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Neuro > Neuro Physical Exam > Flashcards

Neuro Physical Exam Flashcards

1
Q

what are the things you are checking on inspection

A
  • level of consciousness
  • breathing pattern
  • body position
  • involuntary movements
  • muscle bulk
  • gait
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2
Q

Describe what you are checking regarding level of consciousness

A
  • Alert: responding appropriately/timely to normal voice volume
  • Lethargic: drowsy, needed to raise voice
  • Obtunded: requires shaking
  • Stupor: requires painful stim
  • Comatose: no response
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3
Q

Describe what you are looking for on breathing inpection

A

abnormal breathing patterns
- cheyne-stokes: deep breaths followed by apnea (diencephalon)
- ataxic: irregular unpredictable breaths (medulla)

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4
Q

What are you looking for on body position inspection

A
  • Hemiplegia/flaccid/spastic body position: CVA, CP
  • Decorticate/decerebrate rigidity: impending cerebral herniation
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5
Q

Describe the involuntary movements you are looking for

A
  • resting tremor: Parkinsonism, Wilson’s
  • postural tremor: Essential Tremor
  • fasciculations: LMN ALS
  • tics: Tourette’s
  • chorea/athetosis: Huntington’s, dyskinetic CP
  • facial dyskinesias: TD
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6
Q

Describe what you’re looking for when inspecting muscle bulk

A

atrophy/asymmetry indicative of chronic radiculopathy, peripheral neuropathy, ALS, CRPS, charcot marie tooth

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7
Q

Describe what you are looking for in gait inspection

A
  • hemiplegic: spastic CP
  • trendelenburg
  • shuffling: parkinsonism
  • high stepping: L5 radiculopathy
  • ataxic: MS, CP
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8
Q

Describe the CN I test

A

Olfactory
- ensure nares are patent
- sniff 2 distinct familiar smells

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9
Q

Describe the CN II test

A

Optic
- Visual acuity: snellen chart (blindness, blurriness)
- Optic disc: fundoscope (papilledema, atrophy)
- Visual field: biconfrontation (hemianopsia)

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10
Q

Describe the test for CN III, IV, and VI

A

oculomotor, trochlear, abducens
- H pattern: nystagmus (MS, cerebellar stroke), strabismus (CN paralysis)

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11
Q

Describe the CN V test

A

Trigeminal (ophthalmic, maxillary, mandibular)
- sharp v dull
- light touch
- clench teeth/wiggle jaw to test temporalis & masseter muscles
- corneal reflex with light touch (may be desensitized w contact lenses)

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12
Q

Describe the CN VII test

A

Facial
- raise eyebrows
- frown
- close eyes tightly
- show teeth
- smile
- puff out cheeks
(Bell’s palsy, CVA)

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13
Q

Describe the CN VIII test

A

Vestibulocochlear
- Weber (lateralization to bad ear if conductive, to good ear if sensorineural loss)
- Rinne (AC>BC if sensorineural, BC>AC if conductive loss)

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14
Q

Describe the test for CN IX and X

A

Glossopharyngeal and Vagus
- swallow
- observe soft palate rise (partial paralysis = CVA)
- voice: hoars, nasal
- gag reflex (absent = lesion)

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15
Q

Describe the test for CN XI

A

Accessory
- inspect for atrophy
- resisted shrug (trap)
- resisted head turn (SCM)

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16
Q

Describe the test for CN XII

A

Hypoglossal
- assess articulation (dysarthria)
- inspect tongue at rest (atrophy, fasciculations)
- stick tongue out and side to side (deviation to weak side)
(damage to CN X or XII)

17
Q

Describe the reflex tests

A
  • Tricep: C7
  • Brachioradialis: C6
  • Patellar: L4
  • Achilles: S1
  • Clonus: hyper-reflexic (UMN lesion, corticospinal tract, spinal cord injury, cervical myelopathy)
  • Hoffman’s: hyper-reflexic (UMN lesion, corticospinal tract, spinal cord injury, cervical myelopathy)
  • cutaneous stimulation of abdomen: upper T8, 9, 10; lower T10, 11, 12 (absent = UMN/LMN lesion)
  • plantar: Babinski (corticospinal tract lesion)
  • anal reflex: S2, 3, 4 lesion (cauda equina)
18
Q

Describe the areas tested in sensation (pain, light touch)

A
  • shoulders (C5)
  • inner & outer forearms
  • thumb (C6)
  • middle finger (C7)
  • pinky (C8)
  • thighs (L4)
  • medial malleolus
  • dorsum of foot (L5)
  • pinky toe (S1)
  • medial buttocks (S3)

(widespread loss with stroke, spinal nerve root compression, periopheral mononeuropathy, or widespread diabetic/alcoholic peripheral neuropathy)

19
Q

Describe the muscle strength tests

A
  • shoulder abduction (C5)
  • supination (C6)
  • elbow flexion bicep (C6)
  • elbow flexion tricep (C7)
  • wrist extension (C6)
  • wrist flexion (C7)
  • finger extension (radial)
  • finger abduction (ulnar)
  • resisted APB (median)
  • Hip flexion (L3)
  • Hip extension (S1)
  • knee extension (L4)
  • knee flexion
  • dorsiflexion (L5)
  • plantar flexion (S1)

(proximal: radiculopathy, PMR, muscular dystrophy. distal: guillain barre)

20
Q

Describe the vibration test

A
  • distal then proximal prominence
    (MS, Vit B12 deficiency, alc thiamine deficiency)
21
Q

Describe the proprioception test

A

hold digit by its sides, move it up and down (finger and big toe)

(body position in space: MS, B12 deficiency, peripheral neuropathy)

22
Q

Describe the number discriminative sensation test

A

examiner draws a number on pts hand to test associative cerebral cortical function (lesion to posterior column or sensory cortex)

23
Q

Describe the tests for cerebellar function, coordination, balance, position in space

A
  • rapid alternating movements: hand and toe tap
  • point to point movements: finger to nose and heel to shin
  • walk heel to toe
  • romberg
  • pronator drift
24
Q

Describe the meningeal sign tests

A
  • Brudzinskis: pt supine and head flexed forward (positive if knees scrunch up)
  • Kernigs: pt supine with knee flexed then extended (positive if neck flexes forward)

(Meningitis)

25
Q

Describe what the passive straight leg raise is testing for

A
  • muscle weakness, herniated disc, radiculopathy
  • positive if painful along a specific motor sensory radicular pattern (L3, 4, 5, S1)

Neuro (22 decks)

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