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Clinical Medicine > Exam #5: Neurologic Exam > Flashcards

Exam #5: Neurologic Exam Flashcards

1
Q

Why do you preform a neurological examination?

A

1) Exam of patients w/ sx suggestive or neuro problem
2) Screening for at risk individuals
3) Baseline

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2
Q

What are the special senses?

A
  • Vision (the eye)
  • Hearing and balance (the ear, which includes the auditory system and vestibular system)
  • Smell (the nose)
  • Taste (the tongue)
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3
Q

What are the naming conventions in the spinal cord?

A

Origin–terminus

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4
Q

List the 12 cranial nerves.

A 
I= Olfactory 
II= Optic 
III= Oculomotor 
IV= Trochlear
V= Trigeminal 
VI= Abducens 
VII= Facial 
VIII= Vestibulocochlear 
IX= Glossopharyngeal 
X= Vagus 
XI= Accessory 
XII= Hypoglossal
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5
Q

What are the abnormal levels of consciousness?

A 
Confusion
Lethargy 
Obtundant 
Stupor 
Coma
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6
Q

What are the two rating scales for level of consciousness?

A

AVPU

GCS

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7
Q

What does AVPU stand for?

A 
A= Alert 
V= response to verbal
P= response to pain
U= unresponsive
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8
Q

What are the three major responses used to determine a GCS score?

A

1) Eye opening
2) Best motor response
3) Best verbal response

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9
Q

What are the numbers associated with GCS? What are the highest & lowest scores on the GCS?

A

Eye opening= 1-4
Best motor= 1-6
Best verbal= 1-5

15= highest 
3= lowest
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10
Q

What is the Mini-Mental Status exam used for?

A

Determining if a patient is demented

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11
Q

What is the mini-cog test for?

A

Alzheimer’s & Dementia

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12
Q

What are praxis-type tasks?

A

Knowing how to use objects e.g. phone, hammer, comb…etc.

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13
Q

How do you test CN I?

A

Have the patient smell something non-irritating

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14
Q

How do you test CN II?

A
  • Visual acuity
  • Fundoscopic exam
  • Visual fields–confrontation testing
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15
Q

What does the confrontation test evaluate?

A

Visual fields i.e. peripheral vision

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16
Q

What three cranial nerves control the movement of the eye?

A

III, IV, & VI

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17
Q

What cranial nerve control the pupillary response?

A

CN III

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18
Q

What does PERRLA stand for?

A 
Pupils 
Equal 
Round 
Reactive 
Light 
Accomodation
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19
Q

How is PERRLA tested?

A

Swinging flashlight test

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20
Q

How is CN V tested?

A

Sensory

  • Corneal reflex w/ q-tip
  • Fascial sensation to light touch

Motor=
- chewing

**Note that CN V does NOT control smiling

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21
Q

What CN controls smiling?

A

CN VII

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22
Q

What does CN VII provide sensation to?

A

Taste to anterior 2/3 of tongue & soft palate

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23
Q

How do you tell the difference between a CVA & Bell’s Palsy?

A

Bell’s Palsy= cannot raise eyebrow on affected side

CVA= will be able to raise eyebrow on affected side

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24
Q

What is the Dix-Hallpike maneuver?

A

Abrupt lowering of patient from seated position

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25
Q

How do you test CN IX?

A

Gag reflex

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26
Q

How do you test CN X?

A

Gag reflex

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27
Q

Hoarseness is associated with injury to what cranial nerve?

A

CN IX & X

28
Q

How is CN XI tested?

A

Shrug shoulders

Rotation of the head

29
Q

What is the difference between CN XI injury & central lesion leading to weakness in the trapezius/ SCM?

A

CN XI= same

Central=

  • Same trap
  • Opposite SCM
30
Q

How do you test CN XII?

A

Protrusion of the tongue

31
Q

How does protrusion of the tongue differ with peripheral & central lesions?

A 
Central= same
Peripheral= opposite
32
Q

What is the difference between paresis, plegia, and paralysis?

A 
Paresis= weakness 
Plegia= severe weakness but NOT total loss 
Paralysis= total loss
33
Q

What are the general differences between UMN & LMN injury?

A 
Upper= hypertonia
Lower= hypotonia
34
Q

What nerve roots are tested by the biceps reflex?

A

C5-6

35
Q

What nerve roots are tested by the triceps reflex?

A

C6-7

36
Q

What nerve roots are tested by the brachioradialis reflex?

A

C5-C6

37
Q

What nerve roots are tested by the patellar reflex?

A

L3-4

38
Q

What nerve roots are tested by the achilles reflex?

A

S1

39
Q

What is the expected finding for babinski?

A

Downward

40
Q

What is a positive finding in a babinski?

A

Upward

41
Q

How are reflexes graded?

A 
0= absent 
1= reduced 
2= normal
3= increased 
4= clonus
42
Q

What is clonus?

A

Rhythmic series of muscle contractions induced by stretching of the tendon

43
Q

What are the primary sensory modalities?

A

DC/ML

  • Proprioception
  • Vibration

Spinothalamic

  • Light touch
  • Pain
  • Temperature
44
Q

What pathway is effected by a Vitamin B12 deficiency?

A

DC/ML

45
Q

When examining the sensation of a patient where should you start?

A

Distally and work proximally

46
Q

How can you distract superficial pain?

A

Superficial touch e.g. for wart removal, scratch child while liquid nitrogen is being applied

47
Q

How do you test a patient’s “graphesthesia?” Is this is primary or secondary sense?

A
  • Eyes closed, draw a letter or number in the patient’s palm

- Secondary

48
Q

Where is the lesion if a patient has impaired graphesthesia?

A
  • DC/ML

- Sensory cortex

49
Q

What is sterognosis? Is this is primary or secondary sense?

A
  • Ability to recognize a familiar object in hand with eyes closed
  • Secondary
50
Q

Where is the lesion if a patient has impaired sterognosis?

A
  • DC/ML

- Sensory cortex

51
Q

Where is the lesion if a patient has impaired two-point discrimination?

A

DC/ML

52
Q

How many sites should a patient be able to identify with monofilament testing?

A

7/10

53
Q

If a patient has impaired monofilament testing, what is this indicative of?

A
  • Peripheral neuropathy

- Leprosy/ Hansen’s Disease

54
Q

What is the most likely origin of a resting tremor? What is the most likely etiology of an “intention” tremor?

A 
Resting= basal ganglia 
Intention= cerebellum
55
Q

What is the difference between diadochokinesia & dysdiadochokinesia?

A

Diadochokinesia= normal finger to thumb testing

Dysdiadochokinesia= abnormal finger to thumb testing

56
Q

What is Rhomberg’s Test?

A

NOT a cerebellar test; rather, proprioception

- Fail= DC/ML problem

57
Q

What are the characteristics of the Parkinsonian gait?

A

1) Forward posture
2) Flexed extremities
3) Mini-steps

58
Q

Describe the cerebellar gait (ataxic).

A

1) Broad stance
2) Staggering

*Drunk gait

59
Q

What is an afferent pupillary defect or “Marcus-Gunn” pupil?

A

On performing a swinging light test, light is shined into the normal eye, then damaged eye. This defect is when there is continued dilation of the damaged pupil after shining into the normal eye & indicates a pre-chiasmatic optic pathway lesion.

60
Q

What is agraphia?

A

Inability to express oneself in writing due to a central lesion affecting muscle coordination

61
Q

What is akathasia?

A

Inability to sit down b/c the thought causes severe anxiety

62
Q

What is dysarthria?

A

Inability to pronounce or articulate words

63
Q

What is dysdiadochokinesia?

A

Inability to perform rapid alternating movements

64
Q

What is dysesthesia?

A

Abnormal sensations, such as crawling or pin/needle pricks

65
Q

What is fluent aphasia?

A

Fluent effortless speech with words that are malformed & incomprehensible–impaired language comprehension due to lesion of the posterior left superior temporal gyrus
- “Wernicke’s aphasia”

66
Q

What is myoclonus?

A

Twitching or spasm of a muscle/ group of muscles

67
Q

What is non-fluent aphasia?

A

Patient has severe difficulty expression him/herself but can understand language
- “Broca’s” aphasia

Clinical Medicine (27 decks)

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