All That Neuro Stuff Flashcards
What exposure is required for a lower limb exam?
Shorts of underwear
What do you look for in inspection of lower limb neuro
SWIFT
- Scars
- Wasting of muscles
- Involuntary movements
- Fasciculations
- Tremor
Objects
- walking stick
In what position should the patient be for inspection of lower limb neuro?
Lying on bed (45)
What do you look for when assessing gait?
- Speed
- Symmetry
- Balance
- Arm swing
What does walking on tip toes test?
power of plantar flexion
What does heel walking test?
Power test of dorsiflexion
What does rombergs test test for?
And what does positive test suggest?
Assessment of proprioception
positive test suggests that ataxia is sensory in nature
How do you check tone in legs?
- Leg roll
- Leg lift
- ankle clonus
Which way is dorsiflexion of the foot?
lifting toes up
What reflexes do you test in lower limb neuro?
- Knee jerk
- Ankle jerk
- Plantar reflex
Describe the dermatomes of the leg
- L2 (upper thigh)
- L3 (lower thigh)
- L4 (knee)
- L5 (lateral shin)
- S1 (lateral foot)
what tuning fork is used to test vibration sensation in leg?
128Hz
What do you do to test coordination of lower limb?
- heel shin test
- ask patient to tap your hands asap with their feet
What would you do to complete examination of lower limb neuro?
- Cranial nerve examination
- Examination of upper limb
What exposure is required for examination of upper limb?
Remove top (can keep bra on)
What do you look for on inspection of upper limb neuro exam?
- Posture
- Pronator drift
- SWIFT
Tone: what does cog-wheeling and rigidity suggest?
Parkinsons disease
Tone: what does increased tone suggest?
UMN lesions
Example of UMN lesion
Stroke
Where are the dermatomes in upper limb? (where test sensation) describe where
- upper inner and outer arm
- inner and outer forearm
- finger tip
Upper limb neuro: testing coordination (finger to nose): what would suggest cerebellar disease?
- Intention tremor
- Past pointing
What does dysdiadokinesia suggest? and what is it?
- Parkinsons
- Inability to perform rapidly alternating movements
To which side will uvula deviate in glossopharyngeal nerve palsy? why?
Away
Train tracks: Palsy side doesn’t pull up when normal side does => pulled to opposite side than lesion
To which side will tongue deviate in hypoglossal nerve lesion? why?
Toward
Train tracks: trying to stick tongue out straight ahead, lesion side doesn’t move, normal side works and pushes to side of lesion
What tuning fork for rinne’s and weber’s tests
512Hz
What do rinne’s and weber’s test for
to differentiate conductive and sensorineural hearing loss
Tandem gait is particularly good at identifying what dysfunction?
cerebellar vermis
What do you look for when assessing patient gait?
- Stance
- Stability
- Turning
- Arm swing
What does rombergs test test for?
- Tests for loss of proprioceptive or vestibular funciton
What is positive Romberg’s sign and what does this indicate
- positive sign: falling without correction
- indicates unsteadiness is due to sensory ataxia (not cerebellar dysfunction)
Romberg’s test: what does swaying with correction suggest? what is test result?
- Not Romberg positive
- often occurs in cerebellar disease due to truncal ataxia
Rebound phenomenon back to original position is suggestive of what?
Healthy individual
Exaggerated rebound phenomenons suggestive of what?
spasticity (stroke affecting cerebrum)
Absence of rebound phenomenon is suggestive of what?
cerebellar disease
CN exam: what is first thing you do do test CN II ?
Inspect!
- pupils (size + alignment)
Should patient wear their glasses when checking visual acuity
yup
What distance should the Snellen chart be when checking visual acuity?What if patient can’t read it there?
6m
Then if unable to read 3m
if still unable to read then 1m
if still unable assess ability to count fingers
how many lines of Snellen chart should they be able to read
6/9
how do you make sure that consensual light reflex is not biased?
put hand up in-between eyes to make sure light is only shining on one eye
What does swinging light test test for?
may reveal a relative afferent pupillary defect
how would you assess for colour vision?
using Ishihara chart
What tests do you do for optic nerve? (5)
- visual acuity
- visual fields by confrontation
- inattention/ visual extinction
- light reflexes (direct and consensual)
- accommodation
what question do you ask after checking eye movement?
ask if the patient has any double vision
what do you do after checking light sensation of the face (CNV)
pin-prick sensation with a neuro tip - same regions
which muscles do you palpate for CNV
- temporalis
- masseter
what question do you ask for CNVIII?
have you noticed a change in your hearing?
How do you test the patients balance (CNVIII)
get the patient to stand up, cost their eyes and march on the spot. the patient will rotate towards the side of the lesion.
What would you do to complete CN exam?
- full neurological examination including upper and lower limbs
- appropriate neuroimaging
What is the point of tandem gait?
will exaggerate unsteadiness (cerebellar vermis dysfunction)
What test to test for balance?
Romberg’s test
what type of speech is characteristic of cerebellar disease?
slurred staccato speech
cerebellar exam: what do you test for in the eyes?
- ask if they have any double vision
- H pattern (nystagmus)
- overshooting
- check for smooth pursuit
Cerebellar exam: what do you test for in upper limb?
- coordination
- tone
- rebound phenomenon
- happy clappy
cerebellar exam: what do you test for in lower limb?
- tone: leg roll, leg drop
- coordination: heel shin
- reflexes: knee jerk
how would knee jerk reflex change in cerebellar disease?
Hyporeflexia
