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NSG2317 - health assessment > Neurological Assessment > Flashcards

Neurological Assessment Flashcards

1
Q

Health History Points

A
  1. Headache
  2. Head Injury
  3. Dizziness or Vertigo
  4. Seizures
  5. Tremors
  6. Weakness
  7. Incoordination
  8. Numbness or Tingling
  9. Difficulty Swallowing
  10. Difficulty Speaking
  11. Significant Past History
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2
Q

Epilepsy

A

defined as 2+ seizures within a 24h period

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3
Q

Aura

A

a subjective sensation that precedes a seizure
→ auditory, visual or motor

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4
Q

Paresis

A

weakness of voluntary movements or impaired movement

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5
Q

Paralysis

A

loss of motor function as a result of a lesions in the neurological or muscular system, or loss of sensory innervation

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6
Q

Dysmetria

A

inability to control one’s ROM of their muscles

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7
Q

Paraesthesia

A

an abnormal sensation, such as burning or tingling

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8
Q

Dysphagia

A

difficulty swallowing

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9
Q

Dysarthria

A

difficulty forming words → can still understand words

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10
Q

Aphasia

A

difficulty with language compression or expression → can still form words (unrelated to conversation)

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11
Q

CN I

A

olfactory nerve → smell
- tested only when suspected/presence of head
trauma. changes in mental status, or
intracranial lesion

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12
Q

CN II

A

optic nerve → vision
- snellen eye chart
- confrontation test (peripheral vision)

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13
Q

CN III

A

oculomotor nerves → extraocular movement (EOM)
a. Eyelid opening
b. pupil constriction
c. lens shape
- 6 cardinal planes of vision

test CN III, IV, and VI together*

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14
Q

CN IV

A

trochlear nerve → EOM downwards and inward

test CN III, IV, and VI together*

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15
Q

CN V

A

trigeminal nerve → sensation
a. sensation of the face, scalp, cornea, mucous
membranes, mouth, and nose
b. blinking reflex →corneal reflex
c. muscles of mastication → palpate, feel for
bilateral strength

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16
Q

CN VI

A

abducens nerve → lateral eye movement

test CN III, IV, and VI together*

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17
Q

CN VII

A

facial nerve → facial movement, closing of eyes and mouth
a. taste (anterior 2/3 of tongue) → taste
b. saliva and tear production
c. speech

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18
Q

CN VIII

A

Auditory → hearing + equilibrium
- whispered voice test
- Romberg test

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19
Q

CN IX

A

Glossopharyngeal → production of speech and swallowing
- taste (posterior 1/3)
- gag and carotid reflex

test CN X and IX together* (observe uvula and soft palate elevation when saying “ahhh”)

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20
Q

CN X

A

Vagus nerve → talking and swallowing
- sensation from carotid body and sinus,
pharynx, and viscera
- carotid reflex - dec in HR and BP with bilateral
palpation of arteries

**test CN X and IX together ** (observe uvula and soft palate elevation when saying “ahhh”)

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21
Q

CN XI

A

spinal accessory nerve → movement in trapezius/ sternomastoid muscles
- test with should shrug against resistance

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22
Q

CN XII

A

Hypoglossal nerve → movement of the tongue
- tongue tone/ bulk
- tongue movement
- clear speech → “light, tight, dynamite”

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23
Q

Motor System (3)

A
  1. Muscles
  2. Cerebellar Function
  3. Coordination
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24
Q

Motor System: Muscles

A
  1. Inspection -
    a. size - same bilaterally (<1cm difference)
    b. no involuntary movements (if present, note
    location, frequency, rate and amplitude)
  2. Palpation - strength and tone (ROM tests with and without resistance)
    a. strength - test power of homologous muscles
    simultaneously
    b. tone - normal degree of contraction in
    voluntarily relaxed muscles (passive
    resistance to mild stretch)
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25
Q

Motor System: Cerebellar Function (3 tests)

A

a. Gait - should be smooth, rhythmic, and
effortless
- tandem walk (heel-to-toe walk) normally
straight and balanced

b. Romberg Test

c. One-Leg Hop/ Shallow Knee Bend

26
Q

Romberg test

A

ask the patient to stand with feet together and arms relaxed at their sides, close their eyes and stand for 20 seconds → some swaying is normal, but balance should be maintained

  • A positive Romberg sign is loss of balance that
    occurs when the eyes are closed → closed
    eyes eliminate the advantage of orientation by
    removing the compensatory response
27
Q

One-Leg Hop/ Shallow Knee Bend

A

patient should perform a shallow knee bend or hop in place (depending on physical limitations/ capabilities) → Demonstrates normal position sense, muscle strength, and cerebellar function
- Inability to perform knee bend because of
weakness in quadriceps muscle or hip
extensors is abnormal

28
Q

Motor Function Coordination Tests

A

a. Rapid Alternating Movements
b. Ringer-to-Finger Tests
c. Fingers-to-Nose Test
d. Heel-to Shin Test

29
Q

Sensory System (2)

A
  1. Spinothalamic Tract
  2. Posterior Column Tract
30
Q

Sensory System: Spinothalamic Tract

A

a. Pain
b. Temperature
c. Touch

31
Q

Sensory System: Posterior Column Tract

A

a. Vibration
b. Position (kinasthesia)
c. Tactile Discrimination

32
Q

Hypoalgesia

A

decreased pain sensation

33
Q

Analgesia

A

absence of pain sensation

34
Q

Hyperalgesia

A

increased pain sensation

35
Q

Hypoaesthesia

A

decreased touch sensation

36
Q

Anaesthesia

A

absent touch sensation

37
Q

Hyperasthesia

A

increased touch sensation

38
Q

Stereognosis

A

patient’s ability to recognize objects by feeling their forms, sizes, and weights, with the eyes closed

39
Q

Astereognosis

A

inability to identify objects correctly, occurs with sensory cortex lesions

40
Q

Graphesthesia

A

the patient’s ability to read a number traced on skin

41
Q

Two-point discrimination (test)

A

test the patient’s ability to distinguish the separation of two simultaneous pinpoints on the skin, noting the distance at which the point becomes one

42
Q

Extinction (test)

A

simultaneously touch both sides of the body at the same point, asking the patient to identify how many sensations they felt and where

43
Q

point location (test)

A

touch the skin and withdraw the stimulus promptly, ask the patient to identify where the sensation was

44
Q

Reflexes (2)

A
  1. Deep Tendon Reflexes
  2. Superficial (cutaneous) Reflexes
45
Q

Deep Tendon Reflexes

A

involuntary muscle contractions in response to an external stimulus (reflex hammer)

46
Q

Grading Deep Tendon Reflexes

A

4+ = very brisk, hyperactive with clonus
(abnormal, muscles are contracting without
coordination),
indicative of disease

3+ = brisker than average, may indicate disease

2+ - average, normal

1+ = diminished, low normal

0 = no response → patient might need to be
repositioned or distracted to elicit reflex
response (have patient perform isometric
muscle contraction at a muscle group distal to
the location being examined)

47
Q

Biceps Reflex

A
  • contraction of biceps
    • flexion of the forearm
48
Q

Triceps Reflex

A
  • extension of forearm
49
Q

Brachioradialis Reflex

A
  • flexion and supination of forearm
50
Q

Achilles Reflex

A
  • plantar flexion of the foot
51
Q

Colonus

A

Tested for when reflexes examined are hyperactive
- If colonus is present, rapid, rhythmic
contractions of the muscle and movement of
the foot is visible and palpable

52
Q

Superficial Reflexes

A

sensory receptors are located in the skin rather than the muscles

53
Q

Abdominal Reflexes

A
  • ipsilateral contraction of the abdominal muscle
    with an observed deviation of the umbilicus
    towards the stroke
54
Q

Plantar Reflex

A
  • plantar flexion of the toes
    • inversion and flexion of the forefoot
55
Q

Flaccidity

A

Decreased muscle tone (hypotonia), muscle feels limp, soft, and flappy, muscle is weak and fatigued

56
Q

Spasticity

A

Increased tone (hypertonia), increased resistance to passive lengthening and then suddenly giving way

57
Q

Rigidity

A

Constant state of resistance, resistance to passive movement in any direction, dystonia (constant state of involuntary muscle contraction)

58
Q

Cogwheel Rigidity

A

Type of rigidity in which the increased tone lessens by degrees during passive ROM so that it feels like small, regular jerks

59
Q

Multiple Sclerosis

A

Chronic, progressive, immune-mediated disease​
- Axons become inflamed, demyelinated,
degenerated, and undergo sclerosis
- results in uncoordinated muscle movement, muscle spasms, loss of coordination and balance

60
Q

Paraplegia

A

Lower motor neuron damage caused by spinal cord injury
- Initially produces “spinal shock” (no movement
or reflexes below lesion) → gradual return of
deep tendon reflexes (flexor spasms of legs
into extensor spasms of leg
- Spasms lead to extensor tone (knees don’t
bend easily, limited ROM)

NSG2317 - health assessment (18 decks)

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