COMPREHENSIVE Flashcards
what are we looking for when palpating the nose?
tenderness, access patency
mixed hearing loss
combination of conductive and sensorineural types in same ear
Sensorineural hearing loss signifies pathology of cranial nerve ___
8
gradual nerve degeneration resulting in hearing loss
presbycusis
conductive hearing loss
involves mechanical dysfunction of external or middle ear
What can cause conductive hearing loss?
cerumen, foreign bodies, perforated TM, pus, serum, otosclerosis (decrease in mobility of ossicles)
Rinne test expected finding
AC greater than BC
Weber test
patient can hear tuning fork on both sides of head
What do we inspect the tympanic membrane for?
landmarks, color, contour, translucence
What can cause the red reflex to be absent?
cataracts
adaptation of eye for near vision
accommodation
Although the lens cannot be observed directly, the following
components of accommodation
can be observed
convergence, puillary constriction
fixation
a reflex direction of eye toward an object attracting person’s attention
When we fixate on an image, it is fixed in the center of the visual field, the ______
fovea centralis
pupillary light reflex
ormal constriction of
pupils when bright light shines on retina
Subcortical reflex arc, person has no
conscious control over it
why do our pupils have a consensual response?
Because the optic nerve carries the
sensory afferent message in and
then synapses with both sides of the brain
how to perform Corneal light reflex (AKA hirschberg test)
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
What do we inspect ocular structures for?
corneal light reflex, sclera (color, surface characteristics), iris for shape and color, pupils for PERRLA
what do we inspect for on the conjunctiva?
color, moisture, drainage, lesions
Normal Jaeger card result
14/14
How to use a jaeger card
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
What is the most commonly used and accurate measure of visual acuity?
snellen chart
How to use snellen chart
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.
what is the most common type of endocrine malignancy?
thyroid cancer
Thyroid cancer clinical findings?
frequently does not cause symptoms. first idscovered as a small nodule on thyroid
candidiasis (thrush)
oral infection caused by candida albicans in those chronically
debilitated or
immunosuppressed, or as a
result of antibiotic therapy.
Epistaxis
bleeding from nose
inflammation of middle ear space, resulting in accumulation of serous fluid in middle ear
otitis media with effusion
Common symptoms of OME
clogged sensation in ears, problems with hearing and balance
early stage of acute otitis media
tympanic
membrane (TM) appears inflamed,
red, and may be bulging and
immobile.
later stages of otitis media
may reveal
discoloration (white or yellow
drainage) and opacification to the
TM
Purulent drainage from the ear
canal with a sudden relief of pain
suggests
perforation
foreign body in the ear is mostly seen in
children
Cataract
opacity of crystalline
lens from denaturation of lens
protein caused by aging and may
be congenital or caused by
trauma
clinical findings with cataracts
cloudy or blurred vision, poor night vision, absent red reflex, cloudy lens observed on inspection
corneal abrasion clinical findings
intense pain, foreign body sensastion, reports photophobia, tearing and redness observed
inflammation of conjuncgtiva caused by local infection of bacteria or virus, or by allergic reaction, systemic infection or chemical irritation
conjunctivitis
a patient comes in with red eyes that are oozing sticky goo especially in the mornings. what might be going on?
conjunctivitis “pink eye”
common name for hordeolum
sty
Why do we get stys?
they are caused by an acute staph infection of the eye.
Chalazion
nodule of meibomian gland in the eyelid. may be tender if infected.
What age group most commonly gets tension headaches?
20 to 40 years old
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
Which is the most painful of primary headaches?
cluster headache
cluster headache clinical findings
intense epidsodes of excruciating unilateral pain. lasts 30 mins to 1 hour and may repeat daily, sometimes for years.
Age group who most commonly gets cluster headaches?
adolescence to middle age
True or false? recurrent headaches are a symptom of primary headache disorder
true
Starts with aura from vasospasm
of intracranial arteries; throbbing
unilateral distribution of pain
migraine
second most
common headache syndrome in the
United States
migraine
Most common medical complaint.
headache
describe dry cerumen
gray, flaky, and frequently forms thin
mass in ear canal
describe wet cerumen
honey brown to dark brown and
moist
take caution to avoid mistaking flaky, dry cerumen for
eczematous lesions
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
When do teeth begin developing?
in utero
When do decidous teeth emerge?
between 6 months and 24 months. all 20 should emerge by age 2.5
how many decidous teeth do we have?
20
Deciduous teeth are lost beginning at age 6 through 12 and are replaced with permanent teeth. Which permanent teeth emerge first?
central incisors
When does the nose start and stop growing?
starts at 12 or 13, stops at 16 in females and 18 in males
tiny oval clumps of lymphatic tissue, usually located in groups along blood vessels
lymph nodes
True or false? lymph nodes are found in chains or clusters
true
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
What is the largest endocrine gland?
thyroid
where is the thryoid accessible for examination?
either side of the trachea
Where is the larynx?
below the pharynx, above the trachea
structures within the neck include
cervical spine, sternocleidiomastoid muscle, hyoid bone, larynx, trachea, esophagus, thyroid glands, lymph nodes, carotid arteries, jugular veins
components of oropharynx
uvula, tonsils, posterior pharyngeal wall, epiglottis
Cartilagenous structure protecting laryngeal opening
epiglottis
Three turbinates lining the lateral walls of the nasal cavity
inferior meatus, middle meatus, superior meatus
drains nasolacrimal duct
inferior meatus
drains frontal, maxillary, and ethmoid sinuses
middle meatus
drains posterior ethmoid sinus
superior meatus
face comprises _____ bones
14
cranial nerves innervating the face
V (trigeminal), V11 (facial)
palpebral fissure
opening between eyelids
2 thin transparent mucous membranes between eyelids and eyeball
conjunctivae
meibomian gland
secretes
substance to lubricate lids,
slows evaporation of tears,
provides airtight seal when
lids closed
Lacrimal glands
form tears
that combine with
sebaceous secretions to
maintain constant film over
cornea
3 layers of eyeball
sclera (outer)
uvea (middle)
retina (inner)
tough, fibrous, outer layer/ white of eye
sclera
cornea
covers iris and pupil. is transparent, avascular, and richly innervated with sensory nerves
Cornea allows light transmission through lens to ________
retina
tears provide cornea with oxygen and protect the surface from ____
drying
explain the mechanism of the corneal reflex
CN5 will carry afferent sensation to brain, and CN7 carries efferent message that stimulates blink
What does the uvea consist of?
choroid layer (posteriorly), iris (anteriorly), pupil (central opening of iris, allows light transmission to retina), ciliary body, anteriorly
Transparent layer of eye with photoreceptor cells, rods and cones, unevenly distributed over its surface
retina (inner)
occurs when rods and cones respond to various stimuli
vision
lenses constantly adjust to stimuli at different distances by ______
accommodation
CN2
optic nerve
CN3
oculomotor nerve
How many exrinsic eye muscles do we have and what are they?
- 4 rectus, 2 oblique
conjugate movement
when two eyes move, their axes always remain parallel
Why are parallel axes important?
the brain has a binocular, single-image, visual system.
3 cranial nerves repsonsible for eye movement
6 (abducens), 4 (trochelar), 3 (oculomotor)
3 main functions of auricle
collection, location, protection
opens briefly during yawning , swallowing, or sneezing to equalize pressure of middle ear to the atmosphere
eustachian
function of middle ear
amplification of sound
3 middle ear ossicles
malleus, incus, stapes
3 main inner ear structures
cochlea, vestibule, semicircular canals
where are the inner ear receptors for balance found?
vestibule, semicircular canals
pathway of hearing
middle ear ossicles- oval window- through cochlea- vibration - organ of corti- auditory portion of cn 8, brain stem
Where are the maxillary sinuses?
on either side of cheekbones
Where is the sphenoid sinus?
deep in skull, behind ethmoid
where is the ethmoid sinus?
near supeiror portion of nasal cavity
Where is frontal sinus?
frontal bone above nasal cavities
Can the red reflex still be considered present if it is yellow or orange?
yes. think about what was seen on digital cameras
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)
What should the tympanic membrane look like?
pearly grey, shiny, translucent, with no bulging or retraction. 2) Consistency - smooth.
how does blood leave the brain?
venous sinuses that dump into the jugular
CN1
olfactory
CN2
optic
CN3
oculomotor
CN4
trochlear (superior oblique)
CN5
trigeminal (innervates face)
CN6 (abducens)
controls lateral rectus
CN7
facial movement, expression
CN8
vestibulocochlear
CN9
glossopharyngeal (sensory, motor, parasympathetic)
CN10
vagus nerve
CN11
accessory nerve (sternocleidomastoid)
CN12
hypoglossal (tongue efferent nerve)
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
3 types of memory
immediate recall, recent memory, remote memory
Guillain-Barre syndrome
widespread demyelination of nerves of PNS. believed to be caused by cell-mediated autoimmune response to viral infection.
Guillain barre prognosis
80-90% of patients make basically a full recovery but they die if the respiratory depression develops rapidly. (paralysis of thorax)
in someone with an active case of guillan barre syndrome, deep tendon reflexes will be
absent
warning sign of guillain barre
respiratory or gastrointestinal infection weeks before onset
True or false? guillain barre has both an ascending and descending variation
true
acute unilateral paralysis of facial nerve
bell’s palsy
bell’s palsy prognosis
80% of patients recover fully in weeks.months
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.
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
incurable, degenerative neurologic disorder beginning with decline in memory
alzheimer’s
What is a CVA
cerebrovascular accident
neurodegenerative disease that develops slowly due to degeneration of the substantia negra. second most prevalent to alzheimer’s
parkinson’s
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
Encephalitis
inflammation of brain tissue and meninges
encephalitis clinical findings
headache, lethargy, irritability, nasuea, fever, nuchal rigidity, vomiting, decreased LOC< motor weakness, tremors, seizures, positive babinski sign
nuchal rigidity
inability to extend or turn neck
hyperesthesisa
more than normal sensation
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
fine motor tests - lower extremities
heel down opposite shin, toe/ball of foot to nurse’s finger
Gross and Motor Balance Tests
walking gait, romberg test, standing on one foot with eyes closed (5 sec), heel-to-toe walking
What are proprioceptors and where are they?
muscles, tendons, joints, inner ear, give information about position and movement of the body
Test CN11
have patient shrug shoulders and turn head to side against hands
Test CN12
have patient perform controlled movement with tongue including pushing it against a gloved finger
Test CN3
IGNORECARD
Test CN 7,9
test tongue for taste. not done unless problem is reported
Test Cn 9, 10
inspect for gag reflex
how to use Glascow coma scale
goes from 1-15. 7 or less = comatose client
The glascow coma scale tests 3 major areas
eye response, verbal response, motor response
The glascow coma scale was originally developed to __________ and is also used to _______
predict recovery from a head injury, also used to assess LOC
orientation to person, time and place
oriented x3
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
Glascow verbal response scores
1- no response
2- makes incomprehensible sounds
3- uses inappropriate words
4- disoriented, converses
5- oriented, converses
Glascow eye opening scores
1- no response
2-to pain
3- to verbal command
4- spontaneous
sympathetic vs parasympathetic nervous system
parasympathetic : stop it
sympathetic : run now you’re in danger
Scoliosis
s- shaped deformity of vertebrae. usually lateral curvature. can cause unequal leg strength
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
hereditary disorder with increase in
serum uric acid due to increased production, or
decreased excretion of uric acid and urate salts
gout
gout is thought to be caused by
ack of an enzyme
needed to completely metabolize purines for
renal excretion
bursitis clinical findings
pain, limited motion, edema, point tenderness, erythema of affected joint
degenerative change in articular cartilage
osteoarthritis
osteoarthritis clinical findings
joint edema and ache, heberden’s nodes in distal interphalangeal joints, bouchard’s nodes in peripheral interphalangeal joints.
RA rheumatoid arthritis
chronic, autoimmune inflammatory disease of connective tissue.
RA clinical findings
joint involvement bilateral. pain, edema, stiffness, low-grade fever and fatigue, ulnar deviation, swan-neck deformity, boutonniere deformity
loss of bone density and decreased bone strength
osteoporosis
osteoporosis s/s
loss of height, spontaneous fracture from brittle bones, develop kyphosis
True or false? because there is often no “normal” for the musculoskeletal system, normality is established best by comparing sides.
true!
acetablulum and femur form
hip joint
movements permitted by ball and socket joint
flexion, extension, hyperextension, abduction, adduction, internal and external rotation, circumduction
how many cranial bones?
6
Where does the neck have the most mobility?
C4-5, C5-6
long bones act as _____ and have a flat surface for ________ with grooves at end for tendon or nerve
levers, attachment of muscles
2 major divisions of human skeleton
axial, appendicular
articulation where two or more bones come together
joint
Joint Classes
hinge, pivot, condyloid, ball-and-socket, gliding
ligament vs tendon
ligaments attach bones, tendons attach muscles to bones
semi-smooth, gel-like supporting tissue. strong and able to support weight
cartilage
small sacs in connective tissues that act to reduce friction when muscles or tendons rub against other muscles, tendons, or bones
bursae
point of articulation between femur, tibia, patella
hinge joint
What kind of joint is the ankle?
hinge
excessive inward curvature of the spine
lordosis
kyphosis
exaggerated, forward rounding of the upper back
True or false? the esophagus lies outside the abdominal cavity.
true
2 layers of peritoneum (abdominal lining)
parietal, visceral
fluid filled space that reduces friction between organs and membranes, between parietal and visceral layers
peritoneal cavity
strong membrane covering entire ventral surface of abdomen. lies superficial to rectus abdominus.
external oblique aponeurosis
linea alba
tendinous band protecting midline of rectus abdominis muscles from xiphoid process to symphysis pubis
What forms the inferior and superior borders of the abdomen?
inferior : superior aperture of lesser pelvis
superior : diaphragm
Alimentary tract extends from mouth to anus. how many feet/ meters is this?
27 feet, 8.2 meters
Which aspect of the nervous system controls peristalsis?
autonomic
How long is the esophagus? What is its typical pH?
10 inches, 6-8
Where is the stomach?
directly below the diaphragm in the LUQ
pepsin
breaks down proteins to peptones and amino acids
small intestine segments
duodenum, jejunum, ileocecal valve (between ileum and large intestine),
length of small intestine segments
duodenum (1 foot/30cm)
jejunum (8 ft)
ileum
large intestine segments
cecum, appendix, colon, rectum, anal canal
Besides skin, what is the largest organ?
liver
Where is the liver?
under right diaphragm, from 5th intercostal space to below costal margin
