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CLINICAL MED 555 > Neurologic > Flashcards

Neurologic Flashcards

1
Q

what are ways to assess mental status?

A
  • observe physical appearance and behavior
  • assess level of consciousness along a continuum
  • investigate cognitive abilities
  • assess mood, thought, perception and judgement
  • observe speech and language
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2
Q

define AVPU scale

A
  • A = alert
  • V = responsive to verbal stimuli
  • P = responsive to painful stimuli
  • U = unresponive
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3
Q

describe Glasgow coma scale

A
  • assesses level of consciousness
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4
Q

CN I Testing

A
  • Olfactory nerve: damage can occur at epithelium in nose, filaments, bulb or tracts to cortex

–> have patient close eyes and occlude one nostril

–> have patient sniff aroma from a vial

–> lack of recognition can be primary mechanical or metabolic

–> Pt c/o inability to smell and or taste

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5
Q

CN II Testing

A
  • Optic nere - special sensory VISION
  • Visual acuity, fundoscopic exam and fields

–> Visual acuity (snellen or rosenbaum eye chart)

–> pupillary response both direct and consensual response

–> Field testing helps you understand defects behind the retina

–> Confrontation testing

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6
Q

CN III Test

A
  • Motor function (tested via extra-ocular movement)
  • parasympathetic function (pupillary response)

PERLA: Pupils equal, reactive to light and accommodation (focus on far then near object (Ciliary muscle))

  • assess shape of pupil (may be affected by congenital abnormalities)
  • Direct and consensual testing - swinging light test

DEFICITS:

  • eye is DOWN AND OUT
  • Ptosis
  • Dilated pupils
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7
Q

CN IV Test

A
  • Pure motor (internal torsion)
  • defects lead to hypertropia (eye moves up)
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8
Q

CN VI test

A
  • Pure motor (lateral eye movements)
  • Defects lead to esotropia
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9
Q

CN V test

A
  • Sensory (corneal reflex, facial sensation to light touch/pain and motor)
  • corneal reflex = wisp of cotton on cornea
  • Facial sensation = Cotton swab and pin to all three branches on both sides
  • Ask pt to move jaw up/down and side to side
  • Pt c/o pain or jaw weakness with chewing
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10
Q

CN VII test

A
  • Sensory = tase to anterior 2/3 of tongue and soft palate sensation (Salty and sweet)
  • Motor = facial movement (observe face while talking)
  • Pt c/o facial asymmetry, drooling, eye dry on one side, noises too loud in one ear
  • peripheral nerve injury = bell’s palsey (can’t wrinkle forehead on ipsilateral side)
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11
Q

define hyperacusis

A
  • early or initial symptom of peripheral VII nerve palsy
  • patient is painful sensitivity to sound
  • loss of taste also may occur on affected side
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12
Q

left peripheral VII facial weakness**

A
  • attempt to close eye results in eyeball rolling superiorly exposing sclera but no closure of the lid per se
  • patient unable to wrinkle forehead***
  • eyelid droops very slightly
  • cannot show teeth at all on affected side in attempt to smile and lower lip droops slightly
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13
Q

define left centralVII facial weakness

A
  • incomplete smile with very subtle flattening of affected nasolabial fold
  • relative preservation of brow and forehead movement**
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14
Q

Acoustic CN VIII (vestibulocochlear)

A
  • Sensory: hearing and equilibrium
  • Testing: whisper test, weber test, rinne test, Dix-hallpike maneuver (vertigo test)
  • Pt c/o hearing loss and or dizziness
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15
Q

CN IX test

A
  • motor to stylopharyngeus m
  • sensory taste to posterior 1/3 of tongue
  • general sensation to tongue and posterior pharynx (GAG REFLEX afferent limb)
  • Parasympathetic to parotid gland
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16
Q

CN X test

A
  • Motor to muscles of pharynx, larynx and palate (gag reflex EFFERENT limb)
  • parasympathetic to pulmonary, cardiovascular and gastrointestinal systems
  • Sensory to pharynx, larynx, external auditory canal and the thoracic and abdominal viscera
17
Q

CN XI testing

A
  • pure motor = sternocleidomastoid and trapezius mm; some laryngeal mm
  • testing = resisted turning (eg to test the R SCM, have patient turn head to L); shoulder shrug for trapezius mm
  • Defects: pt may c/o asymmetry of shoulders, inability to turn head to opposite side
18
Q

CN XI damage

A
  • Damage to the peripheral CN XI gives SAME SIDED TRAPEZIUS and SCM weakness
  • Central lesion will weaken the ipsilateral trapezius and contralateral SCM muscle
19
Q

CN XII

A
  • Pure motor tongue muscles
  • protrude tongue: tongue deviates to side of peripheral lesion, away from side of central lesion (unopposed genioglossus m )
  • peripheral lesion may also see atrophy and fasciculations
  • Pt has difficulty saying lingual letters: k = posterior weakness and t = anterior tongue
  • Atrophy of the gonue is likely LMN; Stiff pointed tongue = UMN
20
Q

Know the Motor strength levels

A
  • 0 = no contraction
  • 1 = visible muscle twitch but no movement of the joint
  • 2 = weak contraction insufficient to overcome gravity
  • 3 = weak contraction able to overcome gravity but no additional resistance
  • 4 = weak contraction able to overcome some resistance but not full resistance
  • 5 = normal; able to overcome full resistance
21
Q

describe the reflex grading system

A
  • 0 = absent (LMN)
  • 1 = reduced (hypoactive)
  • 2 = normal
  • 3 = increased (hyperactive)
  • 4 = clonus (UMN)
22
Q

Define Babinski sign

A
  • Plantar response
  • blunt narrow surface (handle of reflex hammer) stroke sole of patients foot along lateral edge to base of toes in a J stroke
  • normal response is to thave all toes flex
  • abnormal response (after 2) is extension of great toe and fanning out of other toes out (outgoing or downgoing)
23
Q

What are the expected findings of a sensory exam

A
  • minimal differences bilaterally
  • accurate interpretation of sensation (hot vs cold, sharp vs dull)
  • correct discrimination of side of body (left vs right)
  • accurate location of sensations
24
Q

define Graphesthesia

A
  • carried on posterior columns to cortex
  • eyes closed, draw a letter or number on patients palm with dull object (capped pen)
  • Positive test = problem in posterior columns or sensory cortex, specifically parietal lobe
25
Q

define stereognosis

A
  • carried on posterior columns to cortex
  • eyes closed, place familiar object in hand to feel and manipulate
  • repeat with both hands
  • POSITIVE = called tactile agnosia = inability to recognize objects by touch, from parietal lobe or posterior column lesion
26
Q

define two point discrimination

A
  • carried on posterior columns to sensory cortex
  • eyes closed, alternately touch patient with one point or two simultaneously
  • determine distane at which pt can no longer feel the two points (varies by part of body)
27
Q

define monofilament test

A
  • evaluates fine touch sensory perception of the foot; used in patients with diabetes mellitus to screen for peripheral neuropathy
  • eyes closed, test ten sites each foot in random pattern, each tests last 1.5 secs, varied interval, aoid callused areas
  • Abnormal = not able to feel 7/10 sites may indicate peripheral neuropathy
28
Q

define Finger-to-nose test

A
  • pt seated with eyes open
  • position your finger 18 inches away
  • pt touches their index finger to their nose and then to your finger. Move your finger several times and make sure that full arm extension (with promation and supination)
  • POSITIVE = misjudgement of the range of movement is called dysmetria and may indicate cerebellar disease
29
Q

finger-nose-finger test

A
  • eyes closed, arms extended out to both sides
  • pt touch their nose with index finger of each hand, one hand at a time. Ask pt to increase speed
  • POSTIVE = misjudge the distance (dysmetria) and overshoot and hit their face (hypermetria) or undershoot their nose (hypometria)
30
Q

Heel to shin test

A
  • Evaluates cerebellar function of IPSILATERAL SIDE through accuracy of movements of lower extremity
  • Pt runs heel of one foot up and down the shin of the OPPOSITE LEG, repeat with other side (do not use arch of foot)
  • POSITIVE = abnormal movements, could be part of dysmetria, tremors or ataxia
31
Q

How to test gait and balance

A
  • gait observation
  • tandem gait (heal-toe walking)
  • ability to walk on heels and toes
  • promator drift

* look for foot drop *

32
Q

describe promator drift test

A
  • tests for lesions of corticospinal tract and proprioception (also proximal mm)
  • have patient stand for 20-30 secs with both arms straight forward
  • palms up, eyes closed
  • keep arms still while you tap them downward
  • hands drift downward, pt can’t maintain supination and extension

** REFLECTS UMN LESION**

33
Q

describe meningeal signs

A
  • Nuchal regidity = inability to flex neck with testing
  • Brudzinksi sign = with pt supid, passive flexion of the neck causes involuntary flexion of hips
  • Kernig’s sign = with pt supid and hip and knee flexed; attempt to passive extend the knee is painful and cannot be done
34
Q

What is affected by B12 deficiency

A
  • Dorsal columns are affected by B12 and syphilis
  • control proprioception and vibration
35
Q

sensory exam of superficial pain and superficial touch

A

SUPERFICIAL PAIN

  • part of PNS, carried by small fibers of spinothalamic test
  • used dull and sharp

SUPERFICIAL TOUCH

  • part of PNS and carried by spinothalamic tract and posterior columns by modulated mylinated fibers
  • used cotton wisp or finger (light strokes)
36
Q

describe Romberg test

A
  • NOT test for cerebellar function but tests PROPRIOCEPTION (signals from joint to tell you where you are in space)
  • have pt stand with feet close together, arms at side, if patient is steady have them close eyes and maintain position for 30-60 seconds with feet together and eyes closed
  • Loss of balance with eyes open and closed is suggestive of cerebellar disease
37
Q

Hop test

A
  • Hop in place on one foot and then the other for 5 secs each
  • instability if pt needs to cintunally touch the floor with other foot to maintain balance
38
Q

define gait and balance test

A
  • observe gait sequence and length of stride (without shoes)
  • observe posture of trunks
  • observe arm movements
  • Abnormal = could be cerebellar disease, vestibular disease, proprioception problem, footdrop from peripehral disease or basal ganglia problem
  • PARKINSONS = bradykinesia and have trouble starting and stoping moements (forward pulsion or retropulsion) (fall to side of lesion)

CLINICAL MED 555 (9 decks)

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