-
what are common/concerning symptoms of head
-
What are common/concerning symptoms of eyes
- visual disturbances
- scotomas(spots)
- flashing lights
- use of corrective lenses
- pain
- redness
- excess tearing
- diplopia
-
What are common/concerning symptoms of ears
- hearling loss
- ringing (tinnitus)
- vertigo
- pain
- discharge
-
what are common/concerning symptoms of nose
- rhinorrhea
- cognestion
- sneezing
- epistaxis
-
What are common/concerning symptoms of oropharynx
sore throat/gum bleeding, hoarseness
-
what are common/concerning symptoms of neck
-
What is the most important attributes of a headache
- severity
- chronological patterns
-
What are some red flags when dealing with headaches
- worst headache of my life
- thunderclap
-
What should you consider if a headache is severe & sudden onset
- subarachnoid hemmorrhage
- meningitis
-
Which type of headaches are episodic & peak over several hrs
-
Nausea & vomiting are common with migraine can also occur with
- brain tumors
- subarachnoid hemorrhage
-
what could arise if the onset of bilateral visual loss is gradual
- cataracts
- macular degeneration
-
Moving specks or strands suggest
vitreous floaters
-
What do scotomas suggest
lesions in retinal/visual path
-
flashing lights or new vitreous floaters may suggest
detachement vitreous from retina
-
horizontal diplopia affects what cn's
3 or 6
-
vertical diplopia affects what cn's
3 or 4
-
Diplopia in one eye with other closed may suggest
problem in cornea/lens
-
people with sensorineural loss have particular trouble understanding
speech & that noisy environments make hearing worse
-
What happens in noisy environments if a person has conductive loss
may help hearing
-
which type of hearing deficit results from external or middle ear
conductive
-
which type of hearing deficity results from inner ear or cochlear nerve
sensorneural
-
what is otitis externa
pain in external ear
-
what is otitis media
resp infection in inner ear
-
what is tinnitus
ringing sound or musical ringing sound
-
what is it when tinnitus is associated with hearing loss & vertigo
meniere disease
-
what is vertigo
perception that patient or environment is rotating/spinning
-
where does the problem of vertigo stem from typically
- labyrinths of inner ear
- peripheral lesions of cn8 or its pathways
-
what are some causes of rhinnorhea
- viral infection
- allergic rhinitis(hay fever)
- vasomotor rhinitis
-
what is bleeding from the nose
epistaxis
-
where does blood originate in epistaxis
nose or paranasal sinus or nasopharynx
-
what is a sore throat usually associated with
uri
-
where does hoarseness typically arise from
larynx or perhaps extralaryngeal lesions pressing on laryngeal nerves
-
what are some chronic causes of harseness
- smoking
- allergy
- voice abuse
- TB
-
What are some important topics for health promotion & counseling for the head
- changes in vision:cataracts, macular degeneration, glaucoma
- hearing loss
- oral health
-
what is the leading cause of blindness in african americans & 2nd leading cause of blindness overall
glaucoma
-
What are some risk factors for glaucoma
- age older than 65
- african american descent
- diabetes
- myopia
- ocular hypertension
-
What are the groups at risk for hearing loss
- hx of congential or family hearing loss
- syphilis
- menigitis
- exposure to hazards materials
-
how can you counsel patients on ways to improve oral health
- daily hygiene measures
- fluroide containing toothpastes
- brushing & flossing regularly
- dental care annually
- avoid foods high in refined sugar
-
how do you test for visual acuity
- snellen eye chart
- patient 20ft from chart
- cover one eye
- read smallest line
-
What should you do if the person can't read the largest print on the chart
move them closer to chart & note intervening distance
-
How is visual acuity expressed
- 2 numbers
- first=distance from chart
- second=distance at which normal eye can read the line
-
What does vision of 20/200 mean
20ft the patient can read print that a person with normal vision could read at 200ft
-
what could an enlarged blind spot occur
optic nerve is affected=glaucoma, optic neuritis, papilledema
-
What should you do if the pupils are greater than 5mm or less than 3mm
measure them
-
what is miosis
constriction of pupils
-
what is mydriasis
dilation
-
what does it mean if the the iris bends forwards casting a crescentic shadow on the medial side of the iris
possible acute narrow-angle glaucoma due to sudden increase in intraocular pressure
-
how can you test for argyll robertson & tonic pupils
testing near reaction
-
what does asymmetry of the corneal reflection indicates
deviation from normal ocular alignment
-
what is nystagmus
fine rhythmic oscillation of eyes
-
what is lid lag
eyes move from up to down
-
without dilating the pupils your view is limited to what during the opthalmascope exam
post structures of retina
-
how can you see the peripheral structures better to see the macula better
dilate the pupils with mydriatic drops
-
what are the steps for using the opthalamoscope
- darken room
- shine light on back of hand
- turn lens to 0 diopter
- right hand right eye to patients right eye
- braced against medial aspect of bony orbit at 20 degree slant
- 15 inches from patient
- angle 15 degrees lat to patient's line of visionn
- light beam onto pupil
- look for red reflex
-
What if the red reflex is absent it may suggest what
- cataract
- vitreous
- detatched retina
- retinoblastoma
-
What are the steps for examing the optic disc & retina
- locate OD
- bring into sharp focus=adjusting lens
- inspect OD noting sharpness/clarity; color, size & symmetry
-
how do you adjust the diopters for a myopic patient
rotate lens counterclockwise
-
how do you adjust the diopters for a hyperopic patient
rotate lens clockwise
-
What can papilledema signal
- meningitis
- sub arach hem
- trauma
- mass lesions
-
how are arteries vs veins different in the retina
- A=lighter,smaller with a bright light reflex
- V=darker, larger,absent light reflex
-
how can lesions of retina be measured
disc diameters
-
What is a cause of poor central vision in the elderly
macular degeneration
-
What is the weber test
testing for lateralization by placing a tuning fork on top of head & ask where they hear the sound
-
What is the rinne test
compares the air conduction and bone conduction by placing fork mastoid bone & remove when no longer heard laterally to the ear and ask if they can still hear it
-
Where is sound heard in unilateral conductive hearing loss
impaired ear
-
where is sound heard in unilateral sensorineural hearing loss
good ear
-
How is sound heard in conductive hearling loss
heard through bone as long as or longer than it is through air
-
Increased adrenal cortisol production produces a round or moon face with red cheeks, excessive hair growth in musstache. What are we describing
cushings syndrome
-
face is edematous and often pale with swelling around eyes in morning
nephrotic syndrome
-
A dull puffy face with edema around eyes & hair,eyebrows dry & thinned along with dry skin
myxedema
-
increased growth hormone produces enlargement bone soft tissues
acromegaly
-
drooping of upper lid caused by myasthenia gravis or damage to cn3
ptosis
-
inward turning of lid margin more common in elderly
entropion
-
lower lid is turned outward expoxing palpebral conjunctiva with tearing
ectropion
-
wide eyed stared with retracted eyelids due to hyperthyroidism
lid retraction
-
eyeball protrudes forward
exophthalmos
-
opacities of lenses visible through the pupil
cataracts
-
spokelike shadows that point inward
peripheral cataract
-
What is anisocoria
unequal pupils
-
pupil is large, regular, and usually unilateral with a reduced & slowed reaction to light & slow accommodation
tonic pupil/adie
-
dilated pupil with ptosis & lat deviation of eye
cn3 paralysis
-
affected pupil is small, reacts briskly to light, ptosis, loss of sweating on forehead
horner's syndrome
-
small irregular pupils that accommodate but don't react to light
argyll robertson pupil=syphilis
-
optic disc appears pink & hyperemic
papilledema
-
physiologic cup is enlarged in optic disc
glaucomatous cupping
-
optic disc appears white
optic atrophy
-
ocular fundi had tiny red dots with rings of hard exudates(white spots)
nonproliferative retinopathy
-
retinal hemorrhage of ocular indicates
nonproliferative retinopathy with severe
-
new preretinal vessels arising on disc extending across disc margin with normal visual acuity
proliferative retinopathy with neovascularization
-
neovascularization has increased with fibrous proliferations, distortion of macula & reduced visual acuity
proliferative retinopathy advaced
-
external or middle ear disorder impairs sound conduction to inner ear caused by foreign body, otitis media, perforated eardrum
conductive loss
-
inner ear disorder involves cochlear nerve & neuronal impulse transmission to brain due to loud noise or inner ear infections
sensorineural loss
|
|