Test 2 Study Materials: Patient Assessment for Medical Students covering chapters from 02/23 to 03/01

What are some things to ask about during a head exam?

headaches

lightheadedness

dizziness

h/o head trauma

What disease causes "moon face?"

Cushing's disease

What disease causes peri orbital edema?

severe hypERthyroidism

mixedema

another term for periorbital edema

what are some things to ask about during an eye exam?

visions changes (uni/bi/peripheral/near)

eye pain

eye redness

double vision (horizontal/vertical)

seeing lights

tearing/lack of tears

family history of eye disease

glasses or contacts

How can you measure visual acuity?

a Snellen Chart

What is the standard distance for a patient to stand from a Snellen chart?

20 ft.

What is the visual acuity that indicates a referral to ophthalmology?

20/40 in both eyes or a different in eye acuity

myopia

nearsightedness; difficulty seeing distant objects

presbyopia

farsightedness; problem seeing things close

what visual acuity is legally blind?

20/200 with glasses

What visual acuity is clinically blind?

20/400

how do you perform the static finger wiggle test?

stand arms distance from the patient

patient closes opposite eye of provider

provider wiggles fingers 2 ft apart

What is a common cause of bilateral vision loss at the optic chiasma?

a pituitary gland mass

What is the measurement of a normal eyelid crease?

6-7 mm

What genetic conditions can cause a palpebral slant?

Down syndrome

fetal alcohol syndrome

What is the measurement of a normal eye opening?

9-12 mm

exophthalmus

eyeballs that protrude

What can cause exophthalmus?

hyperthyroidism

ptosis

the eye lid covering the pupil

What can case ptosis?

Bells Palsy

Stroke

entropion

inward turning of the rim of the eyelid

ectropion

outward turning of the rim of the eyelid

xanthelasma

raised yellowish plaque on eyelid caused by lipid disorder

what causes xanthelasma?

hyperlipidemia

blepharitis

erythematous and swollen eyelid

hordeolum

painful infection near the eye

chalazion

painLESS blocked gland near the eye

What is another name for a hordeolum?

stye

What would a yellow sclera indicate?

jaundice

Pinguecula

yellow raised spot on the conjunctiva

asymptomatic fat deposit

Episcleritis

inflamed eye tissue on the sclera

Subconjunctival Hemorrhage

painless red eye with red sclera

Conjunctivitis

can be bacterial or viral inflammatory infection

Corneal Arcus

Lipid deposits in the periphery of the eye that may be detected when light is directed to the iris

What does a corneal arcus indicate?

hyperlipidemia; check the patients lipids

Kayser Fleischer Ring

Deposition of copper in the cornea

What disease is associated with the Kayser Fleischer ring?

Wilson's Disease

Pterygium

thickening of the cornea that crosses the pupil

Cataract

a cloudy opacity of the lens

What are risk factors for cataracts?

old age, smoking, diabetes, UV light

How would you perform the Iris Test?

shine a pen light on the side of the eye to look for a "crescent shadow"

What would a positive iris test indicate?

narrow angle glaucoma

what is a normal size for a pupil?

3-5mm, equal size

Myosis

pupils too small; parasympathetic response

Mydriasis

pupils too big; sympathetic response

Coloboma

unusual shape of the pupil, congenital

Anisocoria

greater than a 0.4mm difference in pupil size

How do you test light reflex?

shine a light in each eye twice, observing for direct and indirect responses

How do you perform the near test?

ask the patient to stare into the distance and then look at a near object

the pupils should constrict with near effect

What is the swinging flashlight test for? What would be a positive test?

it test for optic nerve impairment.

positive = dilation instead of constriction with light

Marcus-Gun Pupil

a pupil that dilates in response to light rather than contracting

Tonic Pupil

constriction and accommodation are slow, usually unilateral

T/F: A tonic pupil is due to a parasympathetic denervation.

True

Horners pupil

mitosis + ptosis + anhydrosis

unilateral

constricts easily, dilates slowly

T/F: Horner's pupil is due to parasympathetic denervation.

False. it is due to a sympathetic lesion

Argyll Robertson Pupil

bilateral, miotic, irregularly shaped pupils that constrict with near vision, dilate with far vision, and do not react to light

Which type of pupil is consistent with neurosyphilis?

Argyll Robertson Pupil

How many quadrants are in an extra ocular movements test?

6 quadrants + near accommodation

Why test should you perform if you suspect strabismus?

the cover uncover test

What is another term for strabismus?

a lazy eye

nystagmus

Involuntary rapid eye movements

Which cranial nerve controls the superior oblique eye movement?

CN 4

Which cranial nerve controls the lateral rectus eye movement?

CN 6

What cranial nerve controls the majority of the EO eye movements?

CN 3

What is the description of a normal physiological cup?

less than 1/2 the diameter of the optic disc

what does papilledema look like?

pink, blurred optic disc margins, with no visible physiologic cup

What causes papilledema?

increased IOP due to a hypertensive emergency

what is cupping?

a big physiological cup, greater than 1/2 the size of the optic disc

What can cause cupping?

glaucoma and increased IOP

What does the fovea look like?

a light spot with a dark spot in the middle

What causes cotton wool spots?

diabetic or hypertensive retinopathy

hypopyon

pus in the anterior chamber of the eye

hyphema

blood in the anterior chamber of the eye

what diagnostic tool can be used to detect corneal abrasions and ulcers?

fluorescent stains with woods lamp or slit lamps

What is the best tool to diagnose herpes keratitis?

woods lamp and fluorescent stain

What does Seidel's test detect?

globe rupture

What questions could you ask for an ear exam?

hearing changes (uni/bi)

ringing

pain

discharge

vertigo

trauma

constitutional symptoms like congestion, cough, etc

Lop Ear

when children ears stick out. can be resolved with pinning

What is a PE finding that differentiates otitis external from otitis media?

TM involvement

externa = no TM involvement

tympanosclerosis

scarring of the TM

bullae retractions

fluid behind the TM that indicated infection

cholesteatoma

ear tumor

valsalva maneuver

"popping" your ears

can determine TM mobility

tympanometry: A vs. B vs. C

A = normal mobility

B = little to no mobility

C = negative pressure (infection)

What are 3 hearing tests?

Whisper test

Weber Test

Rinne Test

What are some eye tests? (6)

visual acuity testing

visual field testing

iris test

light reflex

near test

swinging flashlight test

How would you perform the whisper test? What is a abnormal result?

stand 2 ft behind the patient and have them cover one ear while you whisper a 3 letter/word combination

abnormal = 4/6 possible letters

How do you perform a weber test? When would you use it?

UNIlateral hearing loss

use a 512 Hz tuning fork on top of head

if it conducts to the side with hearing loss = conductive loss

if it conducts to the side w/o hearing loss = neurosensory hearing loss

How would you conduct a Rinne Test?

place a 512 Hz tuning fork to the skull, once they no longer hear it through bone, place it by the ear, they should be able to hear it through air

What questions should you ask prior to a nose exam?

congestion

obstructions

rhinorrhea

epistaxis

nasal mediations

pain

prev nasal surgeries

What would a pale turbinate indicate? A red turbinate?

pale = allergies

red = infection

What is the imaging study of choice for recurrent sinus infections?

CT scan

dysphagia

cannot swallow

odynaphasia

painful to swallow

What questions should you ask prior to a throat exam?

sore throat

lesions

bleeding gums

tongue pain

bad breath

swollen glands

Peutz-Jeghers Syndrome

pigmented macules on the lips.

Assoc with GI cancer and polyps

What CN controls the soft palate and uvula?

CN 10

T/F: if the uvula deviates to the LEFT there is a lesion of CN X on the LEFT

False. the lesion would be contralateral, on the RIGHT side

torus palatinus

a benign isolated protuberance on the midline of the soft palate