixate at the object (it would if it was not straight)
|
|
|
What is Marcus Gunn Pupil?
|
Optic nerve disease. Detected by swinging flashlight test. See paradoxical dilation of pupil when light is shone.
|
|
|
What is Argyll Robertson Pupil?
|
Small, irregular and bilateral. Do not react to light but do react to near vision.
Think CNS syphilis |
|
|
What is Tonic "Adie's" Pupil?
|
Large, regular, usually unilateral. Light reaction decreased or absent. Near reaction present but slow and delayed. DTRs decreased. Female 25-45. Idiopathic. Not serious.
|
|
|
What is Horner's Syndrome?
|
One pupil small, regular and normal reaction to light and near vision. Ptosis of eyelid, loss of sweating on forehead on involved side. Due to interruption of sympathetic nerve supply, usually in neck.
|
|
|
What is chalazion?
|
Chronic granulomatous inflammation of meibomian gland. Localized, generally painless, swelling of eyelid. Points inside lid rather than on lid margin.
|
|
|
What is another term for stye?
|
Hordeolum
|
|
|
What could cause ptosis due to muscular weakness?
|
Myasthenia gravis
|
|
|
What could cause ptosis due to damage to oculomotor nerve?
|
Bells Palsy
|
|
|
What could cause ptosis due to interference w/ sympathetic nerves?
|
Horner's syndrome
|
|
|
What is entropion and ectropion?
|
Entropion: eyelashes turned in
Ectropion: lid rolls out |
|
|
What is chemosis in the eye?
|
Fluid in the space between conjunctiva and episclera. Fluid = blood or serum. Caused by trauma, allergies, neuro deficits
|
|
|
What is pinguecula?
|
Normal, whitish-yellow slightly raised triangular plaque in bulbar conjunctiva on either side of limbus. Does not cross on to cornea. Harmless.
|
|
|
What is a Pterygium?
|
Abnormal vascular growth of bulbar conjunctiva that begins at medial canthus and extends over cornea from limbus. Triangle shaped.
|
|
|
What is arcus senilis?
|
Whitish ring around perimeter of cornea. Usually older age.
|
|
|
What is Kayser-Fleischer Ring?
|
Greenish-yellow ring near limbus. Think Wilson's disease. Ring is due to deposition of copper in the cornea.
|
|
|
What is anisocoria?
|
Pupils not equal in size. 5% ppl have this normally. But could be indication of neurologic disease or could be caused by meds.
|
|
|
What is mydriasis?
|
Pupillary enlargement/ dilation. Assoc w/ sympathomimetic agents, glaucoma, dilating drops.
|
|
|
What is miosis?
|
Pupillary constriction. Assoc w/ parasympathomimetic drugs, inflammation of iris, drug tx for glaucoma
|
|
|
What would suggest obstructed nasolacrimal duct?
|
Regurgitation of mucopurulent fluid from puncta upon palpation of lower lid close to medial canthus.
|
|
|
What is the small aperature on the ophthalmoscope used for?
|
To view fundus w/ undilated pupil
|
|
|
What is the large aperature on the ophthalmoscope used for?
|
To view fundus w/ dilated pupil
|
|
|
What is the fixation aperature on the ophthalmosocope used for?
|
Observation of eccentric fixation w/out maskin macula. Graduated cross hairs can be used to estimate amt of eccentric fixation
|
|
|
What is the slit or streak on the ophthalmoscope used for?
|
Determining various levels of lesions, espeically tumors and edematous discs
|
|
|
What is the cobalt filter on the ophthalmoscope used for?
|
Used to see fluorescence from fluoroscein. For visualization of small corneal lesions.
|
|
|
What is the red-free filter on the opthalmoscope used for?
|
Visualization of blood vessels and hemorrhages. Can distinguish veins from arteries (veins blue, arteries blacker).
|
|
|
What is cross linear polarizing filter on the ophthalmoscope used for?
|
Can be used over all aperatures to eliminate glare from cornea.
|
|
|
What is the normal cup-to-disc ratio of optic disc?
|
0.1-0.5
|
|
|
What is copper wiring in regards to fundoscopy?
|
Hypertension - light reflex has orange metallic appearance
|
|
|
What is arteriovenous nicking?
|
Vein appears to stop abruptly on either side of arteriole
|
|
|
What could a red area of the retina indicate?
|
Hemorrhages
|
|
|
What could a black area of the retina indicate?
|
Retinitis pigmentosa
|
|
|
What could a grey area of the retina indicate?
|
Benign nevi
|
|
|
What could a white area of the retina indicate?
|
Assoc w/ htn, dm
|
|
|
What are considered appendages of the skin? And what layer are they located in?
|
Hair, nails and sebaceous and sweat glands
Sebaceous and sweat glands and hair follicles located in hypodermis/ subcutaneous tissues |
|
|
What is the normal angle between the proximal nail fold and nail plate?
|
< 180 degrees
|
|
|
Where are apocrine glands found?
|
Axilla, anogenital area, nipples, areolae, external ears and eyelids. Usually open into hair follicles.
|
|
|
What is usually responsible for adult body odor?
|
Bacterial decomposition of apocrine sweat
|
|
|
What is secreted in apocrine sweat? And what usually stimulates these sweat glands?
|
Secrete odorless proteins, carbs, ferric ions.
Stimulated by emotional stress. |
|
|
What color is melanin? And what determins it?
|
Brownish pigment. Determined genetically and increases by sunlight
|
|
|
What skin color is a result of carotene?
|
Golden yellow
|
|
|
What skin color is oxyhemoglobin?
|
Bright red pigment - predominates in arteries and capillaries.
|
|
|
What skin color is a result of deoxyhemoglobin?
|
Blue. - loss of oxygen.
**Increase in deoxyhemoglobin inn cutaneous blood vessels gives skin bluish cast |
|
|
Is peripheral bluing central or peripheral?
|
Can be either
|
|
|
Is bluing of mucous membranes central or peripheral?
|
Usually indicates central
|
|
|
What are 4 benign lesions of aging?
|
Cherry angioma, seborrheic keratoses, solar lentigos, actinic keratoses
|
|
|
What are the two common skin cancers of aging?
|
Basal cell carcinoma and squamoous cell carcinoma.
|
|
|
How is hair loss usually determined?
|
Hair loss in the temple to vertex distribution is genetically determined
|
|
|
What are 8 systemic diseases that cause pruritus?
|
Intra/extrahepatic biliary obstruction, DM, P. vera, Chronic renal failure, Lymphoma (hodgkins), hyperthyroidism, allergic reactions, histamine (and other mediators)
|
|
|
What is onychoschizia?
|
Splitting of distal nail plate into layers at free edge.
|
|
|
How should the skin be inspected?
|
Entire surface should be inspected in good light, preferably natural light or artificial light that resembles it.
|
|
|
What are 3 possible causes of central cyanosis?
|
Advanced lung disease, congenital heart disease, abnormal hgb
|
|
|
What are 3 causes of peripheral cyanosis besides anxiety or cold?
|
CHF, pulmonary edema (can also be central), venous obstruction
|
|
|
What could cause carotenemia?
|
Ingestion of beta carotene. Would effect palms, soles and face, but not sclera (vs. jaundice which would effect sclera)
|
|
|
What skin color change might you see in hemochromatosis?
|
Slate-grey pigmentation
|
|
|
What is a venous star?
|
A small red nodule formed by a dilated vein in the skin. It is caused by increased venous pressure.
|
|
|
What are two things that would decrease skin mobility?
|
Scleroderma, edema
|
|
|
What are Lindsay's nails?
|
Proximal nail bed white; distal red. Seen w/ azotemia and renal disease
|
|
|
What are Terry's nails?
|
Mostly whitish w/ distal band of reddish brown. Seen with aging and crhonic diseases.
|
|
|
What is Leukonychia?
|
Common from nail trauma; grow out eventually. Also see in chronic severe disease, liver disease and hypoalbuminemia
|
|
|
What are Splinter Hemorrhages?
|
Asymmetrical splinter-like lesions.
|
|
|
What are Mee's lines?
|
May follow acute or severe illness; grow out w/ nails. Possible arsenic poisoning.
|
|
|
What are Beu's LInes?
|
Narrow, transverse depressions (ridges) assoc w/ acute sever illness; gradually grow out. Can happen w/ chemo
|
|
|
What is koilonychia?
|
Spoon shaped - chronic iron deficiency, vitamin B-12 deficiency
|
|
|
What is tympany?
|
Loud, high, drum-like (eg. gastric air bubble)
|
|
|
What is hyperresonance?
|
Very loud, low, booming (eg. lungs/ches w/ COPD, bad asthma)
|
|
|
What is resonance?
|
Loud, low, hollow (eg. normal lungs)
|
|
|
What is dullness in percussion?
|
Soft, moderate, thud-like (eg. liver, chest/lungs, w/ pneumonia, PE)
|
|
|
What is flatness in percussion?
|
Heard over fat, muscle
|
|
|
What are 9 things you could be assessing on palpation?
|
Texture, temp, moisture, organ location/ size, swelling, vibration, pulsation, rigidity and crepitation
|
|
|
When should you perform auscultation?
|
Last in exam sequence
|
|
|
What is the equation for incidence rate?
|
Incidence rate = number of ppl developing a disease per unit of time/ total number at risk.
# of specified new events during a specified period in a specific pop. (eg. # of pediatric RSV cases in winter of 1997) |
|
|
What is the equation for prevalence?
|
# of persons w/ a disease/ total # in group.
# of caes of a disease existing in a given population at a spec period of timr or at a particular moment in time. Eg. Prevalence of hyperbilirubinemia in full term infants on day 3 post partum is 20% |
|
|
What is sensitivity?
|
Proportion who have a disease and test positive
|
|
|
What is specificity?
|
Proportion of ppl who do NOT have a disease and test negative
|
|
|
What is a sims position?
|
Start lateral recumbent; torso rolled to prone; top leg flexed. Used for exam of rectum or rectal temp.
|
|
|
How would you position the patient to listen for murmur of aortic regurgitation?
|
Have patient sit, leaning forward and exhale while listening for murmur.
|
|
|
How would you position the patient to best listen to the apex of the heart?
|
Roll onto left side
|
|
|
What position should you have the patient in for exam of the abdomen?
|
Flat and supine
|
|
|
What position should you have the patient in for rectal exam for men?
|
Lying on left side or may stand and bend over lying chest on bed
|
|
|
What is the most common nutritional disorder among american adults and children? And leading cause of preventable death in US after smoking.
|
Obesity
|
|
|
What are 8 risks associated with obesity?
|
Arthritis, DM2, Coronary artery calcification, htn, hyperlipidemia, cancer, gout, sleep apnea
|
|
|
By what percentage did the number of overweight children in the US increase in one generation?
|
50%
>30% of children overweight and 10% in US obeses |
|
|
What are medical complications of childhood obesity?
|
Sleep apnea, htn, dyslipidemia, neurocognitive defects, hepatic steatosis, DM2, ortho issues
|
|
|
In counseling patients with obesity, what percent weight loss should we aim for?
|
10-15%
|
|
|
What is a Bisferiens pulse?
|
Inreased arterial pulse w/ a dbl systolic peak. Aortic regurg. Best felt at carotid. Two main peaks.
|
|
|
What is pulsus alternans?
|
Pulse alternates in amp from beat to beat even if rhythm is reg. --> left ventricular failure
|
|
|
What is bigeminal pulse?
|
Normal beat alternating w/ a premature contraction.
|
|
|
What is paradoxical pulse?
|
Palpable decrease in pulse amp on quiet inspiration. Systolic pressure decreases by >10mm Hg during inspiration.
|
|
|
What is a Water-Hammer (corrigan) pulse?
|
Greater amp than normal pulse with rapid rise and sudden descent.
|
|
|
What should you watch to assess respirations in infants?
|
Rise and fall of abdomen
|
|
|
What is Kussmaul breathing?
|
Deep breathing due to metabolic acidosis. May be fast, normal or slow.
|
|
|
What is obstructive breathing?
|
Prolonged expiration due to narrowed airways w/ increase resistance.
Asthma, chronic bronchitis, COPD |
|
|
What should you know about electric bp kits?
|
They sense vibrations and convert them into electrical impulses --> translated into dig readout. Can also measure pulse, but should ALWAYS check pulse manually b/c electric can't sense quality, rhythm, etc
|
|
|
How might a bp cuff that is too wide effect bp?
|
Underestimate it
|
|
|
How might a cuff that is too small effect bp?
|
Artificially elevate it..
|
|
|
What vital sign is frequently omitted?
|
Temperature
|
|
|
What temp is considered fever?
|
101
|
|
|
What temp is considered hyperexia (extreme elevation in temp)?
|
>106
|
|
|
What temp is considered hypothermia?
|
<95 rectally
|
|
|
What is the most reliable form of temperature reading?
|
Rectal
*Early morning - lower, afternoon/ evening- higher. Rectal temp ave 0.4-0.5 degrees > than oral. Rapid resp rates increase discrepancy btwn oral and rectal temp |
