Exam 4 - Neurologic System Flashcards by Katy Peterson

Paralysis on one side of body (spelling)

Hemiplegia

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Difficulty swallowing (spelling)

Dysphagia

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Difficulty speaking (spelling)

Aphasia

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When should you perform a screening neurologic examination?

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

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When should you perform a complete neurologic examination?

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

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When should you perform a neurologic recheck?

On people who have neurologic deficits and require periodic assessments

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How many components are in the neurologic recheck?

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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

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What do you test during a complete neurologic examination?

Mental status (LOC)
Cranial nerves
Motor system
Sensory system
Reflexes

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What do you assess in the motor system?

Muscle size
Muscle strength
Involuntary movements

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How do you test upper extremity strength?

Test hand grips

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How do you test hand grips?

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

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What are the tests for balance?

Gait
Romberg test
Shallow knee bend or hop in place

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How do you test patient’s gait

Have them walk heel-to-toe

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Normal result of gait

Walk straight, stay balanced

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How do you perform the Romberg test?

Pt stands with feet together and arms at side

Close eyes, hold position

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Normal result of Romberg test

Can maintain posture and balance

Slight swaying possible

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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

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How do you have patient perform rapid alternating movements test?

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

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How do you have patient perform finger to finger test?

Have patient touch each finger to thumb on same hand

Then reverse direction

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How do you have pt perform finger to nose test?

Put your finger out

Have patient touch finger then their nose

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How do you have pt perform heel to shin test?

Patient in supine position

Heel on opposite knee and run down shin to ankle

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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

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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

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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