NEURO OSCE Tests 1 Flashcards
Level of Consciousness
- Test steps
- Consciousness: brainstem, hemispheres, thalamus
Causes:
-toxic metabolic, focal lesion, dementia, encephalitis, behavioural or mood
Glascow Coma Scale
-Test
Decorcitate:
- cerebral hemispheres, internal capsule, thalamus
- corticospinals cut, rubrospinals unaposed = dystonia
Decerebrate:
-brainstem, more serious
Memory
Recent n Remote
-Lymbic system damage: anterograde amnesia n short retrograde just prior accident
Declarative
-Medial temporaal lobes n diencephalon
Info -> Brainstem n Diencephalon -> Frontal association cortex (working memory) -> Temporal lobe n Diencephalon (consolidated) -> various cortical areas
Attention n Orientation
Attention: 5 tests
-focal lesion, dementia, encephalitis, behavioural, mood
Orientation: person, place, time
Language
Spontaneous speech
-fluency, rate, errors, abundance, invented words
Comprehension: 3 tasks
Left hemisphere:
- frontal , temporal, parietal lobes
- Wernicke’s, Broca’s
- thalamus, caudate nucleus
Abnormal speeches
Gerstmann’s Syndrome
- Acalculia
- R-L confusion
- Finger agnosia
- Agrapghia
Apraxia
-Miming task
- Test
- Theory
Neglect n Construct
- Visual neglect
- Tactile neglect
- Sensorimotor neglect
Sequencing n Frontal Release
- Manual alternating sequence
- Grasp reflex
- Sucking reflex
- Snout reflex
- Palmomental
Logic n Abstract
- Proverbs
- Analogies
Abnormal Thought Process
- compulsions
- obsessions
- phobias
- anxiety
- delusions (of persecution, grandeur, jelousy)
Mood
- Facial expression
- Body language
- Voice
Euthymic : normal
Dysthymic : depressed
Manic : elated
Olfactory Nerve Test
Object smelling
Optic Nerve Testing
- Ophthallmoscopy
- Pupillary light reflex
- Convergence n Acomodation
- Visual acuity
- Visual field
- Colour vision
Extraocular Muscles
- Eye movements
- Smooth pursuit
- Saccades
- Optokinetic nystagmus
- Oculocephalic testing
Tests for Trigeminal nerve
- Facial sensation
- Corneal reflex
- Mastication muscles
- Jaw jerk reflex
Facial expression n taste
- Facial muscles
- Taste
Hearing n Vestibular
- General hearing
- Otoscopy
Passive Neck Flexion
-protocol
- Brudzinski - meningitis -flex neck = reflex flex knees
- Lhermitte’s sign -electric shock from neck flexion
- Indication: spinal symptoms
- Normal: pulling sensation
Straight Leg Raise
-OG
- Tibial
- Sural
- Peroneal
- Well leg
-pain post thigh, knee, calf
—-straightening of neural slack—|30|—dural sleeves L4-S2 roots mechanically loaded—|70|—hamstrings, Gmax, hip, lumbar, SIJ
Kernig’s sign: flex hip n knee to 90 90, then try to extend knee
-resistance or pain is ++
Prone Knee Bend
OG
-quad pain, tight is normal
- Femoral
- Lateral femoral cutaneous (meralgia paresthetica, passes under inginal lig, obesity, pregnancy, tool belt)
- Saphoneous (adductor/hunter cana, medial knee n leg pain on walking, standing)
Indications: kneeling issues, knee, ant thtigh, hip, lumbar symptoms
+ : U/L lumbar pain, buttock, post thigh pain
Slump
- OG
- Obturator (supplies adductors)
-Hands behind -slump -neck -push -leg -dorsiflex -desensitize
- nerve roots, dural sheath
- pain T8/9, hamstring, post knee pain
- Indication: spinal symptoms, pain getting in car or kicking
Median Nerve
- pistol grip thumb, index, middle fing
- depress shoulder - abduct - supinate - extend wrist n fingers - extend elbow - sensitizing neck
- Indicated if any arm, neck, thoracic symptoms
Positive if:
- reproduce pain symptoms
- reproduce neuro symp
- diff to normal side
- in your experince abnormal
Loads all brachial plexus
Radial Nerve
Depress shoulder - extend elbow - abduct - pronate - flex wrist n fingers - ulnar deviate - abduct more - sensitize w neck
Positive if:
- reproduce pain symptoms
- reproduce neuro symp
- diff to normal side
- in your experince abnormal
Ulnar Nerve
- Tunnel of Guyon
- scap on table
Depress shoulder - wrist n fing - pronate - flex elbow - abduct - externaly rotate - sensitize neck
Positive if:
- reproduce pain symptoms
- reproduce neuro symp
- diff to normal side
- in your experince abnormal
Opthalmoscopy
- dark room
- large scope light n 0 lens setting
- ask pt to focus on one point ahead
- scope against my orbit
- 30cm n 15 degrees from midline
- Find RED LIGHT REFLEX, follow it in
- Find DISC n refocus
- my Thumb on their eyebrow
- REPORT disc: sharp outline, white-yellow cup, cup-disc ration 0.3
- Trace arteries n veins. Report: A- bright red, small; V-dark red, big
- refocus to 10 n observe ant. chamber opacities
- pt look into the light - report fovea n macula
Pathway of the pupillary light reflex
Optic N. -> Chiasm -> Optic Tract -> most* Thalamus LGN
- But also -> Superior Colliculus Brachium -> Pretectal area -> Edinger Westphal Nuclei -> Parasympathetic Preganglionics
- Oculomotos N. -> Ciliary Ganglion -> Postganglionics -> Pupil Constrictor Muscles
What does convergence? And accommodation?
Convergence: Oculomotor GSE
Accomomdation: Oculomotor GVE
Visual acuity
- Snellen eye chart
- pt distance / number assigned to line they can read
Bad eye first
Colour vision
A) Red desaturation
- optic neuritis if acute change
- red will look faded if optic n. Damage
- compare L n R
B) Ishihara Charts
Visual Fields
- block opposite eye to pt.
- stare into each others eyes
- finger EQUIDISTANT pt n Dr
- come from 4 directions
- «tell me when you see my finger»
- I am the baseline
-can do other way without me as baseline
Eye movements
- oculomotor n
- trace H, passing by middle each time
- one eye
- other eye
- both at once
Smooth pursuit
- trace X
- passing by middle each time
- one eye
- other eye
- both at once
Saccades
- hold 2 separate fingers
- have pt alternate (keep head still)
- horizontal
- then vertical
Oculocephalic testing
Brainstem injury = doll’s eyes
Facial sensation
GSA of trigeminal N.
Corneal reflex
Tigeminal is sensory
Facial is motor
- warm pt of what will happen
- note asymmetry
Mastication
- SVE trigeminal N.
- jaw deviates to week side
Causes of Jaw Jerk reflex
- abnormal is hyper-refexia
- UMN lesion
Facial Expression
-Facial SVE
- Smile -> zygomatic n lavator ang ori
- Wrinkle forehead -> frontalis
- Squeeze eyes n resist -> orbic oculi
- Whistle -> buccinator, orbic ori
- Blow cheeks -> buccinators
- Show teeth -> orbic oris
- Platysma muscles
UMNL: C/L week except for forehead (bc B/L bulbar innervation)
LMNL: I/L whole face week
Taste
Facial SVA
Otoscopy
TECHNIQUE:
- hold like a pen
- R ear R hand R eye
- Pinky out on temple
- AT, not IN canal
STEPS:
- warn pt of cough, tickle
- attach speculum
- good ear 1st
- pt on corner couch
- adjust table height
- pt C/L at flex n ext slight
- pull pinna up n back, rest on mastoid
- Report canal inflam, excess wax n hair
- Report eardrum: shiny, pearl gray, translucent, bulldge or retracted
- Report annulus
- no fluid, bubbles, perforations
Abnormal thought processes
- compulsions, obsessions, phobias, anxiety
- delusions of persecutions, grandeur, or jelousy
Caused by:
- toxic metabolic
- psychiatric
- focal lesion, seizure
Manual Alternating Sequencing
Draw tiangles n squares: perseveration
Luria Manual Sequence Task: abulia (slow)
Neglect
R lobe lesion -> neglect left arm
L lobe lesion -> minimal effect
Gerstmann’s Syndrome
- Left parietal angular gyrus lesion
- might also have aphasia, language, praxis, construction, logic, abstraction issues
Abnormal Speaches
- hesitancy
- monotone
- circumduction
- paraphasias
- brocas aphasia
- wenickes aphasia
- incoherence
- blocking
- confabulation
- perseveration
- echolalia
- clanging
- circumstantiality
- derailment
- flight of ideas
- neologisms
Hesitancy
Stroke , brocas aphaia
Circumlocutions
Substitute forgotten word with its definition
Paraphaia
Malformed, wrong or invented words
Brocas aphasia vs wenickes aphasia
Broca: cant express
Wernicke: talks easy but wrong sense n words
Well leg raise
-nerve root on C/L side is pulled toward midline -> medial disc protrusion -> pain on C/L leg
Prone knee bend - Saphenous nerve bias
-prone
extend n abduct hip
- > externaly rotate hip
- > dorsiflex n evert
