Neuro Exam Flashcards
What questions should ask about neuro problem onset?
- abrupt, sudden/acute onset?
- Progressive?
- Intermittent, relapsing episodes?
What specifics should you ask about seizures?
- period of confusion
- loss of bladder/bowel control
- type (whole or part of body)
READING FOR ALERT TERMS
DON’T FORGET TO LOOK AT THIS
What does A&O x 3 and A&O x 4 mean?
Alert and oriented
- person
- person and place
- person, place, time
- person, place, time, event
- objective: under general or neuro
How do we check for depression?
- “Have you been feeling down, depressed or hopeless?”
- “Have you felt little interest or pleasure in doing things” (anhedonia)
What do we do for delirium?
- Screen for it using the CAM Diagnostic Algorithm (read about this in book)
- Common in older adults during hospitalization
What do we do for dementia?
- Must eliminate depression an delirium before can diagnose
- Meds can slow progression, but generally not reversible
- Most common type is AD
What are common symptoms between depression, delirium, and dementia?
- tiredness, flat affect
How do we document CN 2-12?
Cranial Nerves II-XII are intact to testing
CN I
- before giving a scent, test for nasal blockages
* loss of smell indicates ipspilateral lesion
Hx to indicate loss of smell
- smoking, chronic sinus disease, head trauma, aging, PD, and use of cocaine
What is myopia? presbyopia?
- impaired distance vision
- impaired near vision
Lesions to CN II anterior to the chiasm cause?
ipsilateral blindness
What can head tilt to the opposite side of the lesion be misdx as?
idiopathic torticollis
CN VI palsy is often seen in what type of pts?
subarachnoid hemorrhage, late syphilis, and trauma
What side does the jaw device towards with a CN V lesion?
toward lesion (due to unopposed unaffected side)
What is crocodile tear syndrome?
CN VII aberrant regernatin after trauma –> shed tears while eating
What occurs in Miller Fisher variant of Guillain Barre Syndrome?
b/l facial palsy
What part of the gag reflex is CN IX? X?
- afferent
- efferent
What is pyramidal pattern of weakness? peripheral?
- weak extensors in arms and weak flexors in legs
2. weak flexors in arms and weak extensors in legs
What are symmetrical gait patterns?
Parkisonian, scissoring, sensory ataxia, magnetic, and astasia-abasia
What are asymmetrical gait patterns?
hemiplegic, waddling pelvis, foot drop
C2 C3 C 4 C 6 C7 C 8 T 4 T 10 L 1 L 4 L 5 S 1
C2 Auricle C3 Earlobe, ant/post neck C 4 Shoulder top C 6 Radial aspect forearm C7 Long finger C 8 Little finger T 4 Nipple T 10 Umbilicus L 1 Inguinal L 4 Patella, medial calf L 5 Anterolateral calf, Great toe S 1 Posterolateral calf/little toe
Stereognosis
• ability to identify shapes of objects, or recognizing objects placed in the hand
Graphesthesia
• ability to identify numbers written on the palm
Two point Discrimination
• ability to distinguish being touched by one or two points
Double simultaneous stimulation (extinction)
• ability to feel two locations being touched simultaneously
How do we document a babinski sign?
toe upgoing (abnormal) or toe down going ( normal)
Postural tremor v. Resting
- Postural tremor or kinetic tremor usually due to essential tremor.
- Resting (pill rolling) tremor – indicates basal ganglia disease (Parkinson’s)
Postures in coma
- Decorticate – both arms flexed, and legs are stiff and extended (lesion usually above brainstem in thalamus).
- Decerebrate – arms are extended and legs stiff and extended (usually indicates a brainstem lesion in the midbrain).
