Exam 4 - Neurologic System Flashcards
Paralysis on one side of body (spelling)
Hemiplegia
Difficulty swallowing (spelling)
Dysphagia
Difficulty speaking (spelling)
Aphasia
When should you perform a screening neurologic examination?
On seemingly well people who have no significant subjective findings from the history
When should you perform a complete neurologic examination?
People who have neurologic concerns or have shown signs of neurologic dysfunction
When should you perform a neurologic recheck?
On people who have neurologic deficits and require periodic assessments
How many components are in the neurologic recheck?
5
What are the components of a neurologic recheck?
1) Level of consciousness Motor function of: 2) Upper motor strength 3) Lower motor strength 4) Pupillary response 5) Vital signs
What do you test during a complete neurologic examination?
Mental status (LOC) Cranial nerves Motor system Sensory system Reflexes
What do you assess in the motor system?
Muscle size
Muscle strength
Involuntary movements
How do you test upper extremity strength?
Test hand grips
How do you test hand grips?
Put 2 fingers in pt’s hand and have them squeeze
What are the tests for balance?
Gait
Romberg test
Shallow knee bend or hop in place
How do you test patient’s gait
Have them walk heel-to-toe
Normal result of gait
Walk straight, stay balanced
How do you perform the Romberg test?
Pt stands with feet together and arms at side
Close eyes, hold position
Normal result of Romberg test
Can maintain posture and balance
Slight swaying possible
How do you test a patient’s coordination and skilled movements?
Rapid alternating movements
Finger to finger test
Finger to nose test
Heel to shin test
How do you have patient perform rapid alternating movements test?
Pt pats knees with both hands, flipping hands back and forth
How do you have patient perform finger to finger test?
Have patient touch each finger to thumb on same hand
Then reverse direction
How do you have pt perform finger to nose test?
Put your finger out
Have patient touch finger then their nose
How do you have pt perform heel to shin test?
Patient in supine position
Heel on opposite knee and run down shin to ankle
How should you test a pt’s sensory system for pain?
Break tongue blade Alternate between sharp and round ends Ask patient “sharp” or “dull” Use random order and irregular intervals For at least 2 seconds
How do you test a pt’s sensory system for light touch?
Use a wisp of cotton and swipe it against pt’s skin
Random order of sites, irregular intervals
Ask pt to say “now” or “yes” when touch is felt
How do you test a pt’s sensory system with vibration?
Use a tuning fork over bony prominences on fingers and toes
Ask person to tell you when vibration starts and stops
What happens if a pt feels distal vibration?
You can assume it can be felt more proximal and do not need to proceed with test further
How should you test a pt’s sensory system for position?
Move finger or big toe up and down
Ask pt which way it moved
Do a few trials before you ask pt to close eyes
Another name for position testing
Kinesthesia
Ability to recognize objects by feeling it (spelling)
Stereognosis
How should you test a pt’s sensory system by tactile discrimination?
Put familiar object in hand
Ask pt to identify it
Test different object in each hand
Ability to “read” a number by having it traced on hand
Graphesthesia
How should you test a pt’s sensory system for graphesthesia?
Trace number on pt’s hand and ask them to identify number
How do you test a patient’s peripheral nervous system?
By testing their reflex arc (reflexes)
Function of reflexes
Maintain balance and muscle tone
Types of reflexes
Deep tendon reflexes
Superficial reflexes
How do you test a patient’s deep tendon reflexes?
- Limb must be relaxed
- Muscle partially stretched
- Short snappy blow with reflex hammer onto muscles insertion tendon
- Relaxed hold of hammer
- Action in wrist
- Compare left and right sides
What is normal response when testing a pt’s deep tendon reflexes?
Equal response on each side
What should you do if pt wont relax their legs while trying to test their reflex?
Have them hold their hands and pull apart to distract them
Explain the scale to measure reflex response
4+ very brisk, hyperactive clonus, indicative of disease
3+ Brisker than average, may indicate disease
2+ Average, normal
1+ diminished, low normal
0 no response
Best way to enhance pt’s response while testing their reflexes
Have them relax muscle
Have them do an isometric exercise in a muscle group away from the one being tested
Examples of ways to distract patient while trying to test their reflexes
For patellar reflex: have pt lock fingers together and pull
For bicep reflex: have pt clench teeth or grasp thigh with opposite hand
Which reflexes are superficial reflexes?
Abdominal
Plantar reflex
How to test abdominal reflex
Supine position
Touch abdomen moving from side of abdomen toward midline
What is a normal abdominal reflex response?
Contraction of abdominal muscle with deviation of umbilicus toward stroke
How do you test a patients plantar reflex?
Use reflex hammer to draw a light stroke up lateral side of foot and inward across ball of foot (draw upside down J)
What is a normal plantar reflex?
Plantar flexion of all toes, inversion (toward midline) and flexion of forefoot
What is the test called to test the plantar reflex?
Babinski
What does an abnormal result of the plantar reflex look like?
Dorsiflexion of big toe and fanning of all toes
What does a positive babinski result indicate?
Upper motor neuron disease
How do you perform the babinski test on babies?
Stroke you finger up the lateral edge and across the ball of the infant’s foot
What does a positive babinski reflex look like in infants?
Fanning of toes
When does the babinski result change from the infant response to the adult response?
Present at birth
Disappears (and changes to the adult response)
By 24 months of age
CN 1
Olfactory
How do you test CN I?
Assess patency by occluding nostril and having pt sniff
Normal CN I response
Can identify odor on each side of nostril
CN II
Optic
What do you look for while testing CN II?
Visual acuity
Visual fields by confrontation
Ophthalmoscopic exam
Cranial nerves III, IV, VI
Oculomotor
Trochlear
Abducens
How do you test CN III, IV, VI?
Pupil check
EOM (cardinal positions of gaze)
What does an uneven pupil size indicate?
Neurological problem
CN V
Trigeminal
How do you test CN V?
Motor: have pt clench teeth
Sensory: light touch sensation
CN VII
Facial
How do you test CN VII?
Motor: look for symmetry as patient makes different facial expressions (wrinkle forehead, close eyes, smile, pucker lips, puff out cheeks)
Sensory: not tested routinely Test sense of taste
CN VIII
Acoustic
How do you test CN VIII?
Whispered voice test
CN IX & X
Glossopharyngeal
Vagus
How do you test CN IX & X?
Motor: note pharyngeal movement (say “ahh”)
Sensory: Taste (not done)
CN XI
Spinal accessory
How do you test CN XI?
Rotate head forcible against resistance applied to side of chin
Shrug shoulders against resistance
CN XII
Hypoglossal
How do you test CN XII?
Inspect tongue for tremors or wasting
Ask pt to say “light, tight, dynamite”. Should be clear and distinct
CN I name and sensory or motor
Olfactory
Smell (S)
CN II name and sensory or motor
Optic
Vision (S)
CN III name and sensory or motor
Oculomotor Eye movements (M)
CN IV name and sensory or motor
Trochlear Eye movements (M)
CN V name and sensory or motor
Trigeminal
Face (S/M)
CN VI name and sensory or motor
Abducens Eye movements (M)
VII name and sensory or motor
Facial
Face/taste (M)
CN VIII name and sensory or motor
Acoustic (auditory)
Hearing/balance (S)
IX name and sensory or motor
Glossopharyngeal
Throat/taste (S/M)
CN X name and sensory or motor
Vagus Autonomic viscera (S/M)
CN XI name and sensory or motor
Spinal accessory
Head and neck (M)
CN XII name and sensory or motor?
Hypoglossal Lower throat (M)
When does nystagmus occur?
With disease of the vestibular system, cerebellum, or brainstem
What is nystagmus?
Back and forth oscillation of the eyes
Unilateral loss of smell in the absence of nasal disease
Neurogenic anosmia
