1 Neurologic Examination

Question 1

Three-tiered approach in neurologic examination

Answer 1

1. Is there a lesion of the nervous system?
2. Where is the lesion?
3. What is the lesion?

Question 2

8 elements of the neurologic examination

Answer 2

1. Mental status testing
2. Higher cerebral functions
3. Cranial nerves
4. Sensory exam
5. Motor exam
6. Reflexes
7. Cerebellar testing
8. Gait and station

Question 3

________ function defines the dominant hemisphere

Answer 3

Language

Question 4

The nondominant hemisphere is concerned with

Answer 4

spatial relationships

Question 5

For left-handed patients, most will be ______ dominant for language

Answer 5

left-hemisphere
Thus, a large cortical stroke affecting the cortex of the dominant hemisphere (the left hemisphere whether they are left- or right-hand dominant) likely will affect language functions

Question 6

this suggests a central cause of vertigo

Answer 6

vertical or direction-changing vertigo

Question 7

HINTS testing

Answer 7

Head impulse
Nystagmus
Skew

Question 8

Remarks on Head Impulse Test (HIT)

Answer 8

A normal finding is visual fixation with no rapid saccadic movement.
A normal finding suggests a central cause of vertigo

Question 9

A very sensitive sign for upper extreity weakness

Answer 9

having the patient hold the arms outstretched with palms upward and observing for any inward rotation or downward drift

Question 10

______ tremors characterize Parkinson’s disease

Answer 10

Rest tremors

Question 11

This is an abnormal postvoid residual bladder volume

Answer 11

> 100 mL
certainly >200 mL

Question 12

Least important part of the neurologic examination

Answer 12

Muscle stretch reflexes
offr little value when used in isolation

Question 13

Classic indicator of an upper motor neuron lesion

Answer 13

Babinski’s sign - abnormal reflex with movement of the great toe upward and perhaps fanning of the other toes upon mildly stimulating the lateral aspect of the foot

The reliability and accuracy of a Babinski’s sign have been called into question.

Question 14

Cardinal signs of upper motor neuron syndrome

Answer 14

Babinski’s sign and hyperreflexia

although the absence of these signs does not reliably exclude a diagnosis of spinal cord compression

Question 15

This part of the neurologic examination is said to be most informative

Answer 15

observation of the patient walking.

Question 16

One feature common in many patients with cerebellar hemorrhage

Answer 16

the sudden inability to walk
These patients may also have severe nausea and vomiting