neurological assessment

Question 1

what do spinal nerves innervate?

Answer 1

dermatomes

Question 2

reasons to conduct a neuro assessment could be…

Answer 2

headache
head injury
dizziness/vertigo
tremors
seizures
weakness
incoordination
numbness or tingling
difficulty swallowing or talking

Question 3

components of the neurological examination

Answer 3

vital signs
level of consciousness
communication/speech
orientation
motor
sensory pain
pupillary reaction
deep tendon reflexes

Question 4

aphasia

Answer 4

loss of language function

Question 5

babinski sign

Answer 5

dorsiflexion of the foot with extension and splaying of the toes in response to the plantar reflex, normally suppressed by corticospinal input (toes should bend down)

Question 6

paresis

Answer 6

partial loss of or impaired voluntary muscle control

Question 7

sensation

Answer 7

nervous function that recieves info from environment and translates it into electrical signals

Question 8

what is a dermatome

Answer 8

a sensory area of skin related to the spinal cord segment and nerve

Question 9

dermatome landmarks

Answer 9

axilla - T1
nipple - T4
umbilicus - T10
groin - L1
knee - L4

Question 10

glasgow coma scale

Answer 10

standardized objective assessment defining LOC by giving it a numerical value

Question 11

lowest and highest scores for glasgow coma scale

Answer 11

lowest score possible - 3
normal/highest - 15
coma - 8 or less

Question 12

decerebrate and decorticate posturing are signs of…

Answer 12

brain death, the brain can no longer distinguish where pain is coming from

Question 13

decorticate posturing

Answer 13

damage to corticospinal tracts, movement inward and toward the core

Question 14

decerebrate posturing

Answer 14

damage to the brain stem results in movement outward

Question 15

AVPU of mental status assessment

Answer 15

alert, verbal, pain, unresponsive

Question 16

conscious M/S testing

Answer 16

direct commands
assess muscle strength against resistance
assess gait and speech

Question 17

unconscious M/S testing

Answer 17

observe for spontaneous mvmt
assess resistance to mvmt
assess response to painful stimuli (trapezius, sternal rub)
deep tendon reflex

Question 18

Romberg’s test assesses…

Answer 18

proprioception by having patient stand with eyes closed and maintain balance

Question 19

Romberg’s test results

Answer 19

positive = loss of balance
negative = maintain balance
suggests ataxia (poor muscle control) is sensory in nature

Question 20

what tests can assess cerebellar function

Answer 20

balance tests, coordination and skilled movements (RAM)

Question 21

RAM test

Answer 21

patient pats knees with front and back of hands, finger to finger tests (tremors)

Question 22

diadochokinesia

Answer 22

ability to perform RAM

Question 23

dysdiadochokinesis

Answer 23

slow, irregular, clumsy movements

Question 24

balance tests

Answer 24

test gait by having them walk and then turn the other way, tandem walk, Romberg test

Question 25

stereognosis

Answer 25

recognize objects with eyes closed

Question 26

graphesthesia

Answer 26

read number traced on hand

Question 27

two point discriminatoin

Answer 27

distinguish separation of two stimuli (ex: paresthesia and diabetes will have abnormal findings)

Question 28

superficial pain sensation test

Answer 28

assess sharp and dull pain

Question 29

if pain sensation is abnormal how should you proceed?

Answer 29

with a temperature test

Question 30

light touch test

Answer 30

apply wisp of cotton

Question 31

motor function tests (hand and feet)

Answer 31

hand grips, dorsiflexion of feet against resistance

Question 32

primary sensory functions

Answer 32

light touch, pain, temperature, vibration

Question 33

sensory function procedure

Answer 33

observe all sensory function tests for bilateral differences impairments can be mapped by dermatome light touch, vibration w tuning fork, temperature, monofilamnet

Question 34

monofilament test

Answer 34

touch to 6 random sites on sole of foot, should be able to tell when it is touching foot

Question 35

deep tendon reflexes scale

Answer 35

0 - absent 1 - sluggish or diminished 2 - brisk, EXPECTED 3 - more brisk than expected 4 - hyperactive with clonus

Question 36

babinski reflex

Answer 36

draw blunt object along sole of foot from heel to ball, touch should flex down

Question 37

what does brudsinskis sign test for?

Answer 37

meningeal irritation

Question 38

brudzinski's sign test

Answer 38

nuchal rigidity, place hand under neck and on patient's chest, have them point chin to chest abnormal: resistance with pain in neck and flexion of hips

Question 39

kernig's sign

Answer 39

flat, supine position raise leg straight or flex, extend knee abnormal: resistance to straightening

Question 40

PERRLA pupillary assessment

Answer 40

pupils, equal, round, reactive to, light, accomodation

Question 41

accomodation in pupillary assessment

Answer 41

near and far, moving finger in and out, eyes should accomodate for the movement

Question 42

consensual pupillary

Answer 42

light in the right and left eye responds equally

Question 43

direct response pupillary

Answer 43

light in the right eye and the right eye responds

Question 44

unequal pupil sizes could mean...

Answer 44

late sign of brain injury (BAD), tumor, concussion

Question 45

cranial nerve 1

Answer 45

olfactory nerve, able to detect smell in each nostril

Question 46

cranial nerve 2

Answer 46

optic nerve, visual acuity 20/20

Question 47

cranial nerve 3

Answer 47

oculomotor, no drooping eyelids

Question 48

cranial nerve 4

Answer 48

trochlear, PERRLA findings

Question 49

cranial nerve 5

Answer 49

trigeminal, masseter strength and sensation to light touch of forehead, cheeks, jaw

Question 50

cranial nerve 6

Answer 50

abducens, direct and consensual reaction to stimuli

Question 51

cranial nerve 7

Answer 51

facial nerve, no facial asymmetry (close eyes, blow cheeks)

Question 52

cranial nerve 8

Answer 52

acoustic, hearing intact, balance

Question 53

cranial nerve 9

Answer 53

glossopharyngeal, uvula should elevate with palate

Question 54

cranial nerve 10

Answer 54

vagus, swallows easily and speaks clearly

Question 55

cranial nerve 11

Answer 55

spinal accessory, shoulder shrug against resistance and neck rotation

Question 56

cranial nerve 12

Answer 56

hypoglossal, tongue strength and rest/extension

Question 57

common neurological diagnostics

Answer 57

CT, MRI, angiography, EEG, lumbar puncture

Question 58

red flags in neuro assessment

Answer 58

seizure in someone without seizure history change in LOC or sensorium sudden weakness/paralysis sudden inability to speak sudden inability to follow directions sudden loss of vision fever with stiff neck

Question 59

neuro check on hospitalized patinet

Answer 59

LOC pupillary check facial symmetry AVPU or glasgow coma scale tongue midline speech clear and articulate hand grasp strength wiggle fingers wiggle toes