Physical assesment Exam 2

Amblyopia

lazy eye, one eye has poorer vision than the other

astigmatism

irregular curvature of cornea or lens

light is not focused on the same plane

exophthalmos

abnormal protrusion of the eyeball

hyperopia

farsightedness: trouble seeing close up

miosis

small constricted pupil

seen with horner syndrome

mydriasis

dilated pupils

O.D

right eye

O.U

both eyes

O.S

left eye

presbyopia

happens with old age

loss of eye to accomodate

scotoma

bulbar conjunctiva

covers the sclera

keeps eye lubricated and protects against microorganisms

choroid

middle layer of the eye that contains blood vessels

cornea

clear/dome like

protects the eye

bends/focuses light onto retina

extraocular muscles

control eye movement

MR, SR, IR, LR, SO, IO

CN III lesion: MR/SR/IR/IO

CN IV lesion: SO

CN VI lesion: LR

fovea

sharpest point of vision

foveal light reflex: indicated a healthy eye

iris

EYE COLOR

dilator m: makes pupils bigger

sphincter m: makes pupils small

Lateral canthus

corner of eye-supports lower eyelid

helps eye blink and protects eyes surface

limbus

border between cornea and sclera

bluish outline

lens

focuses light onto retina

macula

central vision

medial canthus

inner corner of the eye

assists in drainage of lacrimal sac

meibomian glands

sebaceous oil glands in eyelids and stops tears from evaporating

optic nerve

carries signals to the brain

palpebral conjuctiva

covers inside of eyelids and keeps it lubricated

optic disc

Region at the back of the eye where the optic nerve meets the retina. It is the blind spot of the eye because it contains only nerve fibers, no rods or cones, and is thus insensitive to light.

pupil

absence of tissue in center of iris

retina

neural tissue that carries messages to the brain

innermost layer

scerla

protects and maintains shape of the eye

tarsal plate

main structural component of eyelids

vitreous body

back of the eye that contains vitreous humor

anterior chamber

fluid-filled space between the cornea and iris

contains aqueous humor

Lacrimal system pathway: TEARS drainage

tears secreted by lacrimal duct and drained :

punctum> canaliculi > lacrimal sac > nasolacrimal duct> into nose/back throat

Pathway of aqueous humor

anterior segment (ciliary body) > posterior chamber > anterior chamber > drained via trabecular meshwork

Visual pathway steps

pupil > retina > stimulates photoreceptors in retina > travels to optic nerve > signals carried to the brain

Near reaction

3 parts relfex that brings near objects into focus through lens thickening, pupillary constriction and inward rotation of eyes

Anisocria

unequal pupil size

strabismus

misalignment of the eyes

Dyschromotopsia

color blind

deutan

color blind shifted more towards red

protan

color blind shifted towards green

cataracts

clouding of the lens

natural age related process

corneal arcus

lipid deposits

very common in aging population

no work up needed

intraocular pressure (IOP)

determined by rate at which aqueous humor is being made and drained

Normal IOP

10-21 mmHg

methods to test IOP

goldmann applanation tonometry( gold standard)

icare tonometer(best for kids)

Tono-pen (common in ED)

exotropia

condition where one or both eyes turn inward " wall-eyed appearance"

esotropia

inward turning of the eye

pinguecula

harmless, yellowish white bump that develops on the white part of the eye

pterygium

thin tissue growing into the cornea from the conjunctiva, usually caused from sun exposure

ptosis

drooping eyelid

can be aging/congenital: absence if eye crease

new onset : needs urgent FU

causes of pitosis

Horner's syndrome

CN III palsy

Myasthenia Gravis

entropion

inward turning of the rim of the eyelid

ectropion

outward turning of the rim of the eyelid

stye(chalazion)

plugging of meibomian glands

Acute: hordeolum

chronic

Treatment: warm compress and lid scrubs

papilledema

swollen optic nerves from increased ICP

life and sight threatening

diabetic retinopathy

damage to the retina as a complication of uncontrolled diabetes

treatment:

medication, laser surgery, eye injections

hypertensive retinopathy

Disease of the retina due to high blood pressure.

treatement:

control BP, laser therapy, surgery

chest pain differentials

cardiovascular, pulmonary, gastrointestinal, psychiatric, malignancy, dermatological

apical impulse

point of maximal impulse (PMI); pulsation created as the left ventricle rotates against the chest wall during systole, normally at the 5th left intercostal space in the midclavicular line

cardiac apex

the rounded point at the bottom of the heart

diastole(s2 dub sound)

Relaxation of the ventricles

SLV close

AV open

pressure is decreased

dyspnea

shortness of breath

insufficiency

chronic condition in which the heart is unable to pump blood effectively to meet bodys need for O2 and nutrients

murmer

abnormal heart sound

crescendo murmur

increases in intensity

decrescendo murmur

decreases in intensity

crescendo-decrescendo murmur

increases and then decreases in intensity

plateau murmur

Constant intensity, suggests mitral regurgitation or ventricular septal defect.

orthopnea

difficulty breathing when lying down

paroxysmal nocturnal dyspnea

episodes of sudden dyspnea and orthopnea which awaken patient from sleep

mitral regurgitation

backflow of blood from the left ventricle into the left atrium

happens during systole

plateau murmur

Tricuspid regurgitation

Backflow of blood into the right atrium during systole

aortic valve regurgitation

Backward blood flow from ascending aorta into left ventricle during diastole

aortic stenosis

calcification of aortic valve cusps that restricts forward flow of blood during systole

Mitral valve stenosis

narrowing of the mitral valve during diastole from scarring caused rheumatic fever

pulmonic stenosis

narrowing of the opening and valvular area between the pulmonary artery and right ventricle during systole

hydrostatic pressure

Pressure exerted by a fluid at rest due to force

oncotic pressure

pressure exerted by large proteins in the blood plasma on the capillary walls

systole (s1) lub

ventricular contraction

AV close

SLV open

pressure is increasing

venous hum

continuous, low pitched murmur in the neck or upper chest

often heard in children

Hypertrophic Cardiomyopathy (HCM)

Thickening of heart muscle

Systolic

Plateau M

thickening of left ventricle

usually genetic

ventricular hypertrophy

may be a sign that the heart is working harder to pump blood to the rest of the body.

patent ductus arteriosus

congenital heart defect where the ductus arteriosus, a temporary blood vessel present in the fetus, remains open after birth.

systolic M

ventricular septal defect(VSD)

an opening in the septum separating the ventricles(hole in heart)

systolic Murmur

viens

carry blood towrds the heart

oxygenated blood

arteries

carries blood away from the heart

deoxygenated blood

PATHWAY OF BLOOD

IVC/SVC > RA > tricuspid V > RV > pulmonary valve > pulmonary artery > LUNGS to get oxygenated > pulmonary vein > LA > mitral V > LV > aortic V > aorta

splitting of S1 and S2

when the mitral/tricuspid valves do not close at the same time (S1 split)

when the pulmonic/aortic valves do not close at the same time (S2)

Two sounds instead of one

S3 gallop

rapid ventricular filling

may suggest heart failure: older patients

can be normal in: conditioned athletes, children and 3rd trimester of pregnancy

diastolic sound

S4 gallop

atrial contraction

thickening of heart muscle

diastolic sound

pathologies:

- cardiomyopathy

-aortic stenosis

- hypertension

friction rubs

rubbing of pericardial layers

pericarditis

scratchy or grating sound during expiration

clicks

short, high pitched sound heard during cardiac cycle

indicated abnormal valve function

opening snaps

associated with mitral stenosis

early diastolic sound from abrupt deceleration during opening of a stenotic mitral valve

alveoli

air sacs located in the bronchioles of the lung and main gas exchange

atelectasis

collapsed lung when alveoli become blocks or losing air

bronchophony

voice transmission test

normal= muffles noise

abnormal= louder/clear voice

sign of pneumonia

egophony

ask patient to say "ee"

normal= muffled "ee"

abnormal= ay sound

pneumonia or pleural effusion

whisphered pectoriloquy

whisper 99 to patient

normal: faint and distinct

abnormal: whispered words are louder/clearer

pneumonia or lung mass

consolidation

air spaces within the lung tissue are filled with fluid/pus/blood