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X Physical Diagnosis Final > Neuro Assessment > Flashcards

Neuro Assessment Flashcards

1
Q

What is a gait that lacks coordination and stability?

A

Ataxic- due to cerebellar disease, loss of position sense or intoxication

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2
Q

What is steppage gait?

A

“Foot drop”
Pt drags foot/ft or lifts them high, then foot slaps floor
Unilateral or bilateral

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3
Q

What causes steppage gait?

A

Tibialis anterior and toe extensor weakness

Lower motor neuron/peripheral nerve injury (L4/L5)

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4
Q

What is spastic hemiparesis?

A

When pt drags toe, circle leg stiffly outward and forward (circumduction) or lean trunk to contralateral side to clear affected leg during walking
Affected leg extensors are spastic, ankles are plantar-flexed and inverted

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5
Q

What occurs in the UE during spastic hemiparesis?

A

Affected arm is flexed, immobile and held close to side, with elbow, wrists and interphalangeal joints flexed

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6
Q

What causes spastic hemiparesis?

A

Corticospinal tract lesions (stroke)

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7
Q

What is scissors gait?

A

Pts advance each leg slowly and thighs tend to cross
Stiff gait and short steps
Look like they’re “walking through water”

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8
Q

What causes scissors gait?

A

Spinal cord disease and spasticity disorders (cerebral palsey)

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9
Q

What is sensory ataxia?

A

Unsteady gait and wide based stance
Throw feet forward and outward, first bring down heel then toes with double tap
They watch the ground (probably walk assist device)

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10
Q

What causes sensory ataxia?

A

Loss of proprioception (polyneuropathy or posterior column damage)

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11
Q

What is a Parkinsonian gait?

A

Stooped posture with head, arm, hip and knee flexion
Shuffling, short steps, slow to start
Decreased arm swing and stiff turns
Pill rolling tremor

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12
Q

What causes Parkinsonian gait?

A

Basal ganglia abnormalities (Parkinson disease)

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13
Q

What does coordination require?

A

Integration of the nervous system (motor, cerebellar-control, vestibular-balance, sensory)

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14
Q

Romberg test

A

Position sense

Stand with feet together, eyes closed

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15
Q

What is an abnormal Romberg test?

A 
Unable to maintain upright posture
Dorsal column disease causing loss of position sense
Cerebellar ataxia (can't balance eyes open or closed)
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16
Q

When do you see an abnormal pronator drift test?

A

Upper motor neuron lesion due to possible stroke

Can’t keep arms at shoulder height or arm pronates/drifts downward

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17
Q

What causes an abnormal heel to shin test?

A

Cerebellar disease: heel overshoots knee and foot oscillates side to side
Position sense absent: heel lifts too high

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18
Q

What causes an abnormal finger-to-nose test?

A

Intentional tremor-multiple sclerosis

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19
Q

When do you see an abnormal rapid alternating movements test?

A

Cerebellar disease: slow, clumsy, irregular movement (dydiadochokinesis)

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20
Q

A and O x 4

A

Alert and oriented to person, place, time and situation

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21
Q

Abnormal CN I

A

Anosmia

Head trauma, Parkinsons

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22
Q

Abnormal CN II

A

Visual field defect, 2 degree retinal emboli, optic neuritis, pituitary tumor, stroke

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23
Q

Abnormal CN III

A

Vertical and horizontal diplopia

Ptosis=CN III palsy

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24
Q

Abnormal CN IV

A

Vertical diplopia (might have trouble going down stairs)

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25
Q

Abnormal CN V

A

Trigeminal neuralgia

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26
Q

Abnormal CN VI

A

Horizontal diplopia, esotropia

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27
Q

Abnormal CN VII

A

Peripheral- Bell’s palsy

Central- cerebral infarct

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28
Q

Abnormal CN VIII

A

Disequilibrium, vertigo, nystagmus

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29
Q

Abnormal CN IX

A

No gag reflex, loss of taste posterior 1/3 of tongue

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30
Q

Abnormal CN X

A

Hoarseness, dyspnea, dysarthria, loss of gag reflex

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31
Q

Abnormal CN XI

A

Trap weakness, atrophy and fasiculations=scapular winging

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32
Q

Abnormal CN XII

A

Central lesion= tongue deviates away

Peripheral lesion= tongue deviates to weak side

33
Q

Upper extremity dermatomes

A 
Lateral upper arms (C5)
Radial forearm and thumb (C6)
Middle finger (C7)
Ring and little finger (C8)
Ulnar forearm (T1)
34
Q

Abdomen dermatomes

A

Nipple (T4)
Umbilicus (T10)
Inguinal region (L1)

35
Q

Lower extremity dermatomes

A

Anterior/proximal thigh (L3)
Knee/medial shin (L4)
Lateral shin, dorsal foot to great toe (L5)
Lateral and plantar foot (S1)

36
Q

Streognosis

A

Ask patient to recognize a familiar object

37
Q

Graphesthesia

A

Number identification

38
Q

Two point discrimination

A

Alternate double and single stimulus

Normal <5 mm on finger pads

39
Q

Extinction

A

Touch pt in same place on both sides of body

40
Q

Abnormal body position

A

Mono or hemiparesis (stroke)

41
Q

Static tremor

A 
Seen at rest
Parkinson disease (pill rolling tremor)
42
Q

Postural tremor

A

Seen when affected areas maintains posture

Hyperthyroid, anxiety, fatigue, benign essential

43
Q

Intention tremor

A

Absent at rest, appear with movement

Multiple sclerosis

44
Q

Tics

A

Brief, repetitive, twitching

Tourette syndrome, medications

45
Q

Dystonia

A

Twisted posture of large body parts

Medications, spasmodic torticollis

46
Q

Dyskinesias

A

Bizarre, rhythmic, repetitive movements

Parkinsons, psychoses, medications

47
Q

Akathisia

A

Inability to sit still

Meds (antipsychotics, Compazine)

48
Q

Chorea

A

Brief, jerky, unpredictable movements

Huntingtons, rheumatic fever

49
Q

Athetosis

A

Slow, twisting, writhing movements

Cerebral palsy

50
Q

When do you see muscle bulk?

A

Lower peripheral nerve problem

51
Q

What causes hypotonia/flaccidity?

A

Central and peripheral causes

52
Q

What causes spasticity?

A

Central corticospinal tract disease

Increased muscle tone, velocity dependent

53
Q

What causes rigidity?

A

Cog-wheel rigidity (Parkinsons)

Increased resistance throughout ROM

54
Q

Nerve root and peripheral nerve shoulder abduction

A

C5- axillary

55
Q

Nerve root and peripheral nerve elbow flexion

A

C5, C6- musculocutaneous

56
Q

Nerve root and peripheral nerve elbow extension

A

C6, C7- radial

57
Q

Nerve root and peripheral nerve wrist extension

A

C6, C7- radial

58
Q

Nerve root and peripheral nerve wrist flexion

A

C7, C8- median

59
Q

Nerve root and peripheral nerve finger abduction

A

C8, T1- ulnar

60
Q

Nerve root and peripheral nerve thumb opposition

A

C8, T1- median

61
Q

Nerve root and peripheral nerve hip flexion

A

L2, L3- femoral

62
Q

Nerve root and peripheral nerve hip extension

A

L4, L5- gluteal

63
Q

Nerve root and peripheral nerve knee extension

A

L3, L4- femoral

64
Q

Nerve root and peripheral nerve knee flexion

A

L5, S1- sciatic

65
Q

Nerve root and peripheral nerve ankle dorsiflexion

A

L4, L5- peroneal

66
Q

Nerve root and peripheral nerve ankle plantar flexion

A

S1- plantar

67
Q

How to rate DTRs

A 
0- no response
\+1- diminished
\+2- normal
\+3- increased
\+4- hyperactive, associated with clonus
68
Q

Hypoactive DTRs

A

Diminished or absent
Diseases of spinal nerve roots or peripheral nerves
Additional findings in LMN disease (weakness, atrophy, fasciculations)

69
Q

Hyperactive DTRs

A

Brisk and can be associated with clonus
CNS lesions along descending corticospinal tract
Additional findings in UMN disease (weakness, spasticity, positive babinski)

70
Q

What DTRs do you test?

A

Biceps, brachioradialis, triceps, patella, achilles

71
Q

How do you test for clonus?

A

Alternate dorsi and plantar flexing pts ankle, then briskly dorsiflex ankle-evaluate rhythmic oscillation
Can be normal bilaterally (if abnormal check wrist)

72
Q

When do you see abnormal clonus?

A

Upper motor neuron disease (4+)

73
Q

What does Babinski test?

A

L5, S1- normal for toes to flex

74
Q

When do you see an abnormal Babinski response?

A

CNS lesion affecting corticospinal tract (great toe extends and other toes fan out)

75
Q

When do you see an abnormal superficial abdominal reflex?

A

Central and peripheral pathologies

76
Q

When do you see an abnormal cremasteric reflex?

A

UMN, LMN or L1, L2 nerve injury

Ilioinguinal injury s/p hernia repair

77
Q

What is Brudzinski sign?

A

Normal- pts remains relaxed

Abnormal- hip and knee flexion

78
Q

What is nuchal rigidity?

A

Place hands behind pts head and flex toward chest
Normal- easy motion
Abnormal- pain and resistance indicating potential meningeal irritation

79
Q

What is Kernig sign?

A

Flex pts hip and knee, then straighten knee
Normal- may have tightness in hamstring
Abnormal- back pain and resistance indicating meningeal irritation

X Physical Diagnosis Final (4 decks)

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