Fundamentals of Neurology and Sensory Assessment

Comprehensive practice flashcards covering neurological terminology, sensory pathways, focused neuro assessments, Glasgow Coma Scale (EMV) scoring, headache management, and cerebellar coordination tests based on the Fundamentals of Neurology and Sensory lecture.

Kinesthetic Skills

The ability to be aware of one's own body movement without seeing it.

Stereognosis

The ability to recognize an object in contact with the body without seeing it by perceiving its form, size, and weight, testing parietal lobe sensory integration.

Visceral Sensory

The sensory process by which the body receives and interprets warning signs originating from internal organs.

Stimulus

An agent situated in the external environment or within the body that excites a nerve receptor.

Receptor

A specialized site in the nervous system that detects a stimulus and converts it into a nerve impulse.

Perception

The brain analyzing and integrating sensory data from receptors to form meaningful awareness and determine the correct response.

Impulse Conduction

The transmission of an electrical impulse from the brain along peripheral response pathways.

Reaction

The observable physical or motor response executed by the body following impulse conduction.

Homonymous Hemianopsia

A visual field loss affecting the same half (left or right side) of the vertical midline, which can affect one eye but usually impairs both eyes.

Visual Agnosia

The loss of the ability to recognize objects, faces, voices, or places, resulting in an inability to name or describe the use of an item placed directly in front of the patient.

Dysphasia

An impaired ability to comprehend or produce speech and communication.

Broca's Area (Expressive Speech Deficit)

The motor speech region of the brain affected when a stroke patient can comprehend spoken words but cannot formulate or produce words to respond.

Sensory Overload

A clinical state where excessive environmental or physiological input—such as pain, continuous monitor alarms, frequent clinician entries, and high-intensity unit environments—exceeds a patient's processing ability.

Sensory Deprivation

A state of insufficient sensory stimuli or social contact in healthcare settings that leads to increased daytime sleepiness, cognitive decline, memory impairment, and irritability.

Cluster Care

A nursing intervention in high-stimulus environments like the ICU where staff coordinate and group care activities into scheduled intervals to minimize patient room entries.

Humpty Dumpty Falls Prevention Program

A specialized pediatric fall prevention initiative (such as that utilized at Kentucky Children's Hospital) communicating clinical safety alerts on patient room doors.

Kernig Sign

A physical exam finding diagnostic of meningeal irritation wherein pain is elicited upon extension of the knee with the hip flexed.

Brudzinski Sign

A physical sign of meningitis characterized by involuntary flexion of the hips and knees in response to passive flexion of the patient's neck.

Kernig and Brudzinski Signs

Classic physical diagnostic maneuvers utilized to detect meningeal irritation in patients presenting with severe headache, fever, and neck stiffness.

Migraine Headache

A neurological headache disorder typically presenting with moderate-to-severe unilateral head pain, nausea, and sensitivity to bright sunlight or external triggers.

Thunderclap Headache

A sudden, severe headache that reaches a 10/10 intensity instantly ('like being struck by a hammer'), requiring immediate emergency provider notification to rule out an intracranial hemorrhage.

Focused Neurological Assessment

A targeted clinical exam indicated for patients with acute or chronic disorientation, traumatic brain injury, stroke, CNS infections (e.g., meningitis), hypoxia, or drug-induced mental status changes.

Alert

A level of consciousness in which the patient is fully receptive and responsive to interactions and environmental stimuli.

Lethargic

A level of consciousness where the patient responds appropriately when addressed, but responses are slow and ongoing stimulation is needed to maintain wakefulness.

Obtunded / Somnolent

A level of consciousness marked by difficulty in arousing, a requirement for constant stimulation to stay awake, and inconsistent execution of simple commands.

Semicomatose

A decreased level of consciousness where the patient requires extreme or repeated stimuli, exhibits purposeful motor movement without following verbal commands, and remains nonverbal.

Comatose

A state of profound unconsciousness characterized by a lack of purposeful or meaningful response to any stimuli, often accompanied by pathological posturing.

Orientation Assessment

The clinical evaluation of cognitive orientation across four specific parameters: person, place, time, and situation.

Recent Memory Assessment

A neurological evaluation technique that tests short-term recall by asking verifiable questions about recent occurrences, such as what the patient ate for dinner the night before.

Cranial Nerve III (Oculomotor Nerve)

The motor cranial nerve assessed via pupillary size, equality, shape, direct light reflex, and accommodation.

PERRLA

The neurological documentation acronym indicating that Pupils are Equal, Round, Reactive to Light, and Accommodate (by converging and constricting).

Miosis

Constriction of the pupils resulting in an resting diameter of less than $3\,\text{mm}$.

Mydriasis

Dilation of the pupils resulting in an enlarged diameter of greater than $7\,\text{mm}$.

Anisocoria

A condition characterized by unequal pupillary diameters between the two eyes.

Diplopia

The subjective perception of two images of a single object (double vision).

Pinpoint Pupils

Marked pupillary constriction frequently associated with narcotic and opioid administration or toxicity.

Pharmacological Pupillary Dilation

Pupillary enlargement (mydriasis) caused by agents such as scopolamine patches, amphetamines, cough medicine, cocaine, or LSD.

Cranial Nerve II (Optic Nerve)

The sensory cranial nerve evaluated through testing visual fields and gross peripheral vision.

Glasgow Coma Scale (GCS)

An objective scoring instrument assessing level of consciousness across three distinct categories: Eye opening ($\text{E}$), Motor response ($\text{M}$), and Verbal response ($\text{V}$).

EMV Component Maximums

The maximum point scores allocated in the Glasgow Coma Scale: Eye opening $= 4$, Motor response $= 6$, and Verbal response $= 5$.

GCS Total Score of 15

The maximum achievable score on the Glasgow Coma Scale, denoting fully intact and normal neurological responsiveness.

GCS Total Score of 3

The lowest possible Glasgow Coma Scale score, indicating complete unresponsiveness and severe brain injury.

GCS Comatose Threshold ($\le 7\text{--}9$)

The Glasgow Coma Scale range defining a comatose state, establishing the critical guideline that an score of less than $8$ indicates a need for endotracheal intubation.

GCS NT (Not Testable)

The documentation designation applied when a Glasgow Coma Scale component cannot be evaluated due to an interfering non-neurological barrier (such as a tracheostomy or facial trauma).

GCS Eye Opening: Score 4

The patient opens eyes spontaneously without requiring speech or painful touch ('S' in the EYES mnemonic).

GCS Eye Opening: Score 3

The patient opens eyes in response to verbal command or ear-piercing noise ('E' in the EYES mnemonic).

GCS Eye Opening: Score 2

The patient opens eyes only upon the application of a painful stimulus ('Y' in the EYES mnemonic).

GCS Eye Opening: Score 1

The patient exhibits no eye opening response under any conditions, keeping eyes shut ('E' in the EYES mnemonic).

GCS Verbal Response: Score 5

The patient provides oriented, coherent, and normal verbal conversation ('E' for Elegant in the VOICE mnemonic).

GCS Verbal Response: Score 4

The patient engages in conversation, but responses show confusion, disorientation, or incorrect details ('C' in the VOICE mnemonic).

GCS Verbal Response: Score 3

The patient utters intelligible and comprehensible words, but the statements are inappropriate or out of context ('I' in the VOICE mnemonic).

GCS Verbal Response: Score 2

The patient produces only obscure, incomprehensible sounds or groans rather than formed words ('O' in the VOICE mnemonic).

GCS Verbal Response: Score 1

The patient produces no vocalization or verbal output whatsoever ('V' for Voiceless in the VOICE mnemonic).

GCS Motor Response: Score 6

The patient correctly obeys verbal motor commands ('O' in the OLDBEN mnemonic).

GCS Motor Response: Score 5

The patient moves an extremity purposefully toward a painful stimulus to localize or remove it ('L' in the OLDBEN mnemonic).

GCS Motor Response: Score 4

The patient exhibits a flexion withdrawal response, rapidly pulling the body part away from pain ('D' for Draw away in the OLDBEN mnemonic).

GCS Motor Response: Score 3

The patient exhibits abnormal spastic flexion (decorticate posturing) in response to pain ('B' for Bend in the OLDBEN mnemonic).

GCS Motor Response: Score 2

The patient exhibits abnormal rigid extension (decerebrate posturing) in response to pain ('E' for Extension in the OLDBEN mnemonic).

GCS Motor Response: Score 1

The patient shows a complete absence of motor movement or muscle contraction to painful stimuli ('N' in the OLDBEN mnemonic).

Decorticate Posturing

An abnormal motor posture characterized by flexion of the upper extremities in toward the chest and core ('C' shape toward the cord).

Decerebrate Posturing

An abnormal motor posture marked by rigid extension and internal rotation of the extremities outwards away from the body ('e' shape).

Cervical Spinal Tract or Cerebral Hemisphere Dysfunction

The neuroanatomical site of injury associated with the clinical presentation of decorticate (flexor) posturing.

Midbrain or Pons Dysfunction

The deeper brainstem neuroanatomical site of injury indicated by decerebrate (extensor) posturing.

Graphesthesia

The sensory ability to recognize a number traced onto the skin, used clinically to detect lesions of nerve roots, the brainstem, spinal cord, sensory cortex, or thalamus.

Rapid Alternating Movements (RAM)

A motor coordination test where the patient taps the thumb quickly to each individual fingertip; impairment reflects upper motor neuron or extrapyramidal disease.

Finger-to-Finger Test

A cerebellar coordination assessment where the patient touches the examiner's index finger and then their own nose repeatedly as the examiner alters finger placement.

Proprioception

The neurological awareness that allows a person to perceive the position, motion, and equilibrium of their limbs in space without visual input.

Finger-to-Nose Test

A proprioceptive assessment in which the patient closes their eyes, extends the arms, and rapidly alternates touching the tip of their nose with each index finger.

Heel-to-Shin Test

A coordination and proprioceptive exam where the patient places the heel on the opposite knee and smoothly slides it down the shin to the ankle.

Communication Board

An augmentative visual tool utilized to support two-way expressive communication in patients experiencing dysphasia, aphasia, or mechanical barriers to speech.

Brainstem Herniation

The critical displacement of the cerebrum downward through the brainstem preceding brain death, clinically manifesting with decerebrate posturing.

Presbycusis Communication Strategy

A communication approach for older adults with hearing impairment involving facing the individual directly and speaking at a measured, slow pace without high-pitched tones.

Fall Prevention Teaching Visuals

Patient education recommendations for older adults emphasizing large font and high-contrast imagery while avoiding low-contrast orange or red text.

Tracheostomy Collar (Trach Collar)

A collar-style medical appliance placed around the neck over a tracheostomy tube to administer humidified air or supplemental oxygen.

Central Nervous System (Sensory Role)

The anatomical division composed of the brain and spinal cord that is responsible for receiving, analyzing, and interpreting incoming peripheral sensory impulses.