QUIZ 4

Macula

• sharp, detailed vision

Optic disc

• where the optic nerve begins

• supplies & drains the inner layers of the retina

• appears yellow/pink

red reflex

• reflection of light from inside the eye

Papilledema

• swollen optic disc

• can cause vision loss

Strabismus

• true disparity of the eyes axis

• eyes don’t line up

Nystagmus

• fine, oscillating movement best seen around the iris. Disease of the semicircular canals of the ears, MS, brain lesions, and paretic eye muscles.

Preorbital edema

• due from crying & trauma

• connective tissues in the eyes are loosely connected, fluid can easily get in

• due to crying, trauma, allergies, CHF, renal failure, hypothryoidism

Exopthalmos

• eyeballs stick (bulge) foward

Retinal detachment

• retina seperates

• “curtain” over vision

Cataract

cloudy lens

Glaucoma

• increased eye pressure

• optic nerve damage

Conjunctivitis

pink eye

Ptosis

• drooping upper eyelid

Miosis

• small constricted pupils

Mydriasis

• dialated pupils

External ear

• Auricle/pinna: collects sound

• Auditory canal: carries sound from eardrum

• Cerumen: earwax, protects/lubricates the ear

Middle ear

• Malleus: first bone, connected to eardrum

• Incus: middle bone

• Stapes: last bone, sends vibrations toward the inner ear

Eustachian tube

• connects middle ear to nasopharynx

• helps equalize pressure

Webber vs Rinne

• Webber:

  • “Does sound go equally to both ears?”

  • The turning fork goes on the middle of the forehead/skull

  • normal if sound is equal in both ears

• Rinne

  • Air or bone conduction

  • 1st: mastoid bone

  • 2nd: next to the ear canal

  • normal if air is greater than bone conduction

Hearing loss

• Conductive hearing loss: outer/middle ear problem

• Sensorineural hearing loss: inner ear/nerve problem

• Mixed both

Nasal septum

• divides nose into two passages

Kiesselbach’s plexus

• rich blood vessels

  • common site for nose bleeds

Turbinates

• there are 3 of them

• Superior, middle, inferior

• helps warm, humidify & filter air

Meatus

• space underneath the turbinates

• middle meatus: sinuses drain here

• inferior meatus: tears drain here

Sinuses

• Frontal: forehead, above/medial to eyes

• Maxillary: cheekbones

• Ethmoid: between eyes

• Sphenoid: deep in skull

• Can only easily examine frontal & maxillary

Abnormalities of the nose

• Epitaxis: nosebleeds

• allergic rhinitis: pale/swollen turbinates + clear drainage

• Acute rhinitis: red/swollen mucus + purulent drainage

• Choanal atresia: blockage in newborns nasal passage

• Perforated septum: hole in nasal septum

Mouth

• Palate:

  • hard palate: front & bony

  • Soft palate: back & muscular

• Uvula: hangs down from the soft palate

• Tongue: chewing, swallowing, speech, taste

  • Frenulum: connects underside of tongue to floor of mouth

• Salivary glands:

  • Parotid: cheek, in front of ear

  • Submandibular: underneath jaw

  • Sublingual: underneath tongue

Abnormalities of the mouth

• Angular cheilitis: red/cracked corners of the mouth

• Aphthous ulcer: canker sore

• Koplik spot: blue-white spots (early measle sign)

• Thrush/canadidiasis: white patches on the tongue that rub off

• Leukoplakia: white patches that do not rub off. Precancerous

• Ankyloglossia: tongue tied/short frenulum

• Geographic tongue: smooth red patches

• Black hairy tongue: elongated papillae causing dark/hairy appearance. Can be caused from antibiotics or smoking

• Peritonsillar abscess: severe infection, one tonsil enlarged + uvula pushed to the side

Tonsil grading

• 1+ visible/normal

• 2+ halfway to uvula

• 3+ touching uvula

• 4+ touching eachother

Infants

• are obligate nose breathers

• Macula develops/matures by about 8 months

• Binocular vision develops around 3-4 months

• Epstein pearls: small white spots in the mouth, normal/resolve

• Sucking tubercle: normal pad on upper lip

Aging

• eyes lose elasticity

• less tears

• Presbyopia: lens become less flexible

• Cataracts become more common

• Glaucoma risk

• Macular degeneration: damage to the macula, causing loss of central/sharp vision

• Nose: loss of fat, nose looks more prominent

• Mouth: tooth loss, less saliva, less taste & smell

Structure of the breast

• Made of granular tissue, fibrous tissue & adipose (fat) tissue

• Glandular tissue contains 15-20 lobes radiating from the nipple

• Lobes are made of lobules embedded in adipose tissue

• Copper’s ligaments are fibrous bands that extend from the surface to the breast to chest wall

• Areola surrounds the nipple

• Montgomery glands are sebaceous glands that secrete protective lipid material during lactation

• The tail of spence is the upper lateral portion of the breast that extends into the axilla

Breast abnormalities

• dimpling of the skin: the skin looks pulled inward or intended

• Nipple retraction: nipple pulled inward instead of sticking out

• Edema/Peau 'd’ Orange: looks like an orange peel, breast skin becomes swollen

• fixation of the breast tissue: the breast tissue or lump feels stuck in place & does not move easily

• deviation of the nipple: points in a different direction than normal

• Abnormal breast lumps

• Abnormal nipple discharge

• Mastitis: inflammation of the breast, typically associated with breastfeeding

BSE

• examine breasts in front of a mirror while disrobed to the waist

• look in the mirror for any changes in size, shape or skin. Gently feel breast tissue with fingers, including around the nipple into the armpit, can do it in the shower or laying down

• Look in mirror, palpate in shower then while laying down

• look for lumps, dimpling, nipple changes, skin changes, unusual discharge

• Vertical strip pattern is recommended to detect breast masses

Cancers of the breast

• Breast cancer: cancer that starts in the breast tissue

• Ductal carcinoma in situ (DCIS): abnormal cancer cells that are in inside the milk ducts but have not spread to outside ducts

• Paget disease (intraductal carcinoma): breast cancer that affects the nipple/areola area

• BRCA1/BRCA2 mutations, family history, alcohol use, postmenopausal weight gain, decreased physical activity increase risk

Lymphatics

• central axillary

• Pectoral (anterior)

• Subscapular (posterior)

• lateral

• from the central axillary nodes, drainage continues to the infraclavicular & supraclavicular nodes

Axillary lymph nodes vs tail of spence

• Axillary lymph nodes: located in the axilla (underarm) that recieve lymphatic drainage from the breast

• Tail of spence: portion of breast tissue (not a lymph node) superior lateral part of the breast that projects into the axilla

  • Tail of spence: breast tissue that extends into the armpit

• Axillary nodes: lymph nodes in the armpit

Tanner staging

• describes pubertal breast development

• Stage 1: prepubertal, no glandular breast tissue

• Stage 2: breast bud develops, areola begins to enlarge

• Stage 3: Breast tissue enlarges, no seperation from the areola from the breast contour

• Stage 4: areola & nipples form a secondary mound

• Stage 5: mature adult breast, areola generally returns to the contour of the breast, nipple projects

Supernumerary nipples

• during embryonic development, milk lines extend from the axilla into the groin

• breast develops along the thoracic portion of the ridge while the rest atrophies

• Supernumerary = Occasionally an extra nipple persists along the mammary ridge

  • it is normal/congenital variation

Adolescents, Breast developement, Menstration, BMI

• At puberty estrogen stimulates breast changes

• Thelarche = breast developement

  • precedes menarche by about 2 years

• Menarche = first menstural period

• Obesity is the major driver of early breast budding & early menarche

  • breast budding varies by race, ethnicity & BMI

Gynomastia

glandular male breast enlargment due to relative estrogen/androgen imbalance

Normal findings in breast examination

• common to have slight asymmetry

  • a sudden growth in one breast signifies or new growth is abnormal

• skin is smooth & one skin tone

• a blue vascular network is visibly normal during pregnancy

  • along with striae & stretch marks

  • hyperpigmentation, redness & heat and dialated superficial veins in an unpregnant person is abnormal

• no bulging or edema

• no discharge

Examining the axilla

• down the chest wall in a line from the middle of the axilla

• along the anterior border of the axilla

• along the posterior border

• along inner aspect of upper arm

• move down the women’s arm through ROM

• Palpate breast in a vertical strip pattern, with the women’s arm above her

  • palpate the nipple using your finger and thumb, depress the nipple into the well behind the areola

• Pathologic discharge = spontaneous unilateral, has blood or is clear

• when a women has a mastectomy, tumor grow along the incision site