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neuro Flashcards

1
Q

observation of upper limbs

A 
muscle atrophy 
fasciculations 
skeletal deformity 
scars
tremors
involuntary movements
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2
Q

physiological tremor

A

fine, fast upper limb tremor

increased by anxiety, alcohol excess, hyperthyroidism

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3
Q

parkinsonian tremor

A

slow, coarse, greater at rest, usually asymetrical

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4
Q

dystonia

A

sustained muscle contractions

twisting + repetitive

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5
Q

chorea + athetosis

A

writhing movements

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6
Q

ballismus

A

violent swinging movements

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7
Q

ticks

A

repetitive + stereotyped

can be suppressed by patient

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8
Q

when assessing tone of upper limbs what movements are looked at

A

passive movement of elbow flexion + extension, forearm supination + pronation and wrist flexion + extension

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9
Q

spasticity

A

form of hypertonia

velocity dependent - worse when moved quicker
varies throughout joint motion
UMN lesion, may be accompanied by weakness and hyperreflexia

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10
Q

rigidity

A

form of hypertonia
sustained resistance even with slow movement and present throughout full joint motion

lead-pipe rigidity
cog-wheel rigidity

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11
Q

what movements are tested during upper limb power

A 
shoulder abduction 
elbow flexion + extension 
wrist flexion and extension 
finger extension
finger flexion 
finger abduction 
thumb abduction
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12
Q

what nerves + muscles being tested during resistance of shoulder abduction

A

C5
axillary nerve

deltoid and other shoulder abductors

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13
Q

what nerves + muscles being tested during power of elbow flexion

A

C5/6
musculocutenous and radial nerves

biceps brachii, coracobrachialis, brachialis

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14
Q

what nerves + muscles being tested during resistance of elbow extension

A

C7
radial nerve
triceps brachii

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15
Q

what nerves + muscles being tested during power of wrist extension

A

C6
radial nerve
extensors of wrist

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16
Q

what nerves + muscles being tested during power of wrist flexion

A

C6/7
median nerve
flexors of wrist

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17
Q

what nerves + muscles being tested during resistance of finger extension

A

C7
radial nerve
extensor digitorum

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18
Q

what nerves being tested during resistance of finger flexion

A

median and ulnar nerves

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19
Q

what nerves + muscles being tested during resistance of finger abduction

A

T1
ulnar nerve
intrinsic muscles hanfd

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20
Q

what nerves + muscles being tested during resistance of thumb abduction

A

T1
median nerve
abductor pollicis brevis

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21
Q

UMN lesion pattern of weakness

A

pyramidal pattern of weakness that disproportionately affects upper limb extensors and lower limb flexors

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22
Q

LMN lesion pattern of weakness

A

focal pattern of weakness

only muscles directly innervated by damaged neurones affected

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23
Q

what does presence of pronator drift indicate

A

contralateral pyramidal tract lesion

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24
Q

co-ordination tests upper limb

A

outstretched arms
finger-nose test
rapid alternating hand movements

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25
Q

biceps reflex

A

C5/6

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26
Q

supinator reflex

A

C6

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27
Q

triceps relfex

A

C7

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28
Q

what is hyperreflexia suggestive of

A

UMN lesion e.g. stroke

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29
Q

C5 dermatome area

A

regimental badge area

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30
Q

c6 dermatome area

A

palmar side thumb

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31
Q

c7 dermatome area

A

palmar side middle finger

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32
Q

c8 dermatome area

A

palmar side little finger

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33
Q

t1 dermatome area

A

medial aspect antecubital fossa

proximal to medial epicondyle humerus

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34
Q

sensation tests upper limb

A

light touch
pinprick
vibration sense
joint position sense

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35
Q

checking tone lower limbs

A

hip rotation: roll thighs
knee flex and extend
lift knee and drop quickly
ankle flex and extend

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36
Q

ankle clonus

A

brisk rhythmic contraction of calf muscles

UMN lesion

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37
Q

power hip flexion

A

L1/L2

iliofemoral nerve

38
Q

power hip extension

A

L5/S1

sciatic nerve

39
Q

power knee flexion

A

S1

sciatic nerve

40
Q

power knee extension

A

L3/L4

femoral nerve

41
Q

power ankle dorsiflexion

A

L4/L5

deep peroneal nerve

42
Q

power ankle plantarflexion

A

S1/S2

tibial nerve

43
Q

power big toe extension

A

L5
deep peroneal nerve
extensor hallicus longus

44
Q

testing co-ordination lower limbs

A

heel shin test

45
Q

knee jerk reflex

46
Q

ankle jerk reflex

47
Q

plantar reflex

48
Q

Babinski’s sign

A

abnormal plantar reflex - extension big toe and spread of other toes
suggestive uMN lesion

49
Q

L1

A

inguinal region + top medial thigh

50
Q

L2

A

middle and lateral aspect anterior thigh

51
Q

L3

A

medial aspect knee

52
Q

L4

A

medial aspect lower leg + ankle

53
Q

L5

A

dorsum + medial aspect big toe

54
Q

S1

A

dorsum + lateral aspect little toe

55
Q

what to look for when assessing gait

A

leg movements
patient’s posture
prescence/absence of arm swing

56
Q

when assessing gait get patient to

A

walk + turn
walk heel to toe
rise from sitting
walk on tiptoes and heels

57
Q

CN I

A

olfactory nerve
sense of smell
not routinely tested

58
Q

CN II

A 
optic nerve 
sighy
visual acuity: snellen chart
pupillary reflex
visual fields
visual innattention 
accomodation
59
Q

pupillary reflex afferent and efferent

A

afferent: optic nerve
efferent: occulomotor nerve

60
Q

CN III

A

oculomotor nerve
superior rectus, medial rectus, inferior rectus, inferior oblique, LPS
constrictor pupillae and cililiary muscles

61
Q

CN IV

A

trochlear nerve

superior oblique

62
Q

how are cranial nerves III, IV, VI tested

A

eye movements - draw H

63
Q

CN V

A

trigeminal nerve

V1: ophthalmic
V2: maxillary
V3: mandibular

64
Q

testing CNV

A

sensory:
V1: forehead
V2: cheek
V3: lower jaw

motor (v3)

  • palpate masseter then get them clench teeth
  • open jaw against resistance (pterygoids)

corneal reflex

jaw jerk reflex

65
Q

corneal reflex afferent and efferent

A

afferent: CN V(1)
efferent: CN VII (facual)

66
Q

jaw jerk reflex afferent and efferent

A

afferent: V(3)
efferent: V(3)

67
Q

CN VI

A

abducens nerve

lateral rectus eye muscle

68
Q

CNVII

A

facial nerve
muscles of facial expression
taste ant 2/3 tongue
secretomotor submandibular + sublingual glands

69
Q

testing CNVII

A

inspect face for asymmetry
motor: wrinkle forehead, screw eyes up, smile with teeth
puff out cheeks and I press on them

70
Q

facial nerve palsy, UMN vs LMN

A

UMN: e.g. stroke, forehead spared

LMN: e.g. bell’s palsy, forehead lost (can’t wrinkle)

71
Q

CNVIII

A

vestibulocochlear nerve

vestibular: equilibrium + balance
cochlear: hearing

72
Q

testing CNVIII

A

vestibular: nystagmus and balance (eye movements + gait)

hearing tests from head + neck

73
Q

CN IX

A

glossopharyngeal

sensation pharynx and tonsils
sensation + taste pos1/3 tongue
stylopharyngeus muscle

74
Q

CN X

A

vagus

palantine, pharangeal + laryngeal muscles

75
Q

testing IX and X

A

inspection: open mouth say ah, palate should move symmetrically

cough

gag reflex

76
Q

gag reflex afferent and efferent

A

afferent: IX
efferent: X

77
Q

CN XI

A

accessory nerve

innervates trapezius and SCM muscles

78
Q

GCS: eye opening

A

spontaneous: 4
to speech: 3
to pain: 2
no response: 1

79
Q

GCS: verbal response

A 
orientated: 5
confused (sentences but disorientated): 4
verbalizes (words not sentences): 3
vocalises (sounds not words): 2
no vocalisation: 1
80
Q

GCS: motor response

A 
obeys commands: 6
localises to pain: 5
normal flexion to pain (no localisation): 4
abnormal flexion to pain: 3
extension to pain: 2
no response: 1
81
Q

during fundoscopy; once focused on fundus what to examine

A

optic disc: shape, colour

vessels: appearance
retina: colour, haemorrhages?, exudates?
macula: ask them to look directly into beam of light

82
Q

neuro systemic enquiry

A 
speech disturbance
cognitive impairment
headache
fit/faint/loss consciousness
dizzy, vertigo 
balance
vision - acuity, diplopia 
hearing 
weakness
numbness, tingling, paraesthesia
83
Q

key symptoms for headache history

A 
nausea + vomiting 
visual disturbance
photophobia 
neck stiffness
fever
rash
weight loss
sleep disturbance
84
Q

stroke/TIA symptoms

A 
weakness
sensory, visual, speech disturbance
ataxia
dysphagia 
reduced conscious level 
pain
85
Q

loss of consciousness things to ask

A

before: triggers, prodromal symptoms
during: motor (flaccid, stiff, jerky, eyes), how long?, tongue bite, incontinent
after: time to full recovery, helping factors, pain, injuries sustained

86
Q

oculomotor nerve palsy

A

down and out appearance eye
ptosis
miosis

87
Q

trochlear nerve palsy

88
Q

abducens nerve palsy

A

convergent squint

diploplia

89
Q

optic nerve lesion

A

blindness in one eye

e.g. optic neuritis

90
Q

optic chiasm central lesion

A

bitemporal hemianopia

e.g. pituitary tumour

91
Q

optic tract lesion/optic radiation lesion

A

contralateral homonymous hemianopia

e.g. MCA stroke

OSCEs (18 decks)

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