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Health Assessment > Neuro/Breast > Flashcards

Neuro/Breast Flashcards

1
Q

The Central Nervous System (CNS) consists of the

A

Brain and spinal cord

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2
Q

The Peripheral Nervous System (PNS) consists of

A

12 cranial nerves
31 pairs of spinal nerves
Autonomic Nervous System (ANS)
Somatic Nervous System (SNS)

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3
Q

Sympathetic vs. parasympathetic?

A

Sympathetic –> Fight or Flight
Parasympathetic –> Rest & Digest

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4
Q

What is the function of the somatic nervous system?

A

Voluntary Control of Movements

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5
Q

What does the frontal lobe do?

A

Primary Motor Cortex, Personality, Behavior, Emotion, Intellect, Skilled Movement

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6
Q

What does the temporal lobe do?

A

Sounds (Perception & Interpretation), Smell

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7
Q

What does the parietal lobe do?

A

Processes sensory data

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8
Q

What does the occipital lobe do?

A

Visual Cortex & Interpretation of Visual Data

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9
Q

What is Broca’s area and what happens when there is a deficit to the region?

A

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.

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10
Q

What is Wernike’s area and what happens when there is a deficit to the region?

A

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.

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11
Q

What is the thalamus?

A

The brain’s relay station

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12
Q

What is the hypothalamus?

A

The body’s thermostat. Maintains homeostasis.

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13
Q

What does the cerebellum control?

A

Coordination, Equilibrium, Posture, and Position Sense

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14
Q

What does the brainstem regulate?

A

Heart rate, breathing, and swallowing.

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15
Q

Where do the cranial nerves originate from?

A

Brainstem

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16
Q

What can happen if the brainstem is damaged?

A

Can lose the airway very quickly.

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17
Q

The CNS pathway has a _____________ representation.

A

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.

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18
Q

What does the descending tract control and which way does it move?

A

Motor and DOWN to the body

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19
Q

What does the ascending tract control and which way does it move?

A

Sensory and UP to the brain

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20
Q

Afferent vs. Efferent

A

Afferent - Sensory Towards Brain
Efferent - Motor Away from Brain

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21
Q

VEMDAS

A

Ventral –> Efferent –> Motor —> Dorsal –> Afferent –> Sensory

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22
Q

Deep tendon reflex

A

Muscle tendon

Lower extremities- Patellar, Achilles, and Hamstring
Upper extremities- Triceps, Biceps, and Brachioradialis

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23
Q

Superficial reflex

A

Abdominal, Corneal (CN 5&7), Cremasteric (L1/2)

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24
Q

Visceral reflex

A

Pupillary reflex to light

PERRLA

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25
Q

Pathologic reflex

A

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.

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26
Q

Paresthesia

A

Abnormal Sensation

Loss of SENSORY Function

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27
Q

Paralysis

A

Loss of MOTOR Function

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28
Q

Paresis

A

Partial or Incomplete Paralysis (i.e. Hemiparesis)

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29
Q

Paraphasia

A

Person can Hear and Comprehend words but is unable to speak correctly. Incoherent words are substituted.

Ex: Stroke Broca’s Aphasia

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30
Q

ETOH can cause neuro defects. Why?

A

CNS depressant

Leads to impairment

Examples: Alcoholic Neuropathy, Wernicke’s Encephalopathy, Korsakoff’s Psychosis

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31
Q

Street drugs cause

A

Altered mental status

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32
Q

CNS depressants

A

Barbiturates, Benzodiazepines

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33
Q

CNS stimulants

A

Cocaine, Methamphetamines

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34
Q

What are ADL’s and some examples?

A

Activities of Daily Living

Feeding
Continence
Transferring
Toileting
Dressing
Bathing

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35
Q

What are iADL’s and some examples?

A

Instrumental Activities of Daily Living

Using the telephone
Shopping
Preparing Food
Housekeeping
Doing Laundry
Using Transportation
Handling Medications
Handling Finances

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36
Q

When is the mental status assessment completed?

A

Throughout the exam

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37
Q

ANO x3

A

Alert and Oriented (Person, place, and time)

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38
Q

MMSE

A

Mini Mental State Examination

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39
Q

What are the five levels of consciousness?

A

Alert
Lethargy
Obtunded
Stuporous
Comatose

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40
Q

Patient is able to look and fully respond to stimuli. LOC is __________.

A

Alert

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41
Q

Patient is drowsy, but opens eyes. Responds to questions then falls asleep. LOC is __________.

A

Lethargy

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42
Q

Patient opens eyes, responds slowly, and is somewhat confused. LOC is __________.

A

Obtunded

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43
Q

Patient arouses from sleep after painful stimuli (Ex: sternum rub). Verbal responses are slow or absent. Lapses into unresponsive state after stimuli. LOC is __________.

A

Stuporous

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44
Q

Patient remains unarousable with eyes closed even with painful stimuli. LOC is __________.

A

Comatose

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45
Q

Cranial Nerves 1-12

A

Only Owls Observe Them Traveling And Finding Voldemort Guarding Very Secret Horcruxes.

Some Say Marry Money But My Brother Says Big Butts Matter Most.

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46
Q

What is the Snellen chart used for?

A

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.

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47
Q

What is the Rosenbaum chart used for?

A

To assess near vision

Patient holds 14” from eyes

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48
Q

What is visual inattention?

A

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

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49
Q

Cranial nerves 3, 4, & 6 ….

A

Make the eyes do tricks

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50
Q

What muscles does CN 3 control?

A

Oculomotor controls Superior Rectus, Inferior Oblique, Inferior Rectus, Medial Rectus (All other Movements)

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51
Q

What muscles does CN 4 control?

A

Trochlear controls Superior Oblique ONLY –> Moves eyes inferior & medial (down & in)

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52
Q

What muscles does CN 6 control?

A

Abducens controls Lateral Rectus ONLY –> Moves eyes laterally

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53
Q

How do you perform Romberg’s Test and what constitutes a (+) Romberg’s Test?

A

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.

54
Q

Muscular Response - Grading

A

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

55
Q

What is the Jendrassik Maneuver?

A

Distractive technique- Patient locks fingers together and pulls hard as you tap the quadriceps tendon.

56
Q

How do you properly grade Muscle Reflexes?

A

0- Absent
1- Diminished Reflexes
2- Normal
3- Hyperactive without Clonus
4- Hyperactive with Clonus

57
Q

What type of reflex is the Abdominal Cutaneous Reflex?

A

Superficial Neurological Reflex

58
Q

What is graphesthesia?

A

The ability to recognize numbers/symbols when traced on skin.

59
Q

What are significant changes in a patient’s neuro status?

A

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.

60
Q

What is the Glascow Coma scale?

A

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

61
Q

What is FAST?

A

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.

62
Q

What are the types of Ischemic stroke?

A

Thrombotic (plaque formation) and embolic (traveling clot)

63
Q

What is a Hemorrhagic stroke?

A

Results from acute rupture and bleeding from a weakened artery in the brain.

TPA (clot buster) will kill this patient.

64
Q

What stroke symptoms resolve on their own?

A

TIA (Transient ischemic attack, mini-stroke)

65
Q

NIHSS Score

A

0 No stroke
0-4 Minor stroke
5-15 Moderate stroke
16-20 Moderate to Severe stroke
21-42 Severe stroke

66
Q

Which cranial nerve is affected with Bell’s Palsy?

A

CN VII - Facial

67
Q

Stroke vs. Bell’s Palsy

A

Stroke spares the eyes

Bell’s Palsy - all motor

68
Q

What causes a subdural hematoma?

A

Head trauma (likely from a fall) that causes the rupture of the bridging veins.

69
Q

Who is more susceptible for a subdural hematoma?

A

The elderly and alcoholics

70
Q

What causes an epidural hematoma?

A

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.

71
Q

What does decorticate posturing look like and where is the injury?

A

DeCortiCate –> Arms move towards the core

CGS 3 –> Damage to Spinal Tract (Lateral Corticospinal Tract) or Cerebral Hemisphere

72
Q

What does decerebrate posturing look like and where is the injury?

A

DEcErEbratE –> Arms move Away from the core

GCS 2 –> Caused by Brainstem Damage at the Midbrain or Pons (HIGHER UP)

73
Q

Which is more severe - bacterial meningitis or viral meningitits?

A

Bacterial meningitis

74
Q

What are the two signs that indicate the presence of meningitis?

A

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.

75
Q

What motor track disorder causes resting tremors, bradykinesia, cogwheel rigidity, loss of balance, anxiety & depression, urinary incontinence, and widespread cognitive impariment?

A

Parkinson’s Disease

76
Q

Is cognition impairment a normal part of aging?

A

NO!

77
Q

Identify what is normal & abnormal for the aging woman.

A

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

78
Q

Are lymph nodes palpable?

A

Not usually

79
Q

Is some tenderness expected high in the axilla?

A

Yes

80
Q

Physical signs associated with more advanced cancer

A

BREAST

Breast mass
Retraction
Edema
Axillary mass
Scaly nipple
Tender breast

81
Q

What are modifiable risk factors for breast cancer?

A

-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

82
Q

What are non-modifiable risk factors for breast cancer?

A

**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

83
Q

A breast lump that is painful/tender, round, mobile is __________.

A

benign

84
Q

A breast lump that is non-tender, irregular shaped, firm, w/ skin retraction is associated with __________.

A

cancer

85
Q

What can breast cancer look and feel like?

A

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

86
Q

What is a specific rule that applies to post-mastectomy patients?

A

No blood pressure or needle sticks in the affected limp.

Patient will typically have a “limb alert” bracelet.

87
Q

A benign growth of male breast tissue is known as _________.

A

Gynecomastia

88
Q

The pleural space beneath the lungs where there is a potential to abnormally fill with fluid or air and compromise lung expansion

A

Costodiaphragmatic recess

89
Q

What is the functional respiratory unit called?

A

Acinus

90
Q

Where does gas exchange occur?

A

Alveoli

91
Q

What are the four major functions of the respiratory system?

A
  1. Supplying oxygen to the body for energy production
  2. Removing carbon dioxide as a waste product of energy reactions
  3. Maintaining homeostasis (acid/base balance)
  4. Maintaining heat exchange
92
Q

Air rushes into the lungs by __________.

A

Inspiration

93
Q

Air is expelled and the chest recoils by __________.

A

Expirations

94
Q

What questions do you ask about smoking when collecting data from the patient?

A

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.

95
Q

What is the AT:P ratio of the thorax in a normal, healthy patient?

A

1:2

The transverse diameter is approximately 2x the AP diameter.

96
Q

What does an AT:P ratio of 1:1 indicate?

A

Barrel chest

97
Q

A sunken sternum or funnel chest is called __________.

A

Pectus Excavatum

98
Q

Forward protrusion of the sternum is called __________.

A

Pectus Carinatum

99
Q

What does crepitus feel like?

A

Rice Krispies

100
Q

What is tactile fremitus?

A

The palpable vibration of the chest wall when a patient speaks

101
Q

Tactile fremitus will be more pronounced with __________ __________ and will be decreased with __________ __________.

A

Tactile fremitus will be more pronounced with lung consolidation and will be decreased with pleural effusion.

102
Q

Lung consolidation occurs when

A

the normally air-filled lung is engorged with fluid or tissue.

103
Q

Fluid collects in the space between the lung and chest wall, displacing the lung upward in

A

Pleural effusion

104
Q

What are the different categories of sounds you hear when percussing the intercostal spaces?

A

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)

105
Q

What is the Greek Key Pattern?

A

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.

106
Q

What is the sound, location, and quality of normal breath sounds?

A

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.

107
Q

What are adventitious sounds?

A

Added sounds that are heard in addition to usual breath sounds

108
Q

Examples of adventitious sounds

A

Crackles, rhonchi, wheeze, and stridor

109
Q

Describe crackles (rales)

A

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

110
Q

Describe rhonchi

A

Loud, low coarse noises heard during inspiration and expiration; goes away with cough

111
Q

Describe wheeze

A

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

112
Q

Describe stridor

A

an inspiratory wheeze associated with upper airway obstruction

EMERGENCY Patient is losing airway.

113
Q

Normal respiratory rate

A

12-20

114
Q

Bradypnea

A

Rate <12

115
Q

Tachypnea

A

Rate >20

116
Q

Hyperventalation

A

Respiratory rate and depth increase

117
Q

Sighing

A

Frequently interspersed deeper breath

118
Q

Apnea

A

Cessation of breathing

119
Q

Atelectasis

A

Partial or complete collapse of lung

120
Q

Bronchitis

A

Infection of the trachea and larger bronchi

Acute or chronic

121
Q

Emphysema

A

Hyperinflated lungs

122
Q

Blue bloater

A

Chronic Bronchitis

123
Q

Pink Puffer

A

Emphysema

124
Q

When the lining of the lungs become inflamed due to a pulmonary infection is called __________.

A

Pleurisy

125
Q

Inflammatory response to an infective agent

A

Pneumonia

126
Q

What are the objective signs of Pneumothorax?

Definition: Air in the pleural cavity, resulting in lung collapse

A

Unequal chest expansion

Tachypnea, cyanosis, and apprehension may occur

Tracheal Deviation (shift) to opposite site

Breath sounds decreased or absent

127
Q

Asthma

A

Allergic hypersensitivity to certain inhaled allergens, irritants, microbes, stress, or exercise

Bronchospasm and inflammation

Wheezing, dyspnea and chest tightness

128
Q

Should you be concerned if the patient has absent breath sounds when wheezes were previously heard?

A

Yes. This is a raised concern.

129
Q

What tool prevents lung consolidation/pnuemonia?

A

Incentive Spirometer (IS = I Suck, No inhaling)

130
Q

What is a Peak Flow Meter used for?

A

Monitor pulmonary function in asthmas patients

Patient inhales deeply and then exhales as quick as possible.

131
Q

What are the signs of Hypoxia?

A

Restlessness (#1/early sign)

Decreased LOC or AMS

Clubbing (Chronic/late sign)

Health Assessment (5 decks)

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