Test 2 Flashcards
Name the 4 mental status exam components and also the mini-mental state exam can be used and a normal score is ___-___
Checking the level of alertness, appropriateness of responses, orientation to person/place/time, and congruency of mood
24-29
^** Orientation, registration, attention and calculation, recall, language
To test CN1 what do you do?
Use non-irritating odors, have patient compress 1 nostril and sniff through the other to identify them
To test CN2 what 3 things do you do?
Visual acuity aka sharpness (via snellen chart)
Visual fields aka total area objects can be seen in the side vision (by confrontation)
Light reaction
To test visual acuity using the Snellen eye chart, the patient should be ___ feet from the chart and they are considered legally blind at ___/___
Test visual fields by confrontation via wiggling fingers at edge of fields
Light reaction is done by shining a light into the eye to check for direct reaction and consensual reaction in the other eye and CN 2 looks at ____ relay and constriction/dilation is CN __
20, 20/200
Sensory, 3
Cranial nerves ___, ____, and ___ are checked together using the ____
CN 4 is testing the ___ muscle and CN 6 is testing the ___ muscle
^** Remember, LR6, SO4, R3
3, 4, 6, cardinal signs of gaze
Superior oblique muscle, lateral rectus muscle
The constriction/dilation component of the light reaction is testing CN ___
^** If this nerve is lesioned, then the patient has ___, ___, and eyes turned ___ and ___
To test trochlear (4) patient ___ducts and ___ eye
To test abducens (6) patient __ducts eye
The Near reaction has the patient shift their gaze from a far object to a near one and the pupils should ____ and this tests CN ___ and accommodation
Double vision and head tilt = CN ___ lesion
3
Complete ptosis, mydriasis (pupil dilation), down and out
Adducts and depresses
Abducts
Constrict, 3
4
To test CN5 what 2 things do you do?
** Corneal reflex is also tested and the sensory input is through CN ___ and the output motor is through CN ___*****
Check sensation to the face and motor innervation for muscles of mastication
5, 7
For the motor innervation of the mastication muscles, you should palpate the ___ and ___ muscles, and then ask patient to clench their ___ and move ___ side to side in order to test ___
A unilateral weakness would indicate a ___ lesion, and a bilateral weakness would indicate a ___ disease
*To test sensory to the face for CN 5, you can do pain, temp, our light touch to the forehead, cheeks and jaw
If there is a cortical or thalamic lesion, facial sensory loss will be on the ___ side of the lesion and body sensory loss will be on the ___ side of the lesion
^**EX: Left cortical or thalamic lesion = R facial and R body sensory loss
If there is a brainstem lesion, facial sensory loss will be on the ___ side of the lesion and body sensory loss will be on the ____ side of the lesion
^**EX: Left brain stem lesion = L facial and R body sensory loss
Isolated facial sensory loss (no body loss) occurs in peripheral disorders like ____
Temporal and masster, teeth, jaw, lateral pterygoids
CNS Pontine (aka brainstem), cerebral hemispheric (aka cerebrum)
Contralateral, contralateral
Ipsilateral, contralateral
Trigeminal neuraglia
To test CN7 what 2 thing do you do?
Taste to anterior 2/3rds and motor innervation to muscles of facial expression
To test the motor innervation for the muscles of facial expression, you can have them raise ___, smile, frown, pucker ___, close eyes tightly, and purse lips
A lesion to the facial nerve can result in ___ and this would cause a loss of taste to the ___ of the tongue (affects upper and lower face)
^**A central lesion such as in a stroke affects mainly the ___ face
^** So realize that if the peripheral nerve affected is (like in bells palsy), the ENTIRE face will be affected, if it is going to the nucleus aka central facial palsy, you will only see the LOWER half affected (like in a stroke aka supranuclear facial palsy)
^** So once again, if you can raise ur eyebrows but face is droopy… The lower half of ur face is affected aka a central facial palsy****
*To test sensory innervation, have patient taste something
___ can be tested for via secretion of saliva and tears
Eyebrows, cheeks
Bell’s palsy, anterior 2/3rds
lower
Parasympathetics
To test CN8 (vestibulocochlear) what 3 thing do you do for the cochlear division?
So once again, cochlear division tests ___ and vestibular division tests ___
**Tests for hearing and includes the Whisper test, Weber’s test, and Rinne’s test
** Vestibular division tests balance, and it is often not included in the exam
Hearing, balance
First conduct the whisper test or finger rub test in order to determine if hearing loss is present
If there is, one conducts the weber’s test to look for ___ damage or ___.
This is done by striking a tuning fork and placing it in the middle of the patients forehead and diminished tone in the affected ear indicates ___ loss and a louder tone in the affected ear indicates ___ deafness
The ___ test checks air and bone conduction and confirms the presence of conduction deafness in the affected ear and this is done by placing the tuning fork on the ___ and then when tone is gone, place it over the external auditory meatus and if the patient can’t hear the sound, then conduction deafness is present
Sensorineural or lateralization
Sensorineural, conductive
Rinne’s, Mastoid process
The gag reflex tests CN __ and ___ together and CN 9 is the ___ portion of the reflex and CN 10 is the ___ portion of it
9 and 10, sensory, motor
The only muscle CN 9 innervates is the ___ muscle and this aids in swallowing
CN 9 also supplies taste to the ___terior __/___ of the tongue
Stylopharyngeus, posteiror 1/3
However unlike CN 9, which a lesion results in loss of gag reflex, loss of sensation to posterior 1/3rd of tongue, and slight dysphagia (difficulty swallowing)… CN 10 results in loss of gag OR ___ reflex, ____, dysphagia, and dyspnea
^** One can test the vagus nerve via a water test, gag reflex, evaluating presences of hoarseness, or the inspecting palate and uvula symmetry
^** If uvula fails to rise, think bilateral lesion and if it deviates to one side, it is a unilateral lesion and the uvula is deviating ___ from the affected side (aka moves towards normal side)
Cough, dysphonia (hoarseness)
Away
To test CN11 what 2 thing do you do (one for each muscle)
Paralysis of the SCM results in difficulty turning head to the ___ side
^** AKA if you can’t turn your head to the right, the left SCM is messed up and therefore the lesion is on the left side
Weakness of the traps from a CN 11 lesion results in ___ shoulder drop
^** AKA if the right CN11 is damaged, the right shoulder will drop
Shrug shoulders (testing for traps) and turn head against resistance (testing for SCM)
Opposite
Ipsilateral
To test CN12 what 1 thing do you do?
Look for tongue symmetry
Since CN 12 innervates the intrinsic tongue muscles, if one were to have a lesion it would cause the tongue to deviate towards the ____ side (lick its wound)
Affected
Full muscle strength is graded a +___/___ and name each number on the scale
3,4,5 = gravity alive
+5/5
0 = no contraction 1 = barely detectable flicker or trace of contraction 2 = Active movement with no gravity 3 = Active movement against gravity 4 = Active movement against gravity and some resistance 5 = Active movement against gravity and full resistance
**KNOW THESE**
For the upper extremity, name the Nerves associated with the movements
1) Shoulder shrug of traps
2) Deltoids
2) Flexion and extension of elbow
3) Flexion and extension of wrist
4) Hand grip
5) Finger abduction
6) Thumb opposition
For lower extremity, same thing
1) Hip flexion
2) Hip extension
3) Hip adduction
4) Hip abduction
5) Knee flexion
6) Knee extension
7) Ankle plantar flexion
8) Ankle dorsiflexion
1) CN 11
2) C5
2) C5, C6 = flexion, C6, C7, C8 = extension
3) C6 and C7
4) C7, C8, T1
5) C8, T1
6) C8, T1
1) L2, L3, L4 - psoas and iliacus
2) S1 - glut max
3) L2, L3, L4
4) L4, L5, S1
5) L4, L5, S1, S2 - hamstrings
6) L2, L3, L4 - quads
7) S1 - gastrocs
8) L4, L5 - tibialis anterior
The lack of coordination or instability when walking is called ___ and can be due to a cerebellar disease
__ gait is when a patient walks heel-to-toe in a straight line to reveal ataxia previously not obvious
Also have the patient walk on their heels to test ___ and toes to test ___
** The inability to heel walk is a sensitive test for CST damage
Testing for cerebellar function finger-to-nose and heel-to-shin, along with rapid alternating movements can be performed, if a patient can not perform rapid alternating movements, they have ____
Ataxic
Tandem
Dorsiflexion, Plantarflexion
Dysdiadochokinesis
Dermatomes are a band of skin innervated by sensory roots of a single spinal nerve
First one would test for pain and temperature (____) and then one can test position aka proprioception and vibration (____)
^** Position is done by grasping big toe and should sense movement within ___ degrees or grasping index finger and sense movement within ___ degree
One can also use the ___ test to test proprioception where the patient stands with feet together and then closes eyes for 30-60 seconds and you note patients ability to maintain upright posture and not sway like crazy
Spinothalamic tract, Posterior columns
5, 1
Romberg
Name the dermatome
1) Shoulder top
2) Radial aspect of forearm and tumb
3) Long finger
4) Little finger
5) Nipple
6) Umbilicus
7) Great toe (aka Hallucis)
8) Posteriolateral calf/little toe
1) C4
2) C6
3) C7
4) C8
5) T4
6) T10
7) L5
8) S1
