Cranial Nerves/ Neuromuscular Flashcards
What are the components of the Neurological Exam
Mental Status
Cranial Nerve Function
Sensory Function
Reflex Function
parenstheis
numbness or tingling
What are some drugs that can adversely affect the neurological system
Corticosteroids
Cimetidine - GI - confusion
Sedatives
Muscle Relaxers
Spastic hemiparesis
affected leg stiff and extended. Foot dragged, scraping of toes, affected arm flexed, adducted, No swing
Spastic Diplegia
(scissoring, Scissor Gait)- short steps, drag ball of foot, knocked kneed,
Steppage-
hip and knee excessively high, foot slaps floor, plantar flexed foot off ground, unable to walk on heels
Dystophic
waddling
Dystonia-
jerky, dancing movements appear nondirectional
Scoring of deep Tendon Refelx
0- No response
1+ Sluggish or diminished
2+ Active or expected outcome
3+ More Brisk than expected, slightly hyperactive
4+ Brisk, hyperactive, with intermittent or transient clonus
Clonus
rapid repetitive contraction and relaxation in a muscle movements
CN I
Olfactory Nerve
Pt able to identify aroma using one nostril
CN II
Optic Nerve - Visual acuity and peripheral vision
CN III
Oculomotor - ability of eyes to move up and down, medial, and up and in
CN IV
Trochlear - ability of the eyes to move down and in
CN V
Trigeminal - ask patient to move the jaw from side to side and clench teeth; contraction of temporal and masseter muscles; ability to bite down on tongue blade
Corneal reflex/blinks when something close to eye
CN VI
Abducens - think “abducting” of the eyes. ability of the eye to loo from side to side
CN VII
Facial Nerve - smile, frown, raise eyebrows, puff cheeks, purse lips
Test for sweet, sour, or salty on anterior 2/3 of tongue
CN VIII
Acoustic - watch tick test; Romberg test for balance
CN IX
Glossopharyngeal - cough, talk; posterior of tongue
CN X
Vagus - digestion and ability to swallow
CN XI
Accessory Nerve - Shoulder Shrugs, and neck muscles - turning head/ resistance without pain
CN XII
Hypoglossal - have pt say d, l, n, t - have patient stick out/protude tongue - movement - licking an ice-cream cone
Kiesthetics
aka position sense; have patient identify what direction you are moving a particular limb of theirs with eyes closed
Graphesthesia
with patients eyes closed use point of a closed pen to trace a number on the patients hand and ask the patient to identify it
Stereognoisis
with patients eyes closed, place a familiar object such as a coin or a button in the patients hand, and ask patient to identify it
Two - Point Discrimination
ability to discriminate between 2 points of simultaneous stimulation - toothpick with 2 points - gradually move them further away until they can identify 2 separate points
Primitive reflexes
usually a sign of neurological damage in adult since they are typically only seen in newborns; they include
Grasp
Sucking
Snout - puckering of pts lips when you touch them
Rooting - touch side of face; pt turns towards stimulated side
Glabellar - taping on forehead = pt blinks
Babinski - stroke lateral aspect of foot; dorsiflexion and great toe and fanning of toes
Glasgow Coma Scale (GCS)
provides a score in the range 3-15; patients with scores of 3-8 are usually said to be in a coma. The total score is the sum of the scores in three categories.
What is the best test for LOC
GCS - glassjaw coma scale = evaluates eye, motor, and verbal responses
Which level of disorientation would be of greatest concern?
Time, Place, Purpose, or Person
Person
