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Patient Assessment IV Final
Terms in this set (74)
What's it called when you shine light in an eye and the other constricts?
What is it called when you have the patient move their gaze from near far to far near?
What are the symptoms of CNIII Palsy?
-down and out position in the affected eye.
-ptosis, or drooping of the eyelid, and mydriasis (pupil dilation).
-one could have lid ptosis and mydriasis (a "blown" pupil) as a result of parasympathetic fiber compression before the "down and out" position is seen.
What is Anisocoria?
-Anisocoria is a common condition, defined by a difference of 0.4 mm or more between eye's pupils.
-Horner's syndrome - Mechanical anisocoria: Occasionally previous trauma, eye surgery, or inflammation can lead to adhesions between the iris and the lens.
- Adie tonic pupil: usually an isolated benign entity, presenting in young women. It may be associated with loss of deep tendon reflex (Adie's syndrome).
-Oculomotor nerve palsy: Ischemia, intracranial aneurysm, head trauma, and brain tumors are the most common causes of oculomotor nerve palsy in adults.
What are the symptoms of Papilledema?
-asymptomatic or headache in the early stages.
-may progress to enlargement of the blind spot, blurring of vision, visual obscurations (inability to see in a particular part of the visual field for a period of time) and ultimately total loss of vision may occur.
venous engorgement (usually the first signs)
loss of venous pulsation
hemorrhages over and / or adjacent to the optic disc
blurring of optic margins
elevation of optic disc
Paton's lines = radial retinal lines cascading from the optic disc
On visual field examination, the physician may elicit an enlarged blind spot; the visual acuity may remain relatively intact until papilledema is severe or prolonged.
Which lymph nodes are inflammed with Lung Cancer
Mediastinal lymph nodes - These are lymph nodes that are present in the area of the chest between the lungs (the mediastinum).
Extrathoracic lymph nodes - Refers to lymph nodes found outside of the thorax (chest). These include: supraclavicular lymph nodes, located in the area just above the collar bone; and scalene lymph nodes, which are in the neck, near the uppermost rib.
Where are submandibular lymph nodes located?
Beneath the body of the mandible in the submaxillary triangle, and rest on the superficial surface of the submandibular gland.
What is vision loss with normal aging called?
Raised, triangular thickening of the bulbar conjunctiva is called what?
What is Marcus Gunn Pupil?
Marcus Gunn pupil or relative afferent pupillary defect (RAPD) is a medical sign observed during the swinging-flashlight test whereupon the patient's pupils constrict less (therefore appearing to dilate) when a bright light is swung from the unaffected eye to the affected eye. The affected eye still senses the light and produces pupillary sphincter constriction to some degree, albeit reduced.
The most common cause of Marcus Gunn pupil is a lesion of the optic nerve (between the retina and the optic chiasm) or severe retinal disease. It is named after Scottish ophthalmologist Robert Marcus Gunn.
What does hyperthyroidism do to the eyes (3)?
stare, lid lag, exophthalmus
Skin condition found in dyslipidemias, where certain fats build up under the surface of the skin:
A common type of this condition that appears on the eyelids and may occur without any underlying medical condition, is not necessarily associated with elevated cholesterol or lipids:
Xanthomas (tendon, eruptive, and tuberous), xanthelasma (may occur in healthy people)
What is Argyll Robertson Pupil and what does it signify?
Argyll Robertson pupils ("AR pupils" or colloquially as"Prostitute's Pupil") are bilateral small pupils that reduce in size when the patient focuses on a near object (they "accommodate"), but do not constrict when exposed to bright light (they do not "react" to light). They are a highly specific sign of neurosyphilis, and might also be a sign of diabetic neuropathy. In general, pupils that "accommodate but do not react" are said to show light-near dissociation- i.e., its the absence of a miotic reaction to light, both direct and consensual, with the preservation of a miotic reaction to near stimulus (accommodation-convergence).
Viral vs. Bacterial Conjunctivitis
Clear watery bilateral discharge vs. Purulent unilateral discharge
Which side is the optic disc on?
The nasal side
What is Dysconjugate Gaze?
Cause of developmental DG?
-failure of the eyes to turn together in the same direction.
-imbalance in ocular muscle tone. This imbalance has many causes, may be hereditary, and usually appears in early childhood. These gaze deviations are classified according to direction:
New onset of dysconjugate gaze in adult life is usually the result of:
cranial nerve injuries, lesions, or abnormalities from such causes as trauma, multiple sclerosis, syphilis, and others.
Extreme Opacity in the superior posterior TM
Let's grade tonsils: Tommy has no tonsils. (0, 1+, 2+, 3+, 4+)
Let's grade tonsils: Sophia has tonsils that occupy less than 25%. (0, 1+, 2+, 3+ 4+)
Let's grade tonsils: Janet has tonsils that occupy less than 50%. (0, 1+, 2+, 3+ 4+)
Let's grade tonsils: Bertha has tonsils that occupy less than 75%. (0, 1+, 2+, 3+ 4+)
Let's grade tonsils. Hebert has tonsils that occupy more than 75%. (0, 1+, 2+, 3+, 4+)
Cranial 12 lesion, which way does the tongue deviate
towards the lesion
Alar cartilage location:
tip of nose
Muscle that separates the anterior from posteriortriangle of the neck
Non-ear cause of ear pain
The most common causes are temporomandibular joint syndrome, pharyngitis, dental disease, and cervical spine arthritis.
first of the middle ear bones
The key physical finding of OE is:
pain upon palpation of the tragus (anterior to ear canal) or application of traction to the pinna (the hallmark of OE).
Infectious causes of dysphagia
Infectious esophagitis, Chagas disease (protozoan pathogen that causes esophageal achalasia)
Weber and Rinne Test
If Weber's lateralises to the LEFT, then EITHER there is a CONDUCTIVE hearing loss on the LEFT, or there is SENSORINEURAL deficit on the RIGHT.
If Rinne's test on the left is NEGATIVE, then there is CONDUCTIVE hearing loss on the LEFT.
If Rinne's test on the LEFT is POSITIVE, then there is likely SENSORINEURAL deficit on the RIGHT.
Turbinates in allergic rhinitis
pale boggy blue
apex of the lung—where to palpate?
superior to the clavicles
These lung sounds are heard as small clicking, bubbling, or rattling sounds. They can be described as moist, dry, fine, and coarse. SAME AS CRACKLES: These lung sounds are heard as intermittent, brief, nonmusical..heard in fluid, pneumonia, fibrosis, heart failure, bronchitis, bronchiectasis
These lung sounds are heard as continuous, musical, high-pitches..heard with asthma, COPD, bronchitis.
These lungs sounds are heard as continuous, snoring quality low-pitched, secretions in the large airway...
COPD presentation on sitting:
Croup, foreign body aspiration, epiglottitis, bacterial tracheitis, laryngomalacia, bilateral cord paralysis and papillomas in upper airways can cause what
3 or more ribs must be broken
Traumatic Flail Chest: Multiple rib fractures may result in paradoxical movements of the thorax. As descent of the diaphragm decreases intrathoracic pressure, on inspiration the injured area caves inward; on expiration, it moves outward.
If indicated, assess orthostatic hypotension, common in older adults. Measure blood pressure and heart rate in two positions—supine after the patient is resting from 3 to 10 minutes, then within 3 minutes after the patient stands up. Normally, as the patient rises from the horizontal to the standing position, systolic pressure drops slightly or remains unchanged, while diastolic pressure rises slightly. Orthostatic hypotension is a drop in systolic blood pressure of 20 mm Hg or greater or in diastolic blood pressure of 10 mm Hg or greater within 3 minutes of standing
Where does the pain of appendicitis start
Chronic cough ROS:
Respiratory: Cough, sputum (color, quantity), hemoptysis, dyspnea, wheezing, pleurisy, last chest x-ray. You may wish to include asthma, bronchitis, emphysema, pneumonia, and tuberculosis.
Bulla, target (or iris) lesion seen in:
Silvery plaques with scales and papules:
Vesicles, pustules, erosions, and crusts in:
Excoriation and lichenification in:
Pustule—(yellow proteinaceous fluid filled with neutrophils):
infected atopic dermatitis
In hyperventilation, you might experience numbness and tingling in the (2):
arms or around the mouth
Cranial Nerves II & III
Fixation of the eye in midorbit, unresponsive to vestibular stimulation. Seen in brainstem injury. doll's eye reflex symmetrical deviation of the eyes when the head is moved in different positions, always returning to center. Abnormalities are caused by lesions of the inner ear or brainstem, especially the pons and midbrain. Called also oculocephalogyric reflex, oculovestibulocephalic reflex. Called also doll's head reflex. CNs III, VI, VIII
The Thomas test used to rule out hip flexion contracture. The patient lies supine on the examination table and brings one knee in direction to the chest/ flexes hip, while the other leg remains extended. The Thomas test is said to be also positive if the patient's:
opposite/ contralateral hip flexes without knee extension- tight iliopsoas
hip abducts during the test- tight tensor fascia latae
knee extension occurs- tight rectus femoris
Lateral rotation of tibia- tight biceps femoris
poor balance (postural instability).
Proximal tibial swelling and tenderness
Enlargement or prominence of the tibial tubercle
Reproducible and aggravated pain by direct pressure and jumping (quadriceps contraction)
Pain with resisted knee extension (quadriceps contraction)
hurts going up stairs
ACL tear test
lateral epicondylitis (Mill's test)
Ulnar nerve distribution:
Originates from the C8-T1 nerve roots (and occasionally carries C7 fibres) which form part of the medial cord of the brachial plexus, and descends on the posteromedial aspect of the humerus. One method of injuring the nerve is to strike the medial epicondyle of the humerus ("funny bone"). Runs to 5th phalanx and half of 4th
The Romberg test is a test of the body's sense of _____, which requires healthy functioning of the dorsal columns of the spinal cord. The Romberg test is used to investigate the cause of loss of _____ _____, and Romberg's test is positive in conditions causing:
motor coordination (ataxia).
McBurney's Point is located on the:
right side of the abdomen that is one-third of the distance from the anterior superior iliac spine to the umbilicus (navel).
Appley's Grinding Test:
This test was originally described by Jobe and Moynes to test integrity of the supraspinatus tendon:
The Empty Can Test (ECT)
This test is performed by lightly tapping (percussing) over the nerve to elicit a sensation of tingling or "pins and needles" in the distribution of the median nerve.
Lachman Test. Purpose: To assess the integrity of:
How can sour candy help a swollen parotid gland?
Sour candy can increase saliva production and help relieve the pain, in some cases.
White or grayish, ovoid lesions with irregular "soft" borders. They are moderate in size but usually smaller than the disc. They result from infarcted nerve fibers:
Seen in _______ and many other conditions.
These are creamy or yellowish, often bright, lesions with well-defined "hard" borders. They are small and round but may coalesce into larger irregular spots. They often occur in clusters or in circular, linear, or star-shaped patterns.
Causes include (2):
diabetes and hypertension
Yellowish round spots that vary from tiny to small. The edges may be soft, as here, or hard. They are haphazardly distributed but may concentrate at the posterior pole between the optic disc and the macula. They appear in normal aging but may also accompany various conditions, including:
age-related macular degeneration.
Tiny red dots or microaneurysms on fundoscopy can be indicative of:
Nonproliferative Retinopathy, Moderately Severe Diabetic Retinopathy
Arise on the optic disc and extend across the disc margins (sign of proliferative retinopathy)
Ocular fundi: soft exudates and flame-shaped hemorrhages are typical of accelerated (malignant) ______ and are often accompanied by ______.
In hypertension, retinal arteries may show areas of:
The light reflex is also narrowed. The arterial wall thickens and becomes less transparent.
focal or generalized narrowing
In hypertension, sometimes the retinal arteries, especially those close to the disc, become full and somewhat tortuous and develop an increased light reflex with a bright _____ luster known as:
Occasionally a portion of a narrowed retinal artery develops such an opaque wall that no blood is visible within it. It is then called a:
a silver wire artery
appears to stop abruptly on either side of the artery.
Concealment or AV nicking.
In hypertension, sometimes the retinal vein appears to taper down on either side of the artery, known as ______. When the vein is twisted on the distal side of the artery and forms a dark, wide knuckle, it is called _____.
Increased pressure within the eye leads to increased ______ (backward depression of the disc) and atrophy.
cupping (Glaucomatous cupping—physiologic cup is enlarged, retinal vessels sink in)
In the GCS, extension to painful stimuli is also know as the:
Benign tumor of the eighth cranial nerve:
Progressive or sudden unilateral sensorineural hearing loss, tinnitus, and vertigo. Other symptoms include loss of balance, loss of facial sensation, or loss of function of the facial muscles or the muscles of mastication.
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