Subjective _ _, D______ S____ or loss of ________ S_____ Changes in v______ Changes in h______ Changes in s______ N______ or Pa_____ Pa______ or We______ Changes in m____ Changes in sl_____ A_____, D___ use

HA, Dizziness Syncope, Consciousness Seizure vision hearing speech Numbness, Parasthesia Paralysis, Weakness mood sleep Alcohol, drug use

Health Promotion and Counseling 1. Preventing _____ or _ _ _ 2. Reducing risk of peripheral ________ ( could be connected to __, m_______, are symptoms getting _____? Such as difficulty _____ shirt or w____?) 3. Detecting the "three D's" (3)

1. Stroke, TIA 2. Neuropathy ( DM, medications, worse, buttoning, walking) 3. Delirium, Dementia, Depression

Key Principles As you examine the patient, remember 3 important questions: 1. Is _____ status intact? 2. Are ____ and _____ sided findings the ____, or symmetric? 3. If findings are asymmetric or otherwise abnormal, do the causitive lesions lie in the _____ or _____?

1. mental 2. right, left, same 3. CNS or Peripheral nervous system

Organize your exam into categories _____ status S_____ and La______ _____ nerves M____ system S____ system Re______ C______ G_____

Mental Speech, Language Cranial Motor Sensory Reflexes Coordination Gait

Mental Status O_____ Level C_______ J_______ M____ T_____ process I_____ A_____

Orientation Consciousness Judgement Mood Thought Insight Affect

Mental Status Chart 1. Alertness Speak to the patient in a _____ tone of voice. An alert patient opens the ____, ___ at you, and responds fully and ________ to stimulate (arousal intact) 2. Lethargy Speak to the patient in a ____ voice. For example, call the patient's ____ or ask "How are you?" A lethargic patient appears d____ but ____ the eyes and looks at you, responds to questions, and then falls _____. 3. Obtundation _____ the pt gently as if awakening a sleeper An obtunded patient opens eyes and looks at you, but responds _____ and is somewhat c_____. Alertness and interest in ______ is ______. 4. Stupor Apply a ______ stimulus. For example, p____ a tendon, ___ the sternum, or roll a ____ across a ___ bed. (No stronger stimuli _____!) A stuporous pt arouses from sleep only after ____ stimuli. Verbal responses are ____ or even _____. The pt lapses into an _____ state when the stimulus ceases. There is ______ awareness of self or the environment. 5. Coma Apply repeated _____ stimuli A comatose pt remains ______ with eyes _____. There is no evident response to inner n____ or e____ stimuli.

1. Alertness normal, eyes, looks, appropriately 2. Lethargy loud, name drowsy, opens, asleep 3. Obtundation Shake slowly, confused, environment, decreased 4. Stupor painful, pinch, rub, pencil, nail, needed painful, slow, absent, unresponsive, minimal 5. Coma painful unarousable, closed, need, external

The logical, coherent, and relevance of a patient's thoughts, ____ people think. Speech characterized by indirection and delay due to the patient's excessive use of details that have no connection to the point = Speech where a person shifts topics with no apparent relation between the topics = Accelerated change of topics in a very fast but generally coherent manner = Speech that is comprehensible because it is illogical = Fabrication of facts to hide memory impairment =

Thought Processes HOW people think Circumstantiality ( kind of talks in circles, asking about a HA and they start talking about their fingernails) Derailment (A to B to C to D topics but they are making sense) Flight of ideas Incoherence ( they aren't making sense "theres a bird in my head" Confabulation (to avoid embarassment)

The observable mood of a perosn expressed through their facial expression, body movements, and voice = Assess the patient's facial _______ Lack of facial movement - can be seen due to ta physical reason such as Parkinson's disease or psychological reason such as profound depression = Assess the patient's m____, affect and relationship to p_____ and th_____ Does the affect reflect the m_____ Is the affect s____ or l_____ (mood changing from happy to tears and back quickly) Does the patient seem to ___ or ___ things you don't

Affect expression flat affect manner, person, things mood stable, labile see, hear

Process of comparing and evaluating different possible courses of action = Ask about the _____ behing their clinical or hospital visit; patients with psychological disorders ____ insight into their _____ You can usually assess _____ by noting the pts responses to s_____ on their relationships, jobs, finances

Judgment reasons, lack, disease judgment, stressors

Delirium _____ onset ( ie urosepsis) F_______ course Lasts ____ to ____ _____ disrupted Associated with i_____ or d____ toxicity Distubred level of c________ A____ or S_____ (can have both) Disorganized th____ process Disoriented mostly to t_____

Acute Fluctuating hours to weeks Sleep illness, drug consciousness Agitated, Somnolent thought time

Dementia _____ onset S_____ progressing course Lasts ____ to _____ Sleep f______ ___ usually associated with illness or drugs except with Alzheimers ___ change in consciousness until ____ in disease Normal to slow b_____ Difficulty finding w_____ Often flat or d_______ mood

Insidious Slowly months, years fragmented Not No, late behavior words depressed

Altered Mood Depression More common with significant medical c______ Concern for a_____, d___ use Can be related to m_______ ____ blockers S_____ B________ _______ drugs - Sinemet Anti_______ PHQ-2 What are the two questions?

Depression conditions alcohol, drug medication Beta Steroids Benzodiazepines Parkinson's Anticonvulsants PHQ2 Have you been feeling down, depressed, or hopeless (depressed mood)? Have you felt little interest or pleasure in doing things (anhedonia)?

Assessing Speech 1. _______ of speech: is the pt silent? Must you drag ever word out of the pt? Does the patient speak excessively? 2. R____: is the speech fast (pressured such as in a manic episode) or slow (such as in depression)? 3. L____: Does the pt speak loudly (like in mania) or softly (social anxiety or depression) 4. A________: Does the pt speak clearly? 5. F_______: This involves the rate, flow, and melody of speech. Hesitancies in speech (as seen in pts with aphasia from _____) _______ inflections (schizophrenia or severe depression) __________: in which words or phrases are substituted fro the word a person can't remember (ex) "the thing you block our your writing with" for an "eraser" _______: words are malformed "I write with a den", wrong "I write with a branch", or invented "I write with a dar"

1. Quantity of speech Think about in terms of diff pts, not necessarily neurological if silent, could be in abusive situation 2. Rate 3. Loud 4. Articulation 5. Fluency strokes Monotone Circumlocutions Paraphasia

Difficulty in articulating words with impaired movement of the palate, tongue, or lips = Usually a consequence of? Inability to understand or speak language = 2 types

Dysarthria CNS lesions ( brain tumor, ALS) Aphasia Receptive Expressive

Wernicke's Aphasia 1. Qualities of Spontaneous Speech: 2. Word Comprehension: 3. Repetition: 4. Naming: 5. Reading Comprehension 6. Writing: 7. Location of Lesion:

1. _Fluent,_ often rapid, voluble, and effortless. Inflection and articulation are good, but sentences _lack meaning_ and words are malformed (paraphasia) or invented (neologisms). Speech may be totally incomprehensible 2. Impaired 3. Impaired 4. Impaired 5. Impaired 6. Impaired 7. Posterior superior temporal lobe

Broca's Aphasia 1. Qualities of Spontaneous Speech 2. Word Comprehension 3. Repetition 4. Naming 5. Reading Comprehension 6. Writing 7. Location of Lesion

1. _Nonfluent_; slow with few words and laborious effort. Inflection and are _impaired but words are meaningful_ with nouns, transitive verbs, and important adjectives. Small grammatical words are often dropped 2. Fair to good 3. Impaired 4. Impaired, though the patient recognizes objects 5. Fair to good 6. Impaired 7. Posterior inferior frontal lobe

Motor System-Examination Position, movement, muscle bulk, and tone Observe body ______ and ______ movements such as t____, t___, fa_______ Inspect muscle _____; note any at______ ( from hospitalization or cast)? Assess muscle ____ - flex and extend arm and lower leg for residual tension -\> slight ______ to passive stretch is ______

Position, movement, bulk, tone position, involuntary, tremors, tics, fasciculations bulk, atrophy tone, resistance, normal

Neuro Flashcards by Felita Salim

Subjective

_ _, D______
S____ or loss of ________
S_____
Changes in v______
Changes in h______
Changes in s______
N______ or Pa_____
Pa______ or We______
Changes in m____
Changes in sl_____
A_____, D___ use

HA, Dizziness
Syncope, Consciousness
Seizure
vision
hearing
speech
Numbness, Parasthesia
Paralysis, Weakness
mood
sleep
Alcohol, drug use

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Health Promotion and Counseling

Preventing _____ or _ _ _
Reducing risk of peripheral ________ (could be connected to __, m_______, are symptoms getting _____? Such as difficulty _____ shirt or w____?)
Detecting the “three D’s” (3)

Stroke, TIA
Neuropathy (DM, medications, worse, buttoning, walking)
Delirium, Dementia, Depression

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Key Principles

As you examine the patient, remember 3 important questions:

Is _____ status intact?
Are ____ and _____ sided findings the ____, or symmetric?
If findings are asymmetric or otherwise abnormal, do the causitive lesions lie in the _____ or _____?

mental
right, left, same
CNS or Peripheral nervous system

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Organize your exam into categories

_____ status
S_____ and La______
_____ nerves
- M____ system
- S____ system
Re______
C______
G_____

Mental
Speech, Language
Cranial
- Motor
- Sensory
Reflexes
Coordination
Gait

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Mental Status

O_____
Level C_______
J_______
M____
T_____ process
I_____
A_____

Orientation
Consciousness
Judgement
Mood
Thought
Insight
Affect

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Mental Status Chart

Alertness
- Speak to the patient in a _____ tone of voice. An alert patient opens the ____, ___ at you, and responds fully and ________ to stimulate (arousal intact)
Lethargy
- Speak to the patient in a ____ voice. For example, call the patient’s ____ or ask “How are you?”
- A lethargic patient appears d____ but ____ the eyes and looks at you, responds to questions, and then falls _____.
Obtundation
- _____ the pt gently as if awakening a sleeper
- An obtunded patient opens eyes and looks at you, but responds _____ and is somewhat c_____. Alertness and interest in ______ is ______.
Stupor
- Apply a ______ stimulus. For example, p____ a tendon, ___ the sternum, or roll a ____ across a ___ bed. (No stronger stimuli _____!)
- A stuporous pt arouses from sleep only after ____ stimuli. Verbal responses are ____ or even _____. The pt lapses into an _____ state when the stimulus ceases. There is ______ awareness of self or the environment.
Coma
- Apply repeated _____ stimuli
- A comatose pt remains ______ with eyes _____. There is no evident response to inner n____ or e____ stimuli.

Alertness
- normal, eyes, looks, appropriately
Lethargy
- loud, name
- drowsy, opens, asleep
Obtundation
- Shake
- slowly, confused, environment, decreased
Stupor
- painful, pinch, rub, pencil, nail, needed
- painful, slow, absent, unresponsive, minimal
Coma
- painful
- unarousable, closed, need, external

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Common Causes of AMS

AEIOUTIPS

Alcohol
Epilepsy
Insulin
Overdose
Uremia (maybe in advanced or septic pt)
Trauma (could be trauma that causes a lot of blood)
Infection (sepsis)
Psychological/Poisoning
Stroke/Shock

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The logical, coherent, and relevance of a patient’s thoughts, ____ people think.

Speech characterized by indirection and delay due to the patient’s excessive use of details that have no connection to the point =
Speech where a person shifts topics with no apparent relation between the topics =
Accelerated change of topics in a very fast but generally coherent manner =
Speech that is comprehensible because it is illogical =
Fabrication of facts to hide memory impairment =

Thought Processes

HOW people think

Circumstantiality (kind of talks in circles, asking about a HA and they start talking about their fingernails)
Derailment (A to B to C to D topics but they are making sense)
Flight of ideas
Incoherence (they aren’t making sense “theres a bird in my head”
Confabulation (to avoid embarassment)

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The observable mood of a perosn expressed through their facial expression, body movements, and voice =

Assess the patient’s facial _______
- Lack of facial movement - can be seen due to ta physical reason such as Parkinson’s disease or psychological reason such as profound depression =
Assess the patient’s m____, affect and relationship to p_____ and th_____
- Does the affect reflect the m_____
- Is the affect s____ or l_____ (mood changing from happy to tears and back quickly)
- Does the patient seem to ___ or ___ things you don’t

Affect

expression
- flat affect
manner, person, things
- mood
- stable, labile
- see, hear

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Process of comparing and evaluating different possible courses of action =

Ask about the _____ behing their clinical or hospital visit; patients with psychological disorders ____ insight into their _____
You can usually assess _____ by noting the pts responses to s_____ on their relationships, jobs, finances

Judgment

reasons, lack, disease
judgment, stressors

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Glasgow Coma Scale

What is it used for?*
Do you want to score higher or lower?*

What are the 3 components of the scale?

To assess brain trauma*
HIGHER*

Best eye-opening response

Best motor response

Best verbal response

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Delirium

_____ onset (ie urosepsis)
F_______ course
Lasts ____ to ____
_____ disrupted
Associated with i_____ or d____ toxicity
Distubred level of c________
A____ or S_____ (can have both)
Disorganized th____ process
Disoriented mostly to t_____

Acute
Fluctuating
hours to weeks
Sleep
illness, drug
consciousness
Agitated, Somnolent
thought
time

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Dementia

_____ onset
S_____ progressing course
Lasts ____ to _____
Sleep f______
___ usually associated with illness or drugs except with Alzheimers
___ change in consciousness until ____ in disease
Normal to slow b_____
Difficulty finding w_____
Often flat or d_______ mood

Insidious
Slowly
months, years
fragmented
Not
No, late
behavior
words
depressed

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Altered Mood

Depression
- More common with significant medical c______
- Concern for a_____, d___ use
- Can be related to m_______
  - ____ blockers
  - S_____
  - B________
  - _______ drugs - Sinemet
  - Anti_______
PHQ-2
- What are the two questions?

Depression
- conditions
- alcohol, drug
- medication
  - Beta
  - Steroids
  - Benzodiazepines
  - Parkinson’s
  - Anticonvulsants
PHQ2
- Have you been feeling down, depressed, or hopeless (depressed mood)?
- Have you felt little interest or pleasure in doing things (anhedonia)?

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Assessing Speech

_______ of speech: is the pt silent? Must you drag ever word out of the pt? Does the patient speak excessively?
R____: is the speech fast (pressured such as in a manic episode) or slow (such as in depression)?
L____: Does the pt speak loudly (like in mania) or softly (social anxiety or depression)
A________: Does the pt speak clearly?
F_______: This involves the rate, flow, and melody of speech.
- Hesitancies in speech (as seen in pts with aphasia from _____)
- _______ inflections (schizophrenia or severe depression)
- __________: in which words or phrases are substituted fro the word a person can’t remember (ex) “the thing you block our your writing with” for an “eraser”
- _______: words are malformed “I write with a den”, wrong “I write with a branch”, or invented “I write with a dar”

Quantity of speech Think about in terms of diff pts, not necessarily neurological if silent, could be in abusive situation
Rate
Loud
Articulation
Fluency
- strokes
- Monotone
- Circumlocutions
- Paraphasia

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Disorders of Speech

(2)

Dysarthria

Dysphonia

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Difficulty in articulating words with impaired movement of the palate, tongue, or lips =

Usually a consequence of?
Inability to understand or speak language =
- 2 types

Dysarthria

CNS lesions (brain tumor, ALS)
Aphasia
- Receptive
- Expressive

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Difficulty speaking because of impaired function 

Secondary to impaired function of the?

Dysphonia

vocal cords

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Aphasia

(2)

Wernicke’s Aphasia

Broca’s Aphasia

Although is it important to recognize aphasia early in your encounter with a patient, integrate this info with your neuro exam as you approach a diagnosis

You want to try and recognize aphasia earliest in encounter as possible

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Wernicke’s Aphasia

Qualities of Spontaneous Speech:
Word Comprehension:
Repetition:
Naming:
Reading Comprehension
Writing:
Location of Lesion:

Fluent, often rapid, voluble, and effortless. Inflection and articulation are good, but sentences lack meaning and words are malformed (paraphasia) or invented (neologisms). Speech may be totally incomprehensible
Impaired
Impaired
Impaired
Impaired
Impaired
Posterior superior temporal lobe

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Broca’s Aphasia

Qualities of Spontaneous Speech
Word Comprehension
Repetition
Naming
Reading Comprehension
Writing
Location of Lesion

Nonfluent; slow with few words and laborious effort. Inflection and are impaired but words are meaningful with nouns, transitive verbs, and important adjectives. Small grammatical words are often dropped
Fair to good
Impaired
Impaired, though the patient recognizes objects
Fair to good
Impaired
Posterior inferior frontal lobe

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Motor System-Examination

Position, movement, muscle bulk, and tone
- Observe body ______ and ______ movements such as t____, t___, fa_______
- Inspect muscle _____; note any at______ (from hospitalization or cast)?
- Assess muscle ____ - flex and extend arm and lower leg for residual tension -> slight ______ to passive stretch is ______

Position, movement, bulk, tone
- position, involuntary, tremors, tics, fasciculations
- bulk, atrophy
- tone, resistance, normal

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Pictures on how to test Motor System of Upper Extremities

Do not let me push ___, pull your w____, push providers hand ____

down, wrist, down

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Pictures on how to exam Lower Extremities Motor System

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**Muscle Strength Grading** * What grade is the following? (0-5 scale) 1. Active movement against gravity 2. Active movement against full resistance without evident fatigue; this is normal muscle strength 3. No muscular contraction detected 4. Active movement of the body part with gravity eliminated 5. Active movement against gravity and some resistance 6. A barely detectable flicker or trace of contraction * Ask the pt to move actively against your **opposing resistance****,**assign**Grade \_\_** if the patient overcomes your opposing movement * If the patient can only **move against gravity,** assign **Grade \_\_**

* Scale 0-5 * 3 * 5 * 0 * 2 * 4 * 1 * **5** * **3**

**Examination-Muscle Strength** * Test the following **muscle groups and movements** * **B\_\_\_\_\_ and T\_\_\_\_\_, w\_\_\_\_**: flexion and extension * **Hand\_\_\_\_, f\_\_\_\_:** abduction and adduction, **\_\_\_\_** opposition * **T\_\_\_\_**: flexion, extension, lateral bending * **H\_\_:** flextion, extension, abduction, and adduction * **K\_\_\_\_ and A\_\_\_\_\_ -** flexion, extension

* **Muscle groups and movements** * **Biceps, Triceps, Wrist** * **Handgrip, finger,** **thumb** * **Trunk** * **Hip** * **Knee, Ankle**

**Examination-Coordination** Test Coordination,including **(4)**

**Rapid Alternating movements** **Point to point movements** **Gait** **Stance (The Romberg Test, Pronator Drift)**

**Examination Coordination cont.** 1. **Rapid alternating movements** * patient ____ hand rapidly over and back on th\_\_\_ * taps tip of index _____ on distal th\_\_\_ * taps ball of ____ rapidly on your \_\_\_\_ 2. **Point to point movements** * ****patient touches n\_\_\_ then your index ____ as you move it to different \_\_\_\_\_\_\_ * Patient moves h\_\_\_\_\_ from opposite k\_\_\_\_ down the ____ to the big\_\_\_ 3. **Gait** * ****walks across \_\_\_\_\_ * walks ____ to \_\_\_\_ * walks _____ then \_\_\_\_\_ * ____ in place (*keep in mind older/osteoporosis probs cannot)* 4. **Stance** * **The Romberg Test** * ****pt stands with feet _____ and eyes \_\_\_\_, then with eyes _____ for \_\_-\_\_\_ seconds without support * **Positive test =** * **Pronator Drift** * ****Patient _____ for 20-30 seconds with both ___ straight \_\_\_\_\_\_, ____ up, eyes \_\_\_\_, tap arms briskly \_\_\_\_\_\_\_ * **Positive test =**

1. **Rapid alternating movements** * ****turns, thighs * finger, thumb * foot, hand 2. **Point to point movements** * ****nose, finger, positions * heel, knee, shin, toe 3. **Gait** * room * heel to toe * toes then heels * Hops 4. **Stance** * ****together, eyes open, closed 30-60 s, * **Loss of balance when eyes closed +** * ****stands, arms, forward, palms, closed, downward * **Pronation or downward drift of arm +**

**Impaired Muscle Tone** * **\_\_\_\_\_\_ =** _____ motor neuron of the ______ tract at any point from the cortex to the spinal cord - increased resistance to passive lengthening, then may suddenly give way (clasp-knife phenomenon) - *ie muscular dystrophy* * **\_\_\_\_\_\_\_\_ =** basal ______ system - constant state of resistance; resists passive movement in any direction * Lead pipe rigidity * Cogwheel rigidity * **\_\_\_\_\_\_\_** = _____ neuron at any point from the anterior horn cell to the peripheral nerves-decreased muscle \_\_\_\_, muscle feels \_\_\_\_, soft and flabby, weak and easily f\_\_\_\_\_

* **Spastic** = upper, corticospinal * **Rigid =** ganglia * **Flaccid** = lower, tone, limp, fatigued

**Tremors** | (3)

1. Resting (or static) tremors 2. Postural tremors 3. Intention tremors (*becomes obvious and often exaggerated as the need for precise movement increases)*

**Reflexes** * Select a **properly \_\_\_\_\_** hammer * **Encourage the pt to \_\_\_\_\_;** position the limbs properly and symmetrically * **Hold the hammer \_\_\_\_\_** between your thumb and index finger so that it swings freely in an \_\_\_ * Strike the tendon with a **b\_\_\_\_** **direct movement;** use the ______ force needed to obtain a response * Use **re\_\_\_\_\_\_\_\_\_** when needed * ______ the response

* **weighted** * **releax** * **loosely,** arc * **brisk,** minimum * **reinforcement** *so if you think someone had a weak response, assess another tendon then double back* * Grade

Record Deep Tendon Reflexes ## Footnote Range is __ - \_\_ * Average; normal = * Very brisk, hyperactive, with clonus (rhythmic oscillations between flexion and extension) = * No response = * Brisker than average; possibly but not necessarily indicative of disease = * Somewhat diminished; low normal =

0 - 4+ ## Footnote * 2+ (normal) * 4+ (markedly hyperactive with clonus) * 0 (absent) * 3+ (hyperactive reflex) * 1+ (present but diminished)

**Deep tendon reflexes** with ___ levels for each response helps localize any \_\_\_\_\_ * **Biceps reflex** = \_\_-\_\_ * **Triceps reflex = \_\_-\_\_** * **Supinator** or **Brachioradialis** = \_\_-\_\_ * **Knee reflex** = \_\_-\_\_ * **Ankle reflex =** primarily \_\_\_

cord, abnormalities * C5-6 * C6-7 * C5-6 * L2-4 * S1

Test Arm Reflexes ## Footnote 1) ______ C5-C6 2) _____ C6-C7 3) ______ C5-C6

1) Biceps *(how to hold limb, don't squeeze, using thumb to transfer impulse)* 2) Triceps 3) Brachioradialis

Leg Reflexes ## Footnote 1. Patellar \_\_-\_\_ * *can use the ___ of hammer for an adult, for child use the \_\_\_* 2. Achilles \_\_\_ * *use ___ of hammer for Achilles too*

1. L2-L4 * *back, tip* 2. S1 * *back*

Cutaneous Reflexes ## Footnote (3)

Abdominal Reflexes Plantar Response (Babinski) Anal reflex (wink)

Abdominal Reflex Nerve Segments * Upper abdomen \_\_-\_\_ * Mid abdomen \_\_-\_\_ * Lower abdomen \_\_-\_\_

Plantar Response and Anal Reflex Nerve Segements * \_\_-\_\_ * *Positive babinski normal in?* * \_\_-\_\_ * *So again if you have a lesion in S2-S4 this reflex may __ be present*

* L5-S1 * *normal in pediatric patients until a certain age* * S2-S4 * *not be present*

Pathologic Reflexes ## Footnote 1. Babinski * Method of testing: Stroke _____ aspect and ____ ball of foot * Abnormal Response (Reflex is present): ______ of great toe, _____ of toes * Indications: C\_\_\_\_\_\_\_\_ (pyramidal) tract disease 2. Oppenheim * Method of testing: Stroke a\_\_\_\_\_ medial t\_\_\_\_ muscle * Abnormal Response: ____ as babinski * Indications: _____ as babinski 3. Gordon * Method of testing: Firmly _____ c\_\_\_\_ muscles * Abnormal response: ____ as babinski * Indications: _____ as babinski

1. Babinski * lateral, across * Extension, fanning * Corticospinal 2. Oppenheim * anterior, tibial * same * same 3. Gordon * squeeze calf * same * same

Pathologic Reflexes 1. Hoffman * Method of testing: F\_\_\_\_\_ distal ph\_\_\_\_ of middle or index f\_\_\_\_\_ * Abnormal response: C\_\_\_\_\_\_ of fingers and thumb * Indications: ____ as babinski 2. Kernig * Method of testing: Raise leg ____ or f\_\_\_ thigh on abdomen, then _____ knee * Abnormal response: R\_\_\_\_\_\_ to straightening, ____ down posterior thigh * Indications: \_\_\_\_\_\_\_irritation 3. Brudzinski * Method of testing: Flex c\_\_\_ on c\_\_\_\_\_, ____ hips and knees * Abnormal response: R\_\_\_\_\_ and ____ in neck, with _____ of hips and knees * Indications: _______ irritation

1. Hoffman * Flick, phalynx, finger * clawing * same (corticospinal disease) 2. Kernig * straight, flex, extend * Resistance, pain * Meningeal 3. Brudzinski * chin, chest, watch * resistance, pain, flexion * meningeal *Babinski, Brudzinski, and Kernigs are the three most common ones we use to loof for meningeal irritation in meningitis (positive reflex = positive test)*

Sensory Examination: General Principles ## Footnote * Compare **\_\_\_\_\_ areas** on both sides of the body * When testing **p\_\_\_\_, te\_\_\_\_,** and **t\_\_\_\_, compare d\_\_\_\_ with p\_\_\_\_ areas** of the extremities * **M\_\_\_ out the b\_\_\_\_\_\_\_** of any area of sensory loss or hypersensitivity

* **symmetric** * **pain, temp, touch, distal and proximal** * **Map out boundaries**

Sensory System Components * S\_\_\_\_\_\_ tract * P\_\_\_\_\_ column

* Spinothalmic tract * Posterior column

Spinothalmic Tract ## Footnote **Test pain: ____ and \_\_\_\_** **Light touch: c\_\_\_\_\_ wisp** **Temperature: ommitted if pain is \_\_\_\_** 1. C4 = \_\_\_\_\_\_ 2. C6T1 = inner outer aspect of \_\_\_\_\_ 3. C6-C8 = T\_\_\_\_ and P\_\_\_\_\_ 4. L2 = Front of \_\_\_\_\_ 5. L4-L5 = Medial and lateral aspect of \_\_\_\_\_ 6. S1 = little \_\_\_\_

* **sharp and dull** * **cotton** * **intact** 1. Shoulders 2. forearm 3. Thumbs, Pinky 4. thighs 5. calves 6. toe

Posterior Column ## Footnote 1. **Vibration****** * ****Using a tuning fork and then place on the distal joint of the _____ and big \_\_\_ * Ask the person to tell you when the vibration \_\_\_ * When ready clasp your hand over the fork to make the vibration stop * First sensation to go in p\_\_\_\_\_\_ n\_\_\_\_\_ * If abnormal move p\_\_\_\_\_\_ 2. **Proprioception** * ****Grasp the patient's big \_\_\_ * Holding it by the sides * Move the toe __ and \_\_\_ * Asking the person to \_\_\_\_\_\_up or down as you move the toe in a small arm

1. **Vibration****** * ****finger, big toe * stops * peripheral neuropathy * proximally**** 2. **Proprioception** * ****toe * sides * up and down * respond

Posterior Column: Tactile Discrimination * **Stereognosis =** * ****Distinguish ___ and ___ on a coin * **Two point discrimination** * ****Using a paper clip -\> point pressure on __ parts of finger pad, should be able to feel ___ at the same time * Distance between the 2 stimuli should be \<\_\_mm if unable to discriminate * Move apart until pt can identify both pressures, ___ the distance in \_\_ * **Extinction** * ****\_\_\_\_\_ touch an area on both sides of body * Ask where patient feels your touch, should feel \_\_\_\_ * Stimulus on the side _____ the damaged ____ is e\_\_\_\_\_\_ * **Graphesthesia:** _____ identification * ****unable to identify # means = * How to test graphesthesia?

* **Stereognosis =** ability to identify an object by feeling it * heads, tails * **Two point discrimination** * ****2, both * 5mm * mark, cm * **Extinction** * ****Simultaneously * both * opposite, cortex, extinguished (*so if they can't feel you on the right side the left side of cortex is damaged)* * **Graphesthesia:** number * lesion in sensory cortex * Draw # on person's hand and ask them to identfiy it

Common Patterns of Sensory Loss - *Hemi or full loss sensory loss depending on level of spinal cord injury* * Right cortex damage = left side loss and vice versa*

Coordination ## Footnote * C\_\_\_\_\_\_ * Rapid ______ Movement * P\_\_\_\_ to P\_\_\_\_ Movement * F\_\_\_\_ to N\_\_\_\_ * H\_\_\_\_ to Sh\_\_\_ * F\_\_\_\_ to F\_\_\_\_ * \_\_\_\_\_\_\_; proprioception * ______ drift: upper neuron disorder

* Cerebellum * Alternating * Point to Point * Finger, Nose * Heel, Shin * Finger to Finger * Romberg * Pronator "*had a drink an hour ago and it goes straight to my cerebellum"*

Gait ## Footnote Types of Gait * S\_\_\_\_\_ * N\_\_\_\_\_ walking * T\_\_\_\_ walking * H\_\_\_ to T\_\_\_ * S\_\_\_\_\_ or Foot \_\_\_ * S\_\_\_\_ Hemiparesis * P\_\_\_\_\_ * Cerebellar A\_\_\_\_

* Station * Normal * Tandem * Heel to Toe * Steppage or Foot Drop * Spastic Hemiparesis * Parkinsonian * Cerebellar Ataxia

Ataxic Gait * *Ataxic gait usually a ____ stance, unsteadiness in \_\_\_\_, tendency to j\_\_\_/lunge sideways* * *A way to test this is to ask pt to walk ____ (pt will have a lot of difficulty)*

* *wide, trunk, jerk* * *tandem -\> difficulty*

Parkinsonian Gait * *Parkinsonian: \_\_\_kinetic, pt will have s\_\_\_\_/leaned forward posture, difficulty i\_\_\_\_ gait, small sh\_\_\_\_ steps, t\_\_\_\_\_ in hands associated, picking up of s\_\_\_\_, pt will turn on b\_\_\_\_ (like a statue moving around), again having difficulty initiating gait*

* *hypokinetic, stooped, initiating, shuffling steps, tremor, speed, block*

Steppage Gait * *2 common patterns with food drop* * *Steppage Gait = hiking the \_\_* * *Foot slap gait = ______ foot slap* Scissoring * over\_\_\_\_\_\_ feet while walking (pointed \_\_\_\_\_)

* *2 patterns w foot drop* * *hip* * *audible* * *overlapping (pointed inwards)*

Headaches ## Footnote Headache History 1. A\_\_, T\_\_\_, and M\_\_\_\_ of onset 2. HA p\_\_\_\_\_\_ (*during period, in afternoon from no caffeine?)* 3. Fr\_\_\_\_\_, In\_\_\_\_\_, and Du\_\_\_\_ of attack 4. Presence or absence of a\_\_\_ or prodrome 5. Q\_\_\_\_, si\_\_\_, r\_\_\_\_ of pain 6. A\_\_\_\_\_ sx and abnormalities (*nausea, pain)* 7. Prec\_\_\_\_ and R\_\_\_\_ factors 8. Effect of pain on a\_\_\_\_\_ 9. Past Medical \_\_\_\_ 10. F\_\_\_\_\_ hx of migraine 11. Me\_\_\_\_ 12. R\_\_\_\_\_\_ to previous treatment 13. Any recent changes in v\_\_\_\_\_ 14. Association with recent t\_\_\_\_ 15. Any recent changes in sl\_\_\_\_, ex\_\_\_\_, w\_\_\_, or d\_\_\_ (*not enough sleep i have a HA)* 16. State of g\_\_\_\_ health 17. Change in w\_\_\_ or life\_\_\_\_ 18. Change in method of ____ control (women) 19. Relationship to m\_\_\_\_ cycle 20. Possible association with en\_\_\_\_ factors (all\_\_\_\_)

1. Age, Time, Mode 2. Pattern 3. Frequency, Intensity, Duration 4. aura 5. Quality, site, radiation 6. Associated 7. Precipitating, relieving 8. activity 9. Hx 10. Family 11. Medication 12. Response 13. vision 14. trauma 15. sleep, exercise, weight, diet 16. general 17. weight, lifestyle 18. birth 19. menstrual 20. environmental (allergies)

Differential Diagnoses of Headache 1. Congenital: ____ Cell, Bleed A\_\_\_\_\_ 2. Environmental: T\_\_\_\_\_, Poll\_\_/Poll\_\_\_\_, St\_\_\_\_\_\_ 3. Iatrogenic: L\_\_\_\_ puncture, Caffeine w\_\_\_\_\_, Recent ___ tube, Poor l\_\_\_ correction, Poor fit of den\_\_\_\_ 4. Infections: \_\_\_\_myelitis, Bacterial, Viral M\_\_\_\_\_, Abscess Enc\_\_\_\_\_, \_\_\_\_itis, C\_\_\_\_ivitis, Ot\_\_\_\_ 5. Inflammatory: T\_\_\_\_ Arteritis, All\_\_\_\_, Ir\_\_\_\_, My\_\_\_\_ 6. Mechanical: Old or recent f\_\_\_\_, Mi\_\_\_\_, Cont\_\_\_\_, Filled S\_\_\_\_, Foreign b\_\_\_\_, G\_\_\_\_ teeth, Im\_\_\_\_ 7. Neoplastic: Pa\_\_\_\_, T\_\_\_\_, M\_\_\_\_\_ 8. Psychologic: Vaso\_\_\_\_, St\_\_\_\_

1. Sickle, Aneurysm 2. Trauma, Pollen/Pollution, Stresses 3. Lumbar, withdrawal, NG, lens, dentures 4. Osteomyelitis, Meningitis, Encephalitis, Sinusitis, Conjunctivitis, Otitis 5. Temporal, Allergies, Iritis, Myopathy 6. fracture, migraine, contusion, sinuses, body, grinding, imbalance 7. Pagets, Tumor, Melanoma 8. Vasospasm, Stress *Underlying Processes of HA*

HA: Most Important * Always ask about the p\_\_\_\_\_ of the HAs * Do they ____ an individual at night or w\_\_\_\_ first thing in the morning * Are they worse with increased pressure such as s\_\_\_\_, c\_\_\_\_\_, s\_\_\_\_ to stool * Are they the worst HA they ____ \_\_\_

* progression * wake, worse * sneezing, coughing, straining * ever had

Red Flags **SNOOPS** * ******S** * **N** * **O** * **O** * **P**

* Systemic symptoms (fever, weight loss) * Neurologic sx such as confusion, impaired alertness, consciousness * Onset sudden, aburpt or split second * Older, new onset or progressive, pts \> 50 (giant cell arteritis) * Previous HA history, first HA or new or different HA, change in attack, frequency, severity, or clinical features

Types of HAs * Primary (4) * Secondary =

* Tension * Migraine * Cluster * General * Caused by underlying structural, systemic or infectious process (infection, bleed, tumor, medication)

Differentiating Primary HA ## Footnote **Which HA does this describe?** * Unilateral in 60-70%; bifrontal or global in 30% * Gradual, crescendo pattern, moderate or severe intensity; aggravated by routine physical activity * Pt prefers to rest in dark, quiet room * 4-72 hrs * Asctd sx: N/V, photophobia, may have aura (usually visual, but can involve other senses or cause speech or motor deficits)

Migraine Headaches

What HA does this describe? * Bilateral * Pressure or tightness which waxes and wanes * Patient may remain active or may need to rest * Variable * No asctd. sx

Tension HA

What HA does this describe? * Always unilateral, usually begins around eye or temple * Pain begins quickly, reaches a crescendo within minutes; pain is deep, continuous, excrutiating, and explosive in quality * Patient remaines active * 30min-3hrs * Ipsilateral lacrimation and redness of eye, stuffy nose; rhinorrhea; pallor; sweating; Horner's syndrome; focal neurologic symptoms rare; sensitivity to alcohol

Cluster Headache

Migraines **SULTANS** 1. 1st Criteria (need __ from this list) * **S** * **U\_\_L\_\_\_\_** * **T\_\_\_\_** * **A\_\_\_\_** 2. 2nd Criteria (need __ from this list) * **N** * **S**

1. 2 * **S**evere * **U**ni**L**ateral * **T**hrobbing * **A**ctivity worsens HA 2. 1 * **N**ausea * **S**ensitivity to light/sound

Headaches associated with Illness | (2)

Sinusitis Meningitis

**Sinusitis** * Cause is m\_\_\_\_ in\_\_\_\_ due to \_\_\_\_\_ * Located ____ eye or cheek, \_\_lateral or \_\_lateral * A\_\_\_\_ or th\_\_\_\_\_ * Onset is ____ lasts several ___ at a time; recurs over d\_\_\_ * Local t\_\_\_\_\_\_, nasal c\_\_\_\_\_\_, discharge and f\_\_\_\_\_ * ______ by coughing, sneezing, and jarring the head * More common in ppl with?

* mucusal inflammation, bacterial * above, uni or BL * Aching, throbbing * variable, hours, days * tenderness, congestion, fever * Aggravated * allergic rhinitis

**Meningitis** * What is it? * ______ location, s\_\_\_ throbbing, _____ in quality * Fairly ____ onset, lasting \_\_\_\_ * Associated with (2) * Causative agent in adults (2) * _____ in adolescents prior to college (*bc easily spread in campus dorms dt close quarters)*

* Infection of the meninges * Generalized, steady, severe * rapid, days * fever \>38, nuchal rigidity * S. pneumonia, Neisseria meningitides * Vaccination

Headaches in Older Adults | (2)

**Temporal Arteritis** **Trigeminal Neuralgia**

**Temporal Arteritis** * Chronic ______ of the? Often associated with \_\_\_\_\_\_ * Localized near the involved _____ (temporal or occipital); may become g\_\_\_\_\_\_ * Aching, throbbing, bu\_\_\_\_ oftn severe (*usually burning)* * Onset is gradual or rapid * ____ duration * Recurrent or persistent over w\_\_\_\_ to m\_\_\_\_ * Tenderness of the a\_\_\_\_ scalp, fever, malaise, fatigue and anorexia; m\_\_\_\_\_aches and stiffness, v\_\_\_\_ loss or blindness

* inflammation, cranial arteries, polymyalgia * artery, generalized * burning * Gradual or rapid * variale * weeks to months * adjacent, muscular aches, visual loss or blindness

Trigeminal Neuralgia * Mechanism \_\_\_\_\_\_ * Location in ch\_\_\_, j\_\_\_, l\_\_\_, or g\_\_\_ * Sharp, brief, lightning like \_\_\_\_, very \_\_\_\_\_ * Onset is \_\_\_\_ * Each jab is t\_\_\_\_ * Pain may be **t\_\_\_\_\_\_** for months then disappears, the recurs; uncommon at night * **E**\_\_\_\_\_\_ **results from \_\_\_** (*really detrimental to QOL)* * Typically ______ by touching certain areas of the lower face or by chewing, talking, brushing, teeth * Consider in older adults

* variable * cheeks, jaw, lips, gums * jabs, severe * abtupt * transient * **troublesome** * **Exhaustion from pain** * triggered

HA That can occur from Trauma | (2)

**Mild traumatic brain injury (mTBI) Concussion** **Chronic Subdural Hematoma**

**Mild traumatic brain injury (mTBI) Concussion** * Headache can present when? * Related to cellular m\_\_\_\_ cas\_\_\_\_ that occurs right after an injury coupled with diminished _____ supply * Headache _____ with increased mental or physical exertion (*sports, reading, watching tv exacerbates trauma to the brain)* * Usually resolves within \_\_-\_\_ days in adults but can last months to years * Associated with ______ impairment

* immediately, hours, days, or weeks later * metabolic cascade, energy * intensifies * 10-14 days * cognitive

**Chronic Subdural Hematoma** * Caused by _____ into the ______ space after t\_\_\_\_ * Variabe in l\_\_\_\_\_ * S\_\_\_\_, Ac\_\_\_\_ * ____ onset weeks to months after injury or Progressively severe but may be obscured by ______ consciousness * Associated with changes in p\_\_\_\_\_, hemi\_\_\_\_\_ * Injury is often \_\_\_\_\_\_

* bleeding, subdural, trauma * location * Steady, aching * Gradual, clouded * personality, hemiparesis * forgotten

**Space Occupying Headache** * Caused by dis\_\_\_\_\_\_ of or traction on pain sensitive ____ and ____ or p\_\_\_\_\_\_ on n\_\_\_\_ in the skull * Pain location depends on location of \_\_\_\_\_ * Aching, steady, v\_\_\_\_ in intensity * V\_\_\_\_ onset * Often ____ duration, i\_\_\_\_\_ but pro\_\_\_\_\_ * N\_\_\_logical and mental sx and \_\_/\_\_ may develop * ______ by coughing, sneeaing or sudden movements of the head

* displacement, arteries, veins, pressure, nerves * tumor * variable * variable * brief, intermittent, progressive * Neurological, N/V * Aggravated

**Syncope** ## Footnote * Ask what the pt was _____ prior to the episode * Was the person s\_\_\_\_, s\_\_\_\_, or l\_\_\_\_\_ down (*pt quickly stood and became syncopal could be orthostatic hypotension)* * Was there any _____ signs * D\_\_\_\_\_ of the episode * Could _____ be heard * Was o\_\_\_\_ and o\_\_\_\_ of the episode fast or slow * Were there any p\_\_\_\_\_\_ prior to the episode * Is there a hx of ____ disease * Was the episode ____ by anyone?

* doing * sitting, standing, lying * warning * duration * voices * onset, offset * palpitations * heart * observed

Types of Syncope 1. C\_\_\_\_\_\_ 2. Hy\_\_\_\_\_ 3. Pulmonary \_\_\_\_\_\_ 4. A\_\_\_\_\_ 5. \_\_\_\_glycemia 6. T _ \_ 7. A\_\_\_\_\_

1. Circulatory 2. Hypoxia 3. Emboli 4. Anemia 5. Hypoglycemia 6. TIA 7. Anxiety

Circulatory Syncope * Circulatory * \_\_\_\_\_\_: sudden peripheral vasodilation, without increased cardiac output * \_\_\_\_\_\_\_: *(dehydration, internal bleeding)* * \_\_\_\_\_\_\_\_: mechanical reduction of venous return * Reduced ___ \_\_\_\_ * ______ hypotension * Arr\_\_\_\_\_ * ____ stenosis * Hypertrophic cardio\_\_\_\_ * _ \_

* Vasovagal * Hypovolemia * Valsalva * CO * Orthostatic * Arrhythmia * Aortic stenosis * Cardiomyopathy * MI

**Seizures** Seizure Types (2)

Focal Generalized

Focal Seizures * ____ hemisphere * C\_\_\_\_\_ site of onset * Usually indicates structural _____ in the cortex 1. Focal seizure ______ impairment of consciousness 2. Focal seizure ______ impairment of consciousness

* one * consistent * lesion 1. without 2. with

Generalized Seizures (3) Other types of seizures * p\_\_\_\_ seizure * psy\_\_\_\_\_ non-\_\_\_\_\_ seizure

1. Tonic clonic 2. Absence 3. Myoclonic * pseudo seizures * psychogenic-non-epileptic

What type of seizure does this describe? tonic then clonic; unilateral in hand, foot or face then spread to other body parts on same side

**Jacksonian (motor)** Focal seizure without impairment of consciousness

What type of seizure does this describe? Numbness, tingling, simple visual, auditory or olfactory hallucinations such as flashing lights, buzzing or odors

**Sensory** Focal Seizure without impairment of consciousness

What type of seizure does this describe? A funny feeling in epigastrium, nausea, pallor, flushing, lightheadedness

**Autonomic** Focal seizure without impairment of consciousness

What type of seizure does this describe? Anxiety or fear; feeling of familiarity or unreality; dreamy states

**Psychiatric** Focal seizure without impairment of consciousness

Focal Seizure **WITH** impairment of consciousness * _______ confusion and HA, may remember aura but rest is \_\_\_\_\_\_\* (*they won't remember having a seizure)* * May or may not start with ________ or _____ symptoms (if so, called aura) * ______ may develop (smacking lips, chewing, walking about)

* Temporary, **amnesic** * autonomic or psychic sx * Automatisms

**Tonic Clonic (grand mal)** * Lose consciousnessly s\_\_\_\_\_, s\_\_\_\_\_\_ into tonic extensor r\_\_\_\_\_\_ * _____ stops, cyanosis * ______ phase follows (rhythmic muscular contractions) * Breathing resumes with excessive \_\_\_\_\_\_\_ * Injury tongue _____ and in\_\_\_\_\_ may occur * \_\_\_\_ictal confusion, drowsiness, HA, fatigue and temporary focal de\_\_\_\_ * No _______ of aura or seizure

* suddenly, stiffen, rigidity * Breathing * Clonic * salivation * biting, incontinence * Postictal, deficits * No remembrance

**Absence (petit mal or atypical)** * Sudden b\_\_\_\_ lapse of consciousness, with momentary b\_\_\_\_\_, s\_\_\_\_\_ or movements of lips and hands but no f\_\_\_\_\_ * **Petit mal** ____ sec * **Atypical** _____ sec * No ____ recalled * In petit mal, return to \_\_\_\_\_ * In atypical, some postictal \_\_\_\_\_\_

* brief, blinking, staring, falling * \<10 sec * \>10 sec * aura * normal * confusion

**Atonic** * Sudden _ \_ _ with _____ but no movements * Either prompt return to ____ or brief \_\_\_\_\_

* LOC, falling * normal, confusion

**Myoclonus** * Sudden brief rapid ____ involving t\_\_\_\_ or l\_\_\_\_ * _____ postictal state

* jerks, trunk, limbs * variable

Major Causes of Seizures in Adolescents (12-20) * I\_\_\_\_\_\_ * T\_\_\_\_\_ * D\_\_\_ and A\_\_\_\_ withdrawal

* Idiopathic * Trauma * Drug, Alcohol wdrawal

Major Causes of Seizures Young Adults (20-35) * T\_\_\_\_\_ * A\_\_\_\_ism * Brain \_\_\_\_\_

* Trauma * Alcoholism * Tumor

Major Causes of Seizures in Older Adults (\>35) * Brain \_\_\_\_\_ * _ \_ Disease * Metabolic disorders * H\_\_\_\_\_ * H\_\_\_\_\_ * H\_\_\_\_\_ failure * U\_\_\_\_\_ * A\_\_\_\_\_\_\_\_

* tumor * CVD * Hyponatremia * Hypoglycemia * Hepatic failure * Uremia * Alcoholism

**Peripheral Neuropathy** * _________ = tickling, tingling, burning pricking, or numbness (*usually starts in fingertips or toes)* * Loss of pro\_\_\_\_\_\_\_ or vibratory sense * Motor ______ in extremities * Loss of deep tendon \_\_\_\_\_\_ * Unsteadiness of ____ (*usually ppl have difficulty doing fine motor tasks, buttoning, zipping)*

* **Paresthesia** * proprioception * weakness * reflexes * gait

Paralysis and Weakness **Intermittent** * M\_\_\_\_\_\_ G\_\_\_ * Hypo\_\_\_\_\_\_ * _ \_ \_

* Myasthenia Gravis * Hypokalemia * TIA

Paralysis and Weakness **Persistent** * Sequela of s\_\_\_\_\_ * Peripheral n\_\_\_\_\_ * _____ neuropathy * De\_\_\_\_\_\_ disease such as MS * ______ tissue disorder such as p\_\_\_\_\_ * ______ dystrophies * G\_\_\_\_\_\_-B\_\_\_\_ syndrome - distal

* stroke * neuropathies * diabetic ne. * Demyelinating * Connective - polymyositis * Muscular * Guillain-Barre

Numbness and Paresthesia * N\_\_\_\_ root _____ due to h\_\_\_\_ disc * _____ (pernicious) * Peripheral n\_\_\_\_\_\_ * \_\_\_\_\_\_: hypo\_\_\_\_\_\_, hypo\_\_\_\_\_\_ * Hyper\_\_\_\_\_\_ syndrome * Medications (*\_\_\_\_\_)*

* Nerve root compression, herniated * Anemia * neuropathies * Metabolic, hypocalcemia, hypomagnesium * Hyperventilation * *Chemo*

Cause of Neuropathy ## Footnote **Predominantly Motor** * _____ poisoning * G\_\_\_\_\_-B\_\_\_\_ syndrome * Acute intermittent p\_\_\_\_\_ * Hypo\_\_\_\_\_

* Lead * Guillain-Barre * porphyria * Hypoglycemia

Cause of Neuropathy **Predominantly Sensory** * D\_\_\_\_\_\_\_ * Al\_\_\_\_\_\_ * Heavy _____ exposure (a\_\_\_\_) * \_\_\_thyroidism

* Diabetes * Alcoholism * Metal (arsenic) * Hypothyroidism

Cause of Neuropathy **Mixed Neuropathy** * ****C\_\_\_\_\_ * Ly\_\_\_\_\_ * An\_\_\_\_ * Chronic _____ disease * Multiple \_\_\_\_\_\_

* Carcinoma * Lymphoma * Anemia * liver * myeloma

Neuropathy Acronym "DANG THERAPIST" * **D** * **A** * **N** * **G** * **T** * **H** * **E** * **A** * **R** * **P** * **I** * **S** * **T**

* Drugs: nitrofurantoin, vincristine * Alcohol * Nutrition * Guillain Barre * Toxins: lead * Hereditary * Endocrine; diabetes, thyroid * Amyloidosis (*dx similar to MM, hallmark sx is numbness and paresthesia)* * Renal failure * Poryphyria: metabolic d/o caused by altered enzyme activity with the heme biosynthetic pathway * Infection: syphilis * Systemic disorder; lupus, RA * Tumor

Upper Motor Neuron Disease ## Footnote * Muscle tone will be _____ or sp\_\_\_\_\_ * Muscle mass - may have ____ from disuse, otherwise normal * Movement - w\_\_\_\_\_ or p\_\_\_\_\_ in muscles corresponding to the distribution of damage in the pyramidal/corticospinal tract * Reflexes * \_\_\_\_reflexia, ankle \_\_\_\_ * _____ Babinski

* increased, spastic * atrophy * weakness, paralysis * hyperreflexia, ankle clonus * Positive

Upper Motor Neuron Disease

Lower Motor Neuron Disease ## Footnote * Muscle tone will be ______ or l\_\_\_ - fl\_\_\_\_ * Muscle mass - may have ____ from disuse * Movement * Weakness or paralysis corresponding to the distribution of damage in the ____ segment, r\_\_\_ or _____ nerve * F\_\_\_\_\_\_\_ * Reflexes * ____ reflexia * ______ Babinski's

* decreased, lost-flaccid * atrophy * spinal, root, peripheral * fasciculations * Reflexes * hypo-reflexia * negative

Lower Motor Neuron Disease

Stroke/TIA ## Footnote * What race \>? * What gender? * (2) types * _ \_ \_ * ______ -unkown cause

* Black \> White * Men \> Women * Hemorrhagic, Ischemic * TIA * Cryptogenic

Signs of Stroke * Sudden n\_\_\_\_ or w\_\_\_\_ of the face, arm, or leg * Sudden c\_\_\_\_\_, trouble s\_\_\_\_\_ or understanding * Sudden trouble ____ in one eye or both * Sudden trouble w\_\_\_\_\< dizziness, or loss of balance or coordination * Sudden severe \_\_\_\_\_\_

* numbness, weakness * confusion, speaking * seeing * walking * HA

Signs of Stroke ## Footnote **FAST Acronym**

**F**: face drooping (ask to smile) **A:** arm weakness (ask person to raise both arms) **S**: speech difficulty... **T**: time to call 911!

Meningitis ## Footnote * Can be _____ or ____ etiology * What is it? * Onset is \_\_\_\_ * Sx H\_\_\_\_, F\_\_\_\_, M\_\_\_\_\_ * 2 tests * N\_\_\_\_\_\_ R\_\_\_\_\_

* viral, bacterial * inflammation of meninges * acute * HA, fever, malaise * Kernig's, Brudzinski * Nuchal Rigidity

Coma ## Footnote (2)

**Toxic-Metabolic** **Structural**

**Toxic-Metabolic** 1. Patho 2. Respiratory 3. Pupils 4. LOC 5. Examples

1. Arousal center poisoned or critical substrates depleted 2. If regular, normal or hyperventilation. If irregular, Cheyne-Stokes 3. Equal, reactive to light-may be pinpoint from opiates and cholinergic; May be unreactive due to anticholinergic or hypothermia 4. Changes after pupils change 5. Uremia, hyperglycemia, alcohol, drugs, liver failure, anoxia, meningitis

**Structural** 1. Patho 2. Respiratory 3. Pupils 4. LOC 5. Examples

1. Lesion destroy or compresses brainstem arousal areas, either directly or secondary to more distant expanding masses 2. Cheynes-Stokes 3. Unequal or unreactive to light (fixed); Midposition = midbrain; Dilated, fixed = CN III from herniation 4. Changes before pupils change 5. Brainstem infarct, tumor, hemorrhage

Postures in Comatose Patients ## Footnote 1. **Decorticate (flexor response)** * ****Arms adducted to \_\_\_\_, ____ on chest * Legs plantar \_\_\_\_, knees \_\_\_\_\_ * Associated disruption of lateral cortical ____ tract 2. **Decerebrate (extensor response)** * ****Arms \_\_\_\_, p\_\_\_\_, wrist \_\_\_\_ * Legs plantar \_\_\_\_, knees \_\_\_\_ * Associated with ___ \_\_\_ damage * Severe ____ disorders such as hypoxia, hypoglycemia

1. **Decorticate** * ****side, flexed * flexed, extended * spinal 2. **Decerebrate** * ****adducted, pronated, flexion * flexed, extended * brain stem * metabolic

Oculocephalic Reflex (Dolls Eye) * Assesses _____ functioning * Holding ___ lids open so you can see the eyes * Move the head ____ to one side and then the other * Intact brainstem =

* brainstem * upper * quickly * head turned, eyes move toward opposite direction

Neuro Flashcards

(109 cards)