Exam 3 Study Guide Flashcards
(249 cards)
1
Q
What is the structure and function of the eye?
A
We have the…
1. cornea, where the light enters the eye
2. pupil, adjusts in response to light with ciliary mm.
3. lens, that adjusts its shape to bend and focus light again (upside down image)
4. retina, ligh-sensitive area with rods and cones
5. optic n., from retina, electrical impulses relayed to the optic n., which is then moved to the occipital lobe at the back of the brain.
6. sclera, whites of eyes, below cornea
.
2
Q
What structures are visible in the back of they eye, in the retina?
A
optic disk, macula, fovea,
3
Q
What questions are asked in the subjective assessment of the eyes? (9)
A
Vision difficulty
Pain
Strabismus, diplopia
Redness, swelling
Watering, discharge
History of ocular problems
Glaucoma
Use of glasses or contacts
Self-care behaviors (vision test, meds)
4
Q
strabismus
A
is when the eyes are not working as one unit, one eye is on the object and one is either pointed outward, inward, upward, or downward.
5
Q
xerophthalmia
A
dry eyes
6
Q
phototopia
A
phtosensitivity
7
Q
myopia
A
nearsightedness, can see close, not far
8
Q
presbyopia
A
farsightedness, can see far, not close
9
Q
blind spots aka
A
scotoma
10
Q
clouding of eye indicates…
A
cataract
11
Q
floaters in eye indicate…
A
myopia, retinal detachment
12
Q
scotoma in the eye indicates…
A
glaucoma, migraine, optic atrophy, glaucoma, decreased Vit A
13
Q
halos indicate…
A
glaucoma
14
Q
Always ensure to do ______ in the subjective data assessment
A
PQRSTU
15
Q
external structure of eye
A
eyelid, sclera, iris, pupil
16
Q
internal structure of eye
A
cornea, lens, medial and lateral rectus muscles, and optic n.
17
Q
Which test should be used for color blindness?
A
the Ishihara test involves using pseudo isochromatic plates, in this case Ishihara plates, to test for the detection of red-green color deficiencies.
18
Q
Describe Snellen chart
A
Snellen chart is used to test for visual acuity. Person should stand 20 ft and shield one eye at a time. If they wear glasses or contacts, don’t remove. Encourage them to read line below what they say they can read.
19
Q
Which charts are used to test visual acuity in a child?
A
Tumbling E and picture charts for children below 3-6 yrs old
20
Q
Allen chart
A
picture chart, contains pics of familiar objects. At 15 ft., 3/7 ojecst ID = normal.
21
Q
What does 20/20 mean?
A
You have normal vision and are able to see at 20 ft., what another normal person can see at the same ft.
22
Q
OS, OD, and OU
A
OS= oculus sinister is LEFT
OD= oculus dexter is RIGHT
OU= oculus uterque is BOTH
23
Q
For those over 40, how do we test for near vision (myopia) and how do we test for presbyopia?
A
myopia: using a hand-held vision screener, 14’’ from eyes, test each eye separately. 14/14 is normal. OR use a magazine/newspaper.
presbyopia: loss of accommodation for near vision
24
Q
Accommodation refers to?
A
The ability of the lens to change its focus from distant objects
25
What does the confrontation test assess?
field of vision or peripheral vision
26
ESO stands for
esotropia, eyes turned inwards
27
EXO stands for
exotropia, eyes are turned out
28
How is the corneal light reflex assessed and what are some of the findings?
From a 12-in distance, we shine a light towards the person's eyes, as they stare straight ahead. The cornea should be in the same spot, otherwise, we may see EXO (light reflex displaced toward nasal) or ESO (light reflex displaced toward temporal)
29
Cover test is used to assess for?
strabismus, presence of EXO or ESO, if either is present, Can lead to amblyopia = lazy eye, poor vision not correctable by eyeglasses
30
Exotropia: Eye moves
Esotropia: Eye moves
inward to pick up fixation
outward to pick up fixation
31
The six cardinal positions of gaze will elicit any ...
any muscle weakness during movement, problem with CN, nystagmus
32
nystagmus
fine oscillating movement that is involuntary, best seen around the iris.
33
exopthalmus
What? protuberent eyes
When?
34
ptosis
What? dropping of eyelid
When?
35
What are you looking for when you look at the eye structures? Symmetry, (1), anything that is skin you look for (2) You will look for (3) from the eye. Have the person look up and using your thumbs slide the lower lids down, the area should be (4). The conjunctiva is (5), the sclera is (6).
1- movement that is symmetrical
2- redness, lesions or swelling.
3- discharge
4- pink.
5- clear
6- white
36
Shine a light across the cornea and check for ....
smoothness and clarity, there should be no cloudiness in the cornea.
37
The iris normally appears (1)
Note the (2) of the pupils.
Resting pupil size is (3)
, and it they are irregular ask the patient if it is normally that way because there are a few people out there that have that, and it is called (4)
1- flat with a round regular shape and even coloration.
2- size, shape and equality
3- 3-5mm
4- aniscoria
38
PERRLA
equal, round, reactive to light and accommodation
39
What is another way we test for accommodation?
Ask the person to focus on a distant object, then have them shift their gaze to a near object about 7-8 in from their nose and they should constrict and converge.
40
fundoscopic exam
aka ophthalmoscopy, a test where we see the fundus of the eye. Part of a routine physical exam.
41
red reflex
reflects off retina
42
How does the ophthalmoscope help us better examine the eye?
It enlarges our view of the eye and let's us see the fundus area.
43
How do we use an ophthalmoscope?
Hold it in our r. hand over our r. eye, into their r. eye with our left hand on their brow. Select the large round aperture with the white light for the routine exam, or the smaller white light if the pupil is small.
Have them stare at a distant, fixed object. Put your thumb on the upper lid to keep it from blinking and to anchor it.
Begin about 10 inches away at an angle and then you check the red reflex, and hone in on that, moving steadily closer to the eye. As you advance adjust the lens to +6. Look for black dots or dark shadows interrupting the red reflex – there should not be any. Your forehead will almost touch the patients.
44
If the red reflex is absent it could indicate a....
retinoblastoma which is an eye cancer that begins in the retina.
45
optic disc appearance
round, distinct, creamy-orange,
nasal side
46
diopter
aperture sight component used to assist aim of device
47
aperture
hole through which light travels
48
How do we bring the ocular fundus into sharp focus?
Adjust the diopter setting, If you and the person have normal vision that will be 0.
49
What are you looking for in the ocular fundus?
The general backgroud should be light red to dark brown-red.
No lesions should obstruct the retinal structures. – look for the optic disc, located on the nasal side of the retina. It should be creamy yellow-orange to pink, round or oval, with distinct margins. The nasal edge may be slightly fuzzy.
50
What are two normal variations you may see in the fundus?
scleral crescent and a pigment crescent.
1. The scleral crescent is a gray-white new moon shape and a
2. pigment crescent is black like in this picture. These are seen around the disc margins.
51
How do we examine retinal vessels?
follow a paired artery and vein out to the periphery in the four quadrants, noting the number, color (arteries are brighter red than veins),
52
A/V ratio
the ratio comparing the artery to vein width should be 2:3 or 4:5. The vessels should decrease in caliber as they extend to the periphery.
53
Look at vessel _______, knowing that some twisting is ok, especially if it is in both eyes – then it is likely congenital.
tortuosity
54
Look at the macula which should be about
Look at this area last because....
2 disc diameters from the optic disc towards the temporal side, and about the same size.
..... bright light here can cause some discomfort or eye watering and pupillary constriction. It is usually a little darker than the rest of the fundus.
55
Birth–2 wks: blinks to
bright light
56
by 2-4 wks:
fixates object
57
By 1mos
tracks light or bright object
58
By 3-4m:
fixates, tracks, reaches for object
59
By 6-10m:
can track in all directions
60
What conditions can occur in the aging adult's eyelid?
entropian and actropian
61
entropian
lower lid is turning in.
62
ectropian
the lower lid drops away,
63
These are yellowish elevated nodules on the sclera due to thickening of the conjuctiva from prolonged exposure to sun, wind, and dust. Usually they appear at the 3 and 9 o’clock positions, first on the nasal side and then the temporal side.
pingueculae
64
a fleshy mass of thickened conjunctiva that grows over part of the cornea and causes a disturbance of vision, The exact cause is unknown. It is more common in people who have a lot of exposure to sunlight and wind, such as people who work outdoors.
pterygium aka surfer's eye
65
is a cloudy cornea, sometimes in a ring around the eye, caused by the deposition of lipid material.
It has no effect on vision.
arcus senilis
66
Tiny (1-2 mm) yellowish plaques that are slightly raised on the skin surface of the upper or lower eyelids. ___________ is caused by tiny deposits of fat in the skin and is often associated with abnormal blood fat levels (hyperlipidemia)
xanthelasma
67
is tiny yellow or white accumulations of extracellular material that build up on the retina of the eye.
drusen
68
The presence of a few small _______ is normal with advancing age, and most people over 40 have some.
If there is a lot of it or in specific places can be indicative of specific eye conditions. They have no effect on vision. They are random in the eye, but usually symmetrical in each eye.
drusen
69
________ is caused by: local infections, crying, CHF, renal failure, allergies
periorbital edema
70
inflammation of the eyelids.
blepharitis
71
is a beady nodule protruding on the lid, it is an infection or cyst. It is a non tender, firm swelling, and if it becomes inflamed, it points inside and not out like a hordeolum or stye.
chalazion
72
a localized staph infection of the hair follicles at the lid margin. It is painful, red, and swollen. It can spread if rubbed, so we encourage patients who have this not to rub them.
hordeolum
73
INFLAMMATION OF LACRIMAL SAC
infection and blockage of the lacrimal sac and duct. It will hurt, be warm to the touch, red, and swollen toward the nose. Tearing is present, and pressure on the sac yields purulent discharge from the puncta.
dacryocystitis
74
red eye can be caused by...
conjunctivitis or subconjunctival hemorrhage
75
an infection of the conjunctiva, also called pink eye.
Conjunctivitis
76
a red patch on the sclera, looks alarming, but is usually not serious.
It occurs from increased intraocular pressure from coughing, vomiting, weight lifting, labor during child birth, straining, or trauma.
subconjunctival hemorrhage
77
is rare, but occurs most often on the lower lid and medial canthus (inner corner of the eye). It looks like a papule with an ulcerated center. Metastasis is rare but it should be removed.
Basal cell carcinoma (BCC)
78
Structure of the neck consists of
1. hyoid bone
2. .thyroid cartilage
3. cricoid cartilage
4. isthmus of thyroid
5. thyroid gland
6. sternomastoid muscle
7. trachea
8. clavicle
9. manubrium
79
an important endocrine gland straddles trachea in middle of the neck
thyroid gland
80
What does the thyroid gland do?
Synthesizes and secretes thyroxine (T4) and triiodothyronine (T3), which are hormones that stimulate rate of cellular metabolism
81
Describe structure of thyroid gland
The gland has two lobes, connected in middle by a thin isthmus and above that by the cricoid cartilage or upper tracheal ring
82
________ above thyroid gland, with small palpable notch in upper edge, the “Adam’s apple” in males
Thyroid cartilage
83
__________ __________ an extensive vessel system, is major part of immune system, which detects and eliminates foreign substances from body
lymphatic system
84
Vessels allow flow of clear, watery fluid from tissue spaces into circulation
lymph system vessels
85
are small, oval clusters of lymphatic tissue that filter lymph and engulf pathogens, preventing potentially harmful substances from entering the circulation
lymph nodes
86
Greatest supply is in head and neck
lymphatic
87
Normal nodes feel....
.... movable, discrete, soft, and nontender
88
If any nodes are palpable, note .....
location, size, shape, delimitation (discrete or matted together), mobility, consistency, and tenderness
89
If nodes enlarged or tender, ...
check area they drain for source of the problem; they often relate to inflammation or neoplasm in head and neck
90
What are the 10 lymph nodes
1. preauricular
2. posterior auricular
3. occipital
4. submental
5. submandibular
6. jugulodigastric
7. superficial cervical
8. deep cervical
9. posterior cervical
10. supraclavicular
91
preauricular
in front of ear
92
posterior auricular
mastoid, superficial to it
93
occipital
base of skull
94
submental
behind tip of mandible, midline
95
submandibular
halfway between angle and tip of mandible
96
jugulodigastric
under angle of mandible
97
superficial cervical
overlying sternomastoid muscle
98
deep cervical
deep under sternomastoid muscle
99
in posterior triangle along edge of trapezius muscle
posterior cervical
100
just above and behind clavicle @ sternocmastoid m.
supraclavicular
101
palpate lymph nodes
Using a gentle circular motion of fingerpads
102
Beginning with__________ lymph nodes in front of ear, palpate the 10 groups of lymph nodes in routine order
preauricular
103
Many nodes are _______ _______, so you must be systematic and thorough in your examination
closely packed
104
Do not vary sequence or you may.....
miss some small nodes
105
Bones of .... are separated by sutures & fontanels, spaces where the sutures intersect
neonatal skull
106
The membrane-covered_______ allow growth of brain during 1st yr; gradually ossify
“soft spots”
107
Triangle-shaped _______ ________ closes by 1-2 mths
posterior fontanel
108
Diamond-shaped _________closes between 9mths - 2 years
anterior fontanel
109
During_____ head growth predominates; head size is greater than chest circumference at birth.
Reaches ____ of final size at 6 years old
- fetal period,
- 90%
110
Thyroid gland enlarges slightly during _______ as a result of hyperplasia of tissue and increased vascularity, so may be palpable
pregnancy
111
a blotchy, hyperpigmented area over cheeks and forehead that fades after delivery (2nd trimester)
Chloasma:
112
facial expressions are mediated by which cranial nerve?
Number 7, which is the facial nerve.
113
_______ are located throughout the body but are accessible to examination only in four areas – head and neck, arms, axillae, and inguinal region.
Nodes
114
direction of drainage patterns of lymph nodes
115
In the aging adult:
1. ______ appear more prominent, facial skin sags resulting from decreased elasticity, decreased subcutaneous fat, and decreased moisture in skin
2. ________ may look twisted and prominent
3. Lower face may look smaller if ________
4. _______ tremors of head
1. Facial bones and orbits
2. Temporal arteries
3. teeth have been lost
4. Senile
116
These are all part of which part of the Head/Neck/Lymph assessment: Headaches (frequent or unusual)
Head injury
Dizziness
Neck pain
Lumps or swelling in head or neck
Surgery on head or neck
subjective data
117
Skull is normally...
Normocephalic
118
normally feels smooth and symmetric
skull
119
Palpate ______ _______ above zygomatic (cheek) bone between eye and top of ear
temporal artery
120
Palpate _____ ______ as the person opens the mouth, and note normally smooth movement with no limitation or tenderness
temporomandibular joint
121
__________ is the term used for a round, symeteric skull that is appropriately related to body size – but there is a wide range of sizes that can be considered normal.
normocephalic
122
literally means "inflammation of the temporal arteries.“ Symptoms can range from relatively minor--jaw pain or headache--through major-- including temporary or permanent blindness.
temporal arteritis
123
Term for head position is centered in midline, and accessory neck muscles should be symmetrical
symmetry
124
This is assessed to note any limitation of movement during active motion
ROM
125
Test muscle strength and status of _______ by trying to resist person’s movements with your hands as person shrugs shoulders and turns head to each side
cranial nerve XI
126
Note any obvious pulsations; ______ _______ creates brisk localized pulsation just below angle of the jaw
Normally, there are no other pulsations while person is in sitting position
carotid arteries
127
Note ______ _______enlargement though normally none is present
thyroid gland
128
Normally, _________ is midline; palpate for any tracheal shift
Space should be symmetric on both sides
Note any deviation from midline
trachea
129
Difficult to palpate; check for enlargement, consistency, symmetry, and presence of nodules
thyroid gland
130
If thyroid gland is enlarged...
... auscultate thyroid for presence of bruit, which occurs with accelerated or turbulent blood flow, indicating hyperplasia of thyroid (e.g., hyperthyroidism)
131
______ is the enlargement of thyroid: it can compress the trachea and esophagus leading to symptoms such as coughing,
waking up from sleep feeling like you can’t breathe, and the sensation that food is getting stuck in the upper throat.
goiter
132
_____ occur with turbulent blood flow; indicating hyperplasia of thyroid => hyperthyroidism.
bruit
133
To assess for enlarged thyroid have the patient ...
bend head slightly forward and to right: left hand displaces trachea; right hand palpates thyroid.
Ask to swallow.
134
To palpate the thyroid you can either ....
stand behind the patient and have them turn their head slightly one way and then the other,
or you can stand in front of them and do that.
135
For infants and children's skull
Measure infant’s head at each visit up to age __ years; and yearly up to age ___ years
2
6
136
Note infant’s head posture and head control; infant can turn head side to side by ____
2 weeks
137
Head control achieved by_____, when baby can hold head erect and steady
4 months
138
Shows tonic neck reflex when supine and head turned to one side (extension of same arm and leg, flexion of opposite arm and leg); reflex disappears at _____
3 to 4 months
139
This soft spot is resolved by 9m-2yrs
AF anterior fontanelle
140
______ ______ can tell us a lot about nutrition of baby
soft spots
141
This soft spot is resolved by 2mos
PF posterior fontanelle
142
edematous swelling and ecchymosis of presenting part of head caused by birth trauma; gradually resolves during first few days of life and needs no treatment
caput succedaneum
143
subperiosteal hemorrhage, a result of birth trauma appears several hours after birth and gradually increases in size; will be reabsorbed during first few weeks of life without treatment
cephalhematoma
144
____________ can happen with a forceps delivery
Cephalhematoma
145
Obstruction of drainage of cerebrospinal fluid results in excessive accumulation, increasing intracranial pressure, and enlargement of the head
hydrocephalus
146
Increasing pressure also produces dilated scalp veins, frontal bossing, and downcast or “setting sun” eyes (sclera visible above iris)
hydrocephalus
147
In hydrocephalus, cranial bones are....
Cranial bones thin, sutures separate, and percussion yields a “cracked pot” sound
148
..... is a thyroid deficiency at an early age which produces impaired growth and neurologic deficit. There are facial signs like low hairline, swollen eyelids, narrow palpebral fissures, widely spaced eyes, depressed nasal bridge, and more.
congenital hypothyroidism
149
.... has head and face characteristics line upslanting eyes, flat nasal bridge, small, broad, flat nose, protruding thick tongue, and more.
Down syndrome
150
_____________ is a transverse line on the nose that occurs from a child chronically using their hand to push up the nose to relieve itching and to free swollen turbinates which allows air passage.
Allergic salute and crease
151
___ happens when a pregnant woman abuses alcohol and the facial malformations in this condition includes narrow palpebral fissures, a flat midface, a short nose, thin upper lip and more as shown in the picture.
Fetal alcohol syndrome (FAS)
152
Excessive secretion of growth hormone from pituitary after puberty creates an enlarged skull and thickened cranial bones causes...
acromegaly
153
Acromegaly signs:
Elongated head, massive face, prominent nose and lower jaw, heavy eyebrow ridge, and coarse facial features
154
Covers 20 square feet of surface area in adults
skin
155
____ is waterproof, protective, and adaptive
Protection from environment
Prevents penetration
Perception
Temperature regulation
Identification
Communication
Wound repair
Absorption and excretion
Production of vitamin D
skin
156
These are all ______ data we collect from the skin, hair, and nails assessment:
Past skin disease
Change in skin color/pigmentation
Change is mole
Excessive dryness or moisture
Itching
Bruising
Rash/lesions
Medications
Hair loss/change in nails
Environmental hazards
Skin care
subjective
157
_______ is directed over the area of the suspected problem and the dermatologist looks to see if there is any fluorescence/visible light reflected back.
UV light from the Wood's lamp (black light)
158
involves taking a sample of skin (scrapings) where the suspected infection is. The hair or skin sample is placed on a slide with a little of a 10% to 20% concentration potassium hydroxide solution and gently heated. This solution slowly dissolves the hair and skin cells but not the fungus cells. The fungus cells can then be seen with a microscope.
The KOH test
159
below 95 F
hypothermia
160
99.5-100.9 or greater-resource dependent
hyperthermia
161
Use backs of hands to palpate
Skin should be warm, and temperature equal bilaterally; warmth suggests normal circulatory status
temperature
162
Multiple bruises at different stages of healing and excessive bruises above knees or elbows should raise concern about ______ _____
physical abuse
163
Needle marks or tracks from___________ of street drugs may be visible on antecubital fossae, forearms, or on any available vein
intravenous injection
164
a discoloration of the skin resulting from bleeding underneath, typically caused by bruising.
ecchymosis
165
If any are present note:
Color
Elevation
Pattern or shape
Size
Location and distribution on body
Any exudate: note color and odor
Use a Wood’s light (ultraviolet light filtered through special glass) to detect fluorescing lesions
lesions
166
Teach skin self-examination using ABCDE rule to detect suspicious lesions, which stands for?
A - asymmetry
B - border
C - color
D - diameter
E - elevation or Evolution
167
We want bi-symmetric lesions, that way we don't susepct _______
cancer
168
_____ is just a color change – is is flat and less than 1 cm – examples are freckles.
macule
169
A ______ are macules that are larger than 1 cm, like in vitiligo, or a café au lait spot
patch
170
A ________ is something you can feel – solid, elevated, less than 1 cm diameter, like a mole
papule
171
A ______ is a surface elevation wider than 1 cm, like psoriasis
plaque
172
A ____ is solid and elevated. larger than 1 cm that may extend deeper into the dermis than a papule, and an example is xanthoma – remember – we talked about this when we talked about eyes, and there is a picture there for you.
nodule
173
A ______ is larger than a few centimeters, examples are lipoma or hemangioma
tumor
174
A _____ is a superficial, raised, transient, slightly irregular in shape – and an example is an allergic reaction.
wheal
175
______ – circular – like ring worm
Annular
176
______ – distinct individual lesions that remain separate –ex: skin tags and acne even
Discrete
177
_______ – clusters of lesions (contact dermatitis)
Grouped
178
________ – lesions that run together (urticaria – or hives)
Confluent
179
_____ – snake-like formation
Gyrate
180
_______ is like a bullseye
Target or iris
181
______ – form a streak, line or stripe
Linear
182
_______ – annular lesions that grow together.
Polycyclic
183
_________ – lesions take a linear arrangement along a nerve route (herpes zoster) is painful
Zosteriform
184
- ________ is a fungal infection on the skin – not a worm at all, and people get confused about that, so now you know if you didn’t already.
Ringworm
185
target rash is commonly seen in....
Lyme disease
186
_______ causes a red-purple blotchy rash that occurs on third or fourth day of illness.
The rash starts behind the ears and spreads to the face, over neck, trunk, arms, and legs.
measles
187
measles is an example of which type of skin lesion?
confluent
188
________ a scaly, red patch with silvery scales on top. Usually on the scalp, outside of elbows and knees, low back, and anogenital area.
psoriasis
189
__________ are caused by a benign proliferation of blood vessels in the dermis. This picture is of an immature hemangioma, or strawberry mark, which is present at birth or develops in the first few months, and usually disappears by age 5 to 7. They can be much more extensive than that, and pressure from parents and peers may prompt treatment. It can be much more extensive than this.
Hemangioma
190
_______ red scaly patch with sharp margins, 1 cm or more.
Develops central ulcer and surrounding erythema.
Usually on hands or head, areas exposed to sun. Less common than BCC but grows rapidly.
squamous cell carcinoma SCC
191
_____ = usually starts as a skin-colored papule with translucent top.
Then develops rounded pearly borders with central red ulcer, or looks like large open pore with central yellowing.
Most common form of skin cancer; slow growth.
BCC basal cell carcinoma
192
Edema is graded on a 4 point scale and grading can be subjective.
1+ is mild pitting, slight indentation, no perceptible swelling of the leg
2+ is moderate pitting, indentation subsides rapidly
3+ Deep pitting, indentation remains for a short time, let looks swollen
4+ very deep pitting, indentation lasts a long time, leg is very swollen
193
edema
is fluid accumulating in the intercellular spaces, and is not usually present.
You check for edema by imprinting your thumbs firmly against the ankle or the tibia.
Normally the skin surface remains smooth.
194
________ is a sudden appearance of a circumscribed,
round or oval balding patch, usually with smooth, soft, hairless skin underneath.
The cause is unknown, and the hair usually regrows.
alopecia areata
195
There are rashes that can occur on the scalp, like _____ or ______which presents as flaky,
dry skin that looks like dandruff, or thick, oily, yellowish or brown scaling or crusting patches, it is harmless
and the cause is unknown.
seborrheic dermatitis or cradle cap
196
________ has symptoms like itching of the scalp.
The nits or eggs are easier to see , appearing as 2-3 mm oval translucent bodies, adherent to the hair shafts.
Head lice
197
head lice aka
more officially known as pediculosis capitis,
198
capillary refill times for newborns, adults, and older adults is....
Newborns could take as little as 2 seconds.
Adults refill in about 3 seconds.
Older adults often take more than 3 seconds.
199
______ of nails, from COPD, congenital heart disease, cystic fibrosis.
Clubbing
200
Normal angle between the nail and the base is _____ and a curved nail may have an angle that is less, but when it is straight it is considered clubbing.
160 degrees
201
What causes clubbing?
fragmented platelets that get trapped in the finger tip vasculature,
releasing platelet-derived growth factor and promoting growth of vessels which shows as clubbing.
202
The _______ is a window to the even, pink nail bed underneath.
translucent nail
203
This is checking for, _________ :
Depress nail edge to blanch and then release, noting return of color; indicates status of peripheral circulation
Color return is normally instant
Sluggish color return takes longer than 1 or 2 seconds
capillary refill
204
_______ transverse groove from trauma, acute illness or toxic reaction.
The dent appears first at the cuticle and moves forward as the nail grows.
Beau's lines
205
_________ - white spotting seen in nails, streaking, or discoloration of the fingernails, (congenital/hereditary) or due to a result from arsenic poisoning, injury, heart disease, renal failure, pneumonia, ill health or hypoalbuminemia.
Leukonychia
206
as a result of disease process
primary lesion
207
from primary or patient's own activities
secondary lesion
208
These are all fxns of which system:
Support to stand erect
Movement
Encase and protect the inner vital organs
To produce red blood cells in the bone marrow
hematopoiesis
Reservoir for storage of essential minerals
Calcium and phosphorus
musculoskeletal system
209
where two bones meet
joint
210
bone to bone
ligament
211
m. to bone
tendon
212
________ is the cerebrum’s outer layer, and is the center for human’s highest functions, governing thought, memory, reasoning, sensation, and voluntary movement
cerebral cortex
213
Which type of disease are these signs associated with:
trouble learning or remembering new things, hard time problem solving, slowed thinking, problems walking, balance issues.
white matter diseases
214
fatigue and memory loss.
215
Which type of disease are these signs associated with:
fatigue and memory loss.
gray matter disease
216
______ is the main relay station where the sensory pathways of the spinal cord, cerebellum, and brainstem form synapses on their way to the cerebral cortex
thalamus
217
________ is a major respiratory center with basic vital functions like temperature, appetite, sleep, sex drive, heart rate, and blood pressure control
hypothalamus
218
The ______ is a coiled structure located under the occipital lobe that is concerned with motor coordination of voluntary movements, equilibrium, and muscle tone.
cerebellum
219
The _______ is the central core of the brain consisting of mostly nerve fibers
brain stem
220
What are the three areas of the brain stem?
midbrain, pons, and medulla.
221
Importance of the brainstem:
The brainstem provides the main motor and sensory innervation to the face and neck via the cranial nerves.
Of the twelve pairs of cranial nerves, ten pairs (3-12) come from the brainstem.
This is an extremely important part of the brain as the nerve connections of the motor and sensory systems from the main part of the brain to the rest of the body pass through the brainstem.
The brainstem also plays an important role in the regulation of cardiac and respiratory function.
It also regulates the central nervous system, and is pivotal in maintaining consciousness and regulating the sleep cycle.
The brainstem has many basic functions including heart rate, breathing, sleeping, and eating.
222
Spinal nerves
___ pairs of spinal nerves arise from length of spinal cord and supply rest of body
How many of each?
Named for _________ from which they exit:
“Mixed” nerves, they contain both sensory and motor fibers
Each innervates particular segment of body
__________ is cutaneous distribution of various spinal nerves
- 31
- 8 cervical, 12 thoracic, 5 lumbar, 5 sacral, and
1 coccygeal
- region of spine
- Dermal segmentation
223
A _______ is an area of skin supplied with nerve fibers by a single spinal root.
dermatome
224
________ basic defense mechanisms of nervous system
Involuntary; below level of conscious control permitting quick reaction to potentially painful or damaging situations
reflex arc
225
What are the 4 types of reflexes?
Deep tendon reflexes (myotatic), e.g., knee jerk
Superficial, e.g., corneal reflex, abdominal reflex
Visceral, e.g., pupillary response to light
Pathologic (abnormal), e.g., Babinski’s reflex or extensor plantar reflex
226
This is an example of how the reflex works – the ________ is stimulated with a reflex hammer and the sensory nerve takes this action potential toward the CNS or spinal cord (where the reflex is mediated), it synapses there and then the descending motor nerve is stimulated and a muscle reaction occurs.
patellar tendon
227
These neuro findings are typical of which age group?
Neurologic system not completely developed at birth
Movement directed primarily by primitive reflexes
Persistence of primitive reflexes is an indication of CNS dysfunction
Sensory and motor development proceed with gradual acquisition of myelin needed to conduct most impulses
As myelinization develops, infant able to localize stimulus more precisely and make more accurate motor response
infants
228
These neuro findings are typical of which age group?
general loss of muscle bulk
loss of muscle tone in face, neck, and around spine
decreased muscle strength, impaired fine coordination and agility
loss of vibratory sense at ankle
decreased or absent Achilles reflex, pupillary miosis, irregular pupil shape, and decreased pupillary reflexes
Velocity of nerve conduction decreases making reaction time slower in some older persons
Increased delay at synapse results in diminished sensation of touch, pain, taste, and smell
Progressive decrease in cerebral blood flow and oxygen consumption may cause dizziness and loss of balance
aging adult
229
Tranquilizers (benzodiazepines): diazepam (Valium), alprazolam (Xanax), chloridazepoxide (Librium), Clonazepam (Klonopin)->
anxiety
230
Barbiturates: Amobarbital (Amytal), pentobarbital (Nembutal), butalbital/aspirin/caffeine (Fiorinal) treats?
headaches, insomnia, and seizure
231
Reflexes in infants that you would be looking at are ______, touch the cheek the baby will turn the head toward the touch_____with a loud noise, grasp your finger would be looking at the grasp reflex
- sucking
- , startle reflex
232
What are the3 types of neuro exams?
screening, complete, and recheck
233
A __________ is performed on well persons who have no significant subjective findings revealed in their history. Cholesterol labs, fecal occult lab, Pap test, PSA, Mammography, Colonoscopy.
screening examination
234
A ________ is performed on persons who have neurologic concerns identified through the neurologic history (headache, weakness, loss of coordination). Cranial nerves!
complete examination
235
A _________ is performed on persons who have had a complete neurologic examination and are being seen for follow-up care (hospitalized clients due to head trauma or systemic disease).
neurologic recheck
236
These are all included in which assessment?
LOC, Level of consciousness
Motor Function
Pupils
VS, Vital Signs
What does Perrla stand for:
P:
E:
R:
R:
L:
A:
Neuro recheck exam
237
What is the sequence of the neuro exam?
1. Mental status
2. Cranial nerves
3. Motor system
4. Sensory system
5. Reflexes
238
Which CN is being described:
Sensory:
Smell—coffee, cloves, peppermint
Normal: can smell
Abnormal: can’t smell
Reason: URI, tobacco smoking, cocaine use
CN I Olfactory
239
Which CN is being described:
- Visual acuity—Snellen chart
- Test for visual fields with confrontation test: both cover opposite eye, use wiggling fingers from 6 directions to check peripheral vision
- Examine with ophthalmoscope to determine the color, size, and shape of the optic disc. Do you remember what it should be? Optic disc round, distinct, creamy-orange, nasal side
CN II Optic
240
Which CN is being described: movement of the eye muscles, constriction of the pupil, focusing the eyes and the position of the upper eyelid.
CN III Occulomotor
241
Which CN is being described: Motor:
- Inferior lateral movement of the eye
CN IV Trochlear
242
Which CN is being described: Motor:
- Inferior lateral eye movements
CN VI Abducens
243
Which CNs are being described:
Equal palpebral fissures
PERRLA
EOM’s
III, IV, and VI
244
Which CN is being described:
Motor:
- Chewing, biting, lateral jaw movements (move jaw side to side) – palpate the temporal and masseter muscles as the person clenches the teeth; muscles should feel strong on both sides, you should also try to separate the jaws by pushing sown on the chin, normally you can’t open the mouth
Sensory:
- Corneal reflex – not usually done unless there is other neuro deficits: wisp of cotton to the cornea and the person should blink bilaterally, evidence does not support the use of this test anymore.
- Sensation of skin of the face (eyebrow, cheeks and chin) using a wisp of cotton; they say “now” when they can feel it
CN V Trigeminal
245
Which CN?
Motor:
- Look for mobility and symmetry as the patient smiles, frowns, closes their eyes tight against you attempting to open them, lift their eyebrows, show their teeth, and puff out their cheeks. You should push the air out of their cheeks and make sure the air escapes equally from both sides.
Sensory: is not tested routinely, but only when you suspect facial nerve injury, and it is all about taste.
-you can try either sugar, salt, or sour
V Facial
246
Which CN?
Hearing:
Conversation
Whisper voice test
CN VIII vestibulocochlear or acoustic
247
________ is when you test one ear at the time while masking hearing in the other ear to prevent sound transmission around the head. You pump the tragus of the one ear and whisper about 1 foot from the other ear while shielding your lips. You whisper 3 unrelated numbers or letters, like “3 Y 8”. You can repeat another 3 items like this if they don’t hear you the first time. Out of 6 possible right responses they have to get 3. If they get 3 the first time you can move on.
whisper test
248
Which CNs are these?
Motor: “ahhh” uvula rises and gag reflex
Sensory: Taste posterior 1/3 tongue but…
IX and X GP & Vagus
249
CN IX Glossopharyngeal & X Vagus Nerves
Motor: “ahhh” uvula rises and gag reflex
Sensory: Taste posterior 1/3 tongue but…
