Exam 3 Flashcards
lobes of the brain
frontal
temporal
parietal
occipital
CNS
brain and spinal cord
inc cerebral cortex
and cerebral hemisphere
cerebral cortex
center for highest functioning
controls- thought, mem, reasoning, sensation, volun. mvmnt
covers gray matter (cerebral hemisphere) and white matter (deep to cerebrum)
cerebral hemisphere
lobes
frontal lobe
personality, emotion, beh, volu skeletal mvmnt (post central gyrus)
temporal lobe
hearing, taste and smell, speech
occipital lobe
interpretation of vision
parietal lobe
processing senation (post central gyrus)
damage to cerebral hemisphere lobes=
loss motor function (weakness, paralysis)
loss sensation
diff processing and understanding language
cerebellum
balance and coor (motor volun mvmnt)
equilibrium
muscle tone
*not initiate mvmnt only smoothes
thalamus
relay station for nervous system
all sensory e/x smell
interprets pain, light touch and pressure sensation
PNS
12 pairs cranial n
31 pairs spinal n
ANS- parasym and sympathetic
not include CNS
peripheral n
dev from spinal nerves
dermatome
area conducted by specific nerve
sensory pathway
from periphery to brain
inc. spinothalamic and posterior columns
spinothalamic tracts
anterior and lateral
sensory
lateral spinothalamic
pain and temp
sensory
anterior spinothalamic
light pressure and touch
sensory
posterior column
proprioception- area in space
kinesthesia- directional awareness
vibration, fine local touch
sensory
motor pathways
corticospinal/ pyramidal tract
extrapyramidal tract
cerebellar system
brain to spinal cord
corticospinal/ pyramidal tract
motor
skilled vol mvmnt (writing)
fibers originate in motor cortex (frontal)
extrapyramidal tract
motor
macro mvmnt (walking), main muscle tone
fibers originate outside corticospinal tract
cerebellar system
coord mvmnt, maintain posture, equilibrium, mvmnt is unconsious
gait
upper motor neuron
brainstem to synapse w/ lower motor n
sympt- hyperreflexia, (+) superficial reflexes, musc weakness
lower motor neuron
originate in ant horn cell of spinal cord (bilaterally) sympt- flaccid, mild musc weakness hyporeflexia ex. polio neuron apparent at each spinal segment connect to muscle fibers
importance of hx of HTN
inc risk for stroke
documenting weakness
bilaterally or unilateral
permanent v temporary
warning signs stroke
numbness or weakness on one side of body (sudden)
sudden confusion, trouble speaking or understanding
sudden vision changes
sudden trouble walking, dizzy, loss balance or coord
sudden or severe headache (hemorrhagic stroke)
time considerations for stroke
<3 hours to get to care
60 second test
for stroke have pat smile raise both arms repeat simple sentence call 911 if present signs
neuro assessment incl
mental status- cerebral func, orientation cranial n 2-12 motor system sensory system reflexes
motor system test
muscl tone- tension, flaccid?
musc mass
involv mvmnt (tic or tremor)
strength - 0-5+
5= normalresting tremor
pill rolling
can be familial
not always indicate neuro problem
intention tremor
occurs w/ mvmnt
tic
usually upper motor problem
fasciculation
quiver
ex. eye twitch or after working out
cerebellar function test
gait tandem walking ataxia RAM heel-shin hop on one foot
romberg test
feet together, stand, eyes closed 15-20 seconds
negative= normal
proprioception test
finger to nose
(eyes closed)
finger to finger
(nose to finger, tracking)
sensory system- what to test
pain and touch sensation
sharp v dull
distal to medial
abnormal sensory system findings
pain-
hyppalgesia
analgesia (absent)
hyperalgesia
touch- hypoesthesia (common w diab) anesthesia- absent hyperesthesia paresthesia- abnormal sensations (pins, numbness, tingling)
sensation assessment
microfilament test
poke bottom foot and hand
assess bilaterally
test for position (kinesthesia)
posterior column
grap finger and move up and down
vibration test
posterior column
tuning fork on bony prominence
norm= detect start and stop
stereognosis
post. column
reg object by feeling
controlled by parietal lobe
graphesthesia
post. column
id letters/ numbers drawn on hand
flow chart for deep tendon relfex
afferent fibers synapse efferent fibers neuromuscular junction muscle fibers * all steps have to be intact @lvl spinal cord (brain doesn't initiate) brain only smoothes mvnt
bicep reflex
hold thumb over tendon
palm facing up
norm= flexion arm at elbow
tricep reflex
support arm into H shape
norm= extension arm at elbow
patellar reflex
above patella and below tibial patella
norm= extension at knee
achilles relfex
norm= plantar flexion foot
(toes down)
support foot so bottom is parallel to ground
normal findings for relfex
2-3
symmetrical bilaterally
document if reinforcement used
examples of reflex reinforcement
clench teeth
hold arms
close eyes
superficial reflex
response from skin receptors
ex. plantar or babinski reflex
plantar reflex
normal= toes curl down and negative response
infants should fan feet <2yrs
LOC includes
x3 place, person, time,
x4 incl event or situation
CMS
circulation movement sensation assess distally to affected region commonly done for ppl w/ ortho procedures, splint, cast or fracture
inc risk for fall
inc age fall history within last 6 mon elim-incontinence, frequ or urgency meds- diuretics, analgesics, laxatives equipment- catheter, IV, monitor mobility- assist visual/auditory, gait cognition-dev lvl, confusion, orientation score= low, moderate or high
musculoskeletal assessment incl
temp, tenderness, swelling strength ROM joint pain, crepitus spasticity, rigidity, atrophy spine midline/ straight? fall risk
abdomen assessment order
inspection
auscultation
percussion
palpation
abdomen- inpsection
general appearence eye lvl and above skin- striae, scars contour- protuberant or rounded symmetry umbilicus- midline w/out discoloration
cause of blue umbilicus
internal bleeding
cause asymm abdom.
tumor, hernia, bladder distention, uterine disten
RUQ
liver, gallbladder, ascending colon
RLQ
cecum, appendix, bladder
LUQ
spleen, stomach, sm in
LLQ
desc colon, sigmoid colon, public symphysis
causes abdom distention
fat, fluid, feces, fetus, flatus, fibroid (growth in uterus), fatal tumor, full bladder
diastasis recti abdominis
seperation ab muscles
not true hernia
can occur in adults
(preg. and obesity)
types possible hernias in abdom
umbilical, inguinal and femoral
perastalsis in abdom
not normal
diaphram and bell in abdom
dia- bowel sounds
bell- vascular sounds
absent bowl sounds
not norm
bowl sound factors
time since last ate (4/7hrs)
borborygmi
hyperactive bowl sounds (diahrr)
spots listen for bruits
femoral artery and abdominal aorta
pupose percussion in abdom
id pain
costal vert. angle tenderness (CVA)
12th rib post
place hand flat and hit with fist
abdom palpation
light- 1-2cm
deep 5-8cm
specific organs- liver, spleen and kidney
lymph nodes- femoral, inguinal
palpation liver location
costal margin
palpation spleen and kidney
abnormal if felt
norm abdominal results
soft, non-tender, bowl sounds present, tympanic to percussion
rebound tenderness
=more pain after touch
ex. present w/ appendix
only assess if complain about abdom. pain
anatomical location of breast
2nd rib (by manubriosternal junction) to 6th sternal border to midaxillary line
func of montgomery’s glands
secrete lubricant or protective lipid material during lactation
nipple color variation due to
race, pregnancy, number of deliveries
lobes in breast and milk flow
15-20
extend from nipple
composed of milk producing acini cells
milk produced, lactiferous ducts, sinus duct, nipple
nodes associated w breast
supraclavicular infraclavicular lateral (brachial) central axillary sub scapular (posterior) pectoral (anterior) drain ipsilaterally
breast lymph node locations
lateral- inside upper arm along humerous
central axillary- high in axilla
subscapular- inside posterior axillary fold along lateral edge of scapula
pectoral- inside axil. fold along pec major musc
supernumerary nipple
2nd nipple
resembles mole, can be assoc. w/ renal abnormalities
mammary ridge
“milk line”
axilla through nipple to inguinal ligament
gynecomastia
male breast tissue
1/3 adolescents
temporary 1-2 yrs
gynecomastia- causes
hormonal puberty changes, inc adipose tissue, dec testosterone w age, meds
quadrants of the breast
lower inner q upper inner q axillary tail of spence upper outer q lower outer q
common location for breast tumors in women v men
women- upper outer q
men- behind nipple
nipple discharge
milky is norm w/ lactation
blooduy- always abnorm
breast cancer stats
most common cancer in wmn besides skin 2nd major cause death from cancer in wmn 90% survival rate 80% lumps non-cancerous 1-8 lifetime risk men can dev CA too- not as common
risk factors- breast cancer general
not automatically mean will get CA
anything inc person’s chance getting disease
most wmn have no risk factors but get CA
factors can change overtime
risk factors- breast cancer
female gender >50 yrs old personal hx breast CA family hx breast CA 1st degree= 2x and 2 ppl 1st degree= 4x genetic mutation braca gene 1 or 20 (35-85%) inc risk 100x more likely get in 60s v 20s (wmn) hx uterine, ovarian, colon CA early menarche <12, late menopause >55 (prolonged exposure to estrogen) high breast density breastfeeding dec risk hormone therapy around menopause time (if taken < 4/5 yrs risk will dec) birth control (goes away in 10yrs after stop taking)
breast cancer- risk reduction strategies
limit alcohol (inc estrogen lvl) breast feed control weight be physically active limit hormone therapy around menopause don't smoke
benign breast syndrome
“fibrocystic syndrome”
50% wmn
not precancerous
common in younger childbearing wmn
can cause mastalgia (pain), swelling and discomfort
lumps bilaterally, firm, mobile and rubbery, and can be tender after menstruation
5 positions for breast examination
sitting arms overhead (breast move symmetrically)
sitting arms at sides
hands on hips (contract pectoralis, helps id dimpling)
bending from waist (b should fall freely/ equally from chest wall)
supine (use palpation, raise cooresponding arm overhead and support with pillow)
abnormalities with breast inspection
rash, sores dont heal, lesions, unequal venous patterns (visability), edema, masses, dimpling, unequal nipple directional pointing
unequal sized breasts
common
if sudden change or not usually like that- analyze further
plugged breast duct
happens w lactation
nipple can become hard and dry
erythema
breast dimpling/retraction
abnorm
pot cause- mass affecting coopers ligaments
breast induration
abnorm
area hardness w/ inflamm
breast peau d’orange
“peel of an orange”
pitted, dimpled hair follicles from swelling
nipple inversion
abnorm if not symm bilaterally
or a new change
or if nipple do not point in the same direction
breast palpation-non nipple
bimanual (sitting/standing compress btw hands) if large
pads three fingers
pillow under shoulder when supine
start below clavicles
breast palpation techniques
vertical strip
concentric circles
chest wall sweep (recommended, clavical to nipple or sternum to nipple inc under armpit)
spoke
inframammary ridge
compressed tissue
normal at bootom breast btw 4-8 oclock
can feel like rib poking up
granular consistency of breasts
normal for post meopausal women
masses classification
quadrant and clock location
size, consistency, mobility, borders, tenderness, bilaterall
a mass that is fixed, hard, unilateral, and undefined
concerning
palpation of nipple
push nipple down
squeeze behind areola
axillary lymph node exam
sitting and support arm
start high up in axilla, include sub/infra scapular
enlarged or palpable= abnorm
breast pain
abnorm if not around time of period
breast exam reccom
mammograms and exam= best outlook
25-40 every 1/3 yrs
> 40 yrly
early detection= best for improving qual. of life and survival
male breast cancer
1% of all breast CA
most common site- nipple
often painless mass
common signs- scaly nipple, lesion, discharge
testicular CA
curable
1% CA in males
50% within 15-35 yrs
inc (dont know why)
testicular CA risk factors
undescended testicles
personal/family hx of testicular CA
whites 5x risk v black and 3x risk v indians/ mexican
age 15-35
cryptorchidism
undesc. testes
testicular CA symp
common asympt
nodules, one side lrger than other, painless lumps, dull ache in groin, enlrged/ swollen breasts
normal findings of testes
firm, rubbery, non-tender
leading causes CA in men v women
men- prostate
wmn- breast
b/= lung (2)
colon and rectum (3)
prostate CA risk factors
1-7 lifetime risk 1-36 die >80% in age 65 or greater black> white family hx hereditary breast and ovarian CA
prostate CA sympt
early- none
problems urinating, cant erect, blood in urine
prostate CA screening
talk w doctor around age 45-50
45 if high risk or black
50 if at normal risk
screening= psa blood test
causes of high psa lvl
prostate ca
begning prostatic hypertrophy
UTI
enlrged prostate
consideration w/ prostate ca screening
early detection not always matter
25% get biopsy bc inc psa have cancer, o/ 75% dont
colon cancer-incidence
3 most common in b
colon cancer screening causes
look at prostate func chronic constipation check for compaction rectal tone check around age 50 (every 10 yrs)
colon cancer risk factors
> 50, family hx, personal hx breat CA or polyps, physic inactivity, obesity, smoking, alcoh
polyps (colon)
growth inside colon
if present, screen more frequently
cervical cancer risk factor
HPV infection smoking hx STIs long term use of oral contraceptive (returns norm after 10 yrs) family hx multiple full term pregnancys death risk has dec w/ pap test
cervical cancer ages
frequently 35-45
rare <20 or >65
cervical cancer screening
pap every 3 yrs starting at 21 (3 yrs if norm)
5 yrs 30-65
> 65 if norm results no futher paps
still need screening even if have HPV vaccine
HPV vacc ages
11-12 or early as 9
when is birth history necessary to review
kids < 6 yrs
dev or neuro concern
peds nutritional hx
allergies breast v bottle solids no earlier 4/6 m no honey before 1 juice intake- 8-12 oz per day max
peds oral care
around 6-12mon
when first tooth appears
exposure 2nd hand smoke in kids inc risk
asthma
ear infection
tooth decay risk
parent tooth decay < 6months
juice
frequent snacking
peds assessment incld
weight- lying < 2 yrs
height- recumbent (supine) < 2 yrs
head circum till 2 yrs
chest circum till 18mon (across niples)
peds vital signs
heart r and respirations for 1 min heart rate- 130 norm apical pulse for kids < 2yrs bp lower than adults respir r- 28-20 norm bp- 98/60 norm
milia, lanugo, mongolian spots
milia- white pimple like dots of cebum (norm)
lanugo- excess hair (norm) common in premies
Mongolian spots- common darker ethnicities/races (90%)
inc distribution of melanocytes
thyroid and lymph nodes in peds
usually not palpable
anterior fontanel
"soft spot" closes 9-18 mon abnorm- firm, elevated, sunken sunken- dehydr elevated if not crying= inc ICP
posterior fontanel
closes 2-3 months
peds vision
6-7 20/20
newborn 20/200
EOM’s important!!
red reflex = normal
retinoblastoma and congenital cataracts
retinoblastoma- cancer
cataracts- cloudy lens
peds ears
pull down and back
5 oclock- R and 7 oclock R
eustachian tube wider, shorter, and more horizontal
peds teeth eruption and saliva
saliva- drooling 3 months
tooth- 6-24 months
don’t lose all till 6-12 yrs
peds tonsils
max size 10-12
small at birth
cannot see adenoids
peds sinuses
cannot see
not fully developed
peds respiratory
faster respir rate abdom breathing till 6-7 barrel chest normal till 6 hypperresonance common breath sounds- louder bronchovesicular
peds cardiac
heart sounds louder and higher pitched (norm) split s2 common during inspiration s3 norm sinus dysryth norm inc pulse rate- 120-160 newb dec 80s by 8 yrs
thelarche
breast budding females
onset puberty 8-14
gynecomastia
males
away w 1-2 yrs
peds abdomen
cylindrical/ protuberant abdomen is norm
organs not palpable
nb may feel liver
testicular growth
9-13 months
cryptorchidism
testicles do not descend
menarche
begins 2-2.5 yrs after onset puberty
menstrual cycle is irregu first year or two
full ossification of bones
18 yr old
growth spurt btw 12 girls and 14 in boys
genu varum and valgum
varum- bow legs till 2
valgum- knock knees till 7
scoliosis
curved spine
uneven hips/ shoulders
peds babinski
norm till 2 yrs
if fanning after 2= upper motor neuron dis.
