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290 Cards in this Set
- Front
- Back
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defn of gate keeper
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a pcp serving as the health care provider of first contact...responsible for providing or coordinating a person's overall care
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defn of PCP
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a primary care giver serving as the health care provider of first contact. Someone with whom the pt can make a direct appt without the need of a referral from another health care provider
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defn of diagnosis
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-to distinguish
-the identification of a disease or condition by scientific eval of physical signs, symptoms, and history -the art of naming a disease or condition |
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defn of risk factor
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-a danger or hazard, the probability of suffering harm
-a risk factor is not a disease characteristic -it is something about the person's heredity, environment, or lifestyle that puts them at risk |
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defn of etiology
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-the cause or origin of a disease or disorder
-factors include: susceptibility of the pt, nature of the disease agent, route of invasion by the agent |
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defn of symptoms
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refer to the pts subjective complaints; a report of pain
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defn of signs
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decribe objective observations by the clinician or findings from the examination or lab; a finding of tenderness
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3 techniques of bp measurements
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1. ausculatory method
2. oscillometric method 3. intravascular method |
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this method of measuring bp uses a stethoscope & sphygmomanometer
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auscultatory method
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this method of measuring bp uses a transducer to detect the bld flow
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oscillometric method
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how the oscillometric method of measuring bp different from the ausculatatory method?
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is uses a transducer to detect the bld flow vs a stethoscope
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this is the most accurate way of measuring bp
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intravascular method
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when determing proper cuff size, the width of the bladder should be ____ % of the upper arm circumference
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40%
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when determining proper cuff size, the length of the bladder should be ____% of upper arm circumference
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80%
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steps of the auscultatory method of measuring bp
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1. place bladder over brachial artery
2. determine how much to raise cuff pressure 3. raise pressure to determined amount & listen to korotkoff sounds |
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over which artery do we place the bell to listen for bp?
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brachial artery
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do we use the bell side or the diaphragm side to measure bp?
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bell side
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how do we determing how much to raise the cuff pressure before actually measuring the bp?
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1. rapidly inflate cuff till radial pulse disappears
2. add 30 3. deflate cuff & wait 15 secs before measuring |
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t/f it is standard procedure to measure bp twice each time we examine the pt.
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true
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what is an auscultatory gap?
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a silent interval btw the systolic and diastolic pressures
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what is the name of a silent interval heard btw the systolic and diastolic pressures?
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auscultatory gap
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under what conditions would an auscultatory gap be found in a pt?
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HTN
usually within 20-30 mmHg SBP, rarely above 230 mmHg |
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what can we do when taking a bp measurement to avoid mistaking an auscultatory gap with false systolic or diastolic readings?
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1. determine SBP by palpation then inflate an additional 30
0R 2. inflate to 230 to begin |
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caring for a syncopal pt (when taking bp)
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-should have entry baseline before pt passes out
-MUST be sure pt has stabilized -take & record readings every 5 mins till 2 reading are within 10 mmHg of each other before moving the pt or releasing the pt |
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pre-HTN classification
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systolic 120 - 139
diastolic 80 - 89 |
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HTN stage 1 classification
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systolic 140 - 159
diastolic 90 - 99 |
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HTN stage 2 classification
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systolic 160 and up
diastolic 100 and up |
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are ambulatory bp values usually higher or lower than clinical readings?
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lower
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what type of method for measuring bp is used for the evalution of white-coat HTN?
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ambulatory bp monitoring
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white coat HTN causes an increase in diastolic bp in _____ % of pts
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12-25%
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home msmnt of bp of these values are generally considered to be HTN
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> 135/85
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bp is influenced by:
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-pt lifestyle & variability
-equiptment condition -operator error |
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pt sitting w/o back support will inc or dec bp readings
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increase
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pt actively holding up are while reading bp will increase or decrease bp readings
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increase
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pt sitting in a cold room will increase or decrease bp readings
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increase
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pt talking while measuring bp will increase or decrease bp readings
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increase
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taking a bp reading within 15 mins of smoking or doing excercise will increase or decrease bp readings
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increase
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if pts arm is straight out while doing a bp reading, will the reading be artifically higher or lower
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lower
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if pts are is down at a right angle while reading bp, will the reading be artificially higher or lower
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higher
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appropriate rate of cuff deflation during bp reading
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2-3 mmHg/sec
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what will deflating the cuff too fast do to the bp readings?
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-will under estimate sbp & over estimate dbp
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expected HR
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60-100 beats/min
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appropriate way to measure HR
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count for 30 secs & multiply x2
palpate first with pads of 1st 2 fingers (not thumb) if irregular HR, count for full minute |
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bradycardia is considered...
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HR less than 60
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Tachycardia is considered
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HR over 100
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influences on HR and rhythm
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medications
conditioned athlete age |
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expected resp rate in adult
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12-20 per min
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expected resp rate in child
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at least 20 per min
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appropriate way of measuring resp rate
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record over full minute
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when observing resp rate, what four things must be evaluated?
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rate, rhythm, depth, effort
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what sort of chest mvmt is expected when measuring resp rate in a pt laying down (supine)
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more pronounced abdominal mvmt (slight thoracic)
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what sort of chest mvmt is expected when measuring resp rate in a pt sitting up
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thoracic mvmt
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under what conditions should temp be taken?
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1. signs of inflamm, cellulitis
2. presence of lymphadenopathy 3. concurrent systemic symptoms |
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if an immune disorder is known or suspected a _______________ may be the only warning sign.
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elevated temp
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four ways to measure temp
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oral (97.6 - 99.6)
rectal (98.6 - 100.6) core/tympanic (98.2 - 100.2) axillary (1 below oral) |
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ways to minimize errors when taking a temp
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wait 15 mins if pt has just taken very hot or cold liquid or food & wait 2 mins if pt has just smoked
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defn of sustained fever
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varies little from day to day
< 0.5 degrees (pneumonia) |
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defn of intermittent fever
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returns to normal btw exacerbations (malaria)
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defn of remittent fever
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fevers vary at least 0.5 degrees daily & don't return to normal (typhoid, chronic TB)
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defn of relapsing fever
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fever may last for days interspersed with equally long afebrile periods (lyme, hodgkins, typhoid, rat-bite fever)
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a low grade fever is defined as...
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oral temp of 99-100.4
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a moderate grade fever is defined as...
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oral temp 100.5 to 104
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a high grade fever is defined as...
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over 104
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a core temp above 105 is indicative of..
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hyperpyrexia, or risk of febrile seizure...
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hypothermia values
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(below normal range)
mild - 93.2 - 95 moderate 86 - 93.4 severe below 86 |
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ausculation means...
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to listen
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optimal stethoscope
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-double tubing
-length of 13-15 in -insulated tubing -good, heavy chest piece (head) -binaurals (earpieces) tipped slightly forward into ear canal |
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is the diaphragm or the bell better for low pitched & low frequency sounds (such as murmurs & bruits)
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bell
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is the flat or the corrugated diaphragm better for high pitched sounds?
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flat
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too firm of pressure on the bell while taking bp reading will increase or decrease the reading?
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decrease
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corrugated diaphragm
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increased surface area of the diaphragm amplifies heart sounds and murmurs and allow detection of low freq gallops, murmurs & bruits. good for those docs with hearing loss. good to use on pts with emphysema, obesity, or thick chest walls
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BMI over ____ is considered overweight. how many US adults are considered overweight?
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bmi > 25
50% overweight in us |
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BMI over ____ is considered obese. how many US adults are considered obese?
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bmi > 30
25% US are obese |
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how are radiographic views named?
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by the way the x-ray beam passes thru the pt
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what does attenuate mean?
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slow down - so for ex, air attenuates very little, so on an xray, air appears black. bone attenuates a lot, so on an xray, it appears white
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what are radioactive contrast agents used for in xrays?
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they attenuate a ton, so they can be used to detail and outline specific strxs
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conventional tomography
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-provides radiographic slices of a living pt
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fluoroscopy
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-allows real time radiographic visualization of moving anatomic strxs.
-useful in evaluating motions such as GI peristalsis, diaphragm in respiration, cardiac motion. |
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angiography
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-involves use of contrast agents to opacify bld vessels (via IV)
-ex. fundus angiography |
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t/f CT & MRI examine a 3-D slice of the pt to produce a 2-D image
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true
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Computed Tomography (CT)
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*uses a computer to mathematically reconstrunt a cross sectional img of the body - displays the imaged slice alone w/o the superimposition of blurred strxs seen with conventional tomography
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unit used for CT numbers
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Housenfield Unit (HU) - water is assigned a value of 0; very dense bone is about 4000.
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advantage of CT compared to MRI
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rapid scan acquisition
superior bone detail shows calcifications (MRI looks more at soft tissues) |
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advantage of MRI over CT
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-analyzes multiple tissue characteristics (vs. just one w/ CT)
-outstanding soft tissue resolution -able to provide imgs in any anatomic plane -no ionizing radiation exposure |
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limitations of MRI compared to CT
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-inability to show dense bone detail or calcifications
-long image times -limited spatial resolution -limited availability -expensive |
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Water's projection
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displays view of the maxillary sinus, orbital rim, and orbital roof
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PA Caldwell projection
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displays view of the frontal & ethmoid sinuses, superior orbital fissure, and floor of the sella turcica
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Submentovertex projection
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displays view of hte posterolateral wall of the orbit and the maxillary sinuses
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lateral projection
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displays view of the anterior clinoid processes, sella turcica, and sphenoid sinuses
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indications for x-rays (as ODs)
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-Ankylosing spondylitis
-Reiter's syndrome -Anterior & posterior uveitis -Preganglionic Horners syndrome -Sinusitis -Blowout fracture |
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Indications for an OD to order a CT
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-unilateral exophthalmos(Graves)
-unilateral disc swelling -orbital masses -Visual field defects |
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indications for an OD to order a MRI
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intracranial tumors
multiple sclerosis pts (can show white plaques in the gray matter) |
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this radiographic technique is the test of choice for imaging lesions of the posterior visual system and the brain stem
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MRI
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t/f bone appears than air in an MRI
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false
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radiographic test of choice for imaging lesions in evaluating vascular flow patterns
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MRA - magnetic resonance angiography
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what does MRI & CT stand for?
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magnetic resonance imaging
computed tomography |
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indications for an OD to order a MRA
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orbital arteriovenous malformations
cavernous sinus fistula |
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hematology
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the study of formed elements in blood
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CBC with Diff
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complete blood count with differential
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RBC count
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number of erythrocytes per cubic mm
*low (anemia) - bld loss, nutritional deficiencies, bone marrow dysfxn, kidney dz *high (polycythemia) - malignant bone marrow disorder, high altitudes, lung disease |
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polycythemia
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high rbc count
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HgB - Hemoglobin
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amount of O2 carrying protein contained in RBCs
- imp in diagnosing anemia & polycythemia -does not determine the strx of the hemoglobin |
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Hematocrit (HCT)
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% of bld that contains erythrocytes
HCT = HgB x 3 Low: anemia, sickling disorder High: polycythemia |
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Mean Corpuscular Volume (MCV)
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avg size of rbc
- MCV = Hct/RBC x 1000 -helps in determining macrocytic vs microcytic (iron defecient) anemia |
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Mean Corpuscular Hemoglobin (MCH)
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amount of Hg in the avg rbc
-MCH= Hg x 10/rbc -differentiates hyperchromic, normochromic, or hypochromic anemia |
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Mean corpuscular hemoglobin concentration (MCHC)
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similar to MCH but expressed as a %
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Red cell distribution width (RDW)
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variability of erythrocyte size across a given sample
-High RDW is the first hematological manifestation of iron deficiency anemia (microcytic) |
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this test is helpful in determining macrocytic from microcytic anema
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mean corpuscular volume (MCV)
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this test is helpful in differentiating hyperchromic, normochromic, or hypochromic anema
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mean corpuscular hemoglobin (mch)
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a high ____ is the first hematological manifestation of iron deficiency anemia
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high RDW -red cell distribution width
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platelet count
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number of platelets per cubic mm in a sample of bld plasma
-Low (thrombocytopenia) - bleeding disorders -High (thrombocytosis) - bone marrow disorders, infectioon, cancer, splenectomy, smoking, chronic bleeding |
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thrombocytopenia
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low platelet count
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thrombocytosis
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high platelet count
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mean platelet volume (MPV)
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avg size of platelets in a sample
-Low: aplastic anemia, marker for inflamm bowel disease -High: idiopathic thrombocytopenia purpura, high risk of stroke & heart attach |
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white bld cell count
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number of wbcs (leukocytes) in cubic mm
-High (leucocytosis)-infectious disease, autoimmune disease, leukemia -Low (leucopenia) - immune deficiency (AIDs), bone marrow disorders, aplastic anemia |
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leukocytosis
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high wbc count
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leukopenia
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low wbc count
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wbc differential...
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identifies and gives amounts of the five diff types of wbc present in the bld
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5 types of wbc in the bld
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1. Neutrophils
2. Lymphocytes 3. Monocytes 4. Eosinophils 5. Basophils |
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elevated neutrophils
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suggest bacterial infection
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most common type of wbc
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neutrophils (50-70%)
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elevated lymphocytes
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viral infection
severe allergic rxn leukemia |
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low # of lymphocytes
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HIV/AIDs
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normal % of lymphocytes in wbc
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20-40%
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elevated monocytes
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chronic bacterial or viral infection
malaria TB Sarcoidosis |
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normal monocyte count
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1-10%
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elevated eosinophils
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parasitic infections
atopy asthma |
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elevated basophils
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viral infections
inflamm disease (IBS) Hodgkin's lymphoma |
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ocular indications for ordering a CBC with diff
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-retinal heme
-cotton wool spots -roth's spots -arterial/venous occlusion -hyphema -orbital infection -Optic disc edema -prior to Rxing CAIs or steroids -prior to intraocular surgery |
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Prothrombin time (PT)
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time for bld to clot in a sample
-results measured in secs and compared to avg value in healthy people -clotting factors 1,2,5,7,10 -imp in pts w/ hemophilia or taking coumadin or warfarin -most labs convert PT secs into INR (international normalized ratio) (pts taking anticoags should have INR of 2-3; normal is 1-2) |
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normal INR levels
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1-2
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INR levels of pts on coags (coumadin or warfarin)
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2-3
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Partial thromboplastin time (PTT/aPTT)
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length of time it takes for clotting to occur in a test tube when chemicals are added to plasma.
- checks different clotting factors than PT |
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what clotting factors does a PT check for?
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1, 2, 5, 7, 10
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t/f PTT checks the same clotting factors as PT
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false
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SickleDex
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-for sickle cell anemia; tests for presence of HBS (hemoglobin S)
-bld placed in tube containing a reducing substance - if turns clear = negative - if turns cloudy = positive |
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Ocular Indications for SickleDex
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*Hyphema (increased risk of IOP spike if pt is positive)
*pt on Diamox (Acetazolamide)- leads to acidosis and vaso-oclusive crisis (if pt is positive) *suspect sickle cell retinopathy (iris atrophy, dull gray fundus color, retinal hemorrhage, sea-fan retinopathy, angiod streaks) |
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what test should be ordered for your pts on coumadin?
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PT - INR
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what test should be ordered for your pts on diamox?
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sickledex
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ESR stands for...
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erythrocyte sedimentation rate
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ESR (erythrocyte sed rate)
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rate at which RBCs settle out from plasma in uncoagulated bld in one hour
-measures stickiness of RBCs -highly sensitive but not specific (says there is inflamm, but not what kind) -High ESR=inflamm disease (giant cell arteritis, RA, sjogrens, Lupus) -Male=age/2 ; female = (age+10)/2 |
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normal counts of ESR
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male = age/2
female = (age + 10)/2 |
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high ESR could indicate...
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inflamm diseases
-Giant Cell Arteritis -RA -Sjogrens -Lupus |
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t/f ESR is highly sensitive and specific
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false - it's highly sensitive but not very specific
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CRP - C-Reactive Protein
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another marker for inflamm
-CRP is released in response ot injury, infection, & necrosis -Highly sensitive, but not very specific |
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when ordered together, these 2 tests are 98% specific for Giant Cell Arteritis (GCA)
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ESR & CRP
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Giant Cell Arteritis (GCA)
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-systemic inflamm vasculitis in pts over 50
-leads to systemic, neurologic, and ophthalmic complications -ESR & CRP ordered together are 98% specific for GCA |
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Ocular indications for ordering an ESR and CRP
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-AION (Arteritic Ischemic Optic Neuropathy)
-severe uveitis -nodular or posterior scleritis -severe or recurrent episcleritis |
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this disease is caused by GCA - and can lead to blindness of the non-infected eye is not treated immediately
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Arteritic Ischemic Optic Neuropathy (AION)
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Arteritic Ischemic Optic Neuropathy (AION)
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-caused by Giant Cell Arteritis
-swollen ON, sudden loss of vision in one eye -usually pt is over 60 *run ESR & CRP! |
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Fasting Plasma Glucose
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amount of glucose in bld at time of collection
-pt must not eat 8-10 hrs prior * < 100mg/dL is normal!!! *goal for diabetics is 90-120 |
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Random plasma Glucose
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glucose levels without fasting
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post-prandial plasma glucose
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after meal
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oral glucose tolerance test
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monitors glucose metabolism
*pregnant women who may have gestational diabetes |
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glycosylated Hemoglobin Test (HbA1c)
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-amount of Hg bound to glucose
-if more glu is present in bld, more will bing to Hg (which means less O2 can bing) -measures avg glu control over 120 days (3 months) -ordered for diabetics 2-4 times a year -goal is 7% |
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normal fasting plasma glucose
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under 100
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diabetic fasting plasma glu goal
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90-120
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some pts call this the "3 month test"
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HbA1c (glycosylated hemoglobin test)
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goal of HbA1c (glycosylated Hemoglobin test)
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under 7%
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ocular indications for odering glucose tests
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sudden large refractive shifts
retinal hemorrhages cotton wool spots microaneurysms exudates retinal neo premature cataracts symptomatic, at risk pts |
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Lipid profiles
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*bld sample is taken after pt has fasted for 8 hrs & hasn't drank alcohol in 24 hrs.
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Total Cholesterol
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produced by liver + lipid acquired in diet
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HDLs(high density lipoprotiens)
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-good cholesterol
-removes cholesterol by transporting it to liver -doesn't bind to artery walls |
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LDLs (low density lipoproteins)
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-bad cholesterol
-binds to arteries and forms plaques -increases risk of atherosclerosis and HTN |
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VLDLs (very low density lipoproteins)
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indicator of plaque formation, heart disease, and atherosclerosis
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Triglycerides
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-high if eating large amounts of fatty foods & carbs
-if high, the pt is predisposed to atherosclerosis, HTN, and pancreatitis |
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Ocular indications for ordering a lipid profile
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-premature xanthelasma
-premature arcus -hollenhorst plaque -retinal artery or vein occlusion -Amarosis Fugax |
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Premature Xanthelasma
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order a lipid profile
-50% xanthelasma pts have lipid disorders |
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premature corneal arcus
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*order a lipid profile
*males less than 40 with arcus have an increased risk of death from coronary artery disease or cardiovascular disease |
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Hollenhorst Plaque
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*order a lipid profile
*cholesterol embolus lodged in retinal artery |
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Retinal Artery Occlusion
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*order a lipid profile
*embolus lodges & causes ischemia which leads to vision loss. |
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Retinal Vein Occlusion
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*order a lipid profile
*related to artherosclerosis |
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Amarosis Fugax
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*indication to order a lipid profile
* transient monoc loss of vision * embolus lodges & then moves on |
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Plasma Thyroxine (T4) and Plasma Triiodothyronine (T3)
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-hormones produced by thyroid
-radioimmunoassay used to detect amount in plasma *High (hyperthyroidism) - Graves, Acute thyroiditis, Hepatitis *Low (hypothyroidism) - Hashimoto's, Cretinism, Malnutrition |
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Thyroid Stimulating hormone (TSH)
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-stimulates thyroid to release T3/T4
*TSH is high when T3/T4 is low *TSH is low when T3/T4 is high |
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Ocular indications for ordering a thyroid study
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-Graves: lid edema, lid retraction, bilateral proptosis, EOM restrictions
-Compressive Optic Neuropathy -SLK (57% of these pts have thyroid probs) |
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Aspartate Aminotransferase (AST) & Aminotransferase (ALT)
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-enzymes produced in liver & leaked into circulation when liver is damaged
-high AST & ALT suggests liver damage -can be used to monitor liver dmg. |
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what test can be ordered to monitor liver damage or hepatitis?
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AST & ALT
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Alkaline Phosphatase
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-enzyme assoc w/ biliary tract
-if elevated, indicates biliary tract dmg, inflamm, or malignancy |
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Total Bilirubin
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-a by-product of Hg breakdown by liver
-good indicator of liver fsn *high: mononucleosis & drug toxicity *low: inefficient liver, diet low in nitrogen |
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Ocular indications for liver fxn testing
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*Kayser-Fleicher Ring (depositions of copper in Descemet's, seen in 90% pts with symptomatic Wilson's disease; appears where arcus is usually found)
* Choroidal Melanoma (most common primary malignant intraocular tumor; high rate (85-90%) of metastasis to liver) |
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Kayser-Fleicher Ring
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Deposition of Cu in Descemet's where arcus is usually found
-seen in 90% pts with Wilson's Disease *order liver fxn testing |
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Choroidal Melanoma
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-most common primary malignant intraocular tumor
-high rate (85-90%) of metastasis to liver *order liver fxn testing |
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renal fxn tests
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pts fast before bld in drawn
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Blood urea nitrogen (BUN)
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-amount of nitrogen (end prdct of metabolism)
-High: high proteine intake (Atkins diet), low fluid intake, certain drugs, heart failure -Low: poor protein diet, malabsorption, liver dmg, use of anabolic steroids |
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Serum creatnine
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-waste prdct of muscle metabolism
-excellent indicator of renal fxn |
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Ocular indications for odering renal fxn testing
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*Dot & Fleck Retinopathy
-seen in 85% males w/ Alport Syn (Alport syndrome-genetic defect that leads to progressive hereditary nephritis, deafness, and renal failure) *Corneal Verticallata -corneal opacities seen in Fabry's disease (Fabry's-X-linked lysosomal storage disease that can lead to renal failure) |
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Alport Syndrome
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*indication to order renal fxn testing
-85% males with Alport have dot and fleck retinopathy -genetic defedct that leads to progressive hereditary nephritis, deafness, and renal failure |
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Fabry's Disease
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-indication to order renal fxn testing
- pts may have corneal verticallata -X-linked lysosomal storage disease that can lead to renal failure |
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Serology
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-studies that identify antigens or antibodies
-used to diagnosis & mng disease -most serology tests use bld serum, but CSF can be used |
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ELISA - enzyme-linked immunosorbant Assay
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-used for infectious disease
-HIV, Lyme, toxoplasmosis, Toxocariasis, Cat Scratch Disease |
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Western-Blot
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-DNA based test
-uses electrophoresis -used to confirm HIV -most docs order 2 ELISAs & 1 Western Blot |
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Venereal Disease Research Lab (VDRL) and Rapid Plasma Reagin (RPR)
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-used to identify antibodies that occur in ACTIVE syphilitic infections
-NOT SPECIFIC FOR SYPHILIS -False Positive occur with Tb, Malaria, Lupus, Pregnancy |
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Flurorescent Treponemal Ab Absorption (FTA-ABS) and Microhemagglutination Assay for Treponema Pallidum (MHA-TP)
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-both specific for shyphilis
-Doesn't tell if its currently active -if positive, just means pt has had a syphilitic infection at some time in their lives -most docs order RPR (to test if it's active) & an FTA-ABS |
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what should be ordered if syphilis is suspected?
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a RPR & FTA-ABS
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ANA-antinuclear Antibody test
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-autoantibodies against own tissue
-present in autoimmune diseases -95% pts w/ Lupus have +ANA |
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rf - rheumatoid factor
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-RF is an antibody that binds to IgG & forms a large immune complex
-present in autoimmune inflamm conditions (RA) -only 80% pts with RA will have a positive RF test. |
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t/f all pts with RA will test positive for RF
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false - only 80%
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Human Leukocyte Antigen (HLA-B27)
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-a protein on wbc's that has been known to be the cause of some auto-immune disorders
-95% pts with ankylosing spondylitis -70% Reiter's pts have a positive HLA-B27 |
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ACE - angiotensin converting enzyme
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sarcoidosis (50-80% pts)
autoimmune (granulomatous, retinitis, vasculitis) |
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Epidermis, Dermis, Subcutaneous
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Epidermis - outermost layer; stratified squamous
Dermis - middle layer of CT Subcutaneous tissue - inner layer; loose CT and fat |
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macule
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primary lesion
-a circumscribed flat discoloration (ex. white patch) |
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papule
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primary lesion
-an elevated, solid lesion - up to 0.5 cm |
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Plaque
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primary lesion
-an elevated, superficial, solid lesion - more than 0.5 cm |
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nodule
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primary lesion
-elevated, deeper, solid lesion -more than 0.5 cm |
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pustule
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primary lesion
-a circumscribed collection of pus |
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vesicle
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primary lesion
-a collection of fluid - up to 0.5 cm |
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bulla
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primary lesion
-a collection of fluid - more than 0.5 cm |
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wheal
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primary lesion
- a firm edematous plaque resulting from infiltration of the dermis with fluid |
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Scales
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secondary lesion
- excess dead epidermal cells, redundant keratin |
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Crust
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secondary lesion
-a collection of dried serum and cellular debris - a scab |
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erosion
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secondary lesion
a focal loss of epidermis |
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ulcer
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secondary lesion
a focal loss of epidermis and dermis |
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fissure
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secondary lesion
- a linear loss of epidermis and dermis |
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atrophy
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secondary lesion
- a depression in the skin caused by loss of epidermis or dermis |
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scar
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secondary lesion
- an abnormal formation of CT implying dermal dmg |
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excoriation
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specialized lesion
-an erosion caused by scratching, often linear |
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milia
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specialized lesion
-a small, superficial keratin cyst with no visible opening |
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telangectasia
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specialized lesion
-dilated superficial bld vessels |
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burrow
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specialized lesion
-a narrow elevated channel produced by a parasite -ex. swimmers itch |
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lichenification
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specialized lesion
- area of thickened epidermis produced by scratching -washboard appearance |
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eczema
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specialized lesion
-used for endogenous disorders -chronic |
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dermatitis
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specialized lesion
-used for exogenous disorders -acute -contact allergy & irritants |
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comedone
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specialized lesion
-a plug of sebaceous & keratinous material lodged in the opening of a hair follicle (blackheads vs whiteheads) -if comedone is open to air, it oxidizes & becomes black -if it remains beneath surface of skin, it does not oxidize and stays white |
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purpura
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specialized lesion
-a deposit of bld into the dermis (bld trapped below skin) 1. petechiae 2. ecchymoses 3. actinic purpura |
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Petechiae
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-a type of purpura
-a circumscribed deposit of bld -less than 3 mm - secondary to drugs, valsava, thrombocytopenia |
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Ecchymoses
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-a type of purpura
-deposit of bld greater than 3mm -irregular/bruising -slowly fades to brown or yellow in 2 weeks |
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Actinic Purpura
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- occurs on the hand and forearm in elderly due to vessel fragility
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white lesion on skin
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leukoderma
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pink or purple lesion on skin
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violaceous
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brown lesion on skin
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hypermelanosis
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red lesion on skin
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erythema
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erythema
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-abnormal redness of skin
-blanches with pressure -doesn't apply to conditions in which papules, nodules, or blisters are seen |
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exanthema
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-abnormal redness of skin
-disseminated red spots & patches over large areas; rashes -macular exanthema of measles |
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annular
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ring like
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umbilicated
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having a central dell
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verrucous
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rough surface, thickened, wart like
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serpiginous
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serpent like, healing in one area as extending to another
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discrete configuration
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separated lesions
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confluent configuration
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merging lesions
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grouped vs. disseminated configurations of lesions
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grouped = clustered in small area
disseminated = spread |
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skin Type 1
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always burns, never tans
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skin type 2
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always burns, slight tan
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skin type 3
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sometimes burns, gradually tans
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skin type 4
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sometimes burns, tans well
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skin type 5
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rarely burns, tans profusely
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skin type 6
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never burns, deeply pigmented
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a short term memory loss may be assoc with a lesion where...
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temporal lobe lesion
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dysphasia
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uttering meaningless words
-lesion of the left hemisphere |
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laughing or crying out loud at inappropriate times may indicated...
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bilateral cerebral dmg
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agnosia
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failure to recognize common objects.
-lesion of posterior parietal lobe (test: have pt close eyes and identify a common obj by touch or have pt copy a simple drawing) |
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loss of pain, touch, or vibration indicates a lesion located...
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in the spinal cord
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test of touch
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have pt close eyes and stroke their finger with a tissue
-fail = lesion of spinal cord |
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test of pain
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gently prick finger with a sharp object
-fail = lesion of spinal cord |
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test of vibtration
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use 128 Hz tuning fork over pts index finger nail
-fail = lesion of spinal cord |
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ataxia
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loss of muscle coordination
-indicates lesion of cerebellum |
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Finger to Nose test
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have pt touch finger to nose with eyes closed. -fail = cerebellar lesion
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Romberg Test
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have pt stand in front of doc with heels and toes together. then have pt close eyes and observe their balance.
pt losing balance indicates dysfxn in posterior columns of spinal cord |
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Pronator Drift test
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pt raise arms, palms up, while balancing with eyes closed.
-if one arm drops down, indicates hemiparesis of that side |
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Patellar tendon Reflex test
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loss of reflex indicates cerebellar dysfxn
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loss of patellar tendon reflex can also accompany what other syndrome?
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Adie's pupil (adie's syndrome)
indicated cerebellar dysfxn |
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CN 1
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Olfactory
-occlude nostril & smell |
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anosmia
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loss of smell
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Olfactory CN 1 dysfxn indicates...
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-lesion of frontal or temporal
Unilateral anosmia (loss of smell) = ipsilateral Bilateral anosmia - can't tell |
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what is meant by olfactory hallucination and what does it indicate?
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pt reports an odor that's not there.
= tumor of temporal lobe |
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CN 2
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optic nerve
-pupils, VA, color, Visual Fields |
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CN 3
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Oculomotor
EOMs, Light reflexes |
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CN 4
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Trochlear
Adduction/Abduction of EOMs SO |
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CN 5
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Trigeminal
has both sensory & motor Sensory: cornea, teeth, forehead, cheek, chin Motor: chewing muscles |
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Tests of CN 5 (Trigeminal)
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-Corneal Reflex
-Touch sides of pts Face for feeling (symmetry of sensation) -pt clench jaw & feel muscle |
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Hemiparasthesia
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while testing CN 5 (trigeminal) and touching sides of pts face looking for symmetry and pt reports sensation is not the same on both sides
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CN 6
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Abducens
Lateral Rectus EOM |
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CN 7
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Facial
Motor & Sensory -innervates muscles for facial expressions -stimulates lac gland -test for anterior 2/3 tongue -Test facial muscles & lids |
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CN 8
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Vestibular
Sensory for hearing & Balance -Tests: hearing (Weber's Test)& balance |
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CN 9
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glossopharyngeal
Sensory & Motor Pharynx & posterior 1/3 tongue Test: say "Ah" & look for deflection of uvula -deviation will be pulled toward non-infected side |
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CN 10
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Vagus
Larynx & Pharynx -look for uvula deflection (will deflect toward non-infected side) -pt may also have hoarse voice and trouble swallowing |
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CN 11
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Accessory
Muscles of Neck & Shoulders Test - check for resistance |
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CN 12
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Hypoglossal
Motor for tongue look for deflection of tongue |
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you note a deflection of your pts uvula to the left. which side is affected and what nerve is this indicating?
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affected side is Right side
CN 9 (glossopharyngeal) (if pts voice is also hoarse, then there's also a CN 10 prob) |
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CNs assoc with smell
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1
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CNs assoc with VA, visual fields, fundus
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2
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CNs assoc with pupils
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2,3
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CNs assoc with EOMs
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3,4,6
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CNs assoc with corneal reflex, facial sensation, jaw mvmt
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5
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CNs assoc with facial mvmt
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7
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CNs assoc with hearing
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8
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CNs assoc with swallowing, palate rising, and gag refles
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9, 10
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CNs assoc with voice & speech
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5,7,10,12
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CNs assoc with shoulder & neck mvmt
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11
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CNs assoc with tongue symmetry & positions
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12
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