Chapter 9: The Neurologic Examination, Radiologic and other Dx Studies Flashcards
Afferent
Carrying neural impulses to the CNS
Anterior (ventral) spinal column
The source of neurons that comprise the anterior horn of the spinal cord. Diseases involving the anterior column include:
- amyotrophic lateral sclerosis (ALS)
- spinal muscular atrophy
- poliomyelitis
Babinski Sign
Fanning of the toes and upward flexion of the big toe. Also referred to as the “extensor plantar response.”
Blown Pupil
A pupil that is dilated and unresponsive to changes in light
Clonus
Repetitive, involuntary vibratory movements
Deep Tendon Reflex
Muscular contraction that occurs in response to the stretching of a muscle
Diplopia
The experience of double vision
Dysdiadochokinesia
Impaired ability to smoothly alternate hand movements
Dyskinesia
Impaired voluntary movement
Dysmetria
Inaccurate range of movement during motion-based activities
Efferent
Carrying neural impulses AWAY from the nervous system
Graphesthesia
The ability to identify letters or numbers traced on the skin
Hemianopsia
The loss of a visual hemifield
Homonymous
On the same side (e.g., homonymous hemianopsia)
Long-tract signs
Neurologic signs related to upper neuron lesions, including hyperactive deep tendon reflexes, clonus, and spasticity
Lower Motor Neuron (LMN)
Motor neurons that originate in the anterior horn of the spinal cord. The motor cranial nerve nuclei are also classified as lower motor neurons.
Mental Status
A broad term used in clinical neurology to refer to general cognitive functions such as attention, orientation, memory, spatial abilities, abstraction, and certain aspects of language.
Nystagmus
Rapid involuntary eye movements, which may be lateral, vertical, rotational, or mixed.
Posterior (dorsal) column
The spinal pathway involved in localized fine touch and conscious proprioception.
Proprioception
Perception of one’s body position in space, based on sensory input from the muscles and tendons.
Quadrantanopsia
Loss of one quadrant of the visual field
Reflexes
an involuntary response to a stimulus
Spasticity
Increased muscle tone or increased resistance to stretching
Suppression
The unilateral diminution of sensory input perception in the presence of bilateral stimulation
Upper Motor Neuron (UMN)
Neurons that originate from the cerebral primary motor cortex (i.e., the precentral gyrus) or from certain brainstem nuclei (e.g., the rubrospinal tract from the red nucleus)
Vestibular
Referring to the sense of balance
which cranial nerves are involved in eye movement?
A) CN II, III, IV, VI
B) CN III, IV, VI
C) CN VIII, IX, X
D) CN II and III only
B - CN III, IV, VI
Each of these nerves projects to extraocular muscles involved in eye movement.
CN II only carries visual information.
CN VIII can be involved in nystagmus but IX and X have no role in eye movement.
Field cuts occurring within the temporal visual hemifield of each eye suggests ____.
A) a lesion of the optic chiasm
B) Bilateral temporal lobe lesions
C) bilateral retinal detachment
D) an implausible visual defect
A - chiasmatic lesion of the optic nerve
Axons from the temporal fields pass through the optic chiasm. Temporal lobe lesions are more likely to produce quadrant–rather than hemifield—defects.
A fixed and dilated (“blown”) pupil is typically associated with dysfunction or injury to which cranial nerve?
A) II
B) III
C) IV
D) VI
B - CN III
CN III (oculomotor) specifically mediates the parasympathetic (constricting) ciliary response in the eye. Mechanical damage to CN III interferes with pupil constriction, but the sympathetic function remains and the dilation function remains
The trigeminal nerve is involved in ____.
A) only sensory functions of the face and jaw
B) only motor functions of the face and jaw
C) both sensory and motor functions of the face and jaw
D) neither sensory nor motor functions of the face and jaw
C - both sensory and motor functions
The trigeminal is a mixed cranial nerve and has both sensory and motor capacities
When performing the Dix-Hallpike maneuver, elicitation of vertigo and nystagmus suggest ____ dysfunction that is ____ to the side of the downward ear.
A) oculomotor; Ipsilateral
B) vestibular; contralateral
C) vestibular; Ipsilateral
D) oculomotor; contralateral
C - Vestibular; ipsilateral
Although nystagmus presents as eye movement, it is a vestibular function mediated by dysfunction involving the vestibular branch of CN VIII, and effects are observed ipsilaterally.
Which pairs of these nerves are tested together when eliciting a gag reflex?
A) CN V, VI
B) CN IX, X
C) CN VII, X
D) CN VII, IX
B - CN IX, X
The glossopharyngeal and vagus nerves co-mediate the gag reflex.
CN VII is involved in swallowing and coughing, but only at the level of the neck muscles, not the pharynx
CN V mediates face and jaw sensorimotor functions
CN VI is ocular
A patient presents with decreased shoulder shrug on the left and an inability to resist pressure from an examiner’s hand against the right jaw. These findings could suggest _____.
A) left spinal accessory nerve dysfunction
B) right spinal accessory nerve XI dysfunction
C) bilateral spinal accessory nerve XI dysfunction
D) feigned neurologic impairment
A - left spinal accessory nerve dysfunction
Sternocleidomastoid strength and trapezius muscle lift are innervated by the ipsilateral CN XI
When asked to stand with feet together and arms held palms up and extended at shoulder level, a patient is unable to maintain the position and her left arm slowly turns toward a palm-down position. She is exhibiting a _____, which suggests ______ dysfunction.
A) Hoffman reflex; contralateral pyramidal tract
B) Romberg sign; ipsilateral cerebellar
C) pronator drift; contralateral pyramidal tract
D) Wartenberg sign; ipsilateral cerebellar
C - pronator drift; contralateral pyramidal tract
The example described is classic pronator drift, which localizes to contralateral pyramidal tracts
Wartenberg and Hoffman signs DO NOT involve standing.
A Romberg sign refers to sway when standing, but no upper extremity signs.
Impairment in the ability to perform alternating hand movements is referred to as ____ and suggests cerebellar dysfunction ____ to the more affected side.
A) dysmetria; ipsilateral
B) dysdiadochokinesis; ipsilateral
C) dysmetria; contralateral
D) dysdiadochokinesis; contralateral
B - dysdiadochokinesis; ipsilateral
Dysdiadochokinesis refers to an impairment in alternating motor coordination.
Dysmetria refers to unilateral movement.
Cerebellar output is always ipsilateral, thus contralateral dysfunction is not a feasible option.
Which of the following does NOT involve patient exposure to ionizing radiation?
A) computed tomography
B) magnetic resonance imaging
C) single-photon emission tomography
D) positron emission tomography
B - magnetic resonance imaging
MRI –> uses high field magnetization and radiowave pulses
The rest using ionizing radiation in the form of radioactively tagged binding agents.
Which imaging technique is most likely to be used in case of acute head trauma?
A) MRI
B) SPECT
C) CT
D) DTI
C - Computed tomography (CT)
MRI is not good because it is unsafe during acute injury due to cardiac leads and external stabilizers
SPECT and DTI are investigational techniques in head trauma
The primary dependent variable that is measured using diffusion tensor imaging is ____.
A) diffuse axonal injury (DAI)
B) blood oxygen level dependent response (BOLD)
C) cerebral metabolic rate of glucose metabolism (CMRGlu)
D) fractional anisotrophy (FA)
D - Fractional anisotropy
FA is the primary dependent variable in DTI
DTI may be used to characterize DAI, but is not a specific DTI index
BOLD and fMRI are blood-flow dependent
CMRGlu is only measured with PET
Which of the following is accurate about the radioisotope used in neuroimaging technologies such as SPECT and PET?
A) They are absorbed by glia and provide an indirect index of regional activity.
B) They are absorbed by neurons and provide a direct index of neural activity.
C) They remain in the bloodstream and provide an indirect index of neural activity.
D) They cross the blood-brain barrier and provide an indirect index of regional activity
A - They are absorbed by glia and provide an indirect index of regional activity
They are absorbed by glia but do NOT cross the blood-brain barrier. They decay at the level of the glia and emit photons or positrons.
Electroencephalographic alpha activity is _____ during relaxation and _____ during mental activity.
A) decreased; increased
B) increased; disappears
C) never present; increased
D) none of the above; it is only present during sleep
B - increased; disappears
EEG alpha activity has been consistently demonstrated to increase with relaxation and disappear when a person engages in mental activity (e.g., mental arithmetic). It is not specific to sleep.
The EEG signal represents _____.
A) real-time activity of individual neurons
B) the summation of activity from thousands to millions of neurons
C) normal background activity and epileptiform spikes
D) activity from only those neurons immediately beneath each electrode
B - the summation of activity from thousands to millions of neurons
Although it is time-linked, it does not equate to single-neuron recording, nor is it specific to epileptiform activity.
