Ch 23 Neurological System

Question 1

•Cranial Nerves III, IV, and VI: oculomotor, trochlear, and abducens nerves

(How to test them)

Answer 1

What it does: Eye movement dependent on Cranial Nerves 3, 4, and 6 & muscles they innervate

How to test:
•Check pupils for size, regularity, equality, direct and consensual light reaction, and accommodation
•Assess extraocular movements by cardinal positions of gaze; have them look up and down without moving head
•Nystagmus is back-and-forth oscillation of eyes

• Assess nystagmus carefully, noting:
• Presence of nystagmus in one or both eyes can be a serious cerebellum concern
• Frequency: constant, or fades after a few beats

Question 2

•Cranial nerve VII: facial nerve

How to assess

Answer 2

What it does: •Motor function:

Assessing:
Note mobility and facial symmetry as person responds to requests to smile, frown, close eyes tightly (against your attempt to open them), lift eyebrows, show teeth
•Have person puff cheeks, then press puffed cheeks in, to see that air escapes equally from both sides

Question 3

•Cranial nerve VIII: acoustic nerve (Vestibulocochlear)

How to assess

Answer 3

•Test hearing acuity by ability to hear normal conversation and by whispered voice test

Question 4

•Cranial nerve XI: spinal accessory nerve

How to assess

Answer 4

• Examine sternomastoid and trapezius muscles for equal size
• Check equal strength by asking person to rotate head against resistance applied to side of chin
• Ask person to shrug shoulders against resistance
• These movements should feel equally strong on both sides

Question 5

Muscles

How to assess

Answer 5

Size:
•Compare right side with left; muscle groups should be within normal size limits for age and should be symmetric bilaterally

•Strength:
test muscle groups of extremities, neck, and trunk

•Tone:
normal tension in relaxed muscles
•Persuade person to relax completely, and move each extremity smoothly through a full range of motion; normally, note mild, even resistance to movement
•Involuntary movements
•Normally none occur; if present, note location, frequency, rate, and amplitude; note if movements can be controlled at will

Question 6

Romberg test

How to assess cerebellar function

Answer 6

• Ask person to stand up with feet together and arms at sides; when in stable position, ask person to close eyes and to hold position for about 20 seconds
• Normally, person can maintain posture and balance even with visual orienting information blocked
• Ask person to perform shallow knee bend or hop in place, first on one leg, then other
• Demonstrates normal position sense, muscle strength, and cerebellar function
• Some individuals cannot hop because of aging or obesity

Question 7

Cranial nerve II: optic nerve

(How to test)

Answer 7

•Test visual acuity and visual fields by
confrontation and Snellen chart
•Using ophthalmoscope, examine ocular fundus to determine color, size, and shape of optic disc

Question 8

Paresis

Answer 8

Partial or incomplete paralysis

Question 9

Dysmetria

Answer 9

Inability to control the distance,power, and speed of muscle action

Question 10

Paresthesia

Answer 10

Abnormal sensation

Burning or tingling

Question 11

Dysarthria

Answer 11

Difficulty forming words

Question 12

Dysphasia

Answer 12

Difficulty with language comprehension or expression