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Physical Diagnosis > Neuro exam abnormal > Flashcards

Neuro exam abnormal Flashcards

1
Q

Altered mental status stage: sleppy but will open eyes and respond before falling back to sleep

A

lethargy

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2
Q

Altered mental status stage: harder to arose with verbal stimuli; may need to shake patient; responses are slower and tend to be confused

A

Obtundation

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3
Q

Altered mental status stage: often need painful stimuli (voice and shaking ineffective) to arouse patient; lapse into unresponsiveness when stimuli cease

A

stupor

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4
Q

Altered mental status stage: no response to verbal or painful stimuli; unarousable

A

coma

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5
Q

dysarthria

A

problem with motor speech or articulation

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6
Q

dysphonia

A

(weak) breathy voice

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7
Q

Broca’s (expressive) aphasia

A
  • comprehension intact
  • unable to speak to varying degrees
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8
Q

Wernicke’s (receptive) aphasia

A
  • comprehension not intact
  • fluent, but nonsensical speech
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9
Q

global aphasia

A

combination of receptive and expressive aphasia

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10
Q

apraxia

A

inability to perform a learned motor act

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11
Q

agnosia

A
  • inability to recongize sensory stimuli

**associated with large parieto-occipital-posterior temporal lesion

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12
Q

clinical presentation

  • acute onset
  • duration: hours-weeks
  • alertness: abnormally high or low
  • orientation: impaired for time
  • memory: recent and immediate impaired
  • speech: incoherent
  • perception: visual illusions and hallucination
A

delirium

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13
Q

impaired attention and incoherent thought

A

confusion

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14
Q

pyshomotor disturbances seen in schizoprenia characterized by periods of either muscular rigidity, excitement, or stupor

A

cataonia

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15
Q

glascow coma scale: eye opening

A
  1. none
  2. to pain
  3. to voice
  4. spontaneous
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16
Q

glascow coma scale: motor response

A
  1. none
  2. extensor posturing
  3. flexor posturing
  4. withdraws to pain
  5. localizes to pain
  6. obeys commands
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17
Q

glascow coma scale: verbal response

A
  1. none
  2. makes incomprehensible sounds
  3. uses inappropriate words
  4. conversant and disoriented
  5. conversant and oriented
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18
Q

type of coma: patients “act awake,” usually following a deep coma. eyes are open, they may cough, yawn, and swallow and meaninglessly use thier extremities, but still essentially brain dead

A

coma vigil

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19
Q

decorticate posturing

A

flexion with adduction of arms and extension of legs

  • reflects destructive lesion in corticospinal tract from cortex to upper midbrain
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20
Q

Decerebrate posturing

A

extension, adduction, and internal rotation of the arms and extension of the legs

  • associated with damage to corticospinal tract at levels of pons or upper medulla
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21
Q

What are the three common sites of hernation due to increased intracranial pressure

A
  1. under falx
  2. through tentorium
  3. foramen magnum
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22
Q

signs of third nerve palsy

A
  • unilateral, fixed, and dilated pupil with ptosis

*seen with uncal herniation or aneursym compressing CNIII

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23
Q

This pupillary response is associated with what condition:

  • midposition (2-5 mm) and fixed
A

midbrain lesion

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24
Q

This pupillary response is associated with what condition: pinpoint and reactive

A

Pontine lesion

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25
Q

This pupillary response is associated with what condition:

  • unilateral dilated and fixed
A

CNIII lesion/uncal herniation

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26
Q

This pupillary response is associated with what condition:

  • bilateral dilated and fixed
A

central herniation, hypoxia

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27
Q

Oculocephalic reflex (doll’s eyes)

A
  1. hold eyes open and rotate head side to side
    1. if intact, eyes roll to side opposite of head movement
    2. if eyes remain fixed and move in the same direction of the head movement, suggests lesion in midbrain or pons (CN III- CN VIII) lesion: “doll’s eyes absent”
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28
Q

vestibulocochlear reflex

A
  • hold head at 30 degrees; lavage ear with ice-cold water (30-60cc)
  • normal response is tonic (slow) toward ear (stimulus); fast nystagmus away
    • COWS
      • cold water opposite
      • warm water same
    • if impaired response, suggests brainstem lesion (CN III-CN VI)
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29
Q

metabolic encephalopathy or bihemispheric lesions present with what respiratory patterns in coma

A

cheyne-stokes

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30
Q

metabolic acidosis or hernation present with what respiratory patterns in coma

A

Hyperventilation (Kussmaul’s)

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31
Q

pontine damage present with what respiratory patterns in coma

A

apneustic

32
Q

early medullary damage present with what respiratory patterns in coma

A

cluster

33
Q

Medullary damage present with what respiratory patterns in coma

A

ataxic (biot’s)

34
Q

clinical presentation

  • visual field defect and HA
  • acromegaly
  • infertility, galactorrhea, amenorrhea
  • cushing’s disease
A

pituitary adenoma

  • increased growth hormone, prolactin, and ACTH
35
Q

lesion to optic chiasm

A

bitemporal hemianopsia

36
Q

lesion to (right) optic nerve

A

blind right eye

37
Q

Central VII lesion presentation

A

contralateral paralysis of lower face; sparing of forehead

*upper motor neuron lesion

38
Q

Peripheral VII lesion presentation

A

ipsilateral paralysis of the entire side of the face

39
Q

presentation of glossopharyngeal lesion

A
  • deviation of palate AWAY from side of lesion
  • loss of gag reflex
40
Q

presentation of hypoglossal lesion

A

deviation of the tongue TOWARD the side of the lesion

41
Q

spasticity

A
  • increased tone, worse with rapid movement
    • due to UMN disease; loss of inhibition
42
Q

rigidity

A

increased tone and resistance to movement, independent of rate of movement

  • seen with basal ganglia disease
43
Q

flaccidity

A

decreased tone

  • due to Lower motor neuron disease
44
Q

clinical presentation

  • weakness in affected distribution
  • spasticity
  • hyperactive DTR
  • clonus
  • babinski sign
A

upper motor neuron

45
Q

clinical presentation

  • weakness in segmental distribution
  • muscle atrophy
  • flaccidity
  • fasciculations
  • reduced or absent DTR
A

lower motor neuron

46
Q

nerve root affected: sensory loss to lateral upper arm and shoulder

A

C5

47
Q

nerve root affected: sensory loss to dorsolateral arm, forearm, and thumb

A

C6

48
Q

nerve root affected: sensory loss to mid-dorsal forearm and middle finger

A

C7

49
Q

nerve root affected: sensory loss to medial forearm, ring and small finger

A

C8

50
Q

nerve root affected: motor loss to deltoid, some biceps (shoulder abduction)

A

C5

51
Q

nerve root affected: motor loss to biceps, brachioradialis (forearm extension); wrist extension

A

C6

52
Q

nerve root affected: motor loss to triceps (forearm extension) wrist flexors and finger extensors

A

C7

53
Q

nerve root affected: motor loss to thenar eminence and interossei of hand

A

C8

54
Q

nerve root affected: sensory loss to anterior thigh

A

L3

55
Q

nerve root affected: sensory loss to antero-medial thigh and medial leg

A

L4

56
Q

nerve root affected: sensory loss to lateral thigh and anterior calf

A

L5

57
Q

nerve root affected: sensory loss to posterior calf and heel

A

S1

58
Q

nerve root affected: motor loss to iliopsoas

A

L3

59
Q

nerve root affected: motor loss to quadriceps

A

L4

60
Q

nerve root affected: motor loss to foot dorsiflexion

A

L5

61
Q

nerve root affected: motor loss to gastrocnemius (plantar flexion of foot)

A

S1

62
Q

DTR: knee jerk

A

L3 and L4

63
Q

Upper motor neuron weakness

A
  • neurons arising from motor cortex; pass through brainstem and down spinal cord
  • weakness will be present below the level of the lesion
    • unilateral lesions above medulla -> contralateral weakness
    • unilateral lesions below medulla -> ipsilateral weakness
64
Q

resting tremor

A

most prominent at rest; disappears with movement

*seen with parkinson’s disease

65
Q

postural tremor

A

appears with actively maintaining posture (head or extremity)

*seen with benign familiar tremor and hypothyroidism

66
Q

intention tremor

A

abesnt at rest; appears when reaching for target

*seen with aging, cerebellar disease and MS

67
Q

rhythmic, repetitive bizarre movements of the face, mouth, jaw and tongue

A

oral facial dyskinesias

*due to psychotropic medication

68
Q

rapid, jerky movements (unpredictable) of face, trunk and extermities

A

chorea

*seen with huntington’s

69
Q

writhing, twisting movement of face, trunk and extremities, slower than chorea

A

athetosis

*seen with cerebral palsy

70
Q

sudden and rapid jerks, faster than chorea

A

myoclonus

*seen in infections, strokes, anoxia

71
Q

spastic hemiparesis

A
  • associated with corticospinal disease
  • UE flexed
  • LE extended
  • drags or draws foot around
72
Q

steppage gait

A
  • associated with foot drop, usually due to LMN disease
73
Q

sensory ataxia

A
  • loss of proprioception in the legs
  • unsteady, wide based gait
  • watch the ground while walking
  • associated with + romberg
74
Q

cerebellar ataxia

A
  • associated with cerebellar disease
  • staggering, unsteady and wide-based gait
  • increased difficulty with turns
  • unable to stand with eyes open or closed
75
Q

clinical presentation

  • bradykinesia
  • rigidity (“cog-wheel)
  • resting tremor (pill rolling)
A

parkinson’s disease

  • idiopathic degeneration of dopaminergic neurons in substantia nigra
76
Q

parkinson’s gait

A
  • stooped posture
  • slow to get started
  • shortm shuffling step
  • decreased arm swing
    • arms flexed

Physical Diagnosis (16 decks)

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