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N143 Final exam > Neurological > Flashcards

Neurological Flashcards

1
Q

Older adults developmental considerations

A

atrophy & loss of neurons in brain & spinal cord

  • decrease weight & volume of brain
  • decrease muscle strength & impaired fine coordination
  • Slowed reaction time
  • Dizziness & loss of balance
  • irregular pupil shape
  • decreased cerebral blood flow
  • dyskinesias( reparative grinning)
  • postural hypotension
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2
Q

What subjective data for neurological health history

A
  • Headache
  • head injury
  • dizziness or vertigo
  • seizures
  • tremors
  • weakness
  • incoordination
  • numbness or tingling
  • difficulty swallowing
  • difficulty speaking
  • significant past history
  • environmental or occupational hazards
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3
Q

Additional Neurological subjective info for infant & child

A
  • Maternal health
  • Neonatal period
  • reflexes
  • weakness & balance
  • seizures
  • physical development
  • Environemental hazards
  • cognitive development
  • family history
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4
Q

Additional neurological subjective for older adults

A
  • risk for falls
  • cognitive function
  • tremor
  • vision
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5
Q

Objective data for Neurological assessment

A
  • Mental status
  • crainal nerves
  • inspect & palpate motor system
  • assess sensory system
  • test the reflexes
  • neuro recheck overtime
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6
Q

CRANIAL NERVES HOW TO REMEMBER

A

OOOTTAFVGVAH
SSMMBMBSBBMM
1) Olfactory (smell)
2) Optic (sight)
3) Oculomotor ( moves eye)
4) Trochlear ( oblique eye muscle)
5) Trigeminal ( Sensory from face & mouth & chewing)
6) Abducens (moves eye)
7) Facial ( facial expression & taste)
8) Vestibulocochlear (hearing & equilibrium)
9)Glossopharyngeal (Gagging & swallow & taste )
10) Vagus (Gag, swallow, speech)
11) Spinal accessory ( head & shoulder movement)
12) Hypoglossal (tongue movement)

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7
Q

How to test cerebellar function

A
  • Balance tests (Gain, Tandem walking, Romberg test, shallow knee bend)
  • Coordination & skilled movements (rapidly alternating movements, finger to finger, finger to noes, heel to shin test)
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8
Q

What is the romberg test

A

Stand upright & close eyes. A loss of balance is a positive sign. A patient who has a problem with Proprioception (Somatosensory) can still maintain balance by compensating with vestibular function and vision. Tests cerebellar function

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9
Q

What are you looking for when you assess the sensory system

A
  • intactness of peripheral nerve fibres, sensory tracts, and higher cortical discrimination.
  • Person is alert, cooperative & comfortable
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10
Q

How to test the Spinothalamic tract

A

-Pain, temp, light touch

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11
Q

how to test the posterior column tract

A
  • vibration
  • position/kinesthesia
  • tactile discrimination (fine touch)
  • Stereognosis, Graphesthesia, 2 point discrimination, extinction, point location
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12
Q

what is stereognosis

A

perception of depth

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13
Q

what is graphesthesia

A

the ability to recognize writing on the skin purely by the sensation of touch

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14
Q

Which are the deep tendon/ stretch reflexes

A

Patellar & achilles

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15
Q

what are the superficial reflexes

A
  • abdominal reflex
  • cremasteric reflex
  • plantar reflex
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16
Q

What are the developmental considerations for an infant

A
  • Spontaneous waking & response to environment
  • cranial nerves cannot be directly tested
  • motor system: Nopissing district development screen
  • head control
  • reflexes: Babinski, Palma, moro, rooting, tonic neck, sucking
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17
Q

What are the developmental considerations for preschool & school age

A
  • observe them undress
  • developmental milestones
  • test balance, fine motor coordination
  • lack of reliability in sensation testing
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18
Q

What are the developmental considerations for older adults

A

decrease in muscle bulk

  • senile tremors
  • dyskinesia (abnormal/impaired voluntary movement)
  • Difference in gait
  • loss of ankle jerk
  • less brisk
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19
Q

Order of Neurological recheck

A

1) mental health
2) cranial nerves
3) Motor system
4) sensory system
5) Reflexes

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20
Q

What part of brain regulates vital signs

A

Hypothalamus

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21
Q

what part of brain regulates motor coordination & equilibrium

A

cerebellum

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22
Q

what part of the brain regulates movement (autonomic associated movements)

A

basal ganglia

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23
Q

what part of the brain regulates nerve impulse conduction

A

cerebral cortex ( grey matter)

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24
Q

what part of the brain is for sensory

A

Spinal cord, brain stem & parietal lobe

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25
Q

What part of the brain is for motor speech

A

brocas area

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26
Q

what does the frontal lobe do

A

personality, behaviour, emotions, intellectual function

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27
Q

what does the pre-central gyrus do

A

voluntary movement

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28
Q

what does the parietal lobe/ post central gyrus do

A

sensation

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29
Q

what is the occipital lobe for

A

vision

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30
Q

what is the temporal lobe for

A

auditory

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31
Q

what is the wernickes area for

A

language comprehension

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32
Q

what could a damaged wernickes cause

A

receptive aphasia: hear sound but no meaning

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33
Q

what happens if u damage ur broca’s area

A

Expressive aphasia: can’t talk but understands what everything means & wants to talk

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34
Q

Damage to any area in the cerebral cortex/ cerebrum can cause:

A

moto weakness
paralysis
loss of sensation
impaired ability to understand & process language

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35
Q

What does the hypothalamus do

A

control temp, hr, bp, sleep,

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36
Q

what does the medulla do

A

autonomic centers (resp, cardiac, GI)

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37
Q

What do the extrapyramidal motor pathways do

A

maintain muscle tone, gross movements (walk)

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38
Q

what does the cerebellar motor pathway do

A

things you aren’t aware of doing like flexing back

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39
Q

What is a reflex arc

A

involuntary quick run to potentially painful event

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40
Q

what does somatic mean

A

voluntary (skeletal)

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41
Q

what does visceral mean

A

involuntary (cardiac & smooth muscle)

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42
Q

what inhibits infants reflexes

A

cerebellar function

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43
Q

what is subjective vertigo

A

u spin

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44
Q

what is objective vertigo

A

room spins

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45
Q

what is syncope

A

sudden loss of stenght or temporary loss of consciousness (fainting) causes by lack of cerebral blood flow, occurs with low BP

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46
Q

what is true vertigo

A

feeling of ratational spinning

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47
Q

what is a paresis

A

weakness of voluntary movements

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48
Q

what is dysmetria

A

inability to control ROM of muscles

49
Q

what is paraesthesia

A

abnormal sensation ( burn or tingle)

50
Q

what is dysarthria

A

difficulty forming words

51
Q

what is dysphagia

A

difficulty swallowing

52
Q

what is dysphasia

A

difficulty with langue comprehension or expression

53
Q

what are significant past history

A

stroke, spinal cord injury, meningitis, encephalitis, cognitive defect, alcoholism

54
Q

What are some critical findings

immediate interventions or transport to hospital needed

A
  • Sudden decrease alertness/consciousness
  • sudden change in speech
  • signs of stroke
  • sudden onset of severe headache
  • signs of raised intracranial pressure
  • onset of weak, numb, eye movement problems, double viison
  • sudden seizures
  • sudden extreme lethargy
55
Q

When would u do a screening neurological exam

A

seemingly health patient with a history of no significant findings

56
Q

when would you do a complete neurological exam

A

a pt. with neurological concern or sign of disfunction

57
Q

when would you do a neurological recheck

A

pt with neurological deficits who require periodic reassessment

58
Q

how should pt. be for neurological exam

A

pt. sit up right with head @ eye level

59
Q

How to test olfactory nerve

A
  • not routine, only if loss of smell, head trauma, abnormal mental status, or intercrainal lesion
    1) patentcy
    2) occlude + a scent
60
Q

what is anosmia

A

decrease or loss of smell

-bilaterally with smoking, allergies or cocaine

61
Q

what is neurogenic anosmia

A

unilateral loss w/o nasal disease or trauma

62
Q

What would u inspect for optic never

A
  • visual acuity
  • fields of vision via confrontation
  • papilledema with increase pressure
63
Q

Testing the oculomotor, trochlear & abducens

A

-Pupil: Size, regularity, equality, direct light reaction, accommodation

64
Q

what is ptosis & what cranial nerve

A

drooping of eye & oculomotor

65
Q

what is strabismus

A

deviated gaze & limited movement

66
Q

what is nystagmus

A

back & forth oscillation of eyes

occurs with disease of vestibular, cerebellum or brain stem

67
Q

how to test trigeminal nerve

A
  • palpate temporal & masseter muscle
  • clench teeth
  • close eyes touch face
  • should blink when you bring cotton near eye
68
Q

how to test facial nerve

A

motor: symmetry & muscle weakness

Sensory function: not routine. cotton soaked with lemmon

69
Q

what is bells palsy

A

lower/upper on one side of face

70
Q

how to test vestibulocochlear nerve

A

whisper

71
Q

how to test glossopharyngeal & vagus nerve

A

Depress tongue & note soft palate symmetry

  • uvula should deviate to one side
  • symmetry of tonsillar pillar
  • gag
  • voice smooth (not hoarse or twang)
  • sensory not tested (posterior tongue)
72
Q

How to test spinal acessory nerve

A

head rotate against hand & shrug

73
Q

how to test hypoglossal nerve

A

inspect tongue for wasting, symmetry, midline, tutors or tremors
-say light tight dynamite

74
Q

size of muscles

A

1cm different is insignificant

  • atrophy = small bc disease injury, polio or diabetic neuropathy
  • hypertrophy
75
Q

what is flaccidity vis spasticity

A 
flaccidity = decreased resistance 
spasticity = increased resistance
76
Q

What are the 2 balance tests

A

gain & Romberg

77
Q

what is gait test

A

smooth, rhythmic, opposing arm swing

78
Q

what is ataxia

A

involves uncoordinated or or unsteady gait

79
Q

what would not being able to do tandem walk indicate

A

upper motor neuron lesion

80
Q

what is dysdiabochokinesia

A

lack of coordination or slow & sloppy

can mean cerebellar disease

81
Q

what is demetria

A

clumbsy movement could mean cerebellar disorder or alcohol

82
Q

what is the pain/pinprick test for

A

randomly alternate sharp & dull with 2s in between to avid summation

83
Q

what is hypolgesia & hyperalgesia

A

increase & decreased pain sensation

84
Q

what is analgesia

A

absence of pain sensation

85
Q

how do you do light touch

A

cotton ball on different parts

86
Q

what is hypoaesthesia , hyper & anesthesia

A

decreased touch feel, increased feeling of touch & absent

87
Q

what would inability to feel vibration mean

A

peripheral neuropathy/ diabetes/ alcoholism

-worst at feet

88
Q

if they have problems with tactile discrimination it could mean

A

lesion of the sensory cortex or pos. column

89
Q

where is the most sensitive

A

finger least = upper arm, thigh & back

90
Q

what is stereognosis

A

identify item with eyes closed

so astereognosis = inability to identify (stroke symptom)

91
Q

how are reflexes graded

A 
4+ = brisk, hyperactive w/ clonus disease(not good) 
3+ = brisker than ave, maybe disease
2+ = average and normal 
1+ = diminished /low 
0= nothing
92
Q

what is hyper & hyporeflexia

A 
exaggerated reflex (upper motor neuron lesion or stroke)
and reduced functioning of reflex ( spinal cord injury)
93
Q

Biceps reflex

A
  • hold arm, strike bicep tendon

- it contract & flex

94
Q

triceps reflex

A
  • tap triceps tendon above elbow

- extension

95
Q

brachioradialis reflex

A
  • hod thumb, strike forearm 2-3 cm above raid styloid process
  • flexion & supination od arm
96
Q

quad/patellar reflex

A
  • strike just below patella

- extension of leg & quad contract

97
Q

achilles reflex

A
  • stike achilles

- plantar flexion occurs

98
Q

clonus reflex

A

move foot up and down to relax, dorsiflex & it should just not move

99
Q

abdominal reflex

A

-abs should tighten when stroke skin

100
Q

cremasteric reflex

A

stroke inner right, elevation of ipsilateral testical

101
Q

plantar reflex

A

stroke sole upward, should have flexion, abnormal would be fanning

102
Q

what is opisthotonos

A

head arched back, stiff neck, extended limbs in baby

occurs with meningeal or brainstem irritation

103
Q

babies usually have

A

hypoaesthesia

hyperasetheia could mean a spinal cord lesion, CNS infection, inter cranial pressure

104
Q

what is the rooting reflex

A

brush cheek turn head (3/4m)

105
Q

what is the sucking reflex

A

tough lip will suck (till 10/12m)

106
Q

what is palmar reflex

A

offer finger will grasp (till 3/4 mo)

107
Q

what is plantar grasp

A

toes curl ( 8/10mo)

108
Q

what is babinski reflex

A

toes fan till 2 yr

109
Q

what is tonic neck reflex

A

supine, turn head to side, ipsilateral extension of arm & leg, flexion of opposite side
-till 6 mo

110
Q

what is moro reflex

A

startle - abduction & extension of arms, fan fingers

till 4 months

111
Q

65+ =

A

loss of vibration sensation in ankle & loss of achilles

112
Q

what is the earliest most sensitive indication of change

A

level of consciousness

113
Q

stimulus to awaken

A

1) call name
2) light touch
3) vigorous shoulder shake
4) pain applied

114
Q

Glasgow coma scale

A

original designed for head trauma, assess function of entire brain, standardized
fully alert = 15
coma = 7 or less
limitation: inconsistence, impossibility or verbal score

115
Q

what is decorticate rigidity

A

-hemespheric lesion of cerebral cortex
-felxed arm, wrist, fingers, abducted,
legs extended & internal rotate with plantar flex

116
Q

what is decerebrate rigidity

A

lesion @ midbrain or upper pons

-arms stiffly extended, plantar flexion, palms pronated, legs extended & teeth clenched

117
Q

what is flaccid quadriplegia

A

nonfunctional brainstem

complete loss of muscle. tone & paralysis

118
Q

what is osisthotanos

A

meningeal irritation

-prolonged back arch with head & heels bent backwards

N143 Final exam (11 decks)

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