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PCM2 E2 > Basic Neuro Exam > Flashcards

Basic Neuro Exam Flashcards

1
Q

CNV

1) what 3 things do you check?

A

facial sensation of forehead, cheek, chin (v1-v3) to pinprick, light touch, hot/cold

motor function of jaw and lateral pterygoid

corneal reflex –> cotton wisp to cornea causes blinking so you’re testing 7 (blink) and 5 (touch to cornea)

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2
Q

UMN lesion ,what do you see?

1) what 2 things are we going to see on exam?
2) what pattern does it have of weakness?
3) What specialty test can we use to indicate this?

A

hypertonia, hyperreflexia

pyramidal –> weak extensors in arms and weak flexors in legs

pronator drift

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3
Q

how do we test CNXII?

what side is the lesion if there is one?

A

protrude tongue and push tongue into cheek

tongue deviates to the WEAK SIDE and can’t push tongue to the OPPOSITE CHEEK

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4
Q

Important associated symptoms with neuro exam? (8)

A

headache, dizziness/vertigo, weakness, numbness, fainting or blacking out, seizures, tremors

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5
Q

lesions of 3,4, and 6?

A

diplopia and weakness of muscles innervated by that specific cranial nerve

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6
Q

how do we rate DTRs?

which has clonus?

which would be UMN lesion? LMN lesion?

A

+2/4

+4/4

UMN lesion = +4/4

LMN lesion = 1/4 or 0/4

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7
Q

Bilateral facial palsies can occur in what?

A

Miller-fisher variant of Guillain-Barre Syndrome

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8
Q

Asymmetrical abnormal gaits:

Hemiplegic

waddling pelvis

foot drop

A

circumducted gait –> leg swing in a circular type pattern

usually indicates muscle disease –> hips waddle

foot drop –> UMN or LMN lesions. usual LMN is L5 radiculopathy or perineal neuropathy

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9
Q

Sensory testing

what 4 ways do we test and what pathways for each

A

pinprick for pain and temp – spinothalamic

vibratory – posterior columsn

light touch – both pathways

discriminative sensations – depends

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10
Q

Optic II

1) what response are you checking for? how is this done? (include the muscles)
2) what about vision testing? what are terms to know?
3) what about wiggle test?
4) lesions to the optic nerve anterior to the chiasma cause what?

A

near response –> checks the pupillary constriction, convergence (medial rectus mm), and accommodation of the lens (ciliary m)

myopia –> impaired far vision

Presbyopia –> impaired near vision (worsened after age 40)

static finger wiggle test –> visual field testing

ipsilateral blindness

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11
Q

CN VI

1) what is it most commonly associated with? when is it most commonly seen in patients with clinically?
2) lesions result in?

A

CN palsy due to its long peripheral course –> subarachnoid hemorrhage, late syphilis, trauma

convergent strabismus (esotropia) (inability to abduct the eye due to lateral rectus muscle weakness)

horizontal diplopia –> maximally when looking lateral

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12
Q

Obtundation

Stupor

Coma

A

opens eyes and looks at you, but responds slowly and is somewhat confused. alertness and interest decreased

arouses from sleep ONLY after painful stimuli. verbal response are slow or absent. lapses in unresponsive state. minimal awareness of self or environment

unarousable with eyes closed.

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13
Q

crocodile tears syndrome?

A

due to aberrant regeneration of nerve after trauma. patient sheds tears when chewing!

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14
Q

LMN lesion, what do you see?

1) what do we see on exam?
2) what type of pattern?
3) what disease is this common in?
4) functional pattern?

A

wasting, fasciculation, decreased tone or decreased reflexes

peripheral weakness, weak flexors in arms, weak extensors in legs.

muscle wasting diseases

they have 5/5 on everything but then gives up and is completely weak

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15
Q

Parkinson tremor is what?

essential tremor

A

pill rolling

essential tremor gets worse as you do more and more

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16
Q

CNVIII testing?

1) what 2 things are we testing and how are they tested

A

hearing –> whisper test or finger rub…. if hearing loss, weber Rinne test

balance –> vestibular division

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17
Q

Cerebellar testing, what are the ones to know? (4 of them)

A

finger to nose

finger to finger

heel to shin

rapid alternating movements

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18
Q

CN VII, what four things are we testing?

A

Motor –> facial expressions, eye and mouth closure

Sensory –> taste on anterior 2/3 tongue

Parasympathetic –> secretion of saliva and tears

General sensation –> external ear

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19
Q

Testing CNI

1) what do you need to make sure first before you do this? what scent do you use?
2) how do you do it?
3) why would someone lose smelling?
4) losing on one side indicates what kind of lesion?

A

make sure nasal passages are clear.. non-irritating flavor or easy scents to use like coffee

with eyes closed, compress one nostril and sniff through other. do on each side

smoking, chronic sinus disease, head trauma, aging, Parkinson’s, use of cocaine

ipsilateral

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20
Q

Cranial Nerves.. how do you document it?

there are 3 ways:

A

Cranial nerves are intact –> all working

grossly intact –> just from a conversation with someone, but you’re not doing a specific evaluation

3) cranial nerves II-XII are intact to confrontation (or testing)

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21
Q

What 3 things are tested for CN IX? (what are they innervating or what limb if applicable)

A

Motor –> innervates the stylopharyngeus m. which elevates the pharynx on swallowing

Sensory –> taste to posterior 1/3 of tongue and sensation to the palate and pharynx

afferent limb of the gag reflex

22
Q

Depression vs delirium vs dementia

1) all three have what?
2) Delirium, when is it common? what is it?
3) dementia, how can you diagnose? what can slow it?

A

all three have tiredness, confusion, flat affect

common in older adults during hospitalization. they’re super confused and don’t know what’s going on and try to escape

you need to eliminate depression and delirium as diagnoses before you can diagnose. slow progression, but generally not reversible.

23
Q

Nystagmus is based on what?

what planes can it be seen?

when can it be seen?

A

the fast beating component of the nystagmus

horizontal, vertical, rotatory

impairment of vision, disorders of the labyrinth, cerebellar systems or drug toxicity

24
Q

Bell’s palsy is caused by what?

A

trauma or infection, but mostly we have no idea

25
Q

Gag reflex

1) what are the efferent and afferent limbs of this?
2) how is it done?

***3) loss of gag reflex indicates what?

A

afferent –> CNIX (sensory)
efferent –> CNX (motor)

cotton tip applicator to the back.

ipsilateral CNIX problem!

26
Q

Anhedonia?

A

feeling little interest or pleasure in doing things

27
Q

How do we test proprioception on a patient?

A

grab the great toe and move it up and down and have them close their eyes and ask them what they think the direction is

28
Q

CN IV lesions

1) caused from what usually?
2) what 4 things does it result in?

A

caused by head trauma

extortion of the eye (eye drifts laterally)

weakness of downward gaze (due to weakness of superior oblique

vertical diplopia (when looking down)

head tilting (to opposite side of lesion)

29
Q

lesions of the vestibular division of CNVIII leads to what?

A

disequilibrium (imbalance)

nystagmus

30
Q

Stereognosis

Graphesthesia

two-point discrimination

double simultaneous stimulation?

A

identify shapes of objects or recognizing objects placed in both hands

identify numbers written on the palm

distinguish between one or two points

feel 2 locations being touched simultaneously

31
Q

CN VII lesions can cause 4 things, what are they?

A

paralysis of the muscles of facial expression (BELLS PALSY)

Loss or corneal reflex (efferent limb –> blinking)

Hyperacusis (increased sensitivity to sound)

Crocodile tears syndrome

32
Q

Abnormal gait (symmetrical)?

Parkinsonian –>

Scissoring

Sensory ataxia

Magnetic

Astasia-abasia

A

Parkinsonian –> shuffling, small steps, turns around in one spot

Scissoring –> feet crossing over with toes dragging… cerebral palsy or MS

Sensory ataxia –> high steppage

Magnetic – small steps, feet do not leave ground!

Astasia-abasia –> gait is ALL over the place as if the patient is falling, but they don’t fall

33
Q

Intermittent, relapsing episode neuro usually means what?

A

demyelinating diseases such as MS or certain vascular diseases

34
Q

Supranuclear (central) facial palsy does what?

what is this important for?

A

spares the upper face… associated with hemiplegia

determining if the weakness is CENTRAL or PERIPHERAL in nature

35
Q

Decorticate vs Decerebrate

A

decorticate –> arms flexed, legs are stiff and extended (lesion above brainstem)

decerebrate –> arms extended and legs stiff and extended –> midbrain lesion

36
Q

Abdominal reflex?

cremasteric reflex?

anal wink reflex?

A

T10-T12 –> stroke abdomen causes umbilicus to move toward area of stimulation

L1 aff, L2 off –> stroke thigh causes scrotum to rise on stroked side

S4,S5 –> touch areas around perirectal region and note if contraction

37
Q

Testing gait?

A

rise from a chair with arms folded

Romberg test –> testing proprioception to see if they fall over with their eyes closed

38
Q

Abrupt or sudden onset/acute onset neuro usually means what?

A

cerebral hemorrhages, vascular diseases, and infections and head trauma

39
Q

CNXI: spinal division, what are we testing?

A

shrug shoulders, turn head right and left

40
Q

CAM diagnostic algorithm

A

LOOK AT BOOK

41
Q

Lesions of the cochlear division of CNVIII lead to what?

what are the two types of lesions for this and what are examples of each?

A

destructive lesions –> sensorineural hearing loss

irritative lesions –> cause tinnitus –> (meds and antibiotics do this)

42
Q

What does AAO4 mean?

where do you put this on the objective?

A

Alert and oriented in person, place, time, and event.

general or the neuro

43
Q

What’s good for muscle strength?

what does 3/5 mean?

A

+5/5

+3/5 means good range of motion with gravity but without resistance

44
Q

CNX: how do we test? (4 things)

what indicates a lesion?

A

listen for hoarseness and nasal tone

check gag reflex

difficulty swallowing

say ah and look for symmetry in elevation of soft palate.

unilateral loss = ipsilateral lesion

45
Q

CNV lesions, what 4 things can be there?

what’s to note about something going to the ipsilateral side?

A

decreased sensation

loss of corneal reflex

weakness of muscles of mastication

jaw deviation TOWARD THE WEAK SIDE (unopposed action of opposite pterygoid)

46
Q

Oculomotor III

1) what do we check the eyelid for? why?
2) what about the pupils themselves, what could cause this problem?
3) what positioning can the eye be in for a problem?
4) what about light, what can you do with this?

A

ptosis (drooping eyelid that does not clear the upper margin of the pupil) –> levator palpebrae weakness

pupillary dilation or asymmetry –> parasympathetic fiber disruption

eye down and out –> problem with EOM’s

reactivity to light (light reflex)

47
Q

***say we have space occupying or expanding masses cause the brain to herniate through dural openings in the cranium.. what’s generally the first thing to happen?

what’s the second thing to happen?

A

pupilloconstrictor fibers of CNIII –> dilation and fixation of the pupil

somatic efferent fibers that supply the extra ocular muscles cause external strabismus (DOWN AND OUT)

48
Q

Babinski sign is critical for what?

what else would be seen in this pathology

A

UMN dysfunction

great toe extends in a pathology.. normally all toes flex.

cClonus

49
Q

What do we do to test 3, 4, and 6 together? what does each one do during this test?

A

H test

3 –> adduction, downward gaze, elevation of the eye

4 –> inward rotation, down and lateral

6 –> lateral movement of the eye

50
Q

Mental status, what are we checking?

what about speech? (2 things)

A

alertness –> is the patient drowsy

speech: is it easily understood (dysarthria –> motor control of speech problem)

aphasia –> producing or understanding language, usually on lesions on the left

51
Q

Alertness

Lethargy?

A

alert patient opens eyes, looks at you, and responds fully and appropriately

appears drowsy but opens the eyes and looks at you, responds, then falls asleep

52
Q

Progressive onset neuro usually means what?

A

neoplasms and degenerative diseases.

PCM2 E2 (11 decks)

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