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85 Cards in this Set
- Front
- Back
-Folstein possible points
-Normal -organic problem -Depressed score -Dementia/delirium/schozo |
-30
->23 -<27 -20-24 -<20 |
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Components of Folstein (11)
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1. year, season, date, month
2. State, county, town, hospital, floor 3. Name 3 objects 4. Spell world backwards 5. Repeat 3 objects 6. ID 2 objects pointed to 7. Repeat "no ifs ands or buts" 8. Follow 3 stage command 9. Close eyes 10. Write a senstence 11. Copy design |
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Testing CN II
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Eye chart, visual fields
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CNs in midbrain/pons
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3 - 6
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Testing CN III
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Focus far to near vision; pupillary light reflex
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CN IV
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Rotate eye up, down, R L
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Testing CN 7
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Facial expression
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Bells Palsy symptoms
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Can't raise ipsilateral eyebrow (CN7)
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Stroke symptomes
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Can raise eyebrows
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Testing CN 5
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Touch on bilat forehead, maxilla, mandible; clench teeth
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Testing CN 8
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Balance
Whisper test |
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CN 9
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Swallow, gag
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CN 10
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Uvula rise midline "Ahhh"; hoarseness
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CN 11
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Shrug shoulders (trap), turn head (SCM)
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CN 12
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Protrude tongue (midline)
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CNs in Medulla
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9-12
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Why can pt raise eyebrows w/ stroke?
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Bilateral innervation to facial motor nucleus to mm above eye; Bells palsy affects the n. after the nucleus
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If a pt has decreased touch sensation, test ___ next
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Vibration w/ tuning fork
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Common reasons for decreased touch sensation DCSBP
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Diabetes
Compression Syphilis B12/folate deficiency Peripheral vascular dz |
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What is considered a sufficient screen for dorsal colum?
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If pt feels fingers/toes & has not SC injury
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How will touch sensation return after SC injury?
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Top down (prox --> distal)
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Idiopathic dz where central canal becomes cystic/expands in parts of SC
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Syringomyelia
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Demyelinating disease of PERIPHERAL NERVOUS SYSTEM
Associated with a viral syndrome (EBV, CMV) Rapidly progressive motor and sensory neuropathy |
Gion Beret
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Symptom of syringomyelia
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Loss of P&T bc enlarged canal compresses spinothalamic tract
Then beings to put pressure on motor neurons (LMN type lesion) |
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If pt has decr perception of pain, do ___ next
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Use vacutainer filled w/ hot/cold, start w/ lowest dermatome work way up
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Common reasons for decr pain sensation
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Diabetes
N. compression |
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C1-4 myotome
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Neck
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C4-5 myotome
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Shoulders
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C6 & 7 mytome
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Elbow/wrist
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C8
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Thumb
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T1
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finger abduction
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L2
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Hip flexion
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L3
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Knee extension
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L4
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Ankle dorsiflexion
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Types of reflexes
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Deep Tendon
Cutaneous |
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Normal and symmetrical reflexes tell you:
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Ipsilateral reflex arc & contralateral descending inputs are intact
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S/S of problems w/ Reflex arc
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Hyporeflexia
Muscle atrophy Decr strength |
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S/S of problems w/ descending inputs
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Hyperreflexia
Disuse atrophy only Spasticity |
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Hyperreflexia (enhanced stretch reflex)
No m atrophy Affects groups of mm Babinski present |
Upper motor neuron lesion
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Decreased m tone
Atrophy Fasciculations Hyporeflexia No Babinski |
LMN
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3 tests require the pt to integrate sensation of touch, recognition of object, & speech
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Stereognosis
Graphesthesia Point localization |
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Recognition of object occurs in:
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Contralateral Parietal lobe
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Speech originates from:
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Left frontal lobe in all R handed & 80% of L handed
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Stereognosis procedure
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Pt close eyes, ID object placed in hand
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Graphesthsia procedure
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Pt close eyes, trace number on palm
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Point localization
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Pt close eyes, touch point on upper & lower extremities, pt points to where they were touched
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Key structure for modulating movement/making them smooth
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Cerebellum
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Tests of cerebellar fxn (6)
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1 Pat hands on legs
2 Pat hands back/forth on legs 3 Touch each finger w/ thumb 4 Tap feet on floor 5 Touch nose, then your finger back/forth 6 Run heal down opposite shin |
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If the head and body are in motion: ___- drives the movement, ____ coordinates through input from ____, and balance must be maintained via ___
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Cerebrum; cerebellum; proprioceptors, CN 8
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5 tests that test integration of all these, but don't allow pinpoint of lesion
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Romberg
Stand on 1 foot for 5 s Hop on 1 foot Walk Walk heal to toe |
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Romburg procedure
--What it's testing |
-Pt close eyes, arms out
--Relying on CN 8, proprioceptors in feet, motor fxn for standing |
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___ important in modulating unconscious m. tone
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BG
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Lesions of BG produce ____
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movement disorders at rest (dyskinesias)
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5 dyskinesias common to BG:
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1 Tremor (e.g. resting of Parkinson's)
2 Athetosis 3 Chorea 4 Ballismus 5 Tics |
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-Athetosis
-D/t: |
Slow, writing, snake like movement of limbs; begins in infancy d/t viral encephalopathy
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-Chorea
-E.g. |
Rapid, jerky movements in distal limbs/face
-E.g. Huntington's, Sydenham's |
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-Ballismus
-E.g -Resolution |
-Violent flailing of entire limb
-Hemiballism 2nd to infarct; resolves weeks to months |
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Tics
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-Stereotypical & repetitive movements of face/tongue
-E.g. Tardive dyskinesia d/t long term tx w/ neuroletpics (Thorazine, Prolixen) |
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Allows level of consciousness to be evaluated & quantified when pt has acute brain injury
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Glascow coma scale
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Coma scale < __ gets automatic head scan
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8
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Max Glascow score
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14
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Assessed behaviors of Glascow (3 major categories)
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Eye opening
Appropriate verbal response Integrated motor response |
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Eye opening response scoring Glascow
1 2 3 4 |
Spontaneous (4)
To verbal stim (3) To pain (2) None (1) |
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Verbal response scoring Glascow
(5) |
Oriented 5
Confused 4 Inappropriate words 3 Incoherent 2 None 1 |
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Motor response scoring Glascow (5)
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Obeys commands 5
Localizes pain 4 Flexion to pain (decorticate) 3 Extension to pain (decerebrate) 2 None 1 |
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Numbness in feet/hands after vaccination, hx of Camplobactor
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Gion Baret
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Tx of Gion Baret
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ICU
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Test for R/L brain dominance
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Run cath in L internal carotid, have pt count back from 100
--If speech is on L, pt will stop talking b/c brocas on that side |
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Dominance determined by:
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Side speech center is on
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Anoxi during birth leads to
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Cerebral palsy
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Anoxic during birth, late decels, movement disorder affecting limbs
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Cerebral palsy
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Dementia vs delirium
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Delirium gets better
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Meds to prevent withdraw symptoms in alcoholics
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Adovan, Librium, Valium
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Autoimmune against ACh receptor in middle age male w/ global m. weakness, can;t wink fast --> give parasympathetic blockers --> gets better
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Myestinia gravis
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2 tests for Memingitis
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Kernigs
Broudzinkskis |
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Kernigs procedure
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Pt lay down, flex knees, then hips, then extend knees up in air --> pt will resist re-flexion of knees
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Brudzinksi's procedure
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Pt laying down, raise head, will bring knees to fetal to reduce stretch
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Always do Brud & Kernig when?
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Exams for pharyngitis/URI etc note absence of meningitis
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To test meningitis on babies:
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Take them away from mom, they'll turn
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Ankle Clonys
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Quickly dorsiflex ankle, with UMN lesion = hyperreflexia & ankle will plantar flex against
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Describe motor fxn on scale of __-
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0-4; 2 is normal
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First sensation lost in diabetics
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vibration
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Tabes Dorsalis; indicative of:
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Clopping walk w/ planting of feet while looking; Tertiary syphilis
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Tertiary syphilis is a ___ disruption of ___
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Selective; dorsal column
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If pt has true problem w/ touch sensation, will also have:
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Vibration/proprioception problem
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