Vital Signs
Normal Temperature Values:
1. Oral
2. Axilla
3. Rectal & Tympanic
4. Range
1. Oral: 98.6°F
2. Axilla: 97.6°F
3. Rectal & Tympanic: 99.6°F
4. Range: 96-99.5°F or 35-37.5°C
Patient seated
Instruct patient to rotate head maximally from side to side
Done slowly (at first) then accelerated to patient tolerance
What is Barre-Lieou?
1. Normal vision
2. Nearsighted
3. Farsighted
4. Loss of lens elasticity from aging
1. Emmetropia
2. Myopia
3. Hyperopia
4. Presbyopia
1. Bilaterally small & irregular pupils that accommodate but do not react to light.
Seen with Syphilis (Prostitutes Pupil).
2. Dilated pupil with ptosis and lateral deviation. Doesn't react to light or accommodation.
Seen w/ Multiple Sclerosis
3. Fixed and constricted pupils that react to light and accommodate.
Seen w/ severe brain damage, pilocarpine medications, & narcotic use
1. Argyll Robertson
2. Internal Ophthalmoplegia
3. Miosis
1. Inflammation of the iris
**Bonus: seen in what kind of patients?**
2. Inflammation of the eye seen w/ seborrhea, staph infection, & inflammatory processes
1. Iritis
Seen in PTs with Ankylosing Spondylitis
2. Blepharitis
Normal Respiratory Rate Values:
1. Adult
2. Newborn
1. Adult: 14-18
2. Newborn: 44
Patient seated
Arms are extended forward to shoulder level; hands supinated --> position is maintained for few seconds
Patient then closes eyes, rotates & hyperextends the neck to one side (vice versa)
What is Hautant's?
1. Lid is turned inward & seen in elderly
2. Lid is turned outward & seen in elderly
3. Lid lag/failure to cover the eyeball seen with graves (bilateral) or tumor (unilateral)
1. Entropion
2. Ectropion
3. Exophthalmosis
Definition of Adie's Pupil & Arroyo Sign
1. Adie's Pupil: sluggish pupillary reaction to light that is unilateral; caused by parasympathetic lesion of CN III
2. Arroyo Sign: sluggish pupillary reaction due to hypoadrenalism (Addison's Disease)
Affects the veins more than arteries & presents w/ microaneurysms, hard exudates, & neovascularization
Diabetic Retinopathy
Normal Pulse Values:
1. Adults
2. Elderly
3. Newborn
1. Adults: 60-100
2. Elderly: 70-80
3. Newborn: 120-160
Patient supine
Instruct patient to rotate & extend the head off the table --> turn to each side for 15-45 seconds
Doc can lend minimal support
What is DeKleyn's?
Compare pterygium & pinquecula
Pterygium: Triangular thickening of the bulbar conjuctiva that grows across the cornea; brought on by dry eyes
Pinquecula: Yellowish triangular nodule in the bulbar conjuctiva that is harmless & indicates aging
Definition of Hordoleum (sty) & Chalazion
1. Hordoleum (sty): infection of the sebaceous glands --> pimple/boil on eyelid
2. Chalazion: infection of the Meibomian gland --> nodule which points INSIDE the lid
Horner's Syndrome
Ptosis, miosis, and anhydrosis on the same site as an interruption to the cervical sympathetics
Blood Pressure:
1. Normal value
2. Hypertension
3. Hypotension
1. 120/80 or 90/60 (values increase in elderly)
2. >140/90
3. <90/60
Patient stands (eyes open, arms at side, feet close together)
PT then closes eyes, extends arms, supinates hands ---> PT extends & rotates head to one side
In this position, PT is instructed to march in place
What is Underberg?
What is:
1. Definition of Corneal Arcus & Xanthelasma
2. Similarity to one another
1. Corneal Arcus: grayish opaque ring around the cornea
Xanthelasma: fatty plaques on the nasal surface of the eyelids that is normal
2. If seen in people under <50 yo = hypercholesterolemia
>50 yo = normal
Dilated & fixed pupils seen w/ anticholinergic drugs (atropine/mushrooms/death)
Mydriasis
Damage to the retinal vessels/background will show these signs:
1. Copper wire deformity
2. Silver wire deformity
3. A-V nicking
4. Flame & splinter hemorrhages
Damage to the retinal vessels/background will show these signs:
1. Copper wire deformity
2. Silver wire deformity
3. A-V nicking
4. Flame & splinter hemorrhages
5. Cotton wool soft exudates
What are Korotkoff Sounds and what can a difference of 10-15 mm Hg reading indicate?
Korotkoff Sounds: low pitched sounds produced by turbulent blood flow in arteries
A difference of 10-15 mm Hg in systolic readings can indicate arterial occlusion such as subclavian steal syndrome on the side of the decreased value
Enhanced DeKleyn's
Patient supine, head extended off the table
Examiner offers support for the skull
Examiner brings head into extension, rotation, and lateral flexion
What is Hallpike?
Colors of Sclera and Conjuctiva and what the colors indicate
1. Sclera: White (normal), Yellow (Jaundice ddx from Beta Carotenemia), Blue (Osteogenesis Imperfecta)
2. Conjuctiva: Pink (normal), Pale (anemia), Bright red (infection)
Retinal Detachment vs. Macular Degeneration
Retinal Detachment: painless sudden onset of blindness as curtains closing over vision; lightning flashes & floaters
Macular Degeneration: most common in elderly; central vision lost
Macular Drusen is an early sign of macular degeneration (yellow deposits under the retina)
Glaucoma vs Papilledema (aka Choked Disc)
Glaucoma: Increased intraocular pressure causing cupping of the optic disc (cup:disc ratio = >1:2)
PT will see blurring of their peripheral vision & rings around lights
Crescent sign will be present upon tangential lighting of the cornea
Papilledema: swelling of the optic disc due to increased intercranial pressure
NO visual loss (visual loss w/ optic neuritis)
May be seen w/ brain tumor/brain hemorrhage