Neurology - 2

Neurology - 2

Part 2

Intellectual Function

• Calculations– Count backwards from 100– Spell backwards

• Integrative capacity– How are a cat and a wolf alike?

• Judgment– Interpret a well known proverb

• A bird in the hand is worth more than two in the bush.• The early bird catches the worm

Intellectual Function

• Judgment– You arrive home without a house key, what

alternatives do you have?• Short term memory test?– 3 words– Repeat in 5 minutes– Amnesia• Loss of memory

Thought Content

• Are the thoughts…?– Spontaneous– Natural– Clear– Relevant– Coherent

Thought Content

• Fixed ideas• Preoccupations

Hallucinations

• False perceptions (sensory)

• Does not have an external stimuli

• Patients see, hear, taste things that are not really there

Illusions

• Has a real external stimuli, but the patient misinterprets the stimuli

Delusions

• False beliefs

Emotional Status

• Affect/ Mood• Consistent• Appropriate• Facial expressions,

body language

Perception

• Agnosia– The inability to

interpret or recognize objects • Visual

– Occipital

• Auditory– Temporal

• Tactile– Parietal lobe

Motor Ability

• Ask to perform a small task

• Understanding + motor strength

• Movement smooth, coordinated

• Involuntary movements

• Gait

Language Ability

• Spoken and written• Aphasia– Expressive

• Motor aphasia• Broca’s aphasia

– Receptive• Sensory aphasia• Wernicke’s aphasia

– Global

Language ability

• Dysphasia / aphasia• Dysphagia / aphagia• Dysarthria– Imperfect articulation

of speech

Terminology• Anosmia

– I - Inability to smell• Anisocoria

– J - Inequality of pupil size• Agnosia

– F - Inability to determine meaning or significance of sensory stimulus

• Apraxia– G - Inability to performed learned movements, defect in motor

planning• Analgesia

– M - Loss of pain sensation• Anesthesia

– A - Absence of sensation

Terminology

• Astereognosis– H - Inability to recognize form of object by touch

• Ataxia– L - Lack of coordination of movement

• Diplopia– C - Double vision

• Dysarthria– K - Lack of coordination in articulating speech

• Dyskinesia– E - Impairment of power of voluntary movement,

resulting in fragmentary on incomplete movements

Terminology• Dysphagia– B - Difficulty swallowing

• Homonymous hemianopsia– N - Loss of vision in one side of visual field

• Ophthalmoplegia– P - Paralysis of eye muscles

• Opisthotonus– D - Extreme arching of back with retraction of head

• Paraplegia– O - Paralysis of lower extremities

Small group Questions

• What does battle’s sign indicate• What does raccoon eyes indicate• What is rhinorrhea and how do you know they have it?• What is Otorrhea and what does it indicate?• Described decorticated and Decerebrated posturing and

what they each indicate• What are the three areas of orientation• How do you test judgment? Short term memory• Differentiate be hallucinations, delusions and illusions.

Cranial Nerves

• 12 pairs• PNS• You must know:– The name– The number– The order– The function– S/M– How to assess

Cranial Nerves

• Number -1 • Name: Olfactory• Sensory• Function– Sense of smell

• Assessment– Identify familiar odor

Cranial Nerves

• Number -2 • Name: Optic• Sensory• Function– Visual Acuity

• Assessment– Snellen eye chart

Cranial Nerves

• Number -3 • Name: Oculomotor• Motor• Function

– Muscles that move the eye, lid, papillary constriction, lens accommodation

• Assessment– Test for ocular rotation,

nystagmus, Papillary reflexes, check for ptosis

• Nystagmus:– Involuntary

osculation of the eyeball

• Ptosis– Drooping eyelid

• Papillary reflexes– Pupil changing in size

when exposed to light

Cranial Nerves

• Number -4 • Name: Trochlear• Motor• Function

– Muscles the move the eye, lid, papillary constriction, lens accommodation

• Assessment– Test for ocular rotation,

nystagmus, Papillary reflexes, check for ptosis

Cranial Nerves

• Number -5• Name: Trigeminal• Sensory & Motor• Function– Facial sensation,

corneal reflex, mastication

• Assessment– Distinguish between

sharp and dull on face– Check blink reflex– Have patient clinch

and move jaw from side to side, feel jaw strength

Cranial Nerves

• Number -6 • Name: Abducens• Motor• Function

– Muscles the move the eye, lid, papillary constriction, lens accommodation

• Assessment– Test for ocular rotation,

nystagmus, Papillary reflexes, check for ptosis

Cranial Nerves• Number - 7• Name: Facial• Sensory & Motor• Function

– Facial expression and muscle movement

– Salivation and tearing– Taste

• Assessment– Observe for symmetry

while pt performs facial movement

– Stick out tongue– Distinguish between

sugar and salt

Cranial Nerves

• Number -8 • Name: Acoustic• Sensory• Function– Hearing &

equilibrium• Assessment– Simple hearing test

Cranial Nerves• Number -9• Name:

Glossopharyngeal• Sensory & Motor• Function– Taste– Sensation in pharynx

and tongue– Pharyngeal muscles

• Assessment– Ability to discriminate

btw sugar and salt

Cranial Nerves• Number -10• Name: Vagus• Sensory & Motor• Function

– Muscle of pharynx, larynx, thoracic and abdominal viscera

– Parasympathetic innervations

• Assessment– Gag response– Have person say

“Ah….”– Symmetrical rise of

uvular and soft palate– Assess swallowing

Cranial Nerves

• Number -11 • Name: Accessory• Motor• Function– Shoulder movement

• Assessment– Strength of muscle,

shrug

Cranial Nerves

• Number -12• Name: Hypoglossal• Motor• Function– Tongue movement

• Assessment– Check tongue

strength and movement

Sample quiz questions

What cranial nerve is responsible for hearing and equilibrium?

A. VagusB. AcousticC. GlossopharyngealD. Accessory

Sample Quiz Questions

What Cranial nerve is responsible for tongue movement?

A. 6B. 8C. 10D. 12E. None of the above

Sample Quiz Questions

How do you test for cranial nerve number 3?A. Snellen eye chartB. Hearing testC. Have them follow your pen with their eyes

as you move it aboutD. Have them stick out their tongue

Sample Quiz Questions

When you check for nystagmus, what cranial nerve are you assessing?

A. OlfactoryB. OpticC. AbducensD. All of the aboveE. None of the above

Sample Quiz Questions

When you check someone's shoulder strength, what cranial nerve are you assessing?

A. 6B. 8C. 10D. 12E. None of the above

Learning Tip

On Old Olympus Towing Top a Finn and German

Viewed A Hawk