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Casey: Neurology > Clin Assess-Neuro > Flashcards

Clin Assess-Neuro Flashcards

1
Q

Reflects pts capacity for arousal or wakefulness; determined by level of activity that pt can be aroused to performing the response to stimuli from examiner

A

Level of consciousness

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2
Q

Using normal tone of voice, pts arousal intact; responds fully and appropriately

A

alert

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3
Q

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

A

lethargic

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4
Q

Shake pt gently; pt opens eyes but resounds slowly, somewhat confused

A

obtunded

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5
Q

Apply painful stimulus to arouse pt from sleep, verbal responses slow/absent, unresponsive when stimulus ceases

A

Stuporous

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6
Q

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

A

comatose

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7
Q

Pts with a GCS of ____ are usually considered to be in a coma:

A

3-8

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8
Q

Suggests damage to the sympathetic pathways in hypothalamus, or metabolic encephalopathy, a diffuse failure of cerebral function that has many causes, including drugs; light rxns usually normal.

A

Bilaterally small pupils (1-2.5mm)

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9
Q

Suggests a hemorrhage in the pons or the effects of narcotics; light rxn may be seen with a magnifying glass

A

Pinpoint pupils (

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10
Q

Bilaterally dilated and fixed pupils may be d/t severe anoxia and its sympathetic effects, as seen after cardiac arrest. They may also result from atropine-like agents- phenothiazines or tricyclics

A

Large pupils

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11
Q

Testing for meningeal signs: positive if flexion of both hips and knees is noted when neck is flexed

A

Brudzinski’s sign

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12
Q

Testing for meningeal signs: positive if pain & increased resistance is noted to straightening the knee after hip and knees are flexed

A

Kernig’s sign

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13
Q

Test if mental function is impaired; may indicated METABOLIC ENCEPHALOPATHY; have pt “stop traffic” by extending both areas w/ hands cocked up-watch 1-2min; positive if sudden, brief, non-rhythmic flexion of hands and fingers

A

Asterixis

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14
Q

Ex- pill-rolling tremor of parkinsonism

A

Resting tremor

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15
Q

Ex-benign essential/familial tremor

A

Postural tremor

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16
Q

Ex- cerebellar disease, MS

A

Intention tremor

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17
Q

Ex- Tardive dyskinesia

A

Oral-facial dyskinesias

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18
Q

Ex- tourette’s syndrome

A

Tics

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19
Q

Ex- torticollis (neck muscles twitch and cause head to twist to one side)

A

Dystonia (Involuntary muscle contractions that cause repetitive or twisting movement)

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20
Q

Ex- Cerebral palsy

A

Athetosis (a condition in which abnormal muscle contractions cause involuntary writhing movements. It affects some people with cerebral palsy, impairing speech and use of the hands)

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21
Q

Ex- Huntington’s disease

A

Chorea

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22
Q

Increased tone; rate-dependent, increasing w/ rapid movement (eg, stroke)

A

Spasticity

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23
Q

Increased resistance throughout ROM; it is NOT rate-dependent

A

Rigidity

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24
Q

Marked floppiness (eg Guillain-Barre & spinal shock)

A

Flaccidity

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25
Q

Sudden changes in tone w/ passive ROM (eg dementia)

A

Paratonia

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26
Q

Normal muscle strength = ?

A

5

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27
Q

Motor function of cervical spine: Deltoid and biceps (shoulder abduction and elbow flexion)

A

C5

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28
Q

Motor function of cervical spine: Biceps flexion and wrist extensors

A

C6

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29
Q

Motor function of cervical spine: Triceps, wrist flexors and finger extensors

A

C7

30
Q

Motor function of cervical spine: Finger flexors and interossei muscles (abduction and adduction of the fingers)

A

C8

31
Q

Motor function: Interossei muscles ONLY!

A

T1

32
Q

Motor function of cervical spine: Head

A

C1-C2

33
Q

Motor function of cervical spine: diaphragm, breathing

A

C3-C4

34
Q

Motor function of lumbar spine: Hip flexion

A

L2

35
Q

Motor function of lumbar spine: Knee extension

A

L3

36
Q

Motor function of lumbar spine: Ankle dorsiflexion

A

L4

37
Q

Motor function of lumbar spine: Great toe extension

A

L5

38
Q

Motor function: ankle plantar flexion, ankle eversion, hip extension

A

S1

39
Q

Motor function: Knee flexion

A

S2

40
Q

Test if pt has low back pain w/ lumbosacral radiculopathy (sciatica if in S1 distribution); Positive for lumbosacral radiculopathy if pain radiates into ipsilateral leg (foot dorsiflexion can further increase pain)

A

straight leg raise

41
Q

Tests for cerebellar function=

A

Rapid alternating movements, point-to-point movements, and Gait

42
Q

Stand w/ feet together and eyes open, then close eyes for 30-60 seconds, only minimal sway should occur (+ if pt almost falls)

A

Romberg test

43
Q

Stand for 30 seconds w/ arms straight forward, palms up and eyes closed, then tap arms briskly downward

A

Pronator drift test

44
Q

Wide, unsteady gait

A

Cerebellar ataxia

45
Q

Wide, unsteady gait AND heel strikes first

A

Sensory ataxia

46
Q

Seen in spinal cord disease, causing bilateral lower extremity spasticity; Gait is stiff; pts advance each leg slowly and thighs tend to cross forward on each other at each step (MC in cerebral palsy)

A

Scissor gait

47
Q

Seen in foot drop, usually secondary to peripheral motor unit disease; Pts either drag feet or lift them high, with knees flexed, and bring them down with a slap on the floor

A

Steppage gait

48
Q

The ability to perceive the form of a solid object by touch

A

Stereognosis

49
Q

Ability to detect writing on the skin purely by the sensation of touch

A

Graphesthesia

50
Q

DTRs: ankle reflexes

A

Primarily S1 (some S2)

51
Q

DTR: knee reflex

A

L2, L3, L4

52
Q

DTR: Brachioradialis reflex

A

C5, C6

53
Q

DTR: Biceps reflex

A

C5, C6

54
Q

DTR: Triceps reflex

A

C6, C7

55
Q

If DTRs seem HYPERACTIVE (4+), test for this; Dorsiflex and plantar flex foot a few times then sharply dorsiflex foot and hold-look/feel for rhythmic oscillations between dorsiflexion and plantar flexion; If present, may indicate CNS disease

A

Clonus

56
Q

Stroke lateral aspect of sole from heel to ball of foot, curving medically across the ball-not movement of the great toe; + if dorsiflexion of great toe-may indicate CNS lesion in corticospinal tract, unconscious states from drugs/alcohol intoxication, postictal period after seziure

A

Babinski Response (L5, S1)

57
Q

Used to dx stroke, determine location/size or tumor, aneurysm, or vascular formation; Dye injected via capsule placed via catheter and serial X-rays taken

A

Cerebral angiogram

58
Q

Noninvasive; painless; detect bone and vascular, certain brain tumors, cysts, herniated discs, spinal stenosis, encephalitis, blood accumulation, intracranial bleeding in stroke, tissue damage in trauma; A lot of radiation

A

CT scan

59
Q

Small amounts of dye injected via x-ray guidance into the spinal disc (nucleus propulsus), CT then completed; may cause some residual discomfort requiring short term pain meds

A

Discography

60
Q

Used to detect problems with spinal and spinal nerve toots; Lumbar puncture- fluid is mixed with contrast dye and injected into spinal sac; allows or clearer image of spinal canal and nerve roots

A

Cisternography

61
Q

Monitors brain activity through the skull; assists in dx of seizure disorders, tumor, tissue damage post TBI, inflammation of the brain/spinal cord, psychiatric disorders, sleep disorders; Pre procedure-pts should avoid caffeine and rx/non rx drugs that impact nervous system

A

EEG

62
Q

Diagnoses nerve and muscle dysfunction and spinal cord disease; measures electrical activity from brain and/or spinal cord to a peripheral nerve root; usually completed in conjunction with a Nerve conduction velocity test (NCV) which measures electrical energy by assessing the nerves ability to send a signal

A

EMG

63
Q

Group of tests used to dx disorders such as involuntary eye movement, dizziness and balance disorders; involved electrode taped around eyes to record eye movements; infrared photography may also be used to evaluate eye movements

A

ENG

64
Q

Measures the electoral signals to the brain generated by hearing, touch, and sight; used to evaluate sensory nerve problems, confirm MS, brain tumor, acoustic neuroma, spinal cord injury

A

Evoked potentials

65
Q

Injection of water or oil based contrast dye into the spinal cord to enhance x-ray imaging of the spine; used to dx spinal nerve injury, herniated discs, fx, back or leg pain, and spinal tumors

A

Myelograpy

66
Q

Provides 2D and 3D pictures of brain activity by measuring radioactive isotopes that are injected into bloodstream; used to detect or highlight tumors, diseased tissue, measure cellular and/or tissue metabolism, monitor blood flow, determine brain injury post trauma, substance abuse

A

PET scan

67
Q

Measures brain and body activity during sleep; used to detect sleep disorders, restless leg syndrome, insomnia, OSA; painless, non-invasive, risk-free

A

Polysomnogram

68
Q

Evaluates blood flow to tissue; f/u test to MRI to dx tumors, infections, degenerative spinal disorders, stress fractures; uses radioactive isotope, a rotating camera and production of a detailed 3D image of blood flow and activity in brain

A

SPECT

69
Q

Ultrasound of brain and spinal cord; analysis of blood flow to the brain and can dx stroke, brain tumors, hydrocephalus and vascular problems

A

Neurosonography

70
Q

Uses infrared sensing devices to measure small temp changes between the 2 sides of the body or within a certain organ; used to detect vascular disease of head and neck, soft tissue injury, nerve root compression, and some degenerative disorders; 2D pic

A

thermography

Casey: Neurology (7 decks)

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