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Health Assessment > Unit 3 lecture > Flashcards

Unit 3 lecture Flashcards

1
Q

mediastinum

A

•the space in the chest between the pleural sacs of the lungs that contains all the tissues and organs of the chest except the lungs and pleurae

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2
Q

precordium

A

•anterior chest wall

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3
Q

point of maximum impulse (PMI)

A
  • where auscultate for apical pulse
  • 5th ICS at L midclavicular line
  • heart bumps chest wall w/ each beat
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4
Q

heart wall

A

pericardium -> mycocardium -> endocardium

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5
Q

atrioventricular (AV) valves

A
  • tricuspid (RA -> RV)

* mitral (LA -> LV)

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6
Q

semilunar valves

A
  • pulmonic (RV -> pulmonary artery -> lungs)

* aortic (LV -> aorta -> systemic)

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7
Q

inferior vena cava

A

•returns blood from liver/lower extremities to RA

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8
Q

superior vena cava

A

•returns blood from head/upper extremities to RA

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9
Q

pulmonary artery

A

•delivers unoxygenated blood to lungs

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10
Q

pulmonary veins

A

•return oxygenated blood to LA

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11
Q

diastole

A
  • blood from LA to LV
  • aortic valve closed
  • mitral valve open
  • b/t S2 and S1
  • longer than systole
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12
Q

systole

A
  • ejection of blood from LV into aorta
  • aortic valve open
  • mitral valve closed
  • b/t S1 and S2
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13
Q

S1 heart sounds

A
  • lub
  • when MITRAL and tricuspid valves close
  • ventricular ctx
  • systole begins
  • loudest over APEX
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14
Q

S2 heart sounds

A
  • dub
  • when AORTIC and pulmonic valves close
  • ventricular rlx
  • diastole begins
  • loudest over BASE
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15
Q

split S2

A

•R side events occur slightly later than L
•hear closure of aortic valve (loudest) first then hear pulmonic closure
*A valve closure louder than P

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16
Q

split S1

A
  • mitral valve closure louder than tricuspid

* R side events occur slightly later than L

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17
Q

S3 (ventricular gallop)

A
  • extra heart sound caused by rapid ventricular filling
  • occurs during diastole after S2
  • detected w/ bell
  • normal in children
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18
Q

S4

A
  • extra heart sound caused by strong atrial ctx
  • heard during diastole just before S1
  • normal in older/athletic
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19
Q

murmur

A
  • sound has longer duration
  • result of turbulent blood flow
  • blowing/swooshing
  • caused by increased BV or valvular dz
  • high flow, stenosis, incompetent, etc
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20
Q

conduction through heart

A
  1. ) SA node (pacemaker)
  2. ) AV node
  3. ) Bundle of His
  4. ) Bundle branches
  5. ) Purkinje fibers
  6. ) ventricles
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21
Q

cardiac output

A
  • vol. blood ejected in min

* SVxHR

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22
Q

stroke volume

A
  • vol. of blood ejected w/ each beat

* depends on preload, contractility, afterload

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23
Q

preload

A

•load that stretches cardiac muscle before ctx

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24
Q

myocardial contractility

A

•ability of cardiac muscle to ctx

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25
Q

afterload

A
  • decrees of vascular resistance to ventricular ctx

* pressure of aorta

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26
Q

heart failure

A

•pathogenic increases in pre/after loads
•causes vol./pressure overload
•changes ventricular fxn
*L ventricle stretches and gets tired

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27
Q

carotid arteries

A

•supply blood to brain, neck, face

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28
Q

internal jugular vein

A
  • drains blood head, brain, face, and neck

* deep to sternocleidomastoid

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29
Q

external jugular vein

A

•drains blood from outside of skull and deep parts of face

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30
Q

jugular venous pressure

A
  • reflects RA pressure
  • best estimated from R external jugular v.
  • assess at 30°
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31
Q

aoritc area

A
  • right 2nd ICS at sternal border

* S2 louder

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32
Q

pulmonic area

A
  • left 2nd ICS at sternal border

* S2 louder

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33
Q

Erb’s point

A

•left 3rd ICS at sternal border

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34
Q

tricuspid area

A
  • left 4th-5th ICS at sternal border

* S1 louder

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35
Q

PMI (mitral area)

A
  • 5th ICS at LMCL

* apex

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36
Q

infant CV

A
  • heart more horizontal
  • rate faster (120-160)
  • murmurs common (outgrow)
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37
Q

preggo CV

A
  • blood vol. increase
  • normal to have murmur
  • increase pulse (10-15 bpm)
  • BP decreases 2nd trimester and rises back to normal in 3rd
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38
Q

aging adult CV

A
  • CAD
  • atherosclerosis
  • angina
  • MI
  • arrhythmia
  • S3 or S4 b/c heart loses elasticity (reduced compliance LV)
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39
Q

highest HTN rate

A
  • African Americans

* 36%

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40
Q

female MI symptoms

A
  • Chest pain/discomfort
  • upper back
  • jaw pain
  • lightheadedness
  • unusual fatigue
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41
Q

symptoms of heart dz

A
  • inc. resp rate
  • SOB on exertion
  • dyspnea
  • orthopnea
  • paroxysmal nocturnal dyspnea
  • nocturia
  • ankle edema
  • pallor/cyanosis (sign)
  • arrythmia
  • cough- pink sputum; crackles
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42
Q

order of CV/periphery exam

A
  1. ) pulse/BP
  2. ) neck vessels
  3. ) upper extremities
  4. ) precordium
  5. ) lower extremities
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43
Q

carotid artery assessment

A
  • palpate for contour/amp/strength
  • auscultate w/ bell while pt holds breath
  • rule out bruit/thrill
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44
Q

jugular vein assessment

A 
•30-45 degree angle
•turn head away
•direct strong, tangential light
•should not see distention
*look at R external
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45
Q

JVD

A
  • blood flow refluxes (flows backward) from R atrium into jugular vein
  • jugular vein visible
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46
Q

diaphragm of stethoscope

A

•used for HIGH pitched sounds
•S1 and S2 (systole/diastole)
•hold firmly
*listening to valves close

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47
Q

bell of stethoscope

A
  • used for low pitched sounds
  • extra heart sounds (S3 & S4)
  • murmurs
  • hold gently to produce seal
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48
Q

regular heart rate

A

•60-100 bpm

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49
Q

abnormal findings r/t LV hypertrophy

A
  • heave/lift (see)

* thrill (feel)

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50
Q

abnormal findings related to murmur

A
  • mid systolic click
  • S3
  • S4
  • pericardial friction rub
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51
Q

diastolic murmur

A

•always means heart disease

*systolic murmur is normally not pathogenic

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52
Q

murmur loudest

A

•over faulty valve

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53
Q

Grade I systolic murmur

A
  • lowest intensity (loudness)

* difficult to hear

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54
Q

Grade 2 systolic murmur

A
  • low intensity

* usually audible

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55
Q

Grade 3 systolic murmur

A
  • medium intensity
  • easy to hear
  • no palpable thrill
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56
Q

Grade 4 systolic murmur

A
  • medium intensity

* palpable thrill

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57
Q

Grade 5 systolic murmur

A
  • loud
  • palpable thrill
  • audible w/ very little scope pressure
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58
Q

Grade 6 systolic murmur

A
  • loudest intensity
  • palpable thrill
  • audible w/ scope raised above chest
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59
Q

aortic murmur

A
  • stenosis or regurgitation
  • from rheumatic heart disease or calcific changes of aging
  • cooing
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60
Q

mitral valve murmur

A

•MVP, regurgitation, or stenosis
•midsystolic click
*MVP more common in women

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61
Q

arterial pulses in arm

A
  • brachial
  • radial
  • ulnar
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62
Q

O2 rich blood

A

•expansion/recoil of artery wall

*if present in most distal point, don’t need to check proximal

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63
Q

arterial pulses in legs

A
  • femoral
  • popliteal- medial
  • dorsalis pedis
  • posterior tibial
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64
Q

veins in legs

A
  • great saphenous (med)
  • small saphenous (lat)
  • communicating vv.
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65
Q

lymphatic system

A
  • retrieves excess fluid from tissues
  • returns fluid to venous system
  • drains into R lymphatic duct or thoracic duct
  • major part of immune system
  • absorbs lipids from intestines
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66
Q

major lymph nodes

A
  • upper extremity

* inguinal area

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67
Q

lymphatic capillaries

A
  • located in capillary bed

* remove excess fluid/proteins from interstitial space

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68
Q

lymph dysfunction in capillary bed

A

•results in edema

*excess fluid in interstitial spaces

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69
Q

causes of edema

A
  1. ) increased cap. blood pressure
  2. ) increased capillary membrane permeability
  3. ) low plasma protein levels
  4. ) blockage or removal of lymphatic drainage
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70
Q

causes of increased capillary blood pressure

A
  • CHF

* venous insufficiency

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71
Q

causes of increased capillary membrane permeability

A

•capillary leak syndrome- inflammatory response to burns, allergic rxn, etc

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72
Q

causes low plasma protein levels

A

•renal disorder

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73
Q

lymphedema

A
  • usually non-pitting
  • result of lymph node removal
  • very common post-mastectomy
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74
Q

peripheral vascular symptoms

A
  • leg pain/cramps
  • intermittent claudication
  • varicosities
  • skin/sensation changes
  • edema
  • node enlargement
  • non-healing wounds
  • paresthesia
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75
Q

weak thready pulse

A

•indicates decreased cardiac output or shock

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76
Q

posterior tibial pulse

A

•medial

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77
Q

arterial insufficeincy

A
  • problem getting to periphery
  • lower leg BELOW ankle
  • deep ulcer w/ smooth margin little drainage
  • gangrene
  • shiny, cool lower ext
  • leg hair sparse/absent
  • pulse diminished/absent
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78
Q

venous stasis

A
  • problem getting out of periphery
  • pooling of blood
  • lower leg ABOVE
  • ulcer w/ irregular border and drainage
  • edema
  • warm/red legs/feet
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79
Q

Homan’s Sign

A

•calf pain on dorsiflexion
•indicator of deep vein thrombosis (DVT)
•if suspected, don’t let pt ambulate b/c at risk for pulmonary embolism
*not a diagnostic

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80
Q

virchow’s triad

A 
*those at risk for DVT
•vessel injury- after surgery
•hypercoagulability- preggo
•venous stasis- quadriplegia; immobile 
*also at risk if use contraceptives or smoke
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81
Q

Allen Test

A
  • test for in tact ulnar artery before doing ABG draw on radial artery
  • depress radial artery while pt opens/closes fist
  • normal- blood returns vial ulnar artery
  • occluded ulnar artery- no blood return
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82
Q

congestive heart failure

A
  • as blood flow out of heart slows, blood returning through veins regurgitates
  • causes congestion in tissues (legs, ankles, lungs, etc)
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83
Q

musculoskeletal system

A 
•skeletal muscle
•connective tissue:
1.) bone
2.) cartilage
3.) ligaments
4.) tendons
5.) fascia
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84
Q

more elastic connective tissue…

A

•more ROM

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85
Q

calcium

A

•essential for bone growth

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86
Q

vitamin D

A

•necessary for calcium absorption

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87
Q

non-synovial joints

A
  • bound by fibrous tissue

* immovable

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88
Q

synovial joints

A
  • most common
  • movable
  • ball and socket; hinge
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89
Q

temporomandibular joint (TMJ)

A
  • articulation of mandible and temporal bone
  • hinge
  • anterior targus
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90
Q

spine

A

•33 vertebrae w/ intervertebral disk b/t

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91
Q

landmarks on spine

A

•C7 and T1 are prominent on base of neck

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92
Q

Vertebral curvature

A
  • cervical/lumbar- lordosis (concave)

* thoracic/sacral- kyphosis (convex)

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93
Q

shoulder landmarks

A

•acromion process
•greater tubercle of humerus
•coracoid process of scapula
*important for IM injections

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94
Q

acetabulum

A
  • hip joint/socket

* where femoral head articulates

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95
Q

tibiotalar joint

A
  • ankle

* hinge

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96
Q

medial/lateral malleolus

A
  • bony prominences on either side of ankle
  • medial- distal tibia
  • lateral- distal fibula
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97
Q

behind medial malleolus

A

•posterior tibialis artery

98
Q

goal for pt w/ musculoskeletal problems

A
  • focus on ID specific problem
  • alleviate pain
  • prevent complications
99
Q

sprain

A

•swollen or tender

100
Q

dislocation

A

•joint misaligned

101
Q

fracture

A

•bone misaligned

102
Q

ortolani maneuver

A
  • physical examination of infants for developmental dysplasia of hip
  • tests for posterior dislocation of hip
  • positive if hear clunk when femoral head relocates into acetabulum
103
Q

First assessment when pt reports injured swollen knee?

A

•compare swollen knee to the other

104
Q

order of musculoskeletal exam

A
  1. ) inspect
  2. ) palpate
  3. ) ROM
  4. ) strength testing- apply opposing force
105
Q

active range of motion

A
  • done by pt

* able to stabilize body area proximal to joint moving

106
Q

passive ROM

A
  • done by nurse
  • pt has limited stabilization of body area proximal to joint moving
  • nurse anchors joint w/ one hand and moves it with the other
107
Q

testing for muscle strength

A

•apply opposing force while pt flex or extends

108
Q

grading of muscle strength

A
  • 0- no strength
  • 1- slight ctx- trace
  • 2- slight ctx; no movement
  • 3- movement against gravity
  • 4 movement against gravity w/ some resist
  • 5- full ROM w/ gravity and against resistance (normal strength)
109
Q

ROM expected at TMJ

A
  • open mouth max

* protrude lower jaw and move side to side

110
Q

ROM expected at cervical spine

A
  • chin to chest
  • lift chin
  • ear to each shoulder
  • turn chin to shoulder
111
Q

ROM expected at shoulder

A
  • arms forward and up
  • arm behind back and hands up
  • arms to side and up over head
  • touch hands behind head
112
Q

ROM expected at elbow

A
  • flex/extend

* pronate/supinate

113
Q

ROM expected at wrist/hand

A
  • flex/extend hand/fingers
  • supinate/pronate
  • spread fingers
  • make fist
  • touch thumb to each finger
114
Q

ROM expected at acetabulum

A
  • raise leg
  • knee to chest
  • flex hip & knee
  • swing foot out/in
  • swing legs lat./med.
  • stand and swing leg back
115
Q

ROM expected at knee

A

•bend/extend

116
Q

ROM expected at ankle/foot

A
  • dorsiflex/extend toes
  • inversion/eversion of foot
  • flex/straighten toes
117
Q

ROM expected at spine

A
  • bend sideways, back, forward

* twist shoulders to each side

118
Q

gait assessment

A

•observe for erect head and symmetry of shoulders, scapulae, iliac crests when pt stands w/ feet together
•observe person walking 10-20 ft
•observe mobility, balance, coordination, etc
*important when predicting fall risk

119
Q

usual gait

A
  • oppositional swinging of arms/legs
  • width of 5-7 inches
  • length 12 inches
  • width increase w/ step
120
Q

rheumatoid arthritis (RA)

A

•chronic inflammation of joints

121
Q

osteoarthritis

A
  • degenerative joint dz
  • noninflammatory
  • localized, progressive dz
122
Q

osteoporosis

A
  • decrease in skeletal bone mass
  • reabsorption of bone > formation
  • more common in small frame women, Asian, and whites
123
Q

dislocated shoulder

A
  • usually anterior dislocation
  • hunched shoulder and limited arm abduction
  • due to trauma, falling, throwing, heavy lifting
124
Q

gouty arthritis at elbow

A
  • redness and heat

* bulge

125
Q

epicondylitis

A
  • tennis elbow

* pain at lateral epicondyle that radiates down

126
Q

ulnar deviation (drift)

A
  • swelling of metacarpophalangeal joints
  • causes fingers to be displaced and bend toward pinky
  • secondary to rheumatoid arthritis
127
Q

ganglion cyst

A
  • benign tumor at dorsum of wrist
  • soft, non-tender
  • more prominent w/ flextion
128
Q

carpal tunnel

A
  • compression of median nerve inside carpal tunnel of wrist
  • burning/pain/numb on 1st 3.5 digits
  • more common in women
129
Q

talipes equionovarus

A
  • clubfoot

* foot turns in and down

130
Q

myelomeningocele

A
  • birth defect in which the backbone and spinal canal do not close before birth
  • meninges stick out
131
Q

spina bifida occulta

A

•bones of spine don’t close, but spinal chord and meninges remain in place under skin

132
Q

meningoceles

A

•tissue covering spinal cord sticks out of spin, but the spinal cord remains in place

133
Q

functional scoliosis

A
  • structurally normal spine that appears to have a lateral curve
  • temporary change of spinal curvature
  • caused by leg length diff, inflammatory conditions, muscle spasms
  • corrected by treating the underlying issue
134
Q

structural scoliosis

A
  • fixed curve of vertebrae

* referred if > 7°

135
Q

cultural variations musculoskeletal

A
  • AA more dense and less prone to osteoporosis

* Asians/Caucasians greater risk for osteoporosis

136
Q

gender variations musculoskeletal

A
  • men have larger/stronger bones

* men less prone to osteoporosis

137
Q

musculoskeletal infant

A
  • complete skeleton at 3 months gestation (cartilage)

* C-shaped spine at birth

138
Q

musculoskeletal preggo

A
  • lordosis

* waddling gait

139
Q

older adult musculoskeletal

A
  • decreased height (40-43)
  • decreased bone deposition (30)
  • arms/legs same length
  • muscle atrophy
  • osteoporosis
  • kyphosis
140
Q

which part of the brain is responsible for coordination of movement and maintaining the body upright in space

A

•cerebellum

141
Q

central nervous system

A

•brain and spinal cord

142
Q

peripheral nervous system

A

•cranial, motor, and sensory neurons

143
Q

consciousness

A

•depends on interaction b/t cerebral hemispheres and reticular activating system (arousal) in diencephalon

144
Q

neuron

A

•nerve cell

145
Q

gray matter

A

•neuronal cell bodies

146
Q

white matter

A
  • myelinated axons

* carries nerve impulses quickly

147
Q

voluntary nerve fibers

A
  • connect CNS to muscles and skin

* facilitate deliberate motor actions in response to stimuli

148
Q

involuntary (autonomic) nerve fibers

A

•connect CNS through autonomic pathways to visceral organs, smooth muscle, and glands

149
Q

cerebral cortex

A
  • thought, memory, reasoning, sensation, voluntary movement
  • center for hight fxn
  • 2 hemispheres
150
Q

right hemisphere cerebral cortex

A

•abstract though, music, color, shapes

151
Q

left hemisphere cerebral cortex

A
  • logic, math, speech

* dominant in 95% of people

152
Q

frontal lobe

A
  • orientation
  • personality
  • insight
  • emotion
  • intellect
  • language
  • motor fxn
153
Q

parietal lobe

A
  • sensation
  • pain
  • L lobe- language
154
Q

temporal lobe

A

•auditory

155
Q

Wernicke’s area

A
  • L temporal lobe
  • language comprehension
  • damage- hear, but can’t understand language (RECEPTIVE aphasia)
156
Q

Broca’s area

A
  • L frontal lobe
  • motor speech
  • damage- understand, but can’t talk right (EXPRESSIVE aphasia)
157
Q

basal ganglia

A
  • automatic movement
  • damage/lesions in parkinsons
  • Ex: walking
158
Q

thalamus

A

•processes sensory impulses and relays to cortex

159
Q

hypothalamus

A
  • maintains homeostasis
  • regulates HR, temp, BP, sleep, emotion, pit. regulation, ANS
  • secretes hormones that act on pituitary
160
Q

cerebellum

A
  • voluntary motor coordination
  • equilibrium/balance
  • muscle tone
161
Q

brain stem

A
  • midbrain, pons, medulla
  • contains all ascending and descending fibers
  • ANS
162
Q

spinal cord

A
  • connect brain to spinal nerves
  • mediates reflexes
  • hwy for afferent/efferent fibers
163
Q

sit of lumbar puncture

A
  • L3-4 or L-45 spaces

* below spinal cord

164
Q

damage to area of spinal cord

A

•results in damage to all areas below site of injury

*damage at C3 or above requires ventilator

165
Q

CN I

A

•olfactory

166
Q

CN II

A
  • optic

* visual acuity/confrontation tests

167
Q

CN III

A
  • oculomotor
  • extra ocular movement/pupil tests
  • EYE MOVEMENT/PUPIL RESPONSE
168
Q

CN IV

A
  • trochlear
  • extra ocular movement/pupil tests
  • EYE MOVEMENT
169
Q

CN V

A
  • trigeminal
  • jaw
  • face touch
  • cornea reflex
170
Q

CN VI

A
  • abducens
  • extra ocular movement/pupil tests
  • EYE MOVEMENT
171
Q

CN VII

A
  • facial
  • smile/frown
  • close eyes
  • move brows
  • puff cheeks
172
Q

CN VIII

A
  • vestibulocochlear

* whisper, Rinne, Weber tests

173
Q

CN IX

A
  • glossopharyngeal
  • taste
  • gag
  • raise uvula (ahhh test)
  • smooth voice
  • SWALLOWING
174
Q

CN X

A
  • vagus
  • visceral, swallowing, speech
  • SWALLOWING
175
Q

CN XI

A
  • accessory
  • neck movement
  • hand to cheek/shoulders
  • SWALLOWING
176
Q

CN XII

A
  • hypoglossal
  • tongue
  • light, tight, dynamite
  • SWALLOWING
177
Q

sensory neurons

A
  • afferent

* from stimulus to CNS

178
Q

motor neurons

A
  • efferent

* from CNS to effectors (muscles, glands, etc)

179
Q

peripheral nervous system

A
  • 31 pairs of nerves attach to spinal cord (8C; 12T; 5L; 5S; 1C)
  • nerves contain both motor and sensory fibers
180
Q

ventral (anterior) root

A
  • PNS

* motor fibers

181
Q

dorsal (posterior) root

A
  • PNS

* sensory fibers

182
Q

corticospinal (pyramidal) tract

A
  • motor pwy
  • smooth voluntary movement
  • skilled/complicated movement
  • delicate movement
  • Ex: writing
183
Q

basal ganglia system

A
  • motor pwy
  • maintain muscle tone
  • control body movement
184
Q

cerebellar system

A
  • motor pwy
  • sensory/motor input
  • coordinates motor activity
  • posture
185
Q

extrapyramidal tract

A
  • motor pwy
  • primitive voluntary movement
  • Ex: walking
186
Q

spinothalamic tract

A
  • sensory pwy
  • transmits sensations of pain, temp, touch
  • cotton wisp test
187
Q

dorsal (posterior) columns

A
  • sensory pwy
  • transmit sensations of position, vibration, fine touch
  • proprioception
  • kinesthesia
  • stereognosis
  • graphesthesia
188
Q

autonomic nervous system (ANS)

A
  • PSNS- rest and digest

* SNS- fight or flight

189
Q

upper motor neuron damage

A
  • within CNS

* CVA, cerebral palsy, MS

190
Q

lower motor neuron damage

A
  • within PNS
  • spinal cord injury
  • polio
  • Lou Gehrigs
  • ALS
191
Q

Amyotrophic Lateral Sclerosis (ALS)

A
  • progressive degeneration of motor neurons

* eventually leads paralysis

192
Q

reflex arc

A
  • PNS
  • involuntary defense mechanism
  • motor and sensory neuron directly synapse w/ each other
193
Q

deep tendon reflex arc

A

•patellar

194
Q

superficial reflex arc

A

•corneal reflex

195
Q

visceral reflex arc

A

•pupil response

196
Q

pathologic reflex arc

A

•only present with neural problem

197
Q

spinal reflexes

A
  • deep tendon responses
  • tap tendon of partially stretched muscle
  • abnormal response helps locate pathologic lesion
198
Q

aging adult NS

A
  • general atrophy of neurons
  • rxn time slower
  • diminished special senses
  • decrease cerebral blood flow (fall risk)
  • no change in mental ability, unless dementia
199
Q

dysarthria

A
  • difficulty w/ motor aspect of speech
  • slurred, slow speech
  • rapid mumbling
  • drooling
  • abnormal rhythm
200
Q

screening neurologic exam

A
  • mental status
  • CNs
  • motor system
  • sensory system
  • reflexes
201
Q

CN portion neurologic exam

A
  • visual acuity (II)
  • pupillary light reflex (III)
  • eye movement (III, IV, VI)
  • hearing (XIII)
  • facial strength (V, VII)
202
Q

motor system portion neurologic exam

A
  • strength
  • gait
  • coordination
203
Q

sensory portion neurologic exam

A
  • light touch
  • pain/temp
  • proprioception
204
Q

reflex portion neurologic exam

A
  • DTRs

* plantar response

205
Q

Romberg test

A
  • balance

* POSITIVE if pt stands well w/ eyes open but loses balance when closed

206
Q

pronator drift test

A
  • balance
  • feet together, arms up, eyes closed
  • when tapped briskly, arms should move back horizontal smoothly
207
Q

gait test

A
  • balance
  • walk 10 ft and back
  • tandem walk (heel-toe)
208
Q

coordination & skilled movements test

A
  • RAM
  • thumb to fingers
  • finger to finger
  • heel to skin
209
Q

peripheral neuropathy

A
  • nerve damage
  • caused by chronic disorders (diabetes, alcoholism, nutrient deficiency)
  • initial pain, tingling, burning, etc
  • lose ability to feel heat, cold, pain, vibration
210
Q

DTR ratings

A 
4+: very brisk w/ clonus 
3+: brisker than avg
2+: normal
1+: diminished
0: absent
211
Q

reinforcement

A
  • DTR test
  • using isometric ctx of other muscles
  • engaging some muscles, while rlxing the ones being tested
212
Q

achilles reflex

A
  • foot should push on hand and calf muscle flex when strike

* ankle jerk

213
Q

patellar reflex

A
  • should kick and feel thigh contract when strike

* knee jerk

214
Q

biceps reflex

A
  • hold your own thumb on bicep and strike thumb

* bicep should contract

215
Q

triceps reflex

A
  • strike posterior arm jus above elbow

* arm should swing away from body

216
Q

Babinski response

A
  • plantar response
  • dorsiflexion when lat. plantar stimulated
  • POSITIVE if toes flare back (concerned)
217
Q

Neurologic check

A

•done if head injury or dz

  1. ) LOC- A&O x 3
  2. ) motor fxn- grasp fingers
  3. ) pupillary light response
  4. ) vital signs
  5. ) speech
218
Q

assessing comatose

A
  1. ) ABCs
  2. ) LOC
  3. ) examine
    * DONT dilate pupils or flex neck
219
Q

alertness

A
  • LOC
  • pt opens eyes, looks at you, responds appropriately
  • speak in normal voice
220
Q

lethargy

A
  • LOC
  • drowsy, but opens eyes, looks at you, responds, back to sleep
  • speak loudly
221
Q

obtundation

A
  • LOC
  • opens eyes and looks, responds slowly, alertness decreased
  • shake pt
222
Q

stupor

A
  • LOC
  • only wake w/ pain, verbal response slow/absent, unresponsive when stimulus cease, minimal awareness
  • apply painful stimulus (sternal rub)
223
Q

coma

A
  • LOC
  • unarousable, eyes closed, no response to stimuli
  • apply repeated painful stimuli
224
Q

Glasgow Coma Scale

A
  • used to asses comatose status
  • scored on eye opening, verbal response, motor response
  • higher score -> better
  • max score is 15
225
Q

stroke warning signs

A
  • sudden numb/weak face, arm, leg
  • sudden confusion, trouble speaking/understanding
  • sudden trouble walking, dizziness, LO coordination/balance
  • sudden vision change
  • sudden severe headache
226
Q

mini-mental state examination (MMSE)

A
  • brief test to screen for cognitive dysfunction or dementia

* tests orientation to time, registration, naming, reading

227
Q

cranial nerves swallowing

A
  • glossopharyngeal (IX)
  • vagus (X)
  • accessory (XI)
  • hypoglossal (XII)
228
Q

cranial nerves eye movement

A
  • oculomotor (III)
  • trochlear (IV)
  • abducens (VI)
229
Q

CN to test if mouth drooping

A
  • trigeminal (V)

* facial (VII)

230
Q

spastic hemi-paralysis

A
  • abnormal gait due to stroke
  • poor control of flexors
  • flexed/immobile affected arm
  • extensors on affected leg are spastic
  • ankle/toes flexed and inverted
231
Q

cerebellar ataxia

A
  • abnormal gait due to cerebellar abnormality
  • staggering
  • wide
  • unsteady w/ eyes open AND closed
  • can’t stand w/ feet together
232
Q

scissors gait

A
  • abnormal gait due to spinal cord dz
  • bilateral lower ex. spasticity
  • stiff, slow movement w/ thigh crossing
233
Q

steppage gait

A
  • abnormal gait due to peripheral motor dz

* drag feet or lift high w/ slap on ground

234
Q

parkinson’s gait

A
  • abnormal gait due to parkinson’s dz
  • stooped posture
  • slow start
  • short steps/shuffling
235
Q

sensory ataxia

A
  • abnormal gait due to post. column damage
  • unsteady/wide stance w/ eyes closed ONLY
  • exaggerated steps
236
Q

signs of past stroke

A
  • uvula deviated toward opp. side of throat
  • paralysis on opp. side (atony)
  • drooping facial features
  • spastic hemi-paralysis
237
Q

FAST

A 
•recognize stroke
Face
Arms
Speech
Time
238
Q

causes of stroke

A
  • clot

* hemorrhage

239
Q

Bell’s Palsy

A
  • lesion of CN 7

* temporary facial paralysis

240
Q

The awareness of personal identity, place, and time are referred to as

A

orientation

241
Q

Patients who are drowsy but open their eyes and look at you, respond to questions, and then fall asleep are referred to as

Health Assessment (8 decks)

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