209 FINAL

The skin has two layers. What are they? What lies beneath them?

The outer highly differentiated epidermis and the inner supportive dermis. Beneath these layers is a third layer, the subcutaneous layer of adipose tissue.

What is the protein found within the inner stratum germinatium, or basal cell layer, of the epidermis?

keratin

True or false: everyone has a different number of melanocytes.

False: everyone has the same amount of melanocytes, however, the amount of melanin they produce varies with genetic, hormonal, and environmental influences.

This outer horny cell layer consists of dead keratinized cells that are interwoven and closely backed. The cells are constantly being shed, or desquamated, and replaced.

A) Stratum germinatium

B) Stratum corneum

C) Stratum keratin

D) Stratum basale

The epidermis is:

A) vascular

B) avascular

B: Avascular. it is nourished by blood vessels in the dermis below

What are the three sources in which skin colour is derived from?

Melanin (brown), carotene (yellow-orange), and the red-purple tones in the underlying vascular bed.

Which of the following can be found within the dermis?

A) Collagen

B) Keratin

C) Elastic tissues

D) Nerves and sensory receptors

E) Blood vessels

F) Subcutaneous fat

A C D E

What is the purpose of the subcutaneous layer?

Stores fat for energy, provides insulation for temperature control. aids in protection by its soft cushioning effect.

What are the two kinds of hair? How do they differ?

Faint, fine vellus hair covers most of the body. Terminal hair is darker and thicker that grows on the scalp and eyebrows, and, after puberty, on the axillae, pubic area, and face and chest of males.

True or false: dry skin is a result from loss of oil produced by sebaceous glands

False: dry skin results from loss of water, not directly from loss of oils. Sebum oils and lubricates the skin and hair and forms an emulsion with water that retards water loss from the skin.

what are the 2 kinds of sweat glands?

Eccrine and apocrine glands. Eccrine glands open directly onto the skin surface to produce sweat; evaporation of sweat controls temperature. Apocrine glands produce a thick, milky secretion and open into hair follicles. They become active during puberty; secretion occurs with emotional and sexual stimulation.

list some functions of the skin

Protection, prevents penetration, perception, temperature regulation, identification, communication, wound repair, absorption and excretion, production of vitamin D.

why are infants at greater risk for fluid risk?

Newborn's skin is thin, smooth, and elastic and is relatively for permeable than that of the adult, so the infant is at greater risk for fluid loss.

What is the physiological adaptation to the environment seen in individuals who live in the arctic?

they sweat more through their face than their torso

lower risk of skin cancer in which individuals?

More melanin/darker skin tones. Melanin protects skin against UV rays.

Diaphoresis is...

A) Dry skin

B) Excess sweating

C) Redness in face

What could patchy hair distribution be an indicator of?

Uneven blood flow.

When examining any changes in lesions, the ABCDE rule stands for:

Asymmetry, Border irregularity, Color variation, Diameter, Elevation and enlargement.

what is tenting?

A sign of dehydration. Tested by pinching clavicle. If skin does not spring back right away, patient is dehydrated.

what is the difference between a macule and a papule?

Macules are flat, papules are raised.

What changes occur to the skin of an older adult?

Loss of elastin, collagen, and subcutaneous fat, as well as a reduction in muscle tone. Increased risk for shearing, tearing injuries, as well as wrinkles due to thinning and flattening of the dermis.

What is the difference between a pustule and a vesicle?

Vesicles are filled with clear fluid; pustules are filled with pus.

The human face has a large array of facial expressions that reflect mood. Which cranial nerve mediates the expressions formed by facial muscles?

cranial nerve VII

Facial sensations of pain or touch are mediated by the three sensory branches of cranial nerve:

V: the trigeminal nerve (think tri=three!)

The sternomastoid and trapezius muscles of the neck are innervated by cranial nerve?

XI, the spinal accessory

What is the isthmus?

The isthmus lies over the second and third tracheal rings and connects the two lobes of the thyroid gland.

List all the lymph nodes found in the neck.

Preauricular, posterior auricular, occipital, submental, submandibular, jugulogastric/tonsillar, superficial cervical, deep cervical chain, posterior cervical, supraclavicular

The greatest supply of lymph nodes are found in the head and neck, however they can also be found in?

The arms, axillae, and inguinal region.

Provide an instance in which facial symmetry is not present.

Individuals who have had a stroke will often show asymmetrical facial features/movements.

Upon auscultating the thyroid gland, the nurse hears a low-pitched noise. The nurse knows this is indicative of what?

A bruit: turbulent blood flow resulting from some sort of buildup in the arteries.

Which of the following is the most appropriate health history question?

A) Do you have any unusually frequent or severe headaches?

B) Have you had a headache recently?

C) Have you ever had a headache?

D) When did your headache start?

A

Why might the thyroid gland be enlarged in pregnant women?

The thyroid gland enlarges slightly during pregnancy as a result of hyperplasia of the tissue and increased vascularity.

When testing muscle strength by asking patient to shrug their shoulders and turn their head from side to side against resistance, what cranial nerve were we assessing?

Cranial nerve XI: spinal accessory

What is the space between the eyelids called?

\

palpebral fissure

The border between the cornea and sclera...

A) canthus

B) conjunctiva

C) tarsal plate

D) limbus

D

The caruncle, a small fleshy mass containing sebaceous glands, is found at the inner...

A) conjunctiva

B) lacrimal apparatus

C) canthus

D) limbus

C

\_______ are modified sebaceous glands that secrete an oily lubricating material onto lids to prevent overflowing of tears.

Meibomian glands

What is the difference between the bulbar and palpebral conjunctiva?

The palpebral conjunctiva lines the lids and is clear, with many small blood vessels. It forms a deep recess then folds back over the eye. The bulbar conjunctiva overlays the eyeball, with the white sclera showing through (underneath).

What is the purpose of the lacrimal apparatus?

The lacrimal apparatus provides constant irrigation to keep the conjunctiva and cornea moist and lubricated. The lacrimal gland secretes tears.

What are the extraocular muscles? How many are there?

The extraocular muscles are the six muscles that attach the eyeball to it's orbit and serve to direct the eye to points of the person's interest. There are four straight (rectus) muscles and two slanting (oblique) muscles.

What is meant by "conjugate movement"?

Each extraocular muscle is coordinated with the other eye. This ensures that when the two eyes move, their axes are always parallel. This is important as humans can only tolerate seeing one image at a time.

What three cranial nerves stimulate movement of the extraocular muscles?

Cranial nerve VI: the abducens nerve; cranial nerve IV: the trochlear nerve; cranial nerve III: the oculomotor nerve

What are cataracts?

Clouding of the lens

What are the two components of accommodation that can be observed?

Convergence of the axes of the eyeballs and pupillary constriction.

In aging adults, the lens loses elasticity and becomes hard and glasslike. This glasslike quality decreases the lens's ability to change shape to accommodate for near vision; this condition is known as:

presbyopia

Macular degeneration is caused by:

The breakdown of cells in the macula of the retina

glaucoma is caused by:

increased intraocular pressure

What group has a 3-6 times higher rate of glaucoma?

People of African heritage.

Seeing two images at once is known as:

Diplopia

Strabismus is another word for...

Muscle weakness

The Diagnostic Positions Test moves an image/finger through 6 fields of gaze. In extreme lateral gaze, what might the examiner expect to find?

Nystagmus: very fine vibrations of the eye. This is common in extreme lateral gaze, but is cause for concern in any other field of vision.

The sclera should be white, except for...

Individuals with darker complexion could be more blueish grey

An examiner sees a yellowish spot on the sclera on the medial side of the eye. The examiner recognizes this as a normal variation, not to be confused with what?

Jaundice, associated with kidney or liver problems.

When reading from the Snellen eye chart, a patient is unable to read the largest letter "E" at the top of the chart. The examiner recognizes that this means the patient is:

Legally blind

5% of individuals normally have pupils of different sizes. This is known as:

Anisocoria

The external ear that consists of moveable cartilage and skin is known as:

auricle or pinna

The _______________ separates the external and middle ears.

tympanic membrane

What are two forms of hearing loss?

conductive and sensorineural

What is otosclerosis?

Common cause of conductive hearing loss caused by a disruption of sound vibrations due to a decrease in mobility of the ossicles.

Sensorineural hearing loss is:

Disease of the inner ear, cranial nerve VIII, or the auditory areas of the cerebral cortex.

Presbycusis is:

Gradual nerve degeneration associated with aging that can cause sensorineural hearing loss.

How might cerumen differ in individuals of various ethnicities?

Caucasians and Africans tend to have thick honey coloured cerumen, whereas Asians tend to have dark and dry looking cerumen

List the three functions of the middle ear.

1- Conducts sound vibrations from the outer ear to the central hearing apparatus in the inner ear 2) protects the inner ear by reducing the amplitude of loud sounds 3) eustachian tube allows equalization of air pressure on each side of the tympanic membrane so that the membrane does not rupture

Where would you find the sensory organs for equilibrium and hearing?

In the bony labyrinth located in the inner ear.

A patient explains they are experiencing ringing in their ears. This is known as:

A) Otalgia

B) Vertigo

C) Tinnitus

C

When might the incidence of otitis media (middle ear infections) be increased?

In premature infants, those with Down syndrome, and in babies fed by bottle in supine position.

Which of the following is responsible for increasing surface area so that more blood vessels and mucous membranes are available to warm, humidify, and filter inhaled air?

A) turbinates

B) polyps

C) nasal septum

D) cerumen

A

Another word for nose bleeds is...

epistaxis

Gums that bleed frequently are known as what? In who might this be observed?

Hyperemic. Pregnant women

What are deciduous teeth?

baby teeth

What is malocclusion?

Shifting of teeth due to tooth loss, seen in older adults.

How might an older adult be at risk for malnutrition, considering the developmental changes to the nose, mouth and throat?

Diminished sense of taste and smell decrease the older adult's interest in food.

There is an increased incidence of dental disease within what groups? why?

Indigenous peoples and those in remote communities. Changes in traditional diets to those higher in sugar/processed food and lack of fluoridated water/dental services.

What is the difference between polyps and turbinates? Who might you see polyps in?

Polyps are avascular and appear grey; turbinates are vascularized and are the same deep red colour as the rest of the mucosa. Polyps can be seen in individuals with chronic allergies.

What is meant by being "tongue tied"?

When the frenulum attaches to the tip of the tongue rather than the base; could impact speech. Commonly observed in babies.

Drugs that affect the cochlea could contribute to what?

Sensorineural hearing loss

What are the three components of the malleus?

B) umbo, manubrium, short process

List the paranasal sinuses.

frontal, ethmoid, sphenoid, maxillary

Where would you find Stensen's duct?

Opposite of the upper second molar.

A patient has tonsils that are touching the uvula. The examiner would grade these tonsils as:

3+

Define perfusion. Central perfusion? Tissue perfusion?

Flow of blood through arteries and capillaries to deliver nutrients and oxygen to cells. Central perfusion is generated by cardiac output; tissue perfusion is the volume of blood that flows through to tissues.

True or false: the heart extends from the first to the fourth intercostal space.

False: the heart extends from the second to the fifth intercostal space. It spans from the right border of the sternum to the left midclavicular line.

What is the purpose of pericardial fluid?

Ensures smooth, friction-free movement of the heart muscle.

How is the position of the heart different among infants and children?

Position of heart is more horizontal.

What is meant by the "milking" effect accomplished by walking?

When you walk, calf muscles contract and relax. This helps squeeze veins and direct blood flow. People who undergo prolonged standing, sitting, or bed rest do not get this benefit, and are therefore at a higher risk for venous disease.

How can oral contraceptives and menopause increase risk of strokes and heart attacks?

Cause formation of blood clots and high blood pressure. Menopause results in lower estrogen levels, which is another risk factor for CVD.

How are the symptoms of CVD among men and women different?

Women may not present the same chest pain that men do. They usually present symptoms as shortness of breath, fatigue and nausea.

What is orthopnea? orthostatic hypotension?

Orthopnea: shortness of breath when lying down, relieved when sitting/standing.

Orthostatic hypotension: drop in BP with position changes from lying to sitting to standing

What is nocturia?

frequent urination at night

When is S1 louder than S2? When is S2 louder than S1?

S1 louder than S2 at the apex. S2 louder than S1 at the base

What is arteriosclerosis? atherosclerosis?

Arteriosclerosis: increased rigidity of peripheral blood vessels with age.

Atherosclerosis: fatty deposits in the arteries, plaque build up on walls, common in older adults

Asymmetrical calfs is indicative of what condition?

Deep vein thrombosis (DVT)

What is sinus arrythmia? Who is it commonly observed in?

Normal variation in which heart rate speeds up during inhalation and slows during exhalation. Seen in children and young adults.

The epitrochlear lymph nodes are found:

Between the biceps and triceps.

A patient's blood pressure drops significantly when he changes from a lying to standing position. The nurse recognizes this to be:

Orthostatic hypotension

The direction of blood flow through the heart:

liver - inferior vena cava - right atrium - tricuspid valve - right ventricle - pulmonic valve - pulmonary artery - lungs - pulmonary veins - left atrium - mitral valve - left ventricle - aortic valve - aorta

The first heart sound occurs with the closure of the _____ valves and signals the beginning of _______.

Atrioventricular, systole

What is considered to be the third heart sound (S3) that can be heard in certain conditions?

Normally, diastole is silent. However, in some conditions, ventricular filling creates vibrations that can be heard over the chest. These vibrations are S3.

What is preload? afterload?

Preload is the venous return that builds during diastole. Afterload is the opposing pressure the ventricle must generate to open the aortic valve against the higher aortic pressure. It is the resistance against which the ventricle must pump its blood.

The timing of the carotid artery pulse closely coincides with:

ventricular systole