Neuro-Muscular

Question 1

What are some general assessment questions you can ask for neuro/musculoskeletal?

Answer 1

Have you ever had a seizure, convulsion, fit, stroke, or paralysis?

Have you ever been diagnosed as having a tremor or Parkinson’s disease?

Have you ever had numbness, tingling or “pins and needles” in your arm or leg that has lasted for more than 2 hours?

Have you ever had nerve injury, MS, or any other nervous system disease?

Have you ever had migraie headaches?

Have you taken antidepressant, sedative, tranquilizing, anti-seizure, or herbal medications in the last year?

Have you ever had pains in your joints or lower back?

Have you been working at your usual job or doing your normal activities in the last week, month, year?

Have you taken pain pills or had pain shots in the last 6 months?

Question 2

How do you test cranial nerve 1?

Answer 2

Olfactory- have them plug each nostril and identify a smell

Question 3

How do you test cranial nerve 2?

Answer 3

Optic- cover each eye and test peripheral vision

Question 4

How do you test cranial nerve 3, 4, 6?

Answer 4

Oculomotor, trochlear, abducens- follow a pen light with eyes

oculomotor can also test with pupillary light response

Question 5

How do you test cranial nerve 5?

Answer 5

Trigeminal-sensation on face, have patient clinch face and palpate massetter and temporal muscles, corneal reflex

Question 6

How do you test cranial nerve 7?

Answer 6

Facial- Ask patient to raise both eyebrows, close eyes tightly so you can’t open them, frown, show teeth, smile, puff out both cheeks

Question 7

How do you test cranial nerve 9 and 10?

Answer 7

Glossopharyngeal and Vagus- Listen for voice hoarseness, gag reflex, have the patient say AHH and check for symmetrical palate rise

Question 8

How do you test cranial nerve 12?

Answer 8

Hypoglossal- Have patient stick tongue out and move it side to side.

Question 9

Describe muscle strength ratings 0-5.

Answer 9

0= No muscular contraction detected
1=Barely detectable
2=Active movement with gravity eliminated
3=Active movement against gravity
4=Active movement against gravity with some resistance
5=Active movement against gravity with full resistance

Question 10

What drugs should be avoided in patients taking MAOIs?

Answer 10

Ephedrine, Meperidine.

Watch for these drugs: Iproniazid, phenelzine, isocarboxazid, moclobemide, befloxatone, brofaromine, selegine

Question 11

What are some questions to ask for a patient with MS?

Answer 11

• Immunosuppressant medications-steroids?
• Any recent history of illness or infection?
• Severity and nature of symptoms…triggers?

Question 12

What should you document for MS patients?

Answer 12

-Pre-existing deficits like paralysis, sensory distrubances, autonomic disturbances, visual impairment, seizures, and emotional disturbances

Question 13

What are some negative effects of methotrexate?

Answer 13

• Immunosuppression
• Anemia
• Thrombocytopenia
• Pulmonary toxicity
• Renal and hepatic toxicity

Question 14

What tests would you want to order for someone on methotrexate?

Answer 14

• CBC
• Chemistry panel, BUN/CR
• Consider PFTs
• Consider LFTs

Question 15

What are some questions to ask a patient with a CVA, head injury, or intracranial tumor?

Answer 15

• Mechanism of injury or illness
• Location, size, and time course of lesion
• CT or MRI report (secondary edema, hydrocephalus?)
• Level of consciousness
• ICP status (current symptoms of headache, nausea and vomiting, bradycardia, hypertension, etc.)
• Evaluate cardiovascular status
• Consider cranial nerve assessment
• Consider muscle strength and sensation assessment