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N&SS - Neuro & Stroke > Examinations and Investigations in Neurology > Flashcards

Examinations and Investigations in Neurology Flashcards

1
Q

What neurophysiological studies can we do?

A 
EEG
Nerve conduction studies
Electromyography
Visual evoked responses
Small fibre studies
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2
Q

What are the elements of a neurological examination?

A

Cranial Nerves
Appearance of limbs, power, tone, reflexes, sensation (pinprick, light touch, vibration, and proprioception), co-ordination, and gait.
Cerebellar examination
Cognitive function

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3
Q

Talk me through cranial nerve examination.

Assume you have already introduced yourself and obtained consent

A

First ask if any changes in smell or taste - CN I and VII/IX
Visual assessment - visual fields, visual acuity, eye movements, pupil reactivity (direct and consensual), and accommodation. Fundoscopy if indicated. CN II, III, IV, and VI
Sensation on the face - bilaterally in ophthalmic, maxillary, and mandibular regions of CN V. Also ask pt to clench jaw (musclesof mastication) - CN V
Facial expression - ask pt to raise eyebrows, scrunch eyes against resistance, smile, stick out tongue. CN VII
Hearing and balance assessment - whisper testing, then Rinne’s and Weber’s tests with 256 Hz tuning fork. CN VIII
Ask pt to swallow. CN IX and X
Ask pt to shrug against resistance, and twist head against resistance. CN XI
Ask pt to push tongue into side of mouth (against resistance), and inspect for deviation within the mouth. CN XII.

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4
Q

What do we look for on general examination of a pt in a neurological examination?

A 
Posture
Gait
Obvious muscle wasting
Facial asymmetry
Abnormal movements e.g. tremor
Fasciculations
Monitoring
Treatment
Paraphernalia
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5
Q

Describe how you would assess power in the upper limbs.

A

Ask pt to do high chicken wings and resist you 1) pushing down and 2) pushing up.

Ask pt to do boxing stance and resist you 1) pulling forearms and 2) pushing forearms

Ask pt to make a fist then resist 1) pushing up 2) pushing down, and then grip your fingers.

Ask pt to hold out hand and resist fingers being 1) pushed down 2) pushed up

Ask pt to open fingers while you resist them.

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6
Q

Describe how you would assess power in the lower limbs.

A

Ask pt to raise leg straight and resist pressing up and down on thigh.

Bend knees and ask them to resist pushing on shin and then pulling calf.

Ask pt to resist pulling toes up and pushing toes down against resistance.

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7
Q

How do you assess tone in the limbs?

A

Ask pt to relax limb completely and move each section individually and slowly.

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8
Q

How do you test for clonus in the ankles, and what does that actually mean?

A

Hold calf and foot with relaxed lower limb. Suddenly dorsiflex foot and hold for a few seconds to see if there are jerks of the foot.

Tests for increased tone in the limb.

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9
Q

What is fasciculation, and what is it a sign of?

A

A brief spontaneous contraction affecting a small number of muscle fibres, often causing a flicker of movement under the skin.

LMN sign

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10
Q

On examination of a pt with neurological signs, you ask them to stand up, walk away from you, turn around and walk back.

What signs might you elicit from this assessment?

A
  • Slow to stand and initiate - PD
  • Loss of arm swing - PD
  • Festinating gait - PD
  • Scissoring (involuntary leg crossing) - spasticity i.e. UMN lesion
  • Waddling gait - proximal muscle weakness
  • Foot drop
  • Heel to toe walk - ataxia
  • Romberg’s sign
  • Trendelenberg gait
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11
Q

Which nerve roots is hip flexion testing?

A

L1 L2

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12
Q

Which muscle is hip flexion testing?

A

Iliopsoas

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13
Q

Which nerve is hip flexion testing?

A

Femoral

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14
Q

Which nerve roots is hip extension testing?

A

L5, S1

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15
Q

Which muscle is hip extension testing?

A

Gluteus maximus

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16
Q

Which nerve is hip extension testing?

A

Inferior gluteal

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17
Q

Which nerve roots is knee extension testing?

A

L3 L4

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18
Q

Which nerve roots is knee flexion testing?

A

S1

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19
Q

Which nerve roots is ankle dorsiflexion testing?

A

L4

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20
Q

Which nerve roots is ankle plantarflexion testing?

A

S1 S2

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21
Q

Which nerve roots is extension of the big toe testing?

A

L5

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22
Q

Which muscle is knee extension testing?

A

Quadriceps

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23
Q

Which muscle is knee flexion testing?

A

Hamstrings (semitendinosus, semimembranosus, biceps femoris)

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24
Q

Which muscle is ankle dorsiflexion testing?

A

Tibialis anterior

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25
Q

Which muscle is ankle plantarflexion testing?

A

Gastrocnemius

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26
Q

Which muscle is extension of the big toe testing?

A

Extensor hallucis longus

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27
Q

Which nerve is knee extension testing?

A

Femoral

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28
Q

Which nerve is knee flexion testing?

A

Sciatic

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29
Q

Which nerve is ankle dorsiflexion testing?

A

Deep peroneal nerve (deep fibular)

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30
Q

Which nerve is ankle plantarflexion testing?

A

Tibial nerve

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31
Q

Which nerve is extension of the big toe testing?

A

Deep peroneal nerve (deep fibular)

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32
Q

What are the patterns of muscle weakness that are important to establish?

A
  • Proximal vs distal

- Unilateral vs bilateral

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33
Q

Which nerve roots are tested by the tendon reflex of the knee?

A

L3, L4

34
Q

Which nerve roots are tested by the tendon reflex of the ankle?

A

S1, S2

35
Q

What results can we get from testing the plantar reflex?

A

Extensor - UMN leison
Flexor - normal
Absent

36
Q

Which nerve roots are tested by the plantar reflex?

A

S1

37
Q

Which part of the muscle do you look at when testing a reflex?

A

The muscle belly

38
Q

How does sensation testing differ to power testing in terms of technique?

A

You go from distal to proximal in sensation, but proximal to distal in power

39
Q

A pt has reduced sensation to vibrations and light touch.

Which tract is responsible for these sensory modalities?

A

The ipsilateral dorsal columns

40
Q

A pt has reduced sensation to pain and temperature.

Which tract is responsible for these sensory modalities?

A

The contralateral spinothalamic pathway

41
Q

What are the patterns of sensory loss that are tested for?

A

Dermatomal

Glove and stocking

42
Q

What is 0 on the MRC power scale?

A

No movement

43
Q

What is 1 on the MRC power scale?

A

Flicker of movement

44
Q

What is 2 on the MRC power scale?

A

Movement with gravity but not against

45
Q

What is 3 on the MRC power scale?

A

Movement against gravity but not resistance

46
Q

What is 4 on the MRC power scale?

A

Reduced power against resistance

47
Q

What is 5 on the MRC power scale?

A

Normal power against resistance

48
Q

What kinds of tremors might we observe in a neurology pt?

A
  • Pill-rolling resting tremor (PD)

- Intention tremor (cerebellar)

49
Q

You ask the pt to close their eyes and hold out their hands with the palms upwards.

What sign are you testing for, and which condition does it indicate?

A

Pronator drift.

UMN lesion on contralateral side.

50
Q

What equipment is needed for a FULL neurological examination?

A 
Tendon hammer
Neurotip
Cotton wool
Tuning fork
Light
51
Q

If a reflex is difficult to elicit from a patient, what trick can be used?

A

Get the pt to perform a reinforcement manoeuvre

52
Q

What reinforcement manoeuvres can be used?

A

Upper limb ex - ask pt to clench teeth together

Lower limb ex - ask pt to clasp hands together and pull

53
Q

Which nerve roots are tested by the tendon reflex of the biceps?

A

C5, C6

54
Q

Which nerve roots are tested by the tendon reflex of the triceps?

A

C7

55
Q

Which nerve roots are tested by the tendon reflex of the supinator?

A

C6

56
Q

Where do we test the relfexes of the arm?

A

Biceps - antecubital fossa
Triceps - triceps tendon on posterior arm with arm at 90 degrees flexion
Supinaotr - 4 inches proximal to base of thumb

57
Q

Where can we demonstrate sensation testing on the patient?

A

On the sternum

58
Q

What is it important to do when testing tone of each limb?

A

Isolate each joint in turn

59
Q

Which muscle is shoulder abduction testing?

A

Deltoid

60
Q

Which muscle is elbow flexion testing?

A

biceps

61
Q

Which muscle is elbow extension testing?

A

Triceps

62
Q

Which muscle is wrist flexion testing?

A

Flexor carpi radialis and ulnaris

63
Q

Which muscle is wrist extension testing?

A

Extensor carpi radialis and ulnaris

64
Q

Which muscle is finger abduction testing?

A

dorsal interossei

abductor digiti minimi

65
Q

Which muscle is thumb abduction testing?

A

abductor pollicis brevis

66
Q

Which nerve root and nerve is shoulder abduction testing?

A

C5

Axillary

67
Q

Which nerve root and nerve is elbow flexion testing?

A

C5, C6

Musculocutaenous

68
Q

Which nerve root and nerve is elbow extension testing?

A

C7

Radial

69
Q

Which nerve root and nerve is wrist flexion testing?

A

C8

Median and ulnar

70
Q

Which nerve root and nerve is wrist extension testing?

A

C7

Radial

71
Q

Which nerve root and nerve is finger abduction testing?

A

T1

Ulnar

72
Q

Which nerve root and nerve is thumb abduction testing?

A

C8

Median

73
Q

You examine a pt with Parkinson’s. What signs might you see on the head and neck?

A

Reduced facial expression
Monotonous speech
Hypophonic
Anosmia

74
Q

What is the difference between spasticity and rigidity?

A

Rigidity is a constant opposition to passive movement.

Spasticity is velocity dependant - initial strong opposition then free movement for that one movement.

75
Q

You examine a pt with Parkinson’s. What upper limb signs might you expect?

A 
Increased tone
Rigidity - cog-wheel
Pill-rolling resting tremor
Small handwriting
Reduced dexterity in the hand
76
Q

What are the key elements of a cerebellar examination?

A 
D ysdiadochokinesia
A taxia
N ystagmus
I ntention tremor
S peech (slurred, staccato)
H eel to toe test
77
Q

What is dysdiadochokinesia?

A

An inability to perform this rapidly alternating movements

78
Q

What is ataxia?

A

Co-ordination, gait and posture abnormalities

79
Q

What is nystagmus?

A

Involuntary movement of the eye, usually in horizontal plane.

80
Q

What is an intention tremor?

A

A sign of inco-ordination and cerebellar ataxia characterised by a terminal tremor that occurs as the finger approaches the target

81
Q

When can an intention tremor be demonstrated?

What can this test also show?

A

Finger to nose test

Past pointing.

N&SS - Neuro & Stroke (10 decks)

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