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NPTE Study Practice > Neuro Exam > Flashcards

Neuro Exam Flashcards

1
Q

What does A&O x3 mean

A
  • Patient is alert and orientated to person, place, and time
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2
Q

Define the levels of alertness

A
  • Alertness: pt responds appropriately, opens eyes, respond fully/appropriately to stimuli
  • Lethargy: pt appears drowsy, can open eyes, respond to examiner but falls asleep easily
  • Obtundation: pt can open eyes/look at examiner but responds slowly & is confused
  • Stupor: pt can be aroused from sleep only with painful stimuli, verbal responses are slow or absent
  • Coma: state of unconsciousness from which can not be aroused; no response to external stimuli
  • Unresponsive wakefulness syndrome (AKA vegetative state): return of sleep/wake cycles, normalization of HR/BP/respiration/digestion, & lack of cognitive responsiveness
  • Minimally conscious state (MCS): severely altered consciousness with minimal but definite evidence of self or environmental awareness
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3
Q

Define persistent vegetative state

A
  • State lasting >1 yr for traumatic brain injury (TBI) and >3 mo for anoxic brain injury
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4
Q

Describe the Glascow Coma Scale (GCS)

A
  • Relates consciousness to 3 elements of response: eye opening, motor response, & verbal response
  • Score ranges from 3-15: severe brain injury = 1-8; moderate brain injury = 9-12; minor brain injury = 13-15
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5
Q

Describe the coma recovery scale-revised

A
  • Examines multiple domains including auditory, visual, motor, verbal, communication, & arousal
  • Includes brain stem reflexes such as pupillary light reflex, corneal blink reflex, spontaneous eye movements, oculocephalic reflex, & postural response
  • Recommended for moderate to sever TBI and stroke
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6
Q

How would you assess memory

A
  • Immediate recall: name 3 items previously presented after a brief interval (5 mins)
  • Recent memory: recall of recent event (what did you have for breakfast)
  • Remote memory: recall of past events (where were you born)
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7
Q

What are the different kinds of attention and how to assess them

A
  • Attention span: ability to recall 7 digits in order presented
  • Sustained attention: ability to attend to task without redirection
  • Divided attention: ability to shift attention from one task to another
  • Focused attention: ability to stay on task in presence of distractors
  • Ability to follow commands
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8
Q

Describe the mini-mental state examination (MMSE)

A
  • Screening for cognitive dysfunction
  • Looks at orientation, registration, attention & calculation, recall and language
  • Max score of 30; 21-24 = mild; 16-20 =-4 moderate; ≤15 = severe impairment
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9
Q

Describe the scoring of Rancho Los Amigos levels oof cognitive function (LOCF)

A
  • Assess cognitive recovery from TBI
  • (1) no response
  • (2/3) decreased response levels
  • (4/5/6) confused levels
  • (7/8) appropriate
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10
Q

Define nonfluent aphasia/Broca’s aphasia/expressive aphasia

A
  • Central language disorder in which speech is typically awkward, restricted, interrupted, and produced with effort
  • Result of lesion in 3rd frontal convolution of left hemisphere
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11
Q

Define verbal apraxia

A
  • Impairment of volitional articulatory control secondary to a cortical, dominant hemisphere lesion
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12
Q

Define dysarthria

A
  • Impairment of speech production resulting from damage to the central or peripheral nervous system
  • Causes weakness, paralysis, or incoordination of the motor-speech system
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13
Q

Define fluent aphasia/Wernicke’s/receptive aphasia

A
  • Examines comprehension
  • Central language disorder in which spontaneous speech is preserved & flows smoothly while auditory comprehension is impaired
  • Result of lesion in posterior 1st temporal gyrus of left hemisphere
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14
Q

Define global aphasia

A
  • Examine for marked impairments in comprehension and production of language
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15
Q

Define conduction/association aphasia

A
  • Result of damage to the arcuate fasciculus that connect Wernicke’s and Broca’s areas
  • Causes word finding issues & problems with repeating phrases
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16
Q

Normal vital responses to exercise

A
  • HR increases in direct proportion to intensity of exercise
  • SBP increases while DBP remains the same or slightly decreases
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17
Q

Define Cheyne-Strokes respiration

A
  • Period of apnea lasting 10-60 secs followed by gradually increasing depth and frequency of respirations
  • Accompanies depression of frontal lobe and diencephalic dysfunction
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18
Q

Define hyperventilation

A
  • Increased rate and depth of respirations
  • Accompanies dysfunction of lower midbrain & pons
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19
Q

Define apneustic breathing

A
  • Abnormal respiration marked by prolonged inspiration
  • Accompanies damage to upper pons
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20
Q

What might an elevation in temperature indicate

A
  • May indicate infection, damage to hypothalamus or brainstem
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21
Q

Signs and symptoms of meningeal irritation/brain infection

A
  • Impaired neck mobility: Kernig’s sign and Brudzinski’s sign
  • Irritability, visual discomfort with bright light
  • Altered level of consciousness
  • Severe HA, nausea, and vomiting
  • Altered vital signs, high fever
  • Generalized weakness
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22
Q

Signs and symptoms of increased intracranial pressure (ICP)/cerebral edema and brain herniation

A
  • Altered level of consciousness
  • Altered vital signs: increased SBP, widening pulse pressure & bradycardia, irregular respirations (bradypnea = <12 breaths per min), elevated temperature
  • HA
  • Vomiting secondary to irritation of vagal nuclei (CN X)
  • Pupillary changes (CN III signs)
  • Papilledema at entrance to eye
  • Progressive impairment of motor function
  • seizure activity
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23
Q

How to assess sensation

A
  • Test superficial and proprioceptive sensations first: pain, discriminate touch, vibration, & proprioception
  • Test combined sensations after determining superficial & proprioceptive touch is intact: apply stimulus in random/unpredictable order and avoid summation
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24
Q

What are the combined cortical sensations

A
  • Stereognosis: ability to identify familiar objects placed in hand
  • Tactile localization: ability to identify location of a touch stimulus on the body
  • Two-point discrimination: ability to recognize one or two blunt points applied to the skin simultaneously
  • Barognosis: ability to identify similar size/shaped objects placed in hand with different gradations of weight
  • Graphesthesia: ability to identify numbers, letters, or symbols traced on skin
  • Bilateral simultaneous stimulation: ability to identify simultaneous touch on the two sides/segments of the body
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25
Q

How is screening for loss of protective sensation typically examined

A
  • Typically examined with monofilaments (5.07 for DM/foot) and/or the ability to detect sharp from dull
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26
Q

Define homonymous hemianopsia

A
  • Loss of half of visual field in each eye
  • Contralateral to the side of a cerebral hemisphere lesion
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27
Q

Define bitemporal hemianopsia

A
  • Loss of outer half of both the right and left visual field resulting in a loss of peripheral vision
  • Occurs with damage at the optic chiasm
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28
Q

Define anosognosia

A
  • Severe denial, neglect for lack of awareness of severity of condition
  • Determine whether patient shows severe impairments in neglect & body scheme
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29
Q

Define body scheme disorder (somatognosia)

A
  • Have patient identify body parts or their relationship to each other
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30
Q

How to examine for spatial relations syndrome

A
  • Figure-ground discrimination: pick out an object from an array of objects (brake on wheelchair)
  • Form constancy: pick object out of similarly shaped but different sized objects (large box out of multiple boxes)
  • Spatial relations: duplicate pattern of 2-3 blocks
  • Position in space: demonstrate different limb positions (put arm overhead)
  • Topographical disorientation: determine if patient can navigate a familiar route on their own
  • Depth & distance imperceptions: can pt judge depth/distance (stair navigation)
  • Vertical disorientation: can pt accurately identify when something is upright
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31
Q

Define agnosia

A
  • Inability to recognize familiar objects with one sensory modality while retaining ability to recognize same object with other sensory modalities
    -Doesn’t recognize object by sight but recognizes it by sound
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32
Q

Define apraxia

A
  • Inability to perform voluntary, learned movements in the absence of loss of sensation, strength, coordination, attention, or comprehension
  • Correlates with damage to the pre lateral frontal cortex & somatosensory association cortex
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33
Q

Define ideomotor and ideational apraxia

A
  • Ideomotor: pt cannot perform the task on command but can do the task when left on own
  • Ideational: pt cannot perform the task at all, either on command or on own
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34
Q

Signs of spastic hypertonia

A
  • Clasp knife response: marked resistance to PROM suddenly gives way
  • Clonus: maintained stretch stimulus produces a cyclical, spasmodic contraction
  • Hyperactive cutaneous reflexes/positive Babinski’s sign: DF of great toe with fanning of other toes ins response to stroking up the lateral side of the sole of the foot
  • Hyperreflexia: increased deep tendon reflexes (DTRs)
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35
Q

Is flaccidity seen in UMN lesions

A
  • Seen initially after suprasegmental/UMN lesions (brief period of spinal shock in SCI, cerebral shock in stroke)
  • Decreased or no resistance to PROM
  • After brief period then become spastic
36
Q

Grading for modified Ashworth scale for spasticity

A
  • (0) no increase in muscle tone
  • (1) slight increase in tone, minimal resistance at end of ROM
  • (1+) slight increase in tone, minimal resistance though less than half of ROM
  • (2) more marked increase in tone, through most of ROM, affected part easily moved
  • (3): considerable increase in tone, passive movement difficult
  • (4): affected part rigid in flexion or extension
37
Q

Difference between rigidity and spasticity

A
  • Spasticity is velocity dependent
  • Rigidity is increased resistance to PROM that is independent of the velocity of movement
38
Q

Describe cogwheel versus lead pipe rigidity

A
  • Lead pipe: uniform throughout the range
  • Cogwheel: interrupted by a series of jerks
39
Q

Describe decerebrate rigidity/posturing

A
  • Seen in comatose pts with brainstem lesions b/w the superior colliculus & the vestibular nucleus
  • Results in increased tone & sustained posturing in rigid extension of all 4 limbs & trunk/neck
40
Q

Describe decorticate rigidity/posturing

A
  • Seen in comatose pts with lesions above the superior colliculus
  • Results in increased tone & sustained posturing of upper limbs in flexion & the lower limbs in extension
41
Q

Signs of UMN lesiosn

A
  • Hypertonia
  • Spasticity
  • Hyperreflexia, clonus
  • Babinski’s sign and Hoffman’s sign
  • Muscle spasms
42
Q

Signs of LMN lesions

A
  • Hypotonia, flaccidity
  • Hyporeflexia
  • Fasciculations (muscle twitching)
  • Muscle atrophy
43
Q

Describe the different types of reflexes

A
  • DTRs: normally occurring reflexes in response to stretch of muscle
  • Superficial cutaneous reflexes: normally occurring reflexes in repose to noxious stimulus (light scratch) applied to skin
  • Primitive spinal reflex: Babinski’s sign
  • Midbrain/cortical reactions: protective extension, optical righting
44
Q

Extrapyramidal disorders/basal ganglia dysfunction could have the presence of what involuntary movements

A
  • Tics: spasmodic contractions of specific muscles, commonly involving face, head, neck, or shoulder
  • Chorea: relatively quick twitches or “dancing” movements
  • Athetosis: slow, irregular, twisting, sinuous movements, occurring especially in UEs
  • Tremor: continuous quivering movements; rhythmic, oscillatory movement observed at rest
  • Myoclonus: single, quick jerk
45
Q

Define intention tremors

A
  • Seen in cerebellar disorders
  • Occurs when voluntary movement is attempted
46
Q

Difference between passive and active restraint with strength testign

A
  • Passive: soft tissue changes restrict ability to move (contractures0
  • Active: spastic muscles restrict ability to move
47
Q

Clinical issues with strength testing in PNS, LMN lesions

A
  • Myopathies: typically see proximal weakness of extremities
  • Neuropathies: typically see distal weakness of extremities
  • Myasthenia gravis: produces decremental strength losses that are more pronounced with repetitive testing
48
Q

Standardized tests and measures for fine motor coordination

A
  • Jebsen-Taylor Hand Function Test
  • Minnesota Rate of Manipulation Test
  • Purdue Pegboard
49
Q

Define dyssnergia

A
  • Impaired ability to associate muscles together for complex movement
50
Q

Define dysmetria

A
  • Impaired ability to judge the distance or range of movement
51
Q

Define dysdiadochokinesia

A
  • Impaired ability to perform rapid alternating movements (RAM)
52
Q

What are the 3 systems that play a part in balance control

A
  • Visual system: visual acuity, depth perception
  • Somatosensory system:proprioception, cutaneous sensation
  • Vestibular system: observe balance with changes in head position/movement
53
Q

What are the 6 conditions of the sensory organization test (SOT)

A
  • 1: eyes open, stable surface
  • 2: eyes closed, stable surface
  • 3: visual conflict, stable surface
  • 4: eyes open, moving surface
  • 5: eyes closed, moving surface
  • 6: visual conflict, moving surface
54
Q

What is the grading scale for postural sway

A
  • Scaled from 1 being minimal sway to 4 being a fall
55
Q

Describe the clinical test for sensory interaction in balance (CTSIB)

A
  • Tests the same 6 conditions as the sensory organization test (COT) but uses a medium-density foam instead of a moving platform
56
Q

Describe the modified CTSIB

A
  • Assesses balance but only in 4 conditions involving eyes open versus eyes closed and on stable ground versus foam
57
Q

Define static, dynamic, versus functional stability limits/balance

A
  • Static: ability to maintain COM in varied stance when BOS does not change
  • Dynamic: ability to exert control of COM when BOS is changing
  • Functional stability limits: ability to move COM as far as possible in mediolateral/anteroposterior direction within BOS
58
Q

Which direction do patients push in Pusher’s syndrome

A
  • They push towards their weak side
59
Q

What are the different postural strategies for maintaining balance

A
  • Ankle: ankle muscles & leg/foot proprioception utilized to maintain balance
  • Hip: hip & lower trunk muscles maintain balance by shifting COM using hip motions (flexion/extension)
  • Stepping: rapid step(s) taken to realign COM within BOS
  • Suspensory: bending the knees to lower the COG (center of gravity)
60
Q

Difference between anticipatory and reactive postural control/balance

A
  • Anticipatory: ability to shift COM before a specific voluntary movement
  • Reactive: response to external perturbations & ability to bring COM back within BOS by use of postural strategies
61
Q

Define perturbations

A
  • Can include force against the COM (push/pull) or displacement of the BOS (using a moveable surface such as a platform, ball, or equilibrium board)
62
Q

Describe the functional balance grades

A
  • Normal: ability to maintain steady balance w/o hand hold support; accepts max challenge & can shift weight easily at full ROM
  • Good: ability to maintain balance w/o hand hold support, limit postural sway; accepts moderate challenge; can pick something off the floor
  • Fair: ability to maintain balance with hand hold support, may require occasional min A; accepts minimal challenge, can maintain balance while turning head
  • Poor: require hand hold support & mod-max A; unable to accept challenge
  • Absent: unable to maintain balance
63
Q

Define ataxia

A
  • Wide based gait with uncoordinated movements
  • Typically improved with looking down in polyneuropathies
64
Q

Define hemiplegic gait

A
  • Gait is altered following stroke
  • Gait is typically slow & asymmetrical with decreased stance time & push off on stroke-affected side
  • Stroke affected side UE and LE move as a unit rather than with a dissociating arm swing from the LE on forward progression
65
Q

Define festinating/Parkinson gait

A
  • Characterized by freezing with initiation/termination and short, rapid steps once gait starts
66
Q

Define myopathic gait

A
  • Pelvic girdle and proximal muscle weakness results in hyperlordosis & compensated Tredenlenburg on weight bearing limb
67
Q

Advantages and disadvantages of a head CT

A
  • Advantages: Take minimal time, helpful following trauma/hemorrhagic stroke, & good visualization of osseous tissue & larger cortical lesions
  • Disadvantages: Limited visualization of small/ischemic lesions, & pt has exposure to radiation
68
Q

How soon should TPA (clot busting drug) be administered following a non-hemorrhagic stroke

A
  • Within 3-4 1/2 hours of thromboembolic stroke
69
Q

Head MRI is the primary method of examination for what pathologies

A
  • Tumors
  • Demyelination
  • Vascular abnormalities
70
Q

Advantages and disadvantages of a head MRI

A
  • Advantages: superior visualization of almost all tissue & no exposure to radiation
  • Disadvantages: cost, time, & movement artifact if patient moves
71
Q

Define a PET scan (postion emission tomography)

A
  • Neuroimaging technique in which radioisotopes are inhaled or injected and emissions are measured with a gamma ray detector system
72
Q

Advantages and disadvantages of a PET scan

A
  • Advantages: allows physiological mapping for biochemical analysis, tool for imaging cerebral blood flow and brain metabolism to assist in screening/Dx of tumors, dementia, stroke, & seizure
  • Disadvantages: lacks detailed resolution as compared to CT/MRI; less accurate in detecting small or slow growing tumors; radiation exposure
73
Q

Describe a diffuse tensor imaging (DTI)

A
  • Form of MRI
  • Allows visualization of axons and pathways
  • Advantages: useful fro imaging mild TBI & assessing disruption of association/projection fibers, no radiation exposure
  • Disadvantages: cost and processing time of images
74
Q

Advantages and disadvantages of a functional MRI

A
  • Looks at hemodynamics/changes in deoxygenated hemoglobin
  • Advantages: provides good spatial resolution to identify active areas of the cortex
  • Disadvantages: delayed (3-5 secs) temporal resolution making it difficult to directly relate timing of events
75
Q

Advantages and disadvantages of a carotid.vertebral artery doppler US

A
  • A: useful for imaging lumen or carotid/vertebral arteries to analyze flow & detect plaques in arteries; low cost; take minimal time
  • D: limited visualization of structures surrounding the arteries/veins
76
Q

Define nerve conduction velocity

A
  • Distance between/w 2 points divided by the difference between.w the corresponding latencies, expressed as meters/second (m/s)
77
Q

When is prolonged distal latencies and decreased conduction velocities seen

A
  • Seen in peripheral neuropathies characterized by demyelination
78
Q

When is slowed conduction velocities seen

A
  • Seen with focal compression/disease of longer segments of peripheral nerve
79
Q

When is reduced amplitudes seen

A
  • Result of damage to axons & typically seen in more chronic and/or moderate to severe compression neuropathies, radiculopathies, or polyneuropathies that target axons
80
Q

What does EMG (electromyography) detect

A
  • Detects electrical activity arising from muscles during needle insertion, resting, minimal and maximal muscle recruitment
81
Q

What EMG sign is a hallmark of denervated or diseased muscles

A
  • At rest the muscle should be quiet
  • Spontaneous EMG activity at rest is a hallmark sign of denervated or diseased muscles
82
Q

When do abnormal spontaneous EMG activity typically occur

A
  • Typically occur 7-21 days after peripheral nerve injury/compression & correlates with Wallerian degeneration
83
Q

What is an electroencephalography (EEG)

A
  • Measures electrical activity of the brain
  • Specific wave forms are analyzed & correlated to normal, abnormal, or sleep cycles
  • Provides key info on the timing & firing (temporal resolution) or neurons in the brain
84
Q

Purposes of a lumbar puncture

A
  • Insertion of spinal needle below the level of L1-L2
  • Withdraw CSF for chemical analysis & cytological exam
  • Measure intracranial pressures & spinal fluid dynamics
  • Injection of contrast medium for radiological exam
  • Injection of therapeutic agents
85
Q

Complications of a lumbar puncture

A
  • Severe HA caused by CSF leakage (relieved by lying down)
  • Infection
  • Epidural hematoma
  • Uncal herniation
86
Q

Pathological CSF findings

A
  • Increased pressure occurs with intracranial tumors, abscesses, meningitis, inflammatory processes, subarachnoid hemorrhage, cerebral edema, & thrombosis of venous sinuses
  • Decreased pressure occurs with leaking CSF, subarachnoid block circulatory collapse, severe dehydration
  • Changes in color/appearance
  • Elevated proteins may indicate tumors or inflammation
  • Elevated CSF specific protein (oligoclonal bands) seen in CNS inflammatory diseases (eg. MS)

NPTE Study Practice (17 decks)

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