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H & P Final
Pt Assessment
| Question | Answer |
|---|---|
| Regulates internal environment | Autonomic ns (symp/parasymp) |
| Motor/sensory nerves, ganglia outside CNS | Peripheral ns |
| Components of neuro exam | Mental Status; CNs; Sensory Fn; Cerebellar Fn; Motor fn; DTRs |
| Mental Status exam is performed during what part of exam? | throughout the entire patient interaction |
| Mediates higher mental functions, perception, & behavior | Cerebral cortex |
| Assoc w/speech, emotions, memory | Frontal |
| Processes sensory data | Parietal |
| Hearing, speech, long term memory, language, behavior, emotion & personality | Temporal |
| Mediates survival behavior, affect | Limbic |
| Appearance & Behavior: components | Grooming, emotional status, Body language |
| Body language: | Posture, eye contact, nervousness, psychomotor agitation, immobility |
| Lev els of consciousness | Alert; Lethargy; Obtunded; Stupor; Coma |
| Awake, responds fully and appropriately | Alert |
| Drowsy, respond to questions | Lethargy |
| Slow response and somewhat confused | Obtunded |
| Slow responses, arousable for short periods with painful stimuli | Stupor |
| Not aware nor awake | Coma |
| Pt should be oriented to: | person, place, time, & situation |
| Time disorientation | anxiety, depression, dementia |
| Place disorientation | psychiatric disorders, delirium |
| Person disorientation | cerebral trauma, seizures |
| Registration | repeat a sentence or three unrelated items |
| Recall | show the patient 3 items, have him recall them later |
| Short-term Memory | ask about events within the past few hours or days (weather that morning, etc.) |
| Long-term Memory | ask mother’s maiden name, high school attended, significant historical events |
| Impaired memory | delirium, dementia, anxiety, depression |
| Loss of immediate and recent memory with retention of remote = | dementia |
| Ability to focus or concentrate over time: | Attention span |
| Ask pt to repeat series of numbers, serial 7s, spell WORLD backwards: tests = | Attention span |
| Ask pt to follow series of short commands or repeat short story: tests = | Attention span |
| Decreased attention span may be related to: | fatigue, anxiety, dementia |
| “What would you do if you found a stamped envelope?” – tests: | judgment/insight |
| Mood = | sustained internal emotion |
| Affect = | observable feeling/tone, more episodic* |
| Mood & Affect: Ask pt = | How they feel right now (depressed? Signs of mania?) |
| Thought process/content: Ask pt = | How and what they are thinking |
| Perceptions: assessment includes = | Hallucinations, illusions |
| Aphonia: | loss of voice |
| Dysphonia: | impairment in volume, quality, pitch of voice |
| CN II: tests | acuity, fields, funduscopic |
| CN III tests | pupillary response (direct and consensual); Inspect eyelids for drooping; EOMs |
| CN IV (Trochlear) test | EOM: Inferio-medial |
| CN VI (Abducens) test | EOM: Lateral deviation |
| Tests for Primary Sensory Functions | Light touch; superficial pain; temp |
| Sensory fn test of shoulders = tests: | C5 |
| Sensory fn test of thumb = tests: | C6 |
| Sensory fn test of middle finger = tests: | C7 |
| Sensory fn test of pinky = tests: | C8 |
| Sensory fn test of inner forearms = tests: | T1 |
| Sensory fn test of lateral thigh = tests: | L3 |
| Sensory fn test of medial ankle = tests: | L4 |
| Sensory fn test of 1st inter-digital space = tests: | L5 |
| Sensory fn test of Little toe/Lateral ankle = tests: | S1 |
| Where test vibration sense | Toe, ankle, knee, Finger, wrist, elbow, shoulder |
| Stereognosis | Ability to identify common object; Tactile agnosia suggests parietal lobe lesion |
| Graphesthesia | Identify drawn figure |
| Two-point discrimination | Use one or two points (2-8 mm is normal in fingertips) |
| Decorticate rigidity | Rigid flexion; Corticospinal tract above brainstem |
| Decerebrate rigidity | Rigid extension; Brainstem |
| Aphasia | Disorder in producing or understanding language |
| Broca’s | Expressive |
| Wernicke’s | Receptive |
| Anesthesia | Total or partial loss of sensation |
| Hyperesthesia | Increase in sensitivity to sensory stimuli |
| Nystagmus: | Rhythmic oscillation of eyes; Cerebellar disease, drug toxicity |
| Resting tremor | Pronounced at rest; Parkinsonism |
| Intention tremor | Appears with activity; Multiple Sclerosis |
| Postural tremor | Appears when maintaining a posture; hyperthyroid, fatigue, benign essential |
| Bell’s Palsy | Peripheral paralysis of facial nerve; Central lesion will only affect lower face |
| 5.07 Monofilament tests for: | Test for protective sensation |
| The motor cortex is located in: | the precentral gyrus of the frontal lobe |
| Corticospinal tracts AKA: | pyramidal tracts |
| Corticospinal tracts originate in the | motor cortex |
| 3 “motor pathways” : | corticospinal tracts, basal ganglia and the cerebellum |
| Aids motor cortex in integration of voluntary movement | Cerebellum |
| coordinates control of muscle tone, posture and equilibrium | Cerebellum |
| Cerebellar functions: at ____ level | unconscious |
| Responsible for fine movement of the hands | Cerebellum |
| Upper motor neurons (UMN): Originate & terminate: | within CNS |
| UMN are neurons of the: | corticospinal tracts and the basal ganglia |
| UMN can influence or modify the: | lower motor neurons |
| Examples of UMN disease: | CVA, multiple sclerosis & cerebral palsy |
| The “final common pathway: | LMN |
| Examples of lower motor neuron disease | Spinal cord lesions |
| “lower” or primitive pathway = | Basal Ganglia System: |
| Basal Ganglia System AKA | extrapyramidal system |
| Extinction phenomenon | Touch pt at 2 diff areas of body; they s/b able to exactly locate both |
| Point localization | Touch a point, ask pt to open eyes & indicate location touched |
| 5.07 Monofilament: pos test may indicate: | Peripheral neuropathy, Diabetes mellitus |
| LMNs located in: | peripheral nervous system (cranial nerves & spinal nerves) |
| Spinal nerves: how many pairs? | 31 |
| Sensory afferent fibers of dorsal root carry impulses: | from sensory receptors to the spinal cord |
| Sensory/motor fibers supply/receive information in: | dermatomes |
| Motor exam: | Mx tone/bulk; mx strength; DTRs; Cerebellar fn |
| Cerebellar function: | Gait/balance; Coordination; Romberg |
| Coordination tests: | Rapid alternating movements; point-to-point testing |
| Mx inspection: hands | thenar/hypothenar eminences |
| Mx inspection: Palpation: | Mx tone; mx strength |
| The normal, mild resistance of a relaxed muscle to a passive stretch | Tone |
| Increased tone = | spasticity |
| Spasticity causes: | awkward, rigid movements; |
| Rigidity that persists throughout the range is called: | lead-pipe rigidity |
| Decreased mx tone = | flaccidity |
| Mx inspection: Palpation: Muscle strength: | Compare symmetrically |
| Mx strength scale = | graded on a 0-5 scale |
| Mx strength scale: 0 = | no voluntary contraction |
| Mx strength scale: 5 = | full muscle strength against resistance |
| Weakness may result from: | pain, fatigue or disuse |
| Strength testing is often combined with: | ROM |
| Mx strength scale: a grade of 3 or less = | consistent with disability |
| Babinski response indicates: | dz of pyramidal tract in adults |
| DTRs: Biceps: | C5,6 |
| DTRs: Triceps: | C6,7 |
| DTRs: Brachioradialis: | C5,6 |
| DTRs: Patellar: | L2,3,4 |
| DTRs: Ankle: | S1 |
| Grading DTRs: 0 = | absent response |
| Grading DTRs: 1+ = | sluggish / diminished |
| Grading DTRs: 2+ = | average / anticipated response |
| Grading DTRs: 3+ = | brisk, slightly hyperactive |
| Grading DTRs: 4+ = | hyperactive; clonus may be present |
| DTRs can be recorded: | in chart-style or by using a stick-man figure |
| Biceps Reflex: expected response | visible or palpable flexion of the elbow |
| Triceps Reflex: Response: | visible or palpable extension of the elbow |
| Brachioradial Reflex: Response: | elbow flexion with supination of the hand. |
| DTRs include tests of: | Biceps, triceps, brachioradial, patellar, ankle |
| Patellar Reflex: Response: | extension of the lower leg |
| Ankle Reflex: Response: | plantar flexion of the foot |
| Plantar Reflex is a _____ reflex | superficial |
| Plantar Reflex: Response: | plantar flexion of the toes |
| Cerebellar Function tests: | Coordination/Fine Motor Skills |
| Rapid alternating movements (RAM): | Evaluate rhythm/flow/speed |
| Point-to-point testing: | Finger to nose; Heel to shin |
| Test of balance: | Romberg test; Observe normal gait; Tandem gait |
| Gait Patterns: Spastic hemiparesis = | Stroke |
| Gait Patterns: Spastic diplegia = | Scissoring |
| Gait Patterns: Steppage = | Foot drop |
| Gait Patterns: Waddling = | Weak hip abductors |
| Gait Patterns: Cerebellar ataxia = | Wide based gait |
| Gait Patterns: Sensory ataxia = | Loss of position sense |
| Gait Patterns: Parkinsonian = | Shuffling |
| Gait Patterns: Antalgic limp = | Painful extremity |
| plegia: | absence of strength (paralysis) |
| hemiplegia: | paralysis of one half of the body |
| paraplegia: | paralysis of the legs |
| paresis: | impaired strength (weakness) |
| hemiparesis: | weakness of one half of the body |
| Epicondyles: | for tenderness associated with fx |
| Patella: | for pain, fx, stability |
| Patella tendon: | tendonitis |
| Joint space: | fluid |
| Joint line: | meniscus tears, ACL tears |
| Med/Lat collaterals: | ligament strains |
| Tibial tuberosity: | OSD |
| Medial tibial plateau: | Pes anserine bursitis |
| Posterior joint space: | PCL, Bakers cyst |
| Light touch: Side of Neck: | C2-3 |
| Light touch: Tip of Shoulder: | C4 |
| Light touch: Lateral Deltoid: | C5 |
| Light touch: Thumb: | C6 |
| Light touch: Middle Finger: | C7 |
| Light touch: Pinky Finger: | C8 |
| Light touch: Medial Forearm at elbow: | T1 |
| Light touch: 1st Dorsal web: | Radial nerve |
| Light touch: Palmar middle pad: | Median |
| Light touch: Palmar small pad: | Ulna |
| Light touch: Groin: | L1 |
| Light touch: Upper thigh: | L2 |
| Light touch: Outer thigh at knee: | L3 |
| Light touch: Medial ankle: | L4 |
| Light touch: Dorsal 1st web space: | L5 |
| Light touch: Lateral ankle: | S1 |
| Light touch: Buttock: | L2-3 |
| Light touch: Perianal: | L4 |
| Argyll Robertson pupil = | pupil reacts to light but does not accommodate (seen in tertiary syphilia/tabes dorsalis) |
| Eye deviation occurs in what direction? | toward a unilateral hemispheric lesion and away from a unilateral brainstem lesion |
| Functional testing of eye movements is done by: | oculo-cephalic reflex (Doll's head) or oculo-vestibular reflex (ice water calorics) |
| Oculo-cephalic reflex (Doll's head): CI if: | if there is a question of cervical spine injury |
| Oculo-cephalic reflex: Abnormal response = | absent or asymmetric eye movement: destructive lesion at midbrain or pontine level; poss also deep barbiturate poisoning |
| Oculo-vestibular reflex: Normal response (conscious pt): | Tonic (sustained) deviation of eyes toward stimulated side, w/ quick phase of nystagmus toward the opposite side |
| Oculo-vestibular reflex: Response in comatose pt w/ intact brainstem: | Tonic deviation of eyes, but no nystagmus |
| Oculo-vestibular reflex: Response in comatose pt w/ brainstem dysfn: | Loss of tonic deviation w/ stimulation of one, or both ears; if there is no tonic deviation there can be no fast response |
| Oculo-vestibular response does not distinguish between: | metabolic and structural causes of coma |
| Corneal sensation: | carried by CN V (Trigeminal); test with cotton swab pressed gently onto cornea; abnormal reponse suggests a pontine lesion |
Created by:
Abarnard
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