Assessments and Diagnostics

Question 1

Guaiac test

Answer 1

• Hemoccult, Fecult
• chemical test to ID blood in stool
• possible causes: cancer, hemorrhoids, GI bleed

Question 2

upper GI series

Answer 2

• series of barium X-rays (oral) of esophagus, stomach, small intestines
• used to ID problems with swallowing, stomach ulcers, twisting of small intestine

Question 3

lower GI series

Answer 3

• series of barium X-rays (enema) to show large intestine and rectum
• can ID diverticulitis/diverticulosis, tumors, etc.

Question 4

endoscopy

Answer 4

• flexible, fiberoptic instrument with camera used to visualize esophagus, stomach, large bowel
• different names used for each area explored (colonoscopy)

Question 5

colonoscopy

Answer 5

flexible, fiberoptic instrument with camera used to visualize large bowel

Question 6

ultrasonography (ultrasound)

Answer 6

• high-frequency sound waves used to visualize internal organs
• primarily for abdominal and pelvic organs

Question 7

pitting scale

Question 8

Braden scale

Question 9

delirium rating scale

Answer 9

• tool used to determine level of delirium or likelihood of pt becoming delirius
• Fundamentals Ch. 25

Question 10

blanch (capillary refill) test

Answer 10

• tests integrity of circulation by applying, then releasing pressure to a fingernail or toenail
• expected: regains color in 2-3 sec.
• > 3 sec. indicates impaired blood flow

Question 11

jugular/neck vein distension

Answer 11

• visualized with pt supine, HOB about 45°, head turned to side, tangential light
• can palpate to determine if pulsation is from vein or artery (vein easily occluded)
• sign of increased venous pressure
• used to estimate right atrial pressure
• indicates backup of blood from heart
• seen in heart failure, superior vena cava obstruction, tricuspid valve disease, and pericardial disease

Question 12

corneal light reflex

Question 13

accommodation

Question 14

red reflex

Question 15

red reflex

Question 16

accommodation

Question 17

corneal light reflex

Question 18

jugular/neck vein distension

Answer 18

• visualized with pt supine, HOB about 45°, head turned to side, tangential light
• can palpate to determine if pulsation is from vein or artery (vein easily occluded)
• sign of increased venous pressure
• used to estimate right atrial pressure
• indicates backup of blood from heart
• seen in heart failure, superior vena cava obstruction, tricuspid valve disease, and pericardial disease

Question 19

blanch (capillary refill) test

Answer 19

• tests integrity of circulation by applying, then releasing pressure to a fingernail or toenail
• expected: regains color in 2-3 sec.
• > 3 sec. indicates impaired blood flow

Question 20

delirium rating scale

Answer 20

• tool used to determine level of delirium or likelihood of pt becoming delirius
• Fundamentals Ch. 25

Question 21

Braden scale

Question 22

pitting scale

Question 23

otoscope

Answer 23

instrument with light designed to examine outer ear and tympanic membrane

uses disposible specula in 4 mm for adults and 2 mm for peds

Question 24

nares

Answer 24

• nostrils
• inspect for alignment of septum, drainage (note purulence, blood content, viscosity), coloration of nasal mucosa, edema
• occlude one at a time to check for patency

Question 25

CN I

Answer 25

• olfactory
• (assess patency of nostrils) coffee/mint smell test
• sensory

Question 26

CN II

Answer 26

• optic
• Snellen chart
• sensory

Question 27

CN III

Answer 27

• oculomotor
• draw H to test EOM, test pupillary reflex (PERRLA)
• motor

Question 28

CN IV

Answer 28

• trochlear
• draw H to test EOM, test PERRLA
• motor

Question 29

CN V

Answer 29

• trigeminal
• test
  
  • motor: palpate temporal and masseter muscles as the person clenches the teeth
  • sensory: light touch on forehead (ophthalmic), cheek (maxillary), and chin (mandibular); also corneal reflex test, which we don’t do
• both

Question 30

CN VI

Answer 30

• abducens
• draw H to test EOM, test for PERRLA
• motor

Question 31

CN VII

Answer 31

• facial
• test
  
  • motor: smile and frown, close eyes tightly, lift eyebrows, show teeth and puff cheeks (press cheeks to check for even air escape)
  • sensory: test sense of taste with lemon, salt, etc., which we don’t do
• both

Question 32

CN VIII

Answer 32

• acoustic
• test hearing: whisper test, normal conversation, Weber & Rinne tuning fork tests (which we don’t do)
• sensory

Question 33

CN IX

Answer 33

• glossopharyngeal
• test
  
  • motor: gag reflex
  • sensory: none; taste from back of tongue, sensory from sinuses, etc.
• both

Question 34

CN X

Answer 34

• vagus
• test
  
  • motor: say “ah” to check for midline soft palate rise and fall; listen for smooth, unstrained voice and speech
  • sensory: none
• both

Question 35

CN XI

Answer 35

• spinal accessory
• test sternomastoid and trapezius muscle strength and symmetry with hand pushing against each cheek and down on shoulders
• motor

Question 36

CN XII

Answer 36

• hypoglossal
• stick out tongue, should be midline with no tremor; say “light, tight, dynamite”
• motor

Question 37

pulse deficit

Answer 37

difference between peripheral and apical pulses

Question 38

pulse pressure

Answer 38

difference between systolic and diastolic blood pressures

Question 39

tragus

Answer 39

• projection in front of the ear
• used to block hearing in one ear for testing

Question 40

tympanic membrane

Answer 40

• eardrum
• expected: shiny and pearly gray with reflected cone of light

Question 41

hyperthyroidism

Answer 41

• ultrasound of thyroid gland
• thyroid scan
• serum levels of free and total T4, T3, and calcitonin

Question 42

AKI

Answer 42

acute kidney injury

Question 43

ADR

Answer 43

adverse drug reaction

Question 44

GCS (Glasgow Coma Scale)

Answer 44

• indications: LOC changes in encephalitis, cerebral lesions and infarctions, head injuries
• eye-opening response
  
  • 4 - spontaneous
  • 3 - to voice
  • 2 - to pain
  • 1 - none
• verbal response
  
  • 5 - oriented
  • 4 - confused
  • 3 - inappropriate words
  • 2 - incomprehensible sounds
  • 1 - none
• motor response
  
  • 6 - obeys commands
  • 5 - localizes pain
  • 4 - withdraws
  • 3 - flexion
  • 2 - extension
  • 1 - none

Question 45

AVPU

Answer 45

• Alert
• responsive to Voice
• responsive to Pain
• Unresponsive

Question 46

common causes of pulseless electrical activity

Answer 46

• 5 Hs
  
  • hypovolemia
  • hypoxia
  • H⁺ accumulation → acidosis
  • hypothermia
• 5 Ts
  
  • toxins (accidental or deliberate drug OD)
  • tamponade (cardiac)
  • tension pneumothorax
  • thrombosis (coronary)
  • thrombosis (pulmonary)

Question 47

OLDCARTS

Answer 47

• onset
• location: site/radiation
• duration
• character
• alleviating/aggravating factors
• time
• severity

Question 48

Alzheimer’s dz stages

Answer 48

• stage 1: no apparent manifestation
• stage 2: forgetfulness, esp. of everyday objects; looks like normal age-related change
• stage 3: mild cognitive decline
  
  • losing important things
  • short-term memory loss noticeable to close relatives
  • ↓ ability to plan
  • ↓ attention span
  • diffculty remembering names, words
  • difficulty in social/work situations
  • can get lost while driving
• stage 4: mild to moderate decline
  
  • personality changes
  • obvious memory loss
  • ↓ knowledge and memory or recent events
  • difficulty with tasks that need planning/organizing
  • difficulty with complex math
  • depression/social withdrawal
• stage 5: moderate decline
  
  • ↑ cognitive deficits
  • inability to recall important details
  • memory of info about self and family remains intact
  • assistance with ADLs necessary
  • disorientation/confusion about time and place
• stage 6: moderate to severe decline
  
  • memory problems ↑
  • recalls name, but not personal Hx
  • significant personality changes: hallucinations, delusions, compulsion)
  • wandering
  • assistance with ADLs, personal care
  • sleep/wake cycle disrupted
  • ↑ urinary/fecal incontinence episodes
• stage 7: severe decline
  
  • no ability to respond, speak, control movement
  • urinary incontinence
  • impaired swallowing
  • requires help eating
  • gradual loss of ability to move extremeties (ataxia)

Question 49

MS labs and diagnostic procedures

Answer 49

• labs
  
  • CSF: ↑ protein
  • slight ↑ WBC count
• diagnostic procedures
  
  • MRI: plaques of brain and spine

Question 50

cerebral angiography

Answer 50

• visualization of cerebral blood vessels
• tracks blood flow to and within brain
• indications
  
  • aneurysms
  • surgical planning for tumors
  • inject meds for Tx of blood clots
  • inject chemo

Question 51

cerebral CT scan

Answer 51

• cross-sectional images of cranial cavity
• indications
  
  • find tumors, infarctions, abnormalities
  • monitor response to Tx
  • guide needles used for Bx

Question 52

EEG

Answer 52

• noninvasive
• assess electrical activity to find abnormalities in brain wave patterns
• indications
  
  • find and determine sz activity
  • sleep disorders
  • behavioral changes

Question 53

ICP monitoring

Answer 53

• device inserted into cranial cavity that shows pressure waveforms on monitor
  
  • intraventricular cath (ventriculostomy): drains and monitors pressure via picture
  • subarachnoid screw or bolt: hollow with fluid-filled tubing and transducer
  • epidural or subdural sensor: fiber-optic, does not penetrate dura (noninvasive); numerical value
• indications
  
  • early ID and Tx of ↑ ICP: pts comatose or GCS < 8
  • s/sx of ↑ ICP: severe HA, ↓ LOC, dilated or pinpoint pupiles, slow rxn, irritability, restlessness, alteration in breathing pattern, ↓ motor fxn, abnormal posturing

Question 54

LP (lumbar puncture, spinal tap)

Answer 54

• CSF sample collection
• indications
  
  • presence of dz: MS, syphilis, meningitis
  • infection
  • malignancies
  • ↓ CSF pressure
  • Dx by instillation of contrast or air
  • Tx with meds or chemo

Question 55

MRI of head and spine

Answer 55

• cross-sectional images of cranial cavity
• contrast may be used
• uses magnets, no radiation
• not suitable for those with artificial implanted devices
• discriminate soft tissue from tumor or bone
• indications
  
  • find abnormalities
  • monitor response to Tx
  • guide needles for Bx
  • determine tumor size and blood vessel location

Question 56

PET and SPECT scans of head and spine

Answer 56

• nuclear medicine procedures
• 3-D image of head
• static or functional
• captures regional metabolic processes
• PET: glucose-based tracer injected
• SPECT: uses radioisotope tracer
• may be followed by CT for overlay/add location info
• indications
  
  • most useful in determining tumor activity or response to Tx
  • able to Dx dementia: inability of brain to respond to tracer

Question 57

X-ray of skull and spine

Answer 57

• electromagnetic radiation
• captures images of internal structures
• indications for skull and spine
  
  • fx
  • curvature
  • bone erosion
  • dislocation
  • soft-tissue calcification

Question 58

pain categories

Answer 58

• acute
• chronic
• nociceptive
  
  • somatic
  • visceral
• neuropathic

Question 59

acute pain

Answer 59

• protective
• temporary
• usually self-limiting
• resolves with tissue healing
• physiological response: fight-or-flight
• behavioral response
  
  • grimacing
  • moaning
  • flinching
  • guarding
• no response ≠ no pain
• causes: surgical incision, wounds from injury

Question 60

chronic pain

Answer 60

• not protective
• ongoing or recurs frequently
• > 3 mo
• persists beyond tissue healing
• physiological response
  
  • not usually ↑ VS
  • VS can be ↓ than normal
  • depression
  • fatigue
  • ↓ fxn level
  • disability
• can be idiopathic
• may not respond to Tx
• classified: cancer or non-cancer pain
• examples: OA, neuropathy

Question 61

nociceptive pain

Answer 61

• damage to or inflammation of tissue not in PNS or CNS
• result of activation of normal processing of painful stimuli
• throbbing, aching, localized
• types
  
  • somatic: bones, joints, muscles, skin, connective tissue
  • visceral: internal organs; can be referred

Question 62

neuropathic pain

Answer 62

• abnormal or damaged pain nerves
• abnormal processing or painful stimuli
• includes: phantom pain, pain below spinal injury, diabetic neuropathy
• intense, shooting, burning, “pins and needles”/tingling

Question 63

labs and procedures to Dx meningitis

Answer 63

• culture and sensitivity of urine, throat, nose, and blood: not Dx, but can guide intial antimicrobial choice
• CBC: ↑ WBC count
• CSF analysis (definitive): ↑ WBC, protein, glucose, pressure; cloudy vs clear (bacterial vs. viral); CIE determines if viral or protozoal
• CT scan, MRI: ↑ ICP and/or abscess

Question 64

sz risk factors

Answer 64

• genetic predisposition: absence sz; children, familial
• acute febrile state: esp. < 2 yo
• head trauma: early or late onset (≤ 9 mo); ↑ if skull fx
• cerebral edema: esp. acute; sz gone when edema treated
• abrupt cessation of antiepileptics: rebound
• infection: ↑ ICP or persistent fever
• metabolic: insufficient or excess chemicals in brain; glucose, Na⁺
• toxins: esp. pesticide, CO, lead
• stroke: mostly in 1^st 24 hr because of ↑ ICP
• heart dz: common cause of new-onset sz in adults
• brain tumor: increased bulk if benign; ability to fxn if malignant
• hypoxia: ↓ O₂ in brain = ↓ fxn
• acute withdrawal: dehydration = toxic level of substance
• fluid-electrolyte imbalance
• associated with cerebrovascular dz in older adults

Question 65

sz triggering factors

Answer 65

• ↑ physical activity
• excessive stress
• hyperventilation
• overwhelming fatigue
• acute ETOH ingestion
• excess caffeine
• flashing lights
• cocaine, aerosols, inhaled glue

Question 66

tonic-clonic sz findings

Answer 66

• tonic episode
  
  • duration: a few sec
  • stiffening of muscles
  • possible apnea
  • LOC
• clonic episode
  
  • duration: 1-2 min
  • follows tonic phase
  • rhythmic jerking of extremities
  • irregular breathing
  • possible cyanosis
  • biting cheek or tongue
• incontinence
• postictal: period of confusion and sleepiness

Question 67

tonic sz findings

Answer 67

• generally < 30 sec, but up to several min
• sudden LOC
• sudden ↑ muscle tone
• autonomic manifestations
  
  • arrhythmia
  • apnea
  • vomiting
  • incontinence
  • salivation

Question 68

clonic sz findings

Answer 68

• duration: several min
• muscles contract and relax
• rhythmic, jerking movements of face, neck, arms

Question 69

myoclonic sz findings

Answer 69

• duration: seconds
• brief jerking or stiffening of extremities
• symmetrical or asymmetrical

Question 70

atonic or skinetic sz

Answer 70

• duration: a few seconds
• muscle tone lost
• followed by period of confusion
• frequent results in falling

Question 71

partial or focal/local sz

Answer 71

• occur in only one hemisphere
• types
  
  • complex partial sz
  • simple partial sz

Question 72

complex partial sz

Answer 72

• automatisms: pt unaware; lip smacking, picking at clothes
• LOC/blackout for several min
• amnesia possible immediately before and after

Question 73

simple partial sz

Answer 73

• consciousness maintained
• can include
  
  • unusual sensations
  • sense of déjà vu
  • autonomic abnormalities: HR changes, flushing
  • unilateral abnormal extremity movements
  • pain
  • offensive smell

Question 74

unclassified/idiopathic sz

Answer 74

• half of all sz activity
• no known cause/reason
• don’t fit into other categories

Question 75

labs and diagnostics for sz

Answer 75

• labs
  
  • alcohol/illicit drug screen
  • HIV test
  • screen for excess toxins
• diagnostic procedures
  
  • EEG: activity and origin
  • MRI, CT, CAT, PET, X-ray
  • CSF analysis

Question 76

Parkinson’s risk factors

Answer 76

• onset at 40-70 yo
• more common in males
• genetic predisposition
• environmental toxins and chemical solvents
• chronic use of antipsychotic meds

Question 77

Parkinson’s findings

Answer 77

• fatigue
• ↓ manual dexterity over time
• stooped posture
• slow, shuffling, propulsive gait
• tremors/pill-rolling tremor of fingers
• muscle rigidity
• bradykinesia/akinesia
• masklike expression
• orthostatic hypotension
• flushing
• diaphoresis
• difficulty chewing and swallowing
• drooling
• dysarthria
• progressive ADL difficulty
• mood swings
• cognitive impairment

Question 78

Parkinson’s labs and diagnostics

Answer 78

• there are no labs or diagnostics for Parkinson’s
• diagnosed based on s/sx and ruling out other dz

Question 79

Alzheimer’s risk factors

Answer 79

• advanced age
• chemical imbalance
• family hx of AD or Down syndrome
• genetic predisposition, apolipoprotein E
• herpes
• metal or toxic waste
• previous head injury
• more common in females
• ↑ risk in AA and Hispanic (APOE and ABCA₇ genes)

Question 80

Alzheimer’s findings

Answer 80

• different for each client
• no universal scale for stages and manifestations

Question 81

Alzheimer’s labs and diagnostics

Answer 81

• labs
  
  • genetic test for predisposition
  • tests to rule out other causes of dementia
• diagnostics
  
  • only definitive procedure: postmortem brain tissue exam
  • MRI, CT/CAT, PET, EEG: rule out other causes
  • LP: ↓ sBPP supports Dx of AD

Question 82

brain tumor risk factors

Answer 82

• genetics
• environmental agents
• ionizing radiation
• electromagnetic fields
• previous head injury

Question 83

brain tumor findings

Answer 83

• all types
  
  • dysarthria
  • dysphagia
  • positive Romberg
  • positive Babinski
  • vertigo
  • hemiparesis
  • cranial nerve dysfxn
    
    • inability to discriminate sounds
    • loss of gag reflex
    • loss of blink response
  • papilledema
• supratentorial
  
  • severe HA; worse on awakening, coughing, straining
  • visual: blurring, field deficit
  • sz
  • loss of voluntary movement/control of movement
  • change in cognitive fxn (memory, language)
  • change in personality
  • inability to control emotions
  • paralysis
• infratentorial
  
  • hearing loss, ringing
  • visual changes
  • facial drooping
  • dysphagia
  • nystagmus, crossed eyes, ↓ vision
  • ANS dysfxn
  • ataxia or clumsiness
  • hemiparesis
  • cranial nerve dysfxn
    
    • sounds
    • gag
    • blink

Question 84

lab tests for brain tumors

Answer 84

• CBC and diff: r/o anemia, malnutrition
• blood ETOH and tox: rule out causes
• TB and HIV screening if indicated

Question 85

diagnostics for brain tumor

Answer 85

• X-ray, CT, MRI, brain scan, PET, cerebral angiography: size, location, extent of tumor
• LP: ICP
• EEG
• labs for endocrine fxn, renal status, electrolyte balance
• cerebral Bx: cell pathology

Question 86

MS findings

Answer 86

• fatigue
• pain or paresthesia
• diplopia
• change in peripheral vision
• ↓ visual acuity
• scotomas
• periods of total blindness
• Uhthoff’s sign
• tinnitus
• vertigo
• ↓ hearing
• dysphagia
• dysharthria
• muscle spasticity
• ataxia or muscle weakness
• nystagmus
• bowel dysfxn (constipation, incontinence)
• bladder dysfxn
• cognitive changes (↓ memory, judgment)
• sexual dysfxn

Question 87

migraine findings

Answer 87

• photophobia
• phonophobia
• N&V
• stress and anxiety
• unilateral pain, esp. behind one eye or ear
• health and family Hx for HA pattern
• alterations in ADLs for 4-72 hr
• similar manifestations with each HA

Question 88

migraine categories

Answer 88

• with aura (classic)
• without aura (common)
• atypical

Question 89

migraine with aura findings

Answer 89

• prodromal stage
• awareness for hr or days before
  
  • irritability
  • depression
  • food cravings
  • diarrhea/constipation
  • frequent urination
• aura stage
  
  • develops over mins to 1 hr
  • numbness and tingling of mouth, lips, face, hands
  • acute confusion
  • visual disturbances (light flashes, bright spots)
• second stage
  
  • severe, incapacitating, throbbing HA
  • intensifies over several hr
  • N&V, drowsiness, vertigo
• third stage
  
  • 4-72 hr
  • HA dull
• recovery
  
  • pain and aura subsiding
  • muscle aches and contraction of head and neck muscles common
  • physical activity worsens pain
  • pt may sleep
• older adults may experience aura without pain: visual migraine

Question 90

migraine without aura findings

Answer 90

• pain aggravated by physical activity
• unilateral, pulsating pain
• oe or more of: photophobia, phonophobia, nausea, vomiting
• duration: 4-72 hr
• occurs
  
  • early in morning
  • periods of stress
  • with premenstrual tension
  • with fluid rentention

Question 91

atypical migraine findings

Answer 91

• status migrainous: > 72 hr
• migrainous infarction
  
  • neurologic s/sx for 7 days
  • neuroimaging can indicate ischemic infarct
• unclassified: does not fit other criteria

Question 92

migraine diagnostics

Answer 92

neuroimaging if findings present or pt > 50 yo with new onset

Question 93

cluster headache risk factors

Answer 93

• more frequent in spring and fall
• more common in males 20-50 yo

Question 94

cluster headache findings

Answer 94

• brief episode of intense, unilateral, nonthrobbing pain
• duration: 15 min to 3 hr
• can radiate to forehead, temple, or cheek
  
  • occurring daily 1-8x/day
  • followed by period of remission
• no aura or preliminary s/sx
• less common than migraines
• tearing of eye with runny nose and nasal congestion
• facial sweating
• drooping eyelid and eyelid edema
• pupil constriction
• N&V
• bradycardia
• facial pallor or flushing
• pacing, walking, or sitting and rocking

Question 95

macular degeneration types

Answer 95

• dry
• wet

Question 96

macular degeneration risk factors

Answer 96

• dry
  
  • smoking
  • HTN
  • female
  • short stature
  • family Hx
  • lack of carotene and vitamin E
• wet: can occur at any age

Question 97

macular degeneration findings

Answer 97

• lack of depth perception
• objects appear distorted
• blurred vision
• loss of central vision
• blindness

Question 98

macular degeneration diagnostics

Answer 98

• ophthalmoscopy: fundus of eyeball examined (retina, optic disc, macula, blood vessels)
• visual acuity test: Senllen and Rosenbaum charts

Question 99

cataracts causes

Answer 99

• age-related: drying of lens, ↑ density
• traumatic: blunt or penetrating injury, foreign body, radiation, UV light
• toxic: long-term use of corticosteroids, phenothiazine derivatives, beta blockers, miotic meds
• associated: DM, hypoparathyroidism, Down syndrome, chronic sunlight exposure
• complicated: intraocular dz (retinitis pigmentosa, glaucoma, retinal detachment)

Question 100

cataracts risk factors

Answer 100

• advanced age
• DM
• heredity
• smoking
• eyetrauma
• excessive sun exposure
• chronic use of corticosteroids, phenothiazine derivatives, beta blockers, miotic meds

Question 101

cataracts findings

Answer 101

• ↓ visual acuity
  
  • color perception
  • Rx changes
  • ↓ night vision
• blurred vision
• diplopia
• progressive, painless loss of vision
• visible opacity of lens
• absent red reflex

Question 102

cataracts diagnostics

Answer 102

exam of lens using ophthalmoscope

Question 103

types of glaucoma

Answer 103

• primary open-angle glaucoma (POAG)
• primary angle-closure glaucoma

Question 104

POAG findings

Answer 104

• gradual onset/IOP buildup
• HA
• mild eye pain
• loss of peripheral vision
• ↓ accomodation
• halos around lights
• ↑ IOP (> 21 mm Hg, usually 22-32)

Question 105

primary angle-closure glaucoma findings

Answer 105

• sudden ↑ IOP (≥ 30 mm Hg)
• ↓ or blurred vision
• colored halos around lights
• pupils nonreactive
• severe pain and nausea
• photophobia

Question 106

glaucoma risk factors

Answer 106

• age
• infection
• tumor
• DM
• genetics
• HTN
• eye trauma
• severe myopia
• retinal detachment

Question 107

glaucoma diagnostics

Answer 107

• visual assessment: acuity and peripheral
• tonometry: measures IOP
• gonioscopy: determines drainage angle of anterior chamber

Question 108

middle and inner ear disorder risk factors

Answer 108

• middle ear
  
  • recurrent colds and otitis media
  • enlarged adenoids
  • trauma
  • changes in air pressure (SCUBA, flying)
• inner ear
  
  • viral or bacterial infection
  • damage due to ototoxic meds

Question 109

findings of middle ear disorders

Answer 109

• hearing loss
• feeling of fullness and/or pain in ear
• red, inflamed ear canal and TM
• bulging TM
• fluid and/or bubbles behind TM
• diffuse appearance of or inability to visualize normal light reflex
• fever

Question 110

findings of inner ear disorders

Answer 110

• hearing loss
• tinnitus
• dizziness or vertigo
• vomiting
• nystagmus
• alterations in balance

Question 111

diagnostics for middle- and inner-ear disorders

Answer 111

• audiometry: noninvasive, tests hearing ability; frequency, pitch, intensity
• tympanogram: measures mobility of TM and middle ear structures
• WEBER and Rinner tests: tuning forks; tests for presence of hearing loss
• otoscopy: exam of canal, TM, malleus bone
• ENG: detects involuntary eye movement to test for vestibular dysfxn
• caloric testing: concurrent w/ ENG

Question 112

types of brain injury

Answer 112

• concussion (mild traumatic brain injury)
• contusion
• diffus axonal injury
• intracranial hemorrhage

Question 113

brain injury risk factors

Answer 113

• MVA or motorcycle accident
• illicit drug and ETOH use
• sports injuries
• assault
• gunshot wound
• falls

Question 114

brain injury findings

Answer 114

• amnesa before or after injury
• LOC: duration significant
• CSF leakage from nose and ears: basilar skull fx; + halo sign
• s/sx of ↑ ICP
  
  • severe HA, N&V
  • ↓ LOC, restlessness, irritability
  • dilated or pinpoin nonreactive pupils
  • cranial nerve dysfxn
  • alteration in breathing pattern
  • ↓ motor fxn, abnormal posturing
  • Cushing’s triad: late finding
  • sz

Question 115

halo sign

Answer 115

• clear or yallow-tinted ring surround drop of blood on gauze
• indicates CSF drainage

Question 116

electronystagmography (ENG)

Answer 116

used to test for vestibular disorders via measurement of nystagmus, usually in response to temperature change in ear

Question 117

Cushing’s triad

Answer 117

• severe HTN
• widening pulse pressure
• bradycardia

Question 118

labs for brain injury

Answer 118

• ABGs
• CBC with diff
• BG level
• electrolytes
• blood and urine osmolarity
• toxicology screen
• anti-sz med blood levels (monitor)

Question 119

diagnostic procedures for brain injury

Answer 119

• cervical spine films to Dx injury
• CT and/or MRI of head and/or neck (w/ or w/o contrast)
• calculation of cerebral perfusion using ICP monitor

Question 120

types of strokes

Answer 120

• hemorrhagic
• thrombotic
• embolic
• ischemic

Question 121

risk factors for stroke

Answer 121

• smoking
• cerebral aneurysm
• arteriovenous (AV) malformation
• DM
• obesity
• HTN
• atherosclerosis
• hyperlipidemia
• hypercoagulability
• atrial fibrilation
• oral contraceptives
• cocaine

Question 122

stroke findings

Answer 122

• TIA
  
  • can warn of impending stroke
  • antithrombotic meds and/or surgical removal of plaques can prevent subsequent stroke
• left hemisphere: language, math, analysis
  
  • receptive and expressive aphasia
  • agnosia
  • alexia
  • agraphia
  • right extremity hemiplegia or hemiparesis
  • slow, cautious behavior
  • depression, anger, frustration
  • visual changes (hemianopsia)
• right hemisphere: visual and spatial awareness, proprioception
  
  • altered perception of deficits
  • unilateral neglect syndrome (left side; more common in right hemisphere stroke)
  • loss of depth perception
  • poor impulse control/judgment
  • visual changes (hemianopsia)

Question 123

stroke diagnostics

Answer 123

• non-contrast CT: initial, within 25 min of pt arrival
• MRI: edema, necrosis, ischemia
• MRA or cerebral angiography: hemorrhage, vessel structures, blood flow
• LP: blood in CSF
• GCS: check for changes in LOC

Question 124

spinal cord injury risk factors

Answer 124

• high-risk activities
• impact sports
• acts of violence
• substance use
• dz (cancer, arthritis of spine)
• falls, esp. in older adults

Question 125

spinal cord injury findings

Answer 125

• lack of sensation of dermatomes below lesion
• report of neck or back pain
• inability to
  
  • feel light touch
  • discriminate between sharp and dull
  • discriminate between hot and cold
• absent DTRs
• flaccidity of muscles
• hypotension, more severe sitting upright
• shallow respirations
• spinal shock
  
  • total, temporary loss of reflexive, autonomic fxn below injury
  • duration: days to wks

Question 126

spinal injury labs and diagnostics

Answer 126

• urinalysis
• Hgb
• ABG
• CBC
• X-ray, MRI, CT/CAT