Ch. 14 & 15 Head, Face, Neck & Regional Lymphatics, Eyes
When assessing cervical lymph nodes, which direction would you give to the patient when you begin to search for the supraclavicular node? "Tilt your head back." "Hunch your shoulders and elbows forward." "Straighten your neck and sit tall." "Look to one side and then the other."
"Hunch your shoulders and elbows forward." Hunching the shoulders and elbows forward relaxes the skin and makes the supraclavicular nodes easier to locate. None of the other positions does this.
Which statement made by a 56-year-old patient warrants an immediate referral? "This is the worst migraine of my life. I thought they were getting better with time but this one is awful." "This is the worst headache I've had since puberty." "I've never had a headache like this before; I was fine one minute and had immobilizing pain the next." "I have a headache almost every day, but it has been years since I had one this bad."
"I've never had a headache like this before; I was fine one minute and had immobilizing pain the next." Characteristics of a life-threatening headache are new, sudden onset, and severe. Thus the statement "I've never had a headache like this before; I was fine one minute and had immobilizing pain the next." warrants an immediate referral. All other statements address headaches that are not new and whose onsets are not known.
Which direction should you give to a patient in preparation for examining his eye with an ophthalmoscope? "Look up at the ceiling in front of you." "Watch the white light as it approaches." "Keep looking at one spot on the wall across from you." "Keep your eyes on my forehead."
"Keep looking at one spot on the wall across from you." In preparation for an ophthalmoscopic examination, you would tell the patient to "Keep looking at one spot on the wall across from you" because staring at a distant, fixed object helps to dilate the pupils and hold the retinal structures still.
A 70-year-old woman gives her reason for seeking health care as "I am so dizzy ever since I got up this morning." Which question would you ask her first? "What do you mean by dizzy?" "Have you been dizzy before today?" "Do you feel nauseated?" "What medications do you take?"
"What do you mean by dizzy?" The first question to ask is, "What do you mean by dizzy?" Dizzy is a vague, general term, related to many causes. It includes presyncope, vertigo, and disequilibrium. To begin to understand what is going on with the patient, a description of the sensation in the patient's own words is needed.
Which finding would you expect when assessing an older adult with kyphosis? Lowered center of gravity Forward extension of head and jaw Stiff gait Shuffling walk
Forward extension of head and jaw Kyphosis of the spine is common with aging. To compensate for kyphosis of the spine, older adults extend their heads and jaws forward.
What is a normal finding on an Allen test? A child can follow a brightly colored toy through the cardinal fields of gaze. A child can indicate the direction of an E at a distance of 20 feet five or more times out of eight tries. A child can name three of seven cards in three to five trials at a distance of 15 feet. A child can identify white, yellow, red, and green figures on a white background.
A child can name three of seven cards in three to five trials at a distance of 15 feet. The Allen test is a visual screening test that uses seven picture cards of objects familiar to the young child, such as a birthday cake and a tree. The pictures are shown to the child up close to ensure the child can identify them and are then shown at a distance of 15 feet. Results are normal if the child can name three of seven cards within three to five trials.
Which finding should you classify as expected when examining the eyes of an individual with very dark irises? An increased probability of developing glaucoma Retinitis pigmentosa A darker retina Photophobia
A darker retina An individual who has very dark irises is also more likely to have a darker retina. A darker iris does not increase the probability of developing glaucoma. Retinitis pigmentosa is caused by an abnormal generalized decrease in the diameter of the arteries, which causes the light reflex to also narrow. Photophobia is inability to tolerate light.
What information do you get from performing the confrontation test? Extent of pupillary accommodation to visual stimulation. Balance between the sympathetic and parasympathetic stimulation of cranial nerve III. A gross measurement of peripheral vision. The degree of presbyopia present within the eye.
A gross measurement of peripheral vision. The confrontation test is used to obtain a gross measurement of peripheral vision.
As part of an eye examination, you ask the patient to focus on a distant object and then shift his gaze to your finger held 7 to 8 cm from his nose. For what are you checking? Monocular blindness Accommodation Consensual movement Nystagmus
Accommodation Asking a patient to focus on a distant object and then shift his gaze to your finger, held 7 to 8 cm from his nose, tests for accommodation. Focusing on a distant object causes the pupils to dilate, and then shifting the gaze to near vision results in pupil constriction and convergence of the axes of the eye.
A patient's medical record contains the notation "Pupils equal, round, reactive to light and accommodation" (PERRLA). What is meant by accommodation? The amount of light allowed to penetrate the retina Adaptation of the eye for near vision Parasympathetic stimulation of cranial nerve II The shape of the lens and cornea
Adaptation of the eye for near vision Accommodation is the adaptation of the eye for near vision. It is accomplished by increasing the curvature of the lens through movement of the ciliary muscles. Although the lens cannot be observed directly, components of accommodation can be observed. These are convergence of the axes of the eyeballs and pupillary constriction.
Which statement is a fact to be considered when assessing patients with headaches? Alcohol, stress, and wind or heat exposure may precipitate the onset of cluster headaches. The absence of photophobia is characteristic of migraine headaches. Tension headaches can be treated but not prevented. Nuchal rigidity is associated with estrogen-withdrawal headaches.
Alcohol, stress, and wind or heat exposure may precipitate the onset of cluster headaches. Alcohol, stress, and wind or heat exposure may precipitate the onset of cluster headaches. Presence, not absence, of photophobia is characteristic of migraine headaches. Tension headaches can be treated and prevented. Nuchal rigidity is associated with meningitis, not estrogen-withdrawal headaches.
During a routine physical examination of a young adult, you find an enlarged thyroid gland. Your next step is to check for a bruit. How do you do this? Using the diaphragm of the stethoscope, auscultate on the midline of the neck 3 cm up from the angle of Louis. Auscultate over the thyroid gland using the bell of the stethoscope. Observe for pulsations over the thyroid cartilage with the patient in a supine position. Palpate for a fine vibration over the isthmus of the thyroid while the patient holds the breath.
Auscultate over the thyroid gland using the bell of the stethoscope. To check for a thyroid bruit, you would auscultate over the thyroid, not the midline of the neck, using the bell of the stethoscope, because a bruit is a soft, pulsatile whistling-blowing sound. The bell of the stethoscope is used rather than the diaphragm because the bell works best for soft, low-pitched sounds. A bruit cannot be observed or palpated.
On examination of an elderly man with terminal prostate cancer, you note that he has hollow cheeks, sunken eyes, and an exhausted, defeated facial expression. Which would be an appropriate term to use when describing this patient? Cachectic Myxedematous Cushingoid Atopic
Cachectic Cachectic is the adjective form of cachexia, which is the term for chronic wasting as seen with cancer and other chronic diseases. Prominent facial manifestations of cachexia are hollow cheeks, sunken eyes, and an exhausted, defeated expression. Myxedematous appearance involves periorbital edema, coarse facial features, dry skin, and dry, coarse hair and eyebrows. Cushingoid appearance features a plethoric, "moon-like" face, prominent jowls, red cheeks, and hirsutism in the beard area. Atopic refers to an allergic facies that is characterized by an exhausted face, blue shadows under the eyes, a double or single crease on the lower eyelids, central facial pallor, and open-mouth breathing.
Facial features that include exhausted facies, blue shadows below the eyes, creased lower eyelids, open-mouth breathing, and central facial pallor are characteristic of which condition? Cachexia Scleroderma Myxedema Chronic childhood allergies
Chronic childhood allergies Facial features that include exhausted facies, blue shadows below the eyes, creased lower eyelids, open-mouth breathing, and central facial pallor are characteristic of chronic childhood allergies. Cachexia presents with sunken eyes, hollow cheeks, and an exhausted, defeated expression. A cachectic appearance accompanies cancer, dehydration, and starvation. Scleroderma presents with hard, shiny skin on the forehead and cheeks; thin, pursed lips with radial furrowing; facial and neck muscle atrophy; and expressionless facies. Myxedema is a deficiency of thyroid hormone, and when severe, it causes a nonpitting edema of the face, especially around the eyes (periorbital edema); coarse facial features; dry skin; and dry, coarse hair and eyebrows.
Mr. Sternberg, a 39-year-old patient, comes to the clinic for a routine eye examination. What color do you expect his optic discs to be on examination with an ophthalmoscope? Red Creamy pink Creamy yellow-orange-pink Creamy red to yellow-orange
Creamy yellow-orange to pink The normal color of the optic disc is creamy yellow-orange to pink. Because this is a routine eye examination for Mr. Sternberg, you would expect his optic discs to be normal.
Mr. Sanchez is a 54-year-old patient who has been taking oral steroids for many years to control asthma. On examination, you note that he has a rounded "moon-like" face, plethora, prominent jowls, hirsutism, and chest acne. Which condition do you conclude Mr. Sanchez has based on this information? Acromegaly Scleroderma Myxedema Cushing's syndrome PreviousNext
Cushing's syndrome Excessive corticotropin production and chronic steroid use lead to Cushing's syndrome, which is characterized by a rounded "moon-like" face, plethora, prominent jowls, hirsutism, and chest acne. Acromegaly is characterized by an excessive secretion of growth hormone from the pituitary after puberty, which creates an enlarged skull, thickened cranial bones, a prominent nose and lower jaw, a heavy eyebrow ridge, and coarse facial features. Scleroderma is a rare connective tissue disease characterized by chronic hardening and shrinking and degenerative changes in the skin, blood vessels, synovium, and skeletal muscles. Changes can occur in the skin, heart, esophagus, kidneys, and lungs. Characteristic facies are hard, shiny skin on the forehead and cheeks; thin, pursed lips with radial furrowing; absent skinfolds; muscle atrophy on the face and neck; and absence of expression. Myxedema is caused by a severe deficiency of thyroid hormone. It is a nonpitting edema of the face, especially around the eyes (periorbital edema), and is accompanied by coarse facial features, dry skin, and dry, coarse hair and eyebrows.
In the Snellen chart, the numerator is always 20. To what does this number refer? Height in centimeters of the letters on the chart. Distance in feet between the patient and the chart. Distance in feet between the chart and the place where a patient without eye disorders could stand and be able to read the largest letter on the chart. Distance in meters between the chart and the place where a person could stand and be able to read the middle line of letters.
Distance in feet between the patient and the chart. In the Snellen chart, the numerator is always 20 and refers to the distance in feet between the patient and the chart.
Which problem is suggested by assessment findings of an elongated head, massive face, coarse facial features, and prominent nose, lower jaw, and eyebrow ridge in an adult patient? Excess growth hormone Thyroid deficiency Dopamine deficiency Excess adrenocorticotropic hormone
Excess growth hormone An elongated head, massive face, coarse facial features, and a prominent nose, lower jaw, and eyebrow ridge are associated with excess growth hormone. A deficiency of thyroid hormone, when severe, causes a puffy edematous face, especially around the eyes (periorbital edema), coarse facial features, dry skin, and dry, coarse hair and eyebrows. A deficiency of the neurotransmitter dopamine and degeneration of the basal ganglia occur in Parkinson's disease, which is characterized by immobility of features that produces a face that is flat and expressionless ("mask-like"), with elevated eyebrows, staring gaze, oily skin, and drooling. In Cushing's syndrome, there is an excessive secretion of corticotropin and chronic steroid use, so the person develops a plethoric, rounded, "moon-like" face; prominent jowls; red cheeks; hirsutism on the upper lip, lower cheeks, and chin; and an acneiform rash on the chest.
On the basis of which symptom reported by a patient with conjunctivitis would you conclude that an allergic condition exits? Reddened lid margins Persistent watering Spasmodic blinking Eye itching
Eye itching Symptoms of allergic conjunctivitis include eye itching, redness, watering, and discomfort secondary to inflammation due to exposure to allergens such as pollen, spores, house dust mites, and animal dander. Signs include diffuse redness of conjunctivae; lid swelling; and velvety thickening, redness, and small papillae on the upper tarsal surface. The one symptom that differentiates allergic conjunctivitis from other types is the presence of itching.
Mrs. Navarro brings her 3-year-old son in for a first visit to your office. As the health care provider, you note the following on examination: narrow palpebral fissures, epicanthal folds, and midfacial hypoplasia. What condition do you suspect based on these symptoms? Down syndrome Fetal alcohol spectrum disorder Chronic childhood allergies Congenital hypothyroidism
Fetal alcohol spectrum disorder Narrow palpebral fissures, epicanthal folds, and midfacial hypoplasia are characteristic of fetal alcohol spectrum disorder. Down syndrome is a chromosomal aberration (trisomy 21) in which the head and face characteristics may include upslanting eyes with inner epicanthal folds, flat nasal bridge, small broad flat nose, protruding thick tongue, ear dysplasia, short broad neck with webbing, and small hands with single palmar crease. Children with chronic allergies such as atopic dermatitis often develop characteristic facial features. These include exhausted face, blue shadows below the eyes ("allergic shiners") from sluggish venous return, a double or single crease on the lower eyelids (Morgan's lines), central facial pallor, and open-mouth breathing (allergic gaping). Congenital hypothyroidism is a thyroid deficiency that appears at an early age and produces impaired growth and a neurologic deficit. Without neonatal screening, characteristic facies develop by 3 to 6 months of age: low hairline, hirsute forehead, swollen eyelids, narrow palpebral fissures, widely spaced eyes, depressed nasal bridge, puffy face, thick tongue protruding through an open mouth, and a dull expression. Head size is normal, but the anterior and posterior fontanels are wide open.
Which physiologic event occurs at the optic chiasm? Light waves are converted to nerve impulses. Fibers from the nasal portion of the retina cross over to form the optic tracts. Images that are focused on the retina are flipped from an upside-down orientation to a right-side-up orientation. Visual impulses are sorted and delayed so they do not overstimulate the visual areas in the brain.
Fibers from the nasal portion of the retina cross over to form the optic tracts. Fibers from the nasal portion of the retina cross over to form the optic tracts. It is the function of the retina to transform light waves into nerve impulses. The image formed on the retina is upside down and reversed from its actual appearance in the outside world. Visual impulses are not sorted or delayed.
On examining a 55-year-old male patient, you find an enlarged, nontender, hard left supraclavicular node. What meaning do you attach to this finding? An x-ray for tuberculosis should be ordered. Follow-up to check for a tumor in the chest or abdomen is needed. A test for HIV infection should be scheduled if the node is still palpable in 8 weeks. Antibiotic therapy for lymphadenitis is indicated.
Follow-up to check for a tumor in the chest or abdomen is needed. An enlarged, nontender, hard left supraclavicular node, called a Virchow's node, may indicate a neoplasm of the thorax or abdomen, so follow-up to check for a tumor is needed. Clumped nodes are found with chronic infection such as tuberculosis. With HIV infection, nodes are enlarged, firm, nontender, and mobile, and occipital nodes are commonly affected.
Mr. Staley is a 38-year-old patient who comes to the office for a new patient examination. As part of your assessment of his head and neck, you test muscle strength and the function of cranial nerve XI. What is the expected finding? He can touch his chin to his chest and ears to their respective shoulders. He can hold his head erect, centered in the midline and still. He can shrug his shoulders and turn his head to the sides against the resistance of your hands. He can smile, raise his eyebrows, and grimace smoothly and symmetrically.
He can shrug his shoulders and turn his head to the sides against the resistance of your hands. Cranial nerve XI, the spinal accessory nerve, innervates the major neck muscles (sternomastoid and trapezius) that are responsible for rotation, flexion, extension, turning of the head, and movement of the shoulders. Thus the ability to shrug shoulders and turn the head to the sides against the resistance of the examiner's hands tests the function of cranial nerve XI and strength of the innervated muscles. Ability to touch chin to chest and ears to the respective shoulders is a measure of range of motion of the neck. Holding the head erect, centered, and still is a normal state, not a specific test. Smiling, raising the eyebrows, and grimacing are tests of cranial nerve VII.
In previewing a patient record, you see a notation of homonymous hemianopsia. Which pattern of vision loss would you expect this patient to have? Loss of the same half of the visual field in both eyes Localized blind spot in one eye Unilateral blindness Diminished vision in one half of a visual field
Loss of the same half of the visual field in both eyes Homonymous hemianopsia refers to the loss of the same half of the visual field in both eyes (e.g., visual field loss in the right nasal and left temporal fields).
Where would you observe for the pulsation of the carotid artery in the neck? Just below the angle of the jaw One fingerbreadth above the sternal notch Inferior to the submandibular gland Posterior to the sternomastoid muscle
Just below the angle of the jaw The pulsation of the carotid artery can be observed just below the angle of the jaw. The artery runs medial to the sternomastoid muscle, which arises from the sternum and the clavicle and extends diagonally across the neck to the mastoid process, thus dividing each side of the neck into two triangles: the anterior and posterior triangles.
A school-age child presents with nasal congestion, cough, and sore throat. On examination, you palpate bilaterally tender cervical lymph nodes more than 1 cm in diameter. Which term is most appropriate to use when documenting this finding? Lymphadenitis Lymphoma Lymphadenopathy Lymphedema
Lymphadenopathy Lymphadenopathy is the most appropriate term to use when documenting this finding because it refers to enlargement of the lymph nodes due to infection, allergy, or neoplasm. Lymphadenitis refers to an infection in the lymph node. Lymphoma is cancer of the lymph cells. Lymphedema is the swelling that occurs when the lymph node is obstructed and fluid accumulates in the tissues.
Which part of the ocular fundus should be examined last? Physiologic cup Fundal background Retinal vasculature Macula
Macula The macula should be the last part of the ocular fundus examined because a bright light on this area of central vision causes some watering and discomfort as well as pupillary constriction.
Mr. Roberts, a 28-year-old patient, presents with an acute onset of neck stiffness accompanied by headache and fever. Which problem do these symptoms suggest to you? Whiplash injury Vascular headaches Herniated cervical disks Meningeal inflammation
Meningeal inflammation An acute onset of neck stiffness accompanied by headache and fever is indicative of meningeal inflammation. Neither whiplash injuries nor herniated cervical disks present with fever. Neither migraine nor cluster headaches, both of which are vascular, are associated with stiff neck or fever.
Ms. Marks is a 43-year-old patient who presents with multiple complaints at the dermatology clinic. During the examination, you note nonpitting edema, coarse facial features, dry skin, and dry, coarse hair. In addition, her laboratory results demonstrate a severe deficiency of thyroid hormone. These findings are most suggestive of which disorder? Congenital hypothyroidism Scleroderma Myxedema Hashimoto's thyroiditis
Myxedema Nonpitting edema; coarse facial features; dry skin; dry, coarse hair; and a severe deficiency of thyroid hormone are characteristic of myxedema. Congenital hypothyroidism produces impaired growth and a neurologic deficit, a low hairline, a hirsute forehead, swollen eyelids, narrow palpebral fissures, widely spaced eyes, a depressed nasal bridge, a puffy face, a thick tongue protruding through an open mouth, and a dull expression. Head size is normal, but the anterior and posterior fontanels are wide open. Scleroderma is a rare connective tissue disease characterized by chronic hardening and shrinking and degenerative changes in the skin, blood vessels, synovium, and skeletal muscles, leading to hard, shiny skin on the forehead and cheeks; thin, pursed lips with radial furrowing; absent skinfolds; muscle atrophy on the face and neck; and absence of expression. Goiter is an increase in the size of the thyroid gland and occurs with hyperthyroidism, Hashimoto's thyroiditis, and hypothyroidism.
What are you checking when you perform the Hirschberg test on a patient? Parallel alignment of the eyes Equality and reactivity of the pupils Sympathetic and parasympathetic balance Clarity of the lenses
Parallel alignment of the eyes
Deficiency of a parasympathetic neurotransmitter and degeneration of basal ganglia lead to which disorder? Acromegaly Cushing's syndrome Parkinson's disease Paget's disease
Parkinson's disease Deficiency of a parasympathetic neurotransmitter and degeneration of basal ganglia lead to Parkinson's disease. Acromegaly is characterized by an excessive secretion of growth hormone from the pituitary after puberty, which creates an enlarged skull, thickened cranial bones, a prominent nose and lower jaw, a heavy eyebrow ridge, and coarse facial features. Excessive corticotropin production and chronic steroid use lead to Cushing's syndrome, which is characterized by a rounded "moon-like" face, plethora, prominent jowls, hirsutism, and chest acne. Paget's disease is a skeletal disease of increased bone resorption and formation, which softens, thickens, and deforms bones.
Which disease is characterized by flat, expressionless, or "mask-like" facies; a staring gaze; oily skin; and elevated eyebrows? Acromegaly Scleroderma Cushing's syndrome Parkinson's disease
Parkinson's disease Parkinson's disease is characterized by flat, expressionless, or "mask-like" facies; a staring gaze; oily skin; and elevated eyebrows. Acromegaly is characterized by an excessive secretion of growth hormone from the pituitary after puberty, which creates an enlarged skull, thickened cranial bones, a prominent nose and lower jaw, a heavy eyebrow ridge, and coarse facial features. Scleroderma is a collagen disease that causes chronic hardening and shrinking and degenerative changes in the skin. Excessive corticotropin production and chronic steroid use lead to Cushing's syndrome, which is characterized by a rounded "moon-like" face, plethora, prominent jowls, hirsutism, and chest acne.
What are you assessing when you perform the confrontation test? Corneal light reflex Binocular vision Peripheral vision Extraocular muscle function
Peripheral vision The confrontation test is used to provide a gross measure of an individual's peripheral vision. The Hirschberg test or corneal light reflex assesses the parallel alignment of the eye, which, along with the diagnostic positions test, is an indicator of extraocular muscle function.
Mrs. Jones comes to your office with a complaint of visual disturbance. On examination, you note an abnormal growth of conjunctiva from the limbus over the cornea. Which term might you use in documenting this condition? Pterygium Arcus senilis Xanthelasma Pingueculae
Pterygium Pterygium is an abnormal triangular growth of conjunctiva from the limbus over the cornea. It usually invades from the nasal side of the eye and may obstruct vision as it covers the pupil. Arcus senilis is a gray-white arc or circle around the limbus; it is due to deposition of lipid material. As more lipid accumulates, the cornea may look thickened and raised, but the arcus has no effect on vision. Xanthelasma are soft, raised yellow plaques occurring on the lids at the inner canthus around the fifth decade of life, more frequently in women, and they have no pathologic significance. Pingueculae are yellowish elevated nodules common to the sclera due to a thickening of the bulbar conjunctiva from prolonged exposure to sun, wind, and dust. It is important to distinguish pinguecula from the abnormal pterygium.
In the notation Right 5/2 = 5/2 Left, what do the 5s stand for? Length of response time Pupil size in the resting state Millimeters of maximum pupil dilation Seconds of exposure to light
Pupil size in the resting state The notation describes a normal pupillary response to light. The numerator (5) is the size of the pupil in millimeters before the light reflex was tested and the denominator (2) is the pupil size in millimeters after testing. The fraction following the word Right contains the information for the right eye and the fraction preceding the word Left contains the information for the left eye. The equal sign in the middle indicates the right and left pupils were equal.
Mrs. Black is a 72-year-old patient who comes to the clinic for an annual eye examination. When you review her record from last year, you see a notation of anisocoria. Based on this information, what do you expect to find on examination of her eyes? Pupils of unequal size Pupils with an unequal response to light Pupils of unequal shape Pupils of unequal accommodation
Pupils of unequal size Anisocoria is the term for the normal presence of pupils of two different sizes. This condition is present in approximately 5% of individuals.
You check a patient's pupil size before and after the light reflex. The size of both pupils before is 4 mm. After it is 2 mm. How do you document this finding? 4/2 × 2 L + R = 4/2 mm R = L @ 4 mm > 2 mm Right 4/2 = 4/2 Left
Right 4/2 = 4/2 Left This finding should be documented as: Right 4/2 = 4/2 Left. The numerator (4) is the size of the pupil in millimeters before the light reflex was tested and the denominator (2) is the pupil size in millimeters after testing. The fraction following the word Right contains the information for the right eye and the fraction preceding the word Left contains the information for the left eye. The equal sign in the middle indicates the right and left pupils were equal.
Mrs. Loring is a 45-year-old African-American woman who comes to the clinic for her yearly eye examination. When inspecting the sclera of this patient, which observation should you consider an expected finding? A slight misalignment of the eyeballs A slight, yellow discoloration of the sclera Small, brown macules on the sclera A slight amount of drainage around the lacrimal apparatus
Small, brown macules on the sclera Small, brown macules like freckles on the sclera are often seen in dark-skinned people and should not be confused with foreign bodies or petechiae. The eyeballs of African Americans are normally aligned in their sockets. African Americans occasionally have a gray-blue or "muddy" color to the sclera, not a slight yellow discoloration. Drainage around the lacrimal apparatus is an abnormal finding and warrants further evaluation.
Mrs. Raven is a 55-year-old patient who comes to the office complaining of a headache. As you obtain the health history, you are alert for description of which type of headache because of its life-threatening nature? Sudden onset of a new and severe headache Sudden onset of daily cluster-type headaches A persistent, incapacitating headache Daily incapacitating migraines
Sudden onset of a new and severe headache A life-threatening headache typically is new and severe and has a sudden onset. An examiner is alert to the report of a headache with these characteristics because follow-up is a priority because of its life-threatening nature. Cluster headaches are not life threatening. One to two cluster headaches occur per day, each lasting ½ to 2 hours, for 1 or 2 months; then complete remission may last for months or years. Persistent, incapacitating, or daily as single descriptors of headache do not indicate a life-threatening nature.
Which guidelines apply to testing a patient's near vision? Test each eye separately. Test without corrective lenses. Test with print held 12 inches from the eye. Test in natural light.
Test each eye separately. When testing near vision, each eye is tested separately in good but not necessarily natural light, with the printed card held 14 inches from the eye. Testing is done with glasses on, and normal is 14/14 in each eye.
How do you interpret findings of blinking and pupillary constriction in response to bright light when examining a newborn? The infant has an intact visual pathway. Cranial nerves I and II are functioning. The lower portion of the visual apparatus is intact. The visual pathway is developmentally functional.
The lower portion of the visual apparatus is intact. Blinking and pupillary constriction in the newborn in response to bright light are reflexes, and their presence indicates that the lower portion of the visual apparatus is intact. It cannot be inferred from the presence of these reflexes that the neonate can see; this conclusion requires later observation to show that the brain has received images and can interpret them.
For what are you assessing when you place your index finger on the trachea in the sternal notch and then slip it off to each side? Thyroid symmetry Carotid artery thrills Tracheal shift Goiter
Tracheal shift Tracheal shift is the movement of the trachea out of the midline. By placing your index finger on the trachea in the sternal notch and then slipping it off to each side, the space on each side can be estimated. If the trachea is midline, the two spaces are equal. If the spaces are unequal, the trachea has moved toward the smaller side. The thyroid gland and the carotid artery are not found in the location described. Goiter is a chronic enlargement of the thyroid gland.
When first visualizing the ocular fundus during an ophthalmoscopic exam, you don't see the optic disc. What should you do? Track a blood vessel as it grows larger. Find the macula and move nasally 1 disc size. Change lens diopters. Follow the scleral crescent until the disc comes into view.
Track a blood vessel as it grows larger. Normally, blood vessels include a paired artery and vein extending to each quadrant. These vessels enter and exit at the physiologic cup, which is a smaller circular area located within the optic disc. The vessels are progressively smaller in caliper as they near the periphery of the retina. Thus to find the disc, a blood vessel can be tracked as it grows larger and it will lead to the disc.
Mr. Colt, a 35-year-old patient, comes to the office presenting with complaints of fatigue and "just not feeling well." Which findings on palpation of his lymph nodes would you consider suspicious for lymph node malignancy? Palpable, smooth, soft, discrete, and nontender Palpable, enlarged, firm, nontender, and mobile Unilateral, hard, fixed, and nontender Enlarged, tender, warm, firm, and mobile
Unilateral, hard, fixed, and nontender Unilateral, hard, fixed, and nontender lymph nodes are considered suspicious for lymph node malignancy. Nodes that feel movable, discrete, soft, and nontender are normal. Nodes that are enlarged, firm, nontender, and mobile occur with HIV infection. Bilateral, enlarged, tender, warm, and firm but freely movable nodes are characteristic of infection.
When using the ophthalmoscope to examine retinal blood vessels, which would be normal findings? (Select all that apply.) Venous pulsation near the disc Artery-to-vein width ratio of 2:3 Mild vessel twisting in one eye Crossed artery and vein 3DD outside the disc Paired artery and vein going to each quadrant
Venous pulsation near the disc Artery-to-vein width ratio of 2:3 Paired artery and vein going to each quadrant
As you begin to bring the ophthalmoscope toward the patient's eye, you see the red reflex. Then, as you move closer steadily, it suddenly disappears. What does this mean? A negative diopter setting on the ophthalmoscope is needed. You need to find the pupil again. A cataract is obstructing the light beam. You need to use your other eye.
You need to find the pupil again. The red reflex is a red glow that fills the pupil as you direct the ophthalmoscope at the eye starting at about 25 cm (10 in.) away at an angle about 15 degrees lateral to the person's line of vision. The red reflex is caused by the reflection of the ophthalmoscope light off the inner retina. If the red reflex is lost as you move the ophthalmoscope closer to the eye, it means that the light has wandered off the pupil and onto the iris or sclera and you need to find the pupil again. The angle of the ophthalmoscope needs to be adjusted to do this.
A college-bound student comes for a routine immunization and shares the fact that he fell off a ladder and hit his head the evening before and doesn't feel just right. For which signs/symptoms would you assess? (Select all that apply.) blurred vision nausea and vomiting change in memory headache altered balance slowed reaction time
blurred vision nausea and vomiting change in memory headache altered balance slowed reaction time
When testing for the pupillary light reflex, an expected result is a(n) ________ and a(n) _________ response. immediate; delayed direct; indirect direct; consensual horizontal; vertical
direct; consensual When testing for the pupillary light reflex, an expected result is a direct response, meaning the pupil that the light is shone on responds by constricting, and a consensual response, meaning that the other pupil consents to the first pupil's response and does the same.
When examining a patient's eyes with an ophthalmoscope, the room should be darkened to: increase focusing power of the ophthalmoscope. promote pupil dilation. eliminate glare. limit reflective distortion.
promote pupil dilation. The room is darkened for ophthalmic examination to promote dilation of the pupils. The ophthalmoscope works by directing a beam of light through the pupil to illuminate the media and the ocular fundus. Dilating the pupil provides a wider look at the fundus background and macular area. The greatest dilation is achieved with dilating eyedrops, and this is not needed for a screening examination.
