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Physical Diagnostics > Nervous System > Flashcards

Nervous System Flashcards

1
Q

esthe-

A

pertaining to: feeling

ex: anesthesia
def: loss of feeling

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2
Q

-gnosia

A

pertaining to: recognition

ex: agnosia
def: loss of the power to recognize sensory stimuli

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3
Q

myelo-

A

pertaining to: spinal cord

ex: myelogram
def: radiographic study of the spinal cord

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4
Q

-paresis

A

pertaining to: weakness

ex: hemiparesis
def: muscular weakness affecting half the body

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5
Q

-plegia

A

pertaining to: paralysis

ex: ophthalmoplegia
def: paralysis of the eye muscles

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6
Q

radicul(o)-

A

pertaining to: spinal nerve root

ex: radiculopathy
def: disease of a spinal nerve root

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7
Q

name the 12 cranial nerves

A

CN I= Olfactory | Oh | Some
CN II= Optic | Oh | Say
CN III= Oculomotor | Oh | Money
CN IV= Trochlear | Tiny | Matters
CN V= Trigeminal | Tits | But
CN VI= Abducens | And | My
CN VII= Facial | Furry | Boyfriend
CN VIII= Vestibulocochlear | Vaginas | Says
CN IX= Glossopharyngeal | Give | Big
CN X= Vagus | Victor | Brains
CN XI= Spinal accessories | A | Matter
CN XII= Hypoglossal | Hardon | Most

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8
Q

Why is it important for all diabetic patients to receive a full neuro exam?

A

bc they are at high risk for neuropathy

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9
Q

What is neuropathy?

A

damage/dysfunction of 1+ nerves that typically results in numbness, tingling, muscle weakness and pain in the affected area.

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10
Q

How do you test CN I (olfactory) function?

A

the smell test

  • use coffee beans, or essential oils
  • odor 20cm away from pt
  • have pt close eyes and block one nostril at a time
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11
Q

Define anosmia

A

loss of smell

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12
Q

How do you test CN II (optic) function?

hint: there are 3 tests

A

1) visual acuity test (snellen chart)
2) visual field test
3) pupillary light reflex

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13
Q

How do you test CN III (oculomotor) function?

A

pupillary light reflex test (should be able to see both direct and consensual constriction in pupils if CN III is intact)

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14
Q

Pupillary light reflex test assesses 2 nerves. What are they?

A

CN II (optic, sensory) - light gets in eye and goes through the optic nerve

CN III (oculomotor, motor) - constriction of pupils

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15
Q

What muscles does CN III (oculomotor) control?

hint: extraocular muscles (some)

A

superior rectus
medial rectus
inferior rectus
inferior oblique

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16
Q

What muscle does CN IV (trochlear) control?

A

superior oblique muscle

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17
Q

What muscle does CN VI (abducens) control?

A

lateral rectus muscle

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18
Q

How do you test CN V (trigeminal) SENSORY function?

hint: there are 2 tests

A

1) Corneal cotton swab test
2) Cotton swab test on the 3 trigeminal divisions

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19
Q

How do you test CN V (trigeminal) MOTOR function?

A

have pt clench teeth as you palpate masseter muscle

if jaw deviates to one side, CN V is affected (pt does not feel any pain)

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20
Q

How big is CN V (trigeminal)? What does it span?

A

huge nerve that spans the entire face and head

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21
Q

What are the 3 divisions of the CN V (trigeminal)?

A

ophthalmic, maxillary, and mandibular division

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22
Q

If you have shooting or stabbing pain around, in, or both of maxillary and mandibular division, this indicates….

A

trigeminal neuralgia

also called tic douloureux

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23
Q

Describe the cotton swab test on the 3 trigeminal divisions

A

have pt close eyes and take a wisp of cotton or gauze

gently brush on:

1) L/R of forehead (ophthalmic division)
2) L/R of cheeks (maxillary division)
3) L/R of jaw (mandibular division)

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24
Q

The motor branch of CN V (trigeminal) innervates what?

A

the muscles of mastication (temporalis and masseter muscle)

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25
Q

How do you test CN VII (facial) MOTOR function?

hint: there are 2 tests

A

1) have pt make facial expressions (smile, show teeth, frown, resting face, puff cheeks)
2) have pt close eyes, and see if you can force them open with your fingers

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26
Q

What is the sensory function of CN VII (facial)?

A

provides taste sensation to anterior 2/3 of the tongue

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27
Q

The motor branches of CN VII (facial) innervate….

A

orbicularis oculi (muscle that closes the eyes)

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28
Q

How do you test CN VIII (vestibulocochlear) function?

A

1) hearing acuity tests (whisper technique & finger rubbing technique)
2) hearing loss tests (Weber test and Rinne test)

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29
Q

Which two cranial nerves are responsible for keeping the uvula elevated and in midline?

A

CN IX (glossopharyngeal) and CN X (vagus)

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30
Q

What are the functions of CN IX (glossopharyngeal)?

A

Sensory function: taste sensation to posterior 1/3 of tongue

Motor: keep uvula elevated and in midline

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31
Q

What are the functions of CN X (vagus)?

A

responsible for gag reflex and keeping the uvula elevated/ midline

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32
Q

How do you test CN XI (spinal accessory) function?

hint: there are 2 tests

A

have pt laterally rotate head against your resistance

have pt shrug shoulders against your resistance

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33
Q

The spinal accessory nerve (CN XI) innervates….

A

SCM and trapezius muscles

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34
Q

How do you test XII (hypoglossal) function?

A

have pt stick out tongue; it should be midline

look out for: contractures, fasciculations, or scalloping on tongue

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35
Q

Where do upper motor neurons start?

A

cerebrum

36
Q

The upper motor neurons radiate with…

A

the CNS

37
Q

Which motor neurons decussate (cross over)?

A

upper motor neurons decussate in the medulla

38
Q

The lower motor neurons radiate with…

A

the PNS

39
Q

T/F

spinal nerves are always mixed nerves

A

true!!!

40
Q

The dorsal root ganglion is carrying your _______ neurons _____

A

sensory, in

The dorsal root ganglion is carrying your sensory neurons in

41
Q

The ventral root is carrying your _______ neurons ______

A

motor, out

The ventral root is carrying your motor neurons out

42
Q

The radial nerve is made up of which 3 cervical nerve roots?

A

6, 7, and 8

43
Q

There are 7 types of basic sensory tests. List at least 2

A

1) Sharp/dull test
2) Proprioception test
3) Vibratory test
4) Two-point discrimination test
5) Stereognosis test
6) Point localization test
7) Graphesthesia test

44
Q

Describe sharp/dull test

A

assesses pain

use a pin or applicator stick and have pt close eyes, lightly prick one finger on each hand at a time

can pt determine if it is sharp or dull?

45
Q

Describe proprioception test

A

can pt tell where their body parts are in space?

hold just the lateral distal aspect of digits and show pt up and down on one finger, with eyes open

then have pt close eyes and ask to identify if their finger or toe is up or down

do this to both hands and feet

46
Q

What are the 2 more important neuro exams for diabetic patients?

A

sensory testing: vibratory test and 2-point discrimination test

47
Q

Describe vibratory test

A

use a 1/28 tuning fork and hit it on your hand

place vibrating fork on pt foot or hand, right behind their nail

ask pt if they can feel vibration and when vibration stops

do both hands and feet/compare

48
Q

Describe 2- point discrimination test

A

use tweezers or an applicator and touch pt finger at distal end

the applicator should be set to 3mm and if they cant feel the 2 points then increase to 4mm, 5mm, etc.

the average for a normal pt is 5mm

49
Q

Describe point localization test

A

have pt close eyes and touch their cheek, shoulder, hand, etc. (choose a couple appropriate locations) and then have them open their eyes and point to where you touched them

50
Q

Describe stereognosis test

A

ask pt to close eyes

put something familiar in their hand (ex: pen) and have them identify what it is just on touch alone

if they cannot identify, then there is something wrong with parietal or occipital lobe

51
Q

Describe graphesthesia test

A

have pt close eyes and then you will take a closed pen and “draw” a number on their palm (0-9)

choose one number and do it on both hands, can repeat a couple times

note: you must be writing the number in the direction of the pt (don’t write it sideways or upside down)

if they cannot tell you the correct number after several tries then they most likely have parietal disease

52
Q

List the muscle strength grading scale

A 
0= no movement/strength 
1= trace, slight movement/contracture 
2= weak, no movement/strength against gravity 
3= fair, can move against gravity but no resistance 
4= good, can move against gravity and some resistance 
5= normal strength
53
Q

There are 6 pairs of basic motor tests. List at least 2 pairs of tests

A

1) Finger abduction + adduction
2) Wrist extension + flexion
3) Forearm (elbow) flexion + extension
4) Hip abduction + adduction
5) Knee flexion + extension
6) Ankle dorsiflexion + plantarflexion

54
Q

What is foot dropping?

A

weakness or paralysis of the muscles involved in lifting the front part of the foot

pt is unable to dorsiflex and foot is always in plantarflexion

this is due to damage to the peroneal nerve (branch of sciatic nerve)

55
Q

Are reflexes testing motor, sensory, or both functions?

A

both!

56
Q

Briefly explain how reflexes work

A
  • hit the tendon with medical hammer
  • muscle will stretch
  • sensory information is sent to spinal cord
  • spinal cord will send back impulses through motor nerve
  • muscle contracts to avoid overstretching and the leg extends outward
57
Q

What are the 2 main reflex tendons you should be checking?

A

1) Achilles tendon
2) Patellar tendon

58
Q

Describe how to test Achilles tendon reflex

A

hold pt foot and tap tendon

the reflex is subtle- the calf and/or tendon will contract and foot will go into plantar flexion

59
Q

Describe how to test patellar tendon reflex

A

put your hand on pt thigh and do one quick stroke at the patellar tendon

if there is no reflex distract the pt by asking them to hold/lock their hands at chest level

60
Q

List the reflex grade scale

A 
0= no contracture/reflex at all 
1= diminished, hyporeflexia 
2= normal 
3= excess/exaggerated 
4= hyperreflexia
61
Q

What is hyporeflexia indicative of?

A

lower motor neuron disease

62
Q

What is hyperreflexia indicative of?

A

upper motor neuron disease

63
Q

What is a positive (+) Babinski test indicative of?

A

lower motor neuron disease

64
Q

Describe how to do a babinski test

A

take handle of hammer and run from heel (lateral aspect) to the hallux

if you see dorsiflexion = + Babinski

65
Q

How do you test cerebellar function?

Hint: there are 4 tests

A

1) finger to nose testing
2) rapid alternating movement testing
3) romberg test
4) tandem gait test

66
Q

Describe finger to nose testing

A

have pt touch their finger to their nose (do with open and closed eyes)

hold one finger out toward pt and have them tap your finger with their finger (eyes open) - some pt’s cannot do this and will drift past finger, this is called past pointing (another variation for this is that their finger will start shaking when it gets closer to your finger)

67
Q

Describe rapid alternating movement testing

A

have pt touch each finger to their thumb as fast as possible

have pt flip palm back and forth along their thigh as fast as possible

have pt take their heel and raise to their knee, repeat several times as fast as possible (repeat on other side)

take your palm and lay it flat in the air, have pt flip their hand back and forth on your hand as fast as possible

68
Q

What is adiadochokinesia?

A

inability to perform rapid alternating movement of muscle

69
Q

Describe romberg test

A

have pt walk and then stop, and close their eyes (if they’re not swaying at this point, then ask them to extend their arms forward, palms up)

note: make sure to stand behind or beside pt incase they sway

if they can maintain this position without swaying then that = - Romberg

if they sway at any point = + Romberg = cerebellar dysfunction

IF pt can do this but one arm drifts downward then this is known as a pronator drift = limited muscle strength and they are suffering from hemiparesis (most commonly strike patients)

70
Q

What is hemiparesis?

A

weakness or inability to move on one side of the body

71
Q

Describe tandem gait test

A

DUI police walk

walk heel to toe in a straight line

72
Q

What two nerves innervate taste?

A

facial nerve (CN VII) innervates anterior 2/3 of tongue

glossopharyngeal nerve (CN IX) innervates posterior 1/3 of tongue

73
Q

What is this?

A

contractures/ fasciculations/ scalloping of tongue

74
Q

What is this?

A

finger abduction

have pt abduct fingers and you will apply resistance

75
Q

What is this?

A

finger adduction

pt should be able to grab your forefingers and squeeze

76
Q

What is this?

A

wrist extension

77
Q

What is this?

A

wrist flexion

78
Q

What is this?

A

forearm (elbow) flexion

79
Q

What is this?

A

forearm extension

80
Q

What is this?

A

hip abduction

81
Q

What is this?

A

hip adduction

82
Q

What is this?

A

knee flexion

have pt flex knee and you will try to pull/extend knee out

83
Q

What is this?

A

knee extension

pt has knee extneded and you will try to push down to flex their knee

84
Q

What is this?

A

ankle dorsiflexion

85
Q

What is this?

A

ankle plantarflexion

Physical Diagnostics (13 decks)

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