exam 2 Flashcards
ptosis:
drooping upper lid, occurs from neuromuscular weakness, oculomotor cranial nerve 3 damage, sympathetic nerve damage, congenital, positional defect gives the person a sleepy appearance
vertigo:
a symptom that causes a person to feel like they or the world around them is moving or spinning, even when they are not, objective vertigo:the room is spinning, subjective vertigo they feel like they are spinning themself
presbyopia:
lens loses elasticity, becoming hard and glasslike, which decreases ability
to change shape to accommodate for near vision, farsightedness
myopia:
nearsightedness or short-sightedness, is an eye condition that makes it difficult to see objects that are far away
how to best assess for temperature on skin?
-use backs of hands to palpate
-skin should be WARM, and temperature EQUAL BILATERALLY, WARMTH suggest NORMAL CIRCULATORY STATUS
-hands and feet may be slightly cooler in a cool environment
ABCDEF acronym?
A: asymmetry
B: border irregularity
C: color variations
D: diameter > 6 mm
E: evolution
F: funny looking
what is the meaning of xerosis?
dry skin
papule:
Felt and caused by superficial thickening of the epidermis
what are the types of headaches?
tension, migraines, cluster headaches, sinus, rebound, exertion, hormonal
what is clubbing of the nails?
Nails curve around fingertips
- Could be due to lung disease, infection, neoplastic disease, or vascular disease. (nail tissue can’t get enough oxygen)
what is normal for lymph nodes?
movable (mobile), discrete, soft, non-tender, and < 1cm
what is a migraine?
pain is throbbing, can be associated with auras, pain is supraorbital, retro-orbital, or fronto-temporal
normal findings in palpations for trachea and thyroid?
trachea: should be midline, palpate for any tracheal shift, note any deviation from midline
thyroid: difficult to palpate; check for enlargement, consistency,
symmetry, and presence of nodules, anterior and posterior, look for bruit if enlarged
how to best assess lymph nodes?
1) using a gentle circular motion
of finger pads, palpate lymph
nodes
2) beginning with pre-auricular
lymph nodes in front of ear,
palpate the 10 groups of lymph
nodes in routine order
3) many nodes are closely packed,
so you must be systematic and
thorough in your examination
4) do not vary sequence or you
may miss some small nodes
assessing lymph nodes on neck:
Use gentle circular motion of finger pads
Begin with pre-auricular lymph nodes in front of eat, palpate the 10 groups of lymph nodes in routine order
hyperthyroidism symptom’s: (graves disease)
physical presentation neck and face:
-goiter
-eyelid retraction
-exophthalmos
what does a snellen chart do? test for visual acuity
-snellen alphabet chart is most commonly used and accurate
measure of visual acuity.
-it has lines of letters arranged in decreasing size.
-place chart in a well-lit spot at eye level; position the person exactly
20 feet from chart; hand the person an opaque card with which to
shield one eye at a time during test.
-if the person wears glasses or contact lenses, leave them on;
remove only reading glasses.
-ask the person to read through chart to smallest line of letters
possible; encourage trying next smallest line also
(Numerator) The feet/ distance at which that patient can read
(Denominator) what a normal person can read at ___ feet.
what is the confrontation test for eyes?
-gross measure of peripheral vision; compares the person’s peripheral vision with yours
-direct the person to cover one eye with an opaque card and with other eye to look straight at you.
-cover your own eye opposite to the person’s covered one; you are testing uncovered eye.
-hold pencil or your finger as target midline between you and the person, and slowly advance it in from periphery in several directions
-normal results are about 50 degrees upward, 90 degrees temporal, 70 degrees down, and 60 degrees nasal
what are the 6 cardinal positions of gaze test?
-follow movement of penlight or object proceeding clockwise.
-assess for potential EOM muscle
weakness, nystagmus, or lid lag
what is PERRLA?
Pupils Equal, Round, React to Light, and Accommodation
Normal findings of assessing eyes for accommodation
Accommodation: adaptation of eye for near vision
- Pupillary constriction
- Convergence (motion toward) of the axes of the eyeballs
Interpretation of inner retina red reflex
Normal constriction of pupils when bright light shines on retina
Retinal structures that can be viewed with the ophthalmoscope
optic disc, optic cup, veins, arteries, fovea, macula
Visual changes not common with aging
Conjunctivitis, iritis, primary angle-closure glaucoma, subconjunctival hemorrhage, herpes simplex virus
In lens- central gray, star shaped
Normal appearance of tympanic membrane
normally shiny and translucent, with a pearl-gray color
Flat, slightly pulled in at center
Extra:
- Cone-shaped light reflex prominent in anteroinferior quadrant
- Sections of malleus are visible through translucent drum
- At periphery annulus looks whiter and dense
Functions of the middle ear
It conducts vibrations of sounds to the inner ear
Conductive hearing loss and causes
Conductive hearing loss: mechanical dysfunction of external or middle ear
Causes: impacted cerumen, foreign bodies, perforated TM, pus or serum in middle ear, and otosclerosis.
Ex:
otosclerosis- common between 20 and 40, gradual deafness (and hardening that causes footplate of stapes to become fixed in oval window).
Proper use and positioning of the otoscope for an adult
-Chose largest speculum that will fit comfortably
-Tilt patients head slightly away from you (brings eardrum into better view)
-Pull pinna up and back
-Hold pinna gently but firmly
-Insert speculum slowly and carefully along axis of canal
-Avoid touching the inner bony section of canal wall
-Preform otoscopic examination before testing hearing
Cone of light position for right vs left tympanic membrane
light reflex at 5 o’clock on Right and 7 o’clock on Left
Examination and palpation of the external ear
Size and shape (equal size bilaterally, no swelling)
Skin condition (consistent color with facial skin, no lumps or lesions)
No tenderness when moving pinna or pushing on tragus (should feel firm)
Palpating mastoid process should produce no pain
External auditory meatus should have no swelling, redness, or discharge
Romberg test and meaning of positive test
indicates a loss of balance when a patient closes their eyes during the test, hold arms near patient and tell them to close their eyes and try not to lose balance
Behaviors that may demonstrate hearing loss
Saying that people are mumbling
Lip reading or watching lips rather than eyes
Straining forward to hear
Needing frequent repeats
Speech sounds garbled
Flat monotonous tone of voice
Causes of sensorial hearing loss
Sensorineural hearing loss: signifies pathology of inner ear, cranial nerve VIII, or auditory areas of cerebral cortex.
Causes: presbycusis and ototoxic drugs (effects hair cells in cochlea)
Presbycusis
type of hearing loss that occurs with aging, even in people living in a quiet environment
Palpating sinuses and the normal type of sensation that the patient may report
Use thumbs, press frontal sinuses by pressing up and under eyebrows and over maxillary sinuses below cheekbones.
Signs, symptoms, and oral assessment findings in a patient with dehydration
Dry mouth and deep vertical fissures on tongue
Exam technique for assessing cranial nerve IX and X
Cranial nerve X: say “ahhhh” and watch uvula rise (tests vagus nerve)
Cranial nerve IX: touch posterior wall with tongue blade to elicit gag reflex (glossohprahygeal)
Exam technique for assessing cranial nerve I (olfactory)
Usually not rested in routine examination, but cranial nerve I is the sense of smell (make patient smell something)
Risk factors associated with nose, sinus, mouth, and throat disorders
Old age, poor oral hygiene, tobacco use, some races (american indian, asian, african american)
Locations in the oral exam to assess for cyanosis
lips, tongue, and buccal mucosa
grading tonsils
0 absent
1+ is visible
2+ is halfway between tonsillar pillars and uvula
3+ is touching uvula
4+ is touching each other
(1+ or 2+ is normal)
Frenulum
The stringy thing that connects your tongue to the bottom of your mouth
(Midline fold of tissue connecting tongue to floor of mouth)
pressure ulcer stages:
1- skin intact, red, blue, or purple
2- skin is partially lost, shallow open sore
3- skin is fully lost and extends into subq tissue, crater, dark patches around edges
4- skin is fully lost and extends through fascia
best place to test for temperature:
dorsal side of hands, (back)
skin changes in elderly
Loss of elasticity (skin folds, sags, wrinkles)
Sweat & sebaceous glands decrease in number and production (dry skin)
Discoloration due to increasing capillary fragility
Skin breakdown and slower wound healing
Decrease in melanocytes (fine gray hair)
assess for skin turgor
Check skin tenting by pinching skin near the collarbone, want it to go back within 1-2 seconds, elastic
findings in bells palsy
Complete paralysis of one side of face- patient cannot wrinkle forehead, raise eyebrows, close eyelids, whistle, or show teeth on affected side.
4 areas of body where lymph nodes are generally palpable or accessible
Head + neck, arms, inguinal region, and axillae
