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PCM Last Exam > Abnormal Neuro Exam - Cohen > Flashcards

Abnormal Neuro Exam - Cohen Flashcards

1
Q

neuro exam

A 
mental status
cranial nn
cerebellum
strengths
DTRs
sensory testing, as needed
gait, if possible
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2
Q

LOL AMEN

A

mental status exam

LOC
orientation
language

attention
memory
executive/intellectual fxn
nondominant hemisphere

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3
Q

LOC

A

alert, sleepy, stupor, coma

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4
Q

orientation

A

person, place, time

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5
Q

language

A

fluent, articulation, repetition

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6
Q

attention

A

digit span, slepping, month/days forwards/backwards

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7
Q

memory

A

anterograde/retrograde

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8
Q

executive/intellectual fxn

A

verbal fluency, similarities, proverbs, estimates

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9
Q

non-dominant hemisphere

A

visual spatial, construction, music

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10
Q

fully awake without stimulation - able to cooperate

A

alert

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11
Q

patient prefers sleep, will stay away with minimal verbal or physical stimulation

A

lethargic

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12
Q

patient requires repeated physical stimulation to stay away

A

stuporous

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13
Q

sleep like state - pt cannot be awakened

A

comatose

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14
Q

abnormal LOC

A

always significant

causes:

  • decline organ fxn
  • new med
  • bacterial sepsis
  • low Hct, glucose, PP O2
  • increased CO2
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15
Q

orientation

A

person, place, time

some docs - awareness of their reason for being in hospital

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16
Q

aphasia

A

always dominant hemisphere impairment

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17
Q

brocas aphasia

A

frontal lobe

brief telegraphic output
retained understanding - frustrated

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18
Q

wernickes aphasia

A

superior temporal lobe

fluent speech - poor understanding

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19
Q

anomia

A

inability to name objects

both wernickes and brocas

also - both agraphia

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20
Q

slurred/thick speech

A

dysarthria

med effect
disease of larynx/mouth

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21
Q

testing language

A

listen to patient

have pt REPEAT simple word
have pt READ paragraph
have pt WRITE a sentence
have pt NAME simple objects

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22
Q

apraxia

A

loss of complex tasks

damage dom lobe
-damage to connections

common in stroke survivors/severely demented ppl

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23
Q

gerstmann syndrome

A

damge to angular gyrus of dom parietal lobe

acalculia
agraphia
inability to distinguish R or L
inability to distinguish individual fingers

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24
Q

tests for attention

A

digit span - 7 forward and 5 backwards

serial sevens - from 100

read series of letters - raise hand when hear A

spell WORLD forward and backward

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25
Q

disoriented or inattentive patient

  • fails serial sevens
  • no longer give location, time, place
  • cant stick to subject at hand
A

may have delirium

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26
Q

delirium

A

acute confusion state
encephalopathy

agitation, hallucinations, tremors, BP and HR fluctuates

hyperreactive to stimuli - or sleepy

diffuse systemic problem - affecting large part of brain

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27
Q

abnormal memory

A

bilateral medial temporal lobe damage

-hippocampus

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28
Q

anterograde

A

recent memory - store new info

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29
Q

retrograde

A

distant memories

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30
Q

executive function

A

higher fxn of cerebarl cortex

insight, judgment, decision making

similarities of two objects

31
Q

verbal fluency

A

test of how frontal lobes retrieve information

name as many of category as they can

healthy - 20 or more
path - 12 or less

32
Q

abnormal executive fxn, judgemeny, abnormal nondom hemisphere

A

dementia

33
Q

non-dominant parietal lobe

A

visual-spatial lobes
construction
awareness of ones own body

34
Q

non-dominant temporal lobe

A 
music
tendency to psychosis
depression
bipolar
anxiety
35
Q

non-dominant occipital lobe

A

left homonymous hemianopia, prosopagnosia (cant recognize faces)

36
Q

hemispatial neglect

A

not seeing people or objects in left side of room

37
Q

anosognosia

A

inability to recognize weakness one side of body

38
Q

dressing agnosia

A

inability to put sleeve on one arm

39
Q

lack of construction skills

A

nondom - right - parietal lobe damage

draw, copy simple object

40
Q

abnormal CN

A

localized lesion to brainstem

41
Q

CN II check

A

visual acuity

42
Q

pupil rxn

A

afferent - CN II

efferent - CN III

43
Q

adies pupil

A

polyneuropathy - diabetes

44
Q

U/L loss pupil loss

A

possibly I/L cerebral herniation

45
Q

spare pupil

A

ischemia inside midbrain

46
Q

ptosis

A

droopy upper eyelid
-loss of CN III

loss ov levator palpebrae superiosis

47
Q

horners syndrome

A

see ptosis

weak muellers m

damage U/L sympathetics

48
Q

CN IV

A

only crossed CN

to C/L superior oblique m

test - pt look down and in

49
Q

CN VI

A

abducens

serves I/L lateral rectus m

local disease - pons or skull

increased ICP

50
Q

CN VII

A

facial

mm facial expression
taste anterior tongue

51
Q

stapedius

A

limit hearing damage from loud noise

facial n innervation

52
Q

test of facial nerve

A

close eye, raise eyebrows - upper face

smiling, pursing lips - lower face

53
Q

peripheral CN VII palsy

A

lesion after nerve leaves pons

both upper and lower facial mm impaired

bells palsy if idiopathic

54
Q

central CN VII palsy

A

lesion in brainstem - only lower facial muscles

55
Q

cerebellum

A

coordinate movement of same side

double cross of efferents

lesion - ataxia

56
Q

stroke/hemorrhage in cerebellar hemisphere

A

BS damage - block 4th ventricle CSF flow

57
Q

ataxia

A

lack of coordination

not trouble walking

58
Q

romberg test

A

cerebellar test - test for posterior columns - gracile and cuneus fasciculi

59
Q

upright posture

A

1 vision
2 cerebellum
3 post columns

60
Q

strength testing

A 
0 no movement
1 flicker of movement
2 min horizontal movement
3 some movement vertical (gravity)
4 mod strength against gravity and some resistance
5 normal contraction
61
Q

quadriplegia

A

upper or mid cerv spine disease

62
Q

hemiplegia

A

disease one cerebral hemisphere

or one side of brainstem

63
Q

paraplegia

A

disease of SC - thoracic or high lumbar

64
Q

other muscle features

A

bulk
tone
fasciculations (twitching)

65
Q

DTR

A 
0 no reflex
1 dim reflex
2 average - normal
3 increased - only one beat
4 - increased with clonus (two or more beats)

4 - always pathologic

66
Q

babinski sign

A

plantar reflex

normal - flexion of big toe
abnormal - extension of big toe

67
Q

UMN lesion

A

increased reflex, babinski sign, spasticity

68
Q

LMN lesion

A

decreased reflex, rapid atrophy, sometime fasciciulation

69
Q

peripheral nerve or roots of nerves disease

A

radiculopathy

loss of fine touch in dermatome

70
Q

loss of sensation of entire extremity

A

cerebral hemisphere damage

71
Q

hemiplegic gait

A

inability to bring leg in

72
Q

spastic gait

A

inability to bend at hips and knees

73
Q

festinating gait

A

slow with first steps - faster, then faster, and out of control

PCM Last Exam (6 decks)

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