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NAN Neuroanatomy > Module 2: Neurological Examination > Flashcards

Module 2: Neurological Examination Flashcards

1
Q

What are the 6 components of a neurological exam?

A

1) Mental Status
2) Cranial Nerves
3) Motor Exam
4) Reflexes
5) Coordination & gait
6) Sensory exam

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2
Q

What is assessed during the mental status exam?

A

a. Level of alertness and orientation
b. Attention using months forward/backward
c. Immediate registration and delayed recall of 3 objects for 4 minutes (timed)
d. Naming parts of watch
e. Note behavior, language, affect, etc. while taking history

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3
Q

What is being assessed during the cranial nerves portion of the neurological exam?

A

a. Pupil light reflexes
b. Ophthalamoscopic exam
c. Visual fields, including extinction testing
d. Horizontal and vertical smooth pursuit eye movements
e. Facial sensation to light touch including extinction testing
f. Facial asymmetry during emotional smile
g. Hearing of finger rub bilaterally
h. Palate elevation
i. Voice quality during remainder of exam
j. Head turning and shoulder shrug against resistance
k. Tongue protrusion

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4
Q

What is being assessed during the motor examination portion?

A

a. Drift
b. Rapid hand and foot tapping
c. Upper and lower extremity tone
d. Strength in several proximal and distal muscles in the upper and lower extremities bilaterally

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5
Q

What proximal and distal muscles are examined during the motor exam?

A

a. Finger extensors
b. Finger abductors
c. Wrist extensors
d. Biceps
e. Triceps
f. Deltoids
g. Iliopsoas
h. Quadriceps
i. Foot and toe dorsiflexors
j. Knee flexors

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6
Q

What reflexes are being assessed during the neurological exam?

A

a. Bilateral biceps
b. Brachioradialis
c. Patellar
d. Achilles tendon
e. Plantar reflexes

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7
Q

What is being assessed during the coordination and gait portion of the neurological exam?

A

a. Finger-to-nose bilaterally
b. Heel-to-shin bilaterally
c. Gait
d. Tandem walking

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8
Q

What is being assessed during the sensory examination portion of the neurological exam?

A

a. Light touch in hands and feet, including extinction testing
b. Pin prick or temperature testing in feet bilaterally
c. Vibration and joint position sense in feet bilaterally

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9
Q

Level of consciousness is severely impaired by damage to what brain structures?

A
  • Brainstem (RAS)
  • Bilateral lesions of the thalamus
  • Extensive bilateral lesions of the cerebral hemispheres (as in toxic or metabolic disturbances)
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10
Q

In what cases does level of cooperation factor in most?

A

Behavioral disorders
Mood disorders
Litigation

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11
Q

If immediate recall is intact, then difficulty with delayed recall is indicative of damage to what structures?

A
  • Limbic memory structures located in the medial temporal lobes or medial diencephalon.
  • Frontal lobe lesions and psychogenic amnesia
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12
Q

What components of language are being assessed during the neurological exam?

A 
Spontaneous speech
Comprehension
Naming
Repetition
Reading and writing
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13
Q

Language and speech abnormalities result form damage to which structures?

A

Dominant (usually left) frontal lobe (Broca’s area)
Left temporal and parietal lobes (Wernicke’s area)
Subcortical white matter and gray matter structures, such as thalamus and caudate nucleus

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14
Q

Apraxia

A

Inability to follow a motor command that is not due to a primary motor deficit or language impairment

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15
Q

Ideomotor apraxia (IMA)

A

A neurological disorder characterized by the inability to correctly imitate hand gestures and voluntarily pantomime tool use, e.g. pretend to brush one’s hair.

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16
Q

Gerstmann’s Syndrome

A

A constellation of symptoms including acalculia, right-left confusion, finger agnosia, and agraphia

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17
Q

Hemineglect is most often caused by lesions to what part of the brain?

A

The right (non-dominant) parietal lobe

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18
Q

Abulia

A

Loss or impairment of the ability to make decisions or act independently; a lack of will or initiative; seen as a disorder of diminished motivation (DDM)

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19
Q

Lesions _______ the optic chiasm cause visual deficits in one eye only.

A

In front of (e.g. eye, optic nerve)

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20
Q

Lesions ______ the optic chiasm cause visual field deficits that are similar in both eyes

A

Behind (e.g. along the optic tract, thalamus, white matter, or visual cortex)

21
Q

PERRLA

A

Pupils are equal, reactive, and responsive to light and accommodation

22
Q

Direct optic response

A

constriction of the pupil upon illumination

23
Q

Consensual optic response

A

constriction of the other pupil upon direct illumination of the first pupil

24
Q

The direct response is impaired by lesions in which parts of the brain?

A

The ipsilateral optic nerve, pretectal area, ipsilateral parasympathetics traveling in the CN III, or the pituitary constrictor muscle.

25
Q

The consensual response is impaired by lesions in which parts of the brain?

A

The contralateral optic nerve, pretectal area, contralateral parasympathetics traveling in the CN III, or the pupillary constrictor muscles of the iris.

26
Q

Olfaction

A

CN I

27
Q

Vision

A

CN II

28
Q

Pupillary Response

A

CN II, III

29
Q

Extraocular Movements

A

CN III, IV, VI

30
Q

Facial Sensation and Muscles of Mastication

A

CN V

31
Q

Muscles of Facial Expression and Taste

A

CN VII

32
Q

Hearing and Vestibular Sense

A

CN VIII

33
Q

Palate Elevation and Gag Reflex

A

CN IX, X

34
Q

Muscles of Articulation

A

CN V, VII, IX, X, XII

35
Q

Sternocleomastoid and Trapezius Muscles

A

CN XI

36
Q

Tongue Muscles

A

CN XII

37
Q

Testing extraocular movements

A

Have patient look in all directions without moving her head and ask her if she experiences any double vision.

38
Q

Visual extinction

A

A form of hemineglect in which patients do not report seeing fingers on the affected (usually left) side of the visual field, although they can see fingers when they are presented to that side alone.

39
Q

Afferent pupillary defect

A

Occurs when there is a decreased direct response caused by decreased visual function (CN II) in one eye; however, there is spared pupillary constriction (CN III) when elicited through the consensual response.

40
Q

How does one test for afferent pupillary defect?

A

The swinging flashlight test, in which a light is moved back and forth between the eyes ever 2-3 seconds; the affected eye will dilate rather than constrict in response to the direct light.

41
Q

Hippus

A

Spasmodic, rhythmic, but irregular dilating and contracting pupillary movements.

42
Q

How do you test for smooth pursuit?

A

Have the patient follow an object moved across their full range of horizontal and vertical eye movements

43
Q

How do you test for convergence movements?

A

Have patient fixate on an object as it is moved slowly to a point right between the patient’s eyes.

44
Q

What do you look for while the patient’s eyes are at rest?

A 
Spontaneous nystagmus
Disconjugate gaze (resulting in diplopia)
45
Q

Optokinetic Nystagmus (OKN)

A

Occurs in response to a rotation movement. It is present normally. The optokinetic reflex allows the eye to follow objects in motion when the head remains stationary (e.g., observing individual telephone poles on the side of the road as one travels by them in a car).

46
Q

Spontaneous nystagmus can indicate what?

A

Toxic or metabolic conditions (e.g. drug overdose or intoxication)
Peripheral or central vestibular dysfunction

47
Q

The corneal reflex involves which two cranial nerves?

A

CN V

CN VII

48
Q

Facial sensation can be impaired by lesions to which structures?

A

CN V (trigeminal nerve)
Trigeminal sensory nuclei in the brainstem
Ascending sensory pathways to the thalamus and somatosensory cortex in the postcentral gyrus.

NAN Neuroanatomy (5 decks)

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