neuro

Question 1

vertebrae

Answer 1

7 cervical
12 thoracic
5 lumbar
5 fused sacral
4 fused coccygeal

Question 2

how many spinal nerves

Answer 2

31 pairs

Question 3

infancy differences

Answer 3

major brain growth in first year of life

reflexes and primitive reflexes

Question 4

older adult differences

Answer 4

decreased brain size
cerebral neurons
sensory functions - decreased smell, taste, vision
rate of impulse conduction (slower responses to stimuli, unsteady gait, decreased ROM)
polypharmacy
risk for falls

Question 5

important vaccine for older adults

Answer 5

herpes zoster - can affect nervous system

Question 6

romberg test

Answer 6

have pt stand and close eyes

observe ability to maintain upward posture

more than minimal swaying is positive

Question 7

superficial reflexes

Answer 7

plantar and abdominal

Question 8

deep tendon reflexes

Answer 8

biceps
brachioradialis
triceps
patellar
achilles

Question 9

primitive reflexes of infancy

Answer 9

sucking
rooting
blinking at bright lights
moro reflex (startle) diminishes by 3-4 months, disappears by 6 months
stepping reflex
palmar grasp reflex (strongest at ages 1-2 months, gone by 3 months)
plantar reflex: strong up to 8 months

Question 10

sensory testing

Answer 10

light touch - cotton ball
superficial pain - sharp/dull
temperature
vibration - w tuning fork
proprioception - where am I moving your toe?
hearing

Question 11

reflex grading

Answer 11

4+ very brisk, hyperactive with clonus - abnormal
3+ brisker than average
2+ normal
1+ somewhat diminished
0 no response - abormal

Question 12

monofilament exam

Answer 12

with pt eyes closed, place the monofilament on several sites of the plantar/dorsal foot. testing is positive if the patient cannot feel the monofilament

Question 13

pronator drift test

Answer 13

ask pt to stand for 20-30 seconds with eyes closed and both arms straight forward with palms up. instruct to keep arms out and eyes shut

tap arms briskly downward and they should return smoothly to the horizontal position. if the arms drift sideward or upward, the test is positive

Question 14

coordination exam

Answer 14

rapid alternative movements

finger to nose, heel to shin tests

Question 15

stereognosis test

Answer 15

are they able to recognize objects

put coin in palm of hand and see if they can identify

Question 16

two-point discrimination

Answer 16

take 2 cotton swab/paper clip, touch in different spots.

ask if I am touching with one or 2, is it on the right or left?

Question 17

graphesthesia

Answer 17

write something familiar in hand and see if they can identify

Question 18

Brudzinski’s sign

Answer 18

nuchal rigidity (spinal injury/meningitis)

flex the pt neck forward. test is positive if the patient beds their hips and knees in response

Question 19

Kernig’s sign

Answer 19

nuchal rigidity (spinal injury/meningitis)

flex the patient’s leg at the hip and nee and slowly extend the leg and straigten the knee. if pain with knee extension, test is positive

Question 20

neuro red flags

Answer 20

head trauma
new onset weakness, sensory loss
new loss of bowel/bladder function
new headache
confusion
petichial rash

peds
not babbling by 4 months
loss of developmental milestones
irritability, not consolable
lethargy
bulging fontanelle
hypotonia