Exam 3 Flashcards
(137 cards)
1
Q
What is the function of the cerebral cortex?
A
Center of functions for governing thought, memory, reasoning, sensation, and voluntary movement
2
Q
What are the lobes of the cerebral cortex?
A
-Frontal lobe
-Parietal lobe
-Occipital lobe
-Temporal lobe
3
Q
What is the function of the frontal lobe?
A
-Personality
-Behavior
-Emotions
-Intellectual function
***Contains Broca’s area that mediates motor speech
4
Q
What is the function of the parietal lobe?
A
Sensation
5
Q
What is the function of the occipital lobe?
A
Visual receptor center
6
Q
What is the function of the temporal lobe?
A
-Auditory reception center
-Taste
-Smell
***Contains Wernicke’s area that is associated with language comprehension
7
Q
What are the components of the CNS?
A
-Basal ganglia
-Thalamus
-Hypothalamus
-Cerebellum
-Brainstem
-Spine
8
Q
What does the brainstem contain?
A
Central core of the brain
-Contains: midbrain, pons, and medulla
9
Q
What is the function of the hypothalamus?
A
Main respiratory center with basic function control and coordination
10
Q
What is the function of the cerebellum?
A
Concerned with motor coordination and muscle tone of voluntary movements
11
Q
How many cranial nerves are there?
A
12
12
Q
Where do CN I & II extend from?
A
Cerebrum
13
Q
Where do CN III & XII extend from?
A
Midbrain and brainstem
14
Q
Where does the vagus nerve travel to?
A
-Heart
-Respiratory muscles
-Stomach
-Gallbladder
15
Q
What may cause dizziness and loss of sensation in aging adults?
A
Progressive decrease in cerebral blood flow and oxygen consumption
16
Q
What is cranial nerve I’s function?
A
Olfactory nerve
-Sense of smell
16
Q
What sequence do you use when collecting objective data for neuro?
A
-Mental status
-Cranial nerves (II, III, IV, VI, VII, VIII)
-Motor system
-Sensory system
-Reflexes
17
Q
How do you assess CN I function?
A
-Have pt close eyes
-Occlude one nostril
-Present aromatic substances (familiar smells)
-Have them identify smell
18
Q
What is CN II?
A
Optic nerve
-Acuity and visual fields
19
Q
What are CN III, IV, and VI?
A
-Oculomotor
-Trochlear
-Abducen nerves (eye movements)
20
Q
Wat is CN V?
A
Trigeminal nerve
-Motor and Sensory function (assess jaw and cotton balls)
21
Q
What are coordination and skilled movement tests?
A
-RAMs (flipping hands on knees)
-Finger-to-finger test
-Finger-to-nose test
-Heel-to-shin test
22
Q
What are cerebellar function tests?
A
-Gait (ambulate 10-20 ft and turn around)
-Tandem walking (heel-to-toe)
-Romberg sign (closing eyes while standing – have them perform slight knee bend, etc)
23
Q
How do you assess the anterolateral (spinothalamic) tract?
A
-Pain
-Light touch
-Poke vs wisp of cotton ball
24
How do you assess the posterior (dorsal) column tract?
-Vibration (tuning fork)
-Position (have pt close their eyes and move there fingers and toes up or down)
-Tactile discrimination (fine touch)
-Two-point discrimination test
25
What is stereognosis?
Pts ability to identify object in hand with eyes closes based on form, size, and weight
26
What is graphesthesia?
Pts ability to read a number by having it traced in skin
27
What is extinction?
Simultaneously touch both sides of body at same point -- have pt distinguish how many times they are being touched
28
What is the deep tendon reflex scale?
0-4
0= no response
1= diminished, low normal, or occurs with reinforcement
2= average, normal
3= brisker than average, may indicate disease
4= very brisk, hyperactive with clonus, indicative of disease
29
What does the deep tendon reflex test do?
Measures of stretch reflexes reveals intactness of reflex arc at specific spinal levels
30
What is the normal response of the biceps reflex (C5 to C6)?
Contraction of biceps muscle and flexion of forearm
31
What is the normal response to the triceps reflex (C7 to C8)?
Extension of forearms
32
What is the normal response to the Brachioradialis reflex (C5 to C6)?
Flexion and supination of forearm
33
What is the normal response to the quadriceps reflex (L2 to L4 -- knee jerk)?
Extension of lower leg
34
What is the normal response to the achilles reflex (L5 to S2 -- ankle jerk)?
Foot plantar flexes against your hand
(foot is originally held in dorsiflexion position during testing)
35
What unit of measurement is PERRLA in?
Milimeters
36
What does the neuro recheck consist of?
-Change in LOC
-Motor function
-PERRLA
37
What are the different muscle movement abnormalities?
-Paralysis
-Fasciculations (rapid continuous twitching of resting muscles)
-Tic (involuntary movements)
38
What are the major neck muscles?
Sternomastoid & trapezius
38
What is the function of the sternomastoid?
Enables head rotation and flexion
39
What is the function of the 2 trapezius muscles?
Move shoulders and extend/turn head
40
What is the purpose of the lymph system?
Detects and eliminates foreign substances from the body
41
What is the purpose of lymphatic drainage?
Helps to prevent potentially harmful substances from entering the circulation
42
What are the topics that you would ask about for a health history assessment for HEENT?
-Headaches
-Head injury
-Dizziness
-Neck pain
-Lumps or swelling
-Hx of head or neck surgery
43
What are the 3 types of headaches?
-Tension
-Migraine
-Cluster
43
What is a tension headache?
Headache of the musculoskeletal origin; mild to moderate pain
44
What is a migraine/
Headache of genetically transmitted vascular and trigeminal nerve origin; aura as well as other symptoms
***2-3x more common in women
45
What is a cluster headache?
Headache is intermittent, excruciating and unilateral (rare)
46
What is Graves disease?
**Hyperthyroidism
-An autoimmune disease with increased production of thyroid hormones
47
What are physical clinical manifestations of Graves disease?
**Physical presentation on neck and face
-Goiter
-Eyelid retraction
-Exophthalmos
48
What is Myxedema?
***Hypothyroidism
-A deficiency of thyroid hormone
49
What are the physical clinical manifestations of Myxedema?
**Presentation on face and neck
-Puffy edematous face
-Periorbital edema (eye swelling)
-Coarse facial features
-Coarse hair and eyebrows
50
What are the most common causes of decreased visual functioning in older adults?
-Cataract formation
-Glaucoma
-Age-related macular degeneration
-Diabetic retinopathy
50
True or False:
As we age, our pupil size decreases
True
51
What is cataract formation?
-Lens opacity
-Results from a clumping of proteins in the lens
52
What is glaucoma?
-Increased intraocular pressure
****Chronic open-angle glaucoma is the most common
53
What is age-related macular degeneration (AMD)?
-Breakdown of cells in macula of retina
-Loss of central vision
54
What is the leading cause of blindness in adults ages 25-74 yrs old?
Diabetic retinopathy
55
What is typically used to test central visual acuity?
Snellen alphabet chart
-Person stands 20 ft from chart
-Person can leave glasses or contacts in as long as they are not reading glasses
56
How do you test confrontation?
Peripheral vision
-Pt covers one eye with a card
-Provider covers the eye across from pts covered eye with card about 2 feet away
57
What does PERRLA stand for?
Pupils equal, round, react to light, and accommodation
58
What is esotropia?
Inward turning of eye
59
What is exotropia?
Outward turning of eye
60
What are some eyelid abnormalities?
-Periorbital edema
-Exophthalmos (protruding eyes)
-Enophthalmos (sunken eyes)
-Ptosis
61
What can cause periorbital edema?
-Infection
-Crying
-Trauma
-CHF
-CKD
62
What can cause exophthalmos?
Thyrotoxicosis
63
What can cause enophthalmos?
-Dehydration
-Chronic wasting
64
What can cause ptosis (drooping upper lid)?
-CN III damage
-Sympathetic nerve damage
-Congenital
65
What are the structures of the external ear?
-Auricle (aka pinna)
-Auditory canal
-Outer 1/3 of the canal is cartilage
66
What separates the external and middle ear?
Tympanic membrane (aka eardrum)
67
What are the 3 functions of the middle ear?
1) Conducts sound vibrations from outer ear to central hearing apparatus in inner ear
2) Protects inner ear by reducing amplitude of loud sounds
3) Eustachian tube allows equalization of air pressure on each side of TM so that it does not rupture
68
What is the structure of the middle ear?
***Tiny air-filled cavity inside temporal bone
-Contains tiny ear bones or auditory ossicles:
1) Malleus
2) Incus
3) Stapes
69
True or False:
The inner ear is not accessible for direct examination, but its functions can be assessed
True
70
What does the inner ear contain?
Bony labyrinth -- holds sensory organs for equilibrium and hearing
71
What things can happen related to hearing as we age?
Osteosclerosis & presbycusis
72
What is otosclerosis?
Gradual hardening that causes footplate of stapes to become fixed in oval window
73
What is the common cause of conductive hearing loss in young adults between ages of 20 and 40
Otosclerosis
74
What is presbycusis?
Type of hearing loss that can occur with aging, even in people living in quiet environment
75
When is presbycusis accentuated?
When unfavorable background noise is present
76
What questions do you ask regarding tinnitus?
-Ever felt ringing, crackling, or buzzing in your eyes? When did this occur?
-Does it seem louder at night?
-Are you taking any medications?
77
When does screening for a hearing deficit begin?
During the health history
78
What is the whispered voice test?
-Stand at arms length (2ft) behind the person
-Test one ear at a time while masking the other & place one finger on tragus while rapidly pushing it in and out of auditory meatus
-Shield lips so person cannot compensate for hearing loss by lip reading
-With your head 30 to 60 cm (1 to 2 ft) from person's ear, exhale fully and whisper slowly 3 random number/letter combinations
79
What is the passing score for the whispered test?
Correct repetition of 4 out of 6 possible numbers/letters
80
What are the 2 tuning fork tests?
-Weber test
-Rinne test
81
What do tuning fork tests measure?
Measure hearing air conduction or by bone conduction in which sound vibrates through cranial bones to the inner ear
82
What is the scale for the Weber test?
1) Normal = sound is heard equally in both ears
2) Abnormal = sounds lateralizes to one ear
3) Conductive loss = sounds lateralizes to poorer ear
4) Sensoineural loss = sound lateralizes to better ear
83
What is the scale for the Rinne test?
Normal = AC greater than BC, noted as positive finding
Abnormal related to:
-Conductive loss -- AC = BC or BC> AC
-Sensorineural loss = normal ratio intact but reduced, the person hears poorly both ways
84
What are abnormal findings of the external ear?
-Sebaceous cyst
-Tophi
-Chondrodermatitis
-Keloid
-Battle sign
-Carcinoma
85
What is the first segment of the respiratory system?
Nose
86
True or False
Sinus openings are narrow and easily occluded & may cause inflammation or sinusitis
True
87
Where are olfactory receptors and hair cells found?
Liet at the root of the nasal cavity & upper third of septum
88
What 2 pairs of sinuses are accessible to examine?
-Frontal sinuses
-Maxillary sinuses
89
Where are frontal sinuses located?
In frontal bone above and medial to orbits
90
Where are maxillary sinuses located?
Maxilla (cheekbone) along side walls of nasal cavity
91
What is the first segment of the digestive system and an airway for the respiratory system?
Mouth
92
Why is the tongue arranged in a crosswise pattern?
So it can change shape and position
93
How many permanent teeth do adults have?
32 (16 in each arch)
94
What 2 main structures make up the throat (pharynx)?
Oropharynx & Nasopharynx
95
What structure is inside the oropharynx?
Tonsils
96
Where does the breast lie anatomically?
Anterior to pectoralis major and serratus anterior muscles
97
What surrounds the nipples?
Areola
98
What are Montgomery's Glands?
Sebaceous glands that secrete protective lipid material during lactation
99
What kind of tissues is the breast composed of?
-Glandular tissue
-Fibrous tissue
-Adipose tissue
100
What quadrant on the breast is the most common site for breast tumors?
Upper outer quadrant
101
What 4 groups of axillary nodes are present in the breast lymphatic drainage system?
-Central axillary nodes
-Pectoral (anterior)
-Subscapular (posterior)
-Lateral
102
What is the flow of drainage from the central axillary nodes?
Drainage flows up to infraclavicular and supraclavicular nodes
103
What can cause breast glandular tissue to atrophy in women after menopause?
Decreased ovarian secretion of estrogen and progesterone
104
What ages should women be getting an annual mamography?
45-54
105
When does mammography screening begin?
40-44
106
True or False:
After age 55, women can either continue annual mammograms or biennially
True
107
How do you palpate a woman's breast?
Have her lay supine & uncover one breast at a time
108
True or False:
It is common to have slight asymmetry of breasts
True
109
How do you inspect & palpate the axillae region?
Examine while they are sitting, use ROM exercises to increases surface area
***Node typically not palpable, but you may feel a small, soft, nontender node in the central group
110
What is the typical pattern recommended to palpate breasts?
Vertical stripe pattern -- recommended to detect fro breast masses
111
What are 2 other common patterns used to palpate breasts?
1) From the nipple palpating out to periphery as if following spokes on a wheel
-Palpating in concentric circles out to the periphery
112
True or False:
In nulliparous (woman who hasn't given birth) women, normal breast tissue feels firm, smooth, and elastic
True
113
True or False:
After a woman is pregnant, the breast tissue feels softer and looser
True
114
Why is premenstrual engorgement of the breasts normal?
Increasing progesterone
115
How do you normally palpate the nipple?
With your thumb and forefinger -- gently depress nipple tissue into well behind areola (tissue should move inward easily)
116
How do you palpate the nipple if the woman reports spontaneous nipple discharge?
Press areola inward with index finger
117
True or False:
If a woman mentions a breast lump that was self-discovered, the nurse should examine the unaffected breast first to gain baseline
True
118
What characteristics do you look at for breast lumps or masses?
-Location
-Size
-Shape
-Consistency
-Movable
-Distinctness
-Nipple (displaced or retracted?)
-Note skin over lump
-Tenderness
-Lymphadenopathy
119
What are the ABCDE's of lumps/masses in the breast?
-Asymmetry
-Border
-Color
-Diameter
-Evolution
120
What produces sweat?
Eccrine
121
What do apocrine produce?
Milky secretion and open into hair follicles
122
True or False:
Skin produces Vitamin D
True
123
How do you palpate the skin for temp?
With back of hand
124
What is the normal degree/contour of a nail?
160 degrees
125
What are the different shapes and configurations of skin lesions?
-Annular or circular
-Confluent
-Discrete
-Grouped
-Gyrate
-Target or iris
-Linear
-Polycyclic
-Zosteriform
126
What are the types of primary skin lesions?
-Macules
-Papules
-Patches
-Plaques
-Nodules
-Wheals
-Tumors
-Urticaria
-Vesicles
-Cysts
-Bullas
-Pustules
127
What are types of secondary skin lesions?
-Debris on skin surfaces
-Fissures
-Erosions
-Ulcers
-excoriations
-Scars
-Atrophic scars
-Keloids
128
What are the malignant types of skin lesions?
-Basal cell carcinoma (most common)
-Squamous cell carcinoma (grows rapidly)
-Malignant melanoma (worst)
128
What ages are considered young-old?
65 to 74
129
What ages are considered middle-old?
75 to 84
130
What age is considered old-old?
85+
131
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