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PD Exam 3 > Neuro > Flashcards

Neuro Flashcards

1
Q

Sx that prompt a neuro exam

A

Headache
Dizziness/ Vertigo
Weakness
Loss of sensation
Seizures
Stroke like sx
Confusion
Altered mental status
Intoxication

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2
Q

Components of Neurological exam

A

Mental status exam
Cranial nerve evaluation
Motor function evaluation
Sensory function evaluation
Reflexes

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3
Q

What does mental status exam look for?

A

Level of alertness
Appropriateness of responses
Orientation to date and place

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4
Q

A patient is ALERT if they …. (3 things)

A

Speak to you in normal tone of voice
Are awake
Respond to their surroundings

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5
Q

What does A&O x3 indicate?

A

Patient alert and oriented to person, place and time

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6
Q

Mini-Mental Status Exam is used to screen for……

A

Cognitive impairment and dementia

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7
Q

The MMSE has questions regarding:

A

Level of consciousness (arousal)
Attention and concentration
Memory (immediate, recent, remote)
Language
Visual spatial perception
Executive functioning
Mood and thought content
Calculations

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8
Q

Cranial Nerves (I-XII) names

A

I- Olfactory
II- Optic
III- Occulomotor
IV- Trochlear
V- Trigeminal
VI- Abducens
VII- facial
VIII- acoustic
IX- Glassopharyngeal
X- Vagus
XI- Accessory
XII- Hypoglossal

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9
Q

Function of CN I

A

Sense of smell

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10
Q

Function of CN II

A

Vision

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11
Q

What CN’s are responsible for medial deviation, medial upward deviation, lateral upward and lateral downward devaition of the eyeball

A

CN III

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12
Q

What CN is responsible for medial downward deviation of the eye (SO4LR6)

A

CN IV (superior oblique)

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13
Q

What CN is responsible for lateral deviation of the eye (SO4LR6)

A

CN VI

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14
Q

Function of CN III

A

Pupillary constriction
Lid elevation
Most Extraocular movements

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15
Q

Function of CN IV

A

Trochlear

Downward, internal rotation of the eye

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16
Q

Function of CN V

A

Trigeminal

Motor—> temporal and mass enter muscles (jaw clenching), lateral pterygoids (lateral jaw movment)
Sensory—> facial (1)opthalmic, (2) maxillary, (3) mandibular

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17
Q

Function of CN VI

A

Abducens

Lateral deviation of the eye

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18
Q

Function CN VII

A

Facial

Motor- facial movements
- facial expression
- closing eye
- closing mouth

Sensory- taste for salty, sweet, sour bitter substances on ANTERIOR 2/3 TONGUE
- sear sensation

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19
Q

Function CN VIII

A

Acoustic

Hearing— cochlear division
Balance— vestibular division

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20
Q

Function CN IX

A

Glassopharyngeal

Motor- pharynx
Sensory- POSTERIOR eardrum and ear canal, pharynx, POSTERIOR TONGUE (including taste)

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21
Q

Function CN X

A

Vagus
Motor- palate, phayrnx, larynx
Sensory- pharynx, larynx

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22
Q

Function CN XI

A

Accessory
Motor- sternocleoidmastoid and upper traps

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23
Q

CN XII

A

Hypoglossal
Motor to tongue

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24
Q

Order of testing for neuro exam

A

I
II, III, IV, VI
II
V
VII
VIII
IX
X
XI
XII

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25
Q

Order for CN testing in real live

A

VIII
II, III, IV, VI
IX, X, XII
XI
VII, V, XII

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26
Q

Rapid, shock-like jerks

A

Myoclonus

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27
Q

Rapid, jerky twitches similar to myoclonus but MORE RANDOM in location and more likely to blend into one another

A

Chorea

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28
Q

Slow, writhing movements of limbs

A

Athetosis

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29
Q

Abrupt, stereotyped, coordinated movements OR VOCALIZATIONS

A

Tics

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30
Q

maintenance of an abnormal posture or receptive twisting motion

A

Dystonia

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31
Q

Muscle tone

A

Qualitatively assessed by asking the patient to relax and let you manipulate limbs passively

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32
Q

Increased resistance

A

Hypertonic

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33
Q

Decreased resistance (flaccid)

A

Hypotonia

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34
Q

What spinal nerve roots are responsible for elbow flexion

A

Biceps: C5-6

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35
Q

What spinal nerve roots are responsible for elbow extension?

A

Triceps: C6-8

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36
Q

What spinal nerve roots extend the wrist?

A

C6-8

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37
Q

What spinal nerve roots flex the wrist

A

C6-7

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38
Q

What spinal nerves are responsible for grip strength?

A

C7-8, T1

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39
Q

What spinal nerves are responsible for finger abd?

A

C8, T1, ulnar N

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40
Q

What spinal nerves are responsible for thumb opposition?

A

C8, T1, median n

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41
Q

Spinal nerves responsible for hip flexion

A

L2-4

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42
Q

Spinal nerves responsible for hip add.

A

L2-4

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43
Q

Spinal nerves responsible for hip abd?

A

L4-5, S1

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44
Q

Spinal nerves responsible for hip extension?

A

S1

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45
Q

Spinal nerves responsible for knee extension?

A

L2-L4

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46
Q

Spinal nerves responsible for knee flexion?

A

L4-5, S1-2

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47
Q

Spinal nerves responsible for dorsiflexion?

A

L4-5

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48
Q

Spinal nerves responsible for plantarflexion?

A

S1

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49
Q

Coordination requires what 4 areas of the nervous system?

A

Motor
Cerebellar
Vestibular
Sensory

50
Q

Romberg

A

Position sense

51
Q

Positive Romberg test

A

Loss of balance

52
Q

What does a positive Romberg test indicate?

A

Possible dorsal column disease (proprioception) or Cerebellar disease (issue standing with eyes open or closed)

53
Q

Positive pronator drift

A

Drops of the arms or pronation
Arms don’t return SMOOTHLY to horizontal when tapped

54
Q

What does a positive pronator drift test indicate?

A

Corticospinal tract lesion

55
Q

Reinforcement

A

Isometric contraction of other muscles for up to 10 seconds that may increase reflex activity

56
Q

You need to reinforce the arm reflexes. What would you instruct the patient to do?

A

Ask the patient to clench his or her teeth or to squeeze both knees together

57
Q

You need to reinforce the leg reflexes. What would you instruct your patient to do?

A

Ask the patient to lock fingers and pull one hand away from other

58
Q

Testing biceps reflex (walk me through it)

A

Biceps reflex C5-6

Partially flex elbow, arm pronated
Identify biceps tendon and place finger over it
Strike OUR FINGER

59
Q

Testing brachioradialis reflex

A

Brachioradialis C5-6

Rest the patients hand on their lap, 50% pronated
Strike radius 1-2” above the wrist WITH FLAT SIDE

60
Q

Testing the patellar reflex

A

Patellar L2-4
Perform with patient seated, knee flexed
Legs “dangling”
Locate and tap patellar tendon just below knee cap

61
Q

Testing the Achilles reflex

A

Achilles- S1
Partially dorsiflexion foot at the ankle and support it with our hand
Strike the Achilles with flat portion—> feel for plantar flexion

62
Q

A defect in muscular control of the speech apparatus (lips, tongue, palate or pharynx).

A

Dysarthria

63
Q

How will a patient with dysarthria present?

A

Words may sound nasally, slurred, or indistinct, but central symbolic aspect of language remains intact

64
Q

Disorder in producing or understanding language

65
Q

Causes of Dysarthria

A

Motor lesions of CNS or PNS
Parkinsonism
Cerebellar disease

66
Q

Cause of Aphasia

A

Lesion in dominant cerebellar hemisphere

67
Q

What are the 2 types of dysphagia?

A

Wernike’s (fluent- receptive)
Brocas (non fluent- expressive)

68
Q

Wernicke aphasia

A

Fluent (receptive) aphasia
Wordy and wrong

69
Q

Broca aphasia

A

Non fluent or expressive aphasia
Broken but befitting

70
Q

Pain and temperature are sensed by what?

A

Spinothalamic tracts

71
Q

Position and Vibration are sensed by what?

A

Dorsal/posterior columns

72
Q

Light touch is sensed by which: spinothalamic tracts or dorsal columns?

73
Q

Correctly distinguishing sharp sensation indicates normal function of __________________

A

Spinothalamic pathway

74
Q

In a patient without any signs or symptoms of neurological disease, how can we quickly assess for neurologic disease?

A

Check normal sensation of distal fingers and toes (stocking glove distribution)

75
Q

What is often the 1st sensation lost in peripheral neuropathy?

76
Q

What are the causes of peripheral neuropathy

A

Diabetes
Alcoholism
Posterior Column disease
- tertiary syphilis
- vit B12 deficiency

77
Q

If you are performing proprioception position sense on a patient and they cannot feel you squeezing the IP. What do you do next?

A

Go to the next proximal jt

78
Q

Discriminative sensations

A

Graphesthesia
Stereognosis
2-point discrimination
Point localization
Extinction

79
Q

A descriminative exam where the provider draws a number on the patients hand and the patient is asked to identify the number

A

Graphesthesia

80
Q

Discrimination sensation test where the patient is asked to identify an object in their palm

A

Stereognosis

81
Q

If the patient is able to unable to object in stereognosis with normal cutaneous sensation, that clues the provider in about a lesion where?

A

In the sensory cortex

82
Q

Discrimination test where you find the smallest distance at which a patient can discriminate one from 2 points

A

2 point discrimination

83
Q

Typical variance of 2 point discrimination of the finger tips

A

<5mm often ~2mm

84
Q

Palms of the hands 2 point discrimination norm

85
Q

Back norm for 2 point discrimination

86
Q

A lesion to the ___________ lobe impairs 2 point discrimination

87
Q

Examination where patients eyes are closed and the examiner touches the patient and then the patient must point to the area where the practitioner touched

A

Point localization

88
Q

Inability to perform point localization indicates lesions to where?

A

Sensory cortex

89
Q

Patient closes eye and the examiner touches their body in 2 separate places

A

Extinction

90
Q

A patient with a lesion to the parietal lobe may feel individual touches but may ‘extinguish’ the sensation on the side ________________ to the side of the lesion

A

Contralateral

91
Q

Upper motor neuron lesions will be found where

A

Spinal cord
Brain stem
Motor cortex

92
Q

Upper motor lesions are characterized by

A

Increased muscle tone (spasticity)
Weakness
Exaggerated reflexes
Up-going plantar reflex response and sustained clonus
Positive babinski
Diffuse atrophy

93
Q

Lower motor neuron lesions are found where?

A

Anterior horn cell
Root
Plexus
Peripheral nerve

94
Q

Lower motor lesions are characterized by:

A

Decreased muscle tone
Weakness and wasting (atrophy) of muscles innervated by that nerve
Hyporeflexia or a reflexia
Muscle fasiculations

95
Q

What would you grade an absent reflex?

96
Q

Grading for a reflex that is diminished or below normal

97
Q

Grading of a reflex that is average or normal

98
Q

Grading of a reflex that is brisker than average

99
Q

Grading of reflex that is very brisk, hyperactive W/ CLONUS

100
Q

Abnormal babinski reflex

A

Extension of the great toe with fanning of the other toes

101
Q

Reflex exam where the abdomen is stroked lightly on each side above T8-T10 and elbow T10-T12 patinet supine

A

Superficial abdominal reflex

102
Q

What is a normal superficial abdominal reflex

A

Local abdominal muscles contract cause the umbilicus to move towards the quadrant stimulated

103
Q

What type of lesions will cause the superficial abdominal reflex to be absent

A

Central and peripheral

104
Q

Cremasteric reflex

A

Reflex center at L1-L2
Stroke inner thigh from the inguinal crease downward

105
Q

Normal cremasteric reflex

A

Cremeaster contracts—> prompt elevation of the testes on that side

106
Q

What can cause loss of the cremasteric reflex?

A

Testicular torsion

107
Q

Rhythmic series of muscular contractions induced by stretching a tendon

108
Q

When is clonus most commonly found

A

At the ankle, elicited by sudden dorsiflexion of the patients foot and maintenance of light upward pressure result in a beat downwards into the providers hand (a few beats may be normal if the patient is tense or just exercised

109
Q

Reflex that uses the end of an applicator stick to scratch both sides of the anus looking for contraction

A

Anal reflex

110
Q

Loss of the anal reflex may be indicative of….

A

Lesion in L2-3-4 (like in cauda equina)

111
Q

Occulocephalic reflex is done on what type patients and is used to asses what?

A

Performed on comatose/ unresponsive pateints

Used to assess brainstem function

112
Q

If the eyes in the occulocephalic reflex go in the opposite direction of the head when moved, what type of response is that?

113
Q

If the eyes move in the same direction as the head when performing the occulocephalic reflex, what does that indicate?

A

Lesion to brainstem or upper spine

114
Q

Oculovestibular reflex

A

Done ONLY when the occulocephalic reflex is absent
Irrigate the ear canal with cold water—> if eyes drift towards side of irrigation= brainstem intact

115
Q

Your patient comes in with their upper extremities in a flexed position and their lower extremities in an extended position. What is this called and where does this suggest the lesion is?

A

Decorticate position
Suggests injury in the midbrain

116
Q

Your patient does with their arms and elbow extended, internal rotation and extension of the lower extremities. What is this called and where does this suggest the injury may be?

A

Decerebrate posturing
Caudal (lower) injury

117
Q

Kerning Sign

A

Hip and knee flexed at R ankle and knee is slowly extended by examiner

118
Q

What is positive kerning sign and what is it indicative of?

A

Positive kerning sign= pain or resistance during knee and hip extension
Indicative of meningeal irritation

119
Q

Brudzinski Sign

A

Provider flexes patient’s neck forward—> involuntary flexion of the hips and knees= +

120
Q

Positive straight leg raise

A

Pain at 45 degrees
Pain should be radiating on the Same leg being examined

121
Q

Crossed straight leg raise sign

A

Increased pain on SLR with contralateral leg

PD Exam 3 (3 decks)

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