Quiz #2: Head/Neck, Eyes Flashcards
4 Places in the Body Lymph Nodes are Accessible
Head and Neck
Arms
Axillae
Inguinal
Lymphadenopathy indicates…
Infection, allergy, or Neoplasm
Lymphadenopathy
Increased size of lymph nodes, >1cm
When do posterior and anterior fontanels close?
Posterior- 1-2 months
Anterior- 9 months-2 years
Thyroid gland changes in pregnancy
Gland enlarges slightly due to hyperplasia of the neck and increase in vascularity
Factors associated with head injury
Neck pain, visual changes, nasal/ear discharge
Most important info in evaluating head injury/neurologic deficit
Change in consciousness
What to ask a patient about dizziness
Fluid/food intake, vomiting, bloody or black stools, occupation, falls
Presyncope
Feeling of lightheadedness, fainting/falling, or swimming. Caused by decreased blood flow to the brain or decreased cardiac output.
What to ask about neck pain
PQRSTU, hx of injury, occupation/home lifting, stress, limits to ROM
6 Categories for Subjective Head, Neck, and Regional Lymphatics Assessment
Headache, Head Injury, Dizziness, Neck Pain, Lumps or Swelling, Head and Neck Surgery Hx
Additional head, face, neck hx for infants and children
- Alcohol or drug use in pregnancy
- Vaginal, c-section, forceps? Any issues in birth?
- Has development been normal? fontanels closed? What age did pt gain head control?
What can cause asymmetry in the face?
Damage to cranial nerve VII, which can cause Bell’s Palsy, or stroke.
Objective Data for Head/Face (6)
- Size
- shape
- symmetry
- skin
- muscle tone
- CN VIII
Objective Data for the Neck
- General Swelling
- ROM
- carotid pulsation
- lymph node enlargement
- CN XI
Assessment for CN XI
Have pt move head back and forth and shrug shoulder with you resisting
Why would trachea not be in the midline?
Trachea pushed to the healthy side with aortic aneurysm, tumor, unilater thyroid gland enlargement, or pneumothorax
Trachea pulled to the diseased side with fibrosis, atelectasis, or pleural adhesions
Tracheal Tug
Rhythmic downward movement of the trachea with systole that occurs as a result of aortic arch aneurysm.
bruit
soft, pulsatile, whooshing sound in the thyroid heard with the bell of the stethoscope. Indicates increased/turbulent blood flood and hyperplasia of the thyroid, as in hyperthyroidism.
When to measure head diameter
Each visit up to age 2, then annually up to age 6.
caput succedaneum
edematous swelling and ecchymosis of presenting part of head, may be along suture lines, resolves during the first few days of life without treatment
cephalhematoma
subperiostal hemmorhage causing soft, fluctuant hematoma over one cranial bone. Resorbed during first few weeks of life, large may take up to 3 months. Increases infant risk of jaundice.
molding
Overriding of cranial bones due to passage through the birth canal. Lasts only a few days or a week.
craniosynostosis
Severe deformity due to premature closure of the sutures.
When can infant turn head side to side
2 weeks
When does infant have head control
4 months
What is Nuchal Rigidity and what does it indicate?
Nuchal rigidity is resistance to neck flexion. It may indicate meningeal irritation or meningitis.
Senile Tremors
benign. Head nodding, tongue protrusion
What protects the eye?
Bony orbital cavity, cushion of fat, eyelids, lacrimal apparatus
What do the eyelids protect the eye from?
injury, strong light, and dust.
3 Layers of the Eye
Sclera, choroid, retina
Sclera
Tough, protective white coating
Continuous anteriorly as the cornea
Cornea
Thin, transparent, and sensitive to the touch. Part of the refracting media of the eye- bends incoming light rays to focus them on the inner retina.
Corneal reflex
Stimulation of the cornea with a wisp of cotton causes blinking in both eyes.
CN V
Trigeminal nerve- carries afferent sensation into brain
CN VII
Facial nerve- Carries the efferent messages that signal blinking.
Extraocular muscles
Give the eye straight and rotary movement. Conjugate movement- axes of both eyes always remain parallel.
Movement stimulated by cranial nerves.
CN VI
abducens nerve
innervates lateral rectus muscle, abducts the eye
CN IV
trochlear nerve
innervates superior oblique muscle, moves eye down and in.
CN III
oculomotor nerve
innervates superior, inferior, and medial rectus and inferior oblique muscles.
Moves eyes inward, up/in, up/out, down/out.
Choroid
Middle layer with dark pigmentation to prevent light from reflecting internally
Heavily vascularized to deliver blood to the retina
Continuous with the ciliary body and the iris
Iris
controls the amount of light admitted to the retina
Pupil size
determined by balance of PNS and SNS. CN III stimulation causes pupil to constrict. SNS causes pupil to dilate and eyelid to elevate.
Lens
Biconvex disc posterior to pupil, Serves as refractory medium. Bulges for focusing on near objects, flattens for far objects. Middle layer of the eye.
Vision at birth
Keenest vision in macula absent at birth. Mature by 8 months.
Eye movements poorly coordinated at birth, binocularity established by 3-4 months
80% of babies are born farsighted- decreases by age 7-8
Lens in the aging adult
Looses elasticity- becomes hard and glass-like
Accommodation in the aging adult
Decreased ability to accommodate near vision- presbyopia
Percentage of people with presbyopia at age 40
50%
Cataract
Normally transparent fibers of the lens begin to thicken and yellow. Clumping of proteins that causes clouding. By age 80, >50% of adults have cataracts. Women have a higher risk.
Arcus senilis
Circle or arch around the cornea (limbus) due to the accumulation of lipid material. No effect on vision.
Four most common causes of decreased visual functioning in the older adult
- Cataract formation
- Glaucoma
- Age-related macular degeneration
- Diabetic retinopathy
Age related macular degeneration
Yellow deposits (drusen) and neovascularity in the macula. Loss of central vision. Difficulty with tasks, reading, and recognizing faces. Peripheral vision is not affected.
Subjective Data for Eyes Categories
Vision changes, pain, strabismus/diplopia, redness/swelling, watering/discharge, hx of ocular problems, glaucoma, glasses/contacts, patient centered care
Vision changes to ask about in subjective interview
Floaters, halos around lights, loss of peripheral vision, blind spots
When to refer a pt to provider after a snellen test?
If vision is poorer than 20/30
Why does impaired vision occur in the Snellen test?
Refractive error, opacity in the media, or a disorder in the retina or optic pathway.
What test assesses peripheral vision?
Confrontation test- screens for glaucoma in the older adult. May also test for diseases of the retina and stroke.
Diagnostic positions test
Lead eyes through 6 Cardinal movements. Tests EOM and cranial nerve function.
What does nystagmus indicate?
Ear or eye disease, MS, brain lesions, paretic eye muscle, or phenytoin overdose
Scleral icterus
Even yellowing of the sclera that indicates jaundice.
What does pallor in the lateral canthus indicate?
Anemia
Aniscoria
Difference in size of pupils. Occurs normally in 5% of people.
retina
Visual receptive layer of the eye in which light waves are changed into nerve impulses.
How to view retinal structures?
with opthamoloscope.
Which retinal structures are viewed through the opthamaloscope?
optic disc, retinal vessels, general background, macula
What determines intraocular pressure?
the balance of the amount of aqueous humor produced by the ciliary body and the outflow at the angle of the anterior chamber
What does the aqueous humor do?
Delivers nutrients to surrounding tissue and drains metabolic waste.
pupillary light reflex
normal constriction of the pupil when light hits the retina
Cranial nerves in the pupillary light reflex
CN II- Optic nerve- sensory afferent link
CN III- oculuomotor nerve- motor efferent path
consensual light reflex
simultaneous constriction of one pupil when light hits the other pupil
Accomodation
Adaptation of the eye for near vision. Convergence of the axes of the eyes when changing from far to near vision.
