MS/CNs

Question 1

thoracic outlet syndrome

Answer 1

Compression of brachial plexus and subclavian vessels near the first rib, usually when arms are extended over head in superman position, - associated with proning

• “be certain pt can work or sleep with arms elevated over their head before putting arms beside head in prone positioning”

Question 2

Lithotomy Positioning ROM Qs

Answer 2

1. Lying supine, flex knee to chest/abdomen, check for flattening of lumbar spine
2. Lying supine, stabilize anterior superior iliac spine and abduct the extended leg until the iliac spine moves - find limit

Question 3

Cranial Nerve 1 Assessment

Answer 3

Cranial Nerve 1: Olfactory

Identify small with eyes closed

Question 4

Cranial Nerve 2 Assessment

Answer 4

Cranial Nerve 2: Optic

Assessment:

• Sight:
  
  • Confrontation Test
    
    • can indicate defects in visual field
    • pituitary tumor?
  • Pupillary Reaction to Light

Question 5

Cranial Nerve 3 Assessment:

Answer 5

Cranial Nerve 3: Oculomotor

“SO by 4, LR by 6, all others by 3.”

• 3: Pupillary reaction to light, occular movements

Question 6

Cranial Nerve 4 Assessment:

Answer 6

Cranial Nerve 4 Asessment: Trochlear

“SO by 4, LR by 6, all others by 3”

• SO4: Superior Obliqu
• Extraocular Movements
• Diagonal Motion

Question 7

Cranial Nerve 5 Asessment

Answer 7

Cranial Nerve 5: Trigeminal

“Muscles of Mastication”

• Motor: ask patient to clench his/her teeth as you palpate temptoral, masseter muscles.
• Sensory: check sensation in forehead, cheek, chin (V1, V2, V3)
• Corneal reflex

Question 8

Cranial Nerve 6 Assessment

Answer 8

Cranial Nerve 6: Abducens

“SO4 , LR 6, all others by 3”

• 6 = Lateral Rectus
• Extraoccular movements side to side

Question 9

Cranial Nerve 7 Assessment:

Answer 9

Cranial Nerve 7: Facial Nerve

Ask Patient To (Motor):

• Raise Both Eyebrows
• Frown
• Close eyes tightly so you can’t open them
• Show teeth
• Smile
• Puff Out Both Cheeks

Question 10

Cranial Nerve 8 Asssessment:

Answer 10

Cranial Nerve 8: Acoustic

Hearing

• usually done by audiology in depth

Question 11

Cranial Nerve 9 Assessment

Answer 11

Cranial Nerve 9 Assessment:

• Tested with cranial nerve 10
• Cranial Nerve 9: Glossopharyngeal Nerve
• Cranial Nerve 10: Vagus Nerve

Voice Hoarseness?

Gag Reflex

Phonation -> palate should rise rise symmetrically

Question 12

Cranial Nerve Assessment 11

Answer 12

Cranial Nerve 11: Spinal Accessory

• Ask patient to turn head against resistance
• Ask patient to shrug both shoulders upward against your hand

Question 13

Cranial Nerve 12 Assessment

Answer 13

Cranial Nerve 12: Hypoglossal

• tongue movement
• Ask them to move tongue side to side

Question 14

Important Sensory Dermatomes:

Answer 14

Important Sensory Dermatomes:

• T4 = Nipple Line
• T10 = umbilicus
• C8 = ring finger, pinky finger
• C6 = thumb

Question 15

Numbness in fingers is suspicious of

Answer 15

High spinal block

Question 16

Elbow flexion is

Answer 16

C5, C6

Question 17

Elbow Extension nerve

Answer 17

C5, C6, C7

Question 18

Grip is nerves

Answer 18

C7, C8, T1

Question 19

Finger Abduction is controlled by

Answer 19

C8, T1, Ulnar nerve

Question 20

Opposition of the thumb is contolled by

Answer 20

C8, T1, median nerve

Question 21

Hip Flexion and Adduction is controlled by

Answer 21

L2, L3, L4

Question 22

Hip Abduction is controlled by

Answer 22

L4, L5, S1

Question 23

Hip Extension is controlled by

Answer 23

S1

Question 24

Knee Extension is controlled by

Answer 24

L2, L3, L4

Question 25

Knee Flexion is controlled by

Answer 25

L4, L5, S1, S2

Question 26

Dorsiflexion is controlled by

Answer 26

L4, L5

Question 27

Plantar Flexion is controlled by

Answer 27

S1

Question 28

Glasgow Coma Scale Range

Answer 28

3 - 15 Less than 8 = severe coma. Require inubation for controlled ventilation, ICP control, airway control

Question 29

any patient who has received corticosteroid therapy (suppression of pituitary-adnreal axis) for at least one month **in the past 6-12 months**

Answer 29

needs exogenous supplementation during surgery

Question 30

MAO-Is:

Answer 30

Iproniazid, phenelzine, isocarboxazid, moclebmide, befloxatone, brofaromine, selegiline, trancycopramine. nardil, parnate, eldepryl, marplan

Question 31

_Indications for Methotrexate:_

Answer 31

_Indications for Methotrexate:_ Methotrexate: * Anti-Metabolite Drug, used as chemotherapy and immunosuppresant. * MS * Ankylosing Spondylitis * Rheumatoid Arthritis

Question 32

_Methotrexate SE:_

Answer 32

_Methotrexate SE:_ * Immunosuppresion * Anemia * Thrombocytopenia * Pulmonary Toxicity (8%) * Renal toxicity -\> usually permanent * Hepatotoxicity (can be reversible)

Question 33

_Things to Order for pts on methotrexate :_

Answer 33

_Things to Order for pts on methotrexate :_ * CBC * Chemistry Panels * Consider PFTs- pulm toxicity * LFTs - if history warrants it

Question 34

Common drugs for MS patients

Answer 34

1. Interferon B 2. NSAIDs for SE 3. Methotrexate 4. Steroids 5. \*Mitoxantrone

Question 35

Mitoxantrone

Answer 35

severe myelosuppresion and cardiac toxicity, reduced EF, may need echo work up. Similar to Adriomycin.

Question 36

Pergolide therapy in Parkinson's

Answer 36

**_Peroglide Therapy:_** * Older drug, caused a lot of cardiac valve problems, now off market. * must ask if pt has been on it previously * Aortic or mitral regurg?

Question 37

Co-Existing symptoms to evaluate in Ankylosing Spondylitis

Answer 37

_Co-Existing symptoms to evaluate in Ankylosing Spondylitis_ 1. Vasculitis 2. Aortitis 3. Aortic Insufficiency 4. Pulmonary Fibrosis 5. Severity of kyphosis