Test 4 Flashcards
Presbyopia
loss of the eyes’ ability to focus actively on nearby objects
Common in clients over 45
Strabismus
Constant malalignment of the eyes
Eyes don’t look exactly the same direction at the same time
Nystagmus
An oscillating (shaking) movement of the eyes
May be associated with an inner ear disorder, multiple sclerosis, brain lesion or narcotics use
Involuntary movement side to side
Exotropia
A specific kind of malalignment where there is an outward turn of the eye
Entropion
An inverted lower lid
Ptosis
Drooping of the upper eyelid
Exophthalmos
Protrusion of the eyeballs accompanied by retracted eyelid margins
Miosis
Pinpoint pupils, constricted and fixed
Possibly a result of narcotic drugs or brain damage
Anisocoria
Pupils of unequal size
In some cases is normal, others is not
Accommodation response
Response of eye when shifting focus from distant object to nearby object
Functional reflex allowing eyes to focus on near objects
Pupil constricts to increase the depth of focus of the eye
Six cardinal positions of gaze
Assess eye muscle strength and cranial nerve function
Failure of eyes to follow ant movement symmetrically in any or all directions indicates a weakness in one or more extraocular muscles or dysfunction of the cranial nerve that innervates that muscle
Snellen exam
Used to test distant visual acuity
Chart consists of lines of different letters stacked larger on top and decreasing in size
Client stands 20 ft from, covers one eye and reads until can no longer distinguish
Corneas
Permits the entrance of light
Well supplied with nerve endings making it responsive to pain and touch
Lateral gaze
Looking to the right or left in the horizontal plane
Conjunctivitis
Generalized redness of the conjunctiva
Pink eye
Glaucoma
Group of eye diseases that damage the optic nerve
Often caused by abnormally high pressure within the eye
No warning signs and gradual that no change in vision may be noticed until it is advanced
Vision loss as a result is not reversible
*second leading cause of blindness
Open angle glaucoma
Patchy blind spots in you side or central vision
Frequently in both eyes
Tunnel vision in advanced stages
Signs of Acute angle-closure glaucoma
Severe headache, eye pain, nausea and vomiting, blurred vision, halos around light, redness
Cataracts
Opacity/clouding of eyes and blurry vision
Leading cause of blindness worldwide
Risk factors for cataracts
Increasing age
Diabetes mellitus
Excessive alcohol use
Exposure to sunlight
Exposure to ionizing radiation
High blood pressure
Obesity
Previous eye injury
Inflammation or surgery
Prolonged steroid use
Cigarette smoking
Macular degeneration
Damage to the macula (central part of retina)
Loss in center field of vision
Blind spots, blurry vision
Dry AMD
Most common kind of age related macular degeneration
may advanced and cause loss of vision w/out turning into wet form or may change into wet form in late stages
Wet AMD
Abnormal new blood vessels form deep in the sensory retinue
can leak or bleed and result in marked loss of central vision
Assessing near vision
Use hand held Visual chart, 14 inches away
Jaeger test (pocket screener)
Normal is 14/14
Myopia
Nearsightedness
Hyperopia
Farsightedness
PERRLA
Pupils Equal Round Reactive Light Accommodation
Test pupillary reaction to light
Darken room, client focuses on distant object
Shine light obliquely into one eye and observe
Normally pupils constrict equally
Changes in the structure and function of the inner ear either age
Malformation of the inner ear causes sensorineural or perceptive hearing loss
Visual fields
Sees with one eye
Four quadrants for each eye (upper and lower temporal and upper and lower nasal)
Visual pathway
Anatomical structures responsible for conversion of light energy into electrical action potentials that can be interpreted by the brain
Testing extraocular muscle function
Corneal light reflex test: penlight to observe parallel alignment of light reflection on corneas
Cover test: use opaque card to cover an eye to observe for eye movement
Position test: observe for eye movement
Cover/uncover test
Patient looks straight at distant object
Cover one eye
- look at uncovered eye, should be fixed
Uncover eye
- look at eye that was covered, eye should not move and should be looking in the same direction
Repeat for both eyes
Purpose of Cover/Uncover test
Detects deviation in alignment or strength and slight deviations in eye movement by interrupting the fusion reflex that normally keeps the eyes parallel
Phoria
Term used to describe misalignment that occurs when fusion reflex is blocked
Esotropia
Inward turn of the eye
Ophthalmoscope
Hand held instrument that allows examiner to view the fundus of the eye by the projection of light through a prism that bends the light 90 degrees
AMD
Age related macular degeneration
Major cause of visual impairment that affects the macula portion of the retina
Causes deterioration of the macula (central portion)
People with it have a hard time with daily activities
Risk factors for Macular Degeneration
Advancing age
Smoking
Family history of AMD
Gender (females more likely to be affected)
Obesity
Race (Caucasians)
Light eye color
Prolonged sun exposure
High fat, high cholesterol, high sugar/low antioxidant diet that is low in antioxidants and green leafy vegetables
Hypertension (narrows blood vessels in retina) or blood pressure above 120/80 mm Hg
Cardiovascular disease
Inactivity
AMD in one eye
Genetic predisposition
Ectropion
Everted lower lid
Chalazion
An infection of the meibomian gland (located in eyelid)
May produce extreme swelling, moderate redness but minimal pain
Blepharitis
Redness and crusting along the lid margins suggesting seborrhea or blepharitis
Infection caused by staphylococcus aureus
Hordeolum
Style
A hair follicle infection
Causes local redness swelling and pain
Diffuse episcleritis
Inflammation of the sclera
Mydriasis
Dilated and fixed pupils
Typically resulting from central nervous system injury, circulatory collapse or deep anesthesia
Papilledema
Swollen optic disc
Blurred margins
Hyperemic appearance for accumulation of excess blood
Visible and numerous disc vessels
Lack of visible physiologic cup
Glaucoma (optic disc)
Enlarged physiologic cup covering more than half the disc’s diameter
Pale base of enlarged physiologic cup
Obscure and/or displaced retinal vessels
Optic atrophy
White optic disc
Lack of disc vessels
Pinguecula
Yellowish nodules on the bulbar conjunctiva
Harmless, common in older clients
Appear first on medial side of iris then lateral
Arcus senilis
Normal condition in older clients
Appears as a white arc around the limbus
conductive hearing loss
Something blocks or impairs the passage of vibrations from getting to the inner ear
Causes of conductive hearing loss
- fluid in middle ear
- otisis media (middle ear infection)
- allergies (serous otitis media)
- impacted cerumen
- infection in the ear canal (external otitis)
- presence of foreign body
Sensorineural or perceptive hearing loss
Damage is located in the inner ear
Most common type of permanent hearing loss
Decreases one’s ability to hear faint sounds, even loud speech may be muffled
Causes of sensorineural/perceptive hearing loss
Ototixic drugs
Generic hearing loss
Aging
Head trauma
Malformation of the inner ear
Loud noise exposure
Risk factors for hearing loss
Age
Hereditary
Occupational loud noise
Recreational noises
Ototoxic medications
Illnesses, especially with high fever
Noise exposure
Smoking
Cardiovascular risk factors
Genetic and family susceptibility
Premature birth
Hypoxia during birth
Rubella, syphilis, or other infections in pregnant mother
Inappropriate use of ototoxic drugs during pregnancy
Neonatal jaundice, which can damage the otic nerve in a newborn baby
Infectious diseases
Head/ear injury
Wax/foreign bodies
Otitis media
Inflammation or infection located in the middle ear
Purulent drainage associated pain and a popping sensation is characteristic of otitis media with perforation of the tympanic memebrane
Between 6 months and 2 years most susceptible due to size of euustachian tubes
External eat structures
Inspect: auricle, tragus, and lobule for size, shape, position,lesion/discoloration, and discharge
Palpate: the auricle and mastoid process for tenderness
Acute otitis media
Red, bulging membrane
Decreased/absent light reflex
Serous otitis media
Yellowish, bulging membrane with bubbles behind it
Whisper test
Have client occlude the eat not being tested and rub tragus in circular motion
Start with better hearing ear first
With head 2 ft behind client whisper a 2 syllable work and ask them to repeat
If they don’t get it first try, try one more time
Identifying 3 of 6 words is passing
Jaeger test
Near vision assessment in clients over 40
Pocket screener or newspaper
Held 14 inches from eye
Presbycusis
Gradual sensorineural hearing loss
Common after 50
Often begins with a loss of high frequency sounds (women’s voice) followed by the loss of lower
Romberg test
Tests equilibrium
Client stands feet together, arms at side, eyes opened and then closes
Maintain position for 20 sections without or with minimal swaying
May indicate a vestibular disorder if fail
Weber test use
Performed if client reports diminished or lost hearing in one ear
Helps to evaluate the conduction of sound waves through bones to help distinguish between conductive and sensorineural hearing loss
How waves are transmitted in conductive hearing loss
By external and middle ear
How waves are conducted in sensorineural hearing loss
By inner ear
Weber test procedure
Strike tuning fork softly with back of hand and place at the center of client’s head or forehead
Ask if they hear it better in one ear or the same
Results of Weber test
Conductive: reports lateralization of the sound in the poor ear, they “hear” it, the good ear is distracted by background noise which the poor ear has trouble with, so it receives most of the sound conducted by bone vibration
Sensorineural: client reports lateralization of the sound in three good ear, this is because of limited perception of sound due to nerve damage in bad ear, making sound seem louder in the unaffected ear
Rinne test use
Test compares air and bone conduction sounds
Used to determine cause of hearing loss
Rinne test procedure
Use tuning fork and place at the base of the client’s mastoid process (bone conduction)
Ask client to tell you when they no longer hear it and the move tuning fork to the front of the external auditory canal (air conduction) and ask if the sound is audible after you move it
Rinne test procedure
Use tuning fork and place at the base of the client’s mastoid process (bone conduction)
Ask client to tell you when they no longer hear it and the move tuning fork to the front of the external auditory canal (air conduction) and ask if the sound is audible after you move it
Results of Rinne test
If cause is sensorineural the finding will be AC > BC (which is also a normal hearing result)
Of the cause is conductive the finding will be BC ≥ AC
Tympanic Membrane
Found in the middle eat
Assess the color / position of landmarks / intactness of drum
Shiny / transparent / opaque pearl gray
Slight concave
Cone of light right 5 o’clock left 7 o ‘clock
Otitis externa
Infection of the outer ear canal
Often caused by water (swimmers ear)
Expected changes with aging of the ear
Presbycusis
Neg self image with hearing aid
Elongated earlobes with linear wrinkles
Harder cerumen builds as cilia in ear canal become more rigid
Coarse think wire like hair may grow at canal entrance
Eardrum appears cloud
Tophi
Hard external ear nodules associated with deposits of uric acid in advanced gout
Malignant lesion
Mass or lump of abnormal cells can form in any part of ear
Build up of cerumen in ear canal
Wax build up and block ear can cause hearing loss
Polyp exostosis
Thickening and constriction of the ear canal
Blue dark red tympanic membrane
Indicates blood behind eardrum due to trauma
Scarred tympanic membrane
White spots and streaks indicate scarring from infections
Perforated tympanic membrane
Perforation results from rupture caused by increased pressure usually from untreated infection or trauma
Retracted tympanic membrane
Prominent landmarks are caused by negative ear pressure due to obstructed Eustachian tube or chronic otitis media
Bones
Provide structure and protection
Serve as levers, store calcium and produce blood cells
206
Axial skeleton
Head and trunk
Appendicular skeleton
Extremities, shoulders and hips
Compact bone
Hard and dense
Makes up the shaft and outer layers
Spongy bone
Contains numerous spaces and makes up the ends and centers of the bones
Osteoblasts
Active cells that form bone tissue
Osteoclasts
Cells that help demineralize and destroy old bone
Red vs yellow marrow
Red produces blood cells
Yellow is composed mostly of fat
Skeletal muscles
Under conscious control
Attach to bones by way of strong, fibrous cords card tendons
Assist with posture, produce body head and allow the body to move
Smooth muscle
Aka nonstriated muscle
Involuntary
Under control of the autonomic nervous system
Cardiac muscle
Highly specific striated muscle that can contract without neural stimulation because of the property of automaticity
Automaticity
Allows cardiac tissue to set a contraction rhythm through the presence of pacemaker cells
Flexion
Bending of a joint (elbow)
Extension
Straightening of a joint
Abduction
Moving away from midline
Adduction
Moving toward midline
Rotation
Turning around a specific axis (shoulder) - move around its long axis, turning like a screw
Circumduction
Cone like movement - movement of limp in circle
Supination
Turning upward
As in hand (palm up)
Pronation
Turning downward
As in hand (palm down)
Inversion
Turning inward
As in ankle (big toe faces up)
Eversion
Turning outward
As in ankle (pinky toe faces up)
Protraction
Pushing forward
As in head away from neck
Retraction
Pulling backwards
As in head towards neck (double chin)
Joints
The place where 2+ bones meet
Provide variety of ranges of motion (ROM) for the body parts
Classifications: fibrous, cartilaginous or synovial
Fibrous joints
Joined by fibrous connective tissue and are immovable
Ex: sutures between skull bones
Cartilaginous joints
Joined by cartilage
Ex: joints between vertebrae
Synovial joints
Bones that contain a space between them that is filled with synovial fluid, a lubricant that promotes a sliding movement
Ex: shoulder, wrists, hips, knees, ankles
Ligaments
Join bones in synovial joints
Strong dense bands of fibrous connective tissue
Enclosed by a fibrous capsule made of connective tissue and connected to the periosteum of the bone
Bursae
Small sacs filled with synovial fluid that serves to cushion joints
Found in some synovial joints
Osteoporosis
Disease in which bones demineralize and become porous and fragile, making them susceptible to fractures
More common as a person ages because that is when bone resorption increases, calcium absorption decreases and production of osteoblasts decrease
Uncontrollable risk factors of osteoporosis
Age
Gender
Fam history
Previous fracture
Ethnicity
menopause/hysterectomy
long-term glucocorticoid therapy
rheumatoid arthritis
primary/secondary hypogonadism in men
Modifiable risk factors of osteoporosis
Alcohol
smoking
low body mass index
poor nutrition
vitamin D deficiency
eating disorders
low dietary calcium intake
insufficient exercise (sedentary lifestyle)
frequent falls
Herniated lumbar disc or ankylosing spondylitis
May see a flattened lumbar curvature of the thoracic spine
Scoliosis
Lateral curvature of the thoracic spine with an increase in the convexity on the curved side
Lordosis
An exaggerated lumbar curve just above the butt
Often seen in pregnancy and obesity
Testing ROM of cervical spine
Have client touch chin to chest (flexion) and to look up at the ceiling (hyperextension)
Cervical strain
Most common form of neck pain
Characterized by impaired ROM and neck pain from abnormalities of the soft tissue due to straining or injuring the neck
Signs of dislocation
Flat, hollow, or less rounded shoulder
Signs of rotator cuff tear
Painful and limited abduction accompanied by muscle weakness and atrophy
Lesion of cranial nerve XI sign
Inability to shrug shoulders against resistance
Testing ROM of lumbar spine
Client bends forward and touches toes (flexion)
Leg measurement findings
Unequal are associated with scoliosis
Equal true lengths but unequal apparent lengths are seen with abnormalities in the structure or position of the hips and pelvis
Rotator cuff tendonitis findings
Sharp pain when bringing hands overheard
Calcified tendinitis findings
Chronic pain and severe limitations of all shoulder movement
Rheumatoid arthritis findings
Tenderness and nodules on wrist and hands
Squeeze test
Squeeze patients hand across the knuckle joints
Extreme pain may indicate rheumatoid arthritis and psoriatic arthritis of the hand
Phalen test
Client places the backs of both hands against each other while flexing the wrist 90 degrees with fingers pointed downward and wrists dangling
If tingling, numbness, burning or pain develop within a minute then carpal tunnel syndrome is suspected
Test for tinel sign
Use fingers to percuss lightly over the median nerve (located on the inner aspect of the wrist) tingling or shocking sensation experienced with test
Also test for carpal tunnel
Genu Valgum
Knees turn in with knock knees
Genu varum
Knees turn out with bowed legs
Ballottement test
Helps to detect large amounts of fluid in the knee
Client in supine position
Firmly push the patella
This displaces fluid in the suprapaterllar bursa
Fluid waves or chick is palpated with large amounts of effusion
Positive result mat be present with meniscal tears
Pes planus
Feet with no arches
Flat feet
Pes cavus
Feet with high arches
Corns
Painful thickening of the skin over bony prominences and at pressure points
Calluses
Nonpainful thickened skin that occurs at pressure points
Verruca vulgaris
Painful warts
Plantar warts if under a callus
Plantar fasciitis
Indicated by tenderness of the calcaneus of the bottom of the foot
Most common cause of heel pain
Kyphosis
Rounded thoracic convexity
Acute rheumatoid arthritis
Painful, tender, swollen stiff joints are seen
Chronic rheumatoid arthritis
Chronic swelling and thickening of the metacarpophalangeal and proximal interphalangeal joints, limited range of motion and finger deviation towards the ulnar side
Boutonnière deformities
Wrist abnormality
Flexion of the proximal interphalangeal joint and hyper extension of the distal interphalangeal joint
Commonly seen in chronic rheumatoid arthritis
Swan neck deformity
Wrist abnormality
Hyper extension of the proximal interphalangeal joint and flexion of the distal interphalangeal joint
Commonly seen in chronic rheumatoid arthritis
Ganglion
Wrist abnormality
Non-tender round, enlarged swollen fluid filled cysts
Commonly seen at the dorsum of the wrist
Osteoarthritis
Wrist abnormality
Degenerative joint disease
Osteoarthritis nodules on the dorsolateral aspects of the distal interphalangeal joints are due to the bony overgrowth of osteoporosis
Usually hard and painless, they may affect middle-aged or older adults and often, although not always are associated with arthritic changes and other joints
Tenosynovitis
Wrist abnormality
Infection of the flexor tendon Sheaths
Painful extension of a finger may be seen in acute tenosynovitis
Thenar atrophy
Wrist abnormality
Atrophy of the thenar prominence due to pressure on the median nerve
Is seen in carpal tunnel syndrome
Acute gouty arthritis
The metatarsophalangeal joint of the great toe is tender, painful, red, and hot and swollen
Hallux valgus
An abnormality in which the great toe is deviated laterally and may overlap the second toe
Enlarged painful, inflamed, bursa or bunion may form on the medial side
Hammer toe
Hyper extension at the metatarsophalangeal joint with flexion at the proximal interphalangeal joint
commonly occurs with the second toe
Plantar warts
Painful warts (verruca vulgaris) that often occur under a callus appearing as tiny dark spots
Jobs of the nervous system
Receive sensory stimuli from the environment
Identifies an integrates adaptive processes needed to maintain current body functions
Orchestrates body functions required for adapting and surviving
Integrate rapid response of the central nervous system and response of the endocrine system
Controls voluntary and cognitive behavioral processes
Controls subconscious and involuntary body functions
Three major functioning units of nervous system
Spinal cord level
Brain stem and subcortical level
Cortical level
Spinal cord level
Lowest functional level
Controls automatic, motor responses (reflexes)
Brainstem and some subcortical level
What keeps you alive
Controls blood pressure, respiration, equilibrium, and primitive emotion
Vital sign *
Cortical level
Responsible for cognition
Higher level thinking
Learning and applying
Central nervous system
The brain and the spinal cord
The network of coordination and control of the body
Peripheral nervous system
Motor and sensory nerves and ganglia outside of the central nervous system
Carries information to and from the central nervous system
What makes up the peripheral nervous system
12 pairs of cranial nerves
31 pairs of spinal nerves
Autonomic nervous system
-Sympathetic
-parasympathetic
The brain
Receives blood supply from the two internal carotid arteries and two vertebrae arteries that joined to form the basilar artery
Blood supply - 15-20% of total cardiac output goes to the brain (brain is selfish)
Three major units of the brain
Cerebrum
Cerebellum
Brainstem
Cerebrum
Two cerebral hemispheres - divided into lobes
Outer layer of cerebrum
Gray matter of the cerebral cortex
- higher mental function, general movement, visceral functions, perception, behavior
- Integrates the functions
Inner layer of cerebrum
White matter of the cerebral cortex
- nerve fibers and myelin
Myelin
Encases nerve fibers to allow them to transmit
Issues with it causes neuro issues and deficits
Disorders of the cerebrum
Multiple sclerosis
CMV
Encephalitis
Folate or Vitamin B12 deficiency
Vasculitis
PKU
Frontal Lobe
Part of cerebrum
Motor cortex
Voluntary skeletal movement and fine repetitive motor movements, eye movements (NOT vision)
Parietal lobe
Part of the cerebrum
*Processing received sensory data
Assist in interpretation of tactile, visual, gustatory, olfactory, auditory sensations
Recognition of body parts and body position
*Communication between sensory and motor areas of the brain
Occipital lobe
Part of the cerebrum
Primary vision center
Provides interpretation of visual data
Temporal lobe
Part of the cerebrum
Perception and interpretation of sounds and determination of the source
Integration of taste, smell balance reception, and interpretation of speech
Broca Area
Responsible for speech PRODUCTION
Closer to front of the brain
Located between temporal lobe and frontal lobe
Wernicke Area
Responsible for speech INTERPRETATION
Closer to back of brain
Located between temporal lobe, occipital love and parietal lobe
Cerebellum
Aids the motor cortex of the cerebrum in the integration of voluntary movement
Processes sensory information from the eyes ears, and touch receptors
Cerebellum and vestibular system
Work together for reflexive control of muscle tone equilibrium, and posture to produce study and precise movements
Causes of cerebellum disorders
Congenital malformations, hereditary ataxias and acquired conditions
Symptoms vary with the cause typically include ataxia
Ataxia
Impaired muscle coordination
Brainstem
Pathway between cerebral cortex and the spinal cord
Controls many involuntary movements
Parts of brainstem
Medulla oblongata
Pons
Midbrain
Diencephalon
Nuclei contain 12 cranial nerves
Reticular formation
Part of the brainstem
Contains in network fibers for muscle stimulation
-counteracts gravitational forces
-regulates, cardiac and respiratory systems
-maintains consciousness
Medulla oblongata
Part of brainstem
CN IX -XII (9-12)
Respiratory, circulation, vasomotor activities, houses respiratory center
Reflexes - swallowing, coughing, vomiting, sneezing, hiccuping
Pons
Part of brainstem
CN V-VIII (5-8)
Regulates, respiration, houses portion of respiratory center, control controls, voluntary muscle action
Midbrain
Part of brainstem
CN III-IV (3-4)
Reflex center for eyes and head movement, auditory relay pathway
Thalamus
Part of the brainstem
Perception of pain
temperature control
Epithalamus
Pineal body
Sexual development and behavior
Hypothalamus
Part of the brainstem
*Major processing center of stimuli for autonomic nervous system
Maintains temperature control, H2O metabolism, body fluid osmolarity, eating behavior, neuroendocrine activity
Pituitary gland
A.k.a. master gland
Hormonal pros control
Lactation, vasoconstriction and metabolism
Decerebrate posture
Usually means severe brain stem injury
Arms and legs extended
Toes pointed downward
Head and neck arched backwards
Muscles rigid
Decorticate posture
Arms flexed, clenched fists
Extended legs that are held out straight
Arms are bent inward towards the body with wrist and fingers bent and held on the chest
Muscles are rigid
Spinal Cord
40 to 50 cm
Fibers grouped in two tracks that run through the spinal cord carrying sensory, motor, and autonomic impulses between higher centers of the brain and the body
Make up of spinal cord
32 pairs of spinal nerves
Myelin - coated white matter containing the ascending and descending tracks
Gray matter contains nerve cells, bodies arranged in a butterfly shape with anterior and posterior horns
Ascending tract
Carries sensory data to the brain
Mediates various sensations, facilitate century signals for complex discrimination for touch, pressure, vibration, and position of joint
Two point discrimination
Descending Tract
Carries motor impulses from the brain
Conveys impulses to various muscle groups by inhibiting or exciting spin activity
Cranial nerves
I - Olfactory
II - Optic (not PNS)
III - Oculomotor
IV - Trochlear
V - Trigeminal
VI - Adbucens
VII -Facial
VIII - Acoustic
IX - Glosso-pharyngeal
X - Vagus
XI - Accessory
XII - Hypoglossal
Cranial Nerve I
Olfactory - smell (sensory)
Cranial Nerve II
Optic - vision (sensory)
Cranial Nerve III
Oculomotor - upward, downward, medial eye movement, lid elevation, pupil constriction (motor)
Cranial Nerve IV
Trochlear - downward, medial, eye movement (motor)
Cranial Nerve V
Trigeminal
- face, scalp, nasal mucosa, buccal mucosa (sensory)
- jaw muscle, massager muscle, temporal, digastric muscle (motor)
Cranial Nerve VI
Abducens - lateral eye movement (motor)
Cranial Nerve VII
Facial
- external ear, taste anterior side 2/3 of tongue (sensory)
- facial movement, scalp, salivation, lacrimation (motor)
Cranial Nerve VIII
Acoustic - cochlear hearing (sensory)
Cranial Nerve IX
Glossopharyngeal
- external ear, taste posterior 1/3 carotid reflexes, sinus, baro and chemoreceptors (sensory)
- gag, swallow and salivation (motor)
Cranial Nerve X
Vagus
- external ear, pharynx (sensory)
- swallow, pronation, bronchoconstriction, gastric secretion, peristalsis (motor)
Cranial Nerve XI
Accessory - Swallow, pharyngeal muscles, head turn and shoulder rise (motor)
Cranial Nerve XII
Hypoglossal - tongue muscle, Hypoglossus (motor)
Sensory Cranial Nerves
I olfactory
II optic
VIII acoustic
Motor Cranial Nerves
III Oculomotor
IV trochlear
VI abducens
XI accessory
XII Hypoglossal
Both motor and sensory cranial nerves
V Trigeminal
VII Facial
IX Glossopharyngeal
X Vagus
CN I II III IV VI
Responsible for smell, visual acuity, pupillary constriction, extraocular movement
CN VII and IX
Control taste
Spastic hemiparesis
Affected leg stiff and extended
Foot dragged, scraping of toes, affected arm flexed, adducted, no swing
Ataxia
Uncoordinated uncontrolled falling occurs
Parkinsonian
Stooped, rigid, short shuffling steps starting, difficulty stopping
Glasgow coma scale
Way to measure mental status and LOC
Awake/alert - follows commands
Lethargic - drowsy - tap awake
Stuporous - shake or shout to wake
Comatose - does not response to verbal cues or painful stimuli
Orientation status
X4
Person - name and DOB
Place - where are you
Time - day, month, season
Situation - why are you hear
Cerebral function test
Difficulty with memory?
recollection of past easier then present?
Perform immediate memory test:
Repeat numbers backwards forward
Recent memory test:
Dietary recall
Remote memory test:
Past jobs and birth place
Mini mental status exam
Most often used in the elderly
Assesses:
Orientation
Registration
Attention/calculation
Recall
Language
Mental status change
Early indication of change in neurological status
Can be subtle and difficult to detect
May begin slowly
Causes of mental status change
Neurological issues, fluid and electrolyte imbalance, hypoxia, poor perfusion, nutritional deficiencies, infections, renal and liver disease, hyper/hypothermia, trauma, medication/toxin, drug/alcohol abuse
Proprioception
Posterior columns of spinal cord
Carries stimuli and fibers for touch
Ability to maintain posture, balance, and coordination
Works with cerebellum
Testing cerebellar function
Finger to nose and finger nose finger movements
Rapid alternative movements (thumb to 4 fingers as rapidly as possible) note speed/accuracy
Heel to ship
Romberg test
Tandem/tip toe walking
Testing somatic sensation function
Sensation:
- dermatones and major peripheral nerves
- forehead, cheek, hand foot
Light touch:
- wisp of cotton
Pain & temp:
Sharp/dull and hot/cold
Vibration:
Tuning fork on body prominence
Ask localization stop and start
Dermatomes
Relationship between the spinal nerves and skin sensation
Each spinal nerves root provides a sensation to a predicable area of the skin although there is a lot of overlap
Deep tendon reflexes (DTR)
Biceps
Triceps
Brachiordialis (wrist)
Patellae
Plantar (bottom of foot)
Achilles
DTR grading scale
0 - no response
1 - low normal/slightly diminished
2 - normal
3 - more brisk than normal / not necessarily associated with disease
4 - brisk, hyperactive, associated with disease
DTR strength scale
5 - active motion against full resistance, normal
4 - active motion against some resistance, slight weakness
3 - active motion against gravity, average weakness
2 - passive ROM (assisted by examiner), poor ROM
1 - slight flicker of contraction, severe weakness
0 - no muscular contraction, paralysis
Primitive reflexes
Sucking
Rooting
Moro
Babinski
Glabellar
Palmar/grasp
Plantar
Tonic neck
Cremasteric reflex
When stroke thigh, testicle on that side should elevate
Vertigo
Sensation that everything is “spinning” can be accompanied with nausea, vomiting, nystagmus
Syncope
Temporary loss of consciousness “blackout”, “how to spell”
Paresthesia
Numbness or tingling
Symptoms can be benign or they can be serious such as an impending CVA, requires thorough investigation
Possible causes of paresthesia
Diabetes, neurological, metabolic, cardiovascular, renal, inflammatory diseases, or toxins
Multiple sclerosis
Immune, ruction of myelinated sheath
Generalized seizure disorder
Systemic disease, head, trauma, toxins, stroke, hypoxic syndrome
S/s - disturbances and consciousness, behavior, common sensation, autonomic functioning
Urinary and fecal incompetence can occur
Meningitis
Inflammation, bacterial or viral
Kernig sign
Brudzinski’s signs (tuck chin to chest, significant pain means meningitis)
Limes disease
Comes from ticks
Three Stages:
Bull’s-eye rash
Cardio/Neuro symptoms
Arthritis/worse Neuro s/s
Rx by antibiotics
Space occupying lesion
Primary or metastatic
S/s depend on location
Cerebral Palsy
Nonprogressive
Normal pressure hydrocephalus
Corrected by V-P shunt
Spina Bifida
Neural tube defect (incomplete development of brain, spinal cord and/or protective coverings)
Amyotrophic lateral sclerosis
From of MD
Weakens muscles
Progressive
Brain attack or stroke
Cerevrovascular accident (CVA)
Sudden focal neurological deficit resulting from impaired circulation to/within the brain
Causes of CVAs
Associated with cardiovascular disease
Thrombosis, embolism, hemorrhage cause circulation impairment
Most common site is within the distribution of the anterior circulation of the brain
Warning signs of stroke
Sudden weakness, numbness, paralysis of face, arms,
legs especially on one side.
Sudden trouble with vision either one eye or both,
diplopia, monocular blindness
Sudden confusion, difficulty with speaking (dysarthria)
or understanding speech (aphasia)
Sudden severe headache without apparent reason
Sudden trouble walking, dizziness, loss of balance or
falling without reason, loss of coordination
BEFAST
Balance - sudden loss
Eyes - vision loss
Face - uneven smile
Arm - weakness in one
Speech - slurred
Time - call 911 right away
Parkinson’s Disease
Slow progression, degenerative, disorder of the dopamine neurotransmitters of the brain
Results in poor communication in the neuron system
Causes of Parkinson’s disease
Questionable genetic, environmental components
Can be viral, vascular, toxic
S/S of Parkinson’s
Tremors at rest, fatigue, masked facial expression, shuffling gait, muscle rigidity, “pill rolling”, behavioral changes and dementia, stiffness or slowing of movement
Alzheimer’s Disease
Destruction of brain cells
Progressive, decline in memory and mental functions
**most common causes of dementia
Causes of Alzheimer’s
Combination of genetics, lifestyle, environment
Increasing age - major risk factor, but it is NOT a normal process of aging
Early vs Late onset of Alzheimer’s
Later onset more common
Early onset - age 30-60, <10% of all w/ Alzheimer’s, genetics
Myasthenia Gravis
Disorder of peripheral nervous system
Chronic, autoimmune, involves lower motor neurons and muscle fibers
Immune system attacks synaptic junctions between nerve and muscle fibers
Trigeminal Neuralgia (Tic Douloureux)
Disorder of Peripheral Nervous System
Affects 5th cranial nerve
Chronic, compression by a small artery, wears away the myelin
Possibly associated with MS, tumor, AVM, injury
Rx: meds/injection/surgery
Bells Palsy
Disorder of peripheral nervous system
Affect 7th cranial nerve
Temporary facial paralysis from damage/trauma to facial nerves from swelling, inflammation, compression
Usually caused by virus, possible bacterial infection
Rx: antibiotics, prednisone
Gillian Barre Syndrome (GBS)
Disorder of peripheral nervous system
Autoimmune, acute inflammatory demyelination of peripheral nerves
Rapidly progressive
?bacterial/viral cause
Peripheral Neuropathy
Disorder of peripheral nervous system
Motor and sensory issues
Seen in hands/feet
Numbness/tingling/burning/cramping
Causes of peripheral neuropathy
Diabetes
Toxins
Vitamin B12 deficiency
Autoimmune
Neurologic conditions
