Neurologic exam Flashcards
Deficits in cognitive function include?
intellect, memory, or higher brain function
Deficits in consciousness may indicate?
lesions of the brainstem reticular activating system or bilateral cerevral damage
Paralysis with loss of deep tendon reflexes indicates?
a lower motor neuron lesion at the reflex arc at the spinal cord, spinal root, plexus or peripheral nerve
Unilateral lesion of the spinal cord?
Unilateral loss of touch and position sensation and contralateral loss of temp and pain
A peripheral nerve lesion causes?
lower motor neuron paralysis accompanied by anesthesia in an appropriate distribution
Cranial nerves emerge from?
the brain and pass through the foramina in the base of the skull
Tools for a neuro exam
smelly thing, pen light, otoscope, cotton ball, sharp/dull object, test tube, tuning fork, tongue depressor
How to test Olfactory
Check for patency of both nostrils, ask pt to close eyes and one nostril, inhale, what was it? do other side
How to test optic
Visual acuity with pocket visual acuity chart, test temporal and nasal fields in both eyes
How to test oculomotor
Function of superior rectus, medial rectus, inferior rectus, inferior oblique, levator palpebrae superioris and pupillary reaction
How to test oculomotor
Function of superior rectus, medial rectus, inferior rectus, inferior oblique, levator palpebrae superioris and pupillary reaction
How to test trochlear
Superior oblique, to midline and up
How to test Abducens
Lateral rectus, horizontal plane
Opthalmic branch of trigeminal
Cornea, cil;iary body, conjuctiva, nasal cavity and sinuses, skin of the eyebrows, forehead and nose
Maxillary branch of trigeminal
nose, upper and lower eyelids, palate, maxillary gums
Mandibular branch of trigeminal
Temporal regions, external ears, lower lip, lower face, mucosa of anterior two-thirds of the tongue, mandibular gums, teeth, motor of masseter, temporalis and pterygoids
How to test trigeminal
sharp to dull on forehead, cheeks, and jaw; temperature sensation by tuning fork; light touch with cotton; cornea with cotton; clench jaw
How to test facial
inspect face for asymmetry, note palpebral fissures, nasolabial, and corners of mouth; elevate his eyebrows, wrinkle forehead, frown, close eyes, show teeth, whistle, smile
Cochlear nerve supplies
organ of corti, structure in cochlea of inner ear which produces nerve impulses in response to sound vibration, hearing
Vestibularsensory nerve supplies
semicircular ducts, proprioception of head and balance
Whisper’s test
position about 2 feet away on right or left side, cover far ear, whisper word, ask pt to repeat, increase tone if pt fails
how to do Weber test
distinguish between neurosensory and conductive hearing loss; tuning fork in motion, place handle against midline of skull, ask pt if heard in both ears, if normal should appear to arise in midline
How to interpret weber test
lateralization of sound: if pt reports hearing better in one ear, neurosensory hearing is intact bilaterally with conductive hearing loss, or conductive hearing is intact bilaterally with neurosensory hearing loss
How to do Rinne test
Distinguish between sensorineural and conductive; set tuning fork in motion, press against mastoid and ask if pt can hear, tell when stop, quickly move to ear and ask if can hear again
Interpreting rinne test
sensorineural hearing loss: tone is heard louder by air than bone, positive test means air conduction is better than bone
How to test glossopharyngeal
sensory of posterior tongue, tonsils, taste; motor tested with vagus, gag reflex
How to test vagus
sensory of pharync, larynx, esophagus and external ear, motor of soft palate, larynx, pharynx and speech, swallowing
Testing glossopharyngeal and vagus
Pharynx: Say ah, gag reflex; larynx: ask pt to swallow water observe for coughing or reflux, evaluate voice
How to test accessory nerve
raise shoulders against resistance, turn head to one side and bring chin back to midline against resistance
How to test hypoglossal
ask pt to protrude tongue, also ask to push tongue on inside of cheek
