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  1. Functions of cranial nerve 3
    Cranial Nerve 3 - Oculomotor:

    • eye movement
    • eyelid movement
    • pupil constriction
  2. Functions of cranial nerve 9
    Cranial Nerve 9 - Glossopharyngeal

    • pain and temp from ear
    • taste and sensation from posterior 1/3 of tongue
    • throat muscles
    • parotid gland
  3. Which muscles are tested for deep tendon reflexes?

    What is the rating Scale?
    • biceps
    • triceps
    • brochioradialis
    • quadraceps
    • achilles tendon
  4. 1 hyporeflexive
    • 2 normal
    • 3 stronger or more brisk than normal
    • 4 hyperactive
  5. What is Babinski's sign?

    When is it seen in adults?
    Dorsiflexion of the great toe and fanning of the other toes when the sole of the foot is stroked.

    • adults:
    • pathology in CNS
    • alcohol intoxification
    • after seizure
    • liver disease
    • strokes and brain injury

    Adults without above problems will likely have negative babinski reflex.
  6. List the 3 categories of the Glascow Coma Scale and list the subcategories for each of them.
    • Eye opening:
    • Spontaneous 4
    • To sound 3
    • to pain 2
    • never 1

    • Motor Response:
    • obeys commands 6
    • localizes pain 5
    • normal flexion (withdrawal) 4
    • abnormal flexion 3
    • extension 2
    • nothing 1

    • Verbal Response:
    • oriented 5
    • confused conversation 4
    • inapropriate words 3
    • incomprehensible sounds 2
    • nothing 1
  7. What is Decorticate Posturing and when is it seen?
    • Arms, wrists, and fingers are flexed
    • internal rotation and plantar flexion of legs

    seen in lesions that interrupt the corticospinal pathways
  8. What is decerebrate posturing?
    When is it seen?
    • extension of arms and legs
    • pronation of arms
    • plantar flexion
    • opisthotonos (tetanic spasm in which the head and heels are bent backward and the body is bowed forward)

    Usually associated with dysfunction of the brain stem.
  9. What generally happens with ischemic strokes?
    occlusion of cerebral artery by thrombus or embolus

    • Thrombolytic Stroke
    • Accounts for more than one half of all strokes
    • Associated with atherosclerosis

    • Embolitic stroke
    • Accounts for one-third of all strokes
    • embolus/emboli travel to cerebral arteries via carotid
    • artery
    • Sources of emboli are cardiac
  10. Name the different deficits caused by TIA
    transient ischemic attack
    • Visual Defects:
    • blurred vision
    • diplopia (double vision)
    • blindness in one eye
    • tunnel vision

    • Motor Deficits:
    • transient weakness (arm, hand, leg)
    • gait disturbances (ataxic)

    • Sensory Deficits:
    • transient numbness (face, arm, hand)
    • vertigo

    • Speech deficits:
    • aphasia
    • dysarthria (slurred speach)
  11. List six different areas for clinical manifestations for stroke.
    • cognitive changes
    • motor changes
    • sensory changes
    • cranial nerve dysfunction
    • cardiovascular abnormalities
    • psychosocial issues
  12. Discuss the Motor changes associated with stroke.
    • Hemiplegia or Hemiparesis on opposite side of body.
    • (motor nerve fibers cross in the medula)

    • Hypotonia - flacid paralysis
    • Hypertonia - spastic paralysis

    contractures, decreased range of motion, shoulder subluxation

    loss of proprioception, balance, and coordination, gait abnormalities

    altered bowel and bladder function
  13. What is Hemianopsia?
    blindness in half of the visual field
  14. What is Homonymous hemianopsia?
    blindness in the same side of both eyes
  15. Stroke:
    Differentiate between expressive and receptive aphasia.
    Aphasia is loss of ability to understand speech.

    • Expressive (Broca's or motor) aphasia
    • -motor or speech problem
    • -understands but can't communicate
    • -difficulty with writing
    • -frustration and anger

    • Receptive (Wernicke's or sensory) aphasia
    • -can't understand spoken and written word
    • -neologisms - nonsensical words
    • -global or mixed aphasia
    • -reading and writing equally effected
  16. What is the cause of Astigmatism?
    refractive error caused by unevenly curved surfaces on or in the eye

    results in vision distortion

    caused by uneven corneal surfaces
  17. Criteria for Legal Blindness
    visual acuity of 20/200 or worse in the better eye with the best optical correction

    visual field is not better than 20 degrees in the better eye
  18. What is a cataract?
    How are cataracts classified?
    When is an intervention done?
    opacity of lens that distorts image projected onto retina

    classified by nature of onset

    intervention when the patients lifestyle is affected or unacceptable
  19. Symptoms of Cataracts
    gradual painless blurred vision

    double vision may occur

    may lead to blindness
  20. factors that contribute to cataracts
    medications, alcohol, smoking, diabetes, inadequate intake over time of antioxidants, aging process
  21. Cataracts
    Types
    traumatic - injury, congenital

    secondary - due to other disease processes and/or certain meds
  22. Cataracts
    Surgical Procedures
    Intracapsular Extraction - removal of the entire lens and capsule; method easier, places patient at risk for retina detachment and loss of structure for an intraoccular lens implant.

    Extracapsular Extraction - cut through the anterior capsule to expose the opaque lens (most common).

    The lens replacement (implantation) is inserted at the time of cataract surgery.
  23. Post-Op care for Cataract Surgery
    - avoid straining; no heavy lifting, avoid sneezing, coughing, straining, vomiting, sex

    - bend from the knees to pick things up

    -instruct in the usage of eye drops and eye shields

    -encourage patient to sleep on the unaffected side
  24. Signs and symptoms of Glaucoma
    -cloudy, blurry vision, or loss of peripheral vision, appearance of halos (around lights etc)

    -decreased peripheral vision

    -pain, headache, brow ache

    -nausea, vomiting

    -most of the time vision is lost painlessly and gradually (called the silent thief)
  25. Glaucoma:
    What drug is a common medication to decrease intraoccular pressure?
    Pilocarpine
  26. What are the five danger signs of Glaucoma?
    • brow arching
    • halos around lights
    • blurry vision
    • diminished peripheral vision
    • headache or eye pain
  27. What is detached retina?
    separation of the retina from the pigmented epithelium
  28. Detached Retina:
    Name three types of detachments
    1. rheumatogenous detachment - occur following a hole or tear in the retina caused by mechanical force

    2. traction detachment - created when retina is pulled away from epithelium by bands of fibrous tissue in the vitreous.

    3. exudative detachment - caused by fluid accumulation in subretinal space (no retina breaks occur)
  29. What are the signs and symptoms of detached retina?
    • flashes of light, blurred vision
    • sensation or particles moving in line of vision
    • a feeling of a curtain coming up or down
    • loss of vision
    • confusion, apprehension, not usually painful
    • onset is usually sudden and painless
  30. What are the causes of retinal detachment?
    • trauma
    • aging process
    • diabetes
    • tumors
    • degeneration
    • exudate in front of or behind the retina
  31. Treatment for Retinal Detachment
    Bedrest, patching of eyes to decrease movement of eye, take precautions ot avoid bumping head or any activity that causes eyes to move rapidly, and avoid rapidly jerking the head

    Surgical repair of detachment - opthamologist may close or seal the break.. Goal is to bind the retina and choroid together. Requires general anesthesia.
  32. Surgery for Detached Retina?
    Cryotherapy - freezing probe

    Photocoagulation - lazer

    Diathermy - for small tears, electrode to produce an inflammatory response and therefore form adhesions

    common procedure - scleral buckling
  33. Pre-Op for Detached Retina?
    eye patch to reduce eye movement, activity restrictions
  34. Post op for detached retina?
    observe for complications, hemmorrhage, sharp pain, infection, avoid sneezing, coughing, straining, bending down, protect from injury, administer antiemetics/sedatives, eye shields and patch, give pain meds
  35. First week after surgery for detached retina?
    No reading, writing, or close work like sewing

    avoid activities that increase IOP
  36. Hearing Aids
    Used for patiends with conductive hearing loss

    less effective for sensorineural hearing loss and may make hearing worse

    wear briefly for short periods at first. tone or volume can be adjusted

    patient must learn to filter out background noises
  37. What is Presbycusis?
    How is it caused?
    sensorineural hearing loss that occurs as a result of aging

    caused by degeneration or atrophy of ganglion cells in the cochlea, loss of elasticity of the basilar membrane, or a decreased blood supply to the inner ear

    some say may be due to folic acid and B12 deficiency

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