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HA neuro assessment
health assessment neurologic system
| Question | Answer |
|---|---|
| diencephalon (function and what composes it) | thalamus and hypothalamus, located in the central part of brain sensory relay and motor control |
| brain stem | midbrain, pons, medulla oblongata regulation of basic life functions like breathing and heartrate |
| cerebellum function | coordination, balance and muscle tone located in the posterior brain by the brain stem |
| what makes up the meninges and its function | dura, arachnoid and pia with cerebrospinal fluid protects the brain |
| frontal lobe function | voluntary motor actions, Broca's area, personality and judgement |
| Broca's area | part of frontal lobe used for speech |
| parietal lobe function | sensory perception, touch perception, temperature, pain |
| temporal lobe function | auditory processing, Wernicke's area |
| Wernicke's Area | language comprehension |
| occipital lobe function | visual interpretation and reading comprehension posterior portion of brain |
| thalamus function | direct sensory signals to area of brain (most senses except smell) |
| hypothalamus | regulate temperature, water balance, metabolism, vital signs, sleep cycles homeostasis |
| autonomic control | nervous and endocrine system link, control of involuntary life functions |
| effects of lesion on cerebellum | ataxia (uncoordinated movement) and difficulty with rapid alternating movement |
| ataxia | uncoordinated gait |
| dermatomes | mapped segments of skin (helps pinpoint nerves/segments of body that can be injured) |
| sympathetic nervous system | fight or flight increased HR/BP/pupillary dilation |
| parasympathetic nervous system | rest and digest decreased HR increased digestive activity |
| Dysautonomia | dysregulation of autonomic nervous system --> BP instability |
| what does the autonomic system consist of | sympathetic and parasympathetic system to maintain homeostasis and stress response |
| stroke | disruption of blood flow to brain and cellular death |
| types of stroke | ischemic (blood clot), hemorrhagic (brain bleed), TIA (mini-stroke) |
| consequences of stroke | speech/motor deficit, neurologic deficit, disability |
| stroke risk factors | HTN (#1 modifiable cause), DM, HLD, heart disease, smoking, obesity, sedentary lifestyle, pharmaceuticals (like contraception) |
| why is smoking risk factor for stroke or other cardiovascular disease | nicotine is a vasoconstrictor |
| stroke belt | southeast area of the US |
| BEFAST | balance eye - visual change face - drooping arm (and leg) - weakness speech - difficulty speaking time - call 911 |
| what signs do you look for in seizures | aura, triggers, bladder incontinence, and medication compliance |
| stocking-glove distribution | sensation of wearing gloves/stocking in neuropathy (basically feeling of loss of sensation in peripherals) |
| what does dermatomal pattern indicate | possible nerve root impingement in the spinal cord |
| spinal nerve distribution | 31 pairs, 8 cervical, 12 thoracic, 5 lumbar, 5 sacral, 1 coccygeal |
| how many cervical nerves | 8 cervical nerves |
| somatic fibers | voluntary muscle control |
| autonomic fibers | part of autonomic nervous system, involuntary muscle control like heart and smooth muscle |
| dysarthria | slurred/slow speech |
| aphasia | disability in communication, usually either Broca or Wernicke's area |
| receptive aphasia | Wernicke's area difficulty understanding language (unable to say words at all but know what to say) |
| expressive aphasia | Broca's area difficulty expressing language/saying words (fluent speech but is nonsensical) |
| resting tremor indicates what kind of condition | tremor when resting, possible Parkinson's |
| intention tremor indicates what kind of condition | tremor when moving, possible cerebral disease |
| involuntary movements indicates what kind of conditions | Huntington's or Tourette's |
| what are the 6 main areas of neurological exam | mental status cranial nerves motor/cerebellar function sensory function reflexes meningeal signs (if suspected) |
| where do cranial nerves originate from and what are the exceptions | all CN come from brain stem except for CN I and II |
| Romberg test | testing balance (vestibular)/proprioception eyes open then closed for 20 secs with feet together and arms at side (pt is only standing) minimal sway is normal |
| Snellen test | check eyesight from 20 ft, seeing at 20 ft from what someone sees at x ft |
| Finger to nose test | test coordination (cerebellar function) when eyes are closed vs open dysmetria or intention tremor if overshooting/tremoring near target speed/smoothness/accuracy |
| dysmetria | inability to control the distance, speed, and range of motion of movements |
| heel to shin test | lying supine, slide heel down opposite shin (normal = straight line up) signals cerebellar ataxia/proprioceptive deficit |
| Parksonian Gait | slow shuffling, stooped with minimal arm swing |
| Cerebellar Ataxia gait | wide based (feet facing outwards), staggering and unsteady |
| Scissor gait | legs flexed and thighs crossing |
| foot drop gait | high foot lift and slapping ground |
| hypo/hyperesthesia | decreased sensation vs increased/painful sensation |
| Vibration test | check vibration sensation in the peripheral |
| Stereognosis | recognizing object by touch |
| graphesthesia | recognize numbers traced on palm |
| two point distribution | recognize sensation of 2 points in the peripheral (ie 2 caliper point) |
| what does astereognosis/agraphesthesia indicate | possible parietal lobe/sensory cortex lesion |
| Tricep tendon reflex (what part of spine) | elbow extension, C6-8 |
| Brachioradialis reflex (what part of spine) | forearm flexion/supination, C5-6 |
| Bicep reflex (what part of spine) | elbow flexion, C5-6 |
| Muscle strength | grade 0-5 4- slight weakness 3- move against gravity but not resistance 2- move without gravity 1- visible/palpable contraction w/o movement 0- no contraction |
| pronator drift test | arm extended palm up with eye closed if one arm drifts indicative of subtle weakness |
| Babinski's Sign | babies flex feet outwards, but adults should not indicates upper motor neuron lesion |
| Abdominal Reflex | stroke skin towards umbilicus (should have slight contraction) |
| Cremasteric reflex | in males, dx for testicular torsion stroking inner thigh should elevate ipsilateral (same side) testicle |
| Brudzinski's Sign | hip/knee flexion during neck flexion |
| Kernig's Sign | pain with knee extension when hips are flexed |
| Meningeal Signs | nuchal rigidity/neck pain with neck flexion Brudzinski's sign Kernig's Sign |
| Decorticate Rigidity | CORE meaning facing inwards (kind of like a uwu pose) possible hemispheric lesion of cerebral cortex, TBI, stroke, hemorrhage, increased ICP |
| Decerebrate Rigidity | arms are extended and rotated and feet pointing out lesion in brainstem at midbrain or upper pons or brainstem damage |
| CN I (what does it do and how to assess) | Olfactory Nerve (1) smell test with mild |
| Anosmia | loss of sense of smell |
| CN II (what does it do and how to assess) | Optic nerve (2) vision/peripheral vision Snellen test, confrontation test, ophthalmoscopic exam |
| Confrontation tset | check peripheral vision |
| Papilledema | swelling of optic nerve |
| CN III (what does it do and how to assess) | Oculomotor nerve (3) pupillary constriction and eye movement except lateral |
| CN IV (what does it do and how to assess) | Trochlear Nerve (4) move eye downward and inward |
| Ptosis | drooping eyelid indicative of CN III palsy |
| Nystagmus | rhythmic oscillation of eye possible cerebellar/vestibular issue |
| CN VI (what does it do) | Abducens (6) lateral eye movement |
| Strabismus | eyes do not properly align |
| CN V (what does it do) | Trigeminal (5) facial sensation and chewing |
| CN VIII (what it do and how to assess) | Vestibulocochlear (8) hearing and balance Whisper, Rinne, and Weber tests |
| Weber test | tuning fork on forehead or top of head sound can lateralize (meaning one ear will hear better) sensorineural = unaffected/good ear lateralizes conductive = affected/poorer ear lateralizes |
| Whisper test | whisper simple word/number behind patient |
| Rinne test | compare air conduction (AC) vs bone conduction (BC) BC > AC indicates conductive hearing loss |
| CN VII | Facial (7) facial expression, taste in the front 2/3 of tongue, tear/salivary duct smile/frown/show teeth/puff cheeks |
| Bells Palsy | unilateral forehead/lower face palsy |
| Palsy due to stroke affects | lower facial palsy, forehead not affected usually |
| CN IX (what it do and how to assess) | Glossopharyngeal (9) taste (1/3 back of tongue), gag reflex, salivary production, promote swallowing |
| CN X (what it do and how to assess) | Vagus (10) sensations from the throat down (throat to abdomen), swallowing, talking, production of digestive juice check voice |
| Gag reflex | CN 9/10 uvula should go midline, points opposite way of lesion if deficit touch oropharynx with depressor/swab |
| CN XI (what it do and how to assess) | Accessory (11) neck muscle and larynx movement check shoulder shrug and head turnfasciculations |
| sternocleidomastoid | 2 neck muscles that allow you to turn head left/right |
| CN XII (what it do and how to assess) | Hypoglossal (12) innervate tongue muscle for talking and eating check tongue protrusion (is it straight), tongue strength, speech clarity with (L, T, D, N sounds) |
Created by:
sleepingbear
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