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PCM Exam 2 > Approach to the patient with Neurological complaint > Flashcards

Approach to the patient with Neurological complaint Flashcards

1
Q

Define dysarthria

A

Problem with the motor functions of speech; causes defective articulation

issue with motor control of the speech apparatus- tongue, vocal cords, etc

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2
Q

Define aphasia

A

disorder in producing or understanding the language; there is no language ability whatsoever

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3
Q

What does A&O x 4 mean?

A

Patient is alert and oriented to person, place, time and event

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4
Q

Describe the varying levels of the alert and oriented scale

  1. A&O x 1
  2. A&O x 2
  3. A&O x 3
  4. A&O x 4
A
  1. alert and oriented to person
  2. alert and oriented to person and place
  3. alert and oriented to person place and time
  4. alert and oriented to person, place, time, and event
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5
Q

Differentiate between delirium and dementia

A

Delirium is reversible and typically from a new situation, like an old person being in the hospital

Dementia is not reversible and you must eliminate depression and delirium prior to diagnosing

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6
Q

How do you ask about depression?

A

“Have you been feeling down, depressed, or hopeless?”

“Have you felt little interest or pleasure in doing things?”

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7
Q

Describe cranial nerve testing (what are the steps with the pen light)

A
  1. Test pupil constriction with a light source (II)

2. Use the same light source to look in the patients mouth and have them say “ahhh” which tests cranial nerve X

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8
Q

Describe the cranial nerve testing for CN V

A

Start at the top of the forehead and make your way down the face to see if they are able to feel what you are touching (sensory)

Have the patient clench their jaw to test for the motor portion of CN V

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9
Q

Describe the testing of cranial nerve III, VI, IV of the eyes

A

Do the H test

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10
Q

Describe the cranial nerve testing of CN VIII

A

Check the hearing with the finger rub next to the ear

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11
Q

Describe the cranial nerve testing of CN VIII

A

Have the patient smile, frown and observe the mouth and the eyes while they do it

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12
Q

Describe the cranial nerve testing of IX and XII

A

Have the patient push their tongue against the cheek and feel for strength (IX) then have them stick out their tongue (XII)

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13
Q

Describe the cranial nerve testing of CN XI

A

Have the patient shrug their shoulders against resistance and turn head L/R against resistance to test the trapezius

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14
Q

Briefly describe the steps of a cranial nerve test

A
  1. light test of CN II (constriction) and CN X (mouth say ahhh)
  2. Test V sensory and motor by touching face and having clench jaw
  3. H test to test CN III, IV, VI
  4. Finger rub to test CN VIII
  5. CN VII testing with smile, frown
  6. Strength of tongue and sticking out tongue (IX, XII)
  7. CN XI of shoulder shrug
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15
Q

What are the effects of a lesion in CN III?

A

Ptosis and pupillary dilation

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16
Q

If there is a lesion in CN III, what are the order in which the eye is affected?

A
  1. There is compression of the pupilloconstrictor fibers that cause dilation and fixation of the pupil
  2. weakness in the extra ocular muscles cause a down and out positioning of the eye
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17
Q

If there is a lesion in CN IV (vulnerable in head trauma), what could it result in?

A
  1. Exotropia (eye position drifts laterally) and weaknesss of the downward gaze (weakness of the superior oblique
  2. Vertical diplopia- increases when looking down
  3. Head tilting (opposite of the lesion)
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18
Q

Describe a lesion in CN VI (rare, seen in subarachnoid hemorrhage, late syphilis, trauma) , what does it affect?

A
  1. convergent strabismus (abduct the eye)

2. Horizontal diplopia

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19
Q

Define nystagmus

A

rhythmic oscillation of the eyes; due to the fast beating of the nystagmus

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20
Q

What are the causes of nystagmus?

A

Vision impairment
Disorder of labyrinth of cerebellar systems
drug toxicity

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21
Q

Describe lesions of CN V

A

Trigeminal neuralgia; loss of corneal reflex, jaw deviation toward the weak side, weakness in mastication, etc.

Very bad pain; brief episodes of shock like pains along the distribution of the trigeminal nerve, can be debilitating

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22
Q

Describe lesions in CN VII

A

Paralysis of the facial muscles; loss of corneal reflex, hyperacusis, crocodile tears (cry when eat)

23
Q

How do you test for CN VIII?

A

Whisper test
Finger rub
Weber Rinne testing

24
Q

Lesions in CN VIII can cause what?

A

Dysequilibrium

nystagmus

25
Q

How do you test CN IX and CN X

A

Listen for hoarseness, nasal tone
Check the gag reflex
Check swallowing
Ask the patient to open their mouth and say “ahh”

***unilateral loss indicates an ipsilateral CN X lesion

26
Q

If there is a lesion in CN IX, what happens?

A

loss of gag reflex
loss of sensation in the pharynx and the posterior 1/3 of the tongue
slight dysphagia

27
Q

If there is a lesion in CN X, what happens?

A

Dysphonia, Dysphagia, Dyspnea, Loss of gag reflex

28
Q

How do you test CN XI?

A

SCM: have the patient turn their head against mild resistance; contraction of L SCM causes the head to turn to the right

Trapezius: have them shrug shoulders against resistance

29
Q

Describe testing of CN XII

A

Have the patient protrude their tongue, and you push against their cheeks

30
Q

What is the dermatome of the auricle

A

C2

31
Q

What is the dermatome of the earlobe, anterior or posterior neck

A

C3

32
Q

What is the dermatome of the shoulder top?

A

C4

33
Q

What is the dermatome of the radial aspect of the forearm?

A

C6

34
Q

What is the dermatome of the long finger?

A

C7

35
Q

What is the dermatome of the little finger

A

C8

36
Q

What is the dermatome of the nipple

A

T4

37
Q

What is the dermatome of the umbilicus

A

T10

38
Q

What is the dermatome of the inguinal

A

L1

39
Q

What is the dermatome of the patella/ mid calf

A

L4

40
Q

What is the dermatome of the anterolateral calf and great toe?

A

L5

41
Q

What is the dermatome of the posterolateral calf/ little toe?

A

S1

42
Q

What are ways that you can test the sensory system?

A
  1. pain
  2. temperature
  3. vibration
  4. proprioception
43
Q

Define stereognosis

A

ability to identify shapes of objects, or recognizing objects that are placed in the hand

44
Q

Define graphesthesia

A

ability to identify numbers that are written on the palm

45
Q

Define two point discrimination

A

ability to distinguish being touched by one or two points

46
Q

Define double simultaneous stimulation

A

Ability to feel two locations being touched simultaneously

47
Q

Describe patterns of sensory loss

  1. single root
  2. root or roots
  3. spinal cord
  4. brainstem
  5. thalamic
  6. cortical loss
  7. functional loss
A
  1. loss limited to distribution of a single nerve
  2. loss in different nerve distributions with a common root
  3. complete transverse section
  4. ipsilateral loss in the face and contralateral body
  5. hemisensory loss of modalities
  6. intact primary sensations but no cortical sensations
  7. non-anatomical distribution
48
Q

Describe cerebellar testing and coordination testing

A

Test for rapid alternating movements

Finger to nose

Heel to shin

Gait

Stance

49
Q

What are the observatory motor system components?

A 
Gait 
Body position 
Involuntary movements 
Muscle bulk 
Muscle tone
50
Q

Describe cerebellar ataxia

A

Staggering, unsteady, feet wide apart, other cerebellar signs are present

51
Q

Describe sensory ataxia

A

unsteady, feet wide apart, feet thrown forward and slapped down first on the heel and then forefoot

52
Q

Describe a Parkinsonian gait

A

stooped forward, short steps consistent with a shuffling gait

53
Q

What are the cutaneous and superficial reflexes?

A

Abdominal reflex
plantar response
anal reflex

54
Q

Describe nuchal rigidity

A

neck stiffness with resistance to flexion

common in lateral meningitis patients

PCM Exam 2 (10 decks)

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