3: Basic Neuro Exam - Kruse

Question 1

damage to the cerebral hemispheres –>

Answer 1

deficits of intellect, memory or higher brain function

Question 2

damage to the brainstem or bilateral cerebral hemispheres –>

Answer 2

decreased level of consciousness

Question 3

damage to LMN –>

Answer 3

flaccid paralysis and loss of DTR and muscle wasting with fasciculations

Question 4

damage to UMN –>

Answer 4

spastic paralysis and accentuated DTR

Question 5

cranial nerve name mnemonic

Answer 5

O
O
O
T
T 
A
F
A
G
V
S
H

Question 6

cranial nerve function mnemonic

Answer 6

S
S
M
M
B
M
B
S
B
B
M
M

Question 7

CN I function

Answer 7

smell

Question 8

CN II function

Answer 8

visual acuity, visual fields

parasymp: pupillary constriciton, lens shape change

Question 9

which CN have parasymp activity?

Answer 9

II, VII, IX, X

Question 10

CN III

Answer 10

raise eyelids, most oculomotor movements

Question 11

CN IV

Answer 11

downward, inward movement of eye

Question 12

CN V

Answer 12

jaw opening and closing, chewing

Question 13

CN VI

Answer 13

lateral eye movement

Question 14

CN VII

Answer 14

movement of facial expression except jaw, close eyelids, labial speech sounds

sensory to pharynx, taste anterior 2/3 of tongue

para: secretion of tears and saliva

Question 15

CN VIII

Answer 15

hearing and equilibrium

Question 16

CN IX

Answer 16

voluntary m. for swallowing and phonation

sensation of nasopharynx, gag reflex, taste posterior 1/3 tongue

parasymp: secretion of saliva, carotid reflex

Question 17

CN X

Answer 17

sensory behind ear, part of external ear canal

parasymp: secretion of digestive enzymes, carotid reflex, involuntary action of heart, lungs, digestive tract

Question 18

CN XI

Answer 18

turn head, shrug shoulders, some actions of phonation

Question 19

CN XII

Answer 19

tongue movement for speech and swallowing

Question 20

anosmia =

Answer 20

loss of sense of smell

“CN I grossly intact detects hand sanitizer, lotion)

Question 21

aniscoria =

Answer 21

pupil asymmetry

present in up to 20% of population

if difference is consistent in varying levels of ambient light, its probably normal

Question 22

miosis =

mydriasis=

Answer 22

pupil constriction - parasymp stimulation, light, looking at near object

pupil dilation - symp stimualtion, decrease in light, looking at far object

Question 23

direct v. indirect pupillary reaction to light

Answer 23

direct: light shown on retina (CN II) results in constriction of ipsilateral pupil (CN III)
indirect: light shown on retina (CN II) results in constriction of contralateral pupil (CN III)

Question 24

pupils constrict when focused on near object =

Answer 24

pupillary reaction to accomodation

Question 25

marcus gunn pupil aka relative afferent pupillary defect

Answer 25

due to optic n. or severe retinal disease

direct response to light is absent but indirect response is intact because CN III is intact

DDx - optic neuritis, sever glaucoma, retinal detachment, retinal infection

Question 26

prostitutes pupil aka intact to accomodation but not to light

Answer 26

hallmark of neurosyphillis

pupils small at baseline, nonresponsive to light but do constrict when looking at near object

Question 27

horner’s syndrome aka oculosympathetic paresis

Answer 27

loss of symp tone

• ptosis, miosis, anhydrosis

DDx: carotid a. dissection, pancoast tumor, nasopharyngeal tumor, brachial plexus injury, cavernous sinus thrombosis, fibromuscular dysplasia

Question 28

ABducens _______ the eye

Answer 28

abducens ABducts the eye

CN VI - lateral rectus

CN IV- moves eye in and down with superior oblique

Question 29

inability to bring eye in and down =

Answer 29

CN IV palsy

often leads to vertical diplopia with reading or near vision

Often develop head tilt AWAY from the affected eye

Question 30

saccades vs. nystagmus

Answer 30

saccades - normal jumping movement of the eye with voluntary scanning

nystagmus - slow drift away from the focus with fast beat correction back to focus – NAMED for fast phase

cerebellar = lateral, fast phase towards the side of lesion

vertical = typically indicates a lesion in midbrain

Question 31

***** CN VII innervates the ____ muscle

Answer 31

stapedius

hypersensitivity to sound

Question 32

UMN lesion of CN VII –>

Answer 32

facial droopin gbut spare the forehead

LMN lesion will cause facial drooping involving the forehead (ipsilateral to lesion)

Question 33

conductive v. sensorineural hearing loss

Answer 33

c: hearing loss is due to inefficient conduction from the outer ear to the ear drum to the ossicles
s: damage to inner ear apaprtatus or CN VIII

Question 34

describe rinne and weber tests

Answer 34

r: vibrating handle of tuning fork against the mastoid process until the sound fades, then move the tines to just outside the auditory meatus
(normal = positive = sound lounder on air conduction than bone conduction)

w: vibrating handle of tuning fork against midline of the skull (should be equal in both ears)

Question 35

frequently tested dermatomes =
C2
C6
C7
C8
T1
T4
T10
L3
L4
L5
S1
S2
S3
S5

Answer 35

back of head
thumb
index and middle finger
ring and little fingers
anterior axilla
nipple line
umbilicus
medial knee
medial malleolus
dorsum 3rd MTP joint
lateral Heel
Popliteal fossa
Ischial Tuberosity
Perianal Area

Question 36

inability to identify objects by touch

Answer 36

tactile agnosia

identification of objects by touch = tactile agnosia

parietal lobe function

Question 37

write a letter/number on pts palm

Answer 37

graphesthesia

Question 38

loss of 2pt discrimination with maintenance of other sensory functions indicate…

Answer 38

parietal lobe injury

Question 39

** low threshold to check for saddle anesthesia, urinary retention and rectal tone

Answer 39

needs ER/ imaging

could be impingement, fracture, hx IV drug user

Question 40

DTRs
biceps
brachioradial
triceps
patellar
achilles

Answer 40

C5/6
C5/6
C6/7/8
L2/3/4
S1/2

normal response is 2/4 , hyperactive 4/4, nothing 0/4

Question 41

muscle strength grading

Answer 41

5/5 normal
4/5 full ROM against gravity with some resistance
3/5 Full ROM against gravity - no resistance
2/5 full ROM without gravity
1/5 trace movement
0/5 no movement

Question 42

upper extremity weakness is due to damage in ….

lower extremity…

Answer 42

c-spine or higher

l-spine/sacrum or higher