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Nurs 7330 Midterm Questions With Complete Solutions Essential tremor common, often familial, usually bilateral but can be asymmetric, Action tremor (tremor during voluntary movement), bilateral tremor affecting hands, arms, head, or voice, no significant bradykinesia or rigidity Parkinson's Disease rest tremor, bradykinesia, rigidity, postural instability, shuffling gait, mask-like facial expression Cerebellar tremor action tremor, dysmetria, ataxia, often due to cerebellar lesions Dystonic tremor Tremor with abnormal postures, worsens with specific actions Drug- induced tremor Tremor associated with medications (beta-agonists, antipsychotics) or withdrawal from alcohol Psychogenic tremor Inconsistent tremor that may vary with distraction Wilson's disease Rare, genetic disorder with hepatic and neurological symptoms, including tremor
Migraine Unilateral pulsating headache, moderate to severe intensity, nausea and/or vomiting, photophobia and phonophobia, aura Tension Headache Bilateral band-like headache, mild to moderate intensity, no nausea or vomiting, no aura, not aggravated by physical activity Cluster headache Unilateral severe stabbing or piercing headache, orbital or temporal location, autonomic symptoms, attacks occurring in clusters or bouts, restlessness or agitation during attacks Sinus headache Deep, constant pain in the forehead, cheeks, or bridge of the nose; aggravated by bending forward or lying down; associated symptoms - nasal congestion, facial pressure Intracranial Hypertension HA worsens with bending, straining, or coughing; visual disturbances (blurred vision, transient visual obscurations), papilledema on fundoscopic examination, associate symptoms - pulsatile tinnitus, nausea subarachnoid hemorrhage Sudden onset severe headache ("worst headache of my life"), thunderclap headache, neck stiffness, altered LOC, photophobia
Sudden or stepwise onset of symptoms, hx. of TIAs, executive function impairment, gait disturbances, emotional instability Lewy Body Dementia Visual hallucinations, parkinsonism, fluctuating cognitive impairment, REM sleep behavior disorder, autonomic dysfunction Frontotemporal Dementia Early changes in personality and behavior, aphasia, lack of insight, poor planning and judgment, motor symptoms in some cases Normal Pressure Hydrocephalus Triad (gait disturbance, urinary incontinence, and cognitive impairment), magnetic feet (feet appear stuck to the floor) Depression memory complaints more prominent than actual deficits, depressed mood, anhedonia, sleep disturbances, weight loss or gain Delirium Acute change in mental status, inattention, disorganized thinking or altered LOC, short- and long-term memory problems, sleep- wake cycle disturbance, hallucinations and/or delusions, emotional lability, tremors and asterixis
Progressive Supranuclear Palsy (PSP) Early postural instability and falls, vertical gaze palsy, axial rigidity, speech and swallowing difficulties, cognitive changes, Multiple System Atrophy (MSA) Parkinsonism with poor response to levodopa, autonomic dysfunction, cerebellar ataxia, speech and swallowing difficulties Corticobasal degeneration Asymmetric parkinsonism, apraxia, alien limb phenomenon, cortical sensory deficits, myoclonus Drug- Induced Parkinsonism Parkinsonism induced by medications (antipsychotics, metoclopramide), symptoms typically subside after discontinuation of the offending drug Multiple Sclerosis Episodes of neurological deficits that may fluctuate and remit. Include tremor, weakness, incoordination, paresthesia, and disturbances in vision and speech. A chronic disease of the central nervous system where plaques occur in the brain and spinal cord. Marked by damage to the myelin sheath. Benign Paroxysmal Positional Vertigo (BPPV)
Seizure Sudden onset of abnormal movements, altered consciousness, or postictal confusion Migraine with Aura Gradual onset of visual disturbances, sensory changes, or speech difficulties followed by headache Hypoglycemia Sudden onset of confusion, weakness, sweating, and palpitations; symptoms improve with glucose administration Insomnia A dissatisfaction with sleep quantity or quality resulting in clinically significant distress or impairment in social, occupation, or other important areas of functioning. Difficulty falling asleep or remaining asleep Narcolepsy Chronic neurological disease that manifests as difficulty maintaining continuous wakefulness and sleep. Recurrent periods of an irrepressible need to sleep, lapsing into sleep, or unrefreshing napping occurring within the same day Obstructive Sleep Apnea (OSA)
Sleep disorder characterized by cessation of breathing (apnea) and/or significant decrease in airflow in the presence of breathing effort (hypopnea). Restless Leg Syndrome (RLS) Chronic neurological disorder characterized by an irresistible urge to move the legs. Worsens with rest, relieved by movement, worse in evening/at night. Normally occurs at least 3X/ week Generalized Anxiety Disorder (GAD) Persistent, excessive, and difficult-to-control worry associated with significant symptoms of motor tension, autonomic hyperactivity, and/or disturbances of sleep or concentration Panic disorder Unexpected discrete episodes of intense anxiety that peak within 10 minutes and are associated with Autonomic arousal, feelings of depersonalization/derealization, or fear of dying, losing control, "going crazy", impending doom Social Anxiety Disorder Marked fear of being the center of attention or behaving in a way that will result in embarrassment or humiliation Obsessive- Compulsive Disorder
A mood disorder in which the person alternates between the hopelessness and lethargy of depression and the overexcited state of mania. Anorexia Nervosa (AN) Morbid fear of obesity and nutritionally significant weight loss. Characterized by weight loss, salivary gland enlargement, osteopenia/osteoporosis, dry and cracked skin, fine downy hair, bradycardia, amenorrhea, growth arrest Bulimia Eating a very large amount of food that is larger than someone else might eat in the same amount of time. Characterized by Distorted body image and Compensatory behaviors: self-induced vomiting, use of laxatives, diuretics; rigorous exercise, dieting, or combination of these Binge Eating Disorder Most prevalent eating disorder. See patients with Hyperlipidemia, HTN, CVD, DM, GERD, Sleep-related breathing disorders, Musculoskeletal disorders, Psychiatric co- morbidities, recurrent distressing binge eating episodes PTSD Maladaptive symptoms after an event. Sleep disturbance, low frustration threshold, irritability, socially isolative, panic
symptoms, difficulty with focus and concentration, low energy, loss of interest, feelings of emotional detachment to others, decreased performance at work/school, avoidance, guilt, risk taking behaviors, suicidal thoughts Schizophrenia Psychotic features with two or more of the following :Delusions ,Hallucinations ,Disorganized speech ,Grossly disorganized or catatonic behaviors ,Negative symptoms (Affective flattening, poverty of speech, avolition, anhedonia, and social isolation) Bell's palsy Acute onset of unilateral upper and lower facial paralysis, posterior auricular pain, decreased tearing, poor eyelid closure, ocular pain, blurred vision Sinusitis •Pain over cheek radiating to frontal region or teeth (worse with straining or bending down) •Redness of cheeks, nose, eyelids •Tenderness to frontal sinus (immediately above inner canthus) Referred pain to vertex, temple, or occiput -Suspect if lasts 7-10 days -accompanied by fever, nasal discharge, periorbital edema
macular degeneration Painless breakdown or thinning of the tissues in the macula, resulting in partial or complete loss of central vision. typically, unilateral from gradual to sudden blurring to complete blindness. *Test with the AMSLER GRID Retinal detachment Painless. "Curtain being pulled" Hx of a contributing condition or trauma followed by visual disturbance- flashing light, floaters, black dots, or scotoma. Retina appears wrinkled and grey Viral conjunctivitis Infection associated with erythema, copious watery with strands of mucus discharge Allergic Conjunctivitis Infection associated with Pink conjunctiva, puffy/bumpy, watery discharge. Bacterial conjunctivitis Infection of eye associated with purulent yellow or green discharge the recurs and margins and corners of eye. Conjunctiva is pink or red in appearance. Little to no itching Corneal Abrasion
Possible secondary to trauma or contacts. Redness, eye pain, scratchiness, & reluctance to open eye, tearing, & FB sensation w/blinking. May have blurriness in affected eye *Fluorescein staining &Blue light/woods lamp to assess Preseptal Cellulitis Tenderness, redness, and swelling of the eyelid and periorbital area. Not as bad as orbital cellulitis No: Proptosis (exophthalmos) Optic Neuropathy Restriction of extraocular motility Pain on eye movement Orbital Cellulitis A diffuse infection of tissues in the orbit, causing grossly swollen eyelids and red eye, sometimes without proptosis. Deep eye pain. Fever is usually present. Can also have double vision. Refer for hospital admission Hordeolum (stye) an infected sebaceous gland of the eyelid. Tender, swollen, near an eyelash, bacterial in nature chalazion
Refer to orolarynologist- Can be malignant! If you have patient with Asymmetric tonsils w/ or w/o masses... Possible head and neck malignancy Prolonged s/s of pharyngitis associated w/odynophagia, dysphagia, unilateral otalgia, hoarseness, & trismus Concerning for malignancy If you see persistent, rapidly growing, painless mouth lesions or lesions... Otitis media symptoms Fever, irritability, lethargy, poor appetite, vomiting, pain, URI symptoms Otitis externa symptoms -Otalgia (ear pain) exacerbated by moving pinna/tragus -Erythema and edema of ear canal -Pruritis -Ear discharge -Normal pneumatic otoscopy Bronchitis •Localized lymphadenopathy •Rhinorrhea •Headache •PND (cobblestoning)
•Pharyngeal erythema •Wheezing clears with coughing •Cough duration of 2-6 weeks Chest pain ONLY when coughing NO: fever, dyspnea Allergic Rhinitis Positive findings: -grimace and twist face -chronic mouth breathing -injected conjunctiva -dennie-morgan lines -middle ear effusion -transverse nasal crease -boggy/pale nasal mucosa -high arched palate -frequent, recurrent cough Negatives: -No fever -no malaise Asthma -Pertinent history of nocturnal dyspnea, wheezing with physical activity, or seasonal coughing/sob •I>E
•Recurrent lower respiratory tract infections •Chest tightness (especially after exercise) •Barrel Chest •Wheezing •Diffusely decreased breath sounds •Hyperresonance on percussion •Prolonged expiration •Anorexia/weight loss •Fatigue Chronic Bronchitis •Patient may be obese •Frequent cough and expectoration are typical •Use of accessory muscles with respiration are common •Coarse rhonchi and wheezing •Could have signs of right sided heart failure (such as edema/cyanosis) Influenza •Cough •Fever •Sore Throat •Myalgias •Frontal or retroorbital headache •Weakness •Severe fatigue •Tachycardia
•Red watery eyes Physical- •Sinusitis •Otitis Media •Myositis •Sepsis •PNA •Myocarditis •Encephalitis Multiorgan failure Pneumonia •Cough •Dyspnea •Pleural Pain •Sweating and Night Sweats •Fever greater than 100. •Chills •Myalgias Physical: -Tachycardia -Tachypnea -Fever greater than 100. -Crackles -Tactile Fremitus
