27: Approach To Neuro Exam

Question 1

Dysarthria

Answer 1

Defective articulation, usually due to defect in motor control

Question 2

Aphasia

Answer 2

Disorder in producing or understanding language, usually due to lesion in the dominant hemisphere (usually left)

Question 3

Esotropia

Answer 3

Eye position drifting

Question 4

Vertical diplopia

Answer 4

Double vision that increases when looking down

Question 5

What is the most common isolated CN palsy?

Answer 5

CN 6

Question 6

Three conditions that can cause CN 6 palsy?

Answer 6

SAH, late syphilis, trauma

Question 7

Convergent strabismus

Answer 7

Inability to abduct the eye

Question 8

Horizontal diplopia

Answer 8

Max separation of images when looking towards the paretic LR muscle

Question 9

Why does jaw deviate towards the weak side in a CN 5 lesion?

Answer 9

Unopposed action of opposite lateral pterygoid muscle

Question 10

90% of trigeminal neuralgia is caused by?

Answer 10

Aberrant vein or artery compressing the nerve

Question 11

Hyperacusis

Answer 11

Increased sensitivity to sound due to stapedius not working

Question 12

What can cause bilateral facial palsy?

Answer 12

Guillain-Barré syndrome

Question 13

Supranuclear facial palsy

Answer 13

Spares upper face, usually associated with hemiplegia

Question 14

Three ways to test CN 8

Answer 14

1. Whisper test
2. Finger rub test
3. Weber-Rinne test

Question 15

Two phases of nystagmus

Answer 15

1. Slow drift away from object of focus

2. Saccade: quick reaction back

Question 16

Three types of nystagmus

Answer 16

Horizontal, vertical, rotator

Question 17

Potential causes of nystagmus

Answer 17

Vision impairment at early age, disorder of labyrinth, drug toxicity

Question 18

What does it mean if you document “CNs are grossly intact”

Answer 18

You have spent time talking to the pt and dont see anything that warrants a CN exam, but havent actually tested for anything

Question 19

What is the appropriate way to document CN testing

Answer 19

CNs II-XII are intact to testing

Question 20

Stereognosis

Answer 20

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

Question 21

Graphesthesia

Answer 21

IDing numbers written on the palm

Question 22

Double simultaneous stimulation

Answer 22

Ability to feel two locations being touched simultaneously

Question 23

Thalamic sensory loss

Answer 23

Hemisensory loss of all modalities

Question 24

Cortical loss of sensory

Answer 24

Intact primary sensations but loss of cortical sensations

Question 25

Cerebellar ataxia presentation

Answer 25

Staggering, unsteady, feet wide apart, other cerebellar signs present

Question 26

Sensory ataxia presentation

Answer 26

Unsteady, feet wide apart, feet thrown forward and slapped down heel-to-forefoot, pts watch ground while walking

Question 27

Parkinsonian gait

Answer 27

Stooped forward, shuffling gate with fenstrations, decreased arm swing

Question 28

How many pts with acute bacterial meningitis will have nuchal rigidity

Answer 28

84%

Question 29

What other condition besides meningitis can cause nuchal rigidity

Answer 29

SAH