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321 assessment of clients > Test 4 > Flashcards

Test 4 Flashcards

1
Q

Presbyopia

A

loss of the eyes’ ability to focus actively on nearby objects
Common in clients over 45

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2
Q

Strabismus

A

Constant malalignment of the eyes
Eyes don’t look exactly the same direction at the same time

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3
Q

Nystagmus

A

An oscillating (shaking) movement of the eyes
May be associated with an inner ear disorder, multiple sclerosis, brain lesion or narcotics use
Involuntary movement side to side

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4
Q

Exotropia

A

A specific kind of malalignment where there is an outward turn of the eye

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5
Q

Entropion

A

An inverted lower lid

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6
Q

Ptosis

A

Drooping of the upper eyelid

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7
Q

Exophthalmos

A

Protrusion of the eyeballs accompanied by retracted eyelid margins

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8
Q

Miosis

A

Pinpoint pupils, constricted and fixed
Possibly a result of narcotic drugs or brain damage

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9
Q

Anisocoria

A

Pupils of unequal size
In some cases is normal, others is not

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10
Q

Accommodation response

A

Response of eye when shifting focus from distant object to nearby object
Functional reflex allowing eyes to focus on near objects
Pupil constricts to increase the depth of focus of the eye

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11
Q

Six cardinal positions of gaze

A

Assess eye muscle strength and cranial nerve function
Failure of eyes to follow ant movement symmetrically in any or all directions indicates a weakness in one or more extraocular muscles or dysfunction of the cranial nerve that innervates that muscle

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12
Q

Snellen exam

A

Used to test distant visual acuity
Chart consists of lines of different letters stacked larger on top and decreasing in size
Client stands 20 ft from, covers one eye and reads until can no longer distinguish

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13
Q

Corneas

A

Permits the entrance of light
Well supplied with nerve endings making it responsive to pain and touch

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14
Q

Lateral gaze

A

Looking to the right or left in the horizontal plane

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15
Q

Conjunctivitis

A

Generalized redness of the conjunctiva
Pink eye

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16
Q

Glaucoma

A

Group of eye diseases that damage the optic nerve
Often caused by abnormally high pressure within the eye
No warning signs and gradual that no change in vision may be noticed until it is advanced
Vision loss as a result is not reversible
*second leading cause of blindness

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17
Q

Open angle glaucoma

A

Patchy blind spots in you side or central vision
Frequently in both eyes
Tunnel vision in advanced stages

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18
Q

Signs of Acute angle-closure glaucoma

A

Severe headache, eye pain, nausea and vomiting, blurred vision, halos around light, redness

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19
Q

Cataracts

A

Opacity/clouding of eyes and blurry vision
Leading cause of blindness worldwide

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20
Q

Risk factors for cataracts

A

Increasing age
Diabetes mellitus
Excessive alcohol use
Exposure to sunlight
Exposure to ionizing radiation
High blood pressure
Obesity
Previous eye injury
Inflammation or surgery
Prolonged steroid use
Cigarette smoking

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21
Q

Macular degeneration

A

Damage to the macula (central part of retina)
Loss in center field of vision
Blind spots, blurry vision

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22
Q

Dry AMD

A

Most common kind of age related macular degeneration
may advanced and cause loss of vision w/out turning into wet form or may change into wet form in late stages

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23
Q

Wet AMD

A

Abnormal new blood vessels form deep in the sensory retinue
can leak or bleed and result in marked loss of central vision

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24
Q

Assessing near vision

A

Use hand held Visual chart, 14 inches away
Jaeger test (pocket screener)
Normal is 14/14

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25
Q

Myopia

A

Nearsightedness

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26
Q

Hyperopia

A

Farsightedness

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27
Q

PERRLA

A

Pupils Equal Round Reactive Light Accommodation
Test pupillary reaction to light
Darken room, client focuses on distant object
Shine light obliquely into one eye and observe
Normally pupils constrict equally

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28
Q

Changes in the structure and function of the inner ear either age

A

Malformation of the inner ear causes sensorineural or perceptive hearing loss

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29
Q

Visual fields

A

Sees with one eye
Four quadrants for each eye (upper and lower temporal and upper and lower nasal)

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30
Q

Visual pathway

A

Anatomical structures responsible for conversion of light energy into electrical action potentials that can be interpreted by the brain

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31
Q

Testing extraocular muscle function

A

Corneal light reflex test: penlight to observe parallel alignment of light reflection on corneas
Cover test: use opaque card to cover an eye to observe for eye movement
Position test: observe for eye movement

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32
Q

Cover/uncover test

A

Patient looks straight at distant object
Cover one eye
- look at uncovered eye, should be fixed
Uncover eye
- look at eye that was covered, eye should not move and should be looking in the same direction
Repeat for both eyes

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33
Q

Purpose of Cover/Uncover test

A

Detects deviation in alignment or strength and slight deviations in eye movement by interrupting the fusion reflex that normally keeps the eyes parallel

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34
Q

Phoria

A

Term used to describe misalignment that occurs when fusion reflex is blocked

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35
Q

Esotropia

A

Inward turn of the eye

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36
Q

Ophthalmoscope

A

Hand held instrument that allows examiner to view the fundus of the eye by the projection of light through a prism that bends the light 90 degrees

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37
Q

AMD

A

Age related macular degeneration
Major cause of visual impairment that affects the macula portion of the retina
Causes deterioration of the macula (central portion)
People with it have a hard time with daily activities

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38
Q

Risk factors for Macular Degeneration

A

Advancing age
Smoking
Family history of AMD
Gender (females more likely to be affected)
Obesity
Race (Caucasians)
Light eye color
Prolonged sun exposure
High fat, high cholesterol, high sugar/low antioxidant diet that is low in antioxidants and green leafy vegetables
Hypertension (narrows blood vessels in retina) or blood pressure above 120/80 mm Hg
Cardiovascular disease
Inactivity
AMD in one eye
Genetic predisposition

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39
Q

Ectropion

A

Everted lower lid

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40
Q

Chalazion

A

An infection of the meibomian gland (located in eyelid)
May produce extreme swelling, moderate redness but minimal pain

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41
Q

Blepharitis

A

Redness and crusting along the lid margins suggesting seborrhea or blepharitis
Infection caused by staphylococcus aureus

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42
Q

Hordeolum

A

Style
A hair follicle infection
Causes local redness swelling and pain

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43
Q

Diffuse episcleritis

A

Inflammation of the sclera

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44
Q

Mydriasis

A

Dilated and fixed pupils
Typically resulting from central nervous system injury, circulatory collapse or deep anesthesia

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45
Q

Papilledema

A

Swollen optic disc
Blurred margins
Hyperemic appearance for accumulation of excess blood
Visible and numerous disc vessels
Lack of visible physiologic cup

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46
Q

Glaucoma (optic disc)

A

Enlarged physiologic cup covering more than half the disc’s diameter
Pale base of enlarged physiologic cup
Obscure and/or displaced retinal vessels

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47
Q

Optic atrophy

A

White optic disc
Lack of disc vessels

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48
Q

Pinguecula

A

Yellowish nodules on the bulbar conjunctiva
Harmless, common in older clients
Appear first on medial side of iris then lateral

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49
Q

Arcus senilis

A

Normal condition in older clients
Appears as a white arc around the limbus

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50
Q

conductive hearing loss

A

Something blocks or impairs the passage of vibrations from getting to the inner ear

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51
Q

Causes of conductive hearing loss

A
  • fluid in middle ear
  • otisis media (middle ear infection)
  • allergies (serous otitis media)
  • impacted cerumen
  • infection in the ear canal (external otitis)
  • presence of foreign body
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52
Q

Sensorineural or perceptive hearing loss

A

Damage is located in the inner ear
Most common type of permanent hearing loss
Decreases one’s ability to hear faint sounds, even loud speech may be muffled

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53
Q

Causes of sensorineural/perceptive hearing loss

A

Ototixic drugs
Generic hearing loss
Aging
Head trauma
Malformation of the inner ear
Loud noise exposure

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54
Q

Risk factors for hearing loss

A

Age
Hereditary
Occupational loud noise
Recreational noises
Ototoxic medications
Illnesses, especially with high fever
Noise exposure
Smoking
Cardiovascular risk factors
Genetic and family susceptibility
Premature birth
Hypoxia during birth
Rubella, syphilis, or other infections in pregnant mother
Inappropriate use of ototoxic drugs during pregnancy
Neonatal jaundice, which can damage the otic nerve in a newborn baby
Infectious diseases
Head/ear injury
Wax/foreign bodies

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55
Q

Otitis media

A

Inflammation or infection located in the middle ear
Purulent drainage associated pain and a popping sensation is characteristic of otitis media with perforation of the tympanic memebrane
Between 6 months and 2 years most susceptible due to size of euustachian tubes

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56
Q

External eat structures

A

Inspect: auricle, tragus, and lobule for size, shape, position,lesion/discoloration, and discharge
Palpate: the auricle and mastoid process for tenderness

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57
Q

Acute otitis media

A

Red, bulging membrane
Decreased/absent light reflex

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58
Q

Serous otitis media

A

Yellowish, bulging membrane with bubbles behind it

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59
Q

Whisper test

A

Have client occlude the eat not being tested and rub tragus in circular motion
Start with better hearing ear first
With head 2 ft behind client whisper a 2 syllable work and ask them to repeat
If they don’t get it first try, try one more time
Identifying 3 of 6 words is passing

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60
Q

Jaeger test

A

Near vision assessment in clients over 40
Pocket screener or newspaper
Held 14 inches from eye

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61
Q

Presbycusis

A

Gradual sensorineural hearing loss
Common after 50
Often begins with a loss of high frequency sounds (women’s voice) followed by the loss of lower

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62
Q

Romberg test

A

Tests equilibrium
Client stands feet together, arms at side, eyes opened and then closes
Maintain position for 20 sections without or with minimal swaying
May indicate a vestibular disorder if fail

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63
Q

Weber test use

A

Performed if client reports diminished or lost hearing in one ear
Helps to evaluate the conduction of sound waves through bones to help distinguish between conductive and sensorineural hearing loss

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64
Q

How waves are transmitted in conductive hearing loss

A

By external and middle ear

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65
Q

How waves are conducted in sensorineural hearing loss

A

By inner ear

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66
Q

Weber test procedure

A

Strike tuning fork softly with back of hand and place at the center of client’s head or forehead
Ask if they hear it better in one ear or the same

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67
Q

Results of Weber test

A

Conductive: reports lateralization of the sound in the poor ear, they “hear” it, the good ear is distracted by background noise which the poor ear has trouble with, so it receives most of the sound conducted by bone vibration
Sensorineural: client reports lateralization of the sound in three good ear, this is because of limited perception of sound due to nerve damage in bad ear, making sound seem louder in the unaffected ear

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68
Q

Rinne test use

A

Test compares air and bone conduction sounds
Used to determine cause of hearing loss

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69
Q

Rinne test procedure

A

Use tuning fork and place at the base of the client’s mastoid process (bone conduction)
Ask client to tell you when they no longer hear it and the move tuning fork to the front of the external auditory canal (air conduction) and ask if the sound is audible after you move it

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70
Q

Rinne test procedure

A

Use tuning fork and place at the base of the client’s mastoid process (bone conduction)
Ask client to tell you when they no longer hear it and the move tuning fork to the front of the external auditory canal (air conduction) and ask if the sound is audible after you move it

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71
Q

Results of Rinne test

A

If cause is sensorineural the finding will be AC > BC (which is also a normal hearing result)
Of the cause is conductive the finding will be BC ≥ AC

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72
Q

Tympanic Membrane

A

Found in the middle eat
Assess the color / position of landmarks / intactness of drum
Shiny / transparent / opaque pearl gray
Slight concave
Cone of light right 5 o’clock left 7 o ‘clock

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73
Q

Otitis externa

A

Infection of the outer ear canal
Often caused by water (swimmers ear)

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74
Q

Expected changes with aging of the ear

A

Presbycusis
Neg self image with hearing aid
Elongated earlobes with linear wrinkles
Harder cerumen builds as cilia in ear canal become more rigid
Coarse think wire like hair may grow at canal entrance
Eardrum appears cloud

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75
Q

Tophi

A

Hard external ear nodules associated with deposits of uric acid in advanced gout

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76
Q

Malignant lesion

A

Mass or lump of abnormal cells can form in any part of ear

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77
Q

Build up of cerumen in ear canal

A

Wax build up and block ear can cause hearing loss

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78
Q

Polyp exostosis

A

Thickening and constriction of the ear canal

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79
Q

Blue dark red tympanic membrane

A

Indicates blood behind eardrum due to trauma

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80
Q

Scarred tympanic membrane

A

White spots and streaks indicate scarring from infections

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81
Q

Perforated tympanic membrane

A

Perforation results from rupture caused by increased pressure usually from untreated infection or trauma

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82
Q

Retracted tympanic membrane

A

Prominent landmarks are caused by negative ear pressure due to obstructed Eustachian tube or chronic otitis media

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83
Q

Bones

A

Provide structure and protection
Serve as levers, store calcium and produce blood cells
206

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84
Q

Axial skeleton

A

Head and trunk

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85
Q

Appendicular skeleton

A

Extremities, shoulders and hips

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86
Q

Compact bone

A

Hard and dense
Makes up the shaft and outer layers

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87
Q

Spongy bone

A

Contains numerous spaces and makes up the ends and centers of the bones

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88
Q

Osteoblasts

A

Active cells that form bone tissue

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89
Q

Osteoclasts

A

Cells that help demineralize and destroy old bone

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90
Q

Red vs yellow marrow

A

Red produces blood cells
Yellow is composed mostly of fat

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91
Q

Skeletal muscles

A

Under conscious control
Attach to bones by way of strong, fibrous cords card tendons
Assist with posture, produce body head and allow the body to move

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92
Q

Smooth muscle

A

Aka nonstriated muscle
Involuntary
Under control of the autonomic nervous system

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93
Q

Cardiac muscle

A

Highly specific striated muscle that can contract without neural stimulation because of the property of automaticity

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94
Q

Automaticity

A

Allows cardiac tissue to set a contraction rhythm through the presence of pacemaker cells

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95
Q

Flexion

A

Bending of a joint (elbow)

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96
Q

Extension

A

Straightening of a joint

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97
Q

Abduction

A

Moving away from midline

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98
Q

Adduction

A

Moving toward midline

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99
Q

Rotation

A

Turning around a specific axis (shoulder) - move around its long axis, turning like a screw

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100
Q

Circumduction

A

Cone like movement - movement of limp in circle

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101
Q

Supination

A

Turning upward
As in hand (palm up)

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102
Q

Pronation

A

Turning downward
As in hand (palm down)

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103
Q

Inversion

A

Turning inward
As in ankle (big toe faces up)

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104
Q

Eversion

A

Turning outward
As in ankle (pinky toe faces up)

105
Q

Protraction

A

Pushing forward
As in head away from neck

106
Q

Retraction

A

Pulling backwards
As in head towards neck (double chin)

107
Q

Joints

A

The place where 2+ bones meet
Provide variety of ranges of motion (ROM) for the body parts
Classifications: fibrous, cartilaginous or synovial

108
Q

Fibrous joints

A

Joined by fibrous connective tissue and are immovable
Ex: sutures between skull bones

109
Q

Cartilaginous joints

A

Joined by cartilage
Ex: joints between vertebrae

110
Q

Synovial joints

A

Bones that contain a space between them that is filled with synovial fluid, a lubricant that promotes a sliding movement
Ex: shoulder, wrists, hips, knees, ankles

111
Q

Ligaments

A

Join bones in synovial joints
Strong dense bands of fibrous connective tissue
Enclosed by a fibrous capsule made of connective tissue and connected to the periosteum of the bone

112
Q

Bursae

A

Small sacs filled with synovial fluid that serves to cushion joints
Found in some synovial joints

113
Q

Osteoporosis

A

Disease in which bones demineralize and become porous and fragile, making them susceptible to fractures
More common as a person ages because that is when bone resorption increases, calcium absorption decreases and production of osteoblasts decrease

114
Q

Uncontrollable risk factors of osteoporosis

A

Age
Gender
Fam history
Previous fracture
Ethnicity
menopause/hysterectomy
long-term glucocorticoid therapy
rheumatoid arthritis
primary/secondary hypogonadism in men

115
Q

Modifiable risk factors of osteoporosis

A

Alcohol
smoking
low body mass index
poor nutrition
vitamin D deficiency
eating disorders
low dietary calcium intake
insufficient exercise (sedentary lifestyle)
frequent falls

116
Q

Herniated lumbar disc or ankylosing spondylitis

A

May see a flattened lumbar curvature of the thoracic spine

117
Q

Scoliosis

A

Lateral curvature of the thoracic spine with an increase in the convexity on the curved side

118
Q

Lordosis

A

An exaggerated lumbar curve just above the butt
Often seen in pregnancy and obesity

119
Q

Testing ROM of cervical spine

A

Have client touch chin to chest (flexion) and to look up at the ceiling (hyperextension)

120
Q

Cervical strain

A

Most common form of neck pain
Characterized by impaired ROM and neck pain from abnormalities of the soft tissue due to straining or injuring the neck

121
Q

Signs of dislocation

A

Flat, hollow, or less rounded shoulder

122
Q

Signs of rotator cuff tear

A

Painful and limited abduction accompanied by muscle weakness and atrophy

123
Q

Lesion of cranial nerve XI sign

A

Inability to shrug shoulders against resistance

124
Q

Testing ROM of lumbar spine

A

Client bends forward and touches toes (flexion)

125
Q

Leg measurement findings

A

Unequal are associated with scoliosis
Equal true lengths but unequal apparent lengths are seen with abnormalities in the structure or position of the hips and pelvis

126
Q

Rotator cuff tendonitis findings

A

Sharp pain when bringing hands overheard

127
Q

Calcified tendinitis findings

A

Chronic pain and severe limitations of all shoulder movement

128
Q

Rheumatoid arthritis findings

A

Tenderness and nodules on wrist and hands

129
Q

Squeeze test

A

Squeeze patients hand across the knuckle joints
Extreme pain may indicate rheumatoid arthritis and psoriatic arthritis of the hand

130
Q

Phalen test

A

Client places the backs of both hands against each other while flexing the wrist 90 degrees with fingers pointed downward and wrists dangling
If tingling, numbness, burning or pain develop within a minute then carpal tunnel syndrome is suspected

131
Q

Test for tinel sign

A

Use fingers to percuss lightly over the median nerve (located on the inner aspect of the wrist) tingling or shocking sensation experienced with test
Also test for carpal tunnel

132
Q

Genu Valgum

A

Knees turn in with knock knees

133
Q

Genu varum

A

Knees turn out with bowed legs

134
Q

Ballottement test

A

Helps to detect large amounts of fluid in the knee
Client in supine position
Firmly push the patella
This displaces fluid in the suprapaterllar bursa
Fluid waves or chick is palpated with large amounts of effusion
Positive result mat be present with meniscal tears

135
Q

Pes planus

A

Feet with no arches
Flat feet

136
Q

Pes cavus

A

Feet with high arches

137
Q

Corns

A

Painful thickening of the skin over bony prominences and at pressure points

138
Q

Calluses

A

Nonpainful thickened skin that occurs at pressure points

139
Q

Verruca vulgaris

A

Painful warts
Plantar warts if under a callus

140
Q

Plantar fasciitis

A

Indicated by tenderness of the calcaneus of the bottom of the foot
Most common cause of heel pain

141
Q

Kyphosis

A

Rounded thoracic convexity

142
Q

Acute rheumatoid arthritis

A

Painful, tender, swollen stiff joints are seen

143
Q

Chronic rheumatoid arthritis

A

Chronic swelling and thickening of the metacarpophalangeal and proximal interphalangeal joints, limited range of motion and finger deviation towards the ulnar side

144
Q

Boutonnière deformities

A

Wrist abnormality
Flexion of the proximal interphalangeal joint and hyper extension of the distal interphalangeal joint
Commonly seen in chronic rheumatoid arthritis

145
Q

Swan neck deformity

A

Wrist abnormality
Hyper extension of the proximal interphalangeal joint and flexion of the distal interphalangeal joint
Commonly seen in chronic rheumatoid arthritis

146
Q

Ganglion

A

Wrist abnormality
Non-tender round, enlarged swollen fluid filled cysts
Commonly seen at the dorsum of the wrist

147
Q

Osteoarthritis

A

Wrist abnormality
Degenerative joint disease
Osteoarthritis nodules on the dorsolateral aspects of the distal interphalangeal joints are due to the bony overgrowth of osteoporosis
Usually hard and painless, they may affect middle-aged or older adults and often, although not always are associated with arthritic changes and other joints

148
Q

Tenosynovitis

A

Wrist abnormality

Infection of the flexor tendon Sheaths
Painful extension of a finger may be seen in acute tenosynovitis

149
Q

Thenar atrophy

A

Wrist abnormality
Atrophy of the thenar prominence due to pressure on the median nerve
Is seen in carpal tunnel syndrome

150
Q

Acute gouty arthritis

A

The metatarsophalangeal joint of the great toe is tender, painful, red, and hot and swollen

151
Q

Hallux valgus

A

An abnormality in which the great toe is deviated laterally and may overlap the second toe
Enlarged painful, inflamed, bursa or bunion may form on the medial side

152
Q

Hammer toe

A

Hyper extension at the metatarsophalangeal joint with flexion at the proximal interphalangeal joint
commonly occurs with the second toe

153
Q

Plantar warts

A

Painful warts (verruca vulgaris) that often occur under a callus appearing as tiny dark spots

154
Q

Jobs of the nervous system

A

Receive sensory stimuli from the environment
Identifies an integrates adaptive processes needed to maintain current body functions
Orchestrates body functions required for adapting and surviving
Integrate rapid response of the central nervous system and response of the endocrine system
Controls voluntary and cognitive behavioral processes
Controls subconscious and involuntary body functions

155
Q

Three major functioning units of nervous system

A

Spinal cord level
Brain stem and subcortical level
Cortical level

156
Q

Spinal cord level

A

Lowest functional level
Controls automatic, motor responses (reflexes)

157
Q

Brainstem and some subcortical level

A

What keeps you alive
Controls blood pressure, respiration, equilibrium, and primitive emotion
Vital sign *

158
Q

Cortical level

A

Responsible for cognition
Higher level thinking
Learning and applying

159
Q

Central nervous system

A

The brain and the spinal cord
The network of coordination and control of the body

160
Q

Peripheral nervous system

A

Motor and sensory nerves and ganglia outside of the central nervous system
Carries information to and from the central nervous system

161
Q

What makes up the peripheral nervous system

A

12 pairs of cranial nerves
31 pairs of spinal nerves
Autonomic nervous system
-Sympathetic
-parasympathetic

162
Q

The brain

A

Receives blood supply from the two internal carotid arteries and two vertebrae arteries that joined to form the basilar artery
Blood supply - 15-20% of total cardiac output goes to the brain (brain is selfish)

163
Q

Three major units of the brain

A

Cerebrum
Cerebellum
Brainstem

164
Q

Cerebrum

A

Two cerebral hemispheres - divided into lobes

165
Q

Outer layer of cerebrum

A

Gray matter of the cerebral cortex
- higher mental function, general movement, visceral functions, perception, behavior
- Integrates the functions

166
Q

Inner layer of cerebrum

A

White matter of the cerebral cortex
- nerve fibers and myelin

167
Q

Myelin

A

Encases nerve fibers to allow them to transmit
Issues with it causes neuro issues and deficits

168
Q

Disorders of the cerebrum

A

Multiple sclerosis
CMV
Encephalitis
Folate or Vitamin B12 deficiency
Vasculitis
PKU

169
Q

Frontal Lobe

A

Part of cerebrum
Motor cortex
Voluntary skeletal movement and fine repetitive motor movements, eye movements (NOT vision)

170
Q

Parietal lobe

A

Part of the cerebrum
*Processing received sensory data
Assist in interpretation of tactile, visual, gustatory, olfactory, auditory sensations
Recognition of body parts and body position
*Communication between sensory and motor areas of the brain

171
Q

Occipital lobe

A

Part of the cerebrum
Primary vision center
Provides interpretation of visual data

172
Q

Temporal lobe

A

Part of the cerebrum
Perception and interpretation of sounds and determination of the source
Integration of taste, smell balance reception, and interpretation of speech

173
Q

Broca Area

A

Responsible for speech PRODUCTION
Closer to front of the brain
Located between temporal lobe and frontal lobe

174
Q

Wernicke Area

A

Responsible for speech INTERPRETATION
Closer to back of brain
Located between temporal lobe, occipital love and parietal lobe

175
Q

Cerebellum

A

Aids the motor cortex of the cerebrum in the integration of voluntary movement
Processes sensory information from the eyes ears, and touch receptors

176
Q

Cerebellum and vestibular system

A

Work together for reflexive control of muscle tone equilibrium, and posture to produce study and precise movements

177
Q

Causes of cerebellum disorders

A

Congenital malformations, hereditary ataxias and acquired conditions
Symptoms vary with the cause typically include ataxia

178
Q

Ataxia

A

Impaired muscle coordination

179
Q

Brainstem

A

Pathway between cerebral cortex and the spinal cord
Controls many involuntary movements

180
Q

Parts of brainstem

A

Medulla oblongata
Pons
Midbrain
Diencephalon
Nuclei contain 12 cranial nerves

181
Q

Reticular formation

A

Part of the brainstem
Contains in network fibers for muscle stimulation
-counteracts gravitational forces
-regulates, cardiac and respiratory systems
-maintains consciousness

182
Q

Medulla oblongata

A

Part of brainstem
CN IX -XII (9-12)
Respiratory, circulation, vasomotor activities, houses respiratory center
Reflexes - swallowing, coughing, vomiting, sneezing, hiccuping

183
Q

Pons

A

Part of brainstem
CN V-VIII (5-8)
Regulates, respiration, houses portion of respiratory center, control controls, voluntary muscle action

184
Q

Midbrain

A

Part of brainstem
CN III-IV (3-4)
Reflex center for eyes and head movement, auditory relay pathway

185
Q

Thalamus

A

Part of the brainstem
Perception of pain
temperature control

186
Q

Epithalamus

A

Pineal body
Sexual development and behavior

187
Q

Hypothalamus

A

Part of the brainstem
*Major processing center of stimuli for autonomic nervous system
Maintains temperature control, H2O metabolism, body fluid osmolarity, eating behavior, neuroendocrine activity

188
Q

Pituitary gland

A

A.k.a. master gland
Hormonal pros control
Lactation, vasoconstriction and metabolism

189
Q

Decerebrate posture

A

Usually means severe brain stem injury
Arms and legs extended
Toes pointed downward
Head and neck arched backwards
Muscles rigid

190
Q

Decorticate posture

A

Arms flexed, clenched fists
Extended legs that are held out straight
Arms are bent inward towards the body with wrist and fingers bent and held on the chest
Muscles are rigid

191
Q

Spinal Cord

A

40 to 50 cm
Fibers grouped in two tracks that run through the spinal cord carrying sensory, motor, and autonomic impulses between higher centers of the brain and the body

192
Q

Make up of spinal cord

A

32 pairs of spinal nerves
Myelin - coated white matter containing the ascending and descending tracks
Gray matter contains nerve cells, bodies arranged in a butterfly shape with anterior and posterior horns

193
Q

Ascending tract

A

Carries sensory data to the brain
Mediates various sensations, facilitate century signals for complex discrimination for touch, pressure, vibration, and position of joint
Two point discrimination

194
Q

Descending Tract

A

Carries motor impulses from the brain
Conveys impulses to various muscle groups by inhibiting or exciting spin activity

195
Q

Cranial nerves

A

I - Olfactory
II - Optic (not PNS)
III - Oculomotor
IV - Trochlear
V - Trigeminal
VI - Adbucens
VII -Facial
VIII - Acoustic
IX - Glosso-pharyngeal
X - Vagus
XI - Accessory
XII - Hypoglossal

196
Q

Cranial Nerve I

A

Olfactory - smell (sensory)

197
Q

Cranial Nerve II

A

Optic - vision (sensory)

198
Q

Cranial Nerve III

A

Oculomotor - upward, downward, medial eye movement, lid elevation, pupil constriction (motor)

199
Q

Cranial Nerve IV

A

Trochlear - downward, medial, eye movement (motor)

200
Q

Cranial Nerve V

A

Trigeminal
- face, scalp, nasal mucosa, buccal mucosa (sensory)
- jaw muscle, massager muscle, temporal, digastric muscle (motor)

201
Q

Cranial Nerve VI

A

Abducens - lateral eye movement (motor)

202
Q

Cranial Nerve VII

A

Facial
- external ear, taste anterior side 2/3 of tongue (sensory)
- facial movement, scalp, salivation, lacrimation (motor)

203
Q

Cranial Nerve VIII

A

Acoustic - cochlear hearing (sensory)

204
Q

Cranial Nerve IX

A

Glossopharyngeal
- external ear, taste posterior 1/3 carotid reflexes, sinus, baro and chemoreceptors (sensory)
- gag, swallow and salivation (motor)

205
Q

Cranial Nerve X

A

Vagus
- external ear, pharynx (sensory)
- swallow, pronation, bronchoconstriction, gastric secretion, peristalsis (motor)

206
Q

Cranial Nerve XI

A

Accessory - Swallow, pharyngeal muscles, head turn and shoulder rise (motor)

207
Q

Cranial Nerve XII

A

Hypoglossal - tongue muscle, Hypoglossus (motor)

208
Q

Sensory Cranial Nerves

A

I olfactory
II optic
VIII acoustic

209
Q

Motor Cranial Nerves

A

III Oculomotor
IV trochlear
VI abducens
XI accessory
XII Hypoglossal

210
Q

Both motor and sensory cranial nerves

A

V Trigeminal
VII Facial
IX Glossopharyngeal
X Vagus

211
Q

CN I II III IV VI

A

Responsible for smell, visual acuity, pupillary constriction, extraocular movement

212
Q

CN VII and IX

A

Control taste

213
Q

Spastic hemiparesis

A

Affected leg stiff and extended
Foot dragged, scraping of toes, affected arm flexed, adducted, no swing

214
Q

Ataxia

A

Uncoordinated uncontrolled falling occurs

215
Q

Parkinsonian

A

Stooped, rigid, short shuffling steps starting, difficulty stopping

216
Q

Glasgow coma scale

A

Way to measure mental status and LOC
Awake/alert - follows commands
Lethargic - drowsy - tap awake
Stuporous - shake or shout to wake
Comatose - does not response to verbal cues or painful stimuli

217
Q

Orientation status

A

X4
Person - name and DOB
Place - where are you
Time - day, month, season
Situation - why are you hear

218
Q

Cerebral function test

A

Difficulty with memory?
recollection of past easier then present?
Perform immediate memory test:
Repeat numbers backwards forward
Recent memory test:
Dietary recall
Remote memory test:
Past jobs and birth place

219
Q

Mini mental status exam

A

Most often used in the elderly
Assesses:
Orientation
Registration
Attention/calculation
Recall
Language

220
Q

Mental status change

A

Early indication of change in neurological status
Can be subtle and difficult to detect
May begin slowly

221
Q

Causes of mental status change

A

Neurological issues, fluid and electrolyte imbalance, hypoxia, poor perfusion, nutritional deficiencies, infections, renal and liver disease, hyper/hypothermia, trauma, medication/toxin, drug/alcohol abuse

222
Q

Proprioception

A

Posterior columns of spinal cord
Carries stimuli and fibers for touch
Ability to maintain posture, balance, and coordination
Works with cerebellum

223
Q

Testing cerebellar function

A

Finger to nose and finger nose finger movements
Rapid alternative movements (thumb to 4 fingers as rapidly as possible) note speed/accuracy
Heel to ship
Romberg test
Tandem/tip toe walking

224
Q

Testing somatic sensation function

A

Sensation:
- dermatones and major peripheral nerves
- forehead, cheek, hand foot
Light touch:
- wisp of cotton
Pain & temp:
Sharp/dull and hot/cold
Vibration:
Tuning fork on body prominence
Ask localization stop and start

225
Q

Dermatomes

A

Relationship between the spinal nerves and skin sensation
Each spinal nerves root provides a sensation to a predicable area of the skin although there is a lot of overlap

226
Q

Deep tendon reflexes (DTR)

A

Biceps
Triceps
Brachiordialis (wrist)
Patellae
Plantar (bottom of foot)
Achilles

227
Q

DTR grading scale

A

0 - no response
1 - low normal/slightly diminished
2 - normal
3 - more brisk than normal / not necessarily associated with disease
4 - brisk, hyperactive, associated with disease

228
Q

DTR strength scale

A

5 - active motion against full resistance, normal
4 - active motion against some resistance, slight weakness
3 - active motion against gravity, average weakness
2 - passive ROM (assisted by examiner), poor ROM
1 - slight flicker of contraction, severe weakness
0 - no muscular contraction, paralysis

229
Q

Primitive reflexes

A

Sucking
Rooting
Moro
Babinski
Glabellar
Palmar/grasp
Plantar
Tonic neck

230
Q

Cremasteric reflex

A

When stroke thigh, testicle on that side should elevate

231
Q

Vertigo

A

Sensation that everything is “spinning” can be accompanied with nausea, vomiting, nystagmus

232
Q

Syncope

A

Temporary loss of consciousness “blackout”, “how to spell”

233
Q

Paresthesia

A

Numbness or tingling
Symptoms can be benign or they can be serious such as an impending CVA, requires thorough investigation

234
Q

Possible causes of paresthesia

A

Diabetes, neurological, metabolic, cardiovascular, renal, inflammatory diseases, or toxins

235
Q

Multiple sclerosis

A

Immune, ruction of myelinated sheath

236
Q

Generalized seizure disorder

A

Systemic disease, head, trauma, toxins, stroke, hypoxic syndrome
S/s - disturbances and consciousness, behavior, common sensation, autonomic functioning
Urinary and fecal incompetence can occur

237
Q

Meningitis

A

Inflammation, bacterial or viral
Kernig sign
Brudzinski’s signs (tuck chin to chest, significant pain means meningitis)

238
Q

Limes disease

A

Comes from ticks
Three Stages:
Bull’s-eye rash
Cardio/Neuro symptoms
Arthritis/worse Neuro s/s
Rx by antibiotics

239
Q

Space occupying lesion

A

Primary or metastatic
S/s depend on location

240
Q

Cerebral Palsy

A

Nonprogressive

241
Q

Normal pressure hydrocephalus

A

Corrected by V-P shunt

242
Q

Spina Bifida

A

Neural tube defect (incomplete development of brain, spinal cord and/or protective coverings)

243
Q

Amyotrophic lateral sclerosis

A

From of MD
Weakens muscles
Progressive

244
Q

Brain attack or stroke

A

Cerevrovascular accident (CVA)
Sudden focal neurological deficit resulting from impaired circulation to/within the brain

245
Q

Causes of CVAs

A

Associated with cardiovascular disease
Thrombosis, embolism, hemorrhage cause circulation impairment
Most common site is within the distribution of the anterior circulation of the brain

246
Q

Warning signs of stroke

A

Sudden weakness, numbness, paralysis of face, arms,
legs especially on one side.
Sudden trouble with vision either one eye or both,
diplopia, monocular blindness
Sudden confusion, difficulty with speaking (dysarthria)
or understanding speech (aphasia)
Sudden severe headache without apparent reason
Sudden trouble walking, dizziness, loss of balance or
falling without reason, loss of coordination

247
Q

BEFAST

A

Balance - sudden loss
Eyes - vision loss
Face - uneven smile
Arm - weakness in one
Speech - slurred
Time - call 911 right away

248
Q

Parkinson’s Disease

A

Slow progression, degenerative, disorder of the dopamine neurotransmitters of the brain
Results in poor communication in the neuron system

249
Q

Causes of Parkinson’s disease

A

Questionable genetic, environmental components
Can be viral, vascular, toxic

250
Q

S/S of Parkinson’s

A

Tremors at rest, fatigue, masked facial expression, shuffling gait, muscle rigidity, “pill rolling”, behavioral changes and dementia, stiffness or slowing of movement

251
Q

Alzheimer’s Disease

A

Destruction of brain cells
Progressive, decline in memory and mental functions
**most common causes of dementia

252
Q

Causes of Alzheimer’s

A

Combination of genetics, lifestyle, environment
Increasing age - major risk factor, but it is NOT a normal process of aging

253
Q

Early vs Late onset of Alzheimer’s

A

Later onset more common
Early onset - age 30-60, <10% of all w/ Alzheimer’s, genetics

254
Q

Myasthenia Gravis

A

Disorder of peripheral nervous system
Chronic, autoimmune, involves lower motor neurons and muscle fibers
Immune system attacks synaptic junctions between nerve and muscle fibers

255
Q

Trigeminal Neuralgia (Tic Douloureux)

A

Disorder of Peripheral Nervous System
Affects 5th cranial nerve
Chronic, compression by a small artery, wears away the myelin
Possibly associated with MS, tumor, AVM, injury
Rx: meds/injection/surgery

256
Q

Bells Palsy

A

Disorder of peripheral nervous system
Affect 7th cranial nerve
Temporary facial paralysis from damage/trauma to facial nerves from swelling, inflammation, compression
Usually caused by virus, possible bacterial infection
Rx: antibiotics, prednisone

257
Q

Gillian Barre Syndrome (GBS)

A

Disorder of peripheral nervous system
Autoimmune, acute inflammatory demyelination of peripheral nerves
Rapidly progressive
?bacterial/viral cause

258
Q

Peripheral Neuropathy

A

Disorder of peripheral nervous system
Motor and sensory issues
Seen in hands/feet
Numbness/tingling/burning/cramping

259
Q

Causes of peripheral neuropathy

A

Diabetes
Toxins
Vitamin B12 deficiency
Autoimmune
Neurologic conditions

321 assessment of clients (7 decks)

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