[DSA] Neurologic Evaluation with Mental Status [Howell]

Question 1

Glascow Coma Scale

Scaling for Eye Opening

Answer 1

1: no response even to supraorbital pressure
2: pain from limb/supraorbital pressure
3: Nonspecific response to speech
4: Spontaneous eye opening

Question 2

Glascow Coma Scale

Scaling for Motor response

Answer 2

1: To any pain, limbs flaccid
2: Extension/decerebrate rigidity
3: Flexor response/decorticate rigidity
4: Arm withdraws to pain
5: Arm attempts to remove painful localized stimulus (supraorbital pressure)
6: Follows simple commands

Question 3

Glascow Coma Scale

Scaling for Verbal response

Answer 3

1: No verbalization of any type
2: Moans/groans, no speech, incomprehensible
3: Intelligable, no sustained sentences
4: Converse but confused, disoriented
5: Converses and is oriented

Question 4

Positive finding + interpretation of:

Nuchal rigidity

Answer 4

Pt unable to touch chin to chest either actively or passively

Dx: meningeal irritation

Question 5

Positive finding + Interpretation of:

Brudzinski’s Test

Answer 5

Pt supine. When head is elevated, knees involuntarily flex

Dx: meningeal irritation

Question 6

Positive Finding + Interpretation of:

Kernig Test

Answer 6

Pt supine. Hip and knee begin flexed. When knee is extended => pain in the back

Dx: meningeal irritation

Question 7

Acute, focal unilateral weakness or paralysis in face/UE, LE, and/or difficulty with coordination and gait are highly suggestive of?

Answer 7

Ischemic CVA

Question 8

HA, vomiting, seizures, decreased LOC with unilateral weakness or paralysis worsening over minutes to hours?

Answer 8

Intracerebral hemorrhage

Question 9

Sudden onset of severe HA, may be accompanied by loss of consciousness, seizure, NV, and meningismus is highly suggestive of?

Answer 9

Subarachnoid hemorrhage

Question 10

Present finding + indication of:

Babinski response

Answer 10

Dorsiflexion of the big toe to stimulation of the plantar foot

Dx: CNS lesion in corticospinal tract

Babinski is either present or not present (not a Positive test)

Question 11

Positive finding + indication of:

Arms extended with palms up, eyes closed 20-30 sec => arm drifts downward

Dx: Mild hemiparesis or CVA, UMN lesion

Answer 11

Pronator drift

Question 12

Positive finding + indication of:

Finger to nose test

Answer 12

Have pt touch your finger then touch their nose, repeat bilaterally. Ask pt to close both eyes and try again bilaterally => clumsy movements that are unsteady and vary in speed

Dx; Problem with position sense, fxn of labyrinth of inner ear, cerebellum

Question 13

Positive finding + indication of:

Heel to shin test

Answer 13

Have pt place one heel on the opposite knee, then go up and down the shin. Repeat w/ eyes closed => decreased smoothness and accuracy

Dx: Lesion in motor, basal ganglia, cortical, and cerebellar systems

Question 14

Positive finding + indication of:

Rapid Alternating movements

Answer 14

Instead of quickly, movements are slow, irregular/clumsy (dysdiadochokinesis)

Dx: cerebellar dz

Question 15

Positive finding + Indication of:

Romberg test

Answer 15

Pt with feet together, arms extended and palms upward, eyes closed => pt begins to sway or has to move feet to maintain balance

Dx: Cerebellar dz

Question 16

Positive finding + Indication of:

Gait

Answer 16

Pt asked to walk on toes, heels, and tandem => inability to maintain posture, ataxic gait

Dx: Cerebellar dz, loss of position sense, intoxication

Question 17

______ posturing is ABOVE the red nucleus

Answer 17

Decorticate posturing is ABOVE the red nucleus

Question 18

____ posturing is BELOW the red nucleus

Answer 18

Decerebrate posturing is BELOW the red nucleus