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PCM Year 1 Final 2 > Neuro Exam > Flashcards

Neuro Exam Flashcards

1
Q

What type of deficits are produced by brainstem lesions?

A

Ipsilateral loss in face, contralateral loss in body

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2
Q

Explain the scale for grading muscle strength

A 
0/5= no muscle contraction
1/5= slight contractive but no joint movement
2/5= active movement with gravity eliminated
3/5= complete ROM against gravity but not resistance
4/5= complete ROM against gravity with some resistance, movement at joint with some effort
5/5= complete ROM against gravity with full resistance, no movement at joint
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3
Q

Why are CN VI lesions the most common isolated CN palsy? When is it often seen?

A

D/t long peripheral course

Often seen in pts with subarachnoid hemorrhage, late syphilis and trauma

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4
Q

How is the cerebellum tested? What specifically is being tested?

A

–Finger-to-nose: dysmetria/dystaxia of voluntary movements
–Finger-to-finger: position sense, labyrinth and cerebellum function
–Heel-to-shin: tap heel on opposite patella and glide slowly along shin, look for accuracy and smoothness
–Rapid alternating movements: rapid pronation and supination of hand, deficit seen in frontal and cerebellar damage
–Saccades: tests contralateral cerebral hemisphere

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5
Q

What is the Romberg test?

A

Generally evaluated with gait and station but tests proprioception

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6
Q

What type of deficits are produced with thalamic lesions?

A

Hemisensory loss of all modalities

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7
Q

Differentiate between Bell’s Palsy, bilateral facial palsies and supra nuclear (central) facial palsy

A

Bell’s palsy: peripheral facial paralysis, caused by trauma or infection, but in most cases is idiopathic

Bilateral facial palsies: can occur in Miller:Fisher variant of Guillain-Barre syndrome

Supranuclear (central) facial palsy): spares upper face, usually associated with hemiplegia, important in determining if weakness is central or peripheral

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8
Q

What can lesions in CN X result in?

A

Dysphonia, dysphagia, dyspnea, loss of gag or cough reflex

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9
Q

How do you test CN I? How might CN I be affected?

A

Test via: with eyes closed, have patient depress each nostril and sniff to identify non-irritating, familiar odors on each side

Loss of smell can occur with smoking, chronic sinus dz, head trauma, aging, Parkinson’s dz, cocaine use

Loss of smell can indicate an ipsilateral lesion

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10
Q

What can CN III lesions cause?

A

Ptosis, pupillary dilation or asymmetry, position change of the eye (i.e. down and out)

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11
Q

What is clonus?

A

UMN sign, abnormal pattern involving rapidly alternating involuntary contractions and relaxations of skeletal muscle; test if reflexes are hyperactive

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12
Q

Differentiate between myopia and presbyopia

A

Myopia: nearsightedness (loss of distance vision)
Presbyopia: farsightedness (loss of nearby vision)

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13
Q

Which motor dermatomes are tested with wrist flexion? Extension?

A

Wrist flexion: C6-7

Wrist extension: C6-7

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14
Q

What are the motor dermatomes relevant to the quadriceps?

A

L2-4

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15
Q

Which muscles and motor dermatomes are tested with knee flexion? Extension?

A

Knee flexion: hamstrings, L4-S2

Knee extension: quadriceps: L2-L4

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16
Q

How is temperature tested?

A

Often omitted if pain is intact, test tube with hot and cold water

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17
Q

Which muscles and motor dermatomes are tested with hip flexion? Extension?

A

Hip flexion: psoas and iliaques, L2-4

Hip extension: gluteus maximus, S1

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18
Q

What type of deficits are produced with cortical lesions?

A

Intact primary sensations but loss of cortical sensations

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19
Q

What four umbrella sensations is the sensory system tested for?

A

–pain and temperature
–proprioception, 2-point tactile discrimination and vibration
–light touch
–discriminative sensations

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20
Q

Explain the DTR grading scale

A

0: no response
1: diminished, low normal
2: average, normal
2+: more brisk tha normal but no spread
3: brisk, spread to involve moments across more than 1 joint
4: hyperactive with clonus

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21
Q

What are the motor dermatomes relevant to the triceps?

A

C6-8

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22
Q

What sensory dermatome corresponds to the nipple? Umbilicus? Inguinal?

A

Nipple: T4
Umbilicus: T10
Inguinal: L1

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23
Q

What are the four discriminative (cortical) senses?

A

Stereognosis: ability to ID shapes of objects or recognize objects place in the hand

Graphesthesia: ability to ID #s written on the palm

2-point discrimination: ability to distinguish being touched by one or two points

Double simultaneous stimulation (extinction): ability to feel two locations being touched simultaneously

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24
Q

How do you test CN IX?

A

Afferent limb of the gag reflex: touch posterior pharynx with cotton applicator

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25
Q

Which four systems coordinate muscle movement? What specifically are their roles?

A

–Motor system: strength
–Cerebellar system: rhythmic movement and posture
–Vestibular system: balance, coordination of eye, heady and body movement
–Sensory system: position sense

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26
Q

What is the anal wink reflex?

A

–S4-5
–Cauda equina or lesions affecting the sacral region
–Touch areas around perirectal region and note contraction

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27
Q

What are the functions of CN IX?

A

–motor: innervates stylophayngeus muscle→elevates and widens pharynx during swallowing
–sensory: taste to posterior 1/3 of tongue, sensation to palate and pharynx, skin of external ear
–afferent limb of gag reflex

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28
Q

Explain peripheral pattern of weakness. What might this be a sign of?

A

=weak arm flexors and leg extensors

–associated with LMN dysfxn

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29
Q

What are the motor dermatomes relevant to the biceps?

A

C5-6

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30
Q

What can lesions of CN IV result in?

A

Extorsion, weakness of downward gaze, vertical diplopia, head tilting (opposite lesion)

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31
Q

Describe Parkinsonian gait

A 
–symmetrical abnormal gait
–anteroflexed posture
–festinating
–small steps
–↓arm swing
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32
Q

Describe root sensory loss and give two examples.

A

=loss in different nerve distributions with a common root

Ex) C5-C7 in the arms, L4-S1 in the legs

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33
Q

What can lesions in CN XII cause?

A

Tongue deviation to the weak side and inability to push tongue to the opposite cheek

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34
Q

How is light touch tested?

A

Fine wisps of cotton

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35
Q

Differentiate between dysarthria and aphasia?

A

Dysarthria: defective articulation d/t defect in motor control of speech apparatus

Aphasia: disorder in producing or understanding language, usually d/t lesions in the dominant hemisphere

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36
Q

What can lesions to CN VIII cause?

A

Cochlear division lesions: destructive lesions can lead to sensorineural hearing loss, irritative lesions can cause tinnitus

Vestibular division lesions: disequilibrium, nystagmus

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37
Q

What does the H-test assess?

A

CN III: adduction, downward gaze, elevation
CN IV: inward rotation, downward and lateral movement
CN VI: lateral movement

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38
Q

How do you test CN II?

A

Test via pupillary light reflex (CN II and III), near response (constriction, convergence and accommodation), static finger wiggle test for visual field

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39
Q

Describe magnetic gait

A

–symmetrical abnormal gait
–small steps
–feet do not leave ground
–seen in front lobe processes and hydrocephalus

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40
Q

What are the functions of CN X?

A

Efferent limb of the gag reflex, innervates pharynx and larynx musculature, visceral afferent fibers and parasympathetic innervation to smooth muscle from the mucosal of the esophagus to mid-transverse colon and lining of the respiratory system

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41
Q

List the five commonly tested reflexes

A 
–Biceps: C5
–Brachioradialis: C6
–Triceps: C7
–Patellar: L4
–Achilles: S1
42
Q

How do you test CN V?

A

–check facial sensation in the forehead, cheek and chin
–check motor function via lateral jaw movements and jaw clenching
–check corneal (blink) reflex (CN V and VIII)

43
Q

What sensory dermatome corresponds to the patella? Medial calf? Anterolateral calf? Posterolateral calf? Big toe? Little toe?

A 
Patella: L4
Medial calf: L4 
Anterolateral calf: L5
Posterolateral calf: S1
Big toe: L5
Little toe: @1
44
Q

Where is the lesion located if reflexes are hyperactive? Hypoactive?

A

Hyperactive: CNS
Hypoactive: PNS

45
Q

How might you document findings regarding the CNs on a SOAP note?

A

Cranial nerves are grossly intact: II-XII

Cranial nerves II-XII are intact to confrontation: testing

46
Q

Explain pyramidal pattern of weakness. What might this be a sign of?

A

=weak arm extensors and leg flexors

–associated with UMN dysfxn

47
Q

What is a functional loss?

A

Non-anatomical distribution

48
Q

Which muscles and motor dermatomes are tested with ankle plantar flexion? Dorsiflexion?

A

Plantar flexion: gastrocnemius, S1

Dorsiflexion: tibialis anterior, L4-5

49
Q

What sensory dermatome corresponds to the long finger? Little finger?

A

Long finger: C7

Little finger: C8

50
Q

Describe atasia/abasia (functional) gait

A

–symmetrical abnormal gait
–gait all over the place
–pt does not fall but looks like they will
–usually psychogenic

51
Q

What can lesions of CN III, IV and VI cause?

A

Diplopia and weakness of muscles innervated by that specific cranial nerve

52
Q

Which motor dermatomes are tested with shoulder abduction, flexion and extension?

A

C5

53
Q

Differentiate between delirium, dementia and depression

A

Depression: feeling down or hopeless, anhedonia

Delirium: common in older adults d/t hospitalization, screen via CAM dx algorithm, usually reversible

Dementia: must eliminate depression and delirium before dx, meds can slow progression but usually not reversible

54
Q

What might problems with toe walking indicate? Heel walking? Tandem walking? Hopping in place?

A

Toe walking: distal muscle weakness
Heel walking: CST lesions or distal muscle weakness
Tandem walking: imbalance
Hopping in place: proximal and distal muscle strength, position sense, cerebellar function

55
Q

Differentiate between the different levels of A&O

A

x1: person
x2: person, place
x3: person, place, time
x4: person, place, time, event

56
Q

What can lesions to CN VII cause?

A

paralysis of muscles of facial expression, loss of corneal reflex, hyperacusis, crocodile tears syndrome

57
Q

Differentiate between decorticate and decerebrate

A

Decorticate: both arms flexed, legs stiff and extension, lesion above brainstem in thalamus

Decerebrate: arms extended and legs stiff extended, lesion in midbrain

58
Q

How might compressive brainstem lesions affect CN III?

A

Brain herniation may cause dilation and fixation of the pupil via pupilloconstrictor fibers of CN III. Somatic efferent fibers supplying the EOM can cause external strabismus (second effect)

59
Q

How do you test CN X?

A

Listen to voice for hoarseness and nasal tone, check gag reflex, difficulty swallowing, say “ah”

60
Q

If a patient is unable to rise from a chair with arms folded, what might this indicate?

A

Proximal muscle weakness

61
Q

How do you test CN XI?

A

Test SCM by having pt turn head against resistance; test trapezius muscle by having pt shrug shoulders against resistance

62
Q

How is proprioception tested?

A

Move pt’s big toe through an arc with pt’s eyes closed

63
Q

What do CN VI lesions result in?

A

Convergent (medial) strabismus (esotropia): inability to ABDuct eye d/t LR weakness

Horizontal diplopia: maximal separation of images when looking toward the paretic LR

64
Q

What are the functions of CN XI?

A

Cranial division: innervates muscles of the larynx

Spinal division: innervates trapezius and SCM muscle

65
Q

How do you test CN VIII?

A

Cochlear division: hearing via whisper test or finger rub

Vestibular division: balance

66
Q

Why is CN IV particularly vulnerable to head trauma?

A

Has a long course around the brainstem

67
Q

What sensory dermatome corresponds to the auricle? Earlobe? Anterior/posterior neck? Shoulder?

A

Auricle: C2
Earlobe: C3
Anterior/posterior neck: C3
Shoulder C4

68
Q

What is a Babinski sign?

A

UMN sign, abnormal when sole of foot is scratched from heel toward toes and great toe extends

69
Q

Describe waddling pelvis

A

–asymmetrical abnormal gait
–usually myopathic dz
–hips sway or “waddle” from side to side

70
Q

How do you test CN VII?

A

–motor: facial expression, eye and mouth closure
–sensory: taste for salty, sweet and bitter substances anterior to 2/3 of tongue
–PS: saliva and tear secretion
–general sensation: external ear

71
Q

What are signs and sx of LMN dysfunction?

A

Wasting, fasciculation, ↓muscle tone, ↓reflexes, peripheral pattern of weakness (weak leg extensors), muscle disease; can have normal tone, reflexes and muscle bulk but erratic power

72
Q

What can lesions in CN XII cause?

A

Tongue deviation to the weak side and inability to push tongue to the opposite cheek

73
Q

What sensory dermatome corresponds to the radial aspect of the forearm?

A

C6

74
Q

How is pain tested?

A

Broken bottom tip or tongue depressor

75
Q

What can CN V lesions cause?

A

↓sensation of the face and mucous membranes, loss of corneal reflex, weakness of muscles of mastication, jaw deviation

76
Q

What are important considerations regarding onset during a neuro exam? Give examples

A

Abrupt or sudden onset/acute onset: cerebral hemorrhages, vascular dz, infections, head trauma

Progressive onset: degenerative dz

Intermittent/relapsing episodes: demyelinating dz (i.e. MS), vascular dz

77
Q

What is nystagmus? What causes it?

A

=rhythmic oscillation of the eyes (laterally based on fast beat)
–can be seen slightly in extreme gaze deviation and can occur in one or more planes
–can be d/t impairment of vision at an early age, disorders of the labyrinth and cerebellar systems or drug toxicity

78
Q

Describe scissoring gait

A

–symmetrical abnormal gait
–feet crossing over with toes dragged
–often seen in cerebral palsy or MS

79
Q

Which motor dermatomes are tested with hand grip? Finger abduction? Thumb opposition?

A

Hand grip: C7-T1
Finger abduction: C8-T1
Thumb opposition: C8-T1

80
Q

What are sx of UMN dysfunction?

A

Hypertonia, hyperreflexia, pyramidal pattern of weakness (weak arm extensors), pronator drift

81
Q

Differentiate between postural/kinetic tremors and resting/pill rolling tremors

A

Postural or kinetic: due to essential tremor

Resting (pill rolling): basal ganglia dz

82
Q

Describe hemiplegic gait

A

–asymmetrical abnormal gait
–usually d/t UMN lesion, such as stroke
–circumducted gate
–↓arm swing ipsilateral to affected leg

83
Q

Describe foot drop

A

–asymmetrical abnormal gait
–unable to keep foot up during heel walk
–can be d/t UMN or LMN lesions

84
Q

What is the corneal (blink) reflex?

A

=protective reflex involving CN V (afferent) and VII (efferent)

Ask pt to look up and away from the examiner→touch cornea with cotton wisp→blink

85
Q

How is vibration tested?

A

Tuning fork

86
Q

Which motor dermatomes are tested with elbow flexion? Extension?

A

Elbow flexion: C5-6

Elbow extension: C6-8

87
Q

What might a shallow knee bend in each leg during gait indicate?

A

Weakness of hip extensors, quadriceps or both

88
Q

What are the motor dermatomes relevant to the gastrocnemius?

A

L5-S2

89
Q

How do you test CN III?

A

Check for eyelid ptosis, check pupil shape and symmetry, pupillary light reflex and near reaction

90
Q

Which motor dermatomes are tested with hip adduction? Abduction?

A

Hip adduction: L2-4

Hip abduction: L4-S1

91
Q

How do you test CN XII?

A

Have pt protrude tongue and push into opposite cheek

92
Q

Lesions to the optic nerve in what location would cause ipsilateral blindness?

A

Anterior to the chiasm

93
Q

What is the cremasteric reflex?

A

–Afferent L1, efferent L2

–Stroking inner thigh causes scrotum to rise on stroked side

94
Q

Describe sensory ataxic gait

A

–symmetrical abnormal gait
–high stoppage
–broad based
–seen with posterior column damage and peripheral neuropathy

95
Q

What are important associated sx to assess during a neuro exam?

A

Headache, dizziness or vertigo, weakness, numbness or abnormal sensation, fainting or blacking out, seizures, tremors or involuntary movements

96
Q

What are frontal lobe release reflexes?

A

Rooting, grasping, glabellar and palms-mental reflexes seen in infants

97
Q

Explain pronator drift. What might this bee a sign of?

A

=arms held extended for 2 minutes drift down and supinate

–associated with UMN dysfxn

98
Q

What is an abdominal reflex?

A

–T10-12
–Test all four quadrants
–Stroking abdomen causes umbilicus to move toward area of stimulation

99
Q

What are the functions of CN XII?

A

Innervates all intrinsic and extrinsic tongue muscles

100
Q

What are the two signs of meningitis?

A

Kerning’s sign: pt supine→flex thigh then straighten knee→pt will experience pain in neck

Brudzinski’s sign: pt supine→lift pt’s head→knees come up in response

PCM Year 1 Final 2 (5 decks)

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