KHM LM SNG THN KINHTS Nguyn Hu Cng su tm

Khm chc nng thn kinh cao cp: tnh to.Ngn ngCc dy TK sKhm vn ng: sc c, trng lc c, teo c ?Cc phn x (gn xng v thp).Khm cm gicCc hi chng tiu no, mng noDng i v ngCc xt nghim

Khm cc dy s: dy INhm mt li, bt tng bn mi, ngi v phn bit chnh xc miC th cho ngi 1 ming gc thm cn cch 10 cm, nhng thng dng mi nh (nc hoa, x bng, kem nh rng) trnh cht c mi kch thch mnh (gy kch thch dy V)

Dy II: th lcDng bng ch Snellen treo tng hay cm tay (t cch bnh nhn 14 inch), nu bnh nhn c tt khc x (cn, vin) th cho php eo knh.

Khm cc dy s: dy II th trngThy thuc ngi i din bnh nhn, cch khang 8-12 inch, mt bnh nhn nhn chm chm vo mt thy thuc, thy thuc ngn tay ca mnh khang gia 2 ngi, di chuyn t pha ngoi vo pha trong, ngn tay mp my, bnh thng c hai ngi phi gn nh cng lc nhn thy ngn tay. Sau i t gc trn v di i vo.

Khm vn nhn: III, IV, VI

tn thng dy III

Khm phn x ng t vi nh sng trc tip: co ng tKhm phn x ng t vi nh sng: mt bn kia (phn x ng cm (consensual reflex)Cung phn x: dy II, III v trung no

Khm hi t: 2 mt hI t li v ng t co nh

Lit dy III

Lit III bn phi: quan st v tr nhn cu, sp mi trn, gin ng t

tn thng dy VI bn phi

Lt dy VI bn tri: khng th a mt ra ngai c

Khm dy VChm kim vo vng da ca tng nhnh ca dy V: vng trn, g m, v cm, so snh 2 bn.Phn x gic mcVn ng: c thi dng (nghin rng) v c cn (a cm sang bn)

Khm dy V

phn x gic mccm gic

KHM DY VIIQuan st nt mt: np nhn trn, np mi m, mp. Xem 2 bn c cn i khng.Cho nhn trn v nhm 2 cht mt li.Cho nhe rng: hai mp cn iPhng m: hai bn cn i v khng ph hi ra.

Khm dy VII

du hiu Bell trong lit VII (bn phI)

lit dy VII: trung ng & ngoi bin

Khm thnh lc: bng tay v nghe ng h. Nu c bt thng: Weber v Rinne test.ic do tn thng dy VIII (do thn kinh): do tui cao, do thuc, do u dy VIII.ic do dn truyn: vim tai gia, x cng tai.

Weber test: m thanh nghe thy chnh gia v 2 bn bng nhau.ic do tn thng dy VIII: m nghe c lch v tai bn lnh.ic do dn truyn: m thanh nghe c lc v bn bnh512 Hz Tuning Fork

Rinne test: c trn xng chm (nghe qua xng), khi khng nghe thy m thanh th lp tc t st vo tai (nghe qua khng kh). Bnh thng: ht nghe qua xng, nhng vn cn nghe qua khng kh.ic do tn thng dy thn kinh: qua khng kh tt hn qua xng.ic do dn truyn: qua xng tt hn qua khng kh

Khm dy IX v dy X: h ming ku A vm ming nng cao cn I 2 bn v lI g nm chnh giaChm que tm bng vo thnh sau hng

lit IX v X

Lit dy IX tri: lch li g sang phi

C thang (trapezius)C c n chm (sternomastoid

lit dy XI (bn phi)

Khm dy XII: th di li, quan st xem c mt cn i 2 bn, teo c hay rung git c. Ri a li sang 1 bn v chng sc cn.

lit dy XII (bn phi)

Lit dy XII tri: khi th li th u li lch sang tri

Khm sc c: quan stTeo c: bnh c

Khm sc c: quan st

Khm sc c: thang (trapezius), delta (deltoid), ngcKhm sc c: tam u (triceps), c dui c tay, c nm bn tayKhm sc c: kp ngn ci v tr, kp ngn t v ci, khp 2 ngn

Khm sc c: gp hng (tht lng - chu), gp gi (c hamstrings)Khm sc c: dui gi (t u i), gp mu chn (chy trc)

Khm trng lc c

Khm trng lc c

Khm cm gic

Phn x c nh u (biceps)

Khm phn da gan chn v du hiu Babinski

Nghim php ngn tay tr - miNghim php ngn tay tr

nghim php gt - gi

Du hiu Brudzinski

Khm dng i bnh thng, bng mi chn, v bng gt chn

i trn 1 ng thng (tandem walk)

Ataxia: dng i hi ci ra trc, 2 chn dng, bc i khng u ging nh thy th i trn thuyn khi c sng ln, hay ging dng i ca ngi say ru

Hemiplegic gait: dng i ca ngi lit na ngi sau tai bin mch mu no, dng Werdnicke - Mann

Parkinsonian gait:Dng i ca ngi b bnh parkinson

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