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EC Health Assessment > Exam 2 Material > Flashcards

Exam 2 Material Flashcards

1
Q

Where is the visual center located in the brain?

A

Occipital lobe

Half of the neocortex is involved with processing visual information

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2
Q

What protects the eye?

A

Protected by the bony orbital cavity and cushioned by fat 3/4 protected by bone, 1/4 protected by eyelids

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3
Q

Palpebral fissure

A

Where eyelids touch

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4
Q

Limbus

A

White goes into color; cornea and sclera

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5
Q

Pupil

A

Absence of tissue; aperture of the eye

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6
Q

Medial and lateral canthus

A

Corners of the eye

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7
Q

Conjunctiva (palpebral and bulbar)

A

Always clear unless pathology is present

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8
Q

Lacrimal apparatus

A

Tear glands

Palpated in exam to determine if there is lacrimal reguritation

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9
Q

Extraocular muscles

A

Multiple muscles that are attached to the eyeball that twists and turn the eyeball to where it needs to go.

Innervated by cranial nerves III, IV, and VI

CN IV allows eyes to look toward the nose

CN VI lets the eyes look laterally

CN III does all other movements

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10
Q

If eye is not moving correctly, what is the likely cause?

A

Innervation problem. Muscles normally are fine unless there is trauma.

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11
Q

What cranial nerve innervates the extraocular muscles that moves the eyes laterally?

A

CN VI

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12
Q

What cranial nerve innervates the extraocular muscles that moves the eyes toward the nose

A

CN IV

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13
Q

Layers of the eye

A

The eye is a sphere of three concentric coats

  1. Outer layer -sclera
  2. Middle layer - choroid: ciliary body, iris, pupil, lens, anterior chamber
  3. Inner layer - retina: optic disc, retinal vessels, macula
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14
Q

What is the center of vision in the eye

A

Macula

Does not coincide with where the optic nerve innervates

Dense cones and rods

Fovea: center of the macula - highest density of cones, no rods

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15
Q

What is in the retina

A

Macula (center of vision) and optic disc (where the optic nerve is attached to the eye)

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16
Q

Visual reflexes

A
  • Pupillary light reflex (direct light reflex vs consensual light reflex)
    • Light causes pupils to constrict
    • Both eyes should constrict evenly with light shown only in one eye
  • Accomodation
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17
Q

Vision pathway

A

Light to cornea to lens to retina to nerve impulses to optic nerve to visual cortex

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18
Q

What happens to depth perception when blind in one eye?

A

Do not have depth preception

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19
Q

Health history questions for eyes

A
  • Vision difficulty? acuity, blurring, blind spots
  • Pain
  • Strabismus, diplopia
  • Redness, swelling
  • Watering, discharge
  • Past history of eye problem
  • Glaucoma
  • Use of glasses or contact lenses
  • Self-care behaviors - make up?
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20
Q

Equipment needed for Eye Exam

A
  • Snellen or Rosenbaum
  • Opaque card
  • Penlight
  • Ophthalmoscope
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21
Q

Snellen/Rosenbaum

A

Tests visual acuity (CN II)

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22
Q

Myopia

A
  • Near sighted
  • Flatter eyeball; more oblong
  • Light focuses in front of the retina
  • Develops in childhood
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23
Q

Hypermyopia

A
  • Far-sighted
  • Retina is too high
  • Light focuses behind the retina
  • Develops in childhood
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24
Q

How do glasses help with vision acuity?

A

Change the way the light foces so that it is cetnered on the macule

Hyperopia uses convex lenses

Myopia uses concave lenses

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25
Q

What is an astigmatism?

A
  • Cornea or lens are curved irregularly/enevenly (not round)
  • Causes a fuzzy or distorted vision
    • Refraction of light does not focus the right way
  • Often causes halos and glare at night
  • Sometimes can be corrected
  • Brain learn to compensate
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26
Q

Corneal Light Reflex (Hirschberg Test)

A
  • Shine a light in the middle of the nose and see where the light reflects
  • If pupils are not in the same position, the light will reflect in different places
  • Not about being symmetric, it is about being in the same spot
  • May look cross eyed, but not
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27
Q

Cover Test

A
  • Detects small degrees of stabismus (lazy eye) by interrupting fusion reflex that normally keeps eyes parallel
  • Ask the person to stare straight ahead to your nose even though gaze may be interrupted
  • With a card, cover one eye
    • Not uncovered eye normal response: steady fixed gaze
    • If muscle weakness exists, covered eye will drift into a relaxed position
    • Uncover the eye and observe it for movement - it should be straight ahead; if it jumps to reestablish fixation, eye muscle weaness exists
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28
Q

Causes of strabismus

A

Lazy eye

Eyeball is not turned in the right direction (typically a nerve issue, can be muscular)

Eye patches are used to cover the good eye to try to strengthen the bad one

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29
Q

6 Cardinal Fields of Gaze

A

Tests muscles and their innervations

Can tel if someone has a beat - neurological impairment

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30
Q

PERRLA

A
  • Pupils
  • Equal
  • Round
  • Ractive
  • Light
  • Accomodation: pupils dilate at a distant and constrict and converge when object is closer
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31
Q

Blepheritis

A

Inflammation of the eylash follicles

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32
Q

Hordeolum

A

Stye

Focal acute infection of the eyelash follicle or less commonly the meibomian gland

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33
Q

Chalazion

A

Eyelid cyst

Obstruction of the meibomian gland; may become chronic

Not necessarily injected, just blocked

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34
Q

Conjunctivitis

A

Pink eye

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35
Q

Hemotoma of the conjunctiva

A

Superficial; does not go into the iris; between the conjunctiva and sclera

Can breakthrough the sclera and “bleed”

Can’t do anything about this

Can happen when sneezing or on blood thinners

Bruise on eye

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36
Q

Senile plaque

A

Found on the sclera

Normal

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37
Q

Icterus

A

Jaundice of the eye

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38
Q

Lacrimal examination

A

Pressing on the lacrimal duct to see if there is regurgitation

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39
Q

Use of the ophtalmoscope

A

Diopters

Lens opening

The red refelx

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40
Q

Red Reflex

A

Reflection of the light on your retina

A tumor or cataracts: light goes right through

CANT do with a penlight

Can be seen with cameras

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41
Q

Eyesight and infants/children

A
  • Macula is absent at bith, it is fully developed by 8 months
    • Why babies have no focused vision
  • Infants are born farshighted (80%) but decreases after 7-8 y
  • Some kids will grow out of their glasses
  • Eyeballs reach adult size by 8 years
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42
Q

Arcus senilis

A

Fat deposits on the cornea; gray or white visible arc

Normal varian; does not really do anything to them

Occurs in older adults

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43
Q

Ectropion

A

Eyelid flips open and dries out the eye

Occurs in older adults

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44
Q

Entropion

A

Eyelashes in the eye (mostly lower eyelid)

Many infections

Needs to be surgically corrected

Occurs in older adults

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45
Q

Adults and eyes

A
  • Pupil size decreases
  • Lenses loses elasticity, becomes hard and glasslike, which decreases its ability to change shape to accomodate for near vision (Presbyopia)
  • By age 70, normally transparent fibers of lens begin to thicken and yellow, the beginning of cataracts
  • Visual acuity may diminish graduallly after age 50, and more so after age 70
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46
Q

Ears

A

Sensory organs for hearing and maintaining equilibrium and have three parts:

External ear

Middle ear

Inner ear

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47
Q

Parts of the middle ear

A

Malleus, incus, and stapes

Eustachian tube

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48
Q

Parts of inner ear

A

Vestibule and semicircular canals

Cochlea

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49
Q

Eardrum/tympanic membrane

A
  • Far into the skull
  • Nor really going to damage it with an otoscope
  • Have to pull ear in certain directions to angle the otoscope to see through
  • Can still hear if it is broken
  • Ear infections often have fluid that is backed up behind the membrne
  • Membrane should be pearly gray, intact, and translucent
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50
Q

Middle ear bones

A
  • Malleus, incus, and stapes
  • Bones create waves tha transmit the sounds to the nerves
  • Can be out of place after trauma
    • Can’t hear when the bones are out of place - nothing is transmitting the pulsations
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51
Q

Cristae

A

Part of the inner ear

They move to give a sense of position in space (proprioception)

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52
Q

3 levels of the auditory system

A

Peripheral

Brainstem

Cerebral cortex

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53
Q

Conductive hearing loss

A

Problem with the impulse

Trauma can cause this

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54
Q

Sensorineural (perception) hearing loss

A

Problem with the nerve conducting the impulse to the brain

Could be problems with the brain

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55
Q

Equilibrium problems in the ear

A

Inner ear problems

Not really a hearing problem - can cause tenatis (ringing)

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56
Q

Pathway of hearing

A

Sound waves travel to the ear and produce vibrations on the typanic membrane.

Vibrations are carried by the middle ear ossicles to the oval window.

From the oval window, it travels through the cochlea to the round window.

Basilar membrane vibrates as well that has receptor hair cells of the organ of Corti.

As the hair cells bend, it sends electrical impulses to the brainstem by CN VIII.

Brainstem determines the direction of the sound and identification of the sound.

Cortex interprets the sound and the appropriate response.

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57
Q

How can a hearing aid attached to the skull amplify sounds?

A

Sound waves can go through the skull

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58
Q

Exostosis

A

Bone spur or malformation that prevents the sound waves from reaching the tymanic membrane

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59
Q

Otitis media with effusion

A

Can cause hearing loss

Serum in middle ear that transudes to relieve negative pressure from the blocked eustachian tube.

May see air bubbles or fluid level.

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60
Q

Hearing loss due to cochlea damage

A

Sensorineuro - can’t normally fix sensorineural, can normally fix conductive hearing loss

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61
Q

What frequency is typically lost first?

A

High frequency

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62
Q

Equipment needed for an ear exam

A

Otoscope with a bright light

Tuning fork in 512 Hz (cut of normal hearing - hearing acuity test)

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63
Q

Inspection/palpation of the external ear

A

Palpate for tenderness, not really trying to feel for something

Observe the size and shape, skin condition, external auditory meatus (canal)

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64
Q

Ears and brain formation

A

Ears form when the brain forms.

Can often twll if there is a brain concern by observing the ears.

Low set of ears can be a sign of Down’s.

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65
Q

Darwin’s tubercle

A

The same as the tip of an ear of a dog/cat.

Present in 10% of people

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66
Q

External Otitis

A

Ear infection of the outer ear.

Swimmer’s ear

Swelling can be so bad it can shut.

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67
Q

Hearing acuity test

A

Can assess during conversational speech - turn away to see if they respond and are not just reading your lips.

Voice test: 3 numbers/letters standing behind them they can repeat back.

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68
Q

Weber Test

A

Tuning fork test

  • Hold the tuning fork at the stick
  • Squeeze prongs together
  • Measure sbone conduction
  • Should be able to hear sound bilaterally
  • If they do not, it is a sound processing issue (sensoineural)
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69
Q

Renne Test

A

Measures air and bone conduction

  • Set off tuning fork
  • Put tuning fork behind the ear with the tuning fork angled down (pointing away from the ear)
  • Then tak ethe fork of when they can’t hear it any more and put it next to the ear to see if they can still hear
  • Air conduction should be greater than bone conduction - they can still hear after the fork is removed
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70
Q

Otoscopic examination

A
  • Position the head and ear
    • Down and out for adults
    • Up and out for infant (up to 3)
  • Method of holding the otoscope (whatever is comfortable)
  • External canal (color, swlling, lesions, dishcarge)
  • Cerumen usually present - normal mechanism of the ear to lubricate and clean
    • Dry cerumen: gray and flaky
    • Wet cerumen: honey brown to dark brown and mist
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71
Q

Normal tympanic membrane (TM)

A
  • Color: see-through, white/gray
  • Characteristics: flat
  • Should be intact
  • Cone of light - always pointing toward the jaw
    • 5 o’clock: right ear
    • 7 o’clock right ear
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72
Q

Retracted Tympanic membrane

A
  • Tympanic membrane is pulled backward
  • Dehydrated
  • Makes the bone stick out - like cellophane wrap over the bones
  • Cone of light is not distinct and not in correct location
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73
Q

Bulging tympanic membrane

A
  • May see air bubbles
  • Fluid is behind the membrane
  • Erythematous
  • Fluid is a sign of infection - may be a sinus infection
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74
Q

Tympanostomy

A

Tubes in tympanic membrane to equalize the pressure

Should fall out on their own

If they do not fall out, they may be overgrown but still left unless there is a problem

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75
Q

Ears of older adults

A
  • Cilia become coarse and stiff
  • Cerumen is dryer - why there is cerumen impaction
  • Result is ofter impacted cerumen and hence conductive hearing loss
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76
Q

Presbycusis

A
  • Hearing loss that occurs with aging
  • Sensorineural loss caused by nerve degeneration
  • Starts to occur around 50 and slowly progresses
  • High-frequency tone loss
  • Ability to localize sound is also impaired
  • Not much you can do about it
77
Q

Process of Swallowing

A
  • Tongue elevates to soft palate when bolus is placed in the oral cavity
  • Positive pressure is applied to the bolus tail
  • Epiglottis comes down and closes the entrance of the trachea - prevents aspiration
  • Many different things can go wrong - makes it difficult to diagnose what the dysfunction is
78
Q

Nasal cavity

A
  • Surrounded by bony structures with sinuses behind
  • Lined by mucosa
    • Polyps can grow and form an obstruction (occurs often with allergies and infections)
  • Openings into the cavity:
    • Eustachian tube
    • Tear ducts - why we blow our nose when we cry
    • Frontal sinus
  • Most of the nose is cartilage, only top third is bone
79
Q

Function of the nose:

A

Warms, moistens, and filters inhaled air

Is a sensory organ of smell

Air is turbulent in the cavity

80
Q

Septum of the nose

A

Anterior part of the septum hold a rich vascular network, Kisselbach’s plexus (most common site of nosebleeds - why we put pressure on the nose).

Separates nostrils (naris)

81
Q

Turbinates and meatus

A
  • Lateral walls of each nasal cavity contain three parallel bony projections: superior, middle, and inferior turbinates
  • Underlying each turbinate is a cleft, the meatus, which is named for the turbinate above
  • Sinuses drain into the middle meatus
  • Tears from the nasolacrimal duct drain into the inferior meatus
82
Q

Paranasal sinuses

A
  • Two are accessible to examination
    • Frontal sinuses: in frontal bone above and medial to orbits
    • Maxillary sinuses: in maxilla along side walls of nasal cavity
  • Non-accessible, smaller and deeper:
    • Ethmoid sinuses: between the orbits
    • Sphenoid sinuses: deep within skull in the sphenoid bone
83
Q

What sinuses are present at birth?

A

Maxillary and ethmoid

  • Maxillary sinuses full size after all the permanent teeth have erupted
  • Ethmoid snuses grow rapidly between 6-8 years and after puberty
  • Frontal sunses (absent at birth) are fairly well developed bytween ages 7 and 8, reach full size after puberty
  • Sphenoid sunses are minute at birth and develop after puberty
84
Q

What age can you assess sinuses?

A

8

85
Q

Function of the mouth

A

Functions in the digestive and respiratory systems

86
Q

Parts of the mouth

A
  • Hard and soft palates
  • Tongue
  • Uvula (should be straight)
  • Salivary glands: parotid, submandibular, sublingual
  • Lingual frenulum
  • Teeth
87
Q

Salivary glands

A

Parotid, submandibular, sublingual

Can get blocked, have a stone, get inflamed, get an infection

88
Q

What gets snipped in a tongue tie?

A

Lingual frenulum

89
Q

Why are teeth important?

A

Can get systemic infections from a tooth infection because they grow from bone

Can show how the body is functioning

90
Q

Parts of the throat

A

Tonils

Nasopharynx

91
Q

Equipment needed for nose, mouth/throat exam

A

Otoscope or penlight

Gloves

Tongue blade

Alcohol swab and coffee or other intense smelling substances

92
Q

External nose exam

A
  • Is it striaght? Has light bend or extensive?
  • Test patency of nostrils - with smells
    • Olfactory sense CN I
93
Q

Nasal cavity exam

A
  • Look for color, polyps, exudate
  • Nasal septum - straight?
  • Turbinates
94
Q

Why is it important to look under the tongue?

A

Common site for mouth cancers because it is the site of salivary glands

95
Q

Mouth exam

A
  • Lips
  • Teeth
  • Gums
  • Tongue
  • Under the tongue
  • Buccal mucosa
  • Hard and soft palate
  • Uvula
  • Tonsils
  • Pharynx
96
Q

What cranial nerve causes tongue movment?

A

CN XII

97
Q

Tonsil grading

A

+4 = kissing tonsils

+3 = touching uvula

+2 = prominent tonsils

+1 = have to look to see them

98
Q

Cranial neves in swallowing/gaging

A

CN IX and X

99
Q

Mucocele

A
  • Little blister in the mucosa
  • From trauma
  • Usually benign
100
Q

Mumps

A
  • Infection of the salivary glands
  • Usually unilateral
  • Can cause infertility, especially in males
101
Q

Torus Palatinus

A

Tumor - can be malignant or benign

Needs to be excised

Normal variation in the hard palate

More common in American Indians, Inuits, Asians and females

102
Q

Cleft Palate/Lip

A
  • When it is split all of the way, it needs to be fixed
    • Effects nutrition, risk of infection, failure to thrive
  • Fixed with bone grafts
    • Bone is missine
    • Sometimes needs multiple surgeries
    • Surgery is often done around age 3
  • Often those with cleft palates have ear infections
103
Q

Vagal reflex

A

Pressure on the vagus nerve causes the heart rate to drop and can cause syncope

Can put pressure on the vagal nerve to help with tachycardia

CN X

104
Q

Glossopharyngeal Nerve (CN IX)

A

Specific to the tongue and throat

Coodinates most of the movement with swallowing

Issues with swallowing after stroke due to this nerve

105
Q

Hypoglossal nerve (CN XII)

A

Innervates the botton of the tonuge

Movement of the tongue (lower 2/3)

Should innervate equally bilaterally - why it should stick out straight

Stroke can cause it to go TO THE SIDE THE STROKE OCCURRED on

106
Q

Allergic salute

A

Permanent crease in the nose due to wiping nose from allergies

107
Q

Pediatric mouth teaching

A
  • Saliva and drooling at 3 months
    • Does not mean they should have teeth
  • No bottle to bed
  • Fluoride - stabilizes enamel
108
Q

Pediatric Throat Assessment

A
  • Tonsils: many variations in size
    • Some children normally have “kissing” tonsils
    • Important to compare over time and assess other symotoms
  • Always remember to consider the ear, nose, mouth, and throat for a foreign body
    • Symptoms: foul ordor, purulent drainage, and wheezing if aspirated
109
Q

Changes in older adult nose and mouth

A
  • Nose appears more prominent
    • Subcutaneous tissue in the face becomes diminished
  • Nasal hairs grow coarser
  • Diminished sense of smell
  • Decreased number of taste buds
    • Why older people use more salt
    • Affects flavor of food
  • Changes in teeth
    • Loss in gingiva, discoloration, loss of bone density
110
Q

Non-synovial joints

A

Bones united by fibrous tissue or cartilage

111
Q

Synovial joints

A

Freely moveable

Have synovial membranes and/or bursa

112
Q

Number of bones in the body

A

206

113
Q

Types of bone

A
  • Trabecular
    • Spongy
    • Produces red blood cells
    • Ends of long bones, pelvis, ribs, vertebrae, and skull
  • Cortical
    • Dense and strong
    • 80% of skeletal mass
    • Less bioactive
    • Carrying part of the bone
    • Hollow with bone marrow
114
Q

Cartilage

A

Avascular

Receives nourishment from synovial fluid

Stable connective tissue with a slow cell turnover

Tough, firm consistency, yet flexible

Cushions bones and gives a smooth surface to facilitate movement

115
Q

Ligament

A

Fibrous bands that go from bone to bone

Help prevent undesirable movements

116
Q

Tendon

A

Strong, fibrous cord that connects muscle to bone

117
Q

Bursa

A

Sac full of synovial fluid

118
Q

Bone

A
  • A dynamic tissue that is in constant turnover
  • Basic multicellular unit (BMU)
  • Calcium deposits are the bone structure
119
Q

Osteoclast

A

Remove bone

120
Q

Osteoblasts

A

Replace bone

121
Q

Osteocyte

A

The actual bone cell

122
Q

Bone remodeling

A
  1. Activation: pre-osteoclasts are stimulated and differentiate under the unfluence of cytokines and growth factors into mature active osteoclasts
  2. Resorption: osteoclasts digest bone mineral matrix (old bone)
  3. Reversal: end of resorption
  4. Formation: osteoblasts synthesize new bone matrix
  5. Quiescence: osteoblasts become resting bone lining cells on the newly formed bone surface
123
Q

Muscles

A
  • Account for 40-50% of the body’s weight
  • Muscle mass declines by 8% a year after 40 and 15% a year after age 70
    • Important to determine if muscle loss is sudden or over time
  • Three types: skeletal, smooth, and cariac
124
Q

Skeletal muscle

A
  • Voluntary muscles under conscious cotnrol
    • If there are involuntary movements, there is something wrong
  • Each skeletal muscle is composed of bundles of muscle fibers, or fasciculi
  • Skeletal muscles are attached to bone by tendons, a strong fibrous cord
125
Q

Tempromandibular joint

A

Temporal bone and condyle of mandible

Connected to a muscle in a joint capsule

126
Q

Structure of the spine

A
  • 7 Cerival
  • 12 Thoracic
  • 5 Lumbar
  • 5 Sacral
  • 3-4 cocygeal
127
Q

Spine and Age

A
  • With age, intervertebral disks shrink - why people shring
  • With age, kypohsis often develops
128
Q

Shoulder

A
  • Glenohumeral joint: articulation of the humerus with glenoid fossa of scapula
  • Ball-and-socket action allows mobility of arm on many axis
  • Rotator cuff: group of four muscles and tendons support and stabilize shoulder
  • Palpable landmarks to guide your examination
  • Scapula and clavile form the shoulder girdle
  • Can feel the bumb of the scapula acromion process at the very top of the shoulder
129
Q

Elbow

A
  • 3 bony articulations: humerus, radius, ulna
  • Hinge action moves forearm (radius and ulna) on one plane, allowing flexion and extension
  • Palpable landmarks:
    • Medial and lateral epicondyles of humerus
    • Olecranon process of ulna
    • Radius and ulna articulate with each other at two radioulnar joints, one at the elbow and one at wrist
    • Permit pronation and supination of hand and forearm
130
Q

Wrist and Capals

A
  • Radiocarpal joint
  • Midcarpal joint
  • Metacarpophalangeal joints
  • Interphalangeal joints
  • Carpal tunnel is the tendons that come into the hand in a sheath and then after the carpal tunnel (wrist), they separate
131
Q

Osteoarthritis

A

Typically weight bearing

132
Q

Rheumatoid arthritis

A

Typically not weight bearing

133
Q

Hip

A
  • Articulation between acetabulum and head of the femur
  • Ball-and-socket action
  • Range of motion (ROM) on many axes, less than shoulder, but more stability for weight-bearing function
  • Three bursae facilitate movement
  • Can’t do a full range of motion assessment while laying down/sitting
  • Most weight bearing joint of our body
134
Q

Knee

A
  • Femur, tibia, and patella
  • Suprapatellar pouch
  • Medial and lateral menisci
  • Prepatellar bursa
  • Quadriceps muscle
  • 2 sets of ligaments:
    • Cruciate gives anterior and posterior stability and help control rotation
    • Collateral ligaments give medial and lateral stability and prevent dislocation
  • Patella increases in the number of ligaments (compared to elbow)
  • Should have limited movements
  • Menisci typiclaly will not fix themselves (they are avascular)
135
Q

Baker’s Cyst

A

Synovial syst on the back of the knee from overuse

Typically not painful

Can get irritated

Not in itself harmful

136
Q

Ankle and Foot

A
  • Tibiotalar joint
  • Medial and lateral malleolus
  • Subtalar joint
  • Permits inversion and eversion of foot
  • Metatarsals
137
Q

Inversion Sprain

A
  • Ankle joint is connected with a lot of different tendons and ligaments that become sprained
  • Pulled, overextended will cause microtears that cause bruising
  • Tissue around it that is tender, NOT THE BONE
138
Q

Inspection of musculoskeletal

A
  • Size and contour of the joint
  • Skin and tissues over the joint
139
Q

Palpation of skeletomuscular

A
  • Skin temperature
  • Muscles, bony articulations, area of joint capsule
140
Q

Grading Muscle Strength

A
  • If a person can’t follow commands, this can’t be tested
  • Apply opposing force
  • 5 = Full ROM against gravity, full resistance
  • 4 = Full ROM againse gravity, some resistance
  • 3 = Full ROM with gravity
  • 2 = Full ROM with gravity eliminated (passive motion)
  • 1 = Slight contraction
  • 0 = No contraction
141
Q

Exam of TMJ

A
  • Inspect joint area
  • Palpate as person opens mouth
  • Motion and expected range
    • Open mouth maximally
    • Protrude lower jaw and move side to side
    • Stick out lower jaw
  • Palpate muscles of mastication
142
Q

Cervical Spine Exam

A
  • Inpext alignment of head/neck
  • Palpate spinous processes/muscles
  • ROM:
    • Chin to chest
    • Lift chin
    • Each ear to shoulder
    • Turn chin to each shoulder
143
Q

Shoulder Exam

A
  • Inspect joint
  • Palpate shoulders and axilla
  • Motion and expected range:
    • Arms forward and up
    • Arms behing back and hands up
    • Arms to side and up over head
    • Touch hands behind head
144
Q

Elbow Exam

A
  • Inspect joint in flexed and extended positions
  • Palpate joint and bony prominences
  • Motion and expected range:
    • Bend and straighten elbow
    • Pronate and supinate hand
145
Q

Wrist and Hand Exam

A
  • Inspect joints on dorsal and palmar sides
  • Palpate each joint
  • Motion and expected range:
    • Bend hand up
    • Bend hand down
    • Bend fingers up, down
    • Turn hands out, in
    • Spread fingers, make fist
    • Touch thumb to each finger
146
Q

Physical Exam of the Hip

A
  • Inspect as person stands
  • Palpate with person supine
  • Motion and expected range:
    • Riase leg
    • Knee to chest
    • Flex knee and hip, swing foot out, in
    • Swing laterally, medially
    • Stand and swing leg back
  • Want to inspect when standing (want to see how hip manages weight-bearing), palpate when sitting/laying (want to get into spaces)
147
Q

Physical Exam of the Knee

A
  • Inspect joint and muscle
  • Palpate
  • Motion and expected range
    • Bend knee
    • Extend knee
    • Check knee while ambulating
148
Q

The Physical Exam of the Ankle and Foot

A
  • Inspect with person sitting, standing, and walking
  • Palpate joints
  • Motion and expected range:
    • Point toes up, down
    • Turn soles out, in
    • Flex and straighten toes
149
Q

Physical Exam of the Spine

A
  • Inspect while person stands
  • Palpate spinous processes
  • Motion and expected range:
    • Bend sideways, backward
    • Twist shoulders to each side
150
Q

Parts of the Nervous System

A
  • Central nervous system (CNS)
    • Brain
    • Spinal cord
  • Peripheral Nervous System (PNS)
    • Includes all nerve fibers outside of the brain and spinal cord
    • CN I-XII
    • 31 pairs of spinal nerves and all of their branches
    • Sensory (afferent) messages to CNS from sensory receptors
      • Afferent: leading to something
    • Motot (efferent) messages from CNS to msucles and glands, as well as autonomic messages that govern internal organs and blood vessels
      • Efferent: away from something
151
Q

Cerebral Cortex

A

Center of functions governing thought, memory, reasoning, sensation, and voluntary movement

152
Q

Parts of the CNS

A
  • 2 halves of brain, each divided into 4 lobes
  • Frontal lobe
    • Broca’s area (expressive aphasia, nonfluent aphasia)
  • Parietal lobe
  • Temporal lobe
    • Wernicke’s area (receptive aphasia, fluent aphasia)
  • Occipital
  • Basal ganglia
  • Thalamus
  • Hypothalamus
  • Cerebellum (balance center)
  • Brainstem
    • Midbrain: regulates everything (breathing, heart, etc)
    • Pons
    • Medulla
  • Spinal cord: skeletal muscles are innervated
  • Sensory pathways: afferent
  • Motor pathways: efferent
153
Q

When Broca’s area is damaged, what happens?

A

People have trouble naming words; disconnection between thought and words

154
Q

What happens when there is damage to Wernicke’s area?

A

People can speak just fine, but can’t process what others are saying

Can’t process information

155
Q

Afferent sensory pathways

A
  • Spinothalamic tract
    • Anterior = pressure
    • Lateral = pain
  • Posterior = fine touch
156
Q

Sensory pathway

A

Spinal cord to medulla to pons to midbrain to cortex

157
Q

Motor pathways (efferent)

A
  • Corticospinal or pyramidal tract = higher function
  • 10% do not cross over
  • Extrapyramidal tracts = gross motor function
  • More primitive function gross motor
  • Cerebullar system = movement, equilibrium, posture
  • Upper motor nerves in CNS are affected during a stroke (CVA)
  • MS and ALS influences the lower motor nerves
158
Q

Cortical Homunculus

A

“Little man” of the primary motor cortex in precentral gyrus

Can have very localized deficits with stroke

159
Q

Pathway of Corticospinal Tracts

A
  • Upper motor neurons
    • Can be affected by CVA and MS
  • Lower motor neurons
    • Can be affected by ALS
160
Q

Cranial Nerves

A
  • Enter and exit the brain rather than the spinal cord
  • CN I and II extend from the cerebellum
  • CN II - XII exctend from the lower diencephalon and brainstem
161
Q

CN X

A

Vagus nerve

Travels to heart, respiratory muscles, stomach, and gallbladder

162
Q

Spinal nerves

A
  • 31 pairs of spinal nerves
  • Named for the region of spine from which they exit:
    • 8 cervical
    • 12 thoracic
    • 5 lumbar
    • 5 sacral
    • 1 coccygeal
163
Q

Somatic Nervous System

A

Voluntary muscles (skeletal muscles)

164
Q

Autonomic Nervous System

A

Involuntary (smooth muscle, cardiac muscle)

Innervates the bowels

165
Q

Types of reflexes

A
  • Deep tendon
  • Superficial
  • Visceral PRL
  • Pathologic Babinski
166
Q

Reflex Arc

A
  • Steps
    • Intact sensory, afferent nerve
    • Functional synapse
    • Intact motor, efferent nerve
    • Competent muscle
  • Voluntary muscles but an involuntary response
  • Information makes its way to the brain after the movement already occurred
  • Hitting the tendon stretches the muscle
    • Sensory nerves send the information to the spinal cord which sends information to the motor nerve
    • Motor nerve in spinal cord causes movement without signal from the brain
    • All chemical based - no higher function occurs
      • Issues with electrolyte imbalances can cause reflexes to change
  • Refelxes tells us how excitable the nervous system is
167
Q

Dermatomes

A

Dermal segmentation in cutaneous distribution of various spinal nerves

Can test spinal nerves by touching their skin

168
Q

CN I

A

Olfactory: smell

169
Q

CN II

A

Optic: sight

170
Q

CN III

A

Oculomotor: eye movement

171
Q

CN IV

A

Trochlear

172
Q

CN V

A

Trigeminal

Motor and sensory function

173
Q

CN VI

A

Abducens

174
Q

CN VII

A

Facial

Motor and sensory function

175
Q

CN VIII

A

Acoustic

176
Q

CN IX

A

Glossopharyngeal

Sensory and motor

Taste on the posterior 1/3 of the tongue

Parotid gland, carotid reflex

177
Q

CN X

A

Vagus

Motor and sensory function

Sensory sensation from carotid body, carotid sinus, pharynx, viscera

178
Q

CN XI

A

Spinal accessory

Motor

179
Q

CN XII

Motor

A

Hypoglossal

180
Q

Balance Tests

A

Cerebellar function

  • Gait
  • Tandem walking
  • Romberg test
  • Knee bend
181
Q

Coordination and skilled movments

A

Cerebellar function

  • Rapid alternating movements
  • Finger-to-finger test
  • Finger-to-nose test
  • Heel-to-shine test
182
Q

Exam of the spinothalamic tract

A
  • Pain (sharp-dull) - lateral STT
  • Temperature - lateral STT
  • Crude or light touch - anterior STT
183
Q

Exam of posterior (dorsal) column tract

A
  • Vibration
  • Position (kinesthesia, proprioception)
184
Q

Tactile Discrimination

A
  • Higher cortical function (fine touch)
  • Stereognosis: know what something is just from touch
  • Graphesthesia: know the number/letter from writing it on the skin
  • Two-point discrimination
  • Extinction (inability to perceive multiple stimuli at the same time)
  • Point location
185
Q

Grading reflexes

A
  • 4+ very brisk, hyperactive with clonus, indicative of disease
  • 3+ brisker than average, may indicate disease
  • 2+ average, normal
  • 1+ diminished, low normal
  • 0 no response
  • Reinforcement: concentration on other muscle groups
  • 4+ in preeclampsia can indicate a seizure is going to happen soon
  • Reflexes are named after the tendon that is hit and compared from side to side
186
Q

Plantar reflex

A

Should cause toes to curl in an adult

In a newborn, Babinski sign is normal (toe spreading)

Tested when expecting a brain trauma or demyelinating disease

187
Q

Neurological Recheck

A
  • Level of consciousness
  • Motor function
  • Pupillary response
  • Vital signs
188
Q

Mental Status Exam

A
  • Appearance - posture, dress, hygiene
  • Cognition - orientation, memory, attention span
  • Psycholgicla and psychiatris disorders - depression, anxiety
  • Judgment/though process - reason, logic, hallucinations, obsessions
  • Behavior - affect, speech, LOC
  • Substance use - prescriptions, OTC, street drugs
  • Developmental considerations - Peds: Denver II
189
Q

Level of Consciousness

A
  • Person - own name, occupation, names of workers, their occupation
  • Place - where the person is, name of the building, city, state
  • Time - day of the week, month, year, season, holiday
  • Glasgow coma scale

EC Health Assessment (14 decks)

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