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MS1 Fall > ICM 1 - Exam 3 > Flashcards

ICM 1 - Exam 3 Flashcards

1
Q

What is the fundamental optical principle?

A

Refractive errors are corrected with divergent (minus) lenses or convergent (plus) lenses

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2
Q

If you see this, what disease/condition should you be concerned about?

A

Diabetic retinopathy

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3
Q

What three tests can assess a patient’s coordination?

A

Finger to nose and back

Heel to shin (heel to opposite knee and down the shin to the big toe)

Heel to toe walking

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4
Q

The biceps reflex tests what spinal nerves?

A

C5-6

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5
Q

How do you test CN X?

A

Make sure their uvula isn’t deviated to one side when the mouth is open

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6
Q

From 6 months to 11 months, what should a child be able to do as far as language development?

A

Understand no, babble, try to repeat sounds and communicate with gestures and actions

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7
Q

From 2-3 years old, what should a child be able to do as far as language development?

A

Knows some spatial concepts and descriptive words; speaks in 2-3 word phrases; says around 40 words at 24 months

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8
Q

How do you test CN III, IV, and VI?

A

Drawing an “H” and having the person follow with their eyes and then testing convergence

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9
Q

Foot dorsiflexion: muscle and nerve

A

Tibialis anterior

Deep peroneal nerve - L4, L5

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10
Q

What is personal fable?

A

The story adolescents tell themselves that emphasizes their uniqueness and invulnerability

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11
Q

How do you test CN II?

A

Inspect fundi (light shining), test visual acuity (look at finger and then over shoulder), and by screening visual fields

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12
Q

What color is white matter on CT?

A

Dark gray

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13
Q

What stage of Erikson’s model of psychosocial development is found in emerging adulthood?

A

Intimacy vs. isolation

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14
Q

Foot plantar flexion: muscle and nerve

A

Gastrocnemius & soleus

Tibial nerve- S1, S2

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15
Q

Three elements of consciousness?

A
  1. Arousal
  2. Alertness
  3. Awareness
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16
Q

Wrist extension: muscle and nerve

A

Extensor carpi radialis

Radial nerve - C6-C8

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17
Q

What are three ways you can measure intraocular pressure?

A
  1. Tonopen
  2. Schiotz tonometer
  3. Fingers (high pressures will feel hard instead of spongy)
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18
Q

What is adolescent egocentrism?

A

The belief that an adolescent’s thoughts and ideas are unique and are not understood by others

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19
Q

What three gait tests can you assess in otherwise intact people?

A
  1. Walk across the room
  2. Walk heel-to-toe
  3. Walk on toes then on heels
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20
Q

Three important neurological questions to remember when examining a patient?

A
  1. Is the mental status in tact?
  2. Are the findings symmetric?
  3. If the findings are asymmetric or abnormal does the cause lie in the CNS or PNS?
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21
Q

How do you assess attention and concentration?

A

WORLD backward, serial 7s from 100, months of the year backward

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22
Q

What tool allows you to perform the posterior segment eye exam?

A

The direct ophthalmoscope

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23
Q

What two cognitive capabilities do teens develop?

A
  1. Hypothetic-deductive reasoning: whats used in science
  2. Reflective abstraction: ability to rearrange and rethink information already acquired
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24
Q

The triceps reflex tests what spinal nerves?

A

C6-7

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25
Q

What are the three levels of Kohlberg’s moral development?

A
  1. Pre-conventional morality (reasoning tied to personal concerns)
  2. Conventional morality (reasoning tied to societal concerns)
  3. Post-conventional morality (reasoning is greater that following social norms)
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26
Q

What set of traits and behaviors comprise grit?

A

goal-directedness, motivation, self-control, positive (growth) mindset

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27
Q

What are the disadvantages of noncontrast CT for brain imaging?

A

Small lesions may not be seen, anatomy detail for small structures is limited (i.e. pituitary, sinuses, larynx, etc)

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28
Q

What stain can help you visualize corneal abrasions?

A

Fluorescein

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29
Q

What is clonus?

A

Hyperactive response required for assigning a reflex grade of 4. Usually elicited at the ankle

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30
Q

What are the dimensions of development?

A

Physical growth and motor skills, temperament, cognition and intelligence, language, social relations and attachment

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31
Q

If you see this, what disease/condition should you be concerned about?

A

Optic nerve pallor

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32
Q

If you see this, what disease/condition should you be concerned about?

A

Rheumatoid arthritis, Wegener’s

(“cornea melted”)

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33
Q

How can you tell the difference between Bell’s Palsy (lesion affecting the brain stem) and a stroke (lesion affecting the brain)?

A

In Bell’s Palsy the patient will have a drooped eyebrow, inability to close their eye, flat nasolabial fold, and paralysis of the lower face

In a stroke the other hemisphere can make up for some of the deficits so the patient will be able to close their eyes with some weakness, be able to raise their eyebrows, but have a flat nasolabial fold

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34
Q

Who coined the stages of psychosocial development?

A

Erikson

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35
Q

How do you test CN IX?

A

Have the patient open and say “ah,” and then assess their soft palate/arches on either side of the uvula for symmetry

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36
Q

What is myopia?

A

Nearsightedness

Can focus up close but not far away; image is focused in front of the retina

Eye is too long or cornea/lens is too strong

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37
Q

If you see this, what disease/condition should you be concerned about?

A

Scleromalacia - rheumatoid arthritis

(“scleral melting”)

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38
Q

By what age should a child’s speech be 100% intelligible?

A

4 years old

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39
Q

What are the “ophthalmic vital signs”?

A

visual acuity and intraocular pressure

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40
Q

What test is used to assess temperament?

A

the marshmallow test

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41
Q

For motor skills, what are the shapes a child should be able to draw and the corresponding ages?

A

Circle - 3

Cross - 4

Square - 5

Triangle - 6

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42
Q

How do you test CN XI?

A

Shoulder shrug against resistance, turning head against resistance

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43
Q

If you see this, what disease/condition should you be concerned about?

A

Iritis - autoimmune disease

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44
Q

How does a subdural hematoma appear on noncontrast CT?

A

Crescent shape, crosses sutures in the calvarium

Note: venous hemorrhage

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45
Q

What disease processes can effect cranial nerve function?

A

stroke, tumor, neuromuscular disease

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46
Q

Grip: spinal nerve #s

A

C7-T1

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47
Q

What CNs arise from the midbrain?

A

II, III, IV

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48
Q

What is imaginary audience?

A

Characteristic of adolescents’ self-consciousness, involving the feelings that people are watching their every move

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49
Q

If you see this, what disease/condition should you be concerned about?

A

Arcus senilis - hyperlipidemia

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50
Q

Elbow flexion: muscle and nerve

A

Mostly biceps

Musculocutaneous nerve - C5 and C6

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51
Q

What is a growth mindset?

A

Something that is developed through hard work and practice

Students with it view challenges as an opportunity to grow, learn from criticism, see mistakes as learning opportunities, keep going when things get difficult, etc

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52
Q

What color is gray matter on CT?

A

light gray

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53
Q

Which is higher risk: epidural or subdural hematoma?

A

Epidural

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54
Q

How do you assess recent & remote memory?

A

Tell the patient three words, distract them, then ask them to remember the words

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55
Q

If you see this, what disease/condition should you be concerned about?

A

Familial colon cancer

(“bear track”)

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56
Q

What sensations are assessed during a sensory exam?

A

Light touch, pinprick, vibration, position sense (proprioception)

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57
Q

What are you doing during confrontational field testing?

A

Checking peripheral vision by having the patient (and yourself) cover one eye. Hold fingers in each quadrant and determine if the patient can see them

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58
Q

What four things must you consider when performing a posterior segment exam on the eye?

A
  1. Patient must be looking 20 feet or farther away (point of no confrontation)
  2. Room must be dark
  3. You need to be on the same horizontal plane as the patient
  4. Don’t block the patient’s face (otherwise pupil will constrict due to convergence and accommodation)
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59
Q

What stage of Erikson’s model of psychosocial development are adolescents in?

A

Identity vs. Role Confusion

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60
Q

If a patient has a barely detectable flicker/trace of contraction in their muscle, what grade would you give them on the muscle strength scale?

A

1/5

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61
Q

What CNs arise from the medulla?

A

CN VIII (1/2), IX, X, XI, XII

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62
Q

When is a head CT with contrast used?

A

To evaluate arterial anatomy (aneurysms, stroke), tumor, and infection

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63
Q

What are some recent concerns related to social development?

A

Over-programming of children’s lives, social media (lack of in-person contact), focus on competition, lack of time

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64
Q

If you see this, what disease/condition should you be concerned about?

A

Endocarditis

(“roth spots”)

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65
Q

If you shine light into an eye and the pupil dilates, what does this tell you?

A

There is a cranial nerve defect in this eye

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66
Q

What is the most-common screening tool for the brain?

A

non-contrast CT

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67
Q

Thumb opposition: muscle and nerve

A

Opponens pollicis

Median nerve - C8, T1

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68
Q

What are the stags of Piaget’s cognitive development model?

A
  1. Sensorimotor (birth to 2; object permanence)
  2. Pre-operational (2-7; egocentric stage, lacks object conservation)
  3. Concrete operational (7-11; intro to logical thinking)
  4. Formal operational (11+ abstract thinking)
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69
Q

What are the advantages of non-contrast CT for brain imaging?

A

Fast scanning time, anatomic detail of the brain & calvarium, no real contraindications

70
Q

Knee extension: muscle and nerve

A

Quadriceps

Femoral nerve - L2, L3, L4

71
Q

What are the four childhood attachment patterns?

A
  1. Secure attachment
  2. Avoidant attachment
  3. Ambivalent attachment
  4. Disorganized attachment
72
Q

What scale is used to assess coma?

A

Glasgow scale (remember: would drink too much scotch in Scotland and end up in a coma)

73
Q

Which wing of the sphenoid bone houses the optic canal?

A

The lesser wing

74
Q

From 12 months to 17 months, what should a child be able to do as far as language development?

A

Follows simple directions, answers simple questions nonverbally

75
Q

How do you assess orientation?

A

Ask person, place, and time PPT

76
Q

What nerve senses that your eye is dry and relays that information to the lacrimal gland?

A

CN V1

77
Q

If you see this, what disease/condition should you be concerned about?

A

Alport syndrome/renal failure

78
Q

If you see this, what disease/condition should you be concerned about?

A

Sturge-Weber syndrome

79
Q

Finger spreading: muscle and nerve

A

Mostly dorsal interossei Ulnar nerve - C8, T1

80
Q

What is grit?

A

Persistence over time to overcome challenges and accomplish goals Might determine how we react to failure and how resilient we are in ties of adversity

81
Q

What is separation-individuation?

A

A process by which children learn to identify the boundaries between self and caretaker, and negotiate a balance between attachment and independence Margaret Mahler

82
Q

What are the adolescent stages?

A

Early adolescence: 11-14 Late adolescence: 15-18 Extended adolescence/emerging adulthood: 19-25

83
Q

The ankle reflex tests what spinal nerve?

A

Primarily S1

84
Q

What would we expect to see on a sagittal MRI of a patient with MS?

A

“Dawson’s fingers”

85
Q

What is a clique?

A

Small groups of 5-7 good friends; identified by interests and social status

86
Q

Shoulder abduction: muscle and nerve

A

Mostly deltoids Axillary nerve - C5

87
Q

If you see this, what disease/condition should you be concerned about?

A

Chorodial metastasis - breast/lung cancer

88
Q

What is a crowd?

A

Larger group that includes several cliques; membership based on reputation, stereotype Ex: jocks, nerds, preps

89
Q

What color is acute blood on CT?

A

bright!

90
Q

What type of lens corrects myopia?

A

Divergent/concave lens

91
Q

From birth to 5 months, what should a child be able to do as far as language development?

A

React to loud sounds and turn their heads toward the source

92
Q

What imaging modalities are used to the see the brain?

A

CT, MRI, and others like PET, nuclear medicine, and ultrasound

93
Q

Knee flexion: muscle and nerve

A

Hamstrings Sciatic nerve - L1, S1, S2

94
Q

What type of lens will correct an astigmatism?

A

A lens made opposite to the cornea

95
Q

What CNs arise from the pons?

A

V, VI, VII, VIII (1/2)

96
Q

What hormones increase around 8-9 to stimulate puberty?

A

Growth hormone and thyroxine

97
Q

The brachioradialis reflex tests what spinal nerves?

A

C5-6

98
Q

The plantar response (Babinski) primarily tests what spinal nerves?

A

L5 - S1

99
Q

What is temperament? What are the clusters of temperament?

A

Biologically-based individual differences in emotion, motor activity, and self-regulation Clusters: easy, difficult, and slow-to-warm-up

100
Q

What spaces in the brain are filled with CSF?

A

Ventricles (4), cisterns, fissures, and sulci

101
Q

What score range is considered normal on the mini mental status examination (MMSE)?

A

24 out of 30 or higher

102
Q

What is a standard measurement of visual acuity?

A

20/20 style ratio i.e. 20/60 means that you see at 20 feet what a patient with normal vision sees at 60

103
Q

What structure focuses majority (2/3) of the light coming into your eye?

A

The cornea (the lens does the remaining 1/3)

104
Q

How do you test CN VII?

A

Ask the patient to smile, frown, puff their cheeks, raise eyebrows, and close their eyes tightly (won’t let you open when you try!)

105
Q

Elbow extension: muscle and nerve

A

Triceps Radial nerve - C6-C8

106
Q

What is the Romberg test? Describe it

A

A test of a position sense The patient stands with their feet close together and eyes open and then closes them for 30 - 60 seconds without support Normal result should be minimal swaying. Ataxia or loss of balance is a positive Romberg sign

107
Q

What direction does CN IV move the eye?

A

Medially and downward

108
Q

What direction does CN VI move the eye?

A

Laterally

109
Q

What is accommodation?

A

The ability of the lens to change focus

110
Q

What is normal intraocular pressure (IOP)?

A

11 - 21

111
Q

What is the DENVER II Developmental Screening Test used for?

A

To provide age ranges of normal appearance of various milestones up until 6 years old Ex: fine motor, gross motor, language, and social contact

112
Q

How can you measure visual acuity?

A

Have the patient stand 20 feet from the letter sign, count fingers, see hand motions, or do light perception only/no light perception

113
Q

What are the folds of the cerebral cortex called?

A

Gryus

114
Q

What is emmetropia?

A

Perfect focus on the retina

115
Q

How can you find the optic nerve in the eye?

A

Find a large vessel and follow it; it will slope down into the optic nerve

116
Q

How do you assess tone during a PNS exam?

A

Passively flexing and extending the neck, elbows, and knees

117
Q

How does an epidural hematoma appear on noncontrast CT?

A

Lens shaped, does not cross suture lines Note: arterial hemorrhage (middle meningeal artery) usually related to blunt force trauma to the head

118
Q

What is hyperopia?

A

Farsightedness Can see far away but not up close; image is focused behind the retina Eye is too short or cornea/lens is too weak

119
Q

From 18 months to 23 months, what should a child be able to do as far as language development?

A

Says 8 to 10 words, understands simple words, likes being read to

120
Q

What should you note when assessing a person’s natural gait?

A

speed, stride length, arm swing, and turns

121
Q

Changes in what two areas of the brain impact behavior in adolescence?

A

Prefrontal cortex and the amygdala

122
Q

What are the disadvantages of brain MRI?

A

Claustrophobia, patient unable to tolerate longer scan time, cardiac pacemakers

123
Q

What kind of diseases affect gait?

A

stroke, neuromuscular (i.e. muscular dystrophy), movement disorders (i.e. Parkinson’s)

124
Q

How do you test CN XII?

A

Have the patient stick out their tongue and assess for any deviations

125
Q

What kind of diseases affect coordination?

A

stroke (CVA), cerebellar atrophy, MS, dementia, Parkinson’s (or other movement disorder)

126
Q

How are reflexes graded? What is normal on this scale?

A

0 - 4 Normal is 2/4

127
Q

What is the mini-cog screen?

A
  1. Ask the patient to remember 3 words
  2. Ask the patient to draw a clock and set the time to 10 after 11
  3. After drawing the clock ask them to recall the three words (good for dementia screening)
128
Q

What are peer relationships like in adolescence?

A

Fewer “best friends” than kids, intimacy & loyalty are important, friends are similar or get more similar

129
Q

How will a sulcus appear on CT?

A

Bright white because it has CSF fluid

130
Q

If you see this, what disease/condition should you be concerned about?

A

Kaposi’s sarcoma - AIDS

131
Q

Which eye muscles control extorsion and intorsion?

A

The obliques

132
Q

Hip flexion: muscle and nerve

A

Iliopsoas Femoral nerve - L1, L2

133
Q

What makes you more myopic in darkness?

A

The fact that your peripheral lens is more rounded/stronger

134
Q

If a patient can only move against gravity, what grade on the muscle strength scale would you give them?

A

3/5 (this means a piece of paper would make their arms drop)

135
Q

If you see this, what disease/condition should you be concerned about?

A

Band keratopathy - gout, hypercalcemia

136
Q

How do you test CN VIII?

A

Ask the patient to close their eyes and rub your fingers outside of each ear

137
Q

How do you test CN V?

A

Light touch on forehead, cheeks, and jaw (hitting V1, V2, and V3) Palpation of muscles of mastication while tensed

138
Q

How can you perform a mental status exam on a normal patient?

A

Through basic observation and conversation

139
Q

What is an astigmatism?

A

Eye (cornea) is not perfectly spherical; more egg or football shaped Never gives a sharp focus

140
Q

If you see this, what disease/condition should you be concerned about?

A

Hypertensive retinopathy

141
Q

What is the basis of Erikson’s psychosocial development?

A

Major themes in each phase have to be successfully negotiated. Outcome of prior phases influences how a person masters the next level Ex: Intimacy vs. isolation in adulthood

142
Q

When is an MRI of the brain used?

A

For tumor, infection, stroke, demyelinating disease, seizure

143
Q

If you see this, what disease/condition should you be concerned about?

A

Optic disc swelling

144
Q

What type of lens corrects hyperopia?

A

Convex/convergent lens

145
Q

What is Marcia’s theory of identity development?

A

The balance between exploration and commitment in exploring roles and identity in adolescence

146
Q

If you see this, what disease/condition should you be concerned about?

A

Subluxed cataract - Marfan’s syndrome

147
Q

What is noncontrast CT good for catching?

A

Hemorrhage and fractures

148
Q

What kind of diseases affect sensation?

A

Stroke, peripheral neuropathy, compression neuropathy, radiculopathy

149
Q

How close do you need to be to a patient’s eye with the direct ophthalmoscope to properly visualize the structures?

A

one inch

150
Q

What is presbyopia?

A

The loss of accommodation (usually gone by age 65) With age, the lens loses the ability to change shape. The ciliary muscle contracts more and we experience eye pain/strain when things are up close

151
Q

What kind of stimulus do you need to remember to give during a sensory exam?

A

A null stimulus

152
Q

The knee reflex tests what spinal nerves?

A

L2-4

153
Q

How is strength assessed (scale)? What is normal on this scale?

A

0 - 5 5/5 is normal. This means the patient can overcome your opposing movement

154
Q

Why do we screen for breast cancer?

A

It provides the greatest mortality reduction

Regular mammographic screening leads to the greatest reduction in deaths

155
Q

What are the ACR/SBI breast cancer screening guidelines for AVERAGE risk women?

A

Begin screening at 40 and then screen annual thereafter

156
Q

What are the ACR/SBI breast cancer screening guidelines for HIGH risk women?

A

Begin screening 10 years arlier than the youngest affected relative OR at age 30 - whichever age is later

Screen annually thereafter

157
Q

Women with a greater than 20% lifetime risk of breast cancer are elligible for what additional screen with their mammography?

A

MRI

158
Q

When should breast cancer screening cease?

A

When life expectancy is less than 5-7 years due to comorbid conditions

or when abnormal results would not be acted on due to comorbid conditions

159
Q

Who is at high risk for breast cancer?

A

Anyone with greater than 20% lifetime risk of breast cancer (based on family history, clinical factors)

Those with gene mutations or those of Ashkenazi Jewish descent

160
Q

What are gene mutations related to breast cancer?

A

BRAC1, BRAC2, CHEK2, P53, STK11, PTEN

161
Q

What views are taken during a screening mammogram?

A
  1. Craniocaudal view (CC) - compression plane is transaxial
  2. Medial lateral oblique view (MLO) - compression plan parallels the course of the pectoralis muscle
162
Q

How do you know you’re looking at a CC vs. an MLO view of a mammogram?

A

If you can see the pectoralis muscle then its an MLO view

163
Q

What is the difference between a screening exam for breast cancer and a diagnostic exam?

A

Screening exams are performed on asymptomatic females. They get two views done, leave the imaging center, and get a report within 30 days

Diagnostic exams are performed on patients with problems (mass, discharge, pain) or as follow-ups/additional imaging requests. Can include additional views or an US. Patient sees the breast radiologist before leaving the center

164
Q

What are you looking for on a mammogram?

A

Masses

Asymmetry

Calcifications

Distortion

165
Q

Is breast ultrasound used as part of screening?

A

No, only as part of a diagnostic exam

166
Q

What is the initial breast imaging study of choice for patients under 30?

A

Ultrasound

167
Q

What type of imaging is ALWAYS performed on a patient who presents with a palpable mass in their breast?

A

An ultrasound

168
Q

When is a breast MRI used?

A

In screening for high risk patients

Patients with biopsy-provden invasive ductal carcinoma or invasive lobular carcinoma

169
Q

What scale is used for breast imaging assessment?

A

BIRADS

170
Q

What portion of the BIRADs scale is related to screening only? To diagnosis only?

A

Screening: 0 - 2

Diagnostic: 3 - 6

171
Q

What is each level of the BIRADs scale?

A

0 = incomplete. Additional imaging needed (screening mammograms only)

1 = negative/normal breasts

2 = benign (no additional workup needed)

3 = probably benign (short-interval follow up recommended) Less than 2% malignancy

4 = suspicious (biopsy recommended - subdivided into 4a, 4b, and 4c) malignancy risk 2% to 95%

5 = highly suggestive of malignancy (biopsy or surgery recommended). Malignancy risk greater than 95%

6 = Known malignancy (biopsy-proven, treatment plan in place already)

MS1 Fall (23 decks)

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