Physical Examination CNS Flashcards
I’m checking for cerebral dysfunction in routine CnS examination you check for motor reflex and perception functions
What’s the difference
Reflex-reflex occurs before an individual knows what has happened—for example, what made him lift a foot or drop an object.
Perception: reflex of the sensory organs due to experience
Example: you know a hot object is bad for you so you will move your hand away if it’s coming near to you
And reflex is like it is when the object touches you before you move your hand away . Like fast fast without even knowing what touched you all you’ll know is your hand has moved from there
What is focal dysfunction
focal neurologic deficit is a problem with nerve, spinal cord, or brain function. It affects a specific location, such as the left side of the face, right arm, or even a small area such as the tongue. Speech, vision, and hearing problems are also considered focal neurological deficits.18 Oct 2018
What is apraxia
Difficulty with skilled movements even when a person has the ability and desire to do them.
In global apraxia, spelling knowledge is lost to such a degree that the individual can only write very few meaningful words, or cannot write any words at all. Reading and spoken language are also markedly impaired.
What is hypertonia
Hypertonia is increased muscle tone, and lack of flexibility. Children with Hypertonia make stiff movements and have poor balance.
Importance of muscle tone and what is it
Your muscle tone prepares you for action, maintains your balance and posture, generates heat that keeps your muscles healthy, and allows for a quick, unconscious reaction to any sudden internal/ external stimuli.
Strength of 4/5 means
5: A 4/5 grade indicates that the muscle yields to maximum resistance. The muscle is able to contract and provide resistance, but, when maximum resistance is exerted
In motor system exam what things are looked for
Tone
Strength
Reflexes
Cerebellum or gait
What is agnosia
Loss of the ability to identify objects or people.
What is aphasia
language disorder that affects a person’s ability to communicate.
It can occur suddenly after a stroke or head injury or develop slowly from a growing brain tumour or disease.
Glasgow coma scale assesses what things
Motor,vision and speech
For vision on the Glasgow coma scale someone who opens eyes with response to pain,with response to speech , spontaneously(like the persons eyes are continually open )is graded what numbers
2
3
4
No response is 1
On the Glasgow coma scale for verbal response what number does 1-5 stand for
1- no response
2-Incomprehensible sounds (moaning but no words)
3-Inappropriate words (random or exclamatory articulated speech, but no conversational exchange)
4-Confused (the patient responds to questions coherently but there is some disorientation and confusion)
5-Oriented (patient responds coherently and appropriately to questions such as the patient’s name and age, where they are and why, the year, month)
On the Glasgow coma scale motor response 4 is?
Flexion/Withdrawal to pain (flexion of elbow, supination of forearm, flexion of wrist when supra-orbital pressure applied ; pulls part of body away when nailbed pinched)
Example- if I pinch your toe but you move another part of your body which is different from localized pain meaning if I pinch your toe you move your toe
Motor response graded 2 and 3 are?
2-Abnormal Extension to pain(decerebrate) :arms are straightened and extended and hands are curled
3-Abnormal flexion to pain (decorticate response):arms are adducted and flexed against the chest
Glasgow coma motor response of 1,5,6 are
No response
5-Localizes to pain (Purposeful movements towards painful stimuli; e.g., hand crosses mid-line and gets above clavicle when supra-orbital pressure applied)
6-Obeys commands (the patient does simple things as asked, e.g. stick out tongue or move toes)
How do you interpret a Glasgow coma grade of 15 or 13-15, less than 8 and 3
lowest score for each category is 1, therefore the lowest score is 3 (no response to pain + no verbalisation + no eye opening). A GCS of 8 or less indicates severe injury, one of 9-12 moderate injury, and a GCS score of 13-15 is obtained when the injury is minor.
15- best response 13-15- minor injury 9-12- moderate injury 8 or less- comatose or severe injury 3-totally unresponsive
Cranial nerve one is
Olfactory
Cranial nerve 3 is
Oculomotor
Cranial nerve 2 is
Optic
Cranial nerve 4
Trochlear
Cranial nerve 5
Trigeminal
Cranial nerve six
Abducens
Cranial nerve 7
Facial nerve
Cranial nerve 8
Vestibulocochlear
Cranial nerve 9
Glossopharyngeal
Cranial nerve 10
Vagus
Cranial nerve 11
Accessory
Cranial nerve 12
Hypoglossal
Functions of the cranial nerves whether sensory or motor or both is
Some Say Marry Money But My Brother Says Big Boobs Matter More
What tests are used to assess the optic nerve
Menace test-menace response: Move the hand slowly toward the eye in a menacing movement, without touching the face or pushing air onto the cornea;
Pupillary light reflex-Pupillary light reflex is an example of a brainstem reflex. When light is directed toward eye, CN II (Optic - sensory nerve) will carry the input to CN III. Light directed toward either eye will immediately stimulate CN III in both eyes cuz III is responsible for control of the pupil
Swinging light test: e swinging flashlight test can rule out intracranial damage to the optic nerve and the brain. To perform this test, shine a penlight into one eye to attain maximum pupil constriction, then quickly switch the light source to the other eye and back again.
What tests assess the cranial nerve 3
Pupillary light reflex
Medial movement of globe-Inability to follow and object in direction of CN III (the quickest test is to observe upward gaze which is all CN III; the eye on the affected side does not look upward) Inability to open the eyelid. CN III dysfunction causes the eyelid on the affected side to become “droopy. And moving fingers mdedially and seeing if the eye moves wheee your finger is moving
What tests asses cranial nerve 4
Ventrolateral rotation of the globe
Assessment for cranial nerve 5 and what is it’s function
The trigeminal nerve (the fifth cranial nerve, or simply CN V) is a nerve responsible for sensation in the face and motor functions such as biting and chewing; it is the most complex of the cranial nerves.
Assessment:ear ,eyelid , lip facial reflexes,
Chewing and all too assess mastication
Nerve 6 is assessed along w nerve 3 and 4 . How?
You move your finger up to asses inferior oblique - nerve 3
Move your finger down to assess superior oblique nerve 4
Move your finger side and side to check lateral rectus which is for cranial nerve six
So you do it left up down
Right up down
Remember: LR6- lateral rectus 6
SO4- superior oblique 4
The rest of the oblique eye muscle are for nerve 3
Difference between consensual light reflex. And direct light reflex
Direct- using a torch the pupil is supposed to shrink for each pupil
Consensual- light reflex- using Torch in one eye and the other eye is supposed to react
What is dysphonia and disarthria
Dysphonia- disturbance of voice production which may reflect abnormality of supply of vagus nerve
Dysarthria- motor disorder
How do you grade muscle power with regards to complete paralysis
0
With regards to motor grading what is grade 1
Flicker of contraction if possible
What is grade 2 in motor contraction thing
Movement possible if gravity is eliminated
Or can move the part of the body but can’t lift it against gravity
Grade 3 muscle grading
Movement against gravity but not resistant
Or can move the part of the body, lift it but if resistance is applied by the examiner patient won’t be able to lift it
Grade 4 muscle grading
Movement possible against some resistance
Or patient even with resistance provided by the examiner can move against the resistance
Grade 5 muscle grading
Power is normal
What is used in checking for cerebellum
Finger-Nose-Finger. Dysmetria. Overshooting target. Intention Tremor.
Alternating hand movements.
Heel-knee-shin.
Romberg Test.
Gait (may demonstrate Ataxia) Walking on base of foot. Tandem walking. Overall coordination.
Vestibular Exam. Nystagmus.
What is the mnemonic for CNS
Is The Physician Really So Cool I-inspection T-Tone P-Power R-reflexes S-Sensations C-coordinatoon G-Gait
What is done during inspection
If there are any obvious differences between the legs
Anterior and posterior
If there are ulcers on the legs and thighs
Spontaneous fasciculations(muscle twitching)
Induced fasciculations
Fasciculations are normally due to low magnesium levels, muscle fatigue or medication side effects not always due to underlying problems
What is done during assessing for tone
Tone is checked at the ankle joint
Knee joint
Hip joint
Muscle power assessment
It’s 0-5
You check power in the entire limb and then power in individual muscle groups such as the thighs,legs
Compare right side to left side side
Reflexes assessment
Knee reflex Babinski reflex (to check movement of the toes ) the Palpate tendon in knee then hit to see if there’s movement in the thigh Palpate Achilles tendon then hit to see if there’s movement in the leg
If power is less than 3 don’t check gait true or false
True
What is checked during sensations assessment
Sensation to pain
Sensation to temperature
These two are not done anymore
Sensation to vibration(tuning fork is used and put on bony parts of the body)
You put the fork on the forehead to make patient see how it feels then you put on the other parts you have to put it on to see if patient senses the vibrations
proprioception :include being able to walk or kick without looking at your feet or being able touch your nose with your eyes closed. This is also done under sensation to vibrations
What are dermatomes and which parts of the limbs are supplied by which spinal nerves or cranial nerves
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