PDS Week 6 - Neurologic Flashcards
How do you test CN I (olfactory) function?
Have patient close their eyes and occlude one nostril at a time, hold an item (coffee beans, eucalyptus oil, etc.) 10 cm away from their nose, and have them smell.
What is anosmia?
Loss of smell due to CN I dysfunction
How to test CN II (optic) function?
Visual acuity test (snellen chart) visual field testing, and pupillary light reflex testing
How to test CN III (oculomotor)
Pupillary light reflex test - should see both direct and consensual constriction of pupils if CN III is intact
Pupillary light reflex test tests which cranial nerves?
CN II (sensory) - light gets in through the optic nerve CN III (motor) - constriction of pupils
What muscles does CN III (oculomotor) control?
Superior rectus, medial rectus, inferior rectus, and inferior oblique (extraocular eye muscles)
What muscle does CN IV (trochlear) control?
Superior oblique (extraocular eye muscle)
What muscle does CN VI (abducens) control?
Lateral rectus (extraocular eye muscle)
How to test CN V (trigeminal)
Sensory:
1. Corneal cotton swab test
2. Cotton swab test
- R/L of forehead for ophthalmic division
- R/L of cheeks for maxillary division
- R/L of jaw for mandibular division
Motor:
- patient will clench teeth as you palpate masseter muscle
- if jaw deviates to one side, CN V is affected
-pt does not feel any pain
How to test CN VII (facial)
Motor:
- have pt make facial expressions (smile, frown, puff cheeks)
- have patient close eyes, and see if you can force them open (orbicularis oculi muscle closes eyelid)
Sensory:
-sends taste to anterior 2/3 of the tongue
How to test CN VIII (vestibulocochlear)
whisper technique, finger rubbing technique, Weber test, and Rinne test
Which two CN are responsible for keeping the uvula elevated and in midline?
CN IX (glossopharyngeal) and CN X (vagus)
What are the functions of CN IX (glossopharyngeal)
Sensory: taste to posterior 1/3 of tongue
Motor: keeping uvula elevated and in midline
What are the functions of CN X (vagus)
Gag reflex and keeping the uvula elevated and in midline
How to test CN XI (spinal accessory) function
Have patient laterally rotate head against resistance and shrug shoulders against resistance
What muscles does CN XI (spinal accessory) innervate?
SCM and trapezius muscles
How to test XII (hypoglossal)
Have patient stick out tongue; it should be midline with no contractures, fasciculations, or scalloping
Where do upper motor neurons start?
The cerebrum
Where do the upper motor neurons provide function?
CNS
Where do lower motor neurons provide function to?
PNS
Where do upper motor neurons go?
Cerebrum > brain stem > spinal cord
Why do upper motor neurons affect the opposite side of the body?
They cross over (decussate) in medulla, causing their function to be on the opposite side of the body
Spinal nerves are all -
- Sensory,
- Motor, or
- Mixed neurons?
mixed neurons
Peripheral nerves are made up of…
Multiple nerve roots
Motor nerves exit through the
Ventral root
Sensory nerves enter through
The dorsal root ganglion
What are the tests for basic sensory testing?
- Sharp/dull for pain
- Proprioception test
- Vibratory test
- Two-point discrimination test
- Stereognosis test
- Point localization test
- Graphesthesia test
Basic motor testing
- Finger abduction
- Finger adduction
- Wrist extension
- Wrist flexion
- Forearm (elbow) flexion
- Forearm (elbow) extension
- Hip abduction
- Hip adduction
- Knee flexion
- Knee extension
- Ankle dorsiflexion
- Ankle plantarflexion
All motor testing should be against…
Resistance
Explain the muscle strength scale
0 = no movement/strength 1 = trace - slight movement/contraction 2 = weak - can move, but not against gravity 3 = fair - can move against gravity but not resistance 4 = good - can move against some resistance 5 = normal