What is important to note when a patient has traumatic injury - correct answer If taking Blood Thinners
Define delirium - correct answer Underlying
... [Show More] acute cause, abrupt onset, hours to days, reversible, hallucinations, incoherent speech, confusion
Define Dementia - correct answer Various causes, gradual change with mental status, months to years, progressive to irreversible (speech, memory, mood, judgment)
An older adult with delirium would present with what type of behaviors? - correct answer Agitation and restlessness
At the onset of alzheimers, what category of medications should be initiated? - correct answer Cholinesterase inhibitors
what factors contribute to a patient being high risk for falls? - correct answer History of falls
medications
vision impairment
heart rate/rhythm abnormalities
footwear issues
home environment
gait/mobility issues
poor reflexes
What is the primary reason people have long term effects after a Stroke - correct answer living at home and calling PCP instead of 911 leads to prolonged stroke symptoms and long term effects
S/S of an Absense Seizure - correct answer Blank stare (upward rotation of eye)
Red Flags of back/neck pain - correct answer Incontinence
Fever
Cancers
Unexplained wt loss
Long term steroids
Trauma
IV drug abuse
Intense local pain
No comfy Position
Diagnosing of Alzheimer's - correct answer Impaired ability to learn new info along with a disturbance in language, function, or perception
S/S of Alzheimer's - correct answer *C/O memory problems
* ↑ cognitive difficulty
* ↑ slow response to cognitive challenge
*Word-finding difficulty
* ↑ difficulty with simple tasks
cardinal features of Parkinson's (TRAP)? - correct answer *T-remor at rest (or pill rolling)
*R-igidity
*A-kinesia/Bradykinesia
*P-ostural Disturbances
What disease is "freezing phenomenon" a characteristic of? - correct answer Parkinson's
A 62 y/o patient calls and c/o of a headache what statement would cause the most concern? - correct answer It's the worst headache I've ever had
the headache from a subdural hematoma is of venous origin, typically resulting from ahead injury that is usually mild and easily forgotten by the patient. - correct answer Temporal arteritis
s/s of temporal (giant cell) arteritis - correct answer * unilateral HA (temporal artery, orbital)
* jaw claudication (pain with chewing)
* temporary blindness
(Medical Urgency) Polymyalgia rheumatica (pain/stiff muscles shoulders and hips)
What age group is at higher risk for temporal arteritis - correct answer >50
Clinical manifestations of Articular disorders? - correct answer *characterized by deep or diffuse pain, pain or limited ROM on active and passive movement
*swelling
*crepitus
Clinical manifestations of Non-Articular disorders? - correct answer *Tend to be painful on active but not passive (assisted) ROM.
*Seldom demonstrate swelling, crepitus, instability, or deformity by itself.
What diagnostic assessment is most useful in a patient who presents with lumbar radiculopathy? - correct answer The straight leg raise (assesses L5-S1). pain would indicate most common disc herniation
What cranial nerve is affected in Bell's Palsy? - correct answer CN VII
S/S of Bell's Palsy - correct answer * Acute onset one-sided Facial paralysis with normal ocular movement and sensation
* Affects CN VII (facial)-VII(vestibulocochlear)
* Loss of taste (dysgeusia)
* Postauricular pain
* Sound sensitivity (hyperacusis)
* Heavy feeling in face
How is Bell's Palsy diagnosed? - correct answer Clinical history and exam
What is a serious risk in patients with Bell's Palsey? - correct answer Loss of the ability to blink and close the eyelid subjects the cornea to drying and ulceration
Patient teaching for Bell's Palsey - correct answer *reassure it is self-limiting with 3-6 month recovery
*prevent corneal ulceration/ use artificial tears
*unilateral and tends to have a throbbing or pulsatile (head)
*precipitated by aura
*nausea
*vomiting
*photophobia
*phonophobia - correct answer S/S of Migraine H/A
A patient reports seeing flashes 20 minutes before having a severe H/A what type of H/A is it? - correct answer Classic migraine
*unilateral orbital, supraorbital, and/or temporal (headache)
*causes lacrimation, rhinorrhea, and nasal congestion) - correct answer S/S of cluster H/A
bilateral, non-pulsating, tightening (head) pain that is not aggravated by routine physical activity. It is usually not accompanied by nausea and vomiting or photophobia. - correct answer S/S of tension headache
If a patient c/o sudden 'thunder clap' H/A worst in their life what is a diff dx that should be considered? - correct answer Aneurism (subarachnoid hemorrhage)
potential complications of steroid use in a patient with impaired integrity of bone structure? - correct answer Increased risk of fracture
what maneuver should be used to assess CERVICAL nerve-root compression. - correct answer Spurling
Symptoms are related to compression of the median nerve, which results in pain, paresthesia's, numbness and tingling, and associated weakness in the hand and wrist that radiate to the thumb, index finger, middle finger, and radial half of the ring finger - correct answer Carpal Tunnel Syndrome
Form of arthritis characterized by painful flare-ups in joints of distal extremities? - correct answer Gout
Pain on the inside of elbow, Elbow stiffness, Hand and wrist weakness, Tingling sensation or numbness in the fingers, especially the ring and little fingers, Difficulty moving the elbow - correct answer Medial Epicondylitis (Golfer's Elbow)
Can cause neck pain, radiating arm pain, shoulder pain, and numbness or tingling in the arm or hand. The quality and type of pain can vary from dull, aching, and difficult to localize to sharp, burning, and easy to pinpoint, Can cause weakness in arm (s) - correct answer Ruptured Cervical Disc
In elderly patients, fracture of WHAT would lead to potentially fatal outcomes or problematic long term issues in elderly patients, - correct answer Hip Fracture
What is gold standard test for dx osteoporosis? - correct answer DEXA Bone Density test
Was is an important step during examination of an ortho complaint to be able to have a comparative value of both extremities - correct answer always exam the non-effected side and then effected side for comparison
What medications cause a patient to be at risk for developing osteoporosis? - correct answer • Glucocorticoids
• Excessive thyroxine
• Long-term phenytoin
What populations are at risk for developing osteoporosis? - correct answer • Age (65+)
* medications
• Family history
• Menopause
• Genetics
In a patient who is elderly and falls (does not remember the fall), but there is no clear cause of falls, what should your workup center around? - correct answer syncope associated with Cardiac and neurologic causes
If a patient is alert and oriented and refuses to give consent for a procedure, how do you move forward as a provider? - correct answer Respec their wishes, Discuss risks of NOT having procedure, abort procedure, document refusal
In elderly patients, what factors can contribute to loss of appetite and malnourishment? - correct answer *Diminished taste/smell/vision
*dry mouth
*poor dentition
*chronic illness
*meds
*pain
*depression
*loneliness
How would you assess for a suspected meniscal tear with a physical exam? - correct answer McMurray circumduction test.
Which test assesses the integrity of the anterior cruciate ligament? - correct answer Lachman
Which test assesses for De Quervain's Tenosynovitis? - correct answer Finkelstein's
Pt education for Carpal Tunnel Syndrome - correct answer * prevent flexion and extension movements of the wrist.
* Thumb Spika 24/7 x 3 weeks
*ergonomic Modifications
Patients who would like to incorporate non-traditional therapies for treatment of pain-how do you respond? - correct answer Educate on efficacy of other treatments but ultimately allow them and support them on their own decision as long as the cessation of pharmacological intervention is not detrimental
In terms of physical activity in a patient with Osteoporosis, what would encourage - correct [Show Less]