Lecture 2 Flashcards
1
Q
Components of mental status
A
- Attention
- Memory
- Orientation
- Perceptions
- Thought process/content
- Insight
- Judgement
- Affect
- Mood
- Language
- Higher cognitive functions
2
Q
What triggers a MSE?
A
- Medically unexplained physical Sx
- High Sx count
- High severity of the complaint when organic causes are ruled out
- Chronic pain
- Recent stressor
- Difficult encounters
- Low self rating of health
- Frequent use of healthcare servicces
- Substance abuse
- Cognitive complaints of any sort
3
Q
Illusions & when are they seen?
A
Mis-interpretation of real stimuli
- Grief
- PTSD
- Schizophrenia
4
Q
MMSE components
A
- Date orientation - 5 pts
- Place orientation - 5
- Register - 3 (Name objects & repeat)
- Serial 7’s - 5 (Count back from 7, WORLD)
- Recall - 3 (3 objects from register)
- Naming - 2
- Repeating phrase - 1
- Verbal commands - 3
- Written commands - 1
- Writing - 1
- Drawing - 1
5
Q
What is a normal MMSE score?
A
24 or higher
Depends on age & education
6
Q
What does a neuro exam test?
A
- MSE
- CN
- Sensory
- DTR/Plantar response
- Cerebellar function
- Muscle strength
- Motor screening
7
Q
CN I
A
Olfactory
Sensory
8
Q
CN II
A
Optic
Sensory - visual acuity & visual fields
9
Q
CN III
A
Oculomotor
Motor - raise eyelids, most EOM
Parasympathetic - pupil constriction, lens shape
10
Q
CN IV
A
Trochlear
Motor - downward, inward eye mvmt (SO)
11
Q
CN V
A
Trigeminal
Motor - jaw opening & clenching, mastication
Sensory - 3 branches
12
Q
CN VI
A
Abducens
Motor - lateral eye mvmt (LR)
13
Q
CN VII
A
Facial
Motor - facial expression muscles (except jaw), eye closure, mouth closure
Sensory - taste (ant. 2/3 tongue)
Parasympathetic - Secretion of saliva & tears
14
Q
CN VIII
A
Acoustic
Sensory - hearing & equilibrium
15
Q
CN IX
A
Glossopharyngeal
Motor - voluntary muscles for swallowing & pronation
Sensory - nasopharynx, gag reflex, taste (post. 2/3 tongue)
Parasympathetic - secretion of saliva, carotid reflex
16
Q
CN X
A
Vagus
Motor - Voluntary muscles of phonation & swallow
Sensory - behind ear, part of external canal
Parasympathetic - secretion of digestive enzymes, peristalsis, carotid reflex, heart, lungs, digestive tract
17
Q
CN XI
A
Spinal Accessory
Motor - turn head, shoulder shrug, some phonation
18
Q
CN XII
A
Hypoglossal
Motor - tongue mvmt for speech, sound articulation, swallowing
19
Q
Spinal nerve C3
A
Front & back of neck
20
Q
Spinal nerve C6
A
thumb/C8
5th finger
21
Q
Spinal nerve T4
A
nipple line
22
Q
Spinal nerve T10
A
umbilicus
23
Q
Spinal nerve L1
A
inguinal
24
Q
Spinal nerve S2/3
A
Anogenital
25
Spinal nerve L4
Knee
26
Lesions above & below corticospinal tract
Motor Tract
A - contralateral Sx
B - ipsilateral Sx
27
UMN lesions Sx & when are they seen
1. + babinski
2. Inc. DTRs
3. Muscular spasticity
1. MS
2. ALS
28
LMN lesions Sx & when are they seen
1. Dec. DTRs
2. Ipsilateral weakness
3. Dec. or absent muscle tone
1. Nerve transection
2. Guillan-Barre
3. Polio
29
What are the sensory pathways?
Participate in reflex activity, regulation of position & autonomic function
1. Spinothalamic
2. Posterior Column
30
Spinothalamic tract
```
Sensory pathway
Crosses in cord
1. Pain
2. Temp
3. Crude touch
```
31
Posterior Column tract
```
Sensory pathway
Crosses in the medulla
1. Position
2. Vibration
3. Fine touch
```
All affected by diabetic neuropathy
32
What do differences in reflexes indicate?
1. Level of spinal lesion
2. Electrolyte disturbances
3. Endocrine disturbances
4. UMN vs LMN disease
33
What kind of reflex does hypermagnesemia cause?
Delayed DTR
34
DTR & Spinal nerves
Biceps & Brachioradialis - C5&6
Triceps - C6&7
Patellar - L2,3&4
Achilles - S1
35
Grading DTRs
```
0 - absent
1+ - Hypoactive
2+ - Normal
3+ - Hyperactive
4+ - Hyperactive w/ clonus
```
36
What are cerebellar disease signs?
1. Dysmetria
2. Nystagmus
3. Intention tremor
4. Ataxia
37
Grading Muscle Strength
0/5 - No muscle mvmt
1/5 - Visible contraction but no joint mvmt
2/5 - Mvmt at joint, but not against gravity
3/5 - Mvmt against gravity, but not against resistance
4/5 - Mvmt against resistance but less than normal
5/5 - Normal strength
38
Primitive reflexes
Rooting - 4 mo
Palmar grasp - 6 mo
Moro - 2 mo
Plantar - 1 yr
Frontal Release signs
39
What is the Glabellar reflex?
Tap on Parkinson's Pts head & they don't stop blinking
40
What is Kernig's sign?
Pain when extending knee w/ leg in air
Sign of meningeal irritation
41
What is Brudzinski's sign?
Move hips when flex head while laying down
Sign of meningeal irritation
42
Signs of Parkinson's
1. Rigidity
2. Bradykinesia
3. Resting tremor
4. Slow, shuffling gait w/ loss of arm swing
5. Flexed body posture
6. Excessive salvation
7. Masked facies
43
UMN signs
1. Spastic weakness
2. Hyperactive reflexes
3. + Babinski
4. Pronator drift
44
LMN signs
1. Flaccid weakness
2. Hypoactive reflexes
3. Muscle atrophy
4. Fasciculations
45
Extrapyrimidal signs
1. Resting tremor, rigidity
2. Postural deformity & instability
3. Slow RAM
46
Cerebellar signs (B1 deficiency)
1. Intention tremor
2. Ataxia
3. Impaired RAM
47
What muscle is paralyzed with a winged scapula?
Serratus anterior
From long thoracic nerve
May be caused by C7 entrapment from mastectomy Pts
48
Causes of torticollis
SCM contraction
1. Hematoma
2. Tear
3. Phenothiazines
49
Which vertebrae are most susceptible to compression Fx?
T10-T12
50
Which rotator cuff muscle is most likely to be injured?
Supraspinatous
51
How do you test for AC separation?
Cross over test
52
How do you test for biceps tendonitis?
Yergason test
53
What muscles are involved in supination of forearm?
Biceps & supinator
54
What muscles are involved in pronation of forearm?
Pronator teres
55
What is the Trendelenburg test?
Pt stands on one leg & opposite hip should point down
56
Normal knee deviation ages
0-3 Genu varum
| 3-8 Genu valgus
57
How do you test for ACL tear
Lachman test
Flex knee 20-30 degreses
DIsplace tibia anteriorly
58
+ anterior drawer test?
ACL injury
59
+ posterior drawer test?
PCL injury
60
+ McMurray test?
Meniscal injury
61
Valgus vs. varus stress tests
Valgus - MCL
Varus - LCL
62
Test for patellofemoral syndrome?
Pain w/ patellar grind test
63
Inversion of ankle causes which sprain?
Anterior tibiofibular ligament
64
When do you get an ankle Xray?
Ottawa Ankle rules
1. Malleoli point tenderness
2. Unable to WB
65
What is the Thompson test?
Grab gastrocnemius & soleus
| Foot should plantar flex if achilles intact
66
Who gets alopecia areata?
Kids - autoimmune & hereditary
| Patchy hair loss w/o scarring
67
What is the MCC of hair loss in women?
Telogen effluvium
68
What causes koilonychia?
iron deficiency anemia?
| Spoon shaped nails
69
What causes leukonychia?
White lines on nails
| After serious systemic illness
70
What causes pitted nails?
Psoriasis & atopic dermatitis
71
What is onycholysis?
Separation of nail plate from nail bed
72
What is onychomycosis?
Fungal infection of nail
| Tineal ungium
73
What is paronychia?
Infection of nail
Staph most common
74
What is melanonychia?
Single band along fingernail = cancer
75
When should you start doing routine digital rectal exams?
40
76
What is the most common male cancer?
Prostate
Staged via Gleeson score
Prevalence assoc. w/ age
assoc. w/ BRCA2 gene
Biopsy cut point >4
Start at age 50
77
Acute prostatitis
< 35 GC/chlymidia
>40 GRE - enterobacteraciae
Dysuria, pelvic & rectal pain, fever
78
When do you do mammograms?
40 & yearly
79
When do you do clinical breast exams?
20 then q3y
40 every year
80
Which nerve does finger spread test?
Ulnar
81
Which nerve does the corneal reflex test?
CN V
82
Which nerves does the gag reflex test?
CN IX & X
83
Sensory ONLY Cranial nerves?
I
II
VIII
84
Motor, Sensory & Parasympathetic Cranial nerves?
VII
IX
X
85
Motor ONLY Cranial nerves?
IV
VI
XI
XII
86
Cranial nerves involved in swallowing?
IX
X
XII
87
Nerves involved in abdominal reflex?
T8-12
88
Which surfaces does psoriasis usually appear on?
Extensor
89
Which surfaces does atopic dermatitis usually appear on?
Flexor
