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Sasha: Module 11 Neurology > CA powerpoints > Flashcards

Flashcards in CA powerpoints Deck (138)
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1

7 Major components of the Neurological exam 

•Mental Status

•Cranial Nerves (I-XII)

•Motor System

•Cerebellar Function

•Sensory System

•Deep Tendon Reflexes (DTRs)

•Special Tests, if indicated

2

•Is the mental status intact?

•Are your findings symmetric?

•Where is the lesion? If findings are asymmetric or abnormal, is the lesion in the central nervous system or in the peripheral nervous system?

 

what are these questions?

questions to really think about when seeing a pt

3

brain, brainstem, spinal cord

CNS

4

12 CNs and peripheral nerves (including spinal nerves – 8 cervical, 12 thoracic, 5 lumbar, 5 sacral and 1 coccygeal)

PNS

5

Organization of Exam

  • Assess mental status
    • General appearance/presentation
    • Orientation x 4
  • Test cranial nerves
  • Assess motor system
    • Inspection
    • Muscle strength
  • Assess sensory system
    • Light touch, superficial pain, vibratory sense, proprioception
  • Check deep tendon reflexes (DTRs)
  • Test cerebellar function
    • Rapid alternating movements, point-to-point movements, gait
  • Special tests, if indicated (by PE or ROS)

6

Reflects the patient’s capacity for arousal or wakefulness; determined by level of activity that patient can be aroused to perform in response to stimuli from examiner

Level of Consciousness

7

–Do NOT dilate pupils

–Do NOT flex neck if there is any question of trauma to head or neck (x-ray first)

patient in stupor or coma…

8

using normal tone of voice, patient’s arousal intact; responds fully & appropriately

Alert

9

using loud tone of voice, patient appears drowsy but opens eyes and responds then falls asleep

Lethargic

10

shake patient gently; patient opens eyes but responds slowly, somewhat confused (ie drunk)

Obtunded

11

apply painful stimulus to arouse patient from sleep, verbal responses slow/absent, unresponsive when stimulus ceases

Stuporous

12

unarousable w/ eyes closed after repeated painful stimuli, no response to environment

 

...painful stimuli with no response....

Comatose

13

Explain the 3 main aspects of the glasgow coma scale and then the ratings under each main componenet

 

1. (4)

2. (6)

3. (5)

 

I know this is a long flashcard but this is important to known... i can see her explaining a pt and asking us to assess what their glasgow coma scale is. At least those are questions they would do in my EMT class who knows.....

•Eye opening

–None (1) Even to supraorbital pressure

–To pain (2) Pain from sternum/limb/supraorbital pressure

–To speech (3) Nonspecific response, not necessarily to command

–Spontaneous (4) Eyes open, not necessarily aware

•Motor response

–None (1) To any pain; limbs remain flaccid

–Extension (2) Shoulder adducted and shoulder and forearm internally rotated

–Flexor response (3) Withdrawal response or assumption of hemiplegic posture

–Withdrawal (4) Arm withdraws to pain, shoulder abducts

–Localizes pain (5) Arm attempts to remove supraorbital/chest pressure

–Obeys commands (6)  Follows simple commands

•Verbal response

–None (1) No verbalization of any type

–Incomprehensible (2) Moans/groans, no speech

–Inappropriate (3) Intelligible, no sustained sentences

–Confused (4) Converses but confused, disoriented

–Orientated (5) Converses and is oriented

14

hIghest grade you can get on glasgow coma scale

and lowest 

 

 

 

Lowest 3

Higherst 15

15

patients w/ scores of 3-8

usually are considered to be in a coma

16

no pupillary reaction to light

probably mid brain issue

17

•Midposition fixed pupils

•One large pupil

•Small or pinpoint pupils

•Large pupils

Pupils in Comatose Patients

18

When testing if meningeal inflammation first, make sure there is NO

injury to cervical vertebrae or spinal cord (if trauma, x-ray first)

19

with patient supine place hand behind the patient’s head flex neck forward, chin to chest (check for nuchal rigidity)

•Test if meningeal inflammation suspected  (eg, meningitis or subarachnoid hemorrhage)

20

•Positive if flexion of both hips & knees is noted when neck is flexed

Brudzinski’s Sign

21

•Positive if pain & increased resistance is noted to straightening the knee after hip & knee are flexed 

Kernig’s Sign

22

Fever, headache and altered level of concisouness

with menengitis

23

Test if mental function is impaired; may indicate

metabolic encephalopathy

24

•Ask patient to “stop traffic” by extending both arms w/ hands cocked up – watch for 1 to 2 minutes

•Positive if sudden, brief, nonrhythmic flexion of hands and fingers

Asterixis

25

CN I

smell

26

CN II

– visual acuity, visual fields, funduscopic exam

27

CN II, III

– pupillary reactions (direct and consensual)

28

CN III, IV, VI

extraocular movements (including convergence)

29

CN V

corneal reflexes, facial sensation (3 areas), clinch teeth

30

CN VII

facial movements (raise eyebrows, close eyes, smile, frown, show upper/lower teeth, puff out cheeks)