Neurological Assessment 4

Question 1

CN I

Answer 1

Olfactory (smell); Sensory—correctly identifies scents with each nostril; Some elderly have decrease smell; inspect both nares

Question 2

CN II

Answer 2

Optic; Sensory—read at 20/20; Snellen chart—test with corrective lens; Visual fields by confrontation—8 peripheral area; Ophthalmoscopic Exam

Question 3

CN III, IV, VI

Answer 3

Oculomotor, Trochlear, Abducens (eye movement); Motor function; Exam together to assess extraocular movements; 6 cardinal fields of gaze; Pupillary response to light; Accommodation; Convergence; also look at eyelids - droops could be damage to CN III

Question 4

CN V

Answer 4

Trigeminal; Both motor and sensory function; Motor - Temporal and masseter muscles contract (jaw, clenched teeth); Sensory - 3 major components/areas: Ophthalmic (forehead), Maxillary (cheek), Mandibular (chin); Corneal reflex

Question 5

CN VII

Answer 5

Facial; Both motor and sensory function; Motor (perform voluntary facial movement) - Smile, frown, wrinkle forehead, show teeth, puff out cheeks, purse lips, raise eyebrows, close eyes against resistance; Sensory - Identifies correct taste on anterior two thirds of tongue

Question 6

CN VIII

Answer 6

Acoustic (hearing); Sensory function; Able to distinguish whispered words from 1-2 feet; Romberg test; Weber—lateralization; Rinne—AC>BC

Question 7

corneal reflex

Answer 7

• tested on unconscious pt, pt should blink when cornea is touch w/ sterile cotton swab

Question 8

Romberg test

Answer 8

also for cerebellum function; stand w/ legs together and arms out in front, w/ eyes open then w/ eyes closed’ tests equilibrium

Question 9

Weber Test

Answer 9

lateralization; tuning fork, should ear equal bilaterally on top of head

Question 10

Rhinne Test

Answer 10

air conduction greater than bone conduction; w/ tuning fork behind ear, have pt tell when they hear sound stop then move out to ear

Question 11

air conduction of sound is **

Answer 11

twice as greater as bone conduction

Question 12

CN IX and X

Answer 12

Glossopharyngeal and Vagus; Both motor & sensory function; Motor - Uvula & soft palate rise with “ah”; Gag reflex; Swallow without difficulty; Sensory - Identify correct taste on posterior one-third of tongue

Question 13

Gag reflex—

Answer 13

touch posterior pharynx

Question 14

CN XI

Answer 14

Spinal Accessory; Motor function - muscle strength; Symmetric, strong contraction of neck muscles; no fasciculations noted; shrug shoulders against resistance; turn head against resistance

Question 15

CN XII

Answer 15

Hypoglossal; Motor function; Tongue symmetric with smooth movements and bilateral strength; no fasciculations; Protrude tongue & test strength; have pt say sentence w/ letters D L N T; have tongue push against resistance

Question 16

sensory function

Answer 16

Apply stimuli to person’s skin surface and note ability to perceive and identify stimulus

Question 17

stimuli used

Answer 17

Light touch; Pain; Temperature; Vibration; Stereognosis; Graphognosis; Two-point discrimination

Question 18

light touch

Answer 18

use cotton swab

Question 19

pain

Answer 19

use something sharp (tooth pick)

Question 20

temperature

Answer 20

warm vs cold

Question 21

vibration

Answer 21

use tuning fork

Question 22

stereognosis

Answer 22

ability to recognize a solid object

Question 23

graphognosis

Answer 23

ability to understand outlines of shapers or numbers

Question 24

two-point discrimination

Answer 24

touch at 2 different points and ask where locations are, patient should have eyes closed

Question 25

cerebellar function

Answer 25

Evaluate balance and coordination; Evaluate sensory association

Question 26

Evaluate balance and coordination

Answer 26

Finger to nose; Hand movements (Pronate & Supinate); Romberg test; Heel down shin

Question 27

reflexes

Answer 27

use reinforcement techniques; do not overly test reflex; use reflex hammer

Question 28

reflex grading scale

Answer 28

4+ hyperactive, very brisk, clonus; 3+ more brisk than normal, but not indicative of disease; 2+ normal; 1+ decreased, less than normal; 0 absent

Question 29

reinforcement techniques

Answer 29

clinch teeth when testing arm reflexes; Interlock & tense hands (pull apart)

Question 30

if someone has low calcium then they are

Answer 30

twitching

Question 31

deep tendon reflex: biceps

Answer 31

elbow flexes

Question 32

deep tendon reflex: triceps

Answer 32

elbow extends

Question 33

deep tendon reflex: brachioradalis

Answer 33

foreman flexes and supinates

Question 34

deep tendon reflex: patellar

Answer 34

knee extends

Question 35

deep tendon reflex: achilles

Answer 35

plantar flexion of foot

Question 36

deep tendon reflex: ankle clonus

Answer 36

No rapid oscillations (clonus) with brisk dorsi-flexion of foot

Question 37

superficial reflexes

Answer 37

either positive or negative; plantar reflex, abdominal reflex, cremasteric reflex

Question 38

Plantar reflex

Answer 38

Flexion of the toes is normal; Babinski response is abnormal in adult; normal in infancy

Question 39

meningeal inflammation

Answer 39

Brudzinski’s sign; Kernig’s sign; Nuchal rigidity

Question 40

Brudzinski’s sign

Answer 40

Flexion of hips/knees is a positive sign

Question 41

Kernig’s sign

Answer 41

Pain and increased resistance to extending the knee is a positive sign

Question 42

Nuchal rigidity

Answer 42

Pain and increased resistance to flexion of neck

Question 43

brainstem functioning

Answer 43

hold eyes open and turn patients head to 1 side quickly then to the other side