NUR 202 Final Exam Flashcards
1
Q
What are the major functions of the cerebellum
A
Equilibrium
Motor function of voluntary movement
Muscle tone
2
Q
What are the major functions of the frontal lobe
A
Personality
behavior
emotions
intellectual function
3
Q
What are the major functions of the parietal lobe
A
sensation
4
Q
What are the major functions of the temporal lobe
A
auditory reception center:
- hearing
- taste
- smell
5
Q
What are the major functions of Wernicke’s area; damage to this area can cause
A
language and comprehension (temporal lobe)
- receptive aphasia
- person hears sound, but cannot comprehend
6
Q
What are the major functions of Broca’s area; damage to this area can cause
A
motor speech (frontal lobe)
- expressive aphasia
- person cannot talk
- person understands what you said, but cannot talk back
7
Q
What are the major functions of the basal ganglia
A
subcortical-associated motor system: controls automatic associated movements of the body (e.g. arms swinging when you walk)
8
Q
What are the major functions of the hypothalamus
A
Major respiratory center
sleep center
anterior and posterior pituitary regulator
coordinates autonomic nervous system and stress response
basic vital functions:
- temperature
- heart rate
- blood pressure
- appetite
- sex drive
9
Q
What three structures make up the brainstem
A
Medulla
Pons
Midbrain
10
Q
What is the major function of the brainstem
A
central core of brain that is mostly nerve fibers
contains origin of cranial nerves III-XII
11
Q
What is the major function of the spinal cord
A
mediates reflexes
- posture control
- urination
- pain response
12
Q
What is the major function of the thalamus
A
main hub where the sensory pathways of the spinal cord, cerebellum, basal ganglia, and brainstem form synapses
contains connections that are crucial for human emotion and creativity
13
Q
List the cranial nerves (name and number)
A
I- Olfactory
II - Optic
III- Oculomotor
IV- Trochlear
V- Trigeminal
VI - Abducens
VII- Facial
VIII- Acoustic
IX- Glossopharyngeal
X- Vagus
XI- Spinal accessory
XII- Hypoglossal
14
Q
What is amnesia
A
memory loss due to brain injury, illness, or the effects of drugs or alcohol
15
Q
What is aphasia
A
difficulty speaking
- receptive
- expressive
- global
16
Q
What is apraxia
A
difficulty with skilled movement due to brain disease or damage
17
Q
What is ataxia
A
impaired balance or coordination due to brain damage, nerve damage, or muscle damage
18
Q
What is a coma
A
Period of prolonged unconsciousness due to illness or injury
19
Q
What is decerebrate rigidity
A
Rigidity associated with a poor prognosis; most ominous; indicates lesion in the brainstem at the midbrain or upper pons
Upper extremities:
- stiffly extended
- adducted
- internal rotation, palms pronated
Lower extremities:
- stiffly extended
- plantar flexion
Teeth clenched
Back hyperextended
20
Q
What is decorticate rigidity
A
Indicates lesion in cerebral cortex
Upper extremities:
- flexion of arm, wrist, and fingers
- adduction of arm (tight to thorax)
Lower extremities:
- extension
- internal rotation
- plantar flexion
21
Q
What is dysarthria
A
slurred speech due to weakness in the muscles used for speaking
22
Q
What is dysphasia
A
Difficulty speaking due to brain disease or damage
23
Q
What is dysphagia
A
Difficulty swallowing
24
Q
What is flaccidity
A
Decreased muscle tone; muscle feels limp, soft, and flabby
due to injury in a peripheral nerve
25
What is hemiplegia
Spastic or flaccid paralysis of one side of the body (right or left)
26
What is paralysis
Decreased or loss of motor function caused by issues with the nerves or muscles
27
What is paraplegia
Symmetric paralysis of both lower extremities
28
What is paresthesia
Tingling (pins and needles) sensation usually in the hands, arms, legs, or feet
caused by lack of blood flow to an extremity
29
What is spasticity
Increased muscle tone due to injury of a spinal nerve
30
What is a tic
Involuntary, compulsive, repetitive twitching of a muscle group
usually neurological but can also be psychogenic
31
What is a tremor
Involuntary contraction of opposing muscle groups; rhythmic back-and-forth movement
may occur at rest, or with voluntary movement
always disappear while asleep
can be due to a cerebellar disease
32
What are the three phases of a seizure
Preictal phase
Ictal phase
Postictal phase
33
What is happening during the preictal phase
Aura - subjective sensation felt by the person about to have a seizure (can be auditory, visual, or motor)
34
What is happening during the ictal phase
The seizure is actively occurring
Person may experience:
- involuntary movements
- incontinence
- withdrawal
- loss of consciousness
35
What is happening during the postictal phase
After the seizure is finished the person may experience:
- deep sleep
- fatigue
- confusion
- headache
36
You are caring for a patient and notice that they are beginning to have a seizure, what do you do
1. call for help
2. clear the area of potential hazards (the patient may already be on seizure precautions, so the bed rails may be up and padded)
3. note what time the seizure started and when it stopped
4. you may need to perform CPR
37
What are the three types of aphasia
1. Expressive (Broca's)
2. Receptive (Wernicke's)
3. Global
38
What is expressive aphasia
AKA Broca's aphasia
The person can understand what you are saying, and they know what they want to say, but they cannot respond
Broken speech
39
What is receptive aphasia
AKA Wernicke's aphasia
The person does not understand what you are saying, they do not know how to respond, but they respond with fluent speech that sounds unorganized and has nothing to do with what you said to them
Word salad
40
What is global aphasia
Both expressive and receptive aphasia
41
What are the components of the mental status exam
A- appearance
B- behavior
C- cognition
T- thought process
42
How to test cranial nerve I
Olfactory nerve (not often tested)
- occlude one nostril and have them smell something aromatic
- do the same with the other nostril
43
How to test cranial nerve II
Optic nerve
- test visual acuity (Snellen chart)
- test visual fields (testing peripheral vision)
44
How to test cranial nerve III, IV, and VI
Occulomotor, Trochlear, Abducens nerves
- Check pupils for size, regularity, equality, direct and consensual light reaction, and accommodation
- assess extraocular movements by having them follow your finger or pen
45
How to test cranial nerve V
Trigeminal nerve
Motor function:
- assess muscles of mastication by palpating temporal and masseter muscles as person clenches teeth
- Sensory function: with their eyes closed, touch their face in several different spots with a cotton ball to test light touch sensation
46
How to test cranial nerve VII
Facial Nerve
Motor function:
- note mobility and facial symmetry as they smile, frown, close eyes tightly, lift their eyebrows, and show their teeth
- have person puff out their cheeks then press the air out to see if it escapes evenly
47
How to test cranial nerve VIII
Acoustic nerve
- test hearing acuity by talking to them and then doing the whisper test
48
How to test cranial nerves IX and X
Glossopharyngeal and Vagus nerves
Motor function:
- have them say "ahh" and note pharyngeal movement as well as midline rising of the uvula
- touch posterior pharyngeal wall with tongue blade to test the gag reflex
49
How to test cranial nerve XI
Spinal accessory nerve
- test strength of trapezius muscles: ask person to raise shoulders against pressure as you press down on them
- test strength of sternocleidomastoid muscles: ask person to turn their head against pressure from your hand on their cheek in both directions
50
How to test cranial nerve XII
Hypoglossal nerve
- inspect tongue for tremors and note midline thrust as they stick out their tongue
- have them say "light, tight, dynamite" and note clear, distinct lingual speech
51
When inspecting and palpating the muscles, what are your look at specifically
size
symmetry
strength
tone
involuntary movements
(Super Secret STI)
52
How do you test muscle strength
- Hand grasp with push/pull: have person grab your two fingers on each hand and have them resist you pulling and pushing their hands. Also, cross your arms so that their dominant hand is grabbing your dominant hand
- Plantar flexion and dorsi-flexion against resistance
53
How do you test cerebellar function
Balance tests
Romberg test
Rapid alternating movements
54
How do you conduct the balance tests
- have person walk in a straight line for 10-20 feet, turn, then come back to the starting point
- have them walk heel to toe
- have them walk on their toes and then on their heels
55
How do you conduct the Romberg test
Have person stand tall and once they are stable, have them close their eyes and hold that position for 20 seconds
(make sure to be ready to catch them or be able to push them onto a bed if they begin to fall)
56
How do you conduct the rapid alternating movements test
- ask person to pat their knees with their palms and then the backs of their hands. Then go faster.
- ask person to touch their thumb to each finger on the same hand and then again in the reverse direction (do this with both hands)
- finger-to-finger: ask person to touch your finger, then touch their nose, then touch your finger again but in a different position
- finger-to-nose: ask person to close their eyes, stretch their arms out to the side and touch their nose with alternating hands and then back
- heel-to-shin: when person is supine, have them take the heel of one foot and rub it from the knee to the ankle on the opposite leg
57
How do you test a persons sensory perception
- touch various parts of their extremities and have them tell you where you touched them in order to test peripheral nerves
58
Where do reflexes originate from
Spinal cord
59
Where on the body do you test for reflexes
Biceps
Triceps
Brachioradialis
Quadriceps
Achilles
60
What part of the reflex hammer do you use when assessing reflex response
You can use either the pointed or flat side, it doesn't matter
61
Which muscle group do you strike your thumb over the tendon instead of the tendon directly when assessing for a reflex response
Biceps
62
Will a person having a seizure have a reflex response
No
63
When assessing the brachioradialis for reflex response, how do you instruct the person and where do you strike the hammer
have them hold out their arms, then you grab their thumbs and tell them to relax completely. You will be holding the weight of their arms. Then you strike the wrist and look for the thumb to twitch.
(this is to both take pressure off the tendon and distract the patient from what you are doing)
64
When testing the achilles tendon for reflex response, how do you instruct your patient to stand/sit
have them stand and then place their knee in a chair to take pressure off the tendon
65
Grading scale for reflex response
4+ - very brisk
3+ - more brisk than average
2+ - average
1+ - diminished
0 - no response
66
What are the characteristics of Parkinson's disease
(Defect of extra pyramidal tracts)
- tremors
- rigidity
- cogwheel rigidity
- stooped posture
- short, shuffling steps
- pill rolling maneuver with hands
- flat, staring, expressionless facial expression
67
What does a positive Babinski reflex tell you
Upper motor neuron lesion (stroke, brain injury, spinal cord injury)
68
When doing neurological checks on a patient with past neuro defecits, what are you testing
level of consciousness
motor function
pupillary response
vital signs
Glasgow coma scale
69
What three things are we grading using the Glasgow coma scale
eye-opening response
motor response
verbal response
70
How do you grade eye-opening response
4 - spontaneous
3 - to speech
2 - to pain
1 - no response
71
How do you grade motor response
6 - obeys verbal command
5 - localizes pain
4 - flexion withdrawal
3 - abnormal flexion
2 - abnormal extension
1 - no response
72
How do you grade verbal response
5 - oriented X3 (appropriate)
4 - conversation confused
3 - speech inappropriate
2 - speech incomprehensible
1 - no response
73
Glasgow coma scale grade for a fully alert person
15
74
Glasgow coma scale grade for a person in a coma
7 or less
75
Modifiable risk factors for stroke
smoking
obesity
hypertension
diabetes
heart disease
76
Non-modifiable risk factors for stroke
age
family history
sex
race
prior stroke
77
What is the difference between a stroke and a transient ischemic attack
TIA:
- short lived
- vascular spasms due to restricted blood flow
- restricted blood flow is temporary
Stroke:
- long term
- symptoms worsen
- due to completely occluded artery and lack of blood flow to brain (not temporary)
78
What is the tympanic membrane and what does it look like
Eardrum
- separates the external and middle ear, vibrates from sound waves
- translucent, pearl-grey
- should reflect light (cone of light)
79
Which cranial nerve is associated with hearing loss
VIII acoustic nerve
80
What are the three types of hearing loss
1. Conductive
2. Sensorineural (perceptive)
3. Mixed
81
What is conductive hearing loss
Dysfunction of external or middle ear
- foreign bodies
- perforated tympanic membrane
- otosclerosis
82
What is sensorineural hearing loss
Pathology of inner ear, cranial nerve VIII, or auditory areas of the cerebral cortex
- presbycusis (degeneration of the cochlea or cranial nerve VIII due to age)
- ototoxic drugs
- brain injury
83
What part of the ear affect equilibrium
The Labyrinth in the Inner Ear
- constantly feeds information to your brain about your position in space
84
What is vertigo and what are the two types
A sensation of spinning or whirling
85
What is objective vertigo
The feeling that the room is spinning
86
What is subjective vertigo
The feeling that you are spinning
87
When palpating the ear, which structures are you focusing on and what are you looking for
- The pinna, tragus, and mastoid process
- looking for tenderness (ask patient)
88
What is the proper technique of using the otoscope in an adult vs. a child
Adult: pull pinna back and up
Child: pull pinna back and down
Both: use the largest otoscope that will fit, and hold the scope upside down
89
Where should the cone of light be in the right ear vs. the left
Right: 5 o'clock
Left: 7 o'clock
90
What are the steps to performing the whisper test
1. stand behind the patient on the side that you are testing so that they cannot read your lips
2. have the patient cover their opposite ear
3. tell the patient what to listen for (3 numbers or a word)
4. whisper the numbers or two-syllable word
5. have the patient repeat back what you whispered
6. repeat for the other ear
91
What are the steps to performing the Romberg test
1. have patient stand at the bedside with their back to the bed for safety
2. have the patient close their eyes
3. examine them for 20 seconds to see if they start to sway
4. be sure to have a stance to catch them or lightly push them to the bed if they start to sway
92
What are the three cranial nerves associated with extraocular movement
1. CN IV Trochlear nerve - innervates the superior oblique (down and medial movement; crossing your eyes)
2. CN VI Abducens nerve - innervates the lateral rectus muscle (lateral movement)
3. CN III Oculomotor nerve - innervates the rest (medial, superior, and inferior rectus)
93
What are you looking for with the corneal light reflex test
Shine a light from 2 ft away at the bridge of their nose and tell them to focus on the light. You should see the light reflect at the same point in the pupil on both eyes
94
What is esotropia
An abnormal finding in the corneal light reflex test characterized by the uneven turning in of the eyes
95
What is exotropia
An abnormal finding in the corneal light reflex test characterized by the even or uneven outward turning of the eyes
96
What is strabismus
(also called tropia) Disparity of the eye axes; either esotropic or exotropic
97
What is nystagmus
Involuntary movement of the eye; mostly an abnormal finding except when looking laterally during the cardinal gazes test
98
How do you perform the cardinal gazes test
Have them focus on your finger and follow it as you move it superior, midline, lateral, midline, inferior etc. in a clockwise fashion
99
What is presbyopia
Farsightedness due to loss of elasticity of the lens. Occurs in middle to old age (40+) (also called hyperopia)
100
What is macular degeneration
Loss of central vision due to the breakdown of cells in the retina from age that can cause blindness. Seen in people who:
- diabetes
- hypertension
- smoking
- work with pesticides
- medications
- family history
101
What is cataracts
Clouding of the lens due to aging
102
What is glaucoma
Increased ocular pressure leading to damage of the optic nerve (CN II)causing slow vision loss and eventually, blindness
103
What is the Snellen chart and how is it used
The chart used to test visual acuity
- the lines of the chart determine visual acuity at 20 ft. (20/20 is baseline normal)
- the top number is always 20 for 20 feet away, the bottom number is how far away a "normal" healthy eye needs to be to see that line (20/100 = you are reading the line at 20 ft that a normal eye can read at 100 ft)
- have patient stand 20 feet away from the chart and ask them which line is the lowest line they can read
- If they get one letter wrong, then indicate the line -1 (20/20-1) if they get two of them wrong, then have them read the line above that one until they can read the line with one or fewer mistakes
104
What is periorbital edema
Swelling around the eyes. Seen in heart failure patients
105
What is a hordeolum
Also called a stye, its a red, painful bump near the edge of the eyelid
106
What is blepharitis
Inflammation of the eyelid that affects the eye lashes or tear production
107
What is ptosis
Drooping of the eyes seen in a stroke or TIA
108
What is exophthalmos
The bulging of the eyes seen in Grave's disease
109
What is dacryocystitis
Inflammation of the lacrimal sac
110
What is anisocoria
A condition characterized by unequal pupil sizes. This can be benign (about 5% of the population is born with this) or can indicate an emergency (stroke, TIA, etc.)
111
What is the pupillary light reflex test
A test that is used to determine the pupils reaction to light
- direct: the pupil you are shining the light into
- consensual: the pupil that isn't having the light shined into
both pupils should constrict when light is shined into one or the other
- The pupil change is recorded as a fraction (3 = pupil size at rest, 1 = pupil size when light is shined in, 3/1 documented)
112
What are some medications that can effect the pupils
- Opiates and narcotics can cause the pupils to constrict
- Marijuana and cocaine can cause the pupils to dilate
113
What is accommodation and how do we test it
How the pupil constrict as the patient focuses on an object near to them
- have patient focus on a far object
- introduce your finger or penlight close to their face and tell them to focus on it
- inspect the constriction of their pupils as they switch their focus from the far object to the near object
114
What is the Jager test
It is the test used to test near vision
- tested mostly in older patients
- hold the chart close to you rather than looking at it from 20 feet away
115
What is the red reflex
The normal reflection of light from the retina
- the red eyes in photographs comes from this reflection
116
What is the cause of unreactive pupils
Increased intercranial pressure
117
What is diabetic retinopathy
Damage to the blood vessels in the retina in those with diabetes
118
What is flexion
Bending a limb at a joint
119
What is extension
Straightening a limb at a joint
120
What is abduction
Moving a limb away from the midline of the body
121
What is adduction
Moving a limb toward the midline of the body
122
What is the difference between a synovial joint and a non synovial joint
Synovial joints are moveable joints (hip, elbow, knee etc.)
Non synovial joints are non moveable joints (saggital suture, pubic symphysis, etc)
123
What percentage of body weight do muscles account for
40-50%
124
Which vertebrae is the most prominent
C7
125
What sound would you hear when percussing over a tumor
Dull
126
Which cranial nerve is associated with the temporomandibular joint
CN V Trigeminal
127
What is the difference between active and passive range of motion
Active: the patient does all the work
Passive: you do all the work and physically move their limbs
128
What is scoliosis
An S-shaped, lateral curvature of the spine
129
What is kyphosis
A forward curvature of the spine (hunchback)
130
What is lordosis
An inward curvature of the spine (swayback, pregnant people)
131
What is osteoporosis
Low bone density
- affects women > men
- affects white people > black people
- affects menopausal people > non menopausal people
132
What is Rheumatoid arthritis
An inflammatory autoimmune disease of the joints
133
What is osteoarthritis
A non-inflammatory disease of the cartilage, bone, and joint surfaces
134
What is bursitis
Inflammation of the fluid sack within the joints
135
What is gouty arthritis
Inflammation of the joints due to gout (buildup of uric acid in the joints)
136
What is carpal tunnel
Numbness and tingling in the hands due to a pinched nerve in the wrist
137
What are contractures
The shortening and hardening of tendons, muscles, and tissues resulting in deformed and rigid joints
138
In what order do you inspect, percuss, ascultate, and palpate
In most cases: Inspect, palpate, percuss, then ascultate
In the abdomen: Inspect, ascultate, percuss, then palpate
139
When do you use the bell rather than the diaphragm of your stethoscope
Use the diaphragm to listen to high pitched sounds (bowel sounds, breath sounds, etc)
Use the bell to listen to low pitched sounds (vascular sounds, S3 & S4)
140
Which cranial nerve is located in the nasal cavity
CN I olfactory
141
What is the difference between the hard palate and the soft palate
The hard palate is more anterior and has ridges and a whitish color. The soft palate is more posterior and has no ridges, a pinkish color, and is moveable
142
What are the three different salivary glands and where are they located
Parotid - at the temporal mandibular joint bilaterally
Submandibular - inferior to the mandible bilaterally
Sublingual - inferior to the tongue bilaterally
143
What would the nasal cavity look like in a patient with rhinitis? What about an allergy?
Rhinitis - Swollen, red, with drainage
Allergy - swollen, pale or grey
144
Where do you palpate the frontal and maxillary sinuses
Frontal - just under the medial most part of the eyebrows
Maxillary - just inferior to the eyes and superior to the cheekbones
145
Pain in the sinuses indicate
pain - infection
throbbing pain - chronic allergies/infection
146
How do you grade the tonsils
0 = unseen
1+ = seen just past the pharyngeal wall
2+ = halfway between the pharyngeal wall and the uvula
3+ = past the halfway mark to the uvula but not quite touching it
4+ = touching the uvula
(anything more than a 1+ indicates an infection)
147
What are some abnormalities found on the lips
Herpes simplex I - cold sore (last 4-20 days, clear or red)
Carcinoma - elevated borders, red, hard (anything lasting longer than 2 weeks is suspicious)
148
What are some abnormalities found on the buccal mucosa
Leukoplakia - White, patchy, firmly attatched lesions on the cheeks and tongue (found in heavy smokers)
Candidiasis - Cheesy patches on the cheeks and tongue that can be scraped off; fungal infection (found in those taking antibiotics or chemotherapy)
149
What are the symptoms of acute tonsillitis/pharyngitis
- fever
- sore throat
- painful swallowing
- swollen cervical lymph nodes
150
What is rheumatic fever
A multi-system inflammatory disease
- not common now
- may see this in the history of 70-80 year old patients
