Exam 3

What sensory symptom should be assessed during neurological assessment

numbness/tingling

Equipment needed for neurological assessment

• penlight

• tongue blade

• cotton swab

• cotton ball

• tuning fork

• percussion / reflex hammar

What major areas are assessed during neurological exam

• LOC/mental status

• voice / speech

• involuntary movements

• expression / affect

• cranial nerves

• motor function / gait

• reflexes

• sensation

MMSE

Mini-mental state examination

what is the mini-mental state examination

clinical test to screen for cognitive impairment (i.e dementia/alzheimers) evaluates orientation, registration, attention / calculation, recall, and language

Normal pupil size range

2-6mm

Cranial nerve I

Olfactory nerve

Function of cranial nerve I

sense of smell

Cranial nerve II

optic nerve

Function of cranial nerve II

vision

Which cranial nerves control extraocular eye movements

III (oculomotor), IV (trochlear), and VI (abducens)

Cranial nerve III

oculomotor nerve

which cranial nerve is responsible for pupil constriction

Cranial nerve III

Cranial nerve IV

trochlear nerve

Cranial nerve VI

abducens nerve

Cranial nerve V

trigeminal nerve

Function of cranial nerve V

facial sensation / chewing muscles

Cranial nerve VII

Facial nerve

Function of cranial nerve VII

facial expressions and taste

Cranial nerve VIII

Vestibulocochlear nerve (acoustic)

Function of cranial nerve VIII

hearing and balance

What cranial nerves are tested together for swallowing and gag reflex

CN IX (glossopharyngeal) and CN X (vagus)

Cranial nerve XI

Accessory nerve

Function of cranial nerve XI

shoulder shrug & head turning

Cranial nerve XII

hypoglossal nerve

Function of cranial nerve XII

tongue movement

Balance and cerebellar tests

• Gait

• Romberg test

• Rapid alternating movements

• Finger to finger test

• Finger to nose test

Gait test assesses….

Balance/coordination while walking

Romberg test assesses…

Balance and proprioception

proprioception

the body’s subconscious ability to sense its own movement, position, and orientation in space

What are rapid alternating movements used to assess?

cerebellar function and coordination

pneumonic to remember cranial nerves

Oh, Oh, Oh, To Touch And Feel Very Good Velvet, Ah Heaven!

what does the finger to nose test assess

cerebellar function and coordination

what sensations are carried by the spinothalamic tract

• pain

• temperature

• light touch

What sensations are carried by the posterior column tract

• vibration

• position sense (kinesthesia)

• tactile discrimination

kinesthesia

awareness of body movement

stereognosis

Ability to identify a familiar object by touch

graphesthesia

ability to identify a number / letter traced on the skin

what is two point discrimination

ability to distinguish two separate points touched simultaneously

What is extinction

Inability to perceive one of two simultaneous stimuli

Which reflexes should be assessed during a neurological examination

• biceps

• triceps

• brachioradialis

• quadriceps (patellar)

• achilles

• plantar reflex (babinski sign)

What spinal levels are tested by the biceps reflex

C5-C6

What spinal levels are tested by the triceps reflex

C7-C8

What spinal levels are tested by the brachioradialis reflex

C5-C6

What spinal levels are tested by the quadriceps (patellar) relfex

L2-L4

What spinal levels are tested by the achilles reflex

S1-S2

How is babinski reflex tested

stroke the lateral sole of the foot and across the ball of the foot

What is a normal babinski response in adults

toes curl downward (plantar flexion)

What is a positive babinski sign in adults

great toe dorsiflexes and other toes fan outward

What does a positive babinski sign in adults indicate

upper motor neuron / CNS dysfunction

reflex grading scale

0: absent reflex

1+: present but diminished

2+: normal

3+: slightly increased; may still be normal

4+: hyperactive reflex

Organs in RUQ

• Liver

• Gallbladder

• Head of pancreas

Organs located in RLQ

• Appendix

• Cecum

• Right ureter

Organs located in LUQ

• Spleen

• Stomach

• Body/tail of pancreas

Organs located in LLQ

• descending colon

• Sigmoid colon

• left ureter

What should the patient do before beginning an abdominal assessment?

empty their bladder

correct order of abdominal assessment

inspect —> auscultate —> percussion —> palpate

What part of stethoscope is used to assess bowel sounds

diaphragm

are bowel sounds high or low pitch

high pitch

normal range of bowel sounds per minute

5-30 sounds per minute

NABS stands for…

normal active bowel sounds

Hypoactive bowel sounds

fewer than 5 per minute

hyperactive bowel sounds

more than 30 per minute

How deep is “light palpation”

approximately 1 cm

How deep is deep palpation

approximately 4-6 cm

Positive Blumberg sign suggests…

peritoneal irritation

Murphy’s sign

Inspiratory arrest during palpation of gallbladder area, used to assess for acute cholecystitis

What does a positive Murphy’s sign suggest

Gallbladder inflammation (cholecystitis)

What is assessed with the iliopsoas muscle test

Irritation of the iliopsoas muscle, often associated with appendicitis

What is the predominant percussion sound hear over a normal abdomen?

General tympany

Why is tympany the predominant abdominal percussion sound?

Because of air within the intestines

What organ measurement can be assessed by abdominal percussion?

liver span

What splenic finding can be assessed by abdominal percussion

splenic dullness

What is costovertebral angle (CVA) tenderness?

Pain produced when costovertebral angle is percussed

What can CVA tenderness indicate?

Kidney inflammation / infection

How should a walker be adjusted for proper fit

At waist height with elbows slightly flexed

Which side should a cane be held on?

Strong side

What does SCD stand for

Sequential compression device

How far below the axilla should crutches be positioned?

three finger widths below the axilla

How many bones in the adult human body

206

Approximately how many muscles in the human body

About 600

Hypotonicity

a muscle lacking normal tone or tension

Spasticity

involuntary condition where muscles stiffen or tighten, making movement difficult and painful

Scoliosis

Lateral curvature of the spine

Kyphosis

Excessive outward curvature of the spine, often called a "hunchback" or "roundback"

Lordosis

inward curvature of the spine, typically in the lower back

How are jaw muscles assessed during TMJ examination

Have patient clench their teeth while palpating the jaw muscles for uniformity

Chvostek’s sign

Facial muscle twitching when the facial nerve is tapped; associated with hypocalcemia

Trousseau’s sign

Carpal spasm induced by inflating a blood pressure cuff; sign of hypocalcemia

How long is the blood pressure cuff left inflated when assessing Trousseau’s sign?

1-3 minutes

Heberden’s nodes

Bony enlargements of the distal interphalangeal (DIP) joints, commonly seen in osteoarthritis

Normal hip flexion range?

90º-120º

What position is commonly used for a pelvic examination

lithotomy position

Candidiasis (moniliasis)

yeast infection

true or false: the left testicle typically hangs lower

true

Cryptorchidism

Failure of one or both testes to descend into the scrotum

Hypospadias

urethral opening located on the underside of the penis

epispadias

urethral opening located on the upper suface of the penis

Testicular torsion

Twisting of the spermatic cord causing reduced blood flow to the testicle

Epididymitis

Inflammation of the epididymis