Neuro Exam 1 and 2 Flashcards
(41 cards)
What are common complaints of the nervous system?
Headache Dizziness or vertigo Generalized, proximal, or distal weakness Numbness Abnormal or loss of sensations Loss of consciousness, syncope, or near-syncope Seizures Tremors or involuntary movements
What three things should you keep in mind when examining a neuro pt?
- Is mental status intact?
- Are right- and left-sided findings the same, or symmetric?
- If findings are asymmetric or otherwise abnormal, do the causative lesions lie in the central nervous system or the peripheral nervous system?
How should your thinking be organized when assesing the nervous system?
- mental status,
- speech, and language;
- cranial nerves;
- motor system;
- sensory system; and
- reflexes
How is the mental status examined?
- Appearance & behavior
- Speech & language
- Mood
- Thoughts & perceptions: more relevant for mental health
- Cognitive function – memory, attention, information and vocabulary, calculations, and abstract thinking and constructional ability
What does the mental status exam identify?
identify neurological disease and help distinguish focal deficits from diffuse processes.
What are the levels of consciousness?
- Alert
- lethargic: responds to loud stimuli
- Obtunded: responds after being shaken gently
- Stupor: responds after painful stimuli
- Coma: no response after repeated painful stimuli
How is a patient’s speech and language assessed?
- Quantity: talkative or silent
- Rate: fast or slow
- Loudness: loud of soft
- Articulation of Words: spoken clearly and distinctly or mumbled
- Fluency: rate, flow & melody of speech and content
A. Hesitancies & gaps in flow and rhythm of words
B. Disturbed inflections – monotone vs. singsong
C. Circumlocutions – phrases or sentences are substituted for a word (“what your write with” for “pen”)
D. Paraphasias – worlds are malformed (“I write with a den”)
How do you asses a pt’s orientation?
Person, Place, & Time
How do you assess a pt’s attention?
- Serial 7’s
2. Spelling backward
How do you assess a pt’s remote memory?
Ask patient about birthdays, anniversaries, social security number, names of schools attended, job held, or past historical events. past presidents (What were you doing when JFK was shot?).
How do you assess a pt’s recent memory?
Ask patient about today’s weather, today’s appointment time, how did you get to your appointment, who is the current president.
How do you assess a pt’s short term memory?
3 word Recall: ask patient to remember 3 unrelated items (house, car, dog) and tell them you will re-ask in 5 minutes
How do you assess a pt’s ability to name and follow instructions?
- Ask patient to name 2 items found in the room.
“Please tell me two items that are in the room.” - Ask patient to read this card and do what it says
CLOSE YOUR EYES
What CN need to be examined that aren’t in any other part of the PE?
CN: III, V, VII, XI
How is CN III tested?
Lid elevation
How is CN V tested?
Palpate temporal and masseter muscles while patient clenches teeth; test forehead, each cheek, and jaw on each side for sharp or dull sensation
How is CN VII tested?
Assess face for asymmetry, tics, abnormal movements. Ask patient to raise eyebrows, frown, close eyes tightly, show teeth (grimace), smile, puff both cheeks.
How is CN XI tested?
Assess strength as patient shrugs shoulders up against your hands. Note contraction of opposite sternocleidomastoid, and force as patient turns head against your hands.
How is the motor system tested?
- Position, movement, muscle bulk, and tone
A. Observe body position and involuntary movements such as tremors, tics, fasciculations
B. Inspect muscle bulk; note any atrophy
C. Assess muscle tone — flex and extend the arm and the lower leg for residual tension → slight resistance to passive stretch
How is muscular strength graded?
0-5 Scale:
0: no muscular contraction detected
1: barely detectable trace of contraction
2: active movement of body with gravity eliminated
3: active movement against gravity
4. Active movement against gravity and some resistance
5. Active movement against full resistance without evident fatigue; normal muscle strength
What muscle groups are assessed for strength?
- Biceps and triceps, wrist – flexion and extension
- Handgrip, finger – abduction and adduction, thumb opposition
- Trunk – flexion, extension, lateral bending
- Thorax – expansion, diaphragmatic excursion during respiration
- Hip – flexion, extension, abduction, and adduction
- Knee and ankle – flexion, extension
How is a pt’s coordination tested?
- Rapid alternating movements
- point to point movements
- gait: normal, heel to toe, toes, heels
- Stance: Romberg test, pronator drift test
What is the Romberg test?
Patient stands with feet together and eyes open, then with eyes closed for 30–60 seconds without support
Loss of balance when eyes closed is a positive test
What is the pronator drift test?
Patient stands for 20–30 seconds with both arms straight forward, palms up, and eyes closed; tap arms briskly downward
Pronation and downward drift of the arm is a positive test
