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Advanced Health Assessment > Test #5- MS and Neuro > Flashcards

Test #5- MS and Neuro Flashcards

1
Q

DTR reflexes for biceps

A

C5-C6

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2
Q

DTR reflexes for brachioradialis

A

C5-C6

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3
Q

DTR reflexes for triceps

A

C6-C7

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4
Q

DTR reflexes for patellar

A

L2-L4

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5
Q

DTR reflexes for achilles

A

S1-S2

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6
Q

DTR responses below normal may imply

A

myopathies, decreased muscle mass, nerve root impairment

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7
Q

DTR responses above normal are characteristic of

A

pyramidal tract disease, electrolyte imbalances, hyperthyroidism

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8
Q

new onset radicular pain in older adults is frequently

A

spinal stenosis

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9
Q

patients with bulging discs are

A

asymptomatic

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10
Q

triad of Meniere disease

A

vertigo, hearing loss, and tinnitus

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11
Q

headache is caused by an abnormal metabolism of

A

serotonin, norepi, and dopamine

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12
Q

Headaches of new onset in the elderly tend to have a

A

secondary cause (tumor, bleed)

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13
Q

“worse headache of my life”

A

subarachnoid hemorrhage

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14
Q

Headache worse in the am, deep pain, aggravated by coughing, sneezing

A

brain tumor

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15
Q

Morning headaches worse in the occipital region

A

HTN

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16
Q

Headaches worse when bending over, nasal congestions, facial tenderness

A

sinusitis

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17
Q

Severe headache, tachycardia, diaphoresis

A

pheochromocytoma

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18
Q

Orbital headache

A

acute angle glaucoma

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19
Q

diagnostics for headache

A

CT/MRI, sinus series, CBC, CMP, TSH, EEG, lumbar puncture

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20
Q

risk factors for migraine

A

family hx, female, alcohol, estrogen replacement

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21
Q

foods that can affect migraines

A

food containing tryptophan or tyramine (ripe cheese, red wine, chocolate)

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22
Q

neurotransmitter involved in migraine

A

serotonin

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23
Q

5 phases of migraines

A

prodrome, aura, headache, termination, postdrome

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24
Q

phase of migraine where pt experiences mood swings, fatigue, food craving, yawning

A

prodrome

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25
Q

phase of migraine where pt experiences visual disturbances, visual field cuts, flashing lights, zigzag patterns, floaters

A

aura

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26
Q

phase of migraine where pt experiences unilateral headache that is throbbing, anorexia, N/V, photophobia, vertigo

A

headache phase that lasts 4-72 hours

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27
Q

phase of migraine that usually occurs with sleep or meds

A

termination of headache

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28
Q

foods to avoid for migraines

A

MSG, nitrite-containing food (hot dog), tyramine-containing food

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29
Q

POUND symptoms of migraine

A 
Pulsatile or throbbing
One-day duration, or lasts 4-72 hours 
Unilateral
Nausea or vomiting
Disabling or intensity causing interruption of daily activity.
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30
Q

this type of headache rarely occurs in children and pregnancy

A

cluster headache

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31
Q

risk factors for cluster headache

A

male, age >30, alcohol intake, use of NTG, excessive caffeine/nicotine

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32
Q

commonly referred to as suicide headache

A

cluster headache

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33
Q

peak and duration of cluster headache

A

peaks in 15 min, lasts less than 3 hours

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34
Q

characteristics of cluster headache

A

deep, severe, unilateral, and episodic

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35
Q

associated s/s with cluster headache

A

lacrimation, rhinorrhea, ptosis, injected conjunctiva

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36
Q

typical time of onset for tension headache

A

after age 20, before 50

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37
Q

type of headache that involves precranial muscle tenderness

A

tension type headache

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38
Q

risk factors for tension type headache

A

stress, worry, jaw-clenching

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39
Q

s/s of tension type headache

A

bilateral pressure around head, nonthrobbing, palpable muscle tightness, stiffness in neck, upper shoulders, and scalp.

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40
Q

onset and duration of tension type headache

A

gradual and lasts 30 min-7 days

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41
Q

vertigo is accompanied by

A

nystagmus and ataxia

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42
Q

vertigo can be caused by

A

benign positional vertigo, labyrinthitis, and Meniere’s disease

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43
Q

difference b/t syncope and presyncope

A

in presyncope patient does not lose consciousness

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44
Q

vasovagal syncope is d/t

A

deceased cardiac output

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45
Q

meds that can cause syncope

A 
antihypertensives
antiarrythmics
antidepressants
diuretics
phenothiazines
vasodilators.
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46
Q

diagnostics for syncope

A

CMP, BP in both arms, 24-hr ECG monitoring, neuro exam, tilt test

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47
Q

Bell’s palsy affects CN

A

VII- facial

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48
Q

causes of Bell’s palsy

A

idiopathic, viral, exposure to cold, herpes zoster, Lyme disease

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49
Q

risk factors for Bell’s palsy

A

age > 30, Lyme disease, pregnancy, family hx, DM, herpes zoster

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50
Q

S/S of bell’s palsy

A

unilateral numbness and paralysis, sensitivity to sound, loss of taste

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51
Q

Diagnostic for bell’s palsy

A

CT to r/o stroke, EMG testing

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52
Q

trx for bell’s

A

eyedrops, patch on affected eye at night

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53
Q

trigeminal neuralgia affects CN

A

5

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54
Q

s/s of trigeminal neuralgia

A

severe pain in lip, gum, cheek that is worse with touch or changes in temp. pain occurs in bursts.

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55
Q

onset and duration of labyrinthitis

A

sudden onset that can last for up to 2 weeks. recurrence is common

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56
Q

in labyrinthitis, these are not affected

A

hearing and tinnitus

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57
Q

labyrinthitis can also cause

A

N/V, nystagmus

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58
Q

risk factors for stroke

A

HTN, HLD, DM, obesity, smoking, lack of exercise, alcohol, OCP, CV disease, afib, and carotid artery disease

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59
Q

stroke outcomes are improved it therapy is given within

A

3 hours of onset of symptoms

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60
Q

most common cause of ischemic stroke symptoms is occlusion of the

A

middle cerebral artery

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61
Q

Occlusion of the left middle cerebral artery produces

A

aphasia

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62
Q

occlusion of the right middle cerebral artery produces

A

neglect to opposite side of body

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63
Q

AHA stroke warning signs

A

numbness, confusion, vision problems, trouble walking, severe headache

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64
Q

goal BP and A1c for stroke prevention

A

less than 130/80 and 7%

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65
Q

two kinds of stroke

A

ischemic and hemorrhagic

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66
Q

TIA is characterized as

A

cerebral ischemia without infarction that lasts less than 24 hours

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67
Q

Begins with motor symptoms characterized by recurrent contractions of muscles in one part of the body.

A

partial seizure

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68
Q

begin in one part of the body and progress to contiguous body parts over seconds or minutes.

A

simple partial seizure

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69
Q

seizure that impairs consciousness

A

complex partial seizure

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70
Q

Seizure that is bilaterally symmetrical but without local onset

A

generalized seizure

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71
Q

brief arrest of activity and loss of consciousness.

A

petit mal seizure

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72
Q

seizure where muscle movements are repetitive.

A

myoclonic seizure

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73
Q

causes of seizures

A

alcohol withdrawal, brain tumor, hypoxia, stroke, fever, head injury, meningitis

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74
Q

highest incidence of seizures is in

A

children and elderly

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75
Q

Inflammation of the brain and spinal cord caused by infection with bacteria, viruses, and fungi.

A

meningitis

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76
Q

bacterial causes of meningitis

A

Strep pneumonia, Group B or D Strep, N. meningitides

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77
Q

viral causes of meningitis

A

enterovirus

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78
Q

Fungal causes of meningitis

A

candida species, aspergillus

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79
Q

s/s of meningitis

A

stiff neck, fever, N/V, rash, nuchal rigidity, photophobia

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80
Q

clinical signs of meningitis

A

Kernig and Brudzinski sign

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81
Q

where complete extension of leg causes neck pain and flexion

A

Kernig sign

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82
Q

flexion of legs if neck is passively flexed.

A

Brudzinski sign

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83
Q

CSF in meningitis

A

turbid with WBC and high protein

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84
Q

CSF in bacterial meningitis

A

glucose is decreased

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85
Q

Diagnosis of PD is supported by therapeutic response to

A

levodopa

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86
Q

Parkinson’s is caused by decreased production of

A

dopamine

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87
Q

risk factors for parkinson’s

A

age > 60, family hx

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88
Q

S/s of parkinson’s

A

bradykinesia, muscular rigidity, resting tremor, postural instability

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89
Q

characterized by demyelination of nerve cells in the brain and spinal cord.

A

Multiple sclerosis

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90
Q

risk factors for MS

A

family hx and northern european descent

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91
Q

s/s of MS

A

intermittent; paresthesias, weakness, stiffness to extremities, transient blindness, nystagmus, scanning speech, intention tremor.

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92
Q

diagnostic of MS

A

MRI

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93
Q

CN I

A

olfactory- smell

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94
Q

CN II

A

optic- vision

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95
Q

CN III

A

occulomotor- pupillary response

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96
Q

CN IV

A

trochlear- downward, internal rotation of eye

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97
Q

CN V

A

trigeminal- corneal reflex, facial sensation, jaw movement

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98
Q

CN VI

A

abducens- lateral deviation of eye

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99
Q

CN VII

A

facial- facial movement

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100
Q

CN VIII

A

vestibulocochlear- balance and hearing

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101
Q

CN IX

A

glossopharyngeal- movement of pharynx

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102
Q

CN X

A

vagus- gag reflex

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103
Q

CN XI

A

spinal accessory- shoulder and neck

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104
Q

CN XII

A

hypoglossal- tongue

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105
Q

abd upper reflex

A

T8-T10

106
Q

abd lower reflex

A

T10-T12

107
Q

Plantar response (babinksi)

A

L5, S1

108
Q

anal reflex

A

S2-S4

109
Q

sprain is partial tearing or stretching of

A

ligaments

110
Q

Grade III sprain

A

completely torn ligament, unstable joint

111
Q

an injury to a muscle or tendon usually associated with improper use or overuse.

A

strain

112
Q

If increased ROM occurs at any injured joint, suspect

A

severe tear of rupture of ligament

113
Q

s/s of sprain

A

pain and swelling around joint, redness, bruising, audible pop at time of injury, discomfort on weight bearing

114
Q

suspicion of fracture if there is

A

exquisite tenderness, pain, inability to bear weight

115
Q

trx for sprains

A

Rest, Ice every hour x20 min for first 24 hours, then 4x/day, compression, and elevation

116
Q

pain meds for sprains

A

NSAIDs for adults, acetaminophen for children

117
Q

inflammation of synovial membrane

A

bursitis

118
Q

bursitis occurs in areas where

A

friction is likely to occur

119
Q

Bursitis is often secondary to

A

calcific tendonitis

120
Q

risk factors for bursitis

A

trauma, overuse, gout, RA, OA, obesity, age

121
Q

s/s of bursitis

A

aching pain and swelling over joint, decreased ROM,

122
Q

entrapment neuropathy of the median nerve at the wrist d/t inflammation of wrist tendons, transverse carpal ligament, and/or surrounding soft tissue.

A

carpal tunnel

123
Q

risk factors for carpal tunnel

A

age 40-60, repetitive movement of wrist, weight gain, pregnancy, arthritis, hypothyroidism

124
Q

s/s of carpal tunnel

A

paresthesias affecting fingers (esp at night), dull/aching and weakness, affected hand cool to touch.

125
Q

clinical tests for carpal tunnel

A

phalen and tinel test

126
Q

test where pt holds flexed fingers against each other with wrists flexed at a 90 degree angle for 60 seconds. Considered positive for CPS if paresthesia occurs.

A

Phalen’s test

127
Q

test where you percuss over the median nerve on the volar aspect of the wrist. Considered positive for CPS if paresthesia occurs.

A

Tinel’s test

128
Q

diagnostic for CPS

A

nerve conduction studies, EMG

129
Q

if CPS is untreated then there is a risk of

A

permanent loss of function to affected hand

130
Q

Deposition of monosodium urate (MSU) crystals in joints and other connective tissue causing acute or chronic inflammation

A

gouty arthritis

131
Q

causes of gouty arthritis

A

overproduction or underexcretion of uric acid, dietary excess of purine, alcoholism

132
Q

gouty arthritis is common in

A

men > 45 years old

133
Q

meds that can cause gouty arthritis

A

ASA, nicotinic acid, diuretics, cyclosporine

134
Q

risk factors for gouty arthritis

A

alcoholism, renal disease, psoriasis, family hx, obesity, HTN

135
Q

most commonly affected in gouty arthritis

A

MTP of first toe

136
Q

s/s of gouty arthritis

A

acute joint pain and swelling, warmth and erythema

137
Q

elevated in gouty arthritis

A

ESR and WBC

138
Q

in an acute attack of gouty arthritis, the uric acid is

A

normal.

139
Q

not useful in diagnosing gouty arthritis

A

uric acid level

140
Q

allopurinol

A

decreased production of uric acid

141
Q

med for acute attacks of gouty arthritis

A

NSAID

142
Q

desirable level of uric acid

A

less than 7 mg/dl

143
Q

Progressive destruction of the articular cartilage and subchondral bone accompanied by osteophyte formation and sclerosis

A

osteoarthritis

144
Q

OA is confined to the

A

joints only

145
Q

risk factors for OA

A

age > 40, obesity, overuse of joints, family hx, hemophilia, Paget’s disease

146
Q

s/s of OA

A

asymmetrical joint pain, morning stiffness less than an hr

147
Q

nodes in OA

A

Heberden’s and Bouchard’s nodes

148
Q

node in distal interpharyngeal joints

A

Heberden

149
Q

node in proximal interpharyngeal joints

A

Bouchard

150
Q

in OA, inflammation markers are

A

negative

151
Q

med considered first line for OA

A

Tylenol

152
Q

An autoimmune disease that is systemic, frequently progressive, and is characterized by inflammation and thickening of synovial membrane

A

RA

153
Q

risk factors for RA

A

white, native american, age 30-50

154
Q

juvenile onset of RA begins at

A

1-3 years

155
Q

s/s of RA

A

weakness, anorexia, weight loss, lymphadenopathy, low-grade fever

156
Q

in RA, joint pain and stiffness occur

A

at rest and with movement that lasts > 1 hour in morning

157
Q

these 4 symptoms must be present for at least 6 weeks to diagnose RA

A

morning stiffness > 1 hour, swelling of 3 or more joints, swelling of at least 1 joint in hand/wrist, and symmetrical joint swelling

158
Q

xray in RA shows

A

joint space narrowing, bone erosion, reduced bone density

159
Q

these are elevated in RA

A

RF, ESR, ANA, and C-reactive protein

160
Q

a good measure of RA activity

A

ESR

161
Q

post menopausal fractures occur b/c of

A

lack of estrogren

162
Q

risk factors for osteoporosis

A

genetic, estrogen deficiency, calcium deficiency, alcohol and nicotine

163
Q

Meds that can cause osteoporosis

A

corticosteroids, anticonvulsants, thyroid supplements

164
Q

s/s of osteoporosis

A

asymptomatic until fracture occurs

165
Q

trx for osteoporosis

A

1500 mg of calcium and 1000 IU of vit d

166
Q

describes a disorder of the roots of the spinal nerves d/t compression, inflammation, or tearing of nerve roots at the site of entry into the vertebral canal

A

radiculopathy

167
Q

common cause of low back pain

A

Compression or irritation of a nerve root

168
Q

discs most commonly affected in low back pain

A

L4-L5, and L5-S1

169
Q

s/s of low back pain

A

pain in back, buttocks, and/or one or both thighs

170
Q

consider x-ray if patient presents with these with low back pain

A

age > 50, neuro deficits, hx of cancer, weight loss, substance abuse, trauma

171
Q

apply heat to back pain after

A

first 48 hours

172
Q

med for back pain

A

NSAIDs

173
Q

straight leg raise and dorsiflexion of foot indicates

A

sciatica

174
Q

migraines are thought to result from a longer period of

A

vasodilation

175
Q

triggers for migraines

A

sounds, odors, estrogen fluctuations with menses

176
Q

vomiting can be a sign of

A

increased intracranial pressure

177
Q

patients with cluster headaches have worse pain when

A

lying down

178
Q

tenderness over nodular temporal arteries is a sign of

A

temporal arteritis

179
Q

most common type of migraine

A

migraine without aura

180
Q

Vasculitis of the ophthalmic and posterior ciliary branches of the internal carotid artery.

A

temporal arteritis

181
Q

temporal arteritis affects those who are

A

more than 50 years old

182
Q

s/s of temporal arteritis

A

sharp pain over tender, nodular temporal artery

183
Q

a preceding headache in temporal arteritis can lead to

A

blindness that is permanent

184
Q

temporal arteritis is a

A

medical emergency

185
Q

diagnostic of temporal arteritis

A

ESR greater than 50 mm/hr

186
Q

OA is more ____ and RA is more ______

A

degenerative; inflammatory

187
Q

OA results in

A

spur development

188
Q

rheumatoid arthritis nodules

A

soft and spongy that appear on elbows, forearms, and hands.

189
Q

characterized by chronic fatigue, generalized musculoskeletal pain, and multiple trigger points of pain on physical exam.

A

fibromyalgia

190
Q

fibromyalgia affects mostly

A

women ages 20-50

191
Q

s/s of fibromyalgia

A

pain over trigger points, sleep problems, depression, OCD, and IBS

192
Q

sharp, burning pain that radiates down the posterior and lateral leg to the foot or ankle.

A

sciatica

193
Q

chronic back pain is for more than

A

3 months

194
Q

the most common cause of sciatica is

A

herniated disk

195
Q

The MCPs are often boggy or tender in

A

RA

196
Q

crepitus with flexion and extension of the knee is indicative of

A

OA

197
Q

these maneuvers worsen sciatica

A

coughing and valsalva

198
Q

Clinical test where you draw the tibia forward and observe if it slides forward from under the femur.

A

Anterior test drawer

199
Q

anterior test drawer tests for

A

ACL tear

200
Q

clinical test where you push the tibia posteriorly and observe the degree of backward movement in the femur.

A

posterior test drawer

201
Q

posterior test drawer tests for

A

PCL tear

202
Q

talar tilt test tests for

A

excessive ankle inversion

203
Q

clinical test where you apply force medially to the ankle and note the degree of inversion.

A

talar tilt test

204
Q

inability to bear weight after four steps and tenderness over the posterior aspects of either malleolus.

A

ottawa rules for ankle

205
Q

A click is palpable or audible as the hip is reduced by abduction

A

ortolani

206
Q

A palpable click is heard when the hips are guided into mild adduction.

A

barlow

207
Q

when the patient lays on stomach and the examiner applies downward pressure to the patient’s foot, internally and externally rotating the lower leg.

A

Apley test

208
Q

with the knee extended, the knee is milked downward and pressure is placed behind the lateral margin. A fluid wave is felt.

A

bulge sign

209
Q

bulge sign is indicative of

A

knee effusion

210
Q

apley test is to test for

A

meniscus injury

211
Q

lachman test is to diagnose

A

ACL tear

212
Q

test where the knee is flexed and externally rotated. Then you pull the tibia forward and push femur back.

A

lachman tests

213
Q

McMurray test is used to help diagnose for

A

meniscus tear

214
Q

test where you place the patient supine and internally rotate the foot and apply varus force to the knee, a click may be heard.

A

McMurray test- lateral meniscus tear

215
Q

test where you place the patient supine and externally rotate the foot and apply vaglus force to the knee, a click may be heard

A

McMurray test- medial meniscus tear

216
Q

Q angle helps to diagnose for

A

patellar tendinitis (jumper’s knee)

217
Q

Q angle measures the angle between the center of the _____ to the anterior superior ____ and from the center ___ to the ____ ____.

A

patella; iliac spine; patella; tibial tubercule

218
Q

test when the flexed abducted knee is pushed medially and the ankle is pulled laterally. It is positive if the patient has pain

A

valgus stress test

219
Q

valgus stress test helps diagnose

A

MCL tear

220
Q

test when the flexed abducted knee is pushed laterally and the ankle is pulled medially. It is positive if the patient has pain

A

varus stress test

221
Q

Finkelstein test helps diagnose for

A

Quervain tenosynovitis

222
Q

when patient flexes fingers over a clenched thumb, then passively deviate wrist ulnarly which can cause pain.

A

Finkelstein test

223
Q

An Q angle greater than ___ degrees in males and __ degrees in females is positive.

A

10; 15

224
Q

DTRs in MS are

A

increased

225
Q

c/o pain with movement

A

tendonitis

226
Q

varus stress test helps diagnose for

A

LCL tear

227
Q

rooting reflex occurs in ages

A

birth to 3-4 months

228
Q

rooting reflex

A

stroke perioral skin at mouth, mouth will open and baby will turn toward the side and suck

229
Q

moro (startle) reflex occurs in ages

A

birth to 4 months

230
Q

moro (startle) reflex

A

lower body and arms should extend and feet flex

231
Q

asymmetric tonic neck reflex occurs in age

A

birth to 2 months

232
Q

asymmetric tonic neck reflex

A

turn head to one side. the arm and leg that the head is turned will extend while the other side will flex.

233
Q

trunk incurvation (galant’s) reflex occurs in ages

A

birth to 2 months

234
Q

trunk incurvation (galant’s) reflex

A

support baby prone and stroke one side of the back and the spine should curve in that direction.

235
Q

landau reflex occurs in ages

A

birth to 6 months

236
Q

landau reflex

A

suspend baby prone with one hand, the head will lift and spine will straighten.

237
Q

parachute reflex occurs in ages

A

8 months and doesn’t disappear

238
Q

parachute reflex

A

suspend baby prone and lower head, the arms and legs should extend.

239
Q

positive support reflex occurs in ages

A

birth to 6 months

240
Q

positive support reflex

A

hold the baby standing and the baby will stand and bear weight, then sag after 20-30 sec

241
Q

placing and stepping reflex occur in ages

A

birth to variable

242
Q

placing and stepping reflex

A

hold baby upright and have one sole touch floor, the other foot should step forward.

243
Q

palmar grasp reflex occurs in ages

A

birth to 3-4 months

244
Q

plantar grasp reflex occurs in ages

A

birth to 6-8 months

245
Q

delay or absence in pediatric reflex may indicate

A

pyramidal tract disease or cerebral palsy.

246
Q

a positive barlow does not indicate

A

hip dysplasia but laxity.

247
Q

ligaments connect

A

bone to bone

248
Q

tendons connect

A

muscle to bone

249
Q

when to screen for osteoporosis

A

women at age 65 or women with fracture risk.

250
Q

carpal tunnel finger involvement

A

first 3 fingers, weak thumb abduction

251
Q

age when osteoporotic fractures occur at the same rate in men and women

A

75

252
Q

medial epicondylitis is called

A

golfer’s elbow

253
Q

Yergason’s sign is to help diagnose for

A

bicep tendonitis

254
Q

Cozen’s test is to help diagnose for

A

tennis elbow

255
Q

bakers cyst is commonly associated with

A

RA

256
Q

Testing for vibratory sensation primarily evaluates the function of the

A

posterior columns

257
Q

A patient with lower motor neuron disease will exhibit

A

muscle atrophy

258
Q

A patient with upper motor neuron disease will exhibit:

A

hyperactive DTRs, increased muscle tone

259
Q

The Plantar (Babinski) reflex is normally found in children until the age of:

A

18 months

260
Q

The meningitis vaccine (MCV4) is usually given

A

at 11-12 year olds then a booster at 16

261
Q

Patients with lateral epicondylitis typically present with

A

decreased hand grip

Advanced Health Assessment (5 decks)

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