ACA Exam 1

Superficial solid elevated, greater than or equal to 0.5cm, color varies

Papule

Superficial elevated solid flat topped lesion, >1cm

Plaque

Circumscribed collection of free fluid, >1cm

Bulla

Circular flat discoloratin, <1cm brown, red, blue or hypopigmented

Macule

Circular, elevated, solid lesion, >1cm

Nodule

Circumscribed flat discoloration, >1cm

Patch

Vesicle containing pus

Pustule

Circular collection of free fluid, greater than or equal to 1cm

Vesicle

Swollen plaque, may last a few hours

Wheal

Dried serum or exudate on skin

Crust

Crack or split

Fissure

Epidermal thickening, consists of flakes

Scale

Linear erosion

Excoriation

Loss of epidermis, part or all of it lost

Erosion

Skin becomes thick and deeply wrinkled

Lichinification

Thickened permanent fibrotic changes that occur after damage to the dermis

Scar

Alopecia, hirsutism can be due to

Endocrine disorders, nutrition pal deficiencies

clubbing is seen in

COPD, lung pts. It is a sign of low O2 in the blood

Koilonchyia

Fingernails become brittle and curve upward

Splunter hemorrhages

Trauma to the nail, IV drug use (get echo bc can get ineffective endocarditis)

Melanonychia

Nail beds in darker skin have brown pigmented line. NORMAL

If pt has history of IV drug use and has plunter hemorrhages then

Check echo, pt may have ineffective endocardities

Red flag rashes

Petechiae with fever, steven-johnson syndrome, necrotizing infection, purpura fulminans

CN VII

Number. 7, Facial nerve

How to test CN VII

ask pt to raise eyebrows, close eyes tightly, frown, smile, puff out cheeks, see if both sides of face have equal movement should be symmetrical 

CN V

Number 5, trigeminal. Sensory and motor

How to test CN V

Check sensory with cotton ball (occipital, maxillary, mandibular).

Check motor by palpate temporal and masseter muscles when patient clenches their teeth, move jaw side to side, try to separate the jaw by pushing on the chin but normally should not be able to open it 

Temporal arteritis

The temporal artery is a hard band (indurated), abnormal

TMJ should be

Smooth movement, no crepitus, no pain

JVD

Abnormal, can see neck vein bulging, associated with right side heart failure

Palpate and listen to carotid artery with

The bell and one at a time, should be +2 bilaterally

Normal lymph nodes are

Non-palpable, non-tender. Can be soft and mobile, less than 1 cm

CN XI

Acessory nerve, number 11. Tests traps and SCM

How to test CNXI

• Trapezius by shrugging against resistance 

• Sternocleidomastoid by turning head against resistance 

If thyroid is enlarged then

Use the bell to listen for bruits over thyroid gland

Goiter is

Abnormality of thyroid gland, sign of hyperthyroidism

Red flag findings of head/neck

Hard node, fixed nod, supraclavicular node (virchows node), tracheal deviation, rapid growth

Concerning findings for eyes

Flashes, floaters, curtain over vision

Red flag symptoms for eyes

Sudden vision loss

Flashes or floaters

Curtain or shadow over vision

Eye pain with vision changes

Assessment findings that are abnormal for eyes

Blurred optic disc margins, papilledema, retinal hemorrhage, cotton wool spots

Papilledema

Loss of peripheral vision so optic disc becomes fuzzy

S/sx of papilledema

Visual disturbances, headaches, nausea, increased ICP. This is due to brain trauma or brain mass

Retinal hemorrhage can occur from

Increased ICP

HTN leads to vessel damage. therefore retina shows signs of

AV nicking, hemorrhages, exudates, cotton wool spots, papilledema (if severe)

Glaucoma

loss of peripheral vision, abnormal increase in IOP, caused by a blockage preventing outflow of vitreous humor , “halo effect” is a symptom and you see green halo when you look at lights. 

chronic open angle

slow increase in IOP, genetic. Reduced night vision, aching in eye, gradual loss of peripheral vision  

acute closed angle

SERIOUS!!!! rapid increase in IOP due to sudden blockage and require immediate treatment. Eye trauma, intense eye pain 

age related macular degeneration

central vision loss due to degeneration of the macula. Peripheral vision is intact

CN II

optic nerve

CN III

oculomotor nerve

CN IV

trochlear nerve, number 4

CN VI

abducens nerve, number 6

CN II is responsible for

vision and involved with consensual light reflex

CN III is responsible for

controlling pupil constriction and eye movements. innervate all the rest of the eye muscles

EOM muscles are

CN III, IV, VI

Pupillary light reflex tests

CN II and CN III. direct and consensual response

Corneal light reflex

tests CN III, IV, VI

How to test corneal light reflex

shine light at the bridge of the nose and look for the reflection in both corneas and should be symmetrical.

accommodation and convergence tests

CN II, III, IV

How do you test for accommodation and convergence

focus on finger then the wall then look at the finger, both eyes should move in

How to tests EOM muscles

move finger in H shape

Visual fields tests

CN II

how do you test for visual fields

wiggle fingers in different fields and should see them equally. great to test for glaucoma (bc there is loss of peripheral vision)

how to do cover/uncover test

have pt stare at your nose and cover one eye. Observe uncovered eye and then uncover the covered eye and watch for movement. If the newly uncovered eye jumps then there is weakness in EOM and means strabismus aka lazy eye

Normal findings of optic disc

 yellow, distinct outline, SHARP EDGES

Normal findings of macula

light orange part circular should be two optic disc distances away towards their ear or temple and opposite in other eye

Normal finding of retinal background

red to dark brown red

Pain with triages/auricle indicates

otitis externa

Normal tympanic membrane

pale, gray, semi-transparent

Cone of life is 5:00 on right and 7:00 on left

Weber test

tests lateralization of bone conduction but doesn’t tell you if it is conductive or sensorineural hearing loss so you have to move on to rinne test

how to perform weber test

stroke prong and place it on top of pts head and if pt hears it equally then there is NO LATERALIZATION (normal finding)

Rinne test

 tests air conduction and bone conduction.

Normal finding of Rinne

AC>BC, aka positive test

Bone conduction is performed by

place tuning fork on mastoid bone behind ear

Air conduction

place tuning fork near the ear canal without touching it. Normal is AC>BC so it's a positive test. 

Abnormal finding for conductive hearing loss

weber test will lateralize to bad ear and rinse shows BC>AC or equal to each other so conductive hearing loss

Conductive hearing loss

BC>AC or BC=AC, means there is something blocking it

Abnormal finding for sensorineural hearing loss

during weber there is lateralization to good ear and AC>BC

conductive hearing loss s/sx

everything sound muffled, due to cerumen, otitis media, middle ear effusion

sensorineural hearing loss s/sx

I can hear people talking but I can’t understand them

clear sinuses should

transluminate

Pale boggy turbinates is seen in

allergic rhinitis

polyps in nose can be seen in

chronic allergic rhinitis

perforated septum occurs due to

cocaine, trauma and too much STEROIDAL nasal spray (saline is fine)

NORMAL mouth findings

 Fordyce spots, torus palatinus (bony overgrowth on roof of mouth), fissured tongue, geographic tongue

Wharton’s ducts

under sublingual glans aka under Tongue

CN IX

glossopharyngeal aka gag reflex, number 9

CN VIII

vestibulochlear nerve, number 8

how to test CN IX

touch posterior wall with tongue blade to elicit gag reflex, presence of gag means nerve is intact

CN X

vagus nerve

how to test CN X

 ask pt to open mouth and say ah, note rise of soft palate, should be symmetrical on both sides and uvula remain midline without deviation

If you have abnormality with CN X then

the uvula will deviate and it will deviate towards the unaffected side

CN XII

hypoglossal, number 12

how to test for CN XII

ask pt to stick out tongue and inspect for symmetry

if there is an abnormality with CN XII then

the tongue will deviate and it will towards the lesion

oral malignancies are on the

ventral or lateral side of tongue and will look like white patches or ulcerations that don’t heal

bacterial pharyngitis

red throat with exudate on tonsils

how to palpate for symmetric chest expansion aka respiratory excursion

Place thumbs at T9-T10 and pinch skin slightly and ask pt to take a deep breath, thumbs should move apart symmetrically

how to palpate for tactile fremitus

both palms of hands and have pt say 99

if tactile remits is increased then

the vibrations will be dense and you will feel more vibration in that area because there is fluid moving