Head, neck, eyes Flashcards
What makes up the anterior cervical triangle?
What makes up the posterior cervical triangle?
Posterior:
SCM muscle
Trapezius
Clavicle
anterior:
Superior: mandible
Lateral: SCM
Medial: midline of neck
red free filter/green beam
optic disc pallor
minute vessel changes
slit
anterior eye
elevation of lesions
panoptic ophthalmoscope
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
A persistent neck mass in an adult older than 40 years should raise a suspicion of ____?
malignancy
What do enlarged, tender lymph nodes accompany?
Pharyngitis
hypothyroidism vs hyperthyroidism signs
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
supraclavicular node enlargement, tender vs fixed nodes
Supraclavicular node enlargement- thoracic or abdominal malignancy (virchow’s node)
Tender nodes- inflammation
Fixed node- malignancy
Enlarged tender lymph nodes: pharyngitis
Thyroid: tender, soft, and hard
Hard thyroid
- hashimoto thyroiditis
-cancer
Soft thyroid
- graves
Tender thyroid
- thyroiditis
An enlarged skull may signify…
Hydrocephalus or Paget disease
Hirsutism (excessive facial hair) may appear in some women w/…
PCOS
What causes stridor?
Epiglottitis
Foreign body
Goiter
Stenosis from placement of an artificial airway
What is a goiter?
An enlargement of the thyroid gland to twice its normal size
A localized or systolic or continuous thyroid bruit may be heard in..
Hyperthyroidism from Graves
or toxic multinodular goiter
What testing is advised for a palpable solitary nodule on thyroid?
US
Fine-needle aspiration
What happens to the face in someone with Cushing syndrome?
Round or “moon” face with red cheeks
Excessive hair growth
What happens to the face in someone with Nephrotic syndrome?
Face becomes edematous and pale
Swelling appears first around eyes and in the morning
Severe: eyes appear slit like
Nephrotic syndrome*
What happens to the face in someone with Myxedema (severe hypothyroidism)?
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
What happens to the face in someone with Acromegaly?
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
What happens to the face in someone with Parkinson’s Disease?
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
eye anatomy
-
Distance visual acuity measurements should be performed in all children _______ or after age of ____.
ASAP or after age of 3
Minimal exam for eye
-visual acuity
-pupillary reflex
- extraocular movement
- fundoscopic exam through UNdilated pupils
When a person shifts gaze from a far object to a near object the pupils…
This is mediated by the…
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
what is lid lag?
Lid lag as the eyes move from up to down.
- can see upper sclera above iris with downward gaze
-HYPERTHYROIDISM sign
Pupillary constriction vs dilation and raising of the upper eyelid is parasympathetic or sympathetic?
constriction: parasympathetic
dilation and raising upper eyelid: sympathetic
What extraocular muscles are responsible for eye movements?
Lateral and medial recti
Superior and inferior recti
Superior and inferior obliques
LR6, SO4, CN III
The superior rectus moves the eye…
Upward (elevation)
Difficulty w/ close work suggests
Hyperopia (farisightedness) or presbyopia (aging vision
oval blind spot + when would it be enlarged
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
accommodation vs convergence
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
Diplopia-
CN 4 damage due to trauma
congenital, or central lesion -> superior oblique muscle dysfunction
Horizontal vs verticle diplopia which cranial nerve
Horizontal diplopia suggests palsy of…
CN III or CN VI
Vertical diplopia suggests palsy of…
CN III or CN IV
Diplopia in one eye, with the other closed….
Issue with:
- ocular surface
-cornea
- lens
- macula
If sudden visual loss is painful consider…
Corneal ulcer
Uveitis
Traumatic hyphema
Acute angle closure glaucoma
optic neuritis from MS
If unilateral vision loss is associate with headache, jaw pain or claudication, it may be associated with…
Giant-cell arteritis
If sudden visual loss is unilateral and painless consider…
Vitreous hemorrhage from DM or trauma
Macular degeneration
Retinal detachment
Retinal vein occlusion
Central retinal artery occlusion
If vision loss is bilateral and painless consider…
Vascular etiologies
Stroke
Nonphysiologic causes
If vision loss is bilateral and painful consider..
Chemical or radiation exposures
Gradual vision loss usually arises from…
Cataracts*
Glaucoma
Macular degeneration
Slow central vision loss occurs in…
Nuclear cataract
Macular degeneration
Peripheral vision loss is associated with…
Advanced open-angle glaucoma
Moving specks or strands suggest…
Vitreous floaters
Fixed defects or scotomas suggest…
Lesions in the retinal, visual pathway or brain
Flashing lights with new vitreous floaters suggest…
Detachment of the vitreous body from the retina
red eye: painless vs painful
Painless:
- Subconjunctival hemorrhage
- Episscleritis
painful:
- Corneal abrasions
-Corneal ulcers
-Hyphema
-Acute angle closure glaucoma
-Herpes keratitis
-Foreign body
-Fungal keratitis
-Uveitis
20/30 vision explain each number
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
Vision of 20/200
At 20 ft, the patient can read print that a person with normal vision could read at 200 ft
considered legally blind
Astigmatism
imperfection of the cornea or lens causing distortion while looking at near and far objects
myopia vs hyperopia
Myopia- nearsightedness- near is clear
- elongated globe
Presbyopia- farsightedness- far is clear
- dysfunctional lens with age
hyperopia: Farsightedness
- Foreshortened globe
What does testing color vision help to rule out?
Damage to optic nerve
Abnormalities in eye movements
esotropia (inward deviation)
exotropia (outward deviation), hypertropia (upward deviation)
hypotropia (downward deviation) of the eyes.
Pupils size range
pupils are large (>5 mm)
small (<3 mm)
anisocoria?
Difference in pupillary diameter ≥0.4m without a known pathologic cause?
Contraindications for mydriatic drops
(1) head injury and coma
(2) any suspicion of narrow-angle glaucoma
Absence of a red reflex
opacity of the lens (cataract)*
-artificial eye
-detached retina
-mass
-Children: retinoblastoma
Papilledema
Swelling of the optic disc and anterior bulging of the physiologic cup
optic nerve head swelling associated with increased intracranial pressure
Retina—Arteries vs Veins
What is a cause of poor central vision in older adults?
Macular degeneration - dry atrophic, wet exudative and neovascular
Swinging Flashlight Test
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
left-sided optic nerve damage
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)
Hypertensive retinopathy
copper wiring, silver wiring, edema, AV nicking, flame shaped hemorrahges, cotton wool spots, yellow hard exudates
