Neuro exam, ANS/PNS, and perceptual function

Question 1

If a patient appears drawsy, but can open eyes and look at the examiner, respond to questions, but falls asleep easily, how would you describe them?

Answer 1

lethargic

Question 2

What does a patient with stupor look like?

Answer 2

• aroused from sleep only with painful stimuli
• slow or absent verbal responses
• minimal awareness of self/enviro

Question 3

Describe obtunded vs lethargy.

Answer 3

both able to open eyes and respond to examiner, but obtunded responds slowly and confused
- obtunded also is minimally interested in enviro

Question 4

If a pt is not responsive to external stimuli or enviro, how would you classify them?

Answer 4

in a coma

Question 5

What is the state characterized by severely altered consciousness with minimal but definite evidence of self or environmental awareness?

Answer 5

MCS = minimally conscious state

Question 6

What does the Glascow Coma scale measure? (3). How does scoring go?

Answer 6

1) eye opening
2) motor response
3) verbal response

Scored 1-15, with lower scores indicating severe (1-8) brain injury, moderate (9-12), and minimal (13-15)

Question 7

A person who has difficulty of perserverance to a task has what poor kind of attention?

Answer 7

poor sustained attention

- could also have too much of this: perseveration on a task, getting stuck

Question 8

A person who has difficulty focusing on a task with the presence of distractors has what kind of attention issue?

Answer 8

poor focused attention

Question 9

A person with poor ability to shift attention from one task to another has issue with what kind of attention?

Answer 9

divided attention

Question 10

What kinds of behaviors/emotional responses can be evident in people with cognitive damage?

Answer 10

• egocentric
• insight into disability
• unable to tolerate critisism
• different affect: irritable, depressed, withdrawn, agitated
• poor frustration tolerance

Question 11

A score of 20 on the mini mental would indicate what?

Answer 11

mild cognitive impairment
- scored to 30, higher score is better

• <15 = severe impairment
• 16-20 = moderate impairment
• 21-24 = mild impairment

Question 12

How many levels are there for the Ranchos Los Amigos?

Answer 12

I-VIII levels of behavior

Question 13

What does a Rancho II look like?

Answer 13

II-III = decreased response levels

Question 14

What does a Rancho V look like?

Answer 14

still pretty confused, but better than your typical agitated 4

Question 15

What levels of Rancho indicate appropriate, automatic and purposeful levels?

Answer 15

VII and VIII

- may still have executive function problems

Question 16

What is Broca’s aphasia?

Answer 16

motor aphasia, expressive aphasia

- speech is awkward, slurred, interrupted, lots of effort for production

Question 17

What area of the brain is involved with Brocha’s?

Answer 17

frontal left

Question 18

What is dysarthria? What CN might be involved?

Answer 18

impairment of speech production - incoordination, weakness, paralysis

CN XII

Question 19

What is it called when speech is preserved and flows smoothly, but auditory comprehension is impaired?

Answer 19

Wernicke’s

- they spout off random things that don’t make sense

Question 20

What is Cheyne-Stokes breathing? Why could this happen?

Answer 20

CS breathing: period of apnea for 10-60s, then gradually increased depth and frequency of respirations

• can be after frontal lobe depression and diencephalic dysfunction (thalamus, etc)

Question 21

What is hyperventilation?

Answer 21

increased rate/depth of breathing

Question 22

What is apneustic breathing?

Answer 22

prolonged inspiration (occurs with damage to upper pons)

Question 23

If a pts temp is constantly elevated, what brain area could be damaged?

Answer 23

hypothalamus or brainstem

Question 24

What is Brudzinski’s sign for?

Answer 24

to detect meningeal irritation

- pt in supine: flex neck and you get flexion of hips and knees (drawing up)

Question 25

What is Kernig's sign?

Answer 25

pt in supine, flex hip and knee to chest, then extend knee - pain and increased resistance - bilateral = meningeal irritation

Question 26

When suspecting meningeal irritation, what are things you can do?

Answer 26

- flex neck and look for pain, flexing of hips/knees | - check for Kernig's (knee extended)

Question 27

A patient is having higher than normal HR and RR, continuous headache, and pain with neck mobility. Brudzinski's sign is positive. They are generally weak with all MMT. Just today when you see them, they're very sleepy and somewhat delerious as compared to a previous session. What could be going on?

Answer 27

Infection of CNS, meningeal irritation

Question 28

A patient you're seeing in the hospital has a headache, and is very restless/confused during your session. You check pupillary response, and they have a slowed reaction to light. They're weaker today than last session. During your session, they start to have Cheyne-Stokes respirations and begin to vomit. What could be going on?

Answer 28

increased ICP (intracranial pressure) - could also have increased temp, positive babinski, decorticate/decerebrate - slow pulse

Question 29

What does a positive Babinski look like?

Answer 29

great toe DF, toes fan | - negative = all toes flex

Question 30

What ANS system contracts the bladder?

Answer 30

parasymp (able to pee when not in alarming state)

Question 31

What ANS system dilates or contracts blood vessels to muscles?

Answer 31

sympathetic (PNS does gut)

Question 32

What ANS system dilates pupils?

Answer 32

sympathetic

Question 33

How do you test for homonymous hemianopsia? What CN is being tested?

Answer 33

bring two fingers from lateral visual fields into middle and have them tell you when they see them - CN II

Question 34

How would you test kinesthesia in a patient?

Answer 34

Move their limb for them, and have them either replicate this or verbalize what you did

Question 35

How would you test vibration sense?

Answer 35

apply vibrating tuning fork to bony areas to test proprioceptive receptors

Question 36

What is graphesthesia?

Answer 36

ability to identify numbers/letters written on skin

Question 37

What is anosognosia?

Answer 37

severe denial/neglect of awareness of severity of condition

Question 38

If a patient cannot perform the task on command, but can do the task when left on their own, what kind of apraxia do they have?

Answer 38

ideomotor apraxia

Question 39

If a patient cannot perform the task on their own or on command, what kind of apraxia do they have?

Answer 39

ideational apraxia

Question 40

When looking for spatial relations issues, what kinds of things can you test?

Answer 40

- figure-ground discrimination: have pt find the brake from the rest of the w/c - position in space: "put your foot under the chair, put your arm over your head" - depth/distance perception: sitting in chair - topographical disorientation: get to this room in therapy gym that we always go to