Beyonce Slides (post-quiz 1) Flashcards
What CN isn’t functioning if a patient can’t smell?
CN1
When the visual field is partially disrupted or if acuity is poor, what nerve is affected?
CNII
If a patient has anisocoria (deviation of .4mm or more), what CN is affected?
CN3
If a patient’s pupillary reflex doesn’t work, which CN is affected?
CN3
If a patient has ptosis, what CN is affected?
CN3
If a patient’s EOMs are non-functioning, except for the lateral deviation and inferior medial gaze muscles, what nerve is affected?
CN3
If a patient has nystagmus or abnormal eye movements, which CNs are affected?
3, 4, & 6
Binocular diplopia occurs in neuropathy of what 3 nerves?
3, 4, and 6
What should you suspect if there’s jaw deviation during opening?
Weakness of that side & LMNs of CN5
What nerve is affected if, when touched on both sides of the face, a patient experiences dulled sensation on one side?
CN5 (on affected side)
If a patient can’t differentiate temperature with heated object, or differentiate between sharp and dull sensation, what CN is affected?
CN5 (on affected side)
Failure to blink both eyes indicates sensory deficit in _________ or motor deficit in ___________
Sensory deficit in CN5 or motor deficit in CN7
Absent blinking and sensorineural hearing loss occur in __________, which affects CN__
acoustic neuroma; CN8
*double check this
If a patient has trouble raising both eyebrows or making a happy face or frown, what CN is affected?
CN7 (facial)
If a patient can’t close both eyes tightly, open them, show both upper and lower teeth, or puff out cheeks, what CN is affected?
CN7
Palsy of _______ called “Bells Palsy” will impair a patient’s ability to raise his/her eyebrows
CN7
What CN does Chvostek Sign (twitching upon face being touched) affect?
CN7 (hyperexcitability)
What nerve is affected by hypocalcemia?
CN7
What is tested with Trousseau’s?
Hypocalcemia
If a patient has facial droop, what nerve is affected?
CN7
If a patient has sensorineural hearing loss, what nerve is affected?
CN8 (vestibulocochlear)
If a patient has paralysis of the palate, what nerves are affected?
CNs 9 and 10 (glossopharyngeal and vagus)
If a patient has a nasally voice or dysphagia, what CNs may be affected?
CNs 9 and 10 (glossopharyngeal and vagus)
When you have a patient say “ah” when examining oral pharynx, and the palate only rises on one side, and the other side is pulled toward the normal side (along with the uvula) what CNs are affected and where?
Unilateral damage to CNs 9 and 10 (glossopharyngeal and vagus)
When you have a patient say “ah” when examining oral pharynx, and the palate doesn’t rise at all, what CNs are affected and where?
Bilateral damage to CNs 9 and 10 (glossopharyngeal and vagus)
If a patient has atrophy or fasciculations of the trapezius, what CN is affected?
CN11
If a patient can’t shrug against resistance or turn head to the side against resistance, what CN is affected?
CN11
If a patient’s shoulder droops and the scapula falls down and away (lateral), what CN is affected?
Full paralysis of CN11
If the tongue deviates to the left, what CN is affected and where?
LMN lesion of CN12 on the left side
If a patient has disrupted speech or can’t press their tongue on their inner cheek against resistance, what CN is affected?
CN12
Describe whether tension headaches, migraines, and cluster headaches are bilateral, bifrontal, global, or unilateral.
1) Tension headaches usually bilateral.
2) Migraines 70% unilateral; 30% of the time bifrontal or global. Throbbing or aching, usually not less than moderate. accompanied by aura in up to 30%.
3) Cluster usually unilateral and behind eye or temple.
Describe the quality and severity of tension headaches, migraines, and cluster headaches
1) Tension: Usually a steady pain (not usually throbbing), mild to moderate.
2) Migraine: Throbbing or aching, usually not less than moderate. accompanied by aura in up to 30%.
3) Cluster: Sharp, continuous, intense, and severe intensity.
Describe the associated symptoms of tension headaches, migraines, and cluster headaches
1) Tension: Sometimes photophobia, phonophobia; scalp tenderness; nausea absent
2) Migraines: Prodrome, nausea, vomiting, photophobia, phonophobia; aura in 30%; either visual (flickering, zig-zagging lines) or motor (paresthesia of hand, arm, or face, or language dysfunction).
3) Cluster: Unilateral autonomic symptoms: lacrimation, rhinorrhea, miosis, ptosis, eyelid edema, conjunctival infection
Out of tension headaches, migraines, and cluster headaches, which involve photophobia?
Tension headaches and migraines
Out of tension headaches, migraines, and cluster headaches, which involve nausea? Which involve rhinorrhea and ptosis?
Migraines involve nausea; cluster headaches involve rhinorrhea and ptosis
1) Out of tension headaches, migraines, and cluster headaches, which can last up to 3 days?
2) Which is/ are unilateral?
3) List them in order from slow to fast onset
1) Migraines
2) Migraines and cluster headaches
3) Tension, migraines, cluster
What are the 7 concerning headache (HA) complaints?
1) Progressively frequent or severe over 3-month period
2) Sudden onset “thunderclap”
-SA hemorrhage
3) New recurrent headaches after 50 years old
4) Associated with fever, night sweats, or weight loss
-cancer or TB (sweats, weight loss)
-meningitis (fever)
5) Recent head trauma
-bleeding
6) Change in pattern from past headaches
7) Associated papilledema, neck stiffness, or focal neurologic signs
1) What can a sudden onset “thunderclap” headache be a sign of?
2) What can a headache and recent head trauma be a sign of?
1) SA hemorrhage
2) Bleeding
What can headaches (HA) with associated with night sweats or weight loss be due to? (2 things)
1) Cancer
2) TB
What can headaches (HA) associated with fever be due to?
Meningitis
What can headaches (HA) with associated with fever, night sweats, or weight loss be due to?
1) Cancer or TB (sweats, weight loss)
2) Meningitis (fever)
1) What can trouble with close work indicate?
2) What can trouble with far distance indicate?
1) Hyperopia (farsightedness) or Presbyopia (aging vision)
2) Myopia (nearsightedness)
Hyperopia (farsightedness) or presbyopia (aging vision) both cause what?
Trouble with close work
If a pt has sudden, unilateral, and painless vision loss, what is often the cause? Give 4 examples
Often vascular:
1) Retinal vein occlusion
2) Central retinal artery occlusion
3) Vitreous hemorrhage (DM, trauma)
4) Retinal detachment
If a pt has sudden, unilateral, painful vision loss, what should you be thinking of? Give 5 examples
Cornea and anterior chamber:
1) Acute angle closure glaucoma
2) Corneal ulcer
3) Uveitis
4) Traumatic hyphema
5) Optic neuritis (MS)
If a pt has sudden, bilateral, painless vision loss, what should you be thinking of?
Vascular: Giant cell arteritis (although! usually unilateral and somewhat painful)
If a pt has sudden, bilateral, painful vision loss, what should you be thinking of? (2 things)
1) Radiation
2) Chemical exposure
What can Giant cell arteritis cause?
Vision loss that is sudden, either somewhat painful or painless, and unilateral or bilateral (usually uni),
Traumatic hyphema, optic neuritis (MS), Acute angle closure glaucoma, corneal ulcer, and uveitis all cause vision loss of what nature?
Sudden, unilateral, and painful
What are 3 causes of gradual vision loss?
Cataracts, macular degeneration, glaucoma
What are 2 causes of slow and central vision loss?
Macular degeneration and nuclear cataract
What is a cause of peripheral vision loss?
Advanced open-angle glaucoma
What are two causes of painless redness of the eyes?
1) Subconjunctival hemorrhage
2) Viral conjunctivitis
What are 4 causes of painful red eye?
Acute angle closure glaucoma, herpes keratitis, FB (foreign body), uveitis
What does a patient complaining of “flashing lights” and new floaters in their vision suggest?
Vitreous detachment
1) More than _____ over fifty and ______% of folks over 80 have hearing loss
2) ______________ is the most common age-related cause of HL
1) >1/3 over fifty and 80% of folks over 80
2) Presbycusis
Define edentulous
Missing teeth
1) _______% of folks over ____ are edentulous (missing teeth)
2) What is a warning sign for oral cancer?
3) What should you promote regarding oral health?
1) 25% of folks over 50
2) Leukoplakia
3) Daily hygiene
1) What 3 things should you avoid for oral health?
2) Tobacco and ETOH account for what percent of oral cancers?
1) Excessive starches, excessive sugars, and tobacco use
2) 75%
What is the primary screening for oral cancers?
Your exam
1) What line is straight down the middle of the back?
2) What line is lateral to that?
1) Vertebral line
2) Scapular line
1) What line runs through the middle of the armpit?
2) What line runs parallel and anterior to this?
3) What line runs parallel and posterior to this?
1) Midaxillary line
2) Anterior axillary line
3) Posterior axillary line
What are the 7 respiratory red flags?
1) Chest pain
2) Shortness of breath
3) Wheezing
4) Cough
5) Blood-streaked sputum
6) Painful inspiration
7) Daytime sleepiness
What are the 5 Ps of respiratory related chest pain?
1) Pneumonia (Pneu. . .)
2) Pneumothorax (Pneu. . .)
3) Pulmonary embolus (P E)
4) Pleural effusion (P E)
5) Bronchitis (The ugly P. . .)
What are the 3 key questions you should ask about respiratory related chest pain? What would the answers indicate?
1) Does it hurt when I press on it?
2) Is it worse when you breathe in?
-PE
3) Is there one-sided swelling/redness/pain in your calves?
-DBT
Define SOB / dyspnea / wheezing. Is this subjective or objective?
The feeling of being out of breath; a subjective sensation
What are the 6 diagnoses you should consider when a pt complains of SOB/ dyspnea/ wheezing?
1) COPD: smoking
2) Asthma: childhood
3) PNA (pneumonia): Infxn
4) Anxiety: associated symptoms
5) Cancer: progressive symptoms
6) Heart failure: rapid weight gain and lower extremity edema
-anxiety is a diagnosis of exclusion
What two key questions should you ask when a pt complains of SOB/ dyspnea/ wheezing?
1) Under what circumstances or particular activities does this occur?
2) How much of the activity can you perform?
What are the 3 types of cough? Define the parameters for each
1) Acute: < 3 weeks
2) Subacute: 3-8 WEEKS
3) Chronic: > 8 WEEKS
1) What is the most common cause of cough?
2) What are some other causes?
1) Acute respiratory infxn (virus)
2) Smoking, asthma, COPD, pneumonia, acid reflux, FB, postnasal drip, bronchiectasis, medicines (ACE inhibitor)
1) What is the key question to ask about a cough?
2) What conditions cause foul smelling sputum?
3) What condition causes thick sputum?
4) What causes profuse sputum?
1) Is it productive?
2) Lung abscess
3) CF
4) Bronchiectasis
True or false: sputum is not specific for bacterial infection
True
What 4 diagnoses should you consider regarding hemoptysis?
1) Cancer
2) TB
3) PE
4) Out of the box dx: upper GI bleed or epistaxis
What is the key question to ask when a pt displays/ reports hemoptysis?
Define the source and amount and note the color; is it truly bright red blood from the lungs?
What 3 Dxs should you consider when a pt has painful inspiration?
1) PE
2) Pleurisy
3) MSK
What Dx should you consider when a pt has daytime sleepiness?
OSA (obstructive sleep apnea)
1) Quitting smoking cuts your risk of heart attack in half after __________.
2) Lung cancer risk is cut in half after __________.
3) Stroke risk cut in half after_____________.
1) 1 year
2) 10 years
3) ~3 years
1) When should flu shots begin? What should you do before this?
2) When do pneumococcal vaccines begin?
1) Influenza begins at 6 months
-If they’re under 6 months, vaccinate the family
2) 65 yo
1) Describe the volume of bronchial sounds
2) Are expiratory and inspiratory respiratory sounds the same or different?
3) Where is it heard?
1) Getting loud
2) Expiratory sounds last longer than inspiratory ones
3) Heard normally over manubrium and large, proximal airways
1) What should you think when you hear bronchial signs when you’re listening anywhere besides the manubrium or large proximal airways?
2) Would other supportive PE findings match as well?
1) Follow the same thinking as you would in displaced broncho-vesicular sounds; air > consolidation
2) Would be likely to match as well; transmitted voice sounds, fremitus, etc.
Define adventitious sounds. Are they important?
“Added” breath sounds; an important finding
1) What are rales?
2) What do they sound like?
3) What two conditions are they heard in?
1) Crackles
2) Like little dots, like snap crackle pop
3) HF, fibrosis
1) What are ronchi?
2) What are they also called?
3) What two conditions are they seen in?
4) What causes them?
1) Low-pitched, rough sounds
2) Jankey lung
3) Bronchitis, COPD
4) Congestion from secretions in airway, can sometimes be cleared from coughing
1) Define wheezing
2) What does it sound like?
3) When is it heard? Give 2 examples
1) Wheezing (it’s in the name)
2) High-pitched, sometimes musical sounding noise, whistley
3) Heard in “tight” airways; seen in asthma, respiratory distress
What should you think if a pt’s breathing/ chest is silent?
Ominous; you need air movement to make sound
Give 4 examples of adventitious sounds
1) Rales
2) Ronchi
3) Wheezing
4) Silent chest
1) What is stenosis?
2) What is regurgitation?
1) Stenosis: valve is disfigured, slightly closed even when supposed to be open, causing turbulent flow of blood through it, causing a murmur
2) Regurgitation: valve is open when supposed to be closed
1) When will aortic/ pulmonic stenosis be heard? Why?
2) What does it relate to? What kind of sound?
1) During systole/ S1, because it’s closed when it should be open
2) Carotids; cresendo-decrescendo
What is aortic stenosis characterized by?
Crescendo-decrescendo sound (rises in intensity, then falls)
When does mitral/ tricuspid stenosis occur?
During diastole, S2
When is mitral/ tricuspid regurgitation heard?
Heard throughout
1) When would aortic/ pulmonary regurgitation occur?
2) Where would you hear it?
1) Diastole; blood leaks back into ventricle
2) Left upper sternal boarder
1) What is a VSD?
2) Where does this occur?
3) Where is blood moving? What will happen?
4) What kind of murmur does this cause?
1) Ventricular septal defect
2) L 3-5th interspaces
3) To the right ventricle from the left; goes back to the lungs
4) Plateau murmur
1) What is PDA?
2) What usually happens?
3) What kind of sound does this cause?
1) Patent ductus arteriosus; aorta and pulmonary artery are linked
2) Usually closes, if it doesn’t it will remain patent
3) Continuous machine-like murmur after both S1 and S2
1) Where is hypertrophic cardiomyopathy?
2) When is it decreased?
3) What kind of murmur?
4) What can it cause?
1) L 3-5th interspaces
2) Decreased with squat
3) Systolic murmur (that goes away with squatting)
4) Spontaneous cardiac arrest
1) What does an innocent/ physiologic murmur sound like?
2) Where is it?
3) When does it occur?
1) Soft: grade 1-2
2) Left sternal murmur
3) Always in systole
1) Define cardiac output
2) What would it depend on?
1) How much your heart pumps in a minute
2) How much it pumps per beat, and how often it beats
1) Define preload
2) When does it go up?
1) How much blood you’ve got in the RV before it loads
2) When your venous system dumps a bunch of blood into your heart
1) Define afterload
2) When does it go up? (2)
1) The amount of resistance your heart’s LV has to overcome as it squeezes blood out
2) When you have a bunch of blood in your system or when your arterial system is all “clamping down”
List the red flags for heart issues (5)
1) Chest pain
2) Palpitations
3) SOB: dyspnea, orthopnea, paroxysmal nocturnal dyspnea
4) Swelling
5) Fainting
Give 3 examples of types of SOB
Dyspnea, orthopnea, paroxysmal nocturnal dyspnea
List 3 key symptoms of dissection
1) Tearing pain
2) Rapid onset
3) Sharp pain
Physical exam findings in dissection include what?
Marked difference in upper extremity blood pressure
