Chap 2 Physical Exam Flashcards
7 bones of the skull:
Two Frontal
Two Parietal
Two Temporal
One Occipital
Facial bones:
Frontal Nasal Zygomatic Ethmoid Lacrimal Sphenoid Maxillary Mandible
Major Facial Landmarks
Palpebral Fissures
Nasolabial Folds
Facial muscles are innervated by what cranial nerves?
CN V and CN VII
What forms the neck?
Cervical vertebrae
Ligaments
Sternocleidomastoid muscle
Trapezius muscle
Lymph nodes, ducts, various tissues, responsible for lymph fluid drainage and immune responses
Lymphatic system
How many posterior cervical lymph chains are there?
2
Two lateral lobes are butterfly shaped and are joined by an isthmus at their lower aspect
Thyroid
What mainly covers the thyroid lobes?
Sternocleidomastoid muscle
What history of present illness questions are good for a patient with a thyroid problem?
Temperature preference Neck swelling Skin & Hair Texture Emotional Status Eye Prominence Menstrual and bowel patterns
Nodding synchronized with pulse would indicate?
Aortic insufficiency
Unilateral hearing/vision loss.
Patient’s head is tilted, favoring one side
Torticollis
Expression or appearance of the face from a clinical condition
Facies
Hair texture that indicates hypothyroidism
Coarse, dry, and brittle
Hair texture that indicates hyperthyroidism
Fine, silky
Stensen duct
Parotid duct, Maxillary Second Molar
Wharton duct
Submandibular duct, small papilla at the sides of the frenulum
Enlarged tender salivary gland would indicate:
Viral or Bacterial infection
Ductal stone
Discrete salivary gland would indicate:
Cyst or tumor
Percussion on the masseter muscle may produce a hyperactive masseteric reflex
Chvostek sign
Bruits over the eye and occiput with diplopia may suggest:
Cerebral Aneurysm
Bruits over the temporal artery are associated with:
Temporal arteritis
Trachea tugging sensation, synchronous with the pulse suggests:
(Cardarelli sign or Oliver sign)
Aortic aneurysm
Thyroid is approximately how big?
4cm
Right lobe of the thyroid is often what percent larger than the left?
25%
Coarse/Grittiness thyroid indicates:
Thyroiditis (Inflammatory process)
Hard/irregular thyroid nodules suggest:
Malignancy
Enlarged and tender thyroid may indicate:
Thyroiditis
Persistent, recurrent, and severe headaches may indicate:
Brain tumor or migraines
Webbing or short neck may indicate:
Chomosomal anomalies
- Puffy, dulled yellowed skin
- Coarse, sparse hair
- Temporal loss of eyebrows
- Periorbital edema
- Prominent tongue
Myxedema
- Fine, moist skin
- Fine hair
- Prominent eyes
- Lid retraction
- Staring/startled expression
Hyperthyroidism
- Coarsened features
- Broadened nasal alae
- Prominence of zygomatic arches
Acromegaly
- Sunken eyes, cheeks, temporal areas
- Sharp nose
- Dry, rough skin
- Terminal stages of illness
Hippocratic facies
- Butterfly rash
- Malar surfaces and bridge of nose
- Blush with swelling
- Scaly, red maculopapular lesions
Lupus (SLE)
- Freely movable cystic mass
- High in neck
- Midline
- Duct at base of tongue
- Remnant of fetal development
Thyroglossal duct cyst
Salivary glands most commonly have tumors
Parotid
Wry Neck
From birth trauma, tumors, trauma, cranial nerve palsy, muscle spasms, infection, drug ingestion
Torticollis
Skin and tissue disorder usually due to severe prolonged hypothyroidism
Myxedema
Autoimmune, antibodies to thyroid stimulating hormone receptor, leading to overactive thyroid
Characterized by diffuse thyroid enlargement (goiter)
Graves’ disease
Autoimmune antibodies against thyroid gland, often causing hypothyroidism
Hashimoto disease
Glands in the eyelid provide oils to tear film
Meibomian glands
Provides a skeleton for the eyelid
Tarsus
Thin and clear mucous membrane covering most of the anterior surface of the eye and eyelid
Conjunctiva
Conjunctiva that coats the inside of the eyelids
Palpebral
Conjunctiva that protects the anterior surface of the eye (except the cornea) and the surface of the eyelid in contact with the globe
Bulbar
Eye muscles
Superior, inferior, medial, lateral rectus
Superior and inferior obliques
What cranial nerve controls the levator palpebrae superior (which elevates and retracts the upper eyelid)?
CN III
What cranial nerve controls superior, inferior, medial rectus muscles and the inferior oblique muscles?
CN III
CN that controls the superior oblique muscle
CN IV
CN that controls the lateral rectus muscle
CN VI
Posterior outer layer of the eye
Sclera
Anterior outer layer of the eye
Cornea
Posterior middle layer (uvea) of the eye
Choroid
Anterior middle layer (uvea) of the eye
Ciliary body and iris
Inner layer of the eye
Retina
Posterior 5/6 of the globe, dense, avascular white portion of the eye
Supports the internal structure of the eye
Sclera
Anterior 1/6 of the glove and is continuous with the sclera
Optically clear, has rich sensory innervation, and is avascular
Major refractive power of the eye
Cornea
Composed by the iris, ciliary body, and choroids
Uvea
Produces aqueous humor (fluid that circulates between the lens and cornea)
Contains the muscles controlling accommodation
Ciliary body
Pigmented, richly vascular layer that supplies oxygen to the outer layer of the retina
Choroid
Biconcave, transparent, elastic structure that changes its thickness to focus images on retina (refraction)
Lens
Sensory network of the eye (transforms light impulses into electric impulses that are transmitted to the brain)
Retina
What allows for color perception and central vision
Macula/Fovea
Eye nerve origin
Optic disk
Risk factor for cataract formation, glaucoma, macular degeneration, thyroid eye disease
Cigarette Smoking
Distance for near visual acuity
35 cm, or 14 inches
Distance used for peripheral vision, confrontation test
1m (3 feet)
Irregularly shaped, yellow-tinted lesions suggestive of abnormality of lipid metabolism
Xanthelasma lesion
Eyelid tremors when the eye is closed could indicate:
Hyperthyroidism
Lids do not completely close
Lagophthalmos
If one superior eyelid covers more of the iris than the other, or extends over the pupil
Ptosis
Patient has ptosis.
What could be the cause?
Weakness of levator muscle
Paresis of a branch of CN III
Lid is turned away from the eye (may result in excessive tearing)
Ectropion
Lid is turned inward toward the globe (may cause irritation, increased risk of infection)
Entropion
Acute supportive inflammation (staphylococcal) of the follicle of an eyelash that forms an erythematous or yellow lump
Hordeolum (stye)
Crusting along the eyelashes caused by bacterial infection
Seborrhea, psoriasis, rosacea, or allergic response
Blepharitis
Firm eye palpation may indicate:
Severe glaucoma or tumor
Erythematous or cobblestone eye conjunctiva could indicate:
Allergies or infectious conjunctivitis
Bright red blood in a sharply defined area surrounded by healthy-appearing conjunctiva
Subconjunctiva hemorrhage
