Cerebrovascular disorders
Which part of the brain is responsible for muscle coordination and balance?
A. Cerebellum
B. Brainstem
C. Cerebrum
D. Temporal lobe
A.
Damage to the cerebellum can cause difficulty in balance, muscle coordination, and walking.
Which part of the brain is responsible for regulation of vital functions like breathing and heart rate?
A. Cerebellum
B. Cerebrum
C. Brainstem
D. Occipital lobe
C.
The brainstem is the biggest regulator of autonomic function like breathing and consciousness.
Which type of bone fracture causes an incomplete fracture of the bone, leaving one side intact. This type is also very common in kids.
A. Compound
B. Transverse
C. Spiral
D. Greenstick
D.
These types are the most common in kids and it leaves one side of the bone intact.
This disease is known as the "silent disease" and causes bone breakdown and weakening slowly, over time.
A. Osteoarthritis
B. Osteomalacia
C. Osteoporosis
D. Myasthenia gravis
C.
Osteoporosis or "porous bone" can occur because of a few reasons. Some being loss of certain hormones through aging (estrogen, testosterone), poor calcium and vitamin D intake, and certain conditions like cushing's syndrome. It presents a lot of the time by the person affected actually breaking a bone.
Which term below means to be prescribed multiple medications at one time?
A. Monopharmacy
B. Polypharmacy
C. Manypharmacy
D. Lotsofpharmacy
B.
Older adults are more at risk for forming multiple chronic diseases and so are more at risk of being out on multiple medications at one time. This is why it is important to come up with strategies for them to remember when to take which medicines and to avoid drug-to-drug interctions.
Which cranial nerve is responsible for the gag reflex and some parasympathetic control of the body?
A. IV - Trcohlear
B. X - Vagus
C. IX - Glosopharyngeal
D. VII - Facial
B.
The vagus nerve can be affected during a stroke and that is why it is always important to check a gag reflex in a stroke patient before you feed them.
Which disease causes progressive demyelination of the neurons of the nervous system and has periods of remission and exacerbation?
A. Parkinson's
B. Multiple Sclerosis (MS)
C. Guillain-Barre
D. Myasthenia Gravis
B.
MS is a an autoimmune disease that causes progressive demyelnation of the neurons of the nervous system. S/s can be weakness, dysphagia, dyspnea, and loss of sensation.
This disease causes bone breakdown due to insufficient blood supply to the bone.
A. Avascular necrosis
B. Osteoporosis
C. Osteomalacia
D. Hyperparathyroidism
A.
Avascular necrosis can usually be caused by some sort of trauma/break to a bone, causing damage to the blood vessels that supply it with blood. This causes the bone to necrose and break down.
A 50 yo patient of yours comes to the clinic complaining of chronic knee pain and inability to walk on it correctly. They say the pain "crept up on them" and they are also complaining of increasing stiffness in the joint upon rising in the morning. Which disorder is most likely going on with this patient?
A. Osteomalacia
B. Rheumatoid arthritis
C. Osteoarthritis
D. Osteoporosis
C.
Osteoarthritis (OA) is caused by the degeneration of the cartilage inside of a synovial joint over time. This causes the joint space to shrink and causes the pain/inflammation associated with OA.
Which disease below is defined as a syndrome of loss of cognitive function and memory that is progressive and impedes the functions of daily living.
A. Delirium
B. TIA
C. Dementia
D. Ischemic stroke
C.
Alzheimer's is the most common type of dementia and dementia usually progresses until the person has trouble remembering family members, performing ADLs, etc.
A patient comes to the ER by ambulance because of stroke-like symptoms. While assessing them you find them to have a facial droop, and slurred speech, and left-sided weakness. While they are being prepped for a CT scan, they suddenly lose all s/s and say they "feel normal". What do you think just happened to this patient?
A. Hemorrhagic stroke
B. Ischemic stroke
C. Clonic seizure
D. Transient ischemic attack (TIA)
D.
A TIA is when someone has a "mini stroke" where they have s/s of a stroke but they resolve spontaneously w/ in 24 hours.
This disease causes the progressive destruction of the cells in the brain that produce dopamine.
A. Guillain-Barre'
B. Epilepsy
C. Parkinson's
D. ALS
C.
Parkinson's is a progressive disease that causes the destruction of the cells in the brain that produce the neurotransmitter dopamine. This causes s/s of tremors, poor muscle control, bradykinesia, and a tell-tale "parkinsonian" gait.
Which of the following is one of the most serious complications associated with orthopedic surgery and it tends to occur in upward of about 50% of patients that get orthopedic surgery?
A. DVT/PE
B. Contractures
C. Muscle atrophy
D. Bone deformity
A.
All choices are potential complications of orthopedic surgery but DVT and subsequent PE is the most life threatening to patients recovering from orthopedic surgery.
Which disease is caused by not having enough vitamin D in the diet and usually presents with lumbar back pain?
A. Osteomalacia
B. Osteoarthritis
C. Osteoporosis
D. Spinal stenosis
A.
If someone doesn't take in enough vitamin D, hey can't absorb the calcium they take in. This can cause chronic hypocalcemia, high PTH secretion, and eventual bone breakdown.
Which condition/conditions sometimes first present in older adults as a change in mental status/confusion?
A. Dementia
B. Diabetes
C. Heart failure
D. Infections
D.
Many times, infections first present in older adults as a change in mental status. If this occurs tests are usually run to try to find a source of infection, usually in the lungs, a wound, or the urinary tract.
Which of the following are major risk factors for having a stroke? (select all that apply)
A. Female gender
B. Age >40
C. HTN
D. Atrial fibrillation
E. Family history
C, D, E
Other risk factors are having TIAs, obesity, smoking, diabetes, excessive alcohol, oral contraceptive use, and lack of exercise.
A patient of yours on the neuro floor has epilipesy. You go to see them and in the middle of your assessment they start to seize. What are some things that you should do?
A. Put a bite stick in their mouth to protect their tongue
B. Role them on their left side during the seizure
C. Move all objects away from the patient
D. Monitor their vitals while they are seizing
E. Give them high-flow oxygen by nonrebreather mask
B, C, D
You should never place anything in or over the patients mouth unless to suction away blood, vomit, or secretions. Also protect their head and time the duration of the seizure. If it goes on long enough, medical intervention through IV benzodiazapines may be necessary.
What are some s/s of compartment syndrome that you should look out for in the extremity someone with MS trauma?
A. Cool to the touch
B. Red/pink in color
C. Decreased sensation
D. Decreased pain
E. Pulselessness
A, C, E
This is caused by the swelling of tissue inside of an individual fascia or "compartment", cutting off blood flow to everything distal to the site. S/s of it include: increasing pain besides aggressive pain management, and the 5 Ps (pulselessness, pallor, pain, parathesia, and poikilothermia)
What are some teaching points to go over with an older female patient, that was just diagnosed with osteoporosis, to help them manage their condition?
A. Increase weight bearing exercise
B. Consume a diet high in calcium and vitamin D or take a calcium/vitamin D supplement
C. Avoid hormone replacement therapy if you are post menopausal
D. Increase your exposure to sunlight
A, B, D
Osteoporosis is usually caused by menopause in women, poor calcium/vit D intake, and lack of exercise. Management of it involves increasing weight-bearing exercise, increasing calcium/vti D intake, and hormone replacement therapy, in some cases.
What are some of the most common diseases to look out for in older adult patients? (select all that apply)
A. Chronic kidney disease
B. Heart failure
C. Osteoporosis
D. Diabetes
E. Dementia
A, B, C, D, and E
Older adults are more at risk for all of these diseases and then some. This is why older adults need more care and are usually on multiple medications at once.
A patient of yours was just diagnosed with a stroke. A CT scan shows it to be an ischemic stroke in the left hemisphere of the patients brain. What types of dysfunction do you expect to see in this patient? (ex: which side will be weak, what kind of metal changes, etc.)
Strokes in the left hemisphere can cause right-sided weakness, aphasia, emotional instability, etc. Other general s/s of a stroke are facial drooping, slurred speech, and mental status changes.
You are caring for a patient that was just diagnosed with Guillain-Barre syndrome. How does this disease occur and what are some tings to look out for when caring for this patient?
Guillan-Barre is caused by an autoimmune reaction, usually after a viral illness of some sort, against the myelin of the neurons of the nervous system. This tends to go in a foot-to-head fashion, causing paralysis/loss of sensation of affected body parts. It can eventually reach the diaphragm and stop their stimulus to breathe, hence why they need to be hospitalized and monitored. Most people completely recover from this but there is sometimes permanent damage to the myelin of the nervous system.
How is trauma to the MS system usually diagnosed and what are some major complications and treatments for MS trauma?
MS trauma is usually diagnosed through tests like x-rays, CTs, MRIs, and ultrasounds.
Major complications include neurovascular injury, compartment syndrome, and deformities.
Treatments include RICE therapy, surgery (ORIF), slings, casts, braces, and reduction of the bone.
What are some of the most common risk factors for forming degenerative bone disease and what are the general treatments for these disease?
Major risk factors: Age, poor calcium/vit D intake, hormonal issues, cushing's syndrome, malabsorption diseases like chron's, sedentary lifestyle, family history, bariatric surgery, etc.
Major treatments: joint replacements, exercise, nutritional support, fixing of the underlying cause of the issue.
Name some major physical and mental changes that happen with aging.
Physical: decreased CO and formation of CHF, loss of elasticity in lungs, muscles atrophy and weaken, fat stores increase, hormone production is decreased, bones become more weak/fragile, GI system becomes less effective/slower, kidneys can't filter as quickly -> CKD, vitamin/mineral deficiencies, etc.
Mental: Memory loss, decreased cognition, more susceptible to delerium and dementia, etc.