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Basic Clinical Skills Fall 2018 > Neuro Exam > Flashcards

Neuro Exam Flashcards

1
Q

Dysequilibrium

A

Impaired walking due to difficulties with balance. it sometimes describes as dizziness “in the feet”. Formally speaking, this does not occur in the non-ambulatory patient.

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2
Q

Light-headedness

A

Dizziness that is not vertigo, syncope, or disequilibrium; this form is also called undifferentiated dizziness

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3
Q

Presyncope

A

The feeling that one is about to faint or lose consciousness, but actual loss of consciousness is averted. Syncope is defined as sudden, transient loss of consciousness.

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4
Q

Vertigo

A

An illusion or hallucination of movement, usually rotation, either of oneself or the environment

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5
Q

4 most common causes of dizziness

A
  1. Peripheral vestibulopathy (44%); BBPV 16%
  2. Nonvestibular, nonpyschiatric (24%); medication-related 14%
  3. Psychiatric (16%); Psych disorder 11%
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6
Q

Alarm Symptoms: Dizziness

A
  1. Chest discomfort or presyncope/syncope

Serious Cause (SC): MI, PE, arrhythmia

  1. Acute on-set vertigo plus neurologic deficits

SC: VBI, brainstem mass, meningoencephalitis

  1. Acute-onset vertigo plus neck or occiptal pain plus neurologic deficits

SC: VBI

  1. Acute vertigo (lasting > 1 day), nausea, vomiting, severe imbalance

SC: Cerebellar stroke/mass

  1. Sudden onset severe vertigo, facial paralysis, otalgia, external ear vesicular eruption, hearing loss

SC: Ramsay Hunt Syndrome

  1. Hx of DM (insulin and/or oral hypoglycemic use)

SC: Hypoglycemia

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7
Q

S4 Model

A

Predictive of psych disorder. >2 of 4 = psych evaluation

  1. Symptom count
  2. Stress
  3. Severity
  4. Self-rated health
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8
Q

Primary Headache

A

A chronic, benign, recurring headache without known cause. Examples include migraine and tension-like headache

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9
Q

Secondary Headache

A

Headache due to underlying pathology

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10
Q

New Headache

A

A headache of recent onset or a chronic headache that has changed in character. Such headaches are more than likely to be pathologic than unchanged chronic headaches.

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11
Q

Aura

A

Complex neurologic phenomena that precede a headache. Example includes scotoma, aphasia, and hemiparesis

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12
Q

Thunderclap Headache

A

A headache that occurs instantaneously with maximal intensity at its onset.

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13
Q

Cervicogenic Headache

A

Referred headache pain that originates from the neck, often due to muscle tension or cervical degenerative arthritis. Also referred to as occipital neuralgia.

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14
Q

2 common causes of primary headaches

A
  1. Tension-type headache 12-19%

2. Migraine with or without aura 3-5%

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15
Q

2 common causes of secondary headaches

A
  1. Viral syndrome - 39%

2. Sinusitis - 1%

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16
Q

Serious Dx of headache

A
  1. Posttraumatic headache
  2. HTN emergency
  3. Subarachnoid hemorrhage
  4. Brain tumor
  5. Mengitis
  6. Giant cell arteritis
  7. Benign intracranial HTN
  8. Brain abcess
  9. Carotid or vertebral artery dissection
  10. Stroke
  11. Arteriovenous malformation
  12. Carbon monoxide poisoning
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17
Q

SSNOOP

A

S: systemic symptoms - fever or weight loss
S: Systemic disease - HIV infection, malignancy
N: Neurologic symptoms or signs
O: Onset sudden
O: Onset > 40 yrs
P: previous headache history (first, worst, different headache)

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18
Q

Ascending Paralysis

A

Motor weakness that begins in the feet and progressively moves up the body

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19
Q

Bulbar symptoms

A

Weakness in the muscles of the face and tongue, resulting in difficulty speaking, swallowing, and smiling

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20
Q

Descending paralysis

A

Motor weakness that begins in the face and progressively moves down the body

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21
Q

Distal weakness

A

Weakness in the distal extremeities. Example: foot drop

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22
Q

Hemiparesis

A

Weakness on one side of the body

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23
Q

monoparesis

A

Weakness of one limb

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24
Q

Paraparesis

A

Weakness of both legs

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25
Q

Proximal weakness

A

Weakness in proximal muscles (shoulder girdle, quadriceps) resulting in difficulty standing up from a seated position or raising arms above head

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26
Q

Tetraparesis

A

Weakness of all 4 limbs

27
Q

Upper motor neuron lesions

A

Abnormalities of motor pathways that descend from the central nervous system to the alpha motor neurons, resulting in spasticity, hyperreflexia, and increased muscle tone

28
Q

Lower motor neuron lesions

A

Abnormalities of the alpha motor neuron in the brainstem or spinal gray matter, resulting in muscle atrophy, hyporeflexia, and fasciulations

29
Q

Most common causes of muscle weakness

A
  1. CNS disorders: Stroke or TIA
  2. Motor neuron disease
  3. Radiculopathies
  4. Peripheral neuropathies: Polyneuropathies
  5. Neuromuscular junction disorders
  6. Myopathies
30
Q

Dementia

A

Acute impairment in attention or disorganized thinking, with a fluctuating course and altered level of consciousness

31
Q

Delirium

A

Chronic progressive degenerative condition affecting memory, behavior, and cognition

32
Q

Attention

A

The ability to focus on specific stimuli and change from one stimulus to another when salient

33
Q

Alertness

A

The level of arousal or responsiveness to external cues

34
Q

Coherence

A

The ability to maintain selective attention over time

35
Q

Asterixis

A

Failure to maintain continuous voluntary tone in the limbs resulting in very brief loss of strength

36
Q

Meningismus

A

Neck stiffness and pain on neck flexion and extension, a sign of meningitis

37
Q

Alarm Symptoms of Confusion

A
  1. Fever or hypothermia

SC: Meningitis, sepsis

  1. Abnormal motor activity or Hx of epilepsy

SC: Seizures (status epilepticus) or postictal state

  1. Headache

SC: Stroke, meningitis, mass lesion/truama

  1. Shortness of breath

SC: Hypoxia (CHF, Pneumonia

  1. Diaphoresis, tremors

SC: Hypoglycemia

  1. Negelect (inattention to one side of space) or visual field loss

SC: stroke

  1. Ataxia, nystagmus

SC: Wernicke encephalopathy

38
Q

Major causes of Memory Loss

A
  1. MCI
  2. Alzheimer’s
  3. Vascular dementia
  4. Mixed dementia
  5. Parkinson’s
  6. Diffuse Lewy body
  7. Frontaltemporal dementia
39
Q

Diplopia

A

Seeing a duplicate copy of an image, colloquailly referred to as double vision

40
Q

Monocular diplopia

A

Diplopia with only one eye viewing

41
Q

Binocular diplopia

A

Diplopia present only when both eyes are open

42
Q

Polyopia

A

Seeing multiple copies of an image

43
Q

Comitant

A

diplopia that does not vary with gaze direction

44
Q

Esotropia

A

Crossed eyes; eyes pointing medially with respect to each other

45
Q

Exotropia

A

Eye that are pointing laterally with respect to each other

46
Q

Hypertropia

A

One eye elevated with respect to the other

47
Q

Phoria

A

A tendency for the eyes to be misaligned when one eye is covered; with both eyes open, the subject’s ocular motor control system can use vision to align the eyes so that there is no diplopia

48
Q

Common cause of diplopia

A
  1. Ocular myopathy

Dx: Graves opthalmyopathy

  1. Neuromuscular junction

Dx: Myasthenia gravis

  1. Cranial Neuropathy

Dx: Diabetes, tumor, infection, inflammation

  1. Supranuclear (brainstem) disorders

Dx: Stroke, tumor, demyelination, infection

49
Q

Alarm symptoms of diplopia

A
  1. Eye pain or headache

SC: Cerebral aneurysm, mengitis

  1. Facial numbness

SC: cavernous sinus mass

  1. Facial weakness, limb weakness, limb numbness, imbalance, drowsiness

SC: Brainstem lesion, meningitis

50
Q

Ataxia

A

unbalanced or uncoordinated ambulation

51
Q

Cerebellar ataxia

A

Ataxia due to impaired cerebellar function

52
Q

Sensory ataxia

A

Ataxia due to impaired proprioceptive or sensory feedback from the lower extremeities

53
Q

Spastic paraplegia

A

Tonic muscular contraction leading to an inability to relax the muscles. The increased tone is due to damage of the inhibitory neurons in the spinal cord or brain

54
Q

Peripheral neuropathy

A

Abnormal sensory or motor nerve function leading to weakness, altered sensory perception, or both

55
Q

Serious Dx of gait abnormalities

A
  1. Spinal cord impingement by tumor or infection
  2. Stroke
  3. Normal-pressure hydrocephalus
  4. Aortic dissection causing spinal cord ischemia
56
Q

Action Tremor

A

An oscillation that occurs or increases during voluntary movement, generally, of midrange frequency. Also called kinetic tremor.

57
Q

Postural tremor

A

An oscillation that occurs while maintaining a fixed posture against gravity or during other fixed postures (clenched fist, standing), generally at a lower frequency

58
Q

Rest tremor

A

An oscillation that occurs with the affected body at rest, during no action (voluntary contraction of muscles) and without resisting gravity, generally at a lower frequency

59
Q

Intention tremor

A

A type of action tremor in which oscillation orthogonal to the direction of movement and increases in amplitude as the target is approached. usually denotes disease of the cerebellum and/ or its connections

60
Q

Physiologic tremor

A

Irregular oscillations of 8-10 Hz occurring during maintenance of a posture, which usually disappear when the eyes are closed or a gravity load is placed on the muscles. By definition, mild physiologic tremor may be a normal finding and is common in the general population.

61
Q

enhanced physiologic tremor

A

Physiologic tremor is increased in amplitude due to fatigue, sleep deprivation, treatment with certain drugs, some endocrine disorders, caffeine use, or stress

62
Q

essential tremor

A

Isolated postural or action tremor involving the hands and sometimes the head and voice without other neurologic findings. Genetically determined with a positive family Hx (familial tremor) in approx. 50% of cases

63
Q

Parkinsonian tremor

A

Rest tremor that usually has a very regular “pill-rolling” quality and is frequently, but not always, associated with other symptoms of Parkinson’s disease (stiffness, slowness, gait changes).

64
Q

Task-specific tremor

A

A tremor elicited by a specific task, such as speaking or writing

Basic Clinical Skills Fall 2018 (4 decks)

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