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…?
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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
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•
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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
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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
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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:
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The name
The number
The order
The function
S/M
How to assess
Cranial Nerves
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Number -1
Name: Olfactory
Sensory
Function
– Sense of smell
• Assessment
– Identify familiar odor
Cranial Nerves
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Number -2
Name: Optic
Sensory
Function
– Visual Acuity
• Assessment
– Snellen eye chart
Cranial Nerves
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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
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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
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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
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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
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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
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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
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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
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Number -11
Name: Accessory
Motor
Function
– Shoulder movement
• Assessment
– Strength of muscle,
shrug
Cranial Nerves
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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. Vagus
B. Acoustic
C. Glossopharyngeal
D. Accessory
Sample Quiz Questions
What Cranial nerve is responsible for tongue
movement?
A. 6
B. 8
C. 10
D. 12
E. None of the above
Sample Quiz Questions
How do you test for cranial nerve number 3?
A. Snellen eye chart
B. Hearing test
C. Have them follow your pen with their eyes
as you move it about
D. Have them stick out their tongue
Sample Quiz Questions
When you check for nystagmus, what cranial
nerve are you assessing?
A. Olfactory
B. Optic
C. Abducens
D. All of the above
E. None of the above
Sample Quiz Questions
When you check someone's shoulder strength,
what cranial nerve are you assessing?
A. 6
B. 8
C. 10
D. 12
E. None of the above
Learning Tip
On Old Olympus Towing
Top a Finn and German
Viewed A Hawk