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Health Assessment > Neuro (Exam 3) > Flashcards

Neuro (Exam 3) Flashcards

1
Q

Central Nervous System (CNS)

A

brain and spinal cord

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2
Q

Peripheral Nervous System (PNS)

A

12 cranial nerves
31 pairs of spinal nerves
Autonomic Nervous System (ANS)
Somatic Nervous System (SNS)

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3
Q

How many cerebral hemispheres are there?

A

2

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4
Q

Frontal Lobe

A

personality, behavior, emotions, intellectual functions, skilled movement

Broca’s area!!

Primary motor cortex

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5
Q

Broca’s area

A

left speech-motor

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6
Q

Parietal Lobe

A

processing sensory data
postcentral gyrus

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7
Q

Occipital Lobe

A

vision and interpretation of visual data

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8
Q

Temporal Lobe

A

perception and interpretation of sounds and determination of source of sounds; smell

wernickes area!!

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9
Q

Wernickes area

A

left language-comprehension

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10
Q

Basal Ganglia

A

large bands of gray matter that form the subcortical associated motor system

help initiate and coordinate automatic movement of the body

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11
Q

Thalamus

A

brain relay station

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12
Q

Hypothalamus

A

maintaining homeostasis

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13
Q

Cerebellum

A

motor system which controls coordination of movement, equilibrium, posture, position sense of muscles and joints and body

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14
Q

Brainstem

A

midbrain, pons, and medulla

regulates heart rate, breathing, and swallowing

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15
Q

Crossover/Crossed Representation (CNS Pathways)

A

right cerebrum connects to left side of body and vice versa; left and right cerebral cortex

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16
Q

Left cerebral cortex receives…

A

sensory data from and controls the right side motor function

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17
Q

Right cerebral cortex receives…

A

sensory data from, and controls left side motor function

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18
Q

Descending Tracts (Motor)

A

lateral corticospinal tract (main voluntary motor, upper extremity motor pathways, are more medial)
ventral corticospinal tract (voluntary motor)

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19
Q

Ascending Tracts (Sensory)

A

dorsal columns (DC) (deep touch, vibratory, proprioception)
lateral spinothalamic tract (LST) (pain and temp)
ventral spinothalamic tract (VST) (light touch)

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20
Q

Spinal Nerves

A

mixed nerves; carry sensory (afferent) and motor (efferent) fibers

8 cervical
12 thoracic
5 lumbar
5 sacral
1 coccygeal

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21
Q

PNS carries sensory messages…

A

TO CNS FROM sensory receptors

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22
Q

PNS carries motor messages…

A

FROM CNS TO muscles and glands

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23
Q

PNS sends automatic messages…

A

TO internal organs and blood vessels

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24
Q

Somatic system (PNS)

A

carry motor and sensory info (skin, sensory organs, skeletal muscles)
voluntary muscle movements

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25
Q

Autonomic Nervous System (PNS)

A

involuntary movements
innervates smooth muscle

SYMPATHETIC (fight or flight)
PARASYMPATHETIC (rest and digest)

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26
Q

Deep Tendon Reflexes

A

LE: patellar, achilles, hamstring

UE: triceps, biceps, brachioradialis

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27
Q

Superficial Reflexes

A

corneal
abdominal
cremasteric

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28
Q

Visceral Reflexes

A

pupillary response to light
PERRLA

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29
Q

Pathologic Reflexes

A

Plantar reflex (Babinski sign, positive to 24 months)

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30
Q

Dermatome

A

cutaneous portion of spinal nerves

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31
Q

Subjective Data

A

HA
head injury
dizziness/vertigo/syncope
any seizures
tremors
weakness
problems with gait coordination
numbness
problems speaking or swallowing
PCC
environmental/occupational hazards

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32
Q

Subjective Data: Past Medical History

A

meningitis
deformities
cardiovascular, circulatory problems, HTN, aneurysm, CVA/stroke
neurological disorder, brain surgery, residual effects

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33
Q

Subjective Data: Family History

A

neurological disorders
Parkinson’s
Alzheimer’s
dementia
MS
ALS
Stroke/CVA/TIA

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34
Q

Subjective Data: Social History

A

environmental and occupational hazards
ability to care for themselves
sleeping and eating patterns
ETOH
street drugs

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35
Q

Subjective Data: History of Older Adults

A

gait
ADLs (feeding, continence, transferring, toileting, dressing, bathing)
instrumental ADLs (iADLs)
hearing loss
development of tremor
fecal/urinary incontinence

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36
Q

iADLs Examples

A

using phone
shopping
preparing food
housekeeping
doing laundry
using transportation
handling meds
handlings finances

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37
Q

Objective Data: Mental Health Assessment

A

judgement
abstraction
memory-cognitive
LOC
completed through entire exam

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38
Q

Lethargy

A

drowsy but opens eyes, responds to Qs then falls asleep

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39
Q

Obtunded

A

opens eyes, responds slowly and is somewhat confused

40
Q

Stuporous

A

arouses from sleep after painful stimuli, verbal responses are slow/absent, lapses into unresponsive state after stimuli

41
Q

Comatose

A

remains unarousable with eyes closed even with painful stimuli

42
Q

Glascow Come Scale

A

objective assessment that defines LOC; best response is 15, comatose client is 8 or less, totally unresponsive client is 3

43
Q

CN Mneumonic for names

A

Only
One
Of
The
Two
Athletes
Felt
Very
Good
Victorious
And
Healthy

44
Q

CN Mneumonic for nerve types

A

Some
Say
Marry
Money
But
My
Brother
Says
Big
Brains
Matter
Most

S=sensory, B=Mixed, M=Motor

45
Q

CN 1 Olfactory

A

not routinely tested

NORMAL: patient identifies common odors accurately

TEST IF: reports loss of smell, head trauma, suspected intracranial lesion

46
Q

CN II Optic

A

tested in 5 ways
visual acuity (snellen chart for distance, rosenbaum chart for near vision)
color (ishihara plates for red-green c.b that assesses color vision)
visual fields (peripheral vision)
pupillary reflexes (direct and consensual response, PERRL)
fundoscopy to determine color, size, and shape of optic disc (evaluate optic disc and cup)

47
Q

Testing Peripheral Vision

A

ask patient to look directly at you
wiggle one finger in each of the 4 quadrants
ask patient to say “now” as wiggling finger is first seen

48
Q

PERRL vs PERRLA

A

test accommodation (CN II) vs test accommodation AND convergence (CN II and III)

49
Q

CN III, IV, VI (Oculomotor, Trochlear, Abducens)

A

cardinal fields of gaze tested together

conjugate movements of the eye
H-pattern vs star pattern
can perform convergence test if not performed with CN II
cover/uncover test

50
Q

CN V Trigeminal Motor Function

A

assess muscles of mastification by palpating temporal and masseter muscles as a person clenches his or her teeth

masseter, temporalis, buccinator, zygomaticus

51
Q

CN V Trigeminal Sensory Function

A

with a persons eyes closed, test light touch sensation by touching a cotton wisp (light touch) to designated areas on a persons face (forehead, cheeks, chin)

sharp vs dull

52
Q

CN V Trigeminal

A

assess corneal reflex if person has abnormal facial sensations or abnormalities of facial movement (blink response)

test all 3 divisions (ophthalmic, maxillary, mandibular)

53
Q

CN VII Facial

A

sensory: taste anterior 2/3 tongue
motor: innervates muscles of facial expression; tell patient let’s make some funny ahh/mad faces, have them raise eyebrows, have patient close eyes and don’t let nurse open them, puff out cheeks, smile!!

54
Q

CN VIII Vestibulocochlear (Acoustic)

A

innervates the hearing apparatus of the ear
auditory acuity (whisper test)
conductive vs sensorineural hearing
bone conduction vs air conduction (webber and rinne tests)

vestibular (balance)

55
Q

Auditory Acuity (Whisper Test)

A

stand 45° behind patient
have patient cover opposite ear
2-3 ft away, whisper 3 numbers or a word
ask patient to repeat

56
Q

Webber Test

A

512 Hz Tuning fork

tests for localization
normal=midline

57
Q

Rinne Test

A

512 Hz Tuning fork

tests for conduction

air>bone is normal
bone>air means conductive hearing loss

58
Q

CN IX Glossopharyngeal

A

tested with CN X

sensory supply to the soft palate
taste to posterior 1/3 of tongue

GAG REFLEX

59
Q

CN X Vagus

A

tested with CN IX

motor supply to pharynx
SAY AHHHHH (uvula and soft palate rise to midline)
no deviation of uvula

60
Q

CN XI Spinal Accessory

A

tests strength of sternocleidomastoid (SCM) and trapezius muscles

ask patient to turn head against resistance for SCM
ask patient to shrug shoulders against resistance for trap

61
Q

CN XII Hypoglossal

A

test strength tongue

ask patient to stick tongue out, observe for deviation (weak muscles)
hold tongue to cheek against resistance
ask person to say “light, tight, dynamite” and note lingual speech (letters t, l, d, and n are clear)

62
Q

Inspecting and Palpating Muscle Size

A

inspect all muscle groups for size nothing bilateral comparison

63
Q

Inspecting/Palpating for Muscle Strength

A

test muscle groups of extremities, neck and trunk; giving person specific commands

also measures LOC

64
Q

Inspecting/Palpating Muscle Tone

A

normal tension in relaxed muscles

persuade person to relax completely and move each extremity smoothly through full range of motion, normally not mild, even resistance to movement

65
Q

Inspecting/Palpating Muscle Involuntarily Movements

A

normally none occur; if present, note location, frequency, rate and amplitude; note if movements can be controlled at will

66
Q

Muscular Strength Grading (0-5)

A

0 (no contraction detected)
1 (barely detectable flicker or trace of contraction)
2 (active movement with gravity eliminated)
3 (active movement against gravity)
4 (active movement against gravity and some resistance)
5 (active movement against resistance without evident fatigue, normal)

67
Q

Objective Data: Cerebellar Function (Balance)

A

sternal nudge-can hold balance
Romberg Test (stand with feet together and eyes open and the closed)
POSITIVE ROMBERG is when patient begins to sway which indicates cerebellar ataxia, vestibular dysfunction, sensory loss

68
Q

Objective Data: Cerebellar Function (Gait)

A

tandem walking (weight transfer, stride)

note any abnormalities like shuffling or loss of arm swing

69
Q

Objective Data: Cerebellar Function (Rapid Rhythmic Alternative Movements/Accuracy)

A

pat knees with both hands
play the piano
touch thumb to finger tips on each hand (precision finger tap)

finger and nose
nose to finger (point to point)
heel to shin

70
Q

Testing for Deep Tendon Reflexes

A

A: Biceps Reflex
B. Brachioradialis Reflex
C. Triceps Reflex
D. Patellar Reflex
E. Achillles Reflex
F. Check for Clonus

Jendrassik Maneuver

71
Q

Jendrassik Maneuver

A

distractive technique

UE: clench teeth, squeeze thigh
LE: lock fingers and pull against the other

72
Q

Grading Deep Tendon Reflexes (0-5)

A

0: absent reflex, no response
1+: trace or only seen with reinforcement
2+: normal
3+: brisk, may indicate disease
4+: non sustained clonus (repetitive vibratory movements)
5+: sustained clonus

73
Q

Testing Superficial Reflexes

A

abdominal cutaneous reflex
Babinski
Cremasteric

74
Q

Babinski Reflex

A

absent in humans over 2 years
dorsiflexion of great toe with or without fanning the other toes

75
Q

Cremasteric Reflex

A

males only
elicited by stroking inner part of thigh
normal=contraction of cremaster muscle that pulls up the ipsilateral testis

76
Q

Assessing Sensory (Ascending Tracts) System

A

ask person to identify various sensory stimuli in order to test intactness of peripheral nerve fibers, sensory tracts and higher cortical discrimination

routine screening procedures: testing superficial pain, light touch, and vibration in few distal locations, testing stereognosis

complete testing of sensory system warranted in those with neurologic symptoms like localized pain, numbness, tingling or if any abnormalities are discovered

77
Q

Assessing Sensory System: Comparing Sensations on Symmetric Parts of Body

A
  1. when you find definite decrease in sensation, map it by systemic testing in that area
  2. proceed from point of decreased sensation toward sensitive area; ask person to tell you where sensation changes; you can map exact borders of deficient area and draw results on diagram
  3. persons eyes should be closed during tests
  4. take time to explain what will be happening and exactly how you expect the person to respond
78
Q

Spinothalamic Tract (Pain)

A

tested by persons ability to perceive pinprick

compare symmetric points

79
Q

Spinothalamic Tract (Temperature)

A

test temp sensation only when pain sensation is abnormal; otherwise you may omit it because fiber tracts are the same

compare symmetric points

80
Q

Spinothalamic Tract (Light Touch)

A

apply wisp of cotton to skin in random order of sites and at irregular intervals including arms, forearms, hands, chest, thighs, and legs; ask person to say now or yes when touch is felt

compare symmetric points

81
Q

Dorsal Column Tract (Vibration)

A

test persons ability to feel vibrations of tuning fork over bony prominences

check for bilateral comparison

82
Q

Dorsal Column Tract (Position/Kinesthesia)

A

test persons ability to perceive passive movements of extremities

check for bilateral comparison

83
Q

Dorsal Column Tract (Tactile Discrimination/Fine Touch)

A

tests also measure discrimination ability of sensory cortex

84
Q

Dorsal Column Tract (Stereognosis)

A

test persons ability to recognize objects by feeling their forms, sizes and weights

85
Q

Dorsal Column Tract (Graphesthesia)

A

ability to “read” a number by having it traced on skin

86
Q

Dorsal Column Tract (Two-Point Discrimination)

A

test ability to distinguish separation of 2 simultaneous pin points on skin

87
Q

Dorsal Column Tract (Extinction)

A

simultaneously touch both sides of body at same points; normally both sensations are felt

88
Q

Dorsal Column Tract (Point Location)

A

touch skin and withdraw stimulus promptly; ask person to put finger where you touched

89
Q

SUMMARY CHECKLIST: NEUROLOGIC EXAM

A

screening and complete..
- mental status
- cranial nerves
- motor function
- sensory function
- reflexes

90
Q

Decorticate Rigidity (Posture Abnormality)

A

FLEXOR
arms are like “C’s” moves in toward spinal cord

problems with cervical spinal tract or cerebral hemisphere

91
Q

Decerebrate Rigidity (Posturing Abnormality)

A

EXTENSOR
arms are like “E’s”

problems with midbrain or pons

92
Q

Bacterial Meningitis

A

very serious and can be deadly; death can occur in as little as a few hrs

sudden onset of fever, headache, stiff neck

93
Q

Viral Meningitis

A

less severe; most people get better within 7-10 days on their own

similar symptoms as bacterial

94
Q

Aging Neurological Considerations

A
  1. reduced fine motor coordination and agility
  2. neuron loss resulting in loss of muscle tone and facial tone
  3. neuron loss resulting in reduced muscle strength
  4. slower reaction time
  5. meds may impair gait
  6. proprioception declines
  7. shuffling may occur
  8. reduced DTR

COGNITION IMPAIRMENT IS NOT NORMAL AGING

95
Q

Kernigs Sign

A

indicating presence of meningitis

knee and hip are flexed to 90°, extension of knee is painful or limited in extension

96
Q

Brudzinskis Sign (Meningitis)

A

severe neck stiffness causes a patients hip and knees to flex when neck is flexed

97
Q

Health Promotion and Patient Teaching

A

reduce stroke deaths
increase in awareness of early warning signs and symptoms of stroke
reduce tobacco use
increase activity
increase BP control

Health Assessment (14 decks)

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