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Physical Exam I > Exam 1 review (Gen survery, skin, eyes, ENT) > Flashcards

Exam 1 review (Gen survery, skin, eyes, ENT) Flashcards

1
Q

What is the most critical portion of the physical exam? (Hint: 2)

A

General appearance and vital signs

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2
Q

What percent of arm circumference should width of BP inflatable bladder be?

A

40%

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3
Q

Average adult BP bladder width?

A

12-14cm

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4
Q

What percent of arm circumference should length of BP inflatable bladder be?

A

80%

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5
Q

Average adult BP bladder length?

A

Almost long enough to encircle arm

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6
Q

Which artery should BP bladder be over?

A

Brachial

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7
Q

How far above antecubital crease should lower border of BP cuff be?

A

About 2.5cm

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8
Q

What is a silent interval between systolic and diastolic pressures?

A

Ausculatory gap

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9
Q

What does Ausculatory Gap cause in estimate of systolic and diastolic?

A

Systolic=underestimation

Diastolic=overestimation

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10
Q

Which diseases is Ausculatory Gap associated with? (Hint: 2)

A

Arterial stiffness or atherosclerotic disease

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11
Q

How long to wait between BP readings?

A

At least 2 minutes

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12
Q

Normal BP pressure difference between arms?

A

5-10mmHg

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13
Q

Which 3 diseases can cause a 10-15mmHg difference in BP in both arms?

A
  1. Subclavian steel syndrome
  2. Supravalvular aortic stenosis
  3. Aortic dissection
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14
Q

What is normal lower extremity pressure vs upper extremity pressure?

A

L.E. pressure is 5-10mmHg higher in LE than arms

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15
Q

What 2 conditions cause Upper Extremity HTN and Lower Extremity hypotension?

A
  1. Coarctation of aorta

2. Occlusive aortic disease

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16
Q

Coarctation of aorta and Occlusive aortic disease do what to LE and UE pressures and pulses?

A

UE=high BP

LE=low BP, diminished or delayed pulses

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17
Q

What are the “end organs” which BP can damage?

A

Eyes, heart, brain, kidneys

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18
Q

Define Myopia

A

Near sighted

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19
Q

Define Hyperopia

A

Far sighted

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20
Q

DEfine Presbuopia

A

Aging vision, difficulty with near vision

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21
Q

Pain in eye caused by issues in what 2 places?

A
  1. Cornea

2. Anterior chamber

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22
Q

What 2 things cause gradual bilateral vision loss?

A
  1. Cararact

2. Macular degeneration

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23
Q

Define Scotama

A

specks in the vision or areas where the patient cannot see

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24
Q

Moving specks or strands suggest vitreous floaters due to what?

A

Aqueous floaters

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25
Q

Define Hyphema

A

Blood in anterior chamber

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26
Q

Define Hypopyon

A

Pus in anterior chamber

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27
Q

Define Miosis

A

Constricted pupils

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28
Q

Define Mydriasis

A

Dilated pupils

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29
Q

Descibe Tonic/Avies Pupil

A

Unilateral dilated pupil, severely decreased light reflex. D/T parasympathetic deinnervation.

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30
Q

Describe Horner Syndrome pupil

A

Miosis, ptosis, anhydrosis. D/T sympathetic lesion.

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31
Q

Describe Argyll Robertson Pupils

A

No light reaction, small and irregular pupila

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32
Q

Define diplopia

A

Double vision

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33
Q

Diplopia due to lesion where? (Hint: 3 places)

A
  1. Brainstem
  2. Cerebellum
  3. Cranial nerve
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34
Q

Horizontal diplopia due to palsy of which CNs?

A

3 or 6

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35
Q

Vertical diplopia due to palsy of which CNs?

A

3 or 4

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36
Q

Diplopia in one eye with other eye closed due to problem where? (2 places)

A

Cornea or lens

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37
Q

Legal blind in US?

A

20/200

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38
Q

Describe Papilledema

A

Edema of optic disc due to increased intracranial pressure

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39
Q

Arteries in the retina look like what? (color, light reflex, size)

A

Light red, bright light reflex, small

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40
Q

Veins in the retina look like what? (color, light reflex, size)

A

Dark red, absent light reflex, large

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41
Q

Normal Intraocular Pressure?

A

10-22

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42
Q

What does Hirschberg Test test for?

A

Manifest deviations “tropia”. Strabismus.

Corneal light reflex.

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43
Q

What will eyes do in Hirschberg Test?

A

One eye turns up/down/in/out while other stays straight

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44
Q

What will Cover Test detect?

A

Latent Deviation.

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45
Q

What happens to bad eye in Cover Test?

A

Covering good eye causes deviated eye to focus

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46
Q

Manifest Deviation in which test?

A

Hirschberg Test

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47
Q

Latent Deviation in which test?

A

Cover Test

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48
Q

What kind of pupil does the Swinging Flashlight Test detect?

A

Marcus Gunn Pupil

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49
Q

Swinging Flashlight Test tests which CN?

A

CN 2 optic nerve

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50
Q

Describe Swinging Flashing Light in good eye

A

Pupil constricts in direct response eye and consensual constriction in other eye

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51
Q

Describe Swinging Flashing Light in bad eye

A

Partial dilation of both eyes

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52
Q

Marcus Gunn Pupil due to what?

A

Decreased afferent stimulis in bad eye -> decreased efferent signal in both eyes

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53
Q

Describe Near Reaction and pupils

A

Shift gaze from far to near causes both pupils to constrict

54
Q

What does Convergence test?

A

Eyes coming together at midline when focusing. EOM.

55
Q

Which muscle and nerve tested in Convergence?

A

Medial rectus muscle, CN 3

56
Q

What does Accommodation test for? What can’t the examiner do?

A

Brings near objects into focus. Can’t be seen by examiner.

57
Q

CN for Lateral Rectus?

A

CN 6

58
Q

CN for Superior Oblique?

A

CN 4

59
Q

Describe Ptosis

A

Low lying upper lid during primary gaze

60
Q

Ptosis muscle and nerve?

A

Levator palpebrae

CN 3

61
Q

Define Lagophthalmos

A

Inability to fully close eyelid

62
Q

Lagophthalmos muscle and CN?

A

Obicularis muscle

CN 7

63
Q

Bell’s Phenomenon causes what to the eyelid?

A

Lagophthalmos (incomplete closure of eyelid)

64
Q

Describe Hordeolum (Stye)

A

Infection at inner or outer margin of eyelid. Painful, tender, red, internal or external pustule. S Aureus. D/T obstructed gland or eyelash follicle.

65
Q

Describe Chalazion

A

Subacute, non-tender, painless nodule. Points inside lid/within lid. Blocked meibomian gland.

66
Q

Describe Xantheloma

A

Cholesterol filled plaques along nasal portion of nose

67
Q

Microaneurysm, neovascularization, retinitis proliferans in which DZ?

A

DM

68
Q

Ateriorlar narrowing, copper wiring, AV nicking, flame hemorhage in which DZ?

A

HTN

69
Q

Hyperemia of disc, venous enlargement, retinal hemorrhage, cotten-wool spots in which DZ?

A

Papilledema

70
Q

Which type of glaucoma causes peripheral vision loss?

A

Open angle glaucoma

71
Q

Persistent tearing due to what?

A

Dacryoadenitis=

Dacryocystitis=block of nasolacrimal duct

72
Q

Conductive Hearing loss is due to problems where in the ear?

A

External or middle ear problems

73
Q

What sort of enviroment might help someone with Conductive Hearing Loss?

A

Noisy environment

74
Q

What will Webber Test show in unilateral Conductive Hearing Loss?

A

Lateralizes to impaired ear

75
Q

What will Rhine Test show in Conductive Hearing Loss?

A

Sound heard as long or longer through bone than air.

BC=AC or BC>AC

76
Q

Sensorineural Hearing Loss due to what problems?

A

Inner ear, choclear nerve, connections to brain

77
Q

What will people with Sensorineural Hearing Loss complain about?

A

People mumbling

78
Q

Sensorineural Hearing Loss is worse in what sort of enviroment?

A

Noisy environment

79
Q

What will Webber Test show in unilateral Sensorineural Hearing Loss?

A

Lateralizes to good ear

80
Q

What will Rinne Test show in Sensorineural Hearing Loss?

A

Sound heard longer through air.

AC>BC

81
Q

Where can ear pain be referred from?

A

Structures in the mouth, throat or neck.

82
Q

Does Tinnitus have an external stimulus?

A

perceived sound with no external stimulus

83
Q

Tinnitus with hearing loss and vertigo suggests

A

Meniere’s disease

84
Q

What does Vertigo refer to?

A

Perception that the patient or the environment is rotating or spinning

85
Q

What does a tender nodes suggest?

A

Inflammation

86
Q

What do hard or fixed nodes (fixed to underlying structures and not movable on palpation) suggest?

A

Malignancy

87
Q

Enlargement of a supraclavicular node, especially on the left, suggests? From where?

A

Possible metastasis from a thoracic or an abdominal malignancy.

88
Q

A pulsating “tonsillar node” is really what?

A

The carotid artery

89
Q

A small hard tender “tonsillar node” high and deep between the mandible and the sternocleidomastoid is probably what

A

The styloid process.

90
Q

Describe Nociceptive (somatic) pain

A

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.

91
Q

Describe Neuropathic pain

A

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.

92
Q

Describe Central sensitization

A

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.

93
Q

Describe Psychogenic pain

A

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.

94
Q

Describe Idiopathic pain

A

Idiopathic pain is pain without an identifiable etiology.

95
Q

Overweight BMI range?

A

25-29.9

96
Q

Obesity Class 1 BMI range?

A

30-34.9

97
Q

Obesity Class 2 BMI range?

A

35-39.9

98
Q

Obesity Class 3 (extreme obesity) BMI?

A

≥40

99
Q

Risk for heart disease and obesity related disease if waist above ___ in men and ___ in women

A

Women ≥35

Men ≥40

100
Q

HTN defined as…?

A

≥140/90

101
Q

HTN cut off in home, ambulatory, and automated cuffs

A

135/85 (lower than manual office)

102
Q

5th vital sign?

A

Pain

103
Q

Is “pain” subjective or objective?

A

Subjective. Tenderness is objective.

104
Q

Wong Baker Faces scale is from what?

A

0-10

105
Q

What is the benefit of Wong Baker Faces over others?

A

Wong-Baker can be used by children as well as patients with language barriers or cognitive impairment.

106
Q

How far to insert the Otoscope into the ear canal?

A

1/3 and NO MORE!

107
Q

Ears popping and decreased auditory function might mean sort of dysfunction?

A

Eustachian tube dysfunction

108
Q

Where and what is the Mastoid like?

A

Like a sinus. Air-filled region of temporal bone. Brain very close so infection is mastoid is bad.

109
Q

How to choose speculum size for Otoscope?

A

Select the largest speculum that will fit easily into the canal

110
Q

Pneumatic otoscopy: more readily accomplished with larger or

smaller otoscope speculum tip?

A

Larger! Seals off ear canal and air goes toward drum. Want to see drum moving when puff the ear.

111
Q

How to assess “gross hearing”?

A

With whispered voice

112
Q

If PT might have hearing loss from Gross Hearing Test then what 2 tests to do?

A

Webber and Rinne with 512hz tuning fork

113
Q

Which hearing tests checks for lateralization?

A

Webber

114
Q

Which hearing test compares air conduction to bone conduction?

A

Rinne

115
Q

In Rinne test where is air heard longer normally?

A

Normally the sound is heard longer through air than through bone
(AC > BC).

116
Q

Most common cause of conductive hearing loss?

A

Wax (aka cerumen)

117
Q

Unilateral Conductive Hearing Loss Lateralizes to ____ ear

A

Impaired

118
Q

Unilateral Sensorineural Hearing Loss Lateralizes to ____ ear

A

good

119
Q

In conductive hearing loss, sound is heard through bone

A

As long as or longer than it is through air (BC=AC or BC >AC).

120
Q

In sensorineural hearing loss, sound is heard longer through

A

Air (AC>BC).

121
Q

How to test CN 1 (olfactory nerve)?

A

Familiar scent. Each nostril separately with eyes closed.

122
Q

What is “cobblestoning”?

A

Post nasal drip causing tiny dots of the uvula

123
Q

Which cranial nerve for the tongue and floor of the mouth?

A

Cranial Nerve XII

124
Q

Which cranial nerves for the Soft Palate and Uvula (in the the Pharynx)?

A

Cranial Nerve IX and X

125
Q

Gag reflex tests which CNs?

A

IX and X

126
Q

Stick tongue out and remain midline which CN?

A

CN XII

127
Q

Which CN? is tested by Have the patient say ahh and noting the uvula and hard palate. They should rise symmetrically with speaking.

A

CN X

128
Q

Which CN checks the trachea for mobility and deviation?

A

CN XI

129
Q

Lateral Rectus is which CN?

A

CN 6

130
Q

Superior Oblique is which CN?

A

CN 4

Physical Exam I (8 decks)

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