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6011 Clinical Reasoning Test 3 COMPLETE ☑️ > Module 12: Neuro Assessment > Flashcards

Module 12: Neuro Assessment Flashcards

1
Q

Brain & Nerves

-Common Neuro CC

A
  1. Dizziness
  2. HA
  3. Pain
  4. Paresthesias (numbness or tingling)
  5. Seizures
  6. Syncope
  7. Weakness
  8. Tremors
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2
Q

Brain & Nerves

-Head Complaints

A
  1. Headache
  2. Hair loss
  3. Lice
  4. Moles/lesions
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3
Q

Brain & Nerves

-Health Promotion

A
  1. Helmet use
  2. Car safety
  3. HTN — ICH secondary to HTN
  4. Cerebral vascular disease
  5. Sunscreen
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4
Q

Brain & Nerves

-Developmental Considerations in Infants and Children

A
  1. Growth charts
  2. Birth hx — Premature?
  3. Fever, Lethargy
  4. Co-morbidities
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5
Q

Brain & Nerves

-Developmental Considerations in Pregnancy?

A
  1. Stages of Pregnancy — Trimester

2. HTN

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6
Q

Brain & Nerves

-Developmental Considerations Older Adults

A
  1. Hx of falls
  2. Change in meds — HTN meds causing hypotension
  3. Dizziness
  4. Balance
  5. Coordination
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7
Q

Brain & Nerves

-Headache Red Flags

A
  1. Stiff neck and papilledema
  2. Progressive
  3. Thunderclap
  4. New onset > 50 yrs
  5. Focal Neuro deficit
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8
Q

Brain & Nerves

-Subjective Headache

A
  1. Severe and new onset HA.
  2. Chronic headaches vs Episodic — Chronic points to co-morbidity

ROS
-Auras usually last 5 minutes to 60 minutes and MUST resolve
Family Hx — HUGE family component — If 1st degree relative has it it is more likely

  1. Motion sickness in child is precursor to migraine in adult
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9
Q

Brain & Nerves

-Abnormals in Head Exam

A
  1. Moon face — Cushing’s
  2. Bug eyes — Exophthalmus; hyperthyroid
  3. Periorbital edema
  4. Sinus tenderness
  5. Bumps, lesions, masses
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10
Q

Brain & Nerves

-CC Headache

A
  1. HPI — OLD CARTS — Use of analgesics more than 10x/month = suspicion of rebound headaches
  2. ROS
    - General, HEENT, CV, RESP, ABD (Nausea/Photophobia = migraine) , MSK, Neuro
  3. Fam Hx — Usually onset between 20-40 yrs. Strong family connection
  4. Social Hx — Alcohol and smoking increase HA’s — Excessive Caffeine contributes
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11
Q

Migraine Diagnosis Criteria

A
  1. Unilateral headache
  2. Pulsing or throbbing pain
  3. Typically last between 4-72 hrs —Improve w/ sleep
  4. Accompanied by Nausea & photophobia
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12
Q

Tension Headache Diagnostic Criteria

A
  1. MOST COMMON type of headache
  2. Bilateral “Vice grip” type feeling
  3. Increased w/ stress

MORE common in women — Men more often have cluster headaches

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13
Q

Brain & Nerves

-Neuro health promotion

A
  1. Stroke & TIA prevention
  2. Concussion safety
  3. Reducing risk of peripheral neuropathy
  4. Preventing delirium, dementia, depression
  5. Preventing low back strain
  6. Concussion, TBI guidelines
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14
Q

Brain & Nerves

-Basic Neuro Exam

A
  1. Mental Status
  2. Cranial Nerves
  3. Motor/coordination
  4. Sensory system
  5. Reflexes
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15
Q

Brain & Nerves

-Mini Mental Status Exam

A
  1. Orientation
  2. 3 objects to recall
  3. Serial 7’s or spell world backwards
  4. Identify common objects
  5. 3 step command
  6. Copy shape
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16
Q

Brain & Nerves

-CN 1 - Olfactory

A
  1. Parkinson’s can lead to loss of smell *

2. Trauma, smoking, sinus conditions

17
Q

Brain & Nerves

-CN 2 - Optic

A
  1. Visual Acuity
  2. Fundoscopic exam
  3. Visual fields
18
Q

Brain & Nerves

-CN 3, 4, & 6

A
  1. Oculomotor, trochlear, abducens

2. Extra ocular movements and pupillary response

19
Q

Brain & Nerves

-CV 5 - Trigeminal

A
  1. Palpate TMJ
  2. Light touch on 3 trigeminal divisions — Ophthalmic, maxillary, mandibular
  3. Temperature sensation
  4. Corneal reflex
20
Q

Brain & Nerves

-CN 7 Facial

A
  1. Raise eyebrows, frown, close eyes tightly, show teeth, smile, puff out cheeks
21
Q

Brain & Nerves

-CN 8 - Acoustic TEST

A
  1. Whisper test
  2. Weber
  3. checks symmetry of hearing
    Sensorineural loss — Sound heard in GOOD ear.
    Conductive loss — Sound heard better in BAD ear
  4. Rinne Test — Assesses hearing, not feeling d
    - Normal or sensorineural loss = AC > BC
    - Conductive loss AC = BC or BC is heard more

CONFIRM w/ Audiometry

22
Q

Brain & Nerves

-CN 9 & 10

A
  1. Glossopharyngeal & Vagus
  2. Glossopharyngeal
    - Voice quality, swallowing, gag reflex
  3. Vagus
    - Midline elevation of uvula during phonation “Ahh”
23
Q

Brain & Nerves

-CN 11 - Accessory

A
  1. Symmetrical and equal shoulder elevation

- Shrug shoulders, turn face against resistance

24
Q

Brain & Nerves

-CN 12 Hypoglossal

A
  1. Speech articulation
  2. Protrusion of the tongue
    - Fasciculation, midline, asymmetry
25
Q

Brain & Nerves

-4 Systems of Coordination?

A
  1. Motor — Muscle strength
  2. Cerebelar — Rhythmic movements and steady posture
  3. Vestibular — Balance, coordinating eye, head & body movements
  4. Sensory — position sense
26
Q

Brain & Nerves

-Sensory — Simple Sensation

A
  1. Touch, pain, temperature, vibration

2. Clinical significance — Peripheral nerve injury, Radiculopathy, hyperalgesia

27
Q

Brain & Nerves

-Sensory — Vibration

A
  1. Vibratory sensation often decreased in SPINAL CORD dz and peripheral neuropathy
  2. Vibration is preserved in dz of cerebral cortex
28
Q

Brain & Nerves

-Diabetic Foot Exam

A
  1. Monofilament Exam
    - Quantitative measurement of simple sensation
    - A foot able to sense 5.07 monofilament is protected
  2. Apply monofilament to skin w/ enough force for it to buckle
    - Gently test 6 sites
29
Q

Brain & Nerves

-Proprioception

A
  1. Diminished in Pt’s w/ B12 deficiency, MS & DM & is BASIS of Romberg test
  2. Grab sides of toe and move it up and down. Ask the patient which direction the toe is moving
    - Must have intact contra lateral cerebral cortex for proprioception
30
Q

Brain & Nerves

-Cortical Sensations

A
  1. Tactile Recognition — Identify familiar object by placing it in their hand
  2. Graphesthesia — A written word on the hand
  3. 2-point discrimination — Discern 2 vs 1 point
  4. Point localization — Locate stimulus after it is removed
31
Q

Brain & Nerves

-Deep Tendon Reflexes

A
  1. Hyperactive — CNS Lesions
    - Weakness, spasticity, positive babinski
  2. Hypoactive — Sinal nerve root or plexus Dz - Peripheral nerves
    - Weakness, atrophy or fasciculation, symmetrically diminished or absent reflexes
32
Q

Brain & Nerves

-Meningeal signs

A
  1. Nuchal Rigidity— Test neck mobility
  2. Kernig’s Sign — Flex leg at hip and knee, straighten knee and look for pain
  3. Brudzinski’s Sign — Flex neck, watch for Flexion of hips and knees
33
Q

Brain & Nerves

-Red Flags

A
  1. Loss of Consciousness
  2. Thunderclap HA
  3. Stiff neck & Fever
  4. New onset: paralysis, seizures, HA >50 yrs
  5. Gait or motor abnormality

6011 Clinical Reasoning Test 3 COMPLETE ☑️ (4 decks)

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