Chapter 17: Neuro

Question 1

Spinal Nerve Root: Achilles reflex

Answer 1

S1

Question 2

Spinal nerve root: Patellar/knee reflex

Answer 2

Lumbar 2,3,4

Question 3

spinal nerve root: brachioradialis reflex

Answer 3

C5,6

Question 4

spinal nerve root: biceps reflex

Answer 4

C5,6

Question 5

spinal nerve root: triceps reflex

Answer 5

C6,7

Question 6

spinal nerve root: plantar reflex

Answer 6

L5, S1

Question 7

Grading muscle strength

Answer 7

0- flaccid
1- Barely detectable
2- active movement of body part with gravity eliminated
3- active movement against gravity
4- active movement against gravity and some resistance
5- active movement against full resistance with no detectable fatigue (normal)

Question 8

Tests of coordination (cerebellar, motor, higher sensory) (4)

Answer 8

Rapid alternating movements (hand and foot)
Finger to nose
Heel to shin
Gait tests

Question 9

Positive Romberg test suggests…

Answer 9

Ataxia is from dorsal column disease (loss of proprioception) vs cerebellar

Question 10

Pronator drift

Answer 10

Lesion in contralateral corticospinal tract (pyramidal system)

Question 11

Brudzinski’s sign

Answer 11

Flex patient’s neck, watch for flexion of hips and knees (meningeal sign)

Question 12

Kernig’s sign

Answer 12

Flex patient’s hip and knee, then ask if there is pain when extending knee (Meningeal sign)

Question 13

asterixis

Answer 13

abnormality of diencephalic motor centers

Question 14

2 “don’ts” of comatose patient

Answer 14

don’t dilate the pupils (it’s a clue into the cause of coma)

don’t flex the neck (trauma)

Question 15

Lethargy

Answer 15

A lethargic patient responds to loud stimuli, looks at you, responds to questions, then falls asleep.

Question 16

Obtundation

Answer 16

Patient needs to be shaken to be woken up. Looks at you and responds in a slow, confused fashion

Question 17

Stuporous

Answer 17

Arouses only after painful stimuli (tendon pinch, sternal rub, pencil roll). Verbal responses are slow or absent. Patient will fall back into unconsciousness when stimuli cease.

Question 18

Comatose

Answer 18

Patient does not respond to painful stimuli

Question 19

Doll’s movements

Answer 19

When you hold eyes of comatose patient open and turn head to one side, patients eyes will move to contralateral side. This indicated brainstem is intact.

Question 20

Importance of pupil light response in comatose patient

Answer 20

Normal light responses suggest a metabolic cause of coma

Question 21

decorticate posture

Answer 21

Upper extremities flexed at elbows, held closely to body
Lower extremities internally rotated and exteded
Lesion in corticospinal tracts above the brainstem (eg internal capsule)

Question 22

decerebate posture

Answer 22

Rigid extension with arms fully extended, forearms pronated, wrists and fingers flexed, feet plantar flexed
Indicates lesion in brainstem.

Question 23

Registration

Answer 23

Can patient learn something new and repeat it back?

Question 24

Recent memory

Answer 24

Can patient remember things that happened today?

Question 25

Remote memory

Answer 25

can the patient remember information from long ago?

Question 26

Three areas of cognition:

Answer 26

Attention
Information and vocabulary
Cognition (proverbs)

Question 27

Judgement (how to assess)

Answer 27

Ask patient to propose a solution to a problem (current or hypothetical)

Question 28

Insight

Answer 28

The ability of patients to understand and acknowledge their illness or situation.

Question 29

Aphonia

Answer 29

Loss of ability to speak due to damage in larynx

Question 30

Dysarthria

Answer 30

difficulty speaking due to abnormalities of oral and facial muscles. Sloppy speech.

Question 31

Broca’s aphasia

Answer 31

Expressive aphasia. Patient can comprehend but not speak fluently. They can nod or shake head appropriately.

Question 32

Wernicke’s aphasia

Answer 32

Receptive aphasia. Person cannot comprehend language, but can speak fluently (usually gibberish)

Question 33

Vagus nerve defect will cause

Answer 33

Deviation of uvula away from side of lesion

Question 34

Hypoglossal nerve defect will cause

Answer 34

deviation of tongue toward side of lesion

Question 35

Dysdiadochokinesia

Answer 35

Inability to perform rapid alternating movements

Question 36

Dysmetria

Answer 36

Fails finger to nose and heel to shin

Question 37

Spastic gait

Answer 37

Shuffling gait with one leg extended and stiff. Suggests unilateral corticospinal tract injury (eg stroke)

Question 38

Scissors gait

Answer 38

Adductor spasm, knees pulled together, knees and thighs hit each other. Seen in cerebral palsy, MS.

Question 39

Steppage gait

Answer 39

Hip and knee must elevate extra high to lift the foot off of the ground. Foot slaps floor. Pt cannot walk on heels. Cause is loss of ability to dorsiflex ankle.

Question 40

Cerebellar gait

Answer 40

Feet are set wide apart and steps are unsteady and uncertain. Indicates cerebellar damage.

Question 41

Basal ganglia gait

Answer 41

Small steps and increased arm swing. Head and body are flexed and arms are semi-flexed and abducted. (aka Parkinson’s gait)

Question 42

Chorea

Answer 42

unpredictable, brief, rapid, jerky movements. seen in Huntington’s

Question 43

Atheltosis

Answer 43

Slow, twisting, writhing movements (seen in cerebral palsy).