Block 2 Flashcards by Jol Christer Luching

fundamental purpose of the cardiorespiratory system

to deliver O2 and nutrients to cells and to remove CO2 and other metabolic products from them.

How well did you know this?

Not at all

Perfectly

switch from aerobic to anaerobic metabolism

Pasteur effect

How well did you know this?

Not at all

Perfectly

The adaptations to hypoxia are mediated, in part, by the upregulation of genes encoding a variety of proteins, including

glycolytic enzymes, such as phosphoglycerate kinase and phosphofructokinase
glucose transporters Glut-1 and Glut-2
growth factors, such as vascular endothelial growth factor (VEGF) and erythropoietin, which enhance erythrocyte production.

How well did you know this?

Not at all

Perfectly

The hypoxia-induced increase in expression of these key proteins is governed by this hypoxiasensitive transcription factor?

hypoxia-inducible factor-1 (HIF-1).

How well did you know this?

Not at all

Perfectly

During hypoxia, systemic arterioles

During hypoxia, systemic arterioles dilate, at least in part, by opening of K-ATP channels in vascular smooth-muscle cells due to the hypoxia-induced reduction in ATP concentration.

How well did you know this?

Not at all

Perfectly

What happens in pulmonary vascular smooth-muscle cells during hypoxia?

By contrast, in pulmonary vascular smooth-muscle cells, inhibition of K+ channels causes depolarization which, in turn, activates voltage-gated Ca2+ channels raising the cytosolic [Ca2+] and causing smooth-muscle cell contraction.

Hypoxia-induced pulmonary arterial constriction shunts blood away from poorly ventilated portions toward better ventilated portions of the lung; however, it also increases pulmonary vascular resistance and right ventricular afterload.

How well did you know this?

Not at all

Perfectly

Acute hypoxia causes

impaired judgment, motor incoordination, and a clinical picture resembling acute alcohol intoxication.

How well did you know this?

Not at all

Perfectly

High-altitude illness is characterized

headache secondary to cerebral vasodilation, gastrointestinal symptoms,
dizziness, insomnia, fatigue, or somnolence.

How well did you know this?

Not at all

Perfectly

Pulmonary arterial and sometimes venous constriction causes

capillary leakage and high-altitude pulmonary edema (HAPE), which intensifies hypoxia, further promoting vasoconstriction. Rarely, high-altitude cerebral edema (HACE) develops, which is manifest by severe headache
and papilledema and can cause coma. As hypoxia becomes more severe, the regulatory centers of the brainstem are affected, and death usually results from respiratory failure.

How well did you know this?

Not at all

Perfectly

When hypoxia occurs from respiratory

failure, Pao2 ?

declines

How well did you know this?

Not at all

Perfectly

when respiratory failure is persistent, the

hemoglobin-oxygen (Hb-O2) dissociation curve?

is displaced to the right, with greater quantities of O2 released at any level of tissue Po2.

How well did you know this?

Not at all

Perfectly

TRUE OR FALSE:

Arterial hypoxemia, that is, a reduction of O2 saturation of arterial blood (Sao2), and consequent cyanosis are likely to be more marked when such depression of Pao2 results from pulmonary disease than when the depression occurs as the result of a decline in the fraction of oxygen in inspired air (Fio2).

TRUE

How well did you know this?

Not at all

Perfectly

What happens when the depression occurs as the result of a decline in the fraction of oxygen in inspired air (Fio2)?

In this latter situation, Paco2 falls secondary to anoxia induced hyperventilation and the Hb-O2 dissociation curve is displaced to the left, limiting the decline in Sao2 at any level of Pao2.

How well did you know this?

Not at all

Perfectly

The most common cause of respiratory hypoxia is ?

ventilation-perfusion mismatch resulting from perfusion of poorly ventilated alveoli.

How well did you know this?

Not at all

Perfectly

Respiratory hypoxemia may also be caused by hypoventilation, in which
case it is associated with ?

an elevation of Paco2

How well did you know this?

Not at all

Perfectly

A third cause of respiratory hypoxia is shunting of blood across the lung from the pulmonary arterial to the venous bed (intrapulmonary right-to-left shunting) by perfusion of nonventilated portions of the lung, as in?

pulmonary atelectasis or through pulmonary arteriovenous connections.

How well did you know this?

Not at all

Perfectly

The low Pao2 in intrapulmonary right-to-left shunting is corrected by?

The low Pao2 in this situation is only partially corrected by an Fio2 of 100%.

How well did you know this?

Not at all

Perfectly

ventilation-perfusion mismatch & hypoventilation can be corrected by?

These two forms of respiratory hypoxia are usually correctable by inspiring 100%
O2 for several minutes.

How well did you know this?

Not at all

Perfectly

From a physiologic viewpoint, this cause of hypoxia resembles intrapulmonary right-to-left shunting but is caused by congenital cardiac malformations, such as?

tetralogy of Fallot
transposition of the great arteries
Eisenmenger’s syndrome

How well did you know this?

Not at all

Perfectly

Pao2 in anemic hypoxia

normal

How well did you know this?

Not at all

Perfectly

the presence of COHb shifts the Hb-O2 dissociation curve to the ?

left

How well did you know this?

Not at all

Perfectly

This pathophysiology
leads to an increased arterial-mixed venous O2 difference
(a-v-O2 difference), or gradient.

circulatory hypoxia

How well did you know this?

Not at all

Perfectly

Generalized circulatory hypoxia occurs

in ?

heart failure and in most forms of shock

How well did you know this?

Not at all

Perfectly

clinical
picture of patients with hypoxia due to an elevated metabolic rate, as
in fever or thyrotoxicosis,

the skin is warm and flushed owing to increased cutaneous
blood flow that dissipates the excessive heat produced, and cyanosis is
usually absent.

How well did you know this?

Not at all

Perfectly

Cyanide and several other similarly acting poisons cause cellular hypoxia. The tissues are unable to use O2, and, as a consequence, the venous blood tends to have a high O2 tension. This condition has been termed?

histotoxic hypoxia.

refers to a bluish color of the skin and mucous membranes resulting from an increased quantity of reduced hemoglobin (i.e., deoxygenated hemoglobin) or of hemoglobin derivatives (e.g., methemoglobin or sulfhemoglobin) in the small blood vessels of those tissues.

Cyanosis

Cyanosis is usually most marked in the ?

lips, nail beds, ears, and malar eminences.

A cherry-colored flush, rather than cyanosis, | is caused by ?

COHb

In some instances, central cyanosis can be detected reliably when the Sao2 has fallen to _____%; in others, particularly in dark-skinned persons, it may not be detected until it has declined to _____%.

85% 75%.

In general, cyanosis becomes apparent when | the concentration of reduced hemoglobin in capillary blood exceeds?

40 g/L (4 g/dL).

the higher the total hemoglobin content, the (greater or lower) the tendency toward cyanosis?

greater

the Sao2 is reduced or an abnormal hemoglobin derivative | is present, and the mucous membranes and skin are both affected.

central cyanosis

is due to a slowing of blood flow and abnormally great extraction of O2 from normally saturated arterial blood; it results from vasoconstriction and diminished peripheral blood flow, such as occurs in cold exposure, shock, congestive failure, and peripheral vascular disease.

Peripheral cyanosis

Often in these conditions, the mucous membranes of | the oral cavity or those beneath the tongue may be spared.

Peripheral cyanosis

Decreased Sao2 results from a | marked reduction in the Pao2.

Central Cyanosis

``` Which of the ff is are correct A. Increase in intravascular colloid osmotic pressure causes absorption B. Decrease in intravascular hydrostatic pressure cause filtration C. Increase in extravascular colloid osmotic pressure causes edema D. A and C ```

D. A and C

``` Which of the ff does not cause Edema? A. RAAS B. Natriuretic peptide C. ADH D. Endothelin-1 ```

B. Natriuretic peptide

``` RAAS, Na and water retention and K excretion is the effect of what hormone A. Angiotensin I B. Angiotensin II C. Aldosterone D. Renin ```

C. Aldosterone

ACE is an enzyme mainly produced by the lungs. What is the function of this enzyme? A. Converts angiotensinogen to angiotensin I B. Converts angiotensin I to angiotensin II C. inactivates bradykinin D. B and C

B. Converts angiotensin I to angiotensin II

``` Vasopressin/ADH promotes water retention in which of the ff tubules? a. Collecting Tublules b. Proximal c. Distal d. A & C ```

d. A & C

60y.o male with chief complaint of eyelid swelling at the morning. Px had a history of type1 Diabetes Mellitus and Hypertension. Physical Exam revealed bipedal pitting edema. Urinalysis revealed 3+ proteins. What is the cause of edema? A. Heart failure B. Nephrotic syndrome C. Liver cirrhosis D. Poor protein intake

B. Nephrotic syndrome

``` S2 is closure of what valve A. Mitral B. Tricuspid C. Semilunar D. A and B ```

C. Semilunar

Loud with palpable thrill -

Grade 4

``` 10% of the causes of palpitations are due to? a. Cardiac B. Psychiatric C. Miscellaneous D. Unknown ```

C. Miscellaneous

``` CD, a 48 year old female, experienced palpitations of greater than 15 minutes A. Cardiac B. Psychiatric C. Miscellaneous D. Unknown ```

B. Psychiatric

``` The following are cardiovascular disease that causes dyspnea expect: a. Coronary artery disease b. Restrictive pericarditis c. Pulmonary hypertension d. Cardiomyopathy ```

a. Coronary artery disease

Type 2 Dypnea

Answer: | walk slowly with same age on level ground

``` DOB occurring at night is common to what condition? A. Orthopnea B. Asthma C. MI D. Interstitial lung disease ```

A. Orthopnea

``` Which of the following order is correct in the examination of the respiratory system? A. IPPA (palpation, percussion) B. IPPA (percussion, palpation) C. IAPP (palpation, percussion) D. IAPP (percussion, palpation) ```

D. IAPP (percussion, palpation)

High JVP suggests

Answer: Elevated Right Atrial Pressure.

Orthopnea is relieved by: a. Elevation of both feet b. Use of bronchidilators c. Sit upright d. All of the above

c. Sit upright

Expiratory muscles contract generating | positive intrathoracic pressure as high as

Answer: 300mmHg

Arnold's nerve is a branch of what cranial | nerve?

Answer: Vagus

Most common origin of hemoptysis?

Answer: Bronchi

Most common cause of hemoptysis | worldwide

Answer: Bronchiectasis

``` Classic description of hemoptysis of vascular origin A. Blood-tinged B. Massive C. Cherry red D. Pink and frothy ```

D. Pink and frothy

``` What is the amount of blood expectorated at one time that is considered massive hemoptysis? A. 500 mL B. 150-200 mL C. 400 mL D. 100-150 mL ```

D. 100-150 mL

``` All patients with massive hemoptysis shoud be tested by: A. Chest x-ray B. Culture C. CT scan D. AFB ```

C. CT scan

``` During massive hemoptysis, the following should be done except: a. Protect the non-bleeding lung b. Intubate the patient c. Locate the site of bleeding d. Correct the bleeding ```

d. Correct the bleeding

``` Preferred treatment for massive hemoptysis: A. Bronchial arterial embolization B. Surgical resection of vessel C. Angiography D. Lobectomy ```

A. Bronchial arterial embolization

All true about vestibular vertigo except A. May be paroxysmal or due to fixed unilateral or bilateral vestibular deficit B.Vertigo or Imbalance C. Peripheral disorders that affect the labyrinth or vestibular D nerves D. Anterior Unilateral Lesion that causes imbalance and instability of vision

D. Anterior Unilateral Lesion that causes | imbalance and instability of vision

``` Assessment of eye, ability to fixate two phases clearly. A. Pursuit B. Oacillopia C. Saccade D. Visual acuity ```

C. Saccade

``` Patient presents with maculopapular rash starting from hair line towards down. Palatal petichia was seen. Upon PE post auricular adenopathy. A. B. Rubella C. Rubeola D. Exanthem subitum ```

B. Rubella

``` PGE2 has 4 receptor but only _ is important for fever. A. E3 B. E2 C. E4 D. E1 ```

A. E3

What occurs when hypothalamic setpoint is reset downward?

B. Heat loss through vasodilation and | sweating

Situational: patient has breathlessness when walking in her own pace and level ground stop to rest-

Grade 2

Causes of impaired cough except

a. Inc in respiratory muscle contraction

``` True of Central cyanosis A. Slow blood B. Great oxygen extraction C. Exposure to cold air/h20 D. Abnormal hgb derivatives ```

D. Abnormal hgb derivatives

Cause of edema in patient with nephrotic | disease.

decrease colloid oncotic pressure | due to loss of protein in urine

True of GI bleeding A. Melena may indicate that blood in gi bleeding is <14hrs B. C. Hemoptysis is indicative of upper gi bleeding D. Hematochezia...

*Melena indicates blood has been present in the GI tract for at least 14 hrs and as long as 3 to 5 days. *The more proximal the bleeding site, the more likely the melena will occur *Hematochezia usually presents a lower GI source of bleeding *Hematemesis indicates an upper GI source of bleeding

PE for abdominal swelling, except a. presence of RIGHT supraclavicular lymphadenopathy or Virchow's node b. Spider angiomas, palmar erythema, caput medusae, gynecomastia c. elevated jvp d. pericardial knock in heart failure

a. presence of RIGHT supraclavicular lymphadenopathy or Virchow's node

``` Attacks of meniers consists of, except... A. Vertigo B. Loss of balance C. Loss of hearing D. Fullness of affected ear ```

B. Loss of balance

Hypoxia, when respiratory failure is persistent A. Hemoglobin-oxygen dissociation curve shift to the right B. Hemoglobin-oxygen dissociation curve no shift C. Hemoglobin-oxygen dissociation curve shift to the left D. Hemoglobin-oxygen dissociation curve shift downward

A. Hemoglobin-oxygen dissociation curve | shift to the right

``` What is the main stimulus of increase renin release? A. Decrease sodium reab B. Diminished renal blood flow C. Decrease O2 in juxtamegulary cells D. Increase plasma oncotic pressure ```

B. Diminished renal blood flow

Clouding of the eye lens -

B. Cataract

``` A condition in which eyes are not aligned with each other A.Amblyopia B.Myopia C.Strabismus D.Diplopia ```

C.Strabismus

Bulging of the eyes between eyelids -

Exopthalmos

Assessment of alignment by the location of corneal light reflex within pupil -

Hirschberg Test

``` The procedure used to detect intraocular pressure and glaucoma a. Slit Lamp b. Tonometry c. Fundoscopy d.Perimetry ```

b. Tonometry

``` Loss of focusing ability of the crystallized lens due to normal process of old age A. Myopia B. Hyperopia C. Astigmatism D. Presbyopia ```

D. Presbyopia

Mr Goo a 45 yr old male, sought medical check up from an opthalmologist complaining that he cant read text messages but having no problem with target shooting. Visual acuity is 20/25 jaeger 6. What diagnosis is this. A. Myopia B. Presbyopia C. Beginning of cataract D. Astigmatism

B. Presbyopia

All are central corneal ulceration except a. Bacterial b. Fungal c. acanthomoeba d. Moreens

d. Moreens

Abbreviation for both eyes -

Oculus Universal

``` Procedure used to detect abnormalities in cornea, anterior chamber and lens. A. Endoscopy B. Slit lamp C. Gonioscopy D. Fundoscopy ```

C. Gonioscopy

mr. KB. Went for eye check up due to upper | left eyelid infection. Stye?

Hordelium

The white in the eye?

-SCLERA

Drooping of upper eyelid A. Proptosis (abnormal protrusion or displacement of an ey or other body part) B. Ptosis C. Blepharospasm (involuntary tight closure of eyelids) D. Entropion (eyelid folds inward)

B. Ptosis

``` Optic nerve finding is the most concerning in glaucomatous damage A. Large disk size B. Horizontal cupping C. Vertical cupping D. Tilted disk ```

C. Vertical cupping

``` Finding is most characteristic of orbital cellulitis A. Chemosis B. Warmth and Erythema of Eyelid C. Physical taut-feeling eyelid D. Proptosis ```

D. Proptosis

A 27 year old contact lens wearer presents to the ER with irritation. 2 mm Corneal abrasion. What should you do?

Treat with ciprofloxacin drops

A woman presents to you complaining of a red eye with stinging and some photophobia. Her vision has slightly dropped to 20/30. She has a history of diabetes and is taking drops for glaucoma. What is the likely cause of the redness? A. Angle-closure glaucoma B. Viral conjunctivitis C. Diabetic retinopathy D. Papilledema

B. Viral conjunctivitis

``` Patient presented with MVA and fracture in the orbital floor a. Double vision and worsen upon upward looking b. Chemosis c. Restricted forced ductions d. Decreased extraocular movement ```

c. Restricted forced ductions

``` Which condition leads to innacurately high reading with applanation pressure measurement? a. Thin cornea b. Thick cornea c. Edematous cornea d. Keratoconus ```

b. Thick cornea

32 y/o white man with type-1 diabetes complains of decreased vision. Havent seen doctors for years. On exam: numerous dot blot hemorrhages, hard exudates and abnormal vasculature. Pan-retinal photocoagulation might be used to: A. Kill ischemic retina B. Tamponade retinal tears C. Ablate peripheral blood vessels D. Seal off leaking blood vessels

A. Kill ischemic retina

effect of doxycycline to blepharitis a. therapeutic antibiotic tear secretion b. inhibition of cytokines c. change in lipid viscosity d. increased lacrimal secretion

c. change in lipid viscosity

A man complains of splashed bleach in his eyes.

Irrigate for 15 minutes and go to | opthalmologist

You are trying to measure the deviation in a child with strabismus. The corneal light reflex seen in the pupillary margin temporal to the pupil in the right eye. How much deviation would you estimate? A. 10 diopters esotropia B. 20 diopters exotropia C. 30 diopters esotropia D. 40 diopters exotropia

C. 30 diopters esotropia

``` What is the color of fluorescein stain in corneal ulceration a. Yellow B. Blue C. Green D. Royal blue ```

C. Green

Chalazion is a chronic inflammation | granulomatous of:

Meibomian gland

Most common sensations that is not | dizziness:

Headache

``` Which is paired correctly? A. Superior SC- up and down head movement (nodding) B. Later SC- head tilt towards shoulder C. Posterior SC- side to side D. Anterior- shake head side to side ```

A. Superior SC- up and down head | movement (nodding)

``` Which of the following differential diagnosis of dizziness lasted for seconds? A. TIA B. BBVP C. Meniers Dse D. ```

B. BBVP

Maneuver to treat BBVP

Epley Maneuver

``` the most useful bedside test for peripheral vestibular function a. Epley maneuver d. Dix- Hallpike maneuver c. Head elevation test d. Dix Epley maneuver ```

d. Dix- Hallpike maneuver

Which of the following is true? A. Nystagmus caused by acute peripheral lesion changes direction with gaze B. Unilateral hearing loss is suggestive of central disorder C. Nystagmus due to peripheral lesion is inhibited by visual fixation D. Central nystagmus is inhibited by visual fixation

C. Nystagmus due to peripheral lesion is | inhibited by visual fixation

Otoconia

-Calcium carbonate

``` What are the key features of Meniere's disease? A. Low frequency hearing loss B. Aural symptoms C. Both D. None of the above ```

C. Both

``` Also known as endolymphatic hydrops A. Vestibular margination B. Menieres disease C. Vestibular schwanomma D. Nota ```

B. Menieres disease Menieres disease is thought to be due to excess fluid (endolymph) in the inner ear; hence the term endolymphatic hydrops

Components of vestibular system a. semicircular and olith b. semicircular and Cochlea c. cochlea and saccule d. saccule and utricle

d. saccule and utricle

25 yo male had a motor vehicular accident and suffered a shock like sensation at the left leg. It is also triggered by light touch. What type of pain? A. Acute pain B. Neuropathic pain C. Chronic pain D. Visceral pain

B. Neuropathic pain

Behavioral Arousal and Stress Responses | compose of the ff. except:

-Pupillary Constriction Stress activates the Sympathetic ANS which causes Pupillary Dilatation not constriction

The cellular body of the primary sensory | afferent is found in the?

-Dorsal root ganglia

``` Primary afferent classification except. A. Diameter B. Degree of myelination C. Response to stimuli D. Conduction velocity ```

C. Response to stimuli

``` All sympathetic postganglionic fibers are: A. Unmyelinated B. Myelinated C. None of the above D. All of the above ```

A. Unmyelinated

Which is true about the secondary activation of primary afferent receptors? A. Cell damage induces decrease in pH and release of potassium B. Prostaglandins increases the sensitivity of the terminals by bradykinins and other pain producing substances C. Direct activation by pressure and noxious stimuli

B. Prostaglandins increases the sensitivity of the terminals by bradykinins and other pain producing substances

Major neurotransmitter in pain

-Glutamate

The brain circuits that modulates the activity of pain transmission pathway is? A. Hypothalamus-midbrain-medulla B. Hypothlamus -spinal cord-somatosensory cortex

A. Hypothalamus-midbrain-medulla

True mechanism of referred pain

-convergence of sensory inputs to a single pain-transmission neuron and the convergence patterns are determined by the spinal segment of the dorsal root ganglion that supplies the afferent innervation of a structure.

The suggestion that the pain will worsen ff | the administration of innate substances

-Nocebo effect

``` The ff are included in the physical examination of aortic dissection except A. Murmur B. Pericardial rub C. Loss of peripheral pulse D. Inc in JVP ```

D. Inc in JVP

``` Thermoregulation in what part of hypothalamus? A. Preoptic hypothalamus only B. preoptic hypothalamus and posterior C. post optic and posterior D. Posterior hypothalamus only ```

B. preoptic hypothalamus and posterior

Most common cause on noncardiac chest | discomfort

-Gastroesophageal diseases

``` Pain in dermatomal distribution may be caused by: A. burns B. GERD C. Herpes zoster D. Acute myocardial infarction ```

C. Herpes zoster

``` Pain arising from abdominal wall is: A. Dull, low quality B. Steady and aching C. Poorly localized, intermittent D. Diffuse, severe ```

B. Steady and aching

accounts for 80% of clinician visits.

Pain

is an unpleasant sensation localized to a part of the body

Pain

Any pain of moderate or high intensity is accompanied by anxiety which explains the duality of pain:

SENSATION and EMOTION

→ Also known as Vanilloid receptor | → Mediates perception of some noxious stimuli especially heat sensations.

TrpV1 (Transient receptor potential cation channel subfamily member 1)

TrpV1 is activated by:

o Acidic pH o Endogenous mediators o Capsaicin, a component of chili peppers

Right Eye (Oculus Dexter)

Left Eye (Oculus Sinister)

Both Eyes (Oculus Universal)

Visual Acuity

Without correction (Sans correction)

With correction (Core correction)

Pinhole

Normal visual acuity:

20/20 or 6/6

The First number of visual acuity indicates ?

the distance of the patient from the chart,

The second number of visual acuity indicates ?

the distance at which normal eye can read the line of letters.

As the number increases the vision becomes ?

worse or more blur.

What should be done if the patient cannot see the largest letter on the chart from 20 feet away?

Move patient closer to the chart | o 15/200, 10/200, 5/200

if the patient still can’t read at 5ft use CF but start at ?

4ft to 1ft.

Hand Movements (HM)

1ft, done after CF

Light Perception (LP)

done after HM, make sure the other eye is well covered

No Light Perception (NLP)

blind (endpoint)

VISUAL ACUITY at Near is tested for patients that are how old?

usually 40 years and above

Test for Presbyopia – do not have the ability to accommodate | Affected : _________

Lens, zonules, ciliary muscles

Normal VISUAL ACUITY at Near

JAEGER 1-3

Jaeger Chart value is from __ to ___

Jaeger 1 to 16

Small chart with gradations, as the number increases, more difficult to read.

Jaeger Chart

Proper distance for Jaeger Chart

Proper distance is 14 inches

Newspaper, Magazine or Telephone Directory

Jaeger 1-3

Can be use even without any sophisticated machines only penlight

EXTERNAL EXAMINATION

Normal external examination of the eyes: | Lids

Not swollen

Normal external examination of the eyes: | Lashes

Not matted

Normal external examination of the eyes: | Conjunctiva

Pink

Normal external examination of the eyes: | Sclera

Anicteric

Normal external examination of the eyes: | Cornea

Clear

Normal external examination of the eyes: | Pupils(Lens)

3-4mm RTL

timos-timos

hordeolum

(lagob) sandwiched in conjunctiva and sclera

sub conjunctival hemorrhage

sub conjunctival hemorrhage management

usually summer time, apply cold compress for 2 days

To examine the patient’s RIGHT eye, the Examiner should use his:

→ RIGHT eye | → RIGHT hand

visualize fundus

Ophthalmoscope

Normal ophthalmoscopy: | ROR

(+)

Normal ophthalmoscopy: | Media

Clear

Normal ophthalmoscopy: | Disc Margins

Distinct

Normal ophthalmoscopy: | Cup-Disc Ratio

0.3

Normal ophthalmoscopy: | A-V

2:3 A-V Ratio – artery(smaller):vein

Normal ophthalmoscopy: | Exudates, Hemmorhage

none

Journey of light as it enters the eye

Light ➡Cornea➡ Lens➡ Vitreous

Eye movement: | Medial rectus

adduction

Eye movement: | Lateral rectus

abduction

Eye movement: | Inferior rectus

Primary: depression Secondary: extorsion Tertiary: adduction

Eye movement: | Superior rectus

Primary: elevation Secondary: intorsion Tertiary: adduction

Eye movement: | Inferior oblique

Primary: extorsion Secondary: elevation Tertiary: abduction

Eye movement: | Superior oblique

Primary: intorsion Secondary: depression Tertiary: abduction

Corneal Light Reflex Test

Hirschberg Test

Hirschberg Test is used to?

Assesses eye alignment by the location of the Corneal Light Reflex within the pupil

Temporal Displacement

Esotropia

Nasal Displacement

Exotropia

Inferior Displacement

Hypertropia

What test is used to measure Intraocular Pressure?

TONOMETRY

Normal Intraocular Pressure

10 – 20 mm HG *21 mm HG still normal

How is Intraocular Pressure measured?

• Palpation • Schiotz- Indention tonometer Rarely used, inaccurate, used on bedside pxn • Goldmann Applanation Tonometer (Gold Standard)

Why is it important to learn how to use the Ophthalmoscope?

* Screen for GLAUCOMA, which is one of the most common causes of preventable blindness. Glaucoma is asymptomatic in early stages. * Recognize Papilledema (swelling of pupils). * Stage Hypertensive Retinopathy and Diabetic Retinopathy, other retinal diseases

Significance of the CD Ratio

* Glaucoma Screening * The C:D Ratio is the Ratio of the DIAMETER of the CUP to the DIAMETER of the DISC * NORMAL CD RATIO = 0.3 * Examine also, the RIM: look for “thinning” and “notching”

Significance of Blurred Disc Margins:

Papilledema

Significance of the AV Ratio:

Hypertensive Retinopathy

Murphy’s sign

→ Apply pressure inward then upward at right upper quadrant then instruct the patient to inhale → If there is a respiratory arrest while inhaling, that is the positive murphy’s sign

The most common causes of abdominal pain on admission:

→ acute appendicitis → nonspecific abdominal pain → pain of urologic origin → And intestinal obstruction.

Location of auscultation: | Aortic

2nd ICS right parasternal area

Location of auscultation: | Pulmonic

2nd ICS left parasternal area

Location of auscultation: | Tricuspid

5th ICS left parasternal area

Location of auscultation: | Mitral

5th ICS midclavicular line

Block 2 Flashcards

(195 cards)