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152 Cards in this Set
- Front
- Back
The central nervous system consists of what?
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Brain and Spinal Cord
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function of central nervous system
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main network of coordination and control for the body
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autonomic nervous system function
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1. coordinate and regulate the internal organs of the body, such as cardiac muscle and smooth muscle
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autonomic nervous system divisons
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it has two divisions, each tending to balance the impulses of the other
sympathetic and parasympathetic |
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autonomic nervous system: sympathetic
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i. prods the body into action during times of physiologic and psychologic stress
ii. Stress |
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autonomic nervous system: parasympathetic
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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 |
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Peripheral nervous system: what does it consist of?
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Comprising cranial and spinal nerves and the ascending and descending pathways
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Peripheral nervous system: Function
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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 |
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Interrelationships of nervous system permit the body to perform the following:
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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 |
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Cerebrum: functions
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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 |
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Cerebrum: Frontal lobe
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Voluntary skeletal movement Repetitive movement
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Cerebrum: Parietal Lobe
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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 |
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Cerebrum: Occipital lobe
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Interprets visual data
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Cerebrum: Temporal lobe
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Perception/ interpretation of sounds
Integration of taste/smell/ balance |
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Cerebrum: Limbic system
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Mediates behavior patterns for survival
Problem with it you lose consciousness |
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Cerebellum: Function
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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 |
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Brainstem: function
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o the brainstem is the pathway between the cerebral cortex the spinal cord, and it controls many involuntary functions
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Brainstem: parts
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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 |
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How many cranial nerves
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12
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cranial nerves are peripheral nerves that arise from the ____ rather than the ________
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cranial nerves are peripheral nerves that arise from the brain rather than the spinal cord
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each nerve has motor or _____ functions, and four cranial nerves have ______ functions
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each nerve has motor or sensory functions, and fourr cranial nerves have parasympathetic functions
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CN I
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Olfactory
o sensory: smell reception and interpretation |
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CN II
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Optic
o sensory: visual acuity and visual fields |
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CN III
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Oculomotor
o motor: raise eyelids, most extraocular movements o parasympathetic: a bleary constriction, changes lens shape |
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CN IV
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Trochlear
o motor: downward, inward eye movement |
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CN V
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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 |
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CN VI
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: Abducens
o motor: lateral eye movement |
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CN VII
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: 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 |
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CN VIII
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Acoustic
o sensory: hearing in equilibrium |
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CN IX
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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 |
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CN X
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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 |
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CN XI
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Spinal Accessory
o motor: head turn, shrug shoulders, some actions a phonation |
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CN XII
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Hypoglossal
o motor: tongue movement for speech sound articulation and swallowing |
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CN FUNCTIONS: MOTOR
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• III, IV, V, VI, VII, IX, X, XI, XII
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CN FUNCTIONS: SENSORY
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• I, II, V, VII, VIII, IX, X
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CN FUNCTIONS: PARASYMPATHETIC
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• III, VII, IX, X
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• Anatomy and Physiology: Basal Ganglia
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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. |
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How many spinal nerves
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31 pairs of spinal nerves arise from the spinal cord and exit each inter vertebral foramen
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Spinal nerve: ventral root
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• Motor to muscles/glands
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Spinal nerve: dorsal root
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• Sensory from muscles/glands
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Spinal nerves: function
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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 |
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Spinal nerve: reflex actions
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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 |
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• Anatomy and Physiology: Infants/Children: Major portion of brain growth- when?
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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 |
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newborns: primitive reflexes
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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
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newborn: motor development
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Cephalocaudal (from head to tail)
motor control of the head and neck develops first, followed by the trunk and extremities |
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o Brain growth continues until ______
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o Brain growth continues until 12-15 years of age
First year is most important |
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neurologic alterations: Pregnant Women
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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 |
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neurologic alterations: older adults
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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 |
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Related History: Present Problem: Seizures or convulsions
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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 |
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Related History: Present Problem: Pain
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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 |
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Related History: Present Problem: Gait Coordination
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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 |
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Related History: Present Problem: Weakness or paresthesia
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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. |
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Neuro: Related History: Personal/Social History
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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 |
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Neuro: Related History: INFANTS
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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 |
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Neuro: Related History: CHILDREN
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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 |
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Neuro: Related History: PREGNANT WOMEN
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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) |
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Neuro: Related History: OLDER ADULTS
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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) |
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• Exam & Findings: Screening Exam: COMPONENTS
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Cranial nerves
Proprioception/cerebellar function Sensory function DTRs Articulation Comprehension Symmetry • Facial features • Strength • Gait |
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• Exam & Findings: Screening Exam: COMPONENTS: CRANIAL NERVES
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• 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 |
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Exam & Findings: Screening Exam: COMPONENTS: Proprioception/cerebellar function
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• 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 |
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Exam & Findings: Screening Exam: COMPONENTS: Sensory function
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• 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 |
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Exam & Findings: Screening Exam: COMPONENTS:DTRs
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• all deep tendon reflexes are tested, excluding the plantar reflex in the test for clonus
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Exam & Findings: Cranial Nerves: o Olfactory I
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Sensory/smell
Test for odor identification |
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Exam & Findings: Cranial Nerves: o Optic II
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Sensory/visual acuity
Test for visual acuity Test visual fields Perform ophthalmologic exam |
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Exam & Findings: Cranial Nerves: o III, IV, VI. Oculomotor, trochlear, abducens
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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) |
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Exam & Findings: Cranial Nerves: o V. Trigeminal
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mixed/muscle tone, sensation
Inspect face for atrophy/tremors Palpate jaw for tone/strength Test for pain/sensation Test corneal reflex (only unconscious people ) |
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Exam & Findings: Cranial Nerves: o VII. Facial
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Mixed/ facial expressions, taste
Inspect facial symmetry Test tongue for salt/sweet |
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Exam & Findings: Cranial Nerves: o VIII. Acoustic
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Sensory/hearing, balance
Test hearing Compare bone/air conduction Test for sound lateralization |
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Exam & Findings: Cranial Nerves: o IX. Glossopharyngeal
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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) |
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Exam & Findings: Cranial Nerves: o X. Vagus
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Mixed/swallowing, speech
Inspect palate/uvula for symmetry Inspect for swallow difficulty Evaluate guttural speech sounds |
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Exam & Findings: Cranial Nerves: o XI. Spinal accessory
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Motor/muscle strength
Test trapezius/sternocleidomastoid muscle strength |
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Exam & Findings: Cranial Nerves: o XII. Hypoglossal
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Motor/tongue strength
Inspect tongue for symmetry/tremors/atrophy Test tongue movement Test tongue strength Evaluate lingual speech sounds |
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Exam & Findings: Coordination/Fine Motor Skills:Test rapid rhythmic alternating movements
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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 |
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Exam & Findings: Coordination/Fine Motor Skills: o Test accuracy of movements
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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 |
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Exam & Findings: Coordination/Fine Motor Skills: o Test balance
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Evaluate equilibrium
Observe gait Balance: Rhombergs, one foot stand, heel toe walking |
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• Exam & Findings: Sensory Function: TYPES
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PRIMARY
CORTICAL |
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Exam & Findings: Sensory Function: Primary
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• Superfical touch (sharp/dull), temperature, vibration
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Exam & Findings: Sensory Function: Cortical: • Stereognosis
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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 |
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Exam & Findings: Sensory Function: Cortical: • Two-point discrimination
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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 |
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Exam & Findings: Sensory Function: Cortical: • Extinction phenomenon
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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 |
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Exam & Findings: Sensory Function: Cortical: • Graphesthesia
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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 |
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Exam & Findings: Sensory Function: Cortical: • Point location
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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 |
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• Exam & Findings: Sensory Function: o Observe all sensory function tests for:
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Side-to-side differences
Interpretation of sensation Discrimination Location o If impairment found, map boundaries by dermatome |
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• Exam & Findings: Reflexes: TYPES
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Superificial of deep
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Reflexes: Superficial: Types
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Upper and lower abdomen
Cremastic Plantar |
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Reflexes: Superficial: Upper and lower abdomen
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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 |
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Reflexes: Superficial: Cremastic
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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 |
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Reflexes: Superficial: Plantar
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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 |
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Reflexes: Deep: TYPES
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• Biceps
• Brachioradial • Triceps • Patellar • Achilles |
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o Observe deep tendon reflex tests for:Biceps
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elbow flexion
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o Observe deep tendon reflex tests for:brachioradial
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forearm pronation/elbow flexion
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o Observe deep tendon reflex tests for: triceps
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elbow extension
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o Observe deep tendon reflex tests for: patellar
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- lower leg extension
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Observe deep tendon reflex tests for: Achilles
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foot flexion
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what neurological assessment should you check in pregnant women as a baseline
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DTRs
hyperactive in eclampsia |
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DTR: 0/4
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no response
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DTR: 1/4
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sluggish/diminished
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DTR: 2/4
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active or expected
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DTR: 3/4
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more brisk then expected-slightly hyperactive
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DTR: 4/4
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brisk, hyperactive with intermittent or transient clonus
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• Exam & Findings: Additional Procedures: Monofilament test
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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 |
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Exam & Findings: Additional Procedures: o Meningeal signs
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nuchal rigidity
brudzinskis sign kernig sign |
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Exam & Findings: Additional Procedures: o Meningeal signs: Nuchal rigidity
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• 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 |
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Exam & Findings: Additional Procedures: o Meningeal signs: Brudzinski's sign
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• 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 |
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Exam & Findings: Additional Procedures: o Meningeal signs: Kernig sign
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• 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 |
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• Exam & Findings: Infants: CN testing
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o the cranial nerves are not routinely tested directly, but several observations made during the physical examination provide indirect evaluation
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Exam & Findings: Infants: CNs II, III, IV, VI
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• 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 |
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Exam & Findings: Infants: CN V
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• 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 |
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Exam & Findings: Infants: CN VII
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• Facial expressions
o when crying • Forehead wrinkling o ability to • Smile o symmetry |
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Exam & Findings: Infants: CN VIII
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• 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 |
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Exam & Findings: Infants: CN IX, X
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• Swallow/gag reflex
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Exam & Findings: Infants: CN XII
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• 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 |
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Exam & Findings: Infants: Evaluate primitive reflexes
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• 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 |
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Exam & Findings: Infants: Evaluate primitive reflexes: o Palmar
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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 |
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Exam & Findings: Infants: Evaluate primitive reflexes: o Plantar
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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 |
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Exam & Findings: Infants: Evaluate primitive reflexes: o Moro
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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 |
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Exam & Findings: Infants: Evaluate primitive reflexes: o Placing
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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 |
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Exam & Findings: Infants: Evaluate primitive reflexes: o Stepping
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• 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 |
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Exam & Findings: Infants: Evaluate primitive reflexes: o Asymmetric tonic neck
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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 |
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Exam & Findings: Infants: Observe movement
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• observe the infants spontaneous activity for symmetry and smoothness of movement
o Spontaneity o Symmetry |
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Exam & Findings: Infants: Inspect/palpate muscle strength/tone
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• muscle strength in tone are especially important to evaluate in the newborn and infant
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• Exam & Findings: Children
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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. |
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• Exam & Findings: Pregnant Women
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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) |
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• Exam & Findings: Older Adults
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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 |
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• Common Abnormalities: Central Nervous System: o Multiple sclerosis
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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. |
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• Common Abnormalities: Central Nervous System: Generalized Seizure Disorder
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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. |
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• Common Abnormalities: Central Nervous System: Meningitis
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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 |
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• Common Abnormalities: Central Nervous System: encephalitis
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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. |
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• Common Abnormalities: Central Nervous System: o Lyme disease
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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) |
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• Common Abnormalities: Central Nervous System: intracranial tumor
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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 |
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• Common Abnormalities: Central Nervous System: CVA
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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 |
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• Common Abnormalities: Peripheral Nervous System: o Myasthenia Gravis
|
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. |
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Common Abnormalities: Peripheral Nervous System: o Guillain-Barré
|
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. |
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Common Abnormalities: Peripheral Nervous System: o Peripheral neuropathy
|
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 |
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Common Abnormalities: Peripheral Nervous System: o Bells Palsy
|
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. |
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• Common Abnormalities: Children: o Cerebral palsy
|
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 |
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Common Abnormalities: Children: HIV encephalopathy
|
definition
pathophysiology subjective data objective data |
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Common Abnormalities: Children: Rett Syndrome
|
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. |
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• Common Abnormalities: Pregnant women: o Maternal obstetric palsy
|
definition
pathophysiology subjective data objective data Obstretric palsy: greater gestation, gravid uterus puts pressure on nerves. |
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Common Abnormalities: Older adults: Parkinson's disease
|
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. |
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Common Abnormalities: Older adults: o Normal-pressure hydrocephalus
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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. |
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• Acrodermatitis
|
o definition
o pathophysiology o subjective data o objective data o Later manifestation of Lymes Disease |
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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:
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rhomberg sign
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|
The major portion of brain growth and myelinization occurs between ____ year(s) of age
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birth to 1
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Which area of the brain is responsible for perceiving sounds and for determining their source?
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temporal lobe
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|
When using a monofilament to assess sensory function, the examiner:
|
applies pressure to the monofilament until the filament bends
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|
To assess a cremasteric reflex, the examiner strokes the
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inner thigh and observes whether the testicle and scrotum rise on the stroked side
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|
To assess spinal levels L2, L3, and L4, which deep tendon reflex should be tested?
|
patellar
|
|
The motor cortex of the brain is in the:
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frontal lobe
|
|
The autonomic nervous system coordinates which of the following?
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internal environment of the body
|
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The major function of the sympathetic nervous system is to
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orchestrate the stress response
|
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When assessing superficial pain, touch, vibration, and position perceptions, you are testing:
|
sensory function
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