Unit 3: Neurological Assessment, Cranial Nerves, Musculoskeletal Assessment Flashcards
1
Q
the brain, spinal cord, and the meninges comprise what part of the neurological system?
A
CNS
2
Q
the cranial nerves and spinal nerves comprise what neurological system?
A
PNS
3
Q
the sympathetic and parasympathetic systems comprise what system?
A
ANS
4
Q
what joins the left and right hemispheres of the brain?
A
corpus callosum
5
Q
people with epilepsy have seizures that travel through this and may be removed when seizures do not stop with anti-seizure medications
A
corpus callosum
6
Q
what are the four lobes
A
frontal, parietal, temporal, and occipital
7
Q
includes the thalamus and the hypothalamus
A
diencephalon
8
Q
this is the relay station and reflexes are located here
A
brainstem
9
Q
this makes up the brainstem
A
midbrain, pons, and medulla
10
Q
lose reflexes and can’t breathe
A
damage to brainstem
11
Q
breathing and heart rate are affected by this system
A
Autonomic
12
Q
this is responsible for coordinating movement and maintaining equilibrium
A
cerebellum
13
Q
atlas is C_
A
1
14
Q
axis is C_
A
2
15
Q
column where motor (efferent fibers) exit and carry muscle impulses to produce voluntary movements that involve skill and purpose
A
anterior/ventral
16
Q
column where sensory (afferent fibers) enter
A
posterior/dorsal
17
Q
T or F? Gray matter is where nerves are and where electrical signals travel
A
True
18
Q
in the brain which matter is on the outside
A
gray matter
19
Q
in the brain which matter is on the inside
A
white
20
Q
down descending tracts
A
motor impulses
21
Q
up ascending tracts
A
sensory impulses
22
Q
how many pairs of spinal nerves are there?
A
31
23
Q
how many cervical spinal nerves are there
A
8
24
Q
how many lumbar spinal nerves are there
A
5
25
how many sacral spinal nerves are there
5
26
how many thoracic spinal nerves are there
12
27
how many coccygeal spinal nerves are there
1
28
"rest and digest" nerves
parasympathetic
29
"fight or flight" nerves
sympathetic
30
which type of nerves constrict pupils, stimulate saliva, and slow heart beat
parasympathetic
31
which type of nerves dilate pupils, inhibit saliva, and increase heart beat
sympathetic
32
which type of nerves constrict airways, stimulate activity of stomach, and inhibit the release of glucose; stimulating gallbladder
parasympathetic
33
which type of nerves stimulate activity of intestines, contract bladder, and promote erection of genitals
parasympathetic
34
which type of nerves relax airways, inhibit activity of stomach, and stimulate release of glucose; inhibit gallbladder
sympathetic
35
which type of nerves inhibit activity of intestines, secrete epinephrine and norepinephrine, relax bladder, and promote ejaculation and vaginal contraction
sympathetic
36
what carries cranial and spinal nerves
impulses
37
T or F? Heart and glands have involuntary smooth muscles.
True
38
demyelination of nerves
multiple sclerosis
39
blockage in an artery causes ischemia of brain tissue because of the lack of blood
ischemic stroke
40
blood vessel in brain bursts, leaking blood into brain causing pressure on brain and blood is toxic
hemorrhagic
41
what occurs in pt with epilepsy
seizures
42
20
increased ICP
43
Inflammation of meninges
meningitis
44
f
spinal cord compression
45
neurological disorder PNI
peripheral nerve impairment
46
nerves do not work as well (diabetics last stage)
neuropathy
47
glaucoma causes this, increased pressure in eyeball
increased intra-ocular pressure
48
pins and needles
paraesthesia
49
headaches, seizures, dizziness, numbness, paraesthesia, sensory loss, weakness, decr. lvl of consciousness, dysphagia, tics, loss of bowel/bladder control, and paralysis
neurological common complaints
50
blood clot or plaque that blocks blood flow or hemorrhage of vessels in the brain
stroke
51
many of the same pt with coronary artery disease are at risk for this
CVA
52
north carolina, georgia, alabama, mississippi, louisiana, arkansas, tennessee
stroke belt
53
have the highest levels of HTN and obesity
non-hispanic african americans
54
have more stiffening of carotid arteries with age
hispanic and african americans
55
what type of stroke is this
ischemic
56
what type of stroke is this
hemorrhagic
57
HTN, DM, heart disease, smoking/exposure to secondhand smoke, age and gender, race and ethnicity, personal/family hx, brain aneurysms or arteriovenous malformations (AVMs), alcohol/drugs, certain medical conditions, lack of physical activity, overweight/obesity, stress/depression, unhealthy cholesterol lvls, unhealthy diet, and prolonged NSAID med use.
risk factors for stroke
58
why do NSAIDs cause strokes?
they damage kidneys-> kidneys affect blood pressure-> blood pressure increases risk for stroke
59
sudden numbness or weakness of the face, arm, or leg (esp. once sided), sudden confusion, trouble speaking or understanding speech, sudden trouble seeing in one or both eyes, sudden trouble walking, dizziness, loss of balance, or coordination, and sudden severe headache w/o known cause
CVA assessment findings
60
there are 3 factors in ICP, increase in one causes a decrease in another (keeping ICP the same in the brain), the body can absorb CSF, decrease bloodflow.
monroe kelley doctrine
61
normal ICP
5-15 mmHg
62
MD: patient is in danger if ICP keeps going up bc brainstem can herniate down causing death since the brainstem is being strangled (controls breathing and heart rate) :
ICP above 20
63
once overcompensation is done, there is a limit to how much it can decrease the pressure
increased ICP
64
headache that is worse when waking, better through out the day because once you stand up more flow circulates releasing pressure on the brain. if ICP has increased, bed should be elevated
s&s
65
nausea/vomiting, photophobia, blurred vision
s&s
66
tools: cotton ball, cotton-tipped applicator, objects to feel, paperclip, tuning fork, reflex hammer
assessment of the peripheral nervous system
67
decreased ability to hear, see, sense (taste, scent, light touch, and pain), vibratory sensations at ankles, position sense in greater toe, intentional tremors, reduced muscle mass from degeneration of muscle fibers.
older adult considerations CVA
68
hand or head tremors or dyskinesia (repetitive movements of the lips, jaw, or tongue), slow, certain gait with wide base and bent-forward appearance, decreased reaction time that may slow response of DTRs, and achilles and plantar reflexes that are difficult to elicit or absent
older adult considerations CVA
69
how do you test level of consciousness
glascow coma scale
70
glascow scale of 3
worst
71
glascow scale of 15
best
72
pt is verbally oriented, eyes are spontaneous, and obey motor commands, what is the glascow scale?
15
73
writing a number in hand
graphesthesia
74
motor and cerebellar f(x), rapid alternating movements (finger to nose), heel to shin, gait, balance, involuntary movements, sensory f(x), sharp/dull, light touch, vibratory sensation, proprioception, two point discrimination, and point localization.
focused neuro check
75
familiar object in hand
stereognosis
76
sharp/dull, vibratory sensation, proprioception, stereognosis, two-point discrimination, and graphesthesia
sensory neuro exam
77
react when pinch, remove intubation
localizing
78
indicate brain injury: 7
severe
79
indicate brain injury: 10
moderate
80
indicate brain injury: 14
mild
81
what do you do if GCS is less than 8?
intubate
82
loss of proprioception, motor pain temp is still present, remember that posterior is sensory
posterior cord syndrome, spinal cord injury
83
rapid alternating movements (finger to nose), heel to shin, gat, balance (Romberg), and involuntary movements
motor coordination neuro exam
84
swaying/movement feet apart for balance
positive romberg
85
ask client to stand erect with feet together, note unsteadiness or swaying, have client close eyes for 20 seconds, and make sure they do not fall.
romberg test
86
test where you lift up or push toes and fingers down
proprioception
87
before doing the reflex test what would you ask the patient to do?
relax and position properly
88
palpate the tendon, briskly strike tendon, compare response of one side to the other, and the pointed end should be used for small area, wider end for more tender area
reflex exam
89
reflex grade: 4+
hyperreflexia with clonus
90
reflex grade: 0
absent
91
reflex grade: 3+
exaggerated response
92
reflex grade: normal
2+
93
reflex grade: decreased
1+
94
proprioception is preserved, loss of motor, pain, and temp, anterior is motor
anterior cord syndrome, spinal cord injury
95
injury can result in sacral (still have bowel and bladder f(x) but have weakness in extremities) weakness is more prominent in the upper extremities than lower extremities
central cord syndrome, spinal cord injury
96
hemisection (one side of spinal cord is damaged and the other side is not), motor impulse from left side of brain makes right side of body move, there can be sensory but no motor on the same side
brown-sequard syndrome
97
results in quadriplegia, paralysis or weakness of legs and arms, may result in breathing difficulties (injury of C3 or higher may pt will not be able to breathe)
cervical spine spinal cord injury
98
results in paraplegia, paralysis or weakness of legs, loss of bladder control or bowel function
injury of thoracic/lumbar spine
99
T or F? A negative Babinski is a normal finding
true
100
T or F? flexion of toes is a normal finding in adults
true
101
T or F? fanning of toes is a normal finding in adults
false, only normal in infants
102
repeated rapid contractions or oscillations of the ankle and calf muscle, while supporting leg briskly dorsiflex the foot toward the client's head, is usually seen with lesions of upper motor neurons
clonus
103
normal or abnormal: anosmia
abnormal, its the inability to smell
104
nerve that carries smell impulses from nasal mucous membrane to the brain, sensory
olfactory
105
nerve that carries visual impulses from eye to brain, sensory
optic
106
nerve that tests: visual acuity, round red reflex, and peripheral vision
optic
107
what are abnormal findings for nerve II
presbyopia, myopia, and missing more than a line in the Rosenbaum chart
108
what is a normal finding for the peripheral vision/confrontation test?
see examiner's finger at the same time
109
what test is failed when there is a delayed perception showing reduced peripheral vision, glaucoma, tumor/lesion, cataracts, retinal damage, stroke
peripheral/confrontation test
110
how to test: you're in front of pt, cover opposite eye while looking directly at each other, and assess 3 different angles on each side.
peripheral/confrontation test
111
normal finding: red reflex observed in each eye when pt looks directly at light source
round red reflex
112
what abnormal findings can be found with the round red reflex test?
Papilledema (blurred margins), cataract (enlarged), and retinoblastoma (leukocoria) is seen as white
113
has motor f(x), contracts eye muscles to control eye movements (interior lateral, medial, and superior), constricts pupils, and elevates eyelids.
oculomotor
114
how to test: pupillary response to light (direct and indirect) and accommodation and convergence in both eyes.
oculomotor
115
pupils should be
3-5 mm, round and equal bilaterally, restrict to light (PERRLA- pupils, equal, round, reactive to light and accommodation), accommodation to where pupils constrict and converge when focused on near object
116
pt looks straight ahead w/ dim lights, pen light should eval each pupil at one time, assess size, shape, and response of pupil w/ direct light and indirect to where you look at the response of the other.
pupillary light reflex
117
test: pt follow penlight without moving head
accommodation
118
nerve III abnormal findings
fixed, unequal, pupils do not constrict and converge
119
contracts one eye muscle to control infero-medial eye movement
nerve IV: trochlear
120
controls lateral eye movements
CN VI: abducens
121
no drooping bilaterally is a normal finding for which CN?
CN III: oculomotor
122
which test is this: inspect margins of eyelids of each eye, cardinal fields of gaze test, corneal light reflex, and cover/uncover test?
tests extra-ocular muscle function
123
drooping of eyelid due to weak eye muscles, seen in myasthenia gravis due to stroke, increased ICF, Bell's palsy (can go away).
ptosis
124
quivering of the eye
nystagmus
125
tests CN III, IV, and VI
cardinal field test
126
misalignment of the eye
strabismus
127
detects deviation in alignment or strength
cover and uncover test
128
how to test: ask pt to stare ahead and focus on a distant object, cover one eye with card and remove, observe covered eye for any movement
cover/uncover test
129
T or F? normal finding for cover/uncover test: both eyes move, phoria (misalignment of the eyes so that their natural resting point is not perfectly aligned), strabismus (misalignment of the eye), tropia
false
130
corneal light reflex
assesses parallel alignment of eyes
131
how to test for the corneal light reflex
hold pen light 12 inches away and shine toward the bridge of the nose while pt stare ahead, note location of light reflected on both eyes
132
light is reflected on the same spot bilaterally (parallel alignment)
normal finding for corneal light reflex
133
asymmetric position of light d/t deviation of eye alignment
abnormal finding for corneal light reflex
134
sensory/motor nerve, carries sensory impulses of pain, touch, and temperature from the face to the brain. influences clenching and lateral jaw movements (biting, chewing)
trigeminal
135
able to identify sharp/dull stimuli and light touch
sensory portion of the trigeminal nerve test
136
motor portion of the cranial nerve V test
clench teeth while palpating temporal and masseter muscles for contraction
137
abnormal findings for cranial nerve V
pt is unable to identify sharp/dull sensation or light touch, asymmetric strength, pain, or bilateral weakness.
138
sensory and motor nerve, supplies facial muscles and affects facial expressions (smiling, frowning, closing eyes), contains sensory fibers for taste, stims. secretions from salivary glands and tears from lacrimal glands.
CN VII: facial
139
taste test w/ salt, pt smile, frown, wrinkle forehead, show teeth, puff out cheeks, raise eyebrows, and close eyes tightly against resistance.
CN VII: facial
140
abnormal finding for CN VII
inability to identify flavor, inability to perform movements and/or asymmetrical movements.
141
pt is able to blink eyelids bilaterally when you touch cornea w/ cotton wisp
CN V and VII: corneal reflex
142
CN VIII tests
whisper test, weber, and rinne
143
sensory, has sensory fibers for hearing and balance
CN VIII: vestibulocochlear nerve
144
unilateral conductive and sensorineural hearing, use tuning fork; spin and place bridge next on top forehead, center
weber
145
lateralization is an abnormal finding for the rinne test
false, its abnormal for the weber test
146
vibrations are heard equally in both ears
normal finding for the weber test
147
tests for unilateral conductive hearing, spin tuning fork and place fork on mastoid bone behind ear and as if you can hear then move fork beside ear and ask if they can hear
rinne test
148
AC>BC, should hear when next to ear louder
rinne
149
has sensory fibers for taste, pharynx which is where the gag reflex would be tested, promotes swallowing movements, sensory and motor
CN IX: glossopharyngeal
150
carries sensations from the throat, larynx, heart, lungs, bronchi, GI tract, and abdominal viscera. promotes swallowing, talking, and production of digestive juices, sensory and motor
CN X: vagus
151
test where pt has ability to cough, swallow, and talk
CN IX glossopharyngeal and X vagus
152
normal findings for IX and X
uvula and soft palate rise and fall bilaterally, gag reflex, and able to swallow w/o difficulty and no hoarseness noted
153
motor nerve, control neck and shoulder movement, the intrinsic musculature of the larynx, and the sensitive afferences of the trapezius and sternocleidomastoid musculature
CN XI: spinal accessory
154
how to test CN XI:
pt shrugs shoulders and turn head side to side against resistance
155
motor, innervates tongue muscles that promote the movement of food and talking
CN XII hypoglossal
156
how to test: strength and mobility of the tongue, protrude tongue, move it side to side against resistance
CN XII hypoglossal
157
types of muscles
skeletal, smooth, and cardiac
158
what does the musculoskeletal system consist of
bones, muscles, and joints
159
provide structure and movement for body parts, controlled and innervated by the nervous system
musculoskeletal system
160
provide structure, protection, levers, store calcium, and produce blood cells
bones
161
head and trunk of the body (80 bones)
axial skeleton
162
extremities, shoulders, hips (126 bones)
appendicular skeleton
163
spongy, soft, has holes, makes up the inner layer and ends of the bones
spongy bone
164
hard, dense, makes up the shaft and the other layer of bone
compact bone
165
active cells that form bone tissue, come from the bone marrow and related to structural cells, work in teams to build bone, produce new bone called osteoid which is made of bone and other protein, control calcium and mineral deposition and are found on the surface of the new bone, and can be found in the periosteum, which covers the bones, and helps promote nourishment.
osteoblasts
166
cells that degraade or dissolve the bone tissue to initiate normal bone remodeling, come from the bone marrow and are related to white blood cells. they are formed from two or more cells that fuse together, found the surface of the bone mineral next to the dissolving bone.
osteoclasts
167
RBCs, platelets, and most white blood cells are made by
red bone marrow
168
is mostly composed of fat, fat can be used as a source of energy
yellow marrow
