Exam 3 Blueprint Flashcards
Cranial Nerve 5: What is it, function and assessment
Trigeminal
* Motor and Sensory
* Motor function: Chewing
* Have patient clench teeth
clench, then palpate temporal and masseter muscles
* Sensory function
* Facial sensation
* Taste at anterior tongue
What are the lobes of the cerebral cortex
Parietal
Occipital
Cerebellum
Frontal
Temporal
Brain stem
Focused questions- Breast Exam (8)
Pain, Lumps, Discharge, Rash, Swelling, Trauma, Hx of breast disease, Surgery
Qualifying sensation: what is anesthesia?
no sensation
Neurological injury: stroke
- “3rd most common cause of death in US”
- Men > women
- Thrombotic/embolic - clot
- Hemorrhagic - vessel ruptured/bleeding
- Often from poor control of modifiable risk factors (diabetes, obesity, HTN)
Qualifying sensation: what is hypoesthesia?
loss of sensation
Structure of Nervous system (two parts)
CNS
Brain
Spinal cord
PNS
Everything else
All nerve fibers outside brain/spinal cord
includes autonomicNS
romberg
Describing sensory function-testing senses
Touch, pain, temperature: light/dull
Vibration
Proprioception: awareness of where you are
Romberg: swaying when standing
Stereognosis
Graphesthesia
Superficial Reflexes(5)
- Plantar
- Abdominal
- Anal
- Cremasteric: males, stroke the inner aspect of
upper thigh - Bulbocavernosus: contraction of the anal sphincter
AROM and PROM
What is ROM
Active range of motion (AROM)
- The individual moves a body part on their own without assistance
Passive range of motion (PROM)
-When someone or something else moves the body part for the individual
Deep tendon reflexes: types and grading
Grading
* 4+: brisk, hyperactive
with clonus
* 3+: Brisker than average
* 2+: Normal
* 1+: Diminished
* 0: No response
Areas to test
* Biceps
* Triceps
* Brachioradialis
* Quadriceps
* Achilles
Palpation in neurological assessment (not sure)
just added things about sensation, muscle strength and reflexes but idrk
superficial and deep sensation
muscle strength and tone
DTRs and superficial reflexes
Testing cerebellar function (4)
Test through normal ROM
Testing cerebellar function
- finger to nose
- standing posture
- heel to shin
- gait pace
Hypotonia
Hypertonia
Myoclonus
Hypotonia? low muscle tone/strength
Hypertonia? abnormally high muscle tone/stiff
Tics? tremors?
Myoclonus: tremors that can be pathological
What is the palmar grasp in infants?
strongest? disappears?
Place baby’s head midline to ensure symmetric response
Offer finger from baby’s ulnar side, away from thumb
Note tight grasp of all baby’s fingers
Present at birth; strongest at 1-2 months; disappears at 3-4 months
Motor function disorders: what is multiple sclerosis?
the immune system attacks the myelin sheath
Abnormal postures
Decorticate rigidity: body turns in
Decerebrate rigidity: body turns out
Flaccid quadriplegia
Opisthotonos: back arches
Developmental considerations in Male GU assessment: adult and aging men
- testosterone production declines after age 55 to 60 years
- decline proceeds gradually
- pubic hair decreases and penis size decreases
- scrotal contents hand lower, rugae decrease, and scrotum becomes pendulous
- testes decrease in size and are less firm to palpation
structure and function of male GU
lymphatics
- lymphatics of penis and scrotal surface drain into inguinal lymph nodes
- lymphatics of testes drain into abdomen
- abdominal lymph nodes not accessible to clinical exam
Cranial Nerve 4: What is it, function and assessment
Trochlear (Motor)
Assessed in extraocular movements (6 cardinal fields of gaze “cat whiskers”)
Types of muscles
Skeletal, smooth, cardiac
Neurological injury: Parkinson’s (classic symptom triad)
- Damage to extrapyramidal tracts
* Dopamine loss - Classic symptom triad
* Tremor
* Rigidity
* Bradykinesia (slow walking) - Flat facial expression
- Increased Salivation (drooling)
- Decreased Eye blink (dry eyes)
- Ambulation problems (shuffling)
Assessing mental status (9)
- Is change acute or gradual
- Orientation (person, place, time, situation)
- Response to pain
- Speech patterns
- Person’s appearance
- Coordination
- Thought process
- Level of consciousness (LOC)
– awake and alert
– lethargic
– stuporous: may wake to painful stimuli
– comatose - Speech patterns
– ability to communicate?
– appropriate response?
– speech rhythm
Assessment of the male genitalia: preparation
- position male standing with underwear down and appropriate draping
- examiner should be sitting (male could also be supine for first part and stand for hernia check)
- use firm, deliberate touch (not soft)
– if erection occurs, do not stop exam or leave room
Temporomandibular joint (TMJ) assessment
Formed by the fossa and articular tubercle of the temporal bone and the condyle of the mandible.
TMJ Functions
Hinge: Open & close
Gliding: Protrusion & retraction
Gliding: Side-to-side at lower jaw (Lateral)
Inspection in musculoskeletal assessment (5)
Joint (Size and contour)
Color (red, pale, echymotic)
Swelling
Deformity including masses
Crepitus (audible grinding of the bone)
Mini Mental Status: Example
ORNR
Orientation: what is today’s date?
Registration: i’ll say three words and you say them back to me
Naming: what is this?
Reading: can you read this and do what it says?
Hip; Musculoskeletal/Landmarks
Less mobility than shoulder but stronger, has greater weight bearing ability
Landmarks:
- Anterior superior iliac spine (ASIS)
- Ischial tuberosity
- Greater trochanter
What is the moro reflex in infants?
Startle infant by jarring crib, making a loud noise, or supporting head and back in semi-sitting position and quickly lowering infant to 30 degrees
(when they fan limbs out)
Present at birth; disappears at 1-4 months
Performing a testicular exam - put in palpation portion too
- feel each testicle with thumb and first two fingers
- contents should slide easily
- testes feel oval, firm, rubbery, sooth, equal, freely movable
Brain stem structure/function
Technically - is midbrain, pons, medulla oblongata
Midbrain
- Thalamus/hypothalamus (actually part of diencephalon) relay center and hormone regulation, respectively
Pons
- Respiratory centers
Medulla
- Ascending and descending tracts
- Autonomic centers (respiration, heart, GI)
- regulates breathing, BP, HR, swallowing
Central core
Cranial Nerve 6: What is it, function and assessment
Abducens: Eye movement (Motor)
* EOMs of cardinal gaze
– technically testing lateral eye movement
* Nystagmus? (back and forth movement)
– Unilateral or bilateral?
– Frequency?
– Plane of movement?
* Strabismus? (One eye wonky)
* Ptosis? (droopy eye lid)
Cranial Nerve 2: What is it, function and assessment
Optic
* Vision
* Requires ophthalmoscope
* Sensory
Teaching self-breast exam to patients
- establish a routine
- best time: right after menstrual period (breasts smallest and least congested)
– advise pregnant or menopausal women to select familiar date - stress it will familiarize woman with own breast and variation
– encourage to report unusual findings - describe correct technique, rational, and expected findings
- at home: can palpate in shower w soap and water
- then should also be performed when lying supine
- encourage woman to palpate own breasts while you monitor technique (teach back method)
Characteristics (types) of joint movements (6)
flexion (bending),
extension (straightening),
abduction (movement away from the midline),
adduction (movement towards the midline),
rotation (circular movement),
circumduction (circular movement of a limb),
the most movement occurring in ball-and-socket joints, while hinge joints only allow for flexion and extension in one plane.
Qualifying sensation: what is paresthesia?
pins and needles
Motor function disorders: what is muscular dystrophy?
progressive weakness and loss of muscle mass
Inspection in neurological assessment
cranial nerves?
A&O x3?
Assessment of breasts: patient supine
- palpate the breasts
– tuck small pad under side to be palpated; raise arm over head to flatten breast tissue and displace; lumps more distinct - vertical strip pattern recommended
– start high in axilla
– palpate down to lateral to breast, overlap vertical lines, end at sternal edge - use pads of first 3 fingers
- palpate 4 quadrants of breast and nipple (depress nipple and check for discharge)
normal breast: firm, smooth, elastic
premenstrual: engorgement, slight enlarged
Cerebral Cortex
- outer layer of hrain made up of nerve cells- controls most of the conscious processes.
-Center of functions governing though, memory, reasoning, sensation and voluntary movement.
Motor function disorders: what is Parkinson’s disease?
uncontrollable movements
Developmental considerations in Male GU assessment: adolescents
- puberty begins between ages 9.5-13.5
- first sign is enlargement of testes
- next, pubic hair appears then penis size increases
- complete change in development from preadolescent to adult takes around 3 years - normal range is 2-5 years
Developmental considerations in Breast assessment: pregnancy
+ colostrum/lactation
Breast changes start during 2nd month of pregnancy; are early sign for most women
- breasts enlarge and feel more nodular; nipples are larger, darker, and more erectile
Colostrum may be expressed after 4th month
- thick yellow fluid: precursor for milk
- contains same amount of protein and lactose, but practically no fat
Lactation: milk production begins 1-3 days postpartum (colostrum first)
Joints (two types)
Synovial: freely movable, filled with fluid Ex. Knee, shoulder
Non-synovial: Joined by fibrous tissue or cartilage. Immovable
Tendons
connect muscle to bone
Developmental considerations in Breast assessment (Pregnancy)
Breast changes start during the second month of
pregnancy and are an early sign for most women
Breasts enlarge and feel more nodular, nipples are larger,
darker, and more erectile
Colostrum may be expressed after fourth month
Thick yellow fluid-precursor for milk
Contains same amount of protein and lactose, but practically
no fat
Lactation: milk production
begins 1 to 3 days post partum (colostrum first)
Assessment of the male genitalia: palpation (2)
– palpate inguinal lymph nodes
*- palpate horizontal chain along groin inferior to inguinal ligament and -
* -vertical chain along upper inner thigh
- normal to palpate an isolated node on occasion – small, 1cm, soft, discrete, movable
– enlarged, hard, matted, fixed nodes are abnormal findings
Developmental considerations in Breast assessment (Adolescent)
Puberty: estrogen stimulates breast changes
Breast development
Between 8 and 9 years for African-American girls and
by 10 years for Caucasian girls
Beginning of breast development precedes menarche
by about 2 years
Breasts of nonpregnant woman change with
movement and flow of hormones during monthly
menstrual cycle
Preparation for assessment of breasts
- woman sitting up facing examiner
- when woman is supine, cover one breast with gown while examining other
- after exam: teach breast self-examination
Signs and symptoms of advanced breast cancer: BREAST
BREAST
B: breast mass
R: retraction
E: edema
A: axillary mass
S: scaly nipple
T: tender breast
Developmental considerations in Breast assessment: Older women part 2
inspection: breasts look pendulous, flat, and sagging
Nipples may be retracted but can be pulled outward
Palpation: breasts feel more granular; terminal ducts around nipple feel more prominent and stringy
Ligaments
bone to bone
connective tissue
Developmental considerations in neurological assessment: elderly patients
Physiologic changes:
- general atrophy of neurons
– brain usually decreases in weight
– cerebral cortex thins
- Leads to decreased CBF (cognitive brain function), CSF
- Neural connections slower
- Loss of muscle mass and tone
- Decrease in sensory abilities
Consequences:
- Dizziness
– syncope
- Tremors develop
- Strength (grip) less strong
High risk for falls!
Sign and symptoms of neuro issue (5)
Headache
Mental status change - confusion, lethargy, agitation, restlessness
Dizziness, vertigo, syncope
Numbness or loss of sensation
Deficits of the 5 senses
Function of parietal lobe
(sensation)
7
Tests of balance and sensation: Motor
- gait
- Romberg test: arms at side and legs together, close eyes and assessed for signs of imbalance
- Hop in place
- rapid alternating movements
- finger to nose
- finger to finger
- heel to shin
Shoulder
Ball-and-socket
Rotator cuff (the most sports injuries)
- Four muscles (supraspinatus, infraspinatus, subscapularis, teres minor)
- Tendons
- Glenohumeral joint
Palpable landmarks
- Acromion process
- Greater tubercle
Musculoskeletal abnormalities
-Inflammatory conditions
Rheumatoid arthritis
-Degenerative conditions
Osteoarthritis
Osteoporosis
-Dislocation
-Subluxation
-Fracture
-Effusion
-Torn rotator cuff
-Tennis elbow
-Carpal tunnel syndrome
-Scoliosis
Sensory and motor function - neurological assessment
Sensory assessment:
- Superficial
– pain, temperature, light touch (cotton ball)
- Deep Sensation
– vibration
– position (kinesthesia)
– tactile discrimination
– stereognosis: identify item in hand
– graphesthesia: drawing number
Motor:
motor damage related to level of lesion injury
- assess muscle strength and tone
– test balance
– assess coordination and skilled movement
– test reflexes
Cerebellum function
(“auto pilot”, voluntary movement, equilibrium, coordination)
Assessment of breasts with patient supine: if you feel a lump -
note:
- location
- size: width, length, thickness
- shape: oval, round, lobulated, indistinct
- consistency: soft, firm, hard
- movable or fixed
- distinctness: solitary or multiple
- nipple: displaced or retracted
- skin over lump: erythematous, dimpled, retracted?
- tenderness: lump tender to palpation?
- lymphadenopathy: are any regional lymph nodes palpable?
Knee
3 bones/ landmarks
Largest joint in the body
- Three bones involved
Femur
Tibia
Patella
-Hinge joint
-Landmarks
Patella
Tibial tuberosity
Quadriceps muscle
Ligament supports
Assessment of the breasts: sitting
- inspect and palpate axillae
- inspect skin; note rash or infection; lift woman’s arm and support it so muscles loose and relaxed - use right hand to palpate left axillar
- reach fingers high into axilla; move them firmly down in four directions
Motor function disorders: what is cerebral palsy?
damage that occurs to the developing brain, usually in utero
Abnormal findings in movement
Paresis
Paralysis
Myoclonus
Fasciculation/tic/tremor
- resting
- intention: tic when moving
- chorea: Tourette’s
- athetoid: cerebral palsy
Sensory pathways
skin, muscles, tendons, mucous membranes, viscera: afferent fibers
spinothalamic tract: sensory fibers transmit pain, temperature, touch
posterior columns: position, vibration, fine touch
Cranial Nerve 12: What is it, function and assessment
Hypoglossal
Motor
* Tongue movement
Tests for balance and sensation: sensation
- pain
- light touch
- vibration
Ankle and Foot
Total weight of the body is transmitted through the ankle and foot
Balance the body and absorbs the impact of walking
-Hinge joint
Tibia, fibula, and talus
-Landmarks
Medial malleolus and lateral malleolus
Developmental considerations in Male GU assessment: infants
- prenatally: testes develop in abdominal cavity near kidneys
- at birth: testis measure 1.5-2 cm long and 1 cm wide
- only slight increase in size occurs during prepubertal years
Developmental considerations: Musculoskeletal assessment (older adult)
Osteoporosis
Postural change
Loss of height & sub-Q fat
Postural changes
Decreased height
Kyphosis
Decreased fat in periphery with re-deposition to abdomen and hips
Bony prominences become more obvious
Aging changes in the bones - muscles - joints Information
Decreased muscle strength and decreased bone strength
Increased risk for weakness which leads to reduced ability to function
Person less willing to walk
Results in immobility issues
Walking: one of the most important methods of sustaining independence
Reflexes and posture Abnormal Findings
Pathologic reflexes
* Babinski
* Brudzinski: flex the neck - meningitis
* Kernig: extension of the knee - meningitis
Abnormal postures
* Decorticate rigidity (turned in and up)
* Decerebrate rigidity (neck back/knees up)
* Flaccid quadriplegia
* Opisthotonus (back/neck arches back)
Cranial Nerve 9: What is it, function and assessment
Glossopharyngeal
Both Sensory and Motor
- Sensory: taste (posterior tongue)
- Motor: pharyngeal muscles (swallowing)
Developmental considerations: Musculoskeletal assessment (Pediatric)
Concern for damage to
epiphyseal plate (growth plate)
Pathologic reflexes
Babinski: toes fanning out
Brudzinski: flex the neck - meningitis
Kernig: extension of the knee - meningitis
Structure and function of the penis
should be without lesions
discharge: collect for microscopic exam
Developmental Considerations Neruo- elderly
- General atrophy of neurons
- Brain actually decreases in weight
- Cerebral cortex thins
- Leads to decreased CBF, CSF
- Neural connections slower
- Loss of muscle mass and tone
- Decrease in sensory abilities Consequences
- Dizziness
- Syncope
- Tremors develop
- Strength (grip) less
strong
High risk for falls
Mental status continued: Memory and Intellectual
Memory:
- cerebral function
- recent vs remote memory
- immediate memory test (repeating 3 words back that were just given)
Intellectual:
- learning
- computation
- ability to read
- insight
- judgment
Abnormal findings: Muscle tone and reflexes
Flaccidity
Spasticity
Rigidity
Cogwheel rigidity: gradual halting in movement like a ticking clock
Function of temporal lobe
(Auditory, hearing, taste, smell, Wernicke’s area)
What is the stepping reflex in infants?
Hold infant on flat surface - note regular alternating steps
Reflex disappears before voluntary walking
What is the tonic neck reflex in infants?
With baby supine, turn head to one side with chin over shoulder; note ipsilateral extension of arm and leg, and flexion of opposite arm and leg
“the fencing position”
Appears by 2-3 months; decreases 3-4 months; disappears by 4-6 months
Abnormal findings in male GU
enlarged, hard, matted, fixed nodes
firm, painless lump
hard area
enlarged testicle
Different layers of bone structure
Epiphysis: Muscle to bone
Diaphysis: Shaft
Metaphysis: Between epiphysis and diaphysis
Epiphysial plate (Growth plate)
Periosteum: Thin membrane
Palpation in musculoskeletal assessment
Temperature
Swelling
Masses
Only an abnormal synovial membrane is palpable (inflamed or warm)
Assessing for the 6Ps with injury
Pulses
Pallor
Pain
Paresthesia
Paralysis
Poikilothermia (the inability to maintain a constant core temperature independent of ambient temperature_
Structure and function of breasts
-Breasts lie anterior to pectoralis major and serratus anterior muscles.
-Between 2nd and 6th rib- from side of sternum to midaxillary.
-Superior lateral corner or breast called TAIL OF SPENCE
-Areola surrounds nipples with sebaceous glands called MONTGOMERYS GLANDS
Bursae
fluid filled sacs that act as cushions to reduce friction
Elbow
Three bony articulations
Hinge action
Landmarks
Medial epicondyle (humerus)
Lateral epicondyle (humerus)
Olecrenon process (ulna)
Structure/function of testes
have a solid oval shape, suspended vertically by spermatic cord
left testis is lower because left spermatic cord is longer
Abnormal findings in breasts
- Pain
– pain, tenderness, when noticed, where, cyclic, brought on by activity? - Lump, mass, swelling
– when noticed, changes, relation to period, changes in overlying skin? - Discharge from nipples
– when noticed, color, consistency, odor? - Rash
– when noticed, when did it start, where? - Trauma
– any trauma or injury, result in swelling, lump or break in skin? - Swelling
– one spot, all over, related to period, pregnancy, or breastfeeding, any change in bra size? - History of breast disease
– any in family? yourself? age? - Surgery
What is the plantar grasp in infants?
Touch your thumb at ball of baby’s foot; note that toes curl down tightly
Reflex present at birth; disappears at 8-10 months
Cranial Nerve 1: What is it, function and assessment
Olfactory
* Smell
* Non-noxious smells
* Sensory
What is the rooting reflex in infants?
when does it disapear
Appears at birth; disappears at 3-4 months
Brush the infant’s cheek near mouth; note whether infant turns head toward that side and opens mouth
Cranial Nerve 7: What is it, function and assessment
Facial
Motor
* Facial muscles for expression
* Have client “smile, frown, close eyes tight, lift brows, show teeth, puff cheeks
Sensory
* Taste on anterior tongue
* Tested only if injury occurs or is suspected
* Salt, lemon juice, sugar
Types of hip movement
Flexion
Extension
Abdution
Adduction
External/Internal Rotation
Cerebellar function
Complex motor coordination for movement, equilibrium, posture
Assessment of the male genitalia: inspect and palpate scrotum
- inspect as male holds penis out of way; you could also do so with back of hand
- size varies with ambient room temp; asymmetry is normal (left scrotal half lower)
- spread rugae out between fingers, lift sac to inspect posterior surface
– normally: no scrotal lesions present
– common: sebaceous cysts - yellowish 1cm nodules: firm, nontender, multiple - palpate gently each scrotal half between thumb and first two fingers
- palpate each spermatic cord between thumb and forefinger, along length from epididymis up to external inguinal ring
Types of bones
Classified as long, short, flat, or irregular.
Warning signs of Alzheimer’s
memory loss
losing track
forgetting words
getting lost
poor judgment
abstract failing
losing things
mood swings
personality change
growing passive
Developmental considerations in Breast assessment (Older Woman)
After menopause
Ovarian secretion of estrogen and progesterone
decreases, causing breast glandular tissue to
atrophy
Decreased breast size makes inner structures
more prominent
A breast lump may have been present for years
but is suddenly palpable
https://www.cmsschicago.org/news-blog/moderate-walking-
can-reduce-the-risk-of-breast-cancer-in-older-women/
Function of occipital lobe
(vision)
Cranial Nerve 8: What is it, function and assessment
Acoustic / Vestibulocochlear
Sensory
* Sensory for hearing and equilibrium
- requires special equipment to full assess
- bedside assessment with conversation
* Balance
Shoulder Joint anatomy
Clavicle
scapula
acromiclavicular joint
acromion
Glenohumeral joint
Head of humerous
Humerous
Cranial Nerve 11: What is it, function and assessment
Spinal accessory
Motor
* Trapezius and sternomastoid movement
- have patient turn head and apply resistance
- assess shoulder shrug
Qualifying sensation: what is hyperesthesia?
increased sensitivity
What is the placing reflex in infants?
hold infant up next to table - able to place foot on table
Reflex appears at 4 days after birth
Spinal abnormalities
Kyphosis- (hump) top curvature
Lordosis (lower back curvature)
scoliosis (spinal curvature)
Motor pathways of the CNS
Corticospinal (pyramidal) tract
Motor fibers travel from motor cortex to brainstem, where they cross and go down the opposite (contralateral) side
Testing cerebellar function
Assessing balance and gait/coordination
Romberg test- make sure they dont fall (Stand still for 30 seconds and not lose balance)
Finger-to-nose test
Heel to shin- to test for neurological vs weakness
Rapid alternating movements - flip hands back and forth (how fast pt can do it)
Teaching testicular self-examination (TSE)
- encourage self care: teach every male 13-14
- testicular cancer most common in young men 20-35
– males with undesended testicles at greatest risk; white males 4x more likely to contract cancer - early detection of cancer enhanced if male is familiar with normal consistency
- points to include during teaching (TSE):
– T: timing, once a month
– S: shower, warm water relaxes scrotal sac
– E: examine, check for and report changes immediately - shower or bath
- hold scrotum in palm of hand
- feel each testicle with thumn and first two fingers
– testicle: egg-shaped and movable, feels rubbery with smooth surface - report abnormal findings
Developmental considerations: Musculoskeletal assessment (pregnancy)
Hormones increase joint mobility
Lordosis (low back curvature and pain)
Abnormal Findings: neuro (movement and muscle tone)
Muscle Tone
* Flaccidity
* Spasticity
* Rigidity
* Cogwheel rigidity (watch-hand arm ticking)
Movement
* Paresis
* Paralysis
* Myoclonus
* Fasciculation/Tic/Tremor
* Resting
* Intention
* Chorea
* Athetoid (cerebral palsy)
Cartilage
made up of connective tissue. Provides structure and support. Allows bones to glide over eachother.
Developmental considerations in neurological assessment: Infants
Rooting reflex: (brush cheek, infant should turn head toward side)
Palmar Grasp (tight grasp around finger/toe)
Tonic neck reflex (baby supine, “fencing position”
Moro reflex- scare baby
Placing Reflex- place foot on table
Stepping Reflex- should alternate steps
Function of frontal lobe
(Personality, emotions, intellect, Broca’s area)
Cranial Nerve 10: What is it, function and assessment
Vagus
Both sensory and motor
Sensory: viscera of thorax and abdomen
motor: pharyngeal muscles (swallowing)
- consider the patient with stroke
- assess gag
Vagus is also important during the Valsalva maneuver - bearing down and the HR drops
What is the Glasgow Coma Scale
a tool used to measure the severity of brain injury and impaired consciousness in patients
15 point scale
Developmental considerations in Breast assessment: Older women
- After menopause: ovarian secretion of estrogen and progesterone decreases, causing breast glandular tissue to atrophy
- Decreased breast size makes inner structures more prominent
- breast lump may be present for years but is suddenly palpable
Mini Mental Status
Screening tool
- max score is 30
- 23 or less: cognitive impairment
Used primarily with elderly
- dementia
- delirium
Spinal pain
Midline: over the spinal processes of the vertebrae
Off the midline: in the paraspinal muscles surrounding the spine
how many lobes
Breast structure and function (Internal anatomy) breast composed of 3..
Internal Anatomy
Breast is composed of
* Glandular tissue
* Fibrous tissue including suspensory ligaments
* Adipose tissue
Glandular tissue contains 15 to 20 lobes radiating
from nipple, and these are composed of lobules
Bone function
Provides structure
Provides protection
Enables voluntary movement
Store minerals: calcium
Produce blood cells: hematopoiesis
senile
Neurologic changes related to aging
Probable decline in cranial nerve function
Senile tremors
- Benign: intention
- Dyskinesia: no rigidity; can’t really be controlled
Grip remains intact
Rapid alternating movements more difficulty to perform
DTRs less brisk
Generally, stronger stimuli may be needed to elicit response
Breasts inspection and palpation: general appearance, skin, lymphatic drainage areas, nipple
Note symmetry of size and shape: common to have slight asymmetry in size - often left slightly larger than right
Skin:
- normally smooth and of even color
- note any localized areas of redness, bulging, or dimpling; any lesions or focal vascular pattern
- fine blue vascular network visible during pregnancy; pale linear striae (stretch marks) follow pregnancy
- normally no edema present
Lymphatic drainage areas:
- observe axillary and supraclavicular regions; note bulging, discoloration, edema
Nipple:
- should be symmetrical on same plane
- usually protrude; some inverted or flat
- normal nipple inversion may be unilateral; can be pulled out
- note any dry scaling, fissure, ulceration, bleeding, discharge
3rd nipple is normal variation; along “milk line”
Signs and symptoms of breast cancer
- irregular shape
- firm to stony hard
- poorly defined (no clear margins)
- single in number
- fixed, nonmobile
- usually nontender, but can be tender
- positive skin retraction
- constant growth
Tools for neuro assessment
flashlight, cotton, object with sharp and dull sides, vibration (tuning) fork, reflex hammer
Site of most breast tumors
upper outer quadrant (Tail of spence)
Structure and function of the scrotum
- Loose protective sac; continuation of abdominal wall
- after adolescence: scrotal skin deeply pigmented and has large sebaceous follicles
- scrotal wall consists of thin skin lying in folds (rugae) and underlying cremaster muscle
- septum inside separates sac into halves; in each is a testis which produces sperm
Structure and function of breasts: Internal anatomy
- Breast is composed of:
– glandular tissue
– fibrous tissue including suspensory ligaments
– adipose tissue - Glandular tissue contains 15-20 lobes radiating from nipple; composed of lobules
Can be divided into 4 quadrants intersecting at nipple
- upper outer quadrant is site of most breast tumors
Musculoskeletal degenerative conditions: Osteoarthritis
Most common joint disease
Slowly progressive, non-inflammatory disorder
Cartilage damage
-Secondary synovitis
Aging women
Systemic and local signs and symptoms
What are differences between sensory and motor assessment in musculoskeletal
sensory checks “feeling” and motor checks “movement.”.
Spinal vertebrae
Cervical (C1-C7)
Thoracic (T1-T12)
Lumbar (L1-L5)
Sacral (S1-S5)
Coccyx
Cranial Nerve 3: What is it, function and assessment
Oculomotor (Motor)
* Pupil dilation and constriction
* PERRLA
Male Breast Exam
- completed with thorax exam
- inspect
- palpate nipple area
- palpate axillary lymph nodes
- Gynecomastia: growth of breast tissue, can occur during puberty - normal and temporary
- breast cancer in men is less than 1% worldwide (most often in older men)
