[gwenith]

Here is a bit of a "fun" quiz to sharpen up your neuro assessment skills. Some questions have more than one right answer, some are difficult, some a dead easy and some are just added for a bit of fun!!

I will post the answers in a day or two.

Remember - you can have fun with the answers too.

When assessing a patient with a head injury which order should the assessment take:-

A) Deficit (neuro) Airway, Breathing Circulation
B) Airway, Deficit, Breathing, Circulation
C) Airway Breathing,Deficit, Circulation
D) Airway , Breathing , circulaton, Deficit

Ok now that one was easy lets see how you do on the next ones

The Glasgow Coma Scale

A) is always a 15 point scale
B) measures level of consciousness
C) less valid when used by inexperienced users
D) is the only scale in the world where you can be dead and still score 3

Pupil size is recorded as well as the pupils reaction to light. The size that is recorded should be the size of the pupil:-

A) in the ambient light of the room
B) that it constricts to when testing light reaction
c) after the patient is asked to change focus
D) when the young male patient sees a pretty young female!!

Spontaneous eye opening is a sign of:

A) awareness
B) wakefulness/alertness
C) pain
D) Increased intracranial pressure

Different sized pupils is invariably a sign of

a) Raised intrcranial pressure
B) compression of the oculomotor nerve
C) compression of the midbrain
D) normal finding in patients with anisocoria

Accomodation is the term for

A) a really nice helpful patient
B) how many beds are left in the ward
C) pupil reaction to light
D) pupil reaction to change of focus

That is it for now I will write some more for tomorrow.

[oracle389]

hey, just wondering about the correct answers on this... just to check if i was right...

[gwenith]

I forgot I wrote this

When assessing a patient with a head injury which order should the assessment take:-

A) Deficit (neuro) Airway, Breathing Circulation
B) Airway, Deficit, Breathing, Circulation
C) Airway Breathing,Deficit, Circulation
D) Airway , Breathing , circulaton, Deficit

It is D ABCD is the common assessment priority listing among most neuro and ED texts. (Though there are others)

he Glasgow Coma Scale

A) is always a 15 point scale
B) measures level of consciousness
C) less valid when used by inexperienced users
D) is the only scale in the world where you can be dead and still score 3

Well A is wrong - I have seen 14 point scales and even a 20 point scale!!!

B) Yes is the most common measure for level of consciousness and has superceded the older scales that included terms such as "stuporous"
C) definitely correct and there is plenty of research to back it up. This is why it is important to ascertain at handover what has been used as criteria for assessment (i.e. are you counting "spontaneous eye opening" BEFORE applying noxious stimuli or after)
D) Yes, that is a common critisism of the GCS!

Pupil size is recorded as well as the pupils reaction to light. The size that is recorded should be the size of the pupil:-

A) in the ambient light of the room
B) that it constricts to when testing light reaction
c) after the patient is asked to change focus
D) when the young male patient sees a pretty young female!!

Hmmm - I could have worded this one better but A) surpirsingly, The size is recorded BEFORE shining using a torch to test pupil reaction. But please, no one copy what one night duty nurse I knew did - turn on the lights in the four bed bay so she could "have the same amount of light to assess the pupils as the day shift" - each and every hour!!

Spontaneous eye opening is a sign of:

A) awareness
B) wakefulness/alertness
C) pain
D) Increased intracranial pressure

The answer is B - eye opening measures wakefulness/arousability. It is a function of the hindbrain. The GCS can be thought of a assessing 2 parts of the brain - hindbrain and forebrain. Eye opening is the hindbrain.

Different sized pupils is invariably a sign of

a) Raised intrcranial pressure
B) compression of the oculomotor nerve
C) compression of the midbrain
D) normal finding in patients with anisocoria

Different sized pupils are a normal finding in anisocoria - and are surprisingly common (think of all those who have had eye surgery or disorders such as Glaucoma). So, pupils that have always been unequal is not a cause of panic HOWEVER a sudden change from equal to unequal IS a reason to call for further assessment. Especially if it is a marked change. Such a change is usually caused by compression of the oculomotor nerve.

Accomodation is the term for

A) a really nice helpful patient
B) how many beds are left in the ward
C) pupil reaction to light
D) pupil reaction to change of focus

Accomodation is the pupil reaction to a change of focus. Get someone to look at an object close by then change focus to one further away - that is accommodation.

Now question - do you want more of these if I post the answers?

[NYNewGrad]

yes!

[oracle389]

thanks. uh, just wondering again, about eliciting the best motor response. how does one correctly elicit it, and in situations like the patient flexes abnormally and the such. TY

[RoxanRN2003]

Originally Posted by oracle389

thanks. uh, just wondering again, about eliciting the best motor response. how does one correctly elicit it, and in situations like the patient flexes abnormally and the such. TY

The best motor responses are elicited by squeezing (for the upper extremities) the trapezius muscle or the pectoralis major near the bicep or (for the lower extremities) the inner thigh near the sartorius muscle. By pinching the nail beds, you are only eliciting spinal reflexes. When you cause a stimulus, you are watching for a response, be it normal (localization or withdrawel) or abnormal (flexion, extension, none). Sometimes abnormal responses are seen with any stimulation (turning, moving an extremity, etc).

[gwenith]

Roxan is correct - you have to differentiate between peripheral stimuli and central stimuli.

Okay then - here are some some questions and I will be along later with the answers

(remember you can choose more than one answer)

Peripheral pain stimuli (also called noxious stimuli) is best done by

a) pressing a pen to the base of the finger/toenail
b) pressing a pen to the side of the finger/toenail
c) squeezing the hand
d) sternal rub

Which of the following are NOT appropriate noxious (pain) stimuli

a) Sternal rub
b) sternal pressure
c) trapezius squeeze
d) nipple twist
e) pressure to the calf of the leg

What is the maximum length of time that noxious stimuli should be applied for?

A) 2 seconds
B) 5 seconds
C) 10 seconds
D) 20 seconds
E) 30 seconds
F) 60 seconds

"Best motor response" should be judged on the response seen in

a) upper limbs only
b) lower limbs only
C) both upper and lower limbs
d) whichever is the best

"Best motor reponse" is judged

A) only after pain stimuli is applied
b) only on response to peripheral stimuli
c) only on response to central stimuli
d) on patients normal movement/responses during assessment

To mark the patient as having "localised to pain" the patient must have

a) Grabbed at and removed the noxious stimuli (also known as the sats probe sign)
b) made a purposeful withdrawal from the stimuli
C) Raised an arm by bending an elbow
D) moved an arm across either the nipple line or the central body line toward the stimuli

[gwenith]

Originally Posted by gwenith

(remember you can choose more than one answer)

Peripheral pain stimuli (also called noxious stimuli) is best done by

a) pressing a pen to the base of the finger/toenail
b) pressing a pen to the side of the finger/toenail
c) squeezing the hand
d) sternal rub

b) pressing a pen to the side of the finger/toenail

Pressing a pen to the base of the nail can cause nasty bruising under the nails themselves.

Which of the following are NOT appropriate noxious (pain) stimuli

a) Sternal rub
b) sternal pressure
c) trapezius squeeze
d) nipple twist
e) pressure to the calf of the leg

Sternal pressure is favoured over sternal rubs as it is just as effective without causing the large bruising that rubs can and do cause. The other pain stimuli I have heard of but NEVER seen in a text is nipple twist. Admittedly the only time I have heard of this was a male medical resident who was going to perform it on a female patient. My answer included reference to............... well, let us say he will never even THINK of mentioning THAT one in the presence of a nurse again. All joking aside though ANY pain stimuli like this could and possibly would be viewed as an assault and would not hold up in court.

What is the maximum length of time that noxious stimuli should be applied for?

A) 2 seconds
B) 5 seconds
C) 10 seconds
D) 20 seconds
E) 30 seconds
F) 60 seconds

About the only referrence I have seen to length of time said 20 seconds. Interestingly this is a very under reported aspect of assessment and yet quite a significant one if you are considering the two aspects of assessment - alertness or rousability and awareness. If we truly ARE measuring the patients ability to rouse then the amount of stimuli required to do so should also be datum for collection. There is a vast difference between eyes opening because you touched the patients arm and eyes opening only after you have applied 20 seconds of strong noxious stimuli.

"Best motor response" should be judged on the response seen in

a) upper limbs only
b) lower limbs only
C) both upper and lower limbs
d) whichever is the best

Motor response is jusdged off of the upper limb response.

"Best motor reponse" is judged

A) only after pain stimuli is applied
b) only on response to peripheral stimuli
c) only on response to central stimuli
d) on patients normal movement/responses during assessment

This is one of those "depends" questions. If I have a patient with a postive sats probe sign (keeps taking the !@#@ sats probe off his finger before I can get a reading) then this patient is obviously localising and I do not need to inflict pain to judge a response.

To mark the patient as having "localised to pain" the patient must have

a) Grabbed at and removed the noxious stimuli (also known as the sats probe sign)
b) made a purposeful withdrawal from the stimuli
C) Raised an arm by bending an elbow
D) moved an arm across either the nipple line or the central body line toward the stimuli

The answer here is D) - moved the arm across either the nipple line or the central body line toward the stimuli. This is the marker to differentiate between withdrawal and localising - often hard to do on a ventilated patient.


Please feel free to challenge me on either the answers or the questions!!

[nurzkit]

gee thanks for so much information esp to gwen.... i learned things dat i can use in my assessmnt... thanks!!!