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363 Final Exam| 808 questions| with complete solutions

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Inspect ocular fundus: To examine person Darken room to help ___ pupils; dilating eye drops are not needed during a screening examination Select large round aperture with white light for routine examination If pupils are small, use smaller white light Ask person to please keep looking at mark on wall across room Staring at distant fixed object helps to dilate pupils and to hold ___ structures still Correct Answer: dilate retinal Inspect ocular fundus (cont.): -Begin about ___ cm (10 inches) away from person at angle of ___ degrees to person's line of vision -Note red glow filling person's pupil; this is ____, caused by reflection of ophthalmoscope light off inner retina -Keep sight of red reflex, and steadily move closer to eye -If you lose red reflex, adjust angle to find it again -As you advance, adjust lens to #6 and note any ___ in media; these appear as dark shadows or black dots interrupting ____; normally, none are present Correct Answer: 25, 15 red reflex opacities, red reflex Ocular Fundus continued: -Progress toward person until ____almost touch -Adjust diopter to bring ocular fundus into sharp focus; if you and person have normal vision, this should be at ___ -Moving ____ compensates for near- or farsightedness -Moving in on ___-degree lateral line should bring your view just to optic disc -If disc is not in sight, track a _____ as it grows larger and it will lead to disc Correct Answer: foreheads 0 diopters 15 blood vessel Systematically inspect structures in ocular fundus: 1. O____ 2. R______ 3. General background 4. M_____ Correct Answer: optic disc retinal vessels macula Eye examination often deferred at birth because of transient edema of lids from birth trauma or from the instillation of silver nitrate at birth; eyes should be examined within a few days and at every well child visit thereafter Correct Answer: ----- Infants and children: 1. Visual acuity -Child's age determines screening measures used In newborn, test ____ and ___ behaviors -Test light perception using _____; neonate blinks in response to bright light -Also, ____ reflex shows that pupils constrict in response to light -These reflexes indicate that the ___ portion of the visual apparatus is intact -But cannot infer that infant can see; that requires later observation to show that brain has received images and can interpret them Correct Answer: visual reflexes, attending blink reflex pupillary light lower Infants and children: Visual acuity As you introduce an object to infant's line of vision, note these attending behaviors: i. ___ to ___ weeks: refusal to reopen eyes after exposure to bright light; increasing alertness to object; infant may fixate on an object ii. By ___ to ___weeks: infant can fixate on an object iii. By ___ month: infant can fixate and follow light or bright toy iv. By __ to ___ months: infant can fixate, follow, and reach for toy v. By __ to ___ months: infant can fixate and follow toy in all directions Correct Answer: birth, 2 2-4 1 3-4 6-10 Infants and children: 1. Visual acuity (cont.) ___ test, picture cards, screens children from 2½ years to 2 years, 11 months, and is even reliable with cooperative toddlers as young as 2 Use picture chart or ____ chart for preschooler from age 3 to 6; normally a child achieves 20/20 acuity by age 6 to 7 2. Visual fields Assess peripheral vision with _____ test in children older than ___ years Correct Answer: Allen Snellen E confrontation, 3 Infants and children: 1. Color vision -Color blindness an inherited _____ trait affecting about 8% of white males and 4% of African American males; rare in females -Test only boys for color vision, once between ages of __ and __; use Ishihara test 2. Extraocular muscle function Testing for ___(squint, crossed eye) is important screening measure during early childhood Test ___ by corneal light reflex and cover test Check corneal light reflex Correct Answer: recessive-x linked 4-8 strabismus malalignment Infants and children (External eye structures): Inspect ocular structures as described in earlier section A ____ usually holds the eyes tightly shut. Do not attempt to pry them open; that just increases contraction of the orbicularis oculi muscle Correct Answer: neonate Aging adult: 1. Ocular structures Eyebrows may show loss of outer one third to one half of hair because of decrease in hair follicles; remaining brow hair is ___ As result of ____ of elastic tissues, skin around eyes may show wrinkles or crow's feet; upper lid may be so elongated as to rest on lashes, resulting in ____ Correct Answer: coarse atrophy, pseudoptosis Aging adult 1. Ocular structures (cont.) -Eyes may appear sunken from atrophy of orbital fat; orbital fat may ____, causing bulging at lower lids and inner third of upper lids -Lacrimal apparatus may ____ tear production, causing eyes to look dry and lusterless and person to report a burning sensation Correct Answer: herniate decrease Aging adult (Ocular structures): 1. Cornea may look ___ with age 2. ____ commonly seen around cornea: -Gray-white arc or circle around limbus due to deposition of lipid material -As more lipid accumulates, cornea may look thickened and raised, but arcus has no effect on vision 3. _____: soft, raised yellow plaques occurring on lids at inner canthus They commonly occur around fifth decade of life and more frequently in ____, occur with both high and normal levels of cholesterol, and have no pathologic significance Correct Answer: cloudy Arcus senilis Xanthelasma, women Aging adult 1. Ocular structures: Pupils small in old age; pupillary light reflex may be ____ Lens loses transparency and looks ____ 2. Ocular fundus: -Retinal structures generally have less shine; blood vessels look paler, narrower, and attenuated; arterioles appear paler and straighter, with a narrower light reflex -______, or benign degenerative hyaline deposits are normal development on retinal surface; Often symmetrically placed in eyes with no effect on vision Correct Answer: slowed opaque drusen ___ is rigid box that protects brain and is supported by cervical vertebra Correct Answer: skull facial expressions, formed facial muscles which are mediated by cranial nerve ____ , the facial nerve Correct Answer: VII an extensive vessel system, is major part of immune system, which detects and eliminates foreign substances from body Correct Answer: lymphatic system ____ allow flow of clear, watery fluid from tissue spaces into circulation Correct Answer: vessels ____ are small, oval clusters of lymphatic tissue that filter lymph and engulf pathogens, preventing potentially harmful substances from entering the circulation Correct Answer: nodes greatest supply of lymph nodes is in __ and ___ Correct Answer: head, neck Infants and children: -Bones of neonatal skull are separated by ____ and ____, spaces where the sutures intersect -Triangle-shaped posterior fontanel closes by __ to ___ months, and diamond-shaped anterior fontanel closes between ___ months and ___ years -During *fetal* period, ___ growth predominates; head size is greater than chest circumference at birth and reaches 90% of final size at ___ years old Correct Answer: sutures, fontanels 1-2 9-2 head, 6

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363 Final Exam| 808 questions| with complete solutions
sensory organs for hearing and maintaining equilibrium Correct Answer: ears

Ears three parts: Correct Answer: external, middle, inner

called the auricle or pinna Correct Answer: external ear

Characteristic shape serves to funnel sound waves into its opening, which is called the external
auditory canal Correct Answer: external ear

external ear consists of movable ___ and ____ Correct Answer: cartilage, skin

A cul-de-sac 2.5 to 3 cm long in adults that terminates at eardrum, or tympanic membrane
Correct Answer: auditory canal

a yellow waxy material that lubricates and protects ear; Forms sticky barrier to keep foreign
bodies from entering and reaching sensitive tympanic membrane Correct Answer: cerumen

___Lined with glands that secrete cerumen Correct Answer: auditory canal

separates the external and middle ear Correct Answer: tympanic membrane (eardrum)

External Ear:
-Translucent membrane with a ____ color
-Oval and slightly concave, pulled in at its center by one of middle ear ossicles, the _____
-Parts of malleus show through translucent drum Correct Answer: pearly gray
malleus

Tiny air-filled cavity inside temporal bone Correct Answer: Middle Ear

Middle ear contains tiny ear bones, ossicles: _____, ______, _____ Correct Answer: malleus,
incus, and stapes

Middle Ear:
-Opening to the outer ear is covered by the ____
-Openings to inner ear are _____ at the end of the stapes and the round window
-_______: opening that connects middle ear with nasopharynx and allows passage of air
-Normally closed, but opens with swallowing or yawning Correct Answer: TM
oval window
Eustachian tube

Middle Ear has three functions:
1. Conducts _____ from outer ear to central hearing apparatus in inner ear
2. Protects inner ear by _______ of loud sounds

,3. Eustachian tube allows ____ of air pressure on each side of TM so that it does not rupture
Correct Answer: sound vibrations
reducing amplitude
equalization

Contains the bony labyrinth, which holds sensory organs for equilibrium and hearing Correct
Answer: inner ear

Although the inner ear is not accessible to direct examination, its functions can be assessed
Correct Answer: ------

normal pathway of hearing is ____ and is most efficient Correct Answer: air conduction

alternate route of hearing is ____ Correct Answer: bone conduction

Bones of the skull vibrate and are transmitted directly to inner ear and to cranial nerve VIII
Correct Answer: bone conduction

Anything obstructing transmission of sound impairs hearing Correct Answer: hearing loss

_____ loss involves a mechanical dysfunction of external or middle ear Correct Answer:
conductive hearing

_____ Hearing loss:
1. Partial loss because person is able to hear if sound amplitude is increased enough to reach
normal nerve elements in inner ear
2. May be caused by impacted cerumen, foreign bodies, a perforated TM, pus or serum in middle
ear, and otosclerosis, which is a decrease in mobility of ossicles Correct Answer: Conductive

__________ (perceptive) hearing loss signifies pathology of inner ear, cranial nerve VIII, or
auditory areas of cerebral cortex Correct Answer: Sensorineural

____ Hearing loss:
1. Increase in amplitude may not enable person to understand words
2. May be caused by presbycusis or ototoxic drugs Correct Answer: Sensorineural

a gradual nerve degeneration that occurs with aging Correct Answer: presbycusis

affect hair cells in cochlea Correct Answer: ototxic drugs

____ hearing loss is combination of conductive and sensorineural types in same ear Correct
Answer: mixed

_____ in inner ear constantly feeds information to brain about body's position in space Correct
Answer: Labyrinth

,Labyrinth:
-Works like a plumb line to determine ___ or _____
-Ear's plumb lines register _____ of your head in relation to gravity
-If labyrinth ever becomes inflamed, it feeds wrong information to brain, creating a staggering
gait and a strong spinning, whirling sensation called ____ Correct Answer: verticality/depth
angle
vertigo

1. Inner ear starts to develop early in ____ week of gestation
2. In early development ear is _____ rotated and low set; later ascends to its normal placement
around eye level
3. If maternal _____ infection occurs during first trimester, it can damage organ of Corti and
impair hearing
4. Infant's eustachian tube is relatively shorter and wider and more horizontal than adult's, so it is
easier for pathogens from _____ to migrate through to middle ear Correct Answer: 5th
posteriorly
rubella
nasopharynx

Common cause of conductive hearing loss in young adults between ages of 20 and 40 years
Correct Answer: otosclerosis

Gradual hardening that causes foot plate of stapes to become fixed in oval window, impeding
transmission of sound and causing progressive deafness Correct Answer: otosclerosis

Aging adults:
-In aging persons, cilia lining ear canal become ___ and stiff
-May cause cerumen to accumulate and _____, which greatly reduces hearing
-Cerumen is drier with aging because of atrophy of _____
-Impacted cerumen is a common but reversible cause of hearing loss in older people Correct
Answer: coarse
oxidize
apocrine glands

Aging adults:
_____: type of hearing loss that occurs with aging, even in people living in quiet environment
-Gradual _____ loss caused by nerve degeneration in inner ear or auditory nerve
-Onset usually occurs in ____ and slowly progresses
-First notice a ____-frequency tone loss
-Ability to localize sound is impaired also
-Accentuated when unfavorable background noise is present
-Auditory reaction time increases after age ___; takes longer to process sensory input and to
respond to it Correct Answer: presbycusis
sensorineural
50s
high

, 70

Obstruction of eustachian tube or passage of nasopharyngeal secretions into middle ear Correct
Answer: Otitis media

Otitis media:
-One of most common illnesses in ____
-Incidence and severity increased in _____ children of North America, New Zealand, and
Northern Europe
-Most important cause is _____: children in high risk groups have multiple pathogens and total
bacterial load is high Correct Answer: children
indigenous
environmental

Otitis Media:
1. In the ____ position effects of gravity and sucking tend to draw nasopharyngeal contents
directly into middle ear
2. Urge parents to hold baby partly upright while feeding
3. Do not prop bottle or let baby take a bottle to bed
4. Encouraging _____ helps prevent this problem
5. Most important side effect of otitis media is persistence of fluid in ________ after treatment;
this middle ear effusion can impair hearing, placing child at risk for delayed cognitive
development Correct Answer: supine
breastfeeding
middle ear

Objective (Preparation):
-Position sitting up straight with head at ___ level
Occasionally ear canal partially filled with cerumen, which obstructs view of TM
If TM intact and no current infection present, a method of cleaning canal is to soften cerumen
with a warmed solution of mineral oil and ____
Then, canal irrigated with warm water with a bulb syringe or a low-pulsatile dental irrigator or
WaterPik
Direct fluid to _____; leave space around irrigator tip for water to escape
-Do not irrigate if history or examination suggests ____ or ___ Correct Answer: eye
hydrogen peroxide
posterior wall
perforation, infection

Ear Equipment needed:
_____ with bright light, fresh batteries give off white, not yellow light
______ attachment, sometimes used with infant or young child
Tuning forks in 512 and 1024 Hz Correct Answer: Otoscope
Pneumatic bulb

Inspect and palpate external ear:

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Geschreven in
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