Neurologic Flashcards
Beginning in childhood or adolescence, running in families, and three times more common in adult women then men refers to which type of headache?
Migraine
Stress, lights, alcohol ingestion are common triggers for which type of headache?
Migraine
Preceding aura of scotomata, unilateral location; pulsatile quality and pain that increases with activity is associated with?
Migraine
MOST prevalent form of primary headaches?
Tension
Presents as typically bilateral, non-throbbing, and mild-to-moderate in severity is often found with?
Tension headaches
Headaches that are progressively frequent or severe over a 3 month period, sudden onset with a thunderclap or “worst headache of my life” and/or new onset after age 50 y/o are considered?
Red flags and need prompt investigation
Major section of the neurological exam that assess complex, coordinated motor functions of the cerebellums and associated motor pathways is part of the _____ exam.
Coordination exam
Major section of the neurological exam that assess sensory and motor functions of the cranial nerves and their associated central and peripheral structures is part of the _____ exam.
Cranial nerve exam
Major section of the neurological exam that assess the cerebellum and descending pathways in the spinal cord through coordinated motor functions of walking and is a portion of the coordination exam is known as the ____ exam.
Gait exam
Major section of the neurological exam that assess cognitive functions of the cerebrum is known as the _____.
Mental status exam
Assessing muscle tone, strength, and presence of atrophy are part of the neurologic exam of the ____ systems.
Motor
Vibration, position, pin prick, temperature, and light touch are used as part of the neurologic exam of the _____ system
Sensory system
Clonus, Hoffman’s response, or Babinski are considered?
Reflexes
Observing gait and Rhomberg is used in the neurologic exam to assess?
Coordination
Optimal to assess the vibratory sense is the ____ hertx tuning fork?
126 Hertz
Which system is stimulated by physiological and psychological stressors?
Sympathetic nervous system
Which system conserves body resources, maintains digestion/elimination?
Parasympathetic nervous system
Voluntary movement, fine motor skills, and eye movements occur here
Frontal lobe
This lobe processes sensory data such as sound, taste, smell, sight, temperature, and pain
Parietal lobe
This is the perception and interpretation center of the brain. It also controls balance and speech through Wernicke’s area
Temporal lobe
This is the visual center of the brain
Occipital lobe
This portion of the brain interprets sensory data for reflex control to maintain muscle tone, balance, and posture
Cerebellum
This is regulates respiratory control, circulatory system, swallowing, coughing, and sneezing
Medulla
This regulates respirations and reflexes
Pons
How many cranial nerves are there?
12
How many spinal nerves are there?
31
Fever, headache, and neck stiffness are the triad for this diagnosis
Meningitis
Which area of the brain is associated with strong emotions, anxiety and panic?
Amygdala
What is the screening tool used for depression?
PHQ-9 questionaire
Which areas of the brain are affected by SUDs?
Basal ganglia, extended amygdala, and the prefrontal cortex
Which spinal nerve(s) is this DTR assessing?
Achilles
S1, S2
Which spinal nerve(s) is this DTR assessing?
Biceps
C5, C6
Which spinal nerve(s) is this DTR assessing?
Brachioradial
C5, C6
Which spinal nerve(s) is this DTR assessing?
Patellar
L2-L4
Which spinal nerve(s) is this DTR assessing?
Triceps
C6-C8
Olfactory
CNI
CNI is assessed by…
Inhaling a scent into one nares and a different scent in the other nares. The patient should be able to smell both and differentiate between the two
Optic
CNII
CNII is assessed by….
Visual acuity screening tool
Oculomotor, Trochlear, and Abducens
CNII, CNIV, and CNVI
How are CNIII, CNIV, and CNVI assessed?
EOM (H exam)
Trigeminal
CNV
How is CNV assessed?
CNV has 3 divisions and assessed with sharp, dull, and light touch on the forehead, cheeks and the the chin/jawline bilaterally
Facial
CNVII
How is CNVII assessed?
The facial nerve is assessed with the various facial expressions of: squeeze your eyes shut, raise your eyebrows, wrinkle your forehead, show me your teeth, puff your cheeks, purse your lips
Acoustic
CNVIII
How is CNVIII assessed?
This is the hearing exams such as the whisper test or the Weber/Rinne exams. This is also where vestibular function is assessed due to the CNVIII innervation of the cochlea which is assessed with the Romberg test.
Glossopharyngeal and Vagus
CNIX and CNX
How are CNIX and CNX assessed?
They are assessed simultaneously with the gag reflex and the swallowing reflex. CNIX can also be assessed by taste as it is used for sour and bitter taste, however this is not readily available in practice.
Spinal accessory
CNXI
How is CNXI assessed?
This innervates the trapezius and sternocleidomastoid muscles so it is assessed by placing a hand on each shoulder and asking the patient to shrug against your resistance and then placing a hand on the cheek and asking the patient to turn laterally against your resistance
Hypoglossal
CNXII
How is CNXII assessed?
This nerve innervates the tongue so it is assessed by asking the patient to move their tongue in/out, side-to-side and up/down as well as listening for speech
OOOTTAFAGVSH
Olfactory
Optic
Oculomotor
Trochlear
Trigeminal
Abducens
Facial
Acoustic
Glossopharyngeal
Vagus
Spinal
Hypoglossal
Key Findings/Physical Exam:
Unilateral facial weakness and drooping; eyelid weakness; facial pain; pain around the ear; abnormal taste; reduced hearing; hx of recent infection
Bells Palsy
Key Findings/Physical Exam:
Difficulty eating, drinking, and swallowing; poor nutrition; difficulty with speech, language, and coordination; scoliosis, hip dysplasia, non-specific back pain, increased muscle tone/dystonia and spasticity, muscle fatigue, headaches, nonspecific abdominal pain, dental pain, dysmenorrhea; sleep disturbances; depression, anxiety, antisocial behaviors, learning disabilities, ADHD; vision/hearing impairments; vomitting, regurgitation and reflux; constipation; epilepsy; hx of preterm birth, low birth weight
Cerebral palsy
Key Findings/Physical Exam:
Jerking movements of one or more extremities; nystagmus; abrupt movement of head to one side or the other; moans or cries; fearful or sad emotions; humming or buzzing noises; intense or unpleasant smells or tastes; tingling in one area or side of the body; flashing lights in a portion of the visual fields
Epilepsy
Key Findings/Physical Exam:
Trauma hx; N/V, headache, AMS, seizures; weakness or paralysis, facial droop, monocular or binocular blindness, blurred vision, dysarthria, vertigo, ataxia, aphasia
Hemorrhagic stroke
Key Findings/Physical Exam:
Sudden onset of severe headache; “thunderclap” headache; nuchal rigidity, photophobia or eye pain; N/V; syncope
Subarachnoid hemorrhage
Key Findings/Physical Exam:
Persistent headaches that wake patient from sleep; seizures; visual changes; appetite loss; N/V; changes in behavior or personality; children may experience irritability, lethargy, cranial nerve palsies, and weight loss; confusion; papilledema; aphasia; nystagmus; ataxia; CT/MRI positive findings
Intracranial tumor
Key Findings/Physical Exam:
Sudden severe headache with no known cause; abrupt onset of hemiparesis or monoparesis; visual field changes; facial droop; ataxia; nystagmus; aphasia (expressive or receptive); sudden numbness or weakness of face, arm, or leg; abrupt decrease in LOC
Ischemic stroke
Key Findings/Physical Exam:
Fever; chills; headache; neck stiffness; N/V; lethargy; sleepiness; photophobia; confusion; irritability; delirium; seizures; coma; AMS; nuchal rigidity; increased BP with bradycardia; positive Brudzinski’s and Kernig’s signs; petechial and purpura rash
Meninigitis
Key Findings/Physical Exam:
Paresthesia; muscle cramping d/t spaticity; bowel/bladder dysfunction; constipation; dysarthria, nystagmus, intention tremor; Lhermitte’s sign (electric shock sensation); Trigeminal neuralgia; fatigue; heat intolerance; decreased attention span, concentration, memory loss; depression; BPD; dementia; localized weakness; hyper-reactive reflexes; increased muscle tone/stiffness; optic neuritis
MS
Key Findings/Physical Exam:
Drooping eyelids; double vision; difficulty swallowing or speaking; fatigue or weakness; difficulty walking; facial weakness when puffing out cheeks; hypophonia; respiratory compromise; skeletal muscle weakness
MG
Key Findings/Physical Exam:
Genetic pattern of inheritance; confusion, depression, cognitive dysfunction, dementia, psychosis; rest tremors, slowness of movement, freezing or inability to continue movements, rigidity, postural instability; pill-rolling movement with fingers, head tremors, numbness, tingling, muscle soreness, difficulty swallowing, drooling, stooped posture, shuffled gait, slow slurred speech
Parkinsons Disease
Key Findings/Physical Exam:
Numbness, tingling, shooting, burning, electric shock sensations; all sensation is painful; occurs in hands and feet; night pain in one or both feet; reduced touch sensation; reduced sensation in feet with monofilament examination; diminished post tibial and dorsalis pedis pulses; distal muscle weakness, cannot stand on toes or heels; skin ulcerations
Peripheral neuropathy
Key Findings/Physical Exam:
Unilateral burning, stabbing, electric shock, excruciating facial pain in chin or cheek; pain episodes may occur several times/day to several times/month; increased pain with chewing, swallowing, talking, brushing teeth, cold exposure; intermittent pain-free periods; inflammation of maxillofacial region, ENT; hx of recent dental work, MS
Trigeminal neuralgia
Test: clinician flexes the patient’s neck forward and the patient bends the hips/knees in response to the neck flexion
Positive Brudzinski’s test
Toe walking helps assess which spinal nerve?
S1
