ASSESSING THE THORAX and LUNGS • The Respiratory Cycle

Anatomy and Physiology • Inspiration: the diaphragm descends and accessory muscles
• Chest and Lungs swing ribs up & out to increase chest volume. The visceral
 The chest and lungs allow for respiration. pleura of the lung is “stuck” to the parietal pleura by surface
 Purpose of respiration is to keep the body adequately supplied tension and so expends with the thorax. This creates a negative
with pressure in the airways, so air flows passively into the alveoli.
and protected from excess accumulation of carbon dioxide.
• Respiration involves: • Expiration: as the lung was expanding, its elastic tissue was
a) Movement of air back and forth from the alveoli to the stretched. When the diaphragm relaxes, the lung tissue recoils,
outside environment. and the alveoli collapse some which raises the airway pressure
b) Gas exchange across the alveolar-pulmonary capillary above atmospheric, so air flows out of the lung.
membranes.
c) Circulatory system transport of oxygen to, and carbon • Primary muscles of respiration
dioxide from, the peripheral tissues. o Interior intercostal muscles
• Chest ▪ Decrease the transverse chest diameter during
 Chest or thorax, a cage of bone, cartilage, and muscle expiration.
o Sternum o Sternocleidomastoid and trapezius accessory muscles
o Manubrium ▪ Brought into play when there are pulmonary
o Xiphoid process problems and compromise.
o Twelve pairs of ribs connected to the thoracic vertebrae and o The trachea is formed by 16 to 20 stacked, C-shaped pieces
to the sternum by the costal cartilages. of hyaline cartilage that are connected by dense connective
 Primary muscles of respiration tissue.
o Diaphragm o The trachealis muscle and elastic connective tissue together
 Primary muscle form the fibroelastic membrane, a flexible membrane that
 Contracts during inspiration closes the posterior surface of the trachea, connecting the
 External intercostal muscles o Increase the anteroposterior chest C-shaped cartilages.
diameter during o The trachea branches into the right and left primary
inspiration. bronchi at the carina. These bronchi are also lined by
pseudostratified ciliated columnar epithelium containing
 Muscles of Respiration
o The diaphragm is the principle muscle of respiration. mucus-producing goblet cells.
o A bronchial tree (or respiratory tree) is the collective term
o However, the scalene & intercostal muscles assist the
diaphragm...their contraction creates a taller & wider used for these multiple- branched bronchi. The main
thorax. function of the bronchi, like other conducting zone
o The lung exhales passively due to relaxation of the structures, is to provide a passageway for air to move into
diaphragm & intrinsic elastic recoil. and out of each lung.
o A bronchiole branches from the tertiary bronchi.
Bronchioles, which are about 1 mm in diameter, further
 branch until they become the tiny terminal bronchioles, • Compliance is the ability of lungs and pleural cavity to expand and
which lead to the structures of gas exchange. contract based on changes in pressure.
• Lung compliance is defined as the volume change per unit of
• Respiration Overview: pressure change across the lung, and is an important indicator of
o Involves the lungs taking in oxygen and expelling carbon lung health and function
dioxide during breathing.
• Organs Involved: • Normal Breathing:
o Lungs are the primary organs responsible for respiration. o Rate: 12-20 breaths/min
• Gas Exchange Process: o Pattern: Regular
o Lungs and respiratory system facilitate the exchange of • Tachypnea:
oxygen and carbon dioxide. o Rate: More than 20 breaths/min
• Air Pathway: o Pattern: Shallow
o Air, comprising oxygen and other gases, is inhaled through o Causes: Fever, anxiety, exercise, respiratory insufficiency,
the throat. alkalosis, pneumonia, pleurisy.
o Trachea (windpipe) filters the air, branching into bronchi
that lead to the lungs. • Bradypnea:
• Oxygen Transportation: o Rate: Less than 10 breaths/min
o Oxygen from the inhaled air is absorbed into the o Pattern: Regular
bloodstream, transported to body tissues. o Causes: Well-conditioned athletes, medication-induced
• Carbon Dioxide Removal: depression of respiratory center, diabetic coma, neurologic
o Carbon dioxide, collected by red blood cells from body cells, damage.
is transported back to the lungs. • Hyperventilation
• Alveoli Exchange: o Rate: Increased
o Exchange of oxygen and carbon dioxide occurs in the alveoli, o Depth: Increased
small lung structures. o Causes: Extreme exercise, fear, anxiety, disorders of the
• Diaphragm Function: central nervous system, salicylate overdose, severe anxiety.
o Dome-shaped muscle below the lungs, controlling • Kussmaul Respiration
breathing. o Description: Rapid, deep, labored
o Flattens during inhalation to draw air into the lungs and o Associated with: Diabetic ketoacidosis.
expands during exhalation to expel air. • Hypoventilation:
• Breathing Rate: o Rate: Decreased
o Adults typically breathe at a rate of 12 to 20 breaths per o Depth: Decreased
minute. o Pattern: Irregular
o Associated with: Overdose of narcotics or anesthetics.
• Lung Compliance:
• Cheyne-Stokes Respiration:
• refers to the magnitude of change in lung volume as a result of the
change in pulmonary pressure.
 o Pattern: Regular with alternating periods of deep, rapid ▪ Description: Low-pitched, low-intensity sounds over
breathing followed by periods of apnea. healthy lung tissue.
o Associated with: Severe congestive heart failure, drug ▪ Bronchovesicular:
overdose, increased intracranial pressure, renal failure. ▪ Location: Major bronchi.
• Biot’s Respiration: ▪ Characteristics: Moderate pitch and intensity.
o Pattern: Irregular with varying depth and rate followed by o Bronchial:
periods of apnea. ▪ Characteristics: Highest pitch and intensity; typically
o Associated with: Meningitis, severe brain damage. heard only over the trachea.
• Ataxic Respiration: o Amphoric:
o Description: Significant disorganization with irregular and ▪ Description: Resembles blowing across a bottle
varying depths of respiration. mouth.
o Indicates: Respiratory compromise. ▪ Common Causes: Large pulmonary cavity, tension
• Air Trapping: pneumothorax with bronchopleural fistula.
o Description: Increasing difficulty in expelling breath, seen in o Cavernous:
chronic obstructive pulmonary disease (COPD) due to air ▪ Description: Sounds like coming from a cavern.
trapping during forced expiration. ▪ Common Causes: Pulmonary cavity with rigid wall.
o Crackles (Rales):
Diaphragmatic excursion is the movement of the thoracic diaphragm d u r i ▪ Types: Fine (high-pitched, short) and Coarse (low-
n g breathing. Normal diaphragmatic excursion should be 3–5 cm, but can pitched, longer).
be increased in well-conditioned persons to 7–8 cm. This measures the o Rhonchi (Sonorous Wheezes):
contraction of the diaphragm. It is performed by asking the patient to exhale ▪ Description: Deeper, rumbling, pronounced during
and hold it. expiration.
▪ Causes: Airway obstruction by secretions, spasm,
growth, or pressure.
o Wheezes (Sibilant Wheeze):
▪ Description: Continuous, high-pitched, musical
sound.
▪ Causes: High-velocity airflow through narrowed or
obstructed airway.
o Friction Rub:
▪ Description: Dry, crackly, grating; heard in both
expiration and inspiration.
▪ Cause: Inflamed, roughened surfaces rubbing
together.
o Mediastinal Crunch (Hamman Sign):
• Breath Sounds:
o Vesicular:
 ▪ Description: Sounds synchronous with heartbeat, o Located in the mediastinum, left of midline, above
not particularly with respiration; found with diaphragm, between medial/lower lung borders, behind
mediastinal emphysema. sternum, 3rd to 6th intercostal cartilage.
o Bronchophony: • Pericardium:
▪ Description: Greater clarity, increased loudness of o Fibrous sac enclosing heart, filled with fluid for low friction.
spoken sounds. • Chambers and Valves:
o Pectoriloquy: o Four chambers: atria and ventricles.
▪ Description: Extreme bronchophony; even whispers o Valves prevent backflow of blood, unidirectional flow.
are clearly heard. • Cardiac Cycle:
o Egophony: o Two phases: Systole (contraction) and Diastole (relaxation).
▪ Description: Increased intensity with nasal quality; • Extra Heart Sounds:
changes in vowel sounds. o Third (S3) and Fourth (S4) heart sounds, murmurs.
▪ Significance: Diminished resonance indicates tissue • Characteristics of Sound:
loss, e.g., in emphysema. o Frequency, intensity, duration, timing.
• Electrical Activity:
o Intrinsic conduction system: SA node, AV node, Bundle of
His, Purkinje fibers.
• Conduction:
o Electrical impulse travels across atria to AV node, then to
ventricles, stimulating contraction.
• Developmental Competence: Aging Adult:
o Changes in cardiovascular system influenced by lifestyle,
habits, diseases.
o Increase in systolic blood pressure, pulse pressure;
nochange in resting heart rate; decreased ability to augment
cardiac output with exercise.
o Incidence of coronary artery disease, hypertension, heart
failure increases with age.
ASSESSING THE HEART and CENTRAL VESSELS o Importance of lifestyle habits and physical activity in
reducing risk of cardiovascular diseases.
Structure and Functions of the Heart
Abnormal Findings - Arterial Pulse and Pressure Waves

• Heart Function:
o Circulating blood through body and lungs. • Double Systolic Peak:
• Heart Position: o Characteristics: Regular rhythm.
 o Causes: Pure aortic regurgitation, combined aortic stenosis Abnormal Findings - Extra Heart Sounds
and regurgitation, hypertrophic cardiomyopathy, left
• Aortic Ejection Click:
ventricular failure.
o Characteristics: Heard during early systole at second right
• Bisferiens Pulse:
intercostal space and apex.
o Characteristics: Regular, irregular rhythm.
o Associated with: Opening of aortic valve; usually associated
o Causes: Pericardial tamponade, constrictive pericarditis,
with MI, CHF.
obstructive lung disease.
• S2 (Ventricular Gallop):
• Pulsus Alternans:
o Characteristics: Low-frequency sound heard best using the
o Characteristics: Changes in amplitude from beat to beat.
bell of stethoscope at apical area or lower ventricular area
o Causes: Left ventricular failure.
with patient in left lateral position.
• Bigeminal Pulse:
o Associated with: MI, CHF.
o Characteristics: Alternates in amplitude.
• S4 (Atrial Gallop):
o Causes: Obstructive lung disease.
o Characteristics: Low-frequency sound occurring at end of
• Paradoxical Pulse:
diastole when atria contract.
o Characteristics: Palpable decrease in pulse amplitude;
o Associated with: MI, CHF, patent ductus arteriosus.
becomes stronger with expiration.
• Patent Ductus Arteriosus:
o Causes: Obstructive lung disease.
o Characteristics: Found over second left intercostal space,
may radiate to left clavicle.
Abnormal Findings - Cardiac Lift and Thrill o Associated with: Congenital anomaly leaving open channel
between aorta and pulmonary artery.
• Pericardial Friction Rub:
• Lift (Heave):
o Characteristics: Heard best in third intercostal space to left
o Characteristics: Diffuse lifting left during systole at lower
of sternum, scratchy, scraping sound.
sternal border.
o Associated with: Inflammation of pericardial sac; increases
o Associated with: Right ventricular hypertrophy due to
with exhalation and when patient leans forward.
pulmonic valve disease.
• Thrill:
o Characteristics: Palpated over second and third intercostal
ASSESSING THE ABDOMEN
space.
o Associated with: Severe aortic stenosis and systemic
• Right Upper Quadrant (RUQ):
hypertension (second and third intercostal spaces),
o Liver
pulmonic stenosis and pulmonic hypertension (second and
o Gallbladder
third intercostal spaces).
o Duodenum
o Head of pancreas
o Right kidney and adrenal gland
o Hepatic flexure of colon
 o Part of ascending and transverse colon Abdominal Distention
• Right Lower Quadrant (RLQ):
• Feces:
o Cecum
o Appearance: Hard stools in colon causing localized
o Appendix
distention.
o Right ovary and tube
o Percussion: Dullness.
o Right ureter
• Flatus:
o Right spermatic cord
o Appearance: Gas distention may be generalized or localized.
• Left Upper Quadrant (LUQ):
o Percussion: Tympany.
o Stomach
• Fat:
o Spleen
o Appearance: Obesity resulting in a uniformly protuberant
o Left lobe of liver
abdomen.
o Body of pancreas
o Abdominal Wall: Thick.
o Left kidney and adrenal gland
o Percussion: Tympany.
o Splenic flexure of colon
o Umbilicus: Usually sunken.
o Part of transverse and descending colon
• Left Lower Quadrant (LLQ): Abdominal Bulges
o Part of descending colon
o Sigmoid colon • Umbilical Hernia:
o Left ovary and tube o Bowel protrudes through umbilical ring weakness.
o Left ureter o Common in infants and adults.
o Left spermatic cord • Diastasis Recti:
• The Peritoneum o Bowel protrudes through separation of rectus abdominis
o A serous membrane, lines the cavity and forms a protective muscles.
cover for many of the abdominal structures. o Appears as midline ridge, significant only when client raises
• The Mesentery head or coughs.
o A serous membrane, lines the cavity and forms a protective • Epigastric Hernia:
cover for many of the abdominal structures. o Bowel protrudes through weakness in linea alba.
• The Alimentary Tract o Midline bulge between xiphoid process and umbilicus.
o A serous membrane, lines the cavity and forms a protective • Incisional Hernia:
cover for many of the abdominal structures. o Bowel protrudes through defect or weakness from surgical
o Functions: incision.
• Ingest and digest food o Bulge near surgical scar.
• Absorb nutrients, electrolytes, and water Enlarged Abdominal Organ and Other Abnormalities
• Excrete wastes
• Enlarged Liver:
o Definition: Span >12cm (MCL), >8cm (MSL).
o Causes: Congestive heart failure, acute hepatitis, abscess.
 • Enlarged Kidney: External Breast Anatomy
o Causes: Cyst, tumor, hydronephrosis.
• Nipple: Center of the breast, containing openings of lactiferous ducts for
o Differentiation: Smooth edge, absence of notch, tympany on
milk passage.
percussion.
• Areola: Surrounds the nipple, contains elevated sebaceous glands
• Enlarged Nodular Liver:
(Montgomery glands), and has smooth muscle fibers causing nipple
o Appearance: Firm, hard, nodular liver suggesting cancer, late
erection during stimulation.
cirrhosis, syphilis.
• Hair Follicles: Commonly found around the areola.
• Enlarged Spleen:
• Pigmentation: Nipple and areola typically darker than surrounding
o Definition: Area of dullness exceeding 7 cm.
breast tissue, varying from dark pink to dark brown depending on skin
o Progression: Downward and inward toward midline when
color.
enlarged.
• Enlarged Gallbladder:
o Appearance: Extremely tender, enlarged gallbladder Internal Breast Anatomy
suggesting acute cholecystitis.
• Glandular Tissue: Functional part for milk production, arranged in lobes
o Sign: Murphy’s sign (sharp pain causing client to hold
with lobules containing secreting alveoli.
breath).
• Mammary Ducts: Converge into lactiferous ducts leading to nipples;
• Aortic Aneurysm:
slight enlargements termed lactiferous sinuses or ampullae store milk
o Appearance: Prominent laterally pulsating mass above
until release.
umbilicus.
• Fibrous Tissue: Provides support, mainly via Cooper's ligaments running
o Accompaniments: Bruit, wide bounding pulse.
from skin through breast to chest wall.
• Fatty Tissue: Embeds glandular tissue, determining breast size and
ASSESSING THE BREAST and AXILLAE shape.

Anatomy and Physiology - Structure and Function of the Breasts

• The breasts are paired mammary glands situated over the anterior chest Lymph Nodes
wall, anterior to the pectoralis major and serratus anterior muscles.
• Major axillary lymph nodes include anterior, posterior, lateral, and
• Similarity between male and female breasts exists until puberty, when
central nodes.
female breast tissue enlarges in response to estrogen and progesterone.
• Anterior nodes drain anterior chest wall and breasts; posterior nodes
• Female breasts serve dual functions: milk production and storage for
drain posterior chest wall and part of arms.
nourishing newborns and aiding sexual stimulation, while male breasts
• Lateral nodes drain most of the arms, while central nodes receive
lack functional capability.
drainage from anterior, posterior, and lateral nodes.
• Both male and female breasts contain lymph nodes that drain lymph to
• Some lymph flows into infraclavicular or supraclavicular lymph nodes or
filter microorganisms and return water and protein to the blood.
deeper nodes within the chest or abdomen.
Abnormalities Noted on Inspection of the Breast ASSESSING THE MUSCULOSKELETAL SYSTEM

• Peau D’Orange:
Musculoskeletal System Overview
• Result of edema, giving the breast an orange peel appearance.
• Often associated with cancer, indicating potential malignancy. • Comprised of the muscular and skeletal systems.
• Paget’s Disease: • Primarily responsible for movement and support.
• Early signs include redness, mild scaling, and flaking of the
Components of the Musculoskeletal System
nipple.
• Symptoms may disappear temporarily but disease persists. • Hard Tissues: Bones and cartilages (articular cartilages).
• Late signs include tingling, itching, increased sensitivity, burning, • Soft Tissues: Muscles, tendons, synovial membranes, joint capsules,
discharge, and pain in the nipple. and ligaments.
• Retracted Nipple:
Functions
• Suggestive of malignancy in the breast.
• Dimpling: • Protection of vital structures.
• Indicates potential malignancy in breast tissue. • Provision of body form.
• Retracted Breast Tissue: • Stability.
• Suggests malignancy, particularly when noted during • Storage of salts (e.g., calcium).
examination. • Formation and supply of new blood cells.

Muscles
Abnormalities on Palpation
• Largest soft tissues in the system.
• Cancerous Tumors: • Muscle fibers (cells) produce contractions for movement.
• Irregular, firm, hard masses, typically non-tender and occurring • Associated connective tissue binds fibers into fascicles and conveys
after age 50. nerve fibers and blood vessels.
• Fibroadenomas:
• Lobular, ovoid, or round lesions, well-defined, seldom tender,
Muscle Types
usually singular and mobile; common between puberty and
menopause. • Skeletal Muscle: Moves bones and structures.
• Benign Breast Disease: • Cardiac Muscle: Forms heart walls.
• Also known as fibrocystic breast disease, characterized by • Smooth (Visceral) Muscle: Found in vessels, hollow organs, and
round, elastic, defined, tender, and mobile cysts; most common controls movement.
from age 30 to menopause, decreasing thereafter.
Tendons and Ligaments

• Tendon: Connects muscles to bones, transmitting force during

contraction.
• Ligament: Connects bone to bone, providing stability.
 • Made of dense fibrous connective tissue with collagen fiber bundles. • Hammer Toe: Hyperextension at metatarsophalangeal joint, flexion
at proximal interphalangeal joint, common in second toe.
Joint Capsule and Synovial Membrane
Rheumatoid Arthritis
• Synovial membrane secretes synovial fluid for lubrication and
nutrient supply. • Acute: Tender, painful, swollen, stiff joints.
• Joint capsules are strong and surround synovial joints, composed of • Chronic: Swelling, thickening, limited range of motion, ulnar
dense fibrous connective tissue. deviation of fingers.
• Swan Neck Deformity: Flexion of proximal interphalangeal joint,
Skeletal System Overview
hyperextension of distal interphalangeal joint.
• Composed of bones and cartilages. • Boutonnière Deformity: Flexion of proximal interphalangeal joint,
• Functions include support, shock absorption, blood cell production, hyperextension of distal interphalangeal joint.
and protection of organs.
Osteoarthritis (OA)
Bone Structure and Classification
• Heberden's Nodes : Nodules on dorsolateral aspects of distal
• Long bones: Tubular (e.g., humerus). interphalangeal joints.
• Short bones: Cube-like or round (e.g., tarsals, carpals). • Flexion and deviation deformities may develop.
• Flat bones: Thin, curved, protective (e.g., skull bones, ribs).
Abnormal Spinal Curvature
• Irregular bones: Do not fit other categories (e.g., hip bone).
• Flattening of the Lumbar Curve: Associated with herniated lumbar
Cartilages and Joints
disc or ankylosing spondylitis.
• Cartilages line articulating surfaces, reducing friction. • Kyphosis: Rounded thoracic convexity commonly seen in older
• Joints formed where bones meet, promoting movement. adults.
• Classifications: Fibrous, Cartilaginous, Synovial joints. • Lumbar Lordosis: Exaggerated lumbar curve often seen in pregnancy
or obesity.
Skeletal Muscle Movements • Scoliosis: Lateral curvature of the spine with increased convexity on
• Flexion, Extension, Abduction, Adduction. the curved side.
• External/Internal rotation, Pronation/Supination.
• Inversion/Eversion.
• Rotation of head and hips. ASSESSING THE NEUROLOGIC SYSTEM

Abnormalities of the Feet and Toes Anatomy and Physiology Structure and Functions

• Acute Gouty Arthritis: Tender, painful, swollen joint of the great toe. • CNS (Central Nervous System): Consists of the brain and spinal cord.
• Corn: Painful thickening of skin over bony prominences. • Peripheral: Nerves outside the brain and spinal cord, including 12
• Callus: Nonpainful thickened skin at pressure points. pairs of cranial nerves and 31 pairs of spinal nerves.
• Plantar Wart: Painful warts under callus, appearing as dark spots.
 • Functions: Carries sensory messages to the CNS, motor messages Autonomic Nervous System
from the CNS to muscles and glands, and autonomic messages
• Part of peripheral nervous system.
regulating internal organs and blood vessels.
• Divided into somatic fibers (voluntary muscles) and autonomic fibers
The Brain: (involuntary muscles, cardiac muscle, glands), mediating
unconscious activity.
• Comprises cerebrum, cerebellum, and brainstem.
• Areas: Frontal (motor), Parietal (sensory), Occipital (vision),
Temporal (auditory, taste, smell, balance). Cranial Nerves Examination
• Wernicke’s Area: Language comprehension in temporal lobe.
• Cranial Nerve I (Olfactory):
• Broca’s Area: Mediates motor speech in frontal lobe.
o Test sense of smell with familiar aromas.
Central Nervous System o Assess in cases of smell loss, head trauma, or suspected
intracranial lesions.
• Basal Ganglia: Subcortical motor system for movement
coordination.
• Cranial Nerves II, III, IV, and VI (Optic, Oculomotor, Trochlear, and
• Thalamus: Relay station for sensory pathways, crucial for emotion
Abducens):
and creativity.
o Test visual acuity using Snellen chart.
• Hypothalamus: Controls various functions like appetite, sex drive,
o Evaluate pupillary size, reaction to light, and extraocular
temperature, etc.
movements.
• Cerebellum: Coordinates voluntary movements, equilibrium, and
o Assess for abnormalities like dilated or constricted pupils,
muscle tone.
nystagmus, and muscle weakness.
• Brainstem: Contains cranial nerves, includes midbrain, pons, and
medulla.
• Cranial Nerve V (Trigeminal):
Spinal Cord o Test motor function by palpating temporal and masseter
muscles during teeth clenching.
• Long cylindrical nervous tissue in vertebral canal, mediates reflexes. o Test sensory function by touching designated areas of the
• Contains gray matter (nerve cell bodies) arranged in anterior and face with a cotton wisp.
posterior "horns."

Reflexes • Cranial Nerve VII (Facial):

o Assess motor function by observing facial movements like
• Involuntary reactions below conscious control. smiling, frowning, etc.
• Types: Deep tendon, Superficial, Visceral, Pathologic. o Sensory function can be tested by applying flavored
Spinal Nerves substances to the anterior two-thirds of the tongue.

• 31 pairs arising from spinal cord, named for spinal region. • Cranial Nerve VIII (Acoustic/Vestibulocochlear):
• "Mixed" nerves containing sensory and motor fibers, innervating o Test hearing acuity and perform Weber and Rinne tests.
specific body segments.
 o Assess for sensorineural hearing loss and abnormalities in • Dilated pupil, ptosis (drooping eyelid), eye turns out and slightly
vibratory sound localization. down
• Failure to move eye up, in, down
• Cranial Nerves IX and X (Glossopharyngeal and Vagus): • Absent light reflex
o Test motor function by observing pharyngeal movement
Cranial Nerve VI: Abducens Nerve
during phonation and gag reflex.
o Assess swallowing ability and voice quality. • Abnormalities:
• Failure to move eye laterally, diplopia (double vision) on lateral gaze
• Cranial Nerve XI (Spinal Accessory):
o Examine sternomastoid and trapezius muscles for size and Cranial Nerve VII: Facial Nerve
strength. • Abnormalities:
o Test muscle strength by rotating head and shrugging • Absent or asymmetric facial movement
shoulders against resistance. • Loss of taste

• Cranial Nerve XII (Hypoglossal):

o Assess tongue strength and mobility. Cranial Nerve VIII: Acoustic Nerve
o Inspect tongue for wasting or tremors and assess lingual • Abnormality: Decrease or loss of hearing
speech clarity.
o Look for abnormalities like fasciculation, atrophy, and Cranial Nerve IX: Glossopharyngeal Nerve
deviation of the tongue.
• Abnormality: No gag reflex

Cranial Nerve I: Olfactory Nerve Cranial Nerve X: Vagus Nerve

• Abnormality: Anosmia (loss of sense of smell)
• Abnormality:
• Cranial Nerve II: Optic Nerve
• Uvula deviates to the side
• Abnormalities:
• Voice quality: Hoarse or brassy, nasal twang or husky; dysphagia
• Defect or absent central vision
(difficulty swallowing), fluids regurgitate through the nose
• Defect in peripheral vision, hemianopsia (loss of vision in half of the
visual field) Cranial Nerve XI: Spinal Accessory Nerve
• Absent light reflex
• Papilledema (swelling of the optic nerve head) • Abnormality: Absent movement of sternomastoid or trapezius
muscles
• Optic atrophy (damage to the optic nerve resulting in visual
impairment Cranial Nerve XII: Hypoglossal Nerve
Cranial Nerve III: Oculomotor Nerve • Abnormalities:
• Abnormalities: • Tongue deviates to the side
• Retinal lesions • Slowed rate of tongue movement
 ASSESSING THE FEMALE GENITALIA angle to the vagina when standing. Comprises the fundus, body, and
isthmus.
External Genitalia
• Uterine Wall Layers: Endometrium (inner mucosal layer influenced
• Mons Pubis: Fat pad over the symphysis pubis, covered with pubic by estrogen and progesterone), myometrium (middle layer of
hair in adults, absorbs force and protects during coitus. smooth muscle fibers), and peritoneum (outer layer covering uterus
• Labia Majora: Two folds of skin extending from the mons pubis to and separating it from the abdominal cavity).
the perineum, composed of adipose tissue, sebaceous glands, and • Ovaries: Pair of small, oval-shaped organs situated laterally in the
sweat glands. Outer surface covered with pubic hair, inner surface pelvic cavity, connected to the uterus by the ovarian ligament.
pink, smooth, and moist. Functions include ovum development and release, hormone
• Labia Minora: Hairless, usually darker pink, contain numerous production (estrogen, progesterone, testosterone).
sebaceous glands for lubrication and moisture. • Fallopian Tubes: Tubes connecting the ovaries to the uterus, where
• Clitoris: Small cylindrical mass of erectile tissue and nerves with the ovum travels. Ranges from 8 to 12 cm in length.
three parts: glans, corpus, and crura. The glans is the visible rounded
Common Variations of the Cervix
portion.
• Vestibule: Boat-shaped area formed by skin folds of labia majora • Cervical Eversion: Occurs after vaginal birth or with oral
and labia minora, contains openings such as the urethral meatus contraceptive use. The columnar epithelium from the endocervical
and vaginal orifice. canal everts, appearing as a deep red, rough ring around the
• Hymen: Fold of membranous tissue covering part of the vagina. cervical.
• Bartholin's Glands: Located on either side of the vaginal orifice, • Nabothian (Retention) Cysts: Small, yellow, translucent nodules on
secrete mucus for lubrication during sexual intercourse. the cervical surface. Normal after childbirth, caused by blocked
mucous glands. Typically harmless and do not require treatment.
Internal Genitalia
Vaginal Infections
• Vagina: Muscular, tubular organ extending from the vaginal orifice
to the cervix, lies between the rectum posteriorly and the urethra • Candidal Vaginitis: Caused by yeast overgrowth in the vagina.
and bladder anteriorly. Presents with thick, white, cheesy discharge, inflamed and swollen
• Vaginal Wall Layers: Outer layer of pink squamous epithelium and labia, reddened vaginal mucosa with patches of discharge, intense
connective tissue, submucosal layer containing blood vessels and itching, and discomfort.
nerves, layer of smooth muscle, and layer of connective tissue and • Atrophic Vaginitis: Occurs after menopause due to low estrogen
vascular network. levels. Symptoms include minimal blood-tinged discharge, atrophic
• Cervix: Composed of smooth muscle, muscle fibers, and connective labia and vaginal mucosa, dryness, itching, burning, painful
tissue, covered by pink squamous epithelium and red columnar urination.
epithelium. Functions include allowing sperm entry into the uterus, • Bacterial Vaginosis: Exact cause unknown, possibly sexually
passage of menstrual flow, mucus secretion, and dilation during transmitted. Symptoms include thin, gray-white discharge with a
childbirth. fishy odor (positive amine test), coating the vaginal walls and
• Uterus: Pear-shaped muscular organ with a corpus (body) and cervix ectocervix.
(neck). Positioned above the bladder, approximately 45-degree
Pelvic Disease the cooler-than-body temperature necessary for
sperm production.
• Pelvic Inflammatory Disease (PID): Caused by STI infection of the
fallopian tubes or ovaries. Presents with extremely tender and Internal Genitalia
painful bilateral adnexal masses, known as Chandelier's sign.
Testes
• Adnexal Masses: May indicate various conditions including ovarian
• Paired ovoid-shaped organs, each contained within
cysts, ovarian cancer, or PID. Characteristics vary based on the
one portion of the scrotal sac.
underlying cause:
• Covered by the tunica vaginalis, a serous membrane
• Ovarian Cyst: Benign mass on the ovary, usually smooth, mobile,
separating the testis from the scrotal wall.
round, compressible, and nontender.
Spermatic Cord
• Ovarian Cancer: Masses are usually solid, irregular, nontender, and
• Contains blood vessels, lymphatic vessels, nerves,
fixed. May present with other symptoms such as abdominal
and the vas deferens.
bloating, pelvic pain, and urinary urgency.
• Vas deferens transports sperm from the testes to
the urethra for ejaculation.
Inguinal Area
ASSESSING THE MALE GENITALIA
• Located between the anterior superior iliac spine
Anatomy and Physiology and the symphysis pubis.
• Inguinal canal serves as the passage for the vas
External Genitalia deferens as it passes through the lower abdomen.
Penis Anus and Rectum
• The male reproductive organ.
• Composed of three cylindrical masses of vascular erectile Anal Canal
tissue: two corpora cavernosa on the dorsal side and the • Final segment of the digestive system begins at the
corpus spongiosum on the ventral side. anal sphincter and ends at the anorectal junction.
• Corpus spongiosum extends distally to form the acorn- • Lined with skin containing no hair or sebaceous
shaped glans. glands, but rich in somatic sensory nerves.
• Glans is covered by foreskin or prepuce if uncircumcised. • External and internal anal sphincters control the
passage of feces.
Scrotum Rectum
• Thin-walled sac suspended below the pubic bone, • Lowest portion of the large intestine, approximately
posterior to the penis. 12 cm long.
• Contains sweat and sebaceous glands, folds of skin • Extends from the sigmoid colon to the anorectal
(rugae), and the cremaster muscle. junction, enlarging above the junction to form the
• Functions as a protective covering for the testes, rectal ampulla.
epididymis, and vas deferens, and helps maintain Prostate
 • Gland surrounding the neck of the bladder and • Bowel herniates through the femoral ring and canal, never
urethra, lying between these structures and the travels into the scrotum.
rectum. • Least common type, occurs mostly in women.
• Consists of two lobes separated by the median
Abnormalities of the Anus and Rectum
sulcus.
• Secretes a thin, milky substance that promotes • External Hemorrhoid:
sperm motility and neutralizes vaginal acidic • Painless papules caused by varicose veins, may become
secretions. thrombosed and painful.
• Perianal Abscess:
Abnormalities of the Penis
• Cavity of pus caused by infection around the anal opening,
• Syphilitic Chancre: red, swollen, hard, and tender.
• Initially a small, silvery-white papule that develops a red, • Anal Fissure:
oval ulceration. • Splits in the tissue of the anal canal caused by trauma, may
• Painless. cause intense pain, itching, and bleeding.
• Sign of primary syphilis, regresses spontaneously. • Rectal Prolapse:
• May be misdiagnosed as herpes. • Protrusion of rectal mucosa through the anal opening,
• Genital Warts: appears as a red, doughnut-like mass.
• Single or multiple, moist, fleshy papules. • Anorectal Fistula:
• Painless. • Small, round opening in the skin surrounding the anal
• Caused by human papillomavirus (HPV), a sexually opening, suggests an inflammatory tract.
transmitted infection.
Abnormalities of the Prostate Gland
• Cancer of the Glans Penis:
• Appears as a hardened nodule or ulcer on the glans. • Acute Prostatitis:
• Painless. • Swollen, tender, firm, and warm prostate due to bacterial
• Occurs primarily in uncircumcised men. infection.
• Benign Prostatic Hypertrophy:
Inguinal and Femoral Hernias
• Enlarged, smooth, firm prostate common in men older than
• Indirect Inguinal Hernia: 50 years.
• Bowel herniates through internal inguinal ring and remains • Cancer of the Prostate:
in the inguinal canal or travels into the scrotum. • Hard areas or irregular nodules on the prostate suggest
• Most common type, more frequent in children. cancer.
• Direct Inguinal Hernia:
Abnormalities of the Scrotum
• Bowel herniates from behind and through the external
inguinal ring, rarely travels into the scrotum. • Orchitis:
• Less common, occurs mostly in adult men older than age 40. • Inflammation of the testes, associated frequently with
• Femoral Hernia: mumps, causes pain, heaviness, and fever.
• Varicocele:
 • Abnormal dilation of veins in the spermatic cord, may cause
discomfort, heaviness, and infertility.
• Small Testes:
• Indicates atrophy, may result from various conditions
including cirrhosis, hypopituitarism, or Klinefelter's
syndrome.
• Spermatocele:
• Sperm-filled cystic mass located on the epididymis, usually
small, nontender, and movable.