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

Structure and Function

Subjective DataHealth History Questions

Objective DataThe Physical Exam

Abnormal Findings

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 23-2

Chapter 23: Neurologic System

Structure and Function

Central Nervous System (CNS)

Cerebral cortex

Frontal lobe

Hypothalamus

Cerebellum

Brainstem

Parietal lobe

Occipital lobe

Wernickes area

Midbrain

Brocas area

Pons

Medulla

Basal ganglia
Thalamus

Spinal cord

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 23-3

Chapter 23: Neurologic System

Cerebral Cortex

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 23-4

Chapter 23: Neurologic System

Components of the Central

Nervous System

[PRODUCTION NOTE: Please insert Figure 23-2 (from Jarvis Physical

Examination and Health Assessment, 5e, ISBN: 978-1-4160-3243-4)]

Pat Thomas, 2006.

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 23-5

Chapter 23: Neurologic System

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.

Slide 23-6

Chapter 23: Neurologic System

Sensory Pathways

Pat Thomas, 2006.

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 23-7

Chapter 23: Neurologic System

Motor Pathways

Pat Thomas, 2006.

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 23-8

Chapter 23: Neurologic System

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.

Slide 23-9

Chapter 23: Neurologic System

Reflex Arc

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 23-10

Chapter 23: Neurologic System

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.

Slide 23-11

Chapter 23: Neurologic System

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.

Slide 23-12

Chapter 23: Neurologic System

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.

Slide 23-13

Chapter 23: Neurologic System

Objective DataThe Physical Exam

(cont.)

Test Cranial Nerves

IOlfactory

IIOptic
IIIOculomotor,
IVTrochlear,
VIAbducens
VTrigeminal

VIIFacial

Motor function

Sensory function

VIIIAcoustic
(vestibulocochlear)

IXGlossopharyngeal,
XVagus

Motor function

Motor function

Sensory function

Sensory function

Corneal reflex

XISpinal accessory

XIIHypoglossal

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 23-14

Chapter 23: Neurologic System

Objective DataThe Physical Exam

(cont.)

Motor SystemInspect and palpate

Muscles

Size

Strength

Tone

Involuntary
movements

Cerebellar function

Balance tests

Gait
Tandem walking
Rombergs test
Shallow knee bend

Coordination and skilled

movements

Rapid alternating movements

Finger-to-finger test
Finger-to-nose test
Heel-to-shin test

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 23-15

Chapter 23: Neurologic System

Objective DataThe 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
Graphesthesia
Two-point discrimination
Extinction
Point location

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 23-16

Chapter 23: Neurologic System

Objective DataThe Physical Exam

(cont.)

Test the stretch or deep

tendon reflexes

Test the superficial

reflexes

Technique
Grading

Abdominal reflex
Cremasteric reflex

Reinforcement
Biceps reflex

Plantar reflex

Triceps reflex
Brachioradialis reflex
Quadriceps reflex
Achilles reflex (ankle jerk)
Clonus

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 23-17

Chapter 23: Neurologic System

Objective DataThe Physical Exam

(cont.)

Neurologic recheck
Level of consciousness

Person
Place
Time

Motor function
Pupillary response
Vital signs
Glasgow Coma Scale (GCS)
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Slide 23-18

Chapter 23: Neurologic System

Sample Charting

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 23-19

Chapter 23: Neurologic System

Sample Charting
(cont.)

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 23-20

Chapter 23: Neurologic System

Sample Charting
(cont.)

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 23-21

Chapter 23: Neurologic System

Abnormal Findings

Abnormalities in Muscle Movement

Paralysis

Rest tremor

Fasciculations

Intention tremor

Tic

Chorea

Myoclonus

Athetosis

Tremor

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 23-22

Chapter 23: Neurologic System

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.

Slide 23-23

Chapter 23: Neurologic System

Abnormal Findings
Common Patterns
of Sensory Loss

Peripheral neuropathy

Individual nerves or roots

Spinal cord hemisection (Brown-Squard

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.

Slide 23-24

Chapter 23: Neurologic System

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.

Slide 23-25

Chapter 23: Neurologic System

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.

Slide 23-26

Chapter 23: Neurologic System

Vibratory sense is most frequently

affected in cases of
A.

Heart disease

B.

Crohns disease

C.

Lung Cancer

D.

Diabetes

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 23-27