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Physical Diagnosis > Neuro Exam 1 and 2 > Flashcards

Neuro Exam 1 and 2 Flashcards

1
Q

What are common complaints of the nervous system?

A 
Headache
Dizziness or vertigo
Generalized, proximal, or distal weakness
Numbness 
Abnormal or loss of sensations
Loss of consciousness, syncope, or near-syncope
Seizures
Tremors or involuntary movements
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2
Q

What three things should you keep in mind when examining a neuro pt?

A
  1. Is mental status intact?
  2. Are right- and left-sided findings the same, or symmetric?
  3. If findings are asymmetric or otherwise abnormal, do the causative lesions lie in the central nervous system or the peripheral nervous system?
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3
Q

How should your thinking be organized when assesing the nervous system?

A
  1. mental status,
  2. speech, and language;
  3. cranial nerves;
  4. motor system;
  5. sensory system; and
  6. reflexes
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4
Q

How is the mental status examined?

A
  1. Appearance & behavior
  2. Speech & language
  3. Mood
  4. Thoughts & perceptions: more relevant for mental health
  5. Cognitive function – memory, attention, information and vocabulary, calculations, and abstract thinking and constructional ability
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5
Q

What does the mental status exam identify?

A

identify neurological disease and help distinguish focal deficits from diffuse processes.

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6
Q

What are the levels of consciousness?

A
  1. Alert
  2. lethargic: responds to loud stimuli
  3. Obtunded: responds after being shaken gently
  4. Stupor: responds after painful stimuli
  5. Coma: no response after repeated painful stimuli
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7
Q

How is a patient’s speech and language assessed?

A
  1. Quantity: talkative or silent
  2. Rate: fast or slow
  3. Loudness: loud of soft
  4. Articulation of Words: spoken clearly and distinctly or mumbled
  5. Fluency: rate, flow & melody of speech and content
    A. Hesitancies & gaps in flow and rhythm of words
    B. Disturbed inflections – monotone vs. singsong
    C. Circumlocutions – phrases or sentences are substituted for a word (“what your write with” for “pen”)
    D. Paraphasias – worlds are malformed (“I write with a den”)
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8
Q

How do you asses a pt’s orientation?

A

Person, Place, & Time

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9
Q

How do you assess a pt’s attention?

A
  1. Serial 7’s

2. Spelling backward

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10
Q

How do you assess a pt’s remote memory?

A

Ask patient about birthdays, anniversaries, social security number, names of schools attended, job held, or past historical events. past presidents (What were you doing when JFK was shot?).

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11
Q

How do you assess a pt’s recent memory?

A

Ask patient about today’s weather, today’s appointment time, how did you get to your appointment, who is the current president.

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12
Q

How do you assess a pt’s short term memory?

A

3 word Recall: ask patient to remember 3 unrelated items (house, car, dog) and tell them you will re-ask in 5 minutes

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13
Q

How do you assess a pt’s ability to name and follow instructions?

A
  1. Ask patient to name 2 items found in the room.
    “Please tell me two items that are in the room.”
  2. Ask patient to read this card and do what it says
    CLOSE YOUR EYES
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14
Q

What CN need to be examined that aren’t in any other part of the PE?

A

CN: III, V, VII, XI

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15
Q

How is CN III tested?

A

Lid elevation

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16
Q

How is CN V tested?

A

Palpate temporal and masseter muscles while patient clenches teeth; test forehead, each cheek, and jaw on each side for sharp or dull sensation

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17
Q

How is CN VII tested?

A

Assess face for asymmetry, tics, abnormal movements. Ask patient to raise eyebrows, frown, close eyes tightly, show teeth (grimace), smile, puff both cheeks.

18
Q

How is CN XI tested?

A

Assess strength as patient shrugs shoulders up against your hands. Note contraction of opposite sternocleidomastoid, and force as patient turns head against your hands.

19
Q

How is the motor system tested?

A
  1. Position, movement, muscle bulk, and tone
    A. Observe body position and involuntary movements such as tremors, tics, fasciculations
    B. Inspect muscle bulk; note any atrophy
    C. Assess muscle tone — flex and extend the arm and the lower leg for residual tension → slight resistance to passive stretch
20
Q

How is muscular strength graded?

A

0-5 Scale:

0: no muscular contraction detected
1: barely detectable trace of contraction
2: active movement of body with gravity eliminated
3: active movement against gravity
4. Active movement against gravity and some resistance
5. Active movement against full resistance without evident fatigue; normal muscle strength

21
Q

What muscle groups are assessed for strength?

A
  1. Biceps and triceps, wrist – flexion and extension
  2. Handgrip, finger – abduction and adduction, thumb opposition
  3. Trunk – flexion, extension, lateral bending
  4. Thorax – expansion, diaphragmatic excursion during respiration
  5. Hip – flexion, extension, abduction, and adduction
  6. Knee and ankle – flexion, extension
22
Q

How is a pt’s coordination tested?

A
  1. Rapid alternating movements
  2. point to point movements
  3. gait: normal, heel to toe, toes, heels
  4. Stance: Romberg test, pronator drift test
23
Q

What is the Romberg test?

A

Patient stands with feet together and eyes open, then with eyes closed for 30–60 seconds without support
Loss of balance when eyes closed is a positive test

24
Q

What is the pronator drift test?

A

Patient stands for 20–30 seconds with both arms straight forward, palms up, and eyes closed; tap arms briskly downward
Pronation and downward drift of the arm is a positive test

25
Q

What are the general principles of sensory assessment?

A
  1. Compare symmetric areas on both sides of the body
  2. When testing pain, temperature, and touch, compare distal with proximal areas of the extremities
  3. Map out the boundaries of any area of sensory loss or hypersensitivity
26
Q

How is the sensory system assessed?

A
  1. Test pain: use a disposable object such as a broken cotton swab or pin and discard after each use.
    A. Ask if prick is sharp or dull, or ask the patient to compare 2 sensations: “Does this feel the same on both sides?”
  2. Test light touch, using cotton wisp.
  3. Not on OSCE: Test vibration: tap a 128-Hz tuning fork on your hand, then place it on the DIP joint of the patient’s finger. Ask the patient, “Do you feel a buzz? Tell me when it stops.” Likewise test over the joint of the big toe.
  4. Not on OSCE: Test proprioception: hold the big toe by its sides between your thumb and index finger, pull it away from the other toes, and move it up then down. Ask the patient to identify the direction of movement.
27
Q

How is discriminative sensation assessed?

A
  1. Stereognosis
  2. Number identification (graphesthesia)
  3. Two-point discrimination
  4. Point localization
  5. Extinction
28
Q

Define stereogenesis

A

place a key or familiar object in the patient’s hand and ask the patient to identify it

29
Q

Define number identification/graphesthesia

A

outline a large number in the patient’s palm and ask the patient to identify the number

30
Q

Define two point discrimination

A

using two ends of an opened paper clip, or two pins, touch the finger pad in two places simultaneously; ask the patient to identify 1 touch or 2

31
Q

Define point localization

A

lightly touch a point on the patient’s skin and ask the patient to point to that spot

32
Q

define extinction

A

touch an area on both sides of the body at the same time and ask if the patient feels 1 spot or 2

33
Q

What reinforcement techniques can be used to elicit reflexes?

A

Upper Body: clench teeth or push down on bed with thighs

Lower Body: lock fingers and try to pulls hands apart

34
Q

How are reflexes scored?

A 
0 to 4+ scale
4+: very brisk, hyperactive, with clonus
3+: brisker than average, possibly, but not necessarily indicative of disease
2+ average, normal
1+ somewhat diminished, low normal
0: no response
35
Q

What spinal cord levels are tested with the biceps reflex?

A

C5-C6

36
Q

What spinal cord levels are tested with the triceps reflex?

A

C6, C7, C8

37
Q

What spinal cord levels are tested with the brachioradialis reflex?

A

C5-C6

38
Q

What spinal cord levels are tested with the knee reflex?

A

L3-L4

39
Q

What spinal cord levels are tested with the ankle reflex?

A

S1-S2

40
Q

What spinal cord levels are tested with the babinski’s sign?

A

L5-S1

41
Q

What is clonus?

A

a hyperactive response required for assigning a reflex grade of 4, usually elicited at the ankle

Physical Diagnosis (9 decks)

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