NR75D Exam 1

  1. Injury to what part of the brain would cause a change in personality, behavior, emotion, and intellectual functions?
    Frontal lobe
  2. What does Broca's area control?
    • Motor movement
    • Speech
  3. Injury to what part of the brain would cause a change in hearing, taste, and smell?
    Temporal lobe
  4. What does the precentral gyrus control?
    Motor movements
  5. What does the postcentral gyrus control?
    Sensory input
  6. Injury to what part of the brain would cause a change in sensation?
    Parietal lobe
  7. Injury to what part of the brain would cause a change in speech comprehension?
    Wernicke's area
  8. Injury to what part of the brain would cause a change in visual perception?
    Occipital lobe
  9. Injury to what part of the brain would cause a change in motor coordination, equilibrium and balance?
  10. What subjective information is important to obtain when taking a pt's history?
    • First notice of symptoms
    • Progression of symptoms
    • What alleviates symptoms
    • Family history
  11. What are the two types of seizures?
    • Tonic-clonic
    • Absent
  12. What is the GCS and what is the score based on?
    eye/alertness, verbal and motor responsiveness
  13. What is the scoring for the eye response in the GCS?
    • Spontaneous response: 4
    • Opening eyes to name or command: 3
    • Not opening to other stimuli but will open to pain: 2
    • Not opening eyes to any stimulus: 1
  14. What is the scoring for the verbal response in the GCS?
    • Appropriate orientation, conversant. Correct identification of self, place, yr, and mo: 5
    • Conversant but confused: 4
    • Inappropriate or disorganized use of words, lack of sustained conversation: 3
    • Incomprehensible words, sounds (e.g., moaning): 2
    • Lack of sound, even with painful stimuli: 1
  15. What is the scoring for the motor response in the GCS?
    • Obedience of command: 6
    • Localization of pain, lack of obedience but presence of attempts to remove offending stimulus: 5
    • Flexion withdrawal,* flexion of arm in response to pain without abnormal flexion posture: 4
    • Abnormal flexion, flexing of arm at elbow and pronation, making a fist: 3
    • Abnormal extension, extension of arm at elbow usually with adduction and internal rotation of arm at shoulder: 2
    • Lack of response: 1
  16. When a pt has a GCS of 8 or less is their head injury severe, moderate or mild?
  17. When a pt has a GCS of 9 to 12 is their head injury severe, moderate or mild?
  18. When a pt has a GCS of 13 to 15 is their head injury severe, moderate or mild?
  19. What might be a possible cause of a lowering of the GCS score from high to low?
    Bleeding or hematomas
  20. What is CNI?
  21. What does the olfactory nerve control?
  22. What is CNII?
  23. What does the optic nerve control and how do you assess it?
    • Sensory input from retina
    • Bring pen from periphery and ask when they see it (visual field)
    • Snellen chart for visual acuity.
  24. What is CNIII?
  25. What is CNIV?
  26. What is CNVI?
  27. What does the oculmotor cranial nerve control?
    4 eye movements, visual focusing, pupilary constriction and accommodation and convergence
  28. How do you assess the oculomotor CN?
    • Follow the "H"
    • Pen light PERRLA
  29. What does the Trochlear CN control?
    Depresses and inwardly rotates the eye
  30. How do you assess the trochlear CN?
    Same as CNIII: Follow "H" and PERRLA
  31. What does the abducens CN conrol?
    Abduction of the eye
  32. How do you assess the abducens CN?
    Same as CNIII: Follow "H" and PERRLA
  33. What is CNV?
  34. What does the trigeminal nerve control?
    • Sensory input from the forehead, skin of the cheek
    • Motor muscles used for chewing
    • Taste
  35. What are the 3 branches of the trigeminal CN?
    • Opthalmic
    • Maxillary
    • Mandibular division
  36. What is trigeminal neuralgia?
    Demyelination of the trigeminal nerve: causes intense pain that is unbearable. Surgery must cut the nerve.
  37. How do you assess motor function of the trigeminal nerve?
    • Have pt clench their teeth and palpate the temporal and masseter muscles
    • Try to separate jaws by pushing down
  38. How do you test the sensory function of the trigeminal nerve?
    Have pt close eyes, lightly touch forehead, cheeks and chin with cotton or gauze.
  39. How do you test the taste function of the trigeminal nerve?
    Soak a cotton tipped applicator with a sweet then sour taste.
  40. What is CNVII?
  41. What does the facial nerve control?
    • Motor fibers for facial expression
    • Sensory fibers for taste in the front part of the tongue
  42. How do you assess the facial nerve?
    Have patient smile, frown, puff their cheeks, raise eyebrows
  43. What is CNIX?
  44. What is CNX?
  45. What does the glossopharyngeal CN control?
    • Sensory input from pharynx and posterior tongue (taste)
    • Motor fibers to pharyngeal muscles (soft palate)
  46. What does the vagus nerve control?
    • Sensory input from viscera of the thorax and abdomen
    • Motor fibers to larynx and pharyngeal muscles
    • Parasympathetic response to heart, lungs, digestive system
  47. How do you assess the glossopharyngeal CN?
    • Gag reflex
    • Say "ah" and "gah"
  48. How do you assess the vagus nerve?
    Say "ah" or "gah"
  49. What is CNXI?
    Accessory nerve
  50. What does the accessory CN control?
    Movement of the muscles of the upper shoulders, head and neck
  51. How do you assess the accessory CN?
    • Shrug shoulders
    • Turn head against resistance
  52. What is CNXII?
  53. What does the hypoglossal CN control?
    Muscles of the tongue
  54. How do you assess the hypoglossal CN?
    Stick out tongue, move it side to side, up and down
  55. What is CNVIII?
  56. What does the vestibularcochlear CN control?
    Hearing, balance
  57. How do you assess the vestibulocochlear CN?
    Hearing tests (Weber, Rine), balance
  58. How do you grade motor strength?
    • 5: movement against gravity with full resistance
    • 4: movement against gravity with some resistance
    • 3: movement against gravity only
    • 2: movement with gravity eliminated
    • 1: visible/palpable muscle contraction but no movement
    • 0: no contraction
  59. How do you assess sensory position?
    Have pt close their eyes, hold a digit on the sides and have them name the position digit and if you are moving it up or down
  60. How do you assess sensory vibration?
    Tuning fork
  61. How do you assess gait?
    Walk 10-20 ft and walk back, walk in straight line heel-to-toe
  62. What is Romberg's test?
    Pt stands feet together, arms stretched out at sides, eyes closed and hold position for 20 seconds. Observe swaying/loss of balance.
  63. What part of the brain is the Romberg's test assessing?
  64. Do you want a positive or negative Romberg's test?
    Negative: no impairment
  65. What are the cortical sensory function tests and what are they assessing?
    • Two point discrimination, graphethesia (writing on skin), sterognosis (perceiving form and nature of an object): all w/ eyes closed
    • Evaluates cortical integration of sensory perceptions
  66. When testing for sensory perception, should you start with the affected or non-affected side first?
  67. How do you grade deep tendon reflexes?
    • 4+ very brisk, hyperactive with clonis
    • 3+ brisker than average
    • 2+ normal
    • 1+ diminished, low normal
    • 0 no response
  68. What grades of deep tendon reflexes may indicate disease?
    4, 3
  69. During diagnostics, what differentiates CSF from other body fluids?
    Glucose, will dry on gauze with a halo
  70. How long can HIV asymptomatic stage 2 last and why?
    10+ years, because viral load is building and your body is continuously trying to rebuild CD4 cells.
  71. What number of CD4 cells is considered healthy?
    > 500 CD4 T cells/ul
  72. What number of CD4 cells is when immune function problems begin?
    < 500 CD4 cells/ul
  73. What number of CD4 cells is when severe immune function problems arise?
    < 200 CD4 cells/ul
  74. How is HIV stage 1 classified?
    • Acute infection
    • Seroconversion - development of HIV specific antibodies
    • Viremia - Large amounts of virus in blood
    • Flu/mono "like" symptoms within 2-4 weeks
    • Very contagious
    • Person often unaware of infection
  75. How is HIV stage 2 classified?
    • Chronic infection
    • Asymptomatic - virus is active at low levels up to 10+ years
    • Symptomatic - CD4 level decreases & viral load increases (fever, night sweats, diarrhea, severe fatigue & outbreaks of: candida, shingles, herpes, etc.)
  76. What are the symptoms of symptomatic, chronic HIV infection?
    • Fever
    • Night sweats
    • Diarrhea
    • Severe fatigue
    • Outbreaks of: candida, shingles, herpes
  77. How is HIV stage 3 classified?
    • AIDS
    • High viral load
    • CD4 count below 200 cells/ul
    • Or has an opportunistic infection/cancer
  78. What is the survival expectancy for AIDS?
    3 years
  79. What is cytomegalovirus treated with?
    Foscarnet (Foscavir)
  80. What is PJP and what is it treated with?
    • Pneumocystis Jiroveci Pneumonia
    • Sulfamethoxazole/Trimethoprim (Septra DS)
  81. What are the parenteral risk factors for HIV?
    • Blood transfusions (low risk)
    • Drug use (sharing needles)
    • Needle sticks (low risk)
  82. What are the sexual risk factors for HIV?
    Unprotected sex
  83. What are the perinatal risk factors for HIV?
    • Pregnancy
    • Delivery
    • Breastfeeding
  84. What population is the most affected by HIV?
    Gay and bisexual men, particularly young African Americans
  85. What are the HIV testing methods?
    • Rapid antibody testing
    • Rapid laboratory based tests
    • Antibody/Antigen testing
    • HIV-1/HIV-2 differentiation immunoassay
  86. What is the HIV rapid antibody testing?
    • At home test w/ saliva/blood
    • Tests for antibodies not antigens
    • Cannot detect HIV within 2-month window period between infection and detectable viral antibody load
  87. What is the HIV rapid laboratory based test?
    • Elisa w/ blood
    • Tests for antibodies not antigens
    • Results in 1-3 hours
    • Cannot detect HIV within 2-month window period between infection and detectable viral antibody load
  88. What is the HIV antibody/antigen test?
    • Fourth-generation Western blot
    • Most accurate
    • Gold standard: tests for antibodies and antigens
    • If positive, move on to differentiation immunoassay
  89. What is the HIV-1/HIV-2 differentiation immunoassay?
    • Differentiates between HIV-1 and HIV-2
    • Results in 20 minutes
  90. What is HAART?
    Highly active anti retroviral therapy
  91. What is triple therapy?
    3 antiretrovirals "the cocktail"
  92. What is PrEP?
    • Preexposure prophylaxis for adults at high risk of sexually acquired HIV
    • Tenofovir & Emtricitabine
  93. What is PEP?
    • Postexposure prophylaxis
    • Only used in emergency
    • Must start w/i 72 hours of exposure
    • Taken qd x 28 d
  94. What are the 5 mechanisms of HIV medications?
    • Entry inhibitors
    • NRTIs: nucleoside reverse transcriptase inhibitor: blocks RNA --> DNA
    • NNRTIs: nonnucleoside reverse transcriptase inhibitor: blocks RNA --> DNA
    • Integrase inhibitors: blocks integration of viral DNA into host DNA
    • Protease inhibitors: blocks HIV replication at "budding" stage
  95. What are the benefits of ART?
    • Prevent HIV disease progression
    • Prevent transmission of infections
  96. How do they determine ART prescription strength?
    • CD4 count
    • Transmission risk
  97. What is the current ART medication and how often to pts take it?
    • Complera (Emtriitabine/Rilpivirine/Tenofovir)
    • 1x/day
  98. What is the administration window for ART medications?
    Within minutes, must be given at EXACT same time daily.
  99. What is the recommended initial form of drug resistance testing for HIV drugs and why is it needed?
    • Genotype
    • Used to select effective ART
  100. How often do we assess drug adherence for HIV patients?
    Every visit
  101. What is key to ART effectiveness?
  102. What are the components of improved immune function in HIV patients?
    • Good nutrition
    • Exercise
    • Decreased stress
    • ART adherence
  103. What is the pathophysiology of GBS?
    • Auto-immune disorder, progresses quickly
    • Caused by a loss of myelin and inflammation and edema from autoimmune process in peripheral nerves
    • Nerve damage in motor, sensory and autonomic functions
  104. What triggers GBS?
    • Viruses, typically 1-3 weeks prior to symptom onset (CMV, Epstein-Barr, HIV)
    • Campylobacter jejuni gastroenteritis
    • Trauma
    • Surgery
  105. What are the clinical manifestations of GBS?
    • Ascending, symmetric paralysis
    • Pain that is worse at night
    • Paresthesias
    • Hypotonia
    • Paresis to quadriplegia
    • Diminished or absent reflexes
    • Respiratory dysfunction/failure
    • Autonomic dysfunction
  106. What stays intact in GBS?
    • Cognitive function
    • LOC
  107. How do you diagnose GBS?
    • Lumbar puncture w/ elevated protein and normal WBC count
    • EMG
    • Spinal MRI
    • Nerve conduction studies
  108. How do you score GBS?
    • 0 = healthy state
    • 1 = minor symptoms and capable of running
    • 2 = able to walk 30 ft or more without resistance but unable to run
    • 3 = able to walk 30 ft across an open space with help
    • 4 = bedridden or chair bound
    • 5 = requiring assisted ventilation for at least part of the day
    • 6 = death
  109. How do you treat GBS?
    • Plasmapheresis w/i first 2 weeks to remove plasma containing antibodies launching attack on body
    • High dose IV IG-G w/i first 2 weeks
    • Supportive care
  110. What does "amyotrophic lateral sclerosis" stand for?
    • "A" = no
    • "Myo" = muscle
    • "trophic" = nourishment
    • "Lateral" = where in the spinal cord
    • "Sclerosis" = scarring or hardening due to degeneration
  111. What is the pathophysiology of ALS?
    • Motor neurodegenerative disorder in brainstem and spinal cord
    • End stage is respiratory paralysis and death
  112. What stays intact in ALS?
    • Cognition
    • Bowel & bladder
    • Sensory
    • Extraocular movements
  113. What are the clinical manifestations of ALS?
    • Striated muscle atrophy
    • Muscle weakness
    • Fasciculations (muscle twitches)
    • Spasticity (muscles continuously contracted)
    • Hyperreflexia of deep tendon reflexes
    • Increased creatine kinase
    • Dysarthria (slurred speech)
    • Dysphagia
    • Ineffective cough
    • Flucuations in BP
    • Metabolic changes
    • Emotional lability
  114. What disorder shows a characteristic mark of increased creatine kinase?
  115. What disorder shows a characteristic sign of elevated protein in the CSF with normal WBC counts?
  116. What is a possible treatment for ALS?
    • Riluzole (glutamate blocker)
    • Edaravone
  117. What is edaravone?
    ALS medication, slows muscle atrophy
  118. What is Riluzole?
    ALS medication: glutamate blocker
  119. What is the most common complication of peritoneal dialysis?
Card Set
NR75D Exam 1
GBS/ALS, renal, ARDS/trachs/resp. failure, home care, HIV/AIDS, CVA, adv. IV, research, neuro assessment