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ABSN > 307 Exam 5 Study Guide Questions > Flashcards

307 Exam 5 Study Guide Questions Flashcards

1
Q

What kinda of arthritis of the hands produces Herberden nodes and sometimes Bouchard nodes (bony overgrowth)

A

Osteoarthritis (degenerative joint disease)

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2
Q

What kind of arthritis of the hands presents as fingers deviating towards ulnar side, fingers may form swan neck deformities, and boutonniere deformities might develop?

A

CHRONIC rheumatoid arthritis

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3
Q

What disease creates knobby swelling around the joints that ulcerate and discharge white chalk like urates?

A

Chronic toohaceous gout

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4
Q

What is a positive Tinel sign?

A

When Tapping over the median nerve produces aching and numbness

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5
Q

How long do you hold a phalens sign for a positive result

A

60 seconds

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6
Q

What is the phalen test

A

Holding the wrists in flexion pressed together
Tests for carpal tunnel

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7
Q

When testing opposition of the thumb, the client has difficulty opposing your resistance. What could this indicate

A

Median nerve disorder
Carpal tunnel syndrome

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8
Q

Swelling over the patella suggests what?

A

bursitis, synovial thickening,
Effusion, ruptured achilles tendon

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9
Q

What is the process for physical inspection of the knee

A

Observe the gait, check the alignment and contours of knee, observe any muscle atrophy, look for swelling or hollows on or around knee

Palpate
Tibialfemoral joint
Suprapatellar pouch
Prepatellar bursa and anserine bursa
Gastroc, so keys and Achilles

ROM
Muscle strength test

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10
Q

What position is the patient in during palpating of a knee examination

A

Sitting on the edge of the examining table with knees in flexion.

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11
Q

What is the patellofemoral grinding test?

A

With the patient supine, and knee extended, compress the patella against underlying femur. Ask patient to tighten quads. Check for a smooth sliding motion of patella moving distally in the trochlear groove

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12
Q

If there is tenderness over the patellar tendon or an inability to extend the leg what does this suggest

A

Partial or complete tear of tendon

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13
Q

What movements do you assess with ROM of hip

A

Flexion
Hyperextension
Abduction
Adduction
External and internal rotation

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14
Q

Restricted hip abduction is common with what

A

Hip osteoarthritis

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15
Q

Risk factors for osteoporosis measuring tool is called what?

A

FRAX
Over 50
Low body mass
Low calcium
Low vit d
Poor fragility fracture
Relative with osteoporosis
Sedentary
Tobacco and alcohol
Inflammatory disorders
Corticosteroids use
Long term anticoagulants

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16
Q

What is a scaphoid fracture

A

A broken bone near the base of the thumb.
Tenderness over the “snuff box” is a sign of this. It is the most common injury of carpal bones

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17
Q

4 signs of inflammation in a joint

A

Swelling
Warmth
Tenderness
Redness

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18
Q

Relieving factors for spinal stenosis

A

Flexion

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19
Q

What spinal nerve innervates the diaphragm and controls breathing?

A

Phrenic nerve

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20
Q

The brachial plexus nerves innervate what area

A

The arms

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21
Q

The axillary nerve innervates

A

Teres minor and deltoid

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22
Q

What nerve runs down the anterior region of the arm?

A

Musculocutaneous nerve.
Innervates
Biceps brachii
Coracobrachialis
Brachialis

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23
Q

Nerve runs down back of arm and back of forearm

A

Radial nerve.
Triceps, all wrist extensors
Brachioradialis

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24
Q

Nerve that runs along anterior medial side of forearm and innervates pinky and ring finger is?

A

Ulnar nerve

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25
Q

What nerve runs down the middle of fore arm into the hand innervates carpal tunnel

A

Median nerve

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26
Q

Nerve that runs through anterior portions of thigh

A

Femoral nerve

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27
Q

Hip flexors are innervated by what nerve

A

Femoral nerve

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28
Q

Nerve that runs down the medial portion of thigh.

A

Obtruratur nerve.
Adductor muscles innervated

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29
Q

Nerve that innervates Posterior thigh
And is actually 2 nerves bundled

A

Sciatic nerve.
Branches off at knee into
Tibial (posterior) and peroneal (anterior and lateral)

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30
Q

Primary sensory modalities tested on physical exam include

A

Pain; light touch; vibration ; temperature; proprioception.

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31
Q

T4 dermatome sensory area?

A

Chest at the level of nipple
(Remember “T4 at Teet port”)

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32
Q

T7 dermatome sensory area

A

Chest at level of xyphoid process
Remember T7- at the bottom of sternum

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33
Q

T10 dermatome level of sensory area

A

Abdomen at umbillicus
Remember T10 at belly button

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34
Q

C6 dermatome innervates

A

Radial sure of forearm and Thumb

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35
Q

C7 dermatome innervates

A

Middle finger

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36
Q

C8 dermatome innervates

A

Pinky

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37
Q

T4 dermatome innervates

A

Thorax at level of nipples

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38
Q

Spinal stenosis relieving factors

A

Pain decrease with sitting or walking uphill (flexion)

More pain with extension

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39
Q

Scoliosis ABDC

A

A=Adams test
B=bending
C= cobbs
D= degrees

Adams test is bending foreword
Cobbs measures the degrees

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40
Q

Treatment for various degrees of scoliosis?
(Hint doubles)

A

If scoliometer is greater than 5 degrees - get X-ray.
10 degrees = definition of scoliosis
20 degrees= brace
40 degrees= surgery

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41
Q

C5 dermatome is associated with what deep tendon reflex

A

Biceps

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42
Q

C6 dermatome sensation and DTR

A

Dorsal lateral arm, forearm and thumb
Brachioradialis Deep tendon reflex

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43
Q

C 7 dermatome goes along where?
What dtr?

A

Posterior arm.
Triceps DTR

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44
Q

C8 dermatome controls what?

A

Pinky finger

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45
Q

L5 Dermatome is associated with what area

A

Lateral thigh. Top of foot. First and second toe (flip flop area)
Decreased big toe extension

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46
Q

S1 dermatome is associated with what area and DTR

A

Posterior leg and calf
Achilles tendon DTR (decreased ankle jerk)
Decreased plantar flexion (stepping on gas)

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47
Q

Leg pain that resolves with rest or lumbar forward flexion suggests what

A

Spinal stenosis

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48
Q

What are tremors that would be associated with Parkinson’s and present as fine pill rolling that are prominent with test and disappear with voluntary movement

A

Resting static tremors

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49
Q

What tremors can appear with hyperthyroidism, anxiety and fatigue?

A

Postural (action) tremors

50
Q

What tremors are absent at rest and get worse as the intended object of reach is neared? Seen with what disease?

A

Intention tremors
Multiple sclerosis

51
Q

What is receptive aphasia?

A

Wernicke aphasia

Articulation is good but Sentences lack meaning; speech incomprehensible
Lesion on posterior superior temporal lobe.
Comprehension is not there

52
Q

What is expressive aphasia?

A

Broca aphasia

Nonfluent or laborious effort to speak. Lesion on posterior inferior frontal lobe
Comprehension is there but cannot express

53
Q

Tandem walking can reveal what

A

Ataxia that might not be obvious

54
Q

Corticospinal tract damage is tested with what

A

Inability to heel walk

55
Q

During a hop in place test ,Difficulty with hopping may be due to what

A

Weakness, lack of position sense, or cerebellar dysfunction

56
Q

Reflex grading scale

A

0- no response
1 -diminished
2 -average
3-brisker than average (maybe disease)
4- hyperactive

57
Q

Hyperactive reflexes occur with what kind of lesions

A

CNS lesions along the descending Corticospinal tract

58
Q

What is clonus
And what does sustained clonus indicate?

A

Rhythmic oscillations
CNS disease

59
Q

How to assess an unconscious patient

A

Assess abc are stable
Assess w/ Glasgow coma scale
Assess level of consciousness

Interview friends, relatives, witnesses to establish speed of onset.
***
Observe pupil reactions
Ocular movement
Posture and muscle tone
Meninges signs

60
Q

During examination of a comatose patient what 2 things should you not do!

A

Don’t dilate the pupils
Don’t flex the neck if there is any question of trauma to head or neck.

61
Q

Large, fixed dilated pupils in a comatose patients suggests what

A

Severe anoxia and sympathomimetic effects (stimulant drugs), as seen after cardiac arrest.
Or
Atropine like agents.

62
Q

One large pupil that is fixed and dilated in a comatose patient warns of what

A

Herniation of temporal lobe cause of compression of oculi motor nerve and midbrain.
Common in diabetic patients with CN3 palsy

63
Q

Small pin point pupils less than 1mm suggests what in a comatose patient

A

A hemorrhage in the pons OR
Effects of morphine or narcotics

64
Q

Mid position fixed pupils in a comatose patient means what

A

Structural damage in the midbrain

65
Q

Structural lesions from stroke, bleeding, abscess, or tumor mass may lead to what assessment finding in a comatose patient

A

Asymmetric pupils and loss of light reaction due to pressure on cranial nerves.

66
Q

How to reduce risk of diabetic neuropathy

A

Maintaining optimal glycemic control.

Having feet examined regularly
(128hz tuning fork, semmes-Weinstein monofilament, check for skin breakdown, poor circulation and musculoskeletal abnormalities

67
Q

FAST acronym for stroke warning signs?

A

Face drooping
Arm weakness
Speech difficulty
Time to call 911

68
Q

Stroke risk factors

A

HTN
Smoking
Dyslipidemia
Diabetes
Obesity
Poor diet(high salt high fat)
Inactive
Alcohol
Sleep apnea
CAD
A fib

69
Q

To assess the ROM what instrument to do you use?

A

Goniometer

70
Q

what 3 ROM do you assess in TMJ

A

Open close of mouth
Protrusion and retraction
Lateral (side to side)

71
Q

What would palpable crepitus or clicking over the TMJ suggest

A

Meniscus injury, dislocation, trauma, Tmj syndrome

72
Q

What are the posterior sensory nerve columns of the spinal cord responsible for?

A

Sensations of vibrations,
Proprioception
Kinesthesia
Pressure
Fine touch

73
Q

What is a hemorrhagic stroke

A

Bleeding into the brain

74
Q

What is an ischemic stroke

A

Blood flow to brain in blocked.
These have 3 causes
Thrombus- blood clot in brain or neck
Embolus- moving blood clot from another area of body
Stenosis- narrowing of artery in brain

75
Q

What are important meningeal signs

A

Neck mobility (nuchal rigidity)
-neck stiffness with flexion 👎
Brudzinski sign
- flexion of hips and knees during neck flexion 👎
Kernig sign
-

76
Q

How to assess weakness in the hands

A

Test extension against resistance and test grip.
Finger abduction
Opposition of the thumb

77
Q

What nerve would be impaired with weak finger abduction?

A

Ulnar nerve

78
Q

C3 dermatome is associated with what part of the body

A

Neck

79
Q

L5 dermatome innervates what area of body

A

L5 vertebral area of low back and wraps around the hips, down side of legs and into the front of clad below the knee. Top of foot. Big toe, second toe

80
Q

Interventions for spinal stenosis

A

NSAIDs
Epidural steroid injections
Decompression surgery
PT
Weight loss

81
Q

Muscle strength grading scale

A

0-5
0 = No contraction
1= barely noticed
2= active without gravity
3= active w/ gravity
4= active against some resistance
5= active against full resistance (normal)

82
Q

Tenderness and warmth over a thickened synovium suggests what

A

Arthritis or infection

83
Q

Muscle atrophy or weakness occurs in rheumatoid arthritis t/f

A

True

84
Q

Restless leg syndrome. Aka Willis-ask I’m disease

A

Unpleasant sensation in legs w/ urge to move especially at night. Worse w/rest and improve w/ movement

85
Q

What are reversible causes of restless leg syndrome

A

Pregnancy
Renal disease
Iron deficiency

86
Q

What are oral facial dyskinesias

A

Bizarre facial movements and tix that involve tongue protrusions, jaw deviations, and opening closing of mouth
Can come from psychosis, or be a complication of psychotropic drugs.

87
Q

What is Dystonia

A

Neck twisting. Like from torticollis

88
Q

Athetosis is what

A

Slow twisting and writhing of fingers and hands. Causes include cerebral palsy

89
Q

Brief, rapid, jerky, unpredictable movements that occur at rest and seldom repeat are called.

A

Chorea. From huntingtons and rheumatic fever

90
Q

What is the Pound acronym and what is it for?

A

Pulsatile or throbbing
One day duration or 4-72 hrs untreated
Unilateral
Nausea or vomiting
Disabling

If 3/5 are present it is likely a migraine especially is preceded by aura or prodrome

91
Q

Glasgow coma scale scores less than 10 are concerning for severe brain injury? T/f

A

False.
Scores of 3-8 considered coma
15= fully functioning
3= lowest possible score. No response in any area

92
Q

What assessment techniques are done during a vertebral assessment

A

Inspection and palpation

93
Q

Damage to the sympathetic pathways if the hypothalamus can cause what symptoms.

A

Bilaterally small pupils.

94
Q

What part of the nervous system plays a role in anxiety

A

Autonomic nervous system
—sympathetic nervous system is fight or flight
—parasympathetic nervous system is test and digest
(Think parasympathetic = paralyzed, aka relaxed)

95
Q

When assessing levels of consciousness what techniques are used

A

Alertness- speak in normal tone(responds appropriately)
Lethargy- speak in loud voice( responds drowsy and falls back asleep)
Obtunded- shake patient gently(responds slowly w/ decreased interest in environment)
Stupor- apply painful stimulus (responds only to that)
Coma- apply repeated painful stimuli (no response=coma)

96
Q

Pinpoint pupils in a comatose patient means

A

Pons hemorrhage or narcotic effects

97
Q

Mid position fixed pupils in comatose patient means what

A

Damage to midbrain

98
Q

Abnormal postures in comatose patients

A

Decorticate rigidity- everything flexed, destructive lesion in Corticospinal tract

Hemiplegia- one sided paralysis, unilateral brain damage

Decerebate rigidity- jaw clenched, extended neck, knees and elbows. Probated forearms. Caused by a lesion in the diencephalon, midbrain, pons or from hypoxia or hypoglycemia

99
Q

Aphonia is what

A

Loss of voice
Laryngitis, vocal cord paralysis (CN X) laryngeal tumor.

100
Q

Dysarthria is what

A

Defect in muscle control of speech
(Lips, tongue, palate & pharynx. )
Motor lesion of central and peripheral nervous system. Parkinson’s and cerebral disease

101
Q

Apisia is what

A

A disorder in producing or understanding language.
Lesion in dominant cerebral hemisphere (usually left)

102
Q

When referring to gait what is swing?

A

Gait phase where the foot does not touch the ground

103
Q

Sacral segments dermatomes innervate where

A

Sacral region, back of the legs, and lateral side of feet

104
Q

glasgow coma scale rating

A

13-15 minor
9-12 moderate
3-8 severe

105
Q

eye response scoring for glasgow coma scale

A

spontaneous = 4
to speech= 3
to pain= 2
not= 1

106
Q

verbal response for glasgow coma scale

A

A&O x4 = 5
confused=4
inappropriate verbal response= 3
incomprehensible sounds = 2
none=1

107
Q

motor response for glasgow coma scale

A

obeys commands = 6
moves to localized pain= 5
withdrawas from painful stimuli= 4
abnormal flexion= 3
abnormal extension =2
none= 1

108
Q

comatose clients would rate what on the glasgow scale

A

8 or less (sever brain injury)

109
Q

glasgow rating of 9-12 means

A

moderate brain injury

110
Q

If a person can write a correct sentence can they still have apashia?

A

No

111
Q

A person who scores less than 17 points on a mini mental state exam would indicate what?

A

Severe cognitive impairment

30 is the max points as cognition declines, so does score.

112
Q

What is the PHQ used to screen?

A

Patient health questionnaire is used to screen for depression

113
Q

What screening tools are used for depression

A

PHQ
Geriatric depression scale
EDS (Edinburgh postnatal depression scale)

114
Q

SAFE-T evaluates what?

A

Suicide risk

115
Q

What is anhedonia?

A

Not finding pleasure in daily activities

116
Q

Clients most at risk for depressive symptoms would include

A

Females
Divorced or single
Chronically Ill
Young
Bereaved
Prior or family history of depression

117
Q

What is confabulation

A

Fabrication of facts or events in response to questions, to fill in the gaps of an impaired memory.
Often seen in Korsakoff syndrome from alcoholism, dementia, schizophrenia, aphasia or psychotic disorders.

118
Q

Korsakoff syndrome is what

A

A memory disorder results from vitamin B1 deficiency associated with alcoholism.

119
Q

Derailment is what

A

Tangential speech with shifting topics that are loosely connected or unrelated. Seen with schizophrenia

120
Q

Neologisms are what

A

Invented or distorted words
Words with new and highly idiosyncratic meanings.
Occurs with Korsakoff syndrome from alcoholism.

121
Q

Metabolic syndrome risk factors include

A

Large waist circumference (m> 40, f> 35)
High blood pressure >130/85
High fasting blood sugar 100mg/dL
High triglycerides 150mg/dL or higher

122
Q

What cranial nerve is involved with chewing

A

Trigeminal

ABSN (9 decks)

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