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Principles of Clinical Medicine > Neuro Exam Lecture > Flashcards

Neuro Exam Lecture Flashcards

1
Q

what are the components of the neuro exam?

A

mental status, cranial n., motor system, sensory, reflexes

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2
Q

what neuro dz presents episodically?

A

MS

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3
Q

what are the components of a mental status exam?

A

level of alertness, appropriateness of response, orientation

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4
Q

what cranial n. exits at telencephalon?

A

CN I

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5
Q

what cranial n. exits at the diencephalon?

A

CN II

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6
Q

what cranial n. exits at the mesencephalon?

A

CN III and IV

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7
Q

what cranial n. exits at the metencphalon?

A

CN V

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8
Q

what cranial n. exits at the myelencephalon?

A

CN IX-XII

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9
Q

what part of the brain is the midbrain?

A

mesencephalon

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10
Q

what part of the brain is the pons?

A

metencephalon

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11
Q

what part of the brain is the medulla?

A

myelencephalon

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12
Q

what cranial nerves exit at the pontomedullary junction?

A

CN VI, VII, VIII

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13
Q

what kinds of things can cause loss of smell?

A

smoking, chronic sinus dz, head trauma, aging, PD, use of cocaine

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14
Q

CN I lesion is what side?

A

ipsilateral

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15
Q

lesions to the optic n. anterior to chasm cause what sided blindness?

A

ipsilateral

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16
Q

What are the nerves (afferent and efferent) involved in the pupillary light reflex?

A

CN II and (efferent) CN III

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17
Q

what nerve is responsible for the consensual light reflex?

A

CN III (efferent to opposite eye)

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18
Q

What is opticokinetic nystagmus?

A

normal physiologic response to fixating on a moving target

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19
Q

what can asymmetric loss of opticokinetic nystagmus be due to?

A

frontal or parietal lesion on side to which target is moving to

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20
Q

If there is a lesion of CN III what can present?

A

ptosis, pupillar dilation or asymmetry, position change of eye “down and out”

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21
Q

what is involved in a near reaction?

A

pupils constrict, eyes converge, and accommodation occur (thickens lens)

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22
Q

what kinds of things can lead to compressive brainstem lesions effecting CN III?

A

hematomas, large strokes, abscesses, tumors, space occupying or expanding masses, aneurysms

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23
Q

diabetes mellitus can present with in regards to eye?

A

extraocular m. weakness but often spares the pupilloconstrictor fibers

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24
Q

why is CN IV particularly susceptible to trauma?

A

long course around brainstem

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25
Q

what can lesions of CN IV result in?

A

extorsion (eye drifts laterally), weakness of downward gaze, VERTICAL diplopia (increases when looking down), ** Head tilting** to side opposite of lesion (can be misdiagnosed as idiopathic torticollis

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26
Q

what CN is the most common isolated CN palsy? due to?

A

CN VI, due to its long peripheral course

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27
Q

what pts often have a CN VI lesion?

A

subarachnoid hemorrhage, late syphilis and trauma

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28
Q

what do pts with CN VI lesion present with?

A

convergent (medial) strabismus (estropia)- inability to ABDUCT eye
HORIZONTAL diplopia

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29
Q

pts with CN V lesions present with?

A

decreased sensation of face and mucus membranes, loss of corneal reflex, weakness of m. of mastication, jaw deviation (toward weak side- due to unopposed action of the opposite lateral pterygoid m.)

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30
Q

What nerves are involved in corneal reflex?

A

afferent- CN V

efferent- CN VII

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31
Q

what is CN VII involved in?

A

motor- face expression
sensory- taste to anterior 2/3 of tongue
parasympathetic- secretion of saliva and tears
general sensation- external ear

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32
Q

what do lesions of CN VII result in?

A

paralysis of the m. of facial expression= Bell’s palsy
loss of corneal reflex
hyperacusis
crocodile tears syndrome- tears with chewing

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33
Q

What can cause bilateral facial palsies?

A

miller-fisher variant of Guillian-Barre Syndrome

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34
Q

how does supra nuclear (central) facial palsy? why important?

A

upper face spared and lower face palsy, associated with hemiplegia; important in determining weakness is central or peripheral

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35
Q

what are the 2 tests for the hearing division of CN VIII?

A

Weber and Rinne tests

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36
Q

what can lesions in the vestibular division of CN VIII result in?

A

dysequilibrium and -nystagmus

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37
Q

What can destructive lesions of the cochlear division of CNVIII lead to? example?

A

sensorineural hearing loss; acoustic neuroma

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38
Q

what can irritative lesions cause? example?

A

tinnitus; medications (aspirin, some antibiotics, etc.)

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39
Q

what does weber test for?

A

lateralization

(this is more for knowledge outside this lecture but it

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40
Q

how does Weber result if there is conductive hearing loss?

A

sound lateralizes to impaired ear; seen with occlusion of ear

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41
Q

how does Weber result if there is sensorineural hearing loss?

A

sound lateralizes to good ear

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42
Q

what is the Rinne test used to compare? what is normal?

A

air to bone conduction; AC>BC

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43
Q

how is the Rinne test done?

A

virbrating fork put on mastoid and then near ear canal (with U facing forward)

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44
Q

what is the result of the Rinne test in conductive hearing loss?

A

BC>AC, negative test

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45
Q

what is the result of the Rinne test in sensorineural hearing loss?

A

AC>BC; positive test

– because both AC and BC are diminished keeping ratios the same

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46
Q

What does CN IX do?

A

motor- stylopharyngeus m.
sensory- taste to posterior 1/3 of tongue, sensation to palate and pharynx, skin of ext. ear & afferent of gag reflex

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47
Q

what does the gag reflex?

A

CN IX and X

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48
Q

lesions of CN IX present as?

A

loss of gag reflex, sensation in pharynx and posterior 1/3 of tongue, slight dysphagia

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49
Q

what does the lesions of CN X present as?

A

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

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50
Q

what does the cranial division of CN XI innervate?

A

innervation of the m. of larynx except the Cricothyroid m.

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51
Q

what does the spinal division of CN XI innervate?

A

innervates trapezius (with contributions from C2) and sternocleidomastoid (with contribution from C3 and C4)

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52
Q

what direction does the left SCM turn the head?

A

right

53
Q

what does a CN XI lesion result in?

A

ipsilateral shoulder droop

54
Q

what does hypoglossal n innervate?

A

all intrinsic and extrinsic tongue muscles except palatoglossus (CN X)

55
Q

how do you test the hypoglossal n?

A

have pt protrude tongue into opposite cheek.

56
Q

what does a CN XII lesion result in?

A

deviation to the weak side “lick your wounds”

57
Q

what is dysarthria?

A

slurred speech

58
Q

what is dysphagia?

A

partial or complete impairment of ability to communicate

59
Q

what is aphasia?

A

inability to get words out or understand what is being said

60
Q

what do you do to assess the motor system?

A

inspetion, m. tone, involuntary movement, m. power, body position

61
Q

what does a m. strength grade of 0/5 mean?

A

no m. contraction detected

62
Q

what does a m. strength grade of 1/5 mean?

A

evidence of contraction, no joint movement

63
Q

what does a m. strength grade of 2/5 mean?

A

active movement with gravity eliminated

64
Q

what does a m. strength grade of 3/5 mean?

A

complete ROM against gravity

65
Q

what does a m. strength grade of 4/5 mean?

A

complete ROM against gravity with some resistance

66
Q

what does a m. strength grade of 5/5 mean?

A

complete ROM against gravity with full resistance

67
Q

what m. and n. control shoulder abduction, flexion, and extension?

A

deltoid-C5

68
Q

what nerves control elbow flexion? and extension?

A

flex- C5, C6

extension-C6, C7, C8

69
Q

what nerves control wrist flexion and extension?

A

C6 and C7

70
Q

what n. do hand grip?

A

C7, C8, T1

71
Q

what n. are involved in finger abduction?

A

C8, T1

72
Q

what n. are involved in opposition of the thumb?

A

C8, T1

73
Q

what m. and n control hip flexion?

A

psoas and iliacus- L2, 3, 4

74
Q

what m. and n. control hip extension?

A

gluteus maximus- S1

75
Q

what n. control hip adduction?

A

L2, 3, 4

76
Q

what n. control hip abduction

A

L4, 5, S1

77
Q

what m. and n. control knee flexion?

A

hamstrings- L4, L5, S1, S2

78
Q

what m. and n. control knee extension?

A

quadriceps- L2, L3, L4

79
Q

what m. and n. control plantar flexion of the ankle?

A

gastrocnemius- S1

80
Q

what m. and n. control dorsiflexion of the ankle?

A

primarily tibialis anterior- L4, L5

81
Q

sensory dermatome for the shoulder?

A

C4

82
Q

sensory dermatome for the radial aspect forearm and thumb?

A

C6

83
Q

sensory dermatome for the little finger?

A

C8

84
Q

sensory dermatome for the little toe?

A

S1

85
Q

sensory dermatome for the hallucis?

A

L5

86
Q

sensory dermatome for the nipple?

A

T4

87
Q

sensory dermatome for the umbilicus?

A

T10

88
Q

what kinds of changes in m. tone and reflexes occurs when there is UMN injury? what is the pattern of weakness?

A

hypertonia, hyperreflexia;

pyramidal pattern of weakness-weak extensors in arms and weak flexors in legs

89
Q

how do you test for an UMN injury?

A

pronator drift- arms held extended for up to 2 mins, arms drift down and supinate

90
Q

what kinds of changes in m. tone and reflexes occurs when there is LMN injury? what is the pattern of weakness?

A

hypotonia, hyporeflexia;

peripheral pattern of weakness- weak flexors in arms, weak extensors in legs

91
Q

what happens at NMJ in LMN injury?

A

fatigable weakness

92
Q

what 4 things can be tested for the sensory system?

A

pinprick and temp
proprioception, 2pt tactile discrimination and vibratory
light touch
discriminative sensations

93
Q

what tract does pain and temp travel in?

A

spinothalamic tract

94
Q

what tract does proprioception, 2 pt tactile discrimination and vibratory travel in?

A

posterior columns

95
Q

what are the 4 discriminative (cortical) sensations?

A

sterognosis, graphesthesia, 2 pt discrimination, double simultaneous stimulation (extension)

96
Q

what is sterognosis?

A

ability to ID objects or recognize objects placed in the hand

97
Q

what is graphesthesia?

A

ability to ID numbers written on the palm

98
Q

what is the scale that DTRs are rated on?

A

0-4

99
Q

what is a normal DTR?

A

2/4

100
Q

what does a DTR of 4/4 mean?

A

hyperactive with clonus

101
Q

what does a hyperactive reflex indicate?

A

lesion of CNS

102
Q

what does a hypoactive reflexes indicate?

A

lesion of PNS

103
Q

what does a DTR of 3/4 mean?

A

brisk, spread to involve movement across more than one joint

104
Q

what n. is tested with DTR of biceps?

A

C5*, (6)

105
Q

what n. is tested with DTR of triceps?

A

(C6,) 7*

106
Q

what n. is tested with DTR of brachioradialis?

A

(C5,) C6*

107
Q

what n. is tested with DTR of patella?

A

(L2, 3) L4*

108
Q

what n. is tested with DTR of achilles?

A

S1*

109
Q

what does a Babinski’s sign indicate?

A

critical sign of UMN dysfxn

110
Q

how do you test for a Babinski’s sign?

A

scratch foot from heel to toe and across transverse arch

111
Q

what is a positive Babinski’s?

A

great toe extends and remainder spread

112
Q

what does clonus indicate? what is it?

A

UMN sign, abnormal pattern of NM activity characterized by rapidly alternating involuntary contraction and relaxation of skeletal m.

113
Q

what kind of reflexes are frontal lobe release reflexes?

A

rooting, grasping, glabellar, and palmo-mental

114
Q

what 3 reflexes are superficial tendon reflexes? describe?

A

abdominal reflex- test for all 4 quadrants, stroking abdomen, umbilicus moves toward area of stimulation
cremasteric reflex- afferent L1, efferent L2, scrotum rises on side of stroking
anal wink reflex- cauda equina or sacral lesions

115
Q

what 4 systems are involved in coordination?

A

motor, vestibular, sensory, and cerebellar***

116
Q

what kinds of tests can be done for cerebellar testing?

A

finger to nose, heel to shin, rapid alternating movement, saccades

117
Q

what is heel walking sensitive for testing?

A

corticospinal tract lesions or distal m. weakness

118
Q

romberg test tests for what?

A

proprioception (sensory test)

119
Q

how is the romberg test performed?

A

pt stands in front of examiner with back, pt feet together and arms outstretched, pt closes eyes, pt should maintain balance

120
Q

what part of walking is pathognomic for parkinson’s dz?

A

en bloc turns: taking 5-6+ steps to turn around

121
Q

what kind of gait is scissoring? often seen with?

A

not Liz or Kenna’s, but with feet crossing and toes dragged over; CP or MS

122
Q

sensory ataxia can indicate what? what does it look like?

A

posterior column damage and peripheral neuropathy; high stoppage, broad based gait

123
Q

magnetic gait looks like? indicative of?

A

small steps, feet on ground; frontal lobe processes and hydrocephalus

124
Q

Astasia-abasia gait is what?

A

psychogenic

125
Q

what kinds of abnormal gaits are asymmetrical?

A

hemiplegic, waddling pelvis, foot drop

126
Q

what does does a resting (pill rolling) tremor indicate?

A

basal ganglia disease (parkinson’s)

127
Q

what are the 2 meningitic signs and how do you do them?

A

Kernig’s- flex thigh then straighten leg, pt will experience pain in neck
Brudzinski’s- doc lifts pt head, pt lifts knees in response

128
Q

what are the 2 coma postures and what do they look like?

A

Decorticate- arms flexed and legs extended

Decerebrate- arms and legs extended

Principles of Clinical Medicine (13 decks)

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