Neuro/Breast Flashcards
The Central Nervous System (CNS) consists of the
Brain and spinal cord
The Peripheral Nervous System (PNS) consists of
12 cranial nerves
31 pairs of spinal nerves
Autonomic Nervous System (ANS)
Somatic Nervous System (SNS)
Sympathetic vs. parasympathetic?
Sympathetic –> Fight or Flight
Parasympathetic –> Rest & Digest
What is the function of the somatic nervous system?
Voluntary Control of Movements
What does the frontal lobe do?
Primary Motor Cortex, Personality, Behavior, Emotion, Intellect, Skilled Movement
What does the temporal lobe do?
Sounds (Perception & Interpretation), Smell
What does the parietal lobe do?
Processes sensory data
What does the occipital lobe do?
Visual Cortex & Interpretation of Visual Data
What is Broca’s area and what happens when there is a deficit to the region?
Broca’s Area –> Frontal Lobe, Left Side, Speech & Motor
Deficit to Broca’s Region (i.e. Stroke) –> Broca’s Aphasia=Paraphasia –> Person can Hear and Comprehend words but is unable to speak correctly. Incoherent words are substituted.
What is Wernike’s area and what happens when there is a deficit to the region?
Wernike’s Area –> Temporal Lobe, Left Side, Language & Comprehension
Deficit to Wernike’s Region –> Wernike’s Aphasia (AKA Receptive Aphasia) –> Person has difficulty understanding written or spoken language.
Word salad.
What is the thalamus?
The brain’s relay station
What is the hypothalamus?
The body’s thermostat. Maintains homeostasis.
What does the cerebellum control?
Coordination, Equilibrium, Posture, and Position Sense
What does the brainstem regulate?
Heart rate, breathing, and swallowing.
Where do the cranial nerves originate from?
Brainstem
What can happen if the brainstem is damaged?
Can lose the airway very quickly.
The CNS pathway has a _____________ representation.
Crossed
Left cerebral cortex receives sensory data from and controls the right side motor function.
Right cerebral cortex receives sensory data from and controls left side motor function.
What does the descending tract control and which way does it move?
Motor and DOWN to the body
What does the ascending tract control and which way does it move?
Sensory and UP to the brain
Afferent vs. Efferent
Afferent - Sensory Towards Brain
Efferent - Motor Away from Brain
VEMDAS
Ventral –> Efferent –> Motor —> Dorsal –> Afferent –> Sensory
Deep tendon reflex
Muscle tendon
Lower extremities- Patellar, Achilles, and Hamstring
Upper extremities- Triceps, Biceps, and Brachioradialis
Superficial reflex
Abdominal, Corneal (CN 5&7), Cremasteric (L1/2)
Visceral reflex
Pupillary reflex to light
PERRLA
Pathologic reflex
Plantar reflex –> Babinski Sign –> Fanning of toes –> positive up to age 24 months
If positive after 24 months = damage to brainstem
Normal plantar reflex is downgoing on toes.
Paresthesia
Abnormal Sensation
Loss of SENSORY Function
Paralysis
Loss of MOTOR Function
Paresis
Partial or Incomplete Paralysis (i.e. Hemiparesis)
Paraphasia
Person can Hear and Comprehend words but is unable to speak correctly. Incoherent words are substituted.
Ex: Stroke Broca’s Aphasia
ETOH can cause neuro defects. Why?
CNS depressant
Leads to impairment
Examples: Alcoholic Neuropathy, Wernicke’s Encephalopathy, Korsakoff’s Psychosis
Street drugs cause
Altered mental status
CNS depressants
Barbiturates, Benzodiazepines
CNS stimulants
Cocaine, Methamphetamines
What are ADL’s and some examples?
Activities of Daily Living
Feeding
Continence
Transferring
Toileting
Dressing
Bathing
What are iADL’s and some examples?
Instrumental Activities of Daily Living
Using the telephone
Shopping
Preparing Food
Housekeeping
Doing Laundry
Using Transportation
Handling Medications
Handling Finances
When is the mental status assessment completed?
Throughout the exam
ANO x3
Alert and Oriented (Person, place, and time)
MMSE
Mini Mental State Examination
What are the five levels of consciousness?
Alert
Lethargy
Obtunded
Stuporous
Comatose
Patient is able to look and fully respond to stimuli. LOC is __________.
Alert
Patient is drowsy, but opens eyes. Responds to questions then falls asleep. LOC is __________.
Lethargy
Patient opens eyes, responds slowly, and is somewhat confused. LOC is __________.
Obtunded
Patient arouses from sleep after painful stimuli (Ex: sternum rub). Verbal responses are slow or absent. Lapses into unresponsive state after stimuli. LOC is __________.
Stuporous
Patient remains unarousable with eyes closed even with painful stimuli. LOC is __________.
Comatose
Cranial Nerves 1-12
Only Owls Observe Them Traveling And Finding Voldemort Guarding Very Secret Horcruxes.
Some Say Marry Money But My Brother Says Big Butts Matter Most.
What is the Snellen chart used for?
To assess distance vision
If the patient normally wears glasses or contact lenses, then this test should be assessed both with and without their vision aids.
What is the Rosenbaum chart used for?
To assess near vision
Patient holds 14” from eyes
What is visual inattention?
When testing peripheral vision, you move both fingers to see if patient can identify that it is happening.
Normal inattention –> Patient can identify that both fingers are wiggling
Cranial nerves 3, 4, & 6 ….
Make the eyes do tricks
What muscles does CN 3 control?
Oculomotor controls Superior Rectus, Inferior Oblique, Inferior Rectus, Medial Rectus (All other Movements)
What muscles does CN 4 control?
Trochlear controls Superior Oblique ONLY –> Moves eyes inferior & medial (down & in)
What muscles does CN 6 control?
Abducens controls Lateral Rectus ONLY –> Moves eyes laterally
How do you perform Romberg’s Test and what constitutes a (+) Romberg’s Test?
Have patient stand with their feet together, eyes open, and then closed. Does the patient sway?
Positive test is when patient begins to sway which indicates cerebellar ataxia, vestibular dysfunction, sensory loss. Little bit of sway is normal.
Muscular Response - Grading
Grade 0- No contraction detected
Grade 1- Barely detectable flicker or trace of contraction
Grade 2- Active movement with gravity eliminated
Grade 3- Active movement against gravity
Grade 4- Active movement against gravity and some resistance
Grade 5- Active movement against gravity and resistance without evident fatigue/Normal
What is the Jendrassik Maneuver?
Distractive technique- Patient locks fingers together and pulls hard as you tap the quadriceps tendon.
How do you properly grade Muscle Reflexes?
0- Absent
1- Diminished Reflexes
2- Normal
3- Hyperactive without Clonus
4- Hyperactive with Clonus
What type of reflex is the Abdominal Cutaneous Reflex?
Superficial Neurological Reflex
What is graphesthesia?
The ability to recognize numbers/symbols when traced on skin.
What are significant changes in a patient’s neuro status?
EMERGENCY SITUATIONS
Acute change in mental status –> Sub Dural Hematoma/Epidural Hematoma, Stroke, ICP, etc.
Seizure activity –> Patient Safety
Onset of posturing –> Head Injury, Brain Injury
Change in reactivity or size of pupils –> Brain Injury
Progressing weakness or paralysis –> Cord Injury
Changes in vital signs –> related to Neuro related Brainstem Injury, ICP, etc.
What is the Glascow Coma scale?
Objective assessment that defines the level of consciousness.
Less than 8 –> Intubate
Cannot be lower than 3 –> THERE IS NO GCS of 0
Highest is 15 = normal
What is FAST?
Face drooping, Arm weakness, Speech difficulty, Time to Call 911
Time = Brain
It is important to know Prioritization –> Stroke Alert –> Prep the patient for a CT Scan to evaluate for Stroke.
What are the types of Ischemic stroke?
Thrombotic (plaque formation) and embolic (traveling clot)
What is a Hemorrhagic stroke?
Results from acute rupture and bleeding from a weakened artery in the brain.
TPA (clot buster) will kill this patient.
What stroke symptoms resolve on their own?
TIA (Transient ischemic attack, mini-stroke)
NIHSS Score
0 No stroke
0-4 Minor stroke
5-15 Moderate stroke
16-20 Moderate to Severe stroke
21-42 Severe stroke
Which cranial nerve is affected with Bell’s Palsy?
CN VII - Facial
Stroke vs. Bell’s Palsy
Stroke spares the eyes
Bell’s Palsy - all motor
What causes a subdural hematoma?
Head trauma (likely from a fall) that causes the rupture of the bridging veins.
Who is more susceptible for a subdural hematoma?
The elderly and alcoholics
What causes an epidural hematoma?
Skull fracture from blunt trauma which causes a laceration of arterial vessels, most commonly in the middle meningeal artery.
Keep this patient awake. You do not want them to pass out a second time.
What does decorticate posturing look like and where is the injury?
DeCortiCate –> Arms move towards the core
CGS 3 –> Damage to Spinal Tract (Lateral Corticospinal Tract) or Cerebral Hemisphere
What does decerebrate posturing look like and where is the injury?
DEcErEbratE –> Arms move Away from the core
GCS 2 –> Caused by Brainstem Damage at the Midbrain or Pons (HIGHER UP)
Which is more severe - bacterial meningitis or viral meningitits?
Bacterial meningitis
What are the two signs that indicate the presence of meningitis?
Kernig’s Sign (Extend Knee) - A sign indicating the presence of meningitis
Brudzinski’s Sign (Flex Neck) - Severe neck stiffness causes a patient’s hips and knees to flex when the neck is flexed.
What motor track disorder causes resting tremors, bradykinesia, cogwheel rigidity, loss of balance, anxiety & depression, urinary incontinence, and widespread cognitive impariment?
Parkinson’s Disease
Is cognition impairment a normal part of aging?
NO!
Identify what is normal & abnormal for the aging woman.
Normal: Estrogen and progesterone decreases, breast glandular tissue atrophies, decreased breast size and elasticity, inner structures more prominent, and axillary hair decreases.
Abnormal: Unilateral or bilateral retraction
Are lymph nodes palpable?
Not usually
Is some tenderness expected high in the axilla?
Yes
Physical signs associated with more advanced cancer
BREAST
Breast mass
Retraction
Edema
Axillary mass
Scaly nipple
Tender breast
What are modifiable risk factors for breast cancer?
-Nulliparity or first child after 30 y/o
-Current oral contraceptive use
-Long-term use of HRT
-Not breast feeding
-Alcohol intake 2-5 drinks daily
-Obesity & BMI (especially after menopause)
-Physical inactivity
What are non-modifiable risk factors for breast cancer?
**First-degree relatives of BC patients who were diagnosed premenopausal and had bilateral disease have the greatest risk of developing breast cancer
-Female > 50y/o
-Personal history
-BRCA1 or BRCA2 gene mutation
-History of hyperplasia on biopsy
-Previous breast irradiation
-Menarche before 12 y/o
-Menopause after 50 y/o
-White Race
A breast lump that is painful/tender, round, mobile is __________.
benign
A breast lump that is non-tender, irregular shaped, firm, w/ skin retraction is associated with __________.
cancer
What can breast cancer look and feel like?
Think about the lemons!
Thick mass, indentation, skin erosion, redness or heat, new fluid, dimpling, bump, growing vein, retracted nipple, new shape/size, orange peel skin, invisible lump
What is a specific rule that applies to post-mastectomy patients?
No blood pressure or needle sticks in the affected limp.
Patient will typically have a “limb alert” bracelet.
A benign growth of male breast tissue is known as _________.
Gynecomastia
The pleural space beneath the lungs where there is a potential to abnormally fill with fluid or air and compromise lung expansion
Costodiaphragmatic recess
What is the functional respiratory unit called?
Acinus
Where does gas exchange occur?
Alveoli
What are the four major functions of the respiratory system?
- Supplying oxygen to the body for energy production
- Removing carbon dioxide as a waste product of energy reactions
- Maintaining homeostasis (acid/base balance)
- Maintaining heat exchange
Air rushes into the lungs by __________.
Inspiration
Air is expelled and the chest recoils by __________.
Expirations
What questions do you ask about smoking when collecting data from the patient?
Do you smoke? How many cigarettes do you smoke a day? How long have you been smoking? This gives us pack years.
Remember to ask about e-cigs or vaping, and chewing tobacco.
What is the AT:P ratio of the thorax in a normal, healthy patient?
1:2
The transverse diameter is approximately 2x the AP diameter.
What does an AT:P ratio of 1:1 indicate?
Barrel chest
A sunken sternum or funnel chest is called __________.
Pectus Excavatum
Forward protrusion of the sternum is called __________.
Pectus Carinatum
What does crepitus feel like?
Rice Krispies
What is tactile fremitus?
The palpable vibration of the chest wall when a patient speaks
Tactile fremitus will be more pronounced with __________ __________ and will be decreased with __________ __________.
Tactile fremitus will be more pronounced with lung consolidation and will be decreased with pleural effusion.
Lung consolidation occurs when
the normally air-filled lung is engorged with fluid or tissue.
Fluid collects in the space between the lung and chest wall, displacing the lung upward in
Pleural effusion
What are the different categories of sounds you hear when percussing the intercostal spaces?
Resonant- clear, long low-pitched sounds (normal & healthy)
Dull- short, high-pitched, thudding sounds (fluid or masses in lungs)
Hyperresonant- louder and longer, low-pitched sound (air-trapping, emphysema)
What is the Greek Key Pattern?
During auscultation, use the diaphragm of the stethoscope. Patient breathes through mouth deeper than normal. Listen for one full breath cycle at each spot. Start at apices, side to side comparison.
What is the sound, location, and quality of normal breath sounds?
Tracheal- Heard over trachea, harsh & high-pitched
Bronchial- Heard next to trachea, Loud & High-pitched
Bronchovesicular- Heard Between scapula & Medium loudness & pitch
Vesicular- Heard over most of the lung fields & Soft & low pitched.
What are adventitious sounds?
Added sounds that are heard in addition to usual breath sounds
Examples of adventitious sounds
Crackles, rhonchi, wheeze, and stridor
Describe crackles (rales)
May be fine, medium, or coarse; caused by fluid in lower airways; generally not cleared with cough; heard during inspiration. Sounds like rubbing hair between your fingers.
End of slurpee
Describe rhonchi
Loud, low coarse noises heard during inspiration and expiration; goes away with cough
Describe wheeze
High-pitched, musical noise that may be heard during inspiration and expiration, most louder on expiration; caused by high velocity airflow through a narrowed airway
Describe stridor
an inspiratory wheeze associated with upper airway obstruction
EMERGENCY Patient is losing airway.
Normal respiratory rate
12-20
Bradypnea
Rate <12
Tachypnea
Rate >20
Hyperventalation
Respiratory rate and depth increase
Sighing
Frequently interspersed deeper breath
Apnea
Cessation of breathing
Atelectasis
Partial or complete collapse of lung
Bronchitis
Infection of the trachea and larger bronchi
Acute or chronic
Emphysema
Hyperinflated lungs
Blue bloater
Chronic Bronchitis
Pink Puffer
Emphysema
When the lining of the lungs become inflamed due to a pulmonary infection is called __________.
Pleurisy
Inflammatory response to an infective agent
Pneumonia
What are the objective signs of Pneumothorax?
Definition: Air in the pleural cavity, resulting in lung collapse
Unequal chest expansion
Tachypnea, cyanosis, and apprehension may occur
Tracheal Deviation (shift) to opposite site
Breath sounds decreased or absent
Asthma
Allergic hypersensitivity to certain inhaled allergens, irritants, microbes, stress, or exercise
Bronchospasm and inflammation
Wheezing, dyspnea and chest tightness
Should you be concerned if the patient has absent breath sounds when wheezes were previously heard?
Yes. This is a raised concern.
What tool prevents lung consolidation/pnuemonia?
Incentive Spirometer (IS = I Suck, No inhaling)
What is a Peak Flow Meter used for?
Monitor pulmonary function in asthmas patients
Patient inhales deeply and then exhales as quick as possible.
What are the signs of Hypoxia?
Restlessness (#1/early sign)
Decreased LOC or AMS
Clubbing (Chronic/late sign)
