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NM703 Primary Care of the Woman > Module 8 - Neuro & Musculoskeletal > Flashcards

Module 8 - Neuro & Musculoskeletal Flashcards

1
Q

What is BPPV?

A

Benign Paroxysmal Positional Vertigo - a syndrome that may be a manifestation of several varied inner ear conditions. ** Occurs with position change.

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2
Q

What does the Hallpike-dix maneuver test for?30-45 degrees

How is it done?

A

Nystagmus.

  1. 1st check pt for spontaneous nystagmus while seated.
  2. Next, bring the pt quickly back to recumbent or supine position with head extended 30-45 degrees over table and tilted 30-45 degrees to one side.
  3. Repeat above two times - once with head to right and once with head to left.
  4. Observe the pt for latency, duration, direction, and fatifability of nystagmus in supine and upright position.
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3
Q

If nystagmus is vertical or torsional in nature and lasts less than 30 sec. it is consistent with a:

A

posterior semicircular canal variant

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4
Q

If nystagmus is direction and horizontal (beating toward ground) and lasts about 1 min. it is consistent with a:

A

horizontal canal variant

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5
Q

Vertigo that is spontaneous (not position related) and the presence of focal neurologic findings suggest a:

A

central etiology

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6
Q

BPPV can be confirmed by ____________ and a ____________ Hallpike-dix test result.

A

history; postitive

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7
Q

When the Hallpike-dix test is positive if ____________ is characteristic and _________ and ________ are elicited with the affected ear _________.

A

nystagmus; dizziness, vertigo; down.

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8
Q

Symptom of vertigo is differentiated from sycope or disequilibrium by careful ____________.

A

history.

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9
Q

Treatment for BPPV are typically ____________ maneuvers.

A

postional (liberatory maneuvers and physical therapy interventions

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10
Q

Describe Epley’s manuever

A

Moving the patient from one head-hanging positon to another. Must not lie flat for 48-72 hours following.

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11
Q

Meniere’s is a ___________ condition of the inner ear characterized by ___________ _________ and _____________ ___________.

A

chronic; recurrent vertigo, hearing loss

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12
Q

Four sx assoc with Meniere’s:

A
  1. spinning vertigo/dizziness
  2. sensorineural hearing loss
  3. tinnitus
  4. feeling of fullness in affected ear
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13
Q

Weber test result in Meniere’s? Rinne result?

A

Sound will lateralize to the unaffected ear.

air conduction will be greater than bone conduction.

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14
Q

Should Meniere’s pt be referred?

A

Yes

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15
Q

Definitive dx for Meniere’s requires ________ episodes of spontaneous vertigo lasting __________min., _______________ documented _________ ________ and _____________ or aural ______________. With the exclusion of other causes.

A

2; 20min; audiometrically, hearing loss; tinnitus, fullness

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16
Q

Tension headache: bilateral or unilateral, pulsating or nonpulsating?

A

bilateral, nonpulsating

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17
Q

Is bell’s palsy unilateral or bilateral facial paralysis?

A

unilateral

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18
Q

Which cranial nerve is affected with Bell’s?

A

VII

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19
Q

Bell’s has acute onset with max paralysis in ____ to _____ _______.

A

48-72 hours

20
Q

Bell’s pt may have altered _________ and sensitivity to _________.

A

taste; sound

21
Q

Bell’s palsy is a common neuropathy with __________ disease.

A

Lyme

22
Q

T/F

Bell’s is more common in pregnancy.

A

True

23
Q

Prevention of _____ ___________ is the most important goal in Bell’s.

A

eye injury

24
Q

In Bell’s, ____________ _____________ can cause blindness. To prevent administer ______________ bid and ___________ at HS.

A

exposure keratitis; methylcellulose; ocular lubricant

25
Q

What med is recommended for all Bell’s pts? Dose?

A

Prednisone 60-80mg/day for 1 wk with tapered dose 2nd week

26
Q

What med should be added if Bell’s is severe? dose?

What for pain?

A

Valcyclovir 1000mg TID

NSAIDs

27
Q

Recovery time for Bell’s? at most?

A

4-6months; 12 at most

28
Q

Bell’s and pregnancy.

A

Referral should be considered

29
Q

What disorders should be referred to neuro?

A

Trigeminal neuralgia, meningitis

30
Q

Things to look for in meningitis:

A

nuchal rigidity, brudzinki’s , kernig

31
Q

meds for exposure to meningitis:

A

rifampin, cipro

32
Q

Minor MSK injuries:

RICE

A

Rest
Ice
Compression
Elevation

33
Q

Carpal tunnel results from entrapment of the _________ nerve in the carpal tunnel of the wrist.

A

median

34
Q

Most useful clinical test for carpal tunnel?

A

Phalen’s test

35
Q

First line tx for carpal tunnel

A

night time splinting

36
Q

If night time splinting with addl conservative modality is ineffective :

A

Single injection of methylprednisolone 40mg

37
Q

Bursitis is a pathologic _____________ disorder of the _______.

A

inflammatory; bursae

38
Q

Common features of bursitis:

A

pain at motion and at rest; regional loss of ROM; visible swelling; tenderness to palpation

39
Q

Most common type of bursitis? Who is most commonly affected?

A

Subacromial; older adults secondary to overuse and throwing athletes <25

40
Q

The _________ and ___________ inpingement signs are the most sensitive and specific for subacromial bursitis.

A

Neer and Hawkins

41
Q

Management of bursitis?

A

Gentle ROM joint activities, avoid exacerbating activities, NSAIDs. DO NOT IMMOBILIZE!
For severe cases: corticosteroid injections - limited to 3 injections in 12 months at least 30 days apart.

42
Q

What does Lachman test assess? How is it done?

A

ACL; flex knee 15-30degrees, one hand below knee joint on posterior tib-fib and other hand on ant femur. Lift up on lower leg while pushing down on upper leg. IF ACL is intact should feel a knock or firm stop.

43
Q

What does McMurray test? how?

A

For tears in cartilage/meniscus. Flex the knee while rotating the tibia internally and externally on the femur, then while flexing and externally rotating the leg apply valgus stress on the joint while extending leg and palpating medial joint line. If click or pop is heard or felt the medial meniscus is torn.

44
Q

Thessaly test is for ___________ and is done with pt _________.

A

meniscus tears; standing.

45
Q

What is most common depressive disorder?

How is it dx?

A
  • DSM-5 Major Depressive Disorder (MDD)
  • Must have 5 sx in a 2wk timeframe
  • Must have one of the following: depressed mood or loss of interest or pleasure
  • Other sx for the five: weight change, inability to concentrate, agitation or lethargy, recurrent thoughts of death, feelings of guilt or worthlessness

NM703 Primary Care of the Woman (5 decks)

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