Exam #5: Neurologic Exam Flashcards
Why do you preform a neurological examination?
1) Exam of patients w/ sx suggestive or neuro problem
2) Screening for at risk individuals
3) Baseline
What are the special senses?
- Vision (the eye)
- Hearing and balance (the ear, which includes the auditory system and vestibular system)
- Smell (the nose)
- Taste (the tongue)
What are the naming conventions in the spinal cord?
Origin–terminus
List the 12 cranial nerves.
I= Olfactory II= Optic III= Oculomotor IV= Trochlear V= Trigeminal VI= Abducens VII= Facial VIII= Vestibulocochlear IX= Glossopharyngeal X= Vagus XI= Accessory XII= Hypoglossal
What are the abnormal levels of consciousness?
Confusion Lethargy Obtundant Stupor Coma
What are the two rating scales for level of consciousness?
AVPU
GCS
What does AVPU stand for?
A= Alert V= response to verbal P= response to pain U= unresponsive
What are the three major responses used to determine a GCS score?
1) Eye opening
2) Best motor response
3) Best verbal response
What are the numbers associated with GCS? What are the highest & lowest scores on the GCS?
Eye opening= 1-4
Best motor= 1-6
Best verbal= 1-5
15= highest 3= lowest
What is the Mini-Mental Status exam used for?
Determining if a patient is demented
What is the mini-cog test for?
Alzheimer’s & Dementia
What are praxis-type tasks?
Knowing how to use objects e.g. phone, hammer, comb…etc.
How do you test CN I?
Have the patient smell something non-irritating
How do you test CN II?
- Visual acuity
- Fundoscopic exam
- Visual fields–confrontation testing
What does the confrontation test evaluate?
Visual fields i.e. peripheral vision
What three cranial nerves control the movement of the eye?
III, IV, & VI
What cranial nerve control the pupillary response?
CN III
What does PERRLA stand for?
Pupils Equal Round Reactive Light Accomodation
How is PERRLA tested?
Swinging flashlight test
How is CN V tested?
Sensory
- Corneal reflex w/ q-tip
- Fascial sensation to light touch
Motor=
- chewing
**Note that CN V does NOT control smiling
What CN controls smiling?
CN VII
What does CN VII provide sensation to?
Taste to anterior 2/3 of tongue & soft palate
How do you tell the difference between a CVA & Bell’s Palsy?
Bell’s Palsy= cannot raise eyebrow on affected side
CVA= will be able to raise eyebrow on affected side
What is the Dix-Hallpike maneuver?
Abrupt lowering of patient from seated position
How do you test CN IX?
Gag reflex
How do you test CN X?
Gag reflex
Hoarseness is associated with injury to what cranial nerve?
CN IX & X
How is CN XI tested?
Shrug shoulders
Rotation of the head
What is the difference between CN XI injury & central lesion leading to weakness in the trapezius/ SCM?
CN XI= same
Central=
- Same trap
- Opposite SCM
How do you test CN XII?
Protrusion of the tongue
How does protrusion of the tongue differ with peripheral & central lesions?
Central= same Peripheral= opposite
What is the difference between paresis, plegia, and paralysis?
Paresis= weakness Plegia= severe weakness but NOT total loss Paralysis= total loss
What are the general differences between UMN & LMN injury?
Upper= hypertonia Lower= hypotonia
What nerve roots are tested by the biceps reflex?
C5-6
What nerve roots are tested by the triceps reflex?
C6-7
What nerve roots are tested by the brachioradialis reflex?
C5-C6
What nerve roots are tested by the patellar reflex?
L3-4
What nerve roots are tested by the achilles reflex?
S1
What is the expected finding for babinski?
Downward
What is a positive finding in a babinski?
Upward
How are reflexes graded?
0= absent 1= reduced 2= normal 3= increased 4= clonus
What is clonus?
Rhythmic series of muscle contractions induced by stretching of the tendon
What are the primary sensory modalities?
DC/ML
- Proprioception
- Vibration
Spinothalamic
- Light touch
- Pain
- Temperature
What pathway is effected by a Vitamin B12 deficiency?
DC/ML
When examining the sensation of a patient where should you start?
Distally and work proximally
How can you distract superficial pain?
Superficial touch e.g. for wart removal, scratch child while liquid nitrogen is being applied
How do you test a patient’s “graphesthesia?” Is this is primary or secondary sense?
- Eyes closed, draw a letter or number in the patient’s palm
- Secondary
Where is the lesion if a patient has impaired graphesthesia?
- DC/ML
- Sensory cortex
What is sterognosis? Is this is primary or secondary sense?
- Ability to recognize a familiar object in hand with eyes closed
- Secondary
Where is the lesion if a patient has impaired sterognosis?
- DC/ML
- Sensory cortex
Where is the lesion if a patient has impaired two-point discrimination?
DC/ML
How many sites should a patient be able to identify with monofilament testing?
7/10
If a patient has impaired monofilament testing, what is this indicative of?
- Peripheral neuropathy
- Leprosy/ Hansen’s Disease
What is the most likely origin of a resting tremor? What is the most likely etiology of an “intention” tremor?
Resting= basal ganglia Intention= cerebellum
What is the difference between diadochokinesia & dysdiadochokinesia?
Diadochokinesia= normal finger to thumb testing
Dysdiadochokinesia= abnormal finger to thumb testing
What is Rhomberg’s Test?
NOT a cerebellar test; rather, proprioception
- Fail= DC/ML problem
What are the characteristics of the Parkinsonian gait?
1) Forward posture
2) Flexed extremities
3) Mini-steps
Describe the cerebellar gait (ataxic).
1) Broad stance
2) Staggering
*Drunk gait
What is an afferent pupillary defect or “Marcus-Gunn” pupil?
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.
What is agraphia?
Inability to express oneself in writing due to a central lesion affecting muscle coordination
What is akathasia?
Inability to sit down b/c the thought causes severe anxiety
What is dysarthria?
Inability to pronounce or articulate words
What is dysdiadochokinesia?
Inability to perform rapid alternating movements
What is dysesthesia?
Abnormal sensations, such as crawling or pin/needle pricks
What is fluent aphasia?
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”
What is myoclonus?
Twitching or spasm of a muscle/ group of muscles
What is non-fluent aphasia?
Patient has severe difficulty expression him/herself but can understand language
- “Broca’s” aphasia
