Neuro Exam 1 Flashcards
Psychiatric History Question
Do you have any concerns about your mental health such as excessive sadness, memory difficulties, difficulty sleeping, etc?
Neurologic History Question
Do you have problems with dizziness or headaches? Any problems with movement or abnormal sensations?
SNMFF
- Seizures
- Nutrition
- Medications
- Fever
- Focal
What is vertigo and where is the malfunction?
Feelings of movement; vestibular apparatus (ear or brainstem)
What is ataxia and where is the malfunction?
Feelings of imbalance; malfunction of cerebellum, eyes, ears, proprioreceptors
Insomnia vs. Hypersomnia
Trouble falling and staying asleep; sleeping too much or problems with staying awake
What level of function is a headache?
Lower level
7 things that could cause a headache
- Meningeal irritation (meningitis, hemorrhage)
- Elevated intraocular pressure (acute glaucoma)
- Abnormal sensory function (migraine)
- Sinus pressure (sinusitis)
- Elevated intracranial pressure (tumors, trauma)
- Somatization (depression)
- Scalp injury/inflammation (temporal arteritis)
5 components of the neuro exam
- Mental status (neuro 1)
- Cranial nerves
- Motor system
- Sensory system
- Reflexes
What are the 5 components to the Mental Status Examination?
- Appearance and behavior (what you see)
- Speech and language (what you hear)
- Mood (how they feel)
- Thoughts and perceptions (less concrete thinking)
- Cognitive function (more concrete thinking abilities)
What 6 things do we look for in Appearance and Behavior?
- Facial expression
- Relationship to people and things
- Affect and manner
- Grooming, dress, personal hygiene
- Posture and motor behavior
- Level of consciousness
What 4 things do we look for in Relationship to People and Things?
- Hallucinations (hearing or seeing things)
- Paranoia (anger or suspiciousness)
- Schizophrenia (flat affect and remoteness)
- Dementia
How is the apathy of dementia dulled?
Detachment and indifference
What do we look for in Manner and Affect?
Assess the patient’s affect (external expression of inner emotional state)
What 3 things do we look for in assessing the patient’s affect? (Manner and Affect)
- Variability
- Inappropriateness
- Mania
What 4 things do we look for in Dress, Grooming, and Personal Hygiene?
- Clean clothing
- Compared clothing to people of comparable age
- Compared grooming and hygiene to people of comparable age
What 3 things do we look for in Posture and Motor Behavior?
- Posture and patient’s ability to relax
- Prefer to lie in bed or to walk around?
- Pace, range, and character of movements
What 5 things do we look for in Level of Consciousness? What detail is associated with each?
- Stupor (applying painful stimulus)
- Coma (unarousable with eyes closed)
- Obtundation (shake the patient gently as if awakening)
- Alertness (normal)
- Lethargy (speaking to patient in loud voice)
What 3 things could a Coma be affecting?
- 2 brain hemispheres
- Brainstem
- Both
If a patient is in a coma, does the normal examination occur?
No
What scale can we use for patient’s in a coma?
Glasgow Coma Scale
What are the 3 parts to the Glasgow Coma Scale? What would a deceased patient score?
- Eye
- Motor response
- Verbal response
Score = 3
What are the 2 Cardinal DONT’s in a coma examination?
- Don’t dilate the pupils
2. Don’t flex the neck
What findings should we specifically look for in a coma exam?
Focal or asymmetric findings
What is a Focal Finding?
A certain part of the limb or body wasn’t working; i.e. 1 hand, or 1 foot, etc
What 2 classifications are there for causes of coma?
- Toxic-Metabolic
2. Structural
What is the pathophysiology of a Toxic-Metabolic cause of coma?
Arousal centers poisoned or critical substrates depleted
What is the pathophysiology of a structural cause of coma?
Lesion destroys or compresses brainstem arousal nerves, either directly or secondary to more distant expanding mass lesions
What 3 Clinical Features do we look for in a coma?
- Respiratory pattern
- Pupillary size and reaction
- Level of consciousness
What is the Toxic-Metabolic clinical finding for Pupillary Size and Reaction?
Equal, reactive to light. If pinpoint from opiates or cholinergics, you may need a magnifying glass to see the reaction
What is the Structural finding for Pupillary Size and Reaction?
Unequal/unreactive to light (fixed) or mid position fixed suggesting midbrain compression
What is the Toxic-Metabolic finding for Level of Consciousness?
Changes AFTER pupils change
What is the Structural finding for Level of Consciousness?
Changes BEFORE pupils change
What are 5 examples of Toxic-Metabolic causes for a coma?
- Meningitis
- Uremia
- Drugs
- Ischemia
- Alcohol
What are 4 examples of Structural causes for a coma?
- Hemorrhage
- Abscess
- Cerebral infart/embolus
- Tumor
What are 4 types of pupils in comatose patient?
- Small or pinpoint pupils
- Large pupils
- Mid position fixed pupils
- One large pupil
What is associated with small/pinpoint pupils?
Effects of morphine
What damage is associated with Mid Position Fixed Pupils?
Damage to the midbrain
What could cause Large Pupils fixed bilaterally and dilated?
Severe anoxia
What does One Large Pupil warn of?
Herniation of the temporal lobe
What are the 6 types of Brain Herniation?
- Cingulate
- Uncal
- Central
- Cerebellotonsillar
- Upward
- Transcalvarial
What is associated with “Doll’s Eye Movements”?
Oculocephalic Reflex for comatose patients
Explain Doll’s Eye Movements
- Brain stem is intact
- Eyes don’t passively move in the same direction as turning the head, remain looking forward
- Eyes turn towards cold water side in ear
What is associated with Caloric Stimulation?
Oculovestibular Reflex for comatose patients
Explain Caloric Stimulation
- Brain stem depressed
- Eyes passively move with turning head
- Eyes don’t move when cold water injected into ear
What are the 2 types of laying posture we look at for comatose patients?
- Decerbrate
2. Decorticate
Explain Decerebrate Posture
- Damage to upper brainstem
- Arms adducted and extended
- Wrists pronated and fingers flexed
- Legs stiffly extended with plantar flexion
Explain Decorticate Posture
- Damage to 1 or both corticospinal tracts
- Arms adducted and flexed
- Wrists and fingers flexed on chest
- Legs stiffly extended and internally rotated with plantar flexion of feet
What 4 things do we look for in Speech and Language?
- Quantity
- Quality
- Rate
- Volume
What 2 things are associated with the Quality of speech?
- Articulation of words
2. Fluency
What problem is associated with Articulation of Words?
Dysarthria - difficulty articulation clear speech
What 4 things are involved in Fluency of Speech?
- Hesitancies and gaps
- Montone
- Circumlocutions
- Paraphasias
What is Circumlocutions?
Substituting phrases for a word; “Give me that thing you write with” instead of “Give me a pen”
What is Paraphasisas?
Malformed words, wrong words, or invented words
What does abnormal Quality of Speech suggest? What may the patient have difficulty with?
Aphasia; talking or understanding others
What could slow speech suggest?
Depression
What could accelerated speech suggest?
Mania
Explain Broca’s Area
- Responsible for precise control of the mouth and larynx muscles
- Seat of grammar, comprehension, and production
Explain Wernicke’s Area
Home of meaning; posterior to Broca
What can affect performance when testing for Aphasia?
Deficiencies in vision, hearing, intelligence, and education
How do we assess mood?
Exploring patient’s perceptions of his or her mood
What do we do if we suspect depression?
Assess its depth and any associated risk of suicide
What 10 things are associated with Thought and Perceptions? Give a detail about each.
- Circumstantiality - unnecessary detail
- Derailment (loosening of associations)- shifts from one subject to others
- Flight of ideas - accelerated speech in which a person changes abruptly from topic to topic
- Neoglisms - invented or distorted words
- Incoherence - largely incomprehensible because of illogic
- Blocking - interruption of speech
- Confabulation - fabrication of facts or events in response to questions to fill in gaps in impaired memory
- Perseveration - persistent repetitions of words
- Echolalia - repetition of words and phrases of others
- Clanging - choosing word on basis of sound; “Look at my eyes and nose, wise eyes and rosy nose. Two to one, the ayes”
What are the 7 abnormalities of Thought Content?
- Compulsions (repetitive)
- Obsessions
- Phobias (unrationalized fear)
- Anxieties (focused or free fears/tensions)
- Feelings on unreality
- Feelings of depersonalization (detached mind and body)
- Delusions vs. Illusion
Give an example question to get Insight into a patient? Do psychotic patient’s have insight about this?
“What brings you to the hospital?”
No
How do we assess Judgement?
Patient’s responses to family situations, jobs, use of money, and interpersonal conflicts
Give 2 example questions for Judgement
- How do you plan to get help after you leave the hospital?
2. How are you going to manage if you lose your job?
Can psychotic patients participate in abstract thinking?
No; saying “Don’t count your chickens before they hatch” will imply to them as a literal saying
What 3 things do we ask to assess a patient’s Cognitive Function?
- Time
- Place
- Person
How do we assess Attention?
Ask the patients to recite a series of digits or ask simply math problems
What 3 things would we ask to asses “Remote” Memory?
- Birthdays
- Anniversaries
- Social security number
What would we ask to assess “Recent” Memory?
Events of the day
Explain possibilities of the patient’s calculation ability is bad?
- Possible dementia
- Possible aphasia
- MUST be assessed in terms of patients intelligence and education
How do we assess Constructional Ability?
Copy figures of increasing complexity onto piece of blank unlined pape
What does poor constructional ability suggest IF vision and motor ability are intact?
Possible dementia or parietal lobe damage
What 4 things are in the Mini-Mental State Examination? (MMSE)
- Orientation to time
- Registration (ask to repeat)
- Naming
- Reading
