Neurological System Flashcards
Neurologic System
,
STRUCTURE AND FUNCTION
,
The central nervous system (CNS) includes the brain and spinal cord.
A)true
B)false
A
The peripheral nervous system includes all the nerve fibers outside the brain and spinal cord: the 12 pairs of cranial nerves, the 31 pairs of spinal nerves, and all their branches.
A)true
B)false
A
The peripheral nervous system carries sensory (afferent) messages to the CNS from sensory receptors, motor (efferent) messages from the CNS out to muscles and glands, as well as autonomic messages that govern the internal organs and blood vessels.
A)true
B)false
A
THE CENTRAL NERVOUS SYSTEM {CNS)
,
cerebral cortex is the cerebrum’s outer layer of nerve cell bodies, which looks like “gray matter” because it lacks myelin.
A)true
B)false
A
Myelin is the white insulation on the axon that increases the conduction velocity of nerve impulses.
A)true
B)false
A
The cerebral cortex is the center for human’s highest functions, governing thought, memory, reasoning, sensation, and voluntary movement
A)true
B)False
A
The ________ is the center for human’s highest functions, governing thought, memory, reasoning, sensation, and voluntary movement
cerebral cortex
Each hemisphere is divided into four lobes: frontal, parietal, temporal, and occipital
A)true
B)false
A
The frontal lobe has areas concerned with personality, behavior, emotions, and intellectual function
A)true
B)false
A
The parietal lobe’s postcentral gyrus is the primary center for sensation.
A)true
B)false
A
• The occipital lobe is the primary visual receptor center.
A)true
B)false
A
• The temporal lobe behind the ear has the primary auditory reception center with functions of hearing, taste, and smell.
A)true
B)false
A
Wernicke’s area in the temporal lobe is associated with language comprehension. When damaged in the person’s dominant hemisphere, receptive aphasia results. The person hears sound, but it has no meaning, like hearing a foreign language.
A)true
B)false
A
Wernicke’s area in the temporal lobe is associated with language comprehension and receptive aphasia results.
A)true
B)false
A
receptive aphasia Means that The person hears sound, but it has no meaning, like hearing a foreign language.
A)true
B)false
A
Broca’s area in the frontal lobe mediates motor speech. When injured in the dominant hemisphere, expressive aphasia results; the person cannot talk. The person can understand language and knows what he or she wants to say, but can produce only a garbled sound.
A)true
B)false
A
Broca’s area in the frontal lobe mediates motor speech,and expressive aphasia results; the person cannot talk.
A)true
B)false
A
expressive aphasia means that the person cannot talk. The person can understand language and knows what he or she wants to say, but can produce only a garbled sound.
A)true
B)false
A
The basal ganglia are large bands of gray matter buried deep within the two cerebral hemispheres that form the subcortical associated motor system (the extrapyramidal system). They help to initiate and coordinate movement and control automatic associated movements of the body (e.g., the arm swing alternating with the legs during walking)
A)true
B)false
A
The basal ganglia help to initiate and coordinate movement and control automatic associated movements of the body (e.g., the arm swing alternating with the legs during walking)
A)true
B)false
A
The thalamus is the main relay station where the sensory pathways of the spinal cord, cerebellum, and brainstem form synapses (sites of contact between two neurons) on their way to the cerebral cortex.
A)true
B)false
A
The hypothalamus is a major respiratory center with basic vital functions: temperature, appetite, sex drive, heart rate, and blood pressure (BP) control; sleep center; anterior and posterior pituitary gland regulator; and coordinator of autonomic nervous system activity and stress response.
A)true
B)false
A
The cerebellum is a coiled structure located under the occipital lobe that is concerned with motor coordination of voluntary movements, equilibrium, and muscle tone. It does not initiate movement but coordinates and smoothes it (e.g., the complex and quick coordination of many different muscles needed in playing the piano, swimming, or juggling). It is like the “automatic pilot” on an airplane in that it adjusts and corrects the voluntary movements but operates entirely below the conscious level.
A)true
B)false
A
The brainstem is the central core of the brain consisting of mostly nerve fibers. Cranial nerves III through XII originate from nuclei in the brainstem.
A)true
B)false
A
I. Midbrain-the most anterior part of the brainstem that still has the basic tubular structure of the spinal cord. It merges into the thalamus and hypothalamus. It contains many motor neurons and tracts.
- Pons-the enlarged area containing ascending sensory and descending motor tracts. It has two respiratory centers (pneumotaxic and apneustic) tl1at coordinate with tl1e main respiratory center in the medulla.
- Medulla-the continuation of the spinal cord in the brain that contains all ascending and descending fiber tracts. It has vital autonomic centers (respiration, heart, gastrointestinal function), as well as nuclei for cranial nerves VIII through XII. Pyramidal decussation (crossing of the motor fibers) occurs here (see p. 625).
Structures of the brainstem
The spinal cord is the long, cylindric structure of nervous tissue about as big around as the little finger. It occupies the upper two thirds of the vertebral canal from the medulla to lumbar vertebrae LI-L2. Its white matter is bundles of myelinated axons that form the main highway for ascending and descending fiber tracts that connect the brain to the spinal nerves. It mediates reflexes of posture control, urination, and pain response. Its nerve cell bodies, or gray matter, arc arranged in a butterfly shape with anterior and posterior “horns.”
A)true
B)false
A
Pathways of the CNS
,
Crossed representation is a notable feature of the nerve tracts; the left cerebral cortex receives sensory information from and controls motor function to the right side of the body, whereas the right cerebral cortex likewise interacts with the left side of the body. Knowledge of where the fibers cross the midline will help you interpret clinical findings.
A)true
B)false
A
Sensory Pathways
,
Sensation travels in the afferent fibers in the peripheral nerve, then through the posterior (dorsal) root, and then into the spinal cord.
A)true
B)false
A
The spinothalamic tract contains sensory fibers that transmit the sensations of pain, temperature, and crude or light touch (i.e., not precisely localized)
A)true
B)false
A
Fibers carrying pain and temperature sensations ascend the lateral spinothalamic tract, whereas those of crude touch form the anterior spinothalamic tract.
A)true
B)false
A
Posterior (Dorsal) Columns. These fibers conduct the sensations of position, vibration, and finely localized touch.
• Position (proprioception)-Without looking, you know where your body parts are in space and in relation to each other
Vibration-Feeling vibrating objects
Finely localized touch (stereognosis)-Without looking, you can identify familiar objects by touch
True
Pain in the right hand is perceived at its specific spot on the left cortex map.
A)true
B)false
A
Some organs are absent from the brain map, such as the heart, liver, or spleen.
A)true
B)false
A
Motor Pathways
,
Corticospinal fibers mediate voluntary movement, particularly very skilled, discrete, purposeful movements, such as writing.
A)true
B)false
A
The corticospinal tract is a newer, “higher,” motor system that permits humans to have very skilled and purposeful movements.
A)true
B)false
A
The tract’s origin in the motor cortex is arranged in a specific pattern called somatotopic organization. It is another body map, this one of a person, or homunculus, hanging “upside down” .
A)true
B)false
A
Extrapyramidal Tracts, These subcortical motor fibers maintain muscle tone and control body movements, especially gross automatic movements, such as walking.
A)true
B)false
A
Cerebellar System. This complex motor system coordinates movement, maintains equilibrium, and helps maintain posture.
A)true
B)false
A
The cerebellum receives information about the position of muscles and joints, the body’s equilibrium, and what kind of motor messages are being sent from the cortex to the muscles.
A)true
B)false
A
Upper and Lower Motor Neurons
,
Upper motor neurons are a complex of all the descending motor fibers that can influence or modify the lower motor neurons. Upper motor neurons are located completely within the CNS.
A)true
B)false
A
Examples of upper motor neurons are corticospinal, corticobulbar, and extrapyramidal tracts.
A)true
B)false
A
Examples of upper motor neuron diseases are cerebrovascular accident, cerebral palsy, and multiple sclerosis.
A)true
B)false
a
Lower motor neurons are located mostly in the peripheral nervous system. The cell body of the lower motor neuron is located in the anterior gray column of the spinal cord, but the nerve fiber extends from here to the muscle
A)true
B)false
A
Examples of lower motor neurons are cranial nerves and spinal nerves of the peripheral nervous system.
A)true
B)false
A
Examples of lower motor neuron diseases are spinal cord lesions, poliomyelitis, and amyotrophic lateral sclerosis.
A)true
B)false
A
THE PERIPHERAL NERVOUS SYSTEM
,
nerve is a bundle of fibers outside the CNS.
A)true
B)false
A
Reflex Arc
,
They are involuntary, operating below the level of conscious control and permitting a quick reaction to potentially painful or damaging situations. _________?
Reflex arc
Reflexes also help the body maintain balance and appropriate muscle tone
A)true
B)false
A
There are four types of reflexes:
(1) Deep tendon reflexes (myotatic), e.g., patellar [or knee jerk]
(2) Superficial, e.g., corneal reflex, abdominal reflex;
(3) Visceral (organic), e.g., pupillary response to light and accommodation;
(4) Pathologic (abnormal), e.g., Babinski (or extensor plantar) reflex.
True
The deep tendon (myotatic, or stretch) reflex has five components:
(1) an intact sensory nerve (afferent);
(2) a functional synapse in the cord;
(3) an intact motor nerve fiber (efferent);
(4) the neuromuscular junction; and
(5) a competent muscle.
True
Cranial Nerves
,
Cranial nerves enter and exit the brain rather than the spinal cord .
A)true
B)false
A
The 12 pairs of cranial nerves supply primarily the head and neck, except the vagus nerve, which travels to the heart, respiratory muscles, stomach, and gallbladder.
A)true
B)false
A
Spinal Nerves
,
The 31 pairs of spinal nerves arise from the length of the spinal cord and supply the rest of the body. They are named for the region of the spine from which they exit: 8 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 1 coccygeal. They are “mixed” nerves because they contain both sensory and motor fibers.
A)true
B)false
A
Dermal segmentation is the cutaneous distribution of the various spinal nerves.
A)true
B)false
A
dermatome is a circumscribed skin area that is supplied mainly from one spinal cord segment through a particular spinal nerve. The dermatomes overlap, which is a form of biologic insurance.
A)true
B)false
A
Autonomic Nervous System
,
The somatic fibers innervate the skeletal (voluntary) muscles;
A)true
B)false
A
the autonomic fibers innervate smooth (involuntary) muscles, cardiac muscle, and glands. The autonomic system mediates unconscious activity.
A)true
B)false
A
DEVELOPMENTAL COMPETENCE
Infants
,
The neurologic system is not completely developed at birth.
A)true
B)false
A
Motor activity in the newborn is under the control of the spinal cord and medulla. Very little cortical control exists, and the neurons are not yet myelinated.
A)infants
B)adults
A
Movements are directed primarily by primitive reflexes.
A)infants
B)adults
A
As the cerebral cortex develops during the first year, it inhibits these reflexes and they disappear at predictable times. Persistence of the primitive reflexes is an indication of CNS dysfunction.
A)infants
B)adults
A
The infant’s sensory and motor development proceed along with the gradual acquisition of myelin, because myelin is needed to conduct most impulses.
A)true
B)false
A
The process of myelinization follows a cephalocaudal and proximodistal order (head, neck, trunk, and extremities). This is just the order in which we observe the infant gaining motor control (lifts head, lifts head and shoulders, rolls over, moves whole arm, uses hands, walks).
A)infant
B)adult
A
Sensation also is rudimentary at birth.
A)true
B)false
A
_____ needs a strong stimulus and then responds by crying and with whole body movements. As myelinization develops, the infant is able to localize the stimulus more precisely and to make a more accurate motor response.
A)infant
B)adult
A
DEVELOPMENTAL COMPETENCE
The Aging Adult
,
The aging process causes a general atrophy with a steady loss of neuron structure in the brain and spinal cord. This causes a decrease in weight and volume with a thinning of the cerebral cortex, reduced subcortical brain structures, and expansion of the ventricles.
A)aging adult
B)infant
A
Neuron loss leads many people older than 65 years to show signs that, in the younger adult, would be considered abnormal, such as general loss of muscle bulk; loss of muscle tone in the face, in the neck, and around the spine; decreased muscle strength; impaired fine coordination and agility; loss of vibratory sense at the ankle; decreased or absent Achilles reflex; loss of position sense at the big toe; pupillary miosis; irregular pupil shape; and decreased pupillary reflexes.
A)aging adult
B)infant
A
The velocity of nerve conduction decreases between 5% and 10% with aging, making the reaction time slower in some older persons. An increased delay at the synapse also occurs, so the impulse takes longer to travel. As a result, touch and pain sensation, taste, and smell may be diminished.
A)aging adult
B)infant
A
The motor system may show a general slowing down of movement. Muscle strength and agility decrease.
A)aging adult
B)infant
A
A generalized decrease occurs in muscle bulk, which is most apparent in the dorsal hand muscles. Muscle tremors may occur in the hands, head, and jaw, along with possible repetitive facial grimacing (dyskinesias).
A)aging adult
B)infant
A
Aging has a progressive decrease in cerebral blood flow and oxygen consumption. In some people, this causes dizziness and a loss of balance with position change. These people need to be taught to get up slowly. Otherwise they have an increased risk for falls and resulting injuries. In addition, older people may forget they fell, which makes it hard to diagnose the cause of the injury.
A)aging adult
B)infant
A
When they are in good health, aging people walk about as well as they did during their middle and younger years, except more slowly and more deliberately. Some survey the ground for obstacles or uneven terrain. Some show a hesitation and a slightly wayward path.
A)true
B)false
A
CULTURE AND GENETICS
,
There is racial/ethnic disparity here because 6% of American Indian/Alaska Natives have had a stroke, 4% of African Americans, 2.6% of Hispanics, 2.3% of whites, and only 1.6% of Asian/Pacific Islanders.
A)true
B)false
A
African Americans, American Indian/ Alaska Natives (AI/ AN), Asian/Pacific Islanders, and Hispanics die from stroke at younger ages than do whites.
A)true
B)false
A
There is geographic disparity; many states with high stroke mortality are concentrated in the U.S. southeast region, called the “stroke belt.” This may occur because of the high proportion of people who live in this region who have two or more of the major modifiable risk factors for stroke (high BP, high cholesterol, diabetes, current smoking, physical inactivity, or obesity).
A)true
B)false
A
The AI/AN men have a higher prevalence of hypertension and high cholesterol than any other racial/ethnic group,
A)true
B)false
A
and AI/ AN women have the highest rate of obesity, current smoking, and diabetes.
A)true
B)false
A
African Americans also have high rates of stroke, and their risk factors are the following: higher prevalence of hypertension and diabetes than whites, and less likely to have BP controlled or diabetes treated than white
A)true
B)false
A
SUBJECTIVE DATA
,
- Headache
- Head injury
- Dizziness/vertigo
- Seizures
- Tremors
- Weakness
- Incoordination
- Numbness or tingling
- Difficulty swallowing
- Difficulty speaking
- Significant past history
- Environmental/occupational hazards
True
Headache. Any unusually frequent or severe headaches?
A) assessing A patient who says “This is the worst headache of my life” needs emergency referral to screen cerebrovascular cause.
B)false
A
Dizziness/vertigo. Ever feel light-headed, a swimming sensation, like feeling faint?
A)assessing Syncope- is a sudden loss of strength, a temporary loss of consciousness (a faint) due to lack of cerebral blood flow (e.g., low BP).
B)false
A
Syncope is a sudden loss of strength, a temporary loss of consciousness (a faint) due to lack of cerebral blood flow (e.g., low BP).
A)true
B)false
A
Do you ever feel a sensation called vertigo, a rotational spinning sensation? (Note: Distinguish vertigo from dizziness.) Do you feel as if the room spins (objective vertigo)? Or do you feel that you are spinning (subjective vertigo)? Did this come on suddenly or gradually?
A)True vertigo is rotational spinning caused by neurologic disease in the vestibular apparatus in the ear or in the vestibular nuclei in the brainstem.
B)false
A
True vertigo is rotational spinning caused by neurologic disease in the vestibular apparatus in the ear or in the vestibular nuclei in the brainstem.
A)true
B)false
A
Seizures. Ever had any convulsions? When did they start? How often do they occur?
A)Seizures occur with epilepsy, a paroxysmal disease characterized by altered or loss of consciousness, involuntary muscle movements, and sensory disturbances.
B)false
A
Seizures occur with epilepsy, a paroxysmal disease characterized by altered or loss of consciousness, involuntary muscle movements, and sensory disturbances.
A)true
B)false
A
Aura is a subjective sensation that precedes a seizure; it could be auditory, visual, or motor.
A)true
B)false
A
Any associated signs-Color change in face or lips, loss of consciousness, for how long, automatisms (eyelid fluttering, eye rolling, lip smacking), incontinence?
A)assessing for seizures
B)false
A
Postictal phase-After the seizure, are you told you spend time sleeping or have any confusion, weakness, headache, or muscle ache?
A)assessing
B)false
A
Tremors. Any shakes or tremors in the hands or face? When did these start? • Do they seem to grow worse with anxiety, intention, or rest? Are they relieved with rest, activity, alcohol? Do they affect daily activities?
A)Tremor is an involuntary shaking, vibrating, or trembling
B)false
A
Tremor is an involuntary shaking, vibrating, or trembling
A)true
B)false
A
Weakness. Any weakness or problem moving any body part? Is this generalized or local? Does weakness occur with any particular movement? (For example, with proximal or large muscle weakness, it is hard to get up out of a chair or reach for an object; with distal or small muscle weakness, it is hard to open a jar, write, use scissors, or walk without tripping.)
A)assessing for Paresis is a partial or incomplete paralysis.
B)Paralysis is a loss of motor function due to a lesion in the neurologic or muscular system or loss of sensory innervation.
C)both a and b
C
Paralysis is a loss of motor function due to a lesion in the neurologic or muscular system or loss of sensory innervation.
A)true
B)false
A
Incoordination. Any problem with coordination? Any problem with balance when walking? Do you list to one side? Any falling? Which way? Do your legs seem to give way? Any clumsy movement?
A)assessing for Dysmetria is the inability to control the distance, power, and speed of a muscular action.
B)false
A
Dysmetria is the inability to control the distance, power, and speed of a muscular action.
A)true
B)false
A
Numbness or tingling. Any numbness or tingling in any body part? Does it feel like pins and needles? When did this start? Where do you feel it? Does it occur with activity?
A)assessing for Paresthesia is an abnormal sensation (e.g., burning, tingling).
B)false
A
Paresthesia is an abnormal sensation (e.g., burning, tingling).
A)true
B)false
A
Difficulty speaking. Any problem spealdng: with forming words or with saying what you intended to say? When did you first notice this? How long did it last?
A)assessing for Dysarthria is difficulty forming words; dysphasia is difficulty with language comprehension or expression
B)false
A
Dysarthria is difficulty forming words;
A)true
B)false
A
dysphasia is difficulty with language comprehension or expression
A)true
B)false
A
Significant past history. Past history of: stroke (cerebrovascular accident), spinal cord injury, meningitis or encephalitis, congenital defect, or alcoholism?
A)assessing
B)false
A
Are you taking any medications now?
A)Review anticonvulsants; anti-tremor, anti-vertigo, pain medication
B)false
A
Additional History for Infants and Children
,
Did you (the mother) have any health problems during the pregnancy: any infections or illnesses, medications taken, toxemia, hypertension, alcohol or drug use, diabetes? A)assessing Prenatal history may affect infant's neurologic development. B)false
A
Does the child seem to have any problem with balance? Have you noted any unexplained falling, clumsy or unsteady gait, progressive muscular weakness, problem with going up or down stairs, problem with getting up from lying position?
A)assessing because If occurs, may not be noticed until starts to walk in late infancy. Screens for muscular dystrophy.
B)false
A
Has this child had any seizures? Please describe. Did the seizure occur with a high fever? Did any loss of consciousness occur- how long? How many seizures occurred with this same illness (if occurred with high fever)?
A) assessing for Seizures may occur with high fever in infants and toddlers. Or, seizures may be sign of neurologic disease
B)false
A
Do you know if your child has had any environmental exposure to lead?
A)assessing for Chronically elevated lead levels may cause a developmental delay or a loss of a newly acquired skill or be asymptomatic
B)false
A
Any family history of seizure disorder, cerebral palsy, muscular dystrophy?
A)assessing
B)false
A
Additional History for the Aging Adult
,
Any problem with dizziness? Does this occur when you first sit or stand up, when you move your head, when you get up and walk just after eating? Does this occur with any of your medications?
A)assessing Diminished cerebral blood flow and diminished vestibular response may produce staggering with position change, which increases risk for falls
B)false
A
For men) Do you ever get up at night and then feel famt while standjng to urinate?
A)assessing for Micturition syncope.
B)false
A
Have you noticed any decrease in memory, change in mental function? Have you felt any confusion? Did this seem to come on suddenly or gradually?
A)assessing Memory loss and cognitive decline are early inrucators of Alzheimer disease and can be mistaken for normal cognitive decline of aging
B)false
A
Have you ever noticed any tremor? Is this in your hands or face? Is this worse with anxiety, activity, rest? Does the tremor seem to be relieved with alcohol, activity, rest? Does the tremor interfere with daily or social activities?
A)assessing for Senile tremor is relieved by alcohol, but this is not a recommended treatment. Assess if the person is abusing alcohol in effort to relieve tremor.
B)false
A
Have you ever had any sudden vision change, fleeting blindness? Did this occur along with weakness? Did you have any loss of consciousness?
A)assessing to Screen symptoms of stroke.
B)false
A
OBJECTIVE DATA
,
PREPARATION
,
Perform a complete neurologic examination on persons who have neurologic concerns (e.g., headache, weakness, loss of coordination) or who have shown signs of neurologic dysfunction.
A)true
B)false
A
test cranial nerves while assessing the head and neck
A)true
B)false
A
EQUIPMENT NEEDED
,
Penlight
Tongue blade
Cotton swab
Cotton ball Tuning fork (128 Hz or 256 Hz)
Percussion hammer (Possibly} familiar aromatic substances (e.g., peppermint, coffee, vanilla}
True
TEST CRANIAL NERVES
,
Cranial Nerve 1-Olfactory Nerve
,
Do not test routinely. Test the sense of smell in those who report loss of smell, those with head trauma, and those with abnormal mental status, and when the presence of an intracranial lesion is suspected
A)true
B)false
A
First, assess patency by occluding one nostril at a time and asking the person to sniff. Then, with the person’s eyes closed, occlude one nostril and present an aromatic substance.
A)true
B)false
A
Use familiar, conveniently obtainable, and non-noxious smells, such as coffee, toothpaste, orange, vanilla, soap, or peppermint. Alcohol wipes smell familiar and are easy to find but are irritating.
A)true
B)false
A
One cannot test smell when air passages are occluded with upper respiratory infection or with sinusitis.
A)true
B)false
A
Anosmia-decrease or loss of smell occurs bilaterally with tobacco smoking, allergic rhinitis, and cocaine use
A)true
B)false
A
Smell normally is decreased bilaterally with aging. Any asymmetry in the sense of smell is important.
A)true
B)false
A
Unilateral loss of smell in the absence of nasal disease is neurogenic anosmia
A)true
B)false
A
Cranial Nerve 2-Optic Nerve
,
Test visual acuity and test visual fields by confrontation
A)true
B)false
A
Using the ophthalmoscope, examine the ocular fundus to determine the color, size, and shape of the optic disc
A)true
B)false
A
Visual field loss and Papilledema with increased intracranial pressure; optic atrophy are all abnormal findings of optic nerve 2
A)true
B)false
A
Cranial Nerves Ill, IV, and VI-Oculomotor, IV, , Trochlear, and Abducens Nerves
,
Palpebral fissures are usually equal in width or nearly so
A)true
B)false
A
Ptosis (drooping) occurs with myasthenia gravis, dysfunction of cranial nerve Ill, or Horner syndrome
A)abnormal finding
B)false
A
Check pupils for size, regularity, equality, direct and consensual light reaction, and accommodation
A)true
B)false
A
Increasing intracranial pressure causes a sudden, unilateral, dilated and nonreactive pupil.
A)abnormal finding
B)false
A
Assess extraocular movements by the cardinal positions of gaze
A)true
B)false
a
Strabismus (deviated gaze) or limited movement
A)abnormal finding
B)false
A
Nystagmus is a back-and-forth oscillation of the eyes. End-point nystagmus, a few beats of horizontal nystagmus at extreme lateral gaze, occurs normally.
A)true
B)false
A
Assess any other nystagmus carefully, noting:
Presence of nystagmus in one or both eyes.
Pendular movement (oscillations move equally left to right) or jerk (a quick phase in one direction, then a slow phase in the other).
Classify the jerk nystagmus in the direction of the quick phase.
Amplitude. Judge whether the degree of movement is fine, medium, or coarse.
Frequency. Is it constant, or does it fade after a few beats?
Plane of movement. Horizontal, vertical, rotary, or a combination?
True
Nystagmus occurs with disease of the vestibular system, cerebellum, or brainstem.
A)true
B)false
A
Cranial Nerve V-Trigeminal Nerve
,
Motor Function. Assess the muscles of mastication by palpating the temporal and masseter muscles as the person clenches the teeth. Muscles should feel equally strong on both sides. Next, try to separate the jaws by pushing down on the chin; normally you cannot.
A)true
B)false
A
Decreased strength on one or both sides. Asymmetry in jaw movement. Pain with clenching of teeth. Abnormal finding in motor function
A)true
B)false
A
Sensory Function. With the person’s eyes closed, test light touch sensation by touching a cotton wisp to these designated areas on person’s face: forehead, cheeks, and chin. Ask the person to say “Now,” whenever the touch is felt. This tests all three divisions of the nerve: (1) ophthalmic, {2) maxillary, and {3) mandibular.
A)true
B)false
A
Decreased or unequal sensation. With a stroke, sensation of face and body is lost on the opposite side of the lesion. Abnormal finding of sensory function
A)true
B)false
A
Corneal Reflex. This test of cranial nerves V and VII was usually omitted unless the person had unilateral sensorineural hearing loss. It involves bringing a wisp of cotton in from the side, lightly touching the cornea, and noting a bilateral blink reflex. However, the corneal reflex may be decreased or absent normally in contact lens wearers and in aging persons. Evidence does not support the usefulness of this test.
A)true
B)false
A
The test is limited clinically because an absent blink occurs in only one third of the cases of acoustic neuroma and only then when the tumor has grown quite large. For cornea reflex
A)true
B)false
A
Cranial Nerve VII-Facial Nerve
,
Motor Function. Note mobility and facial symmetry as the person responds to these requests: smile, frown, close eyes tightly (against your attempt to open them), lift eyebrows, show teeth, and puff cheeks. Then, press the person’s puffed cheeks in, and note that the air should escape equally from both sides.
A)true
B)false
A
Muscle weakness is shown by flattening of the nasolabial fold, drooping of one side of the face, lower eyelid sagging, and escape of air from only one cheek that is pressed in. Abnormal finding of motor function
A)true
B)false
A
Loss of movement and asymmetry of movement occur with both central nervous system lesions (e.g., brain attack or stroke that affects the lower face on one side) and peripheral nervous system lesions (e.g., Bell’s palsy that affects the upper and lower face on one side). Abnormal finding of motor function
A)true
B)false
A
Sensory Function. Do not test routinely. Test only when you suspect facial nerve injury. When indicated, test sense of taste by applying to the tongue a cotton applicator covered with a solution of sugar, salt, or lemon juice (sour). Ask the person to identify the taste.
A)true
B)false
A
Cranial Nerve VIII-Acoustic (Vestibulocochlear) Nerve
,
Test hearing acuity by the ability to hear normal conversation and by the whispered voice test
A)true
B)false
A
Cranial Nerves IX and X-Giossopharyngeal and Vagus Nerves
,
Motor Function. Depress the tongue with a tongue blade, and note pharyngeal movement as the person says “ahhh” or yawns; the uvula and soft palate should rise in the midline, and the tonsillar pillars should move medially.
A)true
B)false
A
Absence or asymmetry of soft palate movement or tonsillar pillar movement. Following a stroke, dysfunction in swallowing may increase risk for aspiration.
A)abnormal finding
B)false
A
Touch the posterior pharyngeal wall with a tongue blade, and note the gag reflex. Also note that the voice sounds smooth and not strained.
A)true
B)false
A
Hoarse or brassy voice occurs with vocal cord dysfunction; nasal twang occurs with weakness of soft palate. Abnormal finding
A)true
B)false
A
Sensory Function. Cranial nerve IX does mediate taste on the posterior one third of the tongue, but technically, this sensation is too difficult to test.
A)true
B)false
A
Cranial Nerve XI-Spinal Accessory Nerve
,
Examine the sternomastoid and trapezius muscles for equal size. Check equal strength by asking the person to rotate the head forcibly against resistance applied to the side of the chin. Then ask the person to shrug the shoulders against resistance. These movements should feel equally strong on both sides.
A)true
B)false
A
Atrophy. Muscle weakness or paralysis occurs with a stroke or following injury to the peripheral nerve (e.g., surgical removal of lymph nodes) are abnormal findings
A)true
B)false
A
Cranial Nerve XII-Hypoglossal Nerve
,
Inspect the tongue. No wasting or tremors should be present. Note the forward thrust in the midline as the person protrudes the tongue. Also ask the person to say “light, tight, dynamite,” and note that lingual speech (sounds of letters I, t, d, n) is clear and distinct.
A)true
B)false
A
Atrophy. Fasciculations. Tongue deviates to side with lesions of the hypoglossal nerve (when this occurs, deviation is toward the paralyzed side). Abnormal finding
A)true
B)false
A
INSPECT AND PALPATE THE MOTOR SYSTEM
,
Muscles
,
Size. As you proceed through the examination, inspect all muscle groups for size. Compare the right side with the left. Muscle groups should be within the normal size limits for age and should be symmetric bilaterally. When muscles in the extremities look asymmetric, measure each in centimeters and record the difference. A difference of 1 cm or less is not significant. Note that it is difficult to assess muscle mass in very obese people.
A)true
B)false
A
Atrophy-abnormally small muscle with a wasted appearance; occurs with disuse, injury, lower motor neuron disease such as polio, diabetic neuropathy
A)true
B)false
A
Hypertrophy-increased size and strength; occurs with isometric exercise.
A)true
B)fallen
A
Strength.Test the power of homologous(same) muscles simultaneously. Test muscle groups of the extremities, neck, and trunk.
A)true
B)false
A
Tone. Tone is the normal degree of tension (contraction) in voluntarily relaxed muscles. It shows as a mild resistance to passive stretch. To test muscle tone, move the extremities through a passive range of motion. First, persuade the person to relflx completely, to “go loose like a rag doll.” Move each extremity smoothly through a full range of motion. Support the arm at the elbow and the leg at the knee. Normally, you will note a mild, even resistance to movement.
A)true
B)false
A
Limited range of motion. Pain with motion. Flaccidity-decreased resistance, hypotonia occur with peripheral weakness.
A)abnormal findings
B)false
A
Spasticity and rigidity- types of increased resistance that occur with central weakness
A)abnormal
B)false
A
Involuntary Movements. Normally, no involuntary movements occur. If they are present, note their location, frequency, rate, and amplitude. Note if the movements can be controlled at will.
A)true
B)false
A
Tic, tremor, fasciculation, myoclonus, chorea, and athetosis abnormal findings
A)true
B)false
A
Cerebellar Function
,
Balance Tests
,
Gait. Observe as the person walks 10 to 20 feet, turns, and returns to the starting point. Normally, the person moves with a sense of freedom. The gait is smooth, rhythmic, and effortless; the opposing arm swing is coordinated; the turns are smooth. The step length is about IS inches from heel to heel.
A)true
B)false
A
Stiff, immobile posture. Staggering or reeling. Wide base of support. Lack of arm swing or rigid arms. Abnormal findings in gait
A)true
B)false
A
Unequal rhythm of steps. Slapping of foot. Scraping of toe of shoe.abnormal finding in gait
A)true
B)false
A
Ataxia-uncoordinated or unsteady gait
A)true
B)false
A
Ask the person to walk a straight line in a heel-to-toe fashion (tandem walking) . This decreases the base of support and will accentuate any problem with coordination. Normally, the person can walk straight and stay balanced.
A)true
B)false
A
Crooked line of walk. Widens base to maintain balance. Staggering, reeling, loss of balance.abnormal findings of walking
A)true
B)false
A
An ataxia that did not appear with regular gait may appear now. Inability to tandem walk is sensitive for an upper motor neuron lesion, such as multiple sclerosis, and for acute cerebellar dysfunction, such as alcohol intoxication
A)true
B)false
A
You may also test for balance by asking the person to walk on his or her toes, then on the heels for a few steps. Normally, plantar flexion and dorsiflexion are strong enough to permit this.
A)true
B)false
A
Muscle weakness in the legs prevents heel walking and toe walking
A)true
B)false
A
The Romberg Test. Ask the person to stand up with feet together and arms at the sides. Once in a stable position, ask the person to close the eyes and to hold the position. Wait about 20 seconds. Normally, a person can maintain posture and balance even with the visual orienting information blocked, although slight swaying may occur. (Stand close to catch the person in case he or she falls.)
A)true
B)false
A
Sways, falls, widens base of feet to avoid falling is a positive Romberg test
A)true
B)false
A
Positive Romberg sign is loss of balance that occurs when closing the eyes. You eliminate the advantage of orientation with the eyes, which had compensated for sensory loss. A positive Romberg sign occurs with cerebellar ataxia {multiple sclerosis, alcohol intoxication), loss of proprioception, and loss of vestibular function.
A)true
B)false
A
. A positive Romberg sign occurs with cerebellar ataxia {multiple sclerosis, alcohol intoxication), loss of proprioception, and loss of vestibular function.
A)true
B)false
A
Ask the person to perform a shallow knee bend or to hop in place, first on one leg, then the other. This demonstrates normal position sense, muscle strength, and cerebellar function. Note that some individuals cannot hop because of aging or obesity. Alternatively, you can ask them to rise from a chair without using the armrests for support.
A)true
B)false
A
Unable to perform knee bend because of weakness in quadriceps muscle or hip extensors.
A)abnormal finding
B)false
A
Coordination and Skilled Movements
,
Rapid Alternating Movements (RAM). Ask the person to pat the knees with both hands, lift up, turn hands over, and pat the knees with the backs of the hands. Then ask the person to do this faster. Normally, this is done with equal turning and a quick, rhythmic pace.
A)true
B)false
A
Lack of coordination. Slow, clumsy, and sloppy response is termed dysdiadochokinesia and occurs with cerebellar disease.
A)true
B)false
A
