Examination Flashcards
LOC - obtundation =
can open eyes, look at examiner
but responds slowly and is confused
demonstrates dec alertness and interest in environment
LOC - stupor =
can be aroused from sleep only with painful stimuli
verbal responses are slow or absent
pt returns to unresponsive state when stimuli are removed
demonstrates minimal awareness of self and environment
LOC - unresponsive vigilance (vegetative) state =
characterized by return of sleep/wake cycles, normalization of vegetative functions (resp, HR, BP, digestion) and lack of cog responsiveness (can be aroused but is unaware)
LOC - persistent vegetative state =
a state lasting over 1 year for TBI and over 3 months for anoxic brain injury
LOC - minimally conscious state =
a state characterized by severely altered consciousness with minimal but definite evidence of self or environmental awareness `
GCS - relates
consciousness to three elements of response
Eye opening, motor response, and verbal response
Scored from 3 to 15
GCS - severe brain injury, mod and min
severe = 1 to 8 mod = 9 to 12 minor = 13 to 15
Memory - immediate recall
name three items previously presented after a brief interval of about 5 min
Memory - recent memory (short term)
recall recent events - what did you have for breakfast
Memory - remote memory (long term)
recall past events - where were you born
Mini mental state exam (MMSE) - screening test for
cog dysfunction
includes screening items for orientation, registration, attn, calculation, recall and language
MMSE - scoring
max is 30
mild impairment = 21-24
mod = 16-20
severe = 15 or less
LOCF - rancho los amigos levels of cog function - assesses
cognitive recovery from TBI
LOCF - scoring
8 levels of bx 1 = no response 2 and 3 = decreased response 4, 5, 6 = confused 7, 8 = appropriate automatic, purposeful
vital signs - resp - cheyne stokes respiration is what
a period of apnea lasting 10-60 sec followed by gradual inc depth and freq of respirations
Accompanies depression of frontal lobe and diencephalic dysfunction
vital signs - resp - hyperventilation
inc rate and depth of resp
Accompanies dysfunction of lower midbrain and pons
vital signs - resp - apneustic breathing
abnormal resp marked by prolonged inspiration
Accompanies damage to upper pons
Exam for CNS infection or meningeal irritation - neck mobility test
supine, flex neck to chest
pos - neck pain with limitation and guarding of head flexion due to spasm of post neck mm
can result from meningeal inflammation, arthritis, or neck injury
Exam for CNS infection or meningeal irritation - Kernig’s sign
Supine, flex hip and knee fully to chest and then extend knee
Pos - causes pain and inc resistence to extending knee due to spasm of hamstring
when bilateral - suggests meningeal irritation
Exam for CNS infection or meningeal irritation - Brudzinski’s sign
Supine, flex knee to chest
Pos - causes flexion of hips and knees (drawing up)
Suggests meningeal irritation
Perceptual function - test for homonomous hemianopsia
loss of half of visual field in each eye - contralateral to side of lesion
Slowly bring two fingers from behind head and have them tell you when and where fingers first appear
Perceptual function - body scheme/body image disorders - body scheme disorder =
somatognosia
have pt identify body parts or their relationship to each other