Patient Assessment Test 2 Set 1

Front 1

Peripheral nervous system is...(3)

Back 1

1)cranial nerves
2)spinal nerves
3)autonomic NS

Front 2

CNS is...(2)

Back 2

1)brain
2)spinal cord

Front 3

1)Cerebral fxn screening test
2)scoring (5)
3)pt must...
4)what it tells you

Back 3

1)FOLSTEIN mini-mental status exam
2a)Possible points 30
b)Normal is 23
c)Depressed is 20-24
d)Less than 20= dementia, delirium, schizo

3)be able to read/write and be of reasonable intelligence
4)if something is wrong, not what is wrong

Front 4

Tests for
a)CN1
b)CN2
c)CN3

Back 4

a)Olfactory, have pt detect odor w/ each nostril

b)Optic, have pt do eye chart and test visual fields

c)Oculomotor, focus from far to near vision and pupillary light reflex

Front 5

Tests for
a)CN4
b)CN5
c)CN6

Back 5

a)Trochlear, be able to rotate eyes up, down, right, left

b)Trigeminal, detect touch on bilat forehead, maxillae, mandible regions (clench teeth)

c)Adducens?

Front 6

Tests for
a)CN7
b)CN8
c)CN9

Back 6

a)Facial, facial expressions

b)Vestibulo-cochlear, balance and hear whispered word @ 2ft

c)Glosso-pharyngeal, swallow/gag

Front 7

Tests for
a)CN10
b)CN11
c)CN12

Back 7

a)Vagus, uvula rise in midline in saying "Ahhh"

b)Spinal accessory, shrug shoulders/turn head

c)Hypoglossal, protrude tongue (should protrude in midline)

Front 8

How to tell if pt has Stroke or Bell's Palsy?

Back 8

Test CN7 via...
a)Stroke- can raise both eyebrows (have furrow lines)
b)Bell's- cannot raise ipsilateral eyebrow (no furrow lines)

Front 9

What is Bell's Palsy (3)

Back 9

1)lesion to nucleus of facial nerve so no face muscles on the side where the lesion is
2)ipsilateral loss of facial nerve function
3)ipsilateral facial paralysis above and below angle of eye

Front 10

What is stroke? (2)

Back 10

1)contralateral facial paralysis below angle of eye
2)pt can still wrinkle forehead due to bilateral innervation of neurons facial muscles above the angle of eye

Front 11

Spinal Cord SENSORY tracts (2)

Back 11

1)dorsal column pathway
2)spinothalamic tract

Front 12

Dorsal column pathway carries what senses (4and....)

Back 12

1)fine discriminate touch
2)proprioception (knowing where body parts in space are w/o looking)
3)vibration
4)2point discrimination

ALL UP THE SAME SIDE OF SPINAL CORD (NOT CROSSED), BECAUSE CROSSES IN MEDULLA

Front 13

Testing Dorsal Column pathway
a)touch
b)vibration/proprioception
c)instrument used

Back 13

a)use tuning fork to test vibration or ask pt to ID position of fingers/toes

b)start w/ lowest dermatomes (worm guy) on extremities and work way up)

c)SEMMES WEINSTEIN FILAMENT

Front 14

Common reasons for decr sensation to touch (5)

Back 14

1)DM (lose vibration in feet first)
2)B12/folate deficiency
3)syphilis
4)nerve compression
5)peripheral vascular disease

Front 15

Spinothalamic tract carries what senses (2and....)

Back 15

1)pain
2)temperature

ON OPPOSITE SIDE OF SPINAL CORD

Front 16

Testing Spinothalamic Tract
a)pain
b)temperature

Back 16

a)Vacutainers filled w/ hot/cold water
b)start w/ lowest dermatome on the extremities and work your way up (use dull/sharp object in each dermatome)

Front 17

Common reasons for decr sensation to pain (2)

Back 17

1)DM
2)nerve compression

Front 18

Cell bodies of PROPRIOCEPTORS are (location) and are... (4)

Back 18

in capsules near joints/ligaments/tendons

1)AND are 1st order neurons in dorsal root ganglion
2)then enters the dorsal column and synapses on 2nd order neurons in medulla
3)then it crosses the midline and goes to the thalamus and synapses onto 3rd order neuron
4)info then sent to cerebral cortex (parietal lobe)

Front 19

Spinothalamic tract (pain) pathway (3)

Back 19

1)(1st order neurons) Free nerve endings carry pain and temp sensations from periphery to cell bodies in dorsal root ganglion
2)2nd order neurons are in spinal cord and then it crosses
3)3rd order neurons are in VPL nucleus of thalamus

Front 20

Corticospinal Tract (5)

Back 20

1)MAIN PATHWAY FOR VOLUNTARY MOVEMENTS
2)CROSSED PATHWAY
3)crosses in medulla and terminate on motor neurons in spinal cord
4)spinal cord neurons project to skeletal muscles
5)muscles are segmentally innervated (myotomes)

Front 21

How to test Corticospinal tract? (2)

Back 21

1)assess appearance of muscle mass and intensity of muscle strength
2)mass and strength should be symmetrical

Front 22

Middle cerebral artery stroke=...

Back 22

arm/hand/face deficit, but legs spared (b/c supplied by anterior artery)

Front 23

Deep Tendon reflexes test ____

Back 23

proprioceptors

Front 24

How proprioceptors work? (3)

Back 24

1)proprioceptor neurons go up dorsal column and synapse on a motor neuron in spinal cord
2)muscle doesn't wholely contract due to descending inhibitory tract
3)so when you trip muscle contracts just enough to catch yourself

Front 25

Stroke and proprioceptors? (2)

Back 25

1)Stroke damages descending inhibition (upper motor neuron)
2)so deep tendon reflex will cause HYPERREFLEXIA

Front 26

Achilles tendon reflex tests... (3)

Back 26

1)S1
2)gastrocnemius
3)tibial and sciatic nerve

Front 27

Knee jerk reflex tests (3)

Back 27

1)L4
2)quadriceps
3)femoral nerve

Front 28

Tricep tendon reflex tests...(3)

Back 28

1)C7
2)triceps
3)Radial nerve

Front 29

Bicep tendon reflex tests...(3)

Back 29

1)C6
2)biceps
3)musculocutaneous nerve

Front 30

Normal and symmetrical reflexes tell you...

Back 30

that the ipsilateral reflex arc and contralateral descending inputs are intact

Front 31

Problems w/ reflex arc= (3)

Back 31

1)hyporeflexia
2)muscle atrophy (flaccid paralysis)
3)decreased strength

Front 32

Problems w/ desceding inputs= (4)

Back 32

1)upper motor neuron lesion
2)hyperreflexia
3)disuse atrophy only
4)spasticity/spastic paralysis

Front 33

Cremasteric reflex tests... (1 and how done)

Back 33

1)L1
2)stroke inside of thigh and testicle will move

Front 34

Anal Wink reflex tests...(2)

Back 34

1)S3
2)S4

Front 35

Integration/Corticosensory tests require that the pt integrate....(3) and tests (3)

Back 35

1)sensation of touch (contraleteral dorsal column)
2)recognition of an object (contralateral parietal lobe)
3)speech (left frontal lobe in ALL right handed pts, 80% of left handed pts)

1)stereognosis
2)graphesthesia
3)point localization

Front 36

How to test if a person's speech center is on R side?

Back 36

thread catheter into R internal carotid artery and inject pental (if speech stops= speech center on R)

Front 37

Stereognosis (3)

Back 37

1)have pt close eyes then ID object placed in their hand
2)repeat using opposite hand
3)use of dorsal column for sensation, parietal lobe to process sensory info, then motor to move mouth

Front 38

Graphesthesia (3)

Back 38

1)have pt close eyes then trace a # on their outscretched palm
2)repeat on opposite hand
3)see 3 of last NC

Front 39

Point Localization (3)

Back 39

1)have pt close eyes then touch point on their upper and lower extremities
2)have pt point to where they touched
3)see 3 of last NC

Front 40

Expressive aphasia

Back 40

loss of speech center (brocha's area)

Front 41

Angular gyrus fxn (3)

Back 41

1)interprets what is heard
2)aka werneicke's area
3)formulates speech in response to what is heard

Front 42

Receptive aphasia (3)

Back 42

1)can't tie what you say to what you've been asked
2)pt will say nonsense
3)werneicke's area lesion

Front 43

Cerebellar fxn (2) and is...

Back 43

1)make movement smooth (so problems can result in tremor)
2)coordinates movement through input from proprioceptors
3)CROSSED

Front 44

Cerebellar tremors

Back 44

if movement is attempted and tremor occurs then INTENTION TREMOR

Front 45

Cerebellar tests (6and...)

Back 45

1)pat their legs repeatedly w/ the palms of their hands
2)con't patting their legs, turning their hands repeatedly from front to back
3)touch each finger w/ their thumb
4)tap their feet on floor or table step
5)have them touch their nose, then your finger, then back and forth
6)run each heel down the opposite shin

LESIONS WILL= ABNORMAL MOVEMENT/TREMOR

Front 46

____ maintains your balance

Back 46

CN8 (cochlear nerve)

Front 47

Tests that tell you NS is dysfxnal NOT where dysfxnal (5); so then you need...

Back 47

1)Romberg (feet together and arms out--will fall if problems)
2)Stand on one foot for 5s
3)hop on one foot
4)walking
5)walking heel-to-toe

MRI's

Front 48

Basal ganglia
a)fxn
b)lesions of it=...
c)5 types of b)

Back 48

a)modulating unconscious muscle tone (muscle contraction while NOT moving like eyelids up and posture)
b)movement disorders (dyskinesias) at rest

c1)tremor
c2)athetosis
c3)Chorea
c4)Ballismus
c5)Tics

Front 49

Tremor?

Athetosis?

Chorea?

Back 49

Tremor) most common is resting tremor of Parkinson's

Athetosis) slow, writing, snake-like movements of limbs, begins in infancy due to viral encephalopathy

Chorea) rapid, jerky movements in distal limbs/face

Front 50

Ballismus?

Tics?

Back 50

Ball) violent, flailing of entire limb

Tics) repetitive movements of face/tongue

Front 51

What is Parkinson's? (4)

Back 51

1)substantia nigra and dopamine neurons die
2)problems occur due to decr dopamine in Caudate nucleus (which is in basal ganglia)
3)results in release phenomenon/resting tremor
4)but no tremor if asked to pick something up

Front 52

Central sulcus?

Back 52

marks split b/w frontal and parietal lobe

Front 53

GENERAL fxn of...
a)Frontal lobe
b)Tip of Frontal lobe (3)
c)Parietal lobe
d)Occipital lobe
e)Temporal lobe (4)
f)Cerebellum

Back 53

a)movement
b)prefrontal cortex (emotion, behavior, aggression)

c)sensation, memory stored, process sensory info

d)vision

e)hearing, smell, memory origin and process them into long term memory, primitive urges (MOST OF PERSONALITY)

f)movement

Front 54

Where is sensory info recieved in brain?

Back 54

postcentral gyrus

Front 55

Precentral gyrus is ___ meaning...

Back 55

SOMATOTOPIC

gets info from different areas (most dedicated to hands/face b/c highest degree of sensory receptors there)

Front 56

On a motor/sensory homunculus ___ take up the most space

Back 56

hands/face

Front 57

Pyramidal tract=
Extrapyrimidal tract=
(both are part of....)

Back 57

voluntary mvmnt

unvoluntary mvmnt

corticospinal tract

Front 58

(descending) Corticospinal tract pathway (2 and how to assess fxn)

Back 58

1)crosses in medulla and synapses in ventral horn
2)this will go out to the muscle that will move

ask pt to move/squeeze

Front 59

Glasgow Coma Scale of EYE OPENING RESPONSE (4)

Back 59

1--none (no open eyes to pain)
2--to pain
3--to verbal stimuli
4--spontaneous opening

Front 60

Glasgow Coma Scale of MOST APPROPRIATE VERBAL RESPONSE (5)

Back 60

1--none
2--incoherent
3--inappropriate words
4--confused
5--oriented

Front 61

Glasgow Coma Scale of MOST INTEGRATED MOTOR RESPONSE (5)

Back 61

1--none
2--extension to pain (limb extends)
3--flexion to pain (limb withdraws by flexing)
4--localizes pain
5--obeys commands

Front 62

Brain speech domain is where?

Back 62

ON LEFT SIDE

Front 63

MS disease is... (3)

Back 63

1)demyleinating disease
2)most common in women in 40s+
3)cc is optic neuritis

Front 64

Myesthenia Gravis (4)

Back 64

1)autoimmune disease where Ig's are produced to ACh receptors
2)results in progressive muscle weakness
3)cc is no strength to keep eyes open (b/c this muscles is used most of the day)
4)if pt is given shot of cholinergic drug it goes away

Front 65

Meningitis/Encephalitis (3)

Back 65

1)moving head is painful
2)upper respiratory symptoms
3)pt wont move head

Front 66

A darker brown skin color w/...
a)generalized distribution (3)
b)localized distribution (2)
is caused by.... (BESIDES INCR MELANIN)

Back 66

a1)pituitary disease
a2)adrenal disease
a3)liver disease

b1)nevi
b2)neurofibromatosis

Front 67

White skin color w/...
a)generalized distribution
b)local distribution
is caused by.... (BESIDES DECR IN MELANIN)

Back 67

a)albinism
b)vitiligo

Front 68

Red skin color w/...
a)generalized distribution (3)
b)local distribution
is caused by.... (BESIDES DECR IN CUTANEOUS BLOOD FLOW)

Back 68

a1)fever
a2)viral exanthems
a3)urticaria

b1)inflammation

Front 69

Yellow skin color has 3 main causes (and underlying causes of these 1,3,2)

Back 69

1)incr bile pigmentation (jaundice/liver disease)
2)incr carotene pigmentation (hypothyroid,incr veggies)
3)decr visibility of oxyhemoglobin (anemia, chronic renal disease)

Front 70

Blue skin color
a)cause
b)where seen (3)
c)underlying pathology
d)called...

Back 70

a)incr unsaturated hemoglobin due to hypoxia
b)lips, mouth, nail beds
c)CV/pulmonary disease
d)cyanosis

Front 71

Skin Turgor
a)test for it
b)what it tells you

Back 71

a)tests tension of skin; pinch skin of forearm and then release skin (should move easily back to normal position)
b)if does not spring back quickly its dehydration

Front 72

Purpura? (3desc and 2causes)

Back 72

1)red-purple vascular skin lesions
2)nonblanchable discoloration
3)greater than 0.5cm diameter

1)intravascular defects
2)infection

Front 73

Petechiae (3desc and 2causes)

Back 73

1)red purple vascular skin lesion
2)nonblanchable discoloration
3)less than 0.5cm diameter

1)intravascular defects
2)infexn

Front 74

Ecchymosis (3desc and 3causes)

Back 74

1)red purple vascular skin lesion
2)nonblanchable discoloration
3)various sizes

1)vascular wall destruction
2)trauma
3)vasculitis

Front 75

Spider Angioma (4desc and 2causes)

Back 75

1)red central body w/ radiating spiderlike legs
2)dilated capillaries radiating from a central arteriole
3)blanchable
4)usually on face, forearm, hands

1)liver disease
2)vit B deficiency

Front 76

Venous Star (3desc and 1cause)

Back 76

1)bluish spider
2)linear or irregularly shaped
3)nonblanchable

1)incr pressure in superficial veins

Front 77

Telangiectasia

Back 77

fine irregular red lines produced by capillary dilation

Front 78

Capillary Hemangioma of Infancy (3desc, 1cause, 1resolution)

Back 78

1)bright red to deep purple
2)soft, vascular nodules
3)plaques/patches

1)dilation of dermal capillaries

1)spontoneous resolution by 5yo, no trace by 10yo

Front 79

Macule (3desc and 5ex)

Back 79

1)flat, circumscribed area that is change in color of skin w/o elevation/depression
2)not palpable
3)less than 1cm in diameter

1)freckles
2)flat moles
3)measles
4)scarlet fever
5)petechiae

Front 80

Papule (4desc and 3ex)

Back 80

1)elevated, firm
2)circumscribed area that is palbable
3)superficial solid lesion
4)less than 1cm in diameter

1)warts
2)elevated moles
3)lichen planus

Front 81

Patch? (2desc and 3ex)

Back 81

1)flat nonpalable irregular shaped macule
2)greater than 1cm in diameter

1)vitiligo
2)port-wine stains
3)mongolian spots

Front 82

Plaque (3desc and 3ex)

Back 82

1)elevated firm and rough lesion w/ flat top
2)plateau above skin is will defined
3)greater than 1cm in diameter

1)psoriasis
2)seborrheic keratosis
3)actinic keratosis

Front 83

Wheal? (6desc and 3ex)

Back 83

1)elevated or flat topped
2)pale red
3)irregular shaped area of cutaneous edema
4)change rapidly in size/shape due to shifting edema in dermis (and usually disappears in hours)
5)solid
6)variable diameter

1)insect bites
2)urticaria
3)allergic rxn

Front 84

General desc of nodules (5)

Back 84

1)elevated
2)firm/solid
3)circumscribed lesions
4)deeper in dermis than papule (can involve epidermis, dermis, or SQtissue)
5)1-2cm in diameter

Front 85

Erythema Nodosum (NODULE) (3)

Back 85

1)acute inflammatory-immunologic reaction
2)painful
3)tender nodules on lower legs

Front 86

Lipoma (NODULE) (5)

Back 86

1)benign, SQ tumor
2)soft, rounded
3)movable against overlying skin
4)occurs on neck and trunk
5)made of fat cells

Front 87

Tumor skin lesions (3desc and 3ex)

Back 87

1)elevated/solid lesion
2)greater than 2cm in diameter
3)deeper in dermis

1)neoplasms
2)benign tumor
3)lipoma

Front 88

Vesicle skin lesions (4desc and 2ex)

Back 88

1)elevated
2)circumscribed/superficial (not into dermis)
3)filled w/ serous fluid
4)less than 1cm in diameter

1)varicella
2)chicken pox (herpes zoster)

Front 89

Bulla skin lesions (2desc and 1ex)

Back 89

1)vesicle
2)greater than 1cm

1)blister

Front 90

Pustule skin lesion (2desc and 2ex)

Back 90

1)elevated/superficial
2)like vesicle but filled w/ purulent fluid (many different colors)

1)impetigo
2)acne

Front 91

Cyst skin lesions (3desc and 2ex)

Back 91

1)elevated/encapsulated lesion
2)in dermis or SQ layer
3)filled w/ liquid or semisolid material

1)sebaceous cyst
2)cystic acne

Front 92

Scale skin lesion (2desc and 2ex)

Back 92

1)heaped up keratinized cells
2)flaky skin

1)flaking w/ seborrheic dermatitis
2)dry skin

Front 93

Lichenification skin lesion (2desc and 1ex)

Back 93

1)rough, thick epidermis
2)due to persitant rubbing/itching/irritation

1)chronic dermatitis

Front 94

Keloid skin lesion (2desc and 1ex)

Back 94

1)elevated, progressively enlarging scar
2)grows beyond boundaries of wound

1)due to excessive collagen formation during healing

Front 95

Excoriation skin lesion (2desc and 3ex)

Back 95

1)loss of epidermis
2)linear hollowed-out crusted area

1)abrasion
2)scratch
3)scabies

Front 96

Neurotic excoriations (2)

Back 96

1)caused by habit of picking skin w/ figernails
2)also seen on back, face, extremeties

Front 97

Fissure skin lesion (1desc and 2ex)

Back 97

1)linear crack from epidermis to dermis

1)athlete's foot
2)cracks at corner of mouth

Front 98

Erosion skin lesion (3desc and 1ex)

Back 98

1)loss of part of epidermis
2)depressed
3)follows rupture of vesicle or bulla

1)varicella

Front 99

Ulcer skin lesions (2desc and 2ex)

Back 99

1)loss of epidermis/dermis
2)concave

1)decubiti
2)statsis ulcers

Front 100

Crust skin lesions (3desc and 2ex)

Back 100

1)dried blood
2)slightly elevated
3)various colors

1)scab on abrasion
2)eczems

Front 101

Atrophy skin lesion (3desc and 2ex)

Back 101

1)thinning of skin surface
2)loss of skin markings
3)skin translucent paperlike

1)striae
2)aged skin