Mental Status/Neurologic Exam/Pelvic/Peds/Geriatric Flashcards
Can evaluate this with the MMSE:
Cognitive Abilities
Ability to draw clock, A/O x4?
cognitive abilities
crying, depression, bipolar
Emotional Stability
repeating words, word salads, made-up words
Speech and language skills
Making up words just for yourself
Neologisms
Takes you 20 minutes to tell something very simple, round about way of explanation
Circumlocution
What are signs and symptoms of Wernickes?
Patient doesn’t realize they have a disorder, words don’t make sense together, nonsensical, neologisms, motor skills are perfect
What are the sign and symptoms of Brocas?
They know they have a problem, broken production of speech, takes them a long time, still in sensical words.
A/O x 4?
person, place, time, event
Limitation of the MMSE?
only checks cognitive abilities, ie. slowly progressing Dementia
5 areas tested on MMSE?
orientation (what times is it?), registration (3 words), attention and calculation (count backwards from 100 by 7), recall (3 words later), language (point to a pencil, what is this?)
Maximum score of the MMSE?
30 (24-26 are a positive screen)
Drawing 2 pentagrams test what?
Tests language (following directions)
Where is the motor cortex located?
Frontal Lobe
Where is proprioception processed?
Parietal Lobe
Postive Babinski sign shows a problem in which motor neuron?
Upper
Dysarthria
difficult or labored speech, listen for when testing Hypoglossal nerve (12)
Superficial reflex to evaluate T12, L1 and L2 spinal nerves
Cremasteric reflex in males
Superficial reflex to evaluate T8-T10 spinal nerves
upper abdominal reflex
Superficial reflex to evaluate T10-T12 spinal nerves
lower abdominal reflexes
Abnormal response to plantar reflex?
Babinski = dorsiflexing. Unless under 2 years of age
Where are you more likely to feel the 2 points as separate?
Finger tips easier than back
Sustained clonus is a sign of?
Upper Motor Neuron Disease
Difference between delirium and dementia?
Delerium can be acute, dementia cannot (is progressive). Delerium more perception, dementia more confusion.
Difference between Stupor or Lethargy?
Stupor responds to pain or verbal, where as lethargy respond appropriately when aroused. Stupor both slow to respond and doesn’t to 4 questions. Lethargy answers questions but slowly.
Absence of reflexes
Areflexia, may also indicate neuropathy
Total number of deliveries (not babies) after 20 weeks
Parity (twins are 1)
Total number of pregnancies (regardless of when, where, etc)
Gravida
Easily irritated or inflamed cervical tissue
Friable cervix
Chadwick’s sign
Bluish color in cervix which is a sign of increased vascularity, appears 8-12 weeks
Until which age do you measure head circumference?
2 years
At which age do you start taking BPs in kids?
3 years
At which age do you start testing vision?
3 years
At which age do you switch to BMI?
2 years
Screen for specific developmental milestones?
9, 18, 30 months
When should the posterior fontanelle close?
2 months
When should the anterior fontanelle close?
9-18 months
When should primitive reflexes be gone?
by 6 months
What is the cerebrum responsible for?
Higher order thinking (general movement, visceral functions, perception, behavior) Contains the frontal, parietal, occipital, temporal lobes.
What is the cerebellum responsible for?
Works with the motor cortex (located in frontal lobe) and processes sensory info and sends it to cerebrum. Does fine muscle control, balance, posture.
What does the frontal lobe do?
contains motor cortex, and is associated with voluntary skeletal movement and fine repetitive motor movements. Also, executive functions, thinking, planning. Contains prefrontal cortex.
What kind of symptoms would you expect with someone with prefrontal cortex damage? Think Phineas Gage…
Can’t control behavior, has outbursts, is impulsive, lack of social norms.
What does the parietal lobe do?
Perception - making sense of the world.Visual, gustatory, olfactory, auditory, proprioception.
Which lobe is the primary vision center?
Occipital lobe
Which lobe is responsible for the interpretation of sounds?
Temporal lobe
If damage to Temporal lobe and Wernicke’s area, which symptom may you except from a patient?
Fluent aphasia. aka Sensory aphasia. Produce speech without grammatical error, but cannot comprehend (speaking russian)
Name all the cranial nerves in order I-XII:
Olfactory, Optic, Oculomotor, Trochlear, Trigeminal, Abducens, Facial, Acoustic (vestibulocochlear), Glossopharyngeal, Vagus, Spinal Accessory, Hypoglossal
Which cranial nerves are classified as strictly sensory?
Olfactory (smell), optic (sight), acoustic (hear)
Which cranial nerves are classified as motor?
Oculomotor (eye moves), Trochlear (eye moves), Abducens (eye moves), Facial (face moves), Spinal Accessory (turn head, shrug) , Hypoglossal (tongue moves)
Which cranial nerves are both motor and sensory?
Trigeminal (jaw moves and eye and face feels), Facial (mostly motor), Glossopharyngeal (swallowing and gag reflex), Vagus (peristalsis, heart and senses behind ear)
Which spinal tract carry info from the external environment?
Ascending tract
Which spinal tract conveys impulses to various muscle groups, control muscle tone, posture and precise movements?
Descending tract
What structures receive info for the various dermatomes?
the sensory and motor fibers of the sensory nerves
A patient is believed to have a motor neuron disorder and is symptomatic on the contralateral (opposite) side. Which Type?
Upper Motor Neuron above the brainstem. (if below the brainstem then same side)
A cervix that points anteriorly is positioned how?
Retroverted
A cervix that points posteriorly is positioned?
Anteverted
If the cervix appears pale, that could be a sign that the patient is?
anemic
What type of pressure is applied when inserting the spec?
downward
Swelling, redness, or tenderness of the labia majora may indicate;
infection of the Bartholin’s glands.
Friable cervix
red patchy ares, granular areas, and white patches that could indicate cervicitis, infection or carcinoma
The normal texture of the vaginal walls in a premenopausal women
Rugae
When can a cystocele or rectocele be visible on pelvic exam?
when the patient “bears down”
After 2 attempts in 2 positions to feel for the fundus of the uterus, and you didn’t, you could assume the uterus is in which position?
midline
If unable to palpate adnexa on vaginal bimanual exam, when should you try to locate them again?
During the rectovaginal exam
An uterus palpable during the rectovaginal exam is in what position?
retroverted
A woman who has been pregnant more than once
multigravida
uterine descent
when the cervix itself protrudes out of the vaginal opening
inside out vagina
vaginal prolapse
Why are young women more likely to get HPV?
Because transition zone is still ectropic (not turned in) and is an area of actively growing cells and prone to become cancerous
Cervical motion tenderness
pain elicited when the cervix is manipulated. Suggests inflammatory process or ectopic pregnancy
5 components of pediatric exam?
nutritional, elimination, development, immunization, sleep
4 things you check on a newborn visit:
weight, heart, jaundice, metabolic screen
Amount of days babies take to regain birthweight:
10-14 days
Muscle tone of a “floppy baby”:
hypotonic
Muscle tone of a baby whose legs are hard to spread agart?
Hypertonic
Rooting reflex
stroke perioral skin at the corners of the mouth
Palmar grasp
baby will flex all fingers to grab on
Plantar grasp
Toes curl around
Moro (startle) reflex
arms with abduct and extend, hands open, legs flexed
Placing/Stepping reflex
sole touch ground and hip and knee will flex upward and other foot will step forward
Truncal Incarvation (galant’s reflex)
in prone position, spine will curve to stroked side
Asymmetric tonic neck reflex
turn head to the side and arm and leg from that side will extend and the opposite side will flex
Cephalohematoma
within periosteum of bone and cannot cross the midline. Does not involved blood. Usually result of birth trauma, usually benign.
Caput succedaneum
can cross the midline
frontal bossing
premature closing of suture lines
Anticipatory guidance
educating parents on the development and growth of their child.
Hemangiomas are usually resolved within
1 year
Flat, blue, or gray skin markings near the buttocks, back, and shoulders
Mongolian spots
esotropia
one eye looks in
exotropia
one eye looks out
hypertropia
looks up
hypotropia
looks down
IADLs
instrumental activities of daily living - higher level of functioning: telephoning, shopping, cooking, finances, taking meds. Poor scores on IADLs indicate independence is eroding and may need more help or move to a home
ADLs
basic activities required of adults to be independent - arising, continence, dressing, eating, etc.
Functional Assessment
takes 45 minutes, includes comprehensive history, physical exam, and social assessment
Hippocratic facies
the face of someone who is chronically ill (hollowing of the cheeks, loss of muscle tone)
What are the 3 things associated with the alcohol stigmata?
palmar erythema, gynecomastia in males, and testicular atrophy in males
