Exam 3 Flashcards
Which sinuses are palpable on exam?
Ch 17
- Maxillary sinus
- Frontal sinus
Describe the difference in the hard & soft palates
Ch 17
- Hard Palate: anterior, more white
- Soft Palate: more pink, posterior
List the salivary glands
Ch 17
- Parotid
- Submandibular
- Sublingual
Which salivary gland is the largest & where is it located?
Ch 17
Parotid: in the cheeks
What is important to keep in mind regarding aging adults when examening the nose, mouth, & throat?
Ch 17
Aging Adults have…
- Diminished smell
- Atrophic tissues (no bulk)
- Dental changes (dentures, teeth loss, etc.)
What are some symptoms of dehydration?
Ch 17
- fissures on the tongue
- dehydrated / dry mucosa
Health History Questions to ask regarding examining the nose
Ch 17
- Discharge: what color is it? what does it look like? how often?
- Frequent Colds: how often?
- Trauma: broken nose? septal deviation?
- Sinus Pain, epistaxis, Allergies, Altered Smell
What steps are done when examining the nose?
Ch 17
Inspect & Palpate
What parts of the nasal cavity should you examine?
Ch 17
- Nasal Septum
- Turbinates
What step(s) are done to examine the sinuses?
Ch 17
Palpate
Palpate the maxillary & frontal sinuses
What step(s) are performed to examine the mouth & what parts of the mouth should be examined?
Ch 17
Inspect
- lips, tongue, buccal mucosa, palate, uvula, teeth, & gums
What step(s) should be performed to examine the throat?
Ch 17
Inspect
Explain the Tonsil Grading Scale
Ch 17
- 1+ = visible
- 2+ = halfway between tonsillar pillars & uvula
- 3+ = touching the uvula
- 4+ = touching one another
What is Herpes Simplex & how long does it take to heal?
Ch 17
- contagious cold sore
- spreads via direct contact
- clear vesicle
- indurated, hard, erythematous at the base
- heals within 4 - 10 days
What is carcinoma & explain the healing process
Ch 17
- hard & indurated
- any lesion lasting MORE THAN 2 WEEKS should be evaluated
What is the major difference between Herpes Simplex & a Carcinoma?
Ch 17
Herpes Simplex usually heals within 4 - 10 days while a any lesion lasting more than 2 weeks should be evaluated as it may be a carcinoma
Explain Candidiasis (or monilial infection)
Ch 17
- White, cheesy patches on the buccal mucosa or tongue (can be scraped off & usually bleeds easily)
- also known as oral thrush / yeast infection
- Common in patients who are on chemotherapy or use antibiotics on a regular basis
What are the signs & symptoms of acute tonsillitis & pharyngitis?
Ch 17
- fever
- sore throat
- pain with swallowing
- enlarged tonsils
- tonsillar exudate
- cervical lymph node enlargement
- rheumatic fever
rheumatic fever is due to untreated strep infection
What is rheumatic fever caused by and what are some symptoms?
Ch 17
Rheumatic Fever: due to untreated strep infection
- causes many multi-system problems
Which of the following is likely to elicit the most information?
a.) How often do you brush your teeth?
b.) Has your sense of taste changed?
c.) Tell me about your daily dental care.
d.) Do you have any problems with your dentures?
Ch 17
c.) Tell me about your daily dental care
Which is an expected finding in darkly pigmented people?
a.) Circumolar pallor
b.) Dappled brown patches on the buccal mucosa
c.) Bluish lips
d.) A chalky white raised patch on the mucosa of the tongue
Ch 17 – KNOW THIS!!!
c.) Bluish lips
Where is the temporomandibular (TMJ) joint located?
Ch 23
anterior to the tragus
What questions should be asked when obtaining health history about joints?
Ch 23
- do you have any pain?
- do you have any stiffness?
- do you have any swelling, heat, or redness?
What questions should be asked when obtaining health history about bones?
Ch 23
- do you have any pain?
- do you have any history of deformity or trauma (fracture, sprain, dislocation) to any bones?
- do you have a history of surgery?
What is important to keep in mind / know when evaluating a patient’s functional assessment (activities of daily living) & self-care behaviors?
Ch 23
Know the patient’s baseline!
What step(s) should be performed when assessing the temporomandibular joint (TMJ)?
Ch 23
- Inspect
- Palpate
What are examples of things to inspect when assessing the temporomandibular joint (TMJ)?
Ch 23
- size
- skin color
- swelling
- masses
- deformities
What should you look for when palpating someone’s temporomandibular joint (TMJ)?
Ch 23
- tenderness
- temperature
- swelling
- masses
- palpate muscles of mastication
What is one other way to assess the temporomandibular joint in addition to inspection & palpation?
Ch 23
- check for ROM (limited or full)
What is the difference in active & passive ROM?
Ch 23
- Active ROM: patient moves themselves
- Passive ROM: WE move the patient
What is active range of motion?
Ch 23
patient moves body parts being assesed themselves
What is passive range of motion?
Ch 23
when WE move the patient
What is Flexion?
Ch 23
Bending a limb at a joint
What is Extension?
Ch 23
Straghtening a limb at a joint
What is Abduction?
Ch 23
Moving a limb away from the body
What is Adduction?
Ch 23
Adding a limb back to the body
What is Eversion?
Ch 23
Moving the sole of the food outward at the ankle
What is Inversion?
Ch 23
Moving the sole of the food inward at the ankle
What is Pronation?
Ch 23
Turning the forearm so the palm is down
What is Supination?
Ch 23
Turning the forearm so the palm is upward
“Holding a cup of SOUP”
List the 12 cranial nerves
Ch 24
- I: Olfactory
- II: Optic
- III: Oculomotor
- IV: Trochlear
- V: Trigeminal
- VI: Abducens
- VII: Facial
- VIII: Vestibulocochlear
- IX: Glossopharyngeal
- X: Vagus
- XI: Accessory (spinal)
- XII: Hypoglossal
What is a mnemonic to remember the 12 cranial nerves?
Ch 24
- I: Oh
- II: Once
- III: One
- IV: Takes
- V: The
- VI: Anatomy
- VII: Final
- VIII: Very
- IX: Good,
- X: Vacations
- XI: Are
- XII: Heavenly
How many cervical vertebrae are there?
Ch 24
C1 - C7
How many thoracic vertebrae are there?
Ch 24
T1 - T12
How many lumbar vertebrae are there?
Ch 24
L1 - L5
How many sacral & coccyx vertebrae are there?
Ch 24
S1 - S5 & Coccyx
List all the vertebrae
(Include sacrum & coccyx)
Ch 24
- C1 - C7
- T1 - T12
- L1 - L5
- S1 - S5
- Coccyx
What is CN VI and what does it do?
Ch 15
Abducens
- abducts eye
innervates lateral rectus muscle
What is CN IV and what does it do?
Ch 15
Trochlear
- need it to “cross” your eyes
innervates superior oblique
What is CN III and what does it do?
Ch 15
Oculomotor
Innervates the rest of the eye
What is nystagmus?
Ch 15
Parallel tracking of the eye & lack of muscle control bilaterally
What is strabismus?
Ch 15
cross-eyed or misalignment of the eyes
What is diplopia?
Ch 15
double vision
What is glaucoma & what is it associated with?
Ch 15
Peripheral vision changes
- Can cause vision loss & blindness due to damage to the optic nerve
- peripheral vision changes
Associated with: aging & increased intraocular pressure
checked during eye exam
What are common causes of perioribital edema?
CH 15
- Congestive heart failure
- eye infection
What is a hordeolum?
Ch 15
Stye
What is blepharitis?
Ch 15
Inflammation of the eye
What is ptosis?
Ch 15
drooping of the eyelid
common after a stroke
What is ptosis?
Ch 15
drooping of the eyelid
common after a stroke
What should the conjunctiva & sclera look like?
Ch 15
- Conjunctiva should be clear
- Sclera should be white
What is anisocoria?
Ch 15
Unequal pupils
What is the biggest concern regarding the eyes when a head injury occurs?
Ch 15
Pupils are quick to change
- unequal pupils (can be caused by anything that changes intracranial pressure)
What is accommodation?
Ch 15
How pupils constrict to near objects
Which CN are responsible for accommodation?
CH 15
CN III (oculomotor) & CN IV (trochlear)
How do you test for accommodation?
CH 15
1.) Have patient focus on something far away so that the pupils relax & dilate
2.) Put an object 12 inches away (close) & the pupils should constrict
What is the difference in checking direct & consensual light reflex?
Ch 15
- Direct: checks the pupil you shine the light directly into
- Consensual: Check the eye you do NOT shine the light directly into (shine light into same eye you checked direct with & watch the opposite eye)
How do we write pupil size?
Ch 15
Fraction
- 3/1 –> 3 is at rest & 1 is when stimuli is applied
What CN does visual acuity test for?
Ch 15
CN II (optic)
Explain how the snellen chart works?
Ch 15
- If the patient misses more than 1 letter in a line, then go up a line
- Numerator: indicates the distance from the chart (always 20 feet away from the chart)
- Denominator: indicates the distance at which a normal eye could have read that line
What does it mean as the denominator on the Snellen Chart Score INCREASES?
Ch 15
your vision is WORSE
What does a Snellen Chart Score of 20/30 mean?
Ch 15
At 20 feet (numerator), the normal eye can read at 30 feet
What is the red reflex?
Ch 15
Reflexion of the light (from the opthalmoscope) on the retina
lighter & brighter with a lighter iris
What is the normal appearance of the iris?
Ch 15
flat, round, even color
What is important to note when checking / assessing pupils?
Ch 15
- shape
- size
- equality R to L
What is myopia?
Ch 15
nearsightedness
What is hyperopia?
Ch 15
farsightedness
What is macular degeneration?
Ch 15
breakdown of cells in the macula of the retina causing loss of central vision
Explain Cataracts
Ch 15
- opaque lenses
- related to aging or trauma
- can lead to blindness
What is the tympanic membrane?
CH 16
Eardrum
- separates external & middle ear
- Appearance: translucent, pearly-gray, shiny, slightly concave, & reflects light
What CN is involved in pathological hearing loss?
Ch 16
CN VIII
Vestibulocochlear
What is conductive hearing loss?
Ch 16
dysfunction of external or middle ear
foreign bodies, perforated TM, otosclerosis
What is vertigo?
Ch 16
Sensation of spinning
- dizziness & feeling off balance
How do you assess the ear of an infant vs. the ear of an adult?
Ch 16
- Infants: short & wide eustachian tube (leads to more ear infections)
- Adults: cerumen builds up & cilia lining the inner ear become coarse & stiff
How do we assess a child’s ear vs. an adult’s ear?
Ch 16
Adult: pull pina up & back
Child: pull the ear down
What is the correct way to hold the otoscope?
Ch 16
upside down
Provides barrier w/ back of the hand so speculum doesn’t go in too far
What is tinnitus?
Ch 16
ringing in the ear
Can be due to ear disorders, medications, etc.
What do we inspect on the ears?
Ch 15
- Size
- Shape
- Placement
- Skin condition
Are they large because of inflammation?
What is noted when palpating the ears?
Ch 16
- Tenderness (usually on mastoid process)
Where is the cone of light located in the left & right ears?
Ch 16
Left Ear: 7 o’clock
Right Ear: 5 o’clock
What can tubes in the ears lead to?
Ch 16
scarring on the TM from ear tubes
How do you perform the whisper test?
1.) Stand behind the person
2.) Ask patient to occlude other ear
3.) **Whisper a few nubmers, 2 syllable word, or 2 words **(tell patient what type of word / how many numbers you’re going to tell them)
Do this bilaterally
What test is used for testing equilibrium?
Ch 16
Romberg Test
How do you perform the Romberg Test & what does it assess for?
Ch 16
Balance
1.) Have patient stand near their bed with feet together (not touching anything)
2.) Have patient stand with feet together, eyes closed, & arms at the side for 20 seconds
- Patient should be able to maintain position without swaying
What is the cerebellum responsible for?
Ch 24
- Motor coordination of voluntary movement
- equillibrium
What is the frontal lobe responsible for?
Ch 25
personality, behavior, & emotion
What is Broca’s area responsible for?
Ch 25
speech
in FRONTAL lobe
What is the temproal lobe responsible for?
Ch 25
hearing, taste, smell
What is the parietal lobe responsible for?
sensation
What is the hypothalamus responsible for?
Ch 25
- sleep
- temperature
- blood pressure
- autonomic nervous system
What is Wernicke’s area respnosible for?
Ch 25
speech comprehension
What is the occipital lobe responsible for?
Ch 25
visual reception
What is the occipital lobe responsible for?
Ch 25
visual reception
Is decerebrate rigidity or decorticate rigidity more ominous?
Ch 25
Decerebrate rigidity
What is the Preictal Phase?
Ch 25
Aura: subjective sensation that precedes the seizure
- can be motor, auditory, visiual, etc.
- Sensation the patient knows & can identify they are going to have a seizure
What is the Ictal Phase?
Ch 25
Actual seizure activity
- How long did it last?
- What occured?
What is the Postictal Phase?
Ch 25
Seizure is over
Patients may feel:
* tired
* weak
* don’t recall having a seizure
* headache
* muscle ache
Get vitals: are they different from baseline?
What is Broca’s aphasia (expressive)?
Ch 25
Patient is unable to express their thoughts in words
What is Wernicke’s aphasia (receptive)?
Ch 25
Patient has difficulty understanding language
What is global aphasia?
Ch 25
Patient is unable to expresse their thoughts in words & is unable to understand language
Both Broca’s & Wernicke’s Aphasia
What is global aphasia?
Ch 25
Patient is unable to expresse their thoughts in words & is unable to understand language
Both Broca’s & Wernicke’s Aphasia
What does CN I assess?
Ch 25
Olfactory Nerve
- sense of smell
What does CN II test?
Ch 25
Optic nerve
- tests visual acuity
What do CNs III, IV, & VI test?
Ch 25
Oculomotor (III), Trochlear (IV), & Abducens (VI) nerves
- check pupils for size, regularity, equality, direct & consensual light reaction, & accomodation
- Assesses extraocular movements
What does CN V test?
CH 25
Trigeminal Nerve
- Motor: Assesses TMJ (clenching teech, should feel symmetrical bilaterally)
- Sensory: sensation of light touch (eyes closed, use light touch on forehad, cheeks, chin)
What does CN VII test?
Ch 25
Facial Nerve
- Mobility
- Facial Symmetry (response to smile, frown, close eyes tightly, lift eyebrows, show teeth)
- Have patient puff out cheecks (press cheeks in, air should escape equally)
What does CN VIII test?
Ch 25
Vestibulocochlear Nerve
- Tests hearing (use whisper test)
What do CN IX & X test?
Ch 25
Glossopharyngeal & Vagus Nerves
Tests voice & pharyngeal movement
- touch posterior pharyngeal wall w/ tongue blade & assess gag reflex
- Assess uvula movment, tonsillar pillars, etc.
What does CN XI test?
Ch 25
Spinal Accessory Nerve
- examine sternomastoid & trapezius muscles for equal size
- Check shoulder resistance & rotating head against resistance
Should be equally strong bilaterally
What does CN XII test?
Ch 25
Hypoglossal Nerve
- Inspect tongue: no wasting or tremors, note lingual speech (sounds of letters l, t, d, & n)
How can you test for muscle strength?
Ch 25
- hand grasp w/ push & pull
- plantar felxion & dorsiflexion w/ resistance
List some of the Rapid Alternating Movements (RAM) Tests
Ch 25
- Finger to Finger
- Finger to Nose
- Heel to Shin
What reflexes should be checked?
Ch 25
- Biceps (AC region)
- Triceps (behind elbow)
- Brachioradialis (wrist)
- Quadriceps (front of knee)
- Achilles
What is Parkinson’s Disease & what are symptoms of it?
Ch 25
Defect of extrapyramidal tract
- Posture: stooped; steps short & shuffling
- Facial Expression: flat, staring, expressionless
- Tremors, rigidity
What does a positive Babinski reflex indicate and what can cause a positive Babinski reflex?
Ch 25
Indicates: upper motor neuron lesion
- can be caused by stroke, brain injury, spinal cord injury
What does Decerebrate rigidity indicate in terms of pathophysiology?
Ch 25
lesion in brainstem at midbrain or upper pons
What does Decorticate rigidity indcate in terms of pathophysiology?
Ch 25
lesion at or above brainstem
What is a Babinski sign?
should see upward movement of big toe when running “sharp” object up the bottom of the foot
When can neuro checks occur?
Ch 25
Every 5, 10, 15, 30, or 60 minutes
What is assessed in a neuro check?
Ch 25
- level of consciousness
- vital signs
- pupillary response
- motor function
- GCS
What is assessed in the Glasgow Coma Scale (GCS)?
Ch 25
- Eye-opening response
- Motor respnose
- Verbal response
What does a GCS of 7 or less indicate?
Ch 25
Patient is in a coma
What is a normal GCS score?
Ch 25
15
What is the leading cause of long-term disability?
Ch 25 (neuro)
Stroke
How can you differentiate between a stroke & TIA?
Stroke is usually longer-lasting & symptoms worsen
TIA is brief & there is no permanent damage
What is aphasia?
Ch 25
language impairment due to brain damage / injury
What is ataxia?
Ch 25
Poor musle control that causes involuntary, clumsy movements
What is decerebrate rigidity?
Ch 25
Arms are EXTENDED
Upper Extremities: stiffly extended, adducted, internal rotation, palms pronated
Lower Extremities: stiffly extended, plantar flexxion, hyperextended back, clenched teeth
Decerebrate = Extended
What is decorticate rigidity?
Ch 25
Patient brings arms to the COR of the body
Upper Extremities: flexion of arms, wrists, & fingers; adduction of arm
Lower Extremities: extension, internal rotation, plantar flexion
decorticate = arms come to the COR of the body
What is the difference in dysphasia & dysphagia?
Ch 25
Dysphasia: difficulty with Speech
Dysphagia: difficulty Swallowing
What are the first level priorities?
Ch 1
- Airway
- Breathing
- Circulation
When is the diaphragm used for auscultation & what does it detect?
Ch 8
- Detects high pitched sounds
- used on the abdomen, lungs, heart
When is the bell of the stethoscope used for auscultation & what does it detect?
Ch 8
- detects low pitched sounds
- used for Vascular sounds, extra heart sounds
How should the diaphragm be placed on the body for auscultation?
Ch 8
Diaphragm is placed firmly
How should the bell be placed for auscultation?
Ch 8
Bell is placed lightly
Normal Temperature Range
Ch 9 & 10
- 35.8 - 37.3 °C
- 96.4 - 99.1 °F
How long should the apical pulse be measured for?
Ch 9 & 10
1 minute
What is normal pulse force?
Ch 9 & 10
2+
What is a normal heart rate?
Ch 9 & 10
60 - 100 bpm
What is a bradycardic & tachycardic heart rate?
Ch 9 & 10
- Bradycardic: < 50 BPM
- Tachycardic: > 95 - 100 BPM
What is a normal adult respiratory rate?
Ch 9 & 10
10 - 20 breaths per minute
What is a normal pulse oximetry range?
Ch 9 & 10
97% - 99%
What is pulse pressure?
Ch 9 & 10
Systolic Pulse - Diasotlic Pulse
What constitutes hypertension?
Ch 9 & 10
BP < 120-129 / 80
What is a normal adult blood pressure?
Ch 9 & 10
anything under 120/80
What sound is heard when auscultating over bones or muscles?
Ch 19
Flat
What is the normal sound sound when auscultating over the lung fields?
Ch 19
resonance
What is the normal sound heard when auscultating over the abdomen?
Ch 19
Tympany
What sound is heard when auscultating over an organ?
Ch 19
dullness
What is normal number of bowel sounds when auscultating?
Ch 22
5 - 30 sounds per minute
Hyperactive > 30 sounds per minute
Hypoactive <5 sounds per minute
What spinal nerves are assessed when testing biceps reflexes?
Ch 24
Biceps = C5 - C6
What spinal nerves are assessed when testing triceps reflexes?
Ch 24
Triceps = C7 - C8
What spinal nerves are assessed when testing brachioradialis reflexes?
Ch 24
Brachioradialis = C5 - C6
What spinal nerves are assessed when testing quadriceps reflexes?
Ch 24
Quadriceps = L2 - L4
What spinal nerves are assessed when testing achilles reflexes?
Ch 24
Achilles = L5 - S2
What causes the pupils to dilate?
a.) Brightly lit settings
b.) Narcotis
c.) Dimly lit settings
d.) Cocaine
d.) Dimly lit settings
What type of hearing loss is associated with ototoxic drugs?
a.) Conductive
b.) Sensorineural
b.) Sensorineural
What cranial nerve is tested by having the patient say “ahhh” & checking the gag reflex?
a.) CN IV IV (trochlear)
b.)CN VII (facial)
c.) CN V (trigeminal)
d.) CN X (vagus)
d.) X (vagus nerve)
Which joints are not moveable?
a.) Synovial
b.) Non-synovial
c.) Ball & socket
d.) Hinge
b.) Non-synovial
What disorder causes loss of central vision & commonly has peripheral vision intact?
a.) Cataracts
b.) Glaucoma
c.) Macular degeneration
d.) Strabismus
c.) Macular Degeneration
If Phalen’s test were negative you would expect to see…
a.) No changes in feeling
b.) Tingling
c.) Numbness
d.) Burning
a.) No changes in feeling
Chronic unequal pupils affects about 5% of the population & is called…
a.) Ptosis
b.) Anisocoria
c.) Blepharitis
d.) Exopthalmos
b.) Anisocoria
Which cranial nerve is not associated with the eyes?
a.) CN III
b.) CN IV
c.) CN VI
d.) CN VIII
d.) CN VIII (vestibulocochlear)
What is a round lesion, is indurated, crusted, & ulcerated with an elevated border & is still unhealed after 2 weeks?
a.) Chronic allergies
b.)Acute rhinitis
c.) Carcinoma
d.) Herpes Simplex I
c.) Carcinoma
How do you test CN XI (spinal accessory)?
a.) Pressure on the forehead, cheek, & jaw with a cotton swab to check sensation
b.) Test the tongue by giving the patient a sour, bitter, & salty substance
c.) Use the snellen chart
d.) Ask the patient to rotate their head & shrug their shoulders
d.) Ask the patient to rotate their head & shrug their shoulders
What is found with a perforated spetum?
a.) Light shines through to the other side when a penlight shines up the nares
b.) A valve that moves
c.) Small pale gray nodules
d.) There is a chronic nosebleed
a.) Light shines through to the other side when a penlight shines through
Aging adults do NOT experience…
a.) Diminished smell & taste
b.) Increased tonsil size
c.) Atrophic tissue
d.) Dental changes
b.) Increased tonsil size
Which is not a description of a normal TM?
a.) Translucent
b.) Pearly gray
c.) White
d.) Reflects light
c.) White
What is a pronounced lumbar curvature of the spine called?
a.) lordosis
b.) scoliosis
c.) kyphosis
d.) osteoporosis
a.) Lordosis (swayback, stomach sticks out)
Chronic inflammatory pain condition that is possibly started by an autoimmune response, inflammatory event, or infection is called…
a.) Osteoporosis
b.) Osteoarthritis
c.) Rheumatoid Arthritis
c.) Rheumatoid Arthritis
Which cranial nerve is tested by inspecting the tongue & asking the patient to stick their tongue out?
a.) CN XII (hypoglossal)
b.) CN I (olfactory)
c.) VII (facial)
d.) CN X (vagus)
a.) CN XII (hypoglossal)
True or false:
Kyphosis cannot result from rheumatoid arthritis?
False
What is the correct test to deteremine equilibrium?
a.) Weber test
b.) Whisper test
c.) Romberg test
d.) Rinne test
c.) Romberg test