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PCM 2 Final Exam > (2) Basic Neuro Exam > Flashcards

(2) Basic Neuro Exam Flashcards

1
Q

What type of onset is typical for cerebral hemorrhages, vascular diseases, and infections, and head trauma?

A

Sudden/abrupt onset

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2
Q

What type of onset is typical for demyelinating diseases such as multiple sclerosis?

A

Intermittent, relapsing episodes

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3
Q

Dysarthria is usually caused by what?

A

Defect in motor control of speech aparatus

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4
Q

Aphasia is usually caused by what?

A

Lesion in dominant hemisphere (usually left)

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5
Q

What is A/Ox4? Where is it documented?

A

Oriented to person, place, time, and event

Documented in objective

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6
Q

What is anhedonia?

A

When the things that used to give you pleasure no longer work

(occurs w/ depression)

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7
Q

Associated sx to ask about for a patient presenting with neuro findings (there’s a few…)

A

Headache

Dizziness/vertigo

Weakness (generalized, proximal)

Numbness/abnormal/absent sensation

Syncope

Seizures

Tremors

Loss of bowel or bladder control

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8
Q

What type of response would you expect from a pt who is alert?

A

Pt opens eyes, looks at you, fully responds appropriately to stimuli

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9
Q

What type of response would you expect from a lethargic pt?

A

Pt appear drowsy but opens eyes to look at you, responds to questions, then falls asleep

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10
Q

What type of response would you expect from an obtunded pt?

A

Obtunded pt opens eyes and looks at you but responds slowly and is somewhat confused

Alertness and interest in the environment are decreased

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11
Q

What type of response would you expect from a pt in a stupor?

A

Arouses from sleep only after painful stimuli

Verbal responses slow/absent

Pt lapses into an unresponsive state when the stimulus ceases

Minimal awareness of self or the environment

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12
Q

What mental status finding is common for older adults during hospitalization?

A

Delirium

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13
Q

What diagnoses must be eliminated before diagnosing dementia?

A

Depression

Delirium

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14
Q

What is the difference bw “Cranial nerves intact” and “Cranial nerves grossly intact”?

A

“Cranial nerves intact” means that all of the cranial nerves were actually tested instead of observed (‘grossly”)

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15
Q

Pt with history of smoking and use of cocaine presents with loss of smell. This can indicate what type of lesion?

A

Ipsilateral lesion

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16
Q

What is myopia? What cranial nerve is involved?

A

Impaired distance vision (near sighted)

CN II

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17
Q

What is presbyopia? What cranial nerve is involved?

A

Impaired near vision (farsighted)

CN II

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18
Q

Lesion to the optic nerve anterior to the chiasm cause what kind of blindness?

A

Ipsilateral

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19
Q

What cranial nerves are being tested in the pupillary light reflex?

A

CN II and III

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20
Q

What muscles are involved in pupillary convergence?

A

Medial rectus muscles

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21
Q

What muscles are involved in accomodation of the lens?

A

Ciliary muscle

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22
Q

Pt presenting with ptosis, asymmetrical pupils, and a “down and out” eye may have a lesion in what cranial nerve?

A

CN III (oculomotor)

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23
Q

Pupil dilation or asymmetry is due to what?

A

Disruption of parasympathetic fibers

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24
Q

Space-occupying or expanding masses compressing on the brainstem can affect what cranial nerve? What is the second effect?

A

CN III

No output via somatic efferents => external strabismus

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25
Q

A lesion in CN IV results in what symptoms?

A

Extorsion of the eye

Weakness of downward gaze (due to weak SO M.)

Vertical diplopia

Head tilting away from lesion

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26
Q

What is the most common isolated CN palsy?

A

CN VI palsy

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27
Q

Pt has history of subarachnoid hemorrhage and syphilis presnts with medial strabismus and horizontal diplopia. Where is the lesion?

A

CN VI

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28
Q

What planes can nystagmus occur?

A

All of them (vertical, horizontal, and rotatory)

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29
Q

How is nystagmus lateralized?

A

Based on the direction of the fast beat

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30
Q

What are some common causes of nystagmus?

A

Early vision impairment

Disorders of labyrinth and cerebellum

Drug toxicity

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31
Q

What are the 3 components of testing CN V?

A

Facial sensation - pinprick/light touch, hot/cold to forehead, cheek, and chin

Motor fxn - lateral jaw movement and jaw clenching

Corneal reflex - tests orbicularis oculi m.

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32
Q

Pt presents with decreased sensation to the face. Upon examination, his jaw deviates to one side and there is loss of the corneal reflex. Where is his lesion?

A

CN V

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33
Q

What are the afferent and efferent limbs of the corneal reflex?

A

Afferent - CN V

Efferent - CN VII

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34
Q

What is the parasympathetic function of CN VII?

A

Secrete saliva and tears

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35
Q

What is the sensory function of CN VII?

A

Taste for salty, sweet, bitter substances to anterior 2/3 of tongue

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36
Q

What is crocodile tears syndrome?

A

Abberent regeneration of CN VII nerve after trauma => pt sheds tears when chewing

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37
Q

What are the main sx of a CN VII lesion?

A

Bell’s palsy

Loss of corneal reflex

Hyper acusis (increased sensitivity to sound)

Crocodile tears

38
Q

Supranuclear facial palsy is important in determining what type of lesion?

A

Central facial nerve palsy

(upper face spared but still associated with hemiplegia)

39
Q

When would the Weber-Rinne test be indicated in testing CN VIII?

A

If there is loss of hearing found when performing whisper test or finger rub

40
Q

What kind of lesion to CN VIII can cause tinnitis?

A

Irritative (cochlear division)

41
Q

What kind of lesion to CN VIII can cause sensorineural hearing loss?

A

Destructive (cochlear division)

42
Q

Lesion to the vestibular division of CN VIII can result in what sx?

A

Dysequilibrium (imbalance)

Nystagmus

43
Q

What is the motor function of CN IX?

A

Innervates stylopharyngeus muscle => elevates and widens pharynx on swallowing

44
Q

What is the sensory fxn of CN IX?

A

Taste to posterior 1/3 of tongue, sensation to palate and pharynx, skin of external ear

45
Q

What are the efferent and afferent limbs of the gag reflex?

A

Afferent - CN IX

Efferent - CN X

(lesions usually present on ipsilateral side)

46
Q

What CN innervates muscles of the pharynx (except stylopharyngeus) and larynx?

A

CN X

47
Q

What division of the CN XI innervates muscles of the larynx (except cricothyroid m.)?

A

Cranial division

48
Q

What does the spinal division of CN XI innervate?

A

Trapezius M. and SCM

49
Q

How is CN XII tested?

A

Test by having pt protrude tongue and push tongue into opposite cheek

50
Q

Complete range of motion against gravity, but not resistance would be graded as what muscle strength?

A

3/5 (review this)

51
Q

What motor dermatomes are tested in shoulder abduction, flexion, extension?

A

C5

52
Q

What motor dermatomes are tested in elbow flexion?

A

C5, C6

53
Q

What motor dermatomes are tested in elbow extension?

A

C6, C7, C8

54
Q

What motor dermatomes are tested in wrist flexion and extension?

A

C6, C7

55
Q

What motor dermatomes are tested in hand grip?

A

C7, C8, T1

56
Q

What motor dermatomes are tested in finger abduction and opposition of the thumb?

A

C8, T1

57
Q

What motor dermatomes are tested with hip extension?

A

S1

58
Q

What motor dermatomes are tested with action of gastrocnemius?

A

S1 (gastrocnemius)

59
Q

What motor dermatomes are tested with hip flexion?

A

L2, L3, L4

60
Q

What motor dermatomes are tested with hip abduction?

A

L4, L5, S1

61
Q

What pattern of weakness is seen with upper motor neuron lesion?

A

Pyramidal - weak extensors in arms, weak flexors in legs

62
Q

Wasting, fasciculations, hypotonia/hyporeflexia is classic of what kind of lesion?

A

LMN lesion

63
Q

What pattern of weakness is seen in a LMN lesion?

A

Peripheral pattern of weakness

Weak flexors in arms

Weak extensors in legs

(will have give-away weakness, sudden loss of strength)

64
Q

Coordination of muscle movement requires input from what systems?

A

Motor

Cerebellar

Vestibular

Sensory

65
Q

Romburg test is testing what?

A

Proprioception (is a sensory test)

66
Q

A pt with anteroflexed posture, festinating (difficult start/stop), small steps, and en block turns has what kind of gait?

A

Parkinsonian - symmetrical

67
Q

What type of gait is seen in cerebral palsy or multiple sclerosis?

A

Scissoring - symmetrical

68
Q

What type of gait has high steppage and a broad base?

A

Sensory ataxia - symmetrical

69
Q

Pt has a hx of hydrocephalus, walks with small steps where the feet don’t leave the ground. How is this gait described?

A

Magnetic - symmetrical

70
Q

What is Astasia-abasia?

A

Gait is all over the place as if the pt is falling but they don’t fall bc cause is usually psychogenic

71
Q

What asymmetrical gait is usually due to UMN such as stroke? Will see circumducted gait and decreased arm swing ipsilateral to affected leg.

A

Hemiplegic

72
Q

What is waddling pelvis gait?

A

Asymmetrical gait indicating myopthic disease

Hips sway or waddle side to side

73
Q

What is foot drop gait?

A

Asymmetrical gait where pt is unable to keep foot up during heel walk

LMN or UMN lesion

74
Q

What is stereognosis?

A

Ability to identify shapes of objects, recognizing objects placed in the hand

75
Q

How do you test for spinothalamic tract function?

A

Pinprick pain and temperature

Light touch

76
Q

How do you test for posterior column function?

A

Proprioception, 2 point tactile discrimination and vibratory

Light touch

77
Q

What is the C4 dermatome?

A

Shoulder top

78
Q

Where is the C8 dermatome?

A

Pinky finger

79
Q

How is proprioception tested?

A

Grasp sides of pts big toe b/w thumb and index finger and move it through arc

Ask pt if toe is pointed up or down

80
Q

What is double simultaneous stimulation/Extinction?

A

Ability to feel 2 locations being touched simultaneously

81
Q

Hyperactive reflexes indicate lesion in the ___

A

CNS

82
Q

____ reflexes indicate a lesion in the PNS

A

Hypoactive

83
Q

What pathological reflexes are UMN signs?

A

Babinski

Clonus

84
Q

What is the abdominal reflex?

A

Stroking abdomen causes umbilicus to move towards area of stimulation (T10-L2)

85
Q

What are the superficial tendon reflexes?

A

Abdominal reflex (T10-L2)

Cremasteric reflex (Afferent L1, efferent L2)

Anal wink reflex (S4, S5) - test cauda equina

86
Q

What disease is pill rolling tremor usually seen in? What does this indicate?

A

Parkinson’s

Basal ganglia disease

87
Q

What is Brudzinski’s sign?

A

Pt supine, lift head, knees will come up too

88
Q

If pt experiences neck pain when you flex their thigh and straighten their leg, what sign is this?

A

Kernig’s sign

89
Q

What is postural or kinetic tremor?

A

Tremor with intention

Usually due to essential tremor

90
Q

What is the difference b/w decorticate and decerebrate posturing?

A

Decerebrate posturing - everything extended

Decorticate posturing - body extended, arms flexed

PCM 2 Final Exam (7 decks)

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