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AHA > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

What does SOAP stand for?

A

S- Subjective data, O- Objective Data, A- Assessment, and P- Plan

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2
Q

What is legal blindness?

A

20/200

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3
Q

How is vision on the Snellen chart recorded?

A

Record the smallest written line that the patient can read in full; record as fraction: numerator is the distance of the patient from the chart and denominator is the distance at which the average eye can read the line

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4
Q

How to test for peripheral vision

A

Confrontation test- have the patient cover one eye and have the patient tell you when your fingers come into sight from each side

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5
Q

What is Xanthelasma?

A

flat to slightly raised oval, irregular shaped, yellow-tinted lesions on the periorbital tissues that represent depositions of lipids and a sign of abnormal lipid metabolism

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6
Q

Describe ptosis and its cause

A

When an open eyelid covers the iris to the pupil; typically a congenital acquired weakness of the levator muscle or a paresis of a branch of the 3rd cranial nerve

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7
Q

What is ectropion?

A

When the bottom lid turns away from the eye and can cause excessive tearing

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8
Q

What is entropion?

A

When the eyelid is turned inward towards the globe, eyelashes would cause corneal and conjunctival irritation and increase risk of infection

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9
Q

What is blepharitis?

A

a bacterial infection that causes crusting along the eyelashes

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10
Q

Changes to the eyes in older adults

A

Decreased tear production, lacrimal ducts involute, glaucoma, cataracts, macular degeneration, Drusen bodies

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11
Q

What is the purpose of the lacrimal gland of the eye?

A

It produces tears that moisten the eye

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12
Q

Where is the lacrimal gland located?

A

the temporal region of the superior eyelid

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13
Q

Which cranial nerves innervate the six eye muscles?

A

CN III (oculomoter), IV (trochlear), and VI (abducens)

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14
Q

What is the sclera of the eye?

A

dense, avascular structure that is the white of the eye

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15
Q

What is the conjunctiva of the eye?

A

a clear, thin mucous membrane; palpebral conjunctiva coats the inside of the eyelids and the bulbar conjunctiva covers the outer surface of the eye

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16
Q

What is the cornea of the eye?

A

The anterior sixth of the globe; continuous with the sclera. It is a major part of the refractive power of the eye

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17
Q

What is the major physiologic eye change in the aging population?

A

progressive weakening of accommodation (focusing power) known as presbyopia

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18
Q

Signs of hyperthyroidism seen in the eyes

A

Fasciculations or tremors of the closed eyelids

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19
Q

Lagophthalmos

A

When the eyelids do not close completely- can cause dry cornea and increased risk for infection

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20
Q

What can pain on palpation of the eye indicate?

A

scleritis, orbital cellulitis, and cavernous sinus thrombosis

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21
Q

What can an eye that feels firm upon palpation indicate?

A

severe glaucoma or retrobulbar tumor

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22
Q

What is a pterygium?

A

An abnormal growth of conjunctiva that extends over the cornea from the limbus; common in people exposed to ultraviolet light

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23
Q

How do you test corneal sensitivity?

A

Touch a wisp of cotton to the cornea- patient should blink

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24
Q

What diseases are associated with decreased corneal sensation?

A

diabetes, herpes, trigeminal neuralgia or ocular surgery

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25
Q

What factors can cause miosis (pupillary constriction)

A

iridocyclitis, miotic eye drops, and opioid abuse

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26
Q

What factors can cause mydriasis (pupillary dilation)?

A

mydriatic eye drops, midbrain lesions or hypoxia, oculomotor (CNIII) damage, acute-angle glaucoma, stimulant abuse

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27
Q

What is a corneal arcus (arcus senilis)?

A

lipids deposited in the periphery of the cornea

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28
Q

What is an Argyll Robertson pupil?

A

bilateral, miotic, irregularly shaped pupils that fail to constrict with light; caused by neurosyphillis or lesions in midbrain

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29
Q

Signs of oculomotor (CNIII) nerve damage

A

pupil dilated and fixed, eye is deviated laterally and downward, ptosis

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30
Q

What is adle pupil (tonic pupil)?

A

Affected pupil is dilated and reacts slowly or not at all to light; caused by impairment of postganglionic parasympathetic innervation to sphincter pupillae muscle or ciliary malfunction

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31
Q

How to use ophthalmoscope for eye exam

A

start with the lens on the 0 setting, and place free hand on the patient’s shoulder or head; have patient look at distant fixation point; visualize red reflex first

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32
Q

What is the red reflex of the eye?

A

Caused by the light illuminating the retina during exam

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33
Q

What could absence of the red reflex during exam indicate?

A

improperly positioned ophthalmoscope or total opacity of the pupil by a cataract or hemorrhage

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34
Q

What is the optic disc?

A

where the retina converges to the optic nerve; a blind spot; yellow to creamy pink and 1.5 mm in diameter

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35
Q

Correct order of ophthalmoscope assessment

A

Red reflex, retina, blood vessels, vascular supply to the retina, the optic disk, then the macula

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36
Q

Describe a myelinated retinal nerve fiber

A

white area with soft, ill-defined peripheral margins continuous with the optic disc

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37
Q

Describe papilledema

A

Loss of definition of the optic disc margin; caused by increased intracranial pressure

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38
Q

Describe the cotton wool spot

A

ill-defined, yellow areas caused by infarction of nerve layer of the retina; caused by vascular disease secondary to hypertension or diabetes

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39
Q

What is ophthalmia neonatorum?

A

conjunctival inflammation and drainage in the newborn

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40
Q

Describe coloboma

A

Congenital abnormality in the newborn: keyhole pupil, tissue around the pupil not fully formed

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41
Q

Symptoms of coloboma

A

microphthalmia, blindness, cataracts, increased eye pressure

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42
Q

What are brushfield spots?

A

White or grayish raised spots arranged in a circular pattern around the iris

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43
Q

What population is most likely to have brushfield spots?

A

Children with downsyndrome but can occur in normal children too

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44
Q

Describe hyphema

A

an accumulation of blood in the front chamber of the eye; usually caused by eye trauma

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45
Q

Describe a subconjunctival hemorrhage

A

bright red blood in a sharply defined area surrounded by healthy appearing conjunctiva

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46
Q

Is the cornea a vascular tissue?

A

No it is avascular, blood vessels should not be present

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47
Q

How do you test CN V?

A

Touch a whisp of cotton to the cornea

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48
Q

Describe cornea arcus

A

spots composed of lipids that are deposited in the periphery of the cornea; most often seen in those older than 60

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49
Q

What is the difference between the accommodation and pupillary reflexes?

A

The pupillary light reflex compensates for changes in illumination level, whereas the accommodation responses compensate for changes in eye-to-object-viewed distance.

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50
Q

What is anisocoria?

A

unequal size in pupils, congenital or caused by local eye medications

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51
Q

Signs and symptoms of Oculomotor (CNIII) damage

A

pupil dilated and fixed, eye deviated laterally and downward, ptosis

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52
Q

Why would the sclera appear green or yellow?

A

Liver or hemolytic disease

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53
Q

What is a senile hyaline plaque?

A

a dark, slate gray pigment anterior to the insertion of the rectus muscle; benign

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54
Q

What is epscleritis?

A

Inflammation of the superficial layers of the sclera anterior to the insertion of the rectus muscles; S&S: acute onset mild to moderate discomfort or photophobia, watery discharge without crusting

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55
Q

What is band keratopathy?

A

deposits of calcium in the superficial cornea; S&S: decrease in vision as deposition progresses, foreign body sensation, horizontal grayish bands interspersed with dark areas that look like holes

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56
Q

What is a corneal ulcer?

A

A disruption of the corneal epithelium and stroma; S&S: pain, photophobia, blurry vision, wears contacts, visual acuity changes, inflammation of the lids and conjunctiva, purulent exudate, ulcer often round or oval

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57
Q

What is strabismus?

A

When both eyes do not focus on an object simultaneously but can focus with either eye; may be a sign of increased IOP; S&S: poor vision, sudden onset of double vision, eye deviation

58
Q

Describe horner syndrome

A

interruption of sympathetic nerve innervation to the eye; Triad symptoms: ipsilateral miosis, mild ptosis, and loss of hemifacial sweating; PAM (Ptosis, Anhidrosis, miosis) Horner

59
Q

Name the most common causes of cataracts

A

Denaturation of lens protein caused by aging, hypoparathyroidism, steroids, and congenital cataracts

60
Q

Describe diabetic retinopathy

A

Dot hemorrhages or microaneurysms and the presence of hard and soft exudates; S&S: blood vessels with ballon-like sacs, blots of hemorrhages on the retina, tiny yellow patches of hard exudates, cotton wool spots

61
Q

What is lipemia retinalis?

A

Creamy white appearance of retinal vessels that occurs with excessively high serum triglyceride levels

62
Q

Objective findings for lipemia retinalis

A

elevated serum triglycerides, Grade 1- early white and creamy aspect of peripheral retina vessels, grade 2- creamy color extends toward the optic disk, grade 3- retina appears salmon color and all vessels have a milky appearance

63
Q

What is retinitis pigmentosa?

A

An autosomal recessive disorder in which the genetic defects cause cell death, predominantly in the rod photoreceptors

64
Q

S&S of retinitis pigmentosa

A

Earliest symptom- night blindness, tunnel vision, painless loss of vision; late stages- optic atrophy with a waxy pallor, narrowing of the arterioles, and peripheral bone spicule pigmentation

65
Q

What is glaucoma?

A

Disease of the optic nerve where the nerve cells die, usually due to excessively high intraocular pressure

66
Q

What causes acute angle glaucoma?

A

Dramatic elevated IOP if the iris blocks the exit of an aqueous humor from the anterior chamber

67
Q

What causes open-angle glaucoma?

A

decreasing aqueous humor absorption leads to increased resistance and painless buildup of pressure in the eye

68
Q

S&S of acute angle glaucoma

A

intense ocular pain, blurred vision, halos around lights and a red eye with dilated pupil

69
Q

Objective findings for glaucoma

A

Loss of peripheral vision

70
Q

What are drusen bodies?

A

Small yellowish discrete dots that accumulate under the retina; increased risk for macular degeneration; S&S: glistening yellow deposits seen on fundoscopic exam

71
Q

What is macular degeneration?

A

central portion of the retina, known as the macula, wears down over time causing severe and permanent vision loss

72
Q

What is chorioretinitis?

A

an inflammatory process involving both the choroid and the retina; most common cause is laser therapy; can also be caused by cleaning cat litter box; S&S: floaters, reduced vision, sharply defined whitish-yellow lesion

73
Q

When does development of the inner ear occur?

A

during the first trimester or pregnancy

74
Q

What are some differences to the anatomy of the ear in children?

A

External auditory canal is shorter than the adults and has an upward curve; eustachian tube is wider, shorter, and more horizontal/soft; allows easier reflux of secretions

75
Q

What disease of the ears are children more likely to develop and why?

A

a middle ear effusion: growth of lymphatic tissue may occlude the eustachian tube and interfere with aeration of the middle ear

76
Q

What causes hearing loss in older adults?

A

degeneration of hair cells in the organ of Corti, loss of cortical and organ of Corti auditory neurons, degeneration of the cochlear conductive membrane, and decreased vascularity in the cochlea

77
Q

Name the different types of hearing loss

A

conductive and sensorineural

78
Q

What causes conductive hearing loss?

A

cerumen impaction and tympanosclerosis or otosclerosis caused by calcification of tissues in the middle ear

79
Q

Describe sensorineural hearing loss

A

reduced transmission of sound in the inner ear; caused by damage to CN VIII, congenital infection, trauma, ototoxic meds

80
Q

Why are older adults’ ears often larger than other adults?

A

Cartilage formation continues as we age, making the auricle larger

81
Q

What condition would cause a blue color to the skin of the ear?

A

Cyanosis

82
Q

What can palllor or redness of the external ear indicate?

A

frostbite

83
Q

What can a cauliflower ear indicate?

A

blunt trauma and necrosis of cartilage of the ear

84
Q

Describe tophi

A

white uric acid crystals that deposit on the ear

85
Q

Correct patient positioning for an otoscope exam

A

tilt patient’s head toward the opposite shoulder; pull auricle upward and back to straighten auditory canal; insert speculum 1-1.5 cm

86
Q

For the Rinne test what is the normal result?

A

Air conduction should be twice as long as bone conduction

87
Q

What is otitis externa also known as?

A

Swimmer’s ear: itching in ear canal, usually after swimming

88
Q

S&S of otitis externa

A

itching ear canal, intense pain with movement of the pinna and chewing; watery (early), purulent and foul smelling drainage (late), conductive hearing loss, red, edematous, canal with obscured tympanic membrane

89
Q

S&S of otitis media with effusion

A

sticking or cracking sound on yawning or swallowing; feeling of fullness in the ear; conductive hearing loss; tympanic membrane retracted or bulging, impaired mobility, and yellowish; no discharge

90
Q

S&S of acute otitis media

A

S: abrupt onset, fever, feeling of blockage in ear, anorexia, deep earache that interferes with sleep; discharge present only if tympanic membrane ruptures; conductive hearing loss
O: tympanic membrane- erythema, thickened or clouding, bulging, bubbles

91
Q

What is cholesteatoma?

A

abnormal squamous epithelial tissue behind the tympanic membrane; could cause tympanic membrane perforation, erosion of the ossicles and temporal bone, and invade the inner ear structures

92
Q

S&S of cholesteatoma

A

S: hx or recurrent otitis media, unilateral hearing loss, ear fullness or pain, tinnitus, mild vertigo, discharge from ear canal
O: spherical white cyst or pouch behind tympanic membrane, conductive hearing loss, possible tympanic membrane bulge, facial nerve paralysis (rare)

93
Q

S&S of conductive hearing loss

A

S: turns TV on louder, speaks softly
O: bone conduction > air conducting with Rinne, lateralization to affected ear with Weber, loss of low-frequency sounds

94
Q

S&S of sensorineural hearing loss

A

S: Hearing loss begins with higher frequency sounds, complaints that people mumble, speaks loudly, unable to hear in a crouded room
O: Weber test lateralizes to unaffected ear, loss of high frequency sound, air conduction > bone conduction with Rinne

95
Q

What is vertigo most often related to?

A

a disorder of the inner ear

96
Q

Describe Meniere’s disease

A

an inner ear disorder characterized by episodes of hearing loss, vertigo, tinnitus, and ear fullness; likely caused by genetic and environmental factors, excess secretion of endolymph or failure of reabsorption in the subarachnoid space

97
Q

S&S of Meniere’s

A

S: sudden onset vertigo from moving head, hearing loss, whistling or roaring sounds in ear, ear fullness or pressure
O: hearing loss to low tones initially with fluctuating progression to profound sensorineural hearing loss, imbalance, nystagmus

98
Q

Describe acute vestibular neuronitis

A

inflammation of the vestibular nerve after an acute viral upper respiratory infection

99
Q

S&S of acute vestibular neuronitis

A

S: spontaneous episodes of vertigo that is severe initially and lessens over a few days, difficulty walking , N/V, benign paroxysmal positional vertigo
O: spontaneous horizontal nystagmus with or without rotary nystagmus, staggering gait

100
Q

Development of sinuses in children

A

sphenoid sinuses by age 5, frontal sinuses begin at 7-8 years and complete development during adolescence

101
Q

Changes to nares/sinuses in older adults

A

deterioration of the sense of smell from loss of olfactory sensory neurons- 60 years of age, cartilage formation continues around the nose- nose becomes larger, odor sensitivity declines

102
Q

How do you evaluate patency of a patient’s nares?

A

by occluding one naris and have them breath in and out of non-occluded nares; should be noiseless

103
Q

What color should the nasal mucosa be?

A

glistening and deep pink

104
Q

What cranial nerve is responsible for smell?

A

CN I (olfactory)

105
Q

Where and how to palpate frontal and maxillary sinuses

A

using thumb: under the boney brow on each side of the nose; under the zygomatic processes lateral to the nose using either thumb or index & middle fingers to palpate the maxillary sinuses

106
Q

Expected findings for normal sinus exam

A

no tenderness or swelling over the soft tissue

107
Q

Describe sinusitis

A

bacterial infection of one or more of the paranasal sinuses, inflammation, allergies, or structural defects of the nose may block the sinus meatus and prevent the sinus cavity from draining

108
Q

S&S of sinusitis

A

S: upper respiratory infection that worsens or persists after 7-10 days, frontal headache, facial pain or pressure, purulent nasal discharge, persistent cough, worse at night
O: purulent nasal discharge, tenderness over frontal or maxillary sinuses, sinus does not transilluminate

109
Q

Differences to mouth in infants

A

salivation increases by the time the infant is 3 months old, infant drools until swallowing is learned, teeth erupt between 6-24 months, permanent teeth around 6 years and complete by 15 years

110
Q

Why would tooth eruption timing be delayed in children?

A

poor nutrition and chronic conditions

111
Q

Changes to mouth in older adults

A

gingival tissue may recede: more easy teeth erosion, lost teeth- diet changes and difficulty chewing, the tongue may become more fissured, altered motor function of tongue, problems with swallowing, saliva production may decrease, taste declines

112
Q

Where would the nurse visualize the parotid (Steensen) duct?

A

It would be aligned with the second upper molar, it is a whitish yellow or whitish pink protrusion

113
Q

Expected findings on visual assessment of oral cavity

A

mucous membranes are pinkish-red, smooth, and moist; gums are more pigmented in darker-skinned races, gums should have no inflammation, swelling, or bleeding

114
Q

What would deep fissures in the lips indicate?

A

infection, irritation, nutritional deficiencies, or overclosure of mouth

115
Q

What finding on the lip would indicate peutz-jeghers syndrome?

A

round oval irregular bluish gray macules

116
Q

How would you assess CN VII?

A

have the patient clench their teeth and smile

117
Q

Characteristics of the anterior portion of the tongue

A

papillae and small fissures

118
Q

Characteristics of the posterior portion of the tongue

A

rugae or a smooth, slightly uneven surface with a thinner mucosa

119
Q

What characteristic can be found on either side of the frenulum

A

Wharton ducts- thin tubes that carry saliva

120
Q

Name some expected findings of the hard palate

A

dome shape with transverse rugae

121
Q

How to assess movement of the soft palate

A

have patient say “ah”

122
Q

Normal findings for the pharynx

A

should be smooth, glistening, pink with some small irregular spots of lymphatic tissue and small blood vessels

123
Q

How do you test cranial nerves IX & X?

A

touch the posterior wall of the pharynx to illicit the gag response

124
Q

What is acute bacterial pharyngitis?

A

infection of tonsils or posterior pharynx by Group A beta-hemolytic streptococci

125
Q

S&S of acute bacterial pharyngitis

A

S: sore throat, ear pain, fever, malaise, fetid breath without nasal drainage or cough
O: red and swollen tonsils, crypts filled with purulent exudate, palatal petechiae, enlarged anterior cervical lymph nodes

126
Q

Tonsil grade 1

A

tonsils occupy less than 25% of the lateral dimension of the oropharynx

127
Q

Tonsil grade 2

A

tonsils occupy 26-50% of the lateral dimension of the oropharynx

128
Q

Tonsil Grade 3

A

Tonsils occupy 51-75% of the lateral dimension of the oropharynx

129
Q

Tonsil Grade 4

A

the tonsils and the uvula are Kissing: can occlude airway

130
Q

What is a peritonsillar abscess?

A

A deep infection in the space between the palatine tonsil capsule and pharyngeal muscles; complication of adenotonsillitis or blockage of weber glands

131
Q

S&S of peritonsillar abscess

A

S: dysphagia, odynophagia, drooling, sore throat with pain radiating to the ear, malaise, fever
O: unilateral red, swollen tonsil and adjacent soft palate, tonsil may be pushed forward or backward, trismus, muffled voice

132
Q

What is a retropharyngeal abscess?

A

A 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; could occur from spread of infection or direct inoculation from trauma

133
Q

S&S of retropharyngeal abscess

A

S: recurrent URI, acutely ill, fever, drooling, anorexia, irritable, neck pain, limited neck movement
O: fever, lateral neck movement increases pain, torticollis, lateral pharyngeal wall distorted medially, respiratory distress

134
Q

What is oral cancer often associated with?

A

Squamous cell carcinoma- HPV

135
Q

S&S of oral cancer

A

S: painless sore in mouth that does not heal, pain with later stage lesions
O: ulcerative lesion appearing as piled-up edges around a core on the lateral border of mouth floor; red or white patch on tissues, tooth mobility when no peridontal disease present

136
Q

What is peridontal disease?

A

chronic infection of the gums, bones, and other tissues that surround and support the teeth

137
Q

S&S of periodontal disease

A

S: red and swollen gums that bleed easily, tender gums, loose teeth
O: plaque and tartar buildup on teeth, deep pockets between the teeth and gingiva, loose or missing teeth

138
Q

What are oropharyngeal clefts?

A

craniofacial congenital malformation, result of the lip or palate failing to fuse during embryonic development before the 12th week of gestation; combination of genetic & environmental factors

139
Q

S&S of oropharyngeal cleft

A

S: can be diagnosed in prenatal ultrasound, difficulty sucking, failure to thrive
O: apparent at birth, cleft may be unilateral or bilateral and involve all palates and lips

140
Q

Correct order for a health history

A 
Chief concern
HPI
PMI
Family history
Personal and social history
ROS
141
Q

The 5 Ps of sexual history

A

partners, practices, protection, past history of STI, prevention of pregnancy

142
Q

What is a hordeolum?

A

also known as a stye: red and tender bump on the edge of the eyelid

AHA (2 decks)

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