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7333 Bringman > Exam 2- Neuro Exam > Flashcards

Exam 2- Neuro Exam Flashcards

1
Q

In your Neuro Exam, you want to figure out..

A

~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)

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2
Q

Organic causes

A

~Is there a structural reason

~Swelling, scarring, space (after), bleeding, clots, etc

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3
Q

Inorganic causes

A

~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

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4
Q

Localized causes

A 
~myopathy
~neuropathy
~plexopathy
~radiculopathy
~myelopathy
~encephalopathy
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5
Q

myopathy

A

muscle

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6
Q

neuropathy

A

peripheral nerve

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7
Q

plexopathy

A

nerve plexus

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8
Q

radiculopathy

A

nerve root

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9
Q

myelopathy

A

spinal cord

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10
Q

encephalopathy

A

BRAIN

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11
Q

diffused causes

A

~No specialized terms for these

~Ex: GBS, MS, AIDS, cancer

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12
Q

etiology (10)

A 
~Congenial/ hereditary (Huntington)
~Chromosomal/ Genetic (Downs) 
~Traumatic/ Post traumatic
~Infections/ Post-infection
~Idiopathic
~Environmental
~Vascular (stroke)
~Autoimmune
~Neoplastic (cancerous)
~Toxic metabolic
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13
Q

what does CC stand for?

A

chief complaint

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14
Q

What does HPI stand for?

A

history of present illness

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15
Q

What does PMH stand for?

A

past medical history

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16
Q

What does PHI stand for?

A

pertinent health info

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17
Q

What does FH stand for?

A

family history

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18
Q

What does SH stand for?

A

social history

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19
Q

What does OH stand for?

A

occupational history

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20
Q

What does ROS stand for?

A

review of system

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21
Q

details on CC

A

~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

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22
Q

details on “how do they feel about it?”

A

~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

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23
Q

details on HPI

A

~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

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24
Q

details on PMH

A

~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

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25
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
26
details on FH
~Could be the most important part of the eval or have no help ~CVD, neuro, osteoporosis, stroke, HD, etc
27
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
28
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
29
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
30
objective exam: pain
~What is their pain, did we make it worse, when it is worse, etc
31
what does LOC stand for?
level of consciousness
32
what are the 5 levels of consciousness?
``` ~alert ~lethargic ~obtunded ~stupor ~coma ```
33
AAOx3
~person ~place ~time
34
AAOx4
~person ~place ~time ~oriented (where they are
35
Details on alert
awake/ attentive
36
Details on lethargic
drowsy
37
Details on obtunded
~Difficulty to arouse ~actions largely non-productive ~frequently confused when awake
38
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
39
Details on coma
cannot be aroused by any stimulus
40
attention
Ability to focus/ stay on task without being distracted on another stimuli *can do a mini-mental exam
41
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
42
Orientation: person
name, age, birthplace, etc
43
Orientation: place
Where are you, address, where are you (hospital)
44
Orientation: time
What time is it, season, year, morning/afternoon
45
Orientation: situation
Why are you there? I had a stroke. I don’t know- being held here.. etc
46
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
47
Language function problems (3)
~aphasia ~dysphonia ~dysarthria
48
details on aphasia
~Problem with speak ~Cortical ~Broca’s and Wernickes ~Global
49
details on dysphonia
~cranial nerve problem (X) with the vocal cords | ~low speak, low volume, hoarse
50
details on dysarthria
non-cortical
51
What are the two types of language functions that need to be able to work?
~receptive | ~expressive
52
Expressive is associated with (Wernicke's or Broca's)
Broca's
53
Receptive is associated with (Wernicke's or Broca's)
Wernicke's
54
3 different types in expressive language problems
~broca's ~stutter ~stammer
55
Broca's area
~Difficulty expressing oneself ~Nouns easier to express ~Not much flow to speak
56
stutter
~always on the first phoneme | ~always at the beginning of the word
57
stammer
can get stuck on any part of the word
58
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
59
Comprehension
Ability to understand and give correct meaning to sentences
60
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?
61
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
62
3 levels of memory
~immediate recall ~short term ~long term
63
immediate recall
can recall immediately after
64
short term memory
can recall minutes after
65
long term memory
~can recall days to years after | ~from the past
66
What are the two types of amnesia?
~retrograde | ~anterograde
67
retrograde amnesia
~Forget long time ago/ from your past | ~Can tell you about his day, but cannot tell you about his past
68
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
69
Cognitive function
``` ~fund of knowledge ~proverbs ~gnosia/ agnosia ~praxia/ apraxia ~mood ~affect ~thought content ```
70
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
71
proverb
~Takes higher function to understand them
72
Gnosia
ability to perceive stimuli
73
Agnosia
inability to perceive stimuli
74
Praxis
ability to complete a task
75
Apraxia
inability to complete a task
76
Mood
~Feeling about a certain situation | ~Being able to pick up on nonverbal communication is an important skill
77
Affect
~How the person looks ~The outward sign on the mood ~Flat affect
78
Thought content
~The fullness of a pts thinking | ~Their conversation, interaction, emotions; you should get a lot of this just from talking with them
79
flat affect
~no reaction ~doesn’t really react to anything ~hard to work with these pts bc they don’t give you any reactions

7333 Bringman (23 decks)

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