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ECOS I Exam 2 > Approach To Neuro Exam > Flashcards

Approach To Neuro Exam Flashcards

1
Q

What is dysarthria?

A

Refers to defective articulation usually caused by defect in motor control or speech apparatus

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2
Q

What is aphasia?

A

A disorder in producing or understanding language usually caused by lesions in the dominant hemispheres (usually the left)

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3
Q

What must be checked first during a neuro exam?

A

Mental status, speech and language

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4
Q

What are the three D’s of mental status that needs to be evaluated?

A

Depression, delirium (reversible), dementia (not reversible)

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5
Q

What is the function of CN IV?

A

Downward and internal rotation of the eyes

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6
Q

What is the function of CN VI?

A

Lateral deviation of the eye

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7
Q

What are the functions of CN VII?

A

Motor: facial movements, including expression, closing of eyes and mouth
Sensory: taste for anterior 2/3 tongue

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8
Q

What is the function of CN V?

A

Check sensory dermatomes (V1-3), check motor with clenching jaw, corneal reflex (sensory input)

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9
Q

What are the six cardinal positions of gaze?

A

Look at slides

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10
Q

What abnormalities can be seen associated with CN III?

A

Ptosis, pupillary dilation or asymmetry, opthalamoplegia (down and out due to denervation of extraocular muscles)

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11
Q

How do lesions in CN III present?

A

Sudden unilateral ptosis and opthalamoplegia

Diplopia sx could be marked by severity of ptosis

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12
Q

What abnormalities can be seen associated with CN IV?

A

Hypertropia, weakness of downward gaze (eye drifts upward), vertical diplopia, head tilting (to opposite side of lesion)

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13
Q

What is hypertropia?

A

Eye position drifts medially

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14
Q

What is vertical diplopia?

A

Double vision that increases when looking down

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15
Q

What is the presentation of CN IV lesions?

A

Vertical diplopia, difficulty with reading or walking down stairs
Sx of torticollis may occur secondary to head tilting

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16
Q

The most common isolated CN palsy is due to what?

A

Due to the long peripheral course of CN VI

Seen often in pts with subarachnoid hemorrhage, late syphilis and trauma

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17
Q

CN VI lesions result in what?

A

Convergement (medial) strabismus (eso/hypertropia) and horizontal diplopia

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18
Q

What is convergent strabismus?

A

Inability to abduct the eye

Due to lateral rectus M weakness

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19
Q

What is horizontal diplopia?

A

Maximal separation of the images when looking toward the paretic lateral rectus M

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20
Q

What abnormalities are associated with CN V?

A 
Decreased sensation of face and mucous membranes 
Loss of corneal reflex 
Weakness of the muscles of mastication 
Jaw deviation toward the weak side 
Trigeminal neuralgia
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21
Q

Describe trigeminal neuralgia

A

Recurrent brief episodes of unilateral shock like pains along one or more distributions of the trigeminal N
Can be debilitating and often triggered by innocuous stimuli
Most pt have a trigger and pain can be reproduced on PE by stroking dermatome with light touch

22
Q

What abnormalities are associated with CN VII?

A

Paralysis of the muscles of facial expression (Bell’s palsy), loss of corneal reflex, hyperacusis, crocodile tears syndrome, bilateral facial palsies, supranuclear facial palsy

23
Q

What is Bell’s palsy?

A

Peripheral facial paralysis
Can be caused by trauma or infection but in most cases is idiopathic (unknown etiology)
Paralysis of upper and lower portion of the face

24
Q

What is supranuclear (central) facial palsy?

A

Spares the upper face and usually is associated with hemiplegia (weakness to one side of the body)
This is important in determining if the weakness is central or peripheral in nature

25
Q

How do you test CN VIII?

A

Whisper test, finger rub test, Weber-Rinne testing

26
Q

What abnormalities are associated with CN VIII?

A

Vestibular lesions involving disequilibrium and nystagmus

Cochlear division lesions including destructive lesions or irritative lesions

27
Q

What is nystagmus?

A

Rapid involuntary and rhythmic movement (or oscillation) of the eye
Two phase: 1. Slow drift away from object of focus 2. Saccade (quick reaction back)
Named for saccade phase

28
Q

How do you test CN IX and X?

A

Listen to hoarseness of voice, nasal tone
Gag reflex
Check for difficulty swallowing
Have the pt raise their palate by saying ahhh

29
Q

What abnormalities are associated with CN IX?

A

Loss of gag reflex, loss of sensation in pharynx and posterior 1/3 of tongue
Slight dysphagia

30
Q

What abnormalities are associated with CN X?

A

Dysphonia, dysphagia, dyspnea and loss of gag or cough reflex

31
Q

How do you test CN XI?

A

Test SCM by having pt attempt to turn head against mild resistance
Test trapezius by having pt shrug shoulders against mild resistance

32
Q

If there is a CN XI lesion what will be seen?

A

Paralysis if SCM results in difficulty turning head to the opposite side
Weakness of trapezius results in unilateral shoulder droop

33
Q

What will be seen with a CN XII lesion?

A

Tongue will deviate to the weak side and pt will have inability to push tongue to the opposite side

34
Q

How should you document the CN testing?

A

CN are grossly intact or CN II-XI are intact to testing

35
Q

What do you need to test when evaluating the sensory system?

A

Pain, temperature, vibration and proprioception (moving the toe up or down)
All with pts eyes closed

36
Q

What are the discriminative (cortical) sensations?

A

Stereognosis, graphesthesia, two point discrimination and double simultaneous stimulation (extinction)

37
Q

What is stereognosis?

A

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

38
Q

What is graphesthesia?

A

Ability to ID numbers written on the palm

39
Q

What is double simultaneous stimulation (extinction)?

A

Ability to feel two locations being touched simultaneously

40
Q

What is the result of a lesion in a single nerve?

A

Loss limited to distribution of a single nerve

41
Q

What is result of a lesion of the nerve roots?

A

Loss is in different nerve distributions with a common root
C5-7 common in arms
L4-S1 common in legs

42
Q

What is the result of a thalamic lesion??

A

Hemisensory loss of all modalities

43
Q

What is the result of cortical sensory loss?

A

Intact primary sensations but loss of cortical sensations

44
Q

How do you test cerebellar/coordination function?

A

Rapid alternating movements (RAM), finger to nose and heel to shin
Gait and stance

45
Q

What is cerebellar ataxia?

A

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

46
Q

What is sensory ataxia?

A

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

47
Q

What is a Parkinsoniangait?

A

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

48
Q

What are other examples of cutaneous or superficial reflexes?

A

Abdominal reflex, plantar response, anal wink reflex

49
Q

What are the meningeal signs?

A

Nuchal rigidity, Brudzinski’s sign, Kernig’s sign

50
Q

What is nuchal rigidity?

A

Neck stiffness with resistance to flexion

Make sure there is no injury or concern for vertebral fracture before testing

51
Q

What is a Brudzinski’s sign?*

A

Pt supine, examiner slowly flexes pt’s neck (chin to chest)

Positive sign = involuntary flexion of pt’s hips and knees flex in response

52
Q

What is a the Kernig sign?

A

Examiner flexes pt’s hip and knee then slowly extend leg and straighten knee keeping hip flexed
Positive sign = pain or increased resistance to knee extension can also cause passive flexion of the neck (pain behind the knee can occur due to tight hamstrings so don’t interpret this as a positive test)

ECOS I Exam 2 (9 decks)

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