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Clinical Medicine > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

7 attributes of a symptom

A

Location, Quality, Quantity or severity, Timing, Setting in which it occurs, Remitting or exacerbating factors, Associated manifestations

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2
Q

Common or Concerning Symptoms in Head/Neck

A

Headache, Change in vision, Double vision, Hearing loss, earache, tinnitus, Vertigo, Nosebleed, Sore throat/hoarseness, Swollen glands, Trauma

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3
Q

Questions to ask in head trauma

A

Is pt awake and oriented
Mechanism of injury
Time of injury
Loss of consciousness immediately postinjury, Subsequent level of alterness, Amnesia, Headache, Double or bluured vision, Bleeding from ears, nose, mouth, eyes

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4
Q

A concussion is

A

a disturbance in brain function caused by a direct or indirect force to the head

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5
Q

Symptoms that suspect presence of a concussion

A

Symptoms such as headache
Physical signs such as unsteadiness
Impaired brain function or confusion
Abnormal behavior

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6
Q

Sport concussion Assessment Tool -2

A

Designed for use by medical professionals for pre-season sports screening. Then retaken post-injury

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7
Q

Classic Migraine Headache

A 
Unilateral in 70%
Pulsating or throbbing
Hours to days
Predominately female
Nausea/vomiting
Missing meals, menses, BCP, stress, certain foods
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8
Q

Cluster Headache

A 
Adulthood
Unilateral
1/2 to 2 hours
Intense burning, searing knife like
Several nights then several days then gone
Predominately males
Increased tearing/nasal discharge
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9
Q

Tension Headaches

A 
Adulthood
Unilateral or bilateral
Hours to days
Anytime
Bandlike, constricting
No prodrome
Stress, anger, teeth grinding
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10
Q

Medication Rebound

A 
Diffuse
Lasts hours
Hours or days of last dose
Dull or throbbing
Daily analgesics
Abrupt analgesic stop
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11
Q

Hyperthyroidism

A 
Nervousness
Weight Loss
Excessive sweating heat intolerance
Warm, smooth, moist skin
Graves disease
Tachycardia
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12
Q

Hypothyroidism

A 
Fatigue, lethargy
Modest weight gain
Dry coarse skin, cold intolerance
Swelling of face, hands, legs
Bradycardia
Impaired memory
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13
Q

Head Exam includes

A 
Head inspection, Symmetry
Hair (for bugs/lice)
Scalp (lesions, growths, scapes)
Face (cranial nerve 7)
Palpation
Bony irregularities
Oral mucosa
Facial sensation
Carotid and temporal arteries
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14
Q

Measure the circumference of head every exam from

A

Birth to 24 months

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15
Q

Infant’s head is ___ of its body length and ___ of its body weight at birth

A

1/4

1/3

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16
Q

Bones are separated by membranous tissue spaces called

A

Sutures

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17
Q

The areas where sutures intersect are known as

A

Fontanelle

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18
Q

Anterior fontanelle closes about

A

18 months (range 9-24 m.)

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19
Q

Posterior fontanelle closes about

A

2 months

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20
Q

Bulging fontanelle is caused by

A

increased intracranial pressure (also seen with coughing, vomiting, crying)

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21
Q

Sunken fontanelle are caused by

A

Dehydration

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22
Q

Hydrocephalus

A

increased intracranial pressure from deficient spinal fluid circulation causes enlargement of the clavarium before the sutures are closed

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23
Q

Molding

A

repositioning of cranial bones to allow passage of baby through birth canal

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24
Q

Caput succedaneum

A

Subcutaneous edema over the presenting part of the head at delivery
It usually occurs over the occipitoparietal area and crosses suture lines
Transluminates

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25
Q

Cephalhematoma

A 
Subperiosteal collection of blood
Does not cross over suture lines.
It is commonly found in the parietal region
Does not transluminate
Looks like horns
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26
Q

Plagiocephaly

A

Occurs when infant lies on one side constantly
Treated in most cases with parental education and different holding patterns, placing objects on interest opposite normal head rotation
Self resolves with age

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27
Q

Craniosynostosis

A

Premature closure of sutures, can cause asymmetry as well

Caused by early closure of fontanelles

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28
Q

Brachycephaly

A

premature closure of coronal suture

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29
Q

In neck, palpate for

A

masses, enlarged lymph nodes, cysts, position of thyroid

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30
Q

Congenital Muscular Torticolis

A

injury and possible bleed into sternocleidomastoid muscle at birth
Treatment with stretching exercises

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31
Q

Ear exam HPI/PROS

A

Difficulty understanding people when they talk/noisy environment?
Earache, Vertigo, Upper respiratory infections, Tinnitus, discharge

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32
Q

Nose exam HPI/PROS

A

rhinorrhea, seasonal problems, URI, meds/remedies tried, congestion only on one side, Epistaxis, check if anything is stuck up nose

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33
Q

Before insertion of the otoscope,

A

palpate tragus and pinna for pain - differentiates otitis externa from otitis media

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34
Q

Otoscopic Exam for adult

A

Pull pinna up, out and back

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35
Q

Otoscopic exam for child

A

pull pinna down, out and back

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36
Q

Inspect tympanic membrane for

A

color, light reflex, bone structure

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37
Q

Whisper Test

A

No equipment needed
Stand behind and to the side 1-2 feet away
Have patient put finger in ear not being tested
Exhale fully, then whisper 3 numbers or letters
Ask patient to repeat what they heard

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38
Q

Weber Test differentiates between what kinds of hearing loss?

A

Conductive and neurosensory

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39
Q

Weber Test

A

place vibrating fork in middle of patients vertex and ask where they hear the sound

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40
Q

Rinne Test helps determine

A

whether each ear detects sound better through air or bone

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41
Q

Rinne Test

A

place vibrating fork on pts mastoid process - ask to tell you when no longer hear sound (time in sec)
Immediately move fork so vibrating tines are about 2 cm from pts auditory canal - ask to tell you when can’t hear sound

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42
Q

Rinne Test normal

A

Normally hear sound through air longer than bone

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43
Q

Conductive hearing loss

A

External or middle ear disorder
Causes - foreign body, otitis media, perforated eardrum, otosclerosis
Sound lateralizes to impaired ear
Bone conduction longer than or equal to air conduction

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44
Q

Sensorineural Loss

A

Inner ear disorder involving the cochlear nerve
Causes - loud noise exposure, inner ear infections, trauma, acoustic neuroma, aging, familial disorders
Sound lateralizes to good ear
Air conduction longer than bone conduction

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45
Q

Conductive hearing loss Weber test

A

hear sound in impaired ear

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46
Q

Sensorineural hearing loss Weber test

A

hear sound in good ear

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47
Q

Conductive hearing loss Rinne test

A

Bone conduction longer than or equal to air conduction

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48
Q

Sensorineural hearing loss Rinne test

A

air conduction longer than bone conduction (appears normal)

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49
Q

Throat and mouth HPI/PROS

A

sore throat or pharyngitis, sore tongue, bleeding from gums, hoarsness, swollen glands, temperature intolerance (check thyroid), sweating, skin changes, tobacco use

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50
Q

Grading of tonsil enlargement

A

Scale of 1-4

51
Q

Asymmetric protrusion of tongue suggests

A

Damage to CN 12, tongue goes toward same side of lesion

52
Q

Deviateion of uvula to one side as it raises with phonation suggests

A

lesion to CN 10

53
Q

Trachea in lung volume loss

A

Trachea pulled toward affected side

54
Q

Trachea in thyroid enlargement or pleural effusion

A

Trachea pulled away from affected side

55
Q

Tension pneumothorax

A

trachea deviates away from affected side

56
Q

Collapsed lung

A

Trachea deviates toward affected side

57
Q

If thyroid gland is enlarged listen for

A

bruits

58
Q

Position of ear on infant

A

upper part of auricle joins scalp at or above level of line from canthus of eye

59
Q

Sinuses at 1 year

A

Maxillary sinus

60
Q

Sinuses at 6 years

A

Sphenoid, Ethmoid, and Maxillary sinuses

61
Q

Sinuses at 10 years

A

Sphenoid, Frontal, Ethmoid, Maxillary sinuses

62
Q

Antenatal teeth

A

Inspect infants for these, about 1 in 2000 babies born with them
Need to take out, loose and could be a choking risk for baby

63
Q

Epstein’s pearls

A

pin head sized white or yellow, rounded elevations that are located along the midline of the hard palate near its posterior border or gums caused by retained secretions and disappear within a few weeks

64
Q

Peak size of tonsils occurs between

A

2-6 years of age

Relatively larger in middle childhood than in infancy and adolescence

65
Q

Teeth begin to erupt by

A

6-7 months - upper and lower central incisors

Four teeth added every four months after that

66
Q

Full complement teeth are in by

A

2-3 years

67
Q

Primary teeth usually begin to fall out at

A

5 years

68
Q

Secondary teeth usually begin in the

A

6th to 7th year

69
Q

Nasal foreign body causes

A

chronic unilateral rhinitis or congestion, foul smell or bad breath
Common in children from 9 mo. to 5 years

70
Q

Cataracts

A

usually later in life, leading cause of blindness if not corrected

71
Q

Leading cause of blindness in people over 65

A

Diabetes

72
Q

Macular degeneration

A

central vision loss

73
Q

Glaucoma

A

elevated pressure, peripheral vision lost first

74
Q

Transient loss of vision

A

young patient may be due to migraine; in older adult an emboli problem

75
Q

Flashes of light caused by

A

retinal detachment

76
Q

Diplopia

A

double vision, one eye optical problem, 2 eyes alignment problem

77
Q

Bulging eyes (exophthalmos) typically caused by

A

Thyroid disease

78
Q

Eye Exam HPI & Pros

A

sudden or gradual problem, persistent or transitory, recent trauma, time spent on computer screens, new medications, past medical/surgical history, recent URI, one or both eyes, last eye exam

79
Q

Thinning of eyebrows is one of first signs of

A

hypothyroidism

80
Q

Snellen Eye chart tests

A

Visual Acuity
Use in well lit area, pt 20 ft away from chart
Cover one eye and read smallest line possible
Start left to right for one eye, then read it backwards for other eye

81
Q

Visual acuity fraction

A

Numerator - distance from chart

Denominator - distance the average eye can read the chart

82
Q

Rosenbaum chart tests

A

Near vision - hand held card; helps identify if need reading glasses or bifocals

83
Q

Visual fields by Confrontation tests

A

Any defect in any quadrant of field of vision
Pt closes one eye, slowly bring your fingers into visual field halfway between you and pt at 45 degree angle
Pt says how many fingers they see when they see it through peripherals

84
Q

Extra-ocular Muscles assessment

A

Stand 3 ft from pt and ask them to follow your fingers with eyes only
Draw large X, then a plus with index finger, and convergence (bring finger toward their nose)
Look for jerking or drifting of eyes

85
Q

Nystagmus

A

jerking or drifting of the eyes

86
Q

Accommodation or Near Reaction Testing

A

Checks if eyes will converge and pupils constrict
Stand to one side of pt and hold something close to their eyes - eyes should converge and pupils constrict
Then ask pt to look at the wall in front of them - eyes should diverge and pupils dilate

87
Q

Pupillary Responses

A

measure each pupil size under normal conditions and with light shining in eye
Direct - constriction of pupil with light shining in that eye
Consensual - constriction of eye when shining light in opposite eye

88
Q

Swinging light test

A

for functional impairment of optic nerves
Shine light in one eye, then rapidly swing to other eye
Should have slight dilation in second eye while light is crossing bridge of nose, but constrict equally to first when light enters pupil
Go back and forth several times - if pupil tires and continues to dilate rather than constrict, there is an afferent defect

89
Q

Lateral Penlight Test

A

Estimate depth of the chamber of eye - look for glaucoma
Should be done before putting in mydriatic drops
Shine light from temporal side of head across front of eye parallel to plane of iris -
If nasal part of iris not lightened - shallow anterior chamber and risk of acute-angle glaucoma

90
Q

Corneal light reflex

A

Tests ocular alignment by reflecting light of pt’s pupils
Shine light towards patient and observe where light reflects from
Normal - light reflects from center of pupils

91
Q

Esotropia

A

Eye turned in

Corneal light reflected lateral to pupil

92
Q

Exotropia

A

Eye turned out

Corneal light reflected medial to pupil

93
Q

Cover Tests

A 
Used to detect tropia
Tests eye not being covered
Cover one of pts eyes
Observe movements in the uncovered eye
Normal is no movement
94
Q

Cover - Uncover Testing

A

Used to detect presence of a phoria
Tests covered eye (just as it is uncovered)
Cover and uncover eye - observe if covered eye moves
Normal test is no movement

95
Q

Esophoria

A

Covered eye turns in (after cover uncover test)

96
Q

Exophoria

A

Covered eye turns out (after cover uncover test)

97
Q

Corneal Sensitivity

A

Testing cranial nerve V & VII
Ask pt to look up and away
Touch cornea with wisp of cotton
Intact CN V - afferent, senses touch, blink eye - motor (CN VII)

98
Q

Stenson’s Duct

A

lateral to 2nd upper molar, opening of parotid duct

99
Q

Wharton’s Ducts

A

opening on floor of mouth, opening of submandibular gland

100
Q

Myopic

A

near sighted

101
Q

Hyperopic

A

far-sighted

102
Q

When using ophthalmoscope to look in pt’s right eye, what hand and eye should you use?

A

Right hand, right eye

103
Q

What is the first thing you look for when using an opthalmoscope?

A

Red reflex -light strikes retina and bounces back

104
Q

After seeing the red reflex with the ophthalmoscope, you move in on the eye and look for

A

blood vessels, optic disc, macula

105
Q

Why is pediatric vision screening important?

A

Can affect visual acuity

Find diseases early - can treat and prevent blindness

106
Q

Vision Screening in newborn - check anatomy by looking at

A

size of eyes, epicanthal folds, distance between eyes, and lids first
Then conjunctiva, sclera, iris, pupil

107
Q

Epicanthal folds

A

Vertical fold of skin nasally that covers the lacrimal caruncle
Normal variants in Asian infants but may be a sign of genetic anomalies in others

108
Q

Red reflex

A

orange to red light reflection from fundus

Should be equal in both eyes and fill pupil

109
Q

Leukocoria

A

White reflex - could be caused by congenital cataract or retinoblastoma

110
Q

Visual fixation is present at

A

birth

111
Q

Visual fixation well developed by

A

6-9 wks

112
Q

Visual following present by

A

3 months

113
Q

Accomodation and Stereopsis present by

A

4 months

114
Q

Visual screening in 6 - 12 months consists of

A

Red reflex & corneal light reflex
Inspection
Fixation & following
Poor fixation past 6 months is usually pathologic - requires ophthalmology referral

115
Q

Visual screening in 3- 5 year old consists of

A

Red reflex
Inspection
Visual acuity
Cover-uncover test

116
Q

Visual Acuity in newborns

A

20/400 - 20/800

117
Q

Visual Acuity in 3 year olds and older

A

20/40 or better

118
Q

Strabismus

A 
misalignment of eyes
Iris starts in:
Eso - in (moves out to correct)
Exo - out (moves in to correct)
Hyper - up (moves down to correct)
Hypo - down (moves up to correct)
119
Q

Pseudostrabismus

A

Appearance of misalignment of eyes without actual strabismus present
Most common when there is a broad nasal bridge
Light reflection in same place on both eyes

120
Q

Amblyopia

A

Loss of visual acuity due to active cortical suppression of vision of eye
Strabismus is one cause
Most effective screening is determination of visual acuity via noninvasive screening

121
Q

Requirements for normal visual development

A

Clear retinal image
Equal image clarity
Proper eye alignment

122
Q

Tropia

A

full time eye misdirection
more permanent
need surgery to correct

123
Q

Phoria

A

eye moves because of disturbances in binocular vision

Can correct without surgery

Clinical Medicine (4 decks)

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