Exam 1 Flashcards
(204 cards)
1
Q
Good facial landmarks for symmetry
A
nasolabial fold and palpebral fissure
2
Q
anterior triangle
A
sternocleidomastoid
3
Q
posterior triangle
A
trapezius
4
Q
lymphs behind ear
A
posterior auricular, occipital, posterior cervical
5
Q
lymphs before ear
A
preauricular, tonsilar, submandibular, submental, deep cervical, supraclaviluar
6
Q
normal lymph nodes
A
less than 1/2 cm, movable, non-tender
7
Q
infected lymph node
A
enlarged, tender
8
Q
malignant lymph node
A
hard, non-tender, irregular, fixed
9
Q
CN1
A
olfactory
- sensory
- smell
10
Q
CNII
A
optic, sensory, sight
11
Q
CNIII
A
oculomotor, pupils, EOM
12
Q
CN IV
A
trochlear, EOM
13
Q
CN V
A
trigeminal, facial sensation and motor muscles of mastication
14
Q
CN VI
A
abducen, EOM
15
Q
CN VII
A
facial, muscles, sensory, taste, anterior tongue
16
Q
CN VIII
A
acoustic, sensory hearing/balance
17
Q
CN IX
A
glossopharyngeal, sensory/motor gag, swallow, cough reflex, taste, posterior tongue
18
Q
CN X
A
vagus, sensory and motor
19
Q
CN XI
A
accessory, motor neck and shoulder strength
20
Q
CN XII
A
hypoglossal, motor, tongue, “you can’t teach an old dog new tricks”
21
Q
test CNI
A
Occlude each nostril and breathe to make sure they’re patent
Have pt identify a distinct scent (close eye and occlude one nostril at a time)
22
Q
test CNII
A
Have pt read, do Snellen eye chart when covering one eye and then both together (no more than 2 mistakes)
23
Q
test CN 3,4,6
A
follow finger through 6 vision fields (EOM)
24
Q
test CN 5
A
Sensory- forehead, cheek and chin feel with cotton ball
Motor- strength of jaw muscle, bite on tongue blade and try to pull out on both sides of mouth
25
test CN 7
Have pt make faces: smile, raise eyebrows, frown, puff out cheeks
26
test CN 8
Cover L ear and whisper, cover R ear and whisper
| Inner ear responsible for balance
27
test CN 9, 10
Control gag reflex, swallow, cough, symmetrical rise of uvula
Get tongue blade and look for symmetrical rise of uvula, stick tongue out and say “ahh”
28
test CN 11
Raise shoulders against hands
| -turn head left and right against hand
29
test CN 12
Stick tongue out, move all around, push against sides of mouth
Say “you can’t teach an old dog new tricks”
30
head stuff in children
- large lymph nodes, open fontanels
| - measure head circ
31
normal thyroid enlargement
teens and pregnancy- high metabolic activity
32
can assess for bruit in thyroid
tell pt to hold breath, normal is no sound
33
Cushings
moon face, could be caused by steriods
34
fetal alcohol face
-short palpebral fissure, thin upper lip, flat midface
35
TMJ
- can have referred pain
| - headache, ear problems, jaw, etc
36
exam neck
neutral, hyperextended and swallowing for masses, symmetry, condition of the skin, ROM
37
exam thyroid gland
Use anterior or posterior approach; locate isthmus below cricoid cartilage; note size, shape, consistency, tenderness, and nodules; auscultate bruits
38
examine cervical lymph nodes
Note size, shape, symmetry, consistency, mobility, location, tenderness, and temperature
39
Head, face and neck focused assessment
- facial symmetry
- sensation (CN 5,7)
- skin/membranes
- edema, wasting
- masses, tenderness
40
PMH head face neck
ca history, toxins, allergies, ENT surgeries
- sexual practices (HIV risk)
- thyroid in family
41
ROS head face neck
wt changes, palpitations, bowel changes, temp intolerance, fever, chills, itching
-ETOH and tobacco
42
head face and neck PE
Palpation of thyroid, lymph nodes
Inspect hair, skin, periorbital edema
Reflexes (deep tendon)
Examination of mouth, throat, ears, eyes- look or evidence of infection; if evidence of mono- abdominal exam to see if spleen enlarged
43
tests for head face and neck
```
TSH
CBC
Monospot if evidence consistent with mono
CXR if lymphadenopathy present
Chalmydia, Gonorrhea, HIV testing
```
44
hyperthyroid s/s
heat intolerance, bulging eyes, flushed, enlarged thyroid, tachy, weight loss
45
hypothyroid s/s
-cold intolerance, weak heartbeat, depression, big tongue, high LDL
46
external ear inspection
- low set is down syndrome
- malformed in kids could mean malformed kidneys
- angle of attachment near 10 degrees
47
external ear inspection
- low set is down syndrome
- malformed in kids could mean malformed kidneys
- angle of attachment near 10 degrees
48
ears and aging
hearing loss, thick cerumen, less flexible TM, presbycusis, tinntitis, otoslerosis
-vestibular changes, menieres
49
presbycusis
lose hearing of higher frequency
50
tinnitius
- many with hearing loss, most elderly
| - can be caused by drugs
51
otoslerosis
caused by abnormal bone growth, often herediatary
52
vestibular (inner ear) changes
sensory, dysequillibrium, vertigo
| -decrease in receptors, bony labrynth changes
53
meneieres dx
bone labryrinth dysfunction
- vertigo, ear pressure, tinnitis, neurosensory hearing loss
- *typically unilateral
54
history of ear
```
Hearing loss
Vertigo
Ringing in the ears (tinnitus)
Ear drainage (otorrhea)
Earache (otalgia)
```
55
whispered voice test
assesses gross hearing
| Cover one ear and whisper into opposite ear, standing a few feet away
56
weber test
Tuning fork top of head or forehead
| Should be equal in both ears
57
rinne test
compare bone conduction to air conduction
Air is twice as long as bone, put tuning fork on mastoid process behind ear
Problems in external or middle ear
58
palpate ear
tragus, mastoid, helix for tenderness
59
to straighten adult ear
up and back
60
normal TM
pearly gray, 5 o clock right and 7 o clock left cone of light
61
assess cornea
shoot air over eye causing them to blink
62
assess anterior chamber of eye
space between cornea and iris, should be clear, shine light from side
63
acute closed angle glaucoma
medical emergency
- dilated pupil, red sclera
- pt can go blind
64
adolescent vision
more nearsighted
65
children born with ___ vision
2200
66
aging eyes
-thick cornea, astigmatism, arcus senilus, glaucoma, acuity issues, floaters, presyopia
67
arcus senilus
white fat deposits around rim of cornea
68
floaters
loose cells in vitreous cast shadows on retina, can be worrisome
69
presbyopia
lose close vision as you age
70
history eye assessment
```
Vision loss Eye pain
-Double vision -Blurred vision
Eye tearing -Dry eyes
Eye drainage -Floaters
Eye appearance changes
-glaucoma, surgery, cataracts
```
71
exam far vision
snellen chart, 20 20 normal
72
exam near vision
read newspaper 13-15" away
73
exam color vision
color bars on snellen or color plates
74
assess peripheral vision
come in from the periphery in all fields and note field cuts (wiggle fingers)
*will only see gross field cuts, not small changes
75
extraocular tests
- parallel on inspection
- corneal light reflex (sparkle in same spot)
- 6 fields of gaze
- cover/uncover for drifting (accomodation)
76
what CNs control eye movement
CN 3,4,6
77
pupil tests
- reaction to direct light and consensual
| - accomodation as finger moves toward patient
78
conjunctivitis
pink eye
79
pterygium
benign, abnormal growth of tissue
| -can affect vision if it extends over pupil
80
what to see eyes with otoscope
-red reflex, optic disc, retinal vessels, retina, macula and fovea
81
optic disc assessment
-round, white in center
82
macula assessment
area of most acute vision, dark area, not well defined
83
eye questions
Precipitating event? Previous history? Duration? Contacts??
| Associated sx: burning itching, pain, exudate, allergies, trauma, tearing, dryness, photosensitve, visual changes
84
PE eye
```
Visual acuity
EOM
External Structures
Corneal clarity
Exudate
Tearing
Facial characteristics
Regional lymphadenopathy
```
85
conjunctival exam
```
Note palpebral and bulbar portions
Redness
Cloudiness
Lesions
Follicles
Edema
```
86
differentials for eye
```
Corneal injury/trauma
Blepharitis
Scleritis
Conjunctivitis
Anterior uveitis or iritis
Acute angle glaucoma
Chemical burn
Hordeolum
```
87
glaucoma
Usually complain about peripheral vision
Open angle
Closed angle- severe pain, red conjunctiva, dilated pupil, medical emergency
88
macular degeneration
loss of central vision
89
frontal sinus
above the eye
90
maxillary sinus
either side of nose
91
mumps
parotiditis
92
taste and smell aging changes
- less sensitive taste (nutrition deficiencies)
- less able to identify odors (safety issue?)
- olfactory dysfunction
93
olfactory dysfunction associated with
alz, parkinsons, huntingtons
94
PE nose
- salivary gland- large, tender
- nose, septal deviation, patency
- sinuses- edema, tenderness
- parotid and submandibular glands- edema, red, tender
95
PE oropharynx
test gag reflex
96
tonsils PE
color, exudates, enlarge
97
uvula PE
symmetical rise (CN 9 and 10)
98
to test trigeminal nerve
bite down on stick both sides of mouth
| -stick tongue out and move around
99
chilitis
crack at corner of mouth
100
angioedema
need to maintain airway, s/e of ACEi
101
leukoplakia
- white spots on tongue
| * *precancerous
102
anterior nosebleed
trauma
103
posterior nosebleed
anticoag, OTC meds, drug use, sinus infection
104
pharyngitis PE
Include assessment of the upper and lower respiratory systems; eyes, ears, nose, mouth, throat, and lungs.
Also palpate cervical LN
More thorough neck exam if symptoms warrant
105
respiratory viruses
- s/s HA, fever, chills, rhinnitis, conjunctivities, cough, GI
- inflammed pharynx, present anterior adenopathy
106
herpes pharyngitis
malaise, fever
| -inflammed and ulcered
107
herpangitis (hand foot and mouth)
malaise, lesions on hand feet buttock gentials
| -inflamed and ulcered
108
group a strep
quick onset, malaise, n/v HA sandpaper rash, cough, conjuncitibvies, inflammation with white/gray tonsilar exudate
109
peritonsillar abscess
Usually associated with tonsillitis
Most common pathogen GABHS
Key S/S- worsening unilateral sore throat over days, fever, malaise, increasing difficulty with swallowing, speaking, foul smelling breath, drooling
Exam may be difficult= trismus, area adjacent to tonsil swollen, tonsil & uvula deviated, voice muffled
110
mono
exudates on tonsils
111
ludwigs angina
medical emergency
- can happen after dental work
- lose airway!
112
additional throat tests
```
Strep screen or culture
CBC
Mono spot
Other cultures for viruses, GC
ESR if thyroiditis suspected
```
113
strep vs mono
anterior nodes-strep
posterior nodes-mono
114
infant skin
- lanugo, vernix caseosa
- stork bite, cradle cap, milia
- more prone to fluid loss (poor temp regulation)
115
adolescent skin
- increase in subQ fat
- inc sebaceous gland activity
- secondary sex characteristics
116
pregnant skin
- linea nigra, cholasma on face, striae gravidarum (stretch marks)
- inc body temp, inc fat deposit
117
aging skin
- dec collagen and elastin, dec subQ fat
- inc risk of tearing
- dec ability to cool due to dec sweat glands
- more skin lesions
118
HPI skin
Changes in pigmentation, birthmarks, or moles (size, shape, color)
-skin and hair self care
119
ROS skin
```
Neuro
GI- ex: liver/jaundice, crohns/lesions
CV- HF/edema
Respiratory
Endocrine
```
120
woods light
fungal infection
121
cyanosis
central vs peripheral
122
jaundice
locations, sclera
123
pallor
local vs systemic, low hgb?
124
dependent rubor
vascular dx
125
distribution of lesions
can help you diagnose (ex: shingles)
126
petechiae
small pinpoint red lesions, small capillaries are breaking
127
purpura
larger than petechiae
| -small bursted blood vessels
128
hematoma
walled off collection of blood, can be evacuated
129
inspection
-moisture, temp, texture
130
primary lesion
initial change
131
secondary lesion
change to primary- can add or take away
| -ex: scaling, ulcers, fissures, crusts
132
serpiginous
snakelike
| -seen with hookworm or scabies
133
arrangement of lesions
discrete- one here and there
- reticular- network like structure
- annular- fungal
134
wheal
palpable
| -temporary elevation of skin, ex: PPD
135
Lesions < 1cm
```
Macule (flat)- freckle
Papule (elevated)
Nodule (deep)
Vesicle (clear fluid)
Pustule (pus)
```
136
lesions > 1cm
Patch (flat)- birthmark
Plaque (elevated)
Tumor (Deep)
Bulla (clear fluid)
137
psoriasis
a plaque
| -silvery appearance
138
hive
palpable
| >1 cm
139
vesicle
fluid filled
140
bulla
-fluid filled, often seen in burns
141
hidradenitis suppurativa
example of a cyst
142
lichenification
secondary lesions
- thickened elephant like skin
- seen in venous insufficiency
143
healing pressure ulcer
-doesn't get better stages at it heals
| "healing stage 4" etc.
144
tilangectasis
-spider angiomas on face
145
vascular lesions
spider angioma vs cherry angioma
146
turgor
- decreased = dehydration
| - not accurate in elderly due to dec skin elasticity
147
acne
inflammation of pilosebaceous units with comedones, papulopustules and/or nodular cysts; more severe in males than females
148
roseacea
-disorder of pilosebaceous units coupled with hyperreactivity of capillaries to heat
-flushing and telangiectasia
Onset 30-59 years. Predominant in females
149
hidradenitis suppurativa
Major characteristics: chronic, suppurative disease of apocrine gland-bearing skin. May be associated with severe nodulocystic acne and pilonidal sinuses. Onset at puberty, affects females> males.
150
eczema/dermatitis
polymorphic inflammatory reaction patterns involving the epidermis and dermis. Acute-pruritis, erythema, vesiculation. Chronic-pruritis, xerosis, hyperkeratosis, +/- fissuring
151
psoriasis
- scaly plaques on extensor surfaces, chronic and recurring
| - herediatry, physical trauma is key factor, may flare with stress (BB, steroids, antimalarials, interferon)
152
erythroderma
severe form of psoriasis
| -involves entire body
153
psoriasis arthritis
arthritis-a seronegative spondyloarthropathy, asymmetric peripheral joint disease, usually in UE esp. in small joints.
154
seborrheic dermatitis
a common chronic dermatosis with red, scaly lesions where sebaceous glands most active- face, scalp, skin folds. Yellow-red or gray-white scaly macules & papules with sticky appearance“Cradle cap” in infants, pityriasis sicca(dandruff)
155
dermatophytosis
infection of hair skin nails
156
tinea pedis
Fungal infection of the feet (athlete’s foot) characterized by erythema, scaling, maceration and/or bulla. Often starts on the feet and spreads to other areas of the body.
157
tinea manum
Chronic dermatophytic infection of the hand(s) often unilateral, on the dominant hand, associated with tinea pedis.
158
tinea corpus
Refers to dermatophyte infection of the trunk, arms, legs and/or neck, excludes feet, hands and groin.
159
tinea capitis
Capable of invading the hair follicles and shaft. Appearance may vary, with mild scaling and broken-off hair, to severe painful inflammation with boggy, nodules draining pus, resulting in scarring and alopecia.
160
cutaneous candidiasis
- skin folds
- treated with nystatin
- at risk: diabetes, systemic alterations in immunity, use of broad spectrum antibiotics.
161
impetigo
- infection caused by staph or strep.
- Itching is only symptom.
* *honey comb colored lesions
- common in kids
162
herpes simplex
primary or recurrrent often appears as clustered vesicles on an erythematous base or keratinized skin or MM.
163
herpes zoster
acute dermatomal infection associated with reactivation of varicella-zoster characterized by unilateral pain and vesicular or bullous lesions limited to a dermatome. (shingles)
***can be eye emergency
164
herpes simplex details
- keratinocyte infection
| - HSV 1 and 2
165
HSV2
Fever, lymphadenopathy, perineum pain
Grouped vesicles that ulcerate
Peri-anal lesions
Eruption lasts 18-21 days (8 if recurrent)
Recurrent usually less painful and shorter
Need to distinguish from genital zoster
166
HARMM melanoma risk model
- hx previous melanoma
- age > 50
- reg dermatologist absent
- mole change
- male gender
167
ABCDE for lesions
```
A (asymmetrical)
B (borders) irregular
C (color) is it changing or multicolored
D (diameter) > ½ cm *head of an eraser
E (elevation)- is it enlarging?
```
168
basal cell carcinoma
translucent nodule, firm border with depressed center
Normally on sun exposed areas
Very common
169
squamous cell carcinoma
firm scale; often face or back of hand
| scaly!
170
actinic keratosis
pre-cancerous squamous cell
| -white scale
171
malignant melanoma
- irregular, can be dark
- blacks can get this in nail
- can be anywhere on body
172
leukonychia
white lines or dots, harmless
173
mees lines
white bands across, can be metal poisoning
174
beaus lines
indentations, can be from DM, PVD, zinc deficiency
175
pitting nails
common in psoriasis
176
skin disorders assoc with crohns and UC
erythema nodusum, pyoderma gangrenosum, aphthous ulcers
177
skin disorders associated with diabetes
-diabetic dermopathy, acantosis nigraicans, necrobiosis lipoidica diabeticorum
178
comprehensive health history
- patient identifiers
- reliability
- chief complaint
- HPI, PMH, FH, SH, ROS
179
OLDCART
part of HPI
| -onset, location, duration, character, aggravating, relieving, treatment
180
PQRST
part of HPI
| -Precipitating/palliative factors, Quality/quantity, Region/radiation/related symptoms, Severity, Timing
181
purpose of HPI
symptom analysis
182
chief complaint
expressed in pts own words, quote them, reason for visit
183
PMH
- childhood/adult illness
- allergies, meds
- hospitalizations, injuries
- vaccines, screening exams
- psych/mental health issues
184
FH
Major illnesses and health status of relatives- ask about age, health status, and presence or absence of blood relatives. Ask specifically about cancer (what kind), HTN, stroke, MI, CAD, neurologic disorders such as epilepsy, Huntington’s disease, dementia, DM, TB, asthma and allergic disorders, arthritis, anemia, thyroid disease, mental illness
Genetic defects- CF, Tay-Sachs, beta thalassemia, hemophilia
Deaths-note cause of death and relationship to pt.
Ethnicity
185
SH
-relationship status, education, occupation, housing, safety, diet, exercise, sleep, drug alc use, stress, military service
186
ROS
- list of questions you ask about each system
| - chart peritinent pos and negs
187
general ROS questions
wt. changes, fever, chills, night sweats, changes in appetite, energy level, exercise tolerance, ability to carry out usual ADLs
188
skin ROS
Any changes including- rashes, itching, pigment changes, moisture or dryness, changes in texture, changes in color, shape of moles, changes in nails, hair growth or loss
189
eye ROS
any injuries, double vision, changes in acuity, sudden loss of vision, tearing or dryness, blind spots, floaters or seeing spots, eye pain, inability to see at night, photophobia, haloes around lights.
190
ear ROS
pain, discharge, injury ( including barotrauma), changes in hearing acuity, tinnitus, balance problems, frequency & severity of ear infections, care of ears, including wax removal.
191
nose ROS
nosebleeds, colds, obstruction, discharge (color & quantity), changes in sense of smell, polyps, sneezing, PND.
192
mouth/throat ROS
dental problems, lesions, gum problems, bleeding, dentures, adequacy of saliva, hoarseness, dysarthria, sore throats (frequency, severity & duration), changes in tongue appearance, sense of taste. Neck stiffness, pain or tenderness, masses in thyroid, lymph nodes, or other areas.
193
CV ROS
Chest pain, substernal discomfort, palpitations, syncope, DOE, orthopnea, paroxysmal nocturnal dyspnea, edema, cyanosis, HTN, heart murmurs, varicose veins, phlebitis, claudication, hemoptysis, coldness or color changes in extremities.
194
Respiratory ROS
Pain (associated with location, quality, relation to breathing, SOB, dyspnea, wheezing, stridor, cough-note time, of day, +sputum production (amount, color), hemoptysis, respiratory infections, TB exposure or infection, fever, night sweats, recent CXR if applicable.
195
GI ROS
Appetite, dysphagia, indigestions, food intolerance, abdominal pain, heartburn, eructation, nausea, vomiting, hematemesis, jaundice, polyps, constipations, diarrhea, abnormal stools ( change in color, odor, clay or tarry colored, bloody), flatulence, hemorrhoids, recent change in bowel habits.
196
GU ROS
urgency, frequency, dysuria, colicky pain in flanks, suprapubic pain, facial swelling, nocturia, hematuria, polyuria, oliguria, unusual color or odor of urine. History of stones, infection, nephritis, hernia, hesitancy, changes in force of stream, dribbling, acute retention or incontinence, change in libido, potency, genital lesions, discharge, STIs.
197
breast ROS
Ask about breast masses or lumps, lesions, tenderness, swelling, nipple discharge, dimpling/retraction, BSE. Remember breast cancer can occur in men as well as women.
198
musculoskeletal ROS
pain, swelling, redness, heat of muscles, or joints; bone deformity, limited movements, muscle weakness, atrophy, or cramps.
199
neuro ROS
any headaches, lightheadedness, seizures, paralysis, incoordination, sensory changes, changes in mentation, loss of consciousness, difficulty with memory, or speech, motor disturbances, changes with balance, irregular movements or tremors.
200
mental ROS
mood changes, emotional problems, anxiety, depression, including suicidal ideation, if appropriate, difficulty with concentration, previous psychiatric care, unusual perceptions, hallucinations.
201
hemo ROS
anemia, abnormal bleeding or bruising, clotting disorders, history of transfusion, reactions?
202
endo ROS
polyuria polydipsia, polyphagia, unexplained weight changes, changes in texture of hair, skin, changes in hair distribution, changes in energy, appetite, thyroid enlargement or tenderness, changes in hat, glove, or shoe size, changes in secondary sex characteristics, intolerance to heat or cold.
203
percussion can tell you
Density (air, fluid, solid)
Size and shape
Tenderness
Deep tendon reflexes
204
percussion sounds
- resonance- normal lungs
- hyper-resonance- COPD
- dull- organs
- flat- muscle or soft itssue
- tympany- abdomen
