Neuro Intro Lecture Flashcards
What are the parts of the patient/client management model?
Examination, Evaluation, Diagnosis, Prognosis, and Plan of care (interventions)
The motor control theory provides a framework of ________________
assumptions
Practice model identifies ______________ steps
clinical intervention
Health-related function and disability model provides common way of ____________________
thinking and communicating
Hypothesis-oriented practice allows development of ________________
intervention program
What type of model is the patient client management model?
practice model
What type of model is the ICF model?
Health related function and disability model
What type of model is the HOAC?
Hypothesis-oriented practice
What is part of phase 1 of a medical screen?
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
important Screens/parts of Phase 1
skin lesion screening, referred pain patterns, classification of BP and resting HR, Suicide warning signs, and review of symptoms
Phase 2 of medical screening
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
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 _____________________
Consciousness, arouse, confusion, Seizure, infection, spinal column, autonomic dysreflexia
If a pt is experiencing loss of consciousness or is difficult to arouse then ________________
immediate medical assistance is required
If a pt is experiencing extreme confusion then ___________________
immediate medical assistance is required
If a pt is experiencing uncontrolled seizure activity (status epilepticus) then ______________
immediate medical assistance is required
If a pt is experiencing acute infection with other associated neurologic signs such as nuchal rigidity or intense, localized back pain, then ________________
immediate medical assistance is required
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
Weakness, numbness or tingling of the face, arm or leg; Blurred or decreased; double; speech; Headache; Dizziness or loss of balance or coordination
If a pt is experiencing evidence of _____________ instability then immediate medical assistance is required
spinal column
If a pt is experiencing non-responsive _______________ then immediate medical assistance is required
autonomic dysreflexia
An acute onset of neurologic signs such as ______________________ are non-emergency but require outside referral
incontinence, saddle paresthesia, and abnormal reflexes
Progressive neurologic signs in a know neurologic diagnosis that is not degenerative are ______________________
non-emergency but require outside referral
Evidence of ________ neuron disease is a non-emergency, but outside referral is required
motor
New onset of involuntary movements or tremor require _______________________
outside referral but are a non-emergency
Change in autonomic status requires ________________________
outside referral but are a non-emergency
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 _____________
they have an acute onset or changes in any of the signs/symptoms
Constant ____________ that worsens over time is not an emergency but requires outside referral
Headache
If pt reports symptoms of transient ischemic attack (TIA), it’s ___________________
not an emergency, but outside referral is required
Vertebral artery insufficiency is not an emergency, but outside referral is required, but ____________________ should be discontinued immediately
neck motions
Neurologic signs inconsistent with diagnosis are ___________________________
not an emergency, but outside referral is required
Signs or symptoms of systemic illness (fever, diaphoretic, poor exercise tolerance) are __________________________
not an emergency, but outside referral is required
Significant changes in personality or cognitive status, such as _________________ are not an emergency, but outside referral is required
Memory loss, impaired language ability, and visual-spatial deficits
If a headache is accompanied by these 3 things, then it is an emergency
Meningismus, projectile vomiting, and transient loss of consciousness
What are the 3 types of headaches that can be either primary or secondary?
Migraine, tension, or cluster
3 types of seizures
Complex Partial Seizures (focal onset impaired awareness), Grand Mal Seizure (tonic-clonic), Petit Mal Seizure (absence)
What neuro specific changes in vision should we look for?
Homonymous hemianopia, bitemporal hemianopia, amaurosis Fugax, and retrobulbar neuritis
Homonymous hemianopia occurs with certain _____________
strokes
Bitemporal hemianopia occurs with ___________________
pituitary tumor
Amaurosis Fugax occurs due to _____________ or some form of ________________
carotid artery stenosis; retinal artery occlusion
What neuro specific changes in hearing should we look for?
Tinnitus and deafness
What neuro specific changes in speech should we look for?
Dysphonia, dysarthria, and aphasia
Dysphonia
Really quiet talking, but can’t control it
Dysarthria
difficulty articulating words, motor problem, can understand language but can’t articulate well
Aphasia
inability to produce or understand meaningful speech
Broca’s Aphasia
can’t articulate, can understand what you are saying but can’t produce speech
What should you check as part of your cardiovascular/pulmonary systems review
Blood pressure, edema, heart rate, respiratory rate, and oxygen saturation
Always check vitals when?
at rest and post activity
Check pulse ox particularly with any ____________________________, and general rule of thumb it should be ________%
pulmonary history, trachs, and/or history of ventilator dependence; 94%
What should you check as part of the integumentary portion of the systems review
Pliability (texture), presence of scar formation, skin color, and skin integrity
Always check ___________ assessment of skin and then follow up with your own assessment at some point
nursing
When assessing skin, don’t forget to include: ____________________
tracheotomy, feeding tubes, catheters, and continence
Parts of the musculoskeletal systems review
Gross range of motion, gross strength, gross symmetry, height, and weight
Neuromuscular components of the systems review
Gross coordinated movement (balance, locomotion, transfers, and transitions) and motor function (motor control and motor learning)
communication ability, affect, cognition, language, and learning style may also be included in the _______________
Systems review
Affect
level of emotion
Task-oriented approach to examination includes:
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
after looking at stationary individual in a stationary environment, also need to look at __________________, _________________, and _______________
moving individual in a stationary environment, stationary individual in a moving environment, and moving individual in a moving environment
What are the 6 subdivisions of a neuro exam?
mental status, cranial nerves, motor exam, reflexes, coordination and gait, and sensory exam
Evaluation of mental status includes: _________________
level of alertness, attention, and cooperation, orientation, and memory
Cooperation
how do they cooperate or not during the exam; do they do what you ask them to?
Orientation includes:
Person, place, and time
Memory can be ____________ or _______________
Explicit or implicit
Explicit memory
Declarative
Implicit memory
Procedural
Other than implicit and explicit, memory can also be _____________
immediate, short term, or long term
Amnesia can be ____________ or ___________
anterograde or retrograde
Anterograde amnesia
Amnesia after the event
Retrograde amnesia
amnesia of memory prior to the event
What are 4 higher cognitive functions?
Language, calculations, abstract thinking, and constructional ability
Language includes: _________
one, two, or three-stage commands, repetition and naming of basic objects, dysarthria, and fluent/non-fluent aphasia
Calculations
do mental math at the same time as whatever else they’re doing
Being able to say that a table and chair are both furniture is an example of what?
Abstract thinking
Constructional ability
give them pieces of something to put together such as a clock or cube
Apraxia
understand command and what they are supposed to do, but cannot initiate it
Neglect
Unaware of one side of their body
Delusions and hallucinations are usually __________ and can be related to something psychologically
acute
When testing for _________, we need to document different things based on if they’re awake (eyes open) or asleep (eyes closed)
arousal/alertness
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.
introduce yourself; tired
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
auditory stimulation; gentle nudge; auditory and nudge; noxious stimulation
Tests for attention
vigilance test, digit repetition, and asking to spell world backwards
What kind of test is the vigilance test?
Test for attention
What kind of test is digit repetition?
Test for attention
What is being tested when asking pts to spell world backwards?
Attention
Tests for Mental status
Folstein mini-mental state exam (MMSE) and Montreal cognitive assessment (MoCA)
What is the Folstein mini-mental state exam MMSE testing for?
mental status
What is the Montreal cognitive assessment (MoCA) testing for?
mental status
CN 1 name
Olfactory
CN 2 name
Optic
CN 3 name
Oculomotor
CN 4 name
Trochlear
CN 5 name
Trigeminal
CN 6 name
abducens
CN 7 name
Facial
CN 8 name
Vestibulocochlear
CN 9 name
Glossopharyngeal
CN 10 name
vagus
CN 11 name
Accessory
CN 12 name
Hypoglossal
CN 2 optic nerve track: starts at ___________ and ends in ______________
retina; occipital lobe
The functional integrity of the visual pathway is determined by testing ________________ (central vision) and ________________ (peripheral vision)
visual acuity; visual fields
Make sure to inspect eyes and eyelids for any Asymmetries or abnormalities by looking at: ____________________
pupillary size and shape, opacities of the lens and positions of the lids
The pupils should be equal in ________________
size and shape
What size should the pupils be in dim light
3-5 mm
When looking at the opacities of the lens, we are looking for ________________-
cataracts and trauma
Ptosis is an example of an abnormal ______________ we should be looking for when inspecting the eyes
position
Visual acuity (central vision) tests
Cover one eye for Snellen chart and Rosenbaum screener
Covering one eye and looking at the Snellen chart or Rosenbaum chart tests what?
visual acuity (central vision)
Myopia
near vision intact
Hyperopia
distance vision intact
Presbyopia
lens unable to accommodate for near vision
Presbyopia tends to happen when?
after age 45
Presbyopia occurs due to:
loss of elasticity of the crystalline lens
Visual fields (peripheral vision) test
Confrontation testing
Confrontation testing tests what?
visual fields (peripheral vision)
Visual reflexes are tested using what?
the light reflex
Mydriasis
blown pupil
Iridoplegia
pupil does not react to light stimulation
Amaurotic pupil
one that does not constrict to light
What kind of pt is an Amaurotic pupil seen in?
a pt whose optic nerve or retina have been destroyed
Accommodation reflex
Normal response that comes into play when there is a need to view an object at near distances
How is the accommodation reflex tested?
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
What should be seen by the examiner when testing the accommodation reflex?
Convergence (ocular adduction) and constriction of the pupil
How is an impairment of the accommodation reflex noted?
Note side, if unilateral, and which component of the reflex is abnormal
Heterotropia
malalignment of the visual axes
Lesions of the oculomotor nerve
Ptosis that does not resolve with upward gaze, corectasia, exotropia, hypotropia, cycloplegia, and diplopia with lateral gaze to the contralateral side
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
Oculomotor
Corectasia
dilated pupil
Exotripia
lateral deviation
Hypotropia
downward deviation
Cycloplegia
inability to accommodate the lens for near vision
Diplopia
double vision
Lesions to the sympathetic nerve fibers: horner’s syndrome
Ptosis that goes away with upward gaze, miosis, anhidrosis, and hyperemia on the ipsilateral side of the face
Miosis
constricted pupil
Anhidrosis
absence of sweating
Hyperemia
redness
What extraocular muscles does CN 3 innervate?
superior rectus, inferior rectus, medial rectus, and inferior oblique
What extraocular muscle does CN 4 innervate?
Superior oblique
What extraocular muscle does CN 6 innervate?
lateral rectus
Exotropia
Eye turned outward
Esotropia
Eye turned inward
Hypertropia
Eye turned upward
Hypotropia
Eye turned downward
Sharp and dull with eyes closed tests ____________
sensory
What is the most sensitive test for the sensory innervation for the trigeminal nerve?
Corneal reflex
Facial nerve motor fibers innervate ___________________
Facial muscles
Facial nerve sensory fibers transmit: _________________________
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
The autonomic fibers of the facial nerve innervate:
the lacrimal gland, the submandibular and submaxillary salivary glands, and the glands of the nasal mucosa
What are the components of the facial expression assessment?
Have pt raise eyebrows, close both eyes forcefully and try to pry them open, smile widely, and purse their lips
Taste is tested by applying dilute solutions of what 4 things?
glucose, sodium chloride, citric acid, and quinine
What are the two divisions of the vestibulocochlear nerve?
cochlear and vestibular
The cochlear division of the vestibulocochlear nerve is concerned with: ____________
audition, the sense and experience of hearing
The vestibular division of the vestibulocochlear nerve is concerned with: ____________
equilibrium
Testing the cochlear portion of the vestibulocochlear nerve
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
Ways to test the vestibular portion of the vestibulocochlear nerve
Past-pointing test, march in place with EO/EC, Oscillopsia, Gaze nystagmus, and Positional nystagmus
Oscillopsia
the experience that objects in the visual field seem to be wiggling or moving back and forth
gaze nystagmus
produced when the eyes are in the position of primary gaze or are shifted in a particular direction
How do you test gaze nystagmus?
have pt. look straight ahead then shift the gaze 30 degrees in one direction or the other
Why shouldn’t the pt go past 30 degrees when gaze nystagmus is being tested?
any more than 30 degrees can cause nystagmus in a normal individual
Gaze nystagmus is typically ___________ with a slow and fast phase. Which phase is it named after?
biphasic; fast
Positional nystagmus is induced by _____________________
positional changes
Positional nystagmus is tested with _____________________
Hall-Pike positional testing
Glossopharyngeal nerve does motor info for what two things?
Stylopharyngeus muscle and Parotid gland
Glossopharyngeal nerve visceral sensory info
Sensation from the pharyngeal mucosa, taste from the posterior 1/3 of the tongue, and impulses from the baroreceptors in the carotid sinus
The glossopharyngeal nerve serves as the afferent limb of the pharyngeal ___________ reflex
gag
What two things may suggest disease involving the glossopharyngeal nerve?
Numbness in the back of the throat along with an absent gag reflex in response to touch on one side
Vagus nerve innervates what muscles
Muscles of the soft palate, pharyngeal constrictors, and intrinsic and extrinsic muscles of the larynx
The parasympathetic connections of the vagus nerve (via the dorsal motor nucleus), are associated with ______________________
the pulmonary and cardiac plexus
The vagus nerve, sensory portion, transmits info from _______________________
Thoracic and abdominal structures, chemoreceptors in the carotid body, and taste receptors in the epiglottis
Clinical examination of CN X (vagus)
Dysphagia, nasal escape, uvula symmetry, and gag reflex
Spinal accessory nerve innervates what two muscles?
SCM and Traps
The hypoglossal nerve innervates what muscles of the tongue
Intrinsic and genioglossus
Clinical examination of CN 12 (hypoglossal)
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”
