Test 3 Flashcards
1
Q
Anterior neck triangle
A
Trachea, sternomastoid muscle, and bottom of mandible
2
Q
Posterior neck triangle
A
Sternomastoid muscle,
3
Q
Lymph node locations
A
- Preauricular
- Posterior auricular
- Occipital
- Submental
- Submandibular
- Cervical chain
- Supraclavicular
4
Q
Preauricular
A
In front of ear
5
Q
Posterior auricular
A
Behind ear
6
Q
Occipital
A
Base of skull in back
7
Q
Submental
A
Lower chin
8
Q
Submandibular
A
Lower jaw
9
Q
Cervical chain
A
anterior/posterior, deep; behind/in front and behind sternocleidomastoid muscle
10
Q
Supraclavicular
A
Abnormal if you feel it; on top of clavicle; possible cancer if felt
11
Q
What is normal with lymph nodes?
A
Not feeling them
12
Q
What could it mean if you do feel them or if they are enlarged or tender
A
Infection
13
Q
XWhat to ask about in head, ears, eyes, nose, throat:
A
- How bad is the headache
- Head injury
- Dizziness
- Neck pain or limitation of motion
- Lumps or swelling
- History of head or neck surgery
14
Q
XWhat to inspect on skull:
A
- Size
- Shape
- Temporal area
- Facial structure (drooping)
15
Q
What to inspect on neck
A
- Range of motion
2. Lymph nodes
16
Q
What to palpate on trachea and thyroid
A
- Trachea is midline
2. Thyroid gland
17
Q
What could it mean if trachea is deviated
A
Collapsed lung
18
Q
Ways to palpate thyroid
A
- Anterior approach
2. Posterior approach
19
Q
What do you do if you feel an enlarged thyroid
A
Auscultate, bruits is abnormal
20
Q
Iris
A
Colored part of eye
21
Q
Sclera
A
White part of eye
22
Q
Limbus
A
Dark ring between cornea and sclera
23
Q
Palpebral fissue
A
Slit where eyes come together
24
Q
Lacrimal apparatus
A
Tear duct
25
XWhat to ask with eye exam
1. Vision difficulty
2. Pain
3. Strabismus
4. Diplopia
5. Watering, discharge
6. History of ocular problems
7. History/been tested for glaucoma
8. Glasses or contacts
26
Strabismus
Cross eyes
27
Diplopia
Double vision
28
Additional history for aging adult
1. Visual difficulty
2. Glaucoma test
3. Cataracts
4. Eye dryness
5. Decreased activities
29
XWhat to look for in eye exam
1. Eyebrows
2. Eyelids and lashes
3. Eyeballs
4. Conjuctiva and sclera
5. Eversion of the upper lid
6. Lacrimal apparatus
30
Conjuctiva
Pink membrane under eyelid
31
Blepharitis
Inflammation of eyelids
32
Ptosis
Drooping of eyelid
33
XWhat to inspect in eyeballs
1. Cornea and lens
2. Iris and pupil (PERRLA)
3. Size and shape
4. Pupillary light reflex: Shine light into pupils and it should restrict
5. Consensual reflex
6. Accommodations
7. Converge
34
Consensual reflex
Both eyes should constrict when light is on one
35
How to test accommodations
Have them look off in distance and then look at your finger
36
How to test convergence
Pull fingers in middle and their eyeballs should meet in midline
37
PERRLA
Pupils Equal Round Reactive to Light Accommadations
38
Hirshberg test
Light shown in front of person should reflect in the exact same spot in both eyes
39
Corneal light reflex
Corneal light reflex sign of visual acuity problems
40
Red reflex test
Use abdomoscope to look into eyes and see if it turns red
41
Postitive red reflex test means
Blown retina or tumor (retinoblastoma)
42
6 Cardinal fields of vision
"follow my finger" Looking for fluid eye movement
43
Nystagmus
"Dancing eyes"
44
Cover test
Tell pt to look at something in distance and cover eye; both eyes should still be looking in the same direction when you move the card
45
Snellen eye chart
Pt stands 20 ft from chart; have them cover the eye to test the individually and then test both together; they read the line they can read most comfortably and get all of them correct until they can't
46
What to note with Snellen chart
How far they went down; use numbers off to the side; notate X(what pt saw at 20 ft)/X (what normal person would see)
47
Jaeger chart
Smaller Snellen chart that is held in hand while each eye is covered; older adults may have trouble with this
48
Confrontation test
Tests peripheral vision; Cover opposite eye from pt (mirrored) and check peripheral vision against yours
49
Asian cultural difference
Narrowed palpebral fissures
50
African american cultural risk
Glaucoma is higher risk
51
White cultural risk
Increased macular degeneration: loss of central vision, big black spot
52
Presbyopia
Older adults; Nearsightedness
53
Arcus senillus
Older adults; white line around iris; normal variation
54
Cataracts
Older adults; Lossing contrast; blurred vision
55
Glaucoma
Older adults; increased intraoccular pressure
56
Ear range from external auditory canal
3.5-
57
Tympanic membrane
Eardrum; gray color
58
Where does light reflex in right ear
5 o'clock
59
Where does light reflex in left ear
7 o'clock
60
What is different about kids and adults in the eustachian tube
Kids have a horizontal eustachian tube and adults have sloped
61
XWhat to ask about with ears
1. Earaches
2. Trauma
3. Infections
4. Discharge
5. Hearing loss
62
Tinnitus
Ringing of ears
63
Vertigo
Dizziness
64
XWhat to inspect with ears
1. Size and shape
2. Skin condition
3. Tenderness
4. External auditory meatus
65
Voice test
Stand 1-2 feet from ear and close opposite ear and whisper a 2 syllable word
66
How to inspect ear in kids
Pull down and back
67
How to inspect ear in adults
Back and up
68
Septum
Should be midline; middle of nostril
69
Turbinates
Membranes in nose; there are three; usually can only see 2
70
Paranasal sinuses
1. Frontal (eyebrows)
2. Maxillary (cheeks)
3. Ethmoid
4. Sphenoid
71
When do sinuses develop
Around age 4, young kids can't have a sinus infection
72
Gingivitis
From smokeless tobacco: gumline inflammation
73
Halitosis
Smelly breath
74
Signs of oral cancer
1. Painless sore that does not heal
2. Smooth leathery white patch
3. Restricted movement
4. Difficulty chewing
75
XQuestions to ask with mouth
1. Lesions
2. Pain
3. Epistaxis
4. Difficulty breathing
5. Drainage
6. Change in ability to smell or taste
7. Dysphagia
76
Epitaxis
Nose bleed
77
How to examine nose
Have them push up tip of nose and use otoscope light and slightly insert
78
What to palpate with sinuses
Palpate frontal and maxillary sinuses; looking for sinus infection
79
Transillumination
Shining light in sinuses to look for active sinus infection (not science based anymore)
80
XWhat to inspect in mouth
1. Lips
2. Teeth and gums
3. Tongue
4. Buccal mucosa
5. Palate and uvula
81
Buccal mucosa
Membrane around jaw
82
Tori/Torus
Bony protrusions in mouth; normal
83
What to inspect in throat
1. Tonsils (Grade them)
| 2. Posterior pharyngeal wall (back of throat)
84
Normal tonsil grading
1+
85
4+ tonsil grading
Touching
86
Mental status
Emotional and cognitive functioning; inferred through behaviors
87
XMental status is inferred through
1. Consciousness
2. Language
3. Mood and affect
4. Orientation
5. Attention
6. Memory
7. Thought process
8. Perceptions
88
3 domains of orientation
1. Person
2. Place
3. Time
89
Parts of memory
1. Recent
| 2. Remote
90
Components of mental status exam
A: Appearance
B: Behavior
C: Cognition
T: Thought processes
91
XObjective data of mental status exam appearance wise
1. Posture
2. Body movements
3. Dress
4. Grooming and hygiene
5. LOC: Level of consciousness
92
Levels of consciousness
1. Alert
2. Lethargic: Drifts off to sleep
3. Obtunded: Sleeps most of time
4. Stuporous: Difficult to arouse
5. Comatose
93
XObjective data of mental status behavior wise
1. Facial expression
2. Speech
3. Mood and affect (does facial expression match mood)
94
XObjective data of mental status cognitive function wise
1. Orientation
2. Attention span
3. Recent memory
4. Remote memory
5. New learning: Four unrelated words test
6. Judgment
95
How to test recent memory
Ask what they ate this morning or last night
96
How to test remote memory
When is your anniversary, who was president in...
97
XObjective data of mental status thought processes and perceptions wise
1. Thought processes
2. Thought content
3. Perceptions
4. Screen for suicidal thoughts
98
XWhat does a mini mental state exam check
1. Orientation
2. Registration: Repeating words test
3. Attention and calculation: Count backward from 100 for 3 cycles
4. Recall: Recalling words
5. Language: Ask to define common abstract statement
99
XHealth history questions with mental state
1. Headache
2. Head injury
3. Seizures
4. Lack of coordination
5. Numbness or tingling
6. Dysphagia/Aphasia
7. Environmental/occupational history
100
Leading modifiable risk factors for stroke
1. High BP
2. High cholesterol
3. Cigarette smoking
4. Diabetes
5. Poor diet and physical inactivity
6. Overweight and obesity
101
Signs of stroke
F: Face drooping
A: Arm weakness
S: Speech difficulty
T: Time to call 911
102
BPP Vertigo (BPPV)
Benign paroxysmal positional vertigo
103
Cranial nerves
```
I. Olfactory
II. Optic
III. Oculomotor
IV. Trochlear
V. Trigeminal
VI. Abducens
VII. Facial
VIII. Acoustic
IX. Glossopharyngeal
X. Vagus
XI. Spinal accessory
XII. Hypoglossal
```
104
How to test olfactory cranial nerves
Have pt smell familiar scent
105
How to test optic visual acuity cranial nerve
Have them read snellen chart or your badge
106
How to test oculomotor/trochlear/abducens cranial nerve
```
Palpate fissures (touch eyelids)
Test pupils (direct and consentual)
Extra ocular muscles (doing big H)
```
107
How to test trigeminal cranial nerve
```
Jaw strength (clench teeth)
Sensation (rub q-tip on face)
Corneal reflex (touch q-tip on eye)
```
108
How to test VII. cranial nerve
Have them smile, frown, close eyes, and puff cheeks
109
How to test VIII. cranial nerve
Acoustic test hearing acuity (Whisper test)
110
How to test IX/X cranial nerve
Have them say AH and watch uvula
| Gag reflex
111
How to test XII cranial nerve
Stick out tongue
112
How to test XI cranial nerve
Have them shrug shoulders with resistance, and turn face with resistance
113
How to test cerebellar/motor function (balance and coordination)
1. Gait
2. Tandem walking (heel/toe)
3. Rapid alternating movements (RAM) (use finger to nose test opp. sides)
4. Finger to finger test
5. Finger to nose test
6. Heel to shin test
7. Romberg test
114
Romberg test
Have the patient stand with their heels together and eyes closed. They should be able to maintain their balance
115
XHow to inspect/palpate motor system (muscle)
1. Size
2. Strength
3. Tone
4. Involuntary movements
116
XWhat to check in sensory tests (check upper and lower extremities)
1. Pain
2. Temperature (hot/cold)
3. Light touch
4. Vibration (tuning fork)
5. Position (do fingers up and down)
6. Stereognosis
7. Graphesthesia
8. 2 point discrimination
117
Stereognosis
Advanced practice; putting familiar object in their hand
118
Graphesthesia
Draw a letter or number in their hand
119
2 point discrimination
Use 2 cotton tips and see if they can tell if you are using 1 or 2
120
Deep tendon reflexes
1. Biceps
2. Triceps
3. Quadriceps
4. Achilles
121
Grading reflexes
0-4+
| 2+ is normal
122
What do you do if you cannot elicit a response
Have pt perform an isometric exercise in another area (grab arms for legs)
123
Superficial reflexes
1. Abdominal
2. Cremasteric: Only in males, testes
3. Plantar: Toes curl/fan out
124
Babinski
Infants toes fan out, after 3 months, toes curl
125
Brudzinski's neck sign
In infant, if you lift their head, legs should pull in until about 4 months
126
Frontal release signs (infant)
1. Snout reflex: Put finger under nose, infant lips curl up until 3/4 months
2. Sucking reflex
3. Grasp reflex
127
What to check in neurologic check
1. Level of consciousness (PPT)
2. Motor function
3. Pupillary response
4. Vital signs
5. Glasgow Coma Scale (GCS)
128
Glasgow Coma Scale
1. Eye opening response (1-4)
2. Motor response (1-6)
3. Verbal response (1-5)
129
Bad GCS score
Less than 8
130
Good GCS score
15 (highest)
131
Decorticate (abnormal flexion)
Hands curled up to chest
132
Decerebrate (abnormal extension)
Hands to sides, fists curled out
133
Types of gaits
1. Parkinson's (festination)
2. Scissors gait
3. Steppage gait
4. Cerebellar ataxia
134
Healthy people 2020 Reducing traumatic brain injury goals
1. Seat belts
2. Not riding in back of pickup trucks
3. Not drinking and driving
4. Wear helmets
135
Optimal nutritional status
Taking in enough calories and nutrients
136
Undernutrition
Does not get enough nutrients; at risk for vitamin deficiency, illness, infections, delayed wound healing, longer hospital stays,
137
What are people who are undernutrition at risk for
1. Vitamin deficiency
2. Illness
3. Infections
4. Delayed wound healing
5. Longer hospital stays
138
Who is at risk for undernutrition
1. Poverty
2. Elderly
3. Already sick
4. Pregnant
5. Children/infants
139
Overnutrition
Getting too many calories/nutrients
140
What are people who have overnutrition at risk for
1. Obesity
141
How many adults/children are overweight in USA
2/3 of adults and 1/3 of children
142
What to ask in nutrition exam
1. Diet
2. Height and weight
3. Food allergies
4. Medications/supplements
5. Recent surgery, trauma, burns, infections
6. Self care behaviors/diet fads/exercise
7. Alcohol/drug use
8. Family history
143
Nutrition screening/assessment tools
1. Admission nutrition screening tool
2. Food frequency questionnaire
3. 24-Hour diet recall
4. Food diaries
5. Direct observation
144
Body typles
1. Ectomorph (tall thin)
2. Mesomorph (athletic)
3. Endomorph (round, soft)
145
Anthropometric measures
1. Height/weight
2. BMI
3. Waist to hip ratio
4. Skinfold/tricep thickness
5. Arm span
146
What do you usually don't get from adult pt
Height
147
Underweight BMI
18.5
148
Normal BMI
18.6-24.9
149
Overweight BMI
25-29.9
150
Obese BMI
30-39.9
151
Morbidly Obese BMI
>40
152
What waist to hip ratio indicates increases risk for obesity related disease and early mortality
>.9 in men
| >.8 in women
153
Gynoid obesity
Pear shape, heavier in hipe
154
Android obesity
Apple shape; Round all over
155
How to measure skinfold/tricep thickness
Have pt flex arm and use skin caliber on back of arm; measure it 3 times and take average
156
Normal skinfold/tricep thickness
Men 13.5
| Women 16.5
157
How to measure arm span or total arm length
Measure distance from middle finger to middle finger with arms out, should be equal to height
158
When do you use arm span
If you can't get height, if they are really tall, or in sports medicine
159
Orthadox jews nutrition
Kosher
160
Buddhist nutrition
Vegetarian
161
Muslim nutrition
No pork
162
Seventh day adventist nutrition
Vegetarian, no alcohol or caffeine
163
Parts of musculoskeletal system
1. Joint
2. Bone
3. Tendon
4. Ligaments
164
Questions to ask with musculoskeletal ( joints )
1. Pain
2. Stiffness
3. Swelling
4. Heat
5. Redness
165
Questions to ask with musculoskeletal (muscles)
1. Pain (Cramps)
| 2. Weakness
166
Questions to ask with musculoskeletal (bones)
1. Pain
2. Deformity
3. Trauma
167
What to inspect in joints
1. Swelling
2. Masses
3. Deformity
4. Equal bilaterally
168
What to palpate in joints
1. Temperature
2. Tenderness
3. Swelling
169
rheumatoid arthritis
Affects all joints
170
Bulge sign
Push on inside of knee and it should slide over, when you go to other side there will be a fluid line
171
Weight bearing statuses
1. Full weight bearing
2. Weight bearing as tolerated (WBAT)
3. Partial weight bearing
4. Touch
5. Non-weight bearing
172
Phalens test
Tests for carpal tunnel; have pt hold their hands with the wrist flexed at 90 degrees, should be no pain
173
Tinel's sign
Tests for carpal tunnel; direct percussion on the median nerve; no pain or tingling
174
Chvosteks sign
Tell pt to relax face then stand in front of them and tap the facial nerve either anterior to earlobe and below zygomatic arch or between zygomatic arch and corner of mouth. Positive response is twitching or spasm, usually due to low calcium (hypocalcemia)
175
Troussea sign
Put BP cuff on arm and pump it up greater than systolic and leave in place for 3 minutes; positive sign is a spasm in arm/hand; indicates low calcium (hypocalcemia)
176
Temporomandibular join (TMJ)
Feel jaw joint and have them open and close jaw and move side to side; light crackling is ok, pain or crepitus is positive sign
177
Scoliosis
Lateral curvature of the spine; scapula may be uneven
178
Gangion cyst
Fluid filled cyst, usually on back of hand
179
Gouty arthitis
Buildup of crystals in joints, painful, usually effects great toe
180
Pes planus
Flat feet
181
Kyphosis
Forward bend of spine, in older adults
182
What is normal in ROM for aging adults
Should not decrease unless they have an underlying disease
183
What does functional assessment include
1. ADL's
2. Can they dress/bathe/toilet/feed
3. Can they use phone
4. Can they drive
5. Can they write a check
184
Osteroporosis
Decrease of calcium causing breaking down of bones
185
Who is more at risk for osteoporosis
Caucasions
186
What things prevent osteoporosis
1. Add milk, fish, greens, soy
2. Less caffeine
3. Increase exercise
4. Stop smoking, drink less alcohol
5. Medical screening
6. Supplements
187
How to document strength
5/5
