Medical-Surgical Review: Sensory, Neurological, and Integumentary Systems

Comprehensive practice flashcards covering ear and auditory disorders, visual and ophthalmologic pathologies, cognitive and central neurological conditions, and integumentary/wound care management.

What are the three middle ear ossicles, and in what sequence do sound vibrations travel across them?

Sound vibrations travel sequentially through the malleus (hammer), incus (anvil), and stapes (stirrup) before being transmitted into the cochlea.

Which four major classes of medications are commonly recognized as ototoxic?

1. Antibiotics
2. Diuretics
3. NSAIDs
4. Chemotherapeutic agents

What anatomical landmark is visible as a bright triangular reflection during a normal otoscopic examination of the tympanic membrane?

The cone of light.

What noise level in decibels represents the threshold of pain, and what is a real-world example of this sound level?

$130\,dB$, exemplified by an air raid siren heard at $50\,ft$.

What proportion of Americans between the ages of 65 and 75 experience hearing loss?

One-third ($\frac{1}{3}$) of Americans between the ages of 65 and 75.

What critical instruction regarding water exposure must be given to a client who wears hearing aids?

Remove the hearing aids before taking a shower or swimming to prevent water damage.

When caring for a client documented with presbycusis, how should the nurse communicate verbally?

Speak in a normal tone and pitch, speaking slowly and clearly while facing the client directly, rather than shouting.

What are the anatomical causes of tinnitus originating from the middle ear versus the retrocochlear area?

Middle ear tinnitus is typically caused by otosclerosis or vascular/circulation disorders. Retrocochlear tinnitus is caused by tumors or neoplasms, epilepsy, or damage to CN VIII (vestibulocochlear nerve).

What structural abnormality of the inner ear characterizes Ménière's disease, and what is its classic clinical triad?

It is characterized by endolymphatic hydrops (dilation/swelling of the labyrinth due to abnormal fluid and ion homeostasis), producing the classic triad of episodic vertigo, tinnitus, and sensorineural hearing loss.

What is the priority nursing action for a client experiencing an acute episode of Ménière's disease?

Assist the client in maintaining a safe and stable position to prevent falls and injury caused by severe vertigo.

Which cranial nerves innervate the extraocular muscles responsible for the six cardinal positions of gaze?

CN III (Oculomotor), CN IV (Trochlear - controlling superior oblique), and CN VI (Abducens - controlling lateral rectus).

What is the difference between entropion and ectropion of the lower eyelid?

Entropion is the inward turning of the eyelid margin causing the eyelashes to rub against the cornea. Ectropion is the outward turning and sagging of the eyelid margin, exposing the palpebral conjunctiva.

What are the five clinical red flags requiring emergent medical evaluation of the eye?

1. Sudden loss of vision in any part of the visual field
2. Sudden onset of eye pain
3. Presence of flashing lights
4. Physical trauma or injury to the eye
5. Constant tearing with or without photophobia

How do myopia and hyperopia differ in their focal points, and what lenses are used to correct them?

In myopia (nearsightedness), light rays focus in front of the retina and are corrected using concave lenses. In hyperopia (farsightedness), light rays focus behind the retina and are corrected using convex lenses.

What pathophysiologic change in the crystalline lens leads to cataracts, and what are the classic clinical manifestations?

An increase in protein aggregation causes lens clouding and opacity. Clinical manifestations include clouded or blurred vision, difficulty with night vision, halo vision around light sources, fading or yellowing of colors, and monocular double vision.

What are the key postoperative teaching guidelines following cataract extraction surgery?

Prevent increased intraocular pressure (elevate head of bed, do not strain or bend over), do not sleep on the operative side, report severe pain or signs of infection immediately, limit strenuous activities, and note that best vision is not expected for $4\text{ to }6\text{ weeks}$.

What visual field defect characteristically presents in glaucoma, and what diagnostic tool measures intraocular pressure?

Glaucoma causes a gradual loss of peripheral vision resulting in tunnel vision. Intraocular pressure (IOP) is measured using tonometry.

What yellow lipid-protein deposits observed on ophthalmoscopy characterize dry age-related macular degeneration?

Drusen bodies.

How does macular degeneration affect a client's perception when viewing an Amsler grid?

Straight lines on the grid appear distorted, wavy, bent, or missing, indicating absent or distorted central vision.

What three classic clinical manifestations indicate a retinal detachment?

1. Sudden appearance of floaters in the visual field
2. Light flashes (photopsia)
3. The perception of a shadow or curtain descending across the visual field

What surgical band procedure is illustrated for closing a retinal tear, and what are the key postoperative care rules?

Scleral buckling. Postoperative care includes wearing an eye shield nightly for $1\text{ week}$, lying face up for $3\text{ months}$, no driving for $2\text{ weeks}$, and avoiding vigorous lifting, exercise, or activities for $3\text{ months}$.

What primary functions are localized to the parietal lobe of the cerebrum?

Somatosensory awareness and processing (touch, pain, temperature, pressure, vibration), proprioception, spatial awareness, body awareness, and coordination of visual, auditory, and somatosensory stimuli.

What three behavioral categories comprise the Glasgow Coma Scale (GCS), and what are their maximum scores?

1. Eye Opening Response (maximum of $4\text{ points}$)
2. Verbal Response (maximum of $5\text{ points}$)
3. Motor Response (maximum of $6\text{ points}$) Total maximum score = $15\text{ points}$.

What constitutes an abnormal (positive) Babinski sign in an adult, and what pathology does it suggest?

Dorsiflexion of the great toe with fanning of the outer toes upon stroking the lateral plantar surface of the foot. It indicates upper motor neuron lesions or central nervous system dysfunction.

What three vital sign changes constitute Cushing's triad in a patient with life-threatening intracranial pressure (ICP)?

1. Increased systolic blood pressure (with widening pulse pressure)
2. Bradycardia (decreased pulse rate)
3. Altered or irregular respiratory patterns

What are the priority nursing actions during an active seizure?

Maintain airway and safety, turn the patient to a side-lying position, do not insert anything into the mouth, administer IV benzodiazepines as ordered, have suction and oxygen ready at bedside, and record the duration and characteristics of the seizure.

How is Brudzinski's sign elicited when assessing for meningeal irritation?

Passive flexion of the patient's neck causes involuntary flexion of the hips and knees to reduce tension on the inflamed meninges.

How is Kernig's sign assessed when evaluating a patient suspected of having meningitis?

The patient lies supine while the hip and knee are flexed to $90^\circ$. Attempting to extend or straighten the knee causes hamstring pain and resistance due to stretching of inflamed meninges.

What is the primary neuropathology underlying Parkinson's disease, and what are its cardinal motor symptoms?

Progressive degeneration of dopaminergic neurons in the substantia nigra and basal ganglia leading to decreased dopamine. Cardinal signs include resting tremor, muscle rigidity, bradykinesia/akinesia, masklike face, stooped posture, and a slow, shuffling gait.

How is Alzheimer's disease diagnosed clinically, and what age range exhibits the highest onset frequency?

Diagnosed by history, physical examination, and the Mini-Mental State Examination (MMSE) to exclude other causes (no single definitive lab or diagnostic test exists). It most commonly occurs in clients between ages 60 and 70.

What distinguishes cellulitis from impetigo in clinical presentation?

Cellulitis is an infection of the dermis and subcutaneous tissue characterized by spreading erythema, warmth, and edema. Impetigo is a superficial infection characterized by vesicles that rupture to form honey-colored crusted erosions, most often around the nose and mouth.

What factors can trigger the reactivation of dormant Herpes Simplex Virus (HSV)?

Ultraviolet (UV) light exposure, febrile illness, and physical or emotional stress.

What is the characteristic distribution and clinical course of Herpes Zoster (shingles)?

Reactivation of latent varicella-zoster virus causing unilateral, painful, blister-like sores along a specific dermatomal line. Lesions typically scab over within $7\text{ to }10\text{ days}$ and resolve within $2\text{ to }4\text{ weeks}$. Prevention includes a vaccine starting at age 50.

What fungal condition presents as erythematous, macerated plaques in warm, moist body creases, and how is it managed?

Cutaneous candidiasis (intertrigo). Managed with topical antifungal azoles, prompt hygiene after incontinence, keeping skin dry, and separating skin folds with gauze or dressings.

What are the pathophysiologic features of psoriasis, and what are its primary treatments?

An autoimmune inflammatory disorder with epidermal thickening, hypervascularity, and silvery scaling plaques. Treatments include topical creams, systemic medications, and ultraviolet (UV) light therapy.

How do arterial, venous, and neuropathic (diabetic) ulcers differ regarding skin temperature, pulses, and pain?

Arterial ulcers have cold skin, absent/weak pulses, and severe pain with shiny skin and hair loss. Venous ulcers have warm skin, edema, brownish discoloration/scaling, and mild-to-moderate pain. Neuropathic ulcers are typically painless with callused edges, dry scaly skin, and sensory loss.

What are the four successive phases of wound healing?

1. Hemostasis (platelet aggregation, fibrin clot formation)
2. Inflammatory phase (neutrophils, macrophages, bacteria clearance)
3. Proliferation phase (fibroblasts, collagen deposition, granulation tissue, angiogenesis)
4. Maturation phase (scar tissue remodeling, epithelial regeneration)

How do primary, secondary, and tertiary intention wound closures differ?

Primary intention involves early suturing of a clean wound resulting in a fine hairline scar. Secondary intention leaves gaping, irregular wounds to heal from the bottom up via granulation tissue, leaving a large scar. Tertiary intention involves delayed suturing of contaminated wounds after granulation tissue forms.

How are Stage 1 through Stage 4 pressure injuries differentiated by tissue depth?

Stage 1: Intact skin with non-blanchable erythema. Stage 2: Partial-thickness loss of epidermis or dermis (shallow crater, abrasion, blister). Stage 3: Full-thickness skin loss damaging subcutaneous tissue/fascia (bone/muscle NOT exposed). Stage 4: Full-thickness skin loss with exposed or palpable muscle, tendon, or bone.

What defines an unstageable pressure injury?

Full-thickness tissue loss in which the base of the ulcer is completely covered and obscured by slough (yellow, tan, gray, green, or brown) or eschar (tan, brown, or black), preventing accurate staging until debrided.

What six clinical subscales make up the Braden Scale for predicting pressure sore risk?

1. Sensory Perception
2. Moisture
3. Activity
4. Mobility
5. Nutrition
6. Friction & Shear

What laundering protocol is required to eliminate ectoparasites like scabies, lice, or bedbugs from contaminated clothing and linens?

Wash linens and clothing in hot water and dry them in a dryer on the hottest setting for at least $5\text{ minutes}$.