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415 Cards in this Set
- Front
- Back
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Function of skull is to protect what?.
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cerebrum, cerebellum, brain stem, spinal cord, vision, smell, taste and hearing
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Which glands are protected by and directly affected by abnormalities of skull and neck?
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Pituitary gland, thyroid/parathyroid glands
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Trauma to temporal skull can result in what?
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tear of middle meningeal artery and EPIDURAL hemorrhage
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Basilar skull fracture can reuslt in?
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tear of meninges and leakage of spinal fluid. Meningitis and hemorrhage are risks also
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Trauma to sphenoid, fronta, facial bones, nasal structures and orbital structures affect what?
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Ability to move eyes and see, smell and taste, affect speech and swallowing
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Frontal Trauma associated with
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memory loss and confusion
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occipital trauma associated with
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visual changes and alterations in balance
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temporal trauma associated mostly with
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motor function deficits
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structural abnormalities of mandible, orbits and zygomatic nones will affect
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chewing and speech, eye movement and balance. cephalgia, otodyna, torticollis and neck deformities
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Damage or structural changes to neck and hyoid bone affect
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speech and swallowing, and respiration
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Thyroid cartilage and cricoid cartilage are protective of the vessel and glands ofthe neck and with what help to define the respiratory structures of the mid upper airway
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trachea
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trauma to which part of the skull is a medical emergency
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temporal
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The bodies of which sensory functions are in the skull
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vision - CN II
smell - CN I hearing - CN VIII taste - V, IX |
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when does the skull become smooth and symmetrical
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after 2 years of age
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name two clinically important markers in multiple congenital abnormalities
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angle of the eyes, setting of the ears
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What are the vascular structures of the head and neck that are subject to examination
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temporal arteries
carotid sinus int/ext carotid arteries vertebral basilar arteries optic arteries ext/int jugular veins subclavian arteries and veins brachiocephalic artery/veins |
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what are the salivatory glands of the head and neck
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parotid
sublingual submandibular |
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what are the 8 palpable lymphatic nodes/chains
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occipital
tonsillar ant/post auricular ant/post cervical submandibular submental jugular supraclavicular |
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what are the boundaries of the anterior triangle of the neck
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trachea, anterior margin of SCM, clavicles and mandible
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what does the anterior triangle contain
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lymphatic glands
salivary glands carotid and jugular vessels thyroid hoid bone cricoid and thyroid cartilage |
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where is the bifurcation of the carotid artery generally located
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upper margin of thyroid cartilage
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which gland may have a pyramidal lobe near the midline
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thyroid
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what is an accessory lobe
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defect in embyrological development and migration of the gland generally found in sublingual area - thyroglossal duct/cyst
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what is a brachial cyst
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remnant of embryonic develoment
related to thymus development and generally lateral and superior to thyroid when found in anterior triangle |
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what are the boundaries of the posterior triangle of the neck
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posterior margin of SCM, clavicle, anterior edge of trapezius
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what does posterior triangle contain
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posterior lymph nodes
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what is horizontal jerking
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associated with tremor or tic such as familial tremor, parkinsons.
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nodding of head can be associated with what
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aortic insufficiency if timed with heart beat or can be intentional in anxiety states
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tilting of head can be
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compensatory to defects in hearing or vision.
secondary to torticollis secondary to shortening of muscles from trauma or congenital defect |
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what is torticollis
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abnormailty of scm muscle secondary to spasm, trauma, hematoma
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if mouth is involved in defect of face what does that indicate
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defect in CN V - trigeminal instead of CN VII
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what will you see in palsy of CN VII
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lower face deformity
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what will you see in paralysis of CN VII
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paralysis of CN VII
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what are most common scalp abnormalities that are associated with trauma
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lacerations and hematomas
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what can cause bossing or thinning of outer plates of skull, this is also seen with congenital defects such as downs syndrome
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persistant intracranial pressure
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name a few clinical states that produce changes in appearance of skull
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microencephaly, craniosynostosis, hydrocephalous, persistent torticollis, rickets, bossing
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what are webbing of the neck and short neck often related to
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chromosomal abnormalities and developmental defects
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normal ranges of motion for:
flexion extension side bending rotation |
flexion - 45
extension - 55 side bending - 40 rotation - 70 |
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what is fine hair associated with?
Course thick hair? |
fine hair - hyperthyroidism
course and thick hair - hypothyroidism |
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what are hard, prominent, pustule temporal arteries associated with
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temporal arteritis and vasculities especially in ELDERLY patients
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Temporal arteritis and vasculitis produce what and what are they risk factors for
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persistent cephalgia and visual changes. risk factor for blindness and stroke
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defects of TMJ are associated with
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headaches, ear pain, painful phonation or chewing
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hyper or hypo thyroidism:
preference for cold and weight loss with good appetite |
hyper
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hyper or hypo thyroidism:
prominence of eyeballs puffiness of eyelids |
hyper
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hyper or hypo thyroidism:
double vision decreased motility |
hyper
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hyper or hypo thyroidism:
goiter |
hyper
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hyper or hypo thyroidism:
palpations peripheral edema increased bowel movements |
hyper
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hyper or hypo thyroidism:
polyuria decreased fertility muscular fatigue weakness tremulousness |
hyper
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hyper or hypo thyroidism:
nervousness irritability hair thinning increased perspiration change in skin texture and pigmentation |
hyper
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hyper or hypo thyroidism:
heavier menses decreased fertility |
hypo
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hyper or hypo thyroidism:
lethargy thickened, dry skin hair loss brittle nails leg cramps puffy eyelids and puffy cheeks |
hypo
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hyper or hypo thyroidism
speech disorders short attention span tremor |
hypo
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hyper or hypo thyroidism
weight gain with regular diet chilly while others are warm obesisty |
hypo
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hyper or hypo thyroidism
constipation fatigue enlarged tongue hypotension bradycardia |
hypo
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2 most common symptoms related to neck
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neck mass and stiffness
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capit
capitate |
pertaining to head
head-shaped |
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cepahl(o)
cephalometry |
head
measurement of head |
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cleido
cleidomastoid |
clavicle
pertaining to clavicle and mastoid process |
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cranio
craniomalacia |
skull
abnormal softening of skull |
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occipito
occipitoparietal |
back portion of skull
pertaining to occipital and parietal bones |
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odont(o)
odontorrhagia |
tooth, teeth
hemorrhage following tooth extraction |
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thyro
thyromegaly |
thyroid gland
thyromegaly |
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dysphagia
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difficulty swallowing
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dysphonia
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change in voice, customary with laryngeal disease
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ptyalism
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excessive production of saliva
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deglutition
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act of swallowing particularly food
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where do 85% of lingual cancers occur
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lateral aspect of tongue
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what drains in whartons ducts
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submandibular salivary gland
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how do you assess CN IX and X
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observe uvula when patient says "ah"
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how do you assess XII
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stick out the tongue
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**What happens with right hypoglossal nerve CNXII palsy
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when patient sticks out tongue it goes to right side of mouth
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** what happens with left hypoglossal nerve CN XII palsy
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when patient sticks out tongue it goes to left side of mouth
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** what happens with right glossopharyngeal nerve CN IX palsy
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when patient says ah uvula goes left
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**if the uvula deviates right when the patient says ah what does that indicate
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left glossopharyngeal nerve palsy CN IX
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trachea deviation to one side may indicate what
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intrathoracic or mediastinal defect such as pneumothorax, effusion, lymphoma
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isolated nodes in neck may initially be the only signs of what
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hodgkins lymphomas , actinomycosis, metastatic lesions from lung or liver, tb
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enlargement with pain of the thyroid gland is associated with what
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hashimotos thyroiditis or graves disease
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t/f the loudness of a bruit corresponds to the degree of occlusion of the vessel
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false
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how long is anterior fontanel open
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18-24 months
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when does the posterior fontanel close
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2-6 months
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what do dilated scalp veins, bulging fontanels, increased head circumference in infants indicate
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increased intracranial pressure from mass effect, or increased fluid such as hydrocephalus, hemorrhage or infection
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describe craniotabes
when is it generally seen |
snapping sensation associated with softening of outer table of skull
seen with rickets or hydrocephalus |
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what is caput succedaneum
describe it |
common birth injury associated with edema of scalp
swelling crosses suture lines since it involves soft tissues of skull and not deeper structures |
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what is cephalic hematoma
describe it |
indicates sub periosteal collection of blood, does not cross suture lines
more common in parietal area, can harden and become calcified |
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what is size of light halo in normal translumination
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<2 cm and <1 cm over occipital
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**what are 4 critical components in determining degree of intracranial injury (relating to history)
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loss of consciousness, duration of loss, associated injuries, mechanism of injury
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when do skull injuries gap
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when there is damage to underlying bone and periostium
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**what kind of bleed is associated with tearing of middle meningeal artery, common with trauma to temporal bone
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epidural - rapid deterioration
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**what kind of bleed is associated with tearing of bridgine veins found in subdural area that results in slow accumulation of blood, gradual deterioration of mentation, slow development of lateralizing signs
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subdural bleed
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**what kind of cranial bleed can cause death
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epidural
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**what is stiff neck or neck pain most commonly associated with
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trauma or muscle fatigue
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**what can siff neck or neck pain be indicative of
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inflammatory diseases, meningitis, myositis, thyroiditis, collagen vascular diseases
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**changes in face, eyes, hair, nails, skin, emotions and mentation, reflexes, weight, bowel habits, blood pressure and heart rate can all be associated with what
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thyroid abnormalities
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**lips of this color are associated with what?
pallor |
anemia
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**lips of this color are associated with what?
blueness |
cyanosis
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**lips of this color are associated with what?
cherry redness |
acidosis or CO2 exposure
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**lips of this color are associated with what?
circumoral pallor |
scarlet fever
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**lips of this color are associated with what?
telangiectasias |
osler rendu-weber and peutz jeghers
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**what kind of lip lesions are secondary to HSV 1 and II and occasionally to HSV or HIV
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herpetic lesions
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**what kind of lesions are seen in 60% of the population. they begin as maculopapular lesions that ulcerate then become white and painful, no healing and are not pre-malignant
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aphthous ulcers or chancre sores
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**describe herpetic lesions
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begin as vesicles then ulcerate and heal with crusting
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**what are the five common associations with squamous cell carcinoma of mouth
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smoking, spirits, syphilis, spikes
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**sudden onset of multiple painful ulcers on lips and in mouth is
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erythema multiforma, hsv, drug reactions, malignancies, endocrine changes
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**what is a mucocel and where is it common. what does it look like
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cystic, movile, painless lesion covered by skin. common in oral cavity. bluish in color with clear fluid
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**where do most squamous cell CA occur
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on lateral edges of tongue (85%)
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*what is wharton duct the opening to and where is it located
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opening of saliary glands, portion of sublingual glands and submandibular glands. located on floor of mouht under tongue
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what is dysphagia
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abnormal swallowing
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what is dysphonia
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hoarseness or alteration of vocal quality not loss
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leuko
leukoplakia |
white
white patch on mucous membrane |
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plakia
erthroplakia |
patch
red patch of mucous membrane often premalignant |
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**What is dubowitz clinical assessment scale
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standardized system for assessing gestational age
based on 1- neurological signs and 11 external signs |
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**what is duboqitz score associated with gestational age of 37-41 weeks
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46-60
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**what is gestational age of term infant
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37-41 weeks
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**What are the important tests utilized by duboqitz assesment scale
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square window
arm recoil leg recoil heel to ear scarf sign head lag |
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**what is square window test
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hand flexed on forearm between thumb and index finger
angle between hypothenar eminence and ventral aspect of forearm is measured |
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**what is arm recoil
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flex forearms for 5 seconds then fully extend them by pulling on hands and then release
fully positive if arms return briskly to full flexion(2) |
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**what is leg recoil
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hips and knees fully flexed for 5 seconds and then exteneded and releasedd
maximal response is full flexion (2) |
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**what is heel to ear test
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put baby's foot as near to head as will go without forcing it
observe distance between foot and head and degree of extension of knee |
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**What is scarf sign
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try to put baby hand around neck and as far posteriorly as possible around opposite shoulder
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**head lag
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pull baby into sitting position
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**What is Appropriate for gestational age
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birth weight from 10-90th percentile
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**What can small for gestational age be caused by
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gongenital anomalies, hypogluycemia, congenital infections
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**what are all preterm infants at risk for
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hyaline membrane disease, hypoglycemia, hypocalemia
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**what are large for gestational age babies at risk for
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hypoglycemia and polycythemia
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*What are the normal ranges for vital signs of newborn:
respiratory rate temp pulse |
rr - 30-50 breaths per minute, periods of apnea and periodic breathing are common. check for 1-2 minutes
pulse: 120-140 or 90-140 or > 100 |
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What are two categories used for maturity rating of new born
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dubowitz and weight
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Is red reflex good or bad
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red reflex is good
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What does absence of red reflex indicate
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view is obstructed by cataract or intraocular tumor - most commonly malignant tumor
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what is most common abdominal mass in infant
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hydronephrosis - obstructed urinary tract of kidneys
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**What is ortolani's test and how is it performed
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ortolani's test - examines each hip for joint stability
flex newborn legs at hips, hold legs, then abduct hips to almost 90 degrees. presence of palpable or audible click - dislocated hip |
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**what are the normal neurological reflexes of newborn (infantile automatisms)
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rooting response
plantar grasp palmar grasp moro's reflex perez's reflex galant's reflex placing response and stepping response |
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describe rooting response
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infant lie with hands against cheeck. touch corner of infants mouth or cheek
normal response is turning head to same side and opening of mouth to grasp finger |
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describe plantar grasp
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flex leg at hip and knee. dorsiflex infants foot with hand - normal is plantar felxion of toes over hand
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describe moro's reflex
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hold baby supine, let head drop a little bit, baby should splay upper extremities and then bring them back
one of MOST IMPORTANT motor automatisms normal - intact CNS |
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describe galant's reflex
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stroke one side of back along paravertebral line from shoulder to buttocks, normal response is lateral curvature of trunk toward stimulated side
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describe perez's reflex
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rub thumb firmly along spine toward infants head. normal response is extension of head and spine with flexion of knees
frequently infant will urinate absence - severe neurologic disease of cerebrem or cervical spinal cord |
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what is the purpose for routine use of growth charts to record height and weight
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used to determine if child is growing and developing according to groups of standards
descrepancy between length and wight by more than two percentage lines requires deviation |
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**what is languo hair
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fine, soft, immature hair
covers scalp and brow in premature infants but usually absent in term infants if tuft of hair on lumbosacral area - spina bifida |
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**what is telangtasias
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stork bites or angel kisses - frequently disappear during first few years - eyelids, nape of neck
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**what is nevus flammeus
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port wine stain - pink to purple macular lesion of variable size - present at birth and remains - comonly on face
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**What is mongolian spot
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large, slate blue, well demarcated areas of pigmentation near buttocks
little meaning usually fade present more in african americans adn asian americans |
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**what is erthema toxicum
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common rash among newborns
self limited bengin eruption of unkown cause erythematous macules, papules and pustules |
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**where is anterior fontanelle and when does it close
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junction of sagittal and coronal sutures.
closes at 18-24 months |
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**where is posterior fontanelle and when does it close
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junction of sagittal and lambdoid sutures, closes between 2-6 months
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**describe caput succedaneum
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edema of soft tissues over vertex of skull, related to birth process
CROSSES SUTURES and disappears after a few days |
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**describe cepahlohematoma
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subperiosteal hemorrhage limited to one cranial bone, usually parietal
SWELLING DOES NOT cross suture lines |
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**name routine tests used to assess visual acuity in newborn
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response to bright light - optical blink relex - newborn blinks and dorsiflexes head in response to bright light
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what is normal visual acuity in infant
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20/200
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**what are the developmental milestones utilized for determining normal patterns in infants
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gross motor, fine motor, language, personall development
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**what is the denver developmental screening test
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used to detect developmental delays in first 6 years of childs life
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**when is special emphasis placed upon in denver developmental screening test
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first 2 years
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** what are for main areas measured by denver developmental
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gross motor
fine motor language personal development |
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**what is the apgar score used to measure
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cardiopulmonary system integrity
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** what are the five signs evaluated by apgar
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color
heart rate reflex irritability muscle tone respiratory effort |
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**what does the following apgar score relate to
3-4 5-6 >8 |
3-4 severe cardiopulmonary depression, infant requires immediate resuscitative measures
5-6 mild cns depression >8 grossly normal |
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**when is apgar performed
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immediately and again at 5 minutes
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** what would apgar score be
pale, blue baby hr >100 grimace flaccid muscle tone good crying |
0
2 1 0 2 total 5 |
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**What is tanner scale used for and what is range
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used to record sexual maturity
scale I-V |
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**What do each of the Tanner stages for males indicate
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I - infant genitals
II - enlargement of testes III - enlargement of testes and lengthening of penis IV - enlargment of testes and widening of penis V - mature |
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**What do each of the Tanner stages for females indicate
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I - no breast
II - breast buds III - widening and raising of areola IV - widening of base, areola projects above base, secondary mound V - mature breast |
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What are the components of a mental status exam
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level of consiousness
speech orientation knowledge of current events judgments abstraction vocabulary emotional responses recent memory remote memory calculation ability object reconigtion praxis |
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what is the usefulness of and how do you assess the following
level of consiousness |
is pat awake, alert, oriented to person place and time,
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what is the usefulness of and how do you assess the following
speech |
have pt recite short phrases such as no ifs, ands, or buts
evaluate language articulation, rate of speech, loud or soft voice, fluency, quantity of talking |
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what is the usefulness of and how do you assess the following
organization |
is patient oriented to person, place and time. where are you today, what is todays date
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what is the usefulness of and how do you assess the following
knowledge of current events |
presidents of us
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what is the usefulness of and how do you assess the following
judgments |
checks higher cerebral function - what would you do if you found a wallet
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what is the usefulness of and how do you assess the following
abstraction |
intact higher cerebral function - what do apples and oranges have in common
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what is the usefulness of and how do you assess the following
vocabulary |
many different factors. ask in order of increasing difficulty
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what is the usefulness of and how do you assess the following
emotional response |
mood changes, spirits, patient affect
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what is the usefulness of and how do you assess the following
recent memory |
repeat three words after me, then recall them
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what is the usefulness of and how do you assess the following
remote memory |
inquire about important past life events for patient
potential abnormality in temporal lobe |
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what is the usefulness of and how do you assess the following
calculation ability |
serial sevens test
tests dominant cerebral hemisphere and intelligence and attention span |
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what is the usefulness of and how do you assess the following
object recognition - visual agnosia |
show patient objects have name them
tests for lesion in nondominant parietal lobe |
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what is the usefulness of and how do you assess the following
praxis - integration of motor activity |
have patient do sequence of functions
CNS lesion usually in frontal lobe |
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What is dysarthria
What is generally responsible for dysarthria |
difficulty in articulation
lesions of tongue and palate are responsible |
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What is a motor aphasia?
What are the other names for aphasias |
present when patients known what they want to say but hae motor impairment and cannot articulate properly. Understand written commands but cannot repeat them.
Also called Expressive, nonfluent |
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What is often the cause of motor aphasia
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frontal lobe lesion
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What is sensory aphasia
What are the other names aphasias |
patient articulates spontaneously but uses words inapproprately. difficulty understanding written and verbal commands and cannot repeat them
also called receptive, fluent ephasia |
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What is often the cause of sensory aphasia
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temporoparietal lesion
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What is dysphasia
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difficulty comprehending or speaking as result of cerebral dysfunction
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What are symptoms that relate to neurological disease
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headache
loss of consiousness dizziness ataxia changes in consiousness visual disturbances dysphagia brain failure cerebrovascular accident gait disturbance tremor numbness weakness pain |
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what is amaurosis fugax
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transient visual loss lasting up to 3 minutes
feature of internal carotid artery disease |
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what is acute painless visual loss
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caused by vascular accident or retinal detachment
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what is acute narrow angle glaucoma
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transient loss of vision with intense ocular pain
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what is painless loss of vision
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compression of optic nerve or tract or radiation
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what is glaucoma
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often cause of chronic insidious, painless loss of vision
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What is diplopia caused by
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caused by ocular motor palsies, thyroid abnormalities, myastenia gravis and brain stem lesions
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what happens with brain failure
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progressive impairment of orientation, memory judgement and cause, increasing inability to comprehend written material
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What is tactile agnosia
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inability to recognize object by palpation in absence of sensory deficit
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What leads to tactile agnosia
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lesion in nondominant parietal lobe
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What is a visual agnosia
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normal vision but fails to recognize object
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What is autopagnosia
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inability to recognize own body part
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What is apraxia
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inability to perform voluntary movement in absence of deficits in motor strength, sensation or coordination
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What is dyspraxia
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decreased ability to perform activity. understand comand but cannot integrate motor activities
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What is function of CN I
What is name of nerve How do you test |
olfactory - smell
have patient smell something |
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What is name of CN II
What is function How do you test |
Optic nerve
vision test with confrontation testing and do visual acuity testing |
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What is name of CN III
What is function How do you test |
occulomotor
eye movements, papillary constriction, accomodation test with pupillary response to light and accomodation |
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What does PERRLA mean
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pupils of equal size and reat act to light and accomodation by restricting
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What do the six cardinal eyemovements test
|
CN III, IV, VI
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What is name of CN IV
What is function How do you test |
trochlear
eye movements have pt gaze up, down, sideways. perform extraocular eye movements to check for superior oblique eye muscle movement |
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|
What is name of CN V
What is function |
trigeminal
general sensation of face, scalp, teeth, chewing |
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What is corneal reflex
Which nerve (s) tested |
patient looks up and away, bring hand in with wisp of cotton and touch cornea. normal response is closure of both lids when one eye is touch. tests V and VII
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How do you test CN V
|
touch sensation, distinguish between 2 point discrimination, temperature, clench teeth
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What is name of CN VI
What is function How do you test |
abducens
eye movements test by testing extraocular eye muscles - if lateral rectus muscle is intact |
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What is kussmaul's breathing
|
fast and deepassociated with metabolic acidosis
|
|
|
What is biot's breathing
|
irregular periods with long periods of apnea
increased intracranial pressure, drug induced respiratory, brain damage |
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What is Cheyne-Stokes breathing
|
Irregular breathing with increased or decreased rates and depths of breaths and alternating periods of apnea
|
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What is Cheyne-stokes associated with
|
drug induced resp dep, congenital heart failure, brain damage
- death rattle |
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What are the 5 fxns of the nose
|
humidify
filter warm olfaction airway |
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what drains into inferior meatus
|
nasal lacrimal duct
|
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what drains into middle meatus
|
frontal
maxillary anterior ethmoid |
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drains into superior meatus
|
posterior ethmoid
|
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conduction of sound into inner ear thru external auditory canal and middle ear
|
air conduction
|
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sound conduction thru inner ear and bones of skull
|
bone conduction
|
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2 parts of tympanic membrane
|
pars flaccida - on top, smaller
pars tensa - on bottom, bigger |
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pars tensa divided by malleus into...
|
anterior and posterior folds
|
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external ear composed of
|
external auditory canal
pinna |
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pinna made of
|
cartilage and skin
|
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external auditory canal is made of
|
outer 1/3 - cartilage - hair and ceruminous glands
inner 2/3 - bone |
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biggest turbinate and composition
|
inferior turbinate
semierectile tissue |
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major area bleeding in nose
|
little's area
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|
largest sinus, bounded by eye, cheek, nasal cavity and hard palate
|
maxillary sinus
|
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|
multiple, present in ethmoid bone...medial to orbit
|
ethmoid sinuses
|
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|
above ethmoid sinus, bounded by forehead, orbit, ant cranial fossa
|
frontal sinus
|
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behind ethmoid
|
sphenoid
|
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fxn of paranasal sinuses
|
nothing, lighten head
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major symptoms of ear
|
hearing loss
vertigo tinnitus otorrhea otalgia itching |
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specific symptoms related to nose
|
obstruction
discharge bleeding |
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normal hearing test
|
AC>BC
|
|
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anything that blocks the transmission of sound waves ext --> int
|
conductive hearing loss BC>AC
can be cerumen, foreign bodies, infection, congenital abnormalities |
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sensoneural heariong loss caused by
|
disease process in inner ear structures or auditory nerve VIII
i.e. congenital deafness - 50% deafness in kids rubella, systemic disease, noise, tumors, viral infections |
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ansomia
|
loss of smell
|
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|
otalgia
|
ear pain
may be inflammation conditions/referred from anatomic structures |
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d/c from ear
|
otorrhea
|
|
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Symptoms of sinus infection
|
fever
malaise cough nasal congestion max toothache purulent nasal d/c headache |
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season of otitis externa vs otitis media
|
ext - summer
media - winter |
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fluid behind ear drum in otitis media? ext?
|
yes
not in ext |
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pain on tragus indxicates which - ot med or ot ext
|
externa
|
|
|
otitis externa commonly seen as
|
swimmers ear via p. aeruginosa
|
|
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external ear canal in ot ext vs. media
|
ext - edematous
media - normal |
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fever in otitis ext? media?
|
yes to both
|
|
|
hearing loss in ext or media
|
ext - slight or none
media - yes |
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enlarged lymph nodes in otitis media?
|
yes
|
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|
auditory acuity testing which nerve?
|
VIII
|
|
|
rinne test
|
use 256, 512 HZ tuning fork
AC>BC = normal |
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|
weber test
normal? abnormal? |
determines if unilateral loss is conductive or sensorinueural
normal - sound is midline abnormal - sound laterizes to one ear |
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|
sensoneural hearing loss
|
AC>BC
weber lat to GOOD side rinne hear better in good ear |
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conducting hearing loss
|
BC>AC
weber - lat to bad ear rinne - BC>AC in bad ear |
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Rt ear: AC>BC
Lt ear: BC>AC weber left |
bone conduction loss in left ear
|
|
|
Rt: AC>BC
Lt AC>BC weber: lat right |
sensoneural loss left ear
|
|
|
look @ TM for
|
color
transluecency injection integrity bulge/retraction movement w insuf bulb |
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|
when palpating sinuses use...
look for |
2/3 digits
tederness, bogginess |
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|
transillumination
|
checks for fluid, mucosal thickening, mass
|
|
|
- cusis
|
hearing
|
|
|
- lalia
|
speech
|
|
|
- myrinogo
|
tympanic membrane
|
|
|
- tympano
|
middle ear
|
|
|
which turbinates can you see
|
inferior and middle
|
|
|
triad of nasal polyps
|
aspirin, allergies, asthma
|
|
|
most common sign of allergic rhinitis
|
anosmia
|
|
|
bacterial cause of sinusitis
|
strep pneumo
|
|
|
for chronic sinusitis which exam shows the extent and degree of infection
|
CT scan
|
|
|
these reflexes use small diamter, slow paths
|
superficial
|
|
|
muscle strength grading scale
|
0 - no movement
1 - slight contraction - ABSENT 2- movement w no gravity - WEAK 3 - movement with gravity - FAIR 4 - movement with some resistance - GOOD 5 full movement - NORMAL |
|
|
muscle with hypertonia
how can you test? |
UMN
ankle clonus, rigidity increased DTR - clasp knife |
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|
muscle has too little tone
|
LMN
flaccid, hypotonia |
|
|
proximal mm weakness
distal mm weakness |
proximal weakness - muscle
distal weakness - neurological |
|
|
these reflexes are illicited by short, sharp blow with a tendon hammer. carried by large myelinated sensory neurons from extended muscle
|
DTR - stretch reflex
|
|
|
dorsiflexion tests which nerve root
plantar flexion tests which nerve roots |
dorsi L4-L5
plantar S1 |
|
|
+ ankle clonus indicates what
|
UMN
|
|
|
which DTR tests C5-C6
|
biceps and brachioradialis
|
|
|
triceps tests which nerve root
|
C7-C8
|
|
|
patellar DTR tests which nerve roots
|
L3-L4
|
|
|
which DTR tests S1 nerve root
|
achilles
|
|
|
babinskis' = extensor plantar reflex
abnormal > ? years suggests damage to what tract |
abnormal > 2 years old
suggests damage to either side of corticospinal, can be temp or permanent |
|
|
5 tests to check for sensory function
|
light touch
pain/cold vibration sense proprioception tactile localization |
|
|
irregular twitching
mm atrophy mental deficiencies men 50-80 |
als
umn and lmn |
|
|
5 tests to check for cerebellar fxn
|
finger to nose
heel to knee rapid alt movements - diadokinesia assess gait rhomberg |
|
|
what disease?
bowel and bladder dysfxn nystag diplopia mm weakness paresthesia poor coordination age 30-35 sex - F |
MS
umn |
|
|
What disesae?
men 60-80 rigidity slowing of movements difficulty swallowing UE tremor jerky, cog wheel movements |
parkinson's
|
|
|
men and women 35-50
choreiform movements brain failure face grimacing dysarthia personality change |
huntingtons's
|
|
|
females
20-50 generalized muscle fatigue bilat ptosis diplopia difficulty swallowing voice weakness |
myasthenia gravis
|
|
|
+ straight let test indicates what?
|
L5 or S1, compressed nerve root
|
|
|
brudenski's sign
|
flex patients neck to sternum
pt with meningitis have neck pain and resistance to motion |
|
|
kernig's sign
|
flex pt leg at hip and knee
tests for meningitis |
|
|
myelo -
esthe- -gnosia |
spinal cord
feeling recognition |
|
|
disuse atrophy caused by ? lesion
|
umn
|
|
|
neurogenic atrophy occurs with which lesion
|
lmn
|
|
|
adventitious movements of umn lesions
|
myoclonus (face and UE), tremor, dyaskinesias, dystonia, chorea, convulsions
|
|
|
adventitious movements of lmn lesions
|
fasciculations, cramps
|
|
|
allodynia
hyperpathia analgesia |
allodynia - abnormal threshold to a usually painless stimuli
hyperpathia - abnormal threshold to perception of painful stimuli analgesia - absence, decrease in pain |
|
|
dysarthia
|
difficulty in articulation, slurred speech
- usually due to lesion of tongue or palate |
|
|
vagus nerve
|
CN X
taste, general sense of phar, lar, ear, phonation, swallowing, parasym to heart, abdominal viscera test: say ah...palate should rise evenly |
|
|
spinal accessory nerve - XI
|
phonation, head, neck, shoulder
test - shoulder shrug |
|
|
argyll robertson pupil
|
accomidates but doesnt react
|
|
|
swelling around iris that is due to edema of bulbar conjunctiva
|
chemosis
|
|
|
chronic, granulamatous inflammation of meibmonian gland
|
chalazion
|
|
|
xanthelasma
|
yellow plaques associated with hypercholesteremia
|
|
|
lost, depressed vision in one area surrounded by normal vision
|
scotoma
|
|
|
hordelum laterus
|
stye - caused by staph infection in hair follicle
|
|
|
esotropia?
exotropia? permanant or temproary |
endo - deviation of eye nasally
exo - deviation of eye temporally permanant |
|
|
what innervates and what does it do:
orbicularis oculi |
V or VII
closes eye |
|
|
what innervates and what does it do:
levator palpebrae |
III
lifts eyelid |
|
|
what innervates and what does it do:
muller's |
sympathetic
|
|
|
conjunctiva:
does it have vasculature? which part covers inner surface of lids? bulbar portion covers what? |
yes has vasculature
palpebral part covers inner surface of eye bulbar portion covers sclera-limbus |
|
|
coorresponds to Optic Nerve head, temporal to central fixation
|
blind spot
|
|
|
why do you use..
small aperture large aperture red free |
small - undilated pupil
large - dilated pupil red free - helps doc visualize blood vessels. they appear black |
|
|
what is accomadation
|
eyes converge and pupils constrict
|
|
|
what is marcus gunn pupil
|
dilation of pupil when light is shone (only one)
afferent limb defect |
|
|
what is normal cup to disc ratio
|
1:2 or 1:3
|
|
|
does the macula have Blood vessels?
|
no! CONES only
|
|
|
"copper wiring"
Av nicking flame hemorrhages are signs of... |
hypertension
|
|
|
microaneurysms
neovascularization retinitis proliferans |
diabetes
|
|
|
narrow angle glaucoma...
pupil... cornea... pain... d/c... |
pupil - mid-dilated
cornea - steamy pain - ++++ d/c none |
|
|
cover test test what
|
if eyes are straigt/ deviated
exo vs eso |
|
|
conjunctivitis
pupil.. cornea... pain... d/c.... |
pupil - normal
cornea - normal pain - none, injected d/c - ++++ |
|
|
iritis
pupil... cornea... pain.... d/c... |
pupil - small
cornea - normal pain ++++, injected around cornea d/c - none |
|
|
t/f
arteries in eye are thinner than veins |
true
|
|
|
describe
- optic disk size, shape, color - where is physiologic cup - what is AV ratio |
optic disk - 1.5 mm, ovoid, yellow-pink
physiologic cup is center of disc where ret vessels come out AV ration is 2:3 |
|
|
where is macula in relation to optic disk
does macula have retinal vessels |
macula is temporal and inferior to optic disk
macula has NO retinal vessels |
|
|
where is fovea?
what is fovea made of? |
fovea is in center of macula
fovea is made of CONES only |
|
|
symptoms related to eye problems or disease
|
loss of vision
eye pain tearing/dryness diplopia d/c redness |
|
|
movements of eye from:
medial rectus lateral rectus inferior rectus |
medial rectus - adduction
lateral rectus - abduction inferior rectus - dep, extorsion, adduction |
|
|
movements of eye from:
superior rectus superior oblique inferior oblique |
superior rectus - elevation, intorsion, add
superior oblique - intorsion, dep, abduction inferior oblique - extorsion, elevation, abduction |
|
|
which motion do both superiors do?
which motion to both obliques do |
superiors - intorsion
obliques - abduction |
|
|
gloden brown/green discoloration @descmenets membrane. seen with wilsons and other liver disorders
|
kayser-fleishcer ring
|
|
|
mydriasis?
miosis |
pupillary dilation
pupillary constriction |
|
|
shallow anterior chamber
|
narrow angle glaucoma
|
|
|
edema of optic disc
what causes it? |
papilledema - due to increase ICP, malignant HT, thrombus of central retinal vein
|
|
|
amblyopia
|
deficient vision due to suppression
|
|
|
hyperopia
what does it cause |
light entering eye is brought to focus behind eye
farsightedness |
|
|
myopia
what does it cause |
light brought to focus in front of retina
near sightedness |
|
|
hyperopia and impairment of vision due to an advancement in age
|
presbyopia
|
|
|
arcus senilis
|
grey/white opaque ring
in corneal region, usually |
|
|
light not uniformely focused in all directions due to non-spherical cornea
|
astigmatism
|
|
|
anopsia
diplopia |
anopsia - blindness
diplopia - double vision |
|
|
blepharo -
choroi - -duction |
blepharo - eyelid
choroi - choroids - duction - pupil |
|
|
cyclo -
dacnya - -duction |
cyclo - ciliary body
dacnya - tear -duction - to lead |
|
|
nyct -
-phak tars- -trop |
nyct - night
-phak - lens tars- eyelid structure -trop - turn |
|
|
dont correct amblyopia by age ? then get permanent
which eye do you cover to correct |
age 7
cover good eye |
|
|
snellen uses what scale?
jaeger? rosenbaum? |
snellen - 20/20 - view at 20 ft
jaeger - J1-16 rosenbaum - 20/20 but at 14 inches |
|
|
visual field testing tests....
amsler grid testing test.... use .... plates for color vision |
visual field - testing for lesions of visual path. confrontation tests peripheral vision
amsler grid - macular degeneration, will see wavy lines color plates - ishihara |
|
|
polyuria
common causes? |
voiding of large amounts of urine
diabetes mellitus and insipidus are common causes |
|
|
structures inspected during male genitalia exam?
|
skin, hair, penis and scrotum, testes, urethra, palp penis, external meatus, palp epidydimis and vas, transillum scrotal mass, inguinal and femoral areas, inguinal hernias
|
|
|
common symptoms of male GU disorders
|
infertility, pain, dysuria, changes in urine flow, red urine, penile d.c, penile lesions, genital rashes, scrotal enlargement, groin mass, erectile dysfunction
|
|
|
cyst(o) -
litho - orchi(o) - pyel(o) - |
cyst(o) - bladder
litho - stone orchi(o) - testes pyel(o) - pelvis of kidney |
|
|
pyuria
|
pus in urine
body's response to inflammation of UT most commonly bacteria |
|
|
dysuria
|
pain on urination
|
|
|
hematuria
|
blood in urine
|
|
|
phimosis
|
when foreskin cant be retracted and prevents adequate exam of glans
smegma builds up |
|
|
hypospadius
|
urethral meatus on ventral side
epispadius is on dorsal side but very RARE |
|
|
primary hypospadius
secondary hypospadius tertiary hypospadius |
primary - within glans
secondary - down shaft tertiary - at base |
|
|
normal findings of scrotal contents
|
- no tenderness, nodularity, firm, rubbery
- vasa are firm cords, 2-4 mm diamter, feel like partially cooked spaghetti |
|
|
transillumination of scrotum is useful how?
|
mass that transilluminates is serous fluid - hydrocele
mass that will not transilluminate coul dbe a tumor, a vascular structure, a hernia, normal |
|
|
mass that transilluminates and is partially reducible
|
hydrocele
|
|
|
mass that doesnt transilluminate and wont reduce
|
hernia or tumor
|
|
|
mass that will transilluminate and wont reduce
|
spermatosis
|
|
|
most common site of hernias. direct or indirect
|
inguinal - 90%
|
|
|
Which hernia do you feel on tip of finger?
|
indirect inguinal
|
|
|
what is cryptochism
|
inflammation of 1 or both testes
painful or swollen |
|
|
papular lesions, painful enlarged lymph nodes
|
LGV
|
|
|
torsion testicle
|
vomitting, nausea
elevated, twisted scrotum -ER common in adolescents after physical activity acute onset of pain, dysuria, testicle is horizontal |
|
|
same symptoms as torsion testicle, but not rotated
|
epididymitis
|
|
|
testicular CA most common in which age group
|
15-35
|
|
|
painless, hard chancre
|
syphilis
|
|
|
acute prostitis
|
common in young ment with STD, UTI
have fever, chills, mucus, etc |
|
|
if scrotum is smooth what does that mean
|
testi has not decended
|
|
|
prostate carcinoma
|
initially asymptomatic - rare before 50
many times not diagnosed until metastisis |
|
|
impotency
|
testoerone mediated
|
|
|
worst kind of lesion
|
nonmotile, painless, hard - CA
|
|
|
swelling of testicle, pain, non-rotated
|
epidimytis
|
|
|
varicocele
|
enlargement of spermatic cord due to dilation of pampiniform plexus
feels like bag of worms |
|
|
what lymph nodes are important to check for
|
axilla
|
|
|
symptoms of femal GU disorders
|
vaginal bleeding
dysmenorrhea masses/lesions vag d/c vag itching abd pain dyspareuria change in hair dist change in urinary pattern infertility |
|
|
amni-
colp(o) cyesis - gyn |
amni - amnion
colp(o) - vagina cyesis - pregnancy gyn - female |
|
|
hyster(o) -
metro - oopho(ro) - ov - salping(o) - |
hyster(o) - uterus
metro- uterus oopho(ro) - ovary ov - egg salping(o) - fallopian tube |
|
|
menorrhagia
|
excessive bleeding
|
|
|
uterine bleeding of normal amount with irregular noncyclic intervals
|
metorrhagia
|
|
|
increased bleeding between cycles
|
menometrorrhagia
|
|
|
menstrual cycle > 35 days that is infrequent
|
oligomenorrhea
|
|
|
absence of menses
|
amenorrhea
|
|
|
polymenorrhea
|
menstrual periods that are uncommonly frequent
|
|
|
dysaperuria
|
pain during or after sex
|
|
|
most common place for breast carcinoma
|
upper outer quadrant
|
|
|
where are bartholins glands
|
vulvar vestibule
|
|
|
what is function of bartholin glands
|
secrete watery fluid that serves as lubricant during sex
|
|
|
catamenia
|
age of onset, cycle, length
CAT - 13-28-5 |
|
|
gravidity
|
# of pregs
|
|
|
parity
|
# of deliveries
|
|
|
LMP
|
F - full term
P - preterm A- abortions L - living |
|
|
external female genitalia inspected during exam
|
mons veneris, labia, clitoris, urethral meatus, perineum, hymen
|
|
|
diff between fibradenoma and cysts
|
fibro
15-55 years, nontender cysts 30-50 yrs, tender both - single/multiple, round and well delineated, soft or firm, mobile, no skin retraction |
|
|
cancer
|
30-80 years
often single irregular, no clear dillineation firm fixed nontender retracted/dimple |
|
|
what is the adnexa
|
ovaries, tubes, supporting structures
look for tenderness/masses |
|
|
HPV DNA testing
|
used in triage management of ASC-US
coposcopy if + HPV rpt 12 mo if -HPV HPV is only found in sexually active females |
|
|
fallen bladder due to descend in ant wall
|
cystocele
|
|
|
rectum pushes post wall of vagina forward, bulging into vagina
|
rectocele
|
|
|
what is proper spec technique
|
NEVER vertical
horizontal or oblique |
|
|
pap test significance
|
can diagnose cervical CA in 98% of cases and 80% of endometrial CA
|
|
|
long axis of uterus bent on long axis of vagina
|
anteversion
|
|
|
fundus and uterus are ben t forward on cervix
|
anteflexion
|
|
|
long axis uterus bent back on long axis of vagina
|
retroversion
|
|
|
fundus and long axis of uterus bent back on long axis of vagina
|
retroflexion
|
|
|
bimanual exam examines what
|
uterus and adnexa
|
|
|
relevent med history for breast cancer
|
genetic - mom, daughter, sister
age of onset of menarche and repro cycle painless mass on sbe |
|
|
breast disease relevant symptoms
|
mass
nipple discharge pain change in skin over breast |
|
|
palpate breasts and look for
|
size, shape, symmetry, contour, color, edema
|
|
|
3 ways to palpate breasts
|
spokes of wheel
concentric circle vert strip |
|
|
sbe decreases mortality risk for women between ages
|
50-74
|
|
|
patient should be in what positions to palpate breasts
|
hands on hips
leaning forward so breasts hang arms at sides arms overhead |
|
|
dimpling
|
sign of retraction
phenomena due to underlying neoplasm and fibrotic respons |
|
|
pagets disease
|
surface manifestation of underlying invasive intradural carcinoma
|
|
|
molding
|
used to deterine if retraciton phenomena is +
|
|
|
characteristic of mass - need to palpate
|
size, position
shape delinieation consistency mobility |
|
|
highest in which countries?
male breast disease, how many men in us |
1000 men in us
n america, british isles, japan, finland |
