L2- Exam Pt. 2 Flashcards
major differences between arteries and veins in the eye
arteries
- lighter red
- smaller
veins
- darker red
- larger
pupillary reaction to light - direct reaction
pupillary constriction in the same eye
- light in right eye and right eye constricts
consensual reaction -
pupillary constriction in the opposite eye
- put in right eye and both right and left eyes the pupil constricts
whisper technique for auditory acuity
stand 2 feet behind the patient so that the patient cannot read your lips
occlude the non-test ear with a finger and gently rub the tragus in a circular motion
exhale a full breath before whispering to ensure a quiet voice
whisper a combination of three numbers and letters
use a different number/ letter combination for the other ear
conductive hearing loss
hear better through bone conduction than air
sensorineural hearing loss
congenital or hereditary hearing loss
weber test
hearing test
upper eyelid covers?
portion of iris – but does not normally overlay the pupil
opening between eyelids called
palpebral fissure
conjuctiva
clear mucous membrane with two visible components
- bulbar conjuctiva
- palpebral
bulbar conjuctiva
covers most of the anterior eyeball, adhering lossely to the underlying tissue
- meets cornea at limbus
papebral conjuctiva lines
the eyelids
tarsal plates
firm strips of connective tissue within the eyelids
levator palpebrae
raises the upper eyelid – innervated by CN III
meibomian glands
in the tarsal plates – parallel rows of them and open on the lid margin
controls the pupillary size
the muscles of irsi 8
controlling the thickness of the lens
muscles of the ciliary body
what allows to focus on near or distant objects
muscles of ciliary body
aqueous humor found? flow?
fills anterior and posteior chambers of the eye
circulates from posterior to anterior through the pupil
drains out through the canal of schlemm
canal of schlem
drains the aqueous humor of the eye
- controls the pressure inside the eye
lacrimal location
superior lateral aspect of the eyelid
- mostly in bony orbit, above and lateral to the eyeball
what protects conjuctiva and cornea
fluid from the meiboma glands, conjuctivcal glands, and lacrimal glands
tears drain?
medially through the lacrimal puncta
they pass into the lacrimal sac and into the nose via the nasolacrimal duct –> inferior meatus
cranial nerves associated with the eye
III, IV, VI
superior oblique what nerve
IV
CN VI
lateral rectus
CN III regulates which muscles
- superior rectus
- inferior rectus
- medial rectus
- inferior oblique
lateral rectus controlled by
CN VI
entropin
lower eyelid pushed underneath
ectropin
lower eyelid is lower
subconjunctival hemorrhage
leakage of bloos outside the vessels, producing a hemorhagenous sharpply demarcated, red area that resolves over 2 weeks
fundus is where
posterior part of the eye
- also see retina, choroid, fovea, macula, optic disc and retinal vessels in this area
describe arteries of the eye
- light red in color
- smaller (2/3 to 3/4 the diameter of veins)
- light reflex is bright
describe veins of the eye
- dark red in color
- larger
inconspicuous or absent in the light reflex
arteries of eye in light reflex
bright
chalazion
subacute nontender, usually painless nodule involving a blocked meibomian gland
may become acutely inflammed, unlike a sty – usually points insidie the lid rather than on the lid
pterygium
triangular thickening of the bulbar conjuctiva that grows slowly across the outer surface of the cornea, usually from the nasal side
redenning
can interfer with vision
wall of normal artery in the eye
it is TRANSPARENT –only column of blood can usually be seen
normal light reflex – describe the artery
it is a NARROW – 1/4TH DIAMETER OF THE BLOOD COLUMN
Retinal erteries in hypertension
focal or generalized narrowing – the light reflex is also narrowed
ARTERIAL WALL THICKENS AND BECOMES LESS TRANSPARENT
- copper wiring
- silver wiring
Copper wiring
sometimes seen in hypertension and these retinal arteries are closer to the disc
- become more full and develop an increased light reflex with a bright coppery luster
silver wiring
retinal arteries that become more narrow and wall becomes opaque – no blood is visible within
what happens to arteriovenous crossing with hypertension
when the arterial walls loose their transparency – changes appearance in AV crosssing
- AV nicking / concealment
- tapering
- banking
concealment or av nicking
the vein appears to stop abruptly on either side of the artery
tapering in AV
vein appears to taper down on either side of artery
describe banking
vein is twisted on the distal side of the artery - and forms a dark, wide knickle
normal AV crossing in eye
becasue arterial wall is transparent, a vein crossing beneath the artery can be seen right up to the column of blood on either side
anisocoria
unequal pupils
simple anisocoria
difference in pupillary size of 0.04mm or greater – is seen in approx. 35% of healthy people
if reactions in pupil are normal – considered benign
miosis
constriction of pupils
mydriasis
dilation of pupils
painful on ‘tug test’
describe movement
movement of the auricle and tragus
- acute otitis externa (inflammation of the middle ear canal)
tenderness behind the ear may present in?
otitis media
describe whispered voice test
used for?
for audiotory acuity
stand 2 feet behind
occlude non test ear
exhale to be at a true whisper
whisper combination of three numbers and letters
repeat for other ear - using different comination
normal response to whisper test
patient repeats initial sequence
fail once then on second try patient repeats ATLEAST 3 OUT OF 6 of the possible numbers/ letters correctly
abdnormal response to whisper voice test
4 /6 possible number / letters are incorrect
conduct further testing using audiometry (weber and rinne)
two ways sound gets conducted
- air – faster
2. through bone – not as conductive
conductive hearing loss hear better through?
through bone because here the external and middle ear are the problem
sensorineural hearing loss caused by?
- general
disorder of the inner ear
causes of external ear
infection (otitis externa), trauma, benign bony growths such as extoses or osteomas
causes of middle ear problems
congenital conditions, benign cholesteatomas, and otosclerosis, tumiors, and perforations of the tympanic membrane
disorders causing senorineural hearing loss
- congenital and hereditary conditions
- presbycusis
- viral infections
- rubella
- cytomegalovirus - meniere’s disease
- noise exposure
- acoustin neuroma
describe (basic) conduction with senorineural hearing loss
conduction through the middle ear/ bone is good but once in inner ear – bad
otitis media causes
conductive hearing loss
*pathophysiology of conductive hearing loss
EXTERNAL OR MIDDLE EAR DISORDER
- impairs sound conduction to inner ear
causes
- foregin body
- otitis media
- perforated eardrum
- osteosclerosis of ossicles
pathophysiology of sensorineural loss
inner ear disorder involves cochlear nerve and neuronal impulse transmission to the brain
causes inlude
- load noise exposure
- inner ear infections
- trauma
- acoustic neuroma
- congenital and familial disorders
- aging
loud noises can cause
sensorineural loss
inner ear infections and trauma can cause
sensorineural loss
weber test in unilateral hearing loss with conductive hearing loss
tuning fork at vertex
sound lateralized to IMPAIRED EAR
room noise NOT well heard – so detection of vibrations IMPROVE
weber test in unilateral hearing loss with sensorineural hearing loss
tuning for at vertex
sound lateralizes to GOOD EAR
inner ear or cochlear nerve damage impairs transmission to affected ear
which does detection of vibrations improve
weber test with conductive hearing loss
sound lateralizes to IMPAIRED EAR
conductive loss
sound lateralizes to GOOD EAR
sensorineural loss
bone conduction is longer than or equal to air conduction
conductive loss
air conduction longer than bone conduction
sensorineural loss
vibrations reach the cochlea in?
conductive – although the external or middle ear is impaired, vibrations through bone bypass the problem to reach the cochlea
- cochlear nerve can transmit
which hearing loss is the cochlear nerve more affected?
sensorineural loss
- the inner ear or cochlear nerve is less able to transmit impulses regardless of how the vibrations reach the cochlea
tuning fork where in weber? where in rinne?
weber – at vertex – on top of the head – and see if it lateralizes
rinne – at external audiotry meatus – then on mastoid bone
*conductive hearing loss does what?
basic
LATERALIZES to the impaired ear
if poor hearing in the right ear and lateralizes to right ear?
conductive hearing loss
if poor hearing in the right ear and lateralizes to left ear?
sensorneural loss in the right ear
after weber test which next?
Rhinne
if cannot hear tuning fork next to ear after had it against mastoid process what does this indicate?
conductive hearing loss – because conduction through air is lost
