CNS EXAM Flashcards
(30 cards)
First Step
Introduce and wash hands
Step 2
Inspection: pt overall
apperance and bx Mood Thoughts/Perception Speech Cognition Status
How to inspect patient’s overall appearance and bx?
Checking LOC, posture/motor activity, grooming/hygeine, facial expression and affect
How to inspect patient’s overall mood
check affect
How to inspect patient’s overall thoughts & perceptions
checking though processes, thouhgt content, perception, insight and judgment
How to inspect patients overall Speech?
checking quality, rate, volume, articulation, fluency and language
if fluency is abnormal, we will conduct aphasia testing
How do we preform aphasia testing (4)
4 components
Word Comp: give pt a 3 stage command w/o pausing
ex: stand up, hop on 1 leg and say “dr b is the best professor ever”
Repitition: ask pt to repeat phrase “no ifs, ands, or buts”
Naming: ask pt to identify 2 different objects
Reading comp: show pt paper with task printed, ask pt to do that task
Writing: ask pt to write a sentence + give a specific noun to use in the sentence
Ex: “Write a sentence using the noun
How do we inspect patients overall cognition status?
checking
orientation: time, place, person, event
Attention: spell 5 letter word backwords and forwards
New learning ability: 3 words repeated immediatly and then recalled 3 mins later
**need to set actual timer***
Higher function: draw a clock with all numbers, hands at 12:30
CN 1 exam
Olfactory nerve
Have pt discern b/w two different smells
CN 2 exam
Optic nerve
1. VA: using chart, both eyes seperatlely, then together
- Check fundi - right hand, right eye to right eye
In CN 2 exam what are we checking the fundi for?
assess for a-v anomilies, cotton wool spots, exudates, hemorrhage, optic disc margins and physiologic cupping
CN 2 +3 exam
Optic + Occulomotor
Pupillary reaction-direct and consensual
Near reaction in each eye seperatley
CN exam 3,4,6
Occulomotor, trochlear, abducens
Extra-occular movements + convergence
CORNEAL LIGHT REFLECTION-SHINE LIGHT IN EYE
CN 5 exam
Trigeminal
checking v1,v2,v3 branches
Motor: palpatae masseter, temporal muscles b/l w clenched teeth
Sensory: preform light touch WITH PT EYES closed
pt says “now”
ask if sides feel different from e/o
CN 7 Exam
Facial Nerve
Motor: frown, raise eyebrows, open smile, closed smile, eyes closed/resistance, puff cheeks
CN 8 Exam
Acoustic
Preform Finger Rub
Preform RInne, Weber
CN 9 Exam
Glossopharyngeal
Motor: observe pt swallow + state gag reflex is motor component
CN 10 Exam
Vagus
Motor: use ext light source to observe rise of uvula as pt says “ahh”
Sensory: verbalize articulation + clarity of speech are assessed throughout exam
CN 11 Exam
Spinal Accessory
Trapezii- instruct pt to shrug shoulders upward against resistance
SM-instructs pt to turn and push head against resistance of examniners hand
CN 12 Exam
Hypoglossal
Motor: ext light source-observe tounge in neutral and protruded position
Asses tounge for fasciculation and deviation from midline
Motor: have pt push tounge against inner check and resist examiner push on outisde—preform b/l
Sensory Specials-light tough
PREFORM B/L
UE: shoulders, med/lat forearm, thumbs, 5th finger
LE: front thighs, med/lat calves, great toes, little toes
Sensory Specials- Sharp Dull
Preform B/L
UE: shoulders, med/lat forearm, thumbs, 5th finger
LE: front thighs, med/lat calves, great toe, little toe
Sensory Specials-Vibratory Sense
pt eye closed
can you feel this, describe the sensation and ask pt to tell you when it stops
AT DIP of index finger AND great toe b/l
Discrimination Exam (3 parts)
- Stereognosis–pt eye closed, diff object for each hanf
2: graphethesia- pt eye closed, diff #/letter for each hand
3: proprioception: have pt identify up or down at index finger and great toe b/l hold digit at DIP laterally
