Neruology Flashcards
What are the red flags for headache?
New onset >50 yrs old
Sudden Thunderclap
Worse with position
Sudden onset after exerting (coughing, straining)
Focal Neuro findings- papilledema, change LOC, CN abnormalities
In addition to history of sudden severe, “worse headache of my life,” what history and exam findings support the concern for SAH?
Nausea & vomiting, neck pain, hypertension, tachycardia, with or without focal neuro findings.
Older patient with new onset of headache in one temple accompanied by scalp tenderness with finding of inflammation over temporal area is likely what condition?
Temporal arthritis (giant call arthritis)
What labs would likely be elevated increasing the suspicion for temporal arthritis?
ESR, Sed rate, and CRP.
T/F, hemorrhagic stroke is more common than thrombotic?
False, thrombotic accounts for almost 90% of strokes
T/F in subdural hematoma, blood collection is found deep in the intracranial tissues?
False, blood collects between dura and subarachnoid membrane.
A wide-based gait that is uncoordinated is what type of gait and indicates what type of disorders?
Ataxic, cerebellar dysfunction
How is a tandom gait test performed?
Have patient walk placing one foot right in front of the other, positive test if they are unable or fall over.
What are the classic cerebellar tests and how are they performed?
Gait: observe coordination and stance with ambulation
1) . Tandem: one foot in front of the other
2) . Rapid alternating movements: place hands on top of other and rapidly alternate
3) . Heel-to-shin: patient runs heel down the shin of the opposing leg
4) . Finger-to-nose & finger-to-finger: Have patient touch your finger then their nose (move your position), Repeat finger to finger without moving
5) . Proprioception: Romberg test-Patient stands feet together, arms at side w/ eyes open (observe to positioning), then close eyes and continue to observe positioning. Positive sign is wide stance, excessive swaying or inability
What is sterognosis?
The ability to recognize by touch familiar objects
The ability to identify a number written on the palm is what?
Graphestheisa
When testing for pronator drift, the patient arm falls or lifts sideward/upward after brief tap is considered positive or negative?
Positive
T/F 4+ reflex is hyper-reflexive and noted as clonus?
True
Patellar tendon reflex assessed what spinal level?
L2/3/4/5
Bicep tendon reflex assessed what spinal level?
C5/6
Achilles tendon reflex assessed what spinal level?
S1/2
Tricep tendon reflex assessed what spinal level?
C6/7/8
When assessing for Kernig’s sign, how is it performed and what is a positive result?
Patient supine- raise leg with hip flexed, one at a time, then attempt to straighten leg. + if produces back pain or resistance
How is a positive Brudzinski’s sign demonstrated?
When examiner raises the neck, there is a reflexive flexion of the hips and knees (to relieve pressure)
A few small vesicular lesions on the tip of the nose and temple suggest what condition?
Shingles of the trigeminal nerve (CNV)
If the patient resists or has great pain flexing neck towards chest, what finding is that called?
Nuchal rigidity
T/F + Babinski sign is normal after 1 year?
False, only normal in a young infant