Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Neurologic System Chapter 23
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 23: Neurologic System Slide 23-2 Structure and Function Subjective Data—Health History Questions Objective Data—The Physical Exam Abnormal Findings
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 23: Neurologic System Slide 23-3 Structure and Function Central Nervous System (CNS) Cerebral cortex Frontal lobe Parietal lobe Occipital lobe Wernicke’s area Broca’s area Basal ganglia Thalamus Hypothalamus Cerebellum Brainstem Midbrain Pons Medulla Spinal cord
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 23: Neurologic System Slide 23-4 Cerebral Cortex
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 23: Neurologic System Slide 23-5 Components of the Central Nervous System [PRODUCTION NOTE: Please insert Figure 23-2 (from Jarvis Physical Examination and Health Assessment, 5e, ISBN: )] © Pat Thomas, 2006.
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 23: Neurologic System Slide 23-6 Structure and Function (cont.) Pathways of the CNS Crossed representation Sensory pathways Spinothalamic tract Posterior (dorsal) column Motor pathways Corticospinal or pyramidal tract Extrapyramidal tracts Cerebellar system Upper motor neurons Lower motor neurons
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 23: Neurologic System Slide 23-7 Sensory Pathways © Pat Thomas, 2006.
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 23: Neurologic System Slide 23-8 Motor Pathways © Pat Thomas, 2006.
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 23: Neurologic System Slide 23-9 Structure and Function (cont.) Peripheral Nervous System Cranial nerves Spinal nerves Autonomic nervous system Reflex arc
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 23: Neurologic System Slide Reflex Arc
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 23: Neurologic System Slide Subjective Data— Health History Questions Headache Head injury Dizziness/vertigo Seizures Tremors Weakness
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 23: Neurologic System Slide Health History Questions (cont.) Incoordination Numbness or tingling Difficulty swallowing Difficulty speaking Significant history Environmental/occupational hazards
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 23: Neurologic System Slide Objective Data— The Physical Exam Preparation Screening neurologic examination Complete neurologic examination Neurologic recheck Equipment needed Penlight Tongue blade Cotton swab Cotton ball Tuning fork (128 or 256 Hz) Percussion hammer Occasionally need: familiar aromatic substance
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 23: Neurologic System Slide Objective Data—The Physical Exam (cont.) Test Cranial Nerves I—Olfactory II—Optic III—Oculomotor, IV—Trochlear, VI—Abducens V—Trigeminal Motor function Sensory function Corneal reflex VII—Facial Motor function Sensory function VIII—Acoustic (vestibulocochlear) IX—Glossopharyngeal, X—Vagus Motor function Sensory function XI—Spinal accessory XII—Hypoglossal
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 23: Neurologic System Slide Objective Data—The Physical Exam (cont.) Motor System—Inspect and palpate Muscles Size Strength Tone Involuntary movements Cerebellar function Balance tests Gait Gait Tandem walking Tandem walking Romberg’s test Romberg’s test Shallow knee bend Shallow knee bend Coordination and skilled movements Rapid alternating movements Rapid alternating movements Finger-to-finger test Finger-to-finger test Finger-to-nose test Finger-to-nose test Heel-to-shin test Heel-to-shin test
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 23: Neurologic System Slide Objective Data—The Physical Exam (cont.) Sensory System Person is alert, cooperative, and comfortable Guidelines for sensory testing Spinothalamic tract Pain Temperature Light touch Posterior column tract Vibration Position (kinesthesia) Tactile discrimination (fine touch) Stereognosis Stereognosis Graphesthesia Graphesthesia Two-point discrimination Two-point discrimination Extinction Extinction Point location Point location
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 23: Neurologic System Slide Objective Data—The Physical Exam (cont.) Test the stretch or deep tendon reflexes Technique Grading Reinforcement Biceps reflex Triceps reflex Brachioradialis reflex Quadriceps reflex Achilles reflex (“ankle jerk”) Clonus Clonus Test the superficial reflexes Abdominal reflex Cremasteric reflex Plantar reflex
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 23: Neurologic System Slide Objective Data—The Physical Exam (cont.) Neurologic recheck Level of consciousness Person Place Time Motor function Pupillary response Vital signs Glasgow Coma Scale (GCS)
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 23: Neurologic System Slide Sample Charting
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 23: Neurologic System Slide Sample Charting (cont.)
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 23: Neurologic System Slide Sample Charting (cont.)
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 23: Neurologic System Slide Abnormal Findings Abnormalities in Muscle Movement Paralysis Fasciculations Tic Myoclonus Tremor Rest tremor Intention tremor Chorea Athetosis
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 23: Neurologic System Slide Abnormal Findings for Advanced Practice Abnormal Gaits Spastic hemiparesis Cerebellar ataxia Parkinsonian (festinating) Scissors Steppage or footdrop Waddling Short leg
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 23: Neurologic System Slide Abnormal Findings Common Patterns of Sensory Loss Peripheral neuropathy Individual nerves or roots Spinal cord hemisection (Brown-Séquard syndrome) Complete transection of spinal cord Thalamus Cortex
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 23: Neurologic System Slide Abnormal Findings Abnormal Postures Decorticate rigidity Decerebrate rigidity Flaccid quadriplegia Opisthotonos
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 23: Neurologic System Slide Which area of the brain is most likely affected if the patient is having trouble with the finger-to-nose test? A.Cerebellum B.Cerebrum C.Hypothalmus D.Brain stem
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 23: Neurologic System Slide Vibratory sense is most frequently affected in cases of A.Heart disease B.Crohns’ disease C.Lung Cancer D.Diabetes