Lecutre 2 Reverse Flashcards
- Attention2. Memory3. Orientation4. Perceptions5. Thought process/content6. Insight7. Judgement8. Affect9. Mood10. Language11. Higher cognitive functions
Components of mental status
- Medically unexplained physical Sx2. High Sx count3. High severity of the complaint when organic causes are ruled out4. Chronic pain5. Recent stressor6. Difficult encounters7. Low self rating of health8. Frequent use of healthcare servicces9. Substance abuse10. Cognitive complaints of any sort
What triggers a MSE?
Mis-interpretation of real stimuli1. Grief2. PTSD3. Schizophrenia
Illusions & when are they seen?
- Date orientation - 5 pts2. Place orientation - 53. Register - 3 (Name objects & repeat)4. Serial 7’s - 5 (Count back from 7, WORLD)5. Recall - 3 (3 objects from register)6. Naming - 2 7. Repeating phrase - 18. Verbal commands - 3 9. Written commands - 1 10. Writing - 111. Drawing - 1
MMSE components
24 or higherDepends on age & education
What is a normal MMSE score?
- MSE2. CN3. Sensory4. DTR/Plantar response5. Cerebellar function6. Muscle strength7. Motor screening
What does a neuro exam test?
OlfactorySensory
CN I
OpticSensory - visual acuity & visual fields
CN II
OculomotorMotor - raise eyelids, most EOMParasympathetic - pupil constriction, lens shape
CN III
TrochlearMotor - downward, inward eye mvmt (SO)
CN IV
TrigeminalMotor - jaw opening & clenching, masticationSensory - 3 branches
CN V
AbducensMotor - lateral eye mvmt (LR)
CN VI
FacialMotor - facial expression muscles (except jaw), eye closure, mouth closureSensory - taste (ant. 2/3 tongue)Parasympathetic - Secretion of saliva & tears
CN VII
AcousticSensory - hearing & equilibrium
CN VIII
GlossopharyngealMotor - voluntary muscles for swallowing & pronationSensory - nasopharynx, gag reflex, taste (post. 2/3 tongue)Parasympathetic - secretion of saliva, carotid reflex
CN IX
VagusMotor - Voluntary muscles of phonation & swallowSensory - behind ear, part of external canalParasympathetic - secretion of digestive enzymes, peristalsis, carotid reflex, heart, lungs, digestive tract
CN X
Spinal AccessoryMotor - turn head, shoulder shrug, some phonation
CN XI
HypoglossalMotor - tongue mvmt for speech, sound articulation, swallowing
CN XII
Front & back of neck
Spinal nerve C3
thumb/C85th finger
Spinal nerve C6
nipple line
Spinal nerve T4
umbilicus
Spinal nerve T10
inguinal
Spinal nerve L1
Anogenital
Spinal nerve S2/3
Knee
Spinal nerve L4
Motor TractA - contralateral SxB - ipsilateral Sx
Lesions above & below corticospinal tract
- babinski2. Inc. DTRs3. Muscular spasticity1. MS2. ALS
UMN lesions Sx & when are they seen
- Dec. DTRs2. Ipsilateral weakness3. Dec. or absent muscle tone1. Nerve transection2. Guillan-Barre3. Polio
LMN lesions Sx & when are they seen
Participate in reflex activity, regulation of position & autonomic function1. Spinothalamic2. Posterior Column
What are the sensory pathways?
Sensory pathwayCrosses in cord1. Pain2. Temp3. Crude touch
Spinothalamic tract
Sensory pathwayCrosses in the medulla1. Position2. Vibration3. Fine touchAll affected by diabetic neuropathy
Posterior Column tract
- Level of spinal lesion2. Electrolyte disturbances3. Endocrine disturbances4. UMN vs LMN disease
What do differences in reflexes indicate?
Delayed DTR
What kind of reflex does hypermagnesemia cause?
Biceps & Brachioradialis - C5&6Triceps - C6&7Patellar - L2,3&4Achilles - S1
DTR & Spinal nerves
0 - absent1+ - Hypoactive2+ - Normal3+ - Hyperactive4+ - Hyperactive w/ clonus
Grading DTRs