Exam 2- Neuro Exam Flashcards
In your Neuro Exam, you want to figure out..
~nature/ cause
~location
~extent of severity (Will I get this person better/ can I get this person better)
~benefit of therapy (Will normally take longer to find out if the pt will benefit from therapy)
Organic causes
~Is there a structural reason
~Swelling, scarring, space (after), bleeding, clots, etc
Inorganic causes
~We do not have a structure, but have a functional loss
~Mental disorders
~Munchausen’s (by Proxy) you want to make yourself ill; you cannot trick yourself into showing that you are doing it (our parents are doing it)
~PTSD- nothing is organically wrong, but their body cannot deal with what is going on with them (start treating them and they get better
~Malingering s/s to test to see if they are faking
~NOT phatom limb because there is still part of the nerve here
Localized causes
~myopathy ~neuropathy ~plexopathy ~radiculopathy ~myelopathy ~encephalopathy
myopathy
muscle
neuropathy
peripheral nerve
plexopathy
nerve plexus
radiculopathy
nerve root
myelopathy
spinal cord
encephalopathy
BRAIN
diffused causes
~No specialized terms for these
~Ex: GBS, MS, AIDS, cancer
etiology (10)
~Congenial/ hereditary (Huntington) ~Chromosomal/ Genetic (Downs) ~Traumatic/ Post traumatic ~Infections/ Post-infection ~Idiopathic ~Environmental ~Vascular (stroke) ~Autoimmune ~Neoplastic (cancerous) ~Toxic metabolic
what does CC stand for?
chief complaint
What does HPI stand for?
history of present illness
What does PMH stand for?
past medical history
What does PHI stand for?
pertinent health info
What does FH stand for?
family history
What does SH stand for?
social history
What does OH stand for?
occupational history
What does ROS stand for?
review of system
details on CC
~What their complaint is (I cant walk, etc), will not be the stroke, it will be the most annoying problem/ what problem that they want to solve first
~We have to let them tell us what is bothering us; let them tell us how the pain is (don’t give them adjectives)
~Will help to make goals
details on “how do they feel about it?”
~How does that affect your life?
~If you are now in a wheel chair, were you in one before or were you running?
~Will like to tell you what other clinicians have diagnosed them with; you don’t want get the wrong idea (don’t get a biased before)
~Do not use adjectives when evaluating a neuro patient
~if they don’t come up with something, do not prompt them! Ask them to pay attention to their complaint over the next few days/hrs, etc so they can describe it to us next time.
~Ask how they feel about the problem/limitation
details on HPI
~Get a chronically history of the present illness
~If you are in the hospital, you should be able to look in the chart
~Onset- sudden, etc; constant, gradual,
~Agg/ease factors
details on PMH
~Neuro can be huge; ortho can be short
~Need to look at what is important
~Venous wound- CHF important
~Brain injury- concussions in the past could be important information; ankle sprain not as important
~Birth conditions- can decrease the chance of getting back to function
~Surgeries before the stroke, etc
details on PMI
~Allergies: drugs, food, env
~Immunizations
~Smoking, drinking, illegal drugs
~If you are in outpatient, have them bring their bag of meds (and ask them if you take them all)
~BLOOD PRESSURE- always take blood pressure!!
~Sleep patterns- if your patterns are flipped, you need to know that
~Eating habits- are they eating enough, the right foods
details on FH
~Could be the most important part of the eval or have no help
~CVD, neuro, osteoporosis, stroke, HD, etc
details on SH
~Relationship info with family, etc
~Who are they going home to, are they going to supportive env, abusive env,
~Level of education- need to know how intelligent the pt is; they may not be able to read or they may be highly educated
~If they are a native speaker or not- get a translator; try not to use a family member as a translator
~Need to be aware of the different cultures
details on OH
~Can give you more goals
~Do they have a job; how long have they have they had the job; did they have an accident on the job
~Are they exposed to hazardous chemicals
~May not want to tell you all the s/s bc a neuro diag may not allow them to go back to their job
details on ROS
~Typically done by the doc if it is in the hospital
~HEENT- head eyes ear neck throat
~Some may be important, but some may be able to shed some light on the diagnosis and will tell you where to go next
objective exam: pain
~What is their pain, did we make it worse, when it is worse, etc
what does LOC stand for?
level of consciousness
what are the 5 levels of consciousness?
~alert ~lethargic ~obtunded ~stupor ~coma
AAOx3
~person
~place
~time
AAOx4
~person
~place
~time
~oriented (where they are
Details on alert
awake/ attentive
Details on lethargic
drowsy
Details on obtunded
~Difficulty to arouse
~actions largely non-productive
~frequently confused when awake
Details on stupor
~Only respond to hard, strong noxious stimulus
~how to wake up these pts: Sternal rub, pick the nail bad, nipple twist, thenar pinch
Details on coma
cannot be aroused by any stimulus
attention
Ability to focus/ stay on task without being distracted on another stimuli
*can do a mini-mental exam
mini-mental exams
~say 2 objects, have them repeat it- immediate recall then you have them repeat it later- short term recall then act something from the past- long term
~Can you count backwards from 100 by 7
~spell world backward
Orientation: person
name, age, birthplace, etc
Orientation: place
Where are you, address, where are you (hospital)
Orientation: time
What time is it, season, year, morning/afternoon
Orientation: situation
Why are you there? I had a stroke. I don’t know- being held here.. etc
details on language function
~Verbal may not always be possible
~Can also visually, pictorially (can point to pictures to express their needs/ sign names)- are universal (a glass of water is a glass of water no matter where you go
Language function problems (3)
~aphasia
~dysphonia
~dysarthria
details on aphasia
~Problem with speak
~Cortical
~Broca’s and Wernickes
~Global
details on dysphonia
~cranial nerve problem (X) with the vocal cords
~low speak, low volume, hoarse
details on dysarthria
non-cortical
What are the two types of language functions that need to be able to work?
~receptive
~expressive
Expressive is associated with (Wernicke’s or Broca’s)
Broca’s
Receptive is associated with (Wernicke’s or Broca’s)
Wernicke’s
3 different types in expressive language problems
~broca’s
~stutter
~stammer
Broca’s area
~Difficulty expressing oneself
~Nouns easier to express
~Not much flow to speak
stutter
~always on the first phoneme
~always at the beginning of the word
stammer
can get stuck on any part of the word
details on receptive language problems
~Comprehension
~Can test comprehension
~Word finding: what is the object? knowledge is there, but finding the word is difficult
~Perseveration
Comprehension
Ability to understand and give correct meaning to sentences
how to test comprehension
~Give yes or no question and see if they can answer (they may only say yes/no or want to please)
~Is my sister’s brother a man or a woman?
~If the lion killed the dog, which animal died?
Perseveration in receptive language
~Get stuck on something; yes is the only thing they say; get stuck on one topic
~Can also get stuck on a task
3 levels of memory
~immediate recall
~short term
~long term
immediate recall
can recall immediately after
short term memory
can recall minutes after
long term memory
~can recall days to years after
~from the past
What are the two types of amnesia?
~retrograde
~anterograde
retrograde amnesia
~Forget long time ago/ from your past
~Can tell you about his day, but cannot tell you about his past
anterograde amnesia
~Can’t make new memories
~Can’t tell you what they had for lunch, why they are there, etc but can tell you about the War
Cognitive function
~fund of knowledge ~proverbs ~gnosia/ agnosia ~praxia/ apraxia ~mood ~affect ~thought content
fund of knowledge
~All of our experiences to help grow our knowledge
~If you have a larger fund of knowledge, it will take longer for the knowledge to be lost
proverb
~Takes higher function to understand them
Gnosia
ability to perceive stimuli
Agnosia
inability to perceive stimuli
Praxis
ability to complete a task
Apraxia
inability to complete a task
Mood
~Feeling about a certain situation
~Being able to pick up on nonverbal communication is an important skill
Affect
~How the person looks
~The outward sign on the mood
~Flat affect
Thought content
~The fullness of a pts thinking
~Their conversation, interaction, emotions; you should get a lot of this just from talking with them
flat affect
~no reaction
~doesn’t really react to anything
~hard to work with these pts bc they don’t give you any reactions
