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Clinical Skills I > Head, neck, eyes > Flashcards

Head, neck, eyes Flashcards

1
Q

What makes up the anterior cervical triangle?

What makes up the posterior cervical triangle?

A

Posterior:
SCM muscle
Trapezius
Clavicle

anterior:
Superior: mandible
Lateral: SCM
Medial: midline of neck

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2
Q

red free filter/green beam

A

optic disc pallor
minute vessel changes

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3
Q

slit

A

anterior eye
elevation of lesions

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4
Q

panoptic ophthalmoscope

A

focus scope about 10-15 ft away
put aperature on home position/green line
start 6inches away at 15 degree angle
visualize the fundus and move in until the cup is compressed against pt face

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5
Q

A persistent neck mass in an adult older than 40 years should raise a suspicion of ____?

A

malignancy

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6
Q

What do enlarged, tender lymph nodes accompany?

A

Pharyngitis

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7
Q

hypothyroidism vs hyperthyroidism signs

A

hypothyroidism:
Intolerance to cold
weight gain
dry skin
slowed heart rate
coarse hair

hyperthyroidism:
intolerance to heat,
weight loss
moist velvety skin, palpitations
fine hair

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8
Q

supraclavicular node enlargement, tender vs fixed nodes

A

Supraclavicular node enlargement- thoracic or abdominal malignancy (virchow’s node)

Tender nodes- inflammation

Fixed node- malignancy

Enlarged tender lymph nodes: pharyngitis

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9
Q

Thyroid: tender, soft, and hard

A

Hard thyroid
- hashimoto thyroiditis
-cancer

Soft thyroid
- graves

Tender thyroid
- thyroiditis

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10
Q

An enlarged skull may signify…

A

Hydrocephalus or Paget disease

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11
Q

Hirsutism (excessive facial hair) may appear in some women w/…

A

PCOS

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12
Q

What causes stridor?

A

Epiglottitis
Foreign body
Goiter
Stenosis from placement of an artificial airway

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13
Q

What is a goiter?

A

An enlargement of the thyroid gland to twice its normal size

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14
Q

A localized or systolic or continuous thyroid bruit may be heard in..

A

Hyperthyroidism from Graves
or toxic multinodular goiter

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15
Q

What testing is advised for a palpable solitary nodule on thyroid?

A

US
Fine-needle aspiration

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16
Q

What happens to the face in someone with Cushing syndrome?

A

Round or “moon” face with red cheeks
Excessive hair growth

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17
Q

What happens to the face in someone with Nephrotic syndrome?

A

Face becomes edematous and pale
Swelling appears first around eyes and in the morning
Severe: eyes appear slit like

Nephrotic syndrome*

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18
Q

What happens to the face in someone with Myxedema (severe hypothyroidism)?

A

Dull, puffy facies
Edema pronounced around eyes, does not put with pressure
Hair and eyebrows are dry, coarse, and thinned
Loss of lateral third of the eyebrows
Skin is dry

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19
Q

What happens to the face in someone with Acromegaly?

A

Head is elongated, with bony prominence of the forehead, nose and lower jaw
Soft tissues of the nose, lips and ears also enlarge
Facial features appear generally coarsened

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20
Q

What happens to the face in someone with Parkinson’s Disease?

A

Decreased facial mobility and masklike facies
Decreased blinking and a characteristic stare
Neck and upper trunk tend to flex forward causing the patient to peer upwards toward the observer
Facial skin becomes oily and drooling may occur

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21
Q

eye anatomy

A

-

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22
Q

Distance visual acuity measurements should be performed in all children _______ or after age of ____.

A

ASAP or after age of 3

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23
Q

Minimal exam for eye

A

-visual acuity
-pupillary reflex
- extraocular movement
- fundoscopic exam through UNdilated pupils

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24
Q

When a person shifts gaze from a far object to a near object the pupils…
This is mediated by the…

A

Constrict
Oculomotor nerve (CN III)

this is NEAR REACTION
- If the reaction to light is impaired or questionable, test the near reaction in both dim and normal light

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25
Q

what is lid lag?

A

Lid lag as the eyes move from up to down.
- can see upper sclera above iris with downward gaze
-HYPERTHYROIDISM sign

26
Q

Pupillary constriction vs dilation and raising of the upper eyelid is parasympathetic or sympathetic?

A

constriction: parasympathetic

dilation and raising upper eyelid: sympathetic

27
Q

What extraocular muscles are responsible for eye movements?

A

Lateral and medial recti
Superior and inferior recti
Superior and inferior obliques

LR6, SO4, CN III

28
Q

The superior rectus moves the eye…

A

Upward (elevation)

29
Q

Difficulty w/ close work suggests

A

Hyperopia (farisightedness) or presbyopia (aging vision

30
Q

oval blind spot + when would it be enlarged

A

lack of retinal receptors at the optic disc = blind spot in the normal field of each eye
-15 degrees temporal to the line of gaze

Enlarged blind spot- occurs in conditions affect optic nerve -> glaucoma, optic neuritis, papilledema

31
Q

accommodation vs convergence

A

convergence
- bilateral medial rectus movement
- test by bringing pencil into the nose

accommodation:
- increased convexity of the lenses caused by contraction of the ciliary muscles

32
Q

Diplopia-

A

CN 4 damage due to trauma
congenital, or central lesion -> superior oblique muscle dysfunction

33
Q

Horizontal vs verticle diplopia which cranial nerve

A

Horizontal diplopia suggests palsy of…
CN III or CN VI

Vertical diplopia suggests palsy of…
CN III or CN IV

34
Q

Diplopia in one eye, with the other closed….

A

Issue with:
- ocular surface
-cornea
- lens
- macula

35
Q

If sudden visual loss is painful consider…

A

Corneal ulcer
Uveitis
Traumatic hyphema
Acute angle closure glaucoma
optic neuritis from MS

36
Q

If unilateral vision loss is associate with headache, jaw pain or claudication, it may be associated with…

A

Giant-cell arteritis

37
Q

If sudden visual loss is unilateral and painless consider…

A

Vitreous hemorrhage from DM or trauma
Macular degeneration
Retinal detachment
Retinal vein occlusion
Central retinal artery occlusion

38
Q

If vision loss is bilateral and painless consider…

A

Vascular etiologies
Stroke
Nonphysiologic causes

39
Q

If vision loss is bilateral and painful consider..

A

Chemical or radiation exposures

40
Q

Gradual vision loss usually arises from…

A

Cataracts*
Glaucoma
Macular degeneration

41
Q

Slow central vision loss occurs in…

A

Nuclear cataract
Macular degeneration

42
Q

Peripheral vision loss is associated with…

A

Advanced open-angle glaucoma

43
Q

Moving specks or strands suggest…

A

Vitreous floaters

44
Q

Fixed defects or scotomas suggest…

A

Lesions in the retinal, visual pathway or brain

45
Q

Flashing lights with new vitreous floaters suggest…

A

Detachment of the vitreous body from the retina

46
Q

red eye: painless vs painful

A

Painless:
- Subconjunctival hemorrhage
- Episscleritis

painful:
- Corneal abrasions
-Corneal ulcers
-Hyphema
-Acute angle closure glaucoma
-Herpes keratitis
-Foreign body
-Fungal keratitis
-Uveitis

47
Q

20/30 vision explain each number

A

first number:
- indicates the distance of the patient from the chart
Second number:
- the distance at which a normal eye can read the line of letters

48
Q

Vision of 20/200

A

At 20 ft, the patient can read print that a person with normal vision could read at 200 ft

considered legally blind

49
Q

Astigmatism

A

imperfection of the cornea or lens causing distortion while looking at near and far objects

50
Q

myopia vs hyperopia

A

Myopia- nearsightedness- near is clear
- elongated globe
Presbyopia- farsightedness- far is clear
- dysfunctional lens with age
hyperopia: Farsightedness
- Foreshortened globe

51
Q

What does testing color vision help to rule out?

A

Damage to optic nerve

52
Q

Abnormalities in eye movements

A

esotropia (inward deviation)
exotropia (outward deviation), hypertropia (upward deviation)
hypotropia (downward deviation) of the eyes.

53
Q

Pupils size range

A

pupils are large (>5 mm)
small (<3 mm)

anisocoria?
Difference in pupillary diameter ≥0.4m without a known pathologic cause?

54
Q

Contraindications for mydriatic drops

A

(1) head injury and coma
(2) any suspicion of narrow-angle glaucoma

55
Q

Absence of a red reflex

A

opacity of the lens (cataract)*
-artificial eye
-detached retina
-mass
-Children: retinoblastoma

56
Q

Papilledema

A

Swelling of the optic disc and anterior bulging of the physiologic cup

optic nerve head swelling associated with increased intracranial pressure

57
Q

Retina—Arteries vs Veins

A
58
Q

What is a cause of poor central vision in older adults?

A

Macular degeneration - dry atrophic, wet exudative and neovascular

59
Q

Swinging Flashlight Test

A

test for functional impairment of the optic nerves

1) dim light, note the size of the pupils
2) tell pt to gaze into the distance
3) swing the beam of a penlight for 1 to 2 seconds first into one pupil, then into the other.

Normal:
- each illuminated eye constricts promptly
-opposite eye also constricts consensually

60
Q

left-sided optic nerve damage

A

When light beam shines into normal right eye, there is brisk constriction of both pupils

When light swings over to abnormal left eye, partial DILATION of both pupils will occur (Marcus Gunn pupil)

61
Q

Hypertensive retinopathy

A

copper wiring, silver wiring, edema, AV nicking, flame shaped hemorrahges, cotton wool spots, yellow hard exudates

Clinical Skills I (11 decks)

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