Guided Study Questions Neurologic Assessment 729 2023.docx

NUR 729 2023 Neurologic Assessment Questions 1. List 4 keys for taking a good history Be a good listener, maintain eye contact, use simple language, and review history of present illness 2. The history of the present illness should include which 6 elements Chief complaint Ons...

NUR 729 2023 Neurologic Assessment Questions 1. List 4 keys for taking a good history Be a good listener, maintain eye contact, use simple language, and review history of present illness 2. The history of the present illness should include which 6 elements Chief complaint Onset and precipitating event Associated symptoms Aggravating and relieving factors Past medical and surgical history (including anesthetic history) Occupational, family, and social history 3. Identify 6 elements of a Mental Status examination Memory, Orientation (person, place, time), Intelligence, Affect, Insight and Judgment, General health 4. Describe the three elements of the Modified Glasgow Coma Scale Eye opening, Verbal response, motor response 5. Name each of the 12 cranial nerves and briefly describe the nerves sensory and motor function. +-----------------------+-----------------------+-----------------------+ | Nerve | Type (S/M) | Function | +=======================+=======================+=======================+ | CN I Olfactory |  S |  Olfaction/smell | +-----------------------+-----------------------+-----------------------+ | CN II Optic |  S |  Vision (fields and | | | | acuity) | +-----------------------+-----------------------+-----------------------+ | CN III Oculomotor |  M |  Eye movement | | | | (superior rectus, | | | | medial rectus, | | | | interior rectus, and | | | | inferior oblique) and | | | | pupil reflex | +-----------------------+-----------------------+-----------------------+ | CN IV Trochlear |  M |  Eye movement | | | | (superior oblique) | +-----------------------+-----------------------+-----------------------+ | CN V Trigeminal |  B | Motor - Face | | | | sensation and chewing | | | | | | | | Sensory -- V1 | | | | ophthalmic V2 | | | | maxillary V3 | | | | mandibular | +-----------------------+-----------------------+-----------------------+ | CN VI Abducens |  M |  Eye movement | | | | (lateral rectus) | +-----------------------+-----------------------+-----------------------+ | CN VII Facial |  B |  Motor - Face | | | | movement (most facial | | | | muscles), salivary | | | | glands | | | | | | | | Sensory -- taste from | | | | anterior 2/3 of | | | | tongue, hard and soft | | | | palate | +-----------------------+-----------------------+-----------------------+ | CN VIII Vestibular |  S |  Hearing and balance | | cochlear | | | +-----------------------+-----------------------+-----------------------+ | CN IX |  B |  Motor -- swallowing, | | Glossopharyngeal | | phonation | | | | | | | | Sensory -- taste back | | | | 1/3 of tongue, | | | | sensory component of | | | | gag reflex | +-----------------------+-----------------------+-----------------------+ | CN X Vagus |  B |  Movement, sensation, | | | | parasympathetic | | | | functions | | | | | | | | Motor component of | | | | gag reflex | +-----------------------+-----------------------+-----------------------+ | CN XI Spinal |  M |  Neck movement (SCM | | Accessory | | and upper traps) | +-----------------------+-----------------------+-----------------------+ | CN CII Hypoglossal |  M |  Tongue movement | +-----------------------+-----------------------+-----------------------+ 6. List three functions of testing motor function Trophic state (size, shape, symmetry) Tone (hypertonic, hypotonic) Strength on 0-5 scale 7. Describe the sensory and motor functions of the nerves of the brachial plexus: Anterior rami of C5-T1 responsible for motor innervation of all muscles in upper extremity except the traps and levator scapula **Nerve** **Sensory** **Motor** --------------------------- ------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------- Axillary (C5) Superior lateral cutaneous nerve -- inferior region of deltoid Arm abduction -- deltoid Musculocutaneous (C5, C6) Lateral cutaneous branch of forearm -- lateral half of anterior forearm, tiny lateral portion of posterior forearm Elbow flexion -- biceps and brachioradialis Radial (C7) Posterior aspect of arm and forearm, posterolateral aspect of hand (snuff box) Elbow, wrist, and finger extension (triceps, extensor digitorum) Median (C8) Palmar cutaneous branch -- lateral part of hand and digital cutaneous branch -- lateral 3.5 fingers on palmar surface of hand Wrist flexion (flexor carpi ulnaris) and finger flexion (flexor digitorum superficialis, profundus) Ulnar (C8, T1) Anterior and posterior surfaces of medial 1.5 fingers (pinky and half of ring) and palm Finger abduction (interossei muscles) 8. Describe the sensory and motor functions of the major nerves of the lumbar plexus: +-----------------------+-----------------------+-----------------------+ | **Nerve** | **Sensory** | **Motor** | +=======================+=======================+=======================+ | Femoral | Anterior thigh and | Hip flexion and knee | | | medial leg | extension | | | | | | | | Anterior thigh - | | | | Illiacus, pectineus, | | | | sartorius, quads | +-----------------------+-----------------------+-----------------------+ | Lateral femoral | Anterior and lateral | None | | cutaneous | thigh down to knee | | +-----------------------+-----------------------+-----------------------+ | Obturator | Medial thigh | Knee adduction | | | | | | | | Obturator externus, | | | | adductor longus, | | | | adductor brevis, | | | | adductor magnus, | | | | gracilis | +-----------------------+-----------------------+-----------------------+ | Sciatic | None directly but | Inversion/eversion of | | | sensory info through | foot, | | | terminal branches | dorsiflexion/plantarf | | | (tibial and peroneal | lexion, | | | nerve) | flexion/extension of | | | | toes, knee flexion, | | | | hip adduction | +-----------------------+-----------------------+-----------------------+ | Tibial (branch of | Posterolateral leg, | Posterior compartment | | sciatic) | lateral foot, sole of | of leg -- | | | foot | gastrocnemius, | | | | intrinsic foot | | | | muscles | +-----------------------+-----------------------+-----------------------+ | Peroneal/Common | Anteriorolateral leg, | Dorsiflexion - | | fibular (branch of | dorsum of foot | Anterior tibialis | | sciatic) | | | +-----------------------+-----------------------+-----------------------+ 9. Compare and contrast sensory, motor, and reflex alterations involving upper and lower motor neuron lesions. Upper motor lesion characterized by weakness, increased/spastic muscle tone, increased muscle stretch reflexes, minimal atrophy, absent fasciculations, and altered sensation Lower motor lesions characterized by weakness, decreased/flaccid muscle tone, profound muscle atrophy, fasciculations present, and altered sensation 10. List three elements evaluated in examining light touch discrimination Pins and needles, decreased sensation, anesthetic skin 11. Define the following terms: a. Stereognosia: ability to ID objects by feel b. Graphesthesia: ability to ID what is written/traced on the hand c. Extinction: ability to ID 2+ places being touched 12. Define and provide examples of the following: d. Monosynaptic reflex: reflex arc that has a single synapse between afferent and efferent neurons -- e.g. deep tendon reflexes -- patellar, achilles reflex e. Polysynaptic reflex: reflex arc that has two or more synapses (e.g. synapse and interneuron) between afferent and efferent neurons -- e.g. superficial reflex -- plantar reflex 13. Name 6 basic test of coordination and their evaluation goal. Finger to nose = basic coordination test that should be easily performed Finger to nose to finger = reduces higher function processing compensation -- more complex of a movement so you can better see dysfunction Rapid alternating hand movements = detecting loss of fine motor coordination that is good for high functioning patients Heel to shin = evaluates lower extremity ataxia with an emphasis on accuracy not speed Simultaneous toe tapping = detects loss of fine motor coordination Gait = can be evaluated unobserved and requires an mobile patient 14. Name two elements of gait. Balance and motor coordination. Balance is derived from sensory input. Motor coordination is derived from strength, muscle tone, coordination, and posture 15. Identify 3 problem areas the Tandem Walk exam may reveal. Stepping heel-toe Can reveal balance problems, reduced sensation, and lack of proprioception 16. What capacity if evaluated by the Romberg Test Balancing with feet together and closing eyes Evaluates vestibular function, proprioception of lower extremities, and use of sight to maintain balance 17. Compare and contrast Cerebellar Ataxia and Sensory Ataxia Ataxia = uncoordinated Cerebellar ataxia is characterized by lack of voluntary coordination of muscle movements, a wide and uncoordinated gait, staggering and truncal instability, and lack of ability to perform a tandem walk or a straight line Sensory ataxia is characterized by a loss of proprioception with a stomping, heel-striking gait, symptoms worsen when eyes are closed, and may be the result of dorsal column pathology. This type of ataxia is seen in MS and severe diabetes 18. Define vertigo A symptom of illusory movement 19. List 4 vestibular causes of vertigo Benign paroxysmal positional vertigo Acute vestibular neuritis Menieres disease Migraine 20. Define tremor Involuntary shaking movement with an associated rhythm 21. List 4 sources of tremor i.e. oscillatory centers Mechanic oscillations -- occurs in limbs -- may be normal Reflex oscillations -- result from inherent instability of negative muscle feedback loops in the sensory muscle pathways -- afferent muscle spindles Natural central oscillations -- due to normal neuronal activity in thalamus, basal ganglia, inferior olive Pathologic central oscillations due to disease processes in cerebellum, thalamus, basal ganglia, and inferior olive - Inferior and superior olives are a collection of brainstem nuclei found near the border of the medulla and pons -- inferior olive functions as a relay station between spine and cerebellar neurons to integrate motor and sensory info 22. List 4 general causes of neuropathy Traumatic injuries Infection Metabolic problems e.g. diabetes Toxins e.g. environmental, alcohol