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PE Block 1 Flashcards

1
Q

Define Hyperopia
Define Presbyopia
Define Myopia

A

Farsightedness
Aging vision
Nearsightedness

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2
Q

Gradual loss of vision is usually due to what two issues?

A

Cataracts

Macular degeneration

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3
Q

Slow central loss of vision in nuclear cataract is due to ?

Peripheral loss of vision is usually due to ?

A

Macular degeneration

Open angle glaucoma

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4
Q

One sided loss of vision is usually due to?

A

Hemianopsia

Quadrantic defect

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5
Q

Pt complains of specks or floating debris in field of view, what causes this?

A

Moving- vitreous floaters

Fixed- scotomas, lesion on retina or in visual pathway

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6
Q

PT complains of moving specks or flashing lights is suggestive of what?

A

Detached vitreous from retina

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7
Q

What can cause diplopia in adults?

A

Lesion in brainstem/cerebellum

Weak/paralyzed extraocular muscle

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8
Q

Horizontal diplopia can be attributed to palsy in what nerve?
Vertical diplopia can be attributed to palsy in what nerve?

A

CN3 or 6

CN 3 or 4

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9
Q

PTs with vertigo point to a problem with what CN?

A

CN8

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10
Q

What are the two types of hearing impairment?

A

Conductive loss- problem with external/middle ear

Sensorineural- inner ear, cochlear nerve, connection to brain

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11
Q

What types of difficulties do PTs with sensorineural hearing loss experience?

A

Understanding speech
Complain others mumble
Difficult hearing in noisy environments

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12
Q

PTs with conductive hearing loss exhibit decreased/improvement of symptoms in what type of environment?

A

Noisy

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13
Q

What are some S/Sx of acute/chronic otitis media?

A

Unusually soft ear wax
Debris
Rash in canal
Discharge through perforated ear drum

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14
Q

What Sx identifies true vertigo?

A

Do you feel the room is spinning

Feeling of being pulled= inner ear problem or CN8 lesion

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15
Q

What are 3 causes of rhinorrhea?

A

Viral infections
Allergic rhinitis- proven by itching
Vasomotor rhinits

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16
Q

Define Rhinits Medicamentosa

A

Excessive use of decongestants that worsens symptoms

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17
Q

What are 3 drugs that may cause stuffiness?

A

Oral contraceptives
Reserpine
Guanethidine
ETOH

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18
Q

Epistaxis can come from the nose itself or what other two areas?

A

Paranasal sinus

Nasopharynx

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19
Q

What questions can be asked to test for thyroid function?

A

Temperature intolerance

Sweating

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20
Q

What can apthhous ulcers mean?

A

Sore smooth tongue of nutritional deficiency

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21
Q

What other S/Sx often accompany pharyngitis?

A

Enlarged tender lymph nodes
No fever
Exudate

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22
Q

What are some S/Sx of Hypo/Hyperthyroidism?

A

Hypo- Intolerant to cold, dec sweating

Hyper- palpitations, hot, involuntary weight loss

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23
Q

What are some structures checked when PTs complain of changes in vision?

A

Lens
Macula
Macular degeneration
Glaucoma

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24
Q

Define Nits

A

Lice eggs

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25
Q

What does redness and scaling under the hair/on the scalp indicate?

A

Seborrheic dermatitis
Psoriasis
Pilar cysts
Pigmented nevi

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26
Q

Define Wens

A

Pilar cysts

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27
Q

When/why does hirsutism occur in women?

A

PCOS

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28
Q

Define the Palpebral Conjunctiva

Define the Bulbar Conjunctiva

A

Lines eyelids

Covers most of anterior eye

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29
Q

Define the Visual Field

A

Entire area seen by an eye when it looks at a central point

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30
Q

Define Direct Reaction

Define Consensual Reaction

A

Light beam shining causes pupil constriction in that eye

Light beam shining causes pupil constriction in opposite eye

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31
Q

Which CN controls iris constriction/dilation?

A

CN3

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32
Q

Define Accommodation

A

Increase in convexity of lens cause by contraction of ciliary muscles changing shape of lens to bring near object into focus

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33
Q

How are PTs older than 45y/o tested to see if reading glasses or bifocals are needed?

A

Near vision tested with hand held card

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34
Q

What is the definition for legally blind?

A

Better eye corrected by glasses is 20/200 or less

Constricted field of vision 20* or less in better eye

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35
Q

What area of vision is affected by most defects?

A

Temporal

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36
Q

When/what causes an enlarged blind spot?

A

Conditions affecting optic nerve
Glaucoma
Optic neuritis
Pailledema

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37
Q

What causes inward/outward deviation of eyes when assessing position and alignment?

A

Graves Disease

Ocular tumor

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38
Q

What causes eyebrow scaliness?

A

Seborrheic dermatitis

Lateral sparseness= hypothyroidism

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39
Q

What causes an upstarting palpebral fissure on the tongue?

A

Down’s Syndrome

AKA Scrotal tongue

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40
Q

Define Blephritis

A

Red inflammed lid margins

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41
Q

What can cause excessive tearing from increased production?

What can cause excessive tearing from inadequate drainage?

A

Conjunctival inflammation, corneal irritation

Ectropion, lacrimal duct obstruction

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42
Q

Define Aniosocoria

A

Pupil inequality of less than 0.5mm

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43
Q

Testing the eyes for the near reaction is helpful in diagnosing what disorder?

A

Argyll Robertson/ Tonic(Adies) pupil

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44
Q

What is the follow on test if the reaction to light is impaired or questionable?

A

Near reaction in normal room light

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45
Q

What does the cover-uncover test reveal issues of?

A

Muscle imbalances

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46
Q

Define Nystagmus

A

Fine rhythmic oscillation of the eyes

Few beats w/ later gaze is normal

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47
Q

How does lid lag in hyperthyroidism appear?

A

Rim of sclera is visible above iris with downward gazes

Normal= lid should over lap iris slightly throughout movement

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48
Q

Define Proptosis

A

Abnormal protrusion of eyes in hyperthyroidism

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49
Q

Normal convergence can follow the object to as close as what distance?

A

5 - 8 cm

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50
Q

Poor convergence is a sign of ?

A

Hyperthyroidism

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51
Q

What are the contraindications for using mydriatic drops?

A

Head injury/coma

Suspicion of narrow gaze glaucoma

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52
Q

If a PTs lens has been surgically removed from their eye, how does this change the providers view of examining their eye?

A

Magnifying effect is lost
Retinal structures look smaller than usual
Larger expanse of fundus is visible

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53
Q

What is the function of the diopter

A

Unit that measures the power of a lens to converge/diverge light

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54
Q

Define Hippus

A

Spasm of the pupil from bright, direct light

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55
Q

How is the diopter adjusted for PTs with myopic vision? Hyperopic?

A

My- counterclockwise, minus

Hyper- clockwise to plus

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56
Q

What are 4 characteristics to be noted of the disc during inspection?

A

Clarity of outline
Color
Size
Comparative symmetry

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57
Q

Define Papilledema

A

Swelling of optic disc and anterior bulge of physiologic cup

Indicates serious issue with brain, meningitis, subarachnoid hemorrhage, trauma, lesion

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58
Q

How does light focus to the retina in PTs with hyper/myopia?

Which one will have retinal structures that look larger than normal?

A

My- anterior focus
Hyper- posterior

Myopic

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59
Q

What does an enlarged cup suggest an issue of?

A

Chronic open angle glaucoma

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60
Q

Define SVP and what they indicate

A

Spontaneous Venous Pulsations
Normal in 75% of PTs
Indicates intracranial pressure is probably normal

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61
Q

What is the sequence of inspection from the disc to macula?

A 
1- 10 oclock
2- 7
3- 5
4- 1
5- 3
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62
Q

Loss of SVPs can indicate what 3 things?

A

Head trauma
Meningitis
Mass lesions

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63
Q

To inspect the anterior structures of the eye adjust the number on the diopter to ?

A

10 or 12

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64
Q

What is an important cause of poor central vision in the elderly?

A

Macular degeneration

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65
Q

What are the different types of macular degeneration?

A

Dry atrophic- more severe
Wet exudative- neovascular
Drusen- undigested cell debris

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66
Q

What are the two parts of the external ear?

A

Auricle

Ear canal

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67
Q

What are the two chief landmarks of the malleus when viewing the TM?

A

Handle

Short process

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68
Q

Define the Umbo

A

Where eardrum meets the tip of the malleus

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69
Q

Define the Pars Flaccida

Define Pars Tens

A

Above the short process of the TM

Rest of the TM not ID’s

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70
Q

What structures separate the pars flaccida from the pars tensa?

A

Anterior/posterior malleolar folds, extend obliquely upward from short process

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71
Q

Define the Conductive Phase of hearing?

Define the Sensorineural Phase

A

1st part
External ear to middle ear
Described by air conduction

Cochlea and cochlear nerve

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72
Q

What does a painful “Tug Test” indicate?

A

Acute ottits externa- inflammation of ear canal

Ottits media- inflammation of the middle ear- presents with pain behind the ear

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73
Q

Define Exostoses

A

Nontender nodular swellings covered by normal skin in the ear canal

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74
Q

How does the ear canal appear/present in Acute Otitis Externa
How does it appear with Chronic Otits Externa

A

Swollen, narrow, moist, pale/red, tender

Skin is thickened, red, itchy

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75
Q

An unusually prominent short process and handle that looks more horizontal suggest what?

A

Retracted ear drum

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76
Q

How is mobility of the eardrum evaluated?

A

Pneumatic otoscope

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77
Q

What size tuning fork is preferred for testing hearing?

A

512 Hz
1024 Hz
Normal human speech falls in 300-3000Hz

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78
Q

Define the Weber Test

A

Test for lateralization of hearing

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79
Q

Define the Rinne Test

A

Compares air conduction with bone conduction (an alternate path that bypasses external and middle ear)

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80
Q

What can cause unilateral conductive hearing loss?

A

Acute otitis media
Perforated TM
Obstructed ear canal

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81
Q

The nasolacrimal duct drains into the ___ meatus

The paranasal sinuses drain into the ____ meatus

A

Inferior

Middle

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82
Q

Which sets of sinuses are accessible for clinical examination?

A

Frontal

Maxillary

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83
Q

Define Alae

A

Tenderness of the nasal tip

Suggests local infection (furuncle)

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84
Q

Viral rhinitis causes the mucosa to be ? color

Allergic rhinitis causes the mucosa to be ? color

A 
Viral = Red, swollen
Allergic= pale, blueish, red
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85
Q

Polyps seen in the nasal cavity usually come from which meatus and are associated with?

A

Middle

Chronic allergic rhinitis

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86
Q

When inspecting the sinuses, what combination of S/Sxs suggest acute sinusitis

A

Local tenderness
Pain
Fever
Nasal discharge

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87
Q

Where are Wharton’s Ducts located?

Where are the Stenson’s Ducts located?

A

Base of the tongue for the submandibular glands

Opening in buccal mucosa near 2nd molars

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88
Q

What do bright red edematous mucosa underneath a denture suggest?

A

Denture sore mouth

Can present with ulcers or papillary granulation tissue

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89
Q

Redness of gingiva = ?

Black line of gingiva = ?

A

Gingivitis

Lead poisoning

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90
Q

Define Torus Palatinus

A

Benign midline lump on the tongue

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91
Q

What are the two most common cancers of the mouth?

A

1st- lips

2nd- tongue (1- side, 2-base)

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92
Q

How does the soft palate/uvula respond to CN10 paralysis?

A

Soft palate fails to rise

Uvula deviates to opposite side

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93
Q

What are the borders of the Anterior Triangle

A

Mandible
Sternomastoid
Midline of neck

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94
Q

What are the borders of the Posterior Triangle

A

Sternomastoid muscle
Trapezius
Clavicle

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95
Q

What vessels pass under and over the sternomastoid muscles?

A

Carotid and Internal Jugular- deep

External jugular- over

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96
Q

What are the 5 midline structures of the neck?

A 
Hyoid bone
Thyroid cartilage
Cricoid cartilage
Tracheal rings
Thyroid gland
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97
Q

The deep cervical chain of lymph nodes is largely obscured by the overlying sternomastoid muscle except for what two?

A

Tonislar node

Supraclavicular node

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98
Q

What is a visible clue to an unsuspected thyroid disease?

A

Scar of past thyroid surgery

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99
Q

A tonsilar node the pulsates is actually ?

A

Carotid artery

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100
Q

A hard/tender tonsillar node high and deep between the mandible and sternomastoid is ?

A

Styloid process

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101
Q

What is the sequence for feeling lymph nodes?

A 
Preauricular / Posterior auricular
Occipital
Tonsillar
Submandibular
Submental
Superficial cervical / Posterior cervical
Deep cervical 
Suprclavicular
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102
Q

Enlarged supraclavicular nodes suggests the possibility of?

A

Metastasis from thoracic or abdominal malignancy

ESPECIALLY left side node

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103
Q

Tender nodes suggest ____

Hard/fixed nodes suggest ____

A

Inflammation

Malignancy

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104
Q

Diffuse lymphadenopathy raises the suspicion of ?

A

HIV/AIDS

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105
Q

If unsure a mass is a band of muscle or artery from a lymph node, what test can be done?

A

Roll up and down, side to side

Artery and muscles will not pass the test

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106
Q

Thyroid isthmus is usually found covering which tracheal rings?

A

2-4

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107
Q

If a thyroid gland is enlarged, what follow on test can be conducted?

A

Listen over lateral lobes with stethoscope to detect a bruit (similar to a cardiac murmur)
Localized/continuous bruit may be heard in hyperthyroidism

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108
Q

How with the thyroid adapt/change in response to different diseases?

A

Graves Disease- soft
Hashimotos- firm
Tenderness- thyroiditis

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109
Q

What is an exophthalmometer used for?

A

Measures distance between lateral angle of orbit and line across most anterior of cornea
20mm in whites, 22mm in blacks
F/u testing with CT/US

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110
Q

Discharge of mucopurulent fluid from the puncta suggests ?

A

Obstructed nasolacrimal duct

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111
Q

Absence of glow on one or both sinuses suggests ?

A

Thickened mucosa
Secretions in frontal sinuses
Developmental absence of one/both sinuses

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112
Q

What visual sign indicates a normal air-filled maxillary sinus

A

Bright light shining down from inner aspect of eye
Head tilted back, mouth open
Reddish glow is normal

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113
Q

What does an absence of glow with a bright light- open mouth test mean?

A

Thickened mucosa

Secretion in maxillary sinus

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114
Q

CN_ opens eye lid

CN_ closes it

A

3

7

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115
Q

What are the medial and lateral points of the eye called?

A

Medial/lateral canthus

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116
Q

Define Limbus

Why is this landmark important?

A

Where cornea inserts into the sclera

Peripheral border of iris and determines angle of the eye

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117
Q

What are the differences between the palpebral and bulbar conjunctiva

A

Palpebral- covers posterior lid

Bulbar- covers sclera. single membrane that reflects back onto itself

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118
Q

What is normally the only part of the lacrimal system that is visible?

A

Puncta- medial aspect of eye that drains into lacrimal duct

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119
Q

Cornea covers ___ of eye globe and is continuous with the _____

A

1/6

Sclera

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120
Q

Anterior chamber of the eye is from _____ to _____ and contains______

A

Cornea
Iris
Canal of Schlemm

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121
Q

Where does acute angle glaucoma occur?

A

Anterior chamber

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122
Q

What separates the anterior and posterior chambers of the eye?

A

Iris

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123
Q

What part of what nervous system opens and closes the eye?

A

Sympathetic CN3 open

Parasympathetic CN3 close

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124
Q

Posterior chamber of the eye is between the _____ and _____ and contains the ____

A

Iris
Lens
Ciliary body

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125
Q

What eye structure produces aqueous humor?

A

Ciliary body

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126
Q

What shape is the lens?

A

Biconvex

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127
Q

What are the functions of the vitreous body and occupies what space?

A

Eyeball form
Transmits signals to retina
Hold retina against choroid

Everything posterior to lens

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128
Q

The otpic disc is what CN and contains what landmark structure?

A

CN2

Contains physiologic blind spot

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129
Q

What is the cup in the back of the eye?

A

Entrance/exit of nerves and vessels

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130
Q

The disc in the eye is used as a land mark for what?

A

Describing size of anything found internally and landmark for describing locations of abnormalities within the eye

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131
Q

Where are the rods and cones located within the eye?

How is this area identified?

A

Macula

No blood vessels

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132
Q

What is the function of the fovea?

A

Center of macula with highest density of cones, responsible for fine vision and highest sensitivity to light

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133
Q

What is the “vital signs” of the eye?

A

Visual acuity

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134
Q

What is the function of a Snellen Chart?

A Rosenbaum chart?

A

Vision

Near vision

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135
Q

What does OD OS and OU mean?

A

Oculus dexter
Oculu sinister
Oculus uterque

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136
Q

What types of eye charts should be used for children between 2-3y/o for acuity?

A

HOTV
Tumbling E
Lea
Allen

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137
Q

What is a gross measure of visual acuity in young, preverbal children?

A

Ability to visually follow objects in front of them

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138
Q

If vision acuity of 20/20 is not achieved, what is the next step?

A

Pinhole testing to determine if vision is correctable to 20/20

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139
Q

When/why is pinhole testing useful?

A

Primary care setting

Optimizes vision

140
Q

If child achieves a 20/20 on pinhole test, what does this mean?

A

Refractive error is present

If not, amblyopia is considered

141
Q

What eye criteria means a child should be referred to a ophthalmologist for evaluation?

A

Visual acuity of 20/40 or worse at 3-5y/o
20/30 or worse at 6y/o or,
two line difference in acuity between both eyes

142
Q

What to do if PT can’t see the large E on a snellen chart?

A

Walk PT to chart until visualization is possible, record as 10/400

143
Q

What steps are taken if PT is unable to see large E on snellen chart at 3 ft?

A

Count fingers
Hand motion
Light perception

144
Q

What is defined as legal blindness?

145
Q

What is the Oval Blind Spot?

A

Lack of retinal receptors at optic disc causes blind spot at 15* temporal to line of gaze

146
Q

What is a method to take a gross measurement of peripheral vision?

A

Visual fields by confrontation

147
Q

What are 3 patterns of visual field defects?

A

Homonymous hemianopsia
Bitemporal hemianopsia
Quadratic defects

148
Q

How are eye peripherals reported for being equal or unequal?

A 
Equal= equal by confrontation
Unequal= in lateral field
149
Q

What causes Bitemporal Hemianopia

A

Optic chiasm lesion

Pituitary tumor

150
Q

What causes a horizontal (altidinal) defect?

What other issue can create a similar effect?

A

Retinal artery occlusion

Ischemia of optic nerve

151
Q

What produces unilateral monocular blindness?

A

Lesion on optic nerve

Lesion on eye itself

152
Q

What causes Bitemporal Hemianopsia

A

Optic Chiasm lesion (pituitary gland)

153
Q

What causes Left Homonymous Hemianopsia

A

Right Optic tract lesion

154
Q

What causes Homonymous Left Superior Quadratic Defect?

What can this AKA?

A

Right Optic Radiation, partial lesion

AKA- pie in the sky defect

155
Q

What causes Left Homonymous Hemianopsi

A

Right Optic Radiation

Complete interuption of fibers in optic radiation

156
Q

What part of the EOMI test is the finger paused to test for nystagmus?
What type of PT may need to have their distance/spacing altered during test?

A

Upward and lateral

Middle age/older

157
Q

How do you test for suspected lid lag/hyperthyroidism?

A

Follow finger up and down at midline

Lid should overlap iris
W/ hyperT- Sclera rim is visible above iris w/ down gaze

158
Q

Define Nystagmus

When is it considered normal?

A

Fine rhythmic oscillation of eyes

Extreme lateral gaze

159
Q

What is the next step if a nystagmus is observed?

A

Bring finger into filed of binocular vision and try again

Sustained nystagmus= neurological defect

160
Q

New onset dysconjugate gaze in adult life is usually the result of ?

A

CN injury/lesion
MS
Syphilis

161
Q

EOMs are tested for what 3 things?

A

Normal conjugate movement
Nystagmus
Lid lag

162
Q

CN 6 paralysis will be seen in what ways?

A 
Right= conjugate
Straight= esotropia
Left= no lateral movement of L eye
163
Q

CN 4 paralysis will be noted how?

A

Looking down and to right, L eye can’t look down during inward gaze

164
Q

How will CN3 paralysis be noted?

A

Straight gaze= eye pulled outward

Up/down/in= impaired/lost

165
Q

Other than affected gaze, what othe issues can be demonstrated by paralysis of CN3?

A

Ptosis

Pupil dilation

166
Q

Normal convergence within how close to the face?

Poor convergence = ?

A

5-8cm

Hyperthyroidism

167
Q

Define Strabismus

How is it revealed?

A

Binocular fixation is not present

Cover test/light reflex test

168
Q

Define Amblyopia

A

Reduced VA not correctable by refractive means

169
Q

Amblyopia can be caused by what 3 things?

A

Strabismus
Uremia
Toxins

170
Q

Layman term for strabismus and amblyopia

A

Stra- cross eyed

Ambly- lazy eye

171
Q

Define Tropia and Phoria

A

Tropia- misalignment that is always there, detected with cover-uncover test

Phoria- only occurs some times, when synchronization of eyes is broken/occluded
Break fusion w/ cross-cover test

172
Q 
Define:
Esotropia
Exotropia
Hypertropia
Hypotropia
A 
In 
Out
Up 
Down
Dominant eye does not correct itself
173
Q

If retina reflection is not symmetric during the Hirschberg’s test what does the PT have?

174
Q

PT complaining of diplopia but has not tropia means what?

A

No movement with Cover/Uncover test

175
Q

Define Anisocoria

A

Inequality of pupil size

<0.5mm is visible in 20% of normal PTs

176
Q

Define Direct Reaction

Define Consensual Reaction

A

Direct- constriction of same eye

Consensual- constriction in opposite eye

177
Q

Normal size of pupils?

How far can you vary in size and still be within a normal variant?

A

Norm= 4-6mm

+/- 1

178
Q

When evaluating pupils don’t let the PT focus on the light in order to avoid ? reaction

A

Accommodation

179
Q

Define Argyll Robertson Pupils

A

Bilateral small pupils that constrict w/ focus on near objects but NOT when exposed to bright lights

180
Q

Define Edinger Wesphal Nu

A

Light near dissociation- dorsal mid-brain selectivity

Sign of neurosyphilis and rarely diabetes

181
Q

What is the near response in Argyll Robertson pupils?

A

Brisk and Immediate

182
Q

Define Tonic Pupil

A

Dilated pupil and anisocoria

183
Q

Define Adie’s Tonic Pupil

A

Idiopathic tonic pupil

Minimal/no reaction to light, slow reaction to convergence from damaged parasympathetic innervation to eye

184
Q

Most cases of tonic puil is ?

A

Idiopathic (Adie’s Pupil)
Trauma

Local: tumor, inflammation, surgery, infection of orbit

Systemic neuropathies: DM, Guillain-Barre

185
Q

What extra precaution is taken in PTs +60y/o with acute tonic pupil?

A

ESR to rule out giant cell arteritis

186
Q

How is a Marcus Gunn pupil detected during exam?

187
Q

What is the most common cause of Marcus Gunn pupil?

A

Lesion of optic nerve, proximal to optic chiasm
Optic Neuritis
Retina detachment
Central retinal vein/artery occlusion

188
Q

What does a RAPD test on a Marcus Gunn pupil look like?

A

Unaffected w/ light- normal constriction
Affected w/ light- mild constriction of both pupils
Light on affected eye causes less pupillary constriction than light on unaffected eye

189
Q

Where would you see Hordeolum or Chalazion lesions?

A

External Eye/lids

190
Q

What can cause a PT to lose the outer 1/3 of their eye brow?

A

Thyroid Dz
Normal aging
Syphilis

191
Q

What are the eye brows inspected for?

A

Quantity, Distribution- lateral sparseness in hypothyroidism

Scales- seborrheic dermatitis, AKA scurf

192
Q

Eyelids ares inpsected for what 6 things?

A 
Position
Width
Edema/color
Lesions
Condition/direction
Adequacy
193
Q

Define Blepharitis

A

Red inflammed eye

194
Q

Define Sty

A

Painful red tender infection in gland at lid margin

AKA Hordeolum

195
Q

Define Chalazion

A

Nontender usually painless nodule of meibomian gland

Differs from stye by pointing inside the lid

196
Q

Define Xanthelasma

A

Yellow raised plaques filled with cholesterol along nasal portion of eyelids
Hyperlipidemia
Primary biliary cirrhosis

197
Q

What are the measurements of the palpebral fissure?

A

10mm vertically

30mm horizontal

198
Q

What are the causes of stys on the outter or inner lids?

A

Staph A
Inner- obstructed meibomian gland
Outter- obstructed eyelash follicle or tear gland

199
Q

Define Dacryocystitis

A

Swelling of lacrimal swelling
Acute- pain, red, tender
Chronic- obstructed duct, regurgitation occurs

200
Q

What are two causes of excessive tearing?

A

Inc production- conjunctival inflammation or corneal irritation

Impaired drainage- extropion or duct obstruction

201
Q

When palpating PTs lacrimal ducts, press on the face between what two structures?

A

Close to medial canthus

Inside rim of bony orbit

202
Q

Discharge from lacrimal gland suggests ?

A

Obstructed nasolacrimal duct

203
Q

Define Conjunctiva/Sclera injection

A

Dilatation of conjunctival vessels
Two types:
Diffuse- conjunctivitis
Local- episcleritis

204
Q

Define Hyposphagma

Can be harmless but also associated w/ ?

A

Bleeding under conjunctiva and between conjunctiva/sclera

HTN/Trauma

205
Q

What are four traumatic causes of hyposphagma

A

Choking
Coughing
Straining
Vomiting

206
Q

Define Pinguecula

A

Collection of fat that is medial/lateral to iris but does not extend onto cornea
Starts on nasal

207
Q

Define Pterygium

A

Triangular thickening of bulbuar conjunctiva that slowly grows across outer surface of cornea usually from nasal side (may interfere with vision)

208
Q

Define Chemosis

A

Edema of conjunctiva

Nonspecific sign of eye irritation

209
Q

What are three causes of chemosis?

A

Allergies
Viral infections
Aggressive eye rubbing

210
Q

What is the triad of blue/cyanotic sclera?

A

Fragile bones
Blue sclera
Early deafness

211
Q

Define Corneal Arucs

A

Thing gray arc/circle near edge of cornea, comes with normal aging

212
Q

Define Nuclear Cataract

A

Looks gray when seen by a flashlight

If dilated, the gray opacity surrounded by black rim

213
Q

Define Peripheral Cataract

A

Produces spokelike shadows that point—gray against black, as seen with a flashlight, or black against red with an ophthalmoscope

214
Q

Define Hyphema

A

Blood in anterior chamber of eye from severe trauma

215
Q

Define Narrow Angle Glaucoma and how it appears on exam

A

Iris bows forward forming narrow angle with cornea and creating crescent shadow

216
Q

Define Open-Angle Glaucoma and how it appears on exam

A

Normal spatial relation between iris and cornea

217
Q

What are the S/Sx of Acute Iritis

A

Eye pain
Photophobia
Blurry vision
Redness

218
Q

What is used to dilate pupils for better viewing of structures in the back of the eye?

A

Mydriatic agent- Tropicamide

219
Q

What part of the optic disc margin is often slightly blurry?

A

Nasal portion

220
Q

Pale color or white/pigemented crescents on optic disc mean ?

A

Pale- not well perfused, atrophy

While/crescent- normal

221
Q

What cup to disc ratio is indicative of glaucoma?

A

> 0.6 - 0.7

Norm= 0.4-0.5

222
Q

What is suspected if the eye disc is red?

A

Papilledema

223
Q

How does optic disc atrophy present?

What conditions can cause this?

A

White, tiny disc vessels are absent

Optic neuritis, MS, temporal arteritis

224
Q

Define Papilledema

A

Swelling of optic disc w/ bulge in physiologic cup
Blurred margins
Cupt not visible

225
Q

What can cause Papilledema

A 
Increased ICP
Meningitis
Subarachnoid hemorrhage
Tramua
Mass lesion
226
Q

How do retinal vessels look?

A

Dark red, larger, inconspicuous/absent

227
Q

Define AV nicking

When is it commonly seen?

A

Arteriole crosses venule causing impaction of vein w/ bulging
Most commonly seen in HTN retinopathy

228
Q

How are lesions in the fovea/macula measured?

A

Disc diameters from optic disc

229
Q

Tiny bright reflection at the center of a fovea can help with orientation except w/ ? PT?

230
Q

Shimmering light refleciton in macular area is common in ? PT?

231
Q

What can cause retinal lesions?

A 
HTN
Retinal vein occlusion
DM
Shaking
Severe blows to back of head
232
Q

Define “Cotton-Wool” Spots and what causes them

A

White/yellow/gray lesions with irregular soft borders
Infarcted nerves on retina surface
Most common cause- HTN, DM

233
Q

Define Hard Exudates

A

White/yellow lesions with well defined borders
Accumulation of lipids/protein, show inc permeability and risk of retinal edema. Occurrence in macula=blindness. Occur in circle/linear or star shaped, caused by HTN, DM

234
Q

Define Drusen Bodies

A

Yellow pigmentations located over macula

Asymptomatic/non-pathogenic

235
Q

What type of vision is lost with macular degeneration?

A

Loss of central, peripheral is preserved

236
Q

Define the use of a Amsler Grid

A

Graph/grid sheet showing loss of vision from macular degeneration

237
Q

Defines neovascularization and what does it represent?

A

Prliferative retinopathy

New vessels of poor quality and leak/rupture causing blindness

238
Q

Routine eye exams are performed on what three types of PTs?

A

Diabetes
HTN
Systemic Dz F/u

239
Q

What are routine eye complaints that need to be evaluated?

A

Blurry vision
Eye drainage
Lid swelling

240
Q

Eye exams are needed for what three types/scenarios of urgent eye complaints?

A

Trauma
Periorbital cellulitis
Blindness

241
Q

What is the primary function of CN 1

242
Q

What is the primary function of CN 2

A

Acuity
Fields
Ocular Fundi

243
Q

What is the primary function of CN 3

A

Pupil constriction
Open eye lid
Most extraocular movement

244
Q

What is the primary function of CN 4

A

Down, internal eye rotation

245
Q

What is the primary function of CN 5

A

Motor- temporal/masseter muscles, lateral jaw movement

Sensory- facial dermatome, corneal reflex

246
Q

What is the primary function of CN 6

A

Lateral deviation of eye

247
Q

What is the primary function of CN 7

A

Motor- facial expression, closing eye/mouth

Sensory- taste anterior 2/3 of tongue

248
Q

What is the primary function of CN 8

A

Hearing

Balance

249
Q

What is the primary function of CN 9

A

Motor- pharynx

Sensory- posterior ear drum/canal, pharynx, posterior 1/3 tongue

250
Q

What is the primary function of CN 10

A

Motor- palate, pharynx, larynx

Sensory- pharynx and larynx

251
Q

What is the primary function of CN 11

A

Sternomastoid and trapezius muscles

252
Q

What is the primary function of CN 12

253
Q

What is the common site for epistaxis to occur?

A

Kiesselbach plexus- superficially located on anterior superior septum

254
Q

How is the nasal vestibule different than the rest of the nasal cavity?

A

Unlike rest of cavity, vestibule is lined with hair-bearing skin and not mucosa

255
Q

Define Philtrum

A

Area/groove below nose and in between vermilion border

256
Q

What is the sequence of connections from the labial frenulum to the lip?

A

Frenulum
Gingiva
Alveolar mucose
Labial mucosa

257
Q

Where do nerves/vessels enter a tooth?

A

Apex, pass into pulp canal and chamber

258
Q

Tonsils lie in between what two oral structures?

A

Protrude from tonsillar fossa

Between anterior/posterior pillars

259
Q

What is the medical term for dandrug?

A

Suborrheic dermatitis

260
Q

What can cause mastoiditis

A

Complications of middle ear infections

261
Q

What directions is the ear pulled to view the ear canal?

A

Up
Back
Away

262
Q

What two issues can decrease TM mobility?

A

Fluid in middle ear

Thickened TM

263
Q

What is a general screening for gross estimation of hearing?

A

Auditory acuity

264
Q

Weber or Rinie, what is more accurate for PTs with hearing loss?

265
Q

What are the differences between Conductive Hearing Loss and Sensoneural Hearing Loss?

A

CHL- weber to impaired ear, BC>AC

SNHL- weber lateralizes to good ear, AC>BC

266
Q

What structures should be viewed during the nasal exam?

A

Inferior/middle turbinate
Septum
Passages in between

267
Q

What are the S/Sx of Acute Bacterial Rhonosinusitis?

What structures are affected?

A 
Tenderness
Facial pain
Discharge
Nasal obstruction
Smell disorders 
All greater than 7 days

Frontal or Maxillary sinuses

268
Q

AHHHH uses ? CN
Gag refex uses ? CN
Tongue protrusion

A

10
9 and 10
12

269
Q

What are the criteria for tonsils occupancy?

A 
0- entirely in fossa
1- less than 25%
2- less than 50%
3- less than 75% 
4- more than 75%
270
Q

Tongue cancer is most common in ? PT population?

A

+50y/o
Smoker
Alcohol consumers

271
Q

Define Shotty

A

Normal nodes- small, mobile, discrete, nontender

272
Q

Causes of Diffuse Thyroid enlargement

A

Isthmus and lobe involvement

Graves, Hashimoto, Thyroiditis, goiter

273
Q

Causes of single thyroid nodules

A

Cyst
Benign tumor
Malignancy

274
Q

Multinodular goiter is indicative of ?

A

Enlarged w/ two or more nodules means metabolic issue

275
Q

Define Keloid

A

Firm hypertrophic mass of scar tissue

276
Q

Define Chondrodermatitis Helicis

A

Chronic inflammation lesion starts as painful on helix/antihelix, ulcerates, crusts

277
Q

Define Tophi

A

Uric acid crystal on anti/helix from Chronic Tophaceous gout

278
Q

Define BCC/SCC Carinomas

A

Raised nodule w/ irregular border

279
Q

What PT population is more likely to present with BCC/SCC carcinoma?

A

BCC- Fair skin overexposed to sunlight

280
Q

What grows slower, BCC or SCC?

281
Q

Define Angular Cheilitis

A

Softening/fissure of corner of mouth

Nutrition deficiency or over closure of mouth (no teeth) or ill fitting dentures

282
Q

What is a secondary infection of Angular Cheilitis?

283
Q

Define Actinic Cheilitis

A

Precancerous condition from over exposure to sun, especially on lower lip
Fair skin, men, outdoor worker

284
Q

How does Actinic Cheilitis look

A

Loss of color
Scaly
Thick and everted

285
Q

Solar damage causes damage to lips and make them prone to what type of cancer?

A

Squamous cell carnicnoma

286
Q

Define Peutz-Jeghers Syndrome

A

Small brown spots on dermal layer of lips/buccal and hands/feet

287
Q

What kind of disease is Peutz-jeghers Syndrome?

What issue accompanies this disease?

A

Autosomal dominant

Intestinal polyps

288
Q

How does carcinomas of the lip appear?

A

Scaly plaque
Ulcerated
W or w/out crust or,
Nodular lesion

289
Q

What does pharyngitis look like?

A

Intense redness w/out exudate

290
Q

Define Fordyce Spots

A

Normal sebaceous glands that appear as yellow spots in buccal mucosa

291
Q

How does Oral Candidiasis appear?

A

Thrush

Thick white plaques on mucosa from prolong ABX, corticosteroid use or AIDS

292
Q

How does Leukoplakia appear?

A

Thickened white patch on oral mucosa that CAN’T be scarped off from chewing tobacco and leads to cancer
Hairy is seen in HIV/AIDS

293
Q

How do exudative tonsilitis look?

A

Red w/ white exudate Fever
Enlarged cervical nodes
Ifection from GABHS or Mono

294
Q

What causes Hairy Tongue

A

Elongated papillae

ABX therapy or unknown

295
Q

When does fissure tongue tend to appear?

A

Increased age

Down’s Syndrome

296
Q

Define Atrophic Glossitis

A

Smooth tongue and sore from lost papillae from nutritional deficiency or Chemo treatment

297
Q

What will CN10 paralysis look like?

What will CN12 paralysis look like?

A

Uvula and Soft palate don’t rise, uvula points away from side w/ lesion

Tongue points to side w/ lesion

298
Q

What is the triad of Horner’s Syndrome and when is compared?

A

Ptosis
Meiosis
Anhidrosis

299
Q

Tonic Pupil/Adies Pupil

A 
Unilateral large pupil
Reduced/slowed light reaction
Near reaction slow but present
Slow accomodation
DTRs decreased
300
Q

CN 3 paralysis presentation

A

Dilated pupil is fixed to light and near vision
Ptosis of upper lid
Lateral deviation of eye

301
Q

Argyll Robertson pupils

A

Small irregular pupil that accomodate but DON”T react to light
CNS syphilis

302
Q

Equal pupils and one blind eye

A

Unilateral blindness does not cause anisocoria as long as SNS and PNS are intact
Blind eye does not respond to light

303
Q

Koplick spots

A

Salt specks on dark background appearing near 2nd molars

304
Q

What nerve combinations control pupillary reactions?

305
Q

What nerve combinations control extraocular movements

306
Q

What nerve combinations control swallowing and rise of soft palate?

307
Q

What nerve combinations control voice and speech

308
Q

Why are obnoxious odors like ammonia avoided when testing CN 1?

A

Triggers CN5

309
Q

What circumstances is the sense of smell lost?

A 
Head trauma
Smoking
Aging
Cocaine
Parkinsons
310
Q

Define Prechiasmal defect of the eye and what are 3 examples

A

Anterior defect

Glaucoma
Retinal emboli
Optic neuritits

311
Q

Homoonymous hemianopsias or quadrantanopsia usually occure in what area of the brain?
How do they present?

A

Parietal

Associated findings of stroke but VA is normal

312
Q

Define Ophthalmoplegia

A

Eyes not aligned

Eyes constrict but don’t dilate

313
Q

How are nystagmus’ named?

A

In direction of quick component

314
Q

Isolated facial sensory loss occurs in peripheral nerve disorders like?
How is this finding confirmed?

A

Trigeminal neuralgia

Test tubes with different temp liquids

315
Q

Absent blinking can occur from lesions on ? CNs?

316
Q

Absent blinking and sensorineural hearing occurs in ?

A

Acoustic neuroma

317
Q

Bell’s Palsy affects ? CN?

318
Q

Where is presbyocusis seen?

A

Aging hearing loos

Sensorineural type

319
Q

Hoarse voice = ? CN

Nasal voice = ? CN

A

Vocal cord paralysis

Palate paralysis

320
Q

When assessing CN 11, what is looked for on the trap muscles?

A

Fssciculations- small flickering groups of muscles

PNS disorder

321
Q

Define dysarthria

A

Poor articulation of mouth

322
Q

Tongue atrophy and fasciculations are seen in ? Dzs

A

Amyotrophic Lateral sclerosis

Polio

323
Q

What Dzs can cause ptosis?

A

Myasthenia gravis
CN 3 damage
SNS damage (Horners)

324
Q

Define Entropion

Define Ectropion

A

Lids turn in

Lids turn out

325
Q

Bilateral exophthalmosis is indicative of ?

Unilateral is caused by ?

A

Graves hyperthyroidism

Graves Dz, tumor, inflammation

326
Q

Corneal arcus in young PTs suggests ?

A

Hyperlipoproteinemia

327
Q

Anisocoria in bright light =

In dim light =

A

Larger pupil can’t constrict
Trauma, open glaucoma, PNS damage

Small pupil can’t dilate
Horners, SNS damage

328
Q

How is hereditary Horner’s Syndrome visually ID’d?

A

Heterchromia- one iris is lighter

329
Q

Define Glaucomatous Cupping

A

Bacward depression of cup and atrophy w/ pale base

330
Q

How do superficial retinal hemorrhages appear?

How do deep ones appear?

A

Flame shaped- HTN, papilledema, occlusion

Small/round dots from DM

331
Q

An occassional superficial hemorrhage is ID’d how?

A

White center of fibrin

332
Q

Define Preretinal Hemorrhage

A

Blood escapes from retina and vitreous from sudden ICP

Upright PT allows blood to settle in demarcation line

333
Q

Copper wiring appearance of arterioles in the eye is indicative of ?

A

HTN retinopathy

334
Q

Define Bullous Myringitis

A

Viral infection

Earache, blood color discharge, conductive hearing loss

335
Q

Define Hereditary Hemorrhagic Telangiectasia

A

Dilated capillaries on face and hands, red in color

336
Q

How does exudative tonsillitis present?

A

White exudate
Fever
Enlarged cervical nodes

337
Q

How does diphtheria present?

A

Dull red

Gray exudate on uvula, pharynx, tongue

338
Q

What is Kaposi Sarcoma common in?

A

AIDS

Deep purple color

339
Q

What conditions cause Gingival Hyperplasia?

A

Dilantin therapy
Puberty
Pregnancy
Leukemia

340
Q

How does attrition of teeth look?

A

Long tooth appearance due to gum recession

341
Q

When is teeth erosion commonly seen?

342
Q

What causes teeth abrasions with notching?

A

Biting nails or bobby pins

343
Q

Hutchinson’s teeth is a sign of what congenital disease?

344
Q

Define Tori Mandibulraes

A

Bony growths on inner mandible

Asymptomaic and harmless

345
Q

Define erythroplakia

A

Reddened area of mucosa suggesting malignancy

IPAP (212 decks)

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