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