final pt 1 Flashcards
what does BP difference of 10-15 in each arm indicate
- subclavian steal sydrome
- aortic dissection
what does HTN in UE and low BP in LE indicate
- coarctation of the aorta
- occlusive aortic disease
what is a normal difference in BP in the UE
- 5-10 mmhg
what effect does a cuff that is too narrow have
- BP that is too high
what effect does a cuff have that is too wide
- BP low in small arm
- BP high in a large arm
hyperopia
- farsightedness
myopia
- nearsightedness
presbyopia
- aging vision
pinguecula
- harmless yellowish triangular nodule in conjunctiva next to iris
- d/t aging
xanthelasma
- slightly raised, yellow well demarcated plaque
- on nasal portion of eyelid
- common with lipid disorders
chalazion
- blocked meibomian gland
- points inside eyelid
episcleritis
- inflammation of episcleral vessels
- RA
- Sjorgen’s
- herpes zoster
dacryocystitis
- inflammation of lacrimal sac
- swelling btwn lower eyelid and nose
- tearing prominent
arcus senilus
- corneal acrus
- thin grey circle close to edge of cornea
- normal aging
- hyperlipoproteinemia
kayser- fleischer ring
- Cu deposition
- golden brown ring in periphery of cornea
- mutation in chromosome 13 (wilsons)
corneal scar
- greyish white opacity in cornea
- secondary to injury or inflammation
cataracts
- opacity of lens through pupil
- old age
- smoking
- DM
- steroids
pterygium
- triangular thickening of bulbar conjunctiva
- grows inwards towards cornea
peripheral cataract
- spoke like shadows
CN III paralysis
- dilated pupil fixed
- ptosis if eyelid
- lat deviation
horner’s syndrome
- affected pupil is small but reactive to light
- usu with ptosis of eyelid
- iris may be lighter
argyll robertson pupil
- small irreg pupils
- accommodate but dont react to light
- CNS syphilis
hyphema
- blood in ant chamber
hypopyon
pus in ant chamber
lagopthalmos
- inability to fully close eyelid
- CN VII
coloboma
- cat eye
keratoconus
- thinning disorder of cornea
iritis
- inflamm of iris
- marked photosensitivity
mydriasis
- dilation of pupil
sensorineural hearing loss
- problem in inner ear, nerve or connection to brain
- trouble understanding speech
conductive hearing loss
- problem in middle/ external hear
- noise may help hearing
emergent eye complaint
- requires care in one hour
- chem splash/ burn
- sudden painless vision loss
- acute ocular trauma
- penetrating eye injury
- severe pain with n/v and/or halos
urgent eye complaint
- requires care within 4-6 hours
- FB
- corneal abrasion
- sudden onset double vision
- acute onset flashes/ floaters
- sudden onset red eye +/- pain or change in vision
semi-urgent eye complaint
- requires care within 24 hours
- painful bump on eyelid
- itchy eyes
- mild eye pain with no change in vision over 2-3 days
what is the normal pH of the eye
- 7.0-7.3
what type of chemical burns are worse to the eye
- alkali burns
- irrigate for at LEAST 30 min
why do you not repeatedly use anesthetic in the eye
- can cause cornea to melt
- permanent damage
differential for acute onset flashes and floaters
- retinal detachment
- posterior vitreous detachment
- migraine
retinal detachment
- flashes and floaters -> veil or shade pulled over visual field
- high risk if assoc with trauma, high myopia, younger pt, recent surgery
- requires same day consult
posterior vitreous detachment
- flashes -> floaters -> no loss of vision and no peripheral field loss
- usu in pts > 50
- normal in aging d/t vitreous fluid shrinking
what is the most common cause of conjunctivitis
- viral
viral conjunctivitis
- bilat
- mild photophobia
- tearing
- injection
- often assoc with recent URTI
- self limited 7-10 days
- no abx needed
epidemic keratoconjunctivitis
- highly contagious viral conjunctivitis
- photophobia
- tearing
- severe red eye
- pseudomembrane
- subepithelial infiltrates
bacterial conjunctivitis
- injection
- purulent d/c
- matting of lashes
- photophobia
- blurred vision
- tx with broad spectrum abx 7-10 d
CN I
- olfactory
- determine patency
- occlude one nostril
- with eyes close ID smell
CN II
- optic n
- visual acuity
- visual fields
- fundoscopy
CN III, IV, VI
- PERRL
- RAPD
- EOM
- cover/ uncover
- convergence
- ptosis
- near reaction
- nystagmus
CN V
- trigeminal
- motor -> muscles of mastication
- sensory to face
- corneal reflex
CN VII
- facial symmetry
- facial expressions
- sensory to anterior 2/3 of tongue
CN VIII
- gross hearing
- weber and rinne
CN IX and X
- glossopharygneal and vagus
- symmetric rise of uvula
- gag reflex
- hoarseness
- check swallowing
- taste posterior 1/3 of tongue
CN XI
- spinal accessory
- shoulder shrug
- head turned against resistance
CN XII
- hypoglossal
- observe tongue for atrophy or fasciculations
- stick tongue out
- push tongue into cheek
tests for discriminative sensations
- stereognosis
- graphesthesia
- 2 point discrimination
- point localization
- extinction
stereognosis
- ID common object in hand
graphesthesia
- recognize number drawn on palm
2 point discrimination
- pt touched with 2 points
- distance btwn 2 points measured when the pt can feel them
- normal in fingers: 2-5 mm
- normal on palm: 8-15 mm
point localization
- touch pt on skin
- have them open eyes and ID area touched
extinction
- touch same point on each side of body at same time
- ask pt to ID both spots
upper motor neuron lesions
- hypertonia
- hyperreflexia
- no fasciculations
- no atrophy
- babinski
lower motor neuron lesions
- hypotonia
- hyporeflexia
- fasciculations
- atrophy
- normal plantar reflex
guiding questions of the neuro exam
- is mental status intact
- findings symmetric
- where is lesion- central, peripheral, or both
nociceptive pain
- somatic pain
- tissue damage to skin, MSK system, or viscera
- sensory NS in tact
- acute or chronic
- mediated by a-delta and c- fibers
- sensitized by inflam mediators, psych processes, and neurotransmitters
neuropathic pain
- lesion or disease affecting somatosensory system
- becomes indep of inciting injury
- burning, shock like
- induce neuronal plasticity -> pain that persists beyond yealing
central sensitization
- CNS processes sensation -> amplification of pain signals
- lower pain threshold to non-painful stimulus
psychogenic pain
- based on psych cond, personality, cultural norms, social support
idiopathic pain
- pain without identifiable cause
pain assessment tools
- numeric rating 0-10
- wong baker faces: kids, language barrier, cognitive impairment
anatomic landmarks for LP
- from out to in
- spinous process
- supraspinal ligament
- interspinal ligament
- ligamentum flavum -> “pop”
- epidural space
- dura mater
- arachnoid mater
location of LP
- L3-L4
- L4- L5
- can be in lat recumbent or upright
normal opening pressure
- 18- 20 mm H2O
WBCs on LP
- > 5 cells - possible infection
- bacterial infx: increased neutrophils
- viral infx: increased lymphocytes
RBCs on LP
- < 10 cells is normal
- traumatic tap can be r/o by xanthochromia
glucose on LP
- 50-80 is normal
- low: bacterial meningitis, sarcoid, syphilis, SAH
- viral: variable
- serum hyperglycemia may mask depressed CSF glucose
protein on LP
- 15-45 is normal
- elevated with infections
common GN diplococci on LP
- n meningitidis
common GN bacilli on LP
- h flu
common GP oraganisms on LP
- s pneumo
- other strep spp
- staph
xanthochromia on LP
- prod of RBC lysis
- yellow orange discoloration
- helps differentiate from traumatic tap
diagnostic indications for LP
- CNS infx
- inflam process
- suspected spont SAH
- unexplained seizure
- certain malignancy or paraneoplastic syndrome
therapeutic indications for LP
- relieve sx from increased ICP
- deliver meds
absolute C/I to LP
- local skin infx
- intracranial or SC mass lesion
- raising ICP
- uncontrolled bleeding diathesis or coagulopathy
- coumadin
relative C/I to LP
- raised ICP with known cerebral herniation
- SC deformities
- body deformities at puncture site
- suspected lumbar epidural abscess
- thrombocytopenia
- elevated INR
tube sequencing for LP
- 1: cell count and diff
- 2: glucose and protein
- 3: culture and stain
- 4: cell count and dif
most common complication s/p LP
- HA
- d/t leak in dural layer
- appears 1-3 days after procedure
- can last up to months
- put in recumbent position for 1 hour and hydrate to prevent
grading of DTR
- 0: no reflex
- 1+: diminished
- 2+: normal
- 3+: brisk (can be normal)
- 4+: hyperactive, brisk with clonus
- if hyperreflexia present do babinski
