CA-EXAM#2 Flashcards
what should you always do before and AFTER exams?
visual acuity
why shouldn’t you use topical anestetic
- can be cytotoxic to the epithelium2. retard healing3. increased risk of corneal scaring or infection
Hordeolum
“stye”, swelling at the margin of the eyelid by plugging of eyelash follicle to tear gland, can harden into a chalazion
dacryoadenitis
swelling and pain of the outer portion of the upper eyelid, inflammation of the lacrimal gland
corneal abrasions
severe pain, photophobia, and foreign body sensationExamination:1. penlight, look for penetrating trauma2. visual acuity3. fundoscopic exam4. fluorescin stain5. evert upper eyelid
pterygium
triangle wedge of fibrovascular tissue that starts at the nasal conjustiva and extends into the cornea
strabismus
dysconjugate gase1. imbalance of occular muscle tone2. cover-uncover test (the eye will look forward again when the good eye is covered because it is trying to compensate
cataracts, who are they common in? what do you loose?
opacity of the lense, problems with night driving or difficulty with fine printRF: older age, smoking, corticosteroid useLOSS OF RED REFLEX
open angle glaucoma; how about the cup?
rarely symptomatic, usually incidental findingslow and progressive”tunnel vision”increased cupping, cup plaes, Cup>1/2 diameter of the disc, retinal vessels displaced nasally
closed angle gluacoma
EMERGENCY rapid increase in IOP, severe pain, nausea, halos around lightscilliary injection, dilated and fixed pupils, decreased vision
papilledema
EMERGENCY, increase in IOP, swelling of the optic disk, blurred marginsCauses: intracranial mass, lesion, or hemmorage meningitis
hypertensive retinopathy
AV Nicking- vein appears to stop abruptly on either side of the arterycoper wiring-arteries become full, increased light reflex
diabetic retinopathy
neovascularizationcotton wool spots-white or grayish over lesions due to infarction nerve fibers and reintal ischemia
what tool do you use to remove cerumen?
ear curettes
ottitis externa
ear pain, discharge, tenderness with tragal pressure or when auricle is pulledwick placement for sever infections
what two methods can you use to check for TM mobility and confirm middle ear effusion?
pneumatic otoscopy: creates a puff of air, confirm middle ear effusiontympanogram: creates vibrations of ear pressure in the canal
tympanosclerosis
- chalky white patches with irregular margins2. scarrring from severe AOM
serous effusion; what are two common causes
fullness, popping sensationfluid line and/or bubbles behind the TMoften caused by atmospheric pressure or URI
otitis media, what two bacteria can cause it?
TM erythematous and bulging, landmarks obscured, dilated vesslesS.pneumoniae and H. influenzae
eutachian tube dysfunction
ear fullness, ear pain, tiniitis, autophony
Weber test
UNILATERAL HEARING LOSSconductive: sound in IMPAIRED ear[bones aren’t working and sensineural is working so it works in overdrive and works more to pick up the sounds, think of jordan putting the virbrating thing on my head, heard it bad ear]senorineural loss: sound in GOOD ear
Rinne test
checks air vs bone conductionNormal hearing AC>BCConductive: BC>AC or BC=ACsensorineural: AC>BC
Benign positional vertigo, what causes it? what helps it?
triggered by head position change, N/V, NYSTAGMUScaused by CANALITHIASIS, calcium deposit in the semicircular canalcorrect with dix-hallpike position
acute sinusitis; what is important to do?
mucopurlulent nasal drainage, inferior turbinate hypertrophy, sinus pressure and pain, transluination of the sinuses
allergic rhinitis; color. what are two signs
pale, boggy nasal mucosa with blueish hue, allergic shiners and allergic salute
foreign body; what can you remove it with?
foul smelling, purlulent, unilateral discharge, preschoolersremoval: blowing nose, sneezing, aligator forcepts
nasal polyp; what can cause them?
grape like growthsintranasal corticosteroid spray, refer to ENT
angular cheilitis; what can cause it? what do you use to diagnose it?
erythema, maceration, scaling, fissures at the angle of the mouthcauses: overclosure of the mouth, nuitritional deficiencycandida albicans, KOH prep
gingivostomatitis; what can cause it?
cole sole, HSV, cluster of small vesicles, coalesce to form ulcer
aphthous ulcer; what is the coloration like?
canker sore, round well definied ulcer, GRAYISH BASE, surrounded by halo of reddened mucose
dental decay; what do you want to know?
tooth pain, gum swellingwant to know if the infection source is coronal or root surface of the tooth
gingivitis; what is the coloration? what causes it?
swelling and blueish purple discoloration of gingiva, bleeding gums after eating or brushingcause: dental plaque
oral candidiasis; what can you loose?
thrushpain with eating or swallowing, loss of tastethick white plaques
leukoplakia; what type of cell is this in?
thick white plaques, painlessreactive process of squamous eipthelium, doesn’t go away if you rub it! biopsy it!
sialolothiasis; what should you have to patient do in order to diagnose beter
stones in the salivary glands or ducts, aggrevated by eating,CP: have patient close mouth slightly to relax muscles, allows for better palpation of the floor of the mouth
sialadentitis; where would you find swelling?
gland pain and swelling with pus draining from duct, consider CT, USswelling by the parotid gland or submandicular glands
actue pharyngitis; what is an importantant characteristic? what/where should you look?
viral, bacteria, allergies, irritants (smoke)COBBLESTONINGlook for epiglottis, peritonsillar abcess, submandibular space infections, retropharyngeal space infection form HIV
submandibular space infections
ludwigs angina
what are two conditions that cause exudative tonsillitis
EBV, infectious monoGAS pharyngitis
infectious mono; what two tests can you do? where should you palpate?
POSTERIOR cervical LAD, splenomegly, EBV, monospot and CBC
GAS pharyngitis (Group A Strep); what test do you want to do? where do you want to palpate and what might you see?
ANTERIOR cervical LAD, scarlatiniform rashRADT (rapid antigen detecting test) +/- throat culture
when will you commonly see a erythematous maculopapular rash?
patient with EBV aftering taking ampicillin/amoxicillin
epiglottis; what should you never do? whats something interesting can you see on a xray? symptoms?
muffled voice, drooling, sniffling and tripodding positionDO NOT VISUALIZE THROAT WITH TONGUE BLADELateral xray and look for THUMB SIGN
peritonsillar abscess; explain what happens with the uvula? where is this located? what are the three stages of disease?
muffled voice, trismuspus between palatine tonsil and pharyngeal muscles, FLUCTULANT TONSIL, DEVIATION OF THE UVULA TO OPPOSIT SIDEpolymicrobial…..tonsilitis then cellulitis then abcess
Jugular venous pressure; what side can you visualize this better on? what can cause it to increase and decrease?
pressure in right atrium, best asscessed in the right internal jugular veindecreased in blood loss and increases in heart failure, pulmonary hyper tension, and tricuspid stenosis
the sternal sternal angle remains roughly ____ above the right atrium
5 cm
where do you see the internal jugular venous pulsations
suprasternal notches, along the sternocleomastoid muscle, lower neck basicaly
normal JVP findings
Less than 4 cm above sternal angle or 9 from right atrium (add 5 to the measurement from sternal angle to get the total distance).
what are the differences between carotid and venous pulsations
carotid: palpable, single outward movement, stronger, not elimated when pushing, heigh unchanged by position, height not effected by pulsationsinternal jugular: rarely palpable, soft, height changes with position, falls with inspiration
what are you accessing for when you listen to carotids?
bruits
thrills; How do you find it? what does it sound like?
humming vibrations, like a cat when purring PALPABLE MURMER, FEEL FOR IT
bruits; how do you find it
a mumur like sound from tuburlent flow, LISTEN FOR IT
lift and heaves; where do you access for these? specifically? How do you access for them?
on chest, you feel for them not listen, S3 and S4 at the apex
PMI-point of maximum impulse
apical pulse, 4th or 5th interspace along the mid clavicular line
2nd right intercosta space you hear
aortia
2nd left intercostal space you hear
pulmonary area
3rd intercostal space you hear; what can you hear best here
erbs point, best for S2 auscultation
4th/5th inercostal space you hear
tricuspid area
5th intercostal space in the midclavicular line you hear
apex, mitrial area
left lateral decubitus position; where do you listen? what does it help you to hear?
ascultate with the bell at the apex at the apex or 5th intercostal space, brings left ventricle closer to the chest wall and accentuates MITRIAL MURMERS S3 and S4
by having the person lean forward and listening to their left 2nd and 3rd intercostal spaces, it accentuates
an aortic murmer
explain the sounds you would hear when precussing
flat-thighdull-liverresonant- healthy lungtympanic-gastric air bubbles in the intestines
vesicular sound explination
inspiration>expiration
broncho-vesicular
expiration=inspiration, 1st and 2nd intercostal spaces anteriorly
bronchial
exp>inspiration over manubrium
tracheal
insp=exp over trachea
where do you place your hands to measure respiratory excursion
10th ribs
what are the number of percussion and auscultation fields on the back and front for the lungs?
4 anterior, 2 lateral, and 7 posterior
what is the difference between respiratory expasion and diaphragmatic excursion
respiratory expansion is when you pinch the skin in the back and have them take a deep breath indiaphragmatic excursion is when you have them take a deep breath in and measure where the percussion sounds change from resonant to dull, and do the same thing coming back up 3-5.5 cm normal values
what is the normal measurement for diaphragmatic excursion
3-5.5 cm
where do you precuss on your hand
pleximeter finger at the dip joint
explain the different between pleximeter finger and plexor finger when precussing
pleximeter finger is the left middle fingerplexor finger is the right middle finger
how do you distinguish between resonant and tympanic?
resonant: loud intensity, low pitchtympanic: loud intensity, HIGH pitch
coarse crackles or rales
20-30 sec, louder
fine crackles or rales
5-10 sec, very brief and soft
wheezes
whistles, high pitched
rhonchi
snoring, coarse
what are the grades for pulses
0-none, unable to palpate/absent1- weak pulse, diminished2+ normal pulse, brisk3+ too strong, bounding
what is the order for the cardiac exam
- look at neck2. palpate down the sternal boarder, the the PMI which is between 4th and 5th intercostal in mid clavicular line3. roll over and listen to the apex4. proceed with listening to the rest5. then have them sit up and lean forward listening to the aorta
where should your hands be to palpate the kidney on the back?
12th ribs
striking the back allows you to access for
costovertebral tendernous
what is the rating scale for pitting
0-none1+- depression, disappeares 2+-2-4 mm, 10-20 seconds3+-4-6 mm, >1 min4 6-8 mm for many minutes
S1 systolic is usually ______ than S2
S1 systolic is usually louder than S2 at apex
T or F, you PALPATE for heaves, lifts and thrills. where do you palpate for them?
TRUE, 4-5th intercostal space on midclaicular line
average size of the aorta is
2.5 cm
HOW DO YOU FIND LIFTS, THRILLS, AND HEAVES?
FEELING THEM, NOT LISTENING!!
