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Neuromusculoskeletal Diagnosis > NEURO OSCE Tests 1 > Flashcards

NEURO OSCE Tests 1 Flashcards

1
Q

Level of Consciousness

A
  • Test steps
  • Consciousness: brainstem, hemispheres, thalamus

Causes:
-toxic metabolic, focal lesion, dementia, encephalitis, behavioural or mood

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2
Q

Glascow Coma Scale

A

-Test

Decorcitate:

  • cerebral hemispheres, internal capsule, thalamus
  • corticospinals cut, rubrospinals unaposed = dystonia

Decerebrate:
-brainstem, more serious

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3
Q

Memory

A

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

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4
Q

Attention n Orientation

A

Attention: 5 tests
-focal lesion, dementia, encephalitis, behavioural, mood

Orientation: person, place, time

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5
Q

Language

A

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

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6
Q

Gerstmann’s Syndrome

A
  • Acalculia
  • R-L confusion
  • Finger agnosia
  • Agrapghia
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7
Q

Apraxia

A

-Miming task

  • Test
  • Theory
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8
Q

Neglect n Construct

A
  • Visual neglect
  • Tactile neglect
  • Sensorimotor neglect
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9
Q

Sequencing n Frontal Release

A
  • Manual alternating sequence
  • Grasp reflex
  • Sucking reflex
  • Snout reflex
  • Palmomental
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10
Q

Logic n Abstract

A
  • Proverbs

- Analogies

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11
Q

Abnormal Thought Process

A
  • compulsions
  • obsessions
  • phobias
  • anxiety
  • delusions (of persecution, grandeur, jelousy)
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12
Q

Mood

A
  • Facial expression
  • Body language
  • Voice

Euthymic : normal
Dysthymic : depressed
Manic : elated

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13
Q

Olfactory Nerve Test

A

Object smelling

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14
Q

Optic Nerve Testing

A
  • Ophthallmoscopy
  • Pupillary light reflex
  • Convergence n Acomodation
  • Visual acuity
  • Visual field
  • Colour vision
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15
Q

Extraocular Muscles

A
  • Eye movements
  • Smooth pursuit
  • Saccades
  • Optokinetic nystagmus
  • Oculocephalic testing
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16
Q

Tests for Trigeminal nerve

A
  • Facial sensation
  • Corneal reflex
  • Mastication muscles
  • Jaw jerk reflex
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17
Q

Facial expression n taste

A
  • Facial muscles

- Taste

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18
Q

Hearing n Vestibular

A
  • General hearing

- Otoscopy

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19
Q

Passive Neck Flexion

A

-protocol

  • Brudzinski - meningitis -flex neck = reflex flex knees
  • Lhermitte’s sign -electric shock from neck flexion
  • Indication: spinal symptoms
  • Normal: pulling sensation
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20
Q

Straight Leg Raise

A

-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 ++

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21
Q

Prone Knee Bend

A

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

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22
Q

Slump

A
  • 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
23
Q

Median Nerve

A
  • 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

24
Q

Radial Nerve

A

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
25
Q

Ulnar Nerve

A
  • 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
26
Q

Opthalmoscopy

A
  • 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
27
Q

Pathway of the pupillary light reflex

A

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
28
Q

What does convergence? And accommodation?

A

Convergence: Oculomotor GSE

Accomomdation: Oculomotor GVE

29
Q

Visual acuity

A
  • Snellen eye chart
  • pt distance / number assigned to line they can read

Bad eye first

30
Q

Colour vision

A

A) Red desaturation

  • optic neuritis if acute change
  • red will look faded if optic n. Damage
  • compare L n R

B) Ishihara Charts

31
Q

Visual Fields

A
  • 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

32
Q

Eye movements

A
  • oculomotor n
  • trace H, passing by middle each time
  • one eye
  • other eye
  • both at once
33
Q

Smooth pursuit

A
  • trace X
  • passing by middle each time
  • one eye
  • other eye
  • both at once
34
Q

Saccades

A
  • hold 2 separate fingers
  • have pt alternate (keep head still)
  • horizontal
  • then vertical
35
Q

Oculocephalic testing

A

Brainstem injury = doll’s eyes

36
Q

Facial sensation

A

GSA of trigeminal N.

37
Q

Corneal reflex

A

Tigeminal is sensory

Facial is motor

  • warm pt of what will happen
  • note asymmetry
38
Q

Mastication

A
  • SVE trigeminal N.

- jaw deviates to week side

39
Q

Causes of Jaw Jerk reflex

A
  • abnormal is hyper-refexia

- UMN lesion

40
Q

Facial Expression

A

-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

41
Q

Taste

A

Facial SVA

42
Q

Otoscopy

A

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
43
Q

Abnormal thought processes

A
  • compulsions, obsessions, phobias, anxiety
  • delusions of persecutions, grandeur, or jelousy

Caused by:

  • toxic metabolic
  • psychiatric
  • focal lesion, seizure
44
Q

Manual Alternating Sequencing

A

Draw tiangles n squares: perseveration

Luria Manual Sequence Task: abulia (slow)

45
Q

Neglect

A

R lobe lesion -> neglect left arm

L lobe lesion -> minimal effect

46
Q

Gerstmann’s Syndrome

A
  • Left parietal angular gyrus lesion

- might also have aphasia, language, praxis, construction, logic, abstraction issues

47
Q

Abnormal Speaches

A
  • hesitancy
  • monotone
  • circumduction
  • paraphasias
  • brocas aphasia
  • wenickes aphasia
  • incoherence
  • blocking
  • confabulation
  • perseveration
  • echolalia
  • clanging
  • circumstantiality
  • derailment
  • flight of ideas
  • neologisms
48
Q

Hesitancy

A

Stroke , brocas aphaia

49
Q

Circumlocutions

A

Substitute forgotten word with its definition

50
Q

Paraphaia

A

Malformed, wrong or invented words

51
Q

Brocas aphasia vs wenickes aphasia

A

Broca: cant express

Wernicke: talks easy but wrong sense n words

52
Q

Well leg raise

A

-nerve root on C/L side is pulled toward midline -> medial disc protrusion -> pain on C/L leg

53
Q

Prone knee bend - Saphenous nerve bias

A

-prone

extend n abduct hip

  • > externaly rotate hip
  • > dorsiflex n evert

Neuromusculoskeletal Diagnosis (4 decks)

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