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ECR 2012 > ECR 11.12.12 Neurological Exam > Flashcards

ECR 11.12.12 Neurological Exam Flashcards

1
Q

Guiding principle for Neuro Exam (3)

A
  1. IS mental status intact (able to answer questions)
  2. IS my patient able to partner with me to complete an accurate and reliable exam?
  3. Deficients may be transient/fluctuating (frustrating b/c answers may be different later in time)
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2
Q

Framework

A

Are findings symmetric

Is process generalized or focal (localized)

Is lesion in PNS or CNS (where are the lesion? what are the lesions?)

What is the nature of the lesion/process (infectious? sudden?)

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3
Q

Common presentations for neuro

A

Headach
Dizziness, vertigo, imbalance, clumsiness
Weakness
Sensory complaints
Loss of consciousness, syncope, near-syncope
Seizures
Tremors, involuntary movements, gait distrubance
Memory Changes, confusion

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4
Q

What are common neurological illnesses?

A 
Strokes
Seizures
Headaches
eoplams
Neuromuscular disorders
Nerve disorders
Movement disorders
Neurodegenerative disorders
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5
Q

What else could cuase headache

A

hypetension

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6
Q

Dizziness

A

inner ear infection

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7
Q

confusion-

A

dementia, por oxygenation, pneumonia, pulmonary embolism

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8
Q

loss of consciousness

A

hypokalemia

arrhthymia

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9
Q

What are the components of a the Neuro Exam (7)

A 
Mental Status
Cranial Nerves
Motor Exam
Sensory Exam
Reflexes
Coordination
Gait and Stance
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10
Q

What do you look for doring Motor Exam (4)

A

Involuntary movements
Bulk
Tone
Power/Strength

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11
Q

What type of involuntary movements are you looking for

A 
Tremor
Tics
Dystonia
Athetosis
Chorea

note location, quality, rate, rhythm, amplitude, relation to posture

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12
Q

Tremor

A

can happen at rest (Parkinsons)

when trying to grab soething you might be able to see it

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13
Q

Dystonia

A

twisted posture

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14
Q

Athetosis

A

writhing movements;greater amplitude with movement

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15
Q

Chorea

A

quick movement; often not purposeful but
may try to cover it up with a seemignly purposeful gesture

Chorea happens then pat pretnes like tried to make hand out gout like that

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16
Q

Bulk

A

mass of bulk- is it waht you expect

INspect and palpate

  • shape/size/mass
  • symmetry
  • hypertrophy
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17
Q

Pseudohypertropphy

A

muscle tissue is degenerating
show false enalrgement

Muscle dystrophy (boy on swing with hugeeee calves b/c muscle infiltrated with iprprer tissue)

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18
Q

Atrophy

A

lower motor neuron- wasting disease

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19
Q

Tone

A

tension detected in muslce

normally slight residual maintained even at rest

palpate resitsnce ith movmeent through ROM

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20
Q

What are different tone

A

normal
hypertonic- inc tone
hypotonic- dec dtone
flaccid- complete absence of toen

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21
Q

Spasticity vs rigidity

A

Spastic- resistance at extremems/end of motion

Rigidity- same resistance ENTIRE motion

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22
Q

What is grading scale for Strength?

A

0-5

0- no muscle contrction
1- barely detectable flicker/trace of contraction
2- movement with gravity eliminated
3. movement with gravity, no resisitance
4. movement with gravity, with resistance
5. Normal muscle strenght** active

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23
Q

What is the grade for NORMAL Strength

A

5

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24
Q

What is paresis

A

IMPAIRED strength/weakness

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25
Q

What is plegia

A

ABSENCE of strength/paralysis

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26
Q

what are the different types of plegias?

A

hemiparesis
hemiplegia
paraplegia
quadriplegia

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27
Q

what is a parapleegia? Quadirplegia?

A

paraplegia- both legs paralyzed

Quadriplegia- all four limbs paralyzed (often spinal cord injury)

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28
Q

What are the primary modalities that you check for sensory exam?

A 
pain (spinal)
Temp (spinal)
Proprioception (position) (Dorsal)
vibration (Dorsal)
light touch
*Distcriminateive sensation
29
Q

How do you assess pain

A

sharp object

30
Q

how do you assess temp

A

cool side of tunign fork

31
Q

Howdo ou assess postion/proprioception

A

moving digit

32
Q

How d oyu assess vibration

A

128 Hz tunign fork

33
Q

How do you assess light touch

A

cotton swab or fingers

34
Q

What dermatone is T10

A

umbilicas

35
Q

dermatome for T4

A

Nipple

36
Q

Dermatome for C7

A

middle finger

37
Q

Dermatome for L5

A

big toe

38
Q

what is a dermatome

A

band of skin innervated by sensory root of a single spinal nerve

39
Q

What is a reflex?

A

involuntary stereoteypical repsonse

Predictable reaction to standardized stimulus

40
Q

What are the three types of reflexes

A

DTR- deep tendon reflex

Cutaneious stimulous reflexes

Primitive reflexes (beydong tis class)

41
Q

Describe DTR

A

Deep Tendon Reflex

simplest of relfexes- monosynaptic, strike tendon with reflex hammer
Strike tendo

42
Q

What are the DTR (5)

A 
S1- Achilles
L 2,3,4- Patellar
C5,6- Brachioradialis
C5,6- Biceps
C7- Triceps
43
Q

What is the grading for DTR

A

0-4+

0 = no response
1+ somewhat diminished, low normal
2+ average; noraml
3+ Brisker than avg (possibly, but not necessarily indicative of disease)
4+ Very brisk, hyperactive with Clonus
44
Q

What is normal grading for DTR

A

2+

45
Q

What is clonus

A

sustained rhythmic beating between flexion and extension

46
Q

What are the superficial Cutaneous reflexes (4)

A 
Abdominal Reflexes (T8-T12)
Cremasteric Reflex (L1-L2)
Babinski Reflex/ extensor plantar response (L5, S1)
Anal REflex (S2-S4)
47
Q

Abdominal Reflex

A

T8-T12

polysynaptic, more complicated

Strok outer quadrant, umbilicus mucles pulltoward stimulated area
May not respond (pregnant, surgery),

48
Q

Cremasteric Reflex

A

L1-L2

stroke inner thigh and testes raises

49
Q

Babsinki Response

A

L5,S1

Extensor platnar reposne

Normal: great toe plantarflex
Abnormal” Great toe dorsiflex, toes fan
Upper motor neuron defet! Stroke lateral aspect of foot; then cross-
babies hav+ Babinski till 6 months

50
Q

Superficial Cutaneous Grading

A

Not graded!

Either present or absent!

Asymmetry is important to note

UMN or LMN lesion

51
Q

What does Coordination require integration of fucntion of

A
  1. Cerebellarsystem (rhythmic, smooth, sequential movment)
  2. Motor System
    3 Vestibular System: balance and coordinating eye
  3. Sensory system : position sense
52
Q

How do you test Coordination

A

1 Rapid Alternating Movements (RAM)

  1. Point to point movements
  2. Gait
  3. Stance
53
Q

Cerebellar system

A

rhtymic, smooth, sequential movment and steady psoture

54
Q

Motor system

A

strength

55
Q

Vestibular system

A

balance and coordinating eye, head, body movements

56
Q

sensory system

A

position sense

57
Q

How do you test RAM coordination

A

Rapid Alternating Motion

Upper Extremity- Hands alternate palm and dorsum of hand on the thigh rapidly

Lower extremity- Tap foot against examiners hand

Dysdidiadochokinesis

58
Q

What is Dysdiadochokinesis

A

slow, irregular, slumspy movements in response to attempt to alternately contract and relax agonist and antagonist muscles or muscle groups
Slow, irregular; lack of coordination

Can’t do RAM

59
Q

Coordination : Point to Point

A

Finger-to-nose (F–> N)

Heel to shin (H–>S)

Dymetria

60
Q

What is Dysmetria

A

difficulty with F–>N and H–>S (Point to Point)

inability to control muscle action required to move a body part smothly in a specific direaction or along aaprticular course

61
Q

What is ataxia

A

lack of muscle coordinatino during voluntary movement

usually gait; but any voluntary movmvent

62
Q

What is gait

A

process of recruiting and coordinating activity of various mucle groups of LE, UE, andn trunk to rpoduce at of walking

63
Q

How do you test gait?

A

Normal gait across room

Tandem gait (drunk test)

Walk on toes; walk on heels

64
Q

How do you test stance/station

A

measure of postural control

observe patietn standing

Romberg tst

Pronatory drift

65
Q

What is romberg test

A

tests mainly for posiition sese

take aw ay vision, stay in one place with eyes closed

66
Q

Pronator drift

A

detects subtle weakness (cerebellar disease)

arms out with eyes closed

if weakness in one arm, might drop/ pronate

67
Q

What is the neurologic ROS

A

chagnes in mood, attention, or speech; changes in orientation, memory, insight, or judgemnt;

headache, dizziness, vergito; fainting, balckouts, seizures, weakness, paralysis, numbess of loss of snestiano, tingling or pins and needles’ termors or othe ronvlntary movments seizsures

68
Q

What is the neurologic ROS

A

chagnes in mood, attention, or speech; changes in orientation, memory, insight, or judgemnt;

headache, dizziness, vergito; fainting, balckouts, seizures, weakness, paralysis, numbess of loss of snestiano, tingling or pins and needles’ termors or othe ronvlntary movments seizsures

ECR 2012 (16 decks)

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