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Health Assessment > Week 9 Neuro > Flashcards

Week 9 Neuro Flashcards

1
Q

What is the frontal lobe responsible for

A

personality
behavior
emotion
intellectual functions

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2
Q

What is Broca’s area responsible for

A

motor and speech

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3
Q

What is the temporal lobe responsible for

A

hearing, taste, and smell

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4
Q

What is the parietal lobe responsible for

A

sensation (hot, cold, sharp, etc.)

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5
Q

What is Wernicke’s area responsible for

A

speech, comprehension

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6
Q

What is the occipital lobe responsible for

A

visual reception

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7
Q

What is the cerebellum responsible for

A

motor coordination, equilibrium, and balance

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8
Q

What symptoms will you have with damage to the temporal lobe

A

ringing in the ears, hearing deficit, sensations of smell that aren’t there

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9
Q

What areas of the brain are you assessing when testing the central and peripheral nervous system

A
  • mental status/LOC: cerebral cortex (cerebrum)
  • cranial nerves: brainstem
  • coordination and motor system: cerebellum, cerebral cortex, corticospinal, and extrapyramidal tracts
  • sensory system: cerebral cortex, spinal cord, and posterior columns
  • reflexes
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10
Q

What is the difference between afferent and efferent nerves

A

afferent: sensory messages to the CNS from sensory receptors (the feeling)
efferent: motor messages from the CNS out to the muscles, organs, and glands (effect of the feeling/what I want my body to do as a result of the feeling)

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11
Q

What is the peripheral nerve? What are the two types of fibers

A

peripheral nerve = bundle of fibers outside the CNS

the two types of fibers are afferent and efferent

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12
Q

explain somatic and autonomic movements in the autonomic nervous system

A

Somatic: skeletal muscles (voluntary movement)

Autonomic: smooth muscles (involuntary movement which mediates unconscious activity (homeostasis, heart, glands)

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13
Q

What are the vital sign changes that you will experience with the sympathetic and parasympathetic system

A

sympathetic: heart rate, blood pressure, pupil size (dilation)
parasympathetic: conserves body resources and maintains normal bodily functions; increases gastric secretion, slows heart rate

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14
Q

What are important history questions to know when assessing the neurological system

A
  • headache, fever
  • neck pain, photophobia
  • fainting (syncope): vasovagal response
  • head injury: vomiting, headaches, irritability, LOC
  • seizures, tremors
  • coordination changes: altered balance, altered gait or coordination
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15
Q

What are the classic symptoms of meningitis

A

headache, fever, neck pain, photophobia

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16
Q

Explain vasovagal response

A

autonomic nervous system reacts causing bradycardia and allows vasodilation in the lower extremity vessels, decrease blood, decrease O2 to brain which causes you to faint

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17
Q

What are alterations in sensory function

A
  • weakness, paralysis, spasms
  • vision, hearing, taste, smell
  • pain (neuropathies)
  • paresthesia: numbness, tingling, burning, crawling sensation
  • difficulty swallowing (dysphagia)
  • difficulty speaking, forming words, or language comprehension (dysphasia)
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18
Q

What are the two types of dysphasia

A

expressive and receptive

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19
Q

Explain expressive dysphasia

A
  • can understand what others are saying
  • words are slow and laborious, but meaningful
  • often get frustrated
  • called Broca’s aphasia
  • comprehension is intact, they have trouble answering
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20
Q

Explain receptive dysphasia

A
  • little or no comprehension of words
  • spoken words are fluent and nonsensical
  • no idea the words and language are wrong
  • called Wernicke’s aphasia
  • comprehension is lost, answering is just fine
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21
Q

Explain dysarthria

A

signifies dysfunction of the muscles needed to produce speech like lips, tongue, vocal cords, diaphragm, etc. (think articulation and difficulty forming words)

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22
Q

What medications do we need to know about when gathering a neurological history

A
  • HTN, CV, antidepressants, antianxiety, alternative medications, alcohol, street drugs, tobacco
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23
Q

What PMHx do we want to know about when assessing the neurological system

A
  • strokes, seizure dx, DM, hypertension, hx of trauma (head, neck, back) syphillis, varicella, psych dx, surgical
24
Q

What FMHx do we want to know about when assessing the neurological system

A
  • neoplasms, strokes, Alzeimer’s, psychiatric disorders, HTN, epilepsy, muscular dystrophies, Parkinson’s
25
Q

What is included in a full neuro exam

A
  • mental status
  • cranial nerves
  • motor system: cerebellar, muscular
  • sensory system
  • reflexes
26
Q

What are the different LOCs

A
  • alert
  • inattention
  • confusion
  • delirium
  • hallucinations
  • delusions
27
Q

What do you assess if you have altered LOC (not alert)

A
  • use acute care exam (glasgow coma scale)
  • motor function
  • pupillary responses
  • vital signs
28
Q

When checking vital signs, what areas of the brain are responsible for heart rate, respiratory, BP, and temp

A 
HR = vagus nerve 
Respiratory = medulla, pons 
BP = medulla 
Temp = hypothalamus
29
Q

Explain what CN I is responsible for and the name for it

A

olfactory

responsible for smell

30
Q

Explain what CNII is, what it controls, and the tests used to assess it

A

optic nerve

controls the eyes

snellen, confrontation

31
Q

Explain what CN III, CN IV, and CN VI are, what they assess, and tests used to assess

A 
3 = oculomotor 
4 = trochlear 
6 = abducens

CN III: responsible for eye movements and pupils (PERRLA)
CN IV: responsible for eye movements toward the nose (inner eye movements)
CN VI: lateral eye movements

32
Q

Explain what CN V is, what its used for, and the test used to assess it

A

CN V = trigeminal

mastication, clench teeth, sensory and cotton to cheeks with eyes closed

only one with sensory and motor to assess

33
Q

Explain CN VII

A

facial nerve

responsible for smile, frown, puff cheeks out, keep eyes closed against resistance

34
Q

Explain CN VIII

A

Acoustic nerve

whisper test, rinne, weber

(hearing and earring)

35
Q

Explain CN IX

A

Glossopharyngeal

say ahh, gag reflex, taste, swallowing

the soft palate and uvula should rise and you should not see uvular deviation

36
Q

Explain CN X

A

Vagus

say ahh, gag reflex, taste, swallowing, vagus big daddy

looking at the soft palate and uvula and the post pharangeal wall

37
Q

Explain CN XI

A

spinal accessory

turn head and shrug shoulders against resistance

38
Q

Explain CN XII

A

Hypoglossal

stick out tongue, tongue strength, and speaking

looking at purposeful protrusion when sticking out tongue and looking for deviation from midline

39
Q

Rapid rhythmic alternating movements, point to point movements (finger to nose to examiner’s finger or finger to nose with eyes closed) testing

A

coordination of hands and legs by testing the cerebellar function

40
Q

What are the gait and posture tests to examine cerebellar function

A
  • casual walking
  • heel to toe in straight line (tandem)
  • walking on toes and heels
41
Q

What are the two balance tests to assess cerebellar function. Explain how to perform each

A

Romberg:

  • stand upright, feet together, close eyes
  • positive Romberg = loss of balance (cerebellar/vestibular disorder) altered proprioception

Pronator drift:

  • pizza box chest level, supinated palms, close eyes and holds them there
  • after 20 seconds, tap downwards on alternating arms
  • abnormal = arm drifts downward, palm pronates, or unable to find original point (motor neuron disorder or metabolic disease)
42
Q

All info you get from MSK, what does in mean in Neuro? Think strength. muscle size and symmetry, full ROM of joints, and muscle tone

A

Strength: diabetic neuropathies

Muscle size and symmetry: atrophy from polio, MS, paralysis, involuntary movements (tics and tremors)

Full ROM: pain in ROM, resistance

Muscle tone: flaccid = polio, Guillian Barre, spastic = cerebral palsy, spinal cord injury, rigid = tetanus, cogwheel rigidity = parkinsonism (tic toc movements)

43
Q

How do you test sensation. When should you examine in detail

A

with patients eyes closed, test sensation with:

  • light touch: cotton swab on face (CN V)
  • sharp/dull: always validate your tool first then do the test
  • monofilament: first sensation lost with peripheral neuropathies in the feet
  • if they feel at the most distal portion, you can move on

Examine in detail if:

  • reduced sensation
  • numbness or pain
  • motor or reflex abnormal
44
Q

How do you test cognitive interpretation when assessing sensory function

A

Stereognosis:

  • one hand at a time, place a paperclip or familiar item in hand, have patient ID it
  • unable to ID could be sensory cortex lesion

Graphesthesia:

  • “write” number in palm and have patient identify number
  • face in the same direction as patient so the number is not upside down. Do NOT use your finger because it is not a blunted object and it is not discreet
  • inability to ID could mean sensory cortex lesion
45
Q

What are the different reflexes mentioned in the text?

What are the important things to remember about reflexes?

A
  • DTR (knee)
  • superficial (cornea reflex, abdominal reflex)
  • visceral (pupillary response to light)
  • pathologic (abnormal: present babinski in adult)

Reflexes are:

  • involuntary
  • helps maintain muscle tone
  • protection - permits quick response to bad stimuli
46
Q

What are the 5 components needed for DTR response? (HINT: VERY IMPORTANT)

A
  • intact sensory nerve (afferent)
  • a functional synapse in the cord (where the afferent process)
  • an intact motor nerve fiber (efferent)
  • a functional joint
  • a competent muscle
47
Q

What are the tips and tricks to deep tendon reflexes

A
  • aim right for the tendon
  • position limb so muscle is slightly stretched
  • muscle must be relaxed
  • reflex hammer should strike tendon briskly to stretch tendon
  • compare side to side
48
Q

How do you document DTRs

A 
0 = no response 
1 = somewhat diminished
2 = average 
3 = brisker than average 
4 = very brisk (clonus present)
49
Q

What cutaneous reflexes are normal in infants but abnormal in adults (suggests diffuse brain disease) and why?

A
  • babinski
  • grasp
  • sucking

When the brain starts to decompensate, their brain returns to an infant like state and these infant reflexes will begin to return which is not good

50
Q

Explain the order of neuro deterioration

A
  1. A&O alters: time and or place, last is self
  2. Lose ability to obey simple commands: open your eyes, wiggle your toes
  3. Then responses deteriorate from purposeful to purposeless responses to pain (purposeful = pulling away from sternal rub, purposeless = leg kicks out with sternal rub)
  4. Then, the absence of response to pain
  5. Then, the loss of corneal and gag reflexes
51
Q

What is the acute care neuro assessment to perform on each hospitalized patient

A
  1. LOC - altered specifically
  2. motor function
  3. pupillary response
  4. vital signs

1 & 2 are assessed using the GCS

52
Q

What is the most sensitive indicator for decrease neuro function and earliest change in acute ICP changes?

A

Glasgow coma scale

53
Q

Explain the scoring system of the GCS

A

Eye opening:

  • spontaneously = 4
  • to speech = 3
  • to pain = 2
  • none = 1

Verbal response:

  • orientated = 5
  • confused = 4
  • inappropriate = 3
  • incomprehensible = 2
  • none = 1

Motor response:

  • obeys commands = 6
  • localizes to pain = 5
  • withdraws from pain = 4
  • flexion to pain = 3
  • extension to pain = 2
  • none = 1
54
Q

What GCS score indicates coma

A

3-8

55
Q

How can damage to CN III affect pupil size and symmetry

A

pressure on the brainstem from herniation will cause sudden pupillary dilation and nonreactive pupil = bad

56
Q

What are the two abnormal posturings

A
  • Decerebrate = ominous; brain death is about to occur or has already occurred
  • Decorticate = arms come to the core; this means some brain function is still there

Health Assessment (11 decks)

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