Exam 1 review (Gen survery, skin, eyes, ENT) Flashcards
(130 cards)
1
Q
What is the most critical portion of the physical exam? (Hint: 2)
A
General appearance and vital signs
2
Q
What percent of arm circumference should width of BP inflatable bladder be?
A
40%
3
Q
Average adult BP bladder width?
A
12-14cm
4
Q
What percent of arm circumference should length of BP inflatable bladder be?
A
80%
5
Q
Average adult BP bladder length?
A
Almost long enough to encircle arm
6
Q
Which artery should BP bladder be over?
A
Brachial
7
Q
How far above antecubital crease should lower border of BP cuff be?
A
About 2.5cm
8
Q
What is a silent interval between systolic and diastolic pressures?
A
Ausculatory gap
9
Q
What does Ausculatory Gap cause in estimate of systolic and diastolic?
A
Systolic=underestimation
Diastolic=overestimation
10
Q
Which diseases is Ausculatory Gap associated with? (Hint: 2)
A
Arterial stiffness or atherosclerotic disease
11
Q
How long to wait between BP readings?
A
At least 2 minutes
12
Q
Normal BP pressure difference between arms?
A
5-10mmHg
13
Q
Which 3 diseases can cause a 10-15mmHg difference in BP in both arms?
A
- Subclavian steel syndrome
- Supravalvular aortic stenosis
- Aortic dissection
14
Q
What is normal lower extremity pressure vs upper extremity pressure?
A
L.E. pressure is 5-10mmHg higher in LE than arms
15
Q
What 2 conditions cause Upper Extremity HTN and Lower Extremity hypotension?
A
- Coarctation of aorta
2. Occlusive aortic disease
16
Q
Coarctation of aorta and Occlusive aortic disease do what to LE and UE pressures and pulses?
A
UE=high BP
LE=low BP, diminished or delayed pulses
17
Q
What are the “end organs” which BP can damage?
A
Eyes, heart, brain, kidneys
18
Q
Define Myopia
A
Near sighted
19
Q
Define Hyperopia
A
Far sighted
20
Q
DEfine Presbuopia
A
Aging vision, difficulty with near vision
21
Q
Pain in eye caused by issues in what 2 places?
A
- Cornea
2. Anterior chamber
22
Q
What 2 things cause gradual bilateral vision loss?
A
- Cararact
2. Macular degeneration
23
Q
Define Scotama
A
specks in the vision or areas where the patient cannot see
24
Q
Moving specks or strands suggest vitreous floaters due to what?
A
Aqueous floaters
25
Define Hyphema
Blood in anterior chamber
26
Define Hypopyon
Pus in anterior chamber
27
Define Miosis
Constricted pupils
28
Define Mydriasis
Dilated pupils
29
Descibe Tonic/Avies Pupil
Unilateral dilated pupil, severely decreased light reflex. D/T parasympathetic deinnervation.
30
Describe Horner Syndrome pupil
Miosis, ptosis, anhydrosis. D/T sympathetic lesion.
31
Describe Argyll Robertson Pupils
No light reaction, small and irregular pupila
32
Define diplopia
Double vision
33
Diplopia due to lesion where? (Hint: 3 places)
1. Brainstem
2. Cerebellum
3. Cranial nerve
34
Horizontal diplopia due to palsy of which CNs?
3 or 6
35
Vertical diplopia due to palsy of which CNs?
3 or 4
36
Diplopia in one eye with other eye closed due to problem where? (2 places)
Cornea or lens
37
Legal blind in US?
20/200
38
Describe Papilledema
Edema of optic disc due to increased intracranial pressure
39
Arteries in the retina look like what? (color, light reflex, size)
Light red, bright light reflex, small
40
Veins in the retina look like what? (color, light reflex, size)
Dark red, absent light reflex, large
41
Normal Intraocular Pressure?
10-22
42
What does Hirschberg Test test for?
Manifest deviations “tropia”. Strabismus.
Corneal light reflex.
43
What will eyes do in Hirschberg Test?
One eye turns up/down/in/out while other stays straight
44
What will Cover Test detect?
Latent Deviation.
45
What happens to bad eye in Cover Test?
Covering good eye causes deviated eye to focus
46
Manifest Deviation in which test?
Hirschberg Test
47
Latent Deviation in which test?
Cover Test
48
What kind of pupil does the Swinging Flashlight Test detect?
Marcus Gunn Pupil
49
Swinging Flashlight Test tests which CN?
CN 2 optic nerve
50
Describe Swinging Flashing Light in good eye
Pupil constricts in direct response eye and consensual constriction in other eye
51
Describe Swinging Flashing Light in bad eye
Partial dilation of both eyes
52
Marcus Gunn Pupil due to what?
Decreased afferent stimulis in bad eye -> decreased efferent signal in both eyes
53
Describe Near Reaction and pupils
Shift gaze from far to near causes both pupils to constrict
54
What does Convergence test?
Eyes coming together at midline when focusing. EOM.
55
Which muscle and nerve tested in Convergence?
Medial rectus muscle, CN 3
56
What does Accommodation test for? What can’t the examiner do?
Brings near objects into focus. Can’t be seen by examiner.
57
CN for Lateral Rectus?
CN 6
58
CN for Superior Oblique?
CN 4
59
Describe Ptosis
Low lying upper lid during primary gaze
60
Ptosis muscle and nerve?
Levator palpebrae
| CN 3
61
Define Lagophthalmos
Inability to fully close eyelid
62
Lagophthalmos muscle and CN?
Obicularis muscle
| CN 7
63
Bell’s Phenomenon causes what to the eyelid?
Lagophthalmos (incomplete closure of eyelid)
64
Describe Hordeolum (Stye)
Infection at inner or outer margin of eyelid. Painful, tender, red, internal or external pustule. S Aureus. D/T obstructed gland or eyelash follicle.
65
Describe Chalazion
Subacute, non-tender, painless nodule. Points inside lid/within lid. Blocked meibomian gland.
66
Describe Xantheloma
Cholesterol filled plaques along nasal portion of nose
67
Microaneurysm, neovascularization, retinitis proliferans in which DZ?
DM
68
Ateriorlar narrowing, copper wiring, AV nicking, flame hemorhage in which DZ?
HTN
69
Hyperemia of disc, venous enlargement, retinal hemorrhage, cotten-wool spots in which DZ?
Papilledema
70
Which type of glaucoma causes peripheral vision loss?
Open angle glaucoma
71
Persistent tearing due to what?
Dacryoadenitis=
| Dacryocystitis=block of nasolacrimal duct
72
Conductive Hearing loss is due to problems where in the ear?
External or middle ear problems
73
What sort of enviroment might help someone with Conductive Hearing Loss?
Noisy environment
74
What will Webber Test show in unilateral Conductive Hearing Loss?
Lateralizes to impaired ear
75
What will Rhine Test show in Conductive Hearing Loss?
Sound heard as long or longer through bone than air.
| BC=AC or BC>AC
76
Sensorineural Hearing Loss due to what problems?
Inner ear, choclear nerve, connections to brain
77
What will people with Sensorineural Hearing Loss complain about?
People mumbling
78
Sensorineural Hearing Loss is worse in what sort of enviroment?
Noisy environment
79
What will Webber Test show in unilateral Sensorineural Hearing Loss?
Lateralizes to good ear
80
What will Rinne Test show in Sensorineural Hearing Loss?
Sound heard longer through air.
| AC>BC
81
Where can ear pain be referred from?
Structures in the mouth, throat or neck.
82
Does Tinnitus have an external stimulus?
perceived sound with no external stimulus
83
Tinnitus with hearing loss and vertigo suggests
Meniere’s disease
84
What does Vertigo refer to?
Perception that the patient or the environment is rotating or spinning
85
What does a tender nodes suggest?
Inflammation
86
What do hard or fixed nodes (fixed to underlying structures and not movable on palpation) suggest?
Malignancy
87
Enlargement of a supraclavicular node, especially on the left, suggests? From where?
Possible metastasis from a thoracic or an abdominal malignancy.
88
A pulsating “tonsillar node” is really what?
The carotid artery
89
A small hard tender “tonsillar node” high and deep between the mandible and the sternocleidomastoid is probably what
The styloid process.
90
Describe Nociceptive (somatic) pain
Nociceptive (somatic) pain is linked to tissue damage to the skin, musculoskeletal system, or viscera (vis- ceral pain), but the sensory nervous system is intact, as in arthritis or spinal stenosis. It can be acute or chronic.
91
Describe Neuropathic pain
Neuropathic pain is a direct consequence of a lesion
or disease affecting the somatosensory system. Over time, neuropathic pain may become independent of the inciting injury, becoming burning, lancinating, or shock-like in quality, It may persist even after healing from the initial injury has occurred. Mechanisms pos- tulated to evoke neuropathic pain include central ner- vous system brain or spinal cord injury from stroke or trauma; peripheral nervous system disorders causing entrapment or pressure on spinal nerves, plexuses, or peripheral nerves; and referred pain syndromes with increased or prolonged pain responses to inciting stim- uli.
92
Describe Central sensitization
In central sensitization pain, there is alteration of central nervous system processing of sensation, leading to amplification of pain signals. There is a lower pain threshold to nonpainful stimuli, and the response to pain may be more severe than expected. Mechanisms are the subject of ongoing research. An example is fibromyalgia, which has a strong overlap with depression, anxiety, and somatization disorders and responds best to medica- tions that modify neurotransmitters like serotonin and dopamine.
93
Describe Psychogenic pain
Psychogenic pain involves the many factors that influence the patient’s report of pain—psychiatric conditions like anxiety or depression, personality and coping style, cul- tural norms, and social support systems.
94
Describe Idiopathic pain
Idiopathic pain is pain without an identifiable etiology.
95
Overweight BMI range?
25-29.9
96
Obesity Class 1 BMI range?
30-34.9
97
Obesity Class 2 BMI range?
35-39.9
98
Obesity Class 3 (extreme obesity) BMI?
≥40
99
Risk for heart disease and obesity related disease if waist above ___ in men and ___ in women
Women ≥35
| Men ≥40
100
HTN defined as...?
≥140/90
101
HTN cut off in home, ambulatory, and automated cuffs
135/85 (lower than manual office)
102
5th vital sign?
Pain
103
Is "pain" subjective or objective?
Subjective. Tenderness is objective.
104
Wong Baker Faces scale is from what?
0-10
105
What is the benefit of Wong Baker Faces over others?
Wong-Baker can be used by children as well as patients with language barriers or cognitive impairment.
106
How far to insert the Otoscope into the ear canal?
1/3 and NO MORE!
107
Ears popping and decreased auditory function might mean sort of dysfunction?
Eustachian tube dysfunction
108
Where and what is the Mastoid like?
Like a sinus. Air-filled region of temporal bone. Brain very close so infection is mastoid is bad.
109
How to choose speculum size for Otoscope?
Select the largest speculum that will fit easily into the canal
110
Pneumatic otoscopy: more readily accomplished with larger or
| smaller otoscope speculum tip?
Larger! Seals off ear canal and air goes toward drum. Want to see drum moving when puff the ear.
111
How to assess “gross hearing”?
With whispered voice
112
If PT might have hearing loss from Gross Hearing Test then what 2 tests to do?
Webber and Rinne with 512hz tuning fork
113
Which hearing tests checks for lateralization?
Webber
114
Which hearing test compares air conduction to bone conduction?
Rinne
115
In Rinne test where is air heard longer normally?
Normally the sound is heard longer through air than through bone
(AC > BC).
116
Most common cause of conductive hearing loss?
Wax (aka cerumen)
117
Unilateral Conductive Hearing Loss Lateralizes to ____ ear
Impaired
118
Unilateral Sensorineural Hearing Loss Lateralizes to ____ ear
good
119
In conductive hearing loss, sound is heard through bone
As long as or longer than it is through air (BC=AC or BC >AC).
120
In sensorineural hearing loss, sound is heard longer through
Air (AC>BC).
121
How to test CN 1 (olfactory nerve)?
Familiar scent. Each nostril separately with eyes closed.
122
What is “cobblestoning”?
Post nasal drip causing tiny dots of the uvula
123
Which cranial nerve for the tongue and floor of the mouth?
Cranial Nerve XII
124
Which cranial nerves for the Soft Palate and Uvula (in the the Pharynx)?
Cranial Nerve IX and X
125
Gag reflex tests which CNs?
IX and X
126
Stick tongue out and remain midline which CN?
CN XII
127
Which CN? is tested by Have the patient say ahh and noting the uvula and hard palate. They should rise symmetrically with speaking.
CN X
128
Which CN checks the trachea for mobility and deviation?
CN XI
129
Lateral Rectus is which CN?
CN 6
130
Superior Oblique is which CN?
CN 4
