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
Abnormal growth of conjunctiva that extends over the cornea from the limbus
Pterygium
What uses sensory fibers of CN V and motor fibers of CN VII?
Blinking
Lipids deposited in the periphery of the cornea
Corneal arcus (arcus senilis)
Pupillary constriction to less than 2 mm
Miosis
Pupils fails to dilate in the dark (common with narcotics)
Miotic
Pupillary dilation of more than 6mm and failure of the pupils to constrict with light
Mydriasis
Inequality of pupillary size
Anisocoria
Accommodation should be tested how far from patients’ nose?
10 cm
Yellow or green sclera would indicate:
Liver or a hemolytic disease
Dark or slate gray pigment of the sclera would indicate:
Senile Hyaline plaque
What tests the balance of extraocular muscles?
Corneal light reflex
Distance the light is shined from a corneal light reflex
30 cm
Outward strabismic
Exotropic
Inward strabismic
Esotropic
Distance you want to start for an internal eye exam
30 cm (12 inches)
Eye arterioles are smaller than venules at a ratio of:
3:5 to 2:3
Retina converges to the optic nerve. No photoreceptors, “Blind Spot”
Optic disk
Diameter of the optic disk
1.5mm
What is 2-disc diameters temporal to the optic disc?
Macula (or Fovea)
Fundoscopic exam:
- Small discrete spots
- Slightly more yellow than retina
- Enlarge with time
- Conditions affecting pigment layers of retina
- Aging; precursor of senile macular degeneration
Drusen bodies
Fundoscopic exam:
- ill defined yellow spots
- Infarction of retinal nerve layer
- vascular disease from HTN or DM
Cotton wool spots
Protrusion of the eye
Lids don’t reach iris
Exophthalmos
Inflammation of superficial layers of sclera
Episcleritis
Calcium deposition in superficial cornea
Horizontal grayish bands, dark areas
Band Keratopathy
Disruption of corneal epithelium and stroma
Infection (bacterial/viral) or desiccation
Contact lens wearer
Coneal Ulcer
Both eyes do not focus on an object simultaneously
Strabismus
Internal eye, pupil abnormality
Interruption of sympathetic nerve innervation to the eye
Horner syndrome
Lens opacity
Usually from denaturation of lens protein (aging)
Cataracts
Dot hemorrhage or micro-aneurysms
Hard exudates (bright yellow, superficial in retina) Soft exudates (cotton-wool spots, dull gray spots)
Diabetic retinopathy
Development of new vessels as a result of anoxic stimulation
- Peripheral retina or optic nerve
- Increased hemorrhage risk leads to blindness
Proliferative
Creamy white appearance of retinal vessels
Seum triglycerides >2000mg/dL
Hyperlipidemic states
Lipemia Retinalis
Autosomal recessive disorder in which the genetic defects cause cell death, predominately in the rod photoreceptors
Loss of night vision
Optic Atrophy “waxy pallor” narrowing of arterioles
Retinitis pigmentosa
Disease of the optic nerve wherein the nerve cells die
Usually because of high IOP
Characteristic “cupping” of optic nerve
Glaucoma
Inflammatory process involving both the choroid and the retina
White yellow lesion
Strippled with dark pigment later stage
Chorioretinal scar
Chorioretinitis
Defective vision or blindness in 1/2 of the visual field
Hemianopia
Loss of vision closest to the temples
Bitemporal hemianopia
Loss of half of the field of view on the same side in both eyes
Homonymous hemianopia
Secretes cerumen
Apocrine glands
What does cerumen do?
Provides an acidic pH environment (inhibits growth of mocroorganisms)
3 small connected bones of the middle ear
Malleus, incus, and stapes
Ossicles
Membranous, curved cavity inside a bony labyrinth consisting of the vestibule, semicircular canals, and cochlea
Inner ear
Coiled structure containing the organ of Corti, transmits sound impulses to the CN VIII
Cochlea
Contain the end organs for vestibular function
Equilibrium receptors here respond to movement and send signals to the cerebellum to maintain balance
Semicircular canals and vestibule
Openings of the nose, surrounded by cartilaginous ala nasi and columella
Nares
Part of the nose formed by the frontal and maxillary bones
Bridge
Internal nose, formed by the hard and soft palate
Nasal floor
Internal nose, formed by the frontal and sphenoid bone
Nasal roof
Location of the receptors for smell
Olfactory epithelium
Lies on the roof of the nose and houses the sensory endings of the olfactory nerve
Cribriform plate
Convergence of small fragile arteries and veins, located on the anterior-superior portion of the septum
Kieselbach plexus
Lymphatic nodules that lie on the posterior wall of the nasopharynx
Adenoids
Parallel, curved bony structures covered by vascular mucous membrane
Turbinates
Increases the nasal surface area to warm, humidify, and filter inspired air
Turbinates
Inferior turbinate meatus drains the:
Nasolacrimal duct
Middle turbinate meatus drains the:
Paranasal sinuses
Superior turbinate meatus drains the:
Posterior ethmoid sinus
Air-filled, paired extensions of the nasal cavities within the bones of the skull
Paranasal sinuses
Sinuses that lie behind the frontal sinuses and near the superior portion of the nasal cavity
Ethmoid sinuses
Deep sinuses in the skull behind the ethmoid sinuses
Sphenoid
Dorsal surface of the tongue covered with thick mucous membrane supporting the:
Filiform papillae
What is scattered throughout the filiform papillae of the tongue and has taste receptors?
Fungiform papillae
Attached to the alveolar ridges (alveolar process) of the maxilla and mandible
Teeth
Sudden hearing loss may indicate:
Vascular or autoimmune process
Hearing loss in a few hours or days may indicate:
Viral infection
- Aminoglycosides (Gentamicin)
- Chemotherapy (Cisplatin)
- Antimalarial (Quinine)
- Salicylates
- Furosemide
Ototoxic medications
Thickening along the upper ridge of the helix
Darwin tubercle
Ear:
Results from blunt trauma and necrosis of the underlying cartilage
Cauliflower ear
Small, whitish uric acid crystals along the peripheral margins of the auricles (may include gout)
Tophi
Whisper hearing test:
Unable to correctly repeat what percentage of words indicates a hearing impairment
50%
Helps assess unilateral hearing loss
Weber test
Helps distinguish whether the patient hears better by air or bone conduction
Rinne test
Bridge of tissue separating the nares
Columella
Compared to buccal mucosa, nasal mucosa should be:
More pink
Bluish gray or pale pink turbinates with a swollen boggy consistency may indicate:
Allergies
Dry, cracked lips
Cheilitis
Deep fissures at the corners of the mouth
Angular cheilitis
Circumoral pallor may be associated with:
Scarlet fever due to a strep infection
Round, oval, or irregular bluish gray macules on lips and or buccal mucosa
Peutz-Jeghers syndrome
Red spot on the opening of the Stensen duct, is associated with:
Parotitis (Mumps)
White, round, or oval ulcerative lesions with a red halo
Aphthous ulcers
Thick, white patch lesion that cannot be wiped away
Premalignant oral lesion
Leukoplakia
Diffuse, filmy grayish surface with white streaks, wrinkles, or milky alteration
Normal variant, asymptomatic oral benign lesion
Leukoedema
Teeth:
Yellow stained
Tabacco
Teeth:
Brown stained
Coffee or tea
Teeth:
Discolorations on the crown
Suspect caries
Protrusion of the upper incisors
Overbite
Protrusion of lower incisors or failure of the upper incisors to overlap with the lower incisors
Cross-bite
Failure of back teeth to meet
Open Bite
Superficial denuded circles or irregular areas exposing the tips of the papillae of the tongue
Geographic tongue
Glossitis (smooth red tongue with slick appearance) may indciate:
Vitamin B12 deficiency
Hairy tongue, yellow-brown to black elongated papillae on the dorsum, usually follows what treatment?
Antibiotic therapy
Ducts apparent on each side of the frenulum
Wharton
Indicates sublingual salivary gland obstruction
Ranula (macocele)
Non-midline nodule in the palate may indicate:
Tumor
Bony protuberance at the midline of hard palate
Torus palatinus
Deviation of the soft palate when the patient says “ah” may indicate:
Vagus nerve paralysis
Peritonsillar abscess
Abnormal squamous epithelial tissue behind the tympanic membrane
Cholesteatoma
Reduced transmission of sound to the middle ear
Conductive hearing loss
Reduced transmission of sound in the inner ear
Sensorineural hearing loss
Inner ear disorder characterized by episodes of hearing loss, vertigo, tinnitus, ear fullness
Meniere Disease
Illusion of rotational movement by the patient, often due to a disorder of the inner ear
Vertigo
Deep infection in the space between the palatine tonsil capsule and pharyngeal muscles
Peritonsillar abscess
Life-threatening deep neck space infection that has the potential to occlude the airway; occurs in the potential space extending from the base of the skull to the posterior mediastinum between the posterior pharyngeal wall and prevertebral fascia
Retropharyngeal abscess
Oral cancer occurs most often in what cells?
Squamous cell
Chronic infection of the gums, bones, and other tissues that surround and support the teeth
Periodontal disease (periodontitis)
Most common craniofacial congenital malformation
Oropharyngeal clefts (Cleft lip & palate)
Eye staining:
Inspect the cornea with maginfcation under what color light source?
Cobalt blue
What should you use when a plain fluorescein examination is non-diagnostic?
Slit lamp
Anterior nose bleeds account for what percentage?
90%
Primary source of blood for the posteroinferior septum
Sphenopalatine artery
Uppermost part of the nasal septum is supplied by the:
Anterior and posterior ethmoid arteries
Kiesselbach’s plexus is responsible for what percentage of nose bleeds?
95%
Nosebleeds lasting more than how many minutes may need nasal packing?
10 minutes
Nasal packing absorbable dressings
Gelfoam
Surgical
How long do you apply the silver nitrate stick with gentle pressure for?
3-10 seconds
Do not cauterize a nasal area greater than:
1 cm in diameter (4 dabs of the nitrate stick)
Leave nasal packing in place for:
48 hours
Gauze should be layered from nasal floor to turbinates.
Approximately how much gauze will be required?
4-5 feet
Nasal packing fails to stop epistaxis in up to:
25% of cases
What medications should you avoid post-nasal packing?
Aspirin and other NSAIDS
Patients needing posterior packing or balloon device insertion generally require admission to an ICU and specialist consultation.
What percentage of these patients with require intubation?
40%
