Exam 1 Flashcards by Audrie Khoury

Fatigue/weakness, fever, chills, night sweats, weight changes, pain are all examples of

Constitutional symptoms

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as soon as you enter the exam room, you begin to note pts appearance, height, weight, nutritional status, behavior and mood; this is considered what part of the exam?

General survey

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What is the importance of blood pressure cuff size? (What is the outcome using the wrong size cuff, too narrow and too wide?)

Narrow - false elevated BP
Wide - false low BP on small arm and false high BP on large arm

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What sounds are heard on auscultation during BP reading?

Korotkoff sounds

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When taking BP reading, at what measure do you stop inflating the cuff (mmHg)?

Inflate until loss of Korotkoff sound and then above 30mmHg

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What is the core body temperature? (Celsius)

37*C

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What artery do you palpate when measuring heart rate?

Radial artery (1 minute = 60-90bpm range)

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What is a normal respiratory rate?

20 breaths per min

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What is the proper method in diagnosing a patient with HTN?

Average 2 or more readings obtained on 2 or more occasions to estimate the pts BP (out-of-office and self-monitoring measurements are recommended)

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Drop in systolic BP of 20mmHg or a drop of diastolic BP of 10mmHg or more w/in 3 min

Orthostatic hypotension

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________ pain is linked to tissue damage of skin, musculoskeletal system, or viscera. Sensory nervous system remains intact.

Nociceptive (somatic)

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_________ pain is a consequence of a lesion or disease affecting somatosensory system; can be due to CNS brain or spinal cord injury

Neuropathic

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__________ pain involves many factors that influence how the pt reports pain. (Anxiety, depression, personality, coping style, cultural norms, stress, social support)

Psychogenic

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O
P
Q
R
S
T

Onset
Provocation + Palliation
Quality
Region + Radiation
Severity
Time

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What features should you note for during a lymph node exam?

Pain/tenderness, consistency, matting

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Preauricular

In front of the ear

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Postauricular

Behind the ear

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Occipital

At base of skull

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Tonsillar

At the angle of the jaw

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Submandibular

Under the jaw on the side

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Submental

Under the jaw in the midline

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Anterior superficial cervical

Over and in front of the SCM

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Posterior cervical

Anterior edge of trapezius

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Deep cervical chain

Underneath the SCM muscle

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Supraclavicular

In the angle of the sternomastoid and the clavicle

Opening of the parotid gland by 2nd molar

Stensen’s duct

Opening of submandibular duct next to the frenulum of tongue

Wharton’s duct

Otoscopic exam is performed by gently pulling the auricle ______ and _______ in adults, and _________ and ________ for children

Upward and back; down and back

At which point do you not want to cross in the ear canal when using the speculum?

End of hairline/past the cartilaginous canal

In sensorineural hearing loss, sound lateralizes to the _______ ear during the Weber test

Unaffected

In conductive hearing loss, sound lateralizes to the _________ ear during the Weber test

Impaired

In conductive hearing loss, ______ conduction is louder than air conduction during Rinne’s test

Bone

In sensorineural hearing loss, ______ conduction is louder than bone conduction on the Rinne’s test

Air

Lens loses flexibility with age; increased difficulty focusing on near things

Presbyopia

Nearsightedness

Myopia

Farsightedness

Hyperopia

What does a larger denominator indicate on the Snellen eye chart?

A larger denominator indicates worse vision (ex. 20/200 vision means the pt at 20 feet can read what a normal eye can read at 200 feet)

What is an alternative test for visual acuity? (This can be done at bedside)

Rosenbaum test

What is the purpose of testing a pts visual fields?

Valuable for detection of a lesion in the anterior or posterior pathways (peripheral fields)

What type of anopsia would occur if there was a lesion at the optic nerve of the right eye?

Total right eye vision loss

What type of anopsia would occur if there was a lesion at the optic chiasm?

Bitemporal hemianopia

What type of anopsia would occur if there was a lesion at the left lateral optic nerve?

Left nasal hemianopia

What type of anopsia would occur if there was a lesion on the left optic tracts approaching the lateral geniculate nucleus?

Right homonymous hemianopia

What does the static finger wiggle test evaluate?

Visual fields

Upon inspection of the eyes, you shine a light directly from the temporal side of the pt to look for a crescentic shadow on the medial side of the iris. On a normal exam there is no shadow. What disease process would cast a crescentic shadow?

Acute narrow-angle-glaucoma

Constricted pupils

Miosis

Dilated pupils

Mydriasis

Unequal pupil sizes greater than or equal to 0.4mm without known pathology

Anisocoria

You test the patients direct and consensual pupillary light reflexes. When shining the light on the right eye, you notice the left eye does not have the appropriate reflex. What have you determined?

Loss of consensual pupillary light reflex (CN III lesion)

You test the patients direct and consensual pupillary light reflexes. When shining the light on the right eye, you notice the right eye does not have the appropriate reflex. What have you determined?

Loss of direct pupillary light reflex (CN II lesion)

What causes pupillary defects (miosis, anisocoria), ptosis, and unilateral anhydrosis?

Horner’s Syndrome

A unilateral eye condition in which the affected pupil is larger than the other, responds to accommodation and convergence in a slow, delayed fashion, and reacts to light only after prolonged exposure to dark or light

Adie’s Pupil (Tonic pupil)

What defect causes small, irregular pupils bilaterally? (Constrict with near vision and dilate with far vision, but do not react to light)

Argyll Robertson Pupils

Types of abnormal EOMs

Strabismus, nystagmus, lid lag

Esotropia, exotropia, hypertropia, and hypotropia are all examples of what?

Strabismus

When testing the EOMs you note a rim of sclera visible above the iris with downward gaze, what does this patient exhibit?

Lid lag sign

What test would you use to examine a pts corneal light reflex?

Hirschberg test

_______ ________ is the phenomenon where on exam of the eye a small artery is seen crossing a small vein, which results in compression of the vein with bulging on either side of the crossing

AV nicking

Flame hemorrhages, hard exudates, papilloedema, and cotton wool spot are all forms of what?

Hypertensive retinopathy

Exophthalmos (thyroid disease) may be detected by standing behind the patient and inspecting from above. What would you expect to see?

Eye protrusion

_______ is formed by submucosal growth of fibrovascular connective tissue that migrates onto the cornea

Pterygium

A golden to red brown ring, sometimes shading to green or blue from copper deposition in the periphery of the cornea found in Wilson disease

Kayser-Fleischer ring

A small, yellowish submucosal elevation adjacent to the limbus

Pinguecula

Sensory; smell

CN I: Olfactory

Sensory; vision

CN II: optic

Motor; most eye movement

CN III: oculomotor

Motor; moves eye to look at nose

CN IV: Trochlear

Both motor and sensory; face sensation, mastication

CN V: Trigeminal

Motor; abducts the eye

CN VI: Abducens

Both motor and sensory; facial expression, taste

CN VII: Facial

Sensory; hearing and balance

CN VIII: Vestibulocochlear

Both motor and sensory; taste, gag reflex

CN IX: Glossopharyngeal

Both motor and sensory; gag reflex, parasympathetic innervation

CN X: Vagus

Motor; shoulder shrug

CN XI: accessory

Motor; swallowing, speech

CN XII: Hypoglossal

Which cranial nerve innervates the lateral rectus?

CN VI

Which cranial nerve innervates the superior oblique?

CN IV

The superior oblique muscle moves the eye in which direction?

Down and out

The inferior oblique muscle moves the eye in which direction?

Up and out

The extraocular muscles (EOMs) utilize which cranial nerves?

CN III, IV, VI

What is the only CN that innervates structures contralateral to its nucleus?

CN IV: trochlear

A patient with an injury to CN IV exhibits vertical diplopia and they will tilt their head to the ____________ side to improve their vision

Contralateral

How would you test the motor aspect of CN V?

Palpate the temporal and masseter muscles while the pt clenches their teeth (noting for strength)

How would you examine the sensory aspect of CN V?

Run an instrument (Qtip) down the forehead, cheeks and jaw on each side and note for pain sensation — also test for corneal reflex with cotton

Both peripheral and central facial palsy affect CN VII but how would you differentiate between them?

Central facial palsy will display preservation of forehead and brow movement (forehead-sparing lesions)

During a pt exam you test CN X and have the patient say “ah”. What abnormalities would you expect upon exam if there was a lesion on this nerve?

Deviated uvula (away from the lesion) or laryngeal paralysis (unilateral or bilateral)

What test is appropriate for evaluating CN XI?

Shrug test

Which way would the tongue deviate in an upper motor neuron lesion (central) of CN XII?

Contralateral side to the lesion

Which way would the tongue deviate in an lower motor neuron lesion (peripheral) of CN XII?

Ipsilateral side of lesion

What is the most important symptom when assessing a patients skin rash?

Itching

A macule and a patch are both flat. How do you distinguish the two lesions?

Size; Macule is <1cm, patch is >1cm

A papule and a plaque are both raised lesions. What is the distinguishing factor?

Size; papule is <1cm, plaque is >1cm

A vesicle is smaller or larger than a bulla?

Smaller (<1cm)

Nodules are ________ and ________ than a papule

Larger and deeper

Cleavage of the skin

Fissure

Open depression of the skin

Ulcer

What is the difference in presentation between carotenemia and jaundice?

Carotenemia does not involve yellowing of the eyes

What two tests should you preform on a hair examination?

Hair pull test (root test) and tug test (hair frailty)

Punctate depressions of the nail plate caused by defective layering of the superficial nail plate by the proximal nail matrix

Nail pitting

Exam 1 Flashcards

(99 cards)