N362 Quiz 2 Terms (Skin, Hair, Nails, Eyes)

Front 1

Epidermis

Back 1

Thin, tough, avascular; stratum germinativum--forms new skin cells, stratum corneum--dead cells interwoven, closely packed

Front 2

Dermis

Back 2

Inner supportive layer, mostly collagen (tough fibrous protein) & also elastic tissue; nerves, sensory receptors, blood vessels, lymphatics here; appendages from epidermis (hair follicles, oil & sweat glands) here

Front 3

Subcutaneous tissue

Back 3

Stores fat for energy, provides insulation for temp. control, aids in protection by cushioning; for subcu. Injection, aim for fat, not muscle

Front 4

Terminal hair

Back 4

Darker, thicker hair that grows on scalp, eyebrows & after puberty--axillae, pubic area, face & chest of male

Front 5

Lanugo

Back 5

Fine downy hair of newborn; replaced by fine vellus hair after 1st few mos.

Front 6

Vernix caseosa

Back 6

Thick, cheesy substance made up of sebum & shed epithelial cells

Front 7

Chloasma

Back 7

Irregular brown patch of hyperpigmentation on face due to change in hormone lvls (pregnant female)

Front 8

Linea nigra

Back 8

Brownish-black line down midline of abdomen due to change in hormone lvls (pregnant female)

Front 9

Striae gravidum

Back 9

"Stretch marks"; increased fragility in connective tissue; may develop in skin of abdomen/breasts/thighs; don't go away (pregnant female)

Front 10

Senile purpura

Back 10

Dark red discolored areas produced by minor trauma (aging adult)

Front 11

Vitiligo

Back 11

Complete absence of melanin pigment in patchy areas of white/light skin on face, neck, hands, feet, body folds, around orifices; can occur in all races; treat this pt. like any other-->"I notice that you have some skin pigmentation"-->get them to talk about how they feel-->"I'm more than just my skin"

Front 12

Nevus (mole)

Back 12

Proliferation of melanocytes, tan to brown color, flat/raised; characterized by symmetry, small size (<6mm), smooth borders, single uniform pigmentation; junctional nevus--macular only (children & adolescents) --> compound nevi--macular & papular (young adults) --> intradermal nevus--nevus cells in only dermis (old age)

Front 13

Ephelides (freckles)

Back 13

Small, flat macules of brown melanin pigment, occur on sun-exposed skin

Front 14

Birthmarks

Back 14

May be tan to brown in color

Front 15

Pallor (paleness)

Back 15

Usu. due to lack of O2 (oxygenated hemoglobin); skin takes on color of connective tissue (white); common in acute -high-stress states; pallor can be observed in mucous membranes, lips, & nail beds in dark-skinned individuals

Front 16

Erythema (redness)

Back 16

Intense redness of skin from excess blood (hyperemia) in dilated superficial capillaries; expected w/fever/local inflammation (also increased skin temp) or emotional rxns

Front 17

Asymmetry, Border irregularity, Color variation, Diameter > 6mm, Elevation & Enlargement; also change in mole size, new pigmented lesion, development of itching/burning/bleeding in mole

Back 17

warning signs of malignant melanoma (ABCDE) - 97% sensitivity if client has 2 or more of these signs

Front 18

Cyanosis

Back 18

Bluish mottled color that means decreased perfusion; ears & earlobes; death in adults; indicates hypoxemia & occurs w/shock, Heart failure, chronic bronchitis, congenital heart disease

Front 19

Jaundice

Back 19

Yellow color indicating rising amts of bilirubin in blood; 1st noted in junction of hard & soft palate in mouth & in sclera

Front 20

Hypothermia

Back 20

General--accompanies central circulatory problem (ex: shock); Localized--peripheral arterial insufficiency & Raynaud's disease

Front 21

Hyperthermia

Back 21

Generalized--occurs w/increased metabolic rate (ex: fever, heavy exercise, hyperthyroidism); localized--feels hyperthermic w/trauma, infection, sunburn

Front 22

Moisture

Back 22

Diaphoresis (profuse sweating) accompanies increased metabolic rate (ex: heavy activity, fever, thyrotoxicosis)

Front 23

Texture

Back 23

Normal--smooth, firm, even; hyperthyroidism--skin smoother & softer, hypothyroidism--skin rough, dry, flaky

Front 24

Thickness

Back 24

Uniformly thin over most of body; callus (circumscribed overgrowth of epidermis, adaptation to excessive pressure) normal on palms & soles

Front 25

Edema

Back 25

Fluid accumulating in intercellular spaces; check by imprinting thumbs firmly against ankle malleolus/tibia-->pitting edema present if dent left in skin; 0: normal; 1+: mild pitting, slight indentation; 2+: moderate pitting, indentation subsides rapidly; 3+: deep pitting, indentation remains for short time, leg swollen; 4+: very deep pitting, indentation lasts long time, leg very swollen

Front 26

Unilateral edema

Back 26

Consider local/peripheral cause

Front 27

Bilateral/generalized edema (anasarca)

Back 27

Consider central problem like heart/kidney failure

Front 28

Mobility & turgor

Back 28

Measures hydration; mobility--skin's ease of rising; turgor--ability to promptly return to place

Front 29

Cherry (senile) angioma

Back 29

Small (1-5mm), smooth, slightly raised bright red dots; normally increase in size & number w/aging & not significant

Front 30

Wood's light

Back 30

Filtered, ultraviolet light used to detect fluorescing lesions; darken room, shine the light on area; blue-green fluorescence --> fungal infection

Front 31

KOH preparation

Back 31

Microscopic exam of skin scrapings helps diagnose superficial fungal infections; lightly scrape scale, place on clean slide, add drop 10-20% KOH to dissolve nonfungal skin debris, send to lab

Front 32

Nails

Back 32

Profile: normal (160°)/curved(<160°)/early clubbing(180°); color: linear pigmentation--brown linear streaks abnormal in light-skinned, may indicate melanoma, leukonychia striata--white hairline marks from trauma/picking at cuticle

Front 33

Mongolian spot

Back 33

Blue-black to purple macular area at sacrum/buttocks, sometimes occurs on abdomen, thighs, shoulders, arms; Gradually fades during 1st yr

Front 34

Café au lait

Back 34

Large round/oval patch of light-brown pigmentation, usu. present at birth & normal; fade in time

Front 35

Erythema toxicum

Back 35

Common rash appearing in 1st 3-4 days of life; "flea bite" rash consisting of tiny, punctate, red macules & papules on cheeks, trunk, chest, back, & buttocks; no treatment needed

Front 36

Physiological jaundice

Back 36

Yellowing of skin, sclera, mucous membranes develops after 3-4 days of life b/c of increased nos. of RBCs that hemolyze after birth; after 1 day-->maybe hemolytic disease; after 2 wks-->maybe biliary tract obstruction

Front 37

Milia

Back 37

Tiny white papules on cheeks, forehead, across nose & chin caused by sebum occluding opening of follicles; resolve spontaneously w/in a few wks

Front 38

Storkbite

Back 38

Flat, irregularly shaped red/pink patch found on back of neck (most common)/forehead/eyelid/upper lip; present at birth, usu. fades during 1st yr

Front 39

Acne (comedones)

Back 39

Increase in sebaceous gland activity --> increased oiliness & acne; whitehead--closed comedone, blackhead--open; severe acne: papules, pustules, nodules

Front 40

Senile lentigines

Back 40

"Liver spots"; small, flat, brown macules; clusters of melanocytes appearing after extensive sun exposure; not malignant, treatment not needed

Front 41

Seborrheic keratosis

Back 41

Raised, thickened areas of pigmentation; look dark, greasy, "stuck on"; develop mostly on trunk; don't become cancerous

Front 42

Actinic keratosis

Back 42

Red-tan scaly plaques that increase over time to become raised, roughened; less common; may have silvery-white scale adherent to plaque; directly related to sun-exposure; premalignant, may develop into squamous cell carcinoma

Front 43

Moisture

Back 43

Xerosis (dry skin) common in aging person due to decline in size, no., output of sweat & sebaceous glands; skin itches & looks flaky & loose

Hint 43

in the aging adult

Front 44

Acrochordons

Back 44

"Skin tags"; overgrowths of normal skin that form stalk & are polyplike; occur frequently on eyelids, cheeks & neck, axillae & trunk

Front 45

Turgor

Back 45

Decreased (less elastic); skin recedes slowly (tents) & stands by itself

Hint 45

in the aging adult

Front 46

Hair

Back 46

Hair growth decreases w/age; male-pattern balding--genetic, usu. gradual receding of ant. Hairline in symmetric W shape; greying due to decrease in melanocyte function

Hint 46

in the aging adult

Front 47

Nails

Back 47

Local injuries in nail matrix may produce longitudinal ridges; fungal infections common, w/thickened crumbling toenails & erythematous scaling on contiguous skin surfaces

Hint 47

in the aging adult

Front 48

Tenderness

Back 48

objective data

Hint 48

must be palpated

Front 49

Annular

Back 49

Begins in center, spreads to periphery

Hint 49

Lesion shape/configuration; Ex: Tinea corporis (ringworm), tinea versicolor, pityriasis rosea

Front 50

Confluent

Back 50

Lesions run together

Hint 50

Lesion shape/configuration; Ex: Urticaria (hives)

Front 51

Discrete

Back 51

Distinct, individual lesions that remain separate

Hint 51

Lesion shape/configuration; Ex: Molluscum

Front 52

Grouped

Back 52

Clusters of lesions

Hint 52

Vesicles of contact dermatitis, poison oak

Front 53

Gyrate

Back 53

Twisted, coiled, spiral, snakelike

Hint 53

Scabies

Front 54

Target (iris)

Back 54

Resembles iris of eye, concentric rings of color in lesions

Hint 54

Lesion shape/configuration; Ex: Erythema multiforme

Front 55

Linear

Back 55

Scratch, streak, line, stripe

Hint 55

Lesion shape/configuration; Ex:

Front 56

Polycyclic

Back 56

Annular lesions grow together

Hint 56

Lichen planus, psoriasis

Front 57

Zosteriform

Back 57

Linear arrangement along nerve route

Hint 57

Lesion shape/configuration; Ex: Herpes zoster (shingles); zostavax indicated for pts. 60+

Front 58

Macule

Back 58

Solely color change, flat & circumscribed, <1cm

Hint 58

Freckles, flat nevi, hypopigmentation, petechiae, measles, scarlet fever

Front 59

Papule

Back 59

Solid, elevated, circumscribed, <1cm diameter caused by superficial thickening in epidermis

Hint 59

Elevated nevus (mole), lichen planus, molluscum, wart (verruca)

Front 60

Patch

Back 60

Macules >1cm

Hint 60

Mongolian spot, vitiligo, café au lait spot, chloasma, measles rash

Front 61

Plaque

Back 61

Papules coalesce-->surface elevation wider than 1cm; plateaulike, disk-shaped

Hint 61

Psoriasis, lichen planus

Front 62

Nodule

Back 62

Solid, elevated, hard/soft, >1cm; may extend deeper into dermis than papule

Hint 62

Xanthoma, fibroma, intradermal nevi

Front 63

Tumor

Back 63

> few cm diameter, firm/soft, deeper into dermis; may be benign/malignant

Hint 63

Lipoma, hemangioma

Front 64

Wheal

Back 64

Superficial, raised, transient, erythematous; slightly irregular shape due to edema; may coalesce to form urticaria--intensely pruritic extensive rxn

Hint 64

PPD, mosquito bite, allergic rxn, dermographism

Front 65

Vesicle

Back 65

Elevated cavity up to 1 cm containing free fluid; "blister"

Hint 65

Herpes simplex, early varicella, herpes zoster, contact dermatitis

Front 66

Bulla

Back 66

>1cm diam.; usu. single-chambered; superficial in epidermis; thin-walled--> easily ruptures

Hint 66

Friction blister, pemphigus, burns, contact dermatitis

Front 67

Cyst

Back 67

Encapsulated fluid-filled cavity in dermis/subcutaneous layer, tensely elevating skin

Hint 67

Sebaceous cyst, wen

Front 68

Pustule

Back 68

Turbid fluid (pus) in the cavity; circumscribed & elevated

Hint 68

Impetigo, acne

Front 69

Crust

Back 69

Thickened, dried-out exudate left when vesicles/pustules burst or dry up; color can be red-brown/honey/yellow depending on fluid's contents (blood/serum/pus)

Hint 69

Impetigo (dry, honey colored), weeping eczematous dermatitis, scab after abrasion

Front 70

Scale

Back 70

Compact, desiccated flakes of skin, dry/greasy, silvery/white from shedding of dead excess keratin cells

Hint 70

After scarlet fever/drug rxn (laminated sheets), psoriasis (silver, micalike), seborrheic dermatitis (yellow, greasy), eczema, ichthyosis (large, adherent, laminated), dry skin

Front 71

Fissure

Back 71

Linear crack w/abrupt edges, extends into dermis, dry/moist

Hint 71

Cheilosis (corners of mouth due to excess moisture); athletes foot

Front 72

Erosion

Back 72

Scooped out, shallow depression; superficial; epidermis lost; moist, no bleeding; heals w/o scar b/c erosion doesn't extend to dermis

Front 73

Ulcer

Back 73

Deeper depression extending into dermis, irregular shape; may bleed; leaves scar when heals

Hint 73

Stasis ulcer, pressure sore, chancre

Front 74

Excoriation

Back 74

Self-inflicted abrasion; superficial; sometimes crusted; scratches from intense itching

Hint 74

Insect bites, scabies, dermatitis, varicella

Front 75

Scar

Back 75

After skin lesion repaired, normal tissue lost & replaced w/connective tissue (collagen); permanent fibrotic change

Hint 75

Healed area of surgery/injury, acne

Front 76

Atrophic scar

Back 76

Resulting skin level depressed w/loss of tissue; thinning of epidermis

Hint 76

Striae

Front 77

Lichenification

Back 77

Prolonged intense scratching eventually thickens skin & produces tightly packed sets of papules; looks like surface of moss/lichen; flakes off

Front 78

Keloid

Back 78

Hypertrophic scar; resulting skin level elevated by excess scar tissue, which is invasive beyond site of original injury; may increase long after healing occurs; looks smooth rubbery, clawlike, higher incidence among blacks; often behind ear

Front 79

Pattern injury

Back 79

Bruise/wound whose shape suggests instrument/weapon that caused it (ex: belt buckle, broomstick, burning cig, pinch/bite marks, scalding hot liquid); inflicted scalding-water immersion burns usu. have clear border showing body part was held under water intentionally; deformity results from untreated fracture b/c bone heals out of alignment-->suggest child abuse, w/history that doesn't match severity/type of injury & indicates impaired/dysfunctional parent-child relationship

Front 80

Hematoma

Back 80

Bruise you can feel; elevates the skin & seen as swelling; multiple petechiae & purpura may occur on face when prolonged vigorous crying/coughing raises venous pressure

Front 81

Contusion

Back 81

Large patch of capillary bleeding into tissues; Color change: 1)red-blue/purple w/in 24 rs of trauma, 2)blue to purple, 3)blue-green, 4)yellow, 5)brown to disappearing; recent bruise in dark-skinned person--deep, dark purple; NOT possible to date age of bruise ofrom color; pressure on bruise will not cause it to blanch; usu. occurs from trauma; also from bleeding disorders & liver dysfunction

Front 82

Basal cell carcinoma

Back 82

Usu. starts skin-colored papule w/translucent top-->rounded pearly borders w/central red ulcer or looks like large open pore w/central yellowing; most common form of skin cancer; slow, inexorable growth

Front 83

Squamous cell carcinoma

Back 83

Erythematous scaly patch w/sharp margins, >1cm; central ulcer, surrounding erythema; usu. on hands/head; less common, grows rapidly

Front 84

Malignant melanoma

Back 84

50% arise from preexisting nevi; usu. brown, often irregular/notched borders; commonly on trunk & back (men & women); legs (women); palms, soles of ft & nails (blacks)

Front 85

Koilonychia

Back 85

**"Spoon nails"; thin, depressed nails w/lateral edges tilted up, forming concave profile; if all nails involved-->maybe iron deficiency anemia

Front 86

Paronychia

Back 86

**Red, swollen, tender inflammation of nail folds; acute--usu. bacterial infection, chronic--usu. fungal infection from break in cuticle in "wet" workers

Front 87

Beau's line

Back 87

Transverse furrow/groove; depression across nail extending down to nail bed; occurs w/any trauma that temporarily impairs nail formation

Front 88

Splinter hemorrhages

Back 88

Red-brown linear streaks, embolic lesions, occur w/subacute bacterial endocarditis, also w/minor trauma

Front 89

Late clubbing

Back 89

Proximal edge of nail elevates; angle >180°; distal phalanx rounder & wider; seen w/chronic obstructive pulmonary disease & congenital heart disease w/cyanosis; occurs 1st in thumb & index finger

Front 90

Onycholysis

Back 90

**Slow, persistent fungal infection of toenails (more often)/fingernails; common in older adults; fungus causes change in color, texture, thickness, w/nail crumbling & loosening of nail plate, usu. beginning at distal edge & progressing proximally

Front 91

Pitting

Back 91

Sharply defined pitting & crumbling of nails w/distal detachment; often occurs w/psoriasis

Front 92

Habit-tic dystrophy

Back 92

Depression down middle of nail or multiple horizontal ridges caused by continuous picking of cuticle by another finger of same hand

Front 93

Eyelids

Back 93

two movable shades that protect the eye from injury, strong light and dust. The upper eyelid is the larger and more mobile one.

Front 94

Palpebral fissure

Back 94

elliptical open space btwn the eyelids

Front 95

Limbus

Back 95

the border btwn the cornea and the sclera

Front 96

Canthus

Back 96

**the corner of the eye, the angle where the lids meet

Front 97

Caruncle

Back 97

**at the inner canthus; small fleshy mass containing sebaceous glands

Front 98

Tarsal plates

Back 98

strips of connective tissue that gives the upper lid shape

Front 99

Meibomian glands

Back 99

**the tarsal plates contain these modified sebaceous glands that secret an oily lubrication material onto the lids. This stops the tears from overflowing and helps to form an airtight seal when the lids are closed.

Front 100

Conjunctiva

Back 100

**transparent protective covering in the exposed part of the eye. It is a thin mucous membrane folded like an envelope btwn the eyelids and the eyeball. Merges with the cornea at the limbus.

Front 101

Palpebral conjuctiva

Back 101

lines the lids and is clear, with many small blood vessels. It forms a deep recess and then folds back over the eye.

Front 102

Bulbar conjuctiva

Back 102

overlays the eyeball, with white sclera showing through

Front 103

Cornea

Back 103

covers and protects the iris and pupil.

Front 104

Lacrimal Apparatus

Back 104

provides constant irrigation to keep the conjuctiva and cornea moist and lubricated

Front 105

Lacrimal Gland

Back 105

in the upper outer corner over the eye, secretes tears.

Front 106

Puncta

Back 106

initial region where tears drain that is visible on the upper and lower eyelids at the inner canthus

Front 107

Rectus Muscles

Back 107

gives the eye straight movement. 4 types: superior, inferior, lateral and medial

Front 108

Obliques Muscles

Back 108

two slanting muscles that gives the eyes rotary movement : superior and inferior

Front 109

Conjugate Movement

Back 109

each muscle is coordinated, or yoked, with one in the other eye. This ensures that when the two eyes move, their axes always remain parallel.

Front 110

Parallel Axis

Back 110

important bc the human brain can tolerate seeing only image. Humans have a binocular, single-image visual system. Occurs bc our eyes move as a pair.

Front 111

Cranial Nerve VI

Back 111

the abducens nerve, innervates the lateral rectus muscle (which abducts the eye)

Front 112

Cranial Nerve IV

Back 112

the trochlear nerve, innervates the superior oblique muscle

Front 113

Cranial Nerve III

Back 113

the ocular motor nerve innervates all the rest – superior, inferior, and medial rectus and the inferior oblique muscles.

Front 114

Sclera

Back 114

**the outer fibrous layer of the eye; tough, protective, white covering. It is continuous with the cornea, which covers the iris and the pupil.

Front 115

Cornea

Back 115

**part of the refracting media of the eye, bending incoming light rays so that they will be focused on the inner retina. Sensitive to touch, any stimulation will cause both eyes to blink (corneal reflex).

Front 116

Choroid

Back 116

the middle layer of the eye. Darkly pigmented to prevent light from reflecting internally and is heavily vascularized to deliver blood to the retina. It includes the ciliary body, iris, pupil, lens, anterior and posterior chamber.

Front 117

Ciliary Body

Back 117

controls the thickness of the lens and is continuous with the choroid. Produces aqueous fluid that nourishes the surrounding tissues and drains metabolic waste.

Front 118

Iris

Back 118

functions as a diaphragm, varying the opening at its center, the pupil. This controls the amount of light admitted into the retina. Muscle fibers contract pupil in bright light to accommodate near vision and dilate in the dark for far vision.

Front 119

Pupil

Back 119

round and regular. Size is determined by a balance btwn the parasympathetic (constriction) and sympathetic (dilation) chains of the autonomic nervous system.

Front 120

Lens

Back 120

biconvex disc located posterior to the pupil. Serves as a refracting medium; bulges when focusing on near object and flattens for far objects.

Front 121

Anterior/Posterior Chamber

Back 121

these contain the clear, watery aqueous humor that is produced continually by the ciliary body

Front 122

Retina

Back 122

the inner layer of the eye. It is the visual receptive layer of the eye in which light waves are turned into nerve impulses. Structures viewed through the opthalmoscope in this layer are the optic disc, the retinal vessels, the general background, and the macula

Front 123

Optic Disc

Back 123

**area in which fibers from the retina converge to form the optic nerve; characteristics: creamy yellow-orange to pink; round or oval shape; margins that are distinct and sharply demarcated; and a physiological cup, a small circular area inside the disc where the blood vessel exit and enter

Front 124

Retinal Vessels

Back 124

normally includes a paired artery and vein extending to each quadrant, that becomes smaller as it reaches the periphery

Front 125

Macula

Back 125

**receives and tranduces light from the center of the visual field. Located on the temporal side of the fundus. It is a slightly darker pigmented area surrounding the fovea centralis, the area of sharpest, keenest vision.

Front 126

Visual Pathways

Back 126

Objects reflect light --> ray reflect thru transparent media (cornea, aqueous humor, lens, and vitreous body) strikes the retina (images in the retina are upside down and reversed from the outside world) stimulus transformed into nerve impulses --> optic nerve--> optic tract --> in the optic chiasm, nasal crossover so that the right side of the brain looks at the left side of the world --> visual cortex in occipital lobe

Front 127

Anisocoria

Back 127

Unequal pupil size

Front 128

Arcus senilis

Back 128

**Gray-white arc/circle around limbus of the iris; common w/aging; hyperlipidemia, benign, doesn't go away

Front 129

Argyll Robertson pupil

Back 129

Pupil doesn't react to light; does contrict w/accomodation

Front 130

Astigmatism

Back 130

Refractive error of vision due to differences in curvature in refractive surfaces of eye (cornea & lens)

Front 131

A-V crossing

Back 131

Crossing paths of an artery & vein in the ocular fundus

Front 132

Bitemporal hemianopsia

Back 132

Loss of both temporal visual fields

Front 133

Blepharitis

Back 133

**Inflammation of the glands & eyelash follicles along the margin of the eyelids; red, scaly, greasy flakes & thickened, crusted lid margins occur w/staphylococcal infection or seborrheic dermatitis of lid edge; symptoms: burning, itching, tearing, foreign body sensation, some pain

Front 134

Cataract

Back 134

**Opacity of lens (milky); develops slowly w/aging & gradually obstructs vision; common eye disorder; scotomas (blind spots)

Front 135

Chalazion

Back 135

**Infection or retention cyst of a meibomian gland, showing as a beady nodule on eyelid; nontender, firm, discrete swelling w/freely movable skin overlying the nodule; no pain

Front 136

Conjunctivitis

Back 136

**Infection of conjunctiva, "pink eye"; red beefy-looking vessels at periphery but usu. clearer around iris; common from bacterial/viral infection, allergy, chemical irritation; purulent discharge accompanies bacterial infection; preauricular lymph node often swollen & painful, w/history of URI; symptoms: itching, burning, foreign body sensation, no pain, eyelids stuck together on awakening; most common eye disorder

Front 137

Cotton-wool area

Back 137

Abnormal soft exudates visible as gray-white areas on ocular fundus

Front 138

Cup-disc ratio

Back 138

**Ratio of width of physiologic cup to width of optic disc; normally < 1/2

Front 139

Diopter

Back 139

**Unit of strength of lens settings on ophthalmoscope that changes focus on eye structures

Front 140

Drusen

Back 140

Benign deposits on ocular fundus that show as round yellow dots; commonly occur w/aging

Front 141

Ectropion

Back 141

Lower eyelid loose & rolling outward

Front 142

Entropion

Back 142

Lower eyelid rolling inward

Front 143

Exophthalmos

Back 143

**Protruding eyeballs; forward displacement of eyeballs & widened palpebral fissures; upper lid rests well above limbus & white sclera is visible; associated w/hyperthyroidism

Front 144

Fovea

Back 144

**Area of keenest vision at center of macula on ocular fundus

Front 145

Glaucoma

Back 145

**Group of eye diseases characterized by increased intraocular pressure (30-40 mm Hg); occur in scotomas; cupping of optic disc; adults should be screened for glaucoma by age 40

Front 146

Hordeolum

Back 146

**Red, painful pustule that is a localized staphylococcal infection of hair follicle at eyelid margin; stye; painful, red, swollen, pusule at the lid margin; treatment: warm compress

Front 147

Lid lag

Back 147

Abnormal white rim of sclera visible b/n upper eyelid & iris when a person moves the eyes downward

Front 148

Microaneurysm

Back 148

Abnormal finding of round red dots on ocular fundus that are localized dilations of small vessels

Front 149

Miosis

Back 149

**Constricted pupils; occurs w/use of pilocarpine drops for glaucoma treatment, narcotic use (heroin OD, valium, downers), iritis, brain damage of pons

Front 150

Mydriasis

Back 150

**Dilated pupils; occur w/stimulation of sympathetic nervous system, rxn to sympathomimetic drugs, use of dilating drugs (ecstasy, crack, upper drugs), acute glaucoma, past/recent trauma; herald CNS injury, circulatory arrest, or deep anesthesia

Front 151

Myopia

Back 151

**Globe longer than normal; refractive error in which near vision is better than far vision; "nearsighted"

Front 152

Nystagmus

Back 152

**Involuntary, rapid, rhythmic movement of eyeball; occurs w/disease of semicircular canals in the ears, paretic eye muscle, multiple sclerosis, brain lesions

Front 153

OD

Back 153

**Oculus dexter; right eye

Front 154

Optic atrophy

Back 154

Pallor of optic disc due to partial/complete death of optic nerve

Front 155

OS

Back 155

**Oculus sinister; left eye

Front 156

Papilledema

Back 156

**Venous stasis of blood flow out of ocular fundus; redness, congestion, & elevation of disc; blurred margins; hemorrhages, absent venous pulsations; sign of increased intracranial pressure; visual acuity not affected

Front 157

Presbyopia

Back 157

**Decrease in power of accomodation; occurs w/aging

Front 158

Pterygium

Back 158

Triangular opaque tissue on nasal side of conjunctiva that grows toward center of cornea

Front 159

Ptosis

Back 159

Drooping of upper eyelid over iris & possibly covering pupil

Front 160

Red reflex

Back 160

**Red glow that appears to fill person's pupil when 1st visualized through ophthalmoscope

Front 161

Xanthelasma

Back 161

Soft, raised yellow plaques occurring on the skin at the inner corners of the eyes

Front 162

Pupillary light reflex

Back 162

**Normal constriction of the pupils when bright light shines on retina

Front 163

Direct light reflex

Back 163

**Constriction of a pupil when it is exposed to bright light

Front 164

Consensual light reflex

Back 164

**Simultaneous constriction of one pupil when the other eye is exposed to bright light

Front 165

Fixation

Back 165

Reflex direction of the eye toward an object attracting a person's attention

Front 166

Accomodation

Back 166

**Adaptation of the eye for near vision; test for this by asking person to focus on distant object --> dilates pupils; have person shift gaze to near object; normal = pupillary constriction & convergence of axes of eyes

Front 167

Scotoma

Back 167

**Blind spot in visual field surrounded by an area of normal/decreased vision; occurs w/glaucoma, & optic nerve & visual pathway disorders

Front 168

Photophobia

Back 168

**Inability to tolerate light

Front 169

Strabismus

Back 169

**Deviation in anteroposterior axis of the eye

Front 170

Diplopia

Back 170

Perception of two images of a single object; double vision

Front 171

Lacrimation & Epiphora

Back 171

Tearing & excessive tearing

Front 172

Snellen eye chart

Back 172

**Has lines of letters arranged in decreasing size; most commonly used & accurate measure of visual acuity; if 20/30 --> referral

Front 173

20/20

Back 173

**Normal visual acuity; numerator - distance person is standing from chart, denominator - distance at which a normal eye could have read that line; the larger the denominator, the poorer the vision

Front 174

Near vision test

Back 174

**Hold Jaeger card (handheld vision screener w/various print sizes) ~14 in. from eye; normal = 14/14; tests for presbyopia

Front 175

Confrontation test

Back 175

**Gross measure of peripheral vision; estimate angle b/n anteroposterior axis of eye & peripheral axis where object first seen; normal = 50° upward, 90° temporal, 70° down, 60° nasal

Front 176

Corneal light reflex (Hirschberg test)

Back 176

**Assess parallel alignment of eye axes by shining light toward person's eyes; direct person to stare straight ahead as you hold light ~12 in. away; normal = reflection of light on corneas is symmetrical; asymmetry-->deviation in alignment-->perform cover test

Front 177

Cover test

Back 177

**Detects small degrees of deviated alignment by interrupting fusion reflex that normally keeps the eyes parallel; direct person to stare straight ahead at your nose; cover one eye w/card & as it is covered, note uncovered eye-->normal = steady fixed gaze; uncover eye & observe it for movement-->normal = stare straight ahead

Front 178

Phoria

Back 178

Mild eye muscle weakness noted only when fusion is blocked

Front 179

Tropia

Back 179

Constant malalignment of the eyes; more severe than phoria

Front 180

Diagnostic positions test

Back 180

**Tests for parallel eye movement; ask person to hold head steady, & w/only the eyes, follow movement of your finger; hold target about 12 in. away & move it to each of six positions, hold it momentarily, then move back to center; progress clockwise; normal = parallel tracking of object w/both eyes

Front 181

Eyebrows

Back 181

Present bilaterally, move symmetrically as facial expression changes, no scaling/lesions; hypothyroidism - absent lateral 1/3 of brow; nerve damage - unequal/absent movement; seborrhea - scaling

Front 182

Eyelids & lashes

Back 182

Upper lids normally overlap superior part of iris & approximate completely w/lower lids when closed; skin intact w/out redness, swelling, discharge, lesions; palpebral fissures horizontal/slant (upward) in non Asians/Asians; eyelashes evenly distributed along lid margins, curve outward

Front 183

Eyeballs

Back 183

Aligned normally in sockets w/no protrusion/sunken appearance; Blacks normally may have slight protursion of eyeball beyond supraorbital ridge

Front 184

Enophthalmos

Back 184

Sunken eyes

Front 185

Conjunctiva & sclera

Back 185

Ask person to look up; using thumbs, slide lower lids down along bony orbital rim; eyeball looks moist & glossy; normal = pink over lower lids & white over sclera; note color change, swelling, lesions (anemia - pallor near outer canthus of lower lid)

Front 186

Scleral icterus

Back 186

Even yellowing of sclera extending up to cornea; indicates jaundice

Front 187

Eversion of upper lid

Back 187

Useful when you must inspect conjunctiva of upper lid (i.e. with eye pain or suspicion of foreign body); 1) keep both eyes open, look down, 2) slide upper lid up along bony orbit to lift up lashes, 3) grasp lashes b/n thumb & forefinger & gently pull down & outward, 4)place tip of q-tip on upper lid above level of internal tarsal plates, 5) gently push down w/stick as you lift lashes up, 6) secure everted position by holding lashes against bony orbital rim, 7) inspect for color change, swelling, lesion, foreign body, 8) to return to normal position, gently pull lashes outward as person looks up

Front 188

Lacrimal Apparatus

Back 188

Ask person to look down; w/thumbs, slide outer part of upper lid up along bony orbit to expose under lid --> inspect for redness/swelling; check for blockage of nasolacrimal duct by pressing index finger against sac (just inside lower orbital rim --> normal = pressure slightly everts lower lid

Front 189

Testing pupillary light reflex

Back 189

**Darken room, ask person to gaze into distance; advance light in from the side & note response --> normal = constriction of same-sided pupil & simultaneous constriction of other pupil

Front 190

Recording pupil size

Back 190

R 3/1 = 3/1 L; numerator - resting size of pupils, denominator - size of pupils in response to light

Front 191

Testing for accomodation

Back 191

**Ask person to focus on distant object, have person shift gaze to near object (finger) held ~3 in. from nose --> normal = pupillary constriction & convergence of axes of eyes

Front 192

Pupils Equal, Round, React to Light, Accomodation

Back 192

PERRLA

Front 193

Diopter

Back 193

**Unit of strength of ea. lens; positive diopter = black #/convex lens (for focusing on objects close to ophthalmoscope), negative diopter = red #/concave lens (for focusing on objects farther away)

Front 194

Using ophthalmoscope

Back 194

**Darken room, select large round aperture, hold oph. scope in R hand up to R eye to view persons's R eye; begin ~10 in. away from person ~15° lateral to person's line of vision --> normal = red glow filling person's pupil; steadily move closer to eye, adjust lens to +6, note opacities (cataracts - opaque black areas against red reflex); move closer 'til foreheads almost touch, adjust diopter setting to bring ocular fundus into sharp focus (use red lenses to compensate for nearsightedness, black for farsightedness

Front 195

Scleral crescent

Back 195

Gray-white new moon shape occurring around disc margins; occurs when pigment absent in choroid layer & you are looking directly at sclera, normal variation

Front 196

Pigment crescent

Back 196

Black due to accumulation of pigment in choroid, normal variation

Front 197

DD

Back 197

**Diameter of disc; std of measure for other fundus structures; note clock-face position & its relationship to disc in size & distance

Front 198

Viewing macula through ophthalmoscope

Back 198

**Macula is 1 DD in size, located 2-2.5 DD temporal to disc; normal color = somewhat darker than rest of fundus, even, homogeneous

Front 199

Retinal vessels

Back 199

Where is the only place in the body where you can view blood vessels directly

Front 200

Hyperopia

Back 200

"Farsighted"; globe shorter than normal; refractive error in which far vision better than near vision

Front 201

A:V ratio

Back 201

Ratio comparing artery-to-vein width is 2:3 or 4:5

Front 202

Pseudostrabismus

Back 202

When epicanthal folds give a false appearance of malalignment of the eyes; corneal reflex is normal

Front 203

Periorbital edema

Back 203

Lids are swollen, puffy; lid tissues are loosely connected so excess fluid is easily apparent; occurs w/local infections, crying, systemic conditions (e.g. congestive heart failure, renal failure, allergy, hypothyroidism)

Front 204

Upward palpebral slant

Back 204

Normal in many children, but when combined w/epicanthal folds, hypertelorism (large spacing b/n eyes), & Brushfield spots (light-colored areas in outer iris) --> Down syndrome

Front 205

Basal cell carcinoma (eyes)

Back 205

Rare, but occurs most often on lower lid & medial canthus; looks like papule w/ulcerated center; rolled-out pearly edges

Front 206

Acute narrow-angle glaucoma

Back 206

Shows circumcorneal redness around iris w/dilated, oval pupil; cornea looks steamy; anterior chamber is shallow; occurs w/sudden increase in intraocular pressure from blocked outflow from anterior chamber; sudden clouding of vision, sudden eye pain, halos around lights; requires emergency treatment

Front 207

Corneal abrasion

Back 207

Most common result of a blunt eye injury; top layer of corneal epithelium removed, from scratches or poorly fitting/overworn contacts; b/c area rich in nerve endings, person feels intense pain, foreign body sensation, lacrimation, redness, photophobia

Front 208

Excessive cup-disc ratio

Back 208

W/primary, open-angle glaucoma, increased intraocular pressure decreases blood supply to retinal structures; physiologic cup enlarges to more than half of the DD, vessels appear to plunge over edge of cup, vessels are displaced nasally; asymptomatic, though person may have decreased vision/visual field defects in late stages of glaucoma

Front 209

Open-angle glaucoma

Back 209

Asymptomatic for long time; constriction of visual field, bad peripheral vision

Front 210

Impetigo

Back 210

Moist, thin-roofed vesicles w/thin, erythematous base; rupture to form thick, honey-colored crusts; contagious bacterial infection of skin; most common in infants & children

Front 211

Intertrigo

Back 211

Scalding red, moist patches w/sharply demarcated borders, some loose scales; usu. in genital area extending along inguinal & gluteal folds; aggravated by urine, feces, heat, moisture; Candida fungus infects superficial skin layers

Front 212

Psoriasis

Back 212

Scaly erythematous patch, w/silvery scales on top; usu. on scalp, outside elbows & knees, low back, anogenital area

Front 213

Port-wine stain

Back 213

Large, flat macular patch covering scalp/face, frequently along distribution of CN V; dark red, bluish, or purplish & intensifies w/crying, exertion, exposure to heat/cold; consists of mature capillaries; present at birth & usu. doesn’t fade; yellow light lasers now make photoablation of lesion possible

Front 214

Strawberry mark

Back 214

Raised bright red area w/well-defined borders about 2-3 cm in diameter; doesn't blanch w/pressure; consists of immature capillaries; present at birth or develops in 1st few months but usu. disappears by age 5-7 yrs; requires no treatment

Front 215

Cavernous hemangioma

Back 215

Reddish-blue, irregularly shaped, solid & spongy mass of blood vessels; may be present at birth, may enlarge during 1st 10-15 mos, will not involute spontaneously

Front 216

Spider/star angioma

Back 216

Fiery red, star-shaped marking w/solid circular center; capillary radiations extend from central arterial body; w/pressure, note central pulsating body & blanching of extended legs; develops on face/neck/chest; may be normal or associated w/pregnancy, chronic liver disease, estrogen therapy

Front 217

Petechiae

Back 217

Tiny punctate hemorrhages, 1-3 mm, round & discrete, dark red/purple/brown & will not blanch; caused by bleeding from superficial capillaries; may indicate abnormal clotting factors

Front 218

Purpura

Back 218

Confluent & extensive patch of petechiae & ecchymoses, >3 mm flat, red to purple, macular hemorrhage; seen in thrombocytopenia, scurvy; also occurs in old age as blood leaks form capillaries in response to minor trauma & diffuses through dermis

Front 219

Diaper dermatitis

Back 219

Red, moist maculopapular patch w/poorly defined borders in diaper area, extending along inguinal & gluteal folds; Hx of infrequent diaper changes or occlusive coverings; inflammatory disease caused by skin irritation from ammonia, heat, moisture, occlusive diapers

Front 220

Atopic dermatitis (eczema)

Back 220

Erythematous papules & vesicles, w/weeping, oozing, crusts; usu. develop on scalp, forehead, cheeks, forearms, wrists, elbows, backs of knees; paroxysmal & severe pruritus; family Hx of allergies

Front 221

Rubeola (measles)

Back 221

Red-purple maculopapular blotchy rash in dark & light skin appears on 3rd-4th day of illness; 1st appears behind ears & spreads over face then neck, trunk, arms, legs; looks "coppery" & doesn't blanch; also characterized by Koplik's spots in mouth

Front 222

Chickenpox (varicella)

Back 222

Small tight vesicles 1st appear on trunk, then spread to face, arms, legs; shiny vesicles on erythematous base; vesicles erupt in succeeding crops over several days then become pustules then crusts; intensely pruritic

Front 223

Tinea corporis

Back 223

Scales--hyperpigmented in whites, depigmented in dark-skinned persons--on chest, abdomen, back of arms forming multiple circular lesions w/clear centers

Front 224

Tinea pedis

Back 224

"Athlete's foot"; fungal infection, 1st appears as small vesicles b/n toes, sides of feet, soles; then grows scaly & hard; found in chronically warm moist feet (e.g. children after gym activities, athletes, aging adults who can't dry feet weel)

Front 225

Tinea versicolor

Back 225

Fine, scaling, round patches of pink/tan/white that do not tan in sunlight; caused by superficial fungal infection; usual distribution is on neck, trunk, upper arms; most common in otherwise healthy young adults

Front 226

Labial herpes simplex (cold sores)

Back 226

Prodrome of skin tingling & sensitivity, then erupts w/tight vesicles followed by pustules then acute gingivostomatitis w/many shallow, painful ulcers; commonly located on upper lip, also in oral mucosa & tongue; HSV-1 (lips), HSV-2 (genitalia)

Front 227

Erythema migrans

Back 227

Lyme disease may have serious arthritic, cardiac, neurological sequelae, not fatal; caused by spirochete bacterium carried by black/dark brown deer tick; tick must feed for 24 hrs; common in Northeast, upper Midwest, California in May-Sept; 1st stage: distinctive bull's eye, red macular or papular rash in 50% of cases; rash usu. located in axilla, midriff, inquina, behind knee & fades in 4 wks; antibiotic Tx shortens symptoms & decreases risk of sequelae

Front 228

Kaposi sarcoma

Back 228

Cancerous lining of blood vessels; patch stage: faint pink lesiosn; plaque stage: lesions develop into raised papules or thickened plaques, oval, red to brown; advanced: widely disseminated involving skin, mucous membranes, visceral organs

Front 229

Alopecia

Back 229

Sudden appearance of sharply circumscribed, round/oval balding patch, usu. w/smooth, soft, hairless skin underneath; unknown cause; when limited to a few patches, person usu. has complete regrowth; gene in mother's father

Front 230

Pediculosis capitis (head lice)

Back 230

Hx includes intense itching of scalp, esp. occiput; lice nits easier to see in occipital area & around ears, 2-3 mm oval, translucent, adherent to hair shaft; common among school-age children

Front 231

Trichotillomania

Back 231

Traumatic self-induced hair loss usu. result of compulsive twisting/plucking; forms irregularly shaped patch w/broken off stublike hairs of varying lengths; never completely bald; sign of anxiety

Front 232

Folliculitis

Back 232

Superficial infection of hair follicles; multiple pustules, "whiteheads," w/hair visible at center & erythematous base; usu. on arms, legs, face, buttocks

Front 233

Mad, sad, glad, afraid, ashamed

Back 233

Types of feelings

Front 234

Interview techniques

Back 234

Facilitation, silence, reflection, empathy, clarification

Front 235

Inspection, palpation, percussion, auscultation

Back 235

Techniques in assessment (in order)