Neuro

Question 1

Examination of olfactory nerve

Answer 1

-abnormal olfactory nerve examination findings may be seen in otherwise normal elderly but may also be associated with other conditions such as parkinson’s disease

Question 2

conduction a mental status exam and note impairment of speech and judgement, but rest of exam is intact. Where is the most likely location of the problem

Answer 2

• cerebrum

- cerebrum is responsible for higher cognitive functions such as speech and judgement

Question 3

patient presents with daily headache which has worsened over the past several months. On funduscopic exam, you notice that the disc edge is indistinct and the veins do not pulsate. What is most likely?

Answer 3

• increased intracranial pressure
• description of papilledema - which should make you think of increase intracranial pressure
• patient may have a brain tumor or benign intracranial hypertension
• findings cannot be ignored and should be acted upon quickly

Question 4

Young woman comes in complaining of fatigue, irregular menses and polyuria which have gradually increased over the past few months. What eye finding would be consistent with her condition

Answer 4

• bitemporal hemianopsia
• symptoms are consistent with a pituitary lesion
• enlargement of tumor in this area would compress the fibers responsible for lateral vision fields

Question 5

ability to move an extremity - but not against gravity represents what muscle strength (for example young man following a spinal trauma from a motor vehicle accident. He cannot lift his hand upward, but if the arm is abducted to 90 degrees, he can then move his forearm side to side.)

Answer 5

represents strength of 2/5

• zero represents no muscular contraction detected
• 1 represents a contraction but no movement of the extremity
• 3 means the extremity can move against gravity but not against resistance
• 4 means perceived weakness but the patient can oppose some resistance
• 5 is normal

Question 6

pronator drift

Answer 6

• signifies decreased position sense involvement of the corticospinal tract.
• patient asked to hold arms up, with palms up and then to close eyes. The right arm begins to move downward after a few seconds and her thumb rotates upward.

Question 7

a patient with alcoholism is brought in with confusion. you ask him to “stop traffic” with his palms and notice that every few seconds his palms suddenly move toward the floor. what does this indicate?

Answer 7

• metabolic problems

- this is asterixis and represents that inability to maintain a sustained contraction of the muscles

Question 8

obtunded

Answer 8

-responsive but slow speaking and less interested in surroundings

Question 9

lethargy

Answer 9

-opens eyes to verbal cues and may respond appropriately but promptly falls back to sleep

Question 10

stupor

Answer 10

• responds only to painful stimuli
• when stimulus is withdrawn lapses into unconsciousness again
• have little awareness of self or environment

Question 11

comatose

Answer 11

-no obvious response to external stimuli

Question 12

chorea

Answer 12

• brief, rapid, jerky, irregular movements

- can occur at rest or during other intentional movement

Question 13

tics

Answer 13

irregular but tend to be stereotyped and can be vocal (throat clearing), facial expressions or shoulder shrugging

Question 14

athetosis

Answer 14

slow, squirming motion usually affecting the face and distal extremities.

Question 15

dystonia

Answer 15

similar to athetosis but movements are more coarse and can involve twisted postural changes