Neurological Flashcards
What are some things to see on a general assessment?
“Awake, alert, NAD” Level of alertness Comfort, distress Posture Obvious extremity weakness Obvious muscle atrophy Involuntary movements Tremor- resting, postural, intention, action Chorea, ballismus, myoclonus, athetosis, tics, etc
What is a normal orientation?
Orientatied x 3
What are some characteristics of speech?
“Clear and fluent”
Dysarthric
Aphasic
Voice- nasal, dysphonia, etc
What is the CN I test?
Have the patient close their eyes
Occlude one nare at a time and insure patency
Place smell source under one side with the other occluded (ipsilateral)
Identify a separate smell on each side- Use familiar scents
Orange, mint
What should you NOT have the pt smell?
noxious stimuli: ammonia- stimulates pain endings of trigeminal nerve
What is PERRLA?
Pupillary reflex
Sensory component
Direct and consensual
Which CN’s are involved with the light reflex?
In by II out by III
Light stimulus is perceived by CNII (sensory) but constricts by CNIII (motor)
How do u asses peripheral fields?
Provider stands in front of patient
Each covers an eye
Direct patient to look at provider’s eye
Provider puts up varied number of fingers midway between patient and self
Provider should be able to see the fingers
What do you look for on an opthalamic exam?
Direct visualization of fundus (retina, optic disc, fovea, macula)
How do u test III’s extraocular movements?
Assess for nystagmus
Have patient follow an “H”
How do u asses the motor V?
Muscles of mastication
Have patient clench teeth while palpating
How do u asses the sensory V?
Sensory Branch- V 1, 2, 3
Face sensation to light touch, sharp/dull
Breaks into three branches: forehead, cheek and jaw; *not angle of jaw (great auricular nerve)
What is the corneal reflex?
CN V & VII
Touch cornea with strand of cotton ball with lateral approach
May be diminished in contact wearers
Not routinely tested in awake, screening exam
Useful in uncooperative patient or facial problem
What is the jaw jerk reflex?
N V & V
Not routinely tested
The examiner places their index finger over the middle of the patient’s chin with the mouth slightly open and the jaw relaxed.
The index finger is then tapped with a reflex hammer, delivering a downward stroke.
Normal Response:the jaw should not deviate to either side.the jaw-jerk is usually absent or weakly present.
Abnormal Response:the jaw deviates towards the side of weakness.the jaw-jerk is exaggerated and pathologically brisk with lesions affecting the pyramidal pathways above the 5th nerve motor nucleus, especially if the lesions are bilateral.
What is the sensory branch of VII?
Taste for anterior 2/3rds of the tongue
How do u test VIII hearing?
Whispered word or finger rub Occlude opposite ear Have patient repeat whispered word Document as “whispered word intact at 12” bilaterally See HEENT Flow for deficiency testing
How do u test VIII vestibular?
Assess for nystagmus
How do u assess IX and X using the uvula?
Have patient open mouth and say “Ahh”
Deficiency results in uvula pointing away from the side of the lesion
What is the gag reflex?
Sensory CN IX, motor CN X
Not routinely tested in awake, screening exam
~20% of people do not have a gag reflex
What 2 muscles are associated with XI?
trap and SCM
How do u test motor XII?
Have patient stick out the tongue
Should protrude midline
Deviates to the side of the lesion with peripheral lesions “lick your wounds”
Observe tongue for fasciculations
What is the 0/5-5/5 strength testing?
0/5 = no muscle twitch with attempted movement 1/5 = Twitch 2/5 = Movement against horizontal plane but not against gravity 3/5 = Movement against gravity but not resistance 4/5 = Movement against some resistance 5/5 = Movement against full resistance
How can u test the spinothalamic tract?
Pain/Sharp vs. dull: use safety pin and discard
Temperature (spinothalamic): cold tuning fork
How can u test the posterior columns?
Vibration – 128 Hz tuning fork
Proprioception (posterior columns): hold by sides
How can u test sensory discrimination?
Point localization: patient points to area touched
Extinction: identify right, left, or both
Two point distinction: width on paper clip tips
WHat is stereognosis?
recognition of familiar object in palm
What is graphesthesia?
number recognition on palm with eyes closed
What is the 0/4-4/4 reflex scale?
0/4 = no response 1/4 = diminished 2/4 = normal 3/4 = somewhat increased 4/4 = greatly increased, clonus
What is clonus?
Rhythmic series of muscle contractions from stretching the tendon
Rapidly dorsiflex at the ankle and maintain light upward pressure on the sole
How do u test cerebellar fxn?
Rapid alternating movements Fingers to thumb Tapping palmar then dorsal surfaces to thighs Dysfunction = Dysdiadochokinesia Finger to nose Heel to shin
What is pronator drift?
Arms flexed to 90 degrees at shoulders, shoulder width apart, palms up, close eye
Drifting arm within 30 seconds suggest contralateral corticospinal tract disease
What is the romberg test?
Feet together, arms flexed to 90 degrees at the shoulder, palms up, close eyes
Guard against patient falling and reassure patient but do not support the patient
Note imbalance within 30 seconds
Minimal swaying should occur
What is the brudzinski test?
Patient supine, passively flex neck
Positive results in thigh flexion
WHat is the kernig test?
(k is for knees)
Patient supine, passively flex hip and knee, then straighten leg
Positive results in resistance to knee extension
