CNS exam

Question 1

Mental Status Exam

Answer 1

1) Appearance and behavior
2) Affect/mood
3) Language/speech
4) Thoughts/perceptions
5) Cognitive/EF

Question 2

Appearance and behavior

Answer 2

LOC: Brainstem, RAS, Hemispheres

alert, lethargic, stuporous, comatose
GA of posture, motor activity, hygiene

Question 3

Affect/mood

Answer 3

observe expression and affect (depression, fatigue, insomnia, concentration)
Engaged, angry, anxious (appropriate?)
**Fear (paranoia)

Question 4

Language

Answer 4

Evaluate for aphasia
Spontaneous speech 
naming 
comprehension 
repetition 
reading writing

Question 5

spontaneous speech

Answer 5

part of language exam
appropriate word finding, assess for paraphasia (paraphasic errors)
-“pen” for pencil
-plentil for pencil

Question 6

verbal fluency

Answer 6

do the y maintain appropriate rate, flow, volume, and melody (Prosody**)
*lack of fluency—>eval for aphasia

Question 7

testing for aphasia

Answer 7

Naming (test for ability to name object)
Comprehension (follow commands 1,2,or 3 steps-point to nose then knee)
Repetition (simple words or phrases)
Reading and writing

Question 8

anomia

Answer 8

loss of ability to name common objects, most common deficit in true aphasia

Question 9

aphasia

Answer 9

disorder in understanding or producing language, spoken or written
injury, disease, psychogenic

can be damage to Broca’s and Wernicke’s

Question 10

dysphasia

Answer 10

impairment in use of speech that is clear (failure to arrange properly in sentence)

articualtion is OK, there is just something wrong with their speech

Question 11

dysarthria

Answer 11

imperfect articulation due to lack of motor coordination
damaging even CNS or PNS
language comprehension and use may be fine

i.e. slurring of speech

Question 12

Wernickes area

Answer 12

transforms sensory into neural word representations to give words meaning

On L side

Question 13

Broca’s area

Answer 13

transforms neural word representations into tactual articulations that can be spoken

creates language

on L side

Question 14

Broca’s aphasia

Answer 14

expressive aphasia
understanding of spoken language mostly preserved

*loss of the ability to produce speech

Question 15

Wernicke’s aphasia

Answer 15

receptive aphasia
fluent speech that makes no sense
can put sensory info together to make language

inability to understand language and put together appropriate words

unable to understand language in its written or spoken form, and even though they can speak with normal grammar, syntax, rate, and intonation, they cannot express themselves meaningfully using language.

Question 16

apraxia

Answer 16

inability to turn verbal request into motor performance (cannot follow command)
have difficulties with day-day tasks

Question 17

thoughts and perception

Answer 17

Process: coherent, logical
Content:phobias, anxieties, delusions
insight: ability to understand their own problem
Judgement: appropriate decisions/actions to a situation, understand cause and effect

Question 18

Cognitive function

Answer 18

orientation to person, place, time - most frequently lost (AOx3)
attention
memory

Question 19

EF

Answer 19

abstract thinking, insight, calculation, constructional ability (draw a clock, count backwards)

Question 20

insights

Answer 20

deeper thinking
Proverbs (look before you leap, what does this mean?)
Situations questions
Similarities (what is similar b/w tables and chairs)

Delirium vs dementia

Question 21

calculation

Answer 21

measure of EF (think number span)

repeat numbers in order, or spell a world backwards

Question 22

Cerebellar testing

Answer 22

1) gait (ataxia)
2) Heel to knee
3) Rhomberg/pronator drift

Question 23

Rhomberg tests

Answer 23

tests for ataxia specific to posterior column.
patient is standing with eyes closed, and if there is post column lesion they will fall with eyes shut

if there is cerebellar ataxia, they will fall over with eyes open or closed

Question 24

pronator drift

Answer 24

same stance as Romberg, if the arm pronates and drifts down and lateral when eyes are closed it is specific for a Contralateral corticospinal tract lesion

Question 25

Dysmetria

Answer 25

cannot perform rapid alternating movements (ability to aim and hit) finger to nose eyes open/shut

Question 26

dysdiadochokinesis

Answer 26

one movement cannot be abruptly stopped and followed by the opposite movement. Slow, irregular, clumsy cerebellar ataxia tested by rapidly pronating/supinating the hand, or tapping the palm with fingers

Question 27

CN II testing

Answer 27

1) acuity 2) Pupillary reflex 3) visual field exam *fundoscopic exam is not for CN II function

Question 28

CN III IV and VI

Answer 28

look at eyes in the primary position (look for medial or lateral deviation) efferent pupillary response to light, EOMs Cover test for central focus

Question 29

CN V

Answer 29

test sensation with soft, sharp, temp motor: clench teeth, move jaw side to side Corneal reflex (touch the cornea with cotton, should have blink)

Question 30

CN VII

Answer 30

muscles of facial expression close eyes, raise eyebrows, smile taste on anterior tongue, lacrimation, salivation palsy may be central or peripheral **corneal reflex

Question 31

central VII palsy

Answer 31

cortex or brainstem muscles of lower face only i.e. cannot smile, but can raise eyebrows contralateral problem associated with stroke

Question 32

peripheral VII palsy

Answer 32

distal to brainstem affects the entire face cannot smile or raise eyebrows i.e. Bell's Palsy

Question 33

VIII

Answer 33

hearing and balance use Rhomberg and finger rub esp use after TBI

Question 34

IX and X

Answer 34

Gag reflex ( in by IX out by X) IX does taste on posterior tongue asymmetric lifting of uvula indicates X problem

Question 35

XII

Answer 35

ask the to shrug, or turn head or SB the SCM

Question 36

XII

Answer 36

Purely motor to tongue ask pt to stick tongue out look for atrophy or fasiculations of the tongue with XII lesions the tongue will deviate to the same side

Question 37

paraphasia

Answer 37

substituting similar souding syllables or words (plentil for pencil)

Question 38

delirium vs. dementia

Answer 38

delirium= acute confusion (uremia, ETOH...) Dementia= slowly progressing, but can have acute delusional episodes **poor attention= delirium