Exam 3 Flashcards
(168 cards)
1
Q
lobes of the brain
A
frontal
temporal
parietal
occipital
2
Q
CNS
A
brain and spinal cord
inc cerebral cortex
and cerebral hemisphere
3
Q
cerebral cortex
A
center for highest functioning
controls- thought, mem, reasoning, sensation, volun. mvmnt
covers gray matter (cerebral hemisphere) and white matter (deep to cerebrum)
4
Q
cerebral hemisphere
A
lobes
5
Q
frontal lobe
A
personality, emotion, beh, volu skeletal mvmnt (post central gyrus)
6
Q
temporal lobe
A
hearing, taste and smell, speech
7
Q
occipital lobe
A
interpretation of vision
8
Q
parietal lobe
A
processing senation (post central gyrus)
9
Q
damage to cerebral hemisphere lobes=
A
loss motor function (weakness, paralysis)
loss sensation
diff processing and understanding language
10
Q
cerebellum
A
balance and coor (motor volun mvmnt)
equilibrium
muscle tone
*not initiate mvmnt only smoothes
11
Q
thalamus
A
relay station for nervous system
all sensory e/x smell
interprets pain, light touch and pressure sensation
12
Q
PNS
A
12 pairs cranial n
31 pairs spinal n
ANS- parasym and sympathetic
not include CNS
13
Q
peripheral n
A
dev from spinal nerves
14
Q
dermatome
A
area conducted by specific nerve
15
Q
sensory pathway
A
from periphery to brain
inc. spinothalamic and posterior columns
16
Q
spinothalamic tracts
A
anterior and lateral
sensory
17
Q
lateral spinothalamic
A
pain and temp
sensory
18
Q
anterior spinothalamic
A
light pressure and touch
sensory
19
Q
posterior column
A
proprioception- area in space
kinesthesia- directional awareness
vibration, fine local touch
sensory
20
Q
motor pathways
A
corticospinal/ pyramidal tract
extrapyramidal tract
cerebellar system
brain to spinal cord
21
Q
corticospinal/ pyramidal tract
A
motor
skilled vol mvmnt (writing)
fibers originate in motor cortex (frontal)
22
Q
extrapyramidal tract
A
motor
macro mvmnt (walking), main muscle tone
fibers originate outside corticospinal tract
23
Q
cerebellar system
A
coord mvmnt, maintain posture, equilibrium, mvmnt is unconsious
gait
24
Q
upper motor neuron
A
brainstem to synapse w/ lower motor n
sympt- hyperreflexia, (+) superficial reflexes, musc weakness
25
lower motor neuron
```
originate in ant horn cell of spinal cord (bilaterally)
sympt- flaccid, mild musc weakness
hyporeflexia
ex. polio
neuron apparent at each spinal segment
connect to muscle fibers
```
26
importance of hx of HTN
inc risk for stroke
27
documenting weakness
bilaterally or unilateral
| permanent v temporary
28
warning signs stroke
numbness or weakness on one side of body (sudden)
sudden confusion, trouble speaking or understanding
sudden vision changes
sudden trouble walking, dizzy, loss balance or coord
sudden or severe headache (hemorrhagic stroke)
29
time considerations for stroke
<3 hours to get to care
30
60 second test
```
for stroke
have pat smile
raise both arms
repeat simple sentence
call 911 if present signs
```
31
neuro assessment incl
```
mental status- cerebral func, orientation
cranial n 2-12
motor system
sensory system
reflexes
```
32
motor system test
```
muscl tone- tension, flaccid?
musc mass
involv mvmnt (tic or tremor)
strength - 0-5+
5= normal
```
33
resting tremor
pill rolling
can be familial
not always indicate neuro problem
34
intention tremor
occurs w/ mvmnt
35
tic
usually upper motor problem
36
fasciculation
quiver
| ex. eye twitch or after working out
37
cerebellar function test
```
gait
tandem walking
ataxia
RAM
heel-shin
hop on one foot
```
38
romberg test
feet together, stand, eyes closed 15-20 seconds
| negative= normal
39
proprioception test
finger to nose
(eyes closed)
finger to finger
(nose to finger, tracking)
40
sensory system- what to test
pain and touch sensation
sharp v dull
distal to medial
41
abnormal sensory system findings
pain-
hyppalgesia
analgesia (absent)
hyperalgesia
```
touch-
hypoesthesia (common w diab)
anesthesia- absent
hyperesthesia
paresthesia- abnormal sensations (pins, numbness, tingling)
```
42
sensation assessment
microfilament test
poke bottom foot and hand
assess bilaterally
43
test for position (kinesthesia)
posterior column
| grap finger and move up and down
44
vibration test
posterior column
tuning fork on bony prominence
norm= detect start and stop
45
stereognosis
post. column
reg object by feeling
controlled by parietal lobe
46
graphesthesia
post. column
| id letters/ numbers drawn on hand
47
flow chart for deep tendon relfex
```
afferent fibers
synapse
efferent fibers
neuromuscular junction
muscle fibers
* all steps have to be intact
@lvl spinal cord (brain doesn't initiate)
brain only smoothes mvnt
```
48
bicep reflex
hold thumb over tendon
palm facing up
norm= flexion arm at elbow
49
tricep reflex
support arm into H shape
| norm= extension arm at elbow
50
patellar reflex
above patella and below tibial patella
| norm= extension at knee
51
achilles relfex
norm= plantar flexion foot
(toes down)
support foot so bottom is parallel to ground
52
normal findings for relfex
2-3
symmetrical bilaterally
document if reinforcement used
53
examples of reflex reinforcement
clench teeth
hold arms
close eyes
54
superficial reflex
response from skin receptors
| ex. plantar or babinski reflex
55
plantar reflex
normal= toes curl down and negative response
| infants should fan feet <2yrs
56
LOC includes
x3 place, person, time,
| x4 incl event or situation
57
CMS
```
circulation
movement
sensation
assess distally to affected region
commonly done for ppl w/ ortho procedures, splint, cast or fracture
```
58
inc risk for fall
```
inc age
fall history within last 6 mon
elim-incontinence, frequ or urgency
meds- diuretics, analgesics, laxatives
equipment- catheter, IV, monitor
mobility- assist visual/auditory, gait
cognition-dev lvl, confusion, orientation
score= low, moderate or high
```
59
musculoskeletal assessment incl
```
temp, tenderness, swelling
strength
ROM
joint pain, crepitus
spasticity, rigidity, atrophy
spine midline/ straight?
fall risk
```
60
abdomen assessment order
inspection
auscultation
percussion
palpation
61
abdomen- inpsection
```
general appearence
eye lvl and above
skin- striae, scars
contour- protuberant or rounded
symmetry
umbilicus- midline w/out discoloration
```
62
cause of blue umbilicus
internal bleeding
63
cause asymm abdom.
tumor, hernia, bladder distention, uterine disten
64
RUQ
liver, gallbladder, ascending colon
65
RLQ
cecum, appendix, bladder
66
LUQ
spleen, stomach, sm in
67
LLQ
desc colon, sigmoid colon, public symphysis
68
causes abdom distention
fat, fluid, feces, fetus, flatus, fibroid (growth in uterus), fatal tumor, full bladder
69
diastasis recti abdominis
seperation ab muscles
not true hernia
can occur in adults
(preg. and obesity)
70
types possible hernias in abdom
umbilical, inguinal and femoral
71
perastalsis in abdom
not normal
72
diaphram and bell in abdom
dia- bowel sounds
| bell- vascular sounds
73
absent bowl sounds
not norm
74
bowl sound factors
time since last ate (4/7hrs)
75
borborygmi
hyperactive bowl sounds (diahrr)
76
spots listen for bruits
femoral artery and abdominal aorta
77
pupose percussion in abdom
id pain
78
costal vert. angle tenderness (CVA)
12th rib post
| place hand flat and hit with fist
79
abdom palpation
light- 1-2cm
deep 5-8cm
specific organs- liver, spleen and kidney
lymph nodes- femoral, inguinal
80
palpation liver location
costal margin
81
palpation spleen and kidney
abnormal if felt
82
norm abdominal results
soft, non-tender, bowl sounds present, tympanic to percussion
83
rebound tenderness
=more pain after touch
ex. present w/ appendix
only assess if complain about abdom. pain
84
anatomical location of breast
```
2nd rib (by manubriosternal junction) to 6th
sternal border to midaxillary line
```
85
func of montgomery's glands
secrete lubricant or protective lipid material during lactation
86
nipple color variation due to
race, pregnancy, number of deliveries
87
lobes in breast and milk flow
15-20
extend from nipple
composed of milk producing acini cells
milk produced, lactiferous ducts, sinus duct, nipple
88
nodes associated w breast
```
supraclavicular
infraclavicular
lateral (brachial)
central axillary
sub scapular (posterior)
pectoral (anterior)
drain ipsilaterally
```
89
breast lymph node locations
lateral- inside upper arm along humerous
central axillary- high in axilla
subscapular- inside posterior axillary fold along lateral edge of scapula
pectoral- inside axil. fold along pec major musc
90
supernumerary nipple
2nd nipple
| resembles mole, can be assoc. w/ renal abnormalities
91
mammary ridge
"milk line"
| axilla through nipple to inguinal ligament
92
gynecomastia
male breast tissue
1/3 adolescents
temporary 1-2 yrs
93
gynecomastia- causes
hormonal puberty changes, inc adipose tissue, dec testosterone w age, meds
94
quadrants of the breast
```
lower inner q
upper inner q
axillary tail of spence
upper outer q
lower outer q
```
95
common location for breast tumors in women v men
women- upper outer q
| men- behind nipple
96
nipple discharge
milky is norm w/ lactation
| blooduy- always abnorm
97
breast cancer stats
```
most common cancer in wmn besides skin
2nd major cause death from cancer in wmn
90% survival rate
80% lumps non-cancerous
1-8 lifetime risk
men can dev CA too- not as common
```
98
risk factors- breast cancer general
not automatically mean will get CA
anything inc person's chance getting disease
most wmn have no risk factors but get CA
factors can change overtime
99
risk factors- breast cancer
```
female gender
>50 yrs old
personal hx breast CA
family hx breast CA
1st degree= 2x and 2 ppl 1st degree= 4x
genetic mutation
braca gene 1 or 20 (35-85%) inc risk
100x more likely get in 60s v 20s (wmn)
hx uterine, ovarian, colon CA
early menarche <12, late menopause >55 (prolonged exposure to estrogen)
high breast density
breastfeeding dec risk
hormone therapy around menopause time (if taken < 4/5 yrs risk will dec)
birth control (goes away in 10yrs after stop taking)
```
100
breast cancer- risk reduction strategies
```
limit alcohol (inc estrogen lvl)
breast feed
control weight
be physically active
limit hormone therapy around menopause
don't smoke
```
101
benign breast syndrome
"fibrocystic syndrome"
50% wmn
not precancerous
common in younger childbearing wmn
can cause mastalgia (pain), swelling and discomfort
lumps bilaterally, firm, mobile and rubbery, and can be tender after menstruation
102
5 positions for breast examination
sitting arms overhead (breast move symmetrically)
sitting arms at sides
hands on hips (contract pectoralis, helps id dimpling)
bending from waist (b should fall freely/ equally from chest wall)
supine (use palpation, raise cooresponding arm overhead and support with pillow)
103
abnormalities with breast inspection
rash, sores dont heal, lesions, unequal venous patterns (visability), edema, masses, dimpling, unequal nipple directional pointing
104
unequal sized breasts
common
| if sudden change or not usually like that- analyze further
105
plugged breast duct
happens w lactation
nipple can become hard and dry
erythema
106
breast dimpling/retraction
abnorm
| pot cause- mass affecting coopers ligaments
107
breast induration
abnorm
| area hardness w/ inflamm
108
breast peau d'orange
"peel of an orange"
| pitted, dimpled hair follicles from swelling
109
nipple inversion
abnorm if not symm bilaterally
or a new change
or if nipple do not point in the same direction
110
breast palpation-non nipple
bimanual (sitting/standing compress btw hands) if large
pads three fingers
pillow under shoulder when supine
start below clavicles
111
breast palpation techniques
vertical strip
concentric circles
chest wall sweep (recommended, clavical to nipple or sternum to nipple inc under armpit)
spoke
112
inframammary ridge
compressed tissue
normal at bootom breast btw 4-8 oclock
can feel like rib poking up
113
granular consistency of breasts
normal for post meopausal women
114
masses classification
quadrant and clock location
| size, consistency, mobility, borders, tenderness, bilaterall
115
a mass that is fixed, hard, unilateral, and undefined
concerning
116
palpation of nipple
push nipple down
| squeeze behind areola
117
axillary lymph node exam
sitting and support arm
start high up in axilla, include sub/infra scapular
enlarged or palpable= abnorm
118
breast pain
abnorm if not around time of period
119
breast exam reccom
mammograms and exam= best outlook
25-40 every 1/3 yrs
> 40 yrly
early detection= best for improving qual. of life and survival
120
male breast cancer
1% of all breast CA
most common site- nipple
often painless mass
common signs- scaly nipple, lesion, discharge
121
testicular CA
curable
1% CA in males
50% within 15-35 yrs
inc (dont know why)
122
testicular CA risk factors
undescended testicles
personal/family hx of testicular CA
whites 5x risk v black and 3x risk v indians/ mexican
age 15-35
123
cryptorchidism
undesc. testes
124
testicular CA symp
common asympt
| nodules, one side lrger than other, painless lumps, dull ache in groin, enlrged/ swollen breasts
125
normal findings of testes
firm, rubbery, non-tender
126
leading causes CA in men v women
men- prostate
wmn- breast
b/= lung (2)
colon and rectum (3)
127
prostate CA risk factors
```
1-7 lifetime risk
1-36 die
>80% in age 65 or greater
black> white
family hx
hereditary breast and ovarian CA
```
128
prostate CA sympt
early- none
| problems urinating, cant erect, blood in urine
129
prostate CA screening
talk w doctor around age 45-50
45 if high risk or black
50 if at normal risk
screening= psa blood test
130
causes of high psa lvl
prostate ca
begning prostatic hypertrophy
UTI
enlrged prostate
131
consideration w/ prostate ca screening
early detection not always matter
| 25% get biopsy bc inc psa have cancer, o/ 75% dont
132
colon cancer-incidence
3 most common in b
133
colon cancer screening causes
```
look at prostate func
chronic constipation
check for compaction
rectal tone check
around age 50 (every 10 yrs)
```
134
colon cancer risk factors
> 50, family hx, personal hx breat CA or polyps, physic inactivity, obesity, smoking, alcoh
135
polyps (colon)
growth inside colon
| if present, screen more frequently
136
cervical cancer risk factor
```
HPV infection
smoking
hx STIs
long term use of oral contraceptive (returns norm after 10 yrs)
family hx multiple full term pregnancys
death risk has dec w/ pap test
```
137
cervical cancer ages
frequently 35-45
| rare <20 or >65
138
cervical cancer screening
pap every 3 yrs starting at 21 (3 yrs if norm)
5 yrs 30-65
> 65 if norm results no futher paps
still need screening even if have HPV vaccine
139
HPV vacc ages
11-12 or early as 9
140
when is birth history necessary to review
kids < 6 yrs
| dev or neuro concern
141
peds nutritional hx
```
allergies
breast v bottle
solids no earlier 4/6 m
no honey before 1
juice intake- 8-12 oz per day max
```
142
peds oral care
around 6-12mon
| when first tooth appears
143
exposure 2nd hand smoke in kids inc risk
asthma
| ear infection
144
tooth decay risk
parent tooth decay < 6months
juice
frequent snacking
145
peds assessment incld
weight- lying < 2 yrs
height- recumbent (supine) < 2 yrs
head circum till 2 yrs
chest circum till 18mon (across niples)
146
peds vital signs
```
heart r and respirations for 1 min
heart rate- 130 norm
apical pulse for kids < 2yrs
bp lower than adults
respir r- 28-20 norm
bp- 98/60 norm
```
147
milia, lanugo, mongolian spots
milia- white pimple like dots of cebum (norm)
lanugo- excess hair (norm) common in premies
Mongolian spots- common darker ethnicities/races (90%)
inc distribution of melanocytes
148
thyroid and lymph nodes in peds
usually not palpable
149
anterior fontanel
```
"soft spot"
closes 9-18 mon
abnorm- firm, elevated, sunken
sunken- dehydr
elevated if not crying= inc ICP
```
150
posterior fontanel
closes 2-3 months
151
peds vision
6-7 20/20
newborn 20/200
EOM's important!!
red reflex = normal
152
retinoblastoma and congenital cataracts
retinoblastoma- cancer
| cataracts- cloudy lens
153
peds ears
pull down and back
5 oclock- R and 7 oclock R
eustachian tube wider, shorter, and more horizontal
154
peds teeth eruption and saliva
saliva- drooling 3 months
tooth- 6-24 months
don't lose all till 6-12 yrs
155
peds tonsils
max size 10-12
small at birth
cannot see adenoids
156
peds sinuses
cannot see
| not fully developed
157
peds respiratory
```
faster respir rate
abdom breathing till 6-7
barrel chest normal till 6
hypperresonance common
breath sounds- louder bronchovesicular
```
158
peds cardiac
```
heart sounds louder and higher pitched (norm)
split s2 common during inspiration
s3 norm
sinus dysryth norm
inc pulse rate- 120-160 newb
dec 80s by 8 yrs
```
159
thelarche
breast budding females
| onset puberty 8-14
160
gynecomastia
males
| away w 1-2 yrs
161
peds abdomen
cylindrical/ protuberant abdomen is norm
organs not palpable
nb may feel liver
162
testicular growth
9-13 months
163
cryptorchidism
testicles do not descend
164
menarche
begins 2-2.5 yrs after onset puberty
| menstrual cycle is irregu first year or two
165
full ossification of bones
18 yr old
| growth spurt btw 12 girls and 14 in boys
166
genu varum and valgum
varum- bow legs till 2
| valgum- knock knees till 7
167
scoliosis
curved spine
| uneven hips/ shoulders
168
peds babinski
norm till 2 yrs
| if fanning after 2= upper motor neuron dis.
