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PCMI > 2.3 Neuro exam lecture > Flashcards

2.3 Neuro exam lecture Flashcards

1
Q

what dzs are associated with abrupt onset neurological sxs

A

cerebral hemorrhage
vascular dz
infection
head trauma

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2
Q

what dzs are associated with progressive neurological sxs

A

neoplasm

degenerative dz

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3
Q

what dzs are associated with intermittent neurological sxs

A

demyelinating dz

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4
Q

what must be eliminated before dementia can be dx

A

depression and delerium

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5
Q

what do you have to do before testing CN I

A

make sure nasal passages are clear

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6
Q

what is evaluated by the near response

A
  • pupillary constriction
  • medial rectus (convergence)
  • ciliary m (lens accomodation)
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7
Q

what is presbyopia

A

farsightedness AKA impaired NEAR vision

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8
Q

what is the progression of CN III sxs from space occupying masses

A

first pupil dilation and fixation

THEN down and out position

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9
Q

what CN is responsible for inward rotation, downward and lateral movement

A

CN IV

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10
Q

what CN is responsible for only lateral movement

A

CN VI

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11
Q

what CN lesion is assoc w/ vertical diplopia and how might this present

A

CN IV, difficulty reading for walking down stairs

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12
Q

in CN IV which way does the head tilt

A

opposite to the lesion

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13
Q

what is the most common isolated nerve palsy

A

VI

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14
Q

what CN lesion is associated with convergent strabisus or esotropia (inability to abduct eye)?

A

CN VI

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15
Q

what CN lesion is assoc w/ horizontal diplopia

A

CN VI

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16
Q

when is physiologic nystagmus seen? which direction is the beat?

A

seen in extreme deviation of gaze

eye beats in opposite direction of gaze

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17
Q

what CNs are evaluated by the corneal reflex

A

V and VII

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18
Q

which way does the jaw deviate in a trigeminal lesion

A

toward the weak side

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19
Q

what CN is responsible for saliva and tear secretion

A

VII

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20
Q

what CN lesion causes hyperacusis (inc sensitivity to sound)

A

VII

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21
Q

aberrant regeneration of what CN causes crying w/ chewing

A

VII

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22
Q

supranuclear or central facial palsy spares what part of the face

A

upper and usually associated with hemiplegia (weakness to one side of body)
-important in determining if weakness is central or peripheral

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23
Q

what CN lesion is associated w/ disequilibrium and nystagmus

A

vestibular division of CN VIII

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24
Q

what CN lesion is assoc with sensorineural hearing loss and tinnitus

A

cochlear div of CN VIII

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25
Q

if the pt can swallow, what CN lesions can be ruled out

A

IX and X

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26
Q

how does CN XII lesion present on exam

A

tongue deviates ipsi

cannot push tongue into CONTRA cheek

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27
Q

what muscle and spinal level are responsible for plantarflexion

A

gastrocnemius, S1

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28
Q

what muscle and spinal level are responsible for dorsiflexion

A

tibialis anterior (L4, L5)

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29
Q

what is a pattern of weak EXTENSION of the arms and weak FLEXION of the legs called and what lesion is it assoc w/

A

pyramidal pattern of weakness

UMN lesion

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30
Q

what is a pattern of weak FLEXION of the arms and weak EXTENSION of the legs called and what lesion is it assoc w/

A

peripheral pattern of weakness

LMN dz

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31
Q

heel walking and pronator drift test for lesions of what tract

A

CST

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32
Q

in what dzs is a scissoring gait seen

A

cerebral palsy and MS

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33
Q

what is a gait with high stepping and a broad base called and when is it seen

A

sensory ataxia, seen in posterior column damage and peripheral neuropathy

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34
Q

in what dzs is a magnetic gait seen

A

frontal lobe processes

hydrocephalus

35
Q

what is indicated by a waddling pelvis

A

myopathy

36
Q

how is a positive babinski sign recorded

A

toe up going

37
Q

is clonus associated with UMN or LMN lesion

A

UMN

38
Q

what dermatomes are evaluated by the abd reflex

A

T10-12

39
Q

what is kernigs sign

A

pt has neck pain with hip flexion

+ meningitis

40
Q

what is brudzinski’s sign

A

pts knees raise when you lift their head

+ meningitis

41
Q

Dysarthria

A

defect in speech, usually from defect in motor control of speech apparatus

42
Q

Aphasia

A

disorder in producing or understanding language, usually lesion to dominant hemisphere (usually left)

43
Q

Nystagmus

A

rhythmic oscillation of eyes

44
Q

potential causes for nystagmus

A
  1. vision impairment at early age
  2. disorders of labyrinth or cerebellar systems
  3. drug toxicity
45
Q

Hyperacusis

A

increased sensitivity to sound

46
Q

What does it mean when you chart, “CN are grossly intact”

A

you have spent enough time talking with the patient that you haven’t seen anything that warrants an actual CN test, meaning you haven’t noticed drooling, ptosis, facial droop, difficulty with articulation, etc

47
Q

What does it mean when you chart, “CN II-XII are intact to testing”?

A

you went through the actual confrontation of each nerve bilaterally

48
Q

What sensory dermatome is on the auricle?

A

C2

49
Q

What sensory dermatome is on the earlobe, posterior/ant neck?

A

C3

50
Q

What sensory dermatome is on the shoulder top?

A

C4

51
Q

What sensory dermatome is on the Radial aspect of forearm?

A

C6

52
Q

What sensory dermatome is on the long finger?

A

C7

53
Q

What sensory dermatome is on the little finger?

A

C8

54
Q

What sensory dermatome is on the Nipple?

A

T4

55
Q

What sensory dermatome is on the umbilicus?

A

T10

56
Q

What sensory dermatome is on the inguinal?

A

L1

57
Q

What sensory dermatome is on the Patella, medial calf?

A

L4

58
Q

What sensory dermatome is on the Anterolateral calf, great toe?

A

L5

59
Q

What sensory dermatome is on the posterolateral calf/little toe?

A

S1

60
Q

Sterognosis

A

ability to id shapes of objects or recognize objects placed in hand

61
Q

Graphesthesia

A

ability to id numbers written on palm

62
Q

2 pt discrimination

A

ability to distinguish being touched by 1 or 2 pts

63
Q

double simultaneous stimulation (extinction)

A

ability to feel 2 locations being touched simultaneously

64
Q

thalamic patterns of sensory loss

A

hemisensory loss of all modalities

65
Q

cortical sensory loss

A

intact primary sensations but loss of cortical sensations

66
Q

functional sensory loss

A

non-anatomical distribution

67
Q

Cerebellar ataxia gait

A

staggering, unsteady, feet wide apart, other cerebellar sigs usually present

68
Q

sensory ataxia gait

A

unsteady, feet wide apart, feet thrown forward and slapped down 1st on heels then forefoot, pt watch ground when walking

69
Q

parkinsonian gait

A

stooped forward, short steps commonly called “shuffling gait”

70
Q

What CN is most vulnerable to head trauma? What deficit would you see with damage to this?

A

CN IV- exotropia (lateral eye drift) and weakness of downward gaze, vertical diplopia, and head tilt to side opposite lesion

71
Q

What is the most common isolated CN and why?
What patients do you see damage in?
What deficit would you see with damage to this?

A
  • CN VI, long peripheral course
  • subarachnoid hemorrhage, late syphilis, trauma
  • convergent strabismus (estropia): inability to abduct eye and horizontal diplopia
72
Q

potential causes of nystagmus

A
  1. vision impairment at early age
  2. disorder of labyrinth or cerebella systems
  3. drug toxicity
73
Q

how do you test for pain and what is this testing?

A

pt eye are closed and use a broken tongue depressor on skin, testing spinothalamic tract

74
Q

how do you test for temp of the sensory system?

A

pt eyes are closed and used test tubes filled with hot and cold water- spinothalamic

75
Q

how to you test vibration sense and what is it testing?

A

use a 128 hz tuning fork on bony prominence- PCMLS

76
Q

how to you test proprioception sense and what is it testing?

A
  1. grab pt’s big toe b/t thumb and index finger and move through an arc
  2. when pt’s eyes are closed, ask them if the toe is up or down
    - testing PCMLS
77
Q

what are the 4 discriminative (cortical) sensations?

A
  1. stereognosis: ID shape of object or recognize if in hand
  2. graphesthesia: ID number written on palm
  3. 2 pt discrimination
  4. double simultaneous stimulation (extinction): ability to feel 2 locations being touch simultaneously
78
Q

pattern of single nerve loss

A

limited to distribution of single nerve

79
Q

pattern of root loss

A

loss in different nerve distributions with common root

80
Q

pattern of sensory loss for thalamic path

A

hemisensory loss of all modalities

81
Q

pattern of sensory loss for cortical path

A

intact primary sensation but loss of cortical sensation

82
Q

what nerve does the brudzinski’s sign stretch?

A

femoral

83
Q

what nerve does the kernig’s sign stretch?

A

sciatic

PCMI (15 decks)

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