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89 Cards in this Set

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How many bones are there in the face?
14
How many cervical vertebrae support the skull?
7
Which cervical vertebrae helps flex your head?
C7

*to locate, find the vertebra that sticks out the most during neck flexion
What are fontanelles?
Areas on the infantile skull that feel like "soft spots"

There should be NO protrusion
What are possible findings in fontanelle assessment
1. normal: soft & flat
2. full, bulging: brain injury?
3. sunken: dehydration
Describe the shape of the ANTERIOR fontanelle and when it closes.
Anterior fontanelle:

1. diamond
2. 4mo - 26 months
Describe the shape of the POSTERIOR fontanelle and when it closes.
Posterior fontanelle:

1. triangle
2. 2 months
Which questions about the head should you ask during the health history?
1. headache?
2. head injury?
3. dizziness?
4. history of head injury or surgery?

*pay attention to a severe headache
What are additional questions that you should ask when taking the history of an aging adult?
1. If dizziness is a problem, how does it affect your ADLs?
2. Are you able to drive safely?
3. Are you able to maneuver around the house safely?
What are 4 aspects of the head that you should inspect and palpate?
1. skull
2. scalp
3. hair
4. face
What are 4 facial features that you should pay attention to during the physical exam?
1. Symmetry of features
2. CN VII, V
3. TMJ
4. Temporal arteries
What are 3 descriptions of head size?
1. Macrocephaly
2. Normocephalic
3. Microcephaly
What is macrocephaly? Potential cause?
>90th percentile for gestational age

hydrocephaly
What is microcephaly? Potential causes?
<10th percentile for gestational age

chromosomal abnormalities
intrauterine infection
maternal alcohol/drug abuse
What are 4 reasons why you should inspect the face?
1. symmetry (eyebrows, palpebral fissures lined up with top of ear, nasoliabial folds)
2. facial expression
3. abnormal structures
4. abnormal movements
What is acromegaly?
A disease in which the pituitary gland produces too much GH...causes excessive frontal bone and soft tissue growth
What are some features that appear in a person with fetal alcohol syndrome?
1. epicanthal folds
2. think upper lip
What is CN VII and what does it innervate?
Facial

mediates facial muscles
How can you assess CN VII?
1. expressions should be symmetrical
2. palpebral fissures should be equal bilaterally
3. nasolabial folds should be symmetric
What is a condition that occurs from paralysis of one side of CN VII?
Bell's Palsy
What is CN V and what does it innervate?
trigeminal nerve

forehead, cheeks, and chin bilaterally
What are the 3 distributions of CN V?
1. ophthalmic
2. maxillary
3. mandibular
How can you assess the SENSORY function of CN V?
gently rub a cotton ball over the innervated area (ie cheeks, forehead, chin) and ask if patient feels it
How can you assess the MOTOR function of CN V?
Ask the patient to clench teeth and open mouth while you palpate temporal and masseter muscles bilaterally
What is the most active joint in the body?
TMJ: temporomandibular joint
Where is the TMJ located?
below the temporal artery and anterior to the tragus
What should you assess while palpating the TMJ?
Palpate while the person opens his/her mouth.

-check for normal smooth movement with no limitation or tenderness
-check for ROM (range of motion)
What are problems that could occur in the TMJ?
-decreased ROM (arthritis)
-Click: meniscus tear, poor occlusion, synovial swelling
What should the temporal artery NOT feel like?
-indurated (hard)
-torturous (twisty)
Inflammation of the temporal artery may cause...
blindness
When eyes are approximate, what does that mean?
they're closed
What is a caruncle?
the fleshy part in the medial canthus that has sebaceous glands
What is a palpebral fissure?
opening between the 2 eyelids
What are tarsal plates of the eye?
plates of dense connective tissue that gives the eyelid form and support
What are meibomian glands?
Sebaceous glands that secrete oil to lubricate the eye
What are 2 types of conjunctiva and what do they line?
1. bulbar (lies over cornea)
2. palpebral (lines the lids)
What color should the conjunctiva normally be?
pink
How can you diagnose conjunctivitis?
Since the conjunctiva are swollen, you can see the mucus membrane of the BULBAR conjunctiva sticking away from the eye
What does the lacrimal apparatus do?
Provides constant irrigation by secreting tears
What is the pathway of tear flow?
lacrimal gland secretes-->
flows across eye-->
drains into puncta-->
drain to nasolacrimal sac-->
nose
Which two parts of the eye are continuous with each other
sclera and cornea
What does the choroid do?
gives blood to the retina
Why is the retina significant?
It is the place where light rays become nerve impulses
What are 3 layers of the eye?
1. Sclera
2. Choroid
3. Retina
What is the anterior compartment and what fluid does it contain?
Located between the cornea and iris; filled with aqueous humor
What eye part makes the aqueous humor?
ciliary body


*aqueous humor meant to drain waste
What disease occurs when problems in the anterior compartment occur?
glaucoma
What fluid does the posterior chamber contain?
vitreous humor

*watch for floaters
Describe the 6 extraocular muscles.
straight (4): rectus muscles

oblique (2): rotation of eye
What are 2 possible causes of problems with eye movement?
1. problem with nerve
2. problem with muscle
Name the cranial nerves that innervate the extraocular muscles.
1. CN VI (abducens)
2. CN IV (trochlear)
3. CN III (oculomotor)
Which muscles does CN VI innervate?
the LATERAL rectus muscles
Which muscles does CN IV innervate?
superior oblique muscles
Which muscles does CN III innervate?
Superior, inferior, medial rectus

Inferior oblique
What eye movement does CN VI enable?
looking at the sides
What eye movement does CN IV enable?
down and in
What is the "red reflex"?
When the opthalmoscope light reflects off the retina
What eye parts can you see through the opthalmoscope?
1. retinal vessels
2. retinal field or background
3. optic disc
4. macula
What should the optic disc look like through the opthalmoscope?
creamy color; round or oval; blurred edge on nasal side, demarcated edge on temporal side
How many sets of retinal vessels should you look for?
4, each set consists of a vein + artery, 2 sets are superior, 2 sets are inferior
How are visual pathways projected?
upside down and reversed right to left
What is the visual pathway of nerve impulses?
nerve impulses are conducted through the..
retina-->
optic nerve-->
optic chiasm-->
optic tract on each side-->
through a curving tract called the optic radiation
What are 2 types of pupillary light reflexes?
1. direct
2. consensual
How do you test the direct pupillary light reflex?
shine the light into the left eye, the left pupil constricts
How do you test the consensual pupillary light reflex?
shine the light into the left eye, the right pupil constricts
Accomodation: At far vision, pupils..
dilate
Accomodation: At near vision, pupils...
constrict and converge
How do you use the Snellen chart?
Place the chart 20 ft from the patient.

Shield 1 eye and instruct the patient to read the line that they can see best.

*leave glasses on if needed!
What does the Snellen chart test
distance visual acuity
Interpret 20/50 vision.
What that person read at 20 ft could be read by a person with perfect vision (20/20) at 50 ft.
What occurs in myopia?
near vision; the anterior-posterior measurement is too long
What occurs in hyperopia?
far vision; the anterior-posterior measurement is too short
What is presbyopia?
when the ability of the lens to accommodate decreases
What disease would you expect if the outer 1/3 of the eyebrow is missing?
thyroid disease
What is ptosis?
drooping of the upper eyelid; may be congenital or caused by a disease
What is anisocoria?
When people are born with 1 pupil bigger than the other
How can you decide if aniscocoria is benign?
if the pupils respond to light
What is a normal pupil size?
3mm-5mm
What are the 5 tests for eye function that you should perform during the physical?
1. Corneal light reflex
2. Direct and consensual (pupillary light reflex)
3. Accomodation
4. Extraocular muscles
5. Visual fields
Which pathway does light travel in order to instruct the pupil to constrict?
light-->
CN II-->
cortex-->
CN III-->
constrict
How far away do you need to be in order to test the 6 cardinal positions of a gaze?
~1 foot away from the patient
How do you test the range of peripheral visual fields?
Fishbowl

*do one eye at a time if you expect an eye problem
What are the normal peripheral visual field limits?
nasally: 60 degrees
temporally: 90 degrees
superiorly: 50 degrees
inferiorly: 70 degrees
What is bitemporal hemianopsia?
involves the fibers crossing over tot he opposite side.

since the fibers originate in the NASAL half of each retina, visual loss involves the temporal half of each field
What is left homonymous hemianopsia?
lesion in the RIGHT optic tract inturrupts fibers originating on the same side of both eyes

Visual loss in the eyes is therefore similar and involves half of each eye; in this case left temporal and right nasal
What is A-V nicking?
when the artery crosses over in the vein
When is A-V nicking often seen?
-diabetics
-hypertension
What is papilledema?
Choking of the disc from increased ICP pressing on the optic nerve

It looks puffed up; normally veins pulsate, but not in this case

If you must change your focus to visualize the optic disc, you may have edema
What are causes of papilledema?
1. headache
2. injury