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Nervous System > Neurolocalisation/Examination > Flashcards

Neurolocalisation/Examination Flashcards

1
Q

What is the classical pyramidal posture?

A

In arm:
Flexor > extensors

In leg:
Extensor > Flexor

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2
Q

Thenar wasting is seen in _____________ palsies.

A

Median nerve

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3
Q

Hypothenar wasting is seen in _____________ palsies.

A

Ulnar nerve

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4
Q

Winging of the scapula is seen in _________________ lesion.

A

Long thoracic nerve

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5
Q

Fasciculations imply denervation and are commonly seen in (upper/lower) motor neuron lesions.

A

Lower

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6
Q

When is pes cavus seen?

A

px with longstanding muscle weakness eg. hereditary illnesses like Charcot Marie Tooth, Muscular Dystrophy

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7
Q

What is pronator drift a sign of?

A

Subtle upper motor neuron weakness

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8
Q

When would a px use a reacher?

A

Proximal weakness

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9
Q

When would a px use utensils with modified handles?

A

Distal weakness/clumsiness

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10
Q

What is rigidity a sign of?

A

UMN lesion

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11
Q

What does a positive supinator catch sign indicate?

A

Upper motor neuron lesion

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12
Q

What does a positive knee catch sign indicate?

A

Upper motor neuron lesion

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13
Q

What is a ankle jerk clonus indicative of?

A

Upper motor neuron lesion

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14
Q

What is the (i) root (ii) nerve (ii) and (iii) plexus involved in a biceps reflex?

A

i) C5/6
ii) Musculocutaneous
iii) Upper brachial (Lateral cord)

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15
Q

What is the (i) root (ii) nerve (ii) and (iii) plexus involved in a triceps reflex?

A

i) C7/8
ii) Radial
iii) Lower brachial (posterior cord)

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16
Q

What is the (i) root (ii) nerve (ii) and (iii) plexus involved in a brachioradialis (supinator) reflex?

A

i) C5/6
ii) Radial
iii) Upper brachial (posterior cord)

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17
Q

What is the (i) root (ii) nerve (ii) and (iii) plexus involved in a quadriceps (knee) reflex?

A

i) L2/3/4
ii) Femoral
iii) Lumbosacral

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18
Q

What is the (i) root (ii) nerve (ii) and (iii) plexus involved in a ankle reflex?

A

i) S1
ii) Sciatic and Tibial
iii) Lumbosacral

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19
Q

What is the optimal stretch of a muscle when assessing its stretch reflex.

A

Mid flexion

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20
Q

What can be done to reinforce a reflex when it cannot be initially elicited?

A

1) Clench teeth
2) Clasp hands together and pull (Jendrassik maneuver)

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21
Q

What are the (i) main muscle (ii) nerve and (iii) root assessed in shoulder abduction power?

A

i) Deltoid (middle)
ii) Axillary nerve
iii) C5

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22
Q

What are the (i) main muscle (ii) nerve and (iii) root assessed in elbow flexion power?

A

i) Biceps brachii
ii) Musculocutaneous
iii) C5/6

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23
Q

What are the (i) main muscle (ii) nerve and (iii) root assessed in elbow extension power?

A

i) Triceps
ii) Radial
iii) C7/8

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24
Q

What are the (i) main muscle (ii) nerve and (iii) root assessed in wrist extension power?

A

i) Extensor carpi radialis/ulnaris
ii) radial nerve
iii) C6

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25
Q

What are the (i) main muscle (ii) nerve and (iii) root assessed in finger extension power?

A

i) Extensor digitorum
ii) Radial
iii) C7

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26
Q

What are the (i) main muscle (ii) nerve and (iii) root assessed in finger abduction power?

A

i) Dorsal interossei
ii) Ulnar
iii) T1

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27
Q

What are the (i) main muscle (ii) nerve and (iii) root assessed in thumb abduction power?

A

i) Abductor pollicis brevis
ii) Median
iii) T1

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28
Q

What are the (i) main muscle (ii) nerve and (iii) root assessed in hip flexion power?

A

i) Iliopsoas
ii) lumbar, femoral
iii) L1/2

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29
Q

What are the (i) main muscle (ii) nerve and (iii) root assessed in hip extension power?

A

i) Gluteus
ii) Inferior gluteal
iii) S1

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30
Q

What are the (i) main muscle (ii) nerve and (iii) root assessed in knee flexion power?

A

i) Hamstrings
ii) Sciatic
iii) S1

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31
Q

What are the (i) main muscle (ii) nerve and (iii) root assessed in knee extension power?

A

i) Quadriceps
ii) Femoral nerve
iii) L3

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32
Q

What are the (i) main muscle (ii) nerve and (iii) root assessed in ankle dorsiflexion power?

A

i) Tibialis anterior
ii) Common peroneal
iii) L5

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33
Q

What are the (i) main muscle (ii) nerve and (iii) root assessed in ankle plantarflexion power?

A

i) Soleus, Gastrocnemius
ii) Tibial
iii) S1

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34
Q

What are the 2 sensory modalities that should be tested in a sensory examination?

A

1) Pin prick (Spinothalamic)
2) Proprioception (DCML)

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35
Q

What are saccadic eye movements?

A

The eyes “jump” from one target to the next with perfect accuracy

36
Q

What is the term for impaired saccadic eye movements?

A

Ocular dysmetria/Dysmetric saccades

37
Q

What is “broken pursuit”?

A

Saccadic intrusions into pursuit eye movement:
- eyes are unable to follow the target with accuracy, necessitating corrective adjustments to reacquire the target

38
Q

What is nystagmus?

A

Slow and rapid, repetitive, uncontrolled movements of eye

39
Q

What are 3 eye movement signs that are indicative of cerebellar dysfunction?

A

1) Dysmetric saccades
2) Broken pursuit
3) Nystagmus

40
Q

What are 3 upper limb signs that are indicative of cerebellar dysfunction?

A

1) Impaired rebound check response
2) Finger nose dysmetria
3) Dysdiadochokinesis

41
Q

What are the corrective movements often seen in voluntary movement (eg. finger nose dysmetria test)?

A

Intention tremors

42
Q

What test of the trunk can be used to assess the cerebellar function?

A

Get px to cross him arm and sit up
- if sways → truncal ataxia

43
Q

What are 2 test of the lower limbs that can be used to assess cerebellar function?

A

1) Heel shin test
2) Gait (regular and tandem)

44
Q

What is heel shin ataxia?

A

Struggle to place heel on knee and run it down shin in heel shin test
- indicative of cerebellar dysfunction

45
Q

What is a cerebellar gait?

A

Broad-based gait
→ lose balance when asked to catwalk

46
Q

How does one assess dysdiadochokinesis?

A

Ask to slap back of hand and flip between supination and pronation

47
Q

Why is the jaw spared in cavernous sinus lesions?

A

CN3,4,5,6 all traverse through cavernous sinus

BUT V3 doesnt → supply mandible

48
Q

How are gliomas defined in diagnosis?

A

Molecular/genetic profile

49
Q

Which cranial nerve could be lesioned in a aortic dissection?

A

CNXII: Hypoglossal nerve

50
Q

What are 4 common causes of olfactory sense disruption?

A

1) Cribiform plate injury (Frontal head injury)
2) Rhinitis
3) Kallman Syndrome
4) Parkinson disease

51
Q

What are the testable attributes of vision?

A

1) Acuity
2) Visual field
3) Colour

52
Q

How do the etiology of acuity and visual field defects differ?

A

Acuity
- damage to structures anterior to chiasm (eye, optic nerve)

Visual field
- damage to structures posterior to chiasm (optic tracts, radiation, visual cortex)

53
Q

Why test one eye at a time in visual acuity tests?

A

A good eye can compensate for a bad eye if both open

54
Q

How would you test for visual acuity if the px had forgotten their spectacles?

A

Test with pinhole

55
Q

How would you test for visual acuity if the px has spectacles?

A

Test once with, once without

56
Q

How does one assess the visual field of a px?

A

Use your visual field (on same facing side) to compare limits of field
- EYE LEVEL MUST BE SAME
- both parties have to be looking at each others eyes
- pin should be held midway between 2 people

57
Q

The left visual cortex receives input from the (left/right) retina/visual field.

A

Right (contralateral)
(vice versa)

58
Q

What is the (i) afferent limb (ii) efferent limb of the pupillary light reflex?

A

i) Optic nerve
ii) Oculomotor nerve

59
Q

How is a optic nerve lesion differentiated from a oculomotor nerve lesion on a pupillary light reflex?

A

Optic nerve lesion:
- light in affected eye → neither reflex
- light in unaffected eye → both direct and consensual reflex

Oculomotor:
- light in affected eye → only consensual
- light in unaffected eye → only direct

60
Q

Describe the path of the pupillary light reflex?

A

Optic nerve
→ Lateral geniculate (CNII) nucleus
→ Pretectal nucleus
→ Edinger Westphal (CNIII) nucleus
→ Oculomotor nerve
→ pupil constricts

61
Q

How can you tell if a px can perform visual accomodation?

A

Look at wall and back at pin in visual field convergence → Pupils will constrict

62
Q

Movements of the eyes muscles and nerve:

A

UL: LR6, SR3
ML: LR6
LL: LR6, IR3

UM: MR3, IO3
MM: MR3
LM: MR3, SO4

63
Q

What is the (i) afferent limb and (ii) efferent limb of the corneal reflex?

A

i) Trigeminal
ii) Facial

64
Q

How are UMN and LMN of the face differentiated?

A

UMN (Hemispheric) palsy (eg. stroke)
- C/L lower lose motor
- I/L upper maintain (shared innervation from C/L)

LMN (Facial nerve) lesion(eg. Bell’s palsy):
- I/L lose motor for both upper and lower face
- C/L preserved

65
Q

What is a Rinner and Weber test used for?

A

For deaf px to differentiate between conductive (middle/outer ear) vs sensorineural (inner ear/CN8/brainstem)

66
Q

What is the Rinne’s test?

A

Compares air vs bone conduction in one ear
- Tuning fork on mastoid process and outside ear
- normally bone conduction would be softer

67
Q

What is Weber’s test?

A

Compares bone conduction between both ears
- Tuning fork in middle of forehead
- should sound like in center

68
Q

How is conductive hearing loss diagnosed at bedside?

A

Weber:
- Sound localizes to the affected ear (↓ background noise)

Rinne’s:
- Bone conduction > Air conduction (↓amplification)

69
Q

How is sensorineural hearing loss diagnosed at bedside?

A

Weber:
- Sound localizes to the unaffected ear (affected ↓sensorineural input)

Rinne’s:
- Air conduction > Bone conduction (normal)

70
Q

Which nerves are affected in a cerebellopontine angle lesion?

A

CNVII: Facial nerve
CNVIII: Vestibulocochlear nerve

71
Q

How would a CNIX/X palsy present in an oral examination?

A

Uvula will be pulled to contralateral side
- by unopposed action of palatal muscles on normal side

72
Q

What is the (i) afferent limb and (ii) efferent limb of the gag reflex?

A

i) Glossopharyngeal nerve
ii) Vagus nerve

73
Q

Other than CNIX and CNX, what is tested in a gag reflex?

A

Medulla

74
Q

How is the accessory nerve assessed?

A

CNIX (SCM) test:
Hold lower jaw at side and ask them to push diagonally down (repeat both sides)

75
Q

How is the hypoglossal nerve assessed?

A

CNXII (bulbar muscles) test:
Ask to push tongue against both cheeks
Ask to stick out stick and push sideways against tongue depressor

76
Q

Px asked to stick out tongue and it deviates to one side, where is the lesion?

A

I/L Hypoglossal nerve

77
Q

What muscle protrudes the tongue and what nerve innervates it?

A

Geniohyoid
CNXII: hypoglossal

78
Q

A lesion to the medulla affects which cranial nerves?

A

9, 10, 12

79
Q

A lesion to the jugular foramen affects which cranial nerves?

A

9, 10, 12

80
Q

A lesion to the carotid artery affects which cranial nerves?

A

12

81
Q

What is a positive Rhomberg’s test?

A

Rhomberg’s test:
- loss of balance when shutting eyes → either proprioceptive or vestibular dysfunction

82
Q
A
83
Q

What is the physiological mechanism for side gaze?

A

Frontal cortex
→ C/L Paramedian Pontine Reticular Formation (PPRF) (in pons)
→ (C/L) 6th nerve → Lateral rectus
+ Medial longitudinal fasciculus (up and across) → I/L 3rd nerve → Medial rectus

84
Q

What does a medial longitudinal fasciculus lesion present as?

A

Internuclear ophthalmoplegia
- slowness/failure to adduct both eyes in side view at the same time

85
Q

Guillan-Barre syndrome is associated with _________ infection.

A

Campylobacter jejuni

86
Q

How does Guillain Barre syndrome present?

A

Affects peripheral nerves:
1) Ascending numbness
2) Absent reflexes
3) Descending picture (if roots affected)
4) Miller Fisher, Bickerstaff (if brainstem)

Nervous System (14 decks)

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