Block 2 Flashcards
fundamental purpose of the cardiorespiratory system
to deliver O2 and nutrients to cells and to remove CO2 and other metabolic products from them.
switch from aerobic to anaerobic metabolism
Pasteur effect
The adaptations to hypoxia are mediated, in part, by the upregulation of genes encoding a variety of proteins, including
- glycolytic enzymes, such as phosphoglycerate kinase and phosphofructokinase
- glucose transporters Glut-1 and Glut-2
- growth factors, such as vascular endothelial growth factor (VEGF) and erythropoietin, which enhance erythrocyte production.
The hypoxia-induced increase in expression of these key proteins is governed by this hypoxiasensitive transcription factor?
hypoxia-inducible factor-1 (HIF-1).
During hypoxia, systemic arterioles
During hypoxia, systemic arterioles dilate, at least in part, by opening of K-ATP channels in vascular smooth-muscle cells due to the hypoxia-induced reduction in ATP concentration.
What happens in pulmonary vascular smooth-muscle cells during hypoxia?
By contrast, in pulmonary vascular smooth-muscle cells, inhibition of K+ channels causes depolarization which, in turn, activates voltage-gated Ca2+ channels raising the cytosolic [Ca2+] and causing smooth-muscle cell contraction.
Hypoxia-induced pulmonary arterial constriction shunts blood away from poorly ventilated portions toward better ventilated portions of the lung; however, it also increases pulmonary vascular resistance and right ventricular afterload.
Acute hypoxia causes
impaired judgment, motor incoordination, and a clinical picture resembling acute alcohol intoxication.
High-altitude illness is characterized
by
headache secondary to cerebral vasodilation, gastrointestinal symptoms,
dizziness, insomnia, fatigue, or somnolence.
Pulmonary arterial and sometimes venous constriction causes
capillary leakage and high-altitude pulmonary edema (HAPE), which intensifies hypoxia, further promoting vasoconstriction. Rarely, high-altitude cerebral edema (HACE) develops, which is manifest by severe headache
and papilledema and can cause coma. As hypoxia becomes more severe, the regulatory centers of the brainstem are affected, and death usually results from respiratory failure.
When hypoxia occurs from respiratory
failure, Pao2 ?
declines
when respiratory failure is persistent, the
hemoglobin-oxygen (Hb-O2) dissociation curve?
is displaced to the right, with greater quantities of O2 released at any level of tissue Po2.
TRUE OR FALSE:
Arterial hypoxemia, that is, a reduction of O2 saturation of arterial blood (Sao2), and consequent cyanosis are likely to be more marked when such depression of Pao2 results from pulmonary disease than when the depression occurs as the result of a decline in the fraction of oxygen in inspired air (Fio2).
TRUE
What happens when the depression occurs as the result of a decline in the fraction of oxygen in inspired air (Fio2)?
In this latter situation, Paco2 falls secondary to anoxia induced hyperventilation and the Hb-O2 dissociation curve is displaced to the left, limiting the decline in Sao2 at any level of Pao2.
The most common cause of respiratory hypoxia is ?
ventilation-perfusion mismatch resulting from perfusion of poorly ventilated alveoli.
Respiratory hypoxemia may also be caused by hypoventilation, in which
case it is associated with ?
an elevation of Paco2
A third cause of respiratory hypoxia is shunting of blood across the lung from the pulmonary arterial to the venous bed (intrapulmonary right-to-left shunting) by perfusion of nonventilated portions of the lung, as in?
pulmonary atelectasis or through pulmonary arteriovenous connections.
The low Pao2 in intrapulmonary right-to-left shunting is corrected by?
The low Pao2 in this situation is only partially corrected by an Fio2 of 100%.
ventilation-perfusion mismatch & hypoventilation can be corrected by?
These two forms of respiratory hypoxia are usually correctable by inspiring 100%
O2 for several minutes.
From a physiologic viewpoint, this cause of hypoxia resembles intrapulmonary right-to-left shunting but is caused by congenital cardiac malformations, such as?
- tetralogy of Fallot
- transposition of the great arteries
- Eisenmenger’s syndrome
Pao2 in anemic hypoxia
normal
the presence of COHb shifts the Hb-O2 dissociation curve to the ?
left
This pathophysiology
leads to an increased arterial-mixed venous O2 difference
(a-v-O2 difference), or gradient.
circulatory hypoxia
Generalized circulatory hypoxia occurs
in ?
heart failure and in most forms of shock
clinical
picture of patients with hypoxia due to an elevated metabolic rate, as
in fever or thyrotoxicosis,
the skin is warm and flushed owing to increased cutaneous
blood flow that dissipates the excessive heat produced, and cyanosis is
usually absent.
Cyanide and several
other similarly acting poisons cause cellular hypoxia. The tissues are
unable to use O2, and, as a consequence, the venous blood tends to have
a high O2 tension. This condition has been termed?
histotoxic hypoxia.
refers to a bluish color of the skin and mucous membranes
resulting from an increased quantity of reduced hemoglobin (i.e., deoxygenated
hemoglobin) or of hemoglobin derivatives (e.g., methemoglobin
or sulfhemoglobin) in the small blood vessels of those tissues.
Cyanosis
Cyanosis is usually most marked in the ?
lips, nail beds, ears, and malar eminences.
A cherry-colored flush, rather than cyanosis,
is caused by ?
COHb
In some instances, central cyanosis can be detected reliably when the
Sao2 has fallen to _____%; in others, particularly in dark-skinned persons,
it may not be detected until it has declined to _____%.
85%
75%.
In general, cyanosis becomes apparent when
the concentration of reduced hemoglobin in capillary blood exceeds?
40 g/L (4 g/dL).
the higher the total hemoglobin content, the (greater or lower) the tendency toward cyanosis?
greater
the Sao2 is reduced or an abnormal hemoglobin derivative
is present, and the mucous membranes and skin are both affected.
central cyanosis
is due to a slowing of blood flow and abnormally
great extraction of O2 from normally saturated arterial blood; it results
from vasoconstriction and diminished peripheral blood flow, such
as occurs in cold exposure, shock, congestive failure, and peripheral
vascular disease.
Peripheral cyanosis
Often in these conditions, the mucous membranes of
the oral cavity or those beneath the tongue may be spared.
Peripheral cyanosis
Decreased Sao2 results from a
marked reduction in the Pao2.
Central Cyanosis
Which of the ff is are correct A. Increase in intravascular colloid osmotic pressure causes absorption B. Decrease in intravascular hydrostatic pressure cause filtration C. Increase in extravascular colloid osmotic pressure causes edema D. A and C
D. A and C
Which of the ff does not cause Edema? A. RAAS B. Natriuretic peptide C. ADH D. Endothelin-1
B. Natriuretic peptide
RAAS, Na and water retention and K excretion is the effect of what hormone A. Angiotensin I B. Angiotensin II C. Aldosterone D. Renin
C. Aldosterone
ACE is an enzyme mainly produced by the
lungs. What is the function of this enzyme?
A. Converts angiotensinogen to angiotensin I
B. Converts angiotensin I to angiotensin II
C. inactivates bradykinin
D. B and C
B. Converts angiotensin I to angiotensin II
Vasopressin/ADH promotes water retention in which of the ff tubules? a. Collecting Tublules b. Proximal c. Distal d. A & C
d. A & C
60y.o male with chief complaint of eyelid
swelling at the morning. Px had a history of
type1 Diabetes Mellitus and Hypertension.
Physical Exam revealed bipedal pitting edema.
Urinalysis revealed 3+ proteins. What is the
cause of edema?
A. Heart failure
B. Nephrotic syndrome
C. Liver cirrhosis
D. Poor protein intake
B. Nephrotic syndrome
S2 is closure of what valve A. Mitral B. Tricuspid C. Semilunar D. A and B
C. Semilunar
Loud with palpable thrill -
Grade 4
10% of the causes of palpitations are due to? a. Cardiac B. Psychiatric C. Miscellaneous D. Unknown
C. Miscellaneous
CD, a 48 year old female, experienced palpitations of greater than 15 minutes A. Cardiac B. Psychiatric C. Miscellaneous D. Unknown
B. Psychiatric
The following are cardiovascular disease that causes dyspnea expect: a. Coronary artery disease b. Restrictive pericarditis c. Pulmonary hypertension d. Cardiomyopathy
a. Coronary artery disease
Type 2 Dypnea
Answer:
walk slowly with same age on level ground
DOB occurring at night is common to what condition? A. Orthopnea B. Asthma C. MI D. Interstitial lung disease
A. Orthopnea
Which of the following order is correct in the examination of the respiratory system? A. IPPA (palpation, percussion) B. IPPA (percussion, palpation) C. IAPP (palpation, percussion) D. IAPP (percussion, palpation)
D. IAPP (percussion, palpation)
High JVP suggests
Answer: Elevated Right Atrial Pressure.
Orthopnea is relieved by:
a. Elevation of both feet
b. Use of bronchidilators
c. Sit upright
d. All of the above
c. Sit upright
Expiratory muscles contract generating
positive intrathoracic pressure as high as
Answer: 300mmHg
Arnold’s nerve is a branch of what cranial
nerve?
Answer: Vagus
Most common origin of hemoptysis?
Answer: Bronchi
Most common cause of hemoptysis
worldwide
Answer: Bronchiectasis
Classic description of hemoptysis of vascular origin A. Blood-tinged B. Massive C. Cherry red D. Pink and frothy
D. Pink and frothy
What is the amount of blood expectorated at one time that is considered massive hemoptysis? A. 500 mL B. 150-200 mL C. 400 mL D. 100-150 mL
D. 100-150 mL
All patients with massive hemoptysis shoud be tested by: A. Chest x-ray B. Culture C. CT scan D. AFB
C. CT scan
During massive hemoptysis, the following should be done except: a. Protect the non-bleeding lung b. Intubate the patient c. Locate the site of bleeding d. Correct the bleeding
d. Correct the bleeding
Preferred treatment for massive hemoptysis: A. Bronchial arterial embolization B. Surgical resection of vessel C. Angiography D. Lobectomy
A. Bronchial arterial embolization
All true about vestibular vertigo except
A. May be paroxysmal or due to fixed unilateral
or bilateral vestibular deficit
B.Vertigo or Imbalance
C. Peripheral disorders that affect the labyrinth
or vestibular D nerves
D. Anterior Unilateral Lesion that causes
imbalance and instability of vision
D. Anterior Unilateral Lesion that causes
imbalance and instability of vision
Assessment of eye, ability to fixate two phases clearly. A. Pursuit B. Oacillopia C. Saccade D. Visual acuity
C. Saccade
Patient presents with maculopapular rash starting from hair line towards down. Palatal petichia was seen. Upon PE post auricular adenopathy. A. B. Rubella C. Rubeola D. Exanthem subitum
B. Rubella
PGE2 has 4 receptor but only _ is important for fever. A. E3 B. E2 C. E4 D. E1
A. E3
What occurs when hypothalamic setpoint is reset downward?
B. Heat loss through vasodilation and
sweating
Situational: patient has breathlessness when walking in her own pace and level ground stop to rest-
Grade 2
Causes of impaired cough except
a. Inc in respiratory muscle contraction
True of Central cyanosis A. Slow blood B. Great oxygen extraction C. Exposure to cold air/h20 D. Abnormal hgb derivatives
D. Abnormal hgb derivatives
Cause of edema in patient with nephrotic
disease.
decrease colloid oncotic pressure
due to loss of protein in urine
True of GI bleeding
A. Melena may indicate that blood in gi bleeding
is <14hrs
B.
C. Hemoptysis is indicative of upper gi bleeding
D. Hematochezia…
*Melena indicates blood has been present in the GI tract for at least 14 hrs and as long as 3 to 5 days.
*The more proximal the bleeding site, the
more likely the melena will occur
*Hematochezia usually presents a lower GI source of bleeding
*Hematemesis indicates an upper GI source of bleeding
PE for abdominal swelling, except
a. presence of RIGHT supraclavicular lymphadenopathy or Virchow’s node
b. Spider angiomas, palmar erythema, caput
medusae, gynecomastia
c. elevated jvp
d. pericardial knock in heart failure
a. presence of RIGHT supraclavicular lymphadenopathy or Virchow’s node
Attacks of meniers consists of, except... A. Vertigo B. Loss of balance C. Loss of hearing D. Fullness of affected ear
B. Loss of balance
Hypoxia, when respiratory failure is
persistent
A. Hemoglobin-oxygen dissociation curve
shift to the right
B. Hemoglobin-oxygen dissociation curve no
shift
C. Hemoglobin-oxygen dissociation curve shift to
the left
D. Hemoglobin-oxygen dissociation curve shift
downward
A. Hemoglobin-oxygen dissociation curve
shift to the right
What is the main stimulus of increase renin release? A. Decrease sodium reab B. Diminished renal blood flow C. Decrease O2 in juxtamegulary cells D. Increase plasma oncotic pressure
B. Diminished renal blood flow
Clouding of the eye lens -
B. Cataract
A condition in which eyes are not aligned with each other A.Amblyopia B.Myopia C.Strabismus D.Diplopia
C.Strabismus
Bulging of the eyes between eyelids -
Exopthalmos
Assessment of alignment by the location of corneal light reflex within pupil -
Hirschberg Test
The procedure used to detect intraocular pressure and glaucoma a. Slit Lamp b. Tonometry c. Fundoscopy d.Perimetry
b. Tonometry
Loss of focusing ability of the crystallized lens due to normal process of old age A. Myopia B. Hyperopia C. Astigmatism D. Presbyopia
D. Presbyopia
Mr Goo a 45 yr old male, sought medical
check up from an opthalmologist complaining
that he cant read text messages but having no
problem with target shooting. Visual acuity is
20/25 jaeger 6. What diagnosis is this.
A. Myopia
B. Presbyopia
C. Beginning of cataract
D. Astigmatism
B. Presbyopia
All are central corneal ulceration except
a. Bacterial
b. Fungal
c. acanthomoeba
d. Moreens
d. Moreens
Abbreviation for both eyes -
Oculus Universal
Procedure used to detect abnormalities in cornea, anterior chamber and lens. A. Endoscopy B. Slit lamp C. Gonioscopy D. Fundoscopy
C. Gonioscopy
mr. KB. Went for eye check up due to upper
left eyelid infection. Stye?
Hordelium
The white in the eye?
-SCLERA
Drooping of upper eyelid
A. Proptosis (abnormal protrusion or
displacement of an ey or other body part)
B. Ptosis
C. Blepharospasm (involuntary tight closure of eyelids)
D. Entropion (eyelid folds inward)
B. Ptosis
Optic nerve finding is the most concerning in glaucomatous damage A. Large disk size B. Horizontal cupping C. Vertical cupping D. Tilted disk
C. Vertical cupping
Finding is most characteristic of orbital cellulitis A. Chemosis B. Warmth and Erythema of Eyelid C. Physical taut-feeling eyelid D. Proptosis
D. Proptosis
A 27 year old contact lens wearer presents
to the ER with irritation. 2 mm Corneal abrasion.
What should you do?
Treat with ciprofloxacin drops
A woman presents to you complaining of a
red eye with stinging and some photophobia.
Her vision has slightly dropped to 20/30. She
has a history of diabetes and is taking drops for
glaucoma. What is the likely cause of the
redness?
A. Angle-closure glaucoma
B. Viral conjunctivitis
C. Diabetic retinopathy
D. Papilledema
B. Viral conjunctivitis
Patient presented with MVA and fracture in the orbital floor a. Double vision and worsen upon upward looking b. Chemosis c. Restricted forced ductions d. Decreased extraocular movement
c. Restricted forced ductions
Which condition leads to innacurately high reading with applanation pressure measurement? a. Thin cornea b. Thick cornea c. Edematous cornea d. Keratoconus
b. Thick cornea
32 y/o white man with type-1 diabetes
complains of decreased vision. Havent seen
doctors for years. On exam: numerous dot blot
hemorrhages, hard exudates and abnormal
vasculature. Pan-retinal photocoagulation might
be used to:
A. Kill ischemic retina
B. Tamponade retinal tears
C. Ablate peripheral blood vessels
D. Seal off leaking blood vessels
A. Kill ischemic retina
effect of doxycycline to blepharitis
a. therapeutic antibiotic tear secretion
b. inhibition of cytokines
c. change in lipid viscosity
d. increased lacrimal secretion
c. change in lipid viscosity
A man complains of splashed bleach in his eyes.
Irrigate for 15 minutes and go to
opthalmologist
You are trying to measure the deviation in a
child with strabismus. The corneal light reflex
seen in the pupillary margin temporal to the pupil
in the right eye. How much deviation would you
estimate?
A. 10 diopters esotropia
B. 20 diopters exotropia
C. 30 diopters esotropia
D. 40 diopters exotropia
C. 30 diopters esotropia
What is the color of fluorescein stain in corneal ulceration a. Yellow B. Blue C. Green D. Royal blue
C. Green
Chalazion is a chronic inflammation
granulomatous of:
Meibomian gland
Most common sensations that is not
dizziness:
Headache
Which is paired correctly? A. Superior SC- up and down head movement (nodding) B. Later SC- head tilt towards shoulder C. Posterior SC- side to side D. Anterior- shake head side to side
A. Superior SC- up and down head
movement (nodding)
Which of the following differential diagnosis of dizziness lasted for seconds? A. TIA B. BBVP C. Meniers Dse D.
B. BBVP
Maneuver to treat BBVP
Epley Maneuver
the most useful bedside test for peripheral vestibular function a. Epley maneuver d. Dix- Hallpike maneuver c. Head elevation test d. Dix Epley maneuver
d. Dix- Hallpike maneuver
Which of the following is true?
A. Nystagmus caused by acute peripheral lesion
changes direction with gaze
B. Unilateral hearing loss is suggestive of central
disorder
C. Nystagmus due to peripheral lesion is
inhibited by visual fixation
D. Central nystagmus is inhibited by visual
fixation
C. Nystagmus due to peripheral lesion is
inhibited by visual fixation
Otoconia
-Calcium carbonate
What are the key features of Meniere's disease? A. Low frequency hearing loss B. Aural symptoms C. Both D. None of the above
C. Both
Also known as endolymphatic hydrops A. Vestibular margination B. Menieres disease C. Vestibular schwanomma D. Nota
B. Menieres disease
Menieres disease is thought to be due to excess fluid (endolymph) in the inner ear; hence the term endolymphatic hydrops
Components of vestibular system
a. semicircular and olith
b. semicircular and Cochlea
c. cochlea and saccule
d. saccule and utricle
d. saccule and utricle
25 yo male had a motor vehicular accident
and suffered a shock like sensation at the left
leg. It is also triggered by light touch. What type
of pain?
A. Acute pain
B. Neuropathic pain
C. Chronic pain
D. Visceral pain
B. Neuropathic pain
Behavioral Arousal and Stress Responses
compose of the ff. except:
-Pupillary Constriction
Stress activates the Sympathetic ANS which causes Pupillary Dilatation not constriction
The cellular body of the primary sensory
afferent is found in the?
-Dorsal root ganglia
Primary afferent classification except. A. Diameter B. Degree of myelination C. Response to stimuli D. Conduction velocity
C. Response to stimuli
All sympathetic postganglionic fibers are: A. Unmyelinated B. Myelinated C. None of the above D. All of the above
A. Unmyelinated
Which is true about the secondary activation
of primary afferent receptors?
A. Cell damage induces decrease in pH and
release of potassium
B. Prostaglandins increases the sensitivity of
the terminals by bradykinins and other pain
producing substances
C. Direct activation by pressure and noxious
stimuli
B. Prostaglandins increases the sensitivity of
the terminals by bradykinins and other pain
producing substances
Major neurotransmitter in pain
-Glutamate
The brain circuits that modulates the activity
of pain transmission pathway is?
A. Hypothalamus-midbrain-medulla
B. Hypothlamus -spinal cord-somatosensory
cortex
A. Hypothalamus-midbrain-medulla
True mechanism of referred pain
-convergence of sensory inputs to a single
pain-transmission neuron and the
convergence patterns are determined by the spinal segment of the dorsal root ganglion that supplies the afferent innervation of a structure.
The suggestion that the pain will worsen ff
the administration of innate substances
-Nocebo effect
The ff are included in the physical examination of aortic dissection except A. Murmur B. Pericardial rub C. Loss of peripheral pulse D. Inc in JVP
D. Inc in JVP
Thermoregulation in what part of hypothalamus? A. Preoptic hypothalamus only B. preoptic hypothalamus and posterior C. post optic and posterior D. Posterior hypothalamus only
B. preoptic hypothalamus and posterior
Most common cause on noncardiac chest
discomfort
-Gastroesophageal diseases
Pain in dermatomal distribution may be caused by: A. burns B. GERD C. Herpes zoster D. Acute myocardial infarction
C. Herpes zoster
Pain arising from abdominal wall is: A. Dull, low quality B. Steady and aching C. Poorly localized, intermittent D. Diffuse, severe
B. Steady and aching
accounts for 80% of clinician visits.
Pain
is an unpleasant sensation localized to a part of the body
Pain
Any pain of moderate or high intensity is accompanied by anxiety which explains the duality of pain:
SENSATION and EMOTION
→ Also known as Vanilloid receptor
→ Mediates perception of some noxious stimuli especially heat sensations.
TrpV1 (Transient receptor potential cation channel subfamily member 1)
TrpV1 is activated by:
o Acidic pH
o Endogenous mediators
o Capsaicin, a component of chili peppers
OD
Right Eye (Oculus Dexter)
OS
Left Eye (Oculus Sinister)
OU
Both Eyes (Oculus Universal)
VA
Visual Acuity
sc
Without correction (Sans correction)
cc
With correction (Core correction)
PH
Pinhole
Normal visual acuity:
20/20 or 6/6
The First number of visual acuity indicates ?
the distance of the patient from the chart,
The second number of visual acuity indicates ?
the distance at which normal eye can read the line of letters.
As the number increases the vision becomes ?
worse or more blur.
What should be done if the patient cannot see the largest letter on the chart from 20 feet away?
Move patient closer to the chart
o 15/200, 10/200, 5/200
if the patient still can’t read at 5ft use CF but start at ?
4ft to 1ft.
Hand Movements (HM)
1ft, done after CF
Light Perception (LP)
done after HM, make sure the other eye is well covered
No Light Perception (NLP)
blind (endpoint)
VISUAL ACUITY at Near is tested for patients that are how old?
usually 40 years and above
Test for Presbyopia – do not have the ability to accommodate
Affected : _________
Lens, zonules, ciliary muscles
Normal VISUAL ACUITY at Near
JAEGER 1-3
Jaeger Chart value is from __ to ___
Jaeger 1 to 16
Small chart with gradations, as the number increases, more difficult to read.
Jaeger Chart
Proper distance for Jaeger Chart
Proper distance is 14 inches
Newspaper, Magazine or Telephone Directory
Jaeger 1-3
Can be use even without any sophisticated machines only penlight
EXTERNAL EXAMINATION
Normal external examination of the eyes:
Lids
Not swollen
Normal external examination of the eyes:
Lashes
Not matted
Normal external examination of the eyes:
Conjunctiva
Pink
Normal external examination of the eyes:
Sclera
Anicteric
Normal external examination of the eyes:
Cornea
Clear
Normal external examination of the eyes:
Pupils(Lens)
3-4mm RTL
timos-timos
hordeolum
(lagob) sandwiched in conjunctiva and sclera
sub conjunctival hemorrhage
sub conjunctival hemorrhage management
usually summer time, apply cold compress for 2 days
To examine the patient’s RIGHT eye, the Examiner should use his:
→ RIGHT eye
→ RIGHT hand
visualize fundus
Ophthalmoscope
Normal ophthalmoscopy:
ROR
(+)
Normal ophthalmoscopy:
Media
Clear
Normal ophthalmoscopy:
Disc Margins
Distinct
Normal ophthalmoscopy:
Cup-Disc Ratio
0.3
Normal ophthalmoscopy:
A-V
2:3
A-V Ratio – artery(smaller):vein
Normal ophthalmoscopy:
Exudates, Hemmorhage
none
Journey of light as it enters the eye
Light ➡Cornea➡ Lens➡ Vitreous
Eye movement:
Medial rectus
adduction
Eye movement:
Lateral rectus
abduction
Eye movement:
Inferior rectus
Primary: depression
Secondary: extorsion
Tertiary: adduction
Eye movement:
Superior rectus
Primary: elevation
Secondary: intorsion
Tertiary: adduction
Eye movement:
Inferior oblique
Primary: extorsion
Secondary: elevation
Tertiary: abduction
Eye movement:
Superior oblique
Primary: intorsion
Secondary: depression
Tertiary: abduction
Corneal Light Reflex Test
Hirschberg Test
Hirschberg Test is used to?
Assesses eye alignment by the location of the Corneal Light Reflex within the pupil
Temporal Displacement
Esotropia
Nasal Displacement
Exotropia
Inferior Displacement
Hypertropia
What test is used to measure Intraocular Pressure?
TONOMETRY
Normal Intraocular Pressure
10 – 20 mm HG
*21 mm HG still normal
How is Intraocular Pressure measured?
• Palpation
• Schiotz- Indention tonometer
Rarely used, inaccurate, used on bedside pxn
• Goldmann Applanation Tonometer (Gold Standard)
Why is it important to learn how to use the Ophthalmoscope?
- Screen for GLAUCOMA, which is one of the most common causes of preventable blindness. Glaucoma is asymptomatic in early stages.
- Recognize Papilledema (swelling of pupils).
- Stage Hypertensive Retinopathy and Diabetic Retinopathy, other retinal diseases
Significance of the CD Ratio
- Glaucoma Screening
- The C:D Ratio is the Ratio of the DIAMETER of the CUP to the DIAMETER of the DISC
- NORMAL CD RATIO = 0.3
- Examine also, the RIM: look for “thinning” and “notching”
Significance of Blurred Disc Margins:
Papilledema
Significance of the AV Ratio:
Hypertensive Retinopathy
Murphy’s sign
→ Apply pressure inward then upward at right upper quadrant then instruct the patient to inhale
→ If there is a respiratory arrest while inhaling, that is the positive murphy’s sign
The most common causes of abdominal pain on admission:
→ acute appendicitis
→ nonspecific abdominal pain
→ pain of urologic origin
→ And intestinal obstruction.
Location of auscultation:
Aortic
2nd ICS right parasternal area
Location of auscultation:
Pulmonic
2nd ICS left parasternal area
Location of auscultation:
Tricuspid
5th ICS left parasternal area
Location of auscultation:
Mitral
5th ICS midclavicular line
