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Flashcards in Neuro & Cranial Nerves Deck (88)
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1

What would you first observe when assessing nervous system?

LOC, posture, motor behavior, grooming/personal hygiene, affect (feelings), eye contact, A&Ox3, speech

 

If abnormal, you check MMSE.

(Mini-Mental State Examination/Folstein Test → Cognitive Impairment)

2

What is Cranial Nerve 1 and how do you test it?

Olfactory

Test each nares for sense of smell

→ask any changes in smell recently or taste in food

3

What is Cranial Nerve 2 and how do you test it?

Optic

*Test visual acuity*

1. Test vision with Rosenbaum Vision Chart → hold at 14 inches. Direct to read aloud the line they are able to see. (2 wrong is fail, one wrong is ok)

2. Ophthalmoscopic exam of fundi →Start at 0 on the dial and choose largest light source. Reminder: Left hand, left eye – testing pt’s left eye.

 

Side note: LLL for no kissy kiss with pt. Control distance between pt and yourself by placing hand on their shoulder or head.

4

How do you document your findings from Rosenbaum Vision Chart?

Documentation: → ex.) 20/40 OU with corrected – for glasses/contacts (OU-both, OD-right eye, OS-left eye)

 

→ If pt can’t identify all items correctly, number missed is listed after a ‘-‘ sign. Ex.) "20/40 – 2 OU" for 2 missed on 20/80 line

5

What is Cranial Nerve 3, 4, & 6 and how do you test it?

3- Oculomotor, 4-Trochlear, 6-Abducens

 

1. Test Corneal Light Reflex ASK: pt to look in the corner of the room. Shine light equally into both eyes. Looking for pinpoint of light reflected in the pupils. Stand about 2 feet away. Normal: Negative exotropia (outward), esotropia (inward), strabismus (squint). Symmetry in light reflection.

 

2. Test direct & consensual response • Shine a light in R eye: R pupil should constrict →Again shine light in R eye, though this time watch L pupil (should also constrict) • Shine a light in L eye: L pupil should constrict →Again shine light in L eye, though this time watch R pupil (should also constrict)

 

3. Test accommodation & EOMs Test: Patient doesn’t move head, following your finger w/their eyes as you trace out letter “H” → Constriction occurring when eye follow finger brought in towards pt, directly middle (looks cross eyed) →Alternatively, direct them to follow finger w/their eyes as you trace large rectangle. 4. Cover/uncover test

 

 

6

What is difference between direct and consensual response?

Direct: constriction in response to direct light

 

Consensual: constriction in response to light shined in opposite eye

7

What cranial nerve involves Ophthalmoscopic exam of fundi and what should be your normal finding?

Cranial nerve 2 - Optic

 

Normal finding: Able to see red reflex and visualize vessels for optic disk.

8

What is cranial nerve 4 and what is it testing

Trochlear

Testing internal rotation of the eye

9

What is cranial nerve 6 and what is it testing

Abducens

Test lateral deviation of the eye

10

What is it when patient complains of partial loss of vision and abnormality in peripheral vision? and which cranial nerve is it?

Visual field defect - partial loss of vision when testing both eyes

Abnormality in peripheral vision = homonymous hemianopsia or quadrantanopsia with postchiasmal lesions (usually found in parietal lobe, associated findings with stroke*)

11

With CN 2&3: what is anisocoria?

Optic and Oculomotor

Inspect the size and shape of pupils - compare one side to other.

Anisocoria (difference of >0.4mm in diameter of one pupil compared to another) is seen in healthy individuals!

12

What 3 muscles are being tested with near response (pupillary constriction, convergence, accommodation of lens)?

1. Pupillary constriction = Pupillary constrictor muscle

2. Convergence = medial rectus muscles

3. accommodation of lens = ciliary muscles

 

 

CN 2 & 3

13

When inspecting the optic disk (CN2) - you find cup enlargement, what is this?

glaucoma

14

When inspecting the optic disk (CN2) - you find bulging and blurred margins, what is this?

papilledema

15

When inspecting the optic disk (CN2) - you find it to be pallor what is this?

optic atrophy

16

What is CN III palsy

Pupillary abnormality - large pupil reacting poorly to light or anisocoria worsening at night.

*Abnormal pupillary constriction

 

Reminder: Anisocoria (difference of >0.4mm in diameter of one pupil compared to another) is seen in healthy individuals!

17

When would you suspect Intracranial aneurysm

if ptosis and ophthalmoplegia present

18

What is Horner's syndrome & simple anisocoria

Both pupils react to light and anisocoria worsens in darkness, -

and small pupil has abnormal pupillary dilation

Reminder: Anisocoria (difference of >0.4mm in diameter of one pupil compared to another) is seen in healthy individuals!

19

What is Cranial Nerve 5 and how do you test it?

Trigeminal

1. Palpate jaw muscles for tone & strength when pt clenches teeth

2. Close eyes and test sensation with touch to each side of forehead, cheek, and chin.

Assess TMJ (Temporomandibular Joint) for clicking, popping, crepitus, pain

 

“V” is for 5 for Cranial Nerve 5…

Ophthalmic VI Maxillary V2 Mandibular V3

20

What is Cranial Nerve 7 and how do you test it?

Facial

1. Raise eyebrows (Frontalis muscle)

2. Close eyes against resistance (Orbicularis oculi)

3. Smile & Frown (Orbicularis oris)

4. Clench teeth

5. Puff Cheeks (Buccinators) Looking for symmetry

21

What is Cranial Nerve 8 and how do you test it?

Vestibulocochlear/Acoustic

1. Whisper test → Use # or multi-syllable word covering one ear at a time standing 2 feet away ex.) “baseball”, “cupcake”…or “bacon”

2. Rinne’s Test → Strike tuning fork behind mastoid bone, when pt can’t hear sound, place fork next to ear. Should hear it again as air conduction>bone.

3. Weber’s Test → Strike TF (512 hz) on top of head (ask pt to close their eyes prior)

22

In Rinne's test for CN 8, what is it suggesting when bone conduction is better than air conduction?

If bone conduction Is better than air conduction, suggests conductive hearing loss.

23

In Weber's test for CN 8, what is an normal & abnormal finding?

Normal: Conducts to both sides (if sound hear both sides). Or without lateralization.

 

Abnormal: If conductive hearing loss (ex: ear wax on L), louder on Left*. If sensorineural on left, louder on right.

24

What is cranial nerve 9 and how do you test it

Glossopharyngeal

Ask to swallow

25

What is cranial nerve 10 and how do you test it

Vagus

1. Inspect soft palate and uvula, stick out tongue, say “ahh

2. ASK: to say a sentence

Checking for : Symmetry, tongue midline & Clarity of voice (nasal or hoarse quality)

26

What is cranial nerve 11 and how do you test it

Spinal Accessory 

1. Shrug shoulders against resistance – your hands

2. Turn head to each side against resistance from your hands

 

Checking trapezius strength & Sternomastoid muscle

27

What is cranial nerve 12 and how do you test it

Hypoglossal 

1. Inspect tongue in mouth & stick tongue out

2. Ask to push tip of tongue into inner cheek while you push from outside of cheek

 

Checking for atrophy, fasciculation (muscle twitch) & symmetrical 

28

What is nystagmus

involuntary movement of eyes with quick and slow components 

 

It is a cerebellar disease esp. with gait ataxia ( walking is uncoordinated and appears to be 'not ordered) and dysarthria (muscles of the mouth, face, and respiratory system may become weak, move slowly, or not move at all after a stroke) 

29

what is ptosis

dropping of upper eyelids

 

-Ptosis suggests 3rd nerve palsy (CN3), Horner's syndrome and myasthenia gravis.

 

MG - autoimmune or congenital neuromuscular disease that leads to fluctuating muscle weakness and fatigue.

30

Bell's palsy is seen in injury to which cranial nerve

Cranial nerve 7 - Facial 

- loss of taste, hyperacusis, and increase/decreased tearing

 

Hyperacusis - a health condition characterized by an over-sensitivity to certain frequency and volume ranges of sound