Health Hsitory (Nervous System) Flashcards
What should you ask yourself when a neurological disease is suspected?
- What is the localization of the responsible lesion
- What is the underlying patho physiology that explains the patients symptoms and neurological findings
What are the components of a neurological examination?
- Mental status
- Cranial nerves
- Motor system
- Sensory system
- Reflexes
How should you test the extremities ?
Test for
1. Pain
2. Temperature
3. Touch
4. Compare distal with proximal areas
*patients eyes are closed
While testing for pain and temperature what are you checking for?
- Spinothalamic tracts is working correctly
While testing for position and vibration what are you checking for?
Posterior columns are working correctly
While testing for light touch what are you checking for?
- Spinothalamic tract
- Posterior columns
*make sure they are intact
How should you test for pain?
- Use a disposable object like a broken tongue depressor
- Ask if the prick is sharp or dull
*does this feel the same on both sides
How to test for vibration?
- Tap a 128Hz tuning fork on your hand, place on DIP joint of the patients finger
- Ask if the patient feels a buzz
- Start distal
How to test for proprioception?
- Hold big toe by its side between your thumb and index finger
- Pull away from other toes, and move it up and down
- Ask the patient to identify the direction of movement
- Start distal then repeat with finger
What does assess for discriminative sensation test for?
- Testing the ability of the sensory cortex to analyze and interpret sensations
How to test for stereognosis?
- Place a key or familiar object in the patients hand and ask the patient to identify it
How to test for graphesthesia (number identification)
- Outline a large number in the patients palm and ask the patient to identify the number
*continuous number
How to test for two-point discrimination
- Use two ends of an open paper clip and touch the finger pad/extremity in two places simultaneously
- Ask the patient to identify 1 touch or 2
How to test for point localization
- Lightly touch a point on the patients skin and ask the patient to point to that spot
How to test for extinction
Touch an area on both sides of the body a the same time and ask if the patient feel 1 spot or two
What is a 0/0 muscle strength
No muscular contraction detected
What is a 1 for muscle strength
A barely detectable flicker or trace of contraction
What is a 2 for muscle strength
Active movement of the body part with gravity eliminated
What is a 3 for muscle strength
Active movement against gravity
What is 4 for muscle strength
Active movement against gravity and some resistance
What is a 5 for muscle strength
Active against full resistance without evident fatigue (normal muscle strength)
*ask the patient to move actively against your opposing resistance
*5 if the patient overcomes you opposing movement
What does the motor, cerebellar, vestibular, and sensory system do
M: strength
C: rhyming movement and steady posture
V: Balance and coordinating eye, head, and body movements
S: position sense
How to test for coordination
- Rapid alternating movements
- Point to point movements
- Gait
- Stance
- Pronator drift
How to conducted rapid alternating movements
- Patient turns hand rapidly over and back on thigh
- Taps tip of fingers rapidly on distal thumb
- Taps ball of foot rapidly on your hand
How to conduct point to point movements
- Patient touches nose then your index finger as you move it to different positions
- Patient move heel from opposite knee down the shin to the big toe
How to asses gait?
- Walk across room
- Walk heel to toe
- Walks on toes then heels
- Hops in place on one leg, then the other
How to test stance
Romberg test
1. Patient stands with feet together and eyes open
2. Then eyes closed for 30 to 60 seconds without support
3. Loss of balance when eyes are closed is a positive test
How to conduct pronator drift
- Patient stands for 20-30 seconds with both arms straight forward, palms up, and eyes closed tap arms briskly downward
- Pronation and downward drift of the arm is a positive test
What is the scale for grading reflexes?
0: no response
1: somewhat diminished
2: average
3: brisker than average
4: very brisk hyperactive, with clonus (rhythmic oscillation between flexion and extension)
What does reinforcement mean when assessing contractions?
Used when reflexes are symmetrically dismissed or absent
*You will have the patient hold their hand together and pull apart when testing the reflex
What are the cutaneous stimulation reflexes?
- Abdominal reflexes: upper T8-10; lower T10-T12
- Plantar response: L5-S1
- Anal reflex: S2-S4
What should you NOT do to a comatose patient?
Dilate their pupils or flex the neck
What do the eyes of a comatose patient tell us?
- Eyes should be straight ahead
*if the eye preference a side then the eyes look toward the side of the lesion - Doll eyes
*eyes should move towards the opposite side of the head turning
*midbrain or pons lesion likely is unable to move towards one side
How to conduct oculovestibular reflex
- Put ice water into ear canal
*eyes should drift toward the irrigated ear if brain stem is intact
If a patient presents with a headache what are some things to keep in mind?
- May need evaluation for life-threatening secondary causes such as meningitis, subarachnoid hemorrhage or mass lesion
What are primary headaches?
- Migraine
- Tension
- Cluster
- Trigeminal autonomic cephalagias
- Chronic daily headaches
What are secondary headaches?
- They arise from underlying structural, systemic or infectious causes
EX: subarachnoid hemorrhage and meningitis
What do subarachnoid hemorrhage typically presents as?
- “The worst headache of my life”
What can classify a migraine headache?
POUND
P = pulsatile or throbbing
O = one-day duration or lasts 4 to 72 hours if untreated
U = unilateral
N = Nausea or vomiting
D = disabling
If a headache is severe and has a sudden onset what may need to be considered
- Subarachnoid hemorrhage
- Meningitis
What does vertigo represent?
- Vestibular disease usually from peripheral causes in the nerve ear such as benign positional vertigo
What does progressive but rapid development of lower extremity weakness suggests?
Guillain-Barré syndrome
How to identify proximal weakness?
- Ask them to comb hair or climb stairs
What are proximal limb weakness associated with?
- PM/DrM
- Alcohol
- Drugs
How to identify distal weakness?
- Ask about hand strength when opening a jar or using scissors
What does bilateral distal weakness indicate?
- Polyneuropathy (diabetes)
What is epilepsy defined as?
- Two or more seizures that are not provoked by other illnesses or circumstances
Does epilepsy always involve a loss of consciousness?
No
What is an essential tremor?
- A high-frequency bilateral upper extremity tremor that occur with both limb movement and sustained posture
When do essential tremors go away?
- When the limb is relaxed
What is restless legs syndrome characterized as?
- As an unpleasant sensation in the legs, especially at night that gets worse with rest and improves with movement of the symptomatic limb
