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Neuromuscular 1 > Neuro Intro Lecture > Flashcards

Neuro Intro Lecture Flashcards

1
Q

What are the parts of the patient/client management model?

A

Examination, Evaluation, Diagnosis, Prognosis, and Plan of care (interventions)

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2
Q

The motor control theory provides a framework of ________________

A

assumptions

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3
Q

Practice model identifies ______________ steps

A

clinical intervention

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4
Q

Health-related function and disability model provides common way of ____________________

A

thinking and communicating

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5
Q

Hypothesis-oriented practice allows development of ________________

A

intervention program

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6
Q

What type of model is the patient client management model?

A

practice model

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7
Q

What type of model is the ICF model?

A

Health related function and disability model

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8
Q

What type of model is the HOAC?

A

Hypothesis-oriented practice

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9
Q

What is part of phase 1 of a medical screen?

A

System level screening only, For referral to practitioner who diagnoses disease and pathology (if red flags present), and determine whether to refer only or refer and intervene

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10
Q

important Screens/parts of Phase 1

A

skin lesion screening, referred pain patterns, classification of BP and resting HR, Suicide warning signs, and review of symptoms

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11
Q

Phase 2 of medical screening

A

Client remains within scope of practice, proceed with diagnostic process through the use of more detailed examination and subsequent evaluation; Determine impairments of body structures/functions, activity limitations, and participation restrictions; and develop diagnosis, prognosis and identify appropriate interventions

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12
Q

Immediate medical assistance is required if a pt is experiencing loss of _________________ or difficult to ____________, Extreme ____________, Uncontrolled __________ activity, acute __________________ with other associated neurologic signs such as nuchal rigidity or intense localized back pain, Rapid onset of focal neurologic deficits (stroke in progress); Evidence of ____________ instability, or non-responsive _____________________

A

Consciousness, arouse, confusion, Seizure, infection, spinal column, autonomic dysreflexia

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13
Q

If a pt is experiencing loss of consciousness or is difficult to arouse then ________________

A

immediate medical assistance is required

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14
Q

If a pt is experiencing extreme confusion then ___________________

A

immediate medical assistance is required

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15
Q

If a pt is experiencing uncontrolled seizure activity (status epilepticus) then ______________

A

immediate medical assistance is required

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16
Q

If a pt is experiencing acute infection with other associated neurologic signs such as nuchal rigidity or intense, localized back pain, then ________________

A

immediate medical assistance is required

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17
Q

If pt is experiencing a rapid onset of focal neurologic deficits (suggesting a stroke is in progress), with symptoms such as: ____________________________ especially of one side of the body, ______________ vision of one or both eyes or ______________ vision, loss of or trouble understanding ____________, _______________that is sudden, severe, and unusual, or ___________________ with any of other signs, then immediate medical assistance is required

A

Weakness, numbness or tingling of the face, arm or leg; Blurred or decreased; double; speech; Headache; Dizziness or loss of balance or coordination

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18
Q

If a pt is experiencing evidence of _____________ instability then immediate medical assistance is required

A

spinal column

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19
Q

If a pt is experiencing non-responsive _______________ then immediate medical assistance is required

A

autonomic dysreflexia

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20
Q

An acute onset of neurologic signs such as ______________________ are non-emergency but require outside referral

A

incontinence, saddle paresthesia, and abnormal reflexes

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21
Q

Progressive neurologic signs in a know neurologic diagnosis that is not degenerative are ______________________

A

non-emergency but require outside referral

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22
Q

Evidence of ________ neuron disease is a non-emergency, but outside referral is required

A

motor

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23
Q

New onset of involuntary movements or tremor require _______________________

A

outside referral but are a non-emergency

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24
Q

Change in autonomic status requires ________________________

A

outside referral but are a non-emergency

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25
Q

Bulbar and other cranial nerve signs/symptoms: progressive change in swallowing, dysarthria, voice hoarseness, visual changes, facial weakness, hearing loss, dizziness, and vertigo are a non-emergency but require outside referral unless _____________

A

they have an acute onset or changes in any of the signs/symptoms

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26
Q

Constant ____________ that worsens over time is not an emergency but requires outside referral

A

Headache

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27
Q

If pt reports symptoms of transient ischemic attack (TIA), it’s ___________________

A

not an emergency, but outside referral is required

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28
Q

Vertebral artery insufficiency is not an emergency, but outside referral is required, but ____________________ should be discontinued immediately

A

neck motions

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29
Q

Neurologic signs inconsistent with diagnosis are ___________________________

A

not an emergency, but outside referral is required

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30
Q

Signs or symptoms of systemic illness (fever, diaphoretic, poor exercise tolerance) are __________________________

A

not an emergency, but outside referral is required

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31
Q

Significant changes in personality or cognitive status, such as _________________ are not an emergency, but outside referral is required

A

Memory loss, impaired language ability, and visual-spatial deficits

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32
Q

If a headache is accompanied by these 3 things, then it is an emergency

A

Meningismus, projectile vomiting, and transient loss of consciousness

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33
Q

What are the 3 types of headaches that can be either primary or secondary?

A

Migraine, tension, or cluster

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34
Q

3 types of seizures

A

Complex Partial Seizures (focal onset impaired awareness), Grand Mal Seizure (tonic-clonic), Petit Mal Seizure (absence)

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35
Q

What neuro specific changes in vision should we look for?

A

Homonymous hemianopia, bitemporal hemianopia, amaurosis Fugax, and retrobulbar neuritis

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36
Q

Homonymous hemianopia occurs with certain _____________

A

strokes

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37
Q

Bitemporal hemianopia occurs with ___________________

A

pituitary tumor

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38
Q

Amaurosis Fugax occurs due to _____________ or some form of ________________

A

carotid artery stenosis; retinal artery occlusion

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39
Q

What neuro specific changes in hearing should we look for?

A

Tinnitus and deafness

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40
Q

What neuro specific changes in speech should we look for?

A

Dysphonia, dysarthria, and aphasia

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41
Q

Dysphonia

A

Really quiet talking, but can’t control it

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42
Q

Dysarthria

A

difficulty articulating words, motor problem, can understand language but can’t articulate well

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43
Q

Aphasia

A

inability to produce or understand meaningful speech

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44
Q

Broca’s Aphasia

A

can’t articulate, can understand what you are saying but can’t produce speech

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45
Q

What should you check as part of your cardiovascular/pulmonary systems review

A

Blood pressure, edema, heart rate, respiratory rate, and oxygen saturation

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46
Q

Always check vitals when?

A

at rest and post activity

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47
Q

Check pulse ox particularly with any ____________________________, and general rule of thumb it should be ________%

A

pulmonary history, trachs, and/or history of ventilator dependence; 94%

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48
Q

What should you check as part of the integumentary portion of the systems review

A

Pliability (texture), presence of scar formation, skin color, and skin integrity

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49
Q

Always check ___________ assessment of skin and then follow up with your own assessment at some point

A

nursing

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50
Q

When assessing skin, don’t forget to include: ____________________

A

tracheotomy, feeding tubes, catheters, and continence

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51
Q

Parts of the musculoskeletal systems review

A

Gross range of motion, gross strength, gross symmetry, height, and weight

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52
Q

Neuromuscular components of the systems review

A

Gross coordinated movement (balance, locomotion, transfers, and transitions) and motor function (motor control and motor learning)

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53
Q

communication ability, affect, cognition, language, and learning style may also be included in the _______________

A

Systems review

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54
Q

Affect

A

level of emotion

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55
Q

Task-oriented approach to examination includes:

A

quantification of functional abilities, description of the strategies used to accomplish functional skills, and quantificatio of underlying sensory, motor, and cognitive impairments that constrain functional movement

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56
Q

after looking at stationary individual in a stationary environment, also need to look at __________________, _________________, and _______________

A

moving individual in a stationary environment, stationary individual in a moving environment, and moving individual in a moving environment

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57
Q

What are the 6 subdivisions of a neuro exam?

A

mental status, cranial nerves, motor exam, reflexes, coordination and gait, and sensory exam

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58
Q

Evaluation of mental status includes: _________________

A

level of alertness, attention, and cooperation, orientation, and memory

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59
Q

Cooperation

A

how do they cooperate or not during the exam; do they do what you ask them to?

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60
Q

Orientation includes:

A

Person, place, and time

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61
Q

Memory can be ____________ or _______________

A

Explicit or implicit

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62
Q

Explicit memory

A

Declarative

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63
Q

Implicit memory

A

Procedural

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64
Q

Other than implicit and explicit, memory can also be _____________

A

immediate, short term, or long term

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65
Q

Amnesia can be ____________ or ___________

A

anterograde or retrograde

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66
Q

Anterograde amnesia

A

Amnesia after the event

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67
Q

Retrograde amnesia

A

amnesia of memory prior to the event

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68
Q

What are 4 higher cognitive functions?

A

Language, calculations, abstract thinking, and constructional ability

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69
Q

Language includes: _________

A

one, two, or three-stage commands, repetition and naming of basic objects, dysarthria, and fluent/non-fluent aphasia

70
Q

Calculations

A

do mental math at the same time as whatever else they’re doing

71
Q

Being able to say that a table and chair are both furniture is an example of what?

A

Abstract thinking

72
Q

Constructional ability

A

give them pieces of something to put together such as a clock or cube

73
Q

Apraxia

A

understand command and what they are supposed to do, but cannot initiate it

74
Q

Neglect

A

Unaware of one side of their body

75
Q

Delusions and hallucinations are usually __________ and can be related to something psychologically

A

acute

76
Q

When testing for _________, we need to document different things based on if they’re awake (eyes open) or asleep (eyes closed)

A

arousal/alertness

77
Q

When testing for arousal/alertness, and the patient is awake (eyes open), then _______________, and document if the pt appears _____________, dozed off, or if they are able to direct their attention to you.

A

introduce yourself; tired

78
Q

When testing for arousal/alertness, and the patient is asleep (eyes closed), then try __________________ first (introduce yourself without touch), if nothing then follow up with __________________, then _____________, then _________________ if necessary

A

auditory stimulation; gentle nudge; auditory and nudge; noxious stimulation

79
Q

Tests for attention

A

vigilance test, digit repetition, and asking to spell world backwards

80
Q

What kind of test is the vigilance test?

A

Test for attention

81
Q

What kind of test is digit repetition?

A

Test for attention

82
Q

What is being tested when asking pts to spell world backwards?

A

Attention

83
Q

Tests for Mental status

A

Folstein mini-mental state exam (MMSE) and Montreal cognitive assessment (MoCA)

84
Q

What is the Folstein mini-mental state exam MMSE testing for?

A

mental status

85
Q

What is the Montreal cognitive assessment (MoCA) testing for?

A

mental status

86
Q

CN 1 name

A

Olfactory

87
Q

CN 2 name

A

Optic

88
Q

CN 3 name

A

Oculomotor

89
Q

CN 4 name

A

Trochlear

90
Q

CN 5 name

A

Trigeminal

91
Q

CN 6 name

A

abducens

92
Q

CN 7 name

A

Facial

93
Q

CN 8 name

A

Vestibulocochlear

94
Q

CN 9 name

A

Glossopharyngeal

95
Q

CN 10 name

A

vagus

96
Q

CN 11 name

A

Accessory

97
Q

CN 12 name

A

Hypoglossal

98
Q

CN 2 optic nerve track: starts at ___________ and ends in ______________

A

retina; occipital lobe

99
Q

The functional integrity of the visual pathway is determined by testing ________________ (central vision) and ________________ (peripheral vision)

A

visual acuity; visual fields

100
Q

Make sure to inspect eyes and eyelids for any Asymmetries or abnormalities by looking at: ____________________

A

pupillary size and shape, opacities of the lens and positions of the lids

101
Q

The pupils should be equal in ________________

A

size and shape

102
Q

What size should the pupils be in dim light

A

3-5 mm

103
Q

When looking at the opacities of the lens, we are looking for ________________-

A

cataracts and trauma

104
Q

Ptosis is an example of an abnormal ______________ we should be looking for when inspecting the eyes

A

position

105
Q

Visual acuity (central vision) tests

A

Cover one eye for Snellen chart and Rosenbaum screener

106
Q

Covering one eye and looking at the Snellen chart or Rosenbaum chart tests what?

A

visual acuity (central vision)

107
Q

Myopia

A

near vision intact

108
Q

Hyperopia

A

distance vision intact

109
Q

Presbyopia

A

lens unable to accommodate for near vision

110
Q

Presbyopia tends to happen when?

A

after age 45

111
Q

Presbyopia occurs due to:

A

loss of elasticity of the crystalline lens

112
Q

Visual fields (peripheral vision) test

A

Confrontation testing

113
Q

Confrontation testing tests what?

A

visual fields (peripheral vision)

114
Q

Visual reflexes are tested using what?

A

the light reflex

115
Q

Mydriasis

A

blown pupil

116
Q

Iridoplegia

A

pupil does not react to light stimulation

117
Q

Amaurotic pupil

A

one that does not constrict to light

118
Q

What kind of pt is an Amaurotic pupil seen in?

A

a pt whose optic nerve or retina have been destroyed

119
Q

Accommodation reflex

A

Normal response that comes into play when there is a need to view an object at near distances

120
Q

How is the accommodation reflex tested?

A

by asking the patient to focus both eyes on the examiner’s finger as it is slowly advanced towards the pt’s nose from a distance of 60 cm

121
Q

What should be seen by the examiner when testing the accommodation reflex?

A

Convergence (ocular adduction) and constriction of the pupil

122
Q

How is an impairment of the accommodation reflex noted?

A

Note side, if unilateral, and which component of the reflex is abnormal

123
Q

Heterotropia

A

malalignment of the visual axes

124
Q

Lesions of the oculomotor nerve

A

Ptosis that does not resolve with upward gaze, corectasia, exotropia, hypotropia, cycloplegia, and diplopia with lateral gaze to the contralateral side

125
Q

Ptosis that does not resolve with upward gaze, corectasia, exotropia, hypotropia, cycloplegia, and diplopia with lateral gaze to the contralateral side are all lesions of the _________________ nerve

A

Oculomotor

126
Q

Corectasia

A

dilated pupil

127
Q

Exotripia

A

lateral deviation

128
Q

Hypotropia

A

downward deviation

129
Q

Cycloplegia

A

inability to accommodate the lens for near vision

130
Q

Diplopia

A

double vision

131
Q

Lesions to the sympathetic nerve fibers: horner’s syndrome

A

Ptosis that goes away with upward gaze, miosis, anhidrosis, and hyperemia on the ipsilateral side of the face

132
Q

Miosis

A

constricted pupil

133
Q

Anhidrosis

A

absence of sweating

134
Q

Hyperemia

A

redness

135
Q

What extraocular muscles does CN 3 innervate?

A

superior rectus, inferior rectus, medial rectus, and inferior oblique

136
Q

What extraocular muscle does CN 4 innervate?

A

Superior oblique

137
Q

What extraocular muscle does CN 6 innervate?

A

lateral rectus

138
Q

Exotropia

A

Eye turned outward

139
Q

Esotropia

A

Eye turned inward

140
Q

Hypertropia

A

Eye turned upward

141
Q

Hypotropia

A

Eye turned downward

142
Q

Sharp and dull with eyes closed tests ____________

A

sensory

143
Q

What is the most sensitive test for the sensory innervation for the trigeminal nerve?

A

Corneal reflex

144
Q

Facial nerve motor fibers innervate ___________________

A

Facial muscles

145
Q

Facial nerve sensory fibers transmit: _________________________

A

taste from the anterior two thirds of the tongue, general sensation from the oropharyngeal mucosa in the region of the palatine tonsils, and a small area of skin in the external ear canal

146
Q

The autonomic fibers of the facial nerve innervate:

A

the lacrimal gland, the submandibular and submaxillary salivary glands, and the glands of the nasal mucosa

147
Q

What are the components of the facial expression assessment?

A

Have pt raise eyebrows, close both eyes forcefully and try to pry them open, smile widely, and purse their lips

148
Q

Taste is tested by applying dilute solutions of what 4 things?

A

glucose, sodium chloride, citric acid, and quinine

149
Q

What are the two divisions of the vestibulocochlear nerve?

A

cochlear and vestibular

150
Q

The cochlear division of the vestibulocochlear nerve is concerned with: ____________

A

audition, the sense and experience of hearing

151
Q

The vestibular division of the vestibulocochlear nerve is concerned with: ____________

A

equilibrium

152
Q

Testing the cochlear portion of the vestibulocochlear nerve

A

Quiet environment; Inspect the external ear with otoscope (ear canal must be free of obstruction); Rub fingers together (start far away then get closer) - 20-24 inches away is normal

153
Q

Ways to test the vestibular portion of the vestibulocochlear nerve

A

Past-pointing test, march in place with EO/EC, Oscillopsia, Gaze nystagmus, and Positional nystagmus

154
Q

Oscillopsia

A

the experience that objects in the visual field seem to be wiggling or moving back and forth

155
Q

gaze nystagmus

A

produced when the eyes are in the position of primary gaze or are shifted in a particular direction

156
Q

How do you test gaze nystagmus?

A

have pt. look straight ahead then shift the gaze 30 degrees in one direction or the other

157
Q

Why shouldn’t the pt go past 30 degrees when gaze nystagmus is being tested?

A

any more than 30 degrees can cause nystagmus in a normal individual

158
Q

Gaze nystagmus is typically ___________ with a slow and fast phase. Which phase is it named after?

A

biphasic; fast

159
Q

Positional nystagmus is induced by _____________________

A

positional changes

160
Q

Positional nystagmus is tested with _____________________

A

Hall-Pike positional testing

161
Q

Glossopharyngeal nerve does motor info for what two things?

A

Stylopharyngeus muscle and Parotid gland

162
Q

Glossopharyngeal nerve visceral sensory info

A

Sensation from the pharyngeal mucosa, taste from the posterior 1/3 of the tongue, and impulses from the baroreceptors in the carotid sinus

163
Q

The glossopharyngeal nerve serves as the afferent limb of the pharyngeal ___________ reflex

A

gag

164
Q

What two things may suggest disease involving the glossopharyngeal nerve?

A

Numbness in the back of the throat along with an absent gag reflex in response to touch on one side

165
Q

Vagus nerve innervates what muscles

A

Muscles of the soft palate, pharyngeal constrictors, and intrinsic and extrinsic muscles of the larynx

166
Q

The parasympathetic connections of the vagus nerve (via the dorsal motor nucleus), are associated with ______________________

A

the pulmonary and cardiac plexus

167
Q

The vagus nerve, sensory portion, transmits info from _______________________

A

Thoracic and abdominal structures, chemoreceptors in the carotid body, and taste receptors in the epiglottis

168
Q

Clinical examination of CN X (vagus)

A

Dysphagia, nasal escape, uvula symmetry, and gag reflex

169
Q

Spinal accessory nerve innervates what two muscles?

A

SCM and Traps

170
Q

The hypoglossal nerve innervates what muscles of the tongue

A

Intrinsic and genioglossus

171
Q

Clinical examination of CN 12 (hypoglossal)

A

Observe tongue resting in the floor of the mouth, stick tongue out, push tongue into each cheek, and have pt say “la, la, la,” “tee, tee, tee,” and “dee, dee, dee”

Neuromuscular 1 (1 decks)

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