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107 Cards in this Set
- Front
- Back
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Bruit
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Commonly heard in children <4-5 years, or in anemic children, systolic or continuous, heard over temporal area.
Macewen's Sign - occurs with hydrocephalus from separation of cranial sutures >5years: indicated inceased intracranial pressure, aneurysm, or arteriovenous shunt |
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Deep Cervical Lymph Nodes
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deep under the sternomastoid muscle. To palpate, tip person's head toward the side being examined to relax the ipsilateral muscle, them press fingers under the muscle
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Jugulodigastric Lymph Nodes
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under the angle of the mandible
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Lymphoadenopathy
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enlargement of the lymph nodes >1cm from infection, allergy or neoplasm
Acute infection - onset <14 days, bilateral, enlarged, warm, tender, firm freely movable Chronic inflammation - tb: nodes are clumped Cancerous - hard >3cm, unilateral, nontender, matted, fixed HIV - enlarged, firm, nontender, mobile, occipital enlargement common Virchow's node: single, enlarged, non-tender, hard supraclavicular node indicates neoplasm in thorax or abdomen Hodgkin s lymphoma - painless, rubbery, discrete node that gradually appear |
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Normocephalic
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denotes a round symmetric skull that is appropriately related to body size. Assess by palpating scalp, feeling for symmetry and smoothness
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Occipital Lymph Nodes
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at the base of the skull
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Palpebral Fissures
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the openings between the eyelids. Lines the eyelids and is clear with small blood vessels. Forms a deep recess and then folds back over eye (back of eyelids).
Narrow: down syndrome |
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Preauricular Lymphnodes
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in front of the ear
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Posterior Auricular lymph nodes
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superficial to the mastoid muscle
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Posterior cervical lymph nodes
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in the posterior triangle along the edge of the trapezius muscle. Normally palpable.
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Submandibular lymph nodes
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halfway between the angle and the tip of the mandible
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Submental lymph nodes
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midline, behind the tip of the mandible
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Superficial cervical lymph nodes
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overlying the sternomastoid muscle
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Supraclavicular lymph nodes
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just above and behind the clavicle, at the sternomastoid muscle. To palpate, have person hunch shoulders and elbows forward to relax skin. The inferior belly of the omohyoid muscle crosses the posterior triangle here and should not be mistaken for node
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Tension headaches
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Occipital, frontal, temporal or with bandlike tightness, (forehead, sides, and back of head) vise-like, non-throbbing, gradual onset 30min-days, generally mild-moderate, diffuse, dull, aching pain, caused by anxiety, stress, and posture.
Triggers: stress, anxiety, depression, posture S&S: fatigue, anxiety, stress, vice like band, photophobia, phonophobia Treatment: rest, massage, NSAID |
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Vertigo
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rotational spin ning from neurologic disease (labrynthine-vestibular apparatus, vestibular nuclei in brainstem). When it is objective, the person feels like the room swims. When it is subjective, the perception is that the person spins.
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Goiter
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Chronic enlargement of thyroid. Can occur with low iodine and not caused by neoplasm
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Caput Succcedaneum
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Edematous swelling and ecchymosis of the present part of the head caused by birth trauma. Soft, may extend across suture lines, gradually resolved during first few days of life, no treatment. "Cone Head
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Cephalhematoma
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superiosteal hemorrhage results from birth trauma, is soft, fluctuant and well defined over one cranial bone because periosteum holds the bleeding in place. Appears several hours after birth and gradually increases in size, no discoloration, will reabsorb within first few week to 3months of life depending on size
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Anterior and posterior fontanels
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Soft spots allow for growth of brain during the 1st year. Posterior fontanel is closed by 1-2 months and the anterior fontanel closes between 9 month and 2 years.
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Infant and Children Heads and Lymph
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Head is larger than chest circumference at birth. Head size reaches 90% of adult size by 6 years.
Infancy trunk growth predominates and head size changes in proportion to body height. Toddler: mandible and maxilla are small and nasal bridge is low - face seems small for head Lymphoids well developed at birth, grow to adult size by 6 years, exceeds adult size before puberty then slowly atrophies. Adolescence: 1st facial hair above lip on boys, then cheeks and below lip, last on chin. Enlargement of thyroid cartilage and voice deepens. |
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Pregnant Women Heads and Lymph
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thyroid enlarges during pregnancy as a result of hyperplasia of tissue and increased vascularity
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Aging Adult Heads and Lymph
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Facial bones and orbits prominent, facial skin sags due to decreased elasticity, decreased subcutaneous fat, and decreased moisture in skin. Loss teeth results in lower face looking smaller
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Infant and Children's skull
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Skull should be measured at every visit up to 2 years, then yearly up to 6 years.
Newborn: measures 32-38cm, 2cm larger than chest circumpference Asymmetric, overlapping of cranial bones "molding", Infant: round, smooth, fused except at fontanels. Fontanels firm, concave, well defined, slight arterial pulsation in anterior fontanel Child: 2yrs old head and chest circumference the same, >2 chest grows to exceed head circumference by 5-7cm |
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Cataract
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lens opacity, resulting from clumping of proteins in lens. 46% of those ages 75-85. Most common in blacks
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Glaucoma
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increased intraocular pressure causes gradual loss of peripheral vision 7.2% of those ages 75-85 affecting more men. Most common in blacks and hispanics
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Accommodation
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Adaptation of eye for near vision. Increases curvature of lens through movement of ciliary muscles. Convergence "Flattening" and pupillary constriction
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Presbyopia
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Farsightedness. occurs in older people usually changes around 40 years - 50% of people. Caused by decrease in elasticity of lens.
Globe of eye is shorter than normal, light rays focus behind retina. |
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Corneal Light Reflex (Hirschberg Test)
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Assesses parallel alignment of eye axis by shining a light towards person's eyes. Should have bright white dot at 30cm in same spot on both eyes.
Asymmetry indicates deviation in alignment of eye muscle weakness or paralysis. If abnormal findings are present move on to cover test. |
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Macular Degeneration
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Breakdown of cells in the macula of the retina. Loss of central vision, most common cause of blindness. 28% of those 75-85, women more affected. Unable to read fine print, sew, or do fine work, difficulty distinguishing faces. Can cause great distress. Peripheral vision not affected - can manage self care. Affects whites the most
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Myopia
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Nearsightedness. Globe of eye is longer than normal and light rays focus in front of retina. Generally occurs in younger
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Strabismus
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Cross eyes, lazy eye. Healed by patching stronger eye. If undiagnosed, child may lose vision in weaker eye.
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Confrontation Test
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Gross measure of peripheral vision. Compares persons peripheral vision with your own. Has person recognize when they can begin to see the object. Normal 50 degrees upward, 90 degrees temporally, 70 degrees down and 60 degrees nasally.
Used to screen for glaucoma in older adult. Can indicate disease of retina and stroke |
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Lacrimal Apparatus
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Provides constant irrigation to conjunctiva and cornea. Excessive tearing indicates blockage of nasolacrimal duct
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Fixation
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Reflex direction of the eye toward an object attracting a person's attention. Image is fixed in center of visual field. Impaired by drugs, alcohol, fatigue and inattention
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Canthus
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corners of eyes where the eyelids meet
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Nystagmus
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fine oscillating movement seen around the iris. Normal - mild at extreme lateral gaze only
Occurs with disease of semicircular canals in ears, paratic eye muscle, multiple sclerosis or brain lesion Reflex: disappears at age 2months |
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Red Reflex
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When examining eye with opthalmoscope, the red glow filling the person's pupil "red eye", caused by reflection of light off the inner retina. Can be obscured by cataracts or other eye abnormalities
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Diplopia
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perception of two images of a single object, double vision
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Cover Test
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Detects small degrees of deviation by interrupting the fusion reflex that keeps two eyes parallel. Person stares at testers nose and one eye is covered. Muscle weakness in covered eye results in "lazy eye". If uncovered, eye should return to normal but will jump to position. Normal - steady fixed gaze, no eye movement when covered.
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Sclera
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Outer fibrous layer of eye. Accessible to exam. White covering, continues anteriorly with the smooth transparent cornea
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PERRLA
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Pupils Equal, Round, React to Light and Accomodation
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Conjunctiva
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Thin mucous membrane folded like an envelope between the eyelids and eyeball. Transparent protective covering.
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Conjunctivitis
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Infection of eye: purulent discharge caused by chemical irritant or bacterial or viral agent
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Pterygium
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triangular opaque wing of bulbar conjuntiva overgrows toward venter of cornea. Looks membranous, translucent and yellow-white. Usually invades from nasal side, may obstruct vision. Causes: chronic exposure to hot, dry, sandy climate
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Ptosis
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drooping of upper eyelid over the iris and possible covering pupil.
Causes: MS, fatigue, ocular-motor cranial nerve III damage, sympathetic nerve damage (Horner's syndrome), congenital |
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Anisocoria
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Unequal pupil size. Common in 5% of population, but more common in people suffering intracranial pressure
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Arcus Senilis
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Normal finding in aging person. Grey-white arc or circle around cornea. Lipid deposit. Has no effect on vision
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Xanthelasma
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soft, raised yellow plaques occuring on eyelids at inner canthus. Common around 5th decade of life, more so in women. Cholesterol and blood levels have no effect on them.
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Infants and children Eyes
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Birth: eye function limited, matures in first year. Peripheral vision intact, macula absent but developed by 4 months and mature by 8 months. Eye movements poorly coordinated at birth, 80% are farsided - decreased after 7-8 years. Iris has little pigment and pupils are small, lens spherical,
Infant: 3-4 mo established binocularity and fixates on image with both eyes simultaneously, lens begins to flatten Children: eyeball reaches adult size by 8 years, lens flattens From birth to elderly - lens changes from soft plastic to rigid old glass |
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Aging adult Eyes
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Lacrimal glands involute causing decreased tear production, dryness and burning. Corneal infiltration of degenerative lipids around limbus, pupil size decreases, lense becomes hard and glasslike, loss of near vision by 40yrs (50%), senile cataracts by 70, "floaters" inside, visual acuity diminishes, needs more light to read, night blindness ,
Common: cataracts, glaucoma, macular degeneration |
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Infant and Child Vision
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Visual Acuity - infant: visual reflexes, attending behavior, light perception, (blink in response to bright light), pupilary reflex
Birth - 2 weeks : refusal to reopen eyes after bright light exposure, increase object alertness, fixate on object 2-4 weeks: fixates on object 1 month: fixate and follow bright light and toy 3-4 month: fixate, follow and reach for toy 6-10 month: fixate and follow toy in all directions Children: test with allen test (performed with young children at school) 4-8 years color blindness test for boys |
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Aging Adult Vision
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Central and peripheral acuity diminishes, especially after 70. Decrease in eyebrow follicles. Sunken eyes, bulging lower lids, decrease tear production,pingueculae, arcus seilis, cloudy cornea, xanthelasma, small pupils with delayed reflex, opaque lens, narrow light reflect and atrophy of eye structures
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Atresia
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Absence or closure of the ear canal
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Cerumen
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Ear wax. Secreted by glands in the ear. Yellow waxy material that lubricates and protects the ear canal. Keeps foreign bodies from entering and reaching the TM. Migrates out of ear by movements of chewing and talking.
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Helix
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Fold of external ear
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Otitis Media
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Middle ear infection, caused by obstruction of Eustachian tube or passage of nasopharyngeal secretions in middle ear. Most common in children under 2. Indigenous children from North America, Australia, New Zealand, and Northern Europe more at risk
Predisposition: not breast fed, tobacco exposure, daycare,males, pacifiers, fall and winter, other diseases. Bottle feeding in supine position can increase risk |
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Otitis Externa
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Outer ear infection, swimmers ear. Extreme pain with movement of pinna and tragus, redness and swelling of pinna and canal, scantly purulent discharge, scaling, itching, fever, and enlarged tender lymph nodes. Hearing normal/slightly diminished. Common in hot, humid weather.
Prevention: rubbing alcohol or 2% acetic acid |
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Pinna
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External ear aka auricle, consists of movable cartilage and skin.
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Presbycusis
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Gradual nerve degeneration that occurs with aging. Occurs in 60% of those older than 65.
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Rhinne hearing test
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Tests for conductive hearing loss by placing vibrating tuning fork on mastoid then once heard moving it 1-2cm next to ear. Normal: hearing next to pinna longer than on mastoid
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Tympanic membrane
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Eardrum. Seperates the external and middle ear. Tilted towards ear canal. It is a translucent membrane (pearly gray to white) .
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Weber hearing test
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Tests for middle and senorineural (inner) ear hearing loss. Vibrating tunig fork is placed in middle of forehead then next to ear. Should have hearing in both ears with bone conduction louder than air conduction.
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Tinnitus
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Ringing in the ears, originates within the person. Louder in quiet settings, can be caused by ototoxic medications.
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Tragus
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The flap of cartilage prior to opening of ear canal
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Cone of Light
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In anteroinferior quadrant of TM, reflection of the otoscope light
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Conductive hearing loss
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Involves mechanical dysfunction of the external or middle ear. Considered partial loss.
Causes: impacted cerumen, foreign bodies, perforated TM, pus or serum in middle ear, otosclerosis (decrease mobility of ossicles) |
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Sensorineural hearing loss
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Perceptive loss caused by pathologies of the inner ear, cranial nerve VIII, or auditory areas of the cerebral cortex.
Causes: presbycusis, ototoxic drugs, nerve degeneration with aging |
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Infants and Children Ears
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inner ear begin developing at 5 weeks gestation, and is low set. Later it finds normal higher placement.
Infant and child: eustachian tubes shorter, wider and horizontal. Lumen surrounded by lymphoid tissue and grows throughout childhood. Children at risk for hearing deficit: maternal exposure to rubella during pregnancy or ototoxic drugs, premature infants, low-birth weight infants, trauma or hypoxia at birth, congenital liver or kidney disease. Meningitis, measles, mumps, otitis media, illnesses with high fevers, putting objects in earrs |
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Adult Ears
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Otosclerosis is most common between 20-40years.
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Aging Adult Ears
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Cilia become coarse and stiff. Cerumen accumulates and oxidizes, Cerumen is generally dryer. Ear infections cause scarred TM. First high frequency lost then consonants then vowels
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Ototoxic meds
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asprin, aminoglycosides, gentamicin, naproxen, vancomycin
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Caries
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Cavities - occur more often in other races and poor
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Dysphagia
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Difficulty swallowing. Occurs with pharyngitis, GERD, stroke, esophageal cancer and other neurologic diseases.
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Rhinnorhea
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Runny Nose - itching nose and eyes, lacrimation, nasal congestion, sneezing.. Turbinates are pale or violet, smooth and glistening. Depends on allergens, has family history of seasonal allergies - allergic rhinitis
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Xerostomia
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Dry mouth, increases with age and anticholinergics, antidepressants, antispasmodics, antihypertensives, antipsychotics, bronchodilators
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Nasal trubinates
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3 bony projections in the lateral walls of each nasal cavity. Superior, middle and inferior. Warm, humidify, and filter inhaled air
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Leukoplakia
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Chalky white raised patch on buccal mucosa
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Hard Palate
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Anterior part of roof of mouth made up of bone and is whitish in color
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Soft Palate
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Posterior to hard palate, arch of muscle that is pinker in color and mobile
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Uvula
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Free projection hanging from the middle of the soft palate
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Tonsils
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Grading of Tonsils: 1+ visible, 2+ halfway between tonsillar pillars and uvula, 3+ touching uvula, 4+ touching each other. 1-2 is normal for healthy people
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Epitaxsis
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Nosebleeds. Occurs with trauma, vigorous nose blowing, foreign body
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Gingivitis
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Red swollen gums that bleed easily. Exposes root. Caused by poor oral hygeine and vitamin C dificiency
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Thrush
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Yeast infection of mouth, white to yellow when rubbed off it leaves a clear or raw surface
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Buccal Cavity
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Cavity in cheek containing parotid gland
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Oropharynx
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Throat region behind mouth and nose, separated from mouth by tonsillar pillar
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Nasopharynx
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Continuous with oropharynx, is above oropharynx behind nasal cavity. Contain adenoids, eustachian tubes.
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Infant and Children Nose Mouth and Throat
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Infant: salivation starts at 3 months, does not indicate tooth eruption,
Children 20 deciduous teeth that erupt between 6-24mo, begin losing them at 6 years to 12 yrs. Develops quicker in females and blacks. Nose grows to adult size between 12-16yrs in females and 12-18yrs in males |
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Pregnant Women Nose Mouth and Throat
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Nasal stuffiness and epistaxis, gums hyperemic and soften,
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Aging Adult Nose Mouth and Throat
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Gradual loss of facial lipids makes nose more prominent. Nasal hairs lose elasticity and effectiveness, hairs protrude. Sense of smell diminishes around 60. Soft tissue of oral cavity atrophies, loss of taste buds 80% reduction of taste. Decrease salivary secretion and need for dentures. Ulcers occur easily, and malignant oral lesions. Tooth surface abraded, receding gums, teeth erode at gum line, hypersensitive teeth, tooth loss from osteoporosis can cause malconcclusion, malnutrition,
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Scrotum
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Loose protective sac that is a continuation of the abdominal wall. Contains large sebaceous follicles. Consists of thin skin lying in folds (Rugae) and underlying cremaster muscle. Best to keep testes 3 degrees C below body temp.
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Inguinal area
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Groin. Juncture of lower abdominal wall and the thigh. Potential sight for a hernia.
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Rugae
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Thin skin lying in folds on wall of scotum
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Hernia
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Loop of bowel protruding through a weak spot in the musculature.
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Epispadias
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dorsal location of meatus, broad spadelike penis. Associated with incontinence and seperation of pubic bone
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Orchitis
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Acute inflammation of testis, common with mumps, or other infectious disease
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Prepuce
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Foreskin. A skin flap that covers and protects the glans of the penis. Surgically removed by circumcision
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Epidiymitis
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Sever sudden pain in scrotum, relieved by elevation, rapid swelling and fever
Enlarged scrotum and reddened Tender, thick scrotal skin and edematous Elevated wbc and bacteria in urine Acute infection of epidiymis caused by prostatitis after prostatectomy, chlamydia, gonorrhea, or other bacterial infection. Looks like testicular torsion |
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Priapism
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Seminal vesicle
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Testicular torsion
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Sudden onset of pain in testes, often during sleep or following trauma, presented with lower abdominal pain, nausea and vomiting, no fever
Red swollen scrotum, one testes usually higher Thick swollen cord, tender Sudden twisting of spermatic cord, occurs in late childhood and early adolescence. EMERGENCY Surgery |
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Hemorrhoid
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Steatorrhea
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Melena
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Infants, Children and Adolescent Male Genitalia
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Infants: testes develop in abdomen near kidneys then migrate later in gestation
Children: slight increase in testes size prepubital Adolescents: puberty begins 9.5-13.5yrs and 1st sign is enlarged testes, then pubic hair, then penis size increases. Complete change takes 3yrs (2-5yrs) African Americans mature faster |
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Aging Adult Male Genitalia
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After 40, sperm production decreases and continues to do so into 80-90's. After 55-60 testosterone decreases resulting in physical changes later in life. Pubic hair decreases, penis size decreases, scorum hang lower, testes decrease in size. Slower less intense sexual response,
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