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BOARDS: Neuromuscular > Neuro exam, ANS/PNS, and perceptual function > Flashcards

Neuro exam, ANS/PNS, and perceptual function Flashcards

1
Q

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?

A

lethargic

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2
Q

What does a patient with stupor look like?

A
  • aroused from sleep only with painful stimuli
  • slow or absent verbal responses
  • minimal awareness of self/enviro
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3
Q

Describe obtunded vs lethargy.

A

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

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4
Q

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

A

in a coma

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5
Q

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

A

MCS = minimally conscious state

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6
Q

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

A

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)

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7
Q

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

A

poor sustained attention

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

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8
Q

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

A

poor focused attention

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9
Q

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

A

divided attention

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10
Q

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

A
  • egocentric
  • insight into disability
  • unable to tolerate critisism
  • different affect: irritable, depressed, withdrawn, agitated
  • poor frustration tolerance
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11
Q

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

A

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

  • <15 = severe impairment
  • 16-20 = moderate impairment
  • 21-24 = mild impairment
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12
Q

How many levels are there for the Ranchos Los Amigos?

A

I-VIII levels of behavior

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13
Q

What does a Rancho II look like?

A

II-III = decreased response levels

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14
Q

What does a Rancho V look like?

A

still pretty confused, but better than your typical agitated 4

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15
Q

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

A

VII and VIII

- may still have executive function problems

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16
Q

What is Broca’s aphasia?

A

motor aphasia, expressive aphasia

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

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17
Q

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

A

frontal left

18
Q

What is dysarthria? What CN might be involved?

A

impairment of speech production - incoordination, weakness, paralysis

CN XII

19
Q

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

A

Wernicke’s

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

20
Q

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

A

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)
21
Q

What is hyperventilation?

A

increased rate/depth of breathing

22
Q

What is apneustic breathing?

A

prolonged inspiration (occurs with damage to upper pons)

23
Q

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

A

hypothalamus or brainstem

24
Q

What is Brudzinski’s sign for?

A

to detect meningeal irritation

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

25
Q

What is Kernig’s sign?

A

pt in supine, flex hip and knee to chest, then extend knee

  • pain and increased resistance
  • bilateral = meningeal irritation
26
Q

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

A
  • flex neck and look for pain, flexing of hips/knees

- check for Kernig’s (knee extended)

27
Q

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?

A

Infection of CNS, meningeal irritation

28
Q

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?

A

increased ICP (intracranial pressure)

  • could also have increased temp, positive babinski, decorticate/decerebrate
  • slow pulse
29
Q

What does a positive Babinski look like?

A

great toe DF, toes fan

- negative = all toes flex

30
Q

What ANS system contracts the bladder?

A

parasymp (able to pee when not in alarming state)

31
Q

What ANS system dilates or contracts blood vessels to muscles?

A

sympathetic (PNS does gut)

32
Q

What ANS system dilates pupils?

A

sympathetic

33
Q

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

A

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

  • CN II
34
Q

How would you test kinesthesia in a patient?

A

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

35
Q

How would you test vibration sense?

A

apply vibrating tuning fork to bony areas to test proprioceptive receptors

36
Q

What is graphesthesia?

A

ability to identify numbers/letters written on skin

37
Q

What is anosognosia?

A

severe denial/neglect of awareness of severity of condition

38
Q

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?

A

ideomotor apraxia

39
Q

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

A

ideational apraxia

40
Q

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

A
  • 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

BOARDS: Neuromuscular (16 decks)

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