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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
Q

How do you test CN I (olfactory n)?

A

compress one nasal passage, test smell (repeat on other side)

26
Q

How do you test CN II (optic n)?

A

visual acuity

27
Q

How do you test CN II/III (optic/occulomotor)?

A

pupillary reaction

28
Q

How do you test CN II, IV, VI? (oculomotor, trochlear, abducens)?

A

Extraocular movements

29
Q

How do you test CN V (trigeminal)?

A

Motor: clench teeth
Sensory: test forehead, cheecks for pain w/ sharp and dull object, asking pt to discriminate

30
Q

How do you test CN VII (facial)?

A
  • raise eyebrows
  • close eyes tightly against resistance
  • smile
  • puff out cheeks
31
Q

What will you see in unilateral paralysis?

A

mouth will droop to parallel side

e.g Bell’s Palsy, temporary facial paralysis due to viral infection

32
Q

How do you test CNVIII?

A
  • Weber, Rinne test

- Whisper test

33
Q

How do you test CN IX and X?

A
  • Ask pt to swallow and speak, observe pharynx and uvula as pt says “ah”
  • gag reflex
34
Q

How do you test CN XI?

A

ask pt to shrug both shoulder upward against your hands

35
Q

How do you test CN XII?

A

Ask pt to move tongue from side to side, noting symmetry or fasciculations

36
Q

What do you suspect if the pt has floppiness/hypotonia/flaccidity?

A

PNS disorder

37
Q

What do you suspect if a pt has spasticity?

A

corticospinal tract disorder

38
Q

What do you suspect if the pt has rigidity?f

A

basal ganglia disorder

39
Q

What is impaired muscle strength?

A

paresis

40
Q

What is absent muscle strength?

A

Plegia or paralysis

41
Q

What are you looking for when you test rapid altering movements in patients?

A

Checking for slowed and clumsy movements which can be a sign of cerebellar disease (dsysdiadochokinesis)

42
Q

What is dysmetria?

A

when a finger overshoots a mark, seen in intention tremor

43
Q

What is Ataxia?

A

uncoordinated gait

44
Q

What is the Romberg test?

A

Tests for position sense, pt stands feet together and closes their eyes for 30-60 seconds.

45
Q

What do you suspect if a pt does not pass the Romberg test?

A

Cerebellar ataxia

46
Q

What is the grading for normal muscle strength?

A

5/5

47
Q

What is kernig sign?

A

The knee cannot be extended

stretch spinal nerves

48
Q

What is the Nuchal rigidity test?

A

testing if pt can flex their chin to the chest

stretch sciatic nerve

49
Q

What is the Brudzinski sign?

A

Pt’s hips and knee’s will flex when their neck is flexed

stretch femoral nerve

50
Q

When do you test the straight leg raise?

A

for lumbar radiculopathy

51
Q

How do you test Asterixis?

A

asking pt to stop traffic

52
Q

What do you suspect if there is a winged scapula?

A

long thoracic nerve injury

53
Q

What is considered a coma on the Glasgow scale?

A

scale of 3-8

Physical diagnosis test 2 (4 decks)

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