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

Module 11: Neurologic Examination Flashcards

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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
Q

CNIX provides the _____ _____ of the gag reflex while the CNX provides the ____ _____.

A
  • Sensory component

- Motor reaction

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26
Q

Spinal Accessory Nerve

A
  • Cranial nerve XI

- Responsible for the motor action of the sternocleidomastoid (SCM) & trapezius muscles

27
Q

Hypoglossal Nerve

A
  • Cranial Nerve XII

- Responsible for the motor movement of the tongue

28
Q

Motor Examination

A

Component of the neurologic examination that assesses muscle tone, strength, and reflexes

29
Q

Muscle Tone

A

State of tension of the muscles

30
Q

Hypertonia

A
  • Increased muscle tension/resistance
  • Indicative of upper motor neuron lesions
  • Marked by decreased ability of muscle to stretch
31
Q

Muscle Strength Testing

A

Assessment of the ability to move a joint against gravity & resistance using a scale ranging from 0-5

32
Q

Muscle Strength Scale 0/5

A

No muscle twitch w/ attempted movement

33
Q

Muscle Strength Scale 1/5

A

Muscle can be seen to twitch but no movement at the joint is seen

34
Q

Muscle Strength Scale 2/5

A

Movement occurs in the horizontal plane but not against gravity

35
Q

Muscle Strength Scale 3/5

A

Movement against gravity but not resistance

36
Q

Muscle Strength Scale 4/5

A

Movement against some resistance

37
Q

Muscle Strength Scale 5/5

A

Movement against full resistance

38
Q

Muscle Stretch Reflex

A
  • Test where the provider strikes a muscle w/ a reflex hammer
  • Activates stretch muscle -> communicates w/ lower motor neurons in the anterior horn
39
Q

Muscle Stretch Reflex Scale 0/4

A

No response

40
Q

Muscle Stretch Reflex Scale 1/4

A

Diminished response

41
Q

Muscle Stretch Reflex Scale 2/4

A

Normal

42
Q

Muscle Stretch Reflex Scale 3/4

A

Somewhat increased

43
Q

Muscle Stretch Reflex Scale 4/4

A

Greatly increased, clonus

44
Q

Hyperreflexia

A
  • An increase in contraction
  • Indicates a lesion of upper motor neurons
  • Greatest degree = clonus
45
Q

Biceps reflex testing assesses

A

The C5-6 nerve roots

46
Q

Clonus

A
  • 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
Q

Sensory Examination

A

Component of the neurologic examination that assesses touch, pain, temperature (hot/cold), proprioception (position sense), and vibratory sensation

48
Q

Light Touch perception through

A

The posterior column/medial lemniscus pathway

49
Q

Heavier pressure of touch perception is through

A

The spinothalamic tract

50
Q

Pain

A

Sensory perception transmitted through the spinothalamic tract

51
Q

Temperature

A

Sensory perception transmitted through the spinothalamic tract, assessed through the distinction of hot verses cold

52
Q

How do you assess temperature sensation?

A
  • 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
Q

Vibratory Sensation

A

Sensory perception transmitted through the posterior columns/medical lemniscus

54
Q

Proprioception

A
  • The ability to sense the position of on body part in relation to others
  • Sensory perception transmitted through the posterior columns
55
Q

Stereognosis

A

The ability to recognize common objects by touch as a function of the parietal lobe

56
Q

Assess Stereognosis

A
  • 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
Q

Graphesthesia

A
  • The ability to recognize numbers, letters, or symbols traced on the palm
  • Function of the parietal lobe
58
Q

Extinction

A
  • The inability to appreciate touch in an area on one side of the body
  • Function of the parietal cortex
59
Q

Test for Extinction

A
  • 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
Q

Coordination

A

The interaction between the cerebellum and the motor, vestibular, and sensory systems

61
Q

How is coordination assessed?

A
  • Finger-to-nose
  • Rapid alternating movements
  • Heel-to-shin testing
62
Q

Dysdiadochokinesia

A

A dysfunction in the performance of rapid alternating movements (RAM)

63
Q

Romberg Test

A
  • Evaluation of cerebellar functioning

- Patient’s ability to balance is assessed

64
Q

Gait

A

Pattern of walking requiring interaction of cerebellar, vestibular, motor, and sensory functioning

Medical History and Physical Examination (9 decks)

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