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Physical Diagnosis > Neurologic exam 2 > Flashcards

Neurologic exam 2 Flashcards

1
Q

Components of neuro exam

A

Gait, coordination, motor, reflexes, sensory, mini-mental status exam

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2
Q

How to test gait

A

walk normally, walk on heels, walk on toes, walk heel to toe

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3
Q

How to test coordination

A

Fine finger movement, finger to nose test, rapid alternating movements, heel to shin test

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4
Q

How to test motor

A

Look for muscle atrophy and check extremity tone, assess upper extremity strength with pronator drift and strength of wrists or finger extensors, walk on heels and toes

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5
Q

What to test in motor exam

A

Bulk, movement, tone, strength

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6
Q

Bulk

A

compare body side to side, define with hypertrophy or wasting, note deformities, claw hand, klumpke’s paralysis, erb’s palsy

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7
Q

Myoclonus

A

rapid shock-like muscle jerks

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8
Q

Chorea

A

rapid jerky twitches similar to myoclonus but more random in location and more likely to blend into one another, common in Huntington’s

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9
Q

Athetosis

A

slow, writhing movements of limbs

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10
Q

Ballismus

A

large amplitude flinging limb movement

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11
Q

Tics

A

abrupt, stereotyped, coordinated movements or vocalizations

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12
Q

Dystonia

A

maintenance of abnormal posture or repetitive twisting movements

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13
Q

What to inspect for carpal tunnel

A

the thenar muscles

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14
Q

Fasiculations may be caused by

A

low calcium, electrolyte imbalance

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15
Q

muscle tone

A

ask pt to relax and let you move arm or hand, passively flex and extend elbow and wrist, pronate and supinate forearm

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16
Q

Spasticity

A

clasp knife phenomenon, when limb is moved rapidly, catches, then releases, greatest in flexors of upper extremity and extensors of lower`

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17
Q

Spasticity may be present in

A

umn lesion in CVA

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18
Q

Rigidity

A

increased resistance throughout movement

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19
Q

Lead pipe rigidity

A

applies to resistance that is uniform throughout movement

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20
Q

Rigidity

A

increased resistance throughout movement, accentuated when pt is distracted, maybe present in Parkinson’s

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21
Q

Lead pipe rigidity

A

applies to resistance that is uniform throughout movement

22
Q

Cogwheel rigidity

A

rhythmic interruption of resistance, producing a ratchet-like effect

23
Q

Paratonia

A

increased resistance that becomes less prominent when pt is distracted, otherwise unable to relax, common with dementia or anxiety

24
Q

Muscle strength

A

maneuvers against resistance, test one side to the other, test each joint in isolation

25
Q

Upper extremities strength

A

shoulder abduction, elbow extension, elbow flexion, wrist extension, wrist flexion, finger extension, finger flexion, finger abduction

26
Q

Lower extremities strength

A

hip flexion, hip extension, knee flexion and extension, ankle dorsiflexion and plantar flexion

27
Q

Medical research council scale

A

0=no contraction, 1=visible twitch but no movement, 2=weak contraction, not against gravity, 3= weak able to overcome gravity, 4= weak contraction able to overcome some but not much resistance, 5= normal

28
Q

monoparesis

A

weakness of single limb

29
Q

hemiparesis

A

weakness on one side

30
Q

paraparesis

A

weakness of both lower extremities

31
Q

quadriparesis

A

weakness of all four limbs

32
Q

reflexes

A

subconscious and involuntary, check for lesion on pathway, requires sensory input synapsing within spinal cord to a motor output directly innervating muscle fibers

33
Q

How to do a reflex test

A

talk while testing, compare each side

34
Q

Biceps

A

C5*, C6

35
Q

Supinator

A

C5, C6*

36
Q

Triceps

A

C7*, C8

37
Q

Knee

A

L3*, L4

38
Q

Ankle

A

S1*, S2

39
Q

Ankle

A

S1*, S2

40
Q

Reflex grading

A

2 is normal, 0 absent, 4 clonus

41
Q

Plantar reflexes

A

extension of toes in UMN lesions above the S1 level of the spinal cord

42
Q

Abdominl reflexes

A

absence of umbilicus pulling towards a stroked quadrant in UMN lesion between T9-T12

43
Q

Cremasteric reflex

A

absence of ipsilateral elevation of testicle in lesions L1 and L2

44
Q

Anal reflex

A

anal sphincter contraction, S2,3,4

45
Q

Goals of exam

A

determine exact areas of sensory dysfunction, modality of sensory dysfunction, establish origin of dysfunction

46
Q

Upper extremities dermatome

A

antecubital fossa C5, tip of middle finger or center of palm C7, tip of little finger or ulna aspect of hand C8, axilla T1

47
Q

Lower extremities dermatome

A

below groin along medial thigh L2, medial knee L3, cneter of top of foot, toes L 2,3,4 lateral heel L5, lateral foot or toe L5, behind knee S1, behind knee medially or scrotum S2

48
Q

Cortical sensation

A

mediated by parietal lobes, represents ability to integrate primary sensory stimuli %,

49
Q

Double simultaneous stimulation

A

ask pt to close eyes and touch on one side and then both, if parietal lesion, pt may not be able to feel on one side

50
Q

Graphesthesia

A

identification of letter or number on hand

Physical Diagnosis (8 decks)

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