exam 3 Flashcards
is eye pain possible with upper resp issues
yes
what is a large parotid artery associated with
mumps
how to tell the difference between drooping from stroke or bells palsy
bells palsy is typically just eye drooping
life threatening causes of headaches
meningitis
hemorrhage
tumor
primary headache
the problem is the headache
secondary headache
arises from something else. a symptom of another issue
SNOOP- red flags headaches
S- systemic signs, symptoms, or illness (stiff neck, hiv, cancer, “worst headache of life”
N- neurologic deficits (altered mental status, seizures)
O- onset (new or sudden)
O- other associated conditions (any head trauma? worse when lower/lifting head?)
P- prior history (Is it different than past headaches)
primary headaches
migraines, tension, cluster
migraines
could be unilateral (most common), bifrontal or global
throbbing
moderate to severe intensity
photophobia likely, nausea common
aura
rapid onset
last 4-72 hours
reoccurs weekly/monthly, family history
tension headaches
bilateral (forehead and back of head and neck)
tightening feeling, non throbbing, scalp tenderness, photophobia can occur
mild to moderate severity
gradual onset, last 30 min - 7 days
triggers: stress, muscle tension, sleep disturbance
relieving factors- massage, relaxation
cluster headaches
unilateral. typically around eye or temple
sharp, continuous
severe intensity
last 15 min-3 hours
could have several per day
rhinorrhea/ptosis/eyelid edema
meningitis
inflammation of meninges
could be life threatening
severe and sudden headache
stiff neck is a common sign
Traumatic brain injury
blow to head that interferes with brain function
-symptoms may take time to develop
goiter
enlarged thyroid gland
thyroid function may be increased, decreased, or normal
pharyngitis relation with lymph nodes
enlarged lymph nodes are common with sore throat
macrocephaly
big head. possible brain issues
microcephaly
small head. possible brain issues
cushing syndrome signs
rounded moon face, red cheeks, buffalo hump, hirsutism
from increased cortisol
nephrotic syndrome
periobital edema, puffy and pale face, swollen lips
anosmia
not being able to smell
rhinorrhea
runny nose, clear liquid
xerostomia
dry mouth
dysphagia
difficulty swallowing
dysphasia
difficulty speaking
palpebral fissures
opening between eye
torus palatinus
growth on top of mouth. usually benign. not painful but can cause dysphagia
leukoplakia
white patch on tongue that cant be removed by scraping. can cause cancer
thrush
thick white plaque from yeast. usually due to prolonged antibiotics. can be scraped/removed. usually painful
if parotid gland is only swollen on one side it could be
neoplasm or cancer
acromegaly facial abnormalities
prominent jaw and brow, enlarged soft tissues
from too much growth hormone
parkinson’s disease facial abnormalities
stare, inability to move face, oily skin
where are preauricular lymph nodes
in front of ears
where are posterior auricular lymph nodes
behind ear, near mastoid process
where are occipital lymph node
back of head, near occipital bone of skull
where are tonsillar lymph nodes
below ears near jaw bone
where are submandibular lymph nodes
where submandibular gland sits. about midway of jaw bone between chin and ear
where are submental lymph nodes
below chin
where are superficial cervical lymph nodes at
lateral neck, about inch below ear near jugular veins
where are posterior cervical lymph nodes
back of neck behind jugular veins. between sternomastoid and trapezius muscle
where are the deep cervical chain lymph nodes
close to internal jugular. deep in
where are subclavicular lymph nodes
above clavicle
what do hard and fixed lymph nodes suggest
malignancy
how to inspect thyroid- not paplate
ask patient to sip water and swallow
hyperthyroidism signs and symptoms
nervousness, weight loss, palpitations, tremors, sweating, warm skin, fine hair, exophthalmos, increased systolic, decreased diastolic BP, frequent bowel movements
hypothyroidism signs and symptoms
fatigue, weight gain, dry cold skin, myexdema, constipation, decreased systolic, increased diastolic BP, bradycardia, hypothermia, impaired memory, coarse hair, nonpitting edema
angular chelitus
side of mouth gets cracked
angio edema
lips, mouth, tongue swollen
angioedema
swelling of mouth, lips, tongue
gritty eye
feeling of sand in eye, irritation
diplopia
double vision
cranial nerve II
Optic. vision
cranial nerve III
oculomotor. eye movement and pupil reflex
cranial nerve IV (4)
trochlear. Superior oblique eye movement
cranial nerve VI (6)
abducens. to lateral rectus eye muscles
Strabismus
cross eyed
prothesis
artificial eye
hyperopia
farsighted
presbyopia
gradual loss of ability to focus eye. impaired near vision
myopia
nearsighted
scotomas
blind spot in vision
how does smoking effect eyes
vasoconstriction
numerator/denominator on snellen chart
numerator- distance away the patient is. always 20 feet
denominator- distance at which normal eye could see letters. larger denominator, worse the vision
how many letters can a client miss on snellen chart to pass a line
2
jaegar chart
held 14 inches from clients eye.
read the smallest line possible
this helps identify needs for bifocals
- dont use corrective lenses
confrontation test
tests peripheral view
entropian
eyelid and lashes inverted in. irritation
ectropion
eyelid and lashes turn out, dryness
ptosis
droopy eyelid
pale sclera can indicate
anemia
anisocoria
uneven pupil
accomodation test
bringing a object near and far from eye
the pupil should constrict and converge as objects move near and dialate as they move farther away
direct pupil reaction
light shined in pupil, pupil constricts
consensual pupil reaction
when light is shined in pupil of one eye, the other pupil should still constrict
cardinal movement in eye
H pattern
test for extraocular movements
test cranial nerve 3,4 and 6
amblyopia
lazy eye
can medication affect ears
yes. they can be ototoxic
otalgia
earache
conductive loss
problems w/ external or middle ear. noisy environments may help
sensorineural loss
problems w inner ear. people w this may have trouble understanding speech. noisy environments make hearing worse
vertigo
the room around you is spinning
meniere’s disease
hearing loss, tinnitus, and vertigo
how to move ear for otoscope
pull pinna upward, back and away from head
where is cone of light on ear drum when using otoscope
right ear- 5 o’clock position
left ear- 7 o’clock position
where should cone of light be on eardrum when using otoscope
right ear- 5 o’clock position
left ear- 7 o’clock position
whisper test
stand 2 feet behind client and don’t let them see your lips
ask them to repeat what you say as you whisper
they should hear at least 4/6 things you say
weber test
tuning fork on top of head, ask where they hear sound
rinne test
place tuning fork on mastoid process until they cant hear then place it in front of ear (don’t reactivate) and see how long they can hear
air conduction should be heard longer than bone. If not, could indicate conductive hearing loss
what does nasal speculum do
open nasal passageway for us to see. shouldn’t cause pain
what causes polyps in nose
chronic conditions such as cystic fibrosis, asthma, etc
what sinuses do we palpate
frontal and maxillary
malocculsion
teeth don’t align properly
tongue expected findings
pink with papillae, moist, slightly rough, thin white coating
+1 tonsil
visable
+2 tonsil scale
between tonsillar pillars and uvula
+3 tonsil scale
touching uvula
+4 tonsil scale
touching eachother
mydriasis
extreme dilation of pupil
where is oral cancer most likely to be found
under the tongue
what part of brain is affected by alcohol
cerebellum
can affect coordination and balance
glascow coma scale
measures motor response, verbal response and eye opening
scale goes up to 15,
3-8 comatose
under 3 - no response
what makes up CNS
brain and spinal cord
PNS
nerves that branch off the spinal cord and extend to body
what are the most common nuero symptoms
headaches and dizzy
what is described as “worst headache of life”
hemorrhage
POUND acronym for migraines
P= pulsatile or throbbing
O= one day duration or last 4-72 hours
U= unilateral
N= nausea or vomiting
D= Disabling or intensify causing interruption of ADLs
presyncope
about to fall
what can cause motor weakness
CNS issue or muscle
weakness w abrupt onset of motor and sensory deficits
TIA or stroke
paresthesia
pins and needles feeling (tingling)
dysesthesia
sensation isnt perceived in normal way
ex- light touch feels like burning sensation
complete loss of consciousness, postural tone, and loss of perfusion to brain
syncope
tonic clonic seizure
also called grand mal. loss of consciousness and violent muscle contraction, loss of bladder, decreased level of consciousness after
pseudoseizure
looks like seizure but isn’t associated with electrical charge
absence seizure
seizures that cause a lack of awareness. stares into space
generalized seizure vs focal seizure
generalized starts in both sides of the brain
focal the electrical charge starts on one side of brain, but could spread
atonic seizure
causes person to go limp and fall to floor
tremor
involunary movements
low frequency, unilateral tremor, moving at rest
parkinsons disease
high frequency, bilateral in upper extremites, occurs with movement, subsides with rest
essential tremor
does leg restlessness get better with rest or activity
activity
2 common things causing restless leg that are revirsable
pregnancy and iron deficiency
0 muscle scale
can’t move/contract muscle, totally flaccid
1+ muscle scale
muscle contracts slightly
2+ muscle scale
able to move a joint when gravity is eliminated. cant lift up in air but can bend on something
3+ muscle scale
can move joint against some gravity
4+
can move joint w some resistance throughout full range of motion
5+
joint can move with full resistance thru whole range of motion
flaccid
complete loss of muscle tone
rigidity
muscles are very contracted, very tense
spasticity
muscles are tight and stiff but not completely contracted
hypotonia
decreased muscle tone
hypertonia
increased muscle tone and strength. can result in injury of upper neurons
hemiparesis
one sided decreased muscle tone
paraplegia
paralysis of lower body from spinal cord injury at or below thoracic
quadriplegic
movement and sensation loss of entire body, happens from spinal cord injury in cervical vertebrae
decorticate posturing
internal rotation of feet, arms adducted
decerebrate posturing
arms stiffly extended and hyperpronated, legs hyperextended
posture and rhythmic movements
cerebellar
vestibular
balance and coordination
point to point movement
assess cerebellar function coordination
dysmetria
inability to perform point to point movements
ataxia
loss of position sense
romberg test
person stands still with eyes closed, check for swaying
pronator drift test
ask person to extend both arms, see if arms pronate and return to horizontal position when tapping arms down
sensory tests
temp
dull/sharp pain
vibration (tuning fork)
proprioception (ask what way your moving toe)
light touch
stereognosis
small object in palm- identify
graphesthesia
number identification
close eyes and trace number in their palm
two point discrimination
2 points touching at once, where are they
dermatone
band of skin innervated by the sensory root of a spinal nerve
point localization
can patient identify where you tested?
extinction
checks for patients ability to point to both sides
tendons
muscle to bone
why test reflexes
assess status of CNS
4+ reflex
very brisk, hyperactive, with clonus
3+ reflex
brisker than avg but not necessarily indication of disease
2+ reflex
average, normal
1+ reflex
somewhat diminished, low normal
0+ reflex
no response
bicep reflex
thumb on tendon, strike your own finger
tricep reflex
flex arm downwards, strike above elbow
achilles reflex
dorsiflex foot at ankle, strike
plantar reflex
move hammer from heel to toe
toes should curve inward
babinski response
dorsiflexion of great toe, fanning of others
FAST
Face drooping
Arm weakness
Speech difficulty
Time
FAST
Face drooping
Arm weakness
Speech difficulty
Time
what causes hemorrhagic stroke
bleeding in brain
what causes ischemic stroke
loss of blood supply to brain
thought process
how is it thought thru
mood
sustained emotion, changes perception of things around you
insight
awareness that what they are feeling is normal/abnormal
higher cognitive functions
things that actually require thought, interpretation
judgement
comparing options to make decision
perception
being aware of things in enviroment
thought content
what patient thinks about
ability to focus
attention
affect
outward expression: tone, facial expression
somatoform symtoms
lack medical or physical explanation
functional syndromes
change overall quality of life and ability to function normally
mental exam of speech
quantity, rate, loudness, articulation of words, fluency
could it be cultural
tests for aphasia
word comprehension, repetition, naming, reading comprehension, writting
illusion
misinterpretation of real stimuli
hallucination
no real stimuli
speech w unnecessary detail, doesn’t get to point
circumstantiality
sudden interruption of speech in mid sentence
blocking
everything said is one long sentence
flight of ideas
facts/events are fabulated, made up
confabulation
speech is illogical, does not make sense
incoherence
association between topics are unrelated but patient does not realize
derailment
inverted/distorted words- made up
neologisms
persistent repetition of words or ideas
perseveration
repeating words of someone else
echolalia
choosing words based on sound not meaning
clanging
new learning ability test
give 3-4 words, ask them to tell you 3-5 mins later
abstract thinking test
proverbs, similarities
constructional ability test
have them draw a clock
mini mental exam screen
max score 30 (good)
anything under 17 is severe cognitive impairment
alcohol CAGE
cutting down?
annoyed?
guilty?
eye openers?
olfactory nerve (what it does and roman numeral)
I. sensory
smell
optic nerve (what it does and roman numeral)
II sensory
vision, pupil assessment
oculomotor (what it does and roman numeral)
III. motor
pupil assessment
extraocular moevements
trochlear (what it does and roman numeral)
IV. motor
extraocular movements
abducens (what it does and roman numeral)
VI. motor
extraocular movements
trigeminal (what it does and roman numeral)
V motor and sensory
motor, sensory, corneal reflex
facial (what it does and roman numeral)
VII. motor and sensory
controls muscle of facial expression
Acoustic (what it does and roman numeral)
VIII. sensory
hearing
glossopharyngeal (what it does and roman numeral)
IX. motor and sensory
voice/swallowing
vagus (what it does and roman numeral)
X. motor and sensory
Voice/swallowing.
spinal accessory (what it does and roman numeral)
XI. motor
move shoulder and neck muscles
hypoglossal
XII. MOTOR
movements of tongue
dementia test
slums tool
disorientation when looking at amsler chart
macular degeneration
largest chamber of eye
vitreous
Transforms light rays into nerve impulses that are conducted to the brain
retina
innermost bone in ear
stapes
