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Neuro Behavioral Med I > 3 - Neuro Exam and Testing > Flashcards

3 - Neuro Exam and Testing Flashcards

1
Q

Cranial nerve I

A

Olfactory (I)

Sensory: smell

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2
Q

Cranial nerve II

A

Optic (II)

Sensory: visual acuity, visual fields
Parasympathetic: pupillary constriction, lens shape change

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3
Q

Cranial nerve III

A

Oculomotor (III)

Motor: raises eyelids, most oculomotor movements

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4
Q

Cranial nerve IV

A

Trochlear (IV)

Motor: downward, inward movement of the eye

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5
Q

Cranial nerve V

A

Trigeminal (V)

Motor: jaw opening and closing, chewing

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6
Q

Cranial nerve VI

A

Abducens (VI)

Motor: lateral eye movement

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7
Q

Cranial nerve VII

A

Facial (VII)

Motor: movement of facial expression (except jaw), close eyelids, labial speech sounds
Sensory: pharynx, taste anterior 2/3 of tongue
Parasympathetic: secretion of tears and saliva

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8
Q

Cranial nerve VIII

A

Vestibulocochlear (VIII)

Sensory: hearing and equilibrium

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9
Q

Cranial nerve IX

A

Glossopharyngeal (IX)

Motor: Voluntary muscles for swallowing and phonation
Sensory: sensation of nasopharynx, gag reflex, taste posterior 1/3 of tongue
Parasympathetic: secretion of saliva, carotid reflex

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10
Q

Cranial nerve X

A

Vagus (X)

Sensory: behind the ear, part of external ear canal
Parasympathetic: Secretion of digestive enzymes, carotid reflex, involuntary action of the heart, lungs, digestive tract

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11
Q

Cranial nerve XI

A

Spinal Accessory (XI)

Motor: turn head, shrug shoulders, some actions of phonation

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12
Q

Cranial nerve XII

A

Hypoglossal (XII)

Motor: tongue movement for speech and swallowing

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13
Q

What is anosmia?

A

Loss of sense of smell

Test using whatever is on hand (i.e. hand sanitizer)

Document as “CN I is grossly intact, detects hand sanitizer”

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14
Q

What is aniscoria?

A

Pupil asymmetry, present in up to 20% of the population.

If the difference is consistent in varying levels of ambient light, it’s probably normal.

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15
Q

What is miosis?

A

Pupil constriction

Parasympathetic stimulation, light, looking at a near object

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16
Q

What is mydriasis?

A

Pupil dilation

Sympathetic stimulation, decrease in light, looking at a far object

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17
Q

What is the direct pupullary reaction to light?

A

Light shown on the retina (afferent CN II) results in constriction of the ipsilateral pupil (efferent CN III)

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18
Q

What is the indirect pupillary reaction to light?

A

Light shown on the retina (afferent CN II) results in constriction of the contralateral pupil (efferent CN III)

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19
Q

What is pupillary reaction to accomodation?

A

Pupils constrict when focused on a near object

20
Q

What is a Marcus Gunn pupil?

A

AKA relative afferent pupillary defect

  • Due to optic nerve or severe retinal disease
  • Direct pupillary response to light is absent, but the indirect response is intact because CN III remains intact
  • DDx includes:
    • -> Optic neuritis
    • -> Severe glaucoma
    • -> Retinal detachment
    • -> Retinal infection (CMV, herpes)
21
Q

What is an Argyll Roberson pupil?

A

Intact to accomodation but not to light

  • AKA Prostitute’s pupil
  • Hallmark of neurosyphilis
  • Pupils typically small at baseline, nonresponsive to light but do constrict when looking at a near object
22
Q

What is Horner’s syndrome?

A

AKA oculosympathetic paresis

  • Loss of sympathetic tone…
  • Ptosis (droopy eyelid)
  • Miosis (pupils constricted)
  • Anhydrosis (lack of sweating on that side of the face)
23
Q

What is the DDx for Horner’s syndrome?

A
  • Carotid artery dissection
  • Pancoast tumor
  • Nasopharyngeal tumor
  • Brachial plexus injury
  • Cavernous sinus thrombosis
  • Fibromuscular dysplasia
24
Q

What is CN IV palsy?

A
  • Inability to bring the eye in and down
  • Often leads to vertical diplopia with reading or near vision
  • Often develop head tilt AWAY from the affected eye
25
Q

What is saccades?

A

Normal jumping movements of the eye with voluntary scanning (reading, etc)

26
Q

What is nystagmus?

A
  • Slow drift away from the focus with fast beat correction back to the focus
  • Named for the fast phase (NOT named for the slow drift!)
  • 13 subtypes described in DeGowin! Let’s just talk about 2
27
Q

What are the two types of nystagmus we will focus on?

A
  • Cerebellar = lateral, fast phase towards the side of the lesion
  • Vertical = typically indicates a lesion in the midbrain
28
Q

What suggests an upper motor neuron lesion in the face?

A
  • The forehead has bilateral UMN involvement but unilateral LMN involvement
  • This means that an UMN lesion (eg stroke) will cause facial drooping but spare the forehead
29
Q

What suggests a lower motor neuron lesion (i.e. Bells Palsy) will cause facial drooping involving the forehead?

A

A patient with an LMN lesion (eg Bells Palsy) will cause facial drooping involving the forehead

30
Q

What is conductive hearing loss?

A
  • Hearing loss is due to inefficient conduction from the outer ear to the ear drum to the ossicles
  • Ex: fluid in the middle ear, perforated ear drum, impacted cerumen, foreign body
31
Q

What is a sensorineural hearing loss?

A
  • Damage to the inner ear apparatus or CN VIII

- Ex: med toxicity, genetic hearing loss, aging, trauma, infection, exposure to loud noises

32
Q

What do you use to perform a Weber and a Rinne test?

A

Both performed with 512 hz tuning fork

33
Q

What is a Rinne test?

A
  • Vibrating handle of the tuning fork against the mastoid process until the sound fades, then move the tines to just outside the auditory meatus
  • The sound should be LOUDER on air conduction than bone conduction
  • A normal Rinne test is POSITIVE
  • An abnormal Rinne test is NEGATIVE
34
Q

What is a Weber test?

A
  • Vibrating handle of the tuning fork against midline of the skull
  • The sound should be equal in both ears
  • Louder in one ear is considered Lateralising to that side
35
Q

What are the frequently tested dermatomes?

A
  • C2: back of the head
  • C4: nipple line
  • T1: anterior axilla
  • C6: thumb
  • C7: index and middle finger
  • C8: ring and little fingers
  • T10: umbilicus
  • L3: medial knee
  • L4: medial malleolus
  • L5 : Dorsum 3rd MTP Joint
  • S1:Lateral Heel
  • S2: Popliteal Fossa
  • S3: Ischial Tuberosity
  • S5: Perianal Area

These should be pretty close, but not always exact

36
Q

What is stereognosis?

A
  • Identification of objects (e.g. key, clothespin, spoon) by touch
  • Inability to identify objects by touch is Tactile agnosia
  • Parietal lobe function
37
Q

What is graphesthesia?

A
  • Write a letter/number on patients palm
38
Q

What is tactile agnosia again?

A

Inability to identify objects by touch is Tactile agnosia

39
Q

What is a two-point discrimination?

A

The patient’s ability to distinguish two points being touched rather than 1

40
Q

What is the progression of most sensitive to least sensitive areas for two-point discrimination?

A
  • Tongue
  • Lips
  • Fingertips
  • Dorsum of fingers
  • Palm
  • Back of hand
  • Dorsum of foot
41
Q

What does a lack of two point discrimination ability indicate?

A

Loss of TPD with maintenance of other sensory function may indicate parietal lobe injury!

42
Q

What are the “main points” of sensory testing (what he actually does)?

A

No stars, but said “I should probably have stars up there”

  • Light touch (+/- pin prick): shoulders, inner/outer arm and forearm; 1st, 3rd, 5th fingers; knee cap; inner/outer lower leg; monofilament of feet
  • “sensation grossly intact” (I will detail this further if patient has abnormal findings or a neuro complaint)
  • Further evaluation is based on initial findings.
  • I do temperature/vibration/proprioception only rarely.
  • Confession: I have never performed stereognosis or graphesthesia except out of academic interest in known stroke patients.
  • I have a low threshold to check for saddle anesthesia, urinary retention, and rectal tone.
43
Q

What deep tendon reflexes do we test?

A
  • Biceps
  • Brachioradial
  • Triceps
  • Patellar
  • Achilles
44
Q

What spinal levels are we testing with each of the tendon reflexes?

A
  • Biceps (C5 and C6)
  • Brachioradial (C5 and C6)
  • Triceps (C6, C7***, C8)
  • Patellar (L2, L3, L4)
  • Achilles (S1*** and S2)

*** were bold

45
Q

How do we score deep tendon reflex?

A 
0 - No response
1+ - Sluggish/diminished
2+ - Active or expected
3+ - Brisker than expected
4+ - Brisk/hyperactive, transient clonus
46
Q

How do we score muscle strength testing?

A 
0 - No evidence of movement
1 - Trace movement
2 - Full ROM without gravity
3 - Full ROM against gravity
4 - Full ROM against gravity with some resistance
5 - “Normal”
47
Q

What do you need to remember for motor function testing?

A
  • For my lecture purposes, I don’t need you to memorize all of the muscle innervations.
  • Know that upper extremity weakness is due to damage in the C-Spine or higher.
  • Know that Lower extremity weakness is due to damage in the L-spine/Sacrum or higher.
  • If the patient is having changes in bowel or bladder function or weakness to the point they can no longer ambulate, they need urgent evaluation by somebody else!

Neuro Behavioral Med I (15 decks)

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