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1
Q

How would you describe a normal eye?

A

● Optic disc is orange/yellow/pink with clear margins and bright optic cup

● Optic cup ratio to optic disc 1:3

● Vessels are well defined and show no apparent nicks, hemorrhages or occlusions

● Retina shows no hemorrhages, exudates, or plaques

● Optic disc is the anatomic blind spot where nerves and blood vessels enter the retina.

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2
Q

what causes aortic stenosis

A
  1. degeneration if less than 70y/o
  2. Congenital if less than 70
  3. Congenital bicuspid valve,
  4. Rheumatic heart dz,
  5. Atherosclerosis
    - may be the cause of sudden death, particularly in children and adolescents, either at rest or during exercise; risk related to degree of stenosis
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3
Q

Describe these findings

A

TM retraction

● Increased visualization of bone landmarks

● If light reflex present at >100 degree of malleus

● Sign of eustachian tube dysfunction

● Immediate referral to ENT—can cause sudden deafness

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4
Q

Describe a pulmonary stenosis murmur

A
  • Grade I-IV, systolic harsh diamond shaped murmur, heard loudest over 2nd ICS and radiates to the back. Increased splitting of S2
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5
Q

Diagnose

A

Papilloedema (chronic phase)

  • caused by increased intracranial pressure
  • boundary of the papilla and surrounding retina are unclear
  • small exudate and hemorrhage
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6
Q

Describe these findings

A

● Calcifications with distinct edges and surrounded by margins of normal TM are normal finding
● Seen with hx of TM trauma or PE tubes

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7
Q

Diagnose

A

Serious Otitis Media (SOM)

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8
Q

What causes Wheezes

A

Asthma, fibrotic diseases (Farmer’s lungs, silicosis,etc), bronchiolitis,

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9
Q

What murmur is commonly seen with a narrow pulse pressure and a bounding WIDE pulse pressure

A
  1. narrow pulse pressure: Aortic stenosis
  2. Bounding, wide pulse pressure: Aortic regurgitation, PDA
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10
Q

Describe these findings

A

Abnormal Findings

● Erythema

● Bulging: light reflex at <90 degrees of malleus

● No visualization of incus

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11
Q

Describe an ASD murmur

A
  • Grade I-IV, widely split fixed S2, systolic ejection, diamond-shaped, and early diastolic diamond-shaped murmur heard loudest at 2nd ICS no radiation_._ Heard loudest over pulmonic area.
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12
Q

what causes Mitral stenosis

A
  1. Rheumatic heart disease (Most common by far)
  2. cardiac infection

**Also seen w R-sided HF, PHTN, and Afib

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13
Q

Where is a VSD murmur best heard?

A

Tricuspid (3­5th ICS)
Supine

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14
Q

Diagnose

A

Simple/Background Diabetic Retinopathy

  • microaneurysms
  • spotty hemorrhages
  • hard exudates
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15
Q

Diagnose

A

Traumatic Perforations

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16
Q

Diagnose

A

Age-Related Macular Degeneration

-macular exudates and subretinal hemorrhages

(severe level of visual impairment occurs after repeated hemorrhage from newly formed blood vessels)

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17
Q

Describe these abnormal findings

A

Hollenhorst plaques

● Cholesterol embolus in the vessels of the retina

● Sign of severe atherosclerosis

● Common finding in geriatric population

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18
Q

Diagnose

A

Acute Suppurative Otitis Media

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19
Q

Normal Eye documentation

A

Lashes and brows symmetric, conjunctivae are pink and sclera are without injection or jaundice. No discharge. Cornea and lens clear. Pupils equal, round and reactive to light and accommodation (PERRLA). Extra­ocular movements intact (EOMI). Ophthalmoscopic exam: Optic disc visualized with sharp disc margins. No hemorrhages. Vessels smooth, no nicking. (Note cup:disc ratio if pertinent).

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20
Q

Diagnose

A

Retinal Vein Occlusion (after retinal laser photocoagulation)

  • scar from retinal photocoagulation seen as white spots
  • after bleeding, retinal veins form white lines
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21
Q

Describe these abnormal findings

A

Exudates
● Hard exudates­ f​at spots in the retina

o Related to hyperlipidemia
● Cotton wool spots­​(soft exudates), ill­defined yellow areas caused by infarction of nerve layer, indicate vascular dz

Well defined, associated with a vessel

● Signs of diabetes

● Sign of wet macular degeneration

(age related)

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22
Q

What murmur is associated with a paradoxically split S2, Prominent S1 (clsing snap), widely split S2, and widely split, fixed S2

A
  1. paradoxically split S2: severe aortic stenosis
  2. Prominent S1 (closing snap): Mitral stenosis
  3. widely split S2: Mitral regurgitation
  4. Widely split, fixed S2: ASD
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23
Q

Name these areas

A
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24
Q

Abnormal Eye Findings Documentation

A

External examination: erythema, purulent discharge, clear discharge, injected palpebral or bulbar conjunctiva, corneal abrasion, corneal ulcer, foreign body present, unequal size of pupils ­

Ophthalmoscopic exam: papilledema, glaucomatous cupping, cotton wool spots, hemorrhage, papilledema, drussen bodies

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25
Diagnose
Cerumen Blockage
26
Treatment for aortic regurgitation
1. vasodilators (decrase afterlaod increase forward flow) 2. surgery
27
Diagnose
Toxoplasmosis - localized exudative retinochoroiditis - white and gray lump can be seen at the macula
28
Describe these abnormal findings
- Glaucomatous cupping:​ Optic cup is widened \>1/3 of optic disc ● Glaucoma is due to increased intraocular pressure from vitreous humour, producing additional pathologic cupping. ● Cup:disc ratio­​Normal is 0.3 or 3/10. ● The pink rim of disc contains nerve fibers, the white cup is a pit with no nerve fibers. As glaucoma worsens, cupping increases.
29
What causes VSD
- Congenital, post MI
30
Diagnose
Hypertensive Retinopathy - spotty hemorrhages - cotton wool spots (soft exudates) - arterial vasoconstriction -
31
what murmur is best heard when the patient is sitting and leaning forward?
- Aortic regurgitation - MV prolapse NOT heard in supine
32
Describe these abnornmal findings
● Arterial vein is lighter in color and smaller ● See with hypertension AV nicking ● Vein is thicker and darker in color ● Arterial pressure pushes on vein enough to cause nicked or hour glass appearance
33
What causes MV prolapse
-Risk factors: CT dz: Ehler­ danlos, Marfan’s, pectus excavatum, polycystic kidney disease, Graves disease - during late systole \*\*Most common in young women
34
Diagnose
Papilloedema (acute phase) - caused by increased intracranial pressure - boundary of papilla and surrounding retina are unclear - splinter hemorrhage
35
where is PDA murmur best heard?
- Pulmonic space (1­3rd ICS), lower sternal border, unaltered by postural change - "machine like" - continuous \*\*Wide pulse pressure: bounder peripheral pulses
36
Treatment of MVP
1. reassurance good prognosis in asymptomatic pts or mild sx 2. BB for autonomic dysfunction
37
What cause PDA (patent ductus arteriosus) murmur
Physiologic until 24 hours, prematurity, congenital rubella, Down’s syndrome
38
Describe an aortic regurgitation murmur
Grade I-IV, Diastolic, decrescendo “blowing” murmur. Heard loudest over aortic region (LUSB) and radiates along L sternal border Louder when patient is sitting and leaning forwards.
39
Describe these findings
Acute Otitis Media ● No visualization of malleus ● No light reflex present (or \<90 degrees) ● Purulent fluid behind TM ● Erythema
40
Describe these findings
PE Tubes ● placed by ENT s/p recurrent AOM, retractions, etc
41
What causes Aortic Regurgitation
1. Rheumatic heart dz-HTN 2. endocarditis 3. Syphilis 4. Ankylosing spondylitis 5. dissection/cardiac trauma
42
Describe the abnormal findings
Papilledema ● Blurred disc margins ● Optic disc seemingly protruding ● No visible optic cup ● Caused by increased intracranial pressure, transmitted along the optic nerve. ● Initially vision is not altered.
43
Normal Ear documentation
Appropriate alignment (if this is a neonate you need to describe where the ears are aligned – “at outer canthus”); external auditory canals were clear without lesions or discharge. No cerumen impaction. TMs pearly gray, translucent, bony landmarks visible; (+) light reflex, mobile, bilaterally; Weber midline; Rinne negative, bilaterally; appreciates whisper at 3 feet.
44
Diagnose
Tympanosclerosis
45
Describe these findings
Serous Otitis Media ● Visualization of malleus ● Bulging: light reflex at \<90 degrees ● Bubbles/​S​erous fluid often yellow or orange in color. ● Sign of middle ear effusion ● Sign of resolving acute otitis media
46
where and when is S3 best heard
- Mitral/Apex - early diastolic
47
Describe a VSD murmur
* Grade I-IV, holosystolic murmur. Heard loudest over tricuspid space around 4th ICS. Heard best supine. \*only one heard at this position
48
Descrive a MVP murmur
Grade I-IV, Mid-systolic ejection click followed by late systolic diamond shaped murmur. Heard loudest at mitral and left lower sternal boarder. Not heard in supine position.
49
Describe these findings
Perforation: Ruptured TM ● Clear visualization past TM ● Need to document estimation of percent of TM ruptured​(​~50% in this case)
50
Name these areas
51
Describe PDA murmur
Grade I-IV, continuous, “machine-like” murmur across systole and diastole. Heard loudest over pulmonic space (2nd ICS). Unaltered by postural change.
52
Describe the abnormal findings
Hemorrhages ● Dot hemorrhages­ lying deep in the retina, represent microaneurysms, common in diabetic retinopathy ● Flame hemorrhage­ between layers of the retina (dark red) ● Boat hemorrhage­ bleeding into the vitreous ● Hemorrhages at disc margin often indicates poorly controlled/undiagnosed glaucoma ● Hemorrhage is often moderate hypertensive retinopathy
53
Describe a murmur heard with hypertrophic cardiomyopathy
* Grade I-IV, possible S4 gallop, systolic “harsh” diamond shaped murmur heard loudest along the upper left sternal border that increases with Valsalva maneuver.
54
![]()Describe the abnormal findings
Retinal pigment changes ● Drusen:​pigment changes as a result of build up of products from photoreceptor recycling ● Sign of aging ● Sign of dry macular degeneration (age­related)
55
What causes crackles/rales
Pneumonia, CHF, Atelectasis Chronic bronchitis if early inspiration and expiration
56
Diagnose
Normal
57
Diagnose
Glaucomatous Optic Atrophy - optic papilla is pale and enlarged (increased cup/disc ratio) - nerve fiber bundle defect appears in a radiating pattern
58
What causes Rhonchi
Chronic bronchitis, COPD, cystic fibrosis, pneumonia
59
Describe an aortic stenosis murmur
* Grade I-IV, systolic “harsh,” diamond shaped murmur. Heard loudest over aortic region and radiates to the carotid arteries.
60
Diagnose
Retinal Vein Occlusion (acute phase) - flame-shaped hemorrhage and soft cotton wool spots - caused by venous occlusion at the venous/arterial crossing where the veins are pressed by sclerotic arteries - arteriosclerosis
61
Describe a mitral regurgitation murmur
* Grade I-IV. holosystolic “blowing” or “musical” murmur. Heard loudest at mitral region and radiates to left axilla\*
62
Diagnose
Chronic Suppurative Otitis Media (CSOM) with perforation
63
Diagnose
Normal
64
Describe these findings
Normal ● Pearly/grey TM ● Visualization of umbo, malleus ● Visualization of incus parallel to malleus ● Light reflex at 90­100 degrees of malleus
65
What causes S4
-Athletes, young children, coronary artery disease, and hypertension
66
Diagnose
Cholesteatoma
67
Describe a mitral stenosis murmur
* Grade I-IV. Mid-diastolic, “rumbling,” decrescendo, murmur. Heard loudest at mitral region in the left lateral decubitus position. No radiation
68
Diagnose
Mucoid Otitis Media
69
Abnormal Ear Findings Documentation
discharge present in ear canal, erythema of TM, purulent or serous fluid behind TM, perforation, foreign body, retraction/bulging
70
Where and when is S4 best heard?
- Mitral/Apex - late diastolic
71
Describe the murmur heard with tetralogy of fallot
* Grade I-IV, harsh holosystolic murmur. Heard loudest over 4th and 2nd ICS and radiates to the back
72
What causes S3
- in athletes - if heard after 30 consider heart failure
73
Describe a murmur with coarctation of the aorta
* Grade I-IV, systolic diamond shaped murmur and diastolic early decrescendo murmur. S2 has increased intensity. Heard loudest over 2nd ICS and it radiates to left axilla (and sometimes back)
74
What causes decreased breath sounds?
Pneumothorax, pleural effusion, pneumonia
75
what causes mitral regurgitation
1. MVP 2. Rheumatic fever- endocarditis 3. Ischemia- (rupture of chordae tendinae/papillary msucle s/p MI)

PANCE Practice (26 decks)

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