ICM 1 - Exam 3 Flashcards
(171 cards)
1
Q
What is the fundamental optical principle?
A
Refractive errors are corrected with divergent (minus) lenses or convergent (plus) lenses
2
Q
If you see this, what disease/condition should you be concerned about?
A
Diabetic retinopathy
3
Q
What three tests can assess a patient’s coordination?
A
Finger to nose and back
Heel to shin (heel to opposite knee and down the shin to the big toe)
Heel to toe walking
4
Q
The biceps reflex tests what spinal nerves?
A
C5-6
5
Q
How do you test CN X?
A
Make sure their uvula isn’t deviated to one side when the mouth is open
6
Q
From 6 months to 11 months, what should a child be able to do as far as language development?
A
Understand no, babble, try to repeat sounds and communicate with gestures and actions
7
Q
From 2-3 years old, what should a child be able to do as far as language development?
A
Knows some spatial concepts and descriptive words; speaks in 2-3 word phrases; says around 40 words at 24 months
8
Q
How do you test CN III, IV, and VI?
A
Drawing an “H” and having the person follow with their eyes and then testing convergence
9
Q
Foot dorsiflexion: muscle and nerve
A
Tibialis anterior
Deep peroneal nerve - L4, L5
10
Q
What is personal fable?
A
The story adolescents tell themselves that emphasizes their uniqueness and invulnerability
11
Q
How do you test CN II?
A
Inspect fundi (light shining), test visual acuity (look at finger and then over shoulder), and by screening visual fields
12
Q
What color is white matter on CT?
A
Dark gray
13
Q
What stage of Erikson’s model of psychosocial development is found in emerging adulthood?
A
Intimacy vs. isolation
14
Q
Foot plantar flexion: muscle and nerve
A
Gastrocnemius & soleus
Tibial nerve- S1, S2
15
Q
Three elements of consciousness?
A
- Arousal
- Alertness
- Awareness
16
Q
Wrist extension: muscle and nerve
A
Extensor carpi radialis
Radial nerve - C6-C8
17
Q
What are three ways you can measure intraocular pressure?
A
- Tonopen
- Schiotz tonometer
- Fingers (high pressures will feel hard instead of spongy)
18
Q
What is adolescent egocentrism?
A
The belief that an adolescent’s thoughts and ideas are unique and are not understood by others
19
Q
What three gait tests can you assess in otherwise intact people?
A
- Walk across the room
- Walk heel-to-toe
- Walk on toes then on heels
20
Q
Three important neurological questions to remember when examining a patient?
A
- Is the mental status in tact?
- Are the findings symmetric?
- If the findings are asymmetric or abnormal does the cause lie in the CNS or PNS?
21
Q
How do you assess attention and concentration?
A
WORLD backward, serial 7s from 100, months of the year backward
22
Q
What tool allows you to perform the posterior segment eye exam?
A
The direct ophthalmoscope
23
Q
What two cognitive capabilities do teens develop?
A
- Hypothetic-deductive reasoning: whats used in science
- Reflective abstraction: ability to rearrange and rethink information already acquired
24
Q
The triceps reflex tests what spinal nerves?
A
C6-7
25
What are the three levels of Kohlberg's moral development?
1. Pre-conventional morality (reasoning tied to personal concerns)
2. Conventional morality (reasoning tied to societal concerns)
3. Post-conventional morality (reasoning is greater that following social norms)
26
What set of traits and behaviors comprise grit?
goal-directedness, motivation, self-control, positive (growth) mindset
27
What are the disadvantages of noncontrast CT for brain imaging?
Small lesions may not be seen, anatomy detail for small structures is limited (i.e. pituitary, sinuses, larynx, etc)
28
What stain can help you visualize corneal abrasions?
Fluorescein
29
What is clonus?
Hyperactive response required for assigning a reflex grade of 4. Usually elicited at the ankle
30
What are the dimensions of development?
Physical growth and motor skills, temperament, cognition and intelligence, language, social relations and attachment
31
If you see this, what disease/condition should you be concerned about?
Optic nerve pallor
32
If you see this, what disease/condition should you be concerned about?
Rheumatoid arthritis, Wegener's
("cornea melted")
33
How can you tell the difference between Bell's Palsy (lesion affecting the brain stem) and a stroke (lesion affecting the brain)?
In Bell's Palsy the patient will have a drooped eyebrow, inability to close their eye, flat nasolabial fold, and paralysis of the lower face
In a stroke the other hemisphere can make up for some of the deficits so the patient will be able to close their eyes with some weakness, be able to raise their eyebrows, but have a flat nasolabial fold
34
Who coined the stages of psychosocial development?
Erikson
35
How do you test CN IX?
Have the patient open and say "ah," and then assess their soft palate/arches on either side of the uvula for symmetry
36
What is myopia?
Nearsightedness
Can focus up close but not far away; image is focused in front of the retina
Eye is too long or cornea/lens is too strong
37
If you see this, what disease/condition should you be concerned about?
Scleromalacia - rheumatoid arthritis
("scleral melting")
38
By what age should a child's speech be 100% intelligible?
4 years old
39
What are the "ophthalmic vital signs"?
visual acuity and intraocular pressure
40
What test is used to assess temperament?
the marshmallow test
41
For motor skills, what are the shapes a child should be able to draw and the corresponding ages?
Circle - 3
Cross - 4
Square - 5
Triangle - 6
42
How do you test CN XI?
Shoulder shrug against resistance, turning head against resistance
43
If you see this, what disease/condition should you be concerned about?
Iritis - autoimmune disease
44
How does a subdural hematoma appear on noncontrast CT?
Crescent shape, crosses sutures in the calvarium
Note: venous hemorrhage
45
What disease processes can effect cranial nerve function?
stroke, tumor, neuromuscular disease
46
Grip: spinal nerve #s
C7-T1
47
What CNs arise from the midbrain?
II, III, IV
48
What is imaginary audience?
Characteristic of adolescents' self-consciousness, involving the feelings that people are watching their every move
49
If you see this, what disease/condition should you be concerned about?
Arcus senilis - hyperlipidemia
50
Elbow flexion: muscle and nerve
Mostly biceps
Musculocutaneous nerve - C5 and C6
51
What is a growth mindset?
Something that is developed through hard work and practice
Students with it view challenges as an opportunity to grow, learn from criticism, see mistakes as learning opportunities, keep going when things get difficult, etc
52
What color is gray matter on CT?
light gray
53
Which is higher risk: epidural or subdural hematoma?
Epidural
54
How do you assess recent & remote memory?
Tell the patient three words, distract them, then ask them to remember the words
55
If you see this, what disease/condition should you be concerned about?
Familial colon cancer
("bear track")
56
What sensations are assessed during a sensory exam?
Light touch, pinprick, vibration, position sense (proprioception)
57
What are you doing during confrontational field testing?
Checking peripheral vision by having the patient (and yourself) cover one eye. Hold fingers in each quadrant and determine if the patient can see them
58
What four things must you consider when performing a posterior segment exam on the eye?
1. Patient must be looking 20 feet or farther away (point of no confrontation)
2. Room must be dark
3. You need to be on the same horizontal plane as the patient
4. Don't block the patient's face (otherwise pupil will constrict due to convergence and accommodation)
59
What stage of Erikson's model of psychosocial development are adolescents in?
Identity vs. Role Confusion
60
If a patient has a barely detectable flicker/trace of contraction in their muscle, what grade would you give them on the muscle strength scale?
1/5
61
What CNs arise from the medulla?
CN VIII (1/2), IX, X, XI, XII
62
When is a head CT with contrast used?
To evaluate arterial anatomy (aneurysms, stroke), tumor, and infection
63
What are some recent concerns related to social development?
Over-programming of children's lives, social media (lack of in-person contact), focus on competition, lack of time
64
If you see this, what disease/condition should you be concerned about?
Endocarditis
("roth spots")
65
If you shine light into an eye and the pupil dilates, what does this tell you?
There is a cranial nerve defect in this eye
66
What is the most-common screening tool for the brain?
non-contrast CT
67
Thumb opposition: muscle and nerve
Opponens pollicis
Median nerve - C8, T1
68
What are the stags of Piaget's cognitive development model?
1. Sensorimotor (birth to 2; object permanence)
2. Pre-operational (2-7; egocentric stage, lacks object conservation)
3. Concrete operational (7-11; intro to logical thinking)
4. Formal operational (11+ abstract thinking)
69
What are the advantages of non-contrast CT for brain imaging?
Fast scanning time, anatomic detail of the brain & calvarium, no real contraindications
70
Knee extension: muscle and nerve
Quadriceps
Femoral nerve - L2, L3, L4
71
What are the four childhood attachment patterns?
1. Secure attachment
2. Avoidant attachment
3. Ambivalent attachment
4. Disorganized attachment
72
What scale is used to assess coma?
Glasgow scale (remember: would drink too much scotch in Scotland and end up in a coma)
73
Which wing of the sphenoid bone houses the optic canal?
The lesser wing
74
From 12 months to 17 months, what should a child be able to do as far as language development?
Follows simple directions, answers simple questions nonverbally
75
How do you assess orientation?
Ask person, place, and time PPT
76
What nerve senses that your eye is dry and relays that information to the lacrimal gland?
CN V1
77
If you see this, what disease/condition should you be concerned about?
Alport syndrome/renal failure
78
If you see this, what disease/condition should you be concerned about?
Sturge-Weber syndrome
79
Finger spreading: muscle and nerve
Mostly dorsal interossei Ulnar nerve - C8, T1
80
What is grit?
Persistence over time to overcome challenges and accomplish goals Might determine how we react to failure and how resilient we are in ties of adversity
81
What is separation-individuation?
A process by which children learn to identify the boundaries between self and caretaker, and negotiate a balance between attachment and independence Margaret Mahler
82
What are the adolescent stages?
Early adolescence: 11-14 Late adolescence: 15-18 Extended adolescence/emerging adulthood: 19-25
83
The ankle reflex tests what spinal nerve?
Primarily S1
84
What would we expect to see on a sagittal MRI of a patient with MS?
"Dawson's fingers"
85
What is a clique?
Small groups of 5-7 good friends; identified by interests and social status
86
Shoulder abduction: muscle and nerve
Mostly deltoids Axillary nerve - C5
87
If you see this, what disease/condition should you be concerned about?
Chorodial metastasis - breast/lung cancer
88
What is a crowd?
Larger group that includes several cliques; membership based on reputation, stereotype Ex: jocks, nerds, preps
89
What color is acute blood on CT?
bright!
90
What type of lens corrects myopia?
Divergent/concave lens
91
From birth to 5 months, what should a child be able to do as far as language development?
React to loud sounds and turn their heads toward the source
92
What imaging modalities are used to the see the brain?
CT, MRI, and others like PET, nuclear medicine, and ultrasound
93
Knee flexion: muscle and nerve
Hamstrings Sciatic nerve - L1, S1, S2
94
What type of lens will correct an astigmatism?
A lens made opposite to the cornea
95
What CNs arise from the pons?
V, VI, VII, VIII (1/2)
96
What hormones increase around 8-9 to stimulate puberty?
Growth hormone and thyroxine
97
The brachioradialis reflex tests what spinal nerves?
C5-6
98
The plantar response (Babinski) primarily tests what spinal nerves?
L5 - S1
99
What is temperament? What are the clusters of temperament?
Biologically-based individual differences in emotion, motor activity, and self-regulation Clusters: easy, difficult, and slow-to-warm-up
100
What spaces in the brain are filled with CSF?
Ventricles (4), cisterns, fissures, and sulci
101
What score range is considered normal on the mini mental status examination (MMSE)?
24 out of 30 or higher
102
What is a standard measurement of visual acuity?
20/20 style ratio i.e. 20/60 means that you see at 20 feet what a patient with normal vision sees at 60
103
What structure focuses majority (2/3) of the light coming into your eye?
The cornea (the lens does the remaining 1/3)
104
How do you test CN VII?
Ask the patient to smile, frown, puff their cheeks, raise eyebrows, and close their eyes tightly (won't let you open when you try!)
105
Elbow extension: muscle and nerve
Triceps Radial nerve - C6-C8
106
What is the Romberg test? Describe it
A test of a position sense The patient stands with their feet close together and eyes open and then closes them for 30 - 60 seconds without support Normal result should be minimal swaying. Ataxia or loss of balance is a positive Romberg sign
107
What direction does CN IV move the eye?
Medially and downward
108
What direction does CN VI move the eye?
Laterally
109
What is accommodation?
The ability of the lens to change focus
110
What is normal intraocular pressure (IOP)?
11 - 21
111
What is the DENVER II Developmental Screening Test used for?
To provide age ranges of normal appearance of various milestones up until 6 years old Ex: fine motor, gross motor, language, and social contact
112
How can you measure visual acuity?
Have the patient stand 20 feet from the letter sign, count fingers, see hand motions, or do light perception only/no light perception
113
What are the folds of the cerebral cortex called?
Gryus
114
What is emmetropia?
Perfect focus on the retina
115
How can you find the optic nerve in the eye?
Find a large vessel and follow it; it will slope down into the optic nerve
116
How do you assess tone during a PNS exam?
Passively flexing and extending the neck, elbows, and knees
117
How does an epidural hematoma appear on noncontrast CT?
Lens shaped, does not cross suture lines Note: arterial hemorrhage (middle meningeal artery) usually related to blunt force trauma to the head
118
What is hyperopia?
Farsightedness Can see far away but not up close; image is focused behind the retina Eye is too short or cornea/lens is too weak
119
From 18 months to 23 months, what should a child be able to do as far as language development?
Says 8 to 10 words, understands simple words, likes being read to
120
What should you note when assessing a person's natural gait?
speed, stride length, arm swing, and turns
121
Changes in what two areas of the brain impact behavior in adolescence?
Prefrontal cortex and the amygdala
122
What are the disadvantages of brain MRI?
Claustrophobia, patient unable to tolerate longer scan time, cardiac pacemakers
123
What kind of diseases affect gait?
stroke, neuromuscular (i.e. muscular dystrophy), movement disorders (i.e. Parkinson's)
124
How do you test CN XII?
Have the patient stick out their tongue and assess for any deviations
125
What kind of diseases affect coordination?
stroke (CVA), cerebellar atrophy, MS, dementia, Parkinson's (or other movement disorder)
126
How are reflexes graded? What is normal on this scale?
0 - 4 Normal is 2/4
127
What is the mini-cog screen?
1. Ask the patient to remember 3 words
2. Ask the patient to draw a clock and set the time to 10 after 11
3. After drawing the clock ask them to recall the three words (good for dementia screening)
128
What are peer relationships like in adolescence?
Fewer "best friends" than kids, intimacy & loyalty are important, friends are similar or get more similar
129
How will a sulcus appear on CT?
Bright white because it has CSF fluid
130
If you see this, what disease/condition should you be concerned about?
Kaposi's sarcoma - AIDS
131
Which eye muscles control extorsion and intorsion?
The obliques
132
Hip flexion: muscle and nerve
Iliopsoas Femoral nerve - L1, L2
133
What makes you more myopic in darkness?
The fact that your peripheral lens is more rounded/stronger
134
If a patient can only move against gravity, what grade on the muscle strength scale would you give them?
3/5 (this means a piece of paper would make their arms drop)
135
If you see this, what disease/condition should you be concerned about?
Band keratopathy - gout, hypercalcemia
136
How do you test CN VIII?
Ask the patient to close their eyes and rub your fingers outside of each ear
137
How do you test CN V?
Light touch on forehead, cheeks, and jaw (hitting V1, V2, and V3) Palpation of muscles of mastication while tensed
138
How can you perform a mental status exam on a normal patient?
Through basic observation and conversation
139
What is an astigmatism?
Eye (cornea) is not perfectly spherical; more egg or football shaped Never gives a sharp focus
140
If you see this, what disease/condition should you be concerned about?
Hypertensive retinopathy
141
What is the basis of Erikson's psychosocial development?
Major themes in each phase have to be successfully negotiated. Outcome of prior phases influences how a person masters the next level Ex: Intimacy vs. isolation in adulthood
142
When is an MRI of the brain used?
For tumor, infection, stroke, demyelinating disease, seizure
143
If you see this, what disease/condition should you be concerned about?
Optic disc swelling
144
What type of lens corrects hyperopia?
Convex/convergent lens
145
What is Marcia's theory of identity development?
The balance between exploration and commitment in exploring roles and identity in adolescence
146
If you see this, what disease/condition should you be concerned about?
Subluxed cataract - Marfan's syndrome
147
What is noncontrast CT good for catching?
Hemorrhage and fractures
148
What kind of diseases affect sensation?
Stroke, peripheral neuropathy, compression neuropathy, radiculopathy
149
How close do you need to be to a patient's eye with the direct ophthalmoscope to properly visualize the structures?
one inch
150
What is presbyopia?
The loss of accommodation (usually gone by age 65) With age, the lens loses the ability to change shape. The ciliary muscle contracts more and we experience eye pain/strain when things are up close
151
What kind of stimulus do you need to remember to give during a sensory exam?
A null stimulus
152
The knee reflex tests what spinal nerves?
L2-4
153
How is strength assessed (scale)? What is normal on this scale?
0 - 5 5/5 is normal. This means the patient can overcome your opposing movement
154
Why do we screen for breast cancer?
It provides the greatest mortality reduction
Regular mammographic screening leads to the greatest reduction in deaths
155
What are the ACR/SBI breast cancer screening guidelines for AVERAGE risk women?
Begin screening at 40 and then screen annual thereafter
156
What are the ACR/SBI breast cancer screening guidelines for HIGH risk women?
Begin screening 10 years arlier than the youngest affected relative OR at age 30 - whichever age is ***later***
Screen annually thereafter
157
Women with a greater than 20% lifetime risk of breast cancer are elligible for what additional screen with their mammography?
MRI
158
When should breast cancer screening cease?
When life expectancy is less than 5-7 years due to comorbid conditions
or when abnormal results would not be acted on due to comorbid conditions
159
Who is at high risk for breast cancer?
Anyone with greater than 20% lifetime risk of breast cancer (based on family history, clinical factors)
Those with gene mutations or those of Ashkenazi Jewish descent
160
What are gene mutations related to breast cancer?
BRAC1, BRAC2, CHEK2, P53, STK11, PTEN
161
What views are taken during a screening mammogram?
1. Craniocaudal view (CC) - compression plane is transaxial
2. Medial lateral oblique view (MLO) - compression plan parallels the course of the pectoralis muscle
162
How do you know you're looking at a CC vs. an MLO view of a mammogram?
If you can see the pectoralis muscle then its an MLO view
163
What is the difference between a screening exam for breast cancer and a diagnostic exam?
Screening exams are performed on asymptomatic females. They get two views done, leave the imaging center, and get a report within 30 days
Diagnostic exams are performed on patients with problems (mass, discharge, pain) or as follow-ups/additional imaging requests. Can include additional views or an US. Patient sees the breast radiologist before leaving the center
164
What are you looking for on a mammogram?
Masses
Asymmetry
Calcifications
Distortion
165
Is breast ultrasound used as part of screening?
No, only as part of a diagnostic exam
166
What is the initial breast imaging study of choice for patients under 30?
Ultrasound
167
What type of imaging is ALWAYS performed on a patient who presents with a palpable mass in their breast?
An ultrasound
168
When is a breast MRI used?
In screening for high risk patients
Patients with biopsy-provden invasive ductal carcinoma or invasive lobular carcinoma
169
What scale is used for breast imaging assessment?
BIRADS
170
What portion of the BIRADs scale is related to screening only? To diagnosis only?
Screening: 0 - 2
Diagnostic: 3 - 6
171
What is each level of the BIRADs scale?
0 = incomplete. Additional imaging needed (screening mammograms only)
1 = negative/normal breasts
2 = benign (no additional workup needed)
3 = probably benign (short-interval follow up recommended) Less than 2% malignancy
4 = suspicious (biopsy recommended - subdivided into 4a, 4b, and 4c) malignancy risk 2% to 95%
5 = highly suggestive of malignancy (biopsy or surgery recommended). Malignancy risk greater than 95%
6 = Known malignancy (biopsy-proven, treatment plan in place already)
