Chap 2 Physical Exam Flashcards by Chris Weber

7 bones of the skull:

Two Frontal
Two Parietal
Two Temporal
One Occipital

How well did you know this?

Not at all

Perfectly

Facial bones:

Frontal
Nasal
Zygomatic 
Ethmoid
Lacrimal
Sphenoid
Maxillary
Mandible

How well did you know this?

Not at all

Perfectly

Major Facial Landmarks

Palpebral Fissures

Nasolabial Folds

How well did you know this?

Not at all

Perfectly

Facial muscles are innervated by what cranial nerves?

CN V and CN VII

How well did you know this?

Not at all

Perfectly

What forms the neck?

Cervical vertebrae

Ligaments

Sternocleidomastoid muscle

Trapezius muscle

How well did you know this?

Not at all

Perfectly

Lymph nodes, ducts, various tissues, responsible for lymph fluid drainage and immune responses

Lymphatic system

How well did you know this?

Not at all

Perfectly

How many posterior cervical lymph chains are there?

How well did you know this?

Not at all

Perfectly

Two lateral lobes are butterfly shaped and are joined by an isthmus at their lower aspect

Thyroid

How well did you know this?

Not at all

Perfectly

What mainly covers the thyroid lobes?

Sternocleidomastoid muscle

How well did you know this?

Not at all

Perfectly

What history of present illness questions are good for a patient with a thyroid problem?

Temperature preference
Neck swelling
Skin & Hair Texture
Emotional Status
Eye Prominence
Menstrual and bowel patterns

How well did you know this?

Not at all

Perfectly

Nodding synchronized with pulse would indicate?

Aortic insufficiency

How well did you know this?

Not at all

Perfectly

Unilateral hearing/vision loss.

Patient’s head is tilted, favoring one side

Torticollis

How well did you know this?

Not at all

Perfectly

Expression or appearance of the face from a clinical condition

Facies

How well did you know this?

Not at all

Perfectly

Hair texture that indicates hypothyroidism

Coarse, dry, and brittle

How well did you know this?

Not at all

Perfectly

Hair texture that indicates hyperthyroidism

Fine, silky

How well did you know this?

Not at all

Perfectly

Stensen duct

Parotid duct, Maxillary Second Molar

How well did you know this?

Not at all

Perfectly

Wharton duct

Submandibular duct, small papilla at the sides of the frenulum

How well did you know this?

Not at all

Perfectly

Enlarged tender salivary gland would indicate:

Viral or Bacterial infection

Ductal stone

How well did you know this?

Not at all

Perfectly

Discrete salivary gland would indicate:

Cyst or tumor

How well did you know this?

Not at all

Perfectly

Percussion on the masseter muscle may produce a hyperactive masseteric reflex

Chvostek sign

How well did you know this?

Not at all

Perfectly

Bruits over the eye and occiput with diplopia may suggest:

Cerebral Aneurysm

How well did you know this?

Not at all

Perfectly

Bruits over the temporal artery are associated with:

Temporal arteritis

How well did you know this?

Not at all

Perfectly

Trachea tugging sensation, synchronous with the pulse suggests:

(Cardarelli sign or Oliver sign)

Aortic aneurysm

How well did you know this?

Not at all

Perfectly

Thyroid is approximately how big?

4cm

How well did you know this?

Not at all

Perfectly

Right lobe of the thyroid is often what percent larger than the left?

25%

Coarse/Grittiness thyroid indicates:

Thyroiditis (Inflammatory process)

Hard/irregular thyroid nodules suggest:

Malignancy

Enlarged and tender thyroid may indicate:

Thyroiditis

Persistent, recurrent, and severe headaches may indicate:

Brain tumor or migraines

Webbing or short neck may indicate:

Chomosomal anomalies

- Puffy, dulled yellowed skin - Coarse, sparse hair - Temporal loss of eyebrows - Periorbital edema - Prominent tongue

Myxedema

- Fine, moist skin - Fine hair - Prominent eyes - Lid retraction - Staring/startled expression

Hyperthyroidism

- Coarsened features - Broadened nasal alae - Prominence of zygomatic arches

Acromegaly

- Sunken eyes, cheeks, temporal areas - Sharp nose - Dry, rough skin - Terminal stages of illness

Hippocratic facies

- Butterfly rash - Malar surfaces and bridge of nose - Blush with swelling - Scaly, red maculopapular lesions

Lupus (SLE)

- Freely movable cystic mass - High in neck - Midline - Duct at base of tongue - Remnant of fetal development

Thyroglossal duct cyst

Salivary glands most commonly have tumors

Parotid

Wry Neck From birth trauma, tumors, trauma, cranial nerve palsy, muscle spasms, infection, drug ingestion

Torticollis

Skin and tissue disorder usually due to severe prolonged hypothyroidism

Myxedema

Autoimmune, antibodies to thyroid stimulating hormone receptor, leading to overactive thyroid Characterized by diffuse thyroid enlargement (goiter)

Graves' disease

Autoimmune antibodies against thyroid gland, often causing hypothyroidism

Hashimoto disease

Glands in the eyelid provide oils to tear film

Meibomian glands

Provides a skeleton for the eyelid

Tarsus

Thin and clear mucous membrane covering most of the anterior surface of the eye and eyelid

Conjunctiva

Conjunctiva that coats the inside of the eyelids

Palpebral

Conjunctiva that protects the anterior surface of the eye (except the cornea) and the surface of the eyelid in contact with the globe

Bulbar

Eye muscles

Superior, inferior, medial, lateral rectus Superior and inferior obliques

What cranial nerve controls the levator palpebrae superior (which elevates and retracts the upper eyelid)?

CN III

What cranial nerve controls superior, inferior, medial rectus muscles and the inferior oblique muscles?

CN III

CN that controls the superior oblique muscle

CN IV

CN that controls the lateral rectus muscle

CN VI

Posterior outer layer of the eye

Sclera

Anterior outer layer of the eye

Cornea

Posterior middle layer (uvea) of the eye

Choroid

Anterior middle layer (uvea) of the eye

Ciliary body and iris

Inner layer of the eye

Retina

Posterior 5/6 of the globe, dense, avascular white portion of the eye Supports the internal structure of the eye

Sclera

Anterior 1/6 of the glove and is continuous with the sclera Optically clear, has rich sensory innervation, and is avascular Major refractive power of the eye

Cornea

Composed by the iris, ciliary body, and choroids

Uvea

Produces aqueous humor (fluid that circulates between the lens and cornea) Contains the muscles controlling accommodation

Ciliary body

Pigmented, richly vascular layer that supplies oxygen to the outer layer of the retina

Choroid

Biconcave, transparent, elastic structure that changes its thickness to focus images on retina (refraction)

Lens

Sensory network of the eye (transforms light impulses into electric impulses that are transmitted to the brain)

Retina

What allows for color perception and central vision

Macula/Fovea

Eye nerve origin

Optic disk

Risk factor for cataract formation, glaucoma, macular degeneration, thyroid eye disease

Cigarette Smoking

Distance for near visual acuity

35 cm, or 14 inches

Distance used for peripheral vision, confrontation test

1m (3 feet)

Irregularly shaped, yellow-tinted lesions suggestive of abnormality of lipid metabolism

Xanthelasma lesion

Eyelid tremors when the eye is closed could indicate:

Hyperthyroidism

Lids do not completely close

Lagophthalmos

If one superior eyelid covers more of the iris than the other, or extends over the pupil

Ptosis

Patient has ptosis. What could be the cause?

Weakness of levator muscle Paresis of a branch of CN III

Lid is turned away from the eye (may result in excessive tearing)

Ectropion

Lid is turned inward toward the globe (may cause irritation, increased risk of infection)

Entropion

Acute supportive inflammation (staphylococcal) of the follicle of an eyelash that forms an erythematous or yellow lump

Hordeolum (stye)

Crusting along the eyelashes caused by bacterial infection | Seborrhea, psoriasis, rosacea, or allergic response

Blepharitis

Firm eye palpation may indicate:

Severe glaucoma or tumor

Erythematous or cobblestone eye conjunctiva could indicate:

Allergies or infectious conjunctivitis

Bright red blood in a sharply defined area surrounded by healthy-appearing conjunctiva

Subconjunctiva hemorrhage

Abnormal growth of conjunctiva that extends over the cornea from the limbus

Pterygium

What uses sensory fibers of CN V and motor fibers of CN VII?

Blinking

Lipids deposited in the periphery of the cornea

Corneal arcus (arcus senilis)

Pupillary constriction to less than 2 mm

Miosis

Pupils fails to dilate in the dark (common with narcotics)

Miotic

Pupillary dilation of more than 6mm and failure of the pupils to constrict with light

Mydriasis

Inequality of pupillary size

Anisocoria

Accommodation should be tested how far from patients' nose?

10 cm

Yellow or green sclera would indicate:

Liver or a hemolytic disease

Dark or slate gray pigment of the sclera would indicate:

Senile Hyaline plaque

What tests the balance of extraocular muscles?

Corneal light reflex

Distance the light is shined from a corneal light reflex

30 cm

Outward strabismic

Exotropic

Inward strabismic

Esotropic

Distance you want to start for an internal eye exam

30 cm (12 inches)

Eye arterioles are smaller than venules at a ratio of:

3:5 to 2:3

Retina converges to the optic nerve. No photoreceptors, "Blind Spot"

Optic disk

Diameter of the optic disk

1.5mm

What is 2-disc diameters temporal to the optic disc?

Macula (or Fovea)

Fundoscopic exam: - Small discrete spots - Slightly more yellow than retina - Enlarge with time - Conditions affecting pigment layers of retina - Aging; precursor of senile macular degeneration

Drusen bodies

Fundoscopic exam: - ill defined yellow spots - Infarction of retinal nerve layer - vascular disease from HTN or DM

Cotton wool spots

Protrusion of the eye Lids don't reach iris

Exophthalmos

Inflammation of superficial layers of sclera

Episcleritis

Calcium deposition in superficial cornea Horizontal grayish bands, dark areas

Band Keratopathy

Disruption of corneal epithelium and stroma Infection (bacterial/viral) or desiccation Contact lens wearer

Coneal Ulcer

Both eyes do not focus on an object simultaneously

Strabismus

Internal eye, pupil abnormality Interruption of sympathetic nerve innervation to the eye

Horner syndrome

Lens opacity Usually from denaturation of lens protein (aging)

Cataracts

Dot hemorrhage or micro-aneurysms ``` Hard exudates (bright yellow, superficial in retina) Soft exudates (cotton-wool spots, dull gray spots) ```

Diabetic retinopathy

Development of new vessels as a result of anoxic stimulation - Peripheral retina or optic nerve - Increased hemorrhage risk leads to blindness

Proliferative

Creamy white appearance of retinal vessels Seum triglycerides >2000mg/dL Hyperlipidemic states

Lipemia Retinalis

Autosomal recessive disorder in which the genetic defects cause cell death, predominately in the rod photoreceptors Loss of night vision Optic Atrophy "waxy pallor" narrowing of arterioles

Retinitis pigmentosa

Disease of the optic nerve wherein the nerve cells die Usually because of high IOP Characteristic "cupping" of optic nerve

Glaucoma

Inflammatory process involving both the choroid and the retina White yellow lesion Strippled with dark pigment later stage Chorioretinal scar

Chorioretinitis

Defective vision or blindness in 1/2 of the visual field

Hemianopia

Loss of vision closest to the temples

Bitemporal hemianopia

Loss of half of the field of view on the same side in both eyes

Homonymous hemianopia

Secretes cerumen

Apocrine glands

What does cerumen do?

Provides an acidic pH environment (inhibits growth of mocroorganisms)

3 small connected bones of the middle ear Malleus, incus, and stapes

Ossicles

Membranous, curved cavity inside a bony labyrinth consisting of the vestibule, semicircular canals, and cochlea

Inner ear

Coiled structure containing the organ of Corti, transmits sound impulses to the CN VIII

Cochlea

Contain the end organs for vestibular function Equilibrium receptors here respond to movement and send signals to the cerebellum to maintain balance

Semicircular canals and vestibule

Openings of the nose, surrounded by cartilaginous ala nasi and columella

Nares

Part of the nose formed by the frontal and maxillary bones

Bridge

Internal nose, formed by the hard and soft palate

Nasal floor

Internal nose, formed by the frontal and sphenoid bone

Nasal roof

Location of the receptors for smell

Olfactory epithelium

Lies on the roof of the nose and houses the sensory endings of the olfactory nerve

Cribriform plate

Convergence of small fragile arteries and veins, located on the anterior-superior portion of the septum

Kieselbach plexus

Lymphatic nodules that lie on the posterior wall of the nasopharynx

Adenoids

Parallel, curved bony structures covered by vascular mucous membrane

Turbinates

Increases the nasal surface area to warm, humidify, and filter inspired air

Turbinates

Inferior turbinate meatus drains the:

Nasolacrimal duct

Middle turbinate meatus drains the:

Paranasal sinuses

Superior turbinate meatus drains the:

Posterior ethmoid sinus

Air-filled, paired extensions of the nasal cavities within the bones of the skull

Paranasal sinuses

Sinuses that lie behind the frontal sinuses and near the superior portion of the nasal cavity

Ethmoid sinuses

Deep sinuses in the skull behind the ethmoid sinuses

Sphenoid

Dorsal surface of the tongue covered with thick mucous membrane supporting the:

Filiform papillae

What is scattered throughout the filiform papillae of the tongue and has taste receptors?

Fungiform papillae

Attached to the alveolar ridges (alveolar process) of the maxilla and mandible

Teeth

Sudden hearing loss may indicate:

Vascular or autoimmune process

Hearing loss in a few hours or days may indicate:

Viral infection

- Aminoglycosides (Gentamicin) - Chemotherapy (Cisplatin) - Antimalarial (Quinine) - Salicylates - Furosemide

Ototoxic medications

Thickening along the upper ridge of the helix

Darwin tubercle

Ear: Results from blunt trauma and necrosis of the underlying cartilage

Cauliflower ear

Small, whitish uric acid crystals along the peripheral margins of the auricles (may include gout)

Tophi

Whisper hearing test: Unable to correctly repeat what percentage of words indicates a hearing impairment

50%

Helps assess unilateral hearing loss

Weber test

Helps distinguish whether the patient hears better by air or bone conduction

Rinne test

Bridge of tissue separating the nares

Columella

Compared to buccal mucosa, nasal mucosa should be:

More pink

Bluish gray or pale pink turbinates with a swollen boggy consistency may indicate:

Allergies

Dry, cracked lips

Cheilitis

Deep fissures at the corners of the mouth

Angular cheilitis

Circumoral pallor may be associated with:

Scarlet fever due to a strep infection

Round, oval, or irregular bluish gray macules on lips and or buccal mucosa

Peutz-Jeghers syndrome

Red spot on the opening of the Stensen duct, is associated with:

Parotitis (Mumps)

White, round, or oval ulcerative lesions with a red halo

Aphthous ulcers

Thick, white patch lesion that cannot be wiped away Premalignant oral lesion

Leukoplakia

Diffuse, filmy grayish surface with white streaks, wrinkles, or milky alteration Normal variant, asymptomatic oral benign lesion

Leukoedema

Teeth: Yellow stained

Tabacco

Teeth: Brown stained

Coffee or tea

Teeth: Discolorations on the crown

Suspect caries

Protrusion of the upper incisors

Overbite

Protrusion of lower incisors or failure of the upper incisors to overlap with the lower incisors

Cross-bite

Failure of back teeth to meet

Open Bite

Superficial denuded circles or irregular areas exposing the tips of the papillae of the tongue

Geographic tongue

Glossitis (smooth red tongue with slick appearance) may indciate:

Vitamin B12 deficiency

Hairy tongue, yellow-brown to black elongated papillae on the dorsum, usually follows what treatment?

Antibiotic therapy

Ducts apparent on each side of the frenulum

Wharton

Indicates sublingual salivary gland obstruction

Ranula (macocele)

Non-midline nodule in the palate may indicate:

Tumor

Bony protuberance at the midline of hard palate

Torus palatinus

Deviation of the soft palate when the patient says "ah" may indicate:

Vagus nerve paralysis Peritonsillar abscess

Abnormal squamous epithelial tissue behind the tympanic membrane

Cholesteatoma

Reduced transmission of sound to the middle ear

Conductive hearing loss

Reduced transmission of sound in the inner ear

Sensorineural hearing loss

Inner ear disorder characterized by episodes of hearing loss, vertigo, tinnitus, ear fullness

Meniere Disease

Illusion of rotational movement by the patient, often due to a disorder of the inner ear

Vertigo

Deep infection in the space between the palatine tonsil capsule and pharyngeal muscles

Peritonsillar abscess

Life-threatening deep neck space infection that has the potential to occlude the airway; occurs in the potential space extending from the base of the skull to the posterior mediastinum between the posterior pharyngeal wall and prevertebral fascia

Retropharyngeal abscess

Oral cancer occurs most often in what cells?

Squamous cell

Chronic infection of the gums, bones, and other tissues that surround and support the teeth

Periodontal disease (periodontitis)

Most common craniofacial congenital malformation

Oropharyngeal clefts (Cleft lip & palate)

Eye staining: Inspect the cornea with maginfcation under what color light source?

Cobalt blue

What should you use when a plain fluorescein examination is non-diagnostic?

Slit lamp

Anterior nose bleeds account for what percentage?

90%

Primary source of blood for the posteroinferior septum

Sphenopalatine artery

Uppermost part of the nasal septum is supplied by the:

Anterior and posterior ethmoid arteries

Kiesselbach's plexus is responsible for what percentage of nose bleeds?

95%

Nosebleeds lasting more than how many minutes may need nasal packing?

10 minutes

Nasal packing absorbable dressings

Gelfoam Surgical

How long do you apply the silver nitrate stick with gentle pressure for?

3-10 seconds

Do not cauterize a nasal area greater than:

1 cm in diameter (4 dabs of the nitrate stick)

Leave nasal packing in place for:

48 hours

Gauze should be layered from nasal floor to turbinates. Approximately how much gauze will be required?

4-5 feet

Nasal packing fails to stop epistaxis in up to:

25% of cases

What medications should you avoid post-nasal packing?

Aspirin and other NSAIDS

Patients needing posterior packing or balloon device insertion generally require admission to an ICU and specialist consultation. What percentage of these patients with require intubation?

40%