Chapter 23: Neuro Flashcards
Cranial nerve I test
Olfactory nerve,
test smelling
Cranial nerve II test
Optic nerve:
Test visual acuity and visual fields via the confrontation test, examine ocular fundus
Cranial nerve III, IV, VI test
Oculomotor, Trochlear, Abducens nerves;
check pupil size, extraocular movements via cardinal signs, Checking for nystagmus
Cranial nerve V motor test
Motor function: Trigeminal nerve; muscles of mastication by palpating the temporal and masseter muscles as person clenches teeth, muscles should feel equal and strong
Sensory:
Cranial nerve VII test
Facial nerve;
mobility and facial symmetry, smile, frown, close eyes tightly, lift eyebrows, show teeth, puff cheeks (air should exit from both sides equally)
Cranial nerve VIII test
Acoustic (Vestibulocochlear); test hearing acuity through normal conversation and whisper test, tuning fork, Balance (Romberg)
Cranial nerve IX and X test
Glossopharyngeal and Vagus nerve;
Motor function: depress the tongue and note pharyngeal movement as they say “ahhh”
Note gag reflex
Cranial nerve XI test
Spinal accessory:
examine sternomastoid and trapezius for equal size and check the strength
Cerebellar function
Have person move face laterally against your hand on their chin
Put hands on their shoulder and have them push up against
Cranial nerve XII test
Hypoglossal; have them move their tongue and have them say “light, tight, dynamite” making sure the l,t and d are said clearly
Cerebellar function: Coordination of movements
Cranial nerve V sensory test
Sensory: With persons eyes closed, test light touch sensation by touching cotton wisp to forehead, cheeks and chin and have person say “now” when they feel the cotton (tests ophthalmic, maxillary, mandibular)
Cerebellar function
Coordination of movements
Rapid alternating movements “RAM”
Tests cerebellar function
Have person pat knees with both hands, lift up, turn hands over and then pat knees with back of hand and have patient do it faster in a coordinated rhythmic pace
Finger to Finger test
Tests cerebellar function
Have patient touch thumb to each finger
Finger to nose test
Tests cerebellar function
Have patient close eyes and reach out and then touch tip of nose with each index finger separately
Heel to shin test
Tests cerebellar function
Tests lower extremities; supine position place heel on opposite knee (normally person move their knee in a straight line down the shin)
Balance test
Observe gait, have person walk 10-20 ft in a straight lint and turn around and walk back
Romberg Test
Ask person to stand up with feet together and arms at sides and then close eyes and balance for 20 seconds
What is a positive Romberg test?
If the person falls
What is a negative Romberg test?
If the person doesn’t fall
Spinothalamic tract test for pain
Pain: tested by person’s ability to feel a pinprick, break stick in half and then have patient if they feel the sharp or dull side when you lightly apply point to their skin
Spinothalamic tract test for light touch
Light touch: Apply wisp of cotton (stretched out cotton ball) to the skin and brush it over the skin randomly on arms, forearms, hands, chest, thighs and legs and have them say “now” when they feel it
Posterior dorsal column test for vibration
using low pitch tuning fork you test the ability to feel vibrations on bony surfaces like on the surfaces of the fingers and great toe
Posterior dorsal column test for position (Kinesthesia)
Move a finger or toe and with the patients eyes closed ask them which direction it moved
Posterior Dorsal Column for two point discrimination
Apply the two points of an opened paper clip lightly to the skin in a close distance and see if they can feel both
Posterior Dorsal Column stereognosis test
Ability to recognize objects in their hand with eyes closed, put key in their hand and see if they know what it is
Posterior Dorsal Column graphesthesia test
ability to “read” a number by having it traced on the skin
Posterior Dorsal Column Extinction test
Simultaneously touch both sides of the body at the same point. Ask the person to state how many sensations they felt and where
Posterior dorsal column point location test
Touch the skin and withdraw promptly, tell the person “put your finger where I touched you”
Reflex ratings
4+ = hyperactive, brisk, indicative of disease 3+ = brisker than average, possibly indicative of disease 2+ = Average normal 1+ = Diminished, low, occurs only with reinforcement 0 = no response
6 reflex points
Patellar (right under knee cap), Biceps (use the thumb and apply pressure), Triceps, Brachioradialis (2 cm above where you palpate for radial artery), Quadriceps, Achilles, Clonus (only when reflexes are hyperactive, it’s a repeated reflex muscular movement)
What does the CNS include?
Brain and spinal cord
What does the PNS include?
All nerve fibers outside the brain and spinal cord
What does the PNS do
- Carries sensory (afferent) messages to CNS from sensory receptors
- Motor (efferent) messages from CNS to muscles and glands, as well as autonomic messages that govern internal organs and blood vessels
What is the Cerebral cortex
It is the outer layer of nerve cells and the center of functions governing though, memory, reasoning, sensation and voluntary movement
4 lobes of the cerebral cortex
frontal, parietal, temporal, and occipital
Frontal lobe function
concerned with personality, behavior, emotions, and intellectual function
-Pre-central gyrus of frontal lobe initiates voluntary movement
Parietal lobe
Primary center for sensation
Occipital lobe
Visual receptor center
Temporal Lobe
Behind ears, has primarily auditory reception center, taste and smell
Wernickes area
language comprehension
Result of damage to Wernickes
When damaged in the person’s dominant hemisphere, receptive aphasia results; person hears sound, but it has no meaning, like hearing a foreign language
Brocas area function
Motor speech
Result of damage to Brocas
When injured in dominant hemisphere, expressive aphasia results; person cannot talk; person can understand language and knows what they want to say, but can produce only garbled sound
Damage to cerebral cortex can cause what damage?
Motor weakness
Paralysis
Loss of sensation
Impaired ability to understand and process language
When does damage to cerebral cortex usually occur?
When neurological cells are deprived of blood like when cerebral artery is occluded
Basal Ganglia
Initiate and coordinate movement and control automatic associated movements of body
Thalmus
Main relay station where sensory pathways of spinal cord, cerebellum, and brain stem form synapses
Hypothalamus purpose
Major respiratory center with basic functions such as
**controls hormones by the pituitary gland
controls body **temperature
**control of food and water intake, hunger and thirst
**control of sexual behavior and reproduction
**circadian rhythm
**emotional responses
Cerebellum location and function
under occipital lobe concerned with coordination of voluntary movements, equilibrium, and muscle tone
**Does not initiate, but coordinates and smoothes movements
What cranial nerves originate in the nuclei in the Brain stem
Cranial nerve (CN) III through XII originate from nuclei in brain stem
Midbrain
most anterior part of brain stem with tubular structure of spinal cord; contains many motor neurons and tracts
Pons
enlarged area containing ascending sensory and descending motor tracts
Medulla
continuation of spinal cord in brain; contains all fiber tracts connecting brain and spinal cord
Spinal cord location
Long cylindrical structure of nervous tissue that occupies upper two thirds of vertebral canal from medulla to lumbar vertebrae L1 to L2
Where would you find Nerve cell bodies, or gray matter, arranged in butterfly shape with anterior and posterior “horns”
Spinal cord
