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33 Cards in this Set

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When a diver reports with a medical complaint, what, if available, can help aid in the examination?
The diver’s Health Record, including a baseline neurological examination, if available, and completed Diving Chart or Diving Log
What are the 6 parts of a neuro?
1. Mental status
2. Coordination
3. Cranial nerves
4. Motor (or Strength)
5. Sensory
6. Deep tendon reflexes
Describe things you are looking for when checking mental status?
This is best determined when you first see the patient and is characterized by his alertness, orientation, and thought process. Obtain a good history, including the dive profile, present symptoms, and how these symptoms have changed since onset. The patient’s response to this questioning and that during the neurological examination will give you a great deal of information about his mental status. It is important to determine if the patient knows the time and place, and can recognize familiar people and understands what is happening. Is the patient’s mood appropriate? Next the examiner may determine if the patient’s memory is intact by questioning the patient. The questions asked should be reasonable, and you must know the answer to the questions you ask.
What is the cognitive function in regards to checking mental status?
It is an intellectual process by which one becomes aware of, perceives, or comprehends ideas and involves all aspects of perception, thinking, reasoning, and remembering.
What are some suggested methods of assessing the cognitive functions?
1. The patient should be asked to remember something. An example would be “red ball, green tree, and couch.” Inform him that later in the examination you will ask him to repeat this information.
2. The patient should be asked to spell a word, such as “world,” backwards.
3. The patient should be asked to count backwards from 100 by sevens.
4. The patient should be asked to recall the information he was asked to remember at the end of the examination.
What is a good indicator of muscle strength and general coordination?
Observe how the patient walks. A normal gait indicates that many muscle groups and general brain functions are normal
What are some of the ways to check coordination (Cerebellar/Inner Ear Function)?
1. Heel-to-Toe Test. The tandem walk is the standard “drunk driver” test. While looking straight ahead, the patient must walk a straight line, placing the heel of one foot directly in front of the toes of the opposite foot. Signs to look for and consider deficits include:
a. Does the patient limp?
b. Does the patient stagger or fall to one side?
2. Romberg Test. With eyes closed, the patient stands with feet together and arms extended to the front, palms up. Note whether the patient can maintain his balance or if he immediately falls to one side. Some examiners recommend giving the patient a small shove from either side with the fingertips.
3. Finger-to-Nose Test. The patient stands with eyes closed and head back, arms extended to the side. Bending the arm at the elbow, the patient touches his nose with an extended forefinger, alternating arms. An extension of this test is to have the patient, with eyes open, alternately touch his nose with his fingertip and then touch the fingertip of the examiner. The examiner will change the position of his fingertip each time the patient touches his nose. In this version, speed is not important, but accuracy is.
4. Heel-Shin Slide Test. While standing, the patient touches the heel of one foot to the knee of the opposite leg, foot pointing forward. While maintaining this contact, he runs his heel down the shin to the ankle. Each leg should be tested.
5. Rapid Alternating Movement Test. The patient slaps one hand on the palm of the other, alternating palm up and then palm down. Any exercise requiring rapidly changing movement, however, will suffice. Again, both sides should be tested.
What are the 12 cranial nerves?
I - Olfactory
II - Optic
III - Oculomotor
IV - Trochlear
VI - Abducens
V - Trigeminal
VII - Facial
VIII - Acoustic
IX - Glossopharyngeal
X - Vagus
XI - Spinal Accessory
XII – Hypoglossal
What two nerves are not normally tested?
Olfactory (sense of smell) and Glossopharyngeal (gag reflex)
What does the Olfactory nerve control and how do you check it?
The olfactory nerve, which provides our sense of smell, is usually not tested
What does the Optic nerve control and how do you check it?
The optic nerve is for vision. It functions in the recognition of light and shade and in the perception of objects. This test should be completed one eye at a time to determine whether the patient can read. Ask the patient if he has any blurring of vision, loss of vision, spots in the visual field, or peripheral vision loss (tunnel vision). More detailed testing can be done by standing in front of the patient and asking him to cover one eye and look straight at you. In a plane midway between yourself and the patient, slowly bring your fingertip in turn from above, below, to the right, and to the left of the direction of gaze until the patient can see it. Compare this with the earliest that you can see it with the equivalent eye. If a deficit is present, roughly map out the positions of the blind spots by passing the finger tip across the visual field.
What do the Oculomotor, Trochlear, Abducens nerves control and how do you check them?
These three nerves control eye movements. All three nerves can be tested by having the patient’s eyes follow the examiner’s finger in all four directions (quadrants) and then in towards the tip of the nose (giving a “crossed-eyed” look). The oculomotor nerve can be
further tested by shining a light into one eye at a time. In a normal response, the pupils of both eyes will constrict.
What does the Trigeminal nerve control and how do you check it?
The Trigeminal Nerve governs sensation of the forehead and face and the clenching of the jaw. It also supplies the muscle of the ear (tensor tympani) necessary for normal hearing. Sensation is tested by lightly stroking the forehead, face, and jaw on each side with a finger or wisp of cotton wool.
What does the Facial nerve control and how do you check it?
The Facial Nerve controls the face muscles. It stimulates the scalp, forehead, eyelids, muscles of facial expression, cheeks, and jaw. It is tested by having the patient smile, show his teeth, whistle, wrinkle his forehead, and close his eyes tightly. The two sides should perform symmetrically. Symmetry of the nasolabial folds (lines from nose to outside corners of the mouth) should be observed.
What does the Acoustic nerve control and how do you check it?
The Acoustic Nerve controls hearing and balance. Test this nerve by whispering to the patient, rubbing your fingers together next to the patient’s ears, or putting a tuning fork near the patient’s ears. Compare this against the other ear.
What does the Glossopharyngeal nerve control and how do you check it?
The Glossopharyngeal Nerves transmit sensation from the upper mouth and throat area. It supplies the sensory component of the gag reflex and constriction of the pharyngeal wall when saying “aah.” Test this nerve by touching the back of the patient’s throat with a tongue depressor. This should cause a gagging response. This nerve is normally not tested.
What does the Vagus nerve control and how do you check it?
The Vagus Nerve has many functions, including control of the roof of the mouth and vocal cords. The examiner can test this nerve by having the patient say “aah” while watching for the palate to rise. Note the tone of the voice; hoarseness may also indicate vagus nerve involvement.
What does the Spinal Accessory nerve control and how do you check it?
The Spinal Accessory Nerve controls the turning of the head from side to side and shoulder shrug against resistance. Test this nerve by having the patient turn his head from side to side. Resistance is provided by placing one hand against the side of the patient’s head. The examiner should note that an injury to the nerve on one side will cause an inability to turn the head to the opposite side or weakness/absence of the shoulder shrug on the affected side.
What does the Hypoglossal nerve control and how do you check it?
The Hypoglossal Nerve governs the muscle activity of the tongue. An injury to one of the hypoglossal nerves causes the tongue to twist to that side when stuck out of the mouth.
What are you checking during the Motor examination?
A diver with decompression sickness may experience disturbances in the muscle system. The range of symptoms can be from a mild twitching of a muscle to weakness and paralysis.
Extremity strength testing is divided into what two parts?
Upper body and lower body
What is the scale muscle strength is graded?
(0-5) as follows:

(0) Paralysis. No motion possible.
(1) Profound Weakness. Flicker or trace of muscle contraction.
(2) Severe Weakness. Able to contract muscle but cannot move joint against gravity.
(3) Moderate Weakness. Able to overcome the force of gravity but not the resistance of the examiner.
(4) Mild Weakness. Able to resist slight force of examiner.
(5) Normal. Equal strength bilaterally (both sides) and able to resist examiner.
How are the upper extremities tested?
These muscles are tested with resistance provided by the examiner. The patient should overcome force applied by the examiner that is tailored to the patient’s strength.
What are the six muscle groups tested in the upper extremity?
1. Deltoids
2. Latissimus
3. Biceps
4. Triceps
5. Forearm muscles
6. Hand muscles
How are the lower extremities strength tested?
By watching the patient walk on his heels for a short distance and then on his toes. The patient should then walk while squatting (“duck walk”). These tests adequately assess lower extremity strength, as well as balance and coordination. If a more detailed examination of the lower extremity strength is desired, testing should be accomplished at each joint as in the upper arm.
What are the common presentations of decompression sickness in a diver that may indicate spinal cord dysfunction, checked during the sensory function examination?
1. Pain
2. Numbness
3. Tingling (“pins-and-needles” feeling; also called paresthesia)
How do the dermatomal areas of the trunk run?
In a circular pattern around the trunk
How do the dermatomal areas in the arms and legs run?
In a more lengthwise pattern
How is the trunk sensory tested?
Move the pinwheel or other sharp object from the top of the shoulder slowly down the front of the torso to the groin area. Another method is to run it down the rear of the torso to just below the buttocks. The patient should be asked if he feels a sharp point and if he felt it all the time. Test each dermatome by going down the trunk on each side of the body. Test the neck area in similar fashion.
How is the limbs sensory tested?
In testing the limbs, a circular pattern of testing is best. Test each limb in at least three locations, and note any difference in sensation on each side of the body. On the arms, circle the arm at the deltoid, just below the elbow, and at the wrist. In testing the legs, circle the upper thigh, just below the knee, and the ankle.
How are the hands sensory tested?
The hand is tested by running the sharp object across the back and palm of the hand and then across the fingertips.
How do you note abnormalities during sensory testing?
If an area of abnormality is found, mark the area as a reference point in assessment. Some examiners use a marking pen to trace the area of decreased or increased sensation on the patient’s body. During treatment, these areas are rechecked to determine whether the area is improving. An example of improvement is an area of numbness getting smaller.
What are some things you are looking for when testing the deep tendon reflexes?
Determine if the patient’s response is normal, nonexistent, hypoactive (deficient), or hyperactive (excessive). The patient’s response should be compared to responses the examiner has observed before. Notation should be made of whether the responses are equal bilaterally (both sides) and if the upper and lower reflexes are similar. If any difference in the reflexes is noticed, the patient should be asked if there is a prior medical condition or injury that would cause the difference. Isolated differences should not be treated, because it is extremely difficult to get symmetrical responses bilaterally.