马偕纪念医院临床技能训练学习单讲解

1、焉偕幺己念翳院陶床技能司口糠擘雪罩神；检查(Neurological Examination )I. History taking: most important part of neurological evaluationII. Neurological examinationA. Mental status assessment1. Level of consciousnessa. Alert, awake, and oriented.b. Confusion: responsive to stimuli, but disoriented to time, person and plac

2、e.c. Drowsiness: inclination to sleep; easily aroused and able to response tomost stimuli.d. Stupor: little spontaneous physical or mental activity.e. Coma: lack of response to most painful stimuli.Glasgow coma scale (E4M6V5 漏?分=15 分)GCS分数最佳逋勤反J#Motor ResponseU雄反J® Verbal Response眼睛?Eye Opening

3、6IS优命令5封疼痛刺激腹鳍r用手去 除IS舌有修理4常寸性痛有媒意旨法反力焦洞i偷次自勤?眼睛3封疼痛有屈只曾茂 一些不止 碓的字优命令眼睛?MH2封疼痛有伸展僵直只能彝瞥封疼痛刺激眼睛才1封疼痛全瓢反全瓢反全瓢反2. Memory3. Language : aphasia, fluency , comprehension , repetition4. Mini mental testB. Cranial nerve function1. Olfactory nerve: smell (CN I)2. Optic nerve (CN II) visual acuity , visual fi

4、eld , pupil size , light reflex , funduscopy (papilledema)optic atrophy3. Oculomotor nerve (CN III)、&4. Trochlear nerve (CN IV) 上&6. Abducent nerve (CNVI) control of eye movement5. Trigeminal nerve (CN V) facial sensation corneal reflex muscles of mastication7. Facial nerve (CN VII)Lower mot

5、or neuron facial palsy:weakness of all facial muscles including forehead on same sideUpper motor neuron facial palsy: preserved ability to wrinkle forehead8. Vestibuloacoustic nerve (CN VIII)i. Hearingii. Weber's testiii. Rinne testiv. Nylen-Barany maneuverv. Coloric test (COWS)vi. Nystagmus9. G

6、lossopharynegeai and vagus nerves (CN IX and X) &10. gag reflex uvula deviates toward normal side phonation swallowing11. Spinal accessory nerve (CN XI) sternocleidomastoid muscle trapezius muscle12. Hypoglossal nerve (CN XII) tongue deviates toward weak side tongue atrophy, fasciculationC. Moto

7、r function1. Muscle strengthScoreNormal5Apparent weakness4Movement against gravityJoint movement2Flicker of muscle contraction1No joint movementNo muscle contraction02. Muscle tone3. Atrophy, fasciculation4. Movement and postures: Spasticity RigidityD. Reflexes1. Deep tendon reflexes Scoreclonus+hyp

8、eractive+normal+hypoactive+absent-Biceps reflexC5BrachioradialisC6Triceps reflexC7Knee reflexL4Ankle reflexS12. Plantar reflex Babinski sign3. Releasing signs Rooting reflex Grasp reflex snouting reflexE. Sensation1. Pinprick (pain ), temperature, proprioception2. Cortical sensation : stereognosis g

9、raphesthesiaF. Cerebellar functionG. Gait and balanceH. Autonomic functionMini-Mental Test1 .今天是黑月黑虢？ （2）2 .今天是星期黑？（1）3 . 今天是民阈黑年或什麽年（十二天干）？（1）4 .琪在是那一季f?春夏秋冬？（1）5 .道他院叫什麽名字？6 .琪在在黑模？ （1）7 .道（0ft院在那桂（什麽地方）？ （1）台北 台北宜U IB束健基隆 基隆高雄 高雄8 .道（0ft院在那一（MS （市）？ （1）台北 台北宜U IB束健基隆 基隆高雄 高雄9 .我伸号的阈家叫什麽名字？（1）中阈中莘民阈台湾10 .出三件柬西的名字，言青病人焉上覆H。（3）例：汽串、皮带、碗（等一下要再冏一次）11 .减七测瞬，徙100到65。（5）100-7=9393-7=8686-7=7979-7=7272-7=6512 .回想BJ才三件柬西的名字。（3）13 .出示手和肇，要病人出柬西的名字。 （2