Approach to Neuro Exam

Question 1

What is dysarthria?

Answer 1

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

Question 2

What is aphasia?

Answer 2

Disorder in producing or understanding language, usually caused by lesions in the dominant hemisphere (usually the left)

Question 3

What does A&O x1, x2, x3, and x4 mean?

Answer 3

A&O x1: person

A&O x2: person and place

A&O x3: person, place, time

A&O x4: event

Question 4

Between delirium and dementia, which one is reversible and which one is not reversible?

Answer 4

Delirium is reversible while dementia is not reversible

Question 5

How do you screen for delirium?

Answer 5

CAM diagnostic algorithm

Question 6

What is the most common isolated cranial nerve palsy?

Answer 6

CN VI palsy due to its long peripheral course

Question 7

How do you test CN VIII?

Answer 7

Whisper test, finger rub test, weber-rinne test

Question 8

How do you test for CN IX and X?

Answer 8

Listen to voice for hoarseness, gag reflex, check for difficulty swallowing

Question 9

How do you test for CN XII?

Answer 9

Have patient protrude tongue than have patient push against their cheeks as you apply mild resistance

Question 10

What does it mean if you document that the CNs are grossly intact?

Answer 10

Means you spent enough time talking to the patient that you haven’t seen anything that warrants an actual CN test

Question 11

What does it mean if you document that CNs 2-12 intact to testing?

Answer 11

Means you went through the actual confrontation of each nerve bilaterally

Question 12

Define stereognosis

Answer 12

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

Question 13

Define graphesthesia

Answer 13

Ability to identify numbers written on the palm

Question 14

Define two-point discrimination

Answer 14

Ability to distinguish being touched by one or two points

Question 15

Define double simultaneous stimulation (extinction)

Answer 15

Ability to feel 2 locations being touched simultaneously

Question 16

What is thalamic pattern of sensory loss?

Answer 16

Hemisensory loss of all modalities

Question 17

What is cortical loss pattern of sensory loss?

Answer 17

Intact primary sensations but loss of cortical sensations

Question 18

What is the functional loss pattern of sensory loss?

Answer 18

Non-anatomical distribution

Question 19

Describe cerebellar ataxia

Answer 19

Staggering, unsteady, feet wide apart, other cerebellar signs usually present

Question 20

Describe sensory ataxia

Answer 20

Unsteady, feet wide apart, feet thrown forward and slapped down first on heels then forefoot, patients watch the ground when walking

Question 21

Describe Parkinsonian ataxia

Answer 21

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

Question 22

What does Brudzinski sign stretch? What do you do? What is a positive sign?

Answer 22

Stretches femoral nerve; examiner flexes patient’s neck; positive sign is patient’s hips and knees flex in response

Question 23

What does Kernig’s sign stretch? What do you do? What is a positive sign?

Answer 23

Stretches sciatic nerve; examiner flexes patient’s hip and knee, then slowly extend leg and straighten knee; positive sign is pain or increased resistance to knee extension beyond 135 degrees, can also cause passive flexion of the neck