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Medical History and Physical Examination > Module 11: Neurologic Examination > Flashcards

Module 11: Neurologic Examination Flashcards

1
Q

Level of Consciousness

A

Awareness and cognitive function as assessed through behavior, arousability, and responses to stimuli

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2
Q

Orientation is a person’s ability to identify…

A
  • Person – who they are
  • Place – where they are
  • Time – what the date is
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3
Q

Cranial Nerve

A

A nerve that arises directly from the brain as opposed to the spinal column

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4
Q

Olfactory Nerve

A
  • Cranial nerve I

- Responsible for the sense of smell

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5
Q

Optic Nerve

A
  • Cranial Nerve II
  • Responsible for visual acuity
  • Peripheral visual fields
  • Sensory component of the pupillary reflex
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6
Q

Visual Acuity

A

The ability to see clearly in the central line of vision

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7
Q

Peripheral Fields

A

The areas of vision beyond a person’s central vision

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8
Q

The ophthalmoscopy exam allows the provider to directly visualize

A
  • Optic disc
  • Retina
  • Fovea
  • Macula
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9
Q

Direct Pupillary Reaction

A

Constriction of the pupil as light is shown into the eye being examined

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10
Q

Consensual Pupillary Reaction

A

Constriction of the pupil as light is shown into the opposite eye

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11
Q

Oculomotor Nerve

A
  • Cranial Nerve III
  • Responsible for constricting the pupil with pupillary reaction
  • Keeping the eye open
  • Extraocular movements through all positions of gaze except lateral & inferior movements
  • Think 3 columns keeping the eyes open
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12
Q

Abducens Nerve

A
  • Cranial Nerve VI

- Responsible for the movement of the eye in the lateral direction through innervation of the lateral rectus muscle

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13
Q

Trochlear Nerve

A
  • Cranial Nerve IV
  • Responsible for movement of the eye in the inferior, lateral (up & down) direction through innervation of the superior oblique muscle
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14
Q

Trigeminal Nerve

A
  • Cranial Nerve V

- Responsible for the motor action of the muscles of mastication & sensation to the forehead, cheek, & jaw

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15
Q

Examine the Trigeminal Nerve

A
  • Patient clenches teeth and you palpate mastication muscles
  • Patient opens mouth -> check for symmetry
  • Use soft touch/sharp object to test the sensory branch
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16
Q

Facial Nerve

A
  • Cranial nerve VII
  • Responsible for innervation of the muscles of facial expression
  • The ability to close the eyes
  • Taste sensation of the anterior 2/3 of the tongue
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17
Q

Disruption of the innervation of the CNVII can result in

A
  • Weakness of facial muscles
  • Can be seen as flattening of the forehead winkles
  • Loss of nasolabial fold
  • Drooping of the corner of the mouth
  • Inability to close the eye fully
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18
Q

Vestibulocochlear Nerve

A
  • Cranial Nerve VIII
  • AKA acoustic nerve
  • Responsible for balance (vestibular)
  • Responsible for hearing (cochlear)
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19
Q

Nystagmus

A

Involuntary beating movements of the eyes in horizontal, vertical, or circular motions

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20
Q

Glossopharyngeal Nerve

A
  • Cranial Nerve IX
  • Responsible for taste sensation to the posterior 1/3 of the tongue
  • Sensory component of the gag reflex
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21
Q

Signs of cranial nerve IX (CNIX) injury include

A
  • Dry mouth

- Dysphagia

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22
Q

Vagus Nerve

A
  • Cranial nerve X
  • Responsible for the motor component of the pharynx (gag reflux)
  • Larynx
  • Providing parasympathetic innervation to thoracic & abdominal organs
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23
Q

Approximately ____% of people do not have a gag reflex

A

20%

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24
Q

Asymmetric findings in the vagus nerve are particularly indicative of

A

Pathology

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25
CNIX provides the _____ _____ of the gag reflex while the CNX provides the ____ _____.
- Sensory component | - Motor reaction
26
Spinal Accessory Nerve
- Cranial nerve XI | - Responsible for the motor action of the sternocleidomastoid (SCM) & trapezius muscles
27
Hypoglossal Nerve
- Cranial Nerve XII | - Responsible for the motor movement of the tongue
28
Motor Examination
Component of the neurologic examination that assesses muscle tone, strength, and reflexes
29
Muscle Tone
State of tension of the muscles
30
Hypertonia
- Increased muscle tension/resistance - Indicative of upper motor neuron lesions - Marked by decreased ability of muscle to stretch
31
Muscle Strength Testing
Assessment of the ability to move a joint against gravity & resistance using a scale ranging from 0-5
32
Muscle Strength Scale 0/5
No muscle twitch w/ attempted movement
33
Muscle Strength Scale 1/5
Muscle can be seen to twitch but no movement at the joint is seen
34
Muscle Strength Scale 2/5
Movement occurs in the horizontal plane but not against gravity
35
Muscle Strength Scale 3/5
Movement against gravity but not resistance
36
Muscle Strength Scale 4/5
Movement against some resistance
37
Muscle Strength Scale 5/5
Movement against full resistance
38
Muscle Stretch Reflex
- Test where the provider strikes a muscle w/ a reflex hammer - Activates stretch muscle -> communicates w/ lower motor neurons in the anterior horn
39
Muscle Stretch Reflex Scale 0/4
No response
40
Muscle Stretch Reflex Scale 1/4
Diminished response
41
Muscle Stretch Reflex Scale 2/4
Normal
42
Muscle Stretch Reflex Scale 3/4
Somewhat increased
43
Muscle Stretch Reflex Scale 4/4
Greatly increased, clonus
44
Hyperreflexia
- An increase in contraction - Indicates a lesion of upper motor neurons - Greatest degree = clonus
45
Biceps reflex testing assesses
The C5-6 nerve roots
46
Clonus
- A series of involuntary contractions & relaxations of a muscle - Assessed either by reflex hammer or rapid stretching of the muscles - Sign of upper motion neuron lesions
47
Sensory Examination
Component of the neurologic examination that assesses touch, pain, temperature (hot/cold), proprioception (position sense), and vibratory sensation
48
Light Touch perception through
The posterior column/medial lemniscus pathway
49
Heavier pressure of touch perception is through
The spinothalamic tract
50
Pain
Sensory perception transmitted through the spinothalamic tract
51
Temperature
Sensory perception transmitted through the spinothalamic tract, assessed through the distinction of hot verses cold
52
How do you assess temperature sensation?
- Ask the patient to close their eyes - Use the cold handle of a tuning fork/reflex hammer to touch patient - Ask them to tell you if they feel hot or cold
53
Vibratory Sensation
Sensory perception transmitted through the posterior columns/medical lemniscus
54
Proprioception
- The ability to sense the position of on body part in relation to others - Sensory perception transmitted through the posterior columns
55
Stereognosis
The ability to recognize common objects by touch as a function of the parietal lobe
56
Assess Stereognosis
- Ask patients to close their eyes and place a common object in their hand, such as a key, coin, or paper clip - Assess bilaterally - Deficiency reflects parietal lobe pathology
57
Graphesthesia
- The ability to recognize numbers, letters, or symbols traced on the palm - Function of the parietal lobe
58
Extinction
- The inability to appreciate touch in an area on one side of the body - Function of the parietal cortex
59
Test for Extinction
- Ask patient to close their eyes - Touch them in varying places, one side at a time - Extinction result – they cannot identify touch on one side
60
Coordination
The interaction between the cerebellum and the motor, vestibular, and sensory systems
61
How is coordination assessed?
- Finger-to-nose - Rapid alternating movements - Heel-to-shin testing
62
Dysdiadochokinesia
A dysfunction in the performance of rapid alternating movements (RAM)
63
Romberg Test
- Evaluation of cerebellar functioning | - Patient’s ability to balance is assessed
64
Gait
Pattern of walking requiring interaction of cerebellar, vestibular, motor, and sensory functioning

Medical History and Physical Examination (9 decks)

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