EXAM 2 Flashcards
(202 cards)
1
Q
Cranial Nerve I: Olfactory Test
A
test sense of smell with familiar odor
2
Q
Cranial Nerve II: Optic Test
A
test visual acuity and visual field with confrontation
3
Q
Confrontation Test
A
gross measure of peripheral vision
-stand 2 fett from person
-have patient cover one eye, then cover your own eye opposite to the persons covered one
-hold finger as target midline between you and patient, slowly advance to periphery
-as person to say “now” as target is first seen
4
Q
Confrontation Test: normal
A
50 degrees upward
90 degrees temporal
70 degrees down
60 degrees nasal
5
Q
Cranial Nerve III, IV, VI: Oculomotor, Trochlear, Abducens Test
A
PERRLA
6 cardinal positions of gaze
6
Q
PERRLA
A
pupils equal, round, reactive to light (direct and consensual) and accommodation
7
Q
6 cardinal positions of gaze
A
right & up
right
right & down
left & up
left
left & down
8
Q
nystagmus
A
back-and-forth oscillation of the eyes
9
Q
nystagmus: amplitude
A
fine, medium or coarse movement
10
Q
nystagmus: frequency
A
constant or fades after few beats
11
Q
nystagmus: plane of movement
A
horizontal, vertical, rotary or combo
12
Q
Cranial Nerve V: Trigeminal Test
A
Motor: asking the client to clench her teeth while you palpate the masseter (muscle of mastication)
Sensory- test light touch by having a client closer their eyes while you toucher her face gently with a wisp of cotton, patient identifies location
13
Q
What does the corneal reflex test?
A
CN V sensory, CN VII motor
14
Q
Corneal reflex test
A
-remove contacts, bring cotton wisp from side, lightly touch cornea
NORMALLY: patient blinks bilaterally
15
Q
Cranial Nerve VII: Facial Test
A
Motor: have client smile, frown, puff out her cheeks, raise her eyebrows, close her eyes tightly
Sensory: anterior 2/3 taste (sugar, salt, lemon juice)
16
Q
Cranial Nerve VIII: Vestibulocochlear Test
A
Whispered voice test
17
Q
Cranial Nerve IX & X: Glossopharyngeal and Vagus Test
A
Motor: open mouth say “ahh” & gag reflex
NORMALLY: uvula and soft palate rise in midline
Sensory: CN IX does posterior 1/3 taste
18
Q
Cranial Nerve XI: Accessory Test
A
shrug shoulders
19
Q
Cranial Nerve XII: Hypoglossal Test
A
say “light, tight, dynamite”
20
Q
screening neuro exam
A
perform on well persons who have no significant subjective findings
21
Q
complete neuro exam
A
perform on person with neuro concerns
22
Q
screening neuro exam
A
perform on well persons who have no significant subjective findings
23
Q
neuro recheck exam
A
perform on person with demonstrated neuro defect, who requires period ic assessment
24
Q
ansomia
A
Decrease or loss of smell occurs bilaterally
25
hemianopsia; hemianopia
Defective vision or blindness in one half of the visual field
26
ptosis
drooping eyelid
27
paresthesias
tingling, prickling, "pins & needles" (sensory loss)
28
diplopia
double vision
29
dysphagia
difficulty swallowing
30
What are the test to evaluate cerebellar function?
Balance Test (Gait)
Romberg Test
Rapid Alternating Movements (RAM)
31
Balance Test (Gait)
-observe as the person walks 10 to 20 feet, turns and returns to the starting point
NORMALLY: gait is smooth, rhythmic and effortless opposing arm swing is coordinating
32
Romberg test
-ask client to stand with feet at comfortable distance apart, arms at sides, and eyes closed for ~20 seconds
NORMALLY: patient can maintain posture and balance
33
Rapid Alternating Movements (RAM)
pat the knees with both hands, turn hands over, then faster
NORMALLY: done with equal turning and quick rhythmic pace
34
flaccidity
decreased muscle tone (hypotonia), muscle feels limp, soft, flabby
35
spasticity
increased muscle tone (hypertonia)
36
rigidity
constant state of resistance; resists passive movement in any direction (dystonia)
37
cogwheel rigidity
Increased tone is released by degrees during passive range of motion so it feels like small, regular jerks.
38
paralysis
decreased or loss of motor power
39
hemiplegia
Spastic or flaccid paralysis of one side of the body
40
paraplegia
symmetric paralysis of both lower extremities
41
quadriplegia
paralysis of all four extremities
42
paresis
weakness of muscles rather than paralysis
43
tic
involuntary, compulsive, repetitive twitching of a muscle group
44
myoclonus
Rapid, sudden jerk or a short series of jerks at fairly regular intervals. (ex: hiccup)
45
fasciculation
rapid continuous twitching of resting muscle without movement of limb
46
chorea
sudden, rapid, jerky, purposeless movement involving limbs, trunk, or face
irregular intervals, not rhythmic or repetitive
47
athetosis
slow, writhing involuntary movements
48
tremor
involuntary contraction of opposing muscle groups resulting in rhythmic movement of one or more joints
49
rest tremor
occurs when muscles are quiet and supported against gravity (hand in lap), coarse and slow, partly or completely disappears with voluntary movement
50
intention tremor
worse with voluntary movement (like reaching to a target)
51
spastic hemiparesis
Arm is immobile against the body, with flexion of the shoulder, elbow, wrist, and fingers and adduction of shoulder; does not swing freely. Leg is stiff and extended and circumducts with each step (drags toe in a semicircle).
52
cerebellar ataxia
staggering, wide-based gait; difficulty with turns; uncoordinated movement with positive Romberg sign
53
parkinsonian (festinating)
Posture is stooped; trunk is pitched forward; elbows, hips, and knees are flexed. Shuffling gait. Difficulty with any change in direction.
54
scissors
knees cross or are in contact, like holding an orange between the thighs.
55
steppage or foot drop
slapping quality, looks like walking up stairs with no stairs there
56
waddling
weak hip muscles- when the person takes a step, the opposite hip drops, which allows compensatory lateral movement of pelvis
57
short leg
Leg length discrepancy >2.5 cm (1 inch).
58
cerebral palsy
damage to cerebral cortex from a developmental defect (infancy and childhood), intrauterine meningitis or encephalitis, birth trauma, anoxia
59
muscular dystrophy
a chronic, progressive wasting of skeletal musculature producing weakness contracture and respiratory dysfunction or death
60
Parkinsonism
loss of dopamine-producing neurons causing motor tract disorder
symptoms: resting tremor, bradykinesia, cogwheel rigidity
61
cerebellar
A lesion in one hemisphere produces motor abnormalities on the ipsilateral side.
62
Multiple Sclerosis (MS)
chronic, progressive, immune mediated disease which axons experience inflammation, demyelination, degeneration and finally sclerosis
63
decorticate rigidity
upper: flexion of arm, wrist fingers, adduction of arms
lower: extension, internal rotation, plantar flexion
*tippy toes, puppy cry
64
decerebrate rigidity
Upper: stiffly extended, adducted, internal rotation, palms pronated.
Lower extremities: stiffly extended, plantar flexion; teeth clenched; hyperextended back
*tippy toes, sheet gripper, arched back, head back
65
flaccid quadriplegia
complete loss of muscle tone and paralysis of all four extremities (completely nonfunctional brainstem)
66
Opisthotonos
prolonged arching of back, with head and heels bent backward (meningeal irritation)
*doing the superman on stomach
67
stereognosis
Test the persons ability to recognize objects by feeling their forms, sizes and weights
68
position (kinesthesia)
test person's ability to perceive passive movements of extremities
69
Tactile discrimination (fine touch)
measure the discrimination ability of the sensory cortex
70
Graphesthesia
ability to "read" a number by having it traced on the skin
71
two point discrimination
test ability to distinguish separation of two simultaneous pin points on skin
72
extinction
simultaneously touch both sides of body at the same time, both sensations should be felt
73
point location
touch skin and withdraw stimulus promptly; ask person to put finger where you touched
74
peripheral neuropathy
Loss of sensation involves all modalities; loss most severe distally at feet and hands
*complete loss at fingers and toes, diminished loss up to half forearm/half calf
75
individual nerves or roots
Decrease or loss of all sensory modalities; corresponds to distribution of involved nerve
*such as one entire arm
76
Spinal Cord Hemisection (Brown-Sequard Syndrome)
injury to one-half of the cord, causing contralateral loss of pain and temp
the ipsilateral side side of the lesion has paralysis and loss of vibration and touch sensation
*one leg has complete loss and the other has semi loss
77
Complete transection of spinal cord
Complete loss of all sensory modalities below level of lesion; associated with motor paralysis and loss of sphincter control
78
thalamus
loss of all sensory modality son the face, arm and leg on the side contrateral to lesion
79
cortex lesion
loss of discrimination on contralateral side; loss of graphesthesia, stereognosis, recognition of shapes and weights, finger findings
80
deep tendon reflexes (DTR)
measurement of stretch reflex reveals intactness of reflex arc at specific spinal levels and normal override on reflex of higher cortical levels
81
DTR scale
0 - no response
1+ - diminished low normal or occurs w reinforcement
2+ - normal
3+ - brisker than average may indicate disease
4+ - hyperactive w/ clonus, very brisk, indicative of disease
82
Clonus
test when reflex are hyperactive
83
how do you test clonus?
support lower leg in one hand and with other hand move foot up and down to relax muscle; then stretch muscle by briskly dorsiflexing fort, hold stretch
84
what do you normally and abnormally see in a clonus test?
NORMALLY: you feel no further movement
ABNORMALLY: note rapid rhythmic contractions of calf and foot
85
Tempomandibular Joint (TMJ) assessment
note smooth movement without limitations or tenderness, clicking or popping when jaw opens and closes
86
how do you assess the thyroid gland?
ask client to take a sip of water, hold in mouth, the swallow while palpating thyroid gland
-one hand palpates and the other displaces
87
what is abnormal in palpating the thyroid gland?
an enlarged thyroid
88
What does the nurse do next if the thyroid gland is enlarged?
LISTEN FOR BRUIT (turbulent blood flow)
check the area they drain from for source of the problem
89
how do you examine lymph nodes?
gentle circular motion of finger, palpate lymph nodes
90
visual acuity test: snellen chart
person 20 feet from chart, ask to read smallest line possible
91
what does 10/20 vision mean
patient reads 10 feet way what a normal person reads 20 feet away
92
visual acuity: jaeger card
normal: 14/14 without hesitancy or moving card
93
Corneal Light Reflex (Hirschberg Test)
Assess the parallel alignment of the eye axes by shining a light toward the person's eyes.
94
what is normal for the corneal light reflex test?
light reflection on cornea should be in same spot on each eye
95
pupillary light reflex
normal constriction of pupils when bright light shines on retina
96
consensual light reflex
simultaneous constriction of the other pupil
97
red reflex
red glow that appears to fill the person's pupil caused by reflection of light of inner retina
98
what is a normal finding for the whispered voice test
person can repeat back a the combo of letters and numbers
99
tuning fork test
Measure bone and air conduction of sound
100
what is vestibular apparatus and what test is used?
a sensory organ for detecting sensations of equilibrium.
-romberg test
101
palpation of the sinus area
Using thumbs, press frontal sinuses by pressing up and under the eyebrows and over maxillary sinuses below cheekbones
102
tonsil scale
1+ visible
2+ halfway between tonsillar pillars and uvula
3+ touching uvula
4+ touching each other
NORMAL IS 1-2
103
presbyopia
lens loses elasticity, becoming hard and glasslike. decrease ability to change shape and accommodate near vision
104
cataracts
transparent fibers of lens begin to thicken and yellow, resulting from a clumping of protein in lens
105
glaucoma
increased intraocular pressure
106
macular degeneration
breakdown of cells in macula of the retina
- loss of central vision is the most common cause of blindness (person may be unable to read fine print, sew, etc)
107
pingueculae
common non-cancerous growth that forms on conjunctiva
108
otosclerosis
gradual hardening that causes foot plate of stapes to become fixed in oval window, impeding of sound transmission causing progressive deafness
109
impacted cerumen
common but reversible cause of hearing loss in older people
110
presbycusis
type of hearing loss occurring w aging
111
gradual sensorineural loss
caused by nerve degeneration in inner ear to auditory nerve
112
what tone loss is noticed first in older adults
high-frequency
113
senile tremors
benign and include head nodding (as if saying yes or no) and tongue protrusion (older adult)
114
kyphosis
humpback
115
when performing ROM on older adult...
PERFORM ROM SLOWLY to prevent lightheaded/diziness
116
tension headache
occurs on both sides across frontal, temporal and occipital region, BAND LIKE TIGHTNESS, non throbbing, non pulsatile
117
migraine headache
commonly one sided but can occur on both sides, pain behind eyes, temples and forehead, throbbing, pulsating
118
cluster headache
rare HA, intermittent, excruciating , unilateral, always one sided, often behind or around eye, temple, forehead, cheek, continuous, burning or piercing
119
Parkinsons syndrome facial appearances
immobility of features produces face that is flat, expressionless, "MASK LIKE" with elevated eyebrows, staring gaze, oily skin, drooling
120
Cushing syndrome facial appearances
rounded "MOONLIKE" face, prominent jewels, red cheeks and chin, acneiform rash on chest
121
Graves disease facial appearance
(hyperthyroidism) goiter, eyelid retraction and exophthalmos (bulging eyeballs)
122
Hypothyroidism (myxedema)
puffy, edematous face, periorbital edema, puffy hands feet, coarse face feature, cool dry skin, coarse hair and eyebrow
123
bells palsy facial appearance
complete paralysis of one side of face, person cannot wrinkle forehead, raise eyebrows, close eyelids, whistle or show teeth on left side. usually presents w smooth forehead, wide palepral fissure
124
stroke (brain attack/cerebrovasular accident) facial appearance
note paralysis of lower facial muscle but also note the upper half of the face is NOT affected, person is able to wrinkle forehead and close eyes
*paralyzed quadrant of face
125
cachexia appearance
sunken eyes, hollow cheeks and exhausted defeated expression
126
scleroderma
"hard skin". a chronic connective tissue disorder associated with decreased mobility
127
strabismus
crossed eyes
128
diplopia
double vision
129
what do normal conjunctiva look like
clear and show normal color, pink lower ids and white sclera
130
normal eye appearance in African Americans
have gray/blue or darker color to sclera, normally my see small brown macule (like freckles) on sclera
-may have yellowish fatty deposits beneath lids away from cornea
131
esotropia
inward turning of the eye
132
exotropia
outward turning of the eye
133
periorbital edema
edema around the eyes
134
exophthalmos
protruding eyeballs
135
Enophthalmos
sunken eyes
136
ptosis
drooping upper lid
137
upward palpebral slant
seen in Asians, also it indicates Down syndrome.
138
ectropion
the rolling out (eversion) of the edge of an eyelid
139
entropion
inward turning of the rim of the eyelid
140
blepharitis
inflammation of the eyelid
141
chalazion
beady nodule protruding on the lid (an obstruction and inflammation of meibomian gland)
142
hordeolum
stye, acute localized staph infection of hair follicles at lid margin, painful red swollen
143
dacryocystitis
inflammation of the lacrimal (tear) sac
144
basal cell carcinoma
small painless nodule with central ulceration and sharp, rolled out pearly edges, removal, usually cures it
145
anisocoria
unequal pupil size
146
monocular blindness
When light is directed into blind eye, no response in either eye. When it is directed to normal eye, both pupils constrict.
147
miosis
constricted & fixed pupils
148
mydriasis
dilation & fixed pupil
149
mydriasis
dilation & fixed pupil
150
Argyll Robertson pupil
Constricts w/ accomodation but is not reactive to light.
151
Tonic (Adie's) Pupil
reaction to light and accommodation is sluggish
152
CN III damage
Unilateral dilated pupil has no reaction to light or accommodation. Ptosis with eye deviating down and laterally may be present.
*ptosis, mydriasis, down and out
153
Horner's syndrome
Unilateral, small, regular pupil does react to light and accommodation. also note Ptosis and absence of sweat (anhidrosis) on same side.
*ptosis, miosis, and anhidrosis
154
Conductive hearing loss causes
partial loss caused by impacted cerumen, pus, perforated TM, decrease mobility of ossicles
155
sensorinerual hearing loss
path of inner ear and CN VIII or auditory area of cerebral cortex
156
mixed hearing loss
combination of sensorineural and conductive hearing loss
*sens: dmg to nerve = muffled sound
*cond: blockage/dmg to outer ear; earwax impaction, perf TM
157
dry cerumen
gray, flaky, and frequently forms thin mass in ear canal
158
wet cerumen
honey brown to dark brown and moist
159
otitis externa
swimmers ear
160
sebaceous cyst
a nodule with central black punctum indicates blocked sebaceous glands
161
tophi
Small, whitish yellow, hard, nontender nodules in or near helix or antihelix; contain greasy, chalky material of uric acid crystals and are a sign of gout.
162
Chondrodermatitis Nodularis Helicus
Painful nodules develop on the rim of the helix as a result of repetitive mechanical pressure or environmental trauma
163
keloid
overgrowth of scar tissue
164
bifid uvula
uvula split completely or partially
165
cleft lip and palate
congenital split of the lip and roof of the mouth
166
torus palatinus
bony ridge running in middle of hard palate
167
leukoedema
a benign lesion occurring on buccal mucosa, is seen more often in African Americans
168
epistaxis
nosebleed
169
xerostomia
dry mouth
170
what is a normal appearance in mouth of African Americans
bluish lips and dark line on gingival margin
171
Edentulous
lacking teeth
172
furuncle
A small boil located in the skin or mucous membrane; appears red and swollen and is quite painful.
173
foreign body
putting an object up the nose
174
perforated septum
hole in septum
175
acute rhinitis
(nonallergic) first sign is watery discharge which can become purulent with sneezing
176
rhinorrhea
discharge from the nose
177
allergic rhinitis
abnormal immune response, rhinorrhea , itching of nose eyes, lacrimation, congestion sneezing
178
Sinusitus
acute inflames sinus area may have mucopurulent drainage with face pain/pressure
179
nasal polyps
smooth, pale gray nodules (overgrowth of mucosa) from chronic allergic rhinitis
180
Angular Cheilitis (Stomatitis, Perleche)
Erythema, scaling, and shallow and painful fissures at the corners of the mouth
181
what is the acronym for a stroke?
FAST
F: facial drooping
A: arm weakness
S: speech impairment
T: time to call 911
182
use abbreviation of neurologic examination in the following sequence:
Level of Consciousness (LOC)
Glasgow Coma Scale (GSG)
Motor function
Pupillary respinse
Vital signs
183
Level of Consciousness (LOC)
state of awareness of self and environment
-change in LOC is the single most important factor in this examination
184
Glasgow Coma Scale (GCS)
rate patient on :
-Eye-opening response (4-1):
spontaneous, to speech, to
pain, no response
-Motor response (6-1): obeys
verbal command, localizes pain, flexion (withdrawal), flexion (abnormal), extension (abnormal), no response
-Verbal response (5-1): oriented x3 (appropriate), conversation confused, speech inappropriate, speech incomprehensible, no response
185
what is normal on the GCS?
15 - AOx3
186
what is the sequence of a Neuro exam
mental status
cranial nerves
motor system
sensory system
reflexes
187
Spinothalmic Tract
pain
temperature
light touch
188
posterior column tract
vibration, position, tactile discrimination
189
normal response: biceps reflex
contraction of biceps muscle and flexion of forearm
190
normal response: triceps reflex
extension of forearm
191
normal response: brachioradialis reflex
flexion and supination of forearm
192
normal response: quadriceps reflex
extension of lower leg
193
normal response: achilles reflex
foot is plantar flexes against your hand
194
Superficial (cutaneous) reflexes
sensory receptors in skin rather than in muscles;
motor response is localized muscle contraction
195
Babinski reflex
Reflex in which a newborn fans out the toes when the sole of the foot is touched
-for those 1 year old or younger otherwise its abnormal
196
normal response: abdominal reflexes
ipsilateral contraction of abdominal muscle with observed deviation of umbilicus toward stroke
197
normal response: planter reflex
plantar flexion of toes and inversion and flexion of forefoot
198
dyskinesia
difficult movement
older adults: repetitive stereotyped movements in jaw, lips, or tongue may accompany senile tremors; no associated rigidity present
199
lymph node palpation technique order
-Preauricular: in front of ear
-Posterior auricular (mastoid): superficial to mastoid
process
-Occipital: at base of skull
-Submental: midline, behind tip of mandible
-Submandibular: halfway between angle and tip of
mandible
-Jugulodigastric (tonsillar): under angle of mandible
-Superficial cervical: overlying sternomastoid
muscle
-Deep cervical: deep under sternomastoid muscle
-Posterior cervical: in posterior triangle along edge
of trapezius muscle
-Supraclavicular: just above and behind clavicle, at
sternomastoid muscle
200
hydrocephalus
obstruction of drainage of cerebrospinal fluid results in
excessive accumulation, increasing intracranial pressure, and enlargement of the head
201
objective vertigo
room is spinning
202
subjective vertigo
Person feels like he or she spins
