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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.
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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? • Vagus • Acoustic • Glossopharyngeal • Accessory
Sample Quiz Questions What Cranial nerve is responsible for tongue movement? • 6 • 8 • 10 • 12 • None of the above
Sample Quiz Questions How do you test for cranial nerve number 3? • Snellen eye chart • Hearing test • Have them follow your pen with their eyes as you move it about • Have them stick out their tongue
Sample Quiz Questions When you check for nystagmus, what cranial nerve are you assessing? • Olfactory • Optic • Abducens • All of the above • None of the above
Sample Quiz Questions When you check someone's shoulder strength, what cranial nerve are you assessing? • 6 • 8 • 10 • 12 • None of the above
Learning Tip On Old Olympus Towing Top a Finn and German Viewed A Hawk