Neurological Flashcards
1
Q
Older adults developmental considerations
A
atrophy & loss of neurons in brain & spinal cord
- decrease weight & volume of brain
- decrease muscle strength & impaired fine coordination
- Slowed reaction time
- Dizziness & loss of balance
- irregular pupil shape
- decreased cerebral blood flow
- dyskinesias( reparative grinning)
- postural hypotension
2
Q
What subjective data for neurological health history
A
- Headache
- head injury
- dizziness or vertigo
- seizures
- tremors
- weakness
- incoordination
- numbness or tingling
- difficulty swallowing
- difficulty speaking
- significant past history
- environmental or occupational hazards
3
Q
Additional Neurological subjective info for infant & child
A
- Maternal health
- Neonatal period
- reflexes
- weakness & balance
- seizures
- physical development
- Environemental hazards
- cognitive development
- family history
4
Q
Additional neurological subjective for older adults
A
- risk for falls
- cognitive function
- tremor
- vision
5
Q
Objective data for Neurological assessment
A
- Mental status
- crainal nerves
- inspect & palpate motor system
- assess sensory system
- test the reflexes
- neuro recheck overtime
6
Q
CRANIAL NERVES HOW TO REMEMBER
A
OOOTTAFVGVAH
SSMMBMBSBBMM
1) Olfactory (smell)
2) Optic (sight)
3) Oculomotor ( moves eye)
4) Trochlear ( oblique eye muscle)
5) Trigeminal ( Sensory from face & mouth & chewing)
6) Abducens (moves eye)
7) Facial ( facial expression & taste)
8) Vestibulocochlear (hearing & equilibrium)
9)Glossopharyngeal (Gagging & swallow & taste )
10) Vagus (Gag, swallow, speech)
11) Spinal accessory ( head & shoulder movement)
12) Hypoglossal (tongue movement)
7
Q
How to test cerebellar function
A
- Balance tests (Gain, Tandem walking, Romberg test, shallow knee bend)
- Coordination & skilled movements (rapidly alternating movements, finger to finger, finger to noes, heel to shin test)
8
Q
What is the romberg test
A
Stand upright & close eyes. A loss of balance is a positive sign. A patient who has a problem with Proprioception (Somatosensory) can still maintain balance by compensating with vestibular function and vision. Tests cerebellar function
9
Q
What are you looking for when you assess the sensory system
A
- intactness of peripheral nerve fibres, sensory tracts, and higher cortical discrimination.
- Person is alert, cooperative & comfortable
10
Q
How to test the Spinothalamic tract
A
-Pain, temp, light touch
11
Q
how to test the posterior column tract
A
- vibration
- position/kinesthesia
- tactile discrimination (fine touch)
- Stereognosis, Graphesthesia, 2 point discrimination, extinction, point location
12
Q
what is stereognosis
A
perception of depth
13
Q
what is graphesthesia
A
the ability to recognize writing on the skin purely by the sensation of touch
14
Q
Which are the deep tendon/ stretch reflexes
A
Patellar & achilles
15
Q
what are the superficial reflexes
A
- abdominal reflex
- cremasteric reflex
- plantar reflex
16
Q
What are the developmental considerations for an infant
A
- Spontaneous waking & response to environment
- cranial nerves cannot be directly tested
- motor system: Nopissing district development screen
- head control
- reflexes: Babinski, Palma, moro, rooting, tonic neck, sucking
17
Q
What are the developmental considerations for preschool & school age
A
- observe them undress
- developmental milestones
- test balance, fine motor coordination
- lack of reliability in sensation testing
18
Q
What are the developmental considerations for older adults
A
decrease in muscle bulk
- senile tremors
- dyskinesia (abnormal/impaired voluntary movement)
- Difference in gait
- loss of ankle jerk
- less brisk
19
Q
Order of Neurological recheck
A
1) mental health
2) cranial nerves
3) Motor system
4) sensory system
5) Reflexes
20
Q
What part of brain regulates vital signs
A
Hypothalamus
21
Q
what part of brain regulates motor coordination & equilibrium
A
cerebellum
22
Q
what part of the brain regulates movement (autonomic associated movements)
A
basal ganglia
23
Q
what part of the brain regulates nerve impulse conduction
A
cerebral cortex ( grey matter)
24
Q
what part of the brain is for sensory
A
Spinal cord, brain stem & parietal lobe
25
What part of the brain is for motor speech
brocas area
26
what does the frontal lobe do
personality, behaviour, emotions, intellectual function
27
what does the pre-central gyrus do
voluntary movement
28
what does the parietal lobe/ post central gyrus do
sensation
29
what is the occipital lobe for
vision
30
what is the temporal lobe for
auditory
31
what is the wernickes area for
language comprehension
32
what could a damaged wernickes cause
receptive aphasia: hear sound but no meaning
33
what happens if u damage ur broca's area
Expressive aphasia: can't talk but understands what everything means & wants to talk
34
Damage to any area in the cerebral cortex/ cerebrum can cause:
moto weakness
paralysis
loss of sensation
impaired ability to understand & process language
35
What does the hypothalamus do
control temp, hr, bp, sleep,
36
what does the medulla do
autonomic centers (resp, cardiac, GI)
37
What do the extrapyramidal motor pathways do
maintain muscle tone, gross movements (walk)
38
what does the cerebellar motor pathway do
things you aren't aware of doing like flexing back
39
What is a reflex arc
involuntary quick run to potentially painful event
40
what does somatic mean
voluntary (skeletal)
41
what does visceral mean
involuntary (cardiac & smooth muscle)
42
what inhibits infants reflexes
cerebellar function
43
what is subjective vertigo
u spin
44
what is objective vertigo
room spins
45
what is syncope
sudden loss of stenght or temporary loss of consciousness (fainting) causes by lack of cerebral blood flow, occurs with low BP
46
what is true vertigo
feeling of ratational spinning
47
what is a paresis
weakness of voluntary movements
48
what is dysmetria
inability to control ROM of muscles
49
what is paraesthesia
abnormal sensation ( burn or tingle)
50
what is dysarthria
difficulty forming words
51
what is dysphagia
difficulty swallowing
52
what is dysphasia
difficulty with langue comprehension or expression
53
what are significant past history
stroke, spinal cord injury, meningitis, encephalitis, cognitive defect, alcoholism
54
What are some critical findings
| immediate interventions or transport to hospital needed
- Sudden decrease alertness/consciousness
- sudden change in speech
- signs of stroke
- sudden onset of severe headache
- signs of raised intracranial pressure
- onset of weak, numb, eye movement problems, double viison
- sudden seizures
- sudden extreme lethargy
55
When would u do a screening neurological exam
seemingly health patient with a history of no significant findings
56
when would you do a complete neurological exam
a pt. with neurological concern or sign of disfunction
57
when would you do a neurological recheck
pt with neurological deficits who require periodic reassessment
58
how should pt. be for neurological exam
pt. sit up right with head @ eye level
59
How to test olfactory nerve
- not routine, only if loss of smell, head trauma, abnormal mental status, or intercrainal lesion
1) patentcy
2) occlude + a scent
60
what is anosmia
decrease or loss of smell
| -bilaterally with smoking, allergies or cocaine
61
what is neurogenic anosmia
unilateral loss w/o nasal disease or trauma
62
What would u inspect for optic never
- visual acuity
- fields of vision via confrontation
- papilledema with increase pressure
63
Testing the oculomotor, trochlear & abducens
-Pupil: Size, regularity, equality, direct light reaction, accommodation
64
what is ptosis & what cranial nerve
drooping of eye & oculomotor
65
what is strabismus
deviated gaze & limited movement
66
what is nystagmus
back & forth oscillation of eyes
| occurs with disease of vestibular, cerebellum or brain stem
67
how to test trigeminal nerve
- palpate temporal & masseter muscle
- clench teeth
- close eyes touch face
- should blink when you bring cotton near eye
68
how to test facial nerve
motor: symmetry & muscle weakness
| Sensory function: not routine. cotton soaked with lemmon
69
what is bells palsy
lower/upper on one side of face
70
how to test vestibulocochlear nerve
whisper
71
how to test glossopharyngeal & vagus nerve
Depress tongue & note soft palate symmetry
- uvula should deviate to one side
- symmetry of tonsillar pillar
- gag
- voice smooth (not hoarse or twang)
- sensory not tested (posterior tongue)
72
How to test spinal acessory nerve
head rotate against hand & shrug
73
how to test hypoglossal nerve
inspect tongue for wasting, symmetry, midline, tutors or tremors
-say light tight dynamite
74
size of muscles
1cm different is insignificant
- atrophy = small bc disease injury, polio or diabetic neuropathy
- hypertrophy
75
what is flaccidity vis spasticity
```
flaccidity = decreased resistance
spasticity = increased resistance
```
76
What are the 2 balance tests
gain & Romberg
77
what is gait test
smooth, rhythmic, opposing arm swing
78
what is ataxia
involves uncoordinated or or unsteady gait
79
what would not being able to do tandem walk indicate
upper motor neuron lesion
80
what is dysdiabochokinesia
lack of coordination or slow & sloppy
| can mean cerebellar disease
81
what is demetria
clumbsy movement could mean cerebellar disorder or alcohol
82
what is the pain/pinprick test for
randomly alternate sharp & dull with 2s in between to avid summation
83
what is hypolgesia & hyperalgesia
increase & decreased pain sensation
84
what is analgesia
absence of pain sensation
85
how do you do light touch
cotton ball on different parts
86
what is hypoaesthesia , hyper & anesthesia
decreased touch feel, increased feeling of touch & absent
87
what would inability to feel vibration mean
peripheral neuropathy/ diabetes/ alcoholism
| -worst at feet
88
if they have problems with tactile discrimination it could mean
lesion of the sensory cortex or pos. column
89
where is the most sensitive
finger least = upper arm, thigh & back
90
what is stereognosis
identify item with eyes closed
| so astereognosis = inability to identify (stroke symptom)
91
how are reflexes graded
```
4+ = brisk, hyperactive w/ clonus disease(not good)
3+ = brisker than ave, maybe disease
2+ = average and normal
1+ = diminished /low
0= nothing
```
92
what is hyper & hyporeflexia
```
exaggerated reflex (upper motor neuron lesion or stroke)
and reduced functioning of reflex ( spinal cord injury)
```
93
Biceps reflex
- hold arm, strike bicep tendon
| - it contract & flex
94
triceps reflex
- tap triceps tendon above elbow
| - extension
95
brachioradialis reflex
- hod thumb, strike forearm 2-3 cm above raid styloid process
- flexion & supination od arm
96
quad/patellar reflex
- strike just below patella
| - extension of leg & quad contract
97
achilles reflex
- stike achilles
| - plantar flexion occurs
98
clonus reflex
move foot up and down to relax, dorsiflex & it should just not move
99
abdominal reflex
-abs should tighten when stroke skin
100
cremasteric reflex
stroke inner right, elevation of ipsilateral testical
101
plantar reflex
stroke sole upward, should have flexion, abnormal would be fanning
102
what is opisthotonos
head arched back, stiff neck, extended limbs in baby
| occurs with meningeal or brainstem irritation
103
babies usually have
hypoaesthesia
| hyperasetheia could mean a spinal cord lesion, CNS infection, inter cranial pressure
104
what is the rooting reflex
brush cheek turn head (3/4m)
105
what is the sucking reflex
tough lip will suck (till 10/12m)
106
what is palmar reflex
offer finger will grasp (till 3/4 mo)
107
what is plantar grasp
toes curl ( 8/10mo)
108
what is babinski reflex
toes fan till 2 yr
109
what is tonic neck reflex
supine, turn head to side, ipsilateral extension of arm & leg, flexion of opposite side
-till 6 mo
110
what is moro reflex
startle - abduction & extension of arms, fan fingers
| till 4 months
111
65+ =
loss of vibration sensation in ankle & loss of achilles
112
what is the earliest most sensitive indication of change
level of consciousness
113
stimulus to awaken
1) call name
2) light touch
3) vigorous shoulder shake
4) pain applied
114
Glasgow coma scale
original designed for head trauma, assess function of entire brain, standardized
fully alert = 15
coma = 7 or less
limitation: inconsistence, impossibility or verbal score
115
what is decorticate rigidity
-hemespheric lesion of cerebral cortex
-felxed arm, wrist, fingers, abducted,
legs extended & internal rotate with plantar flex
116
what is decerebrate rigidity
lesion @ midbrain or upper pons
| -arms stiffly extended, plantar flexion, palms pronated, legs extended & teeth clenched
117
what is flaccid quadriplegia
nonfunctional brainstem
| complete loss of muscle. tone & paralysis
118
what is osisthotanos
meningeal irritation
| -prolonged back arch with head & heels bent backwards
