Exam 2

Snellen Chart

Used to test central visual acuity; place patient 20 feet from the chart and ask them to read the smallest line visible.

Jaeger Card

Used to test near vision; hold the card 14 inches from the eye and ask the patient to read the smallest print visible.

Nystagmus

Rapid, involuntary oscillation of the eyeball; often indicates a neurologic or vestibular disorder.

Diagnostic Positions Test

Evaluates extraocular muscle function by asking the patient to follow an object in six cardinal positions of gaze.

Corneal Light Reflex

Assesses the alignment of eye axes by shining a light toward the eyes and observing the reflection on the corneas.

Confrontation Test

Gross measure of peripheral vision by comparing the patient’s peripheral vision with your own.

Accommodation

Adaptation of the eye for near vision, observed as convergence of eyeballs and pupillary constriction.

Consensual Light Reflex

Constriction of the pupil in the opposite eye when light is shone on one eye.

Direct Light Reflex

Constriction of the pupil in the eye exposed to light.

Cover Test

Detects small degrees of deviated alignment by covering one eye and observing the uncovered eye for movement.

PERRLA

Abbreviation for Pupils Equal, Round, Reactive to Light, and Accommodation; used to assess eye function.

Conjunctivitis

Inflammation of the conjunctiva, often presenting with redness, discharge, and irritation.

Cataracts

Clouding of the lens, leading to blurred or diminished vision.

Glaucoma

Increase in intraocular pressure, potentially causing optic nerve damage and vision loss.

Periorbital Edema

Swelling around the eyes, often associated with infections, trauma, or systemic conditions.

Ear Exam - Adults

Pull the pinna up and back to straighten the ear canal for better visualization.

Ear Exam - Pediatrics

Pull the pinna down and back for children under 3 years old to match the ear canal’s slope.

Age-Related Hearing Changes

Presbycusis is a common sensorineural hearing loss with aging, especially for high-frequency tones.

Whisper Test

Tests hearing acuity by whispering a series of words or numbers while masking the opposite ear.

Vertigo

Sensation of spinning or dizziness, often caused by inner ear or neurologic issues.

Tracheal Shift

Occurs with pneumothorax, large pleural effusion, or atelectasis; trachea shifts toward or away from affected side.

TMJ (Temporomandibular Joint)

Palpable joint anterior to the ear; dysfunction may present with pain, clicking, or limited movement.

Tinnitus

Ringing or buzzing in the ears, often associated with hearing loss or noise exposure.

Nosebleeds (Epistaxis)

Prevent by humidifying air and avoiding nose picking; treat by pinching the nose and leaning forward.

Headache Types

Include tension (band-like pressure), migraine (throbbing, unilateral), and cluster (sharp, around the eye).

Tongue Presentation

Normal tongue is pink and moist; abnormalities include fissures, white patches, or swelling.

Hydrocephalus

Enlargement of the head due to accumulation of cerebrospinal fluid, causing increased intracranial pressure.

Acromegaly

Excessive growth hormone secretion leading to enlarged skull, hands, and facial bones.

Down Syndrome

Genetic disorder characterized by flattened facial profile, upward slanting eyes, and intellectual disability.

Bell's Palsy

Facial paralysis due to cranial nerve VII dysfunction; often presents unilaterally with inability to close eye.

Candidiasis Infection

Fungal infection causing white, curd-like patches on the tongue and buccal mucosa.

Thoracic Cage Landmarks

Suprasternal notch, sternum, angle of Louis, costal angle.

Reference Lines

Include midsternal, midclavicular, vertebral, scapular, anterior axillary, posterior axillary, and midaxillary lines.

Lobes of Lungs

Right lung has three lobes; left lung has two lobes; best assessed based on anterior, posterior, and lateral views.

Subjective Data for Respiratory System

Cough, shortness of breath, chest pain with breathing, smoking history, environmental exposures.

Objective Data for Respiratory System

Inspection, palpation, percussion, auscultation to assess respiratory health.

Inspection - Thorax

Observe chest shape, symmetry, and respiratory effort; check skin color and condition.

Symmetric Expansion

Assessed by placing hands on the thorax and observing for symmetrical movement during deep breaths.

Tactile Fremitus

Palpable vibrations on the chest wall as the patient speaks; changes may indicate lung pathology.

Percussion Pattern

Systematically percuss lung fields side-to-side in intercostal spaces to assess resonance or dullness.

Percussion Sounds

Normal lungs produce resonance; dullness suggests fluid, and hyperresonance indicates air trapping.

Auscultation Pattern

Listen to breath sounds in a systematic side-to-side pattern across lung fields.

Types of Breath Sounds

Include bronchial, bronchovesicular, and vesicular; adventitious sounds include crackles, wheezes, and rhonchi.

Measuring Pulmonary Function

Use spirometry, pulse oximetry, and the six-minute walk test to assess lung function.

Developmental Considerations - Respiratory

Infants have a round thorax and diaphragmatic breathing; aging adults may have decreased chest expansion.

Barrel Chest

Associated with COPD; increased anteroposterior diameter.

Scoliosis

Lateral curvature of the spine, which may reduce lung volume.

Kyphosis

Excessive outward curvature of the thoracic spine, common in aging adults.