neurological

Question 1

CNS brain

Answer 1

• Located in cranial cavity
• 4 Major Divisions
  
  1. Cerebrum
  2. Diencephalon
  3. Brain stem (breathing, heart rate)
  4. Cerebellum (think coordination)

Question 2

true or false: whatever affects the left side of the brain affects the right side of the body

Answer 2

true

Question 3

cerebrum

Answer 3

• Divided into left and right hemispheres
  
  • hemispheres joined by corpus callosum
    
    • each hemisphere sends and receives impulses from opposite sides of body
• Consists of 4 Lobes: frontal, parietal, temporal, occipital

Question 4

diencephalon

Answer 4

• Lies beneath cerebral hemispheres
• Consists of:
  
  • thalamus
  • hypothalamus: controls temp

Question 5

brain stem

Answer 5

• control center
• Located between the cerebral cortex and spinal cord
• Consists of:
  
  • Midbrain
  • Pons
  • Medulla oblongata

Question 6

cerebellum

Answer 6

• Located behind brain stem and under cerebrum
• Has two hemispheres
• Functions
  
  • coordination and smoothing of voluntary movements
  • maintenance of equilibrium (balance)
  • maintenance of muscle tone

Question 7

spinal cord

Answer 7

• Located in vertebral canal
• Extends from medulla oblongata to L1 (first lumbar vertebra)
• Spinal cord is NOT as long as spinal canal
• Conducts sensory impulses up ascending tracts to the brain
• Conducts motor impulses down descending tracts to neurons that stimulate glands and muscles throughout the body
• Is responsible for simple reflex activity

Question 8

PNS

Answer 8

• Carries information to and from CNS
• Consists of:
  
  • 12 Pairs of Cranial Nerve
  • 31 Pairs of Spinal Nerves

Question 9

12 cranial nerves

Answer 9

1. olfactory
2. optic
3. oculomotor
4. trochlear
5. trigeminal
6. abducens
7. facial
8. acoustic (vestibulocochlear)
9. Glossopharyngeal
10. vagus
11. spinal accessory
12. hypoglossal

Question 10

subjective data

Answer 10

• Headache
• Head Injury
• Dizziness/Vertigo
• Seizures
• Tremors
• Weakness
• Incoordination
• Numbness/tingling
• Difficulty Swallowing
• Difficulty Speaking
• Patient-centered care
• Environmental/occupational hazards

Question 11

objective data

Answer 11

• Preparation
  
  • Perform a screening neurologic exam on seemingly well people who have no significant subjective findings in the history
  • Sequence
    
    • Mental status (alert, appropriate, orientation)
    • Cranial nerves (II, III,IV, VI, VII, VIII)
    • Motor function(strength, coordination, gait)
    • Sensation(light touch, pain, temp)
    • Reflexes (biceps, patellar, Achilles, plantar responses)

Question 12

neuro exam

Answer 12

• If neurological deficits, perform a complete neurologic exam that includes cognitive & intellectual processes
  
  • Sequence
    
    • Mental status
    • Cranial nerves
    • Motor system
    • Sensory system
    • Reflexes

Question 13

Cognitive & intellectual processes (can assess using the mini-mental examination)

Answer 13

• Memory
• Level of knowledge
• Ability for calculation (by 7s)
• Abstract thinking (abstract ideas)
• Insight (give scenarios)
• Judgement (give scenarios)
• Thought processes
• Thought content

Question 14

equipment used

Answer 14

• penlight
• tongue blade
• cotton swab
• tuning fork
• percussion hammer

Question 15

cranial nerve 1: olfactory

Answer 15

• not tested routinely
• test in those who report loss of smell

Question 16

cranial nerve 2: optive

Answer 16

• Test visual acuity (Snellen chart)
• Test visual fields by confrontation

Question 17

cranial nerve 3 (oculomotor), 4 (trochlear), and 6 (abducens)

Answer 17

• Test all three together
• PEERLA
• Direct & consensual light reflexes
• Accommodation
• Cardinal positions of gaze

Question 18

cranial nerve 5: trigeminal

Answer 18

• Motor function: Clench teeth, attempt to separate clenched jaw
• Sensory function: test light touch sensation to forehead, cheeks, & chin (have them close their eyes and touch them with a cotton swab and ask where they felt it)

Question 19

cranial nerve 7: facial

Answer 19

• Motor function: Smile, frown, close eyes tightly. Lift eyebrows, show teeth, & puff cheeks
• Sensory function: Do not test routinely. Test sense of taste

Question 20

cranial nerve 8: acoustic (vestibulocochlear)

Answer 20

• Test hearing acuity with hearing normal conversation & whispered voice test

Question 21

cranial nerve 9 (glossopharyngeal) and 10 (vagus)

Answer 21

• Motor function: Depress tongue with tongue blade, have person say “ahhh”.
• Sensory: Test taste on posterior 1/3 of tongue

Question 22

cranial nerve 11: spinal accessory

Answer 22

• Test sternomastoid & trapezius muscle for equal size
• Rotate head against resistance applied to side of chin
• Shrug shoulders against resistance

Question 23

cranial nerve 12: hypoglossal

Answer 23

• Inspect tongue
• Ask person to “stick out tongue”
• Check lingual speech (l,t,d)
  
  • say these letters

Question 24

inspect and palpate motor system

Answer 24

• muscles
  
  • size, strength, tone, involuntary movements
• cerebellar fxn
  
  • balance tests
    
    • gait/tandem walking
      
      • tandem: putting one foot in front of the other
    • Romberg test: stand and put arms straight out (sway = neuro or inner ear)

Question 25

cerebral fxn

Answer 25

* Coordination & skilled movements * Rapid alternating movements -- supination and pronation * Finger-to-finger test * Finger-to-nose test --> close eyes, arms out, bring fingers to nose * Heel-to-shin test * Balance tests * Gait * The Romberg Test

Question 26

spinothalamic tract

Answer 26

- Pain - Light touch - use paperclip - have pt close eyes and touch paperclip on them

Question 27

posterior column tract

Answer 27

- Vibration: take tuning fork and put on fingertip - Position (Kinesthesia): close eyes and move finger up and down. should be able to perceive if it is going up and down - Ability to perceive passive motion - Tactile Discrimination (fine touch) - Stereognosis - Able to recognize objects by feel - Graphesthesia - Able to ‘read’ a number by having it traced on the skin

Question 28

two point discrimination test

Answer 28

- Able to distinguish separation of two simultaneous pin points on the skin - taking a paperclip, taking it apart and poke them w/ two pointy sides @ the same time. should be able to say where you touched them

Question 29

extinction

Answer 29

- Simultaneously touch both sides of the body at the same point

Question 30

point location

Answer 30

- Touch skin & withdraw stimulus promptly - Is able to point where touched

Question 31

deep tendon reflexes (stretch reflexes)

Answer 31

- Strike with percussion hammer - Grade on 4-point scale - 4+ Very Brisk - 3+ Brisker than average - 2+ Average, expected - 1+ Diminished - 0 No response

Question 32

superficial reflexes

Answer 32

- Plantar - Normal response (except infancy) - Plantar flexion of toes - Inversion & flexion of forefoot