Health Assessment Exam II

Which cranial nerves stimulate EOM?

Oculomotor (III), Trochlear (IV), Abducens (VI)

What is accommodation of the eye? What happens for accommodation? How is it tested?

-Adaptation of the eye for near vision

-Ciliary muscles contract, lens becomes more curved, and pupils constrict

-Tested by convergence and pupillary constriction

What is normal accommodation of the lens?

The lens will bulge to focus on close objects and flatten to focus on far objects

What is myopia and what are the causes? Where do light rays focus?

-Nearsightedness, have trouble seeing objects at a distance

-Possible causes: globe too long; cornea too curved.

-In front of the retina

What is hyperopia and what are the causes? Where do light rays focus?

-Farsightedness, trouble seeing objects up close

-Possible causes: globe too short, cornea too flat

-Behind the retina

What is presbyopia? What causes it? What do patients who usually have it do? Can it be improved, if so how?

-Very common age-related disorder that results from the lens becoming stiff

-Small print becomes difficult to read

-Pts will hold reading material at a further distance

-Can be improved w/ reading glasses

What is an astigmatism? Where does light rays focus and what does it cause?

-Cornea is shaped more like a football than basketball

-Enters the eye normally via retina, but refracts unevenly causing distortion and blurry vision

What is ptosis? What are the three causes?

-drooping eye

-neuromuscular weakness (myasthenia gravis), oculomotor nerve damage, or sympathetic nerve damage (horner's syndrome)

What is miosis? What are two causes

-pinpoint pupils (constricted and fixed)

-narcotic drugs and brain damage

What is mydriasis? What is the main cause?

-dilated and fixed pupils

-CNS injury

What is aniscoria?

-pupils of unequal size

How is a Snellen test performed? Interpret 20/40 vision and 20/10 vision. Which is good and which is bad

-Have the patient stand 20 feet from the chart and read each line until they fail to starting with 20/40 (normal result is 20/20)

-20/40: You can see at 20 feet what others see at 40 (bad)

-20/10: You can see at 20 feet what others see at 10 (good)

What is a Jaeger chart used for? How far away should it be held from the patient? What is the norm result?

-People with near vision difficulty or people over 40.

-They should hold the chart 14 inches away from the eye

-Normal is 14/14 in each eye

What is strabismus? What are the four types?

-Misalignment of eyes (cross eyed)

-Esotropia (inward turning) -Exotropia (outward turning) -Hypotropia (downward turning) -Hypertropia (upward turning)

What is exophthalmos?

bulging eyes

What is ectropion?

outward turning of the eyelid

What is entropion?

inward turning of the eyelid

What is periorbital edema?

swelling around the eyes

How do you perform the cover/uncover test? What does it test for?

-Have a patient stare at a distance object, cover one eye, uncover, and see if the eye has no movement (normal) or drifts (strabismus)

-Strabismus

What is diagnostic position test?

-6 cardinal fields of gaze/H test

-Tests EOM

What is PERRLA? How is it tested?

-Pupils, equal, round, reactive to light and accommodation

-Pupillary light reflect test (darken room, advance light from the side and not response, normal is constriction of the same sided pupil due to direct light reflex and constriction of the other pupil due to consensual light reflex)

What is the Corneal Light Reflex (Hirschberg) Test?

Tests EOM; shine light toward patient's eyes, light should be seen in same clock location in both eyes

What test tests colorblindness?

Ishihara Test

What is normal for eyebrow inspection?

-symmetrical

-evenly distributed

What is normal for eyelid inspection?

-upper lids normally overlap superior part of iris

-lids close at the same time (no lid lag)

What is normal for eyelash inspection?

-evenly distributed

-curve outward

What is normal for eyeball inspection?

-aligned in sockets

-no protrusion

-no sunken appearance

What is normal for conjunctiva and sclera inspection?

-eyeball should look moist and glossy

-conjunctiva should be clear and white over sclera, but should be pink over lower lids

-no color change, edema, or lesions

What does the lacrimal apparatus do?

produces and drains tears

Presence of excessive tearing can mean what in respect to the lacrimal appartus?

-there is a blockage in the nasolacrimal duct

What is glaucoma?

Neuropathy of the optic nerve characterized by loss of peripheral vision caused by intraocular pressure

What is macular degeneration?

Impaired central vision caused by drusen (yellow deposits) and neovascularity in the macula

What is diabetic retinopathy?

The leading cause of blindness in adults; caused by damage to the blood vessels in the retina

What is a cataract?

Leading cause of blindness worldwide, clouding of the lens partially due to UV radiation; curable by surgery

What is the main function of the ears?

Sensory organ for hearing, maintains equilibrium

What is the auricle? What does it do?

-The visible part of the ear

-External ear structure that functions to collect sound and funnel it into the external meatus where it contacts the tympanic membrane.

What is the external auditory canal? What is its shape? How is it straightened to view?

-Opening of external ear, teminates at eardrum lined with glands that secrete cerumen (wax)

-S shaped in adults 2.5-3 cm long

-Pulled up and back for adults and pulled down and back for a child under 3

What is the tympanic membrane? What is its normal color and appearance? What auditory ossicle can you somewhat see? What part of the TM are we always supposed to see?

-Eardrum, membrane that stretches across the ear canal and separates the middle ear from the outer ear

-Shiny pearly gray, thin, translucent, oval

-Incus

-Cone of light (5 o clock in right ear and 7 o clock in left ear)

What are the three main structures of the middle ear? What tube is important in the middle ear? What are the three main functions of the middle ear?

-Auditory ossicles: malleus, incus, stapes

-Eustachian tube

-Conducts sounds vibrations from outer ear to central hearing apparatus, protects the inner ear by reducing amplitude of sounds, and the eustachian tube allows equalization of pressure on each side of the TM

What structure protects the tympanic membrane and how?

The Eustachian tube equalizes air pressure on each side of the TM to prevent it from rupturing

What is the main structure of the inner ear and what is its purpose?

-Labyrinth

-Holds sensory organs for equilibrium and hearing

What are the normals for inspection of the ears?

-Size and shape should be equal

-Skin should be consistent with the rest of the face

-There should be no tenderness on the auricle, tragus, or mastoid

What should the pinna of the ear line up with and at what angle? If it does not what is it called and what is the cause?

-Lines up with the corner of the eye at an angle of less than 10 degrees

-Low set ears is the term for an angle greater than 10 and it is found in genetic disorders trisomy 13, 18, and 21

What is cerumen?

Ear wa

xWhat cranial nerve is associated with hearing? How is it tested?

-CN VIII (acoustic)

-Tested through the whisper test

What are the two pathways of hearing?

Air conduction (AC) and bone conduction (BC)

What are the three types of hearing loss?

Conductive, sensorineural, and mixed

What is conductive hearing loss? What are the possible causes?

-Caused by mechanical dysfunction of the external or middle ear

-Cerumen, foreign body, perforated TM, purulent or serous fluid in middle ear, otosclerosis

What is otosclerosis? What does it cause?

-Hardening of the stapes

-Causes conductive hearing loss

What is sensioneural hearing loss? What are causes?

-Caused by pathology of the inner ear, CN VIII, or auditory areas of cerebral cortex

-Presbycusis (gradual nerve degeneration with aging) or ototoxic drugs (toxic drugs that decreased cilia in cochlea)

What is mixed hearing loss?

Combination of conductive and sensorineural types in same ear

How is the whisper test perfromed?

-Occlude one ear

-Stand 1-2 feet from ear and whisper a two syllable word

-Repeat on other size with different ear

-Normal client should be able to repeat back both words

What tests are done if the whisper test is failed?

Weber test and Rinne test

What is the Weber test adn how is it performed? What are the expected results? What are the abnormal results?

-A vibrating tuning fork on the scalp or forehead to compare bone conduction in both ears

-Heard equally bilaterally

-Conductive loss: client hears vibration only in bad ear

-Sensorineural loss: client hears vibration only in good ear

What is the Rhinne test and how is performed? What are the expected results? What are the abnormalities?

-Test that measures hearing using bone conduction (placed on the mastoid) and air conduction (placed in front of the external auditory meatus) with a tuning fork, can determine type of hearing loss

-Normal: AC>BC 2:1

-Conductive loss: BC>/= AC

-Sensorineural loss: AC>BC, if anything is heard

What structures are examined when assessing facial symmetry?

-Nasolabial folds -Palprebral fissures -Eyebrows -Eyes -Ears -Nose -Mouth

Where is the vertebra prominens located? is it palpable, if so when?

-C7

-Palpable when neck is flexed

What cranial nerve supports head/neck muscle movement?

-CN XI, spinal accessory , innervates the trapezius and sternomastoid

Where is the trachea located?

Midline in the neck

What does it mean if the trachea is leaning one way?

A pneumothorax is present (leans opposite of where the collapses lung is_

What muscles form the anterior and posterior triangles of the neck?

Sternomastoid and trapezius

Where is the anterior triangle of the neck?

Located under the mandible, anterior to the sternomastoid

Where is the posterior triangle of the neck?

Located between the trapezius and sternomastoid

Where is the thyroid gland located? What is its shape?

-In the anterior triangle of the neck, inferior to the larynx

-Butterfly shaped

What is hypothyroidism and what does it cause?

-lack of T3 and T4 hormone

-causes thyroid to compensate by becoming larger

What is the function of the thyroid gland?

It secretes hormones regulating body metabolism and blood calcium

What is the function of lymph nodes?

Main player in the immune system Small clusters of lymphatic tissue that filter lymph of bacteria and tumor cells to return to vascular system, produce lymphocytes and antibodies in defense to foreign substances, and can show where infection originates. Non-palpable unless infection is present

What are Palpillae?

Taste buds - small bumps on dorsal surface of tongue

What is the function of salivary glands?

The salivary glands produce saliva, start digestion and lubricate food bolus

Where are the different salivary glands located?

-Parotid glands, located in cheeks over mandible and anterior to/below ear

-Submandibular glands, located beneath the mandible at jaw angle

-Sublingual glands, located on either side of the tongue

Where are the salivary gland ducts and what are their names?

-Parotid duct, "Stenson's", located in buccal mucosa, looks like small dimple

-Submandibular duct, "Wharton's", located at either side of the frenulum

-Sublingual duct, located within floor of mouth

What is the purpose of the norse in respect to the respiratory system?

Warms, humidifies, and filters inhaled air

Where are the sinuses located?

Frontal, sphenoid, ethmoid, maxillary

What sinuses can be palpated?

Frontal and maxillary

What is the function of sinuses?

Lined with ciliated mucous membranes that trap debris and move it out

What is the function of the tonsils?

Trap and remove pathogens in food or air

How are tonsils graded?

1+ visible 2+ halfway between tonsillar pillars and uvula 3+ touching the uvula 4+ touching (kissing) each other

What is the suprasternal notch?

U-shaped depression just above the sternum, between the clavicles

What is the manubriosternal angle? What is another name for it?

-"Angle of Louis," at articulation of manubrium and sternum, and continuous with second rib

What is the main muscle of breathing?

diaphragm

What do ribs 1-7 attach to?

sternum

What do ribs 8-10 attach to?

costal cartilage

What are ribs 11-12 referred as?

floating ribs

What is the costal angle? What is the normal angle? What can an increase in this be caused by?

-the angle between the costal margins inferior to the xiphoid process

• <90 degrees

• 90 degrees is barrel chest and can be caused by emphysema

What is the visceral pleura?

serous membrane that covers lungs

What is the parietal pleura?

lines the thoracic cavity

What pressure are the pleural cavities kept at and why?

-Negative pressure

-To keep lungs inflated

What is the cricoid cartilage used to diagnose?

-Above cricoid cartilage is upper respiratory infections

-Below cricoid cartilage is lower respiratory infections

What is the vertebra prominens? What does it singify

-C7

-Where the lungs start

What is the mediastinum?

Middle section of thoracic cavity containing esophagus, trachea, heart, and great vessels

Describe the lobes of the lungs?

-Symmetric

-Right has three lobes, left has two

-Right love is higher because of the underlying liver

-Left is narrower because the heart bulges to the left

-Right bronchus is wider and shorter and more vertical than the left

What are the lung borders?

-Apices extend 3-4cm above inner third of clavicles

-Base rests on diaphragm at about 6th rib in the midclavicular line

-Laterally, the lungs extend down to the 7th or 8th rib

Where do we auscultate the lungs to in the posterior chest? Why?

-Auscultate to 10-12

-T10 on expiration

-T12 on inspiration

What are the four major functions of the respiratory system?

-Supply O2

-Remove CO2

-Maintain acid base balance

-Maintain heat exchange

Describe the body during inspiration. (Chest size, Vertical Diameter, A/P Diameter, and Movement of Diaphragm)

-Chest size increases

-Vertical diameter increases

-A/P diameter increases

-Diaphragm moves down

Describe the body during expiration. (Chest size, Vertical Diameter, A/P Diameter, and Movement of Diaphragm)

-Chest size decreases

-Vertical diameter decreases

-A/P diameter decreases

-Diaphragm moves up

What is a TB skin test? What is used in it? What does it test?

-Tuberculosis test

-Purified protein derivative (PPD) is used

-Measures immune systems response to PPD

What is the normal respirations per minute for an adult?

12-20 R

What is AP:T diameter?

Anteroposterior to transverse The diameter of the side and the transverse wall Normal: AP:T-1:2

What is barrel chest and what is it associated with?

-A/P T diameter is 1:1

-Associated with emphysema