Abnormal and normal

Question 1

Cranial Nerves

Answer 1

• Right homonymous hemianopsia (loss of vision on one side) (CN II).
• Jaw weakness on right (CN V).
• Weakness in right lower face (CN VII).
• Weak shoulder shrug and head movement on right (CN XI). - Stroke affecting motor and sensory cranial nerve pathways on the right side.

Question 2

Motor Function

Answer 2

• Right-sided hemiplegia (arm and leg).
• Spasticity and limited ROM in right arm and leg.

= Damage to the corticospinal tract from the stroke.

Normal
- Symmetrical muscle bulk and tone.
- No involuntary movements.
- No atrophy, weakness, or tremors.
- Smooth, coordinated gait; able to tandem walk.
- Negative Romberg test.
- Smooth and intact rapid alternating movements.

Abnormal
- - Muscle atrophy or hypertrophy.
- Spasticity, rigidity, or flaccidity.
- Involuntary movements like tremors or fasciculations.
- Muscle atrophy or weakness.
- Tremors or spasticity.
- Unsteady gait, ataxia, or inability to tandem walk.
- Positive Romberg test (loss of balance).
- clumsy rapid alternating movements

Question 3

Sensory Function

Answer 3

• Reduced pinprick and light touch sensation in right arm and leg.
• Impaired position sense on right side.

= Cortical sensory loss from CVA.

Normal
- Normal perception of touch, pain, vibration, and position.
- Intact pinprick, light touch, and vibration sensation.
- Stereognosis intact (can identify objects by touch).

• Abnormal
• Decreased sensation (e.g., hypoesthesia, hypoalgesia, analgesia).
  Inability to perceive vibration or proprioception.
• Inability to identify objects (astereognosis).

Question 4

Headache

Answer 4

• No frequent or severe headaches. - Frequent, severe headaches.
• Associated with neurological symptoms (e.g., vision changes, confusion).

Question 5

Head Injury

Answer 5

• No history of head injury.
• Consistent helmet use for sports. - History of head trauma with loss of consciousness.
• Inconsistent helmet use.
• Persistent symptoms like confusion or dizziness post-injury.

Question 6

Dizziness/Vertigo

Answer 6

• No dizziness or vertigo. - Lightheadedness (possible syncope).
• Rotational spinning sensation (true vertigo).
• Associated with positional changes or neurological disorders

Question 7

Seizures

Answer 7

• No history of seizures. - Recurrent seizures with altered consciousness.
• Auras (auditory, visual, motor).
• Postictal confusion, muscle weakness, or headache.

Question 8

Tremors

Answer 8

Normal
- No tremors observed.

Abnormal
- Involuntary shaking, worse with anxiety or purposeful movement.
- Senile tremor (relieved by alcohol).
- Tremors affecting daily or social activities.

Question 9

Weakness

Answer 9

• No weakness or impaired movement. - Generalized or localized weakness (e.g., difficulty getting up or opening jars).
• Proximal or distal muscle weakness (paresis or paralysis).

Question 10

Incoordination

Answer 10

• No problems with balance or coordination. - Difficulty walking straight.
• Clumsy or unsteady movements.
• Dysmetria (inability to control movement range).

Question 11

Numbness/Tingling

Answer 11

• No numbness or tingling sensation.
• Paraesthesia (“pins and needles”) localized or generalized. (pressure and damage to the peripheral nerves)
• Burning or tingling sensations with activity.

Question 12

Difficulty Swallowing

Answer 12

• No problems swallowing. - Dysphagia (difficulty with solids or liquids).
• Excessive drooling or salivation.

Question 13

Difficulty Speaking

Answer 13

• Clear and coherent speech. - Dysarthria (difficulty forming words).
• Aphasia (difficulty comprehending or expressing language).

Question 14

Significant Past History

Answer 14

• No history of stroke, spinal cord injury, meningitis, or congenital defects. - History of neurological diseases (e.g., stroke, encephalitis).

Question 15

Environmental Hazards

Answer 15

• No exposure to harmful substances or excessive alcohol use. - Exposure to insecticides, organic solvents, or lead.
• Regular alcohol or recreational drug use.

Question 16

Risk for Falls (Older Adults)

Answer 16

• Stable balance and no dizziness upon positional changes. - Dizziness or fainting upon standing.
• Increased risk of falls due to poor balance or positional changes (e.g., micturition syncope).

Question 17

Cognitive Function (Older Adults)

Answer 17

• No changes in memory or mental clarity. - Sudden or gradual memory loss.
• Confusion or disorientation.

Question 18

Vision (Older Adults)

Answer 18

• Stable vision with no changes. - Sudden vision changes or blindness.
• Associated weakness or loss of consciousness (possible stroke).

Question 19

Reflexes

Answer 19

• Hyperactive reflexes with clonus on the right side.
• Upgoing toes (positive Babinski sign) on right.
  = Upper motor neuron lesion due to CVA.

Normal
- - Reflexes graded 2+ (normal).
- No Babinski sign (downgoing toes). = good
- Deep tendon reflexes (DTRs) graded 2+ bilaterally.

Abnormal
- Hyporeflexia (diminished reflexes due to lower motor neuron issues).
- Hyperreflexia (exaggerated reflexes due to upper motor neuron issues) (graded 4+) with clonus.
- Positive Babinski sign (upgoing toes).
- Absent abdominal or cremasteric reflexes.

Question 20

Gait

Answer 20

• Smooth, rhythmic, and coordinated gait.
• Ataxia (unsteady or uncoordinated gait).
• Inability to perform tandem walking.

Question 21

Romberg Test

Answer 21

• Able to maintain balance with eyes closed.
• Positive Romberg sign (loss of balance when eyes are closed).
• Indicates cerebellar ataxia, proprioceptive, or vestibular dysfunction.

Question 22

Mental Status

Answer 22

• Slow, effortful speech.
• Limited verbal output, mostly one-word answers. - Aphasia due to cerebrovascular accident (CVA).
• Appearance, behavior, and speech appropriate.
• Alert and oriented to person, place, and time.
• Memory intact (recent and remote). - Confusion, disorientation.
• Memory loss (short-term or long-term).
• Inappropriate behavior or speech patterns.