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H&P II > Neurological > Flashcards

Neurological Flashcards

1
Q

What are some things to see on a general assessment?

A 
“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
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2
Q

What is a normal orientation?

A

Orientatied x 3

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3
Q

What are some characteristics of speech?

A

“Clear and fluent”
Dysarthric
Aphasic
Voice- nasal, dysphonia, etc

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4
Q

What is the CN I test?

A

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

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5
Q

What should you NOT have the pt smell?

A

noxious stimuli: ammonia- stimulates pain endings of trigeminal nerve

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6
Q

What is PERRLA?

A

Pupillary reflex
Sensory component
Direct and consensual

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7
Q

Which CN’s are involved with the light reflex?

A

In by II out by III

Light stimulus is perceived by CNII (sensory) but constricts by CNIII (motor)

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8
Q

How do u asses peripheral fields?

A

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

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9
Q

What do you look for on an opthalamic exam?

A

Direct visualization of fundus (retina, optic disc, fovea, macula)

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10
Q

How do u test III’s extraocular movements?

A

Assess for nystagmus

Have patient follow an “H”

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11
Q

How do u asses the motor V?

A

Muscles of mastication

Have patient clench teeth while palpating

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12
Q

How do u asses the sensory V?

A

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)

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13
Q

What is the corneal reflex?

A

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

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14
Q

What is the jaw jerk reflex?

A

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.

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15
Q

What is the sensory branch of VII?

A

Taste for anterior 2/3rds of the tongue

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16
Q

How do u test VIII hearing?

A 
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
17
Q

How do u test VIII vestibular?

A

Assess for nystagmus

18
Q

How do u assess IX and X using the uvula?

A

Have patient open mouth and say “Ahh”

Deficiency results in uvula pointing away from the side of the lesion

19
Q

What is the gag reflex?

A

Sensory CN IX, motor CN X
Not routinely tested in awake, screening exam
~20% of people do not have a gag reflex

20
Q

What 2 muscles are associated with XI?

A

trap and SCM

21
Q

How do u test motor XII?

A

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

22
Q

What is the 0/5-5/5 strength testing?

A 
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
23
Q

How can u test the spinothalamic tract?

A

Pain/Sharp vs. dull: use safety pin and discard

Temperature (spinothalamic): cold tuning fork

24
Q

How can u test the posterior columns?

A

Vibration – 128 Hz tuning fork

Proprioception (posterior columns): hold by sides

25
Q

How can u test sensory discrimination?

A

Point localization: patient points to area touched
Extinction: identify right, left, or both
Two point distinction: width on paper clip tips

26
Q

WHat is stereognosis?

A

recognition of familiar object in palm

27
Q

What is graphesthesia?

A

number recognition on palm with eyes closed

28
Q

What is the 0/4-4/4 reflex scale?

A 
0/4 = no response
1/4 = diminished
2/4 = normal
3/4 = somewhat 	increased
4/4 = greatly 	increased, 	clonus
29
Q

What is clonus?

A

Rhythmic series of muscle contractions from stretching the tendon
Rapidly dorsiflex at the ankle and maintain light upward pressure on the sole

30
Q

How do u test cerebellar fxn?

A 
Rapid alternating movements
Fingers to thumb
Tapping palmar then dorsal surfaces to thighs
Dysfunction = Dysdiadochokinesia 
Finger to nose 
Heel to shin
31
Q

What is pronator drift?

A

Arms flexed to 90 degrees at shoulders, shoulder width apart, palms up, close eye
Drifting arm within 30 seconds suggest contralateral corticospinal tract disease

32
Q

What is the romberg test?

A

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

33
Q

What is the brudzinski test?

A

Patient supine, passively flex neck

Positive results in thigh flexion

34
Q

WHat is the kernig test?

A

(k is for knees)
Patient supine, passively flex hip and knee, then straighten leg
Positive results in resistance to knee extension

H&P II (7 decks)

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