Neurological Flashcards
Assess level of consciousness
- Alert
- Confused
- Drowsy
- Stupor
- Coma
assess emotional responses
- Affect: how does pt appear
- Mood: how does pt fee
- Speech and vocab
assess behaviors/thoughts
- how pt acts
- how pt thinks
- what pt thinks about
- report if pt is suicidal
- be aware what affects some drugs can have on behavior
Mental status exam
- Recent memory: repeat 3 words and recall in 3-5 min
- remote memory: important past events
- Orientation: person, place,and time
- current events
- judgement
- abstraction
- calculation ability
- object recognition
Mini-Cog
- give 3 words to remember
- clock drawing test
- recall the 3 words
Mini-Cog score
- Recall 0: impaired
- Recall 1-2 w/abnormal clock: impaired
- Recall 1-2 w/normal clock: not impaired
- Recall 3: not impaired
Cranial nerve mnemonic
O - on O - old O - Olympus T - towering T - tops A - A F - Finn A - and G - German V - viewed S - some H - hops
cranial nerve mnemonic for function (S=sensory, M=motor, B=both)
S - some S - say M - marry M - money B - but M - my B - brother S - says B - bad B - businesses M - marry M - money
CNI
olfactory
CNII
optic (visual acuity)
- test snellen chart
- visual fields
- pupillary response
CNIII
oculomotor
- observe for ptosis
- test EOMI
- test pupillary rxn to light
CNIV
trochlear
- test EOMI (inward and down)
CNV
trigeminal
- test temporal and masseter muscle strength
- ask pt to close eyes and tell you if they feel sharp or dull
CNVI
abducens
- test EOMI (lateral)
which cranial nerves are responsible for extraocular movements
3, 4, and 6
which cranial nerves are responsible for pupillary reflexes
2 and 3
CNVII
facial
- observe facial droop or asymmetry
- ask pt to raise eyebrows and close eyes to resistance
CNVII
Acoustic
- hearing, balance, nystagmus
- screen hearing
- test lateralization (weber)
- compare air/bone (rinne)
CNIX and X
Glossopharyngeal and X - vagus:
- gag, palatal movement, and phonation
- listen to pts voice
- ask pt to swallow, say “ah”
- test gag reflex
CN XI
Accessory
- shrug shoulder and turn head
CNXII
Hypoglossal
- stick out tongue
Peripheral nervous system
- sensory function
- motor function
- reflexes
- cerebellar function
Sensory exams
- microfilament - light touch
- sharp vs dull pain
- temperature (cold) sensation
- vibration with tuning fork
Motor exams
- observe: involuntary mvmts, muscle symmetry, muscle atrophy
- muscle strength (out of 5)
- ROM
Reflexes
- deep tendon - depends on force of stimulus
- corresponds to spinal cord segment and peripheral nerves
Biceps reflex
C5 and C6
Triceps reflex
C6 and C7
Brachioradialis
C5 and C6
Knee
L2, L3, L4
Ankle
S1 and S2
Clonus
if reflexes seem hyperactive, test for clonus
- Support the knee in a partly flexed position.
- With the patient relaxed, quickly dorsiflex the foot.
- Observe for rhythmic oscillations
Coordination and Gait: rapid alternating movements
- Ask the patient to strike one hand on the thigh, raise the hand, turn it over, and then strike it back down as fast as possible.
- Ask the patient to tap the distal thumb with the tip of the index finger as fast as possible.
- Ask the patient to tap your hand with the ball of each foot as fast as possible.
Coordination and gait: point-to-point movements
- Ask the patient to touch your index finger and his/her nose alternately several times. Move your finger about as the patient performs this task.
- Hold your finger still so that the patient can touch it with one arm and finger outstretched. Ask the patient to move arm and return to your finger with eyes closed
Coordination and gait: heel-to-shin test
Ask the patient to place one heel on the opposite knee and run it down he shin to the big toe. Repeat with the patient’s eyes closed
Coordination and gait: Romberg
- Be prepared to catch the patient if unstable.
- Ask the patient to stand with feet together and eyes closed for 5-10 seconds without support.
- Positive if the patient becomes unstable (vestibular or proprioceptive problem).
Coordination and gait: pronator drift
- Ask the patient to stand for 20-30 seconds with both arms straight forward, palms up, and eyes closed.
- Instruct the patient to keep the arms still while you tap them briskly downward.
- The patient will not be able to maintain extension and supination (and “drift into pronation”) with upper motor neuron disease
Coordination and gait: gait
Walk across the room, turn and come back. Walk heel-to-toe in a straight line. Walk on toes in a straight line. Walk on heels in a straight line. Rise from a sitting position.
