Neuro Flashcards
1
Q
What do the 12 cranial nerves do?
A
Mediate complex motor and sensory functions
2
Q
Cranial nerves I and II
A
Fiber tracks emerging from the brain.
3
Q
Cranial nerve III-VII
A
Arise from the diencephalon and brain stem.
4
Q
Cranial nerve I
A
Olfactory: sense of smell
5
Q
Cranial nerve II
A
Optic: vision
6
Q
Cranial nerve III
A
Oculomotor: pupillary constriction, opening of the eye lid and most extra ocular movements.
7
Q
Cranial nerve IV
A
Trochlear: downward and internal rotation of the eye
8
Q
Cranial nerve V: motor
A
Trigeminal: motor: temporal and masseter muscles. lateral pterygoids (lateral jaw movements
9
Q
Cranial nerve V: sensory
A
facial: ophthalmic, maxillary, mandibular
10
Q
Cranial nerve VI:
A
abducens: lateral deviation of the eye
11
Q
Cranial nerve VII: motor
A
Facial: facial movements and expression, closing the eye, closing the mouth
12
Q
Cranial nerve VII: sensory
A
facial: taste for salty, sweet, sour, bitter on anterior 2/3 of tongue and sensation in the ear
13
Q
Cranial nerve VIII
A
acoustic: hearing (cochlear) and balance (vestibular)
14
Q
Cranial nerve IX: motor
A
glossopharyngeal: pharynx
15
Q
Cranial nerve IX: sensory
A
glossopharyngeal: posterior portions of the eardrum and ear canal, pharynx, posterior tongue and taste
16
Q
Cranial nerve X
A
vagus: palate, pharynx, larynx
17
Q
Cranial nerve XI
A
spinal accessory: sternocleidomastoid and upper portion of trapezius
18
Q
Cranial nerve XII
A
hypoglossal: tongue
19
Q
Common symptoms to assess in health history
A
headache
dizziness
numbness
weakness
loss of sensation
syncope
seizures
tremors
involuntary movements
appearance
behavior
mood
memory
speech
orientation
20
Q
How to assess cranial nerve I
A
close each nostril and have them state what they are smelling
21
Q
How to assess cranial nerve II
A
visual acuity (reading)
visual fields (fingers to peripheral)
inspect the optic fungi (arteries/veins 1/3) any vascular narrowing, papillaredema, pallor (optic atrophy), cup enlargement (glaucoma)
22
Q
How to assess cranial nerves III, IV, VI
A
- occular movements:
6 cardinal directions - cover/uncover
convergence (look at finger as you bring it close to nose - nystagmus (focus on distant object)
- ptosis: dropping of upper lids
- palpate temporal and masseter muscles: ask them to clinch teeth, move jaw side to side
- pain: sharp vs dull touching points while eyes closed
- light touch with cotton wisp
- corneal reflex: remove contacts, with cotton wisp, lightly touch cornea
23
Q
6 cardinal directions of gaze
A
conjugate movements, any diplopia
worse on one side?
convergence
nystagmus
24
Q
Diplopia
A
double vision
25
Nystagmus
involuntary jerking of the eyes: horizontal, vertical, rotary, mixed; direction
26
What could be a cause for ptosis
palsy of cranial nerve III and myasthenia gravis
27
What is myastenia gravis?
long-term neuromuscular junction disease that leads to varying degrees of skeletal muscle weakness: most commonly affecting the eyes, face, and swallowing. Can cause double vision, dropping eyelids, trouble talking, trouble walking. Those affected often have a large Thymus.
28
How to assess cranial nerve VII
1. inspect patients face at rest and during conversation
2. show teeth
3. close eyes very tightly
4. wrinkle forehead
5. puff out cheeks
6. tense neck muscles
not symmetry and any involuntary movements.
29
How to assess cranial nerve VIII
1. whispered voice test
2. webber test for
3. Renee test
30
What is the webber test?
screening test for hearing using tuning fork to detect unilateral conductive hearing loss and unilateral sensorineural loss
place tuning fork in middle of forehead, is it the same in both ears
31
What is the Rinne test?
vibrating tuning fork placed on the mastoid process behind each ear until they no longer can hear it, then place it in front of the ear
A normal or positive result if the patient can still hear the tuning fork when moved in front of the ear.
32
How to assess cranial nerve IX and X?
1. Say "ah" for yawn observe the soft palate in pharynx.
it should rise promptly, symmetrically, and uvula should remain midline
2. gag reflex
33
How to assess the cranial nerve XI?
1. from behind ask the patient to shrug his shoulders upward against your hands
evaluate strength and contraction of trapezius muscles.
2. from in front of the patient "turn head to each side against your hand"
observe contraction of opposite sternomastoid muscle.
34
How to assess cranial nerve XII?
1. listen to articulation of words.
2. inspect tongue for atrophy
3. stick out tongue and then move it side to side: symmetry or deviation.
35
How to assess the motor system in regards to body position?
body position during movement and at rest: any involuntary movements, symmetric
36
Atrophy in what muscle can increase a risk for falls in elderly patients?
Quadriceps
37
Aging causes atrophy of what muscles?
Hands, shoulders, thighs.
38
Main elements of assessing the motor system?
Body position
muscle bulk
muscle tone
muscle strength
coordination
39
How to assess muscle bulk?
size, contour, flat, concave, atrophy
40
How to assess muscle tone?
resistance to passive stretch. patient resists and the examiner overcomes the patients resistance
1. ask patient to relax
2. flex and extend shoulder, fingers, wrist, elbow
3. should ROM
4. hand on thigh, grasp foot and flex and extend knee and ankle
41
How to assess muscle strength in upper body?
0-5 against full resistance
1. bicep/tricep: pull against hand and then push against hand
2. wrist flexion and extension
3. grip: squeeze finers
4. palm down spread fingers apart and then force fingers together
5. thumb to pinky while you resist
42
How to assess carpal tunnel?
thumb to pinky while examiner pulls them apart.
43
How to assess muscle strength in lower body?
Patient lying supine
1. flexion of hip: hand on their thigh, patient raise leg against your hand
2. extension of hip: hand on posterior thigh, lower leg with your resistance
3. hip abduction: hand on outside of knee; spread legs with resistance
3. hip adduction: hand on inside of knees, bring legs together with resistance.
5. knee: flex and extend
6. ankle: flex and extend
44
What systems assess coordination?
motor
cerebellar
vestibular
sensory
45
Assessing coordination.
1. rapid alternation movements: strike hand while turning it over and over
2. tap fingers to thumb
3. tap foot on your hand
point to point movements
4. touch your finger then their nose
5. finger held stead have them touch finger then raise their arm overhead
6. repeat with eyes closed
heal to shin movements of legs
7. one heal on opposite knee and slide it down leg; repeat with eyes closed
gait
8. walk across the room: with ease and balanced, arms swing smoothly
9. heal to toe in a straight line
10 walk on toes to test plantar flexion and on heels to test dorsiflexion at ankles.
11. hop in place on one leg
12. shallow knee bend on each leg
13. Romberg test
14. pronator drift test
15. both arms up, eyes closed while you tap arms briskly downward
46
What is the Romberg test?
position sense; stand with feet together and eyes open, repeat with eyes closed
47
What is pronator drift test?
hold arms forward in parallel with palms up and eyes closed
48
What is being tested with the heal to toe assessment?
cerebellar function, position sense and balance.
49
How do you test plantar flexion?
walk on their toes
50
How do you test dorsiflexion strength?
walk on their heels
51
What is being tested with the hop on one foot assessment?
Intact motor system and normal cerebellum function, good position sense
52
Objectives in assessing the sensory system and reflexes?
pain
temperature
light touch
vibration sensations
position sense
discriminative sensation
elicit deep tendon reflexes
Babinski sign
53
Sensory impulses participate in?
reflex activity
conscious sensation
calibrate body position
regulate autonomic functions such as BP, HR, RR
54
Sensory pathways
complex system of sensory receptors relay impulses from skin, mucous membranes, muscles, tendons, viscera
and travel through peripheral projections into the posterior root ganglia and eventually directed to the spinal cord and into the brain.
55
When testing sensation...
1. symmetric pattern on both sides of the body
2. comparison helps you identify where the sensory losses occur
3. identify the distribution of sensory abnormalities and the kinds of sensations affected you can infer the location of the lesion
56
Dermatomes
help to localize neurologic lesions; skin bands innervated by the sensory root of a single spinal nerve.
57
Dermatome T4
nipple line
58
Dermatome T10
umbilicus
59
Dermatome L5
ankle and foot
60
Dermatome C3
front and back of neck
61
Dermatome L1
inguinal
62
Dermatome L4
knee
63
Dermatome L5
anterior ankle and foot
64
Dermatome S5
perianal
65
Assessing the sensory system
1. pain sensation in both arms, legs and trunk; sharp stick and dull object, close eyes; and touch areas
2. temperature testing when pain sensation is abnormal
3. light touch with cotton wisp
4. vibration sensation with tuning fork (extremity and trunk)
5. proprioception (position) sensory: hold big toe and ask patient to close eyes and identify the direction of motion: again with middle finger; again with wrist
6. stereognosis
7. graphesthesia
8. two point discrimination
9. point localization
10. extinction
66
What is impaired in alcoholic peripheral neuropathy?
vibratory sense
67
What is steriognosis
ability to identify an object by feeling it
68
What is graphesthesia
number identification; draw a number on the palm
69
What is two point discrimination?
using 2 ends of pins repeatedly touch the finger pad with two points at the same time and at times with one;
ask the patient to identify if it is 1 or 2 points
70
What is point localization?
keep eyes closed and touch a place on skin and have them point to the where the touch is. this helps assess sensory loss on truck and legs.
71
What is double extinction?
use your fingertips to provide stimulus in one side or both sides simultaneously. patient should be able to identify both
72
What are deep tendon reflexes?
involuntary monosynaptic cord reflexes arising from the stimulation of partially stretched muscle fibers. this sudden stretching sends impulses along afferent sensory nerve fibers to synapses in the spinal cord. then efferent nerve fibers carry the impulses back to the muscle fibers, causing them to contract. interruption of theses monosynaptic arcs anywhere along their paths will cause loss of reflex.
73
Ankle reflex relates to which spinal segment?
S1 and L5
74
Knee reflex relates to which spinal segment?
L2,3,4
75
Brachioradialis reflex relates to which spinal segment?
C5,6
76
Bicep reflex relates to which spinal segment?
C5, 6
77
Tricep reflex relates to which spinal segment?
C6, 7
78
Assessing deep tendon reflexes
1. grading 0-4+ (2+ is normal)
2. biceps
3. triceps
4. bracioradialis
5. knee
6. ankle
7. ankle clonus
8. cutaneous stimulation
9. abdominal
10. plantar (down of big toe) vs Babinski
11. brudzinski sign
12. Kernig's sign
13. straight leg raising
79
Normal response to cutaneous stimulation reflex
contraction of abdominal muscles and sometimes deviation of the umbilicus toward the stimulus
80
Babinski sign
Plantar response assessment; pathological response which manifests itself in dorsiflexion (up going) of the big toe in conduction with fanning the other toes. a positive test indicates a corticospinal tract lesion seen in stroke.
81
Brudzinski's sign
used if you suspect meningeal inflammation, test for meningeal signs.
patient lying down, hands behind their head, flex the neck forward until the chin touches chest. should be no resistance or pain, watch hips and knees, normally they should remain relaxed and motionless
a positive result would show hip and knee flexion with this maneuver
82
Kernig sign
flex one of the patients legs at hip and knee and then straighten the knee. Normally there is some discomfort behind the knee with extension
pain and resistance to knee extension is a positive kernig sign.
83
Sciatica
low back pain with nerve pain that radiates down the leg
84
What does the straight leg raise test for
lumbosacral radiculopathy: which causes sciatica pain
raise the supine patients relaxed and straight leg, flexing the leg at the hip; dorsiflex the foot and an angle of 60 degrees
radicular pain into the leg is a positive test
