Exam 5 Flashcards
amsler grid
test used to diagnose vision problems (especially macular degeneration)
distant visual acuity - CNII - pt should be 20 feet away
snellen chart
hold handheld vision card ___ away
14 in
face pt 2 feet away - cover one eye - test when they can see your hands with peripheral vision
confrontation test
shine light 12 inches away - reflection of light on corneas should be in same spot on each eye - if asymmetric, may indicate muscle weakness/paralysis on one eye
corneal light reflex (Hirschberg)
test color vision
ishari plates
position for examining lacrimal apparatus
supine
fog/dark spot in center of vision - loss of central vision
macular degeneration
halos around lights
glaucoma
floaters located in…
vitreous humor
drooping eyelids
ptosis
eyelashes turn inward/inverted
entropion
eyelashes turn outward
ectropion
swelling of optic nerve
papilledema
inflammation of eyelids, typically Staph infection
blespharitis
pinkeye
conjunctivitis
inflammation of episcleral layer
diffuse episcleritis
styes (2)
hordeolum & chalazion
pinkish triangle growing in eye - grows toward inner canthus from the outer
pterygium
lens becomes opaque
cataract
pupil constriction
miosis
pupil dilation
midriasis
one pupil dilated, the other constricted
one reacts to light more
anisocoricas
Adie pupils
muscle wasting in eye
optic atrophy
misalignment of eyes
strabismus
one eye points inward
esotropia
one eye points outward
exotropia
subconjunctival hemorrhage caused by…
caused by any strain (vomiting, lifting something, sneezing etc)
electronic impulse sent to brain from inner ear
peripheral hearing
sound is identified in the…
brain stem
interprets sound
cerebral cortex
ear discharge
otorrhea
ear pain
otalgia
inner ear disorder - tinnitus; nerve deafness; vertigo (Romberg test)
Meniere’s disease
blockage; otosclerosis (inherited bone disorder, irregular stapes - causes tinnitus); otitis (infection)
conductive impairment
problem with inner ear, CNVIII, or cerebral cortex
sensorineural impairment
presbycusis is a ____ type of deafness
sensorineural
r/f for hearing loss
- Medications causing ototoxicity - antibiotics, cancer meds, NSAIDS, etc
- Exposure to loud sounds
- Infection - syphilis, rubella
4 quadrants of breast
most likely location for breast cancer
tail of spence
3 types of breast tissue
- glandular tissue - radiates from nipples
- fibrous tissue - from surface of breast - attaches breast to chest wall
- adipost tissue - fatty portion embedded into different lobes
4 major lymph nodes around breast
- lateral (brachial) - drains the system
- central (midaxillary)
- anterior (pectoral)
- posterior (subscapular)
orange peel appearance around hair follicles of breast
peau d’orange
ask patients suspecting breast cancer if…
sx change during menstrual cycle
r/f for breast cancer
- menarche at early age (before 12yo)
- late menopause (after 52yo)
- family hx of gynecomastia
- family hx of breast cancer
- pregnancy after 30yo
- never being pregnant
- hx of mastitis
- not breastfeeding
- exposure to radiation, benzene, asbestos
- hormones, contraceptives, antipsychotic meds
- alcohol & tobacco consumption
3 breast cancer related genes
- BRCA1 - breast cancer gene 1
- BRCA2- breast cancer gene 2
- HER2 - important to breast cancer growth
what to teach pts about breast cancer screening
- monthly breast self-exams important - in the shower, in front of the mirror - 5-7 days after menstruation
- yearly professional screening at 40-44yo
- mammograms
positioning for breast exam
- have pt sit up straight, expose both breasts
- arms up, hands on hips, clasp hands in front of stomach
- have pts with large breasts lean forward
3 patterns of breast exam
zigzag; circular/concentric; radial
nipple exam
- supine position with pillow beneath shoulders, arms raised above head
- express for discharge (milk normal during pregnancy & lactation)
benign growth of breast tissue in males
gynecomastia
males at risk for gynecomastia
males 13-14yo
older males (reduced testosterone)
Cushing’s syndrome
cirrhosis
hypothyroidism
excessive alcohol & marijuana use
medications (spironolactone, Flagyl)
usually unilateral - nipple retracts & disappears
paget disease
forms vas deferens
spermatic cord
pathway of vas deferens
originates in testicles, runs deep into inguinal ring, around bladder to seminal vesicle - empties into urethra during sex
do not pass through inguinal canal
femoral artery
epididymus
continuation of abd wall - contains testes
scrotal sac
how temp affects scrotal sac
- cold causes cremaster muscles to contract, raising testicles closer to body - must maintain certain temperature for sperm to survive
- hot causes cremaster muscles to relax
coiled duct system on posterior surface of testes - storage site of sperm
epididymus
r/f for prostate cancer
african americans
r/f for penile cancer
HPV
teaching pts about testicular self exams
monthly, starting age 13
in shower or in front of mirror
measures size of genitalia, breasts as pt matures
Tanner staging (1-5)
5 Ps to ask about STIs
- sexual partners
- practices
- protection during sex
- history of past STIs
- preventive measures used
r/f for HIV
- unprotected sex
- anal sex
- having another STI
- IV drug use, needle sharing
- uncircumcised
- fetus of HIV + mother
- exchange of blood/bodily fluid
effects of aging on vitals
BP rises
RR rises (12-24 norm)
pulse remains same
effects of aging on integ
- wrinkles
- skin becomes drier - hormonal changes
- loss of collagen
- epidermis regenerates every 30 days (rather than 20)
- hair becomes more coarse, thin
effects of aging on head & neck
- sensory changes - presbyopia (begins around age 42), presbycusis (usually sensorineural)
- look for precancerous lesions in mouth
- mouth dryness
- dental caries, dentures
effects of aging on thorax
- lungs - changes in gas exchange
- heart & vessels - sclerotic changes in cardiac muscle - CO declines in 35% of people >40yo
- kyphosis, scoliosis, lordosis
effects of aging on peripheral vascular & lymphatic
- atherosclerosis
- narrowing of peripheral vessels - resistance to bloodflow
- HTN
- decreased immune function
1 presenting condition for older adults
falls
intrinsic fall risks
gait & balance changes; taking multiple medications increases risk; cognitive changes such as confusion, disorientation (UTI, etc)
extrinsic fall risks
rugs; poor lighting; equipment (O2, etc); shoes; unfamiliar setting
used to assess fall risk
Morse scale
common neuro problem for older adults
depression
arcus senilis
anisocoria
lazy eye
amblyopia
blepharitis
coloboma
entropion
ectropion
bleeding in eye
hyphema
strabismus
ptosis
noncancerous growth in conjunctiva
pterygium
Xanthelasma
lacrimal gland
amsler grid
CNII function
vision
CNIII function
eye movement—medial, up, down & out
eyelid movement
pupillary light reflex
CNIV function
eye movement—down & in
CNVI function
eye movement—lateral
swimmer’s ear
otitis externa
a skin-lined cyst that begins at the margin of the eardrum and invades the middle ear and mastoid
Cholesteatoma
otitis media
serious bacterial infection that affects the bone behind the ear
mastoiditis
malleus, incus, stapes
Weber test
Rinne test
population?
cutaneous horn
older adults
cherry angiomas
“sun spots”
solar lentigo
actinic keratosis
cutaneous tags
Paget disease
region
tail of spence
pink part
cooper ligaments
combination of milk glands and sebaceous glands.
Mongtomery glands
beginning of adult breast development
thelarche
inflammation of breast, usually affecting breastfeeding women
mastitis
carry milk from mammary lobe to nipple pore
lactiferous ducts
painful menstruation
dysmenorrhea
peau d’orange
supernummary nipple
milk lines (ventral epidermal ridges)
precursors to mammary glands and nipples in embryo development
diagnosis of menopause
12 months after last period
introitus
vaginal opening
cystocele
rectocele
hypospadias
epispadias
fluid in scrotal sac around testicle
hydrocele
normal PSA
1-1.5
strangulated hernia
varicocele
incarcerated hernia leads to..
strangulation (↓ blood supply)
seborrheic keratosis
foreskin too tight to be pulled back
phimosis
gap between eyelids
palpebral fissure
punctum is part of…
lacrimal apparatus