Neuro & Mental Health - Week 13 Flashcards
Part of the diabetic foot exam includes all except: (Bates, 731)
a. Monofilament testing
b. Vibratory perception
c. Romberg
d. Visual inspection
C
In a comatose patient with absent doll’s eye movements (oculocephalic reflex), you would observe: (Bates, p. 770)
a. Extreme bilateral nystagmus when you turn the patient’s head
b. Dilation of left eye when head is turned to the right
c. Dilation of the right eye when head is turned to right
d. Eyes do not move when the head is turned to left or right
D
To assess the integrity of nerve pathway C 5-6, you would assess DTRs (or muscle stretch response) at these 2 locations: (Bates, p. 721)
a. Brachioradialis (a.k.a. supinator)
b. Biceps
c. Triceps
d. Sensory cervical reflex
A&B
brachioradialis - C5, C6
biceps - C5, C6
Triceps - C6, C7
sensory cervical reflex
patellar (quads/knee) - L2, L3, L4
ankle reflex - S1
You see unequal pupil size of > 0.4 mm (anisocoria) & ptosis of the left eye (OS). You know CN _____ is impacted. (Bates, p. 736):
a. II
b. III
c. IV
d. VI
B
All are part of a neurological sensory exam except: (Bates, p. 752 – 757)
a. Proprioception
b. Finger-to-nose test
c. 2-point discrimination
d. Stereognosis
*Extra: How do perform each of the assessments? What category of the neuro exam would the answer go into?
B
Your patient exhibits clonus during your DTR exam. You would document this as: (Bates, 758)
a. 1+ b. 2+ c. 3+ d. 4+
D
You see facial grimacing in your 8-mo-old patient. You understand that CN(s) _____ is/are intact. (Bates, p. 846)
a. V & VII b. VIII c. IX & X d. III, IV & VI
*Extra: How do you assess all the other CNs?
A
V = rooting, sucking VII = crying/smiling IX = coordination during swallow X = gag III, IV, VI = tracking and eye movements
Asking your patient to close both eyes (OU) tightly so you can’t open them assesses the trigeminal nerve. (Bates, 739)
a. T b. F
B
this tests CN VII - facial
CN V trigeminal - assess master strength and mobility
Your patient has slurred speech & difficulty forming words. This likely indicates injury to CN _____. (Bates, 740)
a. V b. XII c. VII d. X
B
Your patient has Bell’s Palsy. You know this is a result of peripheral injury to CN _____. (Bates, 739)
a. Trigeminal b. Facial c. Vagus d. Glossopharyngeal
*Extra: what CN # are each of these?
B
trigeminal = V Facial = VII Vagus = X Glossopharyngual = XII
You are assessing your patient’s motor strength as part of your neuro assessment. You note that he has active movement against gravity. You would document this as: (Bates, 743)
a. 2/5 b. 3/5 c. 4/5 d. 5/5
*Extra: Describe all the other grades on the scale
B
2 = active movement of the body part with gravity eliminated
3 = active movement against gravity
4 = active movement against gravity and some resistance
5 = normal muscle strength
Oculocephalic reflex (aka Doll’s Eyes Movements) in a comatose patient with an intact brainstem would reveal: (Bates, 770)
a. One eye is gazing laterally & one eye gazing horizontally b. Eye movement is in same direction of head movement c. Eye movement is in opposite direction of head movement d. Patient is unarousable eyes are closed
C
It is appropriate to assess CN I – XII in a 6-mo old infant. (Bates, p. 848)
a. T b. F
B
In an organized neurological examination, the FNP begins the assessment with: (Bates, p 734)
a. CN assessment b. Sensory exam c. Mental status, speech, language d. Motor system
*Extra: What is the 5th element of the exam? What should the order of you exam be?
C
1 - mental statue
2 - cranial nerves
3 - motor system
4 - sensory system
5 - reflexes
Infant reflexes include all except: (Bates, p 847 - 851)
a. DTRs b. Superficial reflexes c. Brudzinski sign d. Primitive reflexes
*Extra: Identify all infant primitive reflexes
C
brudzinski is a meningeal sign
You are inspecting the eyes noting that they blink simultaneously. You also lightly touch the cornea of one eye with a wisp of cotton as the patient is looking away (corneal reflex). You are assessing CN ______: (Bates, 738)
a. II b. III c. IV d. V
D
All are considered “headache warning signs” except: (Bates, 216)
a. New onset after age 40 b. Described as “thunderclap” c. Change in pattern from past headaches d. Aggravated or relieved by change in position
A
The three most important attributes in headaches are all except: (Bates, 716)
a. Severity b. Chronologic pattern c. Associated symptoms d. Relieving factors
D
Asking your patient to shrug their shoulders against resistance assesses CN: (Bates, 735)
a. X b. XII c. XI d. IV
C
You note hoarseness in your patient. This involves CN: (Bates, 737)
a. XII b. XI c. IX d. X
- Extra: What function do the other CNs serve?
D
XII = motor-tongue, articulation of words and tongue movement
XI = trapezius muscles, shoulder shrug
IX = motor-pharynx, patient’s voice -hoarse/nasal quality, difficulty swallowing taste
X = motor-pharynx, sensory-pharynx. voice-hose/nasal quality, difficulty swallowing
You ask your patient to open their eyes (lid opening). You are assessing CN: (Bates, 716)
a. Optic b. Trochlear c. Oculomotor d. Abducens
C
As part of your neurologic exam, you ask your patient to clench their jaw. You are assessing the motor function of CN: (Bates, 716)
a. Vagus b. Facial c. Trigeminal d. Glossopharyngeal
C
Your patient presents with injury to the cerebellum. The FNP would expect to see: (Bates, 714)
a. Large fiber neuropathy b. Increased DTRs c. Inhibition of sexual behaviors d. Impaired gait & equilibrium
D
The sensory function of the trigeminal nerve includes: (Bates, 716)
a. Sternocleidomastoid (SCM) muscle, trapezius muscle & 1/3 of posterior tongue b. Ophthalmic, maxillary & mandibular divisions c. Ophthalmic division, 2/3 of anterior tongue & posterior portion of the TM d. Pharynx, larynx & mandibular divisions
B
All are considered examples of primary headaches except: (Bates, p. 267)
a. Cluster b. Migraine c. Tension d. Analgesic Rebound
*Extra: what are symptoms of all the others?
D
