NM Examination

Question 1

Determine LOC (arousal)

7 levels

Answer 1

Alertness
Lethargy
Obtundation
Stupor
Coma
Unresponsive vigilance (vegetative) state
Minimally conscious state (MCS)

Question 2

Pt can open eyes, look at examiner, respond fully/appropriately

Answer 2

Alert

Question 3

Can be aroused from sleep only with painful stimuli, verbal responses slow/absent, pt returns to unresponsive state when stimuli are removed, demonstrates minimal awareness of self/environment

Answer 3

Stupor

Question 4

Pt appears drowsy, can open eyes and look at examiner, respond to questions but falls asleep quickly

Answer 4

Lethargy

Question 5

Can open eyes, look at examiner, responds slowly and is confused, demonstrates decreased alertness and interest in environment

Answer 5

Obtundunded

Question 6

State of unconsciousness from which patient cannot be aroused, eyes remain closed, no response to external stimuli or environment

Answer 6

Coma

Question 7

State characterized by return of sleep/wake cycles, normalization of vegetative functions (HR, resp, BP, digestion) and lack of cognitive responses (can be aroused but unaware)

Answer 7

Unresponsive vigilance (vegetative) state

Question 8

Persistent vegetative state is lasting > __ for TBI and > __ for anoxic brain injury

Answer 8

1 year

3 months

Question 9

state characterized by severely altered consciousness with minimal awareness but definite evidence of self or environmental awareness

Answer 9

Minimally conscious state (MCS)

Question 10

Non-fluent aphasia/expressive aphasia

Answer 10

BROCA’S motor aphasia

Question 11

Where is lesion for non-fluent aphasia

Answer 11

involves the 3rd convolution of the L hemisphere (Broca’s area)

Question 12

Impairment of volitional articulation control secondary to cortical, dominant hemisphere lesion

Answer 12

Verbal apraxia

Question 13

Impairment of speech production from damage to central or peripheral nervous system, causes paralysis, weakness, or incoordination of motor-speech system

Answer 13

Dysarthria

Question 14

Fluent aphasia

Answer 14

Wernicke’s aphasia

Question 15

Fluent aphasia is result of lesion where?

Answer 15

Posterior first temporal gyrus of L hemisphere (Wernicke’s area)

Question 16

Period of apnea lasting 10-60 seconds followed by gradually increasing depth and frequency of respirations

Answer 16

Cheyene-Stokes respiration

Question 17

Cheyenne-stokes accompanies depression of _____ lobe and _____ dysfunction

Answer 17

Frontal

Diencephalic

Question 18

Hyperventilation accompanies dysfunction of ____ and ___

Answer 18

Lower midbrain, pons

Question 19

Abnormal respiration marked by prolonged inspiration

Answer 19

Apneustic breathing

Question 20

Apneustic breathing accompanies damage to ____

Answer 20

Upper pons

Question 21

Increased temperature may indicate ____ (3)

Answer 21

Infection
Damage to hypothalamus
Damage to brainstem

Question 22

What is Kernig’s Sign?

Answer 22

Pt in supine, flex hip and knee fully to chest, then extend knee
(+) is pain and increased resistance to extending the knee due to spasm of hamstring when bilateral suggests meningeal irritation

Question 23

What is Brudzinski’s sign?

Answer 23

Pt supine, flex neck to chest

(+) causes flexion of hips and knees (drawing up) suggests meningeal irritation

Question 24

8 things to assess for meningeal irritation or CNS infection

Answer 24

1. Signs are global, not focal
2. Neck mobility
3. Kernig’s sign
4. Brudzinski’s sign
5. Irritability
6. Slowed mental function
7. Altered vital signs
8. Generalized weakness

Question 25

8 things to examine for increased ICP secondary to cerebral edema/brain herniation

Answer 25

1. Altered level of consciousness
2. Altered vital signs
3. Headache
4. Vomiting
5. Pupillary changes (CN III signs)
6. Papilledema at entrance to eye
7. Progressive impairment of motor function
8. Seizure activity