ask pt to fix sight on something in distance look for equal pupil size check again w/lights off swing light back & forth affected eye will be slower to constrict or will dilate

SM02 Mini3 Flashcards by Brianna Probasco

anosmia

inability to partially or fully detect smell

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Snellen equivalents

standard visual acuity measurement regardless of actual distance used in testing

20/20 feet for US normal vision

Britain & colonies use 6 meters

continental Europe uses decimal equivalents

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hemianopsia

decreased vision in 1/2 the visual field

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diplopia

double vision

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convergence of vision

test moving finger closer toward patient’s nose in midline

observing for symmetric adduction

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consensual reaction

aka consensual response or indirect response

constriction of the pupil when the opposite eye is stimulated to constrict

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PERRLA

pupils are equal, round and reactive to light & accomadation

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visual accommodation

pupils constrict when gazing at something close to them

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how is CN I tested?

ensure inhale/exhale thru both nostrils

close eyes

present with common scent (coffee, cinnamon, curry)

proper identification at 10cm

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how is CN II tested?

visual acuity

visual fields

pupillary action

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anisocoria

unequal pupil size

often seen w/o underlying pathology

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Marcus-Gunn pupil

ask pt to fix sight on something in distance
look for equal pupil size
check again w/lights off
swing light back & forth
affected eye will be slower to constrict or will dilate

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Argyll-Robertson pupils

no direct pupillary response to light in either eye

accommodation is present

highly suggestive of tertiary neurosyphilis, but could also be diabetic neuropathy

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how are CN III, IV, & VI tested?

H test & convergence

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strabismus

eyes do not move together for full excursion

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nystagmus

eyes make repetitive uncontrolled movements

can be side to side or up and down

can result from: inner ear infection, CNS disorders, severe myopia, alcohol & drug toxicity

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how is the motor function of CN V tested?

clenched jaw to check for temporalis & masseter bilateral contraction

lateral pterygoids via jaw movement against resistance

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how is the sensory function of CN V tested?

touch: cotton on either side of the midline on the forehead, cheek, & jaw
temperature: same as touch but with a cold object like a tuning fork

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corneal reflex testing

usually only done in unconscious or in someon suspected of CN V or VII lesion

afferent by V & efferent by VII

wisp of cotton to sclera for CN V

cotton to cornea for CN VII & blink reflex

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trigeminal neuralgia

aka tic douloureux

neuropathic pain that affects one or more branches of CN V

causes lancinating & excruciating facial pain

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how is CN VII tested?

eyebrow raise

clenched eyes→ don’t open w/resistance

smile: look for symmetric nasolabial folds

purse lips: symmetry

puff out cheeks: air leaks from weak side

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how is CN VIII tested?

rub fingers together close to each ear

with pts eyes shut so they can’t cheat

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gag reflex

afferent CN IX

efferent CN X

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how is CN IX tested?

gag reflex

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how is CN X tested?

gag reflex or sustained "ah" for rise of soft palate

how is CN XI tested?

trapezii: shrug shoulders against resistance SCMs: turn head against resistance

fasciculations

brief spontaneous twitching/contractions of a small # of muscle fibers cause flicker of movement under the skin

how is CN XII tested?

protruding tongue should be midline if deviated, LMN lesion on side that tongue deviates to

what is a pronator drift indicative of?

UMN lesion in contralateral primary motor cortex can also be seen as digiti quinti sign (just the pinky drifts

how is muscle strength graded?

* 0= no movement * 1= flicker of movement, not enough to move body part * 2= active movement w/no gravity * 3= active movement against gravity * 4= active movement against some resistance * 5= active movement against full resistance

what myotome is tested by elbow flexion?

biceps test C5 & C6

what myotome is tested by elbow extension?

triceps test C6-C8

what myotomes are tested via wrist extension?

radial nerve C6-C8

Grip tests which myotomes?

C7-T1

finger abduction tests which myotomes?

C8-T1 dorsal interossei

what myotomes does thumb opposition test?

C8-T1 median nerve \*component of carpal tunnel syndrome\*

what myotomes are tested via hip flexion?

L2-L4 iliopsoas m.

what myotome are tested via hip extension?

S1 gluteus maximus m.

what myotome is tested via hip adduction?

L2-L4 adductor mmm./obturator nerve

what myotome is tested by hip abduction?

L4-S1 gluteus medius & minimus mm.

what myotomes are tested by knee extension?

L2-L4 quadriceps mm

what spinal roots are tested by knee flexion?

L4-S2 hamstrings

what myotomes are tested by ankle dorsiflexion?

L4-L5 tibialis anterior m.

what myotome is tested by plantar flexions?

S1 gastrocnemius & soleus mm.

what myotome is tested by hallicus extension?

L5 extensor hallicus longus m.

what spinal levels are checked by ankle reflex?

S1 & S2

what reflex checks C7 & C8?

triceps

what reflex tests C5 & C6?

biceps

what spinal levels are checked by the knee jerk reflex?

L3 & L4

where is C5 dermatome tested?

over the deltoid

where is C6 dermatome tested?

over the thumb (we skipped b/c it is controversal)

where is C7 dermatome tested?

palmar surface of the middle finger

where is C8 dermatome tested?

on the pinky finger or the ulnar side of the hand

where is L2 dermatome tested?

on the anterior thigh

where is L4 dermatome tested?

on the medial calf

where is the L5 dermatome tested?

on the lateral calf or dorsum of foot

where is S1 dermatome tested?

on the lateral foot

how is the lateral spinothalamic pathway best tested?

with pinprick testing but we used tuning fork to test with temperature instead

what is the specific test for the posterior column/medial lemniscus pathway?

vibration with a 128Hz tuning fork

where is the tuning fork placed for testing vibration?

over the hallix or the DIP joint

what should be completed if a patient fails to feel the vibrations of the tuning fork?

continue testing more proximal bony protuberances to determine level of sensory impairment ex. wrist, olecranon process, acromion process OR medial malleolus, patella, anterior superior iliac spine

how is proprioception tested?

movement of the hallix or middle finger up & down OR Romberg test: stand w/feet together and close eyes, + if patient sways or falls over

what is a Hoffmann reflex and what does it indicate?

pressure or flick on nail bed of middle finger that produces contraction of thimb & index finger sign of upper motor neuron lesion (often from spinal cord compression)

dysmetria

missing the mark tested by finger-to-nose test

a right sided cerebellar lesion will cause?

a right sided paresis

dysdiadochokinesia

slow or clumsy movements

truncal ataxia

loss of coordinated muscle movements for maintaining normal posture of the trunk

tandem gait

walk heel-to-toe

a wide clumsy gait is a sign of?

cerebellar ataxia often in the vermis

features of a spastic gait

pronation & flesion of affect arm circumduction of affected leg as wellas medial rotation of that leg decortic hemiplegic

most common peripheral neuropathy of the lower extremity

foot drop caused by peroneal or fibular nerve lesion gait is high stepping to avoid dragging of the toes as they cannot dorsiflex the foot for swing phase

most common peripheral neuropathy of the upper extremity?

carpal tunnel syndrome

indications of carpal tunnel syndrome

* atrophy of the thenar eminence * + Tinel's test * + Phalen's test

radiculopathy

spinal nerve root neuropathy caused by ruptured spinal disc & compression of nerve root as it leaves the spine usually unilateral

tinnitus, hearing loss, and fullness of the ear are associated with what type of vertigo?

peripheral vertigo more common form

what symptoms are associated with central vertigo?

cranial neuropathies disarthria diplopia weakness involves cerebellum or brainstem- less common form

SM02 Mini3 Flashcards

(77 cards)