Lecture 7.3 Neuro PE (14% of final) Flashcards
1) Initial neuro survey should include visual inspection of what?
2) The last thing you should visually inspect involves what in particular?
1) Asymmetry, involuntary motion, muscular atrophy
2) Motor innervation
When is strength tested?
When ROM is resisted
What is the Scale for Grading Muscle Strength? (0-5 scale)
0-No muscular contraction detected
1-A barely detectable flicker or trace of contraction
2-Active movement of the body part with gravity eliminated
3-Active movement against gravity
4-Active movement against gravity and some resistance
5-Active movement against full resistance without evident fatigue. This is normal muscle strength.
Sensation should be tested ___________, noting any _____________ or ___________ changes
bilaterally; decreases or one-sided
1) What is the easiest sensation to test?
2) How is it done?
3) Where should this be done?
1) Light touch
2) Stroking the patient: “Can you feel me touching you, is it the same on both sides”
3) CNV, upper and lower extremities, and trunk
How is vibration tested? Where?
Using large tuning fork, test distal vibration sense on bilat hands and feet
How should you test proprioception?
Move distal extremity, have patent report its direction
“up, down, in out”
1) What sensation test is often omitted?
2) How would it be tested?
1) Temperature
2) Test tubes of warm water can be used
1) How do you test stereognosis?
2) Are the pt’s eyes open or closed?
1) Can they identify a common object that you place in their hand
2) Performed with eyes closed
How do you test number identification?
Can they discern what number you are drawing on their hand?
How do you test two-point discrimination?
Using sharp object, have them identify whether you are lightly poking them in “one” or “two” places at the same time
What are the 3 discriminative sensations?
1) Two-point discrimination
2) Stereognosis
3) Number identification
What are the 7 sensations you should test?
1) Light Touch
2) Vibration
3) Proprioception
4) Temperature
5) Two-point discrimination
6) Stereognosis
7) Number identification
1) What is the C2 dermatome?
2) What is the C3 dermatome?
1) Ear and upper neck
2) Bottom of neck and clavicle to shoulder both anterior and posterior
What is the T10 dermatome?
Umbilical
What is the L1 dermatome?
Inguinal (“bikini” line)
What is the C6 dermatome?
Lateral forearm and distal lat bicep, plus thumb and pointer finger
What is the C8 dermatome?
Medial arm and ring and little fingers + part of wrist
1) What is the L4 dermatome?
2) What is the L5 dermatome?
1) Anterior knee and thigh from lateral to medial side going downward
2) Anterior shin from lateral to medial, plus ankle and big toe + toe next to it both anterior and posterior
1) Hyperactive reflexes are seen in what?
2) Hypoactive or absent reflexes occur in what?
1) CNS lesions
2) Lesions of spinal nerve roots, spinal nerves, plexuses, or peripheral nerves (i.e. not central)
What is the scale for grading reflexes?
4) Very brisk, hyperactive, with clonus (rhythmic oscillations between flexion and extension)
3) Brisker than average; possibly but not necessarily indicative of disease
2) Average; normal
1) Somewhat diminished; low normal
0) Reflex absent
1) Impaired strength is referred to as what?
2) What are fasciculations?
3) When do fasciculations suggest peripheral motor neuron disease?
1) Paresis
2) Rapid and light movements of the muscle
3) With atrophy and weakness
1) Floppiness is “______________” or “_________” and suggests ___________ neuron disease.
2) What is spasticity?
1) “hypertonia” or “flaccidity”; peripheral
2) Increased tone that worsens at extremes of range
1) What is spasticity seen in?
2) How is rigidity seen?
1) Central neuron disease
2) Through full range of motion
1) Where is the biceps reflex?
2) How is it tested?
1) C5,C6
2) Elbow flexed, forearm pronated, thumb or finger over biceps tendon
1) Where is the triceps reflex?
2) Where is the brachioradialis reflex?
2) How is the brachioradialis tested?
1) C6,C7
2) C5,C6
3) Rest hand on abdomen or lap, forearm slightly pronated, strike 1-2 in above the wrist
1) Where are the quadriceps or patellar reflexes?
2) Where are the Achilles or ankle reflexes?
3) How are Achilles/ ankle reflexes tested?
1) L2 - L4
2) Primarily S1
3) Dorsiflex the foot and strike
1) How do you do a heel to shin test?
2) Is this done bilaterally? When is it positive and in what condition?
1) Have patient either sitting or lying down and ask them to stroke shin with heel of opposite leg, from just below the knee down to the ankle
2) Bilat; movement will be clumsy in cerebellar disease
1) How do you do a finger to nose test?
2) When is it positive and in what condition? What may also become apparent?
1) Patient touches nose, then your outstretched finger – several times
2) Movements are clumsy in cerebellar disease; intentional tremor may become apparent at the end of the movement as well
1) How do you do a nuchal rigidity test?
2) Neck stiffness with resistance to flexion is found in ____% of pts with bacterial meningitis
3) Is this an accurate test?
1) Bend neck forward in the supine patient
2) 84%
3) Diagnostic accuracy is low
What is the Brudzinski special test?
Flexion of neck = hips and knees react in pain
How is the Kernig special test done? What is positive?
1) Flex at hip and knee
2) Pain at knee extension = positive
1) When is the Clonus test positive?
2) How is this test done?
3) What are you feeling for? Why?
1) Hyperreflexia
2) Support the flexed knee and “loosen” the patient’s ankle with light dorsiflexion and plantar flexion. Then sharply dorsiflex and maintain pressure.
3) Rhythmic oscillations; these are abnormal and suggest CNS disease
When may a Clonus test give a false positive?
May be a few “light” beats if the patient is tense or has exercised
1) Asterixis is suggestive of what?
2) What pathologies should you think of?
3) What should you ask the pt to do to test it?
4) What is positive?
1) Metabolic encephalopathy
2) Advanced liver disease and high ammonia levels
3) “Stop traffic” holding for 1-2 minutes
4) Sudden, brief, nonrhythmic flexion of the hands
1) How do you perform the Babinski reflex?
2) How do you achieve response?
3) When may it be transiently positive?
1) Using sharp object, stroke lateral aspect of sole from heel to ball of foot, curving medially across the ball.
2) Use lightest stimulus to achieve response.
3) If pt is unconscious from drug or ETOH and during postictal state of seizure
1) What is a positive Babinski test? What does it indicate?
2) What is the sensitivity and specificity of this test?
1) Dorsiflexion of the big toe; CNS lesion of corticospinal tract
2) 50% sensitive
3) 99% specific
1) What is the Romberg test?
2) How is it done? What should the pt be able to do?
1) Test of position sense, can be impaired in cerebellar ataxia
2) Stand with feet together and eyes open, then close if still stable.
-Pt should be able to self-correct any loss of balance
1) How is the pronator drift test done?
2) What should the result be?
3) What are the two ways a test can be positive? What is it positive for?
1) Stand with eyes closed and both arms forward with palms up, tap the arms briskly downward
2) Arms should return smoothly to horizontal position
3) Failure to return or demonstration of spontaneous pronation; for contralateral corticospinal tract lesion
1) How do you test rapid alternating movements of the arms?
2) When is this ability impaired? (3 conditions)
1) Have patient “pat” thighs with dorsal and palmar surfaces of hands in rapid succession
2) In cerebellar disease, impairment of the basal ganglia, and upper motor neuron disease
1) How do you test rapid alternating movements of the fingers?
2) When will it be disturbed? (3 conditions)
1) As pt to “play piano” on thumb
2) In cerebellar disease, impairment of the basal ganglia, and upper motor neuron disease
1) How is the anal reflex tested? What should occur and how is it detected?
2) What would a positive result suggest?
1) Using sharp object like applicator stick, scratch anus on either side. Reflexive contraction should occur and is detected with gloved finger inserted into the anus.
2) Suggests lesion in S2-S4, and is seen in cauda equina
