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SRNAHealthAssessment > NEURO Exam > Flashcards

NEURO Exam Flashcards

1
Q

Sense that does not go to THALAMUS

A

SMELL

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2
Q

• Spinothalamic Tracts
________order _________, then _________to ______
@thalamus, synapse to ______

A
  • Pain/Temp/Light Touch/Crude Touch
  • 2nd orders cross to opposite side, then ascend to Thalamus
  • @ Thalamus, synapse to 3rd order
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3
Q

Posterior Dorsal Columns
1st order enter ______and ______on which sidee?
@ Medullla, synapse to _______then cross over and ascend to ________
@ thalamus, synapse to 3rd order
ascend to cortex

A

• Proprioception/Vibration/2 pt discrim/Stereognosis
• 1st orders enter SC and ascend same side
• @ medulla, synapse to 2nd order then cross over
and ascend to Thalamus
• @ Thalamus, synapse to 3rd order
• Ascend to cortex

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4
Q

OUTSIDE

A

LOWR MOTOR NEURON

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5
Q

Inside

A

UPPER MOTOR NEURON (Stroke)

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6
Q

Dermatome have

A

1/3 OVERLAP

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7
Q

To get dermatome numbing

A

both dermatomes above and below

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8
Q

• 4 types of Reflexes:

•

A

DTR
Superficial
Visceral
Pathologic

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9
Q

• Deep Tendon (DTR)

A

• ex. Patellar

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10
Q

• Superficial

A

• ex. Corneal (blink), abdominal

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11
Q

• Visceral

A

• ex. Pupillary response to light

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12
Q

Pathologic

A

• ex. Babinski’s sign

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13
Q

Example of Lower MN disease

A
  • SC lesions
  • Polio
  • ALS
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14
Q

Examples of Upper MN disease

A
  • CVA
  • CP
  • MS
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15
Q

Extrapyramidal Tracts

• Gross automatic movement

A

(ie. Walking)

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16
Q

Only test in anosmia pt.s with:

A
  • Head trauma
  • Abnormal mental status
  • Suspected intracranial lesion
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17
Q

Ophthalmoscope – fundoscopy

• Optic disc LOOK FOR

A
  • Papilledema

* Optic atrophy

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18
Q

Optic disc is

A

most prominent landmark (nasal side)

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19
Q

Pallor indicated

A

CN 2 atrophy

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20
Q

Hyperemia indicates

A

methanol poisoning

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21
Q

Irregular shape indicates

A

Glaucoma

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22
Q

Margins Blurred =_________ = _________

A

Blurred margins = papilledema = ↑ ICP

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23
Q

CN III is the

A

OCULOMOTOR NERVE

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24
Q

• Asymmetric response indicated

A

CN 3 damage

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25
Q

Asymmetry in Corneal Light REFLEX

What to do next?

A

Asymmetry indicates deviation 2o to muscle weakness or paralysis – if present, do Cover Test

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26
Q

• Phoria =

A

mild weakness when fusion is blocked

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27
Q

• Tropia =

A

severe weakness that is constant

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28
Q

Ptosis occurs with:

A

• Myasthenia Gravis

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29
Q

MG is a ________

A
  • Autoimmune cause

* One or both eyes affected

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30
Q

Horner’s Syndrome (PIAC)

A
  • Pupil constriction
  • Ipsilateral sympathetic n. paresis
  • anhydrosis
  • CN III damage
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31
Q

CN IV is the

A

TROCHLEAR NERVE

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32
Q

CN V is the

A

Abducens

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33
Q

Uneven eye movement, Strabismus or failure to follow =

A

EOM weakness or CN dysfunction

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34
Q

EOM weakness or CN dysfunction

A

Uneven eye movement, Strabismus or failure to follow =

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35
Q

• Nystagmus indicates (2) SPM

A

semicircular canal ds.
paretic eye m.,
MS or brain lesion

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36
Q

Lid lag =

A

hyperthyroidism

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37
Q

CN V is the

A

Trigeminal nerve

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38
Q

EOM testing

A

Hold finger ~12” back, Move through the 6 cardinal positions of gaze, “H” pattern

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39
Q

Motor function of Nerve V trigeminal

A

Mastication

Note: WAP weakness, asymmetry, pain

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40
Q

Sensory testing of CN V trigeminal
• Forehead (ophthalmic branch)
• Cheeks (maxillary branch)
• Chin (mandibular branch)

A

Test light touch with cotton wisp or brush

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41
Q

Sensory testing of CN V trigeminal (FO)

• Forehead

A

(ophthalmic branch)

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42
Q

Sensory testing of CN V trigeminal (CheekMax)

• Cheeks

A

(maxillary branch)

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43
Q

Sensory testing of CN V trigeminal (TRIMAN)

• Chin

A

(mandibular branch)

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44
Q

If there’s no Blink means

A

damaged CN V and/or CN 7

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45
Q

2 typs

A

Circular (sympathetic)

radial (

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46
Q

Facial Nerve

A

motor test CN 7

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47
Q

CN 7 dseases

A

CVA

• Bell’s Palsy

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48
Q

MG looking up makes eyelid

A

droop

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49
Q

CN 8 is the___________

•

A

Vestibulocochlear N.

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50
Q

Vestibulocochlear

A

Test Hearing acuity w/
• normal conversation & whispered voice
• Weber & Rinne tuning fork tests

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51
Q

Weber test

A

normal, both ears hear equally

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52
Q

weber test sound lateralizes to POORER with

A

conductive loss

53
Q

weber test sound lateralizes to BETTER with

A

SENSONEURINAL loss

54
Q

Normal Rinne test

A

AC>BC

55
Q

Conductive loss in Rinne Test

A

AC =BC

AC < BC

56
Q

Sensorineural loss is

A

AC> BC BUT POOR EAR IN BOTH OVERALL REDUCED

57
Q

CN IX IS

A

Glossopharyngeal N.

58
Q

CN X IS

A

Vagus N.

59
Q

MOTOR Function tests IX and X (AATU)

A 
• Note :
absence
asymmetry of soft palate 
tonsil pillar movement, 
uvula deviation
60
Q

• Hoarse/brassy voice =

A

vocal cord dysfunction (CN X)

61
Q

Spinal Accessory N is CN

A

XI

62
Q

Test motor function

A
  • Instruct pt. to rotate head against resistance

* Shrug shoulders against resistance

63
Q

CN XII is

A

• Hypoglossal N.

64
Q

Inspect tongue for (FAT)

A
  • Fasciculations
  • Atrophy
  • Tongue deviates toward paralyzed side
65
Q

When do you use atrophy? (DIL PD)

A

Disuse
injury
LMN ds. (Polio, Diabetic neuropathy)

66
Q

Paresis means

A

diminished strength

67
Q

Paralysis/plegia =

A

absence of strength

68
Q

Decorticate rigidity where is the lesions (decorCORTEX)

A

Lesion in Cerebral Cortex

69
Q

DECEBRATE RIGIDITY where is the lesion

A

Lesion in brain stem @ midbrain or pons

70
Q

in Decorticate there is

A

FLEXION

71
Q

Decerebrate there is

A

EXTENDED

72
Q

Staggering, loss of balance =

Seen UMN lesion such as

A

Ataxia

ie. MS

73
Q

FLACCID

A

Lower

74
Q

Romberg test

A

Sways/falls/widens feet

75
Q

• (+) Romberg sign (CEM)

A
  • Cerebellar ataxia
  • MS
  • Etoh intoxication
76
Q

(+) Romberg sign (CEM)

A
  • Cerebellar ataxia
  • MS
  • Etoh intoxication
77
Q

Slow, clumsy, lack of coord. indicates______For _______

A

dysdiadochokinesia; cerebellar ds.

78
Q

There is dysymmetry means

A

cerebellar disorder

79
Q

Finger to nose test multiple misses

A

Cerebellar ds.

80
Q

Heel to shin test : lack of coordination

A

= cerebellar ds.

81
Q

For pt.s with neurologic symptoms

A

pain, numbness, tingling, motor deficits

full work up s/b done (all sensory modalities, most dermatomes)

82
Q

For pt.s without neurologic symptoms, screening includes:

SLVS

A
  • Superficial pain (sharp/dull discrimination)
  • Light touch
  • Vibration
  • Stereognosis
83
Q

Spinothalamic Tract Testing

A

PAIN (SHARP/DULL)

84
Q

Temp Test

A

May omit since fibers follow same path as pain, or use side of metal tuning fork (cold)

85
Q

Spinothalamic Tract Testing: Light touch

A

Test w/ hammer brush
• Brush over skin in random order of sites at irreg. intervals
• Ask pt. eyes closed; say “now” or “yes” when they feel it

86
Q

Vibration Test
• Vibration sense usually first lost in______
In 2 conditions_______

A

Peripheral Neuropathy

(DM, Etoh abuse

87
Q

Posterior column tract testing

A

Position (Kinesthesia) Test

• Tests ability to perceive passive movement of extremities

88
Q

Posterior Column Tract Testing

2 tests

A

• Position (Kinesthesia) Test

- Tactile Discrimination (Fine Touch)

89
Q

Posterior Column tract testing (GSTEP)

A
  • Graphesthesia
  • Stereognosis
  • Two-point discrimination
  • Extinction
  • Point location
90
Q

Stereognosis Test

A

Tests ability to recognize object by feel, size, shape

91
Q

Stereognosis test steps

A
  • Pt. eyes closed
  • Place a familiar object in one hand, ask them to identify it
  • Left hand assess Right parietal lobe function; Right hand assess Left lobe
92
Q

Graphesthesia –

A

tests ability to “read” a number traced on skin

93
Q

Graphestesia Steps

A
  • Pt. eyes closed
  • Using blunt instrument trace a single digit or letter on palm
  • Useful test for pt.s with limited hand ROM (ie. Arthritis)
94
Q

Failure of either test GRAPHESTESA/ STEREOGNOSIS indicates

A

sensory cortex lesion (ie. CVA)

95
Q

Two-point Discrimination

A
  • Pt. eyes closed
  • Lightly touch two points of opened paper clip to skin in ever-closing distances.
  • Note distance pt. no longer perceives two separate points.
  • Level of perception varies with region tested)
96
Q

Two-point Discrimination• Most sensitive =

A

Fingertips (2 – 8 mm)

97
Q

Two-point Discrimination• Least sensitive =

A

Back, Thigh, Upper Arms (40 – 75 mm

98
Q

Extinction Failure one side indicates

A

a contralateral sensory cortex lesion

99
Q

Point Location TEST

• Failure indicates___________

A

sensory cortex lesion

100
Q

DTRs

Clonus ____________ indicates

A

repeated jerking contractions; UMN lesion (MS)

101
Q

DTRs Hyperreflexia indicates

A

UMN lesion (CVA)

102
Q

Hyporeflexia indicates

A

LMN or Cord damage S

103
Q

Biceps Reflex

• Tests_______

A

C5 – C6

104
Q

Normal for biceps reflex is

A

flexion

105
Q

Triceps Reflex

• Tests

A

C7 – C8

106
Q

Normal for Triceps is

A

extension

107
Q

Brachioradialis Reflex

• Tests_______

A

C5 – C6

108
Q

Brachioradialis Reflex

A

Gently strike 2 to 3 cm above radial styloid process

109
Q

Normal Brachioradialis refex

A

Flexion & supination of forearm

110
Q

Quadriceps Reflex

• Tests_______

A

L2 – L4

111
Q

Quadriceps normal

A

extension

112
Q

Achilles

• Tests______

A

L5 – S2

113
Q

AChilles is Normal =

A

plantar flexion

114
Q

Clonus is

A

Jerky Repeated muscle contractions

115
Q

Clonus is seen in

A

UMN

116
Q

Clonus normal test is

A

no movement

117
Q

Superficial reflex
Abdominal
• Upper _______

A

Upper T8-T10

118
Q

Superficial reflex
Abdominal
Lower________

A

T10 – T12

119
Q

Plantar Reflex test is

A

Babinski Sign

120
Q

Babinski plantar test

A

• Test L4 – S2

121
Q

Abnormal in babinski is dorsiflexion and it is

A

Indicates Lesion in corticospinal (“pyramidal”) tract

122
Q

Babinski is normal up to

A

18 months

123
Q

Neurologic recheck

A

These pts. need close monitoring to chk. for improvement/deterioration/ ↑ICP

124
Q

______can push brain stem down (uncal herniation)

A

↑ICP

125
Q

Pressure on CN III causes

A

pupil dilation

126
Q

Cushing reflex can indicates

A

↑ICP

127
Q

Pain and temp monitor

A

LaTeral SPINOTHALAMIC tract

128
Q

• Light/Crude Touch monitor

A

ANTERIOR spino-thalamic tract

129
Q

Space spinothalamic tract testing

A

2 seconds apart

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