340 Lec Exam 1
corneal scar
A superficial grayish white opacity in the cornea, secondary to an old injury or to inflammation
central retinal artery occlusion
Acute, PAINLESS, monocular vision loss Retina CLOUDY with attenuated vessels and CHERRY RED spot on fovea [Center of macula]
You feel a small mass that you think is a lymph node. It is mobile in both the up-and-down and side-to-side directions. Which of the following is most likely? A) Cancer B) Lymph node C) Deep scar D) Muscle
B) A useful maneuver for discerning lymph nodes from other masses in the neck is to check for their mobility in all directions. Many other masses are mobile in only two directions.
On visual confrontation testing, a stroke patient is unable to see your fingers on his entire right side with either eye covered. Which of the following terms would describe this finding? A) Bitemporal hemianopsia B) Right temporal hemianopsia C) Right homonymous hemianopsia D) Binasal hemianopsia
C) Right homonymous hemianopsia. Because the right visual field in both eyes is affected, this is a right homonymous hemianopsia.
A patient with white lesions on tongue or inner cheeks. A) Leukoplakia B) Torus palatinus C) Thrush (candidiasis) D) Kaposi's sarcoma
C) Thrush is usually painful and is seen in immunosuppressed patients or those taking inhaled steroids for COPD or asthma.
Diplopia, which is present with one eye covered, can be caused by which of the following problems? A) Weakness of CN III B) Weakness of CN IV C) A lesion of the brainstem D) An irregularity in the cornea or lens
D) Double vision in one eye alone points to a problem in "processing" the light rays of an incoming image. The other causes of diplopia result in a misalignment of the two eyes.
Very sensitive methods for detecting hearing loss include which of the following? A) The whisper test B) The finger rub test C) The tuning fork test D) Audiometric testing
D) While it is important to screen for hearing complaints with methods available to you, it should be realized that some physical examination techniques are limited. Nonetheless, you should be comfortable performing these tests, as audiometric testing is not always available.
acute iritis
Don't mistake this for conjunctivitis, sx: Eye pain, photophobia, blurry vision, redness
Cushing Syndrome s/s?
Fatty hump between shoulders, mo0n face, excess hair, sweat, high BP, high HR, Acne, hair loss, weight gain, swelling in extremities. Hypercortisolism.
chalazion
Slow growing, a nodule or cyst, usually on the upper eyelid, caused by obstruction in a sebaceous gland
optic disc
blind spot where optic nerves are located
ectropion
the eversion of the edge of an eyelid, eyelid turns outward.
anisocoria
unequal pupil size
Cluster Headache
A neurological disorder where the headache is generally felt on one side of the head, typically around the eye. Other symptoms may include eye-watering, nasal congestion, or swelling around the affected side.
You note that a patient has anisocoria on examination. Pathologic causes of this include which of the following? A) Horner's syndrome B) Benign anisocoria C) Differing light intensities for each eye D) Eye prosthesis
A) Anisocoria, unequal pupil size can be associated with serious pathology. Remember to exclude benign causes before embarking on an intensive workup. Testing the near reaction in this case may help you to find an Argyll Robertson or tonic (Adie's) pupil.
A 49-year-old administrative assistant comes to your office for evaluation of dizziness. You elicit the information that the dizziness is a spinning sensation of sudden onset, worse with head position changes. The episodes last a few seconds and then go away, and they are accompanied by intense nausea. She has vomited one time. She denies tinnitus. You perform a physical examination of the head and neck and note that the patient's hearing is intact to Weber and Rinne and that there is nystagmus. Her gait is normal. Based on this description, what is the most likely diagnosis? A) Benign positional vertigo B) Vestibular neuronitis C) Ménière's disease D) Acoustic neuroma
A) Benign positional vertigo. This is a classic description of benign positional vertigo. The vertigo is episodic, lasting a few seconds to minutes, instead of continuous as in vestibular neuronitis. Also, there is no tinnitus or sensorineural hearing loss like in Meniere's disease Hallpike maneuvers, are good for dx vertigo.
On visual confrontation testing, a stroke patient is unable to see your fingers and c/o loss of both lateral visual fields. Which of the following terms would describe this finding? A) Bitemporal hemianopsia B) Right temporal hemianopsia C) Right homonymous hemianopsia D) Binasal hemianopsia
A) Bitemporal hemianopsia or temporal hemianopsia. Same thing. A bitemporal hemianopsia refers to loss of both lateral visual fields (impaired peripheral vision)
You feel a small mass that you think is a lymph node. It is fixed and non-mobile in both the up-and-down and side-to-side directions. Which of the following is most likely? A) Cancer B) Lymph node C) Deep scar D) Muscle
A) Cancer, Cancerous masses may also be "fixed," or immobile.
A sudden, painless unilateral vision loss may be caused by which of the following? A) Retinal detachment B) Corneal ulcer C) Acute glaucoma D) Uveitis
A) Corneal ulcer, acute glaucoma, and uveitis are almost always accompanied by pain. Retinal detachment is generally painless, as is chronic glaucoma.
Glaucoma is the leading cause of blindness in African-Americans and the second leading cause of blindness overall. What features would be noted on funduscopic examination? A) Increased cup-to-disc ratio B) AV nicking C) Cotton wool spots D) Microaneurysms
A) It is important to screen for glaucoma on funduscopic examination. The cup and disc are among the easiest features to find. AV nicking and cotton wool spots are seen in hypertension. Micro-aneurysms are seen in diabetes.
A patient with a white lesion on the mucosal surfaces of the tongue, corresponding to chronic mechanical or chemical irritation A) Leukoplakia B) Torus palatinus C) Thrush (candidiasis) D) Kaposi's sarcoma
A) Leukoplakia is a white lesion on the mucosal surfaces corresponding to chronic mechanical or chemical irritation. It can be premalignant.
A patient with hearing loss by whisper test is further examined with a tuning fork, using the Weber and Rinne maneuvers. The abnormal results are as follows: bone conduction is greater than air on the left, and the patient hears the sound of the tuning fork better on the left. Which of the following is most likely? A) Otosclerosis of the left ear B) Exposure to chronic loud noise of the right ear C) Otitis media of the right ear D) Perforation of the right eardrum
A) Otosclerosis of the left ear, the above pattern is consistent with a conductive loss on the left side. Causes would include: foreign body, otitis media, perforation, and otosclerosis of the involved side.
Which area of the fundus is the central focal point for incoming images? A) The fovea B) The macula C) The optic disk D) The physiologic cup
A) The fovea is the area of the retina which is responsible for central vision. It is surrounded by the macula, which is responsible for more peripheral vision. The optic disc and physiologic cup are where the optic nerve enters the eye.
2. A 29-year-old computer programmer comes to your office for evaluation of a headache. The tightening sensation is located all over the head and is of moderate intensity. It used to last minutes, but this time it has lasted for 5 days. He denies photophobia and nausea. He spends several hours each day at a computer monitor/keyboard. He has tried over-the-counter medication; it has dulled the pain but not taken it away. Based on this description, what is your most likely diagnosis? A) Tension B) Migraine C) Cluster D) Analgesic rebound
A) This is a description of a typical tension headache.
A patient complains of epistaxis. Which other cause should be considered? A) Intracranial hemorrhage B) Hematemesis C) Intestinal hemorrhage D) Hematoma of the nasal septum
B) Although the source of epistaxis may seem obvious, other bleeding locations should be on the differential. Hematemesis can mimic this and cause delay in life-saving therapies if not considered. Intracranial hemorrhage and septal hematoma are instances of contained bleeding. Intestinal hemorrhage may cause hematemesis if there is obstruction distal to the bleeding, but this is unlikely.
You are conducting a pupillary examination on a 34-year-old man. You note that both pupils dilate slightly. Both are noted to constrict briskly when the light is placed on the right eye. What is the most likely problem? A) Optic nerve damage on the right B) Optic nerve damage on the left C) Efferent nerve damage on the right D) Efferent nerve damage on the left
B) Because both pupils can constrict, efferent nerve damage is unlikely. When the light is placed on the left eye, neither a direct nor a consensual response is seen. This indicates that the left eye is not perceiving incoming light.
You are conducting a pupillary examination on a 34-year-old man. You note that both pupils dilate. Both are noted to barely constrict when the light is placed on both eyes. What is the most likely problem? A) Optic nerve damage B) Efferent nerve damage
B) Efferent nerve damage
A 29-year-old physical therapist presents for evaluation of an eyelid problem. On observation, the right eyeball appears to be protruding forward. Based on this description, what is the most likely diagnosis? A) Ptosis B) Exophthalmos C) Ectropion D) Epicanthus
B) Exophthalmos is the condition when the eyeball protrudes forward. If it is bilateral, it suggests the presence of Graves' disease. If it is unilateral, it could still be caused by Graves' disease. Alternatively, it could be caused by a tumor or inflammation in the orbit.
A light is pointed at a patient's pupil, which contracts. It is also noted that the other pupil contracts as well, though it is not exposed to bright light. Which of the following terms describes this latter phenomenon? A) Direct reaction B) Consensual reaction C) Near reaction D) Accommodation
B) The constriction of the contralateral pupil is called the consensual reaction. The response of the ipsilateral eye is the direct response. The dilation of the pupil when focusing on a close object is the near reaction. Accommodation is the changing of the shape of the lens to sharply focus on an object.
A patient presents with ear pain. She is an avid swimmer. The history includes pain and drainage from the left ear. On examination, she has pain when the ear is manipulated, including manipulation of the tragus. The canal is narrowed and erythematous, with some white debris in the canal. The rest of the examination is normal. What diagnosis would you assign this patient? A) Otitis media B) External otitis C) Perforation of the tympanum D) Cholesteatoma
B) These are classic history and examination findings for a patient suffering from external otitis. Otitis media would not usually have pain with movement of the external ear, nor drainage unless the eardrum was perforated. In this case the examination of the eardrum is recorded as normal. Cholesteatoma is a growth behind the eardrum and would not account for these symptoms. Otitis media would classically be accompanied by a bulging, erythematous eardrum.
1. A 38-year-old accountant comes to your clinic for evaluation of a headache. The throbbing sensation is located in the right temporal region and is an 8 on a scale of 1 to 10. It started a few hours ago, and she has noted nausea with sensitivity to light; she has had headaches like this in the past, usually less than one per week, but not as severe. She does not know of any inciting factors. There has been no change in the frequency of her headaches. She usually takes an over-the-counter analgesic and this results in resolution of the headache. Based on this description, what is the most likely diagnosis of the type of headache? A) Tension B) Migraine C) Cluster D) Analgesic rebound
B) This is a description of a common migraine (no aura). Distinctive features of a migraine include phonophobia and photophobia, nausea, resolution with sleep, and unilateral distribution. Only some of these features may be present.
A young man is concerned about a hard mass he has just noticed in the midline of his palate. On examination, it is indeed hard and in the midline. There are no mucosal abnormalities associated with this lesion. He is experiencing no other symptoms. What will you tell him is the most likely diagnosis? A) Leukoplakia B) Torus palatinus C) Thrush (candidiasis) D) Kaposi's sarcoma
B) Torus palatinus is relatively common and benign but can go unnoticed by the patient for many years. The appearance of a bony mass can be concerning.
A 49-year-old administrative assistant comes to your office for evaluation of continuous dizziness. You elicit the information that the dizziness is a spinning sensation of sudden onset, worse with head position changes. The episodes are continous throughout the day, and they are accompanied by intense nausea. She has vomited one time. She denies tinnitus. You perform a physical examination of the head and neck and note that the patient's hearing is intact to Weber and Rinne and that there is nystagmus. Her gait is normal. Based on this description, what is the most likely diagnosis? A) Benign positional vertigo B) Vestibular neuronitis C) Ménière's disease D) Acoustic neuroma
B) Vestibular neuronitis, dizziness is continuous. Also, there is no tinnitus or sensorineural hearing loss as occurs
A 12-year-old presents to the clinic with his father for evaluation of a painful lump in the left eye. It started this morning. He denies any trauma or injury. There is no visual disturbance. Upon physical examination, there is a red raised area at the margin of the eyelid that is tender to palpation; no tearing occurs with palpation of the lesion. Based on this description, what is the most likely diagnosis? A) Dacryocystitis B) Chalazion C) Hordeolum D) Xanthelasma
C) A hordeolum, or sty, appears suddenly, is a painful, tender, erythematous infection in a gland at the margin of the eyelid.
Which of the following is a "red flag" regarding patients presenting with headache? A) Unilateral headache B) Pain over the sinuses C) Age over 50 D) Phonophobia and photophobia
C) A unilateral headache is often seen with migraines and may commonly be accompanied by phonophobia and photophobia. Pain over the sinuses from sinus congestion may also be unilateral and produce paicold. An. Migraine and sinus headaches are common and generally benign. A new severe headache in someone over 50 can be associated with more serious etiologies for headache. Other red flags include: acute onset, "the worst headache of my life"; very high blood pressure; rash or signs of infection; known presence of cancer, HIV, or pregnancy; vomiting; recent head trauma; and persistent neurologic problems.
A 55-year-old bank teller comes to your office for persistent episodes of dizziness. The first episode started suddenly and lasted 3 to 4 hours. He experienced a lot of nausea with vomiting; the episode resolved spontaneously. He has had five episodes in the past 1½ weeks. He does note some tinnitus that comes and goes. Upon physical examination, you note that he has a normal gait. The Weber localizes to the right side and the air conduction is equal to the bone conduction in the right ear. Nystagmus is present. Based on this description, what is the most likely diagnosis? A) Benign positional vertigo B) Vestibular neuronitis C) Ménière's disease D) Acoustic neuroma
C) Ménière's disease is characterized by sudden onset of vertiginous episodes that last several hours to a day or more, then spontaneously resolve; the episodes then recur. On physical examination, sensorineural hearing loss is present. The patient does complain of tinnitus.
A patient is assigned a visual acuity of 20/100 in her left eye. Which of the following is true? A) She obtains a 20% correct score at 100 feet. B) She can accurately name 20% of the letters at 20 feet. C) She can see at 20 feet what a normal person could see at 100 feet. D) She can see at 100 feet what a normal person could see at 20 feet.
C) The denominator of an acuity score represents the line on the chart the patient can read. In the example above, the patient could read the larger letters corresponding with what a normal person could see at 100 feet.
A 67-year-old lawyer comes to your clinic for an annual examination. He denies any history of eye trauma. He denies any visual changes. You inspect his eyes and find a triangular thickening of the bulbar conjunctiva across the outer surface of the cornea. He has a normal pupillary reaction to light and accommodation. Based on this description, what is the most likely diagnosis? A) Corneal arcus B) Cataracts C) Corneal scar D) Pterygium
D) A pterygium is a triangular thickening of the bulbar conjunctiva that grows slowly across the outer surface of the cornea, usually from the nasal side. Reddening may occur, and it may interfere with vision as it encroaches on the pupil. Otherwise, treatment is unnecessary.
A 15-year-old high school sophomore presents to the emergency room with his mother for evaluation of an area of blood in the left eye. He denies trauma or injury but has been coughing forcefully with a recent cold. He denies visual disturbances, eye pain, or discharge from the eye. On physical examination, the pupils are equal, round, and reactive to light, with a visual acuity of 20/20 in each eye and 20/20 bilaterally. There is a homogeneous, sharply demarcated area at the lateral aspect of the base of the left eye. The cornea is clear. Based on this description, what is the most likely diagnosis? A) Conjunctivitis B) Acute iritis C) Corneal abrasion D) Subconjunctival hemorrhage
D) A subconjunctival hemorrhage is a leakage of blood outside of the vessels, which produces a homogenous, sharply demarcated bright red area; it fades over several days, turning yellow, then disappears. There is no associated eye pain, ocular discharge, or changes in visual acuity; the cornea is clear. Many times it is associated with severe cough, choking, or vomiting, which increase venous pressure. It is rarely caused by a serious condition, so reassurance is usually the only treatment necessary.
A young woman undergoes cranial nerve testing. On touching the soft palate, her uvula deviates to the left. Which of the following is likely? A) CN IX lesion on the left B) CN IX lesion on the right C) CN X lesion on the left D) CN X lesion on the right
D) CN X lesion on the right. The failure of the right side of the palate to rise denotes a problem with the right 10th cranial nerve. The uvula deviates toward the properly functioning side.
A patient comes in with a growth behind the eardrum. What diagnosis would you assign this patient? A) Otitis media B) External otitis C) Perforation of the tympanum D) Cholesteatoma
D) Cholesteatoma is a growth behind the eardrum
A patient is examined with the ophthalmoscope and found to have red reflexes bilaterally. Which of the following have you essentially excluded from your differential? A) Retinoblastoma B) Cataract C) Artificial eye D) Hypertensive retinopathy
D) Hypertensive retinopathy. Hypertensive retinopathy requires a careful examination of the optic fundus. It cannot be diagnosed or excluded merely from the red reflex. Typically, the red reflex would be normal in this case. The other conditions are all associated with an abnormal red reflex.
A cancer that causes patches of abnormal tissue to grow under the skin, in the lining of the mouth, nose, and throat, or in other organs; frequently associated with HIV A) Leukoplakia B) Torus palatinus C) Thrush (candidiasis) D) Kaposi's sarcoma
D) Kaposi's sarcoma
Sudden, painful unilateral loss of vision may be caused by which of the following conditions? A) Vitreous hemorrhage B) Central retinal artery occlusion C) Macular degeneration D) Optic neuritis
D) Optic neuritis. In multiple sclerosis, sudden painful loss of vision may accompany optic neuritis. The other conditions are usually painless.
A college student presents with a sore throat, fever, and fatigue for several days. You notice exudates on her enlarged tonsils. You do a careful lymphatic examination and notice some scattered small, mobile lymph nodes just behind her sternocleidomastoid muscles bilaterally. What group of nodes is this? A) Submandibular B) Tonsillar C) Occipital D) Posterior cervical
D) Posterior cervical. The group of nodes posterior to the sternocleidomastoid muscle is the posterior cervical chain. These are common in mononucleosis.
A 73-year-old nurse comes to your office for evaluation of new onset of tremors. She is not on any medications and does not take herbs or supplements. She has no chronic medical conditions. She does not smoke or drink alcohol. She walks into the examination room with slow movements and shuffling steps. She has decreased facial mobility and a blunt expression, without any changes in hair distribution on her face. Based on this description, what is the most likely reason for the patient's symptoms? A) Cushing's syndrome B) Nephrotic syndrome C) Myxedema D) Parkinson's disease
D) his is a typical description for a patient with Parkinson's disease. Facial mobility is decreased, which results in a blunt expression—a "masked" appearance. The patient also has decreased blinking and a characteristic stare with an upward gaze. In combination with the findings of slow movements and a shuffling gait, the diagnosis of Parkinson's is almost clinched
Myxedema
Hypothroidism, low BP, low HR, goiter, brittle hair, wt gain, weakness, cold intolerance, low energy, depression
Corneal arcus
Lipid deposits in the periphery of the eye that may be detected when light is directed to the iris
Which of the following is a symptom involving the eye? A) Scotomas B) Tinnitus C) Dysphagia D) Rhinorrhea
Scotomas are specks in the vision or areas where the patient cannot see; therefore, this is a common/concerning symptom of the eye.
vitreous hemorrhage
Sudden loss of vision with floaters, usually secondary to diabetic retinopathy
epicanthus
a vertical fold of skin on either side of the nose or fold on eye upper eyelid indicating Down Syndrome.
corneal abrasion
an injury, such as a scratch or irritation, to the outer layers of the cornea
Binasal hemianopsia
binasal hemianopsia is the loss of the nasal visual fields bilaterally. blindness in the middle halves of the visual field in both eyes, due to damage to uncrossed fibers (often due to calcification of carotid arteries; also associated with hydrocephalus)
Ptosis
drooping eyelid
Conjunctivitis
inflammation of the conjunctiva
dacryocystitis
inflammation of the lacrimal (tear) sac
otis media
inflammation of the middle ear, painless unless eardrum was perforated.
macular degeneration
progressive damage to the macula of the retina. Central and color loss
Xanthelasma
soft, raised yellow plaques occurring on the skin at the inner corners of the eyes
Near reaction
when a person shifts there gaze from a far object to a near one their pupils constrict, mediated by CN III. convergence of the eyes and accommodation (lens decreases in size and becomes thicker)
