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Health Assessment > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

What 3 things make up the musculoskeletal system?

A
  • 206 bones
  • axial skeleton (head & trunk)
  • appendicular skeleton (extremities)
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2
Q

What are 3 functions of bones?

A
  • provide support/protection
  • allow for movement of muscle mass
  • provide for formation of blood cells in red bone marrow - hematopoiesis
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3
Q

Where is red bone marrow located?

A

heads of long bones

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4
Q

What are the two types of bones?

A
  • compact: hard & dense (shaft, outer layers)
  • spongy: numerous spaces (ends & center)
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5
Q

How do we form bone? degrade?

A
  • form w/ osteoblasts
  • degrade w/ osteoclasts
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6
Q

What are 4 characteristics of skeletal muscle?

A
  • conscious control
  • made up of fasciculi
  • attach to bones by tendons
  • assist w/ posture, produce heat, & movement
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7
Q

How many muscles do we have in body and how much body weight do they take up?

A

over 600 muscles that take up 40-50% of body weight

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8
Q

What are joints?

A

place of union of two or more bones and is the functional unit of musculoskeletal system

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9
Q

What are 3 types of joints?

A
  • synovial (diarthrodial): freely moveable
    ex: shoulder, elbow, wrist, knee
  • nonsynovial (cartilaginous): slightly moveable
    ex: vertebra, ribs, pubic bones
  • nonsynovial (fibrous): immovable
    ex: skull
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10
Q

How are synovial joints made up?

A
  • articular cartilage cushions the bone and gives smooth surface
  • synovial membrane forms a synovial cavity filled w/ synovial fluid
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11
Q

What are 9 major joints?

A
  • temporomandibular
  • elbow
  • sternoclavicular
  • shoulder
  • wrist/fingers/thumb
  • hip
  • vertebrae
  • knee
  • ankle & foot
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12
Q

What are 12 types of joint motion?

A
  • flexion: decrease angle of joint
  • extension: increase angle of joint
  • abduction: move away from midline
  • adduction: move toward midline
  • rotation: movement of limb around axis
  • circumduction: circular movement of limb
  • inversion: sole of foot faces inward
  • eversion: sole of foot outward
  • supination: palm up
  • pronation: palm down
  • dorsiflexion: toes toward nose
  • plantar flexion: toes toward floor
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13
Q

ligaments vs tendons?

A
  • ligaments: bone to bone
  • tendons: bone to muscle
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14
Q

What equipment is needed for a musculoskeletal exam?

A
  • tape measure
  • goniometer
  • skin marking pencil
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15
Q

What is a goniometer?

A

device used to measure angle of joints

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16
Q

Hypertrophy vs atrophy?

A

hypertrophy: exaggerated muscle growth
atrophy: muscle wasting away

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17
Q

What should we inspect each joint for?

A
  • size, contour, symmetry
  • skin over joints for color, swelling, masses, or deformities
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18
Q

Palpate each joint for?

A
  • crepitation
  • temp change
  • tenderness
  • masses
  • swelling
  • range of motion
  • strength
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19
Q

What is crepitation?

A

grating, popping, crunch noises of joint from overuse

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20
Q

What is ROM and what are the normal ranges?

A
  • the number of degrees of movement a joint can make
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21
Q

What 3 steps should you do to assess ROM for temporomandibular joint?

A
  • open mouth maximally
  • protrude lower jaw and move side to side
  • stick out lower jaw
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22
Q

What should you do when obtaining objective data about the cervical spine?

A
  • inspect alignment of head and neck
  • palpate spinous processes and muscles
  • motion and expected range
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23
Q

What should you do when obtaining objective data about shoulders?

A
  • inspect joint
  • palpate shoulders and axilla
  • motion and expected range
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24
Q

4 steps to assess motion and expected range of cervical spine?

A
  • chin to chest
  • lift chin
  • each ear to shoulder
  • turn chin to each shoulder
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25
Q

4 steps to assess motion and expected range for shoulders?

A
  • arms forward and up
  • arms behind back and hands up
  • arms to sides and up over head
  • touch hands behind head
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26
Q

What objective data should you gather about the spine?

A
  • inspect while person stands
  • palpate spinous process
  • motion and expected range
  • straight leg raising
  • measure leg length discrepancy
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27
Q

What is differences in leg length a sign of?

A

scoliosis

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28
Q

what are 2 steps to determine motion and expected range of spine?

A
  • bend sideways & backward
  • twist shoulder to each side
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29
Q

What might you see w/ spine related to age changes?

A

decrease in height due to shortening of vertebral disc

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30
Q

Scoliosis vs kyphosis vs lordosis

A
  • scoliosis: curvature of spine
  • kyphosis: rounding of upper back
  • lordosis: pronounced cavity of lumbar spine; seen w/ pregnancy and obesity
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31
Q

How should you measure length of leg? circumference of leg?

A

length: anterior superior iliac spine to medial malleolus
circumference: measure at midgastrocnemius 5 cm below patella and at 5 and 10 cm above patella

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32
Q

What 3 thing w/ objective data should we gather about elbows?

A
  • inspect joint in flexed and extended positions
  • palpate joint and bony prominences
  • motion and expected range
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33
Q

What are 2 steps to determine motion and expected range of elbow?

A
  • bend and straighten elbow
  • pronate and supinate hand
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34
Q

What are 4 thing w/ objective data for wrist and hand?

A
  • inspect joints on dorsal and palmar sides
  • palpate each joint
  • motion and expected range
  • test for carpal tunnel
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35
Q

What are 5 steps to determine motion and expected range of wrist and hand?

A
  • bend hand up and down
  • bend fingers up and down
  • turn hands out and in
  • spread fingers and make fist
  • touch them to each finger
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36
Q

What are two tests for carpal tunnel?

A
  • Phalen’s test: hold hands back to back for 1 min, if numbness and burning sign of carpal tunnel
  • tinels sign: tap median nerve, causes burning or tingling if carpal tunnel
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37
Q

what are 3 things to gather for objective data for hip?

A
  • inspect as person stands
  • palpate w/ person supine
  • motion and expected range
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38
Q

what are 5 things to gather for objective data for knee?

A
  • inspect joint and muscle
  • palpate
  • bulge sign
  • ballottement of patella
  • motion and expected range
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39
Q

What are 5 steps for determining motion and expected range of hip?

A
  • raise leg
  • knee to chest
  • flex knee and hip; swing foot out and in
  • swing leg laterally and medially
  • stand and swing leg back
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40
Q

What are 3 steps for determining motion and expected range of knee?

A
  • bend knee
  • extend knee
  • check knee for ambulation
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41
Q

How do you determine hyperextension of the hip?

A

have client lay prone and extend hip backward

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42
Q

What are two test for effusions? how do you perform?

A
  • bulge sign: small effusion
  • ballottement: large effusion
    -perform: firmly stroke medial aspect of knee 2 or 3 times to displace fluid and then tap lateral aspect for distinct bulge from fluid wave
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43
Q

What 3 things should we collect w/ objective data for ankle and foot?

A
  • inspect w/ person sitting, standing, and walking
  • palpate joints
  • motion and expected range
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44
Q

How do we grade muscle strength? what is normal range?

A
  • 0 through 5 (0 = paralysis, 1 = 10%, 2= 25%, 3 = 50%, 4 = 75%, 5 = 100%)
  • normal range is 5
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45
Q

how can we test for muscle strength?

A

muscle resistance - have them pull against resistance

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46
Q

What 3 steps to determine motion and expected rangeof ankle & toes?

A
  • point toes down and up
  • turn soles out and in
  • flex and straighten toes
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47
Q

What is osteoarthritis?

A

degenerative joint disease that is non inflammatory and involves deterioration of articular cartilages and bony formation at joint surfaces leading to stiffness, edema, and pain

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48
Q

What are heberden’s and bouchard’s nodes?

A
  • heberden’s - closer to nail
  • bouchard’s - closer to hand
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49
Q

What is rheumatoid arthritis?

A

chronic, inflammatory disorder that typically affects small joints in hands & feet

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50
Q

What are 3 deformities w/ rheumatoid arthritis?

A
  • swan neck deformity
  • ulnar deviation
  • boutonniere deformity
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51
Q

polydactyl vs syndactyl?

A
  • polydactyl: client has extra digit
  • syndactyl: fused digits
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52
Q

What is bursitis and what is is caused by and symptoms?

A
  • inflammation of bursae
  • caused by injuries or damage to bursae
  • damage may trigger pain, swelling and redness in affected area
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53
Q

What is fibromyalgia and who is it common in?

A
  • chronic pain disorder where you have widespread MS pain for > 3 months
  • common in women
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54
Q

What are symptoms and treatment of fibromyalgia?

A
  • symptoms: fatigue, impaired sleep, memory impairment, mood issues, diffuse tenderness
  • treatment: medications, self care
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55
Q

What is the drawer sign used to assess?

A

ACL tears

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56
Q

What is osteoporosis?

A
  • bone disease that occurs when body loses too much bone or makes too little bone
  • bone becomes weak and can break
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57
Q

What is the lowest incidence of osteoporosis? highest?

A
  • lowest: black males
  • highest: white females
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58
Q

What makes up the neurologic system?

A
  • central and peripheral nervous system
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59
Q

What makes up the central nervous system?

A
  • brain: cerebrum, diencephalon, brain stem, and cerebellum
  • spinal cord: neural pathways
  • meninges: protect and nourish CNS
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60
Q

what is the cerebrum?

A
  • largest part of brain
  • divided into L & R hemispheres w/ 4 lobes (frontal, parietal, temporal, occipital)
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61
Q

What are the lobes made up of and their functions?

A
  • made of: gray matter
  • functions: mediation of voluntary movements, memory, perception, communication
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62
Q

Where is diencephalon located?

A

beneath the cerebral hemispheres

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63
Q

What two things are located within diencephalon?

A
  • thalamus: man relay station for incoming sensory pathways; relays sensation to cortex
  • hypothalamus: controls temp, sleep, emotions autonomic activity, pituitary gland, appetite, vitals
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64
Q

Where is the brainstem located?

A
  • connects w/ spinal cord and has 10 to 12 cranial nerves originate here
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65
Q

what are the 3 components of the brainstem?

A
  • midbrain: relay center for ear/eye reflexes; relays impulses b/t higher cerebral centers and lower portions
  • pons: links cerebellum to cerebrum and midbrain to medulla
  • medulla: contains nuclei for cranial nerves; has centers that control respirations, heart rate, and blood pressure
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66
Q

What is the location of cerebellum and functions?

A

location: lied behind brain stem and under cerebrum w/ 2 hemispheres
function: coordination of voluntary movements, equilibrium, muscle tone

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67
Q

What occurs w/ injury to Broca’s area? Wernicke’s area?

A
  • Broca: expressive aphasia - difficulty speaking
  • Wernicke: receptive aphasia - difficulty understanding
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68
Q

What is the location and functions of spinal cord?

A

location: vertebral canal, extending from medulla oblongata to 1st lumbar vertebra
functions: conducts sensory impulses up ascending tracts to brain, conducts motor impulses down descending tracts to neurons, responsible for simple reflex activity

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69
Q

What part of vertebral canal does spinal cord occupy?

A

upper 2/3

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70
Q

How is the spinal nerves broken up?

A
  • cervical (8)
  • thoracic (12)
  • lumbar (5)
  • sacral (5)
  • coccygeal (1)
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71
Q

What are the 2 ascending pathways that bring sensory impulses up to brain?

A
  • spinothalamic: pain, temp, light touch
  • posterior (dorsal): position sense, vibration, fine touch
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72
Q

What are the 2 descending pathways that bring motor impulses to muscles?

A
  • corticospinal (pyramidal): originate in motor cortex to medulla, cross opposite side & travel down spinal cord; allow skilled voluntary movements
  • extrapyramidal: travel from frontal lobe to pone, cross opposite side, down cord, connect w/ lower motor neurons; allow for muscle tone & body control
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73
Q

How many cranial nerves? spinal nerves?

A

cranial: 12
spinal: 31

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74
Q

Somatic vs autonomic nerves?

A
  • somatic: carry CNS impulses to voluntary skeletal muscles
  • autonomic: carry CNS impulses to smooth involuntary muscle
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75
Q

For spinal nerves, where do sensory (afferent) fibers enter? motor (efferent)?

A

sensory: dorsal roots of cord
motor: ventral roots of cord

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76
Q

How do we name spinal nerves?

A

after vertebrae below each ones exits point on spinal cord

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77
Q

How are spinal nerves attached to spinal cord?

A

by nerve roots

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78
Q

What cranial nerves have motor fibers? sensory fibers? both?

A
  • motor: 3, 4, 6, 11, 12
  • sensory: 1, 2, 8
  • both: 5, 7, 9, 10
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79
Q

What are dermatomes?

A

area of skin innervated by spinal nerves

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80
Q

sympathetic vs parasympathetic nervous system?

A
  • sympathetic: activated during stress
  • parasympathetic: controls functions to conserve energy
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81
Q

What is the major parasympathetic nerve in body?

A

vagas nerve

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82
Q

What are 6 common neurological chief complaints?

A
  • headaches
  • dizziness
  • seizures
  • loss of consciousness
  • changes in movement, sensation, communication
  • head injury
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83
Q

What 8 lifestyle & health practices should we ask about w/ a neurological assessment?

A
  • prescription or nonprescription medications
  • alcohol/tobacco/illicit drug use
  • use of seatbelts and protective riding gear
  • 24 hr diet recall
  • exposure to lead, pollutants, insecticides
  • heavy lifting or repetitive motions
  • ability to perform IADL’s
  • self view and any added stress due to this
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84
Q

What 5 areas should we look at when doing a neurological exam?

A
  • mental status
  • cranial nerves
  • motor and cerebellar systems
  • sensory system
  • reflexes
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85
Q

What 6 things should we look for to evaluate mental status?

A
  • orientation
  • appearance
  • behavior
  • cognition
  • thought processes
  • recent/remote memory
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86
Q

What are the 4 levels of consciousness?

A
  • alert: awake, aware, and responsive
  • lethargy: drowsy, inattentive, responds to commands, but falls asleep after
  • stupor: marked mental, physical activity. Responds to vigorous stimuli and then only groans or purposeless movement; reflexes still present
  • coma: unconscious; reflex dependent on coma, not aroused by painful stimuli
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87
Q

What are abnormal ranges for Glasgow coma scale?

A
  • < 15 abnormal
  • < 7 is comatose
  • lower the #, deeper the coma
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88
Q

What are the 12 cranial nerves?

A
  1. olfactory: smell; test w/ coffee grounds
  2. optic: visual acuity and peripheral vision; test w/ eye chart
  3. oculomotor: EOM’s, PERRLA, eyelid margins
  4. trochlear: EOM’s, PERRLA, eyelid margins
  5. trigeminal: motor/sensory info; test w/ sharp vs dull stimuli
  6. abducens: EOM’s, PERRLA, eyelid margins
  7. facial: motor function through facial movements; test w/ smile & frown
  8. acoustic/vestibulocochlear: hearing; test w/ tuning fork or whisper
  9. glossopharyngeal: gag reflex, symmetrical rise of uvula, swallowing
  10. vagus: gag reflex, symmetrical rise of uvula, swallowing
  11. Spinal accessory: resistance to shoulders/neck
  12. hypoglossal: tongue strength/mobility
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89
Q

What does PERRLA stand for?

A

pupils equal round and reactive to light and accomodation

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90
Q

How should you evaluate gait and balance?

A
  • client walk naturally across room
  • client walk heel-toes, on heels, then on toes
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91
Q

What is the Romberg test?

A

stand near client and have then close eyes, if they sway it is a positive sign

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92
Q

How do you assess for coordination?

A

finger to nose test

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93
Q

How to asses rapid alternating movements?

A
  • touch each finger to thumb
  • rapidly turn palms up and down
  • perform heel-to-shin test
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94
Q

What should you assess w/ motor and cerebellar system?

A
  • condition and movement of muscles
  • gait and balance
  • romberg test
  • coordination
  • RAM
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95
Q

What should we assess for sensory system?

A
  • light touch, pain, and temp sensation
  • vibratory sensation
  • sensitivity to position
  • stereognosis & tactile discrimination
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96
Q

What is stereognosis? graphesthesia?

A
  • stereognosis: identifying what is in hand w/ eyes closed
  • Graphesthesia: use blunt object to draw letter or number on hand and see if patient can tell what number or letter it is
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97
Q

How to assess for deep tendon reflexes?

A
  • biceps and brachioradialis: C5 & C6
  • triceps: C6-C8
  • patellar: L2-L4
  • Achilles: S1-S2
98
Q

How can you get a true reflec response?

A

have patient focus on something else - locking fingers together and pulling

99
Q

How to test superficial reflexes?

A
  • use handle end of hammer for this
  • plantar: up lateral aspect in over ball of foot, like upside down, L4-S2
  • abdominal: latera toward midline, T8-12
  • cremasteric: stoke inner thigh, L1-2
  • abnormal: positive Babinski response (toes fan out)
100
Q

When do we see Babinski sign in adults?

A
  • upper motor neuron lesions
  • brain damage
  • epilepsy
  • drug & alcohol intoxication
101
Q

When do we use pointed end vs wide end when testing reflexes?

A
  • pointed end for small area
  • wide end for wider or more tender area
102
Q

What are the different scores for DTR’s?

A

0 = no response
1+ = sluggish or diminished
2+ = active or expected response
3+ = slightly hyperactive; more brisk than normal
4+ = brisk, hyperactive w/ intermittent clonus

103
Q

What is clonus?

A

series of involuntary rhythmic contractions

104
Q

What are 3 tests for meningeal irritation?

A
  • nuchal rigidity: flex neck, resistance indicated irritation
  • kernig’s sign: place patient supine, lift leg and flex knee, then try and extend knee; positive is resistance or pain
  • Brudzinski’s sign: patient supine, flex neck; positive if one or both legs flex
105
Q

What are 5 abnormal muscle movements?

A
  • atrophy and fasciculations of tongue = ALS
  • eye tics = Tourette’s & drugs
  • resting tremors = Parkinson’s
  • postural tremors = anxiety, hyperthyroid
  • intention tremors = MS
106
Q

When do intention tremors occur?

A

when individual doing activity

107
Q

What are 4 types of abnormal gait?

A
  • cerebellar ataxia: wide staggering w/ positive Romberg; seen w/ intoxication or cerebellar disease
  • parkinsonian gait: shuffling, stiff, stooped-over
  • spastic hemiparesis: flexed arm held close to body while dragging toe/leg, seen w/ stroke
  • footdrop: lift foot high and slaps down, seen w/ motor neuron disease
108
Q

what are 5 stroke symptoms?

A
  • sudden numbness or weakness of face, arm, or leg (one side)
  • sudden confusion, trouble speaking, or understanding speech
  • sudden trouble seeing in one or both eyes
  • sudden trouble walking, dizziness, loss of balance or coordination
  • sudden severe headache w/ no known cause
109
Q

when can medication be given w/ stroke?

A

w/in 3 hours after last seen normal

110
Q

What is a big risk factor for stroke?

A

HTN and smoking

111
Q

What is the stroke zone?

A

when systolic BP is over 200

112
Q

What does FAST stand for regarding stroke?

A
  • face
  • arms
  • speech
  • time
113
Q

What are the 6 cranial bones?

A
  • frontal: flat bone that makes forehead and upper portion of eye sockets; damage to this affects emotions, behavior, speaking, recall
  • parietal: two behind frontal; damage to this affects your 5 primary senses
  • temporal: two on each side of parietal that forms the ears; damage to this leads to difficulty w/ communication & memory
  • occipital: base of skull w/ opening for spinal cord; damage to this leads to trouble w/ vision or perceiving size
  • sphenoid: irregular bone that sits below frontal and spans width of skull
  • ethmoid: irregular bone located in front of sphenoid that makes up nasal cavity
114
Q

What is the function of the cranial bones?

A

house and protect the brain and major sensory organs

115
Q

What are sutures?

A

nonmovable joints made by thick connective tissue; do not fuse till adulthood which allows for brain growth

116
Q

What are the 4 sutures?

A
  • coronal: separates frontal and parietal
  • sagittal: down middle & separates the parietal lobes
  • squamous: separates parietal & temporal
  • lambdoidal: separates parietal & occipital
117
Q

What are the two fontanels?

A
  • anterior fontanel: diamond shaped, b/w frontal & parietal, closes b/w 9 mo. and 2 yrs.
  • posterior fontanel: triangular shaped, b/w parietal and occipital, closes b/w 1-2 mo.
118
Q

How many total facial bones are there and what is their function?

A

total: 14
function: provide shape to face

119
Q

What does orbit refer to? supraorbital ridge?

A
  • orbit: eye socket
  • supraorbital ridge: eyebrow
120
Q

soft palate vs hard palate?

A

hard: front 2/3 of palate
soft: back of palate consisting of muscle fibers covered by mucous membranes

121
Q

What are 4 main structures of the neck?

A
  • hyoid bone: tongue bone; horseshoe shaped and sits at base of tongue
  • thyroid cartilage: adams apple; forms lower and back part of larynx
  • larynx: voice box; forms passageway for air b/w pharynx & trachea
  • trachea: extends from larynx to main bronchi; make sure it is midline
122
Q

What is an enlarged thyroid gland called?

A

goiter

123
Q

What hormone does the thyroid secrete?

A

thyroxine (T4)

124
Q

Where is the thyroid gland located?

A

below the thyroid cartilage of the larynx

125
Q

What are 6 symptoms of a hypothyroid (underactive gland)?

A
  • increased sensitivity to cold
  • constipation
  • fatigue, weakness
  • heaver menstrual periods
  • pale, dry skin; brittle hair and nails
  • unintentional weight gain
126
Q

What are the two neck muscles and what two landmarks do they form?

A

muscles:
- sternocleidomastoid (SCM): rotate & flex the head
- trapezius: extend from head and move shoulder
landmarks:
- anterior triangle: under mandible and anterior to SCM, middle of neck
- posterior triangle: b/w trapezius & SCM, side of neck

127
Q

What are 3 important cervical vertebrae?

A
  • C1: atlas, carries the skull
  • C2: axis, allows for movement of the head
  • C7: vertebral prominence, largest spinous process
128
Q

Should you be able to palpate lymph nodes?

A

should be nonpalpable or less than 1 cm in size

129
Q

What are 6 symptoms of hyperthyroid (overactive thyroid)?

A
  • weight loss
  • sweating, anxiety, irritability, tremor in hands, insomnia
  • rapid or irregular heartbeat
  • enlarged thyroid gland (goiter)
  • frequent bowel movements
  • bulging eyes (exophthalmos)
130
Q

What occurs to lymph nodes in children? elderly?

A

children: lymph tissue increases during childhood and then begins to decrease during adolescence
elderly: lymph nodes decrease in size and number

131
Q

What can location of enlarged lymph node tell us?

A

give clue to location of infection based of what area it drains

132
Q

What are 5 types of headaches?

A
  • sinus: pressure, tender over sinus cavities
  • classic migraine: severe throbbing, may have N/V, photosensitivity, more common in women, precipitated by aura
  • cluster headache: stabbing pain around one eye/cheek/forehead; usually occurs 1-2 times a day and can last 30 min-2 hrs
  • tension headache: dull, tight, diffuse pain in the occipital/frontal region, common w/ stress and anxiety
  • tumor related: persistent aching pain, patient usually has neurological/ psychological symptoms as well
133
Q

What equipment will you need for head & neck examination?

A
  • gloves
  • penlight or flashlight
  • small glass of water
  • stethoscope
134
Q

For the physical assessment what 5 things should you look at w/ the head?

A
  • size/shape/configuration (normocephalic)
  • consistency of features (symmetry)
  • involuntary movements
  • hair/scalp condition
  • palpate bones/TMJ/temporal artery
135
Q

For the physical assessment what 5 things should you look at w/ the face?

A
  • symmetrical features (round/oval/elongates/square)
  • movement
  • expression/affect
  • skin condition
  • assess CN5 & CN7
136
Q

What is a normal finding w/ palpation f temporal artery?

A
  • nontender and elastic
137
Q

What is a normal finding of palpation of TMJ?

A
  • nontender and w/out swelling or crepitation
  • mouth should be open/close fully and jaw should move smoothly in a lateral direction
138
Q

How to palpate TMJ joint?

A

place fingers in front of ears and have them open mouth wide

139
Q

What is hydrocephalus?

A

abnormal buildup of cerebrospinal fluid in the ventricles of the brain; common in infants & older adults

140
Q

What is down syndrome?

A

extra copy of chromosome 21, slanted eyes, wide epicanthal folds, short flat nose, thick protruding tongue

141
Q

What is acromegaly?

A

excessive growth hormone from pituitary causing enlargement of facial features, hands, and feet

142
Q

What are 2 conditions that cause decreased facial mobility?

A
  • Parkinson’s disease: cause mask like expression
  • scleroderma: autoimmune disease that causes tightening and hardening of the face and skin
143
Q

What is bell palsy?

A

one sided facial paralysis from damage to CN7 and if lost of sensation due to damage of CN5; due to exposure of viral infection and usually treated w/ steroids

144
Q

What can you confuse bells palsy w/?

A

stroke

145
Q

How should you perform a physical assessment of the neck?

A

inspect:
- cervical vertebra = flex chin to chest
- neck ROM = smooth & controlled
palpate:
- trachea = should be midline
- thyroid gland = usually nonpalpable, nontender & auscultate for bruits if enlarges

146
Q

How to palpate the thyroid?

A
  • stand behind client and have them lower chin to chest and turn neck slightly to right
  • place hands on each side of trachea
  • have patient swallow and press left finger on trachea and palpate w/ right finger
147
Q

What are 5 findings related to thyroid?

A
  • normal: if thyroid can be palpated, should be smooth and non-tender
  • enlargement: goiter or autoimmune hyperthyroid (grave’s) disease
  • masses: malignant or benign tumor
  • tenderness: inflammation - thyroiditis
  • if enlarged, auscultate for bruit
148
Q

What are 4 steps to look for when palpating lymph nodes?

A
  • assess size, shape, mobility, consistency, tenderness
  • compare nodes bilaterally
  • should have no swelling, tenderness, or hardness
  • lymphadenopathy = node > 1 cm; caused by cancer, HIV, infection, autoimmune disorder
149
Q

What are 6 characteristics of lymph nodes?

A
  • size: in mm or cm
  • shape: round, oval, irregular
  • delimitation: whether you feel separate individual nodes (discrete) or are they “matted” together
  • consistency
  • mobility: whether it can be moves
  • tenderness
150
Q

What are 4 findings related to lymph nodes?

A
  • normal: non-palpable or small, round, discrete, mobile, and non-tender
  • inflammation/infection: enlarged and tender, but remain mobile and discrete
  • malignancy: matted, hard, fixed, and usually non-tender
  • if nodes are abnormal, reassess area drained by them
151
Q

What are 4 clues nodes gives us?

A
  • single, enlarged, nontender, hard left supraclavicular node = neoplasm in thorax
  • hard, unilateral, nontender, fixed node = cancer
  • painless, rubbery, discrete nodes = Hodgkin’s lymphoma
  • clumped nodes = inflammation
152
Q

\What are 9 ways to palpate nodes?

A
  • preauricular: front of ear
  • postauricular: behind ear
  • occipital: posterior base of skull
  • submental: under chin
  • submandibular: along jawline
  • tonsillar or jugulodigastric: right below ear
  • anterior cervical (deep & superficial): deep= w/in SCM, superficial = superficial to SCM
  • posterior cervical: in posterior triangle
  • supraclavicular: b/w clavicle and SCM
153
Q

What is torticollis (Wryneck)?

A

spasm or contraction of sternocleidomastoid and usually a result of trauma during birth

154
Q

Ischemic vs hemorrhagic stroke?

A

Ischemic: abrupt blockage of arteries leading to brain
hemorrhagic: bleeding into brain

155
Q

How many permanent teeth do we have?

A

32

156
Q

What are the 3 salivary glands?

A
  • parotid: below & in front of the ears
    submandibular: located in lower jaw
  • sublingual: under tongue
157
Q

Where is the throat/pharynx located and what are its three parts?

A

located: behind mouth & nose, serves as muscular passage for food and air
parts: nasopharynx, oropharynx, laryngopharynx

158
Q

What is the purpose of the tonsils?

A

to filter out bacteria and virus

159
Q

How do we grade tonsil size?

A
  • 0 = surgically absent
  • 1 = less than 25%, hidden w/in pillars
  • 2 = 25-50%, extending to pillars
  • 3 = 50-75% extending beyond pillars, touch uvula & seen w/ strep
  • 4 = 75-100%, extending to midline
160
Q

What is the structure of the nose?

A
  • consists of an external portion covered w/ skin and an internal nasal cavity
  • external nose: a bridge, tip, and two oval openings called nares
  • internal nose: nasal cavity; nasal septum; superior, middle, and inferior turbinates
161
Q

kiesselbach plexus vs epistaxis

A
  • kiesselbach plexus: vascular region in anterior portion of septum formed by 5 arteries that supply oxygenated blood to nasal septum
  • epistaxis: nosebleed
162
Q

What is the structure of the sinus and function?

A
  • structure: 4 pairs of paranasal sinuses (frontal, maxillary, ethmoidal, and sphenoidal) located in skull
  • function: sinuses decrease weight of skull and act as resonance chambers during speech
163
Q

What equipment is needed for assessment of mouth, nose, throat, & sinuses?

A
  • gloves
  • cotton gauze pads
  • penlight
  • nasal speculum attached to otoscope
  • tongue blade
164
Q

What 4 things should you assess for nasal structures?

A
  • nares: test for patency by occluding one side and have breath through other
  • CN #1: test sense of smell
  • inspect nares w/ lighted speculum and note septum, lesions, and color
  • turbinate: note color if reddened = viral upper respiratory infection; if pale or bluish = allergic rhinitis
165
Q

What 2 things should you do for assessment of sinuses?

A
  • palpate for tenderness
  • transillumination for air versus fluid or pus = should have reddish glow
166
Q

What 5 thins should you do for assessment of the mouth?

A
  • distinctive odors
  • inspect & palpate lips, buccal mucosa, gums, & tongue for color variation or lesions
  • inspect gums for hyperplasia, blue-black line
  • inspect teeth for number and shape, color, occlusion
  • inspect and palpate tongue for color, texture & consistency, moisture, and size
167
Q

What 4 things should you do for tongue assessment?

A
  • inspect: note color, should be pink and texture; also note rich vascular bed
  • cranial nerve #12 - have client stick out tongue
  • assess frenulum attaching tongue to floor of mouth
  • palpate tongue and oral cavity for masses and lesions
168
Q

What 7 things should you inspect teeth for?

A
  • alignment and malocclusion
  • shape
  • discoloration: due to medications
  • caries (cavities): if below gumline require x-ray
  • dental appliances
  • missing or loose teeth
169
Q

What can untreated strep lead to?

A

damage to valves of heart ( endocarditis) and to kidney damage (glomerulonephritis)

170
Q

strep vs viral pharyngitis?

A
  • strep: all significantly sore throats w/ red, swollen tonsils and discharge require strep test; presents w/ fever malaise, headache, possibly N/V
  • viral pharyngitis: usually less severe than strep
171
Q

what should the palate be during inspection?

A

pink, moist, and intact

172
Q

What is a cleft palate?

A

when palate doesnt fuse

173
Q

How should you note movement of soft palate and uvula?

A
  • have pt. say ahh
  • soft palate should rise symmetrically w/ palate midline
  • gag reflex
  • test CN #10 and CN #9
174
Q

What are 5 age related changes of the mouth?

A
  • gums recede & undergo fibrotic changes
  • tooth surfaces worn down
  • decreased ability to smell and taste
  • oral mucosa drier and more fragile
  • varicose veins in ventral surface of tongue
175
Q

What are 6 abnormal findings of the mouth and throat?

A
  • canker sore: painful ulcer in mouth
  • cold sore: viral and contagious
  • gingivitis: red, swollen gums that bleed easily
  • cheilosis: painful fissures at corner of lips due to vitamin deficiency
  • leukoplakia: thick raised white patches that do not scrape
  • black carrie tongue: overgrowth of dead skin cells and staining bacteria
176
Q

What causes seizures?

A

uncontrolled electrical activity in the brain which results in rapid muscle contractions and involuntary movement

177
Q

what is a febrile seizure?

A

occur w/ small children/infants in response to a high fever

178
Q

What are the 3 sections of the ear and their functions?

A
  • external ear: funnels sound into the external auditory canal
  • middle ear: conducts vibrations of sound
  • inner ear: contains the sensory organs for equilibrium and hearing
179
Q

What are the two parts of the external ear?

A
  • auricle (pinna)
  • external auditory canal
180
Q

What are the 3 parts of the middle ear?

A
  • tympanic membrane: separates external and middle ear
  • ossicles: malleus, incus, stapes; work to amplify sound
  • Eustachian tube: helps changes in pressure and drainage, “pop” in ears when changing elevations
181
Q

What are the 4 parts of the inner ear/bony labyrinth?

A
  • bony & membranous labyrinth: include cochlea, vestibule, and semicircular canals
  • auditory never: CN 8
  • cochlea: sensory receptors for hearing
  • vestibule & semicircular canals: balance and equilibrium
182
Q

What is the inner ear filled vs the middle ear?

A
  • inner: fluid filled
  • middle: air filled
183
Q

What are the two pathways for hearing?

A
  • air conduction
  • bone conduction
184
Q

What are 3 types of hearing loss?

A
  • conductive: transmission of sound from external to inner ear is blocked (BC > AC in affected ear)
  • sensorineural: due to disease, either congenital or acquired (AC > BC in nonaffected ear)
  • presbycusis: due to aging process, lose ability to hear high frequency sounds
185
Q

What is an ototoxic medication?

A

medications that can damage ears

186
Q

How should the patients head be positioned when using an otoscope?

A
  • adult: pt tilt head back and hold helix up and back
  • children: pt tilt head back and pinna down
187
Q

What should you inspect and palpate for the auricle and tragus of external ear?

A
  • position, size, shape, symmetry, color, discharge, lesions
  • palpate for masses, tenderness, as well as mastoid process
  • “tug test” = if painful sign of ear infection
188
Q

What should you inspect and palpate for the canal of external ear?

A
  • look first; then otoscopic exam
  • note redness, lesions, discharge, cerumen
189
Q

what is otitis externa?

A

inflammation or infection of external canal; swimmers ear

190
Q

What is Darwin/s tubercle?

A

thickening of the helix - nonsignificant

191
Q

What is tophi?

A

small white yellow hard nontender nodule in or near helix that contains uric acid crystals; sign of gout

192
Q

How to perform Weber test?

A
  • use tuning fork placed on center of head or forehead
  • ask whether client hears sound better in one ear or the same in both ears
  • normal = no lateralization
193
Q

How to perform the whisper test?

A
  • have client place a finger on tragus of one ear
  • whisper a two syllable word 1-2 ft. behind client
  • recall of 3/6 words is normal
  • repeat on other ear
194
Q

How should you perform an otoscopic exam?

A
  • position patient w/ head tilted, ear up
  • select the largest possible speculum (insert no more than 1/4 inch in infant and 1/2 inch in adult or child)
  • brace the hand against clients head
  • position ear to insert otoscope (adult - pull helix up and back; child under 3 - pull pinna down)
195
Q

How to perform the rinne test?

A
  • use tuning fork and place base on clients mastoid process
  • when client no longer hears sound, note time interval, and move tuning fork in front of external ear. When client no longer hears sound, note time interval
196
Q

How can you test vestibular function?

A

Romberg test

197
Q

What should you inspect for during an otoscope exam of the internal ear?

A
  • inspect external auditory canal for discharge, color, consistency of cerumen, canal walls, and nodules
  • inspect tympanic membrane for shape, consistency, and landmarks
198
Q

What are some deviations of the tympanic membrane?

A
  • perforations: occurs from ear infections or foreign bodies
  • scarred/serous otitis: yellow & air bubble
  • tympanostomy tube: inserted to prevent accumulation of fluid in middle ear
  • acute otitis media: redness or bulging of membrane
  • excess cerumen: covers tympanic membrane
199
Q

Where is the cone of light in the middle ear?

A
  • right: 4 to 5 o clock
  • left: 7 to 8 o clock
200
Q

What are 4 tests you can use for CN 8?

A
  • Whisper test
  • audiometry: tests hearing at varying decibels and frequency
  • weber’s test: checks for lateralization
  • rinne test: compares AC and BC
201
Q

What are the normal findings of audiometry test?

A

adults: 25-30 decibels
children: 15-20 decibels

202
Q

What are 4 risk factors of acute otitis media?

A
  • anatomy (Eustachian tube is wider, shorter, more horizontal)
  • day care attendance
  • second hand smoke exposure
  • bottes in bed
203
Q

What are two consequences of recurrent otitis media?

A
  • antibiotic resistance
  • hearing loss
204
Q

What are two geriatric variations we should look for relating to ears?

A
  • hearing loss at age 50
  • assess for dizziness and balance
205
Q

What are the 5 anatomy parts of the internal eye?

A
  • sclera: outer tough fibrous protective layers that’s visible anteriorly
  • cornea: thin transparent layer sensitive to touch and covers iris and pupil
  • iris: varies its opening at center and controls amt of light to retina; varies in color
  • lens: convex disk posterior to pupil
  • retina: inner nervous layer visible w/ ophthalmoscope
206
Q

What are the 7 anatomy parts of the external eye?

A
  • palpebral fissures: elliptical space b/w eyelids
  • canthus: where eyelids meet on corners
  • inner canthus/caruncle: nasal side and contains glands
  • conjunctiva: transparent protective covering over exposed part of eyeball
  • cornea: covers and protects iris & pupil
  • lacrimal apparatus: provides constant irrigation
  • lacrimal gland: secretes tears
207
Q

What are 4 components of the eye exam?

A
  • visual acuity testing; near and far
  • assessment of EOMs
  • inspection of external eye
  • inspection of the internal eye: lens, retina (fundus)
208
Q

How do you chart visual acuity?

A

ex: 20/80
20= distance from chart
80=what a person with perfect vision could read
- the lower the denominator the poorer the vision

209
Q

How should you look at near visual acuity?

A
  • handheld vision chart
  • jaeger test (pocket screener)
  • normal acuity is 14/14 with or without corrective lenses
210
Q

What are 3 types of vision?

A
  • hyperopia (farsightedness): light rays focus behind the retina
  • myopia (nearsightedness): light rays focus in front of retina
  • normal: light rays focus on the retina
211
Q

What is presbyopia?

A

age related change in the eyes in which the lens cannot accommodate for near vision
- referred to as aging eye condition

212
Q

What is astigmatism?

A

irregular surface of cornea or lens

213
Q

what is color blindness?

A

recessive X linked trait common in boys
- test boys between 4-8 yrs

214
Q

What is the confrontation test?

A
  • measure peripheral vision compared to examiner
  • both examiner and pt cover one eye with card, stand abt 2 ft away and maintain eye contact
  • advance finger, starting from periphery, and ask pt to say “now” when finger is visible
  • inability to see when the examiner sees suggests peripheral field loss
215
Q

is the confrontation test reliable?

A

no, b/c examiner’s vision could be impaired

216
Q

What are 3 tests to test extraocular muscle function?

A
  • corneal light reflex test: use penlight to observe parallel alignment of light reflection on corneas
  • cover test: use opaque card to cover an eye to observe for eye movement
  • positions test: observe for eye movement
217
Q

What controls the extraocular muscles?

A

CN 3, CN 4, CN 6

218
Q

What are 3 tests for EOM’s?

A
  • 6 cardinal fields of gaze
  • cover/uncover
  • corneal light reflex
219
Q

What are tow signs of asymmetrical corneal light reflex?

A
  • strabismus: constant malalignment (tropia) -> amblyopia
  • phoria: mild weakness - seen only w/ cover-uncover test
220
Q

How to perform cover test?

A
  • detects deviated alignment of eyes
  • ask pt. to stare straight at your nose and cover one of pt. eyes w/ a card
  • while noting the uncovered eye, move away the card
  • normal response should be a steady fixed gaze
221
Q

How to perform diagnostic position test?

A
  • ask pt. to hold head straight and move finger in all positions, holding abt. 12 inches away
  • normal response is parallel tracking of the objects w/ both eyes
  • nystagmus: fine oscillating movement around the iris, normal at extreme lateral gaze
222
Q

What are 3 deviations of the eye?

A
  • nystagmus: movement
  • strabismus: cross eye causing asymmetrical corneal light reflex
  • amblyopia: lazy eye, results from strabismus, blurred vision
223
Q

What are 4 types of strabismus?

A
  • Esotropia- turning inward
  • Exotropia - turning outward
  • Esophoria - covering causes eye to turn inward
  • Exophoria - covering causes eye to turn outward
224
Q

How should you test the six cardinal positions?

A
  • have pt follow light (or finger or pencil) through six positions
  • should have smooth even movement w/out nystagmus
225
Q

What 7 things should you inspect the eye for?

A
  • symmetry
  • exophthalmos
  • eyebrows/lashes/lids
  • lacrimal glands
  • conjunctiva
  • iris
  • pupil
226
Q

What is exophthalmos and what is bilateral vs unilateral indicative of?

A

a condition in which eyes are displaced forward (bulging)
- bilateral: associated w/ hyperthyroid
- unilateral: indicates tumor in orbit of eye

227
Q

What is a loss of outer third of eyebrows indicative of?

A

hypothyroid

228
Q

What are 7 abnormalities of external eye?

A
  • ptosis: drooping of eye, look at perebral fissures
  • exophthalmos: bulging of eye(s)
  • entropion vs ectropion: entropion is tight lower lid; ectropion is loose lower lid
  • chalazion: internal sti
  • hordeolum: external sti
  • blepharitis: oil glands of inner eyelid become inflamed; occurs along w/ other skin conditions or allergies
  • conjunctivitis: inflammation of the conjunctiva, contagious, “pink eye”
229
Q

What is the blink reflex associated w/?

A

coordinated action of CN 5 & CN 7

230
Q

What are 3 abnormalities of the cornea and lens?

A
  • corneal scar: grayish or white
  • pterygium: growth of conjunctiva or mucous membrane that covers sclera over cornea; surfers eye
  • cataract: leading cause of blindness where lens appears gray w/ black spot when viewing w/ ophthalmoscope
231
Q

What are 5 risk factors for cataracts?

A
  • smoking
  • alcohol
  • diabetes
  • age
  • sunlight
232
Q

What are 4 abnormalities of iris & pupil?

A
  • miosis: pinpoint, small pupils; due to brain damage or narcotic
  • anisocoria: unequal pupils; could be normal, if new sign of neurological issue
  • iritis: inflammation of iris
  • midritis: dilated pupils; due to anesthesia or CNS injury
233
Q

What is glaucoma?

A

high intraocular pressure interferes w/ blood supply to optic structure leading to damage to optic nerve and loss of peripheral vision

234
Q

What are two types of glaucoma?

A
  • open angle: chronic, gradual loss of peripheral vision
  • closed angle: sudden increase in intraocular pressure
235
Q

What are 7 steps for using ophthalmoascope?

A
  1. dim the room lighting. Do not remove contacts
  2. select the largest ophthalmoscope aperture using the horizontal wheel
  3. turn the number setting (diopter) to 0 for normal
  4. red number - near sight; black - far sight
  5. Stand to side of client, approx. 12-15 inches away and facing them at 15 degrees
  6. to examine the clients right eye, hold the ophthalmoscope in right hand and use your right eye
  7. locate the red reflex in clients eye. Maintain contact w/ the red reflex and more closer at a 15 degree angle
236
Q

What are two findings of the red reflex?

A
  • should be intact red circle, may appear silver in dark skinned clients
  • opacities (dark areas) in red reflex can indicate cataracts
237
Q

How to test pupillary reaction to light?

A
  • darkened room
  • you & client remove glasses (contacts not necessary)
  • have client focus on distant object
  • turn diopter to zero
  • shine light obliquely into pupil and observe the pupil’s reaction to light
  • pupils should constrict and should get red reflex
238
Q

What is accomodation?

A
  • shifting gaze from far to near
  • normally pupils constrict
239
Q

what are 8 older adult considerations relating to eyes?

A
  • arcus senilis: white arc around limbus w/ gray/yellow opaque ring from lipid & cholesterol
  • loss of skin elasticity and tissue atrophy cause orbit to be more prominent
  • lacrimal glands involute -> decreased tears -> dry eye
  • lens become less elastic -> decreased accommodation -> presbyopia
  • by 70, lens begins to yellow & thicken - cataracts
  • decreased vitreous renewal inside eye -> visual floaters
  • decreased ability to adjust for darkness, increases need for light
  • diabetic retinopathy: damage to retina vessels due to hyperglycemia
240
Q
A

Health Assessment (3 decks)

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