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Clinical Assessment > Nervous System > Flashcards

Nervous System Flashcards

1
Q

What are the twelve cranial nerves?

A 
CN I (olfactory)
CN II (optic)
CN III (oculomotor)
CN IV (trochlear)
CN V (trigeminal)
CN VI (abducens)
CN VII (facial)
CN VIII (vestibulococchlear)
CN IX (glossopharyngeal)
CN X (vagus)
CN XI (accessory)
CN XII (hypoglossal)
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2
Q

What is the function of the Olfactory Nerve (CN I)?

A

sense of smell

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3
Q

What is the function of the Optic Nerve (CN II)?

A

vision

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4
Q

What is the function of the Oculomotor Nerve (CN III)?

A
  • pupillary constriction
  • opening the eye
  • most EOMs
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5
Q

What is the function of the Trochlear Nerve (CN IV)?

A

inferior and medial movements of the eye

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6
Q

What is the function of the Trigeminal Nerve (CN V)?

A
  • motor: temporal and masseter muscles, lateral pterygoids

- sensory: facial (ophthalmic, maxillary, and mandibular divisions)

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7
Q

What is the function of the Abducens Nerve (CN VI)?

A

lateral deviation of the eye

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8
Q

What is the function of the Facial Nerve (CN VII)?

A
  • motor: facial movements and expressions (closing eye and mouth)
  • sensory: taste on the anterior 2/3 of tongue
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9
Q

What is the function of the Vestibulocochlear Nerve (CN VIII)?

A
  • hearing (cochlear division)

- balance (vestibular division)

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10
Q

What is the function of the Glossopharyngeal Nerve (CN IX)?

A
  • motor: pharynx

- sensory: posterior portions of TM and ear canal, pharynx, posterior tongue (including taste), uvula

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11
Q

What is the function of the Vagus Nerve (CN X)?

A
  • motor: palate, pharynx, larynx, uvula

- pharynx and larynx

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12
Q

What is the function of the Accessory Nerve (CN XI)?

A
  • motor: SCM and upper portion of trapezius
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13
Q

What is the function of the Hypoglossal Nerve (CN XII)?

A
  • motor: tongue
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14
Q

What are the aspects of the Mental Status Examination (MSE)?

A
  • appearance and behavior
  • speech
  • affect
  • mental content
  • mental function
  • judgment
  • insight
  • suicidal and homicidal risks
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15
Q

What are the components of Appearance and Behavior in the MSE?

A
  • level of consciousness
  • posture and motor behavior
  • dress, grooming and personal hygiene
  • facial expression
  • manner
  • relationship to people and things
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16
Q

What are the components of Speech in the MSE?

A
  • quantity: talkative vs silent
  • rate: fast vs slow
  • volume: loud vs soft
  • articulation of words
  • fluency: look for hesitancies, disturbed inflections (monotone), circumlocations (word substitutions)
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17
Q

What are the components of Affect in the MSE?

A
  • observable, usually episodic, feeling or tone expressed through voice, facial expression, and demeanor
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18
Q

What are the components of Mental Content in the MSE?

A
  • what pt thinks about

- included level of insight and judgment

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19
Q

What are the components of Mental Function in the MSE?

A

assessed by vocab, fund of info, abstract thinking, calculations, construction of objects that have 2 or 3 dimensions

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20
Q

What are the components of Judgment in the MSE?

A
  • process of comparing and evaluating alternatives when deciding on a course of action
  • reflects values that may or may not be based on reality and social conventions or norms
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21
Q

What are the components of Insight in the MSE?

A
  • awareness that symptoms of disturbed behaviors are normal or abnormal
  • ability of pt to understand and acknowledge their illness or situation
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22
Q

What are the components of Suicidal/homicidal Risks in the MSE?

A
  • ask direct questions
  • depression is twice as common in women and is a frequent complaint of chronic medical illness
  • screen high-risk patients for early signs of depression that are often missed: low self-esteem, loss of pleasure in daily activities, sleep disorders, difficulty concentrating or making decisions
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23
Q

What are the levels of consciousness? (5)

A
  • alert: pt able to open eyes, look at you, respond fully and appropriately
  • lethargic: drowsy but can open eyes, look at examiner and respond; falls back to sleep easily
  • obtunded: opens eyes and looks at you; offers confused responses, has lack of interest in the environment
  • stuporous: wakens only with painful stimuli; verbal responses slow or absent; unresponsive unless stimuli is present
  • comatose: unarousable to any stimuli; GCS
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24
Q

What is decorticate posture?

A
  • upper extremities flexed at elbows and held closely to body
  • lower extremities internally rotated and extended
  • thought to occur when brain stem is not inhibited by motor function of cerebral cortex
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25
Q

What is decerebrate posture?

A
  • pts with extensive brain stem damage to pons and lesions that compress lower thalamus and midbrain
  • rigid extension
  • arms fully extended, forearms pronated, wrists/fingers flexed
  • jaw clenched, neck extended, back may be arched
  • feet plantar flexed
  • may occur spontaneously, intermittently, or in response to stimuli
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26
Q

What is aphasia?

A
  • disorder in producing/understanding speech
  • causes: lesions in dominant cerebral hemisphere (L)
  • Broca’s aphasia: (expressive) nonfluent, slow, articulation is impaired but meaningful (with nouns, transitive verbs, important adjs)
  • Wernicke’s: (receptive) fluent, rapid, articulation good but sentences lack meaning; words malformed/invented
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27
Q

What is dysarthria?

A
  • difficulty speaking due to abnormalities of oral and facial muscles that produce speech
  • words may be nasal, slurred, or indistinct
  • causes: motor lesions of the central or peripheral nervous system, parkinsonism, cerebellar disease
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28
Q

What are paraphasias?

A

words are malformed, wrong, or invented

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29
Q

How do you test for aphasia?

A
  • word comprehension: one-staged and two-staged commands
  • repetition: repeat phrase of one-syllable words
  • naming
  • reading comprehension
  • writing
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30
Q

What is circumstantiality?

A
  • speech characterized by indirection and delay in reaching the point due to unnecessary detail
  • components have meaningful connection
  • pts with obsessions
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31
Q

What is derailment?

A
  • shifting from subject to others that are unrelated/related only obliquely without realizing subjects have no connection
  • schizophrenia, manic episodes, psychosis
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32
Q

What is a flight of ideas?

A
  • continuous flow of accelerated speech
  • changing abruptly from topic to topic
  • plays on words, distracting stimuli, no progress to sensible conversation
  • manic episodes
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33
Q

What are neologisms?

A
  • invented/distorted words or words with new/highly idiosyncratic meanings
  • schizophrenia, psychotic disorders, aphasia
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34
Q

What is blocking?

A
  • interruption of speech midsentence/before completion of an idea
  • losing a thought
  • profound in schizophrenia
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35
Q

What is confabulation?

A
  • fabrication of facts/events in response to questions in order to fill in gaps in impaired memory
  • Korsakoff’s syndrome from alcoholism
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36
Q

What is perseveration?

A
  • repetition of words/ideas

- schizophrenia/psychosis or traumatic injuries

37
Q

What is echolalia?

A
  • repeating words/phrases of someone else

- manic episodes and schizophrenia

38
Q

What is clanging?

A
  • choosing word based on sound rather than meaning
  • usually rhyming/punning
  • schizophrenia and manic episodes
39
Q

How can you assess Thought Content?

A
  • assess during interview
  • follow leads suggested by patient instead of asking stereotyped list of questions
  • abnormalities include: compulsions, obsessions, phobias, anxieties, feelings of unreality, feelings of depersonalization, delusion (of persecution, grandeur, jealousy, reference, being controlled, somatic, systematized)
40
Q

How can you assess Mental Function?

A
  • orientation (name, date, place)
  • attention
  • digit spans (serial 7s or spell world backwards)
  • remote memory
  • recent memory
  • new learning ability (repeat 3 words)
  • higher cognitive functions including vocabulary, calculating ability, abstract thinking (proverb), and constructional ability (draw a clock)
41
Q

How can you assess Judgment?

A
  • ability to evaluate situation and form appropriate response
  • assess by asking patient to propose solution to a current problem (how will you get to your follow-up appointment) and/or ask to propose solution to a hypothetical problem
42
Q

How do you test the Olfactory Nerve (CN I)?

A
  • test each nostril with a familiar, non-irritating odor
43
Q

How do you test the Optic Nerve (CN II)?

A
  • test visual acuity (confrontation)
44
Q

How do you test the Optic Nerve (CN II) and Oculomotor Nerve (CN III)?

A
  • inspect size and shape of pupils
  • test pupillary reactions to light
  • check near response
45
Q

How do you test the Oculomotor Nerve (CN III), the Trochlear Nerve (CN IV), and the Abducens Nerve (VI)?

A
  • test EOM in the six cardinal directions of gaze

- look for nystagmus, diplopia, and ptosis

46
Q

How do you test the Trigeminal Nerve (CN V)?

A
  • motor: palpate temporal and masseter muscles (ask patient to clench their teeth, ask pt to move jaw side to side)
  • sensory: test for pain sensation and light touch in each of the 3 areas (ophthalmic, maxillary, and mandibular); corneal reflex
47
Q

How do you test the Facial Nerve (CN VII)?

A
  • motor limb of corneal reflex

- ask patient to raise both eyebrows,frown, close eyes tightly, smile, show both upper and lower teeth, puff out cheeks

48
Q

How do you assess motor strength of the elbow?

A
  • flexion (C5,6 - biceps)

- extensions (C6-8 - triceps)

49
Q

How do you assess motor strength of the wrist?

A
  • extension (C6-8, radial nerve)
50
Q

How do you assess motor strength of the hand?

A
  • test grip of hand (C7-8, T1)
51
Q

How do you assess motor strength of the hip?

A
  • adduction (L2-4, iliopsoas)
  • abduction (L4-5, S1, gluteus medius and minimus)
  • extension (S1 - gluteus maximus)
52
Q

How do you assess motor strength of knees?

A
  • flexion (L4-5, S1-2, hamstrings)
53
Q

How do you assess motor strength of the foots?

A
  • dorsiflexion (L4-5, tibialis anterior)

- plantar flexion (S1-gastrocnemius, soleus)

54
Q

How do you assess cerebellar function?

A
  • observe patient’s performance in rapid alternating movements (finger tapping)
  • point-to-point movements (finger to nose test, heel to chin test)
  • gait and other related body movements (walk normally, heel to toe, on toes, on heels, hop in place, shallow knee bed, rise from sitting position)
  • standing in specified ways (Romberg test, pronator drift)
55
Q

How you assess sensory pathway integrity?

A
  • test pain and temp (spinothalamic tracts), position and vibration (posterior/dorsal column), light touch (both), and discriminative sensations
  • compare symmetric areas
  • compare distal with proximal areas
  • vary place of your testing
  • if you detect sensory loss/hypersensitivity, map out its boundaries
56
Q

What are the deep tendon reflexes?

A
  • ankle (S1)
  • knee (L2, 3, 4)
  • brachioradialis/supinator (C5, 6)
  • biceps (C5, 6)
  • triceps (C6, 7)
57
Q

What are the cutaneous stimulation reflexes?

A
  • abdominal: upper (T8, 9, 10) and lower (T10, 11, 12)
  • plantar responses (L5, S1)
  • anal (S2, 3, 4)
58
Q

How do you assess for discriminative sensations?

A
  • stereognosis
  • graphesthesia
  • two point discrimination
  • point localization
  • extinction
59
Q

How do you assess for stereognosis?

A
  • place familiar object in the patient’s hands while eyes closed
  • ask them to identify it
60
Q

How do you assess for graphestheisa?

A
  • use pen to draw a # on patient’s palm
  • ask them to ID the number
  • bilaterally
61
Q

How do you assess for two point discrimination?

A
  • use 2 ends of an open paper clip to finger pads in two places
  • then touch 1 place at a time and ask patient if they feel 1 or 2 points each time
62
Q

How do you assess point localization?

A
  • touch point on patient’s skin; ask pt to open eyes and point to place touched
63
Q

How do you assess extinction?

A
  • stimulate corresponding areas on both sides of the body simultaneously
  • ask where pts feels your touch
64
Q

What are the levels for Grading Muscle Strength (MRC Scale)?

A
  • 0: no muscular contraction detected
  • 1: barely detectable flicker or trace of contraction
  • 2: active movement of body part with gravity eliminated
  • 3: active movement against gravity
  • 4: active movement against gravity and some resistance
  • 5: active movement against full resistance without evident fatigue; normal muscle strength
65
Q

What dysfunction is seen in Lower Motor Neuron damage?

A
  • IPSILATERAL weakness and paralysis to the limbs

- muscle tone and reflexes are decreased or absent

66
Q

What dysfunction is seen in Upper Motor Neuron Damage?

A
  • above crossover in medulla, impairment develops on CONTRALATERAL side
  • below crossover, impairment is IPSILATERAL side
  • affected limb becomes weak or paralyzed, muscle tone is increased and deep tendon reflexes are exaggerated
67
Q

What is the Babinski response?

A
  • when testing plantar response (L5, S1), the big toe dorsiflexes (CNS lesion in corticospinal tract)
68
Q

What is Clonus?

A
  • test when reflexes seem hyperactive

- dorsiflex ankle and look to see if it maintains this position or if there are rhythmic oscillations (CNS disease)

69
Q

What is Kernig’s sign?

A
  • flex pt’s leg at both hip and knee and straighten knee

- positive sign indicated by pain and increased resistance to extending the knee

70
Q

What is the Brudzinski Sign?

A
  • as you flex neck (pt is passive), hips and knees also move (in pain)
71
Q

What is the Doll’s Eye Response?

A
  • hold patient’s upper eyelids open, turn head quickly
  • eyes should turn toward opposite side otherwise the patient does not have an intact brainstem (used to test comatose patients)
72
Q

What is the Romberg Sign?

A
  • pt stands with feet together and closes eyes

- positive sign: swaying (dorsal column disease, cerebellar ataxia)

73
Q

What is Pronator Drift?

A
  • stand with arms straight forward, palms up, eyes closed

- look for drifting of either forearm (corticospinal tract lesion)

74
Q

What is the Straight Leg Raise?

A
  • raise pt’s relaxed and straightened leg
  • if there is a painful radiculopathy associated with muscle weakness and dermatomal sensory loss can indicate sciatic or herniated disc
75
Q

What is aphonia?

A
  • loss of voice that accompanies disease affecting larynx or its nerve supply
  • causes: laryngitis, laryngeal tumors, unilateral vocal cord paralysis (CN X)
76
Q

What are the types of seizure disorders (3)?

A
  • partial seizures
  • generalized seizures
  • pseudoseizures
77
Q

What are the clinical manifestations of Partial Seizures?

A
  • jacksonian or other motor: tonic than clonic movements that may spread
  • ANS symptoms (nausea, pallor, flushing, lightheadedness)
  • sensory/psychiatric phenomena: numbness, tingling, auditory/olfactory hallucinations, anxiety or fear
78
Q

What is the postictal state of Partial Seizures?

A

normal consciousness in all

79
Q

What are the clinical manifestations of Generalized Seizures?

A
  • tonic-clonic (grand mal): loses consciousness suddenly, body stiffens, breathing stop, cyanosis, clonic phase follows, breathing resumes with excessive salivation
  • absence: sudden brief lapse of consciousness with momentary blinking, staring, movements of lips/hands, no falling
  • myoclonic: sudden, brief, rapid jerks of trunk or limbs
  • myoclonic atonic: sudden loss of consciousness with falling but no movements, injury may occur
80
Q

What is the postictal state of Generalized Seizures?

A
  • tonic-clonic: confusion, drowsiness, fatigue, headache, muscular aching, sometimes temporary persistance of bilateral neurologic deficits (hyperactive reflexes, Babinski responses, amnesia for seizure)
  • absense: no aura recalled
  • myoclonic: variable
  • myoclonic atonic: prompt return to normal or brief period of confusion
81
Q

What are Pseudoseizures?

A
  • clinical manifestations: movements may have personally symbolic significance, do not follow neuroanatomic pattern, injury uncommon
  • postictal state: variable
82
Q

What are the involuntary movements that we need to know? (6)

A
  • tremors
  • oral-facial dyskinesias
  • tics
  • athetosis
  • dystonia
  • chorea
83
Q

What are the types of tremors? (3)

A
  • resting: slow, fine, pill-rolling (Parkinson’s)
  • postural: while maintaining a posture (hyperthyroidism, anxiety, fatigue, or can be benign)
  • intention: absent at rest, appear with movement (cerebellar disorders, MS)
84
Q

What are oral-facial dyskinesias?

A
  • rhythmic, repetitive, bizarre movements of face, mouth, jaw, and tongue
  • grimacing, pursing of lips, protrusion of tongue, opening and closing of mouth, deviation of jaw
  • causes: long term psychotropic drugs, standing psychoses, elderly and edentulous persons
85
Q

What are Tics?

A
  • brief, repetitive, stereotyped, coordinated movements at irregular intervals
  • causes: Tourette’s, drugs (phenothiazines and amphetamines)
86
Q

What is Athetosis?

A
  • slower, more twisting and writhing than choreiform movements with larger amplitude
  • usually of face and distal extremities
  • causes: cerebral palsy
87
Q

What is Dystonia?

A
  • similar to athetoid movements but often involve larger portions of body (including trunk)
  • causes: drugs (phenothiazines), primary torsion dystonia
88
Q

What is Chorea?

A
  • brief, rapid, jerky, irregular, unpredictable movements that occur at rest or interrupt normal coordinated movements
  • seldom repeat themselves
  • causes: Sydenham’s chorea, Huntington’s disease

Clinical Assessment (5 decks)

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