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Physical Diagnosis 1 > Neuro Std Exam Liza > Flashcards

Neuro Std Exam Liza Flashcards

0
Q

sensory processing is which lobe

A

Parietal lobe

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1
Q

which lobe is behavior, judgmnt, mood, motor cortex, Broca’s motor language

A

Frontal love

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2
Q

Auditory processing, memory, Wernicke’s lang comprehension, hearing, taste, smell

A

Temporal lobe

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3
Q

Vision, visuospacial

A

Occipital lobe (back)

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4
Q

Relays visual, auditory, sensation but NOT motor pathways

A

Thalamus

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5
Q

precentral gyrus is

A

Motor

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6
Q

postcentral gyrus is

A

sensory area

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7
Q

What is included in examination

A 
cognition
language
vision
sensory processing
movements and tone
gait
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8
Q

automated movements are

A

Basal ganglia

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9
Q

Primary sensory relay

A

Thalamus

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10
Q

Brainstem consists of

A

Midbrain, pons, medulla

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11
Q

Cranial nerves, sleep wake centers, breathing, descending motor tracts, ascending sensory tacks are contained in

A

Brainstem

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12
Q

Coordination, balance/equilibrium and smoothness movement is

A

Cerebellum: sends track to midbrain from spinal cord and pons

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13
Q

Brainstem exam is made of

A

assess cranial nerves, gait and cerebellar fx (coordination and smoothness of movement)

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14
Q

Where is cardio-respiratory center located in the brain?

A

Brainstem

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15
Q

Where are cranial nerve nuclei are located

A

Brainstem

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16
Q

Where are ascending and descending tracts located

A

brainstem

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17
Q

Spinal cord starts at C1 and ends at

A

T12-L1

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18
Q

Injury above which vertebra is not compatible with life?

A

above C5

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19
Q

meylopathy definition

A

disease of spinal cord

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20
Q

Which tracts transmit sensory info to the CNS/brain?

A
  • Spinothalamic tract (spinal cord to thalamus)

- posterior columns

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21
Q

transmission of motor into from CNS/brain is throug

A

Conticospinal tracts
extrapyramidal tracts
Cerebellar tracts

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22
Q

Which tract carries voluntary motor movement?

A

Corticospinal tract

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23
Q

Where does UMN (Upper Motor Neuron) cross to contralateral side?

A

at medulla, UMN dessicates and goes to contralateral side (sx manifests on opposite side)

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24
Q

Where does UMN (upper motor neuron) originate?

A

In Pre-Central gyrus (responsible for motor cortex)

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25
Q

If have a lesion in precentral gyrus on left side, it will manifest itself on opposite side

A

did I get this right?

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26
Q

??????????? So conticospinal tract dessicates at medulla and fibers cross to contra-lateral side but continue to descend IPSILATERALLY (to sypanse with anterior horn)

A

??????????? ask if that’s correct and if lesion is on the left side above medulla, how will it manifest in real person?

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27
Q

tract that carries light touch, pain, temp, pressure is

A

** spinothalamic tract**

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28
Q

tract that carries vibration, proprioception and discriminative touch is

A

Posterior Columns

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29
Q

!!! what is characterised by increased tone (spascity), “stiff man” gait, elevated reflexes, proprioceptive changes (posterior column), positive Romberg sign and crossed findings (sensory and motor) and also by sensory levels?

A

Myeolopathies

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30
Q

Due to dessication at medulla

A

have sensory deficit on one side and motor on the other

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31
Q

Meylopathies are characterized by

A

!!! increased tone (spascity), “stiff man” gait, elevated reflexes, proprioceptive changes (posterior column), positive Romberg sign and crossed findings (sensory and motor) and also by sensory levels!!!!

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32
Q

Spinal Cord/Meylopathy exam includes

A

gain, Romberg, reflexes and tone

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33
Q

Optic nerve is

A

CNII

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34
Q

Hypoglossal nerve is and responsible for

A

CN XII: tongue movement

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35
Q

Trochlear

A

CNIV: eye movement of SO Superior Oblique

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36
Q

Facial

A

CNVII: facial motor and some taste

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37
Q

Glossopharyngeal

A

CN IX: soft palate

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38
Q

Spinal Accessory

A

CN XI: motor to trapezius

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39
Q

Trigeminal

A

CNV: sensation and taste

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40
Q

Abducens

A

CNVI: eye movement LR (lateral rectus)

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41
Q

Acoustic/Vestibulocochlear

A

CNVIII: hearing and balance

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42
Q

Vagus

A

CNX: soft palate, voice, swallowing

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43
Q

Oculomotor

A

CNIII: eye movement of IO, SR, IR, MR

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44
Q

Olfactory

A

CNI: smell

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45
Q

Optic

A

CNII: vision

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46
Q

Myopathy

A

disease of muscle

47
Q

What has proximal distribution (what is that?)

A

muscle disease

like in muscular dystrophy

48
Q

What are the elements of the muscle/motor exam:

A

bulk, strength, tone

49
Q

Proximal weakness and fatigability that is improved with rest is a characteristic of what disease?

A

dz affecting Neuro Muscular Junctions (NMJ)

50
Q

Whats in NMJ exam?

A

* check strength of certain muscles and for fatigability (e.g., ptosis)*

51
Q

peripheral neuropathy

A

dz affecting peripheral nerves

52
Q

Peripheral neuropathy/Nerve exam:

A

* light touch, pin prick, vibration, proprioception and muscle strength*

53
Q

Most important nerves in upper extremety

A

median, ulnar, radial, musculocutaneous, axiallary

54
Q

Most impt nerves in lower extremity

A

femoral, obturator, sciatic, tibial and peroneal

55
Q

Brachial plexus is at

A

C5-C8

congregation of roots exiting at above

56
Q

lumbarsacreal plexus

A

congregation of L3-S1 roots

in pelvis

57
Q

What are plexopathies characterized by

A

*** loss of reflexes, widely distributed weakness and multifocal numbness with or without pain

58
Q

what is the cause of most plexopathies?

A

* compression or infiltration*

59
Q

Plexopathy exam

A

** strength, motor, reflexes **

60
Q

radiculopathy is

A

dz of the root

61
Q

most rediculopathies are cause by

A

** complression or other mechanical causes **

62
Q

** which cervical root innervate upper extremities? **

A

** C5-C8 **

injury can cause pain, focal weakness, loss of reflexes, motor issues

63
Q

** which lumbarsacrial roots innervate lower extremeties? **

A

L3-S1

64
Q

31 pairs of spinal nerves

A 
cervical 8, 
thoracic 12
lumbar 5
sacral 5
coccygeal 1
65
Q

what is frequently mistaken for neuropathy and how to distinguish?

A

radiculopathies (by careful exam)

66
Q

Root/radiculopathy exam

A

strength, sensation, reflexes

67
Q

lumbar radicular pain/ sciatica

A

look at slide!! memorize!

68
Q

Mental Status exam

A

** behavior, oriented to person/place/time, level of consciousness **
-begins when you first meet the person
-formal MSE only when deficit:
score <24 is dementia
establish baseline and monitor progress

69
Q

Brief Mental Status Exam

A 
JOMAC
Judgement
Orientation
Memory
Affect
Cognition
70
Q

Levels of consciousness

A

Alert, lethargic, stuporous, comatouse

-responsive or not

71
Q

Mental status exam of memory

A

Recent: check recall of 3 words after one minute
remote: ask about well known events, dates locations (name of president, capital of france)

72
Q

CN exam Optic CN II

A 
visual acuity (eye chart)
visual fields (H)
funduscopic exam (direct exam of CNII)
73
Q

Exam of CNIII

A

Extra Ocular Movements: IO, SR, IR, MR
direct and consensual pupillary responses
Eyelid elevation: ptosis
EOMS: H for CN4 and 6: check for conjugate gaze and nystagmus

74
Q

Trigeminal CN V (three)

A

1) Facial sensation/light touch (check frontal, maxillary, mandibular areas)
2) Corneal reflexes (cotton to cornea):
CNV - afferent (sensation TO brain)
CNVII - efferent (motor from brain)
3) Muscles of mastication:
Temporalis and masseter

75
Q

Facial Nerve exam (CN VII)

A
  • m of facial expression (raise eyebrows, frown?? smile, puff out cheeks, close eyes against resistance):
    Central v peripheral VII lesion (what about it??)
  • Taste
  • efferent corneal reflex (motor from brain)
76
Q

Acoustic N exam (CNVIII vestivulocochlear)

A
  • hearing: whisper/rub fingers

- Weber and rinne testing (test sensorineural v conductive hearing loss)

77
Q

Glossopharyngeal exam CN IX (with Vagus X)

A
  • say ah, palate elevation - check for symmetry (vagus)
  • gag reflex
  • swallowing ?
78
Q

spinal accessory nerve (CNXI) exam

A

shrug your shoulders against resistance (and move head right to left?):
eval SternoCleidoMastoid and trapezius

79
Q

Hypoglossal CN XII exam

A

Stick your tongue out and move side to side

80
Q

?????? do we need to know all spinal root nerves for upper and lower extremities exams ??????

A

???? ask prof ?????

81
Q

1) Pronator Drift tests

2) Romberg tests

A

1) Pronator - tests upper extremety motor fx

2) Romberg - test dorsal column fx and in some measures sensation in feet

82
Q

Pronator drift test

A
  • arms extended out/forward and palms up (supinated) for 20-30 secs with eyes CLOSED: watch for pronation of arm and drift down
  • used to detect subtle contralateral upper motor neuron lesions (weakness due to CVA)
83
Q

Robberg test

A

stand with feet together with eyes open and then closed for 20-30 sec.:

  • tests position sense (dorsal column and some sens in feet)
  • stand close in case they fall
  • loss of balance = (+)
  • ** check Romberg BEFORE GAIT to avoid fall **
84
Q

Sensory exam

A
  • is done in RANDOM fashion on pts without specific sensory complaints
  • all tests done with eyes closed
  • check sharp vs dull, keep dermatomes in mind
85
Q

Thumb, middle fingers, 5th digit

A
  • Thumb C6
    mid fingers C7
    5th digit C8
86
Q

Anterior thigh, anterior shin, top of foot, bottom of foot

A

Ant thigh - L3
Ant shin - L4
top of foot - L5
bottom of foot - S1

87
Q

Nipple line

A

T4

88
Q

Umbilicus

A

T10

89
Q

Proprioreceptor exam

A
  • move pt’s thumb/toe up and down, ask which direction, eyes closed
  • make sure to hold SIDE of digit
90
Q

Corticosensory exam

A

2 pnt exam, hold like chopstick

91
Q

Stereognosis

A

ask to id common object places in hand: key, coin

cortical sensory

92
Q

Graphesthesia

A

draw a number (0-9) on palm facing pt (eyes closed) and dorsum of foot
(cortical sensory specialized)

93
Q

Tactile localization

A

aka “extinction” or “double simultaneous stimulation”

- sim. touch 2 separate sites on Opposite sides and ask what is felt

94
Q

1, 2 (S 1, 2)

A

Achilles reflex

95
Q

3, 4 (L!!! 3, 4)

A

Patellar reflex

96
Q

5, 6 ( C5, 6)

A

Biceps reflex

97
Q

7,8 (C7, 8)

A

Triceps reflex

98
Q

Clonus

A

seen with hyperactive reflexes, with UMN dz

  • rhythmic oscillations between plantar and dorsiflexion
  • 4+ on reflex scale
99
Q

Brachioradialis

A

C5-C6 (like bicept) but tap lower arm: 1-2 inches above WRIST!!! (although the muscle is in upper arm)

100
Q

reflex scale

A 
0 no response
1+ diminished
2+ normal
3+ increased
4+ hyperactive, with CLONUS
101
Q

Jendrassik’s maneuver

A

reinforcement technique if difficulty getting reflexes:
UE - grit teeth
LE - isometric exercise

102
Q

Babinski reflex

A

stroke lateral part of plantar foot upwards and then across the ball of the foot:
abnormal : dorsiflexion of great toe and fanning of other toes
(normal in babies)

103
Q

Cerebellar exam

A
  • test coordination of movement, balance and equilibrium

- finger to nose

104
Q

** Heel to Shin **

A
  • cerebellar exam (bilateral)

- slide heel of one foot down shin of other leg SLOWLY AND SMOOTHLY; repeat; then switch legs

105
Q

Rapid Alternating Movements (RAMs)

A
  • rapid pronation supination of forearms
  • touch fingertips to thumb
  • tap feet
106
Q

Dysdiadochokinesia

A

inability to do RAMs

107
Q

if slow but regular RAMs, which part of brain is impaired?

A

Cerebral dysfx

108
Q

if fast but irregular

A

cerebellar dysfx

109
Q

Heel walk gait

A

L5 integrity

Cerebellar test

110
Q

Heel-to-toe (tandem gain)

A

avoid if (+) Romberg

111
Q

Toe walk

A

S1 integrity

112
Q

** Kernig’s sign **

A

pt supine, flex hip and knee, then straighten the leg:

LPB (low back pain)= (+) Kernig’s

113
Q

** Brudzinski’s Sign **

A

pt supine, place your hands behidn the pt’s neck and flex neck toward chest:
involuntary flexion of hips and knees = (+) meningitis irritation

114
Q

10 minutes neuro exam

A

Must know?? check last few slides

115
Q

Stiff man gait is a sign of

A

Myelopathy

Also increased tone and reflexes

Physical Diagnosis 1 (19 decks)

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