PD Exam III Flashcards
(190 cards)
1
Q
Mini-Mental State Exam
A
30 pt questionnaire
cognitive impairment - dementia
cognitive and higher cognitive
2
Q
What are the categories of Mental Status Exam
A
appearance and behavior speech and language mood thought processes thought content judgment insight abstract thinking cognitive higher cognitive
3
Q
speech and language
A
quantity: talkative, silent
rate: fast or slow
volume: loud or soft
fluency: rate, flow, melody
4
Q
thought process
A
flight of ideas, incoherence, confabulation, etc,
5
Q
thought content
A
compulsions, obsessions, phobias, anxieties, delusions, unreality
6
Q
circumstantiality
A
speech with unnecessary detail, indirection, and delay in reaching the point
7
Q
derailment
A
shift topics that are loosely connected or unrelated
8
Q
flight of ideas
A
continuous flow of speech but abrupt changes from one topic to next
9
Q
neologisms
A
invented or distorted words
10
Q
incoherence
A
incomprehensible and illogical speech w/o meaningful connections
11
Q
blocking
A
interruption of speech mid-sentence (losing thought)
12
Q
confabulation
A
fabrication of facts or events in response to questions; to fill in gaps from impaired memory
13
Q
preservation
A
persistent repetition of words or ideas
14
Q
echolalia
A
repetition of words and phrases of others
15
Q
clanging
A
choosing words based on rhyming rather than meaning
16
Q
judgment
A
affected by anxiety, mood, edu, income, intelligence, culture
also delirium, dementia, psychosis
17
Q
insight
A
can have denial of impairment (memory loss/confusion)
18
Q
cognitive function
A
orientation attention remote memory recent memory new learning ability
19
Q
higher cognitive function
A
information and vocab
calculating ability
abstract thinking
constructional ability
20
Q
high cognitive functions
A
calculating
abstract thinking: concrete v abstract
information and vocabulary
constructional ability
21
Q
concrete v abstract thinking
A
concrete: both mouse and rat have tails, sew rip before it gets bigger
abstract: both are animals, prompt attention to problem prevents trouble
22
Q
information and vocabulary
A
name object
word comprehension
reading comprehension
writing
23
Q
constructional ability
A
draw clock with hands pointing to specific time
24
Q
where do the cranial nerves emerge from?
A
1, 2: cerebrum
3-12: brain stem
25
which cranial nerve relates BEYOND head and neck?
vagus CN10
26
Which CNs are Sensory, Motor, Both?*
Some say marry money but my brother says big brains matter more
27
What two muscles does CN11 (accessory) control?
SCM
| Trap
28
What muscles do CN12 control?
strap muscles - infrahyoid ones
29
hyposmia v hyperosmia
hyposmia: partial loss of smell
hyperosmia: exaggerated sensitivity
30
dyosmia
distorted smell
31
anosmia
total loss of smell
32
phantosmia
olfactory hallucination
33
cacosmia
smelling something burned, foul, or rotten
34
what CN do irritating smells stimulate?
trigeminal (peppermint, NH3 --> dont use to test)
35
common olfactory disorders
post traumatic
post infection
olfactory hallucinations in epilepsy
36
what to do to examine olfaction?
```
inspect for obstruction
sniff test (occlude one)
```
37
unilateral olfactory disturbance can be from what?
sub-frontal meningioma
38
rods v cones
rods: low light, low spatial acuity
cones: high light level, color, high spatial acuity
39
L/R VISUAL FIELDS of BOTH eyes go to which side of brain?*
L visual field of BOTH eyes: right brain
| R: left brain
40
The image on the retina is...?
inverted
41
outside areas of both L/R visual fields lost, damage is at..?
chiasm`
42
Isihara's testing
color vision
43
optic nerve testing
snellen chart
color vision
visual fields by confrontation
fundoscopic exam
44
testing CN II, CN III: PERRLA
pupils equal, round, react to light, accomodation
45
direct and consensual response to light
direct: shine light, pupil constrict
consensual: other pupil also constricts w/o direct light
46
anisocoria
different of 0.4mm in pupil diameter
47
testing CN3,4,6
Eyelid for symmetry (ptosis)
extraocular mvmts (6 cardinal directions)
convergence: look towards nose
nystagmus
48
medial/lateral canthus
corners of the eyes
49
sclera
whites of eye, covered by conjunctiva
50
limbus
outer edge between iris and sclera
51
two types of conjunctiva
bulbar: over sclera
palpebral: under eyelid
52
meibomian gland
produce mebium: oily substance to prevent tear evaporation
| dysfunction: dry eyes
53
adie's syndrome
```
neurological: usually unilateral
mydriasis,
no reaction to light,
loss of deep tendon reflex,
abnormal sweating
```
54
who can get Adie's (tonic) pupil?
diabetic neuropathy
| alcoholism
55
what is sustained in Adie's pupil?
accommodation sustained --> complain blur vision from distant to near
56
Argyll Robertson Pupil
moisis
iris atrophy
cant dilate in dark
57
What causes argyl robertson pupil?
neurosyphilis
58
abducens palsy
eye mvmt disorder: lesion of CN6 --> gaze paresis
cant eye abduct
unilateral or bi- increase intracranial pressure
59
complete abducens palsy causes...?
convergent strabismus (looking straight, one goes in )
60
trochlear palsy
CN4: SO weakness
| diplopia on downward gaze
61
oculomotor palsy
CN3 compression from tumor or post communicating a. aneurysm --> dilation (blown pupil)
complete v incomplete
30% pupil sparing
62
causes of trochlear palsy
myasthenia
| dysthyroid eye disease: grave ophthalmology
63
cause of oculomotor palsy
diabetes
64
strabismus
eyes don't align bilaterally: exotropia
65
complete oculomotor palsy
ptosis
| lateral deviation, slightly downward
66
types of nystagmus (oscillation mvmt)
pendular: slow waveform, congenital ,MS
vestibular: peripheral (suppressed by visual fixation), central (unaffected by fixation)
gaze evoked: certain direction (Tav)
down beat: chiari malformation
convergence: dorsal midbrain
endpoint: physiological
67
CN5 Trigeminal
pons
facial sensations
mastication: muscles
68
damage to trigeminal during mastication
jaw deviate to affected side
69
4 muscles of mastication
masseter
temporalis
medial, lateral pterygoids
70
3 divisions of trigeminal nerve
ophthalmic n.
maxillary n.
mandibular n.
71
sensations of trigeminal
sharp-dull
hot-cold
light touch
compare side to side
72
how to test corneal reflex (trigeminal n.)
cotton to one eye --> blinking of both eyes
73
Facial nerve CN7
pons
ant 2/3 taste
facial muscle expression
parasymp: submandibular, sublingual, lacrimal glands
74
Motor function branches of facial n.*
```
two zebras bit my clavicle:
temporal
zygomatic
buccal
mandibular
cervical
```
75
Bell's palsy
one sided facial droop
LOWER motor neuron
facial nerve
76
difference between stroke and bell's palsy
stroke: UMN, paralysis of lower face
| Bell's: LMN, paralysis of entire side
77
Types of hearing loss (vestibulocochlear n.) and how to test for it
conductive
sensorineural
Weber: lateralization
Rinne: conduction
78
Weber Test*
tuning fork midline
conductive hearing loss: heard best affected ear
nerve: heard best by intact ear
79
Rinne Test
conduction test
Normal: AC > BC
conductive loss: BC > AC
nerve: AC > BC, sound stops much earlier
80
How to straighten ear canal?
pull ear up
81
Glossopharyngeal CN9
medulla
swallowing throat muscles
post 1/3 taste
gag reflex
82
jugular foramen syndrome
nasopharyngeal carcinoma compress CN9
83
glossopharyngeal neuralgia
tumor or vascular
| pain swallowing
84
Vagus n. damage*
```
deviation of uvula AWAY from affected side*
dysphagia
dysphasia
dysarthria
flattening palatal arch
```
85
dysphagia
difficult swallowing
86
dysphasia
difficult use/understand language
87
Aphasia
cant use/comprehend words
88
dysarthria
difficult articulating words
89
assess vagus nerve by...?
listen tot quality of voice
| ask pt to say "ahh" and observe uvula, soft palate rising
90
roots of accessory n.
spinal root
| bulbar root
91
Test accessory n.
turn head against resistance
| shoulder shrug against hand
92
what nerve do surgeons nick a lot?
accessory n.
93
hypoglossal n.
tongue mvmt
94
test for hypoglossal n.
voice
tongue midline, side to side
push tongue against cheek
95
hypoglossal damage: which side tongue and uvula deviates to?*
tongue TOWARD*
| uvula: AWAY*
96
Your patient tells you they have a prickly sensation on their lower left anterior thigh. What is a word to describe this?
Paresthesia
97
What is the definition of Fasciculations?
Random involuntary muscle twitches
98
Normal Muscle Strength would be graded as what number?
5/5
99
Define Ataxia
A gait that lacks coordination and is unstable
100
Considering what you know about Anatomy, Besides Balance, what else does walking on your toes and Heels test for (respectively)?
Plantar flexion/ dorsiflexion of ankles
101
Afferent Nerve fibers travel toward the spinal cord and away from the stimulus in a deep tendon reflex
True
102
A normal exam finding would be which of the following?
Patellar DTR, 2/4 bilaterally
103
If you found the previous answer number 4 “Patellar DTR, 2 on the left and 4 on the right” in your patient, What might this suggest?
CNS lesion on the left
104
You all received the “Meningitis vaccine”, what organism does that vaccine protect you from (several serogroups of this bacteria Anyway-but not all)
Neisseria meningitidis
105
fasciculation
muscle twitch
106
When upper motor neurons are damaged above the crossover of its tracts in the medulla, motor impairment is on?
opposite side of the body
107
When upper motor neurons are damaged below the crossover of its tracts in the medulla, motor impairment is on?
same side of the body
108
When do you check temperature sensation?
only if pain sensation (sharp or dull test) is abnormal
109
Analgesia v. Hypoalgesia v. Hyperalgesia
Analgesia – absence of pain sensation
Hypoalgesia - DECREASED sensitivity to pain
Hyperalgesia - INCREASED sensitivity to pain
110
Anesthesia v. Hypesthesia v. Hyperesthesia
Anesthesia – absence of touch sensation
Hypesthesia – DECREASED sensitivity to touch
Hyperesthesia - INCREASED sensitivity to touch
Paresthesia – peculiar sensation without an obvious stimulation
Dysesthesia – distorted sensation in response to stimulus
111
What can loss of proprioception and vibration be causes by?
multiple sclerosis, B12 deficiency, posterior column disease, peripheral neuropathy
112
how to test proprioception (position)
1. hold sides of big toe and move it up and down (tell them which is which)
3. pt close eyes and tell you up or down
113
how to test vibration
1. place tuning fork on DIP big toe
| 2. ask pt when vibration stops
114
what if vibration test abnormal?
move distally, eg medial malleolus, tibial tuberosity
115
How to check light touch?
cotton ball
pt tell you when they feel it (eyes closed)
test side to side (does it feel the same)
looking for anesthesia
116
tests for discriminative sensation
```
stereognosis
graphesthesia
two point discrimination: 1 or 2 pts
point localization
extinction: touch at same place on each side (eyes close), they to where
```
117
What to INSPECT in motor sensory test
muscle bulk: side to side
muscle tone
body position
body stance
118
muscle tone
residual tension in relaxed muscle
| test through passive mvmt
119
muscle bulk
active mvmt: I and palp for atrophy
120
paratonia
increased resistance that decreases when pt distracted
121
rigidity
increased resistance through mvmt
122
what to watch out for in motor exam?
fasciculations
atrophy
abnormal movements
involuntary movements
123
Myoclonus*
Rapid shock-like muscle jerks
124
Chorea*
rapid, jerky twitches, similar to myoclonus but more random in location and more likely to blend into one another
125
Tics*
abrupt, stereotyped, coordinated movements or vocalizations
126
Dystonia*
maintenance of abnormal posture or repetitive twisting movements
127
paresis v plegia
paresis: weakness
plegia: paralysis
128
How to test Grip Strength
pt squeeze 2 fingers as hard as they can
| test bilaterally
129
Rapid alternating mvmt
```
palm up and down, one by one
tap toes to your hand
thumb to fingers
tongue wiggle
"lalala" "papapa"
```
130
how to test coordination and equilibrium (taxia)
rapid alternating mvmt
| point to point mvmt: finger to nose and to finger
131
how to test for gait
walk heel to toe (tandem walking)
walk on toes, heels
hop one foot
shallow knee bend
132
Romberg Test
push pt side to side and have them maintain balance
133
whats a positive romberg test?
pt can stand well w/eyes open but lose balance when they're closed
134
pronator drift
1. pt close eyes
2. have pt flex and supinate and HOLD 20-30sec
POS: if cant hold and starts supinate
3. tap arm downward
135
what is pyramidal drift?
arm tapping of pronator drift
136
pronator drift is positive in what condition?
stroke
| corticospinal tract lesion contralaterally
137
Normal rating in DTR
2/4
138
What muscles does the patellar reflex stimulate?
quadriceps
139
What is 5/4 for a DTR rating?
sustained clonus
140
what type of lesion in a hyper reactive DTR?*
central (CNS/upper motor neuron) lesion
141
What spinal tract is responsible for DTR and where does it cross over?
Corticospinal
| medulla
142
corticospinal tract lesion above medulla result
contralateral hyper reflexia
| below: ipsilateral
143
Where are DTRs?
```
Biceps
Triceps
Brachioradialis
Abdominal
Patellar tendon (knee)
Achilles (ankle)
```
144
abdominal reflex
stimulate ab wall --> see contraction
145
Plantar (Babinski) reflex
stroke foot, curve medially over ball of foot --> flexion
146
Babinski reflex in infants
fanning of toes bc incomplete myelination
147
clonus
rhythmic oscillation response (hands, feet)
148
how to check for clonus?
sharply dorsiflex foot and hold (passive)
| feel for oscillations
149
anal reflex
stroke outward in 4 quadrants from anus --> contraction
150
meningeal signs
neck mobility
brudzinski's sign
Kernig's sign
151
Kernig's sign
for meningitis
| pos: pain bilateral behind knee when flexed knee is extended
152
Brudzinski's sign
for meningitis
| pos: flexion of hips and knee in response to flexing neck
153
priapism
prolonged erection usually w/o sexual arousal
154
CVA tenderness
pain w/percussion of costovertebral angle (over kidneys)
155
What should you inspect in genitourinary exam?
```
perineal skin
tanner staging
position of urethral meatus
compress glans for discharge
lice and eggs
```
156
What to evaluate with inguinal canal?
hernia by having patient bear down
157
What's in inguinal canal?
spermatid cord
genital branch of genitofemoral n.
ilioinguinal n.
158
What is inguinal ligament between
ASIS
| pubic tubercle
159
Sequence of inspection and palpation
inspect penis
palpate testes and epididymis
palpate each spermatid cord
evaluate for hernias
160
What to palpate for hernias in the groin?
observe
pt standing and valsalva maneuver
palpate inguinal rings and femoral canal
161
Which is medial: external or internal inguinal ring?
external
162
How to tell there's a scrotal hernia?
fingers cannot get above mass
163
Indirect Hernia frequency, course, and origin
most common, often children
all sex, age
origin: above inguinal lig, midline (internal ring)
course: down into scrotum through canal
164
where does your finger touch an indirect hernia?*
fingertip
165
Direct Hernia frequency, course, and origin
less common
usually men >40, rare in women
origin: above inguinal lig, close to pubic tubercle (ext ring)
course: bulge ant, rare in scrotum
166
where does your finger touch a direct hernia?*
side of finger forward
167
Femoral Hernia frequency, course, and origin
least common
more women than men
origin: BELOW inguinal lig, more LATERAL (hard diff from nodes)
course: never into scrotum, inguinal canal empty
168
condyloma accuminata
HPV warts
rare symptomatic, sometimes painful
HIV serology 6/11 (not same as cancer)
169
Genital Herpes Simplex
found: penis shaft, vagina/vulva/cervix, around anus
| HSV, painless; painful if blisters rupture
170
chancre
primary syphilis, painless
171
hypospadius
urethral opening on underside of penis
| surgical correction 1st 18months life
172
Peyronie's Disease
fibrous plaques top above cavernosum (beneath buck's fascia) --> painful CURVATURE
connective tissue disorder
173
Carcinoma of penis
squamous cell
localized lesion,
may be painful, drainage can start to bleed and enlarge
174
risks of carcinoma of penis
HIV
HPV
Warts
175
Differential diagnosis of testicular mass
```
tumor
epididymitis
hydrocele: cystic, asymp, around testis
spermatocele: cystic swelling, top of testis
varicocele: cystic, asymp
```
176
epididymitis v. tumor
tumor: painless, swelling, attach to penis, solid
epididymitis: acute, painful, swelling, no fever, around testi
177
epidermoid cysts
benign cysts
| surgical removal if painful
178
causes of scrotal edema
many: cancer, heart liver failure, lymph, vein, bladder
179
risks of cryptorchidism
testicular cancer
| reduced fertility
180
most common testicular tumor
germ cell tumor: seminoma or nonseminoma
181
cause of acute epididymitis
STD, UTI
182
Spermatocele
cyst with sperm on epididymis, painless usually
183
tuberculous epididymitis
inflam, swelling of epididymis from mycobacterium tuberculosis
184
testicular torsion onset
rapid and severe pain
| blood supply compromised
185
What to look at in rectal exam
perianal skin: hemorrhoids, warts, lesions
| digital exam: sphincter tone, prostate, rectal vault, hemoccult card
186
anal fissure
tear in anal lining
187
valve of houston
transverse fold into rectum
188
Patient positions for genitourinary exam
standing
| left lateral decubitus
189
Ext v int hemorrhoids
ext: painful
int: painless
190
Most common rectal cancer
squamous cell, linked to HPV
