COMPREHENSIVE Flashcards
1
Q
what are we looking for when palpating the nose?
A
tenderness, access patency
2
Q
mixed hearing loss
A
combination of conductive and sensorineural types in same ear
3
Q
Sensorineural hearing loss signifies pathology of cranial nerve ___
A
8
4
Q
gradual nerve degeneration resulting in hearing loss
A
presbycusis
5
Q
conductive hearing loss
A
involves mechanical dysfunction of external or middle ear
6
Q
What can cause conductive hearing loss?
A
cerumen, foreign bodies, perforated TM, pus, serum, otosclerosis (decrease in mobility of ossicles)
7
Q
Rinne test expected finding
A
AC greater than BC
8
Q
Weber test
A
patient can hear tuning fork on both sides of head
9
Q
What do we inspect the tympanic membrane for?
A
landmarks, color, contour, translucence
10
Q
What can cause the red reflex to be absent?
A
cataracts
11
Q
adaptation of eye for near vision
A
accommodation
12
Q
Although the lens cannot be observed directly, the following
components of accommodation
can be observed
A
convergence, puillary constriction
13
Q
fixation
A
a reflex direction of eye toward an object attracting person’s attention
14
Q
When we fixate on an image, it is fixed in the center of the visual field, the ______
A
fovea centralis
15
Q
pupillary light reflex
A
ormal constriction of
pupils when bright light shines on retina
Subcortical reflex arc, person has no
conscious control over it
16
Q
why do our pupils have a consensual response?
A
Because the optic nerve carries the
sensory afferent message in and
then synapses with both sides of the brain
17
Q
how to perform Corneal light reflex (AKA hirschberg test)
A
Assess parallel alignment of eye
axes by shining a light toward
person’s eyes
Direct person to stare straight
ahead as you hold the light about
30 cm (12 inches) away
Note reflection of light on
corneas; should be in exactly
same spot on each eye
18
Q
What do we inspect ocular structures for?
A
corneal light reflex, sclera (color, surface characteristics), iris for shape and color, pupils for PERRLA
19
Q
what do we inspect for on the conjunctiva?
A
color, moisture, drainage, lesions
20
Q
Normal Jaeger card result
A
14/14
21
Q
How to use a jaeger card
A
hold card in good light about 35 cm (14 in) from eye. his
distance equals print size on 20-
foot chart
Test each eye separately, with
glasses on
22
Q
What is the most commonly used and accurate measure of visual acuity?
A
snellen chart
23
Q
How to use snellen chart
A
place in a well-lit spot at eye level. position person 20 feet away. hand them an opaque card to shield one eye at a time. they can wear normal glasses but not readers.
24
Q
what is the most common type of endocrine malignancy?
A
thyroid cancer
25
Thyroid cancer clinical findings?
frequently does not cause symptoms. first idscovered as a small nodule on thyroid
26
candidiasis (thrush)
oral infection caused by candida albicans in those chronically
debilitated or
immunosuppressed, or as a
result of antibiotic therapy.
27
Epistaxis
bleeding from nose
28
inflammation of middle ear space, resulting in accumulation of serous fluid in middle ear
otitis media with effusion
29
Common symptoms of OME
clogged sensation in ears, problems with hearing and balance
30
early stage of acute otitis media
tympanic
membrane (TM) appears inflamed,
red, and may be bulging and
immobile.
31
later stages of otitis media
may reveal
discoloration (white or yellow
drainage) and opacification to the
TM
32
Purulent drainage from the ear
canal with a sudden relief of pain
suggests
perforation
33
foreign body in the ear is mostly seen in
children
34
Cataract
opacity of crystalline
lens from denaturation of lens
protein caused by aging and may
be congenital or caused by
trauma
35
clinical findings with cataracts
cloudy or blurred vision, poor night vision, absent red reflex, cloudy lens observed on inspection
36
corneal abrasion clinical findings
intense pain, foreign body sensastion, reports photophobia, tearing and redness observed
37
inflammation of conjuncgtiva caused by local infection of bacteria or virus, or by allergic reaction, systemic infection or chemical irritation
conjunctivitis
38
a patient comes in with red eyes that are oozing sticky goo especially in the mornings. what might be going on?
conjunctivitis "pink eye"
39
common name for hordeolum
sty
40
Why do we get stys?
they are caused by an acute staph infection of the eye.
41
Chalazion
nodule of meibomian gland in the eyelid. may be tender if infected.
42
What age group most commonly gets tension headaches?
20 to 40 years old
43
What type of headache is usually bilateral, with gradual onset, and may be accompanied by contraction of the neck muscles as well as the muscles of mastication?
tension headaches
44
Which is the most painful of primary headaches?
cluster headache
45
cluster headache clinical findings
intense epidsodes of excruciating unilateral pain. lasts 30 mins to 1 hour and may repeat daily, sometimes for years.
46
Age group who most commonly gets cluster headaches?
adolescence to middle age
47
True or false? recurrent headaches are a symptom of primary headache disorder
true
48
Starts with aura from vasospasm
of intracranial arteries; throbbing
unilateral distribution of pain
migraine
49
second most
common headache syndrome in the
United States
migraine
50
Most common medical complaint.
headache
51
describe dry cerumen
gray, flaky, and frequently forms thin
mass in ear canal
52
describe wet cerumen
honey brown to dark brown and
moist
53
take caution to avoid mistaking flaky, dry cerumen for
eczematous lesions
54
True or false? salivation starts at one week and the baby will immediately know how to swallow saliva.
false. 3 months, takes a few months before swallowing and they will drool for a while
55
When do teeth begin developing?
in utero
56
When do decidous teeth emerge?
between 6 months and 24 months. all 20 should emerge by age 2.5
57
how many decidous teeth do we have?
20
58
Deciduous teeth are lost beginning at age 6 through 12 and are replaced with permanent teeth. Which permanent teeth emerge first?
central incisors
59
When does the nose start and stop growing?
starts at 12 or 13, stops at 16 in females and 18 in males
60
tiny oval clumps of lymphatic tissue, usually located in groups along blood vessels
lymph nodes
61
True or false? lymph nodes are found in chains or clusters
true
62
Name all of the lymph nodes of the HEENT
preauricular, parotid, facial, submandibular, submental, sublingual, anterior superficial cervical, posterior auricular, occipital, sternomastoid, retropharyngeal (tonsilar), posterior superficial cervical chain
63
What is the largest endocrine gland?
thyroid
64
where is the thryoid accessible for examination?
either side of the trachea
65
Where is the larynx?
below the pharynx, above the trachea
66
structures within the neck include
cervical spine, sternocleidiomastoid muscle, hyoid bone, larynx, trachea, esophagus, thyroid glands, lymph nodes, carotid arteries, jugular veins
67
components of oropharynx
uvula, tonsils, posterior pharyngeal wall, epiglottis
68
Cartilagenous structure protecting laryngeal opening
epiglottis
69
Three turbinates lining the lateral walls of the nasal cavity
inferior meatus, middle meatus, superior meatus
70
drains nasolacrimal duct
inferior meatus
71
drains frontal, maxillary, and ethmoid sinuses
middle meatus
72
drains posterior ethmoid sinus
superior meatus
73
face comprises _____ bones
14
74
cranial nerves innervating the face
V (trigeminal), V11 (facial)
75
palpebral fissure
opening between eyelids
76
2 thin transparent mucous membranes between eyelids and eyeball
conjunctivae
77
meibomian gland
secretes
substance to lubricate lids,
slows evaporation of tears,
provides airtight seal when
lids closed
78
Lacrimal glands
form tears
that combine with
sebaceous secretions to
maintain constant film over
cornea
79
3 layers of eyeball
sclera (outer)
uvea (middle)
retina (inner)
80
tough, fibrous, outer layer/ white of eye
sclera
81
cornea
covers iris and pupil. is transparent, avascular, and richly innervated with sensory nerves
82
Cornea allows light transmission through lens to ________
retina
83
tears provide cornea with oxygen and protect the surface from ____
drying
84
explain the mechanism of the corneal reflex
CN5 will carry afferent sensation to brain, and CN7 carries efferent message that stimulates blink
85
What does the uvea consist of?
choroid layer (posteriorly), iris (anteriorly), pupil (central opening of iris, allows light transmission to retina), ciliary body, anteriorly
86
Transparent layer of eye with photoreceptor cells, rods and cones, unevenly distributed over its surface
retina (inner)
87
occurs when rods and cones respond to various stimuli
vision
88
lenses constantly adjust to stimuli at different distances by ______
accommodation
89
CN2
optic nerve
90
CN3
oculomotor nerve
91
How many exrinsic eye muscles do we have and what are they?
6. 4 rectus, 2 oblique
92
conjugate movement
when two eyes move, their axes always remain parallel
93
Why are parallel axes important?
the brain has a binocular, single-image, visual system.
94
3 cranial nerves repsonsible for eye movement
6 (abducens), 4 (trochelar), 3 (oculomotor)
95
3 main functions of auricle
collection, location, protection
96
opens briefly during yawning , swallowing, or sneezing to equalize pressure of middle ear to the atmosphere
eustachian
97
function of middle ear
amplification of sound
98
3 middle ear ossicles
malleus, incus, stapes
99
3 main inner ear structures
cochlea, vestibule, semicircular canals
100
where are the inner ear receptors for balance found?
vestibule, semicircular canals
101
pathway of hearing
middle ear ossicles- oval window- through cochlea- vibration - organ of corti- auditory portion of cn 8, brain stem
102
Where are the maxillary sinuses?
on either side of cheekbones
103
Where is the sphenoid sinus?
deep in skull, behind ethmoid
104
where is the ethmoid sinus?
near supeiror portion of nasal cavity
105
Where is frontal sinus?
frontal bone above nasal cavities
106
Can the red reflex still be considered present if it is yellow or orange?
yes. think about what was seen on digital cameras
107
what can we do to rule out inflammation before inserting the otoscope?
tug test on outside of ear. (pull down on kids up on adults)
108
What should the tympanic membrane look like?
pearly grey, shiny, translucent, with no bulging or retraction. 2) Consistency - smooth.
109
how does blood leave the brain?
venous sinuses that dump into the jugular
110
CN1
olfactory
111
CN2
optic
112
CN3
oculomotor
113
CN4
trochlear (superior oblique)
114
CN5
trigeminal (innervates face)
115
CN6 (abducens)
controls lateral rectus
116
CN7
facial movement, expression
117
CN8
vestibulocochlear
118
CN9
glossopharyngeal (sensory, motor, parasympathetic)
119
CN10
vagus nerve
120
CN11
accessory nerve (sternocleidomastoid)
121
CN12
hypoglossal (tongue efferent nerve)
122
neuro problem based history
headaches, diziness, seizures, LOC, movement changes, sensation changes, dysphasia, aphasia--- head trauma, drug use-- genetic conditions-- vertigo--loss of ADL skills -- disorientation
123
3 types of memory
immediate recall, recent memory, remote memory
124
Guillain-Barre syndrome
widespread demyelination of nerves of PNS. believed to be caused by cell-mediated autoimmune response to viral infection.
125
Guillain barre prognosis
80-90% of patients make basically a full recovery but they die if the respiratory depression develops rapidly. (paralysis of thorax)
126
in someone with an active case of guillan barre syndrome, deep tendon reflexes will be
absent
127
warning sign of guillain barre
respiratory or gastrointestinal infection weeks before onset
128
True or false? guillain barre has both an ascending and descending variation
true
129
acute unilateral paralysis of facial nerve
bell's palsy
130
bell's palsy prognosis
80% of patients recover fully in weeks.months
131
Bell's palsy clinical findngs
history of pain behind ear or face few hours and days before paralysis. eye on affected side does not close. forehead does not wrinkle.
132
3 stages of Alzheimer's and how long they last
early stage : 2-4 years. patient's memory begins to fail.
second stage 2-12 years
patient loses ADL skills, language skills, becomes disoriented, confused
final stage : patient requires total care and cannot communicate
133
incurable, degenerative neurologic disorder beginning with decline in memory
alzheimer's
134
What is a CVA
cerebrovascular accident
135
neurodegenerative disease that develops slowly due to degeneration of the substantia negra. second most prevalent to alzheimer's
parkinson's
136
craniocerebral injury clinical findings
LOC can be for a few minutes to several week.s depends on severity of trauma and areas to the brain. may have residual deficits in memory, congnition and motor sensory abilities
137
Encephalitis
inflammation of brain tissue and meninges
138
encephalitis clinical findings
headache, lethargy, irritability, nasuea, fever, nuchal rigidity, vomiting, decreased LOC< motor weakness, tremors, seizures, positive babinski sign
139
nuchal rigidity
inability to extend or turn neck
140
hyperesthesisa
more than normal sensation
141
Fine motor tests- upper extremities
finger to nose, alternating supination and pronation of hands on knees, finger to nose and nurse's finger, finger to finger, finger to thumb
142
fine motor tests - lower extremities
heel down opposite shin, toe/ball of foot to nurse's finger
143
Gross and Motor Balance Tests
walking gait, romberg test, standing on one foot with eyes closed (5 sec), heel-to-toe walking
144
What are proprioceptors and where are they?
muscles, tendons, joints, inner ear, give information about position and movement of the body
145
Test CN11
have patient shrug shoulders and turn head to side against hands
146
Test CN12
have patient perform controlled movement with tongue including pushing it against a gloved finger
147
Test CN3
IGNORECARD
148
Test CN 7,9
test tongue for taste. not done unless problem is reported
149
Test Cn 9, 10
inspect for gag reflex
150
how to use Glascow coma scale
goes from 1-15. 7 or less = comatose client
151
The glascow coma scale tests 3 major areas
eye response, verbal response, motor response
152
The glascow coma scale was originally developed to __________ and is also used to _______
predict recovery from a head injury, also used to assess LOC
153
orientation to person, time and place
oriented x3
154
Glascow motor response scores
1- no response
2- extends abnormally
3-flexes abnormally
4- flexes and withdraws
5- to localized pain
6- to verbal command
155
Glascow verbal response scores
1- no response
2- makes incomprehensible sounds
3- uses inappropriate words
4- disoriented, converses
5- oriented, converses
156
Glascow eye opening scores
1- no response
2-to pain
3- to verbal command
4- spontaneous
157
sympathetic vs parasympathetic nervous system
parasympathetic : stop it
sympathetic : run now you're in danger
158
Scoliosis
s- shaped deformity of vertebrae. usually lateral curvature. can cause unequal leg strength
159
occurs when fibrocartilage surrounding an intervertebral disk ruptures and nucleus pulposus is displaced and compresses adjacent spinal nerves
herniated disk/slipped disk/ herniated nucelus pulposus
160
hereditary disorder with increase in
serum uric acid due to increased production, or
decreased excretion of uric acid and urate salts
gout
161
gout is thought to be caused by
ack of an enzyme
needed to completely metabolize purines for
renal excretion
162
bursitis clinical findings
pain, limited motion, edema, point tenderness, erythema of affected joint
163
degenerative change in articular cartilage
osteoarthritis
164
osteoarthritis clinical findings
joint edema and ache, heberden's nodes in distal interphalangeal joints, bouchard's nodes in peripheral interphalangeal joints.
165
RA rheumatoid arthritis
chronic, autoimmune inflammatory disease of connective tissue.
166
RA clinical findings
joint involvement bilateral. pain, edema, stiffness, low-grade fever and fatigue, ulnar deviation, swan-neck deformity, boutonniere deformity
167
loss of bone density and decreased bone strength
osteoporosis
168
osteoporosis s/s
loss of height, spontaneous fracture from brittle bones, develop kyphosis
169
True or false? because there is often no "normal" for the musculoskeletal system, normality is established best by comparing sides.
true!
170
acetablulum and femur form
hip joint
171
movements permitted by ball and socket joint
flexion, extension, hyperextension, abduction, adduction, internal and external rotation, circumduction
172
how many cranial bones?
6
173
Where does the neck have the most mobility?
C4-5, C5-6
174
long bones act as _____ and have a flat surface for ________ with grooves at end for tendon or nerve
levers, attachment of muscles
175
2 major divisions of human skeleton
axial, appendicular
176
articulation where two or more bones come together
joint
177
Joint Classes
hinge, pivot, condyloid, ball-and-socket, gliding
178
ligament vs tendon
ligaments attach bones, tendons attach muscles to bones
179
semi-smooth, gel-like supporting tissue. strong and able to support weight
cartilage
180
small sacs in connective tissues that act to reduce friction when muscles or tendons rub against other muscles, tendons, or bones
bursae
181
point of articulation between femur, tibia, patella
hinge joint
182
What kind of joint is the ankle?
hinge
183
excessive inward curvature of the spine
lordosis
184
kyphosis
exaggerated, forward rounding of the upper back
185
True or false? the esophagus lies outside the abdominal cavity.
true
186
2 layers of peritoneum (abdominal lining)
parietal, visceral
187
fluid filled space that reduces friction between organs and membranes, between parietal and visceral layers
peritoneal cavity
188
strong membrane covering entire ventral surface of abdomen. lies superficial to rectus abdominus.
external oblique aponeurosis
189
linea alba
tendinous band protecting midline of rectus abdominis muscles from xiphoid process to symphysis pubis
190
What forms the inferior and superior borders of the abdomen?
inferior : superior aperture of lesser pelvis
superior : diaphragm
191
Alimentary tract extends from mouth to anus. how many feet/ meters is this?
27 feet, 8.2 meters
192
Which aspect of the nervous system controls peristalsis?
autonomic
193
How long is the esophagus? What is its typical pH?
10 inches, 6-8
194
Where is the stomach?
directly below the diaphragm in the LUQ
195
pepsin
breaks down proteins to peptones and amino acids
196
small intestine segments
duodenum, jejunum, ileocecal valve (between ileum and large intestine),
197
length of small intestine segments
duodenum (1 foot/30cm)
jejunum (8 ft)
ileum
198
large intestine segments
cecum, appendix, colon, rectum, anal canal
199
Besides skin, what is the largest organ?
liver
200
Where is the liver?
under right diaphragm, from 5th intercostal space to below costal margin
