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Obtunded
- refers to less than full mental capacity in a medical patient, typically as a result of a medical condition or trauma
- Cowlike
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Stuporous
Arousable for short periods but unaware of surroundings
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Dysarthria
- [diss-arr-three-er]
- Speech defects => of motor deficits
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Dysphonia
Speech defects => of vocal cord problems
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Aphasia (expressive or receptive)
Speech defects => of brain damage
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A nervous system exam covers 5 areas:
- 1. Mentation and speech
- 2. Cranial nerves
- 3. Motor system
- 4. Sensory system
- 5. Reflexes
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Cranial nerve I
- Olfactory
- Sensory
- Smell
- Test: Get Pt to ID smells
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Mentation and speech - areas covered?
- * Appearance and behaviour
- * Speech and language
- * Mood
- * Thoughts and perceptions
- * Insight and judgment
- * Memory and attention
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Cranial nerve II
- Optic
- Sensory
- Sight
- Test: Use visual acuity/visual field tests
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Cranial nerve III
- Oculomotor
- Motor
- Test: PERRRL? + EOM
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Direct reaction to light?
pupillary constriction when light shone in eye
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Consensual reaction to light?
pupillary constriction in the opposite eye
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Near response part of EOM
ask pt to follow your finger as you move it towards the bridge of their nose
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Lateral rectus muscle?
Look away from nose
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Medial rectus muscle?
Look towards the nose
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Superior rectus muscle?
Look up, when abducted (looking away from the nose)
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Inferior rectus
Look down, when abducted (looking away from the nose)
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Superior oblique muscle?
Look up, when eye adducted (looking towards the nose)
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Inferior oblique muscle?
Look down, when eye adducted (looking towards the nose)
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Cranial nerve IV
- Trochlear
- Motor
- controls Superior oblique muscles
- test: EOM
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Cranial nerve V
- Trigeminal
- Sensory
- controls: Ophthalmic (forehead)
- controls: Maxillary (cheek)
- controls: Mandibular (chin) regions
- Test: Palpate Temporal & Masseter muscles
- Test: Sharp and dull objects on face (e.g. paper clip)
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Cranial nerve VI
- Abducens
- Motor
- Lateral rectus
- Test: EOM
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Cranial nerve VII
- Facial
- Sensory: Tongue
- Motor: Facial muscles
- Test: Look for asymmetry, tics, ptosis, nystagmus while pt makes a variety of facial expressions and while neutral. Ask pt to shut their eyes tightly while you try to open them to test muscle strength.
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Cranial nerve VIII
- Acoustic
- Sensory
- Hearing balance
- Test: Pt blocks one ear while you whisper in the other. Check if they heard. Evaluate balance when they have their eyes shut.
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Cranial nerve IX
- Glossopharyngeal
- Sensory: Posterior pharynx, taste to anterior tongue
- Motor: Posterior pharynx
- Test: Same as Nerve X
- --- Hoarse voice = vocal cord issues
- --- Nasal = palate issues
- --- Pt sticks out tongue and says "aaahhh" - visualize for weirdness
- --- Check gag reflex with a tongue depressor
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Cranial nerve X
- Vagus
- Sensory: Taste to posterior tongue
- Motor: Posterior palate and pharynx
- Test: Same as Nerve IX
- --- Hoarse voice = vocal cord issues
- --- Nasal = palate issues
- --- Pt sticks out tongue and says "aaahhh" - visualize for weirdness
- --- Check gag reflex with a tongue depressor
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Cranial nerve XI
- Accessory
- Motor
- Trapezius muscles
- Test: Hold the pts shoulders and ask them to shrug.
- Sternocleidomastoid muscles
- Test: Hold pts head and get them to try to look left and right while you provide resistance.
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Cranial nerve XII
- Hypoglossal
- Motor
- Tongue
- Test: Check speech - get pt to stick out their tongue - look for any deviation
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Nystagmus
- [niss-stag-muss]
- involuntary movements
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Fasciculations
- [fa-sick-you-lay-tions]
- twitches
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Motor system assessment areas?
- General body structure,
- Muscle development, Shape/bulk, Tone, Strength
- Positioning,
- Coordination
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Muscle Tone assessment?
- Get Pt to relax and move their affected extremities through all of their range of motions.
- Assess muscle tone: Spastic versus Rigid tone
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Spastic tone is?
- increased muscle tone, especially at range of motion.
- Common in stroke
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Rigid tone is 4 things?
- Lead pipe rigidity
- Cog wheel rigidity
- Flaccidity
- Paratonia
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Lead pipe rigidity?
Increased muscle rigidity throughout movement. E.g. Parkinson's
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Cog wheel rigidity?
Ratchet like jerkiness => pt resistance or fakery
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Flaccidity?
Loss of muscle tone, common in stroke, spinal injury, etc
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Paratonia?
- Sudden changes in tone (increase or decrease) during passive movement.
- Common in dementia.
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Muscle Strength Assessment?
- Assess, and compare bilaterally on a 0 - 5 scale:
- --- Grip
- --- Flexion / Extension of muscles
- --- Abduction / Adduction
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Romberg test?
- Stand feet together with eyes open.
- Then they close their eyes for 20 to 30 seconds - observe any swaying.
- Losing balance indicates a positive Romberg test.
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Tandem walking?
Walk heal to toe in a straight line.
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Babinski response?
Big toe curling up: brain dammage in adult
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