Neurologic System

Front 1

The central nervous system consists of what?

Back 1

 Brain and Spinal Cord

Front 2

function of central nervous system

Back 2

 main network of coordination and control for the body

Front 3

autonomic nervous system function

Back 3

1. coordinate and regulate the internal organs of the body, such as cardiac muscle and smooth muscle

Front 4

autonomic nervous system divisons

Back 4

it has two divisions, each tending to balance the impulses of the other

sympathetic and parasympathetic

Front 5

autonomic nervous system: sympathetic

Back 5

i. prods the body into action during times of physiologic and psychologic stress
ii. Stress

Front 6

autonomic nervous system: parasympathetic

Back 6

i. functions in a complementary and eight counterbalancing manner to conserve body resources and maintain day-to-day body functions such as digestion and elimination
ii. Relaxation
iii. Basal Body Functions

Front 7

Peripheral nervous system: what does it consist of?

Back 7

Comprising cranial and spinal nerves and the ascending and descending pathways

Front 8

Peripheral nervous system: Function

Back 8

Comprising cranial and spinal nerves and the ascending and descending pathways, arries information to and from the central nervous system.
 Motor and sensory nerves and ganglia outside the CNS
 Motor/Sensory Nerves carries information to and from the central nervous system
 Ganglia
1. Transports info to and from CNS

Front 9

Interrelationships of nervous system permit the body to perform the following:

Back 9

 Receiving sensory stimuli from environment
 Identifying/integrating adaptive processes for maintenance
 Orchestrating changes for adaptation/survival
 Integrating responses of CNS/endocrine system
 Controlling cognitive/voluntary behavioral processes
 Controlling subconscious/involuntary functions

Front 10

Cerebrum: functions

Back 10

 to the cerebral hemispheres, each divided into lobes, form the cerebrum
 the gray outer layer, the cerebral cortex, houses the higher mental functions and is responsible for general movement, visceral functions, perception, behavior, and the integration of these functions
 comissural fibers (corpus callosum) interconnects a counterpart. As each hemisphere, permitting the coordination of activities between the hemispheres

Front 11

Cerebrum: Frontal lobe

Back 11

 Voluntary skeletal movement Repetitive movement

Front 12

Cerebrum: Parietal Lobe

Back 12

 Processes sensory data
 assists with the interpretation of tactile sensations (i.e., temperature, pressure, pain, size, shape, texture, and two point discrimination)
 recognition of body parts awareness of body position (proprioception) are dependent on the parietal lobe

Front 13

Cerebrum: Occipital lobe

Back 13

 Interprets visual data

Front 14

Cerebrum: Temporal lobe

Back 14

 Perception/ interpretation of sounds
 Integration of taste/smell/ balance

Front 15

Cerebrum: Limbic system

Back 15

 Mediates behavior patterns for survival
 Problem with it you lose consciousness

Front 16

Cerebellum: Function

Back 16

o Aids in integration of voluntary movement(the cerebellum is the motor cortex of the cerebrum in the integration of voluntary movement)
o Without it movement would be jerky
o Processes sensory information from the eyes, ears, touch receptors, and musculoskeleton
o Uses sensory data for reflexive control of
 Muscle tone
 Equilibrium
 Posture

Front 17

Brainstem: function

Back 17

o the brainstem is the pathway between the cerebral cortex the spinal cord, and it controls many involuntary functions

Front 18

Brainstem: parts

Back 18

 Medulla oblongata
• sites where the descending corticospinal tracts decussate (cross to the contralateral side)
 Midbrain
 Pons
• transmit information between the brainstem and cerebellum, relating motor information from the cerebral cortex to the contralateral cerebellar hemisphere
 Diencephalon

Front 19

How many cranial nerves

Back 19

12

Front 20

 cranial nerves are peripheral nerves that arise from the ____ rather than the ________

Back 20

 cranial nerves are peripheral nerves that arise from the brain rather than the spinal cord

Front 21

 each nerve has motor or _____ functions, and four cranial nerves have ______ functions

Back 21

 each nerve has motor or sensory functions, and fourr cranial nerves have parasympathetic functions

Front 22

CN I

Back 22

Olfactory
o sensory: smell reception and interpretation

Front 23

CN II

Back 23

Optic
o sensory: visual acuity and visual fields

Front 24

CN III

Back 24

Oculomotor
o motor: raise eyelids, most extraocular movements
o parasympathetic: a bleary constriction, changes lens shape

Front 25

CN IV

Back 25

Trochlear
o motor: downward, inward eye movement

Front 26

CN V

Back 26

Trigeminal
o motor: jaw opening and clenching, chewing and mastication
o sensory: sensation to cornea, iris, lacrimal glands, conjunctiva, eyelids, four head, nose, nasal and melt mucosa, teeth, tongue, ear, facial skin

Front 27

CN VI

Back 27

: Abducens
o motor: lateral eye movement

Front 28

CN VII

Back 28

: Facial
o motor: movement of facial expression muscles except jaw, close eyelids, labial speech sounds
o sensory: taste-anterior two thirds of tongue, sensation to pharynx
o parasympathetic: secretion of saliva and tears

Front 29

CN VIII

Back 29

Acoustic
o sensory: hearing in equilibrium

Front 30

CN IX

Back 30

Glossopharyngeal
o motor: voluntary muscles for swallowing phonation
o sensory: sensation of nasopharynx, gag reflex, taste-posterior one third of tongue
o parasympathetic: secretion of salivary glands, carotid reflex
o motor: voluntary muscles of phonation (guttural speech sounds, and swallowing

Front 31

CN X

Back 31

Vagus
o sensory: sensation behind here in part of the external ear canal
o parasympathetic: secretion of the digestive enzymes; peristalsis; carotid reflex; involuntary action of heart, lungs, and digestive tract

Front 32

CN XI

Back 32

Spinal Accessory
o motor: head turn, shrug shoulders, some actions a phonation

Front 33

CN XII

Back 33

Hypoglossal
o motor: tongue movement for speech sound articulation and swallowing

Front 34

CN FUNCTIONS: MOTOR

Back 34

• III, IV, V, VI, VII, IX, X, XI, XII

Front 35

CN FUNCTIONS: SENSORY

Back 35

• I, II, V, VII, VIII, IX, X

Front 36

CN FUNCTIONS: PARASYMPATHETIC

Back 36

• III, VII, IX, X

Front 37

• Anatomy and Physiology: Basal Ganglia

Back 37

 Extrapyramidal pathway-babsinski
 Processing station between motor cortex/upper brainstem
 Gross intentional movement without conscious thought
 Pyramidal cells (pyramid shaped neurons) that originate in the cerebral cortex and follow tracts through the mid brain into the spinal cord.
 Contributes input from visual, labyrinthine and proprioceptive sources to fine tune effect on motor movement.

Front 38

How many spinal nerves

Back 38

31 pairs of spinal nerves arise from the spinal cord and exit each inter vertebral foramen

Front 39

Spinal nerve: ventral root

Back 39

• Motor to muscles/glands

Front 40

Spinal nerve: dorsal root

Back 40

• Sensory from muscles/glands

Front 41

Spinal nerves: function

Back 41

 Sensory/Motor fibers Supply/Receive information in Dermatome
 the sensory and motor fibers of each spinal nerve supply and receive information in a specific body distribution coffee dermatome
 the anterior branch of several spinal nerves combined to form a nerve plexi, so that the spinal nerve may lose its individuality to some extent
 spinal nerve may also complement the effort of anatomically related nerve or even help compensate for some loss of function
 a multitude of peripheral nerves originate from these nerve plexi

Front 42

Spinal nerve: reflex actions

Back 42

 Synapse with Motor fibers in Anterior Horn of spinal cord
 this spinal afferent (sensory) neuron may initiate a reflex arc response when he receives it impulse stimulus such as a tap on a stretcher muscle tendon
 in this case, the response is transmitted outward by the efferent(motor) neuron in the anterior horn of the spinal cord via the spinal nerves and peripheral nerve of the skeletal muscle, stimulating a brisk contraction
 such a reflex is dependent on intact a furry neurons, functional synapses in the spinal cord, intact efferent neurons, functional neuromuscular junctions, and competent muscle fibers

Front 43

• Anatomy and Physiology: Infants/Children: Major portion of brain growth- when?

Back 43

o Major brain growth/myelinization in first year of life
o any intruding event (e.g., infection, biochemical imbalance, or trauma) datasets brain development and growth during this period can have profound effects on eventual brain function

Front 44

newborns: primitive reflexes

Back 44

 some primitive reflexes are present at birth (e.g., morro, stuffy, Paul Martin and plantar grasp), and as the brain develops, these reflexes are inhibited as more advanced cortical functions and voluntary control takeover

Front 45

newborn: motor development

Back 45

 Cephalocaudal (from head to tail)
 motor control of the head and neck develops first, followed by the trunk and extremities

Front 46

o Brain growth continues until ______

Back 46

o Brain growth continues until 12-15 years of age
 First year is most important

Front 47

neurologic alterations: Pregnant Women

Back 47

o Hypothalamic-Pituitary neurohormonal changes
o Common alterations
 Headaches
 Numbness/tingling of hands
• Parathesias occur later in pregnancy
 Not rested after sleep
 Inability to sleep

Front 48

neurologic alterations: older adults

Back 48

o Changes physiologic rather than anatomic
o Cerebral neurons decrease, but this is not necessarily associated with deteriorating mental function
o Velocity of nerve impulse conduction declines
 Slowed response time
 Diminished touch/pain perception

Front 49

Related History: Present Problem: Seizures or convulsions

Back 49

 Sequence of events
• independent observers report, or, fall to ground, shrill cry, motor activity, transition phase, change in color of face or lips, people changes are idea deviations, loss of consciousness, loss of bowel or bladder control
 Character of symptoms
• Usually irregular in rhythm
 Aura
• irritability, tension, confusion, blurred vision, mood changes, focal motor seizure activity, gastrointestinal distress
 Level of consciousness
o loss, impairment, duration
 Automatism
• Automatism: lip smaking, blinking, chewing.
 Muscle tone
• flaccid, stiff, tends, twitching; recess and began to move through the body; changing character of motor activity during seizure
 Postictal behavior
• 15-30 mins –confusion
• weakness, transient paralysis, confusion, drowsiness, headaches, muscle aching, time sleeping after seizure; any lateralization of signs
 Relationship of seizure to other events
• time of day, meals, fatigue, emotional stress, excitement, menses, and disk containing medications or poor compliance medication; activity before attack
 Frequency of seizure
 Medication
• Status epilepticus- benzodiapezines-keeps going-hyperthermia
• anticonvulsant; initiation of medication interacts prescribed anticonvulsant

Front 50

Related History: Present Problem: Pain

Back 50

 Onset
• sudden or progressive, associated with fever or injury
 Quality
• deep or superficial; aching, pouring, throbbing, sharp stabbing, burning, pressing, stinging, cramping, gnawing, precluding, shooting; duration and constancy
 Location
• along distribution of one or more peripheral nerves were a more general distribution; radiating from one part to another
 Associated manifestations
• crying, change in activity or energy level, sweating, muscle rigidity, tremor, impaired mental processes are concentration, weakness
 Efforts to treat
 Medications
• opiates and nonsteroidal anti-inflammatory drugs; prescription, nonprescription

Front 51

Related History: Present Problem: Gait Coordination

Back 51

 Balance
• sensation of meaning when walking to Dorey; unsteadiness when walking
 Falling
• fall one way, backward, forward, consistent direction; Association with looking up; legs simply give away; stiffness of limbs
 Legs simply give way
 Associated problems
• Bowel/bladder, muscular strength, headaches
• arthritis of cervical spine her knees; ataxia, stroke, seizure, arthritis and knees; arrhythmias; sensory changes
 Medications
• Phenytoin, pyrimethamine, etoposide, vinblastine; prescription, nonprescription

Front 52

Related History: Present Problem: Weakness or paresthesia

Back 52

 Onset
• sudden or with activity initiation or following sustained activity, time before symptoms began; rapid or slow
 Character
• generalized or specific body area affected (face, extremity); progressively a sending are transient; proximal or distal extremities, unilateral, bilateral, or asymmetrical; difficulty walking; loss of balance record nation; hypersensitivity to touch or burning sensation
 Associated symptoms
• tingling or numbness; confusion, trouble speaking or understanding speech; severe headache; impaired vision in one or both eyes; limbs feel encased in tight bandage, pain, shortness of breath, stiffness in joints, spasm, muscle tension, sensory deficits; loss of urinary or bowel control
 Concurrent chronic illness
• (HIV, nutritional/ vitamin deficiency)
 Medications
• Vitamin deficiency-malabsorption syndrome, bariatric, alcoholics.

Front 53

Neuro: Related History: Personal/Social History

Back 53

o Environmental/occupational hazards
 exposure to lead, arsenic, insecticides, organic solvents, other chemicals; operate farm or other dangerous equipment; work at heights or in water
o Hand, eye, foot dominance
 family patterns of dexterity and dominance
o Ability to care for self
 hygiene, activities of daily living, finances, communication, shopping; abilities of the worker expectations
o Sleeping/eating patterns
o Use of alcohol/drugs

Front 54

Neuro: Related History: INFANTS

Back 54

o Prenatal history
 mother's health, medications taken, intrauterine infections such as toxoplasmosis, syphilis, tuberculosis, rubella, cytomegalovirus, herpes, and others; feelings of well-being, prior history of hypertension, preeclampsia, pleading, history of trauma or stress, persistent vomiting, hypertension, drug or alcohol use
o Birth history
 Apgar score, gestational age, birth weight, presentation, use of instruments, prolonged or precipitate labor, fetal distress
o Respiratory status at birth
 resuscitation needed, apnea, cyanosis, need for oxygen or mechanical ventilation
o Neonatal health
 jaundice (from ABO blood type incompatibility, breast-feeding, or other causes), post natal infections, seizures, irritability, sucking and swallowing poorly coordinated, need for intensive care and exposure to ototoxic medications
o Congenital anomalies


Front 55

Neuro: Related History: CHILDREN

Back 55

o Developmental milestones
 Age attained
• age attained: smiling, head control and prone position, grasping, transferring objects between hands, rolling over, sitting, crawling, independent walking, toilet trained, similar pattern as in siblings, say words other than "Mama" and "dada"
 Loss of previously achieved function
• Loss of previously achieved functions, consider Retts in girls 6-18 months
• pattern of development: similar to other children; always lower than others; loss of previously achieved function; change in child rate of development; progress occur as expected until a certain age with slow progress afterwards
o Performance of self-care activities
 dressing, toileting, feeding
o Health problems
 Headaches, unexplained vomiting, lethargy, personality changes
 Seizure activity
• Association with fever, frequency, duration, character movement
• First time seizure-esp febrile-doesn’t require full workup if normal (NOT HOW HIGH FEVER GETS, ITS HOW FAST THE FEVER RISES THAT CAUSES THE SEIZURE)
• 1 year old-104 fever-problematic-under not a problem.
 Clumsiness/unsteady gait
 Muscular weakness/falling
 Plumbism: Lead poisoning-neuropathies with paralysis of the intensor muscles of the forearm (wrist drop), anemia, constipation, abdominal pain

Front 56

Neuro: Related History: PREGNANT WOMEN

Back 56

o Weeks of gestation or EDC
 As gestation increases more pressure placed on internal structures, can lead to more peripheral neuropathies, weakness.
o Convulsions/headache
o Seizure activity
 past history of seizures or pregnancy induced hypertension; frequency, duration, character movement
 eclampsia
o Headache
 onset, character, frequency, Association with hypertension; visual changes
o Nutritional status
 dietary supplement such as prenatal vitamins, calcium; salt depletion
 Always do a urine dip stick (protein-eclampsia)

Front 57

Neuro: Related History: OLDER ADULTS

Back 57

o Increased stumbling/falls
o Decreased agility
o Safety modification at home
o Interference with performance of ADLs
o Hearing loss, vision deficit, or anosmia
 Anosmia: loss of sense of smell
o Development of tremor- parkinsons
o Fecal/urinary incontinence
o Transient neurologic deficits
 Stroke like symptom that goes away (TIA)-warning stroke- take daily ASA (81 mg)

Front 58

• Exam & Findings: Screening Exam: COMPONENTS

Back 58

 Cranial nerves
 Proprioception/cerebellar function
 Sensory function
 DTRs
 Articulation
 Comprehension
 Symmetry
• Facial features
• Strength
• Gait

Front 59

• Exam & Findings: Screening Exam: COMPONENTS: CRANIAL NERVES

Back 59

• II-XII
• evaluation of the cranial nerves as an integral part of the neurologic examination
• ordinarily, taste and smell are not evaluated unless a path suspected
• a patient may not recognize that some loss of hearing, certain case sensations, or some vision has been lost
• when a sensory loss is suspected, be compulsive about determining the extent of loss when testing the relevant cranial nerve

Front 60

Exam & Findings: Screening Exam: COMPONENTS:  Proprioception/cerebellar function

Back 60

• Rhombergs, Heel-Toe walking, Pronator drift
• Pronator drift: if hand pronates and/or flexion of the fingers and elbow suggests mild hemiparesis. A sideward or upward drift sometimes with searching or reaching movements suggest loss of proprioception
• Babinski: Pyramidal Tract dysfunction

Front 61

Exam & Findings: Screening Exam: COMPONENTS:  Sensory function

Back 61

• Light touch sensation bilaterally
o Dermatomal- different spots-side to side
• Vibration/Position with toe
• superficial pain in touch added distal point in each extremity are tested; vibration and position sensors are assessed by testing the great toe

Front 62

Exam & Findings: Screening Exam: COMPONENTS:DTRs

Back 62

• all deep tendon reflexes are tested, excluding the plantar reflex in the test for clonus

Front 63

Exam & Findings: Cranial Nerves: o Olfactory I

Back 63

Sensory/smell
 Test for odor identification

Front 64

Exam & Findings: Cranial Nerves: o Optic II

Back 64

Sensory/visual acuity
 Test for visual acuity
 Test visual fields
 Perform ophthalmologic exam

Front 65

Exam & Findings: Cranial Nerves: o III, IV, VI. Oculomotor, trochlear, abducens

Back 65

Motor/eye movement, pupil size, eyelid opening
 Inspect eyelids for drooping
 Inspect pupils for size/equality
 Test consensual response/accommodation
 Test extraocular eye movements
 CRANIAL NERVE 6- FIRST CN TO BE AFFECTED WITH ICP-LOSS OF EXTRAOCULAR MOVEMENT (LATE FINDING WHEN CN AFFECTED)

Front 66

Exam & Findings: Cranial Nerves: o V. Trigeminal

Back 66

mixed/muscle tone, sensation
 Inspect face for atrophy/tremors
 Palpate jaw for tone/strength
 Test for pain/sensation
 Test corneal reflex (only unconscious people )

Front 67

Exam & Findings: Cranial Nerves: o VII. Facial

Back 67

Mixed/ facial expressions, taste
 Inspect facial symmetry
 Test tongue for salt/sweet

Front 68

Exam & Findings: Cranial Nerves: o VIII. Acoustic

Back 68

Sensory/hearing, balance
 Test hearing
 Compare bone/air conduction
 Test for sound lateralization

Front 69

Exam & Findings: Cranial Nerves: o IX. Glossopharyngeal

Back 69

Mixed/taste, swallowing
 Test tongue for sour/bitter
 Test gag reflex/swallow (only on unconscious people, otherwise just observe if they are able to handle their own secretions)

Front 70

Exam & Findings: Cranial Nerves: o X. Vagus

Back 70

Mixed/swallowing, speech
 Inspect palate/uvula for symmetry
 Inspect for swallow difficulty
 Evaluate guttural speech sounds

Front 71

Exam & Findings: Cranial Nerves: o XI. Spinal accessory

Back 71

Motor/muscle strength
 Test trapezius/sternocleidomastoid muscle strength

Front 72

Exam & Findings: Cranial Nerves: o XII. Hypoglossal

Back 72

Motor/tongue strength
 Inspect tongue for symmetry/tremors/atrophy
 Test tongue movement
 Test tongue strength
 Evaluate lingual speech sounds

Front 73

Exam & Findings: Coordination/Fine Motor Skills:Test rapid rhythmic alternating movements

Back 73

 Evaluate rhythm/flow/speed
 Rapid: Palm/dorsal hand alternating movement, Oppose all digits with thumb fast
 the patient should smoothly execute these movements, maintaining rhythm with increasing speed. Stiff, slowed, non-rhythmic, or jerky clonic movements are unexpected

Front 74

Exam & Findings: Coordination/Fine Motor Skills: o Test accuracy of movements

Back 74

 Evaluate accuracy/speed/rhythm
 Accuracy: finger to nose, eyes open and closed.
 Asked the patient to touch his or her nose and your index finger
 the movement should be rapid, smooth, and accurate. Consistent past pointing (i.e., missing the examiner's index finger) may indicate cerebellar disease

Front 75

Exam & Findings: Coordination/Fine Motor Skills: o Test balance

Back 75

 Evaluate equilibrium
 Observe gait
 Balance: Rhombergs, one foot stand, heel toe walking

Front 76

• Exam & Findings: Sensory Function: TYPES

Back 76

PRIMARY
CORTICAL

Front 77

Exam & Findings: Sensory Function: Primary

Back 77

• Superfical touch (sharp/dull), temperature, vibration

Front 78

Exam & Findings: Sensory Function: Cortical: • Stereognosis

Back 78

o Stereognosis: familiar object in hand
o hand the patient familiar object (e.g., calling, key) to identify by touch and manipulation.
o Tactile agnosia, and inability to recognize objects by touch, suggests a parietal lobe lesion

Front 79

Exam & Findings: Sensory Function: Cortical: • Two-point discrimination

Back 79

o used to sterile needles and alternate touching the patient's skin with one point or two point simultaneously at various locations over the body
o find the distance at which the patient can no longer distinguish two points, ranging between two and 75 mm
o Two point discrimination: fingers/toes should be under 8mm

Front 80

Exam & Findings: Sensory Function: Cortical: • Extinction phenomenon

Back 80

o Extinction phenomenon: Ability to simutaneously tell you how many places you are touching on the body and wear they are. Touch 2-3 places bilaterally
o simultaneously touch to areas on each side of the body (e.g., cheek, hand, or other area) with the tongue blade sharp edge or sterile needle. Asked the patient to tell you how many stimuli there are and where they are. Similar sensation should be felt bilaterally

Front 81

Exam & Findings: Sensory Function: Cortical: • Graphesthesia

Back 81

o Graphesthesia: Ability to ID letter or number drawn on the palm with eyes closed.
o With a blunt pen or an applicator stick, try letter, number, or shape on the palm of the patient's hand
o other party locations may also be used
o asked the patient to identify the figure
o repeat using a different figure on the other hand
o the figure should be readily recognized

Front 82

Exam & Findings: Sensory Function: Cortical: • Point location

Back 82

o Point Location: touch and withdraw a spot on body and patient should be able to point to location
o touch an area on the patient's skin and withdraw the stimulus.
o Asked the patient to point to the area touched
o no difficulty localizing the stimulus should be noted

Front 83

• Exam & Findings: Sensory Function: o Observe all sensory function tests for:

Back 83

 Side-to-side differences
 Interpretation of sensation
 Discrimination
 Location
o If impairment found, map boundaries by dermatome

Front 84

• Exam & Findings: Reflexes: TYPES

Back 84

Superificial of deep

Front 85

Reflexes:  Superficial: Types

Back 85

Upper and lower abdomen
Cremastic
Plantar

Front 86

Reflexes: Superficial: Upper and lower abdomen

Back 86

o Stroke away from the umbilicus
o the upper abdominal reflexes are elicited by stroking upward and away from the umbilicus; lower abdominal reflexes are elicited by stripping downward and away from the umbilicus
o a slight movement of the umbilicus toward each area of stimulation should be equal bilaterally
o a diminished reflex may be present in patients who are obese or whose demo muscles have been stretched during pregnancy.
o Abdominal reflexes may be absent on the side of the corticospinal tract lesion, but their presence or absence may have little clinical significance

Front 87

Reflexes: Superficial: Cremastic

Back 87

o Cremastic: stroke medial thigh scrotum should contract.
o Stroke the inner thigh have a male patient (proximal to distal) to elicit the cremasteric reflex.
o The testicle in scrotum should rise of stroke side

Front 88

Reflexes: Superficial: Plantar

Back 88

AKA BABINSKI
o Babinski: normal is toes plantar flexion (down) abnormal is up. Pyramidal defect
o use the end of a reflex hammer to stroke the lateral side of the foot from the heel to the ball and then curve across the ball of the foot to the medial side
o the patient should have plantar flexion of all toes
o the Babinski sign is present when there is dorsal flexion of the great toe with or without fanning of the toes
o the Babinski sign indicates Pyramidal tract disease in patients
o it is, however, an expected finding in children younger than two years of age

Front 89

Reflexes: Deep: TYPES

Back 89

• Biceps
• Brachioradial
• Triceps
• Patellar
• Achilles

Front 90

o Observe deep tendon reflex tests for:Biceps

Back 90

elbow flexion

Front 91

o Observe deep tendon reflex tests for:brachioradial

Back 91

forearm pronation/elbow flexion

Front 92

o Observe deep tendon reflex tests for: triceps

Back 92

elbow extension

Front 93

o Observe deep tendon reflex tests for: patellar

Back 93

- lower leg extension

Front 94

Observe deep tendon reflex tests for: Achilles

Back 94

foot flexion

Front 95

what neurological assessment should you check in pregnant women as a baseline

Back 95

DTRs

hyperactive in eclampsia

Front 96

DTR: 0/4

Back 96

no response

Front 97

DTR: 1/4

Back 97

sluggish/diminished

Front 98

DTR: 2/4

Back 98

active or expected

Front 99

DTR: 3/4

Back 99

more brisk then expected-slightly hyperactive

Front 100

DTR: 4/4

Back 100

brisk, hyperactive with intermittent or transient clonus

Front 101

• Exam & Findings: Additional Procedures: Monofilament test

Back 101

 Protective sensation on foot
 test on several sites of the foot and all patients with diabetes mellitus and peripheral neuropathy
 while the patient's is eyes are close, apply the monofilament in a random pattern in several sites on the plantar surface of the foot and one side of the dorsal surface
 when the monofilament bands, adequate pressure is applied
 patient should feel the sensation at all sites
 loss of sensation to touch the monofilament is an indication of peripheral neuropathy, and a loss of protective paint sensation that alert patients to skin breakdown and injury

Front 102

Exam & Findings: Additional Procedures: o Meningeal signs

Back 102

nuchal rigidity

brudzinskis sign

kernig sign

Front 103

Exam & Findings: Additional Procedures: o Meningeal signs: Nuchal rigidity

Back 103

• stiff neck, a sign that may be associated with meningitis and intracranial hemorrhage
• with the patient supine, slip your hand under the head and raise it, flexing the neck
• try to make the patient's chin touched the sternum, but do not force it
• placing your hand under the shoulders when the patient is supine and reason the shoulder slightly will help relax the neck, making the determination of true neck stiffness more accurate
• patients generally do not resist or complain of pain
• pain in the resistance of neck motion associated with nuchal rigidity
• occasionally painful swollen lymph nodes in the neck and superficial, may also cause pain and resistance to neck motion

Front 104

Exam & Findings: Additional Procedures: o Meningeal signs: Brudzinski's sign

Back 104

• Brudzinski: Flexion of the head with involuntary flexion of the hip and knees
• involuntary flexion of the hips and knees when flexing the neck is a positive Brudzinski sign it may indicate meningeal irritation

Front 105

Exam & Findings: Additional Procedures: o Meningeal signs: Kernig sign

Back 105

• Kernigs: Flexing the legs then extending the lower leg, pain to the lower back and resistance to straightening is positive.
• Evaluated by flexing the lake at the knee and hip when the patient is supine, then attempting to straighten the leg.
• Pain in the lower back and resistance to straightening the leg at the knee constitute a positive kernig sign that may indicate meningeal irritation

Front 106

• Exam & Findings: Infants: CN testing

Back 106

o the cranial nerves are not routinely tested directly, but several observations made during the physical examination provide indirect evaluation

Front 107

Exam & Findings: Infants: CNs II, III, IV, VI

Back 107

• Optical blink reflex
o shine a light at the instances open eyes; observe the quick closure of the eyes and dorsal flexion of the infants had; it no response may indicate poor light perception
• Gaze/tracking
o gazes intensely at close object your face
o focuses on contracts and object with both eyes
• Doll’s eye

Front 108

Exam & Findings: Infants:  CN V

Back 108

• Rooting
o touch one corner of the instances mouth; the infant should open its mouth and turn its head in the direction of stimulation; if the infant has been recently fat, minimal or no response is expected
• Sucking
o place your finger in the infant's mouth, feel the sucking action; the tongue should push up against your finger with good strength; note the pressure, strength, and pattern of sucking

Front 109

Exam & Findings: Infants:  CN VII

Back 109

• Facial expressions
o when crying
• Forehead wrinkling
o ability to
• Smile
o symmetry

Front 110

Exam & Findings: Infants: CN VIII

Back 110

• Acoustic blink reflex
o loudly clap your hands about 30 cm from the infants had
o avoid producing an air current
o note the blink in response to sound
o no response after 2 to 3 days of age may indicate hearing problems
o infant will habituate to repeated testing
• Doll’s eye maneuver
o hold the infant under the axilla and upright position, head held steadily, facing you; rotate the infant first in one direction and then in the other; the infants I should turn in the direction of rotation and then the opposite direction rotation stopped; if the eyes do not move in the expected direction, suspect a vestibular problem or I muscle paralysis

Front 111

Exam & Findings: Infants: CN IX, X

Back 111

• Swallow/gag reflex

Front 112

Exam & Findings: Infants: CN XII

Back 112

• Sucking/swallowing ability
o coordinated sucking and swallowing ability
• Tongue position with pinch test
o Pinch Test: Pinch nose with open mouth and tongue with move to midline position
o Pinch infants nose; mouthful open and tip of tongue will rise in the midline position

Front 113

Exam & Findings: Infants: Evaluate primitive reflexes

Back 113

• these reflexes appear and disappear in a sequence corresponding with central nervous system development.
• Symmetry and smoothness of response are important observations
o Palmar
o Plantar
 the plantar reflexes routinely performed as described in the adult examination
 a positive Babinski sign, fanning of the toes and dorsal flexion of the great toe is found until he infant is 16 to 24 months of age
o Moro
o Placing
o Stepping
o Asymmetric tonic neck

Front 114

Exam & Findings: Infants: Evaluate primitive reflexes: o Palmar

Back 114

 birth
 making sure the infants had is in midline, touch the palm of the infants and from the ulnar side (opposite of the thumb); note the strong grasp of your finger; sucking facilitates the grasp; it should be strongest between one and two months of age and disappear by three months

Front 115

Exam & Findings: Infants: Evaluate primitive reflexes: o Plantar

Back 115

 birth
 touch the plantar surface of the infants feet at the base of the toes; the toes should coral downward; the reflex should be strong up to eight months of age

Front 116

Exam & Findings: Infants: Evaluate primitive reflexes: o Moro

Back 116

 birth
 with the infant supported in semi sitting position, allow the head and trunk to drop back at a 30° angle; observe symmetric abduction and extension of the arms; fingers fanned out in some and index finger for may C; the arms then adduct in and in embracing motion followed by relaxed flexion; the legs may follow a similar pattern of response; the reflex diminishes in strength by 3 to 4 months in disappears by six months

Front 117

Exam & Findings: Infants: Evaluate primitive reflexes: o Placing

Back 117

 four days of age
 hold the infant upright under the arms next to a table or chair; touched the dorsal side of the foot to the table or chair at; observe flexion of the hips and knees in lifting of the foot as a stepping up on the table; age of disappearance varies

Front 118

Exam & Findings: Infants: Evaluate primitive reflexes: o Stepping

Back 118

• between birth and eight weeks
• hold the infants upright under the arms and allow the soles of the feet to touch the surface of the table; observe for alternate flexion and extension of the legs, simulating walking; it disappears before voluntary walking

Front 119

Exam & Findings: Infants: Evaluate primitive reflexes: o Asymmetric tonic neck

Back 119

 by 2 to 3 months
 with the infant lying supine and relax or sleeping, turn its head to one side so the jaws over the shoulders; observe for extension of the arm and leg on the side to which the head is turned and for flexion of the opposite arm and leg; turn the infants had to the other side, observing the reversal of the extremities posture; this reflex diminishes at 3 to 4 months of age and disappears by six months; be concerned if the infant never exhibits the reflex or seems locked in the fencing position; this reflex must disappear before the infant can rollover or bring its hands to its face

Front 120

Exam & Findings: Infants:  Observe movement

Back 120

• observe the infants spontaneous activity for symmetry and smoothness of movement
o Spontaneity
o Symmetry

Front 121

Exam & Findings: Infants:  Inspect/palpate muscle strength/tone

Back 121

• muscle strength in tone are especially important to evaluate in the newborn and infant

Front 122

• Exam & Findings: Children

Back 122

o Observe neuromuscular development progress/ skills displayed during PE
 the neurologic examination of the young child is done by observing the neuromuscular development progress and skills displayed during the examination
 delay in sitting and walking may be a sign of cerebellar disorder
o Evaluate developmental level
 the Denver II is useful tool determine whether the child is developing as expected with fine and gross motor skills, language, and personal social skills
o CN exam modified according to age
 direct examination a cranial nerves require some modifications and procedures according to the aged child.
 Often the game is played elicit the response
o Observe at play
 Gait/fine motor coordination
• the beginning walker exhibits a wide-based gait; whereas the older child walks of the closer together, has better balance, and recovers more easily when unbalanced
• observe the child's skill in reaching for, grasping, and releasing toys
• no tremor or constant overshooting movement should be apparent
 Heel-to-toe walking, hopping, jumping
o DTRs not routinely tested in young children
 deep tendon reflexes are not always tested in a child who demonstrates appropriate development
 when reflexes are tested, use the same techniques described for adults; responses should be the same.
 Your index finger may take the place of a reflex hammer and be less threatening to a child
o Soft signs
 Unexpected findings in school-age child considered normal in younger child
 May be gross/fine motor, sensory, reflex
 Look in book there is a table of soft signs that are concerning.

Front 123

• Exam & Findings: Pregnant Women

Back 123

o Same as for adult
o DTRs on initial exam serve as baseline
o Hyperreflexia: preeclampsia: hypertension, exaggerated edema and proteinuria. Also have liver tenderness, visual changes, headaches reflect severe preeclampsia and may be imminient for ecclampsia (seizure)

Front 124

• Exam & Findings: Older Adults

Back 124

o Exam same as adult
o Medications can impair CNS function
 Slowed reaction time/tremors/ anxiety
o Test gait for decreases in speed/balance/grace
o Check tactile/vibratory sense for impairment
o Check DTRs for diminished response

Front 125

• Common Abnormalities: Central Nervous System: o Multiple sclerosis

Back 125

 Definition
• a progressive autoimmune disorder characterized by a combination of inflammation in degeneration of the myelin of the brain's white matter leading to decrease brain mass and obstructed transmission of nerve impulses
 Pathophysiology
• infectious agents are believed to play a role in triggering MS in susceptible individuals
• gradual but unpredictable, progression, with or without remissions; symptom onset between 20 and 40 years of age, and women are affected twice as often as men
 subjective data
• fatigue
• urinary frequency, urgency, or hesitancy
• sexual dysfunction
• vertical, weakness, numbness
• blurred vision, diplopia, loss of vision
• emotional changes
• relapse symptoms developed rapidly over hours or days, and symptoms take weeks to recede
 objective data
• muscle weakness, ataxia
• hyperactive deep tendon reflexes
• paresthesias, sensory loss, e.g., loss of vibration sense
• intentional tremor
• optic neuritis
• cognitive changes
• MRI reveals brain lesions that are typically Peri ventricular, ovoid, and perpendicular to the ventricles; spinal cord lesions may also be found
 MS:Chronic autoimmune disease. Blood brain barrier breaks down and allows immune cells to cross and attacks the myelinated white matter or the brain and spinal cord. SS: Fatigue, bowel and bladder dysfunction, sensory changes, muscle weakness, cognitive and emotion changes.

Front 126

• Common Abnormalities: Central Nervous System: Generalized Seizure Disorder

Back 126

 Definition
• epilepsy is a chronic disorder characterized by recurrent, unprovoked generalized seizures secondary to an underlying brain abnormality
 Pathophysiology
• episodic abnormal electrical discharges (excessive con current firing) of cerebral neurons may be caused by a central nervous system disorder, a CNS and asked structural defect, or a disorder that affects functioning of the CNS; examples include brain injury, toxins, stroke, brain tumor, or hypoxic syndromes
 subjective data
• history of prior seizure
• premonition or aura (headaches, mood changes, anxiety, irritability, lethargy, changes in appetite, dizziness, and lightheadedness)
• body is stiff and rigid followed by rhythmic jerking movements
• eyes roll up word
• drooling
• loss of bladder or bowel control
 objective data
• tonic phase: reflection and characteristic cry with contraction of abdominal muscles, followed by generalized extension for 10 to 15 min.; loss of consciousness for 1 to 2 min., eyes DVD upward, and dilated pupils
• clonic phase: contractions alternate with muscle relaxation
• postictal state: Cuomo followed by confusion and lethargy
• common EEG findings of spikes and waves
 Up to 1% of the population have seizures. 75% of new cases in childhood and adolescence. Neurologist told me that everyone has a seizure during their lifetime, usually occurs during sleep and not noticed. Epilepsy when no etiology is found.

Front 127

• Common Abnormalities: Central Nervous System: Meningitis

Back 127

 Definition
• an inflammatory process in the meninges, the membrane around the brain and spinal cord
 Pathophysiology
• the bacterial, viral, or fungal organism often colonizes in the upper respiratory tract, invades the bloodstream, and then crosses the blood brain barrier to infect the cerebrospinal fluid in meninges
 subjective data
• fever, chills
• headache, stiff neck
• lethargy, malaise
• vomiting
• irritability
• seizures
 objective data
• altered mental status, confusion
• nuchal rigidity
• fever
• Brudzinski and curtain
• may be positive;
• petechiae and purpura with meningococcal meningitis
• lumbar puncture and cerebrospinal fluid culture confirms the diagnosis
 Meningitis: inflammation of the meninges

Front 128

• Common Abnormalities: Central Nervous System: encephalitis

Back 128

 Definition
• acute inflammation of the brain and spinal cord, involving the meninges often due to a virus such as herpes simplex virus
 Pathophysiology
• a virus may be transmitted by the bite of an arthropod or mosquito, such as with West Nile virus, Eastern equine encephalitis, and Japanese encephalitis
 subjective data
• mild viral illness with fever
• recovery and quiet stage followed by onset of lethargy, restlessness, and mental confusion
 objective data
• altered mental status, confusion, stupor, coma
• photophobia
• stiff neck
• muscle weakness, paralysis, ataxia
 Encephalitis: inflammation of the brain and spinal cord.

Front 129

• Common Abnormalities: Central Nervous System: o Lyme disease

Back 129

 Definition
 Pathophysiology
 subjective data
 objective data
 Lyme disease: borrelia burgdorferi spirochete from ticks. 3 stages: early: circular rash that grow, 1-30 days after exposure. Mid: headaches, meningitis, encephalitis, polyneuritis, facial paralysis, ataxia. Late: Arthritis/acrodermatitis (inflammation of the skin on extremities first appears on the hands, feet, elbow and knees)

Front 130

• Common Abnormalities: Central Nervous System: intracranial tumor

Back 130

 Definition
• an abnormal growth of neural or non-neural tissue within the cranial cavity that may be a primary or metastatic cancer
 Pathophysiology
• the lesion causes displacement of tissue and pressure on the cerebrospinal fluid circulation; function is threatened through compression and destruction of tissues
 subjective data
• persistent headache
• nausea and vomiting
• unsteady gait, impaired coordination
• memory loss and confusion
• reduced vision acuity or vision loss
• behavior or personality change
• seizure
• other symptoms in children may include irritability, lethargy, weight loss, growth failure, precocious puberty
 objective data
• signs may vary by location of tumor
• altered consciousness, confusion
• papilledema
• cranial nerve impairment
• aphasia, language disorder
• vision loss-hemainopia, nystagmus
• gait disturbances, ataxia
• brain imaging by CT scan or MRI confirms the diagnosis
 Tumors: Peaks 3-12 and 50-70 yrs

Front 131

• Common Abnormalities: Central Nervous System: CVA

Back 131

 Definition
• the sudden interruption of blood supply to a part of the brain or rupture of a blood vessel, spilling blood into spaces around brain cells
 Pathophysiology
• ischemic strokes (most common cause) occur when a thrombus or embolism interrupts the blood supply, oxygen, and nutrients to the brain, and the brain cells die
• intracerebral or subarachnoid bleeding causes about 15% of hemorrhagic stroke, often within the distribution of the anterior circulation of the brain; brain cells die due to the bleeding into or around the brain
 subjective data
• sudden numbness or weakness, especially on one side of the body
• sudden confusion or trouble speaking, or understanding speech
• sudden trouble seeing in one or both eyes
• sudden trouble walking, dizziness, or loss of balance or coordination
• sudden severe headache with no known cause
 objective data
• signs vary by part of the brain affected;
• elevated blood pressure
• altered level of consciousness
• difficulty managing secretions
• weakness or paralysis of extremities or facial muscles on one side of both sides of the body
• aphasia, receptive or expressive
• articulation impairment
• impaired horizontal gaze or hemianopia
• brain imaging with CT and MRI diagnose the type of stroke

Front 132

• Common Abnormalities: Peripheral Nervous System: o Myasthenia Gravis

Back 132

 definition
• it autoimmune disorder of neuromuscular transmission involving the production of autoantibodies directed against the nicotinic acetylcholine receptor, leading to the destruction and inflammatory changes in the postsynaptic membranes
 pathophysiology
• the acetylcholine receptor sites stopped transmitting nerve impulses across the neuromuscular junction to direct muscle contraction
• confined to ocular muscles and 15% of cases
 subjective data
• drooping eyelids
• double vision
• fluctuating fatigue or weakness (worse with exercise, and proves with rest)
• inability to work with arms raised above head
• difficulty walking
• symptoms are worse later in the day and improve with rest
 objective data
• ptosis that develops within 2 min. of upward gaze
• facial weakness when puffing out cheeks
• hypophonia
• difficulty managing secretions
• respiratory compromise or failure
• weakness of skeletal muscles without reflex, sensory, or coordination abnormalities
 Myasthenia Gravis: Chronic autoimmune disease involving motor neurons and muscle fibers. Caused by immune systems attack of symaptic junction between nerve and muscle fibers. SS: begin 20-30 yrs or late middle age. Lower extremity weakness and abnormal fatigue in the muscles or eye movement, facial expression, chewing, swallowing. Usually worse at the end of the day.

Front 133

Common Abnormalities: Peripheral Nervous System: o Guillain-Barré

Back 133

 definition
• and autoimmune mediated destruction of peripheral nerve myelin sheath and inflammation of the nerve roots that occur following and nonspecific gastrointestinal or upper respiratory infection 1 to 3 weeks earlier or following immunization
 pathophysiology
• results in in paired conduction of nerve impulses between the nodes of Ranvier
 subjective data
• history of recent illness and recovery
• progressive weakness more in the legs in the arms, increased difficulty walking
• paresthesia
• pain in the shoulder, back, or posterior side
• double vision
 objective data
• distill weakness, usually bilateral and symmetric, and diminished reflexes and ascending pattern
• ataxia, progressing to flaccid paralysis
• facial nerve weakness (Bell palsy), diplopia
• dysphagia, difficulty handling secretions
• respiratory distress
• lumbar puncture reveals increased cocaine in cerebrospinal fluid
 Guillane Barre: Acute idiopathic polyneuritis. Post nonspecific infection (usually viral) 10-14 days. Effects the motor and automonic peripheral nerves. Widespread inflammation or demyelination of the ascending or descending nerves impair conduction between the nodes of Ranvier ( a short interval that occurs in the mylen sheath of a nerve fiber). SS: ascending symmetric weakness with sensation preserved that increases in severity over days or weeks. 85% have full functional recovery after weeks to months.

Front 134

Common Abnormalities: Peripheral Nervous System: o Peripheral neuropathy

Back 134

 Definition
• a disorder of the peripheral nervous system that results in motor and sensory loss in the distribution of one or more nerves, commonly caused by diabetes mellitus
 pathophysiology
• other causes include altered lipid metabolism, vitamin B12 or folate deficiency. Neuropathy associated with limes disease, HIV infection, and diabetic polyneuropathy are believed to have an autoimmune etiology
• impaired blood flow, vasoconstriction, and chronic ischemic changes within the peripheral neuronal fibers lead to the sensory and autonomic nerve function deficits
 subjective data
• gradual onset of numbness, tingling, burning, and cramping, most commonly in hands and feet
• night pain in one or both feet
• early signs may be unusual sensations of walking on cotton, force feeling strange, or inability to distinguish between coins by feel
• sensation of burning accompanied by hyperalgesia or allodynia (all sensation is painful)
 objective data
• reduced sensation in the foot with the monofilament; loss of pain or sharp touch sensation to the midcalf level
• distal pulses may be present or diminished
• diminished or absent ankle and knee reflexes
• decreased or no vibratory sensation below the knees; temperature sensation may be less impaired
• distal muscle weakness, and ability to stand on toes or heels
• skin ulceration or injuries to extremities the patient does not feel

Front 135

Common Abnormalities: Peripheral Nervous System: o Bells Palsy

Back 135

 definition
• a temporary acute paralysis or weakness of one side of the face
 pathophysiology
• may be caused by an acute inflammation of the facial nerve (cranial nerve VII), such as a viral infection with herpes simplex, which leads to ischemia and demyelination
• other potential causes include central nervous system lesions (e.g., multiple sclerosis, stroke, or tumor) or structural lesions in the ear or parotid gland
• occurs more commonly in patients with diabetes mellitus
 subjective data
• rapidly progressive muscle weakness on one side of the face (over 2 to 3 days)
• feeling of facial numbness
 objective data
• facial creases and nasolabial fold disappear on affected side
• eyelid will not close on affected side and lower lid sags; leads to I irritation; I made tear excessively
• food and saliva may pool and affected side of mouth
• facial sensation is intact
 Bells Palsy: VII nerve paralysis. Thought is could be swelling of the nerve at the stylomastoid foramen (where it comes out of the skull). Most common in the 30-50s yrs). In up to 70% of the times can have slight involvment of V and IX CN). SS: acute onset over 2 days, usually reaches maximum SS in 5 days. Unilateral facial paralysis, fullness/pain behind mastoid (61%), hyperacusis (29%, welling of tears (68%), change in taste (57%). Usually (50-85%) resolves in 2 weeks to two months. First symptom to resolve is taste. Differentiate with CVA: BP is usually involves both upper and lower facial paralysis and does not involve the extremities.

Front 136

• Common Abnormalities: Children: o Cerebral palsy

Back 136

 definition
• a permanent disorder of movement and posture development associated with nonprogressive (static) disturbances that occurred in the developing fetal or infant brain
 pathophysiology
• injury to the immature peri ventricular white matter in fetuses and premature infants is believed to be the most common cause
• other causes include brain insult from complications of prematurity; prenatal, perinatal, or genetic factors; or viral infection of the fetus
 subjective data
• delays in Gross motor development that becomes more obvious as the infant ages
• activity limitation
• may have hearing, speech, and language disorders
• feeding difficulties, poor sucking and swallowing coordination
• seizures
 objective data
• mental retardation or learning disabilities
• spastic CP; hypertonicity, tremors, scissor gait, toe walking
• persistent primitive reflexes, exaggerated deep tendon reflexes
• dyskinetic CP; involuntary slow writhing movements of the extremities; tremors may be present
• exaggerated posturing, and consistent muscle tone that varies during the day
• ataxic; abnormalities of movement involving balance and position of trunk and extremities
• intentional tremors, past pointing
• increased or decreased muscle tone, may have hypotonia as infant
• instability, wide-based gait
 group of brain damage syndromes, mental retard in 60% of cases

Front 137

Common Abnormalities: Children: HIV encephalopathy

Back 137

 definition
 pathophysiology
 subjective data
 objective data

Front 138

Common Abnormalities: Children: Rett Syndrome

Back 138

 definition
 pathophysiology
 subjective data
 objective data
 Rett: Progressive encephalopathy of unknown etiology in girls 6-18 months after having normal neuro and mental development. SS: loss of voluntary hand movement. Leads to mental retardation, and helpless state before they die.

Front 139

• Common Abnormalities: Pregnant women: o Maternal obstetric palsy

Back 139

 definition
 pathophysiology
 subjective data
 objective data
 Obstretric palsy: greater gestation, gravid uterus puts pressure on nerves.

Front 140

Common Abnormalities: Older adults: Parkinson's disease

Back 140

 definition
• as a slowly progressive, degenerative neurologic disorder in which deficiency of the dopamine neurotransmitter results in poor communication between parts of the brain that coordinate and control movement and balance
 pathophysiology
• a history of encephalitis, drug use, or cerebrovascular disease may exist
• genetic, environmental, viral, vascular, toxic, or other factors may be associated with disease onset
• occurs most often in patients older than 50 years
 subjective data
• tremors (sometimes unilateral) occur initially at rest and with fatigue, disappearing with intended movement and sleep; progresses to pin rolling movement of fingers bilaterally and tremors of the head
• slowing of voluntary and automatic movements
• numbness, aching, tingling, and muscle soreness occur in many patients
 objective data
• tremors
• muscular rigidity
• stooped posture, balance and postural instability
• short steps, shuffling, freezing gait
• difficulty swallowing, drooling, voice softening
• slow, slurred monotonous speech
• impaired cognition, dementia
 Parkinsons: progessive, degenerative neuro disorder. Deficeiency of dopamine results in poor communication between part of the brain that coordinate and control movement and balance. SS: over 50 initially fine tremor (usually unilateral) at rest and with fatigue that disappears with intended movement and sleep.

Front 141

Common Abnormalities: Older adults: o Normal-pressure hydrocephalus

Back 141

 definition
• a syndrome simulating degenerative disease that is caused by noncommunicating hydrocephalus (dilated ventricles with intracranial pressure within expected ranges)
 pathophysiology
• may be due to a slightly elevated baseline CSF and intermittent increased CSF pressure waves
• compression of brain tissue and decrease cerebral blood flow lead to signs and symptoms
 subjective data
• gait impairment is the first symptom
• unsteadiness and difficulty turning
• cognitive impairment
• urinary frequency that progresses to urgency and incontinence over time
 objective data
• gait impairment, wide based stance, short, small steps, and reduce for clearance
• no tremor
• no sensory impairment
• cognitive impairment, executive functioning.
 Normal pressure hydroceph: noncommunicating hydrocephalsis, dilated ventricles but ICP is normal. It simulates degenerative diseases. SS: gait disorder, psychomotor slowing and incontinence. PSYCHOMOTOR DISTURBANCE. FINDINGS ARE VAGUE Correctable with ventriculoperintoneal shunting.

Front 142

• Acrodermatitis

Back 142

o definition
o pathophysiology
o subjective data
o objective data
o Later manifestation of Lymes Disease

Front 143

You are initially evaluating the equilibrium of Ms. Q. You ask her to stand with her feet together and arms at her sides. She loses her balance. Ms. Q. has a positive:

Back 143

rhomberg sign

Front 144

The major portion of brain growth and myelinization occurs between ____ year(s) of age

Back 144

birth to 1

Front 145

Which area of the brain is responsible for perceiving sounds and for determining their source?

Back 145

temporal lobe

Front 146

When using a monofilament to assess sensory function, the examiner:

Back 146

applies pressure to the monofilament until the filament bends

Front 147

To assess a cremasteric reflex, the examiner strokes the

Back 147

inner thigh and observes whether the testicle and scrotum rise on the stroked side

Front 148

To assess spinal levels L2, L3, and L4, which deep tendon reflex should be tested?

Back 148

patellar

Front 149

The motor cortex of the brain is in the:

Back 149

frontal lobe

Front 150

The autonomic nervous system coordinates which of the following?

Back 150

internal environment of the body

Front 151

The major function of the sympathetic nervous system is to

Back 151

orchestrate the stress response

Front 152

When assessing superficial pain, touch, vibration, and position perceptions, you are testing:

Back 152

sensory function