Patient Care Exam 1

blockage, discharge, sneezing, pain, changes in sense of smell, deformity

lesions, dryness, cracking and bleeding

- inspect and palpate pinnae, press on tragus and mastoid process (bilaterally)

- pull pinnae back and up to inspect tympanic membrane for redness

- test hearing covering one ear at a time and asking patient to repeat what you whisper to them

- palpate paranasal sinuses, around nose and top of nose to feel for pain and deviation

- pull nose up and examine with otoscope, inspect septum for good vascular delivery

- ask patient to remove lipstick, gum or dentures

- with gloved hands, inspect lips and buccal mucosa

- inspect gums and teeth for cuts, bumps, inflammation, discomfort

- look at hard palate, tongue, floor of mouth, oropharynx

- using popsicle stick to depress tongue, ask pt to say "ah" and inspect the tonsils, uvula, soft palate

- using cotton, ask pt to protrude tongue and inspect it for cuts and muscle strength

salivary excretory duct beneath mandible

hearing test using the 256 hz tuning fork

subtype of dizziness; patient feels that room is spinning around them (altered perception of motion)

superficial border of lips

projection off the middle of soft palate, moves up to close the nasopharynx when swallowing

the central, most inverted portion of eardrum

'eardrum' thin cone shaped membrane that separates external ear from middle ear

inferior, middle, superior; long narrow bone shelf that protrudes into breathing passage of the nose, separated by meatus'

prominence on inner side of ear

bony protrusion on the palate (usually midline of hard palate)

nodular mass of uric acid crystals (gout)

ringing in the ears

a fungal infection typically on skin or mucous membranes caused by candida/yeast

inflammation of mucous membranes of mouth

the route saliva takes to enter the mouth from the parotid gland

most common type of hearing loss. Root cause is vestibularcochlear nerve VIII, inner ear (hair cells), or central processing of brain. There is a problem with transmission

hearing loss test using 512 hz tuning fork; determines conductive loss. Evaluates unilateral hearing loss by comparing bone conduction to air conduction sound

discharge from the nose (runny nose)

excessive flow of saliva

hearing loss related to old age

pinpoint flat, round hemorrhages under the skin due to small leaky vessels (smaller than 3mm)

caused by issues of inner ear or nerve pathways; information cannot be coded into electrical signals to the brain. This is generally permanent

main part of the eardrum, next to cone of light

flaccid portion of TM, superior to umbo

small projections off the tongue

separates left and right airways of nose, where the air you breathe in becomes warmer

nostrils

portion of ear internal to the eardrum and external to the oval window of the inner ear. Contains ossicles

process of malleus of the ear

misalignment of the teeth when jaw is closed

hammer shaped small bone or ossicle of middle ear

a mucous membrane disorder characterized by white patches especially on cheek, tongue, vulva, or penis

clustered, white lesions on the buccal mucosa, characteristic of measles

a region in the anteroinferior part of nasal septum where four arteries anastomose to form a vascular plexus

- anterior ethmoidal artery (from ophthalmic a)

- sphenopalatine artery (terminal branch of maxillary a)

- greater palatine artery (from maxillary a)

- septal branch of superior labial artery (from facial a)

bone in middle ear. Anvil shaped, is connected laterally to malleus and receives vibrations from it. Transmits them to stapes, medially.

prominent ring of auricle

inflammation of the tongue

inflammation of the gums

gums

characterized by areas of smooth, red depapillation (loss of lingual papillae) which migrate over time. Map-like appearance of tongue

small fold of mucous membrane beneath the tongue

outer ear, includes pinna and external acoustic meatus

aka auditory tube or Eustachian tube; links anterior wall of middle ear to lateral wall of nasopharynx at the level of inferior nasal concha. Has a bony and cartilaginous part and provides pressure equalization

nosebleeds

external acoustic meatus

dizziness in which the patient feels like the room is spinning would be characterized as vertigo, a balance disequilibrium. Lightheadedness is different

condition in which the nasal septum is slightly off center

unit of measure for expressing sound

chapped lips (inflammation)

ear wax

cavities

cheek

pinna, projecting portion of the ear

canker core, ulcer of mucous membranes

ring-shaped object, structure or region

symmetry of face, midline trachea, good color, no enlarged lymph nodes, normal hair, no lumps or bumps, good turgor, normal thyroid size/no nodules

cheekbone formed by zygomatic arch of temporal bone

neck is twisted, may by due to muscle spasm

temporomandibular joint

sudden, repetitive, nonrhythmic motor movement or vocalization involving discrete muscle groups

sits in front of larynx and above thyroid gland. Composed of two halves and meets at middle peak called laryngeal prominence aka Adam's apple

located in side of neck, extends from thorax to base of skull behind ear

area bordered by posterior SCM, clavicle, trapezius

nervous system disorder, characterized by a flat affect facial expression due to loss of facial muscles (mask-like)

swelling of skin and underlying tissues, giving a waxy consistency, typical of patients with hypothyroidism

rounded face due to fat deposits on cheeks and shoulders

abnormal smallness of head, congenital condition associated with incomplete brain development

overly large head in infants

under production of thyroid gland; thicker hair, weight gain

over production of thyroid gland; thinning of hair, weight loss

combination of signs and symptoms causes by disruption of nerve pathway from brain to face and eye on one side of the body. Result of stroke, tumor, spinal cord injury

abnormal enlargement of thyroid gland

moon facies; fat deposits

hyaline cartilage located under the thyroid cartilage and above tracheal cartilage. Thyroid positioned just under it.

crackling sound of vertebrae

blood supply to neck, head and brain

audible vascular sound associated with turbulent blood flow

flaccidity or paralysis of facial nerve branches

region of neck bordered by midline of mandible and and anterior aspect of SCM

enlargement of facial features and extremities

hair - quantity, distribution, texture, patterns of loss

scalp - scaliness, flaking, lumps, lesions, size, contours, symmetry, deformities, tenderness, sutures, any rashes or sores esp around hairline. For infants: fontanelles

expression and involuntary movements, symmetry and contours, edema, masses, skin disruptions or irritation, TMJ, frontal and maxillary sinuses, palpating parotid glands and temporal arteries for inflammation or discomfort, sensation

lumps, goiter, masses, scars, enlarged nodes (preauricular, postauricular, occipital, tonsillar, submandibular, submental, superficial cervical, deep cervical, supraclavicular), glands, evaluate range of motion and palpate posterior neck muscles and for crepitus of vertebrae by having pt look up, down, left, right, side to side while holding vertbrae, strength of traps and SCM, look at trachea and thyroid for deviation or enlargement (tangential lighting), have patient swallow (offer water), palpate thyroid from behind while having pt tilt head side to side and swallow, palpate carotids and listen for bruits

linear arrangement of skin lesion, usually around dermatome T4 characteristic of shingles

relatively flat localized collection of edema fluid

circumscribed elevations containing serious fluid or blood

type of hair that is short, fine, inconspicuous and relatively unpigmented

chickenpox; generalized, pruritic, vesicular (vesicles on erythematous base) rash, begins on trunk and spreads peripherally, lesions appear in crops and in different stages of healing

hives

circumscribed loss of epidermis which may extend deeply into corium and subcutaneous tissue

examination of fluid from a bulla (blister) in search of Tzanck cells characteristic of varicella, herpes zoster, herpes simplex, pemphigus vulgaris

tenting, how fast your skin returns to normal after you pull up on it, a reflection of hydration and elasticity in skin

a solid mass of cells, larger than a nodule

nail plate turns white with ground-glass appearance, distal band of reddish brown and obliteration of lunula; could be caused by liver or kidney disease or heart failure

abnormal dilation of red, blue or purple superficial capillaries, arterioles or venules typically located just below skin's surface

the third, deepest layer of skin composed of fat

long, slightly depressed lines w/o disruption of the skin, often shiny, colorless, aka stretch marks

thin piece of matter that embeds into skin

serpent or worm-like, describing a lesion

red, itchy rash with white scales (on scalp called dandruff, on face and trunk appears eczema)

oil (glands secrete sebum into hair follicle)

flakes of skin

circumscribed elevation filled with pus

pinpoint flat, round hemorrhages under skin due to small leaky vessels, larger than petechia (3mm-1cm)

dry scaly plaque, can be on skin and nails

on the skin it is a solid, broad area of raised skin where the surface area is larger than the height

bacterial or fungal infection lateral to the nail plate, usually needs to be drained

circumscribed solid elevation of the skin

mole

base of the nail underneath the skin

hard translucent part of nail, made up of keratin

skin beneath the nail plate

pigment that gives skin, hair and eyes their color

flat, circumscribed area of color change without elevation

crescent shaped white area on bed of fingernail at base

thickening and hardening of the skin, with exaggeration of normal markings

"half and half nails" pinkish digital aspect

liver spots, benign lesions that occur on sun exposed areas of body - backs of hands and face. Tend to increase in number with age, common among middle and older aged populations

"spoon nails" associated with chronic iron deficiency/anemia

horny growth on the skin

yellowing of the skin due to a build up of bilirubin

inflammation produced by chafing of adjacent areas of skin

increase in the fibrous elements in a tissue, marked by loss of elasticity and pliability

congenital skin condition causing the epidermis to become dry and rough like fish scales

abnormal thickening of outer layer of skin

abnormal hair growth on face or body, especially in women

crack in the skin, usually through epidermis

scratch marks

superficial destruction of a surface area of tissue, can be from inflammation, trauma, ulceration

thin superficial layer of skin containing no blood vessels

medical condition in which patches of skin become rough and inflamed with blisters that cause itching and bleeding

secrete

bruising

loss of skin, skin peeling or shedding

deep layer of skin containing blood supply, connective tissue, sebaceous glands, sweat glands, hair follicles

"skin writing", patients with this have very sensitive skin; reddened raised wheals appear even if lightly scratched

encapsulated, fluid filled mass in dermis of subcutaneous layer

bluish tint

varying colors of liquid debris (serum or pus) that have dried on surface of skin

tend to run together

dilated hair follicle filled with keratin squamae, bacteria or sebaceous oil, can be closed or open (acne)

rounding of the fingernail beds, seen commonly in patients with emphysema and other pulmonary issues

bright red, pinhead sized smooth spots usually on the trunk, common after age of 30. May become purple with age. Round, flat, sometimes raised and surrounded by pale halo

rounded prominence filled with air or fluid, larger than vesicle

deep horizontal ridges in nail plate, reflects a temporary cessation of production of nail, possibly due to endocrine problems, infection, injury

sweat gland

ring-shaped

baldness

rough scaly patches of skin, developed after many years of sun exposure

patient may have an increased BP due to anxiety at the doctor's office

same as one millimeter of mercury; measurement

vibration

pulse > 100bpm

ventricular contraction

BP cuff

systemic infection

sudden feeling of cold with shivering, accompanied by a rise in temp. Often with copious sweating, especially at onset of high fever

everyday, ordinary

fever

difference between systole and diastole

what you hear when taking BP; 5 phases

increased respiratory rate, increased oxygen consumption and hypercapnia (increased CO2)

incredibly high fever

when patient fakes fever by putting the thermometer to a lamp; make sure the skin and warm and heart rate is high to confirm the presence of fever

swelling caused by excess fluid trapped in body's tissues

normal fluctuations between morning and night (temp lower in morning and higher at night)

ventricular relaxation

head to toe direction

slow heart rate, < 60 bpm

body mass index kg/m2

period of diminished or absent Korotkoff sounds during manual measurement of BP. Improper interpretation may lead to underestimation of systolic BP or overestimation of diastolic BP

anterior elbow joint

observation, palpation, percussion, auscultation, smell

(other senses also)

a reflex action of the eye, in response to focusing on a near object, then looking at distant object (and vice versa), comprising coordinated changes in vergence, lens shape and pupil size

vision in one of the eyes is reduced because the eye and brain are not working together - the eye itself looks normal but the brain is favoring the other eye. Also known as lazy eye

unequal size of pupils

fluid in anterior chamber that fills the space between the cornea and iris - produced by ciliary body, nourishes and gives eye its shape

caused by hyperlipidemia; ring around outside of iris that is composed of cholesterol

common, mild, imperfection in curvature of cornea or lens

inflammation of the eyelid

channel that collects aqueous humor and delivers it to bloodstream

either corner of the eye where the upper and lower eyelids meet. More specifically, the inner and outer canthi are, respectively, the medial and lateral ends/angles of the palpebral fissure

under the lower margin of eyelid - a bump in the eyelid caused by a blockage of oil (Meibomian) gland

vascular layer of the eye, containing connective tissue, and lying between the retina and the sclera

thin, moist membrane that covers inner surface of eyelid (palpabrae) and outer surface of eyelid (bulbar)

unit of measurement of the optical power of a lens or curved mirror

double vision

condition in which the eyelid is rolled inward against the eyeball, typically caused by muscle spasm or by inflammation or scarring of the conjunctiva

in which the eyelid is turned outward away from the eyeball

skin fold of upper eyelid, covering medial canthus

most central part of the macula (in retina), has densely packed cones and highest visual acuity

increased intraocular pressure from aqueous humor build up, resulting in optic nerve damage

blindness in half the visual field

stye

far sighted

blood in the anterior chamber of eye, usually via trauma

border of cornea and sclera (white of eye)

surrounds fovea centralis, many cones and few rods, provides central vision

near sighted

artery of eye crosses vein of eye

involuntary eye movement

where optic nerve leaves the eye - blind spot

right eye

left eye

elliptic space between the medial and lateral canthi of the two open lids. aka the opening between the eyelids

optic disc swelling that is caused by increased intracranial pressure

light sensitivity

no visual correction needed

poor vision associated with old age

eye that protrudes outwards

non-cancerous growth starting on conjunctiva onto the iris/pupil; associated with spending a lot of time outdoors

drooping of upper eyelid

commencement of the canaliculi at minute orfices, on the margin of upper and lower eyelid on nasal side and function to collect tears produced by lacrimal glands

innermost coat of the eye - light sensitive and sends image through optic nerve

dense, white, fibrous membrane that, with the cornea, forms the external covering of the eyeball

a partial loss of vision or a blind spot in an otherwise normal visual field

condition that interferes with binocular vision because it prevents a person from directing both eyes simultaneously towards the same fixation point; the eyes do not properly align with each other

thick, elongated dense connective tissue lining each eyelid for support and formation

sharply demarcated yellowish deposit of fat underneath the skin, usually on or around the eyelids

abnormal protrusion of the eyeball or eyeballs (proptosis)

without corrective lenses

with corrective lenses

pupils are equal round and reactive to light and accommodation bilaterally