head/neck/lypmph/eyes

Question 1

physical exam of skull

Answer 1

Inspect skull - general size and contour
note any lumps, deformities, tenderness
palpate temporal artery, temporomandibular joint
inspect face - expression - involuntary movements, symmetry of movement [nerve VII]
inspect neck - ROM
inspect salivary glands, lymph nodes, thyroid

Question 2

face inverted by what nerves

Answer 2

Cranial nerve V11 - facial nerve
Cranial nerve V - trigeminal
Both are mixed nerves which means they have motor and sensation functions or motor and sensory functions

Question 3

cranial nerve 5

Answer 3

Motor - ask client to clench teeth and try to push down on chin to separate the jaws.
- clench teeth and palpate masseter muscle strength
Sensory - ask client to close eyes, touch forehead, face and chin with cotton ball 6 different places. Ask client to ID sensation.

Question 4

the neck

Answer 4

Supported by:

• cervical vertebrae
• ligaments
• major neck and shoulder muscles

sternocleidmastoid and trapezius create the anterior/posterior triangle (landmark)

Question 5

the thyroid

Answer 5

Vascular and hormonal gland 
Secretes 3 hormones:
- thyroxine T4
- T3 both=cell metabol.
- calcitonin

Question 6

thyroid landmarks

Answer 6

Cricoid cartilage - above thyroid
Thyroid cartilage - above cricoid (adams apple)
Isthmus bottom landmark

Question 7

lymph 1-5

Answer 7

10 locations in head and neck
preauricular - front of ear
postauricular - back of ear (mastoid)
occipital - base of skull
submental - under chin
submandibular - follows jaw line

Question 8

lymph 6-10

Answer 8

Jugulodigastric (tonsillar) - posterior angle of mandible
Superficial cervical - under ear, over upper sternocleidomastoid
Deep cervical - under sternocleid.
Posterior cervical - triangle/edge of trapez.
Supraclavicular - above clavical

Question 9

movement of eyes

Answer 9

We have 4 straight movement muscles and 2 slanting movement muscles

Movement of the extra ocular muscles is stimulated by three cranial nerves.
Cranial nerves: III, IV, VI

The majority of the motion comes from cranial nerve III innervations.

Internal anatomy: The eye is a sphere that is composed by three concentric coats.

A) sclera ( outer), B) choroid ( middle)
and C) retina ( inner)

Question 10

eye structure

Answer 10

Outer Layer: tough protective outer layer. Contains the cornea.

Middle layer: contains the choroid, dark pigment , which is highly vascular.

Contains the pupil, lens,, the lens bulges for near objects and flattens for far vision.

The inner Layer: converts light waves into nerve impulses.

The optic disc ( home of the blood vessels in the back of the eye).

Question 11

eye structure 2

Answer 11

Retinal Vessels: arteries have a thin sliver of light along them ( arterial light reflex).

The MACULA is located temporally . The macula contains the FOVEA CENTRALIS ( the area of sharpest and keenest vision.

Question 12

signs and symptoms of a concussion

Answer 12

• Headache
• Dizziness
• Feeling dazed
• Seeing “stars”
• Sensitivity to light
• Ringing in ears
• Tiredness
• Nausea, vomiting
• Irritability
• Confusion, disorientation

Question 13

pregnant woman thyroid

Answer 13

The thyroid gland enlarges slightly during pregnancy as a result of hyperplasia of the tissue and increased vascularity.

Question 14

bruit

Answer 14

a soft whooshing sound made over the carotid artery

Question 15

Posterior Approach to Palpating the Thyroid

Answer 15

Ask the person to sit up very straight and then to bend the head slightly forward and to the right.

Use the fingers of your left hand to push the trachea slightly to the right.

Curve your right fingers between the trachea and the sternomastoid muscle, retracting it slightly, and ask the patient to take a sip of water.

The thyroid moves up under your fingers with the trachea and larynx as the patient swallows

Question 16

palpitation of thyroid

Answer 16

Usually you cannot palpate the normal adult thyroid. In some patients

Question 17

eyelids/eyelashes

Answer 17

like two movable shades that further protect the eye from injury, strong light, and dust.
The upper eyelid is the larger and more mobile one.
The eyelashes are short hairs in double or triple rows that curve outward from the eyelid margins, filtering out dust and dirt.

Question 18

tarsal plates

Answer 18

are strips of connective tissue that give it shape

The tarsal plates contain the meibomian glands, modified sebaceous glands that secrete an oily lubricating material onto the eyelids.

This stops the tears from overflowing and helps form an airtight seal when the eyelids are closed.

Question 19

conjunctiva

Answer 19

is a thin mucous membrane folded like an envelope between the eyelids and the eyeball

Question 20

palpebral conjunctiva

Answer 20

lines the eyelids and is clear, with many small blood vessels.

Question 21

lacrimal apparatus

Answer 21

constant irrigation to keep the conjunctiva and cornea moist and lubricated. The lacrimal gland, in the upper outer corner over the eye, secretes tears

Question 22

6 muscles attached to the eyeball

Answer 22

(a) superior, (b) inferior, (c) lateral, and (d) medial rectus muscles. two oblique, muscles are the (a) superior and (b) inferior oblique muscles.

Question 23

sclera

Answer 23

tough, protective, white covering. It is continuous anteriorly with the smooth, transparent cornea, which covers the iris and pupi

Question 24

cornea

Answer 24

contact with a wisp of cotton stimulates a blink in both eyes, called the corneal reflex.

Question 25

middle layer of eyes include;

Answer 25

choroid
 iris
pupil
lens
anterior chamber
posterior chamber

Question 26

inner layer

Answer 26

retina is the visual receptive layer of the eye in which light waves are changed into nerve impulses

optic disc (or optic papilla) is the area in which fibres from the retina converge to form the optic nerve

retinal vessels normally include a paired artery and vein extending to each quadrant, growing progressively smaller in calibre as they reach the periphery.

Question 27

Age-related macular degeneration (AMD)

Answer 27

leading cause of blindness in Canada and remains the most common cause of legal blindness in people older than 65

Question 28

cataract formation

Answer 28

lens opacity, which results from a clumping of proteins in the lens

Question 29

Glaucoma

Answer 29

Glaucoma is the second most common cause of vision loss in older adults in Canada

Question 30

Screening intervals in asymptomic low-risk patient

Answer 30

Age 19 to 40 years: at least every 10 years
• Age 41 to 55 years: at least every 5 years
• Age 56 to 65 years: at least every 3 years
• Age older than 65 years: at least every 2 years

Question 31

Screening in symptomatic patients

Answer 31

Any patient noting changes in visual acuity, visual field, colour vision, or physical changes to the eye should be assessed as soon as possible

Question 32

Screening intervals in high-risk patients

Answer 32

Patients at higher risk for visual impairment (e.g., those with diabetes, cataract, macular degeneration, glaucoma [verified or suspected], or a family history of these conditions) should be assessed more frequently and thoroughly
• Age older than 40 to 50 years: at least every 3 years
• Age older than 50 to 60 years: at least every 2 years
• Age older than 60 years: at least annually

Question 33

subjective data for eye exam

Answer 33

1. Vision difficulty (decreased acuity, blurring, blind spots)
2. Pain
3. Strabismus, diplopia
4. Redness, swelling
5. Watering, discharge

Question 34

subjective data for eye exam

Answer 34

6. History of ocular problems
7. Glaucoma
8. Use of glasses or contact lenses
9. Self-care behaviours
10. Medications
11. Coping with vision changes or loss