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Sasha: Module 11 Neurology > CA powerpoints > Flashcards

CA powerpoints Flashcards

1
Q

7 Major components of the Neurological exam

A
  • Mental Status
  • Cranial Nerves (I-XII)
  • Motor System
  • Cerebellar Function
  • Sensory System
  • Deep Tendon Reflexes (DTRs)
  • Special Tests, if indicated
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2
Q
  • Is the mental status intact?
  • Are your findings symmetric?
  • Where is the lesion? If findings are asymmetric or abnormal, is the lesion in the central nervous system or in the peripheral nervous system?

what are these questions?

A

questions to really think about when seeing a pt

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3
Q

brain, brainstem, spinal cord

A

CNS

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4
Q

12 CNs and peripheral nerves (including spinal nerves – 8 cervical, 12 thoracic, 5 lumbar, 5 sacral and 1 coccygeal)

A

PNS

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5
Q

Organization of Exam

A
  • Assess mental status
    • General appearance/presentation
    • Orientation x 4
  • Test cranial nerves
  • Assess motor system
    • Inspection
    • Muscle strength
  • Assess sensory system
    • Light touch, superficial pain, vibratory sense, proprioception
  • Check deep tendon reflexes (DTRs)
  • Test cerebellar function
    • Rapid alternating movements, point-to-point movements, gait
  • Special tests, if indicated (by PE or ROS)
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6
Q

Reflects the patient’s capacity for arousal or wakefulness; determined by level of activity that patient can be aroused to perform in response to stimuli from examiner

A

Level of Consciousness

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7
Q

–Do NOT dilate pupils

–Do NOT flex neck if there is any question of trauma to head or neck (x-ray first)

A

patient in stupor or coma…

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8
Q

using normal tone of voice, patient’s arousal intact; responds fully & appropriately

A

Alert

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9
Q

using loud tone of voice, patient appears drowsy but opens eyes and responds then falls asleep

A

Lethargic

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10
Q

shake patient gently; patient opens eyes but responds slowly, somewhat confused (ie drunk)

A

Obtunded

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11
Q

apply painful stimulus to arouse patient from sleep, verbal responses slow/absent, unresponsive when stimulus ceases

A

Stuporous

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12
Q

unarousable w/ eyes closed after repeated painful stimuli, no response to environment

…painful stimuli with no response….

A

Comatose

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13
Q

Explain the 3 main aspects of the glasgow coma scale and then the ratings under each main componenet

  1. (4)
  2. (6)
  3. (5)

I know this is a long flashcard but this is important to known… i can see her explaining a pt and asking us to assess what their glasgow coma scale is. At least those are questions they would do in my EMT class who knows…..

A

•Eye opening

–None (1) Even to supraorbital pressure

–To pain (2) Pain from sternum/limb/supraorbital pressure

–To speech (3) Nonspecific response, not necessarily to command

–Spontaneous (4) Eyes open, not necessarily aware

•Motor response

–None (1) To any pain; limbs remain flaccid

–Extension (2) Shoulder adducted and shoulder and forearm internally rotated

–Flexor response (3) Withdrawal response or assumption of hemiplegic posture

–Withdrawal (4) Arm withdraws to pain, shoulder abducts

–Localizes pain (5) Arm attempts to remove supraorbital/chest pressure

–Obeys commands (6) Follows simple commands

•Verbal response

–None (1) No verbalization of any type

–Incomprehensible (2) Moans/groans, no speech

–Inappropriate (3) Intelligible, no sustained sentences

–Confused (4) Converses but confused, disoriented

–Orientated (5) Converses and is oriented

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14
Q

hIghest grade you can get on glasgow coma scale

and lowest

A

Lowest 3

Higherst 15

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15
Q

patients w/ scores of 3-8

A

usually are considered to be in a coma

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16
Q

no pupillary reaction to light

A

probably mid brain issue

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17
Q
  • Midposition fixed pupils
  • One large pupil
  • Small or pinpoint pupils
  • Large pupils
A

Pupils in Comatose Patients

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18
Q

When testing if meningeal inflammation first, make sure there is NO

A

injury to cervical vertebrae or spinal cord (if trauma, x-ray first)

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19
Q

with patient supine place hand behind the patient’s head flex neck forward, chin to chest (check for nuchal rigidity)

A

•Test if meningeal inflammation suspected (eg, meningitis or subarachnoid hemorrhage)

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20
Q

•Positive if flexion of both hips & knees is noted when neck is flexed

A

Brudzinski’s Sign

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21
Q

•Positive if pain & increased resistance is noted to straightening the knee after hip & knee are flexed

A

Kernig’s Sign

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22
Q

Fever, headache and altered level of concisouness

A

with menengitis

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23
Q

Test if mental function is impaired; may indicate

A

metabolic encephalopathy

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24
Q
  • Ask patient to “stop traffic” by extending both arms w/ hands cocked up – watch for 1 to 2 minutes
  • Positive if sudden, brief, nonrhythmic flexion of hands and fingers
A

Asterixis

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25
Q

CN I

A

smell

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26
Q

CN II

A

– visual acuity, visual fields, funduscopic exam

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27
Q

CN II, III

A

– pupillary reactions (direct and consensual)

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28
Q

CN III, IV, VI

A

extraocular movements (including convergence)

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29
Q

CN V

A

corneal reflexes, facial sensation (3 areas), clinch teeth

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30
Q

CN VII

A

facial movements (raise eyebrows, close eyes, smile, frown, show upper/lower teeth, puff out cheeks)

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31
Q

CN VIII

A

hearing (whispered voice) (sensory/neuro or cognitive loss)

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32
Q

CN IX, X

A

swallow, say “ah,” gag reflex

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33
Q

CN V, VII, X, XII

A

voice and speech

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34
Q

CN XI

A

shoulder and neck movements

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35
Q

CN XII

A

tongue symmetry and position

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36
Q

with excessive brain swelling you may see _____________ so look in daaa eye

A

papillary edema (swelling around disc)

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37
Q

Weber

is testing for?

if conductive loss?

If sensorineural hearing loss?

A
  • Test for lateralization
  • If conductive hearing loss, lateralizes to impaired ear
  • If sensorineural hearing loss, lateralizes to good ear
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38
Q

impaired “air through ear” transmission

A

loss is conduction

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39
Q

from damage to cochlear branch of CN VIII

A

sensorineural

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40
Q

Rinne

testing for what?

if sensorineural hearing loss?

if conductive hearing loss?

A
  • Test for air and bone conduction
  • If sensorineural hearing loss, AC>BC
  • If conductive hearing loss, BC=AC or BC>AC

AC: air conduction

BC: Bone conduction

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41
Q

sinusitis, smoking, aging, cocaine use, Parkinson’s disease

A

CN I

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42
Q

papilloedema, glaucoma, stroke, retinal emboli, optic neuritis, pituitary tumor

A

CN II

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43
Q

*anisocoria (unequal pupils), intracranial hemorrhage, transtentorial herniation, Horner’s syndrome

*anisocoria can be a normal variant in a percentage of people

A

CN II, III

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44
Q

nystagmus (involuntary jerking movement of eyes), *ptosis (drooping of upper eyelids), diplopia, astigmatism, myasthenia gravis, Grave’s disease, Horner’s syndrome, cerebellar disease

A

CN III, IV, VI

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45
Q

stroke, CNS lesions, trigeminal neuralgia, acoustic neuroma

A

CN V

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46
Q

Stoke, Bell’s Palsy

A

CN VII

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47
Q

cerumen impaction, otitis media, Meniere’s disease, aging

A

CN VIII

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48
Q

pharyngeal weakness, CN X lesion

A

CN IX, X

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49
Q

aphonia (loss of voice) due to vocal cord paralysis, dysarthria (poor articulation) due to cerebellar disease, aphasia (disorder in producing or understanding language) such as Wernicke’s aphasia or Broca’s aphasia

A

CN V, VII, X, XII

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50
Q

trapezius atrophy due to peripheral nerve disorder, bilateral weakness of sternomastoids

A

CN XI

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51
Q

cortical lesion, amyotrophic lateral sclerosis, polio

A

CN XII

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52
Q

–Body position

–Involuntary movements

–Characteristics of muscles (bulk, tone, & strength)

–Coordination (includes cerebellar function)

A

Things to focus on in motor system

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53
Q

3 types of tremors

A
  1. resting
  2. postural
  3. intention
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54
Q

pill-rolling tremor of parkinsonism

A

resting tremor

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55
Q

, benign essential/familial tremor

A

Postural tremor

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56
Q

cerebellar disease, multiple sclerosis

A

Intention tremor

57
Q

–Oral-facial dyskinesias (eg, tardive dyskinesia)

–Tics (eg, Tourette’s syndrome)

–Dystonia (eg, torticollis)

–Athetosis (eg, cerebral palsy)

–Chorea (eg, Huntington’s disease)

A

•Involuntary movements

58
Q

increased tone; rate-dependent, increasing w/ rapid movement(eg, stroke)

A

Spasticity

59
Q

– increased resistance throughout ROM; it is not rate-dependent; “lead pipe rigidity.”

A

Rigidity

60
Q

marked floppiness (eg, Guillain-Barre & spinal shock)

A

Flaccidity

61
Q

sudden changes in tone w/ passive ROM (eg, dementia)

A

Paratonia

62
Q
  • 0 = No contraction noted
  • 1 = Barely detectable contraction
  • 2 = Active movement with gravity eliminated
  • 3 = Active movement against gravity
  • 4 = Active movement against gravity & some resistance
  • 5 = Active movement against full resistance w/o evident fatigue – This is NORMAL strength
A

Scale for Grading Muscle Strength

63
Q
A

dermatones

64
Q
A

Dermatomes of cervical spine

65
Q

for C4-C5, its the ______ nerve thats affected but for T4-T5, it would be ______ affected because of that extra C8 nerve

A

that like for C4-C5, its the C5 nerve thats affected but for T4-T5, it would be T4 affected because of that extra C8 nerve

66
Q

Deltoid and biceps (shoulder abduction and elbow flexion)

A

C5

67
Q

Biceps flexion and wrist extensors

A

C6

68
Q

Triceps, wrist flexors and finger extensors

A

C7

69
Q

:Finger flexors and interossei muscles

(aB and aD duction of the fingers)

A

C8

70
Q

Interossei muscles ONLY

A

T1

71
Q

head

A

C1-C2

72
Q

Diaphragm, breathing

A

C3-C4

73
Q

Go back to the ppt and look at the cool images from slide 28-32… the pictures are not copying over well to brain scape

A

fhdusiagvidsoabvisdba neuro hdiasbgjdsabvjdabvdja

74
Q
A

Dermatomes of Lumbar Spine

75
Q

Hip flexion

A

L2

76
Q

Knee extension

A

L3

77
Q

Ankle dorsiflexion

A

L4

78
Q

Great toe extension

A

L5

79
Q

AnkIe plantar flexion, ankle eversion, hip extension

A

S1

80
Q

Knee flexion

A

S2

81
Q

again look at the cool pictures about L roots from slide 35-37

A

or dont… doesnt really matter haha

82
Q

If shoulder muscles seem weak or atrophic, look for

A

winging

83
Q

•Ask patient to extend both arms and push against a wall

A

looking for winging of scapula

84
Q

___________ if medial border of scapula juts backward, suggesting weakness of serratus anterior muscle, seen in muscular dystrophy or injury to long thoracic nerve

A

winging

85
Q

If patient has low back pain w/ lumbosacral radiculopathy (sciatica if in S1 distribution), test

A

Straight-leg raise on each side

86
Q

•Positive for lumbosacral radiculopathy if pain radiates into ipsilateral leg (foot dorsiflexion can further increase leg pain)

A

Straight-Leg Raise

87
Q

3 types of Cerebellar Function Tests

A

•Rapid alternating movements

–In cerebellar disease, dysdiadochokinesis is noted

•Point-to-point movements

•Gait

–In cerebellar disease, ataxia is noted

88
Q

balance disorder

A

Cerebellar dysfunction

89
Q

•Stand w/ feet together and eyes open, then close eyes for 30-60 seconds, only minimal sway should occur

A

Romberg Test

90
Q

•Stand for 30 seconds w/ arms straight forward, palms up and eyes closed. Then, tap arms briskly downward at the same time

A

Test for Pronator Drift

91
Q

Abnormalities in gait

Spastic Hemiparesis

A

Spastic gait

scissors gait

92
Q

Abnormalities in gait

Parkinsonian Gain

A

Propulsive gait

Steppage gait

93
Q

cerebellar ataxia

A

wide and unsteady gait

94
Q

sensory ataxia

A

wide, unsteady AND heel strikes first

95
Q

Sensory Sytsem

4 exam tests

A
  • Light touch
  • Pain (dull + sharp)
  • Vibration
  • Proprioception
96
Q

•If touch and position sense are intact, you can proceed to testing the sensory cortex w/ __________________

A

discriminative sensations

97
Q

–Stereognosis

–Graphesthesia

–Two-point discrimination

–Point localization

–Extinction

A

discriminative sensations (testing of sensory cortext)

98
Q

Ankle reflex

A

primary S1

99
Q

Knee reflex

A

L2, L3, L4

100
Q

Brachioradialis reflex

A

C5, C6

101
Q

Biceps reflex

A

C5, C6

102
Q

Triceps reflex

A

C6, C7

103
Q

If DTRs (deep tendon reflexes) seem hyperactive (4+), test for _____

A

clonus

104
Q

•Dorsiflex and plantar flex foot a few times then sharply dorsiflex foot and hold – look/feel for rhythmic oscillations between dorsiflexion and plantar flexion

A

testing for Clonus

105
Q

•If clonus present, may indicate

A

central nervous system disease

106
Q

Cutaneous Stimulation Reflexes

•Briskly stroke each side of abdomen above (T8, T9, T10) & below (T10, T11, T12) umbilicus w/ wooden end of cotton-tipped applicator

A

Abdominal Reflexes

107
Q

if Abdominal Reflexes absent

A

may indicate central or peripheral nerve disorders

108
Q
  • Stroke lateral aspect of sole from heel to ball of foot, curving medially across the ball – note movement of great toe
  • Positive if dorsiflexion of great toe
A

Babinski Response (L5, S1)

109
Q

dorsiflexion of great toe in Babinski response may indicate:

A

–CNS lesion in corticospinal tract

–Unconscious states from drugs/alcohol intoxication

–Postictal period after seizure

110
Q

•Using dull object (eg, cotton swab), stroke outward in 4 quadrants from anus

A

Anal reflex

111
Q

If loss of anal reflex contraction, may indicate

A

cauda equina lesions (S2-3-4)

112
Q

so what are the 4 relfexes we jsut learned?

A

–assessing DTRs (like we have always done)

–Clonus

–Abdominal Reflexes

–Babinski Response

113
Q
  • Used to diagnose stroke, determine location and size of tumor, aneurysm, or vascular formation
  • Dye injected via capsule placed via catheter
  • Serial x-rays taken
  • Negative side effects; warmth, slight discomfort
A

Cerebral Angiogram

114
Q

used to diagnose neuromuscular disorders (may also confirm carrier status for genetic disorders)

A

Muscle and/or nerve biopsies

115
Q

are used to determine tumor type

A

•Brain biopsies

116
Q
  • the removal of small amount of spinal fluid via bedside sterile procedure
  • **Common after affect is a headache – helped by having the patient lie flat
  • Diagnostic of infections such as meningitis, helps in diagnosis of MS, measure of intracranial pressure
A

Lumbar Puncture - “Spinal Tap”

Cerebrospinal Fluid Analysis

117
Q

3 contraindications for LP

A
  • Increased Intracranial Pressure
  • Coagulopathy
  • Brain Abscess
118
Q
  • Age > 60
  • Immunocompromised
  • Known CNS Lesions
  • Seizure in last week
  • Altered Consciousness
  • Focal findings on Neurological Exam
  • Papilledema on Physical Exam
A

Perform a Brain CT Prior to LP….

119
Q

Lab Studies Performed on Cerebrospinal Fluid

A
  • Cell Count and differential
  • Glucose and protein levels
  • Gram stain, culture and sensitivity
  • Viral titers, VDRL tests, Crytococcus Antigen, ACE levels, others
120
Q
A

Position for LP

121
Q
  • Noninvasive, Painless
  • Detect bone and vascular, certain brain tumors, cysts, herniated discs, spinal stenosis, encephalitis, blood accumulation, intracranial bleeding in stroke, tissue damage in trauma
  • Drawbacks – some radiation (avoid in pregnancy), dye sensitivities when dye used, claustrophobic patients
A

CT Scan

122
Q
  • Small amount of dye injected via x-ray guidance into the spinal disc, CT then completed
  • May cause some residual discomfort requiring short term pain medication
A

Discography

123
Q
  • Used to detect problems with spine and spinal nerve roots
  • Lumbar Puncture – fluid is mixed with contrast dye and injected into spinal sac.
  • Allows for clearer image of spinal canal and nerve roots
  • Patient may have post procedure headache, residual pain
A

Cisternography – Intrathecal contrast-enhanced CT Scan

124
Q
  • Monitors brain activity through the skull
  • Assists in diagnosis of seizure disorders, tumor, tissue damage post TBI, inflammation of the brain/spinal cord, psychiatric disorders, sleep disorders
  • Pre procedure – patients should avoid caffeine and rx/non rx drugs that impact nervous system
A

Electroencephalography (EEG)

125
Q
  • Diagnoses nerve and muscle dysfunction and spinal cord disease
  • Measures electrical activity from brain and/or spinal cord to a peripheral nerve root
  • Usually completed in conjunction with a Nerve Conduction Velocity (NCV) test – which measures electrical energy by assessing the nerve’s ability to send a signal
A

Electromyography (EMG)

126
Q
  • A group of tests used to diagnose disorders such as involuntary eye movement, dizziness and balance disorders
  • Involved electrode taped around eyes to record eye movements
  • Infrared photography may also be used to evaluate eye movements
A

Electronystagmography (ENG)

127
Q
  • Measure the electrical signals to the brain generated by hearing, touch, and sight.
  • Used to evaluate sensory nerve problems, confirm MS, brain tumor, acoustic neuroma, spinal cord injury
A

Evoked Potentials (also called Evoked Response)

128
Q

•acoustic issues

A

Auditory evoked potentials

129
Q

detect loss of vision from optic nerve nerve damage

A

Visual evoked potentials

130
Q

evaluate for nerve damage or degeneration from cord injury or deg. disease

A

Somatosensory EP

131
Q
  • Used extensively – assists in diagnosis of brain and spinal cord tumor, eye disease, inflammation, infections, vascular irregularities that can lead to stroke
  • May also be used to monitor degenerative disease
  • Used to quantify brain trauma
A

MRI

132
Q
  • Injection of a water or oil based contrast dye into the spinal cord to enhance x-ray imaging of the spine
  • Used to diagnose spinal nerve injury, herniated discs, fractures, back or leg pain, and spinal tumors
  • Again – patients may experience headache post lumbar puncture
A

Myelography

133
Q
  • Provides 2 and 3 dimensional pictures of brain activity by measuring radioactive isotopes that are injected into the bloodstream.
  • Used to detect or highlight tumors, diseased tissue, measure cellular and/or tissue metabolism, monitor blood flow, determine brain injury post trauma, substance abuse
A

Positron Emission Tomography (PET Scan)

134
Q
  • Measures brain and body activity during sleep
  • Used to detect sleep disorders, restless leg syndrome, insomnia, obstructive sleep apnea
  • Painless, noninvasive, risk-free
A

Polysomnogram

135
Q
  • Evaluates blood flow to tissue
  • Follow up test to MRI to diagnose tumors, infections, degenerative spinal disorders, stress fractures.
  • Same theory as PET utilizing radioactive isotope, a rotating camera and production of a detailed 3 dimensional image of blood flow and activity in the brain
A

Single Photon Emission CT (SPECT)

136
Q
  • Analysis blood flow to the brain and can diagnose stroke, brain tumors, hydrocephalus and vascular problems
  • Fetal Ultrasound to Determine Pathology prior to birth
A

Neurosonography (Ultrasound of Brain and Spinal Cord)

137
Q

used to view arteries and blood vessels in neck, determine risk of stroke

A

Transcranial Doppler US

138
Q
  • Uses infrared sensing devices to measure small temperature changes between the two sides of the body or within a certain organ
  • Used to detect vascular disease of head and neck, soft tissue injury, nerve root compression, some degenerative disorders
  • Generates a 2 dimensional picture, is safe, risk-free
A

Thermography (Infrared Thermal Imaging)

Sasha: Module 11 Neurology (2 decks)

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