Exam 4: Neuro Exam

Question 1

What is a two engine gait?

Answer 1

Short choppy gain in thoracic limbs with a long stride gate in the pelvic limbs

Question 2

What is an ataxic gait?

Answer 2

Incoordination
Proprioceptive: does not know where limbs are in space
Vestibular: Loss of balance, head tilt, drifting, falling to one side
Cerebellar: Uncontrollable limb movements

Question 3

What is a recumbent gait?

Answer 3

Lying on one side, not able to rise

Question 4

What is an ambulatory gait?

Answer 4

Walking

Question 5

What is a non-ambulatory gait?

Answer 5

Not walking

Question 6

What is kyphotic posture?

Answer 6

Outward curvature of the spine, hunched back

Question 7

What is lordosis?

Answer 7

Inward curvature of the spine

Question 8

What is scoliosis?

Answer 8

Lateral curvature of the spine

Question 9

How do you check CN 1?

Answer 9

Wave a noxious stimuli in front of patient

Question 10

How do you check CN 2?

Answer 10

Menace response: cover one eye while moving hand towards eye without creating a gust of wind or touching whiskers and checking for blinking
Following response: cover one eye while throwing cotton ball across field of open eye and making sure they follow

Question 11

How do you check CN 3?

Answer 11

Eye position: check for eye symmetry while looking at patient head on
Pupillary light reflex: Shining transilluminator into one eye, pupil should constrict (direct). Quickly glance into opposite eye to check for constriction (consensual)

Question 12

How do you check CN 4?

Answer 12

Make sure eyes are not deviated laterally

Question 13

How do you check CN 5?

Answer 13

Sensory: cover eye and touch the inside of each nostril
Motor: check for symmetry of muscles of mastication and that patient can hold mouth closed

Question 14

How do you check CN 6?

Answer 14

Take a soft cotton ball into a point and gently touch the eye ball. Eyeball should retract

Question 15

How do you check CN 7?

Answer 15

Palpebral reflex: gently touch medial and lateral canthus to fully close eye

Question 16

How do you check CN 8?

Answer 16

Hearing: make a loud noise
Nystagmus:
–Physiologic- slowly turn patient’s head and eyes should track/follow
–Spontaneous- look head on to se if eyes are continuously moving
–Induced- check if eyes continue to click or track

Question 17

How do you check CN 9 and 10?

Answer 17

Gag reflex

Question 18

How do you check CN 11?

Answer 18

Check for symmetry of cervical muscles and make sure there is not torticollis (head turn)

Question 19

How do you check CN 12?

Answer 19

Check tongue movement after gag reflex

Question 20

What is Horner’s syndrome?

Answer 20

Lack of sympathetic input to the eye

Question 21

Describe localization/syndrome in the cerebrum

Answer 21

Circling to side of lesion, normal gait with contralateral postural reaction deficits, mental status change, seizures

Question 22

Describe localization/syndrome in the diencephalon

Answer 22

Can look more cerebral or more midbrain

Question 23

Describe localization/syndrome in the midbrain

Answer 23

CN 3 and 4 deficits, decreased mental status, contralateral postural reaction deficits

Question 24

Describe localization/syndrome in the pons/medulla

Answer 24

CN 5-12 deficits, decreased mental status, ipsilateral postural reaction deficits

Question 25

Describe localization/syndrome in the cerebellum

Answer 25

Cerebellar ataxia, intention tremors, hypermetria

Question 26

Describe cervical localization/syndrome

Answer 26

C1-5 UMN to all 4 limbs UMN bladder

Question 27

Describe cervicothoracic localization/syndrome

Answer 27

C6-T2 LMN forelimbs UMN hindlimbs UMN bladder

Question 28

Describe thoracolumbar localization/syndrome

Answer 28

T3-L3 Normal forelimbs UMN hindlimbs UMN bladder

Question 29

Describe lumbosacral localization/syndrome

Answer 29

L4-S3: normal forelimbs, LMN hindlimbs and bladder L4-S1: Normal forelimbs, LMN hindlimb, UMN bladder S1-3: Normal limbs, LMN bladder

Question 30

Describe neuromuscular localization/syndrome

Answer 30

Neuropathy, junctionopathy, myopathy | LMN to all 4 limbs

Question 31

Describe multi localization/syndrome

Answer 31

Multifocal

Question 32

Describe cardiovascular localization/syndrome

Answer 32

Heart disease leading up to syncope, aortic thromboembolism

Question 33

Describe orthopedic localization/syndrome

Answer 33

Bilateral stifle disease can look like spinal lesion

Question 34

Describe T3-L3 lesion

Answer 34

UMN hindlimbs: increased reflexes and tone muscles | UMN bladder: difficult to express

Question 35

Describe L4-S1 lesion

Answer 35

Femoral L4-5: extends stifle, patella reflex, flex hip Sciatic L6, L7, S1: Extends hock, GST reflex, flex stifle LMN hindlimbs UMN bladder

Question 36

Describe S1-3 lesion

Answer 36

Pelvic nerve: PSANS bladder/colon Pudendal: Somatic motor and sensory to anal sphincter and EUS Normal limbs LMN bladder

Question 37

Describe C1-5 lesion

Answer 37

White matter to all 4 limbs UMN to all 4 limbs: increased reflexes and tone UMN bladder

Question 38

Describe C6-T2 lesion

Answer 38

Gray matter brachial plexus LMN forelimbs: decrease reflexes and tone White matter hindlimbs UMN hindlimbs: increased reflexes and tone Two engine gait UMN bladder