Term
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Definition
| only if you suspect trauma, tumor, or toxic inhalation |
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Term
What do you test when you test CNII?
What chart do you use and what do the numbers mean? |
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Definition
Test Visual Acuity
use the Snellen eye chart
top number=distance from patient to chart
bottom number=distanct normal eye can read the line |
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Term
| What is Vision Fields by Confrontation? Which CN is being tested? |
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Definition
Stand at eye-level and wiggle fingers into patients line of vision from upper, middle, and lower fields
tests CNII |
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Term
| When performing a fundoscopy what rule is important? |
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Definition
| use your right hand for the patient's right eye and use your left hand for the patient's left eye |
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Term
| What four tests are used to test CNIII? |
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Definition
Pupillary reaction to light
Near reaction
Ability to open eye
Extraocular movements |
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Term
Name the eye muscles that go with CNIII, CNIV, and CNVI?
How do you test these muscles? |
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Definition
CNIII-superior rectus, inferior rectus, medial rectus, inferior oblique
CNIV-superior oblique
CNVI-lateral rectus
Test by having patient follow an "H" pattern with a pen |
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Term
How do you test motor function of CNV?
How do you test sensory function of CNV?(pain and light touch) |
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Definition
Motor function-ask patient to clench teeth and compare bilaterally
Sensory-use a broken stick (pain) and a cotton swab(light touch) and test the 3 areas of the face for V1, V2, V3
For light touch place cotton on both sides of face and make sure sensation is equal |
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Term
| How do you test the corneal reflex? What CN? |
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Definition
Ask patient to look up and away, touch cornea with wisp of cotton, look for bilateral blink reaction
CN V senses the stimulus
CN VII causes blinking |
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Term
| How do you test motor and sensory function of CN VII? |
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Definition
Motor-ask patient to do 6 facial movements (closing eyes, closing mouth, raising eyebrows...)
sensory-use different substances to test tast on anterior 2/3 of tongue |
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Term
| What are the three tests for CNVIII? |
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Definition
1. Hearing-ask patient to cover one ear and rub fingers in the uncovered ear or whisper numbers or words from 2ft away into uncovered ear
if abnormalities
2.Weber test-using a tuning fork on top of the patients head want patient to hear vibration equally in both ears
3.Rinne Test-using a tuning fork place it on the mastoid bone when patient can't hear anymore move it to the ear and patient should still hear |
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Term
How can you test CNIX?
What is the sensory component of IX and X? |
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Definition
patient swallow, taste posterior 1/3 tongue
The sensory component is the gag reflex |
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Term
How can you test CN X?
How can you tell if its CN IX or CNX? |
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Definition
listen to patients voice, swallow, look for deviation of uvula
CN IX and CNX can't be distinguished from these tests |
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Term
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Definition
ask patient to shrug against resistance (strenth of trapezius)
have patient turn head sideways against resistance (test opposite SCM) |
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Term
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Definition
| ask patient to stick out tongue and move it quickly from side to side |
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Term
| Where do you document CN testing? |
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Definition
objective section of the SOAP note
Neuro |
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Term
| How do you test for visual acuity? |
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Definition
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Term
| How is visual aquity recorded? |
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Definition
ex. 20/50
top number=distance patient stands from chart
bottom number=distance normal eye can read that line |
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Term
How do you perform the Near Reaction test?
What are you looking for? |
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Definition
normal room light
hold finger 10cm from patients face
ask patient to alternate looking at wall and finger
look for pupillary constriction |
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Term
| How do you look for direct reaction and consensual reaction? |
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Definition
Direct reaction: shine light and look for pupillary constriction in same eye
Consensual reaction: shine light and look for pupillary reaction in opposite eye |
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Term
| How do you test for Extraocular Movement? |
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Definition
| make a wide "H" and make sure to tell patient to follow finger without moving their head |
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Term
| How do you test for covergence? |
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Definition
| move a pen 5-8 cm toward patient's nose |
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Term
| How do you test for Visual Field by Confrontation? |
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Definition
| stand at eye level in front of patient and then wiggle fingers into patient's line of vision from upper, middle, and lower fields bilaterally |
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Term
| What is the red-free filter for? |
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Definition
To remove red from examination field
helps determine arteries and veins |
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Term
| What is Cross/Polarizing filter for? |
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Definition
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Term
| What is the slit light beam for? |
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Definition
| determines if lesion is flat, elevated, protruding |
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Term
| What is the Cobalt blue filter for? |
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Definition
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Term
| What does hyperopia mean and how can you compensate for it? |
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Definition
focal point is behind retina
need convex lenses to converge sooner |
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Term
| What does myopia mean and how do you compensate for it? |
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Definition
focal point anterior to retina
need concave lenses to diverge light further |
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Term
| What can cause papilledema? (4) |
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Definition
| increased intracranial pressure, subarachnoid hemorrhage, meningitis, intracranial mass |
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Term
| What are some signs of hypertensive retinopathy? (3) |
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Definition
veins stop abruptly
thicken arteries
silver wiring(whitish blood vessels) |
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Term
| When performing an otoscopic exam how should you move the auricle? |
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Definition
| pull it upward, backward, and slightly away from the head |
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Term
| When performing the weber test the patient says they hear it in the right ear. What does this mean? |
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Definition
| This means there is a conductive loss of hearing on the right side from lateralization or a perceptive loss of hearing on the left side |
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Term
| With the Rinne test what would be the results for someone complaining of deafness? |
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Definition
| there would be longer bone conduction than air conduction |
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Term
| Where are the 10 places of the lymph nodes of the head and neck? |
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Definition
preauricular
posterior auricular
occipital
tonsillar
submandibular
submental
superficial cervical
posterior cervical
deep cervical chain
supraclavicular |
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Term
| If you suspect a patient to have an upper motor neuron lesion, what do you expect to see? |
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Definition
| big toe will be dorsiflexed, while other toes fan out (when checking Babinski response) |
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Term
| What are you looking for when you assess the ankle reflex? |
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Definition
| you're watching for plantarflexion of the ankle |
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Term
| If someone comes to you and has a hx of hypothyroidism and diabetes and has hypoactive DTRs on both sides bilaterally, what do you tell patient he has? |
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Definition
| hypoactive DTRs (grade = 1+) |
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Term
| Pt. comes complaining of weakness of left elbow after a collision. Motor strength in biceps/triceps on left side is 4/5. Explain to attending what? |
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Definition
| pt can move left arm actively against gravity with some resistance |
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Term
| A homeless man comes in w/fever, chills, AMS. You test for Brebinski sign. What should you see? |
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Definition
| flexion of pt's hip and knees w/passive flexion of head and chest |
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Term
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Definition
| strike hammer 2 inches from wrist and watch for supination and flexion of forearm |
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Term
| What are the main spinal nerve roots in biceps reflex? |
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Definition
| C5/C6 - nerve is musculocutaneous |
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Term
Nerve Roots:
Brachioradialis reflex
triceps reflex
patellar/knee reflex
ankle/achilles reflex |
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Definition
Brachioradialis reflex (C5, C6)
Triceps reflex (C7, C8)
Patellar/ knee reflex (L2, L3, L4)
Ankle/Achilles reflex (S1) |
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Term
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Definition
0 - absent
1+ hypoactive
2+ normal
3+ hyperactive w/o clonus
4+ hyperactive w/clonus |
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Term
| motor strength grading scale |
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Definition
0/5 - No muscle movement. Total paralysis
1/5 Visible muscle movement, but no movement at the joint
2/5 Movement at the joint, but not against gravity
3/5 Movement against gravity, but not against added resistance
4/5 movement against resistance, but with decreased strength
5/5 Normal strength |
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Term
| nerve roots for extension at elbow |
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Definition
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Term
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Definition
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Term
| nerve roots for hip flexion |
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Definition
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Term
| nerve roots for extension of hip |
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Definition
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Term
| nerve roots for adduction of hip |
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Definition
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Term
| nerve roots for abduction of hip |
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Definition
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Term
| nerve roots for abduction of hip |
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Definition
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Term
| nerve roots for knee flexion |
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Definition
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Term
| nerve roots for knee extension |
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Definition
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Term
| nerve roots for ankle dorsiflexion |
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Definition
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Term
| nerve root for plantar flexion |
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Definition
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Term
| Documentation of Neurological Exam (sample) |
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Definition
-Patient is awake, alert and oriented x 3 in no acute distress
-CN II- XII are grossly intact.
-Motor strength is 5/5 in all extremities. Good muscle bulk and tone. Rapid alternating movements and finger-to-nose are intact. Gait is normal. Negative Romberg and pronator drift. Babinski sign is absent.
-Sensory function (pinprick, light touch, position, and vibration) intact bilaterally
-Deep tendon reflexes 2+bilaterally |
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