4. Intro to Neurology: Neuro Exam Flashcards
What is the most important part of the neuro exam?
History
What are the components of the history?
OPQRST O= onset and evolution P = Provocation (exacerbating/relieving factors) Q = Quality R = Radiation S = Severity T = Timing
Put the following neurologic differentials in order of when they might occur: Neoplastic, Infectious, vascular, degenerative
Vascular (trauma), infectious, neoplastic, degenerative (ALS, Parkinson’s, Alzheimer’s)
Tell me about the time course for MS
Relapsing/remitting course. Can have complete recovery, then go through relapse years later
Neuro differential mnemonic
Mitch Vindi, DO M = metabolic I = Infectious T = Traumatic C = congenital H = hereditary V = vascular I = Immune N = neoplastic D = drugs I = Idiopathic D = Degenerative/demyelinating O = other
Mental status exam components (7)
- Level of consciousness (alert and awake)
- Orientation
- Memory
- sustained mental activity
- language
- Folstein examination
What is the folstein examination?
30-point scale used to measure cognitive impairment
important to note the change in score over time
How do you test the optic nerve?
Pupils - important to test for PERLA (pupils equal and reactive to light, accommodation)
Fundoscopic exam - look for papilledema, presence of spontaneous venous pulses (SVP is normal)
Visual Fields
How do test Ocular motility? What does it tell you?
H-test tells you about EOMI (Extra-ocular muscles intact)
What do we test for Trigeminal nerve function?
Facial sensation, Muscles of mastication
What do we test for facial nerve function?
Muscles of facial expression, corneal reflex (CN5, CN7)
Have patient forcefully smile and try to close eyes (weakness would be no smile on one side and barely closing the eye)
If there is a CN12 lesion, what do we see?
Tongue deviation toward side of lesion
If the masseter muscle is atrophic on the right side, what is injured?
CN5 on right side
If the jaw deviates to the left side, what is injured?
CN5 on left side
Tell me about the scale for grading muscle strength
0 - no contraction 1 - trace movements 2 - active movement with no gravity 3 - active movement with gravity 4 - active movement with gravity and resistance 5 - full power
Define spasticity
Excessive muscle contraction - “tightness, stiffness”
Don’t get it confused with clonus = involuntary, rhythmic contractions and relaxations
What are the four sensory components we test for?
- Light touch
- Pain/temp
- Vibration/position
- higher cortical sensation
What are the two forms of higher cortical sensation? Describe them.
- Stereognasia - determine what object is when it is placed in hand by feeling it (no looking)
- Graphesthesia - determine what letter or number was written in their hand
What are the reflexes that are tested?
Brachialis, brachioradialis, triceps, patellar, achilles
What is the grading scale for the deep tendon reflexes? Which is normal?
0 - absent 1 - hypoactive 2 - normoactive 3 - hyperactive 4 - hyperactive with clonus
1,2,3 may all be normal
What is the pathologic reflex? Describe when its positive and negative. Is positive or negative pathologic?
Babinski sign (+): Great toe dorsiflex, toes fan out Babinski sign (-): Toes plantarflex
Postive babinski sign is pathological
A positive babinksi sign is noted by what in the stick figure drawing?
Up arrow
How does a UMN lesion present?
No atrophy
Spasticity
Inc. Deep Tendon Reflex
+ Babinski
How does a LMN lesion present?
Atrphy
Flaccidity
Dec or absent DTR
- Babinski
What is dysmetria?
Lack of coordination, past pointing
Dysdiadakokinesia
Impaired ability to perform rapid alternating movements
Romberg sign
+ Romberg sign means there is a significant reduction in balance (patient loses balance with eyes closed)
