Clinical Skills Nervous System

Front 1

Blood supply to brain (4)

Back 1

circle of willis, vertebral artery, internal carotid artery, basilar artery

Front 2

Components of Reflex arc:

Back 2

Sensory receptor → Afferent neuron (toward brain) → Integrating center → Efferent neuron (away from brain) → Effector

Front 3

# of Cranial nerves

Back 3

12: sensory or mixed nerves (sensory and motor)

Front 4

CN # 1

Back 4

I: Olfactory = Smell

Assessment:
Pick a fragrant, non-irritating odor (peppermint, vanilla)
Close both eyes and occlude one nostril
Place the fragrance below the nose and ask the patient to identify the smell

Front 5

CN # 2

Back 5

II: Optic = Sight

Assessment: Visual acuity; Visual fields; Light reflex; Inspection

Front 6

CN # 3

Back 6

III: Oculomotor:
M: EOM, upper eyelid
PS: lens adjustment, pupil constriction

Assessment: Movement of eyes, pupil size and shape, response to light;
Nystagmus (twitching)

Front 7

CN # 4

Back 7

IV: Trochlear

M: Eye movement: down and inward
S: Muscle sense

Front 8

CN # 5

Back 8

V: Trigeminal:
M: Mastication
S: Touch, pain, temperature of the eye, mouth, nose, scalp

Assessment:
Inspect and palpate jaw muscles with teeth clenched
Touch face, scalp, and chin areas with different types of surfaces, ask patient to report the sensation

Corneal reflex: touch corner of the eye with a piece of cotton, should result in a symmetric blink

Front 9

CN # 6

Back 9

VI: Aducens
M: Lateral movement of the eye
S: Muscle sense

Front 10

CN # 7

Back 10

VII: Facial
M: Facial movements, closure of eye and mouth
S: Taste

Assessment: Observe the following facial movements:
Raising of eyebrows, wrinkling the forehead, closing eyes, frowning, smiling, showing teeth, whistling, puffing cheeks

Front 11

CN # 8

Back 11

VIII: Vestibulocochlear
S: Hearing and balance

Assessment: Audiometer;

Romberg test for balance: Have the patient stand with arms at their side and their eyes closed for 20-30 seconds; Balance should remain intact

Front 12

CN # 9

Back 12

IX: Glossopharyngeal

M: Swallowing
S: Pharynx, taste, carotid reflex

Front 13

CN # 10

Back 13

X: Vagus:
M: Palate, pharynx, larynx
S: Pharynx, viscera, auditory canal
A: GI, cardiac

Assessment
Gag reflex

Front 14

CN # 11

Back 14

XI: Accessory
M: Voluntary swallowing, sternoclediomastoid, and trapezius muscles

Assessment
Have patient shrug shoulders upwards while your hands are applying pressure
Place your hand on the side of the patients face, have them turn toward your hand against pressure

Front 15

CN # 12

Back 15

XII: Hypoglossal:
M: Tongue movement

Assessment
Have the patient stick their tongue out
Look for asymmetry or deviation

Front 16

Balance Romberg test

Back 16

Positive sign = swaying, falling or widening stance to prevent a fall
May indicate cerebellar or vestibular dysfunction, ETOH, MS

Front 17

Conducting balance test

Back 17

Have the patient stand up with their back toward you
Gently pull back on their shoulders
If present = retropulsion, may indicate PD

Front 18

Gait

Back 18

Look for rate, rhythm, arm motion, posture, balance

Walk away and back toward you in a normal manner; Walk on their toes; Walk on their heals
Walk heal to toe in a straight line

Front 19

Gait Abnormalities

Back 19

Spastic hemiparesis:

Paralyzed foot is fixed in a flex position → dragged in a semi-circle
Paralyzed arm is flexed across the body; May be indicative of a CVA

Front 20

Gait: Spastic diplegia

Back 20

Knees cross or touch when walking
May be indicative of MS

Front 21

Gait: Cerebellar Ataxia

Back 21

Wide-based stance

Front 22

Reflex Grade

Back 22

Graded on a scale of 0 – 4+
4+: Hyperactive with clonus
3+: Hyperactive without clonus
2+: Normal
1+: Hypoactive or diminished
0: Absent

Front 23

Deep Tendon Reflexes

Back 23

Biceps, triceps, brachioradialis, patellar, achilles tendon
Patient should relax, muscles partially stretched
Strike the tendon with a reflex hammer

Front 24

Plantar Reflex

Back 24

Patient is seated or lying down with leg out in front of them
Stroke the bottom of the foot with a blunt object
Should result in flexion (toes curling downward)
If results in dorsiflexion (toes being brought toward the shin) =
+ Babinski sign
May be indicative of a CNS lesion

Front 25

Mini Mental State Exam (MMSE) Grade

Back 25

30 question screening tool for cognitive impairment

> 27: normal
20-26: mild impairment
10-19: moderate impairment
< 10: severe impairment

Front 26

MMSE Questions

Back 26

Orientation: Ex: season, date, month, location, city
Registration: Ex: naming of 3 unrelated objects
Attention: Ex: serial 7’s
Recall: Ex: remembering the 3 unrelated words
Language: Ex: following directions, reading, writing, copying