Sheet 1-NURS 314 Study Guide Exam #2 Flashcards
Concept/Question
Explanation/Answer
Valves on left side of heart
Mitral (bicuspid) and aortic
Valves on right side of heart
Tricuspid and pulmonic
What is the direction of blood flow in the heart?
Deoxgenated blood flows from venous system and liver through the Vena cava into the Right Atrium through the Tricuspid valve into the Right Ventricle which pumps blood (systole) through the Pulmonic valve into the Pulmonic arteries to the lungs for oxygenation. From the lungs, oxygenated blood returns via the Pulmonary veins into the Left Atrium through the Mitral valve into the Left Ventricle (diastole) which pumps oxygenated blood (systole) through the Aortic valve into the Aorta for circulation through the arteries to body tissues
When do the AV valves open?
During the heart’s filling phase (diastole) to allow ventricles to fill with blood
When do the AV valves close?
During systole (pumping phase), the valves close to prevent backflow of blood into the atria
What is S1?
Closure of mitral and tricuspid valves close; beginning of systole and ventricular contraction Coincides with carotid pulse Coincides with R wave Heard over entire precordium
What is S2?
Closure of pulmonic and aortic valves; end of systole (opening of mitral and tricuspid valves during to initiate ventricular filling, diastole)
What is betweeen S2 and next S1
Diastole - blood is refilling into ventricles
Electrical conduction of the heart
1 Sinoatrial node (Pacemaker) - 80-100
2 Atrioventricular node -
3 Atrioventricular Bundle (Bundle of His)
4 Left & Right Bundle branches (which fire separately)
5 Bundle Branches
SA node: cells can depolarize on their own (i.e. automaticity; e.g. w/o having a neighboring cell do it first) (pacemaker); specialized band of tissue, highway for depolarization wave; coordinated way evenly through right and left; via internodal tracts to AV node only connection between atria and ventricles, creates a delay between contraction of atria and contraction of ventricles; important because simultaneous contraction would squeeze blood against each other, allows time for blood to move through to ventricles, to ensure blood moves in coordinated way (0.1s); then to the bundle of His down to bottom of both ventricles (right bundle and left bundle); left splits again to Perkinje fibers, electrical signal disperses to involve all the muscle cells of the myocardial cells;
What is a heart murmur?
An abnormal blowing, swooshing sound heard during S1 and S2 due to turbulent blood flow Systolic - can be normal or with heart dz Diastolic - always indicates heart dz
What causes a heart murmur?
- velocity of blood increases (e.g. flow murmur) 2. Viscosity of blood decreases (e.g. anemia) 3. Structural defects in valves (e.g. narrowed valve, incompetent valve) or unusual openings in the chambers (e.g. dilated chamber, wall defect)
Heart murmur grading - Grade 1
Barely audible in a quiet room
Heart murmur grading - Grade 2
Clearly audible, but faint (most common)
Heart murmur grading - Grade 3
Moderately loud, easy to hear
Heart murmur grading - Grade 4
Loud; associated w/ palpable thrill
Heart murmur grading - Grade 5
Very loud, heard w/ one edge of stethoscope off chest
Heart murmur grading - Grade 6
Loudest, heard w entire stethoscope lifted off chest
What are the extra heart sounds?
S3 and S4 Midsystolic click Ejection click
What is S3?
Ventricular gallop; Sound heard during diastole from vibrations from ventricular filling. Ventricular walls are resistant to filling during early rapid filling phase (protodiastole). Occurs immediately after S2, when AV valves open and blood first enters ventricles Occurs with heart failure and volume overload
What is S4?
Atrial gallop; Occurs at the end of diastole, at pre systole, when the ventricle is resistant to filling. Atria contract and push blood into noncompliant ventricle which creates vibrations occurs with CAD
Midsystolic click
Heart sounds associated with mitral valve prolapse
Ejection click
occurs early in systole with the opening of the semilunar valves
Components of an ECG (electrocardiograph)
P wave PR interval QRS complex T wave
P wave
depolarization of atria
PR interval
the time necessary for atrial depolarization plus time for the impulse to travel through the AV node to the ventricles) beginning of P wave to beginning of QRS complex
QRS
depolarization of ventricles
T wave
repolarization of ventricles
What is cardiac output
volume of blood in each systole (stroke volume) x beats per minute
What is preload?
venous return that builds during diastole; the length to which the ventricular muscle is stretched at end of diastole just before contraction
Ausculation of heart sounds
Aortic opening: Right sternal border 2nd ICS (S2 louder than S1) Pulmonic opening: Left sternal border 2nd ICS (S2 louder than S1) Erb’s Point: Left sternal border 3rd ICS (S1 and S2 even) Tricuspid valve: Left sternal border, 5th ICS Mitral valve: (APEX) 5th ICS MCL
Pulse deficit
Apical rate - radial rate
Auscultating the carotid arteries
For middle-aged or older, or patients who show signs of CVD assess for bruits
Bruits
Blowing, swooshing sound indicating blood flow turbulence; normally none is present; usually due to a local vascular cause such as atherosclerosis
What degree of artery narrowing causes a bruit?
When the artery is occluded by 1/2 -2/3, a bruit is audible and up to 2/3 increasing loudness indicates worsening atherosclerosis. After 2/3 bruit loudness decreases. No bruit is audible if artery is completely occluded. Absence of bruit does not indicate absence of carotid lesion
Where do we assess for bruits?
Carotid arteries Abdominal aorta
Risk factors for heart disease and stroke
High blood pressure
abnormal lipids
smoking
high cholesterol
Abdominal obesity
Type 2 diabetes
Age
Genetics
Alcohol intake
Sedntary lifestyle
Blood thinners
Subjective data in assessment of heart
Chest pain, dyspnea, orthopnea; cough; fatigue; cyanosis or pallor; edema; nocturia; past or family hx of cardiac disease
Objective data in assessment of heart
- Neck vessels: assess carotid for bruits; jugular venous pulse and estimate JVP as needed 2. Precordium: Inspection and palpation to assess apical pulse and detect heaves or lifts 3. Precordium: Ausculate heart APETM for heart sounds, murmurs,
Cardiac changes in older adults
Increase in systolic BP, disrhythmias, and the ability of the heart to augment cardiac output with exercise is decreased (max. HR decreased)
Symptoms of angina or chest pain
Chest/back/jaw/L. shoulder/L.arm pain Dypnea Pallor Diaphoresis Fatigue Palpitations/tachycardia Anxiety/denial or sleep disturbance N&V Dizziness Silent MIs
Are pulsations at the apex of heart considered normal?
No, would be called a heave and they indicate ventricular hypertrophy or hyper dynamic/fluid overload
Which position helps facilitate the auscultation or murmurs or additional heart sounds?
To the left, side-lying
What are the abdominal borders?
From the diaphragm to the brim of the pelvis; all internal organs are called viscera
Organs in the RUQ
liver, gallbladder, duodenum, head of pancreas, right kidney, right adrenal gland, hepatic flexure of colon, part of ascending and transverse colon
Organs in the LUQ
Stomach, spleen, left lobe of liver, body of pancreas, left kidney and adrenal gland, splenic flexure of colon, part of transverse and descending colon
Organs in the RLQ
cecum, appendix, right ureter, right ovary and fallopian tube, or right spermatic cord
Organs in the LLQ
Portions of descending colon, sigmoid colon, left ureter, left ovary and fallopian tube or spermatic cord
Organs in the midline of abdomen
Aorta, bladder, uterus
Changes in abdomen in older adults
Abdominal obesity, pernicious anemia, iron def. anemia, calcium malabsoprtion, increase in gallstones, delay in gastric emptying, decreased liver size (by 25%) and hepatic blood flow (33%), delayed metabolism of drugs, constipation, decreased salivation and taste
Subject assessment of abdomen
Appetite Early satiety (feeling of fullness) Weight change (unintentional gain or loss of 5lb in one month) Dysphagia Chronic indigestion N&V food intolerances Bowel habits Abdominal hx Diet recall Nicotine (increase incidence of peptic ulcers and cancers) Medications Abdominal pain
Assessment of abdominal pain
Visceral Parietal Referred
Abdominal pain - visceral
When hollow abdominal organs - intestines- become distended or contract forcefully or when the capsule of solid organs such as liver and spleen are stretched. Poorly defined or localized and intermittently timed, Dully, achy, bruning, cramping or colicky
Abdominal pain - parietal
Parietal peritoneum becomes inflamed (e.g. appendicitis or peritonitis); tends to localize to source Characterized as sever, steady pain
Abdominal pain - referred
occurs at distant sites that are innervated at approximately the same levels as the disrupted abdominal organ; pain travels from source and becomes highly localized at distant site
Constipation
Less than 3 BM/wk OR Straining, lumpy or hard stools, feeling of incomplete evacuation, feeling of anorectal blockage, use of manual maneuvers
Diarrhea
More than 3-4 stools/day Liquid, conforms to container; bloody or mucus; medications can cause
Physical exam of abdomen
- inspection 2. Auscultation 3. Percussion 4. Palpation
Physical exam of abdomen - complete sequence
- Inspect the abdomen Contour (flat, rounded, scaphoid, distended), symmetry, umbilicus, skin (textrure, color, veins, arteries, hydration, lesions), pulsation, movement, hair distribution, demeanor 2. Auscultation - all four quadrants for BS (hypoactive, normal, hyperactive) 3. Percussion - for tympany and dullness (predominating sound should be tympany b/c majority of organs are air-filled; liver and spleen will be dull) Percuss for liver span Percuss for spleen CVA tenderness 4. Palpation - light to deep
Inspection of abdomen
Contour (flat, rounded, scaphoid, distended or protuberant indicating ascites), symmetry, umbilical hernia or inflamation, skin (texture, color, veins and arteries, scars or lesions), pulsation (aneurysm) or movement (flatus); hair distribution; demeanor
Why do we auscultate BS before percussion and palpation?
Actions can increase peristalsis, which may cause misinterpretation of BS
Auscultation of BS
Assess character and frequency of BS; any vascular sounds or bruits High-pitched, gurgling cascading sounds occurring irregularly anywhere from 5-30 times per minute
Hypoactive BS
Absent BS; following abdominal surgery or inflammation of the peritoneum
Hyperactive BS
loud, high-pitched, rushing, tinkling sounds that indicate increased motility (due to diarrhea, gas, irritation)
What is borborygmus?
A hyperactive BS from hyper-peristalsis “stomach growling”
Percussion of the abdomen
Liver span Spleen General tympany
Percussion - general tympany
Tympany should predominate because air in the intestines rises to the surface when person is lying supine
When would dullness occur during percussion of the abdomen?
Distended bladder, adipose tissue, fluid, or mass
When does hyper resonance with percussion occur?
Gaseous distention
What is the purpose of liver span estimation?
Screens for hepatomegaly and monitors changes in liver size; however, its a gross estimation b/c inaccurate detection of upper border
What is the normal adult liver span?
6-12cm; correlates with height; avg.10.5cm for males and 7.5cm for females In chronic emphysema, liver is displaced downward by hyper inflated lungs
What is hepatomegaly?
Enlarged liver indicated by enlarged liver span; misdiagnosed due to dullness percussed in 5th ICS that is actually due to lung disease (pleural effusion or consolidation) and at the lower border by ascites or pregnancy or gas distention of colon
What is a normal finding during percussion of the spleen?
dullness around 9th and 11th ICS at LML; 7 cm, should not encroach on normal tympany over gastric air bubble
What indications lead to an enlarged spleen?
Mononucleosis, trauma, infection
What is the technique for spleen percussion?
Percuss in the lowest ICS at LAAL; tympany should result; ask person to inhale deeply; tympani should remain Positive Spleen Percussion Sign: results when dull note is heard when patient inhales during splenic percussion; indicates moderate splenomegaly before spleen becomes palpable i.e. mono, malaria, hepatic cirrhosis
What is ascites?
Free fluid in the peritoneal space that occurs with heart failure, portal hypertension, cirrhosis, hepatitis, pancreatitis, and cancer
Purpose of light palpation of abdomen?
To form an overall impression of the skin surface and superficial musculature Note: Any muscle guarding, rigidity, large masses, tenderness
Normally palpable organs
muscles, liver, abdominal aorta, small and large intestines, kidneys, partially or full bladder, pregnant uterus, femoral arteries, feces (LLQ)
Normally non-palpable organs
Stomach, gallbladder, spleen, pancreas, adrenal glands, renal arteris, iliac arteries, appendix, ovaries, non-preg uterus, empty bladder, prostate
Common abnormal findings:
Enlarged liver Enlarged Spleen Abdominal aortic aneurysm Masses Ascites Excess air (distention) Adhesions Hernias
Abdominal assessment developmental changes - older adults
- Increased deposits of sub-q fat abdomen and hips 2. Abdominal muscles thinner, more relaxed; organs more easily palpated liver, kidneys
Function of the vascular and lymphatic system
Delivery and transport of oxygen and nutrients and elimination of waste products from cellular metabolism; immune function
Structure and function of arteries
Heart makes high-pressure system Arteries are strong, tough and tense to withstand pressure demands Contain elastic fibers to allow walls to stretch w systole and recoil w diastole Controlled by VSM (vascular smooth muscle) which controls amount of blood delivered to tissues Supply oxygen and essential nutrients to tissues
What is a pulse? Where are they found in the body?
Pressure wave created by each heartbeat is felt at certain arterial sites clos to the skin or over a bone: - Temporal - Carotid - Brachial (major artery in arm) - Radial - Ulnar (deeper and harder to feel) - Abdominal aorta - Femoral artery (major leg) - Popliteal - Posterior tibialis - Dorsalis pedis
What is ischemia?
Deficient supply of oxygenated arterial blood to tissue caused by obstruction of blood vessel Complete blockage: leads to death of distal tissue Partial blockage: insufficient supply; may only be apparent at exercise when oxygen needs increase
Veins accesible to examination
Jugular veins Veins in arms Femoral and popliteal
Three types of veins in the legs
- Deep veins 2. Superficial veins 3. Perforators
What are the deep veins?
Run alongside arteries; conduct most of venous return from legs (as long as these remain intact, superficial veins can be excised without harming circulation) - femoral - popliteal
What are the superficial veins?
- Great saphenous (inside leg, joins popliteal) - Small saphenous (outside leg, joins popliteal)
What are the perforating veins?
Connecting veins that join deep and superficial veins; one-way valves route blood from superficial into deep veins
Structure and function of venous return
Veins drain deoxygenated blood and waste products from tissues and return to the heart low-pressure venous flow mechanism keeps blood moving: - larger in diameter and more distensible than arteries; can expand and hold more blood when volume increases (compensatory mechanism to reduce stress on heart) - ability to stretch is called capacitance vessels
What is important for efficient venous return?
- contracting skeletal muscles - Competent valves in veins - patent lumen
What is the function of the lymphatic system?
- Conserve fluid and plasma proteins that leak out of capillaries (because veins cannot absorb all fluid that is pushed out; prevents fluid build up in interstitial spaces and edema) 2. Forms a major part of immune system 3. Absorbs lipids from intestinal tract
Describe the drainage of the lymph vessels
Lymph vessels converge and drain into two main lymphatic trunks which then empty into venous system at subclavian veins
What areas does the right lymphatic vessel drain?
Right side of head and neck, right arm, right thorax, right lung, and pleura, right side of heart, right upper section of liver
Cervical nodes drain:
Head and neck
Axillary nodes drain:
Breast and upper arm
Epitrochlear nodes drain:
Lower arm and hand
Inguinal nodes:
lower extremity; external genitalia, anterior abdominal wall (normally small, nontender and movable)
What areas does the thoracic duct vessel drain?
Rest of the body
How is lymph fluid moved throughout the body?
Slow compared to blood; 1. contracting skeletal muscles 2. Pressure changes secondary to breathing 3. Contraction of vessel walls themselves
What are lymph nodes? What is their purpose?
Small, oval clumps of lymphatic tissue located at intervals along vessels Filter fluid before its returned to the bloos stream Filter out microorganisms that could be harmful to the body: B and T lymphocytes in the lymph nodes mount an antigen-specific response to eliminate pathogens
What do localized, swollen and tender nodes indicate?
Local inflammation
What do enlarged epitrochlear nodes indicate?
Infection of hand or forearm; Can also occur in generalized lymphadenopathy: lymphoma, leukemia, sarcodosis, infections, mono
What is lymphadenopathy?
Enlargement of the lymph nodes Indicate: infection, malignancy, immunologic diseases
Organs related to lymphatic system
Spleen Tonsils Thymus (T cells develop here during childhood)
What is the function of the spleen?
- Destroy old RBCs 2. Produce antibodies 3. Store RBCs 4. Filter microorganisms
Name the tonsils
Pharyngeal (anterior to tragus) Palatine Lingual
Developmental changes in peripheral vascular
Increased rigidity (arterosclerosis); yields rise in systolic BP Enlargement of intramuscular calf veins Prolonged bed rest and heart failure increase risk of DVT and pulmonary embolism Thin shiny, skin; thick-ridged nails; loss of hair on lower legs
What is DVT?
Occlusion of deep vein by thrombolism Causing inflammation, blocked venous return, cyanosis, and edema S: Sudden onset of intense, sharp, deep muscle pain; may increase w sharp dorsiflexion of foot O: increased warmth, swelling, redness,
Thrombogenesis
- stasis 2. Hypercoagulability 3. Endothelial dysfunction
What is unique about a hard, fixed, nontender lymph node?
Considered cancerous until proven otherwise
Arterial v Venous Leg Cramps
Arterial: Worse with exercise, better with rest or dangling; pain of ischemia, intermittent claudication; caused by arteriosclerosis; risk for infarcts, dry gangrene, amputations Venous: Better with exercise, worse with dangling; pain of pressure, fatigue; caused by venous insufficiency (venous valve failure d/t immobility, diabetes); risk for ulcers, wet gangrene, amputations
Pitting Edema Scale
Normal: Finger should leave no indentation (unless standing all day or pregnancy) 1+: Mild pitting: slight indentation, no perceptible swelling 2+: Moderate pitting, indentation subsides rapidly 3+: Deep pitting, indentation remains, leg looks swollen 4+: Very deep pitting, indentation last long time, leg very swollen
What is lymphedema?
Swelling of a limb caused by an obstructed lymph channel or damage to nodes and vessels
Ligament
Fibrous bands running from one bone to the other Strengthen joint and prevent movement in undesirable directions
Tendon
Attaches skeletal muscle to bone
Cartilage
Covers the surface of opposing bones; Avascular, receives nourishment from synovial fluid that circulates during joint movement; Cushions the bones and provides smooth surface to facilitate joint movement
Bursa
Enclosed sac filled with synovial fluid; located in areas of increased frcition and help muscles and tendons glide smoothly over bone
Inversion
moving sole of foot inward at ankle
eversion
moving sole of foot outward at ankle
rotation
moving head around central axis
protraction
moving body part forward, parallel to the ground
Retraction
moving body part backward parallel to ground
Elevation
raising a body part
Depression
lowering a body part
Internal rotation
toward midline
External rotation
away from midline
Adduction
Move towards midline
Abduction
Away from midline of body
Flexion
beding; decreasing angle of joint
Extension
straightening increasing angle of joint
pronation
turn forearm w palm facing down
supination
turn forearm with palm facing up
Assessment of musculoskeletal system
Inspection: size and contour of joints and muscles; skin and tissue over joint Palpation: Skin temperature, muscles, bony articulations, area of joint capsule; ROM and muscle/motor strngth testing
Developmental changes in musculoskeletal - elderly
Loss of peripheral sub-q fat, muscle, and calcium in bones (osteopenia, osteoporosis) Loss of ligament and tendon elasticity and flexibility (severe is contracture) Flattening of vertebral disks Enlargement and deformity of joint related to wear and destruction of articular cartilage (osteoarthritis); kyphosis, loss of lordotic curvatur, stooped appearance
Number of cervical spine
7
of thoracic
12
lumbar
5
sacral
5
coccygeal
3 or 4
Intervertebral disks
cushion the spine
Herniated disc
Ruptured disk, nucleus pulposus herniates out of vertebral column; compresses on spinal nerve causing pain
Osteoporosis
Disease in which bone demineralizes or loss of bone density Bone becomes porous and fragile Bone remodeling: cyclic process of bone deposition and resorption: deposition occurs up to age 40; bone resorption(loss of bone matrix) occurs more rapidly after 40 Women have more than men; increased risk 5 yrs post menopause due to lack of estrogen leads to increased bone loss Uncontrollable Risk factors: gender, age, ethnicity, hx bone fractures Controllable risk factors: exercise, calcium intake, anorexia, low estrogen levels, smoking, caffeine, alcohol, medication intake Reduce risk: increase exercise, intake of calcium and vit D; ERP
Temporalmandibular joint movement
1) hinge: open and close 2) gliding: protrusion and retraction 3) Gliding: side to side
Vertebral column
1) Flexion: bending forward 2) Extension: bending backward 3) abduction 4) rotation
Glenohumoral
ball and socket; full ROM
Elbow
Hinge: flexion and extension
Wrist and carpals:
radiocarpal: flexion and extension, side to side
midcarpal: flexion, extension and some rotation
metacarpophylangeall and interphalangeal: flexion and extension
Hip
ball and socket
Knee
Femur, tibia, patella Hinge joint: flexion and extension
Muscle strength rating scale
5- normal 4- movement against resistance but less than normal 3- movement against gravity, but not against resistance 2 - movement at the joint but not against gravity 1- visible muscle movement but no movement at the joint 0 - no muscular contraction
Scoliosis
Lateral curvature and rotation
Lordosis
exxagerated lumbar curve; pregnancy is normal, obesity
Kyphosis
exaggerated thoracic curve; common with aging
Tempormandibular joint
Vertical motion: hinge 3-6cm Lateral motion: 1-2 cm Protrusion
Cervical spine
Flexion 45 hyperextension 55 lateral bending 40 rotation 70 (look right or left)
Shoulder
Forward flexion up to 180 (raise arms above head) Hyperextension 50 (arms behind you) Internal rotation 90 External rotation Abduction of 180 (above head and hands together) Adduction 50: across midlin
Elbow
Flexion 150 to 160 Extension 0 supination and pronation 90
Wrist and hand
hyperextension 70 - bend hand up at wrist
Frontal lobe
personality behavior emotion intellectual functions
Precentral gyrus
Primary motor area
Broca’s area (frontal lobe)
Motor speech
Wernicke’s area (temporal lobe)
Speech comprehension
Temporal lobe
Hearing Taste Smell
Parietal lobe
sensation
Post central gyrus
primary sensory area
Occipital lobe
visual reception
Cerebellum
Motor coordination equilibrium balance
Basal ganglia
Initiate and coordinate movement; control automatic associated movements of the body (e.g. arm swinging during walking)
Thalamus
Main relay station where the sensory pathways of the spinal cord, cerebellum and brainstem synapses before going to cerebral cortex
Hypothalamus
Major respiratory center, basic vital functions: temperature, appetite, sex drive, blood pressure; sleep; anterior and posterior pituitary gland regulator; coordinates autonomic nervous system response and stress response
Cerebellum
Motor coordination of voluntary movements
Brainstem
Midbrain: Motor neurons and tracts Pons: Two respiratory centers Medulla: Continuum of spinal cord with brain; autonomic centers (respiration, heart rate, GI) and controls cranial nerves VIII through XII
Spinal cord
Mediates reflexes of posture control, urination and pain response; nerve cell bodies are arranged in butterfly shape with anterior and posterior horns
Major sensory pathways of CNS
Spinothalamic tract: pain, temperature, and crude and light touch Posterior (Dorsal) Columns: Fine touch, proprioception and vibrations
Major motor pathways of CNS
Corticospinal crossed tract Corticospinal uncrossed tract Extrapyramidal Tract
Components of PNS
Afferent nerve fibers: deliver sensory information to CNS Efferent nerve fibers: carry information from the CNS Reflex arcs Cranial nerves Spinal nerves Autonomic nervous system
Function of autonomic nervous system
Innervates heart, glands, diaphragm Mediates unconscious activity Peripheral nervous system composed of cranial nerves and spinal nerves Cranial nerves can be sensory or motor or both
Presyncope
Lightheaded, swimming sensation, like feeling faint
Vertigo
Rotational spinning
Disequilibrium
Unsteady, like on a boat
Sequence of neuro exam
Mental status Cranial nerves Motor system (including gait and coordination) Sensory system Reflexes
DTR
Measure of intactness of reflex arc at specific spinal intervals
DTR assessment scale
4+ - very brisk, hyperactive with clonus, indicative of dz 3+ - brisker than average, may indicate disease, probably normal 2+ - average, normal 1+ - diminished, low normal, occurs only with reinforcement 0 - no response
Hyporeflexia
Absence of reflex, lower motor neuron problem; occurs with interruption of sensory afferents or destruction of motor efferents ad anterior horn cells (e.g. spinal cord injury
Clonus
Set of rapid, rhythmic contractions of same muscle
Hyperreflexia
Exaggerated reflex, upper motor neuron lesions (e.g. brain attack)
Biceps reflex
C5-C6: Place thumb on biceps tendon and strike blow on your thumb; normal response is contraction of biceps and flexion
Triceps reflex
C7-C8: Tell person to let arm go dead; strike just above elbow while holding it; normal response is extension of the forearm
Brachioradialis reflex
C5-C6: Hold person’s thumb, strike forearm directly about 2-3cm above radial styloid process; normal response is flexion and supination of forearm
Quadriceps reflex
L2-L4: Let lower legs dangle, strike just below patella; normal response is leg extension, palpate contraction of quad
Achilles reflex
L5-S2: Position person with knee flexed and hip externally rotated, hold foot in dorsiflexion, strike achilles tendon directly; normal response is plantar flexion against hand
Plantar reflex
L4-S2: with hip slightly externally rotated, draw upside-down J towards ball of foot; normal response is plantar flexion and inversion and flexion of forefoot Positive Babinski sign: abnormal in adulthood dorsiflexion of big toe and fanning of toes (normal in infancy); indicates dz of spinal tract
Sensory tests for posterior column tract
Vibration Position (kinesthesia) (proprioception): tests person ability to perceive passive movements of toes and fingers Tactile discrimination (fine touch): stereognosis, graphesthesia
Aphasia
Loss of power of expression of expression by power of speech, writing or signs, loss of comprehension of spoken word or written language
Dysphagia
Difficulty swallowing
Dysphasia
Difficulty speaking consisting of lack of coordination and inabiity to arrange words in their proper order
Signs of stroke
Sudden weakness or numbness of face, arm and leg on one side of body Loss of speech, difficulty talking Dimness or loss of vision, double vision Unexplained dizziness Unsteadiness or sudden falls Headache Confusion
What is a stroke?
Caused by sudden or gradual interruption of blood supply Infarct: Cerebral vessels prone to atherosclerosis and arteriosclerosis, with narrowing of vessels; thrombus/embolus formation; also cardiogenic thrombus/embolus Hemorrhage: Secondary to HTN, DM, vascular malformation, aneurysm, tumor invasion
CN I
Olfactory: Smell
CN II
Optic: Vision
CN III
Oculomotor: motor-most EOM movement, opening of eyelids; parasympathetic- pupil constriction, lens shape
CN IV
Trochlear: Downward and inward movement of eye
CN V
Trigeminal: Motor- mastication; sensory - sensation of face, scalp, cornea, mucous membranes of mouth and nose
CN VI
Abducens: Lateral movement of eye
CN VII
Facial: motor- facial muscles, close eye, labial speech, close mouth; sensory - tast on anterior two-thirds of tongue; parasympathetic - saliva and tear secretion
CN VIII
Acoustic: hearing and equilibrium
CN IX
Glossopharyngeal: motor- pharynx (phonation and swallowing); sensory - taste on posterior one third of tongue, pharynx (gag reflex); para- parotid gland, carotid reflex
CN X
Vagus: motor-pharynx and larynx (talking and swallowing); sensory-general sensation from carotid body, carotid sinus, pharynx and viscera; para-carotid reflex
CN XI
Spinal: movement of traps and sternomastoid muscles
CN XII
Hypoglossal: movement of tongue
Stress incontinence
Involuntary urine loss with physical strain, sneezing, coughing
Urge incontinence
involuntary urine loss from overactive detrusor muscle in bladder; it contracts and creates urgent need to void
