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Pt Assess II Final > Neuro Lecture > Flashcards

Neuro Lecture Flashcards

1
Q

Elements of complete neuro exam

A 
Mental status
CNs
Motor and sensory
DTRs
Cerebellar
Gait
Special tests
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2
Q

What must first be established in neuro exam?

A

Patient’s dominant hand

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3
Q

R handed people are ___ brain for speech

A

Left

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4
Q

75% of L handed people are ___ brain for speech

A

Left

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5
Q

Mental status exam consists of:

A
  • Level of consciousness
  • Appearance (dress, affect, hygiene)
  • Orientation (to person, date, place)
  • Language (quality, comprehension)
  • Concentration (serial 7s, WORLD backwards)
  • Calculation (17+12)
  • Recall (3 objects in 3 mins)
  • Current events
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6
Q

What tool can be used for the mental status exam? What does it test?

A

Folstein MMSE

  • Orientation
  • Registration
  • Calculation
  • Recall
  • Language
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7
Q

CN I testing:

A
  • Patency of each nostril

- Odor test

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8
Q

CN II testing:

A
  • VA then VF
  • Funduscopic exam
  • PERRLA
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9
Q

CN III, IV, VI testing:

A

EOMs with the H test

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10
Q

CN V testing:

A
  • Pin and light touch on ophthalmic, maxillary and mandiublar divisions
  • Motor test (jaw jerk should be absent, ask patient to chew to test masseter and temporalis muscles)
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11
Q

CN VII testing:

A
  • Show teeth
  • Squeeze eyes shut
  • Wrinkle forehead
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12
Q

What is Bells phenomena?

A

Patient closes eyes and the eye on the SAME side as the peripheral facial weakness will NOT close (but eye rolls superiorly)

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13
Q

Central facial weakness occurs with what disorder?

A

Stroke

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14
Q

Peripheral facial weakness occurs with what disorder?

A

Bell’s palsy, acoustic neuromas

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15
Q

Central facial weakness spares:

A

Forehead and eye closing

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16
Q

CN VIII testing:

A

Hearing, Weber and Rinne

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17
Q

CN IX and X testing:

A
  • Say ahh watch uvula (deviates to strong side)

- Test gag reflex

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18
Q

CN XI testing:

A
  • Shrug shoulders (trap)

- Turn head against resistance (SCM)

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19
Q

CN XII testing:

A

Stick out tongue (deviates to weak side)

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20
Q

What is upper motor neuron weakness characterized by?

A
  • Increased tone/spasticity
  • Increased reflexes
  • Minimal or no atrophy
  • No fasciculations
  • Positive Babinski
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21
Q

What is lower motor neuron weakness characterized by?

A
  • Decreased tone
  • Flaccidity
  • Absent or hyporeflexia
  • Atrophy and fasciculations
  • Absent Babinski
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22
Q

What is upper motor neuron disease often a result of?

A

Stroke or brain injury

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23
Q

What does lower motor neuron disease involve?

A

Can involve spinal cord, peripheral nerve, or muscle

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24
Q

UE motor testing:

A
  • Pronator drift
  • Deltoids (C5)
  • Biceps (C5, C6)
  • Triceps (C6, C7)
  • Wrist extensors (C6, C7 stop traffic)
  • Wrist flexors (C6, C7)
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25
Q

LE motor testing:

A
  • Hip flexion (L2, 3)
  • Adduction (L2-4)
  • Abduction (L4, 5)
  • Knee extension (L3, 4)
  • Knee flexion (L5, S1)
  • Dorsiflex foot (L4, 5)
  • Plantar flex (S1)
  • Extension of great toe (L5)
  • Extension of remaining toes (L5, S1)
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26
Q

Strength grading system of motor exam

A 
0 = no movement
1 = trace/flicker of movement
2 = able to move when gravity is eliminated
3 = able to move against gravity
4 = some weakness against resistance
5 = normal strength (able to move against resistance)
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27
Q

What strength grades are considered functional movement?

A

Above 3/5

so 4/5 is weakness but some function preserved

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28
Q

Sensory exam consists of which tracts?

A
  • Spinothalamic tract (pain and temperature)

- Dorsal (posterior) column (position sense and vibration)

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29
Q

L5 sensory =

A

Lateral portion of lower leg and great toe

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30
Q

S1 sensory =

A

Lateral portion of top and sole of foot

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31
Q

Dermatome of the shoulders

32
Q

Dermatome of inner upper arms

33
Q

Dermatome of nipple level

34
Q

Dermatome of umbilicus

35
Q

Dermatome of groin

36
Q

Dermatome of knee

37
Q

Dermatome of posterolateral thigh

38
Q

Dermatome of upper anterior thigh

39
Q

Dermatome of lateral thigh crossing to anterior lower leg

40
Q

Dermatome of great toe

41
Q

Dermatome of little toe

42
Q

Dermatome of posteromedial thigh

43
Q

Describe position (proprioception) test

A
  • Test distal most portion of an extremity (finger or toe)

- Move up and down with lateral contact points

44
Q

How to test vibration sense?

A
  • Use 128 tuning fork

- Test over bony prominences

45
Q

Define graphesthesia

A
  • Test of discriminatory sense

- Draw number in patient’s palm and have them identify

46
Q

Define stereognosis

A
  • Ability to identify touch alone

- Put an item in palm of pt’s hand and ask them to identify (e.g. key, coin, paper clip)

47
Q

Define 2 point discrimination

A
  • Ability to identify 2 separate stimuli that are close together
  • Use EKG calipers
  • Ask pt if 1 or 2 pins
48
Q

Define extinction and what may cause it

A
  • Patient “extinguishes” 1 of 2 simultaneous contralateral stimuli
  • Lesions in sensory cortex
49
Q

What does the Romberg test assess?

A

Position sense NOT cerebellar function

50
Q

Define ataxia

A

Loss of coordination

51
Q

What 3 senses are required to keep us upright and balanced?

A
  • Vision
  • Equilibrium (semicircular canals)
  • Proprioception (position sense)
52
Q

How many of the 3 senses required for balance do you need to maintain balance?

A

2 of the 3 need to work

remove 2 of the 3 and you will fall over - vision, equilibrium, proprioception

53
Q

What symptom will patients with disequilibrium complain of?

A

Vertigo/dizziness

54
Q

If a patient “passes” the Romberg test, what is it called?

A

ABSENT Romberg (NOT negative)

55
Q

What do the deep tendon reflexes test?

A

Simple spinal reflex (even deeply comatose pts may have preserved DTRs)

56
Q

Grading of DTRs

A 
0 = no reflex
1 = hyporeflexia
2 = normoreflexia
3 = hyperreflexia
4 = marked hyperreflexia (clonus)
57
Q

Reinforcement techniques of DTRs

A
  • Used to “coax” diminished reflexes
  • For LE, pt curls fingertips together in front of themselves and pulls in oppo directions
  • For UE, pt clenches jaw
58
Q

How to use reflex hammer for DTRs?

A
  • UE use pointy portion (smaller tendon target)

- LE use wider portion (wider tendon target)

59
Q

UE DTRs

A
  • Biceps
  • Triceps
  • Brachioradialis
60
Q

LE DTRs

A
  • Patellar

- Achilles

61
Q

What else do we check when doing LE DTRs?

A

Babinski

  • Stroke along lateral aspect of sole and then across
  • POSITIVE (abnormal) is if great toe moves upward
  • ABSENT (normal) is if great toe moves down
62
Q

What are the superficial reflexes?

A
  • Superficial abdominal

- Cremasteric (men only)

63
Q

Describe superficial abdominal reflexes

A

Stroke 4 quadrants lightly and umbilicus will move toward the stimulus

64
Q

Describe cremasteric reflex

A
  • Men only

- Stroke inner upper thigh and ipsilateral testicle will move rostrally (superiorly)

65
Q

What does cerebellar testing assess and what does it consist of?

A
  • Tests coordination
  • Rapid alternating movements (RAMs)
  • Finger nose finger (FNF)
  • Heel knee shin (HKS)
66
Q

How to assess gait?

A
  • Normal walking
  • Heels (brings out AT)
  • Toes (brings out gastroc)
  • Tandem
67
Q

Glabellar sign

A
  • Tap between eyebrows

- Pt eyes blink rhythmically (abnormal)

68
Q

Grasp reflex

A

Just like babies reflex but is pathological in adults

69
Q

Palmomental reflex

A

Scratch palm and patient will purse lips (may be very subtle)

70
Q

Snout reflex

A

Tap mouth and pt will purse lips

71
Q

Asterixis

A

Flapping tremor of the hands seen in liver disease

72
Q

Kernig’s sign

A
  • Flex hip and knee
  • Straighten knee
  • Pt will resist and note pain behind knee
  • Pain is the telling sign
73
Q

Brudzinski sign

A

Flex neck and patient will draw up hips and knees

74
Q

Describe Babinski reflex

A
  • Briskly stroke lateral surface of sole and go across MT heads
  • Absent (normal) is great toe to flex (move down)
  • Positive (abnormal) is great toe to extend (move up)
75
Q

What are you looking at to assess Babinski reflex?

A

Only the FIRST motion of the big toe determines absent or positive Babinski

Pt Assess II Final (17 decks)

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