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Intro to Physical Exam - 2016 > Lecture 2 - Neurologic Exam > Flashcards

Lecture 2 - Neurologic Exam Flashcards

1
Q

What are the 4 regions of the brain?

A

Cerebrum
Diencephalon
Brainstem
Cerebellum

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2
Q

What brings white matter together from the cortex to descend into the brainstem?

A

Internal capsule

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3
Q

What is the role of the thalamus?

A

Regulates sensory impulses

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4
Q

What is the role of the hypothalamus?

A

Regulates body temperature, pulse, BP, endocrine function, emotions

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5
Q

___ ____ mediates reflex activity

A

spinal cord

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6
Q

Anterior (ventral) root contains ___ fibersPosterior (dorsal) root contains ___ fibers

A

Ventral root = motor fibersDorsal root = sensory fibers

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7
Q

What are the 5 areas of examination in a neurologic exam?

A
  • mental status
  • cranial nerves
  • motor system
  • sensory system
  • deep tendon, abdominal, plantar reflexes
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8
Q

How is CN I tested?

A

Sense of smell; test by presenting familiar odors (rarely tested in a routine exam)

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9
Q

How is CN II tested?

A

visual acuity, pupillary reflexes, visual fields

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10
Q

How are CN III, IV, and VI tested?

A

the six cardinal directions of gaze

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11
Q

How is the motor function of CN V tested?

A

Cheek contraction of temporal and masseter muscles

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12
Q

How is the sensory function of CN V tested?

A

Test the forehood, cheeks, and jaw on each side for pain sensation

  • use a sharp object; compare sharp and dull and compare sides
  • test again for light touch
  • test corneal reflexes
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13
Q

How is CN VII tested?

A 
-inspect face for symmetry
ask patient to:
-raise both eyebrows
-close eyes tightly so you can't open them
-show both upper and lower teeth
-smile-puff out both cheeks
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14
Q

How is CN VIII tested?

A

Assess for hearing loss; compare air and bone conduction

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15
Q

How is CN IX and X tested?

A

Assess quality of voice; watch for palate elevation, check gag

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16
Q

How is CN XI tested?

A

Shoulder shrug

turn head against hand

17
Q

How is CN XII tested?

A

tongue movements

18
Q

In a right CN XII palsy, which side of the face does the tongue go?

A

Goes to the right side (tongue moves to side of lesion)

19
Q

What are the 3 types of involuntary movements?

A

Tremors
Tics
Fasciculations

20
Q

What is the scale of grading for muscle strength?

A

0 - no muscular contraction detected
1 - barely detectable trace of contraction
2 - active movement with gravity eliminated
3 - active movement against gravity
4 - active movement against gravity and some resistance
5 - active movement against resistance; normal

21
Q

What 4 areas are integrated for coordination?

A

Motor system for motor strength
Cerebellar system for rhythmic movement and steady posture
Vestibular system for balance and coordinating eye, head, body
Sensory system, for position sense

22
Q

What does the Romberg test assess?

A

Position sense

23
Q

How is a Romberg test conducted?

A

Have patient stand with feet together and eyes open, then close both eyes

24
Q

What is affected if during a Romberg test the patient sways eyes open and eyes closed?

A

Cerebellar disease

25
Q

What is affected if during a Romberg test the patient sways with eyes closed only?

A

Loss of position sense

26
Q

What tract conducts information about pain and temperature?

A

spinothalamic tract

27
Q

What tract conducts information about position and vibration?

A

Posterior columns

28
Q

What tract conducts information about light touch?

A

both spinothalamic tract and posterior columns

29
Q

What patterns of testing are necessary in sensory testing?

A
  • comparison of symmetric areas
  • compare distal with proximal areas of extremities
  • when testing position and vibration, first test fingers and toes; if ok, then it is ok everywhere
  • vary the pace of testing
30
Q

What spinal nerve roots control biceps reflex?

A

C5 and C6

31
Q

What spinal nerve roots control triceps reflex?

A

C6 and C7

32
Q

What spinal nerve roots control brachioradialis reflex?

A

C5 and C6

33
Q

What spinal nerve roots control patellar reflex?

A

L2, L3, and L4

34
Q

What spinal nerve control ankle reflexes bilaterally?

A

S1

35
Q

What is another name for the plantar reflex?

A

Babinski response

36
Q

What is indicated if there is a positive Babinski response?

A

Upper motor neuron lesion

37
Q

What is a normal and abnormal response for the plantar reflex?

A

Test is to stroke the lateral aspect of the foot, curving medially against the ball

  • normal response is flexion
  • upward motion of the toe is abnormal

Intro to Physical Exam - 2016 (7 decks)

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