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69 terms

Nervous System Examination

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Arousal-Alert
Wakefulness
Arousal-Lethargy
Loud voice needed
Arousal-Obtunded
Loud voice+shake
Arousal-Stupor
Loud voice+vigorous shake
Arousal-Coma
Responds to noxious stimulus
Attention-Digit repetition
Accurately repeat up to 7 numbers
Attention-Vigilance
Recognize letter when given a series of different letters
Mental Status-Arousal
Alert, lethargy, obtunded, stupor, coma
Metal Status-Attention
Digit repetition, vigilance
Mental Status-Orientation
Person, place, time
Mental Status-Language
Oral fluency, comprehension, articulation
Mental Status-Proverb interpretation
Abstract reasoning/higher-association cortex function
Mental Status-Calculations
Simple math skills
Mental Status-Writing
Spatial and language skills
Mental Status-Constructional ability
drawing complex figures, manipulation blocks
Mental Status
Arousal and attention, orientation ,language, memory, proverb interpretation, calculations, writing, constructional ability
Mental Status-Memory
Short-term and remote
Vision & Visual Fields
Pupillary light reflex, acuity, visual fields, eye movement, vestibulo-ocular reflex
Vision & Visual Fields-Pupillary light reflex
CN II (sensory) and CN III (motor)
Vision & Visual Fields-Acuity
Ability to read close/far (CN II)
Vision & Visual Fields-Visual fields
Test 1 eye at a time, document peripheral, superior, inferior fields (CN II)
Vision & Visual Fields-Eye movement
Up, down, medial (CN III), look to nose (CN IV), lateral (CN VI)
Vision & Visual Fields-Vestibulo-ocular reflex
Keep eyes on object while head moves (CH VIII)
Reflexes
Deep tendon, posturing, decorticate, decerebrate, plantar, frontal release, gag, cremasteric, analwink
Reflexes-Posturing
Abnormal reflexes
Reflexes-Decorticate
Flexion UE, extension LE
Reflexes-Decerebrate
Extension of both UE and LE
Reflexes-Plantar
positive or negative Babinski
Reflexes-Frontal reflexes
grasp, root, suck reflexes
Reflexes-Gag
Palate elevation (CN IX, X)
Reflexes-Cremasteric
L1-2
Reflexes-Anal wink
S2-4
Tone
Resistance to Passive Stretch (flaccidity, hypotonicity, hypertonicity, spasticity, rigidity,
Tone-Flaccidity
Absence of muscle tone
Tone-Hypotonicity
Decreased
Tone-Hypertonicity
Increased
Tone-Spasticity
Velocity-dependent
Tone-Rigidity
bidirectional, not velocity-dependent
Motor Face & Neck
CN: III, V, VII, IX, X, XI, XII
Eye open
CN III
Facial expression
VII
Muscles mastication
V
Tongue
XII
Sternocleidomastoid and upper trapezius muscles
XI
Coordination
Extremity, dysmetria, dysrhythmia, dysdiadochokinesia, tremor, trunk, muscle activation
Coordination-Extremity
finger to nose, heel to shin, finger or toe tapping, rapid alternating movement (RAM)
Coordination-Dysmetria
Overshoot/undershoot
Coordination-Dysrhythmia
Abnormal timing
Coordination-Dysdiadochokinesia
Difficulty with RAM
Coordination-Tremor-Postural
Arms held out
Coordination-Tremor-Intention
During movement
Coordination-Tremor-Resting
At rest
Coordination-Muscle activation
Coactivation, difficulty scaling movement, slowed reaction/movement time
Balance
Romberg, postural strategies, reaching, sensory
Balance-Romberg
Feet together, arms crossed, eyes closed-general test for vestibular dysfunction (VIII)
Balance-Postural strategies
Test for ankle, hip, stepping strategies with displacement center of mass
Balance-Reaching
Test limit of stability
Balance-Sensory
Romberg eyes open/closed, hard/foam surface; tests reliance on vision/proprioception
Sensation
Somatic, face, Taste, cortical
Sensation-Somatic
light tough, proprioception, pain, temperature, 2-point
Sensation-Face
CN V
Sensation-Taste
CN VII, IX
Anterior 2/3 of tongue taste
CN VII
Posterior 1/3 of tongue taste
CN IX
Sensation-Cortical
Kinesthesia, stereognosis, graphesthesia
Strength-Paralysis
Loss of Voluntary movement
Strength-Weakness
Inability to generate enough force to move
Strength-Tests
Via muscle group (hip flexors), spinal segment (L2), or peripheral nerve (femoral nerve)
Strength-Tests-Methods
Manual muscle test, dynamometer, electromyography isokinetic testing