Lecture 2 - Neurologic Exam Flashcards
What are the 4 regions of the brain?
Cerebrum
Diencephalon
Brainstem
Cerebellum
What brings white matter together from the cortex to descend into the brainstem?
Internal capsule
What is the role of the thalamus?
Regulates sensory impulses
What is the role of the hypothalamus?
Regulates body temperature, pulse, BP, endocrine function, emotions
___ ____ mediates reflex activity
spinal cord
Anterior (ventral) root contains ___ fibersPosterior (dorsal) root contains ___ fibers
Ventral root = motor fibersDorsal root = sensory fibers
What are the 5 areas of examination in a neurologic exam?
- mental status
- cranial nerves
- motor system
- sensory system
- deep tendon, abdominal, plantar reflexes
How is CN I tested?
Sense of smell; test by presenting familiar odors (rarely tested in a routine exam)
How is CN II tested?
visual acuity, pupillary reflexes, visual fields
How are CN III, IV, and VI tested?
the six cardinal directions of gaze
How is the motor function of CN V tested?
Cheek contraction of temporal and masseter muscles
How is the sensory function of CN V tested?
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
How is CN VII tested?
-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
How is CN VIII tested?
Assess for hearing loss; compare air and bone conduction
How is CN IX and X tested?
Assess quality of voice; watch for palate elevation, check gag
How is CN XI tested?
Shoulder shrug
turn head against hand
How is CN XII tested?
tongue movements
In a right CN XII palsy, which side of the face does the tongue go?
Goes to the right side (tongue moves to side of lesion)
What are the 3 types of involuntary movements?
Tremors
Tics
Fasciculations
What is the scale of grading for muscle strength?
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
What 4 areas are integrated for coordination?
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
What does the Romberg test assess?
Position sense
How is a Romberg test conducted?
Have patient stand with feet together and eyes open, then close both eyes
What is affected if during a Romberg test the patient sways eyes open and eyes closed?
Cerebellar disease
What is affected if during a Romberg test the patient sways with eyes closed only?
Loss of position sense
What tract conducts information about pain and temperature?
spinothalamic tract
What tract conducts information about position and vibration?
Posterior columns
What tract conducts information about light touch?
both spinothalamic tract and posterior columns
What patterns of testing are necessary in sensory testing?
- 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
What spinal nerve roots control biceps reflex?
C5 and C6
What spinal nerve roots control triceps reflex?
C6 and C7
What spinal nerve roots control brachioradialis reflex?
C5 and C6
What spinal nerve roots control patellar reflex?
L2, L3, and L4
What spinal nerve control ankle reflexes bilaterally?
S1
What is another name for the plantar reflex?
Babinski response
What is indicated if there is a positive Babinski response?
Upper motor neuron lesion
What is a normal and abnormal response for the plantar reflex?
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
