244 final Review

8 bones

Tinniuts, Incontinence, memory loss, epilepsy, CVA, family history, head trama, sinus problems, headache..etc

Midline, hair distribution, symmetry, facial expression, color, abnormal movments.

Scalp and hair texture, masses, tenderness, swelling, muscle tone, temportal artery, TMJ

Temporal Arteries

• Normocephalic-Normal size and shape
• Mircocephalic- Small head
• Macrocephalic- Big Head

Water in the head

A nervous disorder

Bulging of the eyes from their orbit

Acromegaly is a chronic metabolic disorder in which there is too much growth hormone and the body tissues gradually enlarge

• Get a current status: problems with vision, corrective lenses.
• Past history: changes, sports, flaters, surgeries, drainage, etc

• THe assessment of distance vision
• -Patient stands 20 fe away
• -Test one eye at a time and then together
• -Read smallest line possible
• -Visual acuity as a fraction

Look at the conjunctiva, etc with an otoscope

Palpate eyelids for swelling, eyeball, lacrimal sac

The nasolacrimal duct

Near sighted-ness

• Assessment of the pupils:
• Pupils
• Equal
• Round
• Ractive to
• Light and
• Accomodation

Red reflex, optic fundus, optic disk, blood vessels, and macula

Changes in hearing, ear pain, cerumen, tinnitus, problems with dizziness, medicaitons, chronic ear infections

• Inspect color, size, drainage
• Assess for lesions
• Palpate Tragus
• Mastoid Process
• Pull heliz backwards

• The gross hearing test
• Whisper Test
• Watch Tick test
• Rinne's Test
• Weber's Test

Stand one-two ft behind the patient and have them cover one ear and whisper a few words and have them repeat back to you

Holding a pocket watch and slowly pulling away from the patient until they cannot hear it anymore.

• A tuning fork is placed in the patient's forehead and should be heard equally in both ears.
• If conductive loss, heard louder in affective ear
• If sensorineural loss, head louder in unaffective ear

• Comparing air and bone conduction with a tuning fork.
• AC>BC, normal positve
• AC< BC, negative Rinne Test

Interruption of the sound vibrations in their passage from the outer world to the nerve cells in the inner ear

In nerve deafness, some defect in the sensory cells of the inner ear (e.g., their injury by excessive noise) or in the vestibulocochlear nerve prevents transmission of sound impulses from the inner ear to the auditory centre in the brain

Examine external ear canal, assess cerumen, tympanic membrane, TM should be pearly gray, cone of light

Inspect: Symmetry, deformity, swelling, nasal flaring, and nasal spectulum.

Palpate: for tenderness and nasal patency

• Inspect: Frontal and maxillary sinuses for inflammation
• Palpate nad percuss for tenderness
• Transillumintion-shining light through a body cavity

• Inspect: Lips, gums, mucosa, teeth, hard and soft palate, anterior/ posterior tonsils, pharynx, tongue,
• Stenson- saliva duct
• Wharton Duct- submandibular gland opening into the mouth

• Inspect: Scars, Masses, Trachea
• Palpate: Thyroid

• Frontal
• Parietal
• Temportal
• Ocippital

• CNS- Brain and spinal cord
• PNS- Cranial and spinal nerves, autonomic nervous system.

• Contains the midbrain, pons, and medulla oblongata.
• Relays impulses from spinal cord to cerebrum

The cardiac, respiratory, and vasomoter centers

• Maintenance of the equilibrium
• coordination of movement
• maintenance of muscle tone

• -Smell, assess sense of smell
• Normal Results: Correctly identifies scent in each nostil
• Abnormal: Inablitiy to id scent may be due to nasal disease or smoking

• Sensory
• Vision
• Assess using snellen chart
• Normal Results: 20/20, full visual fields, optic disc intact
• Abnormal Results: <20/20, loss of visual fields, papilledma

• -All motor
• -EOM (extra-ocular movement)
• Pupil size, shape and equality, reaction to light
• EOM in 6 cardinal fields of gaze
• Normal: No ptosis, nystagmus, Perrla

• Both
• Functions:
• S- light touch, pain, temp, corneal reflex
• M- Masseter and temportalis strength
• Clench teeth (M)
• Corneal Reflex
• Sharp v Dull
• Light touch
• Normal: Muscles contract bilaterally

• Both
• S- Taste anterior 2/3
• M- Facial Movements
• Symmtery of face
• Facial Movements
• Taste of sweet, sour, and salty, not bitter
• Abnormal: Inability to do movements may indicate CVA (Stroke), Bells palsy

• Sensory
• Cochlear: gross hearing
• Vestibular: equilibrium
• Hearing (whisper
• Weber and Rinne Test
• Rhomberg
• Normal: Whisper heard from 1-2 ft, AC>BC, vibration heard = in both ears

• S- Taste posterior 1/3- Bitter
• M- Soft palate and uvula, gag reflex, swallowing

• Motor
• Sternocldidomastoid and trapezuis movement
• Shrug shoulders
• Rotate Head
• Normal: Symmetric, strong cnotractions of muscles

• Motor
• Tongue movement and lingual sounds
• Normal: Tongue movement is symmetric, smooth

No

NO, it will be decreased

With a cotton wisp

Yes it should, even if the other eye is covered up

-Often go unnoticed until very bad

Allows eyes to focus on objects

The clouding of the eye's lense

The loss of retainal gaglioan cells-neuropathy

The backdown of retina macula

Sinustis

• -Shortening of the neck
• -Gums decrease
• -Gag reflex is sluggish
• -Smell is diminished
• -Decrease of pupil size
• -Prebyopia-eyes lose ability to focus

Fluid, collecting ducts, lymph tissue- all over but not in the brain

• Bone marrow- makes B cells
• Thymus- Make T-cless
• Spleen- largest lymph organ
• Nodes- antibodies and lymphocytes

• Lymph fluid is clear, composed of H20, and protein.
• Differenet flow in different ways
• Edema

• Recognize foregin substances and respond, stimulate producitonof more B and T cells
• Makes up 20-40% of WBC

• Normal: Unable to palpate or see
• Abnormal: Enlarged nodes, able to palpate, tenderness, firm, hard nodes.
• Larger in child and teens

Cervical chair, axilla, breasts, thymus, tonsils, adenolds, peyers atches, spleen (White-lymph, red- Veins), groin

nasopharyngeal tonsils

• GALT_ gut associated Lymphoid Tissue
• Present in mucosa and submucosa of small intestine (mainly ileum)

Mastectomy, hodgkinds, organ transplant, HIV, FH, current infection, lymphedema

excess lymph tissue in arm or leg, swelling painful, hard to treat, firm feeling, cluster

• Inspect: Red streaks, enlarged nodes, lesions, edema, erythema
• Palpate: Superficial nodes and characteristics

May be indicated when nodes are palpable bilaterally, feel large, warm, tender, firm but freely movable

may be indicated when nodes are unilateral, hard, discrete, asymmetric, fixed, not painful, nontender.

Pathway of cancer

Nodes diminish, decrease and become more fibrotic with age, impaired ability to resist infection

• Begins at age 10-11
• Stimulated by estrogen release during puberty

• Function: Milk production and lactation
• Tail of spense, coopers ligaments, nipple, areola, lobe, lobules, alveoi, lumphatic drainage

90% of breast cancer occurs here

Lobules are milk processing glands

The axillary nodes: central, pectoral, subscapular, lateral, internal mammary chain

Diet, exercise, breast self-exam, and mammogram

Age, Gender, Race, common chief complanits, breast masses, past history, family history

Breasts, areolar areas, nipples, axillae

Color, vascularity, thickening, size and symmetry, contour, lesions, discharge

Sequential manner, suprclaviuclar and infraclauvicular nodes, breasts, arms at side, arms rasied, axillary nodes, supine position

Location, size, number, definition, mobility, tenderness, erythema, dimpling or retraction

• Breast and axillae are flesh colored
• areolar areas and nipples are darker in pigmentation
• moles are normal
• no thickening
• minor size variations
• usually breast on dominant side is larger
• nipples should point upwards and out, sometimes downwards and out

Age > 50, personal history, family history, meopuase at advanced age, menarche at an early age, obseity, american descent, estogen tehrapy, first birth after age 30, higher education/class, >3 alcohol servings a day

Performed once a month, performed on a fixed date each month, or 8 days after period, avoid completein during menstruation or ovulation, use calender for reminder, and include significant other in process

• Lie down
• I arm up, other feeling
• Use finger pads
• Go up and down
• 3 levels of pressure: Light, medium, and firm
• In mirror with hands on hip

• Penis: Assess for tenderness, pulsations, masses
• Urethral meatus: Discharge
• Scrotum: Masses, tenderness, spermatic cord
• Inguinal area: Hernias

• -Testicles are firm, smooth, equal in size
• -Spermatic cord is smooth and round
• -small, freely moblie lymph nodes in inguinal area
• - Scrotal skinis pigmented, rugated, and thin
• -No inflammation or swelling in scrotal area
• -Left scrotal sac is lower than the right

• - age 25-44
• -Mother uses birth control or x-rays
• -Mother or sister having breast cancer
• -White, high class
• -Early puberty
• -Family History

• Mons pubis- look for bumps, warts, or ulcers-note change in skin color
• Check clitoir and clitoral hood
• Examine the labia minora and majora
• move to perineum and check carefully

• -Any new mole, wart, or growth
• -Any areas of discolored skin
• -Ulcers or sores without a known cause
• -Areas of continuing pain, swelling, or itching

HPV, infection, late teens- mid-30s, multiple sex partners, failture to have pap test, HIV, smoking, use of OCPs for more than 5 years