Test 1 Flashcards
The cardinal signs of gaze check for CNs ____
SO4LR6 All rest 3
3, 4, and 6
The rapid cover/uncover test is used to identify weakness of EOM such as strabismus (misalignment of the eyes aka they both can’t turn to the same spot) and this can be involved with ___tropia (aka lateral drift) or ____ (aka medial drift)
Due to the eyes not being aligned properly, ____ can develop leading to blindness if not corrected
Exotropia, Esotropia
Amblyopia (aka lazy eye)
____/____ is normal for the snellen test and it is used to test ___
You hold the chart ___ feet away and read at LEAST ___ lines of letters
20/20, visual acuity
6, 2
The ____ nerve innervates the superior oblique muscle, the ___ nerve innervates the lateral rectus muscle and all the other muscles are innervated by the ___ nerve
____ is the involuntary, alternating fast-slow movements or jerking of the eye
Trochlear, Abducens, Oculomotor
Nystagmus
The Caloric reflex test (aka the Vestibular Caloric Reflex) tests the vestibulo-ocular reflex and can be remembered by the mnemonic ____
So for Cold water, the fast phase of nystagmus is the the Opposite side from the cold water filled ear
^** So for example, lets say the left ear is irrigated with cold water… The eyes will move towards the left ear and quickly oscillate towards the right ear (aka nystagmus towards the Opposite ear aka the right ear)
For Warm water, the fast phase of nystagmus is to the Same side from the warm water filled ear
^** So for example, lets say the left ear is irrigated with warm water…. The eyes will move towards to right ear and quickly oscillate towards the left ear (aka nystagmus towards the Same ear aka the left ear)
** In a braindead patient, the nystagmus will be absent
COWS
Confrontation testing for peripheral vision assessment is used to asses _____s
____ fields can be tests together and ___ fields require testing each eye separately by covering one
Visual Fields
Temporal, Nasal
When conducting the fundoscopic exam, the ___ is nasal and inferior and the ___ is temporal
Optic disc, Macula
____ is a bacterial infection of the eyelid and very common in older adults (in the nursing home)
^** Presents as erythema of the eyelids and FLAKING of the eyelashes
____ is seen in patients when their bilirubin is at least 3 (so something is most likely going on with the liver)
Blepharitis
Scleral icterus
Bacterial conjunctivitis in adults is most common caused by ____ and in children it is ____
^** It is spread by direct contact and usually unilateral. Associated with a purulent discharge throughout the day and often mattes shut during sleep
Viral conjunctivitis is caused by ___virus and usually associated with a prodrome of symptoms like the flu, etc…
^** Also spread by direct contact and a GRITTY SAND feeling occurs with CLEAR discharge. Also quickly becomes bilateral and usually gets better on its own (self-limiting)
Allergic conjunctivitis is associated with an IgE response and mast cell degranulation and is different from viral due to the fact that there is bilateral redness, a WATERY discharge, and ITCHING
Staph Aureus, M. Catarrhalis
Adenovirus
So just to recap, name the conjunctivitis
1) A watery/clear discharge with patient complaining of gritty/sandy feeling in their eyes that started unilaterally but quickly became bilateral
2) A watery/clear discharge with itching that presents bilaterally
3) A purulent discharge that presents unilaterally
1) Viral
2) Allergic
3) Bacterial
An infection of the Tarsal glands of the eyelids (sometimes called the Meibomian glands) that causes an acute purulent inflammation (either sterile or from staph aureus) is associated with a tender, red bump is called a ____
Chronic inflamation from an OBSTRUCTED Tarsal gland AKA Meibomian gland that causes a non tender (painless), rubbery, nodular, and hard lesion is called a _____
____ is cholesterol deposits around the eyes that are yellow in color and often benign. Presents in patients with Hyperlipidemia
** Fluorescein stains are used to identify epithelial defects
Hordeolum
Chalazion
Xanthelasma
The ophthalmoscope is used to examine the Retina/Posterior chambers/Fundus
^** ^** Realize that the fundus is just the inner surface of the eye and contains the retina, optic disc, macula, and fovea
In order to improve visualization, one would dilate the patients pupils aka mydriasis
Once you move the light from the lateral position to midline over the iris, one should see a ____ reflex which is just the NORMAL reflection of light off the ____
Red, Retina
If one were to follow the lateral blood vessels centrally they would get to the ____
Also, ____s are brighter and smaller than _____s
When performing the funduscopic exam approach the patient at ___ degrees lateral of midline
Optic disc
Arterioles, venules
15
In order to demonstrate the examination of the orbital conjunctiva one first depresses the lower eyelid and has the patient look ____ then you raise the upper eyelid and have the patient look ____
The conjunctiva should look ____ without any foreign bodies, erythema, purulence, or pterygiums
In order to remove foreign bodies, one would ___vert the patients ____ eyelid
Up, down
Clear
Evert, Upper
The cornea, anterior chamber, and lens is normally ___ in color and the sclera is ____
The iris and pupil are normally ____ in shape and equal in size
Also bilateral pupillary contraction is normal due to the direct and consensual pupillary light reflex of the ____ and ___ nerves
Clear, white
Round
Optic and Oculomotor aka 2 and 3
If one were to see swelling of the optic disc due to increased intracranial pressure it is called a _____
_____ is often associated with Blurry vision
^** If one sees deposits called DRUSENS, it’s a ____ macular degeneration and if one sees scarring and hemorrhaging on the retina it’s a ____ macular degeneration
____ is seen when patients have a high blood pressure characterized by hemorrhage, cotton wool spots, exudates, etc….
Papilledema
Macular degeneration
Dry, Wet
Hypertensive retinopathy
NEVER perform OMT on a patient with ____
DVT
For assessment 2 and 3, you must use something OTHER than what the patient is primarily concerned about (their chief complaint)
If they have a ___, use this first
If not, you can use a _____ next
If they have neither of those, you can use ___ problems (smoker, excessive alcohol use, etc) and if all else fails, you can use ___ problems
You MUST write family history problems as ____
PMHx (or other active problem)
Somatic dysfunction
Social history, Family history
Family History of ____
Viscerosomatic reflexes
Parasympathetics:
1) ___ nerve (CN X via the OA and AA) supplies everything above and below the diaphragm PROXIMAL to the ____
^** Aka anything proximal to that point like the heart, lungs, stomach, pancreas, adrenal glands, small intestine, etc…
2) ____ nerve goes from ____-____ and supplies everything below the diaphragm DISTAL to the mid transverse colon like the rectum, bladder, kidney, genitals, etc…
1) Vagus nerve, Mid-transverse colon
2) Pelvic splanchnic nerve, S2-S4
Viscerosomatic reflexes
Sympathetics:
1) Head, neck and heart = ___-___
2) Heart and lungs = ____-____
3) Upper extremities = ____-_____
4) GI tract and Pelvis = ____-_____
5) Lower extremity = ___-____
^** The greater splanchnic nerve = ____-____, Lesser = ____-____, Least = ____-____
Greater -> ____ ganglion -> Upper GI, Liver, Duodenum, Pancreas
Lesser -> ____ ganglion -> Small intestines, right colon, adrenals, gonads, kidneys, upper ureter
Least -> ____ ganglion -> Left colon, Pelvis, Lower ureter, bladder, genitalia
1) T1-T4
2) T1-T6
3) T2-T8
4) T5-L2
5) T11-L2
T5-T9, T10-T11, T12-L2
Celiac
Superior mesenteric
Inferior mesenteric
The ____ lymphatic duct drains the right side of the head, right UE, and heart and lungs
The ___ lymphatic duct drains the rest of the body
To treat these patients, release the ____ (aka DRIVE THE BUS)
Name the areas treated
1) UEs
2) Thoracic outlet down to thoracoabdominal diaphragm
3) Head and neck
4) Abdominal diaphragm down to pelvic diaphragm
5) LEs
Right
Left
Thoracic inlet
1) Area 3
2) Area 1
3) Area 5
4) Area 2
5) Area 4
Viscerosomatic levels as it applies to:
1) Common cold
2) CHF
3) COPD
4) Asthma
5) GERD
6) UTI
7) Dysmenorrhea (Painful menstruation)
1) Head and neckish -> T1-T4
2) Heart and lungs -> T1-T6
3) Heart (T1-T6)
4) T1-T6
5) GI tractish T5-L2
6) T5-L2 (Upper lumbar)
7) Upper lumbar
Radiation is seen in Radigraphy, CTs, Fluoroscopy, and Angiography and NOT seen in ____ or ____
^** US is CHEAP and has NO radiation but can be hindered by bowel gas and lung tissue, along with adipose tissue (fat people)
Clinical contraindications include Allergy to _____, Renal patients with ____ greater than ____, female patients that could be pregnant (instead, run a BhCG test), pregnant patients (16-45 days are critical), children
____ is a medication used to increase insulin sensitivity to cells (like T2D or PCOS), but be careful because this can cause ____
^** Presents very non-specific
US or MRI
Contrast, Creatinine, 1.5
Metformin, Lactic Acidosis