Exam 3 HA Flashcards
which cranial nerve is by report, ask if any problems w/ smell
CN I- Olfactory
which cranial nerve is handheld vision chart, read fine print
CN II- Optic
which cranial nerve is pupil size, reactivity (PERRLA aka pupils equal, round, reactive to light, accommodation)
CN II- Optic
which cranial nerve can be done with VI (abducens) and CN III occulomotor ..where you follow a finger with your eyes
CN IV- Trochlear
which cranial nerve tests for sensation (soft/sharp touch bilaterally)
CN V- Trigeminal
which cranial nerve is the 6 cardinal stages of gaze, often tests with CN IV and III
CN VI- Abducens
which cranial nerve is facial expressions where you wrinkle forehead, raise eyebrows, squeeze eyes shut, puff cheeks, smile, frown
CN VII- Facial
which cranial nerve is the whisper test
CN VIII- Acoustic
which cranial nerve is by report, ask if problems w/ taste or gag reflux
CN IX- Glossopharyngeal
which cranial nerve is the symmetrical rise & fall of uvula, able to swallow, no hoarseness
CN X- Vagus
which cranial nerve is the shoulder shrug, face push
CN XI- Spinal accessory
which cranial nerve is when the tongue is midline, move side to side
CN XII- Hypoglossal
How many pairs of spinal nerves are there
31 pairs
how does aging affect CNS?
-slower response delay
-slowing of cognitive ability
-diminished balance
-decreased reflexes
-decreased sedation overall
-decreased coordination
-delay synapse
what are signs of meningeal irritation? (spinal cord meninges / intracranial hemorrhage)
-Flexion of the knee when the leg is pulled up, pt will also have stiffness in neck (nuchal rigidity) w neck pain (kernig and brudzinski signs)
-photophobia
-headaches
-fever
What is Glasgow coma scale (GCS) used for? what are the 3 things it evaluates?
used for LOC on unconscious patient
- eye response (do their eyes respond to voice, pain, touch, nothing, etc)
- motor response (what movement do they make)
- verbal response (do they talk/nonverbal)
if a patient had a hip replacement, what should they not do when it comes to ROM? & why?
they should not test adduction or flexion greater than 90 degrees b/c it could cause dislocation
what is the area where two bones come together, what is it’s function
joint, provides mobility to the skeleton
these are synovial (diarthrotic) joints that are known as the hinge joints & only perform flexion and extension
knee and elbow
**extension - increases angle
**flexion- decreases angle between bone or brings bones together
these are synovial (diarthrotic) joints that are known as the ball and socket joints
hip & shoulder
these are synovial (diarthrotic) joints that are known as the pivot joints
***allows bone rotation about another bone
atlas & axis
**this is the 1st & 2nd cervical vertebrae directly under the skull… allows for turning of the head from side to side
these are synovial (diarthrotic) joints known as the condyloid joint
wrists
Condyloid joints perform flexion, extension, abduction, and adduction movements.
these are synovial (diarthrotic) joints known as saddle joint
thumb
these are synovial (diarthrotic) joints known as the gliding joints
intervertebral
**Gliding joints are numerous, mostly small, allow very little motion.
Ex: carpal joints of the wrist, the tarsal joints of the ankle, and the facet joints of the spine
circular motion that combines flexion, extension, abduction, and adduction
circumduction
movement of a part away from the center of the body
abduction
movement of a part toward the center of the body
adduction
decreases the angle between bones or bring bones together
flexion
increases the angle to a straight line or zero degrees
extension
type of flexion that is bending the ankle so that toes move toward the heel
dorsiflexion
type of flexion that moves the foot so that the toes move away from the heel
plantar flexion
Turing the sole of the foot inward
inversion
turning the sole of the foot outward
eversion
this area integrates understanding of spoken and written words, language is processed here in the temporal lobe/left hemisphere
wernicke area
this area regulates verbal expression and writing ability, the frontal lobe
broca area
broca vs wernicke
wernicke- integrates understanding of spoken and written words (language is processed).. temporal lobe/ left hemisphere
broca- regulates verbal expression and writing ability.. the frontal lobe
a pt w/ a stroke in the brain’s left hemisphere/temporal are more likely to have what?
damage to the wernicke area so will have language deficits- difficulty understanding verbal communication aka receptive aphasia
a pt that has damage to their Broca area (frontal lobe) causes what?
problems with speaking or finding words aka expressive aphasia
what is global aphasia
both expressive and receptive aphasia
CN I
-CN I Olfactory
-sense of smell
-sensory
CN II
-CN II Optic
-optic disc, vision acuity & peripheral vision
-sensory
CN III
-CN III Oculomotor
-eye movement
-motor
**performed with CN IV Trochlear, CN VI Abducens
CN IV
-CN IV Trochlear
-eye movement
-motor
**performed with CN III Oculomotor, CN VI Abducens
CN V
-CN V Trigeminal
-sharp/smooth sensation on face
-motor & sensory
CN VI
-CN VI Abducens
-eye movement
-motor
**performed with CN III Oculomotor, CN IV Trochlear, CN VI Abducens
CN VII
-CN VII Facial
-facial expressions
-sensory & motor
CN VIII
-CN VIII Acoustic
-hearing, whisper test
-sensory
CN IX
-CN IX Glossopharyngeal
-gag reflex, taste taste
-sensory & motor
CN X
-CN X Vagus
-rise/fall of uvula, able to swallow, no hoarseness
-sensory & motor
CN XI
-CN XI Spinal accessory
-shrug shoulders/push face
-motor
CN XII
-CN XII Hypoglossal
-move tongue side to side
-motor
what can cause herniation of the brain which can lead to change in basic vital functions such as breathing, reduced LOC, death
increases in CSF
if a pt had a stroke and you think they’re going through cerebellar herniation that affects the brain stem, what is the number 1 assessment?
priority assessment is RESPIRATORY! bc brain stem controls/is responsible for the respiratory center
a pt will not be able to cough or breathe on their own with this type of injury
C3 (cervical) injury
a pt will have arm movement and sensation, but no leg movement & will be in a wheelchair with this type of injury
T5 (thoracic) injury
a pt will have control of their legs and walk, but may have loss of bowel and bladder control with this type of injury
S4-5 (sacral) injury
Glasgow Coma Scale (GCS) Score
scores range from 3 (deep coma) to 15 (normal)
the test evaluates cortical sensory function and is not usually done. ask the pt to close the eyes and identify a familiar object (coin, key) placed in their palm
stereognosis
this test evaluates cortical sensory function and is not usually done. use a blunt object to trace a number on the patient’s palm. Ask the pt to identify which number has been traced
graphesthesia
How to rate DTRs
0 - 4
0 no response
1+ diminished, low normal
2+ average, normal
3+ brisker than average
4+ very brisk, hyperactive with clonus
**muscle strength is 0-5
How to assess bicep DTR
-Partially flex elbow and place palm down. to assist w/ relaxation, the pt can rest their arm on yours.
-Place 1 finger or thumb on biceps tendon & strike the finger or thumb w/ the reflex hammer.
-Observe flexion at elbow and contraction of bicep muscle
**if pt has diminished or absent results, ask pt to clench teeth or squeeze one hand tight w/ the opposite hand to aid in detection (reinforcement)
how to hold reflex hammer
loosely w/ 2-3 fingers
What do you do as a distraction technique for patellar reflex DTR?
ask pt to lock their fingers in front of the chest and one hand against the other (reinforcement)
what is an abnormal plantar reflex?
where the great toe extends upward and the other toes fan out aka a Babinksi sign when you start at the heel and go upwards
what are the 3 sinuses and how to evaluate them?
- frontal (forehead)
- ethmoid (next to nose)
- maxillary (near cheeks)
evaluate by looking for tenderness and pain at this sites
what separates the middle and external ear?
the tympanic ear drum
what is presbyopia
normal part of aging, far sighted vision so can’t see anything near so they need reading glasses (due to aging, happens later in life)
**hyperopia is also farsightedness (long life condition)
What do people w/ allergies might have a hx of?
frequent upper respiratory infections
**allergy people tend to get sick more frequently than non-allergy people
what are physical signs of dehydration
-dry skin
-cracked/dry lips
-increased HR
-lower B/P
signs of overhydration
-edema / puffiness
when doing an exam of upper respiratory on a person w/ a sore throat, what will you find?
hypertrophic tonsils (enlarged!)
what are the vision changes that are common w/ aging
-decreased depth perception
-decreased night vision
exposure to UV can cause this (foggy/cloudiness/dull), it obstructs light that is going through the eyes
cataracts
what test is when the tuning fork is placed behind the ear on the MASTOID PROCESS, evaluates AC & BC (AC should be twice as long as BC)
Rinne Test
what test is when the tuning fork goes on the middle of the head.. evaluates unilateral hearing loss.. determines if someones has SNHL or conductive HL
Weber Test
What can occur in a post op tonsillectomy pt? & how do we know this is happening?
-bleeding can occur
-we know this by seeing the pt swelling a lot, cleaning their throat, coughing/spitting/vomiting blood (hemoptysis)
What is the term for a pt without smell? What could be a cause of this?
-anosmia
-Covid could be the cause as well as chronic inflammation/infection or a tumor on the CN I Olfactory
How to assess the pupil
PERRLA
-Pupils are Equal, Round, Reactive to Light, Accommodating
what do you do first for a pt w/ a head injury?
Stabilize the C Spine
what is ataxia
irregular, uncoordinated gait
what is the term for loss of bone density
Osteoporosis
non-modifiable vs modifiable risk factors for osteoporosis
non-modifiable = old age, female gender, genetics/family hx
modifiable = diet (low calcium/vit D), no weight bearing activities, smoking, drinking alcohol 2+ more drinks a day, body frame
this is a bone density test for diagnosing osteoporosis
DEXA scan
how else can we document muscle strength besides 1-5 scale
Complete ROM against gravity and full resistance
This is what connects the muscle to the bone
tendon
What is the name of the fall risk scale?
Morse Palmer Scale
s shaped curvature of the spine
scoliosis
forward rounding of the back, which leads to a hunchback or slouching posture
Kyphosis , most common in the thoracic spine
This indicates turbulent blood flow, it’s not normal b/c it’s a blockage AKA stenosis
bruit/thrills
what is the term for lid lag
ptosis
What does it mean if a pt has 20/20 vision vs 20/40 vision?
20/20 vision can see the smallest print at 20 ft.
20/40 vision a person sees at 40ft what a normal person can see at 40ft
How many spinal nerves are there? What are the 5 regions?
31 spinal nerve pairs
- Cervical (C1-8)
- Thoracic (T1-12)
- Lumbar (L1-5)
- Sacral (S1-5)
- Coccygel (Co1)
what eye issues are more common in older adults?
-Cataracts
-Glaucoma
-Macular degeneration
this condition causes blurred distance and near vision
astigmatism
this condition is where your eyes make rapid, repetitive, uncontrolled movements
nystagmus
cloudiness in the lens may indicate what condition?
cataracts
this is used to test distance vision, most common eye exam
Snellen Chart
this is used to test near vision
Jaeger Chart
this is used to test color blindness
Ishihara cards
this is used to test peripheral vision
confrontation
what does it mean if a 60 year old pt has difficulty reading fine print
he has lost the ability to accommodate (contract the pupil for near vision).. this starts at 40 y/o & pts start using reading glasses
the term for unequal pupils
anisocoria (defect in oculomotor nerve)
this term is referred to as lazy eye
amblyopia
this term is referred to as eye strain
asthenopia
how to assess the eyes
PERRLA
this is nearsightedness aka can only see close up
myopia
this term is when eyes are cross eyed
Strabismus
this is the waxy substance in the ear
cerumen
2 ways sound is perceived
- Air conduction (normal pathway, through inner ear)
- Bone conduction (bypassing external ear & delivering sound directly to inner ear through the skull)
connective hearing loss vs sensorineural hearing loss
conductive- blockage in ear like cerumen, hearing loss can be reversed .. middle/external ear
sensorineural- due to loud noises, hearing loss can’t be reversed, inner ear
common causes of hearing loss in adults
-advanced age
-meniere disease
-hearing loss
-ototoxic meds (high dose aspirin, chemotherapy, strong diuretics)
-autoimmune inner ear disease
-noise exposure
these may indicate barotrauma from pressure changes or a basilar skull fracture
hemotympanum, otorrhea, or TM rupture
this is the sensation of the room spinning, indicates dysfunction of the bony labyrinth in the inner ear
vertigo
this is thought to be an inability to filter internal noise from the external input of sound.. ringing in the ear
tinnitus
swimmer’s ear
otitis externa, otalgia indicates ear dysfunction
this test evaluates high pitched hearing loss
whisper test
3 parts to the ear
external ear, middle ear, inner ear
this is the barrier between the external auditory canal & middle ear
Tympanic Membrane
what part of the ear contains the malleus, incus, and stapes
middle ear which conducts sound waves to the inner ear
what part of the ear translates sound to the nerves and brainstem
inner ear
these provide the body w/ proprioception and equilibrium
semicircular canals and vestibule
what are the 2 functions of the ear?
hearing & equilibrium
risk factors for hearing loss
family hx, frequent ear infections, use of certain medications, lack of immunizations, exposure to loud noises, exposure to smoke, allergies, airplane travel, diving, inappropriate celling of ears, age over 50
double vision
diplopia
dry mouth
xerostomia
loss of sense of smell
anosmia
difficulty swallowing, may occur w/ neurovascular disease or injury such as stroke
dysphagia
parts of the upper airway vs parts of the upper GI tract
upper airway: nose, sinuses, throat
upper GI tract: mouth & throat
most common site of anterior nosebleeds aka epistaxis
Kiesselbach plexus
most common site of oral cancer
pharyngeal fossa
this part of the mouth is a good location for absorption of sublingual meds
the highly vascular floor of the mouth
this is known as “sway back”, the spine is curved inward
Lordosis
how to test cerebellar function
-finger to nose
-heel to shin
-tandem walk
-pronator drift
what is the function of cerebellar function
-coordination of movement
also posture & balance, motor learning, muscle tone
age related neurological changes
-slower response
-depth perception impaired
-lack of movement
-slow cognitive ability
-less balance
-decreased sensation
-decreased coordination
warning s/s of spinal injury
-motor or sensory weakness
-bowel or bladder dysfunction
-pain of spine
-breathing issues
care after spine trauma
-immobilization
-bed rest
-blood thinners to prevent clots
-antibiotics to prevent UTIs
this is irregular gait…
what can cause this?
-ataxia is irregular gait
-can be caused by vestibular abnormality aka inflamed labyrinth which causes vertigo
this is caused primarily by brain edema, tumors, trauma
symptoms include mobility issues, severe case of this is stiff neck before going unconscious
cerebellar herniation
treatment of cerebellar herniation
oxygen therapy, antibiotics, steroids
risk factors for CVA (cerebrovascular accident) or Stroke
high bp
diabetes
hyperlipidemia
heart disease
smoking
age related musculoskeletal changes
-bones: less mass, less density
-joints: stiffer, less flexible
-muscles: loss of size & strength
infection that causes inflammation of the membranes that cover the brain and spinal cord
meningitis (headache, fever, back pain, stiff neck)
treatments- oxygen therapy, antibiotics, steroids
Morse fall risk scores
no risk 0-24
low risk 25-50
high risk greater than 51
stiff hunch back gait (ataxia)
propulsive
stiff, drags feet gait (ataxia)
spastic
knees and thighs cross or hit each other gait (ataxia)
scissoring
toes point down, foot scrapes gait (ataxia)
steppage
duck like gait (ataxia)
waddling
pain prevents normal movement, walk w/ a limp gait (ataxia)
antalgic
feet slide gait (ataxia)
shuffle
type of fracture that is small or stress fx
hairline fx
type of fracture that does not break skin
closed fx
type of fracture that bone breaks the skin
Open / compound fx
type of fracture when a tendon or ligament pulls a small piece of bone away
avulsion fx
type of fx that breaks in 2 places leaving a piece floating
segmental fx
type of fracture that is a break in 3 or more pieces
comminuted fx
type of fracture where bone is crushed
compression fx
type of fracture that is a diagonal break
oblique fx
type of fracture that breaks spiral around the bone, twisting
spiral fx
type of fx that is straight line break
transverse fx
type of fx that is incomplete break when one side breaks while the other bends
greenstick fx
hearing is based on what 2 things
frequency and intensity
intentional vs resting tremors
intentional - worse w/ movement, better at resting
resting tremor - Parkinson’s , tremors get better w/ movement.. worse w/ rest
significant changes w/ someone who has a change in neurological status?
-changes of LOC: confusion, lethargy, coma, drowsiness
-AMS: disorientation, delirium, cognitive impairment, aphasia
-changes in motor function: weakness/paralysis, ataxia (irregular gait), loss of balance
-sensory changes: numbness, tingly, visual changes, hearing loss, altered smell/taste
-behavioral changes: irritation, agitation aggression
-signs of increased intracranial pressure (ICP): headache, n/v, pupil changes, Cushing’s triad aka hypertension, bradycardia, irregular respiration.. LATE sign
-seizure activity
-vital sign change is LATE sign
what causes ptosis?
-stroke, MS
lack of normal muscle tone/ strength
atony
diminished tone (elders)
hypotonicity
hypertonic, stiff
spasticity
sudden, violent involuntary contraction
spasm
involuntary twitching
fasciculation
involuntary/ voluntary contraction
tremor
high pressure in eye, causes tunnel vision, damage to optic nerve
glaucoma
