Term
| Three questions to solve during exam |
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Definition
-mental status intact?
-are right and left findings symmetric
-is problem CNS or PNS |
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Term
| Common or Concerning neuro symptoms |
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Definition
-headache
-dizziness or vertigo
-generalized, proximal, or distal weakness
-numbness
-loss of consciousness
-seizures
-tremors or involuntary movements |
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Term
| anytime a Pt tells you "it's the worst headache of my life" you need to |
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Definition
| consult with higher medical authority NOW!!! |
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Term
| Questions to ask about headache |
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Definition
-severity, location, or duration
-associated symptoms (visual changes, weakness, loss of sensation)
-is it affected by coughing, sneezing, or sudden movements |
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Term
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Definition
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Term
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Definition
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Term
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Definition
dizziness-vague, could mean light-headed or feeling faint
vertigo-perception that room is spinning |
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Term
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Definition
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Term
| weakness made worse with repeated effort and improved with rest suggests |
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Definition
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Term
| questions to ask regarding weakness |
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Definition
generalized vs localized
rapid or slow onset
areas involved
associated symptoms |
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Term
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Definition
| distorted sensations in response to a stimulus and may last longer than stimulus itself |
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Term
| odd sensations, with or without stimuli |
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Definition
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Term
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Definition
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Term
| questions to ask regarding numbness |
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Definition
location
sensations
difficulty moving limb
description of feeling |
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Term
| questions to ask for loss of consciousness |
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Definition
begin by exploring what pt means by loss of consciousness.
-warning signs
-what position was the pt in
-duration
-could voices be heard during
-how rapid was recovery
-did anyone observe the event |
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Term
| young people with emotional stress and warning symptoms of flushing, warmth, or nausea may have |
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Definition
| vasodepressor syncope (slow onset) |
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Term
| unlike syncope, tonic clonic seizure may result in injury to tongue or bruising of the limbs T/F |
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Definition
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Term
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Definition
| sudden excessive electrical discharge in the cerebral cortex |
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Term
| questions to ask with seizures |
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Definition
precipitating events
warnings sings (aura)
age of onset
frequency
medications
history of head injury |
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Term
| restless legs syndrome is benign? |
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Definition
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Term
| what gives relief to restlessness of the legs |
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Definition
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Term
| questions to ask about tremors |
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Definition
| trembling, shakiness, body movements that the patient seems unable to control |
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Term
| Which is more common, ischemic or hemorrhagic stroke? |
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Definition
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Term
| most common cause of stroke is occlusion of this artery |
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Definition
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Term
| common signs of stroke and TIA |
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Definition
-sudden numbness or weakness
-sudden confusion, trouble speaking or understanding
-sudden trouble walking, dizziness, or loss of balance
-sudden trouble seeing in one or both eyes
-sudden severe headache |
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Term
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Definition
| Facial droop, arm drift, speech |
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Term
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Definition
hypertension
smoking
hyperlipidemia
diabetes
excess weight
lack of exercise
heavy alcohol use |
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Term
| most common cause of peripheral neuropathies |
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Definition
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Term
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Definition
| avg glucose level over 3 months |
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Term
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Definition
-mental status
-CN
-Motor/Cerebellar
-Sensory
-DTRs |
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Term
| eyelid ptosis is indicative of what CN lesion |
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Definition
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Term
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Definition
| involuntary jerking movement |
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Term
| important thing to remember before testing corneal reflex with fines cotton wisp |
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Definition
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Term
| absent blinking is indicative of what CN lesion |
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Definition
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Term
| absent blinking and sensorineural loss occurs in |
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Definition
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Term
| besides testing shrug strength and head turn against resistance, what else should be done when testing CNXI |
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Definition
| look for muscular atrophy or fasciculations |
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Term
| When assessing motor system, focus on |
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Definition
body position
involuntary movements
characteristics of muscles (bulk tone strength)
coordination |
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Term
| Are fibrillations visible to medic? |
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Definition
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Term
| fasciculations with atrophy and muscle weakness suggest disease of |
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Definition
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Term
| how do you test muscle tone? |
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Definition
| by feeling muscle's natural resistance to passive movement |
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Term
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Definition
marked floppiness
syn. flaccidity |
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Term
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Definition
| increased muscle resistance that worsens at the extremes of ROM |
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Term
| If the Pt is unable to resist your movements during muscle strength test, you should |
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Definition
| test them against gravity or with gravity eliminated, if unable still, watch or feel for muscular contraction |
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Term
| 0-5, muscle strength scale, this is normal strength |
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Definition
| 5-active movement against full resistance without evident fatigue |
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Term
| flexion at the hip is innervated by spinal nerves |
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Definition
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Term
| extension at the hips is innervated by |
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Definition
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Term
| extension of knee innervated by |
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Definition
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Term
| knee flexion innervated by |
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Definition
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Term
| ankle dorsiflexion is innervated by |
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Definition
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Term
| plantar flexion is innervated by |
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Definition
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Term
| ways to test coordination |
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Definition
rapid alternating movements
point to point movements
gait
standing in specific ways |
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Term
| in cerebellar disease, where one movement cannot be followed quickly by its opposite, movements are slow, irregular, clumsy. this is called |
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Definition
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Term
| consistent deviation to one side, aka past pointing, worse with eyes closed, suggests |
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Definition
| cerebellar or vestibular disease |
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Term
| with point to point movements that test cerebellar coordination, observe for |
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Definition
| smoothness and accuracy, remember to repeat with eyes closed |
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Term
| having the Pt walk heel-to-toe in a straight line is a pattern called |
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Definition
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Term
| inability to heel-walk is a sensitive test for |
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Definition
| corticospinal tract damage |
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Term
| how long to wait while using romberg test |
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Definition
| 30-60 sec without support |
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Term
| T/F a positive romberg sign requires pt to lose balance with eyes both open and closed |
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Definition
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Term
| types of sensation to be tested |
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Definition
pain
temperature
position
vibration
light touch
discrimination |
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Term
| sensations of pain and temperature relate to which tract |
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Definition
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Term
| position and vibration relate to what tract |
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Definition
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Term
| light touch relates to which tract(s) |
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Definition
| spinothalamic and posterior columns |
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Term
| when testing sensation remember to |
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Definition
compare symmetric areas
compare proximal to distal areas
vary the pace of testing
map out boundaries when abnormalities detected |
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Term
| Is it okay to reuse pin or sharp device used to test sharp/dull on a pt? |
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Definition
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Term
| T/F Temperature discrimination can be omitted if pain sensation is normal |
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Definition
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Term
| what kind of tuning fork to use for vibration sensation testing? |
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Definition
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Term
| if vibration sense is impaired, you should |
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Definition
| move proximally and try again |
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Term
| loss of discriminative sensations (stereognosis, number ID, two point discrimination) are suggestive of disease of |
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Definition
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Term
| graphesthesia is useful when |
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Definition
| Pt has motor impairment that prevents them from doing stereognosis test |
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Term
| minimal distance at which Pt should be able to discriminate two points |
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Definition
| less than 5mm on finger pads and up to 40 mm on the back |
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Term
| to test point localization, |
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Definition
briefly touch a point on pt,
have them open eyes and point
to place touched |
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Term
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Definition
simultaneously touch corresponding
areas on both sides of body,
ask where pt feels touch, should be
able to feel both |
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Term
| dermatome is a band of skin innervated by sensory root of a single__ |
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Definition
|
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Term
| each spinal nerve has a specific cutaneous sensory distribution besides spinal nerve |
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Definition
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Term
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Definition
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Term
| hyperactive reflexes aka hyperreflexia indicate |
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Definition
| lesions along descending corticospinal tract-upper motor neuron |
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Term
| hyporeflexia points to lower or upper motor neuron lesion |
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Definition
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Term
| which reflex grade is normal |
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Definition
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Term
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Definition
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Term
|
Definition
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Term
| supinator or brachioradialis reflex tests |
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Definition
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Term
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Definition
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Term
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Definition
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Term
| sustained clonus indicates |
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Definition
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Term
| a normal finding for abdominal reflex is |
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Definition
| contraction of abdominal muscles and deviation of umbilicus toward stimulation |
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Term
| dorsiflexion of the big toe is a positive or negative babinski finding? |
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Definition
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Term
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Definition
| run tongue blade along lateral aspect of foot from heel and curve medially to the ball of the foot |
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Term
| anal reflex (anal wink) tests |
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Definition
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Term
| if you suspect meningeal inflammation from CNS infection or subarachnoid hemorrhage, its important to test for |
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Definition
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Term
| What should be done before testing neck mobility |
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Definition
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Term
| what is a positive meningeal sign |
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Definition
| neck pain, stiffness with neck flexion (either active or passive) |
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Term
| Hip and knee flexion during testing for brudzinski's sign most likely suggests |
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Definition
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Term
| what is a positive kernigs sign |
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Definition
| pain and increased resistance to knee extension-bilateral suggests meningeal irritation |
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Term
|
Definition
| flex pt leg at both hip and knee, then straighten knee |
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Term
| is discomfort behind the knee during full extension while testing Kernig's sign normal? |
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Definition
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Term
|
Definition
low back pain with nerve pain
that radiates down the leg if in
S1 distribution |
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Term
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Definition
raise pt straight leg until pain
back off til pain gone
dorsiflex
positive if pain when dorsiflex |
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Term
| asking the pt to "stop traffic" by extending both arms with hands cocked and fingers spread, and having held for 1-2 minutes is testing for |
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Definition
| Asterixis-metabolic encephalopathy, will see sudden brief nonrythmic flexion of hands/fingers, seen in liver disease and uremia |
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Term
| winging of the scapula suggests |
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Definition
| weakness of serratus anterior muscle due to muscular dystrophy or long thoracic nerve injury (compression of which is known as pack strap palsy) |
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Term
| how to test for winging of the scapula |
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Definition
| ask patient to extend both arms and push against wall; protrusion of scapula is positive sign |
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Term
| In evaluation of the stuporous or comatose pt, first ___, then ____ |
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Definition
assess for life threats,
establish LOC |
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Term
| "donts" when assessing a comatose pt |
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Definition
Dont dilate the pupils
Dont flex the neck |
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Term
| "donts" when assessing a comatose pt |
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Definition
Dont dilate the pupils
Dont flex the neck |
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Term
| Why dont you dilate the pupils when assessing a comatose pt |
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Definition
| this takes away the single most important clue to the cause of the coma (structural vs metabolic) |
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Term
| oculocephalic reflex in comatose? |
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Definition
test for brainstem function,
hold open pt upper eyelids
turn pt head rapidly-
if brainstem INTACT, eyes will move to opposite side of movement |
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Term
| oculovestibular reflex testing? |
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Definition
ensure TM is intact and EAC clear
elevate pt head to 30 degrees
inject ice water into ear canal
with large syringe
eyes should deviate toward stimuli
indicates intact brainstem |
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Term
| three patterns of response to pain in comatose pt |
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Definition
| normal avoidant, stereotypic, flaccid |
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