HA MIDTERMS

• Normocephalic


  Normal size of the head
• Deviations from normal skull

  • Disproportionate
  • Asymmetric parietal and temporal prominences; with more prominent nose forehead; longer mandible
  • Increased head circumference
  • Square - head
  • Bulging / depressed bone
  • Abnormal increase in head size in young child: HYDROCEPHALUS
  • Inconsistently large head size in adolescent or adult: ACROMEGALY
• Cervical nodes


  • Occipital nodes
  • Post-auricular nodes
  • Pre-auricular nodes
  • Tonsillar nodes
  • Submandibular nodes
  • Submental nodes
  • Superficial cervical nodes
  • Posterior cervical nodes
  • Deep cervical nodes
  • Supraclavicular nodes
  • Infraclavicular nodes
• Normal findings for cervical nodes

  • Lymph nodes normally not palpable, especially the deep and clavicular nodes
  • If a node is palpable, normal characteristics include small, 1cm, mobile, soft, nontender, and usually superficial
• Palpating the thyroid


  • Anterior approach
  • Posterior approach
• Normal thyroid


  Generally nonpalpable. If some tissue is palpable, consistency is firm, smooth, and meaty, with no nodularity, enlargement or tenderness
• Deviations from normal thyroid

  • Enlarged thyroid
  • Nodular thyroid tissue
  • Tender thyroid
• Anatomy of the eye

  • Choroid
  • Vitreous humor
  • Cornea
  • Pupil
  • Lens
  • Retina
  • Sclera

  
• Visual acuity


  The ability to discern letters or numbers at a given distance
• Testing visual acuity


  • The Snellen chart
  • Jaeger test
  • Snellen E chart
  • Ishihara test
  • Allen card test
• Normal visual acuity

  • 20/20
  • 20/15
• Normal near vision acuity

  • 14/14

  
• Deviations from normal near vision acuity

  • A small fraction (eg. 14/18)
  • Myopia - nearsightedness
  • Hyperopia - farsightedness
  • Presbyopia - farsightedness due to aging
• Normal color vision


  • Correctly identifies embedded figures in the Ishihara cards or identifies colored bars on the Snellen eye chart

  
• Deviations from normal color vision

  • Inability to detect the embedded number or letter in the Ishihara chart: defect in color perception (color blindness)

  
• Normal Allen card test


  • The child should successfully identify three of the seven objects at a distance of 15 feet
• Deviations from normal Allen card test

  • Macular degeneration or diseases that affect the cones that mediate color vision
• Everting the upper eyelid


  1. Place a cotton-tipped applicator approximately 1cm above the eyelid margin and push down with the applicator while still holding the eyelashes

  2. Hold the eyelashes against the upper ridge of the bony orbit just below the eyebrow, to maintain the everted position of the eyelid

  3. Examine the palpebral conjunctiva for swelling, foreign bodies, or trauma

  4. Return the eyelid to normal by moving the lashes forward and asking the client to look up and blink
• Conjunctiva


  The membrane that lines the inner surface of the eyelids and covers the front of the eye
• Normal conjunctiva


  • Shiny, smooth, and pink or red
• Deviations from normal conjunctiva


  • Extremely pale
  • Extremely red
  • Nodules or other lesions
• Common abnormalities of the conjunctiva

  • Conjunctivitis (red palpebral and bulbar conjunctiva)
  • Anemia (pale pink conjunctiva)
  • Pterygium or pinguecula (growth or thickening of conjunctiva from inner canthal area toward iris)
  • Subconjunctival hemorrhage (eye injury)
  • Nevus (benign pigmented congenital discoloration)
  • Papilloma (benign growth)
• Lacrimal apparatus


  The structures involved in the production, distribution, and drainage of tears
• Normal lacrimal apparatus


  • No edema or tenderness or tearing
  • Puncta is visible without swelling or redness
• Deviations from normal lacrimal apparatus


  • Swelling of lacrimal gland visible in the lateral aspect of upper eyelid maybe due to blockage, infection or inflammatory condition
  • Redness / swelling around the puncta may indicate infectious or inflammatory condition
  • Excessive tearing may indicate a nasolacrimal sac obstruction
• Palpating the lacrimal apparatus


  1. Put on disposable gloves to palpate for the nasolacrimal duct to assess for blockage

  2. Use one finger and palpate just inside the lower orbital rim
• Normal palpation of lacrimal apparatus


  • No drainage should be noted for the puncta when palpating the nasolacrimal duct
• Deviations from normal palpation of lacrimal apparatus


  • Expressed drainage from the puncta on palpation on occurs with duct blockage
• Cornea


  The clear, curved front part of the eye

  
• Normal cornea


  • Transparent, shiny and smooth, details of iris are visible
  • In older people, arcus senilis may be evident
• Deviations from normal cornea


  • Opaque
  • Surface not smooth
  • Arcus senilis under age 40 (a normal condition in older clients, appears as a white arc around the limbus and has no effect on vision)
• Corneal light reflect test


  Shine light directly in patient's eyes; note position of the light reflection off the cornea in each eye
• Normal corneal light reflex


  • Light should be seen symmetrically on each cornea
• Deviations from normal corneal light reflex


  • Asymmetrical corneal light reflex
  • Weak extraocular muscles or strabismus, congenital exotropia
• Examining the cornea and lens


  1. Shine a light on the cornea from an oblique angle

  2. Note clarity and abrasions
• Corneal reflex test


  1. Take a wisp of rolled cotton and gently touch the cornea

  2. Take a needleless syringe filled with air and shoot a puff of air over the cornea

  3. Note for blinking and tearing
• Blink reflex test


  Brush your index finger across patient's eyelashes and note blinking
• Normal corneal and lens findings


  • Corneal reflex positive
  • Cornea and lens clear, smooth, and glistening
  • White ring encircling outer rim (arcus senilis) is a normal variant in older adults
• Corneal abnormalities

  • Cloudy cornea (vit A deficiency; infection which may be accompanied by hypopyon)
  • Corneal abrasions and ulcers (roughness and irregularities of cornea)
  • Kayser-Fleischer ring (yellow ring in outer margin, Wilson's disease, increased copper absorption)
  • Corneal scar (appears grayish white, usually due to an old injury or inflammation)
  • Early pterygium (thickening of the bulbar conjunctiva that extends across the nasal side)
  • Negative corneal reflex (indicates neurological problem, CN V and VII, may also be absent or diminished in people who wear contact lenses)
• Lens abnormalities

  Cataracts (lens opacities)