Term
| Objectives of the neuro exam: |
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Definition
mental status
cranial nerves
sensory examination
motor examination
cerebellar function and gait
reflexes |
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Term
| To test for mental status: |
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Definition
physical appearance and behavior
cognitive abilities
emotional stability
speech and language |
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Term
| Grooming, body language, and emotional status are aspects of ______ _________ that must be addressed in a mental status evaluation. |
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Definition
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Term
| Behavior can be assessed as _________, apathetic, _______, docile, labile...etc. |
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Definition
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Term
| Physical appearance can be described as well-groomed, ________, unkempt, well-developed, _____ |
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Definition
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Term
| _____ __ __________ can be used to assess a person's mental status. |
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Definition
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Term
| A and O x4 refers to a patient that is aware of: ____, ____, ____, and ____ |
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Definition
| person, place, time, and situation |
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Term
| Unexpected findings in a mental status exam would be |
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Definition
confusion
lethargy
delirium
stupor
coma |
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Term
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Definition
| Drowsy, falls asleep but rouses and responds- confusion plus sluggishness |
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Term
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Definition
| inability to think with usual speed and clarity, decreased attention span adn trouble remembering |
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Term
| Disordered perception, decreased attention, anxiety, inappropriate reaction- temporary state |
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Definition
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Term
| Aroused by rigorous repeated painful stimuli, only simple motor activity, moaning |
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Definition
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Term
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Definition
| unresponsive even with painful stimuli- state of unconsciousness |
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Term
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Definition
| abnormal flexion, lesion is above brainstem |
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Term
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Definition
| abnormal extension, deeper coma, lesion of the brainstem, brain tries to keep most simple area of brain alive |
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Term
The _____ ___ _____ is a quantitiative test of consciousness that tests ___, verbal, and _____ responses.
Has a maximum score of __ and a minimum score of __. |
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Definition
Glasgow coma scale
eye
motor
15
3 |
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Term
| _________ is an abnormal posture seen in coma patients that is the result of ________ brain damage and manifests as paralysis with ________ early on that progresses to ________. No spontaneous movement. |
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Definition
Hemiplegia
unilateral
flaccidity
spasticity |
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Term
| hemiplegia results from a lesion of the |
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Definition
| corticospinal tract above the brainstem |
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Term
| Decorticate posturing during coma results from damage to the _________ tract and manifests as an abnormal ______ response with arms tight to sides, and ______ of elbows, wrists, and fingers. Legs are _________. |
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Definition
corticospinal tract
flexor
flexion
extended |
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Term
| Decerebrate posturing is due to damage to the _________ and results in abnormal _________ response, arms and legs are _______ and the jaw is clenched. |
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Definition
brainstem
extensor
extended |
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Term
| Delirium differs from dementia in that delirium is ____ and dementia is _____. |
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Definition
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Term
| In order to test a patient's cognitive abilities one would need to assess: |
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Definition
response to questions
calculation
writing ability
execution of motor skills
memory
attention span
judgment |
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Term
| Immediate, ______, and remote ______ will need to be assessed for a patient's mental status. |
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Definition
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Term
| To assess a patient's mood and feelings, watch their ________. |
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Definition
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Term
| When assessing thought process and content be aware of: ____ __ _____, __________ thinking, and ________. |
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Definition
flight of ideas
tangential
blocking |
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Term
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Definition
| jumps from one subject to the next, difficult to follow |
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Term
| Digresses from original topic of discussion, hard to follow |
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Definition
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Term
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Definition
| inappropriately pauses in middle of a thought, phrase, or sentence |
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Term
| _____ lesions can alter voice quality |
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Definition
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Term
| vocal chords are partially paralyzed |
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Definition
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Term
| problems with tongue or partial numbness in the face |
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Definition
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Term
| when a patient can't come up with really basic words but know what they are talking about |
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Definition
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Term
| Voice _____, articulation, ________, and coherence are tested when assessing speech and language skills. |
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Definition
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Term
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Definition
| motor aphasia, frontal lobe |
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Term
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Definition
| sensory aphasia- temporal lobe |
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Term
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Definition
| motor and sensory aphasia |
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Term
| In Broca's aphasia ______ is intact but ______ is impaired. Patients are unable to communicate _______ but does understand ______. |
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Definition
reading
writing
verbally
words |
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Term
| In Wernicke's aphasia, patients can _____ but cannot _______. They are able to _____ but it doesn't make sense. _____ and ______ are both impaired. |
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Definition
hear
understand
speak
reading
writing |
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Term
| In global aphasia a patient may only understand their ____ ______ and they cannot _____, read, or _____. |
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Definition
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Term
| When testing for aphasia, 5 different aspects are tested: |
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Definition
word comprehension
repetition
naming
reading comprehension
writing |
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Term
| Folstein's mini-mental status exam is worth __ points and assesses _______, registration, attention and calculation, ______, and ________. A score above __ is considered normal and a score of __ or less is considered cogntive impairment. |
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Definition
30
orientation
recall
language
24
23 |
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Term
| cognitive impairment test is used to screen for ________. |
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Definition
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Term
| The FACT test is the easiest test to administer. It requires the patient to name 5 ___, ____, ____, and _____. |
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Definition
| fruits, animals, colors, towns |
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Term
| To test CN 1 (olfactory): |
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Definition
| ID familiar odors, one nare at a time, eyes closed |
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Term
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Definition
| vision test (Snellen chart) from 6 ft away, visual fields by confrontation, fundoscopic evaluation |
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Term
| To test CN 3 (oculomotor), 4 (trochlear), and 6 (abducens): |
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Definition
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Term
| CN 3 innervates levator palpebrae superioris and if lesioned could result in _____ of lid, double vision, downward and lateral gaze deviation, _______ and ___________ difficulties. |
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Definition
ptosis
mydriasis
accomodation |
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Term
| CN 4 innervates the superior oblique m. which is responsible for moving the eye _______ and _______. |
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Definition
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Term
| CN VI innervates the lateral rectus m. which is responsible for moving the eye ________. |
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Definition
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Term
| To test CN 5 (trigeminal): |
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Definition
| inspect musculature, palpate jaw strength, light/dull/sharp touch on 3 dermatomes of face, corneal reflex |
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Term
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Definition
| inspect for symmetry, facial movements- smile, frown, puff cheeks, raise eyebrows, close eyes against resistance |
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Term
| To test CN VIII (vestibulocochlear): |
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Definition
finger snap/rub or whispered word, Weber test
Rinne test |
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Term
| Weber test should be heard equally in both ears if it is not then it is said to ____________. |
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Definition
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Term
| In the Rinne test, air conduction should be _____ that of bone conduction. |
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Definition
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Term
| To test CN 9 (glossopharyngeal): |
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Definition
| gag reflex, swallow, sour and bitter taste |
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Term
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Definition
| check for palate and uvula symmetry, speech, gag reflex, and swallow |
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Term
| To test CN 11 (spinal accessory): |
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Definition
| shoulder shrug, SCM against resistance |
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Term
| To test CN 12 (hypoglossal): |
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Definition
| check for tongue symmetry, tone and movement, strength |
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Term
| Rapid ______ movements and ____ motor _____ test for _____ motor neuron lesions. |
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Definition
alternating
fine; skills
upper |
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Term
| Romberg test is a test of ________ _____. Loss of balance with eyes closed may indicate and ______ motor neuron lesion. |
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Definition
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Term
| _______ recovery and ________ drift are also assessed with Romberg. If one arm begins to _______, this indicates ________ /_____ motor neuron lesion. |
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Definition
balance
pronator
pronate
spasticity/upper |
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Term
Gait:
tiptoes tests-
heels tests- |
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Definition
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Term
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Definition
| lack of coordinated muscle movements |
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Term
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Definition
| wide base, staggering & lurching side to side with swaying of trunk |
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Term
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Definition
| wide base, feet thrown forward & outward, high stepping gait, often slapping foot down |
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Term
| positive ataxia = do romberg test. If Romberg is positive pt has _____ ataxia, if negative, pt has ______ ataxia. |
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Definition
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Term
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Definition
| Jerking, dancing movements that appear nondirectional |
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Term
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Definition
Affected leg stiff & difficult to move – extended w/ plantar flexion of foot
Foot moved by tilting pelvis & dragging/circling outward & forward |
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Term
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Definition
| Slapping gait of affected foot due to weakness of dorsiflexors of the foot |
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Term
| primary sensory function tests such as superficial touch/pain, vibratory sense, and proprioception test _____ motor neuron function. |
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Definition
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Term
DCML controls _____________.
Spinothalamic tract controls __________.
Dorsolateral pathway controls _________. |
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Definition
proprioception
light touch, pressure, temperature, pain
vibratory sense |
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Term
| Two point discrimination is localized to the __________ columns. |
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Definition
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Term
| Two point discrimination is localized to the __________ columns. |
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Definition
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Term
| Cortical sensory functions: |
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Definition
stereognosis
graphesthesia
extinction
point localization
2 point distinction |
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Term
| Supraclavicular peripheral sensation: |
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Definition
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Term
| Axillary peripheral sensation: |
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Definition
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Term
| Radial peripheral sensation: |
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Definition
| back of 2/3 of arm, forearm, hand and of 1st-3rd fingers, proximal portion (C7) |
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Term
| Median peripheral sensation: |
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Definition
| thenar eminence, tips of 1st thru 3 to 4th fingers (C6) |
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Term
| Ulnar peripheral sensation: |
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Definition
| hypothenar eminence, 5th finger, ½ of 4th, back of 5th finger (C8) |
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Term
| Saphenous peripheral sensation: |
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Definition
| medial thigh & lower leg to arch of foot (L2, 3) |
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Term
| Sural peripheral sensation: |
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Definition
| gastrocnemius, posterolateral aspect of ankle and posterolateral foot (S1, S2) |
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Term
| Superficial peroneal peripheral sensataion: |
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Definition
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Term
| Deep peroneal peripheral sensation: |
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Definition
| anterior leg to top of foot (L4,5) |
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Term
Abdominal reflexes:
Upper abd – T7, T8, T9
Lower abd – T10, T11 |
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Definition
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Term
| Cremasteric reflex: T12, L1, L2 |
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Definition
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Term
| Plantar reflex: L5, S1, S2 |
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Definition
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Term
| In plantar reflex, toes should _______ flex. If the great toe __________ then that is a positive _________ sign, indicating an ______ motor neuron lesion. |
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Definition
plantar flex
dorsiflexes
Babinski sign
upper |
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Term
| Biceps and brachioradialis deep tendon reflex: C5, C6 |
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Definition
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Term
| Triceps deep tendon reflex: C6, C7, C8 |
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Definition
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Term
| Patellar reflex: L2, L3, L4 |
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Definition
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Term
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Definition
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Term
Scoring deep tendon relfexes (DTR):
GRADE
0
1+
2+
3+
4+ |
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Definition
No response
Sluggish or diminished
Active or expected response
More brisk than expected, slightly hyperactive
Brisk, hyperactive, with intermittent clonus |
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Term
| _______ is an abnormal pattern of neuromuscular activity that is characterized by rapidly alternating ___________ __________ and relaxation of a __________ muscle. ________ is associated with an ______ motor neuron lesion. |
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Definition
clonus
involuntary contraction
skeletal
clonus
upper |
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Term
| Three different meningeal signs |
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Definition
nuchal rigidity
positive Kernig
positive Brudzinski |
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Term
Instant reflexes noted in infants:
Palmar-touch palm of hand and fingers curl around object-disappears about 6 months
Sucking-touch lips and patient will start sucking motion-4 months
Rooting-touch corner of mouth and baby will turn head that way-4 months
Plantar-Babinski-disappears about 1 year
Moro-startle reflex-drop head and upper body and arms reach out-disappears about 3 months
Stepping-place feet on hard surface and baby will move feet like walking-6 weeks
Placing-hold baby up and rub dorsum of foot under a table top and the baby will flex, then extend leg-6 weeks
Tonic neck reflex-lay baby flat and then turn head, arm and leg on that side will extend out and the arm and leg on the other side will flex-occurs from 2-6 months |
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Definition
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