Exam 1 Flashcards
1
Q
Hair
A
quantity
distribution
texture
pattern of loss
2
Q
Scalp
A
scaliness
lumps
nevi
lesions
3
Q
Skull
A
deformities
depressions
lumps
tenderness
4
Q
Face
A
facial expressions contours asymmetry involuntary movements edema masses
5
Q
Skin
A
color pigmentation texture thickness hair distribution lesions
6
Q
Eyebrows
A
fullness
hair distribution
scaliness
7
Q
Eyelids
A
position of lids in relation to eyeballs width of palpebral fissures edema color lesions condition/direction of lashes adequacy of lid closure
8
Q
Lacrimal Apparatus
A
inspect lacrimal gland & lacrimal sac for swelling
excessive tearing or dryness of eye may require referral to ophthalmology
9
Q
Conjunctiva/Sclera
A
have patient look up while depressing lower lids simultaneously
- inspect sclera & conjunctiva for color
- note vascular pattern
- look for nodules/swelling
10
Q
Cornea/Lens
A
inspect for opacities
11
Q
Iris
A
inspect both iris simultaneously
- markings should be clearly defined
- with light shining from the temporal side, look for crescentic shadow on the medial side of iris
12
Q
Pupil
A
dim light
- inspect size, shape, symmetry
- measure both pupils
- test light reaction
13
Q
Extraocular Muscles
A
- assess for conjugate movements, nystagmus, and lif lag
- test the 6 EOM by having patient follow pen/finger
14
Q
Opthalmoscopic Exam
A
- instruct patient to keep both eyes open and look beyond your ear/shoulder while gazing into the distance
- shine light into pupil and look for orange glow in the pupil known as red reflex
- done in NB screen & regular routine eye exams
- note opacities interrupting red reflex
- optic disc
- Retina
- Disturbance in vision
15
Q
Absence of red reflex
A
cataracts
16
Q
Optic Disc
A
round, yellowish-orange to creamy pink structure with pink rim and central depression
17
Q
Retina
A
- inspect arteries and veins
- identify any lesions and note their size, shape, and color
- flashing light mean vitreous detachment from retina
18
Q
Disturbance in Vision
A
flashing light mean vitreous detachment from retina
19
Q
AV Nicking
A
- damage to capillaries due to DM or HTN
- least expected finding in a normal eye
20
Q
Chalazion
A
- chronic inflammation of the UPPER eyelid due to NON-TENDER nodule blocking the meibomian gland.
- PAINLESS
- c/o GRADUAL onset of small superficial nodule that feels like a bead, is discrete, and moveable.
- may resolve in 2-8 weeks
- can slowly enlarge, press on the cornea, and cause blurred vision
21
Q
Hordeolum (stye)
A
- external: abscess of a hair follicle on the upper OR lower lid
- internal: inflammation of the meibomian gland
- PAINFUL and TENDER
- c/o ACUTE onset of a swollen, red, warm abscess on the lids involving 1 hair follicle that gradually enlarges
- usually UNILATERAL
- may spontaneously rupture and drain purulent exudate.
22
Q
Subconjunctival hemorrhage
A
blood shot eyes d/t the rupture of small eye vessels caused by sneezing, coughing, and straining.
23
Q
Blepharitis
A
- chronic condition caused by inflammation of the oil glands of the inner eye
- associated with seborrheic dermatitis, rosacea, or allergies
- c/o itching, irritation, gritty sensation, eye redness, and crusting dryness
- intermittent exacerbations
- lid may be colonized by staph
24
Q
Allergic Conjunctivitis
A
- chronic, seasonal condition caused by hypersensitivity reaction to a specific allergen.
- HALLMARK: itching and tearing disproportionate to findings
- watery, non-purulent, or mucoid discharge BILATERALLY
- painless
- conjunctiva has cobblestone appearance
25
Viral Conjunctivitis
- occurs in young people most commonly
- watery discharge
- gradual onset; may be UNILATERALLY
- slight crusting along eyelid margins
- may be seen with upper resp. tract infections (adenovirus, picornavirus, rhinovirus, and HSV
26
Bacterial Conjunctivitis
- gradual onset, usually starts unilaterally but become bilateral d/t touching/rubbing eye
- most commonly d/t S. aureus, H influenzae, and N. Gonorrhoeae
- least commonly d/t E.coli
- purulent or mucopurulent discharge, matted eyes
- c/o scratchy instead of painful
- no photophobia, no fever
27
Conjunctivitis vs. Corneal Abrasion
- pain w. corneal abrasion; no pain with conjunctivitis
- treat corneal abrasion rapidly to prevent permanent scarring
- NO STEROIDS for corneal abrasion
28
Glaucoma
- can cause blindness if left untreated; early detection saves lives
- c/o interocular pressure and pain
29
Exophthalmos
- bulging, or unusual protrusion of eyes related to thyroid hormone production (
- seen in 60% of hyperthyroidism/Grave's disease patients
30
Diabetic retinopathy
- initially asymptomatic or only mild vision problems
- can cause blindness eventually
- AKA: AV nicking
31
Normal Ear
- visible bony landmarks
- greyish/pearl TM
- honey colored cerumen
- visible cone of light (absence of cone of light is abnormal)
32
Weber Test
- place base of a vibrating tuning fork above head or on midforehead to test for unilateral conductive hearing loss.
- sound is heard best in the IMPAIRED ear
33
Rhinne Test
- used primarily to evaluate loss of conductive hearing in one ear
- AC > BC = normal
- BC > AC = abnormal conductive loss
34
Sensorineural Hearing loss
- permanent.
| - difficult to to speak appropriately and understand
35
Otitis Externa (Swimmer's Ear)
- bacterial infection of the skin in the external ear canal d/t Pseudomonas aeruginosa (gram negative) and S. aureus (gram positive)
- common during warm and humid weather
- c/o external ear pain, swelling, purulent green discharge, pruritus, and hearing loss, red canal
- ear pain with manipulation of the tragus or external ear
- may not be able to visualize the TM
36
Dacrocystitis
- blocked tear duct d/t deviated septum
37
Infant ear infection
- common in 3 month infant
- teach to not bottle prop to prevent
- high risk of recurring infections if less than 3 mo
38
TM immobility
excessive cerumen
39
Otitis Media
- most commonly in childhood
- acute bacterial infection of middle ear cavity d/t trapped mucus, secondary to eustachian tube dysfunction.
- c/o of otalgia (ear pain), ear popping, MUFFLED HEARING/HEARING LOSS
- TM bulging or retracted and erythematous, with DISPLACED LIGHT REFLEX, may look opaque
- DECREASED MOBILITY with flat line tracing on tympanogram
- SEROUS EFFUSION: amber fluid behind the ear drum
- may be accompanied by ruptured TM with relief, or blood/pus.
40
Mastoiditis
- symptoms are similar to ear infection
| - drainage, ear pain, fever, headache
41
Nose Exam
- insert otoscope speculum into turbinate/vestibule of each nostril, AVOID CONTACT WITH SEPTUM (sensitive)
- normal: moist & pink
42
Allergic Rhinitis
nasal mucosa/turbinate is PALE/blusih & BOGGY
43
Acute Sinusitis
- fever, HA, tender sinuses w. palpitation, purulent nasal secretions, TOOTH PAIN, post nasal drip, sore throat.
- EPISTAXIS an uncommon s/s
44
Tongue Cancer
risk factor: men > 50 yo & previous cancer hx
45
Peritonsillar Abscess
- ASYMMETRIC SWELLING of uvula, tonsils, or posterior pharynx
- redness, swelling edema, hx of tonsillitis, inability to swallow, negative strep
46
Step Pharyngitis
- sore throat w. tonsillar exudate, anterior cervical adenopathy, elevated & persistent temp >101.5, no asymmetry,
47
Viral Pharyngitis
- fever, cough, malaise
| - no tonsillar exudate
48
Laryngitis
- sore throat, loudness/quality of voice is affected
- redness & edema of vocal chords
- whispering worsens
- anterior cervical adenopathy
49
Thrush/Candida
- common in patients with asthma, steroid use, or chronic dairy product exposure
- infants with patches on tongue=normal; patches on cheek= TREAT
- educate to rinse after inhaler use
- white patches/candida don't scrape off without bleeding. (not exudate)
50
Chief Complaint
in patients own words
51
S-subjective
```
history of present illness reported by patient in their own words
OLDCART
pertinent past Hx
pertinent preventative hx
ROS
pertinent social hx
pertinent family hx
```
52
OLDCART
```
onset
location
duration
characteristics
aggravating factors
relieving factors
treatment
```
53
Social History
caffeine intake
alcohol use
substance/drug use
tobacco use
54
O-objective
information observed by clinician:
- general: VS, ht, wt, BMI, description of clinical presentation
- HEENT,
- neck
- Respiratory
- Cardiovascular
- Abdominal
- GU/GI
- Musculoskeletal
- Neuro
- Integumentary
- Diagnostics: pertinent diagnostic test (webber, rhinne)
55
A-assessment
- working diagnosis
| - differential diagnoses
56
P-plan
- prescriptions
| - education
57
Predictive Value
dependent on prevalence
58
Sensitivity
- true positive rate (probability that patient with positive actually has the disease)
- high sensitivity=reliable and trustworthy
59
Specificity
- true negative rate (probability that patient with negative test doesn't actually have the disease)
60
SnOUT
a sensitive test with negative results rules out a disease
61
SpPIN
a specific test with a positive result rules in a disease
62
Clinical reasoning
why you make a decisions
63
Differential Diagnosis
list of most likely to least likely causes
64
Early screening
saves lives in absence of s/s
| better outcomes
65
Establish rapport
eye contact, avoid looking at screen
| if another person in the room, ask permission to conduct interview
66
Guided Questions
help narrow open-ended questions
offer multiple reasons/explanations
help understand and confirm facts by repeating what patient says and means
can help prevent misinterpretation and avoid confusion/frustration with interview process
67
Pediatric Physical Exam
- DEVELOPMENTAL assessment (emotional, mental, social)
- LEAST INVASIVE to MOST INVASIVE
- when examining ear, be gentle and quick to examine TM
- temp >101.5 in and infant 2 months or younger=septic work up
- beware of legal aspects of adolescent reprorductive care and resources for pregnant adolescents
68
6th Vital Sign
functional assessment is unique to geriatric population
- assess ADLS/mobility/safety
- what holds them back from independence
- are environmental modifications needed (ramp, shower chair)
69
Amsler Grid
eye exam to test for macular degeneration
70
Hearing Loss
impacted wax vs conductive/sensorineural hearing loss.
| use Webber test for true conductive hearing loss if wax is ruled out
71
Sports Physicals
- comprehensive cardiac hx (exertional symptoms, heart murmur, Marfan Syndrome, family hx of premature or sudden death d/t cardiac condition)
- EKG may not be beneficial unless an abnormal irregularity finding is present on exam.
72
Marfan Syndrome
genetic disorder of the connective tissue that can cause heart problems
