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PCM II > Basic Neuro Exam > Flashcards

Basic Neuro Exam Flashcards

1
Q

what are the main components of the neurologic exam?

A
  1. Mental Status - level of alertness, appropriateness of responses, orientation to time and place.
  2. cranial nerves
  3. Motor systems - muscle strength test, gait, and coordination testing
  4. Sensory - pinprick, light touch, vibratory, proprioception
  5. Reflexes - deep tendon reflexes and plantar response (babinski)
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2
Q

What are the components of mental status exam?

A
  • level of alertness
  • appropriateness to response
  • orientation to time and place
  • congruency of mood
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3
Q 
For each of the following types of disease, state whether the onset and progression of neurologic signs and symptoms are abrupt, progressive or episodic.
A. Cerebral hemorrhages
B. Vascular diseases
C. Infections
D. Head trauma
E. Neoplasms
F. Degenerative diseases like PD, AD
G. Demyelinating diseases like MS
A

A through D all have abrupt or apoplectic onset
E and F are progressive
G -intermittent, relapsing episodes

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4
Q

Whats the proper way to test CN I?

A

Have patient close one nostril and sniff through the other.

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5
Q

How is CN II tested?

A
  • Test visual acuity with a Snellen eye chart- pt stands 20ft from chart
  • Insect the fundi - locate optic disc, check for papilledema, pallor or atrophy. inspect retina for hemorrhages, exudates, spontaneous nervous pulsation, hypertensive vascular changes, trace the arteries and veins peripherally
  • Visual field test - pt in front of examiner, one eye covered during testing, patient to count fingers held up testing all 4 quadrants, also test blink response to lateral threat
  • Color vision
  • pupillary light reflex (tests CN II and III)
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6
Q

What nerves are tested during cardinal signs of gaze testing?

A

CN III, IV, and VI

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7
Q

What are you checking for when testing CN III

A
  • eyelid for ptosis
  • pupil shape and symmetry
  • reactivity to light and accomodation
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8
Q

How is CN V tested?

A
  • facial sensation in forehead, cheek, chin to pinprick, light touch, and hot/cold
  • check motor function: check lateral jaw movements (lateral pteryoids), jaw clenching( temporal and masseter muscles)
  • Check corneal reflex - (tests CN V and VII) - lightly touch cotton wisp to cornea which should result in contraction of the obbicularis oculi muscle
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9
Q

In the corneal blink reflex

A 
Afferent = Trigeminal
Efferent = Facial
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10
Q

When wide opening of the mouth, patient’s chin deviates to right. This is known as _

A

Right trigeminal palsy

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11
Q

How is CN VII tested?

A
  • Motor - facial expressions, eye and mouth closure. Widened palpebral fissure and nasolabial fold indicative of weakness
  • Sensory - taste for salty, sweet and bitter substances to anterior 2/3 of tongue
  • Parasympathetic - secretion of saliva and tears
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12
Q

When testing for CN VIII, before proceeding to do Weber or Rinne test, what tests are usually performed to check for hearing loss?

A

Check for loss of hearing by whisper test or finger rub in each ear, if present then do Weber and Rinne test

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13
Q

For the Weber test, after striking the tuning fork, where is it placed, and what is being tested?

A

on the middle of the forehead, diminished tone in the affected ear indicates sensorineural loss. A louder tone in the affected ear indicates conductive deafnesss (disease in the ossicles int he middle ear)

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14
Q

How is the Rinne test performed and what does it test?

A

Confirms the presence of conduction of deafness in the affected ear. Strike a tuning fork and place it on the mastoid process.

Strike tuning fork and place on mastoid process. When the tone is gone, place it over the external auditory meatus, the patient should hear the tone again, if not, conduction deafness is present

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15
Q

What is the motor and sensory components of CN IX. How is CN IX tested?

A

Motor: innervates stylopharyngeus muscle which elevates and widens the pharynx on swallowing

Sensory - taste to the posterior 1/3 of the tongue, sensation to the palate and pharynx, skin of the external ear

Test: gag reflex - touch posterior pharynx with cotton tipped applicator should illicit a gag response

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16
Q

CN X innervates the larynx and all the muscles of the pharynx except

A

Stylopharyngeus

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17
Q

How is CN X tested?

A
  • test by listening to voice for hoarseness

- check gag reflex

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18
Q

Lesions of IX results in

A
  • loss of gag reflex
  • loss of sensation in pharynx and posterior 1/3 of tongue
  • slight dysphagia
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19
Q

Lesion of X results in

A
  • dysphonia
  • dysphagia
  • dyspnea
  • loss of gag or cough reflex
20
Q

How is CN XI tested?

A

CN XI innervates trap and SCM.
SCM: test by having pt turn head against mild resistance. contraction of the left SCM turns head to the right

Trap: pt shrug shoulders against resistance

21
Q

CN XII innervates all intrinsic muscles of the tongue except

A

palatoglossus (CNX)

22
Q

How is XII tested?

A

pt protude tongue and push tongue into opposite cheek

23
Q

CN XII lesion results in

A

tongue deviation to the weak side and inability to push tongue to the opposite cheek

24
Q 
List the following with the corresponding nerve root
A. shoulder shrug - trapezius
B. Shoulder abduction- deltoid
C. Elbow flexion 
D. Elbow Extension
E. Wrist flexion/extension
F. Hand grip
G. Finger abduction
H. Opposition of the thumb 
I. Hip Flexion
J. Hip Extension
K. Hip Adduction 
L. Hip Abduction 
M. Knee Flexion
N. Knee Extension
O. Ankle plantar flexion
P. Ankle dorsiflexion
A 
A. CN XI
B. C5
C. C5-6
D. C6-8
E. C6-7
F. C7-C8 T1
G. C8-T1
H. C8-T1
I. L2-4
J. S1
K. L2-4
L. L4-S1
M. L4-S2
N. L2-L4
O. s1
P. L4, L5
25
Q

When testing for vibratory sensation, where is the tuning fork usually placed?

A

on interphalangeal joints or malleoli

26
Q

How is proprioception usually tested?

A

Grab pts big toe and move it in a circle with pt’s eyes closed ask for responses of up or down

27
Q

What is the Romberg test?

A

Proprioception test (posterior column). Patient stands with feet together in front of examiner and closes eyes with arms abducted to 90. if patient falls to side, abnormal test

28
Q

What are some ways to test for cortical sensation?

A
  1. Sterogonosis - ability to identify shapes of objects or recognizing objects placed in hand
  2. Graphesthesia - ability to identify numbers written on palm
  3. Two-point discrimination - ability to distinguish being touched by one or two points
  4. double simultaneous stimulation (extinction) - ability to feel two locations being touched simultaneously
29
Q 
List the nerve root with the following DTR
A. Biceps
B. Brachioradialis
C. Triceps
D. Pateller
E. Achilles
A 
A. C5 mostly, some C6
B. Mostly C6 with some C5
C. Tricep - mostly C7, some C6
D. Mostly L4, some L2,3
E. S1
30
Q

What is a positive babinski sign? what is positive sign indicative of?

A

Abnormal when sole of foot is scratched from heel towards toes and across transverse arch, great toe extends and remainder spread.
sign of UMN dysfunction

31
Q

What is clonus?

A

abnormal pattern of neuromuscular activity characterized by rapidly alternating involuntary contraction and relaxation of skeletal muscle.

32
Q

What is abdominal reflex? and nerve root is involved?

A

T10-12. stroking abdomen causes umbilicus to move toward area of stimulation

33
Q

What is cremasteric reflex?

A

Afferent L1, efferent L2 - stroking inner thigh causes scrotum to rise on stroked side

34
Q

What is the anal wink reflex?

A

S2-4. useful for cauda equina or lesion that affect sacral region, touch areas around perirectal region and note for contraction

35
Q 
For each of the systems listed below, name some clinical signs/symptoms when it's dysfunctional
A. Vestibular
B. Cerebellar
C. Pyramidal
D. Extrapyramidal
E. Cortical
A

A. nystagmus, vertigo, vomitting postural impairment, disequilibirum

B. DYsmetria, dysdiadochokinesia, ataxia, intention tremor, slurred spleech, asthenia

C. Spastic paralysis/paresis, hyperreflexia, hypertonia, babinski

D. Dyskinesia, resting tremor

E. Hemi-dysasthesia, hemiplegia, hemiparesis, apraxia, aphasia, cognitive/behavioral

36
Q

What are some Cerebellar testing?

A
  • finger to nose
  • Hell to shin
  • Rapid alternating movement
37
Q

What is Parkinsonian gait?

A

anteroflexed posture, festinating small steps en block turns, decreased arm swing

38
Q

What is scissoring gait?

A

feet crossing over with toes dragged - often seen in cerebral palsy or multiple sclerosis

39
Q

What is sensory ataxic gait?

A

high steppage, broad based - seen with posterior column damage and peripheral neuropathy

40
Q

What is magnetic gait?

A

small steps, feet do not leave ground, seen in frontal lobe processes and hydrocephalus

41
Q

What is astasia-abasia gait?

A

gat is all over like patient is falling, does not fall, usual cause is psychogenic

42
Q

What is hemiplegic gait?

A

leg swing in a circular type pattern, decreased arm swing ipsilateral to affected leg. usually due to UMN such as stroke

43
Q

what is positive Kernig’s sign?

A

patient supine, flex thigh then straighten leg, patient will experience pain in neck

44
Q

What is positive Brudzinki’s sign?

A

patient supine, lift patient’s head, knees will come up in response

45
Q

Explain the presentation of Decorticate posture and decerebrate posture

A

Decorticate- both arms flexed, and legs are stiff and extended

Decerebrate - arms are extended and legs stiff and extended

PCM II (11 decks)

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