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SAM I > INT - Neurological examination > Flashcards

INT - Neurological examination Flashcards

1
Q

NEUROLOGICAL EXAMINATION:

A
  • Ask
  • Watch
  • Touch
  • Pain
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2
Q

WATCH:

• Inspection (without move)

A

◦body posture
◦head position
◦eye position, -movement
◦consciousness

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3
Q

WATCH:

• Inspection (on move)

A

◦walk
◦turn
◦sit-stand

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4
Q

TOUCH:

A
  • palpation (symmetry, muscle atrophy, crepitation, fracture)
  • postural reactions, spinal reflexes
  • cranial nerves
  • sensitivity of the skin and mucous membranes
  • manipulation
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5
Q

PAIN:

A

• Pain sensation
◦superfitial
◦deep pain

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6
Q

DISEASE PROCESSES:

A

DAMNITV

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7
Q

DISEASE PROCESSES:

What is DAMNITV

A

D. Degenerative eg lipofuscinosis - difficult to diagnose
A. Anomalous eg hydrocephalus
M. Metabolic eg hepatic encephalopathy
N. Neoplastic eg tumor
I. Inflammatory eg steroid-responsive meningitis-arteritis
I. Infectious eg bacterial, viral
I. Idiopathic eg idiopathic vestibular syndrome
T. Toxic eg ethylene glycol toxicity
V. Vascular eg ischemia, bleeding

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8
Q

PHYSICAL EXAMINATION - HEAD/SKULL

A
  • Shape (symmetrical - asymmetrical changes)
  • Mobility
  • Ears (drooping or pointing
  • Signs of pain by palpation
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9
Q

MENTAL STATE - INAPPROPRIATE MENTAL FUNCTION

• Reduced:

A

◦Depressed, obtunded, dull, blunt, indolent: lowering or decrease of functional activity
◦Somnolentia: drowsiness
◦Delirium: mental disturbance (hallucinations, illusions, restlesness, incoherence)
◦Dementia: organic loss of intellectual function

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10
Q

MENTAL STATE - INAPPROPRIATE MENTAL FUNCTION

• Increased:

A

◦Exitatio: excitement
◦Aggressive: attacking
◦Furor: rage

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11
Q

OTHER FORMS OF CONVULSIONS NOT NECESSARILY CONNECTED TO CNS

A
  • Tetanus: sustained tonic contraction of muscles without twitching
  • Tetany: violent muscle twitching over the whole body
  • Tremor: regular, rhythmic trembling (oscillation) of muscles
  • Tic: repetitive contractions of one muscle
  • Myoclonus: rhythmic contraction of one muscle group
  • Fibrillation: uncoordinated twitching of individual muscle fibres
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12
Q

EXAMINATION OF PROPRIOCEPTION: POSTURAL REACTIONS

A 
• Wheelbarrowing test
• Hopping tests
       ◦On one leg
       ◦Hemihopping
• Knuckling-over test
• Placing reactions
       ◦Tactile
        ◦Visual
• Extensor postural thrust reaction
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13
Q

ATAXIA

• Classification by

A 
• Classification by signs:
• Classification by anatomical origin:
◦Cortical:
◦Cerebellar:
◦Vestibular:
◦Spinal (proprioceptive):
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14
Q

ATAXIA

• Classification by signs:

A

◦Static: signs in standing position (as well)
◦Locomotive: signs during movement only
◦Intentional: tremor of the head when fine adjustment is demanded

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15
Q

ATAXIA

• Classification by anatomical origin:

A

◦Cortical:
‣ circling, lateral head turn, behavior changes, altered mental state

◦Cerebellar:
‣ wide-based stance, dysmetria-hypermetria, (nystagmus)

◦Vestibular:
‣ ipsilateral head tilt leans to the affected side, nystagmus

◦Spinal (proprioceptive):
‣ paresis/paralysis (muscle weakness) frequent
‣ Hindlimbs are always affected

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16
Q

PARESIS, PARALYSIS/PLEGIA:

• Diagnostic methods

A 
◦Inspection
◦Palpation
◦Evaluation of muscle tone
◦Atony
◦Hypotony (reduced muscular tone
◦Hypertony (increased muscular tone)
17
Q

CLASSIFICATION OF PARALYSIS:

• by

A
  • by severity
  • by affected limbs
  • by muscle tone
  • by origin, related to neuron nucleus
18
Q

CLASSIFICATION OF PARALYSIS:

• by severity

A 
◦paresis = partial loss of strength
◦paralysis/plegia = complete loss of strength
19
Q

CLASSIFICATION OF PARALYSIS:

• by affected limbs

A

◦monoparalysis (-plegia, -paresis): one limb
◦tetraparalysis (-plegia, -paresis): all limbs
◦paraparalysis (-plegia, -paresis): rear/hind limbs
◦hemiparalysis (-plegia, -paresis): ipsilateral limbs

20
Q

CLASSIFICATION OF PARALYSIS:

• by muscle tone

A

◦spastic, rigid

◦atonic, flaccid

21
Q

CLASSIFICATION OF PARALYSIS:

• by origin, related to neuron nucleus

A

◦UMN (upper motor neuron): above the nucleus

◦LMN (lower motor neuron): in or below the nucleus

22
Q 
EXAMINATION OF CRANIAL NERVES:
#1
A

N. Olfactorius I - Smelling
• Patho:
Hyposomia (partial loss) & Anosomia (complete loss of smell)
• Tests: Use strong stimuli objects/materials
• EXCLUDE VISION (avoid to stimulate Opticus) & DON’T IRRITATE NASAL MUCOSA (which stimulates Trigeminus)

23
Q 
EXAMINATION OF CRANIAL NERVES:
#2
A

N. Opticus II - Vision
• Patho: Amaurosis (blindness)
• Tests: Falling cotton test, pupillary light reaction direct & indirect (+Occulomotorius), threat/menace
reflex (+Facial)
• AVOID AIR CURRENT (which stimulates Trigeminus) & TOUCHING SENSORY HAIR (which
stimulates Trigeminus)

24
Q 
EXAMINATION OF CRANIAL NERVES:
#3
A

N. Occulomotorius III - Pupils constriction
• Patho: Anisocoria (uneven size of pupils), Mydriasis (dilatation), Miosis (constriction)
• Horner’s syndrome: Loss of sympathetic innervation
◦Ipsilateral miosis (on affected side),
◦Ipsilateral ptosis (upper eyelid slagging down slightly
◦Enophtalmus (sunken eye)
◦Prolapse of 3rd eyelid

25
Q

Examination of position & movement of eyeballs:

A

N. Occulomotorius, N. Trochlearis, N. Abducens
• Patho:

• 1) Spontaneous Nystagmus (horizontal, vertical, rotatory).
◦Can be physiological/provoked when moving the head manually: Involuntary eye movements
(+Vestibulochoclearis)

• 2) Strabism (abnormal position of eyeballs, not parallel with each other)
◦Strabismus divergens - Ventrolateralis - N. Occulomotorius paralysis
◦Strabismus medioventralis - N. trochlearis paralysis
◦Strabismus convergens - Medialis - N. Abduscens paralysis

26
Q 
EXAMINATION OF CRANIAL NERVES:
#5
A

N. Trigeminus V - Sensory & motor function

  • Sensory = Feeling of face, Palpebral reflex (+Facial), Corneal reflex (+Facial)
  • Motor = Prehension of food, drinking & chewing via innervation of m. Temporalis and m. Masseter

• Patho: Paralysis (sagging of lower jaw), Tic (repeated contractions of chewing muscles eg
distemper), Trismus (Tonic spasm of chewing muscles eg tetanus)

  • Tests: Corneal reflex, palpebral reflex (lateral and medial canthus)
  • TRY TO STAY OUTSIDE OF VISION FIELD to not induce threat reflex.
27
Q 
EXAMINATION OF CRANIAL NERVES:
#7
A

N. facialis VII -
Mainly motor nerve, with Gustatory sensory function of 2/3 rostral tongue.

Responsible for:
• Threat reflex (+Opticus)
• Palpebral reflex (+Trigeminus)
• Corneal reflex (+Trigeminus).

Patho: Paralysis (uni or bilateral)

Diagnostic:
• Nasal plane will be drawn toward the healthy side in unilateral paralysis
• Sagging of upper eyelid: Ptosis
• Sagging of lip
• Sagging of ears (central damage)

Tests: Try to gently touch the nasal plate, the ears’hair, and observe symmetry

28
Q 
EXAMINATION OF CRANIAL NERVES:
#8
A

N. Vestibulocochlearis VII
- Hearing & balance

1) Pars cochlearis - Hearing

Patho: Anacusis (deafness) which can be congenital or acquired

Tests : Calling, clapping outside of vision field
• AVOID TO STIMULATE N.OPTICUS

2) Pars staticus - Vestibular division

Patho: Vestibular syndrome

Diagnostic: Ipsilateral head tilt, leaning and falling, nystagmus (mostly horizontal) toward side of lesion

29
Q 
EXAMINATION OF CRANIAL NERVES:
#9
A

N. Glossopharyngeus IX (sensory) & N. Vagus X (motor) - Innervation of larynx & pharynx & 1/3
caudal tongue
Patho: Swallowing problem causing Dysphagia,
Tests: Swallowing reflex is tested with water or feed, touching the base of the tongue or external
compression of throat

30
Q 
EXAMINATION OF CRANIAL NERVES:
#11
A

N. Accessorius XI - Motor nerve of trapesius, sternocephalicus, brachiocephalicus
Patho: Paralysis & sagging of head, atrophy of muscles on neck & shoulder

31
Q 
EXAMINATION OF CRANIAL NERVES:
#12
A

N. Hypoglossus XII
- Tongue protruding & retracting

Patho: Paralysis of the tongue, bilateral (diagnosed by prolapse of the tongue) or unilateral (tongue is
deviated)

Tests: Check tongue protrusion and withdrawal after swallowing & check the strength of retraction after
grasping it.

32
Q

EXAMINATION OF SPINAL REFLEXES

Evaluation of a reflex

A 
0 = areflexia
1 = hyporeflexia
2 = normoreflexia
3 = hyperreflexia
4 = hyperreflexia with clonus: series of rapid contractions of a muscle in response to a single stimulus
33
Q

EXAMINATION OF SPINAL REFLEXES

Abnormal reflexes

A

• reflex irradiation:
◦a reflex elicited in a larger area / muscle group than expected

• contralateral (crossed) reflex:
◦a reflex elicited in response to a stimulus applied to the other side of the body

34
Q

EXAMINATION OF PAIN PERCEPTION:

SUPERFICIAL PAIN

A
  • Skin (mucous membrane)
  • Pain provoking percussion
  • Normal response
  • Pathway: receptor - spinal ganglion – thalamus - cortex
  • Evaluation:
35
Q

EXAMINATION OF PAIN PERCEPTION:
SUPERFICIAL PAIN
• Skin (mucous membrane)

A

◦Pinching with hemostat

◦Pricking with needle

36
Q

EXAMINATION OF PAIN PERCEPTION:
SUPERFICIAL PAIN
• Normal response

A

◦skin twitch, leg withdrawal
‣ = spinal reflex (panniculus and flexor)
◦Behavioral: crying, biting, turning to direction of pain
‣ = conscious pain perception

37
Q

EXAMINATION OF PAIN PERCEPTION:
SUPERFICIAL PAIN
• Evaluation:

A

◦normaesthesia
◦hyperaesthesia
◦anaesthesia
◦paraesthesia

SAM I (5 decks)

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