Neuro (Exam 3) Flashcards

Question

Autonomic Nervous System (PNS)

Answer 1

involuntary movements innervates smooth muscle **SYMPATHETIC** (*fight or flight*) **PARASYMPATHETIC** (*rest and digest*)

Answer 2

LE: patellar, achilles, hamstring UE: triceps, biceps, brachioradialis

Answer 3

corneal abdominal cremasteric

Answer 4

pupillary response to light PERRLA

Answer 5

Plantar reflex (*Babinski sign, positive to 24 months*)

Answer 6

cutaneous portion of spinal nerves

Answer 7

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

Answer 8

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

Answer 9

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

Answer 10

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

Answer 11

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

Answer 12

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

Answer 13

judgement abstraction memory-cognitive LOC **completed through entire exam**

Answer 14

drowsy but opens eyes, responds to Qs then falls asleep

Answer 15

opens eyes, responds slowly and is somewhat confused

Answer 16

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

Answer 17

remains unarousable with eyes closed even with painful stimuli

Answer 18

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

Answer 19

**O**nly **O**ne **O**f **T**he **T**wo **A**thletes **F**elt **V**ery **G**ood **V**ictorious **A**nd **H**ealthy

Answer 20

**S**ome **S**ay **M**arry **M**oney **B**ut **M**y **B**rother **S**ays **B**ig **B**rains **M**atter **M**ost *S=sensory, B=Mixed, M=Motor*

Answer 21

**not routinely tested** NORMAL: patient identifies common odors accurately TEST IF: **reports loss of smell, head trauma, suspected intracranial lesion**

Answer 22

**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*)

Answer 23

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

Answer 24

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

Answer 25

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

Answer 26

assess muscles of mastification by palpating temporal and masseter muscles as a person clenches his or her teeth **masseter, temporalis, buccinator, zygomaticus**

Answer 27

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

Answer 28

assess corneal reflex if person has abnormal facial sensations or abnormalities of facial movement (blink response) test all 3 divisions (**ophthalmic, maxillary, mandibular**)

Answer 29

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!!**

Answer 30

**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*)

Answer 31

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

Answer 32

**512 Hz Tuning fork** tests for localization normal=midline

Answer 33

**512 Hz Tuning fork** tests for conduction *air>bone is normal* *bone>air means conductive hearing loss*

Answer 34

**tested with CN X** sensory supply to the soft palate *taste to posterior 1/3 of tongue* GAG REFLEX

Answer 35

**tested with CN IX** motor supply to pharynx SAY AHHHHH (uvula and soft palate rise to midline) no deviation of uvula

Answer 36

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*

Answer 37

**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)

Answer 38

inspect all muscle groups for size nothing bilateral comparison

Answer 39

test muscle groups of extremities, neck and trunk; giving person specific commands **also measures LOC**

Answer 40

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**

Answer 41

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

Answer 42

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***)

Answer 43

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***

Answer 44

tandem walking (*weight transfer, stride*) **note any abnormalities like shuffling or loss of arm swing**

Answer 45

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

Answer 46

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

Answer 47

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

Answer 48

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

Answer 49

abdominal cutaneous reflex Babinski Cremasteric

Answer 50

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

Answer 51

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

Answer 52

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**

Answer 53

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

Answer 54

spinothalamic!! tested by persons ability to perceive pinprick **compare symmetric points**

Answer 55

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

Answer 56

spinothalamic!! 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**

Answer 57

DCT!! test persons ability to feel vibrations of tuning fork over bony prominences **check for bilateral comparison**

Answer 58

DCT!! test persons ability to perceive passive movements of extremities **check for bilateral comparison**

Answer 59

DCT!! tests also measure discrimination ability of sensory cortex

Answer 60

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

Answer 61

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

Answer 62

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

Answer 63

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

Answer 64

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

Answer 65

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

Answer 66

FLEXOR *arms are like “C’s” moves in toward spinal cord* **problems with cervical spinal tract or cerebral hemisphere**

Answer 67

EXTENSOR *arms are like “E’s”* **problems with midbrain or pons**

Answer 68

very serious and can be deadly; death can occur in as little as a few hrs **sudden onset of fever, headache, stiff neck**

Answer 69

less severe; most people get better within 7-10 days on their own similar symptoms as bacterial

Answer 70

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**

Answer 71

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

Answer 72

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

Answer 73

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