Lecture/Lab 2: Basic Neuro Exam Flashcards
What are the 4 components of a Mini-Mental Status Exam?
1) Level of alertness
2) Appropriateness of responses
3) Orientation to person, place, time
4) Congruency of modod
Visual acuity is tested using?
Legally blind at?
- Snellen eye chart - position pt 20ft from chart
- 20/200 = legally blind
Bell’s palsy affects?
Central lesion affects?
What CN?
- Affects both upper and lower face, loss of taste
- Affects mainly lower face
- CN VII
What does 0-5 stand for in terms of muscle strength testing?
0 = no muscle contraction
1 = barely detectable flicker or trace of contraction
2 = active movement w/ gravity eliminated
3 = active movement against gravity
4 = active movement against gravity and some resistance
5 = active movement against full resistance w/o fatigue
Nerve roots tested for flexion at elbow?
Extension at elbow?
Flexion = C5, C6
Extension = C6, C7, C8
Nerve roots tested for flexion and extension at wrist?
C6, 7
Nerve roots tested for Hand Grip?
C7, 8, T1
Nerve roots tested for Opposition of thumb, Finger Abduction?
C8, T1
Nerve roots tested for Hip Flexion?
Extension?
Adduction?
Abduction?
- L2, 3, 4 (flexion)
- S1 (extension)
- L2, 3, 4 (adduction)
- L4, 5, S1 (abduction)
Nerve roots tested for Knee Flexion?
Extension?
- L4, 5, S1, 2
- L2, 3, 4
Nerve roots tested for Ankle Plantarflexion?
Dorsiflexion?
- S1 (plantarflexion)
- L4, 5 (dorsiflexion)
Inability to heel-walk is sensitive test for?
CST damage
Abnormal results during Rapid Alternative Movements test may indicate?
Dysdiadochokinesis
Dermatomes of C4
C6
C8
T4
T10
L5
S1
C4 = shoulder top
C6 = Radial aspect forearm
C8 = Little finger
T10 = Umbilicus
L5 = Great Toe (5 (big toe) is > 1 = little toe)
S1 = Posteriolateral calf/little toe
What is the Romberg Test?
- Test of position sense/proprioception (posterior columns).
- Pt stands w/ feet together and eyes open - then close both eyes for 30-60 secs w/o support
- Note pt ability to maintain upright posture
- Normally only minimal swaying occurs
What is the Babinski test?
Abnormal test suggestive of?
- W/ an object stroke to lateral aspect of sole from heel to the ball of the foot.
- Normal response should be plantar
- Dorsiflexion of big toe and fanning of toes is positive and suggestive of UMN dysfunction
Inflammation in the subarachnoid space causes resistance to movement that stretches nerves, which for nuchal rigidity?
Brudzinski’s sign?
Kernig’s sign?
- Nuchal rigidity = spinal nerves
- Brudzinski’s sign = femoral nerve
- Kernig’s sign = sciatic nerve
What is a positive Brudzinski’s Sign?
Hips and knees flex as pt’s neck is flexed
What is a positive Kernig’s Sign?
Pain and increases resistance to extending the knee
Shoulder abduction with the deltoid is what nerve root?
C5
Dorsiflexion of the ankle is primarily what muscle and nerve root?
- Tibialis anterior
- L4, L5
Hypertonia and hyperreflexia are seen in what type of nerve damage?
UMN
A pyramidal pattern of weakness (weak extensors in arms and weak flexors in legs) seen in what kind of damage?
Test for this kind of damage?
- UMN
- Pronator drift: arms held extended for up to 2 minutes, arm drifts down and supinates
Sensory dermatome of the shoulder?
C4
Sterognosis
Ability to identify shapes of objects, or recognizing objects placed in the hand
Graphesthesia
Ability to identify numbers written on the palm
Clonus is a abnormal sign indicating?
UMN sign
Anal wink reflex is what nerve roots and is useful in testing for?
S2-S4
Cauda Equina or lesions that affect sacral region
The cremasteric reflex tests what afferent and efferent component?
Afferent: L1
Efferent: L2
Nystagmus, vertigo, vomiting, postural impairment, disequilibrium are all part of what system?
Vestibular
Dysmetria, dydiadichokinesia, ataxia, intention tremor, slurred speech, asthenia are due to what system?
Cerebellar
Spastic paralysis/paresis, hyperreflexia, hypertonia, babinksi are all signs of what system?
Pyramidal
Dyskinesia and resting tremor are signs of what system?
Extrapyramidal
Hemi-dysasthesia, hemiplegia, hemiparesis, apraxia, aphasia, cognitive/behavioral are all part of what system?
Cortical
Finger-to-nose tests for?
Dysmetria/dysataxia of voluntary movements (cerebellar)
Scissoring gate is often seen in?
Cerebral palsy or MS
Sensory ataxia is what type of gait?
Seen in?
- High steppage, broad based
- Seen with posterior column damage and peripheral neuropathy
Magnetic gait seen in what diseases?
Frontal lobe processes and hydrocephalus
Hemiplegic gait is usually due to?
UMN such as stroke
Waddling pelvis usually indicates?
Myopathic disease (myopathy) - hips sway or “waddle” in a side to side type fashion
