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Physical Exam Midterm & Final > Neurologic > Flashcards

Neurologic Flashcards

1
Q

When do you do a neuro exam

A

General screening
AMS, symptom specific (HA, vertigo, weakness)
Concern over a central or peripheral lesion and where it occured

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2
Q

What is included in the neuro exam in an adult pt

A 
MSE
Cranial nerves
Sensory
DTRs & Plantar reflex
Cerebellar functioning
Muscle strength
Motor screening
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3
Q

What makes up the CNS (brain + cord)

A 
Cerebrum
Diencephalon
Basal ganglia
Thalamus
Hypothalamus
RAS
Brain stem & medulla
Cerebellum
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4
Q

What is the grey matter

A

Cell bodies

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5
Q

What is the white matter

A

Axons

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6
Q

What is the thalamus…sensory or motor

A

Sensory

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7
Q

What is the hypothalamus responsible for

A

Regulation of homeostasis, endocrine function, sex drive, and behavior

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8
Q

What is the RAS responsible for

A

Consciousness

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9
Q

What are the neurotransmitters of the sympathetic nervous system

A

Epinephrine
Norepinephrine
Dopamine

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10
Q

What are the neurotransmitters of the parasympathetic nervous system

A

Acetylcholine

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11
Q

What is CN-I

What is its function?

A

Olfactory nerve

Sensory: reception and interpretation of smells

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12
Q

What is CN-II

What is its function?

A

Optic nerve

Sensory: visual acuity and visual fields

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13
Q

What is CN-III

What is its function?

A

Oculomotor nerve
Motor: raise eyelids, most EOM
Parasympathetic: pupil constriction, lens shape

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14
Q

What is CN-IV

What is its function?

A

Trochlear nerve

Motor: downward, inward eye movement (SO)

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15
Q

What is CN-V

What is its function?

A

Trigeminal nerve
Motor: jaw opening and clenching, mastication
Sensory: 3 branches (opthalmic, maxillary, mandibular)

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16
Q

What is CN-VI

What is its function?

A

Abducens nerve

Motor: lateral eye movement (LR)

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17
Q

What is CN-VII

What is its function?

A

Facial nerve
Motor: facial expression muscles (except jaw), eye closure, mouth closure
Sensory: taste (anterior 2/3 of tongue)
Parasympathetic: secretion of saliva & tears

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18
Q

What is CN-VIII

What is its function?

A

Acoustic nerve

Sensory: hearing and equilibrium

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19
Q

What is CN-IX

What is its function?

A

Glossopharyngeal nerve
Motor: voluntary muscles for swallow and phonation
Sensory: nasopharynx, gag reflex, taste (posterior 1/3 of tongue)
Parasympathetic: secretion of saliva, carotid reflex

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20
Q

What is CN-X

What is its function?

A

Vagus nerve
Motor: voluntary muscles of phonation & swallow
Sensory: behind the ear, part of the external canal
Parasympathetic: secretion of digestive enzymes, peristalsis, carotid reflex, heart, lungs, digestive tract

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21
Q

What is CN-XI

What is its function?

A

Spinal Accessory nerve

Motor: turn head, shoulder shrug, some phonation

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22
Q

What is CN-XII

What is its function?

A

Hypoglossal nerve

Motor: tongue movement for speech, sound articulation, and swallowing

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23
Q

How many cervical nerve roots are there

A

8 (even though there are only 7 vertebrae)

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24
Q

How do spinal nerves innervate?

What do they form?

A

Innervate as individual dermatomes

Form peripheral nerves in plexuses with other nerve roots to innervate bodily regions

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25
Q

Which part of the nerve root is sensory & which part is motor

A

Anterior root = motor

Dorsal root = sensory

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26
Q

What does C3 innervate

A

Front and back of neck

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27
Q

What does C6 innervate

A

Thumb

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28
Q

What does C8 innervate

A

Pinky (5th finger)

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29
Q

What does T4 correspond to

A

Nipple line

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30
Q

What does T10 correspond to

A

Umbilicus

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31
Q

What does L1 correspond to

A

Inguinal region

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32
Q

What does S2/3 correspond to

A

Anogenital region

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33
Q

What does L4 innervate

A

Knee

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34
Q

What part of the hand does the radial nerve innervate

A

Back of the hand near the thenar space

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35
Q

What part of the hand does the median nerve innervate

A

Middle three digits anteriorly & posteriorly

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36
Q

What part of the hand does the ulnar nerve innervate

A

Lateral 5th digit

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37
Q

If there is a lesion above the cross-over in the motor cortex what will the symptom distribution be

A

Contralateral symptoms

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38
Q

If there is a lesion below the cross-over of the motor cortex what will the symptom distribution be

A

Ipsilateral symptoms

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39
Q

What is the basal ganglia for

A

Complex motor and movement pathways in deep grey matter

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40
Q

How do you identify an upper motor neuron (UMN) lesion.

What conditions may cause it

A

+ babinski
Increased DTRs
Muscular spasticity
Ex = MS, ALS

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41
Q

How do you identify a lower motor neuron (LMN) lesion.

What conditions may cause it

A

Decreased DTRs
Ipsilateral weakness
Decreased or absent muscle tone
Ex: nerve transection, polio, Guillan-Barre, ALS

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42
Q

What is a spinothalamic sensory pathway

What does it sense

A

Cross in the cord

Pain, temperature, crude touch

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43
Q

What is the posterior column of the sensory pathway

What does it sense

A

Cross in the medulla

Position, vibration, fine touch

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44
Q

What is a reflex

A

Involuntary response that may involve as few as 2 neurons, one sensory and one motor, across a single synapse

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45
Q

What can DTRs indicate

A

Level of spinal lesion
Electrolyte disturbances
Endocrine disturbances
UMN vs LMN disease

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46
Q

What do you look for regarding general appearance

A 
Level of consciousness
Facial features
Hygiene/clothing
Posture & motor activity
Ht, Wt, build
Vital signs
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47
Q

When evaluating CN-I what do you test

A 
Nostril patency
Identify odors (2)
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48
Q

When evaluating CN-II what do you test

A

Visual acuity
Visual fields
Fudoscopic exam

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49
Q

Lesion of the optic chiasm results in…

A

Bitemporal hemianopsia

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50
Q

Lesion of the optic tract results in…

A

Homonymous hemianopsia

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51
Q

When evaluating CN-III, IV, & VI what do you test

A

Pupillary response
EOMs
Nystagmus
Accommodation

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52
Q

Which type of nystagmus is worse…lateral or vertical

A

Vertical nystagmus

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53
Q

When evaluating CN-V what are you testing

A

Masseter strength
Temporalis strength
Corneal reflex
Pain and light touch sensation of the 3 branches

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54
Q

When evaluating CN-VII what do you test

A 
Raise eyebrows
Keep eyes closed against resistance
Frown
Show teeth & smile
Puff out cheeks
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55
Q

What part of the face is affected during a central lesion (like CVA)

A

Lower face affected

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56
Q

If there is a CVA on the right side what will you see

A

Left side facial droop but may still have forehead wrinkle intact

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57
Q

When evaluating CN-VIII what do you test

A

Gross hearing
Weber
Rinne

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58
Q

What can cause conductive hearing loss

A

Disorders of the external ear

Disorder of the middle ear

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59
Q

What are the 2 MAIN causes of pure conductive hearing loss

A

AOM & cerumen impaction

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60
Q

What can cause sensorineural hearing loss

A

Disorders of the inner ear of brain

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61
Q

What is presbycusis

A

Sensorinerual hearing loss due to normal aging & related to high frequency loss

62
Q

When evaluating CN-IX & X what do you test

A

Observe soft palate with phonation
Vocal quality
Swallowing
Gag reflex

63
Q

What is the result of a unilateral vagus (CN-X) nerve lesion

A

Soft palate rise of the unaffected side only

64
Q

What is the result of a bilateral vagus (CN-X) nerve lesion

A

No rise of the soft palate

65
Q

Damage to what nerve is responsible for recurrent horseness

A

Recurrent laryngeal nerve (part of CN-X)

66
Q

When evaluating CN-XI what do you test

A

SCM strength

Trapexius strength

67
Q

When evaluating CN-XII what do you test

A

Protrude tongue
Tongue side to side
Speech articulation

68
Q

If a lesion is a ________ lesion the tongue will deviate to the ________ side

A

Peripheral lesion

To the affected side

69
Q

If a lesion is a _______ lesion the tongue will deviate to the _______ side

A

Cortical lesion

Unaffected side

70
Q

What tongue manifestation is commonly seen with ALS

A

Atrophy of tongue d/t CN-XII lesion

71
Q

What is 2 point discrimination good for

A

Good for peripheral lesions

72
Q

The biceps DTR is associated with what nerve roots

A

C5 & C6

73
Q

The triceps DTR is associated with what nerve roots

A

C6 & C7

74
Q

The brachioradialis DTR is associated with what nerve roots

A

C5 & C6

75
Q

The patellar DTR is associated with what nerve roots

A

L2, L3, & L4

76
Q

The achilles DTR is associated with what nerve roots

A

S1

77
Q

What are the grades of DTRs and what do they represent

A 
0 = absent
1+ = hypoactive
2+ = NORMAL
3+ = hyperactive
4+ = hyperactive with clonus
78
Q

What is clonus

A

Involuntary muscle contraction (often continuous)

79
Q

What can you do/use to help illicit a DTR if having difficulty with pt

A

Use reinforcement such as pulling hands apart or clenching jaw

80
Q

What part of the brain is responsible for coordination

A

Cerebellar function

81
Q

What is dysmetria

A

Missing the mark in point to point movements

82
Q

What are types/examples of cerebellar disease

A

Movement disorders (Parkinson’s, Huntington’s)
Cerebellar degeneration/atrophy (chronic alcoholism)
Cancers, genetic disease, CVA

83
Q

What are the classic signs of cerebellar disease

A

Dysmetria, nystagmus (up & down, non-fatigueable), intention tremors

84
Q

What are examples of involuntary movements

A

Tremors
Fasiculations
Chorea

85
Q

What nerve roots are responsible for grasp strength

A

Lower cervical & T1

86
Q

What is passive range of motion (PROMI)

A

Examiner provides the motion

87
Q

What is active range of motion (AROMI)

A

Patient does the motion

88
Q

What is ROM against resistance

A

Examiner provides resistance to the pt’s active motion (RAMI)

89
Q

What are the MS grades and what do they mean

A 
0/5 = no movement
1/5 = Visible muscle contraction w/o joint movement
2/5 = Movement at joint but not against gravity
3/5 = Movement against gravity but not against resistance
4/5 = Movement against resistance but less than normal
5/5 = Normal muscle strength
90
Q

What muscles are mainly responsible for raising the arms

A

Deltoid and supraspinatous

91
Q

What is ataxia

A

Inability to walk

92
Q

What things are required to achieve balance

A

Require 2/3 of the following:

  1. ) visual confirmation of position
  2. ) non-visual confirmation of position (including proprioceptive and vestibular input)
  3. ) a normally functioning cerebellum
93
Q

What is sensory ataxia

A

Polyneuropathy (DM, B12) encephalopathy + cerebellar diseases

94
Q

What is a positive Romberg sign

What does it suggest

A

A loss of position with eyes closed

Suggests cerebellar disease

95
Q

What does pronator drift suggest

A

Corticospinal damage (such as CVA)

96
Q

What are examples of circumstantiality

A 
Loose Associations 
Flight of ideas 
Neologisms 
Incoherence/ illogic 
Blocking 
Confabulation 
Perseveration 
Echolalia 
Clanging
97
Q

What are examples of compulsions

A 
Obsessions 
Phobias 
Anxieties 
Feeling of unreality 
Depersonalization 
Delusions
98
Q

Which cranial nerve has ONLY sensory function

A

CN-I

99
Q

What cranial nerve has motor, sensory, and parasympathetic functions

A

CN-VII

100
Q

Which cranial nerves have ONLY motor functions

A

CN-IV, VI, XI, XII

101
Q

Which cranial nerve is responsible for raising the eyelids

A

CN-III

102
Q

The L side of pts face is paralyzed but he can wrinkle the L side of his forehead. Where is the lesion?

A

Right cerebral cortex

103
Q

Which CN is responsible for chewing

A

CN-V

104
Q

Which CN controls the corneal relex

A

CN-V

105
Q

What CNs are involved in swallowing

A

CN-IX, X, & XII

106
Q

Which CN has 3 sensory branches. What are they?

A

CN-V AKA Trigeminal Nerve

Ophthalamic, maxillary, & mandibular branches

107
Q

Pt presents with tongue deviated to the left side. What CN is paralyzed

A

Left CN-XII

108
Q

Pt presents with uvula deviated to the right side. What CN is paralyzed

A

Left CN-X

109
Q

Pt has no sensation over the lateral aspect of the 5th finger. Which peripheral nerve is paralyzed?

A

Ulnar nerve

110
Q

Which of the following is a test of discrimination:

Patting thighs, finger to nose, stereognosis, walking on heels

A

Stereognosis

111
Q

What nerve roots are responsible for the triceps DTR

A

C6 & C7

112
Q

A “normal” DTR is graded/noted as…

A

2+

113
Q

What nerve roots control the abdominal reflex

A

T8 - T12

114
Q

Upon exam you try to illicit an abdominal reflex however your pt doesn’t show one. Is this a normal or abnormal response

A

It is probably normal, many pts don’t exhibit this reflex

115
Q

What are the 2 abnormal positions seen in comatose patients

A

Decorticate and decerebrate

116
Q

What is decorticate rigidity

A

Upper arms flexed tight to the sides with elbows, wrists, and fingers flexed. Legs are extended and internally rotated while feet are plantar flexed

117
Q

What does decorticate rigidity imply

A

Destructive lesion of the corticospinal tracts within or near the cerebral hemisphere

118
Q

What is decerebrate rigidity

A

Jaws are clenched and neck is extended. Arms are adducted and stiffly extended at the elbows with forearms pronated and fingers and wrists flexed. Legs are stiffly extended at the kneeswith the fee plantar flexed

119
Q

When does decerebrate rigidity occur

A

May be spontaneous or may be in response to external stimuli such as light, noise, or pain

120
Q

What is decerebrate rigidity caused by

A

Caused by a lesion in the diencephalon, midbrain, or pons; although severe metabolic disorders like hypoxia & hypoglycemia can cause it

121
Q

Which carries a better prognosis: decorticate or decerebrate rigidity

A

Decorticate

122
Q

What are the 4 primitive reflexes? Who are they more common in

A

Rooting reflex, palmar grasp reflex, Moro reflex, & plantar reflex
More common in peds

123
Q

At what age should the following reflexes go away (roughly, not exact):
Rooting reflex, palmar grasp reflex, Moro reflex, & plantar reflex

A

Rooting reflex = 4 months
Palmar grasp reflex = 6 months
Moro reflex = 2 months
Plantar reflex = 1 year

124
Q

What does a persisting primitive reflex indicate

A

May indicate abnormal neurologic functioning

125
Q

What is the glabellar reflex

What type of pt is it seen with

A

It is where you tap on the pts forehead a couple times. Normal pt may blink the first couple times then stop; abnormal will keep blinking with each tap
Common sign of Parkinson’s

126
Q

Who is Wernicke-Korsakoff’s Syndrome seen in

A

Extremely malnourished alcoholics especially if they have thymine deficiency

127
Q

If a pt presents with Wernicke-Korsakoff’s or is an extremely malnourished alcoholic what should you do first? What do you NOT want to do first

A

Never give them straight fluids first because you can make the condition worse. Need to give them a banana bag with thymine first

128
Q

What is the classic triad of Wernicke-Korsakoff’s

A

Confusion (delirium), ophthalmoplegia, & ataxia

129
Q

Which nerve is involved in carpal tunnel syndrome

A

Median nerve

130
Q

Pt presents with pain and numbness on the ventral surface of the 1st 3 digits of the hand. What is this suggestive of

A

Carpal tunnel

131
Q

What is the phalen’s test

A

Test for carpal tunnel; put backs of hands together and hold for 60 seconds; pain is positive carpal tunnel test

132
Q

What is tinel’s sign

A

Percussion over the median nerve to test for carpal tunnel; pain or tingling in the fingers is a positive sign

133
Q

Who is more at risk of developing carpal tunnel

A

Diabetics and pregnant women

134
Q

Optic neuritis is commonly associated with what condition

A

MS

135
Q

What is Kerning’s Sign

A

Pain and increased resistance to extending the knee with the hip flexed

136
Q

What does bilateral kerning’s sign suggest

A

Meningeal irritation

137
Q

What is Brudzinski’s Sign

A

Flexion of the hips and knees with passive flexion of the neck

138
Q

What does a positive brudzinski’s sign suggest

A

Meningeal irritation

139
Q

Altered mental status with a petichial rash is a BAD sign. What might it suggest?

A

Possible nisseria infection

140
Q

What is a monofiliment & what is it used for

A

Small, thin structure/needle used to test multiple areas of the toes, forefoot, midfoot, and hindfoot for peripheral/diabetic neuropathy

141
Q

What is an early sign of peripheral/diabetic neuropathy

A

Stocking/glove electric burning pain distribution

142
Q

What is the classic triad of Parkinson’s

A

Rigidity, bradykinesia, & resting tremor

143
Q

What is cogwheel rigidity

A

Difficulty moving the extremities

144
Q

Parkinson’s pts also have a certain facial appearance…what is it?

A

Masked facies

145
Q

What are the “on” and “off” periods of Parkinson’s

A

“off period” = symptoms are at their worst

“on period” = symptoms aren’t as bad

146
Q

What are the upper motor neuron signs

A

Spastic weakness
Hyperactive reflexes
Extensor plantar reflexes (+Babinski)
Pronator drift (corticospinal)

147
Q

What are the lower motor neuron signs

A

Flaccid weakness
Hypoactive reflexes
Muscle atrophy
Fasciculations

148
Q

What are the extrapyramidal signs (seen in HD & PD)

A

Resting tremor, Rigidity
Postural deformity and instability
Slowed rapid alternating movements

149
Q

What are the cerebellar signs (seen in B1 def)

A

Intentional tremor
Ataxia
Impaired rapid alternating movements (especially point to point movements)

150
Q

What type of tremor is seen with benign essential tremor

A

Intention tremor

151
Q

Guillain-Barre results mostly in UMN or LMN features/problems

A

LMN

152
Q

ALS results mostly in UMN or LMN signs/problems

A

Mixture of UMN and LMN

Physical Exam Midterm & Final (11 decks)

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