Neuro Exam

Question 1

What questions should ask about neuro problem onset?

Answer 1

1. abrupt, sudden/acute onset?
2. Progressive?
3. Intermittent, relapsing episodes?

Question 2

What specifics should you ask about seizures?

Answer 2

• period of confusion
• loss of bladder/bowel control
• type (whole or part of body)

Question 3

READING FOR ALERT TERMS

Answer 3

DON’T FORGET TO LOOK AT THIS

Question 4

What does A&O x 3 and A&O x 4 mean?

Answer 4

Alert and oriented

1. person
2. person and place
3. person, place, time
4. person, place, time, event

• objective: under general or neuro

Question 5

How do we check for depression?

Answer 5

• “Have you been feeling down, depressed or hopeless?”

- “Have you felt little interest or pleasure in doing things” (anhedonia)

Question 6

What do we do for delirium?

Answer 6

• Screen for it using the CAM Diagnostic Algorithm (read about this in book)
• Common in older adults during hospitalization

Question 7

What do we do for dementia?

Answer 7

• Must eliminate depression an delirium before can diagnose
• Meds can slow progression, but generally not reversible
• Most common type is AD

Question 8

What are common symptoms between depression, delirium, and dementia?

Answer 8

• tiredness, flat affect

Question 9

How do we document CN 2-12?

Answer 9

Cranial Nerves II-XII are intact to testing

Question 10

CN I

Answer 10

• before giving a scent, test for nasal blockages

* loss of smell indicates ipspilateral lesion

Question 11

Hx to indicate loss of smell

Answer 11

• smoking, chronic sinus disease, head trauma, aging, PD, and use of cocaine

Question 12

What is myopia? presbyopia?

Answer 12

• impaired distance vision

- impaired near vision

Question 13

Lesions to CN II anterior to the chiasm cause?

Answer 13

ipsilateral blindness

Question 14

What can head tilt to the opposite side of the lesion be misdx as?

Answer 14

idiopathic torticollis

Question 15

CN VI palsy is often seen in what type of pts?

Answer 15

subarachnoid hemorrhage, late syphilis, and trauma

Question 16

What side does the jaw device towards with a CN V lesion?

Answer 16

toward lesion (due to unopposed unaffected side)

Question 17

What is crocodile tear syndrome?

Answer 17

CN VII aberrant regernatin after trauma –> shed tears while eating

Question 18

What occurs in Miller Fisher variant of Guillain Barre Syndrome?

Answer 18

b/l facial palsy

Question 19

What part of the gag reflex is CN IX? X?

Answer 19

• afferent

- efferent

Question 20

What is pyramidal pattern of weakness? peripheral?

Answer 20

1. weak extensors in arms and weak flexors in legs

2. weak flexors in arms and weak extensors in legs

Question 21

What are symmetrical gait patterns?

Answer 21

Parkisonian, scissoring, sensory ataxia, magnetic, and astasia-abasia

Question 22

What are asymmetrical gait patterns?

Answer 22

hemiplegic, waddling pelvis, foot drop

Question 23

C2 
C3 
C 4 
C 6 
C7 
C 8 
T 4 
T 10 
L 1 
L 4 
L 5 
S 1

Answer 23

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

Question 24

Stereognosis

Answer 24

• ability to identify shapes of objects, or recognizing objects placed in the hand

Question 25

Graphesthesia

Answer 25

• ability to identify numbers written on the palm

Question 26

Two point Discrimination

Answer 26

• ability to distinguish being touched by one or two points

Question 27

Double simultaneous stimulation (extinction)

Answer 27

• ability to feel two locations being touched simultaneously

Question 28

How do we document a babinski sign?

Answer 28

toe upgoing (abnormal) or toe down going ( normal)

Question 29

Postural tremor v. Resting

Answer 29

• Postural tremor or kinetic tremor usually due to essential tremor.
• Resting (pill rolling) tremor – indicates basal ganglia disease (Parkinson’s)

Question 30

Postures in coma

Answer 30

• 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).