Final Health Assessment Neuro

Front 1

Cerebral Cortex:
Frontal ‐

Back 1

personality, emotion, behavior, intellect

Front 2

Cerebral Cortex:
Parietal ‐

Back 2

sensation

Front 3

Cerebral Cortex:
Occipital ‐

Back 3

vision

Front 4

Cerebral Cortex:
Temporal

Back 4

auditory

Front 5

Cerebral Cortex:
Werenike’s

Back 5

temporal associated w/auditory
reception , damage = aphasia

Front 6

Cerebral Cortex
Broca’s

Back 6

frontal lobe mediates speech , damage =aphasia

Front 7

Cerebral Cortex
Basal Ganglia

Back 7

primitive motor areas, automatic
ass’t movement

Front 8

Cerebral Cortex
Thalamus ‐

Back 8

relay station

Front 9

Cerebral Cortex
Hypothalamus

Back 9

temp control, sleep center

Front 10

Cerebellum: located under

Back 10

occipital lobe

Front 11

Cerebellum:
controls
4 points

Back 11

– motor coordination of voluntary movements
– equilibrium, muscle tone
– coordinates movement
– operates entirely below conscious level

Front 12

– Brain Stem ‐ central core
3 parts

Back 12

• Midbrain
• Pons
• Medulla

Front 13

Spinothalamic Tract:
lateral tract =

Back 13

pain, temperature

Front 14

Spinothalamic Tract:
anterior tract =

Back 14

crude or light touch

Front 15

Posterior Columns:
control 3 things

Back 15

• position ‐ proprioception
• vibration
• tactile discrimination

Front 16

Corticospinal / Pyramidal
3 points

Back 16

• voluntary movement ‐ skilled, purposeful, discrete
• cross to other side
• higher level ‐ body map

Front 17

Major Motor Pathways:
Extrapyramidal

Back 17

older, lower level , all fibers outside above
• muscle control, gross automatic movements

Front 18

Major Motor Pathways:
Cerebellar

Back 18

• coordinates movement, equilibrium, posture

Front 19

Nerves outside CNS
• Carry input to CNS via

Back 19

sensory afferent fibers

Front 20

Deliver output from CNS

Back 20

via motor efferent
fibers

Front 21

cranial nerves mneumonic

Back 21

ooo to touch adn feel virgin girls viginas sounds hot

some say marry money but my brother says bad bitches marry money

Front 22

Dorsal ___________ root

Back 22

(afferent)

Front 23

Ventral__________ root

Back 23

(efferent)

Front 24

C6 –

Back 24

thumb

Front 25

T4 –

Back 25

nipple line

Front 26

T10 –

Back 26

umbilicus

Front 27

L5 –

Back 27

top of foot

Front 28

S1

Back 28

bottom of foot

Front 29

S2-S4

Back 29

perineum

Front 30

Neuro Sympathetic

Back 30

Pupils dilate
Incr awareness

Front 31

Neuro Parasympathetic

Back 31

Normal pupils

Front 32

CV Sympathetic

Back 32

Inc: HR, BP,
cardiac motility

Front 33

CV Parasympathetic

Back 33

Dec HR, cardiac
motility

Front 34

Resp Sympathetic

Back 34

Inc RR,depth &
dilation

Front 35

Resp Parasympathetic

Back 35

bronchial constriction

Front 36

GI Sympathetic

Back 36

Dec GI motility
Gastric secretions
Inc glycogenolysis
Dec insulin prod
Sphincter contraction

Front 37

GI Parasympathetic

Back 37

Inc gastric
Motility,gastric
secretions,
sphinc dilation

Front 38

GU Sympathetic

Back 38

Dec urine output &
Renal blood flow

Front 39

GU Parasympathetic

Back 39

Normal urine
output

Front 40

Reflex Arc:

Back 40

Defense mechanism of the nervous system
– operates below consciousness
– permits quick reaction to potentially painful or
damaging situations
– Simple
– DTR

Front 41

Infant Assessment:
Abnormalities present as

Back 41

‘failure to do”

Front 42

DDST

Back 42

Normative measure of development is
the developmental quotient

Developmental Quotients
>85 normal
70‐85 possibly delayed; follow needed
<70 delayed

Front 43

Fluent aphasia –

Back 43

“Wernicke’s” ‐injury to temporal or
parietal lobe ; talk & read easily but words nonsensical,
jumbled, meaningless

Front 44

Nonfluent aphasia‐

Back 44

“Broca’s”‐ frontal lobe lesion:
struggle w/words, slow, monosyllabic

Front 45

Obtunded:

Back 45

sleeps most of the time, makes
few spontaneous movements, vigorous
shaking & name calling required ‐ capable of
verbal response but likely inappropriate

Front 46

Stuporous:

Back 46

semi‐comatose, unconscious most
of time, strong painful stimuli required for w/
drawl response

Front 47

Comatose

Back 47

can not be aroused

Front 48

anosmia

Back 48

(Greek a –lack of & osme sense of smell) loss
from smoking, cocaine allergic rhinitus,
asymmetric loss ‐ significant

Front 49

hemianopsia

Back 49

defect in peripheral vision ‐

Front 50

Olfactory I : test

Back 50

occlude 1 nares at a time and assess patency
– with eyes closed and 1 nares occluded present
aromatic substance for identification
– repeat with other nares
– Norm; + identification or decreased bilaterally
w/aging

Front 51

Optic ‐ II test

Back 51

Visual Acuity
– Visual Fields by confrontation
– Ocular Fundus by Opthalmoscope

Front 52

Oculomotor III, Trochlear IV, Abducens VI
test

Back 52

test pupils for size, regularity, equality, reaction,
accommodation
– test extraoculomotor movement

Front 53

Trigeminal V: motor

Back 53

palpate temporal & masseter
muscles ‐ clench teeth

Front 54

Trigeminal V:Sensory Function:

Back 54

w/eyes closed touch face w/lt
touch ophthalmic, maxillary, mandibular

Front 55

Trigeminal V:
Corneal Reflex:

Back 55

touch cornea w/wisp of cotton
• NORM: blink bilaterally
• ABN: no blink

Front 56

Facial VII: Motor:

Back 56

note mobility & symmetry when Pt smiles, frowns,
closes eye tightly against resistance, lift eyebrows, shows
teeth, puff out cheeks
• ABN muscle ABN: weakness, loss of symmetry, Bell’s Palsy

Front 57

Facial VII: Sensory:

Back 57

apply to tongue w/applicator a sweet, salt & sour
flavor
• NORM: identify taste
• ABN: loss of taste

Front 58

Bell’s Palsy
Main symptom

Back 58

paralysis or weakness on one side of the face, along with a sagging
eyebrow and difficulty closing the eye

Front 59

The exam for CN 7 palsy is remembered by the
mnemonic COWS:

Back 59

C lose your eyes
O pen (PCP tries to open patient's eyes)
Wrinkle your forehead
S mile

Front 60

Acoustic VIII test

Back 60

Vestibular dysfunction
– test hearing acuity w/ Weber, Rinne
– ABN: decrease or loss of hearing, conduction or
sensorial

Front 61

Glossopharyngeal IX, Vagus X:
– Motor

Back 61

Depress tongue w/blade note pharyngeal
movement as Pt says “AHHH”, touch posterior
pharyngeal wall for gag reflex, Note voice smooth
or strained, swallowing

Front 62

Spinal Accessory XI: test

Back 62

examine sternomastoid & trapezius for equal
strength
– Rotate head forcibly against resistance
– Shrug shoulders against resistance
– NORM: equal on both sides
– ABN: atrophy, muscle
weakness, paralysis

Front 63

Hypoglossal XII:

test

Back 63

inspect tongue, have
Pt stick tongue out and
move side to side,
repeat “ light, tight,
dynamite’
– NORM: full movement,
clear distinct tones
– ABN: atrophy,
fasciulations, deviation
of tongue

Front 64

Decerebrate rigidity:

Back 64

rigid & sustained contracture of
extensor – midbrain & pontine damage

Front 65

Decorticate rigidity:

Back 65

rigid & sustained hyperflexion –
lesions that interfere w/corticospinal tract

Front 66

Pronator Drift:

Back 66

downward drifting may indicate
hemiparesis or IICP

Front 67

Meningeal Irritation
General signs

Back 67

Violent headache
– Photophobia
– Fever
– Nausea/vomiting
– Decreased loc & convulsions

Front 68

Nuchal rigidity

Back 68

W/pt in supine position flex neck
– Resisting this movement is a + sign for irritation: meningitis
by bacteria, virus,fungi, mycobacteria

Front 69

Meningeal Irritation
Kernig’s sign

Back 69

Pt in recumbent position, flex hip & flex @ knee,
attempt to extend knee
– + is resistance to extension & pain (spasm of
hamstring) reliable sign of irritation(r/o HD)

Front 70

Acoustic VIII test

Back 70

Vestibular dysfunction
– test hearing acuity w/ Weber, Rinne
– ABN: decrease or loss of hearing, conduction or
sensorial

Front 71

Glossopharyngeal IX, Vagus X:
– Motor

Back 71

Depress tongue w/blade note pharyngeal
movement as Pt says “AHHH”, touch posterior
pharyngeal wall for gag reflex, Note voice smooth
or strained, swallowing

Front 72

Spinal Accessory XI: test

Back 72

examine sternomastoid & trapezius for equal
strength
– Rotate head forcibly against resistance
– Shrug shoulders against resistance
– NORM: equal on both sides
– ABN: atrophy, muscle
weakness, paralysis

Front 73

Hypoglossal XII:

test

Back 73

inspect tongue, have
Pt stick tongue out and
move side to side,
repeat “ light, tight,
dynamite’
– NORM: full movement,
clear distinct tones
– ABN: atrophy,
fasciulations, deviation
of tongue

Front 74

Decerebrate rigidity:

Back 74

rigid & sustained contracture of
extensor – midbrain & pontine damage

Front 75

Decorticate rigidity:

Back 75

rigid & sustained hyperflexion –
lesions that interfere w/corticospinal tract

Front 76

Pronator Drift:

Back 76

downward drifting may indicate
hemiparesis or IICP

Front 77

Meningeal Irritation
General signs

Back 77

Violent headache
– Photophobia
– Fever
– Nausea/vomiting
– Decreased loc & convulsions

Front 78

Nuchal rigidity

Back 78

W/pt in supine position flex neck
– Resisting this movement is a + sign for irritation: meningitis
by bacteria, virus,fungi, mycobacteria

Front 79

Meningeal Irritation
Kernig’s sign

Back 79

Pt in recumbent position, flex hip & flex @ knee,
attempt to extend knee
– + is resistance to extension & pain (spasm of
hamstring) reliable sign of irritation(r/o HD)

Front 80

Meningeal Irritation
Brudzinski sign

Back 80

– Passively flex neck forward to chest
– + response is flexion of 1 or both legs to pelvis
arms may also flex

Front 81

– Romberg’s test:

Back 81

• Stand w/feet together and arms at sides, close
eyes & hold position for 20 sec
• NORM: able to hold w/no or minimal sway
• ABN: + Romberg = sways, falls, must widen
base of feet to stop fall indicates MS, ETOH,
loss of proprioception & vestibular function

Front 82

Rapid Alternating Movement RAM:

Back 82

Pat knees w/ both hands with increasing speed
• NORM: equal turning & quick rhythmic pace
• ABN: lack of coordination, slow, clumsy , sloppy
response seen w/ cerebellar disease

Front 83

Neuro Assessment ‐ Sensory Sys
• Spinothalamic tract:
Pain;
Temperature:
Light touch;

Back 83

Pain; perceive pin prick, “sharp” vs. “dull”
– Temperature: fill 2 test tubes w/warm or cold water,
place
– Light touch; wisp of cotton
• eyes closed
• random, unpredictable order

Front 84

Spinothalamic tract:
Hyperesthesia:

Back 84

increased or altered cutaneous
sensitivity to touch, pain or temperature

Front 85

Spinothalamic tract:
Hypoesthesia:

Back 85

decreased cutaneous sensitivity to
touch, pain or temperature

Front 86

Spinothalamic tract:
Analgesic:

Back 86

absence of cutaneous sensitivity to
touch, pain or temperature

Front 87

Posterior Column:
– Position ‐ Kinesthesia:

Back 87

tests ability to perceive
passive movements of extremities

Front 88

Posterior Column:Tactile Discrimination ‐ Fine
Touch
– Stereogenisis
– Graphesthesia
– Two‐Point Discrimination
– Extinction
– Point location

ABN: indicates

Back 88

inability to perform indicates lesion of
sensory cortex or posterior colum

Front 89

Reflex Response:
4-0

Back 89

4+ very brisk hyperactive w/clonus = disease
– 3+brisker than average, may indicate disease
– 2+average, normal
– 1+ diminished, low normal
– 0 no response = SC damage

Front 90

• Achilles S1 to S2: “ ankle jerk” Hold foot in
dorsi‐flexion & strike tendon directly
– N = plantar flexes against hand
– can see slowed relaxation phase in _______________

Back 90

hypothyroidism

Front 91

Pathological Reflexes:
– Grasp: abn after infancy

Back 91

Frontal lesion on contralateral side

Front 92

Snout: puckering of lips‐ abn after infancy

Back 92

Amyotrophic lateral sclerosis(ALS)

Front 93

Glabellar: hyperactive blinking response w/tap to
forehead

Back 93

Lesion to pons, Parkinson’s

Front 94

Sucking: abn after infancy

Back 94

Bifrontal disease

Front 95

Pathological Reflexes:
– Clonus:

Back 95

Upper motor neuron disease,
preeclampsia

Front 96

Babinski: norm in infancy until 15‐18
months

Back 96

Abn: fan great toe w/toes abduct –
lesions pyramidial tract‐ stroke/trauma

Front 97

Testing for clonus

Back 97

Support knee in slightly flexed position
Quickly dorsiflex foot & hold in that position
+ = rhythmic oscillation of involuntary muscle
contraction