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Setha: Neuro > Clin Assess > Flashcards

Clin Assess Flashcards

1
Q

Reflects patient’s capacity for arousal or wakefulness, determined by level of activity that patient’s can be aroused to perform in response to stimuli from examiner

A

Level of consciousness

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2
Q

What should you not do if patient in stupor or coma?

A

Do not dilate pupils and do not flex neck if any question of trauma to head or neck

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3
Q

What can you do to evaluate for head or neck trauma?

A

X-ray!

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4
Q

Using normal tone of voice, patient’s arousal intact; responds fully & appropriately

A

Alert

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5
Q

Using loud tone of voice, patient appears drowsy but opens eyes and responds then falls asleep

A

Lethargic

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6
Q

Shake patient gently; patient opens eyes, but responds slowly, somewhat confused

A

Obtunded

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7
Q

Apply painful stimulus to arouse patient from sleep, cereal responses slow/absent, unresponsive when stimulus ceases

A

Stuporous

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8
Q

Unarousable with eyes closed after repeated painful stimuli, no response to environment

A

Comatose

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9
Q

Patients with a Glasgow coma scale score of 3-8

A

Coma

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10
Q

3 components of Glasgow coma scale?

A

Eye opening, motor response, verbal response

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11
Q

Small or pinpoint pupils, large pupils, mid position fixed pupils, one large pupil

A

Pupils in comatose patients

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12
Q

No pupillary reaction to light

A

Problem in midbrain (structural lesion or compression)

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13
Q

Constricted or dilated pupils

A

Metabolic/toxic exposure

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14
Q

Two meningeal signs

A

Brudzinski’s sign and Kerning’s sign

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15
Q

Positive if flexion of both hips & knees is noted when neck is flexed

A

Brudzinski’s sign

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16
Q

Positive if pain & increased resistance is noted to straightening the knee after hip and knee are flexed

A

Kernig’s sign

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17
Q

Patient extends both arms with hands cocked up. Positive if sudden, brief, nonrhymic flexion of hands and fingers

A

Asterixis

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18
Q

What does Asterixis test for?

A

If mental function is impaired and may indicate metabolic encephalopathy

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19
Q

Smell

A

CN I

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20
Q

Visual acuity, visual fields, and fundoycopic exam

A

CN II

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21
Q

Pupillary reactions (direct and consensual)

A

CN II, III

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22
Q

Extraocular movements (including convergence)

A

CN III, IV, VI

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23
Q

Corneal reflexes, facial sensation (3), clench teeth

A

CN V

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24
Q

Facial movements

A

CN VII

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25
Q

Hearing (whispered voice)

A

CN VIII

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26
Q

Swallow, say “ah”, and gag reflex

A

CN IX, X

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27
Q

Voice and speech

A

CN V, VII, X, XII

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28
Q

Shoulder and neck movements

A

CN XI

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29
Q

Tongue symmetry and position

A

CN XII

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30
Q

Tests for lateralization

A

Weber test

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31
Q

Lateralizes to impaired ear

A

Positive Weber for conductive hearing loss

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32
Q

Lateralizes to good ear

A

Positive Weber test for sensorineural hearing loss

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33
Q

Tests for air and bone conduction

A

Rinne test

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34
Q

AC>BC

A

Positive Rinne for sensorineural hearing loss

35
Q

BC=AC or BC>AC

A

Positive Rinne if conductive hearing loss

36
Q

Increased tone; rate-dependent, increasing with rapid movement (e.g. stroke)

A

Spasticity

37
Q

Increased resistance throughout ROM, not rate-dependent; “lead pipe rigidity.” Rachetlike jerkiness with flexion/extension of wrist or forearm “cogwheel rigidity” (e.g. parkinsonism)

A

Rigidity

38
Q

Marked floppiness (eg Guillain-Barre & spinal shock)

A

Flaccidity

39
Q

Sudden change in tone with passive ROM (e.g. dementia)

A

Paratonia

40
Q

Deltoid and biceps (shoulder abduction and elbow flexion)

A

C5

41
Q

Bicep flexion and wrist extensors

A

C6

42
Q

Triceps, wrist flexors and finger extensors

A

C7

43
Q

Finger flexors and interossei muscles (aB and aD duction of fingers)

A

C8

44
Q

Interossei muscles ONLY

A

T1

45
Q

Head

A

C1-C2

46
Q

Diaphragm, breathing

A

C3-C4

47
Q

Hip flexion

A

L2

48
Q

Knee extension

A

L3

49
Q

Ankle dorsiflexion

A

L4

50
Q

Great toe extension

A

L5

51
Q

Ankle plantar flexion, ankle eversion, hip extension

A

S1

52
Q

Knee flexion

A

S2

53
Q

Patient extends both arms and pushes against a wall

A

Winging of Scapula

54
Q

Do this test if shoulder muscles seem weak or atrophic

A

Winging of scapula

55
Q

If medial border of scapula juts backwards

A

Positive winging of scapula

56
Q

What can a winging of the scapula suggest?

A

Weakness of serratus anterior muscle, seen in muscular dystrophy or injury to long thoracic nerve

57
Q

When do you test straight-leg raise?

A

If patient has low back pain with lumbosacral radiculopathy

58
Q

Pain radiates into ipsilateral leg (foot dorsiflexion can further increase leg pain)

A

Positive SLR

59
Q

What is noted in rapid alternating movements in cerebellar disease?

A

dysdiadochokinesis

60
Q

What is noted in gait in cerebellar disease?

A

ataxia

61
Q

Stand with feet together and eyes open, then close eyes for 30-60 secs, only minimal sway should occur

A

Romberg test

62
Q

Stand for 30 seconds with arms straight forward, palm up and eyes closed. Then tap arms briskly downward

A

Test for Pronator drift

63
Q

What does Pronator drift test?

A

Proprioception

64
Q

If touch and position sense are intact, what type of testing should you proceed to?

A

Discriminative sensations to test the sensory cortex

65
Q

stereognosis, graphesthesia, two-point discrimination, point localization, and extinction

A

Discriminative sensations for sensory cortex

66
Q

Ankle reflex

A

primary S1

67
Q

Knee reflex

A

L2, L3, L4

68
Q

Brachioradialis reflex

A

C5, C6

69
Q

Biceps reflex

A

C5, C6

70
Q

Triceps reflex

A

C6, C7

71
Q

At what DTR level would you test for clonus?

A

4+

72
Q

Dorsiflex and plantar flex foot a few times then sharply dorsiflex food and hold - look and feel for rhythmic oscillations between dorsiflexion and plantar flexion

A

Clonus

73
Q

What can positive clonus indicate?

A

Central nervous system disease

74
Q

Lesion in lower motor neuron

A

hypofunction

75
Q

Lesion in upper motor neuron

A

hyperfunction

76
Q

What nerves innervate above umbilicus?

A

T8, T9, T10

77
Q

What nerves innervate below umbilicus?

A

T10, T11, T12

78
Q

What can an absent abdominal reflex indicate?

A

central or peripheral nerve disorder

79
Q

Stroke lateral aspect of sole from heel to ball of foot, curving medially across the ball and note the movement of the great toe

A

Babinski response

80
Q

What nerves does Babinski test?

A

L5, S1

81
Q

Positive if dorsiflexion of great toe

A

Babinkski

82
Q

What does positive Babinski indicate?

A

CNS lesion in corticospinal tact, unconscious states from drugs/alcohol intoxication, postictal period after seizure

83
Q

Loss of reflex contraction of the anal reflex may indicate what?

A

Cauda equina lesins (S2, S3, S4)

Setha: Neuro (9 decks)

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