Exam 4 Flashcards
1
Q
Cerebral cortex
A
- center for highest functions
- thoughts, memory, reasoning, sensation, voluntary movement
2
Q
Basal ganglia
A
- large bands of gray matter
- initiates/coordinates movement
3
Q
Thalamus
A
main relay station for all senses
4
Q
Hypothalamus
A
major respiratory center with basic vital functions
5
Q
Cerebellum
A
- coiled structure under occipital lobe
- voluntary movements, equilibrium, mm tone
6
Q
Brainstem
A
- central core of brain made of nn fibers
7
Q
Spinal cord
A
- nervous tissue
- tracts that connect to brain and spinal nn
8
Q
ANS communicates with
A
internal organs and glands
9
Q
PNS
A
all nerve fibers outside CNS
10
Q
Somatic nervous system
A
- communicates with sense organs and voluntary mm
- sensory and motor
11
Q
Cranial nerve 1
A
olfactory - smell
12
Q
Cranial nerve 2
A
optic - near and distant visual acuity, visual fields
13
Q
Cranial nerve 3
A
Oculomotor
- EOM movements (6 cardinal positions)
- palpebral fissures
- PERRLA
14
Q
Cranial nerve 4
A
trochlear
- EOM, palpebral fissure, PERRLA
15
Q
Cranial nerve 5
A
trigeminal
- clench teeth, light touch on cheeks, forehead, chin
16
Q
Cranial nerve 6
A
Abducens
- EOM movements, palpebral fissures, PERRLA
17
Q
Cranial nerve 7
A
Facial: smiling, puffed cheeks, taste
18
Q
Cranial nerve 8
A
vestibulocochlear: hearing
19
Q
Cranial nerve 9
A
Glossopharyngeal
- uvula movement when patient says “ahh”
- gag reflex
20
Q
Cranial nerve 10
A
vagus
-uvula movement when patient says “ahh”
- gag reflex
21
Q
Cranial nerve 11
A
spinal accessory - shoulder shrug
22
Q
Cranial nerve 12
A
hypoglossal - tongue symmetry
23
Q
Nerve mnemonic
A
our old oak table top adds fun and gaudy vibes some holidays
24
Q
Cranial nn function mnemonic
A
some say marry money but my brother says bad bitches marry money
25
AAOx4
alert to person, place, time, situation
26
Cranial nn III, IV, VI assessment
- eye movements
- pupillary light reflex
- PERRLA
- 6 cardinal positions
27
Increased intracranial pressure causes
sudden, unilaterally, dilated, and nonreactive pupils
28
Ptosis can occur with
myasthenia gravis or dysfunction of cranial n 3
29
Strabismus
deviated gaze or limited movement
30
Nystagmus
can occur with disease of visibular system, cerebellum, or brainstem
31
Cranial n. VII assessment
Note mobility and facial symmetry
- smile, frown, close eyes tightly, lift eyebrows, show teeth, puff cheeks
32
Abnormal facial n findings
loss of movement or asymmetry
- can occur with stroke or bells palsy
33
Cranial n. VIII assessment
test hearing by ability to hear normal conversation
34
Cranial nn IX, X assessment
- depress tongue with blade and say "ahhh"
- uvula and soft palate should rise midline
- tonsils should move inward
- absence of symmetry could mean stroke and risk of aspiration
35
Cranial n XII assessment
- have patient stick out tongue
- no tremors, midline
36
Cranial n XI assessment
- examine sternomastoid and trapezius mm for equal size and strength
- ask patient to rotate head against resistance applied to chin
- ask patients to shrug shoulders against resistance
- mm weakness could occur from stroke or peripheral n damage
37
Assessing gait
should be smooth and effortless
38
Romberg test
- pt. stands with feet together arms at side
- have them close eyes and balance
39
Positive romberg test can occur with
multiple sclerosis, intoxication, loss of proprioception, poor vestibular function
40
Assessing pain/sensation
tested using dull and sharp side randomly on extremities x4
- patient should distinguish sharp or dull
41
Assessing sensation
patient identifies random object placed in hands
42
Astereognosis
inability to identify object correctly - can occur in stroke
43
Deep tendon reflex testing
- short snappy blow of hammer onto tendon
- usually patellar/quadriceps
- right and left should have equal response
44
DTR ranking
0 = no response
1+ = diminished
2+ = average, expected
3+ = brisker than average
4+ = very brisk, hyperactive (disease)
45
Plantar reflex testing
- position thigh in slight external rotation
- draw slow stork up lateral side of sole of foot and inward across the ball of foot
46
Plantar reflex testing: expected
plantar flexion of toes and inversion of foot
47
Plantar reflex testing: abnormal
babinski signs - dorsiflexion and fanning of toes
- occurs with brain injury, stroke, brain tumor, MS, spinal cord injury
48
Joints
- union between 2 bones
49
Fibrous joints
- united by fibrous tissue or cartilage
- immoveable
- skull sutures
50
Cartilaginous joints
- separated by fibrocartilaginous discs
- slightly moveable
- vertebrae
51
Synovial joints
- freely moveable
- joint cavity lined with synovial membrane
52
Cartilage
- avascular, tough, firm, flexible
- absorbs shock and allows for movement
53
Ligaments
- connect bone to bone
- stabilize bones and limits movemente
54
Bursae
- fluid filled sacs that cushion bones and ligaments
- located in areas of potential friction
55
Tendons
connect mm to bone, strong fibrous cord
56
MM makes up how much body weight
40-50%
57
Swelling in musculoskeletal indicates
joint irritation, excess joint fluid, inflammation, bony enlargement
58
Subluxation
two bones in joint stay in contact but misaligned
59
Contracture
shortening of mm leading to limited ROM
60
Ankylosis
stiffness or fixation in joint
61
Warmth + tenderness of musculoskeletal means
inflammation
62
5+ mm grade
full ROM against gravity, full resistance, normal
63
4+ mm grade
full ROm against gravity, some resistance, good
64
3+ mm grade
full ROM with gravity, fair
65
2+ mm grade
full ROM with gravity eliminated, passive motion, poor
66
1+ mm grade
slight contraction, trace
67
0 mm grade
no contraction, zero
68
Crepitation
audible/palpable crunching or grating accompanying movement
69
ROM assessment
- start with active motion
- passive motion if limitations are assessed
- should be equal bilaterally
70
TMJ ROM
- place fingers in front of ears and have person open and close mouth then clench jaw
- should feel smooth movement
71
TMJ dysfunction
crepitus and pain during movement or chewing
- tenderness with palpation
72
Cervical spine ROM - flexion
touch chin to chest
73
Cervical spine ROM - extension
lift chin to ceiling
74
Cervical spine ROM - lateral bending
touch ears to shoulders
75
Cervical spine ROM - rotation
turn chin towards shoulder
76
Shoulders ROM - internal rotation
rotate arms internally behind back
77
Shoulders ROM - external rotation
touch both hands behind head
78
Shoulders ROM - abduction
with arms at sides, raise both arms, touch palms together above head
79
Shoulders ROM - adduction
move arms back down in front of body
80
Elbow ROM - flexion/extension
bend and straighten elbow
81
Elbow ROM - pronation/supination
hold hand on table, front and back sides to table
82
Hands and wrist ROM - extension
bend hand up at wrist
83
Hands and wrist ROM - flexion
bend hand down at wrist
84
Hands and wrist ROM - ulnar deviation
with palms flat, turn them outward and in
85
Hands and wrist ROM - abduction
spread fingers apart
86
Hands and wrist ROM - adduction
tight fist
87
Hands and wrist ROM - phalen test
hold both hands back to back
- if patinet has carpal tunnel it willll cause numbness and burning
88
Hips ROM - flexion (90 degrees)
raise leg with knee extended
89
Hips ROMS: flexion 120 degrees
bend knee and raise leg while other leg remains straight
90
Hips ROM - internal and external rotation
flex knee and swing foot outward and inward
91
Hips ROM - abduction and adduction
swing leg laterally, then medially
92
Ankle/Foot ROM - plantar flexion
point toes to floor
93
Ankle/Foot ROM - dorsiflexion
point toes to nose
94
Ankle/Foot ROM - eversion
turn soles of feet out
95
Ankle/Foot ROM - inversion
turn soles of feet in
96
Spine ROM: flexion
bend foward and touch toes
97
Spine ROM: extension
bend backwards
98
Spine ROM: lateral bending
bend sideways
99
Spine ROM: rotation
twist shoulders
100
Mental status is
emotional and cognitive function
101
First sign of impending health crisis
change in mental status/LOC
102
Mental health
state of well-being where they realize their potential, can cope with stress, work productively, and contribute to community
103
Mental disorder
clinically significant syndrome associated with distress or disability
104
Organic disorder
caused by brain disease of known specific organ cause
105
Examples of organic disorders
delirium, dementia, intoxication, withdrawal
106
Psychiatric mental disorder
an organic etiology has not yet been established
107
Consciousness
awareness of one's own existence, feelings, thoughts
108
Language
using voice to communicate
109
Mood
durable, prolonged display of feelings that color the whole emotional life
110
Affect
temporary expression of feelings or state of mind
111
Orientation
awareness of objective world in relation to self
112
Attention
power of concentration, ability to focus on one thing
113
Memory
ability to store experiences and perception for later recall
114
Abstract reasoning
deeper meaning beyond the literal
115
Perceptions
awareness of object through the 5 senses
116
Flat affect
lack of emotional response
117
Inappropriate affect
emotional reaction inappropriate for the situation
118
Depersonalization
loss of identity
119
Elation
joy and optimism, overconfidence, increased motor activity, not necessarily pathologic
120
Euphoria
- excessive well being
- can be inappropriate
- implies a pathologic mood
121
Ambivalence
opposing emotions toward something
122
Liability
rapid shift of emotions
123
Mental status is inferred by assessing...
appearance, behaviors, cognition, thoughts (ABCT)
124
Factors that could affect mental health interpretations
- illness
- current medications
- education and behavioral level
125
Components of assessing appearance
posture, body movements, dress, grooming and hygiene, pupils
126
Body movements that signal anxiety
restless, fidgety
127
Body movements that signal depression and dementia
apathy, psychomotor slowing
128
Body movements that signal schizophrenia
abnormal posturing, bizarre gestures
129
Body movements suggesting pain
facial grimacing
130
Body movements suggesting neurological disorders
involuntary tics
131
Meticulous dress may indicate
OCD
132
Inappropriate dress/poor hygiene may indicate
alzheimer's
133
Unilateral neglect of grooming may suggest
stroke
134
Unexpected LOC
loses track of conversation, falls asleep, lethargic, confused
135
Unexpected speech findings
dysphonia, uncommunicative, dysarthria, inability to find words
136
Components of assessing behavior
LOC, facial expression, speech, mood and affect
137
Components of assessing cognition
orientation, attention span, recent memory, remote memory, new learning
138
Disorientation may indicate
delirium or dementia
139
Recent memory deficit causes
delirium, dementia, alcoholism
140
To test recent memory, ask the patient
what they ate in the last 24 horus
141
To asses remote memory, ask the person about
past birthdays, anniversaries, historical events
142
Remove memory loss occurs in
alzheimer's and dementia
143
Test new learning by
recalling 4 words
144
Components of assessing thoughts
thought process, thought content, perceptions
145
Screening for depression
- patient health questionnaire (PHQ-2)
- 2 questions
- move to full PHQ-9 if patient answers several days
146
LOC: alert
- awake, readily aroused, orientated
- aware of external + internal stimuli
- respond appropriately
- meaningful itneraction
147
LOC: lethargic
- not fully alert
- drifts to sleep when not stimulated
- can be aroused to named when called in normal voice
- looks drowsy
- responds appropriately to questions but thinking is slow/fuzzy
- inattentive, loses train of thought, decreased spontaneous movements
148
LOC: obtunded
- transitional state between lethargy and stupor
- sleeps most of time
- difficult to arouse - needs loud shout or vigorous shake
- confused when aroused
- monosyllable conversation
- speech may be mumbled/incoherent
- requires constant stimulation for marginal cooperation
149
LOC: stupor/semi-coma
- completely unconscious
- no response to pain or stimuli
- light coma has some reflex activity
- deep coma has no motor response
150
LOC: delirium
- clouding of consciousness, inattentive, incoherent conversation
- impaired recent memory
- agitated, visual hallucinations, disorientated, confusion worse at night
151
Glascow coma scale
- accurate, reliable, quantitative tool for testing consciousness
- looks at functional state of brain as a whole
- measures eye opening, verbal response, motor response
152
Glascow score < 7
coma
153
Glascow score of 15
fully alert normal person
154
Galscow coma scale: eye opening response
spontaneous = 4
to speech = 3
to pain = 2
no response = 1
155
Glascow coma scale: motor response
obeys verbal command = 6
localizes pain = 5
flexion - withdrawal = 4
flexion - abnormal = 3
extension - abnormal = 2
no response = 1
156
Glascow coma scale: verbal response
oriented x 3 - appropriate = 5
conversation confused = 4
speech inappropriate = 3
speech incomprehensible = 2
no response = 1
157
Delirium is an
acute confusional state, potentially preventable in hospitalized persons
158
Delirium characteristics
disorientation, illusions, hallucinations, defective memory, agitation, inattention
159
Dementia definition
chronic progressive loss of cognitive and intellectual function
160
Dementia characteristics
- perception and consciousness are intact
- disorientation, impaired judgment, memory loss
161
Depression definition
long-term depressed mood > 2 weeksD
162
Depression characteristics
lack of pleasure, sleep and appetite disturbance, hopelessness, guilt, sadness, despair, suicidal ideation
163
Delirium onset
sudden, hrs to days
164
Dementia onset
over months
165
Depression onset
may be gradual with exacerbation during crisis
166
Delirium cause/contributing factors
hypoglycemia, fever, dehydration, hypotension, infection, adverse drug reactions, head injury, change in environment, pain, stress, substance abuse
167
Dementia cause/contributing factors
alzheimer's, vascular disease, immunodeficiency, virus, neurologic disease, alcoholism, head trauma
168
Depression cause/contributing factor
loneliness, crises, declining health, medical conditions
169
Delirium cognition
impaired memory, judgment, calculations, attention span, fluctuates during the day
170
Dementia cognition
impaired memory, judgment, calculations, attention span, abstract thinking, agnosia
171
Depression cognition
difficulty concentrating, forgetfulness, inattention
172
Delirium LOC
altered
173
Dementia LOC
not altered
174
Depression LOC
not altered
175
Delirium activity levels
- increased or reduced
- sundowning
- reversed sleep/wake cycle
176
Dementia activity level
- not altered
- sundowning
177
Depression activity level
- usually decreased
- lethargy, fatigue, no motivation
- poor sleep, wake up early
178
Delirium emotional state
- rapid swings, fearful, anxious, suspicious, aggressive
- hallucinations, delusions
179
Dementia emotional state
flat, agitation
180
Depression emotional state
extreme sadness, apathy, irritability, anxiety, paranoid, ideation irritability
181
Delirium speech and language
rapid, inappropriate, incoherent, rambling
182
Dementia speech and language
incoherent, slow, inappropriate, rambling, repetitions
183
Depression speech and langauge
slow, flat, low
184
Delirium prognosis
reversible with proper and timely treatment
185
Dementia prognosis
not reversible, progressive
186
Depression prognosis
reversible with proper and timely treatment
187
The greatest influence on health status is
poverty
