Exam 1 review (Gen survery, skin, eyes, ENT) Flashcards
What is the most critical portion of the physical exam? (Hint: 2)
General appearance and vital signs
What percent of arm circumference should width of BP inflatable bladder be?
40%
Average adult BP bladder width?
12-14cm
What percent of arm circumference should length of BP inflatable bladder be?
80%
Average adult BP bladder length?
Almost long enough to encircle arm
Which artery should BP bladder be over?
Brachial
How far above antecubital crease should lower border of BP cuff be?
About 2.5cm
What is a silent interval between systolic and diastolic pressures?
Ausculatory gap
What does Ausculatory Gap cause in estimate of systolic and diastolic?
Systolic=underestimation
Diastolic=overestimation
Which diseases is Ausculatory Gap associated with? (Hint: 2)
Arterial stiffness or atherosclerotic disease
How long to wait between BP readings?
At least 2 minutes
Normal BP pressure difference between arms?
5-10mmHg
Which 3 diseases can cause a 10-15mmHg difference in BP in both arms?
- Subclavian steel syndrome
- Supravalvular aortic stenosis
- Aortic dissection
What is normal lower extremity pressure vs upper extremity pressure?
L.E. pressure is 5-10mmHg higher in LE than arms
What 2 conditions cause Upper Extremity HTN and Lower Extremity hypotension?
- Coarctation of aorta
2. Occlusive aortic disease
Coarctation of aorta and Occlusive aortic disease do what to LE and UE pressures and pulses?
UE=high BP
LE=low BP, diminished or delayed pulses
What are the “end organs” which BP can damage?
Eyes, heart, brain, kidneys
Define Myopia
Near sighted
Define Hyperopia
Far sighted
DEfine Presbuopia
Aging vision, difficulty with near vision
Pain in eye caused by issues in what 2 places?
- Cornea
2. Anterior chamber
What 2 things cause gradual bilateral vision loss?
- Cararact
2. Macular degeneration
Define Scotama
specks in the vision or areas where the patient cannot see
Moving specks or strands suggest vitreous floaters due to what?
Aqueous floaters
Define Hyphema
Blood in anterior chamber
Define Hypopyon
Pus in anterior chamber
Define Miosis
Constricted pupils
Define Mydriasis
Dilated pupils
Descibe Tonic/Avies Pupil
Unilateral dilated pupil, severely decreased light reflex. D/T parasympathetic deinnervation.
Describe Horner Syndrome pupil
Miosis, ptosis, anhydrosis. D/T sympathetic lesion.
Describe Argyll Robertson Pupils
No light reaction, small and irregular pupila
Define diplopia
Double vision
Diplopia due to lesion where? (Hint: 3 places)
- Brainstem
- Cerebellum
- Cranial nerve
Horizontal diplopia due to palsy of which CNs?
3 or 6
Vertical diplopia due to palsy of which CNs?
3 or 4
Diplopia in one eye with other eye closed due to problem where? (2 places)
Cornea or lens
Legal blind in US?
20/200
Describe Papilledema
Edema of optic disc due to increased intracranial pressure
Arteries in the retina look like what? (color, light reflex, size)
Light red, bright light reflex, small
Veins in the retina look like what? (color, light reflex, size)
Dark red, absent light reflex, large
Normal Intraocular Pressure?
10-22
What does Hirschberg Test test for?
Manifest deviations “tropia”. Strabismus.
Corneal light reflex.
What will eyes do in Hirschberg Test?
One eye turns up/down/in/out while other stays straight
What will Cover Test detect?
Latent Deviation.
What happens to bad eye in Cover Test?
Covering good eye causes deviated eye to focus
Manifest Deviation in which test?
Hirschberg Test
Latent Deviation in which test?
Cover Test
What kind of pupil does the Swinging Flashlight Test detect?
Marcus Gunn Pupil
Swinging Flashlight Test tests which CN?
CN 2 optic nerve
Describe Swinging Flashing Light in good eye
Pupil constricts in direct response eye and consensual constriction in other eye
Describe Swinging Flashing Light in bad eye
Partial dilation of both eyes
Marcus Gunn Pupil due to what?
Decreased afferent stimulis in bad eye -> decreased efferent signal in both eyes
Describe Near Reaction and pupils
Shift gaze from far to near causes both pupils to constrict
What does Convergence test?
Eyes coming together at midline when focusing. EOM.
Which muscle and nerve tested in Convergence?
Medial rectus muscle, CN 3
What does Accommodation test for? What can’t the examiner do?
Brings near objects into focus. Can’t be seen by examiner.
CN for Lateral Rectus?
CN 6
CN for Superior Oblique?
CN 4
Describe Ptosis
Low lying upper lid during primary gaze
Ptosis muscle and nerve?
Levator palpebrae
CN 3
Define Lagophthalmos
Inability to fully close eyelid
Lagophthalmos muscle and CN?
Obicularis muscle
CN 7
Bell’s Phenomenon causes what to the eyelid?
Lagophthalmos (incomplete closure of eyelid)
Describe Hordeolum (Stye)
Infection at inner or outer margin of eyelid. Painful, tender, red, internal or external pustule. S Aureus. D/T obstructed gland or eyelash follicle.
Describe Chalazion
Subacute, non-tender, painless nodule. Points inside lid/within lid. Blocked meibomian gland.
Describe Xantheloma
Cholesterol filled plaques along nasal portion of nose
Microaneurysm, neovascularization, retinitis proliferans in which DZ?
DM
Ateriorlar narrowing, copper wiring, AV nicking, flame hemorhage in which DZ?
HTN
Hyperemia of disc, venous enlargement, retinal hemorrhage, cotten-wool spots in which DZ?
Papilledema
Which type of glaucoma causes peripheral vision loss?
Open angle glaucoma
Persistent tearing due to what?
Dacryoadenitis=
Dacryocystitis=block of nasolacrimal duct
Conductive Hearing loss is due to problems where in the ear?
External or middle ear problems
What sort of enviroment might help someone with Conductive Hearing Loss?
Noisy environment
What will Webber Test show in unilateral Conductive Hearing Loss?
Lateralizes to impaired ear
What will Rhine Test show in Conductive Hearing Loss?
Sound heard as long or longer through bone than air.
BC=AC or BC>AC
Sensorineural Hearing Loss due to what problems?
Inner ear, choclear nerve, connections to brain
What will people with Sensorineural Hearing Loss complain about?
People mumbling
Sensorineural Hearing Loss is worse in what sort of enviroment?
Noisy environment
What will Webber Test show in unilateral Sensorineural Hearing Loss?
Lateralizes to good ear
What will Rinne Test show in Sensorineural Hearing Loss?
Sound heard longer through air.
AC>BC
Where can ear pain be referred from?
Structures in the mouth, throat or neck.
Does Tinnitus have an external stimulus?
perceived sound with no external stimulus
Tinnitus with hearing loss and vertigo suggests
Meniere’s disease
What does Vertigo refer to?
Perception that the patient or the environment is rotating or spinning
What does a tender nodes suggest?
Inflammation
What do hard or fixed nodes (fixed to underlying structures and not movable on palpation) suggest?
Malignancy
Enlargement of a supraclavicular node, especially on the left, suggests? From where?
Possible metastasis from a thoracic or an abdominal malignancy.
A pulsating “tonsillar node” is really what?
The carotid artery
A small hard tender “tonsillar node” high and deep between the mandible and the sternocleidomastoid is probably what
The styloid process.
Describe Nociceptive (somatic) pain
Nociceptive (somatic) pain is linked to tissue damage to the skin, musculoskeletal system, or viscera (vis- ceral pain), but the sensory nervous system is intact, as in arthritis or spinal stenosis. It can be acute or chronic.
Describe Neuropathic pain
Neuropathic pain is a direct consequence of a lesion
or disease affecting the somatosensory system. Over time, neuropathic pain may become independent of the inciting injury, becoming burning, lancinating, or shock-like in quality, It may persist even after healing from the initial injury has occurred. Mechanisms pos- tulated to evoke neuropathic pain include central ner- vous system brain or spinal cord injury from stroke or trauma; peripheral nervous system disorders causing entrapment or pressure on spinal nerves, plexuses, or peripheral nerves; and referred pain syndromes with increased or prolonged pain responses to inciting stim- uli.
Describe Central sensitization
In central sensitization pain, there is alteration of central nervous system processing of sensation, leading to amplification of pain signals. There is a lower pain threshold to nonpainful stimuli, and the response to pain may be more severe than expected. Mechanisms are the subject of ongoing research. An example is fibromyalgia, which has a strong overlap with depression, anxiety, and somatization disorders and responds best to medica- tions that modify neurotransmitters like serotonin and dopamine.
Describe Psychogenic pain
Psychogenic pain involves the many factors that influence the patient’s report of pain—psychiatric conditions like anxiety or depression, personality and coping style, cul- tural norms, and social support systems.
Describe Idiopathic pain
Idiopathic pain is pain without an identifiable etiology.
Overweight BMI range?
25-29.9
Obesity Class 1 BMI range?
30-34.9
Obesity Class 2 BMI range?
35-39.9
Obesity Class 3 (extreme obesity) BMI?
≥40
Risk for heart disease and obesity related disease if waist above ___ in men and ___ in women
Women ≥35
Men ≥40
HTN defined as…?
≥140/90
HTN cut off in home, ambulatory, and automated cuffs
135/85 (lower than manual office)
5th vital sign?
Pain
Is “pain” subjective or objective?
Subjective. Tenderness is objective.
Wong Baker Faces scale is from what?
0-10
What is the benefit of Wong Baker Faces over others?
Wong-Baker can be used by children as well as patients with language barriers or cognitive impairment.
How far to insert the Otoscope into the ear canal?
1/3 and NO MORE!
Ears popping and decreased auditory function might mean sort of dysfunction?
Eustachian tube dysfunction
Where and what is the Mastoid like?
Like a sinus. Air-filled region of temporal bone. Brain very close so infection is mastoid is bad.
How to choose speculum size for Otoscope?
Select the largest speculum that will fit easily into the canal
Pneumatic otoscopy: more readily accomplished with larger or
smaller otoscope speculum tip?
Larger! Seals off ear canal and air goes toward drum. Want to see drum moving when puff the ear.
How to assess “gross hearing”?
With whispered voice
If PT might have hearing loss from Gross Hearing Test then what 2 tests to do?
Webber and Rinne with 512hz tuning fork
Which hearing tests checks for lateralization?
Webber
Which hearing test compares air conduction to bone conduction?
Rinne
In Rinne test where is air heard longer normally?
Normally the sound is heard longer through air than through bone
(AC > BC).
Most common cause of conductive hearing loss?
Wax (aka cerumen)
Unilateral Conductive Hearing Loss Lateralizes to ____ ear
Impaired
Unilateral Sensorineural Hearing Loss Lateralizes to ____ ear
good
In conductive hearing loss, sound is heard through bone
As long as or longer than it is through air (BC=AC or BC >AC).
In sensorineural hearing loss, sound is heard longer through
Air (AC>BC).
How to test CN 1 (olfactory nerve)?
Familiar scent. Each nostril separately with eyes closed.
What is “cobblestoning”?
Post nasal drip causing tiny dots of the uvula
Which cranial nerve for the tongue and floor of the mouth?
Cranial Nerve XII
Which cranial nerves for the Soft Palate and Uvula (in the the Pharynx)?
Cranial Nerve IX and X
Gag reflex tests which CNs?
IX and X
Stick tongue out and remain midline which CN?
CN XII
Which CN? is tested by Have the patient say ahh and noting the uvula and hard palate. They should rise symmetrically with speaking.
CN X
Which CN checks the trachea for mobility and deviation?
CN XI
Lateral Rectus is which CN?
CN 6
Superior Oblique is which CN?
CN 4
