Neuro Complaint

Question 1

What do you start a neuro exam with?

Answer 1

Alert and orientation questions! (A&OX4)

Question 2

A reversible condition that is common in older adults during hospitalization

Answer 2

Delirium

Question 3

A non-reversible condition with memory loss

Answer 3

Dementia

Question 4

What must you rule out before diagnosing dementia?

Answer 4

Depression and Delirium

Question 5

What can be seen with a CN3 lesion?

Answer 5

ptosis, pupil asymmetry, opthalmoplegia = down and out

Question 6

What can be seen with a CN4 palsy?

Answer 6

Eye drifts upwards, vertical diplopia (double vision when looking down like to walk down stairs), head tilting away from lesion side

Question 7

What can be seen with CN6 palsy?

Answer 7

Inability to ABduct eye

Question 8

What can be seen with a CN5 palsy?

Answer 8

Decreased sensation from face, loss of corneal reflex and jaw deviation towards weak side

Question 9

Trigeminal neuralgia

Answer 9

Recurrent brief episodes of shock like pain that follow a CNV distribution on the face

• Caused from compression via vein or artery
• Can be elicited by touching face

Question 10

What can be seen with CN7 palsy?

Answer 10

Paralysis of facial expression muscles, loss of corneal reflex, increased sensitivity to sound

Question 11

Bell’s palsy?

Answer 11

Loss of muscle control on one side of the face

Question 12

Crocodile tears syndrome

Answer 12

Crying while chewing

Question 13

Vestibular division CN8 lesion?

Answer 13

Imbalance and nystagmus

Question 14

Cochlear division CN8 lesion?

Answer 14

Hearing loss and ringing in ears

Question 15

What is nystagmus?

Answer 15

Rhythmic oscillations of the eyes

Question 16

What are a few tests to look for meningitis?

Answer 16

Nuchal rigidity, Brudzinski sign, Kernig sign

Question 17

Describe the Brudzinski sign

Answer 17

pt supine, physician slowly flexes their neck

(+) = patient flexes hips and knees involuntarily

Question 18

Describe the Kernig sign

Answer 18

pt supine, physician flexes at hip and knee
- Physician then extends knee but keeps hip flexed
(+) = pain/resistance to knee extension or passive flexion of neck

Question 19

Lhermitte’s Phenomenon

Answer 19

Transient shock like symptoms that occur down spine and into limbs with flexion of the neck

Question 20

What is Lhermitte’s Phenomenon associated with?

Answer 20

Multiple sclerosis

Question 21

Hyperactive DTR?

Answer 21

CNS lesion

Question 22

Hypoactive DTR?

Answer 22

PNS lesion

Question 23

Babinski reflex?

Answer 23

Stroke plantar surface of lateral foot from heal to ball of big toe
(+) = dorsiflexion of toes and fanning
Could indicate CNS lesion

Question 24

Types of headaches?

Answer 24

Tension, migraine, cluster

Question 25

Qualities of a tension headache

Answer 25

Minutes to days
Starts posteriorly and radiates forward
Non-constant pressure

Question 26

Qualities of a migraine headache

Answer 26

4-72 hours
Unilateral but can be bilateral in children
Severe, needs room with no stimulus (light)

Question 27

Qualities of a cluster headache

Answer 27

15 mins-3 hours
Always unilateral near eye/temple
Sharp stabbing pain

Question 28

What symptoms are red flags for a possible dangerous mass?

Answer 28

SNOOP

Systemic, neuro symptoms, old age, onset sudden, papilledema

Question 29

What to check for with dizziness?

Answer 29

TiTrATE
Timing
Triggers
A and a Target Examination

Question 30

Hallpike maneuver

Answer 30

Head rotated 45 degrees and then pt laid down supine

Question 31

What is syncope?

Answer 31

Fainting

Question 32

Possible causes of syncope?

Answer 32

Vasovagal

Carotid sinus syndrome

Question 33

Vasovagal

Answer 33

Over correction to a stimulus of SNS (pain, sight of blood, etc.)