Neurological system

Question 1

cerebral cortex

Answer 1

• center for a human’s highest function
• controls thought, memory and reasoning, sensation and voluntary movement

Question 2

basal ganglia

Answer 2

• large bands of gray matter buried deep within the 2 cerebral hemisphere
• helps to initiate and coordinate movement

Question 3

Thalamus

Answer 3

• main relay station where the sensory pathways of the spinal cord, cerebellum, basal ganglia and the brainstem form synapses

Question 4

hypothalamus

Answer 4

• respiratory center with basic vital functions

Question 5

cerebellum

Answer 5

• coiled structure located under teh occipital lobe
• concerned with voluntary mvmts, equalibrium and mm tone

Question 6

brainstem

Answer 6

• central core of the brain consisting of mostly nerve fibers

Question 7

spinal cord

Answer 7

• long cylindric structure of the nervous tissue about as big around as the little finger
• provides tracts that connect the brain to the spinal nerves

Question 8

CN I

Answer 8

OLFACTORY- SMELL
* sensory

Question 9

CN II

Answer 9

OPTIC- NEAR AND DISTANCE VISUAL ACTIVITES
* sensory

Question 10

CN III, IV, & VI

Answer 10

• OCULOMOTOR
• TROCHLEAR
• ABDUCENS
  **EOM movements(6 cardinal positions of gaze),

** (PERRLA)**- increased intracrainial pressure casues a sudden, unilateral, dilated and nonreactive pupil
ptosis- drooping can occur with myasthenia gravis or dysfunctional of CN III

Assess extraocular movements (Cardinal positions of gaze)

Abnormal

strabismus (deviated gaze) or limited movement

nystagmus (back and forth oscillation of the eyes. Can occur with disease of the visibular
system, cerebellum, or brainstem

Question 11

CN V

Answer 11

TRIGEMINAL- clench teeth, light touch on cheeks, forehead and chin

Question 12

CN VII

Answer 12

FACIAL- SMILING, PUFFED CHEEKS, SENSE OF TASTE

Question 13

CN VIII

Answer 13

ACOUSTIC- VESTIBULOCOCHLEAR; HEARING

Question 14

CN IX & X

Answer 14

GLOSSOPHARYNGEAL & VAGUS- UVULA MOVEMENT WHEN THE PATIENT SAYS “AHH” , GAG REFLEX

Question 15

CN XI

Answer 15

SPINAL ACCESSORY- SHOULDER SHRUGGING
* examine sternomastoid and trapezium mm for equal size and strength

• ask pt to rotate the head forcibly against resistance applied to chin
• ask pt to shrug shoulder against resistance
• mm weakness could occur due to stroke or damage to peripheral nerve

Question 16

CN XII

Answer 16

hypoglossal- tounge symmetry
* should be no tremors, midline

Question 17

motor fnx-coordination

Answer 17

• rapid alternating mvmt
• thumb to finger

Question 18

motor function- gait and balance

Answer 18

gait
* Observe as pt. walks 10-20 feet, turn, and returns to starting point
* Gait should be smooth and effortless

Abnormal
* Stiff immobile posture, staggering
* Unequal rhythm of steps, slapping foot, scraping toe of shoe

Balance
Romberg Test
* Have pt stand up with feet together and arms at sides
* Once stable have them close eyes and hold position
* Normally, a pt can maintain posture and balance
* Slight swaying may occur
Abnormal sways, falls, widens feet to avoid falling
* A positive Romberg test = loss of balance. Can occur with multiple sclerosis, alcohol intoxication, loss of proprioception, and poor vestibular
function

Question 19

sensation-pain/sensation

Answer 19

• Break tongue depressor in half so
  you have a sharp side and dull side
• Have patient close eyes
• Press down using both the dull and
  sharp side in random,
  unpredictable order
• Assess x4 extremities in various
  locations on extremity
• Patient should be able to
  distinguish between sides by saying
  sharp or dull

Question 20

sensation

Answer 20

Have patient close eyes
* Place familiar object in hand

• Have patient identify
• Test both hands
• Astereognosis – inability to
  identify object correctly. Can
  occur with stroke

Question 21

reflexes-Deep tendon

Answer 21

Most common =
patellar/quadriceps
* Have patient relax limb
* Stimulate the reflex by directing a
short, snappy blow of the hammer
onto the tendon of muscle

• Use a relaxed hold on the hammer,
  the action takes place in your wrist
• It is not the force of the strike, it’s
  the swing of the hammer that gets
  the result

Ranking reflexes
* 4+ = very brisk, hyperactive (disease)
* 3+ = brisker than average (usually
normal)
* 2+ = average, expected
* 1+ = diminished
* 0 = No response

Question 22

Reflexes – Plantar

Answer 22

Position thigh in slight external rotation
* Use hammer to draw a slow (5-6 sec)
stroke up the lateral side of the sole of
the foot and inward across the ball of the
foot

• Like an upside-down J

Normal:
* plantar flexion of the toes and inversion of
the foot
Abnormal
Babinski sign: positive is dorsiflexion of the
foot and fanning of toes.
* Occurs with brain injury, stroke, brain
tumor, Lou Gehrig Disease, MS, Spinal Cord
injury

Question 23

Peripheral nervous system

Answer 23

includes all the never fibers outside of the brain and spinal cord
* carries messages from the central nerovous system to the mm and glands

Question 24

reflexes

Answer 24

• basic defense mechanisms of the nervous system
• involuntary, operating below the level of conscious control and permitting a quick reaction to potentially painful or damaging situations
• helps the body maintain balance and appropriate muslce tone

Question 25

autonomic nervous system

Answer 25

* involuntary mm, cardiac mm & glands * function is to maintain homeostasis in the body

Question 26

subjective assesment of the neurological system

Answer 26

ask questions that investigate headaches or head injuries; dizziness, vertigo, or seizures; tremors, weakness, numbness, tingling, and incoordination; difficulty swallowing or speaking; patient-centered care; and environmental/occupational hazards.

Question 27

objective assessments of the neurological system

Answer 27

* Mental status * Cranial nerves * Motor system * Sensory system * Reflexes