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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
biceps reflex
C5/6
26
supinator reflex
C6
27
triceps relfex
C7
28
what is hyperreflexia suggestive of
UMN lesion e.g. stroke
29
C5 dermatome area
regimental badge area
30
c6 dermatome area
palmar side thumb
31
c7 dermatome area
palmar side middle finger
32
c8 dermatome area
palmar side little finger
33
t1 dermatome area
medial aspect antecubital fossa | proximal to medial epicondyle humerus
34
sensation tests upper limb
light touch pinprick vibration sense joint position sense
35
checking tone lower limbs
hip rotation: roll thighs knee flex and extend lift knee and drop quickly ankle flex and extend
36
ankle clonus
brisk rhythmic contraction of calf muscles | UMN lesion
37
power hip flexion
L1/L2 | iliofemoral nerve
38
power hip extension
L5/S1 | sciatic nerve
39
power knee flexion
S1 | sciatic nerve
40
power knee extension
L3/L4 | femoral nerve
41
power ankle dorsiflexion
L4/L5 | deep peroneal nerve
42
power ankle plantarflexion
S1/S2 | tibial nerve
43
power big toe extension
L5 deep peroneal nerve extensor hallicus longus
44
testing co-ordination lower limbs
heel shin test
45
knee jerk reflex
L3, L4
46
ankle jerk reflex
S1
47
plantar reflex
L5, S1
48
Babinski's sign
abnormal plantar reflex - extension big toe and spread of other toes suggestive uMN lesion
49
L1
inguinal region + top medial thigh
50
L2
middle and lateral aspect anterior thigh
51
L3
medial aspect knee
52
L4
medial aspect lower leg + ankle
53
L5
dorsum + medial aspect big toe
54
S1
dorsum + lateral aspect little toe
55
what to look for when assessing gait
leg movements patient's posture prescence/absence of arm swing
56
when assessing gait get patient to
walk + turn walk heel to toe rise from sitting walk on tiptoes and heels
57
CN I
olfactory nerve sense of smell not routinely tested
58
CN II
``` optic nerve sighy visual acuity: snellen chart pupillary reflex visual fields visual innattention accomodation ```
59
pupillary reflex afferent and efferent
afferent: optic nerve efferent: occulomotor nerve
60
CN III
oculomotor nerve superior rectus, medial rectus, inferior rectus, inferior oblique, LPS constrictor pupillae and cililiary muscles
61
CN IV
trochlear nerve | superior oblique
62
how are cranial nerves III, IV, VI tested
eye movements - draw H
63
CN V
trigeminal nerve V1: ophthalmic V2: maxillary V3: mandibular
64
testing CNV
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
corneal reflex afferent and efferent
afferent: CN V(1) efferent: CN VII (facual)
66
jaw jerk reflex afferent and efferent
afferent: V(3) efferent: V(3)
67
CN VI
abducens nerve lateral rectus eye muscle
68
CNVII
facial nerve muscles of facial expression taste ant 2/3 tongue secretomotor submandibular + sublingual glands
69
testing CNVII
inspect face for asymmetry motor: wrinkle forehead, screw eyes up, smile with teeth puff out cheeks and I press on them
70
facial nerve palsy, UMN vs LMN
UMN: e.g. stroke, forehead spared LMN: e.g. bell's palsy, forehead lost (can't wrinkle)
71
CNVIII
vestibulocochlear nerve vestibular: equilibrium + balance cochlear: hearing
72
testing CNVIII
vestibular: nystagmus and balance (eye movements + gait) hearing tests from head + neck
73
CN IX
glossopharyngeal sensation pharynx and tonsils sensation + taste pos1/3 tongue stylopharyngeus muscle
74
CN X
vagus | palantine, pharangeal + laryngeal muscles
75
testing IX and X
inspection: open mouth say ah, palate should move symmetrically cough gag reflex
76
gag reflex afferent and efferent
afferent: IX efferent: X
77
CN XI
accessory nerve innervates trapezius and SCM muscles
78
GCS: eye opening
spontaneous: 4 to speech: 3 to pain: 2 no response: 1
79
GCS: verbal response
``` orientated: 5 confused (sentences but disorientated): 4 verbalizes (words not sentences): 3 vocalises (sounds not words): 2 no vocalisation: 1 ```
80
GCS: motor response
``` 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
during fundoscopy; once focused on fundus what to examine
optic disc: shape, colour vessels: appearance retina: colour, haemorrhages?, exudates? macula: ask them to look directly into beam of light
82
neuro systemic enquiry
``` speech disturbance cognitive impairment headache fit/faint/loss consciousness dizzy, vertigo balance vision - acuity, diplopia hearing weakness numbness, tingling, paraesthesia ```
83
key symptoms for headache history
``` nausea + vomiting visual disturbance photophobia neck stiffness fever rash weight loss sleep disturbance ```
84
stroke/TIA symptoms
``` weakness sensory, visual, speech disturbance ataxia dysphagia reduced conscious level pain ```
85
loss of consciousness things to ask
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
oculomotor nerve palsy
down and out appearance eye ptosis miosis
87
trochlear nerve palsy
diploplia
88
abducens nerve palsy
convergent squint | diploplia
89
optic nerve lesion
blindness in one eye e.g. optic neuritis
90
optic chiasm central lesion
bitemporal hemianopia e.g. pituitary tumour
91
optic tract lesion/optic radiation lesion
contralateral homonymous hemianopia e.g. MCA stroke

mOSCEs (13 decks)

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