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NSB! > CPCP2 Lectures > Flashcards

CPCP2 Lectures Flashcards

- An introduction to integrated urgent care - An Introduction to Social Prescribing - Time for Chronic Illness - Learning on Campus, Learning on Placement - The Cranial Nerve Exam and Introduction to Fundoscopy - Examination of the peripheral nervous system

1
Q

What is IC24?

A
  • integrated urgent care 24 hours
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2
Q

What components make up IC24?

A
  • NHS 111
  • clinical assessment service
  • face to face services
  • home visiting services
  • walk in centres
  • health and justice prison services
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3
Q

Where does IC24 cover?

A
  • kent, Essex, Norfolk and Waveney
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4
Q

What does the term cradle to grave refer to?

A
  • having the same doctor from birth to death
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5
Q

What does CAS refer to in IC24?

A
  • Clinical Assessment Service
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6
Q

What is the NHS telephone triage system?

A
  • a clinical decision support system
  • supports remote assessment of callers to urgent and emergancy services
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7
Q

What is social prescribing?

A
  • linking patients with providers for their specific needs and wants
  • treatment that is non medical to improve health in the community
  • accounts for patients wants and what matters to them
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8
Q

When did social prescribing become adopted by the NHS?

A
  • 2019
  • resourced alongside primary care
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9
Q

What can social prescribers help with?

A
  • put in contact with support groups and charities
  • focus is on patients health and wellbeing
  • practical and emotional support
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10
Q

What is a link worker?

A
  • connect people to community groups and help the person to develop skills, friendships and resilience
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11
Q

What is the main role why social prescribing link workers are employed?

A
  • to give time
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12
Q

How long do social prescribers generally provide support for?

A
  • 3 months
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13
Q

What is the Office of National Statistics Wellbeing measure?

A
  • tool recommended by the NHS
  • tool to measure outcomes
  • 4 questions scored 0-10, so total score is 40 (40 is best)
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14
Q

There are 5 main components to the neurological examination, what are they?

A
  • Mental State / Behavioural evaluation / Cognitive / Language
  • Cranial Nerves
  • Peripheral Nervous system•
  • Gait
  • Cerebellum (some) & Speech
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15
Q

There are 12 crenial nerves. Using the acroynm: Ooh, Ooh, Ooh, to touch and feel very good velvet. Such heaven

What are the 12 nerves?

A
  • Ooh = olfactory
  • Ooh = optic
  • Ooh = oculomotor (means eye-motor movement)
  • To = trochlear (means pulley)
  • Touch =trigeminal
  • And = abducens
  • Feel = facial
  • Very = vesicular/acoustic
  • Good = glossopharyngeal
  • Velvet = vagus
  • Such = spinal accessory
  • Heaven = hypoglossal
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16
Q

What is a snellen chart?

A
  • chart used to assess binocular and monocular visual acuity
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17
Q

What is the Ishihara colour chart?

A
  • the most well known colour blindness test
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18
Q

The first thing we do in a neurological examination is assess cranial nerve I (1). What is this nerve and how do we assess this?

A
  • CN I = olfactory (smell)
  • ASK: have you noticed any change in your smell
  • offer a substance under each nostril to check
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19
Q

The second thing we do in a neurological examination is assess cranial nerve II (2). What is this nerve and what would we ask?

A
  • CN II (optic)
  • Ask: “Can you see out of both eyes equally”
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20
Q

Cranial nerve II (2) is the optic nerve and we would start by asking if the patient can see out of both eyes equally. What are we looking for in the patients vision?

A
  • Visual acuity and colour perception
  • Visual fields & blind spot (use hat pins when offered)
  • Reflex (pupillary reflex & swinging flashlight test)
  • Fundoscopy (red ‘reflex’, optic disc, retinal quadrants and macula)
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21
Q

What is the fundoscopy?

A
  • exam that uses a magnifying lens and a light to check the fundus of the eye (back of the inside of the eye, including the retina and optic nerve).
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22
Q

After cranial nerves I (olfactory) and II (optic) what would we assess next in the neurological examination?

A
  • cranial nerves III (3), IV (4), VI (6) (oculomotor, trochlear, abducens)
    • assess full range of tracking eye movements (reports of diplopia) in a H-shape
  • reflex (convergence-accommodation)
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23
Q

The fourth area to assess is cranial nerve V (5). Which nerve is this?

A
  • trigeminal
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24
Q

The fourth area to assess is cranial nerve V (5) which is the trigeminal nerve. What are the 3 parts of the trigeminal nerve?

A

1 - opthalmic (V1)

2 - maxillary (V2)

3 - mandibular (V3)

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25
Q

The fourth area to assess is cranial nerve V (5) which is the trigeminal nerve. What are we assessing for in the trigeminal nerve?

A
  • Facial sensation (all 3 branches, both sides)
  • Jaw strength (clench and open)
  • Jaw jerk
  • Reflex (corneal)
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26
Q

After assessing cranial nerve V (5) we will need to assess cranial nerve VII (7). What is this nerve and what do we assess for?

A
  • facial nerve
  • facial muscle expression and taste
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27
Q

Following the assessment of the facial nerve (CN V) we will assess cranial nerve VIII (8). Which nerve is this and what will we assess?

A
  • vestibulocochlear nerve
  • hearing
  • rinne & Weber testing
  • vestibular assessment
28
Q

After assessing the cranial nerves VII (7) vestibulocochlear and VIII (8), we assess cranial nerve IX (9) and X (10). Which nerve is this and what are we assessing?

A
  • 9 = glossopharyngeal)
  • 1 = vagus
  • assess elevation of the uvula, cough and reflex (gag)
29
Q

The second to last nerve we will assess is cranial nerve XI (11). What nerve is this and what are we assessing?

A
  • spinal accessory nerve
  • rotation of the head
  • shoulder shrug
30
Q

The final nerve we will assess is cranial nerve XII (12). What nerve is this and what are we assessing?

A
  • hypoglossal
  • fasciculations at rest (muscle twitch)
  • Tongue protrusion
  • Tongue strength (in the cheek)
  • Speech
31
Q

What is a long term condition?

A
  • a condition that cannot currently be cured
  • patients are supported to optimise quality of life
32
Q

Approximately what proportion of life is spent in poor health?

A
  • 43% of adults aged >16 have _>_1 long standing medical condition
  • 15% of children aged <15 have at least one long standing condition
33
Q

What % of the population with long term conditions are in work?

A
  • 59%
34
Q

What % of the population with mental health conditions are in work?

A
  • 35%
35
Q

ISBAR is something that is used when doing a handover to other clinical staff. What does the acronym stand for?

A
  • I = Identify/Introduction
  • S = Situation (explain why you are calling)
  • B = Background (of patient)
  • A = Assessments (this is what I think)
  • R = Recommendation (request specific advice and interventions)
36
Q

What is the PHQ-9?

A
  • a 9-question instrument
  • used to screen for the presence and severity of depression
37
Q

What is the mental health examination?

A
  • a structured way of observing and describing a patient’s current state of mind
  • includes domains of appearance, attitude, behaviour, mood, affect, speech, thought process, thought content, perception, cognition, insight and judgement
38
Q

When we are examining the peripheral nervous system, what 2 systems do we need to divide this into?

A
  • sensory
  • motor (pyramidal = voluntary and extrapyramidal = involuntary)
39
Q

The pyramidal and extrapyramidal tracts are involved in motor control. Which is voluntary and which in involuntary?

A
  • pyramidal = voluntary
  • extrapyramidal = involuntary
40
Q

What is the definition of an upper motor neuron?

A
  • a neuron that transmits from the brain to the spinal cord or brain stem
41
Q

What is the definition of a lower motor neuron?

A
  • a neuron that comes from the brain stem or spinal cord to the target tissue (skeletal muscle)
42
Q

Where needs to be damaged to cause an upper motor neuron disease/disorder?

A
  • damage to the brain, such as stroke or infection
  • damage to the spinal cord, especially the white matter of the spinal cord
43
Q

Where needs to be damaged to cause an lower motor neuron disease/disorder?

A
  • damage to the spinal cord, specifically the grey matter as this is where lower motor neurons begin
  • damage to the neuron between the spinal cord and target tissue
44
Q

In an upper motor neuron disorder is there muscle wasting, if there the affected area is still being used?

A
  • generally no
  • other muscles in area can compensate and activate muscle
45
Q

In an upper motor neuron disorder there only muscle wasting, if there the affected area is still being used. This is because the signal from the brain can activate surrounding muscles which can compensate (synaptic plasticity). However, is there the any change in muscle strength?

A
  • yes, weakness
  • muscle can not be activated as much
46
Q

In a lower motor neuron disorder is there muscle wasting?

A
  • yes
  • signal from brain does not activate the muscles
47
Q

If there is a lesion brain, brain stem or spinal cord, especially the white matter of the spinal cord, this can cause a upper motor neuron disorder. What effect can this have on muscle tone?

A
  • increased muscle tone
  • spasticity
48
Q

If there is a lesion brain, brain stem or spinal cord, especially the white matter of the spinal cord, this can cause an upper motor neuron disorder, resulting in increased muscle tone and spasticity. Why does this occur in upper motor neuron damage?

A
  • imbalance between excitatory and inhibitory alpha motor neurons
  • excitatory = corticospinal tract
  • inhibitory = descending tracts (reticulospinal and ponto-reticularspoinal tracts)
49
Q

If there is a lesion brain, brain stem or spinal cord, especially the white matter of the spinal cord, this can cause an upper motor neuron disorder, resulting in increased muscle tone and spasticity. This occurs due to an imbalance between excitatory and inhibitory alpha motor neurons. The alpha motor neurons are responsible for causing voluntary contraction and relaxation of skeletal muscle. How can upper motor neuron lesions affect reflexes?

A
  • increases the reflex response
50
Q

If there is a lesion brain, brain stem or spinal cord, especially the white matter of the spinal cord, this can cause an upper motor neuron disorder, resulting in increased muscle tone and spasticity. This occurs due to an imbalance between excitatory and inhibitory alpha motor neurons. The alpha motor neurons are responsible for causing voluntary contraction and relaxation of skeletal muscle. In addition to increased muscle tone/spasticity, there is increases in reflex briskness. Why does this occur?

A
  • imbalance between excitatory and inhibitory gamma motor neurons of muscle spindles
  • excitatory = corticospinal tract
  • inhibitory = fibres from corticospinal tract that bifurcate into medulla reticular nuclei
51
Q

If there is a lesion brain, brain stem or spinal cord, especially the white matter of the spinal cord, this can cause an upper motor neuron disorder, resulting in increased muscle tone (alpha motor neurons) and reflex (gamma motor neurons) response. Combined this causes a specific type of paralysis characterised by significant muscle tone, what is this called?

A
  • spasticity
52
Q

If there is a lesion in the grey matter of the spinal cord or the neurons from the spinal cord to the skeletal muscle, this can cause a lower motor neuron disorder. What affect does this have on muscle mass?

A
  • significant muscle atrophy
  • alpha motor neurons are not activated so muscle is not innervated
53
Q

If there is a lesion in the grey matter of the spinal cord or the neurons from the spinal cord to the skeletal muscle, this can cause a lower motor neuron disorder which can cause significant muscle atrophy. What can a lower motor neuron lesion do to the reflex of patients?

A
  • gamma motor neurpns do not innervate muscle spindles
  • alpha 1 and 2 afferent (sensory) neurons do not fire and reflex is slow or non existent
54
Q

During a peripheral nervous exam where are we going to examine?

A
  • arms and legs
55
Q

During a peripheral nervous exam, what position will the patient be in when we examine the legs and arms?

A
  • arms = sat on the edge of the bed faving you
  • legs = lying flat on the bed
56
Q

Following the general overview of the patients surroundings and any clear observations about the patient, what are the 6 tests we need to do?

A
  1. Tone
  2. Power
  3. Reflexes
  4. Sensation
  5. Coordination
  6. Gait
57
Q

When observing the patient, what main thing are we looking for in the limbs?

A
  • asymmetry in limbs
58
Q

When observing the patient, we may see some movement in patients muscles, what can these be?

A
  • fasciculation’s (spontaneous muscle twitch)
  • tremors
59
Q

When observing the patient, we can ask them to hold their arms out in front of them. What 3 things might we see?

A

1 - do arms stay where they should

2 - is there a drift (arms dropping down)

3 - is there an action tremor

REPEAT ALL WITH PATIENT CLOSING THEIR EYES

60
Q

When we are assessing tone in the upper limbs, how do we assess tone in a patients arms?

A
  • hold patients hand with dominant arm
  • non-dominant hand should be on patients elbow
  • then randomly move the patients arm to assess tone
61
Q

When we are assessing tone in the lower limbs, how do we assess tone in a patients legs?

A
  • hands on thighs and roll patients leg from side to side
  • watch the foot
62
Q

What is the difference between spasticity and rigidity?

A

Spasticity

  • damage to corticospinal tract (pyramidal)
  • common in UMN disorders
  • spasticity is dependent on velocity

Rigidity

  • damage to extrapyramidal disorders
  • common in UMN disorders
  • present throughout range of movement
63
Q

What scoring method is used to assess power in a peripheral nervous examination?

A
  • medical research council grading
  • 0 = no movement
  • 5 = full strength
64
Q

How would we assess shoulder abduction?

A
  • testing deltoid muscle supplied by axillary nerve, C5
  • place hands close to elbow and ask patient to push agains you
65
Q

How would we assess elbow flexion?

A
  • Biceps assessed and supplied by musculocutaneous nerve, C5/C6
  • Hold elbow and wrist with palm up and ask patient to bend the arm

NSB! (53 decks)

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