neuro comps 1 Flashcards
what are the two components of mental status: basic
level of consciousness
and
orientation
level of consciousness - how do we test
able to follow commands such
as
1) eye movements/responses
2) motor responses
3) verbal responses
level of consciousness - outcome measure used
glasgow coma scale
orientation - what to ask
Ask for patient’s
1) full name, age, birthplace
2) where they are now, type of
place, city they are in
3) the date, day of week, what
time it is, season
note the response
what is the common outcome measure for orientation
MOCA
what is the purpose of the MOCA
rapid screening instrument for mild cognitive dysfunction.
mental status: complex includes
language
memory
visuospatial functions
lang is assessing what types
receptive and
expressive language
receptive lang
the paitient is asked to follow commands to see if they understand what they have just read or heard
expressive lang
pt asked to perform at task that requires spontaneous speech of writing, naming an object, or repeating phrases,
looking at the fluency and correct use of words
what outcome measure is used to look at lang
MOCA
receptive aphasia
world salad
Expressive aphasia
a condition where a person may understand speech, but they have difficulty speaking fluently themselves
Global aphasia
People with global aphasia may only say a few words, such as “no” or “hey” or “what”, or they may speak in “stereotypies”. Stereotypies are words or phrases that are said over and over with different intonation. Examples may be “ding da ding”, “I love you” or “something wonderful”.
how do we assess memory - immediate recall (STM)
repeat these three words
temporal lobe
how do we assess memory - LTM
spell WORLD backwards
count back from 100’s using 7
frontal lobe
what outcome measure do we use for memory
MoCA
visuospatial function - test
bisect a line
what causes visuospatial dysfunction
damage to the right (parietal
lobe) hemisphere
what is Hemineglect
(unilateral)
inattention to one side that is
not due to a primary sensory
or motor impairment
what are we looking at with meta cognition
executive functioning
self awareness
what is taken over by meta cognition
-Inability to divide attention
-Inability to generalize
-Decreased safety awareness
and judgment
-Poor insight to condition
-Problem-solving deficits
-Impaired executive function:
- inability to:
-prioritize or select a behavior
that is appropriate to the
situation. - inhibit inappropriate behaviors
- to maintain focus to a task
despite distractions
I- Olfactory
Each nostril separately
Have the patient report if they can smell a non-
noxious odorants
Anosmia-
loss of the sense
of smell
II-Optic - 4 tests
Visual acuity
visual fields
pupillary light reflex
accommodation (convergence)
Visual acuity
ability to discern letters or numbers at a given distance according to a fixed standard.
visual fields
Normal VF for each eye extends out from the
patient in all directions
field cut
specific regions where patient lost ability to see
pupillary light reflex
bring penlight from the side of the patient’s head
into the eye
both eyes should constrict *direct light reflex and
indirect (consensual) reflex
what is accommodation (convergence)
Comes into play when there is a need to view an object at near distances without double vision
Automatic response to adjust the position of the eye so that the image falls on the fovea of both eyes and to adjust the lens to maintain sharp focus at near distance
accommodation (convergence)
Tested by asking the patient to focus both eyes on
a target ( ~ 14-point font size)
Patient focuses on the target at arm’s length and slowly brings it to the tip of their nose
Patient is instructed to stop moving the target when they see 2 distinct images or when the examiner
observes outward deviation of one eye.
action of III
up, down, up and in
action of Trochlear Nerve
down and out
action of Abducens Nerve (CN VI)
moves eye laterally, out
Cranial Nerve III
Oculomotor extras
involved with
pupillary light reflex, near point
convergence-NPC and elevation
of the eye lid
Oculomotor, tochlear, abducens
Conjugate movement - H test
what are Smooth Pursuits
ability to follow
an object across full range of
vertical and horizontal eye
movements
what are Saccades
are eye movements
used to rapidly refixate from
one object to another
what are Nystagmus
quick jumping eye movement
Saccade intrusion
eyes jumping to track the object
Cranial Nerve V
Trigeminal - sensory component
Facial Sensation–face, head, cornea, mucosa of
nose, mouth, hard and soft palate, and tongue
Cranial Nerve V
Trigeminal - motor component
muscles of mastication
VII-Facial - motor
Show Teeth superior levator
Smile buccinatior
Eyes Closed Tight orbicularis, frontal belly
Elevating Eyebrows epicranius
Contract Platysma platysma
*Note efferent limb for the Corneal reflex
VII-facial - sensory
Taste Anterior 2/3 of the tongue
issues with facial nerve
bell’s palsy
Horizontal and Vertical VOR- VIII Vestibulocochlear
A target ( of 14 point font size) is held in front of the patient in
midline at a distance of ~3’)
Patient rotate head horizontally and maintains focus on the target
(stable) at a quick speed ( metronome set at 180 beats/minute).
Patient rotate head vertically and maintains focus on the target
(stable) at a quick speed ( metronome set at 180 beats/minute).
Glossopharyngeal does what
taste to posterior 1/3 of tongue
Dysphagia-
difficulty in swallowing
how to test gloss and vagus
Observe the movement of the uvula* and soft
palate with phonation and elicitation of the
pharyngeal reflex
Say AH
test Spinal
Accessory
Trapezius
SCM
Cranial Nerve XII
Hypoglossal
Motor to tongue
Sensory - light touch
Use cotton wisp
Apply gentle touch (don’t drag
the stimulus)
Eyes are closed and the patient
reports YES, every time he
perceives the stimulus
Sensory - pain and temp
testing the anterolateral spinothalamic
system
Use cold reflex hammer handle
Ask the patient if he perceives
the handle as cold
sensory - JPS is testing what
DCML system
testing JPS
Eyes closed (EC)
Hold the digit lightly by the
sides while moving the patient’s
finger or toes up or down.
Ask the patient to report after
each movement the direction of
the movement
Kinesthesia testing
Patient describes the direction
of limb movement while in
motion
Vibration
Vibration Apply stimulus (128 Hz
vibration fork) over the distal
phalanx of the index finger or
great toe
Ask the patient to report
whether they feel the vibration
sense and then to report when it
stops.
testing the DCML
what is Combined Cortical
sensation
EX: Stereognosis
test for lesions of the sensory
cortex
how to testCombined Cortical
sensation
Eyes closed
Place an item such as a coin,
key, paper clip in the hand of
the patient.
The patient is to manipulate the
stimulus and identify the item
Muscle mass-
Inspect bulk, girth
Passive movement
Assess soft tissue limitations
and tone*
Goniometry
*Tone
Ask to patient to relax. Move
each limb at several joints to get
a feel for any resistance or
stiffness that may be present
what is Spasticity
a condition in which there is an abnormal increase in muscle tone or stiffness of muscle, which might interfere with movement
as
a “catch” or a very stiff
limb that cannot be moved
passively
Spasticity is a
manifestation of what
an UMN issue
Rigidity
“lead pipe or
cogwheel” resistance to
passive movement and is
seen with disorders such as
Parkinson’s disease
hypotonia is seen with what issue
LMN issue
tests for coordination
Finger to nose
Heel to shin
Rapid alternating
Movement:
Supination/pronation
Toe/finger tapping
what is Dysmetria-
inability to
judge distance or range of
movement
test for Dysmetria-
finger to nose
shin and heel
hypometria
underreaching an object during voluntary motor activity
hypermetria
overreaching an object during voluntary motor activity
Dysdiadochokinesis
difficulty with reversal of
movements
Dysdiadochokinesis test
Rapid alternating
Movement:
Supination/pronation
Toe/finger tapping
Ataxia-
uncoordinated
movement
Ataxia- test
watch someone move
Static Standing
balance two tests
Sensory Organization (orientation)/ CNS
Integration
and
Reactive postural
control
Sensory Organization (orientation)/ CNS Integration
Ask the patient to maintain
standing with EO/ EC
on floor
and
EO/EC on foam
looking at the ablity to use sensory input
Reactive postural
control
Ask the patient to maintain a
posture or steady oneself with
perturbation
how to assess Dynamic standing
Balance
Voluntary (selfgenerated) postural
control
Voluntary (selfgenerated) postural
control
Ask the patient to while
standing to perform a voluntary
activity