Advanced Health Assessment Exam 1

What is suggested when touch and position sense are normal or only slightly impaired, and there is a disproportionate decrease in, or loss of, discriminative sensations? - correct answer suggests disease of the sensory cortex. Stereognosis, number identification, and two-point discrimination are impaired in? - correct answer posterior column disease. What does primary headaches include? - correct answer migraine, tension, cluster, and chronic daily headaches Where does secondary headaches arise? - correct answer secondary headaches arise from underlying structural, systemic, or infectious causes and may be life threatening What is a symptom of a subarachnoid hemorrhage? - correct answer "the worst headache of my life." What are the signs/symptoms of meningitis? - correct answer Severe headache and stiff neck Dull headache increased by coughing and sneezing, especially in the same location, occurs in? - correct answer mass lesions from brain tumors or abscess Migraine headaches - correct answer *often preceded by an aura or prodrome. *is highly likely if three of the five "POUND" features are present: -Pulsatile or throbbing; -One-day duration, or lasts 4 to 72 hours if untreated -Unilateral -Nausea or vomiting -Disabling or intensity causing interruption of daily activity. Optic discs that are bulging with blurred margins is indicative of? - correct answer papilledema Pallor optic discs is indicative of? - correct answer optic atrophy cup enlargement is indicative of? - correct answer glaucoma Rinne Test assesses? - correct answer air and bone conduction ACBC Weber Test assesses? - correct answer lateralization Sensorineural testing assess? - correct answer cochlear branch of CN VIII What might cause conductive hearing loss? - correct answer Excess cerumen, otosclerosis, and otitis media What might cause sensorineural hearing loss? - correct answer presbyacusis from aging Vertigo with hearing loss and nystagmus typifies? - correct answer Ménière's disease The palate would fail to rise with a bilateral lesion of which CN? - correct answer CN X An absence of the gag reflex with unilateral absence of an elevation of the tounge and palate suggests a lesion of which CNs? - correct answer CN IX, and perhaps CN X If the protruded tongue deviates transiently in a direction away from the side of the cortical lesion, toward the side of weakness, this is indicative of? - correct answer a unilateral cortical lesion what is a sign of carpal tunnel syndrome? - correct answer weak opposition of the thumb Look for ___ in cerebellar disease - correct answer nystagmus, dysarthria, hypotonia, ataxia. A gait that lacks coordination, with reeling and instability, is called? - correct answer ataxia Hyperactive reflexes (hyperreflexia) - correct answer are seen in central nervous system lesions along the descending corticospinal tract. Look for associated upper motor neuron findings of weakness, spasticity, or a positive Babinski sign. Hypoactive or absent re exes (hyporeflexia) - correct answer are seen in diseases of spinal nerve roots, spinal nerves, plexuses, or peripheral nerves. Look for associated findings of lower motor unit disease, namely weakness, atrophy, and fasciculations. How would a lethargic patient look? - correct answer A lethargic patient appears drowsy but opens the eyes and looks at you, responds to questions, and then falls asleep. How would an obtunded patient look? - correct answer An obtunded patient opens the eyes and looks at you but responds slowly and is somewhat confused. Alertness and interest in the environment are decreased. How would a stuporous patient look? - correct answer A stuporous patient arouses from sleep only after painful stimuli. Verbal responses are slow or even absent. The patient lapses into an unresponsive state when the stimu- lus ceases. There is minimal aware- ness of self or the environment. How would a comatose patient look? - correct answer A comatose patient remains unarousable with eyes closed. There is no evident response to inner need or external stimuli Aphonia - correct answer refers to a loss of voice that accompanies disease affecting the larynx or its nerve supply. Dysphonia - correct answer refers to less severe impairment in the volume, quality, or pitch of the voice. For example, a person may be hoarse or only able to speak in a whisper. Causes include laryngitis, laryngeal tumors, and a unilateral vocal cord paralysis (CN X). Dysarthria - correct answer refers to a defect in the muscular control of the speech apparatus (lips, tongue, palate, or pharynx). Words may be nasal, slurred, or indistinct, but the central symbolic aspect of language remains intact. Causes include motor lesions of the central or peripheral nervous system, parkinsonism, and cerebellar disease. Aphasia - correct answer refers to a disorder in producing or understanding language. It is often caused by lesions in the dominant cerebral hemisphere, usually the left. Nystagmus - correct answer is a rhythmic oscillation of the eyes, analogous to a tremor in other parts of the body. It has multiple causes, including impairment of vision in early life, disorders of the labyrinth and the cerebellar system, and drug toxicity. Nystagmus occurs normally when a person watches a rapidly moving object (e.g., a passing train). Thunderclap headaches - correct answer reaching maximal intensity over several minutes occur in 70% of patients with subarachnoid hemorrhage, and are often preceded by a sentinel leak headache from a vascular leak into the subarachnoid space. If headache is severe and of sudden onset, consider? - correct answer subarachnoid hemorrhage or meningitis. Characteristics of migraine and tension headaches - correct answer Migraine and tension headaches are episodic and tend to peak over several hours. *New and persisting, progres- sively severe headaches raise concerns of tumor, abscess, or mass lesion. Unilateral headache occurs in? - correct answer migraine and cluster headaches Where do tension headaches often arise? - correct answer in the temporal areas cluster headaches - correct answer may be retro-orbital (situated or occurring behind the orbit of the eye). Medication for overuse headache is indicated if? - correct answer is indicated if present ≥15 days a month for three months and reverts to 15 days a month when the medication is discontinued bilateral visual loss that is gradual can indicate - correct answer cataracts or macular degeneration Slow central visual loss can occur in - correct answer -macular degeneration, nuclear cataract peripheral visual loss can occur in - correct answer advanced open-angle glaucoma Has the patient seen lights flashing across the field of vision? - correct answer Flashing lights or new vitreous floaters suggest detachment of vitreous from retina. **Prompt eye consultation is indicated.