Neural exam/ observations COPIED

Question 1

What does Romberg’s test signify?

Answer 1

proprioceptive sensory loss in the feet (sensory ataxia)

Question 2

What does unsteadiness with eyes open imply?

Answer 2

cerebellar disorders

Question 3

What is a hemiplegic gait and what does it imply?

Answer 3

Unilateral upper motor neurone lesion.

circumduction of leg on affected side with foot plantar flexed.

Upper limb will be flexed.

Question 4

Ask patient to walk 10 metres and turn.

What to observe?

Answer 4

stride length

arm swing

steadiness (including turning)

limping or other difficulties.

Question 5

Differences between upper and lower motor neurone lesions

Answer 5

Question 6

Hemiplegic gait

Answer 6

circumduction of the leg, with the foot dropping (hence the circumduction).

associated hypertonic flexion of the ipsilateral arm.

Question 7

F A S T

Answer 7

F - face. Has their face fallen on one side?

A - arms. Are the unable to raise one arm?

S - speech. It is affected?

T - time . Call 999 if any of the above is positive.

Question 8

What is the name of unequal pupils?

Answer 8

anisocoria

Question 9

What does inattention to one side indicate when testing peripheral vision?

Answer 9

cortical damage on the opposite side

Question 10

What is Homonymous Hemianopia?

Answer 10

Visual field loss on the SAME SIDE of both eyes.

Question 11

What can cause abnormal size of pupils?

Answer 11

Drugs

damage to optic cranial nerve (II)

Oculomotor nerve (III)

or brain (especially trauma)

Question 12

Squint

(strabismus)

• could be damage to cranial nerves III, IV, VI

Why is it important to treat early?

Answer 12

To prevent lazy eye developing (brain ignores signals)

Question 13

What happens to the reflexes in an upper motor lesion?

Answer 13

They become EXAGGERATED on the side affected by the stroke

Question 14

nerve reflexes (which levels)

biceps

supinator

triceps

patellar

achilles

Answer 14

C5

C6

C7

L4

S1

Question 15

Reduced reflexes at achilles could indicate a lower motor lesion. What else?

Answer 15

diabetic neuropathy

Question 16

Symptoms of diabetic neuropathy

Answer 16

Question 17

What are the characteristics of myopathies?

Answer 17

Tone is affected

Reflexes are affected

* it doesn’t affect sensation *

* no fasciculations *

muscle weakness is usually proximal and symmetrical

Question 18

Radial, median and ulnar nerves.

Focal neuropathies?

Answer 18

Radial - thumb (mainly dorsal), radial pulse… radial artery.

median nerve… in the middle of the hand.

ulnar - outside of hand (little finger and surrounding areas)

Question 19

Lack of expression may indicate

Answer 19

Parkinson’s disease

Question 20

Difficulty understanding speech or using correct words (receptive or expressive dysphasia) may indicate….

Answer 20

stroke

Question 21

What is Bell’s Palsy an example of?

Answer 21

a lower motor neurone weakness

Question 22

How does an upper motor neurone lesion affect the face?

Answer 22

only affects lower part of one side.

Question 23

Dysarthria isn’t just due to stroke. What are other causes?

Answer 23

multiple sclerosis

cerebellar disease

motor neuone disease

Question 24

When do you find a positive Extensor Plantar Response (Babinski)

Answer 24

Upper motor neuron lesion

Question 25

When do you get fibrillations and fasciculations?

Answer 25

Lower motor neurone lesions

Question 26

What are the cardinal features of a MCA stroke?

Answer 26

• hemiplegia (paralysis) of the contralateral side, affecting the lower part of the face, arm, and hand while largely sparing the leg
• contralateral (opposite-side) sensory loss in the same areas
• contralateral homonymous hemianopia—visual-field deficits affecting the same half of the visual field in both eyes.

Question 27

What are the early symptoms of motor neurone disease?

Answer 27

Question 28

Assessing standing.

Why ask px to stand without pushing up with arms?

Answer 28

Difficulty indicates proximal muscle weakness.

(other signs; difficulty getting out of chairs, climbing stairs)

Question 29

What are some signs of distal muscle weakness?

Answer 29

flapping gait when walking

problems grasping

handwriting difficult

Question 30

Freezing is Parkinson’s is called…

Answer 30

hypokinesia

Question 31

What happens with pronator drift

and what does it indicate?

Answer 31

• The hand drifts so the palm turns inward and/or the hand drops
• This is a very sensitive indicator of upper motor neurone weakness, usually due to stroke