Maryville 612 Exam 1
Claudication - Answer a condition in which cramping pain in the leg is induced by
exercise, typically caused by obstruction of the arteries. May be characterized as a dull
ache with accompanying muscle fatigue and cramps. Usually appears with sustained
exercise. Site of pain is distant to narrowing.
How do you test EOM? - Answer Eye movement is controlled by 6 extraocular muscles
and 3 cranial nerves, III, IV, and VI. To evaluate eye movement, use 4 techniques.
● First have the patient watch your finger move through the 6 cardinal fields of gaze.
Jerking or sustained nystagmus is abnormal. A few beats of horizontal nystagmus may
occur.
● Second have the patient follow your finger vertically from the ceiling to the floor.The
globes and the upper eyelids should move smoothly without eyelid lag or exposure of
the sclera.
● Third, test extraocular muscle balance using the corneal light reflex. WIth the patient
looking at a nearby object, shine a light on the nasal bridge. The eyes should converge
and reflect the light symmetrically.
● Fourth, if the corneal light reflex is imbalanced, perform the cover-uncover test. As the
patient stares at a fixed point nearby, cover one eye and observe the uncovered eye.
Then remove the cover and observe that eye as it focuses on the object. Note any eye
movement.
Your patient should be able to follow your finger with full, smooth extraocular
movements and without nystagmus, or "shaky" eye motion. Normal extraocular
movements indicate intact cranial nerves III, IV, and VI.
*******What is the difference between objective and subjective data? What components
of the health history are objective and subjective? *********** - Answer Seidel pg 618:
objective: "direct observation, what you see, hear, and touch". This includes vital signs
and actual assessment. Subjective: "information patients offer about their condition or
feelings." This includes chief complaint, past medical history, history or present illness,
family history, and review of symptoms.
Erb's point - Answer Erb's point is the auscultation location for heart sounds and heart
murmurs located at the third intercostal space and the left lower sternal border. Erb's
point, found two interspaces below the pulmonic area, does not reflect sound from one
particular heart valve, but is a common listening post, lying halfway between the base
and the apex of the heart.
Tonsil assessment - Answer • Enlargement; Acute infection, 2+, 3+, or 4+
o 1+ - visible
o 2+ halfway between tonsillar pillars
o 3+ touching uvula
o 4+ touching each other
Order physical assessment is done - Answer Inspection, Palpation, Percussion,
Auscultation
,Maryville 612 Exam 1
Proper use of Otoscope on adult or child - Answer Adult- straighten the external
auditory canal by pulling auricle up and back
Child- face child sideways with one arm around parents waist. Pull auricle either
downward and back or upward and back to gain best view of tympanic membrane.
How do you assess for sensoineural hearing loss - Answer air conduction heard longer
than bone conduction with Rinne Test; lateralization to unaffected ear; loss of high-
frequency sounds
How do you assess for conductive hearing loss - Answer bone conduction heard longer
than air conduction with Rinne Test; lateralization to affected ear with Weber Test; loss
of low frequency sounds; loss of 11-30 decibels on audiometry with cerumen impaction.
Rinne Test***** - Answer helps distinguish whether patient hears better by air or bone
conduction. Place the tuning fork at base of vibrating tuning fork against the patient's
mastoid bone and ask patient to tell you when the sound is no longer heard. Time this
interval of bone conduction noting number of seconds. Continue timing the interval of
sound due to by air conduction heard by the patient. Compare # of seconds air vs.
bone. Air conducted should be heard twice as long as bone conducted sounds. (If bone
conducted heard for 15 seconds, air conducted should be heard for additional 15
seconds).
Weber Test - Answer helps assess unilateral hearing loss. Place base of fork on mid-
line of patient's head. Ask patient if sound heard equally in both ears or in one ear
(lateralization of sound). Should hear sound equally.
Presbyopia - Answer Progressive weakening of accommodation (focusing power). The
major physiologic change that occurs after the age of 45 years; the lens becomes more
rigid, and the ciliary muscle becomes weaker.
Strabismus - Answer a condition in which both eyes do not focus on the object
simultaneously, although either eye can focus independently; may be paralytic or non-
paralytic.
Photopsia - Answer presence of perceived flashes of light. (Most commonly associated
with posterior vitreous detachment, migraine with aura, retinal break, or detachment).
Amblyopia - Answer also called lazy eye; is disorder of sight d/t eye and brain not
working well together. Results in decreased vision in an eye that otherwise typically
appears normal. Most common cause of decreased vision in a single eye among
children and younger adults.
Macular Degeneration - Answer is caused when part of the retina deteriorates; dry
(atrophic) from gradual breakdown of cells in macula resulting in gradual blurring of
central vision and wet (exudative or neovascular)- new abnormal vessels grow under
, Maryville 612 Exam 1
the center of the retina; the blood vessels leak, bleed, and scar the retina, distorting or
destroying central vision. In contrast to dry, vision loss may be rapid. Is leading cause of
blindness in older than 55 years of age in U.S.
Xanthelasma - Answer condition characterized by elevated plaque of cholesterol;
commonly found on the nasal portion of the eyelid.
Snellen Test***** - Answer The optic nerve is assessed by testing for visual acuity and
peripheral vision.
Visual acuity is tested using a snellen chart, for those who are illiterate and unfamiliar
with the western alphabet, the illiterate E chart, in which the letter E faces in different
directions, maybe used. The chart has a standardized number at the end of each line of
letters; these numbers indicates the degree of visual acuity when measured at a
distance of 20 feet.
The numerator 20 is the distance in feet between the chart and the client, or the
standard testing distance. The denominator 20 is the distance from which the normal
eye can read the lettering, which correspond to the number at the end of each letter
line; therefore the larger the denominator the poorer the version.
Measurement of 20/20 vision is an indication of either refractive error or some other
optic disorder.
In testing for visual acuity you may refer to the following:
1. The room used for this test should be well lighted.
2. A person who wears corrective lenses should be tested with and without them to
check fro the adequacy of correction.
3. Only one eye should be tested at a time; the other eye should be covered by an
opaque card or eye cover, not with client's finger.
4. Make the client read the chart by pointing at a letter randomly at each line; maybe
started from largest to smallest or vice versa.
5. A person who can read the largest letter on the chart (20/200) should be checked if
they can perceive hand movement about 12 inches from their eyes, or if they can
perceive the light of the penlight directed to their yes.
Rosenbaum Test - Answer The Rosenbaum near vision card is intended to measure
near acuity at a distance of 14" ( 36 cm) from the patient.
Preparation:
- Be sure the Rosenbaum is evenly illuminated.
- Have the patient wear their current Rx (contacts or
glasses)
Recommended Process:
1. Occluder the patient's left eye (to examine the right
eye).
Claudication - Answer a condition in which cramping pain in the leg is induced by
exercise, typically caused by obstruction of the arteries. May be characterized as a dull
ache with accompanying muscle fatigue and cramps. Usually appears with sustained
exercise. Site of pain is distant to narrowing.
How do you test EOM? - Answer Eye movement is controlled by 6 extraocular muscles
and 3 cranial nerves, III, IV, and VI. To evaluate eye movement, use 4 techniques.
● First have the patient watch your finger move through the 6 cardinal fields of gaze.
Jerking or sustained nystagmus is abnormal. A few beats of horizontal nystagmus may
occur.
● Second have the patient follow your finger vertically from the ceiling to the floor.The
globes and the upper eyelids should move smoothly without eyelid lag or exposure of
the sclera.
● Third, test extraocular muscle balance using the corneal light reflex. WIth the patient
looking at a nearby object, shine a light on the nasal bridge. The eyes should converge
and reflect the light symmetrically.
● Fourth, if the corneal light reflex is imbalanced, perform the cover-uncover test. As the
patient stares at a fixed point nearby, cover one eye and observe the uncovered eye.
Then remove the cover and observe that eye as it focuses on the object. Note any eye
movement.
Your patient should be able to follow your finger with full, smooth extraocular
movements and without nystagmus, or "shaky" eye motion. Normal extraocular
movements indicate intact cranial nerves III, IV, and VI.
*******What is the difference between objective and subjective data? What components
of the health history are objective and subjective? *********** - Answer Seidel pg 618:
objective: "direct observation, what you see, hear, and touch". This includes vital signs
and actual assessment. Subjective: "information patients offer about their condition or
feelings." This includes chief complaint, past medical history, history or present illness,
family history, and review of symptoms.
Erb's point - Answer Erb's point is the auscultation location for heart sounds and heart
murmurs located at the third intercostal space and the left lower sternal border. Erb's
point, found two interspaces below the pulmonic area, does not reflect sound from one
particular heart valve, but is a common listening post, lying halfway between the base
and the apex of the heart.
Tonsil assessment - Answer • Enlargement; Acute infection, 2+, 3+, or 4+
o 1+ - visible
o 2+ halfway between tonsillar pillars
o 3+ touching uvula
o 4+ touching each other
Order physical assessment is done - Answer Inspection, Palpation, Percussion,
Auscultation
,Maryville 612 Exam 1
Proper use of Otoscope on adult or child - Answer Adult- straighten the external
auditory canal by pulling auricle up and back
Child- face child sideways with one arm around parents waist. Pull auricle either
downward and back or upward and back to gain best view of tympanic membrane.
How do you assess for sensoineural hearing loss - Answer air conduction heard longer
than bone conduction with Rinne Test; lateralization to unaffected ear; loss of high-
frequency sounds
How do you assess for conductive hearing loss - Answer bone conduction heard longer
than air conduction with Rinne Test; lateralization to affected ear with Weber Test; loss
of low frequency sounds; loss of 11-30 decibels on audiometry with cerumen impaction.
Rinne Test***** - Answer helps distinguish whether patient hears better by air or bone
conduction. Place the tuning fork at base of vibrating tuning fork against the patient's
mastoid bone and ask patient to tell you when the sound is no longer heard. Time this
interval of bone conduction noting number of seconds. Continue timing the interval of
sound due to by air conduction heard by the patient. Compare # of seconds air vs.
bone. Air conducted should be heard twice as long as bone conducted sounds. (If bone
conducted heard for 15 seconds, air conducted should be heard for additional 15
seconds).
Weber Test - Answer helps assess unilateral hearing loss. Place base of fork on mid-
line of patient's head. Ask patient if sound heard equally in both ears or in one ear
(lateralization of sound). Should hear sound equally.
Presbyopia - Answer Progressive weakening of accommodation (focusing power). The
major physiologic change that occurs after the age of 45 years; the lens becomes more
rigid, and the ciliary muscle becomes weaker.
Strabismus - Answer a condition in which both eyes do not focus on the object
simultaneously, although either eye can focus independently; may be paralytic or non-
paralytic.
Photopsia - Answer presence of perceived flashes of light. (Most commonly associated
with posterior vitreous detachment, migraine with aura, retinal break, or detachment).
Amblyopia - Answer also called lazy eye; is disorder of sight d/t eye and brain not
working well together. Results in decreased vision in an eye that otherwise typically
appears normal. Most common cause of decreased vision in a single eye among
children and younger adults.
Macular Degeneration - Answer is caused when part of the retina deteriorates; dry
(atrophic) from gradual breakdown of cells in macula resulting in gradual blurring of
central vision and wet (exudative or neovascular)- new abnormal vessels grow under
, Maryville 612 Exam 1
the center of the retina; the blood vessels leak, bleed, and scar the retina, distorting or
destroying central vision. In contrast to dry, vision loss may be rapid. Is leading cause of
blindness in older than 55 years of age in U.S.
Xanthelasma - Answer condition characterized by elevated plaque of cholesterol;
commonly found on the nasal portion of the eyelid.
Snellen Test***** - Answer The optic nerve is assessed by testing for visual acuity and
peripheral vision.
Visual acuity is tested using a snellen chart, for those who are illiterate and unfamiliar
with the western alphabet, the illiterate E chart, in which the letter E faces in different
directions, maybe used. The chart has a standardized number at the end of each line of
letters; these numbers indicates the degree of visual acuity when measured at a
distance of 20 feet.
The numerator 20 is the distance in feet between the chart and the client, or the
standard testing distance. The denominator 20 is the distance from which the normal
eye can read the lettering, which correspond to the number at the end of each letter
line; therefore the larger the denominator the poorer the version.
Measurement of 20/20 vision is an indication of either refractive error or some other
optic disorder.
In testing for visual acuity you may refer to the following:
1. The room used for this test should be well lighted.
2. A person who wears corrective lenses should be tested with and without them to
check fro the adequacy of correction.
3. Only one eye should be tested at a time; the other eye should be covered by an
opaque card or eye cover, not with client's finger.
4. Make the client read the chart by pointing at a letter randomly at each line; maybe
started from largest to smallest or vice versa.
5. A person who can read the largest letter on the chart (20/200) should be checked if
they can perceive hand movement about 12 inches from their eyes, or if they can
perceive the light of the penlight directed to their yes.
Rosenbaum Test - Answer The Rosenbaum near vision card is intended to measure
near acuity at a distance of 14" ( 36 cm) from the patient.
Preparation:
- Be sure the Rosenbaum is evenly illuminated.
- Have the patient wear their current Rx (contacts or
glasses)
Recommended Process:
1. Occluder the patient's left eye (to examine the right
eye).
