Neurological System

Question 1

reflexes

Answer 1

deep tendon reflex, superficial or cutaneous reflex, pathological reflex

Question 2

deep tendon reflex

Answer 2

elicited by tapping a tendon

Question 3

superficial or cutaneous reflex

Answer 3

obtained by stimulating the skin

Question 4

pathological reflex

Answer 4

usually present only in disease

Question 5

reflex scale

Answer 5

0: no response
1+: low normal, slightly diminished 
2+: normal
3+: more brisk than normal, not indicative of disease
4+: brisk, hyperactive, clonus

Question 6

Biceps

Answer 6

palpate the biceps tendon in the antecubital fossa, place your thumb on the tendon, strike your thumb with the hammer

normal response: palpable flexion of the elbow

Question 7

Triceps

Answer 7

flew elbow 90 degrees, strike tendon directly, just above the elbow

normal response: palpable extension of the elbow

Question 8

Supinator or brachioradialis

Answer 8

strike tendon directly
1-2 inches above the wrist
expected response: flexion of the elbow and supination of the forearm

ASSESS BILATERALLY ALL REFLEXES

Question 9

Knee

Answer 9

strike patellar tendon directly

normal response: leg extends and quads contract

Question 10

Ankle

Answer 10

Slightly dorsiflex foot
strike achilles tendon directly
normal: plantar flexion

Question 11

Babinski (plantar reflex)

Answer 11

cutaneous reflex
stroke sole on lateral edge and across ball of foot

normal: toes flex or remain still
abnormal: fanning of the toes, extension of great toe, may indicate a pyramidal tract lesion
relfex normal in infants < 1

Question 12

assess motor coordination

Answer 12

gait: manner or style of walking
gait should me smooth, regular rhythm, symmetrical in stride lengths

abnormal gait could be intoxication, risk for injury, neuromuscular disorder

heel to toe: walk heel to toe in a straight line; this will exaggerate any unexpected finding in gait evaluation

Question 13

assess muscle strength

Answer 13

upper and lower extremities

ask client to flex muscle and then resist when you apply opposing force

Question 14

Muscle strength scale

Answer 14

0: no movement at all
1: Muscle contracts, but no movement
2: Extremity can move, but not against gravity
3: Full ROM against gravity, but not resistance
4: Full ROM against moderate resistance
5: Full ROM against gravity and resistance

Question 15

Romberg Test

Answer 15

instruct client to stand, feet together, arms at sides, eyes open and then closed. be sure to protect from falling. slight swaying is normal. loss of balance is a positive test and indicates cerebellar ataxia or vestibular dysfunction

Question 16

sensory system

Answer 16

patients eyes closed
loss of sensation may indicate spinal tract lesion
brain stem lesion
cerebral lesion

site tested: hands, lower arms, abdomen, feet and lower legs

Question 17

peripheral neuropathy

Answer 17

loss of sensation with diabetes, alcohol, and vitamin b12 deficiency.

Question 18

polyneuropathy

Answer 18

symmetrical sensory loss could indicate this

Question 19

pain and light touch

Answer 19

alternate touching skin with sharp and dull. superficial pain: ask to identify sharp or dull and superficial touch: point to where it is

if not intact: temperature test- touch the skin, ask patient to tell you hot or col

Question 20

Vibration

Answer 20

place tuning fork against bony prominences beginning at most distal joints. Sternum, shoulder, elbow, wrist, finger joints, ankle, toes, should be tested

client should tell when and where vibration is felt
a buzzing or tingling sensation should be felt

Question 21

Position

Answer 21

test great toe of each foot and finger on each hand. flex or extend and they should tell you up or down and which toe is moving

Question 22

discriminative sensation

Answer 22

tests assess cognitive ability to interpret sensations associated with coordination abilities. inability to perform may indicate a lesion

Question 23

Stereognosis

Answer 23

act of recognizing objects on the basis of touching and manipulations.

Question 24

tactile agnosia

Answer 24

inability to recognize objects by touch, may indicate parietal lobe lesion

Question 25

graphesthesia

Answer 25

number identification

blunt end of a pen and trace numbers in there hand

Question 26

point localization

Answer 26

dull object: touch client in various body parts. point to area touched

Question 27

Brudzinski’s sign

Answer 27

supine position, place head under neck and flex the neck causing the clients chin to touch the sternum
note stiffness
note involuntary flexion of hips and knees- this indicates a positive sign for meningeal irratation

Question 28

Kernig’s Sign

Answer 28

supine position, flex the leg at the knee and hip. Then attempt to straighten the leg keeping the hip flexed
note pain in lower back and resistance to straightening the leg at the knee

Question 29

Meningeal signs

Answer 29

Negative Brudzinski’s and a positive Kernig’s consider disc disease