NEUROLOGY Flashcards
1
Q
What are the 12 cranial nerves?
A
- Olfactory
- Optic
- Occulomtor
- Trochlear
- Trigmenial
- Abducens
- Facial
- Vestibulolochulear
- Glossopharyngeal
- Vagus
- Accessory
- Hypoglossal
2
Q
How do you assess the olfactory nerve?
A
- Ask pt if they have any NEW changes in sense of smell.
- Get them to sniff something like wipes if they do.
3
Q
How do you assess the optic nerve? (CN II)
A
- Assess visual acuity using the Snellen chart, stand 3-6m away from pt and get them to cover one eye at a time whilst reading the letters.
- Assess pupils by using a pen torch
- Get pt to look at your face and hold both your arms to the side and wiggle your finger and get them to state which one you are doing.
- You could perform fundoscopy here
4
Q
How would you assess occulomotor, trochlear and abducens (CN III, IV,VI)?
A
- Look out for ptosis (droopy eye)
- Perform the H test, do this slowly and a few times
5
Q
How would you assess the trigeminal nerve? (CN V)
A
- There are 3 divisions of the trigeminal: ophthalmic, maxillary and mandibular.
- Lightly touch both sides of the pts face one at a time with a light cotton bud, assessing the pts sensation, then use a sharper object like a pen or small pin prick on each side. Get the pt to state when you’ve touched their face. Ask if it feels the same on both sides.
- Get pt to clench their jaw
6
Q
How would you assess the facial nerve (CN VII )
A
- Ask if pt has noticed change in sense of taste.
- Get pt to puff out cheeks, raise and lower eyebrows, smile, frown.
- Get pt to scrunch eyes shut tightly and resist you opening them.
7
Q
How would you assess the vestibulocochlear nerve (CN VIII) ?
A
- Assessing pts hearing and balance
- Whisper a number close to the pts ear and ask them to repeat it, move further away and do the same thing on both ears.
- Tuning fork test- tap on table and place behind pts ear and tell them to inform you when they can no longer hear it. Move the fork in front of their ear and ask if they can still hear it. (Rinne’s test)
- Webber’s test- place the fork in the middle of the forehead and ask the pt if they can hear it in both ears.
- Assess balance by getting pt to march on the spot, perform rhombergs test, heel to toe walking (tandem gait), walk on their toes and heels.
8
Q
How would you assess the glossopharyngeal and vagus nerve (CN IX & X)?
A
- Gag reflex and swallowing, ask pt if there is any difficulty swallowing.
- Get pt to open their mouth and say aaaa, shine a light in their mouth and you should see their uvula.
- Get pt to swallow or take a sip of water
9
Q
How would you assess the accessory nerve (CN XI)?
A
- Get pt to shrug their shoulder against resistance (trapezius muscle), compare strength.
- Assess the sternocleidomastoid muscle by getting pt to turn their face against resistance.
10
Q
How would you assess the hypoglossal nerve (CN XII) ?
A
- Get pts to stick their tounge out, as well as stick it out against their check
- Give them a tongue twister
11
Q
How should you assess the pts coordination?
A
- Look for rapidly alternating movements
- Can they touch their nose then your finger, then their nose and your finger, then get them to close their eyes and touch your finger, they should touch it if you haven’t moved it.
- Get pt to tap their heel to their shin, if their unable to it may indicate Parkinson’s or MS and cancer in paeds.
12
Q
What is the rhombergs test?
A
- A test which assesses the pts balance.
Get the pts to stand with their feet together and their arms by their side, get them to close their eyes and say still. Stand next to them ready to catch them. - A positive test indicates MS in young adults or it may be due to a head injury. In paeds, it suggests a tumour of the cerebellum.
13
Q
Abbreviated mental test:
A
- How old are you?
- When is your DOB?
- Who am I/ Who do i work for?
- Where are we?
- Who is the prime minister?
- Give them a small phrase like big blue button and get them to recall that later on to assess their memory!
14
Q
What is Babinskis reflex?
A
- Works on unconscious pts
- Run a pointed object from heel to the toes
- Pathological reflex
- Positive sign indicates disturbance of the CNS
- A normal response is dorsiflexion of the foot (toes pointing upwards)
15
Q
Dolls eye reflex?
A
- With unconscious pts, if you hold their eyes open, it should look like they’re staring up at you even if you turn their head, if you’re not concerned of c spine.
