HA EXAM 2
1. Skin, Hair, and Nails (10 questions)
a. Function
i. Protection
ii. Prevents penetration (invasion of microorganisms, loss of water
and electrolytes)
iii. Perception (sensory surface- touch, pain, temp, and pressure)
iv. Temperature regulation
v. Identification (how someone identifies you)
vi. Communication (nonverbal)
vii. Wound repair
viii. Absorption and excretion
ix. Production of vitamin D
b. EPIDERMIS
i. Thin but tough
ii. Forms a protective barrier
iii. Avascular
 Nourished by the dermis
iv. Inner layer (basal cell layer)
 Forms new skin cells
 Contains the protein keratin
 Contains melanocytes that produce melanin
o Everyone has the same number of melanocytes but
may produce different amounts of melanin
v. Horny cell layer
 Dead keratin cells
o Constantly replaced and shed
o Completely replaced EVERY 4 weeks
c. DERMIS
i. Supportive layer
ii. Mostly made up of collagen (connective tissue)
 Resists tearing
iii. Nerves, sensory receptors, blood vessels, and lymphatics
iv. Hair follicles, sebaceous glands, and sweat glands
d. SUBCUTANEOUS LAYER (adipose tissue)
i. Stores fat for energy
ii. Provides insulation
iii. Aids in protection
e. HAIR
i. Hair growth is cyclical with resting and active phases
 Each follicle functions independently
ii. Arrector pili muscle
 Contracts and elevates the hair (goose bumps)
iii. Types of hair
 Vellus hair
o Fine and faint
f.
g.
h.
i.
j.
o Covers most of the body
 Terminal hair
o Dark and thick
o Scalp, eyebrows, armpits, and pubic area
i. Face and chest for males
SEBACEOUS GLANDS
i. Produce and secrete a protective lipid substance sebum
 Combine with water and stop water loss from the skin
ii. They are everywhere
 Mostly on scalp, forehead, face, and chin
SWEAT GLANDS
i. Eccrine
 Open directly on the skin surface
 Produce dilute saline (SWEAT)
o Reduces body temp
ii. Apocrine
 Produce a thick milky substance
 Open into hair follicles (active after puberty)
o Arm pit, genitals, nipples, and naval
NAILS
i. Hard plates of keratin
ADULT
i. Skin
 Loses elasticity
 Dry and wrinkled
 Thins and flattens
o Allows chemicals easier access into the body
 Loss of collagen, fat, and muscle tone
o Loss of collagen increases risk for tears
ii. Glands
 Decrease and leave skin dry
 Decreased sweat glands = decreased thermoregulatory
iii. Greater risk for skin disease and breakdown
iv. Wound healing is delayed
v. Number of functioning melanocytes decrease (decreased color)
vi. Nails grow slower
Normal Range of Findings
i. Color Change
 Reliable Sites are sites with least pigmentation
o Under the tongue
o Buccal mucosa
o Conjunctiva
o Sclera
 Types of color change
o Pallor- pale (loss of oxygenated hemoglobin)
o Erythema- red (increased blood flow)
o Cyanosis-blue (high levels of deoxygenated blood)
o Jaundice- yellow (increased bilirubin)
i. First found in hard and soft palate
ii. Physiologic jaundice = newborns
ii. Temperature (check with the dorsa of your hand)
 Hypothermia- coolness
 Hyperthermia- hotness (fever)
iii. Moisture
 Diaphoresis- profuse perspiration
 Dehydration
iv. Edema- Swelling
 if pressure leaves a dent in the skin edema is present
o 1+ - mild pitting (edema), slight indentation
o 2+ - moderate pitting, indentation leaves rapidly
o 3+ - deep pitting, indentation remains for a short time
o 4+ - Very deep pitting, indentation lasts a long time
v. Mobility and turgor (CHECK ON CLAVICLE)
vi. Nails
 The base should have a 160-degree angle
o Flat base = clubbing
 Capillary refill – 1-2 seconds
o Status of circulation
vii. Skin Cancer
 A – asymmetry
 B – Border
 C – Color
 D – Diameter
 E – Elevation
2. Head, Face, and Neck (10 Question)
a. HEAD
i. Cranial Bones
 Frontal
 Parietal
 Occipital
 Temporal
ii. Normocephalic = round, symmetric skull that is appropriate to body
size (palpate the scalp)
b. FACE (14 bones)
i. Expressions are mediated by CN VII – facial nerve
ii. Sensations (pain/touch) are mediated by CN V- trigeminal nerve
iii. Facial structures are symmetric
c. NECK
i. Muscles
 Sternomastoid – accomplishes head rotation and flexion
 Trapezius- moves the shoulders and extends/turns head
*Check CN XI and muscles by resisting the person’s movement
ii. Thyroid- endocrine gland with lots of blood (looks like a butterfly)
 Synthesizes and excretes T4 and T3
o Stimulate the rate of cellular metabolism
 Thyroid cartilage is the Adams apple
iii. Make sure trachea is centered in the midline of the neck
iv. Check for ROM
v. Check for pulsations
 Normal if you feel carotid
 Abnormal if you feel/see jugular
d. LYMPHATICS
i. Head and neck have 60-70 lymph nodes
ii. The lymph node labels correspond to adjacent structure
iii. Major part of the immune system
 Nodes slowly filter he lymph and engulf pathogens
 Prevent harmful substances from entering circulation
iv. Accessible to examine
 Head and neck
 Arms
 Armpit
 Inguinal region (groin)
e. AGING ADULT
i. The facial bones and orbits are more prominent
ii. Skin sags
 Decreased elasticity
 Decreased fat
 Decreased moisture
3. Eyes (8 Questions)
a. EXTERNAL
i. Eyelids (protect from injury, light, and dust).
ii. Eyelashes (filter out dust and dirt)
iii. Conjunctiva (transparent protective covering)
iv. Lacrimal apparatus (provides constant irrigation)
 Lacrimal gland – secretes tears
b. INTERNAL
i. Sclera- white covering (back)
 Cornea (front of eye)
ii. Choroid
 Prevents light from reflecting internally
 Heavily vascularized
 Pupil – CN III (causes constriction/dilation)
o Pupillary light reflex
i. (sensory afferent linked to CN II- optic nerve;
motor efferent linked to CN III- oculomotor
nerve)
1. Darken the room (dilates pupils)
2. Advance a light from the side
a. Direct light reflex (constriction of
the same sided pupil)
b. Consensual light reflex
(simultaneous constriction of the
other pupil)
ii. Fixationiii. Accommodation
1. Ask to focus on a distant object (dilates
the pupils)
2. Have them shift gaze to a near object
(your finger) from the person’s nose
3. Normal response is pupillary constriction
and convergence of the axes of eyes
iv. PERRLA
1. Pupils equal
2. Round
3. React to light
4. Accommodation
 Lens – refracting medium
o Thickness is controlled by the ciliary body
o Lens bulges to focus on near objects
o Lens flattens for far objects
iii. Retina – visual receptive layer
 Light waves are changed into nerve impulses
 The image formed is upside down and reversed from its
actual appearance
 Right side of the brain looks at the left side of the world/ left
side of the brain looks at the right side of the world
 Fovea centralis- area pf the sharpest/keenest vision
c. AGING ADULT
i. Lacrimal gland involute- decreased tear production
ii. Pupil size decreases
iii. Lens loses elasticity
 Decreases the ability of the lens to change shape and
accommodate for near vision (presbyopia)
iv. Transparent fibers begin to thicken and yellow (cataract)
v. Decreased adaptation to darkness
vi. Decreased visual functioning
 Cataract = #1
o Clouding of lens from a clumping of proteins
 Glaucoma
o Optic nerve neuropathy (weakness, numbness and
pain from nerve damage)
i. Loss of peripheral vision
o Caused by increased intraocular pressure
 Age-related macular degeneration
o A loss of central vision caused by yellow deposits and
neovascularity in the macula (darker pigmented region
surrounding fovea)
o Peripheral vision is not affected
 Diabetic retinopathy – leading cause of blindness
d. Normal Range of Finding
i. Test
 Snellen Eye Chart
o Most common and accurate
o It is lines of letter arranged in decreasing size
i. Position the person 20 feet away from chart
ii. Use opaque card to shield one eye at a time
iii. If person wears glasses/contacts keep them on
iv. Have person read the smallest line possible
 Near Vision
o Handheld vision screener
o Hold 14 inches from the eye
o Test each eye without glasses/contacts
 Confrontation
o Test for loss of peripheral vision
o Position yourself 2 feet away
o Have patient cover one eye and you cover the
opposite
o Hold finger and advance is from the periphery in
several directions having the patient say now once
they see the finger
 Corneal Light Reflex
o Assess the parallel alignment of the eye axes by
shining a light toward the person’s eye
o Have patient stare straight ahead and hold light 12
inches away
 Diagnostic Positions Test
o Look for any muscle weakness by leading the eyes
through 6 positions
o Have patient keep head steady and only move the
eyes following your finger (12 inches away)
o Progress clockwise
o LOOK FOR NYSTAGMUS (oscillating movement)
o Muscles:
i. Lateral rectus muscle is innervated by the
abducens nerve (CN VI) – abducts eye
ii. Superior oblique is innervated by the trochlear
nerve (CN IV)
iii. Superior, Inferior, Medial rectus, and the
inferior oblique muscles are innervated by the
oculomotor nerve (CN III)
4. Ears (8 Questions)
a. Adult
i. Ostosclerosis is the bone formation that causes foot of the stapes
to become fixed in the oval window
b. Aging adult
i. Cilia lining becomes coarse and stiff
 Causes cerumen to accumulate which reduces hearing
ii. Pendulous earlobes with linear wrinkling because of loss of
elasticity
iii. Eardrum may be whiter
iv. Cerumen is drier
v. Presbycusis is a sensorineural loss caused by nerve degeneration
 High-tone frequency loss
c. Normal range of finding
i. Equal in size bilaterally with no swelling or thickening
ii. Skin color is consistent with facial color
iii. Darwin’s tubercle- small painless nodule at the pinna
iv. Pull pinna up and back for adults when looking inside
v. Test hearing acuity
 Audiometer- precise quantitative measure of hearing by
assessing the ability to hear sounds of varying frequency
o Tell patient to raise hand or finger when they hear the
tone and lower hand or finger when it goes away
 Whispered test (CN 8 – acoustic)
o Stand arm’s length or 2 ft behind person
o Have patient cover the ear opposite from where you
are standing, whisper a two-syllabus word, have them
repeat the word
o Repeat on other ear
 Tuning fork tests- measures hearing by air conduction or
bone conduction
5. Nose, Mouth, and Throat (14 Questions)
a. Nose (1st segment of the respiratory system)
i. Warms, moistens, and filters air
ii. Sensory organ for smell (olfactory CN 1)
iii. Olfactory receptors (hair cells) lie at roof of nasal cavity and upper
part of septum
iv. Paranasal Sinuses
 Frontal
 Maxillary
 Ethmoid
 Sphenoid
v. Normal finding
 Symmetric and patent nares
 Red, smooth, moist mucosa
 Look for deviated septum/perforation/polyps
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b. Mouth (1 segment of the digestive system & airway for respiratory)
i. 32 permanent teeth
ii. Normal finding
 Inspect lips (color, moisture, lesion)
 Teeth should be white, straight, evenly spaced, and clean
 Note alignment of upper and lower jaw
 Tongue is pink and moist
o Has papillae
o Make sure CN 12 is intact
 The uvula is in the midline
o Check CN 10 or vagus nerve by having patient say
AHH
c. Throat
i. Normal Finding
 Observe tonsils
o 1+ visible
o 2+ halfway to uvula
o 3+ touching uvula
o 4+ touching one another
 Swallowing test CN 9 glossopharyngeal
d. Aging Adult
i. Nose
 Loss of subcutaneous fat = more prominent nose
 Nasal hairs are coarser and stiffer and do not filter air as well
 Sense of smell diminishes because of a decrease in # of
olfactory nerve fibers
ii. Mouth
 Mouth and lips fold in
 Soft tissues atrophy in oral cavity
o Tongue thins = loss of taste buds- 80% reduction in
taste functioning
 Decrease in salivary secretion
 Increased risk for infection (candidiasis-thrush)
 Increased risk for lesions
 Teeth
o Gum recedes
o Slightly yellow from worn enamel
o Tooth loss from osteoporosis
i. Malocclusion- drifting of teeth
 Diminished sense of taste which could lead to malnutrition