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OSCE III > Neuro Ddx > Flashcards

Neuro Ddx Flashcards

1
Q

What is the scale for grading reflexes?

A

0 No response

1+ Diminished

2+ Normal

3+ Brisker than average, increased

4+ Hyperactive, very brisk, with clonus (involuntary rhythmic oscillations between flexion and extension)

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2
Q

Positive pronator drift indicates a lesion where?

A

contralateral corticospinal tract

note: even in the presence of overall normal strength, the presence of a pronator drift indicates that there is a lesion somewhere along the path of the pyramidal tract.

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3
Q

What does a positive pronator drift test look like?

A

affected arm starts to pronate and drift downwards, often with flexion at the fingers and elbow

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4
Q

What nerve root/muscle are you testing with strength of shoulder abduction?

A

C5, deltoid

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5
Q

What nerve root/muscle are you testing with strength of elbow flexion?

A

C5, C6, biceps

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6
Q

What nerve root/muscle are you testing with strength of elbow extension?

A

C6, C7, C8-triceps

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7
Q

What nerve root/muscle are you testing with strength of wrist extension?

A

C6-8, radial nerve

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8
Q

What nerve root/muscle are you testing with strength of wrist flexion?

A

C6, C7, median nerve

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9
Q

What nerve root/muscle are you testing with strength of finger extension?

A

C7-8, posterior interosseous nerve

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10
Q

What nerve root/muscle are you testing with strength of finger abduction?

A

C8, T1, ulnar nerve

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11
Q

What nerve root/muscle are you testing with strength of hand grip?

A

C7-8, T1

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12
Q

What nerve root/muscle are you testing with strength of thumb opposition?

A

C8, T1, median nerve

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13
Q

What nerve root/muscle are you testing with strength of hip flexion?

A

L2-4, iliopsoas

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14
Q

What nerve root/muscle are you testing with strength of hip extension?

A

S1, gluteus maximus

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15
Q

What nerve root/muscle are you testing with strength of hip adduction?

A

L2-4, adductors of hip

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16
Q

What nerve root/muscle are you testing with strength of hip abduction?

A

L4-5, S1, Gluteus medius and minimus

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17
Q

What nerve root/muscle are you testing with strength of knee extension?

A

L2-4, quadriceps

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18
Q

What nerve root/muscle are you testing with strength of knee flexion?

A

L4-5, S1-2, hamstrings

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19
Q

What nerve root/muscle are you testing with strength of ankle dorsiflexion?

A

L4-5, tibialis anterior

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20
Q

What nerve root/muscle are you testing with strength of ankle plantar flexion?

A

S1, S2, Soleus

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21
Q

What nerve root/muscle are you testing with strength of great toe dorsiflexion?

A

L5, S1, deep peroneal nerve

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22
Q

Which nerve roots involved in biceps reflex?

A

*C5*, C6

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23
Q

Which nerve roots involved in brachioradialis reflex?

A

C5, *C6*

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24
Q

Which nerve roots involved in triceps reflex?

A

C6, *C7*

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25
Q

Which nerve roots involved in patellar reflex?

A

L2, *L3*, L4

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26
Q

Which nerve roots involved in achilles reflex?

A

*S1*, S2

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27
Q

Draw out how to test extraocular movements. Which directions test each muscle? How are they innervated?

A

LR6SO4

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28
Q

Does CNIII constrict or dilate the pupil?

A

constrict

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29
Q

In a central CN VII lesion, which part of face is affected?

A

Lower face affected, upper half relatively spared

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30
Q

In a peripheral CN VII lesion, which part of the face is affected?

A

both upper and lower face are affected

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31
Q

Which tract carries touch, pain, temperature? Where do they cross?

A

Carried by the small fibers (c-fibers) which enter the lateral spinothalamic tract of the spinal cord and cross to the opposite side in front of the central canal 1 to 2 segments above the level of entry.

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32
Q

Which tract carries vibration and position sense? Where do they cross?

A

Carried by the large fibers which enter the posterior columns of the spinal cord and remain ipsilateral until they cross in the medulla.

33
Q

Light touch tests which tract(s)

A

tests both the spinothalamic tract and the posterior columns

34
Q

Pain/sharp testing assesses which tract?

A

spinothalamic

35
Q

what physical exam finding is typical of distal stocking glove distribution neuropathies?

A

In patients with distal stocking glove distribution neuropathies, the sensation will become stronger as you move proximally.

36
Q

temperature tests which tracts?

A

spinothalamic tracts

37
Q

vibration tests which tract?

A

posterior columns

38
Q

position sense/proprioception tests which tracts?

A

posterior columns

Mild distal vibratory loss can be a normal finding in people older than 65 and vibration sense continues to diminish each decade. Position sense should not change unless there is pathology in the dorsal root, dorsal root ganglion or the posterior columns.

39
Q

what is the pattern of sensory loss for single peripheral nerve?

A

sensory loss in the distribution of the single nerve

40
Q

what is the pattern of sensory loss of single nerve root?

A

sensory loss in a dermatomal distribution of the nerve root

41
Q

what is the pattern of sensory loss for peripheral nerves (diffuse)?

A

stocking and glove type distribution

42
Q

what are the sensory level anatomical landmarks?

A
  • Clavicle: C5
  • Nipples: T4-5
  • Umbilicus: T10
  • Inguinal ligament: L1
43
Q

what do discriminative sensation tests assess for?

A

ability of the cortex to analyze and interpret sensations.

44
Q

impaired stereognosis indicates lesion in ….

A

parietal and/or occipital lobes

45
Q

impaired graphesthesia (number identification) implies lesion in …

A

parietal lobe

46
Q

monofilament test assesses for …

A

peripheral neuropathy

47
Q

The lateral cerebellar hemispheres represent the ________ and the central vermis represents the _______

A

The lateral cerebellar hemispheres represent the extremities and the central vermis represents the trunk

48
Q

What findings would you expect on finger-to-nose and heel-to-shin testing in a pt with unilateral cerebellar lesions?

A

fluctuating velocity of movement and past-pointing on the same side

49
Q

What findings would you expect in a pt with lesion in the vermis?

A

truncal and gait ataxia

50
Q

What is dysdiadochokinesia?

A

inability to perform rapid alternating movements

51
Q

what does the Romberg test assess?

A

posterior columns or proprioceptive function

52
Q

Abnormalities in which functions may be associated with a positive Romberg test?

A

vestibular or cerebellar function

53
Q

What does Spurling’s test assess for?

A

sensitive test for cervical radiculopathy (impingement on cervical nerve root, ex. impingement by herniated disc)

54
Q

what does a positive Spurling’s test look like?

A

pain in affected nerve root distribution due to compression of neuroforaminae

55
Q

What are the signs of C5 cervical radiculopathy?

A

Sensory: lateral elbow

Reflex decreased: biceps (C5/6)

Weakness: elbow flexion (biceps)

56
Q

What are signs of C6 cervical radiculopathy?

A

Sensory: thumb

Reflex decreased: biceps (C5/6), brachioradialis (C5/6)

Weakness: elbow flexion (biceps), pronation (pronator teres)

57
Q

What are signs of C7 cervical radiculopathy?

A

Sensory: 3rd finger

Reflex decreased: triceps (C7/8)

Weakness: elbow extension (triceps)

58
Q

What are signs of C8 cervical radiculopathy?

A

Sensory: 5th finger

Reflex decreased: none

Weakness: finger flexion (flexor digitorum profundus)

59
Q

What are the signs of T1 cervical radiculopathy?

A

Sensory: medial elbow

Reflex decreased: none

Weakness: 5th finger abduction (abductor digiti minimi)

60
Q

what does the straight leg raise test assess for?

A

sensitive test for lumbar radiculopathy (impingement or irritation of a lumbar nerve root, ex. impingement by herniated disc)

61
Q

what does a positive straight leg raise test look like?

A

pain in radicular pattern radiating into the ipsilateral lower limb

62
Q

What are the signs of an L2 lumbosacral radiculopathy?

A

Sensory: anterior thigh

Reflex decreased: none

Weakness: hip flexion (iliopsoas)

63
Q

what are the signs of an L3 lumbosacral radiculopathy?

A

Sensory: medial knee

Reflex decreased: patella

Weakness: knee extension (quadriceps)

64
Q

what are the signs of an L4 lumbosacral radiculopathy?

A

Sensory: medial ankle

Reflex decreased: patella

Weakness: ankle dorsiflexion (tibialis anterior)

65
Q

what are the signs of an L5 lumbosacral radiculopathy?

A

Sensory: dorsal foot

Reflex decreased: medial hamstring

Weakness: great toe extension (extensor hallucis longus)

66
Q

what are the signs of an S1 lumbosacral radiculopathy?

A

Sensory: sole of foot

Reflex decreased: achilles

Weakness: plantar flexion (gastrocnemius)

67
Q

what are the signs of an S2 lumbosacral radiculopathy?

A

Sensory: popliteal fossa

Reflex decreased: none

Weakness: none

68
Q

what are some causes of central CN VII palsies?

A

stroke

tumor (in CNS from cortex to pons)

69
Q

what are some causes of peripheral CN VII palsies?

A

Bell’s palsy (idiopathic or due to activation of HSV/VCV or Lyme or HIV)

otitis media

cholesteatoma

sarcoidosis

sjogren’s syndrome

tumor (in PNS from pons to face, ex. a parotid tumor)

70
Q

where does the corticospinal tract decussate?

A

at caudal medulla at the pyramids

71
Q

what is the function of the dorsal columns? is it ascending or descending?

A

ascending (sensory) pressure, vibration, fine touch, proprioception

72
Q

where do the dorsal columns decussate?

A

in medulla

73
Q

what is the function of the spinothalamic tract? is it ascending or descending?

A

ascending (sensory) lateral: pain, temperature anterior: crude touch, pressure

74
Q

damage to corticospinal tract will cause function reduction/loss [above/below] lesion

A

below

75
Q

UMN damage above crossover in medulla causes impairment on [same/opposite] side of body

A

opposite

76
Q

UMN damage below crossover in medulla causes impairment on [same/opposite] side of body

A

same

77
Q

UMN lesion signs

A

“everything up” increased: reflexes, tone

pos. Babinski (upgoing toes), spastic paralysis

can also have: weakness (not specific)

78
Q

LMN lesion signs

A

“everything lowered” decreased: reflexes, tone

neg Babinski (downgoing toes), flaccid paralysis c

an also have: weakness (not specific), atrophy, fasciculations

OSCE III (4 decks)

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