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2019 PCM Final > Approach To Neuro Complaint > Flashcards

Approach To Neuro Complaint Flashcards

1
Q

What do you look for in terms of mental status, speech & language?

A

Alertness
Speech (easily understood?)
Oriented x 1-4

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2
Q

Dysarthria

A

Defective articulation, usually caused by defect in motor control of speech apparatus

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3
Q

Aphasia

A

Disorder in producing or understanding language, usually caused by lesions in dominant hemisphere

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4
Q

What is A&O x 4?

A

Person
Place
Time
Event

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5
Q

Depression (2 questions)

A

Have you been feeling down, depressed or hopeless?

Have you felt little interest or pleasure in doing things?

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6
Q

Delirium

A

Reversible condition (common in older adults during hospitalization)

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7
Q

Dementia

A

Not reversible condition

Must eliminate both depression & delirium before diagnose w/ dementia

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8
Q

Lesions assoc / CN III

A

Ptosis
Pupillary dilation or asymmetry
Compressive brain stem lesions

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9
Q

Compressive brainstem lesions

A

Space occupying or masses may cause brain to herniate thru dural openings in cranium

Compression of pupilloconstrictor fibers of CN III causing dilation & fixation of pupil

2nd effect on somatic efferent fibers supplying extraocular ms

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10
Q

Lesions of CN IV

A

CN IV vulnerable to head trauma

Exotropia
Vertical diplopia
Head tilting

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11
Q

Exotropia

A

Eye position drifts laterally

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12
Q

Lesions w/ CN VI

A

Most common isolated CN palsy b/c long peripheral course (subarachnoid hemorrhage, trauma)

Convergent strabismus
Horizontal diplopia

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13
Q

Convergent strabismus

A

Inability to abduct the eye (lateral rectus muscle weakness)

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14
Q

Nystagmus

A

Rhythmic oscillation of eyes & can be seen in extreme lateraling of gaze

Horizontal, vertical, rotatory

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15
Q

Lesions of CN V

A

Decreased sensation of face/mucous membranes
Loss of corneal reflex
Weakness of muscles of mastication
Jaw deviation (toward weak side)

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16
Q

Trigeminal Neuralgia

A

Recurrent brief episodes of unilateral shock-like pains along 1 or more distributions of CN V (can be debilitating)

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17
Q

Lesions w/ CN VII

A

Paralysis of muscles of facial expression (Bell’s Palsy)
Loss of corneal reflex (efferent)
Hyperacusis (increased sensitivity to sound)
Crocodile tears syndrome (tearing w/ chewing)

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18
Q

Bell’s Palsy

A

Peripheral facial paralysis can be caused by trauma or infection but usually idiopathic

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19
Q

Supranuclear facial palsy

A

Spares the upper face & usually assoc w/ weakness to 1 side of body (hemiplegia)

**important to determine if weakness is central or peripheral in nature

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20
Q

How to test CN VIII…

A

Whisper test
Finger rub test
Weber Rinne test

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21
Q

Vestibular division lesions of CN VIII

A

Disequilibrium (imbalance)

Nystagmus (rapid involuntary & rhythmic movement of eye)

22
Q

Cochlear division lesions of CN VIII

A

Destructive lesions lead to sensorineural hearing loss

Irritative lesions can cause tinnitus (ringing in ears)

23
Q

How to test for CN IX & X

A

Listen to voice for hoarseness & nasal tone (palatal weakness)
Check gag reflex
Check for difficulty swallowing
Look for elevation of soft palate & uvula position
(Unilateral loss indicates ipsilateral CN X lesion)

24
Q

Lesions specific to CN IX

A

Loss of gag reflex
Loss of sensation in pharynx & posterior 1/3 tongue
Slight dysphagia

25
Q

Lesions specific to CN X

A

Dysphonia
Dysphagia
Dyspnea
Loss of gag or cough reflex

26
Q

Testing of CN XI

A

SCM: Pt attempt to turn head v mild resistance
Trapezius: Pt shrugs shoulders

27
Q

Testing CN XII lesion

A

Have pt protrude tongue & have pt push against cheeks v resistance

(If lesion, tongue will deviate to weak side & pt will not be able to push tongue to opposite side)

28
Q

CN II-XII are intact to testing means

A

You went through the actual confrontation & testing of each nerve BILATERALLY

29
Q

How to test the sensory system

A

Pt eyes should be closed!

Pain
Temp
Vibration
Proprioception

30
Q

Discriminative sensations

A

Stereognosis
Graphesthesia
Two point discrimination
Double simultaneous stimulation

31
Q

Stereognosis

A

Ability to identify shapes of objects or recognizing objects placed in hand

32
Q

Graphesthesia

A

Ability to identify numbers written on palm

33
Q

2 point discrimination

A

Ability to distinguish being touched by 1 or 2 points

34
Q

Double simultaneous stimulation

A

Ability to feel 2 locations being touched simultaneously

35
Q

Sensory loss assoc w/ spinal cord

A

Complete transverse section, hemisection of cord, posterior column, anterior spinal syndrome

36
Q

Sensory loss assoc w/ brainstem

A

Crossed findings w/ ipsilateral loss in face & contralateral in body

37
Q

Thalamic

A

Hemisensory loss of all modalities

38
Q

Cortical loss

A

Intact primary sensations but loss of critical sensations

39
Q

Functional loss

A

Non-anatomical distribution

40
Q

What is cerebellar/coordination testing?

A 
Rapid alternating movements
Finger to nose
Heel to shin
Gait
Stance
41
Q

How do you test the motor system?

A 
Starts w/ observation:
Gait
Body position
Involuntary movements
Muscle bulk
Muscle tone
42
Q

What is a wide based stance?

A

Distance between the feet is greater than normal

43
Q

Cerebellar Ataxia

A

Staggering, unsteady, feet wide apart

44
Q

Sensory ataxia

A

Unsteady, feet wide apart, feet thrown forward & slapped down first on heels then forefoot, pts watch ground when walking

45
Q

Parkinsonian

A

Stooped forward, short steps commonly called “shuffling gait” w/ involuntary hesitation, decreased arm swing

46
Q

What is the abdominal reflex?

A

Cutaneous or superficial reflex, stroke abdomen & muscles should contract toward umbillicus

47
Q

Plantar Response

A

Cutaneous & superficial reflex that when apply pressure from heel to toe on plantar surface of foot, the big toe should flex down

48
Q

Meningeal signs

A

Nuchal rigidity
Brudzinski sign
Kernig sign

49
Q

Nuchal rigidity

A

Neck stiffness w/ resistance to flexion (84% pt w/ acute bacterial meningitis)

50
Q

Brudzinski sign

A

Stretches the FEMORAL nerve

+ sign is pt hips & knees flex when flex neck

51
Q

Kernig sign

A

Stretches the SCIATIC nerve

+ sign: pain or increased resistance to knee extension beyond 135 degrees

2019 PCM Final (7 decks)

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