NUR 225 Study Guide - Final Guide: Corneal Reflex, Vestibulocochlear Nerve, Intention Tremor
21 May 2018
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Final Exam Review/Study Guide
Neuro (21 questions)
- Order of assessment of Cranial Nerves… Ho to test the? What do the idiate?
o CN II Optic: Read Snellen chart, Othalmascope, Confrontation (checks peripheral vision)
o CN III/IV/VI: Palpebral folds (folds of eyes symmetrical), PERRLA, EOM, Nystagmus (eyes
move horizontal/up/down)
o CN V: Palpate temporal, TMJ, Masseter, Corneal reflex (if pt. is unconscious), sharp vs.
dull feeling, cotton on forehead, cheeks, chin
o CN VII: Close eyes and open against resistance, raise eyebrows, smile, frown, puff cheek
o CN VIII: Whisper test
o CN IX: “a ah → uvula should rise midline
o CN X: Gag test → do’t hek uless pt. is uosious
o CN XII: Stick out tongue & move side-to-side, light, tight, daite
o CN XI: Shrug shoulders against resistance, turn head against resistance
- Changes of aging:
o Older people a’t tell hat part of the od ou’re oig → normal; they lose
vibratory and position sense
o MSK → gait becomes slower, reaction time is slower so they compensate by walking
more carefully
o RAM more difficult, vibration sense decreased, Ankle jerk decreased, position sense big
toe decreased, DTR less brisk, abdominal reflex may be absent
- Test sensory functions in patients: Can they feel sharp? Dull?
o Make sure you check side to side and have the patient close their eyes
- How to test vibration sense? Why do we care?
o “a o he iratio stops/starts, start distal ad oe proial if o sesatio
o #1 cause of loss of vibration sense = peripheral neuropathy (especially diabetic)
- Graphestheia → Shut eyes, hold out hand and say what number is drawn on pt. hand
- Stereognosis → Shut eyes, hold out hand and say what object is in hand
- Deep Tendon Reflexes:
o Reflex Normal → 2+, 3+ makes reflexes even more pronounced
o 4+ Very brisk, hyperactive
o 3+ Brisker than average
o 2+ Average, normal
o 1+ Diminished
o 0 No Response
- If ou do reflees ad do’t get a good respose… you can distract the person or use
reinforcement by having them pull their upper hands together, grab thighs, etc.
- Tremors:
o Restig: Better ith olutar oeet; E: Parkiso’s
o Intention: Worse w/ voluntary movement; Ex: Cerebellar disease, MS
▪ Essential: Most common type of intention tremor (and tremor in elderly)
• Familial & benign, head tremors are common
find more resources at oneclass.com
find more resources at oneclass.com
- Muscle Tone Terms
o Flaccid: Weak, hypotonic → CVA, Early SC injury
o Spasticity: Increased resistance to passive lengthening; stiff w/ rapid passive movement
only, late CVA/SC Injury
o Rigidity: Resists any passive movement, Ex: Parkinsonism
o Cogwheel Rigidity: Increased tone released with PROM; Ex: Parkinsonism, Meningitis
- How do you grade muscle strength?
o + 5 Full ROM & strength (100%)
o + 4 Full ROM < normal strength (75%)
o + 3 Raise extremities but not against resistance (50%)
o + 2 Can move extremities but not lift them (25%)
o + 1 Slight movement (10%)
o 0 No movement (0%)
- When checking for Babinski reflex/plantar reflex, stroke with semi-sharp edge in the shape of
an upside-down J → toes should pull away from reflex and go toward the plantar (toes are
down-going) uless the’re not walking yet (babies); dorsiflexing is not normal
- Cerebellum (Balance) tests → Romberg tests, RAM (finger to finger, thumb, nose), walk in a
straight-line heel to toe
o Romberg: Feet together, arms at sides, close eyes, wait 20 seconds; balance
proprioeptio ko here ou’re at i spae, estiular, ETOH, M“
▪ Swaying, loss of balance = failed test
- How to test Cerebrum (mental state/cognition/thinking)
o Pronator Drift: Good test for stroke, close eyes and put hands out and if hands drift away
then it is a sign of a stroke/brain lesion
- Difference between confusion & aphasia
o If the patient speaks in 1 word sentences or repeats the same sentence over, consider
aphasia; test by having them read/repeat a sentence
MSK (15 questions)
- Adduction: Pulling towards the body
- Abduction: Taking away from body, most common sign of hip disease
- Pronation: Back side
- Supination: Front side
- Inversion:
- Eversion:
- What does a broken hip look like?
o Leg is shortened and internally rotated
- How to test for hip dysfunction?
o Eterall rotate hip Patrik’s sig → indicator of hip disease
- Low back pain? → Straight leg raise; will tell us if disc herniation
- Normal MSK Changes of elderly
o Sedentary lifestyle = increased risk of having MSK problems; osteoporosis (loss of bone
desit is ore prealet i feales, thiig diss, kphosis/doager’s hup,
- RA vs. Osteoarthritis → Symptoms, physical findings
find more resources at oneclass.com
find more resources at oneclass.com
