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Health Assessment > Exam 4 - Neurologic System > Flashcards

Exam 4 - Neurologic System Flashcards

1
Q

Paralysis on one side of body (spelling)

A

Hemiplegia

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2
Q

Difficulty swallowing (spelling)

A

Dysphagia

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3
Q

Difficulty speaking (spelling)

A

Aphasia

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4
Q

When should you perform a screening neurologic examination?

A

On seemingly well people who have no significant subjective findings from the history

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5
Q

When should you perform a complete neurologic examination?

A

People who have neurologic concerns or have shown signs of neurologic dysfunction

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6
Q

When should you perform a neurologic recheck?

A

On people who have neurologic deficits and require periodic assessments

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7
Q

How many components are in the neurologic recheck?

A

5

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8
Q

What are the components of a neurologic recheck?

A 
1) Level of consciousness
Motor function of:
	2) Upper motor strength
	3) Lower motor strength
4) Pupillary response
5) Vital signs
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9
Q

What do you test during a complete neurologic examination?

A 
Mental status (LOC)
Cranial nerves
Motor system
Sensory system
Reflexes
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10
Q

What do you assess in the motor system?

A

Muscle size
Muscle strength
Involuntary movements

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11
Q

How do you test upper extremity strength?

A

Test hand grips

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12
Q

How do you test hand grips?

A

Put 2 fingers in pt’s hand and have them squeeze

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13
Q

What are the tests for balance?

A

Gait
Romberg test
Shallow knee bend or hop in place

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14
Q

How do you test patient’s gait

A

Have them walk heel-to-toe

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15
Q

Normal result of gait

A

Walk straight, stay balanced

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16
Q

How do you perform the Romberg test?

A

Pt stands with feet together and arms at side

Close eyes, hold position

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17
Q

Normal result of Romberg test

A

Can maintain posture and balance

Slight swaying possible

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18
Q

How do you test a patient’s coordination and skilled movements?

A

Rapid alternating movements
Finger to finger test
Finger to nose test
Heel to shin test

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19
Q

How do you have patient perform rapid alternating movements test?

A

Pt pats knees with both hands, flipping hands back and forth

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20
Q

How do you have patient perform finger to finger test?

A

Have patient touch each finger to thumb on same hand

Then reverse direction

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21
Q

How do you have pt perform finger to nose test?

A

Put your finger out

Have patient touch finger then their nose

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22
Q

How do you have pt perform heel to shin test?

A

Patient in supine position

Heel on opposite knee and run down shin to ankle

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23
Q

How should you test a pt’s sensory system for pain?

A 
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
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24
Q

How do you test a pt’s sensory system for light touch?

A

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

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25
Q

How do you test a pt’s sensory system with vibration?

A

Use a tuning fork over bony prominences on fingers and toes

Ask person to tell you when vibration starts and stops

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26
Q

What happens if a pt feels distal vibration?

A

You can assume it can be felt more proximal and do not need to proceed with test further

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27
Q

How should you test a pt’s sensory system for position?

A

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

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28
Q

Another name for position testing

A

Kinesthesia

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29
Q

Ability to recognize objects by feeling it (spelling)

A

Stereognosis

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30
Q

How should you test a pt’s sensory system by tactile discrimination?

A

Put familiar object in hand
Ask pt to identify it
Test different object in each hand

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31
Q

Ability to “read” a number by having it traced on hand

A

Graphesthesia

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32
Q

How should you test a pt’s sensory system for graphesthesia?

A

Trace number on pt’s hand and ask them to identify number

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33
Q

How do you test a patient’s peripheral nervous system?

A

By testing their reflex arc (reflexes)

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34
Q

Function of reflexes

A

Maintain balance and muscle tone

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35
Q

Types of reflexes

A

Deep tendon reflexes

Superficial reflexes

36
Q

How do you test a patient’s deep tendon reflexes?

A
  • 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
37
Q

What is normal response when testing a pt’s deep tendon reflexes?

A

Equal response on each side

38
Q

What should you do if pt wont relax their legs while trying to test their reflex?

A

Have them hold their hands and pull apart to distract them

39
Q

Explain the scale to measure reflex response

A

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

40
Q

Best way to enhance pt’s response while testing their reflexes

A

Have them relax muscle

Have them do an isometric exercise in a muscle group away from the one being tested

41
Q

Examples of ways to distract patient while trying to test their reflexes

A

For patellar reflex: have pt lock fingers together and pull

For bicep reflex: have pt clench teeth or grasp thigh with opposite hand

42
Q

Which reflexes are superficial reflexes?

A

Abdominal

Plantar reflex

43
Q

How to test abdominal reflex

A

Supine position

Touch abdomen moving from side of abdomen toward midline

44
Q

What is a normal abdominal reflex response?

A

Contraction of abdominal muscle with deviation of umbilicus toward stroke

45
Q

How do you test a patients plantar reflex?

A

Use reflex hammer to draw a light stroke up lateral side of foot and inward across ball of foot (draw upside down J)

46
Q

What is a normal plantar reflex?

A

Plantar flexion of all toes, inversion (toward midline) and flexion of forefoot

47
Q

What is the test called to test the plantar reflex?

A

Babinski

48
Q

What does an abnormal result of the plantar reflex look like?

A

Dorsiflexion of big toe and fanning of all toes

49
Q

What does a positive babinski result indicate?

A

Upper motor neuron disease

50
Q

How do you perform the babinski test on babies?

A

Stroke you finger up the lateral edge and across the ball of the infant’s foot

51
Q

What does a positive babinski reflex look like in infants?

A

Fanning of toes

52
Q

When does the babinski result change from the infant response to the adult response?

A

Present at birth
Disappears (and changes to the adult response)
By 24 months of age

53
Q

CN 1

A

Olfactory

54
Q

How do you test CN I?

A

Assess patency by occluding nostril and having pt sniff

55
Q

Normal CN I response

A

Can identify odor on each side of nostril

56
Q

CN II

A

Optic

57
Q

What do you look for while testing CN II?

A

Visual acuity
Visual fields by confrontation
Ophthalmoscopic exam

58
Q

Cranial nerves III, IV, VI

A

Oculomotor
Trochlear
Abducens

59
Q

How do you test CN III, IV, VI?

A

Pupil check

EOM (cardinal positions of gaze)

60
Q

What does an uneven pupil size indicate?

A

Neurological problem

61
Q

CN V

A

Trigeminal

62
Q

How do you test CN V?

A

Motor: have pt clench teeth
Sensory: light touch sensation

63
Q

CN VII

A

Facial

64
Q

How do you test CN VII?

A

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

65
Q

CN VIII

A

Acoustic

66
Q

How do you test CN VIII?

A

Whispered voice test

67
Q

CN IX & X

A

Glossopharyngeal

Vagus

68
Q

How do you test CN IX & X?

A

Motor: note pharyngeal movement (say “ahh”)
Sensory: Taste (not done)

69
Q

CN XI

A

Spinal accessory

70
Q

How do you test CN XI?

A

Rotate head forcible against resistance applied to side of chin
Shrug shoulders against resistance

71
Q

CN XII

A

Hypoglossal

72
Q

How do you test CN XII?

A

Inspect tongue for tremors or wasting

Ask pt to say “light, tight, dynamite”. Should be clear and distinct

73
Q

CN I name and sensory or motor

A

Olfactory

Smell (S)

74
Q

CN II name and sensory or motor

A

Optic

Vision (S)

75
Q

CN III name and sensory or motor

A 
Oculomotor
Eye movements (M)
76
Q

CN IV name and sensory or motor

A 
Trochlear
Eye movements (M)
77
Q

CN V name and sensory or motor

A

Trigeminal

Face (S/M)

78
Q

CN VI name and sensory or motor

A 
Abducens
Eye movements (M)
79
Q

VII name and sensory or motor

A

Facial

Face/taste (M)

80
Q

CN VIII name and sensory or motor

A

Acoustic (auditory)

Hearing/balance (S)

81
Q

IX name and sensory or motor

A

Glossopharyngeal

Throat/taste (S/M)

82
Q

CN X name and sensory or motor

A 
Vagus
Autonomic viscera (S/M)
83
Q

CN XI name and sensory or motor

A

Spinal accessory

Head and neck (M)

84
Q

CN XII name and sensory or motor?

A 
Hypoglossal
Lower throat (M)
85
Q

When does nystagmus occur?

A

With disease of the vestibular system, cerebellum, or brainstem

86
Q

What is nystagmus?

A

Back and forth oscillation of the eyes

87
Q

Unilateral loss of smell in the absence of nasal disease

A

Neurogenic anosmia

Health Assessment (17 decks)

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