Full Exam Review Flashcards
Number of spinal nerves
31
Spinal nerve injury
Level of nerve and below will no longer work
SCAT
Sport Concussion Assessment Tool used as baseline prior to competitive sport
FAST
Face drooping, arm weakness, speech problems, time to call 911 for stroke (especially ischemic)
Requirements for neurological exam
Penlight, tongue blade, cotton swab, tuning fork, percussion hammer
Indicators for increased ICP
Falling pulse, rising BP, falling respirations, widening pulse pressure, and decreased O2 saturation
Coma according to GCS
Score of 8 or below
Receptive aphasia
- Language comprehension
- Wernicke’s area (temporal)
- Produced speech makes no sense/cannot write
- Patient is unaware of problem
Expressive aphasia
- Speech productive
- Broca’s area (frontal)
- Can understand but cannot produce
- Frustrating for patients
CN II lesion
Loss of direct light reflex
CN III lesion
Loss of consensual light reflex
Light reflex in blind patients
No constriction as without sensory input, there will be no motor response
Light reflex in unconscious
Should still be a response
Oculomotor/abducens/trochlear nerve tests
Hold up finger and have patient follow finger with eyes
Facial nerve motor function test
Raise eyebrows, frown, clench eyes, bare teeth, smile, puff out cheeks
Facial nerve sensory function test
Anterior 2/3 of tongue; lost with loss of motor function
Glossopharyngeal/vagus nerve motor function test
Aah uvula, palate rise, gag reflex
Glossopharyngeal/vagus nerve sensory function test
Posterior 1/3 of tongue
Spinal testing
Movement/power of arms/legs and for sensation (sharp/dull/vibration sensations) on skin of arms/legs
Tandem walking
Toe-to-heel; no need to look at feet or wobble
Romberg’s test
Close eyes and stand with feet together; will wobble with cerebellar injury
Pronator drift
Test for upper motor neurons
Tests for coordination/skilled movement
Rapid alternating movements, finger-to-finger, finger-to-nose, heel-to-shin
Reduced reflexes
Peripheral problem
Exaggerated reflexes
Central problem
Biceps reflex
C5/C6; depress biceps tendon
Brachioradialis reflex
C5/C6/C7; strike relaxed brachioradialis tendon
Triceps reflex
C6/C7/C8; strike triceps tendon with sharp end while forearm is hanging loose at right angle
Patellar reflex
L2/L3/L4; strike patellar tendon
Ankle jerk reflex
S1/S2; strike Achilles’ tendon of dorsiflexed foot
Abdominal reflex
Blunt object stroke from lateral to medial of all quadrants; supine and relaxed
Cremasteric reflex
Lightly stroke superior and medial part of thigh (male only)
Babinski reflex
L4 to S2; sole of foot stimulated with blunt instrument; CNS issues will fan toes if over 2 years of age; response is normal until age of 2
Paralysis
Decreased/loss motor nerve power due to problem with motor nerve/muscle fibres
Fasciculations
Rapid/continuous twitching of resting muscle that can be seen/palpated
Tic
Involuntary/compulsive/repetitive twitching of muscle group
Myoclonus
Rapid, sudden jerk at regular intervals.
Tremor
Involuntary contraction of opposing muscle groups; rhythmic back/forth movement of joint(s)
Limbic system response to trauma
Amygdala signal release of stress hormones
Brainstem response to trauma
Chronic arousal even without threat resulting in irritability/anger/insomnia, leading to chronic health problems
Delayed responses to trauma
Persistent fatigue, sleep disorders, nightmares, fear, anxiety, depression, emotional avoidance, sensations
Risk factors for PTS
Genetics, epigenetics, early life experiences, social disadvantage, trauma severity, community factors
Youth violence
10-29 years old; often in community settings between acquaintances/strangers; includes bullying and physical assault; gang violence
Prevalence of violence against women
1/3 women worldwide have been affected, usually by an intimate partner
Prevalence of elder abuse
1/6 people 60-years or older in community settings per year; 2 in 3 staff report they were abusive
Most common types of elder abuse
Psychological, then financial, neglect, physical, and sexual
Reporting elder abuse
Mandatory within long-term care home but not if victim lives in home
Social justice
Fair distribution of society’s benefits/responsibilities while eliminating root causes
Prevalence of poverty in Canada
1/7 Canadians live in poverty
Life expectancies between poorest and wealthiest community members
21-year difference
Distal (root) determinants of indigenous health
Residential schools, colonialism, Indian Act, and political decision-making
Intermediate determinants of indigenous health
Economic insecurity, racism, poverty, and inadequate housing
Proximal determinants of indigenous health
Addiction, heart disease, diabetes
Harm reduction
Practical strategies to help people lessen negative consequences of certain physical/social behaviours
High risk areas for skin conditions
HEENT, pressure areas
Melasma
Hyperpigmentation (especially upper lip and cheeks) occurring in pregnancy
Vernix caseosa
Waxy, cheese-like coating on skin of newborns
Mongolian spots
Pigmentation resembling bruising (not at top layer); common in dark-skinned babies
Stage 1 pressure ulcer
- Intact skin, non-blanchable redness of localized area
- Different colour
- Area may be painful/different temperature
Stage 2 pressure ulcer
- Partial thickness loss of dermis
- Shallow ulcer without slough or bruising
- Open/ruptured blister
Stage 3 pressure ulcer
- Full thickness tissue loss with slough
- May have visible subq fat
- May have undermining and tunneling
Stage 4 pressure ulcer
- Full thickness tissue loss with slough or eschar
- Exposed bone/tendon/muscle
- Undermining and tunneling
Calories during pregnancy
Extra 350 calories (2nd trimester), extra 450 calories (3rd trimester)
Veganism
May result in B12 and calcium deficiencies
Ketogenic diet
May result in acidosis, high cholesterol, constipation
Vitamin D with breastfeeding
400 IU/day
Amount of formula for babies
150 ml/kg/day
SCOFF questionnaire
Checks risk for eating disorders
Normal weight gain during pregnancy
11.5-16 kg
Oliguria
Decreased ability to form urine (< 400-500 mL/24 hr)
Dysuria
Pain with urination
Polyuria
Abnormally large quantity of urine (> 1 mL/kg/hr)
Diuresis
Artificially increasing excretion of urine
Average fluid loss for adult
1500-2800 mL per day
Clay-coloured stool
Malabsorption, hepatitis, gallbladder
Leukoplakia
Thickened white patch on tongue
Depapillated smooth tongue
Vitamin/iron deficiency
Pancreatic enzymes
Trypsin/chymotrypsin, amylase, lipase
Mini Mental State Exam
Not sensitive for vascular/mild dementia; developed for Alzheimer’s; 30 questions; arithmetic/memory/orientation; high score is better
Mini Cog
Remember 3 words/repeat them, draw clock with specific time, repeat 3 words; 1 point for each recalled word.
Montreal Cognitive Assessment (MoCA)
Detects cognitive impairment; 30 points; memory recall (STM and delayed) with nouns, visuospatial (CDT, cube), executive functions, attention/working memory (serial subtraction, sustained attention, digits forward/backward), language (naming 3 animals; syntactically-complex sentence repetition, fluency), orientation (time/date/city)
RUDAS
Designed to minimize effect of language/education/culture on cognitive assessments
ASEPTIC physical exam
Appearance, speech, emotion, perception, thought content/process, insight, cognition
Assessments for delirium
Confusion Assessment Method Instrument, I WATCH DEATH (causes)
