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PCM Final > Approach to Neuro Exam > Flashcards

Approach to Neuro Exam Flashcards

1
Q

What 5 things are essential to a basic Neuro Exam?

A

1) mental status, speech, and language
2) cranial Nerves
3) Sensory Testing
4) Cerebellar/ Coordination Testing
5) Motor System

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2
Q

Dysarthria

A

defective articulation, usu caused by defect in motor control of speech apparatus

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3
Q

Aphasia

A

disorder in producing ot understanding language, usu by lesions in dominant hemisphere (left)

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4
Q

A&O x 1

A

oriented to person

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5
Q

A&O x 2

A

oriented to person and place

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6
Q

A&O x3

A

oriented to person palce and thing

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7
Q

A&O x 4

A

oriented to event

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8
Q

Depression

A

“have you been feeling down, depressed, or hopeless?”

“have you felt little interest or pleasure in doing things?”

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9
Q

Delirium

A

Reversible

  • screen using CAM Diagnostic Algorithm
  • common in older hospitalized patients
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10
Q

Dementia

A

NOT reversible

  • must eliminate depression and delirium before can diagnose
  • meds can slow progression
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11
Q

Ptosis

A

drooping of eyelid due to elevator palpable weakness (CN 3)

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12
Q

Pupillary dilation/asymmetry

A

disruption of parasympathetic fibers on cn 3 , if severe = fixed and dilated

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13
Q

compressive brainstem lesions

A

brain herniations
initially = compress pupiloconstrictor fibers of cn 3 -> fixed and dilated pupil
second : somatic efferent fibers = oculomotor palsy (external strabismus)

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14
Q

CN IV LESIONS
trochlear nerve

(vulnerable to trauma)

A

1) extropia (eye drifts laterally)
2) weakness of downward gaze (weakness of SO)
3) vertical diplopia (increases when looking down)
4) Head tilting - to opposite side of lesion
- > CAN BE MISS DIAGNOSED AS IDIOPATHIC TORTICOLLIS

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15
Q

CN VI LESIONS

ABDECENS NERVE

A

MOST COMMON ISOLATED
seen in subarachnoid hem, late syphilis, and trauma

lesions :
1) convergent (medial) strabismus (esotropia) -> inability to abduct the eye (LR weak)

2) horizontal diplopia - maximal separation of the images when looking toward the paretic LR muscle

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16
Q

Nystagmus

definition

types

causes

A

rhythmic beating of the eyes, beat in the fast direction

1) horizontal
2) vertical
3) rotatory

causes:

  • vision impairment at early age
  • disorder of labyrinth or cerebellar systems
  • drug toxicity
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17
Q

CN V Lesions

Trigeminal N

A
  • decreased sensation to face and mucous membranes
  • loss of corneal reflex
  • weakness of jaw muscles
  • jaw deviation to weak side (unopposed action of pterygoid m.)
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18
Q

Trigeminal Neuralgia

A
  • recurrent brief episodes of unilateral shock like pain along one or more distributions of trigeminal n.
  • debilitating
  • innocuous stimuli
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19
Q

CN VII LESIONS

facial n.

A
  • paralysis of m. of facial expression ( Bells palsy)
  • loss of corneal reflex
  • hyperacusis (increase sensitivity to sound)
  • crocodile tear syndrome - due to aberrant regeneration of n. after trauma - patient sheds tears when chewing
20
Q

Bell’s palsy

A

peripheral facial paralysis, caused by trauma or infection

21
Q

Bilateral facial Palsies

A

Miller-fisher variant of Gillian barre syndrome

22
Q

Suprenuclear (central) facial palsy

A

spares upper face, contralateral jaw droop and hemiplegia

*impt for det peripheral vs central palsy

23
Q

CN VIII

vestibulocochlear n.

A
  • whisper test
  • finger rub test
  • Weber-Rinne testing
24
Q

CN VIII LESIONS

vestibular lesions result in?
cochlear lesions result in?

A 
Dysequilibrium = imbalance
nystagmus = rapid involuntary and rhythmic movement of the eye 
Destructive = sensorineural hearing loss (acoustic neuroma)
irritative = tinnitus (ring in ears) ex: meds -> aspirin and antibiotics
25
Q

CN 9 and 10

A
  • listen to voice for hoarseness (vocal cords), nasal tone(palatal weakness)
  • gag reflex
  • difficulty swallowing
  • “ah” -> symmetric elevation if intact
  • UNILATERAL LOSS INDICATED AND IPSILATERAL CN X LESION
26
Q

LESIONS IN CN 9 LEAD TO

A
  • loss of gag reflex
  • los of sensation to pharynx and posterior 1/3 tongue
  • slight dysphagia
27
Q

CN 10 LESIONS RESULT IN

A
  • dysphonia
  • dysphagia
  • dyspnea
  • loss of gag or cough reflex
28
Q

Testing CN 11 lesions

testing?

and result if lesion

A

testing:
SCM = turn head against resistance (contraction of L SCM turn head to the R)

trap = shrug shoulders against resistance

if lesion
SCM = paralysis results in difficulty turning head to opposite side

trap : weakness results in unilateral shoulder droop

29
Q

CN 12

testing and lesion

A

testing : protrude tongue, and push tongue against cheeks as apply resistance

lesions = tongue deviate to side of lesion and inability to push tongue to opposite side

30
Q

Dermatomes

C2, 3, 4, 6, 7, 8
T 4,10
L 1,4,5
S1

A

auricle, earlobe, ant/post neck , top of shoulder, radial forearm and thumb, long finger, little finger

nipple, belly button

inguinal, patella/medial calf, anterolateral calf/great toe

posterolateral calf/achilles/ little toe

31
Q

Testing sensory

pain , temperature, vibration, proprioception

A

spinothalamic tract sharp wood depressor , spinothalamic hot and warm tubes water, 128 hx on bony prominence posterior columns, move toes up and down grabbing at sides posterior columns

32
Q

stereognosis

A

ability to ID shapes of objects, or recognizer placed in hand

33
Q

Graphestheisa

A

ability to ID numbers written on palm

34
Q

Two-point discrimination

A

ability to distinguish being touched by one or two points

35
Q

double silmutaneous stimulation (extinction)

A

ability to feel two locations being touched silmutanously

36
Q

Patterns of sensory loss

1) single nerve
2) root or roots
3) spinal Cord
4) brainstem

A

1) loss limited to distribution of single nerve
2) loss in different distributions
- –> c5,6,7 in arms
- –>L4,5, S1 in legs
3) complete, hemisection of SC, PC, anterior spinal syndrome
4) ipsilateral loss in face and contralateral body

37
Q

Patterns of sensory loss pt 2

1) thalamic
2) cortical loss
3) functional loss

A

1) hemisensory loss fo all modalities
2) intact primary sensations but loss of cortical sensations
3) non-anatomical distribution `

38
Q

Testing for cerebellar functions

A

-rapid alternating movements
-finger to nose
-heel to shin
-gait (regular, hell to toe, hopping, shollow knee bend, get up and go)
stance (Romberg, pronator drift)

39
Q

gait cycle

A 
stance = entire time foot is on ground 
swing= entire time foot is in air

wide base = distance b/w feet is greater than normal

40
Q

Cerebellar ataxia gait

A

staggering, unsteady, feet wide apart

41
Q

Sensory ataxia gait

A

unsteady feet wide apart, feet thrown forward and clopped down on to ground, patient watches ground when walking

42
Q

Parkinsonian gait

A

stooped forward, short steps “shuffling”, involves hesitation “festination”, decrease arm swing

43
Q

Grading motor strength

A 
0 = no contraction
1= barely detectable flicker
2 = active movement of body with gravity eliminated
3= movement against gravity
4= movement against gravity and some resistance
5= active against full resistance w/o fatigue (normal)
44
Q

Reflex scale

A 
0= absent 
1= somewhat diminished, low normal 
2= average 
3= brisker than avg
4= very brisk, hyper reflexive, with clonus
45
Q

Additional reflexes

A

1) abdominal t10-12
2) babinski L5,S1
3) anal reflex S2-4

46
Q

Meningeal Signs

A

1) nuchal rigidity : neck resistance to flexion
- > most have bacterial infection
- > less with subarachnoid hem
2) brudzinkis sign
- > stretches femoral n.
- > flex neck , + = flexion in hips and knees
3) kerning sign
- > stretches sciatic
- > flex hip and knee, slowly extend leg to straight
- > + = pain or increased resistance to knee ext beyond 135 degrees

PCM Final (4 decks)

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