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PD final - need to add special notes

Terms in this set (98)

Visual acuity
What should be the first thing you assess in an eye exam?
Presbyopia
people >40 may complain of Impaired ability to read the paper, or see their phone. This impairment of near vision in older people is known as ________
A
Far sightedness, or not being able to see close up is referred to as

a. Hyperopia
b. Hypertropia
c. Miosis
d. Myopia
Myopia
Near sightedness, or not being able to see far away is referred to as
C
Which is NOT associated with Horner's syndrome?

a. Ptosis
b. Miosis
c. Hyperacusis
d. Anhidrosis
C

Inward: INtropion (entropion)
outward: EXtropion (ectropion)
An inward turning of the lower lid margin, possibly causing conjunctival irritation is called

a. Ectropion
b. Anhidrosis
c. Entropion
d. Lid retraction
Ectropion
Elderly
This condition is called _______________, it is an outward turning of the lower lid margin, and pts may have problems with chronic watering of the eye. Which population is most effected?
C
yellowish plaques along the nasal portion of both eyelids are called ____________________ and should prompt you to think of ____________________

a. Sleral icterus; Liver disease
b. Xanthelasma; liver Cirrhosis
c. Xanthelasma; Hypercholesterolemia
d. Sleral icterus; hypercholesterolemia
corneal light test reveals esotropia

& Exotropia is an outward turning
What is the term for the inward turning of the eye in this photo? What test was used to determine this?
Hypertropia

& Hypotropia would be a downward gaze
What is this condition called? (in the pts L eye)
Corneal light and cover test
What two tests can assess strabismus?
Argyll Robertson pupil - Syphilis!
Small irregular pupils that accommodates (Near/far), but do not react to light should raise your suspicion for what condition? What is the term for this specific Anisocoria?
C
which of the following is a unilateral, enlarged pupil having a slow or absent reaction to light due to a parasympathetic abnormality?

a. Argyll Robertson pupil
b. CNIII palsy
c. Adie's pupil
d. Marcus-Gunn pupil
Pupil is large and fixed to light

(Vs. damage or palsy, which may just involve Ptosis & lateral deviation, but she said specifically large pupil fixed to light for entrapment)
When there is an entrapment of CN III, what are some classic PE findings?
Swinging flashlight test
what is the test used to identify afferent pupillary defects?
Marcus-gunn pupil: Afferent pupillary defect of the optic nerve
When performing the swinging flashlight test, you shine the light into the patients eyes, swinging it back and forth between both eyes and you note pupillary dilation with no initial constriction on the Left side. What does this indicate?
B

This is Corneal Arcus, Common w/ hyperlipidemia & a normal variant of aging in African Americans.
A grayish white circle of the cornea is commonly associated with:

a. Hypercholesterolemia
b. Hyperlipidemia
c. Wilson's disease
d. Normal aging in Asian population
Corneal Arcus
What is the term for this presentation of the eye?
Pterygium
A triangular thickening of the bulbar conjunctiva usually on the nasal side, and may interfere with vision although it is usually very benign.
Kayser-Fleisher rings (green-yellow ring around cornea due to copper deposits) associated with Wilsons dz

Liver dz, renal failure, and Neurologic abnormalities
What condition is associated with this type of corneal abnormality? What is the name for it?
Cataracts

RF: aging, diabetes, and corticosteroid use
This corneal condition involves an opacity of the lens and an abnormal red reflex. What are the risk factors for developing this?
Cataracts
If you are giving a nebulized corticosteroid, you should consider providing the patient with a mask to prevent the mist from entering the eye. This will help prevent which corneal condition?
Episcleritis

(inflammation of the episcleral vessels)
This condition involves an inflammation of the episcleral vessels, and is associated with allergies, rheumatoid arthritis, and Sjogren's syndrome.
B (A sty)


Sty: PAINFUL

CHALAZION: PAINLESS.
you are examining the eyelid of your patient who complains of a painful "pimple like" bump on the lid. There is no scaling of the area, and no redness/swelling near the lacrimal sac or duct. Best dx?

a. Dacrocystitis
b. Hordeleum
c. Chalazion
d. Blepharitis
Dacrocystitis
This is most likely

a. Dacrocystitis
b. Hordeleum
c. Chalazion
d. Blepharitis
Blepharitis - Staph aureus

Tx: No tear shampoo!
Which organism is most commonly responsible for a condition involving inflammation of the hair follicles of the lashes. it is a/w burning, itching, irritation and scaling
Chalazion (painless nodule of the Meibomian gland)

mostly benign and self resolving, but some pts have it removed cosmetically
This pt denies pain or tearing. on exam you note a non-tender nodule without discharge or scaling. Best dx?
Corneal abrasion
Viral conjunctivitis
Allergic conjunctivitis
Bacterial conjunctivitis
Acute glaucoma

She added Uveitits (not on slide)
What are the top 5 conditions causing a red eye in an adult?
B (allergic) -- Big thing here is that the injection is coming from the conjunctiva TOWARD the cornea
Your pt comes in complaining of constant sneezing, itching of the eyes, and constant watering. On exam you note diffuse injection of the conjunctiva with discharge. You also note allergic shiners under the eye and a salute on the nose. Best dx?

a. Episcleritis
b. Acute conjunctivitis
c. Blepharitis
d. Subconjunctival hemorrhage
subconjunctival hemorrhage - Warm compresses/Self limited
Pt comes into the ER with CC of "bloody eye". He tells you he works in construction and felt something fly in his eye and he rubbed it but when he looked in the mirror he saw a huge bloody spot. On exam you note a sharply demarcated red area without discharge. Best tx?
Acute Iritis AKA anterior Uveitis
This condition is commonly associated with autoimmune conditions and is associated with a small pupil, ciliary flush (extending outward from the iris), photophobia, and pain.
corneal injury
With a _________________________, you may see ciliary injection but the pupils are not affected.
D
A 29 year old male presents to ER with Severe R sided eye pain with acute vision disturbance. He denies any trauma or recent infection. PE reveals ciliary injection with diffuse redness. The cornea is cloudy and the R pupil is fixed and dilated. Intra ocular pressure is increased on the R. Most likely diagnosis?

a. Hyphema
b. Acute iritis
c. Corneal injury
d. Acute glaucoma
Optic disk outline clear

Exudates & flame hemorrhages of Retina
What is the presentation of hypertensive retinopathy?
Nonproliferative diabetic Retinopathy
Which retinal abnormality involves mild dilation of retinal veins, with numerous scattered exudates and hemorrhages of the Retina. The optic disc is usually normal
B
Cotton wool spots are most commonly seen in which condition?

a. Hyperlipidemia
b. Hypertension
c. Syphilis
d. Hypercholesterolemia
Cotton wool spots
On fundoscopic exam, White or grey patches with irregular soft borders, possibly as a result fro infarcted nerve fibers, and leakage of fluid are called
Papilledema
What abnormality would you most likely find on fundoscopic exam in a patient with sudden increase in intracranial pressure?
Drusen spots
________________________ are most commonly associated with Macular degeneration and can have soft or hard borders. They tend to concentrate between the disc and macula.
Corneal abrasion
2. Pain & redness of the eye which is associated with trauma is most likely a
Red reflex
You are examining a child's tympanic membrane. they are inconsolable and crying. You note an erythematous appearance of the tympanic membrane. This is called
Exostosis

common in swimmers
Well-defined, hard nodules in the auditory canal are usually benign but may lead to conductive hearing loss. This is called what? Common in who?
Acute otitis EXTERNA
Your pt is complaining of ear pain, with mild hearing loss over the past 7 days. on exam you note a tender pinna, and decreased hearing on the Right. With caution, you gently insert your speculum and notice the cancel is narrowed and erythematous. What is the most likely diagnosis?
Serous otitis media
What can occur post otitis media, in which the patient may complain of a "fullness" in the ear. Effusion or bubbles may be seen behind the TM on exam.
Tympanosclerosis
What may occur due to ear infections, causing the TM to become opaque and thickened?
Peripherall: Otitis media (child may have excruciating pain and then all of a sudden no pain - less concerning)

VS.

Central: usually due to traumatic injury (diving to deep, etc) - requires immediate evaluation to avoid hearing loss
what are the two different types of TM perforation and what are each of them associated with?
B
You are examining your patient and with ear exam, you note the presence of irregular waxy masses. Best next step?

a. Rx for otitis media
b. Refer to ENT for Immediate surgical debridement
c. Treat underlying hyperlipidemia
d. Evaluate for DM
TM becomes dull
TM bulges. +/- perforation
Decreased insufflation
What are the physical exam (otoscope) findings in a pt with Otitis media?
Otomycosis
A fungal infection of the auditory canal with cottony-appearing exudates is called
D

(all others are sensorineural causes of hearing loss, and this pt has conductive loss)
You are performing a Weber test on your patient who has been experiencing hearing loss. She tells you she hears the sound louder in the right ear. To confirm your suspicion, you perform the rinne test and note Bone conduction to be significantly louder than Air conduticion in the right ear, and normal (AC>BC) in the left. Which of the following would most likely cause these findings?

a. Loud noise exposure
b. Deterioration of the cochlear hairs
c. Gentamycin
d. Otosclerosis
B

loud music/noises cause Sensorineural loss, which will cause the sound to lateralize to opposite ear on weber.

Rinne would reveal AC > BC on right


using the rinne for Sensorineural is more difficult (bc results are same if there is no hearing loss)
Your pt comes to you after a weekend of being at a music festival complaining of hearing loss. The finger rub test suggests decreased hearing on the right side. Which of the following would be the most beneficial in confirming the suspected type of hearing loss?

a. Weber: sound lateralizes to the Right
b. Weber: sound lateralizes to the Left
c. Bone conduction 2x > air conduction on the left
d. Air conduction is 2x > bone on the right
B
Which of the following is a common cause of sensorineural hearing loss

A. Cerumen impaction
B. presbycusis
C. serous otitis media
D. Tympanic membrane perforation
C
A 10 year old swimmer presents today for left ear pain and swelling. He denies fever or any concurrent upper respiratory infection. On physical examination there is tenderness of the tragus and swelling of the external canal. The most likely diagnosis is;

A) Otitis Media
B) Serous Otitis Externa
C) Otitis Externa
D) Impacted cerumen
B

"I want you to know this"

DM, so he is immunocompromised, so otitis externa is worsened, and may lead to rapid degradation of the tissue, need to be admitted immediately be treated with IV abx, debridement
An elderly diabetic man presents to the emergency department at 10 P.M. with a complaint of intense otalgia and purulent drainage. Examination of the symptomatic external canal reveals exuberant granulation tissue and greenish purulent drainage. The tympanic membrane appears normal. The most likely diagnosis is


A) Choleastoma
B) Malignant Otitis externa
C) Otitis Media
D) Otitis externa
C) Chronic Otitis Media
A
. A 32 year old female presents with severe left ear pain. On physical examination the tympanic membrane is red and dull and you note a bullous arising from the ear drum. The most likely diagnosis is

A) Mycoplasma infection
B) Acoustic neuroma
C) Choleastoma
D) Ramsy Hunt syndrome
E) Streptococcal infection
C
A patient presents with vertigo. Which of the following characteristics indicates that the vertigo is of a peripheral etiology?

A) absent nausea
B) absent vomiting
C) hearing loss
D) absent tinnitus
Rhinophyma
This is an erythematous bulbuls enlargement fo the distal 2/3 and is usually benign and can be fixed cosmetically
Nasal polyps, asthma, aspirin
what is samter's triad?
Under the ridge of the eyebrow then compare bilaterally
Where should the transilluminator be placed when assessing the frontal sinus?
observe the pattern of transillumination by looking through the Open mouth - Sinusitis may be suspected with dullness to transillumination on one side compared to the other.
To assess the maxillary sinuses, you should ask the pt to tilt the head back and open the mouth. place the transilluminator on the maxillary bone at an angle to project the light toward the roof of the mouth. How will you assess for presence of sinusitis?
D

"key here is bad teeth can penetrate into the maxillary sinus"
A middle-aged man presents to your clinic complaining of fever, purulent nasal drainage, facial pain, and toothache. The most likely diagnosis is:

A) Ethmoid sinusitis
B) Sphenoid sinusitis
C) Frontal sinusitis
D) Maxillary sinusitis
B
In the normal physiology of the sinus, the middle turbinates is responsible for draining the

A)ethmoid sinus only
B) frontal and maxillary sinuses
C) Sphenoid sinus only
D) Sphenoid and ethmoid sinuses
D
A deviated uvula should increase your suspicion of

a. GABHS
b. Mono
c. Corynbacterium
d. Peritonsillar abscess
F.

NOT generally a/w runny nose/cough
T/F: Group A beta hemolytic strep is commonly associated with Pharyngitis, a runny nose, and cough.
Anterior cervical
Which lymph nodes are usually involved in a GABHS infection?
Posterior cervical
Which lymph nodes are usually involved in a Mono infection?
Tonsillar exudates
Tender anterior cervical LAD
Fever
absence of cough

at least 3 is enough to justify testing/tx
The Centor criteria can be used to justify testing/treatment for GAS infection. What are the 4 criteria? and what score is an indication for testing?
Allergic rhinitis
on physical exam you note pale, swollen turbinates with clear mucoid discharge. You should suspect
viral
The etiology of a sore throat associated with runny nose, cough, and congestion is most likely
arthritis/inflammation of the AC joint
A positive crossover test most likely indicates
A (Drop arm test)
This test is performed by passively abducting the patients arm to about shoulder level, and asking them to slowly lower it. If they cannot hold the arm at shoulder level/cannot control the lowering, they most likely have

a. Supraspinatus tear
b. Impingement
c. Teres minor weakness
d. subscapularis muscle weakness
Weakness of the supraspinatus
A positive empty can test indicates weakness of which muscle?
D
Pt presents with complaints of pain in their shoulder that wakes them up at night. After performing a few special maneuvers, you find a positive infraspinatus test. Your ddx may include all of the following except

a. Bicipital tendonitis
b. rotator cuff tear
c. infraspinatus weakness
d. Supraspinatus weakness
D
Which of the following would be most indicative of a subscapularis weakness or injury?

a. positive empty can test
b. positive apply scratch test
c. positive Hawkins test
d. Positive push-off test
A
Pain or difficulty with the apley scratch test most likely indicates:

a. adhesive capsulitis
b. rotator cuff tear
c. impingement
d. subscapularis injury
D
A positive Neers and/or Hawkins test indicates all of the following except?

a. Rotator cuff inflammation
b. rotator cuff tear
c. sub acromial impingement
d. shoulder dislocation
Hawkins test
What test is this?
B


""know the definitions, they'll be spelled out" - ANC
Pathologic flexion at the proximal interphalangeal joint (PIP), and hyperextension at the distal (DIP) is called

a. Bouchards
b. Boutonniere deformity
c. Swan-neck
d. Heberden's
C

""know the definitions, they'll be spelled out" - ANC
Pathologic flexion at the DIP joint and hyperextension at the PIP is common in Rheumatoid arthritis and is called

a. Bouchards
b. Boutonniere deformity
c. Swan-neck
d. Heberden's
D
A positive valgus stress/abductor stress test most indicative of injury to:

a. lateral collateral ligament
b. anterior collateral ligament
c. posterior collateral ligament
d. medial collateral ligament
Medial meniscus
Mcmurrays test is a test for a meniscal tear. While externally rotating the foot, and extending the knee, are you assessing for a medial or lateral meniscal tear?
C
42 year old pt presents with back pain. PE reveals positive straight leg raise while laying supine. However, when you put them in a seated position, and extend the knee they experience no pain. This is most indicative of

a. Radiculopathy
b. Herniated disk
c. Malingering
d. Sciatica
C
Pain that occurs in the contralateral leg during the straight leg test (R leg up, pain in L leg) almost always indicates what?

a. Malingering
b. True Back pain
c. Severe impingement due to large disc herniation
d. Sciatica
Flexion, abduction, and external rotation of the leg and assess the hip joint (SI joint)
What is the FABER test and what is it assessing?
TRUE
T/F: The primary care provider is responsible for the overall health of the patient even after they are referred
A
On a paper document, you should make changes to the documentation by:

a. draw a line though it, make the correction, sign and date it
b. completely white out the note, and sign and date with the correction over top
c. draw a line through it, and make your amendment, but must state "correction:" with your initials and date
C
In an electronic document, to make a change to the document, you should:

a. use the "strike through" tool to draw a line through the entry and write "correction"
b. print out the document, strike through the entry, sign and date
c. write the addendum and date, but must indicate its a correction
true
T/F: Late entries are acceptable, but you must Indicate it as a late entry and specify that the care was delivered the previous day.
A
What type of note would be necessary if a patient is being moved from the ER to the floor, or from pre-op to the floor?

a. Admission H & P
b. Progress note
c. Summary note
24
At most hospitals, a formal discharge note is usually required for any admission longer than ________ hours
B
Preoperative notes last until:

a. The day before surgery
b. the actual surgery
c. the completion of the surgery
d. until the patient reaches PACU
B
The pre-op H&P should be completed no more than _____________ before the patient admission

a. 24 hours
b. 7 days
c. 2 weeks
d. 12 hours
the primary care doctor
The pre op H &P is usually completed by who?
C
The operative note is written

a. during the surgery by the scrub nurse
b. as a comprehensive H & P
c. immediately after surgery by the PA or resident
d. only if the pre-op diagnosis is different than the post-op diagnosis, or if the patient had complications
B
Which of the following is completed the next day after the procedure is finished?

a. post operative note
b. progress note
c. admission H&P
d. operative report
Assessment (A)
"Small bowel obstruction with resection and lysis of adhesions. Post-op day #1" would be best documented in which portion of the post surgery progress note?

S
O
A
P
Breastfeeding?
Contraceptive plan w/ relevant sexual hx
Lochia (vaginal bleeding)
Pain
in regards to Post partum notes, the subjective portion should always include which 4 things?
complete H & P
What type of note is the well woman exam?
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