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Physical diagnosis test 2 > Neurologic > Flashcards

Neurologic Flashcards

1
Q

What is the coroticospinal tract motor pathway?

A

Movement of hands, feet, neck and trunk muscles 90%

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2
Q

What is the corticobulbar tracts?

A

Controls CN III-XII, eye, tongue, chewing

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3
Q

What does the basal ganglia motor pathway do?

A

Fine tunes movement

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4
Q

What does the cerebellar motor pathway manage?

A

Skilled automatic movement

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5
Q

What two types of lesions will result in weakness?

A
  • upper motor neuron lesion

- lower motor neuron lesion

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6
Q

What are the two sensory pathways?

A

1) posterior column (large fibers): vibration, proprioception, pressure, fine touch (contralateral)
2) Spinothalamic tract (small fibers): pain, temp, crude touch (contralateral)

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7
Q

What do you suspect if a pt has HA and fever and a stiff neck?

A

Meningitis

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8
Q

What do you suspect if a pt c/o a HA w/ “thunderclap” or “worst headache of my life” ?

A

Subarachnoid hemorrhage

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9
Q

What are some other alarm symptoms that you should be concerned about with HAs?

A
  • Onset> 50 y/o
  • pailledema
  • Focal neurologic signs
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10
Q

What are some causes of syncope?

A
  • Vasovagal
  • Hypovolemia
  • cardiovascular disorders
  • medications
  • hypoglycemia
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11
Q

What do you suspect of a pt is described to have Lead-pipe rigidity?

A

Parkinson’s

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12
Q

What do you suspect if a pt has increased muscle tone that is rate dependent?

A

Stroke (especially late or chronic stage)

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13
Q

What do you suspect if a pt has loss of muscle tone that causes the limb to be floppy?

A

Guillain-Barre syndrome

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14
Q

If you have bulbar weakness that is work with repetition and improved with rest, what do you suspect?

A

Myasthenia gravis

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15
Q

What are paresthesias?

A

“pins and needles”

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16
Q

What are dysesthesias?

A

distorted sensations: light touch causes burning

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17
Q

What is a resting tremor?

A

Dissapears with voluntary movement, best seen at rest (e.g parkinson’s low frequency)

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18
Q

What is a postural tremor?

A

Seen with maintaining posture (e.g. anxiety, fatigue, benign tremor- high frequency)

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19
Q

What is an intention tremor?

A

it appears with movement, worse nearing target (e.g. cerebellar disorder like MS)

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20
Q

What is delirium?

A

acute state of confusion, fluctuating, innatention

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21
Q

What is dementia?

A

decline in memory and cognitive ability that interferes with ADLs (activities of daily living)

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22
Q

What are some reversible causes of dementia/delirium that you must r/o?

A
  • hypothyroidism
  • major depression
  • medication s/e
  • normal pressure hydrocephalus
23
Q

What is a good order to perform the neurological physical exam?

A
  • Mental status
  • CN testing I-XII
  • Motor
  • Sensory
  • DTR’s
24
Q

What are you looking at in mental status to evaluate a pt?

A

Appearance, behaviour, orientation (place, time person), speech and language pattern, mood, thoughts/perception, cognition

25
How do you test CN I (olfactory n)?
compress one nasal passage, test smell (repeat on other side)
26
How do you test CN II (optic n)?
visual acuity
27
How do you test CN II/III (optic/occulomotor)?
pupillary reaction
28
How do you test CN II, IV, VI? (oculomotor, trochlear, abducens)?
Extraocular movements
29
How do you test CN V (trigeminal)?
Motor: clench teeth Sensory: test forehead, cheecks for pain w/ sharp and dull object, asking pt to discriminate
30
How do you test CN VII (facial)?
- raise eyebrows - close eyes tightly against resistance - smile - puff out cheeks
31
What will you see in unilateral paralysis?
mouth will droop to parallel side | e.g Bell's Palsy, temporary facial paralysis due to viral infection
32
How do you test CNVIII?
- Weber, Rinne test | - Whisper test
33
How do you test CN IX and X?
- Ask pt to swallow and speak, observe pharynx and uvula as pt says "ah" - gag reflex
34
How do you test CN XI?
ask pt to shrug both shoulder upward against your hands
35
How do you test CN XII?
Ask pt to move tongue from side to side, noting symmetry or fasciculations
36
What do you suspect if the pt has floppiness/hypotonia/flaccidity?
PNS disorder
37
What do you suspect if a pt has spasticity?
corticospinal tract disorder
38
What do you suspect if the pt has rigidity?f
basal ganglia disorder
39
What is impaired muscle strength?
paresis
40
What is absent muscle strength?
Plegia or paralysis
41
What are you looking for when you test rapid altering movements in patients?
Checking for slowed and clumsy movements which can be a sign of cerebellar disease (dsysdiadochokinesis)
42
What is dysmetria?
when a finger overshoots a mark, seen in intention tremor
43
What is Ataxia?
uncoordinated gait
44
What is the Romberg test?
Tests for position sense, pt stands feet together and closes their eyes for 30-60 seconds.
45
What do you suspect if a pt does not pass the Romberg test?
Cerebellar ataxia
46
What is the grading for normal muscle strength?
5/5
47
What is kernig sign?
The knee cannot be extended | stretch spinal nerves
48
What is the Nuchal rigidity test?
testing if pt can flex their chin to the chest | stretch sciatic nerve
49
What is the Brudzinski sign?
Pt's hips and knee's will flex when their neck is flexed | stretch femoral nerve
50
When do you test the straight leg raise?
for lumbar radiculopathy
51
How do you test Asterixis?
asking pt to stop traffic
52
What do you suspect if there is a winged scapula?
long thoracic nerve injury
53
What is considered a coma on the Glasgow scale?
scale of 3-8

Physical diagnosis test 2 (4 decks)

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