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  1. Regulates internal environment
    Autonomic ns (symp/parasymp)
  2. Motor/sensory nerves, ganglia outside CNS
    Peripheral ns
  3. Components of neuro exam
    • Mental Status;
    • CNs;
    • Sensory Fn;
    • Cerebellar Fn;
    • Motor fn;
    • DTRs
  4. Mental Status exam is performed during what part of exam?
    Throughout the entire patient interaction
  5. Mediates higher mental functions, perception, & behavior
    Cerebral cortex
  6. Assoc w/speech, emotions, memory
  7. Processes sensory data
  8. Hearing, speech, long term memory, language, behavior, emotion & personality
  9. Mediates survival behavior, affect
  10. Appearance & Behavior: components
    • Grooming,
    • Emotional status,
    • Body language
  11. Body language:
    • Posture,
    • eye contact,
    • nervousness,
    • psychomotor agitation,
    • immobility
  12. Lev els of consciousness
    • Alert;
    • Lethargy;
    • Obtunded;
    • Stupor;
    • Coma
  13. Awake, responds fully and appropriately
  14. Drowsy, respond to questions
  15. Slow response and somewhat confused
  16. Slow responses, arousable for short periods with painful stimuli
  17. Not aware nor awake
  18. Pt should be oriented to:
    Person, place, time, & situation
  19. Time disorientation
    Anxiety, depression, dementia
  20. Place disorientation
    Psychiatric disorders, delirium
  21. Person disorientation
    Cerebral trauma, seizures
  22. Registration
    Repeat a sentence or three unrelated items
  23. Recall
    Show the patient 3 items, have him recall them later
  24. Short-term Memory
    Ask about events within the past few hours or days (weather that morning, etc.)
  25. Long-term Memory
    Ask mother’s maiden name, high school attended, significant historical events
  26. Impaired memory
    Delirium, dementia, anxiety, depression
  27. Loss of immediate and recent memory with retention of remote =
  28. Ability to focus or concentrate over time:
    Attention span
  29. Ask pt to repeat series of numbers, serial 7s, spell WORLD backwards: tests =
    Attention span
  30. Ask pt to follow series of short commands or repeat short story: tests =
    Attention span
  31. Decreased attention span may be related to:
    Fatigue, anxiety, dementia
  32. “What would you do if you found a stamped envelope?” – tests:
  33. Mood =
    Sustained internal emotion
  34. Affect =
    Observable feeling/tone, more episodic*
  35. Mood & Affect: Ask pt =
    How they feel right now (depressed? Signs of mania?)
  36. Thought process/content: Ask pt =
    How and what they are thinking
  37. Perceptions: assessment includes =
    Hallucinations, illusions
  38. Aphonia:
    loss of voice
  39. Dysphonia:
    Impairment in volume, quality, pitch of voice
  40. CN II: tests
    Acuity, fields, funduscopic
  41. CN III tests
    pupillary response (direct and consensual); Inspect eyelids for drooping; EOMs
  42. CN IV (Trochlear) test
    EOM: Inferio-medial
  43. CN VI (Abducens) test
    EOM: Lateral deviation
  44. Tests for Primary Sensory Functions
    Light touch; superficial pain; temp
  45. Sensory fn test of shoulders = tests:
  46. Sensory fn test of thumb = tests:
  47. Sensory fn test of middle finger = tests:
  48. Sensory fn test of pinky = tests:
  49. Sensory fn test of inner forearms = tests:
  50. Sensory fn test of lateral thigh = tests:
  51. Sensory fn test of medial ankle = tests:
  52. Sensory fn test of 1st inter-digital space = tests:
  53. Sensory fn test of Little toe/Lateral ankle = tests:
  54. Where test vibration sense
    Toe, ankle, knee, Finger, wrist, elbow, shoulder
  55. Stereognosis
    Ability to identify common object; Tactile agnosia suggests parietal lobe lesion
  56. Graphesthesia
    Identify drawn figure
  57. Two-point discrimination
    Use one or two points (2-8 mm is normal in fingertips)
  58. Decorticate rigidity
    Rigid flexion; Corticospinal tract above brainstem
  59. Decerebrate rigidity
    Rigid extension; Brainstem
  60. Aphasia
    Disorder in producing or understanding language
  61. Broca’s
  62. Wernicke’s
  63. Anesthesia
    Total or partial loss of sensation
  64. Hyperesthesia
    Increase in sensitivity to sensory stimuli
  65. Nystagmus:
    • Rhythmic oscillation of eyes;
    • Cerebellar disease,
    • drug toxicity
  66. Resting tremor
    Pronounced at rest; Parkinsonism
  67. Intention tremor
    Appears with activity; Multiple Sclerosis
  68. Postural tremor
    Appears when maintaining a posture; hyperthyroid, fatigue, benign essential
  69. Bell’s Palsy
    • Peripheral paralysis of facial nerve;
    • Central lesion will only affect lower face
  70. 5.07 Monofilament tests for:
    Test for protective sensation
  71. The motor cortex is located in:
    The precentral gyrus of the frontal lobe
  72. Corticospinal tracts AKA:
    Pyramidal tracts
  73. Corticospinal tracts originate in the
    Motor cortex
  74. 3 “motor pathways” :
    Corticospinal tracts, basal ganglia and the cerebellum
  75. Aids motor cortex in integration of voluntary movement
  76. Coordinates control of muscle tone, posture and equilibrium
  77. Cerebellar functions: at ____ level
  78. Responsible for fine movement of the hands
  79. Upper motor neurons (UMN): Originate & terminate:
    Within CNS
  80. UMN are neurons of the:
    Corticospinal tracts and the basal ganglia
  81. UMN can influence or modify the:
    Lower motor neurons
  82. Examples of UMN disease:
    CVA, multiple sclerosis & cerebral palsy
  83. The “final common pathway:
  84. Examples of lower motor neuron disease
    Spinal cord lesions
  85. “Lower” or primitive pathway =
    Basal Ganglia System:
  86. Basal Ganglia System AKA
    Extrapyramidal system
  87. Extinction phenomenon
    Touch pt at 2 diff areas of body; they s/b able to exactly locate both
  88. Point localization
    Touch a point, ask pt to open eyes & indicate location touched
  89. 5.07 Monofilament: pos test may indicate:
    Peripheral neuropathy, Diabetes mellitus
  90. LMNs located in:
    Peripheral nervous system (cranial nerves & spinal nerves)
  91. Spinal nerves: how many pairs?
  92. Sensory afferent fibers of dorsal root carry impulses:
    From sensory receptors to the spinal cord
  93. Sensory/motor fibers supply/receive information in:
  94. Motor exam:
    • Mx tone/bulk;
    • Mx strength;
    • DTRs;
    • Cerebellar fn
  95. Cerebellar function:
    • Gait/balance;
    • Coordination;
    • Romberg
  96. Coordination tests:
    • Rapid alternating movements;
    • point-to-point testing
  97. Mx inspection: hands
    Thenar/hypothenar eminences
  98. Mx inspection: Palpation:
    Mx tone; Mx strength
  99. The normal, mild resistance of a relaxed muscle to a passive stretch
  100. Increased tone =
  101. Spasticity causes:
    Awkward, rigid movements;
  102. Rigidity that persists throughout the range is called:
    Lead-pipe rigidity
  103. Decreased Mx tone =
  104. Mx inspection: Palpation: Muscle strength:
    Compare symmetrically
  105. Mx strength scale =
    Graded on a 0-5 scale
  106. Mx strength scale: 0 =
    No voluntary contraction
  107. Mx strength scale: 5 =
    Full muscle strength against resistance
  108. Weakness may result from:
    Pain, fatigue or disuse
  109. Strength testing is often combined with:
  110. Mx strength scale: a grade of 3 or less =
    Consistent with disability
  111. Babinski response indicates:
    dz of pyramidal tract in adults
  112. DTRs: Biceps:
    C5, 6
  113. DTRs: Triceps:
    C6, 7
  114. DTRs: Brachioradialis:
    C5, 6
  115. DTRs: Patellar:
    L2, 3, 4
  116. DTRs: Ankle:
  117. Grading DTRs: 0 =
    No response
  118. Grading DTRs: 1+ =
  119. Grading DTRs: 2+ =
    Expected response
  120. Grading DTRs: 3+ =
    Brisk, slightly hyperactive
  121. Grading DTRs: 4+ =
    Hyperactive; clonus may be present
  122. DTRs can be recorded:
    In chart-style or by using a stick-man figure
  123. Biceps Reflex: expected response
    Visible or palpable flexion of the elbow
  124. Triceps Reflex: Response:
    Visible or palpable extension of the elbow
  125. Brachioradial Reflex: Response:
    Elbow flexion with supination of the hand.
  126. DTRs include tests of:
    Biceps, triceps, brachioradial, patellar, ankle
  127. Patellar Reflex: Response:
    Extension of the lower leg
  128. Ankle Reflex: Response:
    Plantar flexion of the foot
  129. Plantar Reflex is a _____ reflex
  130. Plantar Reflex: Response:
    Plantar flexion of the toes
  131. Cerebellar Function tests:
    Coordination/Fine Motor Skills
  132. Rapid alternating movements (RAM):
    Evaluate rhythm/flow/speed
  133. Point-to-point testing:
    • Finger to nose;
    • Heel to shin
  134. Test of balance:
    • Romberg test;
    • Observe normal gait;
    • Tandem gait
  135. Gait Patterns: Spastic hemiparesis =
  136. Gait Patterns: Spastic diplegia =
  137. Gait Patterns: Steppage =
    Foot drop
  138. Gait Patterns: Waddling =
    Weak hip abductors
  139. Gait Patterns: Cerebellar ataxia =
    Wide based gait
  140. Gait Patterns: Sensory ataxia =
    Loss of position sense
  141. Gait Patterns: Parkinsonian =
  142. Gait Patterns: Antalgic limp =
    Painful extremity
  143. Plegia:
    Absence of strength (paralysis)
  144. Hemiplegia:
    Paralysis of one half of the body
  145. Paraplegia:
    Paralysis of the legs
  146. Paresis:
    Impaired strength (weakness)
  147. Hemiparesis:
    Weakness of one half of the body
  148. Epicondyles:
    For tenderness associated with fx
  149. Patella:
    For pain, fx, stability
  150. Patella tendon:
  151. Joint space:
  152. Joint line:
    Meniscus tears, ACL tears
  153. Med/Lat collaterals:
    Ligament strains
  154. Tibial tuberosity:
  155. Medial tibial plateau:
    Pes anserine bursitis
  156. Posterior joint space:
    PCL, Bakers cyst
  157. What are the 7 primary components of Past Medical History?
    • Childhood illnesses,
    • adult illnesses,
    • psychiatric illnesses,
    • hospitalizations,
    • medications,
    • allergies,
    • health maintenance
  158. What are the 7 primary components of the HPI?
    • Location,
    • quality,
    • quantity (severity),
    • timing,
    • setting,
    • alleviating/aggravating factors,
    • associated symptoms
  159. What are the major childhood illnesses that should be inquired of in the PMH?
    • Measles,
    • mumps,
    • rubella,
    • scarlet fever,
    • rheumatic fever,
    • polio
  160. What are the major allergies which should be inquired about in the PMH?
    • Food allergies,
    • animals or insects,
    • latex
  161. What 3 questions should be involved in the skin review of systems?
    Any rash, itching, or color changes
  162. What 20 components should be evaluated in the review of systems?
    • Skin,
    • head,
    • eyes,
    • ears,
    • nose,
    • mouth,
    • throat,
    • neck,
    • breast,
    • respiratory,
    • cardiac,
    • gastrointestinal,
    • urinary,
    • reproductive,
    • peripheral vascular,
    • musculoskeletal,
    • neurologic,
    • hematologic,
    • endocrine,
    • psychiatric
  163. What should be inquired about during the eye portion of the ROS?
    • Double or blurry vision,
    • color changes
  164. What should be inquired about during the breast portion of the ROS?
    • Lumps,
    • pain or discomfort,
    • discharge,
    • regularity of self examination
  165. What should be inquired about during the genital review of systems (male)?
    • Discharge,
    • sores,
    • testicular pain or masses,
    • STD's
    • sexual preference
    • Note: pain on urination can be asked here but is commonly asked during urinary portion of ROS
  166. What should be inquired about during the genital review of systems (female)?
    • Age at menarche,
    • regularity/frequency/duration of periods,
    • last menstrual period,
    • age at menopause (if applies),
    • menopausal symptoms,
    • discharge,
    • itching,
    • sores,
    • STD's
    • sexual preference,
    • number of pregnancies,
    • deliveries,
    • abortions,
    • birth control.
  167. What should be inquired about during the hematologic review of symptoms?
    • Easy bruising or bleeding,
    • past transfusions and any reactions to them
  168. What should be inquired about during the endocrine ROS?
    • heat or cold intolerance,
    • excessive sweating,
    • diabetes,
    • excessive thirst or hunger
  169. What should be inquired about during the psychiatric ROS?
    • Nervousness,
    • stress,
    • depression,
    • memory problems
  170. What questions should be asked in succession to detect a drinking problem?
    • Start with, "How much alcohol do you drink?",
    • follow with "Have you ever had a drinking problem?" and "When was your last drink?";
    • if affirmative to first and within 24 hrs to second follow with CAGE
    • Cut Down, Annoyed by criticism, Guilt, Eye-opener
  171. What should be inquired about during the neurologic ROS?
    • Weakness,
    • paralysis,
    • numbness or loss of sensation,
    • tingling,
    • tremors or other involuntary movements
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